Trends of Concurrent Ankle Arthroscopy at the Time of Operative Treatment of Ankle Fracture: A National Database Review.

Science.gov (United States)

Ackermann, Jakob; Fraser, Ethan J; Murawski, Christopher D; Desai, Payal; Vig, Khushdeep; Kennedy, John G

2016-04-01

The purpose of this study was to report trends associated with concurrent ankle arthroscopy at the time of operative treatment of ankle fracture. The current procedural terminology (CPT) billing codes were used to search the PearlDiver Patient Record Database and identify all patients who were treated for acute ankle fracture in the United States. The Medicare Standard Analytic Files were searchable between 2005 and 2011 and the United Healthcare Orthopedic Dataset from 2007 to 2011. Annual trends were expressed only between 2007 and 2011, as it was the common time period among both databases. Demographic factors were identified for all procedures as well as the cost aspect using the Medicare data set. In total, 32 307 patients underwent open reduction internal fixation (ORIF) of an ankle fracture, of whom 313 (1.0%) had an ankle arthroscopy performed simultaneously. Of those 313 cases, 70 (22.4%) patients received microfracture treatment. Between 2005 and 2011, 85 203 patients were treated for an ankle fracture whether via ORIF or closed treatment. Of these, a total of 566 patients underwent arthroscopic treatment within 7 years. The prevalence of arthroscopy after ankle fracture decreased significantly by 45% from 2007 to 2011 (Pankle fracture treatment, it appears that only a small proportion of surgeons in the United States perform these procedures concurrently. Therapeutic, Level IV: Retrospective. © 2015 The Author(s).

Operative treatment and avascular necrosis of the hip development disorder.

Science.gov (United States)

Gavrankapetanović, Ismet; Hadžimehmedagić, Amel; Papović, Adnan; Baždar, Elvir

2014-07-01

The purpose of this research was (1) to evaluate the consequences of an operative treatment of hip developmental disorder in children, (2) to evaluate the significance of hip vascular supply in children through indirect radiological signs, such as morphological changes on femoral head, and to classify them with standard classification methods, and (3) to analyse the research results and make a recommendation for the following treatment dilemma: when is the optimal time for an operative treatment of a hip development disorder? The research is a retrospective and observational analysis based on the classification of indirect radiological signs of local vascular disorder by the Bucholz-Ogden's scale. Materials used for this research are medical records of treated patients at the Clinic for Orthopaedics and Traumatology of the Sarajevo University Clinical Centre. Using a random selection, two groups of 30 patients with hip development disorder were formed. The first group was comprised of patients aged six to 18 months and the second group of patients aged 18-60 months. The medical records used for this research included all necessary anamnestic details and postoperative state treatments with clinical findings and regular radiological check-up findings that include the presence or absence of the ossification nucleus as well as its position. All patients underwent surgery with the same operative technique. Data analysis points include the state at the beginning of the treatment, the postoperative state, the state at discharge as well as control findings that followed the development of the proximal femoral part up to 72 months on average. The analysis covered data such as age, sex, family anamnestic data, clinical findings and radiological findings regarding the femoral head morphology (appearance, size, shape, position and indirect signs showing lack of vascular supply). In addition, data analysis included the types of any previous conservative or operative treatments

Acute appendicitis in children: not only surgical treatment.

Science.gov (United States)

Caruso, Anna Maria; Pane, Alessandro; Garau, Roberto; Atzori, Pietro; Podda, Marcello; Casuccio, Alessandra; Mascia, Luigi

2017-03-01

An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the outcome of complicated forms underwent early surgery. Children with acute appendicitis were investigated by clinical, laboratory variables and abdominal ultrasound and divided in two groups: complicated and uncomplicated. Complicated appendicitis underwent early surgery; uncomplicated appendicitis started conservative treatment with antibiotic. If in the next 24-48h it was worsening, the conservative approach failed and patients underwent late surgery. A total of 362 pediatric patients were included. One hundred sixty-five underwent early appendectomy; 197 patients were at first treated conservatively: of these, 82 were operated within 24-48h for failure. The total percentage of operated patients was 68.2%. An elevated association was found between surgery and ultrasound. Conservative treatment for uncomplicated appendicitis had high percentage of success (58%). Complications in operated patients were infrequent. Our protocol was effective in order to decide which patients treat early surgically and which conservatively; specific red flags (age and onset) can identified patients at most risk of complications or conservative failure. treatment study. II. Copyright © 2016 Elsevier Inc. All rights reserved.

[A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

Science.gov (United States)

Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

2010-07-01

We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

[A Distal Bile Duct Carcinoma Patient Who Underwent Surgical Resection for Liver Metastasis].

Science.gov (United States)

Komiyama, Sosuke; Izumiya, Yasuhito; Kimura, Yu; Nakashima, Shingo; Kin, Syuichi; Kawakami, Sadao

2018-03-01

A 70-year-old man with distal bile duct carcinoma underwent a subtotal stomach-preserving pancreaticoduodenectomy without adjuvant chemotherapy. One and a half years after the surgery, elevated levels of serum SPan-1(38.1 U/mL)were observed and CT scans demonstrated a solitary metastasis, 25mm in size, in segment 8 of the liver. The patient received 2 courses of gemcitabine-cisplatin combination chemotherapy. No new lesions were detected after chemotherapy and the patient underwent a partial liver resection of segment 8. The pathological examination revealed a metachronous distant metastasis originating from the bile duct carcinoma. Subsequently, the patient received S-1 adjuvant chemotherapy for 6 months. Following completion of all therapies, the patient survived without tumor recurrence for 3 years and 10 months after the initial operation. Thus, surgical interventions might be effective in improving prognosis among selected patients with postoperative liver metastasis of bile duct carcinoma.

Treatment system operation, management, and finance

Energy Technology Data Exchange (ETDEWEB)

Truax, D.D. (Mississippi State Univ., Mississippi State (United States))

1990-06-01

This article deals with literature on operation, management, and financing of wastewater treatment plants. Some topics discussed are system hydraulics and flow monitoring, odor, reliability, equipment age, management philosophy, performance, reducing operating cost, planning and response to emergencies, preventative maintenance, inspection systems, mechanical vibrations, safety, privatization, municipal leasing, user and impact fees.

Risks and benefits of antireflux operations in neurologically impaired children

NARCIS (Netherlands)

Borgstein, E. S.; Heij, H. A.; Beugelaar, J. D.; Ekkelkamp, S.; Vos, A.

1994-01-01

Gastro-oesophageal reflux (GER) in neurologically impaired children often causes feeding problems and complications of oesophagitis and is frequently resistant to medical treatment. Fifty neurologically impaired children underwent anterior gastropexy as anti-reflux operation, combined with

Cardiovascular operations for Loeys-Dietz syndrome: Intermediate-term results.

Science.gov (United States)

Patel, Nishant D; Crawford, Todd; Magruder, J Trent; Alejo, Diane E; Hibino, Narutoshi; Black, James; Dietz, Harry C; Vricella, Luca A; Cameron, Duke E

2017-02-01

Early experience with Loeys-Dietz syndrome (LDS) suggested an aggressive aortopathy with high risk of aneurysm dissection and rupture at young ages and at smaller aortic diameters than in other connective tissue disorders. We reviewed our experience with LDS to re-examine our indications and outcomes of surgical management. We reviewed all patients with a diagnosis of LDS who underwent cardiovascular surgery at our institution. The primary endpoint was mortality, and secondary endpoints included postoperative complications and need for reintervention. Seventy-nine operated patients with LDS were identified. Mean age at first operation was 25 years, 39 (49%) were female, and 38 (48%) were children (age <18 years). Six (8%) patients presented with acute dissection. Five (6%) patients had a bicuspid aortic valve, and all presented with an ascending aortic aneurysm with a mean root diameter of 3.5cm. Twenty (25%) patients had a previous sternotomy. Sixty-five (82%) patients underwent aortic root replacement, of whom 52 underwent a valve-sparing operation and 4 had concomitant arch replacement. Mean aortic root diameter in this group was 4.2 cm. Nine (11%) patients underwent aortic arch replacement, 2 (3%) had isolated ascending aorta replacement, and 3 (4%) underwent open thoracoabdominal repair. There were 2 (3%) operative and 8 late deaths. Nineteen patients underwent subsequent operations for late aneurysm and/or dissection. Mean follow-up was 6 years (range 0-24 years). Kaplan-Meier survival was 88% at 10 years. Growing experience with LDS has confirmed early impressions of its aggressive nature and proclivity toward aortic catastrophe. Surgical outcomes are favorable, but reintervention rates are high. Meticulous follow-up with cardiovascular surveillance imaging remain important for management, particularly as clinical LDS subtypes are characterized and more tailored treatment is developed. Copyright © 2016 The American Association for Thoracic Surgery

Operation technology of air treatment system in nuclear facilities

CERN Document Server

Chun, Y B; Hwong, Y H; Lee, H K; Min, D K; Park, K J; Uom, S H; Yang, S Y

2001-01-01

Effective operation techniques were reviewed on the air treatment system to protect the personnel in nuclear facilities from the contamination of radio-active particles and to keep the environment clear. Nuclear air treatment system consisted of the ventilation and filtering system was characterized by some test. Measurement of air velocity of blowing/exhaust fan in the ventilation system, leak tests of HEPA filters in the filtering, and measurement of pressure difference between the areas defined by radiation level were conducted. The results acquired form the measurements were reflected directly for the operation of air treatment. In the abnormal state of virus parts of devices composted of the system, the repairing method, maintenance and performance test were also employed in operating effectively the air treatment system. These measuring results and techniques can be available to the operation of air treatment system of PIEF as well as the other nuclear facilities in KAERI.

Non-operative management of isolated liver trauma.

Science.gov (United States)

Li, Min; Yu, Wen-Kui; Wang, Xin-Bo; Ji, Wu; Li, Jie-Shou; Li, Ning

2014-10-01

Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma. Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2% (70/72). The success rates of NOM in the patients with grade I-III, IV and V liver trauma were 100%, 94.4% and 83.3%. The complication rates were 10.0% and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived. NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.

Management of antithrombotic therapy in patients with coronary artery disease or atrial fibrillation who underwent abdominal surgical operations.

Science.gov (United States)

Schizas, Dimitrios; Kariori, Maria; Boudoulas, Konstantinos Dean; Siasos, Gerasimos; Patelis, Nikolaos; Kalantzis, Charalampos; Carmen-Maria, Moldovan; Vavuranakis, Manolis

2018-04-02

Patients treated with antithrombotic therapy that require abdominal surgical procedures has progressively increased overtime. The management of antithrombotics during both the peri- and post- operative period is of crucial importance. The goal of this review is to present current data concerning the management of antiplatelets in patients with coronary artery disease and of anticoagulants in patients with atrial fibrillation who had to undergo abdominal surgical operations. For this purpose, incidence of major adverse cardiovascular events (MACE) and risk of antithrombotic use during surgical procedures, as well as the recommendations based on recent guidelines were reported. A thorough search of PubMed, Scopus and the Cochrane Databases was conducted to identify randomized controlled trials, observational studies, novel current reviews, and ESC and ACC/AHA guidelines on the subject. Antithrombotic use in daily clinical practice results to two different pathways: reduction of thromboembolic risk, but a simultaneous increase of bleeding risk. This may cause a therapeutic dilemma during the perioperative period. Nevertheless, careless cessation of antithrombotics can increase MACE and thromboembolic events, however, maintenance of antithrombotic therapy may increase bleeding complications. Studies and current guidelines can assist clinicians in making decisions for the treatment of patients that undergo abdominal surgical operations while on antithrombotic therapy. Aspirin should not be stopped perioperatively in the majority of surgical operations. Determining whether to discontinue the use of anticoagulants before surgery depends on the surgical procedure. In surgical operations with a low risk for bleeding, oral anticoagulants should not be discontinued. Bridging therapy should only be considered in patients with a high risk of thromboembolism. Finally, patients with an intermediate risk for thromboembolism, management should be individualized according to patient

Ankle Fractures: The Operative Outcome

Directory of Open Access Journals (Sweden)

Ahmad Hafiz Z

2011-03-01

Full Text Available Ankle fractures are commonly seen in orthopaedic practice. This retrospective study of patients with ankle fractures who underwent surgical treatment in our institution from January 2000 to December 2003 was undertaken to analyze the common causes and patterns of ankle fractures; and the functional outcome of operative treatment for these fractures. Eighty patients were identified and reviewed. There were 65 male (81.3% and 15 female patients (18.7% with age ranging from 13 to 71 years old (mean, 32.3y. Common causes of ankle fractures were trauma (especially motor vehicle accidents, sports injuries and the osteoporotic bones in the elderly. Weber C (64.0% was the most common pattern of fracture at presentation. The most common operative treatment for ankle fractures was open reduction and internal fixation (73 patients, 91.2%. Excellent and good outcomes were achieved in 93.8% of cases when measured using the Olerud and Molander scoring system for foot and ankle. In conclusion, operative treatment for ankle fractures restores sufficient stability and allowed mobility of the ankle joint.

Laparoscopic Surgery for the Treatment of Ectopic Pregnancy

Directory of Open Access Journals (Sweden)

Hulusi B ZEYNELOGLU

2005-09-01

Full Text Available OBJECTIVE: To evaluate the outcomes of laparoscopic surgery for the treatment of ectopic pregnancy Design: 43 women with ectopic pregnancy who underwent laparoscopic surgery in our department between 1996 and 2005 were included in this study.\tSetting: Department of Obstetrics and Gynecology, School of Medicine, Baskent University, Ankara Patients: 43 women with ectopic pregnancy who underwent laparoscopic surgery Interventions: Laparoscopic surgery was performed the treatment of ectopic pregnancy Main Outcome Measures: Patients characteristics such as age, parity, gestational age at the time of diagnosis, symptoms, preoperative and postoperative serum _-hCG and hemoglobin levels, sonographic findings, type of laparoscopic surgery, blood transfusion, additional treatments, endometrial sampling and postoperative fertility status were recorded. The size and the location of myomas were obtained from the surgeon’s findings in the operative note. Preoperative and postoperative hemoglobin values, change in hemoglobin values, hemorrhage, blood transfusion, postoperative fewer, duration of operation and length of postoperative hospital stay were the main outcomes. RESULTS: Forty-three women with ectopic pregnancy who underwent laparoscopic surgery were included in this study. Patients were submitted usually with pelvic pain and abnormal vaginal bleeding. Adnexal mass and hemoperitoneum were seen by sonographic evaluation. Ampuller pregnancy was the most common. Most of patients had conservative surgery and 38% of patients underwent salpingectomy. 12 patient had blood transfusion and two ones underwent re-laparoscopy. After treatment 5 intrauterine pregnancies were occurred. Endometrial samplings usually defined as decidual en Aria stella reactions. Serum _-hCG levels were in normal range at the end of the month after the laparoscopy. CONCLUSION: In conclusion according to these findings, laparoscopic surgery remains the definitive and universal

Bronchoplastic operations for lung cancer

International Nuclear Information System (INIS)

Cicenas, S.; Naujokaitis, P.; Jackevicius, A. and others

2002-01-01

Objective of our work was to evaluate efficacy of bronchoplastic operations for lung cancer and time to progression in combined treatment. From 1997 till 2001, 57pts were operated for early I-IIB stages of lung cancer. Operations were: tracheal resections in 3pts (5.2%), window right pneumonectomies in 5pts (8.7%), window left pneumonectomies in 2pts (3.5%), window right upper lobe in 22pts (38.5%), bifurcation resections 2pts (3.5%), sleeve right upper lobe resections 7pts (12.2%), sleeve left upper lobe resections in 11pts (19.2%). We had complications: in 7pts (12.2%) suture failure, 26pts (45.6%) obstructive pneumonia, 3pts (5.2%) kinking of anastomosis, 2pts (3.7%) bronchial bleeding, 6pts (10.5%) covered bronchial fistulas, 5pts (8.7%) died after operations. 32pts (56%) underwent radiation after surgery, 13pts (22.8%) radiation and chemotherapy. Three-year survival was in 82.4% (47pts), in 10pts (17.4%) disease progressed. Bronchoplastic operations are sufficient for early lung cancer treatment. Three-year was in survival 82.7% of pts. Seventeen percent of patients failed after combined treatment. (author)

Operation technology of the ventilation system of the radioactive waste treatment facility(II) - Design and operation note

Energy Technology Data Exchange (ETDEWEB)

Lee, K. M.; Lee, B. C.; Bae, S. M. [Korea Atomic Energy Research Institute, Taejon (Korea)

1999-12-01

As the radioactive waste treatment work, such as compaction and/or solidification of wastes, are done directly by the workers in the Radioactive Waste Treatment Facility, the reasonable design and operation of the ventilation system is essential. In this report, the design criteria and specification of the ventilation equipment, system operation method are described for the effective design and operation of ventilation system in the radioactive waste treatment facility. And the anti-vibration work which was done in the Radioactive Waste Treatment Facility in KAERI to reduce the effect of vibration due to the continuous operation of big rotational equipment, the intake fans and the exhaust fans, are described in the report. 11 refs., 10 figs., 12 tabs. (Author)

Early prediction of treatment response by serum CRP levels in patients with advanced esophageal cancer who underwent definitive chemoradiotherapy

International Nuclear Information System (INIS)

Yoneda, Masayuki; Fujiwara, Hitoshi; Okamura, Shinichi

2010-01-01

Serum C reactive protein (CRP) has been shown to be associated with the progression of esophageal cancer. The purpose of this study was to examine the relationship between treatment response and serum CRP levels in time course during definitive chemoradiotherapy (CRT) in terms of early prediction of CRT response by serum CRP. The subjects of this study were 36 patients with cT3/cT4 esophageal squamous cell carcinoma who underwent definitive CRT in our hospital. Serum CRP levels during definitive CRT (pretreatment, 1W, 2W and 3W after CRT initiation) were compared between CR and non-CR group. In addition, partition model was constructed to discriminate CR with non-CR and the prediction accuracy was evaluated. The patients were consisted of 28 males and 8 females. At pretreatment diagnosis, tumors were categorized as T3 (n=21) and T4 (n=15). Thirty four patients received FP-based chemotherapy and 2 patients received docetaxel-based chemotherapy. Treatment responses were categorized as CR (n=8), partial response (PR) (n=14), no change (NC) (n=2) and progressive disease (PD) (n=12). Serum CRP levels at the time of 2W after CRT initiation (CRT2W) in CR group were low compared to those in non-CR group (p=0.071). The partition model was constructed based on CRP levels at CRT2W. The prediction accuracies to discriminate CR from non-CR by CRP ≤0.1 were 50%, 82%, and 75% in sensitivity, specificity and accuracy, respectively. Serum CRP is a useful biomarker for an early prediction of CRT response. (author)

[Non-operative treatment for severe forms of infantile idiopathic scoliosis].

Science.gov (United States)

Trobisch, P D; Samdani, A; O'Neil, C; Betz, R; Cahill, P

2012-02-01

Infantile idiopathic scoliosis (IIS) is a rare orthopaedic condition. Braces and casts are popular options in the treatment of IIS but there is a paucity of studies commenting on the outcome of non-operative treatment. The purpose of this study was to analyse failure and success after non-operative treatment for severe forms of IIS. We retrospectively reviewed the data of all children who had been treated for IIS between 2003 and 2009 at a single institution. After calculating the failure and success rates, we additionally performed a risk factor analysis for patients who failed non-operative treatment. Chi (2) and T tests were used for statistical analysis with significance set at p failure (55 versus 42) while neither age, gender, nor RVAD seem to influence the outcome. In children who were considered as successfully treated, the Cobb angle decreased from 42 to 18 degrees. Non-operative treatment for IIS is successful in 3 out of 4 patients. © Georg Thieme Verlag KG Stuttgart · New York.

Operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults

DEFF Research Database (Denmark)

Rehn, Carl-Henrik; Kirkegaard, Martin; Viberg, Bjarke

2013-01-01

Intervention studies of clavicle fracture treatment are numerous, but only a few high quality studies prospectively compare operative and nonoperative treatment. The objective of this study was to review evidence from randomized controlled trials on operative versus nonoperative treatment of disp...

Influence of smoking status on treatment outcomes after post-operative radiation therapy for non-small-cell lung cancer

International Nuclear Information System (INIS)

Nguyen, Sonia K.A.; Masson-Cote, Laurence; Fortin, Andre; Dagnault, Anne

2010-01-01

Background and purpose: The role of post-operative radiotherapy in patients with resected non-small-cell lung cancer (NSCLC) is unclear. Modifiable factors, like smoking, may help guide therapy. We retrospectively evaluated the impact of smoking on control in patients undergoing post-operative radiation therapy (PORT) for NSCLC. Materials and methods: Between 1995 and 2007, 152 patients who underwent surgery for NSCLC were analyzed (median follow-up 26 months). Non-smokers were defined as patients who never smoked or who had stopped smoking at the time of initial consultation. Sixty seven percent were non-smokers; 5% never smoked, 40% of the non-smokers had ceased smoking for a year or less, while 55% had stopped for more than a year. Results: On univariate analysis, smokers had worse 5-year local control than non-smokers (70% versus 90%, p = 0.001) and locoregional control (52% versus 77%, p = 0.002). The 5 -year survival rate was 21% for smokers and 31% for non-smokers (p = 0.2). On multivariate analysis, smokers maintained a detrimental effect on locoregional control (HR 3.6, p = 0.0006). Conclusions: Smokers at initial consultation have poorer local and locoregional control after PORT than non-smokers. In patients being considered for PORT for NSCLC, quitting smoking before treatment confers additional treatment advantage.

Correlation between location of transposed ovary and function in cervical cancer patients who underwent radical hysterectomy.

Science.gov (United States)

Yoon, Aera; Lee, Yoo-Young; Park, Won; Huh, Seung Jae; Choi, Chel Hun; Kim, Tae-Joong; Lee, Jeong-Won; Kim, Byoung-Gie; Bae, Duk-Soo

2015-05-01

The study investigated the association between the location of transposed ovaries and posttreatment ovarian function in patients with early cervical cancer (IB1-IIA) who underwent radical hysterectomy and ovarian transposition with or without adjuvant therapies. Retrospective medical records were reviewed to enroll the patients with early cervical cancer who underwent ovarian transposition during radical hysterectomy at Samsung Medical Center between July 1995 and July 2012. Serum follicle-stimulating hormone (FSH) level was used as a surrogate marker for ovarian function. Twenty-one patients were enrolled. The median age and body mass index (BMI) were 31 years (range, 24-39 years) and 21.3 kg/m² (range, 17.7-31.2 kg/m²), respectively. The median serum FSH level after treatment was 7.9 mIU/mL (range, 2.4-143.4 mIU/mL). The median distance from the iliac crest to transposed ovaries on erect plain abdominal x-ray was 0.5 cm (range, -2.7 to 5.2 cm). In multivariate analysis, posttreatment serum FSH levels were significantly associated with the location of transposed ovaries (β = -8.1, P = 0.032), concurrent chemoradiation (CCRT) as an adjuvant therapy (β = 71.08, P = 0.006), and BMI before treatment (underweight: β = -59.93, P = 0.05; overweight: β = -40.62, P = 0.041). Location of transposed ovaries, adjuvant CCRT, and BMI before treatment may be associated with ovarian function after treatment. We suggest that ovaries should be transposed as highly as possible during radical hysterectomy to preserve ovarian function in young patients with early cervical cancer who might be a candidate for adjuvant CCRT and who have low BMI before treatment.

Dual antiplatelet treatment in patients candidates for abdominal surgery.

Science.gov (United States)

Illuminati, Giulio; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

2013-01-01

With the increasing diffusion of percutaneous interventions (PCI), surgeons are often faced with the problem of operating on patients under dual antiplatelet treatment. Replacing dual antiplatelet regiment with low molecular weight heparin may expose to the abrupt thrombosis of coronary stent and massive myocardial infarction. The purpose of this study was to test the hypothesis that abdominal operations can be safely performed under dual antiplatelet treatment. Eleven patients underwent 5 colectomies, 3 nefrectomies, 2 gastrectomies and 1 hysterectomy under aspirin and plavix without any significant perioperative hemorrhage. These preliminary results show that abdominal operations can be safely performed under dual antiplatelet regimen. Abdominal surgery, Dual antiplatelet treatment.

Water Treatment Plant Operation. Volume II. A Field Study Training Program.

Science.gov (United States)

California State Univ., Sacramento. School of Engineering.

The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

Water Treatment Plant Operation. Volume I. A Field Study Training Program.

Science.gov (United States)

California State Univ., Sacramento. School of Engineering.

The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

Low-level wastewater treatment facility process control operational test report

International Nuclear Information System (INIS)

Bergquist, G.G.

1996-01-01

This test report documents the results obtained while conducting operational testing of a new TK 102 level controller and total outflow integrator added to the NHCON software that controls the Low-Level Wastewater Treatment Facility (LLWTF). The test was performed with WHC-SD-CP-OTP 154, PFP Low-Level Wastewater Treatment Facility Process Control Operational Test. A complete test copy is included in appendix A. The new TK 102 level controller provides a signal, hereafter referred to its cascade mode, to the treatment train flow controller which enables the water treatment process to run for long periods without continuous operator monitoring. The test successfully demonstrated the functionality of the new controller under standard and abnormal conditions expected from the LLWTF operation. In addition, a flow totalizer is now displayed on the LLWTF outlet MICON screen which tallies the process output in gallons. This feature substantially improves the ability to retrieve daily process volumes for maintaining accurate material balances

Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases

Directory of Open Access Journals (Sweden)

Bor-Seng-Shu Edson

2004-01-01

Full Text Available The role of decompressive craniectomy in the treatment of severe posttraumatic cerebral swelling remains quite a controversial issue. To the best of our knowledge, there is no study demonstrating the effect of decompressive craniectomy on cerebral blood flow (CBF velocity by means of transcranial Doppler sonography (TCD. We present two patients who developed traumatic brain swelling and uncontrollable intracranial hypertension with coma and signs of transtentorial herniation. One patient underwent bifrontal, while the second, unilateral, frontotemporoparietal decompressive craniectomy with dural expansion. In both patients, TCD examinations were performed immediately before and after surgery to study the cerebral hemodynamic changes related to the operations. Pre and postoperative TCD examinations demonstrated a significant increase in blood flow velocity in the intracranial arteries in both subjects. In conclusion, our cases suggest that decompressive craniectomy with dural expansion may result in elevation of CBF velocity in patients with massive brain swelling. The increase in CBF velocity appears to occur not only in the decompressed hemisphere, but also on the opposite side.

Clinical observation and discussion of different surgical treatment on small-diopter intermittent exotropia

Directory of Open Access Journals (Sweden)

En-Hui Yi

2017-03-01

Full Text Available AIM:To discuss the clinical features and operation methods on small-diopter intermittent exotropia. METHODS:Totally 206 in-patients with small-diopter intermittent exotropia(IXTin different operation groups, from September 2013 to September 2014,were observed for the eyesight, refraction, dominant eye, exotropia degree, synoptophore and near stereopsis before and after operation. Three types were divided in 206 cases. One hundred and thirty-two cases of basic IXT were the first type, in which 52 cases underwent nondominant eye unilateral recess-resection(nondominant eye unilateral recess-resection, ndR& R, 40 cases underwent dominant eye unilateral recess-resection(dominant eye unilateral recess-resection, dR& R, 40 cases underwent bilateral lateral rectus recession(bilateral lateral rectus recession, BLR-rec. Sixty-one cases of convergence insufficiency IXT were the second type, in which 40 cases underwent ndR& R, 21 cases underwent bilateral medial rectus amputation. Thirteen cases of divergence excess IXT were the third type, in which 7 cases underwent ndR& R, 6 cases underwent BLR-rec. The rates of the orthophoria, undercorrection, overcorrection and the recovery of synoptophore and near stereopsis after surgery in 1, 6, 12, 24mo were compared in 3 types. RESULTS: The clinical features of 206 cases with small-diopter IXT were: in the most cases, between 5 and 12 years old; nondominant eye was left eye; the eyesight of nondominant eye was lower than another eye; refraction status were myopia, astigmatism and anisometropia; basic IXT was the most common type; exotropia degree was between 40△ and 60△; some cases owned binocular function and near stereopsis. Comparison of operation methods in 3 groups: orthophoria comparisons in basic IXT among ndR& R group, d R& R group and BLR-rec group were significant difference(PP>0.05after operation. The operation of divergence excess IXT was effective. Orthophoria comparison in ndR& R group between

Long-term functional outcome after type A3 spinal fractures : operative versus non-operative treatment

NARCIS (Netherlands)

Post, Richard B.; van der Sluis, Corry K.; Leferink, Vincent J. M.; ten Duis, Henk-Jan

The authors retrospectively studied, by questionnaires, the long-term (5 years) functional outcome after operative (posterior instrumentation : 38 cases) and non-operative treatment (25 cases) for type A3 spinal fractures (Comprehensive Classification) without neurological deficit. A possible bias

Laparoscopic myotomy in achalasia cardia treatment: Experience after 36 operations

Directory of Open Access Journals (Sweden)

Bjelović Miloš

2013-01-01

Full Text Available Introduction. Laparoscopic Heller­Dor operation, a standard method in the treatment of achalasia, has been performed at the Center for Esophageal Surgery of the First Surgical Clinic since April 2006. Objective. The aim of this study was to present this surgical procedure and initial experiences after 36 consecutive laparoscopic Heller­Dor operations. Methods. This partly retrospective, partly prospective study presented our results after laparoscopic Heller­Dor operation (presentation of the treatment method. We performed a standard anterior esophagocardioymiotomy, without releasing the posterior aspect of the cardia, and anterior partial fundoplication. The type and severity of symptoms and their duration were evaluated based on questionnaires fulfilled by patients. The diagnosis was made based on radiological, endoscopic and manometric findings. Laparoscopic surgery as the method of treatment was evaluated based on the duration of surgery, intra­ and postoperative complications, time interval until the initiation of oral feeding, length of hospital stay, need for additional therapeutic measures after the operation and effect of surgery on the severity of symptoms. Results. Preopereratively, dysphagia was the predominant symptom in all patients, while regurgitation was much lower (44%. The average duration of operation was 127 minutes. Postoperative hospitalization lasted on the average 5.7 days. From 36 treated patients, 34 (94.4% considered that the effect of treatment was good or excellent. Postoperative dysphagia was present in two patients (5.6% and was successfully solved by balloon dilatation. Conclusion. Laparoscopic Heller­Dor operation is an effective and safe surgical procedure in resolving symptoms of achalasia and today presents the method of the first choice in the treatment of this disease.

The Demographics of Patients with Skin Cancer who Underwent Surgery in Diyarbakır and Performed Surgical Techniques

Directory of Open Access Journals (Sweden)

Burhan Özalp

2018-06-01

Full Text Available Objective: The major factor for developing malignant skin cancers is sunlight exposure. This study aimed to evaluate the demographics of patients with skin cancers who underwent surgery in Diyarbakır where the population is exposed to more sunlight than most other Turkish cities. Methods: The medical records of patients who underwent surgery for malignant skin cancer excision between 2011 and 2016 were searched using University Hospital’s patient database program. Data about patients’ demographics, cancer features, and the surgical techniques performed were collected. Results: Over a 5-year period, 190 patients underwent surgical excision. The male to female ratio was 1.56, and the mean age was 65.8 ± 15.7 (range, 20-94 years. The most common skin cancer was basal cell carcinoma (n=138, 72.7%, followed by squamous cell carcinoma (n=45, 23.7% and malignant melanoma (n=5, 2.6%. The most common surgery was primary excision, which was performed in 90 of 190 patients (47.36%; tissue reconstruction with a skin graft or flap surgery was required for the remaining 100 (52.63%, showing a significant difference (p<0.001. Conclusion: Basal cell carcinoma is the most common skin cancer, and less than half of the patients sought treatment immediately after they recognized the lesion. The public should be educated about skin cancers to increase early diagnosis and encourage timely treatment, thereby decreasing morbidity and mortality from skin cancer.

Evaluation of a protocol for the non-operative management of perforated peptic ulcer.

Science.gov (United States)

Marshall, C; Ramaswamy, P; Bergin, F G; Rosenberg, I L; Leaper, D J

1999-01-01

The non-operative management of perforated peptic ulcer has previously been shown to be both safe and effective although it remains controversial. A protocol for non-operative management was set up in this hospital in 1989. Adherence to the guidelines in the protocol has been audited over a 6-year period with a review of outcome. The case-notes of patients with a diagnosis of perforated peptic ulcer were reviewed. Twelve guidelines from the protocol were selected for evaluation of compliance to the protocol. Forty-nine patients underwent non-operative treatment initially. Eight patients failed to respond and underwent operation. Complications included abscess formation (seven patients), renal failure (one), gastric ileus (one), chest infection (two), and cardiac failure and stroke (one). Four deaths occurred in this group. Adherence to certain protocol guidelines was poor, notably those concerning prevention of thromboembolism, use of antibiotics, use of contrast examination to confirm the diagnosis and referral for follow-up endoscopy. Two gastric cancers were detected on subsequent endoscopy. This experience demonstrates that non-operative treatment can be used successfully in a general hospital. Adherence to protocol guidelines was found to be variable and the protocol has therefore been simplified. This study highlights the need for an accurate diagnosis and the importance of follow-up endoscopy.

A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP).

Science.gov (United States)

Kim, J Y; Bae, H S

2001-01-01

Despite recent advances in the treatment of advanced gastric carcinomas, no satisfactory outcomes are available because of micrometastases and free-floating carcinoma cells already existing in the peritoneal cavity. From 1990, we started using intraperitoneal hyperthermo-chemo-perfusion (IHCP) to prevent and to treat peritoneal metastasis after surgical resection of stomach cancer. We analyzed 103 serosa-invasive gastric carcinoma patients who underwent surgical resection between 1990 and 1995. Fifty-two patients who received surgery plus IHCP were compared with 51 patients who underwent surgery only, as controls. IHCP was administered for 2 h with an automatic IHCP device (closed-circuit system) just after surgical resection, with the patient under hypothermic general anesthesia (32.4 degrees C-34.0 degrees C). As perfusate, we used 1.5% peritoneal dialysis solution mixed with 10 micrograms/ml of mitomycin-C (MMC), warmed at an inflow temperature of over 44 degrees C. The overall 5-year survival rate (5-YSR) of the 103 patients was 29.97%. The 5-YSR was higher in the IHCP group than in the control group, at 32.7% and 27.1%, respectively, but this difference was not significant. However, in the 65 serosa-invasive gastric carcinoma patients (excluding those in stage IV) the 5-YSR was significantly higher (P = 0.0379) in the IHCP group than in the control group, at 58.6% and 44.4%, respectively. On multivariate analysis of all 103 patients, depth of tumor invasion and lymph node metastasis were significant factors for survival, whereas significant factors on univariate analysis, such as combined operation, distant metastasis, and peritoneal metastasis, were not significant. The most common recurrence patterns were loco-regional in the IHCP group and peritoneal in the control group. Complete cytoreductive surgery plus IHCP is effective to prevent and to treat peritoneal metastasis, and it should lead to long-term survival for serosa-invasive gastric carcinoma patients

Training manual for process operation and management of radioactive waste treatment facility

Energy Technology Data Exchange (ETDEWEB)

Shon, J. S.; Kim, K. J.; Ahn, S. J. [and others

2004-12-01

Radioactive Waste Treatment Facility (RWTF) has been operating for safe and effective treatment of radioactive wastes generated in the Korea Atomic Energy Research Institute (KAERI). In RWTF, there are evaporation, bituminization and solar evaporation processes for liquid waste, solid waste treatment process and laundry process. As other radioactive waste treatment facilities in foreign countries, the emergency situation such as fire and overflow of liquid waste can be taken place during the operation and result in the spread of contamination of radioactivity. So, easy and definite operating procedure is necessary for the safe operation of the facility. This manual can be available as easy and concise training materials for new employees and workers dispatched from service agency. Especially, in case of emergency urgently occurred during operation, everyone working in the facility can quickly stop the facility following this procedure.

Training manual for process operation and management of radioactive waste treatment facility

International Nuclear Information System (INIS)

Shon, J. S.; Kim, K. J.; Ahn, S. J.

2004-12-01

Radioactive Waste Treatment Facility (RWTF) has been operating for safe and effective treatment of radioactive wastes generated in the Korea Atomic Energy Research Institute (KAERI). In RWTF, there are evaporation, bituminization and solar evaporation processes for liquid waste, solid waste treatment process and laundry process. As other radioactive waste treatment facilities in foreign countries, the emergency situation such as fire and overflow of liquid waste can be taken place during the operation and result in the spread of contamination of radioactivity. So, easy and definite operating procedure is necessary for the safe operation of the facility. This manual can be available as easy and concise training materials for new employees and workers dispatched from service agency. Especially, in case of emergency urgently occurred during operation, everyone working in the facility can quickly stop the facility following this procedure

Radiation protection -Operation of chemical wastewater treatment facility

International Nuclear Information System (INIS)

Lee, M. J.; Lim, M. H.; Ahn, S. S.; Jeong, Y. S.

1996-12-01

The wastewater and sewage treatment facility have been operated. From the results of operation, it was confirmed that the quality of treated wastewater was 1/5 or 1/10 lower than that of regulation of law for environmental conservation. The quality of treated sewage has been maintained to 70% of regulation of law for environmental conservation. (author). 14 tabs., 8 figs

Water Treatment Plant Operation Volume 2. A Field Study Training Program. Revised.

Science.gov (United States)

California State Univ., Sacramento. School of Engineering.

The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

Is non-operative management still justified in the treatment of adhesive small bowel obstruction in children?

Science.gov (United States)

Nasir, Abdulrasheed A; Abdur-Rahman, Lukman O; Bamigbola, Kayode T; Oyinloye, Adewale O; Abdulraheem, Nurudeen T; Adeniran, James O

2013-01-01

Adhesive small bowel obstruction (ASBO) is a feared complication after abdominal operations in both children and adults. The optimal management of ASBO in the pediatric population is debated. The aim of the present study was to examine the safety and effectiveness of non-operative management in ASBO. A retrospective review of 33 patients who were admitted for ASBO over a 5-year period was carried out. Follow-up data were available for 29 patients. Demographic, clinical, and operative details and outcomes were collected for these patients. Data analysis was done with SPSS version 15.0. P ≤ 0.05 was regarded as significant. Out of 618 abdominal surgeries within the 5-year period, 34 admissions were recorded from 29 patients at the follow-up period of 1-28 months. There were 19 boys (65.5%). The median age of patients was 4.5 years. Typhoid intestinal perforation (n = 7), intussusception (n = 6), intestinal malrotation (n = 5), and appendicitis (n = 4) were the major indications for a prior abdominal surgery leading to ASBO. Twenty-five patients (73.5%) developed SBO due to adhesions within the first year of the primary procedure. Of the 34 patients admitted with ASBO, 18 (53%) underwent operative intervention and 16 (47%) were successfully managed non-operatively. There were no differences in sex (P = 0.24), initial procedure (P = 0.12), age, duration of symptoms, and time to re-admission between the patients who responded to non-operative management and those who underwent operative intervention. However, the length of hospital stay was significantly shorter in the non-operative group (P operative management is still a safe and preferred approach in selected patients with ASBO. However, 53% eventually required surgery.

Surrogate pregnancy in a patient who underwent radical hysterectomy and bilateral transposition of ovaries.

Science.gov (United States)

Azem, Foad; Yovel, Israel; Wagman, Israel; Kapostiansky, Rita; Lessing, Joseph B; Amit, Ami

2003-05-01

To evaluate IVF-surrogate pregnancy in a patient with ovarian transposition after radical hysterectomy for carcinoma of the cervix. Case report. A maternity hospital in Tel Aviv that is a major tertiary care and referral center. A 29-year-old woman who underwent Wertheim's hysterectomy for carcinoma of the uterine cervix and ovarian transposition before total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to surrogate mother. Outcome of IVF cycle. A twin pregnancy in the first cycle. This is the second reported case of controlled ovarian stimulation and oocyte retrieval performed on a transposed ovary.

Operative Versus Non-operative Treatment of Grade III Acromioclavicular Joint Dislocations and the Use of SurgiLig: a Retrospective Review.

Science.gov (United States)

Younis, Fizan; Ajwani, Sanil; Bibi, Asia; Riley, Eleanor; Hughes, Peter J

2017-12-30

Acromioclavicular joint dislocations are common shoulder girdle injuries. The treatment of grade III acromioclavicular joint dislocations is controversial. Furthermore, the literature on the use of the Sur-giligTM synthetic ligament for reconstruction of dislocations is sparse. This retrospective review aimed to establish whether operative treatment was superior to non-operative treatment in grade III acromioclavicular joint dislocations treated at our institute over a 5-year period. We also reviewed the effectiveness of reconstruction with SurgiligTM after acute and chronic dislocations across all grades of acromioclavicular joint dislocations. Twenty-five patients completed full follow-up with grade III dislocations. The mean follow-up in the operated group was 3.56 years and in the non-operated group this was 3.29 years. The mean Oxford Shoul-der Score (OSS) in the operated group was 39.8, whereas the mean OSS in the non-operated group was 45.9 (p=0.01). The mean pain score in the operated group was 2.2, and in the non-operated group this was 1.6. The mean satisfaction score in the operated group was 8.2 and that in the non-operated group was 7.8. There was no statistically significant difference in pain or satisfaction scores. In respect to the cohort treated with Surg-iligTM synthetic ligament, 22 patients across all grades of dislocations had this procedure performed. The mean post-operative Oxford Shoulder Score (OSS) was 40. 1. Non-operative treatment is not inferior to operative treatment for grade III acromioclavicular joint dislocations. The data from this study demonstrat-ed that the non-operated group had superior Ox-ford Shoul-der Scores that were statistically significant. 2. Additionally, the use of the SurgiligTM ligament appears to be effective in treating both chronic and acute acromioclavicular joint dislocations.

Treatment of operator actions in the HTGR risk assessment study

International Nuclear Information System (INIS)

Fleming, K.N.; Silady, F.A.; Hannaman, G.W.

1979-12-01

Methods are presented for the treatment of operator actions, developed in the AIPA risk assessment study. Some examples are given of how these methods were applied to the analysis of potential HTGR accidents. Realistic predictions of accident risks required a balanced treatment of both beneficial and detrimental actions and responses of human operators and maintenance crews. Th essential elements of the human factors methodology used in the AIPA study include event tree and fault tree analysis, time-dependent operator response and repair models, a method for quantifying common cause failure probabilities, and synthesis of relevant experience data for use in these models

Operation and Maintenance Manual for the Central Facilities Area Sewage Treatment Plant

Energy Technology Data Exchange (ETDEWEB)

Norm Stanley

2011-02-01

This Operation and Maintenance Manual lists operator and management responsibilities, permit standards, general operating procedures, maintenance requirements and monitoring methods for the Sewage Treatment Plant at the Central Facilities Area at the Idaho National Laboratory. The manual is required by the Municipal Wastewater Reuse Permit (LA-000141-03) the sewage treatment plant.

Operative treatment of radiation-induced fistulae

International Nuclear Information System (INIS)

Balslev, I.; Harling, H.

1987-01-01

Out of 136 patients with radiation-induced intestinal complications, 45 had fistulae. Twenty-eight patients had rectovaginal fistulae while the remainder had a total of 13 different types of fistulae. Thirty-seven patients were treated operatively and eight were treated conservatively. Thirty-three patients were submitted to operation for rectal fistulae. Of these, 28 were treated by defunctioning colostomy, three were treated by Hartmann's method and resection and primary anastomosis was carried out in two patients. In the course of the period of observation, 35% of the patients developed new radiation damage. The frequency in the basic material without fistulae was 21% (0.05< p<0.10). Following establishment of defunctioning colostomy on account of rectovaginal fistulae in 25 patients, eight patients developed new fistulae, Significantly more patients with fistulae died of recurrence as compared with patients with other lesions (p<0.01). Defunctioning colostomy in the treatment of rectal fistula is a reasonable form of treatment in elderly patients and in case of recurrence. Younger patients should be assessed in a special department in view of the possibility of a sphincter-preserving procedure following resection of the rectum and restorative anastomosis. (author)

Operative treatment of radiation-induced fistulae

Energy Technology Data Exchange (ETDEWEB)

Balslev, I.; Harling, H.

1987-01-01

Out of 136 patients with radiation-induced intestinal complications, 45 had fistulae. Twenty-eight patients had rectovaginal fistulae while the remainder had a total of 13 different types of fistulae. Thirty-seven patients were treated operatively and eight were treated conservatively. Thirty-three patients were submitted to operation for rectal fistulae. Of these, 28 were treated by defunctioning colostomy, three were treated by Hartmann's method and resection and primary anastomosis was carried out in two patients. In the course of the period of observation, 35% of the patients developed new radiation damage. The frequency in the basic material without fistulae was 21% (0.05treatment of rectal fistula is a reasonable form of treatment in elderly patients and in case of recurrence. Younger patients should be assessed in a special department in view of the possibility of a sphincter-preserving procedure following resection of the rectum and restorative anastomosis. 11 refs.

The factors influencing the decision making of operative treatment for proximal humeral fractures.

Science.gov (United States)

Hageman, Michiel G J S; Jayakumar, Prakash; King, John D; Guitton, Thierry G; Doornberg, Job N; Ring, David

2015-01-01

The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we addressed (1) factors associated with a recommendation for operative treatment, (2) factors associated with recommendation for arthroplasty, (3) concordance with the recommendations of the treating surgeons, and (4) factors affecting the inter-rater reliability of treatment recommendations. A total of 238 surgeons of the Science of Variation Group rated 40 radiographs of patients with proximal humerus fractures. Participants were randomized to receive information about the patient and mechanism of injury. The response variables included the choice of treatment (operative vs nonoperative) and the percentage of matches with the actual treatment. Participants who received patient information recommended operative treatment less than those who received no information. The patient information that had the greatest influence on treatment recommendations included age (55%) and fracture mechanism (32%). The only other factor associated with a recommendation for operative treatment was region of practice. There was no significant difference between participants who were and were not provided with information regarding agreement with the actual treatment (operative vs nonoperative) provided by the treating surgeon. Patient information-older age in particular-is associated with a higher likelihood of recommending nonoperative treatment than radiographs alone. Clinical information did not improve agreement of the Science of Variation Group with the actual treatment or the generally poor interobserver agreement on treatment recommendations. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Simultaneous double-side Crile operation in larynx cancer

International Nuclear Information System (INIS)

Szmeja, Z.; Kruk-Zagajewska, A.; Wozniak, S.

1994-01-01

Radical operation of lymphatic system of the neck (Crile'a operation) is a classic operation in the treatment of metastases of head and neck cancer. Bilateral Crile'a operation is indicated only in cases of bilateral metastases which in filtrate the jugular vein. According to new statistics the mortality rate around the operation time does not exceed 2,4%, that is why this operation is justified. Between 1978 and 1992 in the Clinic of Otolaryngology of the Medical Academy 8 patients underwent a simultaneous bilateral Crile'a operation due to large metastases to lymphatic system of the neck (N 3 ). The result of the simultaneous resection of both jugular veins was swelling and cyanosis of the face, the increase of blood pressure and others. They were of temporary character and did not cause any brain complications. (author)

Post operative high dose rate intravaginal irradiation in endometrial cancer: a safe and effective outpatient treatment

International Nuclear Information System (INIS)

Chen, Peter; Gibbons, Susan; Vicini, Frank; Weiner, Sheldon; Dmuchowski, Carl; Mele, Beth; Brabbins, Donald; Jennings, John; Gustafson, Gary; Martinez, Alvaro

1995-01-01

Purpose: We reviewed our experience with out patient high dose rate (HDR) intravaginal irradiation given post-operatively in endometrial cancer to assess local control, survival, and toxicity when used alone or in combination with external beam irradiation. Methods and Materials: From (12(88)) to (12(92)), 78 patients underwent TAH/BSO and received post-operative HDR intravaginal irradiation for endometrial cancer. Pathologic stage distribution was IB/IC: 56%, II: 22%, III: 22%. Adjuvant therapy was given in one of three schemes: HDR vaginal radiation alone (6 weekly fractions of 500 cGy prescribed 5 mm from the applicator surface treating the upper 4 cm of the vagina), pelvic irradiation with vaginal HDR (500 cGy x 4 weekly fractions) or whole abdomen/pelvic irradiation (WAPI) with vaginal HDR treatment (500 cGy x 3 weekly fractions). Prior to the first HDR vaginal treatment, a simulation with placement of vaginal apex metallic markers was performed to assure proper positioning of the intravaginal cylinders. Pelvic midline blocking was designed from the HDR intravaginal simulation films. The 55 patients who underwent combined external beam irradiation/brachytherapy received a median dose to the pelvis of 5040 cGy (range 25.2-51.6 Gy), and a median total vaginal dose of 5060 cGy (range 30.0-57.6 Gy). Results: Median follow-up is 37 months (range 6-73 months). Local control (vaginally) is 98.7%. The one vaginal failure was in the distal vagina, outside the treatment volume. All other failures (4) were distant with the vagina controlled [3 intra-abdominal and one bone/intra-abdominal]. For stages I and II, the disease free survival is 92.8%. For stage III the disease free survival is 86.5%. Median overall time to failure is 14.3 months (range 8.5-18.6 months). In terms of acute toxicity, no grade 3-4 acute toxicity of the vagina or bladder was seen. However, 9% acute GI toxicity was encountered. Chronic grade 1-2 toxicities included: vaginal 21.8% (foreshortening and

Seabrook, N.H. Wastewater Treatment Plant Chief Operator Recognized for Outstanding Service

Science.gov (United States)

Dustin Price, a resident of Berwick Maine and the Chief Operator of the Seabrook, N.H. Wastewater Treatment Plant, was honored by EPA with a 2016 Regional Wastewater Treatment Plant Operator of the Year Excellence Award.

early experience of operative treatment of pelvic and acetabular

African Journals Online (AJOL)

Objective: To review early post-operative results of pelvic and acetabular fracture intern al fixation. Design: ... 600 needing operative treatment annually. ... Infection was controlled with debridement and antibiotics. All the patients in the study returned to their work except one who has yet to do so 5 months after his injury.

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 Marfan syndrome; analysis of the patients required multiple surgical interventions].

Science.gov (United States)

Yamazaki, F; Shimamoto, M; Fujita, S; Nakai, M; Aoyama, A; Chen, F; Nakata, T; Yamada, T

2002-07-01

Without treatment, the life expectancy of patients with Marfan syndrome is reduced by the associated cardiovascular abnormalities. In this study, we reviewed our experience of the patients with Marfan syndrome who required multiple surgical interventions to identify the optimal treatment for these patients. Between January 1986 and December 2000, 44 patients with Marfan syndrome were operated on at Shizuoka City Hospital (SCH). Among them, 10 patients (22.7%) underwent multiple surgical interventions. There were 5 male and 5 female patients with a mean age of 40.6 +/- 16.1 years at the initial surgery. Only one patient was operated on at another hospital for his first, second, and third operations. His fourth operation was carried out at SCH. The remaining 9 patients underwent a total of 14 additional surgical procedures at SCH. Computed tomography (CT) scans were taken every 6 months postoperatively, and aortic diameter greater than 60 mm was considered as the indication for the additional surgery. There were no early death and one late death. The causes of additional surgery were enlargement of true aneurysm in 6, enlargement of residual dissection in 4, new dissection in 4, false aneurysm at the coronary anastomosis of Bentall procedure in 1. In 9 patients, both ascending and descending aorta were replaced. Among these 9 patients, only 3 patients underwent total arch replacement, and remaining 6 patients had their arch left in place with or without dissection. Our current strategy of the treatment of Marfan patients with acute type A dissection is total arch replacement with an elephant trunk at the initial emergent surgery.

Video-assisted thoracoscopy treatment of spontaneous pneumothorax

International Nuclear Information System (INIS)

Chen Haitao; Ren Jian; Che Jiaming; Hang Junbiao; Qiu Weicheng; Chen Zhongyuan

2002-01-01

Objective: To propose a treatment protocol by video thoracoscopy in spontaneous pneumothorax. Methods: One hundred and three patients underwent Video-assisted thoracoscopy (VATS) treatment of spontaneous pneumothorax and hemothorax. Indications included recurrent pneumothorax, persistent air leakage following conservative therapy, complicated hemothorax and CT scan identified bullae formation. Results: No operative deaths occurred, conversion rate was 2.91%, recurrence rate was 0.97%, complication rate was 3.81% and mean postoperative hospital stay was 5.6 days. Conclusions: VATS treatment of spontaneous pneumothorax is better than open chest surgery and also superior than conservative therapy

APACHE II SCORING SYSTEM AND ITS MODIFICATION FOR THE ASSESSMENT OF DISEASE SEVERITY IN CHILDREN WHO UNDERWENT POLYCHEMOTHERAPY

Directory of Open Access Journals (Sweden)

А. V. Sotnikov

2014-01-01

Full Text Available Short-term disease prognosis should be considered for the appropriate treatment policy based on the assessment of disease severity in patients with acute disease. The adequate assessment of disease severity and prognosis allows the indications for transferring patients to the resuscitation and intensive care department to be defined more precisely. Disease severity of patients who underwent polychemotherapy was assessed using APACHE II scoring system.

Surgical treatment of radiation enteritis

Energy Technology Data Exchange (ETDEWEB)

Cross, M.J.; Frazee, R.C. (Department of General Surgery, Scott and White Memorial Hospital, Temple TX (United States))

1992-02-01

Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting.

Surgical treatment of radiation enteritis

International Nuclear Information System (INIS)

Cross, M.J.; Frazee, R.C.

1992-01-01

Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting

Sports Hernia: Diagnosis, Management and Operative Treatment

Science.gov (United States)

Emblom, Benton A.

2017-01-01

Objectives: Athletic Pubalgia, also known as sports hernia or core muscle injury, causes significant dysfunction in athletes. Increased recognition of this specific injury distinct from inguinal hernia pathology has led to better management of this debilitating condition. We hypothesize that patients who undergo our technique of athletic pubalgia repair will recover and return to high-level athletics. Methods: Using our billing and clinical database, patients who underwent sports hernia repair by single surgeon at a single institution were contacted for Harris hip score, functional outcome, and return to play data. Results: Of 101 patients who met criteria, 43 were contacted. 93% of patients were able to return to play at an average of 4.38 mo. Normal activities were rated at 95.5% and athletic function was rated at 88.9%. Negative predictors were female sex, multiple operations, and prior inguinal hernia repair. Overall complication rate was 4.6%, and reoperation rate was 4.6%. Conclusion: Our method of adductor to rectus abdominis turn up flap is a safe procedure with high return to play success. Patients who had previously undergone inguinal hernia repair or other hip/pelvic related surgery had a worse outcome.

The value of radionuclide cerebrospinal fluid scintigraphy in the diagnosis and treatment of patients with hydrocephalus

International Nuclear Information System (INIS)

Feng Fang; Wang Hui; Fu Hongliang; Li Jianing; Zou Renjian; Gu Zhenhui; Wu Jingchuan

2009-01-01

Objective: Radionuclide cerebrospinal fluid scintigraphy (RCFS) has been applied to make diagnosis of hydrocephalus clinically for a long time. This study aimed to evaluate clinical value of RCFS in guiding the management of patients with hydrocephalus. Methods: All 13 patients with hydrocephalus (8 adults, 5 children) underwent RCFS and CT/MRI examination before treatment and then follow-up imaging after treatment.Results: Four of 7 patients (6 adults, 1 child) diagnosed as obstructive hydrocephalus by RCFS underwent endoscopic third ventriculostomy (ETV), and 5 of 6 patients (2 adults, 4 children) diagnosed as obstructive hydrocephalus underwent ventriculo peritoneal shunt (VPS). All patients had good recovery after operation and favorable prognosis in follow-up for at least one year. Conclusion: RCFS could differentiate obstructive hydrocephalus from communicating hydrocephalus and had important guiding significance in the treatment of hydrocephalus. (authors)

The preoperative plasma fibrinogen level is an independent prognostic factor for overall survival of breast cancer patients who underwent surgical treatment.

Science.gov (United States)

Wen, Jiahuai; Yang, Yanning; Ye, Feng; Huang, Xiaojia; Li, Shuaijie; Wang, Qiong; Xie, Xiaoming

2015-12-01

Previous studies have suggested that plasma fibrinogen contributes to tumor cell proliferation, progression and metastasis. The current study was performed to evaluate the prognostic relevance of preoperative plasma fibrinogen in breast cancer patients. Data of 2073 consecutive breast cancer patients, who underwent surgery between January 2002 and December 2008 at the Sun Yat-sen University Cancer Center, were retrospectively evaluated. Plasma fibrinogen levels were routinely measured before surgeries. Participants were grouped by the cutoff value estimated by the receiver operating characteristic (ROC) curve analysis. Overall survival (OS) was assessed using Kaplan-Meier analysis, and multivariate Cox proportional hazards regression model was performed to evaluate the independent prognostic value of plasma fibrinogen level. The optimal cutoff value of preoperative plasma fibrinogen was determined to be 2.83 g/L. The Kaplan-Meier analysis showed that patients with high fibrinogen levels had shorter OS than patients with low fibrinogen levels (p factor for OS in breast cancer patients (HR = 1.475, 95% confidence interval (CI): 1.177-1.848, p = 0.001). Subgroup analyses revealed that plasma fibrinogen level was an unfavorable prognostic parameter in stage II-III, Luminal subtypes and triple-negative breast cancer patients. Elevated preoperative plasma fibrinogen was independently associated with poor prognosis in breast cancer patients and may serve as a valuable parameter for risk assessment in breast cancer patients. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Left atrial isolation associated with mitral valve operations.

Science.gov (United States)

Graffigna, A; Pagani, F; Minzioni, G; Salerno, J; Viganò, M

1992-12-01

Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to valvular disease in 100 patients who underwent mitral valve operations. From May 1989 to September 1991, 62 patients underwent mitral valve operations (group I); 19, mitral valve operations and DeVega tricuspid annuloplasty (group II); 15, mitral and aortic operations (group III); and 4, mitral and aortic operations and DeVega tricuspid annuloplasty (group IV). Left atrial isolation was performed, prolonging the usual left paraseptal atriotomy toward the left fibrous trigone anteriorly and the posteromedial commissure posteriorly. The incision was conducted a few millimeters apart from the mitral valve annulus, and cryolesions were placed at the edges to ensure complete electrophysiological isolation of the left atrium. Operative mortality accounted for 3 patients (3%). In 79 patients (81.4%) sinus rhythm recovered and persisted until discharge from the hospital. No differences were found between the groups (group I, 80.7%; group II, 68.5%; group III, 86.7%; group IV, 75%; p = not significant). Three late deaths (3.1%) were registered. Long-term results show persistence of sinus rhythm in 71% of group I, 61.2% of group II, 85.8% of group III, and 100% of group IV. The unique risk factor for late recurrence of atrial fibrillation was found to be preoperative atrial fibrillation longer than 6 months. Due to the satisfactory success rate in recovering sinus rhythm, we suggest performing left atrial isolation in patients with chronic atrial fibrillation undergoing valvular operations.

Operation and effluent quality of a small rural wastewater treatment ...

African Journals Online (AJOL)

The objective of this study was to evaluate the impact of effluent and sludge discharges of an abattoir wastewater treatment plant (WWTP) on the operation of a municipal aerated pond WWTP. Experiments were carried out in Cervera WWTP, located in northeastern Spain, which comprises four ponds operating in series.

Study on evaluation index system of operational performance of municipal wastewater treatment plants in China

Science.gov (United States)

Xiaoxin, Zhang; Jin, Huang; Ling, Lin; Yan, Li

2018-05-01

According to the undeveloped evaluation method for the operational performance of the municipal wastewater treatment plants, this paper analyzes the policies related to sewage treatment industry based on the investigation of the municipal wastewater treatment plants. The applicable evaluation method for the operational performance was proposed from environmental protection performance, resources and energy consumption, technical and economic performance, production management and main equipment, providing a reliable basis for scientific evaluation of the operation as well as improving the operational performance of municipal wastewater treatment plant.

Flexible Ureterorenoscopy versus Mini-Percutaneous Nephrolithotomy for the Treatment of Renal Stones.

Science.gov (United States)

Ergin, Giray; Kirac, Mustafa; Kopru, Burak; Ebiloglu, Turgay; Biri, Hasan

2018-04-22

To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneousnephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones. This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative andpostoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient. Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones.

Operation of Wastewater Treatment Plants, Manual of Practice No. 11.

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Albertson, Orrie E.; And Others

This book is intended to be a reference or textbook on the operation of wastewater treatment plants. The book contains thirty-one chapters and three appendices and includes the description, requirements, and latest techniques of conventional unit process operation, as well as the symptoms and corrective measures regarding process problems. Process…

Operation of Wastewater Treatment Plants: A Home Study Training Program.

Science.gov (United States)

California State Univ., Sacramento. Dept. of Civil Engineering.

This manual was prepared by experienced wastewater treatment plant operators to provide a home study course to develop new qualified workers and expand the abilities of existing workers. The objective of this manual is to provide the knowledge and skills necessary for certification. Participants learn the basic operational aspects of treatment…

Efficacy of post-operative radiotherapy in the treatment of breast cancer

Energy Technology Data Exchange (ETDEWEB)

Api, P; Corcione, S; Magnoni, G

1985-01-01

A clinical evaluation regarding the efficacy of post-operative radiotherapy in 294 patients with breast cancer is presented. In the author's opinion post-operative radiotherapy is fundamental in the treatment of this tumor. 21 refs.

Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

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Alain Moré Duarte

2016-01-01

Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

Guidelines for the design and operation of makeup water treatment systems

International Nuclear Information System (INIS)

Lee, Y.H.; Planek, M.A.; Sopocy, D.M.; Tomaga, C.M.; Abrams, I.M.; Anderson, C.C.; Balazs, M.K.; Houskava, J.; Williams, R.

1989-06-01

These guidelines present the industry with a standardized program to ensure the optimum design and operation of their individual makeup water treatment systems. These guidelines present, in a non-technical and non-proprietary format, the makeup water treatment system design and operating topics that are discussed in detail in Volumes 1 and 2 of NP-6377-SL. The individual guidelines contained in Volumes 1 and 2 are presented as separate imperative statements, followed by a technical justification discussion, which provides further explanations. In addition and when applicable, the guidelines relate pertinent operational in regard to monitoring parameters for operation, alternative actions, troubleshooting, management responsibilities and shutdown practices. Design considerations are also addressed, when applicable, in regard to equipment cost and advantages and disadvantages for the design recommendations. Appendices provide background information for performance criteria, component description, economic evaluation procedures and definitions. 4 refs

Intra-operative radiation treatment of cancers

International Nuclear Information System (INIS)

Dubois, J.B.; Joyeux, H.; Solassol, C.; Pujol, H.

1986-01-01

Intra-operative radiation treatment (I.O.R.T.) is concerning the treatment either of an unresectable tumor or of tumor bed after complete excision of a primary tumor and its first draining lymph nodes. We describe X-ray and electrons techniques and we discuss the delivered doses according to experimental and clinical data. According to the residual disease (macroscopic or microscopic), to the healthy tissues in the target volume, and the histological type, single doses from 20 Gy to 40 Gy can be delivered. Our preliminary results are reported: 25 patients with resectable tumors of the cardia, the stomach and the pancreas, 5 patients with pelvic recurrences of colon and rectum carcinomas. Therapeutic results of the I.O.R.T. providing from the literature are discussed. The I.O.R.T. indications are defined as palliative (unresectable tumors) and curative (irradiation of tumor bed after complete excision of the tumor) [fr

OPERATION OF THE HOUSEHOLD SEWAGE TREATMENT PLANTS IN POLAND

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Marcelina Pryszcz

2015-01-01

Full Text Available In many rural communities the building of sewage collection and treatment system is still current and important problem of water and wastewater management. Besides the collection of sewage in the septic tank, the solution for wastewater treatment from individual buildings without access to sewerage system is the construction of household sewage treatment plants. Construction of household sewage treatment plant poses a number of challenges for municipalities and potential investors. The existing plants should be analyzed, so that in the future the selected systems would be characterized by high performance, simple operation and reliable exploitation. In the paper, the assessment of selection criteria of adopted technical solution and the functioning of household sewage treatment plants is carried out.

[Non operative treatment for perforated peptic ulcer: results of a prospective study].

Science.gov (United States)

Songne, B; Jean, F; Foulatier, O; Khalil, H; Scotté, M

2004-12-01

The conservative management of perforated peptic ulcer has not gained widespread acceptance despite introduction of proton-pomp inhibitors because surgical procedures can achieve immediate closure by eventually using a laparoscopic approach. The aim of this prospective study was to evaluate the results of Taylor's method and to identify predictive factors of failure of medical treatment in patients presenting with perforated peptic ulcer. Between 1990 and 2000, 82 consecutive patients, with diagnosis of perforated peptic ulcer were prospectively included in this study. They were initially treated with non-operative procedure (nasogastric suction and intravenous administration of H2-blockers or proton-pomp inhibitors). No clinical improvement after 24 hours required a surgical treatment. Predictive factors of failure of non-operative treatment were tested in univariate or multivariate analysis. Clinical improvement was obtained with non-operative treatment in 54% of the patients (44/82). The overall mortality rate was 1%. In univariate analysis, significant predictive factors of failure of non-operative treatment were: size of pneumoperitoneum, heart beat >94 bpm, abdominal meteorism, pain at digital rectal exam, and age >59 years. In multivariate analysis, the significant factors were the size of pneumoperitoneum, heart beat, and abdominal meteorism. The association of these criteria: size of pneumoperitoneum >size of the first lumbar vertebra, heart beat >94 bpm, pain at digital rectal exam and age > 59 years , led to surgical treatment in all cases. These results suggest that more than 50% of patients with perforated peptic ulcer respond to conservative treatment without surgery and that the association of few criteria (size of pneumoperitoneum, heart beat, pain at digital rectal exam and age) require emergency surgery.

Operative treatment of lateral humeral condyle fractures in children.

Science.gov (United States)

Wirmer, Johannes; Kruppa, Christian; Fitze, Guido

2012-08-01

The operative treatment of lateral humeral condyle fractures in children remains controversial. The result of incorrectly treated fractures may lead to complications such as pseudoarthrosis and severe deformity, with considerable functional and cosmetic restrictions. The aim of this study was to determine whether operative treatment of lateral humeral condyle fractures in children using Screw-wires (Orthofix GmbH, Ottobrunn, Germany) has any advantage over treatment with Kirschner wires ("K-wires") (aap-Implantate AG, Berlin, Germany). These results were then compared with operative treatment using lag-screw osteosynthesis. We treated surgically 76 cases of fracture of the lateral humeral condyle in children at the Department of Pediatric Surgery in Dresden between 1989 to 2002 and 2004 to 2008, from which 42 were available for follow-up examination. Within this group, there were seven children that were followed-up twice (in 1996 to 2002). Of these, 21 patients were treated with Screw-wires, and another 21 had K-wires inserted. The results were evaluated according to the Dhillon criteria. Only seven patients (17%) had a fair result in the overall grading according to the Dhillon criteria, four after K-wire and three after Screw-wire osteosyntheses. The remaining patients scored good to excellent results. There were no pseudoarthroses. Six patients (14%) had a varisation in the carrying angle between 10 and 16 degrees (three each procedure), and 15 patients (36%) had no difference in the carrying angle at all. Of these 15 patients, 10 were treated with Screw-wire osteosynthesis. Only one patient (2.4%) had a deficit of more than 10 degrees in elbow joint flexion, while only two (4.8%, one each procedure) had a deficit of more than 10 degrees in elbow joint extension, compared with the uninjured arm. Our results demonstrate that the employment of Screw-wire osteosynthesis is superior to the use of K-wires concerning the carrying angle while scoring alike on the

Three or more preoperative injections is the most significant risk factor for revision surgery after operative treatment of lateral epicondylitis: an analysis of 3863 patients.

Science.gov (United States)

Degen, Ryan M; Cancienne, Jourdan M; Camp, Christopher L; Altchek, David W; Dines, Joshua S; Werner, Brian C

2017-04-01

This study was conducted to identify the rate of failure of operative treatment of lateral epicondylitis, defined as progression to ipsilateral revision surgery, and associated patient-specific risk factors for failure. A national database was used to identify patients undergoing surgical treatment of lateral epicondylitis from 2005 to 2012. Patients undergoing concomitant procedures were excluded. Patients who then required subsequent ipsilateral extensor carpi radialis brevis débridement or release within 2 years were identified using similar methods. A multivariate binomial logistic regression analysis was used to evaluate patient-related risk factors for revision surgery. In addition, the number of preoperative injections (1, 2, or ≥3) in the ipsilateral elbow was identified and included in the regression analysis. Adjusted odds ratios (OR) and 95% confidence intervals were calculated for each risk factor. Of 3863 patients who underwent operative treatment of lateral epicondylitis, 58 (1.5%) required ipsilateral revision surgery. Risk factors for revision surgery included age lateral epicondylitis in the studied population is low (1.5%). Risk factors for revision surgery include younger age, male gender, morbid obesity, tobacco use, and inflammatory arthritis. The most significant risk factor for revision surgery is having ≥3 ipsilateral preoperative injections. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Centralized Drinking Water Treatment Operations Shape Bacterial and Fungal Community Structure.

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Ma, Xiao; Vikram, Amit; Casson, Leonard; Bibby, Kyle

2017-07-05

Drinking water microbial communities impact opportunistic pathogen colonization and corrosion of water distribution systems, and centralized drinking water treatment represents a potential control for microbial community structure in finished drinking water. In this article, we examine bacterial and fungal abundance and diversity, as well as the microbial community taxonomic structure following each unit operation in a conventional surface water treatment plant. Treatment operations drove the microbial composition more strongly than sampling time. Both bacterial and fungal abundance and diversity decreased following sedimentation and filtration; however, only bacterial abundance and diversity was significantly impacted by free chlorine disinfection. Similarly, each treatment step was found to shift bacterial and fungal community beta-diversity, with the exception of disinfection on the fungal community structure. We observed the enrichment of bacterial and fungal taxa commonly found in drinking water distribution systems through the treatment process, for example, Sphingomonas following filtration and Leptospirillium and Penicillium following disinfection. Study results suggest that centralized drinking water treatment processes shape the final drinking water microbial community via selection of community members and that the bacterial community is primarily driven by disinfection while the eukaryotic community is primarily controlled by physical treatment processes.

Serum Zn levels in dysphagic patients who underwent endoscopic gastrostomy for long term enteral nutrition

OpenAIRE

Adriana Santos, Carla; Fonseca, Jorge; Brito, José; Fernandes, Tânia; Gonçalves, Luísa; Sousa Guerreiro, António

2014-01-01

Background and aims: Dysphagic patients who underwent endoscopic gastrostomy (PEG) usually present protein-energy malnutrition, but little is known about micronutrient malnutrition. The aim of the present study was the evaluation of serum zinc in patients who underwent endoscopic gastrostomy and its relationship with serum proteins, whole blood zinc, and the nature of underlying disorder. Methods: From patients that underwent gastrostomy a blood sample was obtained minutes before the procedur...

High performance biological process for waste water treatment proven in operation

International Nuclear Information System (INIS)

Timm, C.; Wienands, H.; Brauch, G.; Schlaeger, M.

1993-01-01

A BIOMEMBRAT plant has been in operation for over one year at the Thor Chemie GmbH facility at Speyer, Germany. The process is particularly suitable for waste water with a high organic content and with degradation-resistant components or high nitrogen contents. This article presents the operating results obtained so far with the waste water treatment plant and the operator's experience. (orig.) [de

Post-operative treatment of endometrial carcinoma. Chapter 20

International Nuclear Information System (INIS)

Kuipers, Tj.; Star, W.M.

1980-01-01

The alternative forms of post-operative radiotherapy given in Rotterdam for endometrial carcinoma are described. Patients with infiltration involving less than half the thickness of the myometrium are treated with low dose-rate 137 Cs afterloading techniques. However, in patients with deep infiltration, a combination of high dose-rate Cathetron treatment and external irradiation is used. (U.K.)

Lower Lip Reconstruction after Wide Excision of a Malignancy with Barrel-Shaped Excision or the Webster Modification of the Bernard Operation

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Hyung Joon Seo

2013-01-01

Full Text Available BackgroundBecause there are numerous methods for reconstruction of the lower lip, it is not easy to choose the optimal method. In choosing the surgical method for lower lip reconstruction, we obtained acceptable outcomes based on our treatment strategy, which included either a barrel-shaped excision or the Webster modification of the Bernard operation. We report on the surgical outcomes based on our treatment strategy.MethodsThis study included 26 patients who underwent lower lip reconstructive surgery from September 1996 to September 2010. The operation was done using either a barrel-shaped excision or the Webster modification, considering the location of the defect, the size of the defect, and the amount of residual tissue on the lateral side of the vermilion after excision.ResultsIn our series, 3 patients underwent a single barrel-shaped excision, and nine patients underwent a double barrel-shaped excision. In addition, the unilateral Webster modification was performed on in 6 patients, and there were eight cases of bilateral Webster modification. All of the patients except one were satisfied with the postoperative shape of the lip. In one case both recurrence and dehiscence occurred. One patient had a good postoperative lip shape, but had difficulty wearing a denture, and also underwent commissuroplasty. Furthermore, there were two patients who complained of drooling, and 4 with paresthesia.ConclusionsA soft tissue defect resulting from wide excision of a lower lip malignancy can be successfully reconstructed using only one of two surgical methods: the barrel-shaped excision or the Webster modification of the Bernard operation.

HLA-G profile of infertile couples who underwent assisted reproduction treatment.

Science.gov (United States)

Costa, Cynthia Hernandes; Gelmini, Georgia Fernanda; Nardi, Fabiola Silva; Roxo, Valéria Maria Munhoz Sperandio; Schuffner, Alessandro; da Graça Bicalho, Maria

2016-12-01

HLA-G codes for a non-classical class I (Ib) protein which is mainly expressed in trophoblast cells. Many pieces of evidence pointed out its essential role conferring immunological tolerance to the fetus. Some HLA-G alleles have been linked to enhanced or reduced HLA-G protein levels expression, which have been associated with reproductive failure. In this study 33 couples undergoing ART (assisted reproduction treatment; n=66) and 120 couples who conceived naturally (controls; n=240) were enrolled in the study. Genotyping was performed by SBT and tagged an 1837bp at 5'URR as well as exons 2, 3 and4 of HLA-G. Alleles, genotypes and haplotypes were compared between infertile and control groups using Fisher Exact Test. The haplotype HLA-G ∗ 010101b/HLA-G ∗ 01:01:01 showed statistically significant higher frequency in control groups. The immunogenetics of infertility is complex and might be dependent on different genes involved in the establishment of a successful pregnancy. A better understanding of HLA-G alleles and haplotypes structure and how the genetic diversity at their regulatory sites could impact on their level of expression and build up the susceptibility or protection conditions may shed light on the comprehension of immunogenetics mechanisms acting at the fetus-maternal interface. Copyright © 2016 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.

Clinical observation of two treatments for vitreous hemorrhage

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He-Yi Li

2014-08-01

Full Text Available AIM: To investigate the indications and therapeutic effect of the conservative treatment and surgical treatment for vitreous hemorrhage.METHODS: Hemorrhage reasons, degree of illness, and treatment and final results of vitreous hemorrhage were recorded from 2008 to 2013, and curative effect of different treatments was analyzed.RESULTS: Selected 22 cases(24 eyesof conservative treatment, vision degree of 6 eyes(25%had raised, 5 eyes(21%occurred secondary retinal detachment without treatment, 3 eyes(12.5%suffered neovascular glaucoma were underwent operation, but the vision had lost completely. In 26 cases(31 eyesof control(operationgroup, vision of 17 eyes(55%had improved, 2 eyes(6.5%suffered the second operation, 2 eyes(6.5%suffered the third surgery, 3 eyes(10%suffered eyeball atrophy. The number of ultimate vision improved with conservative treatment were significantly lower than the number of cases with surgical treatment(PCONCLUSION: The surgical treatment is still visible vitreous hemorrhage treatment means of positive, but there will be eyeball atrophy and other serious complications, so we should choose a different methods in according to the different treatment objects and treatment time.

Operation of Wastewater Treatment Plants. Volume 1. A Field Study Training Program. Third Edition. Revised.

Science.gov (United States)

California State Univ., Sacramento. Dept. of Civil Engineering.

The purpose of this wastewater treatment field study training program is to: (1) develop new qualified wastewater treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

Surgical treatment of chronic pancreatitis--a 14 years experience.

Science.gov (United States)

Stroescu, C; Dima, S; Scarlat, A; Ivanov, B; Bouaru, O; Ionescu, M; Vasilescu, C; Popescu, I

2010-01-01

Operative treatment of chronic pancreatitis is indicated for patients with intractable pain after failed medical and endoscopic treatment, or in the presence of complications of the disease. This study evaluates a single-center experience with operative management of chronic pancreatitis over a period of time of 14 years, regarding indication, surgical technique, early and late results. The records of 265 consecutive patients who underwent surgery for chronic pancreatitis between 1995 and 2008 were retrospectively reviewed and analyzed. Long-term outcomes were assessed by patient survey, with a median follow-up of 40 months. 265 patients underwent 275 operations for chronic pancreatitis with the main indication abdominal pain (46.8%), followed by suspected malignancy in 24.8% and recurrent episodes of acute pancreatitis in 18.6%. Resection procedures 54.5% (150), drainage procedures 1.09% (3), bypass and denervation procedures 44.36% (122) and exploratory laparotomy 3.27% (9) were performed with an overall morbidity of 22% and an in-hospital mortality rate of 2.64%. After a median follow-up of 40 months survival information was available for 137 patients (51.69%) with a 5-and actuarial survival rate of 74.7% and quality of life improvement in most patients, especially in the resected group. Our results suggest that in chronic pancreatitis the type of surgery has to be individualized in each patient (resection VS drainage) and organ preserving operations are safe and effective in providing long-term pain relief and in treating CP-related complications

Vacuum-assisted closure in the treatment of extensive lymphangiomas in children.

Science.gov (United States)

Katz, Michael S; Finck, Christine M; Schwartz, Marshall Z; Moront, Matthew L; Prasad, Rajeev; Timmapuri, Shaheen J; Arthur, L Grier

2012-02-01

The management of lymphangiomas in children is a complex problem with frequent recurrence and infection. Vacuum-assisted closure (VAC) devices have been shown to accelerate the healing of open wounds. We hypothesized that VAC therapy might decrease complications after resection of lymphangiomas. A retrospective review was performed on 13 children (August 2005 to April 2010) who were patients undergoing lymphangioma resection with postoperative VAC therapy. Patient demographics, size and location of the lymphangioma, VAC duration and number of changes, hospital stay, complications, need for further surgery, and length of follow-up were recorded. Thirteen children (mean age, 8 years; mean weight, 34 kg) underwent 15 operations for lymphangiomas followed by postoperative VAC therapy. Locations included the head and neck, thorax and abdomen, and lower extremity. The mean VAC duration was 19 days, and they underwent a mean of 2.6 VAC changes. Six children had operative closure of the wound at a mean of 15 days postoperative. The remaining patients underwent closure by secondary intention. There were no recurrences. Complications included VAC device malfunctions requiring intervention and wound infections. Mean follow-up was 289 days. Postoperative VAC therapy for the treatment of lymphangiomas can be an effective adjunct to surgical treatment by decreasing risks of recurrence and infection. Copyright © 2012 Elsevier Inc. All rights reserved.

Tactics and Surgical Treatment of Obstructive Jaundice of Different Etiology

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V.M. Ratchik

2014-11-01

Full Text Available In the department of surgery of the digestive organs of State institution «Institute of gastroenterology of National aca-demy of medical sciences of Ukraine» for the period from 2003 to 2013, 567 patients with pathology of the hepatopancreatobiliary zone of different etiology, complicated with obstructive jaundice, underwent surgery. 197 (34.7 % patients with bilirubinemia more than 200 µmol/l and III degree of liver failure underwent two-stage treatment. Endoscopic (two-step techniques were applied for the treatment of 143 (25.2 % patients with choledocholithiasis. One-step minimally invasive interventions — laparoscopic cholecystectomy, external drainage of the common bile duct, lithoextraction, balloon dilatation of the sphincter of Oddi — implemented in 41 (10.4 % patients. In complications chronic pancreatitis, draining surgeries were performed in 20 (25.6 % patients and resection-draining — in 39 (50.0 %, with the correction of bile outflow, as well as endoscopic, laparoscopic and minimally invasive puncture-draining operations were carried out. 2 (2.6 % patients underwent pancreatoduodenectomy by Whipple. Two-stage surgeries were performed in 26 (33.3 % patients. At tumors of cholangiopancreatoduodenal zone, 18 (30.5 % patients underwent percutaneous endobiliary reducing interventions followed by radical surgery in 10 (16.9 % patients.

Impact of pre-treatment technologies on soil aquifer treatment

Directory of Open Access Journals (Sweden)

A. Besançon

2017-03-01

Full Text Available This study investigates the impact of pre-treatment options on the performances of soil columns simulating soil aquifer treatment (SAT. For this purpose a conventional activated sludge (CAS process, a membrane bioreactor (MBR and vertical flow reed beds were used as single units or in combination before SAT. The influent and effluent from each treatment train were monitored over three successive 6-month periods, corresponding to changes in the operational conditions of the MBR and CAS units from 6 days' sludge retention time (SRT to 12 and 20 days. All the columns acted as efficient polishing steps for solids and bacteria. The column receiving effluent from the CAS system running at 6 days' SRT also presented high total nitrogen and total phosphorus removals, but this column was also associated with the lowest infiltration rates over that period. While the quality of the effluent from the column following the CAS process increased over 18 months of operation, the effluent quality of the columns receiving MBR effluent degraded. No correlations were found between variations in SRT of the MBR and CAS processes and the columns' performances. Overall, all columns, except the one receiving CAS effluent, underwent a reduction in infiltration rate over 18 months.

Megarectumsigma underwent surgery for chronic faecal impact action

International Nuclear Information System (INIS)

Canessa, C.; Gomez del Valle, M.; Caraballo, M.

2002-01-01

Seven patients with megarectumsigma underwent surgery for chronic faecal impaction,reviewing clinical diagnosis, aetiology and medical and surgical management.It is suggested medical management of chronic faecal impaction trying to achieve elective surgery.The curative surgery should include the resection of all pathologic bowel, but in Duhamel procedure and its modifications distal rectal tran section should be at the peritoneal reflection.Habr-Gama modification has shown to be technically easier and it has been communicated good functional results.Local unfavourable conditions may be resolve by staged surgery,which allows outline definitive bowel reconstruction after functional assessment

An Analysis of the Waste Water Treatment Operator Occupation.

Science.gov (United States)

Clark, Anthony B.; And Others

The occupational analysis contains a brief job description for the waste water treatment occupations of operator and maintenance mechanic and 13 detailed task statements which specify job duties (tools, equipment, materials, objects acted upon, performance knowledge, safety considerations/hazards, decisions, cues, and errors) and learning skills…

Effect of operative treatment on psychosocial problems of men with gynaecomastia.

Science.gov (United States)

Kasielska, Anna; Antoszewski, Bogusław

2011-11-01

Gynaecomastia is defined as a hyperplasia of the breast tissue in men, bilateral or unilateral, usually not associated with the presence of malignant lesions.The aim of the study was to explore the psychosocial problems of men with gynecomastia and the effect of operative breast reduction on these problems.Material and methods. The survey was conducted in a group of 47 men who were treated surgically for gynaecomastia in the Department of Plastic, Reconstructive and Aesthetic Surgery. The mean age of the respondents was 25.6±3.5 years. For survey purposes, a questionnaire was developed with questions about the age of onset of gynaecomastia, coexisting disorders and medicines taken and also various aspects of the psychosocial life of the respondents. The questionnaire was completed by patients before surgery and at minimum 6 months after surgery.Results. The findings showed that in almost all patients gynaecomastia had caused emotional discomfort and limitation of everyday activity. In many patients, enlarged breasts caused difficulties in entering into social relationships. More than a half of the surveyed men admitted that their problems were ridiculed by others and they felt isolated. A comparison of the respondents' answers before and after the surgery showed statistically significant differences in all of the analysed questionnaire items.Conclusions. Gynaecomastia causes considerable emotional discomfort and limitation of everyday activity in young men, and that is why it constitutes a psychosocial problem. Surgical treatment of gynaecomastia significantly contributes to an increase in social activity and an improvement of social acceptance and emotional comfort, and thus significantly improves satisfaction from personal life in the men who underwent this intervention.

Topical cyclosporine a treatment in corneal refractive surgery and patients with dry eye.

Science.gov (United States)

Torricelli, Andre A M; Santhiago, Marcony R; Wilson, Steven E

2014-08-01

To evaluate preoperative and postoperative dry eye and the effect of cyclosporine A treatment in patients screened for corneal refractive surgery and treated with photorefractive keratectomy (PRK) or LASIK. A consecutive case series of 1,056 patients screened for corneal refractive surgery from 2007 to 2012 was retrospectively analyzed. The level of preoperative and postoperative dry eye and the responsiveness to topical cyclosporine A treatment were assessed. One eye of each patient was randomly selected. A total of 642 eyes progressed to surgery: 524 (81.6%) and 118 (18.4%) underwent LASIK and PRK, respectively. Of 81 (7.7%) diagnosed as having dry eye, 55 were deemed potential candidates and optimized for refractive surgery. Thirty-seven patients with moderate dry eye were treated with topical cyclosporine A prior to surgery (mean duration: 3.2 ± 2.1 months; range: 1 to 12 months). After cyclosporine A treatment, 28 (75.7%) eyes underwent LASIK, 4 (10.8%) eyes underwent PRK, and 5 (13.5%) eyes were not operated on due to failed treatment of dry eye. Postoperative refractive surgery-induced neurotrophic epitheliopathy (LINE in LASIK) was noted in 132 (27.3%) and 12 (11.1%) eyes that underwent LASIK and PRK, respectively. Topical cyclosporine A was prescribed in 79 LASIK-induced and 3 PRK-induced dry eyes. After 12 months or more of cyclosporine A treatment, 5 (6.1%) eyes continued to have dry eye symptoms or signs. Topical cyclosporine A treatment is effective therapy for optimizing patients for refractive surgery and treatment of new onset or worsened dry eye after surgery. Copyright 2014, SLACK Incorporated.

Repeated morphine treatment influences operant and spatial learning differentially

Institute of Scientific and Technical Information of China (English)

Mei-Na WANG; Zhi-Fang DONG; Jun CAO; Lin XU

2006-01-01

Objective To investigate whether repeated morphine exposure or prolonged withdrawal could influence operant and spatial learning differentially. Methods Animals were chronically treated with morphine or subjected to morphine withdrawal. Then, they were subjected to two kinds of learning: operant conditioning and spatial learning.Results The acquisition of both simple appetitive and cued operant learning was impaired after repeated morphine treatment. Withdrawal for 5 weeks alleviated the impairments. Single morphine exposure disrupted the retrieval of operant memory but had no effect on rats after 5-week withdrawal. Contrarily, neither chronic morphine exposure nor 5-week withdrawal influenced spatial learning task of the Morris water maze. Nevertheless, the retrieval of spatial memory was impaired by repeated morphine exposure but not by 5-week withdrawal. Conclusion These observations suggest that repeated morphine exposure can influence different types of learning at different aspects, implicating that the formation of opiate addiction may usurp memory mechanisms differentially.

Hormonal therapy after the operation for catamenial pneumothorax - is it always necessary?

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Subotic, D; Mikovic, Z; Atanasijadis, N; Savic, M; Moskovljevic, D; Subotic, D

2016-04-14

Our recent clinical observations put into question the routine hormonal therapy for pneumothorax recurrence prevention, in patients operated for catamenial pneumothorax (CP). Retrospective review of the treatment of four women operated for CP in a recent 32-months period. The four presented patients with CP represent 4.8 % of the overall number of patients operated for spontaneous pneumothorax and 19 % of women operated for pneumothorax in the same period. In all patients, typical multiple diaphragm holes existed. The involved part of the diaphragm was removed with diaphragm suture in three patients, whilst in one patient, a diaphragm placation was done. Endometriosis was histologically confirmed in two patients. During the follow-up period of 6-43 months, none of the patients underwent a postoperative hormonal therapy for different reasons, and in none of them the pneumothorax recurrence occurred. The clinical course of these patients, with the absence of the pneumothorax recurrence despite the omission of the hormonal treatment, suggests that the appropriateness of the routine hormonal treatment with gonadotrophin-releasing hormone analogues for 6-12 months, should be reconsidered and re-evaluated in further studies.

Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer

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Krystyna Serkies

2016-12-01

Full Text Available Purpose : To evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively. Material and methods: Between May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT. The BT dose of 15 Gy (1 Gy/pulse/h was given on the following day after surgery. Results: No increased bleeding or delayed wound healing related to the implants were observed. The only side effects included one case of temporary peri-operative breast infection and 3 cases of fat necrosis, both early and late. In 11 patients (11.4%, subsequent WBRT was omitted owing to the final pathology findings. These included eight patients who underwent mastectomy due to multiple adverse prognostic pathological features, one case of lobular carcinoma in situ, and two cases with no malignant tumor. With a median follow-up of 12 years (range: 7-14 years, among 85 patients who completed BCT, there was one ipsilateral breast tumor and one locoregional nodal recurrence. Six patients developed distant metastases and one was diagnosed with angiosarcoma within irradiated breast. The actuarial 5- and 10-year disease free survival was 90% (95% CI: 84-96% and 87% (95% CI: 80-94%, respectively, for the patients with invasive breast cancer, and 91% (95% CI: 84-97% and 89% (95% CI: 82-96%, respectively, for patients who completed BCT. Good cosmetic outcome by self-assessment was achieved in 58 out of 64 (91% evaluable patients. Conclusions : Peri-operative PDR-BT boost with intra-operative tube placement followed by EBRT is feasible and devoid of considerable toxicity, and provides excellent long-term local control. However, this strategy necessitates careful patient selection and histological confirmation

Effects of operative treatment for muscular asthenopia caused by esophoria

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Tao Zeng

2016-05-01

Full Text Available AIM:To observe the effects of operative treatment for muscular asthenopia caused by esophoria. METHODS:Twenty-one cases(42 eyeswith muscular asthenopia caused by esophoria were included. After examination of refraction, phoria and fusion function, all cases were given operative treatment to correct esophoria. RESULTS:At 1wk after surgery, clinical symptoms were improved evidently in all cases, such as headache, diplopia and eye swelling. After followed up for 1a, no recrudescence was found. Before surgery, at 1wk and 1a after surgery, esophoria in the distance were 20.3△±6.3△,-3.1△±1.4△,0.7△±1.6△ respectively and esophoria in the near distance were 10.5△±3.1△,-1.3△±0.6△,1.5△±0.8△ respectively. By comparison of esophoria before and after surgery in different stages separately, the differences were statistically(PP>0.05. CONCLUSION:Esophoria operation may relieve obviously muscular asthenopia caused by esophoria without changing fusion function.

The Patterns Of Surgical Thyroid Diseases And Operative Treatment ...

African Journals Online (AJOL)

The Patterns Of Surgical Thyroid Diseases And Operative Treatment. In Gondar College of Medical sciences, North-western Ethiopia. Abebe B. M.D. Lecturer and General practitioner,. Girmaye T. M.D. Assistant professor of surgery,. Mensur 0. M.D. Assistant professor of surgery,. Sentayehu T. M.D. General practitioner,.

Principles of Design And Operations Of Wastewater Treatment Pond Systems For Plant Operators, Engineers, And Managers

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Wastewater pond systems provide reliable, low cost, and relatively low maintenance treatment for municipal and industrial discharges. However, they do have certain design, operations, and maintenance requirements. While the basic models have not changed in the 30-odd years sinc...

A review on the sustainability of constructed wetlands for wastewater treatment: Design and operation.

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Wu, Haiming; Zhang, Jian; Ngo, Huu Hao; Guo, Wenshan; Hu, Zhen; Liang, Shuang; Fan, Jinlin; Liu, Hai

2015-01-01

Constructed wetlands (CWs) have been used as a green technology to treat various wastewaters for several decades. CWs offer a land-intensive, low-energy, and less-operational-requirements alternative to conventional treatment systems, especially for small communities and remote locations. However, the sustainable operation and successful application of these systems remains a challenge. Hence, this paper aims to provide and inspire sustainable solutions for the performance and application of CWs by giving a comprehensive review of CWs' application and the recent development on their sustainable design and operation for wastewater treatment. Firstly, a brief summary on the definition, classification and application of current CWs was presented. The design parameters and operational conditions of CWs including plant species, substrate types, water depth, hydraulic load, hydraulic retention time and feeding mode related to the sustainable operation for wastewater treatments were then discussed. Lastly, future research on improving the stability and sustainability of CWs were highlighted. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Clinical application of combined hepatic artery resection and reconstruction in surgical treatment for hilar cholangiocarcinoma].

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Dai, H S; Bie, P; Wang, S G; He, Y; Li, D J; Tian, F; Zhao, X; Chen, Z Y

2018-01-01

Objective: To clarify whether the surgical treatment for hilar cholangiocarcinoma combined with artery reconstruction is optimistic to the patients with hilar cholangiocarcinoma with hepatic artery invasion. Methods: There were 384 patients who received treatment in the First Affiliated Hospital to Army Medical University from January 2008 to January 2016 analyzed retrospectively. There were 27 patients underwent palliative operation, 245 patients underwent radical operation, radical resection account for 63.8%. Patients were divided into four groups according to different operation method: routine radical resection group( n =174), portal vein reconstruction group ( n =47), hepatic artery reconstruction group ( n =24), palliative group( n =27). General information of patients who underwent radical operation treatment was analyzed by chi-square test and analysis of variance. The period of operation time, blood loss, the length of hospital stay and hospitalization expenses of the radical operation patients were analyzed by one-way ANOVA. Comparison among groups was analyzed by LSD- t test. Results: The follow-up ended up in June first, 2016. Each of patients followed for 6 to 60 months, the median follow-up period was 24 months. 1-, 3-, and 5-year survival rates were 81.3%, 44.9% and 13.5% of routine radical operation group, and were 83.0%, 44.7% and 15.1% of portal vein reconstruction group, and were 70.8%, 27.7% and 6.9% of hepatic artery reconstruction group, respectively. And 1-, 3-, and 5-year survival rates of hepatic artery reconstruction group was lower than routine radical group and portal vein reconstruction group significantly ( P 0.05). The data shows that the ratio of lymphatic metastasis in hepatic artery reconstruction group (70.8%) is much higher than them in routine radical operation group (20.1%) and portal vein reconstruction group (19.1%) significantly ( P hilar cholangiocarcinoma. Cox regression analysis indicate that hepatic artery resection and

Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

International Nuclear Information System (INIS)

Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee

2016-01-01

By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change

[Case control study of fractures-dislocations of ankle joint with conservative and operative treatment].

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Zhang, Song-Tu; Lin, Yi-Rong; Chen, Lian-Yuan

2010-10-01

To compare the clinical efficacy of grade III, IV supination-eversion fractures-dislocations of ankle joint between manipulative treatment and operative treatment. From September 2007 to December 2008, the clinical data of 60 patients with grade III, IV supination-eversion fractures-dislocations of ankle joint were retrospectively analyzed. There were 32 males and 28 females, ranging in age from 18 to 70 years with an average age of 38.17 years. All patients were respectively treated with manipulative treatment (conservative group, 30 cases) and operative treatment (operative group, 30 cases). The joint function was compared with Mazur standard; the reduction and shifting of fractures were observed with X-ray; the hospitalization day and the therapeutic cost were compared between two groups. All patients were followed up with an average of 15.27 months (ranged, 6 to 25 months). In conservative group, 16 cases got excellent result in joint function, 10 good, 3 fair, 1 poor; in operative group, 20 cases got excellent result, 8 good, 2 fair, 0 poor. In conservative group in the X-ray showed 25 cases obtained excellent and good reduction, 4 fair, 1 poor; and in operative group in the X-ray showed 28 cases obtained excellent and good reduction, 2 fair, 0 poor. There was no significant difference at the joint function and X-ray film after treatment between two groups (P > 0.05). The hospital day was respectively (7.87 +/- 3.34), (17.37 +/- 4.64) d in conservative group and operative group; and the therapeutic cost was respectively (2 506.67 +/- 649.10), (11 473.33 +/- 1 564.90) yuan. There was significant difference at hospital day and therapeutic cost between two groups (P fractures and dislocations of ankle joint. However, conservative treatment has advantage of high safety factor, low therapeutic cost, can reduce medical costs for patients.

Operation, Maintenance and Management of Wastewater Treatment Facilities: A Bibliography of Technical Documents.

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Himes, Dottie

This is an annotated bibliography of wastewater treatment manuals. Fourteen manuals are abstracted including: (1) A Planned Maintenance Management System for Municipal Wastewater Treatment Plants; (2) Anaerobic Sludge Digestion, Operations Manual; (3) Emergency Planning for Municipal Wastewater Treatment Facilities; (4) Estimating Laboratory Needs…

[Surgical treatment of congenital obstruction of the left ventricular outflow tract].

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Biocina, B; Sutlić, Z; Husedinović, I; Letica, D; Sokolić, J

1993-01-01

This report presents the classification and all types of left ventricular outflow tract obstructions. The possibilities of operative therapies are surveyed as well. Results of surgical treatment in 34 patients with obstruction to left ventricular outflow are shown. The majority of patients underwent operation under extracorporeal circulation (84.4%), while the rest were operated by means of the inflow occlusion technique (14.7%). The obtained results were compared with those from the literature. The importance of echocardiographic evaluation of location of the left ventricular outflow tract obstruction and the appropriate choice of a surgical technique according to the patient's age are emphasized.

[Operative treatment of degenerative diseases of the lumbar spine].

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Czabanka, M; Thomé, C; Ringel, F; Meyer, B; Eicker, S-O; Rohde, V; Stoffel, M; Vajkoczy, P

2018-04-20

Degenerative diseases of the lumbar spine and associated lower back pain represent a major epidemiological and health-related economic challenge. A distinction is made between specific and unspecific lower back pain. In specific lower back pain lumbar disc herniation and spinal canal stenosis with or without associated segment instability are among the most frequent pathologies. Diverse conservative and operative strategies for treatment of these diseases are available. The aim of this article is to present an overview of current data and an evidence-based assessment of the possible forms of treatment. An extensive literature search was carried out via Medline plus an additional evaluation of the authors' personal experiences. Conservative and surgical treatment represent efficient treatment options for degenerative diseases of the lumbar spine. Surgical treatment of lumbar disc herniation shows slight advantages compared to conservative treatment consisting of faster recovery of neurological deficits and a faster restitution of pain control. Surgical decompression is superior to conservative measures for the treatment of spinal canal stenosis and degenerative spondylolisthesis. In this scenario conservative treatment represents an important supporting measure for surgical treatment in order to improve the mobility of patients and the outcome of surgical treatment. The treatment of specific lower back pain due to degenerative lumbar pathologies represents an interdisciplinary challenge, requiring both conservative and surgical treatment strategies in a synergistic treatment concept in order to achieve the best results for patients.

Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity.

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Mallet, C; Abitan, A; Vidal, C; Holvoet, L; Mazda, K; Simon, A-L; Ilharreborde, B

2018-02-01

Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. All children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures. A total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4. Both treatments led to good functional results with 75% of congruent hips at skeletal maturity. IV.

A Guide for Developing Standard Operating Job Procedures for the Tertiary Chemical Treatment - Lime Precipitation Process Wastewater Treatment Facility. SOJP No. 6.

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Petrasek, Al, Jr.

This guide describes the standard operating job procedures for the tertiary chemical treatment - lime precipitation process of wastewater treatment plants. Step-by-step instructions are given for pre-start up, start-up, continuous operation, and shut-down procedures. In addition, some theoretical material is presented along with some relevant…

Fatores preditivos do tratamento operatório na úlcera péptica hemorrágica Predictors of operative treatment in patients sustaining bleeding peptic ulcers

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JOSÉ GUSTAVO PARREIRA

2002-12-01

Full Text Available OBJETIVO: Avaliar os fatores preditivos de tratamento operatório nos doentes com úlceras pépticas hemorrágicas. MÉTODOS: Através de um estudo retrospectivo, foram analisados os prontuários dos doentes com úlceras pépticas hemorrágicas admitidos de 1998 a 2001. Foram avaliados 200 doentes, com idade entre 17 e 97 anos e média etária de 52 + 18 anos, sendo 153 (76,5% do sexo masculino. Dados vitais à admissão, antecedentes mórbidos, achados e tratamento endoscópico, bem como a evolução e tratamento definitivo foram revisados. Empregou-se o teste t de student e qui-quadrado para a análise estatística, considerando-se o valor de pOBJECTIVE: To analyze the predictors of operative treatment in patients sustaining bleeding peptic ulcers. METHODS: Retrospective analysis of the patients admitted owing to bleeding peptic ulcers from 1998 to 2001. Vital signs upon admission, associated diseases, endoscopy data, evolution and definitive care were evaluated. Patients who underwent surgery were compared with the others in order to identify the predictors of the operative treatment. Student's t and chi squared test were employed for statistical analysis, considering p< 0,05 as significant. RESULTS: Two hundred patients were included in the study group. The age ranged between 17 and 97 years (mean 52 + 18, and 153 patients (76.5% were male. Shock upon admission was present in 27 (13.5%. The endoscopic exam performed at admission showed that 101 patients sustained ulcers in the duodenum and 99 in the stomach, which were classified as Forrest Ia in 5 (2.5%, Ib in 20 (10%, IIa in 48 (24% and IIb in 48 (24%. Twenty five (12.5% patients needed operation, and 23 (92% were submitted to gastrectomy with Billroth's II reconstruction. The operative treatment were more frequently performed in patients sustaining chronic alcoholic intake (p=0.002, cigarette smoking (p=0.02, diabetes mellitus (p=0.01, chronic peptic disease (p=0.05, shock upon admission

Spas for gynaecological complaints in the follow-up treatment of women operated and irradiated for cancer

International Nuclear Information System (INIS)

Baatz, H.; Verband Deutscher Badeaerzte e.V., Bad Pyrmont

1980-01-01

The therapeutical value of the two main fields of gynaecological balneotherapy, and treatment and brine treatment, is about equal, so that the therapy of choice depends mostly on the 12 possible indications. Mud therapy is never indicated for the post-operative treatment of woman who have undergone primary cancer therapy. It is contra-indicated during cancer treatment as well as afterwards. Brine therapy is the method of choice for post-operative treatment. (orig./MG) [de

[ The new 2010 Ghent criteria for the indication to surgical treatment of patients affected by Marfan syndrome. Experience of a single cardiac surgery center].

Science.gov (United States)

Grego, Susanna; Nardi, Paolo; Gislao, Valentina; Nicolò, Francesca; D'Annolfo, Antonella; Marcucci, Rosaria; Bovio, Emanuele; Versaci, Francesco; Chiariello, Luigi

2013-01-01

The diagnosis and surgical treatment of patients with Marfan syndrome remain controversial. It is of utmost importance to identify patients at risk for acute aortic events to establish the correct surgical timing and the appropriate surgical treatment. From May 2008 to December 2012, 500 patients were screened at the Marfan Presidium of the Tor Vergata University Hospital of Rome (Italy). Patients were evaluated by a cardiac surgeon, including echocardiographic, orthopedic, ophthalmologic and dental examinations. All patients received genetic counseling, and genetic sampling was performed if appropriate. The diagnosis of Marfan syndrome was confirmed in 146 patients (29.2%). Fifty-four patients (37%) underwent cardiac surgery on the aortic root, 4 patients had surgery on the mitral valve, 13 patients had combined surgery; 11 cases were emergent surgery for acute aortic dissection. Twenty-eight patients (52%) were operated on at our Division: 13 underwent valve-sparing aortic root replacement (David procedure), 1 underwent Yacoub remodeling procedure and 14 underwent Bentall procedure. Following the establishment of the Marfan Center, the David aortic valve-sparing operation was the most frequently performed procedure compared to the previous period of surgical activity (63 vs 22%, psyndromes. Early surgical treatment is recommended in these patients to achieve optimal results of valve-sparing procedures and life-saving management, especially for patients who live far away from a cardiac surgery center.

Clinical experience in treatment of complex intrahepatic bile duct stones by regular hepatectomy

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WU Xiao

2016-09-01

Full Text Available Objective To investigate the clinical effect of regular hepatectomy in patients with complex intrahepatic bile duct stones. Methods A retrospective analysis was performed for the clinical data of 98 patients with complex intrahepatic bile duct stones who were treated in our hospital from January to December, 2013. The distribution characteristics of intrahepatic bile duct stones, clinical manifestations, extent of operation, time of operation, complications, and surgical outcome were analyzed. Results All the 98 patients completed regular hepatectomy. Of all patients, 37 underwent choledocholithotomy with T-tube drainage and segmental hepatectomy, 6 underwent resection of the left lateral lobe of the liver, 1 underwent left hemihepatectomy, 7 underwent resection of a single hepatic segment in the right lobe of the liver combined with segmental hepatectomy, 45 underwent combined segmental hepatectomy of the left and right lobes of the liver, and 2 underwent biliary-enteric basin anastomosis after hilar bile duct reconstruction. No patients died during the perioperative period. The mean time of operation was 65.0±5.0 min, and the mean intraoperative blood loss was 83.0±6.2 ml. No patients experienced residual stones after surgery. Of all patients, 5 (5.1% experienced complications, among whom 3 experienced bile leakage and 2 experienced blood exudation on the surface of the wound in the liver; 3 patients were diagnosed with intrahepatic cholangiocarcinoma by postoperative pathological examination. All the patients for followed up for 5 years, and 11 (11.2% experienced recurrence of stones after surgery. Conclusion Regular hepatectomy is safe and effective in the treatment of complex intrahepatic bile duct stones, with few complications and a low recurrence rate of stones. Therefore, it holds promise for wide clinical application.

Clinical Outcomes of Reoperation for Failed Antireflux Operations.

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Wilshire, Candice L; Louie, Brian E; Shultz, Dale; Jutric, Zeljka; Farivar, Alexander S; Aye, Ralph W

2016-04-01

Up to 18% of patients undergoing antireflux operations will require reoperation. Authors caution that with each additional reoperation, fewer patients achieve satisfaction. The quality of life in patients who underwent revision operations was compared with patients who underwent primary antireflux operations to determine the effectiveness of revision operations. We retrospectively reviewed patients who underwent revision after failed antireflux operations from 2004 to 2014. Patients were divided into two groups: first reoperation (Reop[1]) and more than one reoperation (Reop[>1]). For comparison, a control group of patients who underwent primary antireflux operations was included. Patients underwent quality of life assessment preoperatively and postoperatively. We identified 105 reoperative patients: 94 Reop(1), 11 Reop(>1), and 112 controls. The primary reason for failure was combined fundoplication herniation and slippage. Morbidity, mortality, and readmission rates were similar in all groups. Postoperative outcomes were improved in all groups but to a lesser degree in subsequent reoperations. Gastroesophageal Reflux Disease Health-Related Quality of Life: controls, 20.0 to 2.0; Reop(1), 26.5 to 4.0; and Reop(>1), 13.0 to 2.0. Quality of Life in Reflux and Dyspepsia: controls, 4.5 to 7.0; Reop(1), 3.7 to 6.7; and Reop(>1), 3.5 to 5.8. Dysphagia Severity Score: controls, 44.0 to 45.0; Reop(1), 36.0 to 45.0; and Reop(>1), 30.8 to 45.0. Patients undergoing revision antireflux operations have improved quality of life, relatively normal swallowing, and primary symptom resolution at a median of 20 months postoperatively. However, patients who undergo more than one reoperation have lower quality of life scores and less improvement in dysphagia, suggesting that other procedures such as Roux-en-Y or short colon interposition, should be considered after a failed initial reoperation. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

[Laparoscopic treatment of common bile duct lithiasis associated with gallbladder lithiasis].

Science.gov (United States)

Mandry, Alexandra Catalina; Bun, Maximiliano; Ued, María Laura; Iovaldi, Mario Luis; Capitanich, Pablo

2008-01-01

Laparoscopic bile duct exploration has become one of the main options for the treatment of choledocholithiasis associated with cholelithiasis. Our objective is to describe the results of a consecutive series of patients. We retrospectively analyzed 101 (66 female/16 male) patients who underwent laparoscopic bile duct exploration. Age was 58 +/- 18 years. We analyzed operaion time, hospital stay and postoperative complications according to the surgical approach (transcystic or choledochotomy). Clinical follow up was carried out for 90 days after surgery and then subsequently by telephone. 1435 laparoscopic cholecystectomies were performed between January 1998 and December 2005. Of those, 101 of those patients underwent laparoscopic bile duct exploration for cholelithiasis and common bile duct stones. We evaluated clinical, laboratory and ultrasound predictors: 70 patients had positive and 31 negative predictors. Laparoscopic transcystic approach was successful in 78 patients and laparoscopic choledochotomy in 17 patients. Operation time was 154 +/- 59 minutes and hospital stay 4.31 +/- 3.44 days. Six patients (5.9%) were converted to open surgery. Two patients were re-operated for postoperative bile leakage. The overall effectiveness was 94%. Postoperative mortality was 0.99%. Median follow up was 51 months. Three patients died of unrelated conditions, three underwent ERCP and one had transfistular extraction for retained stones (3.96%). Laparoscopic treatment for common bile duct stones associated with gallbladder stones is a highly effective procedure with a low incidence of retained stones.

Effect of heat treatment operations on the Rm tensile strength of silumins

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J. Pezda

2010-10-01

Full Text Available Owing to good technological properties, low weight and good corrosion resistance, aluminum-silicon alloys are widely used as a material for cast machinery components. State of macro- and microstructure of a castings manufactured from Al-Si alloys, which is determined by a shape and distribution of hardening phases, segregation of alloying constituents and impurities, as well as distribution of porosity, create conditions to obtainment of proper mechanical properties. These properties can be improved through modification of the alloy and performed heat treatment operations. The paper presents effect of modification and heat treatment process on the Rm tensile strength of a selected silumins (EN AB-AlSi9Cu3(Fe, EN AB-AlSi12CuNiMg, EN AB-AlSi17Cu1Ni1Mg. Investigated alloys were put to treatments of refining and modification, and next to heat treatment. Temperature range of the heat treatment operations was determined on base of curves from the ATD method. Obtained results illustrate registered curves of melting and solidification from the ATD method and strength tests. On base of performed initial tests one determined parameters of the heat treatment process (temperature and duration of solutionig and ageing treatments enabling obtainment of improved Rm tensile strength of the investigated alloys.

The operative management of children with complex perianal Crohn's disease.

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Seemann, Natashia M; King, Sebastian K; Elkadri, Abdul; Walters, Thomas; Fish, Joel; Langer, Jacob C

2016-12-01

Perianal Crohn's disease (PCD) can affect both quality of life and psychological wellbeing. A subset of pediatric patients with complex PCD require surgical intervention, although appropriate timing and treatment regimens remain unclear. This study aimed to describe a large pediatric cohort in a tertiary center to determine the range of surgical management in children with complex PCD. A retrospective review of children requiring operative intervention for PCD over 13 years (2002-2014) was performed. PCD was divided into simple and complex based on the type of surgical procedure, and the two groups were compared. The 57 children were divided into two groups: the simple group (N=43) underwent abscess drainage ± seton insertion alone, and the complex group (N=14) underwent loop ileostomy ± more extensive surgery. In the complex group, females were more predominant (57% of complex vs 30% of simple), and the average age at diagnosis was lower. Anti-TNF therapy was utilized in 79.1% of simple and 100% of complex PCD. All 14 complex patients underwent a defunctioning ileostomy, with 7 requiring further operations (subtotal colectomy=4, proctocolectomy ± anal sparing=5, plastic surgery reconstruction with perineal flap/graft=4). Complex PCD represents a small but challenging subset of patients in which major surgical intervention may be necessary to alleviate the symptoms of this debilitating condition. retrospective case study with no control group - level IV. Copyright © 2016 Elsevier Inc. All rights reserved.

An intractable empyema proceeded from radiation pneumonitis after operation of lung cancer

International Nuclear Information System (INIS)

Masuya, Daiki; Gotoh, Masashi; Nakashima, Takashi; Okamoto, Taku; Liu, Dage; Ishikawa, Shinya; Yamamoto, Yasumichi; Huang, Cheng-Long; Yokomise, Hiroyasu

2005-01-01

A 54-year-old man underwent left upper lobectomy with c-stage IIIA lung squamous cell carcinoma after concurrent chemo-radiotherapy. Radiation pneumonitis focusing on the residual left S 6 appeared after operation. Following steroid pulse treatment, the pneumonitic focus was cavitated and proceeded to pulmonary abscess. Although chest drainage was performed, control of the pulmonary fistula was poor, so an operation was performed. Pulmonary decortication and pleurodesis were performed, but failed to control the fistula and infection. Finally, thoracoplasty, omentoplasty and free rectus abdominis musculocutaneous flap were filled in intrathorasic to manage the fistula. In this case of operation following concurrent chemo-radiotherapy, the original recovery power declined. We therefore conclude this was an intractable case of empyema. (author)

Mathematics for Water and Wastewater Treatment Plant Operators. Water and Wastewater Training Program.

Science.gov (United States)

South Dakota Dept. of Environmental Protection, Pierre.

This booklet is intended to aid the prospective waste treatment plant operator or drinking water plant operator in learning to solve mathematical problems, which is necessary for Class I certification. It deals with the basic mathematics which a Class I operator may require in accomplishing day-to-day tasks. The book also progresses into problems…

Operative interventions for failed heller myotomy: a single institution experience.

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Pallati, Pradeep K; Mittal, Sumeet K

2011-03-01

Recurrent dysphagia and/or gastroesophageal reflux (GER) are failures of treatment after Heller myotomy for achalasia. We present our single center experience with surgical interventions for these failures. We did a retrospective analysis of a prospectively collected database. Based on preoperative symptoms and endoscopy, esophagogram, and manometry results, patients were divided into three groups to guide management. Telephone follow-up was done using a structured foregut questionnaire. Between December 2003 and June 2009, 16 patients underwent operative interventions for disabling symptoms after previous Heller myotomy. Eight patients presented primarily with recurrent dysphagia and underwent transabdominal Heller myotomy with partial fundoplication. Seven patients reported good to excellent symptom relief at mean follow-up of 42 months. One patient reported no relief and eventually required esophageal bypass with retrosternal gastric pull-up. Four patients presented with uncontrolled GER. Two patients who underwent redo partial fundoplication reported poor symptomatic outcome and one patient has since undergone short limb Roux-en-y gastric bypass (SLRNYGB) with excellent symptom relief. The other two patients underwent SLRNYGB with excellent relief at 10 months. Four patients had end stage achalasia and underwent esophageal resection with reconstruction. All reported excellent symptom relief at mean follow-up of 36 months. Transabdominal redo Heller myotomy for dysphagia has good outcomes. Redo fundoplication for GER after previous myotomy has poor results and SLRNYGB is an effective option in these patients. Esophageal resection remains an effective, albeit morbid, option for end-stage achalasia.

Interventional treatment of iliac vein compression syndrome

International Nuclear Information System (INIS)

Li Xiaoqiang; Zhou Weiming; Nie Zhonglin; Yu Chaowen

2002-01-01

Objective: To explore the clinical significance of interventional treatment of iliac vein compression syndrome (IVCS). Methods: Percutaneous transluminal angioplasty (PTA) was performed in 40 cases. Thirty-three cases underwent endovascular stent implantation and 27 cases underwent second-stage left saphenous vein ligation and stripping and the valves of left femoral veins narrowing. Thirty-one cases were followed-up postoperatively and the duration was 6-66 months (mean 28 months). Results: The dilation of iliac veins was successful in 36 cases and there were god efficacy in all patients when they discharged from hospital. Followed-up during post-operation, all the limbs ulcers were cured and varicose veins disappeared. The skin pigmentation disappeared in 17 of 19 cases and markedly relieved in 2 cases. Left lower limb swelling disappeared in 15 of 17 cases and relieved in 2 cases. Conclusion: There is good efficacy in the interventional treatment of left iliac vein lesions, but second-stage procedures should be performed in secondary lesions of saphenous veins and valves of femoral veins

Efficacy of incision and drainage versus percutaneous catheter drainage in treatment of severe acute pancreatitis complicated by pancreatic abscess

Directory of Open Access Journals (Sweden)

YANG Feng

2016-03-01

Full Text Available ObjectiveTo investigate the clinical features and treatment of severe acute pancreatitis (SAP complicated by pancreatic abscess (PA. MethodsThe clinical data of 17 SAP patients with PA who were admitted to Affiliated Hospital of Luzhou Medical College from January 1, 2005 to August 25, 2015 were analyzed retrospectively. The clinical manifestations, therapeutic methods, and outcome were summarized. ResultsOf all the 17 patients, 12 patients underwent surgical operation, among whom 9 were cured, 1 experienced postoperative intestinal fistula, and 2 experienced recurrence of abscess and underwent the surgery again (1 died of multiple organ failure, and the mean hospital stay was (108.29±52.37 d; 5 patients underwent percutaneous catheter drainage, among whom 4 were cured, and 1 underwent surgical treatment due to inadequate drainage, and the mean hospital stay was (53.03±6.71 d. ConclusionAdequate drainage should be performed once a confirmed diagnosis of PA is made, and appropriate drainage methods should be selected based on the patient′s actual condition. Minimally invasive treatment has a good effect, a short length of hospital stay, and few complications, and holds promise for clinical application.

Surgical treatment of pain in patients with chronic pancreatitis.

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Prochorov, Alexandermiddle Victorovich; Oldhafer, Karl-Jurgen; Tretyak, Stanislaw Ivanovich; Rashchynski, Siarhei Markovich; Donati, Marcello; Rashchynskaya, Nina Timofeevna; Audzevich, Dzmitry Anatolyevich

2012-06-01

The objectives of the research were to compare the outcomes of pancreatoduodenectomy (PD) (Kausch-Whipple or Traverso-Longmire) and resection with drainage operations (RDO) (Frey or Partingtone-Rochelle) in patients suffering from chronic pancreatitis (CP), in management of pain syndrome and quality of life provided by these kinds of surgical procedures. From 2002 to 2008 sixteen patients suffering from CP underwent PD and 16 underwent RDO. Treatment results for the two groups were analyzed with respect to postoperative complications and results of the questionnaire MOS SF-36 v.2(TM). In the immediate postoperative period more complications were observed in the PD group (a<0.05). In both groups a positive effect on removing the painful syndrome and improvement of the quality of life (p<0.01) were observed. In the PD group there were the best results of management by General Health difference criterion (a<0.01). A greater improvement of Physical Functiong value (a<0.01) was noticed in patients who underwent RDO. Both PD and RDO adequately remove pain syndrome and improve the quality of life in patients suffering from CP. Under equal conditions the preference should be given to RDO, as improvement in life quality of operated patients is greater.

Patterns and Timing of Failure for Diffuse Large B-Cell Lymphoma After Initial Therapy in a Cohort Who Underwent Autologous Bone Marrow Transplantation for Relapse

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Dhakal, Sughosh; Bates, James E. [Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (United States); Casulo, Carla; Friedberg, Jonathan W.; Becker, Michael W.; Liesveld, Jane L. [Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (United States); Constine, Louis S., E-mail: louis_constine@urmc.rochester.edu [Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (United States)

2016-10-01

Purpose: To evaluate the location and timing of initial recurrence in patients with diffuse large B-cell lymphoma (DLBCL) who subsequently underwent high-dose chemotherapy with autologous stem cell transplant (HDC/ASCT), to direct approaches for disease surveillance, elucidate the patterns of failure of contemporary treatment strategies, and guide adjuvant treatment decisions. Methods and Materials: We analyzed consecutive patients with DLBCL who underwent HDC/ASCT between May 1992 and March 2014 at our institution. Of the 187 evaluable patients, 8 had incomplete data, and 79 underwent HDC/ASCT as a component of initial treatment for de novo or refractory DLBCL and were excluded from further analysis. Results: The median age was 50.8 years; the median time to relapse was 1.3 years. Patients were segregated according to the initial stage at diagnosis, with early stage (ES) defined as stage I/II and advanced stage (AS) defined as stage III/IV. In total, 40.4% of the ES and 75.5% of the AS patients relapsed in sites of initial disease; 68.4% of those with ES disease and 75.0% of those with AS disease relapsed in sites of initial disease only. Extranodal relapses were common (44.7% in ES and 35.9% in AS) and occurred in a variety of organs, although gastrointestinal tract/liver (n=12) was most frequent. Conclusions: Most patients with DLBCL who relapse and subsequently undergo HDC/ASCT initially recur in the previously involved disease site(s). Time to recurrence is brief, suggesting that frequency of screening is most justifiably greatest in the early posttherapy years. © 2016 Elsevier Inc.

The current status of emergency operations at a high-volume cancer center.

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Komori, Koji; Kimura, Kenya; Kinoshita, Takashi; Ito, Seiji; Abe, Tetsuya; Senda, Yoshiki; Misawa, Kazunari; Ito, Yuichi; Uemura, Norihisa; Natsume, Seiji; Kawai, Ryosuke; Kawakami, Jiro; Asano, Tomonari; Iwata, Yoshinori; Kurahashi, Shintaro; Tsutsuyama, Masayuki; Shigeyoshi, Itaru; Shimizu, Yasuhiro

2014-01-01

This study aimed to assess the pathogenic causes, clinical conditions, surgical procedures, in-hospital mortality, and operative death associated with emergency operations at a high-volume cancer center. Although many reports have described the contents, operative procedures, and prognosis of elective surgeries in high-volume cancer centers, emergency operations have not been studied in sufficient detail. We retrospectively enrolled 28 consecutive patients who underwent emergency surgery. Cases involving operative complications were excluded. The following surgical procedures were performed during emergency operations: closure in 3 cases (10.7%), diversion in 22 cases (78.6%), ileus treatment in 2 cases (7.1%), and hemostasis in 1 case (3.6%). Closure alone was performed only once for peritonitis. Diversion was performed in 17 cases (77.3%) of peritonitis, 4 cases (18.2%) of stenosis of the gastrointestinal tract, and 1 case (4.5%) of bleeding. There was a significant overall difference (P = 0.001). The frequency of emergency operations was very low at a high-volume cancer center. However, the recent shift in treatment approaches toward nonoperative techniques may enhance the status of emergency surgical procedures. The results presented in this study will help prepare for emergency situations and resolve them as quickly and efficiently as possible.

Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation

Science.gov (United States)

Joukainen, Antti; Kröger, Heikki; Niemitukia, Lea; Mäkelä, E. Antero; Väätäinen, Urho

2014-01-01

Background: The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved. Purpose: To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed. Results: Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in

Revisional Surgery after Heller Myotomy for Treatment of Achalasia: A Comparative Analysis Focusing on Operative Approach

OpenAIRE

Gouda, Biswanath P.; Nelson, Thomas; Bhoyrul, Sunil

2012-01-01

Surgical myotomy is the gold standard in therapy for achalasia, but treatment failures occur and require revisional surgery. A MEDLINE search of peer-reviewed articles published in English from 1970 to December 2008 was performed using the following terms: esophageal achalasia, Heller myotomy, and revisional surgery. Thirty-three articles satisfied our inclusion criteria. A total of 12,727 patients, with mean age of 43.3 years (males 46% and females 50%), underwent Heller myotomy (open 94.8% ...

Integrated radwaste treatment system lessons learned from 2 1/2 years of operation

International Nuclear Information System (INIS)

Baker, M.N.; Fussner, R.J.

1997-05-01

The Integrated Radwaste Treatment System (IRTS) at the West Valley Demonstration Project (WVDP) is a pretreatment scheme to reduce the amount of salts in the high-level radioactive waste (vitrification) stream. Following removal of cesium-137 (Cs-137) by ion-exchange in the Supernatant Treatment System (STS), the radioactive waste liquid is volume-reduced by evaporation. Trace amounts of Cs-137 in the resulting distillate are removed by ion-exchange, then the distillate is discharged to the existing plant water treatment system. The concentrated product, 37 to 41 percent solids by weight, is encapsulated in cement producing a stable, low-level waste form. The Integrated Radwaste Treatment System (IRTS) operated in this mode from May 1988 through November 1990, decontaminating 450,000 gallons of high-level waste liquid; evaporating and encapsulating the resulting concentrates into 10,393 71-gallon square drums. A number of process changes and variations from the original operating plan were required to increase the system flow rate and minimize waste volumes. This report provides a summary of work performed to operate the IRTS, including system descriptions, process highlights, and lessons learned

A Manual of Simplified Laboratory Methods for Operators of Wastewater Treatment Facilities.

Science.gov (United States)

Westerhold, Arnold F., Ed.; Bennett, Ernest C., Ed.

This manual is designed to provide the small wastewater treatment plant operator, as well as the new or inexperienced operator, with simplified methods for laboratory analysis of water and wastewater. It is emphasized that this manual is not a replacement for standard methods but a guide for plants with insufficient equipment to perform analyses…

The management of shoreline protection and treatment operations

International Nuclear Information System (INIS)

Owens, E.H.

1996-01-01

The management of shoreline cleaning operations in the event of an oil spill, was discussed. An eight-step approach was introduced which was based on the definition of objectives and strategies. The discussion included evaluation of the feasibility of each of these strategies, as well as the effects of the proposed actions. It was emphasized that apart from natural recovery, any response action will have an effect either directly, by the protection or treatment actions, or indirectly, by the support actions, on the shore zone or the adjacent backshore. The main purpose of a response is to accelerate natural recovery. This new response approach can be an effective management tool, since the use of standard terms and strategy statements give operations personnel a well defined set of instruction which reduce the potential for misinterpretation. 4 refs., 9 figs

Treatment of Wastewater from Electroplating, Metal Finishing and Printed Circuit Board Manufacturing. Operation of Wastewater Treatment Plants Volume 4.

Science.gov (United States)

California State Univ., Sacramento. Dept. of Civil Engineering.

One of four manuals dealing with the operation of wastewater plants, this document was designed to address the treatment of wastewater from electroplating, metal finishing, and printed circuit board manufacturing. It emphasizes how to operate and maintain facilities which neutralize acidic and basic waters; treat waters containing metals; destroy…

Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol.

Science.gov (United States)

Brillantino, A; Iacobellis, F; Robustelli, U; Villamaina, E; Maglione, F; Colletti, O; De Palma, M; Paladino, F; Noschese, G

2016-10-01

The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.

Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity

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Mallet, C.; Abitan, A.; Vidal, C.; Holvoet, L.; Mazda, K.; Simon, A.-L.; Ilharreborde, B.

2018-01-01

Abstract Purpose Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. Methods All children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures. Results A total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4. Conclusion Both treatments led to good functional results with 75% of congruent hips at skeletal maturity. Level of Evidence IV PMID:29456754

Intermittent operation of ultra-low pressure ultrafiltration for decentralized drinking water treatment.

Science.gov (United States)

Peter-Varbanets, Maryna; Gujer, Willi; Pronk, Wouter

2012-06-15

River water was treated by ultrafiltration at a relatively low transmembrane pressure (40 mbar). As observed before, flux stabilization occurred after several days of operation although no back-flushing or cross flow was applied. Interruptions in flux were applied by temporary offset of the transmembrane pressure. After restoration of the transmembrane pressure, the initial flux was higher than the stable flux level, and the flux recovery depended on the standstill time. Furthermore, if a short cross flow was applied after standstill, the flux was restored to an even higher level. In all cases, the flux decreased again during operation to reach finally the same stable level as before standstill. In order to evaluate the influence of intermittent operation as practiced for water treatment on a household level, daily interruptions of flux were applied. An optimum of total daily water production rate was obtained at 21 h of operation and 3 h of standstill per day. A model was developed which can describe the impact of intermittent operation on the flux depending on the duration of the standstill and operating periods. This enables the prediction of production capacity of the system operated intermittently. The flux increase during standstill could be explained by a relaxation and expansion of the biofouling layer, while the higher flux after forward-flushing was caused by this layer being partially sloughed off. Household water treatment with the process presented here will generally be operated on a discontinuous basis. The results show that such operation schemes do not compromise the permeability of the system, but actually lead to higher fluxes after standstill. Copyright © 2012 Elsevier Ltd. All rights reserved.

The factors influencing the decision making of operative treatment for proximal humeral fractures

NARCIS (Netherlands)

Hageman, Michiel G. J. S.; Jayakumar, Prakash; King, John D.; Guitton, Thierry G.; Doornberg, Job N.; Ring, David

2015-01-01

The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we

The factors influencing the decision making of operative treatment for proximal humeral fractures

NARCIS (Netherlands)

Hageman, M.G.; Jayakumar, P.; King, J.D.; Guitton, T.G.; Doornberg, J.N.; Ring, D.; Poelhekke, L.M.S.J.; et al.,

2015-01-01

BACKGROUND: The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information.

Development of a Water Treatment Plant Operation Manual Using an Algorithmic Approach.

Science.gov (United States)

Counts, Cary A.

This document describes the steps to be followed in the development of a prescription manual for training of water treatment plant operators. Suggestions on how to prepare both flow and narrative prescriptions are provided for a variety of water treatment systems, including: raw water, flocculation, rapid sand filter, caustic soda feed, alum feed,…

Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

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Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

2016-06-15

By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change.

Treatment of esophageal achalasia in children: Today and tomorrow.

Science.gov (United States)

Caldaro, Tamara; Familiari, Pietro; Romeo, Erminia Francesca; Gigante, Giovanni; Marchese, Michele; Contini, Anna Chiara Iolanda; Federici di Abriola, Giovanni; Cucchiara, Salvatore; De Angelis, Paola; Torroni, Filippo; Dall'Oglio, Luigi; Costamagna, Guido

2015-05-01

Esophageal achalasia (EA) is a rare esophageal motility disorder in children. Laparoscopic Heller myotomy (LHM) represents the treatment of choice in young patients. Peroral endoscopic myotomy (POEM) is becoming an alternative to LHM. The aim of this study is to evaluate the effectiveness, safety, and outcomes of POEM vs LHM in treatment of children with EA. Data of pediatric patients with EA, who underwent LHM and POEM from February 2009 to December 2013 in two centers, were collected. Eighteen patients (9 male, mean age: 11.6 years; range: 2-17 years) were included. Nine patients (6 male, mean age: 10.7 years; range: 2-16 years) underwent LHM, and the other 9 (3 males, mean age: 12.2 years; range: 6-17 years) underwent POEM procedure. Mean operation time was shorter in POEM group compared with LHM group (62/149 minutes). Myotomy was longer in POEM group than in LHM group (11/7 cm). One major complication occurred after LHM (esophageal perforation). No clinical and manometric differences were observed between LHM and POEM in follow-up. The incidence of iatrogenic gastroesophageal reflux disease was low (1 patient in both groups). Results of a midterm follow-up show that LHM and POEM are safe and effective treatments also in children. Besides, POEM is a mini-invasive technique with an inferior execution timing compared to LHM. A skilled endoscopic team is mandatory to perform this procedure. Copyright © 2015 Elsevier Inc. All rights reserved.

Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

Directory of Open Access Journals (Sweden)

Mehmet Özülkü

2015-08-01

Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility

NARCIS (Netherlands)

Bosteels, Jan; Weyers, Steven; D'Hooghe, Thomas M.; Torrance, Helen; Broekmans, Frank J.; Chua, Su Jen; Mol, Ben Willem J.

2017-01-01

Background: Observational evidence suggests a potential benefit with several anti-adhesion therapies in women undergoing operative hysteroscopy (e.g. insertion of an intrauterine device or balloon, hormonal treatment, barrier gels or human amniotic membrane grafting) for decreasing intrauterine

Exploring the Limits and Utility of Operant Conditioning in the Treatment of Drug Addiction

Science.gov (United States)

Silverman, Kenneth

2004-01-01

This article describes a research program to develop an operant treatment for cocaine addiction in low-income, treatment-resistant methadone patients. The treatment's central feature is an abstinence reinforcement contingency in which patients earn monetary reinforcement for providing cocaine-free urine samples. Success and failure of this…

Arthroscopic treatment for chronic lateral epicondylitis

Directory of Open Access Journals (Sweden)

Bernardo Barcellos Terra

2015-08-01

Full Text Available ABSTRACTOBJECTIVE: To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC in patients with chronic lateral epicondylitis that was refractory to conservative treatment. METHODS: Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS for pain. RESULTS: A total of 15 patients (9 men and 6 women were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100. The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used ( p 0.05. CONCLUSION: Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure.

Arthroscopic treatment for chronic lateral epicondylitis.

Science.gov (United States)

Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Filho, Anis Nahssen; de Almeida, Gustavo Dalla Bernardina; Cavatte, José Maria; De Nadai, Anderson

2015-01-01

To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment. Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain. A total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p  0.05). Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure.

Clinical outcome and radiographic results after operative treatment of Scheuermann's disease

NARCIS (Netherlands)

Poolman, R. W.; Been, H. D.; Ubags, L. H.

2002-01-01

The aim of this prospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome, and to report complications and instrumentation failure after operative treatment of Scheuermann's disease using a combined anterior and posterior spondylodesis. The loss of sagittal

Prolonged operative time increases infection rate in tibial plateau fractures.

Science.gov (United States)

Colman, Matthew; Wright, Adam; Gruen, Gary; Siska, Peter; Pape, Hans-Christoph; Tarkin, Ivan

2013-02-01

Fractures of the tibial plateau present a treatment challenge and are susceptible to both prolonged operative times and high postoperative infection rates. For those fractures treated with open plating, we sought to identify the relationship between surgical site infection and prolonged operative time as well as to identify other surgical risk factors. We performed a retrospective controlled analysis of 309 consecutive unicondylar and bicondylar tibial plateau fractures treated with open plate osteosynthesis at our institution's level I trauma centre during a recent 5-year period. We recorded operative times, injury characteristics, surgical treatment, and need for operative debridement due to infection. Operative times of infected cases were compared to uncomplicated surgical cases. Multivariable logistic regression analysis was performed to identify independent risk factors for postoperative infection. Mean operative time in the infection group was 2.8h vs. 2.2h in the non-infected group (p=0.005). 15 fractures (4.9%) underwent four compartment fasciotomies as part of their treatment, with a significantly higher infection rate than those not undergoing fasciotomy (26.7% vs. 6.8%, p=0.01). Open fracture grade was also significantly related to infection rate (closed fractures: 5.3%, grade 1: 14.3%, grade 2: 40%, grade 3: 50%, pinfection rates (13.9% vs. 8.7%, p=0.36). Multivariable logistic regression analysis of the entire study group identified longer operative times (OR 1.78, p=0.013) and open fractures (OR 7.02, psite infection. Operative times approaching 3h and open fractures are related to an increased overall risk for surgical site infection after open plating of the tibial plateau. Dual incision approaches with bicolumnar plating do not appear to expose the patient to increased risk compared to single incision approaches. Copyright © 2012 Elsevier Ltd. All rights reserved.

Monaldi's technique for treatment of pulmonary abscesses

International Nuclear Information System (INIS)

Fuentes Valdes, Edelberto

2010-01-01

The pulmonary abscesses are usually treated with antibiotics and postural drainage. However, some patients don't improve with conservative measures or have contraindications for conventional surgical treatment. The aim of present paper was the presentation of three cases underwent percutaneous drainage of pulmonary abscesses. The technique used for tube insertion, complications and postoperative course of patients were described. In such cases operation was successful without mortality and with a bronchopleural cutaneous fistula like the only complication requiring a further intervention (pneumonectomy). The percutaneous drainage of pulmonary abscesses was safe and effective in our patients. (author)

Changes in neurotic personality profile associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders.

Science.gov (United States)

Rodziński, Paweł; Rutkowski, Krzysztof; Sobański, Jerzy A; Mielimąka, Michał; Murzyn, Agnieszka; Cyranka, Katarzyna; Dembińska, Edyta; Grządziel, Karolina; Klasa, Katarzyna; Müldner-Nieckowski, Łukasz; Smiatek-Mazgaj, Bogna

2015-01-01

Analysis of associations between changes in neurotic personality profile and reductionof suicidal ideation (SI) - or lack of such reduction - defined as its elimination or reduction of its intensity in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach. Symptom Checklist KO"O", Neurotic Personality Questionnaire KON-2006 and Life Inventory completed by 461 women and 219 men treated due to neurotic, behavioral or personality disorders in a day hospital between 2005-2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved. Patients who improved in terms of SI obtained significantly greater reduction of global neurotic personality disintegration (neuroticism) than others (ppsychotherapy as a treatment method that leads to comprehensive improvement encompassing reduction of neurotic personality disorders (neuroticism) and of majority of neurotic personality traits, as well as SI reduction. The revealed associations weigh in favor of hypothesis on neuroticism as SI predisposing factor in patients with neurotic, behavioral and personality disorders.

Membrane treatment of liquid wastes from radiological decontamination operations.

Science.gov (United States)

Svittsov, A A; Khubetsov, S B; Volchek, K

2011-01-01

The paper focuses on the evaluation of membrane filtration for the treatment of liquid radioactive streams generated in area decontamination operations. In this work, semi-permeable membranes were demonstrated to be effective reducing the volume of wastewater containing cesium and cobalt by two orders of a magnitude. The efficiency of membrane separation was enhanced by employing additives that enlarged the size of target radionuclide species and improved their rejection by the membranes. This was achieved by chelation with synthetic water-soluble polymers and by adsorption on micro particles of adsorbent coupled with micelle formation. The effect of wastewater composition and that of the radionuclide-binding additives on the volume reduction was investigated. Membrane treatment is expected to help simplify further processing and decrease disposal costs.

Improved irrigation for hyphema in the treatment of severe contusion hyphema in 106 cases

Directory of Open Access Journals (Sweden)

Qian-Wei Zhu

2013-09-01

Full Text Available AIM: To investigate the effect of improved irrigation for hyphema in the treatment of severe contusion hyphema.METHODS: Totally 106 patients with severe contusion hyphema underwent viscoelastican and irrigation for hyphema through tunnel incision with urokinas. RESULTS: The hyphema was clear in all patients but 2 cases were rebleeding. The surgery method was superior to the conventional operation in the aspects of vision, intra-ocular pressure and complication.CONCLUSION:Improved irrigation for hyphema could be extended, the operating methods is simple, safe and effective.

The Results of the Treatment of Osteogenesis Imperfecta with Corkscrew Tipped Telescopic Nail

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Hüseyin Günay

2017-03-01

Full Text Available Aim: We aimed to evaluate the clinical and radiological results of an intramedullary fixation system used in surgeries for fractures and deformities of osteogenesis imperfecta where we applied a new design corkscrew tipped intramedullary nailing. Materials and Methods: Twenty extremities of 14 osteogenesis cases, who underwent surgery and to whom corkscrew tipped intramedullary treatment was applied, were retrospectively scanned. Ambulation, discrepancies in the lenght of extremities, deformities and joint mobility range were all noted before the operation. Postoperative union rates, complications and our experience regarding the nail were also evaluated. Results: Six tibia and 14 femurs were operated using corkscrew tipped telescopic nails. Two bones were operated due to non-union, while seven bones underwent surgery due to acute fractures and 11 bones due to deformities. All the bones were seen to have achieved the aimed union. No major complications were observed. Infection was present in two cases. Conclusion: Corkscrew tipped telescopic nail is a safe and effective method of fixation in patients with osteogenesis imperfecta.

Diagnosis and treatment of postoperative intraperitoneal abscess using ultrasonography and abdominal computed tomography

International Nuclear Information System (INIS)

Kamachi, Hisashi; Kumashiro, Ryunosuke; Maekawa, Takafumi; Saku, Haruhisa; Naitoh, Hideaki; Inutsuka, Sadamitsu; Higashi, Yoshitaka

1988-01-01

Ultrasonography and/or abdominal computed tomography revealed 9 patients with subphrenic abscesses derived from gastrointestinal surgery. Out of them 4 cases underwent conservative treatment is chosen with aggresive chemotherapy, but 5 were re-surgically treated including drainage of the intraperitonial abscess or repairing the leakage of the anastomosis. On the conservative treatment for the intraperitonial abscess, frequent monitoring with ultrasonography was very conventional for successful treatment. However, in the cases with severe leukocytosis, leakage of anastomosis or recurrent intraperitonial abscess, resurgical treatment will be required. Thus the monitoring with ultrasonography is quite usefull not only in the drainaging of the intraperitonial abscess, but also in the judgement of treatment whether conservetive or re-operative. (author)

Use of Lactobacillus casei rhamnosus to Prevent Cholangitis in Biliary Atresia After Kasai Operation.

Science.gov (United States)

Lien, Tien-Hau; Bu, Ling-Nan; Wu, Jia-Feng; Chen, Huey-Ling; Chen, An-Chyi; Lai, Ming-Wei; Shih, Hsiang-Hung; Lee, I-Hsien; Hsu, Hong-Yuan; Ni, Yen-Hsuan; Chang, Mei-Hwei

2015-05-01

Recurrent cholangitis may aggravate cholestatic liver cirrhosis in biliary atresia (BA) after the Kasai operation. This pilot study aimed to investigate whether Lactobacillus casei rhamnosus has the prophylactic efficacy for recurrent cholangitis in comparison with the conventional neomycin prophylaxis. Twenty jaundice-free patients with BA ages 0 to 3 years who underwent a Kasai operation were enrolled and randomized into 2 groups with 10 patients each: neomycin (25 mg · kg · day for 4 days/wk) and L casei rhamnosus (8 × 10 colony-forming unit per day) groups. The treatment duration was 6 months. Bacterial stool cultures were performed before treatment and 1, 3, and 6 months after starting treatment. In addition, 10 patients with BA with similar status but without prophylaxis served as the historical control group. In the Lactobacillus group, 2 patients (20%, mean 0.03 ± 0.07 episodes per month) developed cholangitis during the study period, with the same frequency as in the neomycin group and significantly lower than that in the control group (80%, P = 0.005, mean 0.22 ± 0.16 episodes per month). The mean change in body weight z score during the 6 months in the Lactobacillus group was 0.97 ± 0.59, which was significantly better than that in the control group (-0.01 ± 0.79, P = 0.006). In bacterial stool cultures, the Lactobacillus and Escherichia coli populations significantly increased and decreased, respectively, in the Lactobacillus group. The use of L casei rhamnosus was as effective as neomycin in preventing cholangitis in patients with BA who underwent Kasai operation, and therefore could be considered as a potential alternative prophylactic regimen.

[Prophylactic plexus catheter treatment in operations following complex regional pain syndrome (CRPS)].

Science.gov (United States)

Neubrech, Florian; Pronk, Roderick Franciscus; Bigdeli, Amir Khosrow; Tapking, Christian; Kneser, Ulrich; Harhaus, Leila

2017-08-01

Background  This paper investigates and discusses the effect of perioperative plexus catheter treatment in former CRPS patients. Patients and Methods A retrospective matched-pair analysis was conducted on 10 CRPS patients with comparable injuries, who underwent surgery in the disease-free interval. In 10 cases, the procedure was performed with perioperative plexus catheter treatment (intervention group), whereas 10 patients did not receive perioperative plexus catheter treatment (control group). Results  In the intervention group, after a follow-up time of 105 (20-184) days after the last surgical procedure, pain intensity on the visual analogue scale (VAS; 0 to 10) was 6.4 (4-8), fingertip-to-palm distance averaged 3.2 (0-7.6) cm, active range of wrist motion was 47.5 (0-95), and grip strength was 9.2 (2.1-16.6) kg. In the control group, after a follow-up time of 129 (19-410) days since the last surgical procedure, pain intensity on the visual analogue scale was 6 (3-10), fingertip-to-palm distance averaged 2.7 (0-4.5) cm, active range of wrist-motion was 64 (0-125), and grip strength was 12.4 (0.8-23.8) kg. There was no significant difference between the groups. There was no recurrence of CRPS disease in either group after surgery. Conclusion  There is no evidence so far for perioperative plexus catheter treatment to prevent recurrence in former CRPS patients. Georg Thieme Verlag KG Stuttgart · New York.

Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

NARCIS (Netherlands)

Yamaguchi, Akito; Skolarikos, Andreas; Buchholz, Niels-Peter Noor; Chomón, Gonzalo Bueno; Grasso, Michael; Saba, Pietro; Nakada, Stephen; de la Rosette, Jean

2011-01-01

The study investigated factors that affect operating times and bleeding complications associated with percutaneous nephrolithotomy (PCNL) in the PCNL Global Study. All patients who underwent PCNL for primary or secondary treatment of kidney stone indications during the study period (November

Serial in-office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes.

Science.gov (United States)

Koss, Shira L; Baxter, Peter; Panossian, Haig; Woo, Peak; Pitman, Michael J

2017-07-01

Although vocal fold (VF) leukoplakia is commonly treated with in-office laser, there is no data on its long-term effectiveness. This study hypothesizes that VF leukoplakia treated by serial in-office laser results in long-term disease control with maintenance of voice and minimal morbidity. Retrospective review (2008-2015). Forty-six patients with VF leukoplakia treated by in-office KTP (potassium titanyl phosphate) or PDL (pulsed dye laser) were included. Median follow-up from final laser treatment was 19.6 months. Main outcomes included: 1) rate of disease control, 2) percentage of disease regression using ImageJ analysis. Secondary outcomes included vocal assessment using the Voice Handicap Index-10 (VHI-10). Patients underwent a median of 2 (range: 1-6) in-office laser treatments. Time between treatments was median 7.6 months. After final treatment, 19 patients (41.3%) had no disease; two patients (4.3%) progressed to invasive cancer; overall disease regression was median 77.1% (P office treatment only); failures were 13 patients (28.3%) who required operative intervention and two patients (4%) who underwent radiation. Compared to responders, failures demonstrated significantly shorter duration between treatments (median 2.3 vs. 8.9 months, P = 0.038) and significantly less regression (median 49.3% vs. 100%, P = 0.006). Serial outpatient KTP or PDL treatment of VF leukoplakia is effective for disease control with minimal morbidity and preservation of voice quality. We suggest that patients requiring repeated in-office treatment every 6 months may benefit from earlier operative intervention; other factors associated with in-office success remain unclear. 4. Laryngoscope, 127:1644-1651, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

THE FIRST EXPERIENCE OF USING LOCAL HYPERTHERMIA IN COMBINED MODALITY TREATMENT OF OPERABLE NON-SMALL CELL LUNG CANCER

Directory of Open Access Journals (Sweden)

A. Yu. Dobrodeev

2015-01-01

Full Text Available The paper presents the first experience in treating 5 patients with stage II–III non-small cell lung cancer using combined modality treatment including 40 Gy preoperative hyperfractionated radiotherapy with concurrent 2 cycles of paclitaxel/carboplatin chemotherapy and local hyperthermia (10 sessions followed by radical surgery. The overal response rate to preoperative treatment was 80 %. Chemotherapy was well tolerated and hyperthermia resulted no in adverse effects. All patients underwent surgery (4 lobectomies and 1 pneumonectomy. No complications were observed in the postoperative period. The follow-up period ranged from 6 to 20 months. No evidence of disease progression and radiation-induced damages were observed.

Clostridium perfringens infection complicating periprosthetic fracture fixation about the hip: successful treatment with early aggressive debridement.

LENUS (Irish Health Repository)

Baker, Joseph F

2012-07-13

Periprosthetic fracture and infection are both challenges following hip arthroplasty. We report the case of an 87 year old female who underwent open reduction and internal fixation of a periprosthetic femoral fracture. Her post-operative course was complicated by infection with Clostridium perfringens. Early aggressive antibiotic treatment and surgical debridement were successful, and allowed retention of the original components.

Basic Sewage Treatment Operation.

Science.gov (United States)

Ontario Ministry of the Environment, Toronto.

This manual was developed for use at workshops designed to introduce operators to the fundamentals of sewage plant operation. The course consists of lecture-discussions and hands-on activities. Each of the lessons has clearly stated behavioral objectives to tell the trainee what he should know or do after completing that topic. Areas covered in…

Evaluation of Climate Change Impact on Drinking Water Treatment Plant Operation

Science.gov (United States)

It is anticipated that global climate change will adversely impact source water quality in many areas of the United States and, therefore, will influence the design and operation of current and future drinking water treatment systems. Some of these impacts may lead to violations ...

Trends in treatment of ruptured abdominal aortic aneurysm: impact of endovascular repair and implications for future care.

Science.gov (United States)

Park, Brian D; Azefor, Nchang; Huang, Chun-Chih; Ricotta, John J

2013-04-01

Our aim was to determine national trends in treatment of ruptured abdominal aortic aneurysm (RAAA), with specific emphasis on open surgical repair (OSR) and endovascular aneurysm repair (EVAR) and its impact on mortality and complications. Data from the Nationwide Inpatient Sample (NIS) from 2005 to 2009 were queried to identify patients older than 59 years with RAAA. Three groups were studied: nonoperative (NO), EVAR, and OSR. Chi-square analysis was used to determine the relationship between treatment type and patient demographics, clinical characteristics, and hospital type. The impact of EVAR compared with OSR on mortality and overall complications was examined using logistic regression analysis. We identified 21,206 patients with RAAA from 2005 to 2009, of which 16,558 (78.1%) underwent operative repair and 21.8% received no operative treatment. In the operative group, 12,761 (77.1%) underwent OSR and 3,796 (22.9%) underwent EVAR. Endovascular aneurysm repair was more common in teaching hospitals (29.1% vs 15.2%, p < .0001) and in urban versus rural settings. Nonoperative approach was twice as common in rural versus urban hospitals. Reduced mortality was seen in patients transferred from another institutions (31.2% vs 39.4%, p = 0.014). Logistic regression analysis demonstrated a benefit of EVAR on both complication rate (OR = 0.492; CI, 0.380-0.636) and mortality (OR=0.535; CI, 0.395-0.724). Endovascular aneurysm repair use is increasing for RAAA and is more common in urban teaching hospitals while NO therapy is more common in rural hospitals. Endovascular aneurysm repair is associated with reduced mortality and complications across all age groups. Efforts to reduce mortality from RAAA should concentrate on reducing NO and OSR in patients who are suitable for EVAR. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Outcome of Patients Underwent Emergency Department Thoracotomy and Its Predictive Factors

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Shahram Paydar

2014-08-01

Full Text Available Introduction: Emergency department thoracotomy (EDT may serve as the last survival chance for patients who arrive at hospital in extremis. It is considered as an effective tool for improvement of traumatic patients’ outcome. The present study was done with the goal of assessing the outcome of patients who underwent EDT and its predictive factors. Methods: In the present study, medical charts of 50 retrospective and 8 prospective cases underwent emergency department thoracotomy (EDT were reviewed during November 2011 to June 2013. Comparisons between survived and died patients were performed by Mann-Whitney U test and the predictive factors of EDT outcome were measured using multivariate logistic regression analysis. P < 0.05 considered statistically significant. Results: Fifty eight cases of EDT were enrolled (86.2% male. The mean age of patients was 43.27±19.85 years with the range of 18-85. The mean time duration of CPR was recorded as 37.12±12.49 minutes. Eleven cases (19% were alive to be transported to OR (defined as ED survived. The mean time of survival in ED survived patients was 223.5±450.8 hours. More than 24 hours survival rate (late survived was 6.9% (4 cases. Only one case (1.7% survived to discharge from hospital (mortality rate=98.3%. There were only a significant relation between ED survival and SBP, GCS, CPR duration, and chest trauma (p=0.04. The results demonstrated that initial SBP lower than 80 mmHg (OR=1.03, 95% CI: 1.001-1.05, p=0.04 and presence of chest trauma (OR=2.6, 95% CI: 1.75-3.16, p=0.02 were independent predictive factors of EDT mortality. Conclusion: The findings of the present study showed that the survival rate of trauma patients underwent EDT was 1.7%. In addition, it was defined that falling systolic blood pressure below 80 mmHg and blunt trauma of chest are independent factors that along with poor outcome.

Surgical Dislocation of the Hip for the Treatment of Pre-Arthritic Hip Disease.

Science.gov (United States)

Beaulé, Paul E; Singh, Amardeep; Poitras, Stéphane; Parker, Gillian

2015-09-01

The purpose of this study was to report the clinical results of surgical dislocation of the hip in the treatment of pre-arthritic hip disease. Between 2005 and 2010, eighty-two patients (89 hips) underwent a surgical dislocation of the hip at a mean age of 30.5 years (range 14.8-51.7); 10 females and 72 males. At a mean follow-up of 7.1 years (range 5-9.6) clinical function improved significantly. 6 patients were converted to total hip arthroplasty and 3 patients underwent an arthroscopy and an additional three patients had >1mm of joint space narrowing at latest follow-up giving us a 9-year cumulative Kaplan-Meier survivorship of 86.4% (CI, 79% to 94%). Thirty-four patients underwent internal fixation removal at a mean of 12.0 months (range 0.3-40.8 months). Although effective in the treatment of early hip disease, the surgical dislocation approach carries a high re-operation rate for removal of internal fixation; consequently, less invasive approaches should be considered for less complex deformities. Copyright © 2015 Elsevier Inc. All rights reserved.

Bascoms operation for pilonidalcyste

DEFF Research Database (Denmark)

Bertelsen, C.A.; Jørgensen, Lars Nannestad

2008-01-01

. MATERIALS AND METHODS: 59 patients (53 male) underwent surgery between September 2004 and January 2007. The median age was 27.7 (16-48) years. The indication for surgery was recurrent pilonidal cysts in 17 cases, impaired wound healing after prior surgery in 7 cases and large cysts in 35 cases. RESULTS: All......INTRODUCTION: Treatment of pilonidal fistula often results in impaired wound healing and recurrence. After wide excision of the fistula, impaired healing and recurrence occur in up to 69% and 10-29% of cases, respectively. Based on these facts we decided to implement Bascom's cleft-lift operation...... reoperation due to infection, but none of these patients received postoperative antibiotics. 26 (44%) patients developed minor wound defects. In 22 (85%) of these cases, the wounds healed spontaneously in less than 3 months. 42 patients were followed for more than 6 months with a median follow-up of 19 (8...

Satisfaction with pain relief after operative treatment of an ankle fracture

NARCIS (Netherlands)

Helmerhorst, Gijs T. T.; Lindenhovius, Anneluuk L. C.; Vrahas, Mark; Ring, David; Kloen, Peter

2012-01-01

Background: American patients are prescribed more opioid pain medication than Dutch patients after operative treatment of an ankle fracture, but it is possible that pain is undertreated in Dutch patients. This study tests if there is a difference in pain and satisfaction with pain relief between

The effects of physicochemical wastewater treatment operations on forward osmosis

OpenAIRE

Hey, Tobias; Bajraktari, Niada; Vogel, Jörg; Hélix-Nielsen, Claus; La Cour Jansen, Jes; Jönsson, Karin

2016-01-01

Raw municipal wastewater from a full-scale wastewater treatment plant was physicochemically pretreated in a large pilot-scale system comprising coagulation, flocculation, microsieve and microfiltration operated in various configurations. The produced microsieve filtrates and microfiltration permeates were then concentrated using forward osmosis (FO). Aquaporin Inside(TM) FO membranes were used for both the microsieve filtrate and microfiltration permeates, and Hydration Technologies Inc.-thin...

Incidence of Bradycardia and Outcomes of Patients Who Underwent Orbital Atherectomy Without a Temporary Pacemaker.

Science.gov (United States)

Lee, Michael S; Nguyen, Heajung; Shlofmitz, Richard

2017-02-01

We analyzed the incidence of bradycardia and the safety of patients with severely calcified coronary lesions who underwent orbital atherectomy without the insertion of a temporary pacemaker. The presence of severely calcified coronary lesions can increase the complexity of percutaneous coronary intervention due to the difficulty in advancing and optimally expanding the stent. High-pressure inflations to predilate calcified lesions may cause angiographic complications like perforation and dissection. Suboptimal stent expansion is associated with stent thrombosis and restenosis. Orbital atherectomy safely and effectively modifies calcified plaque to facilitate optimal stent expansion. The incidence of bradycardia in orbital atherectomy is unknown. Fifty consecutive patients underwent orbital atherectomy from February 2014 to September 2016 at our institution, none of whom underwent insertion of a temporary pacemaker. The final analysis included 47 patients in this retrospective study as 3 patients were excluded because of permanent pacemaker implantation. The primary endpoint was significant bradycardia, defined as bradycardia requiring emergent pacemaker placement or a heart rate pacemaker appears to be safe.

Results after laparoscopic Heller-Dor operation for esophageal achalasia in 100 consecutive patients.

Science.gov (United States)

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2009-01-01

The laparoscopic Heller-Dor operation has been the procedure of choice for the treatment of achalasia. However, because the incidence of achalasia is low, reports on the outcome of surgical treatment for achalasia are limited. In this study, the therapeutic results after laparoscopic Heller-Dor operation for achalasia at a single university hospital were evaluated. Between August 1994 and July 2006, 100 consecutive patients underwent laparoscopic Heller-Dor operation. The therapeutic results after laparoscopic Heller-Dor operation were assessed based on complications, operation time, blood loss, postoperative hospital stay, and the standardized questionnaire for satisfaction by telephone or outpatient clinic interview. With respect to perioperative complications, lower esophageal mucosal perforation occurred in 14 patients, but all of them could be suture-obliterated laparoscopically. One patient was converted to laparotomy because of uncontrolled bleeding from the short gastric artery. The mean operative time was 169 minutes, and the mean perioperative blood loss was 22 mL. The median postoperative hospital stay was 7 days. Reflux esophagitis, which was seen in five patients, was treated successfully with a proton pump inhibitor. According to the standardized questionnaire for satisfaction, 77 patients rated their recovery as 'excellent', 17 as 'good', 4 as 'fair', and 2 as 'poor'; thus, the overall success rate was 94%. There were no significant differences in surgical outcomes by morphologic type and severity of esophageal dilatation; however, the success rate deteriorated significantly with progression of the morphologic type. Laparoscopic Heller-Dor operation is a safe and effective surgical treatment for achalasia.

Arthroscopic treatment for chronic lateral epicondylitis☆

Science.gov (United States)

Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Filho, Anis Nahssen; de Almeida, Gustavo Dalla Bernardina; Cavatte, José Maria; De Nadai, Anderson

2015-01-01

Objective To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment. Methods Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain. Results A total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p  0.05). Conclusion Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure. PMID:26401498

Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization.

Science.gov (United States)

Göker, Ayşe Enise; Aydoğdu, İmran; Saltürk, Ziya; Berkiten, Güler; Atar, Yavuz; Kumral, Tolgar Lütfi; Uyar, Yavuz

2017-01-01

The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

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

A modern review of the operative management of chronic pancreatitis.

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King, Jonathan C; Abeywardina, Shannon; Farrell, James J; Reber, Howard A; Hines, O Joe

2010-10-01

Chronic pancreatitis is a debilitating disease resulting in pain, intestinal malabsorption, endocrine dysfunction, and poor quality of life (QoL). Our aim was to analyze surgical outcomes for patients with chronic pancreatitis. Data for patients undergoing operations for chronic pancreatitis between 1990 and 2009 were reviewed. Demographics, operative and perioperative data, and survival were catalogued. QoL was determined (Short Form 36 and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire + PAN-26) and compared with historical controls. The mean age was 51 +/- 2 years, 38 patients were male (53%), the most common indication was pain (71%), the etiology of pancreatitis often was alcohol, and most patients underwent a Whipple procedure (56%). Operative time was 316 +/- 17 minutes and blood loss was 363 +/- 75 mL. There were 34 complications in 30 patients (42%) and one death. QoL surveys were administered for 25 of 55 (45%) surviving patients at a mean follow-up of 72 +/- 16 months. Mean survival was 99 +/- 9 months, whereas 5- and 10-year survival were 86 and 75 per cent. QoL scores were uniformly better than historical controls. Our data demonstrate that operations for chronic pancreatitis can be performed with acceptable morbidity and mortality. Patients have excellent survival and improved QoL compared with historical controls. Surgery is an effective and durable treatment option for patients with chronic pancreatitis.

Results of surgical treatment versus chemoradiation therapy in oropharyngeal early tumors

Directory of Open Access Journals (Sweden)

Chedid, Helma Maria

2009-03-01

Full Text Available Introduction: The epidermoid carcinoma of the upper aerodigestive tract is diagnosed in approximately 40% of the cases of advanced clinical stages. Objective: To evaluate the disease-free interval in patients with clinical stages I and II epidermoid carcinoma who were submitted to surgery or chemoradiation. Method: Retrospective study of the records of 139 patients treated for oropharyngeal epidermoid carcinoma submitted to treatment with curative intent. Among those patients, 38 were classified with early tumors clinical stages I and II. Twenty-seven (71.1% underwent surgical treatment whereas eleven (28.9% were treated with chemoradiation. The mean age was 56.4 years; 31 cases (81.6% were in men and seven (18.4% were in women. Results: Among the eleven patients who were submitted to chemoradiation, 72.7% obtained locoregional control of the disease and their disease-free survival was of 42%. Among the 27 patients operated, 19 remained in Clinical Stages I and II in the histological report and six underwent postoperative radiation therapy. The disease-free interval for two years was of 70%. Conclusion: The patients submitted to the surgery had a better disease-free interval as compared to those submitted to chemoradiation treatment.

Simulated versus realistic intra operative radiation therapy (I.O.R.T.) treatment in operating room: from knowledge of stray radiation to action

International Nuclear Information System (INIS)

Andreoli, S.; Moretti, R.; Catalano, M.; Locatelli, F.

2006-01-01

Intra-Operative Radiation Therapy (I.O.R.T.) is carried out with electron beams produced by a Linac (Linear Accelerator) generally used for conventional radiotherapy with external beam, or by dedicated accelerators that can be employed directly into an operating room. I.O.R.T. refers to the application of radiation during a surgical intervention, after the removal of a neoplastic mass. I.O.R.T. uses on the tumour area a direct irradiation, for the possible localisation of sub-clinic illness or macroscopic residue in the case of non-radical resection. Intra-Operative Radiotherapy foresees a single session only, generally preceded or followed by radiotherapy with external beam. It allows the achievement of a selective radiation boost on the tumour volume. In some cases, it can also be used as a one-time/stand alone treatment in initial cancer of small volume, or in unresectable malignancies for palliative purpose. The technical advantages of I.O.R.T. consist in the direct visual control of the target volume, and in the possibility to protect the healthy tissues by moving them away from the path of the radiation beam. The use of electron beams allows the administration of a homogeneous dose to a selected layer of tissues surrounding the tumour. The following professional staff forms the Operative Group: radiation oncologist, surgeon, anaesthetist, medical physicist, radiation technologist, nurse.The choice of a simulation geometry very similar to the clinical situation allows to evaluate radioprotection data very close to the real situation. For a fixed layout, an anthropomorphic phantom was positioned on the operating bed and a breast I.O.R.T. treatment was simulated positioning all the accessories of the operating room in their typical positions. A detailed dose mapping was performed with a Victoreen 450P ionisation chamber and with environment film-dosimeter on the walls of the operating room during the simulation of the clinical treatment. The simulation appears

An innovative concept for handling and operation of the wastewater treatment plant of Cottbus

International Nuclear Information System (INIS)

Spiller, K.; Schmitt, J.

1994-01-01

A new concept for handling and operating the wastewater treatment plant of Cottbus, with computerized modelling and an expert system as integral parts of process analysis and decision-making, is developed. Optimized plant operation and process stability is to be achieved by conrolling process-dependent dosage of wastewater coming from sludge treatment and from faecal wastewater. With the treatment plant still being built, a thorough analysis of the influent and the resulting process conditions is done, using the computerized model. Results and consequences for process optimization are presented in this article. Special attention has to be given to load smoothing and optimization of denitrification, influencing process stability and quality. Thereby not only the legal requirements can be fulfilled but improvement of effluent quality also could be achieved, reducing total nitrogen in the effluent by as much as 50%, lowering wastewater treatment costs by allowing lower control levels and fees to be payed. (orig.) [de

[Rubber band ligation in treatment of hemorrhoids: our experience].

Science.gov (United States)

Gaj, F; Biviano, I; Sportelli, G; Candeloro, L

2015-01-01

Hemorrhoids are a very common condition. The treatment depends upon persistence and severity of symptoms. For hemorrhoids of II and III grade the rubber band ligation may be therapeutic. Our aim is to report the outcomes of rubber band ligation of hemorrhoids, with a follow up of 6 months. A total of 50 patients underwent rubber band ligation for symptomatic hemorrhoids (grade II and III) without prolapse, between June 2012 and June 2014. All patients underwent plug test to rule out presence of rectal mucosal prolapse and were classified according to PATE classification (1). Each hemorrhoid was ligated with one rubber band through a ligator. All patients were evaluated immediately at the end of the procedure, after ten days and six months after the treatment. Patient's demographic and operative data were collected and analyzed. The mean patients age was 47.6±12.3 years (range 24-72). All procedures were performed without complications. Before rubber band ligation, 42 patients had rectal bleeding, 38 had perineal discomfort and 27 had itching. Ten days after the treatment, 12 patients presented self-limited rectal bleeding, but 10 of these had more hemorrhoids and underwent a second rubber band ligation. No patients complained perineal discomfort, and 8 patients had itching; 78% and 16% of patients respectively, experienced feeling of a foreign body inside the canal anal and anal pain. After 6 months, only 13 patients were occasionally symptomatic: 4 patients had rectal bleeding, 2 had perineal discomfort and 4 had itching. Three more patients presented both perineal discomfort and hitching. None had the feeling of a foreign body in anal canal or anal pain. Rubber band ligation is an efficacious, cost-effective and simple treatment for the second and third degree hemorrhoids without rectal mucosal prolapsed. In our hands, no severe complications developed and minor complications could be handled with ease.

75 FR 64683 - Liability for Termination of Single-Employer Plans; Treatment of Substantial Cessation of Operations

Science.gov (United States)

2010-10-20

... Termination of Single-Employer Plans; Treatment of Substantial Cessation of Operations AGENCY: Pension Benefit... cessations of operations by employers that maintain single-employer plans. DATES: Comments must be submitted... 4062(e), which provides for reporting of and liability for certain substantial cessations of operations...

Operational experience of gaseous effluent treatment at the Eurochemic reprocessing plant

International Nuclear Information System (INIS)

Osipenco, A.; Detilleux, E.

1977-01-01

The EUROCHEMIC fuel reprocessing plant applies the PUREX flow sheet. Two particular features of the plant influence gaseous and liquid effluents: chemical decanning and the ability to process a wide range of fuels, uranium metal or oxide, having an initial enrichment typical of power reactors (up to 5%) or material testing reactors (up to 93%). The ventilation circuits, treatment plant and monitoring equipment for gaseous releases are briefly described. No retention facilities for rare gases, tritium, or carbon-14 are provided. The releases are monitored for krypton-85, iodine-131, alpha and beta-gamma aerosols and tritium. Between 1966 and 1974 the plant processes about 200 tonnes of power reactor fuel, from which about 0.7 tonnes of plutonium and 1.5 tonnes of highly enriched uranium were separated. The most important points in the operation of the gas cleaning equipment are indicated: efficiency, operational reliability, incidents, etc.. Actual discharges as measured are compared with the limits set in the operation licence. Using the atmospheric diffusion coefficients, the dose commitment is estimated. The low level liquid effluents are passed, after neutralization, to the treatment plant of the Belgian nuclear center CEN/SCK. However, if the activity exceeds the limit set by the CEN/SCK, the effluents are concentrated by evaporation and stored on the EUROCHEMIC site. (orig.) [de

Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis.

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Chen, Bing-Lin; Guo, Jia-Bao; Zhang, Hong-Wei; Zhang, Ya-Jun; Zhu, Yi; Zhang, Juan; Hu, Hao-Yu; Zheng, Yi-Li; Wang, Xue-Qiang

2018-02-01

To investigate the effects of surgical versus non-operative treatment on the physical function and safety of patients with lumbar disc herniation. PubMed, Cochrane Library, Embase, EBSCO, Web of Science, China National Knowledge Infrastructure and Chinese Biomedical Literature Database were searched from initiation to 15 May 2017. Randomized controlled trials that evaluated surgical versus non-operative treatment for patients with lumbar disc herniation were selected. The primary outcomes were pain and side-effects. Secondary outcomes were function and health-related quality of life. A random effects model was used to calculate the pooled mean difference with 95% confidence interval. A total of 19 articles that involved 2272 participants met the inclusion criteria. Compared with non-operative treatment, surgical treatment was more effective in lowering pain (short term: mean difference = -0.94, 95% confidence interval = -1.87 to -0.00; midterm: mean difference = -1.59, 95% confidence interval = -2.24 to -9.94), improving function (midterm: mean difference = -7.84, 95% confidence interval = -14.00 to -1.68; long term: mean difference = -12.21, 95% confidence interval = -23.90 to -0.52) and quality of life. The 36-item Short-Form Health Survey for physical functions (short term: mean difference = 6.25, 95% confidence interval = 0.43 to 12.08) and bodily pain (short term: mean difference = 5.42, 95% confidence interval = 0.40 to 10.45) was also utilized. No significant difference was observed in adverse events (mean difference = 0.82, 95% confidence interval = 0.28 to 2.38). Low-quality evidence suggested that surgical treatment is more effective than non-operative treatment in improving physical functions; no significant difference was observed in adverse events. No firm recommendation can be made due to instability of the summarized data.

Clinical application of an improved utero-operator in the interventional treatment of infertility

International Nuclear Information System (INIS)

Huang Yaoming; Zhang Guangfu; Li Detai

2002-01-01

Objective: To evaluate the effectiveness of an improved utero-operator in the interventional treatment of tube obstruction infertility, and to make a comparison with other methods. Methods: One hundred cases of infertile women with tubal obstruction were divided into 3 groups and treated separately under TV fluoroscopy with 3 different methods and follow-up examination was made up to 24 months. Among the 100 cases, 60 cases were treated with improved utero-operator (109 tubes), 20 with Cook cupped coaxial catheter (36 tubes), and 20 with emulsoid double-cavity tube (20 tubes). Result: Among the improved utero-operator group, Cook cupped coaxial catheter group, and emulsoid double-cavity tube group, the successful rate of selective catheterization was 92.7%, 80.6% and 80.0%, respectively. The successful rate of recanalization was 72.3%, 72.4% and 71.4%, respectively. The pregnancy rate was 36.4%, 35.7% and 36.4%, respectively. Improved utero-operator has the highest successful rate in selective catheterization (x 2 = 4.275, P < 0.05). Conclusion: Improved utero-operator has a high successful rate of selective catheterization in selective salpingography and treatment of tube obstruction infertility, and it is an easy and stable method which spends less time and received less X-ray. It is an ideal treating method at the moment

Improved image quality in abdominal CT in patients who underwent treatment for hepatocellular carcinoma with small metal implants using a raw data-based metal artifact reduction algorithm

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Sofue, Keitaro; Sugimura, Kazuro [Kobe University Graduate School of Medicine, Department of Radiology, Kobe, Hyogo (Japan); Yoshikawa, Takeshi; Ohno, Yoshiharu [Kobe University Graduate School of Medicine, Advanced Biomedical Imaging Research Center, Kobe, Hyogo (Japan); Kobe University Graduate School of Medicine, Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe, Hyogo (Japan); Negi, Noriyuki [Kobe University Hospital, Division of Radiology, Kobe, Hyogo (Japan); Inokawa, Hiroyasu; Sugihara, Naoki [Toshiba Medical Systems Corporation, Otawara, Tochigi (Japan)

2017-07-15

To determine the value of a raw data-based metal artifact reduction (SEMAR) algorithm for image quality improvement in abdominal CT for patients with small metal implants. Fifty-eight patients with small metal implants (3-15 mm in size) who underwent treatment for hepatocellular carcinoma were imaged with CT. CT data were reconstructed by filtered back projection with and without SEMAR algorithm in axial and coronal planes. To evaluate metal artefact reduction, mean CT number (HU and SD) and artefact index (AI) values within the liver were calculated. Two readers independently evaluated image quality of the liver and pancreas and visualization of vasculature using a 5-point visual score. HU and AI values and image quality on images with and without SEMAR were compared using the paired Student's t-test and Wilcoxon signed rank test. Interobserver agreement was evaluated using linear-weighted κ test. Mean HU and AI on images with SEMAR was significantly lower than those without SEMAR (P < 0.0001). Liver and pancreas image qualities and visualizations of vasculature were significantly improved on CT with SEMAR (P < 0.0001) with substantial or almost perfect agreement (0.62 ≤ κ ≤ 0.83). SEMAR can improve image quality in abdominal CT in patients with small metal implants by reducing metallic artefacts. (orig.)

Improved image quality in abdominal CT in patients who underwent treatment for hepatocellular carcinoma with small metal implants using a raw data-based metal artifact reduction algorithm

International Nuclear Information System (INIS)

Sofue, Keitaro; Sugimura, Kazuro; Yoshikawa, Takeshi; Ohno, Yoshiharu; Negi, Noriyuki; Inokawa, Hiroyasu; Sugihara, Naoki

2017-01-01

To determine the value of a raw data-based metal artifact reduction (SEMAR) algorithm for image quality improvement in abdominal CT for patients with small metal implants. Fifty-eight patients with small metal implants (3-15 mm in size) who underwent treatment for hepatocellular carcinoma were imaged with CT. CT data were reconstructed by filtered back projection with and without SEMAR algorithm in axial and coronal planes. To evaluate metal artefact reduction, mean CT number (HU and SD) and artefact index (AI) values within the liver were calculated. Two readers independently evaluated image quality of the liver and pancreas and visualization of vasculature using a 5-point visual score. HU and AI values and image quality on images with and without SEMAR were compared using the paired Student's t-test and Wilcoxon signed rank test. Interobserver agreement was evaluated using linear-weighted κ test. Mean HU and AI on images with SEMAR was significantly lower than those without SEMAR (P < 0.0001). Liver and pancreas image qualities and visualizations of vasculature were significantly improved on CT with SEMAR (P < 0.0001) with substantial or almost perfect agreement (0.62 ≤ κ ≤ 0.83). SEMAR can improve image quality in abdominal CT in patients with small metal implants by reducing metallic artefacts. (orig.)

Improved image quality in abdominal CT in patients who underwent treatment for hepatocellular carcinoma with small metal implants using a raw data-based metal artifact reduction algorithm.

Science.gov (United States)

Sofue, Keitaro; Yoshikawa, Takeshi; Ohno, Yoshiharu; Negi, Noriyuki; Inokawa, Hiroyasu; Sugihara, Naoki; Sugimura, Kazuro

2017-07-01

To determine the value of a raw data-based metal artifact reduction (SEMAR) algorithm for image quality improvement in abdominal CT for patients with small metal implants. Fifty-eight patients with small metal implants (3-15 mm in size) who underwent treatment for hepatocellular carcinoma were imaged with CT. CT data were reconstructed by filtered back projection with and without SEMAR algorithm in axial and coronal planes. To evaluate metal artefact reduction, mean CT number (HU and SD) and artefact index (AI) values within the liver were calculated. Two readers independently evaluated image quality of the liver and pancreas and visualization of vasculature using a 5-point visual score. HU and AI values and image quality on images with and without SEMAR were compared using the paired Student's t-test and Wilcoxon signed rank test. Interobserver agreement was evaluated using linear-weighted κ test. Mean HU and AI on images with SEMAR was significantly lower than those without SEMAR (P small metal implants by reducing metallic artefacts. • SEMAR algorithm significantly reduces metallic artefacts from small implants in abdominal CT. • SEMAR can improve image quality of the liver in dynamic CECT. • Confidence visualization of hepatic vascular anatomies can also be improved by SEMAR.

Operation of Wastewater Treatment Plants: A Field Study Training Program. Volume I. Second Edition.

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California State Univ., Sacramento. Dept. of Civil Engineering.

This manual was prepared by experienced wastewater collection system workers to provide a home study course to develop new qualified workers and expand the abilities of existing workers. This volume is directed primarily towards entry-level operators and the operators of ponds, package plants, or small treatment plants. Ten chapters examine the…

Effect of Fentanyl Nasal Packing Treatment on Patients With Acute Postoperative Pain After Nasal Operation: A Randomized Double-Blind Controlled Trial.

Science.gov (United States)

Kim, Kwan-Sub; Yeo, Nam-Kyung; Kim, Seong-Su; Park, Woong-Sub; Kwak, Su-Hyun; Cho, Sang-Hyeon; Sung, Gyu-Wan; Kim, Hae-Sook; Yi, Sang-Wook; Cho, Hae Jun

2018-05-01

Nasal packing is an option for bleeding control after endoscopic sinus surgery and septoplasty. Although new packing materials have been developed, patients still suffer from pain and require additional analgesics treatments. In this study, a prospective, randomized, and double-blind controlled trial was designed to evaluate the effect of fentanyl-soaked packing on pain after endoscopic sinus surgery and septoplasty. One hundred fifty-two patients who underwent nasal surgeries due to chronic rhinosinusitis or nasal septal deviation were enrolled in this study. At the end of operation, 50 mcg fentanyl-soaked biodegradable synthetic polyurethane foams packing Nasopore or Merocel were applied to a group of 79 patients, and saline-soaked ones were applied to another group of 73 patients. To evaluate the influence of fentanyl on postoperative nasal pain, patients' conditions were assessed via means of Numeric Rating Scale, patient satisfaction, and Ramsay Sedation Scale. In addition, symptoms of headache or sore throat and any signs of cardiopulmonary-relevant indicators were monitored. The fentanyl group had significantly decreased Numeric Rating Scale and increased patient satisfaction in every operation type for the majority of postoperative time periods ( P fentanyl group showed a higher score on Ramsay Sedation Scale than the control group ( P .05). Fentanyl group showed significantly reduced postoperative pain without serious adverse effects. We suggest that topical fentanyl application to nasal packs can be a useful method to reduce pain during the early postoperative period after endoscopic sinus surgery and septoplasty.

Operational fluid radwaste treatment technology - recent state and outlooks for optimization

International Nuclear Information System (INIS)

Lastovicka, Z.; Kreisl, I.; Taras, P.

2000-01-01

Based on the Dukovany NPP (EDU) order, IPRON a.s. performed in the year 1999 the 'Concept Study of Neutralization of Semi-Liquid RAW Originating in the EDU Processes'. This paper summarizes the conclusions of the Study while emphasizing the sludge and sorbent treatment under the conditions of Czech NPPs operating the VVER blocks. (author)

Association of PTP1B with Outcomes of Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy.

Science.gov (United States)

Rivera Franco, Monica M; Leon Rodriguez, Eucario; Martinez Benitez, Braulio; Villanueva Rodriguez, Luisa G; de la Luz Sevilla Gonzalez, Maria; Armengol Alonso, Alejandra

2016-01-01

PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR). Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5%) and overexpression (≥5%). Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR ( P = 0.2). However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens ( P = 0.02). Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B over-expression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

Association of PTP1B with Outcomes of Breast Cancer Patients who Underwent Neoadjuvant Chemotherapy

Directory of Open Access Journals (Sweden)

Monica M. Rivera Franco

2016-01-01

Full Text Available PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR. Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5% and overexpression (≥5%. Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR (P = 0.2. However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens (P = 0.02. Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B overexpression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis

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Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

2016-01-01

Abstract The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively. We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis. Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach. In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

Neuroblastoma: treatment outcome after incomplete resection of primary tumors.

Science.gov (United States)

Moon, Suk-Bae; Park, Kwi-Won; Jung, Sung-Eun; Youn, Woong-Jae

2009-09-01

For International Neuroblastoma Staging System (INSS) stages III or IV neuroblastoma (intermediate or high risk), complete excision of the primary tumor is not always feasible. Most current studies on the treatment outcome of these patients have reported on the complete excision status. The aim of this study is to review the treatment outcome after the incomplete resection. The medical records of 37 patients that underwent incomplete resection between January 1986 and December 2005 were reviewed retrospectively. Incomplete resection was assessed by review of the operative notes and postoperative computerized tomography. Age, gender, tumor location, INSS stage, N-myc gene copy number, pre- and postoperative therapy, and treatment outcome were reviewed. The treatment outcome was evaluated according to the postoperative treatment protocol in the high-risk group. Intermediate-risk patients were treated with conventional chemotherapy, isotretinoin (ITT) and interleukin-2 (IL-2). High-risk patients were treated with peripheral blood stem cell transplantation (PBSCT), ITT, and IL-2 (N = 11). Before the introduction of PBSCT, the high-risk patients were also treated with the conventional chemotherapy (N = 19). Intermediate-risk patients (N = 5) currently have no evidence of disease (NED). For the high-risk patients (N = 32), 19 patients were treated with chemotherapy alone; 15 patients died of their disease while four patients currently have an NED status. Eight of 11 patients that underwent PBSCT are currently alive. For intermediate risk, conventional chemotherapy appears to be acceptable treatment. However, for high-risk patients, every effort should be made to control residual disease including the use of myeloablative chemotherapy, differentiating agents and immune-modulating agents.

The effects of physicochemical wastewater treatment operations on forward osmosis

DEFF Research Database (Denmark)

Hey, Tobias; Bajraktari, Niada; Vogel, Jörg

2016-01-01

Raw municipal wastewater from a full-scale wastewater treatment plant was physicochemically pretreated in a large pilot-scale system comprising coagulation, flocculation, microsieve and microfiltration operated in various configurations. The produced microsieve filtrates and microfiltration...... for small and medium-sized wastewater treatment plants. The study demonstrates that physicochemical pretreatment can improve the FO water flux by up to 20%. In contrast, the solute rejection decreases significantly compared to the FO-treated wastewater with mechanical pretreatment....... permeates were then concentrated using forward osmosis (FO). Aquaporin Inside(TM) FO membranes were used for both the microsieve filtrate and microfiltration permeates, and Hydration Technologies Inc.-thin-film composite membranes for the microfiltration permeate using only NaCl as the draw solution. The FO...

Second date appendectomy: Operating for failure of nonoperative treatment in perforated appendicitis.

Science.gov (United States)

Lotti, Marco

2017-06-01

Nonoperative treatment of acute appendicitis is embraced by many surgical teams, driven by low to moderate quality randomized studies that support noninferiority of antibiotics versus appendectomy for treatment of acute uncomplicated appendicitis. Several flaws of these studies have emerged, especially in the recruitment strategy and in the diagnostic criteria that were used. The growing confidence given to antibiotics, together with the lack of reliable criteria to distinguish between uncomplicated and perforated appendicitis, exposes patients with perforated appendicitis to the likelihood to be treated with antibiotics instead of surgery. Among them, those patients who experience a temporary relief of symptoms due to antibiotics, followed by early recurrence of disease when antibiotics are discontinued, are likely to undergo appendectomy at their second date. Second date appendectomy, i.e. the removal of the appendix when acute inflammation relapses within the scar of a previously unhealed perforated appendicitis, is the unwanted child of the nonoperative treatment and a new challenge for both the surgeon and the patient. Between June and July 2016, two patients were readmitted and operated for failure of nonoperative treatment with antibiotics. A video is presented, which focuses on the different anatomic presentation and technical challenges between prompt and second date laparoscopic appendectomy. When proposing nonoperative treatment for acute appendicitis, surgeons should be aware and inform their patients that if the appendix is perforated and an incomplete healing and early recurrence occur, a second date appendectomy could be a more challenging operation compared to a prompt appendectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

Anterolateral ankle impingement in adolescents: outcomes of nonoperative and operative treatment.

Science.gov (United States)

Edmonds, Eric W; Chambers, Reid; Kaufman, Elizabeth; Chambers, Henry G

2010-03-01

Ankle sprains in adolescents usually resolve with conservative management but a few patients may develop ankle impingement syndrome. There have been adult studies addressing surgical treatment of this pathology, but our study evaluated the surgical management of anterolateral ankle impingement in adolescents by comparing their outcomes after nonoperative treatment and subsequent surgical intervention. Thirteen patients (children and adolescents) diagnosed with ankle impingement by history, physical examination, and magnetic resonance imaging during a 9-year period at our institution underwent eventual arthroscopic debridement. A retrospective chart review of these patients was performed and they were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) functional rating scale on 3 separate occasions: (1) initial presentation, (2) termination of nonoperative management, and (3) final postoperative follow-up visit. Thirteen adolescents (11 girls and 2 boys; 14 ankles) with a mean age of 15.6 (11.9-18.3) years met the inclusion criteria; of these, all had arthroscopic surgery. Mean duration of reported symptoms was 9.6 (4-15) months and mean duration of nonoperative management (physical therapy, activity modifications) was 6.9 (2-12) months. The mean AOFAS rating (out of 100 total) at initial presentation was 68.4 (40-84) and after nonoperative management was no better with a mean of 68.2 (63-76). The mean AOFAS rating at final follow-up was 90.6 (52-100), which was statistically significant (Pankle impingement in the adolescent population.

Laparoscopic cardiomyotomy in the treatment of esophageal achalasia.

Science.gov (United States)

Radovanovic, N; Feussner, H; Stein, H; Siewert, J R

2000-01-01

Tu evaluate the usefulness of the laparoscopic approach as the standard procedure in the surgical treatment of achalasia. Among different competing options of the treatment of esophageal achalasia, extramucosal myotomy of the lower esophageal sphincter--usually combined with anterior fundoplasty--is the most effective but also the most invasive approach. Minimally invasive performance of this operation reduces invasivity and should make the operative treatment a more attractive alternative to other procedures, such as pneumatic dilatation or botox injection. From 1991 till 1997, 27 patients underwent laparoscopic Heller Dor operation (16 males, 11 females, mean age 37 years). Diagnosis was established in all of them by an esophagogram and esophageal manometry. The main symptom was dysphagia in all of the patients. No mortality was observed in this series. There were no conversions to laparotomy. The single intraoperative complication was one case of iatrogenic mucosal laceration. Post operative complications were found in one case of wound infection, and two cases of pneumomedistinum. After a mean follow-up of 33 months (3-77), all patients are without dysphagia and without pathological gastroesophageal reflux. The mean value of residual LES pressure could be reduced from 21 +/- 6.4 mmHg to 7.44 +/- 2.7 mmHg. Laparoscopic cardiomyotomy is at lesat as safe, in terms of morbidity and mortality, as open surgery and similarily effective in alleviating dysphagia. Short hospitalisation and convalascent periods have provided an attractive alternative to repeated dilations for many patients.

Stigma, career worry, and mental illness symptomatology: Factors influencing treatment-seeking for Operation Enduring Freedom and Operation Iraqi Freedom soldiers and veterans.

Science.gov (United States)

Brown, Nicholas B; Bruce, Steven E

2016-05-01

Mental health related stigma, as well as mental illness symptomatology, have been shown to negatively impact treatment-seeking within military populations. However, few studies have delineated the 2 forms of stigma (self-stigma and public stigma), and none have differentiated between stigma and career-related consequences (career worry). The aim of this study was to increase our understanding of low treatment-seeking rates among soldiers and veterans by expanding upon previous measurements of the stigma construct and examining factors influencing willingness to seek treatment. The sample consisted of 276 Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) soldiers and veterans. Individual levels of self-stigma, public stigma, and career worry were measured, as were levels of willingness to seek treatment. Symptoms of PTSD, depression, and substance abuse were also evaluated to account for the influence of mental illness on treatment-seeking. A confirmatory factor analysis indicated that a 3-factor model including self-stigma, public stigma, and career worry fit the data significantly better than a 1- or 2- factor model. A multiple regression analysis also revealed that these 3 factors, combined with mental illness symptomatology, significantly predicted individual levels of willingness to seek treatment. Career worry was the strongest predictor, particularly for individuals with no treatment history. This study confirmed that career worry is a factor independent of self-stigma and public stigma. Findings indicate that a fear of negatively affecting one's career is the most influential factor in determining willingness to seek mental health treatment for the military population. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

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Valérie Huynh-Trudeau

2015-01-01

Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

Treatment of operational monitoring data

International Nuclear Information System (INIS)

Azevedo P, D. de; Marcondes T, J.

1996-01-01

From effective doses calculation models, published in norms and regulatory guides, the specific dose conversion factors for different installations are used on monitoring data. The monitoring data are achieved from many individual parameters and, in case there is no individual parameters, area monitoring data are used. With the objective of reducing occupational exposures, the results are evaluated in function of the pertinent norms. The measurements are analyzed also in function of the consistency of the data obtained from former similar operations. The results are saved as individual historical dose, in each worker annual dose of every work year. The other files are formed by determined operation individual doses, calculated per capita; dose rates are achieved from individual monitoring data and the averages of each operational function are calculated; dose rates are also obtained by area monitoring, and each workplace mean is calculated. These averages are compared with the correspondent annual dose equivalent limit fraction. The analysis of variance is applied to individuals dose rates and to workplace dose rates in order to verify statistical differences, the largest mean is compared to the remaining. The individual working time in a programmed operation is limited in order to avoid that the predicted dose equivalent of twelve months exceed the established annual limit. When this limit is predicted to be exceeded, the working time is re-programmed, with worker removing at the beginning of the operation or before the end of operation, keeping prevision below the limit. (authors). 7 refs

Operational analysis and improvement of a spent nuclear fuel handling and treatment facility using discrete event simulation

International Nuclear Information System (INIS)

Garcia, H.E.

2000-01-01

Spent nuclear fuel handling and treatment often require facilities with a high level of operational complexity. Simulation models can reveal undesirable characteristics and production problems before they become readily apparent during system operations. The value of this approach is illustrated here through an operational study, using discrete event modeling techniques, to analyze the Fuel Conditioning Facility at Argonne National Laboratory and to identify enhanced nuclear waste treatment configurations. The modeling approach and results of what-if studies are discussed. An example on how to improve productivity is presented.

Introduction to Chemistry for Water and Wastewater Treatment Plant Operators. Water and Wastewater Training Program.

Science.gov (United States)

South Dakota Dept. of Environmental Protection, Pierre.

Presented are basic concepts of chemistry necessary for operators who manage drinking water treatment plants and wastewater facilities. It includes discussions of chemical terms and concepts, laboratory procedures for basic analyses of interest to operators, and discussions of appropriate chemical calculations. Exercises are included and answer…

WE-FG-202-11: Longitudinal Diffusion MRI for Treatment Assessment of Sarcoma Patients with Pre-Operative Radiation Therapy

Energy Technology Data Exchange (ETDEWEB)

Yang, Y; Cao, M; Kamrava, M; Low, D; Sheng, K; Lamb, J; Agazaryan, N; Thomas, D; Hu, P [UCLA, Los Angeles, CA (United States)

2016-06-15

Purpose: Diffusion weighted MRI (DWI) is a promising imaging technique for early prediction of tumor response to radiation therapy. A recently proposed longitudinal DWI strategy using a Co-60 MRI guided RT system (MRIgRT) may bring functional MRI guided adaptive radiation therapy closer to clinical utility. We report our preliminary results of using this longitudinal DWI approach performed on the MRIgRT system for predicting the response of sarcoma patient to preop RT. Methods: Three sarcoma patients who underwent fractionated IMRT were recruited in this study. For all three patients DWI images were acquired immediately following his/her treatment. For each imaging session, ten slices were acquired interleaved with the b values covering the gross tumor volume (GTV). The diffusion images were processed to obtain the ADC maps using standard exponential fitting for each voxel. Regions of interest were drawn in the tumor on the diffusion images based on each patient’s clinical GTV contours. Each patient subsequently underwent surgery and the tumor necrosis score was available from standard pathology. The ADC values for each patient were compared to the necrosis scores to assess the predictive value of our longitudinal DWI for tumor response. Results: Each patient underwent 3 to 5 diffusion MRI scans depending on their treatment length. Patient 1 had a relatively unchanged ADC during the course of RT and a necrosis score of 30% at surgery. For patient 2, the mean ADC values decreased from 1.56 × 10-3 to 1.12 × 10-3 mm2/s and the patient’s necrosis score was less than 10%. Patient 3 had a slight increase in the ADC values from 0.59 × 10-3 to 0.71 × 10-3 mm2/s and patient’s necrosis score was 50%. Conclusion: Based on limited data from 3 patients, our longitudinal changes in tumor ADC assessed using the MRIgRT system correlated well with pathology results.

CLINICAL OUTCOME AFTER OPERATIVE TREATMENT IN FLOATING SHOULDER- A PROSPECTIVE STUDY

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Nabarun Saha

2017-06-01

Full Text Available BACKGROUND The ‘floating shoulder’ is a rare injury consisting of ipsilateral fractures of the clavicle and glenoid neck. Although it may appear to be bony injury, studies suggest that ligamentous disruption associated with ipsilateral clavicle fracture and scapular neck fracture contributes to such entity. More commonly floating shoulder is defined as double disruption of the superior shoulder suspensory complex. Open reduction and internal fixation of both the fractures is the treatment of choice. We have made this study to assess clinical outcome after operative treatment of floating shoulder by DASH score. MATERIALS AND METHODS This is a study of 10 cases of floating shoulder injury operated in the same sitting by anterior approach for fracture clavicle and Judet’s posterior approach for scapula fracture from Jan 2014 to Oct 2016. All cases were assessed with DASH score at the end of six months. RESULTS Results of our study shows that majority of patients had excellent to good results with improvement in DASH score from 92.8 to 16.8 at final follow up. No major complications. All patients had radiological signs of union at the end of 1 year. CONCLUSION Surgical intervention should be considered for all floating shoulder injuries. open reduction and internal fixation not only increases stability but also to improves functional outcome of the patient. DASH score is an effective method to assess clinicofunctional outcome in post-operative cases of floating shoulder.

Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome.

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Beets-Tan, R G H; Lettinga, T; Beets, G L

2005-08-01

To discuss the ability of pre-operative MRI to have a beneficial effect on surgical performance and treatment outcome in patients with rectal cancer. A description on how MRI can be used as a tool so select patients for differentiated neoadjuvant treatment, how it can be used as an anatomical road map for the resection of locally advanced cases, and how it can serve as a tool for quality assurance of both the surgical procedure and overall patient management. As an illustration the proportion of microscopically complete resections of the period 1993-1997, when there was no routine pre-operative imaging, is compared to that of the period 1998-2002, when pre-operative MR imaging was standardized. The proportion of R0 resections increased from 92.5 to 97% (p=0.08) and the proportion of resections with a lateral tumour free margin of >1mm increased from 84.4 to 92.1% (p=0.03). The incomplete resections in the first period were mainly due to inadequate surgical management of unsuspected advanced or bulky tumours, whereas in the second period insufficient consideration was given to extensive neoadjuvant treatment when the tumour was close to or invading the mesorectal fascia on MR. There are good indications that in our setting pre-operative MR imaging, along with other improvements in rectal cancer management, had a beneficial effect on patient outcome. Audit and discussion of the incomplete resections can lead to an improved operative and perioperative management.

Control and decision strategies in wastewater treatment plants for operation improvement

CERN Document Server

Santín, Ignacio; Vilanova, Ramón

2017-01-01

This book examines the operation of biological wastewater treatment plants (WWTPs), with a focus on maintaining effluent water quality while keeping operational costs within constrained limits. It includes control operation and decision schemes and is based on the use of benchmarking scenarios that yield easily reproducible results that readers can implement for their own solutions. The final criterion is the effect of the applied control strategy on plant performance – specifically, improving effluent quality, reducing costs and avoiding violations of established effluent limits. The evaluation of the different control strategies is achieved with the help of two Benchmark Simulation Models (BSM1, BSM2). Given the complexity of the biological and biochemical processes involved and the major fluctuations in the influent flow rate, controlling WWTPs poses a serious challenge. Further, the importance of control goal formulation and control structure design in relation to WWTP process control is widely recogniz...

Objective assessment of dermatitis following post-operative radiotherapy in patients with breast cancer treated with breast-conserving treatment

International Nuclear Information System (INIS)

Yoshida, Ken; Takenaka, Tadashi; Tanaka, Eiichi; Kuriyama, Keiko; Yoshida, Mineo; Yamazaki, Hideya; Nishimura, Tsunehiko; Kotsuma, Tadayuki; Fujita, Yuka; Masuda, Norikazu

2010-01-01

To evaluate radiation dermatitis objectively in patients with breast cancer who had undergone post-operative radiotherapy after breast-conserving surgery. Skin color (L * , a * , and b * values) and moisture analyses were performed for both breasts (before, after, 1 month, 6 months, and 1 year after radiotherapy) to examine irradiated and non-irradiated skin divided into four quadrants in 118 patients. These patients underwent breast conservative surgery followed by 50 Gy/25 fractions (median) of radiotherapy with or without boost irradiation (10 Gy/5 fractions). L * , a * , and moisture values were changed by irradiation and maximized at completion or 1 month after radiotherapy. One year after radiotherapy, the skin color had returned to the range observed prior to radiotherapy. However, moisture did not return to previous values even 1 year after treatment. The lateral upper side (quadrant C) showed greater changes than other quadrants in the L * value (darker) at the end of radiotherapy. The Common Toxicity Criteria version 3 scores were found to correlate well with a * and L * values at the completion and 1 month after radiotherapy. Boost radiotherapy intensified reddish and darker color changes at the completion of radiotherapy, while chemotherapy did not intensify the skin reaction caused by radiotherapy. Moisture impairment as a result of irradiation lasts longer than color alterations. Objective assessments are useful for analyzing radiation dermatitis. (orig.)

Bariatric Surgery Is Gaining Ground as Treatment of Obesity After Heart Transplantation: Report of Two Cases.

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Tsamalaidze, Levan; Elli, Enrique F

2017-11-01

Experience with bariatric surgery in patients after orthotopic heart transplantation (OHT) is still limited. We performed a retrospective review of patients who underwent bariatric surgery after OHT from January 1, 2010 to December 31, 2016. Two post-OHT patients with BMI of 37.5 and 36.2 kg/m² underwent laparoscopic robotic-assisted Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, respectively. Quality of life substantially improved for both patients. Bariatric surgery is safe and feasible in OHT patients, despite numerous risk factors. Careful selection of patients is required with proper preoperative management and overall care. Due to the complexity of treatment and perioperative care in this specific population, these operations should be done in high-volume centers with multidisciplinary teams composed of bariatric, cardiac transplant surgeons and critical care physicians. Bariatric surgery can be highly effective for treatment of obesity after OHT.

Impact of Polypharmacy on Adherence to Evidence-Based Medication in Patients who Underwent Percutaneous Coronary Intervention.

Science.gov (United States)

Mohammed, Shaban; Arabi, Abdulrahaman; El-Menyar, Ayman; Abdulkarim, Sabir; AlJundi, Amer; Alqahtani, Awad; Arafa, Salah; Al Suwaidi, Jassim

2016-01-01

The primary objective of this study was to evaluate the impact of polypharmacy on primary and secondary adherence to evidence-based medication (EBM) and to measure factors associated with non-adherence among patients who underwent percutaneous coronary intervention (PCI). We conducted a retrospective analysis for patients who underwent PCI at a tertiary cardiac care hospital in Qatar. Patients who had polypharmacy (defined as ≥6 medications) were compared with those who had no polypharmacy at hospital discharge in terms of primary and secondary adherence to dual antiplatelet therapy (DAPT), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEIs) and statins. A total of 557 patients (mean age: 53±10 years; 85%; males) who underwent PCI were included. The majority of patients (84.6%) received ≥6 medications (polypharmacy group) while only 15.4% patients received ≥5 medications (nonpolypharmacy group). The two groups were comparable in term of gender, nationality, socioeconomic status and medical insurance. The non-polypharmacy patients had significantly higher adherence to first refill of DAPT compared with patients in the polypharmacy group (100 vs. 76.9%; p=0.001). Similarly, the non-polypharmacy patients were significantly more adherent to secondary preventive medications (BB, ACEI and statins) than the polypharmacy group. In patients who underwent PCI, polypharmacy at discharge could play a negative role in the adherence to the first refill of EBM. Further studies should investigate other parameters that contribute to long term non-adherence.

Operating cost guidelines for benchmarking DOE thermal treatment systems for low-level mixed waste

International Nuclear Information System (INIS)

Salmon, R.; Loghry, S.L.; Hermes, W.H.

1994-11-01

This report presents guidelines for estimating operating costs for use in benchmarking US Department of Energy (DOE) low-level mixed waste thermal treatment systems. The guidelines are based on operating cost experience at the DOE Toxic Substances Control Act (TSCA) mixed waste incinerator at the K-25 Site at Oak Ridge. In presenting these guidelines, it should be made clear at the outset that it is not the intention of this report to present operating cost estimates for new technologies, but only guidelines for estimating such costs

The value of parasternal lymphoscintigraphy in the treatment of operable breast cancer

International Nuclear Information System (INIS)

Oostveen, H.W.

1980-01-01

Internal mammary lymphoscintigraphy is described, a noninvasive technique, which provides data concerning anatomic variations of internal mammary lymph node distribution, involvement by metastasis of the chain and proportion of metastasis. It provides means for greater accuracy in additional radiotherapy treatment planning in patients with operable breast cancer. (Auth.)

Changes in intensity of neurotic symptoms associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders.

Science.gov (United States)

Rodziński, Paweł; Rutkowski, Krzysztof; Murzyn, Agnieszka; Sobański, Jerzy A; Cyranka, Katarzyna; Dembińska, Edyta; Grządziel, Karolina; Klasa, Katarzyna; Mielimąka, Michał; Müldner-Nieckowski, Łukasz; Smiatek-Mazgaj, Bogna

2017-06-18

Analysis of associations between changes in the intensity of neurotic symptoms and reduction of suicidal ideation (SI) or lack of SI reduction, in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach in a day hospital. Symptom Checklist KO"O" and Life Inventory completed by 461 women and 219 men treated in the psychotherapeutic day hospital due to neurotic, behavioral or personality disorders between 2005-2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved. The reduction of neurotic symptoms intensity was greater in patients of both genders who improved in terms of SI than in those who did not. This referred to global intensity of neurotic symptoms (OWK coefficient) in both genders (ppsychotherapy as a treatment method that leads to improvement in terms of both SI and neurotic symptoms. This suggests that the applied therapy may be effective in preventing suicidality in this group of patients. The observed associations also point in favor of hypothesis on similarities in etiopathogenesis of and partly identical personality-related factors predisposing to SI and neurotic disorders.

Long-term outcome in elderly patients after operation for traumatic intracranial hemorrhage.

Science.gov (United States)

Cipolle, Mark D; Geffe, Kevin; Getchell, John; Reed, James F; Fulda, Gerard; Sugarman, Michael; Tinkoff, Glen H

2014-08-01

This study examined outcomes in elderly TBI patients who underwent a cranial operation. We identified TBI patients > or = 65 who underwent a cranial operation from January 1, 2004 to December 31, 2008. Data collected included: age, admission GCS, mechanism of injury, ISS, Head AIS, type of operation, hemorrhage acuity, time to operation, pre-hospital warfarin or clopidogrel, and in-hospital death. Survivors were contacted by phone to determine an Extended Glasgow Outcome Score (GOSE). A favorable outcome was defined as having a GOSE of > or = 5 at follow-up, an unfavorable outcome was defined as: in-hospital death, death within one year of injury, and a GOSE GOSE interview of these: 17 were lost to follow-up, seven refused the GOSE interview, 22 had a GOSE > or = 5, and ten had a GOSE < 5. Mean follow-up was 42.6 +/- 14.9 months. Of all the factors analyzed, only older age was associated with an unfavorable outcome. While age was associated with outcome, we were unable to demonstrate any other early factors that were associated with long-term functional outcome in elderly patients that underwent a cranial operation for TBI.

Percutaneous evacuation for treatment of subdural hematoma and outcome in 28 patients.

Science.gov (United States)

Mostofi, Keyvan; Marnet, Dominique

2011-01-01

Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. There in a high variance in the treatment in literature. We report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients. From January 2007 to July 2009, 28 patients underwent percutaneous evacuation. 27 of the 28 patients (96.4%) became asymptomatic or improved clinically. Six weeks later, the scan showed the hematoma had completely disappeared in 18 of the cases. We did not have any postoperative infection. Treatment of chronic subdural hematoma using a percutaneous operative technique is a minimally invasive method with sufficient outcome and a therapeutic alternative to the craniotomy.

Factors related to postoperative pain among patients who underwent radiofrequency ablation of hepatocellular carcinoma

International Nuclear Information System (INIS)

Hsieh, Y.-C.; Yap, Y.-S.; Hung, C.-H.; Chen, C.-H.; Lu, S.-N.; Wang, J.-H.

2013-01-01

Aim: To evaluate the incidence and associated factors of postoperative intense pain and haemodynamic changes during radiofrequency ablation of hepatocellular carcinoma. Materials and methods: A total of 123 consecutive hepatocellular carcinoma patients who underwent radiofrequency ablation were prospectively recruited. Patient factors, tumour characteristics, procedural factors, intraoperative haemodynamic changes, complications, postoperative events, laboratory values before and after ablation, and postoperative pain were evaluated. Postoperative pain was scored using a visual analogue scale after the procedure. Results: The mean age of the patients was 65.6 ± 9.6 years. In multiple logistic regression analysis, patients who underwent general anaesthesia [odds ratio (95% CI): 2.68 (1.23–5.81); p = 0.013] and had more postoperative nausea and vomiting episodes [3.10 (1.11–8.63); p = 0.036] were associated with intense pain. These findings remain robust after propensity score matching. For mean difference values between before and after RFA, higher in change in aspartate transaminase (p = 0.026), alanine transaminase (p = 0.016) and white blood cell count (p = 0.015), and lower in change in haemoglobin (p = 0.009) were also correlated with intense pain. There was no significant difference in haemodynamic changes between the general anaesthesia and local anaesthesia group during ablation. Conclusion: General anaesthesia, postoperative nausea and vomiting, and laboratory factors were associated with postoperative intense pain in patients who underwent radiofrequency ablation. Counselling and modification of analgesics should be considered in patients with related factors for intense pain

[Surgical treatment of Marfan syndrome; late results and new strategy].

Science.gov (United States)

Aomi, S; Nonoyama, M; Tomioka, H; Endo, M; Nagashima, H; Sakomura, Y; Aoka, Y; Kasanuki, H; Kurosawa, H

2002-07-01

Rapid progress has been made in the treatment of Marfan syndrome. Today, the treatment is relatively established and the results have also improved. Even if surgery is performed, however, vascular lesions may recur late after operation and late prognosis is poor considering the age of patients. Issues such as whether a reoperation should be conducted or how the late results might be improved are subjects of debate. Based on an analysis of recent late data, we have performed operations according to the new treatment policy, and here report the results. A total of 203 consecutive operations were conducted in 141 patients with Marfan syndrome who underwent surgery for aortic aneurysm at our department between February 1973 and August 2001. The mean age of patients was 39 (11 years with a male/female ratio of 95:46. At the first operation, 72 patients were diagnosed with annuloaortic ectasia (AAE), 17 patients with AAE + chronic dissection (DeBakey I), 14 patients with AAE + chronic dissection (DeBakey II), 6 patients with AAE + acute dissection (Stanford A), 11 patients with AAE + dissection (DeBakey III), 9 patients with dissection (DeBakey III) only, 3 patients with AAE + abdominal aortic aneurysm only, and 2 patients with abdominal aortic aneurysm only. The cause of reoperation were a new lesion in 17 patients, dissection in 13 patients and a true aneurysm in 4 patients. In 36 patients, an increase in the remaining lesion occurred or a scheduled stage 2 operation was performed. Reoperation was performed following the Bentall operation in 7 patients, dehiscence of the anastomotic region of the coronary artery in 5 patients, aneurysm of the anastomotic region of the coronary artery in 1 patients, and infection of the artificial valve with aneurysm of the anastomotic region of the coronary artery in 1 patient. Hospital deaths were reported in 8 (6%) patients who underwent composite valve graft replacement (including simultaneous arch replacement) for AAE. Hospital

Is perforated marginal ulcer after the surgery of gastroduodenal ulcer associated with inadequate treatment for Helicobacter pylori eradication?

Science.gov (United States)

Aydinli, Bulent; Yilmaz, Omer; Ozturk, Gurkan; Yildigan, M Ilhan; Gursan, Nesrin; Basoglu, Mahmut

2007-09-01

A marginal ulcer developing after an initial operation for gastroduodenal ulcer is a serious threat to the patient, and a challenge to surgeons. Helicobacter pylori is the primary cause of peptic ulcer disease. However, its role in ulcer recurrence, especially of marginal ulcer (MU), after peptic ulcer surgery is unclear. This study aimed to determine any association between H. pylori infection and perforated MU by comparing the prevalence of H. pylori and nonsteroidal anti-inflammatory drugs (NSAIDs) use in patients with perforated (PMU) and in those with nonperforated MU (NPMU). The study retrospectively evaluated the records of 16 patients with PMU who underwent surgical treatment and 24 patients with NPMU who underwent medical treatment in Atatürk University, School of Medicine, Department of General Surgery and Gastroenterology, between January 1995 and December 2004. The rate of H. pylori in the PMU group was significantly higher than that of the NPMU group (P PMU compared with NPMU patients (P PMU (P PMU operation especially in cases with impaired hemodynamics, severe peritoneal contamination, and/or a diameter smaller than 1 cm and avoiding the use of NSAIDs will surely reduce the risk of relapsing ulcers.

Clinical efficacy and safety of vitrectomy combined with cyclophotocoagulation in treatment of traumatic glaucoma

Directory of Open Access Journals (Sweden)

Guo-Ning Ye

2018-02-01

Full Text Available AIM: To analyze the clinical efficacy and safety of vitrectomy combined with cyclophotocoagulation in the treatment of traumatic glaucoma, and to provide an effective treatment for improving the quality of life of patients with traumatic glaucoma.METHODS: Totally 90 patients(90 eyeswith traumatic glaucoma admitted in our hospital from January 2011 to July 2016 were divided into two groups(45 patients in each groupaccording to different treatment methods. The patients in the observation group underwent vitrectomy combined with cyclophotocoagulation under direct vision; the control group underwent vitrectomy combined with trans-scleral cyclophotocoagulation. We observed the effect of different treatment on visual acuity, intraocular pressure and complication of the two groups. RESULTS: The visual acuity of the observation group was significantly better than that of the control group after treatment(Z=-5.689, PP>0.05. The change of decreased intraocular pressure in the observation group was less than that in the contral group after operation(PP>0.05. The complications of the two groups after treatment were vitreous hemorrhage, choroidal detachment, low intraocular pressure, increased intraocular pressure and other complications, but the complication rate of two groups were no different(χ2=1.553, P=0.213. CONCLUSION: Vitrectomy combined with cyclophotocoagulation under direct vision brings patients better visual acuity than that combined with trans-scleral cyclophotocoagulation.

Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

OpenAIRE

Portanova Michel

2010-01-01

Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent to...

Treatment of Atrial Fibrillation in Elderly Patients with the Cox Maze Procedure Concurrently with Other Cardiac Operations

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Ja Hong Kuh

2017-06-01

Full Text Available Background: In elderly patients who have atrial fibrillation (AF, surgical ablation of the arrhythmia during cardiac surgery may be challenging. Despite the reported advantages of ablating AF with the Cox maze procedure (CMP, the addition of the CMP may complicate other cardiac operations. We evaluated the effect of the CMP in elderly patients concurrent with other cardiac operations. Methods: From October 2007 to December 2015, we enrolled 27 patients aged ＞70 years who had AF and who underwent the CMP concurrently with other cardiac operations. The mean preoperative additive European System for Cardiac Operative Risk Evaluation score was 8±11 (high risk. Results: Only 1 hospital death occurred (4%. The Kaplan-Meier method showed a high 5‐year cumulative survival rate (92%. At mean follow‐up of 51 months, 23 patients (89% had sinus rhythm conversion. The postoperative left atrial dimensions did not significantly differ between the 8 patients who had reduction plasty for giant left atrium (53.4±7.5 cm and the 19 patients who did not have reduction plasty (48.7±5.7 cm. Conclusion: In patients aged ＞70 years, concurrent CMP may be associated with a high rate of sinus rhythm conversion without increased surgical risk, despite the added complexity of the main cardiac procedure.

Limb Salvage After Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy.

Science.gov (United States)

Vaudreuil, Nicholas J; Fourman, Mitchell S; Wukich, Dane K

2017-03-01

Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level III, retrospective case series.

The VEPP-2000 Collider Control System: Operational Experience

CERN Document Server

Senchenko, A I; Lysenko, A P; Rogovsky, Yu A; Shatunov, P Yu

2017-01-01

The VEPP-2000 collider was commissioned and operated successfully in 2010-2013. During the operation the facility underwent continuous updates and experience in maintenance was acquired. Strong cooperation between the staff of the accelerator complex and the developers of the control system proved effective for implementing the necessary changes in a short time.

Efficacy of percutaneous intraductal radiofrequency ablation combined with biliary stenting in treatment of malignant biliary obstruction

Directory of Open Access Journals (Sweden)

ZHANG Kai

2015-05-01

Full Text Available ObjectiveTo investigate the safety and feasibility of percutaneous intraductal radiofrequency ablation (palliative therapy in the treatment of malignant obstructive jaundice. MethodsThis study included 20 patients with unresectable malignant obstructive jaundice, who were treated in the First Affiliated Hospital of Zhengzhou University from January 2013 to March 2014. Nine of them (test group underwent percutaneous intraductal radiofrequency ablation plus metallic biliary stent placement. The other 11 similar cases (control group underwent metallic biliary stent placement alone after successful percutaneous transhepatic cholangiography. Operative complications and remission of jaundice were observed, and the stent patency after at 3 and 6 months after operation was evaluated and compared between the two groups. ResultsAll patients were followed completely by outpatient or telephone. The stent patency rate at 3 months after operation was 9/9 in the test group and 8/11 in the control group (χ2=2.888, P=0.218, and the stent patency rates at 6 months were 7/8 and 3/11, respectively (χ2=6.739, P=0.02. During follow-up, one case in the test group died of gastrointestinal bleeding at 113 d after operation; one case in the control group died of liver failure at 57 d after operation and one case died of disseminated intravascular coagulation at 142 d. ConclusionPercutaneous intraductal radiofrequency ablation is safe and feasible in the treatment of malignant biliary obstruction, and the preliminary efficacy in prolonging the patency of self-expanding metallic stent is satisfactory. However, this therapy needs to be further verified via large-sample randomized controlled studies.

Balance between surgical and therapeutic treatment of chronic pancreatitis is a fundamental factor of functional outcome and quality of life of patients

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V. N. Klymenko

2015-06-01

Full Text Available Relevance. The progressive course of CP with ductal hypertension causes severe pain, exo-, endocrine failure, reduces the quality of life and requires surgical treatment. Aim. In order to select the right surgery functional and anatomical criteria of treatment in 73 patients who underwent the organ preserving operation long-term results were studied. Methods and results. It was found that the best results were obtained in patients (n = 39 who were performed the operation in step of mild exocrine pancreatic insufficiency. Conclusion. This shows the effectiveness of organ-preserving direction that requires timely performing surgery to reduce irreversible functional reserve of the pancreas.

Analysis of operators' surface doses in the common endovascular and on-vascular interventional diagnosis and treatment

International Nuclear Information System (INIS)

Zhang Lin; Zhu Jianguo; Min Nan; Lu Feng

2011-01-01

Objective: To contrast the level of radiation doses of Lead protective clothing both inside and outside in different parts of the body of the first and second operators and touring nurse in common endovascular and non-vascular interventional diagnosis and treatment. Methods: We choose the common endovascular interventional diagnosis and treatment in the head, thorax, abdomen, such as Cerebral angiography, Coronary angiography, Transcatheter arterial chemoembolization and non-vascular interventional diagnosis and treatment such as Endoscopic Retrograde Cholangio-Pancreatography and Percutaneous transhepatic cholangial drainage as experiment objects. Put the thermoluminescence dosimeter on the different spots of Lead protective clothing of subjects (Inside and outside the lead cap and the lead collar, inside and outside of the lead protective clothing in chest and abdomen, left upper arm outside of lead protective clothing, back of the left hand) and X-ray machine outgoing port when the operation was going on. After that, measure the thermoluminescence dosimeter, calculate and analyze exposure doses inside and outside of the lead protective clothing. Results: The skin doses of operators in different types of interventional diagnosis and treatment are listed in Table 1to Table 4; exposure doses of touring nurses are very low; the doses of X-ray machine outgoing port are mostly over the measuring range. Conclusion: The protection of Lead clothes plays a significant role in these two types of interventional diagnosis and treatment based on the conclusion that the dose of inside of Lead clothes is less than that of outside. We should enhance the operators' protection and administration in the process of intervention and arise the conscious of self-protection, to avoid the unnecessary radiation exposure. (authors)

A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: A matched cohort study.

Science.gov (United States)

Townley, William A; Baluch, Narges; Bagher, Shaghayegh; Maass, Saskia W M C; O'Neill, Anne; Zhong, Toni; Hofer, Stefan O P

2015-05-01

Infections following implant-based breast reconstruction can lead to devastating consequences. There is currently no consensus on the need for post-operative antibiotics in preventing immediate infection. This study compared two different methods of infection prevention in this group of patients. A retrospective matched cohort study was performed on consecutive women undergoing implant-based breast reconstruction at University Health Network, Toronto (November 2008-December 2012). All patients received a single pre-operative intravenous antibiotic dose. Group A received minimal interventions and Group B underwent maximal prophylactic measures. Patient (age, smoking, diabetes, co-morbidities), oncologic and procedural variables (timing and laterality) were collected. Univariate and multivariate logistic regression were performed to compare outcomes between the two groups. Two hundred and eight patients underwent 647 implant procedures. After matching the two treatment groups by BMI, 94 patients in each treatment group yielding a total of 605 implant procedures were selected for analysis. The two groups were comparable in terms of patient and disease variables. Post-operative wound infection was similar in Group A (n = 11, 12%) compared with Group B (n = 9, 10%; p = 0.8). Univariate analysis revealed only pre-operative radiotherapy to be associated with the development of infection (0.004). Controlling for the effect of radiotherapy, multivariate analysis demonstrated that there was no statistically significant difference between the two methods for infection prevention. Our findings suggest that a single pre-operative dose of intravenous antibiotics is equally as effective as continued antibiotic prophylaxis in preventing immediate infection in patients undergoing implant-based breast reconstructions. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Serial follow-up of presurgical treatment using pasireotide long-acting release with or without octreotide long-acting release for naïve active acromegaly

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Jan-Shun Chang

2016-06-01

Full Text Available The aim of the present study was to evaluate the serial changes of GH and IGF-1 in seven patients with naïve, active acromegaly following presurgical treatment of the somatostatin analog pasireotide long-acting release (LAR and octreotide LAR. The patients were treated with pasireotide LAR with or without octreotide LAR for two years and underwent transsphenoidal adenomectomy. After treatment with the somatostatin analogs, the surgical cure rate was similar to that in patients who underwent transsphenoidal surgery alone. Diabetes insipidus was not identified in any patients after the operation. Pasireotide LAR was effective on GH as well as IGF-1 suppression and tumor size decreasing when used as the primary therapy. Future large-population studies to investigate the surgical curative rate after presurgical treatment with somatostatin analogs in patients with acromegaly and macroadenomas close to the cavernous sinus are warranted. However, that hyperglycemia developed following pre-surgical treatment with pasireotide should take into consideration.

[Operative treatment of traumatic fractures of the thoracic and lumbar spinal column. Part I: epidemiology].

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Reinhold, M; Knop, C; Beisse, R; Audigé, L; Kandziora, F; Pizanis, A; Pranzl, R; Gercek, E; Schultheiss, M; Weckbach, A; Bühren, V; Blauth, M

2009-01-01

The Spine Study Group (AG WS) of the German Trauma Association (DGU) has now been in existence for more than a decade. Its main objective is the evaluation and optimization of the operative treatment for traumatic spinal injuries. The authors present the results of the second prospective internet-based multicenter study (MCS II) of the AG WS in three consecutive parts: epidemiology, surgical treatment and radiologic findings and follow-up results. The aim of the study was to update and review the state-of-the art for treatment of spinal fractures for thoracic and lumbar spine (T1-L5) injuries in German-speaking countries: which lesions will be treated with which procedure and what differences can be found in the course of treatment and the clinical and radiological outcome? This present first part of the study outlines the new study design and concept of an internet-based data collection system. The epidemiologic findings and characteristics of the three major treatment subgroups of the study collective will be presented: operative treatment (OP), non-operative treatment (KONS), and patients receiving a kyphoplasty and/or vertebroplasty without additional instrumentation (PLASTIE). A total of 865 patients (OP n=733, KONS n=52, PLASTIE n=69, other n=7) from 8 German and Austrian trauma centers were included. The main causes of accidents in the OP subgroup were motor vehicle accidents 27.1% and trivial falls 15.8% (KONS 55.8%, PLASTIE 66.7%). The Magerl/AO classification scheme was used and 548 (63.3%) compression fractures (type A), 181 (20.9%) distraction injuries (type B), and 136 (15.7%) rotational injuries (type C) were diagnosed. Of the fractures 68.8% were located at the thoracolumbar junction (T11-L2). Type B and type C injuries carried a higher risk for concomitant injuries, neurological deficits and additional vertebral fractures. The average initial VAS spine score, representing the status before the trauma, varied between treatment subgroups (OP 80, KONS

Endovascular Treatment of Totally Occluded Superior Mesenteric Artery by Retrograde Crossing via the Villemin Arcade

International Nuclear Information System (INIS)

Ferro, Carlo; Rossi, Umberto G.; Seitun, Sara; Bovio, Giulio; Fornaro, Rosario

2013-01-01

Chronic mesenteric ischemia (CMI) is a rare disorder that is commonly caused by progressive atherosclerotic stenosis or occlusion of one or more mesenteric arteries. Endovascular treatment for symptomatic CMI represents a viable option, especially in high-operative risk patients. We report a case of acute symptomatic CMI with chronic totally occlusion of the superior mesenteric artery (SMA) associated with significant stenosis of celiac trunk (CT) and inferior mesenteric artery (IMA) that underwent endovascular treatment of all the three mesenteric arteries: stenting of CT and IMA stenosis, and recanalization of the SMA occlusion by retrograde crossing via the Villemin arcade.

Operation and control of the critical variables of the process water treatment system in a juice factory

International Nuclear Information System (INIS)

Trejos Quesada, Juan Carlos

2014-01-01

The process water treatment system in a juice factory is studied to learn how to operate and chemically control the critical variables. The variables: concentration of total chlorine; Concentration of free chlorine; Total dissolved solids; alkalinity; hardness; PH; Turbidity are studied. A learning is obtained of the handling of equipment found in the industry, such as: pumps, dosing pumps controlled by frequency variables, static mixers, multimedia filters, carbon filters, storage tanks, electrovalves, flowmeters, pressure meters and equipment Ultraviolet radiation for disinfection. The operation of this equipment is learned to verify and maintain the critical variables in the specification range established by the company. A manual of operation of the system of water treatment and water analysis in the laboratory is carried out. The experience of the management of equipment for the treatment of water is acquired, comprehending integrally the system of water treatment and the process in general. A verification of the capacity of the equipment and the recommendation of the optimization of the system is realized for system improvements [es

Subsurface flow constructed wetlands for the treatment of wastewater from different sources. Design and operation

OpenAIRE

Torrens Armengol, Antonina

2016-01-01

The aim of the thesis is to examine the viability of the subsurface constructed wetlands for the treatment of wastewater derived from three different sources (treatment ponds, pig farms and car wash facilities), and to evaluate the influence of design (size, type and depth of media, presence of Phragmites australis) and operational parameters (hydraulic load, dosing and feeding modes) on treatment efficiency and hydraulic behavior. Several studies were done in the framework of different ...

OUTCOMES OF SURGICAL TREATMENT OF HIATAL HERNIA

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Zhurbenko G. A.

2018-05-01

Full Text Available Background: In traditionally performed fundoplications during the treatment of sliding diaphragmatic hernias, the improvement of surgical techniques to restore acute angle of His remains topical. Aim: To develop a method of surgical treatment of hiatus hernias to restore acute angle of His. Material and methods: Patients (n = 74 were divided into two groups: the main group (I (n = 45, in which the developed operation method was applied and the control group (II (n = 29, in which Toupet method was applied to 26 patients, Nissen method – to 3 patients. GERD-Q and GERD-HRQL questionnaires were applied to all patients of the first group before the operation, during discharge from hospital and 6-12 12-18 18-24 months after surgical intervention. Patients of the second group were surveyed 6-12 months after the operation. Results: According to the results of the survey after 6-12 months statistically significant differences were not revealed in the groups: GERD-Q, p<0,386; GERD-HRQL, p<0,1089. In the main group there was a tendency to decrease the points in the GERD-Q survey when compared before and after surgery, p <0.0001. Out of 16 (55% patients of the second group hospitalized after the operation the relapse was revealed in 9 patients, 7 of them were re-operated. 20(43,3% patients of group I underwent inpatient examination, 2 relapsed and no one was re-operated. Conclusion: The efficiency of the suggested operation technique is comparable to Toupet method in the early stages, although when assessing the remote results there are a less number of relapses.

The clinical application and nursing experience of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus

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YANG Li-rong

2012-02-01

Full Text Available Objective To introduce the application of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus. Methods Twenty-four patients with normal pressure hydrocephalus implanted adjustable shunt valve underwent ventriculo-peritoneal shunt surgery and nursing care. Results After operation, cerebrospinal pressure was regulated for 0-6 (1.88 ± 1.52 times. Clinical symptoms were improved, especially in gait disturbance. Conclusion Treatment of normal pressure hydrocephalus with adjustable shunt valve can alleviate symptoms of hydrocephalus. It is especially suitable for patients with short course and secondary normal hydrocephalus patients.

Treatment time and occlusal outcome of orthognathic therapy in the East of England region.

Science.gov (United States)

Jeremiah, Huw G; Cousley, Richard R; Newton, Tim; Abela, Stefan

2012-09-01

To evaluate the process of combined orthognathic and orthodontic care. To identify factors that affect treatment time and percentage Peer Assessment Rating (PAR) reduction, and the PAR efficiency factor for such cases. Retrospective multi centre study of patients who underwent orthognathic treatment in the East of England region. Analysis of consecutive cases that underwent orthognathic surgery in 2008. Inclusion criteria included pre- and post-surgery orthodontic treatment. Ten orthodontic units submitted data for a total of 118 patients. Within the sample, 64% were class III, 35% class II/1 and 1% class II/2. Overall extraction rate, excluding third molars, was 58%. Median age at bond up was 17 years. Mean total number of orthodontic attendances was 23. Median length of pre-surgical orthodontics was 23 months and post-surgical orthodontics was 7 months. Median length of total treatment was 29 months. Mean wait for surgery was 3·6 months. Diagnosis of incisor relationship and skeletal base, transfer of operator, total number of visits, tooth extraction and treatment unit affected treatment duration. Median pre- and post-treatment PAR scores were 43 and 4, respectively. Median change in PAR score was 38·5. Median per cent reduction in PAR was 90·6%. The median PAR efficiency factor (reduction in PAR score divided by treatment time in months) was 1·24. Diagnosis of incisor relationship and skeletal base correlated with percentage reduction in PAR score. Combined orthognathic treatment was effective. Factors affecting treatment duration and percentage reduction in PAR have been established.

Three cases of temporal bone osteoradionecrosis after nasopharyngeal carcinoma treatment

International Nuclear Information System (INIS)

Yamatodani, Takashi; Mizuta, Kunihiro; Nakanishi, Hiroshi; Takizawa, Yoshinori; Hosokawa, Kumiko; Hosokawa, Seiji; Mineta, Hiroyuki

2012-01-01

Osteoradionecrosis is most commonly caused by radiation-induced injury. We report on 3 cases of temporal bone necrosis that occurred after chemoradiotherapy for nasopharyngeal carcinoma performed more than 10 years previously. Case 1 was a 42-year-old woman who had nasopharyngeal carcinoma in 1991. The patient underwent chemoradiotherapy (70 Gy total) in 1991, and gamma knife irradiation (20 Gy) in 1998 for local recurrence. The bone in the posterior wall of the left external auditory canal began to be exposed in 2003. Otorrhea from the left ear increased and we found a skin defect and ulcer formation in the postauricular region. We performed radical mastoidectomy and debridement on April, 2010. The area of the defect was covered and filled in with a pedicle musculoperiosteal flap. The intra-aural skin became dry in 6 months, however, she lost consciousness due to a temporal lobe abscess and underwent an emergency operation on April, 2011. After operation, the patient recovered with no neurological symptoms and infections up to the present date. Case 2 was a 58-year-old man who had nasopharyngeal carcinoma in 2001. The patient underwent chemoradiotherapy (66 Gy total) in 2001, and X knife irradiation (15 Gy) 3 months later due to the remaining tumor. The left posterior ear canal wall collapsed and the tympanic membrane retracted with pooling epithelial debris appearing in 2007. Left facial nerve palsy was seen in December 2010. We performed a mastoidectomy on January, 2011. Cholesteatoma and necrotic granuloma with fragile bone filled the mastoid cavity, and a facial canal bone defect was seen. Bone necrosis with cholesteatoma and inflammatory granuloma was revealed by the pathological examination. The facial palsy improved after the operation. Case 3 was a 59-year-old man who had left abducens palsy with nasopharyngeal carcinoma invading the clivus. The patient underwent chemoradiotherapy (60 Gy total) in 2001, and X knife irradiation (24 Gy) 4 months later for

Operational amplifiers

CERN Document Server

Dostal, Jiri

1993-01-01

This book provides the reader with the practical knowledge necessary to select and use operational amplifier devices. It presents an extensive treatment of applications and a practically oriented, unified theory of operational circuits.Provides the reader with practical knowledge necessary to select and use operational amplifier devices. Presents an extensive treatment of applications and a practically oriented, unified theory of operational circuits

The Laparoscopic Approach in the Treatment of Diverticular Colon Disease

Science.gov (United States)

del Olmo, J. C. Martin; Blanco, J. I.; de la Cuesta, C.; Atienza, R.

1998-01-01

Background and Objectives: The experience with treatment of diverticular colon disease (DCD) by the laparoscopic method is analyzed. Methods: Between January 1994 and July 1997, a group of 22 patients with criteria for symptomatic diverticular disease in the descending and sigmoid colon underwent laparoscopy with average resections of 40 cm. Intra-abdominal mechanical anastomosis completed the procedure. Results: The operative morbidity was 28%. Two cases, in acute diverticulitis phase, were reconverted to open surgery, and three cases presented postoperative rectorrhagia which ceased spontaneously. No long-term complications have been found. Postoperative hospitalization was 4-8 days (mean 5.5) and mean operative time was 165 minutes (range 120-240). Conclusions: Nevertheless, the learning curve precise to practice this type of surgery, the acceptable morbity-mortality rates which the laparoscopic method presents, especially with these high-risk groups of patients (age > 65, high blood pressure, etc), encouraged us to modified the criteria indicating surgery for the disease, offering first choice operative treatment with efficiency and safety. However, we feel that those patients with acute complications of diverticular colon disease must be excluded initially for laparoscopic approach. PMID:9876730

[Modern diagnosis and treatment in children with congenital basal encephalocele].

Science.gov (United States)

Sakharov, A V; Roginskiy, V V; Kapitanov, D N; Ivanov, A L; Shelesko, E V; Gorelyshev, S K; Evteev, A A; Lemeneva, N V; Zinkevich, D N; Kochkin, Yu A; Ozerova, V I; Satanin, L A

Basal encephalocele is a rare disease that predominantly occurs in children. Its most common symptoms include nasal liquorrhea, difficulty in nasal breathing, and deformity of the naso-orbital region. The study group included 19 patients with basal encephalocele, aged 2 months to 18 years. Ten (59%) patients were operated on through a transnasal endoscopic approach; 3 (17.5%) patients were operated on through a transcranial approach; 4 (23.5%) patients were operated on using a combined approach: the patients underwent simultaneous elimination of a cranio-orbital region deformity using the basal transcranial approach as well as hernial sac resection and hernioplasty using the transnasal endoscopic approach. Two children had no surgery due to minimal symptoms and a lack of cerebrospinal fluid leak. Application of the algorithms for diagnosis and treatment of encephalocele, suggested by the authors, enabled making the timely diagnose, defining the optimal surgical tactics, and achieving good treatment results. A differentiated approach to the choice of a surgical technique for basal encephalocele, the use of auto-tissues for skull base reconstruction, intraoperative and postoperative lumbar drainage, and simultaneous elimination of deformity of the fronto-naso-orbital region enable avoiding complications and achieving good functional and aesthetic results.

Burst fractures of the thoracolumbar spine : changes of the spinal canal during operative treatment and follow-up

NARCIS (Netherlands)

Leferink, VJM; Nijboer, JMM; Zimmerman, KW; Veldhuis, EFM; ten Vergert, EM; ten Duis, HJ

Although multiple studies have concluded operative decompression of a traumatically narrowed spinal canal is not indicated because of spontaneous remodeling, instrumental decompression is frequently used as part of the operative treatment of spinal fractures. To investigate the process of

[The randomized controlled trial of influences of T shape approach on the function of knee joint in the treatment of proximal tibial fractures].

Science.gov (United States)

Peng, Wei-xiong; Zhang, Zhi; Liang, Jie-hong

2008-04-01

To investigate the clinical value of T shape approach in the treatment of proximal tibial fractures. One handrend and thirteen patients of proximal tibial fractures were randomly divided into two groups. Group A: 62 cases underwent the traditional exposure approach. According to Schatzker classification,the cases of II to VI type was 25, 10, 16, 6, 5 respectively. Group B:51 cases underwent T shape approach ahead of knee joint, the cases of II to VI type was 21, 8, 13, 5, 4 respectively. All data were analyzed by SPSS 10.0 to compare operation time, blood loss, duration of hospitalization, healing time, the time of osseous union and complications after operation. Sixty patients in group A and 50 patients in group B were followed-up from 12 to 24 months. (1) Operation time:group B was longer than A (P time:group B was shorter. (4) Mean time of osseous union: 48 group B was shorter. Function of knee: group B was better than group A. (Complication: group B was less than group A. As compared with traditional exposure approach, T shape approach of knee joint had advantages of small scar, fewer complications, faster union of fracture and earlier recovery of joint function. The approach is valuable for the treatment of proximal tibial fractures.

Non-operative treatment of a fracture to the coracoid process with acromioclavicular dislocation in an adolescent

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Vera Pedersen

2014-08-01

Full Text Available Coracoid process fractures are rare and often associated with dislocations of the acromioclavicular (AC joint. There is little evidence about the treatment of these injuries in adolescents, but the few case reports published recommend surgery. We report a case of a dislocated epiphyseal fracture to the base of the coracoid process with AC joint dislocation in a 14-year-old ice-hockey player following direct impact to his left shoulder. Since magnetic resonance tomography revealed intact AC and coracoclavicular ligaments, we initiated non-operative treatment with immobilization and unloading of the shoulder by an abduction brace allowing limited rotation for 6 weeks. This treatment resulted in complete recovery after 8 weeks and return to full sports on first league level after 3 month. In conclusion, non-operative treatment of coracoid base fractures with concomitant AC-joint injury in the adolescent can result in excellent functional results and early recovery.

Centrifuge. Operational Control Tests for Wastewater Treatment Facilities. Instructor's Manual [and] Student Workbook.

Science.gov (United States)

Arasmith, E. E.

Designed for individuals who have completed National Pollutant Discharge Elimination System (NPDES) level 1 laboratory training skills, this module provides waste water treatment plant operators with the basic information needed to: (1) successfully run a centrifuge test; (2) accurately read results obtained in test tubes; and (3) obtain…

Turbidity. Operational Control Tests for Wastewater Treatment Facilities. Instructor's Manual [and] Student Workbook.

Science.gov (United States)

Carnegie, John W.

Designed for individuals who have completed National Pollutant Discharge Elimination System (NPDES) level 1 laboratory training skills, this module provides waste water treatment plant operators with the basic skills and information needed to: (1) standardize a nephelometric turbidimeter; (2) determine the turbidity of a sample; and (3) calculate…

A multidisciplinary clinical treatment of locally advanced rectal cancer complicated with rectovesical fistula: a case report

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Zhan Tiancheng

2012-10-01

Full Text Available Abstract Introduction Rectal cancer with rectovesical fistula is a rare and difficult to treat entity. Here, we describe a case of rectal cancer with rectovesical fistula successfully managed by multimodality treatment. To the best of our knowledge, this is the first such case report in the literature. Case presentation A 51-year-old Chinese man was diagnosed as having rectal cancer accompanied by rectovesical fistula. He underwent treatment with neoadjuvant radiochemotherapy combined with total pelvic excision and adjuvant chemotherapy, as recommended by a multimodality treatment team. Post-operative pathology confirmed the achievement of pathological complete response. Conclusions This case suggests that a proactive multidisciplinary treatment is needed to achieve complete cure of locally advanced rectal cancer even in the presence of rectovesical fistula.

Surgical treatment of hepatic echinococcosis in Prizren (Kosovo)

Science.gov (United States)

Avdaj, Afrim; Namani, Sadie

2014-01-01

Management option of hepatic echinococcosis represents a major challenge for a surgeon. The aim of the study was to evaluate surgical treatment of patients with hepatic echinococcosis at the surgery department of the regional hospital in Prizren (Kosovo). The medical records of 22 patients operated for hepatic echinococcosis in our department during a four year study period (2009–2013) were retrospectively reviewed. Apart from the total of 5850 operated patients, 22 cases were diagnosed for liver echinococcosis (0.4%). The most affected age group was from 26 to 50 years (54.5%). Female gender, 16 cases (73%), and patients living in rural places, 14 patients (64%), dominated significantly. The most affected region was Municipality of Dragash. All patients underwent ultrasonography, 13 patients underwent CT scans and 5 patients MRI of abdomen. The mean preoperative ultrasonographic diameter of cysts was 9.5 cm and maximal 21 cm. Cysts were most often localized in right hepatic lobe (77%) and subcostal laparotomy was most commonly performed (82%). The performed surgical procedures were: endocystectomy and partial pericystectomy with omentoplication according to Papadimitris (73%), endocystectomy and capitonnage and endocystectomy with external drainage (14%). The laparoscopic approach was used only in one patient. In conclusion, hepatic echinococosis was not common among operated patients at our surgery department. Subcostal laparotomy with endocystectomy and partial pericystectomy with omentoplication according to Papadimitris was most commonly used. Exact distribution of echinococcosis is needed to be analyzed with a larger cohort study including all surgery units in the country and with a longer monitoring. PMID:25568800

Vegetated treatment area (VTAs) efficiencies for E. coli and nutrient removal on small-scale swine operations

OpenAIRE

R. Daren Harmel; Rehanon Pampell; Terry Gentry; Doug R. Smith; Chad Hajda; Kevin Wagner; Patti K. Smith; Rick L. Haney; Kori D. Higgs

2018-01-01

As small-scale animal feeding operations work to manage their byproducts and avoid regulation, they need practical, cost-effective methods to reduce environmental impact. One such option is using vegetative treatment areas (VTAs) with perennial grasses to treat runoff; however, research is limited on VTA effectiveness as a waste management alternative for smaller operations. This study evaluated the efficiencies of VTAs in reducing bacteria and nutrient runoff from small-scale swine operation...

A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up.

Science.gov (United States)

Chen, Yuqiao; Lü, Guohua; Wang, Bing; Li, Lei; Kuang, Lei

2016-07-01

To evaluate the clinical efficacy and radiological outcomes of anterior cervical discectomy and fusion (ACDF) using self-locking polyetheretherketone (PEEK) cages for treatment of three-level cervical degenerative spondylopathy. Twenty-eight patients underwent three-level ACDF using self-locking stand-alone PEEK cages (group A), and 26 patients underwent three-level ACDF using cages and plate fixation (group B) were reviewed retrospectively. Clinical efficacy was evaluated by pre- and post-operative Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI). The operation time, blood loss, surgical results according to Odom's criteria and post-operative dysphagia status were also recorded. Radiological outcomes including fusion, cervical Cobb's lordosis, fused segment angle, disc height, and cage subsidence were assessed. Clinical outcome measures such as dysphagia and fusion rate and the results of surgery evaluated according to Odom's criteria were not statistically significant (P > 0.05) between groups. The operation time was shorter and blood loss was less in group A (P  0.05). Post-operative cage subsidence, the loss of disc height, cervical lordosis and the fused segment angle were relatively higher in group A than group B (P < 0.05). ACDF using self-locking stand-alone cages showed similar clinical results as compared to ACDF using cages and plate fixation for the treatment of three-level cervical degenerative spondylopathy. However, potential long-term problems such as cage subsidence, loss of cervical lordosis and fused segment angle post-operatively were shown to be associated with patients who underwent ACDF using self-locking stand-alone cages.

Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

Science.gov (United States)

Yaldiz, Can; Yaldiz, Mahizer; Ceylan, Nehir; Kacira, Ozlem Kitiki; Ceylan, Davut; Kacira, Tibet; Kizilcay, Gokhan; Tanriverdi, Taner

2015-07-01

Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

Multidetector CT angiography influences the choice of treatment for blunt carotid artery injury.

Science.gov (United States)

Beliaev, Andrei M; Civil, Ian

2014-08-06

A 43-year-old woman presented with a 2 h history of left neck pain after striking her neck against a marble bench while playing with her son. The patient was screened for blunt cerebrovascular injury (BCVI) and a left carotid bruit was identified. Subsequently, she underwent multidetector CT angiography (MCTA) of the aortic arch and neck vessels, which demonstrated a flow-limiting dissection of the left common carotid artery (CCA). The patient was started on heparin infusion and underwent an emergency operation. At surgery, a circumferential intimal dissection was excised and the arteriotomy defect closed with an autologous venous patch. This case emphasises the importance of adequately examining patients with direct injury to the neck, screening relevant patients for BCVI and investigating them with MCTA that influences the choice of a treatment option. 2014 BMJ Publishing Group Ltd.

Six-year experiences in the operation of a low level liquid waste treatment plant

International Nuclear Information System (INIS)

Wen, S.-J.; Hwang, S.-L.; Tsai, C.-M.

1980-01-01

The operation of a low level liquid waste treatment plant is described. The plant is designed for the disposal of liquid waste produced primarily by a 40 MW Taiwan Research Reactor as well as a fuel fabrication plant for the CANDU type reactor and a radioisotopes production laboratory. The monthly volume treated is about 600-2500 ton of low level liquid waste. The activity levels are in the range of 10 -5 -10 -3 μCi/cm 3 . The continuous treatment system of the low level liquid waste treatment plant and the treatment data collected since 1973 are discussed. The advantages and disadvantages of continuous and batch processes are compared. In the continuous process, the efficiency of sludge treatment, vermiculite ion exchange and the adsorption of peat are investigated for further improvement. (H.K.)

The effects of physicochemical wastewater treatment operations on forward osmosis.

Science.gov (United States)

Hey, Tobias; Bajraktari, Niada; Vogel, Jörg; Hélix Nielsen, Claus; la Cour Jansen, Jes; Jönsson, Karin

2017-09-01

Raw municipal wastewater from a full-scale wastewater treatment plant was physicochemically pretreated in a large pilot-scale system comprising coagulation, flocculation, microsieve and microfiltration operated in various configurations. The produced microsieve filtrates and microfiltration permeates were then concentrated using forward osmosis (FO). Aquaporin Inside TM FO membranes were used for both the microsieve filtrate and microfiltration permeates, and Hydration Technologies Inc.-thin-film composite membranes for the microfiltration permeate using only NaCl as the draw solution. The FO performance was evaluated in terms of the water flux, water flux decline and solute rejections of biochemical oxygen demand, and total and soluble phosphorus. The obtained results were compared with the results of FO after only mechanical pretreatment. The FO permeates satisfied the Swedish discharge demands for small and medium-sized wastewater treatment plants. The study demonstrates that physicochemical pretreatment can improve the FO water flux by up to 20%. In contrast, the solute rejection decreases significantly compared to the FO-treated wastewater with mechanical pretreatment.

PERIPROSTHETIC JOINT INFECTION IN PATIENTS WITH RHEUMATIC DISEASES: THE PROBLEMS OF DIAGNOSIS, PREVENTION, AND TREATMENT

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A. E. Khramov

2015-01-01

Full Text Available One of the most menacing complications of large joint total endoprosthesis (TE in patients with rheumatic diseases (RD is the development of periprosthetic infection (PI, progression of which may give rise not only to limb loss, but also death. At the same time, early diagnosis and adequate surgical care make it possible not only to arrest the infectious process, but also to preserve an implanted joint.Objective: to define criteria for the diagnosis, prevention, and treatment of PI after hip and knee joint (HJ and KJ TE in patients with RD.Subjects and methods. In 2009 to 2013, 654 KJ and 549 HJ TE was performed in the V.A. Nasonova Research Instituteof Rheumatology performed KJ (n = 654 and HJ (n = 549 joint ERs.Results and discussion. PI developed in 12 (3.63% and 8 (2.95% patients after KJ and HJ ER, respectively. Early, delayed, and late PI was seen in 11, 6, and 3 patients, respectively. Eleven patients with early PI underwent joint revision/ debridement with preservation of an endoprosthesis and replacement of HJ endoprosthetic inserts and heads. The operations were completed with the collagen hemobiotics being left in the wound and its drainage. Systemic antibiotic therapy was used for 4–6 weeks. No recurrent infection was observed in 9 cases. Two patients underwentresurgery, by setting suction-irrigation systems. Nine patients with delayed or late PI had the following operations: A single-stage revision operation (the endoprosthesis was removed and a new one was implanted was performed in two cases of stable endoprosthetic components and accurately verified low-virulent microorganisms susceptible to certain antibiotics. It was imperative to use cement with an antibiotic, collagen hemobiotics, and systemic antibiotic therapy for 6 weeks. The other 7 patients with unstable endoprosthetic components underwent two-stage revision: Stage 1, endoprosthetic removal and antibiotic-loaded spacer implantation; 6-12 weeks after

TAX TREATMENT OF CARBON CREDIT OPERATIONS IN BRAZILIAN COMPANIES WITH CDM PROJECTS

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Vanderlei dos Santos

2012-06-01

Full Text Available The aim in this study is to identify the tax treatment applied to carbon credit operations in Brazilian companies that are developing projects in the context of the Clean Development Mechanism (CDM. Therefore, an exploratory research with a qualitative approach was developed. Data were collected with the help of questionnaire, forwarded to all Brazilian companies with CDM projects that received approval from the Inter-Ministerial Commission on Global Climate Change (CIMGC without safeguards, according to the list of the Brazilian Ministry of Science and Technology. Out of 117 companies listed, only five answered the research instrument, which represents an accessibility sample. The results show that, as for the tax treatment applied in the companies under analysis, IRPJ and CSLL should be charged on carbon credit operations. Regarding PIS, COFINS, ISS, some companies considered that these taxes are due and others that they are not. There is a consensus, though, about the fact that ICMS and IOF should not be charged. In conclusion, no uniform understanding exists as of yet about due taxes in the research sample, as no specific fiscal legislation exists yet on carbon credits in Brazil.

Pulsed radiofrequency ablation for treatment of severe pain after shoulder arthroplasty (case report

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D. V. Zabolotsky

2015-01-01

Full Text Available A case of refractory neuropathic pain syndrome in patient who underwent monopolar shoulder replacement is presented. The patient had right lung tumor metastasis in the right humeral head. Severe neuropathic pain syndrome, not responding to 6-months conservative treatment, developed in post-operative period. Pulsed radiofrequency ablation of C4-C6 nerve roots via interscalene access was performed. The procedure allowed the patient to stop taking painkillers and improved his quality of life. The patient was monitored for 2 months.

[Bladder injury during sling operation in the treatment of SUI--review of literature and case report].

Science.gov (United States)

Gałczyński, Krzysztof; Futyma, Konrad; Bar, Krzysztof; Rechberger, Tomasz

2012-10-01

Sling operations have been performed for over 15 years. In recent years these operations have become the gold standard in the treatment of stress urinary incontinence (SUI) due to their efficacy safety and low invasiveness. Approximately 4% of women will undergo a surgery for SUI in the course of their life. As with any surgical intervention, there may be some technical problems, as well as intra- and postoperative complications, the most common of which is bladder injury Other complications encountered during mid-urethral slings procedures include bleeding (retropubic or vaginal hematomas), urethral perforation, urinary tract infections, postoperative vaginal or urethral erosions, bowel perforation, chronic pelvic pain, wound infection, nerve injury transient and persistent voiding dysfunction such as de novo urgency incomplete bladder emptying or urinary retention. Below we present a case of a patient with diagnosed vesicovaginal fistula after sling operation (TVT-tension-free vaginal tape). Upon admission the patient reported dysuria, persistent urinary leakage and abnormal, abundant vaginal discharge. Case report and review of literature concerning surgical treatment of stress urinary incontinence and its complications. Analysis of medical documentation of the patient treated at the Second Department of Gynecology Medical University of Lublin. Review of abstracts or papers in the Medline database related to surgical treatment of urinary incontinence and its complications. Bladder perforation is one of the most common complications of the retropubic approach for MUS placement. The presence of mesh within the bladder may arise from direct bladder perforation or from subsequent erosion of the sling. Such lesions do not cause any serious health consequences for patients on condition they are detected intraoperatively and appropriately repaired, but when unrecognized, they results in the development of considerable symptoms and negatively influence the quality of

Conventional operation and laser therapy in the treatment of varicose veins

Institute of Scientific and Technical Information of China (English)

无

2007-01-01

Objective: To evaluate the effectiveness of endovenous laser therapy and conventional therapy on the varicose of great saphenous vein. Methods: Thirty-two patients received endovenous laser therapy and 32 patients were operated by conventional therapy (high ligation and stripping). The observation results of great saphenous vein(GSV) were recorded by clinical evaluation and duplex ultrasound examination. And the operating time, intraoperative blood loss, time to become moveable, duration of hospitalization and degree of feeling pain were compared between the two groups. Results: Compared with conventional therapy, laser therapy had good curative effect with less complications and no scars and no pains. There were significant differences between the two groups (P＜0.01). Conclusion: Laser therapy for varicose of great saphenous vein is better than the conventional therapy. It deserves to be widely used in clinical treatment.

Surgical treatment of chronic pancreatitis using Frey's procedure: a Brazilian 16-year single-centre experience.

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Gestic, Martinho Antonio; Callejas-Neto, Francisco; Chaim, Elinton Adami; Utrini, Murillo Pimentel; Cazzo, Everton; Pareja, Jose Carlos

2011-04-01

Surgical treatment of chronic pancreatitis is indicated for intractable pain. Frey's procedure is an accepted treatment for this disease. The aim of the present study was to describe a single-centre experience in the treatment of chronic pancreatitis using Frey's procedure. A retrospective analysis of 73 patients who underwent a Frey's procedure between 1991 to 2007 and had at least 1 year of follow-up. Demographics, indication for surgery, peri-operative complications and late outcomes were analysed. The median age was 39.9 years. Seventy out of the 73 (95.8%) patients were male. The median pre-operative body mass index (BMI) was 19.1 kg/m(2). All patients had abdominal pain, 34 (46.6%) of them daily and 13 (17.8%) weekly, with moderate or severe intensity in 98.6% (n= 72). The aetiology was secondary to alcohol in 70 patients (95.9%), with a median consumption of 278 g per day. The surgical morbidity rate was 28.7%; there were no deaths. Median post-operative follow-up was 77.0 months; 64 patients (91.4%) had complete pain relief and post-operative BMI was 22.4 kg/m(2) (P<0.001). All patients with pre-operative endocrine and exocrine insufficiencies showed no reversal of the situation. New onset insufficiencies appeared late. Frey's procedure was a safe and effective therapeutic option for the surgical treatment of patients with intractable pain caused by chronic pancreatitis. © 2011 International Hepato-Pancreato-Biliary Association.

Surgical resection versus radiofrequency ablation in treatment of small hepatocellular carcinoma

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HE Xiuting

2013-08-01

Full Text Available ObjectiveTo compare clinical efficacy and recurrence between surgical resection and radiofrequency ablation (RFA in the treatment of small hepatocellular carcinoma (HCC. MethodsThe clinical data of 97 patients with small HCC, who underwent surgical resection or RFA as the initial treatment in The First Hospital of Jilin University from January 2002 to December 2008, were collected. Sixty-three cases, who survived 2 years after treatment, were followed up; of the 63 cases, 34 underwent surgical resection, and 29 underwent RFA. The recurrence of these patients was analyzed retrospectively. The measurement data were analyzed by chi-square test. The Cox regression analysis was used for determining the risk factors for recurrence. The log-rank test was used for disease-free survival (DFS difference analysis. ResultsThe 3-month, 1-year, and 2-year intrahepatic recurrence rates for the patients who underwent surgical resection were 15%, 38%, and 64%, respectively, versus 21%, 35%, and 45% for those who underwent RFA, without significant differences between the two groups of patients. The intrahepatic recurrence after initial treatment was not significantly associated with treatment method, sex, age, Child-Pugh grade, tumor size, number of nodules, presence of cirrhosis, and alpha-fetoprotein level. There was no significant difference in DFS between the two groups of patients. ConclusionRFA produces a comparable outcome to that by surgical resection in the treatment of small HCC. RFA holds promise as a substitute for surgical resection.

[Operative treatment strategies for multiple trauma patients : early total care versus damage control].

Science.gov (United States)

Klüter, T; Lippross, S; Oestern, S; Weuster, M; Seekamp, A

2013-09-01

The treatment of multiple trauma patients is a great challenge for an interdisciplinary team. After preclinical care and subsequent treatment in the emergency room the order of the interventions is prioritized depending of the individual risk stratification. For planning the surgery management it is essential to distinguish between absolutely essential operations to prevent life-threatening situations for the patient and interventions with shiftable indications, depending on the general condition of the patient. All interventions need to be done without causing significant secondary damage to prohibit hyperinflammation and systemic inflammatory response syndrome. The challenge consists in determination of the appropriate treatment at the right point in time. In general the early primary intervention, early total care, is differentiated from the damage control concept.

Predictors of Post-operative Mycetoma Recurrence Using Machine-Learning Algorithms: The Mycetoma Research Center Experience.

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Ali Wadal

2016-10-01

Full Text Available Post-operative recurrence in mycetoma after adequate medical and surgical treatment is common and a serious problem. It has health, socio-economic and psychological detrimental effects on patients and families. It is with this in mind, we set out to determine the predictors of post-operative recurrence in mycetoma. The study included 1013 patients with Madurella mycetomatis causing eumycetoma who underwent surgical excision at the Mycetoma Research Centre, Khartoum, Sudan in the period 1991-2015. The clinical records of these patients were reviewed and relevant information was collected using a pre-designed data collection sheet. The study showed, 276 patients (27.2% of the studied population developed post-operative recurrence, 217 were males (78.6% and 59 were females (21.4%. Their age ranged between 5 to 70 years with a mean of 32 years. The disease duration at presentation ranged between 2 months and 17 years. The majority of the patients 118 (42.8% had mycetoma of 1 year duration. In this study, students were the most affected; 105 (38% followed by workers 70 (25.4%, then farmers 48(17.3%. The majority of the patients were from the Central Sudan 207 (75%, Western Sudan 53 (19.2% while 11 patients (4% were from the Northern part. Past history of surgical intervention performed elsewhere was reported in 196 patients (71.1%. Family history of mycetoma was reported in 50 patients (18.1%. The foot was the most affected site, 245 (88.7%, followed by the hand seen in 19 (6.8% patients and 44 (4.5% had different sites involvement. Most of the patients 258 (93.5% had wide local surgical excisions while 18 had major amputation. The model predicted that the certain groups have a high risk of recurrence, and these include patients with disease duration greater than 10 years and extra-pedal mycetoma. Patients with disease duration between [5-10] years, with pedal mycetoma, who had previous surgery, with positive family history and underwent wide local

Trans-obturator Tape in surgical treatment of urinary incontinence

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Ashrafi M

2008-06-01

Full Text Available Background: The aim of this study was to assess the efficacy and safety of a new minimally-invasive surgical procedure using trans-obturator Tape (TOT to treat female stress urinary incontinence.Methods: This clinical trial study was performed from 2003 to 2004 in the Gynecology Department of Imam Hospital, Vali-e-Asr, Tehran, Iran. A total of 35 women with stress urinary incontinence underwent the TOT procedure. All patients underwent pre-operative clinical examination, cough-stress test (full bladder, uroflowmetry and post-voiding residual volume assessment. Results: The mean age of patients was 50 years, ranging from 26 to 74 years, with an average urinary stress incontinence duration of six years. The mean time of follow-up was 14 months (at 1, 6, 12 and 24 months and the average duration of surgery was about 20 minutes. The perioperative complication rate was 9% with no vascular, nerve or bowel injuries. The rate of hemorrhagic side effects (spontaneously-absorbed hematoma and blood loss not requiring blood transfusion was 2.9%. Post-operative urinary retention and vaginal erosion occurred in one case each; the former was treated by intermittent self-catheterization. In total, 91.4% of patients were completely cured and 8.6% were improved without failure of treatment. Conclusions: The present study confirms the results obtained by Delorme and coworkers, and allows us to consider TOT as a safe, minimally invasive and efficient short-term surgical technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Following this study, a randomized control trial is recommended to compare TOT with the gold standard surgery for women with urinary incontinence.

One stage surgical treatment for scoliosis associated with intraspinal abnormalities

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Kai WANG

2017-09-01

Full Text Available Objective To evaluate the effectiveness and safety of one stage surgical treatment for scoliosis and coexisting intraspinal abnormalities. Methods The data of 6 patients who underwent one stage surgical treatment for scoliosis and coexisting intraspinal abnormalities from October 2016 to January 2017 were retrospectively analyzed. Treatment for intraspinal abnormalities, posterior correction, osteotomy and internal fixation were performed simultaneously. The clinical and radiologic presentations, operative details, complications and postoperative outcomes were evaluated. Results The success rate was 100%. The operating time was (470.83 ± 136.20 min and intraoperative bleeding amount was 1350 (625, 2150 ml. Total fusion segments were 11.00 ± 2.76. Both Cobb angle of scoliosis [postoperation (19.60 ± 5.94° vs. preoperation (59.40 ± 14.31°, P = 0.007] and kyphosis [postoperation (25.80 ± 10.87° vs. preoperation (62.40 ± 21.04°, P = 0.005] were improved after operation. Tethered cords were released and epidermoid cyst, ganglioglioma and lipoma were excised. Syringomyelia was left untreated. No neurological functional defect or worsening was found. Muscle strength of all patients was improved. Muscular tone of 4 patients and difficulty in urination of 5 patients were also improved. The mean hospital stay was (8.83 ± 3.31 d. No severe complications, such as infection, cerebrospinal fluid (CSF leakage, failed internal fixation, fractured pedicle screws or rods occurred after operation. None of the patients died, or experienced deterioration of neurological function, delayed infection, pseudoarthrosis, or loss correction during the (7.50 ± 1.22 months follow - up. Conclusions The one stage surgical treatment for scoliosis and intraspinal abnormalities seems to be a safe and effective approach. Neurological functional defect can be improved after operation. Osteotomy can improve correction result. DOI: 10.3969/j.issn.1672-6731.2017.09.011

"Elephant trunk" and endovascular stentgrafting : a hybrid approach to the treatment of extensive thoracic aortic aneurysm

OpenAIRE

Holubec, Tomás; Raupach, Jan; Dominik, Jan; Vojácek, Jan

2013-01-01

A hybrid approach to elephant trunk technique for treatment of thoracic aortic aneurysms combines a conventional surgical and endovascular therapy. Compared to surgery alone, there is a presumption that mortality and morbidity is reduced. We present a case report of a 42-year-old man with a giant aneurysm of the entire thoracic aorta, significant aortic and tricuspid regurgitation and ventricular septum defect. The patient underwent multiple consecutive operations and interventions having, am...

Operation and control of ion-exchange processes for treatment of radioactive wastes

International Nuclear Information System (INIS)

Emelity, L.A.

1967-01-01

A manual dealing with the application of ion-exchange materials to the treatment of radioactive wastes and reviewing the facilities currently using this method. This book is one of three commissioned by the IAEA on the principal methods of concentrating radioactive wastes. The content of this document is: (i) Historical review related to removal of radioactivity; (ii) Principles of ion exchange (iii) Ion-exchange materials; (iv) Limitations of ion exchangers; (v) Application of ion exchange to waste processing; (vi) Operational procedures and experiences; (vii) Cost-of-treatment by ion-exchange. The document also gives a list of producers of ion-exchange material and defines some relevant terms. 101 refs, 31 figs, 27 tabs

Emissions model of waste treatment operations at the Idaho Chemical Processing Plant

International Nuclear Information System (INIS)

Schindler, R.E.

1995-03-01

An integrated model of the waste treatment systems at the Idaho Chemical Processing Plant (ICPP) was developed using a commercially-available process simulation software (ASPEN Plus) to calculate atmospheric emissions of hazardous chemicals for use in an application for an environmental permit to operate (PTO). The processes covered by the model are the Process Equipment Waste evaporator, High Level Liquid Waste evaporator, New Waste Calcining Facility and Liquid Effluent Treatment and Disposal facility. The processes are described along with the model and its assumptions. The model calculates emissions of NO x , CO, volatile acids, hazardous metals, and organic chemicals. Some calculated relative emissions are summarized and insights on building simulations are discussed

Operation and control of ion-exchange processes for treatment of radioactive wastes

Energy Technology Data Exchange (ETDEWEB)

Emelity, L A [Los Alamos National Lab., NM (United States)

1967-12-01

A manual dealing with the application of ion-exchange materials to the treatment of radioactive wastes and reviewing the facilities currently using this method. This book is one of three commissioned by the IAEA on the principal methods of concentrating radioactive wastes. The content of this document is: (i) Historical review related to removal of radioactivity; (ii) Principles of ion exchange (iii) Ion-exchange materials; (iv) Limitations of ion exchangers; (v) Application of ion exchange to waste processing; (vi) Operational procedures and experiences; (vii) Cost-of-treatment by ion-exchange. The document also gives a list of producers of ion-exchange material and defines some relevant terms. 101 refs, 31 figs, 27 tabs.

OPERABILITY RATE OF DISTAL GASTRIC CANCER AND THE EFFECT OF GASTRIC OUTLET OBSTRUCTION IN THE OPERABILITY RATE AND POSTOPERATIVE OUTCOME- A RETROSPECTIVE STUDY

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Rajesh T. R

2017-10-01

Full Text Available BACKGROUND Stomach cancer is the fourth most common malignancy in the world. 1 Except in countries where screening for stomach cancer is prevalent, most of the distal stomach tumours are diagnosed at advanced stage. Gastric outlet obstruction is usually believed to be a sign of locally-advanced disease. Complete surgical removal of the disease (R0 is the only potentially curative treatment for resectable gastric cancer. The aim of the study is to finda The operability rate of gastric cancer in our institution and the incidence of Gastric Outlet Obstruction (GOO in patients undergoing gastrectomy for distal gastric cancer. b To compare the postoperative outcome in patients with gastric outlet obstruction and those without gastric outlet obstruction. c To see if the histology of the tumour has any role in the development of GOO. MATERIALS AND METHODS This is a retrospective study. The study includes patients who were admitted with carcinoma stomach and underwent operative or nonoperative treatment in our institution during 2013 to 2015. RESULTS Overall operability rate was 45.8%. Operable patients in the GOO group were 47%. Operability in the no outlet obstruction group were 45%. Data shows a slightly increased predilection for GOO in diffuse and mixed type of tumours (statistically not significant. Intestinal tumours had significant rate of anaemia compared to diffuse tumours (p <0.005. Overall mortality was 6.7%. Mortality is higher in the GOO group (8.8%. CONCLUSION (a. Operability rate of distal gastric cancer in our institution is 45.8%. (b. Incidence of gastric outlet obstruction in patients undergoing gastrectomy is 38.2%. (c. Presence of gastric outlet obstruction does not influence operability rate (47% vs. 45%. (d. Morbidity and mortality after distal radical gastrectomy is comparable in both groups. (e. Both intestinal and diffuse histology have equal incidence of GOO. (f. Chronic blood loss and incidence of anaemia is more in

Some design and operating aspects of the Ranger uranium mine treatment plant

International Nuclear Information System (INIS)

Baily, P.A.

1984-01-01

Environmental considerations were key factors in the design of the Ranger Uranium Mines treatment plant. The mine is located adjacent to the Kakadu National Park and has an average rainfall of 1.6m per annum. No contaminated water or liquid effluents are to be released from the project area and thus water management is a key design and operating fact. Particulate and gas emission criteria influenced design as did occupational hygiene factors (dust, radon, housekeeping, maintenance access). Equipment selection and engineering standards were conservative and resulted in the plant attaining design performance in less than three months from the date of commissioning. A number of mechanical and operational problems were experienced. However, none of these problems have had a significant effect on production

Surgical treatment of refractory tibial stress fractures in elite dancers: a case series.

Science.gov (United States)

Miyamoto, Ryan G; Dhotar, Herman S; Rose, Donald J; Egol, Kenneth

2009-06-01

Treatment of tibial stress fractures in elite dancers is centered on rest and activity modification. Surgical intervention in refractory cases has important implications affecting the dancers' careers. Refractory tibial stress fractures in dancers can be treated successfully with drilling and bone grafting or intramedullary nailing. Case series; Level of evidence, 4. Between 1992 and 2006, 1757 dancers were evaluated at a dance medicine clinic; 24 dancers (1.4%) had 31 tibial stress fractures. Of that subset, 7 (29.2%) elite dancers with 8 tibial stress fractures were treated operatively with either intramedullary nailing or drilling and bone grafting. Six of the patients were followed up closely until they were able to return to dance. One patient was available only for follow-up phone interview. Data concerning their preoperative treatment regimens, operative procedures, clinical union, radiographic union, and time until return to dance were recorded and analyzed. The mean age of the surgical patients at the time of stress fracture was 22.6 years. The mean duration of preoperative symptoms before surgical intervention was 25.8 months. Four of the dancers were male and 3 were female. All had failed nonoperative treatment regimens. Five patients (5 tibias) underwent drilling and bone grafting of the lesion, and 2 patients (3 tibias) with completed fractures or multiple refractory stress fractures underwent intramedullary nailing. Clinical union was achieved at a mean of 6 weeks and radiographic union at 5.1 months. Return to full dance activity was at an average of 6.5 months postoperatively. Surgical intervention for tibial stress fractures in dancers who have not responded to nonoperative management allowed for resolution of symptoms and return to dancing with minimal morbidity.

The operative treatment of pressure sores in the pelvic region: A 10-year period overview.

Science.gov (United States)

Jósvay, János; Klauber, András; Both, Béla; Kelemen, Péter B; Varga, Zsombor Z; Pesthy, Pál Cs

2015-07-01

Pelvic region pressure sores often develop following spinal cord injury. Surgery is often necessary for long standing, large-sized pressure sores not responding to conservative treatment. Authors analyze their results of a 10-year period, and identify factors contributing to the reduction of the recurrence rate. A total of 119 pressure sores were operated on 98 patients in two institutions during a 10-year period (1 January 2003 to 31 December 2012). The encountered perioperative complications are summarized, and the recurrence rate is analyzed with a patient follow-up questionnaire. We experienced 15 perioperative complications (12.6%). All complications were fully resolved by conservative treatment. Fifty-eight returned patient replies were processed. The average follow-up time after surgery was 5.2 years. The recurrence rate was 5.47%. The strict adherence to surgical indications, full patient compliance, specialized pre- and post-operative patient care, our routinely used preferred surgical method, all contribute to a low post-operative complication rate, long-term flap survival, and an extended recurrence free period.

THORACOLUMBAR BURST FRACTURE: STRUCTURAL CHANGES AND CLINICAL OUTCOME OF TREATMENT

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Rodrigo Arnold Tisot

2016-03-01

Full Text Available ABSTRACT Objective: To evaluate the correlation between structural changes in burst fractures of thoracic and lumbar spine with clinical outcome of the treatment. Methods: A retrospective study in 25 patients with fractures of thoracic and lumbar spine burst fractures without neurological deficit. Eleven patients underwent conservative treatment and for the remaining the treatment was surgical. All patients were followed up for at least 24 months. The cases were evaluated by a protocol that included: posttraumatic measurement of kyphosis, vertebral body collapse and narrowing of the spinal canal, the visual analog scale of pain, and the quality of life questionnaire SF-36 at the follow-up. For statistical analysis, the significance level was 5% and the software SPSS 18.0 was used. Results: No statistically significant difference was observed when comparing the clinical outcomes of one treatment over another. Similarly, there was no statistically significant correlation between kyphosis and post-traumatic narrowing of the spinal canal with clinical worsening in the follow-up, regardless of the treatment used. We found a positive correlation (p<0.05 between initial collapse and SF-36 domains in both groups (operated and non-operated. Conclusion: There was no significant superiority of one treatment over the other, and no correlation was found between kyphosis and spinal canal narrowing in burst fractures of the thoracic and lumbar spine without neurological deficit. However, there was correlation between initial collapse and clinical outcome in some domains of the SF-36 questionnaire.

The multidisciplinary treatment of bronchobiliary fistula present in a patient with pancreatic neuroendocrine tumor

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Baris Ozcan

2017-09-01

Full Text Available Bronchobiliary Fistula (BBF is a rare condition that usually occurs after surgical treatments of pancreas, liver and biliary diseases. Clinical findings are bilioptysis, fever and dyspnea. In treating it, initially, drainage should be conducted using minimally invasive or endoscopic methods, such as endoscopic retrograde cholangiopancreatography (ERCP or percutaneous transhepatic cholangiography (PTK in cases where these methods failed. Next, treatment through performing surgical operations, like hepatectomy or pulmonary resection, should be carried out. In this work, the diagnostic and therapeutic phases of a female patient at the age of 40 who underwent a whipple procedure (pancreatoduodenectomy 10 years earlier because of pancreatic neuroendocrine tumor is presented. Their follow-ups exhibited multiple metastases in the liver, and for this reason, specific chemoembolization treatments were applied. After these treatments, bronchobiliary fistula was formed. [Arch Clin Exp Surg 2017; 6(3.000: 156-161

A comparison of the results of radiotherapy and surgical treatment of tongue cancer

International Nuclear Information System (INIS)

Matsuki, Hirokazu; Ikushima, Hitoshi; Nishitani, Hiromu; Takegawa, Yoshihiro; Kashihara, Kenichi

2000-01-01

To investigate the results of tongue cancer treatments retrospectively in order to compare the outcomes of radiotherapy and surgery among patients presenting with early-stage tongue cancer. One-hundred and forty-three patients who underwent radical treatment of tongue cancer between 1976 and 1996 were classified into six treatment groups in order to compare the 5-year survival rate, 5-year local control and lymph node metastasis between the groups. Furthermore, prognostic factors were determined by univariate and multivariate analyses. The 5-year survival rate for the entire subject population was 71%, and that for patients diagnosed as having stage I, II, III and IV tumors was 85%, 80%, 76% and 53%, respectively. The 5-year survival rate of patients who underwent surgical treatment alone for early-stage tongue cancer was higher than that of patients who underwent interstitial radiotherapy alone (100% and 70%, respectively). The 5-year local control rate did not differ significantly between patients who underwent surgical treatment alone for early-stage cancer and those who underwent interstitial radiotherapy alone (87% and 86%, respectively). Furthermore, the survival rate did not differ significantly between patients presenting with cervical lymph node metastasis upon initial examination and those who developed cervical lymph node metastasis later (62% and 69%, respectively). The results of a univariate analysis showed that prognosis was significantly better for women and N0 patients, and the results of a multivariate analysis confirmed that prognosis was significantly better for patients under 60 years of age, women, and N0 patients. The survival rate of patients treated for early-stage tongue cancer was slightly higher for those who underwent surgical treatment alone compared with those who underwent interstitial radiotherapy alone. However, local control was comparable between these two groups of patients. (author)

Sperm Cryopreservation before Testicular Cancer Treatment and Its Subsequent Utilization for the Treatment of Infertility

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Jana Žáková

2014-01-01

Full Text Available Aims. In this study we report our results with storage of cryopreserved semen intended for preservation and subsequent infertility treatment in men with testicular cancer during the last 18 years. Methods. Cryopreserved semen of 523 men with testicular cancer was collected between October 1995 and the end of December 2012. Semen of 34 men (6.5% was used for fertilization of their partners. They underwent 57 treatment cycles with cryopreserved, fresh, and/or donor sperm. Results. A total of 557 men have decided to freeze their semen before cancer treatment. Azoospermia was diagnosed in 34 men (6.1%, and semen was cryopreserved in 532 patients. Seminoma was diagnosed in 283 men (54.1% and nonseminomatous germ cell tumors in 240 men (45.9%. 34 patients who returned for infertility treatment underwent 46 treatment cycles with cryopreserved sperm. Totally 16 pregnancies were achieved, that is, 34.8% pregnancy rate. Conclusion. The testicular cancer survivors have a good chance of fathering a child by using sperm cryopreserved prior to the oncology treatment, even when it contains only limited number of spermatozoa.

Pancreaticoduodenectomy versus duodenum-preserving pancreatic head resection for the treatment of chronic pancreatitis.

Science.gov (United States)

Zheng, Zhenjiang; Xiang, Guangming; Tan, Chunlu; Zhang, Hao; Liu, Baowang; Gong, Jun; Mai, Gang; Liu, Xubao

2012-01-01

The objective of this study was to assess the efficacy and safety of pancreaticoduodenectomy (PD) and duodenum-preserving pancreatic head resection (DPPHR) for the treatment of chronic pancreatitis (CP). The 123 patients with CP who underwent pancreatic head resection between January 2004 and June 2009 were retrospectively analyzed. The preoperative variables, operative data, postoperative complications, and follow-up information were examined. There were no significant differences in clinical and morphological characteristics, pain relief, and jaundice status between the PD and DPPHR groups. The duration of operation was shorter (251.8 [SD, 43.1] vs 324.5 [SD, 41.4] minutes, P endocrine insufficiency was higher in PD group as compared with DPPHR group. Both procedures are equally effective in pain relief, but DPPHR is superior to PD in operative data, postoperative morbidity, improving quality of life, and preservation of exocrine and endocrine function.

Evaluation of ketorolac compared to ketorolac plus dipyrone in post-operative analgesia of videolaparoscopic cholecystectomy

Directory of Open Access Journals (Sweden)

Silvia Katlauskas Muraro

2009-03-01

Full Text Available Objectives: To compare the analgesic effect of ketorolac with the association of ketorolac plus dipyrone after videolaparoscpic cholecystectomy and with a placebo group. Methods: After approval by the Research Ethics Committee and after having the informed consent signed, 60 patients aged between 18 and 60 years who underwent videolaparoscopic cholecystectomy were evaluated for the post-operative analgesia provided by ketorolac compared to ketorolac plus dipyrone. The patients underwent general anesthesia (with propofol, alfentanil, rocuronium and maintenance with isoflurane. Twenty patients received 20 ml water, 20 patients received ketorolac 30 mg in 20 ml water and 20 received ketorolac 30 mg plus dipyrone 2 g in 20 ml water, during anesthetic induction. In the post-operative recovery room, the patients were evaluated to the moment of their first pain complaint with the use of a visual analogue scale and a verbal pain scale every hour in the first six hours. When necessary, morphine was administered as a rescue medication for pain relief and a PCA pump with morphine solution was turned on. Rresults: Total morphine use was lower in the ketorolac plus dipyrone Group (2 mg and in the ketorolac (2 mg Group, compared to the placebo Group (10.5 mg. Of 20 cases of ketorolac plus dipyrone, eight patients did not complain of pain in the post-operative period, while only three patients did not complain in the ketorolac Group and in the placebo Group (p = 0,05. Cconclusion: Ketorolac is a potent analgesic agent widely used for acute pain treatment, especially after surgeries, with an analgesic potency comparable to that of opiates, the most commonly drugs used during the post-operative of medium to major surgeries. In this study, the results analyzed at this moment show that the association of ketorolac plus dipyrone seemed to be superior to post-operative analgesia compared to the use of ketorolac.

Operational experience at the Sludge Treatment Facility

International Nuclear Information System (INIS)

Sy, D.J.

1987-01-01

The Sludge Treatment Facility (STF) at the Oak Ridge Gaseous Diffusion Plant has been in operation since April 1987. The facility was designed to encapsulate hazardous sludge wastes in a cement matrix. Fixation will allow the waste to meet or exceed applicable compressive strength and leachability requirements. Thus, the grout mixture complies with the Resource Conservation and Recovery Act (RCRA) guidelines as a nonhazardous waste. The grout mixture is based upon a recipe formulation developed after several years of waste stream characterization and formulation studies. The wastes to be treated at the STF are wastes impounded in two ponds. The ponds have a combined capacity of 4.5 million gallons of sludge. The sludge is transferred from the ponds to a 15,000-gallon capacity storage tank by the use of a dredge. The grout mixture recipe dictates the amount of sludge, cement, fly ash, and admixture required for weighing per batch. All ingredients are weighed and then transferred to a tilt or high energy mixer for mixing. The grout mixture is then transferred to 89- or 96-gallon steel drums. The drums are placed in a storage yard designed for a point source discharge from the yard

[Findings from Total Colonoscopy in Obstructive Colorectal Cancer Patients Who Underwent Stent Placement as a Bridge to Surgery(BTS)].

Science.gov (United States)

Maruo, Hirotoshi; Tsuyuki, Hajime; Kojima, Tadahiro; Koreyasu, Ryohei; Nakamura, Koichi; Higashi, Yukihiro; Shoji, Tsuyoshi; Yamazaki, Masanori; Nishiyama, Raisuke; Ito, Tatsuhiro; Koike, Kota; Ikeda, Takashi; Takayanagi, Yasuhiro; Kubota, Hiroyuki

2017-11-01

We clinically investigated 34 patients with obstructive colorectal cancer who underwent placement of a colonic stent as a bridge to surgery(BTS), focusing on endoscopic findings after stent placement.Twenty -nine patients(85.3%)underwent colonoscopy after stent placement, and the entire large intestine could be observed in 28(96.6%).Coexisting lesions were observed in 22(78.6%)of these 28 patients.The lesions comprised adenomatous polyps in 17 patients(60.7%), synchronous colon cancers in 5 patients(17.9%), and obstructive colitis in 3 patients(10.7%), with some overlapping cases.All patients with multiple cancers underwent one-stage surgery, and all lesions were excised at the same time.Colonoscopy after colonic stent placement is important for preoperative diagnosis of coexisting lesions and planning the extent of resection. These considerations support the utility of colonic stenting for BTS.

[Abnormal metabolism of triglycerides fractions in chronic pancreatitis and results after the operation treatment].

Science.gov (United States)

Diakowska, Dorota; Knast, Witold; Diakowski, Witold; Grabowski, Krzysztof; Szelachowski, Piotr; Pelczar, Piotr

2005-06-01

This study was undertaken to determine how fats digestion processes were damaged due to chronic pancreatitis, and identify, whether lipid metabolism improved after surgical treatment the patients with chronic pancreatitis. Total lipids, triglycerides, diglycerides and free fatty acids levels in serum and stool were analysed, using chemical tests, thin-layer chromatography and electrophoresis of serum lipoproteins. The patients before the operations showed higher total lipids and triglycerides concentrations, and lower concentrations of diglycerides and free fatty acids in stool. These patients had high triglycerides, chylomicrons, VLDL, LDL-CH concentrations, and low-diglycerides, free fatty acids, HDL-CH concentrations in serum. These data were statistically significant. After the operations and substitution therapy it was observed normalization of the total lipids and lipids fractions levels in stool and in serum. Concentrations of LDL-CH and HDL-CH fractions were irregular. We conclude, that these lipids parameters could be used in diagnosing and monitoring the results of chronic pancreatitis surgical treatment.

Comparative studies on the differently operated trains of the North-Budapest Wastewater Treatment Plant.

Science.gov (United States)

Jobbágy, A; Palkó, Gy; Weinpel, T; Makó, M

2012-01-01

In order to reduce the pollution load of the Danube, the North-Budapest Wastewater Treatment Plant has been upgraded to enhanced nitrogen removal by establishing a new activated sludge treatment line and modifying the existing unit for nitrification and denitrification. As both the influent flow rate and the influent chemical oxygen demand (COD), biological oxygen demand (BOD(5)) and total suspended solids (TSS) concentration levels remained far below the design values, setting one fourth of the reactor volume out of operation in the Old Line, and operating the nitrification reactor of the New Line with part-time aeration proved to be possible. Analytical data as well as simulation studies supported the advantage of the intermittent-aeration process in efficient N-removal. However, the lengths of the aerated periods have to be increased with decreasing temperature, and thereby effluent total nitrogen (TN) concentration can increase due to decreasing denitrification efficiency. Potential occurrence of low-dissolved oxygen (DO) bulking should be hindered through applying an efficient anoxic selector system.

Estimation of pressure drop in the mixing zone of beds in operation filters as drinking water treatment by a mathematical model

International Nuclear Information System (INIS)

Rodriguez Miranda, J. P.

2010-01-01

This paper describes the correlation of a mathematical model that considers the pressure drop (energy) in the mixing zone of beds in operation filters as drinking water treatment, filters applied in conventional pilot operated and mounted on a water treatment plant of a municipally in Colombia. (Author) 20 refs.

Imaging in the Evaluation of Endoscopic or Surgical Treatment for Achalasia

Directory of Open Access Journals (Sweden)

Diego Palladino

2016-01-01

Full Text Available Purpose. Aim of the study is to evaluate the efficacy of the endoscopic (pneumatic dilation versus surgical (Heller myotomy treatment in patients affected by esophageal achalasia using barium X-ray examination of the digestive tract performed before and after the treatment. Materials and Methods. 19 patients (10 males and 9 females were enrolled in this study; each patient underwent a barium X-ray examination to evaluate the esophageal diameter and the height of the barium column before and after endoscopic or surgical treatment. Results. The mean variation of oesophageal diameter before and after treatment is −2.1 mm for surgery and 1.74 mm for pneumatic dilation (OR 0.167, CI 95% 0.02–1.419, and P: 0.10. The variations of all variables, with the exception of the oesophageal diameter variation, are strongly related to the treatment performed. Conclusions. The barium X-ray study of the digestive tract, performed before and after different treatment approaches, demonstrates that the surgical treatment has to be considered as the treatment of choice of achalasia, reserving endoscopic treatment to patients with high operative risk and refusing surgery.

Complications of operative treatment of injuries of peripheral arteries.

Science.gov (United States)

Velinovic, M M; Davidovic, B L; Lotina, I S; Vranes, R M; Djukic, L P; Arsov, J V; Ristic, V M; Kocica, J M; Petrovic, L P

2000-06-01

In 1991 and 1992, a total of 97 patients with 106 peripherial arterial injuries underwent surgery at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia. Civilian injuries accounted for 53 (54.6%) patients (94.3% males, age range: 16-63 yr, mean: 35.2), and 44 patients had war injuries (93.2% males, age range: 19-61 yr, mean: 34.8). The injuries affected the superfitial femoral artery in 31 (29.24%); the popliteal artery in 28 (26.41%); the brachial artery in 17 (16.04%); the posterior tibial artery in 6 (5.66%); the axillary artery in 5 (4.72%); the anterior tibial artery in 5 (4.72%); the tibioperoneal trunk in 4 (3. 77%); the common femoral artery in 4 (3.77%); the external iliac artery in 2 (1.89%); the profound femoral artery in 2 (1.89%); the radial artery in 1 (0.94%); and ulnar artery in 1 (0.94%).A total of 98 reconstructive procedures were used to treat these patients. Graft interposition carried out in 50 (51.02%); by pass in 25 (25. 51%); end-to-end anastomosis in 9 (9.18%); suture in 8 (8.16%); ligation in 4 (4.08%); and patch-angioplasty in 2 (2.04%). Primary reconstruction of injured arteries was performed in 72.2% and secondary repair in 27.8% cases. Infection developed in 51 (52.57%) patients, and it was significantly (P<0.05) more common in the war injuries (70.45%) and in secondary repairs (88.89%). The presence of associated lesions (69.56%) was also correlated with a greater rate of infection. Amputation was necessary in 21 (21.65%) of our patients, and was significantly (P<0.05) more often performed after secondary (44.44%) than primary operations (12.86%) and in the presence of associated injuries (32.61%).

A web-based remote radiation treatment planning system using the remote desktop function of a computer operating system: a preliminary report.

Science.gov (United States)

Suzuki, Keishiro; Hirasawa, Yukinori; Yaegashi, Yuji; Miyamoto, Hideki; Shirato, Hiroki

2009-01-01

We developed a web-based, remote radiation treatment planning system which allowed staff at an affiliated hospital to obtain support from a fully staffed central institution. Network security was based on a firewall and a virtual private network (VPN). Client computers were installed at a cancer centre, at a university hospital and at a staff home. We remotely operated the treatment planning computer using the Remote Desktop function built in to the Windows operating system. Except for the initial setup of the VPN router, no special knowledge was needed to operate the remote radiation treatment planning system. There was a time lag that seemed to depend on the volume of data traffic on the Internet, but it did not affect smooth operation. The initial cost and running cost of the system were reasonable.

Surgical treatment of GERD. Comperative study of WTP vs. Toupet fundoplication - results of 151 consecutive cases.

Science.gov (United States)

Wróblewski, Tadeusz; Kobryn, Konrad; Nowosad, Małgorzata; Krawczyk, Marek

2016-01-01

Gastroesophageal reflux disease (GERD) is recognized as one of the most common disorders of the upper gastrointestinal tract (GIT). The best choice of management for advanced GERD is laparoscopic surgery. To compare and evaluate the results of surgical treatment of GERD patients operated on using two different techniques. Between 2001 and 2012, 353 patients (211 female and 142 male), aged 17-76 years (mean 44), underwent laparoscopic antireflux surgery. The study included patients who underwent a Toupet fundoplication or Wroblewski Tadeusz procedure (WTP). The mean age of the group was 47.77 years (17-80 years). Forty-nine (32.45%) patients had severe symptoms, 93 (61.58%) had mild symptoms and 9 (5.96%) had a single mild but intolerable sign of GERD. Eighty-six (56.95%) patients had a Toupet fundoplication and 65 (43.04%) had a WTP. The follow-up period was 18-144 months. The average operating time for Toupet fundoplication and the WTP procedure was 164 min (90-300 min) and 147 min (90-210 min), respectively. The perioperative mortality rate was 0.66%. The average post-operative hospitalization period was 5.4 days (2-16 post-operative days (POD) = Toupet) vs. 4.7 days (2-9 POD = WTP). No reoperations were performed. No major surgical complications were identified. Wroblewski Tadeusz procedure due to a low percentage of post-operative complications, good quality of life of patients and a zero recurrence rate of hiatal hernia should be a method of choice.

Orange Peel Excision of Gland: A Novel Surgical Technique for Treatment of Gynecomastia.

Science.gov (United States)

S S, Shirol

2016-12-01

Gynecomastia is a common aesthetic problem faced by men with reported incidence as high as 65% with serious psychosocial impact. Although various techniques of liposculpture combined with glandular excision is the standard of treatment, many of the glandular excision techniques have inherent limitations and complications such as leaving a long scar, long operative time, contour abnormalities, and increased risk of hematoma. Here, we describe an innovative "the orange peel excision of gland (OPEG) technique" which overcomes these limitations with excellent cosmetic results. A total of 38 breasts were operated in 20 patients (18 bilateral and 2 unilateral). All the patients underwent suction-assisted liposuction and glandular excision under general anesthesia by our OPEG technique. The average operative time per breast was 60 minutes. One patient had a small hematoma which did not require evacuation. The patient satisfaction rate was 95%. The technique has reduced operative time and avoids residual gland and hematoma with excellent aesthetic outcome.

[Common types of massive intraoperative haemorrhage, treatment philosophy and operating skills in pelvic cancer surgery].

Science.gov (United States)

Wang, Gang-cheng; Han, Guang-sen; Ren, Ying-kun; Xu, Yong-chao; Zhang, Jian; Lu, Chao-min; Zhao, Yu-zhou; Li, Jian; Gu, Yan-hui

2013-10-01

To explore the common types of massive intraoperative bleeding, clinical characteristics, treatment philosophy and operating skills in pelvic cancer surgery. We treated massive intraoperative bleeding in 19 patients with pelvic cancer in our department from January 2003 to March 2012. Their clinical data were retrospectively analyzed. The clinical features of massive intraoperative bleeding were analyzed, the treatment experience and lessons were summed up, and the operating skills to manage this serious issue were analyzed. In this group of 19 patients, 7 cases were of presacral venous plexus bleeding, 5 cases of internal iliac vein bleeding, 6 cases of anterior sacral venous plexus and internal iliac vein bleeding, and one cases of internal and external iliac vein bleeding. Six cases of anterior sacral plexus bleeding and 4 cases of internal iliac vein bleeding were treated with suture ligation to stop the bleeding. Six cases of anterior sacral and internal iliac vein bleeding, one cases of anterior sacral vein bleeding, and one case of internal iliac vein bleeding were managed with transabdominal perineal incision or transabdominal cotton pad compression hemostasis. One case of internal and external iliac vein bleeding was treated with direct ligation of the external iliac vein and compression hemostasis of the internal iliac vein. Among the 19 patients, 18 cases had effective hemostasis. Their blood loss was 400-1500 ml, and they had a fair postoperative recovery. One patient died due to massive intraoperative bleeding of ca. 4500 ml. Most of the massive intraoperative bleeding during pelvic cancer surgery is from the presacral venous plexus and internal iliac vein. The operator should go along with the treatment philosophy to save the life of the patient above all, and to properly perform suture ligation or compression hemostasis according to the actual situation, and with mastered crucial operating hemostatic skills.

Cross-sectional evaluation of post-operative pain and flare-ups in endodontic treatments using a type of rotary instruments.

Science.gov (United States)

Tanalp, Jale; Sunay, Hakki; Bayirli, Gündüz

2013-01-01

The purpose of this clinical study was to evaluate the general incidence of post-operative pain and flare-ups in patients who were endodontically treated by two endodontics specialists using rotary instruments (Hero 642, Micro Mega, France) with the same treatment protocol. Records of 382 teeth belonging to 268 patients treated by two endodontics specialists during a 6-month period were kept and evaluated. Post-operative pain between treatment visits was categorized using a pre-established scoring system. Ninety-five patients were males, whereas 173 were females. Pulpal necrosis without periapical pathosis was determined as the most common indication for endodontic treatment (21.7%) followed by irreversible pulpitis and re-treatment without periapical lesions (18.3%, 18.3%, respectively). The general prevalence of post-operative pain and flare-ups was determined as 8.1%, whereas cases that could be classified as real flare-ups which were severe and required an unscheduled visit (scores 2 and 3) comprised 3.4% of the cases. No statistically significant correlation was determined between gender and post-operative pain and flare-up (p = 0.05). There was a significant correlation between number of appointments and the presence of pain and flare-ups. Teeth undergoing multiple visits had a higher risk of developing post-operative pain and flare-ups compared to those with single appointments with a statistical significance (p = 0.03). Teeth with pre-operative pain were more prone to developing post-operative pain and discomfort with a statistically significant difference (p = 0.02). While no significant correlation was determined between tooth vitality and pain and flare-ups (p = 0.5), a statistically significant relationship existed between the presence of a periapical pathosis and post-operative pain and flare-ups. Cases with a periapical lesion had a higher risk of developing pain and flare-ups compared to those with no periapical involvement (p = 0.0001). Future

A case that underwent bilateral video- assisted thoracoscopic ...

African Journals Online (AJOL)

Adele

C ventilator was used for controlled ventilation of the lungs. Pres- ... sufficient tidal volume, and the PaO2 value of the Paratrend 7TN ... operative lung. The cause was probably airway obstruction due to his intraluminal tumor plus secretions.

Microdose flare-up vs. flexible-multidose GnRH antagonist protocols for poor responder patients who underwent ICSI.

Science.gov (United States)

Esinler, I

2014-01-01

To compare the performance of microdose flare-up (MF) and flexible-multidose gonadotropin-releasing hormone (GnRH) antagonist protocols in poor responder patients who underwent intracytoplasmic sperm injection (ICSI). One hundred and 12 consecutive patients (217 cycles) suspected to have poor ovarian response were enrolled. Group 1 (MF GnRH agonist group) constituted 64 patients (135 cycles) who underwent MF GnRH agonist protocol. Group 2 (flexible-multidose GnRH antagonist group) constituted 48 patients (82 cycles) who underwent flexible-multidose GnRH antagonist protocol. The duration of stimulation (d) (11.5 +/- 2.1 vs. 10.4 +/- 2.7, p or = seven blastomeres and < 10% fragmentation at day 3 (35.9% vs. 65.1%, p < 0.05) were significantly lower in Group 1 when compared to Group 2. The number of embryos transferred (2.2 +/- 1.3 vs. 2.4 +/- 0.9), the clinical pregnancy per embryo transfer (16.3% vs. 25.8%), and the implantation rate (8.6% vs. 12.2%) were comparable between groups. Although the flexible-multidose GnRH antagonist protocol produced better oocyte and embryo parameters, the clinical pregnancy rate and the implantation rates were comparable between the flexible-multidose GnRH antagonist and MF protocols in poor responder patients.

Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

LENUS (Irish Health Repository)

Bjurlin, Marc A

2012-02-01

Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

Lithiasis coledochus treatment

International Nuclear Information System (INIS)

Salom, A.; Viana, G.; Acevedo, C.; Harguindeguy, M.; Ettlin, A.; Alvez, M.; Touya, G.; Baldi, D.; Peyroulou, A.

2004-01-01

This paper presents the results achieved with patients treated for lithiasis of common bile duct within the last five years, at the Central Hospital of the Armed Forces.Case material involves 100 cases, 77 of which were operated through laparotomy and 23 through laparoscopic surgery. Within the group of those operated by laparotomy, 40 were treated through a choledochotomy, a choledocho-litotomy and drainage through a Kehr tube; in 18 cases calculi were extracteed through the trans-cystic path.Fifteen choledochoduodenostomies,1 hepatojejunostomy,2transduodenal surgical papillotomies were performed and 1 patient underwent left liver resection.Within the goup o those treated through laparoscopic surgery,15 cases were resolved through the transcystic path and 2 through choledochotomy.Six conversions were performed and there were 2 complications(a bilioma and a residual lithiasis).Twenty cases of CPER with papillotomy, were performed whether independently or combined with surgery.Mortality of series was nil and morbility is described in paper.The authors then proceed to analyze the technical aspects of the transcystic path and choledochotomy.Finally they propose an algorithm for treatment of lithiasis of common bile duct according to the characteristics of clinical symptoms, age and condition of patient, anatomic characteristics of the biliary tract and experience and infrastructure available to the treating team

Impact of combinatory growth factor application on rabbit Achilles tendon injury with operative versus conservative treatment: a pilot study.

Science.gov (United States)

Konerding, Moritz A; Arlt, Friederike; Wellmann, Axel; Li, Vincent; Li, William

2010-02-01

Acute Achilles tendon (AT) rupture is a common injury with a comparatively high complication rate. Presently, surgical treatments compete with nonoperative treatment modalities. The aim of this study was to elucidate the possible beneficial effects of short-term combinatory application of growth factors on tendon healing during operative or conservative treatment. In this controlled laboratory study, the left ATs of 40 adult New Zealand White rabbits were transected and either sutured or treated conservatively. Half of the animals from each treatment modality group repetitively received a mixture of VEGF165, bFGF, and rPDGF which was administered peritendineally. The left legs were immobilized with external fixateurs for 6 weeks. The ATs were harvested 3 months after intervention. Tensile strength tests revealed no significant differences between operative and conservative treatments. Compared to the normal right ATs, 60% of the average breaking strength was reached 3 months after surgery. Growth factor application did not result in significant improvements. Only a tendency towards higher blood vessel densities was noted in the groups treated with the factors. Collagen type I/III ratios also displayed no significant differences. This study indicates that there is no difference in the biomechanical outcome of conservative versus operative AT rupture treatment and only a marginal impact of short-term combinatory growth and angiogenesis factor application.

DETERMINATION OF ACTIVATED SLUDGE MODEL ASDM PARAMETERS FOR WASTE WATER TREATMENT PLANT OPERATING IN THE SEQUENTIAL–FLOW TECHNOLOGY

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Dariusz Zdebik

2015-01-01

Full Text Available This paper presents a method for calibration of activated sludge model with the use of computer program BioWin. Computer scheme has been developed on the basis of waste water treatment plant operating in the sequential – flow technology. For calibration of the activated sludge model data of influent and treated effluent from the existing object were used. As a result of conducted analysis was a change in biokinetic model and kinetic parameters parameters of wastewater treatment facilities. The presented method of study of the selected parameters impact on the activated sludge biokinetic model (including autotrophs maximum growth rate, the share of organic slurry in suspension general operational, efficiency secondary settling tanks can be used for conducting simulation studies of other treatment plants.

Performance of atraumatic restorative treatment (ART) depending on operator-experience.

Science.gov (United States)

Jordan, Rainer A; Gaengler, Peter; Markovic, Ljubisa; Zimmer, Stefan

2010-01-01

Oral health care is not of major interest in developing countries because of lack of infrastructure and professional manpower. Therefore, atraumatic restorative treatment (ART) was introduced by the World Health Organization to be performed by dental auxiliary personnel. The aim of this study was to evaluate the performance of ART depending on operator-experience in The Republic of The Gambia. One hundred twenty-eight newly inserted restorations were followed up for 12 months using the clinical ART index in a prospective and blinded study design. The patients were randomly assigned to operators. The clinical performance was compared among three groups: trainees, experienced Community Oral Health Workers (COHW), and professional dentists. The difference in success rates was calculated at a 95 percent confidence interval. There was a statistically significant difference between trainees and dentists in performing leakage/gap-free one-surface restorations (P 0.05). Finally, both groups--experienced COHWs and dentists--performed restorations not showing statistically significant differences (P > 0.05). For The Republic of The Gambia--especially for areas with underdeveloped medical infrastructure--training and assignment to perform ART can be recommended for auxiliary dental staff of Community Oral Health Workers.

Application of the PHREEQC geochemical computer model during the design and operation of UK mine water treatment schemes

Energy Technology Data Exchange (ETDEWEB)

Croxford, S.J.; England, A.; Jarvis, A.P. [IMC White Young Green Engineering and Environment, Sutton-in-Ashfield (United Kingdom)

2004-07-01

The UK Coal Authority operates more than 20 full-scale mine water treatment schemes. The PHREEQC geochemical model has been used during the design and operation of two of the UK Coal Authority's treatment systems to assess whether it is possible to more accurately predict the fate and behaviour of contaminants through the treatment process. These systems are at Frances Colliery, Fife, Scotland, and at Horden Colliery, County Durham, England. The characteristics of the mine water at these sites, and the treatment systems installed to remediate them, are described. At Frances Colliery the following issues have been investigated using the PHREEQC model: determination of optimum alkali dose rate; and investment of secondary mineralization that causes pipe fouling. At Horden Colliery areas investigated using the PHREEQC model are: prediction of sludge volume production for various alkali reagents; predication of the influence of elevated carbon dioxide partial pressures on alkali requirements; and influence of elevated chloride concentration on sludge characteristics and production. The results of the investigation are presented and discussed. The study suggests that geochemical modelling may be a useful tool in determining both the geochemical processes occurring within a mine water treatment system and ultimately the likely costs involved during the operation of a particular scheme. Plans for future work include further validation of the PHREEQC model predictions by careful sampling and analysis of water chemistry and secondary mineral phases through the treatment systems. In the future it is hoped that the PHREEQC model may become a useful tool in the design phase of mine water treatment systems. 7 refs., 8 tabs.

EARLY AND LONG-TERM RESULTS OF SURGICAL TREATMENT OF THE THORACIC AND LUMBAR VERTEBRAL AND SPINAL TRAUMA

Directory of Open Access Journals (Sweden)

V. D. Usikov

2014-01-01

Full Text Available The article demonstrates the outcomes of operative treatment of 190 patients with spinal cord injuryof thoracic and lumbar spine for 10 years. Associated injuries were revealed in 96 patients, the mean ISS score being27.5. All patients underwent decompressive and stabilizing interventions using a transpedicular system of “Synthes” production (Saint Petersburg. Ventral interventions were performed in 27 (14.2% patients. In all cases, decompression of the spinal canalcontents at the level of damage was achieved. In those patients who were operated within two weeks after trauma, transpedicular system allowed for recovery of a form and size of the spinal canal and the damaged vertebral body. The fractures of transpedicular system were observed in patients operated both with only rear and with combined access. The errors and complications, which happened during surgery, did not influence the outcomes of treatment. The outcomes of treatment were assessed according to the neurological statusdynamics (ASIA score, recovery of support ability of the spine, the presence of pain, and patients’ recovery (Е Denis score. Favorable outcomes were achieved in 114 (61.3% patients, satisfactoryin 53 (28.5%,and poor in 19 (10.2 %.

Can modeling of HIV treatment processes improve outcomes? Capitalizing on an operations research approach to the global pandemic

Directory of Open Access Journals (Sweden)

Hollingsworth Eric B

2008-08-01

Full Text Available Abstract Background Mathematical modeling has been applied to a range of policy-level decisions on resource allocation for HIV care and treatment. We describe the application of classic operations research (OR techniques to address logistical and resource management challenges in HIV treatment scale-up activities in resource-limited countries. Methods We review and categorize several of the major logistical and operational problems encountered over the last decade in the global scale-up of HIV care and antiretroviral treatment for people with AIDS. While there are unique features of HIV care and treatment that pose significant challenges to effective modeling and service improvement, we identify several analogous OR-based solutions that have been developed in the service, industrial, and health sectors. Results HIV treatment scale-up includes many processes that are amenable to mathematical and simulation modeling, including forecasting future demand for services; locating and sizing facilities for maximal efficiency; and determining optimal staffing levels at clinical centers. Optimization of clinical and logistical processes through modeling may improve outcomes, but successful OR-based interventions will require contextualization of response strategies, including appreciation of both existing health care systems and limitations in local health workforces. Conclusion The modeling techniques developed in the engineering field of operations research have wide potential application to the variety of logistical problems encountered in HIV treatment scale-up in resource-limited settings. Increasing the number of cross-disciplinary collaborations between engineering and public health will help speed the appropriate development and application of these tools.

SU-E-T-785: Using Systems Engineering to Design HDR Skin Treatment Operation for Small Lesions to Enhance Patient Safety

International Nuclear Information System (INIS)

Saw, C; Baikadi, M; Peters, C; Brereton, H

2015-01-01

Purpose: Using systems engineering to design HDR skin treatment operation for small lesions using shielded applicators to enhance patient safety. Methods: Systems engineering is an interdisciplinary field that offers formal methodologies to study, design, implement, and manage complex engineering systems as a whole over their life-cycles. The methodologies deal with human work-processes, coordination of different team, optimization, and risk management. The V-model of systems engineering emphasize two streams, the specification and the testing streams. The specification stream consists of user requirements, functional requirements, and design specifications while the testing on installation, operational, and performance specifications. In implementing system engineering to this project, the user and functional requirements are (a) HDR unit parameters be downloaded from the treatment planning system, (b) dwell times and positions be generated by treatment planning system, (c) source decay be computer calculated, (d) a double-check system of treatment parameters to comply with the NRC regulation. These requirements are intended to reduce human intervention to improve patient safety. Results: A formal investigation indicated that the user requirements can be satisfied. The treatment operation consists of using the treatment planning system to generate a pseudo plan that is adjusted for different shielded applicators to compute the dwell times. The dwell positions, channel numbers, and the dwell times are verified by the medical physicist and downloaded into the HDR unit. The decayed source strength is transferred to a spreadsheet that computes the dwell times based on the type of applicators and prescribed dose used. Prior to treatment, the source strength, dwell times, dwell positions, and channel numbers are double-checked by the radiation oncologist. No dosimetric parameters are manually calculated. Conclusion: Systems engineering provides methodologies to

The Treatment of Six Sigma in Introductory Operations Management Textbooks: Clearing Up the Confusion

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Ravinder, Handanhal; Misra, Ram B.

2016-01-01

This paper critically examines the treatment of the statistical basis for Six Sigma and process capability in popular operations management textbooks. It discusses areas of confusion and suggest ways of treating the topic that make sense to instructors as well as students. Even though Six Sigma was introduced almost 30 years ago, misconceptions…

Operator decision support system for integrated wastewater management including wastewater treatment plants and receiving water bodies.

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Kim, Minsoo; Kim, Yejin; Kim, Hyosoo; Piao, Wenhua; Kim, Changwon

2016-06-01

An operator decision support system (ODSS) is proposed to support operators of wastewater treatment plants (WWTPs) in making appropriate decisions. This system accounts for water quality (WQ) variations in WWTP influent and effluent and in the receiving water body (RWB). The proposed system is comprised of two diagnosis modules, three prediction modules, and a scenario-based supporting module (SSM). In the diagnosis modules, the WQs of the influent and effluent WWTP and of the RWB are assessed via multivariate analysis. Three prediction modules based on the k-nearest neighbors (k-NN) method, activated sludge model no. 2d (ASM2d) model, and QUAL2E model are used to forecast WQs for 3 days in advance. To compare various operating alternatives, SSM is applied to test various predetermined operating conditions in terms of overall oxygen transfer coefficient (Kla), waste sludge flow rate (Qw), return sludge flow rate (Qr), and internal recycle flow rate (Qir). In the case of unacceptable total phosphorus (TP), SSM provides appropriate information for the chemical treatment. The constructed ODSS was tested using data collected from Geumho River, which was the RWB, and S WWTP in Daegu City, South Korea. The results demonstrate the capability of the proposed ODSS to provide WWTP operators with more objective qualitative and quantitative assessments of WWTP and RWB WQs. Moreover, the current study shows that ODSS, using data collected from the study area, can be used to identify operational alternatives through SSM at an integrated urban wastewater management level.

Rescue pre-operative treatment with Lugol's solution in uncontrolled Graves' disease.

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Calissendorff, Jan; Falhammar, Henrik

2017-05-01

Graves' disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol's solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005-2015 and treated with Lugol's solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Twenty-seven patients were included. Lugol's solution had been chosen due to agranulocytosis in 9 (33%), hepatotoxicity in 2 (7%), other side effects in 11 (41%) and poor adherence to medication in 5 (19%). Levels of free T4, free T3 and heart rate decreased significantly after 5-9 days of iodine therapy (free T4 53-20 pmol/L, P  = 0.0002; free T3 20-6.5 pmol/L, P  = 0.04; heart rate 87-76 beats/min P  = 0.0007), whereas TSH remained unchanged. Side effects were noted in 4 (15%) (rash n  = 2, rash and vomiting n  = 1, swelling of fingers n  = 1). Thyroidectomy was performed in 26 patients (96%) and one was treated with radioiodine; all treatments were without serious complications. Treatment of uncontrolled hyperthyroidism with Lugol's solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol's solution could be recommended pre-operatively in Graves' disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred. © 2017 The authors.

Long-term Outcomes of Operative and Nonoperative Treatment of Congenital Coxa Vara.

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Roberts, David W; Saglam, Yavuz; De La Rocha, Adriana; Frasquillo, Brigid N; Tulchin-Francis, Kirsten; Kim, Harry K W

2018-04-01

Congenital coxa vara (CCV) is a rare hip condition with few long-term studies. The purpose of this study was to assess clinical, radiographic, and functional outcomes after operative and nonoperative treatment of CCV, assess reliability of radiographic parameters, and investigate risk factors for recurrence after surgery. Retrospective review was performed of all CCV patients treated at 1 institution from 1980 to 2010. In addition, patients were recalled for additional follow-up x-rays, modified Harris Hip Score (mHHS), and gait analysis. Radiographic measurements [neck-shaft angle (NSA), head-shaft angle (HSA), Hilgenreiner-epiphyseal angle (HEA), and femoral neck length (FNL)] were assessed for reliability using intraclass correlation coefficients. Multivariate analysis was performed to identify risk factors for recurrence after surgery. Forty-six hips in 32 patients were reviewed. Mean age at presentation was 5.4±4.9 years. Mean follow-up was 11.8±5.8 years. Valgus proximal femoral osteotomy was performed in 27 hips (20 patients). Initial deformity was greater in the operative group (NSA 90±17 degrees, HEA 68±19 degrees) versus nonoperative patients (NSA 122±19 degrees, HEA 34±14 degrees) (PNSA occurred in only 21%. In contrast, 56% of operative hips showed decreased FNL growth rates. Interobserver reliability was excellent for HEA (0.98), NSA (0.90), and FNL (0.89), and good for HSA (0.79). Repeat osteotomy was performed in 6 cases (22%). No significant predictors for recurrence were identified. At long-term follow-up for recalled patients, 72% had significantly abnormal gait, and 50% had fair-poor functional outcomes (mHHSNSA are the most reliable radiographic measurements of proximal femoral deformity in CCV. Recurrence is not uncommon, but no predictors were identified. Many patients have persistent gait abnormalities and functional impairment at long-term follow-up, regardless of prior treatment. Level III-retrospective cohort.

Treatment of perforated giant gastric ulcer in an emergency setting.

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Kumar, Pradeep; Khan, Hosni Mubarak; Hasanrabba, Safarulla

2014-01-27

To study and assess clinical outcomes of various modes of treatment for perforated giant gastric ulcer in an emergency setting. From May 2010 to February 2013, 20 cases of perforated giant gastric ulcer (> 2 cm) were operated on in an emergency setting. All the patients presented with features of peritonitis and were resuscitated aggressively before taking for surgery. In the first 4 cases, primary closure was done after taking a biopsy and among these, the 3(rd) case also underwent partial distal gastrectomy and gastrojejunostomy and the 4(th) case underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy for malignancy. All the remaining 16 cases underwent partial distal gastrectomy and gastrojejunostomy. Among the first 4 cases, 2 had an uneventful recovery and were discharged on the 6(th) postoperative day. The 3(rd) and 4(th) patients developed gastric fistula, leading to prolonged hospitalization. For the 3(rd) patient, conservative management was tried for 1 wk, followed by partial distal gastrectomy and gastrojejunostomy, and he was discharged on the 20(th) day after admission, while the 4(th) patient underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy. Postoperatively, he developed adult respiratory distress syndrome, multiorgan dysfunction syndrome and expired on the 3(rd) postoperative day of the second surgery. All the remaining 16 patients underwent partial distal gastrectomy and gastrojejunostomy and recovered well. Among these, 4 of them were malignant and the remaining were benign ulcers. All had an uneventful recovery. The percentage of malignancy in our series was 30% (6 out of 20 cases). In our study, 86% had an uneventful recovery, complications were seen in about 10%, and mortality was about 5%. In giant gastric ulcer, the chances of malignancy and leak after primary closure are high. So, we feel that partial distal gastrectomy and gastrojejunostomy is better.

Sternal wound complications after primary isolated myocardial revascularization: the importance of the post-operative variables.

NARCIS (Netherlands)

Noyez, L.; Druten, J.A.M. van; Mulder, J.; Schroen, A.M.; Skotnicki, S.H.; Brouwer, R.

2001-01-01

OBJECTIVE: Select pre-, peri-, and post-operative variables, predictive for sternal wound complications (SWC), in a clinical setting. METHODS: We analyzed pre-, peri-, and post-operative data of 3815 patients who underwent a primary isolated bypass grafting. 100 patients (2.6%) had post-operative

Multimodal treatment for resectable epithelial type malignant pleural mesothelioma

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Fukuyama Yasuro

2004-05-01

Full Text Available Abstract Background Malignant pleural mesothelioma is a rare malignancy. The outcome remains poor despite complete surgical resection. Patients and methods Eleven patients with histologicaly proven epithelial type malignant pleural mesothelioma undergoing extrapleural pneumonectomy with systemic chemotherapy and/or radiotherapy before and after surgical resection were retrospectively reviewed. Results Ten out of 11 patients underwent complete surgical resection, of these 7 patients had stage I disease. Of these 7 patients, 5 are alive without any recurrence, a 2-year survival rate of 80% was observed in this group. There was no operative mortality or morbidity. Conclusion Extrapleural pneumonectomy with perioperative adjuvant treatment is safe and effective procedure for epithelial type malignant pleural mesothelioma.

Treatment of primary tracheal carcinoma. The role of external and endoluminal radiotherapy

International Nuclear Information System (INIS)

Harms, W.; Wannenmacher, M.; Becker, H.; Herth, F.; Gagel, B.

2000-01-01

Background and Purpose: In a retrospective study the role of radiation therapy for the treatment of primary tracheal carcinoma was investigated. Patients and Methods: Between 1984 and 1997, 25 patients with primary tracheal carcinoma were treated with external beam radiotherapy (17 squamous-cell carcinoma [SCC], 8 adenoid cystic carcinoma [ACC], median dose SCC 60 Gy, ACC 55 Gy). An additional brachytherapy boost was carried out in 10/25 patients (median dose SCC 18 Gy, ACC 15 Gy). Ten patients underwent operative treatment. Results: The median survival (Kaplan-Meier) for patients with SCC was 33 months (ACC 94.2). The 1-, 2- and 5-year survival rates (Kaplan-Meier) for patients with SCC were 64.7% (ACC 85.7%), 64.7% (ACC 85.7%), and 26% (ACC 85.7%). Patients with ACC and patients with a complete remission after treatment had a significantly better survival probability (log rank test, p [de

Assessing the effectiveness of a guideline recommendation for pre-operative radiochemotherapy in rectal cancer

International Nuclear Information System (INIS)

Manchon-Walsh, Paula; Borras, Josep Maria; Espinas, Josep Alfons; Aliste, Luisa

2011-01-01

Aim: To ascertain the degree of adherence to the guideline recommendation on pre-operative RT/ChT for stage-II and -III patients in Catalonian public hospitals, and its impact on local recurrence among rectal cancer patients. Methods: Data were derived from a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Results: The study covered 1229 patients with TNM stage-II or -III primary rectal cancer. Of these patients, 54.5% underwent pre-operative RT/ChT; 14.9% underwent post-operative RT (± chemotherapy); and 30.6% did not undergo any RT. The crude local recurrence rate at 2 years was 4.1% and the crude distant recurrence rate at 2 years was 6.5%. The results of the univariate analyses showed a local-recurrence hazard ratio of 1.84 for the group of patients that received no RT versus the group that received pre-operative RT/ChT (p < 0.01). Conclusions: This is the first population-based study in Catalonia to support the use of pre-operative RT/ChT in rectal cancer patients because, in line with the results of population-based studies reported from other countries, its application, compared to non-application of RT, was found to lead to a clear reduction in the probability of local recurrence.

Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis

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Robin F. Irons

2017-03-01

Full Text Available Background Ideal operative timing for non-emergent, acute diverticulitis (AD remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy. Objectives To evaluate the effect of operative delay on sepsis and mortality in patients with AD. Methods Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI, pneumonia (PNA, need for blood transfusion, septic shock, return to the operating room, length of stay (LOS, readmission, wound dehiscence, and surgical site infections (SSI. Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR with 95% confidence intervals (CI were calculated for primary and secondary outcomes. Results 32,399 patients underwent colectomy for AD on hospital day 1 - 20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 - 1.057; P < 0.0001 and sepsis (OR = 1.051, 95% CI, 1.035 - 1.067; P < 0.0001. Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion

Vegetated treatment area (VTAs efficiencies for E. coli and nutrient removal on small-scale swine operations

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R. Daren Harmel

2018-06-01

Full Text Available As small-scale animal feeding operations work to manage their byproducts and avoid regulation, they need practical, cost-effective methods to reduce environmental impact. One such option is using vegetative treatment areas (VTAs with perennial grasses to treat runoff; however, research is limited on VTA effectiveness as a waste management alternative for smaller operations. This study evaluated the efficiencies of VTAs in reducing bacteria and nutrient runoff from small-scale swine operations in three counties in Central Texas. Based on 4 yr of runoff data, the Bell and Brazos VTAs significantly reduced loads and concentrations of E. coli and nutrients (except NO3-N and had treatment efficiencies of 73–94%. Most notably, the Bell VTA reduced loads of E. coli, NH4-N, PO4-P, total N, and total P similar to that of the background (control. In spite of significant reductions, runoff from the Brazos VTA had higher concentrations and loads than the control site, especially following installation of concrete pens and increased pen washing, which produced standing water and increased E. coli and nutrient influx. The Robertson VTA produced fewer significant reductions and had lower treatment efficiencies (29–69%; however, E. coli and nutrient concentrations and loads leaving this VTA were much lower than observed at the Bell and Brazos County sites due to alternative solids management and enclosed pens. Based on these results and previous research, VTAs can be practical, effective waste management alternatives for reducing nutrient and bacteria losses from small-scale animal operations, but only if properly designed and managed. Keywords: Bacteria, Nutrients, Swine manure, Waste management, Water quality

Prediction of Pathological Complete Response Using Endoscopic Findings and Outcomes of Patients Who Underwent Watchful Waiting After Chemoradiotherapy for Rectal Cancer.

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Kawai, Kazushige; Ishihara, Soichiro; Nozawa, Hiroaki; Hata, Keisuke; Kiyomatsu, Tomomichi; Morikawa, Teppei; Fukayama, Masashi; Watanabe, Toshiaki

2017-04-01

Nonoperative management for patients with rectal cancer who have achieved a clinical complete response after chemoradiotherapy is becoming increasingly important in recent years. However, the definition of and modality used for patients with clinical complete response differ greatly between institutions, and the role of endoscopic assessment as a nonoperative approach has not been fully investigated. This study aimed to investigate the ability of endoscopic assessments to predict pathological regression of rectal cancer after chemoradiotherapy and the applicability of these assessments for the watchful waiting approach. This was a retrospective comparative study. This study was conducted at a single referral hospital. A total of 198 patients with rectal cancer underwent preoperative endoscopic assessments after chemoradiotherapy. Of them, 186 patients underwent radical surgery with lymph node dissection. The histopathological findings of resected tissues were compared with the preoperative endoscopic findings. Twelve patients refused radical surgery and chose watchful waiting; their outcomes were compared with the outcomes of patients who underwent radical surgery. The endoscopic criteria correlated well with tumor regression grading. The sensitivity and specificity for a pathological complete response were 65.0% to 87.1% and 39.1% to 78.3%. However, endoscopic assessment could not fully discriminate pathological complete responses, and the outcomes of patients who underwent watchful waiting were considerably poorer than the patients who underwent radical surgery. Eventually, 41.7% of the patients who underwent watchful waiting experienced uncontrollable local failure, and many of these occurrences were observed more than 3 years after chemoradiotherapy. The number of the patients treated with the watchful waiting strategy was limited, and the selection was not randomized. Although endoscopic assessment after chemoradiotherapy correlated with pathological response

Results of the Treatment of Talar Neck Fractures in a West African Hospital

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AD Kacou

2011-03-01

Full Text Available Talar neck fractures (TNFs are complex injuries and treatment is fraught with complications. We retrospectively studied 18 patients with TNFs: 6 Hawkins type-I, 7 type-II, 4 type-III, and 1 type-IV. Five patients with type-I and 2 with type-II fractures were treated conservatively. The remaining 11 patients underwent operative treatment. Open reduction via posterolateral approach was performed in 10 patients while closed reduction was used in one patient. All operatively reduced fractures were stabilized with screws. The following postoperative complications were encountered: wound dehiscence (n=1, avascular necrosis (n=2, and post-traumatic osteoarthritis (n=12. Fifteen patients were available for final evaluation at a mean follow- up period of three years (range 10 months to 6 years. Using the American Orthopaedic Foot and Ankle Society (AOFAS score, the mean for type-I fracture was 96.4 points, 80.2 points for type-II, 68.5 points for type-III and 55 points for type-IV fractures. TNFs remain a devastating injury as the prognosis and outcomes of treatment continued to be hampered by the consequences of injury.

Safety and Tolerability of Transitioning from Cangrelor to Ticagrelor in Patients Who Underwent Percutaneous Coronary Intervention.

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Badreldin, Hisham A; Carter, Danielle; Cook, Bryan M; Qamar, Arman; Vaduganathan, Muthiah; Bhatt, Deepak L

2017-08-01

The 3 phase 3 CHAMPION (Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials collectively demonstrated the safety of transitioning from cangrelor, a potent, parenteral rapidly-acting P2Y 12 inhibitor, to clopidogrel in patients who underwent percutaneous coronary intervention (PCI). However, variation in timing of therapy, site-specific binding, and drug half-lives may theoretically complicate switching to other oral P2Y 12 inhibitors. Since regulatory approval, limited data are available regarding the "real-world" safety and tolerability of transitioning to these more potent oral P2Y 12 antagonists. From November 2015 to January 2017, we evaluated the clinical profiles and efficacy and safety outcomes in cangrelor-treated patients who underwent PCI transitioned to clopidogrel (n = 42) or ticagrelor (n = 82) at a large, tertiary care center. Most patients receiving cangrelor underwent PCI with a drug-eluting stent for acute coronary syndrome via a radial approach in the background of unfractionated heparin. Stent thrombosis within 48 hours was rare and occurred in 1 patient treated with ticagrelor. Global Use of Strategies to Open Occluded Coronary Arteries-defined bleeding occurred in 20% of patients switched to ticagrelor and 29% of patients switched to clopidogrel, but none were severe or life-threatening. In conclusion, rates of stent thrombosis and severe/life-threatening bleeding were low and comparable with those identified in the CHAMPION program, despite use of more potent oral P2Y 12 inhibition. Copyright © 2017 Elsevier Inc. All rights reserved.

The effect of surgical treatment for secundum atrial septal defect in patients more than 30 years old.

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Erkut, Bilgehan; Becit, Necip; Unlu, Yahya; Ceviz, Munacettin; Kocogullari, Cevdet Ugur; Ates, Azman; Karapolat, Bekir Sami; Kaygin, Mehmet Ali; Kocak, Hikmet

2007-01-01

We prospectively examined whether surgical treatment of secundum atrial septal defects in patients 30 years old improves their early- and mid-term clinical outcomes. Our clinical experience is reviewed to assess the importance of surgical management in elderly patients with atrial septal defect. We analyzed 41 patients older than 30 years of age who underwent surgical correction of a secundum atrial septal defect. To evaluate the effects of surgical treatment, we compared functional capacity, diuretic administration, rhythm status, and echocardiographic parameters of all patients before and after the operation. The median follow-up period was 4.2 years (range, 6 months-7 years). There were no operative deaths. Functional class in most of the patients improved after operation. Two patients reverted to normal sinus rhythm after the operation. There was only one new atrial fibrilation among patients in the postoperative term. Right atrial and right ventricular dimensions and pulmonary artery pressures were significantly decreased, and ejection fractions were significantly increased after the operation. The need for diuretic treatment was decreased after surgical repair. No residual intracardiac shunts were identified during follow-up. There were no cerebrovascular thromboembolic accidents in the early postoperative period. Surgical closure of atrial septal defects in patients over 30 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seem to be minimal.

A CLINICAL STUDY OF OPERATIVE TREATMENT FOR LUMBAR INTERVERTEBRAL DISC PROLAPSE

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Anilkumar S. D

2016-09-01

Full Text Available BACKGROUND Amongst painful diseases, sciatica occupies a foremost place by reason of its prevalence, its production by a great variety of conditions, the great disablement it may produce and its tending to relapse all of which have led to its recognition as one of the great scourges of humanity. Intervertebral disc prolapse is the important and common cause of low back pain and sciatica. Here, the subject of laminectomy and discectomy in the treatment of proven intervertebral disc prolapse in the lower lumbar region is reviewed and its results examined. AIM OF STUDY This study was undertaken in order to evaluate the following objectives. PRIMARY Analysis of clinical parameters and per operative findings of lumbar intervertebral disc prolapse. SECONDARY Analysis of clinical parameters and surgical outcome in lumbar intervertebral disc prolapse with respect to improvement in pain and neurological status. MATERIALS AND METHODS The study was undertaken in 22 patients who attended the Orthopaedic Department of Mount Zion Medical College, Adoor, between August 2014 to July 2015. All of them were suffering from a prolapsed lumbar vertebral disc as shown by clinical examination and investigations. Lumbar laminectomy and discectomy constituted the operative procedure for all of them. RESULTS In acute onset cases and cases with short duration, results were good. By six months, 80% of patients recorded of good pain relief, 80% of patients returned to work within six 6 months, 60% of patients showed good neurological recovery by 6 months. Laminectomy and discectomy in proven cases of lumbar intervertebral disc prolapse is a rewarding procedure. LT definitely relieved pain in all cases and improved morbidity and neurological deficits in most of the cases. CONCLUSION 1. Laminectomy and discectomy is an effective method of treatment in herniation of lumbar intervertebral disc. 2. The procedure is ideally done in those with the disc prolapse proved with the

Minimally Invasive Surgical Treatment of Esophageal Achalasia

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Mercantini, Paolo; Amodio, Pietro M.; Stipa, Francesco; Corigliano, Nicola; Ziparo, Vincenzo

2003-01-01

Background and Objectives: A minimally invasive approach is considered the treatment of choice for esophageal achalasia. We report the evolution of our experience from thoracoscopic Heller myotomy (THM) to laparoscopic Heller myotomy (LHM). Our objective is to define the efficacy and safety of these 2 approaches. Methods: Between March 1993 and December 2001, 36 patients underwent minimally invasive surgery for achalasia. Sixteen patients underwent THM without an antireflux procedure, and 20 patients underwent LHM with partial anterior fundoplication (n=13) or closure of the angle of His (n=7). Results: Mean operative time and mean hospital stay were significantly shorter for LHM compared with that of THM (148.3±38.7 vs 222±46.1 min, respectively; P=0.0001) and (2.06±0.65 days vs 5.06±0.85 days, respectively; P=0.0001). Six of 16 patients (37.5%) in the THM group experienced persistent or recurrent dysphagia compared with 1 of 20 patients (5%) in the LHM group (P=0.01). Heartburn developed in 5 patients (31.2%) after THM and in 1 patient (5%) after LHM (P=0.06). Regurgitation developed in 4 patients (25%) after THM and in 2 patients (10%) after LHM (P=0.2). Lower esophageal sphincter (LES) basal pressure decreased significantly from 30.1±5.07 to 15.3±2.1 after THM and from 31.8±6.2 to 10.4±1.7 after LHM (P=0.0001). Mean esophageal diameter was significantly reduced after LHM compared with that after THM (from 53.9±5.9 mm to 27.2±3.3 mm vs 50.8±7.6 mm to 37.2±6.9 mm respectively; P=0.0001). Conclusion: In our experience, LHM is associated with better short-term results and is superior to THM in relieving dysphagia. LHM with partial anterior fundoplication should be considered the treatment of choice for achalasia. PMID:14558709

Surgical treatment of osteoid osteomas in children and adolescents

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Gubina, E. V.; Ryzhikov, D. V.; Podorozhnaya, V. T.; Kirilova, I. A.; Senchenko, E. V.; Sadovoy, M. A.; Fomichev, N. G.; Bondarenko, A. V.; Afanasev, L. M.; Andreev, A. V.; Anastasieva, E. A.

2017-09-01

The article is about on the problems of diagnosis and surgical treatment of osteoid osteomas having various localization in children and adolescents. The results of the treatment of 5 patients (2 boys and 3 girls) aged 4-13 years with osteoid osteomas have been analyzed. In 2 cases, lesions were located in the tibia, in 1 case—femoral neck, in 1 case—ischium (fragment of the acetabulum), in 1 case—vertebra (half-arch). At the clinic, all patients underwent preoperative examination by osteoncologist; there was no disagreement as for the preoperative diagnosis and treatment strategy. In all cases, there was a monostotic lesion and all patients underwent scheduled operations. Scheduled surgery included resection of the "nest" and adjacent sclerotic areas, plastic repair of the post-resection defect was not required. In the case of the periarticular location, we replaced defect the bone defects with allogeneic "straw". This material is widely used in the treatment of bone diseases in children and adolescents: it is free of organic substances, has low immunogenicity, and can be used in the patients with positive allergic history; it is versatile, sterile, has high reparative regeneration activity, and does not require prolongation of postoperative antibiotic therapy or administration of antihistamines. In one patient, an autologous bone from the iliac wing was used. Steel structures have not been used. Microscopic description of preparations: among the reactively sclerosed trabeculae, having compact and coarsely glomerular structure, there is a "nest" consisting of poorly calcified small primitive and osteoid trabeculae, having different stages of cell differentiation with no signs of a typia. Pain relief occurred immediately after surgery, resection accuracy was confirmed by the control MSCT examination. Dynamic follow up time was 2 months to 7 years, recovery was achieved in 100% of cases.

The effect of kidney morcellation on operative time, incision complications, and postoperative analgesia after laparoscopic nephrectomy

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Affonso H. Camargo

2006-06-01

Full Text Available INTRODUCTION: Compare the outcomes between kidney morcellation and two types of open specimen extraction incisions, several covariates need to be taken into consideration that have not yet been studied. MATERIALS AND METHODS: We retrospectively reviewed 153 consecutive patients who underwent laparoscopic nephrectomy at our institution, 107 who underwent specimen morcellation and 46 with intact specimen removal, either those with connected port sites with a muscle-cutting incision and those with a remote, muscle-splitting incision. Operative time, postoperative analgesia requirements, and incisional complications were evaluated using univariate and multivariate analysis, comparing variables such as patient age, gender, body mass index (BMI, laterality, benign versus cancerous renal conditions, estimated blood loss, specimen weight, overall complications, and length of stay. RESULTS: There was no significant difference for operative time between the 2 treatment groups (p = 0.65. Incision related complications occurred in 2 patients (4.4% from the intact specimen group but none in the morcellation group (p = 0.03. Overall narcotic requirement was lower in patients with morcellated (41 mg compared to intact specimen retrieval (66 mg on univariate (p = 0.03 and multivariate analysis (p = 0.049. Upon further stratification, however, there was no significant difference in mean narcotic requirement between the morcellation and muscle-splitting incision subgroup (p = 0.14. CONCLUSION: Morcellation does not extend operative time, and is associated with significantly less postoperative pain compared to intact specimen retrieval overall, although this is not statistically significant if a remote, muscle-splitting incision is made. Morcellation markedly reduces the risk of incisional-related complications.

Case-mix analysis and variation in rates of non-surgical treatment of older women with operable breast cancer.

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Morgan, J; Richards, P; Ward, S; Francis, M; Lawrence, G; Collins, K; Reed, M; Wyld, L

2015-08-01

Non-surgical management of older women with oestrogen receptor (ER)-positive operable breast cancer is common in the UK, with up to 40 per cent of women aged over 70 years receiving primary endocrine therapy. Although this may be appropriate for frailer patients, for some it may result in treatment failure, contributing to the poor outcomes seen in this age group. Wide variation in the rates of non-operative management of breast cancer in older women exists across the UK. Case mix may explain some of this variation in practice. Data from two UK regional cancer registries were analysed to determine whether variation in treatment observed between 2002 and 2010 at hospital and clinician level persisted after adjustment for case mix. Expected case mix-adjusted surgery rates were derived by logistic regression using the variables age, proxy Charlson co-morbidity score, deprivation quintile, method of cancer detection, tumour size, stage, grade and node status. Data on 17,129 women aged 70 years or more with ER-positive operable breast cancer were analysed. There was considerable variation in rates of surgery at both hospital and clinician level. Despite adjusting for case mix, this variation persisted at hospital level, although not at clinician level. This study demonstrates variation in selection criteria for older women for operative treatment of early breast cancer, indicating that some older women may be undertreated or overtreated, and may partly explain the inferior disease outcomes in this age group. It emphasizes the urgent need for evidence-based guidelines for treatment selection criteria in older women with breast cancer. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Experience in minimally invasive Nuss operation for 406 children with pectus excavatum.

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Shu, Qiang; Shi, Zhuo; Xu, Wei-Ze; Li, Jian-Hua; Zhang, Ze-Wei; Lin, Ru; Zhu, Xiong-Kai; Yu, Jian-Gen

2011-08-01

This study was to investigate the advantages of thoracoscopy-assisted minimally invasive Nuss operation for the treatment of pectus excavatum (PE) in children. A total of 406 patients with PE (female: 93; male: 313) with an average age of 6.8 years (range: 3.5-17.5 years) were included in this study. Associated diseases included congenital heart disease in 9 patients and congenital pulmonary cyst in 2. The Haller index of the patients ranged from 3.35 to 7.23, with an average of 5.17±1.64. Minimally invasive Nuss operation was performed for all the patients. The operations were performed successfully and no operative mortality occurred. The average blood loss during the operation was less than 10 mL and the operating time ranged from 30 to 85 minutes with an average of 45 minutes. The length of hospital stay ranged from 5 to 9 days with an average of 7 days. Struts were implanted in 12 (3.0%) of the 406 patients. Injury of the pericardium occurred in 1 patient during the operation. Early post-operative complications occurred in 9 patients with pneumothorax and 6 patients with pleural effusion, which were cured by puncture or drainage. Poor wound healing occurred in 4 patients (1.0%) and was cured by nutritional support. During a 3-month to 6-year follow-up, 2 patients had scoliosis and 3 patients had displacement of the strut, which was cured by a second Nuss operation. Allergy occurred in 2 patients: the symptoms were improved in 1 patient after conservative treatment, but the strut was removed in advance due to allergy in the other patient. Totally 154 patients (40.0%) underwent operation for strut removal. Excellent repair results were achieved in 387 (95.3%) patients, good repair results in 12 (3.0%), and fair results in 7 (1.7%). Thoracoscopy-assisted Nuss operation has many advantages including small and masked incision, short operative time, minimal blood loss, fast recovery, less trauma, and satisfactory outcomes of repair. Nuss is a safe and reliable

Efficacy of vacuum-assisted closure therapy on rehabilitation during the treatment for surgical site infection after cardiovascular surgery.

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Yoshimoto, Akihiro; Inoue, Takafumi; Fujisaki, Masayuki; Morizumi, Sei; Suematsu, Yoshihiro

2016-08-01

Surgical site infection (SSI) after cardiovascular procedures is a severe complication, potentially leading to high morbidity and mortality. In addition, during the treatment of SSI, rehabilitation is delayed, which can severely impair postoperative recovery. The aim of this study was to assess the effect of vacuum-assisted closure (VAC) therapy on rehabilitation during the treatment of SSI after cardiovascular surgery. From January 2008 to March 2015, 10 patients underwent VAC therapy for SSI after cardiovascular operations. The patient characteristics, duration of VAC therapy, time interval from the implementation of VAC to physical therapy (PT) (T1), ambulation (T2) and walking (T3), functional independent measure (FIM), and maximum consecutive walking capacity (MCWC) were retrospectively analyzed. Nine patients underwent mid-sternal incision and one patient underwent thoraco-abdominal incision. The mean time interval from the beginning of VAC therapy to PT, ambulation, and walking was 0.38 ± 0.50, 0.63 ± 0.71, and 1.38 ± 1.86 days, respectively. The average FIM was 84.5 ± 14.0 at the beginning of VAC therapy and 106.7 ± 18.5 at the end of VAC therapy (P = 0.000494). On average, MCWC was 52.3 ± 54.6 m at the installation of VAC therapy and 189.7 ± 152.8 m at the completion of VAC therapy (P = 0.0169). FIM and MCWC improvement rate was better in VAC group than non-VAC group although these data are not suitable for statistical analysis because of a small sample size. Although further studies are warranted, VAC therapy may have a role in facilitating rehabilitation and improving the prognosis of SSI cases after major cardiovascular operations.

Risk factors for deep surgical site infection following operative treatment of ankle fractures.

Science.gov (United States)

Ovaska, Mikko T; Mäkinen, Tatu J; Madanat, Rami; Huotari, Kaisa; Vahlberg, Tero; Hirvensalo, Eero; Lindahl, Jan

2013-02-20

Surgical site infection is one of the most common complications following ankle fracture surgery. These infections are associated with substantial morbidity and lead to increased resource utilization. Identification of risk factors is crucial for developing strategies to prevent these complications. We performed an age and sex-matched case-control study to identify patient and surgery-related risk factors for deep surgical site infection following operative ankle fracture treatment. We identified 1923 ankle fracture operations performed in 1915 patients from 2006 through 2009. A total of 131 patients with deep infection were identified and compared with an equal number of uninfected control patients. Risk factors for infection were determined with use of conditional logistic regression analysis. The incidence of deep infection was 6.8%. Univariate analysis showed diabetes (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.0, 4.9), alcohol abuse (OR = 3.8, 95% CI = 1.6, 9.4), fracture-dislocation (OR = 2.0, 95% CI = 1.2, 3.5), and soft-tissue injury (a Tscherne grade of ≥1) (OR = 2.6, 95% CI = 1.3, 5.3) to be significant patient-related risk factors for infection. Surgery-related risk factors were suboptimal timing of prophylactic antibiotics (OR = 1.9, 95% CI = 1.0, 3.4), difficulties encountered during surgery, (OR = 2.1, 95% CI = 1.1, 4.0), wound complications (OR = 4.8, 95% CI = 1.6, 14.0), and fracture malreduction (OR = 3.4, 95% CI = 1.3, 9.2). Independent risk factors for infection identified by multivariable analyses were tobacco use (OR = 3.7, 95% CI = 1.6, 8.5) and a duration of surgery of more than ninety minutes (OR = 2.5, 95% CI = 1.1, 5.7). Cast application in the operating room was independently associated with a decreased infection rate (OR = 0.4, 95% CI = 0.2, 0.8). We identified several modifiable risk factors for deep surgical site infection following operative treatment of ankle fractures.

The cochlear implant as a tinnitus treatment.

Science.gov (United States)

Vallés-Varela, Héctor; Royo-López, Juan; Carmen-Sampériz, Luis; Sebastián-Cortés, José M; Alfonso-Collado, Ignacio

2013-01-01

Tinnitus is a symptom of high prevalence in patients with cochlear pathology. We studied the evolution of tinnitus in patients undergoing unilateral cochlear implantation for treatment of profound hearing loss. This was a longitudinal, retrospective study of patients that underwent unilateral cochlear implantation and who had bilateral tinnitus. Tinnitus was assessed quantitatively and qualitatively before surgery and at 6 and 12 months after surgery. We evaluated 20 patients that underwent unilateral cochlear implantation with a Nucleus(®) CI24RE Contour Advance™ electrode device. During the periods in which the device was in operation, improvement or disappearance of tinnitus was evidenced in the ipsilateral ear in 65% of patients, and in the contralateral ear, in 50%. In periods in which the device was disconnected, improvement or disappearance of tinnitus was found in the ipsilateral ear in 50% of patients, and in the ear contralateral to the implant in 45% of the patients. In 10% of the patients, a new tinnitus appeared in the ipsilateral ear. The patients with profound hearing loss and bilateral tinnitus treated with unilateral cochlear implantation improved in a high percentage of cases, in the ipsilateral ear and in the contralateral ear. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases

Directory of Open Access Journals (Sweden)

Hawkes Eliza A

2012-08-01

Full Text Available Abstract Background Surgery is often advocated in patients with resectable pulmonary metastases from colorectal cancer (CRC. Our study aims to evaluate peri-operative chemotherapy in patients with metastastic CRC undergoing pulmonary metastasectomy. Methods Patients treated for CRC who underwent pulmonary metastasectomy by a single surgeon were identified. Outcome measures included survival, peri-operative complications, radiological and histological evidence of chemotherapy-induced lung toxicities. Results Between 1997 and 2009, 51 eligible patients were identified undergoing a total of 72 pulmonary resections. Thirty-eight patients received peri-operative chemotherapy, of whom 9 received an additional biological agent. Five-year overall survival rate was 72% in the whole cohort - 74% and 68% in those who received peri-operative chemotherapy (CS and those who underwent surgery alone (S respectively. Five-year relapse free survival rate was 31% in the whole cohort - 38% and ≤18% in CS and S groups respectively. Only 8% had disease progression during neoadjuvant chemotherapy. There were no post-operative deaths. Surgical complications occurred in only 4% of patients who received pre-operative chemotherapy. There was neither radiological nor histological evidence of lung toxicity in resected surgical specimens. Conclusions Peri-operative chemotherapy can be safely delivered to CRC patients undergoing pulmonary metastasectomy. Survival in this selected group of patients was favourable.

The emerging trend of non-operative treatment in paediatric type I open forearm fractures.

Science.gov (United States)

Zhang, H; Fanelli, M; Adams, C; Graham, J; Seeley, M

2017-08-01

Open fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures. An Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed. The search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9). The five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.

Operative shortening of the sling as a second-line treatment after TVT failure

Science.gov (United States)

Matuszewski, Marcin; Michajłowski, Jerzy; Krajka, Kazimierz

2011-01-01

Introduction Stress urinary incontinence (SUI) is defined as an involuntary loss of urine during physical exertion, sneezing, coughing, laughing, or other activities that put pressure on the bladder. In some cases, recurrent or persistent SUI after sling operations may be caused by too loose placement of the sling. In the current study, we describe our method of shortening of the sling as a second-line treatment of tension-free vaginal tape (TVT) failure. Materials and methods Four women, aged 46-61, after initial TVT operation were treated for persistent SUI. The severity of SUI was estimated by: physical examinations, cough tests, 24-h pad tests, and King's Health Questionnaire. The shortening procedure, based on excising the fragment of tape and suturing it back, was performed in all patients. Results All cases achieved a good result, which was defined as restoration of full continence. No complications occurred. The 12-month follow-up showed no side-effects. The postoperative control tests: the cough and 24-h pad tests were negative in all women. The general health perceptions increased after the shortening procedure by a mean value 44.25%. The incontinence impact decreased by a mean value 44.6%. In all patients, role and physical limitations significantly decreased (by 88.5% and 80.5%, respectively). The negative emotions connected with SUI significantly decreased after the second procedure. Conclusions The operative shortening of the implanted sling is a simple, cheap, and effective method of second-line treatment in cases of TVT failure and may be offered to the majority of patients with insufficient urethral support after the first procedure. PMID:24578885

Post-operative swallowing in multiple system atrophy.

Science.gov (United States)

Ueha, R; Nito, T; Sakamoto, T; Yamauchi, A; Tsunoda, K; Yamasoba, T

2016-02-01

Some patients with multiple system atrophy (MSA) require surgical interventions such as tracheostomy and aspiration prevention. Few studies have investigated the postoperative clinical course of MSA patients. The aim of this study was to determine a management strategy for dysphagia and respiratory disorder in MSA. From 2001 to 2014, 18 MSA patients (13 males and 5 females, 52-76 years) underwent tracheostomy (TR, n = 11) or laryngeal closure (LC, n = 12). Five patients underwent LC following TR. Vocal fold impairment, the degree of dysphagia and pre/post-operative oral ingestion, and postoperative survival time were evaluated retrospectively. Swallowing function was assessed using the penetration aspiration scale (PAS). TR was performed due to respiratory disorder in seven patients and due to dysphagia in four patients. PAS scores ranged 1-8 in TR patients and 7-8 in LC patients. Seven of 11 patients who underwent TR displayed worsened PAS scores, and no patients displayed improved PAS scores following TR. All patients who underwent LC regained complete or partial oral intake after surgery. There were no significant differences in postoperative survival time between the two groups. Considering the impacts of TR and LC on survival time, postoperative feeding and swallowing, LC is a good option for treating MSA patients with dysphagia. © 2015 EAN.

The effect of public or private structures in wastewater treatment on the conditions for the design, construction and operation of wastewater treatment plants.

Science.gov (United States)

Grünebaum, T; Bode, H

2004-01-01

Organised in public or private structures, wastewater services have to cope with different framework conditions as regards planning, construction, financing and operation. This leads quite often to different modes of management. In recent years there has been a push for privatisation on the water sector in general, the reasons for which are manifold, ranging from access to external know-how and capital to synergistic effects through integration of wastewater treatment into other tasks of similar or equal nature. Discussed are various models of public/private partnership (PPP) in wastewater treatment, encompassing for example the delegation of partial tasks or even the proportional or entire transfer of ownership of treatment facilities to private third parties. Decisive for high performance and efficiency is not the legal or organisational form, but rather the clear and unmistakable definition of tasks which are to be assigned to the different parties, customers and all other partners involved, as well as of clear-cut interfaces. On account of the (of course legitimate) profit-oriented perspective of the private sector, some decision-making processes in relation to project implementation (design and construction) and to operational aspects will differ from those typically found on the public sector. This does apply to decisions on investments, financing and on technical solutions too. On the other hand, core competencies in wastewater treatment should not be outsourced, but remain the public bodies' responsibility, even with 'far-reaching' privatisation models. Such core competencies are all efforts geared to sustainable wastewater treatment as life-supporting provision for the future or as contribution to the protection of health and the environment and to the development of infrastructure. Major areas of wastewater treatment and other related tasks are reviewed. The paper concludes with a list of questions on the issue of outsourcing.

Stereotactic Body Radiotherapy (SBRT) for Operable Stage I Non-Small-Cell Lung Cancer: Can SBRT Be Comparable to Surgery?

Energy Technology Data Exchange (ETDEWEB)

Onishi, Hiroshi, E-mail: honishi@yamanashi.ac.jp [School of Medicine, Yamanashi University, Yamanashi (Japan); Shirato, Hiroki [School of Medicine, Hokkaido University, Sapporo (Japan); Nagata, Yasushi [School of Medicine, Hiroshima University, Hiroshima (Japan); Hiraoka, Masahiro [School of Medicine, Kyoto University, Kyoto (Japan); Fujino, Masaharu [School of Medicine, Hokkaido University, Sapporo (Japan); School of Medicine, Yamanashi University, Yamanashi (Japan); Gomi, Kotaro [Cancer Institute Suwa Red-Cross Hospital, Suwa (Japan); Karasawa, Katsuyuki [Tokyo Metropolitan Komagome Hospital, Tokyo (Japan); Hayakawa, Kazushige; Niibe, Yuzuru [Kitasato University, Kanagawa (Japan); Takai, Yoshihiro [School of Medicine, Hirosaki University, Hirosaki (Japan); Kimura, Tomoki [School of Medicine, Kagawa University, Hiroshima (Japan); Takeda, Atsuya [Ofuna Chuo Hospital, Kanagawa (Japan); Ouchi, Atsushi [Keijinkai Hospital, Sapporo (Japan); Hareyama, Masato [Sapporo Medical University, Sapporo (Japan); Kokubo, Masaki [Institute of Biomedical Research and Innovation, Kobe (Japan); Kozuka, Takuyo [School of Cancer Institute Ariake Hospital, Tokyo (Japan); Arimoto, Takuro [Kitami Red Cross Hospital, Kitami (Japan); Hara, Ryusuke [National Institute of Radiological Science, Chiba (Japan); Itami, Jun [National Cancer Center, Tokyo (Japan); Araki, Tsutomu [School of Medicine, Yamanashi University, Yamanashi (Japan)

2011-12-01

Purpose: To review treatment outcomes for stereotactic body radiotherapy (SBRT) in medically operable patients with Stage I non-small-cell lung cancer (NSCLC), using a Japanese multi-institutional database. Patients and Methods: Between 1995 and 2004, a total of 87 patients with Stage I NSCLC (median age, 74 years; T1N0M0, n = 65; T2N0M0, n = 22) who were medically operable but refused surgery were treated using SBRT alone in 14 institutions. Stereotactic three-dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. Total dose was 45-72.5 Gy at the isocenter, administered in 3-10 fractions. Median calculated biological effective dose was 116 Gy (range, 100-141 Gy). Data were collected and analyzed retrospectively. Results: During follow-up (median, 55 months), cumulative local control rates for T1 and T2 tumors at 5 years after SBRT were 92% and 73%, respectively. Pulmonary complications above Grade 2 arose in 1 patient (1.1%). Five-year overall survival rates for Stage IA and IB subgroups were 72% and 62%, respectively. One patient who developed local recurrences safely underwent salvage surgery. Conclusion: Stereotactic body radiotherapy is safe and promising as a radical treatment for operable Stage I NSCLC. The survival rate for SBRT is potentially comparable to that for surgery.

Stereotactic Body Radiotherapy (SBRT) for Operable Stage I Non–Small-Cell Lung Cancer: Can SBRT Be Comparable to Surgery?

International Nuclear Information System (INIS)

Onishi, Hiroshi; Shirato, Hiroki; Nagata, Yasushi; Hiraoka, Masahiro; Fujino, Masaharu; Gomi, Kotaro; Karasawa, Katsuyuki; Hayakawa, Kazushige; Niibe, Yuzuru; Takai, Yoshihiro; Kimura, Tomoki; Takeda, Atsuya; Ouchi, Atsushi; Hareyama, Masato; Kokubo, Masaki; Kozuka, Takuyo; Arimoto, Takuro; Hara, Ryusuke; Itami, Jun; Araki, Tsutomu

2011-01-01

Purpose: To review treatment outcomes for stereotactic body radiotherapy (SBRT) in medically operable patients with Stage I non–small-cell lung cancer (NSCLC), using a Japanese multi-institutional database. Patients and Methods: Between 1995 and 2004, a total of 87 patients with Stage I NSCLC (median age, 74 years; T1N0M0, n = 65; T2N0M0, n = 22) who were medically operable but refused surgery were treated using SBRT alone in 14 institutions. Stereotactic three-dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. Total dose was 45–72.5 Gy at the isocenter, administered in 3–10 fractions. Median calculated biological effective dose was 116 Gy (range, 100–141 Gy). Data were collected and analyzed retrospectively. Results: During follow-up (median, 55 months), cumulative local control rates for T1 and T2 tumors at 5 years after SBRT were 92% and 73%, respectively. Pulmonary complications above Grade 2 arose in 1 patient (1.1%). Five-year overall survival rates for Stage IA and IB subgroups were 72% and 62%, respectively. One patient who developed local recurrences safely underwent salvage surgery. Conclusion: Stereotactic body radiotherapy is safe and promising as a radical treatment for operable Stage I NSCLC. The survival rate for SBRT is potentially comparable to that for surgery.

Diagnostics and operative treatment of retrorectal cysts - description of five cases

International Nuclear Information System (INIS)

Kolodziejczak, M.; Grochowicz, M.; Kosim, A.; Stefanski, R.; Sudol-Szopinska, I.

2005-01-01

Background. Retrorectal cysts (RC) are unusual lesions. Publications on RC are very rare and describe a few cases at most. Methods. Authors describe five patients with RC. The diagnostics of RC was based on the medical history of the patients and the basic diagnostic investigation was trans rectal ultrasonography. An operation to remove the cysts from perineal access was the treatment administered in these cases. Results. In three cases the histopathological examination showed cystis epidermalis. In another case a cyst epithelialized with ciliated epithelium was found. In the last case bone tissue, fatty tissue and fibrous tissue were depicted, all in the state of chronic inflammation. Conclusions. Per rectum digital exam is the basic examination decisive in making the diagnosis. TRUS should be employed as the diagnostic investigation in order to estimate precisely the size of a cyst and its proportion to the rectum wall. Retrorectal cystectomy in perineal access is an effective method of treatment of this disease. This article, likewise other research works, describes a small group of patients, therefore, its conclusions should be treated as preliminary ones. (author)

Impairment of wound healing after operative treatment of mandibular fractures, and the influence of dexamethasone.

Science.gov (United States)

Snäll, Johanna; Kormi, Eeva; Lindqvist, Christian; Suominen, Anna Liisa; Mesimäki, Karri; Törnwall, Jyrki; Thorén, Hanna

2013-12-01

Our aim was to clarify the incidence of impaired wound healing after open reduction and ostheosynthesis of mandibular fractures, and to find out whether the use of dexamethasone during the operation increased the risk. Patients were drawn from a larger group of healthy adult dentate patients who had participated in a single-blind, randomised study, the aim of which was to clarify the benefits of operative dexamethasone after treatment of facial fractures. The present analysis comprised 41 patients who had had open reduction and fixation of mandibular fractures with titanium miniplates and monocortical screws through one or 2 intraoral approaches. The outcome variable was impaired healing of the wound. The primary predictive variable was the perioperative use of dexamethasone; other potential predictive variables were age, sex, smoking habit, type of fracture, delay in treatment, and duration of operation. Wound healing was impaired in 13/41 patients (32%) (13/53 of all fractures). The incidence among patients who were given dexamethasone and those who were not did not differ significantly. Only age over 25 was significantly associated with delayed healing (p=0.02). The use of dexamethasone 30 mg perioperatively did not significantly increase the risk of impaired wound healing in healthy patients with clinically uninfected mandibular fractures fixed with titanium miniplates through an intraoral approach. Older age is a significant predictor of impaired healing, which emphasises the importance of thorough anti-infective care in these patients during and after the operation. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Capillary Suction Time. Operational Control Tests for Wastewater Treatment Facilities. Instructor's Manual [and] Student Workbook.

Science.gov (United States)

Wooley, John F.

Capillary suction time is time required for the liquid phase of a treated sludge to travel through 1 centimeter of media (blotter or filter paper). Designed for individuals who have completed National Pollutant Discharge Elimination System (NPDES) level 1 laboratory training skills, this module provides waste water treatment plant operators with…

Operative videothoracoscopy in the surgical treatment of penetrating firearms wounds of the chest.

Science.gov (United States)

Brusov, P G; Kuritsyn, A N; Urazovsky, N Y; Tariverdiev, M L

1998-09-01

We prospectively analyzed our experience with operative videothoracoscopy (OVT) performed in a field military hospital in cases of penetrating firearms wounds of the thorax (PFAWT) sustained in Chechnya. From February to April 1996, we treated 206 wounded patients, of whom 37 (18.0%) had sustained chest injuries. PFAWT were present in 23 soldiers, accounting for 62.2% of all chest injuries. Twelve injuries were confined to the thorax, eight patients had associated injuries, and three soldiers had thoracoabdominal injuries. Nineteen patients had pleural drainage performed during medical evacuation. The thoracic injuries were right-sided (17), involved bullets or shell splinters (23); were through and through (16), represented solitary wounds (19), and were associated with internal organ injuries (21). Fifteen patients had indications for OVT when they were delivered from the battle-field 1.5 to 22 hours after injury. All patients manifested signs of hemorrhagic shock and hemodynamic instability. Indications for OVT were ongoing intrapleural bleeding (6), clotted hemothorax (6), or marked air leakage (3) preventing lung inflation with the OP-02 apparatus (field modification). OVT revealed 12 lung wounds, nine of which were multiple wounds, pleural bleeding in 6 patients, clotted hemothorax in 11 patients, and foreign bodies in 5 patients. Two patients underwent thoracotomy, one for suspicion of heart injury and the second because we could not adequately visualize and control bleeding revealed at OVT to be from the intercostal artery in the left costovertebral angle. Eight of 23 patients had no indication for operative videothoracoscopy and were managed with continued pleural aspiration and drug therapy. Wedge resection of the lung using an Endo-GIA-30 stapler was necessary in two patients because of parenchymal destruction and bleeding. Evacuation of clotted blood by fragmentation and aspiration was satisfactory in all cases. Satisfactory manual suturing of selected

[Surgical treatment of the aortic root aneurysm related to Marfan syndrome].

Science.gov (United States)

Zheng, Si-hong; Sun, Yan-qing; Meng, Xu; Zhang, Hong; Hou, Xiao-tong; Wang, Jian-gang; Gao, Feng

2005-08-24

To review the experience of surgical treatment of aortic root aneurysm of Marfan syndrome. We The clinical data of 84 Marfan syndrome patients, 61 males and 23 females, aged 35 +/- 12 (5 - 62), 41 cases presenting with aortic dissection (Debakey type I in 32 cases and type II in 9), 52 cases with moderate to severe aortic regurgitation, and 9 cases with moderate to severe mitral regurgitation, 43 cases with cardiac function of class I - II, 30 with class III and 11 with class IV according the New York Heart Association (NYHA) standard, who underwent surgical treatment for aortic root aneurysm with a mean diameter of 68 mm +/- 14 mm, were analyzed. Bentall procedure was performed in 68 cases, Wheat procedure in 6, Cabrol procedure in 5, and aortic valve replacement and aortoplasty in 5. Concomitant procedures included mitral value replacement and mitral valvuoplasty in 3 cases respectively. Urgent surgery was conducted in 28 cases, and elective operation in 56 cases. There were 3 in-hospital deaths (3.57%). 76 cases were followed up for a mean duration of 55 +/- 31 months. Three patients underwent reoperation. The cardiac function returned to class I - II except for 2 cases that remained at the class III. Bentall procedure should be the first choice of the surgery for aortic root aneurysm of Marfan syndrome with a low mortality and a good late outcome.

Hybrid endovascular treatment of an aortic root and thoracoabdominal aneurysm in a high-risk patient with Marfan syndrome.

Science.gov (United States)

Gelpi, Guido; Mazzaccaro, Daniela; Romagnoni, Claudia; Contino, Monica; Antona, Carlo

2013-05-01

This report describes the hybrid endovascular treatment of an aortic root dilatation and a thoracoabdominal aneurysm in a high-risk patient with Marfan syndrome. A 50-year-old male, in hemodialysis for polycystic kidney and polycystic liver, was referred to our department for aortic root dilatation of 5 cm and a 6.3-cm thoracoabdominal aneurysm . He already underwent surgical repair of abdominal aortic aneurysm 10 years ago, complicated by pseudoaneurysm of the proximal anastomosis that had been treated in another center, with an endoprosthesis. The patient underwent aortic root replacement, aortic valve sparing operation, and rerouting of the superior mesenteric artery and celiac trunk to the ascending aorta. The thoracoabdominal aneurysm was excluded with an endoprosthesis few days after the surgical step. The 12-month computed tomography scan confirmed the complete exclusion of the thoracoabdominal aneurysm.

Construction and Operation Costs of Wastewater Treatment and Implications for the Paper Industry in China.

Science.gov (United States)

Niu, Kunyu; Wu, Jian; Yu, Fang; Guo, Jingli

2016-11-15

This paper aims to develop a construction and operation cost model of wastewater treatment for the paper industry in China and explores the main factors that determine these costs. Previous models mainly involved factors relating to the treatment scale and efficiency of treatment facilities for deriving the cost function. We considered the factors more comprehensively by adding a regional variable to represent the economic development level, a corporate ownership factor to represent the plant characteristics, a subsector variable to capture pollutant characteristics, and a detailed-classification technology variable. We applied a unique data set from a national pollution source census for the model simulation. The major findings include the following: (1) Wastewater treatment costs in the paper industry are determined by scale, technology, degree of treatment, ownership, and regional factors; (2) Wastewater treatment costs show a large decreasing scale effect; (3) The current level of pollutant discharge fees is far lower than the marginal treatment costs for meeting the wastewater discharge standard. Key implications are as follows: (1) Cost characteristics and impact factors should be fully recognized when planning or making policies relating to wastewater treatment projects or technology development; (2) There is potential to reduce treatment costs by centralizing wastewater treatment via industrial parks; (3) Wastewater discharge fee rates should be increased; (4) Energy efficient technology should become the future focus of wastewater treatment.

Intraoperative seizures and seizures outcome in patients underwent awake craniotomy.

Science.gov (United States)

Yuan, Yang; Peizhi, Zhou; Xiang, Wang; Yanhui, Liu; Ruofei, Liang; Shu, Jiang; Qing, Mao

2016-11-25

Awake craniotomies (AC) could reduce neurological deficits compared with patients under general anesthesia, however, intraoperative seizure is a major reason causing awake surgery failure. The purpose of the study was to give a comprehensive overview the published articles focused on seizure incidence in awake craniotomy. Bibliographic searches of the EMBASE, MEDLINE,were performed to identify articles and conference abstracts that investigated the intraoperative seizure frequency of patients underwent AC. Twenty-five studies were included in this meta-analysis. Among the 25 included studies, one was randomized controlled trials and 5 of them were comparable studies. The pooled data suggested the general intraoperative seizure(IOS) rate for patients with AC was 8%(fixed effect model), sub-group analysis identified IOS rate for glioma patients was 8% and low grade patients was 10%. The pooled data showed early seizure rates of AC patients was 11% and late seizure rates was 35%. This systematic review and meta-analysis shows that awake craniotomy is a safe technique with relatively low intraoperative seizure occurrence. However, few RCTs were available, and the acquisition of further evidence through high-quality RCTs is highly recommended.

[Left atrial electric isolation in the treatment of atrial fibrillation secondary to rheumatic valvular disease].

Science.gov (United States)

Graffigna, A; Pagani, F; Minzioni, G; Salerno, J; Viganò, M

1992-08-01

Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to valvular disease in 100 patients who underwent valve surgery. From May 1989 to September 1991, 62 patients underwent mitral valve surgery (Group I), 19 underwent mitral valve surgery and DeVega tricuspid annuloplasty (Group II), 15 underwent mitral and aortic surgery (Group III), and 4 patients underwent mitral and aortic surgery and DeVega tricuspid annuloplasty (Group IV). Left atrial isolation was performed prolonging the usual left paraseptal atriotomy towards the left fibrous trigone anteriorly, and the postero-medial commissure posteriorly. The incision was conducted a few millimeters apart from the mitral valve annulus, and cryolesion were placed at the edges to ensure complete electrophysiological isolation of the left atrium. Operative mortality accounted for 3 cases (3%). In 79 patients (81.4%) sinus rhythm recovered and persisted until discharge from the hospital. No differences were found between the groups (Group I: 80.7%; Group II: 68.5%; Group III 86.7%, Group IV 75% - p = N.S.). Three cases of late mortality (3.1%) were registered. long-term results showed persistence of SR in 71% of Group I, 61.2% of Group II, 85.8% of Group III, and 100% of Group IV. The unique risk factor for late recurrency of atrial fibrillation was found to be a duration of preoperative AF longer than 6 months. Due to the high success rate in recovering the sinus rhythm, we suggest left atrial isolation in patients with chronic atrial fibrillation undergoing valvular surgery.

Operative Complications During Pregnancy After Gastric Bypass—a Register-Based Cohort Study

DEFF Research Database (Denmark)

Andreasen, Lisbeth A; Nilas, Lisbeth; Kjær, Mette M

2014-01-01

the puerperium. CONCLUSIONS: The incidence of internal herniation during pregnancy was 1 % in our study. Internal herniation may be a serious complication in pregnant women, and both the diagnosis and treatment requires handling by experienced obstetrical, radiological, and surgical staff....... during pregnancy in a national cohort of women with a history of gastric bypass surgery. METHODS: A national, register-based cohort study of all Danish women with a history of gastric bypass surgery who had given birth from 2004 to 2010 was conducted. Surgical codes registered during pregnancy and until...... 120 days postpartum were identified in national registers, and the individual charts were reviewed in relevant cases. RESULTS: Of 286 women giving birth, fourteen women underwent procedures that might be related to the earlier gastric bypass surgery. Three women were operated on suspicion of internal...

Surgical treatment of GERD. Comperative study of WTP vs. Toupet fundoplication – results of 151 consecutive cases

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Tadeusz Wróblewski

2016-03-01

Full Text Available Introduction: Gastroesophageal reflux disease (GERD is recognized as one of the most common disorders of the upper gastrointestinal tract (GIT. The best choice of management for advanced GERD is laparoscopic surgery. Aim : To compare and evaluate the results of surgical treatment of GERD patients operated on using two different techniques. Material and methods : Between 2001 and 2012, 353 patients (211 female and 142 male, aged 17–76 years (mean 44, underwent laparoscopic antireflux surgery. The study included patients who underwent a Toupet fundoplication or Wroblewski Tadeusz Procedure (WTP. Results: The mean age of the group was 47.77 years (17–80 years. Forty-nine (32.45% patients had severe symptoms, 93 (61.58% had mild symptoms and 9 (5.96% had a single mild but intolerable sign of GERD. Eighty-six (56.95% patients had a Toupet fundoplication and 65 (43.04% had a WTP. The follow-up period was 18–144 months. The average operating time for Toupet fundoplication and the WTP procedure was 164 min (90–300 min and 147 min (90–210 min, respectively. The perioperative mortality rate was 0.66%. The average post-operative hospitalization period was 5.4 days (2–16 post-operative days (POD = Toupet vs. 4.7 days (2–9 POD = WTP. No reoperations were performed. No major surgical complications were identified. Conclusions : Wroblewski Tadeusz Procedure due to a low percentage of post-operative complications, good quality of life of patients and a zero recurrence rate of hiatal hernia should be a method of choice.

Treatment results in anal cancer: non-operative treatment versus operative treatment

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Chie, Eui Kyu; Park, Jae Gahb; Bang, Yung Jue; Heo, Dae Seog; Kim, Noe Kyeong [Seoul National University College of Medicine, Seoul (Korea, Republic of); Ha, Sung Whan [Medical Reasearch Center, Seoul National University, Seoul (Korea, Republic of)

2002-03-15

This study was undertaken to analyze the efficacy and sphincter preservation rate of platinum based neoadjuvant chemotherapy plus radiotherapy versus abdominoperineal resection and postoperative radiotherapy for anal cancer. Data of forty-two patients with anal cancer were retrospectively analyzed. Among thirty-eight patients with epidermoid histology, four patients received radiotherapy, and nineteen patients received abdominoperineal resection and adjuvant radiotherapy with or without chemotherapy (APR + RT {+-} CT), and fifteen patients received neoadjuvant chemotherapy and radiotherapy (CRT). The CRT regimen was composed of three cycles of 5-fluorouracil (1,000 mg/m{sup 2} bolus on D1 {approx} 5) and cisplatin (60 mg/m{sup 2} bolus on D1) followed by 50.4 Gy to the tumor bed and regional lymphatics over 5.5 weeks. Both inguinal lymphatics were treated with an identical dose schedule. Residual disease was treated with an additional three cycles of identical adjuvant chemotherapy. An identical dose schedule was used for post-operative radiotherapy. Median follow-up period was eighty-five months. Overall five-year survival rates were 80.3%, 88.9% and 79.4% for entire patients, APR + RT {+-} CT group, and the CRT group, respectively. No significant difference was found between the two groups ({rho} = 0.49). Anus preservation rate for the CRT group was 86.7%. Age ({rho} = 0.0164) and performance status ({rho} = 0.0007) were found to be significant prognostic factors by univariate analysis. Age ({rho} = 0.0426), performance status ({rho} = 0.0068), and inguinal lymph node metastasis ({rho} = 0.0093) were statistically significant prognostic factors by multivariate analysis. No case of RTOG grade 3 complication or higher was reported. This and other recent studies have shown that combined chemotherapy plus radiotherapy for anal cancer results in a high rate of anal sphincter preservation as well as local control and survival. Furthermore, neoadjuvant use of

Rating of intra-operative neuro-monitoring results in operative correction of the spinal deformities

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A. A. Skripnikov

2015-01-01

Full Text Available Purpose of the work was filing the electrophysiological phenomena observed in the process of intra-operative neuromonitoring followed by development of the results’ scale of intra-operative neuro-physiological testing of the pyramidal tract. Materials and мethods. The selection for evaluation included data of 147 protocols of intra-operative neuromonitoring in 135 patients (53 males, 82 females, aged from 1 y. 5 m. to 52 years (14,1±0,7 years with spinal deformities of different etiology who underwent instrumentation spinal correction followed by fixation of thoracic / thoracolumbar spine segments using various variants of internal systems of trans-pedicular fixation. Intra-operative neuro-monitoring was performed using system «ISIS IOM» (Inomed Medizintechnik GmbH, Germany. The changes of motor evoked potentials were evaluated according to this scale. Results. Five types of pyramidal system reaction to operative invasion were revealed. According to neurophysiological criteria three grades of the risk of neurological disorders development during operative spinal deformity correction and, correspondingly, three levels of anxiety for the surgeon were defined. Conclusion. Intra-operative neurophysiological monitoring is the effective highly technological instrument to prevent neurological disorders in the spinal deformity. Offered rating scale of the risk of neurological complications gives the possibility to highlight three levels of anxiety during operative invasion.

Vegetated treatment area (VTAs) efficiences for E. coli and nutrient removal on small-scale swine operations

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As small-scale animal feeding operations work to manage their byproducts and avoid regulation, they need practical, cost-effective methods to reduce environmental impact. One such option is using vegetative treatment areas (VTAs) with perennial grasses to treat runoff; however, research is limited ...

Operational readiness review for the TSCA incinerator start-up at the Oak Ridge K-25 site

International Nuclear Information System (INIS)

Jordan, Elizabeth A.; Murray, Alexander P.; Kiang, Peter M.

1992-01-01

The Department of Energy (DOE) Toxic Substances Control Act (TSCA) incinerator at Oak Ridge K-25 Site was designed in the early 1980's as a treatment alternative for the increasing quantities of radioactive mixed waste accumulating from gaseous diffusion plant (GDP) operations. The waste feed principally contains low assay uranium and PCBs, although listed solvents and heavy metal containing sludges have also be incinerated. Construction was completed in 1986 and the unit underwent an extensive series of tests and trial burns, because of the following unique characteristics: the incinerator treats radioactive mixed wastes; increased size of the incinerator for greater waste throughout and treatment capacity; expansion of the waste acceptance criteria to include materials and radionuclides from non-GDP operations, such as ORNL and Y-12; modifications and improvement to the Air Pollution Control (APC) system; treatment of large quantities and concentrations of PCB containing materials; projected longevity of operation (40 years); humid, Eastern location with a high, annual precipitation. The incinerator was initially fired in July, 1986. The full performance testing (with the APC) and DOE acceptance of the facility occurred a year later. The trial burn period lasted from 1988 through 1990. Numerous equipment problems were initially encountered, including excessive draft fan wear and failure. These problems have been overcome, the facility is fully permitted, DOE provided authorization for full operations in 1991, and, to date, over two million pounds of mixed waste have been incinerated, with an average volume reduction factor of approximately nine. This paper discusses the Office of Environmental Restoration and Waste Management Readiness Review for the incinerator. (author)

Study of surgical treatment on neovascular glaucoma

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Xiao-Nü Liu

2014-05-01

Full Text Available AIM: To compare the effect of two surgical methods on neovascular glaucoma(NVG. METHODS: The clinical date of 46 cases(57 eyeswith NVG underwent surgical treatment were retrospectively analyzed and followed-up. Patients were divided into Ahmed glaucoma valve(AGVimplantation group(group A, 24 cases, 31 eyesand semiconductor diode laser transscleral ciliary body photocoagulation(TSCPCgroup(group B, 22cases, 26 eyesaccording to the surgical approach. The intraocular pressure, visual acuity and postoperative complications were compared before and after operation. RESULTS: The intraocular pressure postoperative in two groups were significantly lower than those preoperative(P P>0.05. The changes of visual acuity postoperative showed no statistical difference between the two groups(P>0.05. The postoperative complications of group A was significantly lower than that in group B, in which the incidence of eye pain, anterior chamber bleeding were significant differences between two groups(P CONCLUSION: AGV implantation treatment and TSCPC for NVG are both valid, but AGV implantation is filtration surgery, and TSCPC isciliary body destructive surgery, and the latter has higher rate of postoperative complications.

LONG-TERM SUCCESS OF AORTOILIAC OPERATION FOR ARTERIOSCLEROTIC OBSTRUCTIVE DISEASE

NARCIS (Netherlands)

VANDENAKKER, PJ; VANSCHILFGAARDE, R; BRAND, R; VANBOCKEL, JH; TERPSTRA, JL

The current retrospective study was performed on 747 patients with aortoiliac obstructive disease who under-went reconstructive operation. Unlike many other centers, the University Hospital Leiden has, throughout the years, maintained the strategy of avoiding the implantation of a prosthesis in

[Operative treatment of painful neuromas].

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Stokvis, Annemieke; Coert, J Henk

2011-01-01

3-5% of patients with traumatic or iatrogenic peripheral nerve injury develop a painful neuroma, especially following trauma of small cutaneous sensory nerve branches. Neuroma pain is difficult to treat and often leads to loss of function and reduction of quality of life. Patients with a painful neuroma present with spontaneous electric, shooting or burning pain, allodynia, hyperalgesia and cold intolerance. The diagnosis is based on the medical history and physical examination, supplemented by Tinel's test and a diagnostic nerve blockade. Lasting pain relief is possible by means of surgical neuroma treatment performed by a plastic surgeon. Surgical treatment consists of repair or denervation of the nerve with relocation of the nerve stump in bone or muscle tissue or a vein. Referral of neuroma patients without delay to a plastic surgeon or multidisciplinary consultation is important, because the symptoms become increasingly difficult to treat over time. 3-5% of patients with traumatic or iatrogenic peripheral nerve injury develop a painful neuroma, especially following trauma of small cutaneous sensory nerve branches. Neuroma pain is difficult to treat and often leads to loss of function and reduction of quality of life. Patients with a painful neuroma present with spontaneous electric, shooting or burning pain, allodynia, hyperalgesia and cold intolerance. The diagnosis is based on the medical history and physical examination, supplemented by Tinel's test and a diagnostic nerve blockade. Lasting pain relief is possible by means of surgical neuroma treatment performed by a plastic surgeon. Surgical treatment consists of repair or denervation of the nerve with relocation of the nerve stump in bone or muscle tissue or a vein. Referral of neuroma patients without delay to a plastic surgeon or multidisciplinary consultation is important, because the symptoms become increasingly difficult to treat over time.

Microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches

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Hong-guang WANG

2016-08-01

Full Text Available Objective To investigate surgical strategies, clinical effects and complications of microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches.  Methods Review clinical data of 18 cases with anterior circulation mirror aneurysms who underwent one-stage clipping via bilateral frontolateral approaches from July 2010 to July 2015 admitted to Department of Neurosurgery in Tianjin Huanhu Hospital. The operative efficacy was evaluated according to postoperative Glasgow Outcome Scale (GOS.  Results The 36 aneurysms in 18 patients were successfully clipped via bilateral frontolateral approaches at one-stage, including 18 posterior communicating artery (PCoA mirror aneurysms in 9 cases and 18 middle cerebral artery (MCA mirror aneurysms in 9 cases. GOS score of 5 was discovered in 16 cases, and 4 was discovered in 2 cases after operation. One case underwent ventriculoperitoneal shunting (VPS due to communicating hydrocephalus, one case got postoperative pulmonary infection and no death occurred. Intracranial CTA at 6 months postoperatively showed aneurysms of 18 patients were clipped completely, the parent artery blood flow was smooth, and no recurrence was found.  Conclusions Microsurgical one-stage clipping via bilateral frontolateral approaches for treating intracranial mirror aneurysms is a sugrical method with small incision, fitting surgical field, high safety, satisfactory effect and good prognosis, which is a new minimally invasive neurosurgical technique. DOI: 10.3969/j.issn.1672-6731.2016.08.012

Athletic pubalgia: definition and surgical treatment.

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Ahumada, Leonik A; Ashruf, Salman; Espinosa-de-los-Monteros, Antonio; Long, James N; de la Torre, Jorge I; Garth, William P; Vasconez, Luis O

2005-10-01

Athletic pubalgia, or "sports hernia," affects people actively engaged in sports. Previously described in high-performance athletes, it can occur in recreational athletes. It presents with inguinal pain exacerbated with physical activity. Examination reveals absence of a hernia with pubic point tenderness accentuated by resisted adduction of the hip. Diagnosis is by history and physical findings. Treatment with an internal oblique flap reinforced with mesh alleviates symptoms. A retrospective review from December 1998 to November 2004 for patients with athletic pubalgia who underwent operative repair was performed. Descriptive variables included age, gender, laterality, sport, time to presentation, outcome, anatomy, and length of follow-up. Twelve patients, 1 female, with median age 25 years were evaluated. Activities included running (33%), basketball (25%), soccer (17%), football (17%), and baseball (8%). The majority were recreational athletes (50%). Median time to presentation was 9 months, with a median 4 months of follow-up. The most common intraoperative findings were nonspecific attenuation of the inguinal floor and cord lipomas. All underwent open inguinal repair, with 9 being reinforced with mesh. Four had adductor tenotomy. Results were 83.3% excellent and 16.7% satisfactory. All returned to sports. Diagnosis of athletic pubalgia can be elusive, but is established by history and physical examination. It can be found in recreational athletes. An open approach using mesh relieves the pain and restores activity.

Results of dermatoplastic operations in case of combined treatment of patients with skin melanomas using preoperational thermoradiotherapy

International Nuclear Information System (INIS)

Zalutskij, I.V.

1988-01-01

Dermato-plastic operations are possible and justified following a wide resection of skin melanoma in combined treatment of patients using preoperational local thermoradiotherapy. It is shown that frequency of local postoperational complications in the main group of patients in case of plastics by free skin grafts depends on neoplasm localization. Further improvement of performing dermato-plastic operations and research of effective prophylaxis of local postoperational complications are necessary. 6 refs.; 1 tab

Intrasellar Iatrogenic Carotid Pseudoaneurysm: Endovascular Treatment with a Polytetrafluoroethylene-Covered S tent

International Nuclear Information System (INIS)

Vanninen, R. L.; Manninen, H. I.; Rinne, J.

2003-01-01

This case illustrates successful treatment of a large postoperative intrasellar pseudoaneurysm with a polytetrafluoroethylene (PTFE)-covered stent. The advantages and potential disadvantages of this novel method of treatment are discussed. A previously healthy 59-year-old man underwent transsphenoidal operative treatment for hypophyseal macroadenoma,complicated by bleeding. On the 17 th postoperative day the patient had profuse arterial bleeding from his nose requiring posterior tamponade. Subsequent angiography of the left internal carotid artery(ICA) revealed a large pseudoaneurysm located intrasellarly, with the orifice in the anteromedial wall in the ophthalmic segment of the ICA.Surgical treatment of the pseudoaneurysm was considered very risky. A12-mm PTFE-covered stent (JoMed, Ulestraten, Netherlands), manually compressed on a PTCA-balloon (Maxxum 4.5/13 mm, Boston Scientific,Ireland) was endovascularly delivered covering the orifice of the pseudoaneurysm. Control angiography immediately after the intervention and one year later revealed no flow into the pseudoaneurysm and the ICA was fully patent. In conclusion, deployment of a PTFE-covered stent proved to be feasible and successful in the treatment of an intrasellariatrogenic ICA pseudoaneurysm. Adequate anticoagulative treatment after the procedure is essential to prevent thrombotic complications

Operative treatment of acromioclavicular joint dislocation: a new technique with suture anchors

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Zhang Jingwei

2014-07-01

Full Text Available 【Abstract】Objective: To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation. Methods: Twenty-eight patients with acute traumatic Rockwood III, IV and V dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited. All patients underwent open reduction combined with suture anchors. Function was evaluated using the ConstantMurley shoulder score. Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3, 6 and 12 months. Results:Two cases with fixation loosening were not included in final statistical analysis. Other patients obtained full joint reposition on immediate postoperative radiographs. Follow-up was performed with an average of 15.6 months (range, 12-19. After early range of motion exercises, 96.2% of the patients (25/26 could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months. There was no infection. Average Constant-Murley score was 96.3 points (range, 94-100 and mean Taft shoulder rating was 10.7 points (range, 8-12 at 12 months. Conclusion: The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation. Key words: Acromioclavicular joint; Dislocations; Surgery; Suture anchors

Transcutaneous periorbital electrical stimulation in the treatment of dry eye.

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Pedrotti, Emilio; Bosello, Francesca; Fasolo, Adriano; Frigo, Anna C; Marchesoni, Ivan; Ruggeri, Alfredo; Marchini, Giorgio

2017-06-01

To evaluate efficacy and safety of transcutaneous application of electrical current on symptoms and clinical signs of dry eye (DE). 27 patients with DE underwent transcutaneous electrostimulation with electrodes placed onto the periorbital region of both eyes and manual stimulation with a hand-piece conductor moved by the operator. Each patient underwent 12 sessions of 22 min spread over 2 months, two sessions per week in the first month and one session per week in the second month. Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), fluorescein staining of the cornea, Schirmer I test and adverse events were evaluated at baseline, at end of treatment and at 6 and 12 months. OSDI improved from 43.0±19.2 at baseline to 25.3±22.1 at end of treatment (mean±SD, p=0.001). These effects were substantially maintained at 6-month and 12-month follow-up evaluations. Improvement of the values of TBUT was recorded for the right eye at the end of treatment (p=0.003) and found in the left eye after 12 months (p=0.02). The Oxford scores changed in both eyes at the end of treatment and at the 6-month evaluation (peye at the 12-month evaluation (p=0.035). Schirmer I improved significantly at the end of treatment in the left eye (p=0.001) and in both eyes at the 12-month evaluation (p=0.004 and p=0.039 for the left and right eye, respectively). A significant reduction of the use of tear substitutes was found at the end of treatment (p=0.003), and was maintained during the follow-up (ptreatment satisfying. Transcutaneous electrical stimulation was shown to improve DE, both subjectively and objectively, without any adverse effects and has the potential to enlarge the armamentarium for treating DE. 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/.

Solitary rectal ulcer syndrome: clinical findings, surgical treatment, and outcomes.

Science.gov (United States)

Torres, Carlos; Khaikin, Marat; Bracho, Jorge; Luo, Cheng Hua; Weiss, Eric G; Sands, Dana R; Cera, Susan; Nogueras, Juan J; Wexner, Steven D

2007-11-01

Solitary rectal ulcer syndrome (SRUS) is a rare disorder often misdiagnosed as a malignant ulcer. Histopathological features of SRUS are characteristic and pathognomonic; nevertheless, the endoscopic and clinical presentations may be confusing. The aim of the present study was to assess the clinical findings, surgical treatment, and outcomes in patients who suffer from SRUS. A retrospective chart review was undertaken, from January 1989 to May 2005 for all patients who were diagnosed with SRUS. Data recorded included: patient's age, gender, clinical presentation, past surgical history, diagnostic and preoperative workup, operative procedure, complications, and outcomes. During the study period, 23 patients were diagnosed with SRUS. Seven patients received only medical treatment, and in three patients, the ulcer healed after medical treatment. Sixteen patients underwent surgical treatment. In four patients, the symptoms persisted after surgery. Two patients presented with postoperative rectal bleeding requiring surgical intervention. Three patients developed late postoperative sexual dysfunction. One patient continued suffering from rectal pain after a colostomy was constructed. Median follow-up was 14 (range 2-84) months. The results of this study show clearly that every patient with SRUS must be assessed individually. Initial treatment should include conservative measures. In patients with refractory symptoms, surgical treatment should be considered. Results of anterior resection and protocolectomy are satisfactory for solitary rectal ulcer.

Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

Science.gov (United States)

Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

2017-05-01

A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

Direct mixed antiglobulin reaction (MAR) test in semen at follow-up after testicular biopsy of maldescended testes operated in puberty

DEFF Research Database (Denmark)

Cortes, Dina; Brandt, B; Thorup, Jørgen Mogens

1990-01-01

In thirty patients bilateral orchiopexy was performed in puberty. At the operation twenty-five patients underwent bilateral testicular biopsies, and five patients underwent unilateral biopsies only. In adulthood the semen was analysed for antisperm antibodies by the direct mixed antiglobulin reac...

FRACTURES OF THE FIFTH METATARSAL RESULTS OF THE EARLY OPERATIVE TREATMENT OF ACUTE DISPLACED FRACTURES

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Slaviša Mihaljević

2004-04-01

Full Text Available Background. Fracture of the proximal 5th metatarsal bone (MTB reach almost 2% of all fractures of the foot. Conservative treatment is method of choice in almost all cases. Selected cases can benefit from acute surgery especially if the proximal fragment is severe displaced or the excessive articular step off is present.Materials and methods. In a 4 year period 14 patients were operated due to the acute fracture of proximal 5th MTB. All patients were treated in less than 2 weeks after the injury. 10 patients had base avulsion fracture in zone I and 4 had Jones fracture in zone II with dislocation of fragments? 5 mm, articular step off of 2 mm and 30% of articulation surface. We used tension bend wire in 9 cases (64%, partially threaded cancellous screw in 4 cases (28% and bone sutures in 1 case (7%. Postoperatively all patients used crutches with nonweight bearing for 4 weeks and afterwards partial weight bearing till the end of the treatment. All patients were practicing active exercises for ankle, foot and toes. The results were evaluated according to the Maryland Foot Score (MFS at least 20 months after injury.Results. 13 patients (93% were included in follow up. 12 patients were evaluated as excellent and only one as a good. All 13 patients have no or slight pain with no change in ADL or work ability. 9 patients (69% reached full functional result and 4 (31% patients had slight limitation during distance walk. Patients reached full weight bearing in average 7 weeks (5–13.Conclusions. Early operative treatment of selected cases allows fast return to preoperative activity without long term functional sequel. Both operative procedures, screw fixation and tension wire, yielded comparable and excellent end result.

[The nonpharmacological treatment of tachyarrhythmias. The surgery of supraventricular arrhythmias not due to pre-excitation].

Science.gov (United States)

Viganò, M; Graffigna, A; Pagani, F; Salerno, J A

1991-12-01

Surgery can provide treatment for supraventricular tachyarrhythmias without operative risk and with a definite improvement of patients' quality of life. Ectopic atrial tachycardia is a rare but invalidating arrhythmia that may lead to cardiomyopathy: intraoperative mapping is necessary for the location of the location of the ectopic focus; in our experience, surgical, cryothermal or isolation ablation of the area were effective in 9 patients out of 9, with regression of the cardiomyopathy. Atrioventricular node reentry tachycardia is a reentry tachycardia which is often associated with Wolff-Parkinson-White syndrome and is amenable to surgical treatment. Discrete cryolesions around the Koch triangle are effective in interrupting the atrial inputs to the atrioventricular node and therefore the reentry mechanism: in our experience, 7 patients were successfully treated without operative mortality: 3 patients underwent surgical ablation of Kent bundles as well. Atrial fibrillation is not based on a well-defined mechanism, and therefore does not permit an electrically-guided surgical treatment. However, in case of atrial septal defect it is possible to isolate the enlarged right atrium in order to allow sinus rhythm to activate the left atrium and ventricles.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment in patients with double elevator palsy.

Science.gov (United States)

Yurdakul, Nazife Sefi; Ugurlu, Seyda; Maden, Ahmet

2009-01-01

To evaluate the effectiveness of surgical treatment performed in patients with double elevator palsy (DEP). Patients diagnosed with congenital DEP between April 2003 and March 2007 were included in the study. The cases with positive traction test had inferior rectus (IR) recession followed by full tendon width muscle transposition Knapp surgery or partial tendon width transposition operation, while those without positive traction test underwent transposition procedure alone. Transposition surgery was combined with recession and resection of horizontal rectus muscles in patients with exotropia according to the amount of horizontal deviation. Eyelid surgery was applied in patients with ptosis following strabismus surgery. The average age of 13 patients was 14+/-32.5 years (range, 3-60 years). Five patients (38%) were female and 8 patients (62%) were male. The mean preoperative hypotropia was decreased from 29.2+/-3.5 prism diopters (PD) (range, 16-45 PD) to 2.6+/-2.8 PD (range, 0-6 PD) postoperatively. The median amount of horizontal deviation in patients with exotropia (n=4) was 30 PD (range, 25-45 PD) preoperatively; it was reduced to 2 PD (range, 0-8 PD) postoperatively. Mean follow-up period was 14.1+/-2.8 months (range, 6-31 months). Five patients (38%) underwent eyelid surgery, and all achieved cosmetically satisfactory results. Transposition surgery alone or combined with IR recession is an effective procedure in treatment of double elevator palsy. In patients with moderate horizontal deviations, recession and resection of horizontal rectus muscles combined with transposition provide correction of the horizontal deviation at the same time.

Angiographic embolization in the treatment of intrahepatic arterial bleeding in patients with blunt abdominal trauma.

Science.gov (United States)

Kong, Ya-Lin; Zhang, Hong-Yi; He, Xiao-Jun; Zhao, Gang; Liu, Cheng-Li; Xiao, Mei; Zhen, Yu-Ying

2014-04-01

Angiographic embolization (AE) as an adjunct non-operative treatment of intrahepatic arterial bleeding has been widely used. The present study aimed to evaluate the efficacy of selective AE in patients with hepatic trauma. Seventy patients with intrahepatic arterial bleeding after blunt abdominal trauma who had undergone selective AE in 10 years at this institution were retrospectively reviewed. The criteria for selective AE included active extravasation on contrast-enhanced CT, an episode of hypotension or a decrease in hemoglobin level during the non-operative treatment. The data of the patients included demographics, grade of liver injuries, mechanism of blunt abdominal trauma, associated intra-abdominal injuries, indications for AE, angiographic findings, type of AE, and AE-related hepatobiliary complications. In the 70 patients, 32 (45.71%) had high-grade liver injuries. Extravazation during the early arterial phase mainly involved the right hepatic segments. Thirteen (18.57%) patients underwent embolization of intrahepatic branches and the extrahepatic trunk and these patients all developed AE-related hepatobiliary complications. In 19 patients with AE-related complications, 14 received minimally invasive treatment and recovered without severe sequelae. AE is an adjunct treatment for liver injuries. Selective and/or super-selective AE should be advocated to decrease the incidence and severity of AE-related hepatobiliary complications.

Morel-Lavallée lesion: diagnosis and treatment with imaging techniques.

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Martel Villagrán, J; Díaz Candamio, M J; Bueno Horcajadas, A

We aim to review the characteristics of Morel-Lavallée lesions and to evaluate their treatment. We retrospectively reviewed 17 patients (11 men and 6 women; mean age, 56.1 years, range 25-81 years) diagnosed with Morel-Lavallée lesions in two different departments. All patients underwent ultrasonography, 5 underwent computed tomography, and 9 underwent magnetic resonance imaging. Percutaneous treatment with fine-needle aspiration and/or drainage with a 6F-8F catheter was performed in 13 patients. Two patients required percutaneous sclerosis with doxycycline. All patients responded adequately to percutaneous treatment, although it was necessary to repeat the procedure in 4 patients. Radiologists need to be familiar with this lesion that can be treated percutaneously in the ultrasonography suite when it is not associated with other entities. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Scoliosis Research Society (SRS) Criteria and Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2008 Guidelines in Non-Operative Treatment of Idiopathic Scoliosis.

Science.gov (United States)

Korbel, Krzysztof; Kozinoga, Mateusz; Stoliński, Łukasz; Kotwicki, Tomasz

2014-07-28

According to the Scoliosis Research Society (SRS), idiopathic scoliosis (IS) is a curvature of more than 10° Cobb angle, affecting 2-3% of pediatric population. Idiopathic scoliosis accounts for 80% of all scoliosis cases. Non-operative principles in the therapy of idiopathic scoliosis, including Scoliosis Research Society (SRS) criteria and guidelines proposed by the experts of the Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORTS) were presented. The possibility to carry out quality of life assessments in a conservative procedure was also demonstrated. Based on the natural history of idiopathic scoliosis, SRS criteria, SOSORT 2008 experts' opinion and the knowledge of the possibilities of psychological assessment of conservative IS treatment, rules were proposed regarding nonsurgical IS therapy procedures, with special consideration being paid to the proper treatment start time (age, Risser test, biological maturity, Cobb angle), possibility of curvature progression, the importance of physiotherapy and psychological assessment. The knowledge of SRS criteria and SOSORT guidelines regarding the conservative treatment of IS are essential for proper treatment (the right time to start treatment), and supports establishment of interdisciplinary treatment teams, consisting of a physician, a physiotherapist, an orthopedic technician and a psychologist.

Mesh removal following transvaginal mesh placement: a case series of 104 operations.

Science.gov (United States)

Marcus-Braun, Naama; von Theobald, Peter

2010-04-01

The objective of the study was to reveal the way we treat vaginal mesh complications in a trained referral center. This is a retrospective review of all patients who underwent surgical removal of transvaginal mesh for mesh-related complications during a 5-year period. Eighty-three patients underwent 104 operations including 61 complete mesh removal, 14 partial excision, 15 section of sub-urethral sling, and five laparoscopies. Main indications were erosion, infection, granuloma, incomplete voiding, and pain. Fifty-eight removals occurred more than 2 years after the primary mesh placement. Mean operation time was 21 min, and there were two intraoperative and ten minor postoperative complications. Stress urinary incontinence (SUI) recurred in 38% and cystocele in 19% of patients. In a trained center, mesh removal was found to be a quick and safe procedure. Mesh-related complications may frequently occur more than 2 years after the primary operation. Recurrence was mostly associated with SUI and less with genital prolapse.

A Short-Term Follow-Up Of Tension-Free Vaginal Tape For Surgical Treatment Of Stress Urinary Incontinence

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A.S. Moosavi

2006-05-01

Full Text Available Background and Aim: This study was conducted to evaluate the safety and efficacy of Tension-free Tape for the surgical treatment of female stress urinary incontinence. Materials and Methods: In a prospective open study for pre and post operative, we followed 36 patients at least 1.5 years after surgery (18-28 months; all patients underwent the operation under local anesthesia, allowing the surgeon to check intra-operatively that continence has been obtained. Results: Mean operation time was 36 minutes (range 20-45 minutes. 32(89% of the patients was cured according to the protocol, another 3(8.3% were significantly improved and there was 1(2.7% failure. Mast of patients (about 91% were operated on a one day-care basis, which implies that they were released from the hospital the day after the procedure, and no post operative catheterization, defect healing and tape rejection occurred. Pain free recovery time without any analgesic was another benefit. Five patients needed an indwelling catheter for 3 days and two uncomplicated hematoma occurred. Conclusion: Based on the results, we conclude that Tension-free Vaginal Tape is a safe and effective ambulatory procedure for surgical treatment of genuine stress urinary incontinence, which allows the majority of the women to be discharged from the clinic the day after the procedure and start their works in the second week.

Clinical assessment of diode laser-assisted endoscopic intrasphenoidal vidian neurectomy in the treatment of refractory rhinitis.

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Lai, Wen-Sen; Cheng, Sheng-Yao; Lin, Yuan-Yung; Yang, Pei-Lin; Lin, Hung-Che; Cheng, Li-Hsiang; Yang, Jinn-Moon; Lee, Jih-Chin

2017-12-01

For chronic rhinitis that is refractory to medical therapy, surgical intervention such as endoscopic vidian neurectomy (VN) can be used to control the intractable symptoms. Lasers can contribute to minimizing the invasiveness of ENT surgery. The aim of this retrospective study is to compare in patients who underwent diode laser-assisted versus traditional VN in terms of operative time, surgical field, quality of life, and postoperative complications. All patients had refractory rhinitis with a poor treatment response to a 6-month trial of corticosteroid nasal sprays and underwent endoscopic VN between November 2006 and September 2015. They were non-randomly allocated into either a cold instrument group or a diode laser-assisted group. Vidian nerve was excised with a 940-nm continuous wave diode laser through a 600-μm silica optical fiber, utilizing a contact mode with the power set at 5 W. A visual analog scale (VAS) was used to grade the severity of the rhinitis symptoms for quality of life assessment before the surgery and 6 months after. Of the 118 patients enrolled in the study, 75 patients underwent cold instrument VN and 43 patients underwent diode laser-assisted VN. Patients in the laser-assisted group had a significantly lower surgical field score and a lower postoperative bleeding rate than those in the cold instrument group. Changes in the VAS were significant in preoperative and postoperative nasal symptoms in each group. The application of diode lasers for vidian nerve transection showed a better surgical field and a lower incidence of postoperative hemorrhage. Recent advancements in laser application and endoscopic technique has made VN safer and more effective. We recommend this surgical approach as a reliable and effective treatment for patients with refractory rhinitis.

The Place of Operations upon the Sympathetic System in the Treatment of Poliomyelitis.

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Ogilvie, W H

1933-02-01

Revived interest in sympathetic surgery originated in orthopaedics. Royle's theories and operations. Their trial, failure and final abandonment. Value of sympathetic operations widely investigated; while finality has not been reached they have proved effective for three main purposes: (1) Relief of pain especially in bladder diseases. (2) Removal of inhibition and sphincteric spasm in alimentary, anal and bladder diseases. (3) Production of vaso-dilatation in (a) vaso-spastic diseases; (b) vaso-degenerative diseases; (c) conditions not due to arterial disease in which increased blood supply is beneficial.Poliomyelitis falls into the last group.-Cause of poor blood supply uncertain; ? lack of function; ? upset of some reflex; ? paralysis of vaso-dilators.TWO PROBLEMS ARISE, BOTH OF WHICH MAY BE TREATED BY OPERATIONS ON THE SYMPATHETIC: (1) The cold, blue limb, which develops chilblains, sores, or even deep ulcers every winter, often stopping treatment and requiring patient to be confined to bed. (2) The limb with considerable and rapidly increasing shortening. Sometimes these limbs show a fair return of power, and were it not for the heavy boot made necessary by the shortening, the patient could be made to walk well.Method of attack.-(1) Periarterial sympathectomy; (2) ramisectomy; (3) ganglionectomy. Physiological basis of each. Criticism of (1) and (2).Details of the operation for ganglionectomy.-Alternative approaches and their advantages. The immediate and late results of the procedure.Five cases discussed briefly.

Operating household wastewater treatment plants in the light of binding quality standards for wastewater discharged to water bodies or to soil

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Jawecki Bartosz

2017-03-01

Full Text Available The study presents the legal requirements concerning the quality of wastewater discharged to waterbodies and to soil after treatment in household wastewater treatment plants located in agglomerations or outside them. The procedure of stopping the operation of a household treatment plant that doesn’t meet the statutory wastewater treatment efficiency was presented. The decision ordering to stop the use of a household wastewater treatment plant has to be preceded by a decision ordering to take measures to limit its adverse impact on the environment. The clarification procedure has to determine the adverse impact on the environment in a doubtless manner and it has to be reflected in the documentation. The assessment of adverse impact should take into account the binding standards of use of the environment. Stopping the operation of a household wastewater treatment plant may result in issuing a decision ordering the user to connect to the sanitary sewage system.

Operative volume and outcomes of cerebrovascular neurosurgery in children.

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Bekelis, Kimon; Connolly, Ian D; Do, Huy M; Choudhri, Omar

2016-11-01

OBJECTIVE The impact of procedural volume on the outcomes of cerebrovascular surgery in children has not been determined. In this study, the authors investigated the association of operative volume on the outcomes of cerebrovascular neurosurgery in pediatric patients. METHODS The authors performed a cohort study of all pediatric patients who underwent a cerebrovascular procedure between 2003 and 2012 and were registered in the Kids' Inpatient Database (KID). To control for confounding, the authors used multivariable regression models, propensity-score conditioning, and mixed-effects analysis to account for clustering at the hospital level. RESULTS During the study period, 1875 pediatric patients in the KID underwent cerebrovascular neurosurgery and met the inclusion criteria for the study; 204 patients (10.9%) underwent aneurysm clipping, 446 (23.8%) underwent coil insertion for an aneurysm, 827 (44.1%) underwent craniotomy for arteriovenous malformation resection, and 398 (21.2%) underwent bypass surgery for moyamoya disease. Mixed-effects multivariable regression analysis revealed that higher procedural volume was associated with fewer inpatient deaths (OR 0.58; 95% CI 0.40-0.85), a lower rate of discharges to a facility (OR 0.87; 95% CI 0.82-0.92), and shorter length of stay (adjusted difference -0.22; 95% CI -0.32 to -0.12). The results in propensity-adjusted multivariable models were robust. CONCLUSIONS In a national all-payer cohort of pediatric patients who underwent a cerebrovascular procedure, the authors found that higher procedural volume was associated with fewer deaths, a lower rate of discharges to a facility, and decreased lengths of stay. Regionalization initiatives should include directing children with such rare pathologies to a center of excellence.

Revisional surgery after heller myotomy for treatment of achalasia: a comparative analysis focusing on operative approach.

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Gouda, Biswanath P; Nelson, Thomas; Bhoyrul, Sunil

2012-08-01

Surgical myotomy is the gold standard in therapy for achalasia, but treatment failures occur and require revisional surgery. A MEDLINE search of peer-reviewed articles published in English from 1970 to December 2008 was performed using the following terms: esophageal achalasia, Heller myotomy, and revisional surgery. Thirty-three articles satisfied our inclusion criteria. A total of 12,727 patients, with mean age of 43.3 years (males 46% and females 50%), underwent Heller myotomy (open 94.8% and laparoscopic 5.2%). Revisional surgery was performed in 6.19%. Procedures performed included revision of the original myotomy or creation of a new myotomy with or without an antireflux procedure or esophagectomy. Reasons for reoperation were incomplete myotomy (51.8%), onset of reflux (34%), megaesophagus (16.2%), and esophageal carcinoma (3.04%). Systematic review of the literature for revisional surgery following Heller myotomy revealed a 6.19% rate of reoperation with a low mortality rate.

Evaluation of long-term results and quality of life in patients who underwent rib fixation with titanium devices after trauma.

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Billè, Andrea; Okiror, Lawrence; Campbell, Aideen; Simons, Jason; Routledge, Tom

2013-06-01

To describe the long-term results, quality of life and chronic pain after chest wall fixation for traumatic rib fracture using a quality of life (QOL) score and a numeric pain score. Retrospective analysis of 10 consecutive patients who underwent surgery for rib fractures after trauma and reconstruction between October 2010 and March 2012. Chest rib fractures were fixed with titanium clips and bars or titanium plates and screws through a posterolateral thoracotomy. Pain was assessed with a numeric pain scale 0-10 and quality of life (QOL) with the EORTC questionnaire QLQ-C30. There were 5 males and 5 females. The median age was 58 years (range 21-80). There were no postoperative deaths. The only postoperative complication observed was a contralateral pleural effusion requiring drainage. Median length of stay of the drain and median length of hospital stay were 2 days (range 0-8) and 4 days (range 1-42 days), respectively. The average follow-up period of operatively managed patients was 14 months (range 8-23.5 months). Seven patients scored the pain as 0, one as 1 (mild), one as 4 (moderate) and one as 8 (severe). Only two patients are taking occasionally pain killers. Only one patient presents severe limitation in his life scoring his QOL as poor. Titanium devices (clips and bars; screws and plates) are effective and safe for repair of rib fractures and showed good long-term results in terms of pain and quality of life after the operation.

[A Case of Ascending Colon Cancer with Lynch Syndrome Who Underwent XELOX Adjuvant Chemotherapy].

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Takase, Koki; Murata, Kohei; Kagawa, Yoshinori; Nose, Yohei; Kawai, Kenji; Sakamoto, Takuya; Naito, Atsushi; Murakami, Kohei; Katsura, Yoshiteru; Omura, Yoshiaki; Takeno, Atsushi; Nakatsuka, Shinichi; Takeda, Yutaka; Kato, Takeshi; Tamura, Shigeyuki

2018-01-01

Lynch syndrome is an inherited syndrome with the development of the colorectal and various other cancers. Lynch syndrome is caused by mutations in the mismatch repair genes. A 33 year-old male underwent XELOX adjuvant chemotherapy for ascending colon cancer with Lynch syndrome. Although efficacy of 5-FU is not demonstrated in Lynch syndrome, MOSAIC trial had suggested a benefit from FOLFOX compared with 5-FU in patients who have colorectal cancer with Lynch syndrome. Oxaliplatin-based adjuvant chemotherapy can be a therapeutic option for colorectal cancer in lynch syndrome patients.

Post-Learning Sleep Transiently Boosts Context Specific Operant Extinction Memory

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Marion Inostroza

2017-04-01

Full Text Available Operant extinction is learning to supress a previously rewarded behavior. It is known to be strongly associated with the specific context in which it was acquired, which limits the therapeutic use of operant extinction in behavioral treatments, e.g., of addiction. We examined whether sleep influences contextual memory of operant extinction over time, using two different recall tests (Recent and Remote. Rats were trained in an operant conditioning task (lever press in context A, then underwent extinction training in context B, followed by a 3-h retention period that contained either spontaneous morning sleep, morning sleep deprivation, or spontaneous evening wakefulness. A recall test was performed either immediately after the 3-h experimental retention period (Recent recall or after 48 h (Remote, in the extinction context B and in a novel context C. The two main findings were: (i at the Recent recall test, sleep in comparison with sleep deprivation and spontaneous wakefulness enhanced extinction memory but, only in the extinction context B; (ii at the Remote recall, extinction performance after sleep was enhanced in both contexts B and C to an extent comparable to levels at Recent recall in context B. Interestingly, extinction performance at Remote recall was also improved in the sleep deprivation groups in both contexts, with no difference to performance in the sleep group. Our results suggest that 3 h of post-learning sleep transiently facilitate the context specificity of operant extinction at a Recent recall. However, the improvement and contextual generalization of operant extinction memory observed in the long-term, i.e., after 48 h, does not require immediate post-learning sleep.

Non-operative management of blunt abdominal trauma: positive predictors

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A. A. Pankratov

2017-01-01

Full Text Available Background: Over the last years a non-operative management (NOM of blunt  abdominal  trauma has been included into the standard treatment guidelines  in leading  trauma  centers  all over the world.  The  success  of NOM is based  on  careful patient  selection. Nevertheless, the selection  criteria have not been clearly determined up to now.Aim: To identify predictors of successful NOM and to  create  a diagnostic  and  treatment algorithm for its implementation.Materials and methods: 209 patients  with abdominal  trauma  who underwent  laparoscopy  or NOM from January 2006 to September 2015 were included  in the  study. The hemoperitoneum volume  and  organ  injury rate evaluated   by  using  ultrasonography  and  computed  tomography scan, as well as hemoglobin level, blood  pressure,  and  peripheral  pulse  were analyzed. We performed  comparative  analysis of prognostic  values of various selection  criteria for NOM, such as: 1 Huang and McKenney ultrasound scoring systems for hemoperitoneum quantification; 2 hemodynamic parameters; 3 hemoglobin levels;  4 various combinations  of the  above mentioned factors; 5 Sonographic  Scoring for Operating  Room Triage in Trauma (SSORTT scoring system.Results: Positive prognostic  values of parameters included into the study varied from 88 to 91.7% when used separately or in combination with other scored factors. Furthermore, there was no  significant  difference  between positive  predictive value  of all combinations of factors  and McKenney ultrasound hemoperitoneum scoring system used alone.Conclusion: The proposed predictors  as  well as  diagnostic  and  treatment algorithm are easy-to-use  and available in clinical practice.

Improved operative efficiency using a real-time MRI-guided stereotactic platform for laser amygdalohippocampotomy.

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Ho, Allen L; Sussman, Eric S; Pendharkar, Arjun V; Le, Scheherazade; Mantovani, Alessandra; Keebaugh, Alaine C; Drover, David R; Grant, Gerald A; Wintermark, Max; Halpern, Casey H

2018-04-01

OBJECTIVE MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive method for thermal destruction of benign or malignant tissue that has been used for selective amygdalohippocampal ablation for the treatment of temporal lobe epilepsy. The authors report their initial experience adopting a real-time MRI-guided stereotactic platform that allows for completion of the entire procedure in the MRI suite. METHODS Between October 2014 and May 2016, 17 patients with mesial temporal sclerosis were selected by a multidisciplinary epilepsy board to undergo a selective amygdalohippocampal ablation for temporal lobe epilepsy using MRgLITT. The first 9 patients underwent standard laser ablation in 2 phases (operating room [OR] and MRI suite), whereas the next 8 patients underwent laser ablation entirely in the MRI suite with the ClearPoint platform. A checklist specific to the real-time MRI-guided laser amydalohippocampal ablation was developed and used for each case. For both cohorts, clinical and operative information, including average case times and accuracy data, was collected and analyzed. RESULTS There was a learning curve associated with using this real-time MRI-guided system. However, operative times decreased in a linear fashion, as did total anesthesia time. In fact, the total mean patient procedure time was less in the MRI cohort (362.8 ± 86.6 minutes) than in the OR cohort (456.9 ± 80.7 minutes). The mean anesthesia time was significantly shorter in the MRI cohort (327.2 ± 79.9 minutes) than in the OR cohort (435.8 ± 78.4 minutes, p = 0.02). CONCLUSIONS The real-time MRI platform for MRgLITT can be adopted in an expedient manner. Completion of MRgLITT entirely in the MRI suite may lead to significant advantages in procedural times.

Operative treatment of acute acromioclavicular dislocations Rockwood III and V-Comparative study between K-wires combined with FiberTape(®) vs. TightRope System(®).

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Vrgoč, G; Japjec, M; Jurina, P; Gulan, G; Janković, S; Šebečić, B; Starešinić, M

2015-11-01

Acromioclavicular (AC) joint dislocations usually occur in a young active population as a result of a fall on the shoulder. Rockwood divided these dislocations into six types. Optimal treatment is still a matter of discussion. Many operative techniques have been developed, but the main choice is between open and minimally-invasive arthroscopic procedures. The aim of this study was to compare two different surgical methods on two groups of patients to find out which method is superior in terms of benefit to the patient. The methods were evaluated through objective and subjective scores, with a focus on complications and material costs. A retrospective two-centre study was conducted in patients with acute AC joint dislocation Rockwood types III and V. The two methods conducted were an open procedure using K-wires combined with FiberTape(®) (Arthrex, Naples, USA) (Group 1) and an arthroscopic procedure using the TightRope System(®) (Arthrex, Naples, USA) (Group 2). Groups underwent procedures during a two-year period. Diagnosis was based on the clinical and radiographic examination of both AC joints. Surgical treatment and rehabilitation were performed. Sixteen patients were included in this study: Group 1 comprised 10 patients, all male, average age 41.6 years (range 17-64 years), Rockwood type III (eight patients) and Rockwood type V (two patients); Group 2 had six patients, one female and five male, average age 37.8 years (range 18-58 years), Rockwood type III (two patients) and Rockwood type V (four patients). Time from injury to surgery was shorter and patients needed less time to return to daily activities in Group 1. Duration of the surgical procedure was shorter in Group 2 compared with Group 1. Complications of each method were noted. According to the measured scores and operative outcome between dislocation Rockwood type III and V, no significant difference was found. Implant material used in Group 2 was 4.7 times more expensive than that used in Group 1

Operative Duration and Risk of Surgical Site Infection in Neurosurgery.

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Bekelis, Kimon; Coy, Shannon; Simmons, Nathan

2016-10-01

The association of surgical duration with the risk of surgical site infection (SSI) has not been quantified in neurosurgery. We investigated the association of operative duration in neurosurgical procedures with the incidence of SSI. We performed a retrospective cohort study involving patients who underwent neurosurgical procedures from 2005 to 2012 and were registered in the American College of Surgeons National Quality Improvement Project registry. To control for confounding, we used multivariable regression models and propensity score conditioning. During the study period there were 94,744 patients who underwent a neurosurgical procedure and met the inclusion criteria. Of these patients, 4.1% developed a postoperative SSI within 30 days. Multivariable logistic regression showed an association between longer operative duration with higher incidence of SSI (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.16-1.20). Compared with procedures of moderate duration (third quintile, 40th-60th percentile), patients undergoing the longest procedures (>80th percentile) had higher odds (OR, 2.07; 95% CI, 1.86-2.31) of developing SSI. The shortest procedures (operative duration was associated with increased incidence of SSI for neurosurgical procedures. These results can be used by neurosurgeons to inform operative management and to stratify patients with regard to SSI risk. Copyright © 2016 Elsevier Inc. All rights reserved.

ARTHROSCOPIC TREATMENT OF CALCIFYING TENDINITIS OF THE ROTATOR CUFF.

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Neto, Arnaldo Amado Ferreira; Trevizani, Cassio Silva; Benegas, Eduardo; Malavolta, Eduardo Angeli; Gracitelli, Mauro Emílio Conforto; Bitar, Alexandre Carneiro; Neto, Francisco José Dos Santos

2010-01-01

To evaluate the clinical and radiographic results from arthroscopic surgical treatment of the rotator cuff in patients with calcifying tendinitis. A retrospective study was conducted on twenty patients who underwent arthroscopic treatment for calcifying tendinitis of the shoulder between March 1999 and November 2005. Six patients were excluded due to loss of follow-up. The average follow-up period was 41.4 months. Eight patients (57%) were female and six (43%) were male. The right side was affected in 10 cases (71%) and the left in four cases (29%). Nine cases (64%) had calcification in the supraspinatus tendon, two (14%) in the infraspinatus tendon, and three (21%) in both tendons. In all cases, resection of the calcium deposits was performed by means of a needle (Jelco® No. 14) in combination with curettage (mini-curette). Two shoulders (14%) underwent subacromial decompression, and one (7%) underwent excision of the distal clavicle. A tendon-tendon suture was performed in three shoulders (21%). None of the patients underwent tendon-bone reinsertion. The mean score obtained on the UCLA scale was 33 points (26-35), thus indicating that a majority of patients had good results. In the final radiographic evaluation, none of the patients showed signs of calcification. Arthroscopic treatment of calcifying tendinitis of the shoulder safely allows excision of the calcification, leading to good results in relation to shoulder pain and function.

Preoperative brachyradiotherapy in the treatment of uterine cervix cancer in its first stage of clinical development

International Nuclear Information System (INIS)

Kietlinska, Z.; Haruppa, J.; Zielinski, J.; Kawczynska, M.

1981-01-01

In 58 women with diagnosed stage 1 uterine cervix cancer radium (27 women) or cesium (31 women) were applied into the vagina or in the uterine cavity, then after about 7 weeks they were submitted to surgical treatment - radical hysterectomy with adnexectomy and excision of the obturatory and iliac lymphnodes (Wertheim Meigs operation). In 16 of these women, considering the marked dimensions of the neoplasm teletherapy in a decreased dose preceded the brachytherapy. Total destruction of the neoplasmatic outgrowth as a result of preoperative radiotherapy was met in 44 women (76%). In 8 women the excised tissues revealed neoplasmatic cells persisting in the uterine cervix and in 6 - in the lymphnodes. These women underwent subsequent post-operative teletherapy. The complications of the adapted technique were analysed and found to fall close within limits of those, accepted in cases of classic primary surgical treatment. No exits and no fistulas were met in the material. The value of brachytherapy applied before surgery is evident as it permitted to evade the post-operative teletherapy in 55% of women and to reduce the external irradiation dose in further 21% of women. (author)

[Current Situation of Antibiotic Prophylaxis in Obesity and Metabolic Surgery - Data Analysis from the Study for Quality Assurance in Operative Treatment of Obesity in Germany].

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Stroh, C; Wilhelm, B; Weiner, R; Ludwig, K; Benedix, F; Knoll, C; Lippert, H; Manger, T; Adipositas, Kompetenznetz

2016-02-01

Since January 2005, the situation of metabolic and obesity surgery in Germany has been constantly evaluated by the German Bariatric Surgery Registry (GBSR). Data registration is performed using an internet online database with prospective data collection. All registered data were analysed in cooperation with the Institute of Quality Assurance at the Otto-von-Guericke University Magdeburg. Data collection includes primary and revision/redo-procedures. A main focus of the current study is the analysis of data regarding the perioperative management, in particular, administration of antibiotics. Since 2005 a significant increase of primary bariatric procedures has been reported. For evaluation of the antibiotic regimen 12 296 primary operations including 684 balloons (BIB), 2950 gastric bandings (GB), 5115 Roux-en-Y-gastric bypasses (RYGBP), 120 Scopinaro's biliopancreatic diversions (BPD), 164 duodenal switches (DS), 3125 sleeve gastrectomies (SG) and 138 other procedures were analysed. In total 77.3 % of the patients with primary procedures received perioperative antibiotics. Patients without concomitant comorbidities received antibiotics significantly less often compared to those with comorbidities. Wound infection rates were comparable for patients who underwent either gastric banding or sleeve gastrectomy. Surgery has been accepted step by step as a treatment for morbid obesity and its comorbidities in Germany during the last few years. There is only little experience in the literature regarding antibiotic therapy as well as prophylaxis in bariatric surgery. Based on the results of the current study we recommend rather the selective than the routine use of antibiotics depending on different parameters, e.g., operative time, preoperative BMI and concomitant comorbidities. Georg Thieme Verlag KG Stuttgart · New York.

Analysis of complications of percutaneous X-Ray endoscopic surgical operations of patients with urolithiasis and nephrolithiasis with a single functioning kidney

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S. S. Zenkov

2015-01-01

Full Text Available The presented article focuses on the important matters of development of intraoperative and postoperative complications in patients with urolithiasis undergoing percutaneous operative treatment for coral calculus of a solitary or sole functioning kidney. Complications of percutaneous X-ray-endoscopic operations in these patients always require careful medical and diagnostic approach, as they can lead to oppression of an already impaired solitary kidney function and, as a consequence, can have life-threatening nature. They are divided into two groups: intraoperative and postoperative complications. Intraoperative complications include: bleeding, damage of the renal pelvis in the course of creating of puncture access, perforation of internal organs, loss of stroke. Postoperative complications include: development of acute inflammation in a single kidney, bleeding, urinoma or hematoma development, progression of renal failure, leave of residual concretions, organ loss. There is a sufficient amount of data on the development of complications after percutaneous endoscopic surgeries in the literature, but very few works are devoted to a solitary kidney matter. The object of this study was the group of patients with urolithiasis, coral nephrolithiasis by a solitary or a single functioning kidney, who were on treatment in the urology department of the N.I. Pirogov City Clinical Hospital No. 1 from January 2007 to July 2014. All patients underwent percutaneous operative treatment for the removal of coral calculi. 

The success of 6-hour hospital discharge on patients having vaginal repair operations using a new conscious sedation technique.

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Hill, N; Gupta, A; Zakaryan, A; Morey, R

2011-01-01

Anterior and posterior repair are standard surgical techniques for treatment of vaginal prolapse. These procedures are performed traditionally under general anaesthetic or spinal anaesthetic and usually require overnight admission in the hospital. We describe our case series of 40 patients who underwent anterior (18/40), posterior (20/40) or combined repair (2/40) under local anaesthetic and conscious sedation (Remifentanyl). The majority (35/40) were performed in the day-case surgery unit and 95% patients were discharged within 6 hours of the operation, with no complications. All the patients were satisfied with the anaesthetic technique. We concluded that our technique of vaginal repair avoids the risk of general and spinal anaesthetic. The majority of operations can be performed as day cases with good patient satisfaction and without increasing risks to the patients. This technique has potential significant financial saving for the hospitals.

Coordination Skills during Vitrectomy in Treatment of Proliferative Diabetic Retinopathy

Institute of Scientific and Technical Information of China (English)

Xuehong Chen; Shanshan Luo; Yanchan Liu

2014-01-01

Purpose:.To discuss effective nursing and coordination skills for vitrectomy in the treatment of diabetic retinopathy. Methods: Fifty patients (51 eyes) with diabetic retinopathy required vitrectomy were enrolled in this study..Individual nursing service was delivered by strengthening preoperative preparation, providing psychological nursing, and intraopera-tive observation of the severity of diseases by circulating nurses;meticulous nursing was given postoperatively. Results:All 50 patients underwent surgery successfully..Intra-operatively,.patients had stable physical signs..Five patients had postoperative visual acuity0.3..No complicated infection was seen. Conclusion: For patients diagnosed with proliferative diabetic retinopathy requiring vitrectomy,.full preparations should be made and psychological nursing should be delivered preopera-tively, the severity of diseases and clinical reactions should be closely observed intraoperatively,.and proper processing and nursing measures should be taken postoperatively,.which col-lectively enhance surgical success rate,.decrease surgical com-plications,.and attain favorable treatment efficacy.(Eye Science 2014; 29:55-58).

Laparoscopic treatment for esophageal achalasia: experience at a single center.

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Agrusa, A; Romano, G; Bonventre, S; Salamone, G; Cocorullo, G; Gulotta, G

2013-01-01

Achalasia is a not frequent esophageal disorder characterized by the absence of esophageal peristalsis and incomplete relaxation of the lower esophageal sphincter (LES). Its cause is unknown. The aim of treatment is to improve the symptoms. We report the results of the treatment of this condition achieved in one center. We conducted a retrospective study of patients with esophageal achalasia. In the period 2010-2012 we observed 64 patients, of whom 19 were referred for medical treatment. Three of the remaining patients underwent botulinum toxin injection, 17 underwent multiple endoscopic dilation procedures and 25 underwent laparoscopic surgery. There were no complications in the group undergoing endoscopic therapy, but symptom remission was only temporary. Patients undergoing surgery showed a significant improvement in symptoms and no recurrence throughout the follow-up period, that is still ongoing (3 years). There were no major complications in any case and no morbidity or mortality. Surgical treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor fundoplication gives the best and longest-lasting results in suitably selected patients. The extension of the myotomy and reduction in LES pressure are the most important parameters to achieve a good result.

Predicting in-hospital mortality after redo cardiac operations: development of a preoperative scorecard.

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Launcelott, Sebastian; Ouzounian, Maral; Buth, Karen J; Légaré, Jean-Francois

2012-09-01

The present study generated a risk model and an easy-to-use scorecard for the preoperative prediction of in-hospital mortality for patients undergoing redo cardiac operations. All patients who underwent redo cardiac operations in which the initial and subsequent procedures were performed through a median sternotomy were included. A logistic regression model was created to identify independent preoperative predictors of in-hospital mortality. The results were then used to create a scorecard predicting operative risk. A total of 1,521 patients underwent redo procedures between 1995 and 2010 at a single institution. Coronary bypass procedures were the most common previous (58%) or planned operations (54%). The unadjusted in-hospital mortality for all redo cases was higher than for first-time procedures (9.7% vs. 3.4%; pscorecard was generated using these independent predictors, stratifying patients undergoing redo cardiac operations into 6 risk categories of in-hospital mortality ranging from risk to >40%. Reoperation represents a significant proportion of modern cardiac surgical procedures and is often associated with significantly higher mortality than first-time operations. We created an easy-to-use scorecard to assist clinicians in estimating operative mortality to ensure optimal decision making in the care of patients facing redo cardiac operations. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Association between ambient air pollution and pregnancy rate in women who underwent IVF.

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Choe, S A; Jun, Y B; Lee, W S; Yoon, T K; Kim, S Y

2018-04-05

Are the concentrations of five criteria air pollutants associated with probabilities of biochemical pregnancy loss and intrauterine pregnancy in women? Increased concentrations of ambient particulate matter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO) during controlled ovarian stimulation (COS) and after embryo transfer were associated with a decreased probability of intrauterine pregnancy. Exposure to high ambient air pollution was suggested to be associated with low fertility and high early pregnancy loss in women. Using a retrospective cohort study design, we analysed 6621 cycles of 4581 patients who underwent one or more fresh IVF cycles at a fertility centre from January 2006 to December 2014, and lived in Seoul at the time of IVF treatment. To estimate patients' individual exposure to air pollution, we computed averages of hourly concentrations of five air pollutants including PM10, NO2, CO, sulphur dioxide (SO2) and ozone (O3) measured at 40 regulatory monitoring sites in Seoul for each of the four exposure periods: period 1 (start of COS to oocyte retrieval), period 2 (oocyte retrieval to embryo transfer), period 3 (embryo transfer to hCG test), and period 4 (start of COS to hCG test). Hazard ratios (HRs) from the time-varying Cox-proportional hazards model were used to estimate probabilities of biochemical pregnancy loss and intrauterine pregnancy for an interquartile range (IQR) increase in each air pollutant concentration during each period, after adjusting for individual characteristics. We tested the robustness of the result using generalised linear mixed model, accounting for within-woman correlation. Mean age of the women was 35 years. Average BMI was 20.9 kg/m2 and the study population underwent 1.4 IVF cycles on average. Cumulative pregnancy rate in multiple IVF cycles was 51.3% per person. Survival analysis showed that air pollution during periods 1 and 3 was generally associated with IVF outcomes. Increased NO2 (adjusted HR = 0.93, 95% CI

Comparison between primary closure with karydakis's technique versus open procedure in treatment of pilonidal sinus in terms of frequency of postoperative wound infection

International Nuclear Information System (INIS)

Nafees, A.U.A.; Ahmed, M.

2013-01-01

Objective: The purpose of this study is to compare between primary closure with Karydakis's technique versus open procedure in treatment of pilonidal sinus in terms of frequency of postoperative wound infection. Study Design: Randomized Clinical Trials (RCT). Place and Duration of Study: This study was carried out at Department of Surgery, CMH, Kharian over a period of 2 years from Sept 2010 to Oct 2012. Patients and Methods: Sixty patients were selected out of which 30 patients underwent open excision and secondary healing and 30 patients underwent Karydakis procedure. Post operatively these patients were observed for wound infection on date of discharge and weeks 1, 2 and 3. Results of both groups were compared for wound infection by applying chi-square test. Results: There was no statistically significant difference in the frequency of infection between the two groups when calculated during the complete course of study. Conclusion: Primary closure with Karydakis's technique and open procedure are satisfactory surgical procedures for pilonidal sinus disease in terms of post-operative wound infection. (author)

Diagnosis of accessory conduction pathway using ECG-gated emission CT analysis. Studies in patients with WPW syndrome who underwent surgery

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Misaki, Takuro; Mukai, Keiichi; Tsubota, Makoto; Iwa, Takashi; Nakajima, Ken-ichi; Hisada, Kin-ichi

1987-09-01

Pinpointing the location of accessory conduction pathway (ACP) is of great importance in the surgical treatment for Wolff-Parkinson-White (WPW) syndrome. For this purpose, this study explored the usefulness of ECG-gated emission computed tomography (Gated-ECT) in 30 patients who preoperatively underwent Gated-ECT. The site of earliest contraction at level of atrioventicular valves, obtained on tomographic phase analysis, was compared with the site of earliest activation, obtained on epicardial mapping during surgery. The concordance rate of the two methods was 94 % (28/30). Among them, one patient was found to have the association of corrected transposition of great arteries on Gated-ECT. Gated-ECT was, however, of limited value in differentiating right posterior ACP from right postseptal ACP. The discordance between the sites of earliest contraction and activation, which was observed in the two others, was likely due to decreased wall motion resulting from myocardial disturbance. Gated-ECT may have a diagnostic potential for the location of ACP, especially in view of providing images that corresponded to the surgical anatomy. (Namekawa, K.).

Diagnosis and operatory treatment of the patients with failed back surgery caused by herniated disk relapse.

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Bodiu, A

2014-01-01

THE OBJECT OF STUDY: Analysis of surgical treatment results in patients with recurrent lumbar disc herniation by transforaminal lumbar interbody fusion (TLIF) and repeated laminotomy and discectomy for the improvement of pain and disability. Data analysis was performed on a complex diagnosis and treatment of 56 patients with recurrent lumbar disc herniation who had previously underwent 1-3 lumbar disc surgeries. An MRI investigation with paramagnetic contrast agent (gadolinium) was used for the diagnosis and differentiation of epidural fibrosis, and a dynamic lateral X-ray investigation was carried out for the identification of segmental instability. The evolution period after the previous surgery was between 1 and 3 years after the index surgery. Pain expression degree and dynamics were assessed with the pain visual analog scale (VAS) in early and late postoperative periods. Postoperative success was assessed by using a modified MacNab scale. The follow-up recording period after the last operation was of at least 1 year, ranging from 1 to 4 years. The surgical treatment was effective in most cases, recording a reduction in pain expression level from 7.2-7.7 points on the VAS scale to 1.7-2.1 in the early period and 2.2-2.6 in the late period (1 year). Repeated surgery was effective in 21 of 30 (70%) cases who underwent decompression surgery without fusion and in 20 of 26 (76.9%) cases who underwent repeated surgery with transforaminal lumbar interbody fusion (TLIF). Overall, postoperative success was assessed by using a modified MacNab scale. Repeated surgery is a viable option for patients who have clinical manifestations of recurrent disc herniation. Investigation with contrast agent by MRI allows differentiating disk herniation recurrences from epidural fibrosis. Supplementing repeated discectomies and decompression with intervertebral transforaminal fusion provide superior clinical outcomes, especially in patients with clinical and radiological signs of lumbar

Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

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Moesinger, Robert C.; Davis, Jan W.; Hill, Britani; Johnston, W. Cory; Gray, Carl; Johnson, Harold; Ingersoll, Leslye; Whipple, Gary; Reilly, Mark; Harris, Robert; Hansen, Vincent

2011-01-01

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010) at two community hospitals. Results. There were 51 successful resections of 70 explorations (73%) including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care. PMID:22312532

Perhaps More Consideration of Pavlovian-Operant Interaction May Improve the Clinical Efficacy of Behaviorally Based Drug Treatment Programs.

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Troisi, Joseph R

2013-01-01

Drug abuse remains costly. Drug-related cues can evoke cue-reactivity and craving, contributing to relapse. The Pavlovian extinction-based cue-exposure therapy (CET) has not been very successful in treating drug abuse. A functional operant analysis of complex rituals involved in CET is outlined and reinterpreted as an operant heterogeneous chain maintained by observing responses, conditioned reinforcers, and discriminative stimuli. It is further noted that operant functions are not predicated on Pavlovian processes but can be influenced by them in contributing to relapse; several empirical studies from the animal and human literature highlight this view. Cue-reactivity evoked by Pavlovian processes is conceptualized as an operant establishing/motivating operation. CET may be more effective in incorporating an operant-based approach that takes into account the complexity of Pavlovian-operant interaction. Extinction of the operant chain coupled with the shaping of alternative behaviors is proposed as an integrated therapy. It is proposed that operant-based drug abuse treatments (contingency management, voucher programs, and the therapeutic work environment) might consider incorporating cue-reactivity, as establishing/motivating operations, to increase long-term success-a hybrid approach based on Pavlovian-operant interaction.

Perhaps More Consideration of Pavlovian–Operant Interaction May Improve the Clinical Efficacy of Behaviorally Based Drug Treatment Programs

Science.gov (United States)

Troisi, Joseph R.

2014-01-01

Drug abuse remains costly. Drug-related cues can evoke cue-reactivity and craving, contributing to relapse. The Pavlovian extinction-based cue-exposure therapy (CET) has not been very successful in treating drug abuse. A functional operant analysis of complex rituals involved in CET is outlined and reinterpreted as an operant heterogeneous chain maintained by observing responses, conditioned reinforcers, and discriminative stimuli. It is further noted that operant functions are not predicated on Pavlovian processes but can be influenced by them in contributing to relapse; several empirical studies from the animal and human literature highlight this view. Cue-reactivity evoked by Pavlovian processes is conceptualized as an operant establishing/motivating operation. CET may be more effective in incorporating an operant-based approach that takes into account the complexity of Pavlovian–operant interaction. Extinction of the operant chain coupled with the shaping of alternative behaviors is proposed as an integrated therapy. It is proposed that operant-based drug abuse treatments (contingency management, voucher programs, and the therapeutic work environment) might consider incorporating cue-reactivity, as establishing/motivating operations, to increase long-term success—a hybrid approach based on Pavlovian–operant interaction. PMID:25346551

COMPARATIVE ANALYSIS OF THE TREATMENT OF THE EOSINOPHILIC GRANULOMA WITH VERTEBRAL INVOLVEMENT USING ORTHOPEDIC CORSET AND SURGICAL OPERATION

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A. I. Snetkov

2010-01-01

Full Text Available The results of treatment of 72 patients with pathological fracture of vertebra bodies against eosinophilic granuloma a spine are analysed. Orthopedic corset technologies are used in treatment of 42 patients, surgical treatment was applied. Orthopedic corset may be used in patients with eosinophilic granuloma of backbone. This method of treatment was used in a case of the absence of spine secondary deformations and neurologic semiology. Orthopedic corset treatment is associated with long immobilization on the average within 1,5-2 years and never leads to a complete recovery of the damaged spine. Surgical treatment consists in use only at loss of height of a body to 30-40%, when destruction of spine more severe it is necessary to use operative treatment in two stages. Absolute indications to surgical treatment are the neurologic deficit and secondary deformations of a spine. Surgical treatment allows to reduce terms of treatment till 3-4 months and quickly to return the patient to an active life.

Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program

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Moises Cohen

2004-12-01

Full Text Available Introduction: Quality of life can be defined as the expression of aconceptual model that tries to represent patient’s perspectivesand his/her level of satisfaction expressed by numbers. Theobjective of this study is to evaluate the parameters of quality oflife of 23 patients who underwent surgery for anterior cruciateligament reconstruction. Methods: We adopted SF-36, a generichealth-related evaluation questionnaire, to obtain informationregarding several aspects of patients’ health conditions, and theLysholm questionnaire, specific to evaluate the symptoms andfunction of the knee. The questionnaires were applied at two stagesof the treatment: pre- and postoperatively (after the rehabilitationprogram. Results: Before surgery, the Lysholm questionnairepresented the following results: excellent in 4% of the cases, goodin 22%, fair in 22%, and poor in 52%. After surgery (Lysholm e SF-36 the correlation level was approximately 44% (p = 0.041.Discussion: The correlation between the Lysholm and the SF-36questionnaires showed the following: the lower the level of pain,the higher the Lysholm score. The high scores presented by theLysholm questionnaire are directly proportional to physical andemotional aspects, and to functional capacity. Conclusion:Analysis of both questionnaires, as well as of their correlation,showed some improvement in patients´ quality of life. We werealso able to demonstrate the importance and usefulness of applyingthe two questionnaires at three different moments: before, duringand after physiotherapeutic intervention.

Development of a method for the characterization and operation of UV-LED for water treatment.

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Kheyrandish, Ataollah; Mohseni, Madjid; Taghipour, Fariborz

2017-10-01

Tremendous improvements in semiconductor technology have made ultraviolet light-emitting diodes (UV-LEDs) a viable alternative to conventional UV sources for water treatment. A robust and validated experimental protocol for studying the kinetics of microorganism inactivation is key to the further development of UV-LEDs for water treatment. This study proposes a protocol to operate UV-LEDs and control their output as a polychromatic radiation source. In order to systematically develop this protocol, the results of spectral power distribution, radiation profile, and radiant power measurements of a variety of UV-LEDs are presented. A wide range of UV-LEDs was selected for this study, covering various UVA, UVB, and UVC wavelengths, viewing angles from 3.5° to 135°, and a variety of output powers. The effects of operational conditions and measurement techniques were investigated on these UV-LEDs using a specially designed and fabricated setup. Operating conditions, such as the UV-LED electrical current and solder temperature, were found to significantly affect the power and peak wavelength output. The measurement techniques and equipment, including the detector size, detector distance from the UV-LED, and potential reflection from the environment, were shown to influence the results for many of the UV-LEDs. The results obtained from these studies were analyzed and applied to the development of a protocol for UV-LED characterization. This protocol is presented as a guideline that allows the operation and control of UV-LEDs in any structure, as well as accurately measuring the UV-LED output. Such information is essential for performing a reliable UV-LED assessment for the inactivation of microorganisms and for obtaining precise kinetic data. Copyright © 2017 Elsevier Ltd. All rights reserved.

Treatment for spondylolysis and spondylolisthesis in children.

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Leonidou, Andreas; Lepetsos, Panagiotis; Pagkalos, Joseph; Antonis, Konstantinos; Flieger, Ioannis; Tsiridis, Eleftherios; Leonidou, Omiros

2015-12-01

To review outcome of 44 children who underwent conservative or surgical treatment for spondylolysis or spondylolisthesis. Records of 25 male and 19 female children aged 5 to 14 (mean, 10.2) years who underwent conservative (n=39) or surgical (n=5) treatment for spondylolysis (n=19) or spondylolisthesis (n=25) were reviewed. Conservative treatment involved application of a thoracolumbosacral orthotic brace for all day except bedtime until symptoms resolved and then physiotherapy including exercises to strengthen the abdominal and back muscles and stretching exercises of the hamstrings and hip flexors. Surgery (instrumented posterolateral fusion [n=4] or Wiltse posterolateral fusion [n=1]) with allografts was indicated in patients with refractory pain (n=2) or nerve root irritation (n=1) and in patients with iatrogenic spondylolisthesis (n=2), followed by application of the brace for 3 months and then physiotherapy. Outcome was assessed using the Seitsalo scoring system. The mean follow-up period was 6.5 (range, 3-10) years. No patient developed any postoperative complication. Outcome was excellent in 35 patients, good in 8, and fair in one. All 5 patients who underwent posterolateral fusion for refractory spondylolisthesis achieved good outcome. In 11 patients with spondylolysis, the pars defect healed. None of the spondylolysis progressed to spondylolisthesis. All displacements remained stable, without any progression. Conservative treatment is effective for most patients with spondylolysis or spondylolisthesis. Instrumented posterolateral fusion is indicated in patients with persistent symptoms and for iatrogenic cases.

Operative Treatment of the Insertional Achilles Tendinopathy Through a Transtendinous Approach.

Science.gov (United States)

Ettinger, Sarah; Razzaq, Rameez; Waizy, Hazibullah; Claassen, Leif; Daniilidis, Kiriakos; Stukenborg-Colsman, Christina; Plaass, Christian

2016-03-01

Different operative techniques have been proposed for the treatment of insertional Achilles tendinopathy (IAT), with often disappointing results. The aim of this study was to evaluate the outcome of the transtendinous approach in IAT. Forty patients operated with an IAT between 2010 and 2011 were included in this retrospective study. The mean follow-up was 15.6 (±3.7, 12-27) months. Indication for surgery was IAT with failed conservative therapy. Using a transtendinous approach, the Achilles tendon (AT) was partially detached and all pathologic tissues were debrided. The AT was reinserted using different anchor techniques. Clinical data were recorded using examination and clinical scores (American Orthopaedic Foot & Ankle Society [AOFAS], Foot and Ankle Outcome Score [FAOS], Numerical Rating Scale [NRS], and Short Form-36 [SF-36]). The mean AOFAS hindfoot score improved from 59.4 preoperatively to 86.5 postoperatively (P anchors or double-row fixation technique improved significantly (P anchor fixation, regarding AOFAS score (79.6 and 90.2) and FAOS subscale scores. Eighty-three percent of the patients showed good to excellent results. The transtendinous approach allowed access to all associated pathologies in IAT. It had relatively few complications and lead to good clinical results. Level IV, retrospective case series. © The Author(s) 2015.

The influence of tourniquet use and operative time on the incidence of deep vein thrombosis in total knee arthroplasty.

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Hernandez, Arnaldo José; Almeida, Adriano Marques de; Fávaro, Edmar; Sguizzato, Guilherme Turola

2012-09-01

To evaluate the association between tourniquet and total operative time during total knee arthroplasty and the occurrence of deep vein thrombosis. Seventy-eight consecutive patients from our institution underwent cemented total knee arthroplasty for degenerative knee disorders. The pneumatic tourniquet time and total operative time were recorded in minutes. Four categories were established for total tourniquet time: 120 minutes. Three categories were defined for operative time: 150 minutes. Between 7 and 12 days after surgery, the patients underwent ascending venography to evaluate the presence of distal or proximal deep vein thrombosis. We evaluated the association between the tourniquet time and total operative time and the occurrence of deep vein thrombosis after total knee arthroplasty. In total, 33 cases (42.3%) were positive for deep vein thrombosis; 13 (16.7%) cases involved the proximal type. We found no statistically significant difference in tourniquet time or operative time between patients with or without deep vein thrombosis. We did observe a higher frequency of proximal deep vein thrombosis in patients who underwent surgery lasting longer than 120 minutes. The mean total operative time was also higher in patients with proximal deep vein thrombosis. The tourniquet time did not significantly differ in these patients. We concluded that surgery lasting longer than 120 minutes increases the risk of proximal deep vein thrombosis.

The potential benefit of pre-operative assessment of amputation ...

African Journals Online (AJOL)

The potential benefit of pre-operative assessment of amputation wound healing potential in peripheral vascular disease. M. Mars, R. P. Mills, J. V. Robbs. Abstract. Choosing the most distal amputation level that will heal is difficult in patients with peripheral vascular disease. From 1984 to 1988,965 patients underwent 1 563 ...

Dysphagia among adult patients who underwent surgery for esophageal atresia at birth.

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Huynh Trudeau, Valérie; Maynard, Stéphanie; Terzic, Tatjana; Soucy, Geneviève; Bouin, Mickeal

2015-03-01

Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and⁄or anatomical anomalies. To determine the motor and anatomical causes of dysphagia. A total of 41 adults, followed at the Esophageal Atresia Clinic at Hôpital Saint-Luc (Montreal, Quebec), were approached to particpate in the present prospective study. Evaluation was completed using upper endoscopy, manometry and barium swallow for the participants who consented. The medical charts of respondents were systematically reviewed from the neonatal period to 18 years of age to assess medical and surgical history. All 41 patients followed at the clinic consented and were included in the study. Dysphagia was present in 73% of patients. Esophagogastroduodenoscopy was performed in 32 patients: hiatal hernia was present in 62% (n=20); esophageal diverticulum in 13% (n=4); macroscopic Barrett esophagus in 31% (n=10); and esophagitis in 19% (n=6). Histological esophagitis was present in 20% and intestinal metaplasia in 10%. There were no cases of dysplagia or adenocarcinoma. Esophageal manometry was performed on 56% of the patients (n=23). Manometry revealed hypomotility in 100% of patients and included an insufficient number of peristaltic waves in 96%, nonpropagating peristalsis in 78% and low-wave amplitude in 95%. Complete aperistalsis was present in 78%. The lower esophageal sphincter was abnormal in 12 (52%) patients, with incomplete relaxation the most common anomaly. Of the 41 patients, 29 (71%) consented to a barium swallow, which was abnormal in 13 (45%). The anomalies found were short esophageal dilation in 28%, delay in esophageal emptying in 14%, diverticula in 14% and stenosis in 7

Development and operation of innovative scum to biodiesel pilot-system for the treatment of floatable wastewater scum.

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Anderson, Erik; Addy, Min; Chen, Paul; Ruan, Roger

2018-02-01

A novel process was developed for the biorefining of floatable wastewater scum and other waste oils from water treatment facilities into biodiesel and other value-added bio-products. To test the scalability and commercial potential of the technology, a 7000 l/year pilot-scale system was designed and built. Scum from a wastewater treatment facility, located in St. Paul, Mn, was collected and converted into methyl esters (biodiesel) according to the process chemistry. All of the incoming and outgoing process streams were sampled, tested, weighed and recorded to calculate both the process efficiency and product quality. Data from the pilot-scale system operation was compared to laboratory results and the theoretically expected values for each individual unit operation. The biodiesel was tested using a third party laboratory and confirmed it met all of the US EPA's test requirements for commercial-grade biodiesel. Copyright © 2017 Elsevier Ltd. All rights reserved.

Contractility-afterload mismatch in patients with protein-losing enteropathy after the Fontan operation.

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Ozawa, Hideto; Ueno, Takayoshi; Iwai, Shigemitsu; Kawata, Hiroaki; Nishigaki, Kyouichi; Kishimoto, Hidefumi; Sawa, Yoshiki

2014-10-01

This study aimed to clarify the relationship between onset of protein-losing enteropathy (PLE) and Fontan circulation, with special reference to the development of contractility-afterload mismatch. The PLE group comprised 9 patients who experienced PLE after undergoing the Fontan operation, and the control group consisted of 32 patients had did not experienced PLE more than 10 years after the Fontan operation. The study compared the pre- and postoperative values of arterial elastance (Ea), end-systolic elastance (Ees), and contractility-afterload mismatch (Ea/Ees). Furthermore, the variations in the values were examined during the preoperative, postoperative, and midterm postoperative periods in seven PLE patients who underwent cardiac catheterization at the onset of PLE and during the pre- and postintervention periods in three PLE patients who underwent surgical intervention to improve the Fontan circulation after the onset of PLE. Comparison of the values obtained before and after Fontan operations showed that the Ea values increased significantly in the PLE group. However, the pre- and postoperative Ees values did not differ in the two groups. During the postoperative period, Ea/Ees increased significantly, and the Ea and Ea/Ees values increased continuously until the onset of PLE in the PLE group. In the patients who underwent surgical intervention to improve the Fontan circulation after the onset of PLE, the Ea/Ees decreased significantly, and the serum albumin levels improved after the intervention. Contractility-afterload mismatch, mainly caused by the increase in the afterload of the systemic ventricle, may have an important role in the development of PLE after the Fontan operation.

The indications and timing for operative management of spinal epidural abscess: literature review and treatment algorithm.

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Tuchman, Alexander; Pham, Martin; Hsieh, Patrick C

2014-08-01

Delayed or inappropriate treatment of spinal epidural abscess (SEA) can lead to serious morbidity or death. It is a rare event with significant variation in its causes, anatomical locations, and rate of progression. Traditionally the treatment of choice has involved emergency surgical evacuation and a prolonged course of antibiotics tailored to the offending pathogen. Recent publications have advocated antibiotic treatment without surgical decompression in select patient populations. Clearly defining those patients who can be safely treated in this manner remains in evolution. The authors review the current literature concerning the treatment and outcome of SEA to make recommendations concerning what population can be safely triaged to nonoperative management and the optimal timing of surgery. A PubMed database search was performed using a combination of search terms and Medical Subject Headings, to identify clinical studies reporting on the treatment and outcome of SEA. The literature review revealed 28 original case series containing at least 30 patients and reporting on treatment and outcome. All cohorts were deemed Class III evidence, and in all but two the data were obtained retrospectively. Based on the conclusions of these studies along with selected smaller studies and review articles, the authors present an evidence-based algorithm for selecting patients who may be safe candidates for nonoperative management. Patients who are unable to undergo an operation, have a complete spinal cord injury more than 48 hours with low clinical or radiographic concern for an ascending lesion, or who are neurologically stable and lack risk factors for failure of medical management may be initially treated with antibiotics alone and close clinical monitoring. If initial medical management is to be undertaken the patient should be made aware that delayed neurological deterioration may not fully resolve even after prompt surgical treatment. Patients deemed good surgical

Radiation and combined treatment of Itsenko -Cushing's disease

International Nuclear Information System (INIS)

Barkanov, A.I.; Morozov, A.I.; Pirogov, A.I.; Postnikov, D.A.; Shadyeva, M.M.; Roshchina, V.S.; Devyatykh, Yu.N.

1980-01-01

The authors made observations of 123 patients with the Itsenko - Cushing disease. The mild form of the disease was diagnosed in 27.7 per cent of the patients; moderate in 52 percent, and severe in 20.3 per cent of the patients. A total of 78 patients underwent tele-gamma-therapy in doses of 40-45 Gy, and 45 patients underwent combined treatment consisting in unilateral adrenalectomy and irradiation with the same doses. Protracted remissions with a reverse development of the symptoms of the disease were reached in 69.2 per cent of the patients who had undergone radiation treatment and in 64.4 per cent of the patients who had undergone combined treatment. Radiotherapy was most effective in patients with mild and moderate forms of Itsenko-Cushing's disease, in case of a severe form combined treatment is indicated. Optimal single focal doses are 1.6-1.8 Gy, and cumulative ones 40-45 Gy

The clinical efficacy and prognosis of hemisphere skull bone flap decompression and mild hypothermia treatment for severe craniocerebral trauma

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YANG Hua-tang

2013-10-01

Full Text Available In this study, 1626 patients with severe craniocerebral trauma were assessed by Glasgow Coma Scale (GCS, 886 patients of 3-5 score and 740 of 6-8 score. Patients were divided into 2 groups. Ninety hundred and eleven patients (496 of 3-5 score and 415 of 6-8 score underwent hemisphere calvarial bone flap decompression with auxiliary mild hypothermia (experiment group, and 715 patients (390 of 3-5 score and 325 of 6-8 score underwent traditional frontal, temporal, parietal large traumatic craniotomy (control group. After operation the treatment of 2 groups was basically the same. Compared with control group, the intracranial pressure of experiment group on the 1st, 3rd, 5th and 7th days after surgery decreased significantly (P < 0.05, for all; the consciousness recovery time was significantly shorter (P < 0.05, for all; the prognosis after 3 months was better (P < 0.05, for all. Hemisphere calvarial bone flap decompression with auxiliary mild hypothermia treatment could significantly reduce the morbidity and mortality, and improve the quality of life and prognosis of patients with severe craniocerebral trauma.

SU-F-T-80: A Mobile Application for Intra-Operative Electron Radiotherapy Treatment Planning

International Nuclear Information System (INIS)

Williams, C; Crowley, E; Wolfgang, J

2016-01-01

Purpose: Intraoperative electron radiotherapy (IORT) poses a unique set of challenges for treatment planning. Planning must be performed in a busy operating room environment over a short timeframe often with little advance knowledge of the treatment depth or applicator size. Furthermore, IORT accelerators can have a large number of possible applicators, requiring extensive databooks that must be searched for the appropriate dosimetric parameters. The goal of this work is to develop a software tool to assist in the planning process that is suited to the challenges faced in the IORT environment. Methods: We developed a mobile application using HTML5 and Javascript that can be deployed to tablet devices suitable for use in the operating room. The user selects the desired treatment parameters cone diameter, bevel angle, and energy (a total of 141 datasets) and desired bolus. The application generates an interactive display that allows the user to dynamically select points on the depth-dose curve and to visualize the shape of the corresponding isodose contours. The user can indicate a prescription isodose line or depth. The software performs a monitor unit calculation and generates a PDF report. Results: We present our application, which is now used routinely in our IORT practice. It has been employed successfully in over 23 cases. The interactivity of the isodose distributions was found to be of particular use to physicians who are less-frequent IORT users, as well as for the education of residents and trainees. Conclusion: This software has served as a useful tool in IORT planning, and demonstrates the need for treatment planning tools that are designed for the specialized challenges encountered in IORT. This software is the subject of a license agreement with the IntraOp Medical Corporation. This software is the subject of a license agreement between Massachusetts General Hospital / Partners Healthcare and the IntraOp Medical Corporation. CLW is consulting on

SU-F-T-80: A Mobile Application for Intra-Operative Electron Radiotherapy Treatment Planning

Energy Technology Data Exchange (ETDEWEB)

Williams, C [Brigham and Women’s Hospital & Dana Farber Cancer Institute, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Crowley, E; Wolfgang, J [Harvard Medical School, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States)

2016-06-15

Purpose: Intraoperative electron radiotherapy (IORT) poses a unique set of challenges for treatment planning. Planning must be performed in a busy operating room environment over a short timeframe often with little advance knowledge of the treatment depth or applicator size. Furthermore, IORT accelerators can have a large number of possible applicators, requiring extensive databooks that must be searched for the appropriate dosimetric parameters. The goal of this work is to develop a software tool to assist in the planning process that is suited to the challenges faced in the IORT environment. Methods: We developed a mobile application using HTML5 and Javascript that can be deployed to tablet devices suitable for use in the operating room. The user selects the desired treatment parameters cone diameter, bevel angle, and energy (a total of 141 datasets) and desired bolus. The application generates an interactive display that allows the user to dynamically select points on the depth-dose curve and to visualize the shape of the corresponding isodose contours. The user can indicate a prescription isodose line or depth. The software performs a monitor unit calculation and generates a PDF report. Results: We present our application, which is now used routinely in our IORT practice. It has been employed successfully in over 23 cases. The interactivity of the isodose distributions was found to be of particular use to physicians who are less-frequent IORT users, as well as for the education of residents and trainees. Conclusion: This software has served as a useful tool in IORT planning, and demonstrates the need for treatment planning tools that are designed for the specialized challenges encountered in IORT. This software is the subject of a license agreement with the IntraOp Medical Corporation. This software is the subject of a license agreement between Massachusetts General Hospital / Partners Healthcare and the IntraOp Medical Corporation. CLW is consulting on

Physical therapy treatment in incontinent women provided by a Public Health Service

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Daniela D'Attilio Toledo

Full Text Available INTRODUCTION: Urinary incontinence affects more than 50 million people worldwide, it has a great impact on quality of life by affecting social, domestic, occupational and sex life, regardless of age. Objective: The objective of this study was to analyze the effectiveness of physical therapy treatment in women attending the Urogynecology service of Hospital and Maternity Leonor Mendes de Barros. METHOD: We retrospectively assessed 65 records of patients with diagnosis of urinary incontinence treated between November 2005 and November 2006. In order to have their data analyzed, patients were divided into two groups; group MF, which underwent medical treatment and physiotherapy, and group M, which had only medical treatment. In order to compare both groups' quantitative data, the analysis was performed in Statistica® software using Mann Whitney's non-parametric test. The analysis of association between the quantitative variables was performed through the Chi-Square test at 5% (p > 0.05 significance level. RESULTS: We observed that 60.6% of patients who underwent physical therapy treatment and medical treatment had the urinary incontinence symptoms decreased or completely cured, while 80% of women belonging to the medical treatmen only-group underwent surgery. CONCLUSION: Thus, we conclude that physical therapy is essential in treatment protocols of urinary incontinence outpatient clinics and to prevent surgery.

Treatment of retroauricular keloids: Revision of cases treated at the ENT service of HC/UFPR.

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Carvalho, Bettina; Ballin, Annelyse Cristine; Becker, Renata Vecentin; Ribeiro, Talita Beithum; Cavichiolo, Juliana Benthien; Ballin, Carlos Roberto; Mocellin, Marcos

2012-04-01

 Keloids are benign tumors arising from abnormal healing of the skin, and there are several procedures available for their treatment.  The objective of this study was to evaluate the outcomes of patients undergoing treatment of keloids after ear, nose, and throat (ENT) surgeries at our service center.  We conducted thorough, retrospective and prospective analysis of records of patients undergoing treatment of retroauricular keloids at our center.  Nine patients were evaluated, and 6 underwent resection and adjuvant beta-therapy, 2 underwent resection with local application of corticosteroids, and only 1 underwent resection without adjuvant therapy. There was no recurrence of keloids in patients that were treated with beta-therapy in the early postoperative period. One patient had relapsed despite corticosteroid administration and late beta-therapy.  Several techniques have been used for the treatment of retroauricular keloids, and beta-therapy is thought to yield the best results, followed by the use of intralesional corticosteroids.  Treatment of retroauricular keloids remains a challenge. While new techniques are being developed, resection followed by early beta-therapy is still the best treatment option.

Comparison of outcomes following laparoscopic and open treatment of emergent small bowel obstruction: an 11-year analysis of ACS NSQIP.

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Patel, Richa; Borad, Neil P; Merchant, Aziz M

2018-06-04

Small bowel obstruction (SBO) continues to be a common indication for acute care surgery. While open procedures are still widely used for treatment, laparoscopic procedures may have important advantages in certain patient populations. We aim to analyze differences in outcomes between the two for treatment of bowel obstruction. The American College of Surgeons National Surgical Quality Improvement Program was used to find patients that underwent emergent or non-elective surgery for SBO. Propensity matching was used to create comparable groups. Logistic regression was used to assess differences in the primary outcome of interest, return to operating room, and morbidity and mortality outcomes. Logistic regression was also used to assess the contribution of various preoperative demographic and comorbidity characteristics to 30-day mortality. A total of 24,028 patients underwent surgery for SBO from 2005 to 2011. Of those, 3391 were laparoscopic. Propensity matching resulted in 6782 matched patients. Laparoscopic cases had significantly decreased odds of experiencing any morbidity and wound complications compared to open cases in bowel-resection and adhesiolysis-only cases. There was no significant difference found for odds of returning to operating room. Laparoscopic cases resulted in significantly shorter hospital stays than open cases (7.18 vs.10.84 days, p  25) decreased odds of mortality. Analysis of emergent SBO cases between 2005 and 2015 demonstrates that laparoscopy is not utilized as often as open approaches in surgical treatment. Laparoscopic surgery resulted in reduced postoperative morbidity and significantly shorter hospital stays compared to open intervention and was not associated with significant differences in odds of reoperation compared to open surgery.

Cationic PEGylated polycaprolactone nanoparticles carrying post-operation docetaxel for glioma treatment

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Cem Varan

2017-07-01

Full Text Available Background: Brain tumors are the most common tumors among adolescents. Although some chemotherapeutics are known to be effective against brain tumors based on cell culture studies, the same effect is not observed in clinical trials. For this reason, the development of drug delivery systems is important to treat brain tumors and prevent tumor recurrence. The aim of this study was to develop core–shell polymeric nanoparticles with positive charge by employing a chitosan coating. Additionally, an implantable formulation for the chemotherapeutic nanoparticles was developed as a bioadhesive film to be applied at the tumor site following surgical operation for brain glioma treatment. To obtain positively charged, implantable nanoparticles, the effects of preparation technique, chitosan coating concentration and presence of surfactants were evaluated to obtain optimal nanoparticles with a diameter of less than 100 nm and a net positive surface charge to facilitate cellular internalization of drug-loaded nanoparticles. Hydroxypropyl cellulose films were prepared to incorporate these nanoparticle dispersions to complete the implantable drug delivery system.Results: The diameter of core–shell nanoparticles were in the range of 70–270 nm, depending on the preparation technique, polymer type and coating. Moreover, the chitosan coating significantly altered the surface charge of the nanoparticles to net positive values of +30 to +50 mV. The model drug docetaxel was successfully loaded into all particles, and the drug release rate from the nanoparticles was slowed down to 48 h by dispersing the nanoparticles in a hydroxypropyl cellulose film. Cell culture studies revealed that docetaxel-loaded nanoparticles cause higher cytotoxicity compared to the free docetaxel solution in DMSO.Conclusion: Docetaxel-loaded nanoparticles dispersed in a bioadhesive film were shown to be suitable for application of chemotherapeutics directly to the action site during

Medial rectus Faden operations with or without recession for partially accommodative esotropia associated with a high accommodative convergence to accommodation ratio.

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Akar, Serpil; Gokyigit, Birsen; Sayin, Nihat; Demirok, Ahmet; Yilmaz, Omer Faruk

2013-01-01

To evaluate the results of Faden operations on the medial rectus (MR) muscles with or without recession for the treatment of partially accommodative esotropia associated with a high accommodative convergence to accommodation (AC : A) ratio and to determine whether there was a decrease in the effects of posterior fixation over time. In this retrospective study, 108 of 473 patients who underwent surgery for partially accommodative esotropia with a high AC : A ratio received Faden operations on both MR muscles, and 365 received symmetric MR muscle recessions combined with a Faden operation. For the Faden operation, a satisfactory outcome of 76.9% at 1 month postoperation, decreased to 71.3% by the final follow-up visit (mean 4.8 years). A moderate positive correlation was observed between the increase in the postoperative near deviation and postoperative time. For the Faden operations combined with MR recession, a satisfactory outcome of 78.9% at 1 month post-operation, decreased to 78.4% by the final follow-up visit. A Faden operation of the MR muscles with or without recession is an effective surgical option for treating partially accommodative esotropia associated with a high AC : A ratio. For Faden operations of the MR muscles without recession, the effects of the posterior fixation decline over time.

Surgical treatment of children with hyperparathyroidism: single centre experience.

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Alagaratnam, S; Brain, C; Spoudeas, H; Dattani, M T; Hindmarsh, P; Allgrove, J; Van't Hoff, W; Kurzawinski, T R

2014-11-01

Hyperparathyroidism (HPT) in children is rare and surgical management is supported only by limited evidence. Retrospective case series of all children under the age of 16 years who underwent parathyroidectomy (PTx) between 1978 and 2012. We identified 29 children who had surgery for HPT. Six were neonates with neonatal severe hyperparathyroidism (NSHPT) and 23 older children (age range 7-16 years) with sporadic (16) or familial (7) HPT and 93% were symptomatic. Accuracy of ultrasound and MIbi in localising solitary parathyroid adenomas was 96%, but less helpful in hyperplasia and neonates. Children with NSHPT underwent 5 curative total and 1 subtotal PTx (no reoperations). Children with familial HPT underwent 3 total and 4 subtotal PTx. One child with subtotal PTx required a reoperation. Children with sporadic HPT underwent subtotal PTx prior to 1980 (2), exploration and removal of enlarged glands 1980-2002 (5) and minimally invasive PTx since 2002 (9) and all cured by the first operation. Our study documents that HPT in children is predominantly symptomatic on presentation and genetically determined in 46% of cases. Imaging is accurate in localising parathyroid adenomas, but not hyperplasias. Total PTx for familial HPT was curative and minimally invasive PTx is the operation of choice for older children with sporadic HPT. Copyright © 2014 Elsevier Inc. All rights reserved.

Treatment/Disposal Plan for Drummed Waste from the 300-FF-1 Operable Unit, 618-4 Burial Ground

International Nuclear Information System (INIS)

Lerch, J.A.

1999-01-01

The objective of this plan is to support selection of a safe, environmentally responsible, and cost-effective treatment and disposal method for drums containing depleted uranium metal chips submerged in oil that have been and will be excavated from the 618-4 Burial Ground. Remediation of the 300-FF-1 Operable Unit, 618-4 Burial Ground was initiated in fiscal year (FY) 1998 as an excavation and removal operation. Routine processes were established to excavate and ship contaminated soil and debris to the Environmental Restoration Disposal Facility (ERDF) for disposal

Conservative treatment of premature rectal cancer

International Nuclear Information System (INIS)

Torres, M.

2010-01-01

Objectives: The largest radical resections in rectal cancer with significant morbidity and mortality (Urinary dysfunction, sexual dysfunction, permanent colostomy, etc.), on certain occasions and with high selectivity, they can be avoided with the implementation of local resections. Our intention is to assess the results of conservative treatment of rectal cancer early. Material and Methods: Between 01.01.89 and 31.12.09 14 consecutive patients were treated carriers rectal adenocarcinoma who had never received prior cancer treatment and a second simultaneous showed no neoplasia. The age of the patients presented a range between 44 and 72 years with a mean of 60.4 years; sex similarly partitioned and according to ECOG performance status was 0≤2. All patients were operated through a anal resection of which 4 were performed a submucosal tumor excision (T1) and 10 excision was entire rectal wall and tumor invaded the muscularis propria (T2). For this one type of surgery patients were selected the following criteria: tumor ≤6 cm. the anal verge, size ≤3 cm., GH I-II, vegetative, mobile, and T1-2, N0 by EER. After intervention, the pathological examination of the surgical specimen showed that 4 patients GH III, lymphovascular invasion and / or peri neural, or close surgical margins (+) (≤3 mm.) And T3, so underwent Miles operation (March 1 T1 and T2). Subsequently the rest of the patients (10) underwent concomitant radio chemotherapy. Radiation therapy was similar all using megavoltage photons (CO-60, 18mV) to the entire pelvic volume in a normofraccionamiento to complete 50.40 Gy (1.8 Gy / 28) using multiple fields (box technique). Chemotherapy was prepared 5FU + LV in the first patient (4), in following (4) was used 5FU continuous infusion (1st and 5th week) and the remaining (2) Capecitabine. Follow up was complete. Results: In our sample we extract local failure was 4 (29%), distant failure 3 (20%) and two local and distant failures (14%) so it follows that

Comparison of quality of speech after Veau-Wardill-Kilner pushback operation and the Cronin modification in the primary treatment of cleft palate.

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Haapanen, M L; Rintala, A E

1993-01-01

The quality of speech was compared in 124 young adults with isolated cleft palate. Forty-seven subjects were excluded because of the presence of factors that might have biased the evaluation of the success rate of the two operations studied, leaving 77 subjects who had undergone primary palatoplasty for analysis. One stage closure of the soft and hard palate was done for 43 patients by the mucoperiosteal palatal V to Y pushback technique (Veau-Wardill-Kilner, group V), and 34 underwent the Cronin modification (group C). Their speech was tape recorded, analysed by three qualified listeners, and hypernasality assessed by four published hypernasality indexes. More subjects in group C achieved normal resonance than in group V, who had higher hypernasality index scores than group C. The groups managed pressure consonants similarly. Only a few patients had weak plosives, audible nasal air emission, or compensatory articulation. Similar numbers of secondary operations were done for both groups. However, group V would have actually required secondary surgery more frequently than group C.

Operative treatment of the midshaft fractures of the clavicle – does delay matter?

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Matej Andoljšek

2007-11-01

Full Text Available Background: Fractures of the clavicle are common injuries and mostly treated non-operatively. Nearly always the fracture is clinically united within three to four weeks and functional recovery should be completed within two months. Traditionally thinking has been that operative treatment is indicated exceptionaly and that delayed surgery is less successful. In retrospective comparative study authors have asked – whether delay of surgery in middle-third clavicular fractures negatively affects functional results and – whether after delayed surgery complications are more frequent.Patients and methods: Thirty-seven of 733 fractures of the clavicle were treated operatively. Among these, 11 were fresh Allman Type I fractures (early procedure, 9 delayed- or non-unions and one malunion (late procedure. All fractures were fixed with plates and screws. In none of the reconstructive procedures composite bone grafting was performed, twice spongiotic bone graft and twice morsilized calus grafts were used. DASH and Constant scores were used for outcome evaluation.Results: Twenty-one of 22 patients were evaluated (one foreign turist missed on average 21 month after surgery. Average DASH scores for early operated patients were 14.4 and for late operated 18.5; an average Quich DASH were 16.4 and 20.5 respectively. Average Constant scores were 85.6 and 76.0. Statistically differences are not important. Three patients had early complications (two from early, one from late group. Five patients had late complications (four skin paresthesias, one non-union.Conclusions: In retrospective study, functional results of surgically treated fresh Type I fractures and after reconstructive surgery for delayed-, non- and mal-union of the midshaft of the clavicle were comparable. No significant differences in complication rates were confirmed.

[Comparative results of surgical treatment for perforating and bleeding pyloroduodenal ulcers].

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Gorbunov, V N; Sytnik, A P; Korenev, N N; Gordeev, S A; Stoliarchuk, E V; Urzhumtseva, G A

1998-01-01

Results of treatment of 1309 patients with perforated and bleeding pyloroduodenal ulcers for 20-years period have been analysed. Resection of the stomach performed in 85 cases resulted in high postoperative lethality which made up in bleeding ulcers 14.8%. Drainage operations of the stomach with excision or suturing of ulcer combined with bilateral truncal vagotomy was performed in 60 patients, postoperative lethality rate being 8.4%. 128 patients underwent selective proximal vagotomy together with pyloro- and duodenoplasty, lethality rate being 1.6%. Combined vagotomy (posterior truncal and anterior sero-muscular) with excision of ulcer, transversal pyloroplasty and duodenoplasty was carried out in 1036 patients (postoperative lethality--2.4%). Excellent and good functional results were achieved in 79.6% of the patients.

Experience of treatment of patients with granulomatous lobular mastitis.

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Hur, Sung Mo; Cho, Dong Hui; Lee, Se Kyung; Choi, Min-Young; Bae, Soo Youn; Koo, Min Young; Kim, Sangmin; Choe, Jun-Ho; Kim, Jung-Han; Kim, Jee Soo; Nam, Seok-Jin; Yang, Jung-Hyun; Lee, Jeong Eon

2013-07-01

To present the author's experience with various treatment methods of granulomatous lobular mastitis (GLM) and to determine effective treatment methods of GLM. Fifty patients who were diagnosed with GLM were classified into five groups based on the initial treatment methods they underwent, which included observation (n = 8), antibiotics (n = 3), steroid (n = 13), drainage (n = 14), and surgical excision (n = 12). The treatment processes in each group were examined and their clinical characteristics, treatment processes, and results were analyzed respectively. Success rates with each initial treatment were observation, 87.5%; antibiotics, 33.3%; steroids, 30.8%; drainage, 28.6%; and surgical excision, 91.7%. In most cases of observation, the lesions were small and the symptoms were mild. A total of 23 patients underwent surgical excision during treatment. Surgical excision showed particularly fast recovery, high success rate (90.3%) and low recurrence rate (8.7%). The clinical course of GLM is complex and the outcome of each treatment type are variable. Surgery may play an important role when a lesion is determined to be mass-forming or appears localized as an abscess pocket during breast examination or imaging study.

The Role of Pre-Operative and Post-Operative Glucose Control in Surgical-Site Infections and Mortality

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Jeon, Christie Y.; Furuya, E. Yoko; Berman, Mitchell F.; Larson, Elaine L.

2012-01-01

Background and Objective The impact of glucose control on surgical-site infection (SSI) and death remains unclear. We examined how pre- and post-operative glucose levels and their variability are associated with the risk of SSI or in-hospital death. Methods This retrospective cohort study employed data on 13,800 hospitalized patients who underwent a surgical procedure at a large referral hospital in New York between 2006 and 2008. Over 20 different sources of electronic data were used to anal...

Rescue pre-operative treatment with Lugol’s solution in uncontrolled Graves’ disease

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Jan Calissendorff

2017-04-01

Full Text Available Background: Graves’ disease is a common cause of hyperthyroidism. Three therapies have been used for decades: pharmacologic therapy, surgery and radioiodine. In case of adverse events, especially agranulocytosis or hepatotoxicity, pre-treatment with Lugol’s solution containing iodine/potassium iodide to induce euthyroidism before surgery could be advocated, but this has rarely been reported. Methods: All patients hospitalised due to uncontrolled hyperthyroidism at the Karolinska University Hospital 2005–2015 and treated with Lugol’s solution were included. All electronic files were carefully reviewed manually, with focus on the cause of treatment and admission, demographic data, and effects of iodine on thyroid hormone levels and pulse frequency. Results: Twenty-seven patients were included. Lugol’s solution had been chosen due to agranulocytosis in 9 (33%, hepatotoxicity in 2 (7%, other side effects in 11 (41% and poor adherence to medication in 5 (19%. Levels of free T4, free T3 and heart rate decreased significantly after 5–9 days of iodine therapy (free T4 53–20 pmol/L, P = 0.0002; free T3 20–6.5 pmol/L, P = 0.04; heart rate 87–76 beats/min P = 0.0007, whereas TSH remained unchanged. Side effects were noted in 4 (15% (rash n = 2, rash and vomiting n = 1, swelling of fingers n = 1. Thyroidectomy was performed in 26 patients (96% and one was treated with radioiodine; all treatments were without serious complications. Conclusion: Treatment of uncontrolled hyperthyroidism with Lugol’s solution before definitive treatment is safe and it decreases thyroid hormone levels and heart rate. Side effects were limited. Lugol’s solution could be recommended pre-operatively in Graves’ disease with failed medical treatment, especially if side effects to anti-thyroid drugs have occurred.

Treatment and Prognosis of Isolated Local Relapse after Stereotactic Body Radiotherapy for Clinical Stage I Non-Small-Cell Lung Cancer: Importance of Salvage Surgery.

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Hamaji, Masatsugu; Chen, Fengshi; Matsuo, Yukinori; Ueki, Nami; Hiraoka, Masahiro; Date, Hiroshi

2015-11-01

Many efforts have been made to detect local relapse (LR) in the follow-up after stereotactic body radiotherapy (SBRT) for non-small-cell lung cancer (NSCLC) although limited data are available on its treatment and prognosis. We aimed to characterize treatment options and clarify long-term outcomes of isolated LR after SBRT for patients with clinical stage I NSCLC. We reviewed our institutional database in search of patients with isolated LR after SBRT for clinical stage I NSCLC at our institution between 1999 and 2013. Patient characteristics were compared with Mann-Whitney U test, χ2 test, or Fisher's exact test as appropriate. Survival outcomes were estimated with Kaplan-Meier method. Potential prognostic factors were investigated using Cox proportional hazard model. Of 308 patients undergoing SBRT for clinical stage I NSCLC, 49 patients were identified to have isolated LR. Twelve patients underwent salvage surgery, none underwent radiotherapy, and eight patients received chemotherapy, whereas 29 patients received best supportive care. No patient characteristic except operability was significantly related with patient selection for LR treatments. Five-year overall survival (OS) rate of the whole cohort was 47.9% from SBRT and 25.7% from LR. Salvage surgery was associated with improved OS after LR (p = 0.014), and 5-year OS for patients undergoing salvage surgery was 79.5% from LR. It was confirmed that our patient selection for salvage surgery for isolated LR was associated with favorable survival outcomes. Operability based on multidisciplinary conferences, rather than measurable patient characteristics, is essential for appropriate patient selection for salvage surgery.

Control strategies for nitrous oxide emissions reduction on wastewater treatment plants operation.

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Santín, I; Barbu, M; Pedret, C; Vilanova, R

2017-11-15

The present paper focused on reducing greenhouse gases emissions in wastewater treatment plants operation by application of suitable control strategies. Specifically, the objective is to reduce nitrous oxide emissions during the nitrification process. Incomplete nitrification in the aerobic tanks can lead to an accumulation of nitrite that triggers the nitrous oxide emissions. In order to avoid the peaks of nitrous oxide emissions, this paper proposes a cascade control configuration by manipulating the dissolved oxygen set-points in the aerobic tanks. This control strategy is combined with ammonia cascade control already applied in the literature. This is performed with the objective to take also into account effluent pollutants and operational costs. In addition, other greenhouse gases emissions sources are also evaluated. Results have been obtained by simulation, using a modified version of Benchmark Simulation Model no. 2, which takes into account greenhouse gases emissions. This is called Benchmark Simulation Model no. 2 Gas. The results show that the proposed control strategies are able to reduce by 29.86% of nitrous oxide emissions compared to the default control strategy, while maintaining a satisfactory trade-off between water quality and costs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

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Alessandro Varrica

2015-01-01

Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

The comparison of an inexpensive-modified transobturator vaginal tape versus TVT-O procedure for the surgical treatment of female stress urinary incontinence.

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Zhang, Yan; Jiang, Min; Tong, Xiao-Wen; Fan, Bo-Zhen; Li, Huai-Fang; Chen, Xin-Liang

2011-09-01

To compare the safety and efficacy of an inexpensive-modified transobturator vaginal tape procedure with the transobturator tension-free vaginal tape (TVT-O) procedure for the surgical treatment of female stress urinary incontinence (SUI). Patients with SUI were randomly allocated to either the test group receiving the inexpensive-modified transobturator vaginal tape procedure or the control group receiving the GYNECARE TVT-O procedure. Treatment outcomes and Quality-of-life scores were recorded and analyzed between two groups. A total of 156 patients were enrolled in this trial. Eighty patients underwent the modified transobturator vaginal tape procedure. Among them 75(93.8%) were cured and 5(6.2%) were improved. The rest of the 76 patients underwent the GYNECARE TVT-O procedure with a 92% (70 of 76) cure rate and an 8% (6 of 76) improvement rate. No inefficient or aggravated cases occurred in both groups. The success rates between groups had no significant statistic difference (p > 0.05). The operative time, blood loss, hospital stay, and medical cost were significantly lower in the test group (p < 0.01); the increases in Quality-of-life scores were comparable between groups. The modified transobturator vaginal tape procedure is an efficacious and economic surgical treatment for female SUI. Copyright © 2011. Published by Elsevier B.V.

Pathophysiology and surgical treatment for radiation enteritis