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.

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.

Congenital Double Lip: A Rare Deformity Treated Surgically

Science.gov (United States)

Aggarwal, Titiksha; Chawla, Kirti; Lamba, Arundeep Kaur; Faraz, Farukh; Tandon, Shruti

2016-01-01

Lip is an important aspect of facial features affecting ones personality. A deformity of the lip characterized by excessive tissue sagging below the usual giving it thicker wider appearance is referred to as double lip. It is a rare occurrence with a proposed male predilection. This article is a report of a 20 years old male with this deformity who presented with the complaint of difficult speech and poor aesthetics. There was no other history patient being systemically healthy. It was successively treated with a simple surgical technique without recurrence over a period of 12 months. PMID:27853696

Surgical treatment of acromioclavicular dislocation using the endobutton.

Science.gov (United States)

Teodoro, Renato Loureiro; Nishimi, Alexandre Yukio; Pascarelli, Luciano; Bongiovanni, Roberto Rangel; Velasco, Marcelo Andreotti Perez; Dobashi, Eiffel Tsuyoshi

2017-01-01

To evaluate the clinical and radiographic results of 23 patients diagnosed with acute type III acromioclavicular dislocation treated with the Endobutton. Twenty-three patients with a diagnosis of type III acromioclavicular dislocation were treated surgically. Twenty-one patients were male (91.3%) and 2 (8.7%) were female. The dominant side was affected in 15 patients (65.21%) and the non-dominant side in 8 patients (34.79%). All patients were operated on by the same surgical team within 4 weeks of the trauma. According to the UCLA score, 14 patients (60.86%) presented excellent results, 7 patients (30.43%) had good results and 2 patients (8.69%) had regular results. The technique was effective in treating acute type III dislocations with a high degree of patient satisfaction. Level of Evidence IV, Case Series.

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.

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)

[Hiatal hernias: why and how should they be surgically treated].

Science.gov (United States)

Braghetto, Italo; Csendes, Attila; Korn, Owen; Musleh, Maher; Lanzarini, Enrique; Saure, Alex; Hananias, Baydir; Valladares, Héctor

2013-01-01

There is controversy in the literature about the choice of expectant medical treatment versus surgical treatment of hiatal hernias, depending on the presence or absence of symptoms. This study presents the results obtained by our group, considering disease duration and postoperative results. A total of 121 patients were included and divided by age, disease duration, type of hiatal hernia and postoperative outcome. In 32% of the patients younger than 70 years, symptom duration was longer than 11 years and 68% of those aged more than 71 years had long-term symptoms (p<.05). Type iv hernias (complex) and those with diameters measuring more than 16 cm were observed in the group with longer symptom duration. Complications were more frequent in the older age group, in those with longer symptom duration and in those with type iv complex hernias. There was no postoperative mortality and only one patient (0.8%) with a type iii hernia and severe oesophagitis required reoperation. We recommend that patients with hiatal hernia undergo surgery at diagnosis to avoid complications and risks. Older patients should not be excluded from surgical indication but should undergo a complete multidisciplinary evaluation to avoid complications and postoperative mortality. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

Three-dimensional imaging of acetabular dysplasia: diagnostic value and impact on surgical type classification

Energy Technology Data Exchange (ETDEWEB)

Smet, Maria-Helena E-mail: marleen.smet@uz.kuleuven.ac.be; Marchal, Guy J.; Baert, Albert L.; Hoe, Lieven van; Cleynenbreugel, Johan van; Daniels, Hans; Molenaers, Guy; Moens, Pierre; Fabry, Guy

2000-04-01

Objective: To investigate the diagnostic value and the impact on surgical type classification of three-dimensional (3D) images for pre-surgical evaluation of dysplastic hips. Materials and methods: Three children with a different surgical type of hip dysplasia were investigated with helical computed tomography. For each patient, two-dimensional (2D) images, 3D, and a stereolithographic model of the dysplastic hip were generated. In two separate sessions, 40 medical observers independently analyzed the 2D images (session 1), the 2D and 3D images (session 2), and tried to identify the corresponding stereolithographic hip model. The influence of both image presentation (2D versus 3D images) and observer (degree of experience, radiologist versus orthopedic surgeon) were statistically analyzed. The SL model choice reflected the impact on surgical type classification. Results: Image presentation was a significant factor whereas the individual observer was not. Three-dimensional images scored significantly better than 2D images (P=0.0003). Three-dimensional imaging increased the correct surgical type classification by 35%. Conclusion: Three-dimensional images significantly improve the pre-surgical diagnostic assessment and surgical type classification of dysplastic hips.

Three-dimensional imaging of acetabular dysplasia: diagnostic value and impact on surgical type classification

International Nuclear Information System (INIS)

Smet, Maria-Helena; Marchal, Guy J.; Baert, Albert L.; Hoe, Lieven van; Cleynenbreugel, Johan van; Daniels, Hans; Molenaers, Guy; Moens, Pierre; Fabry, Guy

2000-01-01

Objective: To investigate the diagnostic value and the impact on surgical type classification of three-dimensional (3D) images for pre-surgical evaluation of dysplastic hips. Materials and methods: Three children with a different surgical type of hip dysplasia were investigated with helical computed tomography. For each patient, two-dimensional (2D) images, 3D, and a stereolithographic model of the dysplastic hip were generated. In two separate sessions, 40 medical observers independently analyzed the 2D images (session 1), the 2D and 3D images (session 2), and tried to identify the corresponding stereolithographic hip model. The influence of both image presentation (2D versus 3D images) and observer (degree of experience, radiologist versus orthopedic surgeon) were statistically analyzed. The SL model choice reflected the impact on surgical type classification. Results: Image presentation was a significant factor whereas the individual observer was not. Three-dimensional images scored significantly better than 2D images (P=0.0003). Three-dimensional imaging increased the correct surgical type classification by 35%. Conclusion: Three-dimensional images significantly improve the pre-surgical diagnostic assessment and surgical type classification of dysplastic hips

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.

Surgeon and type of anesthesia predict variability in surgical procedure times.

Science.gov (United States)

Strum, D P; Sampson, A R; May, J H; Vargas, L G

2000-05-01

Variability in surgical procedure times increases the cost of healthcare delivery by increasing both the underutilization and overutilization of expensive surgical resources. To reduce variability in surgical procedure times, we must identify and study its sources. Our data set consisted of all surgeries performed over a 7-yr period at a large teaching hospital, resulting in 46,322 surgical cases. To study factors associated with variability in surgical procedure times, data mining techniques were used to segment and focus the data so that the analyses would be both technically and intellectually feasible. The data were subdivided into 40 representative segments of manageable size and variability based on headers adopted from the common procedural terminology classification. Each data segment was then analyzed using a main-effects linear model to identify and quantify specific sources of variability in surgical procedure times. The single most important source of variability in surgical procedure times was surgeon effect. Type of anesthesia, age, gender, and American Society of Anesthesiologists risk class were additional sources of variability. Intrinsic case-specific variability, unexplained by any of the preceding factors, was found to be highest for shorter surgeries relative to longer procedures. Variability in procedure times among surgeons was a multiplicative function (proportionate to time) of surgical time and total procedure time, such that as procedure times increased, variability in surgeons' surgical time increased proportionately. Surgeon-specific variability should be considered when building scheduling heuristics for longer surgeries. Results concerning variability in surgical procedure times due to factors such as type of anesthesia, age, gender, and American Society of Anesthesiologists risk class may be extrapolated to scheduling in other institutions, although specifics on individual surgeons may not. This research identifies factors associated

[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.

Comparison of Surgically Treated Large Versus Small Intestinal Volvulus (2009-2014).

Science.gov (United States)

Davis, Elizabeth; Townsend, Forrest I; Bennett, Julie W; Takacs, Joel; Bloch, Christopher P

2016-01-01

The purpose of this retrospective study was to compare the outcome for dogs with surgically treated large versus small intestinal volvulus between October 2009 and February 2014. A total of 15 dogs met the inclusion criteria and underwent an abdominal exploratory. Nine dogs were diagnosed with large intestinal volvulus during the study period, and all nine had surgical correction for large intestinal volvulus. All dogs were discharged from the hospital. Of the seven dogs available for phone follow-up (74 to 955 days postoperatively), all seven were alive and doing well. Six dogs were diagnosed with small intestinal volvulus during the study period. One of the six survived to hospital discharge. Three of the six were euthanized at the time of surgery due to an extensive amount of necrotic bowel. Of the three who were not, one died postoperatively the same day, one died 3 days later, and one dog survived for greater than 730 days. Results concluded that the outcome in dogs with surgically corrected large intestinal volvulus is excellent, compared with a poor outcome in dogs with small intestinal volvulus. The overall survival to discharge for large intestinal volvulus was 100%, versus 16% for small intestinal volvulus.

Development of a handy-type laser surgical unit

Science.gov (United States)

Abe, Yusuke; Wakamatsu, Koh; Goto, Shigeru

2005-07-01

We proposed a concept of a handy-type laser surgical unit for use in outpatient, in ward and in open-air field. To investigate the possibility of the concept, a handy-type semiconductor laser surgical unit was developed experimentally using 2-watts power laser diode with no built-in electrical cooling unit (Peltier chip) and a small rechargeable battery. The drive circuit was constructed with only current limit and ACC circuits. The laser diode was cooled with heat sink and simple fan. Laser irradiation was set to stop at 30 degree Celsius by monitoring the temperature of laser diode with thermistor temperature sensor. With this system, 1.18 watts of laser power at the end of optical fiber with both 600 and 900mm core diameter, and about 30 minutes of continuous irradiating time with Ni-Cd battery (4.8V 1,500mA/h) could be obtained with no over heating in laser diode. The result showed that the high power semiconductor laser could be driven with small battery when specially designed. In an animal experiment, small bleeding could be managed with contact irradiation method. This kind of simple laser surgical unit is considered to be useful for the management of small bleedings in clinical.

The prevalence of thyroid cancers in surgically treated patients with nodular goiter in Şırnak city

Directory of Open Access Journals (Sweden)

Sevda Sert Bektaş

2010-12-01

Full Text Available Objectives: Iodine deficiency is still considered to be the major etiological factor for endemic goiter. The pathogenesis of the goiter in iodine deficient area caries different characteristics. The aim of this study investigate the prevalence of thyroid cancers and type of thyroid cancers in surgically treated patients with nodular goiter in Şırnak city where is iodine deficiency region.Materials and methods: Thyroid surgical materials which were sent to our department were screened retrospectively from the archives between the years 2009-2010. Thyroid resection was performed on 241 patients with nodular goiter in one year. We evaluated patients who received the diagnosis of thyroid carcinoma with histhopatological examination.Results: 222 of our patients (92.1% female and 19 (7.9% were male. The youngest patient 16 and the oldest patient was 80 years old and the average age is 40.9 ± 12.8. Histopathological examination of 197 (81.7% cases of nodular goiter, 31 (12.9% cases lymphocytic thyroiditis, 13 (5.4% patients had thyroid tumors. The three tumors on the 2 cases (0.8% benign, 11 (4.6% were malignant. As a type of cancer 1 (0.4% patients, follicular carcinoma-oncocytic variant, 10 (4.2% cases were papillary carcinoma.Conclusions: Iodine deficiency area in the province of Şırnak in patients with nodular goiter who underwent surgery for thyroid cancer rate of 4.6%, and most cancers is seen as a type of thyroid papillary carcinoma.

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

International Nuclear Information System (INIS)

Johnson, Matthew D.; Avkshtol, Vladimir; Baschnagel, Andrew M.; Meyer, Kurt; Ye, Hong; Grills, Inga S.; Chen, Peter Y.; Maitz, Ann; Olson, Rick E.; Pieper, Daniel R.; Krauss, Daniel J.

2016-01-01

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

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

[Medium-term outcome, follow-up, and quality of life in children treated for type III esophageal atresia].

Science.gov (United States)

Lepeytre, C; De Lagausie, P; Merrot, T; Baumstarck, K; Oudyi, M; Dubus, J-C

2013-10-01

The aim of this study was to evaluate the medium-term outcome (health status, medical and surgical French National Health Authority-recommended follow-up, and quality of life) of children born with type III esophageal atresia (EA). Previous events (during the perinatal period, associated abnormalities, respiratory and digestive complications) of children treated for type III EA at the Marseille university hospitals between 1999 and 2009 were noted. Parents completed a standardized questionnaire concerning the health of their children during the previous year, and a quality-of-life questionnaire (PedsQL 4.0) was also completed by children aged more than 8 years. Among the 68 children treated, 44 responded to our solicitation (mean age, 7.6 years; range, 3-12.8 years). Previous important events were : pneumonia(s) (65%), asthma before the age of 3 years (66%), hospitalization for a respiratory event (45%), fundoplication (20%), and esophageal dilatation (45%). We noted current chronic cough (16%), asthma (30%), dysphagia (39%), and symptomatic gastroesophageal reflux (9%). National guidelines were not respected, except for the surgical indications in children aged less than 6 years. The quality-of-life scores (n=43 children) were similar to healthy controls but were negatively influenced by a gastrostomy procedure (P=0.020), pneumonia (P=0.013), and hospitalization due to a respiratory event (P=0.006) or a digestive event (P=0.010), and also by current asthma (P=0.004). In conclusion, despite recurrent respiratory or digestive symptoms and inadequate recommended follow-up, the quality of life of children treated for type III of EA is good. Copyright © 2013. Published by Elsevier SAS.

Duration of orthognathic-surgical treatment.

Science.gov (United States)

Paunonen, Jaakko; Helminen, Mika; Peltomäki, Timo

2017-07-01

The objective of this study was to determine the duration of orthognathic-surgical treatment conducted with conventional pre- and post-surgical orthodontic treatment phases. The study material was comprised of the files of 185 consecutive patients treated in Oral and Maxillofacial Unit, Tampere University Hospital, Finland, in 2007-2014. The files were reviewed and the following data was obtained: gender and age of patients, ICD-10 diagnosis, type of malocclusion, duration of pre- and post-surgical orthodontic treatment and type of operation. Total treatment duration (median) from placement of separating rings for banding until fixed orthodontic appliances were removed and retention period started was 31.1 months, of which pre-surgical orthodontics took 24.4 months and postsurgical 6.4 months. Treatment duration (median) was in BSSO was 32.1, LeFort 1 30.1 and bimaxillary osteotomy 29.7 months. Orthodontic extractions were performed in 35 patients (19%). If the orthodontic treatment included tooth extraction, the duration of pre-surgical treatment was on average 10 months longer, which is a statistically highly significant difference (p pre-surgical orthodontic treatment prolong treatment time by an average of 8-9 months.

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.

Management of Gynecomastia in Patients With Different Body Types: Considerations on 312 Consecutive Treated Cases.

Science.gov (United States)

Innocenti, Alessandro; Melita, Dario; Mori, Francesco; Ciancio, Francesco; Innocenti, Marco

2017-05-01

Gynecomastia is a common finding in male subjects which incidence varies widely in the world population. In adolescents, it is frequently temporary but, if it becomes persistent, it generates considerable embarrassment, inducing the patients to seek surgical consultation. Even in patients with good body contour, gynecomastia creates even greater distress considering the special attention given by these subjects to their physical appearance. The authors present their experience in the treatment of gynecomastia comparing different body types of patients with the aim to investigate dissimilar expectations, needs and surgical outcomes thus optimizing the management of the pathological condition, achieving high levels of agreement and reducing unsatisfied patients arising from cosmetic surgery. Between January 2007 and January 2015, 312 selected patients have been treated surgically for gynecomastia. Patients were grouped according to their physical aspect: 97 were classified as high muscle mass body type (group A), 106 as normal (group B) and 109 as overweight patients (group C). All of them were adults ranging in age between 18 and 52 years. Follow-up ranged from 12 to 60 months. In all cases, an excision of the gland in the form of a subcutaneous mastectomy was performed; the most common surgical access was in the inferior part of the areola. No breast cancers were found at the histological examinations. Also, no skin or areola necrosis have been referred, and no recurrence of gynecomastia disorder has been reported. Six cases of seroma (limited to the fatty gynecomastia) and 3 cases of hematomas (requiring immediate surgical revision) were found. Although the patients in group B resulted more distressed by the disorder, higher levels of postoperative satisfaction were recorded in this group. The study demonstrates the importance of the different management of the same disorder according to the different patients' expectations, related to the different body type. Our

OUTCOME OF GARTLAND TYPE – II SUPRACONDYLAR FRACTURES OF HUMERUS TREATED BY CONSERVATIVE METHOD

Directory of Open Access Journals (Sweden)

Dinesh Mitra

2015-08-01

Full Text Available BACKGROUND: The current literatures recommend operative method (closed reduction and pinning for type II supracondylar fractures of humerus. But some surgeons still prefer conservative method for type II supracondylar fractures of humerus. We pr esent results of 14 cases of type II supracondylar fractures treated with CR and AE POP immobilization . The purpose of this study is to evaluate the outcome of conservative treatment in management of type II supracondylar fracture of humerus. MATERIALS AND METHODS: Fourteen children treated by conservative methods (CR & AE POP between January 2013 and December 2014 is included in this study. The mean age group is 6.8 years (3 years - 11 years. The patient follow up is done for a minimum of 10 - 12 weeks. Treatment outcome is based on final clinical and radiological assessments and grading of results was done using Flynn’s criteria. RESULTS: Gartland type II fracture gives 82% excellent results and 28 % good results as per Flynn’s criteria. Of the 14 patien ts only two cases required re manipulation. Surgical intervention was not needed for any of the patients. No patients in this study developed compartment syndrome / cubitus varus deformity. CONCLUSION: Satisfactory results can be obtained with conservative treatment (closed reduction and above elbow POP if proper selection of the patient and careful clinical and radiological follow up is done

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

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...... pump inhibitors were independently associated with surgically treated ONJ. Conclusions: Our data suggest that recent, long-term, and compliant uses of alendronate are associated with an increased risk of surgically treated ONJ. Nevertheless, the rates remain low, even in long-term adherent users. ONJ...

Cost analysis of surgically treated pressure sores stage III and IV.

Science.gov (United States)

Filius, A; Damen, T H C; Schuijer-Maaskant, K P; Polinder, S; Hovius, S E R; Walbeehm, E T

2013-11-01

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart study of patients who were surgically treated for stage III and IV pressure sores between 2007 and 2010. Volumes of health-care use were obtained for all patients and direct medical costs were subsequently calculated. In addition, we evaluated the effect of location and number of pressure sores on total costs. A total of 52 cases were identified. Average direct medical costs in hospital were €20,957 for the surgical treatment of pressure sores stage III or IV; average direct medical costs for patients with one pressure sore on an extremity (group 1, n = 5) were €30,286, €10,113 for patients with one pressure sore on the trunk (group 2, n = 32) and €40,882 for patients with multiple pressure sores (group 3, n = 15). The additional costs for patients in group 1 and group 3 compared to group 2 were primarily due to longer hospitalisation. The average direct medical costs for surgical treatment of pressure sores stage III and IV were high. Large differences in costs were related to the location and number of pressure sores. Insight into the distribution of these costs allows identification of high-risk patients and enables the development of specific cost-reducing measures. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Surgical management of venous malformations.

Science.gov (United States)

Loose, D A

2007-01-01

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

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.

Urogynecologic Surgical Mesh Implants

Science.gov (United States)

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

Isolated olecranon fractures in children affected by osteogenesis imperfecta type I treated with single screw or tension band wiring system: Outcomes and pitfalls in relation to bone mineral density.

Science.gov (United States)

Persiani, Pietro; Ranaldi, Filippo M; Graci, Jole; De Cristo, Claudia; Zambrano, Anna; D'Eufemia, Patrizia; Martini, Lorena; Villani, Ciro

2017-05-01

The purpose of this study is to compare the results of 2 techniques, tension band wiring (TBW) and fixation with screws, in olecranon fractures in children affected with osteogenesis imperfecta (OI) type I. Between 2010 and 2014, 21 olecranon fractures in 18 children with OI (average age: 12 years old) were treated surgically. Ten patients were treated with the screw fixation and 11 with TBW. A total of 65% of olecranon fractures occurred as a result of a spontaneous avulsion of the olecranon during the contraction of the triceps muscle. The average follow-up was 36 months. Among the children treated with 1 screw, 5 patients needed a surgical revision with TBW due to a mobilization of the screw. In this group, the satisfactory results were 50%. In patients treated with TBW, the satisfactory results were 100% of the cases. The average Z-score, the last one recorded in the patients before the trauma, was -2.53 in patients treated with screw fixation and -2.04 in those treated with TBW. TBW represents the safest surgical treatment for patients suffering from OI type I, as it helps to prevent the rigidity of the elbow through an earlier recovery of the range of motion, and there was no loosening of the implant. In analyzing the average Z-score before any fracture, the fixation with screws has an increased risk of failure in combination with low bone mineral density.

[Surgical management, prognostic factors, and outcome in hepatic trauma].

Science.gov (United States)

Ott, R; Schön, M R; Seidel, S; Schuster, E; Josten, C; Hauss, J

2005-02-01

Hepatic trauma is a rare surgical emergency with significant morbidity and mortality. Extensive experience in liver surgery is a prerequisite for the management of these injuries. The medical records of 68 consecutive patients with hepatic trauma were retrospectively reviewed for the severity of liver injury, management, morbidity, mortality, and risk factors. Of the patients, 14 were treated conservatively and 52 surgically (24 suture/fibrin glue, 16 perihepatic packing, 11 resections, 1 liver transplantation). Two patients died just before emergency surgery could be performed. Overall mortality was 21% (14/68), and 13, 14, 6, 27, and 50% for types I, II, III, IV, and V injuries, respectively. Only nine deaths (all type IV and V) were liver related, while four were caused by extrahepatic injuries and one by concomitant liver cirrhosis. With respect to treatment, conservative management, suture, and resection had a low mortality of 0, 4, and 9%, respectively. In contrast, mortality was 47% in patients in whom only packing was performed (in severe injuries). Stepwise multivariate regression analysis proved prothrombin values 30, and transfusion requirements of more than 10 red packed cells to be significant risk factors for post-traumatic death. Type I-III hepatic injuries can safely be treated by conservative or simple surgical means. However, complex hepatic injuries (types IV and V) carry a significant mortality and may require hepatic surgery, including liver resection or even transplantation. Therefore, patients with severe hepatic injuries should be treated in a specialized institution.

Validated Computational Model to Compute Re-apposition Pressures for Treating Type-B Aortic Dissections

Directory of Open Access Journals (Sweden)

Aashish Ahuja

2018-05-01

Full Text Available The use of endovascular treatment in the thoracic aorta has revolutionized the clinical approach for treating Stanford type B aortic dissection. The endograft procedure is a minimally invasive alternative to traditional surgery for the management of complicated type-B patients. The endograft is first deployed to exclude the proximal entry tear to redirect blood flow toward the true lumen and then a stent graft is used to push the intimal flap against the false lumen (FL wall such that the aorta is reconstituted by sealing the FL. Although endovascular treatment has reduced the mortality rate in patients compared to those undergoing surgical repair, more than 30% of patients who were initially successfully treated require a new endovascular or surgical intervention in the aortic segments distal to the endograft. One reason for failure of the repair is persistent FL perfusion from distal entry tears. This creates a patent FL channel which can be associated with FL growth. Thus, it is necessary to develop stents that can promote full re-apposition of the flap leading to complete closure of the FL. In the current study, we determine the radial pressures required to re-appose the mid and distal ends of a dissected porcine thoracic aorta using a balloon catheter under static inflation pressure. The same analysis is simulated using finite element analysis (FEA models by incorporating the hyperelastic properties of porcine aortic tissues. It is shown that the FEA models capture the change in the radial pressures required to re-appose the intimal flap as a function of pressure. The predictions from the simulation models match closely the results from the bench experiments. The use of validated computational models can support development of better stents by calculating the proper radial pressures required for complete re-apposition of the intimal flap.

Serological analysis of patients treated with a new surgical hemostat containing bovine proteins and autologous plasma.

Science.gov (United States)

Nelson, P A; Powers, J N; Estridge, T D; Elder, E A; Alea, A D; Sidhu, P K; Sehl, L C; DeLustro, F A

2001-01-01

A randomized, controlled clinical study of the management of diffuse bleeding with CoStasis surgical hemostat, a new hemostat containing bovine thrombin and collagen with the patient's own plasma, included patients undergoing cardiac, hepatic, iliac, and general surgery. Sera from 92 patients treated with CoStasis and 84 control patients were collected preoperatively and at a post surgical follow-up of 8 weeks. Among the control group, 57 patients were treated with Instat collagen sponge in noncardiac indications. Results showed that antibody responses in the CoStasis clinical study were similar to the reported literature for all antigens screened and were not associated with any adverse reactions. The bovine thrombin preparations in CoStasis and other commercially available thrombins were compared with the use of SDS-PAGE and Western blot analyses. Within this clinical study, CoStasis was shown to be a safe and effective hemostatic product containing bovine thrombin and bovine collagen and no pooled human blood products. Copyright 2001 John Wiley & Sons, Inc.

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.

The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation

Directory of Open Access Journals (Sweden)

Keykhosro Mardanpour

2013-07-01

Full Text Available BACKGROUND: This study was performed to evaluate functional and radiological results of pelvic ring fractures treatment by open reduction and internal fixation. METHOD: Thirty eight patients with unstable pelvic fractures, treated from 2002 to 2008 were retrospectively reviewed. The mean patients’ age was 37 years (range 20 to 67. Twenty six patients were men (4patients with type B and 22 patients with type C fracture and 12 women (7 patients with type B and 5 patients with type C fracture. The commonest cause was a road traffic accident (N=37, about 97%. Internal fixation was done by plaque with ilioinguinal and kocher-langenbeek approaches for anterior, posterior pelvic wall and acetabulum fracture respectively. Quality of reduction was graded according to Majeed score system. RESULTS: There were 11 type-C and 27 type-B pelvic fractures according to Tile’s classification. Thirty six patients sustained additional injuries. the commonest additional injury was lower extremity fracture. The mean follow-up was 45.6 months (range 16 to 84 months.The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients with type B pelvic fractures and functional outcome was excellent in 46%, good in 27%, fair in 27% and poor in 0% of the patients with type C pelvic fractures. There were four postoperative infections. No sexual functional problem was reported. Neurologic problem like Lateral cutaneous nerve of thigh injury recovered completely in 2 patients and partially in 2 patients. There was no significant relation between functional outcome and the site of fracture (P greater than 0.005. CONCLUSION: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization. It must be carried out as soon as the general condition of the patient permits, and even up to two weeks

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.

A case of surgically treated peristomal pyoderma gangrenosum in a patient with rheumatoid arthritis

Science.gov (United States)

Khajehnoori, Masoomeh; O'Brien, Tim

2016-01-01

Peristomal pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum that is difficult to diagnose and treat. It is characterized by the rapid progression of painful necrotic ulcer surrounding an area of abdominal stoma. It is almost exclusively associated with inflammatory bowel disease even after bowel surgery and is associated with significant morbidity. Diagnosis of pyoderma gangrenosum is based on exclusion of other disorders replicating some of its clinical features and histopathological evidence. This is a case report of a 56-year-old lady with rheumatoid arthritis who presented with rapidly progressing abdominal ulcer 8 months after a Hartmanns procedure for perforated diverticulitis. The ulcer had formed a large cavity causing faecal filling in the dependent defect. The other causes of ulcer were excluded with negative histopathology, negative polymerase chain reaction for Mycobacterium ulcerans and negative acid fast bacillus (AFB) test. She was diagnosed with PPG which is routinely treated medically due to risk of setting off a second focus of pyoderma if surgically intervened. However due to increased risk of faecal peritonitis, it was decided to proceed with surgical debridement. This article will discuss the case in more detail and briefly discuss diagnosis and treatment options for PPG. PMID:27302499

Surgical treatment of type I Chiari malformation: the role of Magendie’s foramen opening e tonsils manipulation

Directory of Open Access Journals (Sweden)

Claudio Henrique Fernandes Vidal

2015-02-01

Full Text Available The treatment for type 1 Chiari malformation (CM 1 is one of the most controversial topics in the neurosurgical field. The present study evaluated two of the most applied surgical techniques to treat CM 1. Method 32 patients were evaluated and divided in two groups: group 1 had 16 patients that were submitted to decompression of occipital bone and dura mater of the craniovertebral junction (CVJ; group 2 also had 16 patients and in addition to the previous procedure, they were submitted to Magendie’s foramen opening e tonsils manipulation. The comparison between the groups included neurological exam and cerebrospinal fluid flow imaging during pre and postoperative periods. Results Both techniques were equivalents in terms of neurological improvement of the patients (p > 0.05, but the group 2 had more surgical complications, with relative risk of 2.45 (CI 1.55-3.86 for adverse events. Whatever the cerebrospinal fluid flow at CVJ, the patients of the group 1 achieved greater amount of flow than the group 2 (p < 0.05 during the postoperative period. Conclusion The cranial and dural decompression of the CVJ without arachnoidal violation was the best surgical intervention for treatment of CM 1, between these two compared techniques.

Family environment, hobbies and habits as psychosocial predictors of survival for surgically treated patients with breast cancer.

Science.gov (United States)

Tominaga, K; Andow, J; Koyama, Y; Numao, S; Kurokawa, E; Ojima, M; Nagai, M

1998-01-01

Many psychosocial factors have been reported to influence the duration of survival of breast cancer patients. We have studied how family members, hobbies and habits of the patients may alter their psychosocial status. Female patients with surgically treated breast cancer diagnosed between 1986 and 1995 at the Tochigi Cancer Center Hospital, who provided information on the above-mentioned factors, were used. Their subsequent physical status was followed up in the outpatients clinic. The Cox regression model was used to evaluate the relationship between the results of the factors examined and the duration of the patients' survival, adjusting for the patients' age, stage of disease at diagnosis and curability, as judged by the physician in charge after the treatment. The following factors were revealed to be significant with regard to the survival of surgically treated breast cancer patients: being a widow (hazard ratio 3.29; 95% confidence interval 1.32-8.20), having a hobby (hazard ratio 0.43; 95% confidence interval 0.23-0.82), number of hobbies (hazard ratio 0.64; 95% confidence interval 0.41-1.00), number of female children (hazard ratio 0.64; 95% confidence interval 0.42-0.98), smoker (hazard ratio 2.08; 95% confidence interval 1.02-4.26) and alcohol consumption (hazard ratio 0.10; 95% confidence interval 0.01-0.72). These results suggest that psychosocial factors, including the family environment, where patients receive emotional support from their spouse and children, hobbies and the patients' habits, may influence the duration of survival in surgically treated breast cancer patients.

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.

Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy

Directory of Open Access Journals (Sweden)

Francesco Tonelli

2012-01-01

Full Text Available Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1 correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2 avoid persistent hypoparathyroidism; and 3 facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1 subtotal parathyroidectomy with removal of at least 3-3 K glands; and 2 total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1 the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2 the surgeon's experience; 3 the timing of surgery; 4 the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay of the curative potential of the surgical procedure; and, 5 the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence.

The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus.

Science.gov (United States)

Rubino, Francesco; Kaplan, Lee M; Schauer, Philip R; Cummings, David E

2010-03-01

To develop guidelines for the use of gastrointestinal surgery to treat type 2 diabetes and to craft an agenda for further research. Increasing evidence demonstrates that bariatric surgery can dramatically ameliorate type 2 diabetes. Not surprisingly, gastrointestinal operations are now being used throughout the world to treat diabetes in association with obesity, and increasingly, for diabetes alone. However, the role for surgery in diabetes treatment is not clearly defined and there are neither clear guidelines for these practices nor sufficient plans for clinical trials to evaluate the risks and benefits of such "diabetes surgery." A multidisciplinary group of 50 voting delegates from around the world gathered in Rome, Italy for the first International Conference on Gastrointestinal Surgery to Treat Type 2 Diabetes--(the "Diabetes Surgery Summit"). During the meeting, available scientific evidence was examined and critiqued by the entire group to assess the strength of evidence and to draft consensus statements. Through an iterative process, draft statements were then serially discussed, debated, edited, reassessed, and finally presented for formal voting. After the Rome meeting, statements that achieved consensus were summarized and distributed to all voting delegates for further input and final approval. These statements were then formally critiqued by representatives of several sientific societies at the 1st World Congress on Interventional Therapies for T2DM (New York, Sept 2008). Input from this discussion was used to generate the current position statement. A Diabetes Surgery Summit (DSS) Position Statement consists of recommendations for clinical and research issues, as well as general concepts and definitions in diabetes surgery. The DSS recognizes the legitimacy of surgical approaches to treat diabetes in carefully selected patients. For example, gastric bypass was deemed a reasonable treatment option for patients with poorly controlled diabetes and a

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.

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.

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.

Surgical Success Rates for Horizontal Concomitant Deviations According to the Type and Degree of Deviation

Directory of Open Access Journals (Sweden)

İhsan Çaça

2004-01-01

Full Text Available We evaluated the correlation with success rates and deviation type and degree inhorizontal concomitant deviations. 104 horizontal concomitan strabismus cases whowere operated in our clinic between January 1994 – December 2000 were included in thestudy. 56 cases undergone recession-resection procedure in the same eye 19 cases twomuscle recession and one muscle resection, 20 cases two muscle recession, 9 cases onlyone muscle recession. 10 ± prism diopter deviation in postoperative sixth monthexamination was accepted as surgical success.Surgical success rate was 90% and 89.3% in the cases with deviation angle of 15-30and 31-50 prism diopter respectively. Success rate was 78.9% if the angle was more than50 prism diopter. According to strabismus type when surgical success rate examined; inalternan esotropia 88.33%, in alternan exotropia 84.6%, in monocular esotropia 88%and in monocular exotropia 83.3% success was fixed. Statistically significant differencewas not found between strabismus type and surgical success rate. The binocular visiongaining rate was found as 51.8% after the treatment of cases.In strabismus surgery, preoperative deviation angle was found to be an effectivefactor on the success rate.

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...

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 (Ppresent 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. © 2012 British Small Animal Veterinary Association.

Result of surgical therapy in esophagogastric junction adenocarcinoma

International Nuclear Information System (INIS)

Shirinzadeh, A.; Fakhrjoo, E.

2007-01-01

To assess the outcome of surgical therapy and choice of surgical strategy for patients with adenocarcinoma of the gastroesophageal junction. Between February 1989 and January 2005 during 16 years, 335 patients (65 female, 270 male, mean age 56 years) with esophagogastric junction adenocarcinoma underwent surgical operation. The choice of surgical approach was based on the anatomical location of the tumor mass. Outcome of surgery, histopathologic characteristics, demographic data and long term survival rates were compared among three types of tumor defined as follows. Type I: Adenocarcinoma of the distal esophagus which infiltrates the esophagogastric junction from above. Type II: True carcinoma of the cardia arising immediately at the esophagogastric junction. Type III: Subcardial gastric carcinoma that infiltrates the esophagogastric junction and distal esophagus from below. Of the 335 patients undergoing resection, 110 (33%) had type I, 96 (28%) had type II, and 129 (39%) had type III. The preponderance of the male sex and the prevalence of metaplasia in distal esophagus decreased from type I to type III tumors (P<0.01). The prevalence of undifferentiated tumors increased from type I to type III tumors (P<0.01). Esophagectomy with resection of the proximal stomach for type I and extended total gastrectomy with transhiatal resection of the distal esophagus for type II and III were the primary procedures. The mean number of removed lymph node was higher in type III and II compared to type I tumors. The overall postoperative 30-day mortality was 8.4%. The death rate in transthoracic esophagectomy was higher than with extended total gastrectomy. The classification of adenocarcinoma of the esophagogastric junction into type I, II and III tumors helps in the selection of surgical approach. Type I tumors are approached as distal esophageal cancer. Type III tumors are a special form of gastric cancer and treated as a gastric cancer. The relation of type II tumors to

[Surgical angioplasty of the left main coronary artery].

Science.gov (United States)

Vranes, Mile; Velinović, Milos; Kocica, Mladen; Mikić, Aleksandar; Velimirović, Dusan; Djukić, Petar

2010-01-01

The conventional treatment for isolated stenosis of the left main coronary artery is bypass surgery (myocardial revascularization). However, the process of atherosclerosis is not arrested by myocardial revascularization and it will lead to the occlusion of the left main coronary artery. Revascularization will establish retrograde perfusion for 50-70% of the myocardium of the left ventricle. Direct surgical angioplasty of the left main coronary artery enables normal physiological perfusion of the whole myocardium and better myocardial function. The aim of our study is to point out a new surgical approach of treating left main coronary artery stenosis. Between October 2002 and October 2003, direct surgical angioplasty of the main left coronary artery was performed on three patients with isolated stenosis of the left main coronary artery using the anterior approach and the pericardium as a patch. The procedure was performed under total endotracheal anaesthesia and standard cardiopulmonary circulation, moderate hypothermia, anterograde St. Tomas cardioplegia and local cooling. Patients were followed clinically, echocardiographically and by load-tests. All three patients were without complications. In postoperative follow-up (54-68 months) neither angina pectoris nor electrocardiographically registered ischaemic changes were found. Load-tests performed every six months on all three patients were negative. Surgical angioplasty of isolated stenosis of the left main coronary artery is a preferred method for treating this type of coronary disease. Contraindications for this type of treatment are stenosis of the left main coronary artery with bifurcation and advanced calcification of the left main coronary artery.

Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy.

Science.gov (United States)

Bao, H; Yan, P; Qiu, Y; Liu, Z; Zhu, F

2016-09-01

There is a paucity of information on the pre-operative coronal imbalance in patients with degenerative lumbar scoliosis (DLS) and its influence on surgical outcomes. A total of 284 DLS patients were recruited into this study, among whom 69 patients were treated surgically and the remaining 215 patients conservatively Patients were classified based on the coronal balance distance (CBD): Type A, CBD 3 cm and C7 Plumb Line (C7PL) shifted to the concave side of the curve; Type C, CBD > 3 cm and C7PL shifted to the convex side. A total of 99 of the 284 (34.8%) patient presented with a pre-operative coronal imbalance (mean CBD: 48.5, standard deviation 18.7 mm). More patients with a Type B malalignment were observed than with a Type C malalignment (62 versus 37). A total of 21 pf the 69 (30.4%) surgically treated patients had a post-operative coronal imbalance, which was found to be more prevalent in Type C patients (p imbalance following posterior osteotomy. Cite this article: Bone Joint J 2016;98-B:1227-33. ©2016 The British Editorial Society of Bone & Joint Surgery.

Surgical treatment of acute type V acromioclavicular joint dislocations in professional athletes: an anatomic ligament reconstruction with synthetic implant augmentation.

Science.gov (United States)

Triantafyllopoulos, Ioannis K; Lampropoulou-Adamidou, Kalliopi; Schizas, Nikitas P; Karadimas, Eleftherios V

2017-12-01

Most acromioclavicular (AC) joint injuries occur in men in their third decade of life during high-speed or high-impact body contact sports. The management of acute complete AC joint dislocation is surgical. Current surgical techniques include anatomic reconstruction of the main restraints of the AC joint and aim to improve functional outcomes and to reduce the complication rate. We present 10 cases of acute type V AC joint dislocation in professional athletes treated surgically with anatomic reconstruction of the coracoclavicular and AC ligaments and augmentation with the use of a synthetic polyester tape. The minimum follow-up of the patients was 2 years (mean, 48 months; range, 24-86 months). The postoperative functional outcome was assessed at 1 year and 2 years using the Constant-Murley, American Shoulder and Elbow Surgeons, and modified University of California-Los Angeles scoring systems. In all cases, the postoperative scores were significantly improved (P < .005 in all comparisons with the preoperative scores), and all patients returned to their preinjury high level of activity 6 months postoperatively. Radiographs at 1 month and 6 months revealed the maintenance of reduction. There were no complications. According to the results of our series of patients, demanding cases of acute AC joint dislocation Rockwood type V, in professional athletes, require anatomic fixation of both coracoclavicular and AC ligaments for return to sports as soon as possible and at the preinjury level of performance. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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.

A Case of Microstomia Subsequent to Toxic Epidermal Necrolysis Surgically Treated by Simple Technique

Directory of Open Access Journals (Sweden)

Takanobu Mashiko, MD

2013-06-01

Full Text Available Summary: Toxic epidermal necrolysis (TEN is a rare but severe adverse dermatitis that is an autoimmune reaction to drugs such as nonsteroidal anti-inflammatory drugs. TEN most severely affects the mucous membranes including the mouth and could develop into microstomia; however, microstomia in relation to TEN has rarely been reported in the literature. We describe an adult female patient who developed microstomia due to scar contracture of the bilateral oral commissures subsequent to TEN and was successfully treated by a simple surgical technique consisting solely of transverse incision of the commissure and longitudinal closure.

Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

African Journals Online (AJOL)

Background and Objective: There are various postulated possible causes of surgically symptomatic prolapsed intervertebral discs in the lumbar and sacral regions. They may be acting singularly or collectively. Yet, these factors, which could vary in different environments, have not been satisfactorily confirmed. The intention ...

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.

Surgical Management of Localized Scleroderma.

Science.gov (United States)

Lee, Jae Hyun; Lim, Soo Yeon; Lee, Jang Hyun; Ahn, Hee Chang

2017-09-01

Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.

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.

Surgical management of abnormal uterine bleeding in fertile age women.

Science.gov (United States)

Finco, Andrea; Centini, Gabriele; Lazzeri, Lucia; Zupi, Errico

2015-07-01

Abnormal uterine bleeding is a common gynecological disease and represents one of the most frequent reasons for hospital admission to a specialist unit, often requiring further surgical treatment. Following the so-called PALM-COEIN system we will attempt to further clarify the surgical treatments available today. The first group (PALM) is characterized by structural lesions, which may be more appropriately treated by means of surgical management. Although hysterectomy remains the definitive and decisive choice, there are many alternative techniques available. These minimally invasive procedures offer the opportunity for a more conservative approach. Precise and accurate counseling facilitates better patient selection, based on the patient's desires, age and disease type, allowing treatment to be individually tailored to each woman.

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.

Capping of the radicular exposed surface (part II). Surgical and not surgical treatment

OpenAIRE

Grados Pomarino, Sixto; Estrada, Andrew Alejandro; Maetahara Rubio, Denis Miguel; Guzmán Vera, Yanina Sara; Tello Barbarán, Javier

2014-01-01

The gingival recession treatment can be made surgical1y with a high predictability of success due to the great advance during the last ones of the mucogingival surgical techniques. The use of connective grafts in coverage of recessions has obtained high rates of success reason why these procedures are common within the modern periodontal surgical practice. Knowing that all patients do not accept the surgical treatment, many investigators have come studying the possibility of treating non-surg...

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

Surgical repair for acute type A aortic dissection in octogenarians.

Science.gov (United States)

El-Sayed Ahmad, Ali; Papadopoulos, Nestoras; Detho, Faisal; Srndic, Edin; Risteski, Petar; Moritz, Anton; Zierer, Andreas

2015-02-01

Despite limited data, the necessity for immediate surgical intervention in octogenarians with acute type A aortic dissection (AAD) has recently been questioned because the surgical risk may outweigh its potential benefits. At the same time, evolving stent graft technologies are pushing in the market for pathology within the ascending aorta, even for treatment of AAD. Against this background, we analyzed our institutional experience in this patient cohort during the last 8 years. Between October 2005 and October 2013, 39 patients aged older than 80 years (82 ± 2 years) underwent surgical repair for AAD, of which 29 patients (74%) were men. Owing to patient age and comorbidities, we aimed to limit the operation to supracoronary hemiarch replacement whenever possible. Clinical data were prospectively entered into our institutional database. Late follow-up was 3.6 ± 2.8 years and was 100% complete. Hemiarch replacement was performed in 32 patients (82%), and full arch replacement was necessary in the remaining 7. In 31 patients (79%), the aortic root could be glued and reconstructed or remained untouched. The remaining 8 patients (21%) underwent the bio-Bentall procedure. Mean ventilation time was 46 ± 23 hours, and the intensive care unit stay was 5 ± 9 days. We observed new postoperative permanent neurologic deficits in 2 patients (5%) and transient neurologic deficits in 3 (8%). The 30-day mortality was 26% (n = 10). Kaplan-Meier estimates for late survival were 46% ± 16% at 5 years. Given the guidelines regarding the predicted risk of death in patients with untreated AAD, current data suggest a survival benefit with immediate open surgical intervention even in octogenarians. Similarly to the early days of transcatheter-based aortic valve implantation, open surgical reference data are warranted to set the bar for upcoming endovascular treatment of AAD in octogenarians. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

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.

MR imaging findings of painful type II accessory navicular bone: correlation with surgical and pathologic studies

International Nuclear Information System (INIS)

Choi, Yun Sun; Lee, Kyung Tai; Kim, Eun Kyung; Kang, Heung Sik

2004-01-01

To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients

Comparison of surgical and non-surgical orthodontic treatment approaches on occlusal and cephalometric outcomes in patients with Class II Division I malocclusions

Directory of Open Access Journals (Sweden)

Sheila Daniels

2017-07-01

Full Text Available Abstract Background This study aimed to examine end-of-treatment outcomes of severe Class II Division I malocclusion patients treated with surgical or non-surgical approaches. This study tests the hypotheses that occlusal outcomes (ABO-OGS and cephalometric outcomes differ between these groups. Methods A total of 60 patients were included: 20 of which underwent surgical correction and 40 of which did not. Cast grading of initial and final study models was performed and information was gathered from pre- to post-treatment cephalometric radiographs. The end-of-treatment ABO-OGS and cephalometric outcomes were compared to Mann-Whitney U tests and multivariable linear regression models. Results Following adjustment for multiple confounders (age, gender, complexity of case, and skeletal patterns, the final deband score (ABO-OGS was similar for both groups (23.8 for surgical group versus 22.5 for non-surgical group. Those treated surgically had a significantly larger reduction in ANB angle, 3.4° reduction versus 1.5° reduction in the non-surgical group (p = 0.002. The surgical group also showed increased maxillary incisor proclination (p = 0.001 compared to the non-surgical group. This might be attributed to retroclination of maxillary incisors during treatment selection in the non-surgical group—namely, extraction of premolars to mask the discrepancy. Conclusions Those treated surgically had a significantly larger reduction in ANB angle and increased maxillary incisor proclination compared to those treated non-surgically with no significant changes in occlusal outcomes.

Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials.

Directory of Open Access Journals (Sweden)

Jia-Guo Zhao

Full Text Available There are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF, intramedullary nail (IMN fixation, and minimally invasive percutaneous osteosynthesis (MIPO. We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures.MEDLINE, EMBASE, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, and Cochrane library were researched for reports published up to May 2016. We only included randomized controlled trials (RCTs comparing two or more of the three surgical procedures, including the ORPF, IMN, and MIPO techniques, for humeral shaft fractures in adults. The methodological quality was evaluated based on the Cochrane risk of bias tool. We used WinBUGS1.4 to conduct this Bayesian network meta-analysis. We used the odd ratios (ORs with 95% confidence intervals (CIs to calculate the dichotomous outcomes and analyzed the percentages of the surface under the cumulative ranking curve.Seventeen eligible publications reporting 16 RCTs were included in this study. Eight hundred and thirty-two participants were randomized to receive one of three surgical procedures. The results showed that shoulder impingement occurred more commonly in the IMN group than with either ORPF (OR, 0.13; 95% CI, 0.03-0.37 or MIPO fixation (OR, 0.08; 95% CI, 0.00-0.69. Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80-124.20. There were no significant differences among the three procedures in nonunion, delayed union, and infection.Compared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures.

Efficacy of Surgical Airway Plasty for Benign Airway Stenosis.

Science.gov (United States)

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

2016-01-01

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

Multiple intracranial aneurysms and moyamoya disease associated with microcephalic osteodysplastic primordial dwarfism type II: surgical considerations.

Science.gov (United States)

Waldron, James S; Hetts, Steven W; Armstrong-Wells, Jennifer; Dowd, Christopher F; Fullerton, Heather J; Gupta, Nalin; Lawton, Michael T

2009-11-01

Microcephalic osteodysplastic primordial dwarfism type II (MOPD II) is a rare genetic syndrome characterized by extremely small stature and microcephaly, and is associated in 25% of patients with intracranial aneurysms and moyamoya disease. Although aneurysmal subarachnoid hemorrhage and stroke are leading causes of morbidity and death in these patients, MOPD II is rarely examined in the neurosurgical literature. The authors report their experience with 3 patients who presented with MOPD II, which includes a patient with 8 aneurysms (the most aneurysms reported in the literature), and the first report of a patient with both moyamoya disease and multiple aneurysms. The poor natural history of these lesions indicates aggressive microsurgical and/or endovascular therapy. Microsurgery, whether for aneurysm clip placement or extracranial-intracranial bypass, is challenging due to tight surgical corridors and diminutive arteries in these patients, but is technically feasible and strongly indicated when multiple aneurysms must be treated or cerebral revascularization is needed.

Surgical orthodontics.

Science.gov (United States)

Strohl, Alexis M; Vitkus, Lauren

2017-08-01

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

A comparative study of the long-term effect of thyroid arterial embolization with surgical thyroidectomy in treating Graves' disease

International Nuclear Information System (INIS)

Tian Jinlin; Chen Shuofei; Du Yahui; Li Chunlei; Wang Wei; Li Yunsong; Guo Yuehui

2012-01-01

Objective: To compare long-term (5 years) therapeutic effect of thyroid arterial embolization with surgical thyroidectomy in treating Graves' disease. Methods: A total of 54 patients with Graves' disease, who were encountered during the period from Jan. 2003 to Dec. 2010 and received thyroid arterial embolization treatment, were collected and were used as interventional group. While 40 patients with Graves' disease, who were encountered during the same period and received surgical thyroidectomy, were used as surgical group. The 1-year, 3-year and 5-year cure rates and efficiency rates (improved and cure) were calculated and the results were compared between the two groups. Results: The 1-year, 3-year and 5-year cure rates of the interventional group were 68.52%, 61.18% and 47.88%, respectively. The 1-year, 3-year and 5-year cure rates of the surgical group were 97.50%, 78.54% and 69.48%, respectively. The 1-year, 3-year and 5-year efficiency rates in the interventional group and in the surgical group were 98.15%, 80.48%, 60.90% and 97.50%, 76.42%, 67.60%, respectively. By using Ridit analysis, statistically significant difference in the 1-year, 3-year and 5-year cure rates and efficiency rates existed between the interventional group and the surgical group (P 0.05%). Conclusion: For the treatment of Graves' disease, thyroid arterial embolization has satisfactory short-term and mid-term result, although its long-term result is less effective than that of thyroidectomy. (authors)

Evaluation of Acute Aortic Dissection Type a Factors and Comparison the Postoperative Clinical Outcomes between Two Surgical Methods.

Science.gov (United States)

Shemirani, Hasan; Mirmohamadsadeghi, Amir; Mahaki, Behzad; Farhadi, Sadaf; Badalabadi, Reza Mohseni; Bidram, Peyman; Badalabadi, Mehdi Mohseni

2017-01-01

Although aortic dissection is a rare disease, it causes high level of mortality. If ascending aorta gets involved in this disease, it is known as type A. According to small number of studies about this disease in Iran, this study conducted to detect the factors related to acute aortic dissection type A, its surgery consequences and the factors affecting them. In this historical cohort study, all patients having acute aortic dissection type A referring to Chamran Hospital from 2006 to 2012 were studied. The impact of two surgical methods including antegrade cerebral perfusion (ACP) and retrograde cerebral one (RCP) on surgical and long-term mortality and recurrence of dissection was determined. The relation of mortality rate and hemodynamic instability before surgery, age more than 70 years old, ejection fraction lower than 50%, prolonged cardiopulmonary bypass pump (CPBP) time and excessive blood transfusion, was assessed. Surgery and long-term mortality and recurrence of dissection were 35.3%, 30.8% and 30.4%. Surgical and long-term death in the patients being operated by ACP method was lower than those one being operated by RCP ( P RCP according to the surgical and long-term mortality.

Ruptured Aortic Aneurysm From Late Type II Endoleak Treated by Transarterial Embolization

International Nuclear Information System (INIS)

Gunasekaran, Senthil; Funaki, Brian; Lorenz, Jonathan

2013-01-01

Endoleak is the most common complication after endovascular aneurysm repair. The most common type of endoleak, a type II endoleak, typically follows a benign course and is only treated when associated with increasing aneurysm size. In this case report, we describe a ruptured abdominal aortic aneurysm due to a late, type II endoleak occurring 10 years after endovascular aneurysm repair that was successfully treated by transarterial embolization.

Intra-Operative Inspired Fraction of Oxygen and the Risk of Surgical Site Infections in Patients with Type 1 Surgical Incisions.

Science.gov (United States)

Wanta, Brendan T; Hanson, Kristine T; Hyder, Joseph A; Stewart, Thomas M; Curry, Timothy B; Berbari, Elie F; Habermann, Elizabeth B; Kor, Daryl J; Brown, Michael J

2018-04-02

Whether the fraction of inspired oxygen (F I O 2 ) influences the risk of surgical site infection (SSI) is controversial. The World Health Organization and the World Federation of Societies of Anesthesiologists offer conflicting recommendations. In this study, we evaluate simultaneously three different definitions of F I O 2 exposure and the risk of SSI in a large surgical population. Patients with clean (type 1) surgical incisions who developed superficial and deep organ/space SSI within 30 days after surgery from January 2003 through December 2012 in five surgical specialties were matched to specialty-specific controls. Fraction of inspired oxygen exposure was defined as (1) nadir F I O 2 , (2) percentage of operative time with F I O 2 greater than 50%, and (3) cumulative hyperoxia exposure, calculated as the area under the curve (AUC) of F I O 2 by time for the duration in which F I O 2 greater than 50%. Stratified univariable and multivariable logistic regression models tested associations between F I O 2 and SSI. One thousand two hundred fifty cases of SSI were matched to 3,248 controls. Increased oxygen exposure, by any of the three measures, was not associated with the outcome of any SSI in a multivariable logistic regression model. Elevated body mass index (BMI; 35+ vs. operative oxygen exposure was associated with higher odds of SSI in the neurosurgical and spine populations. Increased intra-operative inspired fraction of oxygen was not associated with a reduction in SSI. These findings do not support the practice of increasing F I O 2 for the purpose of SSI reduction in patients with clean surgical incisions.

[Intestinal stomas--indications, stoma types, surgical technique].

Science.gov (United States)

Renzulli, P; Candinas, D

2007-09-01

The formation of an intestinal stoma is one of the most frequent operations in visceral surgery. Despite new operative techniques and a more restrictive use of the stoma, the stoma formation remains an often necessary surgical procedure, which results to a dramatic change in the patients' life. The stoma formation and its later closure are associated with a high morbidity. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse, are related to surgical mistakes made during stoma formation. These complications are therefore largely avoidable. The stoma formation needs careful planning together with a professional stoma nursing team. Moreover, it is mandatory that the stoma formation is made with great care and that it meticulously follows the well established surgical principles. A perfectly placed, technically correctly fashioned and easy to care for stoma is essential for a good patients'quality of life.

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.

Evaluation of surgical treatment in mandibular condyle fractures.

Science.gov (United States)

Vesnaver, Aleš; Ahčan, Uroš; Rozman, Janez

2012-12-01

In the past, fractures of the mandibular condylar process were, as a rule, treated conservatively. At the Department of Maxillofacial and Oral Surgery of the University Medical Centre Ljubljana, Slovenia, our doctrine was changed in 2002 on the basis of preliminary results and reports in the literature, and these fractures were started to be treated surgically by open reduction and internal fixation with miniplates and screws, which led to good results and a shorter rehabilitation period. The goal of this study was to determine the safety and efficiency of surgical treatment, as well as to compare long-term results of surgical and conservative treatment, as objectively as possible. Two groups of patients, which had all sustained a unilateral, extra-articular mandibular condyle fracture, were compared. In the test group, there were 42 surgically treated patients, and in the control group, 20 conservatively treated patients. Clinical parameters and X-ray images were assessed in both groups and compared by the two tailed Student t test, and in case of attributive variables by the χ(2) test. Within the surgically treated group, postoperative and intraoperative complications were noted: temporary facial nerve palsy, development of a parotid salivary fistula, disturbance of auricle sensibility due to injury of the greater auricular nerve, miniplate fracture, as well as intraoperative bleeding, postoperative haematoma formation, infection, reoperation due to fragment malposition and other complications. Postoperative scars were also assessed. Statistically significant differences between the surgically and conservatively treated patients were found when comparing clinical parameters as well as X-ray images, the results being better in the surgically treated group. Complications of surgical treatment were also noted, the most important among them temporary paresis of facial nerve branches, which occurred in 10 patients (24%). Plate fractures occurred in five patients (12

Frequency and risk factors of severe hypoglycaemia in insulin-treated Type 2 diabetes

DEFF Research Database (Denmark)

Akram, K; Pedersen-Bjergaard, U; Carstensen, B

2006-01-01

AIMS: The reported risk of severe hypoglycaemia in insulin-treated Type 2 diabetes is highly variable and few studies have evaluated the influence of risk factors. We assessed the incidence and the influence of potential risk factors for severe hypoglycaemia in a questionnaire survey in subjects...... with insulin-treated Type 2 diabetes receiving currently recommended multifactorial intervention. METHODS: Consecutive patients with insulin-treated Type 2 diabetes (n = 401) completed a questionnaire about occurrence of hypoglycaemia in the past, hypoglycaemia awareness and socio-demographic factors. A zero...... treatment and treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor antagonists (ARBs) were associated with reduced risk. C-peptide concentration and HbA1c were not associated with the risk of severe hypoglycaemia. CONCLUSIONS: In this cohort of insulin-treated Type 2...

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

OpenAIRE

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

2013-01-01

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

Pneumatic-type surgical robot end-effector for laparoscopic surgical-operation-by-wire.

Science.gov (United States)

Lee, Chiwon; Park, Woo Jung; Kim, Myungjoon; Noh, Seungwoo; Yoon, Chiyul; Lee, Choonghee; Kim, Youdan; Kim, Hyeon Hoe; Kim, Hee Chan; Kim, Sungwan

2014-09-05

Although minimally invasive surgery (MIS) affords several advantages compared to conventional open surgery, robotic MIS systems still have many limitations. One of the limitations is the non-uniform gripping force due to mechanical strings of the existing systems. To overcome this limitation, a surgical instrument with a pneumatic gripping system consisting of a compressor, catheter balloon, micro motor, and other parts is developed. This study aims to implement a surgical instrument with a pneumatic gripping system and pitching/yawing joints using micro motors and without mechanical strings based on the surgical-operation-by-wire (SOBW) concept. A 6-axis external arm for increasing degrees of freedom (DOFs) is integrated with the surgical instrument using LabVIEW® for laparoscopic procedures. The gripping force is measured over a wide range of pressures and compared with the simulated ideal step function. Furthermore, a kinematic analysis is conducted. To validate and evaluate the system's clinical applicability, a simple peg task experiment and workspace identification experiment are performed with five novice volunteers using the fundamentals of laparoscopic surgery (FLS) board kit. The master interface of the proposed system employs the hands-on-throttle-and-stick (HOTAS) controller used in aerospace engineering. To develop an improved HOTAS (iHOTAS) controller, 6-axis force/torque sensor was integrated in the special housing. The mean gripping force (after 1,000 repetitions) at a pressure of 0.3 MPa was measured to be 5.8 N. The reaction time was found to be 0.4 s, which is almost real-time. All novice volunteers could complete the simple peg task within a mean time of 176 s, and none of them exceeded the 300 s cut-off time. The system's workspace was calculated to be 11,157.0 cm3. The proposed pneumatic gripping system provides a force consistent with that of other robotic MIS systems. It provides near real-time control. It is more durable than the

Chest cage angle difference and rotation of main thoracic curve are independent risk factors of postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis.

Science.gov (United States)

Yagi, Mitsuru; Takemitsu, Masakazu; Machida, Masafumi

2013-09-01

Retrospective case series of surgically treated adolescent patients with scoliosis. To assess the prevalence and independent risk factors for postoperative shoulder imbalance in surgically treated adolescent patients with idiopathic scoliosis. Despite recent reports that have identified risk factors for postoperative shoulder imbalance, the relative risks remain unclear. A retrospective review of 85 consecutive patients treated with thoracic fusion with a minimum 2-year follow-up (mean, 3.1 yr) was conducted to investigate the patient radiographical measurements and demographics. Shoulder height difference (SHD) was measured as the graded height difference of the soft tissue shadows. A SHD more than 2 cm indicated an unbalanced shoulder. Patient demographics and radiographical data were studied to determine risk factors for postoperative SHD. The potential risk factors included age, sex, Risser sign, Cobb angle, flexibility, and apical vertebral rotation (AVR) of the main curve, upper-instrumented vertebra level, SHD, and clavicle chest cage angle difference (CCAD). Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for postoperative shoulder imbalance. Of the 85 patients, 21 patients presented postoperative shoulder imbalance. The univariate analysis indicated age, Risser sign, Cobb angle of the main curve, AVR of the main curve, and CCAD as risk factors, but the multivariate logistic regression analysis showed that only AVR of the main curve and CCAD were independent risk factors for postoperative shoulder imbalance (AVR, P = 0.04, odds ratio (OR): 3.54; CCAD, P = 0.01, OR: 5.10). Postoperative shoulder imbalance was observed in 25% of the surgically treated adolescent patients. The CCAD and AVR of the main thoracic curve were independent risk factors for postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis. The significant correlation between CCAD and

Surgical treatment of advanced stage Freiberg disease

Directory of Open Access Journals (Sweden)

Emin Özkul

2014-09-01

Full Text Available Objective: Freiberg disesase is an avascular necrosis of the 2nd and 3rd metatarsal head and which kind of surgical option to be used is controversial in symptomatic patients. In this study the results of the advanced stage Freiberg’s disease patients, who were treated with surgery were evaluated. Methods: 12 patients (8 female, 4 male whose pain could not be solved with conservative method and underwent surgery (6 debridement, 3 osteotomy, 3 excision of the metatarsal head were included in this study. Themean age of the patients 19.1 (range 13- 31 and the mean follow-up 30.8(range 25-94 months. According to the Smillie classification 3 patients had type 5, 8 patients had type 4 and 1 patient had type 3 osteonecrosis. The results of the patients were evaluated according to Lesser Metatarsophalangeal-Interphalangeal Scale. Results: According to Lesser MetatarsophalangealInterphalangeal Scale 3 patients (%25 had excellent, 6 patients (%50 had good and 3 patients had poor results were obtained. 2 of 3 patients with poor results were type 5, and 1 patient was type 4 and all three patients underwent joint debridement. Conclusion:The method of surgical treatment of Freiberg disease determined according to the stage of the disease. Debridement alone in the treatment of patients with late stage is not enough, it should be combined with other methods.

Evaluation of Acute Aortic Dissection Type a Factors and Comparison the Postoperative Clinical Outcomes between Two Surgical Methods

Directory of Open Access Journals (Sweden)

Hasan Shemirani

2017-01-01

Full Text Available Background: Although aortic dissection is a rare disease, it causes high level of mortality. If ascending aorta gets involved in this disease, it is known as type A. According to small number of studies about this disease in Iran, this study conducted to detect the factors related to acute aortic dissection type A, its surgery consequences and the factors affecting them. Materials and Methods: In this historical cohort study, all patients having acute aortic dissection type A referring to Chamran Hospital from 2006 to 2012 were studied. The impact of two surgical methods including antegrade cerebral perfusion (ACP and retrograde cerebral one (RCP on surgical and long-term mortality and recurrence of dissection was determined. The relation of mortality rate and hemodynamic instability before surgery, age more than 70 years old, ejection fraction lower than 50%, prolonged cardiopulmonary bypass pump (CPBP time and excessive blood transfusion, was assessed. Results: Surgery and long-term mortality and recurrence of dissection were 35.3%, 30.8% and 30.4%. Surgical and long-term death in the patients being operated by ACP method was lower than those one being operated by RCP (P < 0.001. Excessive blood transfusion and unstable hemodynamic condition had significant effect on surgical mortality (P = 0.014, 0.030, respectively. CPBP time and unstable hemodynamic condition affected long-term mortality significantly (P = 0.002. Conclusion: The result found that ACP is the preferable kind of surgery in comparison with RCP according to the surgical and long-term mortality.

Comparing two intramedullary devices for treating trochanteric fractures: A prospective study

Directory of Open Access Journals (Sweden)

Kontogeorgakos Vasileios

2010-02-01

Full Text Available Abstract Background Intertrochanteric fractures are surgically treated by using different methods and implants. The optional type of surgical stabilization is still under debate. However, between devices with the same philosophy, different design characteristics may substantially influence fracture healing. This is a prospective study comparing the complication and final functional outcome of two intramedullary devices, the intramedullary hip screw (IMHS and the ENDOVIS nail. Materials and methods Two hundred fifteen patients were randomized on admission in two treatment groups. Epidemiology features and functional status was similar between two treatment groups. Fracture stability was assessed according to the Evan's classification. One hundred ten patients were treated with IMHS and 105 with ENDOVIS nail. Results There were no significant statistical differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In contrast, the number of total complications was significantly higher in the ENDOVIS nail group. Moreover, the overall functional and walking competence was superior in the patients treated with the IMHS nail. Conclusions These results indicate that the choice of the proper implant plays probably an important role in the final outcome of surgical treatment of intertrochanteric fractures. IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS nail proved more reliable in our study regarding nail insertion and overall uncomplicated outcome.

Current Surgical Options for the Management of Pediatric Glaucoma

Directory of Open Access Journals (Sweden)

Jose Morales

2013-01-01

Full Text Available Currently, there are numerous choices for the treatment of pediatric glaucoma depending on the type of glaucoma, the age of the patient, and other particularities of the condition discussed in this review. Traditionally, goniotomy and trabeculotomy ab externo have been the preferred choices of treatment for congenital glaucoma, and a variety of adult procedures adapted to children have been utilized for other types of pediatric glaucoma with variable results and complications. More recently, seton implantations of different types have become more popular to use in children, and newer techniques have become available including visualized cannulation and opening of Schlemm’s canal, deep sclerectomy, trabectome, and milder more directed cyclodestructive procedures such as endolaser and transcleral diode laser cyclophotocoagulation. This paper reviews the different surgical techniques currently available, their indications, results, and most common complications to allow the surgeon treating these conditions to make a more informed choice in each particular case. Although the outcome of surgical treatment in pediatric glaucoma has improved significantly, its treatment remains challenging.

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

A Patient-Assessed Morbidity to Evaluate Outcome in Surgically Treated Vestibular Schwannomas.

Science.gov (United States)

Al-Shudifat, Abdul Rahman; Kahlon, Babar; Höglund, Peter; Lindberg, Sven; Magnusson, Måns; Siesjo, Peter

2016-10-01

Outcome after treatment of vestibular schwannomas can be evaluated by health providers as mortality, recurrence, performance, and morbidity. Because mortality and recurrence are rare events, evaluation has to focus on performance and morbidity. The latter has mostly been reported by health providers. In the present study, we validate 2 new scales for patient-assessed performance and morbidity in comparison with different outcome tools, such as quality of life (QOL) (European Quality of Life-5 dimensions [EQ-5D]), facial nerve score, and work capacity. There were 167 total patients in a retrospective (n = 90) and prospective (n = 50) cohort of surgically treated vestibular schwannomas. A new patient-assessed morbidity score (paMS), a patient-assessed Karnofsky score (paKPS), the patient-assessed QOL (EQ-5D) score, work capacity, and the House-Brackmann facial nerve score were used as outcome measures. Analysis of paMS components and their relation to other outcomes was done as uni- and multivariate analysis. All outcome instruments, except EQ-5D and paKPS, showed a significant decrease postoperatively. Only the facial nerve score (House-Brackmann facial nerve score) differed significantly between the retrospective and prospective cohorts. Out of the 16 components of the paMS, hearing dysfunction, tear dysfunction, balance dysfunction, and eye irritation were most often reported. Both paMS and EQ-5D correlated significantly with work capacity. Standard QOL and performance instruments may not be sufficiently sensitive or specific to measure outcome at the cohort level after surgical treatment of vestibular schwannomas. A morbidity score may yield more detailed information on symptoms that can be relevant for rehabilitation and occupational training after surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Surgical management of radiation enterocolitis

International Nuclear Information System (INIS)

Sakaguchi, Masahiro; Katsumi, Masaharu; Ishimoto, Kiwao; Yamamoto, Shinji; Yukawa, Hirofumi; Koh, Kenzo; Yamaguchi, Kazuya; Ohta, Masataka; Hayashido, Motonori

1986-01-01

Radiotherapy for malignant tumors is effective and established. However, there are many complications in radiotherapy. A typical complication is radiation enterocolitis. It is difficult to treat severe histological damage to the irradiated tissues. This paper reports our experience with 26 patients with radiation enterocolitis for whom surgical treatment was given during a period of 16 years in our surgical department. The most frequent original disease requiring irradiation was cancer of the cervix uteri (15 cases) which was followed by cancer of the urinary bladder (7 cases). All of these patients had received external 60 Co irradiation. The ileum was the most frequent site of the lesion, followed by the rectum, sigmoid and descending colon. The period between the end of irradiation and the onset of enterocolitis ranged from 2 months to 10 years, with an average of 28 months. The main symptoms were intestinal obstruction in the ileum, and melena and fistula in the rectum and sigmoid colon. Intestinal resection was performed in 10 patients, a bypass operation in 4, and colostomy in 12. As to types of intestinal suture in these cases, Gambee's single layer method was thought useful from our experience. Colostomy as surgical management of melena and fistula did not yield satisfactory results. (author)

Surgical treatment of parastomal hernia

International Nuclear Information System (INIS)

Basti, Z.; Mayer, A.

2013-01-01

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

Late Consequential Surgical Bed Soft Tissue Necrosis in Advanced Oropharyngeal Squamous Cell Carcinomas Treated With Transoral Robotic Surgery and Postoperative Radiation Therapy

International Nuclear Information System (INIS)

Lukens, J. Nicholas; Lin, Alexander; Gamerman, Victoria; Mitra, Nandita; Grover, Surbhi; McMenamin, Erin M.; Weinstein, Gregory S.; O'Malley, Bert W.; Cohen, Roger B.; Orisamolu, Abimbola; Ahn, Peter H.; Quon, Harry

2014-01-01

Purpose: A subset of patients with oropharyngeal squamous cell carcinoma (OP-SCC) managed with transoral robotic surgery (TORS) and postoperative radiation therapy (PORT) developed soft tissue necrosis (STN) in the surgical bed months after completion of PORT. We investigated the frequency and risk factors. Materials and Methods: This retrospective analysis included 170 consecutive OP-SCC patients treated with TORS and PORT between 2006 and 2012, with >6 months' of follow-up. STN was defined as ulceration of the surgical bed >6 weeks after completion of PORT, requiring opioids, biopsy, or hyperbaric oxygen therapy. Results: A total of 47 of 170 patients (28%) had a diagnosis of STN. Tonsillar patients were more susceptible than base-of-tongue (BOT) patients, 39% (41 of 104) versus 9% (6 of 66), respectively. For patients with STN, median tumor size was 3.0 cm (range 1.0-5.6 cm), and depth of resection was 2.2 cm (range 1.0-5.1 cm). Median radiation dose and dose of fraction to the surgical bed were 6600 cGy and 220 cGy, respectively. Thirty-one patients (66%) received concurrent chemotherapy. Median time to STN was 2.5 months after PORT. All patients had resolution of STN after a median of 3.7 months. Multivariate analysis identified tonsillar primary (odds ratio [OR] 4.73, P=.01), depth of resection (OR 3.12, P=.001), total radiation dose to the resection bed (OR 1.51 per Gy, P<.01), and grade 3 acute mucositis (OR 3.47, P=.02) as risk factors for STN. Beginning May 2011, after implementing aggressive avoidance of delivering >2 Gy/day to the resection bed mucosa, only 8% (2 of 26 patients) experienced STN (all grade 2). Conclusions: A subset of OP-SCC patients treated with TORS and PORT are at risk for developing late consequential surgical bed STN. Risk factors include tonsillar location, depth of resection, radiation dose to the surgical bed, and severe mucositis. STN risk is significantly decreased with carefully avoiding a radiation dosage of >2 Gy/day to

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.

Treating tension-type headache -- an expert opinion

DEFF Research Database (Denmark)

Bendtsen, Lars; Jensen, Rigmor

2011-01-01

INTRODUCTION: Tension-type headache (TTH) is a highly prevalent disorder with enormous costs for the individual and the society. AREAS COVERED: Nonpharmacological and pharmacological treatments are reviewed. Electromyographic (EMG) biofeedback has a documented effect in TTH, while cognitive-behav...... and clarify how treatment programs can be optimized and combined to best suit the individual patient. Frequent TTH may be difficult to treat, but an acceptable result can usually be obtained by a combination of nonpharmacological and pharmacological treatments....

Surgical outcomes in two different age groups with Focal Cortical Dysplasia type II: Any real difference?

Science.gov (United States)

Ramírez-Molina, Jorge Luis; Di Giacomo, Roberta; Mariani, Valeria; Deleo, Francesco; Cardinale, Francesco; Uscátegui-Daccarett, Angélica María; Lorenzana, Pablo; Tassi, Laura

2017-05-01

Focal Cortical Dysplasias (FCDs) represent a common architectural cortical disorder underlying drug-resistant focal epilepsy. So far, studies aimed at evaluating whether age at surgery is a factor influencing surgical outcome are lacking, so that data on the comparison between patients harboring Type II FCD operated at younger age and those operated at adult age are still scarce. We compared presurgical clinical features and surgical outcomes of patients with histopathologically diagnosed Type II FCD undergoing surgery at an earlier age with those operated after 20 years of age. We retrospectively analyzed 1660 consecutive patients operated at the "Claudio Munari" Epilepsy Surgery Centre. There were 289 patients (17.4%) with a neuropathological diagnosis of Type II FCD. We included two different groups of patients, the first one including patients operated on at less than 6years, the second sharing the same seizure onset age but with delayed surgery, carried out after the age of 20. Seizure characteristics and, neuropsychological and postoperative seizure outcomes were evaluated by study group. Forty patients underwent surgery before the age of 6 and 66 patients after the age of 20. Surgical outcome was favorable in the whole population (72.6% were classified in Engel's Class Ia+Ic), independently from age at surgery. In the children group, 32 patients were classified in Class I, including 30 (75%) children in classes Ia and Ic. In the adult group, 53 belonged to Class I of whom 47 (71%) were in classes Ia and Ic. The percentage of permanent complications, the surgical outcomes, and AED withdrawal did not significantly differ by study group. Our results indicate that there is no difference between the groups, suggesting that outcome depends mainly on the histological findings and not on timing of surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Functional recovery and surgical indication in putaminal hemorrhage

International Nuclear Information System (INIS)

Fujitsu, Kazuhiko

1983-01-01

Forty-one cases of varied sized putaminal hemorrhage were classified into 4 types according to the precise localization on CT (Fig. 1). All cases with large-sized hemorrhage (more than 4-5 cm in the actual diameter) were treated surgically regardless of their types in CT classification. ADL was assessed 6 months after the onset in all 41 cases, and in 17 of these Standard Language Test of Aphasia (SLTA) was also given 1 to 3 months after the dominant hemispheric hemorrhage. Type I hemorrhage usually showed excellent ADL independently of the size of the hemorrhage (Table 3). In type II hemorrhage, the ADL is determined by the extent of the lesion and tended to deteriorate as the size of the hemorrhage increased (Table 4). Type III hemorrhage resumed less favorable ADL than the type II did (Table 5), and there was scarcely any functional recovery in Type IV hemorrhage (Table 6). On SLTA, impairment of the speaking ability was the prominant feature when the hemorrhage was primarily located in the anterior portion of the insula, while the hearing ability was more markedly impaired in the posteriorly located lesion. These location-dependent specific patterns of impairment on SLTA are schematically presented in Fig. 12. From these results described above, the author's CT classification is considered to be very useful not only in forecasting the prospects of functional recovery, but in determining the surgical indication in putaminal hemorrhage. (author)

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.

Parathyroidectomy in chronic kidney disease patients in Argentina: pre surgical studies, types of surgery, recurrence and persistence

Directory of Open Access Journals (Sweden)

Adriana Peñalba

2014-01-01

Full Text Available Introduction: Parathyroidectomy (PTx is the selecte treatment for patients with severe secondary hyperparathyroidism, refractory to medical treatment. There is not enough information about this procedure in Argentina, that is the reason why we performed this study. Methods: 255 patients with PTx were included from the year 2003 to 2007 on a voluntary register. Studies of pre-surgical localization, phosphocalcic metabolism laboratories before and after surgery were evaluated, and the type of surgical technique used. The persistence and recurrence of post-surgical hyperparathyroidism was analyzed. Results: The PTx rate was 2,7/1000 patients year. 83% of the patients had neck echography and 59% Sestamibi scans with Tc 99. There was a positive correlation (p<0,001 between the number of detected glands by echography and Sestamibi. The parathyroidectomy performed was: subtotal in 77%, total with self-implant in 14% and total without self-implant in 9%. There were significant falls of Ca and P, Alkaline Phosphatase and PTH (1744±788 pg/ml to 247±450 pg/ml; p<0.0001 post-surgical. 2.4 ±2,5 months after the PTx, 72% of patients had PTH <2 50 pg/ml, 19,8% had persistence and 8,3% had recurrence. According to the type of surgery, the persistence and recurrence were for subtotal PTx 22% and 8,3%, total PTx with implant 11% and 11%, and total PTx without selfimplant 13% and 4% respectively. The performance of the Sestamibi scan did not affect the PTx results. No noticeable differences were observed among the centers for persistence and recurrence. Conclusions: The PTx rate was very low, echography was the preferred method of pre-surgical localization, and subtotal PTx was the most used surgical technique. PTx was successful in most of the patients, and persistence and recurrence were not related to the technique.

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

Spine deformities in patients with Ehlers-Danlos syndrome, type IV - late results of surgical treatment

Directory of Open Access Journals (Sweden)

Tesiorowski Maciej

2010-11-01

Full Text Available Abstract Background Spinal deformities in Ehlers-Danlos syndrome are usually progressive and may require operative treatment. There is limited number of studies describing late results of surgery in this disease. Methods This is a retrospective study of the records of 11 patients with Ehlers-Danlos syndrome type IV, treated surgically between 1990 and 2007. All patients underwent surgical treatment for spinal deformity. Duration of operation, type of instrumentation, intraoperative blood loss, complications and number of additional surgeries were noted. Radiographic measurement was performed on standing AP and lateral radiographs acquired before surgery, just after and at final follow up. Results The mean follow up period was 5.5 ± 2.9 years (range 1-10 years. The mean preoperative thoracic and lumbar curve were 109.5 ± 19.9° (range 83° - 142° and 75.6 ± 26.7° (range 40° - 108° respectively. Posterior spine fusion alone was performed on 6 patients and combined anterior and posterior fusion (one- or two stage on 5 cases. Posterior segmental spinal instrumentation was applied with use of hooks, screws and wires. The mean postoperative thoracic and lumbar curve improved to 79.3 ± 16.1° (range 56° - 105° and 58.5 ± 27.7° (range 10° - 95° respectively, with a slight loss of correction during follow up. The average thoracic and lumbar correction was 26.4 ± 14.9% (range 5.3 - 50.4% and 26.3 ± 21.2% (range 7.9 - 75%. Postoperatively, the mean kyphosis was 79.5 ± 40.3° (range 21° -170°, and lordosis was 50.8 ± 18.6° (range 20° -79°. Hyperkyphosis increased during follow up while lordosis remained stable. Mean Th12-L2 angle was -3.5 ±9.9° (range -19° - 15° postoperatively and did not change significantly during follow up. Conclusions Huge spinal deformities in patients with Ehlers-Danlos syndrome require complex and extensive surgery. There is a big risk of sagittal imbalance in this group.

Exercise training improves glycemic control in long-standing insulin-treated type 2 diabetic patients

NARCIS (Netherlands)

Feyter, de H.M.M.L.; Praet, S.F.E.; Broek, van den N.M.A.; Kuipers, H.; Stehouwer, C.D.; Nicolay, K.; Prompers, J.J.; Loon, van L.J.C.

2007-01-01

Regular exercise represents an effective strategy to prevent and/or treat type 2 diabetes ( 1 , 2 ). However, the clinical benefits of exercise intervention in a vastly expanding group of long-standing insulin-treated type 2 diabetic patients with comorbidities are less evident. As these patients

Surgical approach to pineal tumours.

Science.gov (United States)

Pluchino, F; Broggi, G; Fornari, M; Franzini, A; Solero, C L; Allegranza, A

1989-01-01

During a period of 10 years (1977-1986) 40 cases of tumour of the pineal region have been treated at the Istituto Neurologico "C. Besta"-of Milan. Out of these 40 cases, 27 (67.5%) were in the paediatric (10-15 years) or juvenile (15-20 years) age at the time of operation. Since 1983 a specific diagnostic and therapeutic protocol has been adopted and thereafter direct surgical removal of the tumour was performed only when the neuroradiological investigations were highly suggestive of a benign extrinsic lesion. Sixteen cases in this series underwent direct surgical removal; in the remaining 24 cases stereotactic biopsy of the tumour was performed in the first instance. On the basis of the histological diagnosis obtained by this procedure surgical excision of the tumour (9 cases) or radiotherapy (15 cases) was then performed. 25 cases underwent surgical removal of the lesion. In all the cases the infratentorial supracerebellar approach as introduced by Krause and then modified by Stein was adopted. On analysis of the data of this series it was observed that in 25% of the cases completely benign resectable tumours were found; in 25% of the cases astrocytoma (grade I-II) which could be treated at least by partial removal were present; in 30% of the cases radiosensitive lesions were encountered. In the remaining 20% of the cases highly malignant tumours were found which should be treated only by radiotherapy and/or chemotherapy.

Measuring the Burden of Surgical Disease Averted by Emergency and Essential Surgical Care in a District Hospital in Papua New Guinea.

Science.gov (United States)

Stokes, Matthew A R; Guest, Glenn D; Mamadi, Perista; Seta, Westin; Yaubihi, Noel; Karawiga, Grace; Naidi, Billy; Watters, David A K

2017-03-01

Timely access to emergency and essential surgical care (EESC) and anaesthesia in low- and middle-income countries (LMICs) prevents premature death, minimises lifelong disability and reduces their economic impact on families and communities. Papua New Guinea is one of the poorest countries in the Pacific region, and provides much of its surgical care at a district hospital level. We aimed to evaluate the surgical capacity of a district hospital in PNG and estimate the effectiveness of surgical interventions provided. We performed a prospective study to calculate the number of DALYs averted for 465 patients treated with surgical care over a 3-month period (Sep-Nov 2013) in Alotau Hospital, Milne Bay Province, PNG (pop 210,000). Data were also collected on infrastructure, workforce, interventions provided and equipment available using the World Health Organization's Integrated Management of Emergency and Essential Surgical Care Toolkit, a survey to assess EESC and surgical capacity. We also performed a retrospective one-year audit of surgical, obstetric and anaesthetic care to provide context with regards to annual disease burden treated and surgical activity. EESC was provided by 11 Surgeons/Anaesthetists/Obstetricians (SAO) providers, equating to 5.7 per 100,000 population (including 4 nurse anaesthetists). They performed 783/100,000 procedures annually. Over the 3-month prospective study period, 4954 DALYs were averted by 465 surgical interventions, 52 % of which were elective. This equates to 18,330 DALYs averted annually or, approximately 18 % of the published but estimated disease burden in the Province in the 2013 Global Burden of Disease Study. The overall peri-operative mortality rate was 1.29 %, with 0.41 % for elective procedures and 2.25 % for emergencies. Much of the burden of surgical disease in Papua New Guinea presenting to Alotau General Hospital serving Milne Bay Province can be effectively treated by a small team providing emergency and

Efficacy and safety of sotagliflozin in treating diabetes type 1.

Science.gov (United States)

Rendell, Marc S

2018-02-01

Sotagliflozin is the first dual SGLT1/SGLT2 inhibitor developed for use in diabetes. Sotagliflozin blocks SGLT2 in the kidneys and SGLT1 in the intestines resulting in reduced early phase glucose absorption and increased blood levels of GLP-1 and PYY. Urinary glucose excretion is lower than with other agents as a result of decreased glucose absorption. The primary development effort to date has been in Type 1 diabetes. Areas covered: The published information on sotagliflozin is reviewed, along with the recent results of several pivotal Type 1 diabetes trials. Expert opinion: Sotagliflozin treatment lowers HbA1c and reduces glucose variability, with a trend to less hypoglycemic events. In the Type 1 trials, sotagliflozin treated individuals experienced DKA at a higher rate than placebo treated patients. An additional safety issue arises from the as yet unknown potential risks in women of child bearing potential in whom DKA is of utmost concern. The sotagliflozin development program has now been extended to trials in Type 2 diabetes, and long term studies will be needed to assess the benefits and risks of the agent in comparison to other currently marketed SGLT2 inhibitors.

Tension - Type - Headache treated by Positional Release Therapy: a case report.

Science.gov (United States)

Mohamadi, Marzieh; Ghanbari, Ali; Rahimi Jaberi, Abbas

2012-10-01

Tension Type Headache (T.T.H) is the most prevalent headache. Myofascial abnormalities & trigger points are important in this type of headache which can be managed by Positional Release Therapy (PRT). This is a report of a 47 years old female patient with Tension Type Headache treated by Positional Release Therapy for her trigger points. She had a constant dull headache, which continued all the day for 9 months. A physiotherapist evaluated the patient and found active trigger points in her cervical muscles. Then, she received Positional Release Therapy for her trigger points. After 3 treatment sessions, the patient's headache stopped completely. During the 8 months following the treatment she was without pain, and did not use any medication. Positional Release Therapy was effective in treating Tension Type Headache. This suggests that PRT could be an alternative treatment to medication in patients with T.T.H if the effectiveness of that can be confirmed by further studies. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

Combined Surgical Treatment of Gynecomastia

Directory of Open Access Journals (Sweden)

Yordanov Y.

2015-05-01

Full Text Available Surgical treatment of gynecomastia could present unique challenges for the plastic surgeon. Achieving a good balance between effectiveness of the selected approach and the satisfactory aesthetic outcome often is a difficult endeavor. Optimal surgical treatment involves a combination of liposuction and direct excision. In the present study the charts of 11 patients treated with suction-assisted liposuction and direct surgical excision were retrospectively reviewed; a special emphasis is placed on the surgical technique. The mean follow-up period of the patients was 11.6 months. No infection, hematoma, nipple-areola complex necrosis and nipple retraction was encountered in this series. The combined surgical treatment of gynecomastia has shown to be a reliable technique in both small and moderate breast enlargement including those with skin excess.

Surgical therapy in chronic pancreatitis.

Science.gov (United States)

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

2012-12-01

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas which causes chronic pain, as well as exocrine and endocrine failure in the majority of patients, together producing social and domestic upheaval and a very poor quality of life. At least half of patients will require surgical intervention at some stage in their disease, primarily for the treatment of persistent pain. Available data have now confirmed that surgical intervention may produce superior results to conservative and endoscopic treatment. Comprehensive individual patient assessment is crucial to optimal surgical management, however, in order to determine which morphological disease variant (large duct disease, distal stricture with focal disease, expanded head or small duct/minimal change disease) is present in the individual patient, as a wide and differing range of surgical approaches are possible depending upon the specific abnormality within the gland. This review comprehensively assesses the evidence for these differing approaches to surgical intervention in chronic pancreatitis. Surgical drainage procedures should be limited to a small number of patients with a dilated duct and no pancreatic head mass. Similarly, a small population presenting with a focal stricture and tail only disease may be successfully treated by distal pancreatectomy. Long-term results of both of these procedure types are poor, however. More impressive results have been yielded for the surgical treatment of the expanded head, for which a range of surgical options now exist. Evidence from level I studies and a recent meta-analysis suggests that duodenum-preserving resections offer benefits compared to pancreaticoduodenectomy, though the results of the ongoing, multicentre ChroPac trial are awaited to confirm this. Further data are also needed to determine which of the duodenum-preserving procedures provides optimal results. In relation to small duct/minimal change disease total pancreatectomy represents the only

The influence of surgical transection and anastomosis on the rate of cell proliferation in the colonic epithelium of normal and DMH-treated rats.

Science.gov (United States)

Barkla, D H; Tutton, P M

1983-10-01

Normal and DMH-treated male rats aged 18-20 weeks underwent surgical transection and anastomosis of the transverse colon. Animals were subsequently killed at intervals of 14, 30 and 72 days. Three hours prior to sacrifice animals were injected with vinblastine sulphate and mitotic indices were subsequently estimated in histological sections. Possible differences between experimental and control groups were tested using a Student's t-test. The results show that the accumulated mitotic indices in normal and DMH-treated colon are statistically similar. The results also show that transection and anastomosis stimulates cell division in both normal and DMH-treated colon and that the increase is of greater amplitude and more prolonged duration in the DMH-treated rats. Carcinomas developed close to the line of anastomosis in DMH-treated but not in control rats. The results support the hypothesis that non-specific injury to hyperplastic colonic epithelium promotes carcinogenesis.

Cardiovascular morbidity and mortality in surgically treated hyperthyroidism - a nation-wide cohort study with a long-term follow-up.

Science.gov (United States)

Ryödi, Essi; Salmi, Jorma; Jaatinen, Pia; Huhtala, Heini; Saaristo, Rauni; Välimäki, Matti; Auvinen, Anssi; Metso, Saara

2014-05-01

Previous studies suggest that patients with hyperthyroidism remain at an increased risk of cardiovascular morbidity even after restoring euthyroidism. The mechanisms of the increased risk and its dependency on the different treatment modalities of hyperthyroidism remain unclear. The aim of this long-term follow-up study was to compare the rate of hospitalizations for cardiovascular causes and the mortality in hyperthyroid patients treated surgically with an age- and gender-matched reference population. A population-based cohort study was conducted among 4334 hyperthyroid patients (median age 46 years) treated with thyroidectomy in 1986-2007 in Finland and among 12,991 reference subjects. Firstly, the hospitalizations due to cardiovascular diseases (CVD) were analysed until thyroidectomy. Secondly, the hazard ratios for any new hospitalization due to CVDs after the thyroidectomy were calculated in Cox regression analysis adjusted with the prevalent CVDs at the time of thyroidectomy. The risk of hospitalization due to all CVDs started to increase already 5 years before the thyroidectomy, and by the time of the operation, it was 50% higher in the hyperthyroid patients compared to the controls (P hyperthyroidism. Despite the increased CVD morbidity among the patients, there was no difference in cardiovascular mortality. The present study shows that hyperthyroidism increases the risk of hospitalization due to CVDs and the risk is sustained up to two decades after effective surgical treatment. However, there was no excess CVD mortality in the middle-aged patient cohort studied. © 2013 John Wiley & Sons Ltd.

The surgical treatment of acromioclavicular joint injuries

Science.gov (United States)

Boffano, Michele; Mortera, Stefano; Wafa, Hazem; Piana, Raimondo

2017-01-01

Acromioclavicular joint (ACJ) injuries are common, but their incidence is probably underestimated. As the treatment of some sub-types is still debated, we reviewed the available literature to obtain an overview of current management. We analysed the literature using the PubMed search engine. There is consensus on the treatment of Rockwood type I and type II lesions and for high-grade injuries of types IV, V and VI. The treatment of type III injuries remains controversial, as none of the studies has proven a significant benefit of one procedure when compared with another. Several approaches can be considered in reaching a valid solution for treating ACJ lesions. The final outcome is affected by both vertical and horizontal post-operative ACJ stability. Synthetic devices, positioned using early open or arthroscopic procedures, are the main choice for young people. Type III injuries should be managed surgically only in cases with high-demand sporting or working activities. Cite this article: EFORT Open Rev 2017;2:432–437. DOI: 10.1302/2058-5241.2.160085. PMID:29209519

Preoperative renal function and surgical outcomes in patients with acute type A aortic dissection†.

Science.gov (United States)

Imasaka, Ken-ichi; Tayama, Eiki; Tomita, Yukihiro

2015-04-01

There are few data concerning the impact of preoperative renal function, assessed using estimated glomerular filtration rate, on surgical outcomes following acute type A aortic dissection. We investigated the accuracy of estimated glomerular filtration rate (in ml/min/1.73 m(2)) in predicting in-hospital mortality and postoperative renal replacement therapy in such cases. We reviewed 114 consecutive patients with non-dialysis-dependent renal dysfunction who underwent thoracic aortic surgery for acute type A aortic dissection between 1997 and 2012. Preoperative renal function was categorized as normal (estimated glomerular filtration rate >90; n = 15) or as mild (60-89; n = 39), moderate I (45-59; n = 39), moderate II (30-44; n = 14) or severe (15-29; n = 7) renal dysfunction. In-hospital mortality was 14.9%. Eighteen (15.8%) of 114 patients required renal replacement therapy. A more severe stage stratified by preoperative estimated glomerular filtration rate levels could effectively predict postoperative renal replacement therapy (area under the receiver operating characteristic curve 0.786). The best cut-off value of estimated glomerular filtration rate for predicting postoperative renal replacement therapy was 60 (sensitivity 95%, specificity 59%). On multiple regression analysis, the independent preoperative and intraoperative risk factors for postoperative renal replacement therapy were estimated glomerular filtration rate (P replacement (P replacement therapy (OR, 5.47; P regression analysis. Preoperative estimated glomerular filtration rate can effectively predict the need for renal replacement therapy after surgery for acute type A aortic dissection. However, it is not an effective diagnostic tool to predict in-hospital mortality. The complexity of the characteristics of patients who undergo surgical procedures may make prediction of surgical outcomes difficult. Risk models to predict hospital mortality and morbidities are needed to assist clinicians in

Surgical management of giant posterior communicating artery aneurysms.

Science.gov (United States)

Velat, Gregory J; Zabramski, Joseph M; Nakaji, Peter; Spetzler, Robert F

2012-09-01

Giant posterior communicating artery (PCoA) aneurysms (> 25 mm) are rare lesions associated with a poor prognosis and high rates of morbidity and mortality. To review the clinical results of giant PCoA aneurysms surgically treated at our institution, focusing on operative nuances. All cases of giant PCoA aneurysms treated surgically at our institution were identified from a prospectively maintained patient database. Patient demographic factors, medical comorbidities, rupture status, neurological presentation, clinical outcomes, and surgical records were critically reviewed. From 1989 to 2010, 11 patients (10 women) underwent surgical clipping of giant PCoA aneurysms. Presenting signs and symptoms included cranial nerve palsies, diminished mental status, headache, visual changes, and seizures. Five aneurysms were ruptured on admission. All aneurysms were clipped primarily except 1, which was treated by parent artery sacrifice and extracranial-to-intracranial bypass after intraoperative aneurysm rupture. Perioperative morbidity and mortality rates were 36% (4 of 11) and 18.3% (2 of 11), respectively. Excellent or good clinical outcomes, defined as modified Rankin Scale scores ≤ 2, were achieved in 86% (5 of 6) of patients available for long-term clinical follow-up (mean, 12.5 ± 13.6 months). Giant PCoA aneurysms are rare vascular lesions that may present with a variety of neurological signs and symptoms. These lesions can be successfully managed surgically with satisfactory morbidity and mortality rates. To the best of our knowledge, this is the largest surgical series of giant PCoA aneurysms published to date.

[Urgent surgical treatment of gastric volvulus related to upside-down stomach syndrome].

Science.gov (United States)

Hána, L; Kasalický, M; Koblihová, E; Suchánek, Š; Horažďovský, P; Ryska, M

2015-12-01

Upside-down stomach syndrome is a rare type of a large paraoesophageal hiatal hernia, which requires an immediate surgical treatment in case of incarceration. The authors present a case report of a 53-year-old male patient with gastric volvulus related to the upside-down stomach syndrome. Surgical treatment was complicated by an injury to distal oesophagus, which was successfully treated using a self-expandable metallic stent among other methods. Despite the complicated postoperative course with a necessity of reoperation, insertion of an oesophageal stent, thoracotomy for a mediastinal abscess and secondary healing of the laparotomy, the patient was discharged in a good condition with healed oesophageal perforation and laparotomy after 52 days.

Characteristics of the patients undergoing surgical treatment for pneumothorax: A descriptive study.

Science.gov (United States)

Cakmak, Muharrem; Yuksel, Melih; Kandemir, Mehmet Nail

2016-05-01

To identify the characteristic features of pneumothorax patients treated surgically. The retrospective study was conducted at Gazi Yasargil Education and Research Hospital Thoracic Surgery Clinic, Diyarbakir, Turkey and comprised records of pneumothorax patients from January 2004 to December 2014. They were divided into two groups as spontaneous and traumatic. Patients who had not undergone any surgical intervention were excluded. Mean age, gender distribution, location of the disease, type of pneumothorax, and treatment method were noted. Among patients with spontaneous pneumothorax, age and months distribution, smoking habits, pneumothorax size, and treatment method were assessed. The effect of gender, location, comorbid disease, smoking, subgroup of disease, and pneumothorax size on surgical procedures were also investigated. The mean age of the 672 patients in the study was 34.5±6.17 years. There were 611(91%) men and 61(9%) women. Disease was on the right side in 360(53.6%) patients, on the left side in 308(45.8%), and bilateral in 4(0.59%). Besides, 523(77.8%) patients had spontaneous, and 149(22.7%) had traumatic pneumothorax. Overall, 561(83.5%) patients had been treated with tube thoracostomy, whereas 111(16.5%) were treated with thoracotomy/thoracoscopic surgery. The presence of comorbid diseases, being primary, and being total or subtotal according to partial were found to create predisposition to thoracotomy/ thoracoscopic surgery (ppneumothorax being total, the presence of comorbid diseases, and the increase in pneumothorax size, thoracotomy or thoracoscopic surgery is preferred.

Resolution of type 2 diabetes following gastric bypass surgery: involvement of gut-derived glucagon and glucagonotropic signalling?

DEFF Research Database (Denmark)

Knop, Filip Krag

2009-01-01

Certain types of bariatric surgical procedures have proved not only to be effective with regard to treating obesity, but they also seem to be associated with endocrine changes which independently of weight loss give rise to remission of type 2 diabetes. Currently, it is speculated that surgical re......-derived glucagonotropic signalling as putative diabetogenic signals of the foregut hypothesis. In the present paper the hypotheses describing the glucose-lowering mechanisms of bariatric surgical procedures sharing the common feature of a bypass of the duodenum and the proximal jejunum are outlined and a possible role...

Surgical versus non-surgical management for pleural empyema.

Science.gov (United States)

Redden, Mark D; Chin, Tze Yang; van Driel, Mieke L

2017-03-17

thoracotomy versus tube thoracostomy and VATS versus tube thoracostomy. We pooled data for meta-analysis where appropriate. We performed a subgroup analysis for children along with a sensitivity analysis for studies that used fibrinolysis in non-surgical treatment arms.The comparison of open thoracotomy versus thoracostomy drainage included only one study in children, which reported no deaths in either treatment arm. However, the trial showed a statistically significant reduction in mean hospital stay of 5.90 days for those treated with primary thoracotomy. It also showed a statistically significant reduction in procedural complications for those treated with thoracotomy compared to thoracostomy drainage. We downgraded the quality of the evidence for length of hospital stay and procedural complications outcomes to moderate due to the small sample size.The comparison of VATS versus thoracostomy drainage included seven studies, which we pooled in a meta-analysis. There was no statistically significant difference in mortality or procedural complications between groups. This was true for both adults and children with or without fibrinolysis. However, mortality data were limited: one study reported one death in each treatment arm, and seven studies reported no deaths. There was a statistically significant reduction in mean length of hospital stay for those treated with VATS. The subgroup analysis showed the same result in adults, but there was insufficient evidence to estimate an effect for children. We could not perform a separate analysis for fibrinolysis for this outcome because all included studies used fibrinolysis in the non-surgical arms. We downgraded the quality of the evidence to low for mortality (due to wide confidence intervals and indirectness), and moderate for other outcomes in this comparison due to either high heterogeneity or wide confidence intervals. Our findings suggest there is no statistically significant difference in mortality between primary surgical and

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.

Technical considerations for surgical intervention of Jones fractures.

Science.gov (United States)

Mendicino, Robert W; Hentges, Matthew J; Mendicino, Michael R; Catanzariti, Alan R

2013-01-01

Jones fractures are a common injury treated by foot and ankle surgeons. Surgical intervention is recommended because of the high rate of delayed union, nonunion, and repeat fracture, when treated conservatively. Percutaneous intramedullary screw fixation is commonly used in the treatment of these fractures. We present techniques that can increase the surgical efficiency and decrease the complications associated with percutaneous delivery of internal fixation. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

MicroRNA-196a & microRNA-101 expression in Barrett's oesophagus in patients with medically and surgically treated gastro-oesophageal reflux

Directory of Open Access Journals (Sweden)

Bright Tim

2011-02-01

Full Text Available Abstract Background Proton pump inhibitor (PPI medication and surgical fundoplication are used for the control of gastro-oesophageal reflux in patients with Barrett's oesophagus, but differ in their effectiveness for both acid and bile reflux. This might impact on the inflammatory processes that are associated with progression of Barrett's oesophagus to cancer, and this may be evident in the gene expression profile and microRNA expression pattern in Barrett's oesophagus mucosa. We hypothesised that two miRNAs with inflammatory and oncogenic roles, miR-101 and miR-196a, are differentially expressed in Barrett's oesophagus epithelium in patients with reflux treated medically vs. surgically. Findings Mucosal tissue was obtained at endoscopy from patients with Barrett's oesophagus whose reflux was controlled by proton pump inhibitor (PPI therapy (n = 20 or by fundoplication (n = 19. RNA was extracted and the expression of miR-101 and miR-196a was measured using real-time reverse transcription - polymerase chain reaction. There were no significant differences in miR-101 and miR-196a expression in Barrett's oesophagus epithelium in patients treated by PPI vs. fundoplication (p = 0.768 and 0.211 respectively. Secondary analysis showed a correlation between miR-196a expression and Barrett's oesophagus segment length (p = 0.014. Conclusion The method of reflux treatment did not influence the expression of miR-101 and miR-196a in Barrett's oesophagus. This data does not provide support to the hypothesis that surgical treatment of reflux better prevents cancer development in Barrett's oesophagus. The association between miR-196a expression and Barrett's oesophagus length is consistent with a tumour promoting role for miR-196a in Barrett's oesophagus.

MicroRNA-196a & microRNA-101 expression in Barrett's oesophagus in patients with medically and surgically treated gastro-oesophageal reflux

Science.gov (United States)

2011-01-01

Background Proton pump inhibitor (PPI) medication and surgical fundoplication are used for the control of gastro-oesophageal reflux in patients with Barrett's oesophagus, but differ in their effectiveness for both acid and bile reflux. This might impact on the inflammatory processes that are associated with progression of Barrett's oesophagus to cancer, and this may be evident in the gene expression profile and microRNA expression pattern in Barrett's oesophagus mucosa. We hypothesised that two miRNAs with inflammatory and oncogenic roles, miR-101 and miR-196a, are differentially expressed in Barrett's oesophagus epithelium in patients with reflux treated medically vs. surgically. Findings Mucosal tissue was obtained at endoscopy from patients with Barrett's oesophagus whose reflux was controlled by proton pump inhibitor (PPI) therapy (n = 20) or by fundoplication (n = 19). RNA was extracted and the expression of miR-101 and miR-196a was measured using real-time reverse transcription - polymerase chain reaction. There were no significant differences in miR-101 and miR-196a expression in Barrett's oesophagus epithelium in patients treated by PPI vs. fundoplication (p = 0.768 and 0.211 respectively). Secondary analysis showed a correlation between miR-196a expression and Barrett's oesophagus segment length (p = 0.014). Conclusion The method of reflux treatment did not influence the expression of miR-101 and miR-196a in Barrett's oesophagus. This data does not provide support to the hypothesis that surgical treatment of reflux better prevents cancer development in Barrett's oesophagus. The association between miR-196a expression and Barrett's oesophagus length is consistent with a tumour promoting role for miR-196a in Barrett's oesophagus. PMID:21352563

A qualitative study exploring the views, attitudes and beliefs of patients and health professionals towards exercise intervention for people who are surgically treated for lung cancer.

Science.gov (United States)

Crandall, K; Maguire, R; Campbell, A; Kearney, N

2018-03-01

Surgical removal remains the best curative option for patients diagnosed with early-stage lung cancer. However, it is also associated with significant morbidity and reduced quality of life. Interventions to improve patient outcomes are required. This study aimed to explore the views, attitudes and beliefs of key stakeholders on exercise intervention for people who are surgically treated for lung cancer to inform the development of future interventions. Focus groups and individual interviews were carried out at two Scottish sites. The study was guided by the Health Action Process Approach behaviour change model. A total of 23 (12 patients and 11 health professionals) participated in the study. The data analysis resulted in three main themes: attitudes and beliefs, external factors and intervention design. The results highlighted certain key elements that should be included in an exercise intervention, such as the need for supervised sessions, an element of individualisation and the perceived social benefits of exercising with others. This study emphasises the importance of including key stakeholders in the development of complex interventions such as exercise and provides important information for the development of future exercise intervention trials for people who are surgically treated for lung cancer. © 2018 John Wiley & Sons Ltd.

[Experience of the surgical management of the esophageal achalasia in a tertiary care hospital].

Science.gov (United States)

Barajas-Fregoso, Elpidio Manuel; Romero-Hernández, Teodoro; Sánchez-Fernández, Patricio Rogelio; Fuentes-Orozco, Clotilde; González-Ojeda, Alejandro; Macías-Amezcua, Michel Dassaejv

2015-01-01

Achalasia is a primary esophageal motor disorder. The most common symptoms are: dysphagia, chest pain, reflux and weight loss. The esophageal manometry is the standard for diagnosis. The aim of this paper is to determine the effectiveness of the surgical management in patients with achalasia in a tertiary care hospital. A case series consisting of achalasia patients, treated surgically between January and December of 2011. Clinical charts were reviewed to obtain data and registries of the type of surgical procedure, morbidity and mortality. Fourteen patients were identified, with an average age of 49.1 years. The most common symptoms were: dysphagia, vomiting, weight loss and pyrosis. Eight open approaches were performed and six by laparoscopy, with an average length of cardiomyotomy of 9.4 cm. Eleven patients received an antireflux procedure. The effectiveness of procedures performed was 85.7 %. Surgical management offered at this tertiary care hospital does not differ from that reported in other case series, giving effectiveness and safety for patients with achalasia.

Clustering in surgical trials - database of intracluster correlations

Directory of Open Access Journals (Sweden)

Cook Jonathan A

2012-01-01

Full Text Available Abstract Background Randomised trials evaluation of surgical interventions are often designed and analysed as if the outcome of individual patients is independent of the surgeon providing the intervention. There is reason to expect outcomes for patients treated by the same surgeon tend to be more similar than those under the care of another surgeon due to previous experience, individual practice, training, and infrastructure. Such a phenomenon is referred to as the clustering effect and potentially impacts on the design and analysis adopted and thereby the required sample size. The aim of this work was to inform trial design by quantifying clustering effects (at both centre and surgeon level for various outcomes using a database of surgical trials. Methods Intracluster correlation coefficients (ICCs were calculated for outcomes from a set of 10 multicentre surgical trials for a range of outcomes and different time points for clustering at both the centre and surgeon level. Results ICCs were calculated for 198 outcomes across the 10 trials at both centre and surgeon cluster levels. The number of cases varied from 138 to 1370 across the trials. The median (range average cluster size was 32 (9 to 51 and 6 (3 to 30 for centre and surgeon levels respectively. ICC estimates varied substantially between outcome type though uncertainty around individual ICC estimates was substantial, which was reflected in generally wide confidence intervals. Conclusions This database of surgical trials provides trialists with valuable information on how to design surgical trials. Our data suggests clustering of outcome is more of an issue than has been previously acknowledged. We anticipate that over time the addition of ICCs from further surgical trial datasets to our database will further inform the design of surgical trials.

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.

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.

Long-term functional outcome after surgical repair of cranial cruciate ligament disease in dogs.

Science.gov (United States)

Mölsä, Sari H; Hyytiäinen, Heli K; Hielm-Björkman, Anna K; Laitinen-Vapaavuori, Outi M

2014-11-19

Cranial cruciate ligament (CCL) rupture is a very common cause of pelvic limb lameness in dogs. Few studies, using objective and validated outcome evaluation methods, have been published to evaluate long-term (>1 year) outcome after CCL repair. A group of 47 dogs with CCL rupture treated with intracapsular, extracapsular, and osteotomy techniques, and 21 healthy control dogs were enrolled in this study. To evaluate long-term surgical outcome, at a minimum of 1.5 years after unilateral CCL surgery, force plate, orthopedic, radiographic, and physiotherapeutic examinations, including evaluation of active range of motion (AROM), symmetry of thrust from the ground, symmetry of muscle mass, and static weight bearing (SWB) of pelvic limbs, and goniometry of the stifle and tarsal joints, were done. At a mean of 2.8 ± 0.9 years after surgery, no significant differences were found in average ground reaction forces or SWB between the surgically treated and control dog limbs, when dogs with no other orthopedic findings were included (n = 21). However, in surgically treated limbs, approximately 30% of the dogs had decreased static or dynamic weight bearing when symmetry of weight bearing was evaluated, 40-50% of dogs showed limitations of AROM in sitting position, and two-thirds of dogs had weakness in thrust from the ground. The stifle joint extension angles were lower (P <0.001) and flexion angles higher (P <0.001) in surgically treated than in contralateral joints, when dogs with no contralateral stifle problems were included (n = 33). In dogs treated using the intracapsular technique, the distribution percentage per limb of peak vertical force (DPVF) in surgically treated limbs was significantly lower than in dogs treated with osteotomy techniques (P =0.044). The average long-term dynamic and static weight bearing of the surgically treated limbs returned to the level of healthy limbs. However, extension and flexion angles of the surgically treated stifles

Recurrent Complete Pharyngo-Oesophageal Stricture Treated by Multidisciplinary Anterograde-Retrograde Endoscopic Dilation

Directory of Open Access Journals (Sweden)

Paulo Castro Soares

2016-10-01

Full Text Available Complete pharyngo-oesophageal stricture (PES after radiotherapy for head and neck cancer is a relatively rare and difficult complication to manage. Historically this condition has been treated surgically, but endoscopic approaches are now available. We present a 61-year-old man with an epidermoid carcinoma of the supraglottic stage and a micro-invasive epidermoid carcinoma of the oropharynx treated surgically and subsequently by adjuvant radiotherapy. Eight months after the end of the radiotherapy, a complete PES was diagnosed and treated with a combined anterograde-retrograde endoscopic dilation (CARD. The procedure was performed using a transoral anterograde progression with a rigid pharyngoscope and a retrograde progression with an extra-slim nasal endoscope using the percutaneous gastrostomy already in place. Using both transillumination and direct visualisation from both sides of the complete stenosis patency was restored between the neopharynx and the oesophagus. Despite the use of an endoprosthesis, the complete PES recurred and the technique had to be performed a second time. Illustrating the complexity of the case different types of endoprosthesis and several dilations had to be performed for our patient to achieve and maintain a normal oral intake. This case report illustrates that even in complicated recurrent radiation-induced complete PES a CARD can be performed safely and successfully using different types of endoprosthesis.

Successful surgical repair of acute type A aortic dissection without the use of blood products.

Science.gov (United States)

Papalexopoulou, N; Attia, R Q; Bapat, V N

2013-10-01

We report successful surgical treatment of type A aortic dissection in a Jehovah's Witness without the use of any blood products. An interposition graft replacement of the ascending aorta was carried out. This was under right axillo-atrial cardiopulmonary bypass with antegrade cerebral perfusion via right a subclavian and left carotid cannula for 24 minutes at 28°C. Body temperature was kept at 32°C throughout. Autologous transfusion was deployed using cell salvage and a preoperative haemodilution technique. The patient was given tranexamic acid, desmopressin, recombinant factor VIIa, folic acid and epoetin alfa. Patients who object to transfusion represent a significant challenge, especially those who are at a high risk of coagulopathy associated with inherent aortic dissection leading to perturbed haemodynamics, cardiopulmonary bypass and hypothermic circulatory arrest. Type A aortic dissection repair is possible in patients refusing the use of blood products with blood salvage techniques and synthetic products that can limit the risk of bleeding. Minimal hypothermia is vital to preserve platelet function and avoid coagulopathy. Thus, a combination of normothermic/minimal hypothermia and antegrade cerebral protection with a blood conservation strategy can be deployed for a successful surgical outcome in aortic dissection without transfusion.

SURGICAL TREATMENT OF TROCHANTERIC FRACTURES BY GAMMA3 NAIL

Directory of Open Access Journals (Sweden)

Aleksandar Vukićević

2010-09-01

Full Text Available Fractures of the greater trochanter rank amongst severe injuries of bone tissue. They occur most frequently in patients over 65 years of age, nearly all of whom are diagnosed with osteoporosis. Non-surgical treatment does not prove to be satisfactory and results in high mortality rate. Surgical treatment is a method of fracture treatment of the trochanteric region, which enables early activation and thus prevents numerous complications in bedridden patients. Gamma3 nails are one of the most state-of-the-art implants for trochanteric fracture fixation. The implant is easy to embed, which does not require a large surgical team. This implant embedding requires the least invasive surgery and complications are rare.This paper describes 47 patients who received surgical treatment and is focused on the first nine months of 2009. The patients were treated at the Orthopaedics Ward of Health Centre Valjevo. They were in their seventies, average age: 72.21 years, with female sex prevailing (63.82%. The outcome was as follows: excellent in 65.96%, good in 17.02% and satisfactory in 4.25% of patients. Surface infections occurred in 6.38% of patients. One implant broke.We had one death outcome in the early post-surgical treatment.Surgical treatment of trochanteric fractures by Gamma3 implants proved very effective as it resulted in few complications and numerous excellent functional and anatomic outcomes. Thus we recommend it as an option when decision on treatment of this type of fractures is made.

Laryngotracheoesophageal Cleft Type 3 and Severe Laryngotracheomalacia; Delayed Surgical Repair, a Treatment Challenge with an Excellent Outcome

Directory of Open Access Journals (Sweden)

Ahmad Khaleghnejad

Full Text Available Laryngotracheoesophageal clefts (LTEC are rare malformations which involve the upper respiratory and digestive tract. Surgical repair should be undertaken promptly to maintain a secure airway and prevent serious pulmonary aspiration. This paper reports the first case of LTEC type 3 with severe laryngotracheomalacia that was brought to Mofid children's hospital in late infancy with a poor health status. Delayed defect correction was our team strategy for the patient when she had achieved good weight gain. At the age of 22 months in collaboration with the pediatric surgical and otolaryngologist team, the repair of the laryngeal cleft was done with lateral open approach method. She was discharged with tracheostomy and gastrostomy. In the next six months follow up after the surgery tracheostomy decannulation and gastrostomy tube removal were done and the infant is now in regular follow-up. Keywords: Laryngotracheoesophageal clefts, Laryngotracheomalacia, Surgical repair

Surgical Approaches to the Oral Cavity Primary and Neck

International Nuclear Information System (INIS)

Shah, Jatin P.

2007-01-01

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

Endovascular Versus Open Surgical Intervention in Patients with Takayasu's Arteritis: A Meta-analysis.

Science.gov (United States)

Jung, Jae Hyun; Lee, Young Ho; Song, Gwan Gyu; Jeong, Han Saem; Kim, Jae-Hoon; Choi, Sung Jae

2018-06-01

Although medical treatment has advanced, surgical treatment is needed to control symptoms of Takayasu's arteritis (TA), such as angina, stroke, hypertension, or claudication. Endovascular or open surgical intervention is performed; however, there are few comparative studies on these methods. This meta-analysis and systematic review aimed to examine the outcome of surgical treatment of TA. A meta-analysis comparing outcomes of endovascular and open surgical intervention was performed using MEDLINE and Embase. This meta-analysis included only observational studies, and the evidence level was low to moderate. Data were pooled and analysed using a fixed or random effects model with the I 2 statistic. The included studies involved a total of 770 patients and 1363 lesions, with 389 patients treated endovascularly and 420 treated by surgical revascularization. Restenosis was more common with endovascular than open surgical intervention (odds ratio [OR] 5.18, 95% confidence interval [CI] 2.78-9.62; p open surgical intervention patients in the coronary artery, supra-aortic branches, and renal artery. In both the active and inactive stages, restenosis was more common in those treated endovascularly than in those treated by open surgery. However, stroke occurred less often with endovascular intervention than with open surgical intervention (OR 0.33, 95% CI 0.12-0.90; p = .003). Mortality and complications other than stroke and mortality did not differ between endovascular and open surgical intervention. This meta-analysis has shown a lower risk of restenosis with open surgical intervention than with endovascular intervention. Stroke was generally more common with open surgical intervention than with endovascular intervention. However, there were differences according to the location of the lesion, and the risk of stroke in open surgery is higher when the supra-aortic branches are involved rather than the renal arteries. Copyright © 2018 European Society for Vascular

Postoperative peri-axillary seroma following axillary artery cannulation for surgical treatment of acute type A aortic dissection

Directory of Open Access Journals (Sweden)

Katsanos Konstantinos

2010-05-01

Full Text Available Abstract The arterial cannulation site for optimal tissue perfusion and cerebral protection during cardiopulmonary bypass (CPB for surgical treatment of acute type A aortic dissection remains controversial. Right axillary artery cannulation confers significant advantages, because it provides antegrade arterial perfusion during cardiopulmonary bypass, and allows continuous antegrade cerebral perfusion during hypothermic circulatory arrest, thereby minimizing global cerebral ischemia. However, right axillary artery cannulation has been associated with serious complications, including problems with systemic perfusion during cardiopulmonary bypass, problems with postoperative patency of the artery due to stenosis, thrombosis or dissection, and brachial plexus injury. We herein present the case of a 36-year-old Caucasian man with known Marfan syndrome and acute type A aortic dissection, who had direct right axillary artery cannulation for surgery of the ascending aorta. Postoperatively, the patient developed an axillary perigraft seroma. As this complication has, not, to our knowledge, been reported before in cardiothoracic surgery, we describe this unusual complication and discuss conservative and surgical treatment options.

Surgical Treatment Results of Acute Acromioclavicular Injuries

Directory of Open Access Journals (Sweden)

Mahmoud Jabalameli

2010-02-01

Full Text Available Background Different methods of surgical treatment for acromioclavicular(ACjoint injury were considered in the literature. The purpose of the study was to compare intra- articular AC repair technique with the extra-articular coracoclavicular repair technique for the patients with Rockwood type III and VAC joint injury when indicated.Methods: Nineteen consecutive patients with Rockwood type III and VAC joint injury  were treated with intra-articular (Group I - 12 cases and extra-articular (Group II - 7cases repair technique between 1380 - 1386, and the results reviewed. When the diagnosis was established, the mean age of the patients was 32.5 years (Range, 18 - 60; group I and II 31.8 years (Range, 18 - 60 and 34 years (Range, 22 - 58 respectively. The mean duration of postoperative follow - up was 24 months. The Constant shoulder scoring system was applied to obtain clinical results.   Results: Only in group I, the post-surgical complication was associated with fiber allergy, wound infection and pin site infection in two patients respectively. No pain was detected in fourteen cases. Four patients in group I had occasional mild pain during sport activity, while one case in this group reported severe pain during resting which prevented the patient from activity. Also, there was an ossification in thirteen patients particularly in group I. Clinical results showed the mean constant shoulder score was 93.4 in group I and 97.1 in group II.Conclusion: At the time of the follow - up, there was a clear difference between both groups regarding to postoperative pain and discomfort.Therefore, it seemed that potential cause of pain was due to postoperative complications. An interesting postoperative complication without interfere in the functional outcome was coracoclavicular space ossification in most cases. This was probably because of soft tissue injury during the operation.It seemed that surgical treatment of Rockwood type III and VAC joint injuries

Duration of surgical-orthodontic treatment.

Science.gov (United States)

Häll, Birgitta; Jämsä, Tapio; Soukka, Tero; Peltomäki, Timo

2008-10-01

To study the duration of surgical-orthodontic treatment with special reference to patients' age and the type of tooth movements, i.e. extraction vs. non-extraction and intrusion before or extrusion after surgery to level the curve of Spee. The material consisted files of 37 consecutive surgical-orthodontic patients. The files were reviewed and gender, diagnosis, type of malocclusion, age at the initiation of treatment, duration of treatment, type of tooth movements (extraction vs. non-extraction and levelling of the curve of Spee before or after operation) and type of operation were retrieved. For statistical analyses two sample t-test, Kruskal-Wallis and Spearman rank correlation tests were used. Mean treatment duration of the sample was 26.8 months, of which pre-surgical orthodontics took on average 17.5 months. Patients with extractions as part of the treatment had statistically and clinically significantly longer treatment duration, on average 8 months, than those without extractions. No other studied variable seemed to have an impact on the treatment time. The present small sample size prevents reliable conclusions to be made. However, the findings suggest, and patients should be informed, that extractions included in the treatment plan increase chances of longer duration of surgical-orthodontic treatment.

Long-term effectiveness of surgical treatment of ectopic atrial tachycardia.

Science.gov (United States)

Prager, N A; Cox, J L; Lindsay, B D; Ferguson, T B; Osborn, J L; Cain, M E

1993-07-01

The purpose of this study was to determine the long-term clinical outcome of patients with ectopic atrial tachycardias treated surgically. Ectopic atrial tachycardia is an uncommon arrhythmia that can be symptomatic and is associated with the development of a cardiomyopathy. Management strategies are not well defined because of the paucity of data on the long-term effectiveness of pharmacologic and nonpharmacologic therapies. The long-term clinical impact of medical and surgical therapy was determined in 15 consecutive patients with ectopic atrial tachycardia. All 15 patients were initially treated with antiarrhythmic drugs (mean 5.7 +/- 2.2 drugs/patient). An effective drug regimen was identified in only 5 (33%) of the 15 patients; the remaining 10 patients were treated surgically. In each, individualized surgical procedures were guided by computer-assisted intraoperative mapping, with atrial plaques comprising up to 156 electrodes. Focal ablation was performed in four patients and atrial isolation procedures in six. The 10 patients treated surgically were followed up a mean of 4 +/- 3.2 years. Ectopic atrial tachycardia recurred in one patient. A permanent pacemaker was implanted in two patients, one of whom also required reoperation for constrictive pericarditis. There were no operative deaths. Ectopic atrial tachycardia recurred in three (60%) of the five patients discharged on antiarrhythmic drug therapy during a mean follow-up interval of 6.4 +/- 4.3 years. There was one nonarrhythmic death. Map-guided surgery demonstrated long-term efficacy in abolishing symptoms in 9 of the 10 patients with ectopic atrial tachycardia. Results demonstrate that surgery is effective for patients with ectopic atrial tachycardias who are not easily treated with antiarrhythmic drugs.

Deriving DICOM surgical extensions from surgical workflows

Science.gov (United States)

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

2007-03-01

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

[Pre- and post-surgical orthodontic treatment for skeletal open bite].

Science.gov (United States)

Zhou, Y; Hu, W; Sun, Y

2001-05-01

To Study the principles and rules of pre- and post-surgical orthodontic treatment for skeletal open bite patients. Thirty-two surgically treated open bite cases were analyzed, of which 9 were males, and 23 were females, aged from 16 to 38. Open bite was from 1 to 8.5 mm, average was 4 mm. 31 patients were Class III malocclusion, while 1 patient was Class II malocclusion. 1. Totally 21 patients were treated with orthodontics before and after orthognathic surgery, while 8 patients had pre-surgical orthodontics only, and other 3 had post-surgical orthodontics only. The duration for pre-surgical orthodontics was from 4 to 33 months, average was 12 months. The duration for post-surgical orthodontics was from 3 to 17 months, average was 8.5 months. 2. Presurgical orthodontic treatment included: Alignment of arches, decompensation of incisors, avoiding extrusion of incisors, and slight expansion of arches for coordination of arches. 3. Post-surgical orthodontic treatment included: Closure of residual spaces in the arches, realignment of arches, vertical elastics and Class II or III intermaxillary elastics. Skeletal open bites require combined orthodontic-orthognathic surgery for optimal and esthetical pleasing results.

Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study.

Science.gov (United States)

Zrounba, Hugues; Lutz, Jean-Christophe; Zink, Simone; Wilk, Astrid

2014-09-01

Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used. Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP(®) plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%). We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material. The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation. The two approaches used in this study appeared to be safe with good aesthetic results. Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

[Clinical value of "Kou mode of hepatic hilar anastomosis" in resection of type III or IV hepatic hilar cholangiocarcinoma].

Science.gov (United States)

He, Xiao-dong; Liu, Wei; Tao, Lian-yuan; Zhang, Zhen-huan; Cai, Lei; Zhang, Shuang-min

2009-08-01

To evaluate the surgical technique of "Kou mode of hepatic hilar anastomosis" in the treatment for type III or IV hilar cholangiocarcinoma. The clinical data of 89 patients with type III or IV hilar cholangiocarcinoma surgically treated in our department between Jan. 1990 and Jan. 2008 were retrospectively analyzed. Since January 2000, "Kou mode of hepatic hilar anastomosis" was performed for some patients with advanced hilar cholangiocarcinoma. The patients were divided into two groups: group A treated between 1990 and 1999, group B between 2000 and 2008. The rate of resection, therapeutic efficacy and complications in these two groups were compared, respectively. Of the 37 cases with hilar cholangiocarcinoma in group A, 4 were surgically treated (10.8%), with 1 (2.7%) radical resection and 3 (8.1%) palliative resection. Among the 52 cases with hilar cholangiocarcinoma in the group B, 35 (67.3%) received surgical resection, of them 15 (28.8%) underwent radical resection and 20 (38.5%) had palliative resection. Twenty-eight of these 35 cases underwent the "Kou mode of hepatic hilar anastomosis". The resection rate of advanced hilar cholangiocarcinoma in the group B was significantly higher than that in group A (P anastomosis" developed bile leakage to a varying degree and recovered after drainage and symptomatic treatment. The resection rate of type III or IV advanced hilar cholangiocarcinoma can be remarkably improved by using a novel alternative surgical technique called "Kou mode of hepatic hilar anastomosis". However, the long-term outcome still needs to be determined by close follow-up and further observation.

Clinical signs and outcome of dogs treated medically for degenerative lumbosacral stenosis: 98 cases (2004-2012).

Science.gov (United States)

De Decker, Steven; Wawrzenski, Lauren A; Volk, Holger A

2014-08-15

To compare clinical signs of dogs treated medically or surgically for degenerative lumbosacral stenosis (DLSS) and assess outcome after medical treatment. Retrospective case series. Client-owned dogs treated medically (n = 49) or surgically (49) for DLSS. Medical records from 2004 to 2012 were reviewed. Dogs were included if they had clinical signs, clinical examination findings, and MRI abnormalities consistent with DLSS. Several variables were compared between surgically and medically treated dogs: age, sex, duration of clinical signs, presence or absence of neurologic deficits, urinary and fecal incontinence, concurrent medical conditions, and medical treatment before referral. Medical treatment after obtaining a final diagnosis of DLSS consisted of restricted exercise in combination with anti-inflammatory and analgesic drugs. Surgical treatment consisted of dorsal lumbosacral laminectomy. Outcome for medically treated dogs was obtained via a standardized questionnaire. Neurologic deficits were observed significantly more often in surgically treated dogs. Surgically treated dogs had unsuccessful medical treatment before referral significantly more often than did medically treated dogs. Thirty-one of 49 (63.3%) medically treated dogs were available for follow-up evaluation. Of these 31 dogs, 17 (55%) were managed successfully, 10 (32.3%) were managed unsuccessfully and underwent surgical treatment, 3 (9.7%) were euthanized because of progression of clinical signs, and 1 (3.2%) was alive but had an increase in severity of clinical signs after medical management. Clinical signs differed in dogs treated medically or surgically for DLSS. Medical treatment for dogs with DLSS was associated with a fair prognosis.

Surgical outcomes of Majewski osteodysplastic primordial dwarfism Type II with intracranial vascular anomalies.

Science.gov (United States)

Teo, Mario; Johnson, Jeremiah N; Bell-Stephens, Teresa E; Marks, Michael P; Do, Huy M; Dodd, Robert L; Bober, Michael B; Steinberg, Gary K

2016-12-01

OBJECTIVE Majewski osteodysplastic primordial dwarfism Type II (MOPD II) is a rare genetic disorder. Features of it include extremely small stature, severe microcephaly, and normal or near-normal intelligence. Previous studies have found that more than 50% of patients with MOPD II have intracranial vascular anomalies, but few successful surgical revascularization or aneurysm-clipping cases have been reported because of the diminutive arteries and narrow surgical corridors in these patients. Here, the authors report on a large series of patients with MOPD II who underwent surgery for an intracranial vascular anomaly. METHODS In conjunction with an approved prospective registry of patients with MOPD II, a prospectively collected institutional surgical database of children with MOPD II and intracranial vascular anomalies who underwent surgery was analyzed retrospectively to establish long-term outcomes. RESULTS Ten patients with MOPD II underwent surgery between 2005 and 2012; 5 patients had moyamoya disease (MMD), 2 had intracranial aneurysms, and 3 had both MMD and aneurysms. Patients presented with transient ischemic attack (TIA) (n = 2), ischemic stroke (n = 2), intraparenchymal hemorrhage from MMD (n = 1), and aneurysmal subarachnoid hemorrhage (n = 1), and 4 were diagnosed on screening. The mean age of the 8 patients with MMD, all of whom underwent extracranial-intracranial revascularization (14 indirect, 1 direct) was 9 years (range 1-17 years). The mean age of the 5 patients with aneurysms was 15.5 years (range 9-18 years). Two patients experienced postoperative complications (1 transient weakness after clipping, 1 femoral thrombosis that required surgical repair). During a mean follow-up of 5.9 years (range 3-10 years), 3 patients died (1 of subarachnoid hemorrhage, 1 of myocardial infarct, and 1 of respiratory failure), and 1 patient had continued TIAs. All of the surviving patients recovered to their neurological baseline. CONCLUSIONS Patients with MMD

Early experience using the da Vinci Surgical System for the treatment of mediastinal tumors.

Science.gov (United States)

Kajiwara, Naohiro; Taira, Masahiro; Yoshida, Koichi; Hagiwara, Masaru; Kakihana, Masatoshi; Usuda, Jitsuo; Uchida, Osamu; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

2011-10-01

The da Vinci Surgical System has been used in only a few cases for treating mediastinal tumors in Japan. Recently, we used the da Vinci Surgical System for various types of anterior and middle mediastinal tumors in clinical practice. We report our early experience using the da Vinci Surgical System. Seven patients gave written informed consent to undergo robotic surgery for mediastinal tumor dissection using the da Vinci Surgical System. We evaluated the safety and feasibility of this system for the surgical treatment of mediastinal tumors. Two specialists in thoracic surgery who are certified to use the da Vinci S Surgical System and another specialist acted as an assistant performed the tumor dissection. We were able to access difficult-to-reach areas, such as the mediastinum, safely. All the resected tumors were classified as benign tumors histologically. The average da Vinci setting time was 14.0 min, the average working time was 55.7 min, and the average overall operating time was 125.9 min. The learning curve for the da Vinci setup and manipulation time was short. Robotic surgery enables mediastinal tumor dissection in certain cases more safely and easily than conventional video-assisted thoracoscopic surgery and less invasively than open thoracotomy.

Surgical Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

Directory of Open Access Journals (Sweden)

Rendevski Vladimir

2017-12-01

Full Text Available The aim of the paper was to evaluate the surgical outcome in patients with spontaneous supratentorial intracerebral hemorrhage (ICH after surgical intervention, in respect to the initial clinical conditions, age, sex, hemispheric side and anatomic localization of ICH. Thirty-eight surgically treated patients with spontaneous supratentorial intracerebral hemorrhage were included in the study. The surgical outcome was evaluated three months after the initial admission, according to the Glasgow Outcome Scale (GOS. The surgical treatment was successful in 14 patients (37%, whereas it was unsuccessful in 24 patients (63%. We have detected a significant negative correlation between the Glasgow Coma Scale (GCS scores on admission and the GOS scores after three months, suggesting worse neurological outcome in patients with initially lower GCS scores. The surgical outcome in patients with ICH was not affected by the sex, the hemispheric side and the anatomic localization of ICH, but the age of the patients was estimated as a significant factor for their functional outcome, with younger patients being more likely to be treated successfully. The surgical outcome is affected from the initial clinical state of the patients and their age. The treatment of ICH is still an unsolved clinical problem and the development of new surgical techniques with larger efficiency in the evacuation of the hematoma is necessary, thus making a minimal damage to the normal brain tissue, as well as decreasing the possibility of postoperative bleeding.

Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience.

Science.gov (United States)

Polistena, Andrea; Sanguinetti, Alessandro; Lucchini, Roberta; Galasse, Segio; Avenia, Stefano; Monacelli, Massimo; Johnson, Louis Banka; Jeppsson, Bengt; Avenia, Nicola

2017-02-01

Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.

Level of headaches after surgical aneurysm clipping decreases significantly faster compared to endovascular coiled patients

Directory of Open Access Journals (Sweden)

Athanasios K. Petridis

2017-04-01

Full Text Available In incidental aneurysms, endovascular treatment can lead to post-procedural headaches. We studied the difference of surgical clipping vs. endovascular coiling in concern to post-procedural headaches in patients with ruptured aneurysms. Sixtyseven patients with aneurysmal subarachnoidal haemorrhage were treated in our department from September 1st 2015 - September 1st 2016. 43 Patients were included in the study and the rest was excluded because of late recovery or highgrade subarachnoid bleedings. Twenty-two were surgical treated and twenty-one were interventionally treated. We compared the post-procedural headaches at the time points of 24 h, 21 days, and 3 months after treatment using the visual analog scale (VAS for pain. After surgical clipping the headache score decreased for 8.8 points in the VAS, whereas the endovascular treated population showed a decrease of headaches of 3.3 points. This difference was highly statistical significant and remained significant even after 3 weeks where the pain score for the surgically treated patients was 0.68 and for the endovascular treated 1.8. After 3 months the pain was less than 1 for both groups with surgically treated patients scoring 0.1 and endovascular treated patients 0.9 (not significant. Clipping is relieving the headaches of patients with aneurysm rupture faster and more effective than endovascular coiling. This effect stays significant for at least 3 weeks and plays a crucial role in stress relieve during the acute and subacute ICU care of such patients.

Relationship between occurrence of surgical complications and hospital finances.

Science.gov (United States)

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

2013-04-17

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

Rate of displacement for Jakob Type 1 lateral condyle fractures treated with a cast.

Science.gov (United States)

Zale, C; Winthrop, Z A; Hennrikus, W

2018-04-01

The aim of this retrospective study is to report the rate of displacement of Jakob Type 1 lateral condyle fractures that were initially treated in a cast. We performed a retrospective review of all patients that were treated for a non-displaced (Jakob Type 1 displaced and were converted to a closed pinning treatment plan with a conversion rate of 8.5%. There was a mean of 13.2 days (4 to 21) between treatment by initial casting and closed pinning. This study demonstrates an 8.5% displacement and conversion rate from cast treatment to closed pinning for initially non-displaced Jakob Type 1 lateral condyle fractures of the humerus. The internal oblique radiograph is most accurate to determine displacement. We recommend obtaining an internal oblique view at initial evaluation and at follow-up in the cast for lateral condyle fractures. To minimize movement at the fracture site, we recommend treating Jakob Type 1 lateral condyle fractures with a long arm cast with the elbow at 90° and the forearm in the supine position with a sling-loop design. IV - retrospective therapeutic study.

Patient-based outcomes following surgical debridement and flap coverage of digital mucous cysts.

Science.gov (United States)

Hojo, Junya; Omokawa, Shohei; Shigematsu, Koji; Onishi, Tadanobu; Murata, Keiichi; Tanaka, Yasuhito

2016-01-01

The purpose of this prospective cohort study was to evaluate patient-based outcomes and complications following excision of mucous cysts, joint debridement, and closure with one of three types of local flaps. From 2000-2011, 35 consecutive patients with 37 digital mucous cysts were treated surgically. The surgical procedure included excision of the cyst together with the attenuated skin, joint debridement on the affected side including capsulectomy, and removal of osteophytes. Depending on the size and location of the cyst, the skin defect was covered by a transposition flap (31 cysts), an advancement flap (two cysts), or a rotation flap (four cysts). At an average follow-up time of 4 years, 4 months, there was no wound infection, flap necrosis, or joint stiffness. Preoperative nail ridging resolved in seven of nine fingers, and no nail deformities developed after surgery. One cyst, treated with a transposition flap, recurred 10 months after surgery. The average satisfaction score for the affected finger significantly improved from 4.3 to 6.8, and the average pain score decreased from 4.7 to 2.3. This treatment protocol provides reliable results. Patients were satisfied with the reduction of associated pain and the postoperative appearance of the treated finger, and postoperative complications were minimal.

Ruptured hepatoblastoma treated with primary surgical resection

African Journals Online (AJOL)

The remaining part of the left lobe of the liver, including segment IV ... lung, and brain metastasis, and was treated with comfort measures only ... tumor was noted on the right side of the liter. ... invasive and can control the bleeding to allow for a complete workup and ... Our two cases presented here add to the growing body.

Doppler ultrasound and magnetic resonance for evaluation of patients treated surgically for aortic coarctation

International Nuclear Information System (INIS)

Canteli, B.; Saez, F.; Garcia, F.; Cabrera, A.; Galdeano, J.M.; Rodriguez, O.

1994-01-01

Doppler ultrasound and magnetic resonance were performed in a series of 39 patients who had been treated surgically for aortic coarctation. The purpose was to assess the different Doppler gradients, comparing the findings with morphological data disclosed by magnetic resonance. The aortic caliber in the operative field was pathological in 7 patients (ratio between the caliber at the level of the lesion and that of descending aorta of less than 0.7). When the patients were considered as a group. Doppler ultrasound did not show satisfactory sensitivity (29%-43%), specificity (74%) or positive predictive value (17%-23%). Only the negative predictive value (85%-88%) presented more favorable results. When the Subgroup of patients without associated cardiac abnormalities or collateral circulation was studied alone, the following results were found: sensitivity, 100%; specificity, 81%-90%, positive predictive value, 33%-50%, negative predictive value, 100%, similar to those reported in the literature. Thus, we consider that Doppler ultrasound is a harmless and low cost diagnostic method that is highly suitable for follow-up of these patients, within certain limits. Magnetic resonance is the method of choice for the noninvasive assessment of aortic morphology. (Author)

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

Surgical repair of a rupture of the pectoralis major muscle

Science.gov (United States)

Pochini, Alberto De Castro; Andreoli, Carlos Vicente; Ejnisman, Benno; Maffulli, Nicola

2015-01-01

Muscle rupture is rarely treated surgically. Few reports of good outcomes after muscular suture have been published. Usually, muscular lesions or partial ruptures heal with few side effects or result in total recovery. We report a case of an athlete who was treated surgically to repair a total muscular rupture in the pectoralis major muscle. After 6 months, the athlete returned to competitive practice. After a 2-year follow-up, the athlete still competes in skateboard championships. PMID:25716033

To compare the gingival melanin repigmentation after diode laser application and surgical removal.

Science.gov (United States)

Mahajan, Gaurav; Kaur, Harjit; Jain, Sanjeev; Kaur, Navnit; Sehgal, Navneet Kaur; Gautam, Aditi

2017-01-01

The aim of the present study is to compare the gingival melanin repigmentation after diode laser application and surgical removal done by scraping with Kirkland knife. This study was a randomized split-mouth study where 10 patients presenting with unattractive, diffuse, dark brown to black gingival discoloration on the facial aspect of the maxillary gingiva were treated by diode laser application and surgical removal and followed up for 3-, 6-, and 9-month intervals. The results showed a statistically significant difference in repigmentation between the groups at the interval of 3 months ( P = 0.040), but the difference was statistically not significant at 6 months ( P = 0.118) and 9 months ( P = 0.146). On surgically treated sites, all cases showed repigmentation of the gingiva, but in laser treated, there were two individuals which did not show repigmentation of the gingiva even at the end of 9-month observation time. The incidence of repigmentation was slightly less in laser-treated sites as compared to surgical depigmentation although the difference was statistically significant only up to 3 months.

Omnidirectional Internal Fixation by Double Approaches for Treating Rüedi-Allgöwer Type III Pilon Fractures.

Science.gov (United States)

Dai, Chong-Hua; Sun, Jun; Chen, Kun-Quan; Zhang, Hui-Bo

In the present study, we explored the effectiveness and complications of omnidirectional internal fixation using a double approach for treating Rüedi-Allgöwer type III pilon fractures. A retrospective analysis was performed of 19 cases of Rüedi-Allgöwer type III unilateral closed pilon fracture. With preoperative preparation and correct surgical timing, the reduction was performed using anteromedial and posterolateral approaches, and the fracture fragments were fixed by omnidirectional internal fixation. Imaging evaluation was performed using the Burwell-Charnley scoring system. The Johner-Wruhs scoring system was used to assess the functional status of the patients. A comprehensive evaluation of efficacy was performed using a 5-point Likert score. The complications were also recorded and analyzed. All patients were followed up for an average of 16.2 months. The operative incisions of 15 cases healed by primary intent and with delayed healing in 4. All patients had achieved bony union at an average of 16 weeks postoperatively. No deep infection, broken nail or withdrawn nail, exposed plate, or skin flap necrosis occurred. The Burwell-Charnley imaging evaluation showed that 14 patients had anatomic reduction of the articular surface and 5 had acceptable reduction. Using the Johner-Wruhs scoring system, the results were excellent for 8, good for 7, fair for 2, and poor for 2 patients; the combined rate of excellent and good results was 78.9%. The Likert score of efficacy self-reported by the patients was 3 to 4 points for 12 patients, 2 points for 4 patients, and 0 to 1 point for 3 patients. The Likert score of therapeutic efficacy reported by the physicians was 3 to 4 points for 10 patients, 2 points for 5 patients, and 0 to 1 point for 4 patients. Omnidirectional internal fixation using double approaches was an effective method to treat Rüedi-Allgöwer type III pilon fractures with satisfactory reduction and rigid fixation, good joint function recovery, and

Surgical management of tubal pregnancy

NARCIS (Netherlands)

Mol, F.

2013-01-01

The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and

Trends in the incidence rate, type and treatment of surgically verified endometriosis - a nationwide cohort study.

Science.gov (United States)

Saavalainen, Liisu; Tikka, Tuulia; But, Anna; Gissler, Mika; Haukka, Jari; Tiitinen, Aila; Härkki, Päivi; Heikinheimo, Oskari

2018-01-01

To study the trends in incidence rate, type and surgical treatment, and patient characteristics of surgically verified endometriosis during 1987-2012. This is a register-based cohort study. We identified women receiving their first diagnosis of endometriosis in surgery from the Finnish Hospital Discharge Register (FHDR). Quality of the FHDR records was assessed bidirectionally. The age-standardized incidence rates of the first surgically verified endometriosis was assessed by calendar year. The cohort comprises 49 956 women. The quality assessment suggested the FHDR data to be of good quality. The most common diagnosis, ovarian endometriosis (46%), was associated with highest median age 38.5 years (interquartile range 31.0-44.8) and the second most common diagnosis, peritoneal endometriosis (40%), with median age 34.9 years (28.6-41.7). Between 1987 and 2012, a decrease was observed in the median age, from 38.8 (32.3-43.6) to 34.0 (28.9-41.0) years, and in the age-standardized incidence rate from 116 [95% confidence interval (CI) 112-121] to 45 (42-48) per 100 000 women. The proportion of hysterectomy as a first surgical treatment decreased from 38 to 19%, whereas that of laparoscopy increased from 42 to 73% when comparing 1987-1995 with 1996-2012. This nationwide cohort of surgically verified endometriosis showed a decrease in the incidence rate and in the patient age at the time of first diagnosis, even though the proportion of laparoscopy has increased. The number of hysterectomies has decreased. These changes are likely to reflect the evolving diagnostics, increasing awareness of endometriosis, and effective use of medical treatment before surgery. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA).

Science.gov (United States)

Conzelmann, Lars Oliver; Weigang, Ernst; Mehlhorn, Uwe; Abugameh, Ahmad; Hoffmann, Isabell; Blettner, Maria; Etz, Christian D; Czerny, Martin; Vahl, Christian F

2016-02-01

Acute aortic dissection type A (AADA) is an emergency with excessive mortality if surgery is delayed. Knowledge about independent predictors of mortality on surgically treated AADA patients is scarce. Therefore, this study was conducted to identify pre- and intraoperative risk factors for death. Between July 2006 and June 2010, 2137 surgically treated patients with AADA were enrolled in a multicentre, prospective German Registry for Acute Aortic Dissection type A (GERAADA), presenting perioperative status, operative strategies, postoperative outcomes and AADA-related risk factors for death. Multiple logistic regression analysis was performed to identify the influence of different parameters on 30-day mortality. Overall 30-day mortality (16.9%) increased with age [adjusted odds ratio (OR) = 1.121] and among patients who were comatose (adjusted OR = 3.501) or those who underwent cardiopulmonary resuscitation (adjusted OR = 3.751; all P risk for death was (adjusted OR for one organ = 1.651, two organs = 2.440, three organs or more = 3.393, P 0.1). No significant risk factors, but relevant increases in mortality, were determined in patients suffering from hemiparesis pre- and postoperatively (each P risk factors for death in AADA, influencing the outcome of surgically treated AADA patients. Comatose and resuscitated patients have the poorest outcome. Cannulation sites and operative techniques did not seem to affect mortality. Short operative times are associated with better outcomes. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Is Priapism Really A Surgical Emergency? | Adetayo | Nigerian ...

African Journals Online (AJOL)

Fifty-six (56) patients with 60 episodes of priapism treated surgically over a 14 year period were studied. The aim was to determine whether this condition is a surgical emergency or not. The mean age of the patients was 23.6+8.7 years. All the patients who had their priapism relieved within 24 hours (one day) of onset were ...

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.)

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

International Nuclear Information System (INIS)

Courtney, Malachi; Ayyagari, Raj R.

2015-01-01

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.)

Frequency and risk factors of severe hypoglycemia in insulin-treated type 2 diabetes

DEFF Research Database (Denmark)

Akram, Kamran; Pedersen-Bjergaard, Ulrik; Borch-Johnsen, Knut

2006-01-01

Intensive treatment regimens including early initiation of insulin treatment are important to prevent late complications in type 2 diabetes. The assumed risk of severe hypoglycemia (SH) is a major barrier to initiation of insulin treatment. To assess the relevance of this risk we evaluated...... the frequency of SH as reported in the literature. Using Medline and Embase search we identified 11 studies (5 retrospective and 6 prospective) including at least 50 patients with insulin-treated type 2 diabetes followed for at least 6 months in which frequency of SH was reported. The incidence of SH....... Only few studies looked into the impact of risk factors on the rate of SH. Impaired hypoglycemia awareness, high age, long duration of diabetes and insulin therapy increased the risk, while no association was found with HbA1c and insulin dose. The present knowledge of SH in insulin-treated type 2...

Cost analysis of surgically treated pressure sores stage III and IV.

NARCIS (Netherlands)

Filius, A.; Damen, T.H.; Schuijer-Maaskant, K.P.; Polinder, S.; Hovius, S.E.R.; Walbeehm, E.T.

2013-01-01

Health-care costs associated with pressure sores are significant and their financial burden is likely to increase even further. The aim of this study was to analyse the direct medical costs of hospital care for surgical treatment of pressure sores stage III and IV. We performed a retrospective chart

Postirradiation lesions of the brachial plexus. Results of surgical treatment

International Nuclear Information System (INIS)

LeQuang, C.

1989-01-01

In a series of 103 cases of postirradiation lesions of the brachial plexus operated on between 1978 and 1986--of which 60 patients have been reviewed with a follow up from 2 to 9 years--the surgical results are analyzed according to an anatomic classification, a clinical classification, and the surgical procedures. We conclude that the radiation plexitis should be treated surgically and at the earliest possible time after the onset of paresthesias. Also, the surgical procedure which gives the best results is neurolysis with pedicled omentoplasty

Spinal intramedullary ependymoma: surgical approaches and outcome.

Science.gov (United States)

Borges, Lawrence F

2018-02-01

Intramedullary ependymomas are uncommon tumors that can occur within the medullary substance of the spinal cord. Despite this difficult location, they are typically benign tumors that can most often be removed completely with an acceptable surgical risk. Therefore, the recommended management approach is usually surgical excision. This review will consider the historical context in which surgeons began treating these tumors and then review the more recent literature that guides their current management.

[Surgical therapy of gynecomastia].

Science.gov (United States)

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

2011-09-01

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

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.

Surgical Site Infection by Corynebacterium macginleyi in a Patient with Neurofibromatosis Type 1

Directory of Open Access Journals (Sweden)

Bruno Cacopardo

2013-01-01

Full Text Available Corynebacterium (C. macginleyi is a gram positive, lipophilic rod, usually considered a colonizer of skin and mucosal surfaces. Several reports have associated C. macginleyi with ocular infections, such as conjunctivitis and endophthalmitis. However, even if rare, extraocular infections from C. macginleyi may occur, especially among immunocompromised patients and patients with indwelling medical devices. We report herein the first case of surgical site infection by C. macginleyi after orthopaedic surgery for the correction of kyphoscoliosis in a patient with neurofibromatosis type 1. Our patient developed a nodular granulomatous lesion of about two centimetres along the surgical scar, at the level of C4-C5, with purulent discharge and formation of a fistulous tract. Cervical magnetic resonance imaging showed the presence of a two-centimetre fluid pocket in the subcutaneous tissue. Several swabs were collected from the borders of the lesion as well as from the exudate, with isolation of C. macginleyi. The isolate was susceptible to beta-lactams, cotrimoxazole, linezolid, and glycopeptides but resistant to quinolones, third-generation cephalosporins, and erythromycin. Two 30-day courses of antibiotic therapy with amoxicillin/clavulanate (1 g three times/day and cotrimoxazole (800/160 mg twice a day were administered, obtaining a complete healing of the lesion.

Non-surgical and non-chemical attempts to treat echinococcosis: do they work?

Directory of Open Access Journals (Sweden)

Tamarozzi Francesca

2014-01-01

Full Text Available Cystic echinococcosis (CE and alveolar echinococcosis (AE are chronic, complex and neglected diseases. Their treatment depends on a number of factors related to the lesion, setting and patient. We performed a literature review of curative or palliative non-surgical, non-chemical interventions in CE and AE. In CE, some of these techniques, like radiofrequency thermal ablation (RFA, were shelved after initial attempts, while others, such as High-Intensity Focused Ultrasound, appear promising but are still in a pre-clinical phase. In AE, RFA has never been tested, however, radiotherapy or heavy-ion therapies have been attempted in experimental models. Still, application to humans is questionable. In CE, although prospective clinical studies are still lacking, therapeutic, non-surgical drainage techniques, such as PAIR (puncture, aspiration, injection, re-aspiration and its derivatives, are now considered a useful option in selected cases. Finally, palliative, non-surgical drainage techniques such as US- or CT-guided percutaneous biliary drainage, centro-parasitic abscesses drainage, or vascular stenting were performed successfully. Recently, endoscopic retrograde cholangiopancreatography (ERCP-associated techniques have become increasingly used to manage biliary fistulas in CE and biliary obstructions in AE. Development of pre-clinical animal models would allow testing for AE techniques developed for other indications, e.g. cancer. Prospective trials are required to determine the best use of PAIR, and associated procedures, and the indications and techniques of palliative drainage.

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.

Symptomatic unruptured cerebral aneurysms. Features and surgical outcome

International Nuclear Information System (INIS)

Date, Isao

2010-01-01

Development of less invasive imaging studies, such as magnetic resonance angiography, has increased the chances that unruptured cerebral aneurysms are found. The rupture risk of 'symptomatic' aneurysms is higher than for 'asymptomatic' aneurysms; so 'symptomatic' aneurysms are more often surgically treated. Many reviews examine 'asymptomatic' unruptured cerebral aneurysms, but few evaluate 'symptomatic' aneurysms. The author has treated many patients with symptomatic unruptured cerebral aneurysms and found that improved cranial nerve signs can be expected if the surgical treatment is performed before the symptoms become irreversible; the critical period is approximately 3 months. It is important to suppress the pulsation of the aneurysms compressing the cranial nerves; both a clipping procedure and endovascular coiling are effective. Cranial nerve signs are more commonly the symptoms of unruptured cerebral aneurysms, but large to giant aneurysms can also be the causes of hemiparesis, hydrocephalus, epilepsy, or even cerebral infarction. This review summarizes the features and surgical outcome of symptomatic unruptured cerebral aneurysms. (author)

Interventions for treating proximal humeral fractures in adults.

Science.gov (United States)

Handoll, Helen H G; Ollivere, Benjamin J; Rollins, Katie E

2012-12-12

displaced and/or complex fractures, compared surgical versus conservative treatment. Pooled results of patient-reported functional scores at one year from three trials (153 participants) showed no statistically significant difference between the two groups (standardised mean difference -0.10, 95% CI -0.42 to 0.22; negative results favour surgery). Quality of life based on the EuroQol results scores from three trials (153 participants) showed non-statistically significant differences between the two groups at three time points up to 12 months. However, the pooled EuroQol results at two years (101 participants) from two trials run concurrently from the same centre were significantly in favour of the surgical group. There was no significant difference between the two groups in mortality (8/98 versus 5/98; RR 1.55, 95% CI 0.55 to 4.36; 4 trials). Significantly more surgical group patients had additional or secondary surgery (18/112 versus 5/111; RR 3.36, 95% CI 1.33 to 8.49; 5 trials). This is equivalent to an extra operation in one of every nine surgically treated patients.Different methods of surgical management were tested in seven small trials. One trial comparing two types of locking plate versus a locking nail for treating two-part surgical neck fractures found some evidence of better function after plate fixation but also of a higher rate of surgically-related complications. One trial comparing a locking plate versus minimally invasive fixation with distally inserted intramedullary nails found some evidence of a short-term benefit for the nailing group. Compared with hemiarthroplasty, tension-band fixation of severe injuries using wires was associated with a higher re-operation rate in one trial. Two trials found no important differences between 'polyaxial' and 'monaxial' screws combined with locking plate fixation. One trial produced some preliminary evidence that tended to support the use of medial support locking screws in locking plate fixation. One trial found

Outcomes of the distal intraarticular humeral fractures treated by olecranon osteotomy

Directory of Open Access Journals (Sweden)

Erhan Yılmaz

2009-01-01

Full Text Available Objectives: To evaluate the management and outcome of intraarticular fractures of the distal humerus treated by open reduction and internal fixation using the olecranon osteotomy technique. Materials and methods: Twenty-one patients with in-traarticular fractures of the distal humerus were treated by open reduction and internal fixation. The mean age of the patients was 41.6 years and the mean follow-up pe-riod was 25.3 months. All fractures were type C accord-ing to the AO/ASIF fracture classification system. Chev-ron type olecranon osteotomy was performed within 12-24 h after the injury in all cases but 4 of them. Physical and radiological examination of patients with the appro-priate range checks were made.Results: All fractures united within average duration of 3.2 months. Excellent or good results were found in pa-tients less than 50 years-old, in women, when passing time from injury to surgery was within 12 hours and when early mobilization was achieved. The complica-tions were seen as 2 (9.6% transient neuropraxia of the ulnar nerve, 2 (9.6% failure of fixation, 1 (4.8% het-erotopic ossification and 1 (4.8% olecranon non-union. Fracture type (C1 and time from occurrence of injury to surgery (<12 hours are the main prognostic factors for achieving the excellent/ good functional results.Conclusions: The critical factors for a successful out-come of intraarticular fractures of the distal humerus in-cluded meticulous surgical technique, stable internal fix-ation, surgical experimentation and early controlled postoperative mobilization.

Classification of the supraspinatus lesions based on the correlation between MRI and surgical findings

International Nuclear Information System (INIS)

Capiel, Carlos A. h; Sammartino, Mario R.; Bouzas, Carlos A.; Mussini, Daniel

2001-01-01

Objective: The purpose of this study was to evaluate the sensitivity of MR in the diagnosis of supraspinatus disorders and to report a classification based on the correlation between MR and surgical findings. Materials and methods: Thirty-nine patients with clinical suspected rotator cuff abnormalities were examined with MR. Two radiologists interpreted the images without knowledge of the surgical findings. MR findings were correlated with surgical ones. The classification used divides the supraspinatus disorders in two groups: a) With tendinous continuity (tendinosis and partial cuff tear); and b) Interruption of the tendinous continuity (full-thickness tear). Full thickness tears can be with severe or small retraction. Results: All the patients had full-thickness tear. MR correctly diagnosed thirty-eight tears with a sensitivity of 97,4%. Twelve tears showed small retraction and twenty-seven a severe retraction. Five patients had irreparable lesions. Conclusion: MR is an excellent method in the diagnosis of rotator cuff disorders. The classification based on the correlation between MR and surgical findings supplies an accurate diagnosis and gives an integrated scope of supraspinatus disorders. In this way the orthopaedic surgeons can define if the disorders can be clinically or surgically treated, and in this case, determine the type of surgery required (open surgery or arthroscopy). (author)

Use of an automated bolus calculator in MDI-treated type 1 diabetes

DEFF Research Database (Denmark)

Schmidt, Signe; Meldgaard, Merete; Serifovski, Nermin

2012-01-01

To investigate the effect of flexible intensive insulin therapy (FIIT) and an automated bolus calculator (ABC) in a Danish type 1 diabetes population treated with multiple daily injections. Furthermore, to test the feasibility of teaching FIIT in a 3-h structured course....

BRCAness and Prognosis in Triple-Negative Breast Cancer Patients Treated with Neoadjuvant Chemotherapy.

Directory of Open Access Journals (Sweden)

Hirokazu Tanino

Full Text Available BRCAness is defined as the set of traits in which BRCA1 dysfunction, arising from gene mutation, methylation or deletion, results in DNA repair deficiency. In the present study, we addressed BRCAness, therapeutic efficacy, recurrence, and survival in patients with triple negative breast cancer (TNBC who were treated with neoadjuvant chemotherapy at Kitasato University Hospital, Japan, between April 2006 and October 2012. BRCAness was determined by preoperative core needle biopsy (CNB specimens and surgical specimens. Assay was performed using Multiplex Ligation-dependent Probe Amplification (MLPA with P376-B2 BRCA1ness probemix (MRC-Holland, Amsterdam, The Netherlands. The relative copy number ratio of each sample was compared to Human Genomic DNA (Promega, Madison, WI, USA as reference samples was calculated with Coffalyser.NET default settings. The BRCAness score was calculated with the relative copy number ratio of various DNA sequences. Values of 0.5 or more were determined as the BRCA1-like Type (BRCAness and those of less than 0.5 as the Sporadic Type to analyze pathological complete response (pCR rate, recurrence, and survival. pCR (ypT0/Tis/N0 was observed in 15 patients (pCR rate: 37.5%. These patients had no recurrence. Twelve patients recurred, 8 died from breast cancer. The BRCA1-like Type were 22 and Sporadic Type were 18 in CNB specimens. No major differences were observed between the BRCA1-like Type and Sporadic Type with pCR rate, recurrence rate and survival. Twenty four surgical specimens of non-pCR patients were available and 9 were BRCA1-like Type, who had more recurrences (7/9 vs. 5/15, and their relapse-free survival was also lower (p<0.05 than that of Sporadic Type. Seven BRCA1-like Type patients remained BRCA1-like Type in surgical specimens, were worse in recurrence (p<0.01 and survival (p<0.05 compared with 6 patients whose BRCA status in surgical specimens turned to Sporadic Type. New clinical trials assessing the true

To compare the gingival melanin repigmentation after diode laser application and surgical removal

Directory of Open Access Journals (Sweden)

Gaurav Mahajan

2017-01-01

Full Text Available Aim: The aim of the present study is to compare the gingival melanin repigmentation after diode laser application and surgical removal done by scraping with Kirkland knife. Materials and Methods: This study was a randomized split-mouth study where 10 patients presenting with unattractive, diffuse, dark brown to black gingival discoloration on the facial aspect of the maxillary gingiva were treated by diode laser application and surgical removal and followed up for 3-, 6-, and 9-month intervals. Results: The results showed a statistically significant difference in repigmentation between the groups at the interval of 3 months (P = 0.040, but the difference was statistically not significant at 6 months (P = 0.118 and 9 months (P = 0.146. On surgically treated sites, all cases showed repigmentation of the gingiva, but in laser treated, there were two individuals which did not show repigmentation of the gingiva even at the end of 9-month observation time. Conclusion: The incidence of repigmentation was slightly less in laser-treated sites as compared to surgical depigmentation although the difference was statistically significant only up to 3 months.

Relationship between Human Papilloma Virus and Subungual Keratoacanthoma: Two Case Reports and the Outcomes of Surgical Treatment.

Science.gov (United States)

Göktay, Fatih; Kaynak, Emre; Güneş, Pembegül; Yaşar, Şirin; Küçükodacı, Zafer; Aytekin, Sema

2017-01-01

Subungual keratoacanthoma (SUKA) is a rare form of keratoacanthoma, with the majority of the lesions appearing as rapidly growing, painful hyperkeratotic masses located under the distal nail plate of the thumb. In some cases, SUKA causes damage to the underlying bone. The first case presented here was treated by surgical excision alone, and human papilloma virus (HPV) type 6 was detected in the tissue samples. The second case was treated by surgical excision plus curettage; however, HPV was not detected, and tumor cells were not found in the curettage material. There was near complete improvement in both the clinical appearance and the distal phalanx destruction, with no recurrence at the final follow-up in either patient (30 and 14 months, respectively). Overall, simple excision alone or in combination with curettage seemed to be sufficient in the treatment of SUKA; however, the etiopathogenetic role of HPV in SUKA remains controversial, as in its classical form.

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

Directory of Open Access Journals (Sweden)

Narayan H Gandedkar

2016-01-01

Full Text Available Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.

A case of chemotherapy-resistant intestinal-type sinonasal adenocarcinoma treated by gamma knife radiosurgery

Directory of Open Access Journals (Sweden)

Andres M. Alvarez-Pinzon, M.D., Ph.D.

2017-12-01

Full Text Available Intestinal type sinonasal adenocarcinomas are a rare malignancy of the nasal cavity and paranasal sinuses ascending in the nasal cavity are particularly unusual. We report an infrequent case of an Intestinal sinonasal adenocarcinoma from the left lateral nasal wall. A 60-year-old Hispanic male complained of complete progressive nasal obstruction and epistaxis for 8 months. A nasal endoscopic exam displayed a prominent enlargement, which remained in connection with the anterior part of left inferior turbinate. Computed tomography revealed a medium-defined, soft tissue dense lesion in the left anterior nasal cavity. Mass biopsy histology confirmed a low grade differentiate Intestinal type sinonasal adenocarcinomas. The patient underwent 8 cycles of chemotherapy including paclitaxel, platinol and fluorouracil. According to the medical records, the patient responded well to the chemotherapy treatment until about six cycles. When a follow up CT scan showed tumor growth, the patient was placed on Doxorubicin but developed toxicity. The main treatment modality is surgical resection with histological clear margins but concerning the low differentiation, low response of chemotherapy, and surgical risk we offered an option with gamma knife radiosurgery. In our case, the patient demonstrated satisfactory relief of symptoms and reported the ability to breathe through the nose. 80% of tumor resolution was observed in 1 month following the CT scan.

Costs Associated with Surgically Treated Cases of Abdominal Cystic Echinococcosis: A Single Center's Experience from 2008 to 2014, Pavia, Italy.

Science.gov (United States)

Narra, Roberta; Maestri, Marcello; Budke, Christine M; Tamarozzi, Francesca; Mariconti, Mara; Nicoletti, Giovanni J; Rinaldi, Francesca; Brunetti, Enrico

2016-08-03

Cystic echinococcosis (CE) is a globally distributed zoonosis caused by the Echinococcus granulosus sensu lato species complex. Four approaches are available for treatment of abdominal CE: surgery, percutaneous aspiration, chemotherapy with albendazole, and watch-and-wait. Allocation of patients to these different treatment options mainly depends on the stage of the cystic lesion. However, as available guidelines are not widely followed, surgery is often applied even without the correct indication outside referral centers. This is not only a disadvantage for the patient, but also a waste of money. In this study, we evaluated the cost of the surgical approach for abdominal CE by analyzing hospitalization costs for 14 patients admitted to the General Surgery Ward at the "San Matteo" Hospital Foundation in Pavia, Italy, from 2008 through 2014. We found that the total cost of a single hospitalization, including hospital stay, surgical intervention, personnel, drugs, and administrative costs ranged from €5,874 to 23,077 (median €11,033) per patient. Our findings confirm that surgery can be an expensive option. Therefore, surgical intervention should be limited to cyst types that do not benefit from nonsurgical therapies and appropriate case management can best be accomplished by using a cyst stage-specific approach. © The American Society of Tropical Medicine and Hygiene.

Surgical excision of heterotopic ossification of hip in a rare case of Moyamoya disease with extra articular ankylosis

Directory of Open Access Journals (Sweden)

Dhanasekararaja Palanisami

2012-01-01

Full Text Available We report a case of isolated ossification of iliopsoas with ankylosis of the left hip in a 27-year-old female. The patient was diagnosed to have Moyamoya disease, a rare chronic occlusive disorder of cerebrovascular circulation following an acute onset of hemiplegia. The patient presented 9 months later to us with ankylosis of left hip which was successfully treated by surgical excision of the heterotopic bone and there was no recurrence at the end of 5 years. A review of literature failed to reveal a similar case with isolated and complete ossification of iliopsoas muscle associated with Moyamoya disease which required surgical intervention. Surgical excision resulted in dramatic improvement in the quality of life. Surgical excision of neurogenic type of heterotopic ossification is a very successful procedure and timely intervention after maturity of mass is very important to prevent the onset of secondary complications and to avoid recurrence.

Digestive adaptation: A new surgical proposal to treat obesity based on physiology and evolution

Directory of Open Access Journals (Sweden)

Sérgio Santoro

2003-06-01

Full Text Available Objective: To report on a new surgical technique to treat obesity -Digestive Adaptation - and to present its preliminary results.Method: The technique includes a vertical (sleeve gastrectomy,omentectomy and enterectomy maintaining the initial 150-cmportionof the jejunum and the final 150-cm-portion of the ileum.The three first obese patients operated on are described. Results:With a minimum follow-up of 6 months, all patients refer earlysatiety, are free of symptoms and have a BMI <31 Kg/m2.Conclusions: This procedure does not use prostheses and doesnot cause exclusion of gastrointestinal segments. It does notcreate subocclusions neither malabsorption nor blind endoscopicareas and above all, it causes no harm to important digestivefunctions. Conversely, it aims at moderate restriction with earlysatiety by distension, and at interfering in the neuroendocrineprofile, resulting in slow gastric emptying, early and prolongedsatiety, as well as positive changes in the metabolic profile. Basedon recent physiological data, the procedure aims at decreasingthe production of ghrelin, plasminogen activator inhibitor-1 (PAI-1and resistin, and at raising the levels of glucagon-like peptide-1(GLP-1. The patients operated on do not need nutritional supportor to take drugs because of the procedure, which is easy and safeto perform.

Advances in surgical treatment of chronic pancreatitis.

Science.gov (United States)

Ni, Qingqiang; Yun, Lin; Roy, Manish; Shang, Dong

2015-02-08

The incidence of chronic pancreatitis (CP) is between 2 and 200 per 100,000 persons and shows an increasing trend year by year. India has the highest incidence of CP in the world at approximately 114 to 200 per 100,000 persons. The incidence of CP in China is approximately 13 per 100,000 persons. The aim of this review is to assist surgeons in managing patients with CP in surgical treatment. We conducted a PubMed search for "chronic pancreatitis" and "surgical treatment" and reviewed relevant articles. On the basis of our review of the literature, we found that CP cannot be completely cured. The purpose of surgical therapy for CP is to relieve symptoms, especially pain; to improve the patient's quality of life; and to treat complications. Decompression (drainage), resection, neuroablation and decompression combined with resection are commonly used methods for the surgical treatment of CP. Before developing a surgical regimen, surgeons should comprehensively evaluate the patient's clinical manifestations, auxiliary examination results and medical history to develop an individualized surgical treatment regimen.

Surgical treatment of chronic pancreatitis in young patients.

Science.gov (United States)

Zhou, Feng; Gou, Shan-Miao; Xiong, Jiong-Xin; Wu, He-Shui; Wang, Chun-You; Liu, Tao

2014-10-01

The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) intervention and surgical intervention. Therapeutic ERCP intervention is performed much more extensively for its minimally invasive nature, but a part of patients are referred to surgery at last. Historical and follow-up data of 21 young patients with chronic pancreatitis undergoing duodenum-preserving total pancreatic head resection were analyzed to evaluate the outcomes of therapeutic ERCP intervention and surgical intervention in this study. The surgical complications of repeated therapeutic ERCP intervention and surgical intervention were 38% and 19% respectively. During the first therapeutic ERCP intervention to surgical intervention, 2 patients developed diabetes, 5 patients developed steatorrhea, and 5 patients developed pancreatic type B pain. During the follow-up of surgical intervention, 1 new case of diabetes occurred, 1 case of steatorrhea recovered, and 4 cases of pancreatic type B pain were completely relieved. In a part of young patients with chronic pancreatitis, surgical intervention was more effective than therapeutic ERCP intervention on delaying the progression of the disease and relieving the symptoms.

ADVANTAGES OF SURGICAL TREATMENT OF ACHILLES TENDON RUPTURE BY PERCUTANEOUS SUTURE AS OPPOSED TO NONSURGICAL TREATMENT

Directory of Open Access Journals (Sweden)

Goran Vidić

2010-06-01

Full Text Available The Achilles tendon is the strongest tendon in the body, and its rupture appears to be the most common injury of the tendomuscular apparatus. This type of injury is more frequent in sportsmen, especially those who play tennis, gymnastics, skiing, handball, football, basketball and athletics. Also, the ruptures are common in people who engage in sports activities for recreation. They appear more often in males, in proportion of 3:1. It appears reciprocally in 25- 30% of the cases. The rupture is easily diagnosed by means of clinical examination (Thompson's test and ultrasonography.The aim of the analysis was to point to the advantages of surgical treatment of a fresh Achilles tendon rupture as opposed to non-surgical treatment by plaster immobilization.The examination was performed on 35 patients, of which 16 (45,71% were treated operatively and 19 (54,29% were treated nonoperatively. The average age of the patients was 38.8 years, that is 37.1 for those treated operatively and 40.2 for those treated nonoperatively. Among the examinees, there were 29(82,86% men and 6 (17,14% women. The operative treatment method consisted of percutaneous suturing, whereas the nonoperative treatment involved the circular above the knee plaster immobilization. All operatively treated patients underwent the surgical treatment in the first 48 hours from the time when the injury had occured. Anesthesia was local and infiltrative.The obtained results showed that there were no unhealed ruptures or re-ruptures. In the group of patients who did not undergo the surgery, there was 1 re-rupture and 1 unhealed rupture, after which the surgical treatment had to be performed in both cases. In the group of operated patients there were no infections, however, 1 thromboembolism occured. Recovery of muscular strenght of the tendon and the realization of the full range of movement required less time in the operated patients. The ultrasonographic findings in the operated patients

Post-traumatic Perineal Pubic Rami Protrusion: A Simple Surgical Management

Directory of Open Access Journals (Sweden)

Voon Victor

2014-06-01

Full Text Available Although pubic ramus fractures are common, they usually heal without surgical intervention and result in little long-term disability. We herein present two cases of symptomatic malunion of pubic rami fracture, which was successfully treated with a simple and safe surgical technique. The patients' local symptoms resolved afterwards.

Posterior-only spinal fusion without rib head resection for treating type I neurofibromatosis with intra-canal rib head dislocation

Directory of Open Access Journals (Sweden)

Dong Sun

2013-12-01

Full Text Available OBJECTIVES: Patients with Type I neurofibromatosis scoliosis with intra-canal rib head protrusion are extremely rare. Current knowledge regarding the diagnosis and treatment for this situation are insufficient. The purpose of this study is to share our experience in the diagnosis and surgical treatments for such unique deformities. METHODS: Six patients with Type I neurofibromatosis scoliosis with rib head dislocation into the spinal canal were diagnosed at our institution. Posterior instrumentation and spinal fusion without intra-canal rib head resection via a posterior-only approach was performed for deformity correction and rib head extraction. The efficacy and outcomes of the surgery were evaluated by measurements before, immediately and 24 months after the surgery using the following parameters: coronal spinal Cobb angle, apex rotation and kyphosis of the spine and the intra-canal rib head position. Post-operative complications, surgery time and blood loss were also evaluated. RESULTS: Patients were followed up for at least 24 months post-operatively. The three dimensional spinal deformity was significantly improved and the intra-canal rib head was significantly extracted from the canal immediately after the surgery. At follow-up 24 months after surgery, solid fusions were achieved along the fusion segments, and the deformity corrections and rib head positions were well maintained. There were no surgery-related complications any time after the surgery. CONCLUSIONS: Systematic examinations are needed to identify patients with Type I neurofibromatosis scoliosis with rib head dislocation into the canal who can be treated by posterior-only spinal fusion without rib head resection.

Surgical treatment for ectopic atrial tachycardia.

Science.gov (United States)

Graffigna, A; Vigano, M; Pagani, F; Salerno, G

1992-08-01

Atrial tachycardia is an infrequent but potentially dangerous arrhythmia which often determines cardiac enlargement. Surgical ablation of the arrhythmia is effective and safe, provided a careful atrial mapping is performed and the surgical technique is tailored to the individual focus location. Eight patients underwent surgical ablation of ectopic atrial tachycardia between 1977 and 1990. Different techniques were adopted for each patient according to the anatomical location of the focus and possibly associated arrhythmias. Whenever possible, a closed heart procedure was chosen. In 1 patient a double focal origin was found and treated by separate procedures. In 1 patient with ostium secundum atrial septal defect and atrial flutter, surgical isolation of the right appendage and the ectopic focus was performed. In all patients ectopic atrial tachycardia was ablated with maintenance of the sinoatrial and atrioventricular nodal function as well as internodal conduction. In follow-up up to December 1991, no recurrency was recorded.

[Type 2 dens fracture in the elderly and therapy-linked mortality : Conservative or operative treatment].

Science.gov (United States)

Stein, G; Meyer, C; Marlow, L; Christ, H; Müller, L P; Isenberg, J; Eysel, P; Schiffer, G; Faymonville, C

2017-02-01

Type II fractures of the odontoid process of the axis are the most common injury of the cervical spine in elderly patients. Only little evidence exists on whether elderly patients should be treated conservatively or surgically. The mortality and survival probability of 51 patients were determined in a retrospective study. The range of motion, pain and the neck disability index were clinically investigated. Of the 51 patients 37 were treated surgically and 14 conservatively. The conservatively treated group showed a higher mortality (64 % vs. 32 %). Kaplan-Meier analysis revealed a median survival of the conservatively treated group of 29 months, whereby during the first 3 months of treatment this group showed a higher survival probability and afterwards the surgically treated group showed a higher survival probability. The clinical examination of 20 patients revealed limited range of motion of the cervical spine. Additionally, moderate levels of pain and complaints were recorded using the neck disability index. Fractures of the odontoid process pose a far-reaching danger for elderly patients. A balanced assessment of the general condition should be carried out at the beginning of treatment of these patients. In the early phase following trauma no differences were found with respect to survival rates but for long-term survival the operatively treated group showed advantages; however, these advantages cannot be causally attributed to the choice of therapy.

Surgical options in benign parotid tumors: a proposal for classification.

Science.gov (United States)

Quer, Miquel; Vander Poorten, Vincent; Takes, Robert P; Silver, Carl E; Boedeker, Carsten C; de Bree, Remco; Rinaldo, Alessandra; Sanabria, Alvaro; Shaha, Ashok R; Pujol, Albert; Zbären, Peter; Ferlito, Alfio

2017-11-01

Different surgical options are currently available for treating benign tumors of the parotid gland, and the discussion on optimal treatment continues despite several meta-analyses. These options include more limited resections (extracapsular dissection, partial lateral parotidectomy) versus more extensive and traditional options (lateral parotid lobectomy, total parotidectomy). Different schools favor one option or another based on their experience, skills and tradition. This review provides a critical analysis of the literature regarding these options. The main limitation of all the studies is the bias of selection for different surgical approaches. For this reason, we propose a staging system that could facilitate clinical decision making and the comparison of results. We propose four categories based on the size of the tumor and its location within the parotid gland. Category I includes tumors up to 3 cm, which are mobile, close to the outer surface and close to the parotid borders. Category II includes deeper tumors up to 3 cm. Category III comprises tumors greater than 3 cm involving two levels of the parotid gland, and category IV tumors are greater than 3 cm and involve more than 2 levels. For each category and for the various pathologic types, a guideline of surgical extent is proposed. The objective of this classification is to facilitate prospective multicentric studies on surgical techniques in the treatment of benign parotid tumors and to enable the comparison of results of different clinical studies.

A new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap.

Science.gov (United States)

Han, Dong-Seok; Jang, Hoon; Youn, Chang-Shik; Yuk, Seung-Mo

2015-06-19

Until recently, no single, universally accepted surgical method has existed for all types of concealed penis repairs. We describe a new surgical technique for repairing concealed penis by using an advanced musculocutaneous scrotal flap. From January 2010 to June 2014, we evaluated 12 patients (12-40 years old) with concealed penises who were surgically treated with an advanced musculocutaneous scrotal flap technique after degloving through a ventral approach. All the patients were scheduled for regular follow-up at 6, 12, and 24 weeks postoperatively. The satisfaction grade for penile size, morphology, and voiding status were evaluated using a questionnaire preoperatively and at all of the follow-ups. Information regarding complications was obtained during the postoperative hospital stay and at all follow-ups. The patients' satisfaction grades, which included the penile size, morphology, and voiding status, improved postoperatively compared to those preoperatively. All patients had penile lymphedema postoperatively; however, this disappeared within 6 weeks. There were no complications such as skin necrosis and contracture, voiding difficulty, or erectile dysfunction. Our advanced musculocutaneous scrotal flap technique for concealed penis repair is technically easy and safe. In addition, it provides a good cosmetic appearance, functional outcomes and excellent postoperative satisfaction grades. Lastly, it seems applicable in any type of concealed penis, including cases in which the ventral skin defect is difficult to cover.

Surgical treatment of delayed radiation effects in the skin and its indication

International Nuclear Information System (INIS)

Tilkorn, H.; Drepper, H.

1987-01-01

Since 1960 a total of 1200 patients with skin disease as delayed radiation effects were treated at the Hornheide special clinic, 40% of whom received plastic surgery. This requires knowledge of the type of radiation applied and when it was applied, additional harmful influences, exposure, differentiation in cases of ulcers between primary, cumulative, and combination effect, early radiation effects, and late radiation effects. Secondary factors leading possibly to necrosis may be: recidivation of the primary tumours, benign or malignant neoplasms, traumatic injuries such as injections, sampling, tight clothing, chemical factors like therapeuticals for local application, allergies, infections of the skin with bacteria or fungi, osteomyelitis, non-infections skin disease, and internal disease. A precondition for successful dermatological and surgical treatment are a careful review of the previous case history and exact diagnosis. Some clinical cases serve to illustrate the theoretical explanations and point out possibilities for surgical treatment. (TRV) [de

Temporomandibular joint ankylosis: Case-series of two different surgical procedures

Directory of Open Access Journals (Sweden)

Gholamreza Shirani

2014-01-01

Full Text Available Introducation: The long-term outcome and clinical results of gaparthroplasty used for the treatment of condylar ankylosis of the mandible in children with application of postoperative activator appliances and costochondral rib graft are evaluated and compared. The purpose of this study was to compare the effect of gap arthroplasty and costochondral graft methods on reankylosis, a mount of mouth opening and growth. Materials and Methods: A non-randomized, retrospective clinical study of l0 cases (5-12 years old of condylar ankylosis of the mandible, surgically treated during a 10 year period from 2002 to 2012 was performed. Four patients were treated by condylectomy and interpositional flap, whereas six were treated by condylectomy and immediate costachondral rib grafts. The first group underwent long-term postoperative therapy using removable activator appliances. Casts, radiographs, photographs, and computed tomography (CT were used post surgically to evaluate rib graft, condylar growth and function, occlusion, facial, and condylar symmetry. Data were analyzed by SPSS 16 statistical software using Mann-Whitney, Paired T-test and Chi-square tests. Results: Children with long-standing condylar ankylosis of the mandible treated by condylectomy and interpositional flap showed more favorably when activators were used post-surgically. Conclusions: Gaparthroplasty with functional activator post-operatively can be considering for TMJ ankylosis.

Minimizing surgical skin incision scars with a latex surgical glove.

Science.gov (United States)

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

2013-04-01

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

Information Needs of Hepato-Pancreato-Biliary Surgical Oncology Patients.

Science.gov (United States)

Gillespie, Jacqueline; Kacikanis, Anna; Nyhof-Young, Joyce; Gallinger, Steven; Ruthig, Elke

2017-09-01

A marked knowledge gap exists concerning the information needs of hepato-pancreato-biliary (HPB) surgical oncology patients. We investigated the comprehensive information needs of this patient population, including the type and amount of information desired, as well as the preferred method of receiving information. A questionnaire was administered to patients being treated surgically for cancers of the liver, pancreas, gallbladder, or bile ducts at Toronto General Hospital, part of the University Health Network, in Toronto, Canada. The questionnaire examined patients' information needs across six domains of information: medical, practical, physical, emotional, social, and spiritual. Among 36 respondents, the importance of information and amount of information desired differed significantly by domain (both p < 0.001). This group of patients rated information in the medical and physical domains as most important, though they also desired specific items of information from the emotional, practical, and social domains. Patients' overwhelming preference was to receive information via a one-on-one consultation with a healthcare provider. It is important for healthcare providers working with HPB surgical oncology patients to be comprehensive when providing information related to patients' cancer diagnosis, prognosis, associated symptoms, and side effects of treatment. Certain emotional, practical, and social issues (e.g., fears of cancer recurrence, drug coverage options, relationship changes) should be addressed as well. Face-to-face interactions should be the primary mode of delivering information to patients. Our findings are being used to guide the training of healthcare providers and the development of educational resources specific to HPB surgical oncology patients.

Blunt hepatic trauma: comparison between surgical and nonoperative treatment.

Science.gov (United States)

Zago, Thiago Messias; Pereira, Bruno Monteiro; Calderan, Thiago Rodrigues Araujo; Hirano, Elcio Shiyoiti; Rizoli, Sandro; Fraga, Gustavo Pereira

2012-01-01

To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.

Surgical treatment of colorectal cancer complicated with acute intestinal obstruction

Directory of Open Access Journals (Sweden)

S. N. Schaeva

2016-01-01

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

Global curriculum in surgical oncology.

Science.gov (United States)

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

2016-06-01

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

Surgical treatment of tumor-induced osteomalacia: a retrospective review of 40 cases with extremity tumors.

Science.gov (United States)

Sun, Zhi-jian; Jin, Jin; Qiu, Gui-xing; Gao, Peng; Liu, Yong

2015-02-26

Tumor-induced osteomalacia (TIO) is a rare syndrome typically caused by mesenchymal tumors. It has been shown that complete tumor resection may be curative. However, to our knowledge, there has been no report of a large cohort to exam different surgical approaches. This study was aimed to assess outcomes of different surgical options of patients with tumor-induced osteomalacia at a single institution. Patients with extremity tumors treated in our hospital from January, 2004 to July, 2012 were identified. The minimum follow-up period was 12 months. Patient's demography, tumor location, preoperative preparation, type of surgeries were summarized, and clinical outcomes were recorded. Successful treatment was defined as significant symptom improvement, normal serum phosphorus and significant improvement or normalization of bone mineral density at the last follow-up. Differences between patients with soft tissue tumors and bone tumors were compared. There were 40 (24 male and 16 female) patients identified, with an average age of 44 years. The tumors were isolated in either soft tissue (25 patients) or bone (12 patients) and combined soft tissue and bone invasion was observed in 3 patients. For the primary surgery, tumor resection and tumor curettage were performed. After initial surgical treatment, six patients then received a second surgery. Four patients were found to have malignant tumors base on histopathology. With a minimum follow-up period of 12 months, 80% of patients (32/40) were treated successfully, including 50% of patients (2/4) with malignant tumors. Compared to patients with bone tumor, surgical results were better in patient with soft tissue tumor. Surgical treatment was an effective way for TIO. Other than tumor curettage surgery, tumor resection is the preferred options for these tumors.

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

Surgical management of failed endoscopic treatment of pancreatic disease.

Science.gov (United States)

Evans, Kimberly A; Clark, Colby W; Vogel, Stephen B; Behrns, Kevin E

2008-11-01

Endoscopic therapy of acute and chronic pancreatitis has decreased the need for operative intervention. However, a significant proportion of patients treated endoscopically require definitive surgical management for persistent symptoms. Our aim was to determine which patients are likely to fail with endoscopic therapy, and to assess the clinical outcome of surgical management. Patients were identified using ICD-9 codes for pancreatic disease as well as CPT codes for endoscopic therapy followed by surgery. Patients with documented acute or chronic pancreatitis treated endoscopically prior to surgical therapy were included (N = 88). The majority of patients (65%) exhibited chronic pancreatitis due to alcohol abuse. Common indicators for surgery were: persistent symptoms, anatomy not amenable to endoscopic treatment and unresolved common bile duct or pancreatic duct strictures. Surgical salvage procedures included internal drainage of a pseudocyst or an obstructed pancreatic duct (46%), debridement of peripancreatic fluid collections (25%), and pancreatic resection (31%). Death occurred in 3% of patients. The most common complications were hemorrhage (16%), wound infection (13%), and pulmonary complications (11%). Chronic pancreatitis with persistent symptoms is the most common reason for pancreatic surgery following endoscopic therapy. Surgical salvage therapy can largely be accomplished by drainage procedures, but pancreatic resection is common. These complex procedures can be performed with acceptable mortality but also with significant risk for morbidity.

Endovascular Treatment of Late Thoracic Aortic Aneurysms after Surgical Repair of Congenital Aortic Coarctation in Childhood

Science.gov (United States)

Juszkat, Robert; Perek, Bartlomiej; Zabicki, Bartosz; Trojnarska, Olga; Jemielity, Marek; Staniszewski, Ryszard; Smoczyk, Wiesław; Pukacki, Fryderyk

2013-01-01

Background In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1) to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2) to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs) and (3) to assess outcomes after intravascular treatment for TAAs. Methods This study involved 37 asymptomatic patients (26 female and 11 male) who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair. Results Follow-up studies revealed TAA in seven cases (19%) (including six with the gothic type of the aortic arch) and mild recoarctation in other six (16%). Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA), in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure. Conclusions The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch) that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary. PMID:24386233

Embolization as an Alternative Treatment of Insulinoma in a Patient with Multiple Endocrine Neoplasia Type 1 Syndrome

International Nuclear Information System (INIS)

Peppa, Melpomeni; Brountzos, Elias; Economopoulos, Nicolaos; Boutati, Eleni; Pikounis, Vasilios; Patapis, Paul; Economopoulos, Theofanis; Raptis, Sotirios A.; Hadjidakis, Dimitrios

2009-01-01

Insulinoma is a rare neuroendocrine tumor, most commonly originating from the pancreas, which is either sporadic or familial as a component of multiple endocrine neoplasia type 1 syndrome (MEN1). It is characterized by increased insulin secretion leading to hypoglycemia. Surgical removal is considered the treatment of choice, with limited side effects and relatively low morbidity and mortality, both being improved by the laparoscopic procedure. We present the case of a 30-year-old patient with MEN1 and recurrent insulinoma with severe hypoglycemic episodes who could not be surgically treated due to the adherence of the tumor to large blood vessels and to prior multiple surgical operations. He was treated by repeated embolization using spherical polyvinyl alcohol particles, resulting in shrinkage of the tumor, improvement of the frequency and severity of the hypoglycemic episodes, and better quality of life.

Timanoplastia myringoplasty type 1 and in residency surgical results and audiometric

Directory of Open Access Journals (Sweden)

Buschle, Mauricio

2010-12-01

Full Text Available Introduction: The tympanoplasty aims to reconstruct the tympanic membrane, restoring protection to the middle ear and improve hearing. In this study we evaluated the surgical results and audiometric this surgery, performed in the service of Otorhinolaryngology, HC / UFPR by residents of the second year in the year 2008 and factors that may influence the results. Method: A retrospective study through review of medical records. Results: Among the 31 patients evaluated, there was closure of the perforation in 24 (80% and hearing improvement with reduction or closure of the conductive gap by 60% and 26.7% respectively. Discussion: The success rate of surgery was satisfactory and similar to that found in the literature, and factors such as age, presence of unilateral or bilateral pathology and size of perforation were not determinants of surgical success. Conclusion: Tympanoplasty performed by residents of the second year of residence showed satisfactory results regarding both surgical audiometric.

ANALYZES OF ANTIPLATELETS AND ANTICOAGULANTS UTILIZATION IN PATIENTS TREATED IN CARDIOVASCULAR REHABILITATION CENTER FROM CROATIA

Directory of Open Access Journals (Sweden)

Boban Marko

2016-07-01

Full Text Available Purpose: Discordance with the guidelines and underutilization of pharmacotherapy for secondary prevention frequently exists in clinical practice. Aim of our study was to assess the prescription routine and drug utilization patterns for antiplatelets and peroral anticoagulants in tertiary medical center specialized for cardiovascular rehabilitation. Methods: study included 96 consecutive patients scheduled for cardiovascular rehabilitation in period 1-6 months after the acute treatment for ischemic 87(80.2% and valvular heart disease 18(19.8%. Patients were divided according to etiology of heart disease and type of acute cardiovascular treatments (conservative, percutaneous coronary interventions (PCI and surgery. Results: Dual antiplatelet therapy was the most commonly applied regimen in 84(87.5% of conservatively treated myocardial infarctions, 47(61.9% of percutaneous coronary interventions (PCI and 13(58.9% of surgically treated group (p>0.05. Among studied group of patients significant differences in utilization were found for warfarin, or combinations of antiplatelets with warfarin(p0.05. All four of patients that received triple therapy (4.17% were from surgical group. Underutilization of antiplatelets in ischemic heart disease was at 11(14.3% what was congruent with the developed industrial nations. Conclusions: Acute cardiovascular treatment type, but not heart disease etiology, had significant influence on subsequent prescription routine. Decreased use of pharmacological agents for secondary prevention in surgical patients was revealed. Drug utilization analyzes can offer improvement in optimizing medical treatments, quality of care and decrease unnecessary polypragmasia, as well as improve economical efficiency of medical management.

Prevalence, quantification and typing of adenoviruses detected in river and treated drinking water in South Africa.

Science.gov (United States)

van Heerden, J; Ehlers, M M; Heim, A; Grabow, W O K

2005-01-01

Human adenoviruses (HAds), of which there are 51 serotypes, are associated with gastrointestinal, respiratory, urinary tract and eye infections. The importance of water in the transmission of HAds and the potential health risks constituted by HAds in these environments are widely recognized. Adenoviruses have not previously been quantified in river and treated drinking water samples. In this study, HAds in river water and treated drinking water sources in South Africa were detected, quantified and typed. Adenoviruses were recovered from the water samples using a glass wool adsorption-elution method followed by polyethylene glycol/NaCl precipitation for secondary concentration. The sensitivity and specificity of two nested PCR methods were compared for detection of HAds in the water samples. Over a 1-year period (June 2002 to July 2003), HAds were detected in 5.32% (10/188) of the treated drinking water and 22.22% (10/45) of river water samples using the conventional nested PCR method. The HAds detected in the water samples were quantified using a real-time PCR method. The original treated drinking water and river water samples had an estimate of less than one copy per litre of HAd DNA present. The hexon-PCR products used for typing HAds were directly sequenced or cloned into plasmids before sequencing. In treated drinking water samples, species D HAds predominated. In addition, adenovirus serotypes 2, 40 and 41 were each detected in three different treated drinking water samples. Most (70%) of the HAds detected in river water samples analysed were enteric HAds (serotypes 40 and 41). One HAd serotype 2 and two species D HAds were detected in the river water. Adenoviruses detected in river and treated drinking water samples were successfully quantified and typed. The detection of HAds in drinking water supplies treated and disinfected by internationally recommended methods, and which conform to quality limits for indicator bacteria, warrants an investigation of the

Provision of general paediatric surgical services in a regional hospital.

LENUS (Irish Health Repository)

Zgraj, O

2012-01-31

BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.

Surgical and nonsurgical treatment of peritoneopericardial diaphragmatic hernia in dogs and cats: 58 cases (1999-2008).

Science.gov (United States)

Burns, Colby G; Bergh, Mary Sarah; McLoughlin, Mary A

2013-03-01

To determine clinical findings and outcomes for cats and dogs with peritoneopericardial diaphragmatic hernia (PPDH) treated surgically or nonsurgically. Retrospective case series. 28 dogs and 30 cats. Medical records for cats and dogs evaluated at 1 of 2 veterinary teaching hospitals were reviewed, and data regarding clinical signs, diagnostic and surgical findings, and outcome were evaluated. Prevalence of PPDH in the 2 hospitals during the study period was 0.025% (0.062% and 0.015% for cats and dogs, respectively); PPDH was an incidental finding for 13 (46.4%) dogs and 15 (50.0%) cats. Other congenital abnormalities were identified in 16 (571%) dogs and 7 (23.3%) cats (most commonly umbilical hernias, abdominal wall hernias cranial to the umbilicus, or sternal anomalies). Thirty-four (58.6%) animals underwent surgical repair of PPDH; 27 (79.4%) of these animals had a primary diagnosis of PPDH. Detection of clinical signs of PPDH (primary diagnosis) and intestines in the pericardial sac were significantly associated with surgical treatment. Short-term mortality rate for surgically treated animals was 8.8% (3/34). Clinical signs associated with PPDH resolved in 29 (85.3%) of surgically treated animals. No significant differences were detected between dogs and cats or between surgically and nonsurgically treated animals regarding long-term survival rate. Results of this study indicated animals with clinical signs of PPDH were more likely to undergo surgery than were animals without such signs. Herniorrhaphy was typically effective for resolution of clinical signs. Long-term survival rates were similar regardless of treatment method. Surgical or nonsurgical treatment of PPDH may be appropriate for animals with or without clinical signs, respectively.

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

Directory of Open Access Journals (Sweden)

Ford Nathan

2010-04-01

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

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

Science.gov (United States)

Chu, Kathryn; Havet, Philippe; Ford, Nathan; Trelles, Miguel

2010-04-14

The provision of surgical assistance in conflict is often associated with care for victims of violence. However, there is an increasing appreciation that surgical care is needed for non-traumatic morbidities. In this paper we report on surgical interventions carried out by Médecins sans Frontières in Masisi, North Kivu, Democratic Republic of Congo to contribute to the scarce evidence base on surgical needs in conflict. We analysed data on all surgical interventions done at Masisi district hospital between September 2007 and December 2009. Types of interventions are described, and logistic regression used to model associations with violence-related injury. 2869 operations were performed on 2441 patients. Obstetric emergencies accounted for over half (675, 57%) of all surgical pathology and infections for another quarter (160, 14%). Trauma-related injuries accounted for only one quarter (681, 24%) of all interventions; among these, 363 (13%) were violence-related. Male gender (adjusted odds ratio (AOR) = 20.0, p violence-related injury. Immediate peri-operative mortality was 0.2%. In this study, most surgical interventions were unrelated to violent trauma and rather reflected the general surgical needs of a low-income tropical country. Programs in conflict zones in low-income countries need to be prepared to treat both the war-wounded and non-trauma related life-threatening surgical needs of the general population. Given the limited surgical workforce in these areas, training of local staff and task shifting is recommended to support broad availability of essential surgical care. Further studies into the surgical needs of the population are warranted, including population-based surveys, to improve program planning and resource allocation and the effectiveness of the humanitarian response.

Surgical protocol and outcome for sigmoidovesical fistula secondary to diverticular disease of the left colon: A retrospective cohort study.

Science.gov (United States)

El-Haddad, Hany M; Kassem, Mohamed I; Sabry, Ahmed A; Abouelfotouh, Ahmed

2018-06-11

Diverticular disease of sigmoid colon can rarely be complicated by a connective track to urinary bladder. Pneumaturia and fecaluria are the pathognomonic symptoms. Resection surgery is the preferred treatment to overcome the renal sequellae of the disease. The purpose of this study is to propose a guiding classification to help general surgeons during surgical management of diverticular disease complicated by sigmoidovesical fistula (SVF). The data of 40 cases with colovesical fistula due to diverticular disease of sigmoid colon were retrospectively analyzed. Clinicopathological variables, imaging reports, types of treatment and patient outcome were evaluated. There were 36 men (90%) and four women (10%) in which the ages ranged from 32 to 79 with a mean of 58.1 years. Pneumaturia was the most common presenting symptom in 38 cases (95%) followed by urinary symptoms in 35 cases (87.5%) then fecaluria in 33 cases (82.5%). 37 patients underwent surgical resection while three patients were in poor general condition to withstand major resection. 16 patients underwent one stage resection and anastomosis, 16 patients were managed by two stage procedure and the remaining 5 patients were treated by three stages operation. Adequately performed CT followed by colonoscopy is the mainstay for diagnosis. Type 1 SVF should be treated in a single stage by complete resection and immediate anastomosis without a stoma. Type 2 cases are best managed in two stages while those with type 3 SVF are emergently managed by three stage procedure. Treatment of type 4 should be individualized. Copyright © 2018. Published by Elsevier Ltd.

Long-term results of surgically-assisted maxillary protraction.

Science.gov (United States)

Nevzatoğlu, Sirin; Küçükkeleş, Nazan

2014-05-01

The long-term treatment results of surgically-assisted facemask therapy were assessed by a comparison of the immediate protraction effects with those seen at five years review. Nine patients treated with a corticotomy-assisted maxillary protraction protocol were recalled five years following protraction. Cephalometric films taken before treatment (T0), immediately after maxillary protraction (T1) and five years after treatment (T2) were compared. The short-term results of surgically-assisted facemask therapy showed significant skeletal and soft tissue changes. After five years, the profile and dental relationships were well maintained and a cephalometric analysis revealed a stable vertical increase but only partially maintained soft tissue changes with loss of sagittal advancement. There was significant upper incisor proclination providing dental camouflage. Patients who are treated with corticotomy-assisted maxillary advancement should be very carefully selected. Assessment criteria include a low mandibular plane angle Class III patients who have severe maxillary retrognathism unable to be treated by conventional orthopaedic correction alone; patients who have almost completed growth and missed the chance of earlier orthopaedic correction, as well as patients who are not willing to accept bimaxillary orthognathic surgery, may be successfully treated.

Metformin-treated patients with type 2 diabetes have normal mitochondrial complex I respiration

DEFF Research Database (Denmark)

Larsen, Steen; Rabøl, R; Hansen, C N

2012-01-01

The glucose-lowering drug metformin has been shown to inhibit complex I of the mitochondrial electron transport chain in skeletal muscle. To investigate this effect in vivo we studied skeletal muscle mitochondrial respiratory capacity and content from patients with type 2 diabetes treated...

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

Energy Technology Data Exchange (ETDEWEB)

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

1995-07-01

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

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

International Nuclear Information System (INIS)

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

1995-01-01

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

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

International Nuclear Information System (INIS)

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

1996-01-01

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

Recent trends in surgical and reconstructive management of vulvar cancer: review of literature.

Science.gov (United States)

Vitale, Salvatore Giovanni; Valenti, Gaetano; Biondi, Antonio; Rossetti, Diego; Frigerio, Luigi

2015-12-01

Vulvar cancer (VC) is a rare disease. The most common histologic type is squamous-cell carcinoma. VC could be divided into two types: type one, commonly associated with HPV infection, occurs in young women and type two, associated with non-neoplastic lesions that usually occurs in older women. Previously VC was often treated with radical Vulvectomy. Today update in diagnostic and surgery technique, capable to identify early stages of disease and adaptation in surgery procedures, according to the stage of disease, age of patients and possible physical and psychological morbidity consequence, allow using less radical surgery approaches. That has led to decrease therapy-associated morbidity while preserving oncologic safety and improving psychosexual outcomes. Finally, several surgical treatments are available in case of VC and, despite radical surgery is often required, less radical surgery associated with reconstructive plastic surgery decreases some of short- and long-term associated complications.

Paediatric ride-on mower related injuries and plastic surgical management.

LENUS (Irish Health Repository)

Laing, T A

2011-05-01

Lawnmower related injuries cause significant morbidity in children and young teenagers. The \\'ride-on\\' mowers which are more powerful than the \\'walk behind\\' mowers are becoming increasingly popular. The incidence and severity of injuries from either type of lawnmower appears to be steadily rising as is the burden placed on local plastic surgical and emergency services in managing the care of these patients. The aims of the study were to demonstrate changing trends in lawnmower-related injuries to children presenting to a single unit over a ten-year period and to identify any association between injury severity and machine subtype (\\'ride-on\\' versus \\'walk-behind\\'). Hospital databases, theatre records and medical case notes were reviewed retrospectively of all patients under the age of 16 treated for lawnmower related injuries over a 10 year period from July 1998 to June 2008. Data gathered included patient demographics, injury site and severity, management (type and number of surgical procedures), length of hospital stay and outcome. Injury severity score was also calculated for each case. Controlling for estimated regional population changes, there was a significant increase in the number of ride-on mower related accidents in the time period 2003-2008, compared to the time period 1998-2003. Ride-on injuries had significantly higher injury severity scores, longer hospital stays and were more likely to involve amputations as compared with walk-behind injuries. Children can sustain significant injuries with unsafe lawnmower use. The current study demonstrates the increasing incidence of ride-on mower related injuries in children and identifies a greater morbidity associated with such injuries. Such presentations place intense demands on local plastic surgical services.

OPEN SURGICAL VS. MINIMALLY INVASIVE TREATMENT OF THORACOLUMBAR AO FRACTURES TYPE A AND B1 IN A REFERENCE HOSPITAL

Directory of Open Access Journals (Sweden)

José Enrique Salcedo Oviedo

Full Text Available ABSTRACT Objective: The thoracolumbar spine trauma represents 30% of spinal diseases. To compare the minimally invasive technique with the open technique in lumbar fractures. Method: A prospective, cross-sectional, comparative observational study, which evaluated the following variables: surgery time, length of hospital stay, transoperative bleeding, postoperative pain, analyzed by SPSS software using Student's t test with statistical significance of p ≥ 0.05, with 24 patients with single-level thoracolumbar fractures, randomly treated with percutaneous pedicle screws and by open technique with a transpedicular system. Results: The surgery time was 90 minutes for the minimally invasive technique and 60 minutes for the open technique, the bleeding was on average 50 cm3 vs. 400 cm3. The mean visual analogue scale for pain at 24 hours of surgery was 5 for the minimally invasive group vs. 8 for the open group. The number of fluoroscopic projections of pedicle screws was 220 in the minimally invasive technique vs. 100 in the traditional technique. Quantified bleeding was minimal for percutaneous access vs. 340 cm3 for the traditional system. The hospital discharge for the minimally invasive group was at 24 hours and at 72 hours for those treated with open surgery. Conclusions: It is a technique that requires longer surgical time, with reports of less bleeding, less postoperative pain and less time for hospital discharge, reasons why it is supposed to be a procedure that requires a learning curve, statistical significance with respect to bleeding, visual analogue scale for pain and showed no significant difference in the variables of surgical time.

[SURGICAL HIP DISLOCATION APPROACH FOR TREATMENT OF FEMORAL HEAD FRACTURE].

Science.gov (United States)

Tang, Yanfeng; Liu, Youwen; Zhu, Yingjie; Li, Jianming; Li, Wuyin; Li, Qiyi; Jia, Yudong

2015-11-01

To discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture. A retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years (range, 15-63 years). The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type I, 7 cases as type II, 1 case as type III, and 5 cases as type IV. The interval of injury and operation was 2-10 days (mean, 4.1 days). Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital. Primary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months (range, 25-36 months). During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms [staging as IIa and IIb respectively according to Association Research Circulation Osseous (ARCO) staging system], and 1 (stage IIIb) had nonunion of the femoral neck fracture, who underwent total hip arthroplasty (THA). In 4 patients having myositis ossificans (2 cases of grade I, 1 case of grade II, and 1 case of grade III based on Brooker grading), no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%. Surgical hip dislocation approach can not only protect the residual vessels of the

Collagen nerve guides for surgical repair of brachial plexus birth injury.

Science.gov (United States)

Ashley, William W; Weatherly, Trisha; Park, Tae Sung

2006-12-01

Standard brachial plexus repair techniques often involve autologous nerve graft placement and neurotization. However, when performed to treat severe injuries, this procedure can sometimes yield poor results. Moreover, harvesting the autologous graft is time-consuming and exposes the patient to additional surgical risks. To improve surgical outcomes and reduce surgical risks associated with autologous nerve graft retrieval and placement, the authors use collagen matrix tubes (Neurogen) instead of autologous nerve graft material. Between 1991 and 2005, the authors surgically treated 65 infants who had suffered brachial plexus injury at birth. During this time, seven patients were treated using collagen matrix tubes (Neurogen). This study is a retrospective analysis of the initial five patients who were treated using the tubes. Two patients underwent tube placement recently and were excluded from the analysis because of the inadequate follow-up period. Four of the five patients experienced a good recovery (motor scale composite [MSC] > 0.6), and three exhibited an excellent recovery (MSC > 0.75) at 2 years postoperatively. The MSC improved by an average of 69 and 78% at 1 and 2 years, respectively. The movement scores improved to greater than or equal to 50% range of motion in most patients, and the contractures were usually mild or moderate. Follow-up physical and occupational therapy evaluations confirm these patients' functional status. When last seen, four of five of these children could feed and dress themselves. Technically, the use of the collagen matrix tubes was straightforward and efficient, and there were no complications. The outcomes in this small series are encouraging.

Impact of surgeon subspecialty training on surgical outcomes in open globe injuries

Directory of Open Access Journals (Sweden)

Han IC

2015-09-01

Full Text Available Ian C Han,1 Sidharth Puri,1 Jiangxia Wang,2 Shameema Sikder1 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, 2Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA Purpose: The purpose of this study was to evaluate whether subspecialty training of the initial treating surgeon affects visual acuity and surgical outcomes in patients with open globe injuries.Design: This study is a single-institution, retrospective case series.Methods: The charts of adult patients with open globe injuries requiring surgical repair at the Wilmer Eye Institute between July 1, 2007 and July 1, 2012 were retrospectively reviewed. Clinical findings at presentation were recorded, and details of initial repair and follow-up surgeries were analyzed. Differences in visual acuity and surgical outcomes were compared based on subspecialty training of the initial surgeon.Results: The charts of 282 adult patients were analyzed, and 193 eyes had at least 6 months of follow-up for analysis. Eighty-six eyes (44.6% required follow-up surgery within the first year, and 39 eyes (20.2% were enucleated. Eyes initially treated by a vitreoretinal (VR surgeon were 2.3 times (P=0.003 more likely to improve by one Ocular Trauma Score (OTS visual acuity category and 1.9 times (P=0.027 more likely to have at least one more follow-up surgery at 6 months compared to eyes treated by non-VR surgeons. Patients with more anterior injuries treated by a VR surgeon were more likely to improve by one OTS visual acuity category compared to those treated by non-VR surgeons (P=0.004 and 0.016 for Zones I and II, respectively. There was no difference in visual acuity outcomes for eyes with posterior injuries (P=0.515 for Zone III.Conclusion: Eyes initially treated by a VR surgeon are more likely to improve by one OTS visual acuity category than those initially treated by a non-VR surgeon. However, patients initially treated by a VR surgeon also undergo more

[Comparative effectiveness of surgical and non-surgical treatment for pediatric mandibular condylar fractures].

Science.gov (United States)

Hu, Min; Wang, Yanyi; Zhang, Lihai; Yao, Jun

2010-12-01

To compare the effectiveness of open reduction and conservative treatment for pediatric mandibular condylar fractures and to provide the evidence for the selection of clinical therapy. The clinical data were retrospectively analyzed from 25 patients with the mandibular condylar fractures between January 1988 and December 2006. Of them, 8 patients (11 fractures) were treated with surgical treatment (surgical group) and 17 patients (22 fractures) with non-surgical treatment (non-surgical group). In surgical group, there were 6 males (9 fractures) and 2 females (2 fractures) with an age range of 8-13 years; fracture was caused by tumbling in 7 cases and by traffic accident in 1 with an interval of 1-6 days between injury and hospitalization; and 5 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 3 cases as bilateral condylar fractures complicated by mental fractures. In non-surgical group, there were 12 males (15 fractures) and 5 females (7 fractures) with an age range of 3-12 years; fracture was caused by falling from height in 4 cases, by tumbling in 10, and by traffic accident in 3 with an interval of 1-25 days between injury and hospitalization; and 12 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 5 cases as bilateral condylar fractures (1 complicated by mental fracture). Incision healed by first intention in surgical group, and 25 cases were followed up 1-6 years with an average of 3.5 years. At 12 months after treatment, no temporomandibular joint pain, eating disorder, or limited mandibular movement occurred in 2 groups. No significant difference was observed in opening mouth extent, protrusive and lateral movements between 2 groups at 6 and 12 months (P > 0.05). During centric occlusion, mental point located at the midline with symmetric face figure. Two patients in surgical group and 3 in non-surgical group had slight snap when opening their mouths. Mandible

Genetic Diagnosis before Surgery has an Impact on Surgical Decision in BRCA Mutation Carriers with Breast Cancer.

Science.gov (United States)

Park, Sungmin; Lee, Jeong Eon; Ryu, Jai Min; Kim, Issac; Bae, Soo Youn; Lee, Se Kyung; Yu, Jonghan; Kim, Seok Won; Nam, Seok Jin

2018-05-01

The first aim of our study was to evaluate surgical decision-making by BRCA mutation carriers with breast cancer based on the timing of knowledge of their BRCA mutation status. The second aim was to evaluate breast cancer outcome following surgical treatment. This was a retrospective study of 164 patients diagnosed with invasive breast cancer, tested for BRCA mutation, and treated with primary surgery between 2004 and 2015 at Samsung Medical Center in Seoul, Korea. We reviewed types of surgery and timing of the BRCA test result. We compared surgical decision- making of BRCA carriers with breast cancer based on the timing of knowledge of their BRCA mutation status. Only 15 (9.1%) patients knew their BRCA test results before their surgery, and 149 (90.9%) knew the results after surgery. In patients with unilateral cancer, there was a significant difference between groups whose BRCA mutation status known before surgery and groups whose BRCA status unknown before surgery regarding the choice of surgery (p = 0.017). No significant difference was observed across surgery types of risk of ipsilateral breast tumor recurrence (p = 0.765) and contralateral breast cancer (p = 0.69). Genetic diagnosis before surgery has an impact on surgical decision choosing unilateral mastectomy or bilateral mastectomy in BRCA mutation carriers with breast cancer. Knowledge about BRCA mutation status after initial surgery led to additional surgeries for patients with BCS. Thus, providing genetic counseling and genetic testing before surgical choice and developing treatment strategies for patients with a high risk of breast cancer are important.

[Surgical treatment and prognosis of Borrmann type IIII( gastric cancer involving the whole stomach].

Science.gov (United States)

Dong, Ruizeng; Zhang, Zewei; Zhou, Yiming; Hua, Yonghong; Guo, Jianmin

2018-02-25

To explore the surgical treatment and prognosis of Borrmann type IIII( gastric cancer involving the whole stomach. Clinicopathological characteristics and survival data of 223 patients with Borrmann type IIII( gastric cancer involving the whole stomach (defined as the tumor infiltrating 3 regions of the stomach) receiving surgical treatment at the Department of Abdominal Surgery of Zhejiang Cancer Hospital between January 2002 and December 2015 were analyzed retrospectively. The survival time of patients with different clinicopathological features and different treatment methods was compared. Cox regression was used to analyze the independent prognostic factors. Two hundred and twenty-three patients with Borrmann type IIII( gastric cancer involving the whole stomach accounted for 24.0% (223/930) of all Borrmann type IIII( gastric cancer cases undergoing surgical resection at the same period. There were 147 males and 76 females with an average age of 57.8 years. All the patients underwent total gastrectomy. Of these patients, radical resection was performed in 149 cases(66.8%) and palliative resection in 74 cases (33.2%). Combined organ resection was performed in 43 patients (19.3%), including 25 splenectomies, 6 pancreatic body and tail plus spleen and transverse colon resections, 2 transverse colon plus spleen resections, 2 right colon resections, 2 transverse colon resections, 2 ovariectomies, 1 partial jejunal resection, 1 pancreatoduodenectomy, 1 pancreatic tail plus transverse colon resection, and 1 partial pancreatectomy. Postoperative complications occurred in 28 patients(12.6%), including 10 patients with combined organ resection. Esophagojejunal fistula was the most frequent complication, accounting for 39.3%(11/28). Perioperative mortality occurred in 3 patients (1.3%). Thirty-nine patients underwent preoperative adjuvant chemotherapy (clinical stage: cT4aN0M0 in 1 patient, cT4bN1-2M0 in 12 patients, cT4aN1-2M0 in 20 patients, and cT4aN3M0 in 6 patients

[Surgical technique and clinical results of total knee arthroplasty in treating endstage gonarthrosis combined with valgus knee deformity].

Science.gov (United States)

Wang, Xingshan; Weng, Xisheng; Lin, Jin; Jin, Jin; Qian, Wenwei

2012-05-01

To investigate the surgical technique and the clinical results of total knee arthroplasty (TKA) in treating end-stage gonarthrosis combined with valgus knee deformity. Between November 1998 and October 2010, 64 patients (72 knees) with end-stage gonarthrosis combined with valgus knee deformity underwent TKA by a medial parapatellar approach. Of the 64 patients, 18 were male and 46 were female with an average age of 62.5 years (range, 23-82 years), including 44 cases (49 knees) of osteoarthritis, 17 cases (20 knees) of rheumatoid arthritis, 2 cases (2 knees) of haemophilic arthritis, and 1 case (1 knee) of post-traumatic arthritis. Bilateral knees were involved in 8 cases, and single knee in 56 cases. The flexion and extension range of motion (ROM) of the knee joint was (82.2 +/- 28.7) degrees; the femur-tibia angle (FTA) was (18.0 +/- 5.8) degrees; according to Knee Society Score (KSS) criterion, the preoperative clinical score was 31.2 +/- 10.1 and functional score was 37.3 +/- 9.0. According to Krackow's classification, there were 65 knees of type I and 7 knees of type II. By medial parapatellar approach, conventional osteotomy and Ranawat soft tissue release were performed in all cases. Prosthesis of preserved posterior cruciate ligament were used in 7 cases (7 knees), posterior stabilize prosthesis in 54 cases (60 knees), constrained prosthesis in 4 cases (5 knees). Incisions healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient with haemophilic arthritis, severe valgus deformity (FTA was 41 degrees), and flexion contracture (20 degrees), which was cured after 1 year of conservative treatment. Revison surgery was performed in 1 case of deep infection at 2 years after surgery. All the patients were followed up 4.9 years on average (range, 1-13 years). At last follow-up, the FTA was (7.0 +/- 2.5) degrees, showing significant difference when compared with preoperative value (t = 15.502, P = 0.000). The KSS clinical score was 83.0 +/- 6

Local antimicrobial administration for prophylaxis of surgical site infections.

Science.gov (United States)

Huiras, Paul; Logan, Jill K; Papadopoulos, Stella; Whitney, Dana

2012-11-01

Despite a lack of consensus guidelines, local antibiotic administration for prophylaxis of surgical site infections is used during many surgical procedures. The rationale behind this practice is to provide high antibiotic concentrations at the site of surgery while minimizing systemic exposure and adverse effects. Local antibiotic administration for surgical site prophylaxis has inherent limitations in that antibiotics are applied after the incision is made, rather than the current standard for surgical site prophylaxis that recommends providing adequate antibiotic concentrations at the site before the incision. The efficacy and safety of local application of antibiotics for surgical site prophylaxis have been assessed in different types of surgery with a variety of antibiotic agents and methods of application. We identified 22 prospective, randomized, controlled trials that evaluated local application of antibiotics for surgical site prophylaxis. These trials were subsequently divided and analyzed based on the type of surgical procedure: dermatologic, orthopedic, abdominal, colorectal, and cardiothoracic. Methods of local application analyzed included irrigations, powders, ointments, pastes, beads, sponges, and fleeces. Overall, there is a significant lack of level I evidence supporting this practice for any of the surgical genres evaluated. In addition, the literature spans several decades, and changes in surgical procedures, systemic antibiotic prophylaxis, and microbial flora make conclusions difficult to determine. Based on available data, the efficacy of local antibiotic administration for the prophylaxis of surgical site infections remains uncertain, and recommendations supporting this practice for surgical site prophylaxis cannot be made. © 2012 Pharmacotherapy Publications, Inc.

Ethnopharmacological field study of the plants used to treat type 2 diabetes among the Cakchiquels in Guatemala.

Science.gov (United States)

Cruz, Elda Carola; Andrade-Cetto, Adolfo

2015-01-15

Type 2 diabetes is characterized by tissue resistance to the action of insulin, combined with a relative deficiency in insulin secretion. In Guatemala, type 2 diabetes results in significant mortality rates. The low incomes of the indigenous population results in the use of alternative therapies such as medicinal plants to treat the illness. We could not find any previous study related to the use of medicinal plants to treat diabetes in Guatemala. The aim of this work is to determine the most effective plant species used in traditional medicine to treat type 2 diabetes. We performed an ethnopharmacological field study among the Cakchiquels of Chimaltenango to select the most prominent plants used to treat the disease. Type 2 diabetic patients from their community health centers were interviewed using structured questionnaires. Two mathematical tools were used to identify potential plant species: the Disease Consensus Index and the Use Value. International databases, including SCOPUS, PubMed, and Google Scholar, were used to identify whether the plants with the highest scores were known to elicit hypoglycemic effects. After analyzing the data, we can propose the following plants as the most prominent among the Cakchiquels of Chimaltenango to treat type 2 diabetes: Hamelia patens Jacq., Neurolaena lobata (L.) R.Br.ex Cass., Solanum americanum Mill., Croton guatemalensis Lotsy, and Quercus peduncularis Née. The Cakchiquel patients interviewed did not understand type 2 diabetes; however, they associated the onset of their disease with a negative emotion, such as shock, sadness or anger. Despite changes in lifestyle, influences of advertising, the availability of innovative treatments and the use of oral hypoglycemic treatments provided by health facilities serving indigenous communities, the Cakchiquel continue to use medicinal plants as adjunctive treatment. While they are unaware whether the plants can cause additional harm, they consider their consumption

Surgical management of adult type 1 split cord malformation. Report of two cases with literature review.

Science.gov (United States)

Viswanathan, Vibhu K; Minnema, Amy J; Farhadi, H Francis

2018-06-01

Split cord malformation (SCM) is a rare form of spinal dysraphism wherein the spinal cord is divided longitudinally into two distinct hemicords. Surgery is usually performed in children while management in adults, who rarely manifest symptoms, remains controversial. Both expectant management and prophylactic surgery have been variously advocated. The present article describes our experience in two adult patients with predominant pain-related complaints who underwent surgical excision of type 1 SCM lesions. A comprehensive review of the literature on SCM in adults is also provided. While pain, disability, and quality of life scores improved in these two patients, further larger studies will be required to define the role of surgery in adults with type 1 SCM and a pain-dominant presentation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Outcomes after medical and surgical interventions in horses with temporohyoid osteoarthropathy.

Science.gov (United States)

Espinosa, P; Nieto, J E; Estell, K E; Kass, P H; Aleman, M

2017-11-01

Temporohyoid osteoarthropathy (THO) is a cause of neurological disease in horses that is characterised by facial and vestibulocochlear nerve deficits. Studies reporting and comparing survival following medical or surgical treatment of THO are lacking. To compare survival and prognosis in horses with THO treated medically or surgically, and to report surgical complications. Retrospective study. The medical records of horses diagnosed with THO were retrieved, and data on signalment, clinical signs and duration, corneal ulceration and bilateral occurrence were recorded. Neurological severity was graded according to clinical signs. Preoperative radiographic and endoscopic images were graded according to the severity of changes. Factors potentially affecting survival and treatment were compared using Cox proportional hazards regression. A total of 77 horses were identified as having THO during the period 1990-2014. Of these, 25 horses underwent ceratohyoid ostectomy (CHO) and eight underwent partial stylohyoid ostectomy (PSHO). Thirteen of 20, one of 25 and one of eight horses treated by medical therapy, CHO and PSHO, respectively, died or were subjected to euthanasia as a consequence of THO. Compared with CHO, medical therapy was significantly associated with nonsurvival, but there were no significant differences in survival between horses undergoing PSHO and medical therapy. The duration of clinical signs, and neurological, radiographic and endoscopic grades were not associated with survival of THO. However, the age of the horse was significantly associated with poorer survival. Survival time was significantly shorter in the medical therapy group compared with the two surgical groups combined, but did not differ significantly between the two surgical groups. No significant difference between groups was seen in the incidence of surgical complications (33.3% in the PSHO and 22.2% in the CHO group). This was a nonrandomised study of treatment effects on survival and

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

Directory of Open Access Journals (Sweden)

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.

[Diverticular disease of the large bowel - surgical treatment].

Science.gov (United States)

Levý, M; Herdegen, P; Sutoris, K; Simša, J

2013-07-01

Surgical treatment, despite the rapid development of the numerous modern miniinvasive intervention techniques, remains essential in the treatment of complicated diverticular disease. The aim of this work is to summarize indications for surgical treatment in both acute and elective patients suffering from diverticular disease of the large bowel. Review of the literature and recent findings concerning indications for surgical intervention in patients with diverticulosis of the colon. The article describes indications, types of procedures, techniques and postoperative care in patients undergoing surgical intervention for diverticular disease.

Surgical treatment is effective in severe cases of exercise-induced laryngeal obstruction: A follow-up study.

Science.gov (United States)

Norlander, Katarina; Johansson, Henrik; Jansson, Christer; Nordvall, Lennart; Nordang, Leif

2015-01-01

Surgery is an effective treatment in severe cases of supraglottic exercise-induced laryngeal obstruction (E-ILO). Conservatively treated subjects and subjects tested negative for E-ILO, who still experience breathing problems 1-3 years after diagnosis, tend to adjust their physical activity to a greater extent than surgically treated subjects. To investigate how symptoms and level of physical activity change over time in patients with E-ILO who have undergone surgery, patients with E-ILO treated conservatively and patients who tested negative for laryngeal obstruction at continuous laryngoscopy exercise-test (CLE-test). Patients referred for exercise-induced breathing difficulties answered questionnaires at diagnostic CLE-test and at follow-up. Questions regarded exercise-induced breathing problems, current physical activity level, and medical history of asthma and perennial allergy. Out of 84 invited subjects, 59 (70%) answered both questionnaires. Surgically treated subjects had less breathing problems at follow-up compared with conservatively treated subjects and subjects who tested negative (p < 0.001). None of the surgically treated subjects were less physically active or had changed sport due to exercise-induced dyspnoea, whereas 41.7% of the conservatively treated subjects had made such adjustments (p < 0.001).

Localization of Hsp27 in the Rat Submandibular Gland Following the Application of Various Surgical Treatments

International Nuclear Information System (INIS)

Mizobe, Kenichi; Kawabe, Yoshihiro; Bando, Yasuhiko; Sakiyama, Koji; Araki, Hisao; Amano, Osamu

2014-01-01

Salivary glands repair and regenerate following various types of injuries and surgical procedures. However, the tissue responses induced in the contralateral glands have yet to be elucidated in detail. Hsp27, a member of the heat-shock protein (Hsp) family, is strongly expressed in physiological environments, particularly during development. Hsp27 was previously shown to play a role in the regulation of acinar cell proliferation and differentiation in the rat submandibular gland. The present study performed the following surgical treatments on the right submandibular glands of adult rats: 1) duct ligation followed by unligation after one week; 2) partial sialoadenectomy; and 3) total sialoadenectomy. Immunohistochemistry for Hsp27 and Ki67 was performed in the experimental and normal contralateral glands, and localization was histologically and morphometrically analyzed. The results obtained revealed the localization of Hsp27 to the intercalated duct in the submandibular glands of non-treated rats. The expression of Hsp27 was strongly induced in both the uninjured contralateral control glands as well as treated glands of experimental rats regardless of the surgical procedure performed. The number of Hsp27-immunopositive cells increased rapidly following surgery, and subsequently returned to the same level as that in non-treated rats after 4 weeks. However, no marked changes were observed in the number of Ki67-immunopositive proliferating cells. Therefore, the change in the number of Hsp27-immunopositive cells may have contributed to compensatory hypertrophy. The results of the present study indicate that the expression of Hsp27 in the intercalated duct in the submandibular gland may play a role in the differentiation of acinar cells

Mechanism and surgical management of transsellar transsphenoidal encephalocele.

Science.gov (United States)

Yang, Zhijun; Wang, Zhenmin; Wang, Bo; Liu, Pinan

2015-12-01

We performed a retrospective study to assess the mechanisms and surgical strategies for transsellar transsphenoid encephalocele, a rare type of basal encephalocele. Its clinical presentations include multiple endocrine disturbances, visual deficits, cerebrospinal fluid rhinorrhea and dyspnea. However, little is known about the occurrence and optimal treatment of this disease. We retrospectively reviewed six patients who were treated in our hospital from October 2003 to September 2013; five male patients and one female, with an average age of 10 years (range: 2 - 28). We collected data on their general condition, medical history, clinical features, and outcomes. An endoscopic transsphenoidal approach was used for five patients, and one refused surgery. All patients had similar imaging findings, and their pituitary gland could not be seen on MRI. Five of the patients showed gradual disease progression. The clinical symptoms were endocrine disturbance (n=6), decreased visual acuity (n=5), dyspnea (n=3) and cerebrospinal fluid rhinorrhea (n=2). Three of the patients also had a cleft palate. Two patients suffered serious symptoms of fever, tachyarrhythmia, and electrolyte disturbance postoperatively. After a long follow-up period, the symptoms remained stable or improved in all patients postoperatively, but worsened in the patient who did not have a surgical intervention. No mortalities were recorded. This disease may result from pituitary dysplasia, and the symptoms develop as the patients grow. Surgical interventions can be helpful for symptom management, the optimal treatment being a transsphenoidal approach. Those patients with milder symptoms preoperatively have a better prognosis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Surgical Treatment of A Dissecting Aneurysm of the Superior Cerebellar Artery: Case Report

Directory of Open Access Journals (Sweden)

Stefanescu Florin

2014-10-01

Full Text Available Dissecting aneurysm located in the peripheral region of the superior cerebellar artery is very rare. There is little experience regarding their surgical or endovascular treatment. We present the case of a peripheral dissecting superior cerebellar artery aneurysm treated by surgical clipping.

[Surgical treatment of esophageal achalasia--20 years experience].

Science.gov (United States)

Yaramov, N; Sokolov, M; Angelov, K; Toshev, S; Petrov, B

2009-01-01

Achalasia comes from a Greek word that means "failure to relax." Cardiospasm and achalasia refer to the same condition. This report addresses esophageal achalasia--its history, diagnosis, pathophysiology, and treatment options. We report our experience in treating this disorder surgically using modified Heller myotomy combined or not with partial gastric fundoplication. 47 patients with achalasia surgically operated in 20-years period are reported by authors. These features make it reasonable to reasses the relative indications for surgery and nonsurgical therapy in achalasia of the esophagus.

SURGICAL TREATMENT FOR BONE METASTASES OF KIDNEY CANCER

Directory of Open Access Journals (Sweden)

A. S. Semkov

2010-01-01

Full Text Available The data of 67 kidney cancer (KC patients with bone metastases, who had been treated at Moscow City Cancer Hospital Sixty-Two in 2002 to 2009 and had undergone skeletal bone surgery, were retrospectively analyzed. The role of surgical treatment for bone metastases from KC was assessed and the factors influencing the patients survival were determined. Surgical treatment for bone metastases from KC was ascertained to yield satisfactory results in improving the quality of life and increasing survival rates in the patients.

SURGICAL TREATMENT FOR BONE METASTASES OF KIDNEY CANCER

Directory of Open Access Journals (Sweden)

A. S. Semkov

2014-08-01

Full Text Available The data of 67 kidney cancer (KC patients with bone metastases, who had been treated at Moscow City Cancer Hospital Sixty-Two in 2002 to 2009 and had undergone skeletal bone surgery, were retrospectively analyzed. The role of surgical treatment for bone metastases from KC was assessed and the factors influencing the patients survival were determined. Surgical treatment for bone metastases from KC was ascertained to yield satisfactory results in improving the quality of life and increasing survival rates in the patients.

Surgical treatment of intradiploic epidermoid cyst treated as depression

Directory of Open Access Journals (Sweden)

Živković Nenad

2014-01-01

Full Text Available Introduction. Extradural intradiploic epidermoid cysts are rare, representing less than 0.25% of all primary intracranial tumors. They can be neurologically silent and can only present psychiatric symptoms like depression, cognitive or personality changes. Case Outline. A 68-year-old male with two year long history of depressive mood, lack of motivation, helplessness, hopelessness and poor response to antidepressive drug therapy was described. CT scan showed a well-defined mass in the parietal scalp with destruction of the scull. He underwent intracranial tumor resection. Surgical resection and cranioplasty were performed. Pathology confirmed intradiploic epidermoid cyst. Conclusion. Total removal of these cysts and repeated washing of the cavity with 0.9 % saline may prevent recurrence and aseptic meningitis and may improve mental state of the patient. We also emphasize the need for neuroimaging studies in a patient with atypical changes in mental status, even without neurological signs or symptoms.

Surgical Pathology Bootcamp: A Military Experience

Science.gov (United States)

2018-03-17

CAP 2018, Vancouver, British Columbia, Canada, March 17-23, 2018 14. ABSTRACT Surgical Pathology Bootcamp: A Military Experience Nathaniel Smith...REPORT TYPE 3. DATES COVERED (From - To) 17/03/2018 poster 03/17/2018-03/23/2018 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Surgical Pathology ...or its Components. Background A common complaint among pathology department faculty is the variable medical knowledge and histological experience

Evolution of surgical techniques for a progressive risk reduction.

Science.gov (United States)

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

2017-07-18

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

Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

Directory of Open Access Journals (Sweden)

Shan-Xi Wang

2018-06-01

Full Text Available Purpose: To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice. Methods: From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20–65 years. The causes of the fractures included traffic accidents (13 cases, falls from a height (four cases, heavy lifting injuries (three cases, and sport injury (one case. All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction. Results: The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36–76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%. Conclusion: The mid-term curative effects of a

Surgical treatment of adolescent internal condylar resorption (AICR) with articular disc repositioning and orthognathic surgery in the growing patient--a pilot study.

Science.gov (United States)

Bodine, Trevor P; Wolford, Larry M; Araujo, Eustaquio; Oliver, Donald R; Buschang, Peter H

2016-01-01

The aim of this study was to better understand how surgical repositioning and stabilization of anteriorly displaced articular discs using the Mitek mini-anchor technique affects condylar growth in growing patients with adolescent internal condylar resorption (AICR). Twenty-two adolescent patients diagnosed with AICR and anterior temporomandibular disc displacement were compared to untreated control subjects without AICR matched for age, sex, and Angle classification. Pre-surgical (T1 and T2) and post-surgical (T3 and T4) mandibular tracings were superimposed on natural stable structures to evaluate the horizontal, vertical, and total changes in the position of condylion. The treated group showed an overall decrease in condylar height pre-surgically and statistically significant changes in condylar growth direction between the pre- and post-surgical observation periods. Pre-surgically, the treated group showed significantly more posterior condylar growth than the control group; they also showed inferior condylar growth, while the controls showed superior growth. Controls and patients in the treated group showed no significant differences in condylar growth post-surgically. Adolescent patients diagnosed with AICR and anterior disc displacement treated with mandibular ramus and maxillary osteotomies, along with Mitek anchors to reposition internally deranged discs, showed post-surgical normalization of condylar growth.

Surgical treatment of adolescent internal condylar resorption (AICR with articular disc repositioning and orthognathic surgery in the growing patient—a pilot study

Directory of Open Access Journals (Sweden)

Trevor P. Bodine

2016-01-01

Full Text Available Abstract Background The aim of this study was to better understand how surgical repositioning and stabilization of anteriorly displaced articular discs using the Mitek mini-anchor technique affects condylar growth in growing patients with adolescent internal condylar resorption (AICR. Methods Twenty-two adolescent patients diagnosed with AICR and anterior temporomandibular disc displacement were compared to untreated control subjects without AICR matched for age, sex, and Angle classification. Pre-surgical (T1 and T2 and post-surgical (T3 and T4 mandibular tracings were superimposed on natural stable structures to evaluate the horizontal, vertical, and total changes in the position of condylion. Results The treated group showed an overall decrease in condylar height pre-surgically and statistically significant changes in condylar growth direction between the pre- and post-surgical observation periods. Pre-surgically, the treated group showed significantly more posterior condylar growth than the control group; they also showed inferior condylar growth, while the controls showed superior growth. Controls and patients in the treated group showed no significant differences in condylar growth post-surgically. Conclusions Adolescent patients diagnosed with AICR and anterior disc displacement treated with mandibular ramus and maxillary osteotomies, along with Mitek anchors to reposition internally deranged discs, showed post-surgical normalization of condylar growth.

Sacroiliac joint tuberculosis: surgical management by posterior open-window focal debridement and joint fusion.

Science.gov (United States)

Zhu, Guo; Jiang, Li-Yuan; Yi, Zhang; Ping, Li; Duan, Chun-Yue; Yong, Cao; Liu, Jin-Yang; Hu, Jian-Zhong

2017-11-29

Sacroiliac joint tuberculosis(SJT) is relatively uncommon, but it may cause severe sacroiliac joint destruction and functional disorder. Few studies in the literature have been presented on SJT, reports of surgical treatment for SJT are even fewer. In this study, we retrospectively reviewed surgical management of patients with severe SJT of 3 different types and proposed to reveal the clinical manifestations and features and aim to determine the efficiency and security of such surgical treatment. We reviewed 17 patients with severe SJT of 3 different types who underwent posterior open-window focal debridement and bone graft for joint fusion. Among them,five patients with anterior sacral abscess had anterior abscess curettage before debridement. Two patients with lumbar vertebral tuberculosis received one-stage posterior tuberculous debridement, interbody fusion and instrumentation. Follow-up was performed 36 months (26 to 45 months) using the following parameters: erythrocyte sedimentation rate(ESR), status of joint bony fusion on CT scan, visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Buttock pain and low back pain were progressively relieved with time. 6 months later, pain was not obvious, and ESR resumed to normal levels within 3 months. Solid fusion of the sacroiliac joint occurred within 12 months in all cases. No complications or recurrence occurred. At final follow-up, all patients had no pain or only minimal discomfort over the affected joint and almost complete functional recovery. Posterior open-window focal debridement and joint fusion is an efficient and secure surgical method to treat severe SJT. If there is an abscess in the front of the sacroiliac joint, anterior abscess curettage should be performed as a supplement.

Ultrasound Guidance in Performing a Tendoscopic Surgery to Treat Posterior Tibial Tendinitis: A Useful Tool?

Directory of Open Access Journals (Sweden)

Akinobu Nishimura

2016-01-01

Full Text Available A 25-year-old man with a pronation-external rotation type of fracture was surgically treated using a fibular plate. Five years later, he underwent resection of bone hyperplasia because of the ankle pain and limitation of range of motion. Thereafter, the left ankle became intermittently painful, which persisted for about one year. He presented at the age of 43 with persistent ankle pain. Physical and image analysis findings indicated a diagnosis of posttraumatic posterior tibial tendinitis, which we surgically treated using tendoscopy. Endoscopic findings showed tenosynovitis and fibrillation on the tendon surface. We cleaned and removed the synovium surrounding the tendon and deepened the posterior tibial tendon groove to allow sufficient space for the posterior tibial tendon. Full weight-bearing ambulation was permitted one day after surgery and he returned to his occupation in the construction industry six weeks after surgery. The medial aspect of the ankle was free of pain and symptoms at a review two years after surgery. Although tendoscopic surgery for stage 1 posterior tibial tendon dysfunction has been reported, tendoscopic surgery to treat posttraumatic posterior tibial tendinitis has not. Our experience with this patient showed that tendoscopic surgery is useful not only for stage 1 posterior tibial dysfunction, but also for posttraumatic posterior tibial tendinitis.

Innovative Surgical Management of the Synovial Chondromatosis of Temporo-Mandibular Joints: Highly Conservative Surgical Technique.

Science.gov (United States)

Ionna, Franco; Amantea, Massimiliano; Mastrangelo, Filiberto; Ballini, Andrea; Maglione, Maria Grazia; Aversa, Corrado; De Cecio, Rossella; Russo, Daniela; Marrelli, Massimo; Tatullo, Marco

2016-07-01

Synovial chondromatosis (SC) is an uncommon disease characterized by a benign nodular cartilaginous proliferation arising from the joint synovium, bursae, or tendon sheaths. Although the temporomandibular joint is rarely affected by neoplastic lesions, SC is the most common neoplastic lesion of this joint. The treatment of this disease consists in the extraoral surgery with a wide removal of the lesion; in this study, the authors described a more conservative intraoral surgical approach. Patient with SC of temporomandibular joint typically refer a limitation in the mouth opening, together with a persistent not physiological mandibular protrusion and an appearance of a neoformation located at the right preauricular region: the authors reported 1 scholar patient. After biopsy of the neoformation, confirming the synovial chondromatosis, the patient underwent thus to the surgical excision of the tumor, via authors' conservative transoral approach, to facilitate the enucleation of the neoformation. The mass fully involved the pterygo-maxillary fossa with involvement of the parotid lodge and of the right TMJ: this multifocal extension suggested for a trans-oral surgical procedure, in the light of the suspicion of a possible malignant nature of the neoplasm. Our intraoral conservative approach to surgery is aimed to reduce the presence of unaesthetic scars in preauricular and facial regions, with surgical results undoubtedly comparable to the traditional surgical techniques much more aggressive. Our technique could be a valid, alternative, and safe approach to treat this rare and complex kind of oncological disease.

[Surgical treatment of gynecomastia].

Science.gov (United States)

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

2008-01-01

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

Surgical treatment of diplopia in Graves' Orbitopathy patients

NARCIS (Netherlands)

Jellema, H.M.

2016-01-01

This thesis addresses several aspects of the surgical treatment of diplopia in patients with Graves’ Orbitopathy (GO). We evaluated retrospectively the surgical outcome of different types of surgery on eye muscles to correct the diplopia. Each operated muscle seems to have its own dose-effect

Interventions for treating obesity in children

NARCIS (Netherlands)

Oude Luttikhuis, Hiltje; Baur, Louise; Jansen, Hanneke; Shrewsbury, Vanessa A.; O'Malley, Claire; Stolk, Ronald P.; Summerbell, Carolyn D.

2009-01-01

Background Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences. Objectives To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood. Search strategy We searched CENTRAL

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.

POSTEROSUPERIOR SURGICAL ACCESS ROUTE FOR TREATMENT OF ACROMIOCLAVICULAR DISLOCATIONS: RESULTS FROM 84 SURGICAL CASES.

Science.gov (United States)

Dal Molin, Danilo Canesin; Ribeiro, Fabiano Rebouças; Filho, Rômulo Brasil; Filardi, Cantídio Salvador; Tenor, Antonio Carlos; Stipp, Willian Nandi; Petros, Rodrigo Souto Borges

2012-01-01

To evaluate the results from surgical treatment of 84 cases of acute acromioclavicular dislocation, using a posterosuperior access route. Eighty-four cases of acute acromioclavicular dislocation (grade III in the Allman-Tossy classification) operated between November 2002 and May 2010 were evaluated. The patients' mean age was 34 years. The diagnoses were made using clinical and radiographic evaluations. The patients were operated by the same surgical team, within three weeks of the date of the trauma, using a posterosuperior approach to the shoulder to access the top of the base of the coracoid process for placement of two anchors, which were used in reducing the dislocation. The minimum follow-up was 12 months. The postoperative clinical-radiographic evaluation was done using the modified Karlsson criteria and the University of California at Los Angeles (UCLA) score. 92.8% of the 84 patients treated presented good or excellent results, and 7.2% presented fair or poor results, using the UCLA assessment score. According to the modified Karlsson criteria, 76.2% were assessed as grade A, 17.9% as grade B and 5.9% as grade C. The posterosuperior access route to the shoulder is a new option for accessing the coracoid process and treating acromioclavicular dislocation, with clinical and radiographic results equivalent to those in the literature.

Non-surgical management of extradural haematomas

International Nuclear Information System (INIS)

Tysvaer, A.T.; Oedegaard, H.

1987-01-01

The widespread use of computed tomographic (CT) scanning has shown that not all extradural haematomas require surgical evacuation. Eleven patients with epidural haematomas, 8-113 ml in volume, were treated successfully non-surgically. Seven were diagnosed later than four days after the head injury. The haematomas showed complete resolution over a period of 5-12 weeks. As some epidural haematomas have been shown to undergo considerable enlargement during the first weeks of treatment, conservative management of those greather than 35-40 ml initially is not advisable. In patients showing a decreasing level of consciousness and neurological deficits, even smaller haematomas must be evacuated. Extradural haematomas of the posterior fossa are high risk lesion and therefore unsuitable for conservative management

Surgical site infection rates following laparoscopic urological procedures.

Science.gov (United States)

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

2011-04-01

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

Surgical Masculinization of the Breast: Clinical Classification and Surgical Procedures.

Science.gov (United States)

Cardenas-Camarena, Lazaro; Dorado, Carlos; Guerrero, Maria Teresa; Nava, Rosa

2017-06-01

Aesthetic breast area improvements for gynecomastia and gender dysphoria patients who seek a more masculine appearance have increased recently. We present our clinical experience in breast masculinization and a classification for these patients. From July 2003 to May 2014, 68 patients seeking a more masculine thorax underwent surgery. They were divided into five groups depending on three factors: excess fatty tissue, breast tissue, and skin. A specific surgical treatment was assigned according to each group. The surgical treatments included thoracic liposuction, subcutaneous mastectomy, periareolar skin resection in one or two stages, and mastectomy with a nipple areola complex graft. The evaluation was performed 6 months after surgery to determine the degree of satisfaction and presence of complications. Surgery was performed on a total of 68 patients, 45 male and 22 female, with ages ranging from 18 to 49 years, and an average age of 33 years. Liposuction alone was performed on five patients; subcutaneous mastectomy was performed on eight patients; subcutaneous mastectomy combined with liposuction was performed on 27 patients; periareolar skin resection was performed on 11 patients; and mastectomy with NAC free grafts was performed on 16 patients. The surgical procedure satisfied 94% of the patients, with very few complications. All patients who wish to obtain a masculine breast shape should be treated with only one objective regardless patient's gender: to obtain a masculine thorax. We recommend a simple mammary gland classification for determining the best surgical treatment for these patients LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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

[Prevalence of Dental Caries in Type 1 Diabetic Patients Treated with Insulin Pump].

Science.gov (United States)

Garcia, Rosana; Coelho, Ana; Paula, Anabela; Marques Ferreira, Manuel; Caramelo, Francisco; Barros, Luísa; Batista, Carla; Melo, Miguel; Silva, Mário Jorge; Carrilho, Eunice

2016-08-01

Type 1 diabetes mellitus and oral health are strictly related on a reciprocal basis, and an increased susceptibility to a wide variety of oral diseases is recognised in these patients. The aim of the present study was to establish a relationship between the prevalence of dental caries in Type 1 diabetic patients treated with insulin pump and that of non-diabetic patients. An observational clinical study of analytical and cross-sectional nature was conducted. The sample consisted of 30 adults with diabetes mellitus treated with insulin pump (selected from the Coimbra Hospital and Universitary Centre) and 30 nondiabetic adults (selected from the ones accompanying the diabetic patients). One dentist evaluated all of the patients between January and May of 2015 in the Faculty of Medicine of the University of Coimbra. During the clinical evaluation a case report form adapted to the objectives of the investigation was completed. Data analysis was performed and the significance level was set at 5%. Diabetic patients showed similar levels on the caries and plaque index to non-diabetic patients. There were no statistically significant differences between the two groups as regards oral hygiene habits and frequency of visits to the dentist. Discussão: Although diabetics' diet is less abundant in carbohydrates, which provides a smaller exposure to cariogenic food, the regularity of meals can increase the risk of caries since the critical pH for demineralization is reached frequently throughout the day. However, the existence of a chronic condition may determine a high concern for general preventive care, resulting in an overall improvement of their oral health, which could justify the results. Type 1 diabetic patients treated with insulin pump don't have a higher prevalence of dental caries.

Penis augmentation by application of silicone material: complications and surgical treatment.

Science.gov (United States)

Sukop, A; Heracek, J; Mestak, O; Borský, J; Bayer, J; Schwarzmannová, K

2013-01-01

Complications resulting from enlargement of the penis by applications of unknown types of silicone and mineral oils are well described. Surgical removal of the tissue altered by inflammation leads to the development of defects of various sizes, often circular from the glans penis to the scrotum. The options of subsequent surgical treatment described in literature are not very extensive. Most defects are managed with skin grafting, rarely V-Y advancement or bilateral scrotal flaps. We present a 36-year-old patient after application of unknown silicone material into the penis for cosmetic enlargement. After the application developed severe inflammation with ulceration and necrosis around the penis. Conservative treatment was not effective, therefore, the infiltrated skin with subcutaneous tissue of the entire penis was surgically removed. The resulting defect was covered by implantation of the penis under the skin of the scrotum. There were no complications in the postoperative course, pain that was present before the surgery immediately subsided. Skin suture healed completely within 14 days. Three months after the surgery the patient returned to normal sexual life. Implantation of the penis under the skin of the scrotum is a fast, safe and effective method that can treat most of the circular skin defects of the penis. Scrotal skin is thin, soft, elastic and creates abundant and good cover around the entire penis.

A Retrospective Analysis of Pre-surgical Incisor Decompensation Attained in an Orthognathic Surgery Population

Science.gov (United States)

2016-07-01

incisors were more proclined. One of the goals of pre - surgical orthodontic treatment is decompensation of the occlusion and movement of teeth into...purpose of this study is to analyze pre - surgical orthodontic incisor decompensation attained in a group of orthognathic surgery patients treated in...the Tri-Service Orthodontic Residency Program. B. Specific Hypothesis Pre - surgical orthodontic treatment does not achieve full decompensation of

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

Science.gov (United States)

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

2016-11-29

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

Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Science.gov (United States)

Karaduman, Mert

2007-01-01

Cierny-Mader (C-M) Type III osteomyelitis is defined as a localised lesion with both medullary and cortical involvement that is stable mechanically after debridement. The treatment of C-M Type III osteomyelitisis is difficult and requires a precise protocol to achieve a disease-free long-term follow-up. We report here the results of our study on 26 patients (19 men and 7 women; average age: 34.7 years) with C-M Type III osteomylelitis who were treated with radical debridement, irrigation, vancomycin-impregnated custom-made beads and culture-specific systemic antibiotics. Those patients with metaphyseal involvement were treated with deroofing of the cortex and debridement by means of a “trough” (16 patients); those with diaphyseal involvement were treated with both intramedullary reaming and debridement from a trough (ten patients). Antibiotic cement rods were used as an additional therapy in five patients with diaphyseal involvement. Recurrence developed in three patients and was attributed to inadequate debridement; all three patients were treated again in the same manner with success. The mean follow-up is currently 3.6 years (range: 2–6 years). All of the patients have normal clinical, radiographic and laboratory parameters, and all are ambulatory and have returned to their pretreatment level of activity or better. We conclude that C-M Type III chronic osteomyelitis can be safely treated with this protocol. PMID:17375299

A New Surgical Approach for the Treatment of Conjunctivochalasis: Reduction of the Conjunctival Fold with Bipolar Electrocautery Forceps

Science.gov (United States)

Arenas, Eduardo; Muñoz, Diana

2016-01-01

Aim. To report a new surgical technique for the treatment of conjunctivochalasis. Methods. A new surgical technique in which specially designed bipolar electrocautery forceps facilitate the complete reduction of the conjunctival folds without creating lesions near the corneoscleral limbus was designed. A retrospective revision of the medical records of patients treated with this technique between the years 2011 and 2013 was made, and eighteen eyes of sixteen patients with conjunctivochalasis treated with this new technique were included. Results. All the eyes treated showed a significant improvement with no evidence of scar lesions after a mean follow-up time of 10 months. Conclusions. The surgical technique presented here could be a good alternative for the management of conjunctivochalasis. PMID:27200408

Surgical hip dislocation for treatment of cam femoroacetabular impingement

Directory of Open Access Journals (Sweden)

Milind M Chaudhary

2015-01-01

Conclusion: Cam femoroacetabular Impingement causing pain and limitation of hip movements was treated by open osteochondroplasty after surgical hip dislocation. This reduced pain, improved hip motion and gave good to excellent results in the short term.

Type III odontoid fractures: A subgroup analysis of complex, high-energy fractures treated with external immobilization

Directory of Open Access Journals (Sweden)

Thomas E Niemeier

2018-01-01

Conclusions: Complex Type III odontoid fractures are distinctly different from low-energy injuries. In the current study, 21% of patients were unsuccessfully treated nonoperatively with external immobilization and required surgery. For complex Type III fractures, we recommend initial conservative treatment, while maintaining close monitoring throughout patient recovery and fracture union.

Surgical results from treating children with syndactyly through the collective effort system at "SOS Hand Recife" between 2005 and 2009

Directory of Open Access Journals (Sweden)

Mauri Cortez

2014-08-01

Full Text Available Objective:to evaluate the results from and parents' satisfaction with treatment for children with syndactyly who were operated at the "SOS Hand Recife" hospital between 2005 and 2009.Methods:data for assessing the results were gathered from the patients' medical files. The subjective scores, which were ascertained prospectively, were as follows: greater than or equal to 9, good result; between 6 and 8, fair result; less than 6, poor result. The results were analyzed statistically. This study was approved by the institution's ethics committee.Results:among the 35 cases, 21 (60% consisted of simple syndactyly and 14 (40% were complex; 22 (62.8% were boys and 13 (37.1% were girls. The complex cases were predominantly among males. The main complications were infection (11.4%, bleeding (11.4% and pain (8.6%. There were more complications in the complex cases (42.8% than in the simple cases (33.3%. The mean scores from the parents' subjective evaluations were as follows: 7.6 for esthetics (7.7 in simple cases and 7.3 in complex cases; 8.2 for function (8.6 in simple cases and 7.6 in complex cases; 8.3 for the parents' general satisfaction level (8.6 in simple cases and 8.0 in complex cases; and 85.7% of the parents would recommend the surgery to others while 14.5% would not. A strong association was observed between the specialist's objective assessment and the scores given by the parents (p < 0.05.Conclusion:the surgical results from treating syndactyly presented differences between the simple and complex types, even though the parents' esthetic evaluations and satisfaction were similar.

Surgical treatment of pathological obesity

International Nuclear Information System (INIS)

Portie Felix, Antonio; Navarro Sanchez, Gustavo; Hernandez Solar, Abel; Grass Baldoquin, Jorge Alberto; Domloge Fernandez, Joana

2011-01-01

The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)

Obstruction of peritoneal dialysis catheter is associated with catheter type and independent of omentectomy: A comparative data analysis from a transplant surgical and a pediatric surgical department.

Science.gov (United States)

Radtke, Josephine; Schild, Raphael; Reismann, Marc; Ridwelski, Robert-Richard; Kempf, Caroline; Nashan, Bjoern; Rothe, Karin; Koch, Martina

2018-04-01

Peritoneal dialysis (PD) catheter occlusion is a common complication with up to 36% of catheter obstructions described in the literature. We present a comparison of complications and outcome after implantation of PD catheters in a transplant surgical and a pediatric surgical department. We retrospectively analyzed 154 PD catheters, which were implanted during 2009-2015 by transplant surgeons (TS, University Medical Center Hamburg-Eppendorf, Germany, n=85 catheters) and pediatric surgeons (PS, Charité University Medicine Berlin, Germany, n=69 catheters) in 122 children (median (range) age 3.0 (0.01-17.1) years) for acute (n=65) or chronic (n=89) renal failure. All catheters were one-cuffed or double-cuffed curled catheters, except that straight catheters were implanted into smaller children (n=19) by TS in Hamburg. Patient characteristics and operation technique did not differ between the departments. Peritonitis was the most common complication (33 catheters, 21.4%). Leakage (n=18 catheters, 11.7%) occurred more often in children weighing <10kg (p<0.001). The incidence of obstruction and dysfunction was significantly higher in catheters used in PS than catheters used in TS (30.4% vs. 11.8%, p=0.004). Omentectomy did not reduce the incidence of catheter obstruction (p=1.0). Perforation at the catheter tips was larger and appeared to be rougher in catheters used in PS than the catheters in TS. The type of catheter and presumably the type of perforation at the catheter tip may influence the incidence of peritoneal dialysis catheter obstruction. Copyright © 2017 Elsevier Inc. All rights reserved.

Surgical management for displaced pediatric proximal humeral fractures: a cost analysis.

Science.gov (United States)

Shore, Benjamin J; Hedequist, Daniel J; Miller, Patricia E; Waters, Peter M; Bae, Donald S

2015-02-01

The purpose of this investigation was to determine which of the following methods of fixation, percutaneous pinning (PP) or intramedullary nailing (IMN), was more cost-effective in the treatment of displaced pediatric proximal humeral fractures (PPHF). A retrospective cohort of surgically treated PPHF over a 12-year period at a single institution was performed. A decision analysis model was constructed to compare three surgical strategies: IMN versus percutaneous pinning leaving the pins exposed (PPE) versus leaving the pins buried (PPB). Finally, sensitivity analyses were performed, assessing the cost-effectiveness of each technique when infection rates and cost of deep infections were varied. A total of 84 patients with displaced PPHF underwent surgical stabilization. A total of 35 cases were treated with IMN, 32 with PPE, and 17 with PPB. The age, sex, and preoperative fracture angulation were similar across all groups. A greater percentage of open reduction was seen in the IMN and PPB groups (p = 0.03), while a higher proportion of physeal injury was seen in the PPE group (p = 0.02). Surgical time and estimated blood loss was higher in the IMN group (p exposed implants approached 55 %. Leaving pins exposed after surgical fixation of PPHF is more cost-effective than either burying pins or using intramedullary fixation.

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

DEFF Research Database (Denmark)

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

2015-01-01

in the period from 1992 to 2010 in the DPIA database were identified and patient records were reviewed manually. RESULTS: The compensation awarded for the 18-year period totalled 18,147,202 DKK with 41% of patient claims being recognised. Out of 180 surgically treated patients, 79 received a total compensation...... of 14,051,377 DKK, median 47,637 (range: 5,000-3,577,043). Of 114 non-surgically treated patients, 40 received 3,715,224 DKK in compensation, with a median amount of 35,788 DKK (range: 5,000-830,073). CONCLUSION: Compensation after surgical treatment was 3.8 times higher than compensation after non......-surgical treatment. It is noteworthy that 34.5% of patients had an overlooked diagnosis which underlines the importance of a correct primary diagnosis. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

Endovascular Treatment of Anastomotic Pseudoaneurysms after Aorto-iliac Surgical Reconstruction

International Nuclear Information System (INIS)

Lagana, Domenico; Carrafiello, Gianpaolo; Mangini, Monica; Recaldini, Chiara; Lumia, Domenico; Cuffari, Salvatore; Caronno, Roberto; Castelli, Patrizio; Fugazzola, Carlo

2007-01-01

Purpose. To assess the effectiveness of endovascular treatment of anastomotic pseudoaneurysms (APAs) following aorto-iliac surgical reconstruction. Materials. We retrospectively evaluated 21 men who, between July 2000 and March 2006, were observed with 30 APAs, 13 to the proximal anastomosis and 17 to the distal anastomosis. The patients had had previous aorto-iliac reconstructive surgery with a bypass due to aneurysm (15/21) or obstructive disease (6/21). The following devices were used: 12 bifurcated endoprostheses, 2 aorto-monoiliac, 4 aortic extenders, 1 stent-graft leg, and 2 covered stents. Follow-up was performed with CT angiography at 1, 3, and 6 months after the procedure and yearly thereafter. Results. Immediate technical success was 100%. No periprocedural complications occurred. Four patients died during follow-up from causes not related to APA, and 1 (treated for prosthetic-enteric fistula) from sepsis 3 months after the procedure. During a mean follow-up of 19.7 months (range 1-72 months), 2 of 21 occlusions of stent-graft legs occurred 3 and 24 months after the procedure (treated with thrombolysis and percutaneous transluminal angioplasty and femorofemoral bypass, respectively) and 1 type I endoleak. Primary clinical success rate was 81% and secondary clinical success was 91%. Conclusion. Endovascular treatment is a valid alternative to open surgery and can be proposed as the treatment of choice for APAs, especially in patients who are a high surgical risk. Further studies with larger series and longer follow-up are necessary to confirm the long-term effectiveness of this approach

Radioiodine (I-131) therapy in thyroid cancer differentiated type (abstract)

International Nuclear Information System (INIS)

Khan, M.S.

1999-01-01

Carcinoma thyroid is not an uncommon malignancy in Pakistan because of its location in iodine deficient terrain. Painless palpable (solitary) thyroid nodule is the common presentation in majority (>90%) of the patients and > 25% cold nodules in females turned malignant on biopsy whereas in males >75% of cold nodules turned malignant on historical examination. The disease is more common in females as compared to males (3:1) and in females pure papillary carcinoma is more common whereas in males mostly follicular or mixed tumors are seen. Radical surgery (thyroidectomy) is not a routine surgical treatment in our country. In teaching hospitals the routine surgical procedure is lobectomy and Isthmectomy, whereas in DHQ Hospitals less surgical procedures, e.g. tumorectomy or partial labectomy etc. are done. Therefore, in view of limited/partial surgical ablation, I-131 ablation is mandatory for better and longer survival. We have treated 118 patients of thyroid carcinoma (Differential type) at our centre (AEMC) with therapeutic dose of Radioactive iodine (I-131) during the last 13 years with encouraging results (Disease free survival). (author)

Is surgical excision necessary for the treatment of Granulomatous lobular mastitis?

OpenAIRE

Shin, Young Duck; Park, Sung Su; Song, Young Jin; Son, Seung-Myoung; Choi, Young Jin

2017-01-01

Background We aimed to investigate the role of surgical excision in treating granulomatous lobular mastitis. Methods We performed a retrospective chart review of patients with granulomatous lobular mastitis treated from March 2008 to March 2014. We analyzed clinical features and therapeutic modalities and compared the patient outcomes based on treatment. Results During the study period, a total of 34 patients were diagnosed with granulomatous lobular mastitis and treated. Initial treatments i...

Progress in surgical palliative treatment for malignant obstructive jaundice

Directory of Open Access Journals (Sweden)

LIANG Zhang

2013-06-01

Full Text Available Obstructive jaundice, also known as surgical jaundice, is divided into benign and malignant types. Most of the patients newly diagnosed with malignant obstructive jaundice have lost the opportunity of receiving radical surgery due to its insidious onset, so surgical palliative treatment is very important for patients with advanced malignant obstructive jaundice. This paper elaborates on various current modalities of surgical palliative treatment for malignant obstructive jaundice. Appropriate modality of surgical palliative treatment is of great significance for patients with advanced malignant obstructive jaundice.

Surgical management of macroglossia secondary to amyloidosis.

Science.gov (United States)

Gadiwalla, Yusuf; Burnham, Richard; Warfield, Adrian; Praveen, Prav

2016-04-11

The authors report a case of amyloidosis-induced macroglossia treated with surgical reduction of the tongue using a keyhole to inverted T method with particular emphasis on the postoperative sequelae. Significant tongue swelling persisted for longer than anticipated requiring tracheostomy to remain in situ for 14 days. 2016 BMJ Publishing Group Ltd.

Update on the management of menometrorrhagia: new surgical approaches.

Science.gov (United States)

Fernandez, Hervé

2011-12-01

Hysterectomy has traditionally been the definitive surgical approach for heavy menstrual bleeding. However, the more modern concept of 'save the uterus' has led to new surgical approaches for the treatment of heavy menstrual bleeding, based on second-generation endometrial destruction (ablation/resection) techniques, including microwave endometrial ablation, thermal balloon endometrial ablation, radiofrequency electrosurgery, hydrothermal ablation and cryoablation. As pregnancy following endometrial ablation is still possible, we proposed to combine endometrial ablation and sterilization with Essure(®) micro-inserts in women with confirmed menometrorrhagia and the desire, or medical need, for permanent tubal sterilization. Although large diameter resectoscopy provides excellent results in the surgical treatment of myomas, the technique requires dilation of the cervical canal (difficult in nulliparous or menopausal patients), and requires general or epidural anaesthesia and, therefore, must be performed in an operating theatre. A major advance in terms of hysteroscopic procedures is the 'see and treat' approach (i.e. when performing an initial diagnostic hysteroscopy, it is now possible to treat the pathology concurrently). Newer hysteroscopic techniques, often not requiring anaesthesia or analgesia, include OPPIuM (Office Preparation of Partially Intramural Myomas) and use of a mini-resectoscope, allowing office diagnostic-operative hysteroscopic procedures.

Efficacy of vitamin B12 combined with metformin in treating type 2 diabetes and its effect on homocysteine

Directory of Open Access Journals (Sweden)

Na Geng

2016-03-01

Full Text Available Objective: To observe and analyze Vitamin B12 combined with metformin treat for the type 2 diabetes, which affect the homocysteine. Methods: 92 cases of type 2 diabetes were selected in our hospital for treatment and study from October 2014 to April 2014. All patients were randomly divided into control group (46 cases and observation group (46 cases. Treatment of patients in the control group: patients were treated by metformin; observation group patients: Take vitamin B12 to patients treated with metformin. Finally, patient outcomes, as well as vitamin B12 and homocysteine in patients before and after treatment were analyzed. Results: Before treatment, all patients vitamin B12 content difference comparisons were no significant differences (P>0.05. Patients were treated in January, June and 1 year after the vitamin B12 content of the observation group were significantly higher in patients with vitamin B12 levels of data compared to each other there was a significant difference (P0.05. Patients were treated in January, June and 1 year after the homocysteine content of the observation group were not significantly reduced, the control group of patients with homocysteine increased significantly (P<0.000 1. Conclusions: Vitamin B12 combined with metformin in type 2 diabetes treatment, can significantly increase a patient's body to control homocysteine, while the treatment effect is obvious, clinical recommendations widely implemented.

CORRELATION BETWEEN TIME UNTIL SURGICAL TREATMENT AND MORTALITY AMONG ELDERLY PATIENTS WITH FRACTURES AT THE PROXIMAL END OF THE FEMUR.

Science.gov (United States)

Arliani, Gustavo Gonçalves; da Costa Astur, Diego; Linhares, Glauber Kazuo; Balbachevsky, Daniel; Fernandes, Hélio Jorge Alvachian; Dos Reis, Fernando Baldy

2011-01-01

The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures) who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. The following attributes were analyzed and compared with the literature relating to this subject: sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, waiting time for surgery, associated comorbidities, hemogram on admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture. The study showed that higher mortality correlated with higher numbers of clinical comorbidities, longer hospitalization and use of general anesthesia during the surgery. There was no association between the time spent waiting for surgery and mortality.

Pediatric hospitalist comanagement of surgical patients: structural, quality, and financial considerations.

Science.gov (United States)

Rappaport, David I; Rosenberg, Rebecca E; Shaughnessy, Erin E; Schaffzin, Joshua K; O'Connor, Katherine M; Melwani, Anjna; McLeod, Lisa M

2014-11-01

Comanagement of surgical patients is occurring more commonly among adult and pediatric patients. These systems of care can vary according to institution type, comanagement structure, and type of patient. Comanagement can impact quality, safety, and costs of care. We review these implications for pediatric surgical patients. © 2014 Society of Hospital Medicine.

A surgical approach in the management of mucormycosis in a trauma patient.

Science.gov (United States)

Zahoor, B A; Piercey, J E; Wall, D R; Tetsworth, K D

2016-11-01

Mucormycosis as a consequence of trauma is a devastating complication; these infections are challenging to control, with a fatality rate approaching 96% in immunocompromised patients. We present a case where a proactive approach was successfully employed to treat mucormycosis following complex polytrauma. Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proved successful in this instance. In our opinion, mucormycosis in trauma mandates an aggressive surgical approach. This prevents ascending dissemination of mucormycosis and certainly reduces the risk of patient mortality as a direct result. Anti-fungal therapy should be used secondarily as an adjunct together with surgical debridement, or as an alternative when surgical intervention is not feasible.

A case of branch duct type intraductal papillary neoplasm of the bile duct treated by open surgery after 11 years of follow-up.

Science.gov (United States)

Fujita, Mitsuru; Wakui, Noritaka; Yamauchi, Yoshiya; Takeda, Yuki; Sato, Takemasa; Ueki, Nobuo; Otsuka, Takafumi; Oba, Nobuyuki; Nishinakagawa, Shuta; Minagawa, Masami; Takeda, Yasushi; Shiono, Saori; Kojima, Tatsuya

2013-11-01

The intraductal papillary neoplasm of the bile duct (IPNB) is a novel disease concept that was recently classified as a biliary cystic tumor by the revised World Health Organization classification. This is the case report of a 70-year-old female patient who experienced repeated episodes of obstructive jaundice and cholangitis since 2000, attributed to a mucus-producing hepatic tumor. Surgery was advised due to the repeated episodes; however, the patient refused. In May, 2011, the patient developed jaundice and fever and was treated with antibiotics. Since there was no improvement, the patient was admitted to the Tokyo Rosai Hospital. Abdominal computed tomography (CT) revealed a 50-mm cystic mass with an internal septum in the left hepatic lobe. Although the tumor size had remained almost unchanged compared to the initial CT scan performed in 2000, intra- and extra-hepatic bile duct dilation was more prominent on the second CT scan. Following admission, endoscopic retrograde cholangiopancreatography was performed and revealed an expanded papilla of Vater due to a mucous plug. A balloon catheter was inserted into the bile duct to remove the mucous plug, resulting in the drainage of copious amounts of mucus and infected bile. The patient finally consented to surgery and left hepatic lobectomy was performed. Consequently, the diagnosis of low-grade IPNB was made. Branch duct type IPNB, which is characterized by imaging appearance of a cystic mass and slow progression, is attracting increasing attention. In the present case, a cystic mass was identified in the left hepatic lobe, with no significant change in size after 11 years of follow-up, leading to the diagnosis of branch duct type IPNB. Considering the fact that IPNB is usually treated surgically at the time of diagnosis, the present case, due to the long-term follow-up, provides valuable insight into the natural history of the tumor.

Treatment of surgical wounds on the uterus after laparoscopic myomectomy

Directory of Open Access Journals (Sweden)

Sedlar Srđan

2009-01-01

Full Text Available Introduction. The advantages of laparoscopic removal of a myoma over classical surgical technique are shorter hospital stay, rapid recovery and less pain after surgery, as well as a lower frequency of ileus and thromboembolic complications. The surgical technique of laparoscopic removal of myoma involves four basic stages: incision on the wall of the uterus, separation of the myoma from the healthy uterine tissue, to stop bleeding and removal of the myoma from the abdomen. Apart from these four basic stages, it is also necessary to establish a new integrity of the uterine wall, especially in women planning pregnancy. Objective. The aim of the paper is to present the procedures used in the treatment of uterine wall defect during the laparoscopic removal of the myoma. Methods. We analyzed 96 patients who were indicated for laparoscopic myomectomy. All patients were divided into four groups according to the type of the technique of haemostasis and treatment of the defect on the uterine wall: electrocoagulation, electrocoagulation with application of argon plasma, a single suture and extended suture. Results. In order to stop bleeding, we most often used electrocoagulation by monopolar electricity, i.e. in 39.6% of the patients. To stop bleeding and treat the defect of the uterine wall, we used a single suture in 21.9% and in 11.4% patients we used the extended suture. The manner of uterine wall treatment did not have a statistically significant influence on the results of haematological parameters (p>0.05, consumption of carbon dioxide (p>0.05 and the duration of surgical procedure (p>0.05. The increased use of antibiotics (p<0.05 in the group of patients in whom we treated the defect by sutures on the uterus, the length of postsurgical hospitalization and absence from work (p<0.01 was statistically significant. Conclusion. To achieve a better reconstruction of the uterus, it is recommended to use sutures with laparoscopic removal of myoma.

Role of surgical approaches: influencing tumour recurrence in nasopharyngeal angiofibroma

International Nuclear Information System (INIS)

Muhammad, R.; Khan, Z.

2015-01-01

Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon tumour constituting less than 1% of all head and neck tumours. This tumour has an aggressive local behaviour if left untreated. Surgery is the mainstay of treatment with no common consensus on a single approach. Tumour stage and surgical approaches are the major determinants of outcome. The objective of this study was to evaluate the influence of surgical approaches on tumour recurrence in patients with nasopharyngeal angiofibroma. Methods: This descriptive study was conducted in the Department of ENT and Head and Neck Surgery, PIMS, Islamabad and Ayub Medical Institution, Abbottabad from Jan 2010 to Jan 2014 consisting of 34 diagnosed cases of nasopharyngeal angiofibroma. All patients were treated surgically while radiotherapy was given in a few. All patients were followed up for one year. Results: Among 34 patients, 25 were treated by lateral rhinotomy approach with medial maxillectomy, 5 by mid-facial degloving approach and 3 by transpalatine approach. One patient with cavernous sinus involvement was treated by radiotherapy. Patients were followed up for one year both by clinical examination and imaging if needed. Recurrence was found in 15% (5/33) patients and postop radiotherapy was given to them. Conclusion: Lateral rhinotomy approach with medial maxillectomy is highly effective even in advanced stage JNA for complete removal of the disease. Postoperative radiotherapy is an effective adjuvant. (author)

ROLE OF SURGICAL APPROACHES INFLUENCING TUMOUR RECURRENCE IN NASOPHARYNGEAL ANGIOFIBROMA.

Science.gov (United States)

Muhammad, Raza; Hussain, Altaf; Rehman, Fazal; Iqbal, Johar; Khan, Munib; Ullah, Gohar; Khan, Zakir

2015-01-01

Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon tumour constituting less than 1% of all head & neck tumours. This tumour has an aggressive local behaviour if left untreated. Surgery is the mainstay of treatment with no common consensus on a single approach. Tumour stage and surgical approaches are the major determinants of outcome. The objective of this study was to evaluate the influence of surgical approaches on tumour recurrence in patients with nasopharyngeal angiofibroma. This descriptive study was conducted in the Department of ENT and Head and Neck Surgery, PIMS, Islamabad and Ayub Medical Institution, Abbottabad from Jan 2010 to Jan 2014 consisting of 34 diagnosed cases of nasopharyngeal angiofibroma. All patients were treated surgically while radiotherapy was given in a few. All patients were followed up for one year. Among 34 patients, 25 were treated by lateral rhinotomy approach with medial maxillectomy, 5 by mid-facial degloving approach and 3 by transpalatine approach. One patient with cavernous sinus involvement was treated by radiotherapy. Patients were followed up for one year both by clinical examination and imaging if needed. Recurrence was found in 15% (5/33) patients and postop radiotherapy was given to them. Lateral rhinotomy approach with medial maxillectomy is highly effective even in advanced stage JNA for complete removal of the disease. Postoperative radiotherapy is an effective adjuvant.

[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.

Surgical effects in patients with Duane retraction syndrome

Directory of Open Access Journals (Sweden)

Shui-Lian Zhou

2017-03-01

Full Text Available AIM: To investigate the clinical characteristics and surgical effects in patients with Duane retraction syndrome(DRS.METHODS: Totally 13 patients with DRS during June 2011 to December 2015 were analyzed retrospectively. The data including clinical types and manifestations, surgical methods and outcomes were reviewed and analyzed. RESULTS: There were 11 male cases and 2 female cases who all had no ocular and systemic anomalies. The left eye was involved in 9 cases, the right eye was involved in 3 cases and 1 case involved in both eyes. Six cases were type Ⅰ,1 case was typeⅡand 6 cases were type Ⅲ. Eleven cases had abnormal head posture(AHP, 9 cases had the up- or down-shoot phenomenon. The surgical treatment was designed according to subtypes and clinical features which included medial rectus recession, lateral rectus recession, recession of both horizontal rectus muscles and lateral rectus recession combined with Y splitting. After surgery, horizontal deviation was less than ±10△ in all patients, and AHP disappeared in 4 cases and improved in 7 cases. The up- or down-shoot and global retraction disappeared in 5 cases and improved in 4 cases. Simultaneously, the restriction of ocular motility was improved in all patients. CONCLUSION: The clinical features of DRS are variant in different types. Detailed examination before surgery and reasonable surgical design are important in treatment of patients with DRS.

Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

Science.gov (United States)

Kork, Felix; Balzer, Felix; Spies, Claudia D.; Wernecke, Klaus-Dieter; Ginde, Adit A.; Jankowski, Joachim; Eltzschig, Holger K.

2015-01-01

Background Surgical patients frequently experience postoperative increases in creatinine levels. The authors hypothesized that even small increases in postoperative creatinine levels are associated with adverse outcomes. Methods The authors examined the association of postoperative changes from preoperative baseline creatinine with all-cause in-hospital mortality and hospital length of stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary care center between January 2006 and June 2012. Results The data of 39,369 surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were analyzed. Acute kidney injury (AKI)—by definition of the Kidney Disease: Improving Global Outcome group—was associated with a five-fold higher mortality (odds ratio [OR], 4.8; 95% CI, 4.1 to 5.7; P creatinine, exposure to radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly, even minor creatinine increases (Δcreatinine 25 to 49% above baseline but creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to 20.3; P creatinine levels are associated with adverse outcomes. These results emphasize the importance to find effective therapeutic approaches to prevent or treat even mild forms of postoperative kidney dysfunction to improve surgical outcomes. PMID:26492475

Surgical management and clinical prognosis of adrenocortical carcinoma.

Science.gov (United States)

Dong, Dexin; Li, Hanzhong; Yan, Weigang; Ji, Zhigang; Mao, Quanzong

2012-01-01

To study the relationship between surgical management and prognosis of adrenocortical carcinoma (ACC) in order to guide the surgical management of ACC. Clinical data of 45 cases of ACC treated in our hospital were retrospectively analyzed. The 45 cases included 3 cases in stage I, 12 cases in stage II, 7 cases in stage III, and 23 cases in stage IV. 17 cases underwent complete excision, 14 cases underwent palliative excision, 8 cases had non-operative treatment and 6 cases gave up treatment. All patients were followed up from 2 to 141 months. The average survival time of 31 patients with surgery was 32.46 months, and the average survival time of 14 patients without surgery was 4.75 months. There were statistically significant differences between the two groups (p 0.05). Surgery is considered to be the only method to cure ACC. For ACC in stage I and II, tumor resection is the most effective treatment, and second surgical operation is recommended for local recurrence. For ACC in stage III, extensive surgical operation is recommended, and for ACC in stage IV, surgical operation has no effect on the prognosis. Copyright © 2012 S. Karger AG, Basel.

Presentation and Surgical Management of Duodenal Duplication in Adults

Directory of Open Access Journals (Sweden)

Caroline C. Jadlowiec

2015-01-01

Full Text Available Duodenal duplications in adults are exceedingly rare and their diagnosis remains difficult as symptoms are largely nonspecific. Clinical presentations include pancreatitis, biliary obstruction, gastrointestinal bleeding from ectopic gastric mucosa, and malignancy. A case of duodenal duplication in a 59-year-old female is presented, and her treatment course is reviewed with description of combined surgical and endoscopic approach to repair, along with a review of historic and current recommendations for management. Traditionally, gastrointestinal duplications have been treated with surgical resection; however, for duodenal duplications, the anatomic proximity to the biliopancreatic ampulla makes surgical management challenging. Recently, advances in endoscopy have improved the clinical success of cystic intraluminal duodenal duplications. Despite these advances, surgical resection is still recommended for extraluminal tubular duplications although combined techniques may be necessary for long tubular duplications. For duodenal duplications, a combined approach of partial excision combined with mucosal stripping may offer advantage.

[Non-surgical management after blunt traumatic liver injuries: A review article].

Science.gov (United States)

Noyola-Villalobos, Héctor Faustino; Loera-Torres, Marco Antonio; Jiménez-Chavarría, Enrique; Núñez-Cantú, Olliver; García-Núñez, Luis Manuel; Arcaute-Velázquez, Fernando Federico

2016-01-01

Hepatic trauma is a common cause for admissions in the Emergency Room. Currently, non-surgical management is the standard treatment in haemodynamically stable patients with a success rate of around 85 to 98%. This haemodynamic stability is the most important factor in selecting the appropriate patient. Adjuncts in non-surgical management are angioembolisation, image-guided drainage and endoscopic retrograde cholangiopancreatography. Failure in non-surgical management is relatively rare but potentially fatal, and needs to be recognised and aggressively treated as early as possible. The main cause of failure in non-surgical management is persistent haemorrhage. The aim of this paper is to describe current evidence and guidelines that support non-surgical management of liver injuries in blunt trauma. Copyright © 2016 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Vacuum-assisted closure versus closure without vacuum assistance for preventing surgical site infections and infections of chronic wounds: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Tansarli, Giannoula S; Vardakas, Konstantinos Z; Stratoulias, Constantinos; Peppas, George; Kapaskelis, Anastasios; Falagas, Matthew E

2014-08-01

We sought to examine whether vacuum-assisted closure (VAC) is associated with fewer surgical site infections (SSIs) or infections of chronic wounds than other management procedures for surgical wounds. The PubMed and Scopus databases were searched systematically. Randomized controlled trials (RCTs) comparing the development of SSIs or infections of chronic wounds between patients treated with VAC for acute or chronic wounds and those whose wounds were treated without VAC were considered eligible for inclusion in the study. Eight RCTs met the inclusion criteria for the study. Four of the studies included chronic or diabetic lower extremity wounds and four included fractures. In three of four studies reporting on fractures, the wounds were not closed post-operatively, whereas in one study primary closure of the wound was performed. With regard to wounds left open after the stabilization of fractures, patients whose wounds were treated with VAC developed fewer SSIs than those whose wounds were treated without VAC ([367 patients (196 with VAC; 171 without VAC) relative risk [RR], 0.47; 95% CI 0.28-0.81]). On the contrary, no difference in the development of SSIs occurred among patients with chronic or diabetic lower-extremity wounds treated with VAC and those whose wounds were treated without VAC ([638 patients (320 with VAC; 318 without VAC) RR 1.67; 95% CI: 0.71-3.94]). The available evidence suggests that the development of infections in wounds treated with VAC depends on the type of wound being treated.

The choice of surgical approach in the treatment of two-column acetabular fractures

Directory of Open Access Journals (Sweden)

A. A. Grin’

2014-01-01

Full Text Available The study aimed a comparison of treatment results in patients with two-column acetabular fractures (AO, Type C when using different operative approaches: ilioinguinal (12, Y-type (16 and a combination of posterior-lateral and ilioinguinal approaches (3. Surgical treatment was carried out not later than 3 weeks after injury. The joint congruence was reached in all the cases. The operative time, blood loss, complications, long-term results of treatment were evaluated. The study showed the effectiveness of ilioinguinal approach in case of the simple two-column fractures. When treating patients with complex fractures of the anterior column, the authors found no significant difference in operative time and intraoperative blood loss between the cases of V-type and combined approaches. In patients with two-column fractures accompanied with posterior wall lesion the time of surgery was significantly lower when using the Y-shaped approach as against the two different approaches.

[APPLICATION OF COMPUTER-ASSISTED SURGICAL PLANNING IN SURGICAL TREATMENT OF ANKLE FRACTURES].

Science.gov (United States)

Xia, Shengli; Wang, Xiuhui; Fu, Beigang; Lu, Yaogang; Wang, Minghui

2015-12-01

To explore the clinical value of computer-assisted surgical planning in the treatment of ankle fractures. Between January 2012 and January 2014, open reduction and internal fixation were performed on 42 patients with ankle fractures. There were 22 males and 20 females with an average age of 52 years (range, 19-72 years). The causes were spraining injury (20 cases), traffic accident injury (14 cases), and falling from height injury (8 cases). The time from injury to operation was 5 hours to 12 days (mean, 2.5 days). All fractures were closed trimalleolar fractures. According to Lauge-Hansen classification, 25 cases were rated as supination extorsion type IV, 13 as pronation extorsion type IV, and 4 as pronation abduction type III. The preoperative planning was made by virtual reduction and internal fixation using Superimage software. The mean operation time was 93.7 minutes (range, 76-120 minutes). Delayed wound healing occurred in 1 case, and secondary healing was obtained after treatment; primary healing of incision was achieved in the other patients. Postoperative X-ray films and CT images showed anatomic reduction of fracture and good position of internal fixation. All patients were followed up 14.6 months on average (range, 9-27 months). The range of motion of the affected ankle was close to the normal side at 6-8 weeks. The mean fracture healing time was 13.1 weeks (range, 11-17 weeks). Degenerative change of the ankle joint was observed in 3 cases (7.1%) with manifestation of mild narrowing of joint space on the X-ray films at last follow-up. According to Baird-Jackson score system, the results were excellent in 24 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 88%. Computer-assisted surgical planning for ankle fractures can help surgeons identify type of ankle fractures and improve surgical scheme for guiding fracture reduction and selecting and placing implants, so good effectiveness can be obtained.

Roles of 67Ga-scintigraphy and CT in the decision of surgical treatment in cases with suspected abdominal abscess

International Nuclear Information System (INIS)

Kuwabara, Yasuo; Yasumori, Kotaro; Oshiumi, Yoshihiko; Nishitani, Hiromu; Ichiya, Yuichi

1983-01-01

67 Ga-scintigraphy and computed tomography in the decision of surgical treatment of abdominal abscess were evaluated in 37 clinically suspected cases. Eight of them were treated surgically. In the remaining 29 cases, 24 were treated conservatively, and 5 were confirmed not having abscesses at surgery for some other reason or autopsy. The clinical decisions in this study were considered to be appropriate, because there was no fatal case directly related to the existence of abscess. The sensitivity of 67 Ga-scintigraphy for surgically treated abscess was 88% (7/8), that of computed tomography was 100% (8/8). The specificity of 67 Ga-scintigraphy was 45% (13/29), that of computed tomography was 62% (18/29). In cases with descrepancy between 67 Ga-scintigraphy and computed tomography, computed tomography was more specific for abscess. It is concluded that in cases with negative findings in either examination, it is possible to deny a presence of abscess requring surgical treatment. However, even in cases with positive findings in both examinations, surgical treatment should be decided finally including other clinical informations. (author)

Colorectal cancer complicated by perforation. Specific features of surgical tactics

Directory of Open Access Journals (Sweden)

S. N. Shchaeva

2015-01-01

Full Text Available Objective: to assess the immediate results of surgical interventions for colorectal cancer complicated by perforation.Materials and methods. The immediate results of surgical treatment were retrospectively analyzed in 56 patients with colorectal cancer complicated by perforated colon cancer, who had been treated at Smolensk surgical hospitals in 2001 to 2013. Patients with diastatic perforation of the colon in the presence of decompensated obturation intestinal obstruction of tumor genesis were not included into this investigation.Results. The immediate results of uni- and multistage surgical interventions were analyzed in relation to the extent of peritonitis and the stage of colon cancer. More satisfactory immediate results were observed after multistage surgical treatment. Following these interventions, a fatal outcome of disseminated peritonitis in the presence of performed colorectal cancer was recorded in 8 (53.3 % cases whereas after symptomatic surgery there were 11 (67.8 % deaths. A fatal outcome was noted in 1 case (7.7 % after multistage surgery.Discussion. The results of surgical treatment in the patients with perforated colorectal cancer are directly related to the degree of peritonitis and the choice of surgical tactics.

[Orthognathic surgery: surgical failures and complications].

Science.gov (United States)

Guyot, Laurent

2016-03-01

Orthognathic surgery procedures mark the endpoint of lengthy orthodontic-surgical preparations and herald the completion of treatment for patients and their families. The main types of procedure are full maxillary Le Fort I osteotomies, mandibular osteotomies and chin surgery. To ensure a successful outcome, all require a favorable environment and extreme technical skill. But, like all surgical operations, they are also subject to peri- and post-operative complications resulting from treatment hazards or errors. Whatever the cause, surgical complications can entail failures in the management of the malformation. By seeking to understand and analyzing these complications, we can already help to prevent and reduce the contingent risks of failure. © EDP Sciences, SFODF, 2016.

A novel surgical method for total nail ablation: Use of triple flap technique

Directory of Open Access Journals (Sweden)

Berna Aksoy

2017-11-01

Full Text Available Total nail ablation for the treatment of onychodystrophies can be performed by using chemicals, surgical resection or laser ablation of nail matrix. A female patient with bilateral severe onychodystrophy as a result of inadvertent previous nail surgeries was treated surgically. Proximal complete nail matrix resection and distal 10 mm wide transverse strip partial nail bed resection were performed. A 5 mm wide transverse strip of nail bed was left intact proximally. Proximal nail matrix defect was closed by using the skin of proximal nail fold. The distal nail bed defect was reconstructed by using triple flap technique which was composed of a main central advancement flap containing ventral toe skin and two side flaps containing nail fold skin. The patient healed without any problem and her nail problem was treated successfully. The cosmetic appearance of her first toes was acceptable. Surgical nail ablation followed by volar skin coverage of dorsal surface of the distal phalanx bone by using triple flap technique is an effective surgical treatment method for the correction of advanced nail plate deformities requiring total nail ablation. 

Surgical outcomes of a civil war in a neighbouring country.

Science.gov (United States)

Akkucuk, Seckin; Aydogan, A; Yetim, I; Ugur, M; Oruc, C; Kilic, E; Paltaci, I; Kaplan, A; Temiz, M

2016-08-01

The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey. 159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring. The median age of the patients was 30.05 (18-66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients). In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war. 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/

How I do it: surgical ligation of craniocervical junction dural AV fistulas.

Science.gov (United States)

Sorenson, Thomas J; La Pira, Biagia; Hughes, Joshua; Lanzino, Giuseppe

2017-08-01

Dural arteriovenous fistulas (DAVFs) of the craniocervical junction are uncommon vascular lesions, which often require surgical treatment even in the endovascular era. Most commonly, the fistula is placed laterally, and surgical ligation is performed through a lateral suboccipital craniotomy. After dural opening, the area is inspected, and the arterialized vein is identified emerging from the dura, often adjacent to the entry point of the vertebral artery, and ligated. A far lateral craniotomy is the authors' preferred surgical approach for accessing and treating dural arteriovenous fistulas of the craniocervical junction that cannot be reached endovascularly.

Usefulness of CT-scan in the diagnosis and therapeutic approach of gallstone ileus: report of two surgically treated cases

OpenAIRE

Michele, Danzi; Luciano, Grimaldi; Massimiliano, Fabozzi; Stefano, Reggio; Roberta, Danzi; Ernesto, Soscia; Bruno, Amato

2013-01-01

Background Gallstone ileus is a rare cause of gastrointestinal obstruction, more frequent in elderly patients, whose treatment is essentially surgical, although some para-surgical and mini-invasive possibilities exist, allowing the solution of such obstructive condition in a completely non-invasive way. Description In our study, after reporting two cases of biliary ileus managed by our surgical division, we will analyze the most suitable diagnostic procedures and the therapeutic approaches to...

A new technique in the surgical treatment of Hangman's fractures: Neurospinal Academy (NSA) technique.

Science.gov (United States)

Dalbayrak, Sedat; Yaman, Onur; Yılmaz, Mesut

2013-07-01

Treatment of Hangman's fractures is still controversial. Hangman's fractures Type II and IIA are usually treated with surgical procedures. This study aims at describing the Neurospinal Academy (NSA) technique as an attempt to achieve an approximation of the fracture line to the axis body, which may be used for Type II and IIA patients with severe displacement and angulation. NSA technique both pars or pedicle screws are placed bicortically to ensure that anterior surface of C2 vertebral body will be crossed 1-2 mm. A rod is prepared in suitable length and curve to connect the two screws. For placing the rod, sufficient amount of bone is resected from the C2 spinous process. C2 vertebral body is pulled back by means of the screws that crossed the anterior surface of C2 vertebral body. Hangman II and IIA patient are treated with NSA technique. Angulated and tilted C2 vertebral body was pulled back and approximated to posterior elements. In Hangman's fractures Type II and IIA with severe vertebral body and pedicle displacement, NSA technique is an effective and reliable treatment alternative for the approximation of posterior elements to the C2 vertebral body, which is tilted, angulated, and dislocated.

[Anterior Superior and Anterior Interior Iliac Spine Fractures. Comparison of the Results of Conservative and Surgical Treatment].

Science.gov (United States)

Stančák, A; Kautzner, J; Havlas, V

2016-01-01

Avulsion fractures of the anterior superior iliac spine (ASIS) and anterior inferior iliac spine (AIIS) are rare injuries to the skeleton in children. They are most frequent in adolescent athletes, such as sprinters and long-distance runners, and football players. The authors present a group of patients treated at their department and compare the results of procedures used to manage different pelvic avulsion fractures. Between 2005 and 2012, 38 patients (31 boys and seven girls) with an average age of 15.1 years (range, 4-17 years) were treated. Fourteen patients with minimally displaced fractures were treated conservatively, 24 patients with fractures displaced more than 1 cm underwent surgery. All patients had a standard rehabilitation protocol. Post-operative assessments included: the range of motion in the hip; X-ray at 6 weeks, 3 months and 1 year; duration of bed rest; return to previous activities; occurrence of complications (heterotopic ossification, infection, etc). All patients returned to the pre-injury level of sports activities. Recovery was faster and early rehabilitation was better tolerated in patients treated surgically (p = 0.03), particularly in those with AIIS avulsion fractures. Ambulation with partial weight bearing was possible on average at 7.2 days (range, 2-10 days) in surgically treated patients and at 24.1 days (18-27 days) in conservatively treated patients; the difference was statistically significant (p = 0.02). The range of motion markedly improved in surgically treated patients as early as at 6 weeks while, in conservatively treated patients, the comparable outcome was achieved at 3 months of follow-up (p = 0.02). The time necessary for radiographic evidence of fragment union as well as full recovery was comparable in both patient groups. No deep wound infection was recorded; minor heterotopic ossification was detected in five patients, but no further treatment during follow-up was required. Indications for surgical treatment are

Eagle syndrome surgical treatment with piezosurgery.

Science.gov (United States)

Bertossi, Dario; Albanese, Massimo; Chiarini, Luigi; Corega, Claudia; Mortellaro, Carmen; Nocini, Pierfrancesco

2014-05-01

Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic calcification. It is an uncommon condition (4% of the population) that is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloid-carotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently after head turning and neck compression. Although conservative treatment (analgesics, anticonvulsants, antidepressants, local infiltration with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases. We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1-10 insert, pump level 4, vibration level 7. No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES. The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics--such as precision, selective cut action, and bloodless cut.

Catheter for Cleaning Surgical Optics During Surgical Procedures: A Possible Solution for Residue Buildup and Fogging in Video Surgery.

Science.gov (United States)

de Abreu, Igor Renato Louro Bruno; Abrão, Fernando Conrado; Silva, Alessandra Rodrigues; Corrêa, Larissa Teresa Cirera; Younes, Riad Nain

2015-05-01

Currently, there is a tendency to perform surgical procedures via laparoscopic or thoracoscopic access. However, even with the impressive technological advancement in surgical materials, such as improvement in quality of monitors, light sources, and optical fibers, surgeons have to face simple problems that can greatly hinder surgery by video. One is the formation of "fog" or residue buildup on the lens, causing decreased visibility. Intracavitary techniques for cleaning surgical optics and preventing fog formation have been described; however, some of these techniques employ the use of expensive and complex devices designed solely for this purpose. Moreover, these techniques allow the cleaning of surgical optics when they becomes dirty, which does not prevent the accumulation of residue in the optics. To solve this problem we have designed a device that allows cleaning the optics with no surgical stops and prevents the fogging and residue accumulation. The objective of this study is to evaluate through experimental testing the effectiveness of a simple device that prevents the accumulation of residue and fogging of optics used in surgical procedures performed through thoracoscopic or laparoscopic access. Ex-vivo experiments were performed simulating the conditions of residue presence in surgical optics during a video surgery. The experiment consists in immersing the optics and catheter set connected to the IV line with crystalloid solution in three types of materials: blood, blood plus fat solution, and 200 mL of distilled water and 1 vial of methylene blue. The optics coupled to the device were immersed in 200 mL of each type of residue, repeating each immersion 10 times for each distinct residue for both thirty and zero degrees optics, totaling 420 experiments. A success rate of 98.1% was observed after the experiments, in these cases the device was able to clean and prevent the residue accumulation in the optics.

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

Science.gov (United States)

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

2015-12-01

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

Pattern of Maxillofacial Surgical Conditions in North Central Nigeria ...

African Journals Online (AJOL)

2018-02-07

com on Wednesday, February 7, 2018, IP: 197.89.67.237] ... Table 2: Profile of orofacial surgical conditions seen and treated over 5 years during outreach programmes in ..... The North Central zone of the country, with a population of 20.2 ...

Effect of Topical Tetracycline Gel with Non Surgical Periodontal Therapy on Hba1c and Lipid Profile in Type 2 Diabetic Patients: A Clinico- Biochemical Study

Directory of Open Access Journals (Sweden)

A Haerian-Ardakani

2014-11-01

Full Text Available Introduction: The present study aimed to evaluate the Effect of topical tetracycline gel application with non surgical periodontal therapy on HbA1c and lipid profile in type 2 diabetic patients. Methods: A total of 30 type 2 diabetic patients were randomly divided into two groups. The first group received scaling and root planning, whereas the second group received scaling and root planning with topically applied tetracycline gel. Clinical factors such as GI, PI, PPD and biochemical factors such as HbA1c and lipid profile were assessed in beginning of study and 3 months later. Results: Comparing the clinical factors between the two groups revealed that periodontal pocket depth significantly reduced in tetracycline-received group. Regarding the biochemical factors, triglyceride levels decreased significantly in tetracycline-received group. No significant difference was observed between the two groups in regard with other clinical and biochemical factors. Conclusion: The study findings demonstrated that clinical and biochemical parameters have been improved after non surgical periodontal treatment in both groups. Although it seems that application of topical tetracycline gel combined with non-surgical periodontal therapy is effective in improvement of some clinical and biochemical factors like PPD and TG, it doesn’t offer any superiority in regard with other factors compared to mere non surgical periodontal therapy.

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

Science.gov (United States)

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

2013-01-01

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

Open, Arthroscopic, and Percutaneous Surgical Treatment of Lateral Epicondylitis: A Systematic Review.

Science.gov (United States)

Burn, Matthew B; Mitchell, Ronald J; Liberman, Shari R; Lintner, David M; Harris, Joshua D; McCulloch, Patrick C

2017-03-01

Approximately 10% of patients with lateral epicondylitis go on to have surgical treatment; however, multiple surgical treatment options exist. The purpose of this study was to review the literature for the clinical outcomes of open, arthroscopic, and percutaneous treatment of lateral epicondylitis. The authors hypothesized that the clinical outcome of all 3 analyzed surgical treatments would be equivalent. A systematic review was performed using PubMed, Cochrane Central Register of Controlled Trials, and Google Scholar in July 2016 to compare the functional outcome, pain, grip strength, patient satisfaction, and return to work at 1-year follow-up for open, arthroscopic, and percutaneous treatment of lateral epicondylitis. Six studies (2 Level I and 4 Level II) including 179 elbows (83 treated open, 14 arthroscopic, 82 percutaneous) were analyzed. Three outcome measures (Disabilities of the Arm, Shoulder, and Hand [DASH] score, visual analog scale [VAS], and patient satisfaction) were reported for more than one category of surgical technique. Of these, the authors noted no clinically significant differences between the techniques. This is the first systematic review looking at high-level evidence to compare open, percutaneous, and arthroscopic techniques for treating lateral epicondylitis. There are no clinically significant differences between the 3 surgical techniques (open, arthroscopic, and percutaneous) in terms of functional outcome (DASH), pain intensity (VAS), and patient satisfaction at 1-year follow-up.

Conservative surgical management of placenta accreta: a report of 3 cases.

Science.gov (United States)

Pliskow, Steven; Dai, Xiaorong; Kohner, Andrew; Kapnick, Jason

2009-10-01

Placenta accreta is often diagnosed at the time of delivery and is a cause of postpartum hemorrhage, morbidity and mortality. The standard treatment for placenta accreta is hysterectomy to avoid acute blood loss and shock. A conservative surgical approach to the treatment of placenta accreta will allow immediate cure while preserving the patient's future fertility. A 39-year-old woman with placenta accreta diagnosed at the time of vaginal delivery was successfully treated with resection of the placental implantation site. A 33-year-old woman and a 35-year-old woman with placenta accreta/increta diagnosed at the time of cesarean section were successfully treated with resection of the placental implantation site. One patient has since conceived and given birth. Placenta accreta and placenta increta can be safely and successfully treated, in some well-selected cases, by resection of the placental implantation site and uterine repair. This conservative surgical management provides immediate therapy, reduces blood loss and preserves fertility.

Detection surgical treatment and its results in children's thyroid gland

International Nuclear Information System (INIS)

Polyakov, V.G.; Lebedev, V.I.; Belkina, B.M.; Shishkov, R.V.; Makarova, I.S.; Durnov, L.A.

1995-01-01

208 patients with thyroid gland cancer were observed in 1975-1993 . The morphological investigations point to an absolute prevalence of highly differentiated forms of thyroid gland cancer in children. The radiation diagnostic techniques included ultrasound investigations of neck organs, chest roentgenography, thyroid gland scintigraphy. It is shown that the surgical method is the basic technique of treating thyroid gland cancer in children. 5-year survival rate of patients depending on the stage of disease development and scope of surgical treatment is analysed

Trigeminocardiac reflex during non-surgical root canal treatment of teeth with irreversible pulpitis

Directory of Open Access Journals (Sweden)

James I.-Sheng Huang

2018-06-01

Full Text Available Background/Purpose: Trigeminocardiac reflex (TCR is a unique clinical incident of acute change in hemodynamic balance, which may lead to hypotension, bradycardia, and even clinical crisis. Up to date, no study so far considers the impact of non-surgical root canal treatment (NSRCT of irreversible pulpitis teeth under either local infiltration or block anesthesia on hemodynamic change possibly related to TCR. Methods: This study enrolled 111 patients with 138 irreversible pulpitis teeth that were treated by two sessions of NSRCT. The first session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second session included the root canal enlargement and debridement with minimal disturbance to the dental branches of the trigeminal nerve. Vital signs mainly the blood pressure were recorded during both NSRCT sessions. Results: The incidences of NSRCT patients with MABP decrease ≧10%, ≧15%, or ≧20% were all significantly higher in the first NSRCT session than in the second NSRCT session (all the P-values < 0.001. In the first NSRCT session, the incidence of patients with MABP decrease ≧10% was significantly associated with tooth type. For both upper and lower teeth, the patients with premolars treated by NSRCR had significantly higher incidences of MABP decrease ≧10% than those with either anterior or molar teeth treated by NSRCR (all the P-values < 0.05. Conclusion: We conclude that vital pulp extirpation may lead to a substantial drop in patient's blood pressure possibly related to TCR. Keywords: Trigeminocardiac reflex, Non-surgical root canal treatment, Irreversible pulpitis, Mean arterial blood pressure, Hypotension, Teeth

Surgical management for displaced pediatric proximal humeral fractures: a cost analysis

OpenAIRE

Shore, Benjamin J.; Hedequist, Daniel J.; Miller, Patricia E.; Waters, Peter M.; Bae, Donald S.

2015-01-01

Purpose The purpose of this investigation was to determine which of the following methods of fixation, percutaneous pinning (PP) or intramedullary nailing (IMN), was more cost-effective in the treatment of displaced pediatric proximal humeral fractures (PPHF). Methods: A retrospective cohort of surgically treated PPHF over a 12-year period at a single institution was performed. A decision analysis model was constructed to compare three surgical strategies: IMN versus percutaneous pinning leav...

Surgical treatment of open pilon fractures.

Science.gov (United States)

Zeng, Xian-tie; Pang, Gui-gen; Ma, Bao-tong; Mei, Xiao-long; Sun, Xiang; Wang, Jia; Jia, Peng

2011-02-01

To discuss the methods, timing and clinical outcomes of surgical treatment for open pilon fractures. From April 2003 to July 2008, 28 patients with open pilon fractures were treated. All had type C fractures according to the Arbeitsgemeinschaft für osteosynthesefragen-Association for the Study of Internal Fixation (AO/ASIF) classification. Three operative methods were applied, the methods being determined by the types of fracture, soft tissue damage and time interval after injury. Seven cases were treated by debridement and internal fixation with plate; 19 by limited internal fixation combined with external fixation; and 2 by delayed surgery. The clinical outcomes were evaluated by the Burwell-Charnley score. All cases were followed up for from 6 to 48 months (average 24 months). The Burwell-Charnley score of clinical outcomes: anatomic reduction achieved in 12 cases, functional reduction in 15, and unsatisfactory reduction in 1. The healing time was from 2.5 to 11 months (average 4.7 months). Two cases had delayed union. According to the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle joint, there were excellent results in 8 cases, good in 14, fair in 5 and poor in 1. Complications included four cases of skin superficial sloughing, two of superficial infection, one of deep infection, two of delayed fracture union and ten of post-traumatic arthritis. It is important to perform appropriate surgeries for open pilon fracture according to fracture classification, different damage to skin and tissue and time interval after injury. Thorough debridement, proper use of anti-infective medication, appropriate bone grafting, and postoperative ankle function exercise can reduce the occurrence of complications. © 2011 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

Cooperative Study of the Spanish Pancreas Transplant Group (GETP): Surgical Complications.

Science.gov (United States)

Moya-Herraiz, Angel; Muñoz-Bellvis, Luis; Ferrer-Fábrega, Joana; Manrique Municio, Alejandro; Pérez-Daga, José Antonio; Muñoz-Casares, Cristóbal; Alarcó-Hernández, Antonio; Gómez-Gutiérrez, Manuel; Casanova-Rituerto, Daniel; Sanchez-Bueno, Francisco; Jimenez-Romero, Carlos; Fernández-Cruz Pérez, Laureano

2015-05-01

Technical failure in pancreas transplant has been the main cause of the loss of grafts. In the last few years, the number of complications has reduced, and therefore the proportion of this problem. The Spanish Pancreas Transplant Group wanted to analyze the current situation with regard to surgical complications and their severity. A retrospective and multicenter study was performed. 10 centers participated, with a total of 410 pancreas transplant recipients between January and December 2013. A total of 316 transplants were simultaneous with kidney, 66 after kidney, pancreas-only 10, 7 multivisceral and 11 retrasplants. Surgical complication rates were 39% (n=161). A total of 7% vascular thrombosis, 13% bleeding, 6% the graft pancreatitis, 12% surgical infections and others to a lesser extent. Relaparotomy rate was 25%. The severity of complications were of type IIIb (13%), type II (12%) and type IVa (8.5%). Graft loss was 8%. Early mortality was 0.5%. The percentage of operations for late complications was 17%. The number of surgical complications after transplantation is not negligible, affecting one in 3 patients. They are severe in one out of 5 and, in one of every 10 patients graft loss occurs. Therefore, there is still a significant percentage of surgical complications in this type of activity, as shown in our country. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Surgical Consideration for Adolescents and Young Adults With Cervical Chordoma.

Science.gov (United States)

Zhong, Nanzhe; Yang, Xinghai; Yang, Jian; Meng, Tong; Yang, Cheng; Yan, Wangjun; Xiao, Jianru

2017-05-15

Retrospective study. The aim of this study was to compare the clinical outcomes between adolescent and young adult (AYA) patients and old adult patients with cervical chordoma who were treated surgically and present the surgical consideration for adolescents and young adults with cervical chordoma. With predominance in senior patients, chordoma is distinctively rare in AYAs. Because of the rarity of AYA chordoma, individual case report represents most of the literature on this disease entity on mobile spine and lack of long-term follow up, which leads to the paucity of clinical evidence for treatment planning and prognosis prediction. A retrospective study was conducted to investigate the prognosis of AYA patients with cervical chordoma who were treated surgically. We collected the clinical data of these patients and their older counterparts, and further compared the prognosis of the patients in different age groups. To estimate survival curves, Kaplan-Meier method was used, and significance was assessed using a log-rank test. Forty consecutive patients with chordoma of the cervical spine treated in our institution were included in the study. Two groups were identified according to age. Group 1 comprised children and adolescents (age ≤ 25 yrs; n = 9) and Group 2 comprised adults (age > 25 years; n = 31). In comparison, Group 1 was featured by significantly higher rate of recurrence and shorter overall survival, although no difference found in the surgical modality between two groups. There is a dismal prognosis in young patients with chordoma, and thus support the notion that as radical a total en bloc spondylectomy (TES) of the lesions as possible may benefit the overall survival of these young patients. Although the ensuing neurological deficits may be devastating, it will be worth sacrificing if the life expectancy of these young patients is prolonged. 4.

Surgical Orthodontic Treatment of an Impacted Canine in the Presence of Dens Invaginatus and Follicular Cyst

Science.gov (United States)

Canevello, Carola; Laffi, Nicola

2014-01-01

Introduction. “Dens invaginatus” is a dental anomaly which originates from the invagination of the ameloblastic epithelium into the lingual surface of the dental crown during the odontogenesis. It can cause early pulpal necrosis, abscesses, retention or dislocation of contiguous elements, cysts, and internal resorptions. It normally affects the upper lateral incisors. In the following study the authors will discuss the etiology, the physiopathology, and the surgical-orthodontic management of a rare case of impacted canine associated with dens invaginatus and follicular cyst, with the aim of highlighting the importance of taking any therapeutic decision based on the data available in the literature. Case Report. The present study describes a combined surgical-orthodontic treatment of an impacted canine associated with a lateral incisor (2.2) suffering from type III dens invaginatus with radicular cyst, in a 15-year-old patient. Discussion. When treating a dens invaginatus there are different therapeutic solutions: they depend on the gravity of the anomaly and on the association with the retention of a permanent tooth. The aesthetic and functional restoration becomes extremely important when performing a surgical-orthodontic repositioning. PMID:24963421

Strategy for acute type IIIb aortic dissection associated with abdominal-organ malperfusion

International Nuclear Information System (INIS)

Ozawa, Masamichi; Uchida, Naomichi; Shibamura, Hidenori; Iwako, Hiroshi

2006-01-01

The aim of this study was to evaluate our results of treatment for acute type IIIb aortic dissection associated with malperfusion of abdominal organs, and to consider the therapeutic strategies. Between December 1997 and August 2005, 123 patients with acute type IIIb aortic dissection were treated at our hospital. Of those, 11 patients (8.9%) required emergency treatment for malperfusion of abdominal organ. In our hospital, the indication of emergency treatment for acute type IIIb aortic dissection was any symptom of acute abdomen plus insufficiency of visceral arterial circulation on computed tomography or angiography. All of the 11 patients (100%) had cul-de-sac of a false lumen, 8 (72.7%) had at least one symptom of acute abdomen, and 3 (27.3%) had metabolic acidosis before surgical treatment. In 7 patients of the ''true lumen stenosis type,'' 5 patients who were treated with open stent grafting are alive. The other two patients, who were treated with transluminally placed endovascular stent grafting (TPEG) or with superior mesenteric artery (SMA) bypass, died. Of the 2 ''visceral arterial dissection type'' patient, one was treated with transluminal stenting of the celiac artery and the other was treated with resection of the intestine and ileocolic artery bypass, and both are alive. Two ''mixed type'' patients who were treated with open stent grafting died. The mortality rate of this series was 36.4%. In conclusion, to improve the prognosis of acute type IIIb aortic dissection associated with malperfusion of abdominal organ, it is important that we obtain early diagnosis of organ ischemia caused by cul-de-sac of a false lumen and choose the correct treatment based on understanding of the mechanism of organ ischemia. (author)

Prediction of Excessive Weight Gain in Insulin Treated Patients with Type 2 Diabetes

DEFF Research Database (Denmark)

Cichosz, Simon Lebech; Lundby-Christensen, Louise; Johansen, Mette D

2017-01-01

of this study was to identify predictors of weight gain in insulin treated patients with Type 2 diabetes mellitus. METHODS: A total of 412 individuals with Type 2 diabetes mellitus were, in addition to metformin or placebo, randomized into 18-month treatment groups with three different insulin analogue......AIMS: Weight gain is an ongoing challenge when initiating insulin therapy in patients with Type 2 diabetes mellitus. However, if prediction of insulin associated weight gain was possible on an individualized level, targeted initiatives could be implemented to reduce weight gain. The objective...... treatment regimens. Participants with excessive weight gain were defined as the group with weight gain in the 4(th) quartile. We developed a pattern classification method to predict individuals prone to excessive weight gain. RESULTS: The median weight gain among all patients (n = 412) was 2.4 (95...

Comparative evaluation of skin cancer therapy with impulse laser radiation and surgical methods

International Nuclear Information System (INIS)

Moskalik, K.G.; Kozlov, A.P.

1980-01-01

Altogether 324 patients with skin basilomas, 559 with recurrent basiloma and 38 with squamous-cell carcinoma of the skin were treated by means of impulse neodymium laser radiation. A follow-up period was up to 7 years. It was shown that impulse laser radiation is a highly effective means of treating skin cancer, having a number of advantages over the radiation and surgical methods. Laser radiation is also highly effective in the treatment of basiloma relapses. If relapses accounted for by the development of a radioresistant tumour occur at the sites where surgical eXcision yields an unstatisfactory cosmetic effect, laser therapy should be considered a method of choice

Fibrolipoma of the lip treated by diode laser surgery: A case report

Directory of Open Access Journals (Sweden)

Capodiferro Saverio

2008-09-01

Full Text Available Abstract Introduction Several neoplasms of the adipose tissue can involve the soft tissues of the head and neck region. These neoplasms are mainly treated surgically and an accurate histological examination is mandatory for a precise diagnosis. Case presentation We report a case of fibrolipoma involving the lower lip of a 43-year-old man, which was successfully treated by diode laser surgery. This approach allowed adequate resection of the neoplasm with minimal damage to the adjacent tissues, thus reducing post-surgical scarring. Conclusion Diode laser surgery for the treatment of benign lesions of the oral mucosa appears to be a convenient alternative to conventional blade surgery and has proved to be effective for the excision of fibrolipoma of the lip. The possibility of avoiding direct suture after excision is surely helpful when aesthetic areas, such as the lip, are surgically treated. For these reasons, and also considering the lower histological alteration of the specimen obtained with diode laser surgery if adequately used, the diode laser is undoubtedly a good alternative to conventional surgery.

Surgical Approaches to Chronic Pancreatitis: Indications and Techniques.

Science.gov (United States)

Dua, Monica M; Visser, Brendan C

2017-07-01

There are a number of surgical strategies for the treatment of chronic pancreatitis. The optimal intervention should provide effective pain relief, improve/maintain quality of life, preserve exocrine and endocrine function, and manage local complications. Pancreaticoduodenectomy was once the standard operation for patients with chronic pancreatitis; however, other procedures such as the duodenum-preserving pancreatic head resections and its variants have been introduced with good long-term results. Pancreatic duct drainage via a lateral pancreaticojejunostomy continues to be effective in ameliorating symptoms and expediting return to normal lifestyle in many patients. This review summarizes operative indications and gives an overview of the different surgical strategies in treating chronic pancreatitis.

Comparison of Masticatory and Swallowing Functional Outcomes in Surgically and Prosthetically Rehabilitated Maxillectomy Patients.

Science.gov (United States)

Sreeraj, R; Krishnan, Vinod; V, Manju; Thankappan, Krishnakumar

This study compared masticatory and swallowing functional outcomes in maxillectomy patients who underwent surgical and prosthetic rehabilitation or prosthetic rehabilitation only following surgical resection. This comparative cross-sectional study involved 20 maxillectomy patients and compared their masticatory and swallowing functions following combined surgical and prosthodontic management vs an exclusively prosthodontic approach. Masticatory performance was measured by an originally modified sieve method using hydrocolloid material, and video fluoroscopic examination was employed for swallowing assessments. Masticatory performance was significantly better in the patient group treated with flaps and removable denture prostheses compared to patients treated with obturator prosthesis alone. Swallowing outcomes were comparable in both groups. Flap reconstruction followed by an obturator prosthesis seems to be a preferable option when planning for functional rehabilitation in maxillectomy patients. Further research is needed to substantiate the functional outcomes noted in this study.

Endotoxins in surgical instruments of hip arthroplasty

OpenAIRE

Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães

2016-01-01

Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60...

An exact approach for relating recovering surgical patient workload to the master surgical schedule

NARCIS (Netherlands)

Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.; van Lent, Wineke A.M.; van Lent, W.A.M.; van Harten, Wim H.; van Harten, Willem H.

2009-01-01

No other department influences the workload of a hospital more than the Department of Surgery and in particular, the activities in the operating room. These activities are governed by the master surgical schedule (MSS), which states which patient types receive surgery on which day. In this paper we

An exact approach for relating recovering surgical patient workload to the master surgical schedule

NARCIS (Netherlands)

Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.; van Lent, W.A.M.; van Harten, Willem H.

2011-01-01

No other department influences the workload of a hospital more than the Department of Surgery and in particular, the activities in the operating room. These activities are governed by the master surgical schedule (MSS), which states which patient types receive surgery on which day. In this paper, we

Surgical treatment of radiation proctitis

Energy Technology Data Exchange (ETDEWEB)

Maruyama, Izumi; Sato, Gohei; Okaue, Toyotake; Isobe, Yoshinari; Ohtsu, Akira; Sugimoto, Yuzo (Kansai Electric Power Co., Inc., Osaka (Japan))

1982-08-01

Severe radiation proctitis was surgically treated in 8 cases. Colostomy was performed in 2 cases, total resection of the rectum in 2 and proctectomy with colostomy in 4. Perineal abscess developed in the 2 cases with total resection of the rectum. Rather than completely resection of the lesion, a procedure leaving no dead space i.e. proctectomy with colostomy, is desirable for radiation proctitis. Complete preoperative examination of the condition of the underlying disease and possible urinary tract complications is important.

Surgical treatment of radiation proctitis

International Nuclear Information System (INIS)

Maruyama, Izumi; Sato, Gohei; Okaue, Toyotake; Isobe, Yoshinari; Ohtsu, Akira; Sugimoto, Yuzo

1982-01-01

Severe radiation proctitis was surgically treated in 8 cases. Colostomy was performed in 2 cases, total resection of the rectum in 2 and proctectomy with colostomy in 4. Perineal abscess developed in the 2 cases with total resection of the rectum. Rather than completely resection of the lesion, a procedure leaving no dead space i.e. proctectomy with colostomy, is desirable for radiation proctitis. Complete preoperative examination of the condition of the underlying disease and possible urinary tract complications is important. (Chiba, N.)

Surgical treatment of iris and ciliary body melanoma: follow-up of a 25-year series of patients

DEFF Research Database (Denmark)

Klauber, Stefan; Jensen, Peter K; Prause, Jan U

2010-01-01

Purpose: To evaluate outcome of surgical resection of iris and irido-ciliary melanomas. Method: Retrospective analysis of all cases treated in Denmark 1975-1999 with clinical follow-up in 2002 and death certificate analysis in 2008. A quality of life questionnaire was completed at follow-up. Resu......Purpose: To evaluate outcome of surgical resection of iris and irido-ciliary melanomas. Method: Retrospective analysis of all cases treated in Denmark 1975-1999 with clinical follow-up in 2002 and death certificate analysis in 2008. A quality of life questionnaire was completed at follow...... time. However, none had changed job as a consequence of the surgical treatment. Only two patients were emotionally affected by the diagnosis of iris melanoma. Conclusion: Resection of small iris and irido-ciliary melanomas is a safe and efficient procedure, provided that strict diagnostic and surgical...

Endovascular approach to treat ascending aortic pseudoaneurysm in a patient with previous CABG and very high surgical risk.

Science.gov (United States)

Zago, Alexandre C; Saadi, Eduardo K; Zago, Alcides J

2011-10-01

Pseudoaneurysm of the ascending aorta is an uncommon pathology and a challenge in high-risk patients who undergo conventional surgery because of high operative morbidity and mortality. Endovascular exclusion of an aortic pseudoaneurysm using an endoprosthesis is a less invasive approach, but few such cases have been reported. Moreover, the use of this approach poses unique therapeutic challenges because there is no specific endoprosthesis for ascending aortic repair, particularly to treat patients with previous coronary artery bypass graft (CABG). We describe the case of a 74-year-old patient who had undergone CABG and later presented with an iatrogenic ascending aortic pseudoaneurysm that occurred during an angiography. This patient was at very high risk for surgical treatment and, therefore, an endovascular approach was adopted: percutaneous coronary intervention for the left main coronary artery, left anterior descending and left circumflex native coronary arteries followed by endovascular endoprosthesis deployment in the ascending aorta to exclude the pseudoaneurysm. Both procedures were successfully performed, and the patient was discharged without complications 4 days later. At 5 months' clinical follow-up, his clinical condition was good and he had no complications. Copyright © 2011 Wiley-Liss, Inc.

Non-observance of guidelines for surgical antimicrobial prophylaxis and surgical-site infections.

Science.gov (United States)

Lallemand, S; Thouverez, M; Bailly, P; Bertrand, X; Talon, D

2002-06-01

A prospective multicentre study was conducted to assess major aspects of surgical prophylaxis and to determine whether inappropriate antimicrobial prophylaxis was a factor associated (risk or protective factor) with surgical site infection (SSI). Surgical prophylaxis practices were assessed by analysing four variables: indication, antimicrobial agent, timing and duration. Univariate and multivariate analyses were carried out to identify predictors of SSI among patient-specific, operation-specific and antimicrobial prophylaxis-specific factors. The frequency of SSI was 2.7% (13 SSI in 474 observations). Total compliance of the prescription with guidelines was observed in 41.1% of cases (195 prescriptions). Of the 139 patients who received an inappropriate drug, 126 (90.6%) received a drug with a broader spectrum than the recommended drug. Prophylaxis was prolonged in 71 (87.7%) of the 81 patients who received prophylaxis for inappropriate lengths of time and 43 (61.4%) of the 70 patients who did not receive prophylaxis at the optimal moment were treated too late. Multivariate analysis clearly demonstrated that SSI was associated with multiple procedures (relative risk 8.5), short duration of prophylaxis (relative risk 12.7) and long-term therapy with antimicrobial agents during the previous year (relative risk 8.8). The ecological risk of the emergence of resistance associated with the frequent use of broad-spectrum antibiotics and prophylaxis for longer periods was not offset by individual benefit to the patients who received inappropriate prophylaxis.

Isolated cleft palate requires different surgical protocols depending on cleft type.

Science.gov (United States)

Elander, Anna; Persson, Christina; Lilja, Jan; Mark, Hans

2017-08-01

A staged protocol for isolated cleft palate (CPO), comprising the early repair of the soft palate at 6 months and delayed repair of the eventual cleft in the hard palate until 4 years, designed to improve maxillary growth, was introduced. CPO is frequently associated with additional congenital conditions. The study evaluates this surgical protocol for clefts in the soft palate (CPS) and for clefts in the hard and soft palate (CPH), with or without additional malformation, regarding primary and secondary surgical interventions needed for cleft closure and for correction of velopharyngeal insufficiency until 10 years of age. Of 94 consecutive children with CPO, divided into four groups with (+) or without (-) additional malformations (CPS + or CPS - and CPH + or CPH-), hard palate repair was required in 53%, performed with small local flaps in 21% and with bilateral mucoperiosteal flaps in 32%. The total incidence of soft palate re-repair was 2% and the fistula repair of the hard palate was 5%. The total incidence of secondary velopharyngeal surgery was 17% until 10 years, varying from 0% for CPS - and 15% for CPH-, to 28% for CPS + and 30% for CPH+. The described staged protocol for repair of CPO is found to be safe in terms of perioperative surgical results, with comparatively low need for secondary interventions. Furthermore, the study indicates that the presence of a cleft in the hard palate and/or additional conditions have a negative impact on the development of the velopharyngeal function.

[Surgical site infections: antibiotic prophylaxis in surgery].

Science.gov (United States)

Asensio, Angel

2014-01-01

Surgical site infections (SSI) are very common, and represent more than 20% of all hospital-acquired infections. SSIs are associated with a higher mortality, as well as to an extended hospital stay and costs, depending on the surgical procedure and type of SSI. Advances in control practices for these infections include improvement in operating room ventilation, sterilization methods, barriers, and surgical techniques, as well as in surgical antimicrobial prophylaxis. For the latter, the antimicrobial agent should: be active against the most common pathogens, be administered in an appropriate dosage and in a time frame to ensure serum and tissue concentrations over the period of potential contamination, be safe, and be administered over the shortest effective time period to minimize adverse events, development of resistances, and cost. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Comparison of Short vs Long Anti-rotation in Treating Trochanteric Fractures

Directory of Open Access Journals (Sweden)

Raval P

2016-03-01

Full Text Available Introduction: A comparative evaluation of the surgical treatment and outcome of patients with pertrochanteric fractures treated with short versus long proximal femoral nail antirotation. Materials and methods: A retrospective review was conducted of patients with pertrochanteric fractures treated between January 2011 and June 2012. In all 80 patients were enrolled in the study, of which 40 were treated with short PFNA and the remaining with long PFNA. Comparative analyses of demographic data, peri-operative outcome and complications were carried out. Results: There was no significant difference noted in the two groups with regards to Arbeitsgemeinschaft fur Osteosynthesefragen (AO fracture classification, time from injury to surgery, blood transfusion post surgery and hospital stay. The surgical duration for a short PFNA procedure was significantly less (58 minutes when compared to that of a long PFNA (87 minutes. Similarly intra-operative blood loss was significantly higher in the long PFNA group as compared to the short PFNA. Conclusions: A relatively quicker surgical time of just under an hour , lesser blood loss and better learning curve with trainee surgeons make short PFNA a better implant choice in the treatment of pertrochanteric fractures.

Rhabdomyolysis in Critically Ill Surgical Patients.

Science.gov (United States)

Kuzmanovska, Biljana; Cvetkovska, Emilija; Kuzmanovski, Igor; Jankulovski, Nikola; Shosholcheva, Mirjana; Kartalov, Andrijan; Spirovska, Tatjana

2016-07-27

Rhabdomyolysis is a syndrome of injury of skeletal muscles associated with myoglobinuria, muscle weakness, electrolyte imbalance and often, acute kidney injury as severe complication. of this study is to detect the incidence of rhabdomyolysis in critically ill patients in the surgical intensive care unit (ICU), and to raise awareness of this medical condition and its treatment among the clinicians. A retrospective review of all surgical and trauma patients admitted to surgical ICU of the University Surgical Clinic "Mother Teresa" in Skopje, Macedonia, from January 1 st till December 31 st 2015 was performed. Patients medical records were screened for available serum creatine kinase (CK) with levels > 200 U/l, presence of myoglobin in the serum in levels > 80 ng/ml, or if they had a clinical diagnosis of rhabdomyolysis by an attending doctor. Descriptive statistical methods were used to analyze the collected data. Out of totally 1084 patients hospitalized in the ICU, 93 were diagnosed with rhabdomyolysis during the course of one year. 82(88%) patients were trauma patients, while 11(12%) were surgical non trauma patients. 7(7.5%) patients diagnosed with rhabdomyolysis developed acute kidney injury (AKI) that required dialysis. Average values of serum myoglobin levels were 230 ng/ml, with highest values of > 5000 ng/ml. Patients who developed AKI had serum myoglobin levels above 2000 ng/ml. Average values of serum CK levels were 400 U/l, with highest value of 21600 U/l. Patients who developed AKI had serum CK levels above 3000 U/l. Regular monitoring and early detection of elevated serum CK and myoglobin levels in critically ill surgical and trauma patients is recommended in order to recognize and treat rhabdomyolysis in timely manner and thus prevent development of AKI.

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

Science.gov (United States)

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

2011-04-20

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

Long-term surgical-orthodontic management of hemimandibular hyperplasia.

Science.gov (United States)

Bennett, Samuel C; Goonewardene, Mithran S

2016-05-01

Hemimandibular hyperplasia (HH), also known as hemimandibular hypertrophy, is characterised by excessive unilateral three-dimensional growth of the mandible after birth. Vertical unilateral elongation of the mandible becomes clinically evident as a rare form of vertical facial asymmetry. Aberrant growth of the facial skeleton affects the developing dentition and the dental compensatory mechanism is usually unable to maintain optimal occlusal relationships. The resulting malocclusion is effectively managed by combined surgical-orthodontic care to address the facial, skeletal and dental problems that confront clinicians. Orthodontists are advised to assess patients with HH during the post-treatment retention stage for continuing mandibular growth and assess the stability of treatment outcomes with long-term follow-up and records as required. To present a case of hemimandibular hyperplasia treated successfully by combined surgical-orthodontic care and evaluated for stability over a seven-year follow-up period. Surgical-orthodontic management was accomplished in four stages: 1) pre-surgical orthodontic; 21 surgical; 3) post-surgical orthodontic; and 4) post-treatment orthodontic retention. Complete orthodontic records, including extra- and intra-oral photographs, study models, and cephalograms plus panoramic radiographs were taken at the pretreatment, post-treatment, and seven-year orthodontic retention time-points. Facial, skeletal and dental goals were achieved in the three planes of space and the long-term stability of the treatment results was shown during a post-treatment orthodontic retention period of seven years. Hemimandibular hyperplasia is a true growth anomaly which may be managed effectively. Clinicians may expect successful long-term correction and stability by utilising a comprehensive surgical-orthodontic treatment approach.

Surgical treatment of superior oblique palsy: Predictors of outcome

Directory of Open Access Journals (Sweden)

Pilar Merino Sanz

2017-01-01

Full Text Available Purpose: The purpose of this study was to evaluate the incidence and outcome of surgically treated superior oblique palsy (SOP and the factors involved in its resolution. Methods: We performed a retrospective study of 76 patients who underwent surgery for SOP. We recorded data from the physical examination and the number and type of procedures performed. Favorable outcome was defined as resolution of or improvement in torticollis (≤5° and diplopia in primary position (PP and downgaze or as vertical deviation (VD <5 prism diopters (pd in PP and 10 pd in the oblique diagnostic position. Results: Mean age was 33.12 years. Congenital SOP was the most frequent type (65.8%. Mean preoperative VD was 15.89 ± 9.94 pd, decreasing to 3.07 ± 4.36 pd after surgery. Associated horizontal deviation was recorded in 51.32% of cases. The mean number of procedures was 1.37 ± 0.62 (range 1–4, with 69.7% of patients requiring only one procedure. The mean number of muscles operated on was 1.96 ± 1.01 (inferior oblique being the most frequent. A greater reduction in VD after surgery was observed in patients with congenital SOP (P = 0.04. Although none of the factors evaluated influenced surgical outcome, amblyopic patients had a greater risk of reoperation (P = 0.04. A favorable outcome was achieved in 75% of cases. Mean follow-up was 37.08 months. Conclusion: Congenital SOP was twice as frequent as acquired SOP and although surgery was successful in most cases, a greater reduction in VD was obtained in congenital cases. Amblyopia was identified as a risk factor for reoperation.

Features of Brain MRI in Dogs with Treated and Untreated Mucopolysaccharidosis Type I

Science.gov (United States)

Vite, Charles H; Nestrasil, Igor; Mlikotic, Anton; Jens, Jackie K; Snella, Elizabeth M; Gross, William; Shapiro, Elsa G; Kovac, Victor; Provenzale, James M; Chen, Steven; Le, Steven Q; Kan, Shih-hsin; Banakar, Shida; Wang, Raymond Y; Haskins, Mark E; Ellinwood, N Matthew; Dickson, Patricia I

2013-01-01

The mucopolysaccharidosis type I (MPS I) dog model has been important in the development of therapies for human patients. We treated dogs with enzyme replacement therapy (ERT) by various approaches. Dogs assessed included untreated MPS I dogs, heterozygous carrier dogs, and MPS I dogs treated with intravenous ERT as adults (beginning at age 13 to 16 mo), intrathecal and intravenous ERT as adults (beginning at age 13 to 16 mo), or intrathecal ERT as juveniles (beginning at age 4 mo). We then characterized the neuroimaging findings of 32 of these dogs (age, 12 to 30 mo). Whole and midsagittal volumes of the corpus callosum, measured from brain MRI, were significantly smaller in affected dogs compared with unaffected heterozygotes. Corpus callosum volumes in dogs that were treated with intrathecal ERT from 4 mo until 21 mo of age were indistinguishable from those of age-matched carrier controls. Dogs with MPS I showed cerebral ventricular enlargement and cortical atrophy as early as 12 mo of age. Ventricular enlargement was greater in untreated MPS I dogs than in age-matched dogs treated with intrathecal ERT as juveniles or adults. However, treated dogs still showed some ventricular enlargement or cortical atrophy (or both). Understanding the progression of neuroimaging findings in dogs with MPS I and their response to brain-directed therapy may improve preclinical studies for new human-directed therapies. In particular, corpus callosum volumes may be useful quantitative neuroimaging markers for MPS-related brain disease and its response to therapy. PMID:23582423

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. ...

Management of Gynecomastia in Patients With Different Body Types

Science.gov (United States)

Innocenti, Alessandro; Melita, Dario; Mori, Francesco; Ciancio, Francesco; Innocenti, Marco

2017-01-01

Background Gynecomastia is a common finding in male subjects which incidence varies widely in the world population. In adolescents, it is frequently temporary but, if it becomes persistent, it generates considerable embarrassment, inducing the patients to seek surgical consultation. Even in patients with good body contour, gynecomastia creates even greater distress considering the special attention given by these subjects to their physical appearance. The authors present their experience in the treatment of gynecomastia comparing different body types of patients with the aim to investigate dissimilar expectations, needs and surgical outcomes thus optimizing the management of the pathological condition, achieving high levels of agreement and reducing unsatisfied patients arising from cosmetic surgery. Materials and Methods Between January 2007 and January 2015, 312 selected patients have been treated surgically for gynecomastia. Patients were grouped according to their physical aspect: 97 were classified as high muscle mass body type (group A), 106 as normal (group B) and 109 as overweight patients (group C). All of them were adults ranging in age between 18 and 52 years. Follow-up ranged from 12 to 60 months. In all cases, an excision of the gland in the form of a subcutaneous mastectomy was performed; the most common surgical access was in the inferior part of the areola. Results No breast cancers were found at the histological examinations. Also, no skin or areola necrosis have been referred, and no recurrence of gynecomastia disorder has been reported. Six cases of seroma (limited to the fatty gynecomastia) and 3 cases of hematomas (requiring immediate surgical revision) were found. Although the patients in group B resulted more distressed by the disorder, higher levels of postoperative satisfaction were recorded in this group. Conclusions The study demonstrates the importance of the different management of the same disorder according to the different patients

Surgical treatment of hepatic Echinococcus granulosus

Directory of Open Access Journals (Sweden)

Waldemar Patkowski

2017-09-01

Full Text Available Introduction : Infections caused by metacestode stage of the Echinococcus granulosus in humans result in disease named cystic echinococcosis. Aim: To present the outcomes of patients treated surgically for cystic echinococcosis of the liver. Material and methods : One hundred and nineteen patients treated in the period between 1989 and 2014 due to E. granulosus infection in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw were selected for this retrospective study. Diagnostic protocol included imaging examinations, i.e. ultrasonography and computed tomography of the abdomen. Blood samples where used to proceed sequential enzyme-linked immunosorbent assay (ELISA using Em2plus antigen as well as polymerase chain reaction (PCR to detect E. granulosus . Results : Surgery was the choice for treatment for almost all of the patients (98.3%. In 40 (34.2% patients right hemihepatectomy, in 19 (16.2% patients left hemihepatectomy, and in 21 (17.9% patients bisegementectomy were performed. Postoperative complications occurred in 4 (3.4% patients. In 3 patients biliary fistula requiring endoscopic treatment was observed, and 1 patient had subdiaphragmatic abscess successfully treated with drainage under ultrasound guidance. None of the patients died in the postoperative period, and the 1-, 5-, and 10-year survival rates were 100.0%, 90.9%, and 87.9%, respectively. Conclusions : Surgical treatment of the symptomatic cystic echinococcosis is the modality of choice for E. granulosus infection of the liver. Despite substantial development of diagnostic methods and new management opportunities, echinococcal infection still presents a challenge for epidemiologists, pharmacologists, and clinicists.

Treating Type 2 Diabetes

Science.gov (United States)

... health care team is there for you. Your child's diabetes management plan should be easy to understand, detailed, ... Can Diabetes Be Prevented? Monitoring Blood Sugar Your Child's Diabetes Health Care Team Medicines for Diabetes Type 2 ...

Changes in patient's quality of life comparing conservative and surgical treatment of venous leg ulcers.

Science.gov (United States)

Jankūnas, Vytautas; Rimdeika, Rytis; Jasenas, Marius; Samsanavicius, Donatas

2004-01-01

Leg ulcers of different etiology disable up to 1% of total population, and up to 15% individuals over 70 years old. It is an old disease, which troubles the patients and medical personnel and is hard to cure. It might take several years to cure the ulcer fully. Most of the patients with leg ulcers are being treated at home, not in the outpatient departments or hospitals; therefore there is not much information on how the ulcer affects the patient's everyday life and its quality. The researchers often analyze only the financial part of this disorder forgetting its human part: pain, social isolation, and decreased mobility. There are many questionnaires and methods to analyze the quality of life of the patients with leg ulceration. It is often unclear if we should treat the ulcer conservatively for a long time or if part of resources should be used for operation (skin grafting) and the time of treatment should be shortened. To see the advantage of both methods and the influence of the ulcer treatment to the quality of life we decided to estimate the functionality of surgical and conservative treatment. We have analyzed the case histories and the data of special questionnaires of 44 patients, which were treated in Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital in the period of 2001 January-2004 February and had large trophic leg ulcers (m=254 cm2) for 6 months or more. Ten patients were treated conservatively and 34 patients were treated by skin grafting. All of them were interviewed after 3-6 months. We found that the pain in the place of the ulcers has decreased for the patients, who were treated surgically. By making the differences of the pain more exact we found out, that the patients have been feeling pain before the operation and when interviewing them the second time they told that they felt discomfort, not pain. The intensity of pain remained the same for the patients treated conservatively. The regression of pain also

Surgical Management of Chronic Pancreatitis.

Science.gov (United States)

Parekh, Dilip; Natarajan, Sathima

2015-10-01

Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.

Plastic Surgery Complications from Medical Tourism Treated in a U.S. Academic Medical Center.

Science.gov (United States)

Ross, Kimberly M; Moscoso, Andrea V; Bayer, Lauren R; Rosselli-Risal, Liliana; Orgill, Dennis P

2018-04-01

Medical tourism is a growing, multi-billion dollar industry fueled by improvements in the global transportation infrastructure. The authors studied patients living in the United States who travel to other countries for plastic surgical procedures and returned to have their complications treated in the authors' center. A retrospective patient evaluation was performed. Patients who had presented to an urban tertiary academic hospital plastic surgery service with complications or complaints associated with plastic surgery performed in a developing country were studied. The authors collected demographic information, types of surgery performed, destinations, insurance coverage, and complications. Seventy-eight patients were identified over 7 years. Most commonly, complications were seen following abdominoplasty (n = 35), breast augmentation (n = 25), and foreign body injections (n = 15). Eighteen patients underwent multiple procedures in one operative setting. The most common destination country was the Dominican Republic (n = 59). Complications included surgical-site infections (n = 14), pain (n = 14), and wound healing complications (n = 12). Eighty-six percent of patients (n = 67) relied on their medical insurance to pay for their follow-up care or manage their complications, with the most common type of health insurance coverage being Massachusetts Medicaid (n = 48). Cosmetic surgery performed in developing countries can carry substantial risks of complications that can be challenging to patients, primary care providers, insurers, and plastic surgical teams not associated with the original surgery. These complications pose significant burdens on our public health systems.

Surgical management for upper urinary tract transitional cell carcinoma.

Science.gov (United States)

Rai, Bhavan Prasad; Shelley, Mike; Coles, Bernadette; Biyani, Chandra S; El-Mokadem, Ismail; Nabi, Ghulam

2011-04-13

Upper tract transitional cell carcinomas (TCC) are uncommon and aggressive tumours. There are a number of surgical approaches to manage this condition including open radical nephroureterectomy and laparoscopic procedures. To determine the best surgical management option for upper tract transitional cell carcinoma. A sensitive search strategy was developed to identify relevant studies for inclusion in this review. The following databases were searched for randomised trials evaluating surgical approaches to the management of upper tract TCC: Medline EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, British Nursing Index, AMED, LILACS, Web of Science®, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, and ISI Proceedings. The following criteria that were considered for this review.Types of studies - All randomised or quasi-randomised controlled trials comparing the various surgical methods and approaches for the management of localised upper tract transitional cell carcinoma. Types of participants - All adult patients with localised transitional cell carcinoma. Localised disease was defined as limited to the kidney or ureter with no gross regional lymph nodal enlargement on imaging. Types of interventions - Any surgical method or approach for managing localised upper tract transitional cell carcinoma. Types of outcome measures - Overall and cancer-specific survival were primary outcomes. Surgery-related morbidity. Quality of life and health economics outcomes were secondary outcomes. Two review authors examined the search results independently to identify trials for inclusion. We identified one randomised controlled trial that met our inclusion criteria. The trial showed that the laparoscopic approach had superior peri-operative outcomes compared to open approach. Laparoscopic was superior and statistically significant for blood loss (104 mL (millilitres) versus 430 mL, P management of upper tract transitional cell carcinoma

[High complication rate after surgical treatment of ankle fractures].

Science.gov (United States)

Bjørslev, Naja; Ebskov, Lars; Lind, Marianne; Mersø, Camilla

2014-08-04

The purpose of this study was to determine the quality and re-operation rate of the surgical treatment of ankle fractures at a large university hospital. X-rays and patient records of 137 patients surgically treated for ankle fractures were analyzed for: 1) correct classification according to Lauge-Hansen, 2) if congruity of the ankle joint was achieved, 3) selection and placement of the hardware, and 4) the surgeon's level of education. Totally 32 of 137 did not receive an optimal treatment, 11 were re-operated. There was no clear correlation between incorrect operation and the surgeon's level of education.

Autologous fat graft as treatment of post short stature surgical correction scars.

Science.gov (United States)

Maione, Luca; Memeo, Antonio; Pedretti, Leopoldo; Verdoni, Fabio; Lisa, Andrea; Bandi, Valeria; Giannasi, Silvia; Vinci, Valeriano; Mambretti, Andrea; Klinger, Marco

2014-12-01

Surgical limb lengthening is undertaken to correct pathological short stature. Among the possible complications related to this procedure, painful and retractile scars are a cause for both functional and cosmetic concern. Our team has already shown the efficacy of autologous fat grafting in the treatment of scars with varying aetiology, so we decided to apply this technique to scars related to surgical correction of dwarfism. A prospective study was conducted to evaluate the efficacy of autologous fat grafting in the treatment of post-surgical scars in patients with short-limb dwarfism using durometer measurements and a modified patient and observer scar assessment scale (POSAS), to which was added a parameter to evaluate movement impairment. Between January 2009 and September 2012, 36 children (28 female and 8 male) who presented retractile and painful post-surgical scars came to our unit and were treated with autologous fat grafting. Preoperative and postoperative mean durometer measurements were analysed using the analysis of variance (ANOVA) test and POSAS parameters were studied using the Wilcoxon rank sum test. There was a statistically significant reduction in all durometer measurements (p-value treatment with autologous fat grafting. Surgical procedures to camouflage scars on lower limbs are not often used as a first approach and non-surgical treatments often lead to unsatisfactory results. In contrast, our autologous fat grafting technique in the treatment of post-surgical scars has been shown to be a valuable option in patients with short-limb dwarfism. There was a reduction of skin hardness and a clinical improvement of all POSAS parameters in all patients treated. Moreover, the newly introduced POSAS parameter appears to be reliable and we recommend that it is included to give a more complete evaluation of patient perception. Copyright © 2014 Elsevier Ltd. All rights reserved.

Treating Chronic Tension-type Headache Not Responding to Amitriptyline Hydrochloride With Paroxetine Hydrochloride: A Pilot Evaluation

Science.gov (United States)

Holroyd, Kenneth A.; Labus, Jennifer S.; O'Donnell, Francis J.; Cordingley, Gary E.

2007-01-01

Context In some individuals, chronic tension-type headache fails to respond to tricyclic antidepressant medications that often serve as first-line therapy. Objective To evaluate the clinical efficacy of paroxetine hydrochloride for chronic tension-type headache not responding to amitriptyline hydrochloride. Design and Setting Open-label trial of paroxetine conducted at 2 outpatient sites in Ohio. Participants and Intervention Thirty-one adults (mean age, 37 years; 20 women) with chronic tension-type headache (mean, 25 headache days per month) who had failed to respond (less than 30% improvement) to treatment with either amitriptyline (n = 13) or matched placebo (n = 18). All participants were treated with paroxetine (up to 40 mg per day) in a 9-month protocol. Outcome Measures Monthly headache index calculated as the mean of pain ratings (0 to 10 scale) recorded by participants in a diary 4 times per day, number of days per month with at least moderate pain (pain rating of 5 or greater), and analgesic medication use. Results In patients who had not responded to amitriptyline, paroxetine failed to reduce chronic tension-type headaches or analgesic medication use. In patients who had not responded to placebo, paroxetine produced modest reductions in chronic tension-type headaches and analgesic use. Conclusions We found no evidence that chronic tension-type headaches that failed to respond to tricyclic antidepressant therapy with amitriptyline improved when subsequently treated with paroxetine. More support was found for the efficacy of paroxetine in patients with chronic tension-type headaches who had failed to respond to placebo. PMID:14511278

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

African Journals Online (AJOL)

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

Localized type Volkmann's contracture treated with tendon transfer and tension-reduced early mobilization

Science.gov (United States)

Kaji, Yoshio; Nakamura, Osamu; Yamaguchi, Konosuke; Tobiume, Sachiko; Yamamoto, Tetsuji

2017-01-01

Abstract Rationale: For localized type Volkmann's contracture, in which degeneration of the flexor digitorum profundus (FDP) muscle to one or two fingers and restriction of finger extension occur, dissection or excision of the affected muscle is usually recommended. However, these surgical procedures need relatively wide exposure of the muscle, because the FDP muscle is in the deep portion of the forearm. Patient concerns: In this report, the case of a 35-year-old woman with localized type Volkmann's contracture is presented. Her left forearm had been compressed with an industrial roller 4 months earlier, and severe flexion contracture of the long finger and mild flexion contracture of the ring finger developed gradually. Diagnoses: localized type Volkmann's contracture. Intervention: Five months after the injury, transection of the FDP tendon to the long finger and transfer of the transected tendon to the FDP tendon to the index finger was performed after adjusting the tonus of these two tendons using a small skin incision. This procedure was followed by a tension-reduced early mobilization technique in which a tension-reduced position of the tendon suture site was maintained by taping the long finger to the volar side of the index finger, and then immediate active range of motion (ROM) exercise was started. Outcomes: Within 9 weeks after surgery, full ROM had been regained. Lessons: Using the treatment procedure presented in this case report, a good clinical result was obtained in a minimally invasive manner. PMID:28072735

Hospital volumes and later year of operation correlates with better outcomes in acute Type A aortic dissection

DEFF Research Database (Denmark)

Geirsson, Arnar; Ahlsson, Anders; Franco-Cereceda, Anders

2018-01-01

and C and cardiopulmonary bypass time, whereas later calendar year and higher hospital operative volumes predicted improved survival. CONCLUSIONS: Surgical mortality for acute Type A aortic dissection remains high but has decreased significantly over the last decade. This correlated with later year...... A Aortic Dissection is a retrospective database comprising 1159 patients (mean age 61.6 ± 12.2 years, 68% male) treated for acute Type A aortic dissection at 8 centres in Denmark, Finland, Iceland and Sweden from 2005 to 2014. Data gathered included demographics, symptoms, type of procedure, complications...

Surgical pitfalls with custom-made porous hydroxyapatite cranial implants

Directory of Open Access Journals (Sweden)

Bruno Zanotti

2015-03-01

Full Text Available Aim: Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure. Available bone substitutes include porous hydroxyapatite (HA and polymethylmethacrylate. Whichever material is used, however, prosthetic cranial implants are susceptible to intra- and postsurgical complications and even failure. The aim of this study was to investigate such occurrences in HA cranioplasty implants, seeking not only to determine the likely causes (whether correlated or not with the device itself but also, where possible, to suggest countermeasures. Methods: We analyzed information regarding failures or complications reported in postmarketing surveillance and clinical studies of patients treated worldwide with custom-made HA cranial implants (Custom Bone Service Fin-Ceramica Faenza, Italy in the period 1997-2013. Results: The two most common complications were implant fractures (84 cases, 2.9% of the total fitted and infections (51 cases, 1.77%. Conclusion: Although cranioplasties are superficial and not difficult types of surgery, and use of custom-made implants are often considered the "easy" option from a surgical perspective, these procedures are nonetheless plagued by potential pitfalls. If performed well they yield more than satisfactory results from the points of view of both the patient and surgeon, but lack of appropriate care can open the door to numerous potential sources of failure, which can compromise-even irreparably-the ability to heal.

The Hidden Story of Innovation: Charity Hospital, Angola Prison, and the Challenging of Surgical Dogma.

Science.gov (United States)

Greiffenstein, Patrick; Hastings, Paul R

2017-02-01

The late 1960s was a period of significant upheaval of social, cultural, and scientific norms. The generally accepted notion of mandatory laparotomy for all penetrating abdominal injuries was among those norms being called into question across the country and many advocated expectant management of selected patients presenting with this type of injury. Leaders of the surgical community published opinions on either side of the argument. The house staff at Charity Hospital during this period was among the busiest in the nation in treating these injuries, many of them inmates of the Louisiana State Penitentiary who used self-inflicted stab wounds to the abdomen as a means of temporary respite from the inhumane conditions in the prison. Inspired, in part, by the overabundance of negative laparotomies among this group, F. Carter Nance went on to systematically challenge the standard of care. This effort constitutes one of the major forces for change of the surgical dogma of mandatory laparotomy for all abdominal stab wounds. It is the first major study to show conclusively that delayed laparotomy for perforated viscous was not significantly detrimental and posed less of a risk than unnecessary laparotomy. The circumstances surrounding this initiative constitute a powerful and heretofore unknown chapter in the history of surgical innovation.

Peculiarities of diagnosis and surgical treatment of mediastinal thymomas complicated by myasthenia

International Nuclear Information System (INIS)

Gagua, R.; Todua, F.; Kuchava, V.; Gzirishvili, L.; Tsivtsivadze, G.; Vashakidze, M.

2013-01-01

The aim of this work is to improve the results of diagnosis and surgical treatment of mediastinal thymomas. With this reason, 128 patients with the tumors of thymus have been undergone operations at the Thoracic Department of the National Cancer Centre (NCC) of Georgia. Material and methods: Out of 128 patients, type A thymomas were diagnosed in 7, type AB - in 14, type B1 - in 52, typer B2 - in 32, type B3 - in 18 patients. Myasthenia was revealed in 51 patients. Most frequently myasthenia was found in type B1 (48.1%) and in type B2 (40.8%) thymomas while in type A and type AB - in 28.6% and in 28.5% correspondingly, but in type B3 myasthenia was found in 16.7%. Results: Helical Computerized Tomography (CT) is leading in diagnosis of mediastinal thymomas. Surgical method in the volume of thymomtymectomy is the best choice of treatment of thymomas and it is performed basically by sternotomic approach. The effectiveness of surgical treatment depended upon the optimization of patients presurgical preparing and it often included steroidal therapy and plasmapheresis. The period of post surgical liquidation of myasthenia signs was between 1 - 14 months. The remote results of treatment depend on histological type of tumor and its stage. At I-II stages of A and AB type thymomas, 100% of patients survived 5 and more years after radical operation, while in III stage - 86%. 5-year survival rate was 95-97% in thymomas of B1-3 types stage I, but at stage III it was no more than 38%. (author)

Survival and prognostic factors in 321 patients treated with stereotactic body radiotherapy for oligo-metastases

DEFF Research Database (Denmark)

Fode, Mette Marie; Høyer, Morten

2015-01-01

BACKGROUND AND PURPOSE: To establish a model to predict survival after SBRT for oligo-metastases in patients considered ineligible for surgical resection (SR) and radiofrequency ablation (RFA). MATERIAL AND METHODS: Overall survival (OS) rates were estimated in 321 patients treated for 587...... metastases with SBRT over 13years. Patients were treated for a variety of metastasis types with colorectal cancer (CRC) being the most frequent (n=201). RESULTS: With a median follow-up time of 5.0years, the median OS was 2.4years (95% CI 2.3-2.7) and the survival rates were 80%, 39%, 23% and 12% at 1, 3, 5...... and 7.5years after SBRT, respectively. WHO performance status (PS) (0-1) (HR 0.49; pSBRT chemotherapy (HR 0.59; p

Surgical treatment of metachronous metastases in different organs following radical nephrectomy

Directory of Open Access Journals (Sweden)

Carlos M. N. de Jesus

2003-06-01

Full Text Available Renal clear cell carcinoma (RCCC is a neoplasia resistant to radio and chemotherapy, with surgical treatment being the procedure that is recognized for its curative treatment. This case report demonstrates the success of an aggressive surgical treatment for consecutive and late metachronous metastases following radical nephrectomy. CASE REPORT: Asymptomatic 50-year old man. During a routine examination, an incidental mass was found by renal ultrasonography. He underwent right radical nephrectomy due to RCCC in June 1992. During the follow-up metastases were evidenced in cerebellum on the seventh year, and in left lung and pancreas on the eighth year following the radical nephrectomy, with all of them successfully treated by surgical excision. COMMENTS: The surgical excision of consecutive and late metachronous metastases in different organs arising from RCCC is feasible, being a good therapeutic alternative in selected cases.

Surgical Treatment of Tattoo Complications.

Science.gov (United States)

Sepehri, Mitra; Jørgensen, Bo

2017-01-01

With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented. © 2017 S. Karger AG, Basel.

[Surgical correction of cleft palate].

Science.gov (United States)

Kimura, F T; Pavia Noble, A; Soriano Padilla, F; Soto Miranda, A; Medellín Rodríguez, A

1990-04-01

This study presents a statistical review of corrective surgery for cleft palate, based on cases treated at the maxillo-facial surgery units of the Pediatrics Hospital of the Centro Médico Nacional and at Centro Médico La Raza of the National Institute of Social Security of Mexico, over a five-year period. Interdisciplinary management as performed at the Cleft-Palate Clinic, in an integrated approach involving specialists in maxillo-facial surgery, maxillar orthopedics, genetics, social work and mental hygiene, pursuing to reestablish the stomatological and psychological functions of children afflicted by cleft palate, is amply described. The frequency and classification of the various techniques practiced in that service are described, as well as surgical statistics for 188 patients, which include a total of 256 palate surgeries performed from March 1984 to March 1989, applying three different techniques and proposing a combination of them in a single surgical time, in order to avoid complementary surgery.

Pleural fluid drainage: Percutaneous catheter drainage versus surgical chest tube drainage

International Nuclear Information System (INIS)

Illescas, F.F.; Reinhold, C.; Atri, M.; Bret, P.M.

1987-01-01

Over the past 4 years, 55 cases (one transudate, 28 exudates, and 26 empymas) were drained. Surgical chest tubes alone were used in 35 drainages, percutaneous catheters alone in five drainages, and both types in 15 drainages. Percutaneous catheter drainage was successful in 12 of 20 drainages (60%). Surgical tube drainage was successful in 18 of 50 drainages (36%). The success rate for the nonempyema group was 45% with both types of drainage. For the empyema group, the success rate for percutaneous catheter drainage was 66% vs 23% for surgical tube drainage. Seven major complications occurred with surgical tube drainage, but only one major complication occurred with percutaneous catheter drainage. Radiologically guided percutaneous catheter drainage should be the procedure of choice for pleural fluid drainage. It has a higher success rate for empyemas and is associated with less complications

Early and late surgical site infections in ear surgery.

Science.gov (United States)

Bastier, P L; Leroyer, C; Lashéras, A; Rogues, A-M; Darrouzet, V; Franco-Vidal, V

2016-04-01

A retroauricular approach is routinely used for treating chronic otitis media. The incidence of surgical site infections after ear surgery is around 10% in contaminated or dirty procedures. This observational prospective study describes surgical site infections after chronic otitis media surgery with the retroauricular approach and investigated their potential predictive factors. This observational prospective study included patients suffering from chronic otitis media and eligible for therapeutic surgery with a retroauricular approach. During follow-up, surgical site infections were defined as "early" if occurring within 30 days after surgery or as "late" if occurring thereafter. The data of 102 patients were analysed. Concerning early surgical site infections, four cases were diagnosed (3.9%) and a significant association was found with preoperative antibiotic therapy, wet ear at pre-operative examination, class III (contaminated) in the surgical wound classification, NNIS (National Nosocomial Infection Surveillance) index > 1, and oral post-operative antibiotic use. Seven late surgical site infections were diagnosed (7.1%) between 90 and 160 days after surgery and were significantly correlated to otorrhoea during the 6 months before surgery, surgery duration ≤60 minutes, canal wall down technique and use of fibrin glue. Surgical site infections after chronic otitis media surgery seem to be associated with factors related to the inflammatory state of the middle ear at the time of surgery in early infections and with chronic inflammation in late infections. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

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 .

Interventions for treating femoral shaft fractures in children and adolescents.

Science.gov (United States)

Madhuri, Vrisha; Dutt, Vivek; Gahukamble, Abhay D; Tharyan, Prathap

2014-12-01

intramedullary nailing may reduce recovery time. There is insufficient evidence from comparisons of different methods of conservative treatment or of different methods of surgical treatment to draw conclusions on the relative effects of the treatments compared in the included trials. Different methods of treating fractures of the shaft of the thigh bone in children and adolescents Although uncommon, fractures of the femoral shaft (thigh bone) in children may require prolonged treatment in hospital and sometimes surgery. This can cause significant discomfort and can disrupt the lives of the children and their familles. This review compared different methods of treating these fractures. Surgical treatment comprises different methods of fixing the broken bones, such as internally-placed nails, or pins incorporated into an external frame (external fixation). Non-surgical or conservative treatment usually involves different types of plaster casts with or without traction (where a pulling force is applied to the leg). We searched for studies in the medical literature until August 2013. The review includes 10 randomised or quasi-randomised controlled trials that recruited 527 children. Four trials compared different surgical versus non-surgical treatments; three compared different methods of non-surgical treatment and three compared different methods of surgical treatment. Generally we are unsure about the results of these trials because some were at risk of bias, some results were contradictory and usually there was too little evidence to rule out chance findings. Most trials failed to report on self-assessed function or when children resumed their usual activities. Comparing surgical versus non-surgical treatment. Low quality evidence (one trial, 101 children) showed children had similar function at two years after having surgery, involving external fixation, compared with those treated with a plaster cast. The other three trials did not report this outcome. There was moderate

Surgical Site Infection Following Fixation of Acetabular Fractures.

Science.gov (United States)

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

2017-09-01

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

[Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies].

Science.gov (United States)

Zhang, B; Chen, L S; Huang, S L; Liang, L; Gong, X X; Wu, P N; Zhang, S Y; Luo, X N; Zhan, J D; Sheng, X L; Lu, Z M

2017-10-07

Objective: To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies. Methods: Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases. Results: Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web. Conclusions: CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.

Retrospective evaluation of surgical intervention following chemo- and radiotherapy of maxillary sinus cancers

Energy Technology Data Exchange (ETDEWEB)

Kudo, Keigo; Satoh, Yumi; Endo, Mitsuhiro; Segawa, Kiyoshi; Fukuta, Yoshiyasu; Yokota, Mitsumasa; Fujioka, Yukio (Iwate Medical Univ., Morioka (Japan). School of Dentistry)

1992-03-01

During the past 15 years, 30 patients with squamous cell carcinomas of the maxillary sinus were treated by modified partial maxillectomy following chemo- and radiotherapy, taking care to preserve facial contour and function as far as possible. Follow-up evaluation showed that local recurrences, and regional lymph node and distant metastases were more frequent in T4 patients than in T3 patients. Evaluation of the histopathological effects of preoperative chemo- and radiotherapy at the time of surgery showed that T4 patients tended to have a poorer response to the treatment than T3 patients. Analysis according to the direction of primary tumor extension showed that the incidence of local recurrence was higher in the superolateral type, whereas that of regional lymph node metastasis was higher in the medial type. The cumulative 5-year survival was high (72.2%) in Stage III patients and low (22.5%) in Stage IV patients. The overall rate was 55.4%. The treatment produced relatively good outcomes in T3 patients but poor outcomes in T4 patients. These findings indicate that T4 carcinoma of the maxillary sinus must be managed initially by a combination of irradiation and multi-chemotherapeutic drugs, and then treated by more extensive surgical resection. (author).

Retrospective evaluation of surgical intervention following chemo- and radiotherapy of maxillary sinus cancers

International Nuclear Information System (INIS)

Kudo, Keigo; Satoh, Yumi; Endo, Mitsuhiro; Segawa, Kiyoshi; Fukuta, Yoshiyasu; Yokota, Mitsumasa; Fujioka, Yukio

1992-01-01

During the past 15 years, 30 patients with squamous cell carcinomas of the maxillary sinus were treated by modified partial maxillectomy following chemo- and radiotherapy, taking care to preserve facial contour and function as far as possible. Follow-up evaluation showed that local recurrences, and regional lymph node and distant metastases were more frequent in T4 patients than in T3 patients. Evaluation of the histopathological effects of preoperative chemo- and radiotherapy at the time of surgery showed that T4 patients tended to have a poorer response to the treatment than T3 patients. Analysis according to the direction of primary tumor extension showed that the incidence of local recurrence was higher in the superolateral type, whereas that of regional lymph node metastasis was higher in the medial type. The cumulative 5-year survival was high (72.2%) in Stage III patients and low (22.5%) in Stage IV patients. The overall rate was 55.4%. The treatment produced relatively good outcomes in T3 patients but poor outcomes in T4 patients. These findings indicate that T4 carcinoma of the maxillary sinus must be managed initially by a combination of irradiation and multi-chemotherapeutic drugs, and then treated by more extensive surgical resection. (author)

Surgical management of bronchiectasis. The indications and outcomes

International Nuclear Information System (INIS)

Gursoy, S.; Ozturk, A.A.; Ucvet, A.; Erbaycu, A.E.

2010-01-01

Social limitations in addition to treatment failure, despite preventive precautions and aggressive medical treatment, are the main indications for surgery in patients with bronchiectasis. The aim of this study was to evaluate all aspects of treatment outcomes in surgically treated patients with bronchiectasis. Ninety-two patients with bronchiectasis treated by a surgical resection between January 2002 and June 2007 were included in the study. Age, sex, symptoms, etiologic factors, radiological findings, surgical procedures, postoperative morbidity and mortality, and hospital stay were analyzed. Fifty-four patients were female and 38 were male, with an average age of 38.7 (range, 10-67) years, and 84.8% were symptomatic. The etiologic factors included frequent infections (37%), childhood infections (22%), tuberculosis (12%), foreign bodies (3%), and unknown causes (26%). Ten pneumonectomies, 36 lobectomies, 2 bilobectomies, 32 lobectomies and segmentectomies, and 12 segmentectomies were performed. The morbidity was 16%, the mortality was 1%, and the mean follow-up duration was 15.3 months. Follow-up data were obtained in 75 patients of whom 63 (84%) were asymptomatic, 8 (10.7%) were symptomatic with clinical improvement, and 4 (5.3%) had had no clinical improvement. Despite the advances in preventive precautions, medical treatment, and follow-up, surgery, with its low mortality and morbidity rates, remains a good alternative in selected patients in the treatment of bronchiectasis, and fulfills the clinical and social improvement expectations of patients. (author)

Multi-perspective workflow modeling for online surgical situation models.

Science.gov (United States)

Franke, Stefan; Meixensberger, Jürgen; Neumuth, Thomas

2015-04-01

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

A review of surgical methods (excluding hair transplantation and their role in hair loss management today

Directory of Open Access Journals (Sweden)

Sandeep S Sattur

2011-01-01

Full Text Available There is more than one way to manage hair loss surgically. Apart from hair transplantation, there are other techniques which have been used by many to treat baldness. This article attempts to review the surgical methodology and philosophy that have acted as guiding lights in the approach to surgical treatment of baldness over the years and reviews the current role of other techniques in the armamentarium of hair restoration surgeons today.

Congenital H-type tracheoesophageal fistula: A multicenter review of outcomes in a rare disease.

Science.gov (United States)

Fallon, Sara C; Langer, Jacob C; St Peter, Shawn D; Tsao, KuoJen; Kellagher, Caroline M; Lal, Dave R; Whitehouse, Jill S; Diesen, Diana L; Rollins, Michael D; Pontarelli, Elizabeth; Malek, Marcus M; Iqbal, Corey W; Upperman, Jeffrey S; Leys, Charles M; Wulkan, Mark L; Hill, Sarah J; Blakely, Martin L; Kane, Timothy D; Wesson, David E

2017-11-01

To perform a multicenter review of outcomes in patients with H-type tracheoesophageal fistula (TEF) in order to better understand the incidence and causes of post-operative complications. H-type TEF without esophageal atresia (EA) is a rare anomaly with a fundamentally different management algorithm than the more common types of EA/TEF. Outcomes after surgical treatment of H-type TEF are largely unknown, but many authoritative textbooks describe a high incidence of respiratory complications. A multicenter retrospective review of all H-type TEF patients treated at 14 tertiary children's hospital from 2002-2012 was performed. Data were systematically collected concerning associated anomalies, operative techniques, hospital course, and short and long-term outcomes. Descriptive analyses were performed. We identified 102 patients (median 9.5 per center, range 1-16) with H-type TEF. The overall survival was 97%. Most patients were repaired via the cervical approach (96%). The in-hospital complication rate, excluding vocal cord issues, was 16%; this included an 8% post-operative leak rate. Twenty-two percent failed initial extubation after repair. A total of 22% of the entire group had vocal cord abnormalities (paralysis or paresis) on laryngoscopy that were likely because of recurrent laryngeal nerve injury. Nine percent required a tracheostomy. Only 3% had a recurrent fistula, all of which were treated with reoperation. There is a high rate of recurrent laryngeal nerve injury after H-type TEF repair. This underscores the need for meticulous surgical technique at the initial repair and suggests that early vocal cord evaluation should be performed for any post-operative respiratory difficulty. Routine evaluation of vocal cord function after H-type TEF repair should be considered. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

[Modern didactics in surgical education--between demand and reality].

Science.gov (United States)

Pape-Köhler, C; Chmelik, C; Rose, M; Heiss, M M

2010-12-01

Surgical residency contains an inadequate amount of hands-on training in the operating room and time constraints further make this type of education on the floor unlikely. Due to these deficits in residency training, private surgical courses outside of the established residency programmes are in high demand. Therefore, surgical residents must spend their own resources and time in addition to their residency training in order to receive adequate clinical exposure. Didactic approaches like problem-based learning have begun to influence our modern education. These novel education approaches along with visualisation training, video-based presentations, and multimedia-based training can be useful adjuncts to traditional surgical training. © Georg Thieme Verlag Stuttgart ˙ New York.

Risk-factors for surgical delay following hip fracture.

Science.gov (United States)

Sanz-Reig, J; Salvador Marín, J; Ferrández Martínez, J; Orozco Beltrán, D; Martínez López, J F

To identify pre-operative risk factors for surgical delay of more than 2 days after admission in patients older than 65 years with a hip fracture. A prospective observational study was conducted on 180 hip fractures in patients older than 65 years of age admitted to our hospital from January 2015 to April 2016. The data recorded included, patient demographics, day of admission, pre-fracture comorbidities, mental state, level of mobility and physical function, type of fracture, antiaggregant and anticoagulant medication, pre-operative haemoglobin value, type of treatment, and surgical delay. The mean age of the patients was 83.7 years. The mean Charlson Index was 2.8. The pre-fracture baseline co-morbidities were equal or greater than 2 in 70% of cases. Mean timing of surgery was 3.1 days. At the time of admission, 122 (67.7%) patients were fit for surgery, of which 80 (44.4%) underwent surgery within 2 days. A Charlson index greater than 2, anticoagulant therapy, and admission on Thursday to Saturday, were independently associated with a surgical delay greater than 2 days. The rate of hip fracture patients undergoing surgery within 2 days is low. Risk factors associated to surgical delay are non-modifiable. However, their knowledge should allow the development of protocols that can reduce surgical delay in this group of patients. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

A prospective randomized study of conservative versus surgical treatment of unstable palmar plate disruption in the proximal interphalangeal finger joint

DEFF Research Database (Denmark)

Werlinrud, Jens Christian; Petersen, Kirstin; Lauritsen, Jens

2013-01-01

study in which 83 patients were randomly assigned into 2 groups: (1) conservative treatment with a rigid splint for 2 weeks, (2) surgical reattachment of the palmar plate in local anesthesia followed by 2 weeks of immobilization in a plaster cast. Both groups were thereafter treated by taping...... to the neighboring finger for 3 weeks. With regard to hyperextension instability, stiffness, and pain, there is no significant difference in outcome between patients with traumatic palmar plate lesions and hyperextension instability treated with surgical repair and patients treated conservatively with a splint. We...

Surgical lighting

NARCIS (Netherlands)

Knulst, A.J.

2017-01-01

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

P-type conduction in Mg-doped GaN treated with low-energy electron beam irradiation (LEEBI)

International Nuclear Information System (INIS)

Amano, Hiroshi; Kito, Masahiro; Hiramatsu, Kazumasa

1989-01-01

Distinct p-type conduction is realized with Mg-doped GaN by the low-energy electron-beam irradiation (LEEBI) treatment, and the properties of the GaN p-n junction LED are reported for the first time. It was found that the LEEBI treatment drastically lowers the resistivity and remarkably enhances the PL efficiency of MOVPE-grown Mg-doped GaN. The Hall effect measurement of this Mg-doped GaN treated with LEEBI at room temperature showed that the hole concentration is ∼2·10 16 cm -3 , the hole mobility is ∼8 cm 2 /V·s and the resistivity is ∼35Ω· cm. The p-n junction LED using Mg-doped GaN treated with LEEBI as the p-type material showed strong near-band-edge emission due to the hole injection from the p-layer to the n-layer at room temperature. (author)

The Surgical Site Infection Risk Score (SSIRS: A Model to Predict the Risk of Surgical Site Infections.

Directory of Open Access Journals (Sweden)

Carl van Walraven

Full Text Available Surgical site infections (SSI are an important cause of peri-surgical morbidity with risks that vary extensively between patients and surgeries. Quantifying SSI risk would help identify candidates most likely to benefit from interventions to decrease the risk of SSI.We randomly divided all surgeries recorded in the National Surgical Quality Improvement Program from 2010 into a derivation and validation population. We used multivariate logistic regression to determine the independent association of patient and surgical covariates with the risk of any SSI (including superficial, deep, and organ space SSI within 30 days of surgery. To capture factors particular to specific surgeries, we developed a surgical risk score specific to all surgeries having a common first 3 numbers of their CPT code.Derivation (n = 181 894 and validation (n = 181 146 patients were similar for all demographics, past medical history, and surgical factors. Overall SSI risk was 3.9%. The SSI Risk Score (SSIRS found that risk increased with patient factors (smoking, increased body mass index, certain comorbidities (peripheral vascular disease, metastatic cancer, chronic steroid use, recent sepsis, and operative characteristics (surgical urgency; increased ASA class; longer operation duration; infected wounds; general anaesthesia; performance of more than one procedure; and CPT score. In the validation population, the SSIRS had good discrimination (c-statistic 0.800, 95% CI 0.795-0.805 and calibration.SSIRS can be calculated using patient and surgery information to estimate individual risk of SSI for a broad range of surgery types.

Surgical smoke.

Science.gov (United States)

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

2009-10-01

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

Surgical management of cross-bites in orthognathic surgery: Surgically assisted rapid maxillary expansion (SARME) versus two-piece maxilla.

Science.gov (United States)

Seeberger, Robin; Gander, Evelyn; Hoffmann, Jürgen; Engel, Michael

2015-09-01

The surgical treatment of cross-bites includes surgically-assisted maxillary expansion (SARME) or maxillary-bipartition during bimaxillary surgery. This study evaluates and compares the changes in the teeth and lower nasal passage, as well as the stability of the expansion. The measurements were performed on the cone-beam computed tomography (CBCT) scans of 32 patients with transverse (width) deficiencies of the maxilla. To expand the maxilla, 12 patients underwent the two-piece maxilla method, while 20 patients received SARME. The mean distraction width for SARME was 6.8 mm (SD 3.7), while that for the two-piece maxilla was 4.1 mm (SD 1.6). The expansion with SARME was over the entire length of the maxilla, from anterior to posterior, whereas the expansion of the two-piece patient group was only in the posterior part of the maxilla. The segments of the maxilla opened nearly parallel in SARME, while they were reverse V-shaped in the two-piece maxilla, from anterior to posterior. A key point in the planning of combined orthodontic-orthognathic therapy with surgical correction of a cross-bite is the precise determination of the area where the width needs to be increased, and the amount of correction needed to treat the patient using minimal surgical procedures. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Surgical support of Operation Sea Signal: adaptability of the 59th Air Transportable Hospital in Cuba.

Science.gov (United States)

Pelton, Jeffrey J; Buehrer, Jeffrey L; Cull, David L

2003-12-01

The attempted migration of approximately 50,000 Cubans in the summer of 1994 created a large patient population detained at Guantanamo Bay, Cuba. This study examined the roles and results of the 59th Air Transportable Hospital (ATH) in treating surgical problems within that population during Operation Sea Signal. The surgical case log of the 59th ATH was used to identify all patients operated on at the 59th ATH during the interval of August 1994 to April 1995. These case records and the individual records of the three 59th ATH surgeons were used to determine the types of cases performed, complications, and outcomes. A total of 333 operations were performed at the 59th ATH in three types of surgery: (1) elective (267); (2) emergency for nonself-inflicted conditions (46); and (3) emergency for self-inflicted conditions (20). The total perioperative complication rate was 2.4% (8/333), and the wound infection rate for clean surgical cases was 0.87% (2/229). Elective surgery may be performed in a field environment with acceptable complication and wound infection rates. Humanitarian missions will be faced with considerable pathology from pre-existing conditions within the population cared for. The humanitarian mission may be complicated by political situations that may encourage malingering and self-injurious behavior within the population cared for. The latter events have not been previously encountered in humanitarian missions involving the U.S. military and must be considered by policy makers and mission planners in planning future humanitarian missions.

3D vision improves outcomes in early cervical cancer treated with laparoscopic type B radical hysterectomy and pelvic lymphadenectomy.

Science.gov (United States)

Raspagliesi, Francesco; Bogani, Giorgio; Martinelli, Fabio; Signorelli, Mauro; Scaffa, Cono; Sabatucci, Ilaria; Lorusso, Domenica; Ditto, Antonino

2017-01-21

To evaluate the alterations on surgical outcomes after of the implementation of 3D laparoscopic technology for the surgical treatment of early-stage cervical carcinoma. Data of patients undergoing type B radical hysterectomy (with or without bilateral salpingo-oophorectomy) and pelvic lymphadenectomy via 3D laparoscopy were compared with a historical cohort of patients undergoing type B radical hysterectomy via conventional laparoscopy. Complications (within 60 days) were graded per the Accordion severity system. Data of 75 patients were studied: 15 (20%) and 60 (80%) patients undergoing surgery via 3D laparoscopy and conventional laparoscopy, respectively. Baseline patient characteristics as well as pathologic findings were similar between groups (p>0.1). Patients undergoing 3D laparoscopy experienced a trend toward shorter operative time than patients undergoing conventional laparoscopy (176.7 ± 74.6 vs 215.9 ± 61.6 minutes; p = 0.09). Similarly, patients undergoing 3D laparoscopic radical hysterectomy experienced shorter length of hospital stay (2 days, range 2-6, vs 4 days, range 3-11; p<0.001) in comparison to patients in the control group, while no difference in estimated blood loss was observed (p = 0.88). No between-group difference in complication rate was observed. 3D technology is a safe and effective way to perform type B radical hysterectomy and pelvic node dissection in early-stage cervical cancer. Further large prospective studies are warranted in order to assess the cost-effectiveness of the introduction of 3D technology in comparison to robotic assisted surgery.

A New Method for Surgical Treatment of Subcondylar Fractures: A Case Report

Directory of Open Access Journals (Sweden)

Gholamreza Shirani

2017-12-01

Full Text Available AbstractSubcondylar fractures are common in the maxillofacial region following direct trauma to the mandibular ramus. The literature is replete with articles written on the treatment of subcondylar fractures, encompassing a plethora of various surgical approaches; however, the best treatment procedure has remained controversial. Such fractures are either treated by open reduction with internal fixation or closed reduction with maxillomandibular fixation. In this article, we describe a new surgical method for treatment of subcondylar fractures.

CT and sonographic diagnosis of retained surgical sponge

International Nuclear Information System (INIS)

Matsumoto, Syunro; Aikawa, Hisayuki; Miyake, Hidetoshi; Mori, Hiromu; Maeda, Tohru; Nishimura, Hiro; Monzen, Yoshio; Ashizawa, Akira; Isomoto, Ichiro.

1990-01-01

Seven cases of pathologically proven retained surgical sponge were reviewed and classified into four types, depending on CT and US findings. CT showed a mass with tiny gas bubbles, and sonogram showed an echogenic area with strong posterior shadow (Type I). CT showed an irregular high density mass with no gas bubble, and sonogram showed an echogenic area with strong posterior shadow (Type II). CT showed a low density mass with irregular internal high density areas, and somogram showed a cystic mass with zigzag internal components (Type III). CT showed an eliptic high density mass with low density area internally. Judging from the experiment and operative findings, these patterns were decided by the number and status of the gauze, volume of the exudate and hematoma, and status of the granulation. The author concludes that these characteristic CT and US findings, together with a history of surgery, permit the correct diagnosis of retained surgical sponge. (author)

Data to DecisionsTerminate, Tolerate, Transfer, or Treat

Science.gov (United States)

2016-07-25

and resources.  Degradation of current capability continues. Transfer – Opportunities and Consequences:  Requires a surgical knowledge of what...I N S T I T U T E F O R D E F E N S E A N A L Y S E S Data to Decisions—Terminate, Tolerate, Transfer , or Treat Laura A...Data to Decisions—Terminate, Tolerate, Transfer , or Treat For more information Laura Odell(lodell@ida.org, 703-845-2009 The Department

Clinical observation of phacoemulsification combined goniosynechialysis in treating absolute glaucoma after trabeculectomy

Directory of Open Access Journals (Sweden)

Jun-Yong Wang

2014-10-01

Full Text Available AIM: To observe the effect of phacoemulsification combined goniosynechialysis in treating absolute glaucoma after trabeculectomy.METHODS: Phacoemulsification combined goniosynechialysis was performed on 16 patients(16 eyeswith absolute glaucoma after trabeculectomy, and they were followed up for 6～12mo, The postoperative intraocular pressure(IOPand anterior chamber depth, preoperative and postoperative medication types(quantity, preoperative and postoperative 1 month's status of anxiety and depression, symptoms of ocular surface were observed.RESULTS: The IOP decreased significantly after phacoemulsification combined goniosynechialysis. The mean IOP was 35.00±15.43mmHg preoperatively, and it was 12.00±6.69mmHg, 15.00±4.26mmHg and 15.3±5.2mmHg on 1d, 6 and 12mo after the surgery. The statistic difference was found between preoperative and postoperative(t=6.22, Pt=6.65, PCONCLUSION: Phacoemulsification combined goniosynechialysis in treating absolute glaucoma after trabeculectomy is a safe and effective surgical option.

Clinical evaluation of combined surgical/ restorative treatment of gingival recession-type defects using different restorative materials: A randomized clinical trial

Directory of Open Access Journals (Sweden)

Sila Cagri Isler

2018-03-01

Full Text Available Background/purpose: An ideal therapeutic procedure for the treatment of gingival recession associated with an NCCL has presented a challenge to clinicians. Various dental materials and surgical approaches have been used to manage gingival recessions associated with NCCLs for the most predictable combined surgical/restorative treatment. The objective of this study was to evaluate the treatment of gingival recessions associated with non-carious cervical lesions (NCCL using a modified coronally advanced flap (MCAF in combination with a connective tissue graft (CTG on restored root surfaces. Materials and methods: Twenty-three systemically healthy subjects, who were positive for the presence of three cervical lesions associated with gingival recessions in three different adjacent teeth, were enrolled in the study. The NCCL were each restored prior to surgery by using one of three different materials: nanofilled composite resin (NCR, resin-modified glass ionomer cement (RMGI or giomer. The gingival recession defects were treated by CTG. Results: Inter-group differences were not statistically significant for probing depth (PD, relative recession height (rRH, relative clinical attachment level (rCAL, keratinized tissue width (KTW or keratinized tissue thickness (KTT (p > 0.05 among the groups at any time. The mean percentage of defect coverage was 71.18 ± 23.16% for NCR + CTG group; 71.33 ± 22.33% for RMGI + CTG group; and 64.23 ± 20.33% for giomer + CTG group at 1 year postoperatively (p > 0.05. Conclusion: The combined surgical/restorative treatments provided successful clinical results. Giomer + CTG may be less effective compared to other groups for treatment of gingival recession associated with NCCL. Keywords: cervical lesions, connective tissue grafts, gingival recession, restorative materials

Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement

Science.gov (United States)

Zhang, Dagang; Chen, Long; Wang, Guanglin

2016-01-01

Abstract Background: This meta-analysis aims to evaluate the efficacy and safety of hip arthroscopy versus open surgical dislocation for treating femoroacetabular impingement (FAI) through published clinical trials. Methods: We conducted a comprehensive literature search using PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant studies on hip arthroscopy and open surgical dislocation as treatment options for FAI. Results: Compared with open surgical dislocation, hip arthroscopy resulted in significantly higher Nonarthritic Hip Scores (NAHS) at 3- and 12-month follow-ups, a significant improvement in NAHS from preoperation to 3 months postoperation, and a significantly lower reoperation rate. Open surgical dislocation resulted in a significantly improved alpha angle by the Dunn view in patients with cam osteoplasty from preoperation to postoperation, compared with hip arthroscopy. This meta-analysis demonstrated no significant differences in the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, or Hip Outcome Score-Sport Specific Subscale at 12 months of follow-up, or in complications (including nerve damage, wound infection, and wound dehiscence). Conclusion: Hip arthroscopy resulted in higher NAHS and lower reoperation rates, but had less improvement in alpha angle in patients with cam osteoplasty, than open surgical dislocation. PMID:27741133

Alterations of regional pulmonary function in patients with mitral stenosis studied with xenon-133 following surgical treatment

International Nuclear Information System (INIS)

Kurata, Naohiko

1983-01-01

The purpose of this study is to investigate the regional pulmonary function in mitral stenosis using Xenon-133 before and after surgical treatment. Twenty-seven patients with mitral stenosis have been studied. There were four types of distribution of pulmonary perfusion. According to the increase of pulmonary capillary wedge pressure, the distribution of pulmonary perfusion showed a vertical distribution different from that of normal man, as well known according to the many past reports. But Type IV(PCWP > 30mmHg) showed the distribution uniform throughout the lung. The patients with Type IV had severe pulmonary vascular resistance and abnormal distribution of ventilation. They showed decreased %VC, SaO 2 and increased FRV in the tests of total lung functions. Postoperatively, the distribution of pulmonary perfusion in Type II and Type III returned to normal after 6 - 12 months of surgical treatment, but in the Type IV never returned to normal even after 12 months of surgical treatment. The hemodynamic data in the Type IV after 3 - 6 months of surgical treatment showed the moderate pulmonary hypertension and pulmonary vascular resistance. In total lung function tests, %VC, SaO 2 and FRV were recognized the improvement after surgical treatment, but they retained under normal range even after 12 months of sutgical treatment. The abnormal distribution of ventilation improved to normal distribution after 12 months of surgical treatment. The regional pulmonary function test using Xenon-133 is very beneficial to estimate the severity of mitral stenosis and to expect the effects of surgical treatment on the pulmonary circulation and ventilation. (J.P.N.)

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

The application of 3D printed surgical guides in resection and reconstruction of malignant bone tumor.

Science.gov (United States)

Wang, Fengping; Zhu, Jun; Peng, Xuejun; Su, Jing

2017-10-01

The clinical value of 3D printed surgical guides in resection and reconstruction of malignant bone tumor around the knee joint were studied. For this purpose, a sample of 66 patients from October 2013 to October 2015 were randomly selected and further divided into control group and observation group, each group consisted of 33 cases. The control group was treated by conventional tumor resection whereas, in the observation group, the tumor was resected with 3D printed surgical guide. However, reconstruction of tumor-type hinge prosthesis was performed in both groups and then the clinical effect was compared. Results show that there was no significant difference in the operation time between the two groups (p>0.05). However, the blood loss, resection length and complication rate were found significantly lower in the observation group than in the control group (p0.05) between two groups were statistically the same (p>0.05), whereas the Musculoskeletal Tumor Society (MSTS) score of the knee joint in the observation group was significantly better than that of the control group (p3D printed surgical guides can significantly improve the postoperative joint function after resection and reconstruction of malignant bone tumor around the knee joint and can reduce the incidence of complications.

A 9 year-old girl with herpes simplex virus type 2 acute retinal necrosis treated with intravitreal foscarnet.

Science.gov (United States)

King, John; Chung, Mina; DiLoreto, David A

2007-01-01

A 9-year-old girl presented with a 2-week history of redness in the left eye. Examination revealed vitritis, retinal whitening, vasculitis, and optic nerve head edema. Polymerase chain reaction testing of the aqueous fluid revealed herpes simplex virus type 2. The retinitis was controlled with intravenous acyclovir and intravitreal foscarnet. The clinical course was complicated by retinal neovascularization and vitreous hemorrhage, which was treated by pars plana vitrectomy and endolaser. While there are few case reports of herpes simplex virus type 2 retinitis in children, this one is unique for the following reasons: it is the first reported case of herpes simplex virus type 2 retinitis in a child less than 10 years old without a previous history of neonatal infection or central nervous system involvement; no other children have been reported to have been treated with intravitreal foscarnet; and retinal neovascularization complicated the recovery.

Analysis of two different surgical approaches for fractures of the mandibular condyle.

Science.gov (United States)

Kumaran, S; Thambiah, L J

2012-01-01

Fractures of the condyle account for one third of all the mandibular fractures. Different surgical approaches to the condyle described hitherto testify to the advantages and disadvantages of the different surgical techniques used for approaching the condyle in such cases of fractures. We have described and compared two of such surgical techniques in this study. The aim of this study is to compare the outcome of dealing with condylar fractures by two different surgical techniques: the mini retromandibular approach, and the preauricular approach. A prospective study of 31 patients who had suffered with mandibular condylar fractures was carried out. Of these, 26 patients had unilateral condylar fractures, and 5 patients had a bilateral fracture. Further, 19 of these patients were treated by the mini retromandibular approach and 12 by the preauricular approach. The treated patients were followed up and evaluated for a minimum period of 1 year and assessed for parameters such as the maximum mouth opening, lateral movement on the fractured side, mandibular movements such as protrusion, dental occlusion, scar formation, facial nerve weakness, salivary fistula formation and time taken for the completion of the surgical procedure. t- test was used for statistical analysis of the data obtained in the study. Dental occlusion was restored in all the cases, and good anatomical reduction was achieved. The mean operating time was higher 63.53 (mean) ± 18.12 minutes standard deviation (SD) in the preauricular approach compared to 45.22 (mean) ± 18.86 minutes SD in the mini retromandibular approach. Scar formation was satisfactory in almost all the cases.

Requirements for the design and implementation of checklists for surgical processes

NARCIS (Netherlands)

Verdaasdonk, E.G.G.; Stassen, L.P.S.; Widhiasmara, P.P.; Dankelman, J.

2008-01-01

Background- The use of checklists is a promising strategy for improving patient safety in all types of surgical processes inside and outside the operating room. This article aims to provide requirements and implementation of checklists for surgical processes. Methods- The literature on checklist use

[Surgical managment of retinal detachment].

Science.gov (United States)

Haritoglou, C; Wolf, A

2015-05-01

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

Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis

Energy Technology Data Exchange (ETDEWEB)

Upasani, Anand, E-mail: anand.upasani@gosh.nhs.uk [Great Ormond Street Hospital, Department of Paediatric Urology (United Kingdom); Barnacle, Alex, E-mail: alex.barnacle@gosh.nhs.uk; Roebuck, Derek, E-mail: derek.roebuck@gosh.nhs.uk; Cherian, Abraham, E-mail: abraham.cherian@gosh.nhs.uk [Great Ormond Street Hospital (United Kingdom)

2017-03-15

Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis

International Nuclear Information System (INIS)

Upasani, Anand; Barnacle, Alex; Roebuck, Derek; Cherian, Abraham

2017-01-01

Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

Resective surgical approach shows a high performance in the management of advanced cases of bisphosphonate-related osteonecrosis of the jaws: a retrospective survey of 347 cases.

Science.gov (United States)

Graziani, Filippo; Vescovi, Paolo; Campisi, Giuseppina; Favia, Gianfranco; Gabriele, Mario; Gaeta, Giovanni Maria; Gennai, Stefano; Goia, Franco; Miccoli, Mario; Peluso, Franco; Scoletta, Matteo; Solazzo, Luigi; Colella, Giuseppe

2012-11-01

The aim of this study was to evaluate the results of the surgical treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a large cohort. A retrospective cohort multicenter study was designed. Patients were enrolled if they were diagnosed with BRONJ and received operative treatment. Data on demographic, health status, perioperative, and surgical factors were collected retrospectively. The primary outcome variable was a change in BRONJ staging (improvement, worsening, or no change). Interventions were grouped by local debridement and resective surgery. Data were collected for other variables as cofactors. Univariate analysis and logistic regressions were then performed. Of the 347 BRONJ-affected subjects, 59% showed improvement, 30% showed no change, and 11% showed worsening. Improvement was observed in 49% of cases treated with local debridement and 68% of cases treated with resective surgery. Multivariate analysis indicated that maxillary location, resective surgery, and no additional corticosteroid treatment were associated with a positive outcome. Surgical treatment of BRONJ appeared to be more effective when resective procedures were performed. Nonetheless, other factors, such as the absence of symptoms and the types of drug administration, should be taken into account before clinical decisions are made. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Surgical Assisting

Science.gov (United States)

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

Paediatric Abdominal Surgical Emergencies in a General Surgical ...

African Journals Online (AJOL)

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

Incidence and clinical relevance of tibiofibular synostosis in fractures of the ankle which have been treated surgically.

Science.gov (United States)

Droog, R; Verhage, S M; Hoogendoorn, J M

2015-07-01

In this retrospective cohort study, we analysed the incidence and functional outcome of a distal tibiofibular synostosis. Patients with an isolated AO type 44-B or C fracture of the ankle who underwent surgical treatment between 1995 and 2007 were invited for clinical and radiological review. The American Orthopaedic Foot and Ankle Society score, the American Academy of Orthopaedic Surgeons score and a visual analogue score for pain were used to assess outcome. A total of 274 patients were available; the mean follow-up was 9.7 years (8 to 18). The extent of any calcification or synostosis at the level of the distal interosseous membrane or syndesmosis on the contemporary radiographs was defined as: no or minor calcifications (group 1), severe calcification (group 2), or complete synostosis (group 3). A total of 222 (81%) patients were in group 1, 37 (14%) in group 2 and 15 (5%) in group 3. There was no significant difference in incidence between AO type 44-B and type 44-C fractures (p = 0.89). Severe calcification or synostosis occurred in 21 patients (19%) in whom a syndesmotic screw was used and in 31 (19%) in whom a syndesmotic screw was not used.(p = 0.70). No significant differences were found between the groups except for a greater reduction in mean dorsiflexion in group 2 (p = 0.004). This is the largest study on distal tibiofibular synostosis, and we found that a synostosis is a frequent complication of surgery for a fracture of the ankle. Although it theoretically impairs the range of movement of the ankle, it did not affect the outcome. Our findings suggest that synostosis of the distal tibiofibular syndesmosis in general does not warrant treatment. ©2015 The British Editorial Society of Bone & Joint Surgery.

Diagnosis and surgical approach of popliteal artery entrapment syndrome: a retrospective study

Directory of Open Access Journals (Sweden)

Stavros Gourgiotis

2008-02-01

Full Text Available Stavros Gourgiotis1, John Aggelakas1, Nikolaos Salemis1, Charalabos Elias2, Charalabos Georgiou11Second Surgical Department, 401 General Army Hospital of Athens, Greece; 2Second Surgical Department, 417 NIMTS Veterans General Hospital of Athens, GreeceBackground: Popliteal artery entrapment syndrome (PAES is a rare but potentially limb threatening peripheral vascular disease occurring predominantly in young adults. This study is a retrospective review of 49 limbs in 38 patients with PAES treated surgically over an 8-year period.Patients and methods: From 1995 to 2002, 38 patients with a mean age of 21 years (range, 18–29 years underwent surgery for PAES at a single institution. The patients’ demographic data and clinical features are recorded. The preoperative diagnosis of PAES was made based on various combinations of investigations including positional stress test, duplex ultrasonography, computed tomography, computed tomographic angiography, and angiography. Results: Nine, 33, and 7 patients had Delaney’s type I, II, and III PAES respectively. The surgical procedures consisted of simple release of the popliteal artery in 33 limbs (67.3%, autogenous saphenous vein (ASV patch angioplasty with or without thromboendarterectomy (TEA in 5 limbs (10.2% and ASV graft interposition or bypass in 11 limbs (22.5%. At a median follow up of 34 months (range, 8–42 months, there were no postoperative complications and all the patients were cured of their symptoms.Conclusions: PAES is an unusual but important cause of peripheral vascular insufficiency especially in young patients. Early diagnosis through a combined approach is necessary for exact diagnosis. Popliteal artery release alone or with vein bypass is the treatment of choice when intervention is indicated for good operative outcome and to prevent limb loss.Keywords: popliteal artery, entrapment syndrome, diagnosis, surgery, treatment

Surgical management of spasmodic torticollis

Directory of Open Access Journals (Sweden)

Wael Fouad

2011-12-01

Full Text Available Introduction: Spasmodic torticollis (ST is a neuromuscular disorder characterized by uncontrolled clonic and intermittently tonic spasm of the neck muscles. Objective: This retrospective study was done to study clinical picture and to evaluate the surgical results of different surgical procedures in 11 patients who had spasmodic torticollis. Methods: The male to female ratio was 1–2 (4 males and 7 females and their ages ranged from 18 to 65 years. The X-ray of the cervical spine was performed before the operation to exclude cervical disorders that can cause symptoms similar to spasmodic torticollis. MRI of the head and neck was performed in all patients, without finding significant brain lesions. Electromyography of the cervical muscles was performed preoperatively and postoperatively. All cases underwent surgery in the form of variable combinations of ventral rhizotomy of C1, C2+ selective peripheral denervation of neck muscles involved according to the type of torticollis. Mean postoperative follow up period was 24 months. Results: There was no operative mortality. As regards the morbidity, one patient had deficiency of shoulder elevation that was transient and improved after 3 months; one patient had wound infection that responded well to antibiotics after culture and sensitivity. Postoperative dysphagia was found in two cases that improved in one of them after two months. At the last follow up examination period, excellent results were obtained in 55% of patients, good results in 18% of patients, fair results in 18% of patients, and poor results in 9% of cases. Conclusion: There is no standard surgical procedure for treatment of ST; this is adapted to each patient according to type of torticollis. Better results were obtained in simple torticollis (excellent results in 100%, than in complex type (excellent and good results in 33.3%. Keywords: Focal dystonia, Spasmodic torticollis, Anterior rhizotomy, Selective denervation

Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention

Directory of Open Access Journals (Sweden)

Holm Emil Kongsted

2017-01-01

Full Text Available Bertolotti’s syndrome (BS refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV, and low back pain (LBP. Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I–V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II. The remainders were case series (level IV. Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient’s symptoms, especially patients diagnosed with “far out syndrome” treated with laminectomy. Clinical outcomes were more heterogenetic for patient’s treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient’s clinical outcome over time, whereas steroid injection only improves the patient’s symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS.

Symptomatic lumbosacral transitional vertebra: a review of the current literature and clinical outcomes following steroid injection or surgical intervention.

Science.gov (United States)

Holm, Emil Kongsted; Bünger, Cody; Foldager, Casper Bindzus

2017-01-01

Bertolotti's syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I-V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II). The remainders were case series (level IV). Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient's symptoms, especially patients diagnosed with "far out syndrome" treated with laminectomy. Clinical outcomes were more heterogenetic for patient's treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections) and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient's clinical outcome over time, whereas steroid injection only improves the patient's symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS. © The Authors, published by EDP Sciences, 2017.

Non-surgical radiofrequency facelift.

Science.gov (United States)

Narins, David J; Narins, Rhoda S

2003-10-01

There has been considerable interest in using non-ablative methods to rejuvenate the skin. The ThermaCool TC (Thermage Inc.) is a radiofrequency (RF) device that has been introduced to induce tightening of the address the problem of skin via a uniform volumetric heating into the deep dermis tightening, resulting in a 'non-surgical facelift'. Radiofrequency produces a uniform volumetric heating into the deep dermis. Twenty treatment areas in 17 patients were treated to evaluate the efficacy and safety of RF treatment to the brow and jowls. The technique was found to produce gradual tightening in most patients, and there were no adverse effects.

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

DEFF Research Database (Denmark)

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

2007-01-01

Surgical innovations are often introduced for their expected long-term benefits, but the decision to abandon the existing treatment must be based on the available short-term data and rational judgment. We present a framework for monitoring the introduction of a surgical intervention with long-ter...... effects and is adaptable to a wide variety of settings. The methods are illustrated on survival data from a cohort of 325 consecutive neonates treated for simple transposition of the great arteries with either the Senning or the Switch operation during the period 1978-1998....

Surgical repair of an aberrant splenic artery aneurysm: report of a case.

Science.gov (United States)

Illuminati, Giulio; LaMuraglia, Glenn; Nigri, Giuseppe; Vietri, Francesco

2007-03-01

Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.

A new technique in the surgical treatment of Hangman′s fractures: Neurospinal Academy (NSA technique

Directory of Open Access Journals (Sweden)

Sedat Dalbayrak

2013-01-01

Full Text Available Context: Treatment of Hangman′s fractures is still controversial. Hangman′s fractures Type II and IIA are usually treated with surgical procedures. Aim: This study aims at describing the Neurospinal Academy (NSA technique as an attempt to achieve an approximation of the fracture line to the axis body, which may be used for Type II and IIA patients with severe displacement and angulation. Settings and Design: NSA technique both pars or pedicle screws are placed bicortically to ensure that anterior surface of C2 vertebral body will be crossed 1-2 mm. A rod is prepared in suitable length and curve to connect the two screws. For placing the rod, sufficient amount of bone is resected from the C2 spinous process. C2 vertebral body is pulled back by means of the screws that crossed the anterior surface of C2 vertebral body. Materials and Methods: Hangman II and IIA patient are treated with NSA technique. Result: Angulated and tilted C2 vertebral body was pulled back and approximated to posterior elements. Conclusions: In Hangman′s fractures Type II and IIA with severe vertebral body and pedicle displacement, NSA technique is an effective and reliable treatment alternative for the approximation of posterior elements to the C2 vertebral body, which is tilted, angulated, and dislocated.

Surgical pitfalls in patients with Ehlers–Danlos type IV: A case of spontaneous sigmoid perforation in a 17-year-old male

Directory of Open Access Journals (Sweden)

Kai Lyn Ng

2011-07-01

Full Text Available Ehlers–Danlos syndrome (EDS is a group of well described connective tissue disorders in which collagen production is impaired. The surgical management of affected individuals remains challenging, with no general consensus. We report a case of spontaneous sigmoid perforation in a 17-year-old Eurasian male, in whom we subsequently established the diagnosis of EDS type IV (EDS-IV. We review the literature to discuss the clinical features and diagnosis, and the recommended therapeutic management.

[Treatment of Hallux Valgus: Current Diagnostic Testing and Surgical Treatment Performed by German Foot and Ankle Surgeons].

Science.gov (United States)

Arbab, Dariusch; Schneider, Lisa-Maria; Schnurr, Christoph; Bouillon, Bertil; Eysel, Peer; König, Dietmar Pierre

2018-04-01

Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nationwide survey is a description of the current status of diagnostics and therapy of Hallux valgus in Germany. A nationwide online questionnaire survey was sent to two German foot and ankle societies. The participants were asked to answer a questionnaire of 53 questions with four subgroups (general, diagnostics, operation, preoperative management). Surgical treatment for three clinical cases demonstrating a mild, moderate and severe Hallux valgus deformity was inquired. 427 foot and ankle surgeons answered the questionnaire. 388 participants were certified foot and ankle surgeons from one or both foot and ankle societies. Medical history (78%), preoperative radiographs (100%) and preoperative radiographic management (78%) are of high or very high importance for surgical decision pathway. Outcome scores are used by less than 20% regularly. Open surgery is still the gold standard, whereas minimally invasive surgery is performed by only 7%. Our survey showed that diagnostic standards are met regularly. There is a wide variation in the type of procedures used to treat Hallux valgus deformity. TMT I arthrodesis is preferred in severe Hallux valgus, but also used to treat moderate and mild deformities. Minimally invasive surgery is still used by a minority of surgeons. It remains to be seen, to what extent minimally invasive surgery will be performed in the future. Georg Thieme Verlag KG Stuttgart · New York.

Ophthalmology resident surgical competency: a national survey.