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Sample records for surgically treated primary

  1. Ruptured hepatoblastoma treated with primary surgical resection

    African Journals Online (AJOL)

    The aim of this study was to review two cases of ruptured hepatoblastoma treated with primary surgical resection. Hepatoblastoma is the most common primary liver malignancy of childhood, although it remains infrequent. A rare, but serious condition is when the tumor presents with spontaneous rupture. This is a ...

  2. Experiences with surgically treated primary or secondary hepatic sarcoma.

    Science.gov (United States)

    Fahrner, René; Dennler, Sandra G C; Dondorf, Felix; Ardelt, Michael; Rauchfuss, Falk; Settmacher, Utz

    2017-06-01

    Liver resection in hepatic sarcoma is rare, but other alternative treatment options are scarce. Surgery offers the only aggressive approach to achieve a tumour-free state. The aim of this investigation was to evaluate the outcome and survival of these patients at a single hepato-biliary university hospital. Between January 2004 and July 2013, 896 anatomical liver resections were performed. Eleven liver resections (1.2%) were performed due to primary hepatic sarcoma or hepatic sarcoma metastases. The demographic and clinical parameters were collected from the institutional patients' records. In eight patients (83%), liver resection was performed due to hepatic sarcoma metastases. The surgical procedures were as follows: two patients (18%) had segmentectomy, six patients (55%) had hemihepatectomy or extended hemihepatectomy and three patients (27%) had multivisceral resections. In nine patients (82%), the resection margins were tumour free. In 55% (n = 6) of the patients, the maximal tumour diameter was greater than 10 cm. The postoperative morbidity was low with a Clavien-Dindo score of 2 (range 0-5). One patient died on postoperative day 2 after multivisceral resection. During the follow-up of 932 days (range 2-2.220 days) the 1-, 2- and 3-year survival rates were 91, 63 and 45%, respectively. Tumour recurrence was detected in seven patients (63%). Liver resections in patients with primary or secondary hepatic sarcoma are rare. The main goal in these patients is to achieve complete tumour resection because chemotherapy offers no suitable alternative, but the long-term survival rates are limited because of high a recurrence rate even after aggressive surgical approaches.

  3. [Primary orbital tumors treated surgically in ENT department of Silesian Medical Academy in Katowice].

    Science.gov (United States)

    Gierek, T; Markowski, J; Majzel, K; Zbrowska-Bielska, D

    1999-01-01

    Primary tumours of orbital cavity are a difficult diagnostic and therapeutic problem from a borderline of ophthalmology, laryngology and neurosurgery. Particular anatomical relations of orbital cavity surrounded by paranasal sinuses, cranial cavity cause that it has become an interdisciplinary region and the best method of therapy is multispecialistic surgical treatment ("team approach"). In this article the classification and general symptomatology of orbital cavity primary tumours were presented. 37 patients suffering from primary orbital tumours were treated surgically in the ENT Department of Silesian Medical Academy in Katowice. The patients were aged from 23 (woman with neurosarcoma) to 73 (man with melanoma). All patients were treated surgically: 15 of them by orbital exenteration, 10 by lateral orbitotomy m. Kronlein-Reese-Berk, and 12 by canthotomy. Special attention was paid to possible postoperative complications.

  4. [Rare primary malignant orbital neoplasms treated surgically in the I Clinic of Otolaryngology of the Silesian Medical Academy in Katowice in the years 1992-1995].

    Science.gov (United States)

    Gierek, T; Zbrowska-Bielska, D; Majzel, K; Markowski, J

    1995-01-01

    14 patients suffering from primary orbital tumours were treated surgically in the Otolaryngological Department in Silesian Medical Academy in Katowice in the years 1992-1995. The patients were aged from 23 (woman with neurosarcoma) to 67 (woman with haemangioma). All patients were treated surgically: 8 of them by lateral orbitotomy m. Krönlein-Reese-Berk, 3 of them by orbital exenteration, and 3 of them by canthotomy. The author analysed 3 very rare cases of primary orbital malignant neoplasms: neurosarcoma, rhabdomyosarcoma and additionally I case with fibrosarcoma, osteosarcoma and chondrosarcoma simultaneously.

  5. [Surgical Treated Spondylodiscitis Epidemiological Study].

    Science.gov (United States)

    Soares do Brito, Joaquim; Tirado, António; Fernandes, Pedro

    2016-05-01

    The term spondylodiscitis aims to describe any spinal infection. Medical treatment is the gold standard; nevertheless, surgical treatment can be indicated. The aim of this work was to study the epidemiological profile in a group of patients with spondylodiscitis surgically treated in the same medical institution between 1997 and 2013. Eighty five patients with spondylodiscitis were surgically treated in this period. The authors analysed clinical data and image studies for each patient. We treated 51 male and 34 female patients with an average age of 48 years old (min: 6 - max: 80). The lumbar spine was more often affected and Mycobacterium tuberculosis the most frequent pathogen. The number of cases through the years has been grossly stable, with a slight increase of dyscitis due to Staphylococcus aureus and decrease of the dyscitis without pathogen identification. Paravertebral abscess was identified in 39 patients and 17 had also neurological impairment, mostly located in the thoracic spine and with tuberculous aetheology. Immunosuppression was documented in 10 patients. In this epidemiologic study we found a tuberculous infection, male gender and young age predominance. Despite a relative constant number of patients operated over the years, pyogenic infections due to Staphylococcus aureus seems to be uprising. Paravertebral abscess and neurological impairment are important dyscitis complications, especially in tuberculous cases. Spinal infections requiring surgical treatment are still an important clinical condition. Mycobacterium tuberculosis and Staphylococcus aureus represent the main pathogens with a growing incidence for the latest.

  6. [Primary extranodal non-Hodgkin's malignant orbital lymphomas treated surgically in ENT Department of Medical Academy of Silesia in Katowice in the years 1996-2001].

    Science.gov (United States)

    Gierek, Tatiana; Markowski, Jarosław; Zielińska-Pajak, Ewa; Witkowska, Małgorzata; Kajor, Maciej; Pajak, Jacek; Kulesa, Lukasz; Paluch, Jarosław

    2005-01-01

    The authors presented 7 cases of primary extranodal non-l-odgkin's malignant orbital lymphomas in patients treated surgically in the ENT Department of the Medical University of Silesia in the years 1996-2001. In the course of the diagnostic process we examined the patients carefully to be sure that the cancer had not disseminated. We used some imaging techniques such as: ultrasonography (USG), computer tomography (CT) and magnetic resonance imaging (MRI). We also used the needle aspiration biopsy, as an additional examination. However the material was no significant in the most cases and we were unable to make a definitive diagnosis on the basis of this method alone. After prior examinations we performed the radical operations and removed the tumors. In each case the postoperative material was examined using histopatological and immunohistochemical methods. Afterwards the pathomorphological diagnosis was made by the specialists. Next the patients were observed and treated in the Haematological and Radiotherapy Departments.

  7. The "true" incidence of surgically treated deep prosthetic joint infection after 32,896 primary total hip arthroplasties

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Overgaard, Søren; Schønheyder, Henrik Carl

    2015-01-01

    using an algorithm incorporating data from microbiological, prescription, and clinical biochemistry databases and clinical findings from the medical records. We calculated cumulative incidence with 95% confidence interval. RESULTS: 32,896 primary THAs were identified. Of these, 1,546 had first......-time revisions reported to the DHR and/or the NRP. For the DHR only, the 1- and 5-year cumulative incidences of PJI were 0.51% (0.44-0.59) and 0.64% (0.51-0.79). For the NRP only, the 1- and 5-year cumulative incidences of PJI were 0.48% (0.41-0.56) and 0.57% (0.45-0.71). The corresponding 1- and 5-year......, the "true" incidence of PJI following primary THA was estimated to be approximately 40% higher than previously reported by national registries alone....

  8. Primary umbilical endometriosis successfully treated with dienogest.

    Science.gov (United States)

    Chew, Kah Teik; Norsaadah, Salim; Suraya, Aziz; Hing, Erica Yee; Ani Amelia, Zainuddin; Nor Azlin, Mohd Ismail; Nur Azurah, Abdul Ghani

    2017-02-01

    Primary umbilical endometriosis (PUE) is a rare gynaecological disorder. A majority of the reported cases were treated with surgical excision as medical treatment had been found to be less successful. We reported a case of PUE successfully treated with dienogest without any profound side effects from the drug.

  9. Surgical treatment of primary hyperparathyroidism

    DEFF Research Database (Denmark)

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

    1994-01-01

    was cured by percutaneous ethanol injection and one was reoperated and cured in another hospital. Three patients with persistent hypercalcaemia refused reoperation. Transitory hypocalcaemia with a median duration of 15 days was found in 36 patients, and permanent hypocalcaemia in two patients (1.......9%). Permanent paralysis of the recurrent nerve occurred in three patients (2.9%). Twenty-one patients developed other postoperative complications from which they all recovered without sequelae. No postoperative deaths occurred. Our results show that surgical treatment of primary hyperparathyroidism...

  10. Exploratory study of long-term health-related quality of life in patients with surgically treated primary parotid gland cancer.

    Science.gov (United States)

    Stenner, Markus; Beenen, Franziska; Hahn, Moritz; Koopmann, Mario; Weiss, Daniel; Hüttenbrink, Karl-Bernd

    2016-01-01

    Health-related quality of life (HRQOL) has received more and more attention as an outcome in cancer therapy. In this exploratory study, we assessed the long-term HRQOL among 77 surgically treated patients with parotid gland cancer. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC-QLQ-C30) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (EORTC-QLQ-C30-H&N35) questionnaires were used in a cross-sectional design. The mean time-lag between initial diagnosis and completion of the questionnaire was 89.7 months. The HRQOL significantly increased with the time-lag to surgery and decreased with the patients' age. Factors with clinically significant effects in several areas of long-term HRQOL (ie, more than 4 scores) were age, type of neck dissection, preoperative facial nerve palsy, and postoperative radiation therapy. In parotid gland cancer surgery, factors, such as sex, age, type of surgery, facial nerve palsy, and radiation therapy, seem to be associated with clinically meaningful differences in long-term HRQOL scores. © 2015 Wiley Periodicals, Inc.

  11. [Surgical treatment of primary thymoma].

    Science.gov (United States)

    Zhi, Xiu-yi; Liu, Bao-dong; Xu, Qing-sheng; Zhang, Yi; Su, Lei; Wang, Ruo-tian; Hu, Mu; Liu, Lei

    2007-02-13

    To summarize the clinical and pathologic features of thymoma and assess surgical treatment thereof. The clinical data of 66 thymoma patients, 35 males and 31 females, aged 40.8 (30 approximately 59), who underwent surgical treatment in the past 20 years, were analyzed. By Masaoka staging system, underwent extensive or radical or palliative operation, most commonly performed through a median sternotomy and frequently requires en-bloc resection of one or more adjacent structures. Fourteen of the 66 patients had associated myasthenia gravis (MG). The most common symptoms included chest pain, MG, cough, and dyspnea; only 11 of the 66 (16.7%) patients had no symptom. Masaoka staging revealed stage I in 29 patients (43.9%), stage II in 16 (24.2%), stage III in 19 (28.8%), and stage IV in 2 (3.0%). Fourteen of the 66 patients underwent radical resection, resection of the whole thymus and thymoma, 40 underwent simple resection of thymus, 5 underwent palliative resection of thymoma, and 6 underwent thymectomy exploration. Recurrence of tumor was observed in 4 patients. Postoperative radiotherapy and chemotherapy were performed 24 h after the operation, mainly in the cases of invasive or metastatic thymoma. One patient died within 30 days after the operation. Resection and postoperative radiotherapy or chemotherapy are necessary in treatment of thymoma, particularly complete thymectomy.

  12. Clinicopathological study of surgically treated osteoradionecrosis

    International Nuclear Information System (INIS)

    Ohishi, Shin-ichiro

    2001-01-01

    To evaluate prognostic factors affecting surgically treated osteoradionecrosis (ORN) of the mandible, 13 patients with mandibular bone necrosis caused by irradiation for head and neck cancer were examined chlinicopathologically. The subjects were included 12 men and 1 woman, with a mean age of 65.3 years at surgery. The mean total dose of irradiation was 61.6 Gy. The clinical stage according to Epstein et al. (1987) was IIB in 1 patient, IIIA in 4, and IIIB in 8. The mandible was resected 10 mm or more from the lesion. Delayed healing was found in two patients, and three had recurrence of necrosis of the remaining bone. Patients whose mandibular periosteum had been resected previously who received mandibular reconstruction had a poor outcome. Pathological changes, such as stenosis of the inferior alveolar artery, fibrosis of bone marrow, and low osteocyte density in cortical bone, were found in all resected mandibles. Among them, mandibles lacking sequestra and bone remodeling had poor viability. Therefore, the periosteal blood supply should be conserved and surgical interventions, particularly heat, must be minimized to avoid recurrence of ORN. (author)

  13. 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)

  14. Prognostic value of flow cytometry in surgically treated primary gastric lymphoma Valor pronóstico de la citometría de flujo en el linfoma gástrico

    Directory of Open Access Journals (Sweden)

    F. Fernández

    2006-11-01

    Full Text Available Aim: to investigate whether flow cytometry could help to define the optimal therapeutic strategy of primary gastric lymphomas. Material and method: retrospective study of 46 patients having primary gastric lymphoma -according to Dawson criteria- in Ann Arbor stage I E and II E, who were surgically treated. From selected paraffin-embedded tissue blocks of the tumor, DNA content was studied by flow cytometry (FC. Other pathological tumor features were analysed by hematoxiline-eosine and Giemsa stains as well as immunohistochemical study; any possible influence on postoperative survival was investigated through statistical analysis. Results: the DNA ploidy pattern was diploid in 40 cases (87% and aneuploid (hyperdiploid in 6 (13%. Postoperative survival probability (PSP was 62.7% at 5 years. Statistical analysis showed significant prognostic value for Ann Arbor classification -with higher PSP for stage I E (p = 0.009- and FC parameters: diploid tumors had higher PSP than aneuploid tumors. Also tumors having S-phase (p = 0.044 or G2-M phase values (p = 0.023 under the respective mean values had higher PSP. No influence on PSP was found for wall invasion, Helicobacter pylori infection, Isaacson's histologic type or resection margin involvement. No significant relationship was appreciated between Isaacson's histologic type and DNA ploidy patterns. Conclusion: FC could be useful in assessing gastric lymphoma prognosis.

  15. Ruptured hepatoblastoma treated with primary surgical resection

    African Journals Online (AJOL)

    1]. ... episodes of syncope, with a hematocrit of 23. A computed ... ruptured tumor in the right lobe of the liver. The patient was then taken to the operating room, where a bleeding tumor was noted on the right side of the liter. Intraoperative.

  16. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

    The intention of this study is to share the experience of the author in the occurrence, possible causative factors, and treatment of surgically symptomatic prolapsed lumbar and sacral intervertebral discs in females, and to compare this experience in Switzerland, Nigeria, and Jamaica using surgery records for a period of over ...

  17. The morbidity and mortality of surgically treated urological patients ...

    African Journals Online (AJOL)

    Objective: To determine the morbidity and mortality of surgically treated urological patients at Moi Teaching and Referral Hospital (MTRH) and compare them with those of other tertiary centres. Design: A fi ve year hospital based, retrospective study reviewing files of patients who underwent surgery for urological problems in ...

  18. Primary mediastinal hemangiopericytoma treated with preoperative embolization and surgery.

    Science.gov (United States)

    Kulshreshtha, Pranjal; Kannan, Narayanan; Bhardwaj, Reena; Batra, Swati; Gupta, Srishti

    2014-01-01

    Hemangiopericytomas are rare tumors originating from vascular pericytes. The mediastinum is an extremely uncommon site with only a few cases reported. Diagnosis is based on histopathology and immunohistochemistry, which differentiates them from synovial sarcoma and solitary fibrous histiocytoma. They have a variable malignant potential. Treatment is mainly surgical extirpation as the role of adjuvant therapy is controversial. Preoperative embolization has been sparingly used. We report a case of primary mediastinal hemangiopericytoma in a 47-year-old man treated successfully with preoperative embolization and surgery. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Ergonomic analysis of primary and assistant surgical roles.

    Science.gov (United States)

    Zihni, Ahmed M; Cavallo, Jaime A; Ray, Shuddhadeb; Ohu, Ikechukwu; Cho, Sohyung; Awad, Michael M

    2016-06-15

    Laparoscopic surgery is associated with a high degree of ergonomic stress. However, the stress associated with surgical assisting is not known. In this study, we compare the ergonomic stress associated with primary and assistant surgical roles during laparoscopic surgery. We hypothesize that higher ergonomic stress will be detected in the primary operating surgeon when compared with the surgical assistant. One right-hand dominant attending surgeon performed 698 min of laparoscopic surgery over 13 procedures (222 min primary and 476 min assisting), whereas electromyography data were collected from bilateral biceps, triceps, deltoids, and trapezius muscles. Data were analyzed in 1-min segments. Average muscle activation as quantified by maximal voluntary contraction (%MVC) was calculated for each muscle group during primary surgery and assisting. We compared mean %MVC values with unpaired t-tests. Activation of right (R) biceps and triceps muscle groups is significantly elevated while operating when compared with assisting (R biceps primary: 5.47 ± 0.21 %MVC, assistant: 3.93 ± 0.11, P ergonomic differences between operating and assisting. Surgical assisting was associated with similar and occasionally higher levels of muscle activation compared with primary operating. These findings suggest that surgical assistants face significant ergonomic stress, just as operating surgeons do. Steps must be taken to recognize and mitigate this stress in both operating surgeons and assistants. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. [Pseudarthrosis following surgically treated forearm fractures in children and adolescents].

    Science.gov (United States)

    Fernandez Fernandez, F; Langendörfer, M; Wirth, T; Eberhardt, O

    2013-08-01

    Due to the changing attitude of treating paediatric forearm fractures increasingly towards the surgical stabilisation rather than conservatively by the method of elastic stable intramedullary nailing (ESIN), we are confronted with complications which have not been described in childhood previously. Pseudarthrosis following surgically treated forearm fractures in children is only found in single reports with none in the German-speaking area. The goal of this study is to define predisposing factors which may lead to pseudarthrosis after surgery for forearm fractures. From 1990 to 2011 all children having sustained a pseudarthrosis following forearm fractures treated in our institution were included. All children who did not demonstrate a complete consolidation of the forearm fractures after 6 months from injury were considered for the study. Those pseudarthroses which were caused through systemic diseases were excluded. During the time period of 21 years, fourteen children were treated who fulfilled the criteria of having a pseudarthrosis. Nine of the fourteen children had primarily been treated in an outside hospital, five in our institution. The average age was 10.8 years (7-15 years). There were thirteen ulnar shaft and one radius shaft pseudarthroses. In 11 children the pseudarthrosis was located in the middle third and there was one child each with a pseudarthrosis in the proximal and distal third of the ulna. There were 13 ulnar shaft fractures and one monteggia lesion. Twelve of the fractures were primarily closed and there were two open cases. In nine cases an open reduction of the ulna was necessary, the radius was openly reduced in four patients. In five children technical mistakes of the osteosynthesis were identified to contribute to the formation of the pseudarthrosis. Five of the 14 children had experienced a re-fracture. Nine children had revision surgery. These children were treated by plate osteosynthesis or ESIN. In five patients the pseudarthrosis

  1. The Surgical Management of Primary Hyperparathyroidism: The ...

    African Journals Online (AJOL)

    Primary hyperparathyroidism is an endocrine disorder characterized by excessive and inappropriate release of Parathormone (PTH) from parathyroid glands resulting in diverse clinical manifestations involving the skeletal system in the form of bone and joint pains and pathological fractures, the gastrointestinal system in the ...

  2. Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse

    DEFF Research Database (Denmark)

    Boennelycke, M; Gräs, Søren; Lose, G

    2013-01-01

    Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP).......Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP)....

  3. Graviresponsiveness of surgically altered primary roots of Zea mays

    Science.gov (United States)

    Maimon, E.; Moore, R.

    1991-01-01

    We examined the gravitropic responses of surgically altered primary roots of Zea mays to determine the route by which gravitropic inhibitors move from the root tip to the elongating zone. Horizontally oriented roots, from which a 1-mm-wide girdle of epidermis plus 2-10 layers of cortex were removed from the apex of the elongating zone, curve downward. However, curvature occurred only apical to the girdle. Filling the girdle with mucilage-like material transmits curvature beyond the girdle. Vertically oriented roots with a half-girdle' (i.e. the epidermis and 2-10 layers of the cortex removed from half of the circumference of the apex of the elongating zone) curve away from the girdle. Inserting the half-girdle at the base of the elongating zone induces curvature towards the girdle. Filling the half-circumference girdles with mucilage-like material reduced curvature significantly. Stripping the epidermis and outer 2-5 layers of cortex from the terminal 1.5 cm of one side of a primary root induces curvature towards the cut, irrespective of the root's orientation to gravity. This effect is not due to desiccation since treated roots submerged in water also curved towards their cut surface. Coating a root's cut surface with a mucilage-like substance minimizes curvature. These results suggest that the outer cell-layers of the root, especially the epidermis, play an important role in root gravicurvature, and the gravitropic signals emanating from the root tip can move apoplastically through mucilage.

  4. Oesophageal achalasia: an argument for primary surgical management.

    LENUS (Irish Health Repository)

    Leonard, D S

    2009-04-01

    Achalasia is a primary oesophageal motility disorder resulting from damage to the ganglion cells of the myenteric plexus. Impaired relaxation of the lower oesophageal sphincter and aperistalsis causes its cardinal symptoms of dysphagia, chest pain and reflux-type symptoms. Management is somewhat controversial, with options including systemic and local pharmacotherapy, dilatation and oesophagomyotomy. We review the presentation, investigation and management of oesophageal achalasia and make an argument for primary surgical management.

  5. Surgical management of primary hyperparathyroidism: state of the art.

    Science.gov (United States)

    Lew, John I; Solorzano, Carmen C

    2009-10-01

    This article reviews the current state of the art regarding therapy for primary hyperparathyroidism. Clinical evaluation and indications for parathyroidectomy are described, followed by a review of surgical techniques currently being practiced and possible outcomes involved. Focused parathyroidectomy has become a successful alternative to conventional bilateral cervical exploration.

  6. Clinical experience of surgically treating giant neurofibromatosis-1.

    Science.gov (United States)

    Chen, Baoguo; Xu, Minghuo; Song, Huifeng; Gao, Quanwen

    2017-02-01

    The surgical treatment for giant neurofibromatosis-1 (NF-1) requires comprehensive measures. Presently, there is no systematic description of surgical treatment. Because of its high level of risk, we want to share our clinical experience. From 2011 to 2014, patients (n = 8, 5 female and 3 male patients, aging from 31 to 45 years-old) were included in the study. The tumours were located on the trunk (n = 5) or face (n = 3). In addition to routine examination, blood storage was also prepared. Preoperative consultation from related departments was critical at first. Related artery embolisation was also carried out. In the operation, we checked thromboelastography, based on which reasonable blood component transfusion was implemented. Autologous blood transfusion was also ready. An instrument of copper needle or ring ligation was used to reduce haemorrhage before the surgery. Protruding or drooping portions of the tumours were excised. A pressurised bandage was applied when the surgery was completed. After the surgery, besides the routine monitoring of vital signs, re-haemorrhage should be detected in time. Then, we should decide whether blood transfusion or surgery was required again. Expanders were implanted in one female patient with facial injuries before removing the tumour. Then, expanded flaps were applied to repair the secondary wound. According to the above clinical route, after an average of 1-year follow-up, no patients died, and other unforeseen events did not occur. Wounds healed well in all patients. The tumor was excised as much as possible. No facial nerve paralysis occurred in the facial sites. Expanded flaps necrosis WAS not encountered. It is essential to design the educational clinical route for treating NF-1 when a giant protruding tumour is advised to be excised, which can minimise the risk of surgery and assure us of the maximum range of resection. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  7. Can abdominal surgical emergencies be treated in an ambulatory setting?

    Science.gov (United States)

    Genser, L; Vons, C

    2015-12-01

    The performance of emergency abdominal surgery in an outpatient setting is increasingly the order of the day in France. This review evaluates the feasibility and reliability of ambulatory surgical treatment of the most common abdominal emergencies: appendectomy for acute appendicitis and cholecystectomy for acute complications of gallstone disease (acute cholecystitis and gallstone pancreatitis). This study evaluates surgical procedures performed on an ambulatory basis according to the international definition (admission in the morning, discharge in the evening with a hospital stay of less than 12 hours). Just as for elective surgery, eligibility of patients for an ambulatory approach depends on the capacities of the surgical and anesthesia team: to manage the risks, particularly the risk of deferring surgery until the morning); to prevent or treat post-operative symptoms like pain, nausea, vomiting, re-ambulation in order to permit rapid post-operative discharge. Recent studies have shown that appendectomy for non-complicated acute appendicitis can be deferred for up to 12 hours without any increase in danger. Many other studies have shown that early discharge after appendectomy for acute non-complicated appendicitis is feasible and safe. Nonetheless, there is only one published series of truly ambulatory appendectomies. The results were excellent. Patients who presented in the afternoon were brought back for operation the following morning. The appropriate timing for performance of cholecystectomy in patients with acute calculous cholecystitis or gallstone pancreatitis has not been well defined, but is always somewhat delayed relative to the onset of symptoms. To minimize operative complications, cholecystectomy for acute calculous cholecystitis should probably be performed between 24 and 72 hours after diagnosis. Cholecystectomy for gallstone pancreatitis should probably not be delayed longer than a week; the need to keep the patient hospitalized during the

  8. EVALUATION OF TWO SURGICAL TREATMENTS OF PRIMARY VESICOURETERAL REFLUX AMONG CHILDREN: A 15 YEARS EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Memeti Shaban

    2016-07-01

    Full Text Available Aim: aim of the study was to evaluate the efficiency of two different surgical treatments of vesicoureteral reflux (VUR on succesfull rate and patient outcome. Methods: Retrospective study on children with primary VUR and their surgical treatment from 1999 to 2014 in the University Clinic for Pediatric Surgery in Skopje. A total of 76 children (114 ureters with VUR ranging from second to fifth grade were treated surgically, 44 patients (67 ureters with an open surgical technique and 32 patients (47 ureters with endoscopic treatment ”STING” procedure. The following parameters were analyzed: duration of the intervention, duration of the hospitalization, the need for antibiotics and analgesic therapy and the need for blood and blood derivatives transfusion. The result of the surgical treatment was also validated. A good result was considered when reduction of VUR by 2 degrees with the endoscopic method or by 3 degrees in the open surgical technique was noticed. Results: Using open surgical technique, patients were hospitalized for an average of 9 days (range from 5 to 13 days. All children received double antibiotic therapy. The need for analgesics lasted for 3 to 4 days. 90% of treated children needed blood and/or blood derivatives transfusion. Success rate with this method was 93.8%. Endoscopic procedure was performed as a one-day surgical procedure. The average duration was 15 minutes. Single, prophylactic dose of antibiotic was ordinated. There was no need for blood and/or blood derivatives transfusion. The overall success of the treatment was about 70%. Conclusion: Open surgical procedure is used for more complicated cases, VUR grade IV-V or by previously failed. Endoscopic, “STING” procedure was commonly used for patients with VUR grade greater than 2, after previously failed conservative treatment, febrile urinary infection despite antibiotic prophylaxis and/or emergence of new scarring in the renal parenchyma. Patient assessment and

  9. A sixteen year sample of surgically treated supernumerary teeth.

    Science.gov (United States)

    Pippi, R

    2011-03-01

    Supernumerary teeth represent a numerical dental anomaly in which more teeth than the norm are present in the dentition. A sixteen year sample of supernumerary teeth has been reviewed in order to analyse epidemiological data, morphological and topographic features of these teeth, especially of those located in the praemaxillary region. All cases in which supernumerary teeth were surgically treated from 1991 to 2006 at the Oral Surgery Unit of the Sapienza University of Rome have been reviewed. 118 Caucasian subjects with supernumerary teeth have been reviewed in the range of age comprised between 5 and 42 years: 191 SNTs were collected, 136 from the upper jaw and 55 from the mandible. In the maxilla the incisor region was more frequently involved (67.65%), while in the mandible the one most frequently involved was the premolar region (69.1%). Conoid was the most frequent type of supernumerary teeth. Uneruption of the contiguous permanent teeth was the most commonly associated pathological condition, found in 81 out of the 191 cases of supernumerary teeth (40 patients, 42.4%). Tuberculated, infundibuliform and incisiform-shaped teeth caused uneruption of permanent teeth more frequently than the other morphological types of supernumerary teeth. In the upper incisor area, the extraction of SNT is mandatory as early as they are diagnosed, especially if they are tuberculated, infundibuliform and incisiform-shaped, if they are located palatally or just in the middle of the ridge and when more than one SNT is present.

  10. [Adjuvant systemic antibiotic therapy for surgically treated spondylodiscitis].

    Science.gov (United States)

    Marmelstein, D; Homagk, N; Hofmann, G O; Röhl, K; Homagk, L

    2015-04-01

    Recognised methods for the treatment of spondylodiscitis in correspondence to the immobilisation are systemic antibiotic therapy. However, the available data for recommendations of specific antibiotic therapy are very heterogeneous. The aim of this study was to focus on the adjuvant antibiotic therapy in surgical treated cases of spondylodiscitis and to reach a guideline regarding its application in patients' spondylodiscitis. Between 01.10.1998 and 31.12.2011 276 inpatient cases of spondylodiscitis were surgically treated, documented and included in the study. The study involved medical history, germ status, localisation and extent of spondylodiscitis and antibiotic treatment. Between 01.01.2012 and 31.12.2013 a further 20 cases of spondylodiscitis were treated according to a standardised treatment regimen of antibiotic therapy and included in the study. The age distribution shows a marked prominence of 60 to 80 year-olds, with a leading localisation of spondylodiscitis in the lumbar spine with 55 % followed by the thoracic spine (33 %) and the cervical spine (12 %). A constant observation during the study periods was the delayed diagnosis of more than 1 month of spondylodiscitis, so that about 60 % of the patients were not receiving any treatment for their disease at the time of hospitalisation. The aetiology of spondylodiscitis is very heterogeneous and remained unknown in 34 % of cases. However, diabetes mellitus appeared as a disease favouring the occurrence of spondylodiscitis since it was concomitant with almost 50 % of patients with spondylodiscitis. The bacterial spectrum is limited in our area to staphylococci, with a predominance of Staphylococcus aureus. At least about 10 % of the germs are multi-drug resistant. In 45 % of cases, pathogen detection was unsuccessful. Clindamycin is the most commonly used antibiotic in the treatment of spondylodiscitis and is used in 26.8 % in combinations with other antibiotics. The antibiotic therapy

  11. Primary rhegmatogenous retinal detachment - surgical methods and anatomical outcome.

    Science.gov (United States)

    Haugstad, Marta; Moosmayer, Stefan; Bragadόttir, Ragnheiður

    2017-05-01

    The aim of the study was to evaluate the anatomical success of surgical management of primary rhegmatogenous retinal detachment (RRD) and to compare the anatomical outcomes from different surgical techniques. During 2012, 517 consecutive eyes (514 patients) were operated by 11 surgeons at the Department of Ophthalmology, Oslo University Hospital. Patient records were retrospectively analysed with no exclusions. Main outcome measures were primary and final anatomical success. Primary anatomical success was defined as retinal reattachment 6 months after primary surgery with reoperations excluded. Final anatomical success was defined as retinal reattachment 6 months after primary surgery with reoperations included. Incidence of RRD was 18.6 eyes per 100 000 person-years. The macula was detached in 50.5% of the eyes at baseline. Of 517 operated eyes, 317 (61.3%) underwent pars plana vitrectomy (PPV), 23 (4.5%) pars plana vitrectomy together with a scleral buckle (PPV-SB), 175 (33.9%) scleral buckle (SB) surgery and two (0.4%) pneumatic retinopexy (PR). Primary anatomical success was 89.0% in the PPV group, 87.0% in the PPV-SB group and 85.7% in the SB group. Final anatomical success was 98.1% in the PPV group, 100% in the PPV-SB group and 99.4% in the SB group. Factors which were correlated to the redetachment were detachment of more than 6 clock hours (p = 0.003) and visual acuity (VA) on Snellen chart retina were large detachment and low VA. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  12. Surgically treated spinal metastases: Do prognostic scores have a role?

    Science.gov (United States)

    Afsar, Afifa; Qadeer, Mohsin; Sharif, Salman

    2017-01-01

    The outcome for patients with metastatic disease in spine is difficult to predict. Multiple scoring systems were utilized in this study to determine their effectiveness in predicting long-term prognoses. A retrospective analysis of surgically treated patients of spinal metastasis was performed between 2005 and 2016. Data were collected prospectively during which 8 patients were lost to follow-up. Ultimately, data from 63 patients were reviewed. Treatment and prognoses were analyzed utilizing various scoring systems including the SINS, the Tomita, the modified Tokouhashi and Bauer scores. Records of 63 patients, averaging 54 years of age, were analyzed. The Tomita score was applied in 44 patients, a modified Bauer score was studied in 49 patients, while SINS and modified Tokouhashi scores were calculated in all 63 patients. The hazard ratios for the Tomita score were 1, 0.030, 0.622, and 0.272, respectively. The hazard ratios for the modified Bauer scores were 1, 4.663, and 1.622, respectively. The Tokouhashi ratios were 1, 1.656, and 0.501, respectively. Of interest, the Tomita scores provided the highest statistical significance ( P = 0.000) followed by the Bauer ( P = 0.002) and Tokuhashi scores ( P = 0.003). Notably, the SINS score showed no significant correlation in predicting patient survival. For evaluating the metastatic spine disease, this study evaluated the prognostic efficacy of four widely used scores: the Tomita, score, the modified Tokouhashi and Bauer scores, and the SINS scores. The Tomita scores provided the highest statistical significance, followed by the Bauer, and Tokuhashi scores, while the SINS score showed no significant correlation in predicting patient survival.

  13. Surgical interventions for treating fractures of the olecranon in adults.

    Science.gov (United States)

    Matar, Hosam E; Ali, Amjid A; Buckley, Simon; Garlick, Nicholas I; Atkinson, Henry D

    2014-11-26

    Fractures of the olecranon (the bony tip of the elbow) account for approximately 1% of all upper extremity fractures. Surgical intervention is often required to restore elbow function. Two key methods of surgery are tension band wire fixation and plate fixation. To assess the effects (benefits and harms) of different surgical interventions in the treatment of olecranon fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (22 September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 8), MEDLINE (1946 to September week 2 2014), EMBASE (1980 to 19 September 2014), trial registers, conference proceedings and reference lists of articles. Randomised controlled trials (RCT) and quasi-RCTs that compared different surgical interventions for the treatment of olecranon fractures in adults. Two review authors independently performed study selection, risk of bias assessment and data extraction. The primary outcomes of this review were function, pain and adverse events. We included six small trials involving 244 adults with olecranon fractures. Of these, four were RCTs and two were quasi-RCTs; both of were at high risk of selection bias. All six trials were at high risk of performance bias, reflecting lack of blinding, and four trials were at high risk of detection bias. The quality of the evidence for most outcomes was generally very low because of limitations in study design and implementation, and either imprecision of the results or inadequate outcome measures. Thus, we are very uncertain about the estimates of effect.One trial (41 participants) comparing plate fixation with standard tension band wiring provided very low quality evidence at 16 to 86 weeks' follow-up of a better clinical outcome after plate fixation (good outcome (little pain or loss of elbow motion): 19/22 versus 9/19, risk ratio (RR) 1.82 favouring plate fixation, 95% confidence interval (CI) 1.10 to 3.01). There was very low

  14. Minimally invasive surgical approach to treat posterior urethral diverticulum

    Directory of Open Access Journals (Sweden)

    Ossamah Alsowayan

    2015-01-01

    Full Text Available Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS in managing posterior urethral diverticulum.

  15. Severe Primary Raynaud's Disease Treated with Rituximab

    OpenAIRE

    Shabrawishi, Mohammed; Albeity, Abdurahman; Almoallim, Hani

    2016-01-01

    Raynaud’s phenomenon refers to reversible spasms of the peripheral arterioles that can be primary Raynaud’s phenomenon (PRP) or secondary Raynaud’s phenomenon (SRP) to underlying connective tissue disease, both of which are characterized by a triphasic color response triggered by cold exposure or stress. PRP is typically a benign disease, whereas SRP may progress into digital ulcers and/or gangrene. Here, we report a case of a 55-year-old female diagnosed with PRP 7 years ago. Treatment with ...

  16. Sinotomy technique versus surgical excision with primary closure technique in pilonidal sinus disease

    Directory of Open Access Journals (Sweden)

    Seyfi Emir

    2014-11-01

    Full Text Available Pilonidal disease is a common chronic disorder mainly seen in the sacrococcygeal region, especially in young males. Many surgical treatment modalities have been suggested, but an ideal and widely accepted treatment has yet to be established. The aim of this study was to compare quality of life of patients treated with the sinotomy technique with quality of life of patients treated with surgical excision plus primary closure technique by means of quality of life questionnaire. The data of patients who had been treated for pilonidal sinus in our clinic from September 2010 to June 2012 were analyzed retrospectively. Forty patients were treated with sinotomy technique and 40 patients were treated with surgical excision plus primary closure technique. Time to return to work and to time to complete wound healing were evaluated. All patients were asked to fill the questionnaire after complete healing occurred. Postoperative complications were bleeding in 2.5%, infection in 3.75% and fever in 2.5% patients. There were no significant differences between the two groups in terms of complete healing (p=0.1 and sport times (p=0.1. There were significant differences between the groups in terms of length of hospital stay (p≤0.001, time off work (p≤0.001,times to sitting on toilet and walking without pain (p=0.002 and p≤0.001,respectively. The mean postoperative VAS scores were 5.2±3.2 and 2.8±2.2, respectively (p=0.02. The technique of sinotomy with good wound and surrounding skin care seems to be an ideal approach with high chance of cure. The patients returned to their routine in a short period of time.

  17. [Long-term outcome of surgically treated teratology of Fallot].

    Science.gov (United States)

    Ben Khalfallah, Ali; Annabi, N; Ousji, Monia

    2004-01-01

    Tetralogy of Fallot is the most common cyanotic congenital heart disease. The surgical treatment that is palliative or complete repair has allowed to transform the preview of this heart disorder. We suggests to study the long term outcome in patients undergoing surgical repair of tetralogy of Fallot, by emphasizing the quality of their lives, the complications, as well as the mortality. Ventricular arrhythmia and sudden cardiac death after repair of tetralogy of Fallot are devastating complications in adults survivors and their prediction remains difficult.

  18. Severe Primary Raynaud's Disease Treated with Rituximab.

    Science.gov (United States)

    Shabrawishi, Mohammed; Albeity, Abdurahman; Almoallim, Hani

    2016-01-01

    Raynaud's phenomenon refers to reversible spasms of the peripheral arterioles that can be primary Raynaud's phenomenon (PRP) or secondary Raynaud's phenomenon (SRP) to underlying connective tissue disease, both of which are characterized by a triphasic color response triggered by cold exposure or stress. PRP is typically a benign disease, whereas SRP may progress into digital ulcers and/or gangrene. Here, we report a case of a 55-year-old female diagnosed with PRP 7 years ago. Treatment with first-line agents, including calcium channel blocker, aspirin, and phosphodiesterase inhibitor, did not control her symptoms, which progressed to digital ulceration and gangrene. There were no symptoms of underlying autoimmune disease or malignancy, and autoimmune, serology, and immunology test results were normal; a biopsy of her left little finger was negative for vasculitis. Development to critical digital ischemia necessitated treatment with intravenous iloprost and heparin infusion followed by angioplasty, which led to a partial improvement. Due to persistent symptoms, rituximab therapy was initiated and two cycles induced a complete resolution of symptoms.

  19. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds

    NARCIS (Netherlands)

    Eskes, Anne; Vermeulen, Hester; Lucas, Cees; Ubbink, Dirk T.

    2013-01-01

    Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma). However, the effects of HBOT on wound healing are unclear. To determine the effects of HBOT on the healing of acute surgical and traumatic wounds. We searched the Cochrane Wounds

  20. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds

    NARCIS (Netherlands)

    Eskes, Anne; Ubbink, Dirk T.; Lubbers, Maarten; Lucas, Cees; Vermeulen, Hester

    2010-01-01

    Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma) however the effects of HBOT on wound healing are unclear. To determine the effects of HBOT on the healing of acute surgical and traumatic wounds. We searched the Cochrane Wounds

  1. Evaluation of 30 patients with gynecomastia surgically treated

    Directory of Open Access Journals (Sweden)

    Nurettin Yiyit

    2013-10-01

    Conclusions; Surgery is the most effective  treatment of gynecomastia. The most suitable surgical tecnique should be selected according to the skin redundancy. The target always must be breast reduction by the tecnique to provide the best symmetry and leave at least scar.

  2. [Gastrointestinal stromal tumors: a series of 23 surgically treated cases].

    Science.gov (United States)

    D'Amato, A; Brini, A; Montesani, C; Pronio, A; Chessa, A; Manzi, F; Ribotta, G

    2001-01-01

    The recently introduced new nosological category, Gastro Intestinal Stromal Tumors, brought the Authors to a revision of their series and to a critical analysis of surgical behaviour for the treatment of that pathology. A series of 23 cases of GIST, observed between 1977 and 1999 has been taken into account. In the earlier cases, histopathological classification has been reviewed according to the most used criterions in international scientific literature. 17 of 23 observed tumors were located on the stomach, 4 on the duodenum and 2 on the jejunum. 20 of these cases derived from muscular tissue and 3 cases derived both from muscular and neural tissues. In 7 cases (30%) tumors were accidentally discovered during surgical intervention or diagnostic procedures for other causes. Surgical treatment was performed in all cases and consisted in 6 gastric resections, 14 gastric free-margin excisions, 2 duodenal resections and 1 jejunal resection. The follow-up (performed on 18 patients, with a minimum of 1 year, a maximum of 17 years and a median of 6 years) showed 2 deaths (11%) due to oncological causes, while 2 of the patients (11%) died for other causes. The only treatment for that group of tumors is, at the moment, surgery. Although that kind of neoplasms has mainly non-aggressive biological behaviour, a radical resection must be performed, due to the absence of macroscopic criterions to help distinguishing, during surgical intervention, aggressive tumors from non-aggressive ones.

  3. Comparison of primary and delayed primary closure in dirty abdominal wounds in terms of frequency of surgical site infection

    International Nuclear Information System (INIS)

    Aziz, O.B.A.; Ahmed, N.; Butt, M.W.U.D.; Saleem, M.R.

    2013-01-01

    Objective: Objective of this study was to compare primary and delayed primary wound closure for dirty abdominal wounds in terms of frequency of surgical site infection. Study Design: Randomized Controlled Trial. Place and Duration of Study: Combined Military Hospital, Multan. From 16 Sep 2010 to 15 Mar 2011. Patients and Methods: A total of 110 patients were randomly divided into two groups of 55 patients each using random numbers table. Abdominal wounds of one group were closed primarily and of other group were subjected to delayed primary wound closure. The wounds were then checked for surgical site infection for seven post operative days. Results: A higher frequency of surgical site infection was observed in primary closure group (27.3%) as compared to delayed primary closure group (9.1%) which was statistically significant (p=0.013). Conclusion: Delayed primary closure is superior to primary closure in dirty abdominal wounds in terms of frequency of surgical site infection. (author)

  4. Bilateral Extracranial Carotid Artery Aneurysms Treated by Staged Surgical Repair

    Directory of Open Access Journals (Sweden)

    K.-M. Park

    Full Text Available Introduction: Bilateral extracranial carotid artery aneurysms (ECAAs are very rare. The case of a patient with bilateral ECAA who underwent staged surgical repair is reported. Report: A 35 year old man was referred with a slow growing pulsatile neck mass causing mild discomfort. Computed tomography and duplex ultrasound showed a right ECAA, with a 3.0 cm diameter 5 cm long true aneurysm, and a left ECAA, with 2.1 cm diameter 4.5 cm long true aneurysm. In two stages, both aneurysms were excised and bypassed with an interposition graft using saphenous vein. Discussion: ECAAs are rare with an incidence of about 4% of all peripheral aneurysms. Selection of treatment options is largely dependent on the aneurysm anatomy, including size and length. During open repair, it is important to avoid nerve injury. Keywords: Extracranial carotid artery aneurysm

  5. Risk factors in patients surgically treated for peptic ulcer perforation

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Shah, Kamran; Bendix, Jørgen

    2009-01-01

    OBJECTIVE: The overall mortality for patients undergoing surgery for perforated peptic ulcer has increased despite improvements in perioperative monitoring and treatment. The objective of this study was to identify and describe perioperative risk factors in order to identify ways of optimizing...... recorded retrospectively from medical records. Data were analysed using multiple logistic regression analysis. The primary end-point was 30-day mortality. RESULTS: The 30-day mortality rate was 27%. The following variables were independently associated with death within 30 days of surgery: ASA (American...... insufficiency upon admission and insufficient postoperative nutrition have been added to the list of independent risk factors for death within 30 days of surgery in patients with peptic ulcer perforation. Finding that shock upon admission, reduced albumin blood levels upon admission, renal insufficiency upon...

  6. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds.

    Science.gov (United States)

    Eskes, Anne; Vermeulen, Hester; Lucas, Cees; Ubbink, Dirk T

    2013-12-16

    Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma). However, the effects of HBOT on wound healing are unclear.  To determine the effects of HBOT on the healing of acute surgical and traumatic wounds. We searched the Cochrane Wounds Group Specialised Register (searched 9 August 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to July Week 5 2013); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, August 08, 2013); Ovid EMBASE (2010 to 2013 Week 31); EBSCO CINAHL (2010 to 8 August 2013). Randomised controlled trials (RCTs) comparing HBOT with other interventions such as dressings, steroids, or sham HOBT or comparisons between alternative HBOT regimens. Two review authors conducted selection of trials, risk of bias assessment, data extraction and data synthesis independently. Any disagreements were referred to a third review author.  Four trials involving 229 participants were included. The studies were clinically heterogeneous, which precluded a meta-analysis.One trial (48 participants with burn wounds undergoing split skin grafts) compared HBOT with usual care and reported a significantly higher complete graft survival associated with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval (CI) 1.35 to 9.11). A second trial (10 participants in free flap surgery) reported no significant difference between graft survival (no data available). A third trial (36 participants with crush injuries) reported significantly more wounds healed (RR 1.70; 95% CI 1.11 to 2.61), and significantly less tissue necrosis (RR 0.13; 95% CI 0.02 to 0.90) with HBOT compared to sham HBOT. The fourth trial (135 people undergoing flap grafting) reported no significant differences in complete graft survival with HBOT compared with dexamethasone (RR 1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).Many

  7. Issues in treating depression in primary care | Horn | Continuing ...

    African Journals Online (AJOL)

    Issues in treating depression in primary care. NR Horn. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  8. What are the important surgical factors affecting the wound healing after primary total knee arthroplasty?

    Science.gov (United States)

    Harato, Kengo; Tanikawa, Hidenori; Morishige, Yutaro; Kaneda, Kazuya; Niki, Yasuo

    2016-01-13

    Wound condition after primary total knee arthroplasty (TKA) is an important issue to avoid any postoperative adverse events. Our purpose was to investigate and to clarify the important surgical factors affecting wound score after TKA. A total of 139 knees in 128 patients (mean 73 years) without severe comorbidity were enrolled in the present study. All primary unilateral or bilateral TKAs were done using the same skin incision line, measured resection technique, and wound closure technique using unidirectional barbed suture. In terms of the wound healing, Hollander Wound Evaluation Score (HWES) was assessed on postoperative day 14. We performed multiple regression analysis using stepwise method to identify the factors affecting HWES. Variables considered in the analysis were age, sex, body mass index (kg/m(2)), HbA1C (%), femorotibial angle (degrees) on plain radiographs, intraoperative patella eversion during the cutting phase of the femur and the tibia in knee flexion, intraoperative anterior translation of the tibia, patella resurfacing, surgical time (min), tourniquet time (min), length of skin incision (cm), postoperative drainage (ml), patellar height on postoperative lateral radiographs, and HWES. HWES was treated as a dependent variable, and others were as independent variables. The average HWES was 5.0 ± 0.8 point. According to stepwise forward regression test, patella eversion during the cutting phase of the femur and the tibia in knee flexion and anterior translation of the tibia were entered in this model, while other factors were not entered. Standardized partial regression coefficient was as follows: 0.57 in anterior translation of the tibia and 0.38 in patella eversion. Fortunately, in the present study using the unidirectional barbed suture, major wound healing problem did not occur. As to the surgical technique, intraoperative patella eversion and anterior translation of the tibia should be avoided for quality cosmesis in primary TKA.

  9. Mortality and health-related quality of life in patients surgically treated for spondylodiscitis

    DEFF Research Database (Denmark)

    Dragsted, Casper; Aagaard, Theis; Ohrt-Nissen, Søren

    2017-01-01

    PURPOSE: To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. METHODS: A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine...... with spondylodiscitis not related to recent spine surgery. One-year mortality rate was 6%. In all, 36% and 27% had pre- and postoperative neurological impairment, respectively, with only one patient experiencing deterioration postoperatively. At final follow-up (median 2 years), mean ODI was 31% (SD = 22) and mean EQ-5...... neurological impairment. CONCLUSIONS: Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL....

  10. Mortality and health-related quality of life in patients surgically treated for spondylodiscitis

    DEFF Research Database (Denmark)

    Dragsted, Casper; Aagaard, Theis; Ohrt-Nissen, Søren

    2017-01-01

    center. Indications for surgery, pre- and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). RESULTS: Sixty-five patients were diagnosed...... neurological impairment. CONCLUSIONS: Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.......PURPOSE: To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. METHODS: A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine...

  11. Primary Giant Splenic Echinococcal Cyst Treated by Laparoscopy.

    Science.gov (United States)

    Arce, Maira A; Limaylla, Himerón; Valcarcel, Maria; Garcia, Hector H; Santivañez, Saul J

    2016-01-01

    Cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the dog tapeworm Echinococcus granulosus. Liver and lungs are the most commonly affected organs whereas splenic infection is rarer and its primary involvement occurs in less than 2% of abdominal CE. We report a case of primary giant splenic hydatid cyst in a 75-year-old Peruvian woman that was laparoscopically removed without any complications, perioperative prophylactic chemotherapy with albendazole 400 mg twice a day 5 days before, and 7 days after the surgical procedure was administered, postoperative recovery was uneventful, and; at her 3-month follow-up the patient remains asymptomatic and an abdominal computed tomography scan demonstrated a cystic cavity of 15 cm diameter with no daughter vesicles, neither other abdominal organ involvement. This case is in line with the existing literature on laparoscopical treatment of splenic cystic hydatid disease, suggesting that laparoscopical treatment is a safe and effective approach for large splenic hydatid cysts to be preferred to open surgical techniques. © The American Society of Tropical Medicine and Hygiene.

  12. The natural history of surgically treated but radiotherapy-naïve nonfunctioning pituitary adenomas.

    LENUS (Irish Health Repository)

    O'Sullivan, Eoin P

    2009-11-01

    Transsphenoidal surgery is indicated for patients with nonfunctioning pituitary adenomas (NFPAs) causing compressive symptoms. Previous studies attempting to define the rate of recurrence\\/regrowth of surgically treated but radiation-naïve NFPAs were somewhat limited by selection bias and\\/or small numbers and\\/or lack of consistency of findings between studies. A better understanding of the natural history of this condition could allow stratification of recurrence risk and inform future management. We aimed to define the natural history of a large, mainly unselected cohort with surgically treated, radiotherapy (RT)-naïve NFPAs and to try to identify predictors of recurrence\\/regrowth.

  13. Single-institution, multidisciplinary experience with surgical resection of primary chest wall sarcomas.

    Science.gov (United States)

    Kachroo, Puja; Pak, Peter S; Sandha, Harpavan S; Lee, Catherine; Elashoff, David; Nelson, Scott D; Chmielowski, Bartosz; Selch, Michael T; Cameron, Robert B; Holmes, E Carmack; Eilber, Fritz C; Lee, Jay M

    2012-03-01

    Primary chest wall sarcomas are rare mesenchymal tumors and their mainstay of therapy is wide surgical resection. We report our single-institution, multidisciplinary experience with full-thickness resection for primary chest wall sarcomas. A retrospective review of our prospectively maintained databases revealed that 51 patients were referred for primary chest wall sarcomas from 1990 to 2009. All patients required resections that included rib and/or sternum. Twenty-nine patients (57%) had extended resections beyond the chest wall. Forty-two patients (82%) required prosthetic reconstruction and 17 patients (33%) had muscle flap coverage. Overall, 51% (26/51) of patients received neoadjuvant therapy. Seventy-three percent (11/15) of high-grade soft tissue sarcomas, 77% (10/13) of high-risk bony sarcomas, and 67% (4/6) of desmoid tumors were treated with induction therapy. Negative margins were obtained in 46 patients (90%). There were no perioperative mortalities. Eight patients (16%) experienced complications. Local recurrence and metastasis was detected in 14 and 23%. Five-year overall and disease-free survivals were 66% and 47%, respectively. Favorable prognostic variables for survival included age ≤50 years, tumor volume ≤200 cm, desmoid tumor, bony tumor, chondrosarcoma, and low-grade soft tissue sarcoma. We report our multidisciplinary experience with primary chest wall sarcomas that included induction therapy in the majority of high-risk soft tissue and bony sarcomas and desmoid tumors. Despite aggressive preoperative treatments, acceptable surgical results with low morbidity and mortality can be achieved. Neoadjuvant systemic therapy may reduce local and distant recurrence and improve overall survival.

  14. Experience with surgical treatment for primary malignant adrenal tumors

    Directory of Open Access Journals (Sweden)

    V. R. Latypov

    2016-01-01

    Full Text Available Background. Adrenal tumors occur in 3–10 % of the population and are mostly benign adrenal cortical tumors. Adrenocortical carcinoma is a very rare tumor and has an annual incidence of 1–2 cases per million people. The U.S. National Cancer Data Base registered 4275 patients with adrenocortical carcinoma in 1985 to 2007. It is extremely difficult to assess Russia’s epidemiological data, as reports on adrenocortical carcinoma are not presented separately.Materials and methods. A total of 133 patients (49 men and 84 women (1:1.7 with adrenal tumors were operated on at the clinics of the Siberian State Medical University in the period December 1998 to March 2015. The patients’ mean age was 51.3 (16–80 years (median age 51.0 years. The right and left adrenal glands were affected in 49 (36.9 % and 77 (57.9 % patients, respectively; both adrenal glands were involved in 7 (5.3 %. A group of 21 (15.8 % people with primary malignant adrenal tumors was identified among all the patients. The clinical manifestations of the disease were evaluated from the presence of hormonal activity, gastrointestinal symptoms, pain syndrome, and hypertension. All the patients were operated on under endotracheal anesthesia. The data were statistically processed using the program package Statistica 6.0. Survival rates were analyzed by the Kaplan–Meier method. The Gehan–Wilcoxon test was used to compare the groups.Results. The investigation analyzed treatment results in 21 (15.8 % patients with primary malignant adrenal lesions (Group 1. The most common morphological form was adrenocortical carcinoma in 15 (11.3 % patients (5 men and 10 women (1:2; their mean age was 48.1 years. The right, left, and both adrenal glands were affected in 4, 9, and 2 cases, respectively. In Group 2, other malignant adrenal involvements were identified from 1 case of rare malignant adrenal tumors: malignant pheochromocytoma, sarcoma, melanoma, squamous cell

  15. 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.

  16. Cervical spondylodiscitis--a clinical analysis of surgically treated patients and review of the literature.

    Science.gov (United States)

    Ozkan, Neriman; Wrede, Karsten; Ardeshiri, Ardeshir; Hagel, Vincent; Dammann, Phillip; Ringelstein, Adrian; Sure, Ulrich; Erol Sandalcioglu, I

    2014-02-01

    The aim of this study was to analyze our clinical and neurological results of surgically treated patients suffering from cervical spondylodiscitis with focusing particularly on the surgical methods used and to review the literature. We present a series of 21 patients operated with cervical spondylodiscitis between 1998 and 2011. Basic demographic data, comorbidities, the radiological segments involved, the surgical strategy with special consideration of the material used and the clinical outcome were evaluated retrospectively. The mean age of 6 female and 12 male patients was 65 years (range 28-89 years). The mean follow-up was 3.7 years ranging between 4 weeks and 9 years. The leading symptom was neurological deficits rather than pain. The segments C 5/6 (n=8) and C 6/7 (n=7) were most frequently involved. Different surgical methods depending on the location, anatomical and pathological condition and extension of the lesion were performed. In conclusion, cervical spondylodiscitis could effectively be treated in the presented patient cohort by surgical decompression, debridement and PMMA or bone graft implants followed by long term antibiotic therapy. The presented surgical reconstruction technique with PMMA might be a feasible alternative to the use of bone graft or cages. The promising clinical results warrant future prospective studies to further investigate this technique. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Surgical Resection of Brain Metastases and the Risk of Leptomeningeal Recurrence in Patients Treated With Stereotactic Radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Matthew D., E-mail: Matthewjohnson@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Avkshtol, Vladimir [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Baschnagel, Andrew M. [Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (United States); Meyer, Kurt; Ye, Hong; Grills, Inga S.; Chen, Peter Y.; Maitz, Ann [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Olson, Rick E.; Pieper, Daniel R. [Department of Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan (United States); Krauss, Daniel J. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States)

    2016-03-01

    Purpose: Recent prospective data have shown that patients with solitary or oligometastatic disease to the brain may be treated with upfront stereotactic radiosurgery (SRS) with deferral of whole-brain radiation therapy (WBRT). This has been extrapolated to the treatment of patients with resected lesions. The aim of this study was to assess the risk of leptomeningeal disease (LMD) in patients treated with SRS to the postsurgical resection cavity for brain metastases compared with patients treated with SRS to intact metastases. Methods and Materials: Four hundred sixty-five patients treated with SRS without upfront WBRT at a single institution were identified; 330 of these with at least 3 months' follow-up were included in this analysis. One hundred twelve patients had undergone surgical resection of at least 1 lesion before SRS compared with 218 treated for intact metastases. Time to LMD and overall survival (OS) time were estimated from date of radiosurgery, and LMD was analyzed by the use of cumulative incidence method with death as a competing risk. Univariate and multivariate analyses were performed with competing risk regression to determine whether various clinical factors predicted for LMD. Results: With a median follow-up time of 9.0 months, 39 patients (12%) experienced LMD at a median of 6.0 months after SRS. At 1 year, the cumulative incidence of LMD, with death as a competing risk, was 5.2% for the patients without surgical resection versus 16.9% for those treated with surgery (Gray test, P<.01). On multivariate analysis, prior surgical resection (P<.01) and breast cancer primary (P=.03) were significant predictors of LMD development. The median OS times for patients undergoing surgery compared with SRS alone were 12.9 and 10.6 months, respectively (log-rank P=.06). Conclusions: In patients undergoing SRS with deferral of upfront WBRT for intracranial metastatic disease, prior surgical resection and breast cancer primary are associated with an

  18. Optimal primary surgical management of infected pseudoaneurysm in intravenous drug abusers: ligation or reconstruction?

    International Nuclear Information System (INIS)

    Jamil, M.; Usman, R.; Afzal, M.; Malik, N.I.

    2017-01-01

    Objective: To find out the optimal primary surgical treatment options for infected pseudoaneurysm in intravenous drug abusers. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Lahore, from Jan 2010 to Jun 2015. Material and Methods: A total of 31 consecutive patients with a history of intravenous drug abuse and an infected pseudoaneurysm in the groin or elbow, presenting in emergency department; were included in this study. All patients were primarily treated with ligation of the artery, excision of infected pseudoaneurysm and debridement of necrotic tissues. Only one patient underwent additional revascularization procedure. Results: All patients who underwent ligation and excision procedures did well initially. One (3.2%) patient developed severe distal ischemia after ligation of femoral artery within first 24 hours, so extra anatomic revascularization procedure was performed. Five (16.1%) patients required revascularization procedure after 16 weeks due to disabling distal ischemia. No amputation was needed and mortality rate was zero. Conclusion: Primary ligation of the artery with excision of infected pseudoaneurysm and necrotic material was found the optimal initial management for infected pseudoaneurysm in intravenous drug addicts. Ischemic complications if develop should be treated with early or late revascularization.

  19. Surgical Scales: Primary Closure versus Gastric Resection for ...

    African Journals Online (AJOL)

    Perforated gastric ulcer is one of the most life‑threatening complications of peptic ulcer disease with high morbidity and mortality rates. The surgical strategy for gastric perforation in contrast with duodenal perforations often requires consilium and intraoperative debates. The subject of the debate is a 59‑year‑old male patient ...

  20. Elderly women with breast cancer often die due to other causes regardless of primary endocrine therapy or primary surgical therapy

    NARCIS (Netherlands)

    Traa, M.J.; Meijs, C.M.E.M.; Jongh, M.A. de; Borst, E.C. van der; Roukema, J.A.

    2011-01-01

    Survival and cause of death was investigated for Primary Surgical Therapy (PST) and Primary Endocrine Therapy (PET). Of women aged >/=75 years 113 patients received PET, 233 patients underwent PST. PST gave better survival, although this group was younger (p < 0.001). During follow-up the percentage

  1. Unusual late presentation of metastatic extrathoracic thymoma to gastrohepatic lymph node treated by surgical resection.

    Science.gov (United States)

    Billè, Andrea; Sachidananda, Sandeep; Moreira, Andre L; Rizk, Nabil P

    2017-02-01

    In advanced stages, thymic tumors tend to spread locally. Distant metastatic disease is rare. We present the first report of single metastatic abdominal lymph node in a 37-year-old female patient and 5 years after an extrapleural pneumonectomy for stage IV thymoma followed by radiotherapy with no other evidence of abdominal disease successfully treated by robotic surgical resection.

  2. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

    Energy Technology Data Exchange (ETDEWEB)

    Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)

    2015-06-15

    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

  3. Surgical treatment of primary gynecomastia in children and adolescents.

    Science.gov (United States)

    Fischer, Sebastian; Hirsch, Tobias; Hirche, Christoph; Kiefer, Jurij; Kueckelhaus, Maximilian; Germann, Günter; Reichenberger, Matthias A

    2014-06-01

    Idiopathic gynecomastia is a common diagnosis in children and adolescents. Though medical treatments reveal potentially harmful side effects, surgical interventions are performable in numerous techniques. In children and adolescents, only minimal evidence exists. This retrospective study presents our experiences with two common surgical techniques, namely subcutaneous mastectomy and combination with liposuction. This retrospective study included all patients gynecomastia. Height, weight and grade of gynecomastia according to Simon's classification before surgery were reviewed in all patients' files. Additionally, duration of surgery, inpatient stay and postoperative complications were documented. Follow-up examinations were performed with assessment of scar formation, numbness and retraction of the nipple region. Furthermore, patients were asked to report on general satisfaction with surgery (satisfactory/not satisfactory) and esthetic outcome on a numeric scale (1 = good, 6 = bad). 37 patients underwent surgery for verified idiopathic gynecomastia. Grade of gynecomastia was I° in 13.5% (n = 5), II° in 40.5% (n = 15) and III° in 46% (n = 17) of cases. Subcutaneous mastectomy was applied in 11 patients (group I, 30%) and both subcutaneous mastectomy and liposuction in 26 patients (group II, 70.3%). Postoperative complications occurred in two patients. Long-term follow-up was performed in 32 patients after a median of 34 months (range 6-96 months). Hypertrophic scar formation was seen in one patient (3%) and nipple retraction in two patients (5%). Recurrence of gynecomastia occurred in two patients (5%). Patient rating was satisfactory in 9% of cases and esthetic outcome was received with a median of 2.0 (1-5). In comparing both surgical techniques, combination of mastectomy and liposuction revealed better results in every measure except for surgical duration (median 73 vs. 90 min). Surgical correction of gynecomastia remains a purely elective intervention. In

  4. Surgical outcome of cats treated for aqueous humor misdirection syndrome: a case series.

    Science.gov (United States)

    Atkins, Rosalie M; Armour, Micki D; Hyman, Jennifer A

    2016-07-01

    To evaluate the clinical outcome of cats treated surgically for aqueous humor misdirection syndrome. A retrospective analysis of cats treated surgically between January 1, 2006, and January 1, 2013, for aqueous humor misdirection syndrome was performed. Signalment, medical therapy, eyes affected, intraocular pressures prior to and after surgery, surgical procedures performed, postoperative complications, and visual status were evaluated. Seven cats (nine eyes) fit the inclusion criteria. Six of seven cats were female, and five of seven cats were diagnosed with bilateral aqueous humor misdirection syndrome. Three surgical approaches were evaluated as follows: (i) phacoemulsification and posterior capsulotomy, (ii) phacoemulsification, posterior capsulotomy and anterior vitrectomy, and (iii) phacoemulsification, posterior capsulotomy, anterior vitrectomy, and endocyclophotocoagulation. The mean age at diagnosis was 12.9 years. Seven of nine eyes had controlled intraocular pressure (≤25 mmHg) during the first 6 months postoperatively. All cats were visual with controlled intraocular inflammation at 1 year postoperatively; however, one eye had an elevated intraocular pressure. All cats were continued on topical antiglaucoma and anti-inflammatory medications following surgery with the mean number of drops per day decreasing from 3.9 drops/day prior to surgery to 2.2 drops/day postoperatively. Surgical management for feline aqueous humor misdirection syndrome may be a viable option to maintain a visual and normotensive status in cats that no longer have successful control of intraocular pressure with medical therapy. © 2016 American College of Veterinary Ophthalmologists.

  5. A primary care approach to treating women without homes.

    Science.gov (United States)

    Means, R H

    2001-03-01

    Medical practitioners are encountering more women who are presently or formerly homeless. Homelessness negatively affects health and health outcomes. Women without homes experience repeated violence and trauma. In this review, the definition and scope of homelessness as it impacts women is discussed, from the etiology of women's homelessness to a description of their lifestyle. A paradigm of a primary care approach to understanding and treating women without homes is presented, including strategies for history taking, physical exams, and follow-up care that help build trust and improve compliance.

  6. Mild hyperparathyroidism: a novel surgically correctable feature of primary aldosteronism.

    Science.gov (United States)

    Maniero, Carmela; Fassina, Ambrogio; Seccia, Teresa M; Toniato, Antonio; Iacobone, Maurizio; Plebani, Mario; De Caro, Raffaele; Calò, Lorenzo A; Pessina, Achille C; Rossi, Gian P

    2012-02-01

    The parathyroid hormone (PTH) stimulates aldosterone secretion and cell proliferation in human adrenocortical cells; moreover, in rats hyperaldosteronism was associated with hyperparathyroidism. Hence, PTH could drive aldosterone excess in human primary aldosteronism. To test this hypothesis, we recruited 105 consecutive hypertensive patients, of whom 44 had primary aldosteronism due to an aldosterone-producing adenoma (APA) and 61 had primary (essential) hypertension. We measured the plasma levels of (1-84)-PTH, 25(OH)D, 1,25(OH)2D, and serum Ca (total and ionized), inorganic P, Mg, K, and the 24-h urinary excretion of Ca, P, and deoxypyridinoline. In primary aldosteronism patients, these measurements were repeated after adrenalectomy or mineralocorticoid receptor blockade. We also sought for PTH receptor (PTHR-1) mRNA and protein in APA tissue. Compared with primary (essential) hypertension patients, those with primary aldosteronism showed significantly higher plasma PTH (+31%), despite comparable urinary Ca excretion and similarly deficient 25(OH) vitamin D levels. In APA patients, who showed the PTHR-1 transcript and protein in tumor tissue, adrenalectomy normalized PTH levels (from 118 ± 13 to 76 ± 12 ng/l; P = 0.002) and increased ionized Ca(from 1.17 ± 0.04 to 1.22 ± 0.03 mmol/l; P hyperparathyroidism by acting on PTHR-1 in APA might contribute to maintaining hyperaldosteronism despite suppression of angiotensin II formation.

  7. Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury.

    Science.gov (United States)

    Singhal, B; Mohammed, A; Samuel, J; Mues, J; Kluger, P

    2008-09-01

    Retrospective study based on a reference paper. Neurological outcome in patients who were managed surgically with closed traumatic cervical spine injury was evaluated using the ASIA motor scoring system and Frankel grading. To assess the accuracy of motor charting and Frankel grading as tools to evaluate neurological outcome in closed traumatic cervical spine injury, and also to evaluate how the surgically treated patients fared in their neurological recovery by measurement tools as in the reference paper. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Fifty-seven patients were admitted within 2 days of the injury with closed traumatic cervical spine injuries (1997-2004). Thirty-seven (65%) met the inclusion criteria as per the referenced paper, that is, were treated surgically, were Frankel grade B and above and had at least 12 months follow up. The remaining 20 patients were not included as they did not meet the inclusion criteria. The breakdown of the 20 patients is given in Table 1. The mean recovery percentage (MRP) and mean deficit percentage (MDP) were calculated as per the referenced paper. An evaluation of 37 patients surgically treated, who had follow up of at least 12 months, showed that preservation of pin prick below the level of lesion, and preservation of anal tone and perianal sensation were good prognostic indicators. There was no correlation between degree of encroachment of canal or the degree of kyphosis to MDP or MRP. The mean time from injury to mobilization was 7.6 days in 25 out of 37 patients. Twelve of the 37 patients had prolonged immobilization because of ITU stay or because they were initially treated conservatively. Three out of the 37 patients developed DVT/PE. Mean hospital stay was 6.4 months. The neurological outcome in surgically treated patients is comparable to the conservatively treated patients. The Frankel grading and ASIA motor charting combined is a powerful tool in assessing the neurological

  8. Modified lip repositioning: A surgical approach to treat the gummy smile.

    Science.gov (United States)

    Rao, Aditya Gopinath; Koganti, Vijay Prasad; Prabhakar, Ashok Kodangala; Soni, Sweta

    2015-01-01

    Gummy smile has been an esthetic concern for many patients. This clinical report describes a successful surgical coverage obtained by modified lip repositioning, thus surgically treating the gummy smile. The technique was performed to limit the retraction of elevator muscles (e.g., zygomaticus minor, orbicularis oris, leviator anguli oris and levator labi oris.) The technique is fulfilled by removing two strips of mucosa from maxillary buccal vestibule on both the sides leaving the frenum untouched and creating a partial thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display. This technique is different from the conventional surgical lip repositioning as labial frenum is left untouched over here as it helps in maintain Litton the midline for lip repositioning and reduces the morbidity associated with it.

  9. Modified lip repositioning: A surgical approach to treat the gummy smile

    Directory of Open Access Journals (Sweden)

    Aditya Gopinath Rao

    2015-01-01

    Full Text Available Gummy smile has been an esthetic concern for many patients. This clinical report describes a successful surgical coverage obtained by modified lip repositioning, thus surgically treating the gummy smile. The technique was performed to limit the retraction of elevator muscles (e.g., zygomaticus minor, orbicularis oris, leviator anguli oris and levator labi oris. The technique is fulfilled by removing two strips of mucosa from maxillary buccal vestibule on both the sides leaving the frenum untouched and creating a partial thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display. This technique is different from the conventional surgical lip repositioning as labial frenum is left untouched over here as it helps in maintain Litton the midline for lip repositioning and reduces the morbidity associated with it.

  10. Surgically treated cases of lumbar spondylolysis and isthmic spondylolisthesis: a multicenter study.

    Science.gov (United States)

    Hirano, Kenichi; Imagama, Shiro; Matsuyama, Yukihiro; Kawakami, Noriaki; Yukawa, Yasutsugu; Kato, Fumihiko; Hachiya, Yudo; Kanemura, Tokumi; Kamiya, Mitsuhiro; Deguchi, Masao; Ito, Zenya; Wakao, Norimitsu; Ando, Kei; Tauchi, Ryoji; Muramoto, Akio; Ishiguro, Naoki

    2015-06-01

    Prospective database study. To grasp the characteristics of surgically treated cases with lumbar spondylolysis or isthmic spondylolisthesis. A detailed analysis of surgically treated cases with spondylolysis or isthmic spondylolisthesis has never been reported. An epidemiological study in Japan conducted on 2000 subjects found the incidence of lumbar spondylolysis in the Japanese general population (population-based study) to be 5.9% (males: 7.9%, females: 3.9%). Among 124 vertebrae with spondylolysis, there were 0.8% L2 lesions, 3.2% L3 lesions, 5.6% L4 lesions, and 90.3% L5 lesions, including 5 cases (4.3%) with multiple-level lesions. We have been registering surgically treated spine cases in our database since 2000. From this database, we prospectively collected cases with lumbar spondylolysis or isthmic spondylolisthesis that were treated surgically between January 2000 and December 2009. We determined the age at surgery, sex, and vertebral level of spondylolysis. Of the 564 spondylolysis patients treated surgically, 66.8% were male and 33.2% were female. The mean age at surgery was 52.5 years (range, 13-84 y). There were 585 vertebrae with spondylolysis including 21 cases (3.7%) with multiple-level lesions. L5 spondylolysis affected 432 vertebrae and was the most common location (73.8%), followed by 125 L4 lesions (21.4%), 24 L3 lesions (4.1%), and 2 L2 lesions (0.7%). The percentage of L4 lesions in our study was significantly higher and of L5 lesions was significantly lower than those lesions' percentages in the population-based study. L4 spondylolysis may be more unstable or cause clinical symptoms more frequently leading to more surgical intervention. The percentage of multiple-level spondylolysis was similar between the 2 studies, suggesting these patients respond relatively well to conservative treatment. The male/female ratio was 2:1 in both studies, indicating that males and females require surgery at a similar frequency.

  11. Prognostic factors in non-surgically treated sciatica: a systematic review.

    Science.gov (United States)

    Ashworth, Julie; Konstantinou, Kika; Dunn, Kate M

    2011-09-25

    When present sciatica is considered an obstacle to recovery in low back pain patients, yet evidence is limited regarding prognostic factors for persistent disability in this patient group. The aim of this study is to describe and summarise the evidence regarding prognostic factors for sciatica in non-surgically treated cohorts. Understanding the prognostic factors in sciatica and their relative importance may allow the identification of patients with particular risk factors who might benefit from early or specific types of treatment in order to optimise outcome. A systematic literature search was conducted using Medline, EMBASE and CINAHL electronic databases. Prospective cohort studies describing subjects with sciatica and measuring pain, disability or recovery outcomes were included. Studies of cohorts comprised entirely of surgically treated patients were excluded and mixed surgically and conservatively treated cohorts were included only if the results were analysed separately by treatment group or if the analysis was adjusted for treatment. Seven adequate or high quality eligible studies were identified. There were conflicting but mainly negative results regarding the influence of baseline pain severity, neurological deficit, nerve root tension signs, duration of symptoms and radiological findings on outcome. A number of factors including age, gender, smoking, previous history of sciatica and heaviness of work do not appear to influence outcome. In contrast to studies of low back pain and purely surgically treated sciatica cohorts, psychological factors were rarely investigated. At present, the heterogeneity of the available studies makes it difficult to draw firm conclusions about sciatica prognosis, and highlights the need for further research for this group of patients. Large scale prospective studies of high methodological quality, using a well-defined, consistent definition of sciatica and investigating psychosocial factors alongside clinical and

  12. Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically

    OpenAIRE

    Jab?o?ska, Renata; ?lusarz, Robert; Kr?likowska, Agnieszka; Haor, Beata; Zaj?c, Magdalena

    2016-01-01

    Background Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. Material/Methods The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. T...

  13. A prospective randomized study comparing polidocanol foam sclerotherapy with surgical treatment of patients with primary chronic venous insufficiency and ulcer.

    Science.gov (United States)

    Campos, Walter; Torres, Inez Ohashi; da Silva, Erasmo Simão; Casella, Ivan Benaduce; Puech-Leão, Pedro

    2015-08-01

    To compare polidocanol foam sclerotherapy with surgical treatment of patients with primary chronic venous insufficiency and active ulcer treated at a single vascular center. Fifty-eight limbs of 56 patients with active ulcers were prospectively randomized to undergo either surgical treatment or foam sclerotherapy. Patients completed the Aberdeen Varicose Veins Questionnaire (AVVQ), the Venous Clinical Severity Score (VCSS), and Venous Disability Score (VDS). The follow-up was 502 ± 220 days. The ulcer healed in 100% and 91.3% of patients treated with surgery or foam sclerotherapy, respectively (P > 0.05). There were no significant differences in AVVQ, VCSS, and VDS between the 2 groups after the procedures (P = 0.45, 0.58, and 0.66, respectively; Mann-Whitney U test). Complications occurred in 14.2% and 13.0% in the surgical and foam sclerotherapy groups, respectively. Surgical treatment and foam sclerotherapy achieved high rates of ulcer healing, without a statistically significant difference. Both treatments led to significant improvements in VCSS, VDS, AVVQ scores, demonstrating improvements in clinical outcomes and quality of life. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  14. [Effects of Surgically Treated Pelvic Ring and Acetabular Fractures on Postural Control].

    Science.gov (United States)

    Lang, P; Schnegelberger, A; Riesner, H-J; Stuby, F; Friemert, B; Palm, H-G

    2016-04-01

    The aim of surgical treatment of pelvic ring and acetabular fractures is to allow rapid mobilisation of patients in order to restore stance and gait stability (postural control), as this significantly correlates with a positive outcome. The regulation of postural stability is mainly controlled by transmission of proprioceptive stimuli. In addition, the pelvis serves as a connection between the legs and the spine and thus is also of great importance for mechanical stabilisation. It remains unclear whether surgical treatment of pelvic ring and acetabular fractures affects the regulation of postural control. Therefore, the aim of this study was to examine the impact of surgically treated pelvic ring and acetabular fractures on postural stability by means of computerised dynamic posturography (CDP) after a mean of 35 months and to compare the results with a healthy control group. A retrospective case control study of 38 patients with surgically treated pelvic ring and acetabular fractures and 38 healthy volunteers was carried out using CDP. The average time of follow-up was 35 (12-78) months. The most important outcome parameter in this investigation was the overall stability index (OSI). Hip joint mobility, the health-related quality of life (SF-12) and pain were supplementary outcome parameters. It was found that surgically treated pelvic ring and acetabular fractures had no influence on postural stability. The OSI was 2.1 ° in the patient group and 1.9 ° in the control group. There was no significant difference between the groups in hip joint mobility. A total of 52 % of patients showed no or only mild pain. Mean health-related quality of life was the same as in the total population. Surgically treated pelvic ring and acetabular fractures do not lead to deterioration in postural control in the mid term. This is of high prognostic importance for rapid mobilisation of the patients. Therefore no increase in the risk of falling is expected after successfully

  15. Efficacy and safety of treating T4 oral cavity tumors with primary chemoradiotherapy.

    Science.gov (United States)

    Cohen, Ezra E W; Baru, Joshua; Huo, Dezheng; Haraf, Daniel J; Crowley, Maureen; Witt, Mary Ellyn; Blair, Elizabeth A; Weichselbaum, Ralph R; Rosen, Fred; Vokes, Everett E; Stenson, Kerstin

    2009-08-01

    Patients with T4 oral cavity (OC) tumors are often treated with surgery followed by adjuvant chemoradiotherapy (CRT). We performed a retrospective review of 4 multi-institutional phase II studies estimating long-term toxicity, locoregional control (LC), progression-free survival (PFS), and overall survival (OS) of primary CRT. Thirty-nine subjects were identified; 16 (42%) with bony involvement. Median radiotherapy dose delivered to primary tumor was 74 Gy. Five-year OS, PFS, and LC rates were 56%, 51%, and 75%, respectively. Sixty-nine percent of subjects with bony involvement never relapsed. Seven subjects developed osteoradionecrosis. Bone involvement with primary tumor did not appear to be associated with increased risk of death, relapse, or long-term complication. These data suggest that primary CRT is an effective treatment approach in patients with T4 OC tumors including those with bony involvement producing LC, survival, and complication rates comparable to historical series. Prospective clinical trials should evaluate primary surgical versus CRT treatment in these patients. Copyright 2009 Wiley Periodicals, Inc.

  16. [Update on surgical treatment of primary and metastatic cutaneous melanoma].

    Science.gov (United States)

    Zuluaga-Sepúlveda, María Alejandra; Arellano-Mendoza, Ivonne; Ocampo-Candiani, Jorge

    2016-01-01

    Melanoma is a common cutaneous tumour. It is of great importance due to its increasing incidence and aggressive behaviour, with metastasis to lymph nodes and internal organs. When suspecting melanoma, excisional biopsy should be performed to obtain complete histological information in order to determine the adverse factors such as ulceration, mitosis rate, and Breslow depth, which influence preoperative staging and provide data for sentinel lymph biopsy decision making. The indicated management for melanoma is wide local excision, observing recommended and well-established excision margins, depending on Breslow depth and anatomical location of the tumour. Therapeutic lymphadenectomy is recommended for patients with clinically or radiologically positive lymph nodes. This article reviews surgical treatment of melanoma, adverse histological factors, sentinel lymph node biopsy, and radical lymphadenectomy. Details are presented on special situations in which management of melanoma is different due to the anatomical location (plantar, subungual, lentigo maligna), or pregnancy. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  17. Surgical treatment of the primary tumour improves the overall survival in patients with metastatic breast cancer: A systematic review and meta-analysis.

    Science.gov (United States)

    Headon, Hannah; Wazir, Umar; Kasem, Abdul; Mokbel, Kefah

    2016-05-01

    Traditionally, stage IV metastatic breast cancer has been treated with systemic therapy and/or radiotherapy in order to decrease cancer-associated symptoms, maintain quality of life and control disease burden. Previous research suggests that surgical treatment of the primary tumour may prolong survival, as well achieve local control of disease. Using the PubMed and Ovid SP databases, a literature review and meta-analysis was performed in order to assess whether surgical resection of the primary tumour in metastatic breast cancer prolongs survival. In this meta-analysis, a pooled hazard ratio of 0.63 (95% confidence interval, 0.58-0.7; P<0.0001) was revealed, equating to a 37% reduction in risk of mortality in patients that underwent surgical resection of the primary tumour. Therefore, it was concluded that surgery of the primary tumour in stage IV breast cancer appears to offer a survival benefit in metastatic patients.

  18. Extruded talus treated with reimplantation and primary tibiotalocalcaneal arthrodesis.

    Science.gov (United States)

    Mohammad, H R; A'Court, J; Pillai, A

    2017-04-01

    Extruded talus is a rare serious result from a high-energy injury to a supinated and plantar flexed foot. Treatment remains controversial with a lack of congruent evidence for talar reimplantation. A 34-year-old woman was involved in a road traffic accident at 40 mph. Imaging revealed a left talus extruded anterolaterally with a talar neck fracture. Additional injuries included right acetabular fracture, transverse process fractures and rib fractures, which were treated conservatively. The talus was reimplanted and the talar neck fixed with a cortical screw. A hindfoot nail was used to fuse the calcaneus, talus and tibia. Follow-up at two years showed solid tibiotalocalcaneal fusion, with no evidence of avascular development, and the patient was fully weight bearing without pain. We believe this is the first published case of successful primary tibiotalocalcaneal fusion for extruded talus injuries.

  19. Surgical management of impacted primary teeth: report of two cases.

    Science.gov (United States)

    Sfasciotti, G L; Di Carlo, G; Marini, R; Colaci, R; Solidani, M; Polimeni, A

    2017-03-01

    Impaction of deciduous teeth is an uncommon event. The purpose of this report is to describe two unusual eruption failures of a second primary molar and their treatment management. The diagnostic and therapeutic protocol of two cases selected at the Unit of Paediatric Dentistry, Department of Oral and Maxillofacial Science, "Sapienza" University of Rome, Italy, are presented. In both cases, the second deciduous molar was impacted, while no mechanical obstacle like odontomas or supernumerary teeth were present. The two case reports presented in this work are of scientific relevance, due to the rarity of this type of pathology.

  20. Surgical therapy of primary malignant bone tumours and soft tissue sarcomas of the chest wall: a two-institutional experience.

    Science.gov (United States)

    Friesenbichler, Joerg; Leithner, Andreas; Maurer-Ertl, Werner; Szkandera, Joanna; Sadoghi, Patrick; Frings, Andreas; Maier, Alfred; Andreou, Dimosthenis; Windhager, Reinhard; Tunn, Per-Ulf

    2014-06-01

    Primary malignant bone tumours and soft tissue sarcomas of the chest wall are exceedingly rare entities. The aim of this study was a retrospective two-institutional analysis of surgical therapy with respect to the kind and amount of the resection performed, the type of reconstruction and the oncological outcome. Between September 1999 and August 2010 31 patients (seven women and 24 men) were treated due to a primary malignant bone tumour or soft tissue sarcoma of the chest wall in two centres. Eight low-grade sarcomas were noted as well as 23 highly malignant sarcomas. The tumours originated from the sternum in six cases, from the ribs in 12 cases, from the soft tissues of the thoracic wall in 11 cases and from a vertebral body and the clavicle in one case each. In 26 cases wide resection margins were achieved, while four were intralesional and one was marginal. In all 31 cases the defect of the chest wall was reconstructed using mesh grafts. At a mean follow-up of 51 months 20 patients were without evidence of disease, three were alive with disease, seven patients had died and one patient was lost to follow-up. One recurrence was detected after wide resection of a malignant triton tumour. Primary malignant bone tumour or soft tissue sarcoma of the chest wall should be treated according to the same surgical oncological principles as established for the extremities. Reconstruction with mesh grafts and musculocutaneous flaps is associated with a low morbidity.

  1. Usefulness of gadolinium in MRI evaluation of non surgically treated herniated disk.

    Science.gov (United States)

    Motta, E; Boniotti, V; Miserocchi, L; Caudana, R

    2005-01-01

    The rationale for the use of Gadolinium (Gd) in the MRI evaluation of non surgically treated herniated disk is based on the known presence of inflammatory granulation tissue and neoangiogenesis which plays an important role in both pain and the spontaneous resorption of the hernia. of this study was to determine the usefulness of Gd in MRI examination for detecting the inflammatory reaction around the discal hernia. Thirty-eight patients (mean age 45 years; range 20-70 years) with non surgically treated herniated disk were evaluated with MRI between January 2000 and July 2004. T2w-FAST-SE sagittal and T1w-SE transaxial and sagittal images were acquired before and after the administration of Gd. Twenty out of 22 patients with acute sciatic pain (symptoms =/discal hernia in the spinal canal. In the remaining 16 with chronic sciatic pain (symptoms > 6 months) the discal hernia did not show peri-hernial enhancement. In MRI evaluation of the herniated disk, peri-hernial enhancement is correlated with inflammatory reaction around the hernia which is associated with acute symptoms. The absence of peri-hernial enhancement in chronic herniated disk is due to the poorly vascular fibrotic tissue. Therefore, peri-hernial enhancement facilitates the differential diagnosis in uncertain cases and represents a reliable prognostic index of response to non-surgical therapy and of the possible spontaneous resorption of discal hernia.

  2. Sex-related differences in patients treated surgically for aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Horiuchi, Tetsuyoshi; Tanaka, Yuichiro; Hongo, Kazuhiro

    2006-01-01

    Sex-related differences were examined in the clinical course of patients treated surgically for aneurysmal subarachnoid hemorrhage. Retrospective analyses were carried out to evaluate sex-related differences in aneurysm location, aneurysm size, preoperative neurological condition, preoperative computed tomography findings, and outcome among 2577 patients who underwent surgical repair of ruptured aneurysms. The internal carotid artery was most frequently affected in women and the anterior cerebral artery in men. Intracerebral or intraventricular hematoma was more common in men than in women. Some differences may be related to the location of the aneurysm. Sex-related differences were prominent in the 5th decade of life. These findings might be related to the menopause. Sex hormones may be involved in aneurysm formation. (author)

  3. An outcome analysis of seventeen patients treated surgically for intractable extratemporal epilepsy.

    LENUS (Irish Health Repository)

    Mulholland, D

    2010-07-01

    We studied the outcomes of seventeen patients treated surgically for extratemporal lobe epilepsy. A retrospective case review of medical charts was performed. Seizure freedom post surgery was appraised using the Engel classification system. Post-operatively seven patients (41%) were seizure free (Engel class I), four patients were class II (23.5%), two in class III (11.76%) and four in class IV (23.5%). Three patients (17.6%) suffered traumatic injuries due to seizures. The mean duration of epilepsy prior to surgery was 12.2 years and the mean number of anti-epileptic medications given was 6.5. Seizure freedom rates for surgical treatment of extratemporal epilepsy in this centre are similar to those of other centres. Post-operative morbidity in this centre was similar to other centres. Any complications resolved with no lasting impairment.

  4. Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: a case report

    Directory of Open Access Journals (Sweden)

    Tzanakakis George

    2010-08-01

    Full Text Available Abstract Introduction Quadratus femoris tear is an uncommon injury, which is only rarely reported in the literature. In the majority of cases the correct diagnosis is delayed due to non-specific symptoms and signs. A magnetic resonance imaging scan is crucial in the differential diagnosis since injuries to contiguous soft tissues may present with similar symptoms. Presentation with sciatica is not reported in the few cases existing in the English literature and the reported treatment has always been conservative. Case presentation We report here on a case of quadratus femoris tear in a 22-year-old Greek woman who presented with persistent sciatica. She was unresponsive to conservative measures and so was treated with surgical decompression. Conclusion The correct diagnosis of quadratus muscle tear is a challenge for physicians. The treatment is usually conservative, but in cases of persistent sciatica surgical decompression is an alternative option.

  5. TVT and TVT-O for surgical treatment of primary stress urinary incontinence: prospective randomized trial.

    Science.gov (United States)

    Krofta, Ladislav; Feyereisl, Jaroslav; Otcenásek, Michal; Velebil, Petr; Kasíková, Eva; Krcmár, Michal

    2010-02-01

    A study was conducted to compare the efficacy and complications of TVT and TVT-O. This study is a prospective randomized trial involving 300 women with primary SUI; 149 received TVT, and 151 patients were treated with TVT-O. At the 1 year follow-up, 141 TVT patients and 147 TVT-O patients (dropout, 5.3% and 2.6%) were evaluated using urodynamic studies, validated questionnaires, and a 1-h pad test. The mean operating time was shorter in the TVT-O group (p 0.05). Inner thigh discomfort was reported by 5.4% of TVT-O patients. In the TVT and the TVT-O groups, respectively, 90.1% and 88.4% women were objectively cured. The satisfaction with the surgical outcome reflects the significant decrease in the questionnaire mean symptom scores in both groups. Postoperative de novo urgency was significantly more common in the TVT-O patients (p = 0.015). The groups showed comparable objective and subjective cure rates.

  6. An Inexpensive Modified Primary Closure Technique for Class IV (Dirty) Wounds Significantly Decreases Superficial and Deep Surgical Site Infection.

    Science.gov (United States)

    Kim, Bradford J; Aloia, Thomas A

    2016-11-01

    Despite the creation of several programs to decrease the incidence of surgical site infection, it remains a common complication that has a significant impact on patient recovery and medical costs. The following is a description and brief outcome report of a modified primary closure technique used for dirty (Class IV) wounds. There were 14 consecutive patients who had a laparotomy with Class IV wounds treated by a single surgeon (TAA) from 2011 to 2015. All patients had a history of cancer and either showed signs suggestive for an acute abdomen and required an emergent exploratory laparotomy or were found to have purulent intraabdominal infection at the time of elective surgery. The operation and "modified primary closure" technique (subcutaneous wound wicks with stapled skin closure) were performed in every case. The modified primary closure technique was utilized in 14 patients with a Class IV wound. There were no 30-day mortalities or readmissions. Wound wicks were slowly advanced out over a 7-day period, and only one patient required subsequent wound packing of a single-wicked area. There were no superficial or deep surgical site infections, or wound dehiscence during the hospital course, or 30-day postoperative period. The modified primary closure technique is efficient and inexpensive and was effective in a series of 14 patients with wounds classified as dirty.

  7. Unruptured Versus Ruptured AVMs: Outcome Analysis from a Multicentric Consecutive Series of 545 Surgically Treated Cases.

    Science.gov (United States)

    Cenzato, Marco; Tartara, Fulvio; D'Aliberti, Giuseppe; Bortolotti, Carlo; Cardinale, Francesco; Ligarotti, Gianfranco; Debernardi, Alberto; Fratianni, Alessia; Boccardi, Edoardo; Stefini, Roberto; Zenga, Francesco; Boccaletti, Riccardo; Lanterna, Andrea; Pavesi, Giacomo; Ferroli, Paolo; Sturiale, Carmelo; Ducati, Alessandro; Cardia, Andrea; Piparo, Maurizio; Valvassori, Luca; Piano, Mariangela

    2018-02-01

    Recent literature strongly challenged indications to perform preventive surgery in unruptured arteriovenous malformation (AVM) claiming that invasive AVM treatment is associated with a significant risk of complications and thus conservative management may be a preferable alternative in many patients. On the other hand, the recent improvement of surgical instrumentation and treatment strategies (both surgical and interventional) yielded better outcomes than those achieved only a decade ago. Therefore, even among specialists, a wide variety of opinions, concerning the treatment of unruptured AVM, can be found. This multicenter retrospective study analyzes a consecutive series of 545 surgically treated AVMs in 10 different hospitals in Italy. Patients with AVMs treated after hemorrhage had an unfavorable (modified Rankin Scale score >1) outcome in more than one third (37.69%) of the cases. Conversely, with proper indications, unruptured AVMs treated preventively have a good outcome in 93.8% of cases, increasing to 95.7%, with no death, if only Spetzler-Martin grades 1-3 are considered (P < 0.05). Outcomes on discharge significantly (P < 0.05) improve at 6 months with the disappearance of many of the initial neurologic deficits that turn out to be transient. In unruptured low-risk AVMs (Spetzler-Martin grades 1-3), over time, the risk of surgery-associated neurologic deficits becomes lower than that linked to spontaneous hemorrhage, with a crossover point at 6.5 years. Because the average bleeding age is less than 45 years, preventive surgery can be advocated to safeguard the patient and overcome the risks associated with the natural history of AVMs. Copyright © 2017 Elsevier Inc. All rights reserved.

  8.  Treating Children Without Antibiotics in Primary Healthcare

    Directory of Open Access Journals (Sweden)

    Narayanan Kutty

    2011-09-01

    Full Text Available The overuse of antibiotics in children is becoming a major public health problem. Although most of the common childhood infections such as diarrhea and upper respiratory tract infections are caused by viruses, large volumes of antibiotics are prescribed for these infections in children in the primary care settings. Excessive use of antibiotics is the fundamental risk factor for the development of antibiotic resistance. It is estimated that 90�0of upper respiratory tract infections are self limiting viral illnesses and even bacterial infections like acute otitis media often run a self limiting course. Clinical trials have shown that antibiotic use to treat common upper respiratory tract infections like sore throat, nasopharyngitis and otitis media has no or minimal benefit on the clinical outcome. This report discusses two strategies considered to reduce the use of antibiotic in these conditions: i No prescription, and ii Delayed prescription of antibiotics for common upper respiratory tract infections. Moreover, this report calls for a significant modification of the prescribing habits of physicians, and to also extend community awareness on the harms of the misuse and overuse of antibiotics. It is imperative to educate health workers as well as the Community in a coordinated and sustainable manner about the growing public health problem of antibiotic resistance.

  9. What are the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty?

    Science.gov (United States)

    Harato, Kengo; Maeno, Shinichi; Tanikawa, Hidenori; Kaneda, Kazuya; Morishige, Yutaro; Nomoto, So; Niki, Yasuo

    2016-08-01

    It was hypothesized that surgical time of beginners would be much longer than that of experts. Our purpose was to investigate and clarify the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty (TKA) as a multicentre study. A total of 300 knees in 248 patients (averaged 74.6 years) were enrolled. All TKAs were done using the same instruments and the same measured resection technique at 14 facilities by 25 orthopaedic surgeons. Surgeons were divided into three surgeon groups (four experts, nine medium-volume surgeons and 12 beginners). The surgical technique was divided into five phases. Detailed surgical time and ratio of the time in each phase to overall surgical time were recorded and compared among the groups in each phase. A total of 62, 119, and 119 TKAs were done by beginners, medium-volume surgeons, and experts, respectively. Significant differences in surgical time among the groups were seen in each phase. Concerning the ratio of the time, experts and medium-volume surgeons seemed cautious in fixation of the permanent component compared to other phases. Interestingly, even in ratio, beginners and medium-volume surgeons took more time in exposure of soft tissue compared to experts. (0.14 in beginners, 0.13 in medium-volume surgeons, 0.11 in experts, P time in exposure and closure of soft tissue compared to experts. Improvement in basic technique is essential to minimize surgical time among beginners. First of all, surgical instructors should teach basic techniques in primary TKA for beginners. Therapeutic studies, Level IV.

  10. Primary lung sarcoma treated with stereotactic ablative radiotherapy: a case report

    Directory of Open Access Journals (Sweden)

    Yeo SG

    2017-07-01

    Full Text Available Seung-Gu Yeo Department of Radiation Oncology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Cheonan, Republic of Korea Abstract: Primary lung sarcoma (PLS is an extremely rare, very aggressive malignancy. Surgical removal is considered the treatment of choice, and patients who have been given conventional radiotherapy have had inferior outcomes. This study is the first describing a case of PLS treated with stereotactic ablative radiotherapy (SABR, which precisely targets a small tumor with a markedly higher biologically effective dose than conventional radiotherapy. The patient was an 82-year-old man who was diagnosed with primary lung leiomyosarcoma based on radiology, pathology, and immunohistochemical examinations. The PLS was located in the right lower lobe and measured 2.5 cm. No regional nodal or distant organ metastasis was observed. He was inoperable medically. The SABR was performed using volumetric modulated arc therapy and a dose of 56 Gy in four fractions. Follow-up computed tomography 2 months after SABR revealed a complete tumor response. The toxicity was limited to mild respiratory symptoms. The patient is alive and has had no evidence of disease for 2 years. This study suggests that SABR can be a safe and effective treatment option for PLS. Keywords: primary lung sarcoma, leiomyosarcoma, stereotactic ablative radiotherapy, stereotactic body radiotherapy, radiation therapy, sarcoma 

  11. Mortality and health-related quality of life in patients surgically treated for spondylodiscitis.

    Science.gov (United States)

    Dragsted, Casper; Aagaard, Theis; Ohrt-Nissen, Søren; Gehrchen, Martin; Dahl, Benny

    2017-01-01

    To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine center. Indications for surgery, pre- and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). Sixty-five patients were diagnosed with spondylodiscitis not related to recent spine surgery. One-year mortality rate was 6%. In all, 36% and 27% had pre- and postoperative neurological impairment, respectively, with only one patient experiencing deterioration postoperatively. At final follow-up (median 2 years), mean ODI was 31% (SD = 22) and mean EQ-5D time trade-off score was 0.639 (SD = 0.262); this was significantly lower than that in the normal population ( p spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.

  12. Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica.

    Science.gov (United States)

    Verwoerd, A J H; Luijsterburg, P A J; Lin, C W C; Jacobs, W C H; Koes, B W; Verhagen, A P

    2013-09-01

    Identification of prognostic factors for surgery in patients with sciatica is important to be able to predict surgery in an early stage. Identification of prognostic factors predicting persistent pain, disability and recovery are important for better understanding of the clinical course, to inform patient and physician and support decision making. Consequently, we aimed to systematically review prognostic factors predicting outcome in non-surgically treated patients with sciatica. A search of Medline, Embase, Web of Science and Cinahl, up to March 2012 was performed for prospective cohort studies on prognostic factors for non-surgically treated sciatica. Two reviewers independently selected studies for inclusion and assessed the risk of bias. Outcomes were pain, disability, recovery and surgery. A best evidence synthesis was carried out in order to assess and summarize the data. The initial search yielded 4392 articles of which 23 articles reporting on 14 original cohorts met the inclusion criteria. High clinical, methodological and statistical heterogeneity among studies was found. Reported evidence regarding prognostic factors predicting the outcome in sciatica is limited. The majority of factors that have been evaluated, e.g., age, body mass index, smoking and sensory disturbance, showed no association with outcome. The only positive association with strong evidence was found for leg pain intensity at baseline as prognostic factor for subsequent surgery. © 2013 European Federation of International Association for the Study of Pain Chapters.

  13. Surgical outcome of displaced middle third clavicular fractures treated with locking compression plate

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    Rakesh Patil

    2014-01-01

    Full Text Available Conservative management of middle third clavicle fracture has been recently reported with suboptimal outcomes. Despite higher nonunion rates in initial open reduction and internal fixation (ORIF, understanding the problem better and taking in accounts of previous shortcomings, such fractures can be optimally treated by ORIF with locking compression plate (LCP. This study aims at investigating the outcome of middle third clavicle fracture treated with locking compression plating in terms of function using constant score union time, complications, and patient satisfaction. Study includes 98 patients with displaced middle third clavicle fracture treated with ORIF with locking compression plate, which had follow-up for at least 1 year. The mean age was 44 years (15-59, 56 were male patients and 42 were female. Right side was involved in 53.9% of cases. All the fractures united with mean time to union of 9.2 weeks except two, in which the procedure was redone with bone grafting to achieve union. The average constant score was 89. Our study shows that displaced midshaft clavicle fracture can be optimally treated with surgical fixation with the locking compression plate to reduce malunion, unsightly deformity and nonunions. We conclude that precontoured LCP as a reliable option for fixing midshaft clavicle fractures.

  14. Surgical Treatment After Failed Primary Correction of Urogenital Sinus in Female Patients with Virilizing Congenital Adrenal Hyperplasia.

    Directory of Open Access Journals (Sweden)

    Maria Helena Palma Sircili

    2016-10-01

    Full Text Available Purpose: Genital reconstruction in female patients with virilizing congenital adrenal hyperplasia (CAH is very challenging. Our aim was to evaluate the techniques employed to treat complications after failure of primary urogenital sinus (UGS surgery, as well as the result of these reoperations.Patients and Methods: Twenty girls with virilizing CAH who were previously submitted to genitoplasty in our service and elsewhere had recurrent UGS stenosis and vaginal introitus stenosis that required surgical treatment. The main symptoms were recurrent urinary tract infection (UTI in nine, dyspareunia in six and hematocolpos in three (two associated with sepsis. The anatomical findings were the persistence of UGS with stenosis in 17 patients and vaginal introitus stenosis in three. The mean age at procedure was 15.2 yrs., averaging 13.1 yrs. after the first surgery. The surgical techniques employed were: isolated perineal flap in 17 patients and perineal flap with partial mobilization of UGS in three. The mean follow-up after the procedure was 4.8 years (varying from 1 to 17yrs.Results: Vaginal dilations were performed after surgery in 15 patients. Good functional and anatomical results were obtained in 15 patients, with vaginal introitus amenable to dilators of 3.0 cm in diameter. Five patients with high vaginal insertion had recurrent vaginal stenosis and required a surgical revision. No patients presented menstrual obstruction or UTI after surgery. Eight of the 15 adult patients are sexually active. Conclusion: The reoperation to treat failed primary UGS treatment using Y-V flap and partial mobilization techniques associated to vaginal dilations, promoted good anatomical and functional results with low morbidity in 75% of the patients.□

  15. Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Ekdahl Charlotte S

    2009-09-01

    Full Text Available Abstract Background Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal. The aim of this study was to evaluate the effects of a 12-week standardised but individually suited training program (training group versus usual care (control group after plaster removal in adults with surgically treated ankle fractures. Methods In total, 110 men and women, 18-64 years of age, with surgically treated ankle fracture were included and randomised to either a 12-week training program or to a control group. Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group. The main outcome measure was the Olerud-Molander Ankle Score (OMAS which rates symptoms and subjectively scored function. Secondary outcome measures were: quality of life (SF-36, timed walking tests, ankle mobility tests, muscle strength tests and radiological status. Results 52 patients were randomised to the training group and 58 to the control group. Five patients dropped out before the six-month follow-up resulting in 50 patients in the training group and 55 in the control group. Nine patients dropped out between the six- and twelve-month follow-up resulting in 48 patients in both groups. When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS (p = 0.028, muscle strength in the plantar flexors (p = 0.029 and dorsiflexors (p = 0.030. Conclusion The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40. However, as only three

  16. Distribution pattern of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs in males.

    Science.gov (United States)

    Nnamdi, Ibe Michael Onwuzuruike

    2013-09-01

    The pattern of distribution of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs has been published, though scantily, especially in males. We decided to look at our own series, compare and contrast ours with some of those published. We treated 88 locations of this lesion in 68 males. The clinical features were those of lower back pains, with or without radiation into the lower extremities, sensory loss and paresis of the limbs. There was a case of loss of urinary bladder and ano-rectal control. All lesions were confirmed through cauda-equinograms and treated under general anaesthesia in knee-chest position (MECCA position). The patients were followed up for 3-6 months post-operatively. There were 88 locations in 68 males of 21-70 years of age, with 29 prolapses occurring during the age range 31-40 years, while 54 locations were on the left and 48 at L4/5. The procedures were well tolerated by all patients and there were no post-operative complications. This lesion in our series occurred mostly on the left, at the L4/5 level and peaked at 31-40 years age range. The predictability of occurrence of this disease, using side, level and age is still not feasible in males from our series.

  17. Quality of life, pain, anxiety and depression in patients surgically treated with cancer of rectum.

    Science.gov (United States)

    Santos, Letácio José Freire; Garcia, João Batista dos Santos; Pacheco, Jairo Sousa; Vieira, Erica Brandão de Morais; Santos, Alcione Miranda dos

    2014-01-01

    The rectum cancer is associated with high rates of complications and morbidities with great impact on the lives of affected individuals. To evaluate quality of life, pain, anxiety and depression in patients treated for medium and lower rectum cancer, submitted to surgical intervention. A descriptive cross-sectional study. Eighty-eight records of patients with medium and lower rectum cancer, submitted to surgical intervention were selected, and enrolled. Forty-seven patients died within the study period, and the other 41 were studied. Question forms EORTC QLQ-C30 and EORTC QLQ-CR38 were used to assess quality of life. Pain evaluation was carried out using the Visual Analogical Scale, depression and anxiety were assessed through Depression Inventories and Beck's Anxiety, respectively. The correlation between pain intensity, depression and anxiety was carried out, and between these and the EORTC QLQ-C30 General Scale for Health Status and overall quality of life, as well as the EORTC QLQ-CR38 functional and symptom scales. Of the 41 patients of the study, 52% presented pain, depression in 47%, and anxiety in 39%. There was a marking positive correlation between pain intensity and depression. There was a moderate negative correlation between depression and general health status, and overall quality of life as well as pain intensity with the latter. There was a statistically significant negative correlation between future depression perspective and sexual function, and also a strong positive correlation between depression and sexual impairments. A positive correlation between anxiety and gastro-intestinal problems, both statistically significant, was observed. Evaluation scales showed detriment on quality life evaluation, besides an elevated incidence of pain, depression, and anxiety; a correlation among these, and factors which influence on the quality of life of post-surgical medium and lower rectum cancer patients was observed.

  18. Bio-Occlusive Gauze with Tegaderm: A Dressing for Surgical Wounds in Primary THA and TKA

    Directory of Open Access Journals (Sweden)

    Madhav Chowdhry

    2018-01-01

    Full Text Available Background: We introduce a simple, cost-effective bio-occlusive dressing to be used for primary total hip arthroplasty (THA and primary total knee arthroplasty (TKA. Methods: The gauze-Tegaderm™ (GT dressing consists of a 5cm wide 8-layered gauze covered by 3 to 5 medium-sized Tegaderm transparent films. We prospectively evaluated 100 consecutive primary THA’s and 107 consecutive primary TKA’s utilizing this dressing with a minimum of one-year follow-up. Results: In the primary THA group, there was one surgical site infection (SSI requiring oral antibiotic treatment. There were no cases of periprosthetic joint infection (PJI. In the primary TKA group, there were two surgical site infections requiring oral antibiotic treatment and one case of chronic PJI requiring a two-stage exchange protocol. Discussion: Our SSI and PJI rates are comparable to published rates in the literature. The GT dressing is a simple, inexpensive dressing that can compete against the many proprietary bio-occlusive dressings that are more expensive and are not readily available worldwide. Our favorable review has merited a large volume randomized controlled study comparing the GT dressing to another proprietary bio-occlusive dressing.

  19. Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically

    Science.gov (United States)

    Jabłońska, Renata; Ślusarz, Robert; Królikowska, Agnieszka; Haor, Beata; Zając, Magdalena

    2016-01-01

    Background Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. Material/Methods The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. The data are discussed in the context of medical records and the Visual Analogue Scale used for pain assessment. We used a prospective study plan with a 3-time assessment. Results The pain level observed among patients prior to the procedure (M=6.52) was higher than after 7 days (M=3.15) and 6 months from the operation (M= 3.45). The highest level of pain (M=6.88), with a relatively high consistency among the patients (SD=2.25), was observed in the case of left-side hernia (H=7.31; p=0.023). The influence of the analyzed factors on pain experience markedly increased by the third assessment (R2=0.14), and was strongly associated with the type of work performed by the patient. Conclusions Surgical operation significantly reduces pain in patients with disc disorders. The level of pain is predominantly affected by the location of the hernia and the type of work performed by the patient. PMID:27865095

  20. Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically.

    Science.gov (United States)

    Jabłońska, Renata; Ślusarz, Robert; Królikowska, Agnieszka; Haor, Beata; Zając, Magdalena

    2016-11-19

    BACKGROUND Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. MATERIAL AND METHODS The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. The data are discussed in the context of medical records and the Visual Analogue Scale used for pain assessment. We used a prospective study plan with a 3-time assessment. RESULTS The pain level observed among patients prior to the procedure (M=6.52) was higher than after 7 days (M=3.15) and 6 months from the operation (M= 3.45). The highest level of pain (M=6.88), with a relatively high consistency among the patients (SD=2.25), was observed in the case of left-side hernia (H=7.31; p=0.023). The influence of the analyzed factors on pain experience markedly increased by the third assessment (R2=0.14), and was strongly associated with the type of work performed by the patient. CONCLUSIONS Surgical operation significantly reduces pain in patients with disc disorders. The level of pain is predominantly affected by the location of the hernia and the type of work performed by the patient.

  1. Intraabdominal candidiasis in surgical ICU patients treated with anidulafungin: A multicenter retrospective study.

    Science.gov (United States)

    Maseda, Emilio; Rodríguez-Manzaneque, Marta; Dominguez, David; González-Serrano, Matilde; Mouriz, Lorena; Álvarez-Escudero, Julián; Ojeda, Nazario; Sánchez-Zamora, Purificación; Granizo, Juan-José; Giménez, María-José

    2016-02-01

    Patients with recent intraabdominal events are at uniquely risk for intraabdominal candidiasis (IAC). Candida peritonitis is a frequent and life-threatening complication in surgically ill patients. International guidelines do not specifically address IAC. This study describes clinical features of IAC in critical patients treated with anidulafungin in Surgical ICUs (SICUs). A practice-based retrospective study was performed including all adults with IAC admitted to 19 SICUs for ≥24h treated with anidulafungin. IAC was documented (Candida isolation from blood/peritoneal fluid/abscess fluid and/or histopathological confirmation) or presumptive (host factors plus clinical criteria without mycological support). Total population and the subgroup of septic shock patients were analyzed. One hundred and thirty nine patients were included, 94 (67.6%) with septic shock, 112 (86.2%) after urgent surgery. Of them, 77.7% presented peritonitis and 21.6% only intraabdominal abscesses. Among 56.8% cases with documented IAC, C. albicans (52.8%) followed by C. glabrata (27.8%) were the most frequent species. Anidulafungin was primarily used as empirical therapy (59.7%), microbiologically directed (20.9%) and anticipated therapy (15.8%). Favourable response was 79.1% (76.6% among patients with septic shock). Intra-SICU mortality was 25.9% (28.7% among patients with septic shock). Among IACs managed at SICUs, peritonitis was the main presentation, with high percentage of patients presenting septic shock. C. albicans followed by C. glabrata were the main responsible species. Anidulafungin treatment was mostly empirical followed by microbiologically directed therapy, with a favourable safety profile, even among patients with septic shock.

  2. Partial fingertip necrosis following a digital surgical procedure in a patient with primary Raynaud's phenomenon.

    Science.gov (United States)

    Uygur, Safak; Tuncer, Serhan

    2014-12-01

    Raynaud's phenomenon is a common clinical disorder consisting of recurrent, long-lasting and episodic vasospasm of the fingers and toes often associated with exposure to cold. In this article, we present a case of partial fingertip necrosis following digital surgical procedure in a patient with primary Raynaud's phenomenon. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  3. Treating primary insomnia - the efficacy of valerian and hops.

    Science.gov (United States)

    Salter, Shanah; Brownie, Sonya

    2010-06-01

    To evaluate the efficacy of valerian and hops in the treatment of primary insomnia. The AMED and MEDLINE databases were searched for primary sources of literature published between 1950 and 2009, using keywords: herbal medicine, medicinal plants, herbal, Valeriana officinalis, valerian, Humulus lupulus, hops, sleep, insomnia. Studies were included if they evaluated the efficacy of valerian or hops in improving primary insomnia in adults: sixteen studies met the inclusion criteria. Twelve of these found that the use of valerian, on its own, or in combination with hops, is associated with improvements in some sleep parameters (eg. sleep latency and quality of sleep). However, these results need to be interpreted cautiously as there were significant differences in design between the studies. Further randomised, double blind, placebo controlled trials are needed before such herbal treatments can be confidently recommended for the treatment of primary insomnia.

  4. Penile sparing surgical approaches for primary penile tumors: preserving function and appearance.

    Science.gov (United States)

    Baumgarten, Adam S; Fisher, John S; Lawindy, Samuel M; Pavlinec, Jonathan G; Carrion, Rafael E; Spiess, Philippe E

    2017-10-01

    Penile cancer is a rare and potentially disfiguring disease. There are multiple treatment options for primary penile lesions. Penile sparing approaches offer an attractive option as they can provide several quality of life benefits without detrimental oncologic outcomes. With appropriate diagnostic evaluation and staging, penile sparing techniques provide proper cancer control with improved cosmetic and functional results. Regardless of the chosen treatment modality, a commitment to close follow-up remains a critical component of all treatment considerations. The goal of this review is to provide an overview of the multiple treatment strategies for primary penile tumors with a focus on penile sparing surgical approaches.

  5. Clinical Practice Guidelines for the Medical and Surgical Management of Primary Intracerebral Hemorrhage in Korea

    Science.gov (United States)

    Kim, Jeong Eun; Kang, Hyun-Seung; Seo, Dae-Hee; Park, Sukh-Que; Sheen, Seung Hun; Park, Hyun Sun; Kang, Sung Don; Kim, Jae Min; Oh, Chang Wan; Hong, Keun-Sik; Yu, Kyung-Ho; Heo, Ji Hoe; Kwon, Sun-Uck; Bae, Hee-Joon; Lee, Byung-Chul; Yoon, Byung-Woo; Park, In Sung; Rha, Joung-Ho

    2014-01-01

    The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH. PMID:25368758

  6. Larynx preservation with primary non-surgical treatment for loco-regionally advanced larynx cancer

    International Nuclear Information System (INIS)

    Corry, June; Peters, Lester; D'Costa, Leta; Chua, Margaret; Peters, Lester J.; Vallance, Neil; Lyons, Bernard; Kleid, Stephen; Sizeland, Andrew

    2011-01-01

    Full text: The objective of this paper was to review the results of primary non-surgical treatment with the aim of larynx preservation for loco-regionally advanced larynx cancer (LALC). Methods: All patients with LALC presenti:lg between January 2002 and Decem ber 2006 who were selected for primary non-surgical treatment were included in this study. Results: There were 60 patients, 48% with stage III and 52% with stage IV disease. The median follow-up of living patients was 41 months. Larynx preservation with local disease control was achieved in 83% and 77% of patients at 3 and 5 years, respectively. Failure-free survival at 3 and 5 years was 66% and 59%, respectively, and overall survival was 67% and 45%, respectively. All patients with larynx preservation had a functional voice. Two patients became feeding tube dependant. Thirty-nine percent of all deaths were unrelated to LALC. Conclusions: Primary non-surgical treatment achieves high rates of larynx preservation with a low rate of severe complications but overall survival remains disappointing.

  7. Primary CNS lymphoma in a patient treated with azathioprine

    DEFF Research Database (Denmark)

    Glesner, Matilde Kanstrup; Ocias, Lukas Frans; Larsen, Thomas Stauffer

    2014-01-01

    with surrounding oedema. There was cerebrospinal fluid pleocytosis, and Epstein-Barr virus (EBV) DNA was detected in the spinal fluid by PCR. A brain biopsy confirmed the suspicion of primary brain lymphoma. EBV-associated primary brain lymphoma is a relevant differential diagnosis in patients with long......-standing immune suppression presenting with neurological symptoms. Detection of EBV DNA in the spinal fluid together with characteristic radiological findings may serve as a diagnostic clue for a quick diagnosis....

  8. Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

    OpenAIRE

    Wang, Rui; Bi, Chun-Chao; Lei, Chun-Ling; Sun, Wen-Tao; Wang, Shan-Shan; Dong, Xiao-Juan

    2014-01-01

    AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma, and discuss the multiple treating methods of operation combined with primary intraocular lens (IOL) implantation.METHODS:Non-comparative retrospective observational case series. Participants:30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Opht...

  9. SURGICAL OUTCOME OF LATE IN-THE-BAG INTRAOCULAR LENS DISLOCATION TREATED WITH PARS PLANA VITRECTOMY.

    Science.gov (United States)

    Rey, Amanda; Jürgens, Ignasi; Dyrda, Agnieszka; Maseras, Xavier; Morilla, Antonio

    2016-03-01

    To present the visual outcome and postoperative complications of pars plana vitrectomy and intraocular lenses (IOL) removal with or without IOL exchange of late in-the-bag IOL dislocation after uneventful cataract surgery. Retrospective analysis of a consecutive series of 83 eyes with late in-the-bag dislocated IOL treated with pars plana vitrectomy and anterior chamber IOL (25 eyes), transscleral suture-fixated posterior chamber IOL (38 eyes), or aphakia (20 eyes). High myopia was the major predisposing factor (40%). The interval between cataract surgery and the dislocation was 10.9 years. The complication rate after the second surgery was 43%; being transient hypotony (19%) and hypertension (15%) the most frequent. Postoperative best-corrected visual acuity improvement was statistically significant (P bag IOL dislocation is myopia. Despite a complication rate of 43%, mostly minor and transient, IOL exchange surgery is an effective procedure with a good visual outcome (mean 3 Snellen lines improvement). There were no statistically significant differences in the final best-corrected visual acuity or complication rate between anterior chamber IOL and sutured posterior chamber IOL, thus, both surgical techniques may be considered to treat this condition.

  10. Evaluation of Quality Metrics for Surgically Treated Laryngeal Squamous Cell Carcinoma.

    Science.gov (United States)

    Graboyes, Evan M; Townsend, Melanie E; Kallogjeri, Dorina; Piccirillo, Jay F; Nussenbaum, Brian

    2016-12-01

    for all patients (OS aHR, 0.51; 95% CI, 0.29-0.88; DFS aHR, 0.50, 95% CI, 0.32-0.80) and elective neck dissection yield of 18 lymph nodes or more (DFS aHR, 0.36; 95% CI, 0.14-0.99) were associated with improved survival on multivariable Cox proportional hazards analysis. In this cohort of patients with surgically treated laryngeal SCC, multidisciplinary evaluation and elective neck dissection yield of 18 lymph nodes or more are associated with improved survival. Development of better quality metrics is necessary because increased compliance with metrics described by the AHNS and NCCN is not associated with improved survival. Previously described metrics for surgically treated oral cavity cancer are not prognostic for surgically treated laryngeal SCC. Future multi-institutional collaboration will be required to validate these findings, develop better quality metrics, and evaluate whether quality metrics for head and neck cancer are site specific.

  11. Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology

    Science.gov (United States)

    Mukhopadhyay, Sanjay; Feldman, Michael D.; Abels, Esther; Ashfaq, Raheela; Beltaifa, Senda; Cacciabeve, Nicolas G.; Cathro, Helen P.; Cheng, Liang; Cooper, Kumarasen; Dickey, Glenn E.; Gill, Ryan M.; Heaton, Robert P.; Kerstens, René; Lindberg, Guy M.; Malhotra, Reenu K.; Mandell, James W.; Manlucu, Ellen D.; Mills, Anne M.; Mills, Stacey E.; Moskaluk, Christopher A.; Nelis, Mischa; Patil, Deepa T.; Przybycin, Christopher G.; Reynolds, Jordan P.; Rubin, Brian P.; Saboorian, Mohammad H.; Salicru, Mauricio; Samols, Mark A.; Sturgis, Charles D.; Turner, Kevin O.; Wick, Mark R.; Yoon, Ji Y.; Zhao, Po

    2018-01-01

    Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard. Cases were scanned, converted to WSI and randomized. Sixteen pathologists interpreted cases by microscopy or WSI, followed by a wash-out period of ≥4 weeks, after which cases were read by the same observers using the other modality. Major discordances were identified by an adjudication panel, and the differences between major discordance rates for both microscopy (against the reference standard) and WSI (against the reference standard) were calculated. A total of 1992 cases were included, resulting in 15,925 reads. The major discordance rate with the reference standard diagnosis was 4.9% for WSI and 4.6% for microscopy. The difference between major discordance rates for microscopy and WSI was 0.4% (95% confidence interval, −0.30% to 1.01%). The difference in major discordance rates for WSI and microscopy was highest in endocrine pathology (1.8%), neoplastic kidney pathology (1.5%), urinary bladder pathology (1.3%), and gynecologic pathology (1.2%). Detailed analysis of these cases revealed no instances where interpretation by WSI was consistently inaccurate compared with microscopy for multiple observers. We conclude that WSI is noninferior to microscopy for primary diagnosis in surgical pathology, including biopsies and resections stained with hematoxylin and eosin, immunohistochemistry and special stains. This conclusion is valid across a

  12. The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery.

    Science.gov (United States)

    Rutten, I J G; Ubachs, J; Kruitwagen, R F P M; van Dijk, D P J; Beets-Tan, R G H; Massuger, L F A G; Olde Damink, S W M; Van Gorp, T

    2017-04-01

    Sarcopenia, severe skeletal muscle loss, has been identified as a prognostic factor in various malignancies. This study aims to investigate whether sarcopenia is associated with overall survival (OS) and surgical complications in patients with advanced ovarian cancer undergoing primary debulking surgery (PDS). Ovarian cancer patients (n = 216) treated with PDS were enrolled retrospectively. Total skeletal muscle surface area was measured on axial computed tomography at the level of the third lumbar vertebra. Optimum stratification was used to find the optimal skeletal muscle index cut-off to define sarcopenia (≤38.73 cm 2 /m 2 ). Cox-regression and Kaplan-Meier analysis were used to analyse the relationship between sarcopenia and OS. The effect of sarcopenia on the development of major surgical complications was studied with logistic regression. Kaplan-Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia (p = 0.010). Sarcopenia univariably predicted OS (HR 1.536 (95% CI 1.105-2.134), p = 0.011) but was not significant in multivariable Cox-regression analysis (HR 1.362 (95% CI 0.968-1.916), p = 0.076). Significant predictors for OS in multivariable Cox-regression analysis were complete PDS, treatment in a specialised centre and the development of major complications. Sarcopenia was not predictive of major complications. Sarcopenia was not predictive of OS or major complications in ovarian cancer patients undergoing primary debulking surgery. However a strong trend towards a survival disadvantage for patients with sarcopenia was seen. Future prospective studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival. Complete cytoreduction remains the strongest predictor of ovarian cancer survival. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights

  13. Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment

    DEFF Research Database (Denmark)

    Eiken, P A; Prieto-Alhambra, D; Eastell, R

    2017-01-01

    . INTRODUCTION: ONJ is a rare event in users of oral bisphosphonates. Our aims were to evaluate if the risk of surgically treated ONJ increases with longer or more compliant treatment with alendronate for osteoporosis and to identify risk factors for surgically treated ONJ. METHODS: Open nationwide register......-based cohort study containing one nested case-control study. Patients were treatment-naïve incident users of alendronate 1996-2007 in Denmark, both genders, aged 50-94 at the time of beginning treatment (N = 61,990). Participants were followed to 31 December 2013. RESULTS: Over a mean of 6.8 years, 107...

  14. Analysis of CT and MRI investigations of patients with lumbar discopathy treated conservatively or surgically

    International Nuclear Information System (INIS)

    Radziszewski, K.

    2007-01-01

    Imaging investigations (radiculography, X-ray, CT, MRI) constitute an integral part of the therapeutic process in the treatment of patients suffering from lumbar discopathy. The results obtained with the imaging techniques provide the crucial data concerning the stage of disease development; assist the choice of optimal therapy method and the evaluation of the therapeutic actions efficiency. The aim of the study was to analyze the results of CT and MRI investigations carried out on patients suffering from lumbar discopathy, who had been treated with conservative or surgical methods. 665 patients aged between 16 and 76 years with discopathy at L4-L5, L5-S1 levels were enrolled to the study. In the analyzed group, 348 patients received only conservative therapy whereas 317 patients underwent surgical procedures. CT and MRI investigations were applied at the beginning of the observation (W), after three years (III) and after ten years (X) since the operation (or exclusively conservative treatment). The results obtained with imaging techniques were divided into three categories: intradiscal, peridiscal and disc-related changes caused by herniation of vertebral discs. During the subsequent periods of inspection, the rising number of degenerative changes was found. The progression of the imaging technique results concerned both the L4-L5, L5-S1 spaces, which showed distortion initially, and the L3-L4, L2-L3 levels, which were not degenerated in the preliminary examination. The remote examination showed that the number of degenerations in the two examined groups was substantially higher than it had been during the preliminary examination. The total number of degenerative changes among the patients operated on was higher than among the patients in conservative treatment. The number of degenerative changes of the spine grows from level L2-L3 to level L5-S1. The stage of spinal degenerative changes rises along with the duration of the disease. The patients operated on show

  15. Application of surgical navigation in styloidectomy for treating Eagle’s syndrome

    Directory of Open Access Journals (Sweden)

    Dou G

    2016-04-01

    traditional styloidectomy. The visual analog scale analysis showed that the discomfort in all patients was relieved, while ten patients’ symptoms were improved greatly, and two patients had some improvement.Conclusion: The higher accuracy of surgery, lesser amount of bleeding, decreased duration of surgery and hospitalization, absence of complications, and improved subjective symptoms indicated that SN is an effective and minimally invasive surgical procedure suitable for resection of ESP for treating Eagle’s syndrome. Keywords: elongation of styloid process, intraoperative navigation, oral and maxillofacial surgery, computer-aided surgery

  16. Assessment with Oswestry disability index in surgically treated patients with lumbar spondylolisthesis: experience in 96 patients.

    Science.gov (United States)

    Pasha, Ibrahim Farooq; Qureshi, Muhammad Asad; Farooq, Maheen; Talha, Muhammed; Ahmed, Naveed; Ismail, Junaid

    2015-11-01

    To assess the outcome of surgical treatment in spondylolisthesis of lumbosacral region using Oswestry disability Index. The quasi-experimental study was conducted at the Combined Military Hospital, Rawalpindi from 2006 to 2013 and comprised surgically treated patients with spondylolisthesis. The patients with degenerative and isthmic types with follow-up of at least two years were included. A performa was designed for each patient and records were kept in a custom-built database. Oswestry disability index was used as the assessment tool and assessment was done pre-operatively, at 1, 3 and 6 months and then at 1 year and 2 years. There were 96 patients with mean pre-op Oswestry disability index score of 81.06% (range 42.22-100, SD ±11.99). L5-S1 was affected in 44 (45.83%) patients, L4-L5 in 30 (31.25%), L4-5-S1 in 7 (7.29%) and multi or high level was found in the rest of the cases. One level was involved in 77 (80.2%), 2 in 11 (11.45%), 3 in 7 (7.29%) and 4 in 1 (1.04%). The slip grade as per Meyerding grades was 1 in 31 (32.29%), II in 39 (40.62%), III in 19 (19.79%), IV in 5 (5.2%) and 2 (2.08%) had spondyloptosis. Mean follow-up was 42 months (range 24-63). Mean Oswestry disability score at 1 month was 38.51% (range 11- 62.22%, SD ±11.75); at 6 months 10.02% (range 0-40%, SD ±6.99); at 1 year 4.62% (range 0-24%, SD ±5.36) and at 2 years 4.21% (range 0-15%, SD ±4.2). Surgical treatment of spondylolisthesis gives excellent long-term result in most patients.

  17. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle.

    Science.gov (United States)

    Lenza, Mário; Faloppa, Flávio

    2015-05-07

    This review covers two conditions: acute clavicle fractures and non-union resulting from failed fracture healing. Clavicle (collarbone) fractures account for around 4% of all fractures. While treatment for these fractures is usually non-surgical, some types of clavicular fractures, as well as non-union of the middle third of the clavicle, are often treated surgically. This is an update of a Cochrane review first published in 2009. To evaluate the effects (benefits and harms) of different methods of surgical treatment for acute fracture or non-union of the middle third of the clavicle. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (27 June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 5), MEDLINE (1966 to June week 3 2014), EMBASE (1988 to 2014 week 25), LILACS (1982 to 27 June 2014), trial registries and reference lists of articles. We applied no language or publication restrictions. We considered randomised and quasi-randomised controlled trials evaluating any surgical intervention for treating people with fractures or non-union of the middle third of the clavicle. The primary outcomes were shoulder function or disability, pain and treatment failure (measured by the number of participants who had undergone or were being considered for a non-routine secondary surgical intervention for symptomatic non-union, malunion or other complications). Two review authors selected eligible trials, independently assessed risk of bias and cross-checked data. Where appropriate, we pooled results of comparable trials. We included seven trials in this review with 398 participants. Four trials were new in this update.The four new trials (160 participants) compared intramedullary fixation with open reduction and internal fixation with plate for treating acute middle third clavicle fractures in adults. Low quality evidence from the four trials indicated that intramedullary fixation did not

  18. Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre.

    Science.gov (United States)

    Barrera-Ochoa, S; Haddad, S; Rodríguez-Alabau, S; Teixidor, J; Tomás, J; Molero, V

    To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. A case of lipoma of lateral anterior neck treated with surgical enucleation

    Directory of Open Access Journals (Sweden)

    Francesco Grecchi

    2012-01-01

    Full Text Available Lipoma arise in almost 50% of all soft tumours. The neck lipomas are rare tumours that may present as painless masses with slow growth, in the lateral portions of the neck. Some lipomas, such as the one studied in our case, grow deep in the subcutaneous tissue, in close contact with muscles. Here, we report a case of lipoma extending from pre-tragal region up to the ascending branch of the mandible in a 62 year old man, treated with enucleation. The inferior margin of lipoma involved the pharyngeal and the superior margin was achieved by the top of the skull base. The mass of lipoma caused breathing difficulties in the patient, preventing regular sleep. No complication was recorded in the post-operative period and no further surgery was performed. The complete resolution after one year′s follow-up, together with the rarity of the anatomical site, makes this case worthy of description. A correct diagnosis facilitated removal of this lesion with a surgical method.

  20. A case report of primary necrotising fasciitis of the breast: A rare but deadly entity requiring rapid surgical management

    Directory of Open Access Journals (Sweden)

    Kimberley Fayman

    2017-01-01

    Conclusion: This is the youngest patient with primary necrotising fasciitis of the breast described in the literature. Prompt resuscitation and an aggressive surgical approach are critical to the successful management of this life threatening pathology.

  1. The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery

    NARCIS (Netherlands)

    Rutten, I.J.; Ubachs, J.; Kruitwagen, R.F.P.M.; Dijk, D.P. van; Beets-Tan, R.G.; Massuger, L.F.A.G.; Oude Damink, S.W.; Gorp, T. Van

    2017-01-01

    BACKGROUND: Sarcopenia, severe skeletal muscle loss, has been identified as a prognostic factor in various malignancies. This study aims to investigate whether sarcopenia is associated with overall survival (OS) and surgical complications in patients with advanced ovarian cancer undergoing primary

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

    DEFF Research Database (Denmark)

    Duch, Patricia; Møller, Morten Hylander

    2015-01-01

    INTRODUCTION: The aim of the present nationwide Danish cohort study was to examine the association between body mass index (BMI) and reoperation in patients who are sur-gically treated for perforated peptic ulcer (PPU). METHODS: This was a nationwide cohort study of all Danish patients who were...

  3. A Young, Immunocompetent Woman with Small Bowel and Hepatic Mucormycosis Successfully Treated with Aggressive Surgical Debridements and Antifungal Therapy

    Directory of Open Access Journals (Sweden)

    Daniel Vikum

    2017-01-01

    Full Text Available A 24-year-old woman with coeliac disease and transient neutropenia developed mucormycosis with extensive involvement of the liver and small intestine. She was successfully treated with aggressive surgical debridements and long-term antifungal therapy with liposomal amphotericin B and posaconazole.

  4. Retrospective analysis of 27 cases of bisphosphonate-related osteonecrosis of the jaw treated surgically or nonsurgically

    Directory of Open Access Journals (Sweden)

    Shin-Yu Lu

    2014-06-01

    Conclusion: Our study demonstrates a high success rate of conservative and surgical treatment of BRONJ. This is the first reported use of GBR to successfully treat oral BPh-related osteonecrosis of the jaw. Irrigation with antimicrobial rinses may result in pain reduction, and regression or even resolution of BRONJ.

  5. [Surgical resection of primary soft-tissue sarcoma of the extremities].

    Science.gov (United States)

    Kolarz, K; Treder, M; Lorczyński, A

    2001-01-01

    We evaluated 5 patients who had soft tissue sarcoma of the extremity treated by limb sparing surgery. All tumors were adjacent to bone, with no features of infiltration. According to the Surgical Staging System, all tumors were IIB. The mean follow-up was 13 months. To achieve wide resections of the tumors in such cases we recommend resections of the tumor with part of the bone, which is in direct contact with the tumor. Wide resection margins were achieved in all patients and none had local recurrence during the observation period.

  6. Single Positive Lymph Node Prostate Cancer Can Be Treated Surgically without Recurrence.

    Directory of Open Access Journals (Sweden)

    Dae Keun Kim

    Full Text Available To investigate pN1 prostate cancer (PCa patients treated surgically without immediate adjuvant treatment.We analyzed the database of 2316 patients at our institution who underwent robot-assisted radical prostatectomy (RARP/radical prostatectomy (RP between July 2005 and November 2012. 87 patients with pN1 PCa and received no neoadjuvant and immediate adjuvant therapy were included in the study. Included pN1 PCa patients were followed up for median of 60 months. Biochemical recurrence (BCR-free survival, metastasis-free survival (MFS, cancer specific survival (CSS, and overall survival (OS rates were determined by using Kaplan-Meier analysis. Cox regression analysis was performed to investigate the impact of prostate-specific antigen (PSA level, Gleason score, extraprostatic extension, seminal vesicle invasion, perineural invasion, lymphovascular invasion, positive surgical margin, tumor volume, early post-operative PSA(6 weeks, PSA nadir, lymph node yield, and number of pathologically positive lymph nodes on survival.The 5-year OS rate of patients was 86.1%, while the CSS rate was 89.6%. The metastasis-free and BCR-free survival rates were 71% and 19.1%, respectively, and each was significantly correlated with the number of positive lymph nodes on log rank tests (p = 0.004 and p = 0.039, respectively. The presence of 2 or more pathologically positive LNs (HR:2.20; 95% CI 1.30-3.72; p = 0.003 and a Gleason score ≥8 (HR: 2.40;95% CI: 1.32-4.38; p = 0.04 were significant negative predictors of BCR free survival on multivariable regression analysis. Furthermore, the presence of 2 or more positive lymph nodes (HR: 1.06; 95% CI 1.01-1.11; p = 0.029 were significant negative predictors of metastasis-free survival on multivariable regression analysis. Additionally, in the patients who had no BCR without adjuvant treatment 9 patients out of 10 (90% had single positive LN and 5 patients out of 10 (50% had Gleason score 7. Therefore, single positive LN

  7. Post-surgical follow-up of primary hyperparathyroidism associated with multiple endocrine neoplasia type 1

    Directory of Open Access Journals (Sweden)

    Flavia L. Coutinho

    2012-01-01

    Full Text Available The bone mineral density increments in patients with sporadic primary hyperparathyroidism after parathyroidectomy have been studied by several investigators, but few have investigated this topic in primary hyperparathyroidism associated with multiple endocrine neoplasia type 1. Further, as far as we know, only two studies have consistently evaluated bone mineral density values after parathyroidectomy in cases of primary hyperparathyroidism associated with multiple endocrine neoplasia type 1. Here we revised the impact of parathyroidectomy (particularly total parathyroidectomy followed by autologous parathyroid implant into the forearm on bone mineral density values in patients with primary hyperparathyroidism associated with multiple endocrine neoplasia type 1. Significant increases in bone mineral density in the lumbar spine and femoral neck values were found, although no short-term (15 months improvement in bone mineral density at the proximal third of the distal radius was observed. Additionally, short-term and medium-term calcium and parathyroid hormone values after parathyroidectomy in patients with primary hyperparathyroidism associated with multiple endocrine neoplasia type 1 are discussed. In most cases, this surgical approach was able to restore normal calcium/parathyroid hormone levels and ultimately lead to discontinuation of calcium and calcitriol supplementation.

  8. Surgical approach to primary tumors of the chest wall in children and adolescents: 30 years of mono-institutional experience.

    Science.gov (United States)

    Girelli, Lara; Luksch, Roberto; Podda, Marta G; Meazza, Cristina; Puma, Nadia; Scanagatta, Paolo; Pecori, Emilia; Diletto, Barbara; Galeone, Carlotta; Massimino, Maura; Pastorino, Ugo

    2016-01-01

    Chest wall reconstruction after surgical resection for malignancies in children is a challenge for surgeons because of growth-related complications. The aim of this study is to analyze the surgical treatment and outcomes of 30 pediatric and adolescent patients treated at Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, over a 30-year period. Pediatric patients undergoing chest wall resection were retrospectively reviewed and selected for malignant primary tumor. Endpoints were survival, recurrences, and long-term results. We also reported the use of the innovative rib-like technique in 2 young patients. Twenty-one patients were male. Median age was 13.7 years. Eleven patients (37%) presented with a chest wall mass. Twenty-six (87%) had Ewing sarcoma family tumors. Twenty-eight (94%) received neoadjuvant chemotherapy after histologic diagnosis. One rib was resected in 13 cases; 2 or 3 contiguous ribs in 8 cases. No postoperative mortality was observed and the complication rate was 40%. Overall survival was 85.2% (95% confidence interval [CI] 65.2%-94.2%) at 5 and 10 years. Relapse occurred in 7 patients. The 5-year disease-free survival rate was 82% (95% CI 62%-92%). Long-term survival is achievable for chest wall tumors in a high-volume referral center where a multimodal treatment should be set to reach the best result. As advances in medical treatment have increased survival, surgical techniques must ensure a lasting functional result. When refining the reconstruction techniques, such as the rib-like approach, it is necessary to expand the options of curative surgery for young patients.

  9. Effects of Treating Primary Aldosteronism on Renal Function.

    Science.gov (United States)

    Kramers, Bart J; Kramers, Cornelis; Lenders, Jacques W M; Deinum, Jaap

    2017-03-01

    Longstanding primary aldosteronism (PA) has deleterious effects on renal function, often masked until treatment (adrenalectomy or spironolactone) is initiated. It has been suggested that PA causes relative glomerular hyperfiltration, explaining the decline in estimated glomerular filtration rate (eGFR) after treatment. In this retrospective study, the authors retrieved the clinical characteristics and eGFR of 134 PA patients before and 6 months after treatment. Using multiple regression analysis, the predictors for eGFR decline and the predictors of ultimately attained renal function in 113 patients was assessed. eGFR declined by 15.3±14.2 (range 19-63) mL/min, independent predictors were pretreatment plasma aldosterone, eGFR, plasma renin, and plasma potassium. Independent predictors of ultimately attained eGFR after treatment were pretreatment plasma aldosterone, age, eGFR, and plasma potassium. Our findings lend support to the hypothesis that higher aldosterone levels cause relative glomerular hyperfiltration. The severity of pretreatment aldosterone excess is the most important risk factor for renal function decline. ©2016 Wiley Periodicals, Inc.

  10. Surgical versus conservative treatment of primary patellar dislocation. A systematic review and meta-analysis.

    Science.gov (United States)

    Saccomanno, Maristella F; Sircana, Giuseppe; Fodale, Mario; Donati, Fabrizio; Milano, Giuseppe

    2016-11-01

    The purpose of this study was to determine the efficacy of surgical and conservative treatment in the prevention of recurrence after primary patellar dislocation. Studies were searched on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINHAL from their inception to April 2015. All randomized controlled clinical trials comparing surgical versus conservative treatment after first patellar dislocation were included. Primary outcomes were: recurrent dislocation, subluxation, overall instability and subsequent surgery. Secondary outcomes included imaging, and subjective and objective clinical assessment tools. Methodological quality of the studies was assessed using Cochrane Collaboration's "Risk of Bias" tool. Pooled analyses were reported as risk ratio (RR) using a random effects model. Continuous data were reported as standardized mean difference (SMD) and 95 % confidence intervals (CIs). Heterogeneity was assessed using I². Nine studies were included in the meta-analyses. Methodological quality of the studies was moderate to low. Meta-analyses showed that surgical treatment significantly reduces the redislocation rate (RR = 0.62; 95% CI = 0.39, 0.98, p = 0.04) and provides better results on Hughston VAS score (SMD = -0.32; 95% CI = -0.61, -0.03; p = 0.03) and running (OR = -0.52; 95% CI = 0.31, 0.88; p = 0.01). Conservative treatment showed less occurrence of minor complications (OR = 3.46; 95% CI = 2.08, 5.77; p = 0.01) and better results in the figure-of-8 run test (SMD = 0.42; 95% CI = 0.06, 0.77; p = 0.02) and in the squat down test (SMD = -0.45; 95% CI = -0.81, -0.10; p < 0.00001). No other significant differences could be found. Based on the available data, surgical treatment of primary patella dislocation significantly reduces the risk of patella redislocation.

  11. A method for establishing human primary gastric epithelial cell culture from fresh surgical gastric tissues.

    Science.gov (United States)

    Aziz, Faisal; Yang, Xuesong; Wen, Qingping; Yan, Qiu

    2015-08-01

    At present, biopsy specimens, cancer cell lines and tissues obtained by gastric surgery are used in the study and analysis of gastric cancer, including the molecular mechanisms and proteomics. However, fibroblasts and other tissue components may interfere with these techniques. Therefore, the present study aimed to develop a procedure for the isolation of viable human gastric epithelial cells from gastric surgical tissues. A method was developed to culture human gastric epithelial cells using fresh, surgically excised tissues and was evaluated using immunocytochemistry, periodic acid-Schiff (PAS) staining and cell viability assays. Low cell growth was observed surrounding the gastric tissue on the seventh day of tissue explant culture. Cell growth subsequently increased, and at 12 days post-explant a high number of pure epithelial cells were detected. The gastric cancer cells exhibited rapid growth with a doubling time of 13-52 h, as compared to normal cells, which had a doubling time of 20-53 h. Immunocytochemical analyses of primary gastric cells revealed positive staining for cytokeratin 18 and 19, which indicated that the culture was comprised of pure epithelial cells and contained no fibroblasts. Furthermore, PAS staining demonstrated that the cultured gastric cells produced neutral mucin. Granulin and carbohydrate antigen 724 staining confirmed the purity of gastric cancer and normal cells in culture. This method of cell culture indicated that the gastric cells in primary culture consisted of mucin-secreting gastric epithelial cells, which may be useful for the study of gastric infection with Helicobacter pylori and gastric cancer.

  12. Surgical management of secondary hyperparathyroidism: how to effectively reduce recurrence at the time of primary surgery.

    Science.gov (United States)

    Xu, D; Yin, Y; Hou, L; Dai, W

    2016-05-01

    Successful parathyroidectomy (PTX) often results in a dramatic drop in the parathyroid hormone (PTH) levels, relieves the patient from clinical symptoms, and reduces mortality. Although PTX is generally a successful treatment for progressive secondary hyperparathyroidism (SHPT) patients subjected to surgery, a significant proportion develops recurrent SHPT following PTX. SHPT requiring PTX occurs more commonly in progressive chronic kidney disease and in long-term lithium therapy. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages, and disadvantages. Although PTX offers the highest percentage cure for SHPT, compared to all other medical and surgical treatment, recurrent hyperparathyroidism can be observed in some patients dependent on follow-up time. A literature review and analysis of recent data regarding how to reduce recurrence of SHPT at the time of primary surgery was performed. The current literature and our own experience in the field have confirmed that pre-operative imaging, thymectomy, stereo magnifier, and surgical procedure may effectively reduce recurrence of SHPT at the time of primary surgery.

  13. Clinical and mammographic profile of patients with breast cancer surgically treated

    Directory of Open Access Journals (Sweden)

    Raquel Rodrigues Muradas

    2015-06-01

    Full Text Available Summary Objective: to analyze the epidemiological, clinical and mammographic profile of women with breast cancer who were treated at the mastology clinic of the University Hospital of Santa Maria and who underwent breast surgery between January 2007 and December 2012. Methods: this was a cross-sectional study, approved by the Ethics in Research Committee. A review of the patients' medical records was performed. The data were then exported to a software program for statistical analysis, namely Minitab 14.1. Results: the patients' profile indicated that they were mostly born and raised in Santa Maria (respectively 11.1%, n=16, and 26.3%, n=68. They were about 55.6 years old (SD±12.3, white (90.2%, n=213, had already given birth and breastfed their children, were nonsmokers, but also overweight (average BMI of 27kg/m2. On physical examination of the first medical consultation, these patients, as described in the records: had a palpable mass (81.1%, n=184 measuring over three centimeters, located in the left breast, precisely in the upper outer quadrant (41.4%, n=81. Mammography (39%, n=109 showed that this lump was classified as BIRADS ® 5 (40%, n=81. On histopathological examination, the lump was diagnosed as an invasive ductal cancer (71.1%, n=191. Surgery was generally a radical mastectomy (84.7%, n=236 with axillary dissection (92.5%, n=222. Conclusion: some of the epidemiological, clinical and mammographic features mentioned above resembled those found in the literature reviewed. However, these patients had advanced disease and underwent non conservative surgical procedures.

  14. Extracapsular extension is a poor predictor of disease recurrence in surgically treated oropharyngeal squamous cell carcinoma.

    Science.gov (United States)

    Lewis, James S; Carpenter, Danielle H; Thorstad, Wade L; Zhang, Qin; Haughey, Bruce H

    2011-11-01

    Extracapsular extension in squamous cell carcinoma nodal metastases usually predicts worse outcome. However, there are no standard histologic grading criteria for extracapsular extension, and there have been few studies on oropharyngeal squamous cell carcinoma alone. We studied the extent of extracapsular extension utilizing a novel grading system and correlated grades with outcomes while controlling for p16 status. A cohort of surgically treated oropharyngeal squamous cell carcinoma cases were reviewed and metastases graded as 0 (within substance of node), 1 (filling subcapsular sinus with thickened capsule/pseudocapsule, but no irregular peripheral extension), 2 (≤1 mm beyond capsule), 3 (>1 mm beyond capsule), or 4 (no residual nodal tissue or architecture; 'soft tissue metastasis'). There were 101 cases, for which p16 was positive in 90 (89%). Extracapsular extension grades did not correlate with nodal size (P=0.28) or p16 status (P=0.8). In follow up, 10 patients (10%) had disease recurrence with only 3 of 64 (5%) grade 0-3 cases and 7 of 37 (19%) with grade 4 recurring (P=0.04). Grade 4 extracapsular extension was associated with poorer survival (PP=0.02), and in multivariate analysis, was not significantly associated with poorer overall (P=0.14) disease-free (P=0.2), or disease-specific survival (P=0.09). The impact of extracapsular extension in nodal metastases is limited in oropharyngeal squamous cell carcinoma. Only extracapsular extension grade 4 associates with poorer outcomes, but not independently of T-stage and other variables.

  15. Central Nervous System Birth Defects in Surgically Treated Infants in Sarajevo Region of Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Selma Aličelebić

    2007-11-01

    Full Text Available Congenital anomalies of the central nervous system (CNS are common. The prevalence of these anomalies shows considerable geographical variation and female predominance. The aim of this work was to obtain the frequency of different CNS congenital anomalies types and their sex distribution among cases hospitalized in a Department of Neurosurgery, University of Sarajevo Clinics Center, Bosnia and Herzegovina, during the period January 2001 to December 2004. Retrospective study was carried out on the basis of the clinical records. Standard methods of descriptive statistics were performed for the data analysis. A total of 103 cases were surgically treated in the period from 2001 through 2004. Out of that number 56 (54,4% were female patients, while 47 (46,6% were male patients. Seven different CNS birth defect types were found in this investigation. These were: spina bifida (42 cases or 40,78%, congenital hydrocephalus (35 cases or 33,98%, arachnoid cyst (15 cases or 14,56%, Dandy-Walker syndrome (5 cases or 4,85%, dermoid cyst (4 cases or 3,88%, one of Arnold-Chiari syndrome (0,98% and one of encefalocele (0,98%. According to this investigation, CNS congenital birth defects were slightly higher in females (54,4%. The most frequent types were spina bifida (40,78% both in females (22,33% and in males (18,45%, hydrocephalus (33,98% and arachnoid cyst (14,56%. The anomalies of the other organ systems, associated with CNS anomalies obtained in this investigation, were pes equinovarus, cheiloshisis, cardiomegalia and palatoshisis. They were found in six cases (5,82%, equal in both sexes.

  16. Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way?

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the decision of orthopedics surgeons regarding which cases they would indicate surgery or non-surgical treatment. METHODS: 20 images of radiographs with fracture in the middle third of the collar bone (AO/OTA 15-B in anteroposterior view were analyzed, and divided into four groups: group 1 - fracture type AO/OTA 15-B1 without displacement; group 2 - fracture type AO/OTA 15-B1 with displacement; group 3 - fracture type AO/OTA 15-B2; group 4 - fracture type AO/OTA 15-B3. The evaluator was requested to indicate the choice of treatment, surgical or non-surgical. RESULTS: There was no strong correlation between the amount of surgical indications and the working experience or age of the medical evaluator. It was observed that the average of surgical indications in the total sample was 52%. When indications were studied in different areas of Brazil, there was no significant difference among them. No pattern for the Brazilian regions studied was observed in the case analysis. Even within a group (cases of the same complexity, no specific pattern of surgical indication was observed. CONCLUSION: No association between surgical indication and the length of professional experience was found. The Southern and Southeastern regions were those that most recommended surgeries in groups 2, 3, and 4. In no region the same level of surgical indication for cases of the same complexity rate was kept.

  17. [Esophageal perforation: analysis of seven cases treated by early surgical treatment with good functional results].

    Science.gov (United States)

    Sanna, Stefano; Taurchini, Marco; Mengozzi, Marta; Monteverde, Marco; Argnani, Desiderio; Dell'Amore, Davide

    2006-01-01

    Esophageal perforation has been considered a catastrophic and often life-threatening event, with very high mortality rates. Most of the cases are due to a complication in endoscopic manouvers and the best treatment, conservative rather than aggressive, remains a controversial topic. In 1995-2005 period we observed 7 cases of esophageal perforation, 5 women and 2 men mean age 73.2 y (range 60-87). Three cases are due to foreign body ingestion, 2 cases to endoscopic manoeuvres, 2 cases were spontaneous. In 3 cases the lesion was in the cervical tract of the esophagus, in the thoracic tract the others. All the patients were admitted very early to our Unit and presented disphagia, vomiting and dyspnoea, 2 out of them also a pleural effusion. In iatrogenic perforation we performed a cervicotomy and a drainage of mediastinic abscess, while in spontaneous lesions mono (one case) or bipolar esophageal exclusion (one case) with primary suture, jujunostomy and drainage of pleural effusion were the treatment. In foreign body perforation we performed thoracotomic and cervicotomic esophagotomy, extraction of the foreign body, direct suture with pleural or muscle protection. We didn't observe any intra or post-operative mortality. About the complications, we observed a bilateral pleural empyema, a chylous fistula, a digestive bleeding due to gastric ulcer, a laparotomic infection, a parossistic FA and a persistent esophageal fistula. Mean hospital stay was 24.3 days (range 10-43). All the patients were discharged to the hospital in good conditions. In conclusion in most of the cases of esophageal perforation the surgical treatment is the treatment of choice for its lower morbidity and mortality and good functional results.

  18. "PRIMARY PALLIATIVE CARE? - Treating terminally ill cancer patients in the primary care sector"

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Jensen, AB; Olesen, Frede

    that is vital to further improve palliative care in the primary sector.AIM. The aim of the study was to analyse the quality of palliative home care with focus on the GP's role based on evaluations by relatives of recently deceased cancer patients and professionals from both the primary and secondary health care...... sectors.METHOD. A number of focus group interviews were conducted with three types of subgroups: 1) Bereaved relatives, 2) GPs and 3) Various health-care-professionals, namely community nurses, hospital physicians and GPs. The interviews were transcribed and analysed according to a phenomenological......) The primary sector needs easy access to specialist advise, supervision and empowerment. 4) Better and easier communication pathways are important, both within the primary sector and across the sectors to improve accessibility.CONCLUSION. Our study shows a need for improvements in palliative home care...

  19. Idiopathic pulmonary artery aneurysm treated with surgical correction and concomitant coronary artery bypass grafting.

    Science.gov (United States)

    Arnaoutakis, George; Nwakanma, Lois; Conte, John

    2009-07-01

    Idiopathic pulmonary artery aneurysm is a rare clinical entity, and therefore the natural course and clinical management are not well established. We present the case of an elderly woman with a symptomatic idiopathic pulmonary artery aneurysm who underwent surgical repair along with simultaneous coronary artery bypass grafting. With long-term follow-up presented in this report, we describe the safety and durability of surgical repair.

  20. Urinary System Birth Defects in Surgically Treated Infants in Sarajevo Region of Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Selma Aličelebić

    2008-05-01

    Full Text Available Congenital anomalies of the urinary system are relatively common anomalies. In Bosnia and Herzegovina there is no existent unique evidence of congenital anomalies and registries. The aim of this study was to obtain the frequency of different urinary tract anomalies types and their sex distribution among cases hospitalized in the Department of Pediatric Surgery of the University of Sarajevo Clinics Centre, Bosnia and Herzegovina, during the period from January 2002 to December 2006. Retrospective study was carried out on the basis of clinical records. Standard methods of descriptive statistics were performed for the data analysis. Among 289 patients that were surgically treated 62,37% of the patients were male patients, while 37,63% were female patients. Twenty nine different urinary system anomalies types were found in this study. These were: vesicoureteral reflux (99 cases or 30,75%, hypospadias (62 cases or 19,26%, pelviureteric junction obstruction (42 cases or 13,04%, megaureter (35 cases or 10,87%, duplex pelvis and ureter (16 cases or 4,97%, bladder diverticulum (8 cases or 2,48%, ureterocoele (7 cases or 2,17%, stenosis of the external urethral opening (6 cases or 1,86%, ectopic kidney, duplex kidney and pelvis (each 5 cases or 1,55%, polycystic kidneys and urethral stricture (each 4 cases or 1,24%, multicystic kidney (3 cases or 0,93%, kidney agenesis, ureter agenesis, urethral diverticulum, ectopic ureter, horseshoe kidney and fetal kidney (each 2 cases or 0,62%, renal aplasia, urethral atresia, renal cyst, urachal cyst, epispadias, bladder exstrophy, renal hypoplasia, renal malrotation and Prune-Belly syndrome (each 1 case or 0,31%. According to this study, urinary tract anomalies were more common in male than in female patients (62,37%, Generally, the most frequent anomaly type was vesicoureteral reflux in total number of 99 cases, and in females (66 cases, but hypospadias was the most common anomaly in males (62 cases. The anomalies

  1. The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

    Directory of Open Access Journals (Sweden)

    Kaykhosro Mardanpour

    2011-07-01

    Full Text Available Background:Unstable Pelvic fracture,a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation. Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67. Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%. There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months. About 81.6% of patients had either good or excellent radiological reduction. Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fracture Conclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general ndition of the patient permits, and

  2. Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?

    Energy Technology Data Exchange (ETDEWEB)

    Iervolino, Leticia; Scalisse, Nilza Maria; Maeda, Sergio Setsuo, E-mail: leiervolino@hotmail.com [Discipline of Endocrinology, Department of Medicine, Faculdade de Medicina da Santa Casa de Sao Paulo (FMSCSP), Sao Paulo, SP (Brazil)

    2012-06-15

    Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia in outpatients. It is more common in females, after menopause, and the prevalence is 1 to 4:1000 in the general population. Patients with PHPT have abnormal regulation of PTH secretion, resulting in elevated serum calcium and inappropriately high or normal PTH in relation to the calcium value. Sporadic PTH-secreting adenoma alone accounts for 90% of cases of PHPT, while multiglandular hyperplasia is more common in familial hyperparathyroidism syndromes (5%) and parathyroid carcinomas represent less than 1% of cases. Only after making sure there is functional autonomy of one or more parathyroid glands, localization imaging tests should be performed to guide a possible surgical procedure. It is important to highlight that these tests have limitations and can yield false-positive and false-negative results. There are cases in which the parathyroid gland is difficult to be located, requiring a combination of imaging methods for pre-operative localization, such as {sup 99m}Tc-pertechnetate, SPECT, SPECT/CT, and US. We describe the case of a 50-year-old female patient diagnosed with PHPT, who underwent a surgical procedure without success, with maintenance of hypercalcaemia and hyperparathyroidism. In this case, the hyper functioning parathyroid was located in the retrotracheal region only after scintigraphy combined with SPECT/CT were used. (author)

  3. [Primary Neuroendocrine Carcinoma of Thymus Caused Cushing Syndrome: Surgical Treatment and Prognosis Analysis].

    Science.gov (United States)

    Li, Li; Chen, Yeye; Li, Shanqing; Liu, Hongsheng; Huang, Cheng; Qin, Yingzhi

    2015-07-01

    Primary neuroendocrine carcinoma of thymus (pNECT) is a rare thymic neoplasm. Some pNECTs could produce an adrenocorticotropic hormone and cause Cushing syndrome (CS). The aim os this study is to discuss the diagnostic technique and surgical management of pNECT-caused CS and analyze prognosis factors to improve the clinical experience of the disease. The outcome of surgery and follow-up of 14 cases (eight males and six females) of pNECT-caused CS were retrospectively analyzed from November 1987 to June 2013. The median age of the patients was 29, and the median duration of the disease was four months (1 month-44 months). All cases exhibited clinical evidence for the diagnosis of CS, and thoracic computed tomography (CT) was used to detect thymic tumors. Surgical treatment significantly decreased the concentration of both serum cortisol and adrenocorticotropic hormone (Pdisease with aggressive characteristics and unclear prognosis. Early diagnosis and therapy is a challenge for clinicians. Thoracic CT is important for disease location and preoperative evaluation and should be routinely applied to all CS patients to allow early surgery and improved prognosis.

  4. Primary Neuroendocrine Carcinoma of Thymus Caused Cushing Syndrome: 
Surgical Treatment and Prognosis Analysis

    Directory of Open Access Journals (Sweden)

    Li LI

    2015-07-01

    Full Text Available Background and objective Primary neuroendocrine carcinoma of thymus (pNECT is a rare thymic neoplasm. Some pNECTs could produce an adrenocorticotropic hormone and cause Cushing syndrome (CS. The aim os this study is to discuss the diagnostic technique and surgical management of pNECT-caused CS and analyze prognosis factors to improve the clinical experience of the disease. Methods The outcome of surgery and follow-up of 14 cases (eight males and six females of pNECT-caused CS were retrospectively analyzed from November 1987 to June 2013. Result The median age of the patients was 29, and the median duration of the disease was four months (1 month-44 months. All cases exhibited clinical evidence for the diagnosis of CS, and thoracic computed tomography (CT was used to detect thymic tumors. Surgical treatment significantly decreased the concentration of both serum cortisol and adrenocorticotropic hormone (P<0.01 but caused one death in the perioperative period. With multidisciplinary therapy, the median survival was 38 months. Conclusion pNECT-caused CS is a rare disease with aggressive characteristics and unclear prognosis. Early diagnosis and therapy is a challenge for clinicians. Thoracic CT is important for disease location and preoperative evaluation and should be routinely applied to all CS patients to allow early surgery and improved prognosis.

  5. Clinical Outcomes of Surgical Treatments for Primary Malignant Bone Tumors Arising in the Acetabulum

    Directory of Open Access Journals (Sweden)

    Tomohiro Fujiwara

    2015-01-01

    Full Text Available The functional and oncologic results of eighteen patients with primary malignant periacetabular tumors were reviewed to determine the impact of surgical treatment. The reconstruction procedures were endoprosthesis (11, hip transposition (4, iliofemoral arthrodesis (2, and frozen bone autograft (1. After a mean follow-up of 62 months, 13 patients were alive and 5 had died of their disease; the 5-year overall survival rate was 67.2%. The corresponding mean MSTS scores of patients with endoprosthesis (11 and other reconstructions (7 were 42% and 55% (49%, 68%, and 50%, respectively. Overall, postoperative complications including deep infection or dislocation markedly worsened the functional outcome. Iliofemoral arthrodesis provided better function than the other procedures, whereas endoprosthetic reconstruction demonstrated poor functional outcome except for patients who were reconstructed with the adequate soft tissue coverage. Avoiding postoperative complications is highly important for achieving better function, suggesting that surgical procedures with adequate soft tissue coverage or without the massive use of nonbiological materials are preferable. Appropriate selection of the reconstructive procedures for individual patients, considering the amount of remaining bone and soft tissues, would lead to better clinical outcomes.

  6. Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?

    International Nuclear Information System (INIS)

    Iervolino, Leticia; Scalisse, Nilza Maria; Maeda, Sergio Setsuo

    2012-01-01

    Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia in outpatients. It is more common in females, after menopause, and the prevalence is 1 to 4:1000 in the general population. Patients with PHPT have abnormal regulation of PTH secretion, resulting in elevated serum calcium and inappropriately high or normal PTH in relation to the calcium value. Sporadic PTH-secreting adenoma alone accounts for 90% of cases of PHPT, while multiglandular hyperplasia is more common in familial hyperparathyroidism syndromes (5%) and parathyroid carcinomas represent less than 1% of cases. Only after making sure there is functional autonomy of one or more parathyroid glands, localization imaging tests should be performed to guide a possible surgical procedure. It is important to highlight that these tests have limitations and can yield false-positive and false-negative results. There are cases in which the parathyroid gland is difficult to be located, requiring a combination of imaging methods for pre-operative localization, such as 99m Tc-pertechnetate, SPECT, SPECT/CT, and US. We describe the case of a 50-year-old female patient diagnosed with PHPT, who underwent a surgical procedure without success, with maintenance of hypercalcaemia and hyperparathyroidism. In this case, the hyper functioning parathyroid was located in the retrotracheal region only after scintigraphy combined with SPECT/CT were used. (author)

  7. 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.

  8. [Endoscopic lateral parathyroidectomy as surgical treatment for patients with primary hyperparathyroidism].

    Science.gov (United States)

    Vidal-Pérez, Óscar; Valentini, Mauro; Baanante-Cerdeña, Juan Carlos; Ginestà-Martí, César; Fernández-Cruz, Laureano; García-Valdecasas, Juan Carlos

    2016-01-01

    Most surgeons have rapidly accepted the use of minimally invasive surgical approaches for the treatment of primary hyperparathyroidism. The role of the endoscope in neck surgery is still being discussed due to its technical difficulty and complex patient selection criteria. A prospective study was conducted between April 2010 and April 2013. It included patients diagnosed with sporadic primary hyperparathyroidism (sPHPT) by locating a single adenoma using ultrasound and sestamibi scintigraphy imaging. All patients agreed to be included in the study. Experienced endocrine surgeons that had been trained in endocrine minimally invasive surgery performed the procedure. The same surgical technique was used in all of the cases. The demographic and clinical variables were evaluated. A descriptive analysis was performed on the data measuring mean, standard deviation, and range. A total of 28 endoscopic lateral parathyroidectomies were performed. All patients were diagnosed with sporadic hyperparathyroidism sPHPT. The mean age was 68 years (59-89). No intraoperative complications were registered. Postoperative morbidity was comparable to that reported in the classical approach. A favourable outcome was observed in 27 of the 28 patients (96%) after a mean follow-up time of 22 (9 - 53) months. An endoscopic approach for hyperparathyroidism sPHPT is feasible and reproducible, and it obtains comparable results to the classical open surgery. Several factors make this technique suitable for highly specialised hospitals with a high patient volume and specialised endocrine surgery units. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  9. Surgical Interventions for Organ and Limb Ischemia Associated With Primary and Secondary Antiphospholipid Antibody Syndrome With Arterial Involvement.

    Science.gov (United States)

    Hinojosa, Carlos A; Anaya-Ayala, Javier E; Bermudez-Serrato, Karla; García-Alva, Ramón; Laparra-Escareno, Hugo; Torres-Machorro, Adriana; Lizola, Rene

    2017-11-01

    The association of antiphospholipid antibody syndrome (APS) and hypercoagulability is well known. Arterial compromise leading to ischemia of organs and/or limbs in patients with APS is uncommon, frequently unrecognized, and rarely described. We evaluated our institutional experience. Retrospective review was conducted. From August 2007 to September 2016, 807 patients with diagnosis of APS were managed in our Institution. Patients with primary and secondary APS who required interventions were examined. Demographics, comorbidities, manifestations, procedures, complications, and other factors affecting outcomes were recorded. Fourteen patients (mean age 35 years old, standard deviation ±14) were evaluated and treated by our service. Six (43%) of them had primary APS and 8 (57%) had secondary APS; 11 (79%) were female. Two (14%) experienced distal aorta and iliac arteries involvement, 3 (21%) visceral vessels disease, 2 (14%) in upper and 7 (50%) in the lower extremity vasculatures. Thirteen (93%) patients underwent direct open revascularization and 1 with hand ischemia (Raynaud disease) underwent sympathectomy. During the mean follow-up period of 48 months, reinterventions included a revision of the proximal anastomosis of an aortobifemoral bypass graft, 1 (7%) abdominal exploration for bleeding, 1 (7%) graft thrombectomy, and 4 (29%) amputations (2 below the knee, 1 above the knee, and 1 transmetatarsal). One (7%) death occurred secondary to sepsis in a patient who had acute mesenteric ischemia. Significant differences in clinical manifestations and outcomes were not observed among patients with primary and secondary APS. All patients remained on systemic anticoagulation. APS is a prothrombotic disorder that may lead to arterial involvement with less frequency than the venous circulation but has significant morbidity and limb loss rate. Arterial reconstruction seems feasible in an attempt to salvage organs and limbs; however, research is necessary to establish the

  10. Clinical effect comparison of different surgical methods for treating diabetic retinopathy

    Directory of Open Access Journals (Sweden)

    Qing Wu

    2014-12-01

    Full Text Available AIM: To compare the clinical results of different surgical methods for diabetic antipathy. METHODS: Eighty cases(102 eyeswith diabetic antipathy were selected in our hospital from January 2012 to December 2013. Thirty-eight cases(48 eyesin group A received joint surgical treatment, 42 cases(54 eyesin group B took staging of surgical treatment. The clinical effect was observed in both groups.RESULTS: The vision after surgery was improved than that of before surgery in two groups, there were no significant differences(P>0.05. A postoperative complication rate was 16.7% in group A and 22.2% in group B, showed no significant difference(P>0.05. CONCLUSION: Surgery and staging joint surgery are both feasible for diabetic retinopathy patients, can, improve the visionr. Both of them are worthy of clinical application.

  11. Surgical Outcomes in Esophageal Atresia and Tracheoesophageal Fistula: A Comparison between Primary and Delayed Repair

    Directory of Open Access Journals (Sweden)

    H Davari

    2006-01-01

    Full Text Available Background: The purpose of this study was to investigate outcomes of surgical repair of esophageal atresia (EA or tracheoesophageal fistula (TEF in newborns, with respect to incidence of death and other complications in early or late operations. Methods: Charts of all 80 infants with EA/TEF, operated in Alzahra hospital (A tertiary hospital of Isfahan University of Medical Sciences from 2002 to 2004 were reviewed. Patients were designed in two groups as, primary and delayed repair groups. Patients demographics, frequency of associated anomalies, and details of management and outcomes were studied. Results: There were 48 male and 32 female patients with a frequency of 28(35% preterm infant and mean birth weight of 2473±595 g. Overall survival rate was 71.2%. Mortality rate in delayed repair group was significantly higher than the other one (22.5% vs. 6.3% but with matching, according to full term/preterm proportion, the significant differences were failed. Female sex and being preterm were the most powerful predictors of death (nearly odds ratio=7 for both. Conclusion: in this study mortality and complications rates are higher in delayed repair than early one, although our data proposed that in absence of sever life threatening anomalies the most important factor for death is gestational age and female sex, and primary repair is opposed to it. Although mortality rate and complications are equal in two strategies, with matching cases for being preterm, but primary repair stays the better choice due to economic considerations. Keywords: tracheoesophageal fistula, esophageal atresia, delayed repair, primary repair, outcome

  12. An innovative surgical technique for treating penile incarceration injury caused by heavy metallic ring

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    S J Baruah

    2009-01-01

    Full Text Available Penile incarceration injury by heavy metallic ring is a rare genital injury. A man may place metal object for erotic or autoerotic purposes, for masturbation or increasing erection, and due to psychiatric disturbances are some of the reasons for a penile incarceration injury. The incarcerating injury results in reduced blood flow distal to the injury, leading to edema, ischemia, and sometimes gangrene. These injuries are divided into five grades and their treatment options are divided into four groups. Surgical techniques are reserved for the advanced grades (Grades IV and V. We describe an innovative surgical technique, which can be adopted in Grades II and III injuries.

  13. Radiological findings in intracranial arachnoid cysts treated surgically and conservatively; Radiologische Befunde operativ und konservativ behandelter intrakranieller Arachnoidalzysten

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    Ernst, S. [Inst. und Poliklinik fuer Radiologische Diagnostik, Univ. Koeln (Germany); Lanfermann, H. [Inst. und Poliklinik fuer Radiologische Diagnostik, Univ. Koeln (Germany); Heindel, W. [Inst. und Poliklinik fuer Radiologische Diagnostik, Univ. Koeln (Germany); Hildebrandt, G. [Klinik und Poliklinik fuer Neurochirurgie, Univ. Koeln (Germany); Lackner, K. [Inst. und Poliklinik fuer Radiologische Diagnostik, Univ. Koeln (Germany)

    1996-07-01

    To determine which appearances on CT or MRI are indications for surgical treatment of intracranial arachnoid cysts. The images obtained from 26 patients treated either by surgery or conservatively were compared retrospectively. The features evaluated were the size of the cyst, evidence of a space-occupying lesion, cerebral abnormalities near the cyst and skull deformities. In 6 patients (23%), surgical treatment was indicated because of the presence of obstructive hydrocephalus. The presence of all other radiological findings did not differ significantly between the two analysed groups. 92% of the patients treated surgically benefited from the treatment. Fenestration and shunting produced similar results in respect to reduction in size of the cyst and the clinical and neurological symptoms. The only indication for surgery is the presence of obstructive hydrocephalus. The other features were seen equally amongst the patients treated conservatively and the surgical patients and had no influence on the decision to operate. (orig.) [Deutsch] Gibt es mit der CT oder MRT bildmorphologisch fassbare Befunde, die die Indikation zur Entlastung intrakranieller Arachnoidalzysten stuetzen? Die Schnittbilduntersuchungen von je 26 Patienten mit operativ oder konservativ behandelten Arachnoidalzysten wurden vergleichend retrospektiv beurteilt. Auswerteparameter waren Zystengroesse, Raumforderungszeichen, zystenbenachbarte Hirnparenchymdefekte und Kalottendeformierungen. Bei 6 Patienten (23%) war eine operative Entlastung aufgrund eines Hydrocephalus occlusus indiziert. Bei den uebrigen Parametern unterschieden sich die beiden Kollektive nur geringgradig. 92% der operierten Patienten profitierten von der Therapie. Fensterung und Shuntimplantation lieferten vergleichbare Ergebnisse bezueglich der Zystengroessenreduktion und der klinisch-neurologischen Symptomatik. Nur der durch eine Arachnoidalzyste bedingte Hydrocephalus occlusus stellt eine Indikation zur Operation dar. Die

  14. Demography, types, outcome and relationship of surgically treated intracranial suppuration complicating chronic suppurative otitis media and bacterial rhinosinusitis

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    Olufemi Emmanuel Idowu

    2014-01-01

    Full Text Available Introduction: Surgically treated intracranial suppurations (ICS are uncommon, life-threatening neurosurgical emergencies. They can result from complication of chronic suppurative otitis media (CSOM and bacterial rhinosinusitis (BRS. The objective of this study was to know the frequency of BRS and CSOM and relate it to its rare complication of surgically treated ICS while also describing the demography, type and outcome of ICS that resulted from BRS and CSOM. Materials and Methods: All patients that presented to the Otorhinolaryngological department and Neurosurgical unit of the same institution with clinical and radiological features of CSOM, BRS, and ICS were prospectively studied over a 5-year period. Patients were followed up for a minimum of 3 months. Results: Two thousand, two hundred and seventy-nine patients presented during the 5-year study period. Of all these patients, 1511 had CSOM (66.3% and 768 (33.7% presented with features of BRS. Eleven (0.73% had ICS complicating their CSOM while 8 (1.04% cases of surgically treated ICS followed BRS. Bacterial rhinosinusitis was not more likely to lead to ICS (P = 0.4348. The Odds ratio (OR of a child ≤ 18 years of age with CSOM developing ICS was 5.24 (95% Confidence interval 1.13-24.34; P = 0.0345, while it was 7.60 (95% Confidence interval 1.52-37.97; P = 0.0134 for children with BRS. Conclusions: The most common type of ICS complicating CSOM and BRS was brain abscess and subdural empyema, respectively. Children are more prone to develop surgical ICS following CSOM and BRS. The proportion of males that had ICS was higher in both CSOM and BRS patients. Optimal outcome is achieved in patients that presented with GCS of 13 and above.

  15. Surgical management of pilonidal sinus patients by primary and secondary repair methods: a comparative study

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    Haji Barati B

    2010-12-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* 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-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Gross difference in return to work exists in pilonidal sinus patients operated by primary and secondary repair. This survey was to evaluate the results of surgical management of pilonidal sinus with primary or secondary closure."n"nMethods: In a randomized clinical trial, patients with pilonidal sinus referring to the surgical clinic of Shariati Hospital in Tehran, Iran between March 2007 and March 2009 were underwent either excision with midline closure (primary, n=40, or excision without closure (secondary, n=40. The recorded outcomes were hospital stay, healing time, time off work, postoperative pain, patient's satisfaction and the recurrence rate."n"nResults: Majority of the patients were male (87.50%. There was no significant difference in the hospital stay. Time off work (8.65±1.73 Vs. 11.53±2.33 days, p=0.001 and healing time (3.43±0.92 Vs. 5.3±0.79 days, p=0.001 were shorter in primary group; but, there were no significant differences in hospital stay and number of visits. Intensity of postoperative pain in the 1st (37.75±6.5 Vs. 43.63±5.06, p=0.001, 2nd (26.75±6.66 Vs. 34.63±5.48, p=0.001, 3rd (18.25±6.05 Vs. 27.88±6.88, p=0.001, and 7th (8.45±3.85 Vs. 17.88±6.19, p=0.001 days were

  16. Clozapine prescription and quality of life in Chinese patients with schizophrenia treated in primary care.

    Science.gov (United States)

    Hou, C-L; Cai, M-Y; Ma, X-R; Zang, Y; Jia, F-J; Lin, Y-Q; Chiu, H F K; Ungvari, G S; Ng, C H; Zhong, B-L; Cao, X-L; Li, Y; Shinfuku, N; Xiang, Y-T

    2015-09-01

    Clozapine is frequently used to treat schizophrenia in China. Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated the frequency of its use prescribed by primary care physicians. This study described the frequency, demographic and clinical characteristics of clozapine treatment and its impact on insight and quality of life (QOL) of patients with schizophrenia treated in primary care in China. A total of 623 patients with schizophrenia treated in 22 primary care services in Guangzhou, China in 2013 formed the study sample. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects and QOL were recorded using a standardized protocol and data collection. The frequency of clozapine prescription was 35.6% with a mean daily dose of 127.7±88.2 mg. There were no significant differences between the patients with and without clozapine in either of the QOL domains after controlling the confounding factors. Multiple logistic regression analyses revealed that patients on clozapine had younger age of onset, more hospitalizations, more severe extrapyramidal side effects, but better insight and fewer prescriptions of first generation antipsychotics. Clozapine use was found to be common and associated with better insight in patients with schizophrenia treated in primary care in China. Further examination of the rationale and appropriateness of clozapine in primary care in China is warranted. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Chemotherapy effectiveness and mortality prediction in surgically treated osteosarcoma dogs : A validation study

    NARCIS (Netherlands)

    Schmidt, A F; Nielen, M; Withrow, S J; Selmic, L E; Burton, J H; Klungel, O H; Groenwold, R H H; Kirpensteijn, J

    2016-01-01

    Canine osteosarcoma is the most common bone cancer, and an important cause of mortality and morbidity, in large purebred dogs. Previously we constructed two multivariable models to predict a dog's 5-month or 1-year mortality risk after surgical treatment for osteosarcoma. According to the 5-month

  18. Surgical treatment of chronic sacrococcygeal pilonidal sinus. Open method versus primary closure

    International Nuclear Information System (INIS)

    Kareem, Tayeb S.

    2006-01-01

    Objective was to study the comparison between the primary closure and open technique after excision of chronic sacrococcygeal pilonidal sinus. A randomized study was designed and 77 patients with chronic sacrococcygeal pilonidal sinus were included in this study. This study took place in Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, from January 1997 to August 2003. The patients were separated into 2 groups; Group A (37 patients) were treated by open method (excision and healing by secondary intention) and Group B (40 patients) for whom primary midline suturing was performed after excision of the pilonidal sinus. The follow up ranged from 1.5-5.5 years (mean 4.16) was through outpatient visits. The Student t test was applied for statistical analysis for the operating time, hospital-stay, time off from work and wound healing time; and the results show extremely significant differences between the 2 groups (p<0.0001). The statistical analysis of the total number of postoperative complications of both techniques showed a significant difference (p=0.0401), while the differences were insignificant for each complication when analyzed separately. Excision and primary closure for chronic sacrococcygeal pilonidal sinus is superior to excision and healing by secondary intention. We believe that primary midline suturing is a useful method for management of chronic sacrococcygeal pilonidal sinus. (author)

  19. Surgical outcome of primary clipping for anterior circulation aneurysms of size 2 centimeters or larger.

    Science.gov (United States)

    Furtado, Sunil V; Saikiran, Narayanam A; Thakar, Sumit; Dadlani, Ravi; Mohan, Dilip; Aryan, Saritha; Hegde, Alangar S

    2014-07-01

    Aneurysms of the anterior circulation larger than 2cm have a complex relationship to the anterior skull base, requiring a multi-modality management approach. This retrospective study of 54 patients with such aneurysms who underwent clipping between 2001 and 2012 analyzes clinical and surgical data, aneurysm characteristics and correlates them with respect to the Glasgow outcome score at follow-up and immediate post-operative clinical status. Patients with an outcome score of 5 or 4 were categorized as "good", while those with score 3-1 were "poor". Fisher's exact test and paired T-test (p<0.5) were used to test statistical significance for discrete and continuous variables respectively. 44 (81.4%) patients had a good outcome. Patients with non-ophthalmic/paraclinoid aneurysms had significantly lower incidence of adverse intra-operative events (p=0.035). Patients older than 50 years (p=0.045), with adverse intra-operative events (p=0.015) and post-operative infarction (p<0.001) had a poor outcome compared to those younger than 50 years age and those without adverse intra-operative events or infarctions. The grouped age variable had maximum influence on patient outcome. Location and size of aneurysm did not have an overall impact on surgical outcome. There were 4 mortalities. Primary clipping of proximal non-cavernous aneurysms on the internal carotid artery is associated with adverse intra-operative events. A multi-modality treatment approach in these aneurysms should be individualized, more so in patients older than 50 years. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Wound complications and surgical events in de novo heart transplant patients treated with everolimus

    DEFF Research Database (Denmark)

    Rashidi, Mitra; Esmaily, Sorosh; Fiane, Arnt E

    2016-01-01

    associated with failure of tissue healing. Secondary endpoint was total number of events involving surgical intervention. RESULTS: There were no significant differences between the groups with regards to wound complications (EVE=20, CyA=12)(p=0.08) or total surgical events (EVE=38, CyA=34) (p=0.44). Age>54......OBJECTIVES: The use of mammalian target of rapamycin (mTOR) inhibitors have been limited by adverse events (AE), including delayed wound healing. We retrospectively reviewed all AE and serious AE (SAE) in The Scandinavian heart transplant (HTx) everolimus (EVE) de novo trial with early calcineurin...... (CNI) avoidance (SCHEDULE). The aim of the study was to compare wound complications between EVE and CNI based regimen. MATERIALS AND METHODS: A total of 115 patients (mean age 51 ± 13 years, 73% men) were randomized within five days post-HTx to low dose EVE and reduced dose Cyclosporine (CyA) followed...

  1. Limited left atrial surgical ablation effectively treats atrial fibrillation but decreases left atrial function.

    Science.gov (United States)

    Compier, Marieke G; Tops, Laurens F; Braun, Jerry; Zeppenfeld, Katja; Klautz, Robert J; Schalij, Martin J; Trines, Serge A

    2017-04-01

    Limited left atrial (LA) surgical ablation with bipolar radiofrequency is considered to be an effective procedure for treatment of atrial fibrillation (AF). We studied whether limited LA surgical ablation concomitant to cardiac surgery is able to maintain LA function. Thirty-six consecutive patients (age 66 ± 12 years, 53% male, 78% persistent AF) scheduled for valve surgery and/or coronary revascularization and concomitant LA surgical ablation were included. Epicardial pulmonary vein isolation (PVI) and additional endo-epicardial lines were performed using bipolar radiofrequency. An age- and gender-matched control group (n = 36, age 66 ± 9 years, 69% male, 81% paroxysmal AF) was selected from patients undergoing concomitant epicardial PVI only. Left atrial dimensions and function were assessed on two-dimensional echocardiography preoperatively and at 3- and 12-month follow-up. Sinus rhythm (SR) maintenance was 67% for limited LA ablation and 81% for PVI at 1-year follow-up (P = 0.18). Left atrial volume decreased from 72 ± 21 to 50 ± 14 mL (31%, P Atrial transport function was restored in 54% of patients in SR after limited LA ablation compared with 100% of patients in SR after PVI. Atrial strain and contraction parameters (LA ejection fraction, A-wave velocity, reservoir function, and strain rate) significantly decreased after limited LA ablation. After PVI, strain and contraction parameters remained unchanged. Even limited LA ablation decreased LA volume, contraction, transport function, and compliance, indicating both reverse remodelling combined with significant functional deterioration. In contrast, surgical PVI decreased LA volume while function remained unchanged. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  2. Cutaneous myiasis with Dermatobia hominis (human bot fly) larvae treated both conservatively and surgically.

    Science.gov (United States)

    Wild, G

    2006-01-01

    A case is presented of infestation with the larvae of Dermatobia hominis (human bot fly). This case is unusual in that it provides an example of three different outcomes for separate lesions in the same patient; spontaneous resolution, conservative treatment and surgical intervention. It also illustrates that myiasis should be included in the differential diagnosis of any skin lesion of a patient returning from the tropics.

  3. Surgical technique: Gluteus maximus and tensor fascia lata transfer for primary deficiency of the abductors of the hip.

    Science.gov (United States)

    Whiteside, Leo A

    2014-02-01

    Avulsion of the abductor muscles of the hip may cause severe limp and pain. Limited literature is available on treatment approaches for this problem, and each has shortcomings. This study describes a muscle transfer technique to treat complete irreparable avulsion of the hip abductor muscles and tendons. Ten adult cadaver specimens were dissected to determine nerve and blood supply point of entry in the gluteus maximus and tensor fascia lata (TFL) and evaluate the feasibility and safety of transferring these muscles to substitute for the gluteus medius and minimus. In this technique, the anterior portion of the gluteus maximus and the entire TFL are mobilized and transferred to the greater trochanter such that the muscle fiber direction of the transferred muscles closely matches that of the gluteus medius and minimus. Five patients (five hips) were treated for primary irreparable disruption of the hip abductor muscles using this technique between January 2008 and April 2011. All patients had severe or moderate pain, severe abductor limp, and positive Trendelenburg sign. Patients were evaluated for pain and function at a mean of 28 months (range, 18-60 months) after surgery. All patients could actively abduct 3 months postoperatively. At 1 year postoperatively, three patients had no hip pain, two had mild pain that did not limit their activity, three had no limp, and one had mild limp. One patient fell, fractured his greater trochanter, and has persistent limp and abduction weakness. The anterior portion of the gluteus maximus and the TFL can be transferred to the greater trochanter to substitute for abductor deficiency. In this small series, the surgical procedure was reproducible and effective; further studies with more patients and longer followup are needed to confirm this.

  4. Long-Term Follow-Up of Nonoperatively and Operatively Treated Acute Primary Patellar Dislocation in Skeletally Immature Patients

    Directory of Open Access Journals (Sweden)

    Eva Bengtsson Moström

    2014-01-01

    Full Text Available Purpose. The present study reports a long-term follow-up of acute primary patellar dislocation in patients with open physes. The purpose of the study was to evaluate knee function and recurrence rates after surgical and nonsurgical treatment of patellar dislocation. Methods. A total of 51 patients, including 29 girls and 22 boys, who were 9–14 years of age at the time of injury, were retrospectively evaluated. The minimum follow-up time was 5 years. Thigh muscle torque, range of motion, the squat test, the knee injury and osteoarthritis outcome score (KOOS, the Kujala score, and the recurrence rate were registered. Radiological predisposing factors at the time of injury were determined. Results. Quality of life and sports/recreation were the most affected subscales, according to KOOS, and a reduced Kujala score was also observed in all treatment groups. The surgically treated patients had a significantly lower recurrence rate. Those patients also exhibited reduced muscle performance, with a hamstring to quadriceps ratio (H/Q of 1.03. The recurrence rate was not correlated with knee function. Conclusions. Patellar dislocation in children influences subjective knee function in the long term. Surgery appears to reduce the recurrence rate, but subjective knee function was not restored.

  5. [Craniocerebral trauma in acute surgical management. Primary care in a general community hospital].

    Science.gov (United States)

    Friedl, W; Karches, C

    1996-11-01

    Head traumas frequently occur in polytrauma patients but are also found as isolated injuries. In our hospital trauma center without a neurosurgical department, in a 21-month period, 489 patients with head/brain trauma were treated. This represents 6.5% of all patients treated in the trauma and reconstructive surgery clinic. In commotio cerebri (CC = 89.5% of the patients) constant conservative management and an uneventful course were observed; in 69 patients with contusio cerebri, 18 craniotomy operations had to be performed. In contrast, in only two cases was reoperation because of recurrent hematoma necessary. In four cases with complex and/or additional injuries, transfer to a neurosurgical center took place, and in two cases photophone consultation with that center was used. The mortality was 14.5%. The diagnostic and therapeutic regimens for the different types of injury and the requirements for the management of head/brain trauma in trauma centers without neurosurgical departments are presented: emergency service and medical staff, emergency room management, intensive care management, qualified neurological examination, X-ray imaging, including CT scan, OP-room equipment and trained surgeons. If these requirements are not available in a given hospital, early transfer of all patients for whom surgical management could be necessary to a neurosurgical department should be attempted. Only in patients with severe bleeding must immediate craniotomy be performed even in hospitals which do not have all the above mentioned facilities. In patients with intracerebral bleeding, bleeding in the dorsal fossa, injury of brain nerves, carotid artery or sinus cavernosus injuries, frontobasal injuries with liquor fistula or pneumonencephalon, transfer of the patients to specialized neurosurgical centers is indicated. With this selection, we obtained the same results in a trauma center without a neurosurgical department as reported in the literature. This avoids overloading

  6. Duodenocaval Fistula in a Patient with Inferior Vena Cava Leiomyosarcoma Treated by Surgical Resection and Caval Polytetrafluoroethylene Prosthesis

    Directory of Open Access Journals (Sweden)

    Davide Ippolito

    2015-01-01

    Full Text Available Inferior vena cava (IVC leiomyosarcoma represents an extremely rare disease that commonly involves the segment between the inflow of the renal veins and the inflow of the hepatic veins (46% of cases. We report the case of a patient affected by an IVC leiomyosarcoma, treated with surgical resection, caval reconstruction with polytetrafluoroethylene (PTFE, and right nephrectomy, followed by external beam radiotherapy. Oncological follow-up was negative for 17 years after this combined treatment, since the patient developed a duodenocaval fistula (DCF.

  7. Mortality in asymptomatic vs. symptomatic patients surgically treated for non-small cell lung cancer (NSCLC)

    DEFF Research Database (Denmark)

    Madsen, Kirsten Riis; Bødtger, Uffe

    , tobacco pack years, or FEV1. Former malignancy was significantly more prevalent among asymptomatic than symptomatic subjects (33 % vs. 11%), with insignificant differences in prevalence of other co-morbidities or in post-surgical TNM (82% vs 85% in stages IA-IIB). 12-months mortality was insignificantly...... higher in asymptomatic than symptomatic subjects (23% vs. 12%), and in patients with former malignancy compared to patients with no former cancer (17% vs. 16%). Discussion: Symptoms at diagnosis per se appear unrelated to mortality in patients with NSCLC referred for surgery. Asymptomatic patients were...

  8. IPSILATERAL IRRADIATION FOR ORAL AND OROPHARYNGEAL CARCINOMA TREATED WITH PRIMARY SURGERY AND POSTOPERATIVE RADIOTHERAPY

    NARCIS (Netherlands)

    Vergeer, Marije R.; Doornaert, Patricia A. H.; Jonkman, Anja; Kaanders, Johannes H. A. M.; van den Ende, Piet L. A.; de Jong, Martin A.; Leemans, C. Rene; Slotman, Ben J.; Langendijk, Johannes A.

    2010-01-01

    Purpose: The purpose was to evaluate the contralateral nodal control (CLNC) in postoperative patients with oral and oropharyngeal cancer treated with ipsilateral irradiation of the neck and primary site. Late radiation-induced morbidity was also evaluated. Methods and Materials: The study included

  9. Results of primary versus recurrent surgery to treat stress urinary incontinence in women

    NARCIS (Netherlands)

    van der Doelen, Maarten J; Withagen, Mariëlla I J; Vierhout, Mark E; Heesakkers, John P F A

    INTRODUCTION AND HYPOTHESIS: We compared cure rates and complication rates in patients who had undergone primary or recurrent (secondary) surgery for stress urinary incontinence (SUI). METHODS: A retrospective cohort study that included patients who underwent surgery to treat SUI in a tertiary

  10. Results of primary versus recurrent surgery to treat stress urinary incontinence in women

    NARCIS (Netherlands)

    Doelen, M.J. van der; Withagen, M.I.J.; Vierhout, M.E.; Heesakkers, J.P.F.A.

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: We compared cure rates and complication rates in patients who had undergone primary or recurrent (secondary) surgery for stress urinary incontinence (SUI). METHODS: A retrospective cohort study that included patients who underwent surgery to treat SUI in a tertiary

  11. Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and voriconazole

    Directory of Open Access Journals (Sweden)

    Chi-Hsuan Chiang

    2014-03-01

    Full Text Available Scedosporium apiospermum is an emerging opportunistic fungus that can cause localized infection in healthy hosts or severe disseminated disease in immunocompromised hosts. Most cases are reported in Western Europe, Australia, and North America. We report a 52-year-old immunocompetent Taiwanese woman who presented with a 6-year history of recurrent asymptomatic papulonodular lesions on her right foot after minor trauma. Deep fungal infection caused by Scedosporium sp. was diagnosed after a skin biopsy with fungal culture of the skin specimen. She underwent two surgical excisions, each followed by a 4-month course of oral itraconazole and intralesional injections of amphotericin B as well, but similar lesions recurred at the same location 1 year later. She had another surgical excision and the pathological findings showed mycetoma. The fungus was identified as S. apiospermum by PCR assay of fungal culture specimen using the internal transcriber spacers (ITS1, similarity 99.4%; ITS2, similarity 100% and the D1–D2 (similarity 99.0% regions of the ribosomal operon. After 4 months of oral voriconazole (400 mg/day, no recurrence was noted in the subsequent 2 years.

  12. Surgical Outcome of Treating Grades II and III Meningiomas: A Report of 32 Cases

    Directory of Open Access Journals (Sweden)

    Konstantinos Violaris

    2013-01-01

    Full Text Available Aim. To evaluate the frequency of atypical and malignant meningiomas and analyze recurrence rate; to study the morbidity and mortality of these tumors compared to benign meningiomas. Methods. During 1992–2007, 16 patients with malignant and 16 patients with atypical meningioma were operated in Neurosurgery Department of Thessaloniki's Papanikolaou Hospital. We analyzed tumor histology, location, and extent of surgical resection with respect to tumor reappearance and patients' outcome and compared the behavior of benign versus nonbenign meningiomas. Results. Malignant meningiomas accounted for 4.4% (16 patients and atypical meningiomas for another 4.4% of the series of patients (353 who were operated for intracranial meningioma at our department that period. Malignant meningiomas recurred at a rate of 75% and atypical meningiomas recurred at a rate of 41.6%. There was a significant association of the histological classification (benign, atypical, and malignant with recurrence (P0.05 was not significant to recurrence. Conclusions. Atypical and malignant meningiomas appeared at a rate of 8.8% of our series of intracranial meningiomas. They showed a significant predisposition to recur. These rare subtypes have higher morbidity and mortality rates than benign meningiomas. Recurrence depends primarily on the extent of surgical removal and on the histological characterization of the tumor as atypical or malignant.

  13. Pattern of Failure in Surgically Treated Patients with Cervical Esophageal Squamous Cell Carcinoma.

    Science.gov (United States)

    Cao, Cai-Neng; Liu, Shao-Yan; Luo, Jing-Wei; Gao, Li; Xu, Guo-Zhen; Xu, Zhen-Gang; Tang, Ping-Zhang

    2014-08-01

    The aim of this study was to analyze the pattern of failure in patients who have undergone surgical resection for cervical esophageal squamous cell carcinoma. Case series with chart review. University hospital. Sixty-two patients who had undergone surgical resection of cervical esophageal squamous cell carcinoma from January 2001 through April 2012. Sites of failure were documented. Twenty-nine patients had developed treatment failure. Of the 29 patients, 14, 13, and 14 had developed local failure, regional failure, and distant metastasis, respectively. Of the 13 regional failures, the images of 2 patients were lost. The other 11 regional failures included left lateral nodal disease at level II (n = 2), level III (n = 4), and level IV (n = 7); right lateral nodal disease at level II (n = 2), level III (n = 3), and level IV (n = 3); and level VI (n = 4). The overall 2-year local failure-free survival rate and regional failure-free survival rates were 79.6% and 58.6% (P = .04) for patients with stage II disease and 79.6% and 59.6% (P = .054) for patients with stage III disease, respectively. The pattern of failure of cervical esophageal squamous cell carcinoma is characterized by early locoregional failure, especially in patients with stage III disease. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  14. PHYSICAL THERAPY AND FUNCTIONAL REHABILITATION IN PATIENTS WITH HAEMOPHILIC ARTHROPATHY SURGICALLY TREATED

    Directory of Open Access Journals (Sweden)

    Dan V. Poenaru

    2016-09-01

    Full Text Available Patients with haemophilia type A or B may develop, over time, haemophilic arthropathy with different degrees of joint dysfunction. This disorder is a consequence of repeated episodes of intraarticular bleeding, with either spontaneous or traumatic aetiology. In the recent years, the therapeutic management of these patients has changed, still, without prompt early diagnosis and prophylactic treatment, the joints deteriorate to such a degree that only a complex multi-disciplinary approach can offer an optimal outcome. Modern high resolution MRI and prophylaxis treatment can detect and delay early signs of haemophilic arthropathy, but, not all patients have access to these types of early interventions. As a result, there are still patients presenting with different of degrees haemophilic arthropathy, which require surgical treatment. Despite the use of modern, minimal invasive approaches, surgical treatment alone can’t offer a good symptom relief and can’t provide a good functional outcome. Thus, the integration of physical therapy and functional rehabilitation in the therapeutic scheme can provide a good support in order for these patients to be socio-economically re-integrated.

  15. Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

    Directory of Open Access Journals (Sweden)

    Atci Ibrahim Burak

    2017-12-01

    Full Text Available Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU, length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36% patients, 9-13 in 23 (46% patients and 3-8 in 9 (18% patients. The reasons for emergency department admissions were fall from high in 29 (58% patients, assault in 11 (22% patients and motor vehicle accident in 10 (20% patients. The average cost per ICU stay was 2838 $ (range=343-20571 $. The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients. Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.

  16. Prognostic relevance of epithelial-mesenchymal transition and proliferation in surgically treated primary parotid gland cancer.

    Science.gov (United States)

    Busch, Alina; Bauer, Larissa; Wardelmann, Eva; Rudack, Claudia; Grünewald, Inga; Stenner, Markus

    2017-05-01

    Cancer of the major salivary glands comprises a morphologically diverse group of rare tumours of largely unknown cause. Epithelial-mesenchymal transition (EMT) has been shown to play a significant prognostic role in various human cancers. The aim was to assess the expression of EMT markers in different histological subtypes of parotid gland cancer (PGC) and analyse their prognostic value. We examined 94 PGC samples (13 histological subtypes) for the expression of MIB-1, epithelial cadherin (E-cadherin), β-catenin, vimentin and cytokeratin 8/18 (CK8/18) by means of immunohistochemistry. The experimental findings were correlated with clinicopathological and survival parameters. We detected all analysed EMT and proliferation markers in specifically different constellations within the examined histological subtypes of PGC. We found high epithelial marker expressions (CK8/18, E-cadherin, membranous β-catenin) only in a distinct variety of carcinomas. A high proliferation rate (high MIB-1 expression) as well as a combination of high CK8/18 and low vimentin expression was associated with a significantly worse survival. Our findings indicate that activation of the EMT pathway is a relevant explanation for tumour progression in individual histological subtypes of malignant parotid gland lesions, but by far not in all. Evidence of EMT activation in PGC cannot be seen as an isolated prognostic factor. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries

    Directory of Open Access Journals (Sweden)

    Zaatreh, Sarah

    2016-12-01

    Full Text Available Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears to latex gloves during surgery in the case of primary hip and knee prosthesis implantation. Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000.Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon’s glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence.Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage.

  18. Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries

    Science.gov (United States)

    Zaatreh, Sarah; Enz, Andreas; Klinder, Annett; König, Tony; Mittelmeier, Lena; Kundt, Günther; Mittelmeier, Wolfram

    2016-01-01

    Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears) to latex gloves during surgery in the case of primary hip and knee prosthesis implantation. Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000. Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon’s glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence. Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage. PMID:28066701

  19. Blood pressure reduction in patients with irreversible pulpitis teeth treated by non-surgical root canal treatment

    Directory of Open Access Journals (Sweden)

    James I-Sheng Huang

    2017-12-01

    Full Text Available Background/purpose: The hypotension in patients during non-surgical root canal treatment (NSRCT has not yet investigated. This study aimed to assess the mean systolic blood pressure (MSBP, mean diastolic blood pressure (MDBP, and mean arterial blood pressure (MABP reduction percentages in patients with irreversible pulpitis teeth treated by NSRCT. Materials and methods: We prospectively recruited 111 patients with a total of 138 irreversible pulpitis teeth. All patients underwent two NSRCT sessions. The first NSRCT session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second NSRCT session included the root canal debridement and enlargement with minimal disturbance to the dental nerves. The blood pressure of each patient was recorded before and during both NSRCT sessions. Results: There were significantly higher reduction percentages of MSBP, MDBP, and MABP in the first NSRCT session than in the second NSRCT session for all treated patients (all the P-values < 0.001. If the patients were divided into 2 or more groups according to the clinical variables including the patients' gender, age, tooth type, and anesthesia type, we also found significantly higher reduction percentages of MSBP, MDBP, and MABP in the first NSRCT session than in the second NSRCT session for all treated patients except for patients below 40 years of age and for patients with lower anterior teeth treated (all the P-values < 0.05. Conclusion: The decrease in blood pressure in patients receiving vital pulpal extirpation is a relatively common phenomenon. Keywords: hypotension, irreversible pulpitis teeth, non-surgical root canal treatment, blood pressure, parasympathetic effect, vital pulpal extirpation

  20. Occurrence of methicillin-resistant Staphylococci in surgically treated dogs and the environment in a Swedish animal hospital.

    Science.gov (United States)

    Bergström, A; Gustafsson, C; Leander, M; Fredriksson, M; Grönlund, U; Trowald-Wigh, G

    2012-07-01

    To investigate whether hospitalised dogs treated surgically may become culture positive for methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus. Surgically treated dogs (n=45) were sampled for methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus on admission, before and after surgery and at the time of removal of surgical stitches. The hospital environment (n=57), including healthy dogs in the veterinary hospital environment (n=34), were sampled for methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus. Genetic variations among methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus isolates were identified through detection of restriction fragment polymorphisms. No dogs developed a wound infection due to methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus. However, there was a significant increase in the number of dogs carrying methicillin-resistant Staphylococcus pseudintermedius after hospitalisation compared to admission (Pmethicillin-resistant Staphylococcus aureus was isolated from dogs, but was present in the environment. Methicillin-resistant Staphylococcus pseudintermedius isolates were recovered from environmental surfaces and hospitalised animals, but not from healthy dogs. Methicillin-resistant Staphylococcus pseudintermedius isolates representing nine different restriction endonuclease digestion patterns were found, with two of these occurring in both the environment and on dogs. Dogs may contract methicillin-resistant Staphylococcus pseudintermedius in association with surgery and hospitalisation. Resistant bacteria may be transmitted between dogs, staff and the environment. Dogs colonised with methicillin-resistant Staphylococcus pseudintermedius may be a source for hospital- and community-acquired infections.

  1. Overcorrection and generalized joint laxity in surgically treated congenital talipes equino-varus.

    Science.gov (United States)

    Haslam, Paul G; Goddard, Martin; Flowers, Mark J; Fernandes, James A

    2006-07-01

    Fifty patients with 70 previously operated clubfeet were assessed for overcorrection (using Tachdjian's flat foot grade) and generalized joint laxity. Twenty-eight patients (40 feet) had signs of generalized joint laxity using the Biro score and of these 25 feet were overcorrected. Of the 22 patients (30 feet) who did not have signs of joint laxity, only three overcorrected. This difference was statistically significant (P<0.001). A significant correlation exists between flat foot grade and laxity score (P<0.01). Overcorrection is a complication largely ignored in the published literature but we believe it is a serious complication of open release often resulting in poor long-term function. For those patients requiring surgery, the authors urge caution and recommend a limited surgical release, particularly if joint laxity is suspected, or the Ponseti method of treatment, which will probably avoid this complication.

  2. Clinical Results of Surgically Treated Medial Humeral Epicondylar Apophyseal Avulsion Injury in Children and Adolescent.

    Directory of Open Access Journals (Sweden)

    Ruban Raj Joshi

    2014-12-01

    years (SD=2.3. Fifteen (75% dominant elbows were injured in our study and 12(60% elbows had an associated elbow dislocation. On examination in operating room post anaesthesia, all of the elbow injuries revealed some degree of valgus instability. All of our patients(n=20 showed good to excellent results in the MAYO elbow performance score (MEPS. Radiographically, union was achieved in all cases. Three patients developed postoperative ulnar nerve neuropraxia, all recovered at time of final follow up. One patient developed mild lateral heterotrophic ossification but did not require any additional surgical intervention. Conclusion: Our results suggest that open reduction internal fixation of displaced medial epicondyle fractures leads to satisfactory motion and function. A valgus stress test in operating room can reveal the true nature of joint instability that can warrant operative stabilization of medial epicondylar injuries.

  3. [Report of experiences with 31 surgically treated patients with deformity of the femur shaft].

    Science.gov (United States)

    Winter, T; Wolff, R; Bansky, G

    1989-12-01

    In 1986/1987 we made a follow-up of 31 patients having undergone a surgical treatment of a deformity of the femur shaft in 1971 through 1981. For a better interpretation of the results we divided these patients into three partly overlapping groups: Patients with deformities of the angel or rotation, patients being shortened in case of length-differences and those being elongated. Finally we investigated, that in nine out of ten cases we got a good result by correcting angle-and rotation-deformities and by the shortening osteotomy. The extension osteotomy caused more complications and not so good results than those of the first two groups. We recognized, that the follow-up treatment was very long, and the method of the operation was not standardized but was adapted to the circumstances of the single case.

  4. Radiological predictive factors for the outcome of surgically treated calcaneus fractures.

    Science.gov (United States)

    Baptista, Mário; Pinto, Rui; Torres, João

    2015-06-01

    Calcaneus fractures are fairly common and clinically relevant due to their poor outcome. Thus, solving the controversy regarding treatment and outcome prediction should be a target. This study intends to evaluate the predictive ability of common radiologic tools for the surgical outcome of calcaneus fractures, regardless of treatment modality. 44 patients' records, with operated calcaneus fractures between 2008 and 2013, were retrospectively assessed and imagiology was blindly evaluated. Patients were submitted to percutaneous or open lateral approach. No relevant correlations were found between the measurements on the plain lateral radiograph and the outcome. Fractures were also graded according to the Sanders classification. Type 4 fractures predicted the occurrence of any hazard, such as skin or pain related complications and need for secondary surgery (p=0.051, odds=14.00 [CI=1.30-150.89]). However, it's still not possible to accurately target patients with high risk of postoperative complications. Until then, follow-up protocols should be maintained indiscriminately.

  5. A third of patients treated at a tertiary-level surgical service could be ...

    African Journals Online (AJOL)

    primary healthcare.[3,4]. The public healthcare sector in SA is overburdened at all levels of care.[5] Healthcare funding has not kept pace with inflation and the burden of disease.[6] Data are .... An example would be a skin laceration requiring sutures .... care pyramid. If skills and resources are limited, the trend is to refer to.

  6. Hypothesis: primary antiangiogenic method proposed to treat early stage breast cancer

    International Nuclear Information System (INIS)

    Retsky, Michael W; Hrushesky, William JM; Gukas, Isaac D

    2009-01-01

    Women with Down syndrome very rarely develop breast cancer even though they now live to an age when it normally occurs. This may be related to the fact that Down syndrome persons have an additional copy of chromosome 21 where the gene that codes for the antiangiogenic protein Endostatin is located. Can this information lead to a primary antiangiogenic therapy for early stage breast cancer that indefinitely prolongs remission? A key question that arises is when is the initial angiogenic switch thrown in micrometastases? We have conjectured that avascular micrometastases are dormant and relatively stable if undisturbed but that for some patients angiogenesis is precipitated by surgery. We also proposed that angiogenesis of micrometastases very rarely occurs before surgical removal of the primary tumor. If that is so, it seems possible that we could suggest a primary antiangiogenic therapy but the problem then arises that starting a therapy before surgery would interfere with wound healing. The therapy must be initiated at least one day prior to surgical removal of the primary tumor and kept at a Down syndrome level perhaps indefinitely. That means the drug must have virtually no toxicity and not interfere meaningfully with wound healing. This specifically excludes drugs that significantly inhibit the VEGF pathway since that is important for wound healing and because these agents have some toxicity. Endostatin is apparently non-toxic and does not significantly interfere with wound healing since Down syndrome patients have no abnormal wound healing problems. We propose a therapy for early stage breast cancer consisting of Endostatin at or above Down syndrome levels starting at least one day before surgery and continuing at that level. This should prevent micrometastatic angiogenesis resulting from surgery or at any time later. Adjuvant chemotherapy or hormone therapy should not be necessary. This can be continued indefinitely since there is no acquired resistance that

  7. Quality of life in Chinese patients with schizophrenia treated in primary care.

    Science.gov (United States)

    Li, Yan; Hou, Cai-Lan; Ma, Xin-Rong; Zhong, Bao-Liang; Zang, Yu; Jia, Fu-Jun; Lin, Yong-Qiang; Lai, Kelly Y C; Chiu, Helen F K; Ungvari, Gabor S; Hall, Brian J; Cai, Mei-Ying; Ng, Chee H; Xiang, Yu-Tao

    2017-08-01

    In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. This study examined the quality of life (QOL) in patients with schizophrenia treated in primary care and explored the demographic and clinical characteristics associated with QOL. Altogether, 612 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. QOL, psychotic and depressive symptoms, extra-pyramidal symptoms and insight were assessed using standardized instruments. Data analyses were conducted with the one sample t-test and multiple linear regression analyses. Compared with the normative data for the Chinese general population, significantly lower scores in physical and mental QOL domains were found in the patient group. Older age, being unemployed, major medical conditions, no smoking, more severe depressive and negative symptoms, more frequent insomnia, and suicidality were independently associated with poor physical QOL. Male gender, more severe depressive and anxiety symptoms, more frequent insomnia, and suicidality were independently associated with poor mental QOL. Patients with schizophrenia treated in primary care had lower level of QOL in comparison with general population. Effective measures need to be implemented to improve their QOL. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  8. Metastatic clear cell eccrine hidradenocarcinoma of the vulva: survival after primary surgical resection.

    Science.gov (United States)

    Massad, L S; Bitterman, P; Clarke-Pearson, D L

    1996-05-01

    A case of clear cell eccrine hidradenocarcinoma of the vulva metastatic to regional lymph nodes with long survival after surgical resection is presented. Like the only other case reported to date, this suggests that surgical therapy alone may be adequate, even when metastasis is present.

  9. Defining Prolonged Length of Acute Care Stay for Surgically and Conservatively Treated Patients with Spontaneous Intracerebral Hemorrhage: A Population-Based Analysis

    Directory of Open Access Journals (Sweden)

    Marco Stein

    2016-01-01

    Full Text Available Background. The definition of prolonged length of stay (LOS during acute care remains unclear among surgically and conservatively treated patients with intracerebral hemorrhage (ICH. Methods. Using a population-based quality assessment registry, we calculated change points in LOS for surgically and conservatively treated patients with ICH. The influence of comorbidities, baseline characteristics at admission, and in-hospital complications on prolonged LOS was evaluated in a multivariate model. Results. Overall, 13272 patients with ICH were included in the analysis. Surgical therapy of the hematoma was documented in 1405 (10.6% patients. Change points for LOS were 22 days (CI: 8, 22; CL 98% for surgically treated patients and 16 days (CI: 16, 16; CL: 99% for conservatively treated patients. Ventilation therapy was related to prolonged LOS in surgically (OR: 2.2, 95% CI: 1.5–3.1; P<0.001 and conservatively treated patients (OR: 2.5, 95% CI: 2.2–2.9; P<0.001. Two or more in-hospital complications in surgical patients (OR: 2.7, 95% CI: 2.1–3.5 and ≥1 in conservative patients (OR: 3.0, 95% CI: 2.7–3.3 were predictors of prolonged LOS. Conclusion. The definition of prolonged LOS after ICH could be useful for several aspects of quality management and research. Preventing in-hospital complications could decrease the number of patients with prolonged LOS.

  10. Subarachnoid haemorrhage (SAH): long-term cognitive outcome in patients treated with surgical clipping or endovascular coiling.

    Science.gov (United States)

    Latimer, Sophie F; Wilson, F Colin; McCusker, Chris G; Caldwell, Sheena B; Rennie, Ian

    2013-05-01

    To compare long-term cognitive outcomes of patients treated with surgical clipping or endovascular coiling after subarachnoid haemorrhage (SAH). Retrospective matched cohort study assessed neuropsychological functioning at least 12 months after aneurysmal SAH treatment. Fourteen patients treated by endovascular coiling and nine patients treated by surgical clipping participated. After gaining written consent, a comprehensive neuropsychological battery was completed. Standardised tests were employed to assess pre-morbid and current intellectual functioning (IQ), attention, speed of information processing, memory and executive function as well as psychosocial functioning and affect. Treatment groups were not significantly different in terms of age, pre-morbid IQ, time from injury to treatment or time since injury. A significant effect of treatment on full-scale IQ score (p = 0.025), performance IQ (p = 0.045) and verbal IQ score (p = 0.029), all favouring the coiled group was observed. A medium effect size between groups difference in immediate memory (p = 0.19, partial η(2) = 0.08) was also observed. No significant between group differences on attention, executive functioning and speed of information processing measures or mood and psychosocial functioning were noted. Both groups reported increased anxiety and memory, attention and speed of information processing deficits relative to normative data. Study findings indicate fewer cognitive deficits following endovascular coiling. Cognitive deficits in the clipped group may be due in part to the invasive nature of neurosurgical clipping. Further prospective research with regard to long-term cognitive and emotional outcomes is warranted. IMPLICATIONS OF REHABILITATION: • Treatment of ruptured intracranial aneurysms by either endovascualar coiling or neurosurgical clipping can result in significant long-term physical disability as well as cognitive impairment. • Observed cognitive impairment(s) tend to be less in

  11. [Segmental sternal dislocation in children. Apropos of a surgically treated case].

    Science.gov (United States)

    Norotte, G; Peres, E; Vanderweyen, A; Razafindralasitra, P

    1997-01-01

    The authors report one operated case of traumatic sternal segmental dislocation in a child, and propose a mechanism for this uncommon lesion. A fourteen year old boy was admitted in emergency for anterior chest pain, occurring during an exercise in parallel bars without any fall. X ray showed traumatic dislocation of the upper sternal segment. After 12 hours, because of bad clinical tolerance (pain, dyspnea with sweats and disphagia) reduction and plate stabilization (Senegas plate) was performed with immediate pain relief. The boy returned to school after 10 days. Plate was removed two months later after healing, with good clinical and radiological results. According to rare published cases, conservative treatment can be proposed in very young children because of dislocation remodeling. By others, in case of bad tolerance, surgical treatment is suggested despite the inconvenient of device's removal. The originality of this case is the indirect lesion mechanism. Hypothesis is given by authors. Treatment by plate is easy and gives immediate pain relief with good clinical and radiological results in teen-agers.

  12. Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review.

    Science.gov (United States)

    Weitz, Marcus; Schmidt, Maria; Laube, Guido

    2017-12-01

    Ureteropelvic junction obstruction (UPJO) is the most common obstructive uropathy and its optimal management remains controversial. However, there is a current trend towards non-surgical management. We aimed to determine the effects of the non-surgical management in children with unilateral UPJO. For a systematic review, we searched MEDLINE, EMBASE, CENTRAL, clinical trials registries, and selected conference proceedings for eligible studies. Any type of study reporting the outcomes renal function, secondary surgical intervention, drainage pattern or hydronephrosis of non-surgical management in children with unilateral UPJO was included. Data from 20 studies were extracted and evaluated by two independent authors. The pooled prevalence was 21% for split renal function deterioration, 27.9% for secondary surgical intervention, 3.2% for progressive hydronephrosis, and 82.2% for improved drainage pattern. Not all patients with surgical intervention regained split renal function from enrolment. Renal imaging methods did not strongly correlate with each other. Many studies had to be excluded because of a lack of detection of an obstruction or mixed populations with bilateral UPJO or other uropathies. The variable definitions of UPJO, different criteria for surgical intervention, incongruity of management protocols, and the imprecise reporting of outcomes were limiting factors in the comparability of the results, leading to heterogeneity in meta-analyses. Although the available evidence cannot recommend or refute the current non-surgical management, the systematic review clarifies aspects of the ongoing controversy by providing realistic estimates for non-surgical management in children with unilateral UPJO. Additionally, it reveals unclear potential risks, particularly for long-term outcomes, which were rarely reported.

  13. Complete Atlantooccipital Assimilation with Basilar Invagination and Atlantoaxial Subluxation Treated Non-Surgically: A Case Report.

    Science.gov (United States)

    Electricwala, Ali J; Harsule, Amita; Chavan, Vishwajeet; Electricwala, Jaffer T

    2017-06-09

    Atlantooccipital assimilation is a partial or complete congenital fusion between the atlas and the base of the occiput. Most patients with atlas assimilation are asymptomatic, but some may present with neurological problems such as myelopathy. We present the case of a 37-year-old woman who presented with neck and occipital pain, episodic neck stiffness, and dizziness. Medical imaging revealed complete atlantooccipital assimilation associated with basilar invagination, atlantoaxial subluxation, and predisposing anterior spinal cord compression. The patient was treated non-operatively with medications, cervical interferential therapy, and a rigid cervical orthosis.

  14. Immediate chest wall reconstruction during pregnancy: surgical management after extended surgical resection due to primary sarcoma of the breast.

    Science.gov (United States)

    Arruda, Eduardo Gustavo; Munhoz, Alexandre Mendonça; Montag, Eduardo; Filassi, José Roberto; Gemperli, Rolf

    2014-01-01

    Breast sarcoma during pregnancy is an extremely rare event and represents a complex problem because of a more advanced stage at presentation. This report presents the first case of a 24-year-old woman with a gestational age of 20 weeks with a fast growing tumour in her left breast (29 × 19 × 15 cm) and infiltrating the skin/pectoralis muscles. Radical mastectomy was performed with a gestational age of 22 weeks and a different design was planned for the latissimus dorsi musculocutaneous flap (LDMF) with primary closure in the V-Y pattern. Satisfactory chest wall coverage and contour were achieved. Final histopathological findings allowed a diagnosis of undifferentiated sarcoma. With a gestational age of 37 weeks, a healthy infant was delivered by means of a caesarean section. The patient is currently in the second postoperative year and no recurrence has been observed. Management of a large breast sarcoma in a pregnant patient presents unique challenges in consideration of the potential risks to the foetus and the possible maternal benefit. The results of this study demonstrate that the VY-LDMF is a reliable technique and should be considered in cases of immediate large thoracic wound reconstruction. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Comparison of hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients

    Directory of Open Access Journals (Sweden)

    Haamid Bashir

    2012-11-01

    Full Text Available  Abstract Backgrounds: Thyroid hormones play an important physiological role in human metabolism. Erythrocyte abnormalities are frequently associated with thyroid disorder. However, they are rarely investigated and related to the subclinical and primary hypothyroidism in Kashmiri Patients. In this study an attempt was made to study hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients. Methods: This retrospective study included 600 subjects, among which were untreated subclinical hypothyroid (n=110, treated subclinical hypothyroid (n=110, untreated primary hypothyroid (n=100, treated primary hypothyroid (n=100 and euthyroid (n=180. This study was carried out at Department of Biochemistry, Government Medical College Srinagar. The hematological parameters and thyroid profile of the subjects were assessed by the Sysmex (Italy and ECLIA (Germany 2010 automatic analyzer. Mean, standard deviation (SD, analysis of variance (Two-way ANOVA, and multiple comparisons were used to report our results, with p<0.05 or p<0.01 considered as statistically significant. Results: In this study group we compared the hematological parameters in these groups, untreated subclinical hypothyroid, treated subclinical hypothyroid, untreated primary hypothyroid, treated primary hypothyroid and euthyroid. We found that hematological parameters like Hb, RBC, MCV, HCT, RDW,RBC% were significantly increased in untreated subclinical hypothyroidism and untreated primary hypothyroidsm, with the p value being less than 0.05 whereas, in treated SCH & Pr. Hypothyroid, results were insignificant. The results reported in these groups as mean±SD, were statistically tested by ANOVA and multiple comparison tests. In untreated subclinical hypothyroid the values were: Hb (10.83±1.33 g/dl , RBC (4.21±0.66 106/μl, MCV (84.56±6.84 fL, HCT (38.5±2.2 %, RDW (17.91±2.37 fL, RBC% (84.36±13.2 % and in untreated primary

  16. Chemotherapy effectiveness and mortality prediction in surgically treated osteosarcoma dogs: A validation study.

    Science.gov (United States)

    Schmidt, A F; Nielen, M; Withrow, S J; Selmic, L E; Burton, J H; Klungel, O H; Groenwold, R H H; Kirpensteijn, J

    2016-03-01

    Canine osteosarcoma is the most common bone cancer, and an important cause of mortality and morbidity, in large purebred dogs. Previously we constructed two multivariable models to predict a dog's 5-month or 1-year mortality risk after surgical treatment for osteosarcoma. According to the 5-month model, dogs with a relatively low risk of 5-month mortality benefited most from additional chemotherapy treatment. In the present study, we externally validated these results using an independent cohort study of 794 dogs. External performance of our prediction models showed some disagreement between observed and predicted risk, mean difference: -0.11 (95% confidence interval [95% CI]-0.29; 0.08) for 5-month risk and 0.25 (95%CI 0.10; 0.40) for 1-year mortality risk. After updating the intercept, agreement improved: -0.0004 (95%CI-0.16; 0.16) and -0.002 (95%CI-0.15; 0.15). The chemotherapy by predicted mortality risk interaction (P-value=0.01) showed that the chemotherapy compared to no chemotherapy effectiveness was modified by 5-month mortality risk: dogs with a relatively lower risk of mortality benefited most from additional chemotherapy. Chemotherapy effectiveness on 1-year mortality was not significantly modified by predicted risk (P-value=0.28). In conclusion, this external validation study confirmed that our multivariable risk prediction models can predict a patient's mortality risk and that dogs with a relatively lower risk of 5-month mortality seem to benefit most from chemotherapy. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Is surgical debridement necessary in the diabetic foot treated with photodynamic therapy?

    Science.gov (United States)

    Tardivo, João Paulo; Serrano, Rodrigo; Zimmermann, Lívia Maria; Matos, Leandro Luongo; Baptista, Mauricio S; Pinhal, Maria Aparecida Silva; Atallah, Álvaro N

    2017-01-01

    Background : Diabetic patients are susceptible to developing foot ulcers with serious complications such as osteomyelitis and amputations. Treatment approaches are still empirical and the benefit of usual procedures such as surgical debridement has not been properly evaluated. Photodynamic Therapy (PDT) is a non-invasive and highly efficient method for the treatment of the diabetic foot, being able to eradicate the infection and to stimulate healing, decreasing considerably the amputation risk. In the day-to-day practice of our service, we have been faced with the question whether debridement is necessary before PDT. In here, we designed a study to answer that question. Methods : Patients were divided in two groups: In one of the groups (n = 17), debridement was performed before PDT and in the other (n = 40) only PDT treatment was performed. PDT sessions were performed once a week in all patients until healing was achieved, as indicated by visual inspection as well as by radiographic and laboratory exams. At the start of the study, the two groups had no statistical differences concerning their clinical features: average age, gender, insulin use, diabetes mellitus onset time and previous amputations. Results : PDT was effective in the treatment of 100% of the patients showing no relapses after one year of follow up. The group submitted to PDT without previous debridement had a statistically significant (p = 0.036, Mann-Whitney) shorter cure time (29 days, ~27%). Conclusion : Our data indicates that debridement is not necessary in the treatment of diabetic foot in patients that have enough peripheral arterial perfusion. In addition, we reproduced previous studies confirming that PDT is an efficient, safe, simple and affordable treatment method for the diabetic foot.

  18. An intact fibula may contribute to allow early weight bearing in surgically treated tibial plateau fractures.

    Science.gov (United States)

    Carrera, Ion; Gelber, Pablo Eduardo; Chary, Gaetan; Gomez Masdeu, Mireia; González Ballester, Miguel A; Monllau, Juan Carlos; Noailly, Jerome

    2018-03-01

    The role of the proximal tibiofibular joint (PTFJ) in tibial plateau fractures is unknown. The purpose of this study was to assess, with finite-element (FE) calculations, differences in interfragmentary movement (IFM) in a split fracture of lateral tibial plateau, with and without intact fibula. It was hypothesized that an intact fibula could positively contribute to the mechanical stabilization of surgically reduced lateral tibial plateau fractures. A split fracture of the lateral tibial plateau was recreated in an FE model of a human tibia. A three-dimensional FE model geometry of a human femur-tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. The fracture was reproduced using geometrical data from patient radiographs, and two models were created: one with intact fibula and other without fibula. A locking screw plate and cannulated screw systems were modelled to virtually reduce the fracture, and 80 kg static body weight was simulated. Under mechanical loads, the maximum interfragmentary movement achieved with the fibula was about 30% lower than without fibula, with both the cannulated screws and the locking plate. When the locking plate model was loaded, intact fibula contributed to lateromedial forces on the fractured fragments, which would be clinically translated into increased normal compression forces in the fractured plane. The intact fibula also reduced the mediolateral forces with the cannulated screws, contributing to stability of the construct. This FE model showed that an intact fibula contributes to the mechanical stability of the lateral tibial plateau. In combination with a locking plate fixation, early weight bearing may be allowed without significant IFM, contributing to an early clinical and functional recovery of the patient.

  19. The activity of gastric ghrelin positive cells in obese patients treated surgically.

    Directory of Open Access Journals (Sweden)

    Artur Bossowski

    2009-12-01

    Full Text Available Ghrelin is a 28 amino acid peptide hormone regulating food intake and stimulating releasement of growth hormone. It is produced in a distinct endocrine call known as X/A - like cells. The most abundant source of this very important factor in energy homeostasis is gastric fundus. Regulatory mechanisms of ghrelin synthesis and secretion in physiological and pathological states are not discovered completely. The aim of our study was evaluation of the activity of gastric X/A-like cells in obese patients before and after the most popular surgical bariatric procedures - Roux - Y Gastric Bypass (RYGB and Laparoscopic Adjustable Gastric Banding (LAGB. Obese patients in number 18 took part in the study. LAGB was performed in 7 patients and RYGB in 11 patients. Peripheral blood was taken from each patient before operation and first day, seventh day, one month and three months after surgery. Ghrelin level was determined by RIA technique. The specimen of stomach was taken from circular stapler after gastrojejunostomy during RYGB and immunohistochemical study of gastric mucosa, using the EnVision method and specific monoclonal antybodies against ghrelin was performed. The intensity of ghrelin-immunoreactivity in X/A-like cells was analyzed using Olympus Cell D image analysis system. Efficiency of bariatric procedures was estimated by EWL- excess weight loss. We observed very strong immunohistochemical reactions of gastric X/A-like cells, accompanied by lower ghrelin plasma concentration, in comparison to the control group. LAGB procedure induced increase of ghrelin plasma level while RYGB procedure induced decrease of this hormone. The main finding of the present study is the hypoactivity of gastric X/A-like cells in obese patients in comparison to the control group.

  20. Collaborative care psychiatrists’ views on treating bipolar disorder in primary care: a qualitative study

    Science.gov (United States)

    Cerimele, Joseph M.; Halperin, Abigail C.; Spigner, Clarence; Ratzliff, Anna; Katon, Wayne J.

    2014-01-01

    Objective To understand collaborative care psychiatric consultants’ views and practices on making the diagnosis of and recommending treatment for bipolar disorder in primary care using collaborative care. Method We conducted a focus group at the University of Washington in December 2013 with nine psychiatric consultants working in primary care-based collaborative care in Washington State. A grounded theory approach with open coding and the constant comparative method revealed categories where emergent themes were saturated and validated through member checking, and a conceptual model was developed. Results Three major themes emerged from the data including the importance of working as a collaborative care team, the strengths of collaborative care for treating bipolar disorder, and the need for psychiatric consultants to adapt specialty psychiatric clinical skills to the primary care setting. Other discussion topics included gathering clinical data from multiple sources over time, balancing risks and benefits of treating patients indirectly, tracking patient care outcomes with a registry, and effective care. Conclusion Experienced psychiatric consultants working in collaborative care teams provided their perceptions regarding treating patients with bipolar illness including identifying ways to adapt specialty psychiatric skills, developing techniques for providing team-based care, and perceiving the care delivered through collaborative care as high quality. PMID:25174762

  1. Collaborative care psychiatrists' views on treating bipolar disorder in primary care: a qualitative study.

    Science.gov (United States)

    Cerimele, Joseph M; Halperin, Abigail C; Spigner, Clarence; Ratzliff, Anna; Katon, Wayne J

    2014-01-01

    To understand collaborative care psychiatric consultants' views and practices on making the diagnosis of and recommending treatment for bipolar disorder in primary care using collaborative care. We conducted a focus group at the University of Washington in December 2013 with nine psychiatric consultants working in primary-care-based collaborative care in Washington State. A grounded theory approach with open coding and the constant comparative method revealed categories where emergent themes were saturated and validated through member checking, and a conceptual model was developed. Three major themes emerged from the data including the importance of working as a collaborative care team, the strengths of collaborative care for treating bipolar disorder and the need for psychiatric consultants to adapt specialty psychiatric clinical skills to the primary care setting. Other discussion topics included gathering clinical data from multiple sources over time, balancing risks and benefits of treating patients indirectly, tracking patient care outcomes with a registry and effective care. Experienced psychiatric consultants working in collaborative care teams provided their perceptions regarding treating patients with bipolar illness including identifying ways to adapt specialty psychiatric skills, developing techniques for providing team-based care and perceiving the care delivered through collaborative care as high quality. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Reporting of Randomized Controlled Trials With Statistically Nonsignificant Primary Outcomes Published in High-impact Surgical Journals.

    Science.gov (United States)

    Arunachalam, Lakshmanan; Hunter, Iain A; Killeen, Shane

    2017-06-01

    To determine the nature and frequency of distorted presentation or "spin" (ie, specific reporting strategies which highlight that the experimental treatment is beneficial, despite a statistically nonsignificant difference for the primary outcome, or distract the reader from statistically nonsignificant results) in published reports of randomized controlled trials (RCTs) with statistically nonsignificant results for primary outcomes in surgical journals. Multiple reports have suggested that interpretation of RCT results in medical journals can be distorted by authors of published reports. Using a defined search strategy, RCTs with clearly nonsignificant results for the primary outcome (P > 0.05) form 10 high-impact factor surgical journals (Annals of Surgery, Journal of Neurology, Neurosurgery and Psychiatry, Journal of Heart and Lung Transplantation, American Journal of Transplantation, British Journal of Surgery, Journal of Bone and Joint Surgery, Journal of the American College of Surgeons, Endoscopy, Archives of Surgery, and Liver transplantation), published between July 2013 to July 2015, were identified. Two reviewers independently appraised each selected article using a validated, standardized data abstraction form. In all, 110 eligible RCTs with nonsignificant primary outcomes were appraised. The title was reported with spin in 8 (7%) articles. Forty-four (40%) included abstracts and 39 (35%) main texts were classified as having spin in at least 1 section. The level of spin was high in 16 (14%) abstract and 19 (19%) main-text "Conclusions" sections. Twenty-five articles (23%) recommended the intervention of interest despite a nonsignificant primary outcome. There was no relationship between trial funding source, use of statistician and article section, and the presence of spin. In RCTs with statistically nonsignificant primary outcomes published in surgical journals, the reporting and interpretation of findings was frequently inconsistent with the results.

  3. Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing?

    Science.gov (United States)

    Magnussen, Robert A; Verlage, Megan; Stock, Elizabeth; Zurek, Lauren; Flanigan, David C; Tompkins, Marc; Agel, Julie; Arendt, Elizabeth A

    2017-08-01

    While a significant research has gone into identifying patients at highest risk of recurrence following primary patellar dislocation, there has been little work exploring the outcomes of patients who do not have a recurrent patellar dislocation. We hypothesize that patients without recurrent dislocation episodes will exhibit significantly higher KOOSs than those who suffer recurrent dislocations, but lower scores than published age-matched normative data. A retrospective review of patients with nonoperatively treated primary lateral patellar dislocations was carried out, and patients were contacted at a mean of 3.4 years (range 1.3-5.5 years) post-injury. Information regarding subsequent treatment and recurrent dislocations along with patient-reported outcome scores and activity level was collected. One hundred and eleven patients (29.8 %) of 373 eligible patients agreed to study participation, seven of whom were excluded because they underwent subsequent patellar stabilization surgery on the index knee. Seventy-six patients (73.1 %) reported no further dislocation events, and the mean KOOS subscales at follow-up were: symptoms-80.2 ± 18.8, pain-81.8 ± 16.2, ADL-88.7 ± 15.9, sport/recreation-72.1 ± 24.4, and QOL-63.9 ± 23.8 at a mean follow-up of 3.3 years (range 1.3-5.5 years). No significant differences in any of the KOOS subscales were noted between these patients and the group that reported recurrent patellar dislocations. Only 26.4 % of the patients without further dislocations reported they were able to return to desired sport activities without limitations following their dislocation. Patients who do not report recurrent patellar dislocations following nonoperative treatment of primary patellar dislocations are in many cases limited by this injury 3 years following the initial dislocation event. Retrospective cohort study, Level III.

  4. Autopsy findings in surgical-radiotherapeutically treated bladder carcinoma - conclusions for optimization of radiotherapy

    International Nuclear Information System (INIS)

    Fueller, J.; Kob, D.; Fritzsche, V.

    1989-01-01

    Autopsy findings in patients with bladder carcinoma, treated by combined operation and radiotherapy, revealed tendencies of tumor spread as well as complications and late effects of radiotherapy. In 24.5% of the cases tumor tissue was found within the bladder and in 30.5% within the minor pelvis. Metastases were found in 24.1% in iliac lymph nodes, in 21.3% in abdominal lymph nodes. Liver, lungs, bones, and kidneys are main organs for hematological metastasizing. Little or undifferentiated carcinomas and squamous cell carcinomas showed a greater tendency to metastasize than highly and medium-differentiated ureteral carcinomas. The least radiotherapeutical complications and late effects were found in a fractionation with daily 1.5 Gy and a total dose of 60 Gy. (author)

  5. Surgical results and MRI findings of cervical myelopathy treated with anterior decompression and fusion

    International Nuclear Information System (INIS)

    Miyazato, Takenari; Teruya, Yoshimitsu; Kinjo, Yukio

    1995-01-01

    We reviewed 19 patients with cervical myelopathy treated with anterior decompression and fusion. Etiology of cervical myelopathy was cervical disc herniation (CDH) in 13 patients and cervical spondylosis (CSM) in 6. Clinical recovery rate (%) was calculated from preoperative cervical myelopathy score (JOA) and the score at follow-up. Correlation between the clinical recovery rate and MRI findings (area and flatness at the narrowest part of the spinal cord), age at surgery, duration of myelopathy and pre-operative clinical score were analyzed separately in the CDH and CSM groups. Clinical recovery rate averaged 69% in the CDH group and 75% in the CSM group. In the CDH group, average clinical recovery rate in patients younger than 60 years was 80 and in patients over 60 years was 60. There was a significant negative correlation between the clinical recovery rate and age at surgery (p<0.05). No significant correlation was found between the clinical recovery rate and other factors investigated. (author)

  6. Surgical results and MRI findings of cervical myelopathy treated with anterior decompression and fusion

    Energy Technology Data Exchange (ETDEWEB)

    Miyazato, Takenari; Teruya, Yoshimitsu [Chubu Tokushukai Hospital, Okinawa (Japan); Kinjo, Yukio [and others

    1995-09-01

    We reviewed 19 patients with cervical myelopathy treated with anterior decompression and fusion. Etiology of cervical myelopathy was cervical disc herniation (CDH) in 13 patients and cervical spondylosis (CSM) in 6. Clinical recovery rate (%) was calculated from preoperative cervical myelopathy score (JOA) and the score at follow-up. Correlation between the clinical recovery rate and MRI findings (area and flatness at the narrowest part of the spinal cord), age at surgery, duration of myelopathy and pre-operative clinical score were analyzed separately in the CDH and CSM groups. Clinical recovery rate averaged 69% in the CDH group and 75% in the CSM group. In the CDH group, average clinical recovery rate in patients younger than 60 years was 80 and in patients over 60 years was 60. There was a significant negative correlation between the clinical recovery rate and age at surgery (p<0.05). No significant correlation was found between the clinical recovery rate and other factors investigated. (author).

  7. Factors affected by surgical technique when treating total colonic aganglionosis: laparoscopy-assisted versus open surgery.

    Science.gov (United States)

    Miyano, Go; Ochi, Takanori; Lane, Geoffrey J; Okazaki, Tadaharu; Yamataka, Atsuyuki

    2013-04-01

    We compared laparoscopy-assisted Duhamel (Lap-D) with open surgery (Duhamel or Soave = D/S) for treating total colonic aganglionosis (TCA) in children to establish what factors may affect outcome. Fourteen TCA cases treated between 1990 and 2010 were reviewed. Open D/S (O-D/S) through a vertical midline abdominal incision was routine from 1990 to 2005, whereupon Lap-D became routine. Lap-D involves laparoscopic colon resection, ileostomy take-down, and ileum pull-through through an additional Pfannenstiel incision. We compared pre-operative nutrition, operating time, intraoperative blood loss, duration until oral challenge, postoperative analgesic usage, incidence of enterocolitis, early complications that arose within 30 days of surgery, and late complications, and wound cosmesis 1 year postoperatively (Grade-1: unacceptable, Grade-2: passable, Grade-3: excellent). Six had O-D/S (2D, 4S) and eight had Lap-D. Differences in patient demographics, mean ages/weights at surgery, average length of the aganglionic segment from the terminal ileum, operating time, and time taken for oral challenge were all not significant, full feeding took longer in O-D/S (6.7 vs. 5.9 days). Preoperative central vein intravenous hyperalimentation was required for one case in O-D/S and two cases in Lap-D. These three required hospitalization for at least 30 days postoperatively and parenteral nutrition after discharge. Although there were no intraoperative complications in either group, there was one case of transient ileus in O-D/S that resolved conservatively. Cosmesis was significantly better in Lap-D (O-D/S = 1.2; Lap-D = 2.1; p < 0.05). Cosmesis was the only factor that was significantly different between Lap-D and O-D/S; all other factors were similar.

  8. Endophthalmitis associated with Purpureocillium lilacinum during infliximab treatment for surgically induced necrotizing scleritis, successfully treated with 27-gauge vitrectomy.

    Science.gov (United States)

    Yoshida, Masaaki; Yokokura, Shunji; Kunikata, Hiroshi; Takada, Naoko; Maruyama, Kazuichi; Toyokawa, Masahiro; Kashio, Kazushi; Kaku, Mitsuo; Nakazawa, Toru

    2017-04-20

    To report a case of endophthalmitis associated with Purpureocillium lilacinum (P. lilacinum) during infliximab treatment for surgically induced necrotizing scleritis, successfully treated with 27-gauge vitrectomy. A single case report. A 71-year-old man who had undergone immunosuppressive therapy, including infliximab, for surgically induced necrotizing scleritis (SINS) in his left eye complained of visual disturbance and eye pain in the eye. He had a past history of surgery for recurrent pterygium: pterygium excision, amnion transplantation with mitomycin C and limbal transplantation. Visual acuity in the left eye was counting fingers at 30 cm, and intraocular pressure was 3.0 mmHg. Slit-lamp examination revealed the presence of anterior chamber cells (3+), and a B-mode ultrasound scan showed a vitreous opacity. We made a diagnosis of endophthalmitis and performed 27-gauge microincision vitrectomy surgery (27GMIVS) with antibiotic perfusion of ceftazidime, vancomycin and voriconazole. Intraoperative findings included a fungus-like ball-shaped opacity in the vitreous, and a close-to-normal retinal appearance. A vitreous body culture identified the presence of P. lilacinum. After 2 months of antibacterial and antifungal therapy, inflammation decreased and visual acuity recovered to 20/100. This is the first report of a case of endophthalmitis associated with P. lilacinum during infliximab treatment for SINS. Scleral thinning due to necrotizing scleritis, especially during immunosuppressive therapy, is a risk factor for endophthalmitis. We found that 27GMIVS was a useful strategy for such a challenging clinical situation.

  9. Does surgical volume affect outcome after primary and revision knee arthroplasty? A systematic review of the literature.

    Science.gov (United States)

    Critchley, R J; Baker, P N; Deehan, D J

    2012-10-01

    In 2009 there were 72,980 primary and 4565 revision knee arthroplasties performed in England and Wales [1]. Given the large number of procedures done annually any factors that may influence outcome and benefit the patient must be considered seriously. To find out whether a relationship exists between hospital and surgical volume and patient outcomes for primary and revision knee arthroplasty. A systematic review of the literature was performed to evaluate the current evidence using the PRISMA criteria [2]. A computerised literature search was performed on the electronic databases PubMed, Medline, Embase and CINAHL between 1973 and 2011. All abstracts, in the English language, pertaining to either surgical or hospital volume and outcome after primary and revision knee arthroplasty between 1973 and 2011 were considered. Outcomes of interest included morbidity, mortality, clinical and economic outcomes. Both the orthopaedic and surgical specialties literature demonstrates a clear and consistent relationship between both surgeon and hospital volume with outcome, higher volume being associated with improved patient outcomes. In view of the literature consideration should be given to whether all orthopaedic operations should be carried out by all surgeons in all hospitals. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. Gastroduodenal and ileal polyps in patients treated surgically for familial polyposis coli with proctocolectomy and continent ileostomy.

    Science.gov (United States)

    Ojerskog, B; Myrvold, H E; Nilsson, L O; Philipson, B M; Ahrén, C

    1987-01-01

    Eighteen patients, who previously had been treated surgically for familial polyposis coli with proctocolectomy and a continent ileostomy were re-investigated with endoscopy and X-ray for gastric, duodenal and ileal polyps. Gastric and/or duodenal polyps were found in 6 patients and ileal polyps in 2. Altogether upper GI-polyps were found in 7 patients (39%). Most polyps were true adenomas. In one patient with large gastric adenomas, the severe dysplasia called for a gastric resection. It is obvious that familial polyposis may affect the whole gastro-intestinal tract, therefore necessitating regular surveillance of the upper GI-canal as well as the colon and rectum in patients with this hereditary affliction.

  11. Study of serum ctx in 50 oral surgical patients treated with oral bisphosphonates

    Science.gov (United States)

    Flichy-Fernández, Antonio J.; Alegre-Domingo, Teresa; González-Lemonnier, Sandra; Balaguer-Martínez, José; Jiménez-Soriano, Yolanda; Peñarrocha-Diago, David; Bagán-Sebastián, José V.

    2012-01-01

    Objectives: To determine whether there is a relationship between the total BP dose administered and the variations in serum CTX concentration. Study design: The study included 50 patients requiring dental implant surgery and treated with oral BPs, seen in an Oral Surgery and Implantology Unit between January 2007 and June 2009. The patients were divided into two groups: those in which the medication was not suspended before obtaining the laboratory test sample, and those patients referred from other dental clinics in which BPs was suspended before reporting to our Unit. The total drug dosage administered and the total dose per kilogram body weight were evaluated for comparison with serum CTX. The data obtained were correlated to the osteonecrosis risk table developed by Marx et al. in 2007. Results: There were no significant differences between the two groups in relation to the total administered dose and the dose in mg/kg b.w. Likewise, in both groups no relationship was observed between the serum CTX value and the total administered dose or the dose in mg/kg b.w. No differences were found between the two patient groups regarding chemical osteonecrosis risk based on the criteria of Marx et al. Conclusions: No relationship was observed between the oral BP dose administered (total dose or expressed in mg/kg b.w.) and serum CTX concentration, and suspension of the medication did not influence the serum CTX levels. Key words:Serum CTX, osteonecrosis, oral bisphosphonates. PMID:22143730

  12. The surprising outcome of a giant primary mediastinal synovial sarcoma treated with neoadjuvant chemotherapy.

    Science.gov (United States)

    Balieiro, Marcos Alexandre; Lopes, Agnaldo José; Costa, Bruno Pinheiro; Veras, Gustavo Perissé Moreira; Perelson, Paulo Sergio; Acatauassú Nunes, Rodolfo; Saito, Eduardo Haruo

    2013-02-01

    There are only a few cases of primary mediastinal synovial sarcoma in the literature. Normally, they do not respond well to chemotherapy. In our case, a 30-year-old patient was admitted due to thoracic pain, dyspnea, orthopnea, cough, hoarseness and weight loss over a 3-month period as well as a dramatic worsening a week before the admission. A chest radiography showed a completely white left hemithorax and contralateral mediastinal shift; in addition, a chest tomography revealed a giant heterogeneous mediastinal mass, lung atelectasia and a small pleural effusion. The patient was submitted to Chamberlain procedure (biopsy) under local anesthesia and the diagnosis of a synovial sarcoma was obtained after immunohistochemical analysis. Due to his poor general condition, he received chemotherapy first, with a dramatic response, after what, the mass that had been reduced was removed surgically. After a 5-year- follow-up period there are no signs of disease recurrence.

  13. A retrospective analysis of 33 primary intraspinal tumors treated with postoperative radiotherapy

    International Nuclear Information System (INIS)

    Li Li; Xu Changshao; Zhou Juying; Yu Zhiying; Xu Xiaoting

    2005-01-01

    Objective: To describe the clinical characteristics, outcome and prognostic factors of primary intraspinal tumor treated with postoperative radiotherapy. Methods: Thirty-three patients diagnosed as suffering from intraspinal tumor treated with postoperative radiotherapy were analyzed. There were eighteen male and fifteen female, with a median age of 37 years (range 7-64 years). Two patients were treated with grossly total resection, 25 subtotal resection, 2 biopsy only. These patients were treated either with 60 Co (n=18, before 1998) or 6 MV-X ray (n=15, after 1998) to the total dose of 45-68 Gy. The overall response and survival rates were calculated by Kaplan-Meier method and the difference between groups was tested by the log-rank method. The prognostic factors related to the characteristics of patient, tumor, and treatment were determined. Results: The overall response, five-year and disease-free survival rate was 81.3%, 59.4% and 56.3%, respectively. By multivariate analysis, the histological type (P=0.039) and gender (P=0.049) had independent impact on the 5-year survival rate. Ependymoma had a better prognosis compared to other histological subsets and female gained more survival advantage over male. There was no close relationship between survival and other factors, such as age, extent of surgery, initial site, irradiation dose, or the interval between surgery and radiotherapy. Conclusions: Postoperative radiotherapy is safe and effective for primary intraspinal tumor. The histological type and gender are important prognostic factors of survival in primary intraspinal tumors. (authors)

  14. The role of oncoplastic breast surgery in the management of breast cancer treated with primary chemotherapy.

    Science.gov (United States)

    Mazouni, Chafika; Naveau, Alix; Kane, Aminata; Dunant, Ariane; Garbay, Jean-Rémi; Leymarie, Nicolas; Sarfati, Benjamin; Delaloge, Suzette; Rimareix, Françoise

    2013-12-01

    The purpose of this study was to evaluate the benefit of Oncoplastic Breast Conserving Surgery (BCS) compared to standard BCS after primary CT, in terms of oncologic safety and cosmetic outcomes. The development of new drugs has led to greater use of primary chemotherapy (CT) for bulky breast cancer (BC) and has allowed wider indications for conservative surgery. We identified 259 patients consecutively treated with BCS for primary BC from January 2002 to November 2010. All patients had undergone Oncoplastic Breast Surgery (OBS) or standard BCS after primary CT. Mastectomy rates, and oncological and cosmetic outcomes were compared. A total of 45 OBS and 214 standard BCS were analyzed. The median tumor size was 40 mm in the two groups (p = 0.66). The median operative specimen volumes were larger in the OBS group than in the standard group (respectively, 180 cm3 and 98 cm3, p Oncoplastic Breast Conserving Surgery (BCS) after primary chemotherapy allows wider breast resection than standard BCS. Survival and relapse probabilities are similar in both groups. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year followup

    DEFF Research Database (Denmark)

    Ageberg, Eva; Thomeé, Roland; Neeter, Camille

    2008-01-01

    surgery in restoring muscle function is unclear. METHODS: Of 121 patients with ACL injury included in a randomized controlled trial on training and surgical reconstruction versus training only (the Knee, Anterior cruciate ligament, NON-surgical versus surgical treatment [KANON] study, ISRCTN: 84752559...... Symmetry Index (LSI; injured leg divided by uninjured and multiplied by 100) value and absolute values were used for comparisons between groups (analysis of variance). An LSI >or=90% was considered normal. RESULTS: There were no differences between the surgical and nonsurgical treatment groups in muscle...... strength or functional performance. Between 44% and 89% of subjects had normal muscle function in the single tests, and between 44% and 56% had normal function in the test batteries. CONCLUSION: The lack of differences between patients treated with training and surgical reconstruction or training only...

  16. Primary care models for treating opioid use disorders: What actually works? A systematic review.

    Directory of Open Access Journals (Sweden)

    Pooja Lagisetty

    Full Text Available Primary care-based models for Medication-Assisted Treatment (MAT have been shown to reduce mortality for Opioid Use Disorder (OUD and have equivalent efficacy to MAT in specialty substance treatment facilities.The objective of this study is to systematically analyze current evidence-based, primary care OUD MAT interventions and identify program structures and processes associated with improved patient outcomes in order to guide future policy and implementation in primary care settings.PubMed, EMBASE, CINAHL, and PsychInfo.We included randomized controlled or quasi experimental trials and observational studies evaluating OUD treatment in primary care settings treating adult patient populations and assessed structural domains using an established systems engineering framework.We included 35 interventions (10 RCTs and 25 quasi-experimental interventions that all tested MAT, buprenorphine or methadone, in primary care settings across 8 countries. Most included interventions used joint multi-disciplinary (specialty addiction services combined with primary care and coordinated care by physician and non-physician provider delivery models to provide MAT. Despite large variability in reported patient outcomes, processes, and tasks/tools used, similar key design factors arose among successful programs including integrated clinical teams with support staff who were often advanced practice clinicians (nurses and pharmacists as clinical care managers, incorporating patient "agreements," and using home inductions to make treatment more convenient for patients and providers.The findings suggest that multidisciplinary and coordinated care delivery models are an effective strategy to implement OUD treatment and increase MAT access in primary care, but research directly comparing specific structures and processes of care models is still needed.

  17. Primary Vaginal Cancer Treated With Concurrent Chemoradiation Using Cis-Platinum

    International Nuclear Information System (INIS)

    Samant, Rajiv; Lau, Bedy; E, Choan; Le, Tien; Tam, Tiffany

    2007-01-01

    Purpose: To evaluate the feasibility of concurrent weekly Cis-platinum chemoradiation (CRT) in the curative treatment of primary vaginal cancer. Methods: A retrospective review was performed of all primary vaginal cancer patients treated with curative intent at the Ottawa Hospital Regional Cancer Centre between 1999 and 2004 using concurrent Cis-platinum CRT. Results: Twelve patients were treated with concurrent weekly CRT. The median age at diagnosis was 56 years (range, 34-69 years), and the median follow-up was 50 months (range, 11-75 months). Ten patients (83%) were diagnosed with squamous cell carcinoma and 2 patients (17%) with adenocarcinoma. The distribution according to stage was as follows: 6 (50%) Stage II, 4 (33%) Stage III, and 2 (17%) Stage IVA. All patients received pelvic external beam radiotherapy (EBRT) concurrently with weekly intravenous Cis-platinum chemotherapy (40 mg/m 2 ) followed by brachytherapy (BT). The median dose of EBRT was 4500 cGy given in 25 fractions over 5 weeks. Ten patients received interstitial BT, and 2 patients received intracavitary BT, with the median dose being 3000 cGy. The 5-year overall survival, progression-free survival, and locoregional progression-free survival rates were 66%, 75%, and 92%, respectively. Late toxicity requiring surgery occurred in 2 patients (17%). Conclusions: For the treatment of primary vaginal cancer, it is feasible to deliver concurrent weekly Cis-platinum chemotherapy with high-dose radiation, leading to excellent local control and an acceptable toxicity profile

  18. Skin tumour surgery in primary care: do general practitioners need to improve their surgical skills?

    NARCIS (Netherlands)

    Rijsingen, M.C.J. van; Vossen, R.; Huystee, B.E.W.L. van; Gorgels, W.J.; Gerritsen, M.J.P.

    2015-01-01

    BACKGROUND: Due to a rapid increase in the incidence of skin cancer, it seems inevitable that general practitioners (GPs) will play a larger role in skin cancer care. OBJECTIVES: To assess surgical procedures used by GPs in skin tumour management. METHODS: We performed a retrospective study of 1,898

  19. Executive dysfunction in patients with chronic primary insomnia treated with clonazepam.

    Science.gov (United States)

    Contreras-González, Noé; Téllez-Alanís, Bernarda; Haro, Reyes; Jiménez-Correa, Ulises; Poblano, Adrián

    2015-01-01

    Clonazepam (CNZ) is a drug used for insomnia treatment. Our objective was to search CNZ effects on executive functions (EF) in patients with chronic primary insomnia (CPI)-CNZ treated. Ninety participants were studied divided into three groups: a group of patients with CPI only (n = 30), a group of patients with CPI-CNZ treated (n = 30) and a healthy control drug-free subjects group (n = 30). EF were examined by means of E-Prime and by the Tower of London tests. Data of the EF were compared between groups, and correlation calculations between EF and CNZ dose were performed. Patients with CPI-CNZ treated showed more deleterious effects on EF (attention, inhibition, working memory, planning, cognitive flexibility, and monitoring) than patients with CPI only. Attention and cognitive flexibility correlated with CNZ dose. In conclusion, CNZ treatment was associated with deficits in some EF in patients with CPI-CNZ treated compared to CPI only and controls. We found a dose dependency between CNZ and some EF deficits.

  20. Treating late-life generalized anxiety disorder in primary care: an effectiveness pilot study.

    Science.gov (United States)

    Calleo, Jessica S; Bush, Amber L; Cully, Jeffrey A; Wilson, Nancy L; Kraus-Schuman, Cynthia; Rhoades, Howard M; Novy, Diane M; Masozera, Nicholas; Williams, Susan; Horsfield, Matthew; Kunik, Mark E; Stanley, Melinda A

    2013-05-01

    To increase the sustainability of cognitive behavior therapy (CBT) in primary care for late-life anxiety, we incorporated nonexpert counselors, options for telephone meetings, and integration with primary care clinicians. This open trial examines the feasibility, satisfaction, and clinical outcomes of CBT delivered by experienced and nonexperienced counselors for older adults with generalized anxiety disorder (GAD). Clinical outcomes assessed worry (Penn State Worry Questionnaire), GAD (Generalized Anxiety Disorder Severity Scale), and anxiety (Beck Anxiety Inventory and Structured Interview Guide for Hamilton Anxiety Scale). After 3 months of treatment, Cohen's d effect sizes for worry and anxiety ranged from 0.48 to 0.78. Patients treated by experienced and nonexperienced counselors had similar reductions in worry and anxiety, although treatment outcomes were more improved on the Beck Anxiety Inventory for experienced therapists. Preliminary results suggest that adapted CBT can effectively reduce worry. The piloted modifications can provide acceptable and feasible evidence-based care.

  1. Preliminary results from digestive adaptation: a new surgical proposal for treating obesity, based on physiology and evolution

    Directory of Open Access Journals (Sweden)

    Sérgio Santoro

    Full Text Available CONTEXT AND OBJECTIVE: Most bariatric surgical techniques include essentially non-physiological features like narrowing anastomoses or bands, or digestive segment exclusion, especially the duodenum. This potentially causes symptoms or complications. The aim here was to report on the preliminary results from a new surgical technique for treating morbid obesity that takes a physiological and evolutionary approach. DESIGN AND SETTING: Case series description, in Hospital Israelita Albert Einstein and Hospital da Polícia Militar, São Paulo, and Hospital Vicentino, Ponta Grossa, Paraná. METHODS: The technique included vertical (sleeve gastrectomy, omentectomy and enterectomy that retained three meters of small bowel (initial jejunum and most of the ileum, i.e. the lower limit for normal adults. The operations on 100 patients are described. RESULTS: The mean follow-up was nine months (range: one to 29 months. The mean reductions in body mass index were 4.3, 6.1, 8.1, 10.1 and 10.7 kg/m², respectively at 1, 2, 4, 6 and 12 months. All patients reported early satiety. There was major improvement in comorbidities, especially diabetes. Operative complications occurred in 7% of patients, all of them resolved without sequelae. There was no mortality. CONCLUSIONS: This procedure creates a proportionally reduced gastrointestinal tract, leaving its basic functions unharmed and producing adaptation of the gastric chamber size to hypercaloric diet. It removes the sources of ghrelin, plasminogen activator inhibitor-1 (PAI-1 and resistin production and leads more nutrients to the distal bowel, with desirable metabolic consequences. Patients do not need nutritional support or drug medication. The procedure is straightforward and safe.

  2. Long-Term Cognitive Functioning and Psychological Well-Being in Surgically Treated Patients with Low-Grade Glioma.

    Science.gov (United States)

    Campanella, Fabio; Palese, Alvisa; Del Missier, Fabio; Moreale, Renzo; Ius, Tamara; Shallice, Tim; Fabbro, Franco; Skrap, Miran

    2017-07-01

    The aim of this work is to provide an in-depth investigation of the impact of low-grade gliomas (LGG) and their surgery on patients' cognitive and emotional functioning and well-being, carried out via a comprehensive and multiple-measure psychological and neuropsychological assessment. Fifty surgically treated patients with LGG were evaluated 40 months after surgery on their functioning over 6 different cognitive domains, 3 core affective/emotional aspects, and 3 different psychological well-being measures to obtain a clearer picture of the long-term impact of illness and surgery on their psychological and relational world. Close relatives were also involved to obtain an independent measure of the psychological dimensions investigated. Cognitive status was satisfactory, with only mild short-term memory difficulties. The affective and well-being profile was characterized by mild signs of depression, good satisfaction with life and psychological well-being, and good personality development, with patients perceiving themselves as stronger and better persons after illness. However, patients showed higher emotional reactivity, and psychological well-being measures were negatively affected by epileptic burden. Well-being was related to positive affective/emotional functioning and unrelated to cognitive functioning. Good agreement between patients and relatives was found. In the long-term, patients operated on for LGG showed good cognitive functioning, with no significant long-term cognitive sequelae for the extensive surgical approach. Psychologically, patients appear to experience a deep psychological change and maturation, closely resembling that of so-called posttraumatic growth, which, to our knowledge, is for the first time described and quantified in patients with LGG. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Antipsychotic polypharmacy and quality of life in patients with schizophrenia treated in primary care in China.

    Science.gov (United States)

    Hou, Cai-Lan; Ma, Xin-Rong; Zang, Yu; Jia, Fu-Jun; Lin, Yong-Qiang; Chiu, Helen F K; Ungvari, Gabor S; Ng, Chee H; Zhong, Bao-Liang; Cao, Xiao-Lan; Li, Yan; Cai, Mei-Ying; Xiang, Yu-Tao

    2016-01-01

    In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians, but their prescribing patterns have not been studied. This study examined the frequency as well as demographic and clinical correlates of antipsychotic polypharmacy (APP) and its impact on quality of life (QOL) in patients with schizophrenia treated in primary care in China. A total of 623 community-dwelling patients from 18 randomly selected primary care services were interviewed. Patients' socio-demographic and clinical characteristics, including number of hospitalizations, antipsychotic drug-induced side effects, and QOL were recorded using a standardized protocol and data collection procedure. The rate of APP prescription was 31% (193/623). Of the patients on APP, 89.6% received 2 antipsychotics, 10.4% received 3 or more antipsychotics. Clozapine (35.6%) was the most commonly prescribed second generation antipsychotic (SGA), while perphenazine (17.8%) was the most commonly prescribed first generation antipsychotic (FGA). Multiple logistic regression analyses revealed that patients on APP were more likely to receive SGAs and anticholinergics, had fewer hospitalizations, younger age of onset, and higher doses of antipsychotics. There were no significant differences between the two groups in any of the QOL domains. Approximately a third of Chinese patients with schizophrenia in primary care receive APP. Further examination of the rationale and appropriateness of APP and its alternatives is warranted.

  4. Changing Concepts in the Surgical Repair of Primary Retinal Detachment (Part 2: Comparison of Four Current Surgical Techniques for Repair of Primary Retinal Detachments

    Directory of Open Access Journals (Sweden)

    Ingrid Kreissig

    2008-12-01

    Full Text Available

    The second part of this literature review deals with the comparison of two intraocular (pneumatic retinopexy and primary vitrectomy and two extraocular (segmental sponge buckle without drainage, i.e. minimal extraocular surgery and the temporary balloon operation procedures used to seal off the leaking break in primary retinal detachments. The outcomes, rate of complications and reoperations will be compared among these procedures.

  1. A Study of Patients with Primary Mediastinal Germ Cell Tumors Treated Using Multimodal Therapy

    Directory of Open Access Journals (Sweden)

    Yutaro Tanaka

    2017-01-01

    Full Text Available Objectives. Primary mediastinal germ cell tumors (PMGCTs are rare, which often makes them difficult to treat. Herein, we examined patients with PMGCTs who underwent multimodal treatment. Methods. We examined 6 patients (median age: 25 years, range: 19–27 years with PMGCTs who underwent multimodal treatment between April 2001 and March 2015. Three patients had seminomas, 2 patients had yolk sac tumors, and 1 patient had choriocarcinoma. The median observation period was 32.5 months (range: 8–84 months. Results. Three of the 6 patients received initial operation followed by 3-4 courses of chemotherapy (bleomycin, etoposide, and cisplatin (BEP or etoposide and cisplatin (EP. One patient developed multiple lung metastases 17 months after surgery; received salvage chemotherapy with vinblastine, ifosfamide, and cisplatin; and achieved complete remission. The remaining 3 patients received initial BEP and EP chemotherapy. Multiple lung metastases and supraclavicular lymph node metastases were detected in 2 of these patients at the initial diagnosis. The patients underwent resections to remove residual tumor after treatment, and no viable tumor cells were found. Conclusions. Reliable diagnosis and immediate multimodal treatments are necessary for patients with PMGCTs. The 6 patients treated in our hospital have never experienced recurrence after the multimodal treatment.

  2. Evaluation of mandibular infiltration versus mandibular block anaesthesia in treating primary canines in children.

    Science.gov (United States)

    Yassen, Ghaeth H

    2010-01-01

    The objectives of this study were to determine the effectiveness of mandibular infiltration compared with mandibular block in treating primary canines in children and to relate the effectiveness to the type of treatment performed. A total of 89 children, 6-9 years old, requiring identical treatment on contralateral mandibular canines were selected. The split mouth study design was used. The anaesthetic used in both techniques was 2% lidocaine solution with 1 : 80,000 epinephrine. Dental procedures included class III, IV, and V restorations, formocresol pulpotomies, and extractions. Child's pain reaction and behaviour for each anaesthesia technique and the type of treatment were rated at certain intervals of treatment using sounds, motor, and ocular changes indicating pain and the Frankl Behaviour Rating Scale. Evaluations were made upon injection, probing, rubber dam placement, and during tooth preparation and extraction. No statistically significant difference was found between the two anaesthetic techniques for either pain or behaviour at all evaluation intervals (P > 0.05), during the performance of restorations, pulpotomies, or during extractions. Mandibular infiltration anaesthesia is as effective as mandibular block for restoration, pulpotomy, and extraction in primary canines. The mandibular infiltration anaesthesia was not significantly less painful than the mandibular block.

  3. Prognosis was not deteriorated by multiple primary cancers in esophageal cancer patients treated by radiotherapy

    International Nuclear Information System (INIS)

    Shirai, Katsuyuki; Tamaki, Yoshio; Kitamoto, Yoshizumi

    2013-01-01

    Esophageal cancer patients are often associated with multiple primary cancers (MPC). The aim of this study is to evaluate the effect of MPC on prognosis in esophageal cancer patients treated by radiotherapy. Between 2001 and 2008, esophageal cancer patients treated by definitive radiotherapy at Gunma Cancer Center were retrospectively reviewed. Exclusion criteria were preoperative or postoperative radiotherapy, palliative radiotherapy, follow-up of <6 months, radiation dose of <50 Gy and no information on MPC. We analyzed 167 esophageal cancer patients and 56 (33.5%) were associated with MPC. Gastric cancer was the most frequent tumor (38.2%), followed by head and neck cancer (26.5%). Median follow-up time was 31.5 months (range 6.1-87.3 months). Patients with MPC included more stage I/II esophageal cancer than those without MPC (66.1% vs. 36.9%, P<0.01). The 5-year overall survival rate for esophageal cancer with MPC was relatively better than those without MPC (46.1% vs. 26.7%), although the difference did not reach statistical significance in univariate analysis (P=0.09). Stage I/II esophageal cancer patients had a significantly better overall survival than stage III/IV patients (P<0.01). Among esophageal cancer patients with MPC, there was no difference in overall survival between antecedent and synchronous cancer (P=0.59). Our study indicated that the prognosis of esophageal cancer patients treated by radiotherapy was primarily determined by the clinical stage itself, but not the presence of MPC. (author)

  4. Is hydroxychloroquine effective in treating primary Sjogren's syndrome: a systematic review and meta-analysis.

    Science.gov (United States)

    Wang, Shi-Qin; Zhang, Li-Wei; Wei, Pan; Hua, Hong

    2017-05-12

    To systematically review and assess the efficacy and safety of hydroxychloroquine (HCQ) for treating primary Sjogren's syndrome (pSS). Five electronic databases (Pubmed, EMBASE, Web of science, Ovid, Cochrane Library) were searched for randomized controlled trials and retrospective or prospective studies published in English that reported the effect of HCQ on pSS. The subjective symptoms (sicca symptoms, fatigue and pain) and the objective indexes (erythrocyte sedimentation rate and Schirmer test) were assessed as main outcome measures. A meta-analysis and descriptive study on the efficacy and safety of HCQ were conducted. The estimate of the effect of HCQ treatment was expressed as a proportion together with 95% confidence interval, and plotted on a forest plot. Four trials with totals of 215 SS patients, including two randomized controlled trials, one double blind crossover trial and one retrospective open-label study, were analyzed in this review. For dry mouth and dry eyes, the effectiveness of HCQ treatment was essentially the same as placebo treatment. For fatigue, the effectiveness of HCQ was lower than placebo. The efficacy of HCQ in treating pain associated with pSS was superior to that of the placebo. There was no significant difference between HCQ-treated groups and controls in terms of Schirmer test results, but HCQ could reduce the erythrocyte sedimentation rate compare with placebo. A descriptive safety assessment showed that gastrointestinal adverse effects were the most common adverse effects associated with HCQ. This systematic review showed that there is no significant difference between HCQ and placebo in the treatment of dry mouth and dry eye in pSS. Well-designed, randomized, controlled trials are needed to provide higher-quality evidence to confirm our findings, and future studies should focus on some other index or extraglandular measures, such as cutaneous manifestations, to further explore the therapeutic effect of HCQ in

  5. Pre-surgical study of the biological effects of the selective cyclo-oxygenase-2 inhibitor celecoxib in patients with primary breast cancer.

    Science.gov (United States)

    Martin, Lesley-Ann; Davies, Giles L S; Weigel, Marion T; Betambeau, Nadine; Hills, Margaret J; Salter, Janine; Walsh, Geraldine; A'Hern, Roger; Dowsett, Mitch

    2010-10-01

    Cyclo-oxygenase 2 (COX-2) is implicated in the regulation of aromatase transcription in malignant breast tissue and has been considered as a potential target for tissue specific aromatase suppression. We initiated a randomised controlled pre-surgical study of celecoxib versus no treatment in women with primary breast cancer to determine the effects of COX-2 inhibition on markers of biological response. Postmenopausal women (50-80 years of age) with stage I or II, primary breast cancer, were randomised 2:1 to receive 400 mg/day celecoxib or no treatment for 14 days prior to surgery. A core biopsy was obtained pre- and post-treatment. Paired baseline and endpoint biopsies were analysed for Ki67, apoptosis, COX-2, CD31, estrogen receptor (ER) and progesterone receptor (PgR). Comparisons between the treatment groups were conducted using the Mann-Whitney test with a two-sided 5% significance. Of the 25 patients treated, 23 had evaluable data and 19 (83%) were ER positive. Overall the geometric mean change in Ki67, the primary end point, relative to baseline in the celecoxib arm was -16.6% (P = 0.056). The change in the no-treatment group was -8.1% (P = 0.24). There was no statistically significant difference in the change between the two groups. Celecoxib did not significantly affect apoptosis, COX-2, ER or PgR expression. There is only modest evidence for a biological effect of celecoxib in primary breast cancer. However, the trend towards a reduction in Ki67 in ER-positive breast cancer warrants further investigations in a larger cohort of patients.

  6. Impacts of a Size Ratio on Outcome in Patients with Surgically Treated Unruptured Nondissecting Anterior Cerebral Artery Aneurysms.

    Science.gov (United States)

    Matsukawa, Hidetoshi; Kamiyama, Hiroyasu; Miyazaki, Takanori; Kinoshita, Yu; Noda, Kosumo; Ota, Nakao; Saito, Norihiro; Takeda, Rihee; Tokuda, Sadahisa; Tanikawa, Rokuya

    2018-03-01

    Anterior cerebral artery aneurysms (ACAs) are characterized by higher rupture rate and small size at rupture. It was shown that the aneurysm/vessel size ratio, and not the absolute size, might predict the risk of rupture in small unruptured intracranial aneurysms. The present study aimed to investigate the relationship between a size ratio and outcome in patients with unruptured nondissecting ACA aneurysms (UNDAs). A total of 187 consecutive patients with 12 A1 (6.2%), 149 anterior communicating artery (77%), and 33 distal ACA (17%) aneurysms were retrospectively evaluated. The size ratio was defined as (size of aneurysm)/(size of parent artery). Neurologic worsening (NW) was defined as an increase in score of 1 or more on the modified Rankin Scale (mRS). The mean age of the patient population was 63 ± 11 years and 132 UNDAs (68%) were seen in women. Complete, partial neck clipping, and aneurysm trapping were archived in 188 (97%), 2 (1.0%), and 4 (2.1%) UNDAs, respectively. An excellent outcome (mRS score 0) at 12 months was archived in 177 (93%) UNDAs overall and 177 (95%) in UNDAs with preoperative mRS score of 0 (n = 186). Postoperative ischemic lesions (odds ratio, 193; 95% confidence interval, 17-2205; P 3.0 (odds ratio, 11; 95% confidence interval, 1.2-105; P = 0.031) were related to 12-month NW on multivariate analysis. The aneurysm size was not related to 12-month NW. The present study showed that the size ratio, and not the absolute size, was related to 12-month NW in surgically treated UNDAs. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Influence of postoperative sagittal balance and spinopelvic parameters on the outcome of patients surgically treated for degenerative lumbar spondylolisthesis.

    Science.gov (United States)

    Radovanovic, Ingrid; Urquhart, Jennifer C; Ganapathy, Venkat; Siddiqi, Fawaz; Gurr, Kevin R; Bailey, Stewart I; Bailey, Christopher S

    2017-04-01

    OBJECTIVE The object of this study was to determine the association between postoperative sagittal spinopelvic alignment and patient-rated outcome measures following decompression and fusion for lumbar degenerative spondylolisthesis. METHODS The authors identified a consecutive series of patients who had undergone surgery for lumbar degenerative spondylolisthesis between 2008 and 2012, with an average follow-up of 3 years (range 1-6 years). Surgery was performed to address the clinical symptoms of spinal stenosis, not global sagittal alignment. Sagittal alignment was only assessed postoperatively. Patients were divided into 2 groups based on a postoperative sagittal vertical axis (SVA) spondylolisthesis (p = 0.044), spondylolisthesis at the L3-4 level (p = 0.046), and multiple levels treated with fusion (p = 0.028) were more common among patients in the group with an SVA ≥ 50 mm. Patients with an SVA ≥ 50 mm had a worse SF-36 physical component summary (PCS) score (p = 0.018), a worse Oswestry Disability Index (ODI; p = 0.043), and more back pain (p = 0.039) than those with an SVA spondylolisthesis and multilevel fusion. The spinopelvic parameters differing between the < 50-mm and ≥ 50-mm groups included lumbar lordosis (LL; 56.4° ± 4.7° vs 49.8° ± 4.3°, respectively, p = 0.040) and LL < pelvic incidence ± 9° (51% vs 23.1%, respectively, p = 0.013) after controlling for type of surgical procedure. CONCLUSIONS Data in this study revealed that patient-rated outcome is influenced by the overall postoperative sagittal balance as defined by the SVA.

  8. Gait analysis and functional outcomes after twelve-week rehabilitation in patients with surgically treated ankle fractures.

    Science.gov (United States)

    Suciu, Oana; Onofrei, Roxana Ramona; Totorean, Alina Daniela; Suciu, Silviu Cristian; Amaricai, Elena Constanta

    2016-09-01

    Ankle fractures are the most common type of lower extremity fractures. The objective of our study was to analyse the changes of temporal and spatial gait parameters and functional outcomes in patients with bimalleolar fractures who followed surgery and rehabilitation compared to healthy controls. 49 patients with ankle fractures and 21 age-matched healthy volunteers were recruited. There were two assessments for the study group: T1 - once weight-bearing was allowed and T2 - twelve weeks after exercise-based rehabilitation programme. Each evaluation consisted in a functional questionnaire (Olerud-Molander Ankle Score-OMAS) and temporal and spatial gait parameters analysis. The gait parameters were analysed using a Zebris FDM platform. 30 patients completed the final assessment and their data were analysed. In T1 assessment there were significant differences in all temporal and spatial gait parameters between the patients group and controls. In T2 evaluation step time in affected ankle and non-affected ankle, swing time and stance time on affected ankle, stride time and cadence showed no significant differences in patients compared with controls. The within-group analysis showed significant differences in all temporal and spatial gait parameters except for single support time on non-affected ankle after rehabilitation. The OMAS improved significantly from T1 to T2 in all subscales except for squatting. Median value of OMAS improved from 60 (35-90) to 95 (55-100). Our study revealed significant improvements of all temporal and spatial gait parameters, as well as of the functional outcome in patients with surgically treated ankle fractures after twelve-week rehabilitation. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Use of the Toric Surgical Marker to Aid in Intraoperative Plaque Placement for the USC Eye Physics Plaques to Treat Uveal Melanoma: A New Surgical Technique.

    Science.gov (United States)

    Berry, Jesse L; Kim, Jonathan W; Jennelle, Richard; Astrahan, Melvin

    2015-09-01

    To describe a new surgical technique for intraoperative placement of Eye Physics (EP) plaques for uveal melanoma using a toric marker. A toric marker is designed for cataract surgery to align the axis of astigmatism; its use was modified in this protocol to mark the axis of suture coordinates as calculated by Plaque Simulator (PS) software. The toric marker can be used to localize suture coordinates, in degrees, during intraoperative plaque placement. Linear marking using the toric marker decreases potential inaccuracies associated with the surgeon estimating 'clock-hours' by dot placement. Use of the toric marker aided surgical placement of EP plaques. The EP planning protocol is now designed to display the suture coordinates either by clock-hours or degrees, per surgeon preference. Future research is necessary to determine whether routine use of the toric marker improves operative efficiency. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:866-870.]. Copyright 2015, SLACK Incorporated.

  10. Surgical Treatment of primary hyperparathyroidism in children: report of 10 cases

    Czech Academy of Sciences Publication Activity Database

    Libánský, P.; Astl, J.; Adámek, S.; Naňka, O.; Pafko, P.; Špačková, J.; Foltán, R.; Šedý, Jiří

    2008-01-01

    Roč. 72, č. 8 (2008), s. 1177-1182 ISSN 0165-5876 Grant - others:GA MZd(CZ) NR8308 Institutional research plan: CEZ:AV0Z50390512; CEZ:AV0Z50110509 Keywords : Primary * Hyperparathyroidism * Child Subject RIV: FH - Neurology Impact factor: 1.118, year: 2008

  11. Prevalence of Insomnia and Clinical and Quality of Life Correlates in Chinese Patients With Schizophrenia Treated in Primary Care.

    Science.gov (United States)

    Hou, Cai-Lan; Li, Yan; Cai, Mei-Ying; Ma, Xin-Rong; Zang, Yu; Jia, Fu-Jun; Lin, Yong-Qiang; Ungvari, Gabor S; Chiu, Helen F K; Ng, Chee H; Zhong, Bao-Liang; Cao, Xiao-Lan; Tam, Man-Ian; Xiang, Yu-Tao

    2017-04-01

    To describe the prevalence and clinical correlates of insomnia in schizophrenia patients treated in primary care. Six hundred and twenty-three schizophrenia patients from 22 primary care services were recruited. The prevalence of at least one type of insomnia was 28.9% (180/623), while those of difficulty initiating sleep, difficulty maintaining sleep, and early morning wakening were 20.5%, 19.6%, and 17.7%, respectively. Only 53.3% of patients suffering from insomnia received treatment. Insomnia is common in Chinese patients with schizophrenia treated in primary care and the rate of treatment appears low. © 2015 Wiley Periodicals, Inc.

  12. Primary tumor SUVmaxon preoperative FDG-PET/CT is a prognostic indicator in stage IA2-IIB cervical cancer patients treated with radical hysterectomy.

    Science.gov (United States)

    Yagi, Shigetaka; Yahata, Tamaki; Mabuchi, Yasushi; Tanizaki, Yuko; Kobayashi, Aya; Shiro, Michihisa; Ota, Nami; Minami, Sawako; Terada, Masaki; Ino, Kazuhiko

    2016-09-01

    The objective of the present study was to investigate the prognostic value of 18 F-fluoro-2-deoxy-D-glucose (FDG) uptake by primary tumors on positron emission tomography/computed tomography (PET/CT) in surgically resectable cervical cancer. A total of 59 patients with stage IA2-IIB cervical cancer who underwent preoperative FDG-PET/CT, followed by radical hysterectomy and lymphadenectomy, were included in the study. The maximum standardized uptake value (SUV max ) of the primary tumor was measured, and the association between the SUV max and clinicopathological factors or patient outcomes was analyzed. The SUV max was significantly higher in patients with an advanced stage, lymph node metastasis, lymph-vascular space involvement and large tumors. The overall survival (OS) and progression-free survival (PFS) of patients with a high SUV max were significantly lower compared with patients with a low SUV max , using an optimal cut-off value of 7.36 for OS and 5.59 for PFS obtained from receiver operating characteristic curve analysis. Similarly, OS and PFS in patients with a high SUV max were significantly lower in 39 patients with stage IB using a cut-off value of 7.90 and 6.69 for OS and PFS, respectively. Finally, multivariate analyses showed that the SUV max of the primary tumor was an independent prognostic factor for impaired PFS in all patients and those with stage IB alone. These findings demonstrated that a high SUV max on preoperative PET/CT was correlated with unfavorable clinical outcomes in patients receiving radical hysterectomy, suggesting that the SUV max of the primary tumor may be a prognostic indicator for surgically-treated, early-stage invasive cervical cancer.

  13. Surgical Control of a Primary Hepatic Carcinoid Tumor: A Case Report

    Directory of Open Access Journals (Sweden)

    Norio Yokoigawa

    2009-04-01

    Full Text Available We report a primary hepatic carcinoid tumor occurring in a 47-year-old man. The patient consulted our hospital complaining of epigastralgia. Abdominal ultrasonography, computed tomography scanning, and magnetic resonance imaging showed a large mass in the right lobe of the liver. FDG-PET revealed 18F-FDG uptake by the right hepatic lobe. The tumor was a solid mass with cystic components, approximately 15 cm in diameter. We conducted an extended right lobectomy of the liver. The resected specimen was a solid tumor with cystic components and hemorrhagic lesion. Microscopic findings showed that the tumor cells had round nuclei and formed trabecular patterns. Immunohistologically, tumor cells were stained positive for chromogranin A, neuron specific enolase, CD56, and S-100. Careful examinations before and after the operation revealed no other possible origin of the tumor. Based on these findings, the tumor was diagnosed as a primary hepatic carcinoid. This is a report of a rare case of a primary hepatic carcinoid tumor with a discussion of several other relevant reports.

  14. Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures.

    Science.gov (United States)

    Houben, I B; Raaben, M; Van Basten Batenburg, M; Blokhuis, T J

    2018-04-09

    The relation between timing of weight bearing after a fracture and the healing outcome is yet to be established, thereby limiting the implementation of a possibly beneficial effect for our patients. The current study was undertaken to determine the effect of timing of weight bearing after a surgically treated tibial shaft fracture. Surgically treated diaphyseal tibial fractures were retrospectively studied between 2007 and 2015. The timing of initial weight bearing (IWB) was analysed as a predictor for impaired healing in a multivariate regression. Totally, 166 diaphyseal tibial fractures were included, 86 cases with impaired healing and 80 with normal healing. The mean age was 38.7 years (range 16-89). The mean time until IWB was significantly shorter in the normal fracture healing group (2.6 vs 7.4 weeks, p bearing is independently associated with impaired fracture healing in surgically treated tibial shaft fractures. Unlike other factors such as fracture type or soft tissue condition, early resumption of weight bearing can be influenced by the treating physician and this factor therefore has a direct clinical relevance. This study indicates that early resumption of weight bearing should be the treatment goal in fracture fixation. 3b.

  15. Cerebral glucose metabolism in long-term survivors of childhood primary brain tumors treated with surgery and radiotherapy

    DEFF Research Database (Denmark)

    Andersen, Preben B.; Krabbe, Katja; Leffers, Anne M.

    2003-01-01

    Delayed structural cerebral sequelae has been reported following cranial radiation therapy (CRT) to children with primary brain tumors, but little is known about potential functional changes. Twenty-four patients were included, diagnosed and treated at a median age of 11 years, and examined after...... that there is a general reduction in rCMRglc in long-term recurrence free survivors of childhood primary brain tumors treated with CRT in high doses (44-56 Gy)...... evaluable and regional cerebral metabolic rate for glucose (rCMRglc) was estimated in nontumoral brain regions in 12 patients treated with surgery alone and 9 patients treated with both surgery and CRT. Furthermore 10 normal controls matched for age at examination were included. Patients treated with both...

  16. [A case of refractory deep incisional surgical site infection due to methicillin-resistant Staphylococcus aureus (MRSA) and successfully treated with oral linezolid].

    Science.gov (United States)

    Matsumoto, Hironori; Kawabata, Ryohei; Kishimoto, Tomono; Yamamoto, Emiko; Kimura, Yutaka; Imamura, Hiroshi; Yamamoto, Tameyoshi; Takemoto, Hiroyoshi; Fukunaga, Mutsumi; Ohzato, Hiroki

    2012-11-01

    We report a case of methicillin-resistant Staphylococcus aureus(MRSA) surgical site infection successfully treated with linezolid. A 66-year-old man had undergone total gastrectomy for gastric cancer after neoadjuvant chemotherapy. Three days after the operation, he was diagnosed with deep incisional surgical site infection due to MRSA, and wound care was started. After discharge, he received adjuvant chemotherapy and wound care, but the wound had not healed in 10 months. We started treatment with oral linezolid and nutritional support, and the wound was fully healed 12 months after the operation. Antibiotic treatment with oral linezolid may be effective for refractory deep incisional surgical site infection due to MRSA in outpatients.

  17. Outcomes of Primary Unilateral Cheiloplasty in Same-Day Surgical Settings

    Directory of Open Access Journals (Sweden)

    Mansoor Khan

    2016-05-01

    Full Text Available BackgroundFinancial, clinical, and psychological considerations have made same-day surgery an attractive option for a variety of procedures. This article aimed to analyse the postoperative results of same-day primary unilateral cleft nasolabial repair.MethodsThis study was performed from 2011 to 2014. Unilateral cleft lip patients fulfilling the inclusion criteria were preoperatively classified as mild, moderate, and severe. All patients underwent same-day surgery and were discharged after satisfying the appropriate clinical criteria, receiving thorough counselling, and the establishment of a means of communication by phone. Postoperative outcomes were assessed and stratified according to preoperative severity and the type of repair.ResultsA total of 423 primary unilateral cleft lip patients were included. Fisher's anatomical subunit approximation technique was the most common procedure, followed by Noordhoff's technique. The postoperative outcome was good in 89.8% of cases, fair in 9.9% of cases, and poor in 0.2% of cases. The complication rate was 1.18% (n=5, and no instances of mortality were observed. The average hospital stay was 7.5 hours, leading to a cost reduction of 19% in comparison with patients who stayed overnight for observation.ConclusionsMild unilateral cleft lip was the most common deformity for which Fisher's anatomical subunit approximation technique was performed in most of the cases, with satisfactory postoperative outcomes. Refinements in the cleft rhinoplasty techniques over the course of the study improved the results regarding cleft nasal symmetry. Single-day primary unilateral cleft cheiloplasty was found to be a cost-effective procedure that did not pose an additional risk of complications.

  18. Primary pancreatic perivascular epithelioid cell tumor (PEComa): A surgical enigma. A systematic review of the literature.

    Science.gov (United States)

    Zizzo, Maurizio; Ugoletti, Lara; Tumiati, David; Castro Ruiz, Carolina; Bonacini, Stefano; Panebianco, Michele; Sereni, Giuliana; Manenti, Antonio; Lococo, Filippo; Carlinfante, Gabriele; Pedrazzoli, Claudio

    2018-04-01

    Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor, with distinctive morphology and expression of myo-melanocytic markers. Current scientific literature reported just 24 cases of pancreatic PEComas. With our systematic review, we aimed at improving our understanding of the disease, focusing on the knowledge gained on epidemiology, etiology, clinical presentation, diagnosis, treatment and prognosis. Based on the PRISMA guidelines, a systematic research was carried out on PubMed/MEDLINE, Web of Science, Scopus, EMBASE, and EBSCO using the search terms: ("perivascular epithelioid cell tumor" OR ″PEComa") and ("pancreas "OR″ pancreatic"). The 4th-6th decades of life and female sex (86.9%) turned out as the most affected. Pancreatic head was the most involved site (50%), with a single lesion in almost all cases. The diagnosis was only obtained after histopathological examination (70.8%). The clinical presentation was non-specific, abdominal pain being the main symptom (60.9%). At immunohistochemistry, PEComa showed benign epithelioid predominance and a strong positivity for HMB-45, Melan-A, and α-SMA. Surgical resection was performed in almost all cases, while for one patient the multidisciplinary group chose just endoscopic and imaging follow-up, based on the benign nature of the lesion. The biological characteristics of pancreatic PEComa remain an enigma. Its prognosis seems to depend on whether atypical ("worrisome") histological features are available or not. Surgery turned out as the most appropriate treatment, without reaching any agreement on surgery timing. Further studies on larger population are needed to better understand the biological features of pancreatic PEComa, in order to set up guidelines in the diagnosis, treatment and follow-up. Copyright © 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  19. A consecutive series of patients with laryngeal carcinoma treated by primary irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Greisen, O. [ENT Dept. and the Oncological Dept., Aalborg Sygehus (Denmark); Carl, J. [ENT Dept. and the Oncological Dept., Aalborg Sygehus (Denmark); Pedersen, M. [ENT Dept. and the Oncological Dept., Aalborg Sygehus (Denmark)

    1997-09-01

    In Denmark there is an increasing frequency of laryngeal carcinoma, in particular in women and among these especially in supraglottic tumours. The incidence during the past 20 years has risen from about 40 to 60 cases per million per year. A series of 335 consecutive patients treated with primary radiation is presented. In one-third of all patients the tumour was localized in the supraglottic area; in women in more than half and in men in about one-fourth of the cases. The frequency of primary lymph node metastases in the supraglottic and the glottic tumours was 24% and 2% respectively. A multivariate analysis identified sex and tumour size as independent prognostic parameters of local control. Five-year survival corrected for intercurrent deaths was obtained in 59% of all cases, in 56% of supraglottic and in 92% of glottic tumours. A multivariate analysis defined localization, tumour grade and stage as independent prognostic parameters of survival. Salvage surgery was performed in about 32% of the cases, total laryngectomy in 26%, and partial laryngectomy in 6%. The survival rate among all total laryngectomies was 55%. A tracheostomy during or before radiation treatment prior to total laryngectomy had no influence on complication rate, admission time or recurrence rate. The frequency of pharyngo-cutaneous fistulae in the entire series was 11.5%; after routine use of metronidazol, however, only 5.7%. Radical neck dissection was carried out in 7.8% of the cases, by far most in the supraglottic group, only a few in the glottic carcinomas, in three-fourth in connection with a laryngectomy and in one-fourth without local recurrence in the larynx. (orig.).

  20. Improved outcome after primary vitrectomy in diabetic patients treated with statins.

    Science.gov (United States)

    Tuuminen, Raimo; Sahanne, Sari; Haukka, Jari; Loukovaara, Sirpa

    2016-01-01

    To evaluate the effect of preoperative statin treatment on the outcome of primary vitrectomy in type 1 and 2 diabetic patients. In this open, observational institutional study, a total of 192 eyes of 171 type 1 and 2 adult diabetic patients admitted for primary vitrectomy for management of sight-threatening forms of diabetic retinopathy were divided according to the use of lipid-lowering therapy: those with statin treatment (79 eyes of 73 patients) and those taking no statin medication (113 eyes of 98 patients). One-month best-corrected visual acuity (BCVA) gain and cumulative 12-month revitrectomy frequency were analyzed. In multivariate linear regression, diabetic patients with statin treatment had a better 1-month BCVA improvement than did those without statin treatment (absolute difference 0.26, 95% confidence interval [CI] 0.02-0.50, p = 0.028). Subgroup analysis revealed that diabetic patients on statin had better postoperative BCVA improvement when preoperative status included partial or panretinal laser photocoagulation (p = 0.042 and p = 0.049) and anti-vascular endothelial growth factor therapy (p = 0.011). Moreover, diabetic patients with preoperative macular edema (p = 0.009), vitreous hemorrhage (p<0.001), proliferative retinopathy (p<0.001), or tractional retinal detachment (p = 0.010) had better BCVA recovery if receiving statin. In Cox proportional hazards regression model, revitrectomies in our 12-month follow-up were less frequent in diabetic patients on statin treatment (hazard ratio 0.28, 95% CI 0.08-0.93, p = 0.037). These data provide novel insight into the potential clinical benefit for patients with sight-threatening diabetic retinopathy undergoing vitrectomy treated with statin.

  1. Other primary malignancies in breast cancer patients treated with breast conserving surgery and radiation therapy.

    Science.gov (United States)

    Yi, Min; Cormier, Janice N; Xing, Yan; Giordano, Sharon Hermes; Chai, Christy; Meric-Bernstam, Funda; Vlastos, Georges; Kuerer, Henry M; Mirza, Nadeem Q; Buchholz, Thomas A; Hunt, Kelly K

    2013-05-01

    Our purpose was to examine the incidence and impact on survival of other primary malignancies (OPM) outside of the breast in breast cancer patients and to identify risk factors associated with OPM. Patients with stage 0-III breast cancer treated with breast conserving therapy at our center from 1979 to 2007 were included. Risk factors were compared between patients with/without OPM. Logistic regression was used to identify factors that were associated with OPM. Standardized incidence ratios (SIRs) were calculated. Among 4,198 patients in this study, 276 (6.6 %) developed an OPM after breast cancer treatment. Patients with OPM were older and had a higher proportion of stage 0/I disease and contralateral breast cancer compared with those without OPM. In a multivariate analysis, older patients, those with contralateral breast cancer, and those who did not receive chemotherapy or hormone therapy were more likely to develop OPM after breast cancer. Patients without OPM had better overall survival. The SIR for all OPM sites combined after a first primary breast cancer was 2.91 (95 % confidence interval: 2.57-3.24). Significantly elevated risks were seen for numerous cancer sites, with SIRs ranging from 1.84 for lung cancer to 5.69 for ovarian cancer. Our study shows that breast cancer patients have an increased risk of developing OPM over the general population. The use of systemic therapy was not associated with increased risk of OPM. In addition to screening for a contralateral breast cancer and recurrences, breast cancer survivors should undergo screening for other malignancies.

  2. Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB-IIA Cervical Cancer.

    Science.gov (United States)

    Canaz, Emel; Ozyurek, Eser Sefik; Erdem, Baki; Aldikactioglu Talmac, Merve; Yildiz Ozaydin, Ipek; Akbayir, Ozgur; Numanoglu, Ceyhun; Ulker, Volkan

    2017-10-01

    Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1-IIA2 cervical cancer. A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1-IIA2 from 2001 to 2015. All patients underwent clinical staging examination under anesthesia by the same gynecological oncologists during the study period. Evaluated variables were age, menopausal status, body mass index, smoking status, FIGO (International Federation of Obstetrics and Gynecology) stage, clinically measured maximal tumor diameter, clinical presentation (exophytic or endophytic tumor), histological type, tumor grade, lymphovascular space invasion, clinical and pathological vaginal invasion, and uterine body involvement. Endophytic clinical presentation was defined for ulcerative tumors and barrel-shaped morphology. Two-dimensional transvaginal ultrasonography was used to measure tumor dimensions. Of 127 eligible women, 37 (29.1%) had PMI. On univariate analysis, endophytic clinical presentation (P = 0.01), larger tumor size (P PMI. In multivariate analysis endophytic clinical presentation (odds ratio, 11.34; 95% confidence interval, 1.34-95.85; P = 0.02) and larger tumor size (odds ratio, 32.31; 95% confidence interval, 2.46-423.83; P = 0.008) were the independent risk factors for PMI. Threshold of 31 mm in tumor size predicted PMI with 71% sensitivity and 75% specificity. We identified 18 patients with tumor size of more than 30 mm and endophytic presentation; 14 (77.7%) of these had PMI. Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB-IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic

  3. Diode laser trans - scleral cyclo - ablation as a primary surgical treatment for primary open - angle glaucoma after maximum tolerated medical therapy

    International Nuclear Information System (INIS)

    Mahmood, K.; Khan, M.T.; Butt, J.B.Y.

    2011-01-01

    The incidence rate and prevalence of glaucoma in Pakistan is similar to that of other dark - colored population countries. Primary trabeculectomy is still a preferred surgical approach. Diode laser is widely accepted as the therapy of choice in severe glaucoma cases. The purpose of this study was to deter-mine the role of Diode Laser Transscleral Cyclo-ablation as a primary surgical treatment option in Primary Open Angle Glaucoma after maximum tolerated medical therapy. This quasi - experimental study was con-ducted at Layton Rahmatullah Benevolent Trust Free Eye Care and Cancer Hospital, Lahore. Sixty patients fulfilling the inclusion criteria were selected from the Glaucoma unit for this study. 25 - 30 burns of Diode Laser were applied to 270 degrees avoiding 3 and 9 O clock positions, 1.5 mm posterior to the limbus. Laser was set at duration of 1 second and power between 1000 and 1500 mw. Patients were followed up for a period of one year. Results: Out of a total of 60 eyes with mean age 52.73 +- 7.40 years, 36 (60%) were male and 24 (40%) were female. The mean pre-operative Intra Ocular Pressure IOP was 41.0 +- 7.0 mmHg (The pre-operative IOP ranged from 28 mmHg to 60 mmHg). The mean post-operative IOP was 18.97 mmHg on day one, 16.75 mmHg at 1 week, 15.68 mmHg at 1 month, 15.00 mmHg at 6 months and by the end of a year it was about 14.15 mmHg (The post-operative IOP ranged from 6 mmHg to 52 mmHg). There was a significant drop of more than 50% of post-operative IOP as compared to pre-operative IOP. Conclusion: Diode Laser Transscleral Cycloablation is a practical, rapid, well - tolerated procedure that provides a significant lowering of intraocular pressure with few complications and can considered as alternative treatment in POAG if medical therapy fails. (author)

  4. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Conversion Total Hip Arthroplasty: Is it a Primary or Revision Hip Arthroplasty.

    Science.gov (United States)

    Baghoolizadeh, Mahta; Schwarzkopf, Ran

    2016-09-01

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, no study has identified whether patients undergoing conversion THA better resemble patients undergoing primary THA or revision THA. The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database collects data from hospitals nationwide about preoperative characteristics, intraoperative factors, and 30-day postoperative complications. The purpose of our study was to use these variables in the ACS-NSQIP dataset to compare patients undergoing conversion THA to those undergoing primary and revision THA in order to ensure proper DRG classification of these procedures. Between 2009-2014, the ACS-NSQIP database identified 2,009 conversion THA patients, 5,089 revision THA patients, and 67,854 primary THA patients. Univariate analysis was used to compare fifty-three preoperative, intraoperative, and postoperative variables among these groups. A conservative Bonferroni-adjusted P-value of .0003 was calculated, and a less conservative P-value of .01 was used for comparison. Seventeen variables exhibited a significant difference (P ≤ .0003) only between conversion and primary THA, one variable exhibited a difference only between conversion and revision THA, and three variables exhibited a difference between both conversion and primary THA, and conversion and revision THA. With P ≤ .01, twenty-three, zero, and six differences were observed, respectively. The disproportionate number of differences between conversion and primary THAs suggests that patients undergoing conversion THAs better resemble patients undergoing revision THAs. DRGs are traditionally comprised of procedures that have similar diagnoses and require comparable levels of resources from a hospital, so these results suggest that conversion THA should rather be bundled in the same DRG as

  5. An observational study on surgically treated adult idiopathic scoliosis patients' quality of life outcomes at 1- and 2-year follow-ups and comparison to controls.

    Science.gov (United States)

    Theis, Jennifer C; Grauers, Anna; Diarbakerli, Elias; Savvides, Panayiotis; Abbott, Allan; Gerdhem, Paul

    2017-01-01

    Prospective data on health-related quality of life in patients with idiopathic scoliosis treated surgically as adults is needed. We compared preoperative and 1- and 2-year follow-up data in surgically treated adults with idiopathic scoliosis with juvenile or adolescent onset. Results were compared to untreated adults with scoliosis and population normative data. A comparison of preoperative and 1- and 2-year follow-up data of 75 adults surgically treated for idiopathic scoliosis at a mean age of 28 years (range 18 to 69) from a prospective national register study, as well as a comparison with age- and sex-matched data from 75 untreated adults with less severe scoliosis and 75 adults without scoliosis, was made. Outcome measures were EuroQol-5 dimensions (EQ-5D) and Scoliosis Research Society (SRS)-22r questionnaire. In the surgically treated, EQ-5D and SRS-22r scores had statistically significant improvements at both 1- and 2-year follow-ups (all p   up was large ( r  = -0.54) and small-medium ( r  = -0.20) at 2-year follow-up. The effect size of surgery on SRS-22r outcomes was medium-large at 1- and 2-year follow-ups ( r  = -0.43 and r  = -0.42 respectively). At the 2-year follow-up, the EQ-5D score and the SRS-22r subscore were similar to the untreated scoliosis group ( p  = 0.56 and p  = 0.91 respectively), but lower than those in the adults without scoliosis ( p  up, approaching the health-related quality of life of untreated individuals with less severe scoliosis, but remain lower than normative population data.

  6. Individualized medicine for renal cell carcinoma: establishment of primary cell line culture from surgical specimens.

    Science.gov (United States)

    Kim, Fernando J; Campagna, Adriano; Khandrika, Lakshmipathi; Koul, Sweaty; Byun, Seok-Soo; vanBokhoven, Adrie; Moore, Ernest E; Koul, Hari

    2008-10-01

    The lack of effective "in vivo" and "in vitro" models to predict success of pharmacological therapy for patients with renal cell carcinoma, as well as, the variety of cancer cell types demands the development of better experimental models to understand the pathophysiology of the disease and evaluate drug sensitivity in vitro. To develop primary renal cancer cell culture irrespective of tumor grade and tumor type, harvested from the patient's pathological specimen immediately after the laparoscopic radical nephrectomy to study potential "in vivo" pharmacological sensitivity. A total of 24 patients (17 males and 7 females). Mean age of 63.1+/-3.1 y.o. The mean size of the renal masses was 7.56+/-3.1 cm. Normal and pathological renal tissue was collected immediately after the specimen was extracted and submitted to enzymatic digestion for 16-24 hours. Clear cell carcinoma cells were selected through multiple passages in DMEM medium supplemented with glucose and antibiotics. Establishment of cell line culture from all the patients' specimens irrespective of tumor grade and tumor type was achieved successfully. In addition to the tumor cell line culture, normal parenchyma tissue yielded primary cell lines to allow testing the response of tumor types to various pharmacological therapeutic agents and toxicity of such treatments to healthy tissue. From the initial collection of the specimens obtained after the removal of the kidney to the development of cell lines took occurred in average 32+6 hrs. The cells in culture showed characteristics of epithelial cells; like expression on cytokeratin and were maintained in culture for more than 20 passages. The development of renal cancer cell cultures in vitro is labor intense but may yield a more realistic model to tailor pharmacological therapies and predict therapeutic success prior to "in vivo" application-a step in the direction of individualized medicine for RCC.

  7. Immunostimulatory sutures that treat local disease recurrence following primary tumor resection

    Energy Technology Data Exchange (ETDEWEB)

    Intra, Janjira; Zhang Xueqing; Salem, Aliasger K [Division of Pharmaceutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242 (United States); Williams, Robin L; Zhu Xiaoyan [Department of Surgery, Roy J and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA 52242 (United States); Sandler, Anthony D, E-mail: aliasger-salem@uiowa.edu [Department of Surgery and Center for Cancer and Immunology Research, Children' s National Medical Center, Washington DC 20010 (United States)

    2011-02-15

    Neuroblastoma is a common childhood cancer that often results in progressive minimal residual disease after primary tumor resection. Cytosine-phosphorothioate-guanine oligonucleotides (CpG ODN) have been reported to induce potent anti-tumor immune responses. In this communication, we report on the development of a CpG ODN-loaded suture that can close up the wound following tumor excision and provide sustained localized delivery of CpG ODN to treat local disease recurrence. The suture was prepared by melt extruding a mixture of polylactic acid-co-glycolic acid (PLGA 75:25 0.47 dL g{sup -1}) pellets and CpG ODN 1826. Scanning electron microscopy images showed that the sutures were free of defects and cracks. UV spectrophotometry measurements at 260 nm showed that sutures provide sustained release of CpG ODN over 35 days. Syngeneic female A/J mice were inoculated subcutaneously with 1 x 10{sup 6} Neuro-2a murine neuroblastoma wild-type cells and tumors were grown between 5 to 10 mm before the tumors were excised. Wounds from the tumor resection were closed using CpG ODN-loaded sutures and/or polyglycolic acid Vicryl suture. Suppression of neuroblastoma recurrence and mouse survival were significantly higher in mice where wounds were closed using the CpG ODN-loaded sutures relative to all other groups. (communication)

  8. Preozonation of primary-treated municipal wastewater for reuse in biofuel feedstock generation

    Energy Technology Data Exchange (ETDEWEB)

    Mondala, Andro H.; Hernandez, Rafael; French, W. Todd; Estévez, L. Antonio; Meckes, Mark; Trillo, Marlene; Hall, Jacqueline

    2010-11-09

    The results of a laboratory scale investigation on ozone pretreatment of primary-treated municipal wastewater for potential reuse in fermentation processes for the production of biofuels and bio-based feedstock chemicals were presented. Semi-batch preozonation with 3.0% (w/w) ozone at 1 L min -1 resulted into a considerable inactivation of the indigenous heterotrophic bacteria in the wastewater with less than 0.0002% comprising the ozone-resistant fraction of the microbial population. The disinfection process was modeled using first-order inactivation kinetics with a rate constant of 4.39 10 -3 s -1. Chemical oxygen demand (COD) levels were reduced by 30% in 1-h experiments. COD depletion was also modeled using a pseudo-first-order kinetics at a rate constant of 9.50 10 -5 s -1. Biological oxygen demand (BOD 5) values were reduced by 60% up to 20 min of ozonation followed by a plateau and some slight increases attributed to partial oxidation of recalcitrant materials. Ozone also had no substantial effect on the concentration of ammonium and phosphate ions, which are essential for microbial growth and metabolism. Preliminary tests indicated that oleaginous microorganisms could be cultivated in the ozonated wastewater, resulting in relatively higher cell densities than in raw wastewater and comparable results with autoclave-sterilized wastewater. This process could potentially produce significant quantities of oil for biofuel production from municipal wastewater streams.

  9. Relationship between radiation pneumonitis and prognosis in patients with primary lung cancer treated by radiotherapy.

    Science.gov (United States)

    Yamano, Mototsugu; Ogino, Hiroyuki; Shibamoto, Yuta; Horii, Naotoshi

    2007-01-01

    Relationship between the grade of radiation pneumonitis (RP) and treatment outcome in lung cancer patients has not been clarified yet. The purpose of this study was to retrospectively evaluate the relationship in patients with primary lung cancer treated by radiotherapy. One hundred thirty-five patients who underwent definitive radiotherapy with known grade of RP were analyzed. RP was scored by using the Radiation Therapy Oncology Group (RTOG) acute radiation morbidity scoring criteria. Survival and local control data were analyzed in relation to the grade of RP. RP was grade 0 in 5 patients, grade 1 in 71, grade 2 in 39, grade 3 in 15 (11%), grade 4 in 0 and grade 5 in 5 (3.7%). There were no significant correlations between patient or tumor characteristics and grade of RP. Excluding 5 patients with grade 5 pneumonitis, survival rates were similar between those with grade 0 or 1 pneumonitis and those with grade 2 or 3. Also, there was no difference in survival between patients with grade 0-2 pneumonitis and those with grade 3. Local control rates were similar between the two groups. Grade of RP did not appear to be associated with prognosis when patients with grade 5 pneumonitis were excluded from analysis.

  10. Improved sperm count and motility in young men surgically treated for cryptorchidism in the first year of life.

    Science.gov (United States)

    Feyles, Francesca; Peiretti, Valentina; Mussa, Alessandro; Manenti, Marco; Canavese, Ferdinando; Cortese, Maria Grazia; Lala, Roberto

    2014-10-01

    The timing of surgery in cryptorchidism has been debated for a long time. Reports on histology suggest better fertility outcomes with early surgery, whereas evidence of long-term improved fertility still lacks sound data. The aim of this study is to analyze sperm count and motility in a cohort of young men operated on during the first 2 years of life for cryptorchidism. A total of 78 young men (age, 18-26 years) surgically treated for cryptorchidism in the second year of life were recalled to evaluate testicular volume and sperm count and motility. Of the 78 young men, 51 accepted to participate to clinical and sperm evaluation. Relationship between total sperm count (TSC), sperm motility (SM), and age at surgery was investigated by Student t-test and Fisher test. Patients were divided into two groups: those patients who were submitted to surgery in their first year of life (Group A) and those patients who were submitted to surgery in their first and the second year of life (Group B). We investigated the ratio of those patients with normal sperm count to those patients with abnormal sperm count (we defined as normal TSC > 15 million and SM > 15%) and compared the mean TSC and SM in the two groups. TSC were slightly but not significantly higher in the first group (45.5 ± 15.5 million/mL vs. 36.5 ± 23.6 million/mL, p = 0.107) and SM (30.5% ± 11.3% vs. 26.5% ± 15.4%, p = 0.341). The percentage of patients with normal sperm count and motility were significantly higher in the first group: normal TSC was found in 26 of 27 patients (96.3%) in Group A versus 18 of 24 patients (75.0%) in Group B (p = 0.042), normal SM was found in 26 of 27 patients (96.3%) versus 16 of 24 patients (66.7%), respectively (p = 0.008). In the two groups, no statistically significant difference was found neither in the proportion of patients with bilateral cryptorchidism, in the position of the testes, nor in the ratio of subjects treated with hormonal

  11. Prognostic factors in patients with hepatitis B-related primary liver cancer treated with transcatheter arterial chemoembolization

    Directory of Open Access Journals (Sweden)

    YIN Hao

    2014-01-01

    Full Text Available ObjectiveTo analyze the prognostic factors in patients with hepatitis B-related primary liver cancer treated with transcatheter arterial chemoembolization (TACE and to provide a basis for properly selecting indications and treatment regimen in clinical practice. MethodsA total of 140 patients with hepatitis B-related primary liver cancer, who underwent TACE in our hospital from January to December 2010, were enrolled in this study. Follow-up was continued until December 2011 to observe the patients′ survival within 12 months after treatment. The Kaplan-Meier method and log-rank (Mantel-Cox test were used for univariate and multivariate analyses to identify the prognostic factors in patients with hepatitis B-related primary liver cancer treated with TACE. ResultsThe univariate analysis showed that age, portal vein metastasis, peritoneal metastasis, pleural metastasis, Child-Pugh classification, bilirubin, alanine aminotransferase, number of interventional therapies, and antiviral therapy were prognostic factors in patients with hepatitis B-related primary liver cancer treated with TACE. There was significant difference in 12-month survival curve between patients treated with TACE plus antiviral therapy and those who did not receive antiviral therapy (P<0.05. The multivariate analysis showed that portal vein metastasis (P=0.004, peritoneal metastasis (P=0.009, bilirubin level (P=0.017, antiviral therapy (P=0.000, and number of TACE therapies (P=0.000 were prognostic factors in patients with hepatitis B-related primary liver cancer treated with TACE. ConclusionPortal vein metastasis, peritoneal metastasis, and bilirubin level may be independent risk factors in patients with hepatitis B-related primary liver cancer treated with TACE, and antiviral therapy and number of interventional therapies may be protective factors for these patients.

  12. A rapid and simple procedure for the establishment of human normal and cancer renal primary cell cultures from surgical specimens.

    Directory of Open Access Journals (Sweden)

    Maria João Valente

    Full Text Available The kidney is a target organ for the toxicity of several xenobiotics and is also highly susceptible to the development of malignant tumors. In both cases, in vitro studies provide insight to cellular damage, and represent adequate models to study either the mechanisms underlying the toxic effects of several nephrotoxicants or therapeutic approaches in renal cancer. The development of efficient methods for the establishment of human normal and tumor renal cell models is hence crucial. In this study, a technically simple and rapid protocol for the isolation and culture of human proximal tubular epithelial cells and human renal tumor cells from surgical specimens is presented. Tumor and normal tissues were processed by using the same methodology, based on mechanical disaggregation of tissue followed by enzymatic digestion and cell purification by sequential sieving. The overall procedure takes roughly one hour. The resulting cell preparations have excellent viabilities and yield. Establishment of primary cultures from all specimens was achieved successfully. The origin of primary cultured cells was established through morphological evaluation. Normal cells purity was confirmed by immunofluorescent staining and reverse transcription-polymerase chain reaction analysis for expression of specific markers.

  13. Cardiovascular changes in patients with primary aldosteronism after surgical or medical treatment.

    Science.gov (United States)

    Bernini, G; Bacca, A; Carli, V; Carrara, D; Materazzi, G; Berti, P; Miccoli, P; Pisano, R; Tantardini, V; Bernini, M; Taddei, S

    2012-03-01

    Data on the cardiovascular middle-term follow-up of patients with primary aldosteronism (PA) are scanty. To detect the cardiovascular effects of surgery in patients with aldosterone (ALD)-producing adenoma (APA) and of pharmacotherapy in those with bilateral adrenal hyperplasia (BAH), a prospective study involving 60 consecutive patients with PA was performed. MATERIAL/ METHODS: Clinical, biochemical, and cardiovascular assessment was obtained before and after (31.5±4.4 months) surgery or proper medical treatment (32.1±5.0 months) in 19 and 41 patients, respectively. As expected, plasma ALD normalized in all operated patients, while in the other group it did not change. Systolic and diastolic blood pressure decreased (pbody mass index (p<0.0008), drug number (p<0.03), and ALD/plasma renin activity ratio (p<0.01). Allocating the patients according to plasma ALD and cardiac parameters, patients who presented ALD reduction during the study also had a decrement in cardiac mass (p<0.04). Our data indicate that in patients with PA the removal of ALD excess by surgery in APA is effective in reducing blood pressure and in improving cardiac parameters, while anti-hypertensive therapy in BAH shows less positive impact on cardiovascular system. © 2012, Editrice Kurtis.

  14. Clinical evaluation of fiber-reinforced composite crowns in pulp-treated primary molars: 12-month results

    OpenAIRE

    Mohammadzadeh, Zahra; Parisay, Iman; Mehrabkhani, Maryam; Madani, Azam Sadat; Mazhari, Fatemeh

    2016-01-01

    Objective: The aim of this study was to evaluate the clinical performance of tooth-colored fiber-reinforced composite (FRC) crowns in pulp-treated second primary mandibular teeth. Materials and Methods: This split-mouth randomized, clinical trial performed on 67 children between 3 and 6 years with two primary mandibular second molars requiring pulp treatment. After pulp therapy, the teeth were randomly assigned to stainless steel crown (SSC) or FRC crown groups. Modified United States Public ...

  15. Triple synchronous primary malignancies of the colon, endometrium and kidney in a patient with Lynch syndrome treated via minimally invasive techniques

    Directory of Open Access Journals (Sweden)

    Luis E. Mendez

    2016-08-01

    It is important to consider hereditary cancer syndromes in women with a strong family history presenting with synchronous multiple primary malignancies. A multidisciplinary surgical approach is key to best practices and optimal patient outcomes.

  16. Incidence of breast cancer in the five-year period (2001-2006 in patients treated surgically in the Cantonal Hospital in Zenica

    Directory of Open Access Journals (Sweden)

    H. Drljević

    2006-02-01

    Full Text Available Breast cancer is currently one of the most common malignant tumors of human race and at the same it is the most frequent cancer of female population. The war and post-war migrations of population have significantlychanged the demographic and age structure in Bosnia and Herzegovina. Absence of a National Cancer Register and a unique database on malignant diseases makes monitoring of breast cancer even more difficult.Theobjectiveof this retrospective study was to analyze the incidence of breast cancer in Zenica-Doboj Canton, to conduct a survey based on the age of patients in the five-year period starting from 1 January 2001 until 30 November 2005 and results of the study have been compared with 1990. All the patients were treated surgically with pre-surgical clinical examination, ultra-sound examination and mamography, and pathohistological verification of cancer and pathologically determined size of tumor. A total of 297 patients were treated out of the series of 583 breast surgeries.During this five-year survey a continuous increase of breast cancers in Zenica-Doboj Canton was noted.Therehas been an increased incidence of breast cancer in women aged 30-45, the average size of tumor has decreased, and there has been no change in the relationship between the pathohistological types of tumors and tendencies in surgical treatments to use breast conserving surgical methods. The program of early detection of breast cancer or screening of healthy women and search for “small” cancers (screening programs will enable a wider use of breast conserving surgical methods and it requires a more active involvement of the state and society.

  17. Primary Cleft Lip and Palate Repair in Assam, India: Does Preoperative Anthropometric Analysis Help Identify Patients With Increased Surgical Risk in a Clinically Prescreened Population?

    Science.gov (United States)

    Jerome, Mairin A; Gillenwater, Justin; Laub, Donald R; Osler, Turner; Allan, Anna Y; Restrepo, Carolina; Campbell, Alex

    2017-11-01

      To compare anthropometric z-scores with incidence of post-operative complications for patients undergoing primary cleft lip or palate repair.   This was a retrospective observational analysis of patients from a surgical center in Assam, India, and includes a cohort from a single surgical mission completed before the opening of the center.   Patients included in the study underwent surgery during an Operation Smile mission before the opening of Operation Smile's Guwahati Comprehensive Cleft Care Center in Guwahati, India. The remaining cohort received treatment at the center. All patients received preoperative assessment and screening; surgery; and postoperative care, education, and follow-up.   Our sample size included 1941 patients and consisted of all patients with complete information in the database who returned for follow-up after receiving primary cleft lip repair or primary cleft palate repair between January 2011 and April 2013.   Preoperative anthropometric measurements.   Postoperative complications.   Anthropometric z-scores were not a significant predictor of adverse surgical outcomes in the group analyzed. Palate surgery had increased risk of complication versus lip repair, with an overall odds ratio of 5.66 (P < .001) for all patients aged 3 to 228 months.   Anthropometric z-scores were not correlated with increased risk of surgical complications, possibly because patients were well screened for malnutrition before surgery at this center. Primary palate repair is associated with an approximate fivefold increased risk of developing postoperative complication(s) compared with primary lip repair.

  18. P12.01 Epidemiology in spinal tumors treated surgically at the South Central Hospital of High Specialty from PEMEX in Mexico

    Science.gov (United States)

    Hernandez Resendiz, R.; Cordoba Mosqueda, M.; Guerra Mora, J.; Loya Aguilar, I.; Garcia Gonzalez, U.

    2016-01-01

    Abstract Introduction: The spinal tumors are rare neoplasms, they can be primary or metastatic; in the literature they are divided in extradural and intradural, extramedullary and intramedullary, from which extradural tumors are the most frequent and are usually metastatic, the intramedullary are generally gliomas. From the primary tumors up to 78% are benign and 22% malign, the histological stripe and the involvement to the spinal compartments are of great importance for the results and the treatment which is mainly surgical, individualized and meticulously planned with the support of technological resources such as the electrophysiological monitoring during the surgery. Methods and Materials: Observational study with a range of patients from March 1999- March 2016 to whom surgical resection of the spinal tumor was performed and reported on the Electronic Files of the South Central Hospital of High Specialty PEMEX. A Statistical analysis is made with the SPSS Statistic of disease of the Institution program. Results: 23 patients with spinal tumor surgical resection were found. The median age was 53 ± 10 years. The most common clinical manifestation was radiculopathy (65%). The Karnofsky scale was used for initial evaluation where a 43% of patients had a 90 score at the moment of the diagnosis, while 65% had an ECOG 1. The most frequent tumor was the Spinal Shwannoma (39%), followed in prevalence by the Condroid Cordoma (17%), where the intradural extramedullary location was the most prevalent (78%). The medium rate of survival after the surgical procedure was from 11 months. Conclusions: Our cases and the international statistics coincide. Radiculopathy as high prevalence initial manifestation conceals us to dismiss in the sixth decade of life any possibility for spinal tumor presentation. Most of spinal tumor patients do not have any clinical deterioration in their basal state, which indicates that performing a successful surgical procedure and the right

  19. Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

    Directory of Open Access Journals (Sweden)

    Rui Wang

    2014-04-01

    Full Text Available AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma, and discuss the multiple treating methods of operation combined with primary intraocular lens (IOL implantation.METHODS:Non-comparative retrospective observational case series. Participants:30 cases (30 eyes of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi''an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. Main outcome measures:visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations.RESULTS: The follow-up time was 11-36mo (21.4±7.13. Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL

  20. A qualitative study of primary care clinicians' views of treating childhood obesity

    Directory of Open Access Journals (Sweden)

    Atchinson Rebecca

    2007-09-01

    Full Text Available Abstract Background The prevalence of childhood obesity is rising and the UK Government have stated a commitment to addressing obesity in general. One method has been to include indicators relating to obesity within the GP pay-for-performance Quality and Outcomes Framework (QOF contract. This study aimed to explore general practitioners' and practice nurses' views in relation to their role in treating childhood obesity. Methods We interviewed eighteen practitioners (twelve GPs and six nurses who worked in general practices contracting with Rotherham Primary Care Trust. Interviews were face to face and semi structured. The transcribed data were analysed using framework analysis. Results GPs and practice nurses felt that their role was to raise the issue of a child's weight, but that ultimately obesity was a social and family problem. Time constraint, lack of training and lack of resources were identified as important barriers to addressing childhood obesity. There was concern that the clinician-patient relationship could be adversely affected by discussing what was often seen as a sensitive topic. GPs and practice nurses felt ill-equipped to tackle childhood obesity given the lack of evidence for effective interventions, and were sceptical that providing diet and exercise advice would have any impact upon a child's weight. Conclusion GPs and practice nurses felt that their role in obesity management was centred upon raising the issue of a child's weight, and providing basic diet and exercise advice. Clinicians may find it difficult to make a significant impact on childhood obesity while the evidence base for effective management remains poor. Until the lack of effective interventions is addressed, implementing additional targets (for example through the QOF may not be effective.

  1. The results of 163 Achilles tendon ruptures treated by a minimally invasive surgical technique and functional aftertreatment

    NARCIS (Netherlands)

    Lansdaal, J. R.; Goslings, J. C.; Reichart, M.; Govaert, G. A. M.; van Scherpenzeel, K. M.; Haverlag, R.; Ponsen, K. J.

    2007-01-01

    BACKGROUND: There is still controversy regarding the optimal surgical technique and post-operative treatment of acute Achilles tendon ruptures. We evaluated a treatment protocol for Achilles tendon ruptures consisting of a minimally invasive Achilles tendon repair combined with early full weight

  2. Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection.

    Science.gov (United States)

    Heal, C F; Banks, J L; Lepper, P; Kontopantelis, E; van Driel, M L

    2017-08-01

    Surgical-site infections (SSIs) increase patient morbidity and costs. The aim was to identify and synthesize all RCTs evaluating the effect of topical antibiotics on SSI in wounds healing by primary intention. The search included Ovid MEDLINE, Ovid Embase, the Cochrane Wounds Specialized Register, Central Register of Controlled Trials and EBSCO CINAHL from inception to May 2016. There was no restriction of language, date or setting. Two authors independently selected studies, extracted data and assessed risk of bias. When sufficient numbers of comparable trials were available, data were pooled in meta-analysis. Fourteen RCTs with 6466 participants met the inclusion criteria. Pooling of eight trials (5427 participants) showed that topical antibiotics probably reduced the risk of SSI compared with no topical antibiotic (risk ratio (RR) 0·61, 95 per cent c.i. 0·42 to 0·87; moderate-quality evidence), equating to 20 fewer SSIs per 1000 patients treated. Pooling of three trials (3012 participants) for risk of allergic contact dermatitis found no clear difference between antibiotics and no antibiotic (RR 3·94, 0·46 to 34·00; very low-quality evidence). Pooling of five trials (1299 participants) indicated that topical antibiotics probably reduce the risk of SSI compared with topical antiseptics (RR 0·49, 0·30 to 0·80; moderate-quality evidence); 43 fewer SSIs per 1000 patients treated. Pooling of two trials (541 participants) showed no clear difference in the risk of allergic contact dermatitis with antibiotics or antiseptic agents (RR 0·97, 0·52 to 1·82; very low-quality evidence). Topical antibiotics probably prevent SSI compared with no topical antibiotic or antiseptic. No conclusion can be drawn regarding whether they cause allergic contact dermatitis. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  3. Surgical versus non-surgical approach in primary desmoid-type fibromatosis patients: A nationwide prospective cohort from the French Sarcoma Group.

    Science.gov (United States)

    Penel, Nicolas; Le Cesne, Axel; Bonvalot, Sylvie; Giraud, Antoine; Bompas, Emmanuelle; Rios, Maria; Salas, Sébastien; Isambert, Nicolas; Boudou-Rouquette, Pascaline; Honore, Charles; Italiano, Antoine; Ray-Coquard, Isabelle; Piperno-Neumann, Sophie; Gouin, François; Bertucci, François; Ryckewaert, Thomas; Kurtz, Jean-Emmanuel; Ducimetiere, Françoise; Coindre, Jean-Michel; Blay, Jean-Yves

    2017-09-01

    The outcome of desmoid-type fibromatosis (DTF) is unpredictable. Currently, a wait-and-see approach tends to replace large en bloc resection as the first therapeutic approach. Nevertheless, there are no validated factors to guide the treatment choice. We conducted a prospective study of 771 confirmed cases of DTF. We analysed event-free survival (EFS) based on the occurrence of relapse after surgery, progressive disease during the wait-and-see approach, or change in therapeutic strategy. Identification of prognostic factors was performed using classical methods (log-rank test and Cox model). Overall, the 2-year EFS was 56%; this value did not differ between patients undergoing an operation and those managed by the wait-and-see approach (53% versus 58%, p = 0.415). In univariate analysis, two prognostic factors significantly influenced the outcome: the nature of diagnostic sampling (p = 0.466) and primary location (p = 0.0001). The 2-year EFS was only 32% after open biopsy. The 2-year EFS was 66% for favourable locations (abdominal wall, intra-abdominal, breast, digestive viscera and lower limb) and 41% for unfavourable locations. Among patients with favourable locations, the 2-year EFS was similar in patients treated by both surgery (70%) and the wait-and-see approach (63%; p = 0.413). Among patients with unfavourable locations, the 2-year EFS was significantly enhanced in patients initially managed with the wait-and-see approach (52%) compared with those who underwent initial surgery (25%; p = 0.001). The location of DTF is a major prognostic factor for EFS. If these findings are confirmed by independent analysis, personalised management of DTF must consider this easily obtained parameter. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Patient characteristics do not predict poor glycaemic control in type 2 diabetes patients treated in primary care

    NARCIS (Netherlands)

    Goudswaard, AN; Stolk, RP; Zuithoff, P; Rutten, GEHM

    Many diabetic patients in general practice do not achieve good glycaemic control. The aim of this study was to assess which characteristics of type 2 diabetes patients treated in primary care predict poor glycaemic control (HbA(1c) greater than or equal to7%). Data were collected from the medical

  5. What is the value of emission tomography studies in patients with a primary glioblastoma multiforme treated by Ir-192 brachytherapy?

    NARCIS (Netherlands)

    Koot, R. W.; Habraken, J. B. A.; Hulshof, M. C. C. M.; Paans, A. M. J.; Bosch, D. A.; Pruim, J.

    2008-01-01

    Background. We studied the use of (201)Thallium SPECT and L-[1-C-11]-tyrosine PET in patients with a primary glioblastoma multiforme treated with Ir-192 brachytherapy after surgery and external beam radiation therapy. We hypothesised that the patients most likely to benefit from further surgery

  6. What is the value of emission tomography studies in patients with a primary glioblastoma multiforme treated by Ir-192 brachytherapy?

    NARCIS (Netherlands)

    Koot, R. W.; Habraken, J. B. A.; Paans, A. M. J.; Bosch, D. A.; Pruim, J.; Hulshof, M.C.C.M.

    Background. We studied the use of (201)Thallium SPECT and L-[1-C-11]-tyrosine PET in patients with a primary glioblastoma multiforme treated with Ir-192 brachytherapy after surgery and external beam radiation therapy. We hypothesised that the patients most likely to benefit from further surgery

  7. Analysis of Short- and Long-term Outcomes of Patients With Surgically Treated Left-sided Infective Endocarditis: A 5-Year Longitudinal Follow-up Study.

    Science.gov (United States)

    Marushchak, Oksana; Cole, Holy; Hiebert, Brett; Lo, Evelyn; Keynan, Yoav; Tam, James; Shaikh, Nasir; Menkis, Alan H; Arora, Rakesh C; Shah, Pallav

    2017-01-01

    This study aims to analyze survival, repeat hospitalization, and risk factors for surgically treated left-sided endocarditis. Retrospective review of all 166 (114 native and 52 prosthetic) patients operated between January 2004 and March 2015 was performed. Long-term survival and repeat hospitalization data for 134 of 166 patients were obtained via linked clinical databases with the Manitoba Centre for Health Policy. Kaplan-Meier estimates of survival and hospital readmission and Cox multivariable regression analysis of factors influencing outcomes were performed. Survival at 1 and 5 years was 91% and 80%, respectively, and major adverse prosthesis-related event repeat hospitalization rates were 12% and 21%, respectively. Repeat hospitalization because of endocarditis was 7% and 11% at 1 and 5 years, respectively. Survival and repeat hospitalization were similar for aortic and mitral valves. Survival after surgically treated endocarditis was similar to survival for age-, sex-, and valve-matched surgical valve replacements for noninfectious indications (P = 0.53). Viridans Streptococci was the most common organism in native valve endocarditis, and culture negative endocarditis was most common in prosthetic valves. Prosthetic valve endocarditis (P hospital mortality and major postoperative adverse events. Diabetes and renal dysfunction were associated with poor long-term survival, functional survival, and repeat hospitalization. This analysis suggests that surgery remains a very effective tool in management of these complex patients in terms of survival and major adverse prosthesis-related event repeat hospitalization. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Nasomaxillary complex in size, position and orientation in surgically treated and untreated individuals with cleft lip and palate: A cephalometric overview

    Directory of Open Access Journals (Sweden)

    Rohit Khanna

    2012-01-01

    Full Text Available Background: This cross-sectional retrospective cephalometric study was designed to clarify whether the maxillary deficiency seen in surgically treated individuals with non-syndromic complete unilateral cleft lip and palate (UCLP is due to inherent growth potential or iatrogenicity. Materials and Methods: 72 adult individuals were randomly selected in the age range of 12-20 years, and were divided into two groups. Group I had 47 untreated individuals. Group II consisted of 25 surgically treated individuals. Lateral and frontal cephalograms of the selected individuals were taken and analysed using Nemoceph software. Results: Group II showed a marked reduction in the cranial base angle, maxillary base length, anterior and posterior maxillary positions, palatal plane angle, maxillary width, maxillary height, occlusal plane height, nasal width and nasal height. Conclusion: Surgical intervention does interfere with growth in the facial region. This could be attributed to the scar tissue in lip and palate region, which has a restraining effect on growth in the facial region. These altered functional matrices play a significant role in determining the growth of facial structures.

  9. Primary hyperparathyroidism in MEN1 patients: a cohort study with longterm follow-up on preferred surgical procedure and the relation with genotype.

    NARCIS (Netherlands)

    Pieterman, C.R.; Hulsteijn, L.T. van; Heijer, M. den; Luijt, R.B. van der; Bonenkamp, J.J.; Hermus, A.R.M.M.; Borel Rinkes, I.H.M.; Vriens, M.R.; Valk, G.D.

    2012-01-01

    OBJECTIVE: To identify the optimal surgical strategy for multiple endocrine neoplasia type 1 (MEN1)-related primary hyperparathyroidism (pHPT). To describe the course of postoperative hypoparathyroidism and to assess whether genotype is associated with persistent/recurrent pHPT. BACKGROUND: Surgery

  10. Primary hyperparathyroidism in MEN1 patients: a cohort study with longterm follow-up on preferred surgical procedure and the relation with genotype

    NARCIS (Netherlands)

    Pieterman, Carolina R. C.; van Hulsteijn, Leonie T.; den Heijer, Martin; van der Luijt, Rob B.; Bonenkamp, J. J.; Hermus, Ad R. M. M.; Borel Rinkes, Inne H. M.; Vriens, Menno R.; Valk, Gerlof D.; Valk, G. D.; Zonnenberg, B. A.; Hermus, A. R. M. M.; Dekkers, O. M.; de Herder, W. W.; van der Horst-Schrivers, A. N. A.; Drent, M. L.; Bisschop, P. H. L. T.; Havekes, B.; Vasen, H. F. A.

    2012-01-01

    To identify the optimal surgical strategy for multiple endocrine neoplasia type 1 (MEN1)-related primary hyperparathyroidism (pHPT). To describe the course of postoperative hypoparathyroidism and to assess whether genotype is associated with persistent/recurrent pHPT. Surgery is the preferred

  11. QRS Complex Enlargement as a Predictor of Ventricular Arrhythmias in Patients Affected by Surgically Treated Tetralogy of Fallot: A Comprehensive Literature Review and Historical Overview

    Science.gov (United States)

    Bassareo, Pier Paolo; Mercuro, Giuseppe

    2013-01-01

    Tetralogy of Fallot (TOF) is a congenital heart disease frequently treated by surgical repair to relieve symptoms and improve survival. However, despite the performing of an optimal surgical repair, TOF patients are at times characterized by a poor long-term survival rate, likely due to cardiac causes such as ventricular arrhythmias, with subsequent sudden death. In the 80s it was irrefutably demonstrated that QRS prolongation ≥180 msec at basal electrocardiogram is a strong predictor for refining risk stratification for ventricular tachycardia in these patients. The aim of this research was to undertake a review of all studies conducted to assess the impact of QRS duration on the development of life-threatening ventricular arrhythmias in repaired TOF subjects. PMID:23509638

  12. Surgical resection of locally advanced primary transverse colon cancer--not a worse outcome in stage II tumor.

    Science.gov (United States)

    Hung, Hsin-Yuan; Yeh, Chien-Yuh; Changchien, Chung-Rong; Chen, Jinn-Shiun; Fan, Chung-Wei; Tang, Reiping; Hsieh, Pao-Shiu; Tasi, Wen-Sy; You, Yau-Tong; You, Jeng-Fu; Wang, Jeng-Yi; Chiang, Jy-Ming

    2011-07-01

    In locally advanced primary transverse colon cancer, a tumor may cause perforation or invade adjacent organs. Extensive resection is the best choice of treatment, but such procedures must be weighed against the potential survival benefits. This study was performed to identify the clinicopathological features and treatment outcomes of such tumors. We retrospectively reviewed the database of the Colorectal Cancer Registry of Chang Gung Memorial Hospital between February 1995 and December 2005. Patients with colon cancer sited between the hepatic and splenic flexure that involved an adjacent organ without distant metastasis were defined as having locally advanced transverse colon cancer. A total of 827 patients who underwent surgery for transverse primary colon cancer were enrolled in the study. Stage II and stage III colon cancer were diagnosed in 548 patients. Thirty-two (5.8%) patients were diagnosed with locally advanced tumors. Multivariate analysis revealed that stage III, preoperative carcinoembryonic antigen ≥5 ng/mL, a tumor with perforation or obstruction, and the presence of a locally advanced tumor were significant prognostic factors for both overall and cancer-specific survival. Postoperative morbidity rates differed significantly between the locally advanced and non-locally advanced tumor groups (22.7% vs. 12.3%, P transverse colon tumors (P = 0.21). Surgical resection of locally advanced transverse colon tumors resulted in a higher morbidity and mortality than that of non-locally advanced tumors, but the benefit of extensive surgery in the case of locally advanced tumors cannot be underestimated. Furthermore, this benefit is more pronounced in the case of stage II tumors.

  13. Infantile hypertrophic pyloric stenosis and subsequent ulcer dyspepsia. A follow-up study of medically and surgically treated patients

    DEFF Research Database (Denmark)

    Rasmussen, L; Hansen, L P; Qvist, N

    1988-01-01

    Infantile hypertrophic pyloric stenosis was treated in 324 cases in 1950-1966. At follow-up 19-35 years later, 296 of the patients could be traced, and 284 replied to a questionnaire concerning ulcer dyspepsia. Among the 80 patients who had been medically treated for pyloric stenosis...

  14. A retrospective study of 113 consecutive cases of surgically treated spondylodiscitis patients. A single-center experience.

    Science.gov (United States)

    Shiban, Ehab; Janssen, Insa; Wostrack, Maria; Krieg, Sandro M; Ringel, Florian; Meyer, Bernhard; Stoffel, Michael

    2014-06-01

    Recommendations for the operative treatment of spondylodiscitis are still a controversial issue. A retrospective review identified 113 consecutive patients who underwent surgical debridement and instrumentation for spondylodiscitis between 2006 and 2010 at our department. The mean age at presentation was 65 years; 78 patients were male (69 %). Distribution of the inflammation was lumbar in 68 (60 %), thoracic in 19 (17 %) and cervical in 20 (18 %) cases. Six patients (5 %) had two concomitant non-contiguous spondylodiscitis foci in different segments of the spine. Epidural abscess was found in 33 patients (29 %). One hundred four patients (92 %) had pain. Neurological deficit was found in 40 patients (35 %). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 26 cases; additional interbody fusion from the posterior was performed in 44 cases. A 360° instrumentation was performed in 22 cases. In the cervical cases, only ventral spondylodesis and plating were performed in eight cases, only dorsal instrumentation in five and 360° instrumentation in seven. Postoperative intravenous antibiotics were administered for 14.4 ± 9.3 (mean ± SD) days followed by 3.2 ± 0.8 (mean ± SD) months of oral antibiosis. Complete healing of the inflammation was achieved in 111 (98 %) cases. Two patients died because of septic shock, both with fulminant endocarditis. Pain resolved in all cases. Neurological deficits were completely resolved in 20 patients, and 14 patients had a partial recovery. The results of our retrospective study show that surgical treatment of spondylodiscitis with a staged surgical approach (if needed) and a short 1-2-week period of intravenous antibiotics followed by 3 months of oral antibiotics is appropriate for most patients in whom conservative treatment has failed or is not advisable. Furthermore, surgical treatment of newly diagnosed spondylodiscitis might be recommended as an initial treatment option in

  15. Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

    Directory of Open Access Journals (Sweden)

    Guang HAN

    2016-04-01

    Full Text Available Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation (LDH and lumbar intervertebral foraminal stenosis by percutaneous transforaminal endoscopic discectomy (PTED.  Methods From December 2009 to December 2014, 286 patients with LDH (N = 201 and lumbar intervertebral foraminal stenosis (N = 85 were confirmed by X-ray, CT or MRI and treated by PTED in our hospital. Visual Analogue Scale (VAS was used to evaluate the degree of pain in each paitent before and after operation. The curative effect was evaluated by Macnab score. Surgical complications were recorded to find out the causes and methods to prevent them.  Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 (0.00, 1.05 vs 8.50 (7.75, 9.25; Z = 2.825, P = 0.050]. According to Macnab score, the rate of excellent and good functional recovery was 95.45% (273/286. Procedure-related complications included nerve injury in 8 cases (2.80%, hemorrhage at the operation site and hematoma formation around nerve root in 6 cases (2.10%, rupture of dural sac in one case (0.35%, muscle cramps in 3 cases (1.05%, surgical infection in one case (0.35%, postoperative recurrence in 4 cases (1.40%. All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening the operation time and postoperatively symptomatic treatment, etc. DOI: 10.3969/j.issn.1672-6731.2016.04.007

  16. A double-barrelled fibula graft restoring pelvic stability after late posterior ring instability related to a surgical treated osteitis pubis: a case report.

    Science.gov (United States)

    Pieroh, Philipp; Spindler, Nick; Langer, Stefan; Josten, Christoph; Böhme, Jörg

    2016-01-01

    Osteitis pubis or symphysitis pubis is a rare occurring non-infectious inflammation of the symphysis, the adjacent pubic bones and surrounding tissue. The therapy might be conservative or surgical by a resection of the symphysis and involved parts of the pubic bone. Nevertheless, this resection might lead to an anterior instability impairing the posterior arch and the sacroiliac joints in the aftermath. Here, we report about a 50-year-old women suffering from osteitis pubis treated by wedge resection of the symphysis and parts of the pubic bone. To maintain stability and for local antibiotic treatment a cement spacer was implemented. By clinical inconspicuous findings and the patient's desire, no further surgery was performed. However, 2 years after surgery the spacer dislocated and the patient complained about pain in the posterior arch due to an impaired mobility. Reconstruction surgery was planned including the bridging of the accrued space with a vascularized double-barrelled fibula graft, plate osteosynthesis and rectus abdominis flap coverage. The performed surgery led to pain relief and increased mobility. The present case highlights the possible complication of surgical treated osteitis pubis leading to anterior arch instability affecting the posterior arch and thus impairing pelvic ring stability and patient mobility. Furthermore, we describe an opportunity to treat this complication or other etiologies contributing to anterior pelvic ring stability with large bone defects using a vascularized double-barrelled fibula graft to restore pelvic stability.

  17. Cerebral glucose metabolism in long-term survivors of childhood primary brain tumors treated with surgery and radiotherapy

    DEFF Research Database (Denmark)

    Andersen, Preben B.; Krabbe, Katja; Leffers, Anne M.

    2003-01-01

    Delayed structural cerebral sequelae has been reported following cranial radiation therapy (CRT) to children with primary brain tumors, but little is known about potential functional changes. Twenty-four patients were included, diagnosed and treated at a median age of 11 years, and examined after...... a median recurrence free survival of 16 years by MRI and Positron Emission Tomography using the glucose analog 2-18F-fluoro-2-deoxy-D-glucose (18FDG). Three patients were not analyzed further due to diffuse cerebral atrophy, which might be related to previous hydrocephalus. Twenty-one patients were...... evaluable and regional cerebral metabolic rate for glucose (rCMRglc) was estimated in nontumoral brain regions in 12 patients treated with surgery alone and 9 patients treated with both surgery and CRT. Furthermore 10 normal controls matched for age at examination were included. Patients treated with both...

  18. Pelvic inflammatory disease increases the risk of a second primary malignancy in patients with cervical cancer treated by surgery alone.

    Science.gov (United States)

    Chiou, Wen-Yen; Chen, Chien-An; Lee, Moon-Sing; Lin, Hon-Yi; Li, Chung-Yi; Su, Yu-Chieh; Tsai, Shiang-Jiun; Hung, Shih-Kai

    2016-11-01

    As the number of long-term cervical cancer survivors continues to increase because of improvements in treatment, concerns about second primary malignancy have grown. The high-risk area of second primary cancers in cervical cancer survivors is the pelvis. Pelvic inflammatory disease (PID) could be a useful marker for gynecological cancers. Thus, we designed a large-scale, nationwide, controlled cohort study to investigate whether PID or other risk factors increased the risk of second primary cancers in patients with cervical cancer treated by surgery alone.Between 2000 and 2010, a total of 24,444 cervical cancer patients were identified using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan. Patients who received definite surgery were selected. To exclude the effect on second primary malignancy by treatment modalities, all cervical patients who ever having received adjuvant or definite radiotherapy or chemotherapy for primary cervical cancer were excluded. Finally, 3860 cervical cancer patients treated by surgery alone without adjuvant treatments were analyzed.Cox proportional hazards model was used for multivariate analysis and the Kaplan-Meier method was used to assess the cumulative risks. Regarding the incidence of second primary cancers, the standardized incidence ratio (SIR) was used.The median follow-up time was 56.6 months. The 6-year cumulative risk of second primary cancers is 0.16% and 0.12% for PID and without PID, respectively. After adjustment for confounders, age of less than 50 years, the presence of diabetes mellitus, and PID were significantly positivity associated with the risk of second primary cancers. The hazard ratios (HRs) of age less than 50 years, diabetes mellitus, and PID were 1.38 (95% CI = 1.11-2.04), 1.40 (95% CI = 1.06-1.85), and 1.35 (95% CI = 1.00-1.81), respectively. A higher incidence of second primary cancers was observed in the genitals, bladder, and

  19. 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

  20. Enhancing predicted efficacy of tumor treating fields therapy of glioblastoma using targeted surgical craniectomy: A computer modeling study

    DEFF Research Database (Denmark)

    Korshoej, Anders Rosendal; Saturnino, Guilherme Bicalho; Rasmussen, Line Kirkegaard

    2016-01-01

    Objective: The present work proposes a new clinical approach to TTFields therapy of glioblastoma. The approach combines targeted surgical skull removal (craniectomy) with TTFields therapy to enhance the induced electrical field in the underlying tumor tissue. Using computer simulations, we explore...... the potential of the intervention to improve the clinical efficacy of TTFields therapy of brain cancer. Methods: We used finite element analysis to calculate the electrical field distribution in realistic head models based on MRI data from two patients: One with left cortical/subcortical glioblastoma and one...

  1. Primary non-small cell lung cancer in a transplanted lung treated with stereotactic body radiation therapy. A case study

    International Nuclear Information System (INIS)

    Oskan, F.; University Hospital of Saarland, Homburg; Ganswindt, U.; Belka, C.; Manapov, F.

    2014-01-01

    The first case of primary lung cancer in a transplanted lung was described in 2001. Since then, only 5 cases of lung cancer in donated lung have been reported. We present one more patient with non-small cell cancer in the transplanted lung treated with stereotactic body radiation therapy. In most cases of primary lung cancer in transplanted lung, rapid progression of the cancer was reported. Occurrence of the locoregional failure in our case could be explained by factors related to the treatment protocol and also to underlying immunosuppression.

  2. Olfactory groove meningioma: report of 99 cases surgically treated at the Catholic University School of Medicine, Rome.

    Science.gov (United States)

    Pallini, Roberto; Fernandez, Eduardo; Lauretti, Liverana; Doglietto, Francesco; D'Alessandris, Quintino Giorgio; Montano, Nicola; Capo, Gabriele; Meglio, Mario; Maira, Giulio

    2015-02-01

    We reviewed our series of olfactory groove meningiomas (OGMs) with the aim to relate the surgical approach with outcome and to define clinical and pathologic predictors of prognosis. Ninety-nine patients who underwent 113 craniotomies at our Institution between 1984 and 2010 were entered this study. The relationship between surgical approach (bifrontal, fronto-orbito-basal, and pterional) and either tumor diameter, extent of tumor resection, complication rate, need of reoperation, and Karnofsky Performance Status (KPS) was analyzed. The impact of age (≤ 70 vs. > 70 years), sex, tumor diameter (OGMs published to date, the bifrontal approach was associated with a greater risk of life-threatening complications compared with the lateral pterional and fronto-orbito-basal approaches. The fronto-orbito-basal approach provided greater chances of total tumor removal than the bifrontal and pterional approaches. Two independent factors for overall survival of patients with OGM were identified, namely age and WHO grade. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  3. Repeated echocardiography after first ever ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention - is it necessary?

    DEFF Research Database (Denmark)

    Søholm, Helle; Lønborg, Jacob; Andersen, Mads J

    2015-01-01

    AIM: Changes in left ventricular (LV) function using echocardiography and cardiac magnetic resonance (CMR) imaging were assessed in a contemporary ST-segment elevation myocardial infarction (STEMI) population to assess whether repeated imaging is necessary. METHODS: In a prospective study patients...... with first STEMI were treated with primary percutaneous coronary intervention (PCI) and examined with 2D-echocardiography and CMR at baseline (echocardiography at baseline preserved left ventricular...

  4. The association between preoperative mental distress and patient-reported outcome measures in patients treated surgically for cervical radiculopathy.

    Science.gov (United States)

    Skeppholm, Martin; Fransson, Roland; Hammar, Margareta; Olerud, Claes

    2017-06-01

    Previous research indicates that there might exist a link between the experience of pain and mental distress. Pain can possibly trigger anxiety and chronic pain, as well as also depression. On the other hand, anxiety and depression might also be risk factors for painful conditions and more pronounced subsequent disability and thus, the pathways may be bidirectional. Expanded knowledge of how different factors affect pain and function may help surgeons in preoperative decision-making. The aim of this study was to evaluate the impact of potential preoperative risk factors with special reference to mental distress. This is a prospective outcome study in a cohort from a multicenter randomized controlled trial comparing anterior cervical decompression and fusion with disc replacement. The sample included 151 patients with cervical radiculopathy planned for surgery. Surgical outcome was evaluated with Neck Disability Index (NDI), health related quality-of-life with European Quality of Life-5 Dimensions, and pain with visual analogue scale for arm and neck. Mental distress was preoperatively measured with the Hospital Anxiety and Depression (HAD) scale. Preoperative data regarding possible risk factors for poor outcome were analyzed in multiple linear regression models with postoperative NDI and change of NDI as dependent factors. Patients with high preoperative levels of anxiety or depression (H-HAD), indicating mental distress, were compared with patients scoring low/moderate levels (L-HAD) regarding patient-reported outcome measures (PROMs) preoperatively and at 1- and 2-year follow-up. Outcome data were available for 136 patients at the 2-year follow-up. No statistically significant difference in any outcome data could be demonstrated between the two surgical treatment groups. Mental distress was the variable most strongly associated with NDI at 2 years in the regression analysis. There were 42 patients classified as H-HAD and 94 as L-HAD. The average improvement in

  5. Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma.

    Science.gov (United States)

    Korosec Jagodic, Helena; Jagodic, Klemen; Podbregar, Matej

    2006-01-01

    Our aim was to determine long-term survival and quality of life of patients admitted to a surgical intensive care unit (ICU) because of sepsis or trauma. This was an observational study conducted in an 11-bed, closed surgical ICU at a 860-bed teaching general hospital over a 1-year period (January 2003 to December 2003). Patients were divided into two groups according to admission diagnoses: group 1 included patients with sepsis; and group 2 included patients with trauma (polytrauma, multiple trauma, head injury, or spinal injury). Quality of life was assessed after 2 years following ICU admission using the EuroQol 5D questionnaire. A total of 164 patients (98 trauma patients and 66 patients with sepsis) were included in the study. Trauma patients were younger than patients with sepsis (53 +/- 21 years versus 64 +/- 13 years; P Trauma patients stayed longer on the general ward (35 +/- 44 days versus 17 +/- 24 days; P trauma group (surgical ICU survival: 60% versus 74%; in-hospital survival: 42% versus 62%; post-hospital survival: 78% versus 92%; cumulative 2-year survival: 33% versus 57%; P quality of life in all five dimensions of the EuroQol 5D between groups: 60% of patients had signs of depression, almost 60% had problems in usual activities and 56% had pain. Patients with sepsis treated in a surgical ICU have higher short-term and long-term mortality than do trauma patients. However, quality of life is reduced to the same level in both groups.

  6. Combined detection of preoperative serum CEA, CA19-9 and CA242 improve prognostic prediction of surgically treated colorectal cancer patients.

    Science.gov (United States)

    Wang, Jingtao; Wang, Xiao; Yu, Fudong; Chen, Jian; Zhao, Senlin; Zhang, Dongyuan; Yu, Yang; Liu, Xisheng; Tang, Huamei; Peng, Zhihai

    2015-01-01

    We assessed the prognostic significance of preoperative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 242 (CA242) levels in surgically treated colorectal cancer patients. The relationship of preoperative serum CEA, CA19-9 and CA242 levels with disease characteristics was investigated in 310 patients. Correlation between tumor markers was investigated using Pearson correlation test. Univariate and multivariate survival analyses were used to study the relationship between preoperative tumor markers and prognosis [disease free survival (DFS) and overall survival (OS)]. Kaplan-Meier analysis with log rank test was used to assess the impact of tumor marker levels on survival. Positive rate of preoperative serum CEA, CA19-9 and CA242 were 54.84%, 47.42% and 37.10%, respectively. High preoperative CEA level was associated with tumor size (P = 0.038), T stage (P tumor AJCC stage (P = 0.023). Preoperative CA242 positively correlated with CEA (P markers was of independent prognostic value in CRC (HR = 2.532, 95% CI: 1.400-4.579, P = 0.002 for OS; and HR = 2.366, 95% CI: 1.334-4.196, P = 0.003 for DFS). Combined detection of preoperative serum CEA, CA19-9 and CA242 is of independent prognostic value for management of CRC patients treated surgically.

  7. Risk of metastasis and orbital recurrence in advanced retinoblastoma eyes treated with systemic chemoreduction versus primary enucleation.

    Science.gov (United States)

    Berry, Jesse L; Kogachi, Kaitlin; Aziz, Hassan A; McGovern, Kathleen; Zolfaghari, Emily; Murphree, A Linn; Jubran, Rima; Kim, Jonathan W

    2017-04-01

    The purpose of this study was to evaluate the risk of metastatic disease and orbital recurrence in advanced retinoblastoma treated with systemic chemoreduction versus primary enucleation. A retrospective review of patients with Group D/E retinoblastoma was conducted with data collection from 1995 to 2015. Overall, 345 eyes (294 patients) were included (165 Group D and 180 Group E). Primary outcome measures were orbital recurrence and metastatic disease. Of the 345 eyes, 139 were treated with systemic chemoreduction (102 Group D, 37 Group E) and 206 with primary enucleation (63 Group D, 143 Group E). In the chemoreduction group, one patient developed metastasis (0.7%) and one an orbital recurrence (0.7%). In the primary enucleation group, two patients developed metastases (0.9%) and one an orbital recurrence (0.5%). After systemic chemoreduction, 58 of the 139 eyes (30 Group D, 28 Group E) were secondarily enucleated for treatment failure (41.7%). The median time to secondary enucleation from diagnosis was 8.1 months. None of the eyes in the systemic chemoreduction group had high-risk pathologic features. In the primary enucleation group, 56 eyes had high-risk pathology. Over a 20-year period, 345 eyes were treated for advanced retinoblastoma at Children's Hospital Los Angeles. Incidence of orbital recurrence and metastatic disease was risk pathology, and none of these patients developed metastatic disease. Globe salvage therapy with systemic chemoreduction and subsequent enucleation for poor response does not increase the risk of metastatic disease or orbital recurrence. © 2016 Wiley Periodicals, Inc.

  8. [Rupture of interventricular septum secondary to blunt chest trauma. Report of a case surgically treated with success (author's transl)].

    Science.gov (United States)

    Gallotti, R; Gordini, V; Botta, M; Pezzano, A

    1976-01-01

    A case of interventricular septal defect secondary to blunt chest trauma is reported. It was characterized by a disconnection of the interventricular muscolar septal in the anterosuperior part of the heart wall. The diagnosis, suspected by clinical and instrumental parameters, was definitely confirmedy by hemodynamic and contrastographic examination. Repair surgery of the defect with a dacron patch was performed, using extracorporea normothermic circulation seven months after the accident. The patient was examined three months and twelve months after the operation; the clinical examinations did not reveal any cardiac murmur and the patient's health was satisfactory. The incidence, mechanism of rupture of interventricular septum and the main surgical and clinical aspects of this type of pathology are discussed.

  9. Some cardiopulmonary effects of midazolam premedication in clenbuterol-treated bitches during surgical endoscopic examination of the uterus and ovariohysterectomy

    Directory of Open Access Journals (Sweden)

    G.F. Stegmann

    2001-07-01

    Full Text Available Midazolam was administered intravenously to 8 bitches in a randomised, placebo-controlled clinical trial before propofol induction of surgical anaesthesia. Anaesthesia was maintained with isoflurane-in-oxygen during surgical endoscopic examination of the uterus and ovariohysterectomy. Clenbuterol was administered at the start of surgery to improve uterine muscle relaxation, and to facilitate endoscopic examination of the uterus. Ventilation was controlled. Induction of anaesthesia with propofol to obtain loss of the pedal reflex resulted in a statistically significant (P < 0.05 decrease in minute volume and arterial oxygen partial pressure in the midazolam group. Apnoea also occurred in 50 % of dogs in the midazolam group. The dose for propofol in the midazolam group was 7.4 mg/kg compared to 9.5 mg/kg in the control. Minute volume was significantly (P < 0.05 higher in both groups during isoflurane maintenance, compared to the value after incremental propofol to obtain loss of the pedal reflex. Propofol induction resulted in a 25-26 % reduction in the mean arterial blood pressure in both groups, and the administration of clenbuterol at the start of surgery resulted in a transient, but statistically significant (P < 0.05, decrease in mean arterial blood pressure in the midazolam group during isoflurane anaesthesia. It is concluded that intravenous midazolam premedication did not adversely affect cardiovascular function during propofol induction, but intra-operative clenbuterol during isoflurane maintenance of anaesthesia may result in transient hypotension. Midazolam premedication may increase adverse respiratory effects when administered before propofol induction of anaesthesia.

  10. Uncommon primary hydatid cyst occupying the adrenal gland space, treated with laparoscopic surgical approach in an old patient

    Directory of Open Access Journals (Sweden)

    Aprea Giovanni

    2016-01-01

    Full Text Available Hydatid disease (HD is caused by Echinococcus Granulosus (EG, which is a larva endemic in many undeveloped areas. The most common target is the liver (59%–75%. The retroperitoneal space is considered as a rare localization. We report an uncommon case of HD located in the adrenal gland space.

  11. White matter lesions and encephalopathy in patients treated for primary central nervous system lymphoma

    NARCIS (Netherlands)

    Wassenberg, MWM; Bromberg, JEC; Witkamp, TD; Terhaard, CHJ; Taphoorn, MJB

    A retrospective analysis of the clinical presentations and neuroimaging characteristics of 33 patients with a primary central nervous system lymphoma (PCNL) who received cranial radiotherapy was performed to assess incidence of and risk factors for radiation-induced encephalopathy. CT and MRI scans

  12. Is high-viscosity glass-ionomer-cement a successor to amalgam for treating primary molars?

    NARCIS (Netherlands)

    Hilgert, L.A.; Amorim, R.G. de; Leal, S.C.; Mulder, J.; Creugers, N.H.; Frencken, J.E.

    2014-01-01

    OBJECTIVES: To assess and compare the cumulative survival rate of amalgam and atraumatic restorative treatment (ART) restorations in primary molars over 3 years. METHODS: 280 children aged 6-7 years old were enrolled in a cluster randomized controlled clinical trial using a parallel group design

  13. Recent trends in the surgical management of primary vesicoureteral reflux in the era of dextranomer/hyaluronic acid.

    Science.gov (United States)

    Herbst, Katherine W; Corbett, Sean T; Lendvay, Thomas S; Caldamone, Anthony A

    2014-05-01

    Since its inception as a technology in the United States, endoscopic correction of vesicoureteral reflux has become a popular treatment option in children with vesicoureteral reflux with reported wide use. We determined whether the increasing trend in use in the United States after the introduction of dextranomer/hyaluronic acid has been sustained. We abstracted data on pediatric patients treated with ureteral reimplantation or dextranomer/hyaluronic acid intervention for vesicoureteral reflux from 2004 to 2011 from the PHIS (Pediatric Health Information System) database. Patients with coding data indicating diagnoses other than primary vesicoureteral reflux and hospitals reporting less than 80% of ambulatory surgery cases by CPT code were excluded from study. We identified 14,430 patients (17,826 procedures), of whom 49% underwent reimplantation and 51% underwent dextranomer/hyaluronic acid injection. Of the patients 83% were female with a median age at surgery of 4.7 years (IQR 2.5-7.2). Linear regression showed a significant downward trend in the average total number of antireflux operations per institution during the study period. This was attributable to a decrease in the average rate of dextranomer/hyaluronic acid interventions because the average reimplantation rate remained stable during this time. At freestanding pediatric hospitals enrolled in the PHIS database there is a trend toward decreasing intervention for primary vesicoureteral reflux, which appears to be due to decreased use of injection therapy. This may reflect a philosophical change in reflux management by injection therapy. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. Factors predicting the duration of adrenal insufficiency in patients successfully treated for Cushing disease and nonmalignant primary adrenal Cushing syndrome.

    Science.gov (United States)

    Prete, Alessandro; Paragliola, Rosa Maria; Bottiglieri, Filomena; Rota, Carlo Antonio; Pontecorvi, Alfredo; Salvatori, Roberto; Corsello, Salvatore Maria

    2017-03-01

    Successful treatment of Cushing syndrome causes transient or permanent adrenal insufficiency deriving from endogenous hypercortisolism-induced hypothalamus-pituitary-adrenal-axis suppression. We analyzed pre-treatment factors potentially affecting the duration of adrenal insufficiency. We conducted a retrospective analysis on patients successfully treated for Cushing disease (15 patients) who underwent transsphenoidal surgery, and nonmalignant primary adrenal Cushing syndrome (31 patients) who underwent unilateral adrenalectomy, divided into patients with overt primary adrenal Cushing syndrome (14 patients) and subclinical primary adrenal Cushing syndrome (17 patients). Epidemiological data, medical history, and hormonal parameters depending on the etiology of hypercortisolism were collected and compared to the duration of adrenal insufficiency. The median duration of follow-up after surgery for Cushing disease and primary adrenal Cushing syndrome was 70 and 48 months, respectively. In the Cushing disease group, the median duration of adrenal insufficiency after transsphenoidal surgery was 15 months: younger age at diagnosis and longer duration of signs and symptoms of hypercortisolism before diagnosis and surgery were associated with longer duration of adrenal insufficiency. The median duration of adrenal insufficiency was 6 months for subclinical primary adrenal Cushing syndrome and 18.5 months for overt primary adrenal Cushing syndrome. The biochemical severity of hypercortisolism, the grade of hypothalamus-pituitary-adrenal-axis suppression, and treatment with ketoconazole before surgery accounted for longer duration of adrenal insufficiency. In patients with Cushing disease, younger age and delayed diagnosis and treatment predict longer need for glucocorticoid replacement therapy after successful transsphenoidal surgery. In patients with primary adrenal Cushing syndrome, the severity of hypercortisolism plays a primary role in influencing the duration of

  15. Incidence of second primary malignancies and related mortality in patients with imatinib-treated chronic myeloid leukemia.

    Science.gov (United States)

    Gugliotta, Gabriele; Castagnetti, Fausto; Breccia, Massimo; Albano, Francesco; Iurlo, Alessandra; Intermesoli, Tamara; Abruzzese, Elisabetta; Levato, Luciano; D'Adda, Mariella; Pregno, Patrizia; Cavazzini, Francesco; Stagno, Fabio; Martino, Bruno; La Barba, Gaetano; Sorà, Federica; Tiribelli, Mario; Bigazzi, Catia; Binotto, Gianni; Bonifacio, Massimiliano; Caracciolo, Clementina; Soverini, Simona; Foà, Robin; Cavo, Michele; Martinelli, Giovanni; Pane, Fabrizio; Saglio, Giuseppe; Baccarani, Michele; Rosti, Gianantonio

    2017-09-01

    The majority of patients with chronic myeloid leukemia are successfully managed with life-long treatment with tyrosine kinase inhibitors. In patients in chronic phase, other malignancies are among the most common causes of death, raising concerns on the relationship between these deaths and the off-target effects of tyrosine kinase inhibitors. We analyzed the incidence of second primary malignancies, and related mortality, in 514 chronic myeloid leukemia patients enrolled in clinical trials in which imatinib was given as first-line treatment. We then compared the observed incidence and mortality with those expected in the age- and sex-matched Italian general population, calculating standardized incidence and standardized mortality ratios. After a median follow-up of 74 months, 5.8% patients developed second primary malignancies. The median time from chronic myeloid leukemia to diagnosis of the second primary malignancies was 34 months. We did not find a higher incidence of second primary malignancies compared to that in the age- and sex-matched Italian general population, with standardized incidence ratios of 1.06 (95% CI: 0.57-1.54) and 1.61 (95% CI: 0.92-2.31) in males and females, respectively. Overall, 3.1% patients died of second primary malignancies. The death rate in patients with second primary malignancies was 53% (median overall survival: 18 months). Among females, the observed cancer-related mortality was superior to that expected in the age- and sex-matched Italian population, with a standardized mortality ratio of 2.41 (95% CI: 1.26 - 3.56). In conclusion, our analysis of patients with imatinib-treated chronic myeloid leukemia did not reveal a higher incidence of second primary malignancies; however, the outcome of second primary malignancies in such patients was worse than expected. Clinicaltrials.gov: NCT00514488, NCT00510926. Copyright© 2017 Ferrata Storti Foundation.

  16. Acupuncture to Treat Primary Dysmenorrhea in Women: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Caroline A. Smith

    2011-01-01

    Full Text Available We examined the effectiveness of acupuncture to reduce the severity and intensity of primary dysmenorrhea. A randomized controlled trial compared acupuncture with control acupuncture using a placebo needle. Eligible women were aged 14–25 years with a diagnosis of primary dysmenorrhea. Women received nine sessions of the study treatment over 3 months. The primary outcomes were menstrual pain intensity and duration, overall improvement in dysmenorrhea symptoms and reduced need for additional analgesia, measured at 3, 6 and 12 months from trial entry. A total of 92 women were randomly assigned to the intervention (acupuncture =46 and control =46. At 3 months although pain outcomes were lower for women in the acupuncture group compared with the control group, there was no significant difference between groups. Women receiving acupuncture reported a small reduction in mood changes compared with the control group, relative risk (RR 0.72, 95% confidence interval (CI 0.53–1.00, =.05. Follow-up at 6 months found a significant reduction in the duration of menstrual pain in the acupuncture group compared with the control group, mean difference –9.6, 95% CI –18.9 to –0.3, =.04, and the need for additional analgesia was significantly lower in the acupuncture group compared with the control group, RR 0.69, 95% CI 0.49–0.96, =.03, but the follow-up at 12 months found lack of treatment effect. To conclude, although acupuncture improved menstrual mood symptoms in women with primary dysmenorrhea during the treatment phase, the trend in the improvement of symptoms during the active phase of treatment, and at 6 and 12 months was non-significant, indicating that a small treatment effect from acupuncture on dysmenorrhea may exist. In the study, acupuncture was acceptable and safe, but further appropriately powered trials are needed before recommendations for clinical practice can be made.

  17. Cost-effectiveness of a Primary Care Intervention to Treat Obesity

    Science.gov (United States)

    Tsai, Adam G.; Wadden, Thomas A.; Volger, Sheri; Sarwer, David B.; Vetter, Marion; Kumanyika, Shiriki; Berkowitz, Robert I.; Diewald, Lisa; Perez, Joanna; Lavenberg, Jeffrey; Panigrahi, Eva R.; Glick, Henry A.

    2013-01-01

    Background Data on the cost-effectiveness of the behavioral treatment of obesity are not conclusive. The cost-effectiveness of treatment in primary care settings is particularly relevant. Methods We conducted a within-trial cost-effectiveness analysis of a primary care-based obesity intervention. Study participants were randomized to: Usual Care (quarterly visits with their primary care provider); Brief Lifestyle Counseling (Brief LC; quarterly provider visits plus monthly weight loss counseling visits; or Enhanced Brief Lifestyle Counseling (Enhanced Brief LC; all above interventions, plus choice of meal replacements or weight loss medication). A health care payer perspective was used. Intervention costs were estimated from tracking data obtained prospectively. Quality adjusted life years (QALYs) were estimated with the EuroQol-5D. We estimated cost per kilogram-year of weight loss and cost per QALY. Results Weight losses after 2 years were 1.7, 2.9, and 4.6 kg for Usual Care, Brief LC, and Enhanced Brief LC, respectively (p = 0.003 for comparison of Enhanced Brief LC vs. Usual Care). The incremental cost per kilogram-year lost was $292 for Enhanced Brief LC compared to Usual Care (95% CI $38 to $394). The incremental cost per QALY was $115,397, but the 95% CI were undefined. Comparison of short term cost per kg with published estimates of longer term cost per QALYs suggested that the intervention could be cost-effective over the long term (≥ 10 years). Conclusions A primary care intervention that included monthly counseling visits and a choice of meal replacements or weight loss medication could be a cost-effective treatment for obesity over the long term. However, additional studies are needed on the cost-effectiveness of behavioral treatment of obesity. PMID:23921780

  18. [Health literacy in patients with heart failure treated in primary care].

    Science.gov (United States)

    Santesmases-Masana, Rosalia; González-de Paz, Luis; Real, Jordi; Borràs-Santos, Alicia; Sisó-Almirall, Antoni; Navarro-Rubio, Maria Dolors

    2017-01-01

    The level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area. A multicentre cross-sectional study. 10 Primary care centres from the metropolitan area of Barcelona. Patients diagnosed with heart failure. to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation. Health Literacy Survey-European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model. The study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%). In patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failure. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  19. 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.

  20. Pathological Risk Factors and Outcomes in Women With Stage IB2 Cervical Cancer Treated With Primary Radical Surgery Versus Chemoradiotherapy.

    Science.gov (United States)

    Bradbury, Melissa; Founta, Christina; Taylor, Wendy; Kucukmetin, Ali; Naik, Raj; Ang, Christine

    2015-10-01

    Both radical hysterectomy with pelvic lymphadenectomy and primary chemoradiotherapy have been shown to be effective in the management of women with stage IB2 cervical cancer. This study aims to review the outcomes related to each treatment modality and the effects of pathological risk factors on overall survival (OS) and disease-free survival. We performed a retrospective study of 92 women with stage IB2 cervical cancer who were treated at the Northern Gynecological Oncology Center (Gateshead, United Kingdom) across a 22-year period between January 1991 and July 2013. Women were divided into those undergoing primary surgery and those undergoing primary radiotherapy/chemoradiotherapy. The main outcome measures were OS and progression-free survival (PFS). Pathological risk factors of survival were assessed using multivariate analysis. Sixty-seven women (72.8%) underwent primary surgery, and 25 women (27.2%) had primary radiotherapy/chemoradiotherapy. Thirty-one of 67 women (46.3%) required adjuvant radiotherapy/chemoradiotherapy after surgery because of positive lymph nodes in 77.4% of cases. The median follow-up was 57.5 months (range, 3-137 months). Thirty-two women (34.8%) had disease recurrence: 6 women (16.7%) in the group undergoing surgery alone, 15 women (48.4%) in the group requiring adjuvant treatment after surgery, and 11 women (44%) in the group having primary radiotherapy/chemoradiotherapy. Overall survival and PFS were higher for women undergoing surgery alone (91.7% and 83.3%) compared with women requiring adjuvant treatment after surgery (54.8% and 51.4%) and those having primary radiotherapy/chemoradiotherapy (60% and 56%) (P = 0.0004 and P = 0.005, respectively). Lymph node metastasis was a significant pathological risk factor of OS and PFS in multivariate analysis. Most women require adjuvant treatment after surgery because of positive lymph nodes. Because survival outcomes for women requiring dual treatment are similar to those for women

  1. Sexual dysfunction and its impact on quality of life in Chinese patients with schizophrenia treated in primary care.

    Science.gov (United States)

    Hou, Cai-Lan; Zang, Yu; Rosen, R C; Cai, Mei-Ying; Li, Yan; Jia, Fu-Jun; Lin, Yong-Qiang; Ungvari, Gabor S; Ng, Chee H; Chiu, Helen F K; Xiang, Yu-Tao

    2016-02-01

    Sexual dysfunction in schizophrenia patients is common. In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. Illness- or treatment-related sexual dysfunction in this patient population has been never studied. This study describes the prevalence and correlates of sexual dysfunction and its impact on quality of life (QOL) in patients with schizophrenia treated in primary care in China. A total of 607 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. Patients' socio-demographic and clinical characteristics including sexual function and QOL were recorded using a standardized protocol and data collection. Sexual dysfunction was present in 69.9% of all patients; 60.7% in males and 80.6% in females. Multiple logistic regression analysis revealed that female gender, being single, older age and use of first-generation antipsychotics were independently and significantly associated with more sexual dysfunction accounting for 23.5% of its variance (Pprimary care in China. Given its negative impact on social adjustment, QOL and treatment adherence, efforts should be made to address sexual dysfunction in this patient population. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Primary hyperhidrosis: Implications on symptoms, daily life, health and alcohol consumption when treated with botulinum toxin.

    Science.gov (United States)

    Shayesteh, Alexander; Boman, Jens; Janlert, Urban; Brulin, Christine; Nylander, Elisabet

    2016-08-01

    Primary hyperhidrosis affects approximately 3% of the population and reduces quality of life in affected persons. Few studies have investigated the symptoms of anxiety, depression and hazardous alcohol consumption among those with hyperhidrosis and the effect of treatment with botulinum toxin. The first aim of this study was to investigate the effect of primary hyperhidrosis on mental and physical health, and alcohol consumption. Our second aim was to study whether and how treatment with botulinum toxin changed these effects. One hundred and fourteen patients answered questionnaires regarding hyperhidrosis and symptoms, including hyperhidrosis disease severity scale (HDSS), visual analog scale (VAS) 10-point scale for hyperhidrosis symptoms, hospital anxiety and depression scale (HADS), alcohol use disorder identification test (AUDIT) and short-form health survey (SF-36) before treatment with botulinum toxin and 2 weeks after. The age of onset of hyperhidrosis was on average 13.4 years and 48% described heredity for hyperhidrosis. Significant improvements were noted in patients with axillary and palmar hyperhidrosis regarding mean HDSS, VAS 10-point scale, HADS, SF-36 and sweat-related health problems 2 weeks after treatment with botulinum toxin. Changes in mean AUDIT for all participants were not significant. Primary hyperhidrosis mainly impairs mental rather than physical aspects of life and also interferes with specific daily activities of the affected individuals. Despite this, our patients did not show signs of anxiety, depression or hazardous alcohol consumption. Treatment with botulinum toxin reduced sweat-related problems and led to significant improvements in HDSS, VAS, HADS and SF-36 in our patients. © 2016 Japanese Dermatological Association.

  3. The efficacy of postoperative radiotherapy in localized primary soft tissue sarcoma treated with conservative surgery

    International Nuclear Information System (INIS)

    Zhao, Ru-Ping; Yu, Xiao-Li; Zhang, Zhen; Jia, Li-Juan; Feng, Yan; Yang, Zhao-Zhi; Chen, Xing-Xing; Wang, Jian; Ma, Sheng-Lin; Guo, Xiao-Mao

    2016-01-01

    To evaluate the efficacy of postoperative radiotherapy (RT) on local failure-free survival (LFFS), distant metastasis-free survival (DMFS) and overall survival (OS) in patients with localized primary soft tissue sarcoma (STS) and to identify prognostic factors. Between January 2000 and July 2010, 220 consecutive patients with localized primary STS, who received conservative surgery with or without postoperative RT, were enrolled in the study. Survival curves were constructed by the Kaplan-Meier method and log-rank test was used to assess statistical significance. Multivariate analysis was applied to identify the prognostic factors. After a median follow-up of 68 months (range, 5–127 months), the 5-year LFFS, DMFS and OS were 70.0, 78.2 and 71.2 %, respectively. Tumor size, histological subtypes, margin status and postoperative RT were independent predictors for OS. Postoperative RT was associated with a significant reduced local recurrence risk versus surgery alone (hazard ratio [HR] = 0.408, 95 % confidence interval [CI] 0.235–0.707, P = 0.001), with 5-year LFFS of 81.1 and 63.6 %, respectively (log-rank, P = 0.004). The log-rank test showed that postoperative RT had a tendency of improving OS compared with surgery alone, with 5-year OS of 74.8 and 65.0 %, respectively (P = 0.089). Multivariate analysis demonstrated that postoperative RT significantly reduced mortality rate compared with surgery alone (HR = 0.512, 95 % CI 0.296–0.886, p = 0.017), especially in patients with liposarcoma (p = 0.034). Postoperative radiotherapy reduce both local recurrence and STS mortality in patients with localized primary STS. The efficacy of RT on survival warrants further prospective study. The online version of this article (doi:10.1186/s13014-016-0605-y) contains supplementary material, which is available to authorized users

  4. Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG.

    Science.gov (United States)

    Van Schayck, O C P; Williams, S; Barchilon, V; Baxter, N; Jawad, M; Katsaounou, P A; Kirenga, B J; Panaitescu, C; Tsiligianni, I G; Zwar, N; Ostrem, A

    2017-06-09

    Tobacco smoking is the world's leading cause of premature death and disability. Global targets to reduce premature deaths by 25% by 2025 will require a substantial increase in the number of smokers making a quit attempt, and a significant improvement in the success rates of those attempts in low, middle and high income countries. In many countries the only place where the majority of smokers can access support to quit is primary care. There is strong evidence of cost-effective interventions in primary care yet many opportunities to put these into practice are missed. This paper revises the approach proposed by the International Primary Care Respiratory Group published in 2008 in this journal to reflect important new evidence and the global variation in primary-care experience and knowledge of smoking cessation. Specific for primary care, that advocates for a holistic, bio-psycho-social approach to most problems, the starting point is to approach tobacco dependence as an eminently treatable condition. We offer a hierarchy of interventions depending on time and available resources. We present an equitable approach to behavioural and drug interventions. This includes an update to the evidence on behaviour change, gender difference, comparative information on numbers needed to treat, drug safety and availability of drugs, including the relatively cheap drug cytisine, and a summary of new approaches such as harm reduction. This paper also extends the guidance on special populations such as people with long-term conditions including tuberculosis, human immunodeficiency virus, cardiovascular disease and respiratory disease, pregnant women, children and adolescents, and people with serious mental illness. We use expert clinical opinion where the research evidence is insufficient or inconclusive. The paper describes trends in the use of waterpipes and cannabis smoking and offers guidance to primary-care clinicians on what to do faced with uncertain evidence. Throughout, it

  5. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Terkelsen, Christian Juhl; Sørensen, Jacob Thorsted; Maeng, Michael

    2010-01-01

    Timely reperfusion therapy is recommended for patients with ST-segment elevation myocardial infarction (STEMI), and door-to-balloon delay has been proposed as a performance measure in triaging patients for primary percutaneous coronary intervention (PCI). However, focusing on the time from first...... contact with the health care system to the initiation of reperfusion therapy (system delay) may be more relevant, because it constitutes the total time to reperfusion modifiable by the health care system. No previous studies have focused on the association between system delay and outcome in patients...

  6. Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study).

    Science.gov (United States)

    Mukhopadhyay, Sanjay; Feldman, Michael D; Abels, Esther; Ashfaq, Raheela; Beltaifa, Senda; Cacciabeve, Nicolas G; Cathro, Helen P; Cheng, Liang; Cooper, Kumarasen; Dickey, Glenn E; Gill, Ryan M; Heaton, Robert P; Kerstens, René; Lindberg, Guy M; Malhotra, Reenu K; Mandell, James W; Manlucu, Ellen D; Mills, Anne M; Mills, Stacey E; Moskaluk, Christopher A; Nelis, Mischa; Patil, Deepa T; Przybycin, Christopher G; Reynolds, Jordan P; Rubin, Brian P; Saboorian, Mohammad H; Salicru, Mauricio; Samols, Mark A; Sturgis, Charles D; Turner, Kevin O; Wick, Mark R; Yoon, Ji Y; Zhao, Po; Taylor, Clive R

    2018-01-01

    Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard. Cases were scanned, converted to WSI and randomized. Sixteen pathologists interpreted cases by microscopy or WSI, followed by a wash-out period of ≥4 weeks, after which cases were read by the same observers using the other modality. Major discordances were identified by an adjudication panel, and the differences between major discordance rates for both microscopy (against the reference standard) and WSI (against the reference standard) were calculated. A total of 1992 cases were included, resulting in 15,925 reads. The major discordance rate with the reference standard diagnosis was 4.9% for WSI and 4.6% for microscopy. The difference between major discordance rates for microscopy and WSI was 0.4% (95% confidence interval, -0.30% to 1.01%). The difference in major discordance rates for WSI and microscopy was highest in endocrine pathology (1.8%), neoplastic kidney pathology (1.5%), urinary bladder pathology (1.3%), and gynecologic pathology (1.2%). Detailed analysis of these cases revealed no instances where interpretation by WSI was consistently inaccurate compared with microscopy for multiple observers. We conclude that WSI is noninferior to microscopy for primary diagnosis in surgical pathology, including biopsies and resections stained with hematoxylin and eosin, immunohistochemistry and special stains. This conclusion is valid across a wide

  7. Culture-independent analyses reveal novel Anaerolineaceae as abundant primary fermenters in anaerobic digesters treating waste activated sludge

    DEFF Research Database (Denmark)

    McIlroy, Simon Jon; Kirkegaard, Rasmus Hansen; Dueholm, Morten Simonsen

    2017-01-01

    Anaerobic digestion for biogas production is reliant on the tightly coupled synergistic activities of complex microbial consortia. Members of the uncultured A6 phylotype, within the phylum Chloroflexi, are among the most abundant genus-level-taxa of mesophilic anaerobic digester systems treating...... to be anaerobic chemoorganoheterotrophs with a fermentative metabolism. Given their observed abundance, they are likely important primary fermenters in digester systems. Application of fluorescence in situ hybridisation probes designed in this study revealed their morphology to be short filaments present within...

  8. Shoulder morbidity after non-surgical treatment of the neck

    International Nuclear Information System (INIS)

    Wouwe, Merian van; Bree, Remco de; Kuik, Dirk J.; Goede, Cees J.T. de; Verdonck-de Leeuw, Irma M.; Doornaert, Patricia; Rene Leemans, C.

    2009-01-01

    Background and purpose: Reports on shoulder function after non-surgical treatment are not available. In the present study shoulder morbidity after surgical and non-surgical treatment of the neck is determined and compared. Materials and methods: In 100 head and neck cancer patients 174 neck sides were treated by surgery (n = 51) or (chemo)radiation (n = 123). Abduction, anteflexion, endorotation and exorotation were assessed. Subjective measurements were performed using the Visual Analogue Scale for pain, the Shoulder Disability Questionnaire (SDQ) and stiffness reporting. Results: Predictive factors for SDQ-score > 0 (n = 54) were VAS pain score, stiffness, abduction, anteflexion, physiotherapy, low shoulder position and surgical treatment. The SDQ, stiffness and pain scores were significantly higher in the surgically treated group than in the non-surgical group (p < 0.01). Anteflexion, abduction and exorotation were less impaired in the non-surgically treated group than in the surgically treated group (p < 0.01). No differences between neck dissection and neck dissection with post-operative radiotherapy, and radiotherapy and chemoradiation were found for these movements. Conclusions: Shoulder morbidity is often present after non-surgical treatment of the neck, but to a lesser extent compared to surgical treatment. Radiotherapy adds no morbidity to neck dissection and chemotherapy does not add extra morbidity to primary radiation

  9. More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture.

    Science.gov (United States)

    Armour, Michael; Dahlen, Hannah G; Smith, Caroline A

    2016-01-01

    Background. Primary dysmenorrhea is a common gynaecological condition. Traditional Chinese medicine (TCM) acupuncturists commonly treat primary dysmenorrhea and dispense specific self-care advice for this condition. The impact of self-care advice on primary dysmenorrhea is unknown. Methods. 19 TCM acupuncture practitioners from New Zealand or Australia and 12 New Zealand women who had recently undergone acupuncture treatment for primary dysmenorrhea as part of a randomised controlled trial participated in this qualitative, pragmatic study. Focus groups and semistructured interviews were used to collect data. These were recorded, transcribed, and analysed using thematic analysis. Results. The overarching theme was that an acupuncture treatment consisted of "more than needles" for both practitioners and participants. Practitioners and participants both discussed the partnership they engaged in during treatment, based on openness and trust. Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms. Conclusions. Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial.

  10. [Effect on blood pressure and microcirculation of nail fold in primary hypertension patients treated with acupuncture according to syndrome differentiation].

    Science.gov (United States)

    Xing, Xiao-min; Wang, Rui-chen; Sun, Qi-wei; Li, Hu

    2011-04-01

    To verify the efficacy of primary hypertension treated with acupuncture at acupoints selected according to syndrome differentiation and probe into the mechanism of acupuncture for primary hypertension. One hundred and thirty-five cases of primary hypertension were randomized into an observation group (108 cases) and a control group (27 cases). In either group, Fengchi (GB 20), Quchi (LI 11), Zusanli (ST 36) and Sanyinjiao (SP 6) were selected conventionally. In observation group, on the basis of the acupoints selected above, the supplementary points were selected according to syndrome differentiation in Chinese medicine and the control group was selected main points only, once per day. After 15 days acupuncture, the efficacy and changes in microcirculation of nail fold were observed. The remarkable effective rate and the total effective rate were 29.6% (32/108) and 84.2% (91/108) in observation group respectively, which were superior to 18. 5% (5/27) and 70.4% (19/27) as compared with control group separately (both P Acupuncture is effective significantly on primary hypertension and the point selection according to syndrome differentiation can improve the efficacy, which is probably relevant with the reduction in the peripheral vascular resistance due to the improvements of microcirculatory state in mechanism.

  11. More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture

    Directory of Open Access Journals (Sweden)

    Michael Armour

    2016-01-01

    Full Text Available Background. Primary dysmenorrhea is a common gynaecological condition. Traditional Chinese medicine (TCM acupuncturists commonly treat primary dysmenorrhea and dispense specific self-care advice for this condition. The impact of self-care advice on primary dysmenorrhea is unknown. Methods. 19 TCM acupuncture practitioners from New Zealand or Australia and 12 New Zealand women who had recently undergone acupuncture treatment for primary dysmenorrhea as part of a randomised controlled trial participated in this qualitative, pragmatic study. Focus groups and semistructured interviews were used to collect data. These were recorded, transcribed, and analysed using thematic analysis. Results. The overarching theme was that an acupuncture treatment consisted of “more than needles” for both practitioners and participants. Practitioners and participants both discussed the partnership they engaged in during treatment, based on openness and trust. Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms. Conclusions. Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial.

  12. Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group

    International Nuclear Information System (INIS)

    Huynh, Thanh-Khoa; Montemurro, Michael; Bompas, Emmanuelle; Rios, Maria; Isambert, Nicolas; Cupissol, Didier; Blay, Jean-Yves; Duffaud, Florence; Meeus, Pierre; Cassier, Philippe; Bouché, Olivier; Lardière-Deguelte, Sophie; Adenis, Antoine; André, Thierry; Mancini, Julien; Collard, Olivier

    2014-01-01

    Rectal and pararectal gastrointestinal stromal tumors (GISTs) are rare. The optimal management strategy for primary localized GISTs remains poorly defined. We conducted a retrospective analysis of 41 patients with localized rectal or pararectal GISTs treated between 1991 and 2011 in 13 French Sarcoma Group centers. Of 12 patients who received preoperative imatinib therapy for a median duration of 7 (2-12) months, 8 experienced a partial response, 3 had stable disease, and 1 had a complete response. Thirty and 11 patients underwent function-sparing conservative surgery and abdominoperineal resection, respectively. Tumor resections were mostly R0 and R1 in 35 patients. Tumor rupture occurred in 12 patients. Eleven patients received postoperative imatinib with a median follow-up of 59 (2.4-186) months. The median time to disease relapse was 36 (9.8-62) months. The 5-year overall survival rate was 86.5%. Twenty patients developed local recurrence after surgery alone, two developed recurrence after resection combined with preoperative and/or postoperative imatinib, and eight developed metastases. In univariate analysis, the mitotic index (≤5) and tumor size (≤5 cm) were associated with a significantly decreased risk of local relapse. Perioperative imatinib was associated with a significantly reduced risk of overall relapse and local relapse. Perioperative imatinib therapy was associated with improved disease-free survival. Preoperative imatinib was effective. Tumor shrinkage has a clear benefit for local excision in terms of feasibility and function preservation. Given the complexity of rectal GISTs, referral of patients with this rare disease to expert centers to undergo a multidisciplinary approach is recommended

  13. Advanced-Stage Primary Cutaneous T-Cell Lymphoma Treated with Bexarotene and Denileukin Diftitox

    Directory of Open Access Journals (Sweden)

    Iván Cervigón-González

    2011-02-01

    Full Text Available Advanced-stage primary cutaneous T-cell lymphoma has an unfavorable prognosis and low survival rates. Aggressive treatment with chemotherapy is not curative and causes considerable side effects. The combination of bexarotene and denileukin diftitox is associated with an acceptable safety profile and a likely synergistic effect because bexarotene is capable of modulating expression of IL-2 receptor and enhance the susceptibility of T-cell leukemia cells to denileukin diftitox. In the case reported here, the response to this combined treatment was satisfactory and well tolerated. The patient showed a complete regression of pruritus, restlessness, and insomnia. Skin lesions improved partially, and lymphadenopathy was reduced and finally disappeared completely.

  14. Is high-viscosity glass-ionomer-cement a successor to amalgam for treating primary molars?

    Science.gov (United States)

    Hilgert, Leandro A; de Amorim, Rodrigo G; Leal, Soraya C; Mulder, Jan; Creugers, Nico H J; Frencken, Jo E

    2014-10-01

    To assess and compare the cumulative survival rate of amalgam and atraumatic restorative treatment (ART) restorations in primary molars over 3 years. 280 children aged 6-7 years old were enrolled in a cluster randomized controlled clinical trial using a parallel group design covering two treatment groups: conventional restorative treatment with amalgam (CRT) and atraumatic restorative treatment (ART) using a high-viscosity glass-ionomer (HVGIC) Ketac Molar Easymix. Three pedodontists placed 750 restorations (364 amalgam and 386 ART in 126 and 154 children, respectively) which were evaluated at 0.5, 1, 2 and 3 years. The proportional hazard rate regression model with frailty correction, ANOVA and Wald tests, and the Jackknife procedure were applied in analysing the data. The cumulative survival rates over 3 years for all, single- and multiple-surface CRT/amalgam restorations (72.6%, 93.4%, 64.7%, respectively) were no different from those of comparable ART/HVGIC restorations (66.8%; 90.1% and 56.4%, respectively) (p=0.10). Single-surface restorations had higher survival rates than multiple-surface restorations for the both treatment procedures (prestorations failed because of mechanical reasons (94.8%) than of secondary caries (5.2%). No difference in reasons for restoration failures between all types of amalgam and ART/HVGIC restorations were observed (p=0.24). The high-viscosity glass-ionomer used in this study in conjunction with the ART is a viable option for restoring carious dentin lesions in single surfaces in vital primary molars. Copyright © 2014 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  15. The hardness and chemical changes in demineralized primary dentin treated by fluoride and glass ionomer cement

    Directory of Open Access Journals (Sweden)

    Gisele Fernandes DIAS

    Full Text Available Abstract Background Fluoride plays an important role in the control of dental caries. Aim To evaluate the chemical exchange between restoration of glass ionomer cement of high viscosity (GIC and primary dentin with application of sodium fluoride (NaF 2% through changes in hardness from uptake of calcium, phosphate and fluoride. Material and method Class I cavities were prepared in 40 sound primary molars, and the sample was divided into two groups (n=20 according to dentin condition: sound (1 and demineralized (2. Sub-groups (n=10 were formed to investigate the isolated action of the GIC or the association with NaF (F. This in vitro study examined the chemical exchange under two conditions, sound and demineralized dentin (pH cycling, to simulate the occurrence of mineral loss for the caries lesion. G1 and G2 received GIC restoration only; groups G1F and G2F received NaF before GIC restoration. The specimens were prepared for Knoop hardness test and micro-Raman spectroscopy. A two-way ANOVA test (α = 0.05 was used for statistical analysis. Micro-Raman data were qualitatively described. Result Increased hardness was observed in all the sites of direct contact with GIC in sound and demineralized dentin for all groups (p0.05. In the evaluation of micro-Raman, direct contact between GIC and dentin for sound and demineralized dentin resulted in increased peaks of phosphate. Conclusion The exchange between GIC and demineralized dentin may induce changes of mechanical properties of the substrate, and uptake of mineral ions (phosphate occurs without the influence of NaF.

  16. Comparison of autologous bone marrow and adipose tissue derived mesenchymal stem cells, and platelet rich plasma, for treating surgically induced lesions of the equine superficial digital flexor tendon.

    Science.gov (United States)

    Romero, A; Barrachina, L; Ranera, B; Remacha, A R; Moreno, B; de Blas, I; Sanz, A; Vázquez, F J; Vitoria, A; Junquera, C; Zaragoza, P; Rodellar, C

    2017-06-01

    Several therapies have been investigated for equine tendinopathies, but satisfactory long term results have not been achieved consistently and a better understanding of the healing mechanism elicited by regenerative therapies is needed. The aim of this study was to assess the separate effects of autologous bone marrow (BM) and adipose tissue (AT) derived mesenchymal stem cells (MSCs), and platelet rich plasma (PRP), for treating lesions induced in the superficial digital flexor tendon (SDFT) of horses. Lesions were created surgically in both SDFTs of the forelimbs of 12 horses and were treated with BM-MSCs (six tendons), AT-MSCs (six tendons) or PRP (six tendons). The remaining six tendons received lactated Ringer's solution as control. Serial ultrasound assessment was performed prior to treatment and at 2, 6, 10, 20 and 45 weeks post-treatment. At 45 weeks, histopathology and gene expression analyses were performed. At week 6, the ultrasound echogenicity score in tendons treated with BM-MSCs suggested earlier improvement, whilst all treatment groups reached the same level at week 10, which was superior to the control group. Collagen orientation scores on histological examination suggested a better outcome in treated tendons. Gene expression was indicative of better tissue regeneration after all treatments, especially for BM-MSCs, as suggested by upregulation of collagen type I, decorin, tenascin and matrix metalloproteinase III mRNA. Considering all findings, a clear beneficial effect was elicited by all treatments compared with the control group. Although differences between treatments were relatively small, BM-MSCs resulted in a better outcome than PRP and AT-MSCs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Clinical importance of TERT overexpression in hepatocellular carcinoma treated with curative surgical resection in HBV endemic area.

    Science.gov (United States)

    Yu, Jeong Il; Choi, Changhoon; Ha, Sang Yun; Park, Cheol-Keun; Kang, So Young; Joh, Jae-Won; Paik, Seung Woon; Kim, Seonwoo; Kim, Minji; Jung, Sang Hoon; Park, Hee Chul

    2017-09-25

    This study was designed to investigate the associations between TERT overexpression and the clinicopathologic factors of hepatocellular carcinoma (HCC). A total of 291 patients with HCC were enrolled. The site of first recurrence (anywhere in the liver) was classified as intrahepatic recurrence (IHR). Recurrence was then sub classified as either early or late IHR according to whether it was discovered within 2 years of resection, or after, respectively. TERT overexpression was not significantly correlated with previously recognized prognostic factors. During follow-up, early IHR occurred in 126 (63.6%) patients, while late IHR was detected in 59 patients among 145 patients who remained free of HCC recurrence for ≥ 2 years after surgery. Multivariate analysis showed late IHR was significantly correlated with TERT overexpression (P overexpression (P overexpression was the only significant prognostic factor for late IHR in HCC treated with curative resection. And, the statistical significance of TERT overexpression on late IHR was limited to HBsAg-positive patients.

  18. The effects of unilateral and bilateral spinal anaesthesia on hemodynamic parameters in patients surgically treated for inguinal hernia: Hemodynamic parameters and spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Milosavljević Snežana

    2016-01-01

    Full Text Available Introduction: Conventional bilateral spinal anaesthesia is commonly used for surgical treatment of inguinal hernia because it causes fast development of block with relatively small dosage of local anaesthetic; furthermore, it is easily administered, reduces the level of metabolic response to stress, reduces the incidence of deep venous thrombosis and respiratory depression. On the other hand, the main side effect is hypotension Objective: The goal of the research was to determine which of the two methods of spinal anaesthesia (conventional bilateral, achieved with regular dosage of long-lasting bupivacaine or hypobaric unilateral, achieved with combined application of bupivacaine and fentanyl ensures higher hemodynamic stability during tension-free hernioplasty in patients from group I and II of ASA classification system. Methods: The research was conducted as a prospective, controlled clinical study with the total amount of 50 patients, males and females, and within the age span ranging from 17 to 77, who all had indications for surgical treatment of one-sided inguinal hernia under spinal anaesthesia. The hemodynamic parameters (heart rate, systolic, diastolic and mean arterial pressure were measured during following intervals: T1 - during preanaesthetic visit, T2 - after premedication and the iv administration of Ringer's lactate solution, T3 - 15 minutes after the administration of spinal anaesthesia, T4 - after the surgical incision, T5 - intraoperatively, T6 - during the placement of the last surgical stitch on the skin, T7 - one hour postoperatively. Results: The results showed that the frequency of clinically relevant hypotension was statistically much higher in patients with bilateral spinal anaesthesia (24 % when compared to patients administered with unilateral spinal anaesthesia (4%. Ten minutes after the application of spinal anaesthesia the mean arterial pressure has decreased by 20% when compared to basic values in group BB, and by

  19. Lack of change in glucose metabolism in eszopiclone-treated primary insomnia patients

    Directory of Open Access Journals (Sweden)

    Buxton OM

    2017-07-01

    Full Text Available Orfeu M Buxton,1-4 Milena K Pavlova,1,5 Shawn P O’Connor,1 Wei Wang,1,2 John W Winkelman1,6 1Division of Sleep Medicine, Harvard Medical School, 2Department of Medicine, Brigham and Women’s Hospital, 3Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, 4Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, 5Department of Neurology, Brigham and Women’s Hospital, 6Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Study objectives: Primary insomnia (PI may increase diabetes risk. We tested the hypothesis that the effects of PI on glucose metabolism could be improved by 2 months of pharmacological treatment.Methods: Adult men and women meeting clinical criteria for PI were studied (n=20, body mass index 25.1±2.7 kg/m2, age 39.7±7.9 in a randomized, double-blind, placebo-controlled clinical trial. The study consisted of two 1-day inpatient admissions to a General Clinical Research Center separated by 2 months of at-home treatment with 3 mg eszopiclone or placebo. During inpatient admissions, each subject underwent two intravenous glucose tolerance tests (IVGTTs pre- and post-treatment. Diet was controlled for micro- and macro-nutrient content and calories on the day prior to pre- and post-treatment IVGTTs. Subjects were randomized following completion of the initial IVGTT to take either placebo or eszopiclone 30 min prior to bedtime at home for 2 months.Results: Two-month eszopiclone treatment did not change insulin sensitivity, glucose tolerance, or any of the sleep measures significantly, compared with placebo. Changes in glycated hemoglobin (HbA1c, clinical measure of glycemic control were correlated with changes in diary-reported total sleep time in the eszopiclone group (r=0.66, p=0.0360, and in the combined groups’ data (r=0.55, p=0.0125. Changes in polysomnography-measured wake after sleep onset, a hallmark of PI, were positively related

  20. Usefulness of pulmonary scintigraphy in primary lung cancer patients treated by radiotherapy

    International Nuclear Information System (INIS)

    Mitomo, Osamu

    1994-01-01

    To assess the pulmonary function of lung cancer patients treated by radiotherapy, we tried qualitative and semiquantitative analysis of pulmonary scintigrams using 133 Xe and 99m Tc-MAA. Individual scores for ventilation, perfusion and the ventilation-perfusion ratio of tumor-bearing lungs were calculated on the basis of healthy control cases in order to analyze whether, and to what degree, the tumor-bearing lung was functionally impaired. The score was proportional to the severity of impairment, and when the ventilation and perfusion of tumor-bearing lungs had a score of one or greater than one, the tumor-bearing lung was functionally defined as an 'impaired lung'. Impaired lungs were demonstrated in 68% of tumor-bearing lungs. Hilar and left hilar-type cancers, clinically more advanced cancers, patients whose tumors were confirmed by bronchofiberscopy, small-cell and epidermoid cancers, etc., had higher rates of impairment and more severe impairment. Many patients with impaired lungs had a worse prognosis, but patients in whom scintigraphy showed improvement after radiotherapy had a better prognosis. It can be concluded that pulmonary scintigraphy scoring is capable of semiquantitatively indicating the degree of pulmonary impairment and is useful in deciding on a radiotherapeutic plan and predicting the outcome in pre- and post-radiotherapy lung cancer patients. (author)

  1. Using ultrasound visual biofeedback to treat persistent primary speech sound disorders.

    Science.gov (United States)

    Cleland, Joanne; Scobbie, James M; Wrench, Alan A

    2015-01-01

    Growing evidence suggests that speech intervention using visual biofeedback may benefit people for whom visual skills are stronger than auditory skills (for example, the hearing-impaired population), especially when the target articulation is hard to describe or see. Diagnostic ultrasound can be used to image the tongue and has recently become more compact and affordable leading to renewed interest in it as a practical, non-invasive visual biofeedback tool. In this study, we evaluate its effectiveness in treating children with persistent speech sound disorders that have been unresponsive to traditional therapy approaches. A case series of seven different children (aged 6-11) with persistent speech sound disorders were evaluated. For each child, high-speed ultrasound (121 fps), audio and lip video recordings were made while probing each child's specific errors at five different time points (before, during and after intervention). After intervention, all the children made significant progress on targeted segments, evidenced by both perceptual measures and changes in tongue-shape.

  2. ‘Thumbs Up‘: Surgical Management and Outcome of Primary Osteoarthritis at the Base of the Thumb

    NARCIS (Netherlands)

    G.M. Vermeulen (Guus)

    2014-01-01

    markdownabstract__Abstract__ ‘One does never operate on a bone you can swallow’, said Sir John Charnley (1911–1982) a pioneer in orthopaedic surgery. For many years this was probably the best thing to do, because surgical treatment of wrist and hand problems was not yet common knowledge.

  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. A Case Report of Primary Pericardial Malignant Mesothelioma Treated with Pemetrexed and Cisplatin.

    Science.gov (United States)

    Kim, Jung Sun; Lim, Sang Yup; Hwang, Jinwook; Kang, Eun Joo; Choi, Yoon Ji

    2017-11-01

    Primary pericardial malignant mesothelioma (PPM) is a very rare malignancy, with an incidence of less than 0.002% and represents less than 5% of all mesotheliomas. The cause of pericardial mesothelioma is uncertain that differ from pleural mesothelioma which is associated with asbestos exposure. This malignancy is terribly aggressive and has very poor prognosis with less than six months of overall survival. We present a case of a 71-year-old woman who was diagnosed with cardiac tamponade caused by PPM and received chemotherapy with pemetrexed and cisplatin for six months. During two years she was alive without disease progression. To better understand the clinical, pathologic features and treatment outcome of this entity, we reviewed 23 cases described in the English literature from 2009, together with our case, provided a total of 24 cases. Based on this review, we suggest that PPM must be considered in patients who have unexplained massive pericardial effusion and recommend chemotherapy with pemetrexed and cisplatin for the better outcome of PPM. © 2017 The Korean Academy of Medical Sciences.

  5. Chronic kidney disease in hypertensive subjects ≥60 years treated in Primary Care.

    Science.gov (United States)

    Salvador-González, Betlem; Mestre-Ferrer, Jordi; Soler-Vila, Maria; Pascual-Benito, Luisa; Alonso-Bes, Eva; Cunillera-Puértolas, Oriol

    Hypertension (HT) is the second leading cause of kidney failure. In hypertensive patients with chronic kidney disease (CKD), blood pressure (BP) control is the most important intervention to minimise progression. For CKD diagnosis, standardised creatinine and estimated glomerular filtration rate (eGFR) testing by CKD-EPI is recommended. To describe the prevalence and factors associated with a moderate decrease in eGFR (by CKD-EPI) and BP control in subjects with HT. Cross-sectional descriptive study in subjects ≥ 60 years included in the SIDIAP plus database with hypertension and standardised serum creatinine and BP tests in the last 2years. eGFRdiabetes and obesity. BP control: 66.14 and 63.24% in eGFR≥60 and eGFR <60, respectively (P<.05). Exposure to drugs was higher in eGFR<60. One in 5hypertensive patients without cardiovascular disease ≥60 years in primary care presented with a moderate decrease in eGFR. In addition to age and sex, albuminuria and heart failure were the main associated factors. Despite the increased exposure to drugs, BP control was lower in CKD. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  6. Selected Aspects of Mental Health of Elderly Patients with Chronic Back Pain Treated in Primary Care Centers.

    Science.gov (United States)

    Cabak, Anna; Dąbrowska-Zimakowska, Anna; Tomaszewski, Paweł; Łyp, Marek; Kaczor, Ryszard; Tomaszewski, Wiesław; Fijałkowska, Barbara; Kotela, Ireneusz

    2015-11-02

    Improvement of the effectiveness and efficiency of chronic back pain therapy is a continuing challenge on an international scale. The aim of the present study was to tentatively assess mental health of patients with chronic back pain treated in primary care centers. The study enrolled 100 persons over 50 years of age. The back pain group consisted of 53 patients with chronic back pain and the control group consisted of 47 pain-free persons. The assessment of mental health used a Polish version of the international Goldberger's General Health Questionnaire (GHQ-28). ANOVA (1- and 2-factor) analysis of variance, Tukey's test, and Pearson's simple correlation were used to analyze the significance of differences, with the significance level set at α=0.05. All patients with chronic back pain, regardless of their age and gender, displayed poorer mental well-being compared to the control group: their overall score was higher by over 7 points than in persons without back pain (F1.96=14.8; pmental health score from the questionnaire. Mental health was considerably poorer among patients occasionally (pmental health was markedly poorer in patients with chronic back pain than in healthy controls. A preliminary assessment of aspects of mental health should be given more attention in the rehabilitation of patients with chronic back pain treated in primary care center outpatient clinics.

  7. The overlap of sleep disturbance and depression in primary care patients treated with buprenorphine.

    Science.gov (United States)

    Garnaat, Sarah L; Weisberg, Risa B; Uebelacker, Lisa A; Herman, Debra S; Bailey, Genie L; Anderson, Bradley J; Sharkey, Katherine M; Stein, Michael D

    2017-01-01

    Sleep disturbance is common among patients receiving long-term opioid therapies, such as methadone maintenance. However, little is known about sleep disturbances in patients receiving medication treatment with buprenorphine. We sought to determine the frequency of subjective sleep disturbance in a sample of patients receiving medication treatment and to examine clinical factors related to sleep disturbance. Participants were 328 persons receiving buprenorphine at 3 primary care sites. Sleep difficulty was assessed 2 questions adapted from the Patient Health Questionnaire-9 (PHQ-9) item assessing sleep. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD)-10 and PHQ-2. In addition, information was gathered on participant demographics and treatment characteristics. Demographics, buprenorphine treatment history, and depressive symptoms were compared for those with and without self-reported sleep difficulty. Logistic regression was used to estimate the adjusted association of sleep disturbance with these correlates. Seventy-one percent of persons receiving medication treatment with buprenorphine in the present study reported sleep difficulty. Persons reporting sleep disturbance reported shorter time in buprenorphine treatment and more depressed mood compared with those without sleep difficulty (p disturbed sleep than women (odds ratio [OR] = 0.57, 95% confidence interval [CI]: 0.33, 0.98). Sleep disturbance was not associated significantly with age, ethnicity, educational attainment, or buprenorphine dose. Sleep disturbance is common in patients receiving medication treatment with buprenorphine and is associated with more depressive symptoms as well as a shorter duration of medication treatment. Future research, using subjective and objective sleep measures, is warranted to understand whether sleep disturbance is mitigated by longer buprenorphine treatment and whether difficulty sleeping predicts buprenorphine

  8. Analysis of prognostic factors in 1180 patients with oral cavity primary cancer treated with definitive or adjuvant radiotherapy

    Directory of Open Access Journals (Sweden)

    Murthy V

    2010-01-01

    Full Text Available Introduction: The present study identifies the prognostic factors influencing oral cancers in a large cohort of patients treated at a single institute. Materials and Methods: This is an audit of 1180 patients treated from 1990 to 2004 in the service setting with prospective data collection. Patients were treated with radical radiotherapy or were planned for surgery and post operative radiotherapy (PORT. None of the patients received postoperative concurrent chemoradiation. For analysis, patients were divided into Group 1 and Group 2 based on the oral cavity subsite. Results: Of the entire cohort, 810 patients had tumors of the Gingivo-alveolo-buccal complex, lip and hard palate (Group 1 and 370 patients had primaries in tongue and floor of mouth (Group 2. Three year locoregional control for the entire cohort was 58%. The three year local control (LC, locoregional control (LRC and disease free survival (DFS for PORT group were 74%, 65% and 60%, respectively, with pathological nodal status, perinodal extension and cut margin status showing statistical significance (P <0.001. In the definitive radiotherapy group, the three year LC, LRC and DFS were 34%, 31% and 30%, respectively, with age, T stage, nodal status and stage being significant. Group 1 patients showed significantly better LC, LRC and DFS than Group 2 patients for the entire cohort. Conclusion: The results indicate superior outcomes with PORT particularly in advanced stages of oral cancer and inferior outcomes in tongue and floor of mouth subsites. There is scope for improving outcomes by adopting treatment intensification strategies.

  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. Long-term follow-up of conjunctival melanoma treated with topical interferon alpha-2b eye drops as adjunctive therapy following surgical resection.

    Science.gov (United States)

    Kikuchi, Iku; Kase, Satoru; Ishijima, Kan; Ishida, Susumu

    2017-11-01

    The purpose of this study was to report the clinical outcomes of patients with conjunctival melanoma treated with interferon (IFN) α-2b eye drops following local tumor resection. Five eyes of five patients were enrolled in this study. All patients underwent the local resection of tumors, and topical IFNα-2b eye drops were subsequently administered 4 times/day until the complete disappearance of the pigmented lesions determined by slit-lamp examination. Ophthalmological findings, histopathological findings, and imaging modalities were retrospectively analyzed. The age of the patients ranged from 65 to 84 years (mean: 75.4 years). Locations of the tumor were the bulbar conjunctiva in three eyes, multiple palpebral conjunctivas in one eye, and palpebral conjunctiva and caruncle in one eye. All patients received topical IFNα-2b eye drop treatment for 6-10 months. Follow-up periods after resection ranged from 18 to 78 months. Histologically, all excised conjunctival tumors were diagnosed with malignant melanoma, where the surgical margins were completely negative in one patient. No patients had suffered from severe adverse effects related to IFNα-2b. Four out of five patients consequently achieved complete remission. Since one eye in one case showed resistance to the local chemotherapy containing IFNα-2b eye drops and the subconjunctival injection of IFN-β, orbital exenteration was eventually required 12 months after local resection. Topical IFNα-2b eye drops may be safe and one of the useful adjunctive treatments following surgical resection for patients with conjunctival melanoma.

  11. Long-Term Follow-Up of Primary Medical Versus Surgical Treatment of Prolactinomas in Men: Effects on Hyperprolactinemia, Hypogonadism, and Bone Health.

    Science.gov (United States)

    Andereggen, Lukas; Frey, Janine; Andres, Robert H; El-Koussy, Marwan; Beck, Jürgen; Seiler, Rolf W; Christ, Emanuel

    2017-01-01

    In men with prolactinomas, impaired bone density is the principle consequence of hyperprolactinemia-induced hypogonadism. Although dopamine agonists (DAs) are the first-line approach in prolactinomas, surgery can be considered in selected cases. In this study, we aimed to investigate the long-term control of hyperprolactinemia, hypogonadism, and bone health comparing primary medical and surgical therapy in men who had not had prior DA treatment. This is a retrospective case-note study of 44 consecutive men with prolactinomas and no prior DAs managed in a single tertiary referral center. Clinical, biochemical, and radiologic response to the first-line approach were analyzed in the 2 cohorts. Mean age at diagnosis was 47 years (range, 22-78 years). The prevalence of hypogonadism was 86%, and 27% of patients had pathologic bone density at baseline. The primary therapeutic strategy was surgery for 34% and DAs for 66% of patients. Median long-term follow-up was 63 months (range, 17-238 months). Long-term control of hyperprolactinemia required DAs in 53% of patients with primary surgical therapy, versus 90% of patients with primary medical therapy (P = 0.02). Hypogonadism was controlled in 73% of patients. The prevalence of patients with pathologic bone density was 37% at last follow-up, with no differences between the 2 therapeutic cohorts (P = 0.48). Despite control of hyperprolactinemia and hypogonadism in most patients independent of the primary treatment modality, the prevalence of impaired bone health status remains high, and osteodensitometry should be recommended. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Gender-related differences in outcome after BMS or DES implantation in patients with ST-segment elevation myocardial infarction treated by primary angioplasty

    DEFF Research Database (Denmark)

    De Luca, Giuseppe; Verdoia, Monica; Dirksen, Maurits T

    2013-01-01

    Several studies have found that among patients with ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, female sex is associated with a worse outcome. However, still controversial is the prognostic impact of gender in primary angioplasty, especially in the era of drug......-eluting stents (DES). Therefore, the aim of this study was to investigate sex-related differences in clinical outcome in patients with STEMI treated with primary angioplasty with Bare-Metal Stent (BMS) or DES....

  13. Primary Cutaneous Carcinosarcoma of the Basal Cell Subtype Should Be Treated as a High-Risk Basal Cell Carcinoma.

    Science.gov (United States)

    Bourgeault, Emilie; Alain, Jimmy; Gagné, Eric

    2015-01-01

    Cutaneous carcinosarcoma is a rare primary tumor of the skin, characterized by biphasic epithelial and mesenchymal differentiation. Due to the limited number of cases reported, there is no consensus regarding treatment and prognosis. Some authors suggest that cutaneous carcinosarcomas should be viewed as aggressive tumors, with ancillary imaging used to evaluate potential metastatic disease. Other reports demonstrate an indolent disease course, especially with epidermal-type cutaneous carcinosarcomas. We report a case of cutaneous carcinosarcoma, which we treated with electrodessication and curettage following a shave biopsy. The tumor had an epithelial component resembling a basal cell carcinoma and a fibrosarcomatous stroma. At 1-year follow-up, our patient did not show evidence of recurrence or metastasis. Our case suggests that a cutaneous carcinosarcoma with an epithelial component composed of basal cell carcinoma can be regarded as a high-risk nonmelanoma skin cancer. © The Author(s) 2015.

  14. Preliminary results from 28 cases of pilonidal cyst treated by excision and primary closure of the wound, reinforced with support suturing

    Directory of Open Access Journals (Sweden)

    Nelson de Souza Liboni

    2007-06-01

    Full Text Available Objectives: To describe the results of the surgical technique of pilonidalcyst excision with margins and primary closure of the operative woundwith support suturing. Methods: Twenty-eight patients with pilonidaldisease admitted to a private clinic between 1999 and 2006 underwentsurgical treatment by means of an elliptical longitudinal medial incisionproportional to the palpable tumor size and excision of cyst with 2-cmmargins above, below and laterally, and primary closure of the wound.To reduce the tension in the operative wound, suturing was performed,with a single support stitch of horizontal U-shape. The patients werefollowed up for periods ranging from 6 months to 3 years. Results:Two patients developed abscesses at the surgical site (7.1%, andone required complete opening of the operative wound for drainage.Both underwent excision and primary closure again. The pathologicalexamination demonstrated that these were not cases of relapse, butof recurrent abscess. No cases of non-infected collection (seroma andhematoma, spontaneous dehiscence of the operative wound or diseaserecurrence were recorded. Conclusions: The technique of pilonidal cystexcision with margins and primary closure of the wound reinforcedwith support suturing seems to be attractive, since it is characterizedby low complexity and low infection rate. Studies with larger samplesare needed to validate this surgical technique.

  15. Intracranial arachnoid cysts treated surgically

    International Nuclear Information System (INIS)

    Okamoto, Junji; Matsumoto, Keizo

    1982-01-01

    Craniotomy and an examination of the maximal extent of extirpation of the cystic membrane were performed under an operative microscope in a series of 30 consecutive cases of intracranial arachnoid cysts. From these clinical features and a histological examination of the membrane, the etiologies of the arachnoid cysts may be divided into three fundamental categories: arachnoid cysts due to local brain atrophy or malformation (Category I), arachnoid cysts due to a malformation of the local arachnoid membrane itself (Category II), and arachnoid cysts due to acquired etiology (Category III). The postoperative reduction rates were investigated by means of a serial CT examination over a follow-up period of from 1 month to 6.5 years (average 2 years) in 27 cases. The postoperative reduction rates of 5 cases were less than 20% (Group A), 15 cases had rates from 30 to 80% (Group B), and 7 cases had rates of more than 90% (Group C). Cases of females, large cysts, round-shaped cysts, and cases with positive mass signs and poorly communicating cysts are revealed by metrizamide CT examination seemed to have a tendency for cystic cavity to be reduced well, judging from the postoperative analysis of the clinical findings. Furthermore, from the standpoint of our hypothesis concerning the etiology of the arachnoid cysts, Group A fit in almost all cases in Category I, though a few cases of Group A who had severe secondary local brain damage were in Category II. Group C fit in Category III in almost all cases, though a few cases of Group C who had minimal local brain damage were in Category II. Cases of Group B were considered to show some changes in the local cerebrum of various degrees in the cases of Categories II and III. (J.P.N.)

  16. Potential risk of developing herpes simplex encephalitis in patients treated with sildenafil following primary exposure to genital herpes.

    Science.gov (United States)

    Goren, A; Mccoy, J; Kovacevic, M; Situm, M; Lonky, N

    2017-01-01

    Herpes simplex encephalitis (HSE) is associated with significant mortality and morbidity. As a consequence of HSE, up to 75% of infected individuals die or experience irreversible neurological damage. While the pathogenesis of the disease is unknown, it is traditionally hypothesized that the viral infection occurs by neuronal transmission directly from peripheral sites. Non-neuronal modes of infection have generally been overlooked as the brain is protected by the blood-brain-barrier (BBB). The BBB poses an effective barrier to pathogens as well as to drugs such as chemotherapies. In the pursuit to deliver chemotherapeutic agents to the brain, several studies demonstrated that phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, may increase the permeability of the BBB enabling successful delivery of chemotherapeutic agents to the brain. In this communication, we report a case of HSE infection in a 62-year-old man, which we suspect was facilitated by the use of sildenafil during a primary genital herpes simple virus (HSV) infection. Due to large number of patients treated with PDE5 inhibitors for erectile dysfunction and the high incidence of genital HSV infection in the general population, a larger study should examine the potential risk of developing HSE in patients treated with PDE5 inhibitors.

  17. Persistence and concomitant medication in patients with overactive bladder treated with antimuscarinic agents in primary care. An observational baseline study.

    Science.gov (United States)

    Sicras-Mainar, A; Navarro-Artieda, R; Ruiz-Torrejón, A; Sáez-Zafra, M; Coll-de Tuero, G

    2016-03-01

    To assess therapeutic persistence and its relationship with concomitant medication in patients treated with fesoterodine versus tolterodine and solifenacin for overactive bladder (OAB) in standard clinical practice conditions. An observational, multicentre retrospective study was performed based on medical registries of patients followed-up in primary care (PC). Three study groups were analysed. Persistence was defined as the time (in months) without withdrawing from the initial therapy or without changing to another medication for at least 30 days after the initial prescription. The concomitant medications were antidepressants, anxiolytic/hypnotic agents, antibiotics, antiseptic agents, laxatives and skin products. We employed the SPSSWIN program version 17 (statistical significance, P<.05). We selected 3094 patients for the study. The median age was 54.0 years and 62.2% were women. The patients treated with fesoterodine shown greater treatment persistence (12 months) when compared with those who took solifenacin and tolterodine (40.2% vs. 34.7% and 33.6%, respectively; P=.008). They also showed a lower use of concomitant medication (1.1 vs. 1.2 and 1.2 drugs, respectively; percentages: 61.6% vs. 67.1% and 70.1%, respectively; P<.03). The patients undergoing OAB treatment with fesoterodine, when compared with those taking solifenacin and tolterodine, were associated with greater treatment persistence and a reduced use of concomitant medication. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Effect of number of retrieved lymph nodes on prognosis in FIGO stage IB-IIA cervical cancer patients treated with primary radical surgery.

    Science.gov (United States)

    Lim, Soyi; Cho, Kyungjoo; Lee, Seungho; Lee, Kwangbeom; Shin, Jinwoo; Chung, Donghae; Park, Chanyong

    2017-01-01

    In the treatment of cervical cancer, the extent of lymphadenectomy is a matter of debate. The goal of the current study was to examine the question of whether the number of retrieved lymph nodes (RLN) can influence survival of patients with early stage cervical cancer. The medical records of 180 FIGO stage IB-IIA cervical cancer patients treated with primary radical surgery were reviewed. Patients were divided into two groups: those with ≤ 40 RLN and those with > 40 RLN. Patients were also assigned to either the bulky (tumor size > 4 cm) cervical cancer group or the non-bulky (tumor size ≤ 4 cm) cervical cancer group. The number of RLN had a statistically significant effect on both disease-free survival (P = 0.04) and overall survival (P = 0.02) of all patients. Patients with > 40 RLN had better prognoses than those with ≤ 40 RLN. In the bulky cervical cancer group, the number of RLN was an independent prognostic factor. In multivariate analysis for the bulky cervical cancer group, > 40 RLN had a significant positive effect on disease-free survival (adjusted hazard ratio, 0.36; 95% confidence interval, 0.13-0.97) and overall survival (adjusted hazard ratio, 0.23; 95% confidence interval, 0.06-0.90). However, number of RLN was not an independent prognostic factor in the non-bulky cervical cancer group. A more extensive lymphadenectomy increased the survival of bulky cervical cancer patients. This finding may be helpful in determining surgical extent before surgery for cervical cancer. © 2016 Japan Society of Obstetrics and Gynecology.

  19. Social workers' perceptions of barriers to interpersonal therapy implementation for treating postpartum depression in a primary care setting in Israel.

    Science.gov (United States)

    Bina, Rena; Barak, Adi; Posmontier, Barbara; Glasser, Saralee; Cinamon, Tali

    2018-01-01

    Research on evidence-based practice (EBP) implementation in social work often neglects to include evaluation of application barriers. This qualitative study examined social workers' perspectives of provider- and organisational-related barriers to implementing a brief eight-session interpersonal therapy (IPT) intervention, a time-limited EBP that addresses reducing depressive symptoms and improving interpersonal functioning. Implementation took place in a primary care setting in Israel and was aimed at treating women who have postpartum depression (PPD) symptoms. Using purposeful sampling, 25 primary care licensed social workers were interviewed between IPT training and implementation regarding their perceived barriers to implementing IPT in practice. Data analysis was facilitated using a phenomenological approach, which entails identifying the shared themes and shared experiences of research participants regarding barriers to implementing IPT. Three themes emerged from the analysis of interviews: Perceived lack of flexibility of IPT intervention in comparison with more familiar methods social workers previously applied, specifically regarding the number of sessions and therapeutic topics included in the IPT protocol; insecurity and hesitance to gain experience with a new method of intervention; and organisational barriers, including difficulties with referrals, the perception of HMOs as health facilities not suitable for therapy, and time constraints. Addressing perceived barriers of social workers toward implementing EBPs, such as IPT for postpartum depression, during the training phase is crucial for enabling appropriate implementation. Future training should include examining practitioners' attitudes toward implementation of EBPs, as part of standardised training protocols. © 2017 John Wiley & Sons Ltd.

  20. Clinical evaluation of fiber-reinforced composite crowns in pulp-treated primary molars: 12-month results.

    Science.gov (United States)

    Mohammadzadeh, Zahra; Parisay, Iman; Mehrabkhani, Maryam; Madani, Azam Sadat; Mazhari, Fatemeh

    2016-01-01

    The aim of this study was to evaluate the clinical performance of tooth-colored fiber-reinforced composite (FRC) crowns in pulp-treated second primary mandibular teeth. This split-mouth randomized, clinical trial performed on 67 children between 3 and 6 years with two primary mandibular second molars requiring pulp treatment. After pulp therapy, the teeth were randomly assigned to stainless steel crown (SSC) or FRC crown groups. Modified United States Public Health Service criteria were used to evaluate marginal integrity, marginal discoloration, and secondary caries in FRC crowns at intervals of 3, 6, and 12 months. Retention rate and gingival health were also compared between the two groups. The data were analyzed using Friedman, Cochran, and McNemar's tests at a significance level of 0.05. Intact marginal integrity in FRC crowns at 3, 6, and 12 months were 93.2%, 94.8%, and 94.2%, respectively. Marginal discoloration and secondary caries were not found at any of the FRC crowns. The retention rates of the FRC crowns were 100%, 98.3%, and 89.7% at 3, 6 and 12 months, respectively, whereas all the SSCs were found to be present and intact after 12 months ( P = 0.016). There was no statistically significant difference between the two groups in gingival health. According to the results of this study, it seems that when esthetics is a concern, in cooperative patients with good oral hygiene, FRC crowns can be considered as a valuable procedure.

  1. Culture-Independent Analyses Reveal Novel Anaerolineaceae as Abundant Primary Fermenters in Anaerobic Digesters Treating Waste Activated Sludge

    Directory of Open Access Journals (Sweden)

    Simon J. McIlroy

    2017-06-01

    Full Text Available Anaerobic digestion for biogas production is reliant on the tightly coupled synergistic activities of complex microbial consortia. Members of the uncultured A6 phylotype, within the phylum Chloroflexi, are among the most abundant genus-level-taxa of mesophilic anaerobic digester systems treating primary and surplus sludge from wastewater treatment plants, yet are known only by their 16S rRNA gene sequence. This study applied metagenomics to obtain a complete circular genome (2.57 Mbp from a representative of the A6 taxon. Preliminary annotation of the genome indicates these organisms to be anaerobic chemoorganoheterotrophs with a fermentative metabolism. Given their observed abundance, they are likely important primary fermenters in digester systems. Application of fluorescence in situ hybridisation probes designed in this study revealed their morphology to be short filaments present within the flocs. The A6 were sometimes co-located with the filamentous Archaea Methanosaeta spp. suggesting potential undetermined synergistic relationships. Based on its genome sequence and morphology we propose the species name Brevefilum fermentans gen. nov. sp. nov.

  2. Recurrence-free survival, but not surgical therapy per se, determines 583 patients' long-term satisfaction following primary pilonidal sinus surgery.

    Science.gov (United States)

    Doll, Dietrich; Luedi, Markus M; Evers, Theo; Kauf, Peter; Matevossian, Edouard

    2015-05-01

    With pilonidal sinus disease (PSD) incidence increasing and patients freely choosing their surgeon, patients' interest issues have been brought forward estimating patient satisfaction following pilonidal sinus surgery. The influence of wound healing time and long-term recurrence rate on patient satisfaction in primary PSD surgery has not been investigated yet. Five hundred eighty-three patients (German military cohort) were interviewed, compiling wound healing time, aesthetic satisfaction, long-term recurrence-free survival and patient satisfaction having undergone primary open (PO) treatment, marsupialization (MARS) or primary midline closure (PMC) treatment. Recurrence rate was determined by Kaplan-Meier calculation following up to 20 years after primary PSD surgery. Patient satisfaction ranking from 1 to 10 (10 = max. satisfied) showed an average satisfaction of 8.2 (range 0-10; 95% confidence interval (CI) 7891-8250). In-hospital stay time was significantly longer in primary open (PO) and marsupialization (MARS) group as compared to primary midline closure (PMC; p < 0.0001, Kruskal-Wallis test). Satisfaction was comparable between treatment groups, and was neither linked to in-hospital stay time nor to longer outpatient wound care period or total treatment time. Recurrence-free survival, as seen in the PO and PMC treatment group, revealed a highly significant difference for all patients. Improvement in MARS patients with versus without recurrence was low, as satisfaction with primary treatment was lower as the other groups. Neither choice of surgical treatment nor treatment duration within hospital or after hospital influences patient satisfaction, as long as recurrence-free survival can be provided. Marsupialization was ranked lower in both groups (with or without recurrence), and should be abandoned, as patients are significantly less satisfied with either results, independent of recurrence.

  3. Profile of patients with fibromyalgia being treated in primary care centers in Terrassa, a city in northeastern Spain.

    Science.gov (United States)

    Mur Martí, Teresa; Llordés Llordés, Montse; Custal Jordà, Mercè; López Juan, Gemma; Martínez Pardo, Silvia

    To perform an extensive clinical and epidemiological characterization of our fibromyalgia patients. Two-year observational study in 3 primary care centers in Terrassa, Spain. We recruited a sample of 235 individuals diagnosed with fibromyalgia being treated in primary care or rheumatology clinics who, when offered inclusion in a multidisciplinary program, agreed to provide the initial data we requested. The main measures were sociodemographic data, unhealthy habits and physical activity, comorbidities, treatment for fibromyalgia, Fibromyalgia Impact Questionnaire (FIQ), Hospital Anxiety and Depression Scale (HADS), and a family functioning scale (family APGAR). In all, 97.8% were women and the average age was 54.6 years. Most of the patients had a primary school education and the majority was on sick leave. Ninety-four percent had associated comorbidity and only 3% were not taking any medication for their disease. Many were taking drugs with no proven efficacy in fibromyalgia. The majority had intermediate scores on the FIQ, the HADS showed that 63% and 53% had an anxious and/or probable depressive disorder, respectively, and, according to the family APGAR score, 62% received proper family support. In agreement with the literature, the major findings in our fibromyalgia patients were a marked predominance of women, a high incidence of comorbidities-mainly psychiatric disorders-a moderate impact of the disease and widespread use of drugs with no demonstrated efficacy. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  4. Treating primary dysmenorrhoea with acupuncture: a narrative review of the relationship between acupuncture 'dose' and menstrual pain outcomes.

    Science.gov (United States)

    Armour, Mike; Smith, Caroline A

    2016-12-01

    A number of randomised controlled trials have been performed to determine the effectiveness or efficacy of acupuncture in primary dysmenorrhoea. The objective of this review was to explore the relationship between the 'dose' of the acupuncture intervention and menstrual pain outcomes. Eight databases were systematically searched for trials examining penetrating body acupuncture for primary dysmenorrhoea published in English up to September 2015. Dose components for each trial were extracted, assessed by the two authors and categorised by neurophysiological dose (number of needles, retention time and mode of stimulation), cumulative dose (total number and frequency of treatments), needle location and treatment timing. Eleven trials were included. Components of acupuncture dose were well reported across all trials. The relationship between needle location and menstrual pain demonstrated conflicting results. Treatment before the menses appeared to produce greater reductions in pain than treatment starting at the onset of menses. A single needle during menses may provide greater pain reduction compared to multiple needles. Conversely, multiple needles before menses were superior to a single needle. Electroacupuncture may provide more rapid pain reduction compared to manual acupuncture but may not have a significantly different effect on overall menstrual pain. There appear to be relationships between treatment timing and mode of needle stimulation, and menstrual pain outcomes. Needle location, number of needles used and frequency of treatment show clear dose-response relationships with menstrual pain outcomes. Current research is insufficient to make definitive clinical recommendations regarding optimum dose parameters for treating primary dysmenorrhoea. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. Adolescent patient with bilateral crossbite treated with surgically assisted rapid maxillary expansion: a case report evaluated by the 3d laser scanner, and using FESA method.

    Science.gov (United States)

    Ivanov, Ch I; Velemínská, J; Dostálová, T; Foltán, R

    2011-01-01

    Our purpose in this case report is to present an orthodontic treatment obtained and the results achieved in 17-year-old white female patient with Angle Class II malocclusion and bilateral posterior crossbite. Patient was treated with bonded acrylic Hyrax appliance and surgically assisted rapid maxillary expansion (SARME). The multiloop system 0.16 TMA (ß titanium) arch wire was used in the alignment phase and on purpose to prohibit bite opening and optimize threedimensional movement control. After treatment bonded lingual retainers were placed in between maxillary central incisors and in mandible canine-to-canine. A functional removable Klammt appliance was used for retention. The 3D Laser Scanner Roland LPX-250 was used in order to obtain digital dental casts. Evaluation of the treatment results was measured on these models and using finite element scaling analysis (FESA). An Angle Class I relationship was obtained after 2½ years of treatment, function and facial aesthetics were improved. The shape of the palate changed significant in the width direction, not significantly in length and high direction. The greatest expansion of palate was found in the region between the palatal cusps of the first molars 26.6%, followed by first 21.9% and second premolars 16.5%. SARME in adult patients with bilateral cross bite and maxillary deficiency lead to satisfactory results. The 3D laser scanned models and their measurements, using advanced software's are successfully used for precise studies.

  6. The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care

    LENUS (Irish Health Repository)

    McCarthy, Suzanne

    2012-06-19

    AbstractBackgroundAttention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterised by the symptoms of inattention, impulsivity and hyperactivity. ADHD was once perceived as a condition of childhood only; however increasing evidence has highlighted the existence of ADHD in older adolescents and adults. Estimates for the prevalence of ADHD in adults range from 2.5–4%. Few data exist on the prescribing trends of the stimulants methylphenidate and dexamfetamine, and the non-stimulant atomoxetine in the UK. The aim of this study was to investigate the annual prevalence and incidence of pharmacologically treated ADHD in children, adolescents and adults in UK primary care.MethodsThe Health Improvement Network (THIN) database was used to identify all patients aged over 6 years with a diagnosis of ADHD\\/hyperkinetic disorder and a prescription for methylphenidate, dexamfetamine or atomoxetine from 2003–2008. Annual prevalence and incidence of pharmacologically treated ADHD were calculated by age category and sex.ResultsThe source population comprised 3,529,615 patients (48.9% male). A total of 118,929 prescriptions were recorded for the 4,530 patients in the pharmacologically treated ADHD cohort during the 6-year study. Prevalence (per 1000 persons in the mid-year THIN population) increased within each age category from 2003 to 2008 [6–12 years: from 4.8 (95% CI: 4.5–5.1) to 9.2 (95% CI: 8.8–9.6); 13–17 years: from 3.6 (95% CI: 3.3–3.9) to 7.4 (95% CI: 7.0–7.8); 18–24 years: from 0.3 (95% CI: 0.2–0.3) to 1.1 (95% CI: 1.0–1.3); 25–45 years: from 0.02 (95% CI: 0.01–0.03) to 0.08 (95% CI: 0.06–0.10); >45 years: from 0.01 (95% CI: 0.00–0.01) to 0.02 (95% CI: 0.01–0.03). Whilst male patients aged 6-12 years had the highest prevalence; the relative increase in prescribing was higher amongst female patients of the same age - the increase in prevalence in females aged 6–12 years was 2.1 fold

  7. The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD in children, adolescents and adults in UK primary care

    Directory of Open Access Journals (Sweden)

    McCarthy Suzanne

    2012-06-01

    Full Text Available Abstract Background Attention Deficit Hyperactivity Disorder (ADHD is a common neurodevelopmental disorder characterised by the symptoms of inattention, impulsivity and hyperactivity. ADHD was once perceived as a condition of childhood only; however increasing evidence has highlighted the existence of ADHD in older adolescents and adults. Estimates for the prevalence of ADHD in adults range from 2.5–4%. Few data exist on the prescribing trends of the stimulants methylphenidate and dexamfetamine, and the non-stimulant atomoxetine in the UK. The aim of this study was to investigate the annual prevalence and incidence of pharmacologically treated ADHD in children, adolescents and adults in UK primary care. Methods The Health Improvement Network (THIN database was used to identify all patients aged over 6 years with a diagnosis of ADHD/hyperkinetic disorder and a prescription for methylphenidate, dexamfetamine or atomoxetine from 2003–2008. Annual prevalence and incidence of pharmacologically treated ADHD were calculated by age category and sex. Results The source population comprised 3,529,615 patients (48.9% male. A total of 118,929 prescriptions were recorded for the 4,530 patients in the pharmacologically treated ADHD cohort during the 6-year study. Prevalence (per 1000 persons in the mid-year THIN population increased within each age category from 2003 to 2008 [6–12 years: from 4.8 (95% CI: 4.5–5.1 to 9.2 (95% CI: 8.8–9.6; 13–17 years: from 3.6 (95% CI: 3.3–3.9 to 7.4 (95% CI: 7.0–7.8; 18–24 years: from 0.3 (95% CI: 0.2–0.3 to 1.1 (95% CI: 1.0–1.3; 25–45 years: from 0.02 (95% CI: 0.01–0.03 to 0.08 (95% CI: 0.06–0.10; >45 years: from 0.01 (95% CI: 0.00–0.01 to 0.02 (95% CI: 0.01–0.03. Whilst male patients aged 6-12 years had the highest prevalence; the relative increase in prescribing was higher amongst female patients of the same age - the increase in prevalence in females aged 6–12 years was 2

  8. [Choice of surgical approaches for salvage surgery of primary lesion recurrence and residual cases of nasopharyngeal carcinoma].

    Science.gov (United States)

    Tao, Zhong-Qiang; Si, Yong-Feng; Lan, Sheng-Yong; Zhang, Zheng; Deng, Zhuo-Xia; Huang, Bo; Zhou, Ri-Jing; Lu, Jin-Long

    2011-02-01

    The choice of surgical approaches for salvage surgery based on the location and invasion of recurrent and residual lesions of nasopharyngeal carcinoma (NPC), surgical results, complications, and survival were assessed. Thirty-seven cases with recurrent and residual lesions of NPC underwent salvage surgery between March 1991 and January 2005 were analysed retrospectively. Of 37 patients, 23 were men and 14 women, with a median age of 46.5 years (26 - 57 years); 4 were at stage I, 10 at stage II, 14 at stage III, and 9 at stage IV; 5 cases were with cervical metastasis, including 3 cases of N1 and 2 cases N2. All recurrent and residual lesions of NPC were determined by biopsy. On the location and invasion of recurrent and residual lesions of NPC, 8 cases underwent endoscopic resection of lesions, 12 cases of the palate nasopharyngectomy, 5 cases of maxillary swing, 4 cases of maxillary swing plus prerenal approach, 2 cases of lateral rhinotomy plus coronal flap approach, and 6 cases transfacial plus nasal pyramid swing approach. Five cases with cervical metastasis received neck dissection in addition to the operations for recurrent and residual lesions of NPC. Postoperatively 31 cases received radiotherapy with dosage of 60 Gy, among them 15 cases with concurrent chemoradiation therapy, and 6 cases with clear surgical margin did not received radiotherapy or chemotherapy. The cases were followed up for 12 - 72 months, with a median of 45 months. Total resection for the recurrent and residual lesions of NPC accounted for 91.8% (34/37) and subtotal resection for 8.2% (3/37). The accident of perioperative complications was 24.3% (9/37). The 3- and 5-year overall disease-free survival rates (DFSR) were 62.1% and 43.3%, respectively. The 3- and 5-year overall survival rates (OSR) were 72.9% and 51.3%, respectively. The 5 year DFSR of cases at stage I-IV were 100%, 40%, 28% and 11% (χ(2) = 10.0, P < 0.01), respectively. The 5 year OSR were 100%, 70%, 35% and 28% (χ(2

  9. Effectiveness of Online Collaborative Care for Treating Mood and Anxiety Disorders in Primary Care: A Randomized Clinical Trial.

    Science.gov (United States)

    Rollman, Bruce L; Herbeck Belnap, Bea; Abebe, Kaleab Z; Spring, Michael B; Rotondi, Armando J; Rothenberger, Scott D; Karp, Jordan F

    2018-01-01

    Collaborative care for depression and anxiety is superior to usual care from primary care physicians for these conditions; however, challenges limit its provision in routine practice and at scale. Advances in technology may overcome these barriers but have yet to be tested. To examine the effectiveness of combining an internet support group (ISG) with an online computerized cognitive behavioral therapy (CCBT) provided via a collaborative care program for treating depression and anxiety vs CCBT alone and whether providing CCBT in this manner is more effective than usual care. In this 3-arm randomized clinical trial with blinded outcome assessments, primary care physicians from 26 primary care practices in Pittsburgh, Pennsylvania, referred 2884 patients aged 18 to 75 years in response to an electronic medical record prompt from August 2012 to September 2014. Overall, 704 patients (24.4%) met all eligibility criteria and were randomized to CCBT alone (n = 301), CCBT+ISG (n = 302), or usual care (n = 101). Intent-to-treat analyses were conducted November 2015 to January 2017. Six months of guided access to an 8-session CCBT program provided by care managers who informed primary care physicians of their patients' progress and promoted patient engagement with our online programs. Mental health-related quality of life (12-Item Short-Form Health Survey Mental Health Composite Scale) and depression and anxiety symptoms (Patient-Reported Outcomes Measurement Information System) at 6-month follow-up, with treatment durability assessed 6 months later. Of the 704 randomized patients, 562 patients (79.8%) were female, and the mean (SD) age was 42.7 (14.3) years. A total of 604 patients (85.8%) completed our primary 6-month outcome assessment. At 6-month assessment, 254 of 301 patients (84.4%) receiving CCBT alone started the program (mean [SD] sessions completed, 5.4 [2.8]), and 228 of 302 patients (75.5%) in the CCBT+ISG cohort logged into the ISG at least once, of

  10. Survival and surgical outcomes of cardiac cancer of the remnant stomach in comparison with primary cardiac cancer.

    Science.gov (United States)

    Wang, Yi; Huang, Chang-Ming; Wang, Jia-Bin; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Lin, Jian-Xian; Lu, Jun

    2014-01-27

    Although cardiac cancer of the remnant stomach and primary cardiac cancer both occur in the same position, their clinical characteristics and outcomes have not been compared previously. The objective of this study was designed to evaluate the prognosis of cardiac cancer of the remnant stomach in comparison with primary cardiac cancer. In this retrospective comparative study, clinical data and prognosis were compared in 48 patients with cardiac cancer of the remnant stomach and 96 patients with primary cardiac cancer who underwent radical resection from January 1995 to June 2007. Clinicopathologic characteristics, survival times, mortality, and complications were analyzed. The 5-year survival rate was significantly higher in patients with primary cardiac cancer than in those with cardiac cancer of the remnant stomach (28.4% vs. 16.7%, P = 0.035). Serosal invasion, lymph node metastasis and tumor location were independent prognostic factors for survival. Subgroup analysis, however, showed similar survival rates in patients with primary cardiac cancer and cardiac cancer of the remnant stomach without serosal invasion (25.0% vs. 43.8%, P = 0.214) and without lymph node metastasis (25.0% vs. 38.8%, P = 0.255), as well as similar complication rates (20.8% vs. 11.5%, P = 0.138). Although the survival rates after radical resection in patients with cardiac cancer of the remnant stomach were poorer than in those with primary cardiac cancer, they were similar in survival rates when patients without serosal invasion or lymph node metastasis. Therefore, early detection is an important way to improve overall survival in cardiac cancer of the remnant stomach.

  11. Contrast-induced acute kidney injury and mortality in ST elevation myocardial infarction treated with primary percutaneous coronary intervention.

    Science.gov (United States)

    Silvain, Johanne; Nguyen, Lee S; Spagnoli, Vincent; Kerneis, Mathieu; Guedeney, Paul; Vignolles, Nicolas; Cosker, Kristel; Barthelemy, Olivier; Le Feuvre, Claude; Helft, Gérard; Collet, Jean-Philippe; Montalescot, Gilles

    2017-11-01

    Contrast-induced acute kidney injury (CI-AKI) is a common and potentially severe complication in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). There is no consensus on the best definition of CI-AKI to identify patients at risk of haemodialysis or death. The objective of this study was to assess the association of CI-AKI, using four definitions, on inhospital mortality, mortality or haemodialysis requirement over 1-year follow-up, in patients with STEMI treated with pPCI. In this prospective, observational study, all patients with STEMI referred for pPCI were included. We identified independent variables associated with CI-AKI and mortality. We included 1114 consecutive patients with STEMI treated by pPCI. CI-AKI occurred in 18.3%, 12.2%, 15.6% and 10.5% of patients according to the CIN, Acute Kidney Injury Network (AKIN), Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) Modification of Diet in Renal Disease(MDRD) and RIFLE Chronic Kidney Disease - Epidemiology Collaboration(CKD-EPI) definitions, respectively. The RIFLE (CKD-EPI) definition was the most discriminant definition to identify patients at higher risk of inhospital mortality (27.1% vs 4.0%; adjusted OR 2.7(95% CI 1.4 to 5.1), p=0.003), 1-year mortality (27.4% vs 6.6%; adjusted OR 2.8(95% CI 1.5 to 5.3), p=0.002) and haemodialysis requirement at 1-year follow-up (15.6% vs 2.7%; adjusted OR 6.7(95% CI 3.3 to 13.6), p=0.001). Haemodynamic instability, cardiac arrest, preexisting renal failure, elderly age and a high contrast media volume were independently associated with 1-year mortality. Of interest, contrast-media volume was not correlated to increase of creatininaemia (r=0.06) or decrease in estimated glomerular filtration rate (r=0.05) after percutaneous coronary intervention in our population. CI-AKI is a frequent and serious complication of STEMI treated by pPCI. The RIFLE definition is the

  12. [Contribution of surgical margin for surgical outcome of the chest wall tumors].

    Science.gov (United States)

    Maeda, Sumiko; Yamada, Takehiro; Watanabe, Tatsuaki; Niikawa, Hiromichi; Sado, Tetsu; Noda, Masafumi; Sakurada, Akira; Hoshikawa, Yasushi; Endo, Chiaki; Okada, Yoshinori; Kondo, Takashi

    2014-01-01

    We present here our institutional review of surgical treatment for the chest wall tumors. Chest wall resections were performed on 80 patients, and subsequent chest wall reconstructions were performed on 45 patients. Primary malignant tumors in the chest wall required more extensive rib resections combined with the neighboring structures such as the sternum and the vertebral bones than benign or metastatic/recurrent tumors did. Postoperative mortality and morbidity occurred in 5 patients who underwent the sternal resection and the rib resection combined with the vertebral bodies. Primary malignant tumors in the chest wall are sarcomas originating from the bones, the cartilage tissues, and the soft tissues of the chest wall. We general thoracic surgeons may not have expertise in treating sarcomas,because primary malignant chest wall tumors are rare and a single institution has limited experiences in surgical treatment of such tumors. We should be aware that a surgical margin of primary malignant chest wall tumors is important to achieve excellent local control and better prognosis. We recommend cooperation with an orthopedic oncologist who is experienced with treating sarcomas. Not only preoperative planning but also intraoperative evaluation for the surgical margin with orthopedic oncologists is necessary for better surgical outcome.

  13. Primary flexor tendon repair: surgical techniques based on the anatomy and biology of the flexor tendon system.

    Science.gov (United States)

    Tonkin, M A

    1991-01-01

    The anatomy, biology and bio-mechanics of the flexor tendon system demand a precise approach to flexor tendon repair. Within the fibroosseous canal, the synovial fluid and a complex intratendinous vascular network provide nutrition for intrinsic flexor tendon healing. Retention of the synovial sheath theoretically maintains an enclosed tendon/tendon sheat environment in which the tendon repair is bathed in synovial fluid, and may glide within a smooth tunnel. The preservation of the intricate double tendon inter-relationship and the annular pulley system is vital to the efficiency of finger flexion. This review details surgical and postoperative techniques aimed at restoring the normal anatomy and providing optimal conditions for the return of flexor tendon function.

  14. Prospective study of exclusive strontium-/yttrium-90 {beta}-irradiation of primary and recurrent pterygia with no prior surgical excision. Clinical outcome of long-term follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Vastardis, Iraklis [Ophthalmology Clinic Pallas, Olten (Switzerland); Pajic, Bojan; Pajic-Eggspuehler, Brigitte [Swiss Eye Research Foundation - ORASIS Eye Clinic, Reinach (Switzerland); Greiner, Richard H. [Radiooncology, Cantonal Hospital Luzern (Switzerland); Aebersold, Daniel M. [Dept. of Radiation Oncology, Inselspital, Bern Univ. Hospital (Switzerland)

    2009-12-15

    Purpose: to evaluate the consecutive treatment results regarding pterygium recurrence and the efficacy of exclusive strontium-/yttrium-90 {beta}-irradiation for primary and recurrent pterygia and to analyze the functional outcome. Patients and Methods: Between October 1974 and December 2005, 58 primary and 21 recurrent pterygia were exclusively treated with strontium-/yttrium-90 {beta}-irradiation with doses ranging from 3,600 to 5,500 cGy. The follow-up time was 46.6 {+-} 26.7 months, with a median of 46.5 months. Results: the treatment led to a size reduction in all pterygia (p < 0.0001). Neither recurrences nor side effects were observed during therapy and follow-up in this study. Best-corrected visual acuity increased (p = 0.0064). Corneal astigmatism was reduced in recurrent pterygia (p = 0.009). Conclusion: exclusive strontium-/yttrium-90 {beta}-irradiation of pterygia is a very efficient and well-tolerated treatment, with remarkable aesthetic and rehabilitative results in comparison to conventional treatments, especially for recurrent lesions which have undergone prior surgical excision. (orig.)

  15. A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia.

    LENUS (Irish Health Repository)

    O'Reilly, Elma A

    2012-05-01

    Laparoscopic inguinal hernia repair (LIHR), using a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) technique, is an alternative to conventional open inguinal hernia repair (OIHR). A consensus on outcomes of LIHR when compared with OIHR for primary, unilateral, inguinal hernia has not been reached.

  16. Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R.

    Science.gov (United States)

    Giulino-Roth, Lisa; O'Donohue, Tara; Chen, Zhengming; Bartlett, Nancy L; LaCasce, Ann; Martin-Doyle, William; Barth, Matthew J; Davies, Kimberly; Blum, Kristie A; Christian, Beth; Casulo, Carla; Smith, Sonali M; Godfrey, James; Termuhlen, Amanda; Oberley, Matthew J; Alexander, Sarah; Weitzman, Sheila; Appel, Burton; Mizukawa, Benjamin; Svoboda, Jakub; Afify, Zeinab; Pauly, Melinda; Dave, Hema; Gardner, Rebecca; Stephens, Deborah M; Zeitler, William A; Forlenza, Christopher; Levine, Jennifer; Williams, Michael E; Sima, Jody L; Bollard, Catherine M; Leonard, John P

    2017-12-01

    Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the standard of care for primary mediastinal B-cell lymphoma (PMBCL) at many institutions despite limited data in the multi-centre setting. We report a large, multi-centre retrospective analysis of children and adults with PMBCL treated with DA-EPOCH-R to characterize outcomes and evaluate prognostic factors. We assessed 156 patients with PMBCL treated with DA-EPOCH-R across 24 academic centres, including 38 children and 118 adults. All patients received at least one cycle of DA-EPOCH-R. Radiation therapy was administered in 14·9% of patients. With median follow-up of 22·6 months, the estimated 3-year event-free survival (EFS) was 85·9% [95% confidence interval (CI) 80·3-91·5] and overall survival was 95·4% (95% CI 91·8-99·0). Outcomes were not statistically different between paediatric and adult patients. Thrombotic complications were reported in 28·2% of patients and were more common in paediatric patients (45·9% vs. 22·9%, P = 0·011). Seventy-five per cent of patients had a negative fluorodeoxyglucose positron emission tomography (FDG-PET) scan at the completion of DA-EPOCH-R, defined as Deauville score 1-3. Negative FDG-PET at end-of-therapy was associated with improved EFS (95·4% vs. 54·9%, P < 0·001). Our data support the use of DA-EPOCH-R for the treatment of PMBCL in children and adults. Patients with a positive end-of-therapy FDG-PET scan have an inferior outcome. © 2017 John Wiley & Sons Ltd.

  17. Expression profiling of Dexamethasone-treated primary chondrocytes identifies targets of glucocorticoid signalling in endochondral bone development

    Directory of Open Access Journals (Sweden)

    Beier Frank

    2007-07-01

    Full Text Available Abstract Background Glucocorticoids (GCs are widely used anti-inflammatory drugs. While useful in clinical practice, patients taking GCs often suffer from skeletal side effects including growth retardation in children and adolescents, and decreased bone quality in adults. On a physiological level, GCs have been implicated in the regulation of chondrogenesis and osteoblast differentiation, as well as maintaining homeostasis in cartilage and bone. We identified the glucocorticoid receptor (GR as a potential regulator of chondrocyte hypertrophy in a microarray screen of primary limb bud mesenchyme micromass cultures. Some targets of GC regulation in chondrogenesis are known, but the global effects of pharmacological GC doses on chondrocyte gene expression have not been comprehensively evaluated. Results This study systematically identifies a spectrum of GC target genes in embryonic growth plate chondrocytes treated with a synthetic GR agonist, dexamethasone (DEX, at 6 and 24 hrs. Conventional analysis of this data set and gene set enrichment analysis (GSEA was performed. Transcripts associated with metabolism were enriched in the DEX condition along with extracellular matrix genes. In contrast, a subset of growth factors and cytokines were negatively correlated with DEX treatment. Comparing DEX-induced gene expression data to developmental changes in gene expression in micromass cultures revealed an additional layer of complexity in which DEX maintains the expression of certain chondrocyte marker genes while inhibiting factors that promote vascularization and ultimately ossification of the cartilaginous template. Conclusion Together, these results provide insight into the mechanisms and major molecular classes functioning downstream of DEX in primary chondrocytes. In addition, comparison of our data with microarray studies of DEX treatment in other cell types demonstrated that the majority of DEX effects are tissue-specific. This study provides

  18. Anaerobic co-digestion of food waste and chemically enhanced primary-treated sludge under mesophilic and thermophilic conditions.

    Science.gov (United States)

    Obulisamy, Parthiba Karthikeyan; Chakraborty, Debkumar; Selvam, Ammaiyappan; Wong, Jonathan W C

    2016-12-01

    Anaerobic co-digestion of food waste with primary sewage sludge is beneficial for urban centers, while the optimized conditions reported in the literature are not locally suitable for Hong Kong. Therefore, the present study was aimed to develop an optimized mixing ratio of food waste to chemically enhanced primary-treated sewer sludge (CEPT) for co-digestion using batch tests under mesophilic (37°C) and thermophilic (55°C) conditions. The mixing ratios of 1:1, 1:2, 1:3, 2:1 and 3:1 (v v(-1)) of food waste to CEPT sludge was tested under the following conditions: temperature - 35°C and 55°C; pH - not regulated; agitation - 150 rpm and time - 20 days. The thermophilic incubations led a good hydrolysis rate and 2-12-fold higher enzyme activities than in mesophilic incubations for different mixing ratios. While the acidogenesis were found retarded that leading to 'sour and stuck' digestion for all mixing ratio of food waste to CEPT sludge from thermophilic incubations. The measured zeta potential was most favourable (-5 to -16.8 mV) for methane production under thermophilic incubations; however the CH4 recovery was less than that in mesophilic incubations. The results suggested that the quick hydrolysis and subsequent acid accumulation under thermophilic incubation lead to inhibited methanogenesis at the early stage than in mesophilic systems. It is concluded that buffer addition is therefore required for any mixing ratio of food waste to CEPT sludge for improved CH4 recovery for both mesophilic and thermophilic operations.

  19. Comparison of predictive accuracy of pre surgical serum parathormone (PTH) level with that of parathyroid scan in case of primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Nasreen, F.; Yasmeen, S.; Ahsan, A.S.M.; Mandal, T.; Sultana, K.S.A.; Shirin, A.

    2007-01-01

    Full text: Aims and Objective: Parathyroid scintigraphy with Tc-99m Sestamibi is a sensitive and specific test for pre operative localization of parathyroid adenoma (PA) in patients with primary hyperparathyroidism. However false ve studies are not uncommon. Our aim was to find out the predictive accuracy of pre surgical parathormone (PTH) level with that of parathyroid scan in case of primary hyperparathyroidism. Materials And Method: A total of 54 patients (29 male, 25 female) with a mean age of 41. 24+14.26 years suspected of primary hyperparathyroidism were included in this study. All patients had serum PTH and calcium level higher than the normal limit. Parathyroid scintigraphy was done by subtraction method using 185 MBq of Tc-99m PO4 which was given first and images were taken by planar gamma camera after 20 minutes followed by Tc-99m Sestamibi (740MBq) injection without moving the patient. We calculated the sensitivity and specificity at different cut off values of PTH such as >70pg/ml, >80pg/ml, >90pg/ml and >100pg/ml and observed the changes in sensitivity, specificity, PPV and NPV against scintigraphic diagnosis of PA. Result: Parathyroid scintigraphy revealed 15 positive cases (27.8%) amongst 54 patients, which were surgically proven to be so. The sensitivity of PTH in predicting positive parathyroid scan revealed to be 86.7% at serum PTH level of 70-90pg/ml. Then the sensitivity declines steadily to 73.3% at PTH level of >100pg/ml. The specificity increases gradually from 20.5% at serum PTH level >70pg/ml to 53.8% at serum PTH level >100pg/ml. However, PPV and NPV of serum PTH did not experience significant change like sensitivity and specificity with the increase of cut off values. Conclusion: We can use a cut off value of pre surgical serum PTH level at 90pg/ml before doing parathyroid scan as this has maximum sensitivity and optimum specificity. It will help to predict the outcome of scan and avoid unnecessary parathyroid scan and false ve cases

  20. Malignant melanoma of the conjunctiva – successful surgical excision of the primary tumor and reconstruction by conjunctival auto transplantation from the contralateral eye.

    Science.gov (United States)

    Sivkova, N; Chokoeva, A A; Dobrev, H; Staribratova, D; Belovezhdov, V; Tchernev, G; Wollina, U

    2014-01-01

    Malignant melanoma of the conjunctiva is a rare tumor with incidence of 0.5 cases/year per million population. It may also occur as de novo, as on the basis of preexisting melanocytic lesions (nevus or freckle) or most often from the so-called primary acquired melanosis of the conjuctiva (PAM). It metastasizes mainly lymphogenic and hematogenous. The size of the primary tumor lesion, histopathological findings and absolute tumor thickness are essential for unfavorable prognosis. Conjunctival auto transplantation from the other eye is modern and innovative, but also a seldomly feasible method of reconstruction after conjunctival excision of tumors in this area. We present a rare case of a 75-year-old patient with epithelioid cell malignant melanoma of the bulbar conjunctiva of the right eye, which de novo occurred, successfully treated by excision of the primary tumor and subsequent reconstruction by conjunctival auto transplant from the other eye. A very good therapeutic and aesthetic result was achieved.

  1. Assessment of Primary Cancer Incidence in Growth Hormone-Treated Children: Comparison of a Multinational Prospective Observational Study with Population Databases.

    Science.gov (United States)

    Child, Christopher J; Zimmermann, Alan G; Jia, Nan; Robison, Leslie L; Brämswig, Jürgen H; Blum, Werner F

    2016-01-01

    Although results of the majority of clinical studies have shown no association between growth hormone (GH) treatment in childhood and risk of primary cancer, concerns remain regarding the potential influence of GH therapy on neoplastic cell growth. This study evaluated the incidence of primary malignancies in a large observational study of paediatric GH treatment. Primary cancer incidence was assessed in a cohort of 19,054 GH-treated children without a reported prestudy history of malignancy in the observational Genetics and Neuroendocrinology of Short Stature International Study (GeNeSIS). The standardised incidence ratio (SIR) for primary cancer in GH-treated children was determined by comparing cancer incidence in the GeNeSIS study population with incidence rates for country-, age-, and sex-matched cohorts of the general population. During a mean follow-up of 3.4 years in GeNeSIS (64,705 person-years), 13 incident potential primary cancers were identified in GH-treated patients. The SIR (95% confidence interval) for all observed cancers was 1.02 (0.54-1.75), and the crude incidence was 20.1 (10.7-34.4) cases per 100,000 person-years. Acknowledging the relatively short follow-up in our study, GH-treated children without a history of previous malignancy did not have a higher risk of all-site primary cancer during the study when compared to general-population cancer registries. © 2016 S. Karger AG, Basel.

  2. Long-term follow-up of surgical resection alone for primary intracranial rostrotentorial tumors in dogs: 29 cases (2002-2013

    Directory of Open Access Journals (Sweden)

    Anna Suñol

    2017-12-01

    Full Text Available Intracranial neoplasia is frequently encountered in dogs. After a presumptive diagnosis of intracranial neoplasia is established based on history, clinical signs and advanced imaging characteristics, the decision to treat and which treatment to choose must be considered. The objective of this study is to report survival times (ST for dogs with intracranial meningiomas and gliomas treated with surgical resection alone (SRA, to identify potential prognostic factors affecting survival, and to compare the results with the available literature. Medical records of 29 dogs with histopathologic confirmation of intracranial meningiomas and gliomas treated with SRA were retrospectively reviewed. For each dog, signalment, clinical signs, imaging findings, type of surgery, treatment, histological evaluation, and ST were obtained. Twenty-nine dogs with a histological diagnosis who survived >7 days after surgery were included. There were 15 (52% meningiomas and 14 (48% gliomas. All tumors had a rostrotentorial location. At the time of the statistical analysis, only two dogs were alive. Median ST for meningiomas was 422 days (mean, 731 days; range, 10-2735 days. Median ST for gliomas was 66 days (mean, 117 days; range, 10-730 days. Kaplan-Meier analysis indicated that ST was significantly longer for meningiomas than for gliomas (P7 days postoperatively, SRA might be an appropriate treatment, particularly for meningiomas, when radiation therapy is not readily available. Also, the presence of midline shift and ventricular compression might be negative prognostic factors for dogs with meningiomas.

  3. Profile of patients with hepatic hydatid disease not treated surgically Perfil del paciente con hidatidosis hepática al que no se realiza tratamiento quirúrgico

    Directory of Open Access Journals (Sweden)

    José Manuel Ramia

    2011-09-01

    Full Text Available Background: hepatic hydatid disease (HHD is still an important health problem in certain areas of Spain where it is endemic. The treatment of HHD is usually surgical but certain patients are found to be ineligible after assessment for surgery (asymptomatic disease, comorbidity, patient refusal, or other. Material and methods: description of patients assessed in the Department of Surgery for hepatic hydatid disease. Results: in a group of 70 patients with HHD, 27 patients were not treated surgically (mean age: 72.7 years [range: 47-97], 14 women [51.8%]. The number of cysts presented by these patients was 33, with 1.22 cyst/patient (range: 1-4. The cyst size was 5.5 cm (range: 2.1-12.5 cm. The cysts, according to the WHO classification, were CE1: 3 patients, CE3B: 5 patients, CE4: 10 patients and CE5: 9 patients. The form of presentation was: symptomatic in 9 patients, although only 6 were attributable to HHD (22% and asymptomatic in 18 patients. In these cases, imaging was performed for study of tumor extension in 6 patients and diverse medical reasons in 12. Only two therapeutic interventions were performed: endoscopic retrograde cholangiopancreatography (ERCP with insertion of a bile duct stent, and puncture-aspiration-injection-re-aspiration (PAIR, both in patients who did not wish to undergo surgery. Ten patients had surgical indications: CE1 (3 patients, CE3B (5 patients, CE4 (1 patient, and CE5 (1 patient. The reasons why the patients did not undergo surgical treatment were: refusal (9 patients and advanced neoplasm (1 patient. Surgery was judged necessary in 5 patients. In the mean follow-up period of 17 months (range: 1-37, no surgery was performed. Conclusions: there were various causes for not performing surgical intervention of HHD after medical evaluation: asymptomatic patients, older patients, patients with multiple pathologies and oncologic patients. Usually, they were patients who voluntarily chose not to undergo surgery

  4. Favorable outcome of primary mediastinal large B-cell lymphoma patients treated with sequential RCHOP-RICE regimen without radiotherapy.

    Science.gov (United States)

    Goldschmidt, Neta; Kleinstern, Geffen; Orevi, Marina; Paltiel, Ora; Ben-Yehuda, Dina; Gural, Alex; Libster, Diana; Lavie, David; Gatt, Moshe E

    2016-05-01

    Outcomes in primary mediastinal B cell lymphoma (PMBL) improved with the introduction of dose intense treatments, consolidation radiotherapy and rituximab. DA-EPOCH-R, which omits radiotherapy has been adopted with worldwide enthusiasm, despite lack of proven superiority in randomized trials. We aimed to evaluate the course and outcome of PMBL using an alternative intensive rituximab-containing regimen, RCHOP-RICE. We also evaluated the prognostic value of (18)FDG-PET-CT (PET-CT). We reviewed the clinical, laboratory and imaging data of PMBL patients receiving 1st-line treatment in Hadassah Medical Center between 8/2002 and 10/2014. Of 47 PMBL patients, 24 (51 %) were treated with RCHOP-RICE and 23 (49 %) with other protocols. Overall, the 5-year progression-free survival was 93 % and the overall survival was 98 % (87 and 100 %, respectively, for the RCHOP-RICE regimen). Patient characteristics and treatment toxicities were balanced among protocols. A mean of 11.1 ± 1.3 hospitalization days/patient were needed to administer RCHOP-RICE regimen compared to 37 ± 2 days/patient for DA-EPOCH-R (n = 2). Radiotherapy was given to 3 patients (12 %) treated with RCHOP-RICE compared to 18 patients (78 %) treated with other protocols (p < 0.01). For patients followed with interim and end of treatment (EOT) PET-CT, we observed a significant reduction in the uptake between the two (p < 0.0001). Using a Deauville score cutoff of 3, the negative and positive predictive values (NPV and PPV) of EOT PET-CT were 94 and 33 %, respectively. The RCHOP-RICE protocol results in excellent survival outcomes, generally permits omission of RT and is simpler to administer than DA-EPOCH-R. Interim PET-CT in PMBL may be unjustified; however, EOT Deauville scores ≤3 predicts a favorable outcome.

  5. A Retrospective Study of 39 Patients Treated With Anterior Approach of Thoracic and Lumbar Spondylodiscitis: Clinical Manifestations, Anterior Surgical Treatment, and Outcome.

    Science.gov (United States)

    Yaldz, Can; Özdemir, Nail; Yaman, Onur; Feran, Hamit Günes; Tansug, Tugrul; Minoglu, Mustafa

    2015-11-01

    The aim of this study is to report our 39 patients treated with anterior debridement and autologous iliac bone grafting with or without anterior instrumentation, which is the presumed treatment of choice for thoracic or lumbar spondylodiscitis.Our patients underwent surgical treatment of spondylodiscitis using anterior debridement and autologous iliac bone grafting with or without anterior instrumentation and were analyzed with a mean follow-up of 8 years (range, 2-11 years). Kaneda 2-rod system instrumentation was used in 12 patients, in total. Clinical outcomes were assessed by the Frankel grade. Radiographic fusion was characterized based on 3-dimensional computed tomography.Of the whole group, 20 patients suffered from tuberculous spondylodiscitis and 19 suffered from hematogenous spondylodiscitis. Pathogens responsible for pyogenic infection included Staphylococcus aureus (4 patients), Pseudomonas aeruginosa (3 patients), and Brucella melitensis (1 patient). Fifteen patients had thoracic involvement, 20 had lumbar involvement, and 4 had thoracolumbar junction involvement. Preoperative neurological deficits were noted in 13 of the 39 patients. In terms of Frankel grade, 8 patients have improved, 4 have remained the same, and 1 patient has worsened during the follow-up period. Imaging-documented fusion was achieved in 23 of 27 patients in the graft group (85% fusion rate) and 11 of 12 patients in the graft + Kaneda instrumentation group (91% fusion rate).There was no instrumentation failure, loosening, or graft-related complication such as slippage or fracture of the graft. This approach demonstrated a good recovery rate of neurological functions and a high fusion rate.

  6. Delayed wound healing and postoperative surgical site infections in patients with rheumatoid arthritis treated with or without biological disease-modifying antirheumatic drugs.

    Science.gov (United States)

    Tada, Masahiro; Inui, Kentaro; Sugioka, Yuko; Mamoto, Kenji; Okano, Tadashi; Kinoshita, Takuya; Hidaka, Noriaki; Koike, Tatsuya

    2016-06-01

    Biological disease-modifying antirheumatic drugs (bDMARDs) have become more popular for treating rheumatoid arthritis (RA). Whether or not bDMARDs increase the postoperative risk of surgical site infection (SSI) has remained controversial. We aimed to clarify the effects of bDMARDs on the outcomes of elective orthopedic surgery. We used multivariate logistic regression analysis to analyze risk factors for SSI and delayed wound healing among 227 patients with RA (mean age, 65.0 years; disease duration, 16.9 years) after 332 elective orthopedic surgeries. We also attempted to evaluate the effects of individual medications on infection. Rates of bDMARD and conventional synthetic DMARD (csDMARD) administration were 30.4 and 91.0 %, respectively. Risk factors for SSI were advanced age (odds ratio [OR], 1.11; P = 0.045), prolonged surgery (OR, 1.02; P = 0.03), and preoperative white blood cell count >10,000/μL (OR, 3.66; P = 0.003). Those for delayed wound healing were advanced age (OR, 1.16; P = 0.001), prolonged surgery (OR, 1.02; P = 0.007), preoperative white blood cell count >10,000/μL (OR, 4.56; P = 0.02), and foot surgery (OR, 6.60; P = 0.001). Risk factors for SSI and medications did not significantly differ. No DMARDs were risk factors for any outcome examined. Biological DMARDs were not risk factors for postoperative SSI. Foot surgery was a risk factor for delayed wound healing.

  7. Spleen hydatidosis treated by hemi-splenectomy: A low-morbidity, cost-effective management by a recently improved surgical technique.

    Science.gov (United States)

    Costi, Renato; Castro Ruiz, Carolina; Zarzavadjian le Bian, Alban; Scerrati, Daniele; Santi, Caterina; Violi, Vincenzo

    2015-08-01

    Splenic hydatidosis is a rare condition and is usually managed by total splenectomy, which is associated to various complications, including overwhelming post-splenectomy sepsis and thrombosis. Probably due to supposed technical difficulties, the partial splenectomy is rarely performed being often unknown to physicians, infectious disease specialists and surgeons. Demographic, clinical and surgical data were collected of four consecutive patients undergoing partial (or hemi-) splenectomy using an original, recently improved technique as a treatment for polar splenic hydatid cyst. The procedure implies a selective vascular ligation, a mechanical stapler-assisted section and haemostatic agents (Surgicel(®)) application on the cutting surface. Three patients were treated by laparotomy (including one affected by both liver and spleen localizations) whereas the last one was approached laparoscopically. Partial splenectomy operative time reached 74 min (range: 60-94 min) and blood loss was 8 ml (range: 5-10 ml). Hospital stay was 5.6 days (range: 5-7 days). At a mean follow-up of 20 months (range: 12-36 months), outcomes were uneventful. Partial splenectomy for hydatidosis is effective and safe. Physicians and surgeons should be aware of such an easy-to-catch option when dealing with benign splenic conditions, such as parasitic cysts. Cost-effectiveness, low morbidity and the possible prevention of splenectomy-related infectious complications should plead in favor of this technique in developing countries, where hydatidosis is endemic and post-splenectomy drugs and vaccines may be lacking. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  8. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention

    NARCIS (Netherlands)

    Lewis, R.; Whiting, P.; ter Riet, G.; O'Meara, S.; Glanville, J.

    2001-01-01

    BACKGROUND: Most surgically sutured wounds heal without any complication. However, in some cases wound healing can be delayed due to the presence of infection or wound breakdown. This can result in the wounds becoming cavity wounds and thus necessitate healing by secondary intention. Other surgical

  9. Radiotherapy May Offer a Recurrence and Survival Benefit in Rectal Cancers Treated Surgically with Transanal Endoscopic Microsurgery: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Sideris, Michail; Donaldson, Ana Nora; Hanrahan, John; Grunwald, Matthew; Papagrigoriadis, Savvas

    2018-04-01

    Several studies report outcomes of Transanal Endoscopic Microsurgery (TEMS) surgery in combination with radiotherapy, however the combination of those treatments is provided mostly on an adhoc individual basis and the role of radiotherapy remains unclear. The aim of this study was to identify the effect of neo-adjuvant or adjuvant radiotherapy in the oncological outcomes of rectal cancer treated surgically with TEMS. We performed a systematic review of the literature on MEDLINE and Pubmed databases. Data were extracted by two independent reviewers and meta-analyzed using an inverse variance heterogeneity model to calculate overall (pooled) effect sizes for survival or recurrence of disease against neo+/-adjuvant treatment. A total of 48 studies were included in the qualitative meta-analysis which included 3,285 patients with rectal cancer. The overall survival odds ratio (OR), was 9.39 (95% CI=6.1-14.4) with a Cochran's Q variable of 151.7 on 47 degrees of freedom (d.f.) (p=0.000). Recurrence-free OR was 8.7 (95%CI=6.58-11.44) with a Cochran's Q variable of Q=145.2 on 44 d.f. (p=0.000). Studies which contained more than 10% of pT3 tumours, and provided neo+/-adjuvant treatment in more than 35% of cases, were associated with survival benefit, as demonstrated by an overall odds of survival of 32.2 (95%CI=16.3-63.5, p=0.001, Q=8.4, p=0.21). Studies that contained more than 10% of pT3 tumours and provided neo+/-adjuvant treatment in more than 20% of the cases had an overall effect size of recurrence-free odds of 20.23 (95%CI=13.84-29.57, p=0.000, Q=2.18, p=0.54). There seems to be a benefit from radiotherapy on overall survival and recurrence-free odds, which is more apparent in cohorts with more than 10% of pT3 tumours. Our results suggest that neo-adjuvant or adjuvant radiotherapy should be considered for inclusion in formal treatment protocols for rectal cancers treated with TEMS as they offer a recurrence and survival benefit. Copyright© 2018, International

  10. Class III Restoration of Anterior Primary Teeth: In Vitro Retention Comparison of Conventional, Modified and Air-abrasion Treated Preparations

    Directory of Open Access Journals (Sweden)

    Naser Asl Aminabadi

    2014-06-01

    Full Text Available Background and aims. Anterior esthetic restoration is challenging in pediatric dentistry, due to limited durability and poor retention of the restoration.This study assessed the effect of air abrasion on tensile failure load of composite class III restorations using different preparation techniques. Materials and methods. 100 extracted human anterior primary teeth were divided, based on the preparation methods, into four groups each consisting of 25 subjects : conventional (A, labial surface bevel (B, conventional + air abrasion (C, and labial surface bevel + air abrasion (D. After restoring cavities, tensile failure load of samples was measured in Newton by Universal testing machine at a crosshead speed of 1 mm per minute. The data were analyzed by Kruskal-Wallis and Mann Whitney U tests using SPSS software. Results. There were statistically significant differences between groups A and C (P = 0.003, groups A and B (P < 0.001, groups A and D (P < 0.001, groups B and C (P = 0.028, groups B and D (P = 0.027, and also groups C and D (P < 0.001. Group D demonstrated the highest mean tensile failure load. Conclusion. Labial surface bevel treated by air abrasion showed significantly more retention of composite restoration.

  11. Can We Predict the Surgical Margin Positivity in Patients Treated with Radical Prostatectomy? A Multicenter Cohort of Turkish Association of Uro-Oncology

    Directory of Open Access Journals (Sweden)

    Deniz Bolat

    2015-03-01

    Full Text Available Objective To analyze the parameters that predict the surgical margin positivity after radical prostatectomy for localized prostate cancer. Materials and Methods In this multicenter study, the data of 1607 consecutive patients undergoing radical prostatectomy for localized prostate cancer in 12 different clinics in Turkey between 1993-2011 were assessed. Patients who had neoadjuvant treatment were excluded. We assessed the relationship between potential predictive factors and surgical margin status after radical prostatectomy such as age, cancer characteristics, history of transurethral prostate resection, surgical experience and nerve-sparing technique by using univariate and multivariate Cox regression analyses and t test. Results The overall surgical margin positivity rate was 22.6% (359 patients. In univariate analyses, preoperative prostate specific antigen level, clinical stage, biopsy Gleason score, percentage of tumor involvement per biopsy specimen, transurethral prostate resection history, surgical experience and nerve-sparing technique were significantly associated with positive surgical margin rate. In multivariate analyses, preoperative prostate specific antigen level (OR: 1.03, p=0.06, percentage of tumor involvement per biopsy specimen (OR: 7,14, p<0,001, surgical experience (OR: 2.35, p=0.011 and unilateral nerve-sparing technique (OR: 1.81, p=0.018 were independent predictive factors for surgical margin positivity. Conclusion Preoperative prostate specific antigen level, percentage of tumor involvement per biopsy specimen, surgical experience and nerve-sparing technique are the most important predictive factors of surgical margin positivity in patients undergoing radical prostatectomy for localized prostate cancer.

  12. 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. ...

  13. Surgical approach in patients with T4 bladder cancer as primary treatment: Disaster or option with improved quality of life

    Directory of Open Access Journals (Sweden)

    Udo Nagele

    2008-01-01

    Full Text Available Objectives: Whereas local control is often insufficient in conservative management of T4 bladder cancer, neoadjuvant chemotherapy delays definite treatment, which could result in increased therapy-associated morbidity and mortality during the course of the disease. Primary cystectomy has been reported to be associated with a high complication rate and unsatisfactory clinical efficacy. Herein, we report postoperative outcome in 21 T4 bladder cancer patients subjected to primary cystectomy. Materials and Methods: Twenty-one patients underwent radical cystectomy for T4 (T4a/b: 14 and seven cases, respectively bladder cancer. At the time of surgery, eight patients had regional lymph node metastases (N2: 6; N3: 2. The average age was 64 (52-77 years (≥70 years: n = 7. The postoperative follow-up was 13 (1-36 months for the whole group. Results: Mean duration of postoperative hospitalization was 19 (11-50 days. Whereas 10 patients received no intra - or postoperative blood transfusions, an average number of 3 (1-7 blood units were administered in the remaining cases. The mean postoperative hemoglobin value of patients not receiving any blood transfusions was 10 (8.5 - 11.4 g/dl. Major therapy-associated complications were paresthesia affecting the lower extremities (n = 3 as well as insignificant pulmonary embolism, enterocutaneous fistulation and acute renal failure in one patient, respectively. At the time of data evaluation, 11 patients were still alive after a follow-up of 20 (6-36 months. Four patients ≥70 years at the time of cystectomy were still alive 11, 11, 22 and 31 months following surgery, respectively. Conclusion: Primary cystectomy for T4 bladder cancer is a technically feasible approach that is associated with a tolerable therapy-related morbidity/mortality. Additionally, a satisfactory clinical outcome is observed even in a substantial number of elderly patients.

  14. Moist wound healing compared with standard care of treatment of primary closed vascular surgical wounds: a prospective randomized controlled study

    DEFF Research Database (Denmark)

    Vogt, Katja C; Uhlyarik, M; Schroeder, Torben V

    2007-01-01

    This study was a randomized-controlled trial comparing the standard type of dry dressing, Mepore, with moist wound healing, using a hydrofiber dressing, Aquacel, in primary closed wounds after vascular surgery. The endpoints were patient comfort, cost-effectiveness, infections, wound complications....... No difference in the infection rate (13% vs. 11%, p=0.73), length of hospital stay, or wound complications was noted between the two groups. We conclude that although the Aquacel dressing needed significantly fewer changes than the conventional dressing, this did not influence the patient comfort. Moreover...

  15. Doppler Tissue Imaging Is an Independent Predictor of Outcome in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Jensen, Jan Skov; Pedersen, Sune

    2014-01-01

    in patients treated with primary percutaneous coronary intervention. METHOD: In total, 391 patients who were admitted with STEMIs and treated with primary percutaneous coronary intervention were prospectively included. All participants were examined by echocardiography 2 days (interquartile range, 1-3 days......) after STEMI. Longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured using color DTI at six mitral annular sites and averaged to provide global estimates. RESULTS: The median follow-up period was 25 months (interquartile range, 19-32 months...

  16. Effect of lens status in the surgical success of 23-gauge primary vitrectomy for the management of rhegmatogenous retinal detachment: the Pan American Collaborative Retina Study (PACORES) group results.

    Science.gov (United States)

    Caiado, Rafael R; Magalhães, Octaviano; Badaró, Emmerson; Maia, Andre; Novais, Eduardo A; Stefanini, Francisco Rosa; Navarro, Rodrigo Milan; Arevalo, J Fernando; Wu, Lihteh; Moraes, Nilva; Farah, Michel Eid; Maia, Maurício

    2015-02-01

    To determine the effects of lens status on the success rate of primary pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment using either perfluoropropane gas (C3F8) or silicone oil (SO) tamponade. A retrospective chart analysis was made of 97 eyes from 92 patients with rhegmatogenous retinal detachment with no proliferative vitreoretinopathy that were treated with primary 23-gauge PPV. Eyes included in this were phakic (n = 28), pseudophakic (n = 41), or phakic eyes subject to simultaneous phacoemulsification, intraocular lens implantation, and PPV during primary rhegmatogenous retinal detachment repair (n = 28). Tamponade at the end of PPV was with either C3F8 (n = 65) or SO (n = 32). Success was defined as retinal reattachment at 1 year follow-up after a single procedure in eyes submitted to C3F8 injection; in eyes treated with SO injection, the success rate was defined as retina reattached 1 year after oil removal. Statistical comparisons were made between groups using chi-square, Fisher's exact test, Kruskal-Wallis, Mann-Whitney, and multivariate analysis. All eyes were operated by 2 experienced retina surgeons and had a minimum follow-up of 12 months. The vitreoretinal redetachment rate in eyes subjected to C3F8 tamponade was significantly higher (28.6%) for phakic eyes (P = 0.011) compared with pseudophakic or phakic eyes that underwent to phacoemulsification and intraocular lens implantation (4.5%). Eyes in which SO was used at the end of the surgical procedure demonstrated a similar trend of higher reoperation rates in phakic eyes (28.6%) compared with pseudophakic or phakic eyes (8%) subjected to phacoemulsification and intraocular lens implantation; however, no statistically significant difference was observed (P = 0.201). No statistically significant differences were found between groups in relation to the number of tears (P = 0.863) and their location (inferior: P = 0.189, superior: P = 0.708, nasal: P = 0.756, and temporal: P = 0.08). The

  17. Outcomes of Patients With Head-and-Neck Cancer of Unknown Primary Origin Treated With Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Shoushtari, Asal; Saylor, Drew; Kerr, Kara-Lynne; Sheng, Ke; Thomas, Christopher; Jameson, Mark; Reibel, James; Shonka, David; Levine, Paul; Read, Paul

    2011-01-01

    Purpose: To analyze survival, failure patterns, and toxicity in patients with head-and-neck carcinoma of unknown primary origin (HNCUP) treated with intensity-modulated radiotherapy (IMRT). Methods and materials: Records from 27 patients with HNCUP treated during the period 2002-2008 with IMRT were reviewed retrospectively. Nodal staging ranged from N1 to N3. The mean preoperative dose to gross or suspected disease, Waldeyer's ring, and uninvolved bilateral cervical nodes was 59.4, 53.5, and 51.0 Gy, respectively. Sixteen patients underwent neck dissection after radiation and 4 patients before radiation. Eight patients with advanced nodal disease (N2b-c, N3) or extracapsular extension received chemotherapy. Results: With a median follow-up of 41.9 months (range, 25.3-93.9 months) for nondeceased patients, the 5-year actuarial overall survival, disease-free survival, and nodal control rates were 70.9%, 85.2%, and 88.5%, respectively. Actuarial disease-free survival rates for N1, N2, and N3 disease were 100%, 94.1%, and 50.0%, respectively, at 5 years. When stratified by nonadvanced (N1, N2a nodal disease without extracapsular spread) vs. advanced nodal disease (N2b, N2c, N3), the 5-year actuarial disease-free survival rate for the nonadvanced nodal disease group was 100%, whereas for the advanced nodal disease group it was significantly lower at 66.7% (p = 0.017). Three nodal recurrences were observed: in 1 patient with bulky N2b disease and 2 in patients with N3 disease. No nodal failures occurred in patients with N1 or N2a disease who received only radiation and surgery. Conclusion: Definitive IMRT to 50-56 Gy followed by neck dissection results in excellent nodal control and overall and disease-free survival, with acceptable toxicity for patients with T0N1 or nonbulky T0N2a disease without extracapsular spread. Patients with extracapsular spread, advanced N2 disease, or N3 disease may benefit from concurrent chemotherapy, targeted therapeutic agents, or

  18. Prevalence of the middle mesial canal in non surgical root canal treated mandibular first and second molars in a local military population

    Science.gov (United States)

    2016-06-13

    dental denture. Implants are highly successful but a patient may still succumb to implant failure. Fixed partial denture preparations can cause an...Army Post Graduate Dental School Douglas D. Lancaster, COL, DC 3 August 2016 Prevalence of the middle mesial canal in non-surgical root canal...Methods: 7000 dental records were reviewed for non-surgical root canals performed from October 1970 to October 2015. The data collected included

  19. Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma

    OpenAIRE

    Korošec Jagodič, Helena; Jagodič, Klemen; Podbregar, Matej

    2006-01-01

    Introduction Our aim was to determine long-term survival and quality of life of patients admitted to a surgical intensive care unit (ICU) because of sepsis or trauma. Methods This was an observational study conducted in an 11-bed, closed surgical ICU at a 860-bed teaching general hospital over a 1-year period (January 2003 to December 2003). Patients were divided into two groups according to admission diagnoses: group 1 included patients with sepsis; and group 2 included patients with trauma ...

  20. Surgical management of gynecomastia: 20 years' experience.

    Science.gov (United States)

    Lapid, O; Jolink, F

    2014-03-01

    Gynecomastia, breast hypertrophy in men, is a common finding. The diagnosis is clinical, and ancillary tests may be performed; however, there is no unanimity in the literature about their use or utility. The mainstay of management is conservative, with a minority of patients being operated on. The surgical treatment of gynecomastia is not restricted to one discipline and is performed by plastic, general, and pediatric surgeons. The aim of this study was to assess the experience treating gynecomastia in a university hospital and the practices of the different surgical disciplines in the diagnosis and surgical treatment of gynecomastia; this knowledge could be used for the formulation of guidelines and the allocation of health-care resources. a university medical center. A retrospective cohort study in which all records of patients operated on for gynecomastia over a 20-year period were retrieved. Data were obtained concerning patient demographics, responsible surgical discipline, the workup and etiology found, the surgical technique used, the occurrence of reoperations and revisions, and the use of pathological examination and its results. A total of 179 patients were treated. There was a difference between the patient groups operated on by the different disciplines regarding the indication, the workup, as well as in the operative techniques used. Plastic surgeons performed more bilateral operations than the other disciplines. Surgeons used more radiology and cytology testing. These results most probably represent differences in the population and pathologies treated. This is possibly due to a bias in the referrals by primary care physicians.

  1. Complications of the surgical treatment early and tardy of supracondylar fractures of the humerus in children: a retrospective study of 111 patients treated at the Hospital Nacional de Ninos Carlos Saenz Herrera in the period January 2010 to January 2011

    International Nuclear Information System (INIS)

    Zuniga Blanco, Adrian

    2012-01-01

    Supracondylar fractures of the humerus up much of the emergency consultation of any pediatric orthopedic service, of them, Gartland III fractures are usually treated by closed reduction and percutaneous fixation with nails smooth. Often treatment has been delayed by factors such as the unavailability of an orthopedic specialist or local anesthesia or an operating room. At other times, the patient has come belatedly to consult. This retrospective study has analyzed whether a delay greater than 12 hours in the surgical treatment of supracondylar fractures of the humerus in children is associated with an increased risk of perioperative complications. Of 111 children who have been treated surgical in national children's hospital, underwent 59 surgeries before 12 hours from the trauma and 52 underwent surgery after 12 hours of trauma. The groups have developed without significant differences in terms of iatrogenic neurological injury, tract infection of the nails, vascular complications and compartment syndrome. Surgical time and hospital stay neither have had differences. In 2 cases of the tardy treatment group has been necessary to perform a opened reduction. As for the bad union, 9 cases (8%) have been of elbow varus radiological and clinical, of these 5 cases (4.5%) have occurred in the tardy treatment group and 4 cases (3,5) in the group early treatment. Findings of similar studies are confirmed in which the rate of perioperative complications is significantly unchanged if the surgical treatment is carried out before 12 hours or after 12 hours after the trauma. (author) [es

  2. Serum levels of renin, angiotensin-converting enzyme and angiotensin II in patients treated by surgical excision, propranolol and captopril for problematic proliferating infantile haemangioma.

    Science.gov (United States)

    Sulzberger, L; Baillie, R; Itinteang, T; de Jong, S; Marsh, R; Leadbitter, P; Tan, S T

    2016-03-01

    The role of the renin-angiotensin system (RAS) in the biology of infantile haemangioma (IH) and its accelerated involution induced by β-blockers was first proposed in 2010. This led to the first clinical trial in 2012 using low-dose captopril, an angiotensin-converting enzyme (ACE) inhibitor, demonstrating a similar response in these tumours. This study aimed to compare serial serum levels of the components of the RAS in patients before and after surgical excision, propranolol or captopril treatment for problematic proliferating IH. Patients with problematic proliferating IH underwent measurements of serum levels of plasma renin activity (PRA), ACE and angiotensin II (ATII) before, and 1-2 and 6 months following surgical excision, propranolol or captopril treatment. This study included 27 patients undergoing surgical excision (n = 8), propranolol (n = 11) and captopril (n = 8) treatment. Treatment with either surgical excision or propranolol resulted in significant decrease in the mean levels of PRA. Surgical excision or captopril treatment led to significant decline in the mean levels of ATII. All three treatment modalities had no significant effect on the mean levels of ACE. This study demonstrates the effect of surgical excision, propranolol and captopril treatment in lowering the levels of PRA and ATII, but not ACE, supporting a mechanistic role for the RAS in the biology of IH. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy.

    Science.gov (United States)

    Chugh, Ashish; Husain, Mazhar; Gupta, Rakesh K; Ojha, Bal K; Chandra, Anil; Rastogi, Manu

    2009-05-01

    Endoscopic third ventriculostomy (ETV) is increasingly being used as an alternative treatment for post-tuberculous meningitis (TBM) hydrocephalus. The aim of this study was to affirm the role of ETV in patients with TBM hydrocephalus and also to study the usefulness of cine phase-contrast MR imaging (cine MR imaging) for functional assessment of the ETV stoma. An additional goal was to identify factors that influence the outcome of ETV, so as to define patients with TBM hydrocephalus in whom ETV is warranted. Twenty-six patients with TBM hydrocephalus treated with ETV were evaluated clinically and with cine MR imaging postoperatively. The duration of follow-up ranged from 1 to 15 months. The authors evaluated flow void changes in the floor of the third ventricle and analyzed parameters from the preoperative data, which they then used as a basis for comparison between endoscopically successful and endoscopically unsuccessful cases. The overall success rate of ETV in TBM hydrocephalus was 73.1% in this case series. Cine MR imaging showed a sensitivity of 94.73% and specificity of 71.42% for the functional assessment of third ventriculostomy in these patients, with the efficacy being maintained during follow-up. The outcome of ETV showed a statistically significant correlation with the stage of illness and presence of intraoperative cisternal exudates. Although duration of symptoms and duration of preoperative antituberculous therapy (ATT) appeared to influence the outcome, their correlation with outcome was not statistically significant. Endoscopic third ventriculostomy should be considered as the first surgical option for CSF diversion (that is, before shunt surgery) in patients with TBM hydrocephalus. Cine MR imaging is a highly effective noninvasive tool for the postoperative functional assessment of stomata. Patients who presented with a history of longer duration and those who were administered preoperative ATT for a longer period had a better outcome of

  4. Two-year post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany.

    Science.gov (United States)

    Kaier, Klaus; von Kampen, Frederike; Baumbach, Hardy; von Zur Mühlen, Constantin; Hehn, Philip; Vach, Werner; Zehender, Manfred; Bode, Christoph; Reinöhl, Jochen

    2017-07-11

    This study presents data on post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement over a two year period. Based on a prospective clinical trial, post-discharge utilization of health services and status of assistance were collected for 151 elderly patients via 2250 monthly telephone interviews, valued using standardized unit costs and analysed using two-part regression models. At month 1 post-discharge, total costs of care are substantially elevated (monthly mean: €3506.7) and then remain relatively stable over the following 23 months (monthly mean: €622.3). As expected, the majority of these costs are related to in-hospital care (~98% in month 1 post-discharge and ~72% in months 2-24). Patients that died during follow-up were associated with substantially higher cost estimates of in-hospital care than those surviving the two-year study period, while patients' age and other patient characteristics were of minor relevance. Estimated costs of outpatient care are lower at month 1 than during the rest of the study period, and not affected by the event of death during follow-up. The estimated costs of nursing care are, in contrast, much higher in year 2 than in year 1 and differ substantially by gender and type of procedure as well as by patients' age. Overall, these monthly cost estimates add up to €10,352 for the first and €7467.6 for the second year post-discharge. Substantial cost increases at month 1 post-discharge and in case of death during follow-up are the main findings of the study, which should be taken into account in future economic evaluations on the topic. Application of standardized unit costs in combination with monthly patient interviews allows for a far more precise estimate of the variability in post-discharge health service utilization in this group of patients than the ones given in previous studies. German Clinical Trial Register Nr. DRKS00000797 .

  5. Improving Pre-Operative Flexion in Primary TKA: A Surgical Technique Emphasizing Knee Flexion with 5-Year Follow-Up

    Directory of Open Access Journals (Sweden)

    Edward McPherson

    2014-06-01

    Full Text Available This study prospectively reviews a consecutive series of 228 primary total knee arthroplasty (TKA procedures utilizing a technique to optimize knee flexion. The main features include: (1the use of a “patellar friendly” femoral component and reduced thickness patellar components, (2 patient individualized adjustment of the femoral component rotation set strictly to the anterior-posterior femoral axis, (3a rigorous flexion compartment debridement to remove non-essential posterior femoral bone with a Z-osteotome, and (4incorporation of a rapid recovery protocol with features to promote knee flexion. Results were categorized into three groups: low pre-op flexion (90 degrees and below, regular pre-op flexion (91-125 degrees, and high pre-op flexion (126 degrees and above. Average flexion in the low flexion group improved by 20 degrees at 6 weeks, 28 degrees at 3 months, 31 degrees at 1 year, and 30 degrees at 5 years. In the regular flexion group, average flexion improved by 2 degrees at 6 weeks, 10 degrees at 3 months, 12 degrees at 1 year, and 13 degrees at 5 years. Finally, in the high flexion group, average flexion decreased by 7 degrees at 6 weeks, regained preoperative levels at 3 months, and increased by 3 degrees at 1 year and 4 degrees at 5 years. In summary, a technique that emphasizes patellofemoral kinematics can consistently improve flexion in TKA in short and long-term follow-up.

  6. Surgical management of pain

    African Journals Online (AJOL)

    the spinal cord.[4] In this article, the reader is referred back to this illustration to understand the surgical techniques used to manage pain. Pain is caused by ... Injured dorsal root neurons discharge at higher frequencies and more spontaneously than normally. Surgical techniques. The physician should ensure that treat-.

  7. Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: Considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control

    OpenAIRE

    Misterska, Ewa; Jankowski, Roman; Głowacki, Maciej

    2013-01-01

    Background Pain catastrophizing, appraisals of pain control, styles of coping, and social support have been suggested to affect functioning in patients with low back pain. We investigated the relation of chronic pain coping strategies to psychological variables and clinical data, in patients treated surgically due to lumbar disc herniation and coexisting spondylotic changes. Material/Methods The average age of study participants (n=90) was 43.47 years (SD 10.21). Patients completed the Polish...

  8. [The Effect of Activation of the Shoulder Girdle Muscles on Functional Outcomes of Rehabilitation in Patients with Surgically Treated Distal Radius Fractures].

    Science.gov (United States)

    Jančíková, V; Opavský, J; Dráč, P; Krobot, A; Čižmář, I

    2017-01-01

    PURPOSE OF THE STUDY The aim of the study was to assess the functional outcomes of rehabilitation in patients with surgically treated distal radius fractures in the early postoperative period. We compared the functional outcomes of patients undergoing standard rehabilitation with the group of patients whose postoperative rehabilitation was extended with shoulder girdle exercises of the affected upper limb while the wrist was immobilized. Several indices and variables were used for the assessment of the functional therapeutic outcomes of the affected wrist. MATERIAL AND METHODS Forty patients (32 females and 8 males, the mean age 60.5 years) with distal radius fractures treated by internal fixation using volar surgical approach were involved in the study between 2013-2016. The tested subjects were randomized and split into two groups according to the selected method of rehabilitation. The tested subjects with standard rehabilitation extended with shoulder girdle muscles activation were labelled as group I. It included patients (n = 20) of the mean age 59.8 (age range 42-73 years) with immobilized wrist (i.e. for 3-4 weeks) performing shoulder girdle muscles exercises at the same time. Furthermore, standard kinesiotherapy continued after their fixation was removed. The other tested group, labelled as group II (n = 20), the mean age 61.3 (variation 40-74 years of age) involved patients with distal radius fractures. Only standard rehabilitation was performed in this group as late as their forearm fixation was removed. The following indices and parameters were assessed in the early postoperative period (i.e. by 8 weeks after the fixation removal): wrist and fingers range of motion (ROM), hand grip strength (dynamometry), local swelling, pain, scores of a nine hole peg test (NHPT), and a DASH score. RESULTS After the fixation had been removed, the group I reported statistically significantly higher values of movement compared to the values of the contralateral limb in

  9. Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: Surgical and oncological outcomes. Single institution experience.

    Science.gov (United States)

    Peiretti, Michele; Zanagnolo, Vanna; Aletti, Giovanni D; Bocciolone, Luca; Colombo, Nicoletta; Landoni, Fabio; Minig, Lucas; Biffi, Roberto; Radice, Davide; Maggioni, Angelo

    2010-11-01

    To determinate the impact of maximal cytoreductive surgery on progression free survival (PFS), overall survival (OS) rates and morbidity, in patients with advanced epithelial ovarian or fallopian tube cancer. We reviewed all medical records of patients with stages IIIC-IV epithelial ovarian and fallopian tube cancer that were managed at our institution between January 2001 and December 2008. The following information was collected: demographics, tumor characteristics, operative information, surgical outcomes and peri-operative complication. A total of 288 patients with advanced epithelial ovarian and fallopian tube cancer were referred to our institution between January 2001 and December 2008, 259 consecutive patients were enrolled in the study. After a median follow-up of 29.8 months, the PFS and OS were 19.9 and 57.6 months, respectively. At univariate analysis, factors significantly associated with decreased PFS included: age greater than median (>60 years), stage IV, presence of ascites >1000 cc, presence of diffuse peritoneal carcinomatosis and diameter of residual disease. This was confirmed also at multivariate analysis with age greater than 60 years (P=0.025), stage IV vs IIIC (P=0.037) and any residual disease (P=0.032) having an independent association with worse PFS. Our study seems to demonstrate that a more extensive surgical approach is associated with prolonged disease-free interval and improved survival in patients with stages IIIC-IV epithelial ovarian and fallopian tube cancer. Moreover all patients with no residual tumor seem to have the best prognosis and in view of these results we believe that the goal of primary surgery should be considered as leaving no macroscopic disease. Copyright © 2010 Elsevier Inc. All rights reserved.

  10. Efficacy of Mindfulness-Based Cognitive Therapy on Late Post-Treatment Pain in Women Treated for Primary Breast Cancer: A Randomized Controlled Trial

    DEFF Research Database (Denmark)

    Johannsen, Maja; O Connor, Maja; OToole, Mia Skytte

    2016-01-01

    pain rehabilitation strategy for women treated for breast cancer. In addition, the effect on neuropathic pain, a pain type reported by women treated for breast cancer, further suggests the potential of MBCT but should be considered preliminary.......PURPOSE: To assess the efficacy of mindfulness-based cognitive therapy (MBCT) for late post-treatment pain in women treated for primary breast cancer. METHODS: A randomized wait list-controlled trial was conducted with 129 women treated for breast cancer reporting post-treatment pain (score ≥ 3...... medication. All outcome measures were assessed at baseline, postintervention, and 3-month and 6-month follow-up. Treatment effects were evaluated with mixed linear models. RESULTS: Statistically significant time × group interactions were found for pain intensity (d = 0.61; P = .002), the Present Pain...

  11. Estudo retrospectivo de cães com luxação patelar medial tratados cirurgicamente Retrospective study of dogs with medial patellar luxation surgically treated

    Directory of Open Access Journals (Sweden)

    Mariana Moraes Dionisyio de Souza

    2010-06-01

    , o que indica a necessidade de realização de estudos acerca de novas condutas.The aim of this study was to evaluate retrospectively 48 medium to toy breed dogs with developmental medial patellar luxation submitted to corrective surgical procedures. In the grade 1 limbs, 46.7% were treated by lateral retinacular overlap and 53.3% by lateral retinacular overlap and deepening of the femoral groove with no complications. In the grade 2 limbs (n=35 were used the techniques of deepening of the femoral groove and lateral retinacular overlap (100% of the cases, medial desmotomy (28.6%, fabello-patellar sutures (2.8% with 14.3% of reluxation. The last evaluation varied from 3 to 9 months, and clinical signs of lameness were still observed in 20% of the limbs. In all grade 3 cases (n=11 were performed deepening of the femoral groove, lateral retinacular overlap, partial quadriceps released, medial desmotomy and lateral transposition of the tibial tuberosiy that was fixated with Kirschner wire or screw. Reluxation occurred in 27.3% of the limbs that were reoperated. In this group 72.7% of the limbs had absence of lameness. In the grade 4 limbs (n=10 were used the same techniques of grade 3, but it was also necessary the femoral corrective osteotomy in 4 limbs. Reluxation was observed in 30% of the limbs that were reoperated. Although 60% of the limbs showed a positive evolution of the locomotion after 5.2 months of evaluation, in general the dogs showed a posture with the hind limbs in a semi-flexed position, due to the inability to fully extend the stifle. In conclusion, the surgical procedures used allowed an improvement of the locomotion, but except to grade 1, the patellar reluxation may occur in the other degrees suggesting the necessity of other protocols.

  12. Metformin Hydrochloride and Combination Chemotherapy in Treating Patients With Stage III-IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

    Science.gov (United States)

    2018-02-06

    Brenner Tumor; Malignant Ascites; Malignant Pleural Effusion; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mixed Epithelial Carcinoma; Ovarian Serous Cystadenocarcinoma; Ovarian Undifferentiated Adenocarcinoma; Recurrent Fallopian Tube Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Primary Peritoneal Cavity Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Ovarian Germ Cell Tumor; Stage IIIC Primary Peritoneal Cavity Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Primary Peritoneal Cavity Cancer

  13. Significance of primary tumor volume and T-stage on prognosis in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy.

    Science.gov (United States)

    Chen, Chuanben; Fei, Zhaodong; Pan, Jianji; Bai, Penggang; Chen, Lisha

    2011-04-01

    The aim of this study was to evaluate the effect of the primary tumor volume on prognosis in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. Between August 2003 and April 2005, 112 patients with Stage I-IVB nasopharyngeal carcinoma treated by intensity-modulated radiation therapy were included. Measurement of the primary tumor volume was based on contrast-enhanced computed tomography scans before treatment. A receiver operating characteristics curve was used to determine the best cut-off point of the primary tumor volume. The mean primary tumor volume for 112 patients with nasopharyngeal carcinoma was 33.9 ± 28.7 ml. Within the framework of UICC T-staging, all patients were divided into four groups according to the primary tumor volume. We call it the volume stage (V1 50.55 ml). The 5-year overall survival rates for V1, V2, V3 and V4 were 88.5, 83.3, 82.4 and 54.5% (P = 0.014), respectively. The cumulative survival curves for V1, V2 and V3 were very close, but clearly separated from V4. In addition, Cox proportional hazards regression model analysis showed that a primary tumor volume >50 ml was an independent risk factor for radiotherapy (risk ratio = 3.485, P = 0.025). This study demonstrated that the primary tumor volume had significantly impacted on the prognosis of patients with nasopharyngeal carcinoma. We proposed that the primary tumor volume should be considered as an additional stage indicator in the new revision of the clinical stage of nasopharyngeal carcinoma.

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

    Directory of Open Access Journals (Sweden)

    Edvin Prifti, MD, PhD

    2017-04-01

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

  15. Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report.

    Science.gov (United States)

    St-Onge, Eric; MacIntyre, Ian G; Galea, Anthony M

    2015-12-01

    To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy.

  16. Assessment of clinically related outcomes and biomarker analysis for translational integration in colorectal cancer (ACROBATICC): study protocol for a population-based, consecutive cohort of surgically treated colorectal cancers and resected colorectal liver metastasis.

    Science.gov (United States)

    Søreide, Kjetil; Watson, Martin M; Lea, Dordi; Nordgård, Oddmund; Søreide, Jon Arne; Hagland, Hanne R

    2016-06-29

    More accurate predictive and prognostic biomarkers for patients with colorectal cancer (CRC) primaries or colorectal liver metastasis (CLM) are needed. Outside clinical trials, the translational integration of emerging pathways and novel techniques should facilitate exploration of biomarkers for improved staging and prognosis. An observational study exploring predictive and prognostic biomarkers in a population-based, consecutive cohort of surgically treated colorectal cancers and resected colorectal liver metastases. Long-term outcomes will be cancer-specific survival, recurrence-free survival and overall survival at 5 years from diagnosis. Beyond routine clinicopathological and anthropometric characteristics and laboratory and biochemistry results, the project allows for additional blood samples and fresh-frozen tumour and normal tissue for investigation of circulating tumour cells (CTCs) and novel biomarkers (e.g. immune cells, microRNAs etc.). Tumour specimens will be investigated by immunohistochemistry in full slides. Extracted DNA/RNA will be analysed for genomic markers using specific PCR techniques and next-generation sequencing (NGS) panels. Flow cytometry will be used to characterise biomarkers in blood. Collaboration is open and welcomed, with particular interest in mutual opportunities for validation studies. The project is ongoing and recruiting at an expected rate of 120-150 patients per year, since January 2013. A project on circulating tumour cells (CTCs) has commenced, with analysis being prepared. Investigating molecular classes beyond the TNM staging is under way, including characteristics of microsatellite instability (MSI) and elevated microsatellite alterations in selected tetranucleotides (EMAST). Hot spot panels for known mutations in CRC are being investigated using NGS. Immune-cell characteristics are being performed by IHC and flow cytometry in tumour and peripheral blood samples. The project has ethical approval (REK Helse Vest, #2012

  17. A comparison of the 'cost per child treated' at a primary care-based sedation referral service, compared to a general anaesthetic in hospital.

    Science.gov (United States)

    Jameson, K; Averley, P A; Shackley, P; Steele, J

    2007-09-22

    To compare the cost-effectiveness of dental sedation techniques used in the treatment of children, focusing on hospital-based dental general anaesthetic (DGA) and advanced conscious sedation in a controlled primary care environment. Data on fees, costs and treatment pathways were obtained from a primary care clinic specialising in advanced sedation techniques. For the hospital-based DGA cohort, data were gathered from hospital trusts in the same area. Comparison was via an average cost per child treated and subsequent sensitivity analysis. Analysing records spanning one year, the average cost per child treated via advanced conscious sedation was pound245.47. As some treatments fail (3.5% of cases attempted), and the technique is not deemed suitable for all patients (4-5%), DGA is still required and has been factored into this cost. DGA has an average cost per case treated of pound359.91, 46.6% more expensive than advanced conscious sedation. These cost savings were robust to plausible variation in all parameters. The costs of advanced conscious sedation techniques, applied in a controlled primary care environment, are substantially lower than the equivalent costs of hospital-based DGA, informing the debate about the optimum way of managing this patient group.

  18. Primary Care Interventions to Prevent or Treat Traumatic Stress in Childhood: A Systematic Review.

    Science.gov (United States)

    Flynn, Anna B; Fothergill, Kate E; Wilcox, Holly C; Coleclough, Elizabeth; Horwitz, Russell; Ruble, Anne; Burkey, Matthew D; Wissow, Lawrence S

    2015-01-01

    To systematically assess the evidence base for prevention and treatment of child traumatic stress in primary care settings. PubMed, Embase, PsycINFO, Scopus, Academic Search Complete, CINAHL, Web of Science, Cochrane Library, the National Registry of Evidence-based Programs and Practices, the National Child Traumatic Stress Network website, Google search. Studies were eligible for inclusion if they described the results of intervention studies in a primary care setting addressing child traumatic stress. Study participants could include primary care providers, pediatric patients, and their parents or other caregivers. Each study was assessed for inclusion, and each included study was assessed for risk of bias by 2 reviewers. We found 12 articles describing 10 different studies that met the inclusion criteria. The intervention approaches taken in the studies were diverse and included the implementation of screening programs or tools, training clinicians to recognize and discuss psychosocial issues with patients and their families, and providing primary care professionals with community resource lists. Nine out of 10 studies included in the review reported favorable results. Studies included in the review had relatively short follow-up periods, and the diversity of studies identified precluded the possibility of conducting a meta-analysis. Findings suggest that interventions in pediatric primary care settings are feasible and can favorably affect clinical practices and families' outcomes. Copyright © 2015 Academic Pediatric Association. All rights reserved.

  19. Associations between statin use and progression in men with prostate cancer treated with primary androgen deprivation therapy

    DEFF Research Database (Denmark)

    Mikkelsen, Marta Kramer; Thomsen, Frederik Birkebæk; Berg, Kasper Drimer

    2017-01-01

    INTRODUCTION: In several observational studies, statin use has been associated with reduced risk of progression and mortality in men with prostate cancer (PCa). The study aim was to investigate the association between statin use at time of PCa diagnosis and time to PCa progression in men...... with advanced or metastatic PCa receiving androgen deprivation therapy (ADT) as primary treatment. PATIENTS AND METHODS: The study population consisted of all men receiving ADT as primary therapy at two Danish Urological Departments in 2007-2013. The primary outcome was time to progression defined as castration...... between statin use and risk of progression, HR 0.98 (95% CI: 0.72-1.32). In competing risk analyses the 5-year cumulative incidence of progression was 55% (95% CI: 46-64%) for statin users and 62% (95% CI: 57-67%) for non-statin users, p = 0.11. CONCLUSION: In the current study, statin use at time of PCa...

  20. Smoking and its associations with sociodemographic and clinical characteristics and quality of life in patients with schizophrenia treated in primary care in China.

    Science.gov (United States)

    Li, Yan; Hou, Cai-Lan; Ma, Xin-Rong; Zang, Yu; Jia, Fu-Jun; Zhong, Bao-Liang; Lin, Yong-Qiang; Chiu, Helen F K; Ungvari, Gabor S; Himelhoch, Seth; Cao, Xiao-Lan; Cai, Mei-Ying; Lai, Kelly Y C; Xiang, Yu-Tao

    2016-01-01

    Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated smoking rates in this population. This study investigated the rate of smoking and its associations with sociodemographic and clinical characteristics and quality of life (QOL) in patients with schizophrenia treated in primary care in China. This was a cross-sectional, community-based survey. A total of 621 schizophrenia patients were recruited from 22 primary care services in Guangzhou, China, in 2013. Patients' sociodemographic and clinical characteristics, smoking status, and QOL were recorded. The frequency of current smoking was 23.8% in the whole sample; 41.5% for men and 2.5% for women. Multiple logistic regression analysis revealed that male gender, married status, alcohol use, older age at onset, fewer major medical conditions, lower education level and more hospitalizations were independently associated with current smoking. The frequency of smoking in Chinese schizophrenia patients treated by primary care physicians is lower than most figures reported from Western and Chinese psychiatric settings. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Culture-independent analyses reveal novel Anaerolineaceae as abundant primary fermenters in anaerobic digesters treating waste activated sludge

    DEFF Research Database (Denmark)

    McIlroy, Simon Jon; Kirkegaard, Rasmus Hansen; Dueholm, Morten Simonsen

    2017-01-01

    primary and surplus sludge from wastewater treatment plants, yet are known only by their 16S rRNA gene sequence. This study applied metagenomics to obtain a complete circular genome (2.57 Mbp) from a representative of the A6 taxon. Preliminary annotation of the genome indicates these organisms...... to be anaerobic chemoorganoheterotrophs with a fermentative metabolism. Given their observed abundance, they are likely important primary fermenters in digester systems. Application of fluorescence in situ hybridisation probes designed in this study revealed their morphology to be short filaments present within...

  2. Treating pediatric obesity in the primary care setting to prevent chronic disease: perceptions and knowledge of providers and staff.

    Science.gov (United States)

    Silberberg, Mina; Carter-Edwards, Lori; Murphy, Gwen; Mayhew, Meghan; Kolasa, Kathryn; Perrin, Eliana M; Armstrong, Sarah; Graham, Cameron; Menon, Nidu

    2012-01-01

    The national and international epidemic of chronic disease, including among children, is largely fueled by increasing obesity. It is recommended that primary care play a key role in the treatment of pediatric obesity. A written survey was administered to providers and staff at 13 primary care practices across North Carolina, assessing perceptions on multiple dimensions of pediatric obesity treatment and knowledge of dietitian services. The response rate for the survey was 66.9% (n = 273). Although providers reported feeling comfortable and confident in many areas of childhood obesity, perceived effectiveness was low. Moreover, comfort and confidence were lower for non-primary care providers (PCPs) involved in obesity treatment than for PCPs, and PCP comfort and confidence levels were low for the ability to conduct motivational interviewing and for knowledge of billing for obesity as a diagnosis. Personnel perceived that there were benefits to having a registered dietitian (RD) in their practice and generally understood RD capacity. Survey results provided no evidence that integration of an RD into the practice changed perceptions or knowledge over the course of 1 year. The present study included only 13 practices, mostly rural and all of at least moderate size. Significant change is required if primary care practices are to play the role envisioned for them in stemming childhood obesity and chronic disease. Change will require identifying and addressing specific knowledge and skill gaps, such as those identified in this study. Respondents' positive perceptions of the benefits of RD integration suggest the importance of exploring this clinical model.

  3. More Than 25?Years of Surgical Treatment of Hydatid Cysts in a Nonendemic Area Using the ?Frozen Seal? Method

    OpenAIRE

    Stoot, J. H. M. B.; Jongsma, C. K.; Limantoro, I.; Terpstra, O. T.; Breslau, P. J.

    2009-01-01

    Background Hydatid disease of the liver remains endemic in the world and is an imported disease in The Netherlands. The aim of this study was to evaluate the treatment and outcome of surgically treated patients for hydatid disease in a single center in The Netherlands. Methods This retrospective study included 112 consecutive patients surgically treated for hydatid disease between 1981 and 2007. The primary outcome was relapse of the disease. Secondary outcomes were infections, complications,...

  4. Surgical Treatment of Primary Intracardiac Myxoma: 20-Year Experience in “Shahid Modarres Hospital”—A Tertiary University Hospital—Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Zahra Ansari Aval

    2015-01-01

    Full Text Available Although cardiac tumors are not common they may vary in terms of race and surgical approach in different countries. Method. Patients data of 20 years was collected and evaluated in the “Shahid Modarres Hospital”—a tertiary university hospital—Tehran, Iran. Results. 42 patients with cardiac myxoma (all cases in 20 years were included in study, 17 males and 25 females, age difference: 13 to 76 years (mean 50.6. Most of patients were in functional classes I, II. 35 patients complained of dyspnea and 3 patients had embolic events. 97.6% of tumors were primary (41 patients and one tumor was recurrent (2.4%, 85.7% of tumors (36 cases were located in LA, and 88.1% of tumors (37 cases were pediculated. 40 patients (95% had one tumor. In 22 patients (52.3% after tumor resection septal defects were repaired primarily while in 18 patients (42.8% the defects were repaired with pericardial patch and In one patient, tumor resected without any septal defect. Mean tumor size was about 5.22 cm (range of 2.2 to 8.2 cm. Postoperatively, 33 patients discharged from hospital without any complication. Discussion. The research reveals that patients’ age and gender were similar to that of other studies in other countries while tumor’s incidence seems to be higher. 3 patients were diagnosed after remote embolic event and one patient was diagnosed after MI reflecting relatively high tumor complications and late diagnosis. Conclusion. In our study mean time from diagnosis to operation was too long. The patients had more preoperative embolic events and complication. However, size of myxoma and location of that was as same as its rate in the other literature. As recommendation we suggested that in all patients with vague chest pain or remote embolic events cardiac myxomas should be ruled out.

  5. Methods dentists use to diagnose primary caries lesions prior to restorative treatment: findings from The Dental PBRN

    DEFF Research Database (Denmark)

    Rindal, D Brad; Gordan, Valeria V; Litaker, Mark S

    2010-01-01

    To (1) quantify the diagnostic techniques used by Dental Practice-Based Research Network (DPBRN) dentists before they decide to treat primary caries lesions surgically and (2) examine whether certain dentist, practice, and patient characteristics are associated with their use....

  6. Contemporary Management of Primary Distal Urethral Cancer

    NARCIS (Netherlands)

    Traboulsi, S.L.; Witjes, J.A.; Kassouf, W.

    2016-01-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation

  7. Survival Outcomes and Patterns of Recurrence in Patients with Stage III or IV Oropharyngeal Cancer Treated with Primary Surgery or Radiotherapy.

    Science.gov (United States)

    Debenham, Brock J; Banerjee, Robyn; Warkentin, Heather; Ghosh, Sunita; Scrimger, Rufus; Jha, Naresh; Parliament, Matthew

    2016-07-26

    To compare and contrast the patterns of failure in patients with locally advanced squamous cell oropharyngeal cancers undergoing curative-intent treatment with primary surgery or radiotherapy +/- chemotherapy. Two hundred and thirty-three patients with stage III or IV oropharyngeal squamous cell carcinoma who underwent curative-intent treatment from 2006-2012, were reviewed. The median length of follow-up for patients still alive at the time of analysis was 4.4 years. Data was collected retrospectively from a chart review. One hundred and thirty-nine patients underwent primary surgery +/- adjuvant therapy, and 94 patients underwent primary radiotherapy +/- chemotherapy (CRT). Demographics were similar between the two groups, except primary radiotherapy patients had a higher age-adjusted Charleston co-morbidity score (CCI). Twenty-nine patients from the surgery group recurred; 15 failed distantly only, seven failed locoregionally, and seven failed both distantly and locoregionally. Twelve patients recurred who underwent chemoradiotherapy; ten distantly alone, and two locoregionally. One patient who underwent radiotherapy (RT) alone failed distantly. Two and five-year recurrence-free survival rates for patients undergoing primary RT were 86.6% and 84.9% respectively. Two and five-year recurrence-free survival rates for primary surgery was 80.9% and 76.3% respectively (p=0.21). There was no significant difference in either treatment when they were stratified by p16 status or smoking status. Our analysis does not show any difference in outcomes for patients treated with primary surgery or radiotherapy. Although the primary pattern of failure in both groups was distant metastatic disease, some local failures may be preventable with careful delineation of target volumes, especially near the base of skull region.

  8. Correlation of general and oral health-related quality of life in malocclusion patients treated with a combined orthodontic and maxillofacial surgical approach.

    Science.gov (United States)

    Tamme, Johannes Alexander; Rohnen, Michael; Gaßling, Volker; Ciesielski, Robert; Fischer-Brandies, Helge; Wiltfang, Jörg; Koos, Bernd

    2017-12-01

    The aim of the study was to collect information about the oral health-related quality of life (OHRQoL) after combined orthodontic and maxillofacial surgical treatment as well as its influence on health-related quality of life (HRQoL). The study includes data from a total of 130 subjects, 65 of whom (21 male, 44 female, mean age at baseline: 24 years, mean age at the time of surgery: 26 years) were compared with control subjects matched on the basis of gender and age. The set of questionnaires used consisted of a questionnaire advanced by the authors including 35 general and treatment-specific questions, and the German version of the validated "Orthognathic Quality of Life Questionnaire" (OQLQ) to analyze the specific OHRQoL, and the SF-36 to measure HRQoL. The main reason for treatment was most often a combination of esthetic and functional complaints. In most cases, the treatment results met the expectations of subjects well or very well, particularly in the areas of aesthetics and masticatory function. Postoperative numbness or paresthesia were present in 59% of patients, especially in the chin and lower lip areas. In all, 20% of subjects considered the temporary restriction of mouth opening as very bothersome. A decrease in HRQoL was noted as compared with the control group in the subscales of "role physical" (p oral function" (p maxillofacial surgical treatment. However, even after combined orthodontic and maxillofacial surgical treatment of malocclusion patients, it is possible to detect smaller limitations with regard to the specific OHRQoL, which may have a negative impact on HRQoL. Based on the results, a participatory decision-making process focusing on the individual therapy-related expectations, desires, and psychological factors of the patient concerning the improvements effected by the treatment appears to be advisable. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  9. Radiological, clinical and functional evaluation using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire of children with medial epicondyle fractures treated surgically.

    Science.gov (United States)

    Canavese, Federico; Marengo, Lorenza; Tiris, Alexandru; Mansour, Mounira; Rousset, Marie; Samba, Antoine; Andreacchio, Antonio; Dimeglio, Alain

    2017-07-01

    The main goal of this study was to retrospectively evaluate the clinical, functional and radiographic outcomes of displaced medial epicondyle fractures with or without associated elbow dislocation in children undergoing surgical treatment and to evaluate upper-extremity function with the Quick Disbilities of the Arm, Shoulder and Hand (Quick DASH) questionnaire. The hypothesis was that patients with associated elbow dislocation would have similar functional outcome to patients with displaced fractures with or without intra-articular entrapment of the medial epicondyle. A review of medical charts was performed to identify all children and adolescents who underwent surgical treatment for displaced medial epicondyle humeral fractures managed at a single institution. Patients with a closed fracture on plain radiographs, presence of growth cartilages and managed surgically were included in the study. Fractures were radiologically assessed on anteroposterior and lateral radiographs and rated according to Papavasiliou and Crawford classification. Functional outcome was measured with the Quick DASH questionnaire. Sixty-six patients met inclusion criteria, and 38 children presented with isolated displaced medial epicondyle fracture (Group A: type II and type III) and 28 with medial epicondyle fractures associated with elbow dislocation (Group B: type IV). The Papavasiliou and Crawford system classified 36 fractures as type II (54.6%), two (3%) as type III and 28 as type IV (42.4%). All patients underwent open reduction. Fracture fixation was performed with K-wires in 26 (35%) children and a with single screw in 40 (65%). Mean follow-up was 37.5 months (range, 12-68). Overall complication rate was 18%. In particular, three adverse events (3/38, 8%) were recorded in Group -A and nine (9/28, 32%) in Group B (p = 0.003). Mean Quick DASH score at final follow-up was 4.6 ± 3.8 (range, 0-15.9) and was not significantly different between Groups A (5.4 ± 4.3; range, 0

  10. Primary Meningeal Rhabdomyosarcoma

    Science.gov (United States)

    Palta, Manisha; Riedel, Richard F.; Vredenburgh, James J.; Cummings, Thomas J.; Green, Scott; Chang, Zheng; Kirkpatrick, John P.

    2011-01-01

    Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI) demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13). Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC) systemic therapy. PMID:21772793

  11. Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches.

    Science.gov (United States)

    Al-Moraissi, Essam Ahmed; Louvrier, Aurélien; Colletti, Giacomo; Wolford, Larry M; Biglioli, Federico; Ragaey, Marwa; Meyer, Christophe; Ellis, Edward

    2018-03-01

    The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches. A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches. The main outcome variable was transient facial nerve injury (TFNI) and permanent facial nerve injury (PFNI) according to the fracture levels, namely: condylar head fractures (CHFs), condylar neck fractures (CNFs), and condylar base fractures (CBFs). For studies where there was no delineation between CNFs and CBFs, the fractures were defined as CNFs/CBFs. The dependent variables were the surgical approaches. A total of 3873 patients enrolled in 96 studies were included in this analysis. TFNI rates reported in the literature were as follows: A) For the transoral approach: a) for strictly intraoral 0.72% (1.3 in CNFs and 0% for CBFs); b) for the transbuccal trocar instrumentation 2.7% (4.2% in CNFs and 0% for CBFs); and c) for endoscopically assisted ORIF 4.2% (5% in CNFs, and 4% in CBFs). B) For low submandibular approach 15.3% (26.1% for CNFs, 11.8% for CBFs, and 13.7% for CNFs/CBFs). C) For the high submandibular/angular subparotid approach with masseter transection 0% in CBFs. D) For the high submandibular/angular transmassetric anteroparotid approach 0% (CNFs and CBFs). E) For the transparotid retromandibular approach a) with nerve facial preparation 14.4% (23.9% in CNFs, 11.8% in CBFs and 13.7% for CNFs/CBFs); b) without facial nerve preparation 19% (24.3% for CNFs and 10.5% for CBFs). F) For retromandibular transmassetric anteroparotid approach 3.4% in CNFs/CBFs. G) For retromandibular transmassetric anteroparotid

  12. Acute diverticulitis and surgical treatment.

    Science.gov (United States)

    Roig, José V; Sánchez-Guillén, Luis; García-Armengol, Juan J

    2018-04-01

    Diverticulitis is a common condition in industrialized countries and an important cause of hospital admissions. Its growing trend is a challenge for the surgeons who perform emergency surgery, because approximately 15-25% of the patients will require surgery, being the surgical management of complicated acute diverticulitis controversial. The past decade has seen a paradigm shift in the treatment of sigmoid diverticulitis based on new epidemiological studies and refinement of surgical techniques that has produced a reassessment of our guidelines. CT imaging and sepsis scores allows to stratify the patients and better define the therapeutic strategies in each case. Special considerations must also be made for patients with a high surgical risk, such as immunosuppressed ones. The recommendations to perform surgery after two episodes of uncomplicated diverticulitis have been re-evaluated and the belief that new episodes may be complicated and associated with high morbidity and mortality has been rejected, since the clinical manifestations of this disease are usually defined by the first attack. In complicated cases, more patients can be treated with resection and primary anastomosis with or without an associated stoma, whose reversal rate is much higher than that of a Hartmann's procedure. Likewise, laparoscopic surgery performing a peritoneal lavage and drainage without associated resection may have an increasing role in the management of these patients, although with controversial results, having become laparoscopic colon resection the approach of choice for the treatment of this pathology in elective settings.

  13. Quantitative 1H NMR metabolomics reveals extensive metabolic reprogramming of primary and secondary metabolism in elicitor-treated opium poppy cell cultures

    Directory of Open Access Journals (Sweden)

    Vogel Hans J

    2008-01-01

    Full Text Available Abstract Background Opium poppy (Papaver somniferum produces a diverse array of bioactive benzylisoquinoline alkaloids and has emerged as a model system to study plant alkaloid metabolism. The plant is cultivated as the only commercial source of the narcotic analgesics morphine and codeine, but also produces many other alkaloids including the antimicrobial agent sanguinarine. Modulations in plant secondary metabolism as a result of environmental perturbations are often associated with the altered regulation of other metabolic pathways. As a key component of our functional genomics platform for opium poppy we have used proton nuclear magnetic resonance (1H NMR metabolomics to investigate the interplay between primary and secondary metabolism in cultured opium poppy cells treated with a fungal elicitor. Results Metabolite fingerprinting and compound-specific profiling showed the extensive reprogramming of primary metabolic pathways in association with the induction of alkaloid biosynthesis in response to elicitor treatment. Using Chenomx NMR Suite v. 4.6, a software package capable of identifying and quantifying individual compounds based on their respective signature spectra, the levels of 42 diverse metabolites were monitored over a 100-hour time course in control and elicitor-treated opium poppy cell cultures. Overall, detectable and dynamic changes in the metabolome of elicitor-treated cells, especially in cellular pools of carbohydrates, organic acids and non-protein amino acids were detected within 5 hours after elicitor treatment. The metabolome of control cultures also showed substantial modulations 80 hours after the start of the time course, particularly in the levels of amino acids and phospholipid pathway intermediates. Specific flux modulations were detected throughout primary metabolism, including glycolysis, the tricarboxylic acid cycle, nitrogen assimilation, phospholipid/fatty acid synthesis and the shikimate pathway, all of which

  14. Data on gene and protein expression changes induced by apabetalone (RVX-208 in ex vivo treated human whole blood and primary hepatocytes

    Directory of Open Access Journals (Sweden)

    Sylwia Wasiak

    2016-09-01

    Full Text Available Apabetalone (RVX-208 inhibits the interaction between epigenetic regulators known as bromodomain and extraterminal (BET proteins and acetyl-lysine marks on histone tails. Data presented here supports the manuscript published in Atherosclerosis “RVX-208, a BET-inhibitor for Treating Atherosclerotic Cardiovascular Disease, Raises ApoA-I/HDL and Represses Pathways that Contribute to Cardiovascular Disease” (Gilham et al., 2016 [1]. It shows that RVX-208 and a comparator BET inhibitor (BETi JQ1 increase mRNA expression and production of apolipoprotein A-I (ApoA-I, the main protein component of high density lipoproteins, in primary human and African green monkey hepatocytes. In addition, reported here are gene expression changes from a microarray-based analysis of human whole blood and of primary human hepatocytes treated with RVX-208. Keywords: Bromodomain, BET proteins, BET inhibitor, RVX-208, JQ1, Vascular inflammation, ApoA-I, Apolipoprotein A-I, African green monkey, Primary human hepatocytes, Gene expression, Microarrays

  15. Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies.

    Directory of Open Access Journals (Sweden)

    Anick Nater

    Full Text Available While several clinical prediction rules (CPRs of survival exist for patients with symptomatic spinal metastasis (SSM, these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL. We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs.Seven electronic databases were searched (1990-2015, without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor.Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret.The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs.

  16. Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke: Primary Results of the STRATIS Registry.

    Science.gov (United States)

    Mueller-Kronast, Nils H; Zaidat, Osama O; Froehler, Michael T; Jahan, Reza; Aziz-Sultan, Mohammad Ali; Klucznik, Richard P; Saver, Jeffrey L; Hellinger, Frank R; Yavagal, Dileep R; Yao, Tom L; Liebeskind, David S; Jadhav, Ashutosh P; Gupta, Rishi; Hassan, Ameer E; Martin, Coleman O; Bozorgchami, Hormozd; Kaushal, Ritesh; Nogueira, Raul G; Gandhi, Ravi H; Peterson, Eric C; Dashti, Shervin R; Given, Curtis A; Mehta, Brijesh P; Deshmukh, Vivek; Starkman, Sidney; Linfante, Italo; McPherson, Scott H; Kvamme, Peter; Grobelny, Thomas J; Hussain, Muhammad S; Thacker, Ike; Vora, Nirav; Chen, Peng Roc; Monteith, Stephen J; Ecker, Robert D; Schirmer, Clemens M; Sauvageau, Eric; Abou-Chebl, Alex; Derdeyn, Colin P; Maidan, Lucian; Badruddin, Aamir; Siddiqui, Adnan H; Dumont, Travis M; Alhajeri, Abdulnasser; Taqi, M Asif; Asi, Khaled; Carpenter, Jeffrey; Boulos, Alan; Jindal, Gaurav; Puri, Ajit S; Chitale, Rohan; Deshaies, Eric M; Robinson, David H; Kallmes, David F; Baxter, Blaise W; Jumaa, Mouhammad A; Sunenshine, Peter; Majjhoo, Aniel; English, Joey D; Suzuki, Shuichi; Fessler, Richard D; Delgado Almandoz, Josser E; Martin, Jerry C; Haussen, Diogo C

    2017-10-01

    Mechanical thrombectomy with stent retrievers has become standard of care for treatment of acute ischemic stroke patients because of large vessel occlusion. The STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) aimed to assess whether similar process timelines, technical, and functional outcomes could be achieved in a large real world cohort as in the randomized trials. STRATIS was designed to prospectively enroll patients treated in the United States with a Solitaire Revascularization Device and Mindframe Capture Low Profile Revascularization Device within 8 hours from symptom onset. The STRATIS cohort was compared with the interventional cohort of a previously published SEER patient-level meta-analysis. A total of 984 patients treated at 55 sites were analyzed. The mean National Institutes of Health Stroke Scale score was 17.3. Intravenous tissue-type plasminogen activator was administered in 64.0%. The median time from onset to arrival in the enrolling hospital, door to puncture, and puncture to reperfusion were 138, 72, and 36 minutes, respectively. The Core lab-adjudicated modified Thrombolysis in Cerebral Infarction ≥2b was achieved in 87.9% of patients. At 90 days, 56.5% achieved a modified Rankin Scale score of 0 to 2, all-cause mortality was 14.4%, and 1.4% suffered a symptomatic intracranial hemorrhage. The median time from emergency medical services scene arrival to puncture was 152 minutes, and each hour delay in this interval was associated with a 5.5% absolute decline in the likelihood of achieving modified Rankin Scale score 0 to 2. This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community. The decrease of clinical benefit over time warrants optimization of the system of care. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02239640. © 2017 American Heart Association, Inc.

  17. Phaeoacremonium parasiticum phaeohyphomycosis in a patient with systemic lupus erythematosus treated successfully with surgical debridement and voriconazole: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Rima I. El-Herte

    2014-01-01

    Full Text Available A 26-year old woman presented for evaluation of extensive edema, erythema, sinus tract formation and purulent drainage from the left lower extremity after trauma from a wooden object approximately three months prior. Skin biopsies and blood cultures revealed Phaeoacremonium parasiticum consistent with a diagnosis of phaeohyphomycosis. Despite hospitalization and initial treatment with several antifungals, including voriconazole, her infection progressed. Surgical debridement with split thickness skin grafting was performed. Subsequent clinical improvement allowed a transition from intravenous to oral voriconazole and discharge home. Seven months post presentation she remained on oral voriconazole with significant improvement and no clinical evidence of recurrence. This case illustrates an approach to management where aggressive debridement with split-thickness skin grafting and a prolonged course of intravenous and oral antifungals resulted in a good long-term outcome for the patient.

  18. DENTAL CAST STUDY OF ADULT PATIENTS WITH UNTREATED UNILATERAL CLEFT-LIP OR CLEFT-LIP AND PALATE IN INDONESIA COMPARED WITH SURGICALLY TREATED PATIENTS IN THE NETHERLANDS

    NARCIS (Netherlands)

    SPAUWEN, PHM; HARDJOWASITO, W; BOERSMA, J; LATIEF, BS

    To determine differences in maxillary and dentoalveolar relationships between untreated and treated patients having unilateral clefts of the lip and alveolus (UCLA) or lip and palate (UCLP), dental cast assessments were done on 70 untreated adult Indonesian patients (UCLA-I, UCLP-I) and 67 Dutch

  19. [Retrosternal luxation of the clavicle. Apropos of 4 cases surgically treated using a temporary screwed anterior plate and review of the literature].

    Science.gov (United States)

    Asfazadourian, H; Kouvalchouk, J F

    1997-01-01

    The authors report 4 new cases of retrosternal dislocation of the clavicle operated by capsular and ligament restoration, and temporary stabilization by anterior plating. The 4 patients were men with a mean age of 17.5 years. The lesion was caused by a sports injury (football, rugby) in 3 out of 4 cases and was related to an indirect mechanism. Clinical examination allowed the diagnosis, was related to based on painful palpation of a dip over the joint, supported by radiology and computed tomography. CT did not reveal the epiphyseal separation present in two cases. Complications were frequent: 1 case of tracheal compression, 2 cases of temporary paresthesia of the upper limb, 2 cases of venous compression with one case of subclavian and medial jugularis venous thrombosis, 1 hemopneumothorax. Surgical reduction was performed in all 4 cases after 2 failures of attempted orthopedic treatment under general anesthesia. All patients recovered a full range of movement, a painless shoulder and no recurrence has been observed. All complications resolved after reduction. Venous thrombosis responded favourably after 6 months of anticoagulant therapy. One plate breakage was observed with no clinical implications. On the basis of an extensive review of the literature, the authors discuss the epidemiology, pathology and the importance of associated injuries, which are frequent and sometimes serious, justifying urgent reduction. Computed tomography is the most useful radiologic modality, both for diagnosis and for investigation of complications. Orthopedic treatment must be attempted first (especially in children) according to a well systematized technique. One third of attempts fail, and cases of delayed diagnosis and serious vascular complications, then require surgical treatment. The costoclavicular ligament is repaired either by Burrows's ligamentoplasty or by bone suture; the clavicle is stabilized by bone suture or by anterior plating. The authors do not advocate either

  20. Vitamin B12 screening in metformin-treated diabetics in primary care: were elderly patients less likely to be tested?

    Science.gov (United States)

    Fogelman, Yacov; Kitai, Eliezer; Blumberg, Gari; Golan-Cohen, Avivit; Rapoport, Micha; Carmeli, Eli

    2017-04-01

    Low serum B12 level is a common occurrence in patients with type 2 diabetes (T2DM) treated with metformin. There is lack of evidence concerning blood testing of vitamin B12 and current clinical guidelines make no recommendations on the detection or prevention of vitamin B-12 deficiency during metformin treatment. Our objective was to examine the current practice and clinical determinants of vitamin B12 testing in metformin treated T2DM patients. Data were collected from health maintenance organization patients, and consisted of T2DM patients who were newly prescribed metformin from 2008 to 2013. Patients were randomly divided into two subgroups: referred for a vitamin B12 blood test, and did not receive a referral. The demographic data and medical characteristics were analyzed. 5131 patients began taking metformin during the study period. Of these 2332 (44.5 %) had vitamin B12 tested. Significant differences were found between the groups in regard to glycosylated hemoglobin, low density lipoprotein, systolic blood pressure, dyslipidemia, chronic renal failure, and disease duration. A significant positive association (p vitamin B12 testing and insulin treatment, retinopathy, neuropathy and hypertension. Vitamin B12 in elderly (>75 years) patients was significantly lower (p vitamin B12 testing. T2DM patients 75 years and above were less likely to be tested for B12 deficiency.

  1. Primary cutaneous sweat gland carcinoma

    OpenAIRE

    Xiao-Xia Wang; Hai-Yan Wang; Jun-Nian Zheng; Jian-Chao Sui

    2014-01-01

    Primary cutaneous sweat gland carcinoma is a rare neoplasm of malignant sweat gland lesions. It is characterized clinically with non-symptomatic, slow-growing nodules. We report the case of a patient with cutaneous sweat gland carcinoma with local recurrence and metastasis to the lung that was treated with surgical resection therapy and chemotherapy. The initial neoplasm was excised but biopsy was not performed. The tumor then recurred 7 years later, was re-excised, biopsy was performed, and ...

  2. Treating primary insomnia: clinical effectiveness and predictors of outcomes on sleep, daytime function and health-related quality of life.

    Science.gov (United States)

    Van Houdenhove, L; Buyse, B; Gabriëls, L; Van den Bergh, O

    2011-09-01

    Primary insomnia, as defined by DSM-IV-TR, refers to a persistent sleep disturbance which is not connected to a current psychiatric or physical condition, but significantly impairs social and occupational functioning. This study explored the impact of Cognitive Behavioral Therapy for Insomnia (CBT-i) on sleep, daytime functioning and health-related quality of life (HRQoL). Next, we investigated which factors predicted positive treatment outcome by examining demographics, insomnia characteristics, baseline levels of daytime function, HRQoL, sleep-disruptive beliefs and psychological health on post-treatment sleep quality, daytime function and HRQoL. 138 consecutive primary insomnia patients completed questionnaires pre- and post-treatment and at 6 months follow-up. After CBT-i, robust clinical improvements were observed in sleep, daytime function and HRQoL, regardless of age, gender, type or duration of the complaint. Patients with pre-treatment severe insomnia, pronounced daytime impairment and low psychological well-being benefited most.

  3. [Amebiasis. Surgical treatment in 1989].

    Science.gov (United States)

    Sigler Morales, L; Mier y Díaz, J; Melgoza Ortiz, C; Blanco Benavides, R; Medina González, E

    1989-01-01

    Even when the number of patients with invasive amebiasis has decreased, the internist and surgeon must be alert in case that the patient requires an operation. Amebic liver abscess is treated medically; percutaneous evacuation is rarely used and surgical drainage is made when there is not response to medical treatment or there is high risk of abscess rupture. Operation is mandatory when the abscess has ruptured to the abdominal cavity or through the pericardial sac. In fulminant colitis it is necessary to resect the diseased portion of the colon without primary anastomoses. Amebic apendicitis is difficult to diagnosis before an operation. It may be suspected in cases of apendicitis if the cecal wall is inflammed. Colon ameboma requires medical treatment except if it is associated with necrosis or perforation. In a four year period (1985-1988) 294 patients with diagnosis of invasive amebiasis were admitted to three hospitals of the Instituto Mexicano del Seguro Social in Mexico City. 218 had hepatic abscess, 45 required surgical drainage with four deaths (9%) and four not operated patients died. In this series only four patients had their abscess drained percutaneously. 31 patients with amebic colitis were treated; three required colonic resection with one death. Ameboma was seen in five patients and there were 11 cases of amebic apendicitis. No deaths occurred in these last two groups.

  4. Mindfulness-based cognitive therapy (MBCT) is cost-effective compared to a wait-list control for persistent pain in women treated for primary breast cancer

    DEFF Research Database (Denmark)

    Johannsen, M.; Sørensen, J.; O'Connor, M.

    2017-01-01

    Objective: To investigate the cost-effectiveness of mindfulness-based cognitive therapy (MBCT) compared to a wait-list control group for pain in women treated for breast cancer. Methods: A total of 129 women were randomly allocated to MBCT or a wait-list control group. The primary outcome...... assumed. Conclusions: Our results suggest that MBCT is a cost-effective pain intervention for women treated for breast cancer. Future studies could include utility measures, indirect costs, and active control groups to increase the generalizability and pragmatic value of the results....... group (N:14/48; 29.2%) achieved an MCID in pain intensity (OR=2.71, P =.03). The MBCT was cost-effective with a probability of 85% with a value of an additional women achieving MCID set to zero remained cost-effective with a probability of 70% to 82% when smaller effect and higher MBCT costs were...

  5. Interstitial cystitis associated with primary Sjögren's syndrome successfully treated with a combination of tacrolimus and corticosteroid: A case report and literature review.

    Science.gov (United States)

    Ueda, Yo; Tomoe, Hikaru; Takahashi, Hiroyuki; Takahashi, Yuko; Yamashita, Hiroyuki; Kaneko, Hiroshi; Kano, Toshikazu; Mimori, Akio

    2016-01-01

    We report a case of interstitial cystitis (IC) associated with primary Sjögren's syndrome (SS) successfully controlled with combination therapy of tacrolimus and a corticosteroid. In 2011, a 69-year-old female, who had been diagnosed with primary SS 23 years ago, developed IC and was successfully treated with tacrolimus and prednisolone combination therapy. The mechanism of IC, including the involved autoimmunity, has not been elucidated. Clinical observation studies suggest a potential association between SS and IC. However, IC is currently thought to be underdiagnosed in patients with SS as well as in the general population. Based on our case and others reported previously, IC associated with SS responds well to immunosuppressive therapy. In particular, a combination of a calcineurin inhibitor (tacrolimus or cyclosporine) with a corticosteroid seems to be highly effective. The possibility of IC in patients with SS complaining of lower urinary tract symptoms without features of infection or other identifiable causes should be given attention.

  6. Primary Tumor Characteristics Are Important Prognostic Factors for Sorafenib-Treated Patients with Metastatic Renal Cell Carcinoma: A Retrospective Multicenter Study

    Directory of Open Access Journals (Sweden)

    Sung Han Kim

    2017-01-01

    Full Text Available We aimed to identify prognostic factors associated with progression-free survival (PFS and overall survival (OS in metastatic renal cell carcinoma (mRCC patients treated with sorafenib. We investigated 177 patients, including 116 who received sorafenib as first-line therapy, using the Cox regression model. During a median follow-up period of 19.2 months, the PFS and OS were 6.4 and 32.6 months among all patients and 7.4 months and undetermined for first-line sorafenib-treated patients, respectively. Clinical T3-4 stage (hazard ratio [HR] 2.56 and a primary tumor size >7 cm (HR 0.34 were significant prognostic factors for PFS among all patients, as were tumor size >7 cm (HR 0.12, collecting system invasion (HR 5.67, and tumor necrosis (HR 4.11 for OS (p<0.05. In first-line sorafenib-treated patients, ≥4 metastatic lesions (HR 28.57, clinical T3-4 stage (HR 4.34, collecting system invasion (univariate analysis HR 2.11; multivariate analysis HR 0.07, lymphovascular invasion (HR 13.35, and tumor necrosis (HR 6.69 were significant prognosticators of PFS, as were bone metastasis (HR 5.49 and clinical T3-4 stages (HR 4.1 for OS (p<0.05. Our study thus identified a number of primary tumor-related characteristics as important prognostic factors in sorafenib-treated mRCC patients.

  7. Recent surgical options for vestibular vertigo

    Science.gov (United States)

    Volkenstein, Stefan; Dazert, Stefan

    2017-01-01

    Vertigo is not a well-defined disease but a symptom that can occur in heterogeneous entities diagnosed and treated mainly by otolaryngologists, neurologists, internal medicine, and primary care physicians. Most vertigo syndromes have a good prognosis and management is predominantly conservative, whereas the need for surgical therapy is rare, but for a subset of patients often the only remaining option. In this paper, we describe and discuss different surgical therapy options for hydropic inner ear diseases, Menière’s disease, dehiscence syndromes, perilymph fistulas, and benign paroxysmal positional vertigo. At the end, we shortly introduce the most recent developments in regard to vestibular implants. Surgical therapy is still indicated for vestibular disease in selected patients nowadays when conservative options did not reduce symptoms and patients are still suffering. Success depends on the correct diagnosis and choosing among different procedures the ones going along with an adequate patient selection. With regard to the invasiveness and the possible risks due to surgery, in depth individual counseling is absolutely necessary. Ablative and destructive surgical procedures usually achieve a successful vertigo control, but are associated with a high risk for hearing loss. Therefore, residual hearing has to be included in the decision making process for surgical therapy. PMID:29279721

  8. [Subclinical hypothyroidism : should we still treat elderly patients? Clinical implications of a new trial in primary care].

    Science.gov (United States)

    Collet, Tinh-Hai; Sykiotis, Gerasimos P; Aubert, Carole E; Baumgartner, Christine; Blum, Manuel R; Feller, Martin; Stettler, Christoph; Rodondi, Nicolas

    2018-02-28

    Subclinical hypothyroidism, defined as an elevated level of thyrotropin hormone (TSH) and normal thyroxin, is more frequent in women and above 65 years old. This condition is associated with an increased cardiovascular risk, in particular with TSH > 10,0 mIU/L. Although overt hypothyroidism is rare (prevalence of 0,3 %), levothyroxine has become the most prescribed medication in the US, while its indications are still debated. The European-funded TRUST trial showed no improvement in Hypothyroid Symptoms and Tiredness scores among patients ≥ 65 years with subclinical hypothyroidism treated with levothyroxine, and no improvement in blood pressure, weight, muscle strength and cognition. The results of this study call for a revision of the current international recommendations on the treatment of subclinical hypothyroidism.

  9. Data on Na,K-ATPase in primary cultures of renal proximal tubule cells treated with catecholamines

    Directory of Open Access Journals (Sweden)

    Mary Taub

    2016-03-01

    Full Text Available This data article is concerned with chronic regulation of Na,K-ATPase by catecholamines. After a chronic treatment, inhibition of Na,K-ATPase activity was observed in cultures with dopamine, while a stimulation was observed in cultures treated with norepinephrine. Following a chronic incubation with guanabenz, an α adrenergic agonist, an increase in Na,K-ATPase α and β subunit mRNAs was observed. This data supports the research article entitled, “Renal proximal tubule Na, K-ATPase is controlled by CREB regulated transcriptional coactivators as well as salt inducible kinase 1” (Taub et al. 2015 [1]. Keywords: Catecholamines, Kidney, Proximal tubule, Na,K-ATPase, Chronic

  10. [Comparative study on Chinese medical syndrome typing and treatment combined different surgical methods for treating clomiphene-resistant polycystic ovary syndrome].

    Science.gov (United States)

    Zeng, Lei; Zeng, Cheng; Tao, Li-Li

    2012-11-01

    To observe the therapeutic efficacy of Chinese medical syndrome typing and treatment combined cold needle puncture drainage operation or unipolar electrocoagulation drilling technique under laparoscope for treating clomiphene-resistant polycystic ovary syndrome (PCOS). Forty infertility patients with clomiphene-resistant PCOS were assigned to two groups using stratified random sampling method according to age, infertility time, and body mass index, 20 in each group. Patients in Group A were treated with Chinese medical syndrome typing and treatment combined cold needle puncture drainage operation, while those in Group B were treated with Chinese medical syndrome typing and treatment combined unipolar electrocoagulation drilling technique. After operation Chinese herbal treatment was administered to all patients according to syndrome typing. The serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), androgen (T), estradiol (E2), and prolactin (PRL) were determined before and after operation. The ovulation was monitored. The pregnancy rate and the pregnancy outcomes were recorded after operation. There was no statistical difference in the 3-month spontaneous ovulation rate or the 1-year pregnancy rate (P > 0.05). The levels of LH, T, and PRL were significantly lower after operation than before operation in the two groups (P typing and treatment combined cold needle puncture drainage operation or unipolar electrocoagulation drilling technique could effectively promote the ovulation. The two methods showed similar therapeutic effects.

  11. Risk factors associated with gastroesophageal reflux disease relapse in primary care patients successfully treated with a proton pump inhibitor.

    Science.gov (United States)

    López-Colombo, A; Pacio-Quiterio, M S; Jesús-Mejenes, L Y; Rodríguez-Aguilar, J E G; López-Guevara, M; Montiel-Jarquín, A J; López-Alvarenga, J C; Morales-Hernández, E R; Ortiz-Juárez, V R; Ávila-Jiménez, L

    There are no studies on the factors associated with gastroesophageal reflux disease (GERD) relapse in primary care patients. To identify the risk factors associated with GERD relapse in primary care patients that responded adequately to short-term treatment with a proton pump inhibitor. A cohort study was conducted that included GERD incident cases. The patients received treatment with omeprazole for 4 weeks. The ReQuest questionnaire and a risk factor questionnaire were applied. The therapeutic success rate and relapse rate were determined at 4 and 12 weeks after treatment suspension. A logistic regression analysis of the possible risk factors for GERD relapse was carried out. Of the 83 patient total, 74 (89.16%) responded to treatment. Symptoms recurred in 36 patients (48.64%) at 4 weeks and in 13 patients (17.57%) at 12 weeks, with an overall relapse rate of 66.21%. The OR multivariate analysis (95% CI) showed the increases in the possibility of GERD relapse for the following factors at 12 weeks after treatment suspension: basic educational level or lower, 24.95 (1.92-323.79); overweight, 1.76 (0.22-13.64); obesity, 0.25 (0.01-3.46); smoking, 0.51 (0.06-3.88); and the consumption of 4-12 cups of coffee per month, 1.00 (0.12-7.84); citrus fruits, 14.76 (1.90-114.57); NSAIDs, 27.77 (1.12-686.11); chocolate, 0.86 (0.18-4.06); ASA 1.63 (0.12-21.63); carbonated beverages, 4.24 (0.32-55.05); spicy food 7-16 times/month, 1.39 (0.17-11.17); and spicy food ≥ 20 times/month, 4.06 (0.47-34.59). The relapse rate after short-term treatment with omeprazole was high. The consumption of citrus fruits and NSAIDs increased the possibility of GERD relapse. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  12. The Primary Results of the Treating Adult Smokers at Risk for Weight Gain with Interactive Technology (TARGIT) Study.

    Science.gov (United States)

    Johnson, Karen C; Thomas, Fridtjof; Richey, Phyllis; Tran, Quynh T; Tylavsky, Fran; Miro, Danielle; Coday, Mace

    2017-10-01

    To evaluate whether a behavioral weight management program combined with a smoking cessation program delivered via interactive technology could prevent postcessation weight gain. Three hundred and thirty young adult smokers, age 18 to 35 years, were randomized to a smoking cessation program alone (comparison group), which included behavioral counseling and nicotine replacement, or to a behavioral weight management program adapted from the Look AHEAD trial plus the same smoking cessation program (intervention group). The Treating Adult Smokers at Risk for Weight Gain with Interactive Technology study randomized 164 participants to the comparison group and 166 participants to the intervention group. On average, the participants gained 0.91 kg after 24 months in the trial (comparison group + 1.45 kg and intervention group + 0.32; P = 0.157). The only variable systematically affecting weight change over time was smoking abstinence, in which those who were abstinent, on average, gained 0.14 kg more per month compared with those who continued to smoke (P technology was not associated with greater long-term weight gain prevention. © 2017 The Obesity Society.

  13. [A Case of Locally-Advanced Breast Cancer with Liver Metastasis, Treated with Mastectomy of the Primary Tumor after Chemotherapy].

    Science.gov (United States)

    Kanada, Yoko; Matsuzaki, Hiroshi; Kobayashi, Hiroshi; Suzuki, Keisuke; Sawada, Hisato; Senba, Yoshihide; Yoshioka, Takafumi; Note, Hiromasa; Sato, Yayoi; Miyazaki, Akinari; Natsume, Toshiyuki; Tanaka, Hajime; Maruyama, Takashi

    2015-11-01

    The patient was a 39-year-old woman who was referred to our hospital with suspicion of locally-advanced breast cancer. After several tests, she received a diagnosis of cT4bN1M1 (liver), Stage Ⅳbreast cancer. The liver metastasis was located in S4, and was 1 cm in size. Core needle biopsy was performed on the breast tumor; the pathological diagnosis was invasive ductal carcinoma (scirrhous carcinoma), nuclear Grade (NG) 3, and HER2-positive. She received epirubicin plus cyclophosphamide (EC) followed by docetaxel (DOC) plus pertuzumab (PER) plus trastuzumab (HER). After chemotherapy, the liver metastasis and axillary lymph node metastases had disappeared on imaging findings, showing a complete response (CR), but the primary breast tumor remained, showing a partial response (PR). She underwent mastectomy and axillary lymph node dissection for local control. After surgery, no metastases including liver metastases were seen on CT. The patient is currently receiving tamoxifen and anti-HER2 therapy.

  14. [VIPoma: surgical treatment].

    Science.gov (United States)

    Procacciante, F; Picozzi, P; Fantini, A; Pacifici, M; Di Nardo, A; Ribotta, G; Delle Fave, G; Catani, M; Ruggeri, S; Romeo, F

    1992-02-01

    This paper reports a case of pancreatic VIPoma with widespread hepatic metastasis which was treated for approximately 2 years with a synthetic somatostatin analog (SMS 201/995). The treatment of choice in cases in which the tumour was fully removable is surgical resection. This occurred rarely since approximately 80% of VIPomas are malignant and are operated late when local infiltration is already widespread; in addition, 50% of cases are already metastasised at diagnosis. In this case, due to the infiltration of the superior mesenteric artery by the primary tumour it was necessary to carry out a left pancreasectomy which included two-thirds of the neoplastic mass. This was justified by slow tumour growth and also facilitated control of diarrhea and ensured a greater efficacy of possible postoperative chemotherapy. The use of synthetic somatostatin analog (SMS 201/995) enabled diarrhea to be satisfactorily controlled and is therefore specifically indicated for this type of tumour. NSE serum assay (neuron specific enolase) allowed the evolution of disease to be monitored during follow-up.

  15. Comorbid Moderate-Severe Depressive Symptoms and their Association with Quality of Life in Chinese Patients with Schizophrenia Treated in Primary Care.

    Science.gov (United States)

    Hou, Cai-Lan; Ma, Xin-Rong; Cai, Mei-Ying; Li, Yan; Zang, Yu; Jia, Fu-Jun; Lin, Yong-Qiang; Chiu, Helen F K; Ungvari, Gabor S; Hall, Brian J; Zhong, Bao-Liang; Cao, Xiao-Lan; Xiang, Yu-Tao

    2016-11-01

    This study described the prevalence and correlates of comorbid moderate-severe depressive symptoms (comorbid depression thereafter) and their association with quality of life (QOL) in schizophrenia patients treated in primary care. 623 schizophrenia patients were enrolled. Patients' socio-demographic and clinical characteristics including comorbid depression [defined as a total score of 18 or above on the Montgomery-Asberg Depression Rating Scale (MADRS)] were recorded. Depressive symptoms (defined as a total score of 9 or above on the MADRS) were present in 54.1 % of patients, while 17.7 % had comorbid depression. Analysis of covariance revealed that comorbid depression was significantly associated with lower mental QOL. Multiple logistic regression analysis revealed that more severe positive and negative symptoms, anxiety symptoms, use of first-generation antipsychotics and antidepressants, were independently associated with comorbid depression. Given the negative association between comorbid depression and QOL, attempts to address comorbid depression in schizophrenia patients treated in primary care should be made.

  16. Impact of primary para-aortic lymphadenectomy on distant failure in locally advanced cervical cancer patients treated in the era of image-guided adaptive brachytherapy.

    Science.gov (United States)

    Chargari, Cyrus; Mazeron, Renaud; Dunant, Ariane; Gouy, Sébastien; Petit, Claire; Maroun, Pierre; Uzan, Catherine; Annede, Pierre; Bentivegna, Enrica; Balleyguier, Corinne; Genestie, Catherine; Pautier, Patricia; Leary, Alexandra; Lhomme, Catherine; Deutsch, Eric; Morice, Philippe; Haie-Meder, Christine

    2016-12-01

    To investigate the impact of a primary para-aortic lymphadenectomy (PAL) in locally advanced cervical cancer patients receiving definitive chemoradiation, we reviewed the clinical records of consecutive patients treated in our Institution and receiving an external beam irradiation followed with an image-guided adaptive brachytherapy for a locally advanced cervical cancer. We examined the impact of performing a primary PAL as part of primary staging for guiding irradiation fields in patients without extra-pelvic PET uptake. The outcome of patients presenting para-aortic lymph node uptake (PALNU) was also examined. 186 patients were identified. Median follow-up was 44.4 months. Patients receiving a primary PAL (PAL group) and those who received upfront pelvic chemoradiation (no-PAL group) did not significantly differ for loco-regional failures. Survival without distant failure (DFFS), including para-aortic relapses, was at 3 years 87 % (95 % CI 84-90 %) in PAL group, 67 % (95 % CI 59-85 %) in the no-PAL group and 44 % (95 % CI 32-66 %) in the PALNU group (p = 0.04 for comparison between PAL and no-PAL groups). In a multivariate model including para-aortic lymphadenectomy, pelvic nodal uptake and high-risk clinical target volume as adjustment variables, a para-aortic lymphadenectomy was significant for DFS (HR = 0.47, 95 % CI 0.26-0.84, p = 0.01). Although confounding factors could account for these retrospective results, a primary PAL with tailored irradiation fields based on para-aortic histological findings seems to be associated with a better control for distant metastases. A randomized trial is testing the benefit of this strategy.

  17. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients

    Directory of Open Access Journals (Sweden)

    Vochteloo Anne JH

    2011-11-01

    Full Text Available Abstract Background Anemia is more often seen in older patients. As the mean age of hip fracture patients is rising, anemia is common in this population. Allogeneic blood transfusion (ABT and anemia have been pointed out as possible risk factors for poorer outcome in hip fracture patients. Methods In the timeframe 2005-2010, 1262 admissions for surgical treatment of a hip fracture in patients aged 65 years and older were recorded. Registration was prospective from 2008 on. Anemic and non-anemic patients (based on hemoglobin level at admission were compared regarding clinical characteristics, mortality, delirium incidence, LOS, discharge to a nursing home and the 90-day readmission rate. Receiving an ABT, age, gender, ASA classification, type of fracture and anesthesia were used as possible confounders in multivariable regression analysis. Results The prevalence of anemia and the rate of ABT both were 42.5%. Anemic patients were more likely to be older and men and had more often a trochanteric fracture, a higher ASA score and received more often an ABT. In univariate analysis, the 3- and 12-month mortality rate, delirium incidence and discharge to a nursing home rate were significantly worse in preoperatively anemic patients. In multivariable regression analysis, anemia at admission was a significant risk factor for discharge to a nursing home and readmission Conclusions This study has demonstrated that anemia at admission and postoperative anemia needing an ABT (PANT were independent risk factors for worse outcome in hip fracture patients. In multivariable regression analysis, anemia as such had no effect on mortality, due to a rescue effect of PANT. In-hospital, 3- and 12-month mortality was negatively affected by PANT, with the main effect in the first 3 months postoperatively.

  18. Sino-orbital osteoma: a clinicopathologic study of 45 surgically treated cases with emphasis on tumors with osteoblastoma-like features.

    Science.gov (United States)

    McHugh, Jonathan B; Mukherji, Suresh K; Lucas, David R

    2009-10-01

    Osteomas are limited almost exclusively to craniofacial and jaw bones. Histologically, they can be divided into ivory, mature, or mixed types. Osteomas may have osteoblastoma-like areas and distinguishing it from true osteoblastoma can be challenging. Some believe osteomas with osteoblastoma-like features behave more aggressively. To perform a clinicopathologic comparison of sino-orbital osteomas both with and without osteoblastoma-like features. We studied 45 surgically excised sino-orbital osteomas. Tumors were categorized as ivory, mature, or mixed type and presence of osteoblastoma-like areas and Paget-like bone were noted. Clinical features of those with and without osteoblastoma-like areas were compared. Men outnumbered women (3:2); median age was 37 years. Frontal sinus was the most common location (62%) followed by ethmoid and maxillary sinuses. Twelve tumors (27%) involved the orbit, 2 primarily and 10 secondarily. All cases were symptomatic with headache, sinusitis, visual changes, pain, and proptosis being most common. Seventeen tumors (38%) had osteoblastoma-like areas. Extension into an adjacent sinus/anatomic compartment was more common in osteoblastoma-like tumors (47% versus 29%), including more frequent orbital involvement (41% versus 13%). Visual changes were more frequent in the osteoblastoma-like group. Distribution of histologic subtypes and Paget-like bone were similar between the 2 groups. Osteomas with osteoblastoma-like features were more often incompletely excised (25% versus 14%). However, clinical recurrence was less common (8% versus 27%). Osteoblastoma-like features are common in sino-orbital osteomas, but it does not correlate with more adverse clinical features or worse outcome. Osteoblastoma-like areas appear to represent active remodeling within an osteoma rather than defining a distinct clinicopathologic entity. Distinguishing it from osteoblastoma may require careful histologic evaluation and radiographic correlation.

  19. Cytoplasmic Hu-Antigen R (HuR) Expression is Associated with Poor Survival in Patients with Surgically Resected Cholangiocarcinoma Treated with Adjuvant Gemcitabine-Based Chemotherapy.

    Science.gov (United States)

    Toyota, Kazuhiro; Murakami, Yoshiaki; Kondo, Naru; Uemura, Kenichiro; Nakagawa, Naoya; Takahashi, Shinya; Sueda, Taijiro

    2018-05-01

    Hu-antigen R (HuR) is an RNA-binding protein that regulates the stability, translation, and nucleus-to-cytoplasm translocation of messenger RNAs (mRNAs). The aim of this study was to investigate the prognostic significance of HuR in cholangiocarcinoma patients who received adjuvant gemcitabine-based chemotherapy (AGC) after surgical resection. Nuclear and cytoplasmic HuR expression was investigated immunohistochemically in 131 patients with resected cholangiocarcinoma, including 91 patients administered AGC and 40 patients who did not receive adjuvant chemotherapy. The correlation between HuR expression and survival was evaluated by statistical analysis. High nuclear and cytoplasmic HuR expression was observed in 67 (51%) and 45 (34%) patients, respectively. Cytoplasmic HuR expression was significantly associated with lymph node metastasis (p < 0.01), while high cytoplasmic HuR expression was significantly associated with poor disease-free survival [DFS] (p = 0.03) and overall survival [OS] (p = 0.001) in the 91 patients who received AGC, but not in the 40 patients who did not receive AGC (DFS p = 0.17; OS p = 0.07). In the multivariate analysis of patients who received AGC, high cytoplasmic HuR expression was an independent predictor of poor DFS (hazard ratio [HR] 1.77; p = 0.04) and OS (HR 2.09; p = 0.02). Nuclear HuR expression did not affect the survival of enrolled patients. High cytoplasmic HuR expression was closely associated with the efficacy of AGC in patients with cholangiocarcinoma. The current findings warrant further investigations to optimize adjuvant chemotherapy regimens for resectable cholangiocarcinoma.

  20. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Wang D

    2013-03-01

    Full Text Available Dan Wang, Jia-Xin Yang, Dong-Yan Cao, Xi-Run Wan, Feng-Zhi Feng, Hui-Fang Huang, Keng Shen, Yang Xiang Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China Background: The purpose of this study was to evaluate the relationship between preoperative inflammatory markers (neutrophil-lymphocyte ratio and platelet-lymphocyte ratio and cervical stromal involvement in patients with endometrioid adenocarcinoma. Methods: We studied 318 patients with endometrioid adenocarcinoma who underwent comprehensive surgical staging. We used univariate and multivariate analyses of cervical stromal involvement and receiver-operating curves to calculate optimal cutoff values for neutrophil-lymphocyte and platelet-lymphocyte ratios to predict cervical stromal involvement. Results: The presence of cervical stromal involvement was associated with neutrophil-lymphocyte ratio and platelet-lymphocyte ratio (P = 0.009 and P = 0.031, respectively. Multivariate analysis showed that higher neutrophil-lymphocyte and platelet-lymphocyte ratios independently predicted cervical stromal involvement (odds ratio 3.10, 95% confidence interval 1.10–8.76, P = 0.032, and odds ratio 5.27, 95% confidence interval 1.94–14.35, P = 0.001, respectively. At a threshold of 2.01, the neutrophil-lymphocyte ratio was 71.0% sensitive and 63.8% specific for stromal involvement; at a 172.24 threshold, the platelet-lymphocyte ratio was 48.4% sensitive and 88.9% specific. Conclusion: Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios can help identify the risk of cervical stromal involvement in patients with endometrial cancer. Evaluating these ratios may help select patients who should be particularly watched and tested for cervical stromal involvement. Keywords: neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, endometrioid adenocarcinoma

  1. Treating postnatal depressive symptoms in primary care: a randomised controlled trial of GP management, with and without adjunctive counselling

    Directory of Open Access Journals (Sweden)

    Leigh Bronwyn

    2011-05-01

    Full Text Available Abstract Background Postnatal depression (PND is under-diagnosed and most women do not access effective help. We aimed to evaluate comparative management of (PND following screening with the Edinburgh Postnatal Depression Scale, using three best-practice care pathways by comparing management by general practitioners (GPs alone compared to adjunctive counselling, based on cognitive behavioural therapy (CBT, delivered by postnatal nurses or psychologists. Methods This was a parallel, three-group randomised controlled trial conducted in a primary care setting (general practices and maternal & child health centres and a psychology clinic. A total of 3,531 postnatal women were screened for symptoms of depression; 333 scored above cut-off on the screening tool and 169 were referred to the study. Sixty-eight of these women were randomised between the three treatment groups. Results Mean scores on the Beck Depression Inventory (BDI-II at entry were in the moderate-to-severe range. There was significant variation in the post-study frequency of scores exceeding the threshold indicative of mild-to-severe depressive symptoms, such that more women receiving only GP management remained above the cut-off score after treatment (p = .028. However, all three treatment conditions were accompanied by significant reductions in depressive symptoms and mean post-study BDI-II scores were similar between groups. Compliance was high in all three groups. Women rated the treatments as highly effective. Rates of both referral to the study (51%, and subsequent treatment uptake (40% were low. Conclusions Data from this small study suggest that GP management of PND when augmented by a CBT-counselling package may be successful in reducing depressive symptoms in more patients compared to GP management alone. The relatively low rates of referral and treatment uptake, suggest that help-seeking remains an issue for many women with PND, consistent with previous research. Trial

  2. Prevalence and costs of treating uncomplicated stage 1 hypertension in primary care: a cross-sectional analysis.

    Science.gov (United States)

    Sheppard, James P; Fletcher, Kate; McManus, Richard J; Mant, Jonathan

    2014-10-01

    Treatment for uncomplicated stage 1 hypertension is recommended in most international guidelines but there is little evidence to indicate that therapy is beneficial. To estimate the prevalence of this condition in an untreated population and the potential costs of initiating therapy in such patients. Cross-sectional study of anonymised patient records in 19 general practices in the West Midlands, UK. Data relating to patient demographics, existing cardiovascular disease (CVD), and risk factors (blood pressure and cholesterol) were extracted from patient records. Patients with a blood pressure of 140/90-159/99 mmHg, no CVD, and hypertension. Missing data were imputed. The prevalence of untreated, uncomplicated stage 1 hypertension was estimated using descriptive statistics and extrapolated using national data. The cost of achieving blood pressure control in this population was examined in a cost-impact analysis using published costs from previous studies. Of the 34 975 patients (aged 40-74 years) in this study, untreated, uncomplicated stage 1 hypertension was present in 2867 individuals (8.2%, 95% confidence interval [CI] = 7.9 to 8.5). This is equivalent to 1 892 519 patients in England and Wales, for whom the additional cost of controlling blood pressure, according to guidelines, was estimated at £106-229 million per annum, depending on the health professional delivering care. Untreated, uncomplicated stage 1 hypertension is relatively common, affecting 1 in 12 patients aged 40-74 years in primary care. Current international guidelines and pay-for-performance targets, if followed, will incur significant costs for a patient benefit that is debatable. © British Journal of General Practice 2014.

  3. Effect of PS-K on long-term survival of primary lung cancer patients treated with radiation

    International Nuclear Information System (INIS)

    Okazaki, Atsushi; Nakajima, Nobuaki; Hayakawa, Kazushige; Saito, Yoshihiro; Mitomo, Osamu; Niibe, Hideo

    1984-01-01

    The effect of PS-K on long-term survival of primary lung cancer patients irradiated over 60 Gy through 1977 to 1982 was studied. PS-K was administrated orally 3.0 g, daily or intermittently in the pattern of 2 weeks per a month on patients of positive PPD skin test. All cases irradiated over 60 Gy were 174 (Group A) containing 62 cases with PS-K (Group B) and 112 cases without PS-K (Group C). Of group B, 44 cases were administrated within a month after curative irradiation (Group B1), 7 cases were administrated on time maintaining long-term good condition after irradiation (Group B2) and 11 cases were administrated after recognition of recurrence or metastasis (Group B3). Following results were obtained. 1. Obvious prolongation of survivals was recognized in the patients with PS-K after irradiation. (1) The cumulative 5 years survival rates of Group A, B 1 and C were 11.0%, 28.8% and 4.8%, respectively. (2) The cumulative 5 years survival rates of stage I,11 were 45.7% with PS-K and 10.7% without PS-K. (3) The cumulative 5 years survival rates of 21 cases matched age, sex, stage, histological type and tumor dose with and without PS-K were 37.8% and 7.2%. (4) In Group B 2, 5 cases out of 7 cases have been alived, but in Group B 3, satisfactory long-term survivals ware not obtained. 2. The necessary conditions which obtain long-term survival with PS-K were thought to be follows. One is that the tumor is brought almost to vanish by irradiation. Another is that the condition of host is superior to that of tumor in host-tumor relationship. 3. The possibility of intermittent administratio