WorldWideScience

Sample records for underwent primary surgery

  1. An evaluation of quality of life in women with endometriosis who underwent primary surgery: a 6-month follow up in Sabah Women & Children Hospital, Sabah, Malaysia.

    Science.gov (United States)

    M F, Ahmad; Narwani, Hussin; Shuhaila, Ahmad

    2017-10-01

    Endometriosis is a complex disease primarily affecting women of reproductive age worldwide. The management goals are to improve the quality of life (QoL), alleviate the symptoms and prevent severe disease. This prospective cohort study was to assess the QoL in women with endometriosis that underwent primary surgery. A pre- and post-operative questionnaire via ED-5Q and general VAS score used for the evaluation for endometrial-like pain such as dysmenorrhoea and dyspareunia. A total of 280 patients underwent intervention; 224 laparoscopically and 56 via laparotomy mostly with stage II disease with ovarian endometriomas. Improvements in dysmenorrhoea pain scores from 5.7 to 4.15 and dyspareunia from 4.05 to 2.17 (p <.001) were observed. The Self Rate Assessment was improved; 6.66-4.68 post-operatively (p < .05). In EQ-5 D Index, the anxiety and activities outcomes showed a significant worsening post-intervention. There was no correlation between the stage of disease and endometrial pain; (p = .289), method of intervention (p = .290) and usage of post-operative hormonal therapy (p = .632). This study concluded that surgical treatment improved the QoL with added hormonal therapy post-intervention, despite not reaching statistical significance, showed a promising result. Impact statement Surgical intervention does improve the QoL for women with endometriosis however post interventional hormonal therapy is remain inconclusive.

  2. NUTRITION SUPPORT COMPLICATIONS IN PATIENT WHO UNDERWENT CARDIAC SURGERY

    OpenAIRE

    Krdžalić, Alisa; Kovčić, Jasmina; Krdžalić, Goran; Jahić, Elmir

    2016-01-01

    Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analy...

  3. Evaluation of patients who underwent resympathectomy for treatment of primary hyperhidrosis.

    Science.gov (United States)

    de Campos, José Ribas Milanez; Lembrança, Lucas; Fukuda, Juliana Maria; Kauffman, Paulo; Teivelis, Marcelo Passos; Puech-Leão, Pedro; Wolosker, Nelson

    2017-11-01

    Video thoracoscopic sympathectomy is the recommended surgical treatment for primary hyperhidrosis and has a high success rate. Despite this high success rate, some patients are unresponsive and eventually need a resympathectomy. Few studies have previously analysed exclusively the results of these resympathectomies in patients with primary hyperhidrosis. None of the studies have objectively evaluated the degree of response to surgery or the improvement in quality of life after resympathectomies. This is a retrospective study, evaluating 15 patients from an initial group of 2300 patients who underwent resympathectomy after failure of the primary surgical treatment. We evaluated sympathectomy levels of resection, technical difficulties, surgical complications preoperative quality of life, response to treatment and quality-of-life improvement 30 days after each surgery. Regarding gender, 11 (73.3%) patients were women. The average age was 23.2 with SD of 5.17 years, and the mean body mass index was 20.9 (SD 2.12). Ten patients had major complaints about their hands (66%) and 5 (33%) patients about their forearms. A high degree of response to sympathectomy occurred in 73% of patients. In 11 of these patients, the improvement in quality of life was considered high, 3 showed a mild improvement and 1 did not improve. No major complications occurred; the presence of adhesions was reported in 11 patients and pleural drainage was necessary in 4 patients. Resympathectomy is an effective procedure, and it improves the quality of life in patients with primary hyperhidrosis who failed after the first surgery. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    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.

  6. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    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.

  7. [Patients with astigmatism who underwent cataract surgery by phacoemulsification: toric IOL x asferic IOL?].

    Science.gov (United States)

    Torres Netto, Emilio de Almeida; Gulin, Marina Carvalho; Zapparoli, Marcio; Moreira, Hamilton

    2013-01-01

    Compare the visual acuity of patients who underwent cataract surgery by phacoemulsification with IOL AcrySof(®) toric implantation versus AcrySof(®) IQ and evaluate the reduction of cylindrical diopters (CD) in the postoperative period. Analytical and retrospective study of 149 eyes with 1 or more diopters of regular symmetrical keratometric astigmatism, which underwent cataract surgery by phacoemulsification. The eyes were divided into two groups: the toric group with 85 eyes and the non-toric group with 64 eyes. In the pre-operative phase, topographic data and refraction of each eye to be operated were assessed. In the postoperative phase, refraction and visual acuity with and without correction were measured. The preoperative topographic astigmatism ranged from 1.00 to 5.6 DC in both groups. Average reduction of 1.37 CD (p<0.001) and 0.16 CD (p=0.057) was obtained for the toric and non-toric group when compared to the refractive astigmatism, respectively. Considering visual acuity without correction (NCVA), the toric group presented 44 eyes (51.7%) with NCVA of 0 logMAR (20/20) or 0.1 logMAR (20/25) and the toric group presented 7 eyes (10.93%) with these same NCVA values. The results show that patients with a significant keratometric astigmatism presented visual benefits with the toric IOL implantation. The reduction of the use of optical aids may be obtained provided aberrations of the human eye are corrected more accurately. Currently, phacoemulsification surgery has been used not only for functional improvement, but also as a refraction procedure.

  8. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Shantavasinkul, Prapimporn Chattranukulchai; Omotosho, Philip; Corsino, Leonor; Portenier, Dana; Torquati, Alfonso

    2016-11-01

    Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. An academic medical center in the United States. A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (Pweight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (Pweight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Directory of Open Access Journals (Sweden)

    Wang Fang

    2013-02-01

    Full Text Available Abstract Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS. Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p  1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively. The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively. Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in guiding the treatment of patients with asymptomatic recurrent ovarian cancer, who have shown CCR to primary therapy, can facilitate optimal secondary CRS and extend the survival duration of the patients.

  10. [Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

    Science.gov (United States)

    Saito, Hajime; Minamiya, Yoshihiro

    2016-01-01

    Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

  11. [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.

  12. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Science.gov (United States)

    2013-01-01

    Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR) to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS). Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p CA-125 biochemical progression prior to clinically-defined relapse was 31 days (ranging from 1 to 391 days). The median number of the negative imaging studies for the clinical relapse findings in patients with a CA-125 level of CA-125 level at relapse was an independent predictor of overall and progression free survival in patients who had shown CCR to primary therapy (p = 0.04 and 0.02 respectively). The overall and progression free survival durations in patients with a CA-125 level ≤ 1.68 × nadir at relapse (69.4 and 13.8 months) were longer than those with a CA-125 level > 1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively). The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively). Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in

  13. The Effectiveness of Adjuvant Hyperbaric Oxygen Therapy in Adults who Underwent Hypospadias Surgery

    Directory of Open Access Journals (Sweden)

    Onder Kara

    2017-01-01

    Full Text Available Aim: To evaluate the role of hyperbaric oxygen therapy (HBO2T with buccal mucosal tube urethroplasty in adult patients with hypospadias. Material and Method: Sixteen adult patients with hypospadias were included in our study. Patients with a short urethra and penile curvature were treated in two stages (orthoplasty buccal mucosal tube urethroplasty. Buccal mucosa was taken and prepared for tube urethroplasty around a 16 French (Fr nelaton catheter and the urethral tube was introduced between the urethral meatus and glans penis. Beginning the 1st postoperative day (HBO2T was applied for 10 sessions during weekdays in 13 patients. Results: The mean age was 21 (±1.23 years and mean follow-up time was 10.1 (±2.1 months. In the group who received HBO2T postoperatively (n=13, a two-stage (orthoplasty buccal mucosal tube urethroplasty procedure was performed in 6 (46%, and the mean length of graft was 5.4 (±1.23 cm. In this group of 13 the success rate without any additional manipulations (urethrotomy intern, fistula repair was 54% (7/13. After additional manipulations, complete healing was achieved in 11 out of 13 patients (84.6%. In the group who did not receive HBO2T postoperatively (n=3, a two-stage procedure was performed in 1 patient (33%, and the mean length of graft was 8 (±5 cm. In this group of 3, complete healing was not achieved in any of these patients as a result of the hypospadias surgery. However, after the additional manipulations, complete healing was achieved in 1 patient (33%. Discussion: Given the promising rates of surgical success, postoperative HBO2T might be considered as a supportive treatment modality for adult patients with hypospadias who undergo buccal mucosal tube urethroplasty. Randomized controlled studies are needed.

  14. Analysis of Ulcer Recurrences After Metatarsal Head Resection in Patients Who Underwent Surgery to Treat Diabetic Foot Osteomyelitis.

    Science.gov (United States)

    Sanz-Corbalán, Irene; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; García-Morales, Esther; Molines-Barroso, Raúl; Alvaro-Afonso, Francisco Javier

    2015-06-01

    Metatarsal head resection is a common and standardized treatment used as part of the surgical routine for metatarsal head osteomyelitis. The aim of this study was to define the influence of the amount of the metatarsal resection on the development of reulceration or ulcer recurrence in patients who suffered from plantar foot ulcer and underwent metatarsal surgery. We conducted a prospective study in 35 patients who underwent metatarsal head resection surgery to treat diabetic foot osteomyelitis with no prior history of foot surgeries, and these patients were included in a prospective follow-up over the course of at least 6 months in order to record reulceration or ulcer recurrences. Anteroposterior plain X-rays were taken before and after surgery. We also measured the portion of the metatarsal head that was removed and classified the patients according the resection rate of metatarsal (RRM) in first and second quartiles. We found statistical differences between the median RRM in patients who had an ulcer recurrence and patients without recurrences (21.48 ± 3.10% vs 28.12 ± 10.8%; P = .016). Seventeen (56.7%) patients were classified in the first quartile of RRM, which had an association with ulcer recurrence (P = .032; odds ratio = 1.41; 95% confidence interval = 1.04-1.92). RRM of less than 25% is associated with the development of a recurrence after surgery in the midterm follow-up, and therefore, planning before surgery is undertaken should be considered to avoid postsurgical complications. © The Author(s) 2015.

  15. The Mid-Term Results of Patients who Underwent Radiofrequency Atrial Fibrillation Ablation Together with Mitral Valve Surgery

    Directory of Open Access Journals (Sweden)

    Abdurrahim Çolak

    Full Text Available Abstract Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74 underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90% were in NYHA class III; 34 (85% patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

  16. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability

    Directory of Open Access Journals (Sweden)

    Lirong Zhang

    2018-01-01

    Full Text Available Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS. Three main components (naringin, naringenin, and hesperetin were isolated from C. aurantium. Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n=47 and control group (CG, received 20 mg placebo daily, n=48. After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group (P>0.01. The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

  17. Effect of advanced blood pressure control with nifedipine delayedrelease tablets on the blood pressure in patients underwent nasal endoscope surgery

    Directory of Open Access Journals (Sweden)

    Qing-Hua Xia

    2016-08-01

    Full Text Available Objective: To explore the effect of advanced blood pressure control with nifedipine delayedrelease tablets on the blood pressure in patients underwent nasal endoscope surgery and its feasibility. Methods: A total of 80 patients who were admitted in ENT department from June, 2012 to June, 2015 for nasal endoscope surgery were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the observation group were given nifedipine delayed-release tablets for advanced blood pressure control before operation, and were given routine blood pressure control during operation; while the patients in the control group were only given blood pressure control during operation. The changes of blood pressure, mean central arterial pressure, and heart rate before anesthesia (T0, after intubation (T1, during operation (T2, extubation when waking (T3, 30 min after extubation (T4, and 3 h after back to wards (T5 in the two groups were compared. The intraoperative situation and the surgical field quality in the two groups were compared. Results: SBP, DBP, and MAP levels at T1-5 in the two groups were significantly lower than those at T0. SBP, DBP, and MAP levels at T2 were significantly lower than those at other timing points, and were gradually recovered after operation, but were significantly lower than those at T0. The effect taking time of blood pressure reducing, intraoperative nitroglycerin dosage, and postoperative wound surface exudation amount in the observation group were significantly less than those in the control group. The surgical field quality scores in the observation group were significantly superior to those in the control group. Conclusions: Advanced blood pressure control with nifedipine delayed-release tablets can stabilize the blood pressure during the perioperative period in patients underwent nasal endoscope surgery, and enhance the surgical field qualities.

  18. The effects of transfusion of irradiated blood upon cellular immune response in patients underwent open heart surgery

    International Nuclear Information System (INIS)

    Togashi, Ken-ichi; Nakazawa, Satoshi; Moro, Hisanaga; Yazawa, Masatomo; Kanazawa, Hiroshi; Hayashi, Jun-ichi; Yamazaki, Yoshihiko; Eguchi, Shoji

    1989-01-01

    The purpose of this paper is to demonstrate the effect of the transfusion of blood received 1500 rad exposure upon the immune response in 14 patients underwent various type of cardiac surgery. 13 patients received known amounts banked blood and irradiated fresh blood, while one patient received a lot of amounts of banked and irradiated and non-irradiated fresh blood. The authors studied the numbers of lymphocytes as well as lymphocyte subsets such as pan-T cells, B cells, helper/inducer T cells (T H/I ), cytotoxic/supressor T cells (T C/S ), active T cells, natural killer (NK) cells and NK cell activity during two weeks after surgeries. In all 14 patients, pan-T lymphocytes decreased markedly in a few days after surgeries, but increased to higher levels on the eight postoperative day than the levels preoperatively. T H/I and T C/S lymphocytes changed on the similar pattern as pan-T lymphocytes. Active T and B cells did not change significantly in two weeks. The number and activity of NK cells gave the lowest levels on the second postoperative day and did not recovery to the preoperative levels in two weeks. One patient received non-irradiated fresh blood showed the similar immune response as other 13 patients, while he gave the lower levels than others did. This patient died of graft-versus-host disease (GVHD)-like syndrome on the 36th postoperative day. It may be thought that the transfusion of irradiated blood would prevent the host from GVHD and gave the better effects on the immune response than that of non-irradiated blood following open-heart surgeries. (author)

  19. Primary Surgery or Interval Debulking for Advanced Epithelial Ovarian Cancer

    DEFF Research Database (Denmark)

    Markauskas, Algirdas; Mogensen, Ole; dePont Christensen, René

    2014-01-01

    OBJECTIVE: The aim of the present study was to investigate the surgical complexity, the postoperative morbidity, and the survival of the women after primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for advanced epithelial ovarian cancer....... MATERIALS AND METHODS: We consecutively included all patients who underwent debulking surgery at our institution between January 2007 and December 2012 for stages IIIc and IV of epithelial ovarian cancer. RESULTS: Of the 332 patients included, 165 (49.7%) underwent PDS, and 167 (50.3%) had NACT...

  20. [Retrospective analysis of 856 cases with stage 0 to III rectal cancer underwent curative surgery combined modality therapy].

    Science.gov (United States)

    Chen, Pengju; Yao, Yunfeng; Zhao, Jun; Li, Ming; Peng, Yifan; Zhan, Tiancheng; Du, Changzheng; Wang, Lin; Chen, Nan; Gu, Jin

    2015-07-01

    To investigate the survival and prognostic factors of stage 0 to III rectal cancer in 10 years. Clinical data and follow-up of 856 rectal cancer patients with stage 0-III underwent curative surgery from January 2000 to December 2010 were retrospective analyzed. There were 470 male and 386 female patients, with a mean age of (58 ± 12) years. Kaplan-Meier method was used to analyze the overall survival and disease free survival. Log-rank test was used to compare the survival between groups. Cox regression was used to analyze the independent prognostic factors of rectal cancer. The patients in each stage were stage 0 with 18 cases, stage I with 209 cases, stage II with 235 cases, and stage III with 394 cases. All patients received curative surgery. There were 296 patients evaluated as cT3, cT4 and any T with N+ received preoperative radiotherapy. 5.4% patients got pathological complete response (16/296), and the recurrence rate was 4.7% (14/296). After a median time of 41.7 months (range 4.1 to 144.0 months) follow-up, the 5-year overall survival rate in stage 0 to I of was 91.0%, stage II 86.2%, and stage III 60.0%, with a significant difference (P=0.000). The cumulative local recurrence rate was 4.8% (41/856), of which 70.7% (29/41) occurred within 3 years postoperatively, 97.6% (40/41) in 5 years. The cumulative distant metastasis rate was 16.4% (140/856), of which 82.9% (129/140) occurred within 3 years postoperatively, 96.4% (135/140) in 5 years. The incidence of abnormal imaging findings was significantly higher in pulmonary than liver and other sites metastases (75.0% vs. 21.7%, χ² =25.691, P=0.000). The incidence of CEA elevation was significantly higher in liver than lung and other sites metastases (56.8% vs. 37.8%, χ² =25.691, P=0.000). Multivariable analysis showed that age (P=0.015, HR=1.385, 95% CI: 1.066 to 1.801), surgical approach (P=0.029, HR=1.337, 95% CI: 1.030 to 1.733), differentiation (P=0.000, HR=1.535, 95% CI: 1.222 to 1.928), TNM stage (P

  1. Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Mattos

    2001-01-01

    Full Text Available OBJECTIVE: Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI in the first 24 hours of AMI. METHODS: The patients were divided into three different age groups (60/69, 70/79, and > or = 80 years and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the intervencionist discretion. RESULTS: We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015. Those with ages above 80 were treated later with PCI (p=.054, and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or = 80 year old patients (p=.022, and the death rate was higher in > or = 70 years olds (p=.019. Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064. CONCLUSION: Elderly patients ( > or = 70 years presented with adverse clinical and angiographic profiles and patients > or = 80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or = 70 years had a higher death rate.

  2. Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention.

    Science.gov (United States)

    Mattos, L A; Zago, A; Chaves, A; Pinto, I; Tanajura, L; Staico, R; Centemero, M; Feres, F; Maldonado, G; Cano, M; Abizaid, A; Abizaid, A; Sousa, A G; Sousa, J E

    2001-01-01

    Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI) in the first 24 hours of AMI. The patients were divided into three different age groups (60/69, 70/79, and > or =80 years) and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the interventionist discretion. We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015). Those with ages above 80 were treated later with PCI (p=.054), and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or =80 year old patients (p=.022), and the death rate was higher in > or =70 years olds (p=.019). Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064). Elderly patients (> or =70 years) presented with adverse clinical and angiographic profiles and patients > or =80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or =70 years had a higher death rate.

  3. 65. Impact of focused echocardiography in clinical decision of patients presented with STMI, underwent primary percutenouse angioplasty

    Directory of Open Access Journals (Sweden)

    M. Qasem

    2016-07-01

    Full Text Available Echocardiography in coronary artery diseases is an essential, routine echocardiography prior to primary percutaneous angioplasty is not clear. In our clinical practice in primary angioplasty we faced lots of complications either before or during or after the procedure. Moreover, lots of incidental findings that discovered after the procedure which if known will affect the plan of management. One-hundred-nineteen consecutive underwent primary angioplasty. All patients underwent FE prior to the procedure in catheterization lab while the patient was preparing for the procedure. FE with 2DE of LV at base, mid and apex, and apical stander views. Diastology grading, E/E′ and color doppler of mitral and aortic valve were performed. (N = 119 case of STMI were enrolled, mean age 51 ± 12 year. Eleven cases (9.2% had normal coronary and normal LV function. Twenty cases (17% of MI complication detected before the procedures: RV infarction 8.4% (5.1% asymptomatic and 3.3% symptomatic, ischemic MR (8.4%, LV apical aneurysm (0.8%, significant pericardial effusion (0.80%. Acute pulmonary edema in 17 cases (14.3%: six cases (5.1% developed acute pulmonary edema on the cath lab with grade 3 diastolic dysfunction and E/E ′  >20, 9 cases (7.6% develop acute pulmonary edema in CCU with grade 2–3 diastolic dysfunction and E/E′ 15–20. 2 cases (2.7% develop acute pulmonary in CCU with grade 1–2 diastolic dysfunction and E/E′ 9–14. One case (0.8% presented cardiac tamponade 2 h post PCI. Incidental finding not related to STMI were as follow: 2 cases (1.7% with severe fibro degenerative MR, 2 cases (1.7% with mild to moderate AR and 2 cases (1.7% with mild to moderate AS. Isoled CABG 5/4.2% and CABG and MVR 2/1.7%. FE play an important role in guiding the management, early detection the incidental findings and complication post PCI.

  4. A comparison of revisional and primary bariatric surgery.

    Science.gov (United States)

    Fulton, Courtney; Sheppard, Caroline; Birch, Daniel; Karmali, Shazeer; de Gara, Christopher

    2017-06-01

    Revisional surgery is an important component of addressing weight regain and complications following primary bariatric surgery. Owing to provincial need and the complexity of this patient population, a specialized multidisciplinary revision clinic was developed. We sought to characterize patients who undergo revision surgery and compare their outcomes with primary bariatric surgery clinic data. We completed a retrospective chart review of bariatric revision clinic patients compared with primary bariatric surgery patients from December 2009 to June 2014. We reviewed the charts of 2769 primary bariatric clinic patients, 886 of whom had bariatric surgery, and 534 revision bariatric clinic patients, 83 of whom had revision surgery. Fewer revision clinic patients underwent surgery than primary clinic patients (22% v. 32%). The mean preoperative body mass index (BMI) was 44.7 ± 9.5 in revision patients compared with 45.7 ± 7.6 in primary bariatric surgery patients. Most revision patients had a prior vertical banded gastroplasty (VBG; 48%) or a laparoscopic adjustable gastric band (LAGB; 24%). Bands were removed in 36% of all LAGB patients presenting to clinic. Of the 134 procedures performed in the revision clinic, 83 were bariatric weight loss surgeries, and 51 were band removals. Revision clinic patients experienced a significant decrease in BMI (from 44.7 ± 9.5 to 33.8 ± 7.5, p bariatric revision clinic manages a wide variety of complex patients distinct from those seen in a primary clinic. Operative candidates at the revision clinic are chosen based on favourable medical, anatomic and psychosocial factors, keeping in mind the resource constraints of a public health care system.

  5. Prognostic factors for perioperative myocardial infarction and immediate mortality in patients who underwent coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Mirtha López Ramírez

    2016-03-01

    Conclusions: Older age and higher body mass index were protective prognostic factors for perioperative acute myocardial infarction events. Prolonged surgical time and complications were independently associated with perioperative infarction and mortality after coronary artery bypass graft surgery. Low preoperative glomerular filtration rate was also associated with mortality.

  6. Atrioventricular septal defect (AVSD) : A study of 219 patients who underwent surgery for AVSD at Rikshospitalet from 1979 to 1999

    OpenAIRE

    Skraastad, Ingrid Birthe Bendixen; Skraastad, Berit Kristine

    2010-01-01

    Background: The present study evaluates 219 consecutive patients that underwent surgical repair for AVSD in a long term follow-up. Methods: The patients had a surgical correction for AVSD at Rikshospitalet from January 1979 to December 1999. The follow-up was closed in January 2009. AVSD with additional defects and syndromes were included. Results: Forty-two patients died during the observational period. Early mortality was 12.8% and late mortality was 6.4%. Early mortality declined f...

  7. Normalized lactate load is associated with development of acute kidney injury in patients who underwent cardiopulmonary bypass surgery.

    Directory of Open Access Journals (Sweden)

    Zhongheng Zhang

    Full Text Available Cardiac surgery associated acute kidney injury is a major postoperative complication and has long been associated with adverse outcomes. However, the association of lactate and AKI has not been well established. The study aimed to explore the association of normalized lactate load with AKI in patients undergoing cardiac surgery.This was a prospective observational cohort study conducted in a 47-bed ICU of a tertiary academic teaching hospital from July 2012 to January 2014. All patients undergoing cardiopulmonary bypass surgery were included. Normalized lactate load (L was calculated by the equation: [Formula: see text], where ti was time point for lactate measurement and vi was the value of lactate. L was transformed by natural log (Lln to improve its normality. Logistic regression model was fitted by using stepwise method. Scale of Lln was examined by using fractional polynomial approach and potential interaction terms were explored.A total of 117 patients were included during study period, including 17 AKI patients and 100 non-AKI patients. In univariate analysis Lln was significantly higher in AKI as compared with non-AKI group (1.43±0.38 vs 1.01±0.45, p = 0.0005. After stepwise selection of covariates, the main effect logistic model contained variables of Lln (odds ratio: 11.1, 95% CI: 1.22-101.6, gender, age, baseline serum creatinine and fluid balance on day 0. Although the two-term fractional polynomial model was the best-fitted model, it was not significantly different from the linear model (Deviance difference = 6.09, p = 0.107. There was no significant interaction term between Lln and other variables in the main effect model.Our study demonstrates that Lln is independently associated with postoperative AKI in patients undergoing CPB. There is no significant interaction with early postoperative fluid balance.

  8. [Perioperative management of a child with central diabetes insipidus who underwent two surgeries before and after desmopressin administration].

    Science.gov (United States)

    Kiriyama, Keiji; Tachibana, Kazuya; Nishimura, Nobuyuki; Takeuchi, Muneyuki; Kinouchi, Keiko

    2013-03-01

    A 14-year-old girl weighing 32 kg was diagnosed with suprasellar tumor causing hydrocephalus, hypothyroidism, adrenal dysfunction and central diabetes insipidus. She was treated with levothyroxine and hydrocortisone and urged to take fluid to replace urine. She was scheduled to undergo ventricular drainage to relieve hydrocephalus prior to tumor resection. For the first surgery, desmopressin was not started and urine output reached 4,000 to 6,000 ml x day(-1), urine osmolality 64 mOsm x l(-1) and urine specific gravity 1.002. Anesthesia was induced with sevoflurane and maintained with propofol and remifentanil. Maintenance fluid was with acetated Ringer's solution and urine loss was replaced with 5% dextrose. Bradycardia and hypotension occurred after intubation, which was treated with volume load. Infusion volume was 750 ml and urine output was 1100 ml during 133 min of anesthesia. Postoperative day 1 nasal desmopressin was started. Ten days later, partial tumor resection was performed. Anesthesia was induced with propofol and fentanyl and maintained with sevoflurane and remifentanil. Infusion volume was 610 ml, urine output 380 ml, and blood loss 151 ml during 344 min of anesthesia. Hemodynamic parameters were stable throughout the procedure. Pathology of the tumor was revealed to be germinoma. Bradycardia and hypotension experienced during the first surgery was suspected to be caused by preoperative hypovolemia brought by polyuria. Desmopressin was proved to be effective to treat excessive urine output and to maintain good perioperative water balance.

  9. The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital

    Directory of Open Access Journals (Sweden)

    Luciana Takata Pontes

    2015-11-01

    Full Text Available OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

  10. The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital.

    Science.gov (United States)

    Takata Pontes, Luciana; Fantelli Stelini, Rafael; Cintra, Maria Leticia; Magalhães, Renata Ferreira; Velho, Paulo Eduardo N F; Moraes, Aparecida Machado

    2015-11-01

    Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating "skip areas" and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

  11. A single FTO gene variant rs9939609 is associated with body weight evolution in a multiethnic extremely obese population that underwent bariatric surgery.

    Science.gov (United States)

    Rodrigues, Gisele K; Resende, Cristina M M; Durso, Danielle F; Rodrigues, Lorena A A; Silva, José Luiz P; Reis, Rodrigo C; Pereira, Solange S; Ferreira, Daniela C; Franco, Gloria R; Alvarez-Leite, Jacqueline

    2015-01-01

    The rs9939609 single nucleotide polymorphism (SNP) in the fat mass and obesity-associated (FTO) gene is involved in obesity. Few studies have been conducted on patients who underwent bariatric surgery. The aim of this study was to evaluate the influence of FTO SNPs on body weight, body composition, and weight regain during a 60-mo follow-up period after bariatric surgery. The rs9939609 was genotyped in 146 individuals using a real-time polymerase chain reaction TaqMan assay. Data for lifestyle, comorbidities, body weight, body mass index (BMI), excess weight loss (EWL), and body composition were obtained before and 6, 12, 18, 24, 36, 48, and 60 mo after surgery. Data were analyzed by comparing two groups of patients according to rs9939609 FTO gene polymorphism. Mixed-regression models were constructed to evaluate the dynamics of body weight, BMI, and EWL over time in female patients. No differences were observed between the groups during the first 24 mo after surgery. After 36, 48, and 60 mo, body weight, fat mass, and BMI were higher, whereas fat-free mass and EWL were lower in the FTO-SNP patient group. Weight regain was more frequent and occurred sooner in the FTO-SNP group. There is a different evolution of weight loss in obese carriers of the FTO gene variant rs9939609 after bariatric surgery. However, this pattern was evident at only 2 y postbariatric surgery, inducing a lower proportion of surgery success and a greater and earlier weight regain. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Facial cosmetic surgery: a primary care perspective.

    Science.gov (United States)

    Landis, B J

    1994-11-01

    Primary care providers are often the source of information regarding health matters including elective cosmetic surgery. Practitioners should know about the more common cosmetic surgical procedures to assist their clients in making informed decisions regarding these operations. This article describes facial cosmetic surgical procedures performed to modify the signs of aging, which includes rhytidectomy ("face lift"), blepharoplasty ("eyelid surgery"), chemical peels, and dermabrasion. Issues discussed include preoperative considerations, expected outcomes, length of recovery period, costs, and complications (hemorrhage, necrosis, nerve injury, psychologic sequelae). Because facial cosmetic surgery usually has a positive impact on one's self-esteem, there has been an overall increase in facial cosmetic procedures during the past decade.

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

    NARCIS (Netherlands)

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

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  15. Prediction of vascular involvement and resectability by multidetector-row CT versus MR imaging with MR angiography in patients who underwent surgery for resection of pancreatic ductal adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Kyong [Department of Radiology, School of Medicine, Ewha Womans University, 911-1 Mok-dong, YangCheon-ku, Seoul 158-710 (Korea, Republic of); Kim, Ah Young [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnab-dong, Songpa-ku, Seoul 138-736 (Korea, Republic of)], E-mail: aykim@amc.seoul.kr; Kim, Pyo Nyun; Lee, Moon-Gyu; Ha, Hyun Kwon [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnab-dong, Songpa-ku, Seoul 138-736 (Korea, Republic of)

    2010-02-15

    Purpose: To compare the diagnostic value of dual-phase multidetector-row CT (MDCT) and MR imaging with dual-phase three-dimensional MR angiography (MRA) in the prediction of vascular involvement and resectability of pancreatic ductal adenocarcinoma. Methods and materials: 116 patients with proven pancreatic adenocarcinoma underwent both MDCT and combined MR imaging prior to surgery. Of 116 patients, 56 who underwent surgery were included. Two radiologists independently attempt to assess detectability, vascular involvement and resectability of pancreatic adenocarcinoma on both images. Results were compared with surgical findings and statistical analysis was performed. Results: MDCT detected pancreatic mass in 45 of 56 patients (80.3%) and MR imaging in 44 patients (78.6%). In assessment of vascular involvement, sensitivities and specificities of MDCT were 61% and 96% on a vessel-by-vessel basis, respectively. Those of MR imaging were 57% and 98%, respectively. In determining resectability, sensitivities and specificities of MDCT were 90% and 65%, respectively. Those of MR imaging were 90% and 41%, respectively. There was no statistical difference in detecting tumor, assessing vascular involvement and determining resectability between MDCT and MR imaging (p = 0.5). Conclusion: MDCT and MR imaging with MRA demonstrated an equal ability in detection, predicting vascular involvement, and determining resectability for a pancreatic ductal adenocarcinoma.

  16. Gender reassignment surgery for male primary transsexuals

    African Journals Online (AJOL)

    Gender reassignment surgery for male primary transsexuals. DERK CRICHTON. 347. Abstract This article describes certain innovations and aspects of surgical technique together with SODle stirgical asseSSDlents of results in a series of 58 operations for gender reassignDIent undertaken by the author over the past 24 ...

  17. Molteno3 Implantation as Primary Glaucoma Surgery

    Directory of Open Access Journals (Sweden)

    Juha O. Välimäki

    2014-01-01

    Full Text Available Purpose. To determine the outcome of Molteno3 implantation as primary glaucoma surgery and to analyze the factors influencing the surgical outcome. Methods. This is a retrospective clinical study of 106 consecutive eyes (97 patients with no previous glaucoma surgery. Surgical failure was defined as an IOP > 21 mmHg or less than a 20% reduction below baseline, or IOP ≤ 5 mmHg, on two consecutive visits after 3 months follow-up, or reoperation for glaucoma or loss of light perception. Results. At the end of the follow-up (mean, 35 months; range, 12–71 months, the mean postoperative IOP (14.2 ± 4.4 mmHg was statistically significantly lower than the preoperative IOP (35.2 ± 9.7 mmHg (P<0.001. Life-table success rates were 97%, 94%, and 91% after follow-up of 12, 24, and 36 months, respectively. Success rate for an IOP ≤ 18 mmHg was 77% at the last visit. Success was not influenced by previous cataract surgery, sex, age, laser trabeculoplasty (LTP, preoperative IOP, or number of antiglaucoma medications. Forty-seven eyes had 66 postoperative complications. Conclusions. The primary Molteno3 implant provided significant IOP lowering with minimal and manageable complications in uncontrolled glaucoma. Neither previous cataract surgery nor LTP had any detrimental effect on surgical success.

  18. 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

  19. Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.

    Science.gov (United States)

    Keller, Robert A; Mehran, Nima; Marshall, Nathan E; Okoroha, Kelechi R; Khalil, Lafi; Tibone, James E; Moutzouros, Vasilios

    2017-02-01

    Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers. We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery. The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction. Copyright © 2017. Published by Elsevier Inc.

  20. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

    International Nuclear Information System (INIS)

    Shim, Su Jung; Cha, Jihye; Koom, Woong Sub; Kim, Gwi Eon; Lee, Chang Geol; Choi, Eun Chang; Keum, Ki Chang

    2010-01-01

    The aim of this study was to assess the results of curative surgery with and without radiotherapy in patients with T 1-2 N 0-1 oral tongue squamous cell carcinoma (OSCC) and to evaluate survival and prognostic factors. Retrospective analysis of 86 patients with T 1-2 N 0-1 OSCC who received surgery between January 2000 and December 2006. Fourteen patients (16.3%) received postoperative radiotherapy (PORT). Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were analyzed. The median follow-up was 45 months. The five-year overall survival (OS) and disease-free survival (DFS) rates were 80.8% and 80.2%, respectively. Higher tumor grade and invasion depth ≥ 0.5 cm were the significant prognostic factors affecting five-year OS and DFS (OS rate; 65% vs. 91%, p = 0.001 for grade; 66% vs. 92%, p = 0.01 for invasion depth: DFS rate; 69% vs. 88%, p = 0.005 for grade; 66% vs. 92%, p = 0.013 for invasion depth). In the risk group, there was no local failure in patients with postoperative radiotherapy. In T 1-2 N 0-1 OSCC, factors that affected prognosis after primary surgery were higher tumor grade and deep invasion depth over 0.5 cm. Postoperative radiotherapy should be considered in early oral tongue cancer patients with these high-risk pathologic features

  1. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

    Directory of Open Access Journals (Sweden)

    Choi Eun

    2010-05-01

    Full Text Available Abstract Background The aim of this study was to assess the results of curative surgery with and without radiotherapy in patients with T1-2N0-1 oral tongue squamous cell carcinoma (OSCC and to evaluate survival and prognostic factors. Methods Retrospective analysis of 86 patients with T1-2N0-1 OSCC who received surgery between January 2000 and December 2006. Fourteen patients (16.3% received postoperative radiotherapy (PORT. Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were analyzed. Results The median follow-up was 45 months. The five-year overall survival (OS and disease-free survival (DFS rates were 80.8% and 80.2%, respectively. Higher tumor grade and invasion depth ≥ 0.5 cm were the significant prognostic factors affecting five-year OS and DFS (OS rate; 65% vs. 91%, p = 0.001 for grade; 66% vs. 92%, p = 0.01 for invasion depth: DFS rate; 69% vs. 88%, p = 0.005 for grade; 66% vs. 92%, p = 0.013 for invasion depth. In the risk group, there was no local failure in patients with postoperative radiotherapy. Conclusions In T1-2N0-1 OSCC, factors that affected prognosis after primary surgery were higher tumor grade and deep invasion depth over 0.5 cm. Postoperative radiotherapy should be considered in early oral tongue cancer patients with these high-risk pathologic features.

  2. [Assessment of the correlation between histological degeneration and radiological and clinical parameters in a series of patients who underwent lumbar disc herniation surgery].

    Science.gov (United States)

    Munarriz, Pablo M; Paredes, Igor; Alén, José F; Castaño-Leon, Ana M; Cepeda, Santiago; Hernandez-Lain, Aurelio; Lagares, Alfonso

    The use of histological degeneration scores in surgically-treated herniated lumbar discs is not common in clinical practice and its use has been primarily restricted to research. The objective of this study is to evaluate if there is an association between a higher grade of histological degeneration when compared with clinical or radiological parameters. Retrospective consecutive analysis of 122 patients who underwent single-segment lumbar disc herniation surgery. Clinical information was available on all patients, while the histological study and preoperative magnetic resonance imaging were also retrieved for 75 patients. Clinical variables included age, duration of symptoms, neurological deficits, or affected deep tendon reflex. The preoperative magnetic resonance imaging was evaluated using Modic and Pfirrmann scores for the affected segment by 2 independent observers. Histological degeneration was evaluated using Weiler's score; the presence of inflammatory infiltrates and neovascularization, not included in the score, were also studied. Correlation and chi-square tests were used to assess the association between histological variables and clinical or radiological variables. Interobserver agreement was also evaluated for the MRI variables using weighted kappa. No statistically significant correlation was found between histological variables (histological degeneration score, inflammatory infiltrates or neovascularization) and clinical or radiological variables. Interobserver agreement for radiological scores resulted in a kappa of 0.79 for the Pfirrmann scale and 0.65 for the Modic scale, both statistically significant. In our series of patients, we could not demonstrate any correlation between the degree of histological degeneration or the presence of inflammatory infiltrates when compared with radiological degeneration scales or clinical variables such as the patient's age or duration of symptoms. Copyright © 2017 Sociedad Española de Neurocirug

  3. The Role of Liver-directed Surgery in Patients with Hepatic Metastasis from a Gynecologic Primary Carcinoma

    Science.gov (United States)

    Kamel, Sarah I.; de Jong, Mechteld C.; Schulick, Richard D.; Diaz-Montes, Teresa P.; Wolfgang, Christopher L.; Hirose, Kenzo; Edil, Barish H.; Choti, Michael A.; Anders, Robert A.

    2013-01-01

    Background The management of patients with liver metastasis from a gynecologic carcinoma remains controversial, as there is currently little data available. We sought to determine the safety and efficacy of liver-directed surgery for hepatic metastasis from gynecologic primaries. Methods Between 1990 and 2010, 87 patients with biopsy-proven liver metastasis from a gynecologic carcinoma were identified from an institutional hepatobiliary database. Fifty-two (60%) patients who underwent hepatic surgery for their liver disease and 35 (40%) patients who underwent biopsy only were matched for age, primary tumor characteristics, and hepatic tumor burden. Clinicopathologic, operative, and outcome data were collected and analyzed. Results Of the 87 patients, 30 (34%) presented with synchronous metastasis. The majority of patients had multiple hepatic tumors (63%), with a median size of the largest lesion being 2.5 cm. Of those patients who underwent liver surgery (n = 52), most underwent a minor hepatic resection (n = 44; 85%), while 29 (56%) patients underwent concurrent lymphadenectomy and 45 (87%) patients underwent simultaneous peritoneal debulking. Postoperative morbidity and mortality were 37% and 0%, respectively. Median survival from time of diagnosis was 53 months for patients who underwent liver-directed surgery compared with 21 months for patients who underwent biopsy alone (n = 35) (p = 0.01). Among those patients who underwent liver-directed surgery, 5-year survival following hepatic resection was 41%. Conclusions Hepatic surgery for liver metastasis from gynecologic cancer can be performed safely. Liver surgery may be associated with prolonged survival in a subset of patients with hepatic metastasis from gynecologic primaries and therefore should be considered in carefully selected patients. PMID:21452068

  4. Outcome of Triple Antiplatelet Therapy Including Cilostazol in Elderly Patients with ST-Elevation Myocardial Infarction who Underwent Primary Percutaneous Coronary Intervention: Results from the INTERSTELLAR Registry.

    Science.gov (United States)

    Jang, Ho-Jun; Park, Sang-Don; Park, Hyun Woo; Suh, Jon; Oh, Pyung Chun; Moon, Jeonggeun; Lee, Kyounghoon; Kang, Woong Chol; Kwon, Sung Woo; Kim, Tae-Hoon

    2017-06-01

    Compared with dual antiplatelet therapy including aspirin and clopidogrel, triple antiplatelet therapy including cilostazol has a mortality benefit in patients with ST-segment elevation myocardial infarction. However, whether the mortality benefit persists in elderly patients is not clear. From 2007 to 2014, 1278 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were retrospectively analyzed. The patients were divided into four groups by age (elderly, respectively) and antiplatelet strategy (triple or dual antiplatelet therapy). We compared the mortality rates between the triple and dual antiplatelet therapy groups. There were 1052 (male, 85%; mean age, 56.3 ± 10.4 years) patients in the young group and 241 (male, 52.7%; mean age, 80.3 ± 4.5 years) patients in the elderly group. In the young and elderly groups, 220 (20.9%) and 28 (12.3%) patients were treated with triple antiplatelet therapy. During a 1-year follow-up period, 80 patients died (4.2% in the young group vs. 15.5% in the elderly group). Kaplan-Meier survival analysis revealed that triple antiplatelet therapy was associated with a lower mortality rate in the young group (log-rank, p = 0.005). Although there were more angiographic high-risk patients in the elderly group, similar mortality rates were reported (log-rank, p = 0.803) without increased bleeding rates (1 vs. 3.6% in the elderly group, p = 0.217). Triple antiplatelet therapy might be a better antiplatelet regimen than dual antiplatelet therapy for patients with ST-segment elevation myocardial infarction. Although this benefit was strong in patients aged elderly patients (aged ≥75 years).

  5. Radioguided surgery in primary hyperparathyroidism: Results and correlation with intraoperative histopathologic diagnosis.

    Science.gov (United States)

    Suárez, Juan P; Domínguez, María L; de Santos, Francisco J; González, José M; Fernández, Nuria; Enciso, Fidel J

    2017-08-11

    Radioguided surgery is a minimally invasive surgical technique for the treatment of primary hyperparathyroidism. The goals of our study were to evaluate the rate of success and compare the results with intraoperative histological analysis. We retrospectively studied 84 patients with primary parathyroidism who had undergone radioguided surgery. All the patients had a positive parathyroid scintigraphy prior to surgery. An intravenous injection of Tc-99m sestamibi was administered before surgery, and radioguided location of the pathologic parathyroid tissue was performed using an intraoperative gamma probe, applying the "20% rule". All resected specimens underwent intraoperative histologic analysis. All patients were followed up for at least 6 months. Positive predictive values of both parathyroid scintigraphy and cervical ultrasonography were also compared. Radioguided surgery success rate was 99%. Sensitivity, specificity, positive and negative predictive values for gamma probe were 99, 73, 97 and 89%, respectively. After surgery, 83 of 84 patients were eucalcaemic (99%) and parathyroid hormone normalised in 77 of 84 patients (92%). Ultrasonography showed low positive predictive value (41%) when compared with scintigraphy. Radioguided surgery is a minimally invasive surgical technique with excellent results for the treatment of primary hyperparathyroidism and could replace both intraoperative histological analysis and intraoperative parathyroid hormone assay. Further studies are needed to confirm these findings. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  6. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery ?

    OpenAIRE

    Nunes, Viviane Regina Hernandez; Jacob, Charbel; Cardoso, Igor Machado; Batista, Jos? Lucas; Brazolino, Marcus Alexandre Novo; Maia, Thiago Cardoso

    2016-01-01

    ABSTRACT OBJECTIVE: To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. METHODS: This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. RESULTS: Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, an...

  7. Investigating the Impacts of Preoperative Steroid Treatment on Tumor Necrosis Factor-Alpha and Duration of Extubation Time underwent Ventricular Septal Defect Surgery

    Directory of Open Access Journals (Sweden)

    H. Hakan Poyrazoğlu

    2016-04-01

    Full Text Available Background: Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-α (TNF-α playing an active role in this process. Aims: This research was to investigate the effects of preoperative steroid use on inflammatory mediator TNF-α and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery. Study Design: Controlled clinical study. Methods: This study included 30 patients. These patients were assigned into two groups, each containing 15 patients. 5 micrograms/kg methylprednisolone was injected intravenously 2 hours before the surgery to Group I, whereas there was no application to the patients in Group II. TNF-α (pg/mL level was measured in arterial blood samples obtained at four periods including: the preoperative period (Pre TNF; at the 5th minute of cross-clamping (Per TNF; 2 hours after termination of cardiopulmonary bypass (Post TNF; and at the postoperative 24th hours in cardiovascular surgery intensive care unit (Post 24 h TNF. Results: The mean cross-clamp time was 66±40 and 55±27 minutes in Group I and Group II respectively. No significant difference was found between the groups in terms of cross-clamp time (p>0.05. The mean time to extubation was 6.1±2.3 hours in Group I and 10.6±3.4 hours in Group II. Group I extubation time was significantly shorter than Group II. Group I TNF-α levels at Post TNF and Post24h TNF was lower than Group II. These differences are also statistically significant (p<0.05. Conclusion: There is a strong indication that preoperative steroid treatment reduced the TNF-α level together with shortens duration of postoperative intubation and positively contributes to extubation in ventricular septal defect

  8. Risk factors for treatment failure in surgery for primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Madsen, Anders Rørbæk; Rasmussen, Lars; Godballe, Christian

    2016-01-01

    Surgery for primary hyperparathyroidism (pHPT) has a high cure-rate and few complications. Preoperative localization procedures have permitted a dramatic shift from routine bilateral exploration to focused, minimally invasive procedures. At Odense University Hospital, Denmark, the introduction...

  9. Bariatric Surgery: A Brief Primer for Primary Care Physicians

    OpenAIRE

    Frichtel, Christina M

    2004-01-01

    Bariatric surgery is on the rise as treatment for the increasing number of obese patients in the US population. As this procedure becomes more common, primary care physicians are assuming increased responsibility not only for preoperative selection and education of bariatric surgery candidates but also for their postoperative care and monitoring—two factors necessary for a successful surgical outcome. This article highlights some issues relevant for primary care physicians and reports an illu...

  10. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery.

    Science.gov (United States)

    Nunes, Viviane Regina Hernandez; Jacob, Charbel; Cardoso, Igor Machado; Batista, José Lucas; Brazolino, Marcus Alexandre Novo; Maia, Thiago Cardoso

    2016-01-01

    To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, and mean PI of 45. In patients with degenerative spondylolisthesis at the L4-L5 level, a mean tilt of 22.1, mean slope of 38.3, and mean PI of 61.4 were observed. This article reinforces the finding that the high mean tilt and PI are related to the onset of degenerative spondylolisthesis, and also concluded that the same angles, when low, increase the risk for disk herniation.

  11. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery

    Directory of Open Access Journals (Sweden)

    Viviane Regina Hernandez Nunes

    Full Text Available ABSTRACT OBJECTIVE: To correlate spinopelvic balance with the development of degenerative spondylolisthesis and disk herniation. METHODS: This was a descriptive retrospective study that evaluated 60 patients in this hospital, 30 patients with degenerative spondylolisthesis at the L4-L5 level and 30 with herniated disk at the L4-L5 level, all of whom underwent Surgical treatment. RESULTS: Patients with lumbar disk herniation at L4-L5 level had a mean tilt of 8.06, mean slope of 36.93, and mean PI of 45. In patients with degenerative spondylolisthesis at the L4-L5 level, a mean tilt of 22.1, mean slope of 38.3, and mean PI of 61.4 were observed. CONCLUSION: This article reinforces the finding that the high mean tilt and PI are related to the onset of degenerative spondylolisthesis, and also concluded that the same angles, when low, increase the risk for disk herniation.

  12. Primary care physician decision making regarding referral for bariatric surgery

    DEFF Research Database (Denmark)

    Stolberg, Charlotte Røn; Hepp, Nicola; Juhl, Anna Julie Aavild

    2017-01-01

    Background: Bariatric surgery is the most effective treatment for severe obesity. It results in significant and sustained weight loss and reduces obesity-related co-morbidities. Despite an increasing prevalence of severe obesity, the number of bariatric operations performed in Denmark has decreased...... during the past years. This is only partly explained by changes in the national guidelines for bariatric surgery. The purpose of the cross-sectional study is to investigate referral patterns and possible reservations regarding bariatric surgery among Danish primary care physicians (PCPs). Setting......: Primary care physicians in Denmark. Methods: A total of 300 Danish PCPs were invited to participate in a questionnaire survey regarding experiences with bariatric surgery, reservations about bariatric surgery, attitudes to specific patient cases, and the future treatment of severe obesity. Most questions...

  13. Comportamiento de los pacientesancianosoperados de cirugíacardíaca con circulaciónextracorpórea/ Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2015-10-01

    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.

  14. Laparoscopy to Predict the Result of Primary Cytoreductive Surgery in Patients With Advanced Ovarian Cancer: A Randomized Controlled Trial.

    Science.gov (United States)

    Rutten, Marianne J; van Meurs, Hannah S; van de Vrie, Roelien; Gaarenstroom, Katja N; Naaktgeboren, Christiana A; van Gorp, Toon; Ter Brugge, Henk G; Hofhuis, Ward; Schreuder, Henk W R; Arts, Henriette J G; Zusterzeel, Petra L M; Pijnenborg, Johanna M A; van Haaften, Maarten; Fons, Guus; Engelen, Mirjam J A; Boss, Erik A; Vos, M Caroline; Gerestein, Kees G; Schutter, Eltjo M J; Opmeer, Brent C; Spijkerboer, Anje M; Bossuyt, Patrick M M; Mol, Ben Willem; Kenter, Gemma G; Buist, Marrije R

    2017-02-20

    Purpose To investigate whether initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery (PCS) by identifying patients with advanced-stage ovarian cancer in whom > 1 cm of residual disease will be left after PCS. Patients and Methods This multicenter, randomized controlled trial was undertaken within eight gynecologic cancer centers in the Netherlands. Patients with suspected advanced-stage ovarian cancer who qualified for PCS were eligible. Participating patients were randomly assigned to either laparoscopy or PCS. Laparoscopy was used to guide selection of primary treatment: either primary surgery or neoadjuvant chemotherapy followed by interval surgery. The primary outcome was futile laparotomy, defined as a PCS with residual disease of > 1 cm. Primary analyses were performed according to the intention-to-treat principle. Results Between May 2011 and February 2015, 201 participants were included, of whom 102 were assigned to diagnostic laparoscopy and 99 to primary surgery. In the laparoscopy group, 63 (62%) of 102 patients underwent PCS versus 93 (94%) of 99 patients in the primary surgery group. Futile laparotomy occurred in 10 (10%) of 102 patients in the laparoscopy group versus 39 (39%) of 99 patients in the primary surgery group (relative risk, 0.25; 95% CI, 0.13 to 0.47; P laparoscopy group, three (3%) of 102 patients underwent both primary and interval surgery compared with 28 (28%) of 99 patients in the primary surgery group ( P laparoscopy reduced the number of futile laparotomies in patients with suspected advanced-stage ovarian cancer. In women with a plan for PCS, these data suggest that performance of diagnostic laparoscopy first is reasonable and that if cytoreduction to < 1 cm of residual disease seems feasible, to proceed with PCS.

  15. Oncological and functional outcomes of salvage renal surgery following failed primary intervention for renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Fernando G. Abarzua-Cabezas

    2015-02-01

    Full Text Available Purpose To assess the oncologic and functional outcomes of salvage renal surgery following failed primary intervention for RCC. Materials and Methods We performed a retrospective review of patients who underwent surgery for suspected RCC during 2004-2012. We identified 839 patients, 13 of whom required salvage renal surgery. Demographic data was collected for all patients. Intraoperative and postoperative data included ischemic duration, blood loss and perioperative complications. Preoperative and postoperative assessments included abdominal CT or magnetic resonance imaging, chest CT and routine laboratory work. Estimated glomerular filtration rate (eGFR was calculated according to the Modification of Diet in Renal Disease equation. Results The majority (85% of the patients were male, with an average age of 64 years. Ten patients underwent salvage partial nephrectomy while 3 underwent salvage radical nephrectomy. Cryotherapy was the predominant primary failed treatment modality, with 31% of patients undergoing primary open surgery. Pre-operatively, three patients were projected to require permanent post-operative dialysis. In the remaining 10 patients, mean pre- and postoperative serum creatinine and eGFR levels were 1.35 mg/dL and 53.8 mL/min/1.73 m2 compared to 1.43 mg/dL and 46.6 mL/min/1.73 m2, respectively. Mean warm ischemia time in 10 patients was 17.4 min and for all patients, the mean blood loss was 647 mL. The predominant pathological stage was pT1a (8/13; 62%. Negative surgical margins were achieved in all cases. The mean follow-up was 32.9 months (3.5-88 months. Conclusion While salvage renal surgery can be challenging, it is feasible and has adequate surgical, functional and oncological outcomes.

  16. Intrathymic ectopic parathyroid adenoma caused primary hyperparathyroidism with vitamin D deficiency several years after bariatric surgery.

    Science.gov (United States)

    Sellitri, Francesco; Tamburrini, Alessandro; Tacconi, Federico; Bollero, Patrizio; Ortensi, Andrea; Mineo, Tommaso Claudio

    2015-01-01

    Up to 25% of patients with primary hyperparathyroidism have ectopic parathyroid adenoma. A 45-year-old formerly obese woman underwent extended thymectomy for a parathyroid adenoma located in hyperplastic thymic tissue, associated with primary hyperparathyroidism and severe vitamin D deficiency, but normal bone mineral density. At nine months follow-up, all laboratory test results were within normal limits and she presented no symptoms and no recurrence of disease. In this case, autonomous growth of a parathyroid adenoma was reasonably secondary to chronic calcium and vitamin D malabsorption, which often occurs after bariatric surgery for pathologic obesity.

  17. Prevalência de transtornos depressivos e de ansiedade em pacientes obesos submetidos à cirurgia bariátrica Prevalence of depression and anxiety disorders in obese patients who underwent bariatric surgery

    Directory of Open Access Journals (Sweden)

    Mateus Astolfi

    2011-09-01

    Full Text Available A obesidade mórbida está relacionada a muitos transtornos psiquiátricos e possui como opção terapêutica a cirurgia bariátrica. Objetivo: caracterizar a prevalência de transtornos depressivos e de ansiedade em pacientes submetidos à cirurgia bariátrica no Hospital Universitário Regional de Maringá e do Centro de Cirurgia de Obesidade de Maringá. Métodos: o estudo foi realizado com 50 pacientes obesos mórbidos submetidos à Cirurgia Bariátrica em diferentes períodos: pré-operatório, um mês de pós-operatório, três meses de pós-operatório e seis meses de pós-operatório. A avaliação do Transtorno Depressivo foi realizada pela aplicação do Inventário de Depressão de Beck, sendo outro instrumento utilizado neste trabalho a Escala Hospitalar de Ansiedade e Depressão (HAD. Resultados: a prevalência de quadros sugestivos de ansiedade foi: 40% (20 pacientes no pré-operatório, 18% no primeiro mês pós-operatório, 8% no terceiro mês pós-operatório e 14% no sexto mês pós-operatório. Quadros sugestivos de depressão foram encontrados em: 26% (13 pacientes no pré-operatório, 10% no primeiro mês pós-operatório e no terceiro mês pós-operatório e 8% no sexto mês pós-operatório. Conclusão: Os níveis de Ansiedade foram altos no pré-operatório, diminuíram no 1º e 3º mês pós-operatório e voltaram a subir no sexto mês, atingindo níveis mais altos que no terceiro mês.Morbid obesity is associated to several psychiatric disorders and bariatric surgery is a therapeutic option. Current research characterizes the prevalence of depression and anxiety disorders in patients who underwent bariatric surgery at the Regional Hospital of Maringá and at the Obesity Surgery Center of Maringá, Maringá PR Brazil. Study was undertaken with 50 morbid obese patients who underwent bariatric surgery and comprised different periods, namely, pre-surgery, one month after surgery, three months after surgery and six months

  18. Low-Level Laser and Light-Emitting Diode Therapy for Pain Control in Hyperglycemic and Normoglycemic Patients Who Underwent Coronary Bypass Surgery with Internal Mammary Artery Grafts: A Randomized, Double-Blind Study with Follow-Up.

    Science.gov (United States)

    Lima, Andréa Conceição Gomes; Fernandes, Gilderlene Alves; Gonzaga, Isabel Clarisse; de Barros Araújo, Raimundo; de Oliveira, Rauirys Alencar; Nicolau, Renata Amadei

    2016-06-01

    This study aimed to evaluate the efficacy of low-level laser therapy (LLLT) and light-emitting diodes (LEDs) for reducing pain in hyperglycemic and normoglycemic patients who underwent coronary artery bypass surgery with internal mammary artery grafts. This study was conducted on 120 volunteers who underwent elective coronary artery bypass graft (CABG) surgery. The volunteers were randomly allocated to four different groups of equal size (n = 30): control, placebo, LLLT [λ = 640 nm and spatial average energy fluence (SAEF) = 1.06 J/cm(2)], and LED (λ = 660 ± 20 nm and SAEF = 0.24 J/cm(2)). Participants were also divided into hyperglycemic and normoglycemic subgroups, according to their fasting blood glucose test result before surgery. The outcome assessed was pain during coughing by a visual analog scale (VAS) and the McGill Pain Questionnaire. The patients were followed for 1 month after the surgery. The LLLT and LED groups showed a greater decrease in pain, with similar results, as indicated by both the VAS and the McGill questionnaire (p ≤ 0.05), on the 6th and 8th postoperative day compared with the placebo and control groups. The outcomes were also similar between hyperglycemic and normoglycemic patients. One month after the surgery, almost no individual reported pain during coughing. LLLT and LED had similar analgesic effects in hyperglycemic and normoglycemic patients, better than placebo and control groups.

  19. Patient-reported outcomes after revision surgery compared to primary total hip arthroplasty.

    Science.gov (United States)

    Postler, Anne E; Beyer, Franziska; Wegner, Tim; Lützner, Jörg; Hartmann, Albrecht; Ojodu, Ishaq; Günther, Klaus-Peter

    2017-03-31

    Patients who undergo either primary or revision total hip arthroplasty (THA) mainly expect improvement in pain, function/activity and quality of life. The purpose of the study was to measure the degree of short-term and medium-term improvement and the differences in patient-reported outcome that can be expected in patients undergoing revision THA, compared to patients undergoing primary THA. In this study, the results of patient-reported outcome measurements were compared in 124 matched patients, who underwent revision surgery and primary THA between 01/2007 and 12/2009. Assessment was performed at short-term and medium-term follow-up and included the WOMAC score, the UCLA activity score and EuroQol scores. 6 months after revision THA, the mean total WOMAC score improved by 22.1 points, the UCLA activity score by 0.6 points and the EuroQol-Index by 0.2 points. After primary THA, the improvement was 41.4 points on the WOMAC, 1.1 points on the UCLA and 0.3 points on the EuroQol-Index. At medium-term follow-up, 3.6 years after revision surgery and 2.3 years after primary THA, patients undergoing revision THA showed significantly less overall improvement, as well as lower final outcome scores, than patients undergoing primary THA. Patients undergoing revision arthroplasty, as well as patients undergoing primary THA, can expect major improvement in function, activity and quality of life postoperatively. However, overall level of improvement, as well as peak attainable outcome levels, are lower after revision surgery than after primary THA. Appropriate information for patients who undergo hip revision surgery is necessary in order to avoid unrealistic expectations and postoperative dissatisfaction.

  20. Arthroscopic revision release of gluteal muscle contracture after failed primary open surgery.

    Science.gov (United States)

    Zhang, Xintao; Jiang, Xiaocheng; He, Feilin; Liang, Zuru; You, Tian; Jin, Dadi; Zhang, Wentao

    2017-08-01

    The treatment of gluteal muscle contracture (GMC) after failed primary open release surgery has rarely been reported in the literature. GMC is a troublesome health problem in some developing countries, and it can result in the limitation of patients' hip function, leading to the development of inferiority complexes. The aim of this study is to evaluate the effect of arthroscopic revision surgery after failed primary open release on patients with GMC. A total of 278 hips of 140 patients who underwent arthroscopic revision procedures after failed primary open surgeries were gathered from the department files. All patients were treated using a "three-step" arthroscopic release procedure by the same surgeon group. The mean follow-up for the 136 patients was 38.9 months. There was significant difference (P revision and pre-operative results on the Harris scoring system. Unreleased contracture tissues that needed revision operations included the gluteus maximus, tensor fasciae latae muscle, and gluteus medius in all patients, and the gluteus minimus and hip capsule in 11.0% and 8.1% of patients, respectively. Short-term complications included subcutaneous bruising of the abdomen in 11 patients, extensive ecchymosis in the lateral thigh in 12 patients, and a transient reduction of muscle strength in all patients. No complications involving postoperative incision infection, nerve and blood vessel damage, or positive Trendelenburg sign occurred. Symptoms of hip snapping and limitation of range of motion (ROM), combined with a positive Trendelenburg sign in two patients after the primary open surgery, were all resolved except for the Trendelenburg sign through arthroscopic revision release. The overall satisfaction rate of the revision operations was 90.4%. The three-step arthroscopic release procedure is effective for failed primary open GMC surgeries as shown by improved post-operative function and patient satisfaction regardless of which primary procedure was performed.

  1. The mortality after surgery in primary lung cancer

    DEFF Research Database (Denmark)

    Green, Anders; Hauge, Jacob; Iachina, Maria

    2015-01-01

    OBJECTIVES: The study has been performed to investigate the mortality within the first year after resection in patients with primary lung cancer, together with associated prognostic factors including gender, age, tumour stage, comorbidity, alcohol abuse, type of surgery and post-surgical complica...

  2. Improving access to oral surgery services in primary care.

    Science.gov (United States)

    Kendall, Nick

    2009-10-01

    This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.

  3. Rapid intraoperative determination of intact parathyroid hormone during surgery for primary hyperparathyroidism. Experience at our center.

    Science.gov (United States)

    García-Santos, Esther Pilar; Martín-Fernández, Jesús; Gil-Rendo, Aurora; Menchén-Trujillo, Bruno; Martínez de Paz, Fernando; Manzanares-Campillo, M Carmen; Muñoz-Atienza, Virginia; Sánchez-García, Susana

    2014-01-01

    Primary hyperparathyroidism (PHPT) is due to a single adenoma in 85%-95% of cases, and is often cured after adenoma removal. Intraoperative rapid determination of intact parathyroid hormone (PTHio) may be a tool for monitoring the effectiveness of PHPT surgery. The main objective of our study was to evaluate PTHio determination and to establish whether its successful implementation contributed to achieve minimally invasive surgery (MIS) and major ambulatory surgery (MAS) in the treatment of PHPT. Retrospective study of a consecutive series of patients diagnosed and operated on for PHPT at the University General Hospital of Ciudad Real between January 2005 and January 2012. In the study period, 91 patients underwent surgery. 39 (42.9%) under general anesthesia, while 52 (57.1%) were candidates for regional anesthesia by cervical block. Seventy-six of all patients (83.5%) were amenable to MIS using a unilateral approach. Classical cervicotomy was performed in all other patients. PTHio determination was done in 75 patients, showing cure in the same surgery in 68 of them. MAS was performed in 70.3% (64) of patients. Determination of PTHio may allow for changing the surgical approach to PHPT at our department, allowing for performance of MIS on an outpatient basis in a significant proportion of patients with some cosmetic improvement, probably less pain, shorter hospital stay, and less potential complications than bilateral cervical exploration. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  4. Diaphragmatic surgery during primary cytoreduction for advanced ovarian cancer: peritoneal stripping versus diaphragmatic resection.

    Science.gov (United States)

    Zapardiel, Ignacio; Peiretti, Michele; Zanagnolo, Vanna; Biffi, Roberto; Bocciolone, Luca; Landoni, Fabio; Aletti, Giovanni; Colombo, Nicoletta; Maggioni, Angelo

    2011-12-01

    Standard approach for medically stable advanced ovarian cancer patients should be primary cytoreduction following platinum-based chemotherapy. The aim of surgical effort should be the complete removal of all visible disease. Our objective was to compare perioperative features, postoperative complications, and secondarily oncological outcomes of patients who underwent diaphragmatic stripping with those who underwent diaphragmatic resection for advanced ovarian cancer. One hundred twelve cases were identified, among them 79 underwent diaphragmatic stripping and 33 underwent diaphragmatic full-thickness resection. Data collected included patients' age, all perioperative details and pathological findings, International Federation of Gynecology and Obstetrics stage, adjuvant therapy, and follow-up data. Larger residual tumors (mean, 5.1 vs 1.6 mm, respectively; P < 0.01) but shorter operating time (25 minutes shorter operative time, P = 0.07) were observed in the stripping group. Higher postoperative pleural effusions rates (63.6% vs 37.9%, P = 0.01), but no differences in the remaining complications, were observed in the resection group. After a mean of 31 months of follow-up, disease-free survival rates were 27.8% in the stripping group and 39.4% in the resection group (P = 0.04). No significant differences were observed for overall survival. Diaphragmatic surgery at the time of primary cytoreductive surgery for advanced ovarian cancer may contribute to the achievement of complete cytoreduction with low perioperative complication rate; full-thickness resection is preferable if peritoneum stripping will not achieve a complete removal of the disease.

  5. Pleural abrasion for mechanical pleurodesis in surgery for primary spontaneous pneumothorax: is it effective?

    Science.gov (United States)

    Park, Joon Suk; Han, Woo Sik; Kim, Hong Kwan; Choi, Yong Soo

    2012-02-01

    Some patients with primary spontaneous pneumothorax suffer from recurrence of bullous lesions of the lung after resection. Mechanical pleurodesis by pleural abrasion is one of the standard procedures to prevent recurrence. However, there is actually little evidence that pleural abrasion reduces the recurrence of primary spontaneous pneumothorax. Our aim was to evaluate the efficacy of mechanical pleurodesis by pleural abrasion during thoracoscopic procedures for primary pneumothorax. From January 2003 to December 2009, 263 patients underwent 294 initial thoracoscopic wedge resections with or without pleural abrasion for primary spontaneous pneumothorax at the Samsung Medical Center. Medical records of patients were reviewed retrospectively. Thirty-one patients were excluded from the study due to various comorbidities. The remaining 232 patients underwent 257 thoracoscopic wedge resections with (165) or without (92) pleural abrasion. No mortality was observed. Seven additional chemical pleurodesis and 3 reoperations were performed due to persistent air leakage after initial surgery. There were 18 instances of recurrence, and the overall recurrence rate was 7.1%. Twelve additional wedge resections were performed because of recurrence after initial surgery. The mean duration of postoperative pleural drainage was 2.86 days. There were no significant differences in the recurrence rate (P=0.9499), and duration of chest tube drainage (P=0.5200) between the patients with and without pleural abrasion. Younger patients, especially below 17 years of age, had significant risk of recurrence (Ppleural abrasion did not decrease the recurrence of pneumothorax after wedge resection of bullae for primary spontaneous pneumothorax. Younger age was associated with higher risk of recurrence.

  6. Diagnostic Accuracy of Detecting Hashimoto's Thyroiditis in Thyroid Cancer Patients Who Underwent Thyroid Surgery: Comparison of Ultrasonography, Positron Emission Tomography/CT, Contrast Enhanced CT, and Anti-Thyroid Antibody

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Gyun; Lee, Tae Hyun; Park, Dong Hee; Nam, Sang Been [Dept. of Radiology, Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    2012-11-15

    To compare the diagnostic accuracy of ultrasonography (US), F18-fluorodeoxyglucose positron emission tomography/CT (PET/CT), contrast enhanced CT (CECT), serum anti-thyroid antibody for detecting Hashimoto's thyroiditis in thyroid cancer patients who underwent neck surgery. A total of 150 patients with suspicious for thyroid cancer, who had previously undergone US guided needle aspiration of thyroid, were evaluated with the use of US, PET/CT, CECT and serum anti-thyroid antibody. The four studies were performed within two months before neck surgery. Hashimoto's thyroiditis was confirmed by histopathological results. The diagnostic accuracy of US, PET/CT, CECT and serum anti-thyroid antibody were calculated statistically. Hashimoto's thyroiditis was diagnosed in 51 out of the 150 patients, following neck surgery. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US were 76.5%, 92.9%, 84.8%, 88.5%, and 87.3%, respectively. The corresponding values of PET/CT were 37.3%, 96.0%, 82.6%, 74.8%, and 76.0%, and CECT were 62.7%, 89.9%, 76.2%, 82.4%, and 80.7%, and serum anti-thyroid antibody level were 90.2%, 93.9%, 88.5%, 94.9%, and 92.7%, respectively. McNemar test revealed significant difference among PET/CT and others, but no significant differences among US, CECT and serum anti-thyroid antibody. Overall, serum anti-thyroid antibody showed most accurate diagnostic performance. In detecting Hashimoto's thyroiditis, serum anti-thyroid antibody showed higher diagnostic accuracy than others. US also showed relatively high diagnostic accuracy.

  7. Management of refractory bleeding post-cardiopulmonary bypass in an acute heparin-induced thrombocytopenia type II renal failure patient who underwent urgent cardiac surgery with bivalirudin (Angiox®) anticoagulation.

    Science.gov (United States)

    Hassen, Kimberly; Maccaroni, Maria R; Sabry, Haytham; Mukherjee, Smitangshu; Serumadar, Shankari; Birdi, Inderpaul

    2018-04-01

    Acute heparin-induced thrombocytopenia (HIT) patients present a myriad of anticoagulation management challenges, in clinical settings where unfractionated heparin (UFH) is the traditional drug of choice. UFH use in cardiac surgery is a known entity that has been subject to rigorous research. Research has, thus, led to its unparalleled use and the development of well-established protocols for cardiac surgery. In comparison to UFH, bivalirudin use for acute HIT patients requiring urgent cardiac surgery with cardiopulmonary bypass (CPB) is still in its infancy. We describe the tailored post-CPB management of refractory bleeding in a 65-year-old infective endocarditis, acute HIT patient with renal failure who underwent urgent aortic valve replacement and mitral valve repair with bivalirudin anticoagulation. A management approach that entailed a combination of continuous venovenous haemofiltration (CVVH), 4-Factor prothrombin complex concentrate (PCC) (Beriplex), recombinant factor VIIa (rFactor VIIa) and desmopressin (DDAVP) were consecutively used post-operatively in theatre. Based on this case study experience, two modifications to institutional protocols are recommended. The first is the use of CVVH in theatre to eliminate bivalirudin in renal failure patients or in patients where bivalirudin elimination is prolonged. Secondly, a 'rescue therapy/intervention' algorithm for the swift identification of refractory bleeding post-CPB is also recommended. Rescue therapy agents, such as a 4-Factor PCCs and rFactor VIIa, should be incorporated into the protocol after a robust evidence-based search and agreement with the haematologist. The aim of these recommendations is to reduce the risk of bleeding associated with bivalirudin use for inexperienced institutions and experienced institutions alike, until larger randomized, controlled studies provide more in-depth knowledge to expand our clinical practice.

  8. Perfil epidemiológico de pacientes submetidos a tratamento cirúrgico de varizes de membros inferiores Epidemiologic profile of the patients underwent varicose vein surgery of the lower limbs

    Directory of Open Access Journals (Sweden)

    Esdras Marques Lins

    2012-12-01

    underwent to this surgery in the city of Recife. OBJECTIVE: The aim of this report was evaluate the epidemiologic profile of the patients underwent to varicose vein surgery of the lower limbs. MATERIAL AND METHODS: They were evaluated 201 patients underwent to varicose vein surgery of the lower limbs at the Vascular Surgery Service at the Instituto de Medicina Integral Professor Fernando Figueira (IMIP from august 2006 to april 2007. All the patients were evaluated considering the gender, age, sedentarism, overweight, obesity and the report of long-time in a standing position during work shift. RESULTS: Over all patients evaluated, 175 (87.1% were females and 26 (12.9% males. The majority of them (32.3% were aged from 41 to 50 years, overweight was found in 38.8% of the patients, and obesity in 7.5% of the cases. Long time standing during work shift was reported by 82.1% of the patients, and the time at the school, found in 83.2% of the patients, was eight or less years. Sedentarism was found in 69.2% of the patients. CONCLUSION: The majority of the patients evaluated in the present study was female and more than 40 years-old, reported sedentarism, did not have overweight or obesity and reported to stay a long-time in a standing position during work shift.

  9. Predictive factors of isolated distant metastasis after primary definitive surgery without systemic treatment for head and neck squamous cell carcinoma.

    Science.gov (United States)

    Lim, Jae-Yol; Lim, Young Chang; Kim, Se-Heon; Kim, Jae Wook; Jeong, Ha Min; Choi, Eun Chang

    2010-07-01

    Incidence of isolated distant metastasis (IDM) was relatively low in patients who achieved locoregional control after primary definitive surgery. However, the prognosis of patients with IDM was dismal. The aim of this study was to evaluate the clinical outcome of patients with IDM and identify independent predictive factors of IDM after primary definitive surgery for head and neck squamous cell carcinoma (HNSCC). A retrospective data review was conducted for 795 patients who underwent primary definitive surgery without any systemic treatment for squamous cell carcinoma (SCC) of the oral cavity, oropharynx, larynx, and hypopharynx. Distant metastasis-free survival was calculated and independent predictive factors for IDM were determined by Cox proportional-hazards model. For the entire study cohort, IDM developed in 75 patients (9.4%). Among 631 patients who achieved locoregional control, IDM occurred in 44 patients (7%). The median time to IDM after primary surgery was 13months, ranging from 2 to 70months. The overall salvage rate was 9% (4 of 44) after salvage treatment for IDM. In the Cox proportional-hazards model, clinical N status, and histological grade were independent predictive factors of IDM. Patients who had clinically palpable neck disease and a histologically poor grade were more likely to develop IDM after primary definitive surgery. Patients with these factors should be considered candidates for proper adjuvant systemic treatment and evaluated more thoroughly for early detection of IDM during follow-up.

  10. The knowledge of Polish primary care physicians about bariatric surgery

    Directory of Open Access Journals (Sweden)

    Piotr Major

    2016-09-01

    Full Text Available Introduction: The general practitioner (GP can play a key role in this multi-disciplinary team, coordinating care provided by dietitians and surgeons, maximizing the potential benefits of surgery. Therefore, it seems important to verify changes in GPs’ knowledge about surgical treatment of obesity. Aim : To reassess knowledge of obesity surgical treatment among Polish primary care physicians and their willingness to improve it in the future. Material and methods: To assess the knowledge of Polish primary care physicians about surgical treatment of obesity, a prospective study, which included an anonymous online questionnaire, was conducted in the years 2015–2016. Results : Two hundred and six physicians answered the invitation. One hundred and sixty-six (81.8% respondents were familiar with the indications for bariatric operation. The great majority of respondents, 198 (96.6%, were aware that bariatric surgery is efficient in the treatment of the metabolic syndrome. The study revealed a disproportion between the number of patients who would be potential candidates for bariatric treatment, who are currently under care of participating physicians, and the number of patients who are referred to a bariatric surgeon. Conclusions : Our study demonstrates that nowadays bariatric surgery is a recognized method of treatment, but physicians remain reluctant to refer their patients for surgical treatment of obesity. It was found that there is a large disproportion between the number of patients who are referred to a bariatric surgeon and the number of patients who require this treatment. It may be a result of lack of knowledge in the field of bariatric surgery.

  11. Minimally invasive glaucoma surgery as primary stand-alone surgery for glaucoma.

    Science.gov (United States)

    Kerr, Nathan M; Wang, Jing; Barton, Keith

    2017-05-01

    Recently, many new devices and procedures have been developed to lower intraocular pressure in a less invasive and purportedly safer manner than traditional glaucoma surgery. These new devices might encourage an earlier transition to surgery and reduce the long-term commitment to topical glaucoma medications with their associated compliance and intolerance issues. Although often seen as an adjunct to cataract surgery, a growing body of evidence suggests that primary minimally invasive glaucoma surgery may be a viable initial treatment option. New studies have shown that primary ab interno trabeculectomy (Trabectome, NeoMedix Inc., Tustin, CA, USA), trabecular micro-bypass stent insertion (iStent and iStent Inject, Glaukos Corporation, Laguna Hills, CA, USA), canalicular scaffolding (Hydrus, Invantis Inc., Irvine CA, USA), the ab interno gel Implant (XEN, Allergan, Dublin, Ireland) or supraciliary stenting (CyPass Micro-Stent, Alcon, Fort Worth, TX, USA) may lower the lowering intraocular pressure and/or topical medication burden in phakic or pseudophakic patients with glaucoma. This effect seems to last at least 12 months but reliable cost-effectiveness and quality of life indicators have not yet been established by investigator-initiated randomized trials of sufficient size and duration. © 2016 Royal Australian and New Zealand College of Ophthalmologists.

  12. Trabectome surgery for primary and secondary open angle glaucomas.

    Science.gov (United States)

    Jordan, Jens F; Wecker, Thomas; van Oterendorp, Christian; Anton, Alexandra; Reinhard, Thomas; Boehringer, Daniel; Neuburger, Matthias

    2013-12-01

    In most forms of open angle glaucoma, the trabecular meshwork is the main barrier for aqueous humor outflow, causing elevated intraocular pressure (IOP). The Trabectome is a minimal invasive device for the surgical treatment of open angle glaucoma, particularly eliminating the juxtacanalicular meshwork. This study was conducted to compare the effectiveness and complication profile among different glaucoma subgroups. Single center prospective observational study. There were 557 consecutive eyes of 487 patients included in this study. Trabectome surgery was performed either alone or in combination with cataract surgery. Intraoperative and postoperative complications were documented systematically. Main outcome measures were IOP reduction over time and the preoperative and postoperative number of IOP-lowering medications. Due to subgroup sizes, only data from eyes with primary open angle glaucoma and pseudoexfoliation glaucoma were processed for statistical analysis. For the 261 eyes classified as primary open angle glaucoma, preoperative IOP was 24 ± 5.5 mmHg (mean ± SD) under 2.1 ± 1.3 IOP-lowering medications. After a mean follow-up of 204 ± 238 days, IOP was reduced to 18 ± 6.1 mmHg, and medication was reduced to 1.2 ± 1.1. For the 173 eyes classified as pseudoexfoliation glaucoma, after a mean follow-up of 200 ± 278 days, IOP was reduced from 25 ± 5.9 mmHg to 18 ± 8.2 mmHg, and medication was reduced from 2.0 ± 1.2 to 1.1 ± 1.1. A Cox proportional hazards model hinted forward superiority of the combined surgery cases (Trabectome + Phaco + intraocular lens) in comparison to Trabectome surgery only in phakic or pseudophakic eyes. No serious complications were observed. Minimal invasive glaucoma surgery with the Trabectome seems to be safe and effective. The subgroup analysis of different kinds of open angle glaucomas presented in this study may help in first-line patient selection. The lack of ocular surface alterations makes it a valuable addition to

  13. Survival Outcomes and Patterns of Recurrence in Patients with Stage III or IV Oropharyngeal Cancer Treated with Primary Surgery or Radiotherapy.

    Science.gov (United States)

    Debenham, Brock J; Banerjee, Robyn; Warkentin, Heather; Ghosh, Sunita; Scrimger, Rufus; Jha, Naresh; Parliament, Matthew

    2016-07-26

    To compare and contrast the patterns of failure in patients with locally advanced squamous cell oropharyngeal cancers undergoing curative-intent treatment with primary surgery or radiotherapy +/- chemotherapy. Two hundred and thirty-three patients with stage III or IV oropharyngeal squamous cell carcinoma who underwent curative-intent treatment from 2006-2012, were reviewed. The median length of follow-up for patients still alive at the time of analysis was 4.4 years. Data was collected retrospectively from a chart review. One hundred and thirty-nine patients underwent primary surgery +/- adjuvant therapy, and 94 patients underwent primary radiotherapy +/- chemotherapy (CRT). Demographics were similar between the two groups, except primary radiotherapy patients had a higher age-adjusted Charleston co-morbidity score (CCI). Twenty-nine patients from the surgery group recurred; 15 failed distantly only, seven failed locoregionally, and seven failed both distantly and locoregionally. Twelve patients recurred who underwent chemoradiotherapy; ten distantly alone, and two locoregionally. One patient who underwent radiotherapy (RT) alone failed distantly. Two and five-year recurrence-free survival rates for patients undergoing primary RT were 86.6% and 84.9% respectively. Two and five-year recurrence-free survival rates for primary surgery was 80.9% and 76.3% respectively (p=0.21). There was no significant difference in either treatment when they were stratified by p16 status or smoking status. Our analysis does not show any difference in outcomes for patients treated with primary surgery or radiotherapy. Although the primary pattern of failure in both groups was distant metastatic disease, some local failures may be preventable with careful delineation of target volumes, especially near the base of skull region.

  14. Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function

    Directory of Open Access Journals (Sweden)

    Sertel Serkan

    2011-09-01

    Full Text Available Abstract Background Surgery after (chemoradiation (RCTX/RTX is felt to be plagued with a high incidence of wound healing complications reported to be as high as 70%. The additional use of vascularized flaps may help to decrease this high rate of complications. Therefore, we examined within a retrospective single-institutional study the peri--and postoperative complications in patients who underwent surgery for salvage, palliation or functional rehabilitation after (chemoradiation with regional and free flaps. As a second study end point the Karnofsky performance status (KPS was determined preoperatively and 3 months postoperatively to assess the impact of such extensive procedures on the overall performance status of this heavily pretreated patient population. Findings 21 patients were treated between 2005 and 2010 in a single institution (17 male, 4 female for salvage (10/21, palliation (4/21, or functional rehabilitation (7/21. Overall 23 flaps were performed of which 8 were free flaps. Major recipient site complications were observed in only 4 pts. (19% (1 postoperative haemorrhage, 1 partial flap loss, 2 fistulas and major donor site complications in 1 pt (wound dehiscence. Also 2 minor donor site complications were observed. The overall complication rate was 33%. There was no free flap loss. Assessment of pre- and postoperative KPS revealed improvement in 13 out of 21 patients (62%. A decline of KPS was noted in only one patient. Conclusions We conclude that within this (chemoradiated patient population surgical interventions for salvage, palliation or improve function can be safely performed once vascularised grafts are used.

  15. Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery.

    Science.gov (United States)

    Cazelli, José Guilherme; Camargo, Gabriel Cordeiro; Kruczan, Dany David; Weksler, Clara; Felipe, Alexandre Rouge; Gottlieb, Ilan

    2017-10-01

    The prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement. To evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score. Cross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877; 95%CI: 0.830 - 0.923) in different valve populations. Obstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease.

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

    Science.gov (United States)

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

    2014-01-01

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

  17. Splenectomy as part of primary cytoreductive surgery for advanced ovarian cancer: a retrospective cohort study.

    Science.gov (United States)

    Zapardiel, Ignacio; Peiretti, Michele; Zanagnolo, Vanna; Biffi, Roberto; Bocciolone, Luca; Landoni, Fabio; Aletti, Giovanni; Colombo, Nicoletta; Maggioni, Angelo

    2012-07-01

    The aim of surgical approach in advanced ovarian cancer should be the complete removal of all visible disease. Our purpose was to compare perioperative features and postoperative complications, and secondarily oncological outcomes, between patients who underwent splenectomy and those who did not at the time of surgery. Thirty-three subjects underwent splenectomy, and we selected 99 controls with similar surgical characteristics but who did not undergo splenectomy. Data collected included perioperative details and follow-up data. Longer operating time (33 minutes longer; P = 0.02), larger estimated blood loss (812 mL more; P = 0.03), higher rate of intraoperative blood transfusions (78.8% vs 42.4%; P < 0.01), and intensive care unit stay (1.4 vs 0.5 days; P < 0.01) as well as higher pneumonia rate (2% vs 0%; P = 0.01) were observed in the splenectomy group. Disease-free and overall survival rates were 30.3% and 66.6%, respectively, in the splenectomy group, and 33.3% and 59.6%, respectively, in the control group. Splenectomy at the time of primary cytoreductive surgery for advanced ovarian cancer may contribute to achieve complete cytoreduction with low perioperative complication rate. This procedure seems to be an acceptable and rational intervention to increase the survival rates of those patients.

  18. Failed surgery in primary hyperparathyroidism - what has changed with time.

    Science.gov (United States)

    Wirowski, D; Goretzki, P E; Schwarz, K; Lammers, B J; Dotzenrath, C; Röher, H-D

    2013-06-01

    Advanced preoperative imaging of parathyroid adenomas and intraoperative parathyroid hormone determination optimized the results in the surgical treatment of primary hyperparathyroidism patients. We asked, whether reasons for failure have changed during the last 25 years.We retrospectively analyzed operations for persistent primary hyperparathyroidism in our department between 2001 and 2011 (n=67), and compared these results to our experience between 1986 and 2001 (n=80).From 2001 to 2011, 765 primary hyperparathyroidism patients were operated on at our department. All but 4 patients were cured (761/765, 99.5%). 67 operations were performed for persistent primary hyperparathyroidism. Main reasons for failure were a misdiagnosed sporadic multiple gland disease in our own patients (18/29, 62.1%), and an undetected solitary adenoma in patients referred to us after -initial operation in another hospital (22/38, 57.9%) (statistically significant). From 1986 to 2001 (1 105 primary hyperparathyroidism patients), main indications for re-operation due to persistent disease were an undiagnosed sporadic multiple gland disease in our own patients (15/24, 62.5%), and a missed solitary adenoma in patients being operated on primarily somewhere else (38/56, 67.9%) (statistically significant).Comparing our experience in 147 patients with persistent primary hyperparathyroidism being operated on between 2001-2011 and 1986-2001, not much has changed with the modern armamentarium of improved preoperative imaging or intraoperative biochemical control. Whereas sporadic multiple gland disease was the most common reason for unsuccessful surgery in experienced hands, other units mainly failed due to an undetected solitary adenoma. Re-operations for persistent primary hyperparathyroidism performed by us were successful in 93.8% (2001-2011) and 96.0% (1986-2001), respectively. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.

  19. Prognostic Impact of Combined Dysglycemia and Hypoxic Liver Injury on Admission in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (from the INTERSTELLAR Cohort).

    Science.gov (United States)

    Jang, Ho-Jun; Oh, Pyung Chun; Moon, Jeonggeun; Suh, Jon; Park, Hyun Woo; Park, Sang-Don; Lee, Kyounghoon; Kim, Je Sang; Lee, Hyun Jong; Choi, Rak Kyeong; Choi, Young-Jin; Kang, Woong Chol; Kwon, Sung Woo; Kim, Tae-Hoon

    2017-04-15

    Dysglycemia on admission is known to predict the prognosis of ST-segment elevation myocardial infarction (STEMI). Recently, hypoxic liver injury (HLI) has been proposed as a novel prognosticator for STEMI. We evaluated the prognostic impact of combined dysglycemia and HLI at the time of presentation in patients with STEMI who underwent primary percutaneous coronary intervention. From 2007 to 2014, 1,525 consecutive patients (79% men, mean age 61 years) who underwent primary percutaneous coronary intervention for STEMI in the INTERSTELLAR (Incheon-Bucheon Cohort of Patients Undergoing Primary PCI for Acute ST-Elevation Myocardial Infarction) cohort were analyzed retrospectively. Dysglycemia was defined as either hypoglycemia (serum glucose 250 mg/dl). HLI was defined as more than twofold increase of any serum aminotransferases above the upper normal limit. Patients were divided into 4 groups according to their dysglycemia and HLI status on admission: group 1, normoglycemia without HLI; group 2, dysglycemia without HLI; group 3, normoglycemia with HLI; and group 4, dysglycemia with HLI. Primary end point was inhospital death and secondary end point was all-cause mortality at 12 months after the index procedure. Of the 1,525 patients, there were 87 inhospital deaths (5.7%) and 113 all-cause deaths (7.4%) at 12 months after the index procedure. Both dysglycemia and HLI on admission were independent predictors of inhospital death. Inhospital mortality rate was the highest in group 4 (32.1%), followed by groups 2 and 3. Kaplan-Meier survival analysis at 12 months showed similar trends among the 4 groups. In conclusion, combined dysglycemia and HLI on admission predicts early prognosis for STEMI. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Risk Factors for Intraoperative Hypertension during Surgery for Primary Hyperparathyroidism

    Science.gov (United States)

    Sabljak, Vera D.; Zivaljevic, Vladan R.; Milicic, Biljana R.; Paunovic, Ivan R.; Toskovic, Anka R.; Stevanovic, Ksenija S.; Tausanovic, Katarina M.; Markovic, Dejan Z.; Stojanovic, Marina M.; Lakicevic, Mirko V.; Jovanovic, Milan D.; Diklic, Aleksandar D.; Kalezic, Nevena K.

    2017-01-01

    Objective To investigate the incidence and identify risk factors for the occurrence of intraoperative hypertension (IOH) during surgery for primary hyperparathyroidism (pHPT). Subjects and Methods The study included 269 patients surgically treated between January 2008 and January 2012 for pHPT. IOH was defined as an increase in systolic blood pressure ≥20% compared to baseline values which lasted for 15 min. The investigated influence were demographic characteristics, surgical risk score related to physical status (based on the American Society of Anesthesiologists [ASA] classification), comorbidities, type and duration of surgery, and duration of anesthesia on IOH occurrence. The investigated factors were obtained from the patients' medical history, anesthesia charts, and the daily practice database. Logistic regression analysis was done to determine the predictors of IOH. Results Of the 269 patients, 153 (56.9%) had IOH. Based on the univariate analysis, age, body mass index, ASA status, duration of anesthesia, and preoperative hypertension were risk factors for the occurrence of IOH. Multivariate analysis showed that independent predictors of IOH were a history of hypertension (OR = 2.080, 95% CI: 1.102–3.925, p = 0.024) and age (OR = 0.569, 95% CI: 0.360–0.901, p = 0.016). Conclusion In this study, a high percentage (56%) of the patients developed IOH during surgery for pHPT, which indicates that special attention should be paid to these patients, especially to the high-risk groups: older patients and those with a history of hypertension. Further, this study showed that advanced age and hypertension as a coexisting disease prior to parathyroid surgery were independent risk factors for the occurrence of IOH. PMID:28399538

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

    Science.gov (United States)

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

    2015-10-01

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

  2. A Population-based Study Evaluating the Association between Surgery in Early Life and Child Development at Primary School Entry.

    Science.gov (United States)

    O'Leary, James D; Janus, Magdalena; Duku, Eric; Wijeysundera, Duminda N; To, Teresa; Li, Ping; Maynes, Jason T; Crawford, Mark W

    2016-08-01

    It is unclear whether exposure to surgery in early life has long-term adverse effects on child development. The authors aimed to investigate whether surgery in early childhood is associated with adverse effects on child development measured at primary school entry. The authors conducted a population-based cohort study in Ontario, Canada, by linking provincial health administrative databases to children's developmental outcomes measured by the Early Development Instrument (EDI). From a cohort of 188,557 children, 28,366 children who underwent surgery before EDI completion (age 5 to 6 yr) were matched to 55,910 unexposed children. The primary outcome was early developmental vulnerability, defined as any domain of the EDI in the lowest tenth percentile of the population. Subgroup analyses were performed based on age at first surgery (less than 2 and greater than or equal to 2 yr) and frequency of surgery. Early developmental vulnerability was increased in the exposed group (7,259/28,366; 25.6%) compared with the unexposed group (13,957/55,910; 25.0%), adjusted odds ratio, 1.05; 95% CI, 1.01 to 1.08. Children aged greater than or equal to 2 yr at the time of first surgery had increased odds of early developmental vulnerability compared with unexposed children (odds ratio, 1.05; 95% CI, 1.01 to 1.10), but children aged less than 2 yr at the time of first exposure were not at increased risk (odds ratio, 1.04; 95% CI, 0.98 to 1.10). There was no increase in odds of early developmental vulnerability with increasing frequency of exposure. Children who undergo surgery before primary school age are at increased risk of early developmental vulnerability, but the magnitude of the difference between exposed and unexposed children is small.

  3. The role of neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy

    International Nuclear Information System (INIS)

    Peters, Lester J.; Weber, Randal S.; Morrison, William H.; Byers, Robert M.; Garden, Adam S.; Goepfert, Helmuth

    1996-01-01

    Purpose: The role of neck surgery in node- positive patients whose primary tumours are treated by definitive radiotherapy is controversial. A planned neck dissection following radiotherapy is frequently recommended regardless of response of the neck nodes to treatment. This analysis was undertaken to assess the risk of withholding planned neck dissection in patients who obtain a complete nodal response to irradiation. Materials and Methods: The analysis is based on all 100 patients treated using the concomitant boost protocol described below who presented between 1984 and 1993 with primary squamous cell carcinomas of the oropharynx and clinically positive cervical lymphadenopathy. There were 73 males and 27 females with a median age of 59. Primary disease site was base of tongue 39, tonsil 40, soft palate 14 and pharyngeal wall 7. Nodal stages were N1: 35, N2: 51 and N3: 15. Nodal size varied from 1 - 9 cm with a median of 3 cm. Radiotherapy consisted of 54 Gy in 30 fractions over 6 weeks to large fields with a boost to gross disease of 18 Gy in 12 fractions being delivered as a second daily fraction during the last 2.4 weeks of treatment. Seventy-five patients had their nodal disease treated definitively by radiotherapy; those who had complete clinical resolution of all nodal disease (62) had no planned surgery, while the remaining 13 underwent neck dissection for presumed residual disease. Twenty-five patients had either node excision (8) or neck dissection (17) prior to radiotherapy. Results: There were 8 cases of isolated neck failure of which 3 occurred in the 62 patients who had no planned neck surgery, 0 in the 13 patients who were operated for presumed residual disease (pathologically negative in 7) and 5 in the 25 patients who had initial neck surgery. Of the 62 patients who had a complete response to radiotherapy, the two year probability of neck control was 87% if the initial nodal size was ≤ 3 cm versus 85% for nodes > 3 cm. However the likelihood of

  4. Comparison of primary and reoperative surgery in patients with Crohns disease.

    Science.gov (United States)

    Heimann, T M; Greenstein, A J; Lewis, B; Kaufman, D; Heimann, D M; Aufses, A H

    1998-04-01

    This study was performed to determine the clinical results of patients with Crohns disease who require surgical resection. The outcome of patients undergoing initial surgery was compared with those having reoperation. One hundred sixty-four patients undergoing intestinal resection for Crohns disease at The Mount Sinai Hospital from 1976 to 1989 were studied prospectively. The mean duration of follow-up was 72 months. Ninety patients (55%) underwent initial intestinal resection whereas 74 patients (45%) underwent reoperation for recurrent disease. Patients undergoing reoperation were older (33.4 vs. 38.7 years), had longer durations of disease (8.7 vs. 15.2 years), had shorter resections (60 vs. 46 cm), and were more likely to require ileostomy. Forty-seven percent of the patients with multiple previous resections required an ileostomy. This group also received a mean of 2.3 U blood in the perioperative period and showed a trend to increased symptomatic recurrence (49% vs. 71% at 5 years). Patients with Crohns disease undergoing first and second reoperation have outcomes similar to those in patients undergoing primary resection. Patients requiring multiple reoperations are more likely to require blood transfusions and permanent ileostomy and to show a greater trend to early symptomatic recurrence.

  5. Staple line coverage with a polyglycolic acid sheet plus pleural abrasion by thoracoscopic surgery for primary spontaneous pneumothorax in young patients.

    Science.gov (United States)

    Haraguchi, Shuji; Koizumi, Kiyoshi; Mikami, Iwao; Okamoto, Junichi; Iijima, Yoshihito; Ibi, Takayuki; Shimizu, Kazuo

    2012-01-01

    We investigated surgical results of staple line coverage with a polyglycolic acid sheet plus pleural abrasion by thoracoscopic surgery for treating primary spontaneous pneumothorax in young patients. Forty-seven patients younger than 40 years underwent 48 thoracoscopic surgical procedures for spontaneous pneumothorax at the Division of Thoracic Surgery, Department of Surgery, Nippon Medical School, from May 2007 through August 2010. All patients underwent thoracoscopic bullectomy with stapling devices and pleural abrasion performed with a gauze sponge held by forceps until the pleura became petechial. Finally, the staple line was covered with a polyglycolic acid sheet (10 × 10 cm). No fibrin glue was used. We investigated both short-time results after surgery and the postoperative recurrence of pneumothorax. There was no operative mortality or morbidity, such as air leakage from staple lines or hemorrhage due to pleural abrasion. Pneumothorax recurred after surgery in 3 cases. In 2 cases, neither re-operation nor tube thoracostomy was necessary because intrapleural adhesions allowed only partial collapse of the lung. One patient underwent re-operation for an overlooked bulla facing the diaphragm in left lower lobe of the lung 2 days after the first operation. The rate of freedom from pneumothorax 4 years after surgery was 94%. Staple line coverage with a polyglycolic acid sheet plus pleural abrasion by thoracoscopic surgery is a useful method for preventing morbidity and the postoperative recurrence of pneumothorax.

  6. Primary and Revision Amputation Surgery in a Tertiary Institution in ...

    African Journals Online (AJOL)

    We set out to study the cases undergoing amputation surgery with special interest of determining the prevalence rate of revision amputation surgery; its indication ... The commonest indication found for amputation surgery was trauma while it was ascending gangrene for revision amputation. Among those who had revision ...

  7. Acceptability of surgery as initial treatment for primary open angle ...

    African Journals Online (AJOL)

    One hundred and fifty four new glaucoma patients at the University of Benin Teaching Hospital were interviewed to determine the acceptance of surgery, reasons for refusal, and factors affecting acceptability of surgery as an initial treatment option. Fifty patients (32.5%) accepted surgery while 89 (57.8%) refused. The main ...

  8. Outpatient versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications.

    Science.gov (United States)

    Kantar, Rami S; Cammarata, Michael J; Rifkin, William J; Plana, Natalie M; Diaz-Siso, J Rodrigo; Flores, Roberto L

    2018-05-01

    Fiscal constraints are driving shorter hospital lengths of stay. Outpatient primary cleft lip surgery has been shown to be safe, but outpatient primary cleft palate surgery remains controversial. This study evaluates outcomes following outpatient versus inpatient primary cleft lip and palate surgery. The American College of Surgeons National Surgical Quality Improvement Program Pediatric database was used to identify patients undergoing primary cleft lip and palate surgery between 2012 and 2015. Patient clinical factors and 30-day complications were compared for outpatient versus inpatient primary cleft lip and palate surgery. Univariate and multivariate analyses were performed. Three thousand one hundred forty-two patients were included in the primary cleft lip surgery group and 4191 in the primary cleft palate surgery group. Patients in the cleft lip surgery group with structural pulmonary abnormalities had a significantly longer hospital length of stay (β, 4.94; p = 0.001). Patients undergoing outpatient surgery had a significantly higher risk of superficial (OR, 1.99; p = 0.01) and deep wound dehiscence (OR, 2.22; p = 0.01), and were at a significantly lower risk of reoperation (OR, 0.36; p = 0.04) and readmission (OR, 0.52; p = 0.02). Outpatient primary cleft lip surgery is safe and has a complication profile similar to that of inpatient surgery. Outpatient primary cleft palate surgery is common practice in many U.S. hospitals and has a significantly higher rate of wound complications, and lower rates of reoperation and readmission. In properly selected patients, outpatient palatoplasty can be performed safely. Therapeutic, III.

  9. Assessment of pre and postoperative anxiety in patients undergoing ambulatory oral surgery in primary care.

    Science.gov (United States)

    Reyes-Gilabert, E; Luque-Romero, L-G; Bejarano-Avila, G; Garcia-Palma, A; Rollon-Mayordomo, A; Infante-Cossio, P

    2017-11-01

    To analyze the pre- and postoperative anxiety level in patients undergoing ambulatory oral surgery (AOS) in a primary healthcare center (PHC). Prospective and descriptive clinical study on 45 patients who underwent AOS procedures in the dental clinic of a public PHC of Spain between April and September 2015. Anxiety analysis was carried out with pre- and postoperative anxiety-state (STAI-S), anxiety-trait (STAI-T) and dental anxiety (MDAS) questionnaires. A descriptive, inferential and binary logistic regression analysis were performed for the variables age, sex, educational level, previous experience of oral treatment, type of oral surgery, degree of third molar impaction, surgical time, intraoperative complications, postoperative complications, and pain score with a visual analogue scale (VAS). The majority were female (57.8%) with a mean age of 33.5±9.6 years. The most frequent procedure was the lower third molar removal (82.2%). The mean pain score on the VAS was 1.6±1.8. The incidence of complications was low (7.8%). There was a statistically significant association between post- and preoperative anxiety (r=0.56, p<0.001) and a correlation between pain score and postoperative anxiety (Rho= -0.35, p=0.02). The likelihood of postoperative anxiety was related to preoperative anxiety (OR=1.3, p=0.03). AOS in a PHC is safe and should be more encouraged in the public primary care. The emotional impact on users was relatively low, highlighting that the preoperative anxiety levels were higher than the postoperative ones. Psychological factors related to pre- and postoperative anxiety should be considered in the AOS carried out in PC.

  10. Prevention and control of proliferative vitreoretinopathy: primary retinal detachment surgery using silicone oil as a planned two-stage procedure in high-risk cases.

    Science.gov (United States)

    Alexander, P; Prasad, R; Ang, A; Poulson, A V; Scott, J D; Snead, M P

    2008-06-01

    For rhegmatogenous retinal detachment, reattachment with a single procedure is associated with better visual outcomes. In the past, silicone oil has been used mostly as a last resort following failed primary surgery. This study evaluates a novel approach to patients at high risk of primary failure, using silicone tamponade as the primary stage of a planned two-stage procedure. We report a series of 140 eyes that underwent primary surgery for rhegmatogenous retinal detachment. Patients at higher risk of surgical failure (eg giant retinal tear, inability to posture, poor view, uncertainty of location of primary break, primary proliferative vitreoretinopathy (PVR), multiple tears with rolled posterior edges, retinoschisis/detachment, staphyloma with macular hole) were managed by a planned staged procedure using primary silicone oil tamponade. This was followed by silicone removal at a later date. Fifty-four eyes underwent scleral buckling alone, with primary success in 52/54 (96%). Fifty-three eyes underwent vitrectomy and gas, achieving primary success in 50/53 (94%). Thirty-three eyes were classified high risk and managed with primary silicone. Silicone was safely removed in 22/25. In eight eyes, silicone was retained without attempt at removal. In total, primary retinal reattachment was achieved in 128 of 140 eyes (91.4%). Of these, 124 (97%) did not require long-term tamponade. Only four eyes (2.9%) developed PVR. A planned two-stage approach to highrisk cases of retinal detachment using primary silicone oil tamponade followed by silicone removal can achieve a high primary reattachment rate with less than 3% incidence of PVR.

  11. Cost Implications of Primary Versus Revision Surgery in Adult Spinal Deformity.

    Science.gov (United States)

    Qureshi, Rabia; Puvanesarajah, Varun; Jain, Amit; Kebaish, Khaled; Shimer, Adam; Shen, Francis; Hassanzadeh, Hamid

    2017-08-01

    Adult spinal deformity (ASD) is an important problem to consider in the elderly. Although studies have examined the complications of ASD surgery and have compared functional and radiographic results of primary surgery versus revision, no studies have compared the costs of primary procedures with revisions. We assessed the in-hospital costs of these 2 surgery types in patients with ASD. The PearlDiver Database, a database of Medicare records, was used in this study. Mutually exclusive groups of patients undergoing primary or revision surgery were identified. Patients in each group were queried for age, sex, and comorbidities. Thirty-day readmission rates, 30-day and 90-day complication rates, and postoperative costs of care were assessed with multivariate analysis. For analyses, significance was set at P average reimbursement of the primary surgery cohort was $57,078 ± $30,767. Reimbursement of revision surgery cohort was $52,999 ± $27,658. The adjusted difference in average costs between the 2 groups is $4773 ± $1069 (P day and 90-day adjusted difference in cost of care when sustaining any of the major medical complications in primary surgery versus revision surgery was insignificant. Patients undergoing primary and revision corrective procedures for ASD have similar readmission rates, lengths of stays, and complication rates. Our data showed a higher cost of primary surgery compared with revision surgery, although costs of sustaining postoperative complications were similar. This finding supports the decision to perform revision procedures in patients with ASD when indicated because neither outcomes nor costs are a hindrance to correction. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Outcomes of Primary Transsphenoidal Surgery in Cushing Disease: Experience of a Tertiary Center.

    Science.gov (United States)

    Keskin, Fatma Ela; Ozkaya, Hande Mefkure; Bolayirli, Murat; Erden, Secil; Kadioglu, Pınar; Tanriover, Necmettin; Gazioglu, Nurperi

    2017-10-01

    To report the initial and long-term remission rates and related factors, secondary treatments, and outcomes of a series of patients with Cushing disease (CD). We included 147 consecutive adult patients with CD who underwent primary transsphenoidal surgery (TSS) between 1998 and 2014 in this study. Eighty-two were followed up in the Cerrahpasa Medical Faculty Endocrinology and Metabolism outpatient clinic. Patients were requested to attend a long-term remission assessment; 55 could be contacted, and data for the remaining 27 patients' last visit to the outpatient clinics were reviewed for early and late remission. Six patients were excluded from the study. Magnetic resonance imaging (MRI) findings and pathologic results including mitosis, Ki-67 levels, and P53 in immunostaining of all patients were evaluated. Data of 82 patients with CD with an average age of 36 years [interquartile range: 29-47] were analyzed with a mean follow-up of 7.5 years [interquartile range: 5-10]. Overall initial remission rates were 72.3% after TSS. Among the 82 patients, 16 patients had Gamma Knife radiosurgery and 7 patients underwent adrenalectomy. After these additional treatments, the long-term remission rate was found as 69.7%. The highest remission rates were with microadenomas. Recurrence was most frequently seen in patients without tumor evidence on MRI. Patients with high Ki-67 levels had higher recurrence rates in long-term follow-up (P = 0.02). Life-long follow-up for patients with CD seems essential. Undetectable tumors on MRI before TSS and high Ki-67 immunopositivity were found as risk factors for tumor recurrence. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Radioguided surgery of primary hyperparathyroidism in a population with a high prevalence of thyroid pathology

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Talavera, Paloma [University Hospital of Valladolid, Department of Nuclear Medicine, Valladolid (Spain); Gonzalez, Carmen; Gomez, Alberto [University Hospital of Salamanca, Department of Surgery, Salamanca (Spain); Garcia-Talavera, Jose Ramon; Martin, Esther; Martin, Mariano [University Hospital of Salamanca, Department of Nuclear Medicine, Salamanca (Spain)

    2010-11-15

    Patients with concomitant thyroid pathology are usually excluded from minimally invasive radioguided parathyroidectomy (MIRP). We assessed the value in these patients of the gamma probe, alone or in combination with other techniques, in MIRP and unilateral or bilateral approaches. We evaluated its performance in association with intraoperative determination of intact parathyroid hormone (ioPTHi) and preoperative {sup 99m}Tc-MIBI dual phase scintigraphy. Included in the study were 87 patients with a diagnosis of primary hyperparathyroidism who underwent radioguided surgery. They were divided into two groups depending on the presence of concomitant thyroid pathology (TP group, 33 patients) or absence of concomitant thyroid pathology (NTP group, 54 patients). In the TP group, ioPTHi achieved the highest accuracy (90.9%), followed by the gamma probe (81.8%) and scintigraphy (69.7%). In the NTP group, the probe (94.4%) performed better than ioPTH and scintigraphy (both 85.2%). In the TP group, scintigraphy in combination with the gamma probe had a success rate of 90.9%, and 94% in combination with ioPTHi. The three techniques are applied together had a success rate of 97%. For all patients undergoing MIRP, the probe alone worked well, irrespective of the presence or absence of concomitant thyroid pathology. Patients with concomitant thyroid pathology should not be a priori excluded from a MIRP, as long as other adjuvant techniques (scintigraphy or ioPTHi) are used in conjunction with the gamma probe. In these patients, the probe can also be helpful in unilateral or bilateral surgery. (orig.)

  14. Pathologic evaluation of primary laryngeal anterior commissure carcinoma both in patients who have undergone open surgery as initial treatment and in those who have undergone salvage surgery after irradiation failure.

    Science.gov (United States)

    Ahmed, Wael A; Suzuki, Kenji; Horibe, Yoshimune; Kato, Ichiro; Fujisawa, Toshiyuki; Nishimura, Yoichi

    2011-05-01

    Laryngeal anterior commissure (AC) cancer has been the subject of much controversy. Our study was aimed at pathologically evaluating the tendency of AC cancer to invade the thyroid cartilage and analyzing the role of thyroid cartilage invasion by tumor cells at the AC as an anatomic cause for irradiation failure. Our study included 36 patients with glottic cancer involving AC. Patients with recurrent or persistent disease after radiotherapy underwent salvage surgery. Surgical specimens from 22 patients who had open surgery, either as primary or salvage surgery, were available for pathologic examination to identify the presence of cartilage invasion. We found microscopic invasion of the thyroid cartilage in 40.9% of the studied tumors. Only 21.4% of patients who had open salvage surgery showed evidence of cartilage invasion at the AC. We concluded that laryngeal AC cancers are more likely to invade the cartilage, and that anatomic risk factors are not the main cause of irradiation failure.

  15. Young infants with severe tetralogy of Fallot: Early primary surgery versus transcatheter palliation.

    Science.gov (United States)

    Wilder, Travis J; Van Arsdell, Glen S; Benson, Lee; Pham-Hung, Eric; Gritti, Michael; Page, Alexandra; Caldarone, Christopher A; Hickey, Edward J

    2017-11-01

    Infants with severe tetralogy of Fallot may undergo (1) early primary surgical repair (EARLY) or (2) early transcatheter palliation (CATH) before delayed surgical repair. We compared these strategies with (3) elective single-stage tetralogy of Fallot repair (IDEAL). From 2000 to 2012, 453 children underwent tetralogy of Fallot repair (excluding systemic-pulmonary shunts), including 383 in the IDEAL (75%), 42 in the EARLY (9%), and 28 in the CATH (6%) groups. IDEAL repair at The Hospital for Sick Children occurs after 3 months. Risk-adjusted hazard analysis compared freedom from surgical or catheter reintervention. Somatic size, branch pulmonary artery size, and right ventricle systolic pressure were modeled using 2780 echocardiogram reports via mixed-model regression. CATH involved right ventricular outflow tract stent in 18 patients, right ventricular outflow tract balloon in 9 patients, and ductal-stent in 1 patient. Three patients died (1 per group). Risk-adjusted freedom from surgical reoperation was 89% ± 4%, 88% ± 5%, and 85% ± 6% for the IDEAL, EARLY, and CATH groups, respectively, at 10 years. Patients in the EARLY and CATH groups had similar reoperation rates, except for neonates (tetralogy of Fallot. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  16. The role of primary plastic surgery in the management of open fractures.

    Science.gov (United States)

    Court-Brown, Charles M; Honeyman, Calum S; Clement, Nick D; Hamilton, Stuart A; McQueen, Margaret M

    2015-12-01

    A study was undertaken to determine the requirement for primary plastic surgery in the treatment of open fractures. We reviewed 3297 consecutive open fractures in a 22-year period in a defined population. Analysis showed that 12.6% of patients required primary plastic surgery with 5.6% being treated with split skin grafting and 7.2% with a flap. Only 3.5% of open upper limb fractures required primary plastic surgery compared to 27.9% of open lower limb fractures. The fractures that required most primary plastic surgery were those of the femoral diaphysis and all fractures between the proximal tibia and the midfoot. The incidence of open fractures that require primary plastic surgery was 28/10(6)/year. The incidence in open upper and lower limb fractures was 5.3/10(6)/year and 22.7/10(6)/year respectively. Using these figures it is possible to estimate the numbers of open fractures that will require primary plastic surgery each year in the United Kingdom. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Primary care physician decision making regarding referral for bariatric surgery: a national survey.

    Science.gov (United States)

    Stolberg, Charlotte Røn; Hepp, Nicola; Juhl, Anna Julie Aavild; B C, Deepti; Juhl, Claus B

    2017-05-01

    Bariatric surgery is the most effective treatment for severe obesity. It results in significant and sustained weight loss and reduces obesity-related co-morbidities. Despite an increasing prevalence of severe obesity, the number of bariatric operations performed in Denmark has decreased during the past years. This is only partly explained by changes in the national guidelines for bariatric surgery. The purpose of the cross-sectional study is to investigate referral patterns and possible reservations regarding bariatric surgery among Danish primary care physicians (PCPs). Primary care physicians in Denmark METHODS: A total of 300 Danish PCPs were invited to participate in a questionnaire survey regarding experiences with bariatric surgery, reservations about bariatric surgery, attitudes to specific patient cases, and the future treatment of severe obesity. Most questions required a response on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree) and frequency distributions were calculated. 133 completed questionnaires (44%) were returned. Most physicians found that they had good knowledge about the national referral criteria for bariatric surgery. With respect to the specific patient cases, a remarkably smaller part of physicians would refer patients on their own initiative, compared with the patient's initiative. Fear of postoperative surgical complications and medical complications both influenced markedly the decision to refer patients for surgery. Only 9% of the respondents indicated that bariatric surgery should be the primary treatment option for severe obesity in the future. Danish PCPs express severe concerns about surgical and medical complications following bariatric surgery. This might, in part, result in a low rate of referral to bariatric surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  18. [A study of the predictive value of the primary review and complementary examinations in assessing the need for surgery in patients with stab wounds in the torso].

    Science.gov (United States)

    Martínez Casas, Isidro; Sancho Insenser, Joan; Climent Agustín, Marta; Membrilla Fernández, Estela; Pons Fragero, María José; Guzmán Ahumada, Juan; Grande Posa, Luis

    2013-01-01

    Observation is the gold standard for stable patients with stab wounds. The aim of the study was to analyse the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times. A retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analysed. The main variable was the need for surgery. A total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8±7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control haemoglobin levels were significantly lower in patients who required surgery. A positive computerised tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications. None of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24 hours is recommended in torso penetrating wounds. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  19. Local melanoma recurrences in the scar after limited surgery for primary tumor

    DEFF Research Database (Denmark)

    Drzewiecki, K T; Andersson, A P

    1995-01-01

    The clinical and histologic records of 46 consecutive patients were reviewed who during the period 1980-1993 had recurrence from melanoma in the scar after limited surgery for a skin tumor. They constituted about 50% of all patients admitted with local recurrence from melanoma during this period...... recurrences in the form of a new primary in a scar following limited surgery supports the theory of limited field change around a primary melanoma. Furthermore, limited procedures for primary melanoma, if followed by a recurrence in the scar, worsen the prognosis....

  20. Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity.

    Science.gov (United States)

    Wee, Christina C; Huskey, Karen W; Bolcic-Jankovic, Dragana; Colten, Mary Ellen; Davis, Roger B; Hamel, Marybeth

    2014-01-01

    Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery. To describe primary care patients' consideration of bariatric surgery, potential variation by sex and race, and factors that underlie any variation. Telephone interview of 337 patients with a body mass index or BMI > 35 kg/m(2) seen at four diverse primary care practices in Greater-Boston. Patients' consideration of bariatric surgery. Of 325 patients who had heard of bariatric surgery, 34 % had seriously considered surgery. Men were less likely than women and African Americans were less likely than Caucasian patients to have considered surgery after adjustment for sociodemographics and BMI. Comorbid conditions did not explain sex and racial differences but racial differences dissipated after adjustment for quality of life (QOL), which tended to be higher among African American than Caucasian patients. Physician recommendation of bariatric surgery was independently associated with serious consideration for surgery [OR 4.95 (95 % CI 2.81-8.70)], but did not explain variation in consideration of surgery across sex and race. However, if recommended by their doctor, men were as willing and African American and Hispanic patients were more willing to consider bariatric surgery than their respective counterparts after adjustment. Nevertheless, only 20 % of patients reported being recommended bariatric surgery by their doctor and African Americans and men were less likely to receive this recommendation; racial differences in being recommended surgery were also largely explained by differences in QOL. High perceived risk to bariatric surgery was the most commonly cited barrier; financial concerns were uncommonly cited. Single geographic region; examined consideration and not who eventually proceeded with bariatric surgery. African Americans and men were less likely to

  1. Clinical outcomes and advantages of laparoscopic surgery for primary Crohn's disease: are they significant?

    Science.gov (United States)

    Tanaka, Shinnosuke; Matsuo, Katsuichi; Sasaki, Takamitsu; Nakano, Masahiho; Shimura, Hideo; Yamashita, Yuichi

    2009-01-01

    The clinical outcomes and advantages of laparoscopic surgery for Crohn's disease have not yet been recognized in general. The aim of this study was to critically assess the clinical outcomes, safety, cosmesis, quality of life (QOL) and feasibility of laparoscopic surgery for primary Crohn's disease. The study subjects consisted of 48 patients who had primary surgical treatment for Crohn's disease, 28 through conventional laparotomy and 20 in whom surgery was laparoscopically assisted. The short-term and long-term outcomes, cosmesis, and postoperative QOL were evaluated in both groups. There were no statistically significant differences in the patient characteristics between the two groups. In the laparoscopic group, non-resected procedures were significantly more frequent (p cosmetic results were very satisfactory in 11 patients (64.7%). There were no severe complications and no increase of the recurrence rate for laparoscopic surgery. Moreover, there was no definite clinical disadvantage and no prolonged operating time in the laparoscopic procedures. Laparoscopic surgery for primary Crohn's disease is safe and feasible in selected patients without severe adhesion, fistula or abscess, and was associated with better cosmesis than conventional open surgery. Therefore, laparoscopic procedures should be considered as the preferred operative approach for a primary bowel resection.

  2. Analysis of complications in primary cleft lips and palates surgery.

    Science.gov (United States)

    Zhang, Zhaoqiang; Fang, Silian; Zhang, Qingbin; Chen, Lei; Liu, Yarui; Li, Kefeng; Zhao, Yan

    2014-05-01

    A series of retrospectively recorded patients with cleft lip and palate was uniquely investigated to demonstrate and analyze the complications after cleft repairing operations in a selected Chinese population. From January 2005 to January 2012, a selected group of 2100 patients with cleft lip and/or palate who have complete records were chosen from a large sample in the units. Complete data were retrieved, including sex, age, clinical classification, surgical modality, complications, and follow-up results. The complications were classified into 2 categories: early and long-term complications. After surgery, most patients with cleft lip remained in the hospital for 7 days and cleft palate repairs for 10 days. A standard regimen of antibiotics was administered for 3 to 5 days clinically. Of the 2100 patients, there were 1360 males and 760 females who had congenital cleft deformity with complete clinical records in the department of oral and maxillofacial surgery. The age distribution was as follows: 1600 patients in the group of 3 months to 2 years, 320 patients in the group of 2 to 10 years, 130 patients in the group of 11 to 19 years, and 50 patients in the group of older than 20 years. As to the treatment modality, cleft lips were repaired by rotation advancement method with various minor modifications or Tennison modality. The cleft palates were closed using the von Langenbeck, Veau/Wardill/Kilner, or Furlow technique. The overall complication rate was 16.8% of the patients. Of the early complications, there were 6 cases of asphyxia, 17 cases of pyrexia, 5 cases of edema of the respiratory tract, 8 cases of upper respiratory tract infection, 6 cases of bronchiolitis, 7 cases of pneumonia, 9 cases of diarrhea and vomiting, 6 cases of hemorrhage, 5 patients of odontoptosis, 11 cases of erosion of the corner of mouth, 5 cases of drowsiness, 11 cases of incision dehiscence, 9 cases of wound infection, 6 cases of palatal dehiscence/fistula, 3 cases of nostril floor

  3. Surgery for necrotising enterocolitis : primary anastomosis or enterostomy?

    NARCIS (Netherlands)

    Hofman, FN; Bax, NMA; van der Zee, DC

    The ideal surgical management of neonates with necrotising enterocolitis (NEC) is still a matter of debate. The purpose of this study was to compare the results of bowel resection with primary anastomosis with the results of bowel resection with enterostomy. Sixty-three neonates with NEC had a bowel

  4. Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer.

    Science.gov (United States)

    van de Vrie, Roelien; van Meurs, Hannah S; Rutten, Marianne J; Naaktgeboren, Christiana A; Opmeer, Brent C; Gaarenstroom, Katja N; van Gorp, Toon; Ter Brugge, Henk G; Hofhuis, Ward; Schreuder, Henk W R; Arts, Henriette J G; Zusterzeel, Petra L M; Pijnenborg, Johanna M A; van Haaften, Maarten; Engelen, Mirjam J A; Boss, Erik A; Vos, M Caroline; Gerestein, Kees G; Schutter, Eltjo M J; Kenter, Gemma G; Bossuyt, Patrick M M; Mol, Ben Willem; Buist, Marrije R

    2017-09-01

    To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1cm residual disease) in patients suspected of advanced stage ovarian cancer. An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility=0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were € 1400 per intervention, making the overall costs of both strategies comparable (difference € -80 per patient (95% CI -470 to 300)). Findings were consistent across various sensitivity analyses. In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Consequências da vasectomia: experiência de homens que se submeteram à cirurgia em Campinas (São Paulo, Brasil Consequences of vasectomy: experience of men who underwent the surgery in Campinas (São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Nádia Maria Marchi

    2011-09-01

    qualitative stage, 10 semi-structured interviews were performed with men selected according to purposeful criteria of level of schooling and number of children. Then, a structured form was provided for 202 men, drawn from the complete list of those who had had a vasectomy between 1998 and 2004. A thematic analysis of the content of the semi-structured interviews was carried out. The quantitative data were keyboarded and a descriptive analysis was conducted. RESULTS: It was observed that 97% of the men were satisfied because they had undergone the surgery and only a few of them mentioned undesired effects. Among the few dissatisfied men, only one had had vasectomy reversal because he lived with a new partner and wanted to have children; among the others, dissatisfaction was due to the pain caused by the surgical procedure. The majority of the interviewees attributed to vasectomy changes for the best in their health, body, general relationship with their families and wives, in their sexual life and economic situation. The idea that prevailed was that vasectomy had brought only benefits. The possibility of regret was mentioned by the interviewees as something that would not happen to them. CONCLUSION: The results of this study allowed to verify that men who decide to have a vasectomy tend to see the method as a factor of positive changes, mainly in the sexual life and in the relationship with the partner and family in general.

  6. Criticism of conservative surgery for primary operable breast cancer

    International Nuclear Information System (INIS)

    Urban, J.A.

    1977-01-01

    A critical evaluation about the adoption of a less adequate primary surgical procedure is done with respect to patients with similar extent of disease. A comparison is done between the results obtained for groups of patients submitted to conservative surgical treatment and to radical mastectomy, both accompanied by radiotherapy. Emphasis is given to the need for removing all disease in breast and regional nodes at the time of original surgical treatment. (M.A.) [pt

  7. Treatment outcome of advance staged oral cavity cancer: concurrent chemoradiotherapy compared with primary surgery.

    Science.gov (United States)

    Tangthongkum, Manupol; Kirtsreesakul, Virat; Supanimitjaroenporn, Pasawat; Leelasawatsuk, Peesit

    2017-06-01

    Concurrent chemoradiotherapy (CCRT) has been reported as effective and has become an acceptable treatment in advanced oral cancer. However, to date there is insufficient data to conclude that CCRT provides a good survival outcome. The purpose of this study was to compare survival rates and complications in patients with resectable advanced oral cavity squamous cell carcinoma treated with either CCRT or surgery with adjuvant radiotherapy (RT)/chemoradiotherapy (CRT). Stage III or IVa oral cavity carcinoma patients treated with curative intent by either CCRT or surgery with adjuvant RT were identified over a 7-year period (2009-2015). Survival rates and treatment complications were analyzed and compared between the two groups. 61 patients underwent CCRT and 128 patients underwent surgical excision and received postoperative RT. There was no statistically significant difference in survival outcome between the two treatment groups. 5-year overall survival rates (OS) were 33 versus 24% (P = 0.191) and the disease-specific survival rates (DSS) were 27 versus 25% (P = 0.857) when comparing the CCRT group and surgery with adjuvant RT/CRT group, respectively. Long-term complications were comparable between the two groups. CCRT has comparable survival outcome and complications for the treatment of advanced oral cavity squamous cell carcinoma, compared to surgery with adjuvant RT/CRT.

  8. Primary Endoscopic Transnasal Transsphenoidal Surgery for Magnetic Resonance Image-Positive Cushing Disease: Outcomes of a Series over 14 Years.

    Science.gov (United States)

    Kuo, Chao-Hung; Yen, Yu-Shu; Wu, Jau-Ching; Chen, Yu-Chun; Huang, Wen-Cheng; Cheng, Henrich

    2015-09-01

    There are scant data of endoscopic transsphenoidal surgery (ETS) with adjuvant therapies of Cushing disease (CD). To report the remission rate, secondary management, and outcomes of a series of CD patients. Patients with CD with magnetic resonance imaging (MRI)-positive adenoma who underwent ETS as the first and primary treatment were included. The diagnostic criteria were a combination of 24-hour urine-free cortisol, elevated serum cortisol levels, or other tests (e.g., inferior petrosal sinus sampling). All clinical and laboratory evaluations and radiological examinations were reviewed. Forty consecutive CD patients, with an average age of 41.0 years, were analyzed with a mean follow-up of 40.2 ± 29.6 months. These included 22 patients with microadenoma and 18 with macroadenoma, including 9 cavernous invasions. The overall remission rate of CD after ETS was 72.5% throughout the entire follow-up. Patients with microadenoma or noninvasive macroadenoma had a higher remission rate than those who had macroadenoma with cavernous sinus invasion (81.8% or 77.8% vs. 44.4%, P = 0.02). After ETS, the patients who had adrenocorticotropic hormone-positive adenoma had a higher remission rate than those who had not (76.5% vs. 50%, P = 0.03). In the 11 patients who had persistent/recurrent CD after the first ETS, 1 underwent secondary ETS, 8 received gamma-knife radiosurgery (GKRS), and 2 underwent both. At the study end point, two (5%) of these CD patients had persistent CD and were under the medication of ketoconazole. For MRI-positive CD patients, primary (i.e., the first) ETS yielded an overall remission rate of 72.5%. Adjuvant therapies, including secondary ETS, GKRS, or both, yielded an ultimate remission rate of 95%. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Persson, Anita; Bollerslev, Jens; Rosen, Thord

    2011-01-01

    The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery.......The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery....

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

    Science.gov (United States)

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

    2013-12-01

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

  11. Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study.

    Science.gov (United States)

    Funk, Luke M; Jolles, Sally A; Greenberg, Caprice C; Schwarze, Margaret L; Safdar, Nasia; McVay, Megan A; Whittle, Jeffrey C; Maciejewski, Matthew L; Voils, Corrine I

    2016-05-01

    Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization. To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral. Focus groups with PCPs practicing in small, medium, and large cities in Wisconsin. PCPs were asked to discuss prioritization of treatment for a severely obese patient with multiple co-morbidities and considerations regarding bariatric surgery referral. Focus group sessions were analyzed by using a directed approach to content analysis. A taxonomy of consensus codes was developed. Code summaries were created and representative quotes identified. Sixteen PCPs participated in 3 focus groups. Four treatment prioritization approaches were identified: (1) treat the disease that is easiest to address; (2) treat the disease that is perceived as the most dangerous; (3) let the patient set the agenda; and (4) address obesity first because it is the common denominator underlying other co-morbid conditions. Only the latter approach placed emphasis on obesity treatment. Five factors made PCPs hesitate to refer patients for bariatric surgery: (1) wanting to "do no harm"; (2) questioning the long-term effectiveness of bariatric surgery; (3) limited knowledge about bariatric surgery; (4) not wanting to recommend bariatric surgery too early; and (5) not knowing if insurance would cover bariatric surgery. Decision making by PCPs for severely obese patients seems to underprioritize obesity treatment and overestimate bariatric surgery risks. This could be addressed with PCP education and improvements in communication between PCPs and bariatric surgeons. Copyright © 2016 American Society for Bariatric Surgery. All rights reserved.

  12. Primary Surgery for Malignant Large Bowel Obstruction: Postoperative Nasogastric Tube Reinsertion is Not Mandatory.

    Science.gov (United States)

    Venara, A; Barbieux, J; Colas, P A; Le Fouler, A; Lermite, E; Hamy, A

    2017-07-01

    Malignant large bowel obstructions frequently require emergency surgery. Compliance with enhanced recovery after surgery programmes is significantly reduced due to non-removal of the nasogastric tube in the postoperative period. The first aim of the present study was to research factors associated with the failure of immediate nasogastric tube removal in patients who had undergone emergency surgery for malignant large bowel obstruction. The second aim was to assess the morbidity linked to nasogastric tube reinsertion. This retrospective and monocentric study included all consecutive patients admitted for acute malignant large bowel obstruction who underwent emergency surgery. Patients who were not primarily operated on were excluded (n = 178; 69.3%). The group of patients requiring nasogastric tube (NGT) reinsertion was compared with the group that did not require NGT reinsertion. Seventy-nine patients underwent emergency surgery, of which 18 (22.8%) required nasogastric tube reinsertion. There was no difference between the two groups with regard to (a) immediate nasogastric tube removal (p = 0.87) and (b) inclusion in an enhanced recovery programme (p = 0.75). However, preoperative small bowel dilatation was associated with a reduction in the need for NGT reinsertion (p = 0.04). A left-sided tumour was also associated with the need for NGT reinsertion in uni- (p = 0.034) and multivariate analysis (OR = 8; p reinsertion. The postoperative course influenced NGT reinsertion, which was significantly associated with postoperative ileus (OR = 4; p reinsertion was not affected by immediate removal of the tube. Left-sided tumours and patients at risk of postoperative ileus should be managed with caution. Immediate nasogastric tube removal is not contraindicated in the case of large bowel obstruction because it is not associated with a higher risk of NGT reinsertion.

  13. T(3) LARYNGEAL-CANCER, PRIMARY SURGERY VS PLANNED COMBINED RADIOTHERAPY AND SURGERY

    NARCIS (Netherlands)

    TJHOHESLINGA, RE; TERHAARD, CHJ; SCHOUWENBURG, P; HILGERS, FJM; DOLSMA, WV; CROLL, GA; HOOGENHOUT, J; KNEGT, PP; LEER, JWH; HORDIJK, GJ

    1993-01-01

    The Dutch Co-operative Head and Neck Oncology Group performed a retrospective, nationwide study of laryngeal cancer between 1975 and 1984. The results for T3 laryngeal cancer treated with primary laryngectomy (n = 137) with post-operative radiotherapy when indicated or planned combined

  14. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

    NARCIS (Netherlands)

    Lodders, J.N.; Parmar, S.; Stienen, N.L.M.; Martin, T.J.; Karagozoglu, K.H.; Heymans, M.W.; Nandra, B.; Forouzanfar, T.

    2015-01-01

    BACKGROUND: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. MATERIAL AND METHODS: Desired data was retrieved

  15. Is simultaneous surgery for nodes and primary in carcinoma penis safe?

    Directory of Open Access Journals (Sweden)

    Senthil Kumar Azhisoor Chandrasekhar

    2017-01-01

    Conclusions: Simultaneous surgery for the primary and nodes in carcinoma penis is very much feasible. Simultaneous and early-staged lymphadenectomy have no difference in results with respect to drain duration, hospital stay, wound morbidity, and long-term complications. Simultaneous lymphadenectomy can be combined with penectomy both in the prophylactic and therapeutic settings.

  16. Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction

    NARCIS (Netherlands)

    Hofbauer, Marcus; Muller, Bart; Murawski, Christopher D.; Baraga, Michael; van Eck, Carola Franziska; Fu, Freddie H.

    2013-01-01

    The purpose of this article was to discuss pre- and intra-operative considerations as well as surgical strategies for different femoral and tibial tunnel scenarios in revision surgery following primary double-bundle anterior cruciate ligament (ACL) reconstruction. Based on the current literature of

  17. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

    NARCIS (Netherlands)

    Lodders, J.N.; Parmar, S.; Stienen, N.-L.M.; Martin, T.J.; Karagozoglu, K.H.; Heymans, M.W.; Nandra, B.; Forouzanfar, T.

    2015-01-01

    Background: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Material and Methods: Desired data was retrieved

  18. Primary Stapes Surgery in Patients With Otosclerosis Prediction of Postoperative Outcome

    NARCIS (Netherlands)

    Bittermann, Arnold J. N.; Rovers, Maroeska M.; Tange, Rinze A.; Vincent, Robert; Dreschler, Wouter A.; Grolman, Wilko

    Objectives: To evaluate the audiometric results of primary stapes surgery in patients with otosclerosis and to determine predictors of a postoperative air-bone gap (ABG) of 10 dB or less and a postoperative gain in air conduction (AC) exceeding 20 dB. Design: Retrospective cohort study. Setting:

  19. Primary stapes surgery in patients with otosclerosis: prediction of postoperative outcome

    NARCIS (Netherlands)

    Bittermann, Arnold J. N.; Rovers, Maroeska M.; Tange, Rinze A.; Vincent, Robert; Dreschler, Wouter A.; Grolman, Wilko

    2011-01-01

    To evaluate the audiometric results of primary stapes surgery in patients with otosclerosis and to determine predictors of a postoperative air-bone gap (ABG) of 10 dB or less and a postoperative gain in air conduction (AC) exceeding 20 dB. Retrospective cohort study. Tertiary referral center in

  20. Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Persson, Anita; Bollerslev, Jens; Rosen, Thord

    2011-01-01

    The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery....

  1. Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Bollerslev, Jens; Rosen, Thord; Mollerup, Charlotte

    2009-01-01

    CONTEXT: Mild primary hyperparathyroidism (pHPT) seems to have a good prognosis, and indications for active treatment (surgery) are widely discussed. The extraskeletal effects of PTH, such as insulin resistance, arterial hypertension, and cardiovascular (CV) risk, may however be reversible...

  2. Plastic surgery in the treatment of primary melanoma of the skin

    Directory of Open Access Journals (Sweden)

    Panajotović Ljubomir

    2003-01-01

    Full Text Available Surgery is still the most effective treatment modality of skin melanoma. The margins of excision are determined by the thickness of primary tumor. From January 1999 to December 2001, 99 patients (57 male and 42 female, of the average age 55, were surgically treated at the Clinic for Plastic Surgery and Burns of the Military Medical Academy. The most usual localization of the primary tumor was the back (23.23%, followed by the forearm, and the lower leg. Regarding the clinical type of the melanoma, nodular melanoma dominated (62.62%. Microscopic staging of the melanoma (classification according to Clark and Breslow, showed that the majority of patients already suffered from the advanced primary disease, which called for radical excision and the choice of reconstructive methods in the closure of post-excision defects. The reconstructive plastic surgical methods enabled the closure of post-excision tissue defects, regardless of their size, structure, and localization. During the closure of post-excision defects, direct wound closure or split skin draft was performed in 76.76% of patients. Flaps were applied in 19.19% of patients with the primary melanoma of the head, face foot, and hand. The sufficiency of the available reconstructive procedures makes plastic surgery irreplaceable in the surgical treatment of the primary melanoma of the skin.

  3. Timing of surgery with regard to the menstrual cycle in women with primary breast cancer.

    Science.gov (United States)

    Badwe, R A; Mittra, I; Havaldar, R

    1999-10-01

    There is sufficient evidence to support both the hormonal influence on the outcome of breast cancer surgery and the SDA hypothesis. The SDA model produces a paradigm shift in the understanding of the natural history of breast cancer. It offers opportunities to try modifying a tumor's biological potential for metastasis (e.g., by tamoxifen, progesterone, antiprotease, or angiostatin) in the neoadjuvant setting. It continues to support the beneficial effects of detection and surgery early in the natural history of disease. It would be worthwhile to plan a trial comparing standard practice (unplanned surgery as the patient enrolls) with surgery during the luteal phase of the menstrual cycle in premenopausal women. Another possibility, based on studies of circulating progesterone, would be to compare primary progesterone treatment (for 4 to 10 days before surgery) with standard practice. Such a trial of primary progesterone is already under way, conducted by the Indian Breast Group. More than 200 patients have enrolled so far. The details of the trial are available from Clinical Research Secretariat, Tata Memorial Centre, Parel, Mumbai, India (e mail: tmho3@bom2.vsnl.in).

  4. Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery

    Directory of Open Access Journals (Sweden)

    Pukhraj Rishi

    2014-01-01

    Full Text Available A 65-year-old lady presented with decreased vision in left eye since seven months. Vision was 6/9 in right eye and 6/36 in left. Examination revealed idiopathic, full-thickness macular hole in left eye; confirmed by optical coherence tomography (OCT. Patient underwent phacoemulsification with intraocular lens (IOL implantation, vitrectomy, internal limiting membrane (ILM peeling and 14% C 3 F 8 gas injection. OCT repeated after six weeks revealed type II closure with cuff of subretinal fluid. Four weeks later, patient underwent fluid-gas exchange with 14% C 3 F 8 gas and postoperative positioning. OCT was repeated after two weeks, which showed complete closure of the macular hole. OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure. Macular holes with cuff of subretinal fluid are probably more likely to close on re-surgery than those without. However, larger studies with longer follow-up are required to validate this finding.

  5. F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: the APACH1 study.

    Science.gov (United States)

    Quak, Elske; Blanchard, David; Houdu, Benjamin; Le Roux, Yannick; Ciappuccini, Renaud; Lireux, Barbara; de Raucourt, Dominique; Grellard, Jean-Michel; Licaj, Idlir; Bardet, Stéphane; Reznik, Yves; Clarisse, Bénédicte; Aide, Nicolas

    2018-04-01

    To evaluate the sensitivity of F18-choline (FCH) PET/CT for parathyroid adenoma detection prior to surgery in patients with primary hyperparathyroidism and negative or inconclusive cervical ultrasound and Tc99m-sestaMIBI SPECT/CT. We conducted a prospective bicentric study (NCT02432599). All patients underwent FCH PET/CT. The result was scored positive, inconclusive or negative. The number of uptakes and their sites were recorded. The FCH PET/CT result guided the surgical procedure (minimally invasive parathyroidectomy, bilateral cervical exploration, or other in case of multiple or ectopic foci). FCH PET/CT results were compared to the surgical and pathological findings and the follow-up. Twenty-five patients were included. Mean calcium and PTH levels prior to surgery were 2.76 ± 0.17 mmol/l and 94.8 ± 37.4 ng/l. Nineteen (76%) FCH PET/CTs were scored positive, 3 (12%) inconclusive and 3 (12%) negative, showing 21 cases of uniglandular disease, including 1 ectopic localization and 1 case of multiglandular (3 foci) disease. Mean lesion size was 13.1 ± 8.6 mm. Twenty-four patients underwent surgery. FCH PET/CT guided surgery in 22 (88%) patients, allowing for 17 minimally invasive parathyroidectomies, 1 bilateral cervical exploration for multifocality and 4 other surgical procedures. Two patients with negative FCH-PET/CT underwent bilateral cervical exploration. When dichotomizing the FCH PET/CT results, thereby classifying the inconclusive FCH PET/CT results as positive, the per lesion and per patient sensitivities were 91.3% (95%CI: 72.0-98.9) and 90.5% (95%CI: 69.6-98.8) and the corresponding positive predictive values were 87.5% (95%CI: 67.6-97.3) and 86.4% (95%CI: 65.1-97.1), respectively. Twenty-one (88%) patients were considered cured after surgery. Their mean calcium level after surgery was 2.36 ± 0.17 mmol/l. Preoperative FCH PET/CT has a high sensitivity and positive predictive value for parathyroid adenoma detection in patients

  6. F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive. The APACH1 study

    International Nuclear Information System (INIS)

    Quak, Elske; Lireux, Barbara; Bardet, Stephane; Blanchard, David; Raucourt, Dominique de; Houdu, Benjamin; Le Roux, Yannick; Ciappuccini, Renaud; Grellard, Jean-Michel; Licaj, Idlir; Clarisse, Benedicte; Reznik, Yves; Aide, Nicolas

    2018-01-01

    To evaluate the sensitivity of F18-choline (FCH) PET/CT for parathyroid adenoma detection prior to surgery in patients with primary hyperparathyroidism and negative or inconclusive cervical ultrasound and Tc99m-sestaMIBI SPECT/CT. We conducted a prospective bicentric study (NCT02432599). All patients underwent FCH PET/CT. The result was scored positive, inconclusive or negative. The number of uptakes and their sites were recorded. The FCH PET/CT result guided the surgical procedure (minimally invasive parathyroidectomy, bilateral cervical exploration, or other in case of multiple or ectopic foci). FCH PET/CT results were compared to the surgical and pathological findings and the follow-up. Twenty-five patients were included. Mean calcium and PTH levels prior to surgery were 2.76 ± 0.17 mmol/l and 94.8 ± 37.4 ng/l. Nineteen (76%) FCH PET/CTs were scored positive, 3 (12%) inconclusive and 3 (12%) negative, showing 21 cases of uniglandular disease, including 1 ectopic localization and 1 case of multiglandular (3 foci) disease. Mean lesion size was 13.1 ± 8.6 mm. Twenty-four patients underwent surgery. FCH PET/CT guided surgery in 22 (88%) patients, allowing for 17 minimally invasive parathyroidectomies, 1 bilateral cervical exploration for multifocality and 4 other surgical procedures. Two patients with negative FCH-PET/CT underwent bilateral cervical exploration. When dichotomizing the FCH PET/CT results, thereby classifying the inconclusive FCH PET/CT results as positive, the per lesion and per patient sensitivities were 91.3% (95%CI: 72.0-98.9) and 90.5% (95%CI: 69.6-98.8) and the corresponding positive predictive values were 87.5% (95%CI: 67.6-97.3) and 86.4% (95%CI: 65.1-97.1), respectively. Twenty-one (88%) patients were considered cured after surgery. Their mean calcium level after surgery was 2.36 ± 0.17 mmol/l. Preoperative FCH PET/CT has a high sensitivity and positive predictive value for parathyroid adenoma detection in patients with primary

  7. A diagnostic dilemma following risk-reducing surgery for BRCA1 mutation – a case report of primary papillary serous carcinoma presenting as sigmoid cancer

    Directory of Open Access Journals (Sweden)

    Nash Guy F

    2007-09-01

    Full Text Available Abstract Background Women that carry germ-line mutations for BRCA1 or BRCA2 genes are at an increased risk of developing breast, ovarian and peritoneal cancer. Primary peritoneal carcinoma is a rare tumour histologically identical to papillary serous ovarian carcinoma. Risk-reducing surgery in the form of mastectomy and oophorectomy in premenopausal women has been recommended to prevent breast and ovarian cancer occurrence and decrease the risk of developing primary peritoneal cancer. Case presentation We present a case report of a woman with a strong family history of breast cancer who underwent risk-reducing surgery in the form of bilateral salpingo-oophorectomy following a mastectomy for a right-sided breast tumour. Following the finding of a BRCA1 mutation, a prophylactic left-sided mastectomy was performed. After remaining well for twenty-seven years, she presented with rectal bleeding and altered bowel habit, and was found to have a secondary cancer of the sigmoid colon. She was finally diagnosed with primary papillary serous carcinoma of the peritoneum (PSCP. Conclusion PSCP can present many years after risk-reducing surgery and be difficult to detect. Surveillance remains the best course of management for patients with known BRCA mutations.

  8. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Heliövaara, Arja; Küseler, Annelise; Skaare, Pål

    2017-01-01

    BACKGROUND AND AIM: Good dentofacial growth is a major goal in the treatment of unilateral cleft lip and palate (UCLP). The aim was to evaluate dental arch relationships at age 5 years after four different protocols of primary surgery for UCLP. DESIGN: Three parallel randomised clinical trials were...... undertaken as an international multi-centre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. METHODS: Three different surgical procedures for primary palatal repair (Arms B, C, D) were tested against a common procedure (Arm A) in the total cohort of 448 children born...

  9. Transoral robotic surgery for the management of head and neck squamous cell carcinoma of unknown primary

    DEFF Research Database (Denmark)

    Channir, Hani Ibrahim; Rubek, Niclas; Nielsen, Hans Ulrik

    2015-01-01

    CONCLUSION: The addition of transoral robotic surgery (TORS) in the diagnostic management of patients classified with head and neck squamous cell carcinoma of unknown primary (SCCUP) is promising and appears to improve detection rates of the primary tumour. The approach presented in this first...... Scandinavian study could potentially minimize the radiation field to the pharyngeal axis in patients with identified primary tumours. OBJECTIVES: The aim of the study was to investigate whether bilateral lingual tonsillectomy performed with TORS is feasible, and whether it could improve the detection rates...... of primary tumours in patients diagnosed and classified as having SCCUP. METHODS: The study was retrospective and included 13 patients with SCCUP who were referred to TORS between October 2013 and January 2015. All 13 patients had previously undergone a full investigation programme following the national...

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

    International Nuclear Information System (INIS)

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

    2016-01-01

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

  11. [Penis-preserving surgery in patients with primary penile urethral cancer].

    Science.gov (United States)

    Maek, M; Musch, M; Arnold, G; Kröpfl, D

    2014-12-01

    Primary urethral cancer in males is a rare entity with only approximately 800 cases described, which is why it is difficult to formulate evidence-based guidelines for treatment. For tumors in the pT2 stage with a localization distal to the membranous urethra, a penis-preserving operation can be carried out. In the period from November 2006 to February 2014 a total of 4 patients with primary urethral cancer underwent a penis-preserving urethral resection. The tumor characteristics and treatment results were collated retrospectively. Of the four patients one had a transitional cell carcinoma of the mid-penile urethra in stage pT2 G2. In two out of the four patients a squamous cell carcinoma (PEC) was present in the mid-penile urethra in stages pT2 G2 and pT2 G3, respectively, with concomitant carcinoma in situ (CIS). The fourth patient had a PEC of the fossa terminalis in stage pT2 G2. Initially all patients underwent a penis-preserving resection. In one case, despite an initial R0 resection a local recurrence occurred and a complete penectomy was performed. Irradiation and lymphadenectomy were not carried out. At a mean follow-up of 37 months all patients are currently in complete remission. Primary penile urethral cancer can be treated by a penis-preserving operation. Close follow-up is essential because recurrence can arise despite an initial R0 resection.

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

    Science.gov (United States)

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

    2016-05-01

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

  13. [Internal limiting membrane role in primary surgery of the macular hole].

    Science.gov (United States)

    Brănişteanu, D; Moraru, Andreea

    2013-01-01

    To assess the anatomical result after primary macular hole surgery with or without internal limiting membrane (ILM) peeling. To assess the safety and stability results; Prospective, comparative, interventional case study of 47 eyes with stage 3 or 4 macular hole treated by pars-plana vitrectomy between 2006 and 2011. In 19 cases (40.42%) only posterior hyaloid was removed (control group) while in the other 28 cases (59.57%) additional ILM peeling was performed. All cases had gas endotamponade. Postoperatively the cases were followed-up at least 6 months clinically and by OCT. Statistical analysis was performed using ANOVA and Wilcoxon tests. The mean age of patients in the study was 54, 47 +/- 4, 83 years (ranging from 47 to 74 years). In 36 cases (76.59%) the macular hole was idiopathic. After surgery, the macular hole closed in 22 out of 28 cases with ILM peeling (78.57%) as compared to only 13 out of 19 cases from the control group (68.42%). No intraoperative complications were noted. Main postoperative complications were cataract augmentation and macular hole enlargement in 4 out of 12 failed cases (33.33%). No recurrence was noted if macular hole closed after surgery. These results confirm the stability, safety and efficacy of both techniques but with a significant higher success rate if ILM is peeled. The main postoperative complication was macular hole enlargement if surgery failed.

  14. Postoperative abnormal response of C-reactive protein as an indicator for infectious complications after oral oncologic surgery with primary reconstruction.

    Science.gov (United States)

    Akashi, Masaya; Furudoi, Shungo; Hashikawa, Kazunobu; Sakakibara, Akiko; Hasegawa, Takumi; Shigeta, Takashi; Minamikawa, Tsutomu; Komori, Takahide

    2015-04-02

    C-reactive protein (CRP) screening has been reported to be reliable for detection of infectious complications. Postoperative abnormal response of CRP can predict wound infection in colorectal surgery. This study aimed to determine the efficacy of CRP monitoring to detect infectious complications in oral oncologic surgery. One hundred patients who underwent oral cancer resection with primary reconstruction were enrolled. Postoperative kinetics of CRP were classified into a normal or abnormal response. A normal CRP response after surgery was observed in 61 patients and an abnormal response was observed in 39. There were postoperative infectious complications in 21 patients, with surgical site infections in 13 patients (early onset in six and late onset in seven). Non-wound infections were found in nine patients. Sensitivity, specificity, the positive predictive value, and the negative predictive value for abnormal CRP response as a predictor for early infectious complications were 100%, 70.1%, 35.9%, and 100%, respectively. Postoperative serial CRP screening is a useful test as an indicator of infectious complications in oral oncologic surgery. Normal CRP responses can rule out almost all early infectious complications.

  15. Primary radiation therapy or surgery combined or not to radiation therapy in the management of squamous cell carcinoma of the penis

    International Nuclear Information System (INIS)

    Zouhair, Abderrahim; Ozsahin, Mahmut; Douglas, Pelham; Coucke, Philippe A.; Mirimanoff, Rene O.

    1997-01-01

    Purpose: To assess the prognostic factors and the outcome in patients with squamous cell carcinoma of the penis. Materials and Methods: A retrospective review of 41 consecutive patients with non-metastatic invasive carcinoma of the penis, treated between 1962 and 1994, was performed. The median age was 59 years (range: 35-76). Eight (20%) patients were circumcised, 30 (73%) were married, and only 2 (5%) had a history of venereal disease. Existence of a penile mass was the first symptom in 32 (78%) patients. The anatomic site was distributed as follows: glans in 17 (41%), prepuce in 9 (22%), shaft in 8 (20%), coronary localization in 4 (10%), prepuce and glans in 2 (5%), and shaft and prepuce in 1 (2%). According to UICC staging, there were 12 (29%) T1, 24 (59%) T2, 4 (10%) T3, and 1 TX (2%) tumors. The N-stage was distributed as follows: 29 (71%) patients with N0, 8 (20%) with N1, 3 (7%) with N2, and 1 (2%) with N3. Thirteen (32%) patients had grade 1, 7 grade 2, and 9 grade 3 tumors (grade was determined in 12). Forty-four percent (n = 18) of the patients underwent a curative surgery: partial penectomy with (n = 4) or without (n = 12) lymph node dissection, or total penectomy with (n = 1) or without (n = 1) lymph node dissection. All but 4 patients (operated) underwent primary (n = 23) or postoperative (n 14) radiotherapy to the penis and inguinal lymph nodes (n = 20), penis alone (n 9), or inguinal lymph nodes alone (n = 8). The median and mean follow-up period was 70 and 96 months, respectively (range: 20-331). Results: In a median period of 12 months (range: 5-139), 63% (n = 26) of the patients relapsed (local in 18, locoregional in 2, regional in 3, and distant in 3). Local failure was observed in 4 out of 16 (25%) patients treated with partial penectomy ± postoperative radiotherapy vs. in 14 out of 23 (61%) treated with primary radiotherapy (p = 0.06). Fifteen (83%) out of 18 local failures were successfully salvaged with surgery. At the time of analysis

  16. Salvage definitive chemo-radiotherapy for locally recurrent oesophageal carcinoma after primary surgery: retrospective review

    International Nuclear Information System (INIS)

    Baxi, S. H.; Burmeister, B.; Harvey, J. A.; Smithers, M.; Thomas, J.

    2008-01-01

    Full text: To determine the overall survival and gastrointestinal toxicity for patients treated with salvage definitive chemo-radiotherapy after primary surgery for locoregional relapse of oesophageal carcinoma. A retrospective review of 525 patients who had a resection for oesophageal or oesophagogastric carcinoma at Princess Alexandra Hospital identified 14 patients treated with salvage definitive radiotherapy or chemo-radiotherapy, following localized recurrence of their disease. We analysed the patient and treatment characteristics to determine the median overall survival as the primary end point. Gastrointestinal toxicity was examined to determine if increased toxicity occurred when the stomach was irradiated within the intrathoracic radiotherapy field. The median overall survival for patients treated with curative intent using salvage definitive chemo-radiotherapy was 16 months and the 2-year overall survival is 21%. One patient is in clinical remission more than 5 years after therapy. Age <60 years old and nodal recurrence were favourable prognostic factors. Treatment compliance was 93% with only one patient unable to complete the intended schedule. Fourteen per cent of patients experienced grade 3 or 4 gastrointestinal toxicity. Salvage definitive chemo-radiotherapy should be considered for good performance status patients with oesophageal carcinoma who have a locoregional relapse after primary surgery. The schedule is tolerable with low toxicity and an acceptable median survival

  17. Restorative Surgery in Patients With Primary Sclerosing Cholangitis and Ulcerative Colitis Following a Colectomy.

    Science.gov (United States)

    Nordenvall, Caroline; Olén, Ola; Johan Nilsson, Per; Ekbom, Anders; Bottai, Matteo; Myrelid, Pär; Bergquist, Annika

    2018-02-15

    Studies on surgical procedures in patients with concomitant primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) have mainly been restricted to single centers. The aim was to compare surgical treatment of UC with or without PSC in a nationwide study. A cohort study including all patients diagnosed with UC between 1987 and 2014 in Sweden was undertaken. The impact of PSC on the risk of colectomy, the chance of restorative surgery, and risk of failure (presence of a stoma) following restorative surgery were estimated. Survival analyses were performed using the Kaplan-Meier method and multivariable Cox regression models. Of 49 882 UC patients, 2079 had a PSC diagnosis at the end of follow-up. The risk of colectomy was unaffected by PSC diagnosis, whereas the chance of restorative surgery was elevated in PSC-UC patients (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.02-1.44). Ileorectal anastomosis (IRA) was performed in 63% of the PSC-UC patients and 43% of the non-PSC-UC-patients, and the corresponding numbers for ileal pouch anal anastomosis (IPAA) were 35% and 53%. There was no significantly increased risk of failure following restorative surgery in PSC patients (HR, 1.44; 95% CI, 0.93-2.22). In PSC-UC patients, the cumulative failure rates following an IRA at 3 and 5 years were 15% and 18%, and following an IPAA they were 11% and 18%, respectively. Presence of PSC is not associated with the risk of colectomy, whereas the chance of restorative surgery in PSC-UC patients is higher than in UC alone.

  18. Melatonin, cortisol, prolactin, and calcitonin secretion in primary hyperparathyroidism before and after surgery.

    Science.gov (United States)

    Brismar, K; Werner, S; Bucht, E; Wetterberg, L

    1987-01-01

    The aim of the present study was to determine the diurnal secretion of melatonin, cortisol, prolactin, and calcitonin during chronic parathyroid hormone-dependent hypercalcemia. Eight women, aged 40-76 years, with primary hyperparathyroidism (PHPT) were studied before and after surgical removal of a parathyroid adenoma. The hormone concentrations in blood were determined at 08, 12, 16, 22, 02, 04, and 06 h. Concomitantly, the excretion of melatonin and cortisol in urine between 07-19 h and 19-07 h, and the clearance of calcium and creatinine were measured. Nyctohemeral serum prolactin and calcitonin were unaffected by moderate parathyroid hormone-dependent hypercalcemia. In contrast, serum cortisol and melatonin were significantly higher during active disease than after surgical cure. Mean 24-h variation of serum cortisol was 349 +/- 34 nmol/liter vs. 223 +/- 17 nmol/liter and mean serum melatonin was 0.13 +/- 0.04 nmol/liter vs. 0.06 +/- 0.02 nmol/liter. Endogenous creatinine clearance was similar before and after surgery, while the clearance of melatonin and cortisol significantly increased after surgery, indicating an increased tubular reabsorption of both hormones during active disease. Fasting morning glucose concentrations were also significantly decreased after successful surgery, 6.1 +/- 0.6 vs. 5.2 +/- 0.5 mmol/liter. It is suggested that the relative hypercortisolism may be the cause of the glucose intolerance in primary hyperparathyroidism. Three to 4 months after surgical cure the serum melatonin levels were significantly lower than those seen in age-matched controls, indicating a melatonin insufficiency in patients successfully treated for PHPT. The meaning of this finding is not yet understood but might be of importance in the development of primary hyperparathyroidism.

  19. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Willadsen, Elisabeth; Lohmander, Anette; Persson, Christina

    2017-01-01

    BACKGROUND AND AIM: Normal articulation before school start is a main objective in cleft palate treatment. The aim was to investigate if differences exist in consonant proficiency at age 5 years between children with unilateral cleft lip and palate (UCLP) randomised to different surgical protocols...... for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. DESIGN: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark......, Finland, Norway, Sweden, and the UK. METHODS: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with non-syndromic UCLP. Speech audio- and video-recordings of 391 children (136 girls and 255 boys) were available...

  20. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Lohmander, Anette; Persson, Christina; Willadsen, Elisabeth

    2017-01-01

    BACKGROUND AND AIM: Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP...... cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. METHODS: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children......) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. DESIGN: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10...

  1. Local melanoma recurrences in the scar after limited surgery for primary tumor

    DEFF Research Database (Denmark)

    Drzewiecki, K T; Andersson, A P

    1995-01-01

    primary melanomas: 18 superficial spreading, 4 nodular, 3 lentigo malignant, and 9 unclassified. Twelve tumors were dermal melanoma metastases. The median thickness of the 25 measurable melanomas was 0.78 mm. The 5-year overall survival was 69%. At the closing date of the study 15 patients had died, 13......The clinical and histologic records of 46 consecutive patients were reviewed who during the period 1980-1993 had recurrence from melanoma in the scar after limited surgery for a skin tumor. They constituted about 50% of all patients admitted with local recurrence from melanoma during this period....... At reexamination of the primary tumors, 16 were found to be malignant melanomas and 9 were nevi (four atypical and five benign). Twenty-one were missing, 11 of which had never been set for histologic examination. The median thickness of nine measurable melanomas was 0.66 mm. The recurrences in scar consisted of 34...

  2. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction.

    Science.gov (United States)

    Lodders, Johannes N; Parmar, Satyesh; Stienen, Niki L M; Martin, Timothy J; Karagozoglu, K Hakki; Heymans, Martijn W; Nandra, Baljeet; Forouzanfar, Tymour

    2015-11-01

    The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Desired data was retrieved from a computer database at the department of Oral and Maxillofacial Department, Queen Elisabeth hospital Birmingham, United Kingdom, between June 2007 and October 2012. Logistic regression was used to study relationships between preoperative variables and postoperative outcomes. The study population consisted 184 patients, comprising 189 composite resections with reconstruction. Complications developed in 40.2% of the patients. Three patients (1.6%) died, 11.1% returned to the operating room, 5.3% developed donor site complications and 6.9% flap complications of which 3.2% total flap failure. In the multivariable analysis systemic complications were associated with anaesthesia time and hospital stay with red cell transfusion. A significant proportion of the patients with primary free flap reconstructions after oral cancer surgery develops postoperative complications. Prolonged anaesthesia time and red cell transfusion are possible predictors for systemic complications and hospital stay respectively. Preoperative screening for risk factors is advocated for patient selection and to have realistic information and expectations.

  3. Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System.

    Science.gov (United States)

    Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chen, Xi; Cakiner-Egilmez, Tulay; Chomsky, Amy; Baze, Elizabeth; Vollman, David; Lawrence, Mary G; Daly, Mary K

    2016-03-01

    To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases. Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers. Retrospective data analysis of deidentified data. Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B). The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001). Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  4. Changing Epidemiology of Bariatric Surgery in the UK: Cohort Study Using Primary Care Electronic Health Records.

    Science.gov (United States)

    Booth, Helen P; Khan, Omar; Fildes, Alison; Prevost, A Toby; Reddy, Marcus; Charlton, Judith; Gulliford, Martin C

    2016-08-01

    This study aimed to use primary care electronic health records to evaluate the epidemiology of bariatric surgery in the UK. A cohort comprising all obese patients with a bariatric surgical procedure was drawn from the Clinical Practice Research Datalink (CPRD). Rates of bariatric surgery were estimated using the registered CPRD population as denominator. There were 3039 adult obese patients with first bariatric surgery procedures between 2002 and 2014, including laparoscopic adjustable gastric banding (LAGB), 1297; gastric bypass (GBP), 1265; and sleeve gastrectomy (SG), 477. Annual procedures increased from one in 2002 to a maximum of 525 in 2010. Intervention rates were greatest among those aged 35-54, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. The mean age and body mass index of participants increased, as did the proportion of men and proportion with diabetes. Between 2002 and 2006, LAGB accounted for >90 % of procedures; in 2014, GBP accounted for 52 % and SG 26 %. Among patients initially receiving LAGB, the rate of band removal was 1.6 (95 % confidence interval 1.3-2.0) per 100 patient years; the rate of a second procedure of a different type was 1.2 (0.9-1.5) per 100 patient years. Numbers of bariatric surgical procedures have increased with increasing use of GBP and SG. Rates of bariatric surgery per 100,000 population remain low and provide evidence of limited access to bariatric surgical procedures in relation to need.

  5. Parathyroid Carcinoma in Patients that Have Undergone Surgery for Primary Hyperparathyroidism.

    Science.gov (United States)

    Libánský, Petr; Adámek, Svatopluk; Broulík, Petr; Fialová, Martina; Kubinyi, Josef; Lischke, Robert; Naňka, Ondřej; Pafko, Pavel; Šedý, Jiří; Bobek, Vladimír

    2017-01-01

    Parathyroid carcinoma is a rare clinical entity, which represents one of the main reasons, why surgery should be performed in specialized centres. Preoperatively, it is very difficult to distinguish between benign and malignant hyperparathyroidism. During the years 1996-2016, we performed 2,220 operations in 2,075 patients with a diagnosis of primary hyperparathyroidism. Among these 2,220 operations, there were 16 operations for parathyroid carcinoma. These 16 operations, including reoperations, were performed in four patients. Two patients had no reoperation, but another 2 patients required 14 reoperations in total. Parathyroid carcinoma was described in 0.2% of all patients with a diagnosis of primary hyperparathyroidism. The number of operations was 0.73% of all operations of primary hyperparathyroidism in years 1996-2016. Prognosis of parathyroid carcinoma is quite favourable, patients evidence a long-term survival rate after the primary operation. However, every reoperation increases the number of possible complications, including recurrent laryngeal nerve injury. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  6. Management of biliary symptoms after bariatric surgery.

    Science.gov (United States)

    Brockmeyer, Joel R; Grover, Brandon T; Kallies, Kara J; Kothari, Shanu N

    2015-12-01

    Biliary disease requiring intervention can be complicated in the postbariatric surgery patient. A retrospective review was completed to identify patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy from September 2001 to September 2014, and those who underwent biliary intervention were identified. A total of 1527 patients underwent bariatric surgery during the study period. Of the 1,112 patients without prior cholecystectomy, 91 (8%) had biliary symptoms requiring intervention. Ninety patients underwent cholecystectomy, with 86 successfully completed laparoscopically. Six patients required laparoscopy-assisted percutaneous transgastric endoscopic retrograde cholangiopancreatography along with cholecystectomy to clear gallstones from the common bile duct. Three patients who had undergone cholecystectomy before bariatric surgery developed primary common bile duct stones. Surgery for biliary disease after bariatric surgery can be completed successfully with minimal complications, and percutaneous transgastric endoscopic retrograde cholangiopancreatography has a high success rate of access to and clearance of the biliary tree. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Assessment of intraoperative tube thoracostomy after diaphragmatic resection as part of debulking surgery for primary advanced-stage Müllerian cancer.

    Science.gov (United States)

    Kato, Kazuyoshi; Tate, Shinichi; Nishikimi, Kyoko; Shozu, Makio

    2013-10-01

    The present study assessed the use of an intraoperative tube thoracostomy for patients with primary advanced-stage ovarian, fallopian tube, or peritoneal cancer who underwent a diaphragmatic resection as part of debulking surgery and to define which patients are more likely to benefit from an intraoperative tube thoracostomy. All consecutive patients with stage IIIC-IV Müllerian cancer who underwent diaphragmatic resection at our institution between April 2008 and March 2013 were retrospectively reviewed. When a full-thickness resection of the diaphragm was performed and the thoracic cavity was opened, a chest tube was routinely placed during surgery. Patient-, disease-, and surgery-related data were collected from the patients' medical records. The data were evaluated with particular attention directed at pleural effusion after diaphragmatic resection. A total of 37 patients were included in this study. No complications associated with the intraoperative tube thoracostomy procedures occurred. An infection of the thoracic cavity occurred in one patient, following the presence of intra-abdominal abscess. The total volume of pleural drainage ranged from 88 to 2826 mL (median, 965 mL). The estimated blood loss, intraoperative blood transfusion, and area of the diaphragmatic opening were significantly associated with the total volume of pleural drainage in univariate analyses. In a multivariate analysis, the estimated blood loss was the only factor to be significantly associated with the total volume of pleural drainage. A prophylactic tube thoracostomy might be considered if the volume of the estimated blood loss is higher than usual. © 2013.

  8. Reduction in primary genu recurvatum gait after aponeurotic calf muscle lengthening during multilevel surgery.

    Science.gov (United States)

    Klotz, M C M; Wolf, S I; Heitzmann, D; Krautwurst, B; Braatz, F; Dreher, T

    2013-11-01

    Knee hyperextension (genu recurvatum, GR) is often seen in children with bilateral spastic cerebral palsy (CP). Primary GR appears essential without previous treatment. As equinus deformity is suspected to be one of the main factors evoking primary GR, the purpose of this study was to determine whether lengthening the calf muscles to decrease equinus would decrease coexisting GR in children with bilateral spastic CP. In a retrospective study, 19 CP patients with primary GR (mean age: 9.4 years, 13 male, 6 female, 26 involved limbs) in whom an aponeurotic calf muscle lengthening procedure was performed during single-event multilevel surgery were included and investigated using three-dimensional gait analysis before and at a mean follow-up of 14 months after the procedure according to a standardized protocol. After calf muscle lengthening, a significant improvement in ankle dorsiflexion (9.5°) and a significant reduction (10.5°) in knee hyperextension (pcalf muscle lengthening can effectively reduce GR in patients with CP. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Resultado funcional e índice macular em portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna Functional outcome and macular index in macular hole patients who underwent surgery with internal limiting membrane removal

    Directory of Open Access Journals (Sweden)

    José Ricardo Diniz

    2008-04-01

    Full Text Available OBJETIVOS: Avaliar o resultado funcional e o índice macular dos portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna. MÉTODOS: Quinze olhos de 15 pacientes com buraco macular estágios 2, 3 e 4 foram incluídos no estudo. Todos foram submetidos à cirurgia de buraco macular convencional com remoção da membrana limitante interna corada pelo azul de tripan. Melhor acuidade visual com correção e cortes transversais medidos por tomografia de coerência óptica (OCT foram avaliados no pré- e pós-operatório. O índice macular (razão entre a altura e base do buraco macular foi calculado e correlacionado com o diâmetro mínimo do buraco macular e o ganho de acuidade visual pós-operatória. RESULTADOS: Obteve-se fechamento do buraco macular em todos pacientes operados. Em 86,7%, houve ganho de pelo menos três linhas de visão. O índice macular demonstrou correlação negativa significante com o diâmetro mínimo (r=0,811. Não foi observada correlação significante entre o índice macular e o ganho de acuidade visual pós-operatória (r=0,351. CONCLUSÃO: Os resultados funcionais na cirurgia do buraco macular com remoção da membrana limitante interna foram bons neste grupo de pacientes. O índice macular demonstrou ser compatível com a configuração espacial do buraco macular, porém não foi preditor de resultados visuais.PURPOSE: To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS: Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT were evaluated pre- and postoperatively. The macular hole index

  10. Psychological, behavioral, and weight-related aspects of patients undergoing reoperative bariatric surgery after gastric band: comparison with primary surgery patients.

    Science.gov (United States)

    Conceição, Eva; Pinto-Bastos, Ana; de Lourdes, Marta; Brandão, Isabel; Teixeira, Cristina; Machado, Paulo P P

    2018-02-15

    Patients experiencing insufficient weight loss or weight regain in their first bariatric surgery may represent a high-risk group with greater problematic eating and general psychopathology levels, which may compromise the success of a reoperative procedure. This study seeks to describe and compare disordered eating-related psychological and behavioral features of primary and reoperative surgery candidates after gastric band. Hospital center and university in Portugal. The baseline (preoperative) data from a longitudinal observational study are presented. Patients were interviewed by trained psychologists to identify binge-eating episodes and grazing and responded to a set of self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. Two hundred twenty-five patients were undergoing primary surgery, and 166 were undergoing reoperative (REOP group) surgery. The groups did not differ in body mass index preoperatively, but the REOP group had greater weight suppression (t 387 = -5.35, P = .001), higher highest (t 387 = -3.40, P = .001) and lower lowest body mass index (t 381 = 2.22, P = .03). The main reasons for reoperative surgery were weight regain/poor weight loss (42.8%) or medical complications (32.5%). REOP patients with objective binge eating reported a higher frequency of these episodes (t 47 = 2.15, P = .04). No significant difference was found for the self-report measures assessed (only shape concern was higher for REOP group, F 1,216 = 8.30, Psurgeries, the differences in binge eating and weight-related variables may associate with postoperative difficulties. The link between binge eating, weight suppression, and weight gain found in other samples suggests that patients undergoing reoperative surgery may be at increased risk for poor weight outcomes. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  11. No. 127-The Evaluation of Stress Incontinence Prior to Primary Surgery.

    Science.gov (United States)

    Farrell, Scott A

    2018-02-01

    To provide clinical guidelines for the evaluation of women with stress urinary incontinence prior to primary anti-incontinence surgery. The modalities of evaluation range from basic pelvic examination through to the use of adjuncts including ultrasound and urodynamic testing. These guidelines provide a comprehensive approach to the preoperative evaluation of urinary incontinence to ensure that excessive evaluation is avoided without sacrificing diagnostic accuracy. Published opinions of experts, supplemented by evidence from clinical trials, where appropriate. The quality of the evidence is rated using the criteria described by the Canadian Task Force on the Periodic Health Examination. Comprehensive evaluation of women considering surgery to treat urinary incontinence is essential to rule out causes of incontinence that may not be amenable to surgical treatment. Simplifying the evaluation minimizes the discomfort and embarrassment potentially experienced by women. VALIDATION: These guidelines have been approved by the Urogynaecology Committee and the Executive and Council of The Society of Obstetricians and Gynaecologists of Canada. Copyright © 2018. Published by Elsevier Inc.

  12. The natural history and hip geometric changes of primary hyperparathyroidism without parathyroid surgery.

    Science.gov (United States)

    Jung, Kyong Yeun; Hong, A Ram; Lee, Dong Hwa; Kim, Jung Hee; Kim, Kyoung Min; Shin, Chan Soo; Kim, Seong Yeon; Kim, Sang Wan

    2017-05-01

    There have been few reports on changes in bone geometry in asymptomatic patients with primary hyperparathyroidism (PHPT) not treated surgically. We reviewed the records concerning biochemical parameters, bone mineral density (BMD), and hip geometry in 119 PHPT patients who did not undergo parathyroidectomy, followed up at one of three hospitals affiliated to Seoul National University from 1997 to 2013. We examined biochemical parameters over 7 years and BMD and hip geometry over 5 years of follow-up. We further compared hip geometry and BMD derived from dual-energy X-ray absorptiometry (DXA) between patients and age- and sex-matched controls. The median follow-up duration of 56 patients for whom surgery was not indicated was 33.9 months (range 11.2-131.2 months), and 19.6 % of these patients had disease progression during follow-up. Serum calcium levels remained stable for 7 years in all 119 patients. From a comparison of the PHPT patients for whom surgery was not indicated with controls, both male and postmenopausal female patients had significantly lower hip axis length (P Hip geometry is a potential tool for monitoring skeletal complication in asymptomatic PHPT patients.

  13. Scandcleft Randomised Trials of Primary Surgery for Unilateral Cleft Lip and Palate. Planning and Management

    DEFF Research Database (Denmark)

    Semb, Gunvor; Enemark, Hans; Paulin, Gunnar

    2017-01-01

    Background and aims: Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born...... with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project. Method: Ten established national or regional...... cleft centres participated. Lip and soft palate closure at 3–4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3–4 months and hard and soft palate closure at 12...

  14. A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Semb, Gunvor; Enemark, Hans; Friede, Hans

    2017-01-01

    BACKGROUND AND AIMS: Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born...... with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project. METHOD: Ten established national or regional...... cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12...

  15. Primary stapedotomy in children with otosclerosis : A prospective study of 41 consecutive cases

    NARCIS (Netherlands)

    Vincent, Robert; Wegner, Inge; Vonck, Bernard M D; Bittermann, Arnold J; Kamalski, Digna M A; Grolman, Wilko

    2016-01-01

    OBJECTIVES/HYPOTHESIS: To prospectively evaluate hearing outcomes in children with otosclerosis undergoing primary stapes surgery. STUDY DESIGN: A nonrandomized, nonblinded, prospective case series. METHODS: Thirty-four consecutive pediatric patients who underwent 41 primary stapedotomies for

  16. Surgery

    Science.gov (United States)

    ... and sterile gloves. Before the surgery begins, a time out is held during which the surgical team confirms ... the Consumer Version. DOCTORS: Click here for the Professional Version What Participants Need to Know About Clinical ...

  17. The potential for cross-addiction in post-bariatric surgery patients: Considerations for primary care nurse practitioners.

    Science.gov (United States)

    Bak, Melissa; Seibold-Simpson, Susan M; Darling, Rosa

    2016-12-01

    Possible mental health issues for post-bariatric surgery patients include the development of cross-addictions after the rapid weight loss period. No validated screening tool to assess for possible cross-addictions exists. The main purpose of this study was to develop recommendations for modifying an existing addiction screening tool (the Shorter PROMIS Questionnaire) for use by primary care providers. A qualitative descriptive design was used with triangulation of input from the scholarly literature, content experts (CEs), and post-bariatric surgery patients. Three focus groups were conducted with post-bariatric surgery patients (n = 12) with the same questions asked of the CEs (n = 3). Content analysis was used to analyze the transcripts. The following themes regarding addictions after bariatric surgery were identified through consensus: alcohol, gambling, shopping, exercise, food starving/bingeing, and sexuality/relationships. Dissonant themes included caffeine and tobacco by the post-bariatric surgery patients and prescription/illicit medications by the CEs. Targeted screening for early identification of problem behaviors by primary care providers may result in appropriate referral to and management by mental health providers, assisting ongoing success of bariatric surgery. ©2016 American Association of Nurse Practitioners.

  18. [Primary intestinal parasitic fibroid, an incidental finding during gynecological laparoscopic surgery].

    Science.gov (United States)

    Alcalá-Alcalde, M M; Pantoja-Garrido, M; Frías-Sánchez, Z

    2016-09-01

    Uterine fibroids are the most frequent solid pelvic benign tumors in women. Their most common location is the uterine corpus, cervix and broad ligament but they can also be found in other areas, less commonly as extragenital locations and/or in a parasitic way. A 40 years old patient, who consulted for menorrhagia and dysmenorrhea on long evolution. On physical examination, the enlarged uterus, inflamated, hard consistency and normal mobility was identified. The sonographic features and location suggested a fibroid nodule type II (Wamsteker classification), which deformed the endometrial cavity. It was decided to perform the surgery and during the procedure the enlarged uterus, deformed at the expense of a localized fundal formation, like a intramural fibroid. By mobilizing the intestinal loops and change the position of the patient (Trendelenburg) a solid tumor, cranially separated from the internal genitals it was observed. In reviewing the insertion site, it was visualized that remained attached to antimesial of the jejunum. Total hysterectomy was performed with monopolar and bipolar energy, and vascular sealant. The postoperative was favorable, without complication. The pathological study reported a primary leiomyoma of the small intestine, while in the uterus of multiple myomas was confirmed. The parasitic fibroids are those located separately from the uterus that receive vascular irrigation from another organ or abdominopelvic structure. They are a very rare pathology. The diagnosis has made as an accidental event, during an abdominal surgery or during the differential diagnosis of a abdominopelvic tumor. The therapeutical choice depends on the clinical presentation, the location of the fibroid and the reproductive desires of the patient, most commonly recomending their surgycal removal.

  19. Health-Related Quality of Life after surgery for primary advanced rectal cancer and recurrent rectal cancer

    DEFF Research Database (Denmark)

    Thaysen, Henriette Vind; Jess, Per; Laurberg, Søren

    2012-01-01

    Aim: A review of the literature was undertaken to provide an overview of Health-related quality of life (HRQoL) after surgery for primary advanced or recurrent rectal cancer and to outline proposals for future HRQoL studies in this area. Method: A systematic literature search was undertaken. Only...... studies concerning surgery for primary advanced or recurrent rectal cancer and describing methods used for measuring HRQoL were considered. Results Seven studies were identified including two prospective longitudinal, three cross-sectional and two based on qualitative data. Global quality of life...... of time of impaired HRQoL and also if this is different after surgery for locally advanced or recurrent disease than after total mesorectal excision used for earlier tumours.. Conclusion Several aspects of HRQoL are impaired for a variable time after treatment for locally advanced or recurrence of rectal...

  20. Parental Decisional Regret after Primary Distal Hypospadias Repair: Family and Surgery Variables, and Repair Outcomes.

    Science.gov (United States)

    Ghidini, Filippo; Sekulovic, Sasa; Castagnetti, Marco

    2016-03-01

    Decisional regret is defined as distress after making a health care choice and can be an issue for parents electing distal hypospadias repair for their sons. We assessed the influence on decisional regret of variables related to the family, surgery and outcomes. Charts for 372 patients undergoing primary distal hypospadias repair between 2005 and 2012 were reviewed, and validated questionnaires, including the Decisional Regret Scale, Pediatric Penile Perception Score and Dysfunctional Voiding and Incontinence Scoring System, were administered to parents. Data were available for 172 of 372 families (response rate 46.2%). Of 323 parents 128 (39.6%) presented with moderately strong decisional regret, with good agreement within couples. Predictors of decisional regret included intermediate parental educational level (OR 3.19, 95% CI 1.52-6.69), patient not being the first born (OR 2.01, 95% CI 1.07-3.78), family history of hypospadias (OR 4.42, 95% CI 1.96-9.97), initial desire to avoid surgery (OR 2.07, 95% CI 1.04-4.12), younger age at followup (OR 0.81, 95% CI 0.72-0.91), presence of lower urinary tract symptoms (OR 4.92, 95% CI 1.53-15.81) and lower Pediatric Penile Perception Score (OR 0.86, 95% CI 0.75-0.99). Decisional regret was unrelated to parental desire to avoid circumcision, surgical variables, development of complications and duration of followup. Decisional regret is a problem in a significant proportion of parents electing distal hypospadias repair for their sons. In our experience family variables seemed to be predictors of decisional regret, while surgical variables did not. Predictors of decisional regret included worse parental perception of penile appearance and the presence of lower urinary tract symptoms. However, the latter could be unrelated to surgery. Irrespective of the duration of followup, decisional regret seems decreased in parents of older patients. Copyright © 2016 American Urological Association Education and Research, Inc

  1. Early and late physical and psychosocial effects of primary surgery in patients with oral and oropharyngeal cancers

    DEFF Research Database (Denmark)

    Mortensen, Annelise; Jarden, Mary

    2016-01-01

    The purpose of this systematic review is to explore early and late physical and psychosocial effects of primary surgery for oral and oropharyngeal cancers and to investigate the factors that influence these effects. PubMed, Cinahl, and PsycInfo were searched for studies concerning patients...

  2. The value of contrast-enhanced laparoscopic ultrasound during robotic-assisted surgery for primary colorectal cancer

    DEFF Research Database (Denmark)

    Ellebaek, Signe Bremholm; Fristrup, Claus Wilki; Pless, Torsten

    2018-01-01

    AIM: The aim of this study was to assess the potential clinical value of contrast enhanced laparoscopic ultrasonography (CE-LUS) as a screening modality for liver metastases during robotic assisted surgery for primary colorectal cancer (CRC). METHOD: A prospective, descriptive (feasibility) study......, but larger controlled studies on high-risk patients seem relevant....

  3. A predictive model of suitability for minimally invasive parathyroid surgery in the treatment of primary hyperparathyroidism [corrected].

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2012-05-01

    Improved preoperative localizing studies have facilitated minimally invasive approaches in the treatment of primary hyperparathyroidism (PHPT). Success depends on the ability to reliably select patients who have PHPT due to single-gland disease. We propose a model encompassing preoperative clinical, biochemical, and imaging studies to predict a patient\\'s suitability for minimally invasive surgery.

  4. Surgery for post-operative entero-cutaneous fistulas: is bowel resection plus primary anastomosis without stoma a safe option to avoid early recurrence? Report on 20 cases by a single center and systematic review of the literature.

    Science.gov (United States)

    Lauro, A; Cirocchi, R; Cautero, N; Dazzi, A; Pironi, D; Di Matteo, F M; Santoro, A; Faenza, S; Pironi, L; Pinna, A D

    2017-01-01

    A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas). The search yielded 4.098 articles but only 15 were relevant: 1.217 patients underwent surgery. The interval time between fistula's diagnosis and operative repair was between 3 months and 1 year. A bowel resection with primary anastomosis was performed in 1.048 patients, 192 (18.3%) underwent a covering stoma: 856 patients (81.7%) had a fistula takedown in one procedure. The patients had 14.3% recurrence and 13.1% mortality rate. In our experience 75% were surgically treated after a period equal or above one year from fistula occurrence: surgery was very demolitive (in 40% remnant small bowel was less than 100 cm). We performed a bowel resection with a hand-sewn anastomosis (95%) without temporary stoma. In-hospital mortality was 0% and at discharge all were back to oral intake with 0% early re-fistulisation. Literature supports our experience: ECF takedown could be safely performed after an adequate period of recovery from 3 months to one year from fistula occurrence. In our series primary repair (bowel resection plus reconnection surgery without temporary stoma) avoided an early recurrence without mortality.

  5. Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis?

    Science.gov (United States)

    Byrne, Kathryn; Levins, Kirk J; Buggy, Donal J

    2016-02-01

    Mortality among cancer patients is more commonly due to the effects of metastasis and recurrence as opposed to the primary tumour. Various perioperative factors have been implicated in tumour growth, including anesthetic agents and analgesia techniques. In this narrative review, we integrate this information to present a summary of the best available evidence to guide the conduct of anesthesia for primary cancer surgery. We conducted a search of the PubMed database up to May 31, 2015 to identify relevant literature using the search terms "anesthesia and metastases", "anesthetic drugs and cancer", "volatile anesthetic agents and cancer", and "anesthetic technique and cancer". There is conflicting evidence regarding volatile agents; however, the majority of studies are in vitro, suggesting that these agents are associated with enhanced expression of tumourigenic markers as well as both proliferation and migration of cancer cells. Nitrous oxide has not been shown to have any effect on cancer recurrence. Local anesthetic agents may reduce the incidence of cancer recurrence through systemic anti-inflammatory action in addition to direct effects on the proliferation and migration of cancer cells. Nonsteroidal anti-inflammatory drugs affect cancer cells via inhibition of cyclooxygenase 2 (COX-2), which leads to reduced resistance of the cancer cell to apoptosis and reduced production of prostaglandins by cancer cells. Nonsteroidal anti-inflammatory drugs also suppress the cancer cell growth cycle through effects independent of COX-2 inhibition. Opioids have been shown to inhibit the function of natural killer cells and to stimulate cancer cell proliferation through effects on angiogenesis and tumour cell signalling pathways. Supplemental oxygen at the time of surgery has a proangiogenic effect on micrometastases, while the use of perioperative dexamethasone does not affect overall rates of cancer survival. Current laboratory research suggests that perioperative

  6. Surgery

    Science.gov (United States)

    ... surgery has several common causes, including the following: Infections at the operative site Lung problems such as pneumonia or collapsed lung ... the trauma of an operation. The risk of infections at the operative site, DVTs, and UTIs can be decreased by meticulous ...

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

    Directory of Open Access Journals (Sweden)

    Zaatreh, Sarah

    2016-12-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  9. Knowledge and Perception of Bariatric Surgery Among Primary Care Physicians: a Survey of Family Doctors in Ontario.

    Science.gov (United States)

    Auspitz, Mark; Cleghorn, Michelle C; Azin, Arash; Sockalingam, Sanjeev; Quereshy, Fayez A; Okrainec, Allan; Jackson, Timothy D

    2016-09-01

    The primary objective of this study was to identify Ontario family physicians' knowledge and perceptions of bariatric surgery. The study population included all physicians practicing family medicine in Ontario who were listed in the Canadian Medical Directory. A self-administered questionnaire consisting of 28 questions was developed and validated using a focus group of seven primary care physicians. The questionnaire was distributed to 1328 physicians. One hundred sixty-five surveys were completed. 8.8 % of physicians did not have any bariatric surgical patients, and 71.3 % had no more than five in their practice. 70.2 % referred no more than 5 % of their morbidly obese patients for surgery. Only 32.1 % had the appropriate equipment and resources to manage obese patients. 92.5 % of physicians would like to receive more education about bariatric surgery. Physicians with no history of referral (n = 21) were earlier into their practices and had less morbidly obese patients than physicians with previous referrals (n = 141). They were also less likely to discuss bariatric surgery with their patients (30 vs. 79.3 %; p surgery, compared to 85.4 % of physicians with previous referrals; p = 0.002. There appears to be a knowledge gap in understanding the role of bariatric surgery in the treatment of obesity. There is an opportunity to improve education and available resources for primary care physicians surrounding patient selection and follow-up care. This may improve access to treatment.

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

    Science.gov (United States)

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

    2016-11-01

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

  11. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  12. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  13. Avaliação da dor em recém-nascidos submetidos à cirurgia cardiáca Evaluación del dolor en recién nacidos sometidos a cirugía cardiaca Pain assessment in neonates who underwent cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mariana Bueno

    2007-12-01

    Full Text Available OBJETIVOS: Identificar o método utilizado para avaliar a dor pós-operatória em cirurgia cardíaca neonatal; verificar a freqüência de avaliação e identificar a prevalência de dor pós-operatória. MÉTODOS: Estudo transversal com coleta de dados retrospectiva. RESULTADOS: A maioria (80,0% dos neonatos foi avaliada quanto a dor, o método mais utilizado foi a escala Neonatal Infant Pain Scale (NIPS (56,7%. A freqüência de avaliações variou entre uma e 13 vezes e a maior parte dos neonatos teve sete ou mais avaliações. A maioria (56,7% apresentou registro de dor e a média de episódios de dor foi 1,8. CONCLUSÃO: Tanto o método quanto a freqüência de avaliação de dor não seguem padronização e a prevalência de ocorrência de dor foi elevada.OBJETIVOS: Identificar el método utilizado para evaluar el dolor post-operatoria en cirugía cardiaca neonatal; verificar la frecuencia de la evaluación e identificar la prevalencia del dolor post-operatorio. MÉTODOS: Estudio transversal con recolección de datos retrospectiva. RESULTADOS: La mayoría (80,0% de neonatos fue evaluado en cuanto al dolor, el método más utilizado fue la escala Neonatal Infant Pain Scale (NIPS (56,7%. La frecuencia de evaluaciones varió entre una y 13 veces y la mayor parte de los neonatos tuvo siete o más evaluaciones. La mayoría (56,7% presentó registro de dolor y el promedio de los episodios fue de 1,8. CONCLUSIÓN: el método respecto a la frecuencia de evaluaciones del dolor no siguen un patrón y la prevalencia de su ocurrencia fue elevada.Objectives: To identify pain assessment methods used in neonates who underwent cardiac surgeries, to verify pain assessment frequency and to verify pain prevalence. METHODS: Cross-sectional study. Retrospective data collection. RESULTS: Pain assessment was performed in most (80.0% of the neonates, between one and thirteen times. Specific pain assessment scale was used in 56.7% neonates. Pain assessment was

  14. Do Patients Prefer a Pessary or Surgery as Primary Treatment for Pelvic Organ Prolapse

    NARCIS (Netherlands)

    Thys, S. D.; Roovers, J. P.; Geomini, P. M.; Bongers, M. Y.

    2012-01-01

    Background/Aims: To assess whether patients prefer surgery or a pessary as treatment for pelvic organ prolapse (POP). Methods: A structured interview was performed among treated and untreated women with POP. We conducted fictive scenarios of potential disadvantages of surgery and pessary use. Our

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

    DEFF Research Database (Denmark)

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

    2003-01-01

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

  16. Comparison of Survival Rate in Primary Non-Small-Cell Lung Cancer Among Elderly Patients Treated With Radiofrequency Ablation, Surgery, or Chemotherapy

    International Nuclear Information System (INIS)

    Lee, Heon; Jin, Gong Yong; Han, Young Min; Chung, Gyung Ho; Lee, Yong Chul; Kwon, Keun Sang; Lynch, David

    2012-01-01

    Purpose: We retrospectively compared the survival rate in patients with non-small-cell lung cancer (NSCLC) treated with radiofrequency ablation (RFA), surgery, or chemotherapy according to lung cancer staging. Materials and Methods: From 2000 to 2004, 77 NSCLC patients, all of whom had WHO performance status 0–2 and were >60 years old, were enrolled in a cancer registry and retrospectively evaluated. RFA was performed on patients who had medical contraindications to surgery/unsuitability for surgery, such as advanced lung cancer or refusal of surgery. In the RFA group, 40 patients with inoperable NSCLC underwent RFA under computed tomography (CT) guidance. These included 16 patients with stage I to II cancer and 24 patients with stage III to IV cancer who underwent RFA in an adjuvant setting. In the comparison group (n = 37), 13 patients with stage I to II cancer underwent surgery; 18 patients with stage III to IV cancer underwent chemotherapy; and 6 patients with stage III to IV cancer were not actively treated. The survival curves for RFA, surgery, and chemotherapy in these patients were calculated using Kaplan–Meier method. Results: Median survival times for patients treated with (1) surgery alone and (2) RFA alone for stage I to II lung cancer were 33.8 and 28.2 months, respectively (P = 0.426). Median survival times for patients treated with (1) chemotherapy alone and (2) RFA with chemotherapy for stage III to IV cancer were 29 and 42 months, respectively (P = 0.03). Conclusion: RFA can be used as an alternative treatment to surgery for older NSCLC patients with stage I to II inoperable cancer and can play a role as adjuvant therapy with chemotherapy for patients with stage III to IV lung cancer.

  17. Factors affecting refractive outcome after cataract surgery in patients with a history of acute primary angle closure.

    Science.gov (United States)

    Lee, Hyo Seok; Park, Jung Won; Park, Sang Woo

    2014-01-01

    This study was conducted to evaluate the influence of preoperative or intraoperative factors on the refractive outcome after cataract surgery in patients with a history of acute primary angle closure (APAC). Eyes were divided into two groups: those with stable refractive outcome and those with unstable refractive outcome at 8 weeks after uneventful cataract surgery. Univariate and multivariate regression analyses were performed to investigate factors associated with the postoperative refractive outcome. Fifty-three eyes of 53 patients with a history of APAC (21 eyes with stable refractive outcome, 32 eyes with unstable refractive outcome) were enrolled. In the univariate regression analysis, longer duration of APAC [odds ratio (OR) 1.328; 95 % confidence interval (CI) 1.137-1.552; P = 0.001] and poor preoperative best corrected visual acuity (OR 4.648; 95 % CI 1.071-20.168; P = 0.040) were associated with unstable refractive outcome after cataract surgery in patients with a history of APAC. In the multivariate regression analysis, the duration of APAC was the only independent factor predicting refractive outcome after cataract surgery in patients with a history of APAC (OR 1.317; 95 % CI 1.113-1.558; P = 0.001). Normalization of elevated intraocular pressure as soon as possible after APAC onset is recommended to obtain a stable refractive outcome after cataract surgery in patients with a history of APAC.

  18. Genome-wide assessment for genetic variants associated with ventricular dysfunction after primary coronary artery bypass graft surgery.

    Directory of Open Access Journals (Sweden)

    Amanda A Fox

    Full Text Available BACKGROUND: Postoperative ventricular dysfunction (VnD occurs in 9-20% of coronary artery bypass graft (CABG surgical patients and is associated with increased postoperative morbidity and mortality. Understanding genetic causes of postoperative VnD should enhance patient risk stratification and improve treatment and prevention strategies. We aimed to determine if genetic variants associate with occurrence of in-hospital VnD after CABG surgery. METHODS: A genome-wide association study identified single nucleotide polymorphisms (SNPs associated with postoperative VnD in male subjects of European ancestry undergoing isolated primary CABG surgery with cardiopulmonary bypass. VnD was defined as the need for ≥2 inotropes or mechanical ventricular support after CABG surgery. Validated SNPs were assessed further in two replication CABG cohorts and meta-analysis was performed. RESULTS: Over 100 SNPs were associated with VnD (P2.1 of developing in-hospital VnD after CABG surgery. However, three genetic loci identified by meta-analysis were more modestly associated with development of postoperative VnD. Studies of larger cohorts to assess these loci as well as to define other genetic mechanisms and related biology that link genetic variants to postoperative ventricular dysfunction are warranted.

  19. Feasibility of single-incision thoracoscopic surgery using a modified chest wall pulley for primary spontaneous pneumothorax: a propensity score matching analysis.

    Science.gov (United States)

    Tsuboshima, Kenji; Nagata, Machiko; Wakahara, Teppei; Matoba, Yasumi; Maniwa, Yoshimasa

    2017-09-01

    Recently, single-incision thoracoscopic surgery (SITS) has been recognized as a favorable treatment choice for primary spontaneous pneumothorax (PSP) compared with conventional three-port video-assisted thoracoscopic surgery (VATS). However, conventional SITS bullectomy often results in collisions with surgical devices. Therefore, we devised a method of SITS using a chest wall pulley for lung excision (PulLE) and modified PulLE (mPulLE) system, which substitutes threads to eliminate such collisions. We compared the mPulLE system with conventional procedures using propensity score matching (PSM) to adjust for patient backgrounds. Using PSM, we evaluated the surgical results of 210 PSP patients who underwent VATS, including mPulLE (n = 23) and three-port VATS (n = 102), at our institution between January 2010 and August 2016. We selected 17 mPulLE cases and 17 three-port VATS. There were no marked differences between the groups in the patient backgrounds or surgical results. However, there was a significant difference between the mPulLE cases and the three-port VATS cases in the operative time (71.7 ± 15.7 vs. 85.9 ± 25.5 min, respectively, P = 0.0388) and the number of autosutures used (3.6 ± 1.2 vs. 4.5 ± 1.2, respectively, P = 0.0178). The surgical results of mPulLE in patients with PSP with multiple lesions were equivalent to those achieved with three-port VATS under the same conditions.

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

    DEFF Research Database (Denmark)

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

    2003-01-01

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

  1. Diagnostic accuracy of risk of malignancy index in predicting complete tumor removal at primary debulking surgery for ovarian cancer patients

    DEFF Research Database (Denmark)

    Fagö-Olsen, Carsten L; Håkansson, Fanny; Antonsen, Sofie L

    2013-01-01

    to investigate whether the risk of malignancy index (RMI) was a useful marker for this evaluation. RMI and surgical outcome were investigated in 164 patients, 49 of whom had no residual tumor after PDS. The receiver operating characteristic curve showed an area under the curve of 0.72 (confidence interval: 0......Ovarian cancer patients in whom complete tumor removal is impossible with primary debulking surgery (PDS) may benefit from neoadjuvant chemotherapy and interval debulking surgery. However, the task of performing a pre-operative evaluation of the feasibility of PDS is difficult. We aimed.......64-0.80). The possibility of complete tumor removal decreased with increasing RMI and there was a tendency towards higher RMI in patients with residual tumor after PDS, but no single cut-off value of RMI produced useful clinical predictive values. In conclusion, RMI alone is not an optimal method to determine whether...

  2. Mammographic Features of Local Recurrence after Conservative Surgery and Radiation Therapy: Comparison with that of the Primary Tumor

    International Nuclear Information System (INIS)

    Guenhan-Bilgen, I.; Oktay, A.

    2007-01-01

    Purpose: To compare the mammographic features of recurrent breast cancer with those of the primary tumor and to determine whether certain mammographic features are associated with a higher risk of local recurrence after breast-conserving therapy. Material and Methods: A retrospective review of mammograms of 421 patients who were treated with conservative surgery and radiotherapy revealed 41 recurrent tumors. Mammographic findings, location, and histopathologic characteristics were retrospectively compared between primary and recurrent tumors. Results: Recurrent tumors were similar in mammographic appearance to primary tumors in 27 (66%) cases. Of 27 primary tumors that occurred as masses without calcifications, 19 (70%) recurred as a mass, and of the six isolated calcifications, five (83%) recurred with calcifications. Ten (53%) of the 19 recurrent masses and five (100%) of the five recurrent calcifications had morphologic features that were similar to those of the primary tumor. Ninety-two percent (11/12) of the recurrences containing microcalcifications (isolated or associated with a mass) had microcalcifications in their primary tumor. Of 27 masses that recurred, the morphology of the primary tumor was obscured in 13 (48%), ill defined in 10 (37%), and spiculated in four (15%) of the masses. Seventy-six percent (31/41) of recurrences were within the lumpectomy quadrant. In 25 (61%) cases, the histologic findings from the primary tumor and the recurrence were identical. Conclusion: The majority of recurrent tumors appear to be mammographically similar to primary tumors. Therefore, it is important to review preoperative mammograms during follow-up of these patients. Although the study population is small, it was noted that mass with spiculated contour is associated with a lower risk for local recurrence

  3. Can primary health care staff be trained in basic life-saving surgery ...

    African Journals Online (AJOL)

    The following article by Leet et al advocates training rural PHC staff in basic emergency surgery in those areas of South Sudan where there is no access to secondary or tertiary level facilities (i.e. surgical task-shifting). Based on their experience, the authors describe and recommend the type of on-the-job training that they ...

  4. A γ detecting probe developed for radioguided surgery and its primary using for animal experiment

    International Nuclear Information System (INIS)

    Wei Haipeng, Lin Yingwu; Gong Peirong; Yang Zhirong; Qiu Shi

    2003-01-01

    A new γ detecting probe device was described, which was used in radioguided surgery (RGS) for detecting tumor and its micrometastasis. The concrete scheme for this system was given in this paper and its performance was also evaluate. The animal experimental results showed that the γ detecting probe has excellent location resolution, and its collimator is practical

  5. Can primary health care staff be trained in basic life-saving surgery?

    African Journals Online (AJOL)

    2012-08-03

    Aug 3, 2012 ... If so, what type of training is best? Should there be a recognized curriculum and accreditation? What further information would you like the authors to provide? Is your organisation training non-medical health staff in surgery (or other medical procedures)? If so, what are the results? Write to the editor at: ...

  6. Primary experience of bariatric surgery in a newly established private obesity center

    Science.gov (United States)

    Al-Shurafa, Haider; Elzaafarany, Ahmed H.; Albenmousa, Ali; Balata, Mona G.

    2016-01-01

    Objectives: To assess the outcomes of different types of bariatric surgeries in a single newly established private obesity center. Methods: Retrospectively, we included patients who were entered in the registry for bariatric surgeries in the Obesity Unit, Riyadh National Hospital, Riyadh, Saudi Arabia between January 2013 and September 2014, and completed one year of follow up. Baseline characteristics, percent excess weight loss, and safety data were collected and analyzed. Results: A total of 79 patients were included. Based on the type of surgery, patients were divided into 3 groups: laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic minigastric bypass (MGBP), and laparoscopic vertical sleeve gastrectomy (SG). After one year, RYGB and MGB patients lost more weight than SG patients. No mortality, or leak were reported and one patient had reoperation after revision laparoscopic RYGB for bleeding. There was one readmission, while 4 patients visited the emergency room for vomiting and dehydration (2 patients), anemia (one patient), and port site infection (one patient). Conclusion: Bariatric surgeries are safe when carried out by an experienced bariatric surgeon in the private sector. The outcome of this series is similar to the published results from large international obesity databases. PMID:27652359

  7. Retrograde intrarenal surgery with holmium-YAG laser lithotripsy in the primary treatment of renal lithiasis.

    Science.gov (United States)

    Redondo, C; Ramón de Fata, F; Gimbernat, H; Meilán, E; Andrés, G; Angulo, J C

    2015-06-01

    retrograde intrarenal surgery (RIRS) appears as a safe and effective technique as well as a good therapeutic alternative to extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL). descriptive study in 50 patients surgically treated between November 2012 and April 2013. Demographic, operative and postoperative data as well as early and late complications data were collected. The minimum follow-up of patients was one year. Surgery was performed under general anesthesia. Flexible ureteroscopy with ureteral access sheath and laser fragmentation were employed. Surgery success was defined as stone free rate in postoperative control test and at three months after surgery (simple radiography, abdominal ultrasound or CT without contrast). mean age was 51.1±15.5 years old. The highest-frequency location was the lower calyceal group (26%), single stones were described in 58% of patients whilst multiple lithiasis were found in the 42%. Regarding the stone burden in 44% of the patients was low (3 cm) in 22% of the patients. The stone clearance rate was 89.7±17.5. Average surgery time was 96.6±35.2min. Complications were reported in 4 patients (8%), all of them early ones and minor in nature. RIRS is an effective and safe option whose results are comparable to ESWL and PCNL. RIRS can be considered as first-line treatment. These results are corroborated by numerous studies. To strengthen these findings, prospective studies focusing on quality of life, length of stay, complications and cost-effectiveness of different treatments are needed. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. [Choice of surgical approaches for salvage surgery of primary lesion recurrence and residual cases of nasopharyngeal carcinoma].

    Science.gov (United States)

    Tao, Zhong-Qiang; Si, Yong-Feng; Lan, Sheng-Yong; Zhang, Zheng; Deng, Zhuo-Xia; Huang, Bo; Zhou, Ri-Jing; Lu, Jin-Long

    2011-02-01

    The choice of surgical approaches for salvage surgery based on the location and invasion of recurrent and residual lesions of nasopharyngeal carcinoma (NPC), surgical results, complications, and survival were assessed. Thirty-seven cases with recurrent and residual lesions of NPC underwent salvage surgery between March 1991 and January 2005 were analysed retrospectively. Of 37 patients, 23 were men and 14 women, with a median age of 46.5 years (26 - 57 years); 4 were at stage I, 10 at stage II, 14 at stage III, and 9 at stage IV; 5 cases were with cervical metastasis, including 3 cases of N1 and 2 cases N2. All recurrent and residual lesions of NPC were determined by biopsy. On the location and invasion of recurrent and residual lesions of NPC, 8 cases underwent endoscopic resection of lesions, 12 cases of the palate nasopharyngectomy, 5 cases of maxillary swing, 4 cases of maxillary swing plus prerenal approach, 2 cases of lateral rhinotomy plus coronal flap approach, and 6 cases transfacial plus nasal pyramid swing approach. Five cases with cervical metastasis received neck dissection in addition to the operations for recurrent and residual lesions of NPC. Postoperatively 31 cases received radiotherapy with dosage of 60 Gy, among them 15 cases with concurrent chemoradiation therapy, and 6 cases with clear surgical margin did not received radiotherapy or chemotherapy. The cases were followed up for 12 - 72 months, with a median of 45 months. Total resection for the recurrent and residual lesions of NPC accounted for 91.8% (34/37) and subtotal resection for 8.2% (3/37). The accident of perioperative complications was 24.3% (9/37). The 3- and 5-year overall disease-free survival rates (DFSR) were 62.1% and 43.3%, respectively. The 3- and 5-year overall survival rates (OSR) were 72.9% and 51.3%, respectively. The 5 year DFSR of cases at stage I-IV were 100%, 40%, 28% and 11% (χ(2) = 10.0, P < 0.01), respectively. The 5 year OSR were 100%, 70%, 35% and 28% (χ(2

  9. Sinus surgery can improve quality of life, lung infections, and lung function in patients with primary ciliary dyskinesia

    DEFF Research Database (Denmark)

    Alanin, Mikkel Christian; Aanaes, Kasper; Hoiby, Niels

    2017-01-01

    Background Chronic rhinosinusitis (CRS) and bacterial sinusitis are ubiquitous in patients with primary ciliary dyskinesia (PCD). From the sinuses, Pseudomonas aeruginosa can infect the lungs. Methods We studied the effect of endoscopic sinus surgery (ESS) on symptoms of CRS and lower airway...... patients (62%). Four patients with preoperative P. aeruginosa lung colonization (25%) had no regrowth during follow-up; 2 of these had P. aeruginosa sinusitis. Sinonasal symptoms were improved 12 months after ESS and we observed a trend toward better lung function after ESS. Conclusion We demonstrated...

  10. En-bloc pelvic resection with concomitant rectosigmoid colectomy and immediate anastomosis as part of primary cytoreductive surgery for patients with advanced ovarian cancer.

    Science.gov (United States)

    Yildirim, Y; Ertas, I E; Nayki, U; Ulug, P; Nayki, C; Yilmaz, I; Gultekin, E; Dogan, A; Aykas, A; Ulug, S; Ozdemir, A; Solmaz, U

    2014-01-01

    To assess the authors' experiences in en bloc pelvic resection with concomitant rectosigmoid colectomy and primary anastomosis as a part of primary cytoreductive surgery for patients with advanced ovarian cancer. Atotal of 22 patients with FIGO Stage IIB-IV epithelial ovarian cancer who underwent en bloc pelvic resection with anastomosis were retrospectively reviewed. Data analyses were carried out using SPSS 10.0 and descriptive statistics, Kaplan-Meier survival curves, and Log Rank (Mantel-Cox) test were used for statistical estimations. Median age was 58.8 years. FIGO stage distribution of the patients was; one (4.5%) IIB, three (13.7%) IIC, three (13.7%) IIIA, six (27.3%) IIIB, and nine (40.9%) IIIC. Median peritoneal cancer index (PCI) was 8 (range 5-22) and optimal cytoreduction was achieved in 18 patients (81.8%) of whom 13 (59.1%) had no macroscopic residual disease (complete cytoreduction). There was no perioperative mortality. A total of nine complications occurred in seven (31.8%) patients. Anastomotic leakage was observed in one (4.5%) patient. There was no re-laparotomy. Mean follow-up time was 60 months. There were 15 (68.2%) recurrences of which 12 (80%) presented in extra-pelvic localizations. Mean disease-free survival (DFS) and overall survival (OVS) were estimated as 43.6 and 50.5 months, respectively. Patients with complete cytoreduction had a better DFS (p = 0.006) and OVS (p = 0.003) than those with incomplete cytoreduction. En bloc pelvic resection, as a part of surgical cytoreduction, seems to be a safe and effective procedure in many patients with advanced ovarian cancer if required. Despite relatively high general complication rate, anastomosis-related morbidity of this procedure is low as 0.8%. Nevertheless, surgical plan and perioperative care should be personalized according to medical and surgical conditions of the patient.

  11. Assessment of perioperative complications following primary bariatric surgery according to the Clavien-Dindo classification: comparison of sleeve gastrectomy and Roux-Y gastric bypass.

    Science.gov (United States)

    Goitein, David; Raziel, Asnat; Szold, Amir; Sakran, Nasser

    2016-01-01

    Laparoscopic Roux-Y gastric bypass (LRYGBP) is the gold-standard procedure for the treatment of morbid obesity. It has been reported to be somewhat more efficient and durable than laparoscopic sleeve gastrectomy (LSG). However, it is considered more invasive and, therefore, more hazardous. There is a lack of unity in complication reporting following bariatric surgery. Thus, there is a possible misconception regarding the relative safety of the two major bariatric procedures performed worldwide. This may have contributed to a shift in practice with LSG gaining momentum "at the expense" of LRYGBP. The aim of this study was to evaluate the relative safety of primary LSG and LRYGBP according to the Clavien-Dindo complication grading system. A total of 2651 and 554 patients underwent primary LSG and LRYGBP, respectively at three high-volume centers. Thirty-day perioperative complications were recorded and graded. Length of hospital stays (LOS) and readmission rates were collected as well. Complications occurred in 110 (3.7%) and 24 (4.3%) patients following LSG and LRYGBP, respectively (p = 0.9). No significant difference was found between the groups regarding overall and complication-grade-specific rates. Individual complication types were unevenly distributed, but not significantly so. Patients with complications were older than those without (47 and 43 years, respectively; p = 0.01). Gender was not a risk factor for complication. Median LOS and readmission rates were not significantly different. LSG and LRYGBP are equally safe, at least in the perioperative period. Acknowledging and conveying this finding to surgeons and patients alike is important and might cause a pendulum shift in the distribution of bariatric procedures performed.

  12. Radical surgery compared with intracavitary cesium followed by radical surgery in cervical carcinoma stage IB

    Energy Technology Data Exchange (ETDEWEB)

    Tinga, D.J.; Bouma, J.; Aalders, J.G. (Dept. of Obstetrics and Gynaecology, State Univ. Hospital, Groningen (Netherlands)); Hollema, H. (Dept. of Pathology, State Univ. Hospital, Groningen (Netherlands))

    1990-01-01

    Forty-nine patients aged {le} 45 years, with cervical carcinoma stage IB ({le} 3 cm) were treated with either primary radical surgery (n = 26), or intracavitary irradiation followed by radical surgery (n = 23). With primary surgery, ovarian function had been preserved in 15 of the 25 patients, who were alive and well. Seven of the primary surgery patients were irradiated postoperatively and 2 others with a central recurrence were cured by irradiation. One other patient, who was not irradiated postoperatively, had an intestinal metastasis and died of the disease. If any of the adverse prognostic factors (as reported in the literature) had been considered as an indication for postoperative irradiation, 17 patients instead of 7 would have been irradiated after primary radical surgery. In the comparable group of 23 patients treated by intracavitary irradiation and radical surgery (and in 4 cases postoperative irradiation as well) there was no recurrence. There was no significant statistical difference between the treatment results in the cesium + surgery group and those who underwent primary radical surgery. Young patients with early cervical carcinoma without prognostic indicators for postoperative irradiation can benefit from primary radical surgery, because their ovarian function can be preserved. (authors).

  13. Perfil de recém-nascidos submetidos à cirurgia cardíaca em hospital privado do Município de São Paulo Perfil de los recién nacidos sometidos a cirugía cardiaca en un Hospital privado del municipio de Sao Paulo Profile of newborns who underwent cardiac surgery in a private hospital in the city of São Paulo

    Directory of Open Access Journals (Sweden)

    Mariana Bueno

    2008-03-01

    planificación y organización del servicio en la implementación de la asistencia a estos pacientes.The aim of this cross-sectional study was to characterize newborns that underwent cardiac surgery in a private hospital, a reference center in neonatal cardiac surgery, in the city of São Paulo. Data were collected from medical reports from July, 2001 to December, 2005. Newborns with gestational age of more than 35 weeks were included in the study. Newborns that died on the first 48 postoperative hours and with other malformations were excluded. Most of the neonates were term, weighted 2,500 grams or more, and underwent surgery in the first week of life. There were 24 different diagnoses identified and 14 different types of surgery performed. In the first post-operative day, all newborns had invasive devices for vital signs monitoring or for treatment and life support, which shows not only the complexity of the treatment but the need for planning and organizing health services in order to provide adequate care for these patients.

  14. Avaliação dos níveis basais de FSH em pacientes inférteis com endometriose profunda de ovário tratadas cirurgicamente Evaluation of basal FSH serum levels in infertile patients with deep ovarian endometriosis who underwent surgery

    Directory of Open Access Journals (Sweden)

    Sandra Frankfurt

    2009-07-01

    Full Text Available OBJETIVO: avaliar a reserva ovariana de pacientes inférteis portadoras de endometriose profunda de ovário, submetidas à cirurgia excisional dos endometriomas, atendidas entre os meses de Fevereiro e Novembro de 2008. MÉTODOS: estudo prospectivo que incluiu 30 pacientes portadoras de endometriose graus III e IV com comprometimento profundo de ovário submetidas à cirurgia excisional dos endometriomas e 30 pacientes portadoras de endometriose graus I e II que foram alocadas como Grupo Controle. A reserva ovariana foi avaliada indiretamente a partir do valor do hormônio folículo estimulante (FSH basal (U/L, entre o terceiro e quinto dias do ciclo, após um período de 12 meses da cirurgia. O índice de massa corpórea (IMC foi calculado conforme a fórmula de Quetelet [peso (kg/estatura (cm²]. Para a comparação das variáveis "idade", "IMC" e "valores de FSH basal" entre os grupos, foi utilizado o teste não paramétrico U de Mann-Whitney. RESULTADOS: não foi encontrada diferença significativa entre os grupos em relação à idade e ao IMC. Em relação ao FSH basal, observou-se que, no grupo das pacientes com endometriose profunda, o valor médio foi de 7,0 U/L, enquanto que, no Grupo Controle, foi de 5,6 U/L (p=0,3, o que demonstra que a diferença no valor médio de FSH encontrado nos dois grupos não foi significativa. CONCLUSÕES: a cirurgia não influenciou de forma deletéria a reserva ovariana das pacientes com endometriose profunda de ovário.PURPOSE: to evaluate the ovarian reserve of infertile patients with severe ovarian endrometriosis, submitted to excisional surgery of endometriomas and attended from February to November, 2008. METHODS: prospective study, including 30 patients with endometriosis grades III and IV, with severe ovarian impairment, submitted to excisional surgery of the endometriomas, and 30 patients with endometriosis grades I and II, allocated as a Control Group. The ovarian reserve was indirectly assessed

  15. Factors influencing quality of life in patients with benign primary brain tumors: prior to and following surgery.

    Science.gov (United States)

    Tsay, Shiow-Luan; Chang, Jui-Yen; Yates, Patsy; Lin, Kuan-Chia; Liang, Shu-Yuan

    2012-01-01

    Few studies have repeatedly evaluated quality of life and potentially relevant factors in patients with benign primary brain tumor. The purpose of this study was to explore the relationship between the experience of the symptom distress, functional status, depression, and quality of life prior to surgery (T(1)) and 1 month post-discharge (T(2)). This was a prospective cohort study including 58 patients with benign primary brain tumor in one teaching hospital in the Taipei area of Taiwan. The research instruments included the M.D. Anderson Symptom Inventory, the Functional Independence Measure scale, the Hospital Depression Scale, and the Functional Assessment of Cancer Therapy-Brain. Symptom distress (T(1): r = -0.90, p life. Multivariate analysis identified symptom distress (explained 80.2%, R (inc)(2) = 0.802, p = 0.001) and depression (explained 5.2%, R (inc)(2) = 0.052, p life prior to surgery (T(1)) after controlling for key demographic and medical variables. Furthermore, only symptom distress (explained 27.1%, R (inc)(2) = 0.271, p = 0.001) continued to have a significant independent influence on quality of life at 1 month after discharge (T(2)). The study highlights the potential importance of a patient's symptom distress on quality of life prior to and following surgery. Health professionals should inquire about symptom distress over time. Specific interventions for symptoms may improve the symptom impact on quality of life. Additional studies should evaluate symptom distress on longer-term quality of life of patients with benign brain tumor.

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

    Science.gov (United States)

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

    2017-04-01

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

  17. Surgery or no surgery: What works best for the kidneys in primary hyperparathyroidism? A study in a multi-ethnic Asian population

    Directory of Open Access Journals (Sweden)

    Yu Kwang Donovan Tay

    2016-01-01

    Full Text Available Introduction: Whether parathyroidectomy is more beneficial to renal function when compared to medical therapy or observation in primary hyperparathyroidism (PHPT is unclear. Neither has this premise been explored in non-Caucasian populations. The estimated glomerular filtration rate (eGFR threshold below which parathyroid hormone (PTH levels rise if at all in PHPT has also not been established. We determined if surgery was superior to medical therapy and observation in a multi-ethnic Asian patient population with PHPT and whether there was an eGFR threshold below which PTH levels further increased in them. Methods: Retrospective evaluation of patients with PHPT. Results: There were 68.6% Chinese, 17.4% Malays, 10.7% Indians, and 3.3% Eurasians. The median (interquartile range follow-up was 18.0 months (4.5–46.8. At last follow-up, eGFR in the surgical (80 ± 30 ml/min was higher than the medical (52 ± 32 ml/min or observation groups (48 ± 33 ml/min; P < 0.01. This difference persisted after adjusting for age, gender, ethnicity, pre-intervention eGFR levels, nephrolithiasis, serum calcium, phosphate, urinary calcium, and duration of follow-up; P = 0.035. There was no definite eGFR level below which PTH values rose. Conclusion: Our study provides compelling evidence that in PHPT, surgery may be associated with a better renal outcome compared to medical management or observation. This has to be confirmed through prospective randomized controlled trials and the reasons for this finding have to be elucidated through functional and histological measures. The finding in our study of a lack of a specific eGFR threshold below which PTH levels further rose challenges the concept of a fixed renal threshold for secondary elevations of PTH in PHPT.

  18. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

    Directory of Open Access Journals (Sweden)

    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  20. Clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion in primary versus revision surgery

    NARCIS (Netherlands)

    Hentenaar, B.; Spoor, A. B.; Malefijt, J. de Waal; Diekerhof, C. H.; den Oudsten, B. L.

    2016-01-01

    Purpose The aim of this study is to compare the clinical and radiological outcome of minimally invasive posterior lumbar interbody fusion (MI-PLIF) in revision and primary cases. Methods In a retrospective study, we compared the clinical and radiological results of MI-PLIF for lytic

  1. Pterygium surgery with conjunctival autograft and induced astigmatism in young men

    OpenAIRE

    Hüseyin Mayalı

    2012-01-01

    Objectives: To evaluate the results obtained from malesubjects who underwent pterygium surgery with conjunctivalautograft and to calculate the induced astigmatism.Materials and methods: Pterygium surgery with conjunctivalautograft was performed on 22 eyes of 20 subjectsdiagnosed with primary pterygium. If pterygium caused avision problem or approached the pupil level, and if surgerywas requested from the individuals for cosmetic reasons,the decision to operate was made. Patients who underwent...

  2. Health-related Quality of Life after complex rectal surgery for primary advanced rectal cancer and locally recurrent rectal cancer

    DEFF Research Database (Denmark)

    Thaysen, Henriette Vind

    2013-01-01

    Advances in the treatment of rectal cancer, have made it possible to perform complex rectal cancer surgery (COMP-RCS) with curative intent in patients with primary advanced rectal caner (PARC) and local recurrent rectal cancer (LRRC). Due to the complexity of the treatment and its high...... postoperative morbidity, Health-related Quality of Life (HRQoL) is an important issue. The overall aim of this thesis was therefore to evaluate HRQoL in patients with PARC and LRRC treated with COMP-RCS and curative intent. In study I a review of the literature was undertaken to provide an overview of HRQo...... demands larger prospective longitudinally studies in order to get more reliable information of the patients HRQoL after treatment with COMP-RCS. In study II an examination of the psychometric properties of the Danish version of the colorectal specific questionnaire, EORTC QLQ-CR38 was undertaken. Included...

  3. Public-private partnerships to improve primary healthcare surgeries: clarifying assumptions about the role of private provider activities.

    Science.gov (United States)

    Mudyarabikwa, Oliver; Tobi, Patrick; Regmi, Krishna

    2017-07-01

    Aim To examine assumptions about public-private partnership (PPP) activities and their role in improving public procurement of primary healthcare surgeries. PPPs were developed to improve the quality of care and patient satisfaction. However, evidence of their effectiveness in delivering health benefits is limited. A qualitative study design was employed. A total of 25 interviews with public sector staff (n=23) and private sector managers (n=2) were conducted to understand their interpretations of assumptions in the activities of private investors and service contractors participating in Local Improvement Finance Trust (LIFT) partnerships. Realist evaluation principles were applied in the data analysis to interpret the findings. Six thematic areas of assumed health benefits were identified: (i) quality improvement; (ii) improved risk management; (iii) reduced procurement costs; (iv) increased efficiency; (v) community involvement; and (vi) sustainable investment. Primary Care Trusts that chose to procure their surgeries through LIFT were expected to support its implementation by providing an environment conducive for the private participants to achieve these benefits. Private participant activities were found to be based on a range of explicit and tacit assumptions perceived helpful in achieving government objectives for LIFT. The success of PPPs depended upon private participants' (i) capacity to assess how PPP assumptions added value to their activities, (ii) effectiveness in interpreting assumptions in their expected activities, and (iii) preparedness to align their business principles to government objectives for PPPs. They risked missing some of the expected benefits because of some factors constraining realization of the assumptions. The ways in which private participants preferred to carry out their activities also influenced the extent to which expected benefits were achieved. Giving more discretion to public than private participants over critical

  4. A comparison of radiotherapy and surgery as primary treatment in the management of T[sub 3]N[sub 0]M[sub 0] glottic tumours

    Energy Technology Data Exchange (ETDEWEB)

    Simpson, D.; Robertson, A.G. (Western Infirmary, Glasgow (United Kingdom). Beatson Oncology Centre); Lamont, D. (Ruchill Hospital, Glasgow (United Kingdom). West of Scotland Cancer Surveillance Unit)

    1993-10-01

    Seventy-four patients with Stage T[sub 3]N[sub 0]M[sub 0] squamous carcinoma of the glottis were treated initially by surgery or radiotherapy between 1980 and 1985. The treatment adopted was determined by consultant preference. Long-term survival in both groups was approximately the same. Of 38 patients treated initially by radiotherapy, 25 had local recurrence. Fifteen of these underwent salvage surgery and 10 died of disease. Thirteen patients (33%) retained their larynx. One of the major advantages of treating patients with stage T[sub 3]N[sub 0]M[sub 0] carcinoma of larynx by radiotherapy initially is that approximately one-third will retain their larynx. Local recurrences can usually be treated readily by salvage surgery. (Author).

  5. Unilateral blindness after orthognathic surgery: hypotensive anaesthesia is not the primary cause.

    Science.gov (United States)

    Rodríguez-Navarro, Á; Gonzalez-Valverde, F M

    2018-01-01

    Perioperative vision loss in non-ocular surgery represents a rare but devastating complication and multiple causes have been proposed. Any portion of the visual system may be involved and several authors have tried to relate that complication with deliberate hypotension anaesthetic technique, used to control intraoperative bleeding. We report a patient operated for orthognathism who suffered unilateral blindness. After review of similar cases, we can state that the transmission of forces generated during Le fort I osteotomy is related to the complication. This osteotomy technique is regularly performed in our hospital using a curved osteotome to achieve the pterygomaxillary disjunction and the adverse transmission of forces via the sphenoid bone is the main reason for indirect damage to the optic nerve and its vascular structures causing the neuropathy and blindness. Hypotensive anaesthesia may certainly lead to transient ischaemia but only in specific cases because of decreased ocular perfusion pressured. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Indications for non-transplant surgery in primary sclerosing cholangitis1

    Science.gov (United States)

    Domajnko, Bastian

    2005-01-01

    Primary sclerosing cholangitis (PCS) is a progressive disease leading to secondary biliary cirrhosis. Patients are at increased risk of developing cholangiocarcinoma, which is usually diagnosed at an advanced stage. Treatment of PCS includes medical therapy, endoscopic biliary dilation, percutaneous transhepatic stenting, extrahepatic biliary resection and liver transplantation. The most effective management of primary sclerosing cholangitis before the onset of cirrhosis remains unclear. Non-transplant surgical procedures have a limited but defined role in patients with PCS. Resection of the extrahepatic biliary tree in symptomatic non-cirrhotic patients improves hyperbilirubinaemia and prolongs both transplant-free and overall survival when compared with non-operative dilation and/or stenting. Surgical resection may also definitively establish or exclude a diagnosis of cholangiocarcinoma in patients with dominant extrahepatic or perihilar strictures. Extrahepatic bile duct resection may also reduce the risk of cholangiocarcinoma. Extrahepatic biliary resection should be considered in selected non-cirrhotic patients with symptomatic biliary obstruction and dominant extrahepatic and/or perihilar strictures. Those patients in whom cholangiocarcinoma is suspected should also undergo resection. PMID:18333210

  7. Magnetic resonance guided focused ultrasound surgery (MRgFUS) of bone metastases: From primary pain palliation to local tumor control

    Science.gov (United States)

    Napoli, A.; Leonardi, A.; Andrani, F.; Boni, F.; Anzidei, M.; Catalano, C.

    2017-03-01

    Purpose: To evaluate the clinical performance of MRgFUS in primary pain palliation of painful bone metastases and in local tumor control. Materials and Methods: We enrolled 26 consecutive patients (female/male 12/14; age: 64.7±7.5yrs) with painful bone metastases. Before and 3 months after MRgFUS treatment pain severity and pain interference scores were assessed according to Brief Pain Inventory-Quality of Life (BPI-QoL) criteria and patients underwent both CT and MRI. Local tumor control was evaluated according to lesion size, density and perfusion at CT, dynamic contrast enhancement at MRI (Discovery 750HD, GE; Gd-Bopta, Bracco) and metabolic activity at PET or scintigraphy. Patients were classified as responders or non-responders. Results: No treatment-related adverse events were recorded during the study. As statistically significant difference between baseline and follow-up values for both pain severity and pain interference scores was observed (pbone density was observed in 9/26 (34.6%) patients. Non-Perfused Volume values ranged between 20% and 92%. There was no difference in NPV values between responders and non-responders (46.7±24.2% [25 - 90 %] vs. 45±24.9% [20 - 93 %]; p=0.7). In 6 patients (5 prostate and 1 breast primary cancer) there was nearly absence of metabolic activity after treatment (mean SUV=1.2). Conclusion: MRgFUS can be safely and effectively used as the primary treatment for pain palliation in patients with painful bone metastases; moreover our experience demonstrated also a potential role for the MRgFUS in local tumor control.

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

    African Journals Online (AJOL)

    No Abstract Available A case that underwent bilateral video-assisted thoracoscopic surgical (VATS) biopsy combined with pneumonectomy is presented. The patient developed hypoxia during the contralateral VATS biopsy. His hypoxia was treated with positive expiratory pressure (PEEP) to the dependent lung and apneic ...

  9. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Pedersen, Kirsten Mølsted; Humerinta, Kirsti; Küseler, Annelise

    2017-01-01

    BACKGROUND AND AIM: Facial appearance is one of the most relevant measures of success in cleft lip and palate treatment. The aim was to assess nasolabial appearance at 5 years of age in all children in the project. In this part of the project the local protocol for lip closure continued to be used...... the three trials. CONCLUSION: The Millard procedure combined with McComb technique had been used in the majority of the cases in all three trials. There were statistically significant differences between the three trials concerning upper lip, nasal form, and cleft side profile. TRIAL REGISTRATION: ISRCTN...... because the primary lip and nose operations were not part of the randomisation. The great majority of the surgeons used Millard's technique together with McComb's technique for the nose. One center used Tennison-Randalls technique and in one center the centers own technique as well as nose plugs were used...

  10. Primary acquired spondylodiscitis shows a more severe course than spondylodiscitis following spine surgery: a single-center retrospective study of 159 cases.

    Science.gov (United States)

    Tschugg, Anja; Lener, Sara; Hartmann, Sebastian; Rietzler, Andreas; Neururer, Sabrina; Thomé, Claudius

    2018-01-01

    Spondylodiscitis may arise primarily via hematogenous spread or direct inoculation of virulent organisms during spine surgery. To date, no comparative data investigating the differences between primary and postoperative spondylodiscitis is available. Thus, the purpose of this retrospective study was to investigate differences between these two etiologies. One hundred fifty-nine patients that were treated at our department were included in the retrospective analysis. The patients were categorized into two groups based on the etiology of spondylodiscitis: group NS, primary spondylodiscitis without prior spinal surgery; group S, spondylodiscitis following spinal surgery. Evaluation included magnetic resonance imaging (MRI), laboratory values, clinical outcome, and operative or conservative management. Preoperative MRI showed higher rates of epidural and paraspinal abscess in patients with primary spondylodiscitis (p < 0.005). Vertebral bone destruction was more severe in group NS (p < 0.05). Survival rate in group S (98.2%) was higher than in group NS (87.5%, p = 0.024). The extent of the operative procedure in patients who were surgically treated (n = 116) differed between the two groups (p < 0.005). In conclusion, spondylodiscitis is a life-threatening and serious disease and requires long-term treatment. Primary spondylodiscitis is frequently associated with epidural and paraspinal abscess, vertebral bone destruction and has a higher mortality rate than postoperative spondylodiscitis. Therefore, primary spondylodiscitis shows a more severe course than spondylodiscitis following spine surgery.

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

    Science.gov (United States)

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

    2013-05-01

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

  12. A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management.

    Science.gov (United States)

    Semb, Gunvor; Enemark, Hans; Friede, Hans; Paulin, Gunnar; Lilja, Jan; Rautio, Jorma; Andersen, Mikael; Åbyholm, Frank; Lohmander, Anette; Shaw, William; Mølsted, Kirsten; Heliövaara, Arja; Bolund, Stig; Hukki, Jyri; Vindenes, Hallvard; Davenport, Peter; Arctander, Kjartan; Larson, Ola; Berggren, Anders; Whitby, David; Leonard, Alan; Neovius, Erik; Elander, Anna; Willadsen, Elisabeth; Bannister, R Patricia; Bradbury, Eileen; Henningsson, Gunilla; Persson, Christina; Eyres, Philip; Emborg, Berit; Kisling-Møller, Mia; Küseler, Annelise; Granhof Black, Birthe; Schöps, Antje; Bau, Anja; Boers, Maria; Andersen, Helene Søgaard; Jeppesen, Karin; Marxen, Dorte; Paaso, Marjukka; Hölttä, Elina; Alaluusua, Suvi; Turunen, Leena; Humerinta, Kirsti; Elfving-Little, Ulla; Tørdal, Inger Beate; Kjøll, Lillian; Aukner, Ragnhild; Hide, Øydis; Feragen, Kristin Billaud; Rønning, Elisabeth; Skaare, Pål; Brinck, Eli; Semmingsen, Ann-Magritt; Lindberg, Nina; Bowden, Melanie; Davies, Julie; Mooney, Jeanette; Bellardie, Haydn; Schofield, Nina; Nyberg, Jill; Lundberg, Maria; Karsten, Agneta Linder-Aronson; Larson, Margareta; Holmefjord, Anders; Reisæter, Sigvor; Pedersen, Nina-Helen; Rasmussen, Therese; Tindlund, Rolf; Sæle, Paul; Blomhoff, Reidunn; Jacobsen, Gry; Havstam, Christina; Rizell, Sara; Enocson, Lars; Hagberg, Catharina; Najar Chalien, Midia; Paganini, Anna; Lundeborg, Inger; Marcusson, Agneta; Mjönes, Anna-Britta; Gustavsson, Annica; Hayden, Christine; McAleer, Eilish; Slevan, Emma; Gregg, Terry; Worthington, Helen

    2017-02-01

    Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project. Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes. Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years. The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series. ISRCTN29932826.

  13. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

    Energy Technology Data Exchange (ETDEWEB)

    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  14. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

    DEFF Research Database (Denmark)

    Karsten, Agneta; Marcusson, Agneta; Hurmerinta, Kirsti

    2017-01-01

    controlled trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. METHODS: Three different surgical procedures for primary palatal repair (Arms B, C, and D) were tested against a common procedure (Arm A) in the total......- and intra-examiner reliability was good-to-excellent (0.61-0.94; 0.66-1.0, respectively). The mean total scores (+2 to -18) varied from -5.56 (Trial 2C) to -7.21 (Trial 3D). The mean anterior scores (+2 to -6) varied from -1.66 (Trial 2C) to -2.56 (Trial 3A). The mean posterior cleft-side scores (0 to -6......) varied from -3.24 (Trial 3A) to -3.82 (Trial 3D) and the mean non-cleft-side scores (0 to -6) varied from -0.60 (Trial 2C) to -1.30 (Trial 3A); however, no significant differences were found within the trials. CONCLUSION: There was no statistical evidence of a difference in occlusion between the two...

  15. Readmission rates after abdominal surgery: the role of surgeon, primary caregiver, home health, and subacute rehab.

    Science.gov (United States)

    Martin, Robert C G; Brown, Russell; Puffer, Lisa; Block, Stacey; Callender, Glenda; Quillo, Amy; Scoggins, Charles R; McMasters, Kelly M

    2011-10-01

    To prospectively evaluate predictive factors of hospital readmission rates in patients undergoing abdominal surgical procedures. Recommendations from MedPAC that the Centers for Medicare and Medicaid Services (CMS) report upon and determine payments based in part on readmission rates have led to an attendant interest by payers, hospital administrators and far-sighted physicians. Analysis of 266 prospective treated patients undergoing major abdominal surgical procedures from September 2009 to September 2010. All patients were prospectively evaluated for underlying comorbidities, number of preop meds, surgical procedure, incision type, complications, presence or absence of primary and/or secondary caregiver, their education level, discharge number of medications, and discharge location. Univariate and multivariate analyses were performed. Two hundred twenty-six patients were reviewed with 48 (18%) gastric-esophageal, 39(14%) gastrointestinal, 88 (34%) liver, 58 (22%) pancreas, and 33 (12%) other. Seventy-eight (30%) were readmitted for various diagnoses the most common being dehydration (26%). Certain preoperative and intraoperative factors were not found to be significant for readmission being, comorbidities, diagnosis, number of preoperative medications, patient education level, type of operation, blood loss, and complications. Significant predictive factors for readmission were age (≥69 years), number of discharged (DC) meds (≥9 medications), ≤50% oral intake (52% vs. 23%), and DC home with a home health agency (62% vs. 11%) Readmission rates for surgeons WILL become a quality indicator of performance. Quality parameters among Home Health agencies are nonexistent, but will reflect on surgeon’s performance. Greater awareness regarding predictors of readmission rates is necessary to demonstrate improved surgical quality.

  16. Longitudinal evaluation of restricted mouth opening (trismus) in patients following primary surgery for oral and oropharyngeal squamous cell carcinoma.

    Science.gov (United States)

    Scott, B; D'Souza, J; Perinparajah, N; Lowe, D; Rogers, S N

    2011-03-01

    Trismus is a serious problem for some patients after oral and oropharyngeal cancer, and it has a detrimental impact on quality of life and function. We know of few published papers that include preoperative assessment in reports on the longitudinal outcomes of mouth opening after oral and oropharyngeal surgery. We prospectively measured mouth opening in patients who had primary surgery for oral and oropharyngeal cancer from baseline to six months to find out the characteristics at baseline and at discharge of those who develop trismus at six months. Ninety-eight patients were eligible between February 2007 and March 2008, and 64 (65%) were recruited into the study. The range of mouth opening was measured on three occasions: before operation, on the ward before discharge from hospital, and at follow-up six months after operation. Using a criterion of 35 mm or less as an indication of trismus, 30% (19/63) had trismus before operation, 65% (37/57) at hospital discharge, and 54% (26/48) at six month follow-up. Patients at high risk of trismus were those with T stage 3 or 4 cancers who required free flap reconstruction and adjuvant radiotherapy; radiotherapy was the most significant factor at six months. Trismus at discharge was a prediction of trismus at six months. Interventions such as spatulas or a passive jaw mobiliser should be targeted at patients at high risk early in the postoperative phase. The efficacy of such interventions needs further research. Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. The Birmingham experience of high-pressure methylene blue dye test during primary and revisional bariatric surgery: A retrospective cohort study

    Directory of Open Access Journals (Sweden)

    G.C. Kirby

    2017-11-01

    Conclusion: Despite routine use of methylene blue dye test in 924 patients, there were only two positive tests. Whilst HPMB may demonstrate technical failure, this study suggests that there is no role for its routine use in primary bariatric surgery. Discontinuation of this practice would reduce risk of anaphylaxis to the dye, cost, and intra-operative time.

  18. Physical activity in the elderly who underwent joint replacement surgery in the course of rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Agnieszka Prusinowska

    2016-07-01

    Full Text Available According to the forecasts of the Central Statistical Office of Poland, in 2030 people at the age of 65 and older will account for 23.8%, i.e. their number will amount to approx. 8.5 m people. Geriatric rheumatic patients more often decide to undergo surgical joint replacement. According to the National Health Fund, the number of joint replacement services provided in 2014 increased by 93%, as compared to 2005. Improving the physical performance of this constantly expanding group of patients requires taking into account many factors to raise their functional status, reduce the risk of falling, teach rules of proper functioning with an artificial joint and encourage unassisted physical activity. Restoring fitness and independence is a difficult but necessary task due to an increasing number of seniors with replaced joint.

  19. Intensive Nutrition Management in a Patient with Short Bowel Syndrome Who Underwent Bariatric Surgery

    OpenAIRE

    Kweon, MeeRa; Ju, Dal Lae; Park, Misun; Choe, JiHyeong; Suh, Yun-Suhk; Seol, Eun-Mi; Lee, Hyuk-Joon

    2017-01-01

    Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due ...

  20. 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.

  1. Preoperative infusional chemoradiation and surgery with or without an electron beam intraoperative boost for advanced primary rectal cancer

    International Nuclear Information System (INIS)

    Weinstein, Geoffrey D.; Rich, Tyvin A.; Shumate, Charles R.; Skibber, John M.; Cleary, Karen R.; Ajani, Jaffer A.; Ota, David M.

    1995-01-01

    Purpose: To compare the multimodality treatment results of surgical resection plus preoperative radiotherapy with concomitant protracted infusion chemotherapy (preop-chemoXRT), with or without an electron beam intraoperative radiotherapy (EB-IORT) boost, in 37 patients having advanced primary rectal cancer, with the results of a protocol using only preoperative radiotherapy (preop-XRT) plus surgical resection in a historic control group of 36 patients. Methods and Materials: Thirty-eight patients with tethered T3 or T4 primary rectal cancer were treated with 45 Gy delivered in 25 fractions over 5 weeks plus infusional chemotherapy. Thirty-seven patients underwent surgical resection: 13 (35%) had restorative operations, and the remainder had either abdomino-perineal resection (APR) or pelvic exenteration (PE). Electron beam intraoperative radiotherapy (EB-IORT) was used in doses of 10-20 Gy for 11 patients with adherent pelvic tumor. In the 36 historic control patients, the preop-XRT dose was 45 Gy, and 93% of them had APR or PE. Results: The local recurrence rate was 3% for the preop-chemoXRT group and 33% for the historic control group. The 3-year survival rate for patients treated with preop-chemoXRT plus resection was 82% compared with 62% for the historic control group. Distant metastases occurred more frequently in patients treated with an EB-IORT boost than in patients who were not (64% vs. 19%, p < 0.05), and the overall 3-year survival rate was lower for the former (67% vs. 96%, p < 0.05). Acute and late toxicities were acceptable. Conclusions: Preop-chemoXRT for advanced primary rectal cancer results in better control of pelvic disease and better overall survival rates than does preop-XRT alone. With preop-chemoXRT, acute chemoradiation toxicity is increased whereas late morbidity is unchanged compared with preop-XRT alone. Local control in patients with areas of residual or clinically adherent disease is improved by the use of EB-IORT; however, patients

  2. [Sequential intervention with primary excision and Limberg plastic surgery procedure for treatment of sacrococcygeal pilonidal sinus : Results of a pilot study].

    Science.gov (United States)

    Ardelt, M; Dittmar, Y; Scheuerlein, H; Fahrner, R; Rauchfuß, F; Settmacher, U

    2015-08-01

    The current German S3 guidelines recommend radical excision for pilonidal sinus disease. Furthermore, the Karydakis operation and the plastic surgery procedure according to Limberg are also recommended. Contrary to the S2 guidelines of 2008, these two plastic surgery procedures for coverage are recommended for the treatment of the first-time manifestation of this disease. Most studies on the classical Limberg plastic surgical procedure are comparative in nature and describe a simultaneous intervention from which patients with an abscess are excluded. The aim of this present study was to analyze the results of a sequential procedure including primary excision followed by a Limberg plastic surgery procedure for the treatment of acute abscesses and chronic pilonidal sinus disease. From July 2010 to June 2013 a total of 50 patients with pilonidal sinus disease were treated at the University Hospital Jena with an initial radical excision. In accordance with the Association of the Scientific Medical Societies in Germany (AWMF) guidelines which were valid during that time, patients were offered plastic surgery coverage for recurrence prophylaxis and in cases of recurrence a Limberg plastic surgery procedure was recommended. Of the 50 patients 22 opted for a Limberg plastic surgery procedure during the interval. The mean follow-up after the Limberg plastic surgery procedure was 20.1 months (range 2-36 months). During the follow-up period, there were no recurrences (0 %) but four major complications (18.2 %) and one minor complication (4.5 %) were observed. This concept can be applied in cases of acute abscess formation and in chronic pilonidal sinus disease. The patient's decision with respect to a Limberg plastic surgery procedure for recurrence prophylaxis does not have to be made immediately. In addition, the Limberg plastic surgery procedure is performed in an infection-free stage. The second inpatient stay, second surgical procedure and prolonged time off work are a

  3. Variation among cleft centres in the use of secondary surgery for children with cleft palate: a retrospective cohort study

    Science.gov (United States)

    Sitzman, Thomas J; Hossain, Monir; Carle, Adam C; Heaton, Pamela C; Britto, Maria T

    2017-01-01

    Objectives To test whether cleft centres vary in their use of secondary cleft palate surgery, also known as revision palate surgery, and if so to identify modifiable hospital factors and surgeon factors that are associated with use of secondary surgery. Design Retrospective cohort study. Setting Forty-three paediatric hospitals across the USA. Patients Children with cleft lip and palate who underwent primary cleft palate repair from 1999 to 2013. Main outcome measures Time from primary cleft palate repair to secondary palate surgery. Results We identified 4939 children who underwent primary cleft palate repair. At 10 years after primary palate repair, 44% of children had undergone secondary palate surgery. Significant variation existed among hospitals (ppalate repair before 9 months of age was associated with an increased hazard of secondary palate surgery (initial HR 6.74, 95% CI 5.30 to 8.73). Postoperative antibiotics, surgeon procedure volume and hospital procedure volume were not associated with time to secondary surgery (p>0.05). Of the outcome variation attributable to hospitals and surgeons, between-hospital differences accounted for 59% (ppalate surgery exists depending on a child’s age at primary palate repair and the hospital and surgeon performing their repair. Performing primary palate repair before 9 months of age substantially increases the hazard of secondary surgery. Further research is needed to identify other factors contributing to variation in palate surgery outcomes among hospitals and surgeons. PMID:29479567

  4. Predictive factors of a beneficial quality of life outcome in patients undergoing primary sinonasal surgery: a population-based prospective cohort study.

    Science.gov (United States)

    Alakärppä, Antti I; Koskenkorva, Timo J; Koivunen, Petri T; Alho, Olli-Pekka

    2018-02-28

    To assess predictive factors of a beneficial quality of life (QoL) outcome after primary sinonasal surgery. A population-based prospective cohort study among 160 adult patients undergoing primary sinonasal surgery (76 septoplasties, SP; 84 endoscopic sinus surgeries, ESS) was conducted. We collected QoL data using the Sinonasal Outcome Test-22 (SNOT-22) before and after surgery. A beneficial QoL outcome was defined as a SNOT-22 score change ≥ 9 points 12 months after surgery. Various demographic, clinical and symptom-related factors predicting a beneficial QoL outcome were sought using binary logistic regression analysis. The mean age of the patients was 39 years (range 18-61) and 82 (51%) were males. The SNOT-22 score change varied markedly after SP (range - 17 to + 80) and ESS (range - 20 to + 58), but on average it improved (median + 15 after SP and + 16 after ESS). 41 patients (64%) achieved beneficial QoL outcome after SP and 46 (66%) after ESS. In a multivariate analysis, poor QoL before surgery (preoperative SNOT-22 ≥ 20 points) predicted a beneficial QoL outcome after SP and ESS (adjusted odds ratio 10; 95% confidence interval 1.6-64 and 12; 2.5-55, respectively) and a senior surgeon operating after SP (9.9; 1.5-67). On receiver operating characteristic curve analysis, the integer threshold value for the preoperative SNOT-22 score that gave the highest sensitivity (74%) and specificity (70%) was 30. QoL change after primary SP and ESS varies. A preoperative SNOT-22 score of at least 30 best predicted a beneficial QoL outcome after both procedures.

  5. Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nevzat Dabak

    2014-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

  6. Recurrence-free survival, but not surgical therapy per se, determines 583 patients' long-term satisfaction following primary pilonidal sinus surgery.

    Science.gov (United States)

    Doll, Dietrich; Luedi, Markus M; Evers, Theo; Kauf, Peter; Matevossian, Edouard

    2015-05-01

    With pilonidal sinus disease (PSD) incidence increasing and patients freely choosing their surgeon, patients' interest issues have been brought forward estimating patient satisfaction following pilonidal sinus surgery. The influence of wound healing time and long-term recurrence rate on patient satisfaction in primary PSD surgery has not been investigated yet. Five hundred eighty-three patients (German military cohort) were interviewed, compiling wound healing time, aesthetic satisfaction, long-term recurrence-free survival and patient satisfaction having undergone primary open (PO) treatment, marsupialization (MARS) or primary midline closure (PMC) treatment. Recurrence rate was determined by Kaplan-Meier calculation following up to 20 years after primary PSD surgery. Patient satisfaction ranking from 1 to 10 (10 = max. satisfied) showed an average satisfaction of 8.2 (range 0-10; 95% confidence interval (CI) 7891-8250). In-hospital stay time was significantly longer in primary open (PO) and marsupialization (MARS) group as compared to primary midline closure (PMC; p < 0.0001, Kruskal-Wallis test). Satisfaction was comparable between treatment groups, and was neither linked to in-hospital stay time nor to longer outpatient wound care period or total treatment time. Recurrence-free survival, as seen in the PO and PMC treatment group, revealed a highly significant difference for all patients. Improvement in MARS patients with versus without recurrence was low, as satisfaction with primary treatment was lower as the other groups. Neither choice of surgical treatment nor treatment duration within hospital or after hospital influences patient satisfaction, as long as recurrence-free survival can be provided. Marsupialization was ranked lower in both groups (with or without recurrence), and should be abandoned, as patients are significantly less satisfied with either results, independent of recurrence.

  7. Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study

    International Nuclear Information System (INIS)

    Rutten, Marianne J; Pijnenborg, Johanna MA; Schreuder, Henk WR; Schutter, Eltjo MJ; Spijkerboer, Anje M; Wensveen, Celesta WM; Zusterzeel, Petra; Mol, Ben Willem J; Kenter, Gemma G; Buist, Marrije R; Gaarenstroom, Katja N; Van Gorp, Toon; Meurs, Hannah S van; Arts, Henriette JG; Bossuyt, Patrick M; Ter Brugge, Henk G; Hermans, Ralph HM; Opmeer, Brent C

    2012-01-01

    Standard treatment of advanced ovarian cancer is surgery and chemotherapy. The goal of surgery is to remove all macroscopic tumour, as the amount of residual tumour is the most important prognostic factor for survival. When removal off all tumour is considered not feasible, neoadjuvant chemotherapy (NACT) in combination with interval debulking surgery (IDS) is performed. Current methods of staging are not always accurate in predicting surgical outcome, since approximately 40% of patients will have more than 1 cm residual tumour after primary debulking surgery (PDS). In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer. Multicentre randomized controlled trial, including all gynaecologic oncologic centres in the Netherlands and their affiliated hospitals. Patients are eligible when they are planned for PDS after conventional staging. Participants are randomized between direct PDS or additional diagnostic laparoscopy. Depending on the result of laparoscopy patients are treated by PDS within three weeks, followed by six courses of platinum based chemotherapy or with NACT and IDS 3-4 weeks after three courses of chemotherapy, followed by another three courses of chemotherapy. Primary outcome measure is the proportion of PDS's leaving more than one centimetre tumour residual in each arm. In total 200 patients will be randomized. Data will be analysed according to intention to treat. Patients who have disease considered to be resectable to less than one centimetre should undergo PDS to improve prognosis. However, there is a need for better diagnostic procedures because the current number of debulking surgeries leaving more than one centimetre residual tumour is still high. Laparoscopy before starting treatment for ovarian cancer can be an additional diagnostic tool to predict the outcome of PDS. Despite the absence

  8. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

    DEFF Research Database (Denmark)

    Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge

    2010-01-01

    Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments m...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  10. Frequency of Helicobacter pylori in patients underwent endoscopy

    Directory of Open Access Journals (Sweden)

    Ahmet Tay

    2012-06-01

    Full Text Available Objectives: The aim of this study was to investigate thefrequency of Helicobacter pylori in patients underwent endoscopyeastern Anatolia.Materials and methods: The patients whose endoscopicantral biopsies were taken for any reason in our endoscopyunit in February-June 2010 period were includedand retrospectively investigated. The frequency of Helicobacterpylori was determined as separating the patientsaccording to general, sex and the age groups. Antral biopsieswere stained with hematoxylin-eosin and modified giemsamethod and examined under light microscope andreported as (+ mild, (++ moderate, (+++ severe positiveaccording to their intensities.Results: Biopsy specimens of 1298 patients were includedinto the study. The mean age was 47.5 ± 17.5 years(range 14-88 and 607 of these patients (47% were male.Histopathological evaluation revealed that, 918 of the patientswere (71% positive and 379 (29% were negativefor Helicobacter pylori. Approximately 60% of our patientshad mild, 29% had moderate and 11% had severe positivityfor Helicobacter pylori. No significant difference wasfound in the frequency of Helicobacter pylori betweenwomen and men. The frequencies of Helicobacter pyloriwere 73.2%, 71.5%, 68.6% and 70.4%, respectively, inthe age groups of 14-30 years, 31-45 years, 46-60 yearsand 61-88 years.Conclusion: The frequency of Helicobacter pylori was71% in Eastern Anatolia Region. No statistically significantdifference was found between genders and agegroups in term of the frequency of Helicobacter pylori.

  11. [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.

  12. Gender as a Moderator between Having an Anxiety Disorder Diagnosis and Coronary Artery Bypass Grafting Surgery (CABG) Outcomes in Rural Patients

    Science.gov (United States)

    Dao, Tam K.; Voelkel, Emily; Presley, Sherine; Doss, Brendel; Huddleston, Cashuna; Gopaldas, Raja

    2012-01-01

    Purpose: This paper examines gender as a moderating variable between having an anxiety disorder diagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients. Methods: Using the 2008 Nationwide Inpatient Sample (NIS) database, 17,885 discharge records of patients who underwent a primary CABG surgery were identified.…

  13. Successful use of levosimendan as a primary inotrope in pediatric cardiac surgery: An observational study in 110 patients

    Directory of Open Access Journals (Sweden)

    Reena Khantwal Joshi

    2016-01-01

    Conclusions: Levosimendan-based inotropic regime offers optimized cardiac output with a well-controlled heart rate and a low incidence of arrhythmias in patients undergoing all categories of congenital heart surgeries.

  14. Isokinetic muscle performance after anterior cruciate ligament surgery. Long-term results and outcome predicting factors after primary surgery and late-phase reconstruction.

    Science.gov (United States)

    Natri, A; Järvinen, M; Latvala, K; Kannus, P

    1996-04-01

    The purpose of this study was to evaluate the long-term isokinetic muscle performance after ACL surgery and to analyze by a multiple stepwise regression which factors (if any) predict the overall outcome. The study subjects were 119 patients who had a complete rupture of the ACL and had been treated surgically at the Tampere University Hospital between 1981 and 1990. They were divided into the acute group (N = 62) and into the chronic group (N = 57) according to the time delay between the injury and the ACL surgery. The isokinetic strength measurements of the quadriceps and hamstring muscles were performed on average 4 years after the operation using Cybex II and Cybex 6000 dynamometers (Lumex Inc., Ronkokoma, NY, USA). The peak torques were determined at speeds of 60 and 180 degrees/s and the peak work at speed of 180 degrees/s. The measurements revealed that after the ACL surgery there was still a considerable thigh muscle strength deficit especially in extension of the injured extremity, the average extension strength deficit ranging from 9 to 20%. The extension strength deficit was significantly more prominent in the chronic (18-20%) than in the acute group (9-15%). The extension strength deficit was significantly greater ar the slower (15-20%) than higher (9-18%) speed of the isokinetic movement. In both the acute and chronic groups, a multiple stepwise regression analysis indicated that patellofemoral pain and flexion deficit of the knee were the factors that most frequently and significantly associated with the strength deficits. At the higher speed of the isokinetic movement, these two factors accounted 20% and 21% for the variation seen in the quadriceps strength deficit of the acute group and the chronic group. No correlation could be found between age, sex, height, weight, body mass index, length of the follow-up time, injury type, athletic activity level, immobilization method, knee stability, and the isokinetic muscular performance.

  15. MRI in primary intraspinal extradural hydatid disease: case report

    Energy Technology Data Exchange (ETDEWEB)

    Berk, C. [Department of Neurosurgery, Ankara University Faculty of Medicine, Avicenna Medical Centre, Ankara (Turkey); Ciftci, E. [Camlik Sitesi, Ankara (Turkey); Erdogan, A. [Department of Radiology, Ankara University Faculty of Medicine, Avicenna Medical Centre, Ankara (Turkey)

    1998-06-01

    A rare case of pathologically proven primary intraspinal extradural hydatid disease of the thoracic region with spinal cord compression is reported. The diagnosis was established preoperatively on the basis of the MRI findings. The patient underwent surgery and recovered completely. (orig.) With 2 figs., 12 refs.

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

    Science.gov (United States)

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

    2015-01-01

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

  17. A Pregnant Woman Who Underwent Laparoscopic Adrenalectomy due to Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Halit Diri

    2014-01-01

    Full Text Available Cushing’s syndrome (CS may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertension-induced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone- (ACTH- independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.

  18. Body contouring after obesity surgery is associated with a weight loss benefit among patients.

    Science.gov (United States)

    Agarwal, Shailesh; Shenaq, Deana; Teven, Chad M; Prachand, Vivek; Roughton, Michelle; Zachary, Lawrence

    2017-09-01

    Patients who undergo obesity surgery often require body contouring procedures to eliminate excess skin. Recent studies suggest that body contouring surgery may provide psychological benefits to patients after obesity surgery. However, it remains unclear how body contouring may affect weight loss maintenance after obesity surgery. This is a retrospective review of patients who underwent obesity surgery with or without body contouring at a single institution from 2000 to 2005. Charts were reviewed for demographic, medical, and surgical information. The primary outcome of interest was the difference in weight loss maintenance among patients who underwent body contouring versus those who did not. A total of 318 patients were included for analysis in this study, of which 70 underwent obesity surgery with body contouring and 248 underwent obesity surgery without body contouring. The mean change in BMI among patients who did not undergo body contouring was 19.7 kg/m 2 . The mean change in BMI among patients who underwent body contouring was 22.1 kg/m 2 . Among patients who underwent body contouring surgery, 2.9% (2/70) of patients did not maintain at least a 20% decrease in body weight during the entire follow-up period (mean follow-up time 92.2 months). Among patients who did not undergo body contouring surgery, 10% (25/248) of patients did not maintain at least a 20% decrease in body weight during the entire follow-up period (mean follow-up time 39.0 months) (χ 2  = 3.67, p = 0.055). Body contouring surgery may have a positive effect on weight loss maintenance after body contouring determined from the mean weight change and on percentage of patients who maintain at least a 20% decrease in body weight. Copyright © 2017. Published by Elsevier Ltd.

  19. An investigation into the variables associated with length of hospital stay related to primary cleft lip and palate surgery and alveolar bone grafting.

    Science.gov (United States)

    Izadi, N; Haers, P E

    2012-10-01

    This retrospective study evaluated variables associated with length of stay (LOS) in hospital for 406 admissions of primary cleft lip and palate and alveolus surgery between January 2007 and April 2009. Three patients were treated as day cases, 343 (84%) stayed one night, 48 (12%) stayed 2 nights and 12 (3%) stayed > 2 nights. Poisson regression analysis showed that there was no association between postoperative LOS and age, distance travelled, diagnosis and type of operation, with a p value > 0.2 for all variables. 60/406 patients stayed 2 nights or more postoperatively mostly due to poor pain control and inadequate oral intake. Patients with palate repair were more likely to have postoperative LOS > 1 night, compared to patients with lip repair, p value = 0.011. Four patients (1%), all of whom had undergone cleft palate surgery, were readmitted within 4 weeks of the operation due to respiratory obstruction or haemorrhage. Using logistic regression, evidence showed that these readmissions were related to a longer original postoperative LOS. This study shows that length of stay for primary cleft lip, palate and alveolus surgery can in most cases be limited to one night postoperatively, provided that adequate support can be provided at home. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Surgical Outcomes After Segmental Limited Surgery for Adjacent Segment Disease: The Consequences of Makeshift Surgery.

    Science.gov (United States)

    Ryu, Dal-Sung; Park, Jeong-Yoon; Kuh, Sung-Uk; Chin, Dong-Kyu; Kim, Keun-Su; Cho, Yong-Eun; Kim, Kyung-Hyun

    2018-02-01

    To minimize surgical morbidity, surgeons may opt to perform segmental limited surgery instead of fusion extension for adjacent segment disease (ASD) after lumbar fusion surgery. This study evaluated clinical outcomes from segmental limited surgery without fusion extension for ASD and assessed which clinical factors were associated with reoperation after segmental limited surgery. Medical data of 50 patients who underwent segmental limited surgery for ASD after lumbar fusion surgery between 2005 and 2015 were reviewed. Demographic data, ASD type, preoperative disc and facet degeneration, ASD location, and surgical summary were collected. The primary outcome was reoperation rate at 24 months after surgery. Of patients, 28 (56%) experienced recurrent radiculopathy (visual analog scale score ≥4). Revision surgery was performed in 22 patients (44%). Reoperation was performed more frequently in multilevel fusion first-surgery cases (15/23; 65.2%) than single-level fusion first-surgery cases (7/27; 25.9%; P = 0.005). The lowermost mobile segment group had a lower reoperation-free survival rate than the other group (hazard ratio = 9.85, 95% confidence interval 1.32-73.54, P = 0.01 [log-rank]). The 2-year reoperation-free survival rate for the lowermost mobile segment group was 31.5%, whereas the rate for the other group was 83.3%. Segmental limited surgery as a treatment for ASD after lumbar fusion surgery is likely to fail frequently and result in a high rate of recurrent radiculopathy and revision surgery. Fusion extension surgery is especially recommended for ASD at the lowermost mobile segment owing to the high failure rate. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Diode laser surgery. Ab interno and ab externo versus conventional surgery in rabbits.

    Science.gov (United States)

    Karp, C L; Higginbotham, E J; Edward, D P; Musch, D C

    1993-10-01

    Fibroblastic proliferation of subconjunctival tissues remains a primary mechanism of failure in filtration surgery. Minimizing the surgical manipulation of episcleral tissues may reduce scarring. Laser sclerostomy surgery involves minimal tissue dissection, and is gaining attention as a method of potentially improving filter duration in high-risk cases. Twenty-five New Zealand rabbits underwent filtration surgery in one eye, and the fellow eye remained as the unoperated control. Ten rabbits underwent ab externo diode laser sclerostomy surgery, ten underwent ab interno diode sclerostomy surgery, and five had posterior sclerostomy procedures. Filtration failure was defined as a less-than-4-mmHg intraocular pressure (IOP) difference between the operative and control eyes. The mean time to failure for the ab externo, ab interno, and conventional posterior sclerostomy techniques measured 17.4 +/- 11.5, 13.1 +/- 6.7, and 6.0 +/- 3.1 days, respectively. In a comparison of the laser-treated groups with the conventional procedure, the time to failure was significantly longer (P = 0.02) for the ab externo filter. The mean ab interno sclerostomy duration was longer than the posterior lip procedure, but this difference was not statistically significant (P = 0.15). The overall level of IOP reduction was similar in the three groups. These data suggest that diode laser sclerostomy is a feasible technique in rabbits, and the ab externo approach resulted in longer filter duration than the conventional posterior lip procedure in this model.

  2. A approach for differential diagnosis of primary lung cancer and breast cancer relapse presenting as a solitary pulmonary nodule in patients after breast surgery

    International Nuclear Information System (INIS)

    Fujita, Takashi; Iwata, Hiroharu; Yatabe, Yasushi

    2009-01-01

    The differential diagnosis of primary lung cancer from metastatic breast cancer is crucial in patients presenting with a solitary pulmonary nodule after breast surgery. However definitive diagnosis of these nodules is often difficult due to similar radiological and pathological features in primary lung and metastatic breast cancer nodules. We assessed the feasibility of our diagnostic approach for these nodules by morphopathological and immunohistochemical examination (thyroid transcription factor-1 (TTF-1), surfactant pro-protein B (SPPB), estrogen receptor (ER), mammaglobin-1 (MGB1)), and estimated the frequency of primary lung cancer occurrence in 23 breast cancer patients. Biopsy specimens were obtained using CT-guided needle biopsy (NB) and transbronchial lung biopsy (TBLB) in 21 patients (91.3%). Surgical resection was performed for diagnosis and treatment in two patients. Differential diagnosis was obtained by morphopathological methods alone in 17 patients (73.9%, primary lung cancer: 6 cases, metastatic breast cancer: 11 cases) and by immunohistochemical examination in the remaining 6 (26.1%, primary lung cancer: 1 case, metastatic breast cancer: 5 cases). Our results show the clinical feasibility of our approach to the differential diagnosis of breast cancer relapse and primary lung cancer presenting as a solitary nodule in breast cancer patients. (author)

  3. Influence of perioperative administration of amino acids on thermoregulation response in patients underwent colorectal surgical procedures

    Directory of Open Access Journals (Sweden)

    Zeba Snježana

    2007-01-01

    Full Text Available Background. Hypothermia in the surgical patients can be the consequence of long duration of surgical intervention, general anesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition, but some investigations reported that infusion of aminoacids during surgery can induce thermogenesis and prevent postoperative hypothermia. Case report. We reported two males who underwent major colorectal surgery for rectal carcinoma. One patient received Aminosol 15% solution, 125 ml/h, while the other did not. The esophageal temperatures in both cases were measured every 30 minutes during the operation and 60 minutes after in Intensive Care Unit. We were monitoring blood pressure, heart rate, ECG, and shivering. Patient who received aminoacids showed ameliorated postoperative hypothermia without hypertension, arrhythmia, or shivering, while the other showed all symptoms mentioned above. Conclusion. According to literature data, as well as our findings, we can conclude that intraoperative intravenous treatment with amino acid solution ameliorates postoperative hypothermia along with its complications. .

  4. The importance of surgery as part of multimodal therapy in rapid progressive primary extraosseous Ewing sarcoma of the cervical intra- and epidural space

    Directory of Open Access Journals (Sweden)

    Richard Bostelmann

    2016-12-01

    Full Text Available Primary extraosseous Ewing sarcomas (EESs are an extremely rare pathological entity. Less than 32 cases have been reported in the literature. Here we report an uncommon case with very rapid progression in the cervical region with extra- and intradural involvement. We present a thorough review of the literature and discuss possible treatment modalities. The Medline database was searched using the search terms: Ewing sarcoma, extraosseus tumour, treatment, management, cervical spine. A previously healthy 29-year-old man complained of right-sided radiculopathy (C7. Magnetic resonance imaging showed an enhancing foraminal, sandglass shaped neurinoma- like lesion. Surgery revealed an intraand extra-dural lesion, which was histologically diagnosed as Ewing sarcoma. Despite gross total resection, there was a massive symptomatic tumor recurrence within 6 weeks. A second gross total resection was realized. The patient was treated according to the EURO E.W.I.N.G.-Protocol (VIDE and recovered very well (progression-free interval during therapy. Several decompressive re-surgeries were realized with adjuvant radio-chemotherapy. At the last follow-up (17 months after initial surgery the patient was in remission with a good quality of live. This case is to illustrate that despite extensive therapeutic efforts, the progression- free survival in case of primary EES may be very short. To maintain neurological function and good quality of live as long as possible, a multimodal strategy seems to be adequate. Like in the present case this implies several surgeries and adjuvant chemo-and radiotherapy. Whether this improves overall survival remains unclear.

  5. Prediction of incomplete primary debulking surgery in patients with advanced ovarian cancer: An external validation study of three models using computed tomography.

    Science.gov (United States)

    Rutten, Iris J G; van de Laar, Rafli; Kruitwagen, Roy F P M; Bakers, Frans C H; Ploegmakers, Marieke J M; Pappot, Teun W F; Beets-Tan, Regina G H; Massuger, Leon F A G; Zusterzeel, Petra L M; Van Gorp, Toon

    2016-01-01

    To test the ability of three prospectively developed computed tomography (CT) models to predict incomplete primary debulking surgery in patients with advanced (International Federation of Gynecology and Obstetrics stages III-IV) ovarian cancer. Three prediction models to predict incomplete surgery (any tumor residual >1cm in diameter) previously published by Ferrandina (models A and B) and by Gerestein were applied to a validation cohort consisting of 151 patients with advanced epithelial ovarian cancer. All patients were treated with primary debulking surgery in the Eastern part of the Netherlands between 2000 and 2009 and data were retrospectively collected. Three individual readers evaluated the radiographic parameters and gave a subjective assessment. Using the predicted probabilities from the models, the area under the curve (AUC) was calculated which represents the discriminative ability of the model. The AUC of the Ferrandina models was 0.56, 0.59 and 0.59 in model A, and 0.55, 0.60 and 0.59 in model B for readers 1, 2 and 3, respectively. The AUC of Gerestein's model was 0.69, 0.61 and 0.69 for readers 1, 2 and 3, respectively. AUC values of 0.69 and 0.63 for reader 1 and 3 were found for subjective assessment. Models to predict incomplete surgery in advanced ovarian cancer have limited predictive ability and their reproducibility is questionable. Subjective assessment seems as successful as applying predictive models. Present prediction models are not reliable enough to be used in clinical decision-making and should be interpreted with caution. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Novel incision design and primary flap closure reduces the incidence of alveolar osteitis and infection in impacted mandibular third molar surgery.

    Science.gov (United States)

    Elo, Jeffrey A; Sun, Ho-Hyun Brian; Dong, Fanglong; Tandon, Rahul; Singh, Hardev M

    2016-08-01

    To measure the influence of flap design on alveolar osteitis (AO) and postoperative complications following mandibular third molar surgery. This study was designed as a randomized single-blind, split-mouth clinical trial. The predictor variable was flap type. Envelope flap, modified triangular flap (MTF), and two related experimental flaps (second molar mesial papilla-sparing marginal incision with distobuccal release with double-pass single-layered primary closure [MPMI-2 X] and single-pass single-layered primary closure [MPMI-1 X]) were used. The primary outcome variable was AO. The secondary outcome variables were wound dehiscence and infection. Bivariate and logistic analyses were computed. P value third molars participated. No sites (0 of 196) treated with MPMI-2 X developed AO, and only two sites (2 of 196) treated with MPMI-2 X developed postoperative infection. Both MPMI-1 X and MPMI-2 X were associated with decreased odds of complications compared with MTF and envelope flap. MPMI-2 X sites were significantly less likely than MTF sites to experience complications for both sides. MPMI-2 X is a reliable technique to reduce complications, such as AO, wound dehiscence, and infection in mandibular third molar surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Laparoscopic Roux-en-Y gastric bypass: Outcomes of a case-matched comparison of primary versus revisional surgery

    Directory of Open Access Journals (Sweden)

    Pradeep K Chowbey

    2018-01-01

    Conclusion: Comorbidity resolution after revisional and pLRYGB are similar. Less weight loss is achieved after revision than after pLRYGB, but total weight loss is comparable. Revisional surgery is safe when performed by experienced surgeons in high-volume centres.

  8. Morphological and functional outcome of scleral buckling surgery compared to primary vitrectomy in patients with retinal detachment.

    Science.gov (United States)

    Stamenković, Miroslav; Stefanović, Ivan; Senćanić, Ivan; Jakšić, Vesna; Mavija, Milka; Babović, Siniša

    2014-10-01

    Among the proposed operative techniques for retinal detachment (RD) the most commonly applied are classical method with scleral buckling and pars plana vitrectomy (PPV). The aim of this paper was to determine which surgical intervention of these two leads to better morphological results in terms of the applied retina and better functional outcomes in terms of visual acuity (VA) of the operated eye in patients with RD. A retrospective study on the comparative section of the effects of scleral buckling surgery and PPV in uncomplicated rhegmatogenous RD was performed. In a 2-year period 97 patients, i.e. 98 eyes with RD were operated on (68 eyes with scleral buckling surgery vs 30 by PPV). In the group with classically operated detachment, the retina was applied in 52 (76.5%) cases vs 30 (100%) patients in PPV group (p buckling surgery. VA was significantly improved in both observed groups, while its mean value was postoperatively better in the group that was operated with the classical method. The reason for this could be due to better VA in baseline in the scleral buckling surgery group.

  9. Primary human alveolar bone cells isolated from tissue samples acquired at periodontal surgeries exhibit sustained proliferation and retain osteogenic phenotype during in vitro expansion.

    Directory of Open Access Journals (Sweden)

    Darja Marolt

    Full Text Available OBJECTIVES: Bone tissue regeneration requires a source of viable, proliferative cells with osteogenic differentiation capacity. Periodontal surgeries represent an opportunity to procure small amounts of autologous tissues for primary cell isolation. Our objective was to assess the potential of human alveolar bone as a source of autologous osteogenic cells for tissue engineering and biomaterials and drug testing studies. MATERIALS AND METHODS: Alveolar bone tissue was obtained from 37 patients undergoing routine periodontal surgery. Tissue harvesting and cell isolation procedures were optimized to isolate viable cells. Primary cells were subcultured and characterized with respect to their growth characteristics, gene expression of osteogenic markers, alkaline phosphatase activity and matrix mineralization, under osteogenic stimulation. RESULTS: Alveolar bone cells were successfully isolated from 28 of the 30 samples harvested with bone forceps, and from 2 of the 5 samples obtained by bone drilling. The yield of cells in primary cultures was variable between the individual samples, but was not related to the site of tissue harvesting and the patient age. In 80% of samples (n = 5, the primary cells proliferated steadily for eight subsequent passages, reaching cumulative numbers over 10(10 cells. Analyses confirmed stable gene expression of alkaline phosphatase, osteopontin and osteocalcin in early and late cell passages. In osteogenic medium, the cells from late passages increased alkaline phosphatase activity and accumulated mineralized matrix, indicating a mature osteoblastic phenotype. CONCLUSIONS: Primary alveolar bone cells exhibited robust proliferation and retained osteogenic phenotype during in vitro expansion, suggesting that they can be used as an autologous cell source for bone regenerative therapies and various in vitro studies.

  10. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer.

    Science.gov (United States)

    Suidan, Rudy S; Ramirez, Pedro T; Sarasohn, Debra M; Teitcher, Jerrold B; Mironov, Svetlana; Iyer, Revathy B; Zhou, Qin; Iasonos, Alexia; Paul, Harold; Hosaka, Masayoshi; Aghajanian, Carol A; Leitao, Mario M; Gardner, Ginger J; Abu-Rustum, Nadeem R; Sonoda, Yukio; Levine, Douglas A; Hricak, Hedvig; Chi, Dennis S

    2014-09-01

    To assess the ability of preoperative computed tomography (CT) scan of the abdomen/pelvis and serum CA-125 to predict suboptimal (>1cm residual disease) primary cytoreduction in advanced ovarian, fallopian tube, and peritoneal cancer. This was a prospective, non-randomized, multicenter trial of patients who underwent primary cytoreduction for stage III-IV ovarian, fallopian tube, and peritoneal cancer. A CT scan of the abdomen/pelvis and serum CA-125 were obtained within 35 and 14 days before surgery, respectively. Four clinical and 20 radiologic criteria were assessed. From 7/2001 to 12/2012, 669 patients were enrolled; 350 met eligibility criteria. The optimal debulking rate was 75%. On multivariate analysis, three clinical and six radiologic criteria were significantly associated with suboptimal debulking: age ≥ 60 years (p=0.01); CA-125 ≥ 500 U/mL (p1cm (p1cm in the small bowel mesentery (p=0.03), root of the superior mesenteric artery (p=0.003), perisplenic area (p<0.001), and lesser sac (p<0.001). A 'predictive value score' was assigned for each criterion, and the suboptimal debulking rates of patients who had a total score of 0, 1-2, 3-4, 5-6, 7-8, and ≥ 9 were 5%, 10%, 17%, 34%, 52%, and 74%, respectively. A prognostic model combining these nine factors had a predictive accuracy of 0.758. We identified nine criteria associated with suboptimal cytoreduction, and developed a predictive model in which the suboptimal rate was directly proportional to a predictive value score. These results may be helpful in pretreatment patient assessment. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Tests and visits before surgery

    Science.gov (United States)

    Before surgery - tests; Before surgery - doctor visits ... Pre-op is the time before your surgery. It means "before operation." During this time, you will meet with one of your doctors. This may be your surgeon or primary care ...

  12. Outcomes and Prognostic Factors for Adult Patients With Congenital Heart Disease Undergoing Primary or Reoperative Systemic Atrioventricular Valve Surgery.

    Science.gov (United States)

    Stephens, Elizabeth H; Han, Jiho; Ginns, Jonathan; Rosenbaum, Marlon; Chai, Paul; Bacha, Emile; Kalfa, David

    2017-05-01

    Adults with congenital heart disease (ACHD) undergoing systemic atrioventricular valve (SAVV) surgery are a complex, understudied population. We assessed midterm outcomes and prognostic factors in ACHD undergoing SAVV surgery. We performed retrospective evaluation of ACHD undergoing SAVV surgery from January 2005 to February 2016: 14 (33%) patients with congenital mitral valve stenosis/regurgitation, 15 (35%) with atrioventricular septal defect (AVSD), and 14 (33%) with congenitally corrected transposition of the great arteries (ccTGA) with systemic tricuspid valve regurgitation. Adverse events were defined as mortality, reoperation on SAVV, and late more-than-moderate (> moderate) SAVV regurgitation. Statistical analysis was performed using Fisher's exact test and one-way analysis of variance as well as univariate and multivariate risk factor analysis. Fifteen (35%) patients had preoperative systemic ventricular dysfunction, including 13 patients with ccTGA (93%, P moderate SAVV regurgitation, and SAVV reoperation rates were 5% (n = 2), 2% (n = 1), 9% (n = 3), and 7% (n = 3), respectively. On multivariate analysis, predischarge SAVV regurgitation grade was the only significant predictor of adverse events (odds ratio = 8.2, 95% confidence interval: 1.1-63.8, P = .045). Overall outcomes in this challenging population are good. The single factor associated with adverse events was predischarge SAVV regurgitation grade.

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  14. Age- and gender-related differences in the use of secondary medical prevention after primary vascular surgery

    DEFF Research Database (Denmark)

    Høgh, A; Lindholt, Jonas; Nielsen, H

    2012-01-01

    This study examined the possible age- and gender-related differences in the use of secondary medical prevention following primary vascular reconstruction in a population-based long-term follow-up study.......This study examined the possible age- and gender-related differences in the use of secondary medical prevention following primary vascular reconstruction in a population-based long-term follow-up study....

  15. Information needs and decision-making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer.

    Science.gov (United States)

    Burton, Maria; Kilner, Karen; Wyld, Lynda; Lifford, Kate Joanna; Gordon, Frances; Allison, Annabel; Reed, Malcolm; Collins, Karen Anna

    2017-12-01

    To establish older women's (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify women's preferences for the mode of information presentation and decision-making (DM) style. This was a UK multicentre survey of women, ≥75 years, who had been offered a choice between PET and surgery at diagnosis of breast cancer. A questionnaire was developed including 2 validated scales of decision regret and DM preferences. Questionnaires were sent to 247 women, and 101 were returned (response rate 41%). The median age of participants was 82 (range 75 to 99), with 58 having had surgery and 37 having PET. Practical details about the impact, safety, and efficacy of treatment were of most interest to participants. Of least interest were cosmetic outcomes after surgery. Information provided verbally by doctors and nurses, supported by booklets, was preferred. There was little interest in technology-based sources of information. There was equal preference for a patient- or doctor-centred DM style and lower preference for a shared DM style. The majority (74%) experienced their preferred DM style. Levels of decision regret were low (15.73, scale 0-100). Women strongly preferred face to face information. Written formats were also helpful but not computer-based resources. Information that was found helpful to women in the DM process was identified. The study demonstrates many women achieved their preferred DM style, with a preference for involvement, and expressed low levels of decision regret. Copyright © 2017 John Wiley & Sons, Ltd.

  16. Attachment of Primary Vaginal Fibroblasts to Absorbable and Nonabsorbable Implant Materials Coated With Platelet-Rich Plasma: Potential Application in Pelvic Organ Prolapse Surgery.

    Science.gov (United States)

    Medel, Sebastian; Alarab, May; Kufaishi, Hala; Drutz, Harold; Shynlova, Oksana

    2015-01-01

    Pelvic organ prolapse (POP) is a common condition in women. The lifetime risk of undergoing surgery to correct POP is 11%, with 30% recurrence rate. Various types of vaginal implants, absorbable and nonabsorbable, that have been introduced in pelvic floor reconstructive surgeries have numerous serious adverse effects. Platelet-rich plasma (PRP) is an autologous product that accelerates tissue healing and regeneration. We hypothesized that autologous PRP will promote human vaginal fibroblast (HVF) attachment to vaginal implants and increase their healing potential. Vaginal tissue biopsies were collected from postmenopausal patients with POP (n = 10) and asymptomatic control subjects (n = 4) during vaginal hysterectomy or repair. Primary cells were isolated and characterized by immunocytochemistry. Cell attachment and proliferation were compared between POP HVFs and control HVFs (n = 4/group). Twelve weeks after the surgery, blood samples were collected from 6 POP patients to obtain autologous PRP. Two meshes, absorbable (Vicryl) and nonabsorbable (Restorelle), were coated in PRP or control media; autologous POP HVFs (n = 6) were seeded on meshes for 2 hours. Cells attached to the meshes were fixed, stained with DAPI (4,6-diamidino-2-phenylindole dihydrochloride), and counted. Pelvic organ prolapse HVFs were similar to control HVFs in attachment to different matrix substrates and in proliferation rate. Attachment of POP HVFs to both meshes was significantly increased after coating with PRP versus Dulbecco modified Eagle medium (Vicryl: 9875 vs. 1006 cells/cm, Restorelle: 3724 vs. 649 cells/cm; P attachment to implant materials when treated with PRP, which may lead to reduced mesh-related complications in vivo, indicating its great potential for urogynecologic surgeries.

  17. The influence of mechanical bowel preparation in elective colorectal surgery for diverticulitis.

    Science.gov (United States)

    Van't Sant, H P; Slieker, J C; Hop, W C J; Weidema, W F; Lange, J F; Vermeulen, J; Contant, C M E

    2012-08-01

    Mechanical bowel preparation (MBP) has been shown to have no influence on the incidence of anastomotic leakage in overall colorectal surgery. The role of MBP in elective surgery in combination with an inflammatory component such as diverticulitis is yet unclear. This study evaluates the effects of MBP on anastomotic leakage and other septic complications in 190 patients who underwent elective surgery for colonic diverticulitis. A subgroup analysis was performed in a prior multicenter (13 hospitals) randomized trial comparing clinical outcome of MBP versus no MBP in elective colorectal surgery. Primary endpoint was the occurrence of anastomotic leakage in patients operated on for diverticulitis, and secondary endpoints were septic complications and mortality. Out of a total of 1,354 patients, 190 underwent elective colorectal surgery (resection with primary anastomosis) for (recurrent or stenotic) diverticulitis. One hundred and three patients underwent MBP prior to surgery and 87 did not. Anastomotic leakage occurred in 7.8 % of patients treated with MBP and in 5.7 % of patients not treated with MBP (p = 0.79). There were no significant differences between the groups in septic complications and mortality. Mechanical bowel preparation has no influence on the incidence of anastomotic leakage, or other septic complications, and may be safely omitted in case of elective colorectal surgery for diverticulitis.

  18. Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution

    Directory of Open Access Journals (Sweden)

    Souza, José Celso Rodriques de

    2015-11-01

    Full Text Available Introduction Otosclerosis is a primary disease of the temporal bone that leads to stapes ankylosis. Hearing loss is the main symptom. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. Objective To evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in a teaching institution. Method Retrospective descriptive study. Results A total of 210 ears of 163 patients underwent stapes surgery. Of the 163 patients, 116 (71.2% underwent unilateral surgery and 47 (28.8% underwent bilateral surgery. Six of the 210 operated ears had obliterative otosclerosis. The average preoperative and postoperative air–bone gap was 32.06 and 4.39 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 23.17 and 19.82 dB, respectively. A total of 184 (87.6% ears had a residual air–bone gap <10 dB, and 196 (93.3% had a residual air–bone gap ≤15 dB. Two patients (0.95% had severe sensorineural hearing loss. Conclusion Stapes surgery showed excellent functional hearing outcomes in this study. This surgery may be performed in educational institutions with the supervision of experienced surgeons.

  19. Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Nakamura, Yoshiharu; Matsushita, Akira; Katsuno, Akira; Yamahatsu, Kazuya; Sumiyoshi, Hiroki; Mizuguchi, Yoshiaki; Uchida, Eiji

    2016-02-01

    The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  20. Combined eyelid and strabismus surgery: examining conventional surgical wisdom.

    Science.gov (United States)

    McCracken, Michael S; del Prado, Jonathan D; Granet, David B; Levi, Leah; Kikkawa, Don O

    2008-01-01

    To determine whether satisfactory results of both eyelid surgery and strabismus surgery can be obtained when these procedures are performed in the same setting in selected patients. Nine patients (16 eyelids) who had undergone surgery in the same setting for eyelid malposition and strabismus of the horizontal rectus muscles, with or without concurrent vertical rectus muscle surgery, were retrospectively reviewed. Eyelid malposition surgery success was defined as a postoperative margin reflex distance (MRD1) within 1 mm of the target. Strabismus surgery success was defined as a postoperative deviation within 8 prism diopters of orthophoria or a decrease in binocular diplopia if the patient had a less than 8 prism diopters deviation in primary gaze preoperatively. Eyelid retraction repair was performed on 13 upper eyelids, levator advancement was performed on 2 eyelids, and frontalis suspension was performed on 1 eyelid. Four patients underwent bilateral medial rectus recession and the remaining 5 patients received varying strabismus surgery. Four patients received adjustable sutures. Mean follow-up was 11 months. Postoperatively, 13 of 16 eyelids (81%) achieved an MRD1 within 1 mm of the target. Eight of 9 patients (89%) demonstrated satisfactory strabismus correction. Combined eyelid malposition and strabismus surgery can be successfully performed in selected cases, particularly when the strabismus surgery involves the horizontal rectus muscles. Combined surgery is not recommended in cases that do not involve the horizontal rectus muscles.

  1. Voiding patterns of adult patients who underwent hypospadias repair in childhood.

    Science.gov (United States)

    Jaber, Jawdat; Kocherov, Stanislav; Chertin, Leonid; Farkas, Amicur; Chertin, Boris

    2017-02-01

    This study aimed at evaluating the voiding patterns of adult patients who underwent hypospadias repair in childhood. Following IRB approval 103 (22.7%) of 449 adult patients who underwent hypospadias repair between 1978 and 1993 responded to the following questionnaires: International Prostate Symptom Score (I-PSS) and Short Form 12 questionnaire (SF-12). Uroflowmetry (UF) was performed for all patients. The patients were divided into three groups according to the primary meatus localization. Group I had 63 patients (61.5%) treated for glanular hypospadias, group II had 19 patients (18.4%) treated for distal hypospadias, and group III comprised the remaining 21 patients (20.4%) treated for proximal hypospadias. The mean ± SD I-PSS score for all patients who responded to the questionnaire was 2.3 ± 2.4, and UF was 21.1 ± 4.3 mL/s. The patients from groups I and III had fewer urinary symptoms compared with those of the group II: 1.3 ± 1.5, 5.5 ± 2.4, and 1.6 ± 1.4, respectively (p hypospadias repair in childhood had normal or mild voiding disturbance, with no effects on their physical or mental status. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  2. Circulating vascular endothelial growth factor six months after primary surgery as a prognostic marker in patients with colorectal cancer

    DEFF Research Database (Denmark)

    Werther, Kim; Sørensen, Steen; Christensen, Ib Jarle

    2003-01-01

    curative resection of primary CRC, the prognostic value of VEGF concentrations in plasma and serum obtained 6 months postoperatively was analysed and the results compared with the prognostic value of postoperative carcinoembryonic antigen (CEA) concentrations in matched serum samples. In univariate...

  3. Outcome of surgery for primary and recurrent desmoid-type fibromatosis. A retrospective case series of 174 patients

    Directory of Open Access Journals (Sweden)

    Panagiotis Tsagozis, BSc, MD, PhD

    2017-05-01

    Conclusions: A complete primary excision is the best window of opportunity to achieve local control of desmoid-type fibromatosis. Once the disease relapses, surgical intervention is accompanied with a high risk of failure, irrespective of the quality of the margins and adjuvant treatment given.

  4. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leão

    Full Text Available ABSTRACT OBJECTIVES: To evaluate through the visual analog scale (VAS the pain in patients undergoing total knee replacement (TKR with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard and the other with systolic blood pressure plus 100 mmHg (P + 100. These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM, complications, and blood drainage volume in each group; the data were subjected to statistical analysis. RESULTS: After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612, ROM (p = 0.202, bleeding after 24 and 48 h (p = 0.432 and p = 0.254 or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding. CONCLUSIONS: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

  5. Congenital hydrocele: prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria.

    Science.gov (United States)

    Osifo, O D; Osaigbovo, E O

    2008-06-01

    To determine the prevalence and spontaneous resolution of congenital hydrocele diagnosed in male neonates who underwent circumcision at our centre. All male neonates presented for circumcision at the University of Benin Teaching Hospital, Benin City, Nigeria between January 2002 and December 2006 were examined for the presence of hydrocele. Those diagnosed with this condition were recruited and followed up in a surgical outpatient clinic for 2 years. The number of cases of spontaneous resolution and age at which this occurred were documented on a structured pro forma. A total of 2715 neonates were circumcised and 128 (4.7%) were diagnosed with 163 cases of hydrocele, while 27 cases in 25 (0.9%) children failed to resolve at the age of 2 years. Neonatal hydrocele was bilateral in 112 (68.7%), and there were 20 (12.3%) right and 31 (19.0%) left. Among those with hydrocele, 28.1% were delivered preterm and resolution was spontaneous in many of them, with no observed significant statistical difference to those delivered full term (P=0.4740). Of the 163 hydrocele cases, 136 (83.4%) resolved spontaneously by age 18 months with peak resolution at 4-6 months. No spontaneous resolution occurred after 18 months and no hydrocele-related complication occurred during follow up. Neonates with congenital hydrocele should be observed for spontaneous resolution for at least 18 months before being subjected to surgery.

  6. One Step Melanoma Surgery for Patient with Thick Primary Melanomas: "To Break the Rules, You Must First Master Them!"

    Directory of Open Access Journals (Sweden)

    Georgi Tchernev

    2018-02-01

    CONCLUSIONS: In this case remains unclear the following question: For what reason a preoperative high - frequent ultrasonography (HFUS is not recommended to be used as it will allow only one surgical excision with the elimination of a tumour with a safety field of 2cm in all directions? The enigma about the obstacles preventing such a rational optimisation of the current diagnostic and therapeutic algorithm in patients with melanomas remains unresolved. One step surgery for cutaneous melanoma is widely used in many countries although it continues to be considered as a matter of dispute for some experts. Once again, by a clinical case and the following analysis, we would like to focus the attention of the dermatosurgical community on this crucial and highly significant problem. Innovations are very often resulting from the simplicity of logic, which unfortunately is not always accepted appropriately.

  7. Surgeon specialty and outcomes after elective spine surgery.

    Science.gov (United States)

    Seicean, Andreea; Alan, Nima; Seicean, Sinziana; Neuhauser, Duncan; Benzel, Edward C; Weil, Robert J

    2014-09-01

    Retrospective cohort analysis of prospectively collected clinical data. To compare outcomes of elective spine fusion and laminectomy when performed by neurological and orthopedic surgeons. The relationship between primary specialty training and outcome of spinal surgery is unknown. We analyzed the 2006 to 2012 American College of Surgeons National Surgical Quality Improvement Project database of 50,361 patients, 33,235 (66%) of which were operated on by a neurosurgeon. We eliminated all differences in preoperative and intraoperative risk factors between surgical specialties by matching 17,126 patients who underwent orthopedic surgery (OS) to 17,126 patients who underwent neurosurgery (NS) on propensity scores. Regular and conditional logistic regressions were used to predict adverse postoperative outcomes in the full sample and matched sample, respectively. The effect of perioperative transfusion on outcomes was further assessed in the matched sample. Diagnosis and procedure were the only factors that were found to be significantly different between surgical subspecialties in the full sample. We found that compared with patients who underwent NS, patients who underwent OS were more than twice as likely to experience prolonged length of stay (LOS) (odds ratio: 2.6, 95% confidence interval: 2.4-2.8), and significantly more likely to receive a transfusion perioperatively, have complications, and to require discharge with continued care. After matching, patients who underwent OS continued to have slightly higher odds for prolonged LOS, and twice the odds for receiving perioperative transfusion compared with patients who underwent NS. Taking into account perioperative transfusion did not eliminate the difference in LOS between patients who underwent OS and those who underwent NS. Patients operated on by OS have twice the odds for undergoing perioperative transfusion and slightly increased odds for prolonged LOS. Other differences between surgical specialties in 30-day

  8. A Prospective Randomized Clinical Study of the Influence of Primary Closure or Dressing on Post-operative Morbidity after Mandibular Third Molar Surgery

    Science.gov (United States)

    Egbor, Peter E; Saheeb, Birch D

    2014-01-01

    Objective: The aim of the following study is to determine the effect of primary closure or dressing on post-operative morbidity after impacted lower third molar surgery. Materials and Methods: This was a randomized clinical study of 72 patients who had surgical extraction of impacted mandibular third molars. The subjects were divided into two groups of A and B. Group A had total closure (primary closure) and Group B had whitehead varnish dressing of the socket. Pain, swelling and trismus were evaluated pre-operatively using visual analogue scale, flexible tape measuring method and inter-incisal distance measurement with Vernier Callipers respectively as well as post-operatively on 1st, 2nd, 3rd, 5th and 7th day. Results: The study participants consisted of 27 males and 45 females in a ratio 1:1.7. With a mean age of 24.7 ± 4.9 years (range 19-33 years) for Group A and 25.5 ± 4.3 years (range 20-39 years) for Group B. Post-operative pain was not significantly affected by the closure techniques (P > 0.05). Dressing was found to significantly reduce the degree of swelling and trismus peaking on the 2nd day (P = 0.0207 and P = 0.010 respectively). Conclusion: The use of dressing was more effective than primary closure to reduce the degree of swelling and trismus though its effect on post-operative pain reduction was not significant. PMID:25191094

  9. Comparison of primary radiation versus robotic surgery plus adjuvant radiation in high-risk prostate cancer: A single center experience

    OpenAIRE

    Prabhsimranjot Singh; Prashant Desai; Shruthi Arora; Anthony H Pham; A Gabriella Wernicke; Michael Smith; Dattatreyudu Nori; K S Clifford Chao; Bhupesh Parashar

    2015-01-01

    Objective: The objective of this study was to compare robotic-prostatectomy plus adjuvant radiation therapy (RPRAT) versus primary RT for high-risk prostate cancer (HRPCa). Materials and Methods: A retrospective chart review was performed for the HRPCa patients treated in our institution between 2000 and 2010. One hundred and twenty-three patients with high-risk disease were identified. The Chi-square test and Fisher′s exact test were used to compare local control and distant failure rate...

  10. All-Cause Mortality After Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer.

    Science.gov (United States)

    Melamed, Alexander; Rizzo, Anthony E; Nitecki, Roni; Gockley, Allison A; Bregar, Amy J; Schorge, John O; Del Carmen, Marcela G; Rauh-Hain, J Alejandro

    2017-07-01

    To compare all-cause mortality between women who underwent fertility-sparing surgery with those who underwent conventional surgery for stage I ovarian cancer. In a cohort study using the National Cancer Database, we identified women younger than 40 years diagnosed with stage IA and unilateral IC epithelial ovarian cancer between 2004 and 2012. Fertility-sparing surgery was defined as conservation of one ovary and the uterus. The primary outcome was time from diagnosis to death. We used propensity score methods to assemble a cohort of women who underwent fertility-sparing or conventional surgery but were otherwise similar on observed covariates and conducted survival analyses using the Kaplan-Meier method and Cox proportional hazard models. We identified 1,726 women with stage IA and unilateral IC epithelial ovarian cancer of whom 825 (47.8%) underwent fertility-sparing surgery. Fertility-sparing surgery was associated with younger age, residence in the northeastern and western United States, and serous or mucinous histology (Pfertility-sparing surgery and 37 deaths among propensity-matched women who underwent conventional surgery after a median follow-up of 63 months. Fertility-sparing surgery was not associated with hazard of death (hazard ratio 0.80, 95% confidence interval [CI] 0.49-1.29, P=.36). The probability of survival 10 years after diagnosis was 88.5% (95% CI 82.4-92.6) in the fertility-sparing group and 88.9% (95% CI 84.9-92.0) in the conventional surgery group. In patients with high-risk features such as clear cell histology, grade 3, or stage IC, 10-year survival was 80.5% (95% CI 68.5-88.3) among women who underwent fertility-sparing surgery and 83.4% (95% 76.0-88.7) among those who had conventional surgery (hazard ratio 0.86, 95% CI 0.49-1.53, P=.61). Compared with conventional surgery, fertility-sparing surgery was not associated with increased risk of death in young women with stage I epithelial ovarian cancer.

  11. Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus.

    Science.gov (United States)

    Ronellenfitsch, Ulrich; Schwarzbach, Matthias; Hofheinz, Ralf; Kienle, Peter; Kieser, Meinhard; Slanger, Tracy E; Jensen, Katrin

    2013-05-31

    The outcome of patients with locally advanced gastroesophageal adenocarcinoma (adenocarcinoma of the esophagus, gastroesophageal (GE) junction, and stomach) is poor. There is conflicting evidence regarding the effects of perioperative chemotherapy on survival and other outcomes. To assess the effect of perioperative chemotherapy for gastroesophageal adenocarcinoma on survival and other clinically relevant outcomes in the overall population of participants in randomized controlled trials (RCTs) and in prespecified subgroups. We performed computerized searches in the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Review of Effectiveness (DARE), the Cochrane Database of Systematic Reviews (CDSR) from The Cochrane Library, MEDLINE (1966 to May 2011), EMBASE (1980 to May 2011), and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), combining the Cochrane highly sensitive search strategy with specific search terms. Moreover, we handsearched several online databases, conference proceedings, and reference lists of retrieved papers. We included RCTs which randomized patients with gastroesophageal adenocarcinoma, in the absence of distant metastases, to receive either chemotherapy with or without radiotherapy followed by surgery, or surgery alone. Two independent review authors identified eligible trials. We solicited individual patient data (IPD) from all selected trials. We performed meta-analyses based on intention-to-treat populations using the two-stage method to combine IPD with aggregate data from RCTs for which IPD were unavailable. We combined data from all trials providing IPD in a Cox proportional hazards model to assess the effect of several covariables on overall survival. We identified 14 RCTs with 2422 eligible patients. For eight RCTs with 1049 patients (43.3%), we were able to obtain IPD. Perioperative chemotherapy was associated with significantly longer overall survival (hazard ratio (HR) 0.81; 95

  12. Use of {sup 99m}Tc 2-methoxyisobutyl isonitrile in minimally invasive radioguided surgery in patients with primary hyperparathyroidism: A narrative review of the current literature

    Energy Technology Data Exchange (ETDEWEB)

    Denmeade, Kristie A [Nuclear Medicine and Ultrasound Department, Bankstown-Lidcombe Hospital, Bankstown, New South Wales (Australia); Constable, Chris [Brain and Mind Research Institute, University of Sydney, New South Wales (Australia); Reed, Warren M [Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, New South Wales (Australia); Nuclear Medicine and Ultrasound Department, Bankstown-Lidcombe Hospital, Bankstown, New South Wales (Australia)

    2013-06-15

    The use of technetium-99m 2-methoxyisobutyl isonitrile ({sup 99m}Tc MIBI) for assistance in minimally invasive radioguided surgery (MIRS) is growing in popularity as a safe, effective, and proficient technique used for parathyroidectomy in primary hyperparathyroidism (PHPT) treatment. Previously, the preferred treatment for PHPT was bilateral neck exploration (BNE), a very invasive, costly, and lengthy procedure. However, as a large majority (80–85% of cases of PHPT) are attributed to a single parathyroid adenoma (PA), a simpler more direct technique such as MIRS is a far better option. The following article is an exploration of the current literature concerning varied protocols utilizing {sup 99m}Tc MIBI for assistance in MIRS for patients undergoing treatment of PHPT. This technique boasts many advantageous outcomes for patients suffering from PHPT. These include a reduction in cost, operating time, and patient recovery; less evidence of post-surgical hypocalcaemia, less pain, and complications; superior cosmetic results; same-day discharge; and the possibility of local anaesthesia which is particularly beneficial in elderly patients. Better outcomes for patients with deep or ectopic PAs, reduced intra-operative complications, and improved cosmetic outcomes for patients who have previously undergone thyroid and/or parathyroid surgery are also advantageous. Of the literature reviewed it was also found that no patients suffered any major surgical complications such as laryngeal nerve palsy or permanent hypoparathyroidism using {sup 99m}Tc MIBI for assistance in MIRS.

  13. Use of 99mTc 2-methoxyisobutyl isonitrile in minimally invasive radioguided surgery in patients with primary hyperparathyroidism: A narrative review of the current literature

    International Nuclear Information System (INIS)

    Denmeade, Kristie A; Constable, Chris; Reed, Warren M

    2013-01-01

    The use of technetium-99m 2-methoxyisobutyl isonitrile ( 99m Tc MIBI) for assistance in minimally invasive radioguided surgery (MIRS) is growing in popularity as a safe, effective, and proficient technique used for parathyroidectomy in primary hyperparathyroidism (PHPT) treatment. Previously, the preferred treatment for PHPT was bilateral neck exploration (BNE), a very invasive, costly, and lengthy procedure. However, as a large majority (80–85% of cases of PHPT) are attributed to a single parathyroid adenoma (PA), a simpler more direct technique such as MIRS is a far better option. The following article is an exploration of the current literature concerning varied protocols utilizing 99m Tc MIBI for assistance in MIRS for patients undergoing treatment of PHPT. This technique boasts many advantageous outcomes for patients suffering from PHPT. These include a reduction in cost, operating time, and patient recovery; less evidence of post-surgical hypocalcaemia, less pain, and complications; superior cosmetic results; same-day discharge; and the possibility of local anaesthesia which is particularly beneficial in elderly patients. Better outcomes for patients with deep or ectopic PAs, reduced intra-operative complications, and improved cosmetic outcomes for patients who have previously undergone thyroid and/or parathyroid surgery are also advantageous. Of the literature reviewed it was also found that no patients suffered any major surgical complications such as laryngeal nerve palsy or permanent hypoparathyroidism using 99m Tc MIBI for assistance in MIRS

  14. Salvage surgery following radiation failure in squamous cell carcinoma of the supraglottic larynx

    International Nuclear Information System (INIS)

    Parsons, James T.; Mendenhall, William M.; Stringer, Scott P.; Cassisi, Nicholas J.; Million, Rodney R.

    1995-01-01

    Purpose: We analyzed the clinical course of patients who developed local (primary) recurrence following high-dose irradiation of squamous cell carcinoma of the supraglottic larynx. Methods and Materials: Between October 1964 and July 1991, 206 patients with previously untreated squamous cell carcinoma of the supraglottic larynx underwent radiotherapy with curative intent. Local failure occurred in 46 (22%) patients. Successful surgical salvage was defined as no evidence of recurrent cancer for at least 2 years after salvage surgery and continuously thereafter. Results: Sixteen patients did not undergo salvage surgery because of refusal (7 patients), severe medical illness (2 patients), concurrent distant metastasis (5 patients), or unresectable neck disease (2 patients). Twenty-six patients underwent total laryngectomy, and 4 patients had a voice-sparing procedure. Successful salvage was achieved in 50% of patients who underwent surgery. The rate of successful salvage did not correlate with preirradiation T-stage or time to failure after irradiation. Most of the failures after surgery were because of failure to control the primary cancer. The overall rate of postsurgical complications was 37%. No operative or perioperative deaths occurred. The 5-year survival rate for all 46 patients, calculated from the date of irradiation failure, was 20%, while the 5-year survival rate after salvage surgery for the 30 patients who underwent the procedure was 29%. Conclusion: There are few data in the literature regarding the clinical outcome in patients whose tumors are not controlled by initial radiotherapy. In the current and previous series, one-half to two-thirds of patients who developed primary failure underwent salvage surgery, which was successful in approximately half of the operated patients, leading to a 25-30% rate of long-term disease-free survival among the entire group of patients who developed failure

  15. Bariatric surgery

    Science.gov (United States)

    Karmali, Shahzeer; Stoklossa, Carlene Johnson; Sharma, Arya; Stadnyk, Janet; Christiansen, Sandra; Cottreau, Danielle; Birch, Daniel W.

    2010-01-01

    Abstract OBJECTIVE To review the management of bariatric surgical patients. QUALITY OF EVIDENCE MEDLINE, EMBASE, and Cochrane Library databases were searched, as well as PubMed US National Library, from January 1950 to December 2009. Evidence was levels I, II, and III. MAIN MESSAGE Bariatric surgery should be considered for obese patients at high risk of morbidity and mortality who have not achieved adequate weight loss with lifestyle and medical management and who are suffering from the complications of obesity. Bariatric surgery can result in substantial weight loss, resolution of comorbid conditions, and improved quality of life. The patient’s weight-loss history; his or her personal accountability, responsibility, and comprehension; and the acceptable level of risk must be taken into account. Complications include technical failure, bleeding, abdominal pain, nausea or vomiting, excess loose skin, bowel obstruction, ulcers, and anastomotic stricture. Lifelong monitoring by a multidisciplinary team is essential. CONCLUSION Limited long-term success of behavioural and pharmacologic therapies in severe obesity has led to renewed interest in bariatric surgery. Success with bariatric surgery is more likely when multidisciplinary care providers, in conjunction with primary care providers, assess, treat, monitor, and evaluate patients before and after surgery. Family physicians will play a critical role in counseling patients about bariatric surgery and will need to develop skills in managing these patients in the long-term. PMID:20841586

  16. Comparison of primary radiation versus robotic surgery plus adjuvant radiation in high-risk prostate cancer: A single center experience

    Directory of Open Access Journals (Sweden)

    Prabhsimranjot Singh

    2015-01-01

    Full Text Available Objective: The objective of this study was to compare robotic-prostatectomy plus adjuvant radiation therapy (RPRAT versus primary RT for high-risk prostate cancer (HRPCa. Materials and Methods: A retrospective chart review was performed for the HRPCa patients treated in our institution between 2000 and 2010. One hundred and twenty-three patients with high-risk disease were identified. The Chi-square test and Fisher′s exact test were used to compare local control and distant failure rates between the two treatment modalities. For prostate-specific antigen comparisons between groups, Wilcoxon rank-sum test was used. Results: The median follow-up was 49 months (range: 3-138 months. Local control, biochemical recurrence rate, distant metastasis, toxicity, and disease-free survival were similar in the two groups. Conclusions: Primary RT is an excellent treatment option in patients with HRPCa, is equally effective and less expensive treatment compared with RPRAT. A prospective randomized study is required to guide treatment for patients with HRPCa.

  17. Robotic surgery

    Science.gov (United States)

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  18. Primary investigations on the potential of a novel diode pumped Er:YAG laser system for bone surgery

    Science.gov (United States)

    Stock, Karl; Diebolder, Rolf; Hausladen, Florian; Wurm, Holger; Lorenz, Swetlana; Hibst, Raimund

    2013-03-01

    Flashlamp pumped Er:YAG-lasers are successfully clinically used for both precise soft and hard tissue ablation. As an alternative, actually a novel diode pumped Er:YAG laser system (Pantec Engineering AG) becomes available, with mean laser power up to 15W and pulse repetition rate up to 1kHz. The aim of the presented study is to investigate the effect of this laser system on bone tissue at various irradiation parameters, particular at repetition rates exceeding 100 Hz. For reproducible experiments, firstly an appropriate experimental set-up was realized with a beam delivery and focusing unit, a computer controlled stepper unit with sample holder, and a shutter unit. It allowed to move the sample (1mm- 3mm sawed slices of pig bone) with a defined velocity while irradiation by various laser parameters. A water spray served to moisten the sample surfaces. After irradiation the grooves were analyzed by light microscopy and laser scanning microscopy regarding to the ablation quality, the groove geometry, the ablation efficacy, and the thermal effects. The resulting grooves are slightly cone shaped (groove depth up to 3mm, width about 200μm) with sharp edges at the surface. At 1W, 200Hz, 5mm/s sample movement and with water irrigation the measured ablation speed Δz/Δt is 10.8 mm/s. The ablation depth per pulse is 54μm. In conclusion, these first experiments demonstrate that the diode pumped Er:YAG laser system is an efficient tool for use in bone surgery.

  19. Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications.

    Science.gov (United States)

    Wilches, C; Sulbarán, J D; Fernández, J E; Gisbert, J M; Bausili, J M; Pelfort, X

    To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups. Both groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months. There are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Sinus surgery: optimal surgery, optimal outcome?

    NARCIS (Netherlands)

    Fokkens, Wytske J.

    2016-01-01

    Sinus surgery remains an issue of discussion. We lack data on a number of important issues. In this issue of the journal Jiang et al. show that 67 % of their patients who underwent FESS for CRS had OSAS (of which more than half moderate to severe) but only 38% complained of daytime sleepiness

  1. [Sensibility changes of the infraorbital nerve after primary surgery on patients with unilateral cleft lip according to J. Delaire].

    Science.gov (United States)

    Rousseau, P; Zimmermann, S; Schupp, W; Schmelzeisen, R; Otten, J E

    2012-06-01

    The aim was to determine the overall sensibility changes in the area of the infraorbital nerve on patients with unilateral clefts lips and unilateral clefts lips and palate who had undergone primary surgical correction according to the principles of Delaire. Twenty patients (7-20years) with unilateral cleft lips (and palate) who had undergone surgery in infancy according to Delaire were included. Cutaneous sensibilities of the nasolabial fold and of the upper lip were tested using four cutaneous modalities. A tactil superficial sensibility light touch test, a two-point discrimination test (McKinnon-Dellon Disk-Criminator), and the determination of cold and warm detection thresholds (Quantitative Sensory Testing, Medoc Thermal Sensory Analyser). The possible difference of the sensibility between operated and controlateral sides of the face were compared. Results were finally compared to a control group of twenty healthy volunteers. No significant difference could be found between the operated and non-operated side of the cleft group. There was also no difference between the cleft and the control group. Specific difference of perception between nasolabial fold and lip encountered in the literature were confirmed by the experiments. The large subperiostal approach according to Delaire during the primary surgical procedure have not affected long term infraorbital sensibility of patients with unilateral complete cleft lip. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  2. External dacryocystorhinostomy surgery in patients with Wegener granulomatosis.

    Science.gov (United States)

    Lee, Brian J; Nelson, Christine C; Lewis, Craig D; Perry, Julian D

    2012-01-01

    To determine surgical outcomes after external dacryocystorhinostomy (DCR) surgery in patients with Wegener granulomatosis (WG). The authors retrospectively reviewed the charts of consecutive patients with WG who underwent primary or secondary external DCR surgery between January 2001 and January 2010. Clinical data reviewed included patient demographics, systemic disease involvement and immunosuppression therapy, intraoperative biopsy findings, and postoperative outcomes and complications. Success was defined as resolution of epiphora. Sixteen primary external DCRs were performed on 9 patients with WG, and 2 secondary external DCRs were performed on 2 patients. At the time of surgery, all patients with WG were on systemic immunosuppressive agents including methotrexate, rapamycin, sirolimus, tacrolimus, azathioprine, cyclophosphamide, rituximab, and prednisone, and no patients received increased corticosteroids after surgery. Intraoperative biopsy in patients with WG revealed chronic inflammation (4 patients) and fibrosis (1 patient). Silicone stents were removed at an average of 5.8 months (range, 3-12 months). All surgeries were successful in resolving epiphora with an average follow up of 3.5 years (range, 10 months-6 years) and no complications. Primary and secondary external DCR surgery successfully treats nasolacrimal duct obstruction in patients with WG on systemic immunosuppression.

  3. Robot-assisted spleen preserving pancreatic surgery in MEN1 patients.

    Science.gov (United States)

    Nell, Sjoerd; Brunaud, Laurent; Ayav, Ahmet; Bonsing, Bert A; Groot Koerkamp, Bas; Nieveen van Dijkum, Els J; Kazemier, Geert; de Kleine, Ruben H J; Hagendoorn, Jeroen; Molenaar, I Quintus; Valk, Gerlof D; Borel Rinkes, Inne H M; Vriens, Menno R

    2016-09-01

    Multiple Endocrine Neoplasia type 1 (MEN1) patients often undergo multiple pancreatic operations at a young age. To describe robot-assisted and laparoscopic spleen-preserving pancreatic surgery in MEN1 patients, and to compare both techniques. Robot-assisted pancreatectomies of the DutchMEN1 study group and the Université de Lorraine, Nancy, France were compared to a historical cohort of laparoscopic treated MEN1 patients. Perioperative outcomes were compared. A total of 21 MEN1 patients underwent minimally invasive pancreatic surgery for pancreatic neuroendocrine tumors, seven patients were subjected to robot-assisted surgery, and 14 patients underwent laparoscopic surgery. Demographics and clinical characteristics did not differ between the cohorts and no significant differences in operative outcomes were found. A high number of ISGPS grade B/C pancreatic fistulas were observed in both cohorts (38%), and no conversions were seen in the robot-assisted cohort (respectively 0% vs. 43%, P = 0.06). In one laparoscopic and one robot-assisted case the primary tumor was not resected. Minimally invasive spleen-preserving surgery in MEN1 patients is safe and feasible. Patients who underwent robot-assisted surgery did not require conversion to open surgery. J. Surg. Oncol. 2016;114:456-461. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  4. Surgical outcomes of 380 patients with double outlet right ventricle who underwent biventricular repair.

    Science.gov (United States)

    Li, Shoujun; Ma, Kai; Hu, Shengshou; Hua, Zhongdong; Yang, Keming; Yan, Jun; Chen, Qiuming

    2014-09-01

    The study objective was to report the outcomes of biventricular repair in patients with double outlet right ventricle. Patients with double outlet right ventricle who underwent biventricular repair at Fuwai Hospital from January 2005 to December 2012 were included. Patients were excluded if double outlet right ventricle was combined with atrioventricular septal defect, heterotaxy syndrome, atrioventricular discordance, or univentricular physiology. A total of 380 consecutive patients with a mean age of 1.9 ± 2.1 years (range, 1 month to 6 years) were included. Varied types of biventricular repair were customized individually. Follow-up was 90.4% complete, and the mean follow-up time was 3.4 ± 3.9 years. There were 17 (4.5%) early deaths and 7 (2.1%) late deaths. Preoperative pulmonary hypertension was the only risk factor for early mortality. Postoperative significant left ventricular outflow tract obstruction was present in 9 survivors. Patients with noncommitted ventricular septal defect had a longer crossclamp time, longer cardiopulmonary bypass time, and higher incidence of postdischarge left ventricular outflow tract obstruction. There were 4 reoperations, all of which were caused by subaortic left ventricular outflow tract obstruction. All of the pressure gradients were decreased to less than 20 mm Hg after the modified Konno procedure with an uneventful postoperative course. Optimal results of varied types of biventricular repair for double outlet right ventricle have been acquired. Although noncommitted ventricular septal defect is technically difficult, the outcomes of patients are favorable. Late-onset left ventricular outflow tract obstruction is the main reason for reoperation but can be successfully relieved by the modified Konno procedure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

    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

  6. Evaluating the referral preferences and consultation requests of primary care physicians with otolaryngology - head and neck surgery.

    Science.gov (United States)

    Scott, John R; Wong, Eric; Sowerby, Leigh J

    2015-12-29

    No literature exists which examines referral preferences to, or the consultation process with, Otolaryngology. In a recent Canadian Medical Association nation-wide survey of General Practitioners and Family Physicians, Otolaryngology was listed as the second-most problematic specialty for referrals. The purpose of this study was to learn about and improve upon the referral process between primary care physicians (PCPs) and Otolaryngology at an academic centre in Southwestern Ontario. PCPs who actively refer patients to Otolaryngology within the catchment area of Western University were asked to complete a short paper-based questionnaire. Data was analyzed using descriptive statistics. A total of 50 PCPs were surveyed. Subspecialty influenced 90.0% of the referrals made. Specialist wait times altered 58.0% of referrals. All PCPs preferred to communicate via fax. Half of those surveyed wanted clinical notes from every encounter. Seventy-four percent of respondents wanted inappropriate referrals forwarded to the proper specialist automatically. Twenty-two percent of those surveyed were satisfied with current wait times. A central referral system was favored by 74% of PCPs. Improvements could help streamline the referral and consultation practices with Otolaryngology in Southwestern Ontario. A central referral system and reduction in the frequency of consultative reports can be considered.

  7. Primary Neuroendocrine Carcinoma of Ocular Adnexa

    Directory of Open Access Journals (Sweden)

    Daisuke Yamanouchi

    2013-01-01

    Full Text Available We present our findings in a case of primary neuroendocrine carcinoma (NEC of the lacrimal gland and a case of primary Merkel cell carcinoma (MCC of the eyelid. An 86-year-old man noticed a swelling of the left upper eyelid three months earlier. We performed excision biopsy and histopathological examination indicated that he had a primary NEC of the left lacrimal gland. He underwent chemotherapy followed by excision including the clinically visible margins and 50 Gy radiotherapy of the surgical margins. He had neither recurrence nor metastasis for 6 months since the last radiotherapy. An 80-year-old man noticed a nodule in the right upper eyelid and was referred to our hospital because the size was increasing rapidly. A complete surgical excision of the margins of the tumor was performed with histopathological confirmation of negative margins. The final diagnosis was a primary MCC of the right upper eyelid. After surgery, he underwent 50 Gy radiotherapy on the neck to prevent metastasis. No recurrence or metastasis was found for two years. Although primary NEC of the ocular adnexa is extremely rare, the tumor has high malignancy and readily metastasizes. Thus, combined therapy including surgery, radiotherapy, and/or chemotherapy is needed for complete management of NEC.

  8. Surgery for Primary Hyperparathyroidism with Normal Non-suppressed Parathyroid Hormone can be Both Challenging and Successful.

    Science.gov (United States)

    Orr, Lauren E; McKenzie, Travis J; Thompson, Geoffrey B; Farley, David R; Wermers, Robert A; Lyden, Melanie L

    2018-02-01

    Criteria for diagnosing primary hyperparathyroidism (PHPT) include hypercalcemia in the presence of parathyroid hormone (PTH) levels that are either elevated (classic PHPT) or normal but non-suppressed. However, there is no standard definition of what constitutes normal non-suppressed levels, and data are lacking regarding the potential for surgical cure in these patients. A retrospective review of patients undergoing parathyroidectomy for sporadic PHPT between 2012 and 2014 was performed. Patients with normal PTH were compared to classic PHPT patients to assess demographics, imaging, operative findings, and outcomes. In total, 332 patients met study criteria, and 60 (18%) had normal PTH levels. Negative sestamibi scans were seen more often with normal PTH levels (18.3 vs. 4.8%, p normal PTH were more likely to have ≥2 glands removed (26.7 vs. 14.3%, p = 0.02), and the specimens were more likely to be classified as only mildly hypercellular or normocellular (20 vs. 2.9%, p normal PTH group, compared to 96% in classic PHPT (p = 0.02). Among patients with normal PTH, those with PTH ≤ 55 pg/mL had an 83% cure rate, whereas those with PTH 56-65 had a 96% cure rate (p = 0.12). Parathyroidectomy can have a high cure rate in the context of normal PTH levels despite an increased likelihood of negative imaging and multigland resection. Operative success is equivalent to classic PHPT when PTH levels are > 55 pg/mL.

  9. Assessment of Patients Who Underwent Nasal Reconstruction After Non-Melanoma Skin Cancer Excision.

    Science.gov (United States)

    Uzun, Hakan; Bitik, Ozan; Kamburoğlu, Haldun Onuralp; Dadaci, Mehmet; Çaliş, Mert; Öcal, Engin

    2015-06-01

    Basal and squamous cell carcinomas are the most common malignant cutaneous lesions affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges. Although multiple options exist, optimal results are obtained when "like is used to repair like". We aimed to introduce a simple algorithm for the reconstruction of nasal defects with local flaps, realizing that there is always more than one option for reconstruction. We retrospectively reviewed 163 patients who underwent nasal reconstruction after excision of non-melanoma skin cancer between March 2011 and April 2014. We analyzed the location of the defects and correlated them with the techniques used to reconstruct them. There were 66 males and 97 females (age, 21-98 years). Basal cell carcinoma was diagnosed in 121 patients and squamous cell carcinoma in 42. After tumor excision, all the defects were immediately closed by either primary closure or local flap options such as Limberg, Miter, glabellar, bilobed, nasolabial, V-Y advancement, and forehead flaps. Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.

  10. Congenital penile pathology is associated with abnormal development of the dartos muscle: a prospective study of primary penile surgery at a tertiary referral center.

    Science.gov (United States)

    Spinoit, A-F; Van Praet, C; Groen, L-A; Van Laecke, E; Praet, M; Hoebeke, P

    2015-05-01

    Pathophysiological mechanisms leading to chordee in patients with hypospadias and to the hidden state of buried penis in the prepubic fat remain unclear. Resection of dartos tissue usually makes the penis straight in patients with hypospadias and corrects it in those with buried penis, suggesting a common pathophysiology related to dartos tissue. Tissue samples from 113 children undergoing primary penile surgery for hypospadias (94 patients), epispadias (1) or buried penis (18) were collected between November 2011 and September 2013. Tissue samples from 79 children undergoing circumcision for nonmedical reasons served as controls. All samples were stained with smooth muscle actin and analyzed by the same pathologist, who was blinded to indication for surgery. Chi-square and Fisher exact tests were applied. Three different dartos tissue patterns were observed. Pattern I (normal) consisted of smooth muscle fibers of dartos tissue organized in a parallel configuration in the subcutaneous tissue. Pattern II was characterized by poorly developed and hypotrophic smooth muscle fibers. Pattern III was determined by randomly distributed smooth muscle fibers in the subcutaneous tissue, without parallel configuration. Pattern I was observed in 45 circumcision specimens (64%). Of buried penis cases 78% were considered abnormal (pattern II in 4 cases and III in 10, p = 0.001). Of hypospadias cases 70% were considered abnormal (pattern II in 31 cases, III in 32, and mixed II and III in 3, p Congenital penile pathology (hypospadias, buried penis) is associated with structural anomalies in dartos tissue. Further research is needed to unveil the pathophysiology of the condition. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Role of maximal primary cytoreductive surgery in patients with advanced epithelial ovarian and tubal cancer: Surgical and oncological outcomes. Single institution experience.

    Science.gov (United States)

    Peiretti, Michele; Zanagnolo, Vanna; Aletti, Giovanni D; Bocciolone, Luca; Colombo, Nicoletta; Landoni, Fabio; Minig, Lucas; Biffi, Roberto; Radice, Davide; Maggioni, Angelo

    2010-11-01

    To determinate the impact of maximal cytoreductive surgery on progression free survival (PFS), overall survival (OS) rates and morbidity, in patients with advanced epithelial ovarian or fallopian tube cancer. We reviewed all medical records of patients with stages IIIC-IV epithelial ovarian and fallopian tube cancer that were managed at our institution between January 2001 and December 2008. The following information was collected: demographics, tumor characteristics, operative information, surgical outcomes and peri-operative complication. A total of 288 patients with advanced epithelial ovarian and fallopian tube cancer were referred to our institution between January 2001 and December 2008, 259 consecutive patients were enrolled in the study. After a median follow-up of 29.8 months, the PFS and OS were 19.9 and 57.6 months, respectively. At univariate analysis, factors significantly associated with decreased PFS included: age greater than median (>60 years), stage IV, presence of ascites >1000 cc, presence of diffuse peritoneal carcinomatosis and diameter of residual disease. This was confirmed also at multivariate analysis with age greater than 60 years (P=0.025), stage IV vs IIIC (P=0.037) and any residual disease (P=0.032) having an independent association with worse PFS. Our study seems to demonstrate that a more extensive surgical approach is associated with prolonged disease-free interval and improved survival in patients with stages IIIC-IV epithelial ovarian and fallopian tube cancer. Moreover all patients with no residual tumor seem to have the best prognosis and in view of these results we believe that the goal of primary surgery should be considered as leaving no macroscopic disease. Copyright © 2010 Elsevier Inc. All rights reserved.

  12. Effect of number of retrieved lymph nodes on prognosis in FIGO stage IB-IIA cervical cancer patients treated with primary radical surgery.

    Science.gov (United States)

    Lim, Soyi; Cho, Kyungjoo; Lee, Seungho; Lee, Kwangbeom; Shin, Jinwoo; Chung, Donghae; Park, Chanyong

    2017-01-01

    In the treatment of cervical cancer, the extent of lymphadenectomy is a matter of debate. The goal of the current study was to examine the question of whether the number of retrieved lymph nodes (RLN) can influence survival of patients with early stage cervical cancer. The medical records of 180 FIGO stage IB-IIA cervical cancer patients treated with primary radical surgery were reviewed. Patients were divided into two groups: those with ≤ 40 RLN and those with > 40 RLN. Patients were also assigned to either the bulky (tumor size > 4 cm) cervical cancer group or the non-bulky (tumor size ≤ 4 cm) cervical cancer group. The number of RLN had a statistically significant effect on both disease-free survival (P = 0.04) and overall survival (P = 0.02) of all patients. Patients with > 40 RLN had better prognoses than those with ≤ 40 RLN. In the bulky cervical cancer group, the number of RLN was an independent prognostic factor. In multivariate analysis for the bulky cervical cancer group, > 40 RLN had a significant positive effect on disease-free survival (adjusted hazard ratio, 0.36; 95% confidence interval, 0.13-0.97) and overall survival (adjusted hazard ratio, 0.23; 95% confidence interval, 0.06-0.90). However, number of RLN was not an independent prognostic factor in the non-bulky cervical cancer group. A more extensive lymphadenectomy increased the survival of bulky cervical cancer patients. This finding may be helpful in determining surgical extent before surgery for cervical cancer. © 2016 Japan Society of Obstetrics and Gynecology.

  13. Current predictive models do not accurately differentiate between single and multi gland disease in primary hyperparathyroidism: a retrospective cohort study of two endocrine surgery units.

    Science.gov (United States)

    Edafe, O; Collins, E E; Ubhi, C S; Balasubramanian, S P

    2018-02-01

    Background Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is dependent upon accurate prediction of single-gland disease on the basis of preoperative imaging and biochemistry. The aims of this study were to validate currently available predictive models of single-gland disease in two UK cohorts and to determine if these models can facilitate MIP. Methods This is a retrospectively cohort study of 624 patients who underwent parathyroidectomy for primary hyperparathyroidism in two centres between July 2008 and December 2013. Two recognised models: CaPTHUS (preoperative calcium, parathyroid hormone, ultrasound, sestamibi, concordance imaging) and Wisconsin Index (preoperative calcium, parathyroid hormone) were validated for their ability to predict single-gland disease. Results The rates of single- and multi-gland disease were 491 (79.6%) and 126 (20.2%), respectively. Cure rates in centres 1 and 2 were 93.2% and 93.8%, respectively (P = 0.789). The positive predictive value (PPV) of CaPTHUS score . 3 in predicting single-gland disease was 84.6%, compared with 100% in the original report. CaPTHUS . 4 and 5 had a PPV of 85.1 and 87.1, respectively. There were no differences in Wisconsin Index (WIN) between patients with single- and multi-gland (P = 0.573). A WIN greater than 1600 and weight of excised gland greater than 1 g had a positive predictive value of 86.7% for single-gland disease. Conclusions The use of CaPTHUS and WIN indices without intraoperative adjuncts (such as IOPTH) had the potential to result in failure to cure in up to 15% (CaPTHUS) and 13% (WIN) of patients treated by MIP targeting a single enlarged gland.

  14. Photodynamic Therapy Using HPPH in Treating Patients Undergoing Surgery for Primary or Recurrent Head and Neck Cancer

    Science.gov (United States)

    2018-03-28

    Recurrent Adenoid Cystic Carcinoma of the Oral Cavity; Recurrent Basal Cell Carcinoma of the Lip; Recurrent Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Recurrent Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Lymphoepithelioma of the Oropharynx; Recurrent Metastatic Squamous Neck Cancer With Occult Primary; Recurrent Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Recurrent Mucoepidermoid Carcinoma of the Oral Cavity; Recurrent Salivary Gland Cancer; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Thyroid Cancer; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Stage I Adenoid Cystic Carcinoma of the Oral Cavity; Stage I Basal Cell Carcinoma of the Lip; Stage I Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage I Follicular Thyroid Cancer; Stage I Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage I Lymphoepithelioma of the Nasopharynx; Stage I Lymphoepithelioma of the Oropharynx; Stage I Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage I Mucoepidermoid Carcinoma of the Oral Cavity; Stage I Papillary Thyroid Cancer; Stage I Salivary Gland Cancer; Stage I Squamous Cell Carcinoma of the Hypopharynx; Stage I Squamous Cell Carcinoma of the Larynx; Stage I Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage I Squamous Cell Carcinoma of the Oropharynx; Stage I Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage I Verrucous Carcinoma of the Larynx; Stage I Verrucous Carcinoma of the Oral Cavity; Stage II Adenoid Cystic Carcinoma of the

  15. Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program

    Directory of Open Access Journals (Sweden)

    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.

  16. Incremental direct and indirect cost burden attributed to endometriosis surgeries in the United States.

    Science.gov (United States)

    Soliman, Ahmed M; Taylor, Hugh; Bonafede, Machaon; Nelson, James K; Castelli-Haley, Jane

    2017-05-01

    To compare direct and indirect costs between endometriosis patients who underwent endometriosis-related surgery (surgery cohort) and those who have not received surgery (no-surgery cohort). Retrospective cohort study. Not applicable. Endometriosis patients (aged 18-49 years) with (n = 124,530) or without (n = 37,106) a claim for endometriosis-related surgery were identified from the Truven Health MarketScan Commercial and Health and Productivity Management databases for 2006-2014. Not applicable. Primary outcomes were healthcare utilization during 12-month pre- and post-index periods, annual direct (healthcare) and indirect (absenteeism and short- and long-term disability) costs during the 12-month post-index period (in 2014 US dollars). Indirect costs were assessed for patients with available productivity data. Patients in the surgery cohort had significantly higher healthcare resource utilization during the post-index period and had mean annual total adjusted post-index direct costs approximately three times the costs among patients in the no-surgery cohort ($19,203 [SD $7,133] vs. $6,365 [SD $2,364]; average incremental annual direct cost = $12,838). The mean cost of surgery ($7,268 [SD $7,975]) was the single largest contributor to incremental annual direct cost. Mean estimated annual total indirect costs were $8,843 (surgery cohort) vs. $5,603 (no-surgery cohort); average incremental annual indirect cost = $3,240. Endometriosis patients who underwent surgery, compared with endometriosis patients who did not, incurred significantly higher direct costs due to healthcare utilization and indirect costs due to absenteeism or short-term disability. Regardless of the surgery type, the cost of index surgery contributed substantially to the total healthcare expenditure. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  17. Ovarian Low-grade Serous Carcinoma: A Clinicopathologic Study of 33 Cases With Primary Surgery Performed at a Single Institution.

    Science.gov (United States)

    Okoye, Ekene; Euscher, Elizabeth D; Malpica, Anais

    2016-05-01

    Ovarian low-grade serous carcinoma (LGSC) is an entity with distinct pathologic and clinical features. The number of studies on this type of tumor is limited. In this article, we present our experience with 33 cases of ovarian LGSC with primary surgical treatment at our institution. For comparison, a cohort of ovarian high-grade serous carcinoma (HGSC) was also studied. Clinical information was obtained from the patients' charts or from the treating physicians. Hematoxylin and eosin slides were reviewed of 28 available LGSCs, and the following parameters were recorded: presence/absence of a serous borderline tumor (SBT), presence/absence of micropapillary/cribriform pattern (MP/CP), architectural pattern in the invasive component, and presence/absence of desmoplasia or fibrosis. The incidence of ovarian LGSC was 4.7%. LGSC patients ranged in age from 19 to 79 years (mean, 52 y), with 21.2% younger than 40 years. HGSC patients ranged in age from 38 to 90 years (mean, 62 y), with 1.6% younger than 40 years. LGSCs were staged as follows: stage I (2), stage III (23), and stage IV (8). Twenty-eight of 33 LGSC cases had concurrent SBT, with this component accounting for >50% of the neoplasm in 15 cases. In addition, MP/CP was noted in 19 cases. Invasion patterns included micropapillae (93%), cribriform nests (74%), elongated papillae (26%), glandular (44.4%), medium-sized papillae (33.3%), solid nests (22.2%), macropapillae (19%), and single cells (19%). In addition, desmoplasia (44.4%) and fibrosis (37%) were noted. Follow-up data ranging from 13 to 195 months (median 61.2 mo) were available on 30/33 LGSC patients: 18 (60%) were dead of disease; 1 (3.3%) was dead of other cause; 5 (16.7%) were alive with disease; and 6 (20%) had no evidence of disease. Follow-up data from 1 to 169 months (median 48 mo) were available on 185 HGSC patients: 132 (71.4%) were dead of disease; 3 (1.6%) were dead of other cause; 21 (11.4%) were alive with disease; and 29 (15.7%) had no

  18. Cosmetic Surgery

    Science.gov (United States)

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

  19. Local-regional radiotherapy and surgery is associated with a significant survival advantage in metastatic breast cancer patients.

    Science.gov (United States)

    Ly, Bevan Hong; Vlastos, Georges; Rapiti, Elisabetta; Vinh-Hung, Vincent; Nguyen, Nam Phong

    2010-01-01

    There is growing evidence of a survival benefit for metastatic breast cancer patients receiving surgery of the primary tumor. We investigated whether or not adjuvant radiotherapy can improve survival. Women diagnosed between 1988 and 2003 with metastatic, histologically confirmed unilateral primary breast cancer were selected from the SEER Program. Overall survival and specific survival were computed by the Kaplan-Meier method. Treatment hazard ratios of breast-conserving surgery or mastectomy versus no surgery, and radiotherapy versus none, were computed by Cox regression adjusting for period of diagnosis, age, marital status, race, histology, grade, and hormone receptors. Of 8761 women, radiotherapy was given to 1473 of 3905 who did not undergo surgery, to 882 of 2070 who underwent breast-conserving surgery, and to 1103 of 2786 mastectomy patients. Median overall survival was: for no surgery, 14 months; for breast-conserving surgery, 23 months; and for mastectomy, 28 months (P < 0.0001). The median overall survival of radiotherapy versus none was respectively 16 vs. 13 months without surgery (P = 0.0003), 28 vs. 20 months for breast-conserving surgery patients (P < 0.0001), and 28 vs. 28 months among mastectomy patients (P = 0.895). Multivariate analysis showed relative mortality reductions of 28% by breast-conserving surgery, 42% by mastectomy, and 10% by radiotherapy. Specific survival showed comparable results. Surgery and radiotherapy were associated with a significant survival advantage. We argue that local therapy should be considered even in metastatic disease.

  20. Small hook thread (Quill) and soft felt internal splint to increase the primary repair strength of lacerated rabbit Achilles tendons: biomechanical analysis and considerations for hand surgery.

    Science.gov (United States)

    Buschmann, Johanna; Müller, Angela; Feldman, Kirill; Tervoort, Theo A; Fessel, Gion; Snedeker, Jess G; Giovanoli, Pietro; Calcagni, Maurizio

    2011-07-01

    For the prevention of re-rupture during early healing phase, the primary repair strength of repaired lacerated tendons in hand surgery should be maximal and the reconstructed diameter minimal. Two new repair methods (small hook thread and internal splint) were assessed for strength and reconstructed diameter characteristics. Achilles tendons of 43 female New Zealand White rabbits were sectioned 2 cm above the calcaneus. Specimens were divided into 7 groups and repaired as follows: Kirchmayr method 2-strand with 4.0 polypropylene thread; Becker method 4-strand; 6-strand; internal splint; Kirchmayr method small hook 2-strand; Becker method small hook 4-strand, non-modified tendon. Load until failure, load until gap formation, gap length, cross-sectional area and failure stress were determined. The small hook 2-strand suture had 1.3 fold higher loads until failure compared to a conventional 2-strand suture, P<0.05. The internal splint had a similar load until failure (22 N (SD 6)) as the conventional 2-strand suture (23 N (SD 4)); around half the load until failure of the conventional 4-strand suture (38 N (SD 9)). Load until gap formation correlated positively with load until failure (y=0.65+3.6; r(2)=0.72). The running suture increased the cross-sectional area at the repair site by a factor of 1.3. Using a small hook thread instead of a 4.0 polypropylene thread significantly increases the primary repair strength with the same number of strands. Internal splints may be an alternative to conventional 2-strand sutures for bridging large gaps. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Trends in Mortality After Primary Cytoreductive Surgery for Ovarian Cancer: A Systematic Review and Metaregression of Randomized Clinical Trials and Observational Studies.

    Science.gov (United States)

    Di Donato, Violante; Kontopantelis, Evangelos; Aletti, Giovanni; Casorelli, Assunta; Piacenti, Ilaria; Bogani, Giorgio; Lecce, Francesca; Benedetti Panici, Pierluigi

    2017-06-01

    Primary cytoreductive surgery (PDS) followed by platinum-based chemotherapy is the cornerstone of treatment and the absence of residual tumor after PDS is universally considered the most important prognostic factor. The aim of the present analysis was to evaluate trend and predictors of 30-day mortality in patients undergoing primary cytoreduction for ovarian cancer. Literature was searched for records reporting 30-day mortality after PDS. All cohorts were rated for quality. Simple and multiple Poisson regression models were used to quantify the association between 30-day mortality and the following: overall or severe complications, proportion of patients with stage IV disease, median age, year of publication, and weighted surgical complexity index. Using the multiple regression model, we calculated the risk of perioperative mortality at different levels for statistically significant covariates of interest. Simple regression identified median age and proportion of patients with stage IV disease as statistically significant predictors of 30-day mortality. When included in the multiple Poisson regression model, both remained statistically significant, with an incidence rate ratio of 1.087 for median age and 1.017 for stage IV disease. Disease stage was a strong predictor, with the risk estimated to increase from 2.8% (95% confidence interval 2.02-3.66) for stage III to 16.1% (95% confidence interval 6.18-25.93) for stage IV, for a cohort with a median age of 65 years. Metaregression demonstrated that increased age and advanced clinical stage were independently associated with an increased risk of mortality, and the combined effects of both factors greatly increased the risk.

  2. Assessing Patient-Reported Outcomes Following Orthognathic Surgery and Osseous Genioplasty.

    Science.gov (United States)

    Schwitzer, Jonathan A; Albino, Frank P; Mathis, Ryan K; Scott, Amie M; Gamble, Laurie; Baker, Stephen B

    2015-11-01

    Primary outcomes for orthognathic surgery and genioplasty patients include satisfaction with appearance, improved motor function, and enhanced quality of life. The goal of this study was to assess outcomes among patients undergoing these procedures, and to highlight the potential use of FACE-Q instrument for use in patients with dentofacial deformities. A total of 56 patients presenting for orthognathic surgery and/or osseous genioplasty completed the FACE-Q during preoperative and/or at postoperative visits. FACE-Q scores increased following surgery in satisfaction with facial appearance overall (+24.5, P jawline (+40.7, P < 0.01), and in all satisfaction with chin items (profile, prominence, shape, and overall). Patients also demonstrated increased social confidence (+8.9, P = 0.29). There was no improvement in psychologic well-being (-0.8, P = 0.92). All 3 surgical groups of patients experienced gains in satisfaction with appearance following surgery. Patients who underwent orthognathic surgery either alone or in combination with genioplasty demonstrated statistically significant improvements in satisfaction with facial appearance overall (P < 0.01 for both groups), whereas patients who underwent genioplasty alone did not (P = 0.13). In addition, patients who underwent orthognathic surgery combined with genioplasty demonstrated greater improvement in satisfaction with chin than patients who underwent genioplasty alone. In conclusion, patients who underwent orthognathic surgery and/or genioplasty demonstrated improvement in appearance and social confidence. The use of this model supports the successful outcomes possible for patients undergoing these procedures.

  3. External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities. A retrospective analysis

    Energy Technology Data Exchange (ETDEWEB)

    Andrae, Claudia; Rauch, Josefine; Belka, Claus [University Hospital of Munich (LMU), Department of Radiation Oncology, Munich (Germany); Klein, Alexander; Duerr, Hans Roland [University Hospital of Munich (LMU), Department of Orthopedics, Munich (Germany); Lindner, Lars Hartwin [University Hospital of Munich (LMU), Deparment of Internal Medicine, Munich (Germany); Knoesel, Thomas [University Hospital of Munich (LMU), Institute of Pathology, Munich (Germany); Angele, Martin [University Hospital of Munich (LMU), Department of Surgery, Munich (Germany); Baur-Melnyk, Andrea [University Hospital of Munich (LMU), Department of Radiology, Munich (Germany); Roeder, Falk [University Hospital of Munich (LMU), Department of Radiation Oncology, Munich (Germany); German Cancer Research Center (DKFZ), CCU Molecular Radiation Oncology, Heidelberg (Germany)

    2017-08-15

    To report our experience with EBRT combined with limb-sparing surgery in elderly patients (>70 years) with primary extremity soft tissue sarcomas (STS). Retrospectively analyzed were 35 patients (m:f 18:17, median 78 years) who all presented in primary situation without nodal/distant metastases (Charlson score 0/1 in 18 patients; ≥2 in 17 patients). Median tumor size was 10 cm, mainly located in lower limb (83%). Stage at presentation (UICC7th) was Ib:3%, 2a:20%, 2b:20%, and 3:57%. Most lesions were high grade (97%), predominantly leiomyosarcoma (26%) and undifferentiated pleomorphic/malignant fibrous histiocytoma (23%). Limb-sparing surgery was preceded (median 50 Gy) or followed (median 66 Gy) by EBRT. Median follow-up was 37 months (range 1-128 months). Margins were free in 26 patients (74%) and microscopically positive in 9 (26%). Actuarial 3- and 5-year local control rates were 88 and 81% (4 local recurrences). Corresponding rates for distant control, disease-specific survival, and overall survival were 57/52%, 76/60%, and 72/41%. The 30-day mortality was 0%. Severe postoperative complications were scored in 8 patients (23%). Severe acute radiation-related toxicity was observed in 2 patients (6%). Patients with Charlson score ≥2 had a significantly increased risk for severe postoperative complications and acute radiation-related side effects. Severe late toxicities were found in 7 patients (20%), including fractures in 3 (8.6%). Final limb preservation rate was 97%. Combination of EBRT and limb-sparing surgery is feasible in elderly patients with acceptable toxicities and encouraging but slightly inferior outcome compared to younger patients. Comorbidity correlated with postoperative complications and acute toxicities. Late fracture risk seems slightly increased. (orig.) [German] Erfahrungsbericht zur perkutanen Radiotherapie (EBRT) kombiniert mit extremitaetenerhaltender Operation bei Patienten >70 Jahre mit Weichteilsarkom der Extremitaet. Retrospektiv

  4. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 3. Descriptive study of postoperative nursing care following first stage cleft closure.

    Science.gov (United States)

    Bannister, Patricia; Lindberg, Nina; Jeppesen, Karin; Elfving-Little, Ulla; Semmingsen, Ann-Margritt; Paganini, Anna; Gustavsson, Annica; Slevin, Emma; Jacobsen, Gry; Eyres, Phil; Semb, Gunvor

    2017-02-01

    Cleft lip and palate is one of the most common congenital anomalies requiring surgical treatment in children, normally commenced in the first year of life. Following the initiation of a group of multicentre surgical trials of primary surgery, variations in postoperative recovery and management became apparent. An agreement was made for a nurse-led survey in eight surgical centres to document postoperative care and recovery. A postoperative recovery clinical report form was developed to capture relevant data for the children participating in the four arms of the trials. This included the age and weight at admission, the postoperative recovery setting, pain management, postoperative feeding, post-operative complications, and length of hospital stay. Four hundred and three nursing forms from the first surgical procedure were returned for analysis. Differences in important aspects of care such as postoperative analgesia and postoperative feeding were evident. Postoperative care was influenced by local custom and practice, as little firm clinical evidence exists to guide optimal management. Postoperative recovery may play a significant role in the future selection of surgical protocols, and future trials need to consider cross-study site training to familiarise nurses, prior to any changes in surgical methods. ISRCTN29932826.

  5. Reduction in admissions of patients with acute primary angle closure occurring in conjunction with a rise in cataract surgery in Taiwan.

    Science.gov (United States)

    Hu, Chao-Chien; Lin, Herng-Ching; Chen, Chin-Shyan; Kuo, Nai-Wen

    2008-06-01

    Using 8 year nationwide administrative data, this study sets out to investigate the relationship between the total number of cataract operations undertaken in Taiwan and admissions for acute primary angle closure (APAC). Monthly cataract surgery and APAC admission rates, per 100,000 of the population, were provided by 1997-2004 inpatient and outpatient data obtained from the Taiwanese National Health Insurance Research Database. The 3814 cases of APAC and 503 687 patients who had undergone cataract operations were categorized by age groups (40-49, 50-59, 60-69 and > or =70 years) and by gender. Spearman rank correlation coefficients were used to examine the direction and strength of the relationships. Throughout the study period, the admissions for APAC showed a steady decline from 630 cases in 1997 to 351 cases in 2004, while the number of cataract operations revealed a gradual increase from 26 600 in 1997 to 77 924 in 2004. The Spearman rank correlation coefficients showed significant inverse relationships between monthly APAC admission rates and monthly cataract operation rates for the total group (r = -0.407, P or =70 age group. Significant inverse relationships were noted between the monthly APAC admission rates and the monthly cataract operation rates. We recommend that data should be collected from other regions and ethnic groups to determine the inter-relationships.

  6. Awake perimetry testing for occipital epilepsy surgery.

    Science.gov (United States)

    Joswig, Holger; Girvin, John P; Blume, Warren T; Burneo, Jorge G; Steven, David A

    2017-12-08

    In the literature, there are few reports that provide a detailed account on the technique of visual electrocortical stimulation in the setting of resective surgery for occipital epilepsy. In this technical note, the authors describe how a 26-year-old male with long-standing occipital epilepsy underwent resective surgery under awake conditions, using electrocortical stimulation of the occipital lobe, with the aid of a laser pointer and a perimetry chart on a stand within his visual field. The eloquent primary visual cortex was found to overlap with the seizure onset zone that was previously determined with subdural electrodes. A maximum functionally safe resection was performed, rendering the patient seizure free as of his last follow-up at 20 months, with no visual field impairment.

  7. An audit of cytoreductive surgeries in ovarian cancer from a rural based cancer center.

    Science.gov (United States)

    Dessai, S B; Patil, V M; Chakraborty, S; Babu, S; Bhattacharjee, A; Nayanar, S; Vikram, S; Balasubramanian, S

    2016-01-01

    Ovarian cancers are frequently seen at an advanced stage in our center. This audit was planned to see the morbidity and efficacy of different types of cytoreductive surgeries (radical vs. ultra-radical) done in such patients. This was a retrospective analysis of all ovarian cancer patients who underwent cytoreductive surgery at our center from January 2009 to August 2013. The case records of these patients were reviewed and the demographic, disease-related and treatment-related data were extracted. Fifty-fivepatients were identified. Ten (18.2%) patients underwent primary cytoreduction while 45 patients had (81.8%) interval cytoreduction. The resections achieved were optimal in 50 patients (90.9%) and suboptimal in five patients (9.1%). The postoperative median blood loss was 400 (350-600) mL. The median time interval for surgery was 4.0 h (3-5 h). The type of resection achieved (optimal vs. suboptimal) was the only factor affecting the progression free survival (PFS) (Hazard ratio = 0.08 95% confidence interval 0.02-0.3). There was no significant difference in postoperative morbidity in patients undergoing the ultra-radical surgery as compared to those who underwent radical surgery. Optimal cytoreduction may improve PFS in advanced ovarian cancer patients and needs to be done even if it mandates an ultra-radical surgery.

  8. Retinal changes detected by wide-field autofluorescence imaging of patients with primary rhegmatogenous retinal detachment

    DEFF Research Database (Denmark)

    Poulsen, Christina Døfler; Grauslund, Jakob; Peto, Tunde

    2014-01-01

    .2 million inhabitants. Methods: A clinical prospective study of 99 eyes in 99 patients undergoing surgery for primary RRD between 1st of January 2013 and 12th of July 2013. All patients underwent surgery with pars plana vitrectomy (PPV) and had either gas or silicone oil tamponade. Patients were examined...... and 2 months follow-up and 59 had gradable images with characteristics studied in this part of the study. Exclusions were: poor images (n=8), major surgery or changes on fellow-eye (n=11), no baseline or 2-month image (n=7), re-detachment at 2-month follow-up (n=1) and eyes traumas (n=2). Retinal...

  9. A novel index for preoperative, non-invasive prediction of macro-radical primary surgery in patients with stage IIIC-IV ovarian cancer-a part of the Danish prospective pelvic mass study

    DEFF Research Database (Denmark)

    Karlsen, Mona Aarenstrup; Fagö-Olsen, Carsten Lindberg; Høgdall, Estrid Vilma Solyom

    2016-01-01

    samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor...... removal. One hundred fifty patients with advanced epithelial ovarian cancer were treated with primary debulking surgery (PDS). Complete PDS was achieved in 41 cases (27 %). The receiver operating characteristic curves demonstrated an area under the curve of 0.785 for HE4, 0.678 for CA125, and 0...

  10. Primary Hyperparathyroidism with Thyroid Hemiagenesis

    Directory of Open Access Journals (Sweden)

    Kenichi Sakurai

    2007-04-01

    Full Text Available Thyroid hemiagenesis is a very rare anomaly. We herein report a case with right thyroid lobe agenesis, which was incidentally found during the assessment of primary hyperparathyroidism. A 42-year-old male presenting with urinary lithiasis was suspected of having primary hyperparathyroidism, and had elevated levels of both serum calcium and intact parathyroid hormone. Both computed tomography and ultrasonography demonstrated the absence of right thyroid lobe and a mass of 1 cm in diameter at the left lower pole of the thyroid. The patient underwent lower left parathyroidectomy, which confirmed the right thyroid hemiagenesis, as well as the absence of both upper and lower right parathyroid glands. The resected left lower parathyroid gland was pathologically diagnosed as adenoma. The postoperative course was favourable and he was discharged on the 2nd day after surgery, without complications.

  11. Risk-group definition by recursive partitioning analysis of patients with squamous cell head and neck carcinoma treated with surgery and postoperative radiotherapy

    NARCIS (Netherlands)

    Langendijk, JA; Slotman, BJ; van der Waal, [No Value; Doornaert, P; Berkof, J; Leemans, CR

    2005-01-01

    BACKGROUND. The objective of this study was to define different prognostic groups with regard to locoregional control (LRC) derived from recursive partitioning analysis (RPA). METHODS. Eight hundred one patients with squamous cell head and neck carcinoma underwent with primary surgery and received

  12. Primary nodal hemangiosarcoma in four dogs.

    Science.gov (United States)

    Chan, Catherine M; Zwahlen, Courtney H; de Lorimier, Louis-Philippe; Yeomans, Stephen M; Hoffmann, Karon L; Moore, Antony S

    2016-11-01

    CASE DESCRIPTION 4 dogs with a slow-growing mass in the cervical region were evaluated. CLINICAL FINDINGS All dogs had no clinical signs at the time of the evaluation. There was no apparent evidence of visceral metastases or other primary tumor based on available CT or MRI data for any dog. TREATMENT AND OUTCOME For each dog, surgery to remove the mass was performed. Histologic examination of the excised tissue revealed a completely excised grade 1 or 2 lymph node hemangiosarcoma. All dogs received adjuvant chemotherapy; 2 dogs underwent curative intent chemotherapy, 1 dog underwent metronomic treatment with cyclophosphamide, and 1 dog underwent metronomic treatment with chlorambucil. The survival time was 259 days in 1 dog; 3 dogs were still alive 615, 399, and 365 days after surgery. CLINICAL RELEVANCE Primary nodal hemangiosarcoma in dogs is a rare and, to the authors' knowledge, previously undescribed disease that appears to develop in the cervical lymph nodes as a slow-growing mass or masses. Surgical excision and adjunct treatment resulted in long survival times for 3 of the 4 dogs of the present report. Given the aggressive biologic behavior of hemangiosarcomas in other body locations, adjunct chemotherapy should be considered for affected dogs, although its role in the cases described in this report was unclear. Additional clinical information is required to further characterize the biologic behavior of this tumor type and determine the expected survival times and associated risk factors in dogs.

  13. Long-term Outcomes and Quality of Life of 186 Patients With Primary Parotid Carcinoma Treated With Surgery and Radiotherapy at the Daniel den Hoed Cancer Center

    International Nuclear Information System (INIS)

    Al-Mamgani, Abrahim; Rooij, Peter van; Verduijn, Gerda M.; Meeuwis, Cees A.; Levendag, Peter C.

    2012-01-01

    Purpose: To assess the outcomes, toxicity, and quality of life (QOL) of patients with primary parotid carcinoma treated with surgery and postoperative radiotherapy at the Daniel den Hoed Cancer Center. Methods and Materials: Between 1995 and 2010, 186 patients with parotid carcinoma were treated with parotidectomy with or without neck dissection, followed by radiotherapy. Elective nodal irradiation (ENI) was applied to high-risk, node-negative disease. End points were locoregional control (LRC), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS), late toxicity, and QOL. Results: After a median follow-up of 58 months (range, 4–172 months), the 5-year Kaplan-Meier estimates for LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%, respectively. Forty-five events were reported: 24 distant metastases (DM) and 21 locoregional failures (LRF). Event-free survival rates by histological types were 89%, 78%, 76%, 74%, and 70% for acinic cell, mucoepidermoid, adenoid cystic, adenocarcinoma, and squamous cell carcinoma, respectively. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%, respectively) than in patients with other histological types (p = 0.04) and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%, respectively) than in patients with other types (p = 0.03). None of the high-risk node-negative patients who received ENI developed regional failure. On multivariate analysis, T stage, N stage, grade, and presence of perineural invasion and facial paralysis correlated significantly with DFS. The 5-year cumulative incidence of grade ≥2 late toxicity was 8%. QOL scores deteriorate during and shortly after treatment but returned in almost all scales to baseline scores within 6 months. Conclusions: Of the entire group, surgery and postoperative radiotherapy resulted in excellent outcomes with minimal side effects and preservation of good QOL scores. However, in

  14. Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity?

    Science.gov (United States)

    Al-Ghazal, S K; Fallowfield, L; Blamey, R W

    1999-12-01

    To investigate any influence of cosmetic outcome on psychosocial morbidity in patients who have undergone breast-conserving surgery for primary breast cancer. Cosmetic outcome was assessed both objectively and subjectively in 254 patients, aged 20-69 years, who underwent breast-conserving surgery for operable primary breast cancer, Self-esteem scale. Patient satisfaction was high (90.5% of the patients were very or moderately satisfied). There was an excellent correlation between cosmesis and levels of anxiety (r=-0.81, Pself-esteem (r=-0.64, Pcosmetic result achieved has a marked bearing on the subsequent development of psychological outcome. Copyright 1999 Harcourt Publishers Ltd.

  15. Patients' preferences for information in bariatric surgery.

    Science.gov (United States)

    Coblijn, Usha K; Lagarde, Sjoerd M; de Raaff, Christel A L; van Wagensveld, Bart A; Smets, Ellen M A

    2018-01-31

    The decision to undergo bariatric surgery is multifactorial and made both by patient and doctor. Information is of the utmost importance for this decision. To investigate the bariatric surgery patient's preferences regarding information provision in bariatric surgery. A teaching hospital, bariatric center of excellence in Amsterdam, the Netherlands. All patients who underwent a primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between September 2013 and September 2014 were approached by mail to participate. A questionnaire was used to elicit patient preferences for the content and format of information. Sociodemographic characteristics, clinicopathologic factors, and psychologic factors were explored as predictors for specific preferences. Of the 356 eligible patients, 112 (31.5%) participated. The mean age was 49.2 (±10.7) years, and 91 (81.3%) patients were female. Patients deemed the opportunity to ask questions (96.4%) the most important feature of the consult, followed by a realistic view on expectations-for example, results of the procedure (95.5%) and information concerning the consequences of surgery for daily life (89.1%). Information about the risk of complications on the order of 10% was desired by 93% of patients; 48% desired information about lower risks (.1%). Only 25 patients (22.3%) desired detailed information concerning their weight loss after surgery. Bariatric patients wished for information about the consequences of surgery on daily life, whereas the importance of information concerning complications decreased when their incidence lessened. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  16. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 10. Parental perceptions of appearance and treatment outcomes in their 5-year-old child.

    Science.gov (United States)

    Feragen, Kristin Billaud; Semb, Gunvor; Heliövaara, Arja; Lohmander, Anette; Johannessen, Emma Christine; Boysen, Betty Marie; Havstam, Christina; Lundeborg, Inger; Nyberg, Jill; Pedersen, Nina-Helen; Bogh-Nielsen, Joan; Eyres, Philip; Bradbury, Eileen; Rumsey, Nichola

    2017-02-01

    Few studies have explored children's emotional and behavioural reactions to cleft surgery and treatment-related stress. The objective was to investigate parents' evaluations of appearance and treatment outcomes in their 5-year-old child with unilateral cleft lip and palate (UCLP), and their perceptions of how their child was coping with treatment, comparing this information with recorded postsurgical complications. Three parallel group randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Three different surgical procedures for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. A total of 356 parents completed the Scandcleft Parent Questionnaire, and 346 parents completed the Cleft Evaluation Profile. The results indicated that the majority of parents were satisfied with cleft-related features of their child's appearance. Further, most children coped well with treatment according to their parents. Nevertheless, 17.5% of the children showed minor or short-term reactions after treatment experiences, and 2% had major or lasting difficulties. There were no significant relationships between parent perceptions of treatment-related problems and the occurrence of post-surgical medical complications. Most parents reported satisfaction with their child's appearance. However, treatment-related problems were described in some children, urging cleft centres to be aware of potential negative emotional and behavioural reactions to treatment in some young children, with a view to preventing the development of more severe treatment-related anxiety. ISRCTN29932826.

  17. Forty years of shunt surgery at Rigshospitalet, Denmark

    DEFF Research Database (Denmark)

    Mansson, Philip Kofoed; Johansson, Sofia; Ziebell, Morten

    2017-01-01

    Objective The objective of this study is to review our experience of shunt surgery by investigating 40years of development in terms of rates of revision and infection, shunt survival and risk factors. Design and participants Medical records and operative reports were reviewed retrospectively...... for all patients who underwent primary shunt surgery at our department in the years 2010 to 2012. All results were compared with a previous study from our department. A mixed population consisting of 434 patients was included. Adults (≥15years) accounted for 89.9% of all patients and the mean follow.......1-54.9). Within 4weeks postoperatively, 3.2% had an infection and overall infection rate was 5.5%. Short duration of surgery and the use of antibiotic prophylaxis were associated with a lower risk of infection. The most frequent causes of revision were valve defects (18.4%) and proximal defects or obstructions...

  18. Maze Surgery

    Science.gov (United States)

    ... Center > Maze Surgery Menu Topics Topics FAQs Maze Surgery Article Info En español Electrical impulses in your ... called an arrhythmia. Why do I need Maze surgery? Maze surgery is also called the Maze procedure. ...

  19. How traumatic is breast cancer? Posttraumatic stress symptoms (PTSS) and risk factors for severe PTSS at 3 and 15 months after surgery in a nationwide cohort of Danish women treated for primary breast cancer

    DEFF Research Database (Denmark)

    O'Connor, Maja; Christensen, Søren; Jensen, Anders Bonde

    2011-01-01

    physical and mental illness, axillary lymph node involvement (>3), and reduced physical functioning at 3 months. Conclusion: The results confirm that receiving a breast cancer diagnosis can be a significant traumatic experience, and that many women experience persistent cancer-related PTSS. Low social......The literature shows considerable between-study variation in the prevalence of Post-traumatic Stress Symptoms (PTSS) among women with breast cancer. Our aim was therefore to explore the prevalence of and risk factors for cancer-related PTSS in a nationwide inception cohort of women treated...... for primary breast cancer. Methods: Sixty-eight percent of all Danish women receiving surgery for primary breast cancer between October 2001 to March 2004 completed a questionnaire 3 months post-surgery (n=3343), which included the Impact of Event Scale (IES). Ninety-four percent of the disease-free women...

  20. Probability, rate and timing of reconstructive surgery following colectomy for inflammatory bowel disease in Sweden: a population-based cohort study.

    Science.gov (United States)

    Nordenvall, C; Myrelid, P; Ekbom, A; Bottai, M; Smedby, K E; Olén, O; Nilsson, P J

    2015-10-01

    Many patients with inflammatory bowel disease (IBD) need colectomy, but the rate of reconstructive surgery with restoration of intestinal continuity is unknown. The aim of this study was to investigate the probability, rate and timing of reconstructive surgery after colectomy in patients with IBD in a population-based setting. The study cohort included all patients with IBD in Sweden who underwent colectomy from 2000 to 2009. Each patient was followed from admission for colectomy to admission for reconstructive surgery, date of death, migration or 31 December 2010. Kaplan-Meier survival curves and multivariable Poisson regression models were used to describe the probability, rate and timing of reconstructive surgery. Out of 2818 IBD patients treated with colectomy, 61.0% were male and 78.9% had ulcerative colitis. No reconstructive surgery had been performed in 1595 (56.6%) patients by the end of follow-up. Of the remaining 1223 patients, 526 underwent primary reconstructive surgery and 697 had a secondary reconstruction following a median interval of 357 days from primary surgery in the form of colectomy. The probability of reconstructive surgery was dependent on age (55.6% and 18.1% at ages 15-29 and ≥ 59 years, respectively), and the chance of reconstructive surgery was higher in hospitals that performed more than 13 colectomies for IBD per year [incidence rate ratio and 95% confidence interval 1.27 (1.09-1.49)]. Fewer than half of the patients having a colectomy for IBD underwent subsequent reconstructive surgery. Older age and low hospital volume were risk factors for no reconstructive surgery. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  1. Pleurectomy versus pleural abrasion for primary spontaneous pneumothorax in children.

    Science.gov (United States)

    Joharifard, Shahrzad; Coakley, Brian A; Butterworth, Sonia A

    2017-05-01

    Primary spontaneous pneumothorax (PSP) represents a common indication for urgent surgical intervention in children. First episodes are often managed with thoracostomy tube, whereas recurrent episodes typically prompt surgery involving apical bleb resection and pleurodesis, either via pleurectomy or pleural abrasion. The purpose of this study was to assess whether pleurectomy or pleural abrasion was associated with lower postoperative recurrence. The records of patients undergoing surgery for PSP between February 2005 and December 2015 were retrospectively reviewed. Recurrence was defined as an ipsilateral pneumothorax requiring surgical intervention. Bivariate logistic regressions were used to identify factors associated with recurrence. Fifty-two patients underwent 64 index operations for PSP (12 patients had surgery for contralateral pneumothorax, and each instance was analyzed separately). The mean age was 15.7±1.2years, and 79.7% (n=51) of patients were male. In addition to apical wedge resection, 53.1% (n=34) of patients underwent pleurectomy, 39.1% (n=25) underwent pleural abrasion, and 7.8% (n=5) had no pleural treatment. The overall recurrence rate was 23.4% (n=15). Recurrence was significantly lower in patients who underwent pleurectomy rather than pleural abrasion (8.8% vs. 40%, ppleural abrasion without pleurectomy, the relative risk of recurrence was 2.36 [1.41-3.92, ppleural abrasion. Level III, retrospective comparative therapeutic study. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Pain and Function Recovery Trajectories following Revision Hip Arthroplasty: Short-Term Changes and Comparison with Primary Hip Arthroplasty in the ADAPT Cohort Study.

    Directory of Open Access Journals (Sweden)

    Erik Lenguerrand

    Full Text Available Patients report similar or better pain and function before revision hip arthroplasty than before primary arthroplasty but worse results are reported after revision surgery than after primary surgery. The trajectory of post-operative recovery during the first months and any differences by type of surgery have received little attention. We explored the trajectories of change in pain and function after revision hip arthroplasty to 12-months post-operatively and compare them with those observed after primary hip arthroplasty.This study is a prospective cohort study of patients undergoing primary (n = 80 with 92% for an indication of osteoarthritis and revision (n = 43 hip arthroplasties. WOMAC pain and function scores and walking speed were collected pre-operatively, at 3 and 12-months post-operatively. Multilevel regression models were used to chart and compare the trajectories of change (0-3 months and 3-12 months between types of surgery.The improvements in pain and function following revision arthroplasty occurred within the first 3-months with no evidence of further change beyond this initial period. While the pattern of recovery was similar to the one observed after primary arthroplasty, improvements in the first 3-months were smaller after revision compared to primary arthroplasty. Patients listed for revision surgery reported lower pre-operative pain levels but similar post-operative levels compared to those undergoing primary surgery. At 12-months post-operation patients who underwent a revision arthroplasty had not reached the same level of function achieved by those who underwent primary arthroplasty.The post-operative improvements in pain and function are larger following primary hip arthroplasty than following revision hip arthroplasty. Irrespectively of surgery type, most of the improvements occur in the first three post-operative months. More research is required to identify whether the recovery following revision surgery could be

  3. Internal hernia following laparoscopic colorectal surgery: a rare but fatal complication.

    Science.gov (United States)

    Lee, S Y; Kim, C H; Kim, Y J; Kim, H R

    2017-04-01

    Internal hernia of the small bowel through a mesenteric defect following colorectal cancer surgery is a serious but rarely reported complication. The aim of this study was to evaluate the incidence, clinical features, and management of these hernias. We retrospectively reviewed 4589 primary colorectal cancer patients who underwent surgical resection between January 2007 and December 2015. The incidence, clinical presentations, and short-term outcomes of patients with symptomatic internal hernia following colorectal surgery were investigated in detail. We found 9 (0.2 %) patients who presented with symptomatic internal hernia. In all cases, preceding surgical procedures were laparoscopic anterior resection (n = 9), including low anterior resection (n = 3) and intersphincteric resection (n = 3). The median time interval between initial surgery and the occurrence of internal hernia was 4 months (range 5 days-27 months). Main symptoms were abdominal distension and pain; 4 (44.4 %) patients presented with systemic inflammatory response syndrome. Most cases (7/9, 77.8 %) were suspected of internal hernia by preoperative abdominal computed tomography. Six (66.6 %) patients underwent emergency surgery, after which all developed postoperative complications without mortality. The median hospital stay was 27.5 days (range 25-54 days) among patients who underwent surgical intervention. Internal hernia following colorectal cancer surgery is a rare but potentially fatal complication, and as such, early recognition and management of these cases are important.

  4. Do current indications for surgery of primary gastric lymphoma exist? ¿Existen indicaciones actuales para la cirugía en el linfoma gástrico?

    Directory of Open Access Journals (Sweden)

    J. C. Rodríguez-Sanjuán

    2006-03-01

    Full Text Available Objective: to analyze the results of our series in order to assess whether surgical excision is still a valid therapeutic option in case the patient needs surgery. Secondarily, to analyze Helicobacter pylori infection rate. Patients and method: a retrospective study of 69 consecutive patients having stage IE-IIE primary gastric lymphoma; of these, 65 were treated by gastrectomy between 1974 and 1999. Mean age: 62.6 years (28-85. New staining of paraffin-embedded samples from the surgical specimen were carried out (hematoxiline-eosine, Giemsa, immunohistochemistry and reviewed. The histological classification was performed according to Isaacson's criteria. The statistical analysis was done by Chi-squared and Fisher's exact tests, as well as Kaplan-Meier and Log-Rank tests. Results: mortality was 9.2%. There were non-fatal complications in 10.8%. Helicobacter pylori was identified in 62.7%. Seven patients (11.9% suffered a relapse. The 5-year survival probability was 87%. The statistical analysis did not show any influences of Ann Arbor stage, gastric wall invasion, Helicobacter pylori infection, histological type, or margin resection involvement on survival. Conclusions: surgical excision provides a high rate of complete remissions and excellent long-term survival with acceptable mortality. Therefore it appears to be a valid treatment in case of emergency surgery, incidental finding, or lack of histological diagnosis.Objetivo: analizar los resultados de nuestra serie a fin de establecer si la extirpación quirúrgica continúa siendo una opción terapéutica válida para las situaciones en las que pudiera precisarse cirugía. Como objetivo secundario, analizar la prevalencia de infección por Helicobacter pylori. Pacientes y método: estudio retrospectivo de 69 pacientes consecutivos diagnosticados de linfoma gástrico primario, en estadio I E y II E de Ann Arbor, 65 de los cuales fueron tratados mediante gastrectomía entre 1974 y 1999. Edad

  5. Role of {sup 99m}Tc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery

    Energy Technology Data Exchange (ETDEWEB)

    Rubello, Domenico; Massaro, Arianna; Cittadin, Silvia; Rampin, Lucia [Istituto Oncologico Veneto (IOV), Nuclear Medicine Service - PET Unit, ' S. Maria della Misericordia' Hospital, Rovigo (Italy); Al-Nahhas, Adil [Hammersmith Hospital, Department of Nuclear Medicine, London (United Kingdom); Boni, Giuseppe; Mariani, Giuliano [University of Pisa Medical School, Regional Center of Nuclear Medicine, Pisa (Italy); Pelizzo, Maria R. [University of Padova Medical School, Department of Special Surgery, Padova (Italy)

    2006-09-15

    A prerequisite for optimum minimally invasive radio-guided surgery (MIRS) for primary hyperparathyroidism (PHPT) is the demonstration of significant uptake of {sup 99m}Tc-sestamibi in a parathyroid adenoma (PA). The aim of this study was to evaluate the clinical role or {sup 99m}Tc-sestamibi SPECT in selecting patients for this procedure. Fifty-four consecutive PHPT patients were evaluated by single-session {sup 99m}Tc-pertechnetate/{sup 99m}Tc-sestamibi planar subtraction scintigraphy, followed by {sup 99m}Tc-sestamibi SPECT acquisition to localise hyperfunctioning PAs and assist in planning the surgical approach. Scintigraphy showed the presence of a solitary PA in 47/54 patients (87%) and two or more PAs in four patients (7.4%); it was negative in the remaining three patients (5.6%). The overall sensitivity of {sup 99m}Tc-sestamibi scintigraphy was 94.6%. In 7/54 patients, the PA was located deep in the para-oesophageal/paratracheal space. So far, 22 patients with scintigraphic evidence of a solitary PA (in four of whom the PA was located deep in the neck) have undergone successful MIRS using the low 37 MBq (1 mCi) {sup 99m}Tc-sestamibi dose protocol. Intraoperative quick parathyroid hormone (QPTH) assay demonstrated a fall in all 22 patients, thus confirming successful removal of the hyperfunctioning PA. No major surgical complications were observed. After a period of follow-up ranging between 6 and 27 months (median 13 months), no case of persistent/recurrent PHPT was recorded. When comparing the parathyroid to background (P/B) ratio measured at planar and SPECT preoperative scintigraphy with that measured intraoperatively with the gamma probe, a good linear correlation was found between the SPECT and the intraoperative gamma probe measurements (r=0.89; p<0.01) but no correlation was found with planar scintigraphic data. Our preliminary data suggest that measurement of the P/B ratio by means of {sup 99m}Tc-sestamibi SPECT is more accurate in predicting the

  6. Efficacy of Early Surgery for Neurological Improvement in Spinal Cord Injury without Radiographic Evidence of Trauma in the Elderly.

    Science.gov (United States)

    Inoue, Tomoo; Suzuki, Shinsuke; Endo, Toshiki; Uenohara, Hiroshi; Tominaga, Teiji

    2017-09-01

    The optimal timing for surgery for patients with spinal cord injury without radiographic evidence of trauma (SCIWORET) remains unclear. This is especially true in the elderly, given that most studies are done with younger patients to avoid age-related comorbidities. We aimed to compare the efficacy of early (24 hours postinjury) surgery in patients with SCIWORET aged ≥65 years. We identified patients aged ≥65 years who underwent surgery for SCIWORET between January 1995 and February 2016. The primary outcome was a change in the Japanese Orthopaedic Association (JOA) score at discharge, with a recovery of >50% defined as a favorable neurologic outcome. Logistic regression analysis was performed, and model fit was assessed using the Hosmer-Lemeshow test. Eighty patients aged ≥65 years with SCIWORET underwent surgery were enrolled. Favorable neurologic outcomes were seen in 43.3% of those who underwent early surgery, but only in 18.0% of those who underwent late surgery. Logistic regression analysis, adjusted for age, sex, comorbidities (Charlson Comorbidity Index), and JOA score, revealed that early surgery independently predicted favorable outcomes (odds ratio, 4.06; 95% confidence interval, 1.25-13.20), with excellent calibration (Hosmer-Lemeshow, P = 0.857). The present study indicated that early surgery within 24 hours of injury for elderly patients with SCIWORET could lead to more favorable neurologic improvements. We believe that chronological age alone should not be considered sufficient justification to deny patients early surgical decompression for SCIWORET. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. [Evaluation of the antithrombotic strategy in low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis].

    Science.gov (United States)

    Aceves-Velázquez, Eduardo; Vieyra-Herrera, Gerardo; Rodríguez-Chávez, Laura; Herrera-Alarcón, Valentín

    2017-07-16

    According to current guidelines, in patients without additional risk factors who have undergone aortic valve replacement with a bioprosthesis, anticoagulation in the first 3 months after surgery is still a matter of debate. According to current evidence, aspirin in low doses is a reasonable alternative to vitamin K antagonists (VKA). A comparison is made between the incidence of thrombotic and haemorrhagic complications in patients with low thrombotic risk who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico. The hypothesis: aspirin as monotherapy has a beneficial effect compared to VKA. The studied patients were the low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico from 2011 to 2015. The groups studied were: aspirin only, VKA only, and the combination of VKA plus aspirin. The patients were retrospectively followed-up for 12 months, and the thrombotic and haemorrhagic complications were documented. Of the 231 patients included in the study, only one patient in the VKA only group presented with a haemorrhagic complication. No thrombotic complications were observed. In the present study no thrombotic complications were observed in patients who did not receive anticoagulation in the first 3 months after an aortic valve replacement with a bioprosthesis after a follow up period of 12 months. This suggests that the use of aspirin only is safe during this period. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  8. Two years of experience with robot-assisted anti-reflux surgery: A retrospective cohort study.

    Science.gov (United States)

    Jensen, Jonas Sanberg; Antonsen, Henning Kold; Durup, Jesper

    2017-03-01

    Robot-assisted anti-reflux surgery (RAAS) is an alternative to conventional laparoscopic anti-reflux surgery (CLAS). The purpose of this study was to evaluate initial Danish experiences with robot-assisted anti-reflux surgery compared to conventional laparoscopic anti-reflux surgery incorporating follow-up and evaluation of possible learning curve. Patients undergoing primary RAAS or CLAS at The Department of Surgery A, Odense University Hospital and The Department of General Surgery, Kolding Hospital from April 2013 to April 2015 was included. Demographic data, comorbidity, docking time, length of procedure, type of fundic wrap as well as perioperative complications and postoperative complications, need for reoperation or any upper gastrointestinal endoscopy from surgery to final follow-up was retrospectively extracted from patient records. 103 patients were included in this study. 39 patients underwent RAAS and 64 patients underwent CLAS. There were no statistically significant differences in demographic data or comorbidities except distribution of heart disease (RAAS: 5.1% vs. CLAS: 18.8%, p = 0.05) and previous abdominal surgery (RAAS: 28.2% vs. CLAS: 48.4%, p = 0.04). Duration of surgery was significantly increased in patients undergoing RAAS (RAAS: 135 ± 27 min vs. CLAS: 86 ± 19 min, p surgery as robot-assisted procedures neither intra-operatively nor at follow-up. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion.

    Science.gov (United States)

    Knebel, Rogerio; Fraga, Jose Carlos; Amantea, Sergio Luis; Isolan, Paola Brolin Santis

    To evaluate the effectiveness of videothoracoscopic surgery in the treatment of complicated parapneumonic pleural effusion and to determine whether there is a difference in the videothoracoscopic surgery outcome before or after the chest tube drainage. The medical records of 79 children (mean age 35 months) undergoing videothoracoscopic surgery from January 2000 to December 2011 were retrospectively reviewed. The same treatment algorithm was used in the management of all patients. Patients were divided into two groups: in group 1, videothoracoscopic surgery was performed as the initial procedure; in group 2, videothoracoscopic surgery was performed after previous chest tube drainage. Videothoracoscopic surgery was effective in 73 children (92.4%); the other six (7.6%) needed another procedure. Sixty patients (75.9%) were submitted directly to videothoracoscopic surgery (group 1) and 19 (24%) primarily underwent chest tube drainage (group 2). Primary videothoracoscopic surgery was associated with a decrease of hospital stay (p=0.05), time to resolution (p=0.024), and time with a chest tube (ptube, and the hospital stay after videothoracoscopic surgery. No differences were observed between groups regarding the need for further surgery and the presence of complications. Videothoracoscopic surgery is a highly effective procedure for treating children with complicated parapneumonic pleural effusion. When videothoracoscopic surgery is indicated in the presence of loculations (stage II or fibrinopurulent), no difference were observed in time of clinical improvement and hospital stay among the patients with or without chest tube drainage before videothoracoscopic surgery. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  10. Surgery for abdominal metastases of cutaneous melanoma.

    Science.gov (United States)

    Gutman, H; Hess, K R; Kokotsakis, J A; Ross, M I; Guinee, V F; Balch, C M

    2001-06-01

    The objective of this study was to support our hypothesis that surgical resection of abdominal metastases of melanoma, regardless of symptomatology, could provide prolonged palliation and improved survival. We performed a retrospective chart review at M.D. Anderson Cancer Center. A series of 251 melanoma patients (stages I, II, or III at registration) who developed intraabdominal metastases during follow-up were studied. Altogether, 96 patients underwent 119 laparotomies; 51 underwent endoscopic or percutaneous procedures; and 116 patients were treated medically. Surgery was associated with a median survival of 11 months, significantly longer than that with other treatment (p < 0.001). Tumor was extirpated during 37% of the first laparotomies, and in an additional 33% very good palliation was achieved with incomplete resection. Tumor extirpation was associated with 10-month symptom-free survival (SFS), significantly longer than that with any other approach (p < 0.0001). In the nonsurgically treated patients, good palliation was achieved in 8% to 17% of patients with no complete response. The median SFS after surgery was 5 months, but 23% of patients were symptom-free more than 12 months; 87 patients with minimal symptoms; and 72 severely symptomatic patients underwent surgery. Complete resection was feasible in 42% and 34%, respectively. Surgery was associated with 12 months median survival in both groups. There was a significant survival benefit from surgery in patients with gastrointestinal (GI) tract metastases in contrast to those who had non-GI metastases. For the 96 surgically treated patients, a time interval of more than 4 years between diagnosis of the primary lesion and the abdominal recurrence predicted decreased risk of death (p = 0.038). The 30-day postoperative complication and mortality rates were 19.0% and 3.3%, respectively. Complete surgical resection of melanoma metastases in the abdomen is associated with median and symptom-free survival

  11. [Primary intrahepatic lithiasis: indications and results of liver resection].

    Science.gov (United States)

    Clemente, Gennaro; De Rose, Agostino Maria; Giordano, Marco; Mele, Caterina; Vellone, Maria; Ardito, Francesco; Murazio, Marino; Giuliante, Felice; Giovannini, Ivo; Nuzzo, Gennaro

    2009-01-01

    The aim of this study was to review a series of patients submitted to hepatectomy for primary intrahepatic lithiasis to evaluate early and late results with an assessment of indications, methods and long-term outcomes. From January 1992 to December 2007, 40 patients (25 males and 15 females with a mean age of 51 years) underwent surgery for primary intrahepatic lithiasis in our Hepato-biliary Surgery Unit. Left hepatectomy (20 patients) and left lateral segmentectomy (12 patients) were the most common procedures performed. A cholangiocarcinoma was found in 4 patients (10%) and only two of these underwent liver resection, while an exploratory laparotomy was performed in the remaining two patients for an unresectable tumour, unexpected before surgery. There was no postoperative mortality. The morbidity rate was 22.5% with a prevalence of infectious complications related to bile leakage. Long-term results, assessed in 30 patients with a follow-up longer than 12 months, were good or fair in 28 patients (93.3%). Primary intrahepatic lithiasis is diagnosed increasingly in Western countries as a result of the improvement in imaging techniques. The stones originate inside the liver at the level of dilatations of the bile ducts above congenital strictures of the main hilar ducts. Biliary pain and cholangitis are the most common presenting symptoms, whereas cholangiocarcinoma represents the unfavourable complication of the disease. In the majority of cases, a single liver lobe or segment is involved and liver resection allows definitive treatment of the disease and prevention of cancer.

  12. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

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

    Science.gov (United States)

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

    2017-03-01

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

  14. Factors associated with late specialized rehabilitation among veterans with lower extremity amputation who underwent immediate postoperative rehabilitation.

    Science.gov (United States)

    Kurichi, Jibby E; Xie, Dawei; Kwong, Pui L; Bates, Barbara E; Vogel, W Bruce; Stineman, Margaret G

    2011-05-01

    The aim of this study was to determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Data were obtained from eight administrative databases for 2,453 patients who underwent lower limb amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazard ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from surgical hospitalization. There were 2304 patients who received only immediate postoperative services, whereas 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared with the Southeast region, and had their surgeries in facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were all more likely to receive late services. The hazard ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt; however, after 3 mos, those who received early specialized rehabilitation were significantly less likely to receive late services. The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding units accredited by the Commission on Accreditation of Rehabilitation Facilities.

  15. Carotid intima-media thickness and ınsulin resistance changes in patients who underwent sleeve gastrectomy: A prospective study.

    Science.gov (United States)

    Yorulmaz, G; Cilekar, M; Bilge, U; Akcan, E; Akalin, A

    2016-01-01

    Our aim was to examine changes in insulin resistance, Carotid Intima-Media Thickness (CIMT), in morbid obese patients without any known associated chronic diseases who underwent sleeve gastrectomy. The subjects of this study were patients with minimum BMI of 40, who did not have any known chronic diseases. Sleeve gastrectomy was performed and perioperative control endoscopy was performed. The following values were measured before the operation and after follow-up period after the operation: Fasting blood glucose and insulin, lipid profile, BMI, liver function tests, right and left CIMT. Furthermore, the patients' insulin resistance was calculated by HOMA method, and the values of 2.7. Six-teen patients (14 women and 2 men, average age: 39.12 ± 10.63 years), who did not have a known additional chronic disease, took part in the study. There was a significant difference between baseline and follow-up values of the patients, and the mean weight loss was 20.5%. Given the statistical evaluation of baseline and follow-up values, there was a significant difference in BMI, insulin resistance rates and right and left CIMT values. Bariatric surgery may provide some additional advantages for the management of cardiovascular risks in obese patients. However, it should be kept in mind that the most important components of fight against obesity are appropriate diet and exercise programs.

  16. The impact of advancing age on postoperative outcomes in plastic surgery.

    Science.gov (United States)

    Shih, Kevin; De Oliveira, Gildasio S; Qin, Charles; Kim, John Y

    2015-11-01

    Age has been shown to be an independent predictor of complications in general surgery patients. In contrast, the effect of age on outcomes after plastic surgery has yet to be confirmed or refuted. The objective of the current investigation was to evaluate a possible association between age and postoperative outcomes after plastic surgery. The 2005-2012 NSQIP database was retrospectively reviewed for all patients undergoing plastic surgery. Patients ≥60 years with procedures under the category of plastic surgery in NSQIP were selected for analysis. The primary outcome of interest was 30-day overall complication rates. Multivariate regression models were constructed to control for potential perioperative confounders. Of the 2,320,920 patients captured in the NSQIP database, 36,819 patients underwent plastic surgery and met inclusion criteria. The incidence of unadjusted overall complications increased with age with an overall complication rate of 9.0% in patients plastic surgery. Medical complications and mortality were more likely in extremes of age (>80 years). Age alone should not be included as a decisional factor in patients plastic surgery. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Impact of Spanish-language information sessions on Spanish-speaking patients seeking bariatric surgery.

    Science.gov (United States)

    Martin, Allison N; Marino, Miguel; Killerby, Marie; Rosselli-Risal, Liliana; Isom, Kellene A; Robinson, Malcolm K

    2017-06-01

    Bariatric centers frequently provide preoperative educational programs to inform patients about the risks and benefits of weight loss surgery. However, most programs are conducted in English, which may create barriers to effective treatment and access to care for non-English speaking populations. To address this concern, we instituted a comprehensive Spanish-language education program consisting of preoperative information and group nutrition classes conducted entirely in, and supported with Spanish-language materials. The primary aim was to examine the effect of this intervention on Spanish-speaking patients' decision to undergo surgery in a pilot study. University Hospital/Community Health Center, United States. Three cohorts of patients seeking bariatric surgery between January 1, 2011 and March 31, 2012 were identified: 1) primary English speakers attending English-language programs ("English-English"); 2) primary Spanish speakers attending Spanish-language programs ("Spanish-Spanish"); and 3) primary Spanish speakers attending English-speaking programs with the assistance of a Spanish-to-English translator ("Spanish-English"). 26% of the English-English cohort ultimately underwent surgery compared with only 12% of the Spanish-Spanish cohort (P = .009). Compared with the English-English group, time to surgery was 35 days longer for the Spanish-Spanish and 185 days longer for the Spanish-English group (both P< .001). Spanish-speaking patients were less likely to undergo bariatric surgery regardless of the language in which educational sessions are provided. For those choosing surgery, providing Spanish-language sessions can shorten time to surgery. A barrier to effective obesity treatment may exist for Spanish speakers, which may be only partially overcome by providing support in Spanish. Copyright © 2017. Published by Elsevier Inc.

  18. Outcome of Expedited Rotator Cuff Surgery in Injured Workers: Determinants of Successful Recovery.

    Science.gov (United States)

    Razmjou, Helen; Boljanovic, Dragana; Lincoln, Sandra; Holtby, Richard; Gallay, Stephen; Henry, Patrick; Macritchie, Iona; Borthwick, Cheryl; Mayer, Lauren; Roknic, Carolyn; Shore, Deborah; Kamino, Allison; Grossman, Julie; Hill, Joanne; Singh, Gargi; Travers, Niki; Yanofsky, Loraine; Wilson, Marni; Sumar, Shellina; Savona, Alicia; De Medeiros, Filomena; Mann, Helen; Champsi, Aisha; Chau, Stefanie; Medeiros, Danielle; Richards, Robin R

    2017-05-01

    Work-related rotator cuff injuries are a common cause of disability and employee time loss. To examine the effectiveness of expedited rotator cuff surgery in injured workers who underwent rotator cuff decompression or repair and to explore the impact of demographic, clinical, and psychosocial factors in predicting the outcome of surgery. Case series; Level of evidence, 4. Injured workers who were seen at a shoulder specialty program and who underwent expedited arthroscopic rotator cuff decompression or repair were observed for a period of 6 to 12 months based on their type of surgery and recovery trajectory. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form. The impact of surgery was assessed by whether the change in the ASES score exceeded the minimal clinically important difference (MCID) of 17 points. Secondary outcomes were range of motion (ROM), medication consumption, and work status. One hundred forty-six patients (43 women [29%], 103 men [71%]; mean age, 52 years; SD, 8 years) completed the study. Sixty-seven (46%) patients underwent rotator cuff repair. The mean time between the date the patient consented to have surgery and the date of surgery was 82 (SD, 44) days. There was a statistically significant improvement in ASES score and ROM and work status (52 returned to regular duties and 59 to modified duties) ( P satisfaction with the job. Expedited rotator cuff surgery improved disability, ROM, and work status in injured workers. Successful recovery after work-related shoulder injuries may further be facilitated by improving the psychosocial work environment and increasing access to care.

  19. Hypocarotenemia after bariatric surgery: a preliminary study.

    Science.gov (United States)

    Granado-Lorencio, F; Herrero-Barbudo, C; Olmedilla-Alonso, B; Blanco-Navarro, I; Pérez-Sacristán, B

    2009-07-01

    Dietary carotenoids have attracted a great deal of attention due to their potential clinical relevance in conditions such as age-related maculopathy, osteoporosis, cardiovascular disease, and cancer. Surgical procedures have become the primary treatment of severe obesity, although nutrient deficiencies are common and long-term metabolic sequelae remain unknown. Thus, our aim was to assess the carotenoid status in serum of subjects after obesity surgery. We evaluated the status of lutein, zeaxanthin, alpha- and beta-cryptoxanthin, lycopene, alpha- and beta-carotene, and fat-soluble vitamins by a quality-controlled high-performance liquid chromatography method in serum of 53 patients. Subjects were consecutively included as they were monitored for nutritional status after Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD). Average follow-up time was 18 and 14 months for each protocol, respectively. After obesity surgery, a consistent and continuous decline in all carotenoids to almost undetectable levels occurs, especially in those who underwent BPD diversion who, on average, displayed serum levels about one half to one third of those found in RYGBP patients. The hypocarotenemia observed after bariatric surgery may compromise the availability of carotenoids to tissues and the vitamin A status, reducing the fat-soluble antioxidant capacity and constituting an additional risk factor for several clinical conditions. Given the emerging role of carotenoids in disease prevention, dietary advice on carotenoid-rich and fortified foods or the use of supplements in these patients should be considered.

  20. Evolution of surgery in advanced epithelial ovarian cancer in a dedicated gynaecologic oncology unit-seven year audit from a tertiary care centre in a developing country.

    Science.gov (United States)

    Rajanbabu, Anupama; Kuriakose, Santhosh; Ahmad, Sheikh Zahoor; Khadakban, Tejal; Khadakban, Dhiraj; Venkatesan, R; Vijaykumar, D K

    2014-01-01

    To audit our performance as a dedicated gynaecologic oncology unit and to analyse how it has evolved over the years.To retrospectively evaluate the outcome of advanced ovarian cancer treated with neoadjuvant chemotherapy (NACT) followed by interval surgery versus upfront surgery. One hundred and ninety-eight patients with advanced epithelial ovarian cancer (EOC) who were treated from 2004 to 2010 were analysed. Eighty-two patients (41.4%) underwent primary surgery and 116 (58.6%) received NACT. Overall, an optimal debulking rate of 81% was achieved with 70% for primary surgery and 88% following NACT. The optimal cytoreduction rate has improved from 55% in 2004 to 97% in 2010. In primary surgery, the optimal debulking rate increased from 42.8% in 2004 to 93% in 2010, whereas in NACT group the optimal cytoreduction rate increased from 60% to 100% by 2010. On the basis of the surgical complexity scoring system it was found that surgeries with intermediate complexity score had progressively increased over the years. There was a mean follow-up of 21 months ranging from 6 to 70 months. The progression-free survival and overall survival (OS) in patients undergoing primary surgery were 23 and 40 months, respectively, while it was 22 and 40 months in patients who received NACT. However, patients who had suboptimal debulking, irrespective of primary treatment, had significantly worse OS (26 versus 47 months) compared with those who had optimal debulking. As a dedicated gynaecologic oncology unit there has been an increase in the optimal cytoreduction rates. The number of complex surgeries, as denoted by the category of intermediate complexity score, has increased. Patients with advanced EOC treated with NACT followed by interval debulking have comparable survival to the patients undergoing primary surgery. Optimal cytoreduction irrespective of primary modality of treatment gives better survival.

  1. Pterygium surgery with conjunctival autograft and induced astigmatism in young men

    Directory of Open Access Journals (Sweden)

    Hüseyin Mayalı

    2012-09-01

    Full Text Available Objectives: To evaluate the results obtained from malesubjects who underwent pterygium surgery with conjunctivalautograft and to calculate the induced astigmatism.Materials and methods: Pterygium surgery with conjunctivalautograft was performed on 22 eyes of 20 subjectsdiagnosed with primary pterygium. If pterygium caused avision problem or approached the pupil level, and if surgerywas requested from the individuals for cosmetic reasons,the decision to operate was made. Patients who underwentany ocular surgery, have ocular surface disease,eyelid problems or systemic disease were not includedin the study. A complete ophthalmologic examination wasperformed before surgery, at one month following the surgery,and during the final controls. Induced astigmatismwas calculated by using refractive parameters and VectorialAnalysis Program.Results: Twenty-two eyes of 20 subjects were included inthe study. Mean age was 22.50 ± 4.15 (20-39 years. Allsubjects included in the study were male patients. Of the22 eyes, 14 were right and 8 were left eyes. In the evaluationsof visual acuity and intraocular pressure values preandpost- surgery, no statistical significance was detected(p=0.142, p=0.831. During the surgery, relapse was detectedin 4 eyes (18% and conjunctival granuloma (9%was detected in 2 eyes. Following the surgery, arithmeticaverage of the induced astigmatisms at 1st month was0.91±1.19 D; against-the-rule astigmatism was detectedin nearly 60% of the eyes. The subjects were followed upfor 93.59±36.47 days after the surgery.Conclusions: In primary pterygium subjects of youngage, surgery with conjunctival autograft was consideredas a preferable method due to its low number of relapseand complications, as well as absence of any adverse effecton visual acuity.Key words: Astigmatism, pterygium, young adult

  2. Clinical outcome and prognostic factors of primary gastric mucosa-associated lymphoid tissue lymphoma: a retrospective analysis of 77 cases

    International Nuclear Information System (INIS)

    Wang Shulian; Song Yongwen; Jin Jing; Wang Weihu; Liu Yueping; Liu Xinfan; Yu Zihao; Li Yexiong; Xue Liyan; Lv Ning

    2009-01-01

    Objective: To analyze the clinical results and prognostic factors of patients with early-stage primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: Seventy-seven patients with primary gastric MALT lymphoma treated from 1985 to 2006 were retrospectively analyzed. All patients were pathologically confirmed as MALT lymphoma in stage I, II and II E (by modified Blackedge staging system). Thirty-seven patients had stage I disease, 23 stage II and 17 stage II E . Sixty patients underwent surgical resection and 17 received non-surgical treatment. Survival rates were calculated by the Kaplan-Meier analysis with the Logrank test. Results: With a median follow up of 57 months for the surviving patients (ranging from 1 to 198 months for all patients), the 5-year overall survival rate, disease-free survival rate, loco-regional control rate and distant metastasis free survival rate were 74%, 70%, 76% and 87%, respectively. In univariate analysis, clinical stage was significantly associated with overall survival. Patients with stage I or II disease had a better overall survival than those with stage II E (P=0.01). Tumor size and surgical resection were significantly associated with disease-free survival. Patients with primary tumor 8 cm or less in diameter had better disease-free survival than those with primary tumor more than 8 cm in diameter (P =0.03). Patients who underwent complete resection had better disease-free survival than those who underwent incomplete resection or no surgery (P=0.02). Clinical stage, tumor size and surgical resection were significantly associated with loco-regional control. Patients with stage I or II disease had better loco-regional control than those with stage II E (P=0.03). Patients with primary tumor 8 cm or less in diameter had better loco-regional control than those with primary tumor more than 8 cm in diameter (P=0.01). Patients who underwent complete resection had better loco-regional control than those who underwent

  3. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  6. [Prognostic Analysis of Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy Using QOL-ACD].

    Science.gov (United States)

    Fukui, Yasuhiro; Kashiwagi, Shinichiro; Takada, Koji; Goto, Wataru; Asano, Yuka; Morisaki, Tamami; Noda, Satoru; Takashima, Tsutomu; Onoda, Naoyoshi; Hirakawa, Kosei; Ohira, Masaichi

    2017-11-01

    We investigated into association of quality of life(QOL)and prognosis of breast cancer patients who underwent neoadjuvant chemotherapy(NAC). We retrospectively studied 228 patients with breast cancer who were performed NAC during a period between 2007 and 2015. TheQ OL score was measured with"The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs(QOL-ACD)". We evaluate association between QOL score with antitumor effect and prognosis. Changes in the QOL score between before and after NAC were compared as well. We divided 2 groups by QOL-ACD scoreinto high and low groups. Therapeautic effect of NAC on 75 patients were pathological complete response(pCR). QOL-ACD score was not significantly associated with pCR rate in both high and low groups(p=0.199). High group was significantly associated with higher survival rate in both of disease free survival(p=0.009, logrank)and overall survival(p=0.040, logrank). QOLACD score decreased after NAC in both of pCR and non-pCR patients. In conclusion, QOL evaluation using QOL-ACD could be an indicator of breast cancer patients' prognosis who underwent NAC.

  7. HLA-G regulatory haplotypes and implantation outcome in couples who underwent assisted reproduction treatment.

    Science.gov (United States)

    Costa, Cynthia Hernandes; Gelmini, Georgia Fernanda; Wowk, Pryscilla Fanini; Mattar, Sibelle Botogosque; Vargas, Rafael Gustavo; Roxo, Valéria Maria Munhoz Sperandio; Schuffner, Alessandro; Bicalho, Maria da Graça

    2012-09-01

    The role of HLA-G in several clinical conditions related to reproduction has been investigated. Important polymorphisms have been found within the 5'URR and 3'UTR regions of the HLA-G promoter. The aim of the present study was to investigate 16 SNPs in the 5'URR and 14-bp insertion/deletion (ins/del) polymorphism located in the 3'UTR region of the HLA-G gene and its possible association with the implantation outcome in couples who underwent assisted reproduction treatments (ART). The case group was composed of 25 ART couples. Ninety-four couples with two or more term pregnancies composed the control group. Polymorphism haplotype frequencies of the HLA-G were determined for both groups. The Haplotype 5, Haplotype 8 and Haplotype 11 were absolute absence in ART couples. The HLA-G*01:01:02a, HLA-G*01:01:02b alleles and the 14-bp ins polymorphism, Haplotype 2, showed an increased frequency in case women and similar distribution between case and control men. However, this susceptibility haplotype is significantly presented in case women and in couple with failure implantation after treatment, which led us to suggest a maternal effect, associated with this haplotype, once their presence in women is related to a higher number of couples who underwent ART. Copyright © 2012. Published by Elsevier Inc.

  8. 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.

  9. Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

    Directory of Open Access Journals (Sweden)

    Ai-Yun Shen

    2016-10-01

    Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

  10. Bariatric surgery insurance requirements independently predict surgery dropout.

    Science.gov (United States)

    Love, Kaitlin M; Mehaffey, J Hunter; Safavian, Dana; Schirmer, Bruce; Malin, Steven K; Hallowell, Peter T; Kirby, Jennifer L

    2017-05-01

    Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; Psurgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, Psurgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  11. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study.

    Science.gov (United States)

    Kim, Jong Wan; Kim, Jeong Yeon; Kang, Byung Mo; Lee, Bong Hwa; Kim, Byung Chun; Park, Jun Ho

    2016-01-01

    The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer. We conducted a retrospective review of patients who underwent surgery for transverse colon cancer at six Hallym University-affiliated hospitals between January 2005 and June 2015. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery. Of 226 patients with transverse colon cancer, 103 underwent laparoscopic surgery and 123 underwent open surgery. There were no differences in the patient characteristics between the two groups. Regarding perioperative outcomes, the operation time was significantly longer in the laparoscopic group than in the open group (267.3 vs 172.7 minutes, Ptransverse colon cancer. Therefore, laparoscopic surgery offers a safe alternative to open surgery in patients with transverse colon cancer.

  12. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature.

    Science.gov (United States)

    Hershman, Stuart H; Kunkle, William A; Kelly, Michael P; Buchowski, Jacob M; Ray, Wilson Z; Bumpass, David B; Gum, Jeffrey L; Peters, Colleen M; Singhatanadgige, Weerasak; Kim, Jin Young; Smith, Zachary A; Hsu, Wellington K; Nassr, Ahmad; Currier, Bradford L; Rahman, Ra'Kerry K; Isaacs, Robert E; Smith, Justin S; Shaffrey, Christopher; Thompson, Sara E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Multicenter retrospective case series and review of the literature. To determine the rate of esophageal perforations following anterior cervical spine surgery. As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients' charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality.

  13. Formal analysis of the surgical pathway and development of a new software tool to assist surgeons in the decision making in primary breast surgery.

    Science.gov (United States)

    Catanuto, Giuseppe; Pappalardo, Francesco; Rocco, Nicola; Leotta, Marco; Ursino, Venera; Chiodini, Paolo; Buggi, Federico; Folli, Secondo; Catalano, Francesca; Nava, Maurizio B

    2016-10-01

    The increased complexity of the decisional process in breast cancer surgery is well documented. With this study we aimed to create a software tool able to assist patients and surgeons in taking proper decisions. We hypothesized that the endpoints of breast cancer surgery could be addressed combining a set of decisional drivers. We created a decision support system software tool (DSS) and an interactive decision tree. A formal analysis estimated the information gain derived from each feature in the process. We tested the DSS on 52 patients and we analyzed the concordance of decisions obtained by different users and between the DSS suggestions and the actual surgery. We also tested the ability of the system to prevent post breast conservation deformities. The information gain revealed that patients preferences are the root of our decision tree. An observed concordance respectively of 0.98 and 0.88 was reported when the DSS was used twice by an expert operator or by a newly trained operator vs. an expert one. The observed concordance between the DSS suggestion and the actual decision was 0.69. A significantly higher incidence of post breast conservation defects was reported among patients who did not follow the DSS decision (Type III of Fitoussi, N = 4; 33.3%, p = 0.004). The DSS decisions can be reproduced by operators with different experience. The concordance between suggestions and actual decision is quite low, however the DSS is able to prevent post- breast conservation deformities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Parental education predicts change in intelligence quotient after childhood epilepsy surgery.

    Science.gov (United States)

    Meekes, Joost; van Schooneveld, Monique M J; Braams, Olga B; Jennekens-Schinkel, Aag; van Rijen, Peter C; Hendriks, Marc P H; Braun, Kees P J; van Nieuwenhuizen, Onno

    2015-04-01

    To know whether change in the intelligence quotient (IQ) of children who undergo epilepsy surgery is associated with the educational level of their parents. Retrospective analysis of data obtained from a cohort of children who underwent epilepsy surgery between January 1996 and September 2010. We performed simple and multiple regression analyses to identify predictors associated with IQ change after surgery. In addition to parental education, six variables previously demonstrated to be associated with IQ change after surgery were included as predictors: age at surgery, duration of epilepsy, etiology, presurgical IQ, reduction of antiepileptic drugs, and seizure freedom. We used delta IQ (IQ 2 years after surgery minus IQ shortly before surgery) as the primary outcome variable, but also performed analyses with pre- and postsurgical IQ as outcome variables to support our findings. To validate the results we performed simple regression analysis with parental education as the predictor in specific subgroups. The sample for regression analysis included 118 children (60 male; median age at surgery 9.73 years). Parental education was significantly associated with delta IQ in simple regression analysis (p = 0.004), and also contributed significantly to postsurgical IQ in multiple regression analysis (p = 0.008). Additional analyses demonstrated that parental education made a unique contribution to prediction of delta IQ, that is, it could not be replaced by the illness-related variables. Subgroup analyses confirmed the association of parental education with IQ change after surgery for most groups. Children whose parents had higher education demonstrate on average a greater increase in IQ after surgery and a higher postsurgical--but not presurgical--IQ than children whose parents completed at most lower secondary education. Parental education--and perhaps other environmental variables--should be considered in the prognosis of cognitive function after childhood epilepsy

  15. Socioeconomic status, immigration/acculturation, and ethnic variations in breast conserving surgery, San Francisco Bay area.

    Science.gov (United States)

    Gomez, Scarlett L; France, Anne-Marie; Lee, Marion M

    2004-01-01

    Previous studies have demonstrated substantial variations in breast conserving surgery (BCS) across sociodemographic groups. This study explored the joint influences of socioeconomic, immigration/acculturation, and clinical factors on ethnic differences in breast cancer surgery for early-stage disease. The study used interview data for 297 women, under the age of 70, who resided in the San Francisco Bay area, and had been diagnosed with primary early-stage breast cancer (carcinoma in-situ or invasive) between January 1990 and December 1992. The proportion of patients who either had undergone BCS or had no surgery was 45%, 20%, 45%, and 34%, among Whites, Chinese, Blacks, and Hispanics, respectively. The proportion of patients diagnosed at in-situ or localized stages, with tumors of less than 4 centimeters, was higher among those who received BCS or no surgery, compared to those who had undergone a mastectomy. White women who received BCS/no surgery tended to be younger than their counterparts who underwent mastectomies, but Chinese and Black women who received BCS/no surgery were older. The proportion of women diagnosed in smaller, private hospitals was higher among those receiving BCS/no surgery, although these associations varied by ethnicity. Women who had undergone BCS/no surgery were characterized as being of higher socioeconomic status, more acculturated, and less likely to be recent immigrants. In a multivariate regression model adjusting for clinical, socioeconomic, and immigration/acculturation factors, Chinese women were more likely than Whites to have a mastectomy, rather than BCS/no surgery (odds ratio, 2.8; 95% confidence interval, 1.0-7.8). Use of BCS or no surgery was associated with various clinical, socioeconomic, and immigration/acculturation characteristics, although some of the associations varied by ethnicity. However, these factors did not account for the reduced presence of BCS, or no surgery, among Chinese women.

  16. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

    Science.gov (United States)

    Adibi, Atoosa; Nouri, Shadi; Moradi, Maryam; Shahabi, Javad

    2016-01-01

    Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE) who underwent computed tomography pulmonary angiography (CTPA). Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells’ criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results. Results: PTE was diagnosed in 53 (17.1%) of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05). Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05). Frequency of all criteria of Wells’ criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05). The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05). Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences. PMID:28255326

  17. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

    Directory of Open Access Journals (Sweden)

    Atoosa Adibi

    2016-01-01

    Full Text Available Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE who underwent computed tomography pulmonary angiography (CTPA. Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells' criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results. Results: PTE was diagnosed in 53 (17.1% of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05. Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05. Frequency of all criteria of Wells' criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05. The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05. Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences.

  18. Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery.

    Science.gov (United States)

    Schneider, Christian; Ramaswamy, Vijay; Kulkarni, Abhaya V; Rutka, James T; Remke, Marc; Tabori, Uri; Hawkins, Cynthia; Bouffet, Eric; Taylor, Michael D

    2015-03-01

    While medulloblastoma was initially thought to comprise a single homogeneous entity, it is now accepted that it in fact comprises 4 discrete subgroups, each with its own distinct demographics, clinical presentation, transcriptomics, genetics, and outcome. Hydrocephalus is a common complication of medulloblastoma and not infrequently requires CSF diversion. The authors report the incidence of CSF diversion surgery in each of the subgroups of medulloblastoma (Wnt, Shh, Group 3, and Group 4). The medical and imaging records for patients who underwent surgery for medulloblastoma at The Hospital for Sick Children were retrospectively reviewed. The primary outcome was the requirement for CSF diversion surgery either before or within 60 days of tumor resection. The modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) was compared among subgroups. Of 143 medulloblastoma patients, treated from 1991 to 2013, sufficient data were available for 130 patients (15 with Wnt, 30 with Shh, 30 with Group 3, and 55 with Group 4 medulloblastomas). Of these, 28 patients (22%) ultimately underwent CSF diversion surgery: 0% with Wnt, 29% with Shh, 29% with Group 3, and 43% with Group 4 tumors. Patients in the Wnt subgroup had a lower incidence of CSF diversion than all other patients combined (p = 0.04). Wnt patients had a lower mCPPRH score (lower risk of CSF diversion, p = 0.045), were older, had smaller ventricles at diagnosis, and had no leptomeningeal metastases. The overall rate of CSF diversion surgery for Shh, Group 3, and Group 4 medulloblastomas is around 30%, but no patients in the present series with a Wnt medulloblastoma required shunting. The low incidence of hydrocephalus in patients with Wnt medulloblastoma likely reflects both host factors (age) and disease factors (lack of metastases). The absence of hydrocephalus in patients with Wnt medulloblastomas likely contributes to their excellent rate of survival and may also contribute to a higher quality

  19. Enteral nutrition is superior to total parenteral nutrition for pancreatic cancer patients who underwent pancreaticoduodenectomy.

    Science.gov (United States)

    Liu, Changli; Du, Zhi; Lou, Cheng; Wu, Chenxuan; Yuan, Qiang; Wang, Jun; Shu, Guiming; Wang, Yijun

    2011-01-01

    To determine the effects of total parenteral nutrition (TPN) and enteral nutrition (EN) on biochemical and clinical outcomes in pancreatic cancer patients who underwent pancreaticoduodenectomy. From the year 2006 to 2008, 60 patients who underwent pancreaticoduodenectomy in Tianjin Third Central Hospital were enrolled in this study. They were randomly divided into the EN group and the TPN group. The biochemical and clinical parameters were recorded and analyzed between the two groups. There was no significant difference in the nutritional status, liver and kidney function, and blood glucose levels between the TPN and EN groups on the preoperative day, the 1st and 3 rd postoperative days. However, on the 7th postoperative day, there was significant difference between the two groups in 24 h urinary nitrogen, serum levels of, total protein (TP), transferrin (TF), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transpeptadase (GGT), blood urea nitrogen (BUN) and creatinine (Cr). On the 14th postoperative day, there was a significant difference between the two groups in terms of urinary levels of 24 h nitrogen, TP, TF, retinol binding protein, ALT, AST, ALP, GGT, total bilirubin, direct bilirubin, BUN, Cr, and glucose. The incidence of delayed gastric emptying in the EN and TPN groups was 0% and 20%, respectively. Moreover, the incidence of pancreatic fistulas and hemorrhages in the EN group were 3.6% and 3.6%, versus 26.7% and 30% in the TPN group, respectively. EN is better than TPN for pancreatic cancer patients who received pancreaticoduodenectomy.

  20. Unaugmented vertical muscle transposition surgery for chronic sixth nerve paralysis.

    Science.gov (United States)

    Bansal, Shveta; Khan, Javeed; Marsh, Ian B

    2006-12-01

    Chronic sixth nerve palsy can cause incapacitating diplopia requiring vertical muscle transposition surgery. Augmentation of surgery, with lateral fixation sutures, medial rectus recession or botulinum toxin injection, is associated with an increased risk of complications. Our aim was to evaluate the efficacy and safety of unaugmented full-tendon vertical rectus transposition in chronic sixth nerve paralysis. Longitudinal study of 21 patients with chronic sixth nerve paralysis of longer than 6 months duration, who underwent superior and inferior recti transposition surgery without medial rectus recession or botulinum toxin injection. Details of surgery, preoperative and postoperative examinations including full orthoptic examination were obtained from an electronic database. Outcomes included the change in angle of deviation, the requirement for further surgery to the medial rectus and postoperative improvement in diplopia. SPSS software (Version 12.0.1, SPSS Inc. Chicago, IL) was used to summarize baseline characteristics and outcomes and to compare preoperative and postoperative deviation (paired t-test). Twenty-one patients (10 (47.6%) men and 11 (52.4%) women) with a mean age of 41 years (range 4 to 74 years) were operated in the period between April 1998 and November 2000. Eighteen patients had unilateral and three had bilateral acquired sixth nerve palsy. Nineteen patients required unilateral surgery and two had bilateral transposition procedures. In patients with unilateral sixth nerve palsy, mean esotropia in primary position before surgery was 46.7 prism-diopters (PD) (95% CI 35.9-57.4 PD) and improved to 14.6 PD after surgery (95% CI 6.4-22.7 PD). The angle of deviation was significantly reduced by an average of 32.1 PD (p < 0.001, paired t-test; 95% CI 22.6-41.6 PD). Over all, 10 patients (55.6%) had a well-controlled esophoria with a postoperative alignment of within 10 PD of orthophoria without diplopia in the primary position, for distance and near. A

  1. Microvascular reconstruction and tracheotomy are significant determinants of resource utilization in head and neck surgery.

    Science.gov (United States)

    Cohen, J; Stock, M; Chan, B; Meininger, M; Wax, M; Andersen, P; Everts, E

    2000-08-01

    Successful "critical pathway" design and implementation are dependent on appropriate patient stratification according to those factors that are primary determinants of resource utilization. To test the validity of our previously reported critical pathway design and to determine whether tracheotomy and microvascular reconstruction (MR) are primary determinants of resource utilization. Cost-effectiveness analysis. Tertiary referral academic institution. Retrospective analysis of data from 133 head and neck surgery cases in which the treatment regimen was based on critical pathways over a 26-month period. Length of stay and total patient charges were used as indices of resource utilization. One-way analysis of variance and t tests were used for statistical analysis of significance. Ninety patients (67.7%) underwent MR; 43 (32. 3%) did not. Seventy-five patients (56.4%) underwent tracheotomy; 58 (43.6%) did not. Four patient groups were constructed in decreasing order of complexity as follows: group 1, patients who underwent both tracheotomy and MR (n = 58); group 2, patients who underwent MR alone (n = 32); group 3, patients who underwent tracheotomy alone (n = 17); and group 4, patients who did not undergo either procedure (n = 26). Both tracheotomy and MR were found to be independent determinants of resource utilization and were additive when both were present. The length of stay varied from 8.4 days (in patients who underwent both procedures) to 6.7 days (in patients who did not undergo either procedure), with intermediate values in cases in which only 1 procedure was performed. The total charges varied in a similar manner from a high of $33,371 to a low of $19,994. Subanalysis with respect to intensive care unit, ward, and operating room charges showed a similar stratification. Tracheotomy and MR are both significant determinants of charges and length of stay in head and neck surgery cases and must be considered in the design of strategies to promote efficient

  2. The role of minimally invasive spine surgery in the management of pyogenic spinal discitis

    Science.gov (United States)

    Turel, Mazda K; Kerolus, Mena; Deutsch, Harel

    2017-01-01

    Background: Diagnostic yields for spondylodiscitis from CT guided biopsy is low. In the recent years, minimally invasive surgery (MIS) has shown to have a low morbidity and faster recovery. For spinal infections, MIS surgery may offer an opportunity for early pain control while obtaining a higher diagnostic yield than CT-guided biopsies. The aim of this study was to review our patients who underwent MIS surgery for spinal infection and report outcomes. Methods: A retrospective review of seven patients who underwent MIS decompression and/or discectomy in the setting of discitis, osteomyelitis, spondylodiscitis, and/or an epidural abscess was identified. Patient data including symptoms, visual analog score (VAS), surgical approach, antibiotic regimen, and postoperative outcomes were obtained. Results: Of the 7 patients, 5 patients had lumbar infections and two had thoracic infections. All seven patients improved in VAS immediately after surgery and at discharge. The average VAS improved by 4.4 ± 1.9 points. An organism was obtained in 6 of the 7 (85%) patients by the operative cultures. All patients made an excellent clinical recovery without the need for further spine surgery. All patients who received postoperative imaging on follow-up showed complete resolution or dramatically improved magnetic resonance imaging changes. The follow-up ranged from 2 to 9 months. Conclusions: MIS surgery provides an opportunity for early pain relief in patients with discitis, osteomyelitis, spondylodiscitis, and/or epidural abscess by directly addressing the primary cause of pain. MIS surgery for discitis provides a higher diagnostic yield to direct antibiotic treatment. MIS surgery results in good long-term recovery. PMID:28250635

  3. Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy.

    Science.gov (United States)

    Chareancholvanich, Keerati; Pornrattanamaneewong, Chaturong; Narkbunnam, Rapeepat

    2014-06-01

    High tibial osteotomy (HTO) is a surgical procedure used to correct abnormal mechanical loading of the knee joint; additionally, intra-articular hyaluronic acid injections have been shown to restore the viscoelastic properties of synovial fluid and balance abnormal biochemical processes. It was hypothesized that combining HTO with intra-articular hyaluronic acid injections would have benefit to improve the cartilage volume of knee joints. Forty patients with medial compartment knee osteoarthritis (OA) were randomly placed into 1 of 2 groups. The study group (n = 20) received 2 cycles (at 6-month intervals) of 5 weekly intra-articular hyaluronic acid injections after HTO operation. The control group (n = 20) did not receive any intra-articular injections after HTO surgery. Cartilage volume (primary outcome) was assessed by magnetic resonance imaging (MRI) pre-operatively and 1 year post-operatively. Treatment efficacy (secondary outcomes) was evaluated with the Western Ontario and McMaster Universities OA Index (WOMAC) and by the comparison of the total rescue medication (paracetamol/diclofenac) used (weeks 6, 12, 24, 48). MRI studies showed a significant increase in total cartilage volume (p = 0.033), lateral femoral cartilage volume (p = 0.044) and lateral tibial cartilage volume (p = 0.027) in the study group. Cartilage volume loss was detected at the lateral tibial plateau in the control group. There were significant improvements after surgery in both groups for all subscales of WOMAC scores (p hyaluronic acid injections may be beneficial for increasing total cartilage volume and preventing the loss of lateral tibiofemoral joint cartilage after HTO. Therapeutic study, Level I.

  4. Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study.

    Science.gov (United States)

    Tolboom, Robert C; Draaisma, Werner A; Broeders, Ivo A M J

    2016-03-01

    Surgery for refractory gastroesophageal reflux disease (GERD) and hiatal hernia leads to recurrence or persisting dysphagia in a minority of patients. Redo antireflux surgery in GERD and hiatal hernia is known for higher morbidity and mortality. This study aims to evaluate conventional versus robot-assisted laparoscopic redo antireflux surgery, with the objective to detect possible advantages for the robot-assisted approach. A single institute cohort of 75 patients who underwent either conventional laparoscopic or robot-assisted laparoscopic redo surgery for recurrent GERD or severe dysphagia between 2008 and 2013 were included in the study. Baseline characteristics, symptoms, medical history, procedural data, hospital stay, complications and outcome were prospectively gathered. The main indications for redo surgery were dysphagia, pyrosis or a combination of both in combination with a proven anatomic abnormality. The mean time to redo surgery was 1.9 and 2.0 years after primary surgery for the conventional and robot-assisted groups, respectively. The number of conversions was lower in the robot-assisted group compared to conventional laparoscopy (1/45 vs. 5/30, p = 0.035) despite a higher proportion of patients with previous surgery by laparotomy (9/45 vs. 1/30, p = 0.038). Median hospital stay was reduced by 1 day (3 vs. 4, p = 0.042). There were no differences in mortality, complications or outcome. Robotic support, when available, can be regarded beneficial in redo surgery for GERD and hiatal hernia. Results of this observational study suggest technical feasibility for minimal-invasive robot-assisted redo surgery after open primary antireflux surgery, a reduced number of conversions and shorter hospital stay.

  5. Adding pregabalin to a multimodal analgesic regimen does not reduce pain scores following cosmetic surgery: a randomized trial.

    Science.gov (United States)

    Chaparro, Luis Enrique; Clarke, Hance; Valdes, Paola A; Mira, Mauricio; Duque, Lorena; Mitsakakis, Nicholas

    2012-12-01

    Multimodal analgesia increases the chance of successful discharge and pain control after surgery, and pregabalin is being promoted as an effective analgesic, based on placebo-controlled studies. We investigated whether adding pregabalin improved pain control and reduced opioid requests when it was added to a multimodal analgesic regimen for cosmetic surgery. One hundred and ten women who underwent same-day cosmetic surgery were randomized to receive oral pregabalin, 75 mg q12 h for five consecutive days starting the night before surgery, or identical placebos. Participants, outcomes assessors, and the statistician were blinded. The primary outcome was postoperative numerical movement-evoked pain scores at 2, 24, 48, 72, and 96 h after surgery. The secondary outcomes included pain scores at rest; incidence of moderate to severe pain; and analgesic and antiemetic requirements; as well as the incidence of nausea, vomiting, and somnolence. Based on 99 patients who completed the study, we found no difference between the groups in the primary outcome; 72 h after surgery, movement-evoked median pain scores were cosmetic surgery. Several factors could explain our findings, including the possibility of publication bias in the current literature.

  6. Overproduction of an amino-terminal form of PTH distinct from human PTH(1-84) in a case of severe primary hyperparathyroidism: influence of medical treatment and surgery.

    Science.gov (United States)

    Räkel, Agnès; Brossard, Jean-Hugues; Patenaude, Jean-Victor; Albert, Caroline; Nassif, Edgard; Cantor, Tom; Rousseau, Louise; D'Amour, Pierre

    2005-06-01

    Rare patients with severe primary hyperparathyroidism present with large parathyroid tumours, severe hypercalcaemia, very high PTH levels and osteitis fibrosa cystica. Some of these patients display a large amount of C-PTH fragments in circulation and present with a higher C-PTH/I-PTH ratio than seen in less severe cases of primary hyperparathyroidism. We wanted to determine how PTH levels and circulating PTH high-performance liquid chromatography (HPLC) profiles analysed with PTH assays having different epitopes could be affected by medical and surgical treatment in such patients. A 55-year-old man with severe hypercalcaemia (Ca(2+): 2.01 mmol/l), very high PTH levels (CA-PTH 82.1 and T-PTH 72 pmol/l) caused by a large parathyroid tumour (7.35 g) and accompanied by significant bone involvement (alkaline phosphatase of 185 UI/l and subperiostal bone resorption of hands) was referred to us. Blood was obtained at various time points during his medical treatment, before and after surgery, to measure parameters of calcium and phosphorus metabolism, and of bone turnover. HPLC separations of circulating PTH molecular forms were performed and analysed with PTH assays having 1-4 (CA), 12-18 (T), 26-32 (E) and 65-84 (C) epitopes. Before surgery, serum Ca2+ was nearly normalized with hydratation, intravenous (IV) pamidronate and oral vitamin D administration. Despite a decrease in Ca2+ to 1.31 mmol/l, CA-PTH and T-PTH levels decreased by half in relation to a threefold increase in basal 1,25-dihydroxyvitamin D [1,25(OH)2D] level (94 to 337 pmol/l). After this initial positive response, hypercalcaemia and elevated CA- and T-PTH levels recurred even if 1,25(OH)2D levels remained elevated. The tumour was removed surgically and proved to be poorly differentiated with nuclear atypia and mitosis. After surgery, the Ca2+ level and PTH secretion normalized. The higher CA-PTH level relative to the T-PTH level observed before surgery in this patient was related to the oversecretion of

  7. Hemorrhoid surgery

    Science.gov (United States)

    ... surgery. Hemorrhoid surgery may involve: Putting a small rubber band around a hemorrhoid to shrink it by blocking blood flow. Stapling a hemorrhoid to block blood flow, causing it to shrink. Using a ...

  8. Plastic Surgery

    Science.gov (United States)

    ... idea for teens? As with everything, there are right and wrong reasons to have surgery. Cosmetic surgery is unlikely to change your life. Most board-certified plastic surgeons spend a lot of time ... the right reasons. Many plastic surgery procedures are just that — ...

  9. Patient participation in free cataract surgery: a cross-sectional study of the low-income elderly in urban China.

    Science.gov (United States)

    Lin, Haotian; Lin, Duoru; Long, Erping; Jiang, Haofeng; Qu, Bo; Tang, Jinzhu; Lin, Yingfen; Chen, Jingjing; Wu, Xiaohang; Lin, Zhuoling; Li, Xiaoyan; Liu, Zhenzhen; Zhang, Bo; Chen, Hui; Tan, Xuhua; Luo, Lixia; Liu, Yizhi; Chen, Weirong

    2016-04-15

    To explore the characteristics of the low-income elderly who underwent free cataract surgery and to determine the degree of patient satisfaction with the free cataract surgery programme in urban China. A free cataract surgery management workflow was designed as a poverty relief project in Guangzhou. In this study, participants who underwent free cataract surgery between January and August 2014 received a telephone interview based on a structured questionnaire. Data were collected on patient demographics, resources, health conditions, reasons for undergoing the free surgery and overall evaluation of the free cataract surgery programme. Among the 833 participants, the mean surgical age was 76.85±7.46 years (95% CI 76.34 to 77.36), and the male to female ratio was 385:448. The majority (94.31%, 746/791) of patients resided in the main urban districts. Patients underwent surgery 61.08±60.15 months (95% CI 56.17 to 66.00) after becoming aware of the cataract, although 66.83% of them reported that their daily lives were influenced by cataracts. Only 21.5% of the respondents underwent physical examinations that included regular eye screening, and only 6.30% were highly educated patients. Financial problems were the primary reason cited by patients for participating in the free surgery programme. Those patients with a monthly family income of 1000-2999¥ (US$161-482) per capita constituted the largest patient population. The free clinics in the parks and the free cataract surgery were highly rated (9.46 and 9.11 of 10 points) by the beneficiaries. The telephone survey revealed a high level of patient satisfaction regarding the free cataract surgery programme. Most of the patients who participated in the programme resided in major urban districts and had poor health awareness and a low level of education. The information provided by this study is crucial for improving and expanding the management of free cataract surgery programmes. NCT02633865; Post

  10. Reoperation rate after surgery for lumbar spinal stenosis without spondylolisthesis: a nationwide cohort study.

    Science.gov (United States)

    Kim, Chi Heon; Chung, Chun Kee; Park, Choon Seon; Choi, Boram; Hahn, Seokyung; Kim, Min Jung; Lee, Kun Sei; Park, Byung Joo

    2013-10-01

    Lumbar spinal stenosis is one of the most common degenerative spine diseases. Surgical options are largely divided into decompression only and decompression with arthrodesis. Recent randomized trials showed that surgery was more effective than nonoperative treatment for carefully selected patients with lumbar stenosis. However, some patients require reoperation because of complications, failure of bony fusion, persistent pain, or progressive degenerative changes, such as adjacent segment disease. In a previous population-based study, the 10-year reoperation rate was 17%, and fusion surgery was performed in 10% of patients. Recently, the lumbar fusion surgery rate has doubled, and a substantial portion of the reoperations are associated with a fusion procedure. With the change in surgical trends, the longitudinal surgical outcomes of these trends need to be reevaluated. To provide the longitudinal reoperation rate after surgery for spinal stenosis and to compare the reoperation rates between decompression and fusion surgeries. Retrospective cohort study using national health insurance data. A cohort of patients who underwent initial surgery for lumbar stenosis without spondylolisthesis in 2003. The primary end point was any type of second lumbar surgery. Cox proportional hazards regression modeling was used to compare the adjusted reoperation rates between decompression and fusion surgeries. A national health insurance database was used to identify a cohort of patients who underwent an initial surgery for lumbar stenosis without spondylolisthesis in 2003; a total of 11,027 patients were selected. Individual patients were followed for at least 5 years through their encrypted unique resident registration number. After adjusting for confounding factors, the reoperation rates for decompression and fusion surgery were compared. Fusion surgery was performed in 20% of patients. The cumulative reoperation rate was 4.7% at 3 months, 7.2% at 1 year, 9.4% at 2 years, 11.2% at

  11. HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

    Directory of Open Access Journals (Sweden)

    R. Sh. Saitgareev

    2016-01-01

    Full Text Available Heart Transplantation (HTx to date remains the most effective and radical method of treatment of patients with end-stage heart failure. The defi cit of donor hearts is forcing to resort increasingly to the use of different longterm mechanical circulatory support systems, including as a «bridge» to the follow-up HTx. According to the ISHLT Registry the number of recipients underwent cardiopulmonary bypass surgery increased from 40% in the period from 2004 to 2008 to 49.6% for the period from 2009 to 2015. HTx performed in repeated patients, on the one hand, involves considerable technical diffi culties and high risks; on the other hand, there is often no alternative medical intervention to HTx, and if not dictated by absolute contradictions the denial of the surgery is equivalent to 100% mortality. This review summarizes the results of a number of published studies aimed at understanding the immediate and late results of HTx in patients, previously underwent open heart surgery. The effect of resternotomy during HTx and that of the specifi c features associated with its implementation in recipients previously operated on open heart, and its effects on the immediate and long-term survival were considered in this review. Results of studies analyzing the risk factors for perioperative complications in repeated recipients were also demonstrated. Separately, HTx risks after implantation of prolonged mechanical circulatory support systems were examined. The literature does not allow to clearly defi ning the impact factor of earlier performed open heart surgery on the course of perioperative period and on the prognosis of survival in recipients who underwent HTx. On the other hand, subject to the regular fl ow of HTx and the perioperative period the risks in this clinical situation are justifi ed as a long-term prognosis of recipients previously conducted open heart surgery and are comparable to those of patients who underwent primary HTx. Studies

  12. ERα and ERβ expression in correlation with Ki-67, Bcl-2 and Bak in primary tumors and lymph node metastases of breast cancer: The effect of pre-operative chemotherapy

    OpenAIRE

    KANCZUGA-KODA, LUIZA; KODA, MARIUSZ; TOMASZEWSKI, JAKUB; JARZABEK, KATARZYNA; LOTOWSKA, JOANNA; BALTAZIAK, MAREK; SULKOWSKA, URSZULA; SOBANIEC-LOTOWSKA, MARIA; SULKOWSKI, STANISŁAW

    2010-01-01

    This study aimed to assess the pre-operative chemotherapy impact on the relationship between estrogen receptor (ER) expression and markers of proliferation and apoptosis in primary and metastatic breast cancer. Immunohistochemical examinations were conducted on surgically removed ductal invasive breast cancers and their lymph node metastases in 135 patients. A total of 64 patients from this group underwent pre-operative chemotherapy and in 71 cases the surgery was performed without primary ch...

  13. Assessment of quality of life in patients who underwent minimally invasive cosmetic procedures.

    Science.gov (United States)

    de Aquino, Marcello Simão; Haddad, Alessandra; Ferreira, Lydia Masako

    2013-06-01

    There are increasingly more patients seeking minimally invasive procedures, which have become more effective and safer in reducing the signs of facial aging. This study included 40 female adult patients who voluntarily underwent selected minimally invasive procedures (filling with hyaluronic acid and botulinum toxin injection) for facial rejuvenation. All patients were followed for a period of 6 months. They were evaluated with the use of questionnaires, a quality-of-life questionnaire (DLQI), the self-esteem scale of Rosenberg (EPM/Rosenberg), and a pain scale. The minimally invasive procedures resulted in improvement in quality of life and self-esteem, which were stronger the first 3 months after the procedures but remained at a higher level than that before treatment, even after 6 months. Hyaluronic acid with lidocaine in the formula is more comfortable for the patient as it makes the injection less painful. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  14. Stress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment.

    Science.gov (United States)

    Cheng, Ching-Yu; Stevenson, Eleanor Lowndes; Yang, Cheng-Ta; Liou, Shwu-Ru

    2018-04-28

    To describe the psychological stress and quality of life experienced by women who underwent fertility treatment in Taiwan. Cross-sectional, correlational study. Recruitment was conducted and questionnaires administered at a reproductive medicine center in Chiayi City, Taiwan. Informed consent to participate was obtained from 126 women who sought fertility treatment at the center. The Chinese Fertility Problem Inventory and Fertility Quality of Life scale were used to measure participants' levels of fertility-related stress and fertility-related quality of life. Descriptive statistics, correlation, and regression analysis were used. Overall, participants reported low levels of fertility-related stress and fertility-related quality of life; however, they had relatively high levels of stress related to need for parenthood. Women who were older, had greater body mass indexes, and consumed coffee regularly had lower fertility-related quality of life. Social and relationship concerns and stress related to need for parenthood were significant predictors of low fertility-related quality of life. In a culture in which childbearing is generally an expectation and an important part of family life, women who experience infertility are at risk to experience fertility-related stress. Social support and family consultation might be offered to improve women's fertility-related quality of life. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  15. Management of low anal fistula: fistulectomy alone versus fistulectomy with primary closure

    International Nuclear Information System (INIS)

    Shahid, M.; Malik, S.; Ahmed, Z.

    2017-01-01

    To compare fistulectomy with primary closure of the wound and fistulectomy alone in the treatment of low anal fistula in terms of healing time. Study Design: Randomized control trial. Place and Duration of Study: Department of General Surgery Combined Military Hospital (CMH) Rawalpindi, from Nov 2006 to May 2007. Material and Methods: Total 60 patients of low anal fistula were enrolled in this study after informed consent and ethical approval. Patients were divided in two groups (A and B) each containing 30 patients. Patient of group A underwent fistulectomy alone whereas patients of group B underwent fistulectomy with primary closure of wound. All the patients were followed two weekly for 06 weeks. On each visit, healing was assessed by naked eye examination of epithelialization and noted on a Proforma. SPSS 17 was used to analyze the results. A p-value of <0.005 was considered statistically significant. Results: At 02 weeks after surgery, none of the patient in group A and 6.6% of group B patients showed wound healing, p-value was not significant i.e. 0.492. At 04 weeks after surgery, 23.3% of group A and 86.6% of group B patients showed wound healing p-value <0.001. At 06 weeks after surgery, 93.3% of group A and 100% of group B patients showed wound healing, p-value was not significant i.e. 0.492. Healing of wound was found more rapid in group B patients who underwent fistulectomy with primary closure of wound. Conclusion: Fistulectomy with primary repair was a better treatment as compared to fistulectomy alone in terms of healing time of wound. (author)

  16. NUTRITIONAL ASPECTS AND THE USE OF NUTRITIONAL SUPPLEMENTS BY WOMEN WHO UNDERWENT GASTRIC BYPASS.

    Science.gov (United States)

    Trindade, Elisangela Mara; Gebara, Telma Souza E Silva; Cambi, Maria Paula Carlini; Baretta, Giorgio Alfredo Pedroso

    2017-01-01

    Bariatric surgery is deemed one of the most effective procedures for the treatment of obesity and it aims at the reduction and maintenance of weight loss in long term, as the control of the related comorbidities. Quantify the occurrence of alterations of the gastrointestinal tract, suggestive signs of nutritional deficiencies and the use of supplements in a group of women undergoing bariatric surgery. The sample consisted of women aged 20-65 years submitted to Roux-en-Y gastric bypass with monitoring equal to or higher than 24 months. For the qualitative analysis, the Feeding Frequency Questionnaire was used. In the postoperative period, alopecia was the most reported (79.3%), followed by changes in the texture of the nails, both considered predictive of nutritional deficiencies. Changes in the gastrointestinal tract were described in 86.2%, and episodes of dumping were reported in 65.5%. Qualitative analysis has shown reduced daily consumption of sources of animal and plant proteins. After bariatric surgery can occur flatulence, vomiting and dumping syndrome as the most frequent representative symptoms of digestive functional disorders. Alopecia and nail changes are the most important signs of nutritional deficiency. The use of dietary supplements in the postoperative period is scarce and sporadic. A cirurgia bariátrica é considerada um dos procedimentos mais eficazes para tratamento da obesidade e objetiva a redução e manutenção da perda de peso em longo prazo, assim como, o controle das comorbidades associadas. Quantificar a ocorrência de alterações funcionais do trato gastrointestinal, sinais sugestivos de carências nutricionais e o uso de suplementos em um grupo de mulheres submetidas à cirurgia bariátrica. A amostra foi constituída por mulheres com idades entre 20-65 anos submetidas ao bypass gástrico em Y-de-Roux com seguimento igual ou superior a 24 meses. Para análise qualitativa foi utilizado o Questionário de Frequência Alimentar. No per

  17. a comparative study between manual small incision cataract surgery ...

    African Journals Online (AJOL)

    ... October 2012 to October 2014 for cataract surgery were followed up for 6 weeks after surgery. They were divided into two groups based on the type of surgical procedure opted by the patients. Group A consisted of 50 patients who underwent Manual Small Incision Cataract. Surgery with rigid Polymethyl Methacrylate IOL ...

  18. Computed tomography-guided cryoablation of local recurrence after primary resection of pancreatic adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Claudio Pusceddu

    2015-06-01

    Full Text Available The optimal management of local recurrences after primary resection of pancreatic cancer still remains to be clarified. A 58-yearold woman developed an isolated recurrence of pancreatic cancer six year after distal pancreatectomy. Re-resection was attempted but the lesion was deemed unresectable at surgery. Then chemotherapy was administrated without obtaining a reduction of the tumor size nor an improvement of the patient’s symptoms. Thus the patient underwent percutaneous cryoablation under computed tomography (CT-guidance obtaining tumor necrosis and a significant improvement in the quality of life. A CT scan one month later showed a stable lesion with no contrast enhancement. While the use of percutaneous cryoblation has widened its applications in patients with unresectable pancreatic cancer, it has never been described for the treatment of local pancreatic cancer recurrence after primary resection. Percutaneous cryoablation deserves further studies in the multimodality treatment of local recurrence after primary pancreatic surgery.

  19. Effects on quality of life, anti-cancer responses, breast conserving surgery and survival with neoadjuvant docetaxel: a randomised study of sequential weekly versus three-weekly docetaxel following neoadjuvant doxorubicin and cyclophosphamide in women with primary breast cancer

    Directory of Open Access Journals (Sweden)

    Wiseman Janice

    2011-05-01

    Full Text Available Abstract Background Weekly docetaxel has occasionally been used in the neoadjuvant to downstage breast cancer to reduce toxicity and possibly enhance quality of life. However, no studies have compared the standard three weekly regimen to the weekly regimen in terms of quality of life. The primary aim of our study was to compare the effects on QoL of weekly versus 3-weekly sequential neoadjuvant docetaxel. Secondary aims were to determine the clinical and pathological responses, incidence of Breast Conserving Surgery (BCS, Disease Free Survival (DFS and Overall Survival (OS. Methods Eighty-nine patients receiving four cycles of doxorubicin and cyclophosphamide were randomised to receive twelve cycles of weekly docetaxel (33 mg/m2 or four cycles of 3-weekly docetaxel (100 mg/m2. The Functional Assessment of Cancer Therapy-Breast and psychosocial questionnaires were completed. Results At a median follow-up of 71.5 months, there was no difference in the Trial Outcome Index scores between treatment groups. During weekly docetaxel, patients experienced less constipation, nail problems, neuropathy, tiredness, distress, depressed mood, and unhappiness. There were no differences in overall clinical response (93% vs. 90%, pathological complete response (20% vs. 27%, and breast-conserving surgery (BCS rates (49% vs. 42%. Disease-free survival and overall survival were similar between treatment groups. Conclusions Weekly docetaxel is well-tolerated and has less distressing side-effects, without compromising therapeutic responses, Breast Conserving Surgery (BCS or survival outcomes in the neoadjuvant setting. Trial registration ISRCTN: ISRCTN09184069

  20. Intraoperative endoscopic nasobiliary drainage over primary closure of the common bile duct for choledocholithiasis combined with cholecystolithiasis: a cohort study of 211 cases.

    Science.gov (United States)

    Yin, Pei; Wang, Min; Qin, Renyi; Zhang, Jian; Xiao, Guangqin; Yu, Haifeng; Ding, Zhiqiang; Yu, Yahong

    2017-08-01

    Endoscopic nasobiliary drainage (ENBD) was often used for preoperative biliary drainage in cases like cholangiocarcinoma or acute obstructive suppurative cholangitis, reports on endoscopic nasobiliary drainage (ENBD) over primary closure of the common bile duct (CBD) are limited. This study compares outcomes of laparoscopic cholecystectomy (LC) + laparoscopic CBD exploration (LCBDE) + intraoperative ENBD + primary closure of CBD with equivalent patients who underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) and subsequent LC. From January 2013 to December 2015, 829 consecutive patients with choledocholithiasis combined with cholecystolithiasis underwent surgery in our department. 211 patients underwent LC + LCBDE + intraoperative ENBD + primary closure of CBD (group A) and 117 preoperative ERCP + subsequent LC (group B). A total of 501 patients (355 who underwent T-tube drainage and 146 who underwent transcystic exploration) were excluded from the analysis. Clinical records, operative findings, and postoperative follow-up were analyzed. Age and sex distribution, comorbidity, presentations, CBD diameter, and size and number of stones were similar in the two groups, and there was no postoperative mortality. Duration of surgery in group A was shorter (83 vs. 104 min, P choledocholithiasis combined with cholecystolithiasis.

  1. Early postoperative intraocular pressure stability after combined 23-gauge sutureless vitrectomy and cataract surgery in patients with proliferative diabetic retinopathy.

    Science.gov (United States)

    Lee, Jong Yeon; Jeong, Hoon Seok; Lee, Dae Yeong; Sohn, Hee Jin; Nam, Dong Heun

    2012-10-01

    To compare rates of early postoperative hypotony and intraocular pressure (IOP) elevation between 23-gauge sutureless vitrectomies with and without phacoemulsification and intraocular lens implantation in patients with proliferative diabetic retinopathy. This study reviewed the medical records of 302 eyes of patients who underwent primary 23-gauge sutureless vitrectomy for the complications of proliferative diabetic retinopathy. A case series of 207 eyes that underwent combined vitrectomy and cataract surgery (combined group) was compared with that of 95 eyes that underwent vitrectomy only (vitrectomy group): The eyes that remained phakic after the vitrectomy were excluded from this study. The main outcome measures were postoperative hypotony (IOP 30 mmHg). Postoperative hypotony was identified in 4 (1.9%) of 207 eyes in combined group, but in 7 (7.4%) of 95 eyes in vitrectomy group (P = 0.048). Rate of IOP elevation was very low and not different between the two groups. The multivariate analysis showed that vitrectomy without cataract surgery was associated with the postoperative hypotony (odds ratio = 4.6, P = 0.045). The incidence of early postoperative hypotony was lower in combined sutureless vitrectomy and cataract surgery than in sutureless vitrectomy alone and that of IOP elevation was very low in both groups. The maintenance of a stable IOP with a low risk of IOP fluctuation may be an additional advantage of sutureless diabetic vitrectomy combined with cataract surgery.

  2. Relationship between preoperative axial length and myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation at the National Institute of Ophthalmology of Peru, 2007-2011.

    Science.gov (United States)

    Valera Cornejo, Diego Alejandro; Flores Boza, Abel

    2018-01-01

    To determine the relationship between the preoperative axial length and the myopic shift over 3 years after congenital cataract surgery with primary intraocular lens implantation and other related factors. In this retrospective cohort study, the axial length was measured and assigned into 2 groups (>21.5 mm and ≤21.5 mm), visual axis obscuration, laterality of cataract, age of surgery and follow-up time were assessed and compared to the myopic shift. The mean myopic shift was 3.6 (standard deviation [SD]: 2.3) diopters (D) in all patients; 3.2 (3.3) and 3.9 (3.2) D for each group respectively ( p =0.359). In unilateral cataracts the mean myopic shift was 6.3 D and in bilateral cases was 3.0 D ( p =0.001). In bilateral cataracts, the shift was 2.6 D (SD: 2.0) and 3.4 D (SD: 1.8), respectively ( p =0.098). There was no relationship between the initial axial length and the myopic shift in all patients. Unilateral cataracts had a greater myopic shift over 3 years.

  3. Long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal reconstruction.

    Science.gov (United States)

    Tazuke, Yuko; Okuyama, Hiroomi; Uehara, Shuichiro; Ueno, Takehisa; Nara, Keigo; Yamanaka, Hiroaki; Kawahara, Hisayoshi; Kubota, Akio; Usui, Noriaki; Soh, Hideki; Nomura, Motonari; Oue, Takaharu; Sasaki, Takashi; Nose, Satoko; Saka, Ryuta

    2015-12-01

    The aim of this study was to evaluate the long-term outcomes of four patients with tracheal agenesis who underwent airway and esophageal/alimentary reconstruction. We reviewed the medical records of four long-term survivors of tracheal agenesis and collected the following data: age, sex, type of tracheal agenesis, method of reconstruction, nutritional management, and physical and neurological development. The patients consisted of three boys and one girl, who ranged in age from 77 to 109months. The severity of their condition was classified as Floyd's type I (n=2), II (n=1), or III (n=1). Mechanical respiratory support was not necessary in any of the cases. Esophageal/alimentary reconstruction was performed using the small intestine (n=2), a gastric tube (n=1), and the esophagus (n=1). The age at esophageal reconstruction ranged from 41 to 55months. All of the cases required enteral nutrition via gastrostomy. Three of the patients were able to swallow a small amount of liquid and one was able to take pureed food orally. The physical development of the subjects was moderately delayed-borderline in childhood. Neurological development was normal in two cases and slightly delayed in two cases. None of the long-term survivors of tracheal agenesis required the use of an artificial respirator, and their development was close to normal. Future studies should aim to elucidate the optimal method for performing esophageal reconstruction to allow tracheal agenesis patients to achieve their full oral intake. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Newly Developed Sarcopenia as a Prognostic Factor for Survival in Patients who Underwent Liver Transplantation.

    Directory of Open Access Journals (Sweden)

    Ja Young Jeon

    Full Text Available The relationship between a perioperative change in sarcopenic status and clinical outcome of liver transplantation (LT is unknown. We investigated whether post-LT sarcopenia and changes in sarcopenic status were associated with the survival of patients.This retrospective study was based on a cohort of 145 patients from a single transplant center who during a mean of 1 year after LT underwent computed tomography imaging evaluation. The cross-sectional area of the psoas muscle of LT patients was compared with that of age- and sex-matched healthy individuals. The Cox proportional hazards regression model was used to determine whether post-LT sarcopenia and changes in sarcopenic status affect post-LT survival.The mean age at LT of the 116 male and 29 female patients was 50.2 ± 7.9 years; the mean follow-up duration was 51.6 ± 32.9 months. All pre-LT patients with sarcopenia still had sarcopenia 1 year after LT; 14 (15% patients had newly developed sarcopenia. The mean survival duration was 91.8 ± 4.2 months for non-sarcopenic patients and 80.0 ± 5.2 months for sarcopenic patients (log-rank test, p = 0.069. In subgroup analysis, newly developed sarcopenia was an independent negative predictor for post-LT survival (hazard ratio: 10.53, 95% confidence interval: 1.37-80.93, p = 0.024.Sarcopenia in LT recipients did not improve in any of the previously sarcopenic patients and newly developed within 1 year in others. Newly developed sarcopenia was associated with increased mortality. Newly developed sarcopenia can be used to stratify patients with regard to the risk of post-LT mortality.

  5. Scleral buckling surgery using multiple radial buckles: A valid option?

    Science.gov (United States)

    Sudhalkar, Aditya; Sudhalkar, Anand

    2015-01-01

    To determine whether radial buckling surgery using two or more radial buckles with or without circumferential silicone tires is still a treatment option for rhegmatogenous retinal detachment (RRD) in the current scenario. Retrospective chart review. Patients with RRD with two or more horse-shoe tears with/without proliferative vitreoretinopathy up to grade C1 who underwent buckling surgery using at least two radial buckle segments without encircling bands or drainage and with at least a 3 year follow up were included in the study. Data collected included demographics, corrected distance visual acuity (CDVA) at baseline and final follow up, details of the examination, surgical procedure(s) and complications noted, if any. Appropriate statistical analysis was done. Statistical significance was set at p buckle segments placed varied between 2 and 4 per eye. One patient required vitrectomy for persistent retinal detachment. One required buckle removal for infection 5 years after the primary procedure. One patient required strabismus surgery. 12.25 years ± 2.14 years. None of the other patients had any complications. Radial buckling surgery (two or more segments) is a reasonably safe and valid alternative to vitrectomy for RDs with multiple breaks in different planes.

  6. Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery

    Directory of Open Access Journals (Sweden)

    Tejsu Malla

    2018-03-01

    Full Text Available AIM: To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation (CAT with AMT, conjunctival autograft transplantation (CAT alone and amniotic membrane transplantation (AMT alone. METHODS: In this retrospective study, 142 eyes of 142 pterygium patients (104 primary, 38 recurrent who underwent CAT (group A, AMT (group B or CAT with AMT (group C respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS: The number of recurrence post-surgery were 17 (9 from primary, 8 from recurrent; the same description below, 18 (10, 8 and 2 (1, 1 in groups A, B, and C respectively; dry eyes were 22 (16, 6, 27 (18, 9 and 7 (3, 4; conjunctival inflammations were 30 (17, 13, 27 (16, 11 and 11 (6, 5. Patients in group C (either primary or recurrent or both mainly showed significantly better results than those in group A or B (P<0.05 regarding above-mentioned clinical effects. CONCLUSION: Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone.

  7. Analysis of failures and clinical outcome of advanced epithelial ovarian cancer in patients with microscopic residual disease at second-look reassessment following primary cytoreductive surgery and first-line platinum-based chemotherapy.

    Science.gov (United States)

    Gadducci, A; Tana, R; Landoni, F; Ferrari, F; Peiretti, M; Perrone, F; Sartori, E

    2013-01-01

    To assess the pattern of failure and survival of advanced ovarian cancer patients with microscopic residual disease at second-look following cytoreductive surgery and platinum-based chemotherapy. Nine-five women were retrospectively analyzed. Residual disease after initial surgery was > one cm in 58 (61.1%) patients, first-line chemotherapy was paclitaxel/platinum-based in 70 (73.7%) patients, second-look findings showed no macroscopic residuum but positive random peritoneal biopsies and/or positive washing ("true" microscopic residual disease) in 79 (83.2%) patients, and a macroscopic residuum which was completely resected (converted complete response) in 16(16.8%) patients. Eight-one (85.2%) patients developed recurrent disease after a median time of 14 months (range four to 51). The abdomen (29.6%) and the pelvis (28.4%) were the most common sites of failure. Two- and five-year survival after second-look were 78.1% and 31.0%, respectively. The clinical and pathological features with prognostic relevance at presentation (age, histotype, and tumor grade), as well as type of first-line chemotherapy and treatment after second-look were not related to the clinical outcome. There was a trend for a better survival in patients with optimal primary cytoreduction compared with those with suboptimal primary cytoreduction (five-year survival = 42.7% vs 23.4%). There was no significant difference in survival between the converted complete responders and the patients with "true" microscopic residual disease. These data confirm the unsatisfactory clinical outcome of patients with microscopic residual disease after first-line chemotherapy and the limited benefit of second-look reassessment.

  8. Usefulness of diagnostic imaging in primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Sekiyama, Kazuya; Akakura, Koichiro; Mikami, Kazuo; Mizoguchi, Ken-ichi; Tobe, Toyofusa; Nakano, Koichi; Numata, Tsutomu; Konno, Akiyoshi; Ito, Haruo

    2003-01-01

    In patients with primary hyperparathyroidism, prevention of urinary stone recurrence can be achieved by surgical removal of the enlarged parathyroid gland. To ensure the efficacy of surgery for primary hyperparathyroidism, preoperative localization of the enlarged gland is important. In the present study, usefulness of diagnostic imaging for localization of the enlarged gland was investigated in primary hyperparathyroidism. We retrospectively examined the findings of imaging studies and clinical records in 79 patients (97 glands) who underwent surgical treatment for primary hyperparathyroidism at Chiba University Hospital between 1976 and 2000. The detection rates of accurate localization were investigated for imaging techniques, such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) thallium-201 and technetium-99m pertechnetate (Tl-Tc) subtraction scintigraphy and 99m Tc-methoxyisobutylisonitrile (MIBI) scintigraphy, and analysed in relation to the size and weight of the gland and pathological diagnosis. The detection rates by US, CT, MRI, Tl-Tc subtraction scintigraphy and MIBI scintigraphy were 70%, 67%, 73%, 38% and 78%, respectively. The overall detection rate changed from 50% to 88% before and after 1987. The detection rate of MIBI scintigraphy was superior to Tl-Tc subtraction scintigraphy. In primary hyperparathyroidism, improvement of accurate localization of an enlarged parathyroid gland was demonstrated along with recent advances in imaging techniques including MIBI scintigraphy. (author)

  9. Functional Recovery After Rotator Cuff Repair: The Role of Biceps Surgery.

    Science.gov (United States)

    Gialanella, Bernardo; Grossetti, Francesco; Mazza, Marina; Danna, Laura; Comini, Laura

    2018-01-01

    Surgical cuff repair is recommended in a full-thickness rotator cuff tear when nonoperative treatment fails. Surgical cuff repair can include surgery of the long head of the biceps when concomitant biceps pathology is present. However, the studies executed up till now have not yet clearly defined if additional biceps surgery affects the shoulder functionality in patients who underwent rotator cuff repair. To verify if the concomitant biceps surgery prejudices shoulder functionality during the short-term period in rotator cuff repair patients. Prospective and observational study. Outpatient service for rehabilitation. Ninety-three consecutive patients who had undergone surgery for full-thickness symptomatic rotator cuff tear were enrolled for rehabilitation; 25 underwent rotator cuff repair and tendon biceps surgery (ABS), while 68 underwent rotator cuff repair only (RCR). Motor rehabilitation after surgical treatment of rotator cuff repair. Final Constant score was used as primary outcome measure, and efficiency and effectiveness in Constant score were evaluated both at the end of the last cycle of rehabilitation and 6 mo postsurgery. Patients with rotator cuff repair and tendon biceps surgery had lower final scores (36.5 ± 12.0 vs 49.3 ± 13.0, P < .001), effectiveness (40.6 ± 18.0 vs 60.3 ± 20.0, P < .001), and efficiency (0.80 ± 0.5 vs 1.19 ± 0.6, P = .010) in Constant score than those with rotator cuff repair only at the end of rehabilitation. Moreover, they had a lower final score (53.3 ± 14.0 vs 64.5 ± 10.0, P < .001) and effectiveness (66.9 ± 21.0 vs 84.0 ± 16, P < .001) in Constant score 6 mo postsurgery. Gender was a determinant of final score, efficiency, and effectiveness in Constant score at the end of the rehabilitation period, while tendon biceps surgery was a determinant of final score and effectiveness in Constant score at the end of the rehabilitation period and at 6

  10. PRIMARY SCLERAL BUCKLING FOR PEDIATRIC RHEGMATOGENOUS RETINAL DETACHMENT.

    Science.gov (United States)

    Errera, Marie-Hélène; Liyanage, Sidath E; Moya, Rene; Wong, S Chien; Ezra, Eric

    2015-07-01

    To evaluate the anatomical outcomes of primary scleral buckling (SB) procedures for pediatric rhegmatogenous retinal detachments. Retrospective consecutive case series. One hundred and four eyes of 99 consecutive nonselected pediatric patients undergoing primary SB were identified. Baseline factors recorded were demographics, presenting clinical examination findings, previous ocular surgery, predisposing factors. Intraoperative factors recorded were the type of buckle, number and distribution of retinal breaks, number of retinal quadrants detached, macular status (involved vs. uninvolved), the use of subretinal fluid drainage, and surgical complications. Anatomical reattachment rate at last follow-up. Subgroup analysis was carried out to identify any predisposing factors for failure of primary surgery, effect of age on outcome, intraoperative pathology, effect of posterior versus anterior SB, and redetachment and secondary-procedure complications specific to SB. The initial surgery was segmental SB alone in 87 eyes (83.6%). Retinal reattachment was achieved with 1 operation in 73% (76 of 104 eyes). Of the 28 cases that redetached, 14 eyes underwent a repeat SB procedure (success rate of this second operation: 85.7% [12 of 14 eyes]), 13 eyes underwent vitrectomy (success rate of this second operation: 38.4% [5 of 13 eyes]), and 1 case was not reoperated. Overall, the final success rate was 94% (98 of 104 eyes). Factors associated with a statistically significant increased risk of failure included more than one break; three or more quadrants of detachment; horseshoe tears; no breaks seen on preoperative examination; Stickler syndrome. In selected cases, primary SB is an effective treatment for pediatric, rhegmatogenous retinal detachment.

  11. Revisional Bariatric Surgery.

    Science.gov (United States)

    Switzer, Noah J; Karmali, Shahzeer; Gill, Richdeep S; Sherman, Vadim

    2016-08-01

    Revisional bariatric procedures are increasingly common. With more primary procedures being performed to manage severe obesity and its complications, 5% to 8% of these procedures will fail, requiring revisional operation. Reasons for revisional bariatric surgery are either primary inadequate weight loss, defined as less than 25% excess body weight loss, or weight recidivism, defined as a gain of more than 10 kg based on the nadir weight; however, each procedure also has inherit specific complications that can also be indications for revision. This article reviews the history of each primary bariatric procedure, indications for revision, surgical options, and subsequent outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Mast Cells Density Positive to Tryptase Correlate with Microvascular Density in both Primary Gastric Cancer Tissue and Loco-Regional Lymph Node Metastases from Patients That Have Undergone Radical Surgery

    Directory of Open Access Journals (Sweden)

    Michele Ammendola

    2016-11-01

    Full Text Available Mast Cells (MCs play a role in immune responses and more recently MCs have been involved in tumoral angiogenesis. In particular MCs can release tryptase, a potent in vivo and in vitro pro-angiogenic factor via proteinase-activated receptor-2 (PAR-2 activation and mitogen-activated protein kinase (MAPK phosphorylation. MCs can release tryptase following c-Kit receptor activation. Nevertheless, no data are available concerning the relationship among MCs Density Positive to Tryptase (MCDPT and Microvascular Density (MVD in both primary gastric cancer tissue and loco-regional lymph node metastases. A series of 75 GC patients with stage T2–3N2–3M0 (by AJCC for Gastric Cancer Seventh Edition undergone to radical surgery were selected for the study. MCDPT and MVD were evaluated by immunohistochemistry and by image analysis system and results were correlated each to other in primary tumor tissue and in metastatic lymph nodes harvested. Furthermore, tissue parameters were correlated with important clinico-pathological features. A significant correlation between MCDPT and MVD was found in primary gastric cancer tissue and lymph node metastases. Pearson t-test analysis (r ranged from 0.74 to 0.79; p-value ranged from 0.001 to 0.003. These preliminary data suggest that MCDPT play a role in angiogenesis in both primary tumor and in lymph node metastases from GC. We suggest that MCs and tryptase could be further evaluated as novel targets for anti-angiogenic therapies.

  13. Prognostic relevance of induced and spontaneous apoptosis of disseminated tumor cells in primary breast cancer patients

    International Nuclear Information System (INIS)

    Krawczyk, Natalia; Fehm, Tanja; Hartkopf, Andreas; Banys, Malgorzata; Meier-Stiegen, Franziska; Staebler, Annette; Wallwiener, Markus; Röhm, Carmen; Hoffmann, Juergen; Hahn, Markus

    2014-01-01

    An imbalance between cell proliferation and programmed cell death can result in tumor growth. Although most systemic cytotoxic agents induce apoptosis in tumor cells, a high apoptotic rate in primary breast cancer correlates with poor prognosis. The aim of this study was to investigate the incidence and the prognostic significance of apoptotic disseminated tumor cells (DTC) in the bone marrow (BM) of breast cancer patients who either underwent primary surgery or primary systemic chemotherapy (PST). A total of 383 primary breast cancer patients with viable DTC in the BM were included into this study. Eighty-five patients were initially treated with primary systemic chemotherapy whereas 298 patients underwent surgery first. Detection of apoptotic DTC were performed by immunocytochemistry using the M30 antibody which detects a neo-epitope expressed after caspase cleavage of cytokeratin 18 during early apoptosis. The median follow up was 44 months (range 10–88 months). Eighty-two of 298 (27%) primary operated patients and 41 of 85 (48%) patients treated with primary systemic systemic therapy had additional apoptotic DTC (M30 positive). In the neoadjuvant group M30-positive patients were less likely to suffer relapse than those without apoptotic DTC (7% vs. 23% of the events, p = 0.049). In contrast, the detection of apoptotic DTC in patients treated by primary surgery was significantly associated with poor overall survival (5% vs. 12% of the events, p = 0.008). Apoptotic DTC can be detected in breast cancer patients before and after systemic treatment. The presence of apoptotic DTC in patients with PST may be induced by the cytotoxic agents. Thus, both spontaneous and chemotherapy-induced apoptosis may have different prognostic significance

  14. The prevalence of glaucoma in patients undergoing surgery for eyelid entropion or ectropion

    Directory of Open Access Journals (Sweden)

    Golan S

    2016-10-01

    Full Text Available Shani Golan, Gilad Rabina, Shimon Kurtz, Igal Leibovitch Division of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Purpose and design: The aim of this study was to establish the prevalence of known glaucoma in patients undergoing ectropion or entropion surgical repair. In this study, retrospective review of case series was performed.Participants: All patients who underwent ectropion or entropion surgery in a tertiary medical center between 2007 and 2014 were included. The etiology of eyelid malpositioning was involutional or cicatricial.Methods: The medical files of the study participants were reviewed for the presence and type of glaucoma, medical treatment, duration of treatment, and the amount of drops per day. These data were compared to a matched control group of 101 patients who underwent blepharoplasty for dermatochalasis in the same department during the same period.Main outcome measure: In this study, the prevalence of glaucoma in individuals with ectropion or entropion was the main outcome measure.Results: A total of 227 patients (57% men, mean age: 79.2 years who underwent ectropion or entropion surgery comprised the study group and 101 patients who underwent upper blepharoplasty for dermatochalasis comprised the control group. Compared to four patients in the control group (4%, P=0.01, 30 of the study patients (13.2% had coexisting glaucoma. Of 30 glaucomatous patients, 25 had primary open-angle glaucoma for a mean duration of 10.3 years. The glaucomatous patients were treated with an average of 2.7 antiglaucoma medications.Conclusion: An increased prevalence of known glaucoma in patients undergoing ectropion or entropion repair surgery was found. This observation may indicate that the chronic usage of topical anti-glaucoma eyedrops may lead to an increased risk of developing eyelid malpositions, especially in

  15. Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy.

    Science.gov (United States)

    Ozgor, Faruk; Kucuktopcu, Onur; Sarılar, Omer; Toptas, Mehmet; Simsek, Abdulmuttalip; Gurbuz, Zafer Gokhan; Akbulut, Mehmet Fatih; Muslumanoglu, Ahmet Yaser; Binbay, Murat

    2015-11-01

    In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62%) compared to the other groups (77.10% in Group 2 and 75.61% in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success.

  16. Evaluating the Efficacy of Primary Treatment for Graves’ Disease Complicated by Thyrotoxic Periodic Paralysis

    Directory of Open Access Journals (Sweden)

    Rita Yuk-Kwan Chang

    2014-01-01

    Full Text Available Objective. Thyrotoxic periodic paralysis (TPP is a potentially life-threatening complication of Graves’ disease (GD. The present study compared the long-term efficacy of antithyroid drugs (ATD, radioactive iodine (RAI, and surgery in GD/TPP. Methods. Sixteen patients with GD/TPP were followed over a 14-year period. ATD was generally prescribed upfront for 12–18 months before RAI or surgery was considered. Outcomes such as thyrotoxic or TPP relapses were compared between the three modalities. Results. Eight (50.0% patients had ATD alone, 4 (25.0% had RAI, and 4 (25.0% had surgery as primary treatment. Despite being able to withdraw ATD in all 8 patients for 37.5 (22–247 months, all subsequently developed thyrotoxic relapses and 4 (50.0% had ≥1 TPP relapses. Of the four patients who had RAI, two (50% developed thyrotoxic relapse after 12 and 29 months, respectively, and two (50.0% became hypothyroid. The median required RAI dose to render hypothyroidism was 550 (350–700 MBq. Of the 4 patients who underwent surgery, none developed relapses but all became hypothyroid. Conclusion. To minimize future relapses, more definitive primary treatment such as RAI or surgery is preferred over ATD alone. If RAI is chosen over surgery, a higher dose (>550 MBq is recommended.

  17. Type A aortic dissection in Marfan syndrome: extent of initial surgery determines long-term outcome.

    Science.gov (United States)

    Rylski, Bartosz; Bavaria, Joseph E; Beyersdorf, Friedhelm; Branchetti, Emanuela; Desai, Nimesh D; Milewski, Rita K; Szeto, Wilson Y; Vallabhajosyula, Prashanth; Siepe, Matthias; Kari, Fabian A

    2014-04-01

    Data on outcomes after Stanford type A aortic dissection in patients with Marfan syndrome are limited. We investigated the primary surgery and long-term results in patients with Marfan syndrome who suffered aortic dissection. Among 1324 consecutive patients with aortic dissection type A, 74 with Marfan syndrome (58% men; median age, 37 years [first and third quartiles, 29 and 48 years]) underwent surgical repair (85% acute dissections; 68% DeBakey I; 55% composite valved graft, 30% supracoronary ascending replacement, 15% valve-sparing aortic root replacement; 12% total arch replacement; 3% in-hospital mortality) at 2 tertiary centers in the United States and Europe over the past 25 years. The rate of aortic reintervention with resternotomy was 24% (18 of 74) and of descending aorta (thoracic+abdominal) intervention was 30% (22 of 74) at a median follow-up of 8.4 years (first and third quartiles, 2.2 and 12.7 years). Freedom from need for aortic root reoperation in patients who underwent primarily a composite valved graft or valve-sparing aortic root replacement procedure was 95±3%, 88±5%, and 79±5% and in patients who underwent supracoronary ascending replacement was 83±9%, 60±13%, 20±16% at 5, 10, and 20 years. Secondary aortic arch surgery was necessary only in patients with initial hemi-arch replacement. Emergency surgery for type A dissection in patients with Marfan syndrome is associated with low in-hospital mortality. Failure to extend the primary surgery to aortic root or arch repair leads to a highly complex clinical course. Aortic root replacement or repair is highly recommended because supracoronary ascending replacement is associated with a high need (>40%) for root reintervention.

  18. [Advanced age--indication or contraindication for laparoscopic colorectal surgery?].

    Science.gov (United States)

    Gunka, I; Dostalík, J; Martínek, L; Guńková, P; Mazur, M; Vávra, P

    2010-10-01

    The aim of this study was to evaluate the results of laparoscopically-assisted (LAC) and open (OC) colorectal surgery in elderly patients (a 75 years) and to compare them to a cohort of younger patients (Patients who underwent elective laparoscopically-assisted or open colorectal surgery in the period between January 2001 and December 2009 were included in the analysis. The primary end point was the incidence of short-term postoperative morbidity and mortality, long-term overall and colorectal cancer specific survival which were analyzed in relation to the age and operative technique. During the study period, 557 elective laparoscopic and 404 elective open colorectal operations were performed. 190 patients (20 %) were older than 75 years, 99 of which underwent laparoscopic and 91 open surgery. In geriatric patients, the open approach was associated with increase of postoperative morbidity, statistically nonsignificant (LAC > or = 75 years 30% vs. OC or = 75 years 30% vs. LAC patients were associated with a significant increase of postoperative complications compared to younger patients (OC > or = 75 years 40% vs. OC geriatric patients (LAC > or = 75 years 5% vs. OC > or = 75 years 3%, p=0,548). Mortality rate did not differ in both age groups operated laparoscopically (LAC > or = 75 years 5% vs. LAC or = 75 years 3% vs. OC or = 75 years 43 +/- 8% vs. LAC or = 75 years 76 +/- 9% vs. LAC or = 75 years 67 +/- 7% vs. OC patients surgical technique did not influenced overall five year survival (LAC > or = 75 years 43 +/- 8% vs. OC > or = 75 years 35 +/- 7%, p = 0,428), even five year colorectal cancer specific survival (LAC . or = 75 years 76 +/- 9% vs. OC a 75 years 69 +/- 7%, p = 0,393). Laparoscopically-assisted colorectal surgery should be particularly considered in geriatric patients, for the reason of lower incidence of postoperative complications. Oncological safety of miniinvasive approach in the treatment of colorectal cancer is valid also for the specific

  19. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Berna Dogan

    2016-01-01

    Full Text Available Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG. Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40 who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT, total macular volume (TMV, and retinal ganglion cell layer (RGCL were measured by spectral-domain optical coherence tomography (SD-OCT. Subfoveal choroidal thickness (SFCT was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT. Results. The mean CMT was 237.4±24.5 μm, 239.3±24.1 μm, and 240.4±24.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean TMV was 9.88±0.52 mm3, 9.96±0.56 mm3, and 9.99±0.56 mm3 preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean RGCL was 81.2±6.5 μm, 82.7±6.6 μm, and 82.9±6.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean SFCT was 309.8±71.8 μm, 331.0±81.4 μm, and 352.7±81.4 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p=0.34, disc area (p=0.64, vertical cup/disc ratio (p=0.39, cup volume (p=0.08, or retinal nerve fiber layer (p=0.90. Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery.

  20. Primary choledocholithiasis after cholecystectomy: a clinical analysis of 70 cases

    Directory of Open Access Journals (Sweden)

    ZHANG Heping

    2014-11-01

    Full Text Available ObjectiveTo investigate the relationship between cholecystectomy and the subsequent occurrence of primary choledocholithiasis and to review the surgical treatment of primary choledocholithiasis. MethodsThe clinical data of 70 patients with forward common bile duct stones after cholecystectomy who were admitted to our hospital from January 2007 to December 2013 were retrospectively analyzed. ResultsAll 70 patients underwent open surgery for removal of common bile duct stones, which were identified as bile pigment calculi. The postoperative complications included incisional wound infection (8 cases and lung infection (5 cases, and no severe complications as biliary leakage or hematobilia were observed. All patients fully recovered at the time of discharge. Eight cases of recurrent common bile duct stones were found and surgeries were performed 2.5 to 4 years after the recurrence. All patients were cured by choledocholithotomy, common bile duct transection, and Roux-en-Y hepaticojejunostomy. ConclusionPrimary choledocholithiasis is an age-related disease, not a long-term complication of cholecystectomy. If no bile duct injury occurs during the cholecystectomy, the incidence rate of primary choledocholithiasis will not be increased. Surgical treatment is required for primary choledocholithiasis. For the cases of choledochectasia with the diameter of common bile duct greater than 2.5 cm or recurrent choledocholithiasis, the laparotomy with common bile duct transection and Roux-en-Y anastomosis is recommended.

  1. An analysis of causes of readmission after spine surgery.

    Science.gov (United States)

    McCormack, Richard A; Hunter, Tracey; Ramos, Nicholas; Michels, Ryan; Hutzler, Lorraine; Bosco, Joseph A

    2012-06-15

    Retrospective review of medical records. We reviewed all early readmissions after elective spine surgery at a single orthopedic specialty hospital to analyze the causes of unplanned readmissions. Recent advances in techniques and instrumentation have made more complex spinal surgeries possible, although sometimes with more complications. Early readmission rate is being used as a marker to evaluate quality of care. There is little data available regarding the causes of early readmissions after spine surgery. Using the hospital's administrative database of patient records from 2007 to 2009, all patients who underwent spine surgery and were readmitted to the hospital within 30 days were identified and broadly categorized as planned (a staged or rescheduled procedure or a direct transfer) or unplanned. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Analysis was focused on 12 common spine procedures based on the principle procedure International Classification of Diseases, Ninth Revision, Clinical Modification code for the patient's initial admission. The readmission rate was calculated for each procedure. A total of 156 early readmissions were identified, of which 141 were unplanned. Of the unplanned readmissions, the most common causes were infection or a concern for an infection (45 patients, 32% of unplanned readmissions), nonsurgical complications (31 patients, 22% of readmissions), complications requiring surgical revision (21 patients, 15% of readmissions), and wound drainage (12 patients, 9% of readmissions). Fifty-seven percent of unplanned readmissions required a return to the operating room (76% of infections or concern for infection). The average length of stay for the unplanned readmissions was 6.5 days. When using the 12 most common procedures based on the International Classification of Diseases, Ninth Revision, Clinical Modification, the early readmission rate was 3.8% (141 early

  2. C-Reactive protein level in morbidly obese patients before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    M.E. Rojano-Rodríguez

    2014-04-01

    Conclusions: Preoperative CRP had a significant lineal relation to weight and body mass index. Patients who underwent bariatric surgery had a significant decrease in CRP, weight, and fasting glucose at 6 months after surgery.

  3. Effects of maxillary sinus floor elevation surgery on maxillary sinus physiology

    NARCIS (Netherlands)

    Timmenga, NM; Raghoebar, GM; Liem, RSB; van Weissenbruch, R; Manson, WL; Vissink, A

    In a prospective study, the effects of elevation surgery of the maxillary sinus floor on maxillary sinus physiology were assessed. Seventeen consecutive patients without preoperative anamnestic, clinical and radiological signs of maxillary sinusitis underwent sinus floor elevation surgery with iliac

  4. Kosovo’s Experience for Children with Feeding Difficulties after Cardiac Surgery for Congenital Heart Defect

    Directory of Open Access Journals (Sweden)

    Ramush Bejiqi

    2017-11-01

    CONCLUSION: Feeding disorder is often and a frequent long-term sequel in children after neonatal or early infancy heart surgery. Patients with chromosomal and associated anomalies who underwent multiple cardiac surgeries are at risk of developing feeding difficulties.

  5. Sexual and psychological functioning in women after pelvic surgery for gynaecological cancer

    NARCIS (Netherlands)

    Aerts, L.; Enzlin, P.; Verhaeghe, J.; Vergote, I.; Amant, F.

    2009-01-01

    Pelvic surgery for gynecological cancer can affect sexuality through a number of anatomical, physiological and psychological mechanisms. We aimed to examine the prevalence Of Sexual dysfunction and psychological functioning in women who underwent pelvic surgery for gynecological cancer. Fifty women

  6. [Comparison of the results of laparotomy and laparoscopic surgery in patients with Crohn's disease].

    Science.gov (United States)

    Horváth, Gyula; Simonka, Zsolt; Lázár, György

    2014-01-05

    Crohn's disease is an inflammatory bowel disease which may affect different parts of the gastrointestinal tract. To compare retrospectively the results of laparotomy and laparoscopic surgery performed in patients with Crohn's disease between January 1, 2005 and October 31, 2012 in the Department of Surgery, University of Szeged, Hungary. Patients were divided into two groups based on the types of surgery; 103 patients underwent laparotomy and 30 patients had laparoscopic surgery programmed. 22 patients had 24 primary acute interventions. The mean age was significantly lower in the laparoscopic surgery group (p = 0.042). The laparoscopic ileocecal resections have been found significantly shorter than laparotomies (p = 0.033). When ileocecal resection was performed the operation time was significantly longer (p = 0.033) while hospitalization time (p = 0.025) and intensive care unit treatment time (plaparotomy group. Laparoscopic surgery results in smaller surgical trauma, better cosmetic outcome, shorter hospitalization time and not higher complication- and morbidity-rate as well as shorter operation time in certain cases. However, it requires more qualified surgical team and the operation expenses are higher.

  7. Epiretinal membrane surgery

    DEFF Research Database (Denmark)

    Hamoudi, Hassan; Correll Christensen, Ulrik; La Cour, Morten

    2017-01-01

    and subsequent pars plana vitrectomy (PPV) (CAT group), (2) PPV and subsequent cataract surgery (VIT group) or (3) phaco-vitrectomy (COMBI group). Examinations were at baseline, one month after each surgery, and at 3 months and 12 months of follow-up. Primary outcome was the RE (the difference between predicted...... and achieved spherical equivalent); secondary outcomes were best-corrected visual acuity (BCVA), and incidence of cystoid macular oedema (CME) defined as >10% increment of central subfield macular thickness (CSMT). Results: Sixty-two eyes were enrolled. The mean RE showed a small myopic shift of -0.36D in all...

  8. Comparison of Perioperative and Oncologic Outcomes with Laparotomy, and Laparoscopic or Robotic Surgery for Women with Endometrial Cancer.

    Science.gov (United States)

    Manchana, Tarinee; Puangsricharoen, Pimpitcha; Sirisabya, Nakarin; Worasethsin, Pongkasem; Vasuratna, Apichai; Termrungruanglert, Wichai; Tresukosol, Damrong

    2015-01-01

    To compare perioperative outcomes and oncologic outcomes in endometrial cancer patients treated with laparotomy, and laparoscopic or robotic surgery. Endometrial cancer patients who underwent primary surgery from January 2011 to December 2014 were retrospectively reviewed. Perioperative outcomes, including estimated blood loss (EBL), operation time, number of lymph nodes retrieved, and intra and postoperative complications, were reviewed. Recovery time, disease free survival (DFS) and overall survival (OS) were compared. Of the total of 218 patients, 143 underwent laparotomy, 47 laparoscopy, and 28 robotic surgery. The laparotomy group had the highest EBL (300, 200, 200 ml, plaparotomy (125 min) (plaparotomy group (four days) but there was no difference between the laparoscopy (three days) and robotic (three days) groups. Recovery was significantly faster in robotic group than laparotomy group (14 and 28 days, p=0.003). No significant difference in DFS and OS at 21 months of median follow up time was observed among the three groups. Minimally invasive surgery has more favorable outcomes, including lower blood loss, shorter hospital stay, and faster recovery time than laparotomy. It also has equivalent perioperative complications and short term oncologic outcomes. MIS is feasible as an alternative option to surgery of endometrial cancer.

  9. Analysis of 175 Cases Underwent Surgical Treatment in Our Hospital After Having Abdominal Wounding by Firearm in the War at Syria

    Directory of Open Access Journals (Sweden)

    Yusuf Yucel

    2016-04-01

    Full Text Available Aim: We aimed at analysing the patients, who underwent surgical treatment in our hospital after having abdominal wounding by firearm in the war at Syria, retrospectively. Material and Method: The files of Syrian patients, who applied to Emergency Service of Harran University Medical Faculty because of gunshot wounds and had operation after being hospitalized in General Surgery Clinic due to abdominal injuries between the years of 2011 and 2014, were analysed retrospectively. Results: 175 Syrian patients, who had abdominal injuries by firearms, underwent operation in our general surgery clinic. 99.4% (n=174 of the patients were male, and 0.6% (n=1 were female. Trauma-admission to hospital times of all cases were %u2265 6 hours. 62.8% (n=110 of the patients had isolated abdominal injuries, and 37.1% (n=65 had two or more system injuries. The frequency of more than one organ injuries in abdominal region was 44.5% (n=78 and the most frequent complication was wound infection (10%. Negative laparoscopy was 2.8% (n=5, support for intensive care was 38.2% (n=67, average duration of intensive care unit stay was 5.57 days and mortality was 9.7% (n=17. Discussion: In our study, it was seen that infectious morbidity and mortality increased for the patients, who applied to our hospital because of abdominal injuries by firearm, particularly the ones with gastrointestinal perforation, if trauma-admission to hospital times were %u2265 6 hours. And this shows us that the early intervention to injuries that perforate gastrointestinal tract was an important factor for decreasing morbidity and mortality.

  10. Primary classical hemangiopericytomas of thorax.

    Science.gov (United States)

    Bicakcioglu, Pinar; Aydin, Ertan; Celik, Ali; Demirag, Funda; Karaoglanoglu, Nurettin

    2012-07-01

    Hemangiopericytoma, an uncommon hypervascular tumor, occurs anywhere in the body with capillary vessels originating from the pericyte. These tumors most frequently occur in the musculature of the lower extremities and retroperitoneum, but are rarely seen in the thoracic cavity. The objective of this study is to present primary classical hemangiopericytomas of the thorax together with a literature review. The postoperative pathologic records of 17,165 operations that were performed between January 1990 and December 2010 in the clinic were retrospectively searched, and the files of 6 cases with the diagnosis of primary classical hemangiopericytoma were analyzed for clinical characteristics of patients, surgical procedures, histopathologic features, treatments after surgery, and morbidity and mortality results. There were 4 female and 2 male patients with an average age of 30.3 years (range, 15 to 60 years). Three patients had thoracic wall lesions, 2 patients had intrathoracic extrapulmonary lesions, and 1 patient had mediastinal lesion. Four left and two right posterolateral thoracotomies were performed. Chest wall resection was performed in 3 patients, intrathoracic extrapulmonary mass excision in 2 patients, and mediastinal mass excision and left lower lobectomy in 1 patient. Postoperative histopathologic diagnoses were primary classical hemangiopericytomas in 4 patients and primary classical malignant hemangiopericytomas in 2 patients. Four patients underwent reoperation for recurrence. In the follow-up period, 2 patients are still alive at 30 months and 14 years postoperatively; 3 patients died at 7, 8, and 16 years postoperatively. One patient was lost to follow-up. All 3 mortalities were related to the recurrence or distant metastasis of the tumor. Although hemangiopericytomas are benign or malignant tumors, they generally display malignant behaviors. The risk of recurrence and distant metastasis occurs even many years after resection, suggesting that the

  11. [Pregnancy and bariatric surgery: Critical points].

    Science.gov (United States)

    Ciangura, C; Nizard, J; Poitou-Bernert, C; Dommergues, M; Oppert, J M; Basdevant, A

    2015-06-01

    More than 200,000 people underwent obesity surgery in France. Most of them are women. Pregnancy after bariatric surgery is becoming a common situation. This surgery results in major nutritional and gastro-intestinal tract modifications that may influence or be influenced by pregnancy, and yields benefits as well as complications. A multidisciplinary management including a nutritionist, an obstetrician, an anesthesiologist, and a bariatric surgeon is required. The aim of this review is to analyze the impact of bariatric surgery on pregnancy and vice versa, and to identify the key points of this management. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  12. Primary hyperparathyroidism: intraoperative PTH-measurements

    DEFF Research Database (Denmark)

    Rolighed, L; Heickendorff, L; Hessov, I

    2004-01-01

    BACKGROUND: With the development of rapid assays and intraoperative measurement of intact parathyroid hormone (PTH), new strategies in the handling of patients with primary hyperparathyroidism (pHPT) have evolved. AIM: The aim of our study was to illustrate the performance of the intraoperative PTH...... measurement as a predictor of successful cure. MATERIAL AND METHODS: From September 1999 to April 2002 143 patients with pHPT underwent a parathyroid operation (bilateral neck exploration with identification of all parathyroid glands) with intraoperative measurements of plasma PTH (immediately prior...... to surgery (T0) and 5 minutes after gland excision (T5)). A positive test result was defined as plasma PTH values at T5 below 20% of T0 or a value in the normal range below 7.6 pmol/l. Hence T5 values above 20% of T0 and above 7.6 pmol/l were considered test negative. RESULTS: 122 patients (85%) were test...

  13. Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV Infected and Uninfected Veterans

    Science.gov (United States)

    King, Joseph T.; Gordon, Adam J.; Perkal, Melissa F.; Crystal, Stephen; Rosenthal, Ronnie A.; Rodriguez-Barradas, Maria C.; Butt, Adeel A.; Gibert, Cynthia L.; Rimland, David; Simberkoff, Michael S.; Justice, Amy C.

    2011-01-01

    Study Design Retrospective analysis of nationwide Veterans Health Administration (VA) clinical and administrative data. Objective Examine the association between HIV infection and the rate of spine surgery for degenerative spine disease. Summary of Background Data Combination anti-retroviral therapy (cART) has prolonged survival in patients with HIV/AIDS, increasing the prevalence of chronic conditions such as degenerative spine disease that may require spine surgery. Methods We studied all HIV infected patients under care in the VA from 1996–2008 (n=40,038) and uninfected comparator patients (n=79,039) matched on age, gender, race, year, and geographic region. The primary outcome was spine surgery for degenerative spine disease defined by ICD-9 procedure and diagnosis codes. We used a multivariate Poisson regression to model spine surgery rates by HIV infection status, adjusting for factors that might affect suitability for surgery (demographics, year, comorbidities, body mass index, cART, and laboratory values). Results Two-hundred twenty eight HIV infected and 784 uninfected patients underwent spine surgery for degenerative spine disease during 700,731 patient-years of follow-up (1.44 surgeries per 1,000 patient-years). The most common procedures were spinal decompression (50%), and decompression and fusion (33%); the most common surgical sites were the lumbosacral (50%), and cervical (40%) spine. Adjusted rates of surgery were lower for HIV infected patients (0.86 per 1,000 patient-years of follow-up) than for uninfected patients (1.41 per 1,000 patient-years; IRR 0.61, 95% CI: 0.51, 0.74, Pdegenerative spine disease. Possible explanations include disease prevalence, emphasis on treatment of non-spine HIV-related symptoms, surgical referral patterns, impact of HIV on surgery risk-benefit ratio, patient preferences, and surgeon bias. PMID:21697770

  14. Readmission After Gynecologic Surgery: A Comparison of Procedures for Benign and Malignant Indications.

    Science.gov (United States)

    Cory, Lori; Latif, Nawar; Brensinger, Colleen; Zhang, Xiaochen; Giuntoli, Robert L; Burger, Robert A; Morgan, Mark; Ko, Emily

    2017-08-01

    To compare 30-day postsurgical readmission rates and associated risk factors for readmission among women undergoing gynecologic surgery for benign and malignant conditions. In a retrospective cohort study, we identified patients after surgery for benign and malignant gynecologic conditions in the National Surgical Quality Improvement Program database between January 1, 2011, and December 31, 2012. Data collected included surgical factors, perioperative characteristics, surgical complications, and 30-day readmissions. The primary study outcome was readmission rates after gynecologic surgery for benign and oncologic conditions. Secondary study outcomes were risk factors associated with readmission among gynecologic surgeries performed for benign and oncologic conditions. Approximately 3% (1,444/46,718) compared with 8.2% (623/7,641) of patients who underwent gynecologic surgery for benign and malignant indications, respectively, were readmitted (Pgynecologic cancer surgery included worse preoperative conditions (OR 1.49, 95% CI 1.17-1.90) and major complications (OR 17.84, 95% CI 14.19-22.43). In comparison, independent risk factors for readmission after surgery for benign indications included comorbid conditions (OR 1.36, 95% CI 1.18-1.57), operative time (15-59 minutes: referent; 60 minutes or greater: 1.37, 95% CI 1.14-1.63) and major complications (OR 53.91, 95% CI 46.98-61.85). Among gynecologic surgeries, those performed for oncologic indications were associated with readmission rates 2.8 times that of surgeries performed for benign indications. In adjusted models, worse preoperative conditions and surgical complications remained independent risk factors associated with the higher rate of readmission among patients with gynecologic cancer.

  15. PAEDIATRIC SURGERY

    African Journals Online (AJOL)

    3 Department of Paediatric Surgery, Sophia's Children Hospital/Erasmus Medical Centre, Rotterdam, The Netherlands. 4 Department of Paediatric Surgery, Emma's Children Hospital/Academic Medical Centre, Amsterdam, The Netherlands. 5 Department of Radiology, Red Cross War Memorial Children's Hospital, ...

  16. PAEDIATRIC SURGERY

    African Journals Online (AJOL)

    Gastroschisis in a developing country: poor resuscitation is a more significant predictor of mortality than postnatal transfer time. PAEDIATRIC SURGERY. P Stevens,1 E Muller,1 P Becker2. 1 Department of Paediatric Surgery, Steve Biko Academic Hospital, University of Pretoria. 2 South African Medical Research Council.

  17. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 8. Assessing naso-labial appearance in 5-year-olds - a preliminary study.

    Science.gov (United States)

    Mølsted, Kirsten; Humerinta, Kirsti; Küseler, Annelise; Skaare, Pål; Bellardie, Haydn; Shaw, William; Karsten, Agneta; Kåre Sæle, Paul; Rizell, Sara; Marcusson, Agneta; Eyres, Philip; Semb, Gunvor

    2017-02-01

    Facial appearance is one of the most relevant measures of success in cleft lip and palate treatment. The aim was to assess nasolabial appearance at 5 years of age in all children in the project. In this part of the project the local protocol for lip closure continued to be used because the primary lip and nose operations were not part of the randomisation. The great majority of the surgeons used Millard's technique together with McComb's technique for the nose. One center used Tennison-Randalls technique and in one center the centers own technique as well as nose plugs were used. Three hundred and fifty-nine children participated in this part of the project. Standardised photos according to a specific protocol developed for the Scandcleft project were taken. Only the nasolabial area was shown, the surrounding facial features were masked. Three components were scored using a 5-point ordinal scale. A new developed Scandcleft Yardstick was used. The reliability of the method was tested using the weighted kappa statistics. Both the interrater and intrarater reliability scores were good to very good. There were statistically significant differences between the three trials. The Millard procedure combined with McComb technique had been used in the majority of the cases in all three trials. There were statistically significant differences between the three trials concerning upper lip, nasal form, and cleft side profile. ISRCTN29932826.

  18. The Effect of a Mediterranean Diet on the Incidence of Cataract Surgery

    Directory of Open Access Journals (Sweden)

    Alfredo García-Layana

    2017-05-01

    Full Text Available Background: Cataract is a leading cause of vision impairment worldwide, and surgery is the only available treatment. The process that initiates lens opacification is dependent on the oxidative stress experienced by the lens components. A healthy overall dietary pattern, with the potential to reduce oxidative stress, has been suggested as a means to decrease the risk of developing cataract. We aimed to investigate the hypothesis that an intervention with a Mediterranean diet (MedDiet rather than a low-fat diet could decrease the incidence of cataract surgery in elderly subjects. Methods: We included 5802 men and women (age range: 55–80 years from the Prevención con Dieta Mediterránea study (multicenter, parallel-group, randomized controlled clinical trial who had not undergone cataract surgery. They were randomly assigned to one of three intervention groups: (1 a MedDiet enriched with extra-virgin olive oil (EVOO (n = 1998; (2 a MedDiet enriched with nuts (n = 1914, and a control group recommended to follow a low-fat diet (n = 1890. The incidence of cataract surgery was recorded yearly during follow-up clinical evaluations. Primary analyses were performed on an intention-to-treat basis. Cox regression analyses were used to assess the relationship between the nutritional intervention and the incidence of cataract surgery. Results: During a follow-up period of 7.0 years (mean follow-up period: 5.7 years; median: 5.9 years, 559 subjects underwent cataract surgery. Two hundred and six participants from the MedDiet + EVOO group, 174 from the MedDiet + Nuts group, and 179 from the control group underwent cataract surgery. We did not observe a reduction in the incidence of cataract surgery in the MedDiet groups compared to the control group. The multivariable adjusted hazard ratios were 1.03 (95% confidence interval [CI]: 0.84–1.26, p = 0.79 for the control group versus the MedDiet + EVOO group and 1.06 (95% CI: 0.86–1.31, p = 0.58 for the

  19. The Effect of a Mediterranean Diet on the Incidence of Cataract Surgery

    Science.gov (United States)

    García-Layana, Alfredo; Ciufo, Gianfranco; Toledo, Estefania; Martínez-González, Miguel A.; Corella, Dolores; Fitó, Montse; Estruch, Ramon; Gómez-Gracia, Enrique; Fiol, Miguel; Lapetra, José; Serra-Majem, Lluís; Pintó, Xavier; Portillo, Maria P.; Sorli, José V.; Bulló, Mónica; Vinyoles, Ernest; Sala-Vila, Aleix; Ros, Emilio; Salas-Salvadó, Jordi; Arós, Fernando

    2017-01-01

    Background: Cataract is a leading cause of vision impairment worldwide, and surgery is the only available treatment. The process that initiates lens opacification is dependent on the oxidative stress experienced by the lens components. A healthy overall dietary pattern, with the potential to reduce oxidative stress, has been suggested as a means to decrease the risk of developing cataract. We aimed to investigate the hypothesis that an intervention with a Mediterranean diet (MedDiet) rather than a low-fat diet could decrease the incidence of cataract surgery in elderly subjects. Methods: We included 5802 men and women (age range: 55–80 years) from the Prevención con Dieta Mediterránea study (multicenter, parallel-group, randomized controlled clinical trial) who had not undergone cataract surgery. They were randomly assigned to one of three intervention groups: (1) a MedDiet enriched with extra-virgin olive oil (EVOO) (n = 1998); (2) a MedDiet enriched with nuts (n = 1914), and a control group recommended to follow a low-fat diet (n = 1890). The incidence of cataract surgery was recorded yearly during follow-up clinical evaluations. Primary analyses were performed on an intention-to-treat basis. Cox regression analyses were used to assess the relationship between the nutritional intervention and the incidence of cataract surgery. Results: During a follow-up period of 7.0 years (mean follow-up period: 5.7 years; median: 5.9 years), 559 subjects underwent cataract surgery. Two hundred and six participants from the MedDiet + EVOO group, 174 from the MedDiet + Nuts group, and 179 from the control group underwent cataract surgery. We did not observe a reduction in the incidence of cataract surgery in the MedDiet groups compared to the control group. The multivariable adjusted hazard ratios were 1.03 (95% confidence interval [CI]: 0.84–1.26, p = 0.79) for the control group versus the MedDiet + EVOO group and 1.06 (95% CI: 0.86–1.31, p = 0.58) for the control group

  20. The outcome of rectal cancer after early salvage TME following TEM compared with primary TME: a case-matched study.

    Science.gov (United States)

    Levic, K; Bulut, O; Hesselfeldt, P; Bülow, S

    2013-08-01

    Transanal endoscopic microsurgery (TEM) allows locally complete resection of early rectal cancer as an alternative to conventional radical surgery. In case of unfavourable histology after TEM, or positive resection margins, salvage surgery can be performed. However, it is unclear if the results are equivalent to primary treatment with total mesorectal excision (TME). The aim of this retrospective study was to determine whether there is a difference in outcome between patients who underwent early salvage resection with TME after TEM, and those who underwent primary TME for rectal cancer. From 1997 to 2011, early salvage surgery with TME after TEM was performed in 25 patients in our institution. These patients were compared with 25 patients who underwent primary TME, matched according to gender, age (±2 years), cancer stage and operative procedure. Data were obtained from the patients' charts and reviewed retrospectively. No patients received preoperative chemotherapy. Perioperative data and oncological outcome were analysed. The Mann-Whitney U-test and Fisher's exact test were used to compare the results between the two groups. There was no significant difference between the two groups in median operating time (P = 0.39), median blood loss (P = 0.19) or intraoperative complications (P = 1.00). The 30-day mortality was 8 % (n = 2) among patients who underwent salvage TME after TEM, and no patients died in the primary TME group (P = 0.49). There was no significant difference between two groups of patients in the median number of harvested lymph nodes (P = 0.34), median circumferential resection margin (CRM) (P = 0.99) or the completeness of the mesorectal fascia plane. No local recurrences occurred among the patients with salvage TME, and there were 2 patients (8 %) with local recurrences among the patients with primary TME (P = 0.49). Distant metastasis occurred in one patient (4 %) after salvage TME and in 3 patients (12 %) with primary TME (P = 0.61). The median

  1. Revision Surgery for Zygoma Reduction: Causes, Indications, Solutions, and Results from a 5-Year Review of 341 Cases.

    Science.gov (United States)

    Lee, Sang Woo; Jeong, Yeon Woo; Myung, Yujin

    2017-02-01

    Many patients undergo a revision surgery after malar reduction, which is one of the most popular aesthetic surgeries in Asia. We reviewed the leading causes of revision for malar reduction surgery to establish proper indications for revision, seek adequate surgical strategies, and share the results from revision surgical cases. A retrospective review was conducted involving 341 patients who underwent malar reduction reoperation between March 2010 and June 2015. Surgical strategies were decided based upon specific problems and complaints from the previous surgery. Facial photographs, cephalography, and computed tomography images were analyzed, and a patient satisfaction survey was conducted before and after the surgery. A total of 341 patients (321 women, 20 men; average age, 26.6 years, range 18-40 years) were included. The main causes of reoperations were subjective dissatisfaction and nonunion-related symptoms. Undercorrection of the zygomatic body and arch (n = 175, 51.3%) was the most frequent reason for dissatisfaction. The patients underwent revision surgeries via different techniques and strategies based on previous problems from primary surgery, and postoperative patient satisfaction was high. Complications occurred in 35 patients (10.3%) after revision. Based on the results of this study, patient dissatisfaction with the procedure can be minimized beforehand through accurate goal identification and careful planning. Bone nonunion is usually due to excessive bone resection during zygoma reduction surgery. Careful selection of the reposition site and appropriate fixation based on a thorough understanding of masseter action are essential in ensuring satisfactory outcomes without adverse side effects. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  2. Total weight loss associated with increased physical activity after bariatric surgery may increase the need for total joint arthroplasty.

    Science.gov (United States)

    Trofa, David; Smith, Eric L; Shah, Vivek; Shikora, Scott

    2014-01-01

    Retrospectively, our institution noticed an increased number of patients undergoing total joint arthroplasty (TJA) after bariatric surgery. Considering that bariatric surgery is a proven modality to reduce osteoarthritic pain, we sought to identify a reason some patients may later require TJA. The objective of this study was to investigate the hypothesis that rapid or increased weight loss after bariatric surgery may be a risk factor for TJA. Weight loss parameters were retrospectively assessed in 15 bariatric surgery patients who subsequently received a primary TJA and compared with matched bariatric controls. Patients who required a TJA lost 27.9% more of their body mass index (BMI) compared with controls (P = .049). Furthermore, patients who underwent TJA 25-48 months postbariatric surgery lost 78.2% more of their BMI compared with controls (Pweight loss is universally protective against arthritis and merit larger prospective investigations. © 2013 American Society for Bariatric Surgery Published by American Society for Metabolic and Bariatric Surgery All rights reserved.

  3. [The profile surgery. Mandibular osteotomies].

    Science.gov (United States)

    Sancho, M A; Grande, C; Parri, F J; Rivera, A; Sarget, R; Morales, L

    1996-04-01

    During the years 1987-1994, 31 mandibular osteotomies have been performed in 25 patients, 15 had mandibular alteration alone, 10 of them with prognatism, 2 with microretrognatia and 3 with chin hipoplasia. The other 10 had a combined maxillary-mandibular alteration with hipoplasia and maxillary retrussion. The preoperative work-up included cephalometric and dental study, and a cast model was done to asses the theoretical benefic of the osteotomy. All these patients underwent orthodontic treatment before and after surgery. The results have been good or very good in 96% of the cases. The ortognatic surgery offers significant aesthetic and functional improvement to these patients.

  4. Glaucoma Surgery Outcome in Rwanda.

    Science.gov (United States)

    De Smedt, Stefan K; Fonteyne, Yannick S; Muragijimana, Felicienne; Palmer, Katie; Murdoch, Ian

    2016-08-01

    To assess long-term intraocular pressure (IOP) outcome after adult trabeculectomy surgery in Central Africa. All adult glaucoma patients who underwent trabeculectomy surgery in the Kabgayi Eye Unit, Rwanda between August 2003 and March 2008 were invited for a follow-up visit. Surgical and clinical data were collected from medical records. At the study visit, best-corrected visual acuity was measured and Goldmann applanation tonometry and biomicroscopy were done. Good IOP outcome was defined as both an IOPglaucoma management in Africa. However, the IOP control reduced at a follow-up duration beyond 2 years, highlighting the importance of regular long-term follow-up.

  5. Laparoscopic revisional surgery after Roux-en-Y gastric bypass and sleeve gastrectomy.

    Science.gov (United States)

    Morales, Mario P; Wheeler, Andrew A; Ramaswamy, Archana; Scott, J Stephen; de la Torre, Roger A

    2010-01-01

    Failure of primary bariatric surgery is frequently due to weight recidivism, intractable gastric reflux, gastrojejunal strictures, fistulas, and malnutrition. Of these patients, 10-60% will undergo reoperative bariatric surgery, depending on the primary procedure performed. Open reoperative approaches for revision to Roux-en-Y gastric bypass (RYGB) have traditionally been advocated secondary to the perceived difficulty and safety with laparoscopic techniques. Few studies have addressed revisions after RYGB. The aim of the present study was to provide our experience regarding the safety, efficacy, and weight loss results of laparoscopic revisional surgery after previous RYGB and sleeve gastrectomy procedures. A retrospective analysis of patients who underwent laparoscopic revisional bariatric surgery for complications after previous RYGB and sleeve gastrectomy from November 2005 to May 2007 was performed. Technical revisions included isolation and transection of gastrogastric fistulas with partial gastrectomy, sleeve gastrectomy conversion to RYGB, and revision of RYGB. The data collected included the pre- and postoperative body mass index, operative time, blood loss, length of hospital stay, and intraoperative and postoperative complications. A total of 26 patients underwent laparoscopic revisional surgery. The primary operations had consisted of RYGB and sleeve gastrectomy. The complications from primary operations included gastrogastric fistulas, refractory gastroesophageal reflux disease, weight recidivism, and gastric outlet obstruction. The mean prerevision body mass index was 42 ± 10 kg/m(2). The average follow-up was 240 days (range 11-476). The average body mass index during follow-up was 37 ± 8 kg/m(2). Laparoscopic revision was successful in all but 1 patient, who required conversion to laparotomy for staple line leak. The average operating room time and estimated blood loss was 131 ± 66 minutes and 70 mL, respectively. The average hospital stay was 6

  6. Magnetic resonance in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Cabada, M.T.; Gomez, M.N.; Friera, A.; Carvajal, I.; Garcia, A.

    1995-01-01

    We assess the role of magnetic resonance (MR) as an imaging method for the preoperative localization of pathological parathyroid glands in a series of 14 patients with primary hyperparathyroidism secondary to parathyroid adenoma who underwent surgical resection. We selected 14 patients diagnosed as having primary hyperparathyroidism who underwent preoperative MR. All the studies were carried out with a toshiba MRT 50 MR unit with a 0.5 T superconductor magnet. MR located the adenoma in nine of the 14 patients (64%), including the only two who had previously undergone surgery. Our results indicate that MR without contrast is not effective in the preoperative localization of parathyroid adenomas and should be performed only in patients with recurrent hyperparathyroidism or that persisting after surgical treatment. (Author)

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

    Science.gov (United States)

    Haugstad, Marta; Moosmayer, Stefan; Bragadόttir, Ragnheiður

    2017-05-01

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

  8. Multidisciplinary management of stage III breast cancer: chemotherapy, surgery and radiotherapy

    International Nuclear Information System (INIS)

    Chavez P, C.E. de; Vigil R, C.

    1998-01-01

    A prospective study, in which women with clinically stage III breast cancer underwent multidisciplinary therapy by using primary (neoadjuvant) chemotherapy, followed randomly by loco-regionally therapy, either with surgery or radiotherapy; and postoperative systemic chemotherapy, in both groups of treatment, was conduced at the Peruvian Institute of Neoplasic Diseases. This is a randomized, prospective, descriptive, interventionist and analytical clinical study. Clinical response to primary chemotherapy was positive in 80,23% of cases, complete resolution was observed in 18,60% of cases, partial resolution in 61,63% of cases and there was absolutely no response in 19,77% of cases. No residual neoplasm, pathologically proven, was observed in 8,33% of surgical cases. We demonstrated that high-dose primary chemotherapy, using only 2 drugs (cyclophosphamide and 5-fluorouracil), used here because of its lower price, brought similar results compared to anthracycline-containing regimens. Recurrence rates were similar and showed no significative differences in both groups of treatment. Both, the disease-free survival (DFS) and overall survival (OS), were similar in both groups of treatment. We also demonstrated that in patients who underwent surgery, the lower the number of axillary lymph node metastases, the higher the overall survival (OS) time. Patients with clinically stage III (A or B) breast cancer, showed similar clinical responses to neoadjuvant chemotherapy, they also showed similar recurrence rates, DFS and OS, when treated with radical mastectomy or radiotherapy. (authors)

  9. Does Simultaneous Third Molar Extraction Increase Intraoperative and Perioperative Complications in Orthognathic Surgery?

    Science.gov (United States)

    Steinbacher, Derek M; Kontaxis, Katrina L

    2016-06-01

    Prior to orthognathic surgery, most surgeons recommend third molar extraction. Espoused reasons include potential risk for infection, untoward osteotomies, and worsened postoperative discomfort. However, in addition to being another procedure for the patient, this may necessitate a longer preorthognathic surgery phase. The purpose of this study is to compare the outcomes of orthognathic surgery with staged versus simultaneous third molar extractions. This was a retrospective analysis of patients who underwent orthognathic surgery from 2013 to 2014, with at least a 1-year follow-up period. Patients were stratified into 2 groups: Extraction of third molars at the time of surgery and prior extraction of third molars. Primary outcomes included the occurrence of unfavorable splits, infection, bleeding, malocclusion, and hardware failure. Secondary outcomes were procedure time, postoperative pain, and length of stay. Pearson χ tests and 2-tailed unpaired t tests were performed to determine if there was an association between the simultaneous removal of third molars and the primary and secondary outcome measures, respectively. One hundred patients were included in the study. Forty-nine patients had third molars extracted at the time of surgery and fifty-one did not. Complications included unfavorable split, postoperative infection, mild postoperative bleeding, postoperative malocclusion, and hardware failure. There was no significant difference in the incidence of complications in both groups. Procedure time was not considerably increased with extractions. There was no significant difference in postoperative pain or length of stay between both groups. Removing third molars concurrently with orthognathic surgery does not increase the risk of adverse outcomes, nor does it significantly influence hospital course.

  10. Innovations in Bariatric Surgery.

    Science.gov (United States)

    Zhu, Catherine; Pryor, Aurora D

    2015-11-01

    Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.

  11. Reasons and outcomes of laparoscopic revisional surgery after laparoscopic adjustable gastric banding for morbid obesity.

    Science.gov (United States)

    Patel, Sheetal; Eckstein, Jeremy; Acholonu, Emeka; Abu-Jaish, Wasef; Szomstein, Samuel; Rosenthal, Raul J

    2010-01-01

    Laparoscopic adjustable gastric banding (LAGB) is a purely restrictive procedure that has been proved to be an effective tool in achieving weight loss. The low operative morbidity and reversibility are often seen as advantages of this procedure compared with other bariatric approaches. We have attempted to define the reasons for revisional surgery after LAGB and the outcomes. A retrospective review of a prospectively maintained database was performed from February 2001 to October 2008 at a center of excellence after institutional review board approval. The patients who had undergone revisional surgery after primary LAGB were evaluated. Of 343 patients who had undergone primary LAGB, 60 subsequently underwent a revisional procedure. In addition, 28 revisional procedures were performed on patients who had undergone primary LAGB at an outside institution. These procedures included 39 (44.3%) band removals alone, 12 (13.6%) band removals with conversion to sleeve gastrectomy, 13 (14.8%) band removals with conversion to Roux-en-Y gastric bypass, 9 (10.2%) band repositioning, and 2 (2.3%) band replacements. In addition, 13 (14.8%) port-related procedures (3 relocations, 6 reconnections, and 4 replacements/removals) were performed. Although reversible and efficacious, LAGB appears to have a high incidence of complications requiring revisional surgery and/or band removal. The results of our study have shown that laparoscopic revisional surgery after primary LAGB is safe and can be performed with minimal morbidity. Copyright 2010 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. Primary pulmonary sarcomatoid carcinomas.

    Science.gov (United States)

    Avila Martínez, Régulo José; Marrón Fernández, Carmen; Hermoso Alarza, Fátima; Zuluaga Bedoya, Mauricio; Meneses Pardo, José Carlos; Gámez García, A Pablo

    2013-09-01

    To describe the characteristics and the result of surgical treatment in a series of patients with primary pulmonary sarcomatoid carcinoma (PSC). A descriptive study of 11 patients with primary PSC who were treated by the Thoracic Surgery Department at the Hospital Universitario 12 de Octubre in Madrid (Spain) between 2005 and 2009. We analyzed age, gender, histologic type, pathological stage, type of surgery and survival (in months). Ten patients were male and 11 were smokers; mean age of was 55. The pathologic stages were: 4 stage IIA, 3 stage IIB, 2 stage IB and 2 stage IA. The most frequent histologic type was pleomorphic carcinoma, which was found in 5 cases. Complete resection was performed in 10 cases, and 7 received adjuvant therapy. Seven are disease-free after a mean follow-up period of 49 months. Complete surgery in the initial stages of primary PSC can improve survival. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

  13. Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery.

    Science.gov (United States)

    Jones, Philip M; Cherry, Richard A; Allen, Britney N; Jenkyn, Krista M Bray; Shariff, Salimah Z; Flier, Suzanne; Vogt, Kelly N; Wijeysundera, Duminda N

    2018-01-09

    Handing over the care of a patient from one anesthesiologist to another occurs during some surgeries and might increase the risk of adverse outcomes. To assess whether complete handover of intraoperative anesthesia care is associated with higher likelihood of mortality or major complications compared with no handover of care. A retrospective population-based cohort study (April 1, 2009-March 31, 2015 set in the Canadian province of Ontario) of adult patients aged 18 years and older undergoing major surgeries expected to last at least 2 hours and requiring a hospital stay of at least 1 night. Complete intraoperative handover of anesthesia care from one physician anesthesiologist to another compared with no handover of anesthesia care. The primary outcome was a composite of all-cause death, hospital readmission, or major postoperative complications, all within 30 postoperative days. Secondary outcomes were the individual components of the primary outcome. Inverse probability of exposure weighting based on the propensity score was used to estimate adjusted exposure effects. Of the 313 066 patients in the cohort, 56% were women; the mean (SD) age was 60 (16) years; 49% of surgeries were performed in academic centers; 72% of surgeries were elective; and the median duration of surgery was 182 minutes (interquartile [IQR] range, 124-255). A total of 5941 (1.9%) patients underwent surgery with complete handover of anesthesia care. The percentage of patients undergoing surgery with a handover of anesthesiology care progressively increased each year of the study, reaching 2.9% in 2015. In the unweighted sample, the primary outcome occurred in 44% of the complete handover group compared with 29% of the no handover group. After adjustment, complete handovers were statistically significantly associated with an increased risk of the primary outcome (adjusted risk difference [aRD], 6.8% [95% CI, 4.5% to 9.1%]; P < .001), all-cause death (aRD, 1.2% [95% CI, 0.5% to 2%]; P

  14. The Bt-DUX: Development of a subjective measure of health-related quality of life in patients who underwent surgery for lower extremity malignant bone tumor

    NARCIS (Netherlands)

    W.P. Bekkering (Peter); T.P.M. Vliet Vlieland (Theodora); H.M. Koopman (Hendrik); G.R. Schaap (Gerard); H.W.B. Schreuder; A. Beishuizen (Auke); W.J.E. Tissing (Wim); P.M. Hoogerbrugge (Peter); J.K. Anninga (Jacob); A.H.M. Taminiau (Antonie)

    2009-01-01

    textabstractBackground. To examine the practical applicability, internal consistency, and validity of the Bt-DUX, a disease-specific Health Related Quality of Life (HRQoL) instrument. The Bt-Dux was developed to examine patients' individual values of their life after a malignant bone tumor of the

  15. Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

    Directory of Open Access Journals (Sweden)

    Osman Karakus

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS system Class 4 (50%, Cormack-Lehane classification (CLS Grade 4 (95.7%, previous knowledge of difficult airway (86.2%, restricted neck movements (cervical ROM (75.8%, short thyromental distance (TMD (81.6%, vocal cord mass (49.5% as indicated in parentheses (p < 0.0001. MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

  16. Retrospective comparison between preoperative diagnosis by International Consensus Diagnostic Criteria and histological diagnosis in patients with focal autoimmune pancreatitis who underwent surgery with suspicion of cancer

    DEFF Research Database (Denmark)

    Ikeura, Tsukasa; Detlefsen, Sönke; Zamboni, Giuseppe

    2014-01-01

    in 7) with a diagnosis of AIP based on histology of surgical specimens were classified according to ICDC based on their preoperative data. RESULTS: Pancreatic core biopsies and diagnostic steroid trial were not preoperatively performed in any of the patients. Based on preoperative data, ICDC diagnosed...... 6 patients (20%) as having type 1 AIP and 24 (80%) as probable AIP. Assuming all patients had responded to a steroid trial preoperatively, ICDC would have diagnosed 8 patients (27%) as having type 1 AIP, 4 (13%) as type 2 AIP, 10 as AIP-not otherwise specified (33%), and 8 (27%) as probable AIP....... In the hypothetical situation, 7 of 8 type 1 AIP patients and 3 of 3 type 2 AIP patients would have been classified into the correct subtype of AIP. CONCLUSIONS: A steroid trial enhances the possibility of correctly diagnosing AIP by ICDC despite the lack of histology. However, some patients cannot be diagnosed...

  17. Rodding Surgery

    Science.gov (United States)

    ... usually undertaken as a scheduled elective procedure. An optimal age for a first rodding surgery has not ... which may prevent or postpone the need for replacement. The smallest diameter expanding rods are still too ...

  18. Lung surgery

    Science.gov (United States)

    ... the pulmonary artery ( pulmonary embolism ) Treat complications of tuberculosis Video-assisted thoracoscopic surgery can be used to ... Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed ...

  19. Bariatric Surgery

    Science.gov (United States)

    ... action of certain hormones, such as ghrelin —“the hunger hormone.” People have these types of surgery if ... organizations to further patient education on hormone related issues. Network Sponsors The Hormone Health Network is supported ...

  20. Epilepsy Surgery

    Science.gov (United States)

    ... and the portion of your brain that's involved: Memory problems. The temporal lobe handles memory and language functions, so surgery on this part ... computerized tomography (SPECT). The scan image varies in color depending on the amount of blood flow in ...

  1. After Surgery

    Science.gov (United States)

    After any operation, you'll have some side effects. There is usually some pain with surgery. There ... anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions. ...

  2. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... Barnett J, Mohanty A, Desai SK, Patterson JT. Neurosurgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, ...

  3. [Impact of timing of surgery on outcome in children with bilateral congenital cataract].

    Science.gov (United States)

    Kuhli-Hattenbach, C; Fronius, M; Kohnen, T

    2017-03-01

    The optimal time for surgical intervention in bilateral congenital cataract is still a matter of controversy. Herein, we evaluated clinical and functional results after bilateral congenital cataract surgery and performed subgroup analysis based on the age at the time of surgery. We retrospectively reviewed the records of 52 eyes of 26 children who underwent surgery for bilateral congenital cataract without intraocular lens implantation within the first 12 months of life; 16 eyes underwent phacoaspiration within the first 10 weeks of life (group A) and 26 eyes had cataract extraction at an age of >10 weeks (group B). We defined the primary outcome measure to be the prevalence of mild, moderate, and severe amblyopia in relationship to age-dependent visual acuity norms after a mean follow-up of 59.7 ± 43.2 months. Secondary outcome measures were interocular difference of visual acuity and the presence of strabismus, nystagmus, posterior capsule opacification, and aphakic glaucoma. The prevalence of amblyopia was not statistically different between the two age groups. Of all children, 62.5 % (A) and 61.1 % (B) developed age-dependent normal visual acuity or mild amblyopia. However, the younger cohort developed significantly less strabismus than the older cohort (P = 0.03). There was a strong relationship between cataract surgery within the first 14 weeks of life and the development of aphakic glaucoma. All children developing secondary cataract formation underwent cataract surgery in the first 20 weeks of life. Our results suggest that long-term prevalence of mild, moderate, and severe amblyopia is similar between the two cohorts of bilateral congenital cataract eyes based on the age ≤ or >10 weeks at the time of surgery. Because there is a strong relationship between postoperative complications and a young age at the time of cataract surgery, close postoperative follow-up is essential. Strabismus is less likely to develop in infants after

  4. A safe technique for in-the-bag intraocular lens implantation in pediatric cataract surgery.

    Science.gov (United States)

    Khokhar, Sudarshan; Sharma, Reetika; Patil, Bharat; Sinha, Gautam; Nayak, Bhagabat; Kinkhabwala, Ravish Akhilkumar

    2015-01-01

    To describe a safe technique for in-the-bag intraocular lens (IOL) implantation in pediatric cataract patients who undergo lens aspiration with primary posterior capsulorhexis and anterior vitrectomy. Sixty eyes of 45 consecutive patients with congenital/developmental cataract underwent lens aspiration with primary posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy and in-the-bag IOL implantation using the described technique of IOL implantation using anterior capsule as support. All eyes had stable IOL at the end of surgery and none of the eyes had lens decentration/dislocation in posterior vitreous. Implantation of in-the-bag IOL is difficult in children who undergo primary PCCC with anterior vitrectomy. Our technique of implanting IOL by pushing it against the back surface of anterior capsule is a safe method and results in no complications related to faulty IOL implantation.

  5. Initial results of robot-assisted thoracoscopic surgery in Japan.

    Science.gov (United States)

    Nakamura, Hiroshige; Suda, Takashi; Ikeda, Norihiko; Okada, Morihito; Date, Hiroshi; Oda, Makoto; Iwasaki, Akinori

    2014-12-01

    As surgical robots have become increasingly used, verification of their usefulness in the general thoracic surgery field is required. Initial results of robot-assisted thoracoscopic surgery in Japan were investigated. A questionnaire survey was performed to retrospectively examine the current status of robotic surgery for general thoracic disease in Japan. The subjects were 112 cases performed by the end of September 2012 at 9 institutions. There were 60 cases of primary lung cancer, 38 cases of anterior-middle mediastinal disease, and 14 cases of posterior mediastinal disease. In lung cancer cases, the operative time was 284.7 min, the blood loss was 129 mL, the drainage period was 3.3 days, and the conversion rate was 3.3 %. The incidence of postoperative complications was 6.7 %. The postoperative hospital stay was 8.2 days. In cases of anterior-middle mediastinal disease, the operative time was 184.3 min, the blood loss was 43.8 mL, the drainage period was 2.3 days, and there was no conversion. The incidence of postoperative complications was 7.9 %. The postoperative hospital stay was 7.1 days. In cases of posterior mediastinal disease, the operative time was 142.6 min, the blood loss was 61.4 mL, the drainage period was 1.6 days, and there was no conversion. No postoperative complication developed in any case. The postoperative hospital stay was 5 days. In all cases underwent robotic surgery, there was no operation related mortality. Robotic surgery was safely introduced, and the incidence of postoperative complications tended to be low, although the operative time was long. Preparations for its employment in advanced medical care and coverage by national health insurance are urgent issue.

  6. Primary Carcinosarcoma of the Skin

    OpenAIRE

    El Harroudi, Tijani; Ech-charif, S.; Amrani, M.; Jalil, A.

    2010-01-01

    Primary cutaneous carcinosarcoma is a biphasic tumour containing both malignant epithelial and malignant mesenchymal elements. The disease is a rare malignant skin tumour of unknown aetiology with significant potential to recur locally and to metastasise. Surgery is the primary therapeutic modality. We describe an unusual case of primary cutaneous Carcinosarcoma localised in the hand.

  7. Factors associated with strabismus after cataract extraction and primary intraocular lens implantation in congenital cataracts

    Directory of Open Access Journals (Sweden)

    Soo Jung Lee

    2014-06-01

    Full Text Available AIM: To evaluate factors associated with the development of strabismus after cataract extraction and primary intraocular lens implantation.METHODS: The medical records of 122 patients, aged 1.5mo to 9y, who had undergone cataract extraction with primary intraocular lens implantation between January 1993 and August 2011 were reviewed. Fourteen patients (17 eyes with strabismus before cataract surgery were excluded. Patients were divided into those with congenital bilateral cataracts (64 patients, 128 eyes and those with unilateral cataracts (44 patients, 44 eyes. The associations between the development of strabismus and age at cataract surgery, pre- and post-cataract extraction corrected distance visual acuity (CDVA, interocular CDVA difference, nystagmus, surgical method, and secondary cataract were evaluated.RESULTS: Factors significantly associated with the development of strabismus included age at cataract surgery (≤1y, preoperative mean CDVA ≤20/100, presence of nystagmus in the bilateral cataract group and postoperative interocular CDVA difference >20/70 in the unilateral group. Postoperative CDVA ≤20/100 and preservation of posterior capsule, and presence of secondary cataract were significant factors in both groups.CONCLUSION: Children with congenital cataracts should be monitored carefully after cataract surgery for the development of strabismus, especially when they underwent surgery at age ≤1y, and they have nystagmus, large postoperative interocular CDVA difference, poor preoperative and postoperative CDVA, preservation of the posterior capsule, or secondary cataract.

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ... to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is ...

  9. Primary Cardiac Tumours: A Single-Center 41-Year Experience

    Science.gov (United States)

    Steger, Christina Maria; Hager, Thomas; Ruttmann, Elfriede

    2012-01-01

    Primary cardiac tumours are extremely rare with the most commonest being left atrial myxomas. In general, surgical resection is indicated, whenever the tumour formation is mobile and embolization can be suspected. Within 17280 patients receiving heart surgery at the Innsbruck Medical University, 78 patients (0.45%) underwent tumourectomy of primary cardiac tumours. The majority of patients (63) suffered from a left or right atrial myxoma, 12 showed a papillary fibroelastoma of the valves at echocardiographical or histological examination, 1 suffered from a hemangioma, 1 from a chemodectoma, and another one from a rhabdomyosarcoma. The mean age of cardiac tumour patients was 54.29 ± 13.28 years (ranging from 18 to 83 years). 67.95% of the patients were female and 32.05% were male. The majority of tumours were found incidentally; 97.44% of the patients showed no tumour recurrence. PMID:22792486

  10. Comparative study to determine the need for intraoperative colonic irrigation for primary anastomosis in left-sided colonic emergencies.

    Science.gov (United States)

    Ortiz, H; Biondo, S; Ciga, M A; Kreisler, E; Oteiza, F; Fraccalvieri, D

    2009-07-01

    To compare the outcome of resection and primary anastomoses in patients undergoing emergency surgery of the left colon with and without intraoperative colonic irrigation. From January 2004 to December 2006, 102 consecutive patients with acute occlusion or perforation of the left colon were operated on an emergency basis in two Coloproctology units. According to the sample size calculation, 61 patients from one unit underwent surgery with intraoperative colonic irrigation, whereas 41 patients from the second unit underwent surgery without intraoperative colonic irrigation. The endpoints were mortality and morbidity. Thirty (49.2%) patients with intraoperative colonic irrigation and 8 (19.5%) without colonic irrigation developed one or more complications postoperatively (odds ratio 4.0, 95% CI 1.6-10.0, P = 0.002). An increased number of wound infections was seen in the group managed with colonic irrigation 15 vs 3 (P = 0.034). The postoperative mortality rate and the occurrence of dehiscence of the anastomoses were similar in both study groups. The present findings indicate that resection and primary anastomosis in patients undergoing emergency surgery of the left colon can be safely performed without intraoperative colonic irrigation.

  11. Perioperative Rosuvastatin in Cardiac Surgery.

    Science.gov (United States)

    Zheng, Zhe; Jayaram, Raja; Jiang, Lixin; Emberson, Jonathan; Zhao, Yan; Li, Qi; Du, Juan; Guarguagli, Silvia; Hill, Michael; Chen, Zhengming; Collins, Rory; Casadei, Barbara

    2016-05-05

    Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (PSTICS ClinicalTrials.gov number, NCT01573143.).

  12. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  13. Mohs micrographic surgery

    Science.gov (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  14. Total thyroidectomy as primary elective procedure in multinodular thyroid disease

    International Nuclear Information System (INIS)

    Sheikh, I.A.; Haider, I.Z.; Haroon, A.; Ashfaq, M.

    2009-01-01

    Multinodular goitre is one of the commonest thyroid diseases encountered in the practice of surgery. The most common surgery being performed for multinodular goitre is subtotal thyroidectomy. Total thyroidectomy is designed to remove all of the thyroid tissue. The objective of this study was to evaluate total thyroidectomy as a primary elective procedure for treatment of multinodular thyroid disease. This descriptive study was carried out at Combined Military Hospital Rawalpindi from June 2003 to September 2006. 88 patients of multinodular thyroid disease were included. Patients having evidence of recurrent laryngeal nerve damage, recurrent goitre, evidence of altered parathyroid functions or evidence of malignancy were excluded. All patients underwent total thyroidectomy by the same team of surgeons and the patients were closely followed up for postoperative complications especially in terms of recurrent laryngeal nerve damage and hypocalcaemic tetany. No major postoperative complication was noted. Only 1 patient (1.14%) developed unilateral recurrent laryngeal nerve damage and 2 patients (2.27%) developed transient hypocalcaemia that recovered quickly. Total thyroidectomy as a primary elective procedure in multinodular thyroid disease is a safe option and it removes the disease proces