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Sample records for underwent urgent surgery

  1. 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.

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    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.

  2. Anticipating urgent surgery in operating room departments

    NARCIS (Netherlands)

    van der Lans, M.; Hans, Elias W.; Hurink, Johann L.; Wullink, Gerhard; van Houdenhoven, M.; Kazemier, G.

    2005-01-01

    Operating Room (OR) departments need to create robust surgical schedules that anticipate urgent surgery, while minimizing urgent surgery waiting time and overtime, and maximizing utilization. We consider two levels of planning and control to anticipate urgent surgery. At the tactical level, we study

  3. Logistics and outcome in urgent and emergency colorectal surgery

    DEFF Research Database (Denmark)

    Elshove-Bolk, J.; Ellensen, V. S.; Baatrup, G.

    2010-01-01

    Aim: Infrastructure-related factors are seldom described in detail in studies on outcome after surgical procedures. We studied patient, procedure, physician and infrastructure characteristics and their effect on outcome at a Norwegian University hospital. Method: All patients admitted between 1st...... January 2002 and 30th June 2003 who underwent urgent or emergency colorectal surgery were extracted from the hospital databases and retrospectively analysed. Results: There were 196 patients. The overall complication rate was 39%. Forty-six (24%) patients died during admission after surgery. Those who......). Conclusion: The outcome after emergency colorectal surgery was consistent with the literature but the infrastructure was not optimal. Improvements may be achieved by a focus on decreasing waiting times, abandoning of out-of-office emergency surgery and increasing the involvement of senior staff....

  4. Anaesthesia for urgent and emergency surgery.

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    Brusseau, Roland; McCann, Mary Ellen

    2010-11-01

    The general principles that guide a pediatric anesthesiologist in the care of a newborn needing urgent and emergent neonatal surgery are reviewed. These include careful evaluation and assessment of the newborn including a detailed prenatal history. A brief review of neonatal physiology including the development of the autonomic nervous system and the development of nociceptive pathways is discussed and how important it is to suppress the stress response to surgical intervention in order to improve surgical outcomes. Most of the current general anesthetics have been associated with anesthetic neurotoxicity in juvenile mammals and several epidemiologic studies in human infants and toddlers have linked surgery occurring in the first 3 years of life with neurocognitive delays in school age children. These concerns are discussed in this paper. Practical considerations about neonatal intubation, line placement and intraoperative fluid management are also reviewed. And the anesthetic management of specific neonatal conditions such as congenital diaphragmatic hernias, transesophageal fistulas, gastroschisis and omphaloceles, necrotizing enterocolitis and meningomyeloceles is examined. Copyright © 2010. Published by Elsevier Ireland Ltd.

  5. 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...

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

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    Valérie Huynh-Trudeau

    2015-01-01

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

  7. Urgent Carotid Surgery: Is It Still out of Debate?

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    C. Battocchio

    2012-01-01

    Full Text Available Patients with symptomatic tight carotid stenosis have an increased short-time risk of stroke and an increased long-term risk of ischaemic vascular events compared with the general population. The aim of this study is to assess the safety, efficacy, and limitations of urgent CEA or CAS, in patients with carotid stenosis greater than 70% and clinically characterized by recurrent TIA or brain damage following a stroke (<2.5 cm. This study involved 28 patients divided into two groups. Group A consisted of sixteen patients who had undergone CEA, and group B consisted of twelve patients who had undergone CAS. Primary endpoints were mortality, neurological morbidity (by NIHSS and postoperative hemorrhagic cerebral conversion, at 30 days. Ten patients (62.5% of group A experienced an improvement in their initial neurological deficit while in 4 cases (26% the deficit remained stable. Two cases of neurologic mortality are presented. At 1 month, 9 patients (75% of group B experienced an improvement in their initial neurological deficit while 3 patients (25% had a neurological impairment. Urgent or deferred surgical or endovascular treatment have a satisfactory outcome considering the profile in very high-risk patient population. Otherwise in selected patients CEA seems to be preferred to CAS.

  8. [Anaesthetic management of patients in the third trimester of pregnancy undergoing urgent laparoscopic surgery. Experience in a general hospital].

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    López-Collada Estrada, María; Olvera Martínez, Rosalba

    2016-01-01

    Laparoscopic surgery is well accepted as a safe technique when performed on a third trimester pregnant woman. The aim is to describe the anaesthetic management of a group of patients undergoing this type of surgery. An analysis was made of records of 6 patients in their third trimester of pregnancy and who underwent urgent laparoscopic surgery from 2011 to 2013. The study included 6 patients, with a diagnosis of acute cholecystitis in 4 of them. The other 2 patients had acute appendicitis, both of who presented threatened preterm labour. The most frequent indications for laparoscopic surgery during the last trimester of birth were found to be acute cholecystitis and acute appendicitis. Acute appendicitis is related to an elevated risk of presenting threatened preterm labour. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

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

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    Alain Moré Duarte

    2016-01-01

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

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

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    Alessandro Varrica

    2015-01-01

    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

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

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    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.

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

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    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.

  13. Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures.

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    Kothari, Anai N; Zapf, Matthew A C; Blackwell, Robert H; Markossian, Talar; Chang, Victor; Mi, Zhiyong; Gupta, Gopal N; Kuo, Paul C

    2015-10-01

    We hypothesized that perioperative hospital resources could overcome the "weekend effect" (WE) in patients undergoing emergent/urgent surgeries. The WE is the observation that surgeon-independent patient outcomes are worse on the weekend compared with weekdays. The WE is often explained by differences in staffing and resources resulting in variation in care between the week and weekend. Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007 to 2011 and linked to the American Hospital Association (AHA) Annual Survey Database to determine hospital level characteristics. Extended median length of stay (LOS) on the weekend compared with the weekdays (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE. Included were 126,666 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified full adoption of electronic medical records (OR 4.74), home health program (OR 2.37), pain management program [odds ratio (OR) 1.48)], increased registered nurse-to-bed ratio (OR 1.44), and inpatient physical rehabilitation (OR 1.03) as resources that were predictors for overcoming the WE. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared with those hospitals that overcame the WE (P general surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care.

  14. Single port laparoscopic colorectal surgery in debilitated patients and in the urgent setting.

    LENUS (Irish Health Repository)

    Moftah, M

    2012-09-01

    Single port laparoscopy is a relatively new niche in the expanding spectrum of minimal access surgery for colorectal disease. To date the published experience has predominantly focused on planned operations for neoplasia in the elective setting. It seems probable however that the benefits of minimal abdominal wounding will be greatest among those patients with the highest risk of impaired wound healing. Combining this with the impression of improved cosmesis suggests that (the mostly young) patients with inflammatory bowel disease needing urgent operation are the most likely to appreciate and benefit from the extraoperative effort. The extension of single port surgery to the acute setting and for debilitated individuals is therefore a likely next step advance in broadening the category of patients for whom it represents a real benefit and ultimately aid in focusing by selection the subgroups for whom this technique is best suited and most appropriate. We describe here our approach (including routine use of a surgical glove port) to patients presenting for urgent colorectal operation for benign disease. As provision of specialized approaches regardless of timing or mode of presentation is a defining component of any specialty service, this concept will soon be more fully elucidated and established.

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

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    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.

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

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    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.

  17. Managing urgent surgery as a process: Case study of a trauma center.

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    Torkki, Paulus Mikael; Alho, Antti Ilmari; Peltokorpi, Antti Veikko; Torkki, Markus Ilmari; Kallio, Pentti Ensio

    2006-01-01

    Industrial management principles could be used to improve the quality and efficiency of health care. In this study, we have evaluated the effects of a process management approach to trauma patient care. The major objective was to reduce the waiting times and increase the efficiency of the hospital. Urgent surgery care was analyzed as an overall process. The process development followed the Plan-Do-Check-Act (PDCA) cycle and was based on statistical analysis of certain performance metrics. Data were collected from hospital databases and by personnel interviews. To develop the process, the anesthesia induction was performed outside the operating room, better process guidance was developed, and patient flow was reorganized. The transition time for these changes was 1 year (2002 to 2003). Waiting times decreased by 20.5 percent (p quality of care without a need to increase personnel resources. The focus should be on reducing waiting times and waste times.

  18. Effects of implementation of an urgent surgical care service on subspecialty general surgery training

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    Wood, Leanne; Buczkowski, Andrzej; Panton, Ormond M.N.; Sidhu, Ravi S.; Hameed, S. Morad

    2010-01-01

    Background In July 2007, a large Canadian teaching hospital realigned its general surgery services into elective general surgery subspecialty-based services (SUBS) and a new urgent surgical care (USC) service (also know in the literature as an acute care surgery service). The residents on SUBS had their number of on-call days reduced to enable them to focus on activities related to SUBS. Our aim was to examine the effect of the creation of the USC service on the educational experiences of SUBS residents. Methods We enrolled residents who were on SUBS for the 6 months before and after the introduction of the USC service. We collected data by use of a survey, WEB eVAL and recorded attendance at academic half days. Our 2 primary outcomes were residents’ attendance at ambulatory clinics and compliance with the reduction in the number of on-call days. Our secondary outcomes included residents’ time for independent study, attendance at academic half days, operative experience, attendance at multidisciplinary rounds and overall satisfaction with SUBS. Results Residents on SUBS had a decrease in the mean number of on-call days per resident per month from 6.28 to 1.84 (p = 0.006), an increase in mean attendance at academic half days from 65% to 87% (p = 0.028), at multidisciplinary rounds (p = 0.002) and at ambulatory clinics and an increase in independent reading time (p = 0.015), and they reported an improvement in their work environment. There was no change in the amount of time residents spent in the operating room or in their overall satisfaction with SUBS. Conclusion Residents’ education in the SUBS structure was positively affected by the creation of a USC service. Compliance with the readjustment of on-call duties was high and was identified as the single most significant factor in enabling residents to take full advantage of the unique educational opportunities available only while on SUBS. PMID:20334744

  19. Specific improvement measures to reduce complications and mortality after urgent surgery in complicated abdominal wall hernia.

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    Martínez-Serrano, M A; Pereira, J A; Sancho, J; Argudo, N; López-Cano, M; Grande, L

    2012-04-01

    Morbidity and mortality are increased after urgent surgery for complicated abdominal wall hernia. We analysed prospectively early morbidity and mortality after implementing specific management measures in patients undergoing urgent hernia repair. The study population included 244 patients with complicated abdominal wall hernia requiring surgical repair on an emergency basis over 1-year period. Patients were managed according to a protocol that included specific actions to be implemented in the pre-, intra- and postoperative periods. Outcomes of these patients were compared with those of 402 undergoing similar operations before development of the protocol. Patients in whom acute complication was the first hernia symptom had higher mortality (7.2% vs 2.5%; P = 0.07) and were consulted later than 24 h (49.4% vs 36%; P = 0.044). Patients consulting later than 24 h had higher mortality (8.1% vs 1.4%, P = 0.017). Femoral hernias exhibited specific characteristics and were associated with higher mortality (13% vs 1.6%; P = 0.001). Overall, both groups had similar mortality (4.5% vs 4.1%; P = 0.8); complications (38.8% vs 37.7%; P = 0.2), and bowel resection rates (12.2% vs 11.5%; P = 0.8). Excluding the group of femoral hernias, the measures achieved a lower rate of severe complications (21.2% vs 10.3%; P = 0.04) and a decrease in mortality (2.9% vs 0.6%; P = 0.05) after bowel resection. Specific measures for improvement of management and prevention of complications and mortality were effective in patients without femoral hernia. To reduce mortality, the best applicable measure is early detection and to prioritize the scheduled operation of femoral hernias and those affecting high risk patients. The implementation of preventive and educational programs in high risk patients is essential.

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

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    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.

  1. 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.

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

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    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.

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

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    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.

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

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    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.

  5. 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)

  6. Urgent carotid stenting before cardiac surgery in a young male patient with acute ischemic stroke caused by aortic and carotid dissection

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    Popović Rade

    2016-01-01

    Full Text Available Introduction. Acute aortic dissection (AD is the most common life-threatening disorder affecting the aorta. Neurological symptoms are present in 17-40% of cases. The management of these patients is controversial. Case report. We presented a 37-year-old man admitted for complaining of left-sided weak-ness. Symptoms appeared two hours before admission. The patient had no headache, neither thoracic pain. Neurological examination showed mild confusion, left-sided hemiplegia, National Institutes of Health Stroke Scale (NIHSS score was 10. Ischemic stroke was suspected, brain multislice computed tomography (MSCT and angiography were performed and right intrapetrous internal carotid artery dissection noted. Subsequent color Doppler ultrasound of the carotid arteries showed dissection of the right common carotid artery (CCA. The patient underwent thoracic and abdominal MSCT aortography which showed ascending aortic dissection from the aortic root, propagating in the brachiocephalic artery and the right CCA. Digital subtraction angiography was performed subsequently and two stents were successfully implanted in the brachiocephalic artery and the right CCA prior to cardiac surgery, only 6 hours after admission. The ascending aorta was reconstructed with graft interposition and the aortic valve re-suspended. The patient was hemodynamically stable and with no neurologic deficit after surgery. Unfortinately, at the operative day 6, mediastinitis developed and after intensive treatment the patients died 35 days after admission. Conclusion. In young patients with suspected stroke and oscillatory neurological impairment urgent MSCT angiography of the brain and neck and/or Doppler sonography of the carotid and vertebral artery are mandatory to exclude carotid and aortic dissection. The prompt diagnosis permits urgent carotid stenting and cardiosurgery. To the best of our knowledge, this is the first published case of immediate carotid stenting in acute ischemic

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

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    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.

  8. 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

  9. [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

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

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    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.

  11. 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...

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

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    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.

  13. [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.

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

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    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.

  15. 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.

  16. 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.

  17. 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

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    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.

  18. 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.

  19. 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

  20. TRATAMIENTO QUIRÚRGICO URGENTE EN PACIENTE CON MIXOMA AURICULAR IZQUIERDO PEDICULADO / Emergency surgery in a patient with a pedunculated left atrial myxoma

    Directory of Open Access Journals (Sweden)

    Gustavo de Jesús Bermúdez Yera

    2009-12-01

    Full Text Available The intracavitary cardiac tumors have a special place in cardiac surgery due to their peculiar characteristics. Some of them are considered surgical emergencies. The resection must not be delayed because 8 to 10 percent of the affected patients can die, while waiting for surgery, as a result of an intracardiac obstruction of the blood flow. In everyday practice it is not common that patients with cardiac tumors undergo surgery just a few hours after the confirmation of the diagnosis by means of echocardiographic studies. The case of a patient, who had a diagnosis of a large pedunculated left atrial myxoma, with incursion into the left ventricle during diastole, and underwent an emergency surgery due to the threat of fragmentation and embolization resulting from the morphologic characteristics of the tumor, is presented in this article.

  1. [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

  2. Application of technetium-99m hexamethylpropylene amine oxime single-photon emission tomography to neurologic prognosis in patients undergoing urgent carotid surgery

    International Nuclear Information System (INIS)

    Shvera, I.Y.; Cherniavsky, A.M.; Ussov, W.Yu.; Plotnikov, M.P.; Sokolov, A.A.; Shipulin, V.M.; Chernov, V.I.

    1995-01-01

    In this study we aimed to work out a quantitative prognostic index for preoperative assessment of brain technetium-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission tomography (SPET) in patients referred for urgent carotid endarterectomy due to acute abstructive disease of the internal carotid artery (ICA) and neurological deficit. To this end we compared data from preoperative SPET studies with the postinterventional changes in neurological status in 20 patients (17 males, three females; mean age 53 years, SD 4 years) with acute ischaemic cerebral disorders induced by obstruction of the ICA. Carotid obstruction was diagnosed by ultrasound B-mode study. All patients underwent urgent carotid endarterectomy from the ICA. Patients were divided into two groups in accordance with the results of postoperative follow-up: group A comprised patients with significant (more than 3 points) postoperative improvement in neurological condition as quantified by the Canadian Neurological Scale (11 patients); group B consisted of patients with minimal improvement or deterioration (nine, three of whom died). All patients were studied preoperatively by 99m Tc-HMPAO SPET. The volume of nonperfused tissue (VS, cm 3 ) was quantified using the Mountz technique. Hypoperfused volume (V hypoperf , cm 3 ) in the affected hemisphere was calculated as the total volume of voxels with 99m Tc-HMPAO uptake hypoperf ). Patients with preoperative PF values 8.90 comprised patients who demonstrated minimal improvement or deterioration. PF values in the range 8.20-8.90 carried an indefinite prognosis. (orig.)

  3. Acidente vascular cerebral de etiologia rara com indicação cirúrgica urgente: caso clínico Stroke of a rare etiology with need of urgent surgery: case report

    Directory of Open Access Journals (Sweden)

    Ana Vieira Baptista

    2012-03-01

    Full Text Available Doente de 19 anos com quadro de febre com 8 dias de evolução e posterior instalação súbita de afasia, hemiparésia esquerda e alterações do comportamento. Aumento das proteínas de fase aguda no estudo analítico. TAC e RMN crânio-encefálicas revelaram lesão isquémica temporo-parietal direita. Ecocardiograma excluiu endocardite. Eco-döppler e angio-TAC carotídeo-vertebrais mostraram formação vegetante, móvel com a pulsação cardíaca, na artéria carótida comum direita. Submetido, de urgência, a cirurgia carotídea. Intraoperatoriamente constatou-se a presença de trombo ligeiramente aderente à artéria carótida comum e na dependência de lesão da íntima subjacente, tendo-se procedido à sua exérese e a arteriorrafia primária. Aponta-se como etiologia mais provável do quadro, uma vasculite secundária a infecção por HSV1 (infecção activa ou por Rickettsia conorii.19 years old patient with fever for 8 days associated with sudden aphasia, left hemiparesis and abnormal behavior. Increased acute phase proteins in the analytical study. Head CT scan and MRI revealed a right temporo-parietal ischemic lesion. An echocardiogram excluded endocarditis. Ultrasound and CT angiography scanning of the extracranial cerebral circulation showed a vegetative formation, mobile with the heartbeat, in the right common carotid artery. Submitted, urgently, to carotid surgery. Intraoperatively, a slightly adherent thrombus to the common carotid artery was found and in the dependence of an underlying injury to the intima. The thrombus was ressected and a primary arteriorrhaphy performed. It is pointed out a vasculitis secondary to HSV1 (active infection or to Rickettsia conorii infection as the most likely etiology of the clinic.

  4. 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

  5. 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.

  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. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.

    Science.gov (United States)

    Weiser, Thomas G; Haynes, Alex B; Dziekan, Gerald; Berry, William R; Lipsitz, Stuart R; Gawande, Atul A

    2010-05-01

    To assess whether implementation of a 19-item World Health Organization (WHO) Surgical Safety Checklist in urgent surgical cases would improve compliance with basic standards of care and reduce rates of deaths and complications. Use of the WHO Surgical Safety Checklist has been shown to be associated with significant reductions in complications and deaths. Before evaluation of this safety tool, concern was raised about whether its use would be practical or beneficial during urgent surgical procedures. We prospectively collected clinical process and outcome data for 1750 consecutively enrolled patients 16 years of age or older undergoing urgent noncardiac surgery before and after introduction of the WHO Surgical Safety Checklist in 8 diverse hospitals around the world; 842 underwent urgent surgery-defined as an operation required within 24 hours of assessment to be beneficial-before introduction of the checklist and 908 after introduction of the checklist. The primary end point was the rate of complications, including death, during hospitalization up to 30 days following surgery. The complication rate was 18.4% (n=151) at baseline and 11.7% (n=102) after the checklist was introduced (P=0.0001). Death rates dropped from 3.7% to 1.4% following checklist introduction (P=0.0067). Adherence to 6 measured safety steps improved from 18.6% to 50.7% (PSafety Checklist in urgent operations is feasible and should be considered.

  16. 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.

  17. MEDICAL SERVICE - URGENT CALLS

    CERN Multimedia

    Service Médical

    2000-01-01

    IN URGENT NEED OF A DOCTOR GENEVA: EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME: Open 24h/24h 748-49-50 AMG- Association Of Geneva Doctors: Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin 719-61-11 EMERGENCIES 719-61-11 CHILDREN'S EMERGENCIES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112   FRANCE: EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ...

  18. Urgent recommendation. Interim report

    International Nuclear Information System (INIS)

    Nakano, Masayuki

    2000-01-01

    The Investigation Committee for Critical Accident at Uranium Processing Plant was founded immediately after the accident to investigate the cause of the accident and to establish measures to prevent the similar accident. On September 30, 1999 around 10:35, the Japan's first criticality accident occurred at JCO Co. Ltd. Uranium processing plant (auxiliary conversion plant) located at Tokai-mura Ibaraki-ken. The criticality continued on and off for approximately 20 hours after the first instantaneous criticality. The accident led the recommendation of tentative evacuation and sheltering indoors for residents living in the neighborhood. The serious exposure to neutrons happened to three workers. The dominant effect is dose due to neutrons and gamma rays from the precipitation tank. When the accident took place, three workers dissolved sequentially about 2.4 kg uranium powder with 18.8 % enrichment in the 10-litter bucket with nitric acid. The procedure of homogenization of uranium nitrate was supposed to be controlled using the shape-limited narrow storage column. Actually, however, the thick and large precipitation tank was used. As a result, about 16.6 kg of uranium was fed into the tank, which presumably caused criticality. The first notification by JCO was delayed and the following communication was not smooth. This led to the delay of correct understanding of the situation and made the initial proper response difficult, then followed by insufficient communication between the nation, prefecture, and local authority. Urgent recommendations were made on the following items; (1) Safety measures to be taken at the accident site, (2) health cares for residents and others, (3) Comprehensive safety securing at nuclear operators such as Establishment of the effective audit system, Safety education for employees and Qualification and licensing system, Safety related documents, etc. (4) Reconstruction of the government's safety regulations such as How safety regulation

  19. Urgent recommendation. Interim report

    Energy Technology Data Exchange (ETDEWEB)

    Nakano, Masayuki [International Affairs and Safeguards Division, Atomic Energy Bureau, Science and Technology Agency, Tokyo (Japan)

    2000-12-01

    The Investigation Committee for Critical Accident at Uranium Processing Plant was founded immediately after the accident to investigate the cause of the accident and to establish measures to prevent the similar accident. On September 30, 1999 around 10:35, the Japan's first criticality accident occurred at JCO Co. Ltd. Uranium processing plant (auxiliary conversion plant) located at Tokai-mura Ibaraki-ken. The criticality continued on and off for approximately 20 hours after the first instantaneous criticality. The accident led the recommendation of tentative evacuation and sheltering indoors for residents living in the neighborhood. The serious exposure to neutrons happened to three workers. The dominant effect is dose due to neutrons and gamma rays from the precipitation tank. When the accident took place, three workers dissolved sequentially about 2.4 kg uranium powder with 18.8 % enrichment in the 10-litter bucket with nitric acid. The procedure of homogenization of uranium nitrate was supposed to be controlled using the shape-limited narrow storage column. Actually, however, the thick and large precipitation tank was used. As a result, about 16.6 kg of uranium was fed into the tank, which presumably caused criticality. The first notification by JCO was delayed and the following communication was not smooth. This led to the delay of correct understanding of the situation and made the initial proper response difficult, then followed by insufficient communication between the nation, prefecture, and local authority. Urgent recommendations were made on the following items; (1) Safety measures to be taken at the accident site, (2) health cares for residents and others, (3) Comprehensive safety securing at nuclear operators such as Establishment of the effective audit system, Safety education for employees and Qualification and licensing system, Safety related documents, etc. (4) Reconstruction of the government's safety regulations such as How safety

  20. The importance of preoperative magnetic resonance imaging in valve surgery for active infective endocarditis

    International Nuclear Information System (INIS)

    Takagi, Yasushi; Higuchi, Yoshiro; Kondo, Hiroshi; Akita, Kiyotoshi; Ishida, Michiko; Kaneko, Kan; Hoshino, Ryo; Sato, Masato; Ando, Motomi

    2011-01-01

    Valve surgery for active infective endocarditis (IE) can cause fatal brain hemorrhage. Our current study aimed to evaluate the incidence of septic cerebral lesions in active IE patients by performing preoperative magnetic resonance imaging (MRI) including T 2 *-weighted sequences and magnetic resonance angiography (MRA) before urgent valve surgery, and to investigate whether such preoperative evaluation affects postoperative outcomes. Eighteen patients were referred to our department for native valve IE during 2006-2010. Urgent surgery was indicated in cases of hemodynamic failure resulting from valve destruction, refractory sepsis, and mobile vegetations measuring >10 mm. For these patients, we performed preoperative MRI and MRA. Males comprised 67% of the subjects, with average age 53±15 years. No clinical evidence of acute stroke was noted. Of the 18 patients, urgent surgery was indicated in 15; of these, 10 (67%) showed a brain lesion related to IE: 6 patients had acute or subacute brain infarctions, 2 patients had brain infarction with brain abscess, and 2 patients had hemorrhagic brain infarction and so did not undergo urgent surgery. Thus, 13 patients underwent urgent valve surgery. Among the 5 patients who did not undergo urgent surgery, 4 patients later underwent valve surgery for healed IE. No hospital deaths or neurological complications occurred. MRI of patients with active IE revealed a high incidence of cerebral lesions caused by IE. The use of MRI to detect septic embolism and intracerebral hemorrhage may provide important information for better surgical outcomes. (author)

  1. 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.

  2. Between Urgent and Lifelong Matters

    DEFF Research Database (Denmark)

    From, Ditte-Marie

    2017-01-01

    constructionist and post-structuralist perspective, the analysis demonstrates how the children both subscribe to discourses of discipline and control over health actions, as well as legitimate narratives of having to adjust, accommodate and negotiate health challenges to everyday life practices. The article......This article addresses the learner perspective on doing overweight by listening to 39 Danish overweight children aged 8 to 13 years old. In accordance with the existing critique of the ‘obesity epidemic’ and medico-scientific discourses around food and exercise, this article explores how new health...... imperatives shape overweight children’s self-narratives. Health pedagogical activities in Denmark are between urgent and lifelong approaches to achieving health, and the article presents overweight children’s voices on having to learn new health behaviour in between these two schisms. From a social...

  3. Outcomes of urgent carotid endarterectomy for stable and unstable acute neurologic deficits.

    Science.gov (United States)

    Barbetta, Iacopo; Carmo, Michele; Mercandalli, Giulio; Lattuada, Patrizia; Mazzaccaro, Daniela; Settembrini, Alberto M; Dallatana, Raffaello; Settembrini, Piergiorgio G

    2014-02-01

    The aim of the study was to assess the outcomes of carotid endarterectomy (CEA) performed in an urgent setting on acutely symptomatic patients selected through a very simple protocol. From January 2002 to January 2012, 193 symptomatic patients underwent CEA. Of these, 90 presented with acute symptoms, and after a congruous carotid stenosis was identified, underwent urgent operations (group 1): 27 patients had transient ischemic attack (group 1A), 52 patients had mild to moderate stroke (group 1B), and 11 patients had stroke in evolution (group 1C). The remaining 103 patients with a nonrecent neurologic deficit were treated by elective surgery in the same period (group 2). End points were 30-day neurologic morbidity and mortality. The median delay of urgent CEA (U-CEA) from deficit onset was 48 hours (interquartile range, 13-117 hours). Groups 1 and 2 were comparable in demographics. Acute patients showed a higher rate of stroke at presentation (70% vs 37%; P = .001) and of history of coronary artery disease (30% vs 13.5%; P = .007). Acute patients sustained six postoperative strokes (6.6%). Neurologic outcomes were correlated to clinical presentation: no strokes occurred in group 1A patients, and 5.8% group 1B patients and 27.3% group 1C patients had postoperative stroke (P two thromboembolic strokes. Elective patients sustained four postoperative strokes (3.9%), with one death (0.9%) as a consequence of hyperperfusion cerebral edema. U-CEAs performed ≤48 hours from symptom onset had a lower postoperative stroke rate than those performed >48 hours (4.4% vs 8.8%; P = .3). Among patients presenting with a stroke (group 1B), the National Institutes of Health Stroke Scale (NIHSS) assessment at discharge showed improvement in 79% (although only 25% had ≥4 points in reduction), stability in 17%, and deterioration in 4%. Patients with moderate stroke were slightly better in NIHSS improvement than those with mild stroke (median NIHSS variation at discharge, -3 vs -1; P

  4. URGENT NEED OF A DOCTOR

    CERN Multimedia

    Medical Service

    2001-01-01

    IN URGENT NEED OF A DOCTOR GENEVA EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGAD 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME, open 24h/24h 748-49-50 Association Of Geneva Doctors Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin EMERGENCIES 719-61-11 URGENCES PEDIATRIQUES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European EmergencyCall 112 FRANCE EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ANTI-POISONS CENTRE Open 24h/24h 04-72-11-69-11 All doctors will...

  5. 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

  6. 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 ...

  7. 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 ...

  8. 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

  9. 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

  10. 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

  11. Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant

    NARCIS (Netherlands)

    Smits, Jacqueline M.; Nossent, George D.; de Vries, Erwin; Rahmel, Axel.; Meiser, Bruno; Strueber, Martin; Gottlieb, Jens

    BACKGROUND: The purpose of the study was to investigate the impact of the lung allocation score (LAS) on mortality among highly urgent (HU) and urgent (U) lung transplant (LTx) candidates in Eurotransplant (ET) and to identify useful additional parameters (LASplus). METHODS: All adult LTx candidates

  12. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

    Science.gov (United States)

    Lok, Charmaine E

    2016-03-01

    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis.

  13. Education and Nature Conservation: an Urgent Alliance

    Directory of Open Access Journals (Sweden)

    Ana Isabel Pereira-Pérez

    2011-11-01

    Full Text Available This paper aims at pointing out not only Costa Rica’s richness in terms of flora and fauna, but also the risk we face if we are unable to educate citizens for the appropriate nature conservation. In this sense, the authors state that it is through education that nature conversation, which is a necessity, can be promoted among citizens and communities. This is the reason why conservation and education must create an urgent alliance.

  14. Quantitative comparisons of urgent care service providers.

    Science.gov (United States)

    Qin, Hong; Prybutok, Gayle L; Prybutok, Victor R; Wang, Bin

    2015-01-01

    The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service providers: hospital emergency rooms, urgent care centres (UCC), and primary care physician offices. This study develops, validates, and uses a survey instrument to measure/compare differences in perceived service quality among three types of UC service providers. Six dimensions measured the components of service quality: tangibles, professionalism, interaction, accessibility, efficiency, and technical quality. Primary care physicians' offices scored higher for service quality and perceived value, followed by UCC. Hospital emergency rooms scored lower in both quality and perceived value. No significant difference was identified between UCC and primary care physicians across all the perspectives, except for interactions. The homogenous nature of the sample population (college students), and the fact that the respondents were recruited from a single university limits the generalizability of the findings. The patient's choice of a health care provider influences not only the continuity of the care that he or she receives, but compliance with a medical regime, and the evolution of the health care landscape. This work contributes to the understanding of how to provide cost effective and efficient UC services. This study developed and validated a survey instrument to measure/compare six dimensions of service quality for three types of UC service providers. The authors provide valuable data for UC service providers seeking to improve patient perceptions of service quality.

  15. Urgent-Start Peritoneal Dialysis Complications: Prevalence and Risk Factors.

    Science.gov (United States)

    Xu, Damin; Liu, Tianjiao; Dong, Jie

    2017-07-01

    Mechanical complications are of particular concern in urgent-start peritoneal dialysis (PD) because of the shorter break-in period. However, risk factors have been reported inconsistently and data in urgent-start PD populations are limited. Observational cohort study. All patients treated with urgent-start PD, defined as PD therapy initiated within 1 week after catheter insertion, January 2003 to May 2013. Age, sex, abdominal surgery history, body mass index, hemoglobin level, albumin level, C-reactive protein level, break-in period (period between catheter insertion and PD therapy initiation), dialysate exchange volume, and use of overnight dwell. The presence of mechanical complications related to abdominal wall or catheter, including hernia, hydrothorax, hydrocele, subcutaneous leak, pericatheter leak, catheter malposition, omental wrap, and obstruction. 922 patients on urgent-start PD therapy were enrolled (mean age, 59.1±15.0 [SD] years). Prevalences of abdominal wall and catheter complications were 4.8% and 9.5%, respectively. The most common abdominal wall complication was hernia (55%), followed by hydrothorax (25%). On adjustment, male sex (HR, 5.41; 95% CI, 2.15-13.59; Pstart PD and conventional PD. Urgent-start PD is a safe and practicable approach. Male sex and history of abdominal surgery could contribute to the development of abdominal wall complications. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. 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

  18. Community-based urgent care in Israel and worldwide

    OpenAIRE

    Zimmerman, Deena R

    2013-01-01

    Background Intermittent treatment of acute lower acuity situations has come to be defined as urgent rather than emergent care. The location of urgent care delivery has been shifting from exclusively hospital or office settings to other community locales. Aims To review the concept of urgent care and the new models of health care delivery in the niche between hospitals and primary care. To highlight the roles of urgent care in Israel and compare these roles with those in other countries. Metho...

  19. 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%.

  20. IN URGENT NEED OF A DOCTOR

    CERN Multimedia

    Medical Service

    2001-01-01

    IN URGENT NEED OF A DOCTOR GENEVA EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGADE 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME, open 24h/24h 748-49-50 Association Of Geneva Doctors Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin EMERGENCIES 719-61-11 URGENCES PEDIATRIQUES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European Emergency Call 112 FRANCE EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ANTI-POISONS CENTRE Open 24h/24h 04-72-11-69-11 All doctors ...

  1. Urgent medical response in CBR incidents

    International Nuclear Information System (INIS)

    Castulik, P.; Slabotinsky, J.; Kralik, L.; Bradka, S.

    2009-01-01

    During CBR incidents with releases of hazardous materials (HazMat), there is extremely urgent aim of first rescuing responders to safe the life for as much as possible victims and reducing health consequences from the exposure of the HazMat. Highest priority of the response is to be applied, if victims are exposed with chemicals through their airways and/or mucous membranes. There is general approach in the emergency medical services (EMS) stated that the victims being in critical status have to receive emergency medical care on-site even prior the transportation to a medical facility. However, in a case of CBR events the EMS prefer to provide the First Aid for victims to be already decontaminated as mass casualties, e.g. by the firemen and transferred to a safe zone. This approach is to be time consuming and thus creating delays in medical care not in the favor of a victim's successful survival. In order to overcome this approach, there are needs for eminent ceasing of the victims exposure, protection of breathing tract/ventilation support and administration of antidotes, if available. All this have to be done in shortest time since HazMat incident/accident occurs. This presentation is focusing on emergency provisions for saving victims directly in contaminated environment through the assistance by responders, concentrating on search and rescue of victims, their emergency decontamination, breathing protection, clothing removal, ventilation support, antidote administration, fixing and bandage of trauma injuries prior transportation and/or mass decontamination. This experience is shared based on a field exercise with the EMS volunteers (Red Cross), fire brigade volunteers and university's students.(author)

  2. Off-the-shelf multibranched endograft for urgent endovascular repair of thoracoabdominal aortic aneurysms.

    Science.gov (United States)

    Gallitto, Enrico; Gargiulo, Mauro; Freyrie, Antonio; Pini, Rodolfo; Mascoli, Chiara; Ancetti, Stefano; Faggioli, Gianluca; Stella, Andrea

    2017-09-01

    The aim of this paper was to report early and midterm results of endovascular repair of urgent thoracoabdominal aortic aneurysms (TAAAs) by the off-the-shelf multibranched Zenith t-Branch endograft (Cook Medical, Bloomington, Ind). Between January 2014 and April 2016, all patients with urgent TAAAs (asymptomatic with diameter >8 cm, symptomatic, or ruptured TAAAs) and aortoiliac anatomic feasibility underwent endovascular repair by t-Branch and were prospectively enrolled. Clinical, morphologic, intraoperative, and postoperative data were recorded. Follow-up was performed by duplex ultrasound, contrast-enhanced duplex ultrasound, and computed tomography angiography. Early end points were technical success (absence of type I or type III endoleak, loss of target visceral vessels [TVVs], conversion to open repair, or 24-hour mortality), spinal cord ischemia, and 30-day mortality. Follow-up end points were survival, TVV patency, type I or type III endoleaks, and freedom from reintervention. Seventeen patients (male, 71%; age, 73 ± 6 years; American Society of Anesthesiologists class 3/4, 60%/40%) affected by type II (47%), III (29%), and IV (24%) TAAAs were enrolled. The indications for t-Branch were as follows: contained TAAA rupture, four (24%); symptomatic TAAA (pain or peripheral embolism), four (24%); and TAAA diameter ≥8 cm, nine (52%). The mean TAAA diameter was 80 ± 19 mm, with 63 TVVs. Fifteen patients (87%) needed adjunctive intraoperative procedures: 14 proximal thoracic endografts (thoracic endovascular aortic repair), 1 left carotid-subclavian bypass, 2 endovascular hypogastric branches, and 2 surgical iliac conduits. In four cases (24%), a significant malorientation (≥60 degrees) of the main body occurred during t-Branch deployment. Technical success was achieved in 14 cases (82%), with technical failures consisting of the loss of three renal arteries (TVV patency, 95%). Spinal cord ischemia occurred in one case (6%) with temporary

  3. Impact on Clinical Management of After-Hours Emergent or Urgent Breast Ultrasonography in Patients with Clinically Suspected Breast Abscesses

    Directory of Open Access Journals (Sweden)

    Tanya W. Moseley

    2018-02-01

    Full Text Available Newly diagnosed breast abscesses are generally treated as a medical emergency that may necessitate immediate interventional treatment. At our institution, there is no in-house after-hours coverage for breast ultrasonography. We could find no peer-reviewed studies on the cost-effectiveness or clinical management impact of on-call ultrasound technologist coverage for imaging of breast abscesses. The purposes of this study were to determine the incidence of breast abscess in patients with clinical findings highly suggestive of abscess, identify clinical factors associated with breast abscess in such patients, and determine the impact of after-hours emergent or urgent breast ultrasonography on the clinical management of breast abscesses in both outpatients and inpatients. We retrospectively reviewed 100 after-hours breast ultrasound studies performed at our tertiary care center from 2011 to 2015 for evaluation of a suspected breast abscess. Only 26% of our patients with clinically suspected abscess ultimately had a confirmed abscess. Factors associated with breast abscess were a palpable abnormality and a history of breast surgery within the eight weeks before presentation. After-hours diagnosis of an abscess was associated with after-hours clinical intervention. Of the 74 patients in whom after-hours ultrasound imaging showed no evidence of abscess, only three patients underwent after-hours drainage. Our findings support overnight and weekend breast ultrasound coverage in large tertiary care centers.

  4. Impact on Clinical Management of After-Hours Emergent or Urgent Breast Ultrasonography in Patients with Clinically Suspected Breast Abscesses.

    Science.gov (United States)

    Moseley, Tanya W; Stanley, Ashley; Wei, Wei; Parikh, Jay R

    2018-02-23

    Newly diagnosed breast abscesses are generally treated as a medical emergency that may necessitate immediate interventional treatment. At our institution, there is no in-house after-hours coverage for breast ultrasonography. We could find no peer-reviewed studies on the cost-effectiveness or clinical management impact of on-call ultrasound technologist coverage for imaging of breast abscesses. The purposes of this study were to determine the incidence of breast abscess in patients with clinical findings highly suggestive of abscess, identify clinical factors associated with breast abscess in such patients, and determine the impact of after-hours emergent or urgent breast ultrasonography on the clinical management of breast abscesses in both outpatients and inpatients. We retrospectively reviewed 100 after-hours breast ultrasound studies performed at our tertiary care center from 2011 to 2015 for evaluation of a suspected breast abscess. Only 26% of our patients with clinically suspected abscess ultimately had a confirmed abscess. Factors associated with breast abscess were a palpable abnormality and a history of breast surgery within the eight weeks before presentation. After-hours diagnosis of an abscess was associated with after-hours clinical intervention. Of the 74 patients in whom after-hours ultrasound imaging showed no evidence of abscess, only three patients underwent after-hours drainage. Our findings support overnight and weekend breast ultrasound coverage in large tertiary care centers.

  5. Abdominal vascular injury during lumbar disc surgery: report of three cases.

    Science.gov (United States)

    Torun, Fuat; Tuna, Hakan; Deda, Haluk

    2007-04-01

    Anterior longitudinal ligament perforation and abdominal vascular injury is one of the most critical complications that may develop during lumbar disc surgery. The vascular injury-related symptoms that warns the surgeon may be late to appear; they usually turn out to be mortal. The hypotension during the operation, tachycardia and pulsatile unstoppable hemorrhage observed in the disc space are the major findings. Urgent detection of this complication and the repair of the vascular injury prevent the case from turning out to be fatal. In the present study, three patients who underwent surgical treatment of abdominal vascular injuries that had developed during lumbar disc surgery, were presented.

  6. 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 ...

  7. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon Resultados del tratamiento conservador inicial y de la cirugía urgente en la apendicitis aguda evolucionada

    Directory of Open Access Journals (Sweden)

    J. M. Aranda-Narváez

    2010-11-01

    Full Text Available Background: Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval appendectomy compared with immediate surgery. Methods: We undertook an observational, retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital between January 1997 and March 2009. Patients younger than 14, with severe sepsis or with diffuse peritonitis were excluded. A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment. A control group was composed of the other patients, who all underwent urgent appendectomy, matched for age and later randomized 1:1. The infectious risk stratification was established with the National Nosocomial Infections Surveillance System (NNIS index. Dependent variables were hospital stay and surgical site infection. Analysis was with SPSS, with p Introducción: Existe controversia acerca del tratamiento idóneo de la apendicitis aguda evolucionada en forma de absceso o flemón. Realizamos un estudio para la evaluación de resultados del tratamiento conservador inicial (antibiótico y drenaje percutáneo si se precisa, con/sin apendicectomía diferida y del tratamiento quirúrgico urgente. Método: Estudio observacional analítico de cohortes retrospectivas. Criterios de inclusión: pacientes con diagnóstico clínico y radiológico de apendicitis aguda evolucionada en forma de absceso o flemón, tratados en nuestro hospital entre enero 1997 y marzo 2009, excluyendo pacientes pediátricos, con sepsis grave o peritonitis difusa. En 15 pacientes con apendicitis complicada con absceso o flemón (cohorte de estudio se indicó tratamiento conservador inicial. El grupo control se obtuvo del resto de pacientes (en

  8. Can different physicians providing urgent and non-urgent treatment improve patient flow in emergency department?

    Science.gov (United States)

    Yau, Flora Fei-Fei; Tsai, Tsung-Cheng; Lin, Yan-Ren; Wu, Kuan-Han; Syue, Yuan-Jhen; Li, Chao-Jui

    2017-11-06

    Emergency Department (ED) overcrowding is a worldwide problem, and it might be caused by prolonged patient stay in the ED. This study tried to analyze if different practice models influence patient flow in the ED. A retrospective, 1-year cohort study was conducted across two EDs in the largest healthcare system in Taiwan. A total of 37,580 adult non-trauma patients were involved in the study. The clinical practice between two ED practice models was compared. In one model, urgent and non-urgent patients were treated by different emergency physicians (EPs) separately (separated model). In the other, EPs treated all patients assigned randomly (merged model). The ED length of stay (LOS), diagnostic tool use (including laboratory examinations and computed tomography scans), and patient dispositions (including discharge, general ward admission, intensive care unit (ICU) admissions, and ED mortality) were selected as outcome indicators. Patients discharged from ED had 0.4h shorter ED LOS in the separated model than in merged model. After adjusting for the potential confounding factors through regression model, there was no difference of patient disposition of the two practice models. However, the separated model showed a slight decrease in laboratory examination use (adjusted odds ratio, 0.9; 95% confidence interval, 0.83-0.96) compared with the merged model. The separated model had better patient flow than the merged model did. It decreased the ED LOS in ED discharge patients and laboratory examination use. Copyright © 2017. Published by Elsevier Inc.

  9. Emergency surgery for jejunal diverticulosis: our experience and review of literature.

    Science.gov (United States)

    Tan, Ker-Kan; Liu, Jody Zhiyang; Ho, Choon-Kiat

    2011-05-01

    Jejunal diverticulosis is a rare entity and is often asymptomatic. However, some of its complications may require acute surgical intervention. This study was performed to evaluate the presentation and outcome of patients who underwent urgent surgery for complicated jejunal diverticulosis. A retrospective review of all patients who underwent emergency surgery for complicated jejunal diverticulosis from November 2005 to December 2008 was performed. Six cases of complicated jejunal diverticulosis required urgent surgery during the study period. Three patients presented with acute abdomen from perforated jejunal diverticulum. Preoperative computed tomographic (CT) scans were useful in localizing the source of sepsis. One patient died from the subsequent complications. The other three patients presented with massive lower gastrointestinal haemorrhage for which CT angiography was able to localize the source of haemorrhage in two of them. Small bowel resection was then performed and all three were discharged well eventually. Though rare, jejunal diverticulosis can present with several life-threatening complications that mandates immediate surgery. While the surgical procedure may be technically simple, achieving the accurate preoperative diagnosis is often fraught with challenges. CT scan could prove invaluable in the management if the situation permits. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.

  10. 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.

  11. 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 ...

  12. 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.

  13. Community-based urgent care in Israel and worldwide.

    Science.gov (United States)

    Zimmerman, Deena R

    2013-10-23

    Intermittent treatment of acute lower acuity situations has come to be defined as urgent rather than emergent care. The location of urgent care delivery has been shifting from exclusively hospital or office settings to other community locales. To review the concept of urgent care and the new models of health care delivery in the niche between hospitals and primary care. To highlight the roles of urgent care in Israel and compare these roles with those in other countries. Narrative review of the literature. The new models of community based urgent care include 1) the urgent care center; 2) the retail or convenience clinic, 3) the free standing emergency center, and 4) the walk-in clinic. These models fall on a continuum of comprehensiveness. They offer care at a lower cost than hospital-based emergency departments and greater temporal convenience than primary care physicians. However, their impact on emergency department utilization and overcrowding or primary care physician overload is unclear.Israel has integrated its urgent care centers into its national health system by encouraging the use of urgent care centers and by requiring all health insurance funds to reimburse patients who use these centers. This integration is similar to the approach in England; however, the type of service is different in that the service in England is provided by nurses. It is different from most other countries where urgent care facilities are primarily private ventures. Community-based acute care facilities are becoming a part of the medical landscape in a number of countries. Still, they remain primarily on the fringe of organized medicine. Despite the important role of community-based acute care facilities in Israel, no nationwide study has been done in two decades. Health policy planning in Israel necessitates further study of urgent care use and its clinical outcomes.

  14. 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

  15. Access to urgent dental care: a scoping review.

    Science.gov (United States)

    Worsley, D J; Robinson, P G; Marshman, Z

    2017-03-01

    To summarise the literature on urgent dental care and to identify research priorities on the organisation and delivery of urgent dental services. Scoping review using Andersen's behavioural model of health service utilisation for a framework analysis of the data. Gaps in the literature, defined as those factors and interactions identified by Andersen's model as having a contributory role in access to health services that were not evident in the source papers. Fifty-six papers met the inclusion criteria for the review. The factors most often considered were; demographic, socioeconomic, perceived and evaluated need, and health behaviours. Patient outcomes of evaluated health and quality of life following urgent dental care were the least studied variables, with the exception of patient satisfaction. No studies were identified on community values/norms of people accessing urgent dental care, on health economic evaluations or on studies of how urgent dental services mitigate use of other medical services. No studies were identified on urgent need for populations living in water fluoridated areas or on the relationship between service design and efficient or effective access as measured by patient outcomes. Future research on patient outcomes and the comparison of different service models for urgent dental care through measures of equity, effectiveness and efficiency of access are needed to inform future policy and organisation of these services. Copyright© 2017 Dennis Barber Ltd

  16. Quantitative comparison of measurements of urgent care service quality.

    Science.gov (United States)

    Qin, Hong; Prybutok, Victor; Prybutok, Gayle

    2016-01-01

    Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

  17. Urgent computing for decision support in critical situations

    NARCIS (Netherlands)

    Boukhanovsky, A.V.; Krzhizhanovskaya, V.V.; Bubak, M.

    Urgent computing for decision support in critical situations requires a cutting-edge interdisciplinary research combining data-driven modelling, high-performance computing, advanced numerical simulation and visualization. Examples of critical situations arising in complex technical, environmental

  18. 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.

  19. 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.

  20. [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.

  1. Failed regional anesthesia with reduced spinal bupivacaine dosage in a parturient with achondroplasia presenting for urgent cesarean section.

    Science.gov (United States)

    DeRenzo, J S; Vallejo, M C; Ramanathan, S

    2005-04-01

    A 36-year-old patient with a history of previous back surgery, asthma, latex allergy and achondroplasia presented for urgent cesarean delivery at 31 weeks' gestation for worsening nonimmune fetal hydrops. The fetus was diagnosed with trisomy 21 and achondroplasia. Because of the urgent clinical situation, the patient was given a spinal anesthetic, which required supplemental intravenous sedation after delivery of the fetus. This case report discusses the controversies in anesthetic management of this complicated patient and compromised fetus regarding general anesthesia, epidural, spinal and combined spinal-epidural anesthesia.

  2. 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.

  3. Improving access for Urgent patients in Paediatric Neurology

    Science.gov (United States)

    Mohamed, Khalid; Al Houri, Basema; Ibrahim, Khalid; M Khair, Abdulhafeez

    2017-01-01

    Referral and flow management is an important part of outpatient care; some patients require to be seen earlier than the next available appointment because of the nature of their presentation. We did not have a clear pathway for urgent patients being referred to our pediatric neurology service. When we reviewed this process in our Quality Improvement meeting we identified wide variation in the length of time such patients wait to be seen in clinic ranging from 2 to 11 weeks. Only 25% of patients identified as requiring urgent clinic appointments were seen in clinic within 2 weeks of triage. A new triage system was designed to identify urgent patients consistently. Three PDSA cycles tested change ideas: the first cycle tested introducing an urgent triage system, the second cycle tested giving urgent appointments directly from the triage decision utilising clinic cancellations and the third PDSA tested double notification of appointments for all urgent patients using the call centre and the neurology specialist nurses. After the third PDSA the percentage of patients seen within 2 weeks of triage increased from 25% to 80%. This change was tested across one clinic initially then tested across two more clinics. Our balancing measure, the third available routine appointment, remained stable indicating that improving access to emergency patients did not affect the waiting time for routine appointments. With good management of triage it is possible to improve access for urgent patients to be seen in clinic without impact on availability of routine appointments, resulting in better quality of care and patient satisfaction. Earlier appointments also improve clinic attendance rates. PMID:28469906

  4. Access and care issues in urban urgent care clinic patients

    Directory of Open Access Journals (Sweden)

    Adams Jill C

    2009-12-01

    Full Text Available Abstract Background Although primary care should be the cornerstone of medical practice, inappropriate use of urgent care for non-urgent patients is a growing problem that has significant economic and healthcare consequences. The characteristics of patients who choose the urgent care setting, as well as the reasoning behind their decisions, is not well established. The purpose of this study was to determine the motivation behind, and characteristics of, adult patients who choose to access health care in our urgent care clinic. The relevance of understanding the motivation driving this patient population is especially pertinent given recent trends towards universal healthcare and the unclear impact it may have on the demands of urgent care. Methods We conducted a cross-sectional survey of patients seeking care at an urgent care clinic (UCC within a large acute care safety-net urban hospital over a six-week period. Survey data included demographics, social and economic information, reasons that patients chose a UCC, previous primary care exposure, reasons for delaying care, and preventive care needs. Results A total of 1, 006 patients were randomly surveyed. Twenty-five percent of patients identified Spanish as their preferred language. Fifty-four percent of patients reported choosing the UCC due to not having to make an appointment, 51.2% because it was convenient, 43.9% because of same day test results, 42.7% because of ability to get same-day medications and 15.1% because co-payment was not mandatory. Lack of a regular physician was reported by 67.9% of patients and 57.2% lacked a regular source of care. Patients reported delaying access to care for a variety of reasons. Conclusion Despite a common belief that patients seek care in the urgent care setting primarily for economic reasons, this study suggests that patients choose the urgent care setting based largely on convenience and more timely care. This information is especially applicable to

  5. 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.

  6. Urgent Safety Measures in Japan after Great East Japan Earthquake

    International Nuclear Information System (INIS)

    Taniura, Wataru; Otani, Hiroyasu

    2012-01-01

    Due to tsunami triggered by the Great East Japan Earthquake, the operating and refueling reactor facilities at Fukushima Dai-ichi and Dai-ni Nuclear Power Plants caused a nuclear hazard. Given the fact, Japanese electric power companies voluntarily began to compile various urgent measures against tsunami. And then the Nuclear and Industrial Safety Agency (NISA) ordered the licensees to put into practice the voluntarily compiled urgent safety measures, in order to ensure the effectiveness of the means for recovering cooling functions along with avoiding the release of radioactive substances to the possible minimum, even if a huge tsunami following a severe earthquake hits nuclear power plants. The following describes the state and the effect of the urgent safety measures implemented for 44 reactors (under operation) and 1 reactor (under construction) in Japan and also describes the measures to be implemented by the licensees of reactor operation in the future.

  7. Urgent Safety Measures in Japan after Great East Japan Earthquake

    International Nuclear Information System (INIS)

    Taniura, W.; Otani, H.

    2012-01-01

    Due to tsunami triggered by the Great East Japan Earthquake on March 11, 2011, the operating and refueling reactor facilities at Fukushima Dai-ichi and Dai-ni Nuclear Power Plants of Tokyo Electric Power Co. caused a nuclear hazard. Japanese electric power companies voluntarily began to compile various urgent measures against tsunami within the week the hazard was caused. As for the urgent safety measures of each licensee, it is clarified that effective measures have been appropriately implemented as a result of the inspection of the national government, the verification based on the guideline of the Japan Society of Maintenology and the stress test. (author)

  8. 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. .

  9. Fall-related traumas in urgent care centers.

    Science.gov (United States)

    Cartaxo, Carla Kalline Alves; Nunes, Mariangela da Silva; Raposo, Oscar Felipe Falcão; Fakhouri, Ricardo; Hora, Edilene Curvelo

    2012-10-01

    To identify the scope and the characteristics of fall-related traumas in urgent care centers in Sergipe, Brazil and to verify potential associations among the following variables: gender, age, and where the event occurred. This descriptive, cross-sectional study with a quantitative approach was conducted in the urgent care centers of two public referral hospitals in the state of Sergipe, Brazil. The data collection was conducted in November 2010, after approval was obtained from the Human Research Ethics Committee, through a structured interview with a sample of 509 fall victims. Most of the participants were male, between 0 and 19 years old, single, with no impairments or preexisting diseases, nor regular use of medication or alcohol. The victims were brought to the hospital by ambulance and were accompanied. Most events occurred at home, were same-level falls, and most frequently resulted from slipping and tripping during recreational activities with a subsequent fracture, contusion or sprain. Most victims were discharged from the hospital after care delivery. Statistically significant associations were found between place of fall and age and gender. There is a high incidence of seeking out care in urgent care centers due to falls, which constitutes a severe public health problem that affects both genders in different age groups. The adoption of preventive measures aimed to reduce such events is urgently required.

  10. Actual Problems of Conclusion and Discharge of Urgent Labour Contracts

    Directory of Open Access Journals (Sweden)

    Shevelyova A. A.

    2013-05-01

    Full Text Available This article is devoted to the consideration of the questions connected with the conclusion and the termination of the urgent labour contract. The author, analyzing judicial practice, allocates the problems of separate regulation of the RF labour legislation enforcement.

  11. 77 FR 42947 - Unexpected Urgent Refugee and Migration Needs

    Science.gov (United States)

    2012-07-20

    ... July 12, 2012 Unexpected Urgent Refugee and Migration Needs Memorandum for the Secretary of State By..., including section 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as amended, (22... from the United States Emergency Refugee and Migration Assistance Fund, for the purpose of meeting...

  12. 77 FR 21389 - Unexpected Urgent Refugee and Migration Needs

    Science.gov (United States)

    2012-04-10

    ... April 3, 2012 Unexpected Urgent Refugee and Migration Needs Memorandum for the Secretary of State By the... 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as amended, (22 U.S.C... United States Emergency Refugee and Migration Assistance Fund, for the purpose of meeting unexpected and...

  13. Super obese 33-week parturient undergoing an urgent laparoscopic bowel resection: A case report and review of anesthetic implications

    Directory of Open Access Journals (Sweden)

    Yury Khelemsky

    2011-01-01

    Full Text Available Approximately two percent of women undergo non-obstetric surgery during their pregnancies. The following case report describes the anesthetic management of a super obese parturient in her third trimester of pregnancy undergoing urgent laparoscopic (converted to open bowel resection. Such a case, which has not been previously reported, has multiple clinical implications for both mother and fetus and was further complicated by super obesity (BMI>50 and laparoscopy. The anesthetic implications for this patient population are reviewed.

  14. Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.

    Science.gov (United States)

    Owler, Brian K; Carmo, Kathryn A Browning; Bladwell, Wendy; Fa'asalele, T Arieta; Roxburgh, Jane; Kendrick, Tina; Berry, Andrew

    2015-09-01

    Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median "time saved" was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours). Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

  15. A data management system to enable urgent natural disaster computing

    Science.gov (United States)

    Leong, Siew Hoon; Kranzlmüller, Dieter; Frank, Anton

    2014-05-01

    Civil protection, in particular natural disaster management, is very important to most nations and civilians in the world. When disasters like flash floods, earthquakes and tsunamis are expected or have taken place, it is of utmost importance to make timely decisions for managing the affected areas and reduce casualties. Computer simulations can generate information and provide predictions to facilitate this decision making process. Getting the data to the required resources is a critical requirement to enable the timely computation of the predictions. An urgent data management system to support natural disaster computing is thus necessary to effectively carry out data activities within a stipulated deadline. Since the trigger of a natural disaster is usually unpredictable, it is not always possible to prepare required resources well in advance. As such, an urgent data management system for natural disaster computing has to be able to work with any type of resources. Additional requirements include the need to manage deadlines and huge volume of data, fault tolerance, reliable, flexibility to changes, ease of usage, etc. The proposed data management platform includes a service manager to provide a uniform and extensible interface for the supported data protocols, a configuration manager to check and retrieve configurations of available resources, a scheduler manager to ensure that the deadlines can be met, a fault tolerance manager to increase the reliability of the platform and a data manager to initiate and perform the data activities. These managers will enable the selection of the most appropriate resource, transfer protocol, etc. such that the hard deadline of an urgent computation can be met for a particular urgent activity, e.g. data staging or computation. We associated 2 types of deadlines [2] with an urgent computing system. Soft-hard deadline: Missing a soft-firm deadline will render the computation less useful resulting in a cost that can have severe

  16. [Urgent Visits to Nursing Homes: A General Practitioner's Perspective].

    Science.gov (United States)

    Bleckwenn, Markus; Ashrafnia, David; Schnakenberg, Rieke; Weckbecker, Klaus

    2017-06-06

    Aim of the study Due to demographic changes, home visits to nursing care facilities are increasing. Urgent home visits represent a challenge for general practitioners. There are no recommendations for the implementation of urgent home visits. Therefore, in this study, we investigated how GP practices deal with urgent home visits and what improvements can be made to the medical emergency care. Methods A total of 15 teaching doctors of the Department of Family Medicine at the University of Bonn were interviewed using semi-structured interviews on the subject. We evaluated the interviews with the qualitative content analysis according to Mayring. Results Urgent house visits were requested by telephone or fax. The home visits were carried out usually after the consultation hours during the lunch break of the doctors. General practitioners consider forwarding the request for a house visit to the rescue service as an absolute exception. At the nursing home, there were waiting times until the responsible nursing staff could do a joint emergency visit. In addition, there were clear differences in the qualifications of nurses and in dealing with emergencies. The physicians therefore saw improvements in their ability to provide further training to the nursing staff, to preventive house visits, and to assess the urgency of home visits. Conclusion To improve emergency care in elderly homes, the suggestions for improvement proposed by the family doctors should be tested in controlled studies. In addition, the cooperation between general practitioners and nursing homes could be strengthened by joint training in geriatric emergency care. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Pediatric Referrals to an Emergency Department From Urgent Care Centers.

    Science.gov (United States)

    Olympia, Robert P; Wilkinson, Robert; Dunnick, Jennifer; Dougherty, Brendan J; Zauner, Debra

    2016-10-08

    The aims of this study were to describe pediatric emergency department (ED) referrals from urgent care centers and to determine the percentage of referrals considered essential and serious. A prospective study was conducted between April 2013 and April 2015 on patients younger than 21 years referred directly to an ED in central Pennsylvania from surrounding urgent care centers. Referrals were considered essential or serious based on investigations/procedures performed or medications/consultations received in the ED. Analysis was performed on 455 patient encounters (mean age, 8.7 y), with 347 (76%) considered essential and 40 (9%) considered serious. The most common chief complaints were abdominal pain (83 encounters), extremity injury (76), fever (39), cough/cold (29), and head/neck injury (29). Thirty-three percent of the patients received laboratory diagnostic investigations (74% serum, 56% urine), and 52% received radiologic investigations (67% x-ray, 17% computed tomography scan, 13% ultrasound, 11% magnetic resonance imaging). Forty-four percent of the patients received a procedure, with the most common being intravenous (IV) placement (66%); reduction, casting, or splinting of extremity fracture/dislocation (18%); and laceration repair (14%). The most common medications administered were IV fluids (33%), oral analgesics (30%), and IV analgesics (26%). Eighty-three percent of the patients were discharged home, 12% were hospitalized, and 4% had emergent surgical intervention. The most common primary diagnoses were closed extremity fracture (60 encounters), gastroenteritis (42), brain concussion (28), upper respiratory infection (24), and nonsurgical, unspecified abdominal pain (24). Many ED referrals directed from urgent care centers in our sample were considered essential, and few were considered serious. Urgent care centers should develop educational and preparedness strategies based on the epidemiology of emergencies that may occur.

  18. 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.

  19. Study on treatment of postpartum hemorrhage with urgent interventional embolization

    International Nuclear Information System (INIS)

    Xi Jiayuan; Ren Shuping; Lu Liang; Jiao Cunxian; Liu Yunxia; Yang Yu; Deng Gang; Li Jikang; Cao Xinhua; Mi Lan

    2002-01-01

    Objective: To evaluate urgent selective arterial embolization to treat massive postpartum hemorrhage. Methods: Twenty-seven patients with ages of 21-53 years undergoing severe postpartum hemorrhage, were due to central placental previa, uterine atony, birth canal trauma, placenta accretio, cervical pregnancy etc. All of the patients had lost a volume of blood about 1000 ml to 5000 ml while the hemorrhage could not be controlled with vaginal packing and administration of uterotonic drugs. Urgent hemostatic embolization was performed for them. After angiography, super selective catheterization was performed for bilateral anterior division of internal iliac branch of uterine arteries and embolized with Gelfoam particles. Results: Catheterization success rate was 96.3%. Angiography showed ectopic uterine artery in one case. Immediate block of hemorrhage took place in 22 cases and gradual hemostasis appeared in 4 cases, the efficacy rate was 96.3%. The one with ectopic uterine artery was operated upon to ablate the uterus. 11 patients with (bleeding) shock and 8 patients with DIC were all saved. Conclusions: Urgent arterial embolization is an ideal method for treating life-threatening postpartum hemorrhage. The procedure saves the maternal uterus and is also effective for postpartum DIC

  20. 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.

  1. 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.

  2. Percutaneous cholecystostomy to treat acute cholecystitis in patients with high risk for surgery.

    Science.gov (United States)

    Cortázar García, R; Sánchez Rodríguez, P; Ramos García, M

    2016-01-01

    To evaluate the results of percutaneous cholecystostomy for urgent treatment of acute cholecystitis, with the aim of identifying factors that predict survival. To analyze the recurrence of cholecystitis after catheter withdrawal in patients considered unsuitable candidates for delayed surgery, with the aim of identifying factors that predict recurrence. We reviewed 40 patients who underwent percutaneous cholecystostomy in a two-year period. We analyzed survival during hospitalization in relation with fever, abdominal pain, leukocytosis, and C-reactive protein before and after the procedure. We analyzed the recurrence of cholecystitis after catheter withdrawal in patients considered unsuitable candidates for delayed surgery, as well as the influence of obstruction seen on cholangiography, age, sex, and comorbidities on the recurrence rate. During the hospital stay, 4 (10%) patients died of septic shock. Cholecystostomy improved fever, leukocytosis, and abdominal pain within five days of the procedure, but these improvements did not have a statistically significant effect on survival and were not therefore considered useful prognostic factors. Among the 15 patients considered unsuitable candidates for delayed surgery, 6 (40%) had recurrences of cholecystitis during a mean follow-up period of 6.7 months after catheter withdrawal. We found no association between recurrence and any of the parameters analyzed. Outcomes in our series of patients with high risk for surgery who underwent cholecystostomy for urgent treatment of acute cholecystitis were similar to those reported in other series. Withdrawing the catheter in patients considered unsuitable candidates for delayed surgery is not recommended due to the high risk of recurrence of cholecystitis in comparison with other series. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  3. [Anesthetic Management of an Infant who Underwent Awake-intubation for Her Pharyngeal Injury Caused by a Toothbrush].

    Science.gov (United States)

    Nakano, Yoko; Suzuki, Hiroaki; Arai, Takero; Hashimoto, Yuichi; Okuda, Yasuhisa

    2016-04-01

    A 2-year-and-4-month-old female infant, 12 kg in weight and 90 cm in height fell off from a table, which was about 1 m height with a toothbrush in her mouth without her parents noticing. Urgent CT scan showed that it penetrated the left side of her oropharyngeal wall to the bifurcation of her right carotid artery. According to the initial assessment, carotid artery seemed intact and there seemed to be no sign of CNS involvement. She underwent general anesthesia for further investigation and operation. We could detect vocal code with ease by inserting Glidescope between her tongue and the toothbrush. After the intubation, we administered fentanyl 25 μg rocuronium 15 mg and sevoflulane 3-5% to her, and then she underwent arteriography. The neurosurgeon found no sign of major arterial injury nor traumatic aneurysm nor CNS involvement. She went to the ICU intubated after the removal of the toothbrush. She was extubated 5 days after operation. One of the benefits of the Glidescope is that we can share the visual image, and we chose it this time. When we expect a difficult airway during management for oropharyngeal trauma, we have to consider the way to manage the airway.

  4. Feasibility of Urgent-Start Peritoneal Dialysis in Older Patients with End-Stage Renal Disease: A Single-Center Experience.

    Science.gov (United States)

    Jin, Haijiao; Ni, Zhaohui; Mou, Shan; Lu, Renhua; Fang, Wei; Huang, Jiaying; Hu, Chunhua; Zhang, Haifen; Yan, Hao; Li, Zhenyuan; Yu, Zanzhe

    2018-01-01

    Patients with end-stage renal disease (ESRD) frequently require urgent-start dialysis. Recent evidence suggests that peritoneal dialysis (PD) might be a feasible alternative to hemodialysis (HD) in these patients, including in older patients. This retrospective study enrolled patients aged > 65 years with ESRD who underwent urgent dialysis without functional vascular access or PD catheter at a single center, from January 2011 to December 2014. Patients were grouped based on their dialysis modality (PD or HD). Patients unable to tolerate PD catheter insertion or wait for PD were excluded. Each patient was followed for at least 30 days after catheter insertion. Short-term (30-day) dialysis-related complications and patient survival were compared between the 2 groups. A total of 94 patients were enrolled, including 53 (56.4%) who underwent PD. The incidence of dialysis-related complications during the first 30 days was significantly lower in PD compared with HD patients (3 [5.7%] vs 10 [24.4%], p = 0.009). Logistic regression identified urgent-start HD as an independent risk factor for dialysis-related complications compared with urgent-start PD (odds ratio 4.760 [1.183 - 19.147], p = 0.028). The 6-, 12-, 24-, and 36-month survival rates in the PD and HD groups were 92.3% vs 94.6%, 82.4% vs 81.3%, 75.7% vs 74.2%, and 69.5% vs 60.6%, respectively, with no significant differences between the groups (log-rank = 0.011, p = 0.915). Urgent-start PD was associated with fewer short-term dialysis-related complications and similar survival to urgent-start HD in older patients with ESRD. Peritoneal dialysis may thus be a safe and effective dialysis modality for older ESRD patients requiring urgent dialysis. Copyright © 2018 International Society for Peritoneal Dialysis.

  5. Emergency correction of coagulation before major surgery in two elderly patients on oral anticoagulation

    Directory of Open Access Journals (Sweden)

    Pechlaner Christoph

    2007-01-01

    Full Text Available Abstract Recommendations for urgent reversal of oral anticoagulation with vitamin K1 antagonists are largely derived from case series employing empirical dosing regimens with vitamin K1 and prothrombin complex concentrates. Data on the use of prothrombin complex concentrates in this indication are scarce in the elderly who are at high risk of both hemorrhagic and thrombotic complications. The two cases presented here describe patients older than 75 years who underwent rapid International Normalized Ratio (INR reversal with prothrombin complex concentrates for surgical treatment of a bleeding ruptured spleen and for emergency surgery of a dissecting aorta. Both patients had their INRs rapidly corrected to ≤ 1.6 and underwent operation without complications. Evidence on treatment of patients who present with elevated INR and who have major bleeding or need to undergo emergency surgery is based mainly on observational studies. The two elderly patients presented here underwent successful emergency surgery after their INRs had been corrected with the intravenous use of vitamin K1 in combination with prothrombin complex concentrate that was administered according to current guideline recommendations.

  6. Early or late surgery for endocarditis with neurological complications.

    Science.gov (United States)

    Oh, Timothy Hou Teng; Wang, Tom Kai Ming; Pemberton, James A; Raudkivi, Peter J

    2016-06-01

    The European Society of Cardiology 2015 guidelines advise urgent surgery for endocarditis complicated by cerebral embolism or transient ischemic events (1B evidence). Nevertheless, the timing of surgery remains contentious. This study aimed to review our experience of early versus delayed surgery in a selected cohort. Our surgical database was examined for patients with a discharge diagnosis of endocarditis from 2005 to 2011. Selection was limited to patients who fulfilled the Duke criteria and underwent brain imaging for a clinically diagnosed preoperative neurological event. Patients were categorized as early surgery (≤7 days of clinical or cerebral imaging diagnosis of stroke) or delayed surgery (>7 days after diagnosis). Thirty-nine patients were identified: 20 in the early group (mean age 52 ± 15 years, diagnosis-to-surgery time 4 ± 2 days) and 19 in the delayed group (mean age 45 ± 15 years, diagnosis-to-surgery time 17 ± 11 days). There were no statistical differences in preoperative risks, operative data (cardiopulmonary bypass and crossclamp times) or postoperative neurological and mortality outcomes between the 2 groups. The size of the cerebral lesion was not a significant predictor of postoperative hemorrhagic or neurological outcome. Multivariate analysis did not show any independent predictor of mortality during follow-up (mean 51 ± 27 months). There was no difference in long-term survival, freedom from reoperation, or recurrent endocarditis between the 2 groups. This study showed no statistical excess of mortality or neurological outcomes after early surgical intervention, regardless of the preoperative cerebral lesion size. © The Author(s) 2016.

  7. 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. ...

  8. 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

  9. 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.

  10. Space nonweaponization. An urgent task for arms control

    International Nuclear Information System (INIS)

    Du Xiangwan; Pan Jusheng; Zhang Xinwei; Du Shuhua; Xu Changgen

    1990-05-01

    The authors attempt to expound the basic points of veiw and put forward a proposal on the space nonweaponization. The authors analyse the nature of space weaponry and its impact on arms race and point out that the space nonweaponization is an urgent task for arms control. The relations between prohibition of space and ASAT weapons, between prohibition of space weapons and reduction of nuclear weapons and between space weapon and nuclear test are all analysed. The inadequacy of the existing space treaties is made clear based on the evaluation. It is hoped that a verifiable treaty on the prohibition of space weapons should be made and international cooperation on peaceful use of outer space is necessary

  11. Quality of emergency rooms and urgent care services: user satisfaction.

    Science.gov (United States)

    Lima, Cássio de Almeida; Santos, Bruna Tatiane Prates dos; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; Costa, Fernanda Marques da; Carneiro, Jair Almeida

    2015-01-01

    To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself.

  12. An urgent access neurovascular clinic: audit of timeliness.

    Science.gov (United States)

    Briley, Dennis; Durkin, Chris; Meagher, Tom

    2009-06-01

    This study aimed to evaluate timeliness of an outpatient urgent access neurovascular clinic in a district general hospital setting through an audit of delay from event to completion of evaluation following transient ischaemic attack (TIA) or minor stroke. Participants included those referred for evaluation of suspected TIA or minor stroke. The median delay from event to completion was 16 days, with 45% seen within two weeks of symptom onset, and 15% within one week of symptom onset. A weekly TIA clinic is not capable of achieving the National Clinical Guidelines for Stroke recommendation for evaluation within one week of symptoms. This audit supports the National Stroke Strategy recommendation for immediate evaluation of patients presenting with a recent TIA or minor stroke.

  13. 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

  14. Enoximone improves selection of candidates for urgent cardiac transplantation.

    Science.gov (United States)

    Loisance, D; Benvenuti, C; Dubois Randé, J L; Deleuze, P; Castaigne, A; Cachera, J P

    1990-07-01

    Immediate cardiac transplantation, or urgent implantation of devices for mechanical support of the failing heart, has been shown to be effective as life-saving procedures in patients with cardiogenic shock unresponsive to maximal sympathomimetic treatment. The intravenous administration of enoximone in these patients, in addition to previous inotropic support, should permit a 'buying of time' strategy, leading to a reduction in the need for complex, invasive and costly techniques, such as artificial hearts. In addition, it should permit improved selection of candidates for cardiac transplantation. A prospective study was started in 1985 to obtain data on the haemodynamic and clinical efficacy of intravenous enoximone in these critically ill patients, and to determine the time gained for evaluation of the need for urgent transplantation. Cardiac index rose from 1.82 +/- 0.26 litres/minute/m2 to 2.67 +/- 0.56 litres/minute/m2 after 30 minutes, while pulmonary capillary wedge pressure decreased from 29.9 +/- 7 mm Hg to 18.0 +/- 7 mm Hg (n = 30). This early beneficial effect waned progressively after 6 hours. Prior to the next intravenous infusion at 8 hours, cardiac index was 2.07 +/- 0.53 litres/minute/m2 and pulmonary capillary wedge pressure was 25 +/- 8.5 mm Hg. Only four patients could not wait for a biological graft and had to be implanted with a complete artificial heart (3 patients), or a ventricular assist device (1 patient). In all, 30 patients improved and their increased survival allowed a re-evaluation for cardiac transplantation itself; 13 were rapidly (1.7 days; range 0.5-5) confirmed as good candidates. As a whole, this strategy compares favourably with the results of a strategy based on mechanical bridging alone.

  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. 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 ...

  17. The hydrogen economy urgently needs environmentally sustainable hydroelectricity

    International Nuclear Information System (INIS)

    Goodland, R.

    1995-01-01

    Only two sources of energy were said to have the capacity to bridge the transition to fully sustainable and renewable energy, namely natural gas and hydro. The argument was made that because of this advantage, both forms will have to be promoted fast, since the transition to sustainable energy is urgent. In so far as natural gas supplies are concerned, it was estimated that they will last for perhaps the next 50 years, whereas hydroelectric potential is practically unlimited. Developing nations could vastly accelerate their development, reduce poverty and approach sustainability by exporting hydro to industrial countries. Similarly, industrial nations switching from fossil fuels to hydrogen could move up the environmental ranking, and significantly help alleviating global pollution and climate risks. Environmental ranking of new energy sources, world reservoirs of hydroelectric power, environmental and social ranking of hydro sites, the environmental impacts of hydro projects, and the concept of environmental sustainability in hydro reservoirs, were summarized. Greater acceptance of the need for sustainable development by the hydro industry was urged, along with more care in selecting hydro development sites with sustainability as a prime objective. 23 refs., 6 figs

  18. [Functional state of upper urinary tract in urgent extracorporeal lithotripsy].

    Science.gov (United States)

    Dzeranov, N K; Mudraia, I S; Volkov, I N; Moskalenko, S A; Kirpatovskiĭ, V I

    2000-01-01

    Seven patients have undergone urgent extracorporeal lithotripsy (UEL) for renal colics. 3 patients were cured. Before UEL they had insignificant defects of urodynamics and ureteral contraction. 3 patients with initial dilation of the upper urinary tracts > 2 cm and reflux ureteral motility, residual concrements eliminated spontaneously or after additional UEL procedures or combined treatment. One female with initial pelvic and uretral dilation and disturbed motility of the upper urinary tracts was treated for 6 months. 1-2.5-year follow-up detected neither concrements nor marked dilation of the calyceropelvic system. Patients with renal colics have more pronounced local defects of contraction rhythm and activity, peristaltic direction. Peristaltic disorders in the upper urinary tracts in patients with renal colics are local and may be related to acute occlusion and neuroreflex effects. This explains why UEL produces good results in renal colics, especially in patients with minimal defects of urodynamics. Complicated course after UEL early after the operation occurred in patients with dilated upper urinary tracts, high contraction amplitude registered by high tonicity of the ureteral wall and the presence of retrograde peristaltic waves.

  19. Innovative Urgent Care for the Palliative Patient at Home.

    Science.gov (United States)

    Montgomery, Carmel L; Pooler, Charlotte; Arsenault, Julia E; Berean, Colleen; Sharman, Robert; Cameron, Cheryl L; de Kock, Ingrid

    2017-04-01

    Palliative and end-of-life patients in their homes are at risk of developing symptom crises requiring urgent care. The usual care for these patients involves transport to an Emergency Department (ED) despite the preference of most palliative patients to stay home. The objective of this initiative was to develop an innovative strategy to provide collaborative care in the home to alleviate symptoms and avoid transport. A partnership was created among Emergency Medical Services and Community Care staff, physicians, and leaders to enable patients to stay at home with existing resources during symptom crisis. As a result of the initiative, patients were able to stay at home more frequently. When patients required transport to the ED, it occurred after attempted symptom management in the home. A total of 110 calls were tracked in the first 18 months of the initiative. Of those, 61% ended with the patient staying home, in alignment with their preferred place of care at the end of life. A collaborative approach by care providers in the community enabled patients to stay home despite symptom crisis near the end of life.

  20. Preoperative stoma site marking in the general surgery population.

    Science.gov (United States)

    Zimnicki, Katherine M

    2013-01-01

    Preoperative teaching and stoma site marking are supported by research and professional organizations as interventions that can reduce the incidence of problematic stomas and improve patient outcomes. This study investigated the translation of this research into practice in the acute care surgery population. A retrospective chart review using convenience sampling was conducted at a large urban hospital in the Midwestern United States. Thirty patients underwent a surgical procedure that resulted in the creation of a fecal ostomy over a 5-month period. Descriptive statistical analysis examined the reason for surgery, preoperative length of stay (LOS), the percentage of patients who received preoperative teaching and stoma marking and the relationship between preoperative LOS and the use of preoperative teaching and stoma marking. Twenty-one of 30 patients were admitted to hospital 24 hours or more before surgery. No participants were admitted urgently. Three (14%) of those admitted for more than 24 hours received preoperative marking or teaching. There was no significant relationship between preoperative LOS and preoperative teaching and stoma marking. The opportunity exists to promote successful adaptation in this surgical population through the implementation of the evidence-based interventions of preoperative teaching and stoma marking. Additional study is needed to determine barriers to their use as well as to develop effective implementation strategies.

  1. Urgent need for warming experiments in tropical forests.

    Science.gov (United States)

    Cavaleri, Molly A; Reed, Sasha C; Smith, W Kolby; Wood, Tana E

    2015-06-01

    powerful and urgent way forward in order to improve our understanding of tropical forest responses to climate change. © 2015 John Wiley & Sons Ltd.

  2. Urgent need for warming experiments in tropical forests

    Science.gov (United States)

    Calaveri, Molly A.; Reed, Sasha C.; Smith, W. Kolby; Wood, Tana E.

    2015-01-01

    powerful and urgent way forward in order to improve our understanding of tropical forest responses to climate change.

  3. Fusion is urgent needed for the developing countries

    International Nuclear Information System (INIS)

    Li Jiangang

    2005-01-01

    Energy is a global problem, as it is central to economic development, climate and environment, and international stability and sustainability. Energy need is expected to double in 40 years and an even larger increase is needed to lift the world out of poverty. 80% of world's energy is generated by burning fossil fuels, which is driving climate change and generating pollution. China will grow up to be a moderate developed country in 2050. The coal-centred energy structure will remain until 2050. Annual Energy Consumption per person will increase from near 1 TCE to no less than 3 TCE ( at present time, US: 11.5 TCE; West Europe: 5.6 TCE; Japan: 5.1 TCE) Estimated Energy Demand: increasing from near 1B TCE to over 4B TCE within next 3-4 decades. To realize the long-term sustainable development, it is necessary for China to explore reliable ways and develop thousands of GW non- fossil fuel power. The fission energy is a transit solution. To build hundreds of GW Fission Nuclear Power Plants in China - social problems, safety and environmental concerns, technical difficulties should be solved in near future. It is crucial and urgent for China to realize the controlled Nuclear Fusion Energy for our long-term development in the future as early as possible. Fusion shows environmentally responsible and intrinsically safe, the supplies of fuel are essentially limitless. JET has produced 16MW of fusion power and shown that fusion can be mastered on earth. Fusion has a long and successful history of international collaboration with obvious benefits to all partners for peaceful purpose. ITER is a device for us to bring the Sun to earth for the first time in the history. A properly organised and funded fusion development programme could lead to a proto-type fusion power plant to generate electricity to the grid within about 30 years (ITER+IFMIF). For developing countries, such as China and India, fusion is one of the very few options for large-scale sustainable energy generation

  4. 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.

  5. 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. ...

  6. 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

  7. Italy-Greece cooperation for transplantation of medically urgent Greek patients: is it an effective, efficient model?

    Science.gov (United States)

    Peritore, D; Pretagostini, R; Di Ciaccio, P; Fiaschetti, P; Gabbrielli, F; Oliveti, A; Stabile, D; Ricci, A; Vaia, F; Nanni Costa, A

    2012-09-01

    In 2005 the Italian National Transplant Centre (CNT) signed a cooperation agreement with the Hellenic Transplant Organization (HTO) fostering the transfer and transplantation of urgent Greek liver patients at Italian transplantation centers. So as to not reduce access to transplantation for Italian patients, the agreement provided compensation for organs allocated to Greek transplant recipients. The aim of this study was to analyze the flow of patients from Greece to Italy and the number of received livers to consider the possibility to extend this kind of agreement to other countries, so that this should not penalize Italian recipients. The agreement provides the possibility for Greek patients affected by acute disease to be transferred to Italian transplantation centers participating in the agreement. Until 2008 livers transplanted into Greek recipients were returned through a preferential offer of surplus Greek organs, whereas from 2009 an obligation of payback was introduced. During the reviewed period requests for transfer, transferred patients, and number of patients who later underwent transplantation in Italy were 56, 26, and 23, respectively. Livers offered by the Greek organization that were accepted, transferred, and transplanted in Italy have been 82, 50, and 44, respectively. According to our analysis, the cooperation has had as positive impact for both Greece, which has difficulties transplanting urgent recipient because of the low number of donors, and for Italy, which is not penalized by the use of an organ in a Greek recipients, but is also rewarded for helpfulness. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Relationship between seasonal weather changes, risk of dehydration, and incidence of severe bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population

    Science.gov (United States)

    Palmisano, Pietro; Accogli, Michele; Zaccaria, Maria; Vergari, Alessandra; De Luca De Masi, Gabriele; Negro, Luca; De Blasi, Sergio

    2014-09-01

    There is little information on any seasonal variations or meteorological factors associated with symptomatic bradyarrhythmias requiring cardiac pacing. The aim of this single-center study was to investigate the seasonal distribution of the incidence of severe, life-threatening bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population. Consecutive patients who underwent urgent temporary transvenous cardiac pacing between 2007 and 2012 were enrolled. The baseline characteristics of the patients and some meteorological parameters, including the calculation the daily heat index (HI), were recorded. During the study period, 79 consecutive patients (mean age 82 ± 8 years, 41 % male) underwent urgent temporary transvenous cardiac pacing, mainly for third-degree atrioventricular block (79 %). The incidence of bradyarrhythmias was significantly higher in summer than in the other seasons ( P 90 °F for >3 h per day for at least 10 days ( P renal function impairment and hyperkalemia (all P < 0.05). This study showed an increased incidence of severe bradyarrhythmias in an elderly population during the hottest months of the year. In these months, in subjects characterized by increased susceptibility to dehydration, the risk of developing bradyarrhythmias was increased significantly.

  9. The importance of empiric abdominal computed tomography after urgent laparotomy for trauma: do they reveal unexpected injuries?

    Science.gov (United States)

    Weis, Joshua J; Cunningham, Kelly E; Forsythe, Raquel M; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

    2014-10-01

    Many institutions now use empiric full-body computed tomography (CT) as a standard step in the initial workup of stable trauma patients. Recent data suggest that these scans may reveal unexpected injuries and improve survival in patients with polytrauma. However, patients who are unstable on presentation are often taken to the operating room (OR) without CT. Many of these patients undergo empiric full-body CTs after being stabilized in the OR, yet few data exist regarding how often early postoperative CT reveals unexpected injuries within compartments that have been explored surgically. Thus, the objective of this study was to determine if empiric abdominal/pelvic (ABD) CT after emergent trauma laparotomies are likely to reveal missed injuries requiring urgent management and improve patient management compared with clinical judgment alone. We review retrospectively 496 trauma patients who required urgent exploratory laparotomy at UPMC Presbyterian Hospital from 2007 to 2011. Patients were included if they went to the OR for exploratory laparotomy directly from the emergency department within 2 hours of arrival. Patients were excluded if they received any preoperative ABD CT imaging. Patients who expired in the OR were similarly excluded. Patients were stratified into 2 groups based on whether or not they received an empiric ABD CT in the 24 hours immediately after laparotomy. Medical records were reviewed to look for differences in missed injuries, urgent reexplorations, nontherapeutic interventions, and time to urgent reexploration. There were 278 patients who met inclusion at exclusion criteria and constituted the study cohort. Of these patients, 124 underwent early empiric postoperative ABD CT imaging (45%). The remaining 154 patients did not undergo early ABD imaging (no CT group). The overall cohort had a 45% incidence of damage control procedures and a 9% rate of negative laparotomy. The 2 groups were statistically similar in age, presenting vitals, and

  10. 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.

  11. Urgent Dental Care” – A preclinical patient case scenario as an aid to clinic preparation for treating a patient with urgent dental care needs

    Directory of Open Access Journals (Sweden)

    Gary L. Drahos

    2017-08-01

    Full Text Available Background Pre-clinical student competencies are usually assessed in only one specific area and not contextualized in a patient care scenario. Exposing preclinical students to a high fidelity simulated urgent care patient scenario will help the student develop critical thinking and intuitive dental treatment skills that will prepare them for actual urgent dental care (UDC treatment in the clinic. Aims Dental students, in the preclinical years, have difficulty in applying various disciplines of dentistry to an actual patient. The goal of this exercise is to contextualize several disciplines (diagnosis, material selection, oral pathology, electronic record keeping, patient interview and critical thinking into a real patient case. The hypothesis is that providing a preclinical urgent care session in this manner will better prepare students for clinical UDC treatment. Methods An urgent care patient scenario was developed that integrated multiple disciplines and contextualized common urgent clinical situations that are encountered daily, focusing on interviewing skills, basic diagnostic skills, manipulation of electronic patient records, material selection and defence of selection, image and data procurement, prescription writing, critical decision making, oral medicine diagnosis, treatment planning for a focused need, and performance of dental treatment. Second year dental students are required to interview a first time (walk-in urgent care patient to determine the chief complaint, diagnose the urgent problem (based on information obtained by interviewing the patient and to make critical patient care decisions and self-assess their performance. Results Students generally completed the session on time and in a satisfactory fashion. Preparation for the session was key and faculty calibration was essential. Conclusion Completion of this case scenario better prepared the students for the clinic as indicated by student self-assessment, post course

  12. Manejo quirúrgico urgente de heridas faciales por mordedura humana Urgent surgical management of facial human bite wounds

    Directory of Open Access Journals (Sweden)

    A. Fernández García

    2011-09-01

    Full Text Available Las heridas por mordedura pueden generar algunas dificultades quirúrgicas en su manejo inicial debido a su especial predisposición a las complicaciones sépticas y la importante destrucción tisular frecuentemente asociada. Sin embargo, es importante su reparación inmediata, especialmente en el caso de amputaciones y colgajos por avulsión. Las mordeduras humanas se hallan envueltas además en consideraciones psicológicas que incrementan la dificultad del tratamiento debido a las espectativas estéticas de los pacientes que las sufren. Este trabajo analiza 7 casos de mordedura facial humana desde los puntos de vista epidemiológico y clínico. Presentamos y discutimos el uso de los tejidos amputados como fuente de injertos de piel, injertos condrales y el papel de los colgajos locales en dos tiempos en la cirugía de urgencia de estas lesiones.Bite wounds can create several surgical difficulties in their initial management due to the special facility for infectious complications and the frequent association with extensive tissue damage. However, the immediate repair its desirable, mainly in amputations and flap avulsions. The human bite wounds are also involved by psychological considerations that increase the difficulty of the treatment due to patient´s aesthetic expectations. This article analyzes 7 cases of facial human bites under the epidemiological and clinical points of view. The use of the amputated tissues to obtain skin grafts, condral grafts, and the role of local two stage flaps in the emergency surgery of these wounds are exposed and discussed.

  13. A strategic-interaction analysis of an urgent appeal system and its outcomes for garment workers

    NARCIS (Netherlands)

    den Hond, F.; Stolwijk, Sjoerd; Merk, J.

    2014-01-01

    Within the global garment industry the term "urgent appeal" is used to describe a request for action to Western activist groups for support in a specific case of labor rights violations. The urgent appeal system has become an important strategy for the transnational antisweatshop movement. It is

  14. 3 CFR - Unexpected Urgent Refugee and Migration Needs Related to the Continuing Conflict in Pakistan

    Science.gov (United States)

    2010-01-01

    ... 3 The President 1 2010-01-01 2010-01-01 false Unexpected Urgent Refugee and Migration Needs... Presidential Determination No. 2009-16 of March 11, 2009 Unexpected Urgent Refugee and Migration Needs Related... Migration and Refugee Assistance Act of 1962 (the “Act”), as amended (22 U.S.C. 2601), I hereby determine...

  15. 78 FR 9569 - Unexpected Urgent Refugee and Migration Needs Relating to Syria

    Science.gov (United States)

    2013-02-08

    ...-04 of January 29, 2013--Unexpected Urgent Refugee and Migration Needs Relating to Syria Memorandum of... Urgent Refugee and Migration Needs Relating to Syria Memorandum for the Secretary of State By the... 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as amended (22 U.S.C...

  16. 3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Gaza

    Science.gov (United States)

    2010-01-01

    ... 3 The President 1 2010-01-01 2010-01-01 false Unexpected Urgent Refugee and Migration Needs... of January 27, 2009 Unexpected Urgent Refugee and Migration Needs Related to Gaza Memorandum for the..., including section 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the “Act”), as amended (22 U...

  17. 76 FR 53295 - Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa

    Science.gov (United States)

    2011-08-25

    ...-12 of August 8, 2011--Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa...) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as amended, (22 U.S.C. 2601(c)(1... Emergency Refugee and Migration Assistance Fund, for the purpose of meeting unexpected and urgent refugee...

  18. [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.

  19. 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 ...

  20. Does peritoneal dialysis have a role in urgent-start end-stage kidney disease?

    Science.gov (United States)

    McQuillan, Rory F; Lok, Charmaine E

    2018-04-19

    Despite its many positive attributes, peritoneal dialysis remains underutilized, particularly in the United States. Urgent-start peritoneal dialysis (PD) has been proposed as a method of increasing PD prevalence. Urgent-start PD has been shown to be safe, feasible, and effective. However, urgent-start PD is also accompanied by several multidimensional challenges. This article is intended to equip the reader with a practical sense of whether an urgent-start PD program would be appropriate in his or her own clinical context and if appropriate, what factors would be necessary for such a program to flourish. As such, we summarize latent factors, which are necessary to consider before instituting an urgent-start PD. Then, using a series of clinical vignettes, highlight the component parts of a successful urgent-start PD program and the patient population who stand to benefit most from this strategy. The discussion is then balanced by presenting limitations to consider in the urgent-start PD approach. © 2018 Wiley Periodicals, Inc.

  1. 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.

  2. 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.

  3. 212. Incidencia de complicaciones graves en trasplantes cardíacos urgentes y no urgentes. 10 años de experiencia

    Directory of Open Access Journals (Sweden)

    L. Donate Bertolín

    2010-01-01

    Conclusiones: En nuestra serie, el trasplante urgente no presentó una mayor mortalidad perioperatoria. Sin embargo, observamos mayor número de complicaciones graves, asociadas a mortalidad a más largo plazo, como FAI, infección bacteriana y ventilación mecánica prolongada.

  4. The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008.

    Science.gov (United States)

    Naavaal, Shillpa; Barker, Laurie K; Griffin, Susan O

    2017-12-01

    We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance. © 2016 American Association of Public Health Dentistry.

  5. Stroke is not a treatment dilemma for early valve surgery in active infective endocarditis.

    Science.gov (United States)

    Wan, Su; Sung, Kiick; Park, Pyo Won; Kim, Wook Sung; Lee, Young Tak; Jun, Tae-Gook; Yang, Ji-Hyuk; Jeong, Dong Seop; Cho, Yang Hyun

    2014-09-01

    While early valve surgery for active infective endocarditis (AIE) is recommended, surgeons have hesitated to operate on patients complicated by cerebral septic embolism resulting in cerebral bleeding when cardiopulmonary bypass is required intraoperatively. The study aim was to review the outcomes of operations for AIE, and to determine the risks of neurologic complications resulting from cerebral septic embolism. Between 1994 and June 2011, among 278 patients who underwent heart valve surgery for AIE at the authors' institution, 39 (14%) had cerebral septic embolisms. Cerebral lesions were verified by imaging, and were predominantly multiple embolic infarctions (34 patients; 87.2%). Five patients had brain abscess, and 10 had hemorrhage with or without infarction. The mean interval between the recent onset of a stroke and surgery was 10.1 ± 10.1 days (range: 0-43 days). One patient died postoperatively of septic shock. New neurologic complications occurred in five patients, including secondary hemorrhagic transformation in the previous lesions (n = 2), newly developed subdural and subarachnoid hemorrhage (n = 2), and an increased degree of subarachnoid hemorrhage (n = 1). One patient needed a craniotomy, and the others were treated medically. There were five late deaths, including one cardiac death, and one redo valve surgery due to repaired valve failure during the follow up period of 46.3 ± 40.4 months (range: 1.9-127.4 months). The overall and event-free survival rates at five and 10 years were 84.3 ± 6.5% and 75.9 ± 9.9%, and 81.7 ± 6.8% and 73.6 ± 9.9%, respectively. Surgery for AIE with cerebral septic embolisms can be performed safely, with good early and mid-term follow-up results. When urgent or emergent surgery for AIE is needed, neurologic complications should not be a reason for delay.

  6. Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

    Science.gov (United States)

    Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

    2014-08-01

    Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P general surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in

  7. The duplex-Doppler colour echography of the scrotum and testicles in adults and boys. II. the contribution of the urgent study of acute scrotum symptoms; Ecografia duples-Doppler color del escroto y el testiculo en el adulto y el nino. II. Aportacion al estudio urgente del escroto agudo

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    Rangel-Villalobos, E.; Jimenez-Castellanos, R.; Bustos, C.; Linares, A.; Gonzalez-Prada, F. [Hospital Universitario Virgen Macarena. Sevilla (Spain)

    1999-07-01

    To analyse the findings, contributions and limitations of the Doppler echography for the urgent study of acute scrotum symptoms, both in adults and in boys. 60 patients (22 adults and 38 boys) with acute scrotal symptomatology were examined using B mode echography, followed by a colour duplex-Doppler (CDD) echography with a lineal 7.5 MHz transducer. We compared the findings obtained with those of the healthy contralateral testicle and with surgery or clinical-echographical evolution. The most common pathology was inflammation (27%) followed by ischemic (24%) and traumatic (17%). 12% of the patients had miscellaneous conditions. To conclude, in 20% of the cases the B mode and the Doppler examination was normal, the symptoms were resolved spontaneously. After carrying out the CDD only 14 (23%) of the cases needed immediate surgery and 3 (5%) delayed surgery, the remaining 43 (72%) patients responded to the traditional treatment. The CDD allows for a safe, quick and harmless diagnosis in practically all the acute scrotum cases, for both adults and boys. Its limitations in pre-puberty patients or in cases that were atypical are overcome when put in the hands of an expert radiologist, as they need a longer exploration time and suitable Doppler equipment. The main contribution to the urgent diagnosis of acute scrotum symptoms is that it accurately establishes which patients should be chosen for immediate surgery. (Author) 33 refs.

  8. Dental Implant Surgery

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    ... 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, ...

  9. 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, ...

  10. 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, ...

  11. 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.

  12. [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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Open Heart Surgery in a Newly Established Cardiovascular Department: The first 300 cases

    Directory of Open Access Journals (Sweden)

    Kemal Korkmaz

    2016-01-01

    Full Text Available Aim: Evaluation of the results of open heart surgery in a newly established cardiovascular clinic: Ankara Numune Education and Research Hospital. Material and Method: Between June 2012 and January 2014, 300 open heart surgeries were performed. Urgent operation was performed in 22 patients (7.3% because of ST-elevation myocardial infarction and in 1 patient because of left ventricular aneurysm rupture. Coronary artery bypass grafting was performed in 211 (70.3% patients. The other patients underwent various complex operations such as valve repair, Tirone-David procedure and repair of atrioventricular canal defect. Results: In 3 patients (1% hospital mortality was seen. Reoperation was performed in 8 patients (2.6% because of pericardial tamponade and in 9 patients (3% because of bleeding. Atrial fibrillation was developed in 28 patients (9.3% in the postoperative period and normal sinus rhythm was established with medical cardioversion. Intra-aortic balloon pump(IABP was used in 4 patients preoperatively and in 11 patients postoperatively, including 15 patients(%5. Discussion: In the current era, the patients who are consulted to cardiovascular surgery clinics become more chronic, high risk and patients with additional co-morbid diseases because of the developments in interventional cardiology. Our newly established center aims to be a nationally and internationally successful clinic which was proved by low mortality and morbidity rates with a team who follows the developments and constantly educate and trained.

  18. 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.

  19. Long-term results after proximal thoracic aortic redo surgery.

    Directory of Open Access Journals (Sweden)

    Martin Czerny

    Full Text Available OBJECTIVE: To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery. METHODS: We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40 who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed. RESULTS: In hospital mortality was 13%, perioperative neurologic injury was 7%. Fifty percent of patients underwent redo surgery in an urgent or emergency setting. In 65%, partial or total arch replacement with or without conventional or frozen elephant trunk extension was performed. The preoperative logistic EuroSCORE I confirmed to be a reliable predictor of adverse outcome- (ROC 0.786, 95%CI 0.64-0.93 as did the new EuroSCORE II model: ROC 0.882 95%CI 0.78-0.98. Extensive individual logistic EuroSCORE I levels more than 67 showed an OR of 7.01, 95%CI 1.43-34.27. A EuroSCORE II larger than 28 showed an OR of 4.44 (95%CI 1.4-14.06. Multivariate logistic regression analysis identified a critical preoperative state (OR 7.96, 95%CI 1.51-38.79 but not advanced age (OR 2.46, 95%CI 0.48-12.66 as the strongest independent predictor of in-hospital mortality. Median follow-up was 23 months (1-52 months. One year and five year actuarial survival rates were 83% and 69% respectively. Freedom from reoperation during follow-up was 100%. CONCLUSIONS: Despite a substantial early attrition rate in patients presenting with a critical preoperative state, proximal thoracic aortic redo surgery provides excellent early and mid-term results. Higher EuroSCORE I and II levels and a critical preoperative state but not advanced age are independent predictors of in-hospital mortality. As a consequence, age alone should no longer be regarded as a contraindication for surgical treatment in this particular group of patients.

  20. 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

  1. 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.

  2. 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.

  3. Management for CBD stone-related mild to moderate acute cholangitis: urgent versus elective ERCP.

    Science.gov (United States)

    Jang, Sang Eon; Park, Sang Wook; Lee, Ban Seok; Shin, Cheol Min; Lee, Sang Hyub; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho; Park, Joo Kyung; Hwang, Jin-Hyeok

    2013-07-01

    There is no doubt that urgent biliary decompression needs to be done in case of severe acute cholangitis. However, it remains to be determined how early biliary decompression should be performed and elective intervention would be comparable to urgent intervention, in case of mild to moderate choledocholithiasis associated cholangitis. One hundred ninety-five patients were enrolled who were diagnosed with mild to moderate cholangitis with common bile duct (CBD) stones between January 2006 and August 2010. They were divided into two groups according to door to intervention time, and urgent (≤24 h, n = 130) versus elective (>24 h, n = 82). Primary outcomes of this study were technical success rate (CBD stones removal) and clinical success rate (improvement of cholangitis) between the two groups. Hospital stay and intervention-related complications were also evaluated. There was no statistically significant difference in technical, clinical success rate and intervention-related complications between the urgent and elective groups (P = 0.737, 0.285, 0.398, respectively). Patients in the urgent group had significantly shorter hospitalization than in the elective group (6.8 vs. 9.2 days, P CBD stone-related mild to moderate acute cholangitis because of the advantage of short hospital stay and intervention to discharge time.

  4. [Review of 197 cases of urgent cesarean section performed in 2010 using NICE classification].

    Science.gov (United States)

    Sakoda, Atsushi; Ikuma, Shinichiro; Baba, Mariko; Sato, Masaki; Sumikura, Hiroyuki

    2014-12-01

    NICE (National Institute for Health and Clinical Excellence) of UK introduced a new classification of urgent cesarean section consisting of four categories. We classified 197 cases of urgent cesarean section performed at our institution between April 1st, 2010 and March 31, 2011, using the NICE classification. Clinical records including obstetric record and anesthetic record were reviewed to identify possible cases as candidates of category 1 and 2, from 197 cases. Final classification was then decided at a case conference with four anesthesiologists and one obstetrician. Five cases were classified into category 1, and 51 cases were into category 2. There were 9 cases with umbilical pH < 7.2 among 51 cases of category 2. In these cases, quicker decision to delivery accompanies worse umbilical pH of the delivered neonate. The present review classifying urgent cesarean section using NICE classification revealed that most cases of urgent cesarean section were treated appropriately at our hospital. NICE guideline seems to be useful to improve anesthetic management of urgent cesarean section.

  5. 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 ...

  6. [Perioperative treatment for the urgent orbital decompression surgery in a 30-weeks pregnant woman with Graves' orbitopathy].

    Science.gov (United States)

    Guerrero-Domínguez, R; López-Herrera-Rodríguez, D; Domínguez-Blanco, A; Medina-de Moya, I; Sánchez-Carrillo, F

    2014-01-01

    Thyroid ophthalmopathy is a rare extra-thyroid complication usually associated with Graves' disease. This disease can occur in the euthyroid pregnant patient. Graves' orbitopathy is characterized by eyelid retraction, proptosis, extraocular muscle dysfunction, and periorbital edema. In some cases an emergency surgical repair may be required to avoid irreversible vision loss. We present the case of a 35-year-old woman in her 30th gestational week, who suffered from Graves' ophthalmopathy, severe exophthalmia, and visual acuity decrease. Following consultations among anesthesiologists, ophthalmologists, maxillofacial surgeons, endocrinologists, obstetricians and the patient, it was decided to perform a surgical orbital wall decompression. The anesthetic and perioperative implications associated with gestational age and the considerations for this surgical procedure, and how to avoid increasing intraocular pressure are discussed. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  7. 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 — ...

  8. SCINTIGRAPHY IN URGENT CONDITIONS AND COMPLICATIONS OF ACUTE DISEASES AND TRAUMAS

    Directory of Open Access Journals (Sweden)

    N. Ye. Kudryashova

    2014-01-01

    Full Text Available ABSTRACT. The data generalized in the review characterize radionuclide method as a high informative technique in diagnosis of the row of acute diseases and traumas and complications of them. It was shown that each radionuclide technique decides the concrete clinical tests and has a strictly definite place in the diagnostic algorithm. Urgent radionuclide techniques give the important information for the choice of the treatment’s policy or operation’s volume in such acute diseases as tromboembolism, arterial occlusions, small bowel obstruction, acute cholecystitis and cholelithiasis, acute myocardial infarct, rhabdomyolysis, differentiation of acute urological and acute abdominal surgical diseases and so on. The main aim of the work of our radionuclide department is to perfect, modificate of urgent radionuclide techniques and to correct the place of them in urgent conditions’s diagnostic algorithm for increasing of the quality and the rapidity in diagnosis. 

  9. Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer

    Directory of Open Access Journals (Sweden)

    Remzi Kızıltan

    2016-02-01

    Full Text Available Aim To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had undergone emergency surgery due to complicated colorectal cancer. Methods A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department of General Surgery, Dursun Odabaş Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed. Results There were 14 (42.5% male and 19 (57.5% female patients. Mean age was 60 years (range: 32- 83 years; 14 (42.5% patients were less than 60 years old , while 19 (57.5% were 60 years old or older. Operations were performed due to perforation (39.3% and obstruction (60.6% in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2% and in the left colon in 24 cases (72.7%. Eleven (33.3% patients underwent resection and anastomosis, 13 (39.3% resection and ostomy, and nine (27.2% patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%. Conclusions High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity rates.

  10. Success of Urgent-Start Peritoneal Dialysis in a Large Canadian Renal Program.

    Science.gov (United States)

    Alkatheeri, Ali M A; Blake, Peter G; Gray, Daryl; Jain, Arsh K

    2016-01-01

    ♦ Many patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area. ♦ In this prospective observational study, we report on our experience in a single academic center. This program started in July 2010. We included patients who initiated PD urgently, that is within 2 weeks of catheter insertion. We followed all incident PD patients until October 2013 for mechanical and infectious complications. Peritoneal dialysis catheters were inserted either percutaneously or laparoscopically and dialysis was initiated in either an inpatient or outpatient setting. ♦ Thirty patients were started on urgent PD during our study period. Follow-up ranged from 28 to 1,050 days. Twenty insertions (66.7%) were done percutaneously and 10 (33.3%) were laparoscopic. Dialysis was initiated within 2 weeks (range: 0-13 days, median = 6 days). Twenty-four patients (80%) started PD in an outpatient setting and 6 patients (20%) required immediate inpatient PD start. Three patients (10%) developed a minor peri-catheter leak during the first week of training that was managed conservatively. There were no episodes of peritonitis or exit-site/tunnel infection during the first 4 weeks post-insertion. Four patients (13.3%) from the percutaneous insertion group and 2 patients (6.7%) from laparoscopic insertions developed catheter dysfunction due to migration, which was managed by repositioning, without need for catheter replacement or modality switch. ♦ Our results are consistent with other studies in this area and demonstrate that urgent-start PD is an acceptable and safe alternative to hemodialysis in patients who need to start dialysis urgently without established

  11. Exercise-induced wheeze, urgent medical visits, and neighborhood asthma prevalence.

    Science.gov (United States)

    Mainardi, Timothy R; Mellins, Robert B; Miller, Rachel L; Acosta, Luis M; Cornell, Alexandra; Hoepner, Lori; Quinn, James W; Yan, Beizhan; Chillrud, Steven N; Olmedo, Omar E; Perera, Frederica P; Goldstein, Inge F; Rundle, Andrew G; Jacobson, Judith S; Perzanowski, Matthew S

    2013-01-01

    Exercise-induced wheeze (EIW) may identify a distinct population among asthmatics and give insight into asthma morbidity etiology. The prevalence of pediatric asthma and associated urgent medical visits varies greatly by neighborhood in New York City and is highest in low-income neighborhoods. Although increased asthma severity might contribute to the disparities in urgent medical visits, when controlling for health insurance coverage, we previously observed no differences in clinical measures of severity between asthmatic children living in neighborhoods with lower (3%-9%) versus higher (11%-19%) asthma prevalence. Among these asthmatics, we hypothesized that EIW would be associated with urgent medical visits and a child's neighborhood asthma prevalence. Families of 7- to 8-year-old children were recruited into a case-control study of asthma through an employer-based health insurance provider. Among the asthmatics (n = 195), prevalence ratios (PRs) for EIW were estimated. Final models included children with valid measures of lung function, seroatopy, and waist circumference (n = 140). EIW was associated with urgent medical visits for asthma (PR, 2.29; P = .021), independent of frequent wheeze symptoms. In contrast to frequent wheeze, EIW was not associated with seroatopy or exhaled NO, suggesting a distinct mechanism. EIW prevalence among asthmatics increased with increasing neighborhood asthma prevalence (PR, 1.09; P = .012), after adjustment for race, ethnicity, maternal asthma, environmental tobacco smoke, household income, and neighborhood income. EIW may contribute to the disparities in urgent medical visits for asthma between high- and low-income neighborhoods. Physicians caring for asthmatics should consider EIW an indicator of risk for urgent medical visits.

  12. 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 .

  13. 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.

  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. 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

  16. 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 ...

  17. 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.

  18. 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.

  19. 75 FR 67015 - Unexpected Urgent Refugee And Migration Needs Resulting From Flooding InPakistan

    Science.gov (United States)

    2010-11-01

    ... September 3, 2010 Unexpected Urgent Refugee And Migration Needs Resulting From Flooding InPakistan... laws of the United States, including section 2(c)(1) of the Migration and Refugee Assistance Act of... amount not to exceed $33 million from the United States Emergency Refugee and Migration Assistance Fund...

  20. 76 FR 14271 - Unexpected Urgent Refugee and Migration Needs Related to Libya

    Science.gov (United States)

    2011-03-16

    ... March 7, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya Memorandum for the... States, including section 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as... million from the United States Emergency Refugee and Migration Assistance Fund, for the purpose of meeting...

  1. 75 FR 67013 - Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan

    Science.gov (United States)

    2010-11-01

    ... August 26, 2010 Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan... laws of the United States, including section 2(c)(1) of the Migration and Refugee Assistance Act of... amount not to exceed $9.5 million from the United States Emergency Refugee and Migration Assistance Fund...

  2. Urgent-start peritoneal dialysis: a chance for a new beginning.

    Science.gov (United States)

    Arramreddy, Rohini; Zheng, Sijie; Saxena, Anjali B; Liebman, Scott E; Wong, Leslie

    2014-03-01

    Peritoneal dialysis (PD) remains greatly underutilized in the United States despite the widespread preference of home modalities among nephrologists and patients. A hemodialysis-centric model of end-stage renal disease care has perpetuated for decades due to a complex set of factors, including late end-stage renal disease referrals and patients who present to the hospital requiring urgent renal replacement therapy. In such situations, PD rarely is a consideration and patients are dialyzed through a central venous catheter, a practice associated with high infection and mortality rates. Recently, the term urgent-start PD has gained momentum across the nephrology community and has begun to change this status quo. It allows for expedited placement of a PD catheter and initiation of PD therapy within days. Several published case reports, abstracts, and poster presentations at national meetings have documented the initial success of urgent-start PD programs. From a wide experiential base, we discuss the multifaceted issues related to urgent-start PD implementation, methods to overcome barriers to therapy, and the potential impact of this technique to change the existing dialysis paradigm. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  3. If climate action becomes urgent: The importance of response times for various climate strategies

    NARCIS (Netherlands)

    van Vuuren, D.P.; Stehfest, E.

    2013-01-01

    Most deliberations on climate policy are based on a mitigation response that assumes a gradually increasing reduction over time. However, situations may occur where a more urgent response is needed. A key question for climate policy in general, but even more in the case a rapid response is needed,

  4. BI-RADS lexicon: An urgent call for standardization of breast ...

    African Journals Online (AJOL)

    BI-RADS lexicon: An urgent call for standardization of breast ultrasound in Nigeria. MO Obajimi, OO Akute, AO Afolabi, AA Adenipekun, AO Oluwasola, EEU Akang, RU Joel, ATS Adeniji-Sofoluwe, O Funmi, G Newstead, R Schmitt, C Sennett ...

  5. 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.

  6. The effects of aprotinin on blood product transfusion associated with thoracic aortic surgery requiring deep hypothermic circulatory arrest.

    LENUS (Irish Health Repository)

    Seigne, P W

    2012-02-03

    OBJECTIVE: To compare the effects of aprotinin on blood product use and postoperative complications in patients undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest. DESIGN: A retrospective study. SETTING: A university hospital. PARTICIPANTS: Nineteen patients who underwent elective or urgent thoracic aortic surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The total number of units of packed red blood cells, fresh frozen plasma, and platelets was significantly less in the group that received aprotinin (p = 0.01, 0.04, and 0.01). The intraoperative transfusion of packed red blood cells and platelets, collection and retransfusion of cell saver, and postoperative transfusion of fresh frozen plasma were also significantly less in the aprotinin group (p = 0.01, 0.02, 0.01, and 0.05). No patient in either group sustained renal dysfunction or a myocardial infarction. Two patients who had not received aprotinin suffered from chronic postoperative seizures, and one patient who had received aprotinin sustained a perioperative stroke. CONCLUSIONS: Low-dose aprotinin administration significantly decreases blood product transfusion requirements in the setting of thoracic aortic surgery requiring deep hypothermic circulatory arrest, and it does not appear to be associated with renal or myocardial dysfunction.

  7. 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.

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. [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.

  13. 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, ...

  14. 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.

  15. An audit of urgent referrals by the Procurator Fiscal to the Tayside Forensic Psychiatric Service.

    Science.gov (United States)

    White, T; Rutherford, H

    2005-10-01

    This study describes the demographic, offence and diagnostic characteristics of subjects referred by the Procurators Fiscal operating from three courts in Tayside, Scotland. A comparison is made of referrals made between 1988 to 1995 and 1997 to 1998. There was an increased rate of referral on an urgent basis over time, primarily involving patients already in contact with the psychiatric services, 37% of whom were detained and admitted to hospital. This urgent assessment ensured that mentally-disordered offenders were not remanded in custody simply for the preparation of a report, and it allowed an early assessment to be made regarding the suitability for diversion from prosecution. This outcome is compatible with guidelines issued by the Home Office in 1990 (Home Office, 1990).

  16. Urgent-SQ implant in treatment of overactive bladder syndrome: 9-year follow-up study.

    Science.gov (United States)

    Janssen, Dick A; Farag, Fawzy; Heesakkers, John P

    2013-06-01

    Electrical stimulation of the posterior tibial nerve (PTN) is an established therapy for the treatment of refractory overactive bladder syndrome (OAB). The Urgent-SQ™ is an implant that is surgically placed near the PTN and activated by an external pulse generator, allowing for "on demand" PTN stimulation, without the need for needle insertion. The current study presents results of a 9-year, open-label, follow-up of eight patients to address the long term safety and efficacy of the implant. In 2003, eight patients with refractory OAB received a Urgent-SQ™ implant and were systematically followed up for 1 year. After that, the follow up continued as open-label study. The seven patients who still had the implant were contacted after 9 years and evaluated with an interview, physical exam, ankle X-ray, voiding diaries, and completed questionnaires about adverse events, performance, efficacy, safety, and quality of life (validated iQoL). Six of the seven patients still had sensory and loco-motor responses on stimulation at 9-year follow-up. Three of four patients who had a successful treatment response at 1 year, still use the device. The fourth patient restarted therapy. The implants are intact with no migration and/or displacement. All patients reported easy handling of the Urgent-SQ™. One patient reported sporadic spontaneous sensory responses. One patient reported occasional localized ankle discomfort. After 9 years of clinical experience, we demonstrated that implant driven PTNS with the Urgent-SQ™ is a safe therapy for OAB. The implant has a long lifespan and is well tolerated by patients. Copyright © 2012 Wiley Periodicals, Inc.

  17. Finding the moral fiber: Why reform is urgently needed for a fair cotton trade

    OpenAIRE

    Pfeifer, K.; Kripke, G.; Alpert, E.

    2004-01-01

    Metadata only record US subsidies have led to depressed world cotton prices, which in turn have cost countries in Africa millions of dollars in lost export earnings. Oxfam estimates that sub-Saharan African countries lost $305 million due to US subsidies in crop year 2001. Because cotton is an important livelihood for millions of poor people, Oxfam believes action is urgently needed to reform the distortions in cotton trade that undermine the value of cotton to developing countries. The ce...

  18. Impact on Quality When Pediatric Urgent Care Centers Are Staffed With Radiology Technologists.

    Science.gov (United States)

    Kan, J Herman; Orth, Robert C; Yen, Terry A; Schallert, Erica K; Zhang, Wei; Donnelly, Lane F

    2018-02-02

    The proliferation of pediatric urgent care centers has increased the need for diagnostic imaging support, but the impact of employing radiology technologists at these centers is not known. The purpose of this study was to evaluate radiographic impact and quality at urgent care centers with and without radiology technologists. A retrospective case-control study was conducted comparing 235 radiographic examinations (study) performed without and 83 examinations (control) performed with a radiology technologist at the authors' pediatric urgent care centers. Studies were evaluated for quality using a five-point, Likert-type scale (1 = poor, 5 = best) regarding field of view, presentation, and orthogonal view orientation. Studies were also evaluated for the incidence of positive results, need for repeat imaging, and discrepancies between initial study and follow-up. Imaging quality comparisons between study and control groups were statistically different for field of view (3.98 versus 4.29, P = .014), presentation (4.39 versus 4.51, P = .045), and orthogonal view orientation (4.45 versus 4.69, P = .033). The incidence of repeat imaging was similar (4.7% versus 2.4%, P = 0.526), as well as the discrepancy rates (3.4 versus 2.4%, P = 1.00). The incidence of abnormal radiographic findings for the study and control groups was similar (40.9% versus 34.9%, P = .363). Radiography is an important triage tool at pediatric urgent care centers. It is imperative to have optimal radiographic imaging for accurate diagnosis, and imaging quality is improved when radiology technologists are available. If not feasible or cost prohibitive, it is important that physicians be given training opportunities to bridge the quality gap when using radiographic equipment and exposing children to radiation. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  19. Crisis or Opportunity: The Urgent Need for Defense Reform in the 21st Century

    Science.gov (United States)

    2012-03-26

    lower the overall corporate tax rate, eliminate loopholes, and reduce or eliminate the double taxation of overseas profits. Under current tax code...THE URGENT NEED FOR DEFENSE REFORM IN THE 21ST CENTURY The single biggest threat to national security is the national debt. American taxpayers ...twentieth century the relations among civilizations have thus moved from a phase dominated by the unidirectional impact of one [western] civilization on

  20. Describing team development within a novel GP-led urgent care centre model : a qualitative study.

    OpenAIRE

    Morton, Sarah; Ignatowicz, Agnieszka; Gnani, Shamini; Majeed, Azeem; Greenfield, Geva

    2016-01-01

    Objective:\\ud Urgent care centres (UCCs) co-located within an emergency department were developed to reduce the numbers of inappropriate emergency department admissions. Since then various UCC models have developed, including a novel general practitioner (GP)-led UCC that incorporates both GPs and emergency nurse practitioners (ENPs). Traditionally these two groups do not work alongside each other within an emergency setting. Although good teamwork is crucial to better patient outcomes, there...

  1. [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.

  2. 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.

  3. Urgent Protection versus Chronic Need: Clarifying the Dual Mandate of Child Welfare Services across Canada

    Directory of Open Access Journals (Sweden)

    Nico Trocmé

    2014-08-01

    Full Text Available This study analyzed data from the 1998, 2003 and 2008 Canadian Incidence Study of reported child abuse and neglect (CIS and compared the profile of children who were reported for an urgent protection investigation versus any other investigation or assessment. As a proportion of all investigations, urgent protection cases have dropped from 28% of all investigations in 1998, to 19% in 2003, to 15% in 2008. Results from the CIS-2008 analysis revealed that 7% of cases involved neglect of a child under four, 4% of cases involved sexual abuse, 2% of cases involved physical abuse of a child under four and 1% of cases involved children who had sustained severe enough physical harm that medical treatment was required. The other 85% of cases of investigated maltreatment involved situations where concerns appear to focus less on immediate safety and more on the long-term effects of a range of family related problems. These findings underscore the importance of considering the dual mandate of child welfare mandates across Canada: intervening to assure the urgent protection and safety of the child versus intervening to promote the development and well-being of the child.

  4. Audit of radiology communication systems for critical, urgent, and unexpected significant findings.

    Science.gov (United States)

    Duncan, K A; Drinkwater, K J; Dugar, N; Howlett, D C

    2016-03-01

    To determine the compliance of UK radiology departments and trusts/healthcare organisations with National Patient Safety Agency and Royal College of Radiologist's published guidance on the communication of critical, urgent, and unexpected significant radiological findings. A questionnaire was sent to all UK radiology department audit leads asking for details of their current departmental policy regarding the issuing of alerts; use of automated electronic alert systems; methods of notification of clinicians of critical, urgent, and unexpected significant radiological findings; monitoring of results receipt; and examples of the more common types of serious pathologies for which alerts were issued. One hundred and fifty-four of 229 departments (67%) responded. Eighty-eight percent indicated that they had a policy in place for the communication of critical, urgent, and unexpected significant radiological findings. Only 34% had an automated electronic alert system in place and only 17% had a facility for service-wide electronic tracking of radiology reports. In only 11 departments with an electronic acknowledgement system was someone regularly monitoring the read rate. There is wide variation in practice across the UK with regard to the communication and monitoring of reports with many departments/trusts not fully compliant with published UK guidance. Despite the widespread use of electronic systems, only a minority of departments/trusts have and use electronic tracking to ensure reports have been read and acted upon. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  5. Influence of neighborhood household income on early death or urgent hospital readmission.

    Science.gov (United States)

    van Walraven, Carl; Wong, Jenna; Forster, Alan J

    2013-05-01

    The relationship of socioeconomic status (SES) with hospital readmissions is unclear. We used population-based administrative datasets to randomly select 40,827 adult Ontarians discharged from hospital to the community. Patient postal codes were linked to average neighborhood household-income quintiles. The association of this SES measure with 30-day death or urgent readmission was measured after controlling for outcome risk using a validated index, LACE+: length of stay (L), acuity of the admission (A), comorbidity of the patient (measured with the Charlson Comorbidity Index score (C), and emergency-department use (E). Within 1 month of discharge, 2638 (6.5%) people died or were urgently readmitted. Lower neighborhood income was significantly associated with both an increased outcome risk (P income was no longer associated with 30-day death or urgent readmission (P = 0.21). After accounting for known risk factors, early death or readmission is not more common in people from lower-income neighborhoods. Further study is required to determine if SES is associated with adverse postdischarge outcomes in settings without publicly funded healthcare. Copyright © 2013 Society of Hospital Medicine.

  6. Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization.

    Science.gov (United States)

    Barbash, Israel M; Gaglia, Michael A; Torguson, Rebecca; Minha, Sa'ar; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2013-10-01

    Marriage confers various health advantages in the general population. However, the added value of marriage among patients who undergo percutaneous coronary intervention (PCI) beyond the standard cardiovascular risk factors is not clear. This study aimed to assess the effects of marital status on outcomes of patients undergoing elective or urgent PCI. Clinical observational analysis of consecutive patients undergoing elective or urgent PCI from 1993 to 2011 was performed. Patients were stratified by marital status, comparing married to unmarried patients. Clinical outcome up to 12 months was obtained by telephone contact or office visit. A total of 11,216 patients were included in the present analysis; 55% were married and 45% unmarried. Significant differences in baseline characteristics were noted, including a lower prevalence of hypertension (86% vs 88%), diabetes (34% vs 38%), and smoking (19% vs 25%) among married vs unmarried patients, respectively (P < .001). However, married patients had a higher prevalence of hypercholesterolemia and family history of coronary artery disease. Early and late major adverse cardiac event rates were significantly lower for married vs unmarried patients up to 1 year (13.3% vs 8.2%, P < .001). Married status was independently associated with improved outcome in multivariable analysis (hazard ratio 0.7, 95% CI 0.6-0.9). Married patients who undergo urgent or elective PCI have superior short- and long-term outcomes up to 1 year when compared with unmarried patients. These benefits persist after adjustment for multiple traditional cardiovascular risk factors. © 2013.

  7. Orbital compartment syndrome following aneurysm surgery.

    Science.gov (United States)

    Gauden, Andrew J; Hardy, Thomas; Mack, Heather G; Danesh-Meyer, Helen V; Kaye, Andrew H

    2012-07-01

    Orbital compartment syndrome (OCS) is a rare cause of blindness following intracranial surgery. We report a patient with OCS following intracranial cerebrovascular surgery precipitated by severe straining. OCS occurred due to a rapid increase in intraorbital pressure within the rigid confines of the orbit causing hypoperfusion of critical neural structures, which resulted in visual loss and a complete external ophthalmoplegia. Treatment involved urgent surgical soft tissue decompression of the orbit, corticosteroids and osmotic agents. It is important to consider OCS as a cause of blindness in the neurosurgical postoperative setting as without rapid treatment this condition has a very poor prognosis. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  8. Ambulation and survival following surgery in elderly patients with metastatic epidural spinal cord compression.

    Science.gov (United States)

    Itshayek, Eyal; Candanedo, Carlos; Fraifeld, Shifra; Hasharoni, Amir; Kaplan, Leon; Schroeder, Josh E; Cohen, José E

    2017-12-28

    Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore/preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management. Evaluate the duration of ambulation and survival in elderly patients following surgical decompression of MESCC. Retrospective file review of a prospective database, under IRB waiver of informed consent, of consecutive patients treated in an academic tertiary care medical center from 8/2008-3/2015. Patients ≥65 years presenting neurological and/or radiological signs of cord compression due to metastatic disease, who underwent surgical decompression. Duration of ambulation and survival. Patients underwent urgent multidisciplinary evaluation and surgery. Ambulation and survival were compared with age, pre- and postoperative neurological (American Spinal Injury Association [ASIA] Impairment Scale [AIS]) and performance status (Karnofsky Performance Status [KPS], and Tokuhashi Score using Kruskal-Wallis and Wilcoxon signed-rank tests, Pearson correlation coefficient, Cox regression model, log rank analysis, and Kaplan Meir analysis. 40 patients were included (21 male, 54%; mean age 74 years, range 65-87). Surgery was performed a mean 3.8 days after onset of motor symptoms. Mean duration of ambulation and survival were 474 (range 0-1662) and 525 days (range 11-1662), respectively; 53% of patients (21/40) survived and 43% (17/40) retained ambulation for ≥1 year. There was no significant relationship between survival and ambulation for patients aged 65-69, 70-79, or 80-89, although Kaplan Meier analysis suggested stratification. There was a significant relationship between duration of ambulation and pre- and postoperative AIS (p=0.0342, p=0.0358, respectively) and postoperative KPS (p=0.0221). Tokuhashi score was not significantly related to duration of

  9. 77 FR 58404 - Announcing the Award of Two Urgent Single-Source Grants To Support Unaccompanied Alien Children...

    Science.gov (United States)

    2012-09-20

    ...] Announcing the Award of Two Urgent Single-Source Grants To Support Unaccompanied Alien Children Program...) announces the award of two urgent single-source grants from the Unaccompanied Alien Children's Program to... providing services under the Unaccompanied Alien Children's program. Award Grantee organization Location...

  10. Why is surgery cancelled? A retrospective evaluation | Chamisa ...

    African Journals Online (AJOL)

    Introduction. The cancellation of surgery wastes theatre time and creates hardship for patients, who often plan their working and family lives around the proposed operation date. Methods. A retrospective evaluation of cancellations of scheduled elective and urgent operations was done using theatre records from May 2006 ...

  11. 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

  12. 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.

  13. 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...

  14. 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 ...

  15. 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 ...

  16. 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 ...

  17. 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 ...

  18. 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. ...

  19. 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, ...

  20. 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

  1. 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 ...

  2. Routine pre-operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures

    DEFF Research Database (Denmark)

    Bøtker, M T; Vang, M L; Grøfte, T

    2014-01-01

    Background Unexpected cardiopulmonary complications are well described during surgery and anesthesia. Pre-operative evaluation by focused cardiopulmonary ultrasonography may prevent such mishaps. The aim of this study was to determine the frequency of unexpected cardiopulmonary pathology...

  3. The use of technology for urgent clinician to clinician communications: a systematic review of the literature.

    Science.gov (United States)

    Nguyen, Cristina; McElroy, Lisa M; Abecassis, Michael M; Holl, Jane L; Ladner, Daniela P

    2015-02-01

    Urgent clinician-clinician communications require routes of contact that are fast and dependable, and allow for the exchange of complex information. Despite the increasing focus on improving healthcare delivery systems over the past decade, few studies have examined the role of technology in clinician-clinician communication. The aim of this study was to review the literature examining the role of devices and technology in facilitating urgent clinician-clinician communication to identify critical areas for future research. A search of Pub Med was performed using the terms (((("Critical Care"[Mesh] OR "urgent")))) AND (((hospital communication systems[MeSH Terms]) OR health communication[MeSH Terms]) OR interdisciplinary communication[MeSH Terms]). Commentaries and editorials were excluded. The initial search returned 272 articles, which were reviewed to identify articles describing: (1) the role of technological support or devices in clinician-clinician communication, (2) technology-based interventions that improved clinician-to-clinician communication in hospitals or acute care facilities related to critically ill patients, or (3) critical information exchange. A total of 16 articles were included in the final review. These were grouped into three categories: alphanumeric pagers, cellular and smart telephones, and novel uses of technology. Breakdowns in clinician-clinician communication are complex and cannot be solved through the implementation of devices or technologically advanced systems alone. It is essential to understand the correlation between emerging technologies, a demanding workload, and clinician-clinician interaction. Enhanced communication of clinical ideas, opportunities for team discussion, and a sense of partnership and support require not just increased information, but enhanced delivery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Urgent Chemotherapy for Life-Threatening Complications Related to Solid Neoplasms.

    Science.gov (United States)

    Zerbib, Yoann; Rabbat, Antoine; Fartoukh, Muriel; Bigé, Naïke; Andréjak, Claire; Mayaux, Julien; De Prost, Nicolas; Misset, Benoît; Lemiale, Virginie; Bruneel, Fabrice; Maizel, Julien; Ricome, Sylvie; Jacobs, Frédéric; Bornstain, Caroline; Dupont, Hervé; Baudin, François; Azoulay, Elie; Pène, Frédéric

    2017-07-01

    Solid neoplasms can be directly responsible for organ failures at the time of diagnosis or relapse. The management of such specific complications relies on urgent chemotherapy and eventual instrumental or surgical procedures, combined with advanced life support. We conducted a multicenter study to address the prognosis of this condition. A multicenter retrospective (2001-2015) chart review. Medical and respiratory ICUs. Adult patients who received urgent chemotherapy in the ICU for organ failure related to solid neoplasms were included. The modalities of chemotherapy, requirements of adjuvant instrumental or surgical procedures, and organ supports were collected. Endpoints were short- and long-term survival rates. None. One hundred thirty-six patients were included. Lung cancer was the most common malignancy distributed into small cell lung cancer (n = 57) and non-small cell lung cancer (n = 33). The main reason for ICU admission was acute respiratory failure in 111 patients (81.6%), of whom 89 required invasive mechanical ventilation. Compression and tissue infiltration by tumor cells were the leading mechanisms resulting in organ involvement in 78 (57.4%) and 47 (34.6%) patients. The overall in-ICU, in-hospital, 6-month, and 1-year mortality rates were 37%, 58%, 74%, and 88%, respectively. Small cell lung cancer was identified as an independent predictor of hospital survival. However, this gain in survival was not sustained since the 1-year survival rates of small cell lung cancer, non-small cell lung cancer, and non-lung cancer patients all dropped below 20%. Urgent chemotherapy along with aggressive management of organ failures in the ICU can be lifesaving in very selected cancer patients, most especially with small cell lung cancer, although the long-term survival is hardly sustainable.

  5. [Practice assistant sometimes misses urgent request for help: telephone triage in general practice].

    Science.gov (United States)

    Smits, M; Hanssen, S; Huibers, L; Giesen, P

    2016-01-01

    To assess the organisation and appropriateness of telephone triage in general practices in the Netherlands. Cross-sectional observational study. Via e-mail we invited all members of the Dutch Association of practice assistants to complete an online survey. The questionnaire included questions about practice assistants' background characteristics and the practices' triage organisation. Furthermore, they were asked to assess the indicated type of care for a number of fictive case scenarios involving a variety of health problems and levels of urgency. To determine the appropriateness of the respondents' assessments, each was compared to a reference standard agreed by experts. In addition, the association between practice assistants' background characteristics and organizational setup of the triage organisation with the appropriateness of triage was examined. The response rate was 41.1% (N=973). The required care was assessed appropriately in 63.6% of the cases, over-estimated in 19.3% and under-estimated in 17.1% of cases. The sensitivity of identifying patients with a highly urgent problem was 76.7%, whereas the specificity was 94.0%. The appropriateness of the assessments of the required care was higher for more experienced assistants and assistants with regular daily work meetings with the GP. Triage training, use of a triage tool and authorization of advice provision were not associated with appropriateness of triage. Triage by practice assistants in general practices is efficient, but potentially unsafe in highly urgent cases. It is therefore important to train practice assistants in the identification of highly urgent cases.

  6. 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 ...

  7. 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 ...

  8. Los Alamos National Laboratory: 21st century solutions to urgent national challenges

    Energy Technology Data Exchange (ETDEWEB)

    Mcbranch, Duncan [Los Alamos National Laboratory

    2008-01-01

    Los Alamos National Laboratory has been called upon to meet urgent national challenges for more than 65 years. The people, tools, and technologies at Los Alamos are a world class resource that has proved decisive through our history, and are needed in the future. We offer expertise in nearly every science, technology, and engineering discipline, a unique integrated capability for large-scale computing and experimentation, and the proven ability to deliver solutions involving the most complex and difficult technical systems. This white paper outlines some emerging challenges and why the nation needs Los Alamos, the premier National Security Science Laboratory, to meet these challenges.

  9. Social service in medicine in Mexico. An urgent and possible reform.

    Directory of Open Access Journals (Sweden)

    Gustavo Nigenda

    2013-09-01

    Full Text Available One third of the primary care units in the public system keeps being covered exclusively by interns. It is shown that with the resources available in the System for Social Protection in Health it is possible to hire graduate health personnel for all Ministry of Health rural units. It is necessary to modify the current legislation to impede an intern to be located in units without supervision of a graduate doctor. There is an urgent need for a reform of social service in medicine that responds both to the institutional modernization and to the increased capacity of the newly insured to demand high-quality services.

  10. [Are urgent imaging tests indicated in the management of acute pancreatitis?].

    Science.gov (United States)

    Fornell Pérez, R; Lozano Rodríguez, A

    2016-01-01

    Acute pancreatitis is a common emergency within abdominal disease. It is accepted that two of three conditions must be fulfilled for its diagnosis: characteristic clinical presentation, characteristic laboratory findings, and/or characteristic diagnostic imaging findings. The first two conditions are the most often used, probably for reasons of efficiency and frequency. Nevertheless, the need for imaging studies is sometimes a source of conflict. For this reason, we decided to review the current evidence regarding the indication of urgent imaging tests in the management of acute pancreatitis. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  11. [Pelvi-perineal chronic pain, urgent demands of care and decision-making].

    Science.gov (United States)

    Quistrebert-Davanne, V; Boudoukha, A-H; Levesque, A; Guérin, P; Nizard, J; Labat, J-J

    2017-06-01

    Some patients suffering from pelvi-perineal chronic pain express urgent, even vital, demands of care. The objective was to compare the profile and the psychological functioning of the patients, who have shown an imperious demand of care, in that of the patients who do not have an imperious demand of care. From the medical consultations for chronic pelviperineal pain, we realized a comparative study including 26 patients (experimental group) expressing an urgent demand of care (i.e., patients who, during the last 3months, called an emergency service concerning the pains for which they consult in the service) and 28 patients (control group) without an urgent demand of care (i.e., patient who, during the last 3months, did not call an emergency service concerning the pains for which they consult in the service). All the patients were tested through a cognitive task of decision-making (Iowa Gambling Task) and through explicit measures of pain and its main psychological associated factors (anxiety, depression, impulsivity an catastrophism). In the first place, the patients from the experimental group possess decision-making abilities equivalent to the patients of the control group; however, both groups of patients show, in the beginning of the test, a deficit in the decision-making (F(4.208)=3.4116; P=.009). Secondly, the measures to questionnaires reveal that the patients of the control group have less severe scores in the scales of depression (t(52)=-2.068; Pcatastrophism (amplification : t(52)=-3.069; P<0035; powerlessness: t(52)=-2.866, P<.006) and impulsivity (positive urgency: t(52)=-2.246, P<029; lack of premeditation: t(52)=-2.175, P<035) than the patients of the experimental group. The use of explicit measures (questionnaire) and implicit measures (experimental task) allowed to objectify more precisely the differences between the chronic pain patients in urgent demand of care and the other chronic pain patients. This psychological specificity obliges us to

  12. "Surgery For Intractable Epilepsy, Loghman Hakim hospital, 1997-2003 "

    Directory of Open Access Journals (Sweden)

    Haddadian K

    2004-08-01

    Full Text Available Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003. Materials and Methods: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria. Results: Patients mean age was 22.4 years. Three cases (10% were females that all underwent temporal mesial lobectomy. In 18 cases (60% there were concordant brain lesion with seizure origin that 9 cases (30% underwent mesial temporal lobectomy and remainder 9 cases (30% underwent lesionectomy.other12 cases (40% that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively. Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.

  13. Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Reza Arefizadeh

    2017-05-01

    CONCLUSIONS: Regarding QOL and psychological status, there were no differences in the CR outcome between those who underwent off-pump bypass surgery and those who underwent on-pump surgery; nevertheless, the off-pump technique was superior to the on-pump method on METs improvement following CR.

  14. Can the use of urgent care clinics improve access to care without undermining continuity in primary care?

    Science.gov (United States)

    Villaseñor, Sally; Krouse, Helene J

    2016-06-01

    There is a niche for urgent care clinics as an alternate source of health care in the United States. This systematic review examines whether the use of urgent care clinics can improve access to care or if these facilities undermine continuity of primary care. Databases used were Cumulative Index for Nursing and Allied Health (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE). Articles from 2004 to 2014 were searched using keywords-access, barriers, continuity of care, nurse practitioner (NP), urgent care, retail clinic, emergency, and primary care. Urgent care clinics can improve access to care, but may also negatively impact continuity of care, preventative services, and ongoing management of chronic conditions. Barriers to primary care and benefits of urgent care are inversely related. Insufficient knowledge regarding navigation of the healthcare system, perceived urgency of medical need, and deflection of care contribute to use of urgent care over primary care. NPs are frontline healthcare providers essential to developing and maintaining successful communication and collaboration among providers across healthcare settings. In both primary care and urgent care facilities, NPs can ensure continuity of care, decreased healthcare costs, and optimized health outcomes for patients. ©2015 American Association of Nurse Practitioners.

  15. Elective bowel surgery with or without prophylactic nasogastric ...

    African Journals Online (AJOL)

    Methodology: 100 patients who underwent elective bowel surgery were randomized into two groups: Study group (50): Nasogastric tube was removed immediately after operation or in the recovery room. Control group (50): Underwent nasogastric tube removal postoperatively after the patient passed flatus and audible ...

  16. Urgent Biophilia: Human-Nature Interactions and Biological Attractions in Disaster Resilience

    Directory of Open Access Journals (Sweden)

    Keith G. Tidball

    2012-06-01

    Full Text Available This contribution builds upon contemporary work on principles of biological attraction as well as earlier work on biophilia while synthesizing literatures on restorative environments, community-based ecological restoration, and both community and social-ecological disaster resilience. It suggests that when humans, faced with a disaster, as individuals and as communities and populations, seek engagement with nature to further their efforts to summon and demonstrate resilience in the face of a crisis, they exemplify an urgent biophilia. This urgent biophilia represents an important set of human-nature interactions in SES characterized by hazard, disaster, or vulnerability, often appearing in the 'backloop' of the adaptive cycle. The relationships that human-nature interactions have to other components within interdependent systems at many different scales may be one critical source of resilience in disaster and related contexts. In other words, the affinity we humans have for the rest of nature, the process of remembering that attraction, and the urge to express it through creation of restorative environments, which may also restore or increase ecological function, may confer resilience across multiple scales. In making this argument, the paper also represents a novel contribution to further theorizing alternatives to anthropocentric understandings of human-nature relations, and strongly makes the case for humans as part of, not separate from, ecosystems.

  17. A tale of two veterans: homeless vs domiciled veterans presenting to a psychiatric urgent care clinic.

    Science.gov (United States)

    Lee, Haoyu; Iglewicz, Alana; Golshan, Shah; Zisook, Sidney

    2013-11-01

    The relationship between homelessness among veterans and mental illness and suicidality has not been clearly defined. To further examine this relationship, we compared rates of mental illness and suicidality among homeless and domiciled veterans seeking urgent psychiatric care at a US Department of Veterans Affairs (VA) facility. Information was collected by survey from 482 consecutive veterans seeking care at the Psychiatric Emergency Clinic (PEC) at the VA San Diego Healthcare System. A total of 73 homeless veterans were designated the homeless group and 73 domiciled veterans were randomly selected as the domiciled group. Suicidality and mental illnesses were assessed by self-assessment questionnaires and chart review of diagnoses. The homeless group had significantly higher rates of past suicide attempts (47% vs 27%) and recent reckless or self-harming behavior (33% vs 18%) compared with the domiciled group but significantly lower rates of depressive disorder (25% vs 44%), as diagnosed by a PEC physician. There were no differences between groups on the questionnaires for posttraumatic stress disorder (PTSD), depression, or alcohol abuse. Nor were there differences in diagnoses of bipolar disorder, PTSD, anxiety disorder, schizophrenia/schizoaffective disorder, or alcohol abuse. Veterans seeking help from a VA-based urgent psychiatric care clinic often are burdened by substantial depression, alcohol use disorders, PTSD, and both past and present suicide risk.

  18. The urgent requirement for new radioanalytical certified reference materials for nuclear safeguards, forensics, and consequence management

    International Nuclear Information System (INIS)

    Inn, K.G.W.; Martin Johnson, Jr.C.; Warren Oldham; Lav Tandon; Simon Jerome; Thomas Schaaff; Robert Jones; Daniel Mackney; Pam MacKill; Brett Palmer

    2013-01-01

    A multi-agency workshop was held from 25 to 27 August 2009, at the National Institute of Standards and Technology (NIST), to identify and prioritize the development of radioanalytical Certified Reference Materials (CRMs, generally provided by National Metrology Institutes; Standard Reference Materials, a CRM issued by NIST) for field and laboratory nuclear measurement methods to be used to assess the consequences of a domestic or international nuclear event. Without these CRMs, policy makers concerned with detecting proliferation and trafficking of nuclear materials, attribution and retribution following a nuclear event, and public health consequences of a nuclear event would have difficulty making decisions based on analytical data that would stand up to scientific, public, and judicial scrutiny. The workshop concentrated on three areas: post-incident Improvised Nuclear Device (IND) nuclear forensics, safeguard materials characterization, and consequence management for an IND or a Radiological Dispersion Device detonation scenario. The workshop identified specific CRM requirements to fulfill the needs for these three measurement communities. Of highest priority are: (1) isotope dilution mass spectrometry standards, specifically 233 U, 236 gNp, 244 Pu, and 243 Am, used for quantitative analysis of the respective elements that are in critically short supply and in urgent need of replenishment and certification; (2) CRMs that are urgently needed for post-detonation debris analysis of actinides and fission fragments, and (3) CRMs used for destructive and nondestructive analyses for safeguards measurements, and radioisotopes of interest in environmental matrices. (author)

  19. Bullying Victimization (Being Bullied) Among Adolescents Referred for Urgent Psychiatric Consultation: Prevalence and Association With Suicidality.

    Science.gov (United States)

    Alavi, Nazanin; Roberts, Nasreen; Sutton, Chloe; Axas, Nicholas; Repetti, Leanne

    2015-10-01

    To examine the prevalence of bullying victimization among adolescents referred for urgent psychiatric consultation, to study the association between bullying victimization and suicidality, and to examine the relation between different types of bullying and suicidality. A retrospective chart review was conducted for all adolescents referred to a hospital-based urgent consultation clinic. Our study sample consisted of adolescents with a history of bullying victimization. The Research Ethics Board of Queen's University provided approval. Data analysis was conducted using SPSS (IBM SPSS Inc, Armonk, NY). Chi-square tests were used for sex, suicidal ideation, history of physical and sexual abuse, and time and type of bullying, and an independent sample t test was used for age. The prevalence of bullying victimization was 48.5% (182 of 375). There was a significant association between being bullied and suicidal ideation (P = 0.01), and between sex and suicidal ideation (P ≤ 0.001). Victims of cyberbullying reported more suicidal ideation than those who experienced physical or verbal bullying (P = 0.04). Bullying victimization, especially cyberbullying, is associated with increased risk of suicidal ideation among adolescents referred for psychiatric risk assessment. The detailed history of the type and duration of bullying experienced by the victims should be considered when conducting a psychiatric risk assessment.

  20. Urgent embolization for the treatment of serious epistaxis in nasopharyngeal carcinoma after radiotherapy

    International Nuclear Information System (INIS)

    Zhu Jun; Ni Caifang; Liu Yizhi; Jing Yonghai; Zhu Xiaoli; Zou Jianwei

    2009-01-01

    Objective: To discuss the clinical effect and safety of urgent embolization with arterial catheterization in the treatment of serious epistaxis in patients with nasopharyngeal carcinoma after radiotherapy. Methods: Fifteen patients with nasopharyngeal carcinoma occurred serious epistaxis after radiotherapy. Because of failure to respond to the treatment of nasal packing and medication, embolization of the bleeding arteries with gelfoam or steel coils was carried out within 1-4 hours after the bleeding. The target arteries were judged by the internal and external carotid angiographic findings. Results: The embolization procedure was successfully completed, in all of 15 patients within 1.5 hours with the technical successful rate of 100%. The bleeding ceased in all 15 patients with the effective rate of 100%. Mild facial palsy occurred in 2 cases, and facial pain of the affected side in one case. All above symptoms were relived and disappeared in about one week after the procedure, leaving no serious complications. Conclusion: Urgent arterial embolization is an effective, safe and simple method for controlling the serious epistaxis in nasopharyngeal carcinoma after radiotherapy. (authors)

  1. Frequency and Predictors of Urgent Coronary Angiography in Patients With Acute Pericarditis

    Science.gov (United States)

    Salisbury, Adam C.; Olalla-Gómez, Cristina; Rihal, Charanjit S.; Bell, Malcolm R.; Ting, Henry H.; Casaclang-Verzosa, Grace; Oh, Jae K.

    2009-01-01

    OBJECTIVES: To determine the frequency of urgent coronary angiography in patients with acute pericarditis and to examine clinical characteristics associated with coronary angiography. PATIENTS AND METHODS: This is a retrospective analysis of all incident cases of acute viral or idiopathic pericarditis evaluated at Mayo Clinic's site in Rochester, MN, between January 1, 2000, and December 31, 2006. The main outcome measures were use of urgent coronary angiography and rate of concomitant coronary artery disease in patients with pericarditis. RESULTS: There were 238 patients with a final diagnosis of acute pericarditis (mean age, 47.7±17.9 years; 157 [66.0%] were male). On the initial electrocardiogram, 146 patients (61.3%) had ST-segment elevation, and 92 (38.7%) had no ST-segment elevation. Coronary angiography was performed in 40 patients (16.8% of all patients); the frequency was 5-fold higher among those with ST-segment elevation (24.7% vs 4.3%; Ppericarditis, particularly those with ST-segment elevation, typical myocardial infarction symptoms, and elevated troponin T values. Coronary artery disease was present angiographically in one-third of patients undergoing the procedure. Although patients with ST-segment elevation myocardial infarction must receive prompt reperfusion, clinicians must also consider the diagnosis of pericarditis to avoid unneeded coronary angiography. PMID:19121248

  2. Urgent Living-Donor Liver Transplantation in a Patient With Concurrent Active Tuberculosis: A Case Report.

    Science.gov (United States)

    Jung, B-H; Park, J-I; Lee, S-G

    2018-04-01

    Although active tuberculosis (TB) is considered a contraindication for liver transplantation (LT), this is the only treatment in patients with liver failure and concurrent active TB. We report a case with successful urgent living-donor LT for irreversible liver failure in the presence of active TB. A 48-year-old man, with a history of decompensated alcoholic liver cirrhosis, was presented with stupor. At admission, his consciousness had deteriorated to semi-coma, and his renal function also rapidly deteriorated to hepatorenal syndrome. A preoperative computed tomography scan of the chest revealed several small cavitary lesions in both upper lobes, and acid-fast bacillus stain from his sputum was graded 2+. Adenosine deaminase levels from ascites were elevated, suggesting TB peritonitis. A first-line anti-TB drug regimen was started immediately (rifampin, isoniazid, levofloxacin, and amikacin). An urgent living-donor LT was performed 2 days later. After LT, the regimen was changed to second-line anti-TB drugs (amikacin, levofloxacin, cycloserine, and pyridoxine). The sputum acid-fast bacillus stain tested negative on postoperative day 10. His liver function remained well preserved, even after the reversion to first-line anti-TB treatment. The patient recovered without any anti-TB medication-related complications and was discharged. LT can be prudently performed as a life-saving option, particularly for patients with liver failure and concurrent active TB. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Impact of Marijuana Legalization in Colorado on Adolescent Emergency and Urgent Care Visits.

    Science.gov (United States)

    Wang, George Sam; Davies, Sara Deakyne; Halmo, Laurie Seidel; Sass, Amy; Mistry, Rakesh D

    2018-03-30

    Approximately 6%-8% of U.S. adolescents are daily/past-month users of marijuana. However, survey data may not reliably reflect the impact of legalization on adolescents. The objective was to evaluate the impact of marijuana legalization on adolescent emergency department and urgent cares visits to a children's hospital in Colorado, a state that has allowed both medical and recreational marijuana. Retrospective review of marijuana-related visits by International Classification of Diseases codes and urine drug screens, from 2005 through 2015, for patients ≥ 13 and marijuana-related visits were identified. Behavioral health evaluation was obtained for 2,813 (67%); a psychiatric diagnosis was made for the majority (71%) of these visits. Coingestants were common; the most common was ethanol (12%). Marijuana-related visits increased from 1.8 per 1,000 visits in 2009 to 4.9 in 2015. (p = marijuana use, our data demonstrate a significant increase in adolescent marijuana-associated emergency department and urgent cares visits in Colorado. Copyright © 2018 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  4. Bariatric surgery

    Directory of Open Access Journals (Sweden)

    Alojz Pleskovič

    2013-07-01

    Full Text Available Background: In almost six decades different surgical techniques have been developed to treat patients with morbid obesity. Various surgical techniques are generally divided with respect to their effect into restrictive, malabsorbtive and humoral and a combination of these. Surgically modified human metabolism ameliorates metabolic diseases, particularly diabetes, even in nonobese patients. The understanding of metabolic effects changed the traditional paradigm of bariatric surgery from simple weight-loss procedure to metabolic surgery affecting whole-body metabolism. Proper surgical technique for individual patient is the most important factor influencing long- term results, comorbidities and quality of life. Recommendations for patient selection, surgical methods and pre- and postoperative patient management are to be respected. Metabolic surgery principles and current concepts are presented.

  5. Perioperative Factors Predicting Prolonged Postoperative Ileus After Major Abdominal Surgery.

    Science.gov (United States)

    Sugawara, Kotaro; Kawaguchi, Yoshikuni; Nomura, Yukihiro; Suka, Yusuke; Kawasaki, Keishi; Uemura, Yukari; Koike, Daisuke; Nagai, Motoki; Furuya, Takatoshi; Tanaka, Nobutaka

    2017-11-08

    Prolonged postoperative ileus (PPOI) is among the common complications adversely affecting postoperative outcomes. Predictors of PPOI after major abdominal surgery remain unclear, although various PPOI predictors have been reported in patients undergoing colorectal surgery. This study aimed to devise a model for stratifying the probability of PPOI in patients undergoing abdominal surgery. Between 2012 and 2013, 841 patients underwent major abdominal surgery after excluding patients who underwent less-invasive abdominal surgery, ileus-associated surgery, and emergency surgery. Postoperative managements were generally based on enhanced recovery after surgery (ERAS) program. The definition of PPOI was based on nausea, no oral diet, flatus absence, abdominal distension, and radiographic findings. A nomogram was devised by evaluating predictive factors for PPOI. Of the 841 patients, 73 (8.8%) developed PPOI. Multivariable logistic regression analysis revealed smoking history (P = 0.025), colorectal surgery (P = 0.004), and an open surgical approach (P = 0.002) to all be independent predictive factors for PPOI. A nomogram was devised by employing these three significant predictive factors. The prediction model showed relatively good discrimination performance, the concordance index of which was 0.71 (95%CI 0.66-0.77). The probability of PPOI in patients with a smoking history who underwent open colorectal surgery was calculated to be 19.6%. Colorectal surgery, open abdominal surgery, and smoking history were found to be independent predictive factors for PPOI in patients who underwent major abdominal surgery. A nomogram based on these factors was shown to be useful for identifying patients with a high probability of developing PPOI.

  6. Pharyngeal airway changes following mandibular setback surgery

    Directory of Open Access Journals (Sweden)

    Babu Ramesh

    2005-01-01

    Full Text Available Treatment of dentofacial deformities with jaw osteotomies has an effect on airway anatomy and therefore mandibular setback surgery has the potential to diminish airway size. The purpose of this study was to evaluate the effect of mandibular setback surgery on airway size. 8 consecutive patients were examined prospectively. All patients underwent mandibular setback surgery. Cephalometric analysis was performed preoperatively and 3 months post operatively with particular attention to pharyngeal airway changes. Pharyngeal airway size decreased considerably in all, patients thus predisposing to development of obstructive sleep apnea. Therefore, large anteroposterior discrepancies should be corrected by combined maxillary and mandibular osteotomies.

  7. [Surgery of renoureteral lithiasis. Current indications].

    Science.gov (United States)

    González Enguita, C; Calahorra Fernández, F J; Cabrera Pérez, J; García Cardoso, J; Rodríguez-Miñón Cifuentes, J L; García de la Peña, E; Vela Navarrete, R

    2001-10-01

    Today, the issue about kidney and ureteral stone and their management is based on ESWL (Extracorporeal Shock Wave Lithotripsy) like singly or as a part of combination therapy. In some cases, endoscopic procedures (URS, PNL) with contact lithotripsy, is the first-line treatment. Retroperitoneoscopic is a therapeutical option in some hospitals. Open stone surgery is now drastically reducing and the endoscopic and extracorporeal methods are increasing, overcoat ESWL in those hospitals who has an own lithotripter. The optimal results of non-invasive procedures, and the ESWL advantages for the patients (outpatient and anesthesia-free treatment, decreased morbidity,...), has caused limited annual indications of open surgery for stone disease even a complete disappearance in many center. The Stone and Lithotripsy Unit of "Jiménez Díaz" Foundation (FJD) (Madrid), who has an own lithotipter (Modulith SL 20, STORZ) make an evaluation of 54 patients treated with open surgery (1990-2000) in order to reflect on the indications. Nephrectomy for serious paremquimal lithiasic lesions (complicated pyelonefhritis, xantogranulomatosis....) is not included. The open surgery techniques for stone diseases were the classic according to every case: pielolithotomy (simple or extended +/- infundibulolithotomy), anatrophic nephrotomy, ureterolithotomy,.... At the same time it should be resolved those anomalous structures or obstruction associated to the stone disease (congenital hydroneprosis, ureterocele,...). Now days are difficult cases of stone diseases to be managed for any methods included open surgery. It's the renal complex stone. Of course, surgery is the best option, the more effectively choice. When endoscopic procedures (URS, NPL) fall and the stone is synthomatic must be operated. When they are serious situation (septic shock, complications derived from the others methods,...). It's necessary an urgent and effectively treatment and it's the open surgery. Open surgery is

  8. The advantages of using photographs and video images in telephone consultations with a specialist in paediatric surgery

    Directory of Open Access Journals (Sweden)

    Ibrahim Akkoyun

    2012-01-01

    Full Text Available Background: The purpose of this study was to evaluate the advantages of a telephone consultation with a specialist in paediatric surgery after taking photographs and video images by a general practitioner for the diagnosis of some diseases. Materials and Methods: This was a prospective study of the reliability of paediatric surgery online consultation among specialists and general practitioners. Results: Of 26 general practitioners included in the study, 12 were working in the city and 14 were working in districts outside the city. A total of 41 pictures and 3 videos of 38 patients were sent and evaluated together with the medical history and clinical findings. These patients were diagnosed with umbilical granuloma (n = 6, physiological/pathological phimosis (n = 6, balanitis (n = 6, hydrocele (n = 6, umbilical hernia (n = 4, smegma cyst (n = 2, reductable inguinal hernia (n = 1, incarcerated inguinal hernia (n = 1, paraphimosis (n = 1, burried penis (n = 1, hypospadias (n = 1, epigastric hernia (n = 1, vulva synechia (n = 1, and rectal prolapse (n = 1. Twelve patients were asked to be referred urgently, but it was suggested that only two of these patients, who had paraphimosis and incarcerated inguinal hernia be referred in emergency conditions. It was decided that there was no need for the other ten patients to be referred to a specialist at night or at the weekend. All diagnoses were confirmed to be true, when all patients underwent examination in the pediatric surgery clinic in elective conditions. Conclusion: Evaluation of photographs and video images of a lesion together with medical history and clinical findings via a telephone consultation between a paediatric surgery specialist and a general practitioner provides a definitive diagnosis and prevents patients from being referred unnecessarily.

  9. Vision-related quality of life following glaucoma filtration surgery.

    Science.gov (United States)

    Hirooka, Kazuyuki; Nitta, Eri; Ukegawa, Kaori; Tsujikawa, Akitaka

    2017-05-12

    To evaluate vision-related quality of life (VR-QOL) following glaucoma filtration surgery. A total of 103 glaucoma patients scheduled to undergo glaucoma filtration surgery. Prior to and at three months after glaucoma filtration surgery, trabeculectomy or EX-PRESS, all patients completed the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). A total of 48 patients underwent combined cataract and filtration surgery. The clinical data collected pre- and postoperatively included best-corrected visual acuity (BCVA) and intraocular pressure (IOP). The IOP decreased significantly from 19.0 ± 8.1 mmHg to 9.7 ± 3.9 mmHg (P glaucoma filtration surgery by itself did not decrease the VR-QOL in glaucoma patients, there was significant improvement in the VR-QOL after the patients underwent combined cataract and glaucoma filtration surgery.

  10. Cosmetic surgery.

    OpenAIRE

    Harris, D. L.

    1989-01-01

    The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks.

  11. PLASTIC SURGERY

    African Journals Online (AJOL)

    surgery or subcutaneous mastectomy utilizing a periareolar or circumareolar ... old. Informed consent was obtained. The height of the patients was measured from heel to vertex with a standard height measuring device. The chest circumference was ... The procedure was followed with liposuction 3-6 months later if required.

  12. GENERAL SURGERY

    African Journals Online (AJOL)

    Summary: The multidisciplinary management of Breast Cancer (BC) has evolved over the past 50 years: the patient is offered a choice of .... Choice of procedure. – For women with early BC, there is essentially a choice between 2 procedures: mastectomy or breast conserving surgery with radiation (BCT). The standard.

  13. GENERAL SURGERY

    African Journals Online (AJOL)

    Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

  14. GENERAL SURGERY

    African Journals Online (AJOL)

    We plan to protocolise earlier surgery and blood conservation strategies intraoperatively in addition to a restrictive strategy in ..... Marshall JC. Review Transfusion trigger: when to transfuse? Crit Care. 2004;8(Suppl 2):S31-3. 11. Hofmann A, Farmer S, Towler SC. Strategies to preempt and reduce the use of blood products: ...

  15. Cosmetic Surgery

    Science.gov (United States)

    ... http://www.mayoclinic.com/health/cosmetic-surgery/SN00006 Medical Tourism (Copyright © American Society of Plastic Surgeons) — People considering ... in exotic vacation spots. This publication talks about "medical tourism" and whether it's safe. http://www.plasticsurgery.org/ ...

  16. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  17. GENERAL SURGERY

    African Journals Online (AJOL)

    after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Surg Oncol. 2016;113(2):188-193. http:// dx.doi.org/10.1002/jso.24125. 2. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): An international study group of pancreatic surgery (ISGPS) definition. Surg. 2007;142(1):20-25. http://.

  18. Metabolic Surgery

    DEFF Research Database (Denmark)

    Pareek, Manan; Schauer, Philip R; Kaplan, Lee M

    2018-01-01

    the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity...

  19. TRAUMA SURGERY

    African Journals Online (AJOL)

    deaths due to other trauma types (gunshot wounds, road traffic fatalities and assault) ... the axillary artery was ligated during surgery. Type of ... Left axillary artery. Ischaemic left upper limb. 3. Fifth intercostal space on the left. Bilateral pneumothorax and haemothorax still present at autopsy. (intercostal drain only inserted on ...

  20. Salvage surgery of hypopharyngeal carcinoma with local recurrence after chemoradiotherapy

    International Nuclear Information System (INIS)

    Maeda, Akiteru; Umeno, Hirohito; Chijiwa, Hideki; Ono, Takeharu; Chitose, Shun-ichi; Nakashima, Tadashi; Inoue, Youjirou; Kiyokawa, Kensuke; Fujita, Hiromasa

    2009-01-01

    This study reviewed the results of salvage surgery in patients with local recurrence of hypopharyngeal carcinoma after chemoradiotherapy. Between 1989 and 2008, 74 patients with hypopharyngeal carcinoma were treated with chemoradiotherapy. Ten of these patients underwent salvage surgery, and we analyzed postoperative complications and prognosis. Postoperative complications were found in 9 cases (90%). The survival rate after salvage surgery was 30%. These results suggest that accurate diagnosis of recurrence at an early stage is important for improving the outcome of salvage surgery. The indication as well as operative risks of salvage surgery should be carefully determined. (author)

  1. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  2. Risk stratification for the development of respiratory adverse events following vascular surgery using the Society of Vascular Surgery's Vascular Quality Initiative.

    Science.gov (United States)

    Genovese, Elizabeth A; Fish, Larry; Chaer, Rabih A; Makaroun, Michel S; Baril, Donald T

    2017-02-01

    Postoperative respiratory adverse events (RAEs) are associated with high rates of morbidity and mortality in general surgery, however, little is known about these complications in the vascular surgery population, a frail subset with multiple comorbidities. The objective of this study was to describe the contemporary incidence of RAEs in vascular surgery patients, the risk factors for this complication, and the overall impact of RAEs on patient outcomes. The Vascular Quality Initiative was queried (2003-2014) for patients who underwent endovascular abdominal aortic repair, open abdominal aortic aneurysm repair, thoracic endovascular aortic repair, suprainguinal bypass, or infrainguinal bypass. A mixed-effects logistic regression model determined the independent risk factors for RAEs. Using a random 85% of the cohort, a risk prediction score for RAEs was created, and the score was validated using the remaining 15% of the cohort, comparing the predicted to the actual incidence of RAE and determining the area under the receiver operating characteristic curve. The independent risk of in-hospital mortality and discharge to a nursing facility associated with RAEs was determined using a mixed-effects logistic regression to control for baseline patient characteristics, operative variables, and other postoperative adverse events. The cohort consisted of 52,562 patients, with a 5.4% incidence of RAEs. The highest rates of RAEs were seen in current smokers (6.1%), recent acute myocardial infarction (10.1%), symptomatic congestive heart failure (9.9%), chronic obstructive pulmonary disease requiring oxygen therapy (11.0%), urgent and emergent procedures (6.4% and 25.9%, respectively), open abdominal aortic aneurysm repairs (17.6%), in situ suprainguinal bypasses (9.68%), and thoracic endovascular aortic repairs (9.6%). The variables included in the risk prediction score were age, body mass index, smoking status, congestive heart failure severity, chronic obstructive pulmonary

  3. Nosocomial outbreak of Pantoea agglomerans in a pediatric urgent care center

    Directory of Open Access Journals (Sweden)

    Eliana L. Bicudo

    Full Text Available Pantoea agglomerans is a Gram-negative bacterium whose isolates can be found in blood cultures and other secretions. This article described one outbreak of sepsis due to this bacterium in the pediatric urgent care center of a tertiary hospital, in Brasilia, Federal District. This was a case-control study and it evaluated the risk factors for acquisition of nosocomial sepsis caused by Pantoea agglomerans. Six case-patients and 15 control-patients have been found. The risk factors were: vomiting in the internment and presence of solution compositions in the intravenous hydration therapy received in bigger number than 2 compositions. The transference tube used for the compositions was contaminated with Pantoea agglomerans, characterizing the outbreak with common source. The evolution of all the patients was favorable.

  4. Design Methodology of a Sensor Network Architecture Supporting Urgent Information and Its Evaluation

    Science.gov (United States)

    Kawai, Tetsuya; Wakamiya, Naoki; Murata, Masayuki

    Wireless sensor networks are expected to become an important social infrastructure which helps our life to be safe, secure, and comfortable. In this paper, we propose design methodology of an architecture for fast and reliable transmission of urgent information in wireless sensor networks. In this methodology, instead of establishing single complicated monolithic mechanism, several simple and fully-distributed control mechanisms which function in different spatial and temporal levels are incorporated on each node. These mechanisms work autonomously and independently responding to the surrounding situation. We also show an example of a network architecture designed following the methodology. We evaluated the performance of the architecture by extensive simulation and practical experiments and our claim was supported by the results of these experiments.

  5. [Urgent therapeutic penetrating autokeratoplasty for a purulent corneal ulcer in the only functional eye].

    Science.gov (United States)

    Onishchenko, A L; Kolbasko, A V; Tatarnikova, G N; Mamontova, É G

    2014-01-01

    The article presents a case of severe purulent corneal ulcer in the only functional eye of a young patient with Frank-Kamenetsky glaucoma and high-degree myopia. Combination therapy was ineffective and the patient developed a descemetocele. Due to the absence of cadaver corneas and small size of the only available conserved Alloplant cornea, the contralateral cornea (of the blind eye, which was enucleated under general anesthesia) was used for urgent therapeutic penetrating autokeratoplasty. Postoperative period was complicated with ocular hypertension, which was surgically resolved. To overcome the critical situation around keratoplasty, with results from Russian regulation gaps, the authors suggest creating interregional eye banks in large cities that would provide sampling, conservation and storage control of donor material in accordance with the existing legislation.

  6. Paulo Emilio: crítica de cinema no Brasil, Urgente (1963

    Directory of Open Access Journals (Sweden)

    Pedro Plaza Pinto

    2015-07-01

    Full Text Available Estudo do conjunto de textos da crítica de cinema de Paulo Emilio Salles Gomes no jornal Brasil, Urgente, ligado aos religiosos dominicanos do Convento de Perdizes, em São Paulo. No período de grande agitação que antecede o Golpe de 1964, o reconhecido crítico e conservador da Cinemateca Brasileira elabora um modo de intervenção que questiona preconceitos e visões rígidas sobre cinema e vida cultural. A tática da escrita é dirigir um convite ao diálogo e surpreender os leitores com construções formais que revelam novos ângulos sobre si, na abordagem de temas e problemas relacionados com o cinema brasileiro e com o papel do espectador de filmes.

  7. Anesthetic management of urgent cesarean delivery in a parturient with acute malaria infection: a case report.

    Science.gov (United States)

    Zanfini, Bruno Antonio; Dell'Anna, Antonio Maria; Catarci, Stefano; Frassanito, Luciano; Vagnoni, Salvatore; Draisci, Gaetano

    2016-04-01

    Malaria is associated with high rates of morbidity and mortality worldwide, particularly in Africa, Southeast Asia and South America. Nonetheless, several cases of malaria have been reported in Western countries involving travelers from endemic areas, though very few involve pregnant women. In this article, we report a case of a young woman born in Sierra Leone who had been living in Italy for two years. She was admitted to our hospital with malaise; worsening of her condition led to Plasmodium falciparum infection diagnosis early during her hospital stay, as well as an urgent cesarean delivery. We briefly discuss the features of malaria in pregnancy, the difficulties associated with early diagnosis, and the possible fetal and maternal implications, and also consider how the disease may affect anesthetic management.

  8. Noncardiac Surgery in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Jørgensen, Mads Emil; Martinsson, Andreas

    2014-01-01

    (MACE) and all-cause mortality were investigated in a contemporary Danish cohort. HYPOTHESIS: AS is not an independent risk factor for adverse outcomes in noncardiac surgery. METHODS: All patients with and without diagnosed AS who underwent noncardiac surgery in 2005 to 2011 were identified through......BACKGROUND: Past research has identified aortic stenosis (AS) as a major risk factor for adverse outcomes in noncardiac surgery; however, more contemporary studies have questioned the grave prognosis. To further our understanding of this, the risks of a 30-day major adverse cardiovascular event...... nationwide administrative registers. AS patients (n = 2823; mean age, 75.5 years, 53% female) were matched with patients without AS (n = 2823) on propensity score for AS and surgery type. RESULTS: In elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death...

  9. Global occupational health: current challenges and the need for urgent action.

    Science.gov (United States)

    Lucchini, Roberto G; London, Leslie

    2014-01-01

    Global occupational health and safety (OHS) is strictly linked to the dynamics of economic globalization. As the global market is increasing, the gap between developed and underdeveloped countries, occupational diseases, and injuries affect a vast number of workers worldwide. Global OHS issues also become local in developed countries due to many factors, including untrained migrant workers in the informal sector, construction, and agriculture. To identify the current status and challenges of global occupational health and safety and the needs for preventive action. Absence of OHS infrastructure amplifies the devastating consequences of infectious outbreaks like the Ebola pandemic and tuberculosis. Interventions in global OHS are urgently needed at various levels: 1. Increased governmental funding is needed for international organizations like the World Health Organization and the International Labor Organization to face the increasing demand for policies, guidance, and training. 2. Regulations to ban and control dangerous products are needed to avoid the transfer of hazardous production to developing countries. 3. The OHS community must address global OHS issues through advocacy, position papers, public statements, technical and ethical guidelines, and by encouraging access of OHS professionals from the developing countries to leadership positions in professional and academic societies. 4. Research, education, and training of OHS professionals, workers, unions and employers are needed to address global OHS issues and their local impact. 5. Consumers also can influence significantly the adoption of OHS practices by demanding the protection of workers who are producing he goods that are sold in the global market. Following the equation of maximized profits prompted by the inhibition of OHS is an old practice that has proven to cause significant costs to societies in the developed world. It is now an urgent priority to stop this process and promote a harmonized global

  10. Urgent ultrasound guided hemodynamic assessments by a pediatric medical emergency team: a pilot study.

    Directory of Open Access Journals (Sweden)

    David J Zorko

    Full Text Available PURPOSE: To determine the feasibility of using the Ultrasound Cardiac Output Monitor (USCOM as an adjunct during hemodynamic assessments by a pediatric medical emergency team (PMET. METHODS: Pediatric in-patients at McMaster Children's Hospital aged under 18 years requiring urgent PMET consultation, were eligible. Patients with known cardiac outflow valve defects, Pediatric Critical Care Unit in-patients, and those in cardiorespiratory arrest, were excluded. The primary outcome was feasibility, and the ease of USCOM transport and application as assessed by a self-administered user questionnaire. Secondary outcomes included the quality of USCOM measurements, and agreement in clinical versus USCOM-derived assessments. RESULTS: Forty-one patients from 85 eligible PMET consultations were enrolled between March and August 2011. A total of 55 USCOM assessments were performed on 36 of 41 (87.8% participants. USCOM could not be completed in 5 (12.2% participants due to patient agitation (n = 4 and emergent care (n = 1. USCOM was reported as easy to transport and apply by 97.4% and 94.7% of respondents respectively, not obstructive to patient care by 94.7%, and yielded timely measurements by 84.2% respondents. USCOM tracings were of good quality in 41 (75.9% assessments. Agreement between clinical and USCOM-derived hemodynamic assessments by two independent raters was poor (Rater 1: κ = 0.094; Rater 2: κ = 0.146. CONCLUSION: USCOM can be applied by a PMET during urgent hemodynamic assessments in children. While USCOM has been validated in stable children, its role in guiding hemodynamic resuscitation and informing therapeutic goals in a hemodynamically unstable pediatric population requires further investigation.

  11. Describing team development within a novel GP-led urgent care centre model: a qualitative study.

    Science.gov (United States)

    Morton, Sarah; Ignatowicz, Agnieszka; Gnani, Shamini; Majeed, Azeem; Greenfield, Geva

    2016-06-23

    Urgent care centres (UCCs) co-located within an emergency department were developed to reduce the numbers of inappropriate emergency department admissions. Since then various UCC models have developed, including a novel general practitioner (GP)-led UCC that incorporates both GPs and emergency nurse practitioners (ENPs). Traditionally these two groups do not work alongside each other within an emergency setting. Although good teamwork is crucial to better patient outcomes, there is little within the literature about the development of a team consisting of different healthcare professionals in a novel healthcare setting. Our aim was therefore to describe staff members' perspectives of team development within the GP-led UCC model. Open-ended semistructured interviews, analysed using thematic content analysis. GP-led urgent care centres in two academic teaching hospitals in London. 15 UCC staff members including six GPs, four ENPs, two receptionists and three managers. Overall participants were positive about the interprofessional team that had developed and recognised that this process had taken time. Hierarchy within the UCC setting has diminished with time, although some residual hierarchical beliefs do appear to remain. Staff appreciated interdisciplinary collaboration was likely to improve patient care. Eight key facilitating factors for the team were identified: appointment of leaders, perception of fair workload, education on roles/skill sets and development of these, shared professional understanding, interdisciplinary working, ED collaboration, clinical guidelines and social interactions. A strong interprofessional team has evolved within the GP-led UCCs over time, breaking down traditional professional divides. Future implementation of UCC models should pro-actively incorporate the eight facilitating factors identified from the outset, to enable effective teams to develop more quickly. Published by the BMJ Publishing Group Limited. For permission to use

  12. Current status of alcohol marketing policy--an urgent challenge for global governance.

    Science.gov (United States)

    Casswell, Sally

    2012-03-01

    To review research literature and available information on the extent and impacts of marketing, current policy response and the interests engaged in the policy debate in order to inform recommendations for policy change on alcohol marketing. Relevant literature, including systematic reviews and publicly available information (websites and participant observation) is reviewed and synthesized. Alcohol marketing has expanded markedly in the past 50 years and, while there remains uncertainty about the impact across the population, there is now clear evidence of its impact on the consumption of young people. Few countries have effective policy in place restricting alcohol marketing, and there is a lack of an international response to alcohol marketing which crosses national boundaries. The protection of alcohol marketing has been a major focus for vested interest groups and this has affected governmental response at national and international levels. There has been a lack of non-governmental organization engagement. The policy response to tobacco marketing provides a clear contrast to that of alcohol marketing policy and provides a model for alcohol marketing policy. The global exposure of young people to alcohol marketing requires an urgent policy response. The Framework Convention on Tobacco Control provides an appropriate model for global governance to control alcohol marketing. There are extant examples of national level legislation achieving comprehensive bans with France's Loi Evin providing a feasible model. Resources from philanthropic organizations to allow non-governmental organization engagement are urgently required, as is engagement by the governmental sector independent of commercial influence. © 2012 The Author, Addiction © 2012 Society for the Study of Addiction.

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

    Directory of Open Access Journals (Sweden)

    А. V. Sotnikov

    2014-01-01

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

  14. Nursing Care for Patient after Surgery of Valvular Defects

    OpenAIRE

    Beranová, Veronika

    2015-01-01

    This thesis is focused on the nursing care for patient after valvular defects surgery. The aim of this final paper is to ascertain the principles of specialized nursing care for patient after valvular defects surgery, analyse the condition of written standards for providing aftercare to patients who underwent valvular defects surgery, or the state of the nursing protocols in specialized nursing care. The purpose of qualitative - observational research in providing specialized nursing care is ...

  15. 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.

  16. 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.

  17. Comparison of libido, Female Sexual Function Index, and Arizona scores in women who underwent laparoscopic or conventional abdominal hysterectomy

    Science.gov (United States)

    Kayataş, Semra; Özkaya, Enis; Api, Murat; Çıkman, Seyhan; Gürbüz, Ayşen; Eser, Ahmet

    2017-01-01

    Objective: The aim of the present study was to compare female sexual function between women who underwent conventional abdominal or laparoscopic hysterectomy. Materials and Methods: Seventy-seven women who were scheduled to undergo hysterectomy without oophorectomy for benign gynecologic conditions were included in the study. The women were assigned to laparoscopic or open abdominal hysterectomy according to the surgeons preference. Women with endometriosis and symptomatic prolapsus were excluded. Female sexual function scores were obtained before and six months after the operation from each participant by using validated questionnaires. Results: Pre- and postoperative scores of three different quationnaires were found as comparable in the group that underwent laparoscopic hysterectomy (p>0.05). Scores were also found as comparable in the group that underwent laparotomic hysterectomy (p>0.05). Pre- and postoperative values were compared between the two groups and revealed similar results with regard to all three scores (p>0.05). Conclusion: Our data showed comparable pre- and the postoperative scores for the two different hysterectomy techniques. The two groups were also found to have similar pre- and postoperative score values. PMID:28913149

  18. Vaginal and pelvic recurrence rates based on vaginal cuff length in patients with cervical cancer who underwent radical hysterectomies.

    Science.gov (United States)

    Kim, K; Cho, S Y; Park, S I; Kim, B J; Kim, M H; Choi, S C; Ryu, S Y; Lee, E D

    2011-09-01

    The objective of this study was to determine the association of vaginal cuff length (VCL) with vaginal and pelvic recurrence rates in patients with cervical cancer who underwent radical hysterectomies. The clinicopathologic characteristics were collected from the medical records of 280 patients with cervical cancer who underwent radical hysterectomies. The association of VCL with 3-year vaginal and pelvic recurrence rates was determined using a Z-test. The association of VCL with other clinicopathologic characteristics was also determined. The VCL was not associated with 3-year vaginal and pelvic recurrence rates. The 3-year vaginal recurrence rate was 0%-2% and the 3-year pelvic recurrence rate was 7%-8%, independent of VCL. The VCL and the age of patients had an inverse relationship. However, the VCL was not associated with histologic type, FIGO stage, clinical tumor size, tumor size in the surgical specimen, depth of invasion, lymphovascular space invasion, parametrial involvement, lymph node involvement, and adjuvant therapy. One-hundred ninety of 280 patients (68%) underwent adjuvant therapies following radical hysterectomies. Although it is limited by the high rate of adjuvant therapy, the current study suggested that the VCL following radical hysterectomy in patients with cervical cancer was not associated with vaginal and pelvic recurrence rates. Copyright © 2011 Elsevier Ltd. All rights reserved.

  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. Outcomes of bariatric surgery in the elderly.

    Science.gov (United States)

    Varela, J Esteban; Wilson, Samuel E; Nguyen, Ninh T

    2006-10-01

    The Medicare Coverage Advisory Committee recently concluded that evidence supports the safety and effectiveness of bariatric surgery in the general adult population. However, more information is needed on the role of bariatric surgery in the elderly. The aim of this study was to examine the outcome of bariatric surgery in the elderly performed at academic centers. Using International Classification of Diseases, 9th Revision diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all elderly (>60 years) and nonelderly (19-60 years) patients who underwent bariatric surgery for the treatment of morbid obesity between 1999 and 2005. Outcome measures, including patient characteristics, length of stay, 30-day readmission, morbidity, and observed and expected (risk-adjusted) mortality, were compared between groups. Bariatric surgery in the elderly represents 2.7 per cent (n = 1,339) of all bariatric operations being performed at academic centers. Of the 99 University HealthSystem Consortium centers performing bariatric surgery, 78 centers (79%) perform bariatric surgery in the elderly. Compared with nonelderly patients, elderly patients who underwent bariatric surgery had more comorbidities, longer lengths of stay (4.9 days vs 3.8 days, P elderly group (0.7% vs 0.3%, P = 0.03). When risk adjusted, the observed-to-expected mortality ratio for the elderly group was 0.9. In a subset of elderly patients with a pre-existing cardiac condition (n = 236), the in-hospital mortality was 4.7 per cent. Bariatric surgery in the elderly represents only a small fraction of the number of bariatric operations performed at academic centers. Although the morbidity and mortality is higher in the elderly, bariatric surgery in the elderly is considered as safe as other gastrointestinal procedures because the observed mortality is better than the expected (risk-adjusted) mortality.

  1. Glaucoma Drainage Device Erosion Following Ptosis Surgery.

    Science.gov (United States)

    Bae, Steven S; Campbell, Robert J

    2017-09-01

    To highlight the potential risk of glaucoma drainage device erosion following ptosis surgery. Case report. A 71-year-old man underwent uncomplicated superotemporal Ahmed glaucoma valve implantation in the left eye in 2008. Approximately 8 years later, the patient underwent bilateral ptosis repair, which successfully raised the upper eyelid position. Three months postoperatively, the patient's glaucoma drainage implant tube eroded through the corneal graft tissue and overlying conjunctiva to become exposed. A graft revision surgery was successfully performed with no further complications. Caution and conservative lid elevation may be warranted when performing ptosis repair in patients with a glaucoma drainage implant, and patients with a glaucoma implant undergoing ptosis surgery should be followed closely for signs of tube erosion.

  2. Nutritional Status of Bariatric Surgery Candidates

    Science.gov (United States)

    Al-Mutawa, Aliaa; Anderson, Alfred Kojo; Alsabah, Salman; Al-Mutawa, Mohammad

    2018-01-01

    Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseline data on the nutritional status of bariatric candidates. A retrospective study was conducted on obese patients who underwent bariatric surgery from 2008 to 2015. The medical records of 1538 patients were reviewed for this study. Pre-operatively, the most commonly observed vitamin deficiencies were Vitamin D (76%) and Vitamin B12 (16%). Anemia and iron status parameters were low in a considerable number of patients before surgery, as follows: hemoglobin 20%, mean corpuscular volume (MCV) 48%, ferritin 28%, serum iron 51%, and transferrin saturation 60%. Albumin and transferrin were found to be low in 10% and 9% of the patients, respectively, prior to surgery. In addition to deficiencies, a great number of patients had hypervitaminosis pre-operatively. Excess levels of Vitamin B6 (24%) was the most remarkable. The findings in this study advocate a close monitoring and tailored supplementation pre- and post-bariatric surgery. PMID:29324643

  3. Nutritional Status of Bariatric Surgery Candidates.

    Science.gov (United States)

    Al-Mutawa, Aliaa; Anderson, Alfred Kojo; Alsabah, Salman; Al-Mutawa, Mohammad

    2018-01-11

    Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseline data on the nutritional status of bariatric candidates. A retrospective study was conducted on obese patients who underwent bariatric surgery from 2008 to 2015. The medical records of 1538 patients were reviewed for this study. Pre-operatively, the most commonly observed vitamin deficiencies were Vitamin D (76%) and Vitamin B 12 (16%). Anemia and iron status parameters were low in a considerable number of patients before surgery, as follows: hemoglobin 20%, mean corpuscular volume (MCV) 48%, ferritin 28%, serum iron 51%, and transferrin saturation 60%. Albumin and transferrin were found to be low in 10% and 9% of the patients, respectively, prior to surgery. In addition to deficiencies, a great number of patients had hypervitaminosis pre-operatively. Excess levels of Vitamin B₆ (24%) was the most remarkable. The findings in this study advocate a close monitoring and tailored supplementation pre- and post-bariatric surgery.

  4. Nutritional Status of Bariatric Surgery Candidates

    Directory of Open Access Journals (Sweden)

    Aliaa Al-Mutawa

    2018-01-01

    Full Text Available Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseline data on the nutritional status of bariatric candidates. A retrospective study was conducted on obese patients who underwent bariatric surgery from 2008 to 2015. The medical records of 1538 patients were reviewed for this study. Pre-operatively, the most commonly observed vitamin deficiencies were Vitamin D (76% and Vitamin B12 (16%. Anemia and iron status parameters were low in a considerable number of patients before surgery, as follows: hemoglobin 20%, mean corpuscular volume (MCV 48%, ferritin 28%, serum iron 51%, and transferrin saturation 60%. Albumin and transferrin were found to be low in 10% and 9% of the patients, respectively, prior to surgery. In addition to deficiencies, a great number of patients had hypervitaminosis pre-operatively. Excess levels of Vitamin B6 (24% was the most remarkable. The findings in this study advocate a close monitoring and tailored supplementation pre- and post-bariatric surgery.

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the extent of ... and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the extent of ...

  6. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  7. Tennis elbow surgery - discharge

    Science.gov (United States)

    Lateral epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... Soon after surgery, severe pain will decrease, but you may have mild soreness for 3 to 6 months.

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving ...

  9. Cancer surgery: risks and opportunities.

    LENUS (Irish Health Repository)

    Coffey, J C

    2012-02-03

    In the recent past, several papers have pointed to the possibility that tumour removal generates a permissive environment in which tumour growth is potentiated. This phenomenon has been coined "perioperative tumour growth" and whilst it represents a departure in terms of our attitude to the surgical process, this concept was first hinted at by Paget(1) himself. Despite this, the time interval immediately before and after cancer surgery (i.e. the perioperative period) remains an underutilised interval during which chemotherapeutic regimens are rarely implemented. Herein, we present a summarised review of the literature that supports the concept that tumour removal may potentiate the growth of residual neoplastic disease. We also outline current knowledge regarding underlying mechanisms and in this manner highlight potential therapeutic entry points. Finally, we emphasise the urgent need for trials of agents that could protect patients against the harmful host-tumour interactions that may occur during the perioperative period.

  10. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were......The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... to sex, age, and somatosensory change. High satisfaction and improvement in facial esthetic after OS were seen. Young patients (16-25 years) and men indicated a higher degree of satisfaction than old (>25 years) patients and women. The use of social media seems to be an interesting platform...

  11. Nucleus accumbens surgery for addiction.

    Science.gov (United States)

    Li, Nan; Wang, Jing; Wang, Xue-lian; Chang, Chong-wang; Ge, Shun-nan; Gao, Li; Wu, He-ming; Zhao, Hai-kang; Geng, Ning; Gao, Guo-dong

    2013-01-01

    Opiate addiction remains intractable in a large percentage of patients, and relapse is the biggest hurdle to recovery because of psychological dependence. Multiple studies identify a central role of the nucleus accumbens (NAc) in addiction; several studies note decreased addictive behavior after interventions in this area. Based on animal experiments, our institute started the clinical trial for the treatment of drug addicts' psychological dependence by making lesions in the bilateral NAc with stereotactic surgery from July 2000. The short-term outcomes were encouraging and triggered rapid application of this treatment in China from 2003 to 2004. However, lack of long-term outcomes and controversy eventually led to halting the surgery for addiction by the Ministry of Health of China in November 2004 and a nationwide survey about it later. Our institute had performed this surgery in 272 patients with severe heroin addiction. The follow-up study showed that the 5-year nonrelapse rate was 58% and the quality of life was significantly improved. Patients had several kinds of side effects, but the incidence rate was relatively low. The patients gradually recovered more than 5 years after the surgery. The side effects did not severely influence an individual's life or work. Nationwide surgery showed that the nonrelapse rate was 50% in the sample of 150 cases, from 1167 patients overall who underwent stereotactic surgery in China. Although sometimes accompanied by neuropsychological adverse events, stereotactic ablation of NAc may effectively treat opiate addiction. Lesion location has a significant impact on treatment efficacy and requires further study. Because ablation is irreversible, the NAc surgery for addiction should be performed with cautiousness, and deep brain stimulation (DBS) is an ideal alternative. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Long-term follow-up of DDH patients who underwent open reduction without a postoperative cast.

    Science.gov (United States)

    Szepesi, Kálmán; Szücs, Gabriella; Szeverényi, Csenge; Csernátony, Zoltán

    2013-03-01

    We present the results - assessed after bony maturation - of an early anterior approach open reduction performed using our modified technique on 49 hips at 6-24 months of age. We start postoperative functional treatment using a Pavlik harness and an abduction splint, abandoning plaster cast. Secondary surgeries were performed in 11 hips (22.4%) at 3-7 years of age. Our results were 'satisfactory' (Severin Grade I, II) in 96% of the cases. According to the joints' Severin Grade, the total hip replacement probability at an early age is 8.16% in our series. Our principles and practice, introduced in 1980 in terms of secondary surgeries, are in total harmony with the recent literature.

  13. The prognostic significance of preoperatively assessed AST/ALT (De Ritis) ratio on survival in patients underwent radical cystectomy.

    Science.gov (United States)

    Gorgel, Sacit Nuri; Kose, Osman; Koc, Esra Meltem; Ates, Erhan; Akin, Yigit; Yilmaz, Yuksel

    2017-09-01

    We aimed to evaluate prognostic significance of preoperatively assessed aspartate aminotransaminase (AST)/alanine aminotransferase (ALT) (De Ritis) ratio on survival in bladder cancer (BC) patients underwent radical cystectomy (RC). We, respectively, analysed clinical and pathological data of 153 patients who underwent RC for BC between February 2006 and December 2016 at a tertiary level hospital. The potential prognostic value of De Ritis ratio was assessed by using ROC curve analysis. The effect of the De Ritis ratio was analysed by the Kaplan-Meier method and Cox regression hazard models for patients' disease-specific survival (DSS) and overall survival (OAS). We had 149 BC patients, in total. Mean age was 61.65 ± 9.13 years. One hundred and thirty-nine (93.3%) of the patients were men. According to ROC analysis, optimal threshold of De Ritis ratio for DSS was 1.30. In Kaplan-Meier analyses, the high De Ritis ratio group showed worse progression in DSS and OAS (all parameters, p < 0.001). On Cox regression models of clinical and pathological parameters to predict DSS, De Ritis ratio (HR 5.79, 95% CI 2.25-15.13), pathological T stage (HR 15.89, 95% CI 3.92-64.33, in all p < 0.001); and to predict OAS, De Ritis ratio (HR 2.61, 95% CI 1.49-4.56; p < 0.001), pathological T stage (HR 5.42, 95% CI 2.63-11.64; p < 0.001) and age (HR 1.05, 95% CI 1.02-1.08; p = 0.001) were determined as independent prognostic factors. Preoperative elevated De Ritis ratio could be an independent prognostic factor in BC patients underwent RC. Our results should be confirmed by large and properly designed prospective, randomized trials.

  14. Systematic review with network meta-analysis: comparative efficacy of different enteral immunonutrition formulas in patients underwent gastrectomy.

    Science.gov (United States)

    Song, Guo-Min; Liu, Xiao-Ling; Bian, Wei; Wu, Jing; Deng, Yong-Hong; Zhang, Hui; Tian, Xu

    2017-04-04

    Optimal enteral immunonutrition (EIN) regime for gastric cancer (GC) patients underwent gastrectomy remains uncertainty. To assess comparative efficacy of different EIN formulas in GC patients underwent gastrectomy, we performed network meta-analysis. We included 11 RCTs enrolling 840 patients. Pairwise meta-analysis indicated that EIN (RR 0.56, 95% CI 0.36-0.86; MD -0.42, 95% CI -0.74-0.10), Arg+RNA+ω-3-FAs (RR 0.37, 95% CI 0.22-0.63; MD -0.42, 95% CI -0.75-0.07), Arg+Gln+ω-3-FAs (RR 0.22, 95% CI 0.05-0.94; MD -0.69, 95% CI -1.22-1.07) reduced ICs and LOS. Network meta-analysis confirmed the potential of Arg+RNA+ω-3-FAs for ICs (OR 0.27, 95% Crl 0.12-0.49) and Arg+Gln+ω-3-FAs for CIs (OR 0.22, 95% Crl 0.02-0.84) and LOS (SMD -0.63, 95% Crl -1.07-0.13), and indicated that Arg+RNA+ω-3-FAs was superior to Arg+RNA and Arg+Gln for ICs as well. We performed direct and network meta-analyses for randomized controlled trials comparing EIN formulas with each other or standard enteral nutrition (SEN) in reducing infectious complications (ICs), noninfectious complications (NICs) and length of hospital stay (LOS), through January 2016. The surface under the cumulative ranking curve (SCURA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to rank regimes and rate qualities of evidences respectively. As for GC patients underwent gastrectomy, Arg+RNA+ω-3-FAs and Arg+Gln+ω-3-FAs are the optimal regimes of reducing ICs and LOS.

  15. Monitoring of the 2007 Eruption of Kluichevskoi Volcano Using the ASTER Urgent Request Protocol

    Science.gov (United States)

    Rose, S.; Ramsey, M.

    2007-12-01

    The automated rapid response system and urgent request protocol of the Earth-orbiting ASTER instrument have provided an unprecedented time series of high-resolution, multispectral data throughout the 2007 eruption of Kluichevskoi Volcano, Russia. The Kamchatka Volcanic and Eruption Response Team (KVERT) first reported a weak thermal anomaly within the summit crater on 14 December 2006. By mid-January 2007, Strombolian explosions initiated along with associated ash, gas/steam plumes, and an increase in volcanic tremor. Immediately thereafter, the ASTER urgent request protocol was initiated, capturing day and night paired data approximately once every ten days, resulting in 40 datasets from January through June. During this time, small Strombolian explosive events punctuated longer-lived effusive stages, which produced three lava flows (~ 4 km in length) on the northern (26 April), northwestern (28 May), and southeastern (6 June) flanks. Lahars, associated with flow emplacement over snow/ice, extended up to 3 km from the flow terminus. Initially, maximum temperatures of the summit thermal anomaly were approximately 10 C above background (-30 C). However, steadily increasing temperatures coincident with the onset of lava effusion from the summit on 26 April resulted in the first occurrence of saturated thermal infrared (TIR; 97 C) and subsequently the short-wave infrared (SWIR; 467 C) pixels. Incandescence of the active lava flows was also observed in the visible-near infrared (VNIR) data and solar-corrected daytime datasets yielded maximum lava flow temperatures between 856 and 905 C. Consistent saturation of both the TIR and SWIR data between April and June suggests that vigorous effusive activity from the summit crater was continuous and well established in open channels at that time. The lava flow time series in conjunction with ASTER's digital elevation model (DEM) capabilities provide a framework for extracting additional information such as lava effusion rates

  16. [Four patients with hepatitis A presenting with fulminant hepatitis and acute renal failure and who underwent liver transplantation].

    Science.gov (United States)

    Oh, Se Hoon; Lee, Joon Hyoek; Hwang, Ji Won; Kim, Hye Young; Lee, Chang Hoon; Gwak, Geum Youn; Choi, Moon Seok; Koh, Kwang Chul; Paik, Seung Woon; Yoo, Byung Chul

    2009-09-01

    Hepatitis A is generally known as a mild, self-limiting disease of the liver, but in rare instances it can progress to fulminant hepatitis, which may require liver transplantation for recovery. Such cases are known to be related to old age and underlying liver disease. We report four cases of hepatitis A in which patients presented with fulminant hepatitis and acute renal failure and underwent liver transplantation. The following common features were observed in our cases: (1) occurrence in relatively old age (>/=39 years old), (2) association with acute renal failure, (3) presence of hepatomegaly, and (4) microscopic features of submassive hepatic necrosis.

  17. Clinical Outcomes of patients with coronary artery disease who underwent FFR evaluation of intermediate coronary lesionS– COFFRS study

    Directory of Open Access Journals (Sweden)

    Srinivasa Prasad

    2017-07-01

    Conclusion: In our experience, MACE events were not higher in patients with FFR > 0.8 and kept under medical therapy and were similarly lower in patients with FFR ≤0.8 and underwent revascularisation (p = 0.73. Also MACE events were higher in patients with FFR ≤ 0.8 and did not undergo revascularisation compared to other two appropriately treated groups (p = 0.03. FFR based revascularization decision appears to be a safe strategy in Indian patients.

  18. [Temporary replacement of the common biliary duct by a silicone tube as an urgent repair of iatrogenic injury. Experimental study in pigs].

    Science.gov (United States)

    Napolitano, Daniel A; Rodríguez Bertola, Xavier; Sambuelli, Gabriela M; Vial, Luis H; Torrecillas, Daniel A

    2015-03-01

    Surgery of the biliary tract is complex, and its volume has increased with iatrogenic injuries and living donor transplantation. The aim of this study was to analyze if the common duct can be temporarily replaced. We used nine 18-20 kg pigs. They were operated on, and their bile duct was replaced by a 100% silicone tube. All pigs underwent laboratory tests, magnetic resonance imaging, intraoperative ultrasound, cholangiography and biliar manometry with pathological biopsy examination within 60 days from the initial surgery. All pigs survived the first surgery over 60 days without laboratory evidence of evident cholestasis. Nine pigs were re-operated on at 60 days showing dilated common bile duct and hepatic ducts doubling its original size without dilating the intrahepatic bile ducts. There were no clinical, relevant laboratory or biopsy signs showing cholestasis. This experience represents the initial intention to find an optimal situation and prosthesis for replacement of the thin biliary tract, in surgical emergencies or palliative situations. The silicon tube, is a positive answer that remains permeable. A non-fibrotic reaction was found that allows a posterior definitive procedure, maintaining a good nutritional status. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Prognostic Impact of the Geriatric Nutritional Risk Index on Long-Term Outcomes in Patients Who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Wada, Hideki; Dohi, Tomotaka; Miyauchi, Katsumi; Doi, Shinichiro; Naito, Ryo; Konishi, Hirokazu; Tsuboi, Shuta; Ogita, Manabu; Kasai, Takatoshi; Hassan, Ahmed; Okazaki, Shinya; Isoda, Kikuo; Suwa, Satoru; Daida, Hiroyuki

    2017-06-01

    Malnutrition has been identified as an important predictor of poor clinical outcomes in patients with heart failure. The aim of this study is to examine the prognostic impact of nutritional status in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). The impact of nutrition, assessed using the geriatric nutritional risk index (GNRI) calculated by serum albumin and body mass index, was evaluated in 2,853 patients with CAD who underwent their first PCI between 2000 and 2011. Patients were assigned to tertiles based on their GNRI levels. The incidences of all-cause death and cardiac death were assessed. The median GNRI values were 101 (interquartile range 95 to 106). Lower GNRI levels were associated with older age and higher prevalence of acute coronary syndrome and chronic kidney disease. During the median follow-up period of 7.4 years, Kaplan-Meier curves showed ongoing divergence in rates of mortality among tertiles (GNRI nutritional status was associated with long-term clinical outcomes in CAD patients after PCI. Evaluation of GNRI carries important prognostic information and may guide the therapeutic approach to such patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Tuberculosis, drug use and HIV infection in Central Asia: an urgent need for attention.

    Science.gov (United States)

    Schluger, Neil W; El-Bassel, Nabila; Hermosilla, Sabrina; Terlikbayeva, Assel; Darisheva, Meruyert; Aifah, Angela; Galea, Sandro

    2013-11-01

    Rates of tuberculosis in Central Asia are extremely high, and even more alarming are the very high rates of multidrug-resistant tuberculosis (MDR-TB) in Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan. In addition, rates of HIV infection related to injection drug use seems to be rising as well, thus creating conditions for a potentially devastating co-epidemic of TB/HIV and MDR-TB/HIV which would have terrible consequences for public health in these countries. In many countries of Central Asia, diagnosis of tuberculosis still rests on clinical grounds or simple technologies such as chest radiograph and sputum smear examination. Modern molecular techniques such as GenExpert are being introduced in Kazakhstan and Uzbekistan, and perhaps soon in Kyrgyzstan. Treatment of TB is still often centered around prolonged inpatient stay at TB hospitals. Only a minority of patients with HIV infection are receiving ART, and TB and HIV services are not well integrated. Needle exchange programs are becoming increasingly available, but opioid substitution therapy is rarely used in Central Asia. TB, drug treatment and HIV services are generally not well-integrated. To combat this developing storm, integration of TB services, HIV care, and substance abuse treatment programs is needed urgently to allow efficient and effective diagnosis and treatment of these conditions in a coordinated manner. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  1. Health literacy in the urgent care setting: What factors impact consumer comprehension of health information?

    Science.gov (United States)

    Alberti, Traci L; Morris, Nancy J

    2017-05-01

    An increasing number of Americans are using urgent care (UC) clinics due to: improved health insurance coverage, the need to decrease cost, primary care offices with limited appointment availability, and a desire for convenient care. Patients are treated by providers they may not know for episodic illness or injuries while in pain or not feeling well. Treatment instructions and follow-up directions are provided quickly. To examine health literacy in the adult UC population and identify patient characteristics associated with health literacy risk. As part of a larger cross-sectional study, UC patients seen between October 2013 and January 2014 completed a demographic questionnaire and the Newest Vital Sign. Descriptive, nonparametric analyses, and a multinomial logistic regression were done to assess health literacy, associated and predictive factors. A total of 57.5% of 285 participants had adequate health literacy. The likelihood of limited health literacy was associated with increased age (p literacy is common in a suburban UC setting, increasing the risk that consumers may not understand vital health information. Clear provider communication and confirmation of comprehension of discharge instructions for self-management is essential to optimize outcomes for UC patients. ©2017 American Association of Nurse Practitioners.

  2. Research and increase of expertise in arachno-entomology are urgently needed.

    Science.gov (United States)

    Mehlhorn, Heinz; Al-Rasheid, Khaled A S; Al-Quraishy, Saleh; Abdel-Ghaffar, Fathy

    2012-01-01

    Considering the contents of international journals of parasitology dealing with broader topics inside this field show that rather a few papers appear with studies in the discipline of arachno-entomology. In the journals Journal of Parasitology, Parasitology Research and Trends in Parasitology, the relations of published papers on protozoology, helminthology and arachno-entomology showed that in all three journals, papers on protozoans were the most common, while those on helminths of any kind reached the second place being rather as common as the protozoan papers in Parasitology Research and in the Journal of Parasitology. In Trends of Parasitology, however, the papers on helminths reached only about 25% of the numbers published on protozoan topics. But in all three journals-and this is important-the papers on arachno-entomological themes were scarce reaching less than the half of the protozoan papers in Parasitology Research, and only about 15% in the Journal of Parasitology and in the Trends of Parasitology. These disproportions between the three great subdivisions of targets in the focus of parasitological research are dangerous, since this lack exists already for several decades and thus led to a backlog of unsolved increasing problems that are caused by ticks, mites, insects and/or parasitic crustaceans especially in times of intensive globalization and global warming. Studies on the biology, vectorship, invasion and spreading of wanted vectors and on the control of pests and parasites belonging to the field of arachno-entomology are urgently needed.

  3. Environmental Assessment of Urgent-Relief Acceptance of Foreign Research Reactor Spent Nuclear Fuel

    International Nuclear Information System (INIS)

    1994-04-01

    The Department of Energy has completed the Environmental Assessment (EA) of Urgent-Relief Acceptance of Foreign Research Reactor Spent Nuclear Fuel and issued a Finding of No Significant Impact (FONSI) for the proposed action. The EA and FONSI are enclosed for your information. The Department has decided to accept a limited number of spent nuclear fuel elements (409 elements) containing uranium that was enriched in the United States from eight research reactors in Austria, Denmark, Germany, Greece, the Netherlands, Sweden, and Switzerland. This action is necessary to maintain the viability of a major US nuclear weapons nonproliferation program to limit or eliminate the use of highly enriched uranium in civil programs. The purpose of the EA is to maintain the cooperation of the foreign research reactor operators with the nonproliferation program while a more extensive Environmental Impact Statement (EIS) is prepared on a proposed broader policy involving the acceptance of up to 15,000 foreign research reactor spent fuel elements over a 10 to 15 year period. Based on an evaluation of transport by commercial container liner or chartered vessel, five eastern seaboard ports, and truck and train modes of transporting the spent fuel overland to the Savannah River Sits, the Department has concluded that no significant impact would result from any combination of port and made of transport. In addition, no significant impacts were found from interim storage of spent fuel at the Savannah River Site

  4. Improving efficiency and saving money in an otolaryngology urgent referral clinic.

    Science.gov (United States)

    Ibrahim, Nader; Virk, Jagdeep; George, Jason; Elmiyeh, Behrad; Singh, Arvind

    2015-06-16

    A closed loop audit of the ear nose and throat (ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed, referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The re-audit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P saving of £32490 in a period of 3 mo (£590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are non-labour intensive can have a significant impact on service provision and cost.

  5. Funding for tuberculosis research-an urgent crisis of political will, human rights, and global solidarity.

    Science.gov (United States)

    Frick, Mike

    2017-03-01

    Tuberculosis (TB) killed more people in 2015 than any other single infectious agent, but funding for research to develop better prevention, diagnosis, and treatment methods for TB declined to its lowest level in 7 years. TB research and development (R&D) is woefully underfunded, a situation best viewed as a crisis of political will and a failure on the part of governments to see unmet innovation needs in the TB response as a human rights issue requiring immediate action. Over 60% of available money for TB R&D comes from public sources, and 67% of public money comes from a single country: the USA. The election of Donald Trump to the US presidency in November 2016 has introduced great uncertainty into the support that science generally, and TB research in particular, will receive in the coming years. Advocacy on the part of all actors-from civil society to TB-affected communities to scientists themselves-is urgently needed to increase US government support for TB research moving forward. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  6. Funding for tuberculosis research—an urgent crisis of political will, human rights, and global solidarity

    Directory of Open Access Journals (Sweden)

    Mike Frick

    2017-03-01

    Full Text Available Tuberculosis (TB killed more people in 2015 than any other single infectious agent, but funding for research to develop better prevention, diagnosis, and treatment methods for TB declined to its lowest level in 7 years. TB research and development (R&D is woefully underfunded, a situation best viewed as a crisis of political will and a failure on the part of governments to see unmet innovation needs in the TB response as a human rights issue requiring immediate action. Over 60% of available money for TB R&D comes from public sources, and 67% of public money comes from a single country: the USA. The election of Donald Trump to the US presidency in November 2016 has introduced great uncertainty into the support that science generally, and TB research in particular, will receive in the coming years. Advocacy on the part of all actors—from civil society to TB-affected communities to scientists themselves—is urgently needed to increase US government support for TB research moving forward.

  7. Environmental Assessment of Urgent-Relief Acceptance of Foreign Research Reactor Spent Nuclear Fuel

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The Department of Energy has completed the Environmental Assessment (EA) of Urgent-Relief Acceptance of Foreign Research Reactor Spent Nuclear Fuel and issued a Finding of No Significant Impact (FONSI) for the proposed action. The EA and FONSI are enclosed for your information. The Department has decided to accept a limited number of spent nuclear fuel elements (409 elements) containing uranium that was enriched in the United States from eight research reactors in Austria, Denmark, Germany, Greece, the Netherlands, Sweden, and Switzerland. This action is necessary to maintain the viability of a major US nuclear weapons nonproliferation program to limit or eliminate the use of highly enriched uranium in civil programs. The purpose of the EA is to maintain the cooperation of the foreign research reactor operators with the nonproliferation program while a more extensive Environmental Impact Statement (EIS) is prepared on a proposed broader policy involving the acceptance of up to 15,000 foreign research reactor spent fuel elements over a 10 to 15 year period. Based on an evaluation of transport by commercial container liner or chartered vessel, five eastern seaboard ports, and truck and train modes of transporting the spent fuel overland to the Savannah River Sits, the Department has concluded that no significant impact would result from any combination of port and made of transport. In addition, no significant impacts were found from interim storage of spent fuel at the Savannah River Site.

  8. Parents were accurate proxy reporters of urgent pediatric asthma health services: a retrospective agreement analysis.

    Science.gov (United States)

    Ungar, Wendy J; Davidson-Grimwood, Sara R; Cousins, Martha

    2007-11-01

    To assess agreement between parents' proxy reports of children's respiratory-related health service use and administrative data. A retrospective analysis of statistical agreement between clinical and claims data for reports of physician visits, emergency department (ED) visits, and hospitalizations in 545 asthmatic children recruited from sites in the greater Toronto area was conducted. Health services use data were extracted from the Ontario Health Insurance Plan and Canadian Institute for Health Information databases for each child for the interval coinciding with the proxy report for each health service type. Agreement between administrative data and respondent reports (n=545) was substantial for hospitalizations in the past year (kappa=0.80 [0.74, 0.86]), moderate for ED visits in the past year (kappa=0.60 [0.53, 0.67]), and slight for physician visits (kappa=0.13 [0.00, 0.27]) in the past 6 months. Income, parent's education, and child quality-of-life symptom scores did not affect agreement. Agreement for ED visits was significantly higher (Pasthma attack in the past 6 months (kappa=0.61 [0.54, 0.68]) compared to children who did not (kappa=0.25 [0.00, 0.59]). Parents of asthmatic children are reliable reporters of their child's respiratory-related urgent health services utilization.

  9. The furthest left behind: the urgent need to scale up harm reduction in prisons.

    Science.gov (United States)

    Sander, Gen; Murphy, Fionnuala

    2017-09-11

    Purpose Raise awareness about the disproportionate impact of HIV and hepatitis C (HCV) on prisoners worldwide and the need for key harm reduction services such as needle and syringe programmes and opioid substitution therapy in prisons offer practical recommendations to assist policy makers in implementing or scaling up these services. The paper aims to discuss these issues. Design/methodology/approach This study is a desk review of existing data and evidence on HIV, HCV and harm reduction in prisons, analysis of political barriers and formulation of key policy recommendations. Findings Harm reduction works, yet service provision in prisons remains extremely limited. There is an urgent need for governments to enhance political leadership and funding for harm reduction in prisons. Authorities must also work to remove obstacles to the implementation of harm reduction services in prisons, enhance the monitoring and evaluation of laws, policies and programmes relating to HIV, HCV and drugs in prison settings, and recognise access to harm reduction in prisons as a fundamental human right. Until these obstacles are addressed, the world will not meet the Sustainable Development Goal of eradicating HIV and HCV by 2030. Originality/value More than just a desk review, this policy brief provides a political analysis of the harm reduction crisis in prisons and offers clear-cut recommendations for policy makers.

  10. Characteristics of motorcyclists involved in road traffic accidents attended at public urgent and emergency services.

    Science.gov (United States)

    Mascarenhas, Márcio Dênis Medeiros; Souto, Rayone Moreira Costa Veloso; Malta, Deborah Carvalho; Silva, Marta Maria Alves da; Lima, Cheila Marina de; Montenegro, Marli de Mesquita Silva

    2016-12-01

    Injuries resulting from motorcycle road traffic accidents are an important public health issue in Brazil. This study aimed to describe the characteristics of motorcyclists involved in traffic accidents attended in public urgent and emergency services in the state capitals and the Federal District. This is a cross-sectional study based on data from the Violence and Accident Surveillance System (VIVA Survey) in 2014. Data were analyzed according to sociodemographic, event and attendance characteristics. Proportional differences between genders were analyzed by chi-square test (Rao-Scott) with 5% significance level. Motorcyclist-related attendances (n = 9,673) reported a prevalence of men (gender ratio = 3.2), young people aged 20-39 years (65.7%), black / brown (73.6%), paid work (76.4%). Helmet use was reported by 79.1% of the victims, 13.3% had consumed alcohol in the six hours prior to the accident, 41.4% of the events were related to the victim's work. Accidents were more frequent on weekends, in the morning and late afternoon. These characteristics can support the development of public accident prevention policies and health promotion.

  11. 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.

  12. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...... to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients....

  13. Understanding the "Weekend Effect" for Emergency General Surgery.

    Science.gov (United States)

    Hoehn, Richard S; Go, Derek E; Dhar, Vikrom K; Kim, Young; Hanseman, Dennis J; Wima, Koffi; Shah, Shimul A

    2018-02-01

    Several studies have identified a "weekend effect" for surgical outcomes, but definitions vary and the cause is unclear. Our aim was to better characterize the weekend effect for emergency general surgery using mortality as a primary endpoint. Using data from the University HealthSystem Consortium from 2009 to 2013, we identified urgent/emergent hospital admissions for seven procedures representing 80% of the national burden of emergency general surgery. Patient characteristics and surgical outcomes were compared between cases that were performed on weekdays vs weekends. Hospitals varied widely in the proportion of procedures performed on the weekend. Of the procedures examined, four had higher mortality for weekend cases (laparotomy, lysis of adhesions, partial colectomy, and small bowel resection; p surgery (p surgery procedures that incur higher mortality when performed on weekends. This may be due to acute changes in patient status that require weekend surgery or indications for urgent procedures (ischemia, obstruction) compared to those without a weekend mortality difference (infection). Hospitals that perform weekend surgery must acknowledge and identify ways to manage this increased risk.

  14. Challenges During Baha Surgery: Our Experience.

    Science.gov (United States)

    Marfatia, Hetal; Priya, Ratna; Sathe, Nilam U; Mishra, Shampa

    2016-09-01

    Baha has proven performance and advantages for patients with aural atresia or chronic ear drainage. Being a per cutaneous osseo integrated implant the skin around the fixture is in contact with a foreign body that leads to chronic inflammatory reaction and complications such as skin irritation and overgrowth occur frequently. Challenges that are faced during Baha surgery include those during candidate selection, work up, anesthesia related as well as intra-operative and post operative complications. Ours was a retrospective and observational study where case records of 10 patients who underwent Baha surgery in the Department of E.N.T during the time period from January 2010 to June 2013 were reviewed. Here, the candidates were advised Baha either for congenital external ear deformity or single sided deafness. Out of 10 patients, who underwent Baha implantation, 8 underwent single staged Baha implant and two patients had two staged implant owing to bone thickness implant in two patients, skin overgrowth due to more thickness of scalp (Holgers grade 4) in one of the patient. The patient had to undergo revision surgery to replace the abutment. And one of the patients underwent failure of osseointegration and was re-implanted later. Proper surgical technique and post operative wound care play an important role in avoiding complications.

  15. Remote cerebellar hemorrhage after lumbar spinal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Cevik, Belma [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: belmac@baskent-ank.edu.tr; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)

    2009-04-15

    Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

  16. Staff perceptions on patient motives for attending GP-led urgent care centres in London: a qualitative study.

    Science.gov (United States)

    Greenfield, Geva; Ignatowicz, Agnieszka; Gnani, Shamini; Bucktowonsing, Medhavi; Ladbrooke, Tim; Millington, Hugh; Car, Josip; Majeed, Azeem

    2016-01-14

    General practitioner (GP)-led urgent care centres were established to meet the growing demand for urgent care. Staff members working in such centres are central in influencing patients' choices about which services they use, but little is known about staff perceptions of patients' motives for attending urgent care. We hence aimed to explore their perceptions of patients' motives for attending such centres. A phenomenological, qualitative study, including semistructured interviews. The interviews were analysed using thematic content analysis. 2 GP-led urgent care centres in 2 academic hospitals in London. 15 staff members working at the centres including 8 GPs, 5 emergency nurse practitioners and 2 receptionists. We identified 4 main themes: 'Confusion about choices', 'As if increase of appetite had grown; By what it fed on', 'Overt reasons, covert motives' and 'A question of legitimacy'. The participants thought that the centres introduce convenient and fast access for patients. So convenient, that an increasing number of patients use them as a regular alternative to their community GP. The participants perceived that patients attend the centres because they are anxious about their symptoms and view them as serious, cannot get an appointment with their GP quickly and conveniently, are dissatisfied with the GP, or lack self-care skills. Staff members perceived some motives as legitimate (an acute health need and difficulties in getting an appointment), and others as less legitimate (convenience, minor illness, and seeking quicker access to hospital facilities). The participants perceived that patients attend urgent care centres because of the convenience of access relative to primary care, as well as sense of acuity and anxiety, lack self-care skills and other reasons. They perceived some motives as more legitimate than others. Attention to unmet needs in primary care can help in promoting balanced access to urgent care. Published by the BMJ Publishing Group Limited

  17. Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

    Directory of Open Access Journals (Sweden)

    Ignacio Couto-Worner

    2013-09-01

    Full Text Available Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.

  18. Patient satisfaction with cataract surgery

    Directory of Open Access Journals (Sweden)

    Wasfi Ehab I

    2008-10-01

    Full Text Available Abstract Introduction Measuring the patient satisfaction is a very important issue that will help very much in improving the service provided to patients and improve the level of satisfaction. Aim To evaluate patient satisfaction with the cataract surgery service and identify any areas for improvement, determination of patient satisfaction with referral, out-patient consultation, pre-assessment clinic, surgery and post-operative care, also to report patients' comments relating to improvement in service provision. Methodology A retrospective study was undertaken for 150 patients underwent cataract surgery at Barrow General Hospital, UK, the survey sample was by postal questionnaires. We collected our data from the theatre lists for a period of 4 month. Results This study included 150 patients; the response rate was (72% 108 patients, Most patients were referred from their general practitioner 86.1%, 93 (86.1% patients were happy with the time interval from seeing their GP to eye clinic. In the eye out patient department many factors significantly affected the level of patient satisfaction, in general the more information provided for the patient the more the satisfaction. Conclusion Patient satisfaction is on important health outcome old understanding both the domains of satisfaction as well as their relative importance to patients is necessary to improve the overall quality of patient care. Meeting the doctor, presenting all relevant information and giving printed information are very important factors in improving the patient's satisfaction with cataract surgery.

  19. Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy

    OpenAIRE

    Barbadoro, Pamela; Di Tondo, Elena; Menditto, Vincenzo Giannicola; Pennacchietti, Lucia; Regnicoli, Februa; Di Stanislao, Francesco; D?Errico, Marcello Mario; Prospero, Emilia

    2015-01-01

    Objective The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED) for non-urgent visits. Methods The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use. Results Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32?6.47) of re-admissions have be...

  20. A Case of Type 2 Amiodarone-Induced Thyrotoxicosis That Underwent Total Thyroidectomy under High-Dose Steroid Administration

    Directory of Open Access Journals (Sweden)

    Koshi Hashimoto

    2015-01-01

    Full Text Available Amiodarone is used commonly and effectively in the treatment of arrhythmia; however, it may cause thyrotoxicosis categorized into two types: iodine-induced hyperthyroidism (type 1 amiodarone-induced thyrotoxicosis (AIT and destructive thyroiditis (type 2 AIT. We experienced a case of type 2 AIT, in which high-dose steroid was administered intravenously, and we finally decided to perform total thyroidectomy, resulting in a complete cure of the AIT. Even though steroid had been administered to the patient (maximum 80 mg of prednisolone, the operation was performed safely and no acute adrenal crisis as steroid withdrawal syndrome was found after the operation. Few cases of type 2 AIT that underwent total thyroidectomy with high-dose steroid administration have been reported. The current case suggests that total thyroidectomy should be taken into consideration for patients with AIT who cannot be controlled by medical treatment and even in those under high-dose steroid administration.

  1. Infants with Atypical Presentations of Alveolar Capillary Dysplasia with Misalignment of the Pulmonary Veins Who Underwent Bilateral Lung Transplantation.

    Science.gov (United States)

    Towe, Christopher T; White, Frances V; Grady, R Mark; Sweet, Stuart C; Eghtesady, Pirooz; Wegner, Daniel J; Sen, Partha; Szafranski, Przemyslaw; Stankiewicz, Pawel; Hamvas, Aaron; Cole, F Sessions; Wambach, Jennifer A

    2018-03-01

    To describe disease course, histopathology, and outcomes for infants with atypical presentations of alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV) who underwent bilateral lung transplantation. We reviewed clinical history, diagnostic studies, explant histology, genetic sequence results, and post-transplant course for 6 infants with atypical ACDMPV who underwent bilateral lung transplantation at St. Louis Children's Hospital. We compared their histology with infants with classic ACDMPV and compared their outcomes with infants transplanted for other indications. In contrast with neonates with classic ACDPMV who present with severe hypoxemia and refractory pulmonary hypertension within hours of birth, none of the infants with atypical ACDMPV presented with progressive neonatal respiratory failure. Three infants had mild neonatal respiratory distress and received nasal cannula oxygen. Three other infants had no respiratory symptoms at birth and presented with hypoxemia and pulmonary hypertension at 2-3 months of age. Bilateral lung transplantation was performed at 4-20 months of age. Unlike in classic ACDMPV, histopathologic findings were not distributed uniformly and were not diffuse. Three subjects had apparent nonmosaic genetic defects involving FOXF1. Two infants had extrapulmonary anomalies (posterior urethral valves, inguinal hernia). Three transplanted children are alive at 5-16 years of age, similar to outcomes for infants transplanted for other indications. Lung explants from infants with atypical ACDMPV demonstrated diagnostic but nonuniform histopathologic findings. The 1- and 5-year survival rates for infants with atypical ACDMPV are similar to infants transplanted for other indications. Given the clinical and histopathologic spectra, ACDMPV should be considered in infants with hypoxemia and pulmonary hypertension, even beyond the newborn period. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. The association between orthostatic hypotension and cognitive state among adults 65 years and older who underwent a comprehensive geriatric assessment

    Science.gov (United States)

    Punchick, Boris; Freud, Tamar; Press, Yan

    2016-01-01

    Abstract The prevalence of cognitive impairment and orthostatic hypotension (OH) increases with age, but the results of studies that assessed possible associations between them are inconsistent. The aim of this study is to assess possible associations between cognitive impairment and OH in patients ≥65 years of age who underwent a comprehensive geriatric assessment. A retrospective analysis was conducted of the computerized medical records of the study population from 2005 to 2013. Data collected included blood pressure measurements that enabled the calculation of OH, results of the mini-mental state examination (MMSE), results of the Montreal cognitive assessment (MoCA) test, and cognitive diagnoses that were determined over the course of the assessment. The rate of OH in the study population of 571 adults was 32.1%. The mean MMSE score was 22.5 ± 5.2 among participants with OH and 21.6 ± 5.8 among those without OH (P = 0.09). The absence of a significant association between OH and MMSE remained after adjusting the MMSE score for age and education level. The mean MoCA score was 16.4 ± 5.0 among participants with OH and 16.4 ± 4.8 among those without (P = 0.33). The prevalence of OH was 39% among participants without cognitive impairment, 28.9% among those with mild cognitive impairment (MCI), and 30.6% among those with dementia (P = 0.13). There was no association between OH and cognitive impairment in adults who underwent a comprehensive geriatric assessment. PMID:27442658

  3. Long-term prognosis and clinical characteristics of young adults (≤40 years old) who underwent percutaneous coronary intervention.

    Science.gov (United States)

    Konishi, Hirokazu; Miyauchi, Katsumi; Kasai, Takatoshi; Tsuboi, Shuta; Ogita, Manabu; Naito, Ryo; Katoh, Yoshiteru; Okai, Iwao; Tamura, Hiroshi; Okazaki, Shinya; Daida, Hiroyuki

    2014-09-01

    Limited data exist regarding the long-term prognosis of percutaneous coronary intervention (PCI) in young adults. The aim of this study was to retrospectively assess the long-term clinical outcomes in young patients who underwent PCI. Between 1985 and 2011, 7649 consecutive patients underwent PCI, and data from 69 young adults (age ≤40 years) and 4255 old adults (age ≧65 years) were analyzed. A Cox proportional hazards regression analysis was used to determine the independent predictors of a composite endpoint that included all-cause death and acute coronary syndrome (ACS) during the follow-up period. The mean age of the 69 young patients was 36.1±4.9 years, and 96% of them were men. Approximately 30% were current smokers, and their body mass index (BMI) was 26.7±5.0kg/m(2). The prevalence of diabetes and hypertension was 33% and 48%, respectively. All patients had ≥1 conventional cardiovascular risk factor. At a median follow-up of 9.8 years, the overall death rate was 5.8%, and new-onset ACS occurred in 8.7%. Current smoking was an independent predictor of the composite endpoint (hazard ratio 4.46, confidence interval 1.08-19.1, p=0.04) for young adults. Current smoking and obesity (high BMI) are the important clinical characteristics in young Japanese coronary heart disease patients who undergo PCI. The long-term prognosis in young patients is acceptable, but current smoking is a significant independent predictor of death and the recurrence of ACS in young Japanese coronary heart disease patients who are obese. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  4. Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

    Directory of Open Access Journals (Sweden)

    Brandt Carlos Teixeira

    1998-01-01

    Full Text Available Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

  5. Theory and practice of laparoscopic surgery against omohyoid muscle syndrome.

    Science.gov (United States)

    Sun, Zhipeng; Zhu, Yubing; Zhang, Nengwei

    2017-08-01

    Omohyoid muscle syndrome (OMS) is a rare disease characterized as a protruding lateral neck mass feature during swallowing. Because there is a 5 cm scar after traditionally surgery, we designed a laparoscopic surgery procedure to meet the cosmetic needs of patients. From the year 2006 to 2016, there were 3 patients diagnosed as omohyoid muscle syndrome that underwent laparoscopic surgery. Operative and postoperative follow-up data were summarized. Average surgery time was 35 ± 13 min. Average blood loss was 3 ± 1 mL. No case converted to open surgery. No major vessel or nerve damage complications occurred. After the surgery, the neck mass completely disappeared during swallowing, and there were no operative scars on the neck. All patients were discharged within 2 days. During the follow-up of a year, no recurrence occurred. In conclusion, the endoscopic procedure is suitable for OMS. It's a safe, effective and cosmetic surgery.

  6. Danish experience with paediatric epilepsy surgery

    DEFF Research Database (Denmark)

    Underbjerg, Ebba von Celsing; Hoei-Hansen, Christina E; Madsen, Flemming Find

    2015-01-01

    INTRODUCTION: Epilepsy surgery is increasingly used to treat children with medically intractable epilepsy. This study investigates the aetiology and seizure outcome in Danish children operated between 1996 and 2010. METHODS: Retrospectively collected data on structural magnetic resonance imaging...... of children who undergo epilepsy surgery have a good, worthwhile seizure outcome. The seizure outcome for Danish children corresponds to that of other epilepsy surgery centres. The clinical criteria for selection of patients changed over time. FUNDING: none. TRIAL REGISTRATION: The Danish Data Protection...... (MRI) diagnoses, surgical procedures and seizure outcomes classified according to the Engel Classification were used. Changes over time grouped as 1996-2000, 2001-2005 and 2006-2010 were analysed. RESULTS: A total of 95 children underwent epilepsy surgery. Sixty-three operations were performed...

  7. Vitreoretinal surgery in advanced coats disease.

    Science.gov (United States)

    Ozdamar, Yasemin; Berker, Nilufer; Batman, Cosar; Zilelioglu, Orhan

    2009-01-01

    To report the outcomes of vitreoretinal surgery for a patient with total retinal detachment and a subretinal nodule associated with Coats disease (CD). A 20-year-old woman stage 3B CD underwent vitreoretinal surgery with triamcinolone acetonide-assisted pars plana vitrectomy, limited retinotomy, removal of the subretinal nodule and membrane, endolaser photocoagulation, and silicone oil tamponade. The surgical outcomes were observed. Retinal attachment was achieved after vitreoretinal surgery, removal of the subretinal membrane, and endoresection of the subretinal fibrous nodule. No intraoperative or postoperative complications occurred due to the surgical technique. The retina remained attached during the postoperative follow-up period of 6 months. Vitreoretinal surgery is an effective surgical technique that provides successful reattachment of the retina and enables endoresection of the subretinal fibrous nodule in eyes with advanced CD. It also prevents the devastating intraocular complications leading to enucleation.

  8. Danish experience with paediatric epilepsy surgery

    DEFF Research Database (Denmark)

    Underbjerg, Ebba von Celsing; Hoei-Hansen, Christina E; Madsen, Flemming Find

    2015-01-01

    INTRODUCTION: Epilepsy surgery is increasingly used to treat children with medically intractable epilepsy. This study investigates the aetiology and seizure outcome in Danish children operated between 1996 and 2010. METHODS: Retrospectively collected data on structural magnetic resonance imaging...... (MRI) diagnoses, surgical procedures and seizure outcomes classified according to the Engel Classification were used. Changes over time grouped as 1996-2000, 2001-2005 and 2006-2010 were analysed. RESULTS: A total of 95 children underwent epilepsy surgery. Sixty-three operations were performed...... of children who undergo epilepsy surgery have a good, worthwhile seizure outcome. The seizure outcome for Danish children corresponds to that of other epilepsy surgery centres. The clinical criteria for selection of patients changed over time. FUNDING: none. TRIAL REGISTRATION: The Danish Data Protection...

  9. Clinical profile of hospitalized children provided with urgent assistance from a medical emergency team.

    Science.gov (United States)

    Kinney, Sharon; Tibballs, James; Johnston, Linda; Duke, Trevor

    2008-06-01

    The purpose of this work was to describe the frequency, characteristics, and outcomes of critical events and hospitalized children requiring medical emergency team review. We conducted an audit of prospectively collected medical emergency team forms and a retrospective review of medical charts during an 18-month period at a tertiary pediatric hospital in Australia. Critical events were defined as cardiac arrest, endotracheal intubation on the ward, reversal of analgesia or sedation, fluid resuscitation at >/=40 mL/kg, hyponatremia (serum sodium level of /=155 mmol/L), hypoglycemia (glucose level of metabolic acidosis (pH urgent medical assistance from the medical emergency team in a tertiary hospital. Children in the postoperative phase were overrepresented among those with a critical event. A critical event significantly increased the risk of hospital mortality. Greater knowledge of high-risk groups is required to further improve outcomes for hospitalized children.

  10. Use of the SONET score to evaluate Urgent Care Center overcrowding: a prospective pilot study.

    Science.gov (United States)

    Wang, Hao; Robinson, Richard D; Cowden, Chad D; Gorman, Violet A; Cook, Christopher D; Gicheru, Eugene K; Schrader, Chet D; Jayswal, Rani D; Zenarosa, Nestor R

    2015-04-14

    To derive a tool to determine Urgent Care Center (UCC) crowding and investigate the association between different levels of UCC overcrowding and negative patient care outcomes. Prospective pilot study. Single centre study in the USA. 3565 patients who registered at UCC during the 21-day study period were included. Patients who had no overcrowding statuses estimated due to incomplete collection of operational variables at the time of registration were excluded in this study. 3139 patients were enrolled in the final data analysis. A crowding estimation tool (SONET: Severely overcrowded, Overcrowded and Not overcrowded Estimation Tool) was derived using the linear regression analysis. The average length of stay (LOS) in UCC patients and the number of left without being seen (LWBS) patients were calculated and compared under the three different levels of UCC crowding. Four independent operational variables could affect the UCC overcrowding score including the total number of patients, the number of results pending for patients, the number of patients in the waiting room and the longest time a patient was stationed in the waiting room. In addition, UCC overcrowding was associated with longer average LOS (not overcrowded: 133±76 min, overcrowded: 169±79 min, and severely overcrowded: 196±87 min, povercrowded: 0.28±0.69 patients, overcrowded: 0.64±0.98, and severely overcrowded: 1.00±0.97). The overcrowding estimation tool (SONET) derived in this study might be used to determine different levels of crowding in a high volume UCC setting. It also showed that UCC overcrowding might be associated with negative patient care outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. An initial marketing/financial screen for a multiprogram urgent care center.

    Science.gov (United States)

    Craig, T T

    1986-12-01

    The initial marketing/financial screen described here is a framework for discussing and evaluating the feasibility of an urgent care center. It is a forum for filtering the objective criteria to reach a continuation decision and ensures involvement of key constituencies that are important to implementation. Each phase (from program requirements, market share forecast, operations, physician relationship options, to marketing survey) provides additional evidence as a basis for either proceeding, expecting higher risk, or abandoning the project. This reality base serves as the floor for the marketing plan should management decide to proceed. The marketing plan provides a realistic foundation for making a decision. Ultimately, both the initial marketing/financial screen and the marketing plan do what every proposal or feasibility study should do. They describe the new venture in objective terms and thereby enable management to make a clear decision, knowing the risks and commitment required. The initial marketing/financial screen also provides a bridge from strategic planning to implementation. It does not commit the organization to go ahead, but rather provides a means of investing crucial constituencies so that if the organization does decide to act, effective implementation is one step closer. Therefore, the real contribution of the marketing/financial screen is that it takes a concept (a strategic planning proposal) and moves it closer to reality (the initial marketing/financial screen). If the decision is made to go ahead, the likelihood for success has been vastly improved as the project proceeds from one reality level (the initial marketing/financial screen) to the next (the marketing plan) with a short step to total reality (opening the operation).

  12. Psychopathology of the General Population Referred by Primary Care Physicians for Urgent Assessment in Psychiatric Hospitals

    Directory of Open Access Journals (Sweden)

    Judith McLenan

    2016-12-01

    Full Text Available Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18–65 years referred by their primary general practitioners (GPs to an Urgent Referral Team (URT based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays for rapid assessments and early interventions to the outpatients referred by their primary family doctors.Method: One-sample t-test and z statistic were used for data analysis. From the total population, a convenience sample of 40 people was selected and assessed to evaluate whether follow-up appointments after the first visit could reduce the severity of suicidal ideation, depression and anxiety in the outpatients seen by the URT. A two-sample t-test and a Wilcoxon signed-rank test were used to assess the variations in the scores during the follow-up visits.Results: We found a statistically significant prevalence of depressive disorders, comorbid with anxiety at first presentation in people who were females, white, never married, living with a partner, not studying and not in paid employment. The common presentation of borderline personality disorder and dysthymia in this population underscores its vulnerability to major socioeconomic challenges.Conclusion: The data confirmed the impact that primary care cooperation with psychiatric hospitals can have on the psychiatric system, and as a reflection, on the population’s mental health and well-being. In fact, active cooperation and early diagnosis and intervention will help detect cases at risk in the general population and reduce admissions into hospitals.

  13. An audit of non-urgent general adult referrals to Stikland State Psychiatric Facility

    Directory of Open Access Journals (Sweden)

    J Ras

    2011-12-01

    Full Text Available Objectives. The national Department of Health strongly advocates the strengthening of primary health care systems, and recommendations for appropriate level of care referrals exist. Very few published data on the scope of current ambulatory specialised psychiatric hospital services in South Africa are currently available, making it difficult to assess whether these recommendations are being followed. As a starting point, an audit was conducted to obtain a profile of new non-urgent general adult patients seen at Stikland Hospital with a view to evaluating system needs and demands. Methods. The folders of 103 consecutively seen patients were selected for retrospective review. Patient demographic, referral and assessment information was entered into a single database. Descriptive statistics were compiled with reference to the above variables using SPSS. Results. Overall 58.3% of referrals were from the private sector. More than a third (36.7% of referral letters stated no clear reason for referral and 41.7% no psychiatric diagnosis, and 29.1% of patients were referred without psychotropic medication being started. On assessment 62.1% of patients were found to have a single Axis I diagnosis. Despite virtually no referral letters making any mention of them, substance use disorders (30.1%, personality traits/disorders (35.9% and co-morbid medical illness (36.7% were commonly found on assessment. Conclusions. A significant portion of the patients in our sample could have been managed at primary care level and were referred prematurely. The overall quality of referral letters was poor, and they lacked vital information required for appropriate pre-assessment decision making. Undergraduate training focusing on these skills should be intensified, and consideration should be given to incorporating aspects of our findings into primary health care updates.

  14. 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.

  15. Use of National Burden to Define Operative Emergency General Surgery.

    Science.gov (United States)

    Scott, John W; Olufajo, Olubode A; Brat, Gabriel A; Rose, John A; Zogg, Cheryl K; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2016-06-15

    Emergency general surgery (EGS) represents 11% of surgical admissions and 50% of surgical mortality in the United States. However, there is currently no established definition of the EGS procedures. To define a set of procedures accounting for at least 80% of the national burden of operative EGS. A retrospective review was conducted using data from the 2008-2011 National Inpatient Sample. Adults (age, ≥18 years) with primary EGS diagnoses consistent with the American Association for the Surgery of Trauma definition, admitted urgently or emergently, who underwent an operative procedure within 2 days of admission were included in the analyses. Procedures were ranked to account for national mortality and complication burden. Among ranked procedures, contributions to total EGS frequency, mortality, and hospital costs were assessed. The data query and analysis were performed between November 15, 2015, and February 16, 2016. Overall procedure frequency, in-hospital mortality, major complications, and inpatient costs calculated per 3-digit International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. The study identified 421 476 patient encounters associated with operative EGS, weighted to represent 2.1 million nationally over the 4-year study period. The overall mortality rate was 1.23% (95% CI, 1.18%-1.28%), the complication rate was 15.0% (95% CI, 14.6%-15.3%), and mean cost per admission was $13 241 (95% CI, $12 957-$13 525). After ranking the 35 procedure groups by contribution to EGS mortality and morbidity burden, a final set of 7 operative EGS procedures were identified, which collectively accounted for 80.0% of procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs nationwide. These 7 procedures included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. Only 7 procedures account

  16. No more broken hearts: weight loss after bariatric surgery returns patients' postoperative risk to baseline following coronary surgery.

    Science.gov (United States)

    Baimas-George, Maria; Hennings, Dietric L; Al-Qurayshi, Zaid; Emad Kandil; DuCoin, Christopher

    2017-06-01

    The obesity epidemic is associated with a rise in coronary surgeries because obesity is a risk factor for coronary artery disease. Bariatric surgery is linked to improvement in cardiovascular co-morbidities and left ventricular function. No studies have investigated survival advantage in postoperative bariatric patients after coronary surgery. To determine if there is a benefit after coronary surgery in patients who have previously undergone bariatric surgery. National Inpatient Sample. We performed a retrospective, cross-sectional analysis of the National Inpatient Sample database from 2003 to 2010. We selected bariatric surgical patients who later underwent coronary surgery (n = 257). A comparison of postoperative complications and mortality after coronary surgery were compared with controls (n = 1442) using χ 2 tests, linear regression analysis, and multivariate logistical regression models. A subset population was identified as having undergone coronary surgery (n = 1699); of this population, 257 patients had previously undergone bariatric surgery. They were compared with 1442 controls. The majority was male (67.2%), white (82.6%), and treated in an urban environment (96.8%). Patients with bariatric surgery assumed the risk of postoperative complications after coronary surgery that was associated with their new body mass index (BMI) (BMI999.9, 95% CI .18 to>999.9, P = .07). Length of stay was significantly longer in postbariatric patients (BMIbariatric patients have a return to baseline risk of morbidity and mortality after coronary surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  17. Characterising non-urgent users of the emergency department (ED: A retrospective analysis of routine ED data.

    Directory of Open Access Journals (Sweden)

    Colin O'Keeffe

    Full Text Available The pressures of patient demand on emergency departments (EDs continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings.We undertook a retrospective analysis of three years of Hospital Episode and Statistics Accident Emergency (HES A&E data for one large region in England, United Kingdom (April 1st 2011 to March 31st 2014. Data was collected on all adult (>16 years ED attendances from each of the 19 EDs in the region. A validated process based definition of non-urgent attendance was refined for this study and applied to the data. Using summary statistics non-urgent attenders were examined by variables hypothesised to influence them as follows: age at arrival, time of day and day of week and mode of arrival. Odds ratios were calculated to compare non-urgent attenders between groups.There were 3,667,601 first time attendances to EDs, of which 554,564 were defined as non-urgent (15.1%. Non-urgent attendances were significantly more likely to present out of hours than in hours (OR = 1.19, 95% CI: 1.18 to 1.20, P<0.001. The odds of a non-urgent attendance were significantly higher for younger patients (aged 16-44 compared to those aged 45-64 (odds ratio: 1.42, 95% CI: 1.41 to 1.43, P<0.001 and the over 65's (odds ratio: 3.81, 95% CI: 3.78 to 3.85, P<0.001. Younger patients were significantly more likely to attend non-urgently out of hours compared to the 45-64's (OR = 1.24, 95% CI: 1.22 to 1.25, P<0.001 and the 65+'s (OR = 1.38, 95% CI: 1.35 to 1.40, P<0.001. 110,605/554,564 (19.9% of the non-urgent attendances arrived by ambulance, increasing significantly out of hours versus in hours (OR = 2

  18. A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery.

    Science.gov (United States)

    Dy, Christopher J; Baty, Jack; Saeed, Mohammed J; Olsen, Margaret A; Osei, Daniel A

    2016-09-01

    Despite the importance of timely evaluation for patients with brachial plexus injuries (BPIs), in clinical practice we have noted delays in referral. Because the published BPI experience is largely from individual centers, we used a population-based approach to evaluate the delivery of care for patients with BPI. We used statewide administrative databases from Florida (2007-2013), New York (2008-2012), and North Carolina (2009-2010) to create a cohort of patients who underwent surgery for BPI (exploration, repair, neurolysis, grafting, or nerve transfer). Emergency department and inpatient records were used to determine the time interval between the injury and surgical treatment. Distances between treating hospitals and between the patient's home ZIP code and the surgical hospital were recorded. A multivariable logistic regression model was used to determine predictors for time from injury to surgery exceeding 365 days. Within the 222 patients in our cohort, median time from injury to surgery was 7.6 months and exceeded 365 days in 29% (64 of 222 patients) of cases. Treatment at a smaller hospital for the initial injury was significantly associated with surgery beyond 365 days after injury. Patient insurance type, travel distance for surgery, distance between the 2 treating hospitals, and changing hospitals between injury and surgery did not significantly influence time to surgery. Nearly one third of patients in Florida, New York, and North Carolina underwent BPI surgery more than 1 year after the injury. Patients initially treated at smaller hospitals are at risk for undergoing delayed BPI surgery. These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Vitamin D deficiency in pregnancy after bariatric surgery.

    Science.gov (United States)

    Medeiros, Marina; Saunders, Cláudia; Chagas, Cristiane B; Pereira, Silvia E; Saboya, Carlos; Ramalho, Andréa

    2013-10-01

    The objective of this study was to describe the main factors related to the installation and/or aggravation of vitamin D deficiency (VDD) and its clinical consequences in pregnant women after bariatric surgery. An electronic search on VDD in pregnancy and after bariatric surgery was conducted in publications from 1998 until 2012 that presented studies performed in humans. We provided an overview of VDD after bariatric surgery, in pregnancy, and in pregnancy in women who underwent bariatric surgery. In view of the high percentage of VDD postoperatively and the role of this vitamin in pregnancy, we recommend the investigation of vitamin D nutritional status in prenatal care.

  20. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed...... and many patients said that they joined the RCT in order to bypass waiting lists. Patients who chose to cross-over described training as time consuming, boring and as unable to provide sufficient results within a reasonable timeframe. Some said their injured knees had given-way; others experienced new knee...... a variety of views and beliefs about those treatments, and trial participation happens in the absence of equipoise. Furthermore, opting for surgical reconstruction does not necessarily provide patients with satisfactory outcomes. Definition of successful outcome may require an individualised approach...

  1. 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).

  2. Food pattern and quality of life in metabolic syndrome patients who underwent coronary artery bypass grafting in Taiwan.

    Science.gov (United States)

    Tung, Heng-Hsin; Tseng, Li-Hua; Wei, Jeng; Lin, Cheng-Hsin; Wang, Tsae-Jyy; Liang, Shu-Yuan

    2011-12-01

    Metabolic syndrome is associated with poor operative outcomes of coronary artery bypass grafting surgery (CABG). A healthy food pattern for metabolic syndrome patients is necessary not only in the initial stage to prevent cardiovascular disease but for those who experience cardiovascular problems and undergo heart surgery. Empirical studies that explore food pattern and quality of life metabolic syndrome patients who undergo CABG are lacking. Therefore, the objectives of this study are to explore the food pattern and quality of life of metabolic syndrome patients who undergo CABG and to examine the relationship between these two variables. A descriptive, correlational and cross section design was conducted. Through convenience sampling, 104 patients were recruited. Data were collected through three instruments: a demographic questionnaire; the Chinese Food Frequency Questionnaire-Short Form (Short C-FFQ), used to assess food pattern; and the Taiwanese version of the Medical Outcomes Study Short Form 36-Health Survey (SF-36), used to assess quality of life. Descriptive analysis, one-way analysis of variance (ANOVA) and Pearson correlation were used to analyze the data. The results indicated that patients who ate fruit more frequently tended to have a better quality of life, while the intake of fried food was more frequently associated with a poor quality of life. The use of these data gives the health care provider a better understanding of food pattern and their impact on quality of life in this population. Such an understanding can be used to develop targeted interventions to promote health in this and in other populations. Copyright © 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2018-04-02

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

  4. 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.

  5. Management of cosmetic eyelid surgery complications.

    Science.gov (United States)

    Klapper, Stephen R; Patrinely, James R

    2007-02-01

    There is a broad spectrum of complications that can occur following cosmetic eyelid surgery. The experienced eyelid surgeon should be able to avoid most serious complications through proper patient selection, a comprehensive preoperative assessment and surgical plan, meticulous surgical technique, and appropriate postoperative care. The aesthetic eyelid surgeon must counsel a patient contemplating blepharoplasty surgery regarding typical expectations including edema, eyelid numbness, dry eyes, and mild blurred vision. Patients must also be aware of the risks and the signs of serious complications such as infection, hematoma, or severe vision loss. Oculofacial surgeons must be capable of managing these adverse outcomes. The management of these urgent complications as well as other significant postoperative problems including diplopia, lagophthalmos, eyelid malposition, severe chemosis and edema, crease abnormalities, and wound dehiscence is outlined in this review.

  6. [Vascular complications associated with lumbar spinal surgery].

    Science.gov (United States)

    Riedemann-Wistuba, M; Alonso-Pérez, M; Llaneza-Coto, J M

    2016-01-01

    Although there are currently less invasive techniques available for the treatment of spinal injuries, open surgery is still required in many cases. Vascular injuries occurring during lumbar spine surgery, although uncommon, are of great importance due to their potential gravity. Clinical manifestations vary from an acute hemorrhagic shock that needs urgent treatment to save the patient's life, to insidious injuries or an asymptomatic evolution, and should be studied to choose the best therapeutic alternative. Four cases are reported that represent this range of possibilities and emphasize the importance of a careful surgical technique during lumbar spine interventions, and the need for high clinical suspicion, essential for the early diagnosis of these vascular complications. The current therapeutic options are also discussed. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  7. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

    Science.gov (United States)

    Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

    2011-11-01

    To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for

  8. [Treatment with inhibitors of new oral direct anticoagulants in patients with severe bleedings or urgent surgical procedures. The new dabigatran antidote: the place of idarucizumab in clinical practice].

    Science.gov (United States)

    Boda, Zoltán

    2016-03-20

    Only vitamin K antagonists could be applied as oral anticoagulants over the past six decades. Coumarols have narrow therapeutic range, and unpredictable anticoagulant effects are resulted by multiple drug interactions. Therefore, regular routine monitoring of the international normalized ratio is necessary. There are two groups of factor-specific anticoagulants: molecules with anti-FIIa (dabigatran) and anti-FXa (rivaroxaban, apixaban and edoxaban) effect. Author summarizes the most important clinical features of the new oral anticoagulants, their indications and the possibilities of laboratory controls. Bleedings are the most important side effects of anticoagulants. This review summarizes the current published evidences for new oral anticoagulants reversal (non-specific and specific) agents, especially in cases with severe acute bleedings or urgent surgery procedures. It reports on how to use inhibitors, the recommended doses and the most important clinical results. The review focuses on idarucizumab - already approved by the U.S. Food and Drug Administration and the European Medicines Agency - which has a key role as the first specific inhibitor of dabigatran.

  9. 76 FR 53913 - Award of an Urgent Single-Source Grant to Survivors of Torture International (SOTI) in San Diego...

    Science.gov (United States)

    2011-08-30

    ... Torture International (SOTI) in San Diego, CA; Correction AGENCY: Office of Refugee Resettlement, ACF, HHS... urgent single-source grant to Survivors of Torture, International (SOTI), San Diego, CA. The document... the Torture Victims Relief Act (TVRA) of 1998,'' Public Law 105-320 (22 U.S.C. 2152 note...

  10. Emergency Department Referrals for Adolescent Urgent Psychiatric Consultation: Comparison of Clinical Characteristics of Repeat-presentations and Single-presentation.

    Science.gov (United States)

    Roberts, Nasreen; Nesdole, Robert; Hu, Tina

    2018-01-01

    a) to examine the demographic and clinical characteristics of repeat-presentations to an adolescent urgent psychiatric clinic, and b) to compare them with single-time presentation. This 18-month retrospective study compared repeat-presenters to age and gender matched single-time presenters. Demographic variables included age gender and ethnicity. Clinical variables included reason for referral, family history, diagnosis, recommendations and compliance. Data were analyzed using descriptive statistics, McNemar's Chi-square tests for matched pairs, and conditional logistic regression. Of 624 assessments 24% (N=151) were repeat-presentations. Compared with single-presentation, repeat-presentation group had a higher proportion of Aboriginal youth (X2 (1) = 108.28 p presentation group had higher odds of past hospital admission (OR: 3.50, p presentations for urgent psychiatric consultation constitute a quarter of referrals to the urgent psychiatric clinic. Identifying and addressing factors that contribute to repeat-presentations may, assist in improving treatment compliance by ensuring focused interventions and service delivery for these youth. In turn, this will improve access to the limited urgent services for other youth.

  11. Genomic analysis of diversity, population structure, virulence, and antimicrobial resistance in Klebsiella pneumoniae, an urgent threat to public health

    NARCIS (Netherlands)

    K.E. Holt (Kathryn E.); H.F.L. Wertheim (Heiman); R.N. Zadoks (Ruth N.); S. Baker (Stephen); C.A. Whitehouse (Chris A.); D. Dance (David); A. Jenney (Adam); T.R. Connor (Thomas R.); L.Y. Hsu (Li Yang); J.A. Severin (Juliëtte); S. Brisse; H. Cao (Hanwei); J. Wilksch (Jonathan); C. Gorrie (Claire); M.B. Schultz (Mark B.); D.J. Edwards (David J.); K. Van Nguyen (Kinh); T.V. Nguyen (Trung Vu); T.T. Dao (Trinh Tuyet); M. Mensink (Martijn); V. Le Minh (Vien); N.T.K. Nhu (Nguyen Thi Khanh); C. Schultsz (Constance); K. Kuntaman (Kuntaman); P.N. Newton (Paul N.); C.E. Moore (Catrin E.); R.A. Strugnell (Richard A.); N.R. Thomson (Nicholas R.)

    2015-01-01

    textabstractKlebsiella pneumoniae is nowrecognized as an urgent threat to human health because of the emergence of multidrug-resistant strains associated with hospital outbreaks and hypervirulent strains associated with severe community-acquired infections. K. pneumoniae is ubiquitous in the

  12. 76 FR 35719 - Unexpected Urgent Refugee and Migration Needs Related to Libya and C[ocirc]te d'Ivoire

    Science.gov (United States)

    2011-06-20

    ... June 8, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya and C[ocirc]te d'Ivoire... laws of the United States, including section 2(c)(1) of the Migration and Refugee Assistance Act of... amount not to exceed $15 million from the United States Emergency Refugee and Migration Assistance Fund...

  13. Irrigation port hydration in phacoemulsification surgery.

    Science.gov (United States)

    Suzuki, Hisaharu; Masuda, Yoichiro; Hamajima, Yuki; Takahashi, Hiroshi

    2018-01-01

    In most cases, hydration is performed by water injection into the stromal tissue with a needle. The technique is simple, however it is sometimes troublesome. We describe a simple technique for hydrating the corneal stroma in cataract surgery using an irrigation port. The technique began by pushing the irrigation port against the corneal stroma for a few seconds during phacoemulsification, which generated edema in the corneal incision that subsequently prevented leakage. This procedure is called the hydration using irrigation port (HYUIP) technique. A total of 60 eyes were randomized and placed in two groups, 30 eyes underwent surgeries using the HYUIP technique (HYUIP group) and 30 eyes underwent surgeries without the HYUIP technique (control). The three points evaluated during each surgery included 1) the occurrence of anterior chamber collapse during the pulling out of the I/A tip after inserting the intraocular lens, 2) the need for conventional hydration, and 3) watertight completion at the end stage of surgery. The anterior chamber collapse and the need for conventional hydration were significantly smaller in the HYUIP group compared to the control group. Regarding the self-sealing completion, no significant difference was observed between the two groups. The HYUIP technique is an effective method for creating self-sealing wound. In addition, this technique helps to prevent anterior chamber collapse.

  14. Epilepsy surgery in children: outcomes and complications.

    Science.gov (United States)

    Kim, Seung-Ki; Wang, Kyu-Chang; Hwang, Yong-Seung; Kim, Ki Joong; Chae, Jong Hee; Kim, In-One; Cho, Byung-Kyu

    2008-04-01

    Ideal epilepsy surgery would eliminate seizures without causing any functional deficits. The aim of the present study was to assess seizure outcomes and complications after epilepsy surgery in children with intractable epilepsy. Data obtained in 134 children (75 boys and 59 girls) age 17 years or younger who underwent epilepsy surgery at Seoul National University Children's Hospital between 1993 and 2005 were retrospectively reviewed. Epilepsy surgery included temporal resection (59 cases), extratemporal resection (56 cases), functional hemispherectomy (7 cases), callosotomy (9 cases), multiple subpial transection (1 case), and disconnection of a hamartoma (2 cases). The mean follow-up duration was 62.3 months (range 12-168 months). The overall seizure-free rate was 69% (93 of 134 cases). The seizure-free rate was significantly higher in children who underwent temporal resection than in those in whom extratemporal resection was performed (88 vs 55%, p surgery is an effective and safe therapeutic modality in childhood. In children with extratemporal epilepsy, more careful interpretation of clinical and investigative data is needed to achieve favorable seizure outcome.

  15. Heart failure - surgeries and devices

    Science.gov (United States)

    CHF - surgery; Congestive heart failure - surgery; Cardiomyopathy - surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure

  16. 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.

  17. The urgent matter of online pro-eating disorder content and children: clinical practice.

    Science.gov (United States)

    Custers, Kathleen

    2015-04-01

    During the last decade, much concern has been expressed about online pro-eating disorder communities (e.g., pro-anorexia websites and blogs) which encourage their users to engage in disordered eating behavior. The aim of the current paper is to reemphasize the importance of pro-eating disorder communities in light of the recent changes in the media landscape. With the increase of social networking sites, pro-anorexia messages have transplanted to more volatile and constantly changing media, such as Snapchat, Twitter, Facebook, Instagram, Pinterest, and many others. Most parents, educators, and health professionals are unaware of the sheer scope and nature of such pro-anorexia messages in these new contexts. The current paper will provide a review of pro-eating disorder websites, overview the effects of such websites on young people's health, examine the emergence of these messages on social media platforms, and highlight a number of guidelines for clinicians and parents. The dissemination of online pro-eating disorder content to different types of social networking sites is becoming an urgent issue. • Existing research on pro-eating disorder websites examines the prevalence and the content of these websites, and the effects of pro-eating disorder content on both clinical (eating disordered individuals) and non-clinical samples (non-eating disordered individuals). • The scope and nature of such anorexia messages is unknown to most adults, and many people (including parents and medical professionals) are insufficiently aware of the ease with which young people access, navigate, and use a wide range of online platforms. • Pro-anorexia messages are no longer limited to websites that can be easily monitored, but instead have been transplanted to more volatile and constantly changing media such as Snapchat, Twitter, Facebook, Pinterest, and Tumblr which makes pro-eating disorder content much more easily accessible. • This paper wants to emphasize the implications

  18. Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits.

    Science.gov (United States)

    Schoenfeld, Adam J; Davies, Jason M; Marafino, Ben J; Dean, Mitzi; DeJong, Colette; Bardach, Naomi S; Kazi, Dhruv S; Boscardin, W John; Lin, Grace A; Duseja, Reena; Mei, Y John; Mehrotra, Ateev; Dudley, R Adams

    2016-05-01

    Commercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously-via videoconference, telephone, or webchat-to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed. To assess the variation in the quality of urgent health care among virtual visit companies. This audit study used 67 trained standardized patients who presented to commercial virtual visit companies with the following 6 common acute illnesses: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent female urinary tract infection. The 8 commercial virtual visit websites with the highest web traffic were selected for audit, for a total of 599 visits. Data were collected from May 1, 2013, to July 30, 2014, and analyzed from July 1, 2014, to September 1, 2015. Completeness of histories and physical examinations, the correct diagnosis (vs an incorrect or no diagnosis), and adherence to guidelines of key management decisions. Sixty-seven standardized patients completed 599 commercial virtual visits during the study period. Histories and physical examinations were complete in 417 visits (69.6%; 95% CI, 67.7%-71.6%); diagnoses were correctly named in 458 visits (76.5%; 95% CI, 72.9%-79.9%), and key management decisions were adherent to guidelines in 325 visits (54.3%; 95% CI, 50.2%-58.3%). Rates of guideline-adherent care ranged from 206 visits (34.4%) to 396 visits (66.1%) across the 8 websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (adjusted rates, 12.8% to 82.1%) than for streptococcal pharyngitis and low back pain (adjusted rates, 74.6% to 96.5%) or ankle pain and recurrent urinary tract infection (adjusted rates, 3.4% to 40

  19. Radon survey in Montenegro - A base to set national radon reference and "urgent action" level.

    Science.gov (United States)

    Vukotic, Perko; Antovic, Nevenka; Djurovic, Andrija; Zekic, Ranko; Svrkota, Nikola; Andjelic, Tomislav; Svrkota, Ranko; Mrdak, Radivoje; Bjelica, Natasa; Djurovic, Tamara; Dlabac, Aleksandar; Bogicevic, Marija

    2018-02-28

    The first nationwide indoor radon survey in Montenegro started in 2002 and year-long radon measurements with CR-39 track-etch detectors, within the national grid of 5 km × 5 km and local grids in urban areas of 0.5 km × 0.5 km, were performed in homes in half of the country's territory. The survey continued in 2014 and measurements in the rest of the country were completed at the end of 2015. The 953 valid results, obtained in the national radon survey, give an average radon activity concentration in Montenegrin homes of 110 Bq/m 3 . Assuming a log-normal distribution of the experimental results, geometric mean GM = 58.3 Bq/m 3 and geometric standard deviation GSD = 2.91 are calculated. However, normality tests show that the experimental data are not log-normal, and that they become closest to a log-normal distribution after subtracting from them radon concentration in the outdoor air of 7 Bq/m 3 , which is theoretically calculated. Such a transformed distribution has GM tr  = 46.7 Bq/m 3 and GSD tr  = 3.54. The estimations derived from positing a priory that the experimental results conform to a log-normal distribution underestimate the percentage of homes with radon concentrations at the thresholds of 300 Bq/m 3 and above, which is better estimated by using GM tr and GSD tr . Based on the results of radon survey, a new national radon reference level of 300 Bq/m 3 and an "urgent action level" of 1000 Bq/m 3 are suggested, with estimated fractions of the national dwelling stock above these levels of 7.4% and 0.8% respectively. Fractions of homes with radon concentrations above the suggested levels are also estimated for each of the 23 municipalities in Montenegro, using appropriate GM tr and GSD tr . The six municipalities which have more than 10% of homes with radon concentration above 300 Bq/m 3 are recommended as radon priority areas. Copyright © 2018 Elsevier Ltd. All rights reserved.

  20. Infecciones como causa de ingreso urgente en adultos en un hospital terciario

    Directory of Open Access Journals (Sweden)

    Miriam Saiz-Rodríguez

    2017-01-01

    Full Text Available OBJETIVO: Estudiar la prevalencia de las enfermedades infecciosas que son atendidas en el Servicio de Urgencias Hospitalario (SUH y que requieren ingreso hospitalario, así como identificar los principales agentes causales y describir el tratamiento y evolución de los pacientes. MÉTODO Estudio observacional retrospectivo que evalúa todos los pacientes que requieren ingreso urgente en un hospital terciario durante el mes de Marzo de 2016. Se recogieron como variables: enfermedades concomitantes, agentes causales, cultivos realizados, resistencias antibióticas y tratamiento prescrito. Las infecciones se clasificaron en: urinarias, respiratorias, intraabdominales, infección de piel y partes blandas, neurológicas, y otras. RESULTADOS Ingresaron un total de 903 pacientes durante este periodo. De estos, se consideró que el 36,2% podían tener una causa infecciosa. La edad media fue de 72,3 años y la estancia media en el hospital de 9,6 días. Las infecciones predominantes fueron respiratorias (47,2%, urinarias (19% e intraabdominales (18,1%. El 46,5% de las pruebas microbiológicas fueron positivas, siendo E. coli el principal agente causal (22,3%. Los perfiles de sensibilidad de los aislados fueron similares a los esperados, excepto para K. pneumoniae (50% resistente a fluoroquinolonas y amoxicilina-clavulánico. Los antibióticos predominantemente prescritos fueron β-lactámicos (51,2% y fluoroquinolonas (25,1%. La mortalidad fue del 7,3%, siendo la edad y presentar criterios de sepsis factores de riesgo asociados. CONCLUSIONES: Las infecciones son una de las principales causas de ingreso hospitalario y suponen un alto porcentaje de la atención sanitaria que se presta en el SUH. Nuestro estudio demuestra que la edad y los criterios de sepsis son factores cruciales asociados a la mortalidad de los pacientes. Este es el primer estudio que analiza cuantos ingresos a través del SUH se deben a una causa infecciosa.

  1. Emergency Department Non-Urgent Visits and Hospital Readmissions Are Associated with Different Socio-Economic Variables in Italy.

    Directory of Open Access Journals (Sweden)

    Pamela Barbadoro

    Full Text Available The aim of this paper was to evaluate socio-economic factors associated to poor primary care utilization by studying two specific subjects: the hospital readmission rate, and the use of the Emergency Department (ED for non-urgent visits.The study was carried out by the analysis of administrative database for hospital readmission and with a specific survey for non-urgent ED use.Among the 416,698 sampled admissions, 6.39% (95% CI, 6.32-6.47 of re-admissions have been registered; the distribution shows a high frequency of events in the age 65-84 years group, and in the intermediate care hospitals (51.97%; 95%CI 51.37-52.57. The regression model has shown the significant role played by age, type of structure (geriatric acute care, and deprivation index of the area of residence on the readmission, however, after adjusting for the intensity of primary care, the role of deprivation was no more significant. Non-urgent ED visits accounted for the 12.10%, (95%CI 9.38-15.27 of the total number of respondents to the questionnaire (N = 504. The likelihood of performing a non-urgent ED visit was higher among patients aged <65 years (OR 3.2, 95%CI 1.3-7.8 p = 0.008, while it was lower among those perceiving as urgent their health problem (OR 0.50, 95%CI 0.30-0.90.In the Italian context repeated readmissions and ED utilization are linked to different trajectories, besides the increasing age and comorbidity of patients are the factors that are related to repeated admissions, the self-perceived trust in diagnostic technologies is an important risk factor in determining ED visits. Better use of public national health care service is mandatory, since its correct utilization is associated to increasing equity and better health care utilization.

  2. 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, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  3. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Other Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons ...

  5. Hip Replacement Surgery

    Science.gov (United States)

    ... Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB Download ... What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or diseased ...

  6. Lung surgery - discharge

    Science.gov (United States)

    ... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

  7. Laser surgery - skin

    Science.gov (United States)

    Surgery using a laser ... used is directly related to the type of surgery being performed and the color of the tissue ... Laser surgery can be used to: Close small blood vessels to reduce blood loss Remove warts , moles , sunspots, and ...

  8. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  9. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Surgery Dental Implant Surgery Facial Cosmetic Surgery Head, Neck and Oral Pathology Obstructive Sleep Apnea TMJ and Facial Pain Treatment of Facial Injury Wisdom Teeth Management Procedures ...

  10. Pediatric heart surgery

    Science.gov (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... Ginther RM, Forbess JM. Pediatric cardiopulmonary bypass. In: ... Care . 5th ed. Philadelphia, PA: Elsevier; 2017:chap 37. LeRoy S, ...

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and ... Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more surgeries ...

  12. What Is Refractive Surgery?

    Science.gov (United States)

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Glaucoma Education Center Pediatric Ophthalmology Education Center Oculofacial Plastic ... Center Laser Surgery Education Center Redmond Ethics Center ...

  13. LASIK - Laser Eye Surgery

    Science.gov (United States)

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Glaucoma Education Center Pediatric Ophthalmology Education Center Oculofacial Plastic ... Center Laser Surgery Education Center Redmond Ethics Center ...

  14. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on ... without straining Chronic mouth breathing Sleep apnea (breathing problems when sleeping, including snoring) Your dentist, orthodontist and ...

  15. Intermittent exotropia surgery: results in different age groups.

    Science.gov (United States)

    Issaho, Dayane Cristine; Wang, Serena Xiaohong; Weakley, David Robert

    2017-01-01

    To report the outcomes in patients undergoing surgical correction of intermittent exotropia and to compare the age at surgery to motor and sensory success. This was a retrospective cohort study. The results of patients with intermittent exotropia treated with surgery over a 4-year period were reviewed. Patients were divided into two groups based on age at first surgery (groups. One hundred thirty-six patients were evaluated, with 67 and 51 patients undergoing surgery before and after the age of 4 years, respectively. The mean age at surgery was 6.8 ± 2.6 years. The reoperation rate for the patients who underwent surgery before 4 years of age was 48% versus 42% for the ones who underwent surgery after this age (p=0.93). Postoperative stereopsis showed an inverse linear association with age at surgery (page, and may even present better motor results than older patients. Postoperative stereoacuity in younger children revealed to be worse than in older children; however, this result is unlikely to be due to inadequate age for surgery, but rather, immaturity for performing the stereopsis test.

  16. The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes.

    Science.gov (United States)

    Terzioglu, Fusun; Turk, Rukiye; Yucel, Cigdem; Dilbaz, Serdar; Cinar, Ozgur; Karahalil, Bensu

    2016-06-01

    The aim of this study was to determine the effect of anxiety and depression scores of couples who underwent Assisted Reproductive Techniques (ART) on pregnancy outcomes. This study was conducted as a prospective and comparative study with 217 couples. The study data was collected by using a semi-structured questionnaire and the Turkish version of the State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). The questionnaire, STAI and BDI were applied to couples who initiated ART treatment. Couples' state anxiety scores were re-evaluated after embryo transfer (ET). A significant relationship was found between the depression score of women and pregnancy outcome (p 0.05) and lower depression scores (p positive pregnancy outcome. Study results indicated that the anxiety and depression scores of couples who had achieved a positive pregnancy result were lower than for couples with a negative result. The results of this study will contribute to the health professionals especially to the nurses who spend the most time with couples in providing consulting services and supporting psychological status of couples during ART process in Turkey.

  17. The Effects of Functional Knee Brace on Postural Control in Patients Who Underwent Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Salehi

    2016-09-01

    Full Text Available Background The current study aimed to evaluate the postural control in patients underwent anterior cruciate ligament reconstruction pre and post wearing functional knee brace. Methods Eighteen athletes undergone unilateral anterior cruciate ligament reconstruction included in the study. They had unilateral anterior cruciate ligament reconstruction at least six months before session test. Postural control was assessed pre and post wearing custom-fit functional knee brace using a posturographic platform prokin 254. The balance tests included: 1 standing on prokin platform with eyes open/closed on anterior cruciate ligament reconstruction limb, 2 standing on prokin platform with eyes open/closed on both limbs. The standard deviation (SD of body sway along the anteroposterior (AP and mediolateral (ML axis, mean velocity of center of pressure (COP along AP/ ML axis and the area ellipse (measured in 2 mm were calculated. Results Results of the paired T-test revealed a significant effect on selected postural control variables for the brace conditions especially in low challengeable conditions (double leg, eyes open test situations (P < 0.05. But in high challengeable conditions this effect was not significant. Conclusions Functional knee brace improved postural control in the simple balancing task in the subjects with anterior cruciate ligament reconstruction. But this improvement in more difficult balancing task was limited.

  18. The Effect of Prazosin and Oxybutynin on the Symptoms Due to Using Double J Catheter in Patients Underwent TUL

    Directory of Open Access Journals (Sweden)

    K. Tavakkoli Tabassi

    2014-01-01

    Full Text Available Background & Aims: Double J catheter has been used for years as an independent practice or a part of other urological practices. Although these catheters have solved many patients’ problems but those can cause symptoms and problems for patients. The aim of this study was the investigation the effect of prazosin and oxybutynin on the degree of symptoms due to using Double J catheter. Methods: In this interventional study, patients who underwent TUL from July 2008 to march 2008 in the lithotripsy ward of Imam Reza hospital were entered to the study and randomly divided in 3 groups randomly. In the first group, placebo, in the second group, oxybutynin, in the third group prazosin were prescribed. Three weeks later standard questionnaire Ureteric Stent Symptom Questionnaire (USSQ was completed. After collecting data, was analyzed using SPSS software. Results: A total of 113 patients (70 men 43 women were included to the study. The mean age was 39 years. There were no significance difference among urinary symptoms score pain of body and physical activity problems in three groups (P>0.05, but there was a significant difference in general health and work problems among them (P<0.05. Conclusion: Oxybutynin caused a low effect on improvement of general health and work problems in patients who were studied. It might Prazosin does not has a sufficient time to affect on urinary symptoms, because of shortness of usage.

  19. Anatomical location of metastatic lymph nodes: an indispensable prognostic factor for gastric cancer patients who underwent curative resection.

    Science.gov (United States)

    Zhao, Bochao; Zhang, Jingting; Zhang, Jiale; Chen, Xiuxiu; Chen, Junqing; Wang, Zhenning; Xu, Huimian; Huang, Baojun

    2018-02-01

    Although the numeric-based lymph node (LN) staging was widely used in the worldwide, it did not represent the anatomical location of metastatic lymph nodes (MLNs) and not reflect extent of LN dissection. Therefore, in the present study, we investigated whether the anatomical location of MLNs was still necessary to evaluate the prognosis of node-positive gastric cancer (GC) patients. We reviewed 1451 GC patients who underwent radical gastrectomy in our institution between January 1986 and January 2008. All patients were reclassified into several groups according to the anatomical location of MLNs and the number of MLNs. The prognostic differences between different patient groups were compared and clinicopathologic features were analyzed. In the present study, both anatomical location of MLNs and the number of MLNs were identified as the independent prognostic factors (p location of MLNs was considered (p location of MLNs had no significant effect on the prognosis of these patients, the higher number of MLNs in the extraperigastric area was correlated with the unfavorable prognosis (p location of MLNs was an important factor influencing the prognostic outcome of GC patients. To provide more accurate prognostic information for GC patients, the anatomical location of MLNs should not be ignored.

  20. Prospective observational study comparing traditional laparoscopy and three-dimensional laparoscopy in gynecologic surgery.

    Science.gov (United States)

    Lara-Domínguez, Maria D; López-Jiménez, Araceli; Grabowski, Jacek P; Arjona-Berral, Jose E; Zapardiel, Ignacio

    2017-03-01

    To compare perioperative details among patients who underwent gynecologic surgery between traditional laparoscopy and three-dimensional laparoscopy. The present prospective non-randomized study enrolled all consecutive patients diagnosed with gynecologic pathology who underwent laparoscopic surgery at Reina Sofia Hospital, Cordoba, Spain between January 1 and April 30, 2014. Perioperative data, adverse events, and patient satisfaction were compared between patients who underwent treatment with two-dimensional and three-dimensional laparoscopic surgery techniques. The study enrolled 60 consecutive patients; 31 (52%) patients who underwent three-dimensional surgery and 29 (48%) who underwent traditional two-dimensional surgery. No significant differences were observed in the adverse-event rate, operating time, or perioperative parameters. A higher use of sealing devices was recorded among patients who underwent three-dimensional laparoscopy (P=0.021). No difference was recorded in patient satisfaction between the two patient groups. Although there was no impact on surgical outcomes, three-dimensional surgery could give a more accurate view of the surgical field. Performing three-dimensional surgery could be beneficial for more complex procedures although further comparative studies are required to investigate this hypothesis. © 2016 International Federation of Gynecology and Obstetrics.

  1. Outcome after translabyrinthine surgery for vestibular schwannomas

    DEFF Research Database (Denmark)

    Springborg, Jacob Bertram; Fugleholm, Kåre; Poulsgaard, Lars

    2012-01-01

    The objective of this article is to study the outcome after translabyrinthine surgery for vestibular schwannomas, with special focus on the facial nerve function. The study design is a case series from a national centralized database and it is set in two University Hospitals in Denmark. Participa......The objective of this article is to study the outcome after translabyrinthine surgery for vestibular schwannomas, with special focus on the facial nerve function. The study design is a case series from a national centralized database and it is set in two University Hospitals in Denmark....... Participants were 1244 patients who underwent translabyrinthine surgery during a period of 33 years from 1976 to 2009. Main outcome measures were tumor removal, intraoperative facial nerve preservation, complications, and postoperative facial nerve function. In 84% patients, the tumor was totally resected...... and in ~85% the nerve was intact during surgery. During 33 years, 12 patients died from complications to surgery and ~14% had cerebrospinal fluid leakage. Before surgery, 74 patients had facial paresis and 46% of these improved after surgery. In patients with normal facial function, overall ~70% had a good...

  2. Necessity of suction drains in gynecomastia surgery.

    Science.gov (United States)

    Keskin, Mustafa; Sutcu, Mustafa; Cigsar, Bulent; Karacaoglan, Naci

    2014-05-01

    The aim of gynecomastia surgery is to restore a normal chest contour with minimal signs of breast surgery. The authors examine the rate of complications in gynecomastia surgery when no closed-suction drains are placed. One hundred thirty-eight consecutive male patients who underwent gynecomastia surgery without drains were retrospectively analyzed to determine whether the absence of drains adversely affected patient outcomes. Patients were managed by ultrasonic-assisted liposuction both with and without the pull-through technique. The mean age of the patients was 29 years, and the mean volume of breast tissue aspirated was 350 mL per beast. Pull-through was needed in 23 cases. There was only 1 postoperative hematoma. These results are comparable with previously published data for gynecomastia surgery in which drains were placed, suggesting that the absence of drains does not adversely affect postoperative recovery. Routine closed-suction drainage after gynecomastia surgery is unnecessary, and it may be appropriate to omit drains after gynecomastia surgery.

  3. Should bariatric surgery be performed in adolescents?

    Science.gov (United States)

    Beamish, Andrew J; Reinehr, Thomas

    2017-04-01

    Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications. © 2017 European Society of Endocrinology.

  4. EARLY COMPLICATIONS IN BARIATRIC SURGERY:

    Directory of Open Access Journals (Sweden)

    Marco Aurelio SANTO

    Full Text Available ContextBariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control.MethodThe medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2.ResultsEarly complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%.ConclusionThe incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.

  5. Value of microvascular surgery in academic oral and maxillofacial surgery.

    Science.gov (United States)

    Fattahi, Tirbod; Fernandes, Rui

    2013-01-01

    The specialty of oral and maxillofacial surgery has witnessed a large trend of inclusion of maxillofacial oncology and microvascular reconstructive surgery within its scope of practice in recent years. The purpose of this report is to describe the authors' experience with a very active oncologic and microvascular reconstructive surgical service within an academic oral and maxillofacial surgical program at a large university teaching hospital. The operative log from July 1, 2010, to June 30, 2011, of 325 operations devoted to head and neck oncology and reconstruction was examined. Thirty-nine patients (group A) received a pedicled flap for head and neck reconstruction. Sixty-three patients (group B) received a microvascular free tissue transfer for head and neck reconstruction. Financial records of 20 consecutive patients who underwent simultaneous ablative and reconstructive procedures in each group were then reviewed for total hospital charges, including direct (surgical fees) and indirect (hospital stay, operating room expenses, and ancillary services) charges, and length of stay. Total hospital charges and direct surgical fees, were higher for the microvascular reconstruction group (group B). Length of hospital stay was not statistically different between the two groups. Microvascular reconstructive surgery performed within an academic oral and maxillofacial surgical program has many financial and intangible benefits within a medical center. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Postoperative pleural effusion following upper abdominal surgery

    DEFF Research Database (Denmark)

    Nielsen, P H; Jepsen, S B; Olsen, A D

    1989-01-01

    Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum a...... to postoperative sodium and water retention, and aggravated by an age-related relative cardiac decompensation. Early postoperative pleural effusions are common and do not require specific treatment....

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

    International Nuclear Information System (INIS)

    Yoneda, Masayuki; Fujiwara, Hitoshi; Okamura, Shinichi

    2010-01-01

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

  8. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  9. Posttraumatic Stress Disorder, Orientation to Pain, and Pain Perception in Ex-Prisoners of War Who Underwent Torture.

    Science.gov (United States)

    Tsur, Noga; Defrin, Ruth; Ginzburg, Karni

    Studies suggest that torture survivors often experience long-term chronic pain and increased pain perception. However, it is unclear whether the actual experience of torture or rather the subsequent posttraumatic stress disorder (PTSD) explains these pain problems. Furthermore, although catastrophic and fearful orientations to pain have been suggested to play a significant role in the association between trauma and pain, the underlying mechanisms remain unclear. This study examined whether chronic pain and pain perception among torture survivors are associated with torture experience or PTSD and whether catastrophic and fearful orientations mediate or moderate these associations. Fifty-nine ex-prisoners of war who underwent torture and 44 matched veterans participated in this study. Pain perception was evaluated by assessing pain threshold and reactivity to experimental suprathreshold noxious stimuli. Participants completed self-administered questionnaires assessing PTSD, chronic pain, pain catastrophizing, and fear of pain. Although chronic pain was associated with PTSD (0.44 < β < 0.49, p < .002), increased pain perception was correlated with torture (0.33 < β < 0.65, p < .05). Pain catastrophizing was found to mediate the association between PTSD and chronic pain (β = 0.18 and 0.19, respectively; p < .05). Fear of pain moderated the association between torture and pain perception (β = 0.41 and 0.42, respectively; p < .017). The findings suggest that chronic pain is contingent upon the psychological toll of torture, that is, PTSD. This study also indicates that PTSD exacerbates catastrophic orientation, which in turn may amplify chronic pain. Reactivity to experimental noxious stimuli was related to previous experiences of torture, which enhances perceived pain intensity when interacting with a fearful pain orientation. These findings highlight the significance of orientation to bodily experiences after trauma.

  10. Periodical assessment of genitourinary and gastrointestinal toxicity in patients who underwent prostate low-dose-rate brachytherapy

    International Nuclear Information System (INIS)

    Tanaka, Nobumichi; Asakawa, Isao; Anai, Satoshi; Hirayama, Akihide; Hasegawa, Masatoshi; Konishi, Noboru; Fujimoto, Kiyohide

    2013-01-01

    To compare the periodical incidence rates of genitourinary (GU) and gastrointestinal (GI) toxicity in patients who underwent prostate low-dose-rate brachytherapy between the monotherapy group (seed implantation alone) and the boost group (in combination with external beam radiation therapy (EBRT)). A total of 218 patients with a median follow-up of 42.5 months were enrolled. The patients were divided into 2 groups by treatment modality, namely, the monotherapy group (155 patients) and the boost group (63 patients). The periodical incidence rates of GU and GI toxicity were separately evaluated and compared between the monotherapy group and the boost group using the National Cancer Institute - Common Terminology Criteria for Adverse Events, version 3.0. To elucidate an independent factor among clinical and postdosimetric parameters to predict grade 2 or higher GU and GI toxicity in the acute and late phases, univariate and multivariate logistic regression analyses were carried out. Of all patients, 78.0% showed acute GU toxicity, and 7.8% showed acute GI toxicity, while 63.8% showed late GU toxicity, and 21.1% showed late GI toxicity. The incidence rates of late GU and GI toxicity were significantly higher in the boost group. Multivariate analysis showed that the International Prostate Symptom Score (IPSS) before seed implantation was a significant parameter to predict acute GU toxicity, while there were no significant predictive parameters for acute GI toxicity. On the other hand, combination with EBRT was a significant predictive parameter for late GU toxicity, and rectal volume (mL) receiving 100% of the prescribed dose (R100) was a significant predictive parameter for late GI toxicity. The boost group showed higher incidence rates of both GU and GI toxicity. Higher IPSS before seed implantation, combination with EBRT and a higher R100 were significant predictors for acute GU, late GU and late GI toxicity

  11. Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation.

    Science.gov (United States)

    Kapetanakis, Stylianos; Gkasdaris, Grigorios; Thomaidis, Tryfon; Charitoudis, Georgios; Kazakos, Konstantinos

    2017-01-01

    Studies describing the efficacy of TPED on shortness of recovery and improvement of postoperative quality of life are limited, especially regarding gender something that has never been reported before in the literature. The purpose of this study is to evaluate possible differences of the health-related quality of life in patients who underwent TPED for LDH in accordance with sex. Seventy-six patients diagnosed and treated with TPED for LDH with 1 year follow-up were selected and divided into two groups of equal number depending on sex. Their quality of life was evaluated by using the SF-36 before the operation, six weeks, three, six and twelve months postoperatively. A statistical analysis was conducted, in order to compare the 8 scaled scores of the SF-36 combining each time two chronological phases in the total of patients, in each group and between groups. Fifty-two (68.4%) patients were ≤63 years old, while the rest 24 (31,4%) were >63 years old (mean ±SD = 56,5 ±12,1 years). Apart from the PF domain, the scores were higher in every visit for the two groups, but the change between groups was not significant. Women had a significantly higher increase of PF score in 3 months after TPED and in the interval 6 weeks-3 months comparing with men. However, in the intervals 3 months-6 months and 3 months-12 months men presented significantly higher increase compared to women. Statistically significant improvement of the quality of life for both men and women was observed. Generally, there was no significant difference between the two groups. As regards to the physical functioning, it appears to be a significant difference which is counterpoised over time. 2. TPED for LDH does not present major differences in the improvement of quality of life regarding gender.

  12. Bariatric Surgery and Infertility: A Prospective Study.

    Science.gov (United States)

    Consalvo, Vincenzo; Canero, Antonio; Salsano, Vincenzo

    2017-12-22

    Obesity is a worldwide disease affecting 13% of the world's adult female population. The reasons and the fetal risk are still unclear. The effect of weight loss as a result of bariatric surgery seems to induce an improvement in fertility in obese women. The main purpose of this prospective study is to demonstrate if there is an association between bariatric surgery-induced weight loss and an improvement in the fertility of women at reproductive age. From June 2013 to April 2016, all bariatric female patients from our institutes were prospectively evaluated for suitability in this study. A pool of 52 eligible patients was extracted from our database in the recruitment period. Of these, 28 underwent bariatric surgery and 24 did not. Both groups were observed for two-year follow-up. During follow-up, anthropometrics parameters, blood analysis, and comorbidities were checked and a gynaecological consultation was prescribed. Fifty participants were studied. Twenty-seven successfully underwent bariatric surgery with a percentage of excess weight loss (EWL) >70% at 24 months, while 23 accepted the observation and control for 24 months as an integral part of the pre-surgical bariatric program. The contingency table analysis showed an extremely significant association (Pbariatric surgery) and event (pregnancy), with a relative risk (RR) = 15.33 and confidence interval (CI) 95%=2.213 to 106.26. Bariatric surgery improves fertility in obese women at two years' postoperative. Every obese woman with difficulties becoming pregnant should undergo a bariatric surgery consultation. Further studies are necessary to confirm our results.

  13. More patients should undergo surgery after sigmoid volvulus.

    Science.gov (United States)

    Ifversen, Anne Kathrine Wewer; Kjaer, Daniel Willy

    2014-12-28

    To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus. We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery. Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality. Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or PEC insertion if feasible.

  14. Negative pressure pulmonary edema in healthy cosmetic surgery patients.

    Science.gov (United States)

    Dieu, Tam; Upjohn, Edward

    2003-01-01

    Anesthetic complications are uncommon in young and healthy patients undergoing cosmetic surgery. We report 2 cases of negative pressure pulmonary edema (NPPE) in young patients, 1 who underwent rhinoplasty and another who underwent augmentation mammaplasty and suction-assisted lipoplasty of the thighs and buttocks This rare and potentially fatal complication requires admission to an intensive-care unit and delayed discharge. Although cases of NPPE have been reported in the medical and anesthetic literature, NPPE in plastic surgery has never been reported previously.

  15. Transcatheter aortic valve implantation versus redo surgery for failing surgical aortic bioprostheses

    DEFF Research Database (Denmark)

    Spaziano, Marco; Mylotte, Darren; Thériault-Lauzier, Pascal

    2017-01-01

    independent predictors used for propensity scoring were age, NYHA functional class, number of prior cardiac surgeries, urgent procedure, pulmonary hypertension, and COPD grade. Using a calliper range of ±0.05, a total of 78 well-matched patient pairs were found. All-cause mortality was similar between groups...

  16. The Irish epilepsy surgery experience: Long-term follow-up.

    LENUS (Irish Health Repository)

    Dunlea, Orla

    2010-05-01

    To assess the long-term seizure outcome of Irish patients who underwent resective surgery for refractory epilepsy since 1975. We also wished to determine the impact of pathology and surgical technique (with particular reference to neocorticectomy) on seizure outcome.

  17. Visual acuity and nystagmus following strabismus surgery in patients with oculocutaneous albinism.

    Science.gov (United States)

    Villegas, Victor M; Díaz, Lilliam; Emanuelli, Andres; Izquierdo, Natalio J

    2010-12-01

    To evaluate the effect of strabismus surgery on nystagmus and visual acuity in patients with oculocutaneous albinism. We conducted a non-concurrent retrospective study of 13 Puerto Rican patients with all types of oculocutaneous albinism who underwent strabismus surgery. Patients underwent genetic linkage analysis to reach a final oculocutaneous albinism classification prior to surgery. Strabismus surgery was modified by under-correction of 0.5 mm in each muscle from the standard Marshall Parks' measurements in all patients. Six of the 13 patients with oculocutaneous reported an improved best corrected visual acuity after surgery. Two of the 13 patients with oculocutaneous had no nystagmus following strabismus surgery. All patients were orthotropic following surgery. Strabismus surgical undercorrection may be of benefit in patients with oculocutaneous albinism.

  18. Timing of Haemophilus influenzae type b vaccination after cardiac surgery.

    Science.gov (United States)

    Takanashi, Manabu; Ogata, Shohei; Honda, Takashi; Nomoto, Keiko; Mineo, Eri; Kitagawa, Atsushi; Ando, Hisashi; Kimura, Sumito; Nakahata, Yayoi; Oka, Norihiko; Miyaji, Kagami; Ishii, Masahiro

    2016-08-01

    The best time for vaccination in infants with congenital heart disease (CHD) after cardiopulmonary bypass (CPB) surgery is unclear, but it is important to prevent Haemophilus influenzae type b (Hib) infection in infants with CHD after CPB surgery. To identify the best time for Hib vaccination in infants with CHD after CPB surgery, we investigated the immunological status, and the efficacy and safety of Hib vaccination after CPB surgery. Sixteen subjects who underwent surgical correction of ventricular septal defect with CPB were investigated. Immunological status and cytokines were analyzed before surgery, 2 months after surgery, and before Hib booster vaccination. Hib-specific IgG was also measured to evaluate the effectiveness of vaccination. Immunological status before and 2 months after surgery (e.g. whole blood cells and lymphocyte subset profile) was within the normal range and no subjects had hypercytokinemia. Additionally, all subjects who received Hib vaccination at 2-3 months after CPB surgery had effective serum Hib-specific IgG level for protection against Hib infection without any side-effects. CPB surgery does not influence acquired immunity and Hib vaccination may be immunologically safe to perform at 2 months after CPB surgery. Hib vaccination at 2-3 months after CPB surgery was effective in achieving immunization for infants with simple left-right shunt-type CHD. © 2015 Japan Pediatric Society.

  19. Comparison of Standard Catheters Versus Radial Artery-Specific Catheter in Patients Who Underwent Coronary Angiography Through Transradial Access.

    Science.gov (United States)

    Chen, On; Goel, Sunny; Acholonu, Michael; Kulbak, Guy; Verma, Shivani; Travlos, Efstratios; Casazza, Richard; Borgen, Elliot; Malik, Bilal; Friedman, Michael; Moskovits, Norbert; Frankel, Robert; Shani, Jacob; Ayzenberg, Sergey

    2016-08-01

    In this prospective, randomized controlled study, we aim to compare the performance outcomes of standard catheters with the radial artery-specific catheter. Over the past decade, transradial cardiac catheterization has gained widespread popularity because of its low complication rates compared with transfemoral access. Operators have the choice of using either standard catheters (used for both transfemoral and transradial approach, with need for separate catheter use for either right or left coronary artery engagement) or a dedicated radial artery catheter, which is specifically designed to engage both coronary arteries through radial artery access. A total of 110 consecutive patients who underwent coronary angiography at our institution from March 2015 to April 2015 were prospectively randomized to either radial artery-specific Tiger catheter (5Fr; Terumo Interventional Systems, Somerset, New Jersey) versus standard Judkins left and right catheters (5Fr R4, L4; Cordis Corporation, Miami, Florida). The end points of the study included fluoroscopy time, dose-area product, contrast volume used, and total procedure time for the coronary angiography. A total of 57 patients (52%) were randomized to radial artery-specific catheter and 53 (48%) to the standard catheter. Tiger catheter was associated with significantly lower fluoroscopy time (184 ± 91 vs 238 ± 131 seconds, p = 0.015), which was statistically significant. Other outcome measures such as dose-area product (2,882.4 ± 1,471.2 vs 3,524.6 ± 2,111.7 Gy·cm(2), p = 0.07), total contrast volume (48.1 ± 16.1 vs 53.4 ± 18.5 ml, p = 0.114), and total procedure time (337 ± 382 vs 434 ± 137 seconds, p = 0.085) were also lower in single-catheter group, but it did not reach statistical significance. A total of 8 patients (14%) were crossed over from radial-specific catheter arm to standard catheter arm because of substandard image quality and difficulty in coronary engagement. Six patients had to be

  20. A Parallel World for the World Bank: A Case Study of Urgent: Evoke, An Educational Alternate Reality Game

    Directory of Open Access Journals (Sweden)

    David I. Waddington

    2013-01-01

    Full Text Available In 2010, the World Bank launched Urgent: Evoke, an alternate reality game. Conceived in response to the demands of African universities, the game was designed to promote the World Bank Institute’s vision of positive global change through social innovation, and made substantial use of Web 2.0 tools such as blogs, personal profiles, and social networks. This article offers a case study of Urgent: Evoke, divided into four sections: first, the potential to use video games as citizenship education tools is discussed; second, the unique game genre (alternate reality games into which Evoke falls is explained and some possible uses of this genre in higher education are examined; third, the functioning of the Evoke game world is explained; and fourth, the results of the Evoke educational project are assessed. The case study concludes with some commentary on Evoke’s ideological message, which those less sympathetic to capitalism may view as problematic.

  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. Varicose vein surgery using a pneumatic tourniquet: reduced blood loss and improved cosmesis.

    OpenAIRE

    Thompson, J. F.; Royle, G. T.; Farrands, P. A.; Najmaldin, A.; Clifford, P. C.; Webster, J. H.

    1990-01-01

    A prospective controlled randomised study has been performed of 100 consecutive patients undergoing varicose vein surgery. One group underwent saphenofemoral flush ligation and multiple lower leg avulsions with the leg exsanguinated with a Rhys-Davies cuff, and ischaemia maintained with a pneumatic tourniquet. The other group underwent identical surgery but with a 30 degree head down tilt only. Blood loss was significantly less (13.5 +/- 12 ml vs 133 +/- 78 ml; P less than 0.01) and postopera...

  3. Conservative cricoid surgery for chondrosarcoma: a case report.

    Science.gov (United States)

    Gaio, Elena; Maggiore, Giandomenico; Canesso, Alessandra; Artico, Riccardo

    2014-02-01

    We present the case of a 39-year-old man who presented with hoarseness and progressively worsening dyspnea. Findings on laryngoscopy and computed tomography strongly suggested the presence of a chondrosarcoma. The patient underwent open surgery for removal of the lesion with wide margins. Reconstruction was carried out with two segments of costal cartilage. Laryngeal chondrosarcomas are rare, malignant, usually well-differentiated neoplasms that should be treated with conservative surgery. Recurrences should be treated more aggressively.

  4. MINIMALLY-INVASIVE SURGERY FOR COLLORECTAL CANCER IN ELDERLY PATIENTS

    OpenAIRE

    I. L. Chernikovskiy; V. M. Gelfond; A. S. Zagryadskikh; S. A. Savchuk

    2016-01-01

    Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were pres...

  5. Rescue Surgery 19 Years after Composite Root and Hemiarch Replacement

    Directory of Open Access Journals (Sweden)

    Konstantin von Aspern

    2013-01-01

    Full Text Available A 59-year-old male patient with Marfan's syndrome was referred to our clinic due to acute chest pain. His medical history contains complex surgery for type A aortic dissection 19 years ago including composite root replacement using a mechanical aortic valve. Immediate computed tomography indicated perforation at the distal ascending aortic anastomosis plus complete avulsion of both coronary ostia. The patient underwent successful rescue surgery with ascending aortic and arch replacement using a modified Cabrol technique.

  6. Outcome of Colonic Surgery in Elderly Patients with Colon Cancer

    OpenAIRE

    Hermans, E.; van Schaik, P. M.; Prins, H. A.; Ernst, M. F.; Dautzenberg, P. J. L.; Bosscha, K.

    2010-01-01

    Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients aged 65 years or older. Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare five-year survival rates between the younger and elderly patients. Methods. 207 consecutive patients underwent surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years. Results. Elderly patients presented significantly m...

  7. Analysis of safety of short-stay thyroid surgery

    OpenAIRE

    Dedivitis, RA; Pfuetzenreiter Jr, EG; Castro, MAF; Denardin, OVP

    2009-01-01

    The duration of hospital stay, following surgical procedures, has undergone a significant reduction in recent years. However, there are some risks associated with short-stay thyroid surgery. An analysis has been made of data from patients who underwent short-stay thyroid surgery, analyzing the complications associated with this procedure. Overall 270 consecutive patients undergoing thyroidectomy in 2007 and 2008 were prospectively analyzed. Post-operative care included routine ward overnight ...

  8. Gastric Bypass Surgery

    Science.gov (United States)

    ... gastrointestinal system Death (rare) Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They ... room, where medical staff monitors you for any complications. Your hospital stay may ... of bariatric surgery Each type of bariatric surgery has pros and ...

  9. Facial Cosmetic Surgery

    Science.gov (United States)

    ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  10. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  11. Corrective Jaw Surgery

    Science.gov (United States)

    ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  12. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We Are Find a Surgeon News Videos Contact Anesthesia Cleft Lip/Palate and Craniofacial Surgery Corrective Jaw Surgery Dental Implant Surgery Extractions and Other Oral Surgeries Facial Cosmetic ...

  13. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft tissues of the ... and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft tissues of the ...

  14. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Procedures Who is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery Life ... Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity 100 SW 75th Street, Suite 201, Gainesville, FL, ...

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ...

  16. Use of healthcare information and advice among non-urgent patients visiting emergency department or primary care.

    Science.gov (United States)

    Backman, Ann-Sofie; Lagerlund, Magdalena; Svensson, Tobias; Blomqvist, Paul; Adami, Johanna

    2012-12-01

    Healthcare information provided by telephone service and internet sources is growing but has not been shown to reduce inappropriate emergency department (ED) visits. To describe the use of advice or healthcare information among patients with non-urgent illnesses seeking care before attendance at an ED, or primary care (PC) centres in an urban region in Sweden. Patients with non-urgent illnesses seeking care at an ED or patients attending the PC were followed up with a combination of patient interviews, a questionnaire to the treating physician and a prospective follow-up of healthcare use through a population-based registry. Half of the non-urgent patients attending the ED had used healthcare information or advice before the visit, mainly from a healthcare professional source. In PC, men were more likely to have used information or advice compared with women (OR 2.5 95% CI 1.3 to 5.0), whereas the situation was reversed among ED patients (OR=0.4 95% CI 0.2 to 0.9). Men with no previous healthcare experience attending the ED had the lowest use of healthcare information (pinformation on the internet in a case of perceived emergency. ED patients rated as non-urgent by the triage nurse used more advice and healthcare information than PC patients, irrespective of the physician-rated urgency of the symptoms. The problem seems not to be lack of information about appropriate ED use, but to find ways to direct the information to the right target group.

  17. Pre-implementation Assessment of An Antimicrobial Stewardship Program for Acute Respiratory Infections within Emergency and Urgent Care Settings

    OpenAIRE

    May, Larissa; Shigyo, Kristina; Stahmer, Aubyn; Yadav, Kabir

    2017-01-01

    Abstract Background Inappropriate antibiotic use in emergency department (ED) and urgent care center (UCC) settings is a major public health concern, yet few antibiotic stewardship programs have been designed for these settings. We report a qualitative pre-implementation workflow analysis of five ED and UCC settings investigating the facilitators and barriers to incorporating an adapted CDC Get Smart antibiotic stewardship intervention for antibiotic-nonresponsive acute respiratory infections...

  18. Consensus methods to identify a set of potential performance indicators for systems of emergency and urgent care.

    Science.gov (United States)

    Coleman, Patricia; Nicholl, Jon

    2010-04-01

    To identify a comprehensive set of indicators to enable Primary Care Trust (PCT) commissioners in England and other NHS decision-makers to monitor the performance of systems of emergency and urgent care for which they are responsible. Using a combination of Delphi RAND methods in three successive rounds of consultation and nominal group review, we canvassed expert opinion on 70 potential indicators as good measures of system performance. The two Delphi panels consisted of senior clinicians and researchers, and urgent care leads and commissioners in PCTs and Strategic Health Authorities (SHAs). The indicators were formatted into a questionnaire according to whether they were outcome, process, structure, or equity-based measures. Participants scored each indicator on a Likert scale of 1-9 and had the opportunity to consider their scores informed by the group scores and feedback. The questionnaire was refined after each round. To ensure that the indicators rated most highly by the Delphi panels covered all dimensions of performance, the results of the Delphi were reviewed by a nominal group consisting of two researchers and three clinicians from the local health services research network (LHSR). Overall, the process yielded 16 candidate indicators. It also produced a core set of serious, emergency and urgent care-sensitive conditions (defined as conditions whose exacerbations should be managed by a well-performing system without admission to an inpatient bed), for use with the indicators. System-wide measures to monitor performance across multiple services should encourage providers to work for patient benefit in an integrated way. They will also assist commissioners to monitor and improve emergency and urgent care for their local populations. The indicators are now being calculated using routinely available data, and tested for their responsiveness to capture change over time.

  19. Limited-Access Heart Surgery

    Science.gov (United States)

    ... Surgery Menu Topics Topics FAQs Limited-Access Heart Surgery Article Info En español Thousands of heart surgeries ... with cardiovascular disease. What is minimally invasive heart surgery? In minimally invasive heart surgery, surgeons take steps ...

  20. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study

    Directory of Open Access Journals (Sweden)

    Kim JW

    2016-04-01

    Full Text Available Jong Wan Kim,1 Jeong Yeon Kim,1 Byung Mo Kang,2 Bong Hwa Lee,3 Byung Chun Kim,4 Jun Ho Park5 1Department of Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong Si, 2Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon Si, 3Department of Surgery, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang Si, 4Department of Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, 5Department of Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea Purpose: The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer.Patients and methods: 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.Results: 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, P<0.001, but the time to soft food intake (6.0 vs 6.6 days, P=0.036 and the postoperative hospital stay (13.7 vs 15.7 days, P=0.018 were shorter in the laparoscopic group. The number of harvested lymph nodes was lower in the laparoscopic group than in the open group (20.3 vs 24.3, P<0.001. The 5-year overall survival (90.8% vs 88.6%, P=0.540 and disease-free survival (86.1% vs 78.9%, P=0.201 rates were similar in both groups.Conclusion: The present study showed that laparoscopic surgery is associated

  1. Blindness, cataract surgery and mortality in Ethiopia.

    Science.gov (United States)

    Thomas, Benjamin J; Sanders, David S; Oliva, Matthew S; Orrs, Mark S; Glick, Peter; Ruit, Sanduk; Chen, Wei; Luoto, Jill; Tasfaw, Alemu Kerie; Tabin, Geoffrey C

    2016-09-01

    To examine the relationships between blindness, the intervention of cataract surgery and all-cause mortality in a rural Ethiopian population. Population-based, interventional prospective study. Community-based detection methods identified blind Ethiopian persons from two selected kebeles in Amhara region, Ethiopia. Data from 1201 blind patients were collected-628 cataract-blind and 573 blind from other conditions. Free cataract surgery was provided for consenting, cataract-blind patients. Follow-up surveys were conducted after 12 months (±1 month)-the main outcome measure for this report is all-cause mortality at 1 year. During the follow-up period, 110 persons died from the selected population (mortality 9.2%), which consisted of those cataract-blind patients who received cataract surgery (N=461), cataract-blind patients who did not receive surgery (N=167) and all non-cataract-blind patients (N=573). Of the 461 patients who received cataract surgery, 44 patients died (9.5%). Of the 740 patients who did not receive surgery, 66 died (8.9%)-28 patients from the cohort of cataract-blind patients who did not receive surgery (16.8%) and 38 patients from the cohort of non-cataract blind (6.6%). Subgroup analysis revealed significantly increased odds of mortality for cataract-blind patients over 75 years of age who did not receive surgery and for unmarried patients of all age groups. In this population, mortality risk was significantly elevated for older cataract-blind patients when compared with non-cataract-blind patients-an elevation of risk that was not noted in an age-matched cohort of cataract-blind patients who underwent cataract surgery as early as 1-year follow-up. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Pain Resolution After Hallux Valgus Surgery.

    Science.gov (United States)

    Chen, Jerry Yongqiang; Ang, Benjamin Fu Hong; Jiang, Lei; Yeo, Nicholas Eng Meng; Koo, Kevin; Singh Rikhraj, Inderjeet

    2016-10-01

    Although more than 1500 publications on hallux valgus can be found in the current literature, none of them have reported on the course of pain resolution after hallux valgus surgery. Thus, this study aimed to investigate pain resolution after hallux valgus surgery and to identify predictive factors associated with residual pain at 6 months after surgery. We prospectively followed up 308 patients who underwent hallux valgus surgery at a tertiary hospital at 6 months and 2 years after surgery. Multivariate logistic regression analysis was performed to evaluate the risk factors associated with residual pain after surgery. Ninety-four patients (31%) had some degree of residual pain at 6 months after surgery. After excluding 4 patients who developed osteoarthritis of the first metatarsophalangeal joint over the next 18 months, 73 of the remaining 90 (81%) experienced improvement in visual analog scale (VAS) by the 2-years follow-up. Their median VAS improved from 4 (interquartile range [IQR] 3, 5) at 6 months to 0 (IQR 0, 3) at 2 years (P < .001). A higher preoperative VAS increased the risk of having persistent pain at 6 months after sugery (odds ratio [OR] 1.388, 95% confidence interval [CI] 1.092, 1.764, P = .007), whereas a higher preoperative Mental Component Score of SF-36 (MCS) reduced this risk (OR 0.952, 95% CI 0.919, 0.987, P = .007). As much as 31% of patients will have residual pain at 6 months after surgery. Preoperative VAS and MCS are predictors for residual pain. However, these patients will continue to improve over the next 18 months, with 71% of them being pain free at 2 years after surgery. Level II, prospective comparative study. © The Author(s) 2016.

  3. Long-Term Survival Outcomes of Cancer-Directed Surgery for Malignant Pleural Mesothelioma: Propensity Score Matching Analysis.

    Science.gov (United States)

    Nelson, David B; Rice, David C; Niu, Jiangong; Atay, Scott; Vaporciyan, Ara A; Antonoff, Mara; Hofstetter, Wayne L; Walsh, Garrett L; Swisher, Stephen G; Roth, Jack A; Tsao, Anne; Gomez, Daniel; Giordano, Sharon H; Mehran, Reza; Sepesi, Boris

    2017-10-10

    Purpose Small observational studies have shown a survival advantage to undergoing cancer-directed surgery for malignant pleural mesothelioma (MPM); however, it is unclear if these results are generalizable. Our purpose was to evaluate survival after treatment of MPM with cancer-directed surgery and to explore the effect surgery interaction with chemotherapy or radiation therapy on survival by using the National Cancer Database. Patients and Methods Patients with microscopically proven MPM were identified within the National Cancer Database (2004 to 2014). Propensity score matching was performed 1:2 and among this cohort, a Cox proportional hazards regression model was used to identify predictors of survival. Median survival was calculated by using the Kaplan-Meier method. Results Of 20,561 patients with MPM, 6,645 were identified in the matched cohort, among whom 2,166 underwent no therapy, 2,015 underwent chemotherapy alone, 850 underwent cancer-directed surgery alone, 988 underwent surgery with chemotherapy, and 274 underwent trimodality therapy. The remaining 352 patients underwent another combination of surgery, radiation, or chemotherapy. Thirty-day and 90-day mortality rates were 6.3% and 15.5%. Cancer-directed surgery, chemotherapy, and radiation therapy were independently associated with improved survival (hazard ratio, 0.77, 0.74, and 0.88, respectively). Stratified analysis revealed that surgery-based multimodality therapy demonstrated an improved survival compared with surgery alone, with no significant difference between surgery-based multimodality therapies; however, the largest estimated effect was when cancer-directed surgery, chemotherapy, and radiation therapy were combined (hazard ratio, 0.52). For patients with the epithelial subtype who underwent trimodality therapy, median survival was extended from 14.5 months to 23.4 months. Conclusion MPM is an aggressive and rapidly fatal disease. Surgery-based multimodality therapy was associated with

  4. Application of automated peritoneal dialysis in urgent-start peritoneal dialysis patients during the break-in period.

    Science.gov (United States)

    Liu, Shengmao; Zhuang, Xiaohua; Zhang, Min; Wu, Yanfeng; Liu, Min; Guan, Sibo; Liu, Shujun; Miao, Lining; Cui, Wenpeng

    2018-03-01

    Whether automated peritoneal dialysis (APD) is a feasible strategy for urgent-start peritoneal dialysis (PD) therapy during the break-in period remains unclear. This study was conducted to compare the efficacy as well as complications among three PD modes during the break-in period. Ninety-six patients treated with urgent-start PD after catheterization were retrospectively analyzed. Patients were divided into three groups, incremental continuous ambulatory PD (CAPD) group (n = 26); APD group (n = 42); and APD-CAPD group (n = 28). Clinical parameters at the end of the break-in period and 1 month after the initiation of PD treatment were collected and analyzed. Compared with the traditional incremental CAPD, APD and APD-CAPD were superior as they could effectively remove small-molecule uremic toxins and correct electrolyte imbalance (P break-in period (P > 0.05). However, APD led to a significant decline in albumin and pre-albumin, as compared with APD-CAPD and CAPD (P  0.05). Application of APD for urgent-start PD during the break-in period is feasible. A combination of APD and CAPD regimens seems to be a more reasonable mode.

  5. Aesthetic/Cosmetic surgery and ethical challenges.

    Science.gov (United States)

    Atiyeh, Bishara S; Rubeiz, Michel T; Hayek, Shady N

    2008-11-01

    Is aesthetic surgery a business guided by market structures aimed primarily at material gain and profit or a surgical intervention intended to benefit patients and an integral part of the health-care system? Is it a frivolous subspecialty or does it provide a real and much needed service to a wide range of patients? At present, cosmetic surgery is passing through an identity crisis as well as an acute ethical dilemma. A closer look from an ethical viewpoint makes clear that the doctor who offers aesthetic interventions faces many serious ethical problems which have to do with the identity of the surgeon as a healer. Aesthetic surgery that works only according to market categories runs the risk of losing the view for the real need of patients and will be nothing else than a part of a beauty industry which has the only aim to sell something, not to help people. Such an aesthetic surgery is losing sight of real values and makes profit from the ideology of a society that serves only vanity, youthfulness, and personal success. Unfortunately, some colleagues brag that they chose the plastic surgery specialty just to become rich aesthetic surgeons, using marketing tactics to promote their practice. This is, at present, the image we project. As rightly proposed, going back a little to Hippocrates, to the basics of being a physician, is urgently warranted! Being a physician is all that a "cosmetic" surgeon should be. In the long run, how one skillfully and ethically practices the art of plastic surgery will always speak louder than any words.

  6. Impact of cataract surgery in reducing visual impairment: a review.

    Science.gov (United States)

    Khandekar, Rajiv; Sudhan, Anand; Jain, B K; Deshpande, Madan; Dole, Kuldeep; Shah, Mahul; Shah, Shreya

    2015-01-01

    The aim was to assess the impact of cataract surgeries in reducing visual disabilities and factors influencing it at three institutes of India. A retrospective chart review was performed in 2013. Data of 4 years were collected on gender, age, residence, presenting a vision in each eye, eye that underwent surgery, type of surgery and the amount the patient paid out of pocket for surgery. Visual impairment was categorized as; absolute blindness (no perception of light); blind (visual impairment (SVI) (visual impairment (6/18-6/60) and; normal vision (≥6/12). Statistically analysis was performed to evaluate the association between visual disabilities and demographics or other possible barriers. The trend of visual impairment over time was also evaluated. We compared the data of 2011 to data available about cataract cases from institutions between 2002 and 2009. There were 108,238 cataract cases (50.6% were female) that underwent cataract surgery at the three institutions. In 2011, 71,615 (66.2%) cases underwent surgery. There were 45,336 (41.9%) with presenting vision visual disability. The goal of improving vision related quality of life for cataract patients during the early stages of visual impairment that is common in industrialized countries seems to be non-attainable in the rural India.

  7. Effects of a surgical ward care protocol following open colon surgery as part of an enhanced recovery after surgery programme.

    Science.gov (United States)

    Kim, BoYeoul; Park, SungHee; Park, KyuJoo; Ryoo, SeungBum

    2017-11-01

    To investigate the effects of a standardised care protocol as part of an enhanced recovery after surgery programme on the management of patients who underwent open colon surgery at the University Hospital, South Korea. Patients who undergo open colon surgery often have concerns about their care as they prepare for hospitalisation. By shortening hospital stay lengths, enhanced recovery after surgery programmes could reduce the number of opportunities for patient education and communication with nurses. Therefore, our surgical team developed an enhanced recovery after surgery programme, applied using a care protocol for patients with colorectal cancer, that spans the entire recovery process. A retrospective, comparative study was conducted using a care protocol as part of an enhanced recovery after surgery programme. Comparisons were made before and after the implementation of an enhanced recovery after surgery programme with a care protocol. Records of 219 patients who underwent open colon surgery were retrospectively audited. The records were grouped according to the care protocol used (enhanced recovery after surgery programme with a care protocol or traditional care programme). The outcomes, including postoperative bowel function recovery, postoperative pain control, recovery time and postoperative complications, were compared between two categories. Patients who were managed using the programme with a care protocol had shorter hospital stays, fewer complications, such as postoperative ileus wound infections, and emergency room visits than those who were managed using the traditional care programme. The findings can be used to facilitate the implementation of an enhanced recovery after surgery programme with a care protocol following open colon surgery. We present a care protocol that enables effective management using consistent and standardised education providing bedside care for patients who undergo open colon surgery. This care protocol empowers long

  8. Public private partnership in vascular surgery.

    Science.gov (United States)

    Mendes, Cynthia de Almeida; Martins, Alexandre de Arruda; Teivelis, Marcelo Passos; Kuzniec, Sérgio; Wolosker, Nelson

    2014-09-01

    To describe and analyze the results of a public-private partnership between the Ministry of Health and a private hospital in a project of assistance and scientific research in the field of endovascular surgery. The flows, costs and clinical outcomes of patients treated in a the public-private partnership between April 2012 and July 2013 were analyzed. All patients underwent surgery and stayed at least one day at the intensive care unit of the private hospital. They also participated in a research protocol to compare two intravenous contrast media used in endovascular surgery (iodinated contrast and carbon dioxide). A total of 62 endovascular procedures were performed in 57 patients from the public healthcare system. Hospital and endovascular supplies expenses were significantly higher as compared to the amount paid by the Unified Health System (SUS - Sistema Único de Saúde) in two out of three disease groups studied. Among outpatients, the average interval between appointment and surgery was 15 days and, in hospitalized patients 7 days. All procedures were successful with no conversion to open surgery. The new contrast medium studied - carbon dioxide - was effective and cheaper. The waiting time for patients between indication and accomplishment of surgery was significantly reduced. Public-private partnerships can speed up care of patients from public health services, and generate and improve scientific knowledge.

  9. Public private partnership in vascular surgery

    Science.gov (United States)

    Mendes, Cynthia de Almeida; Martins, Alexandre de Arruda; Teivelis, Marcelo Passos; Kuzniec, Sérgio; Wolosker, Nelson

    2014-01-01

    Objective To describe and analyze the results of a public-private partnership between the Ministry of Health and a private hospital in a project of assistance and scientific research in the field of endovascular surgery. Methods: The flows, costs and clinical outcomes of patients treated in a the public-private partnership between April 2012 and July 2013 were analyzed. All patients underwent surgery and stayed at least one day at the intensive care unit of the private hospital. They also participated in a research protocol to compare two intravenous contrast media used in endovascular surgery (iodinated contrast and carbon dioxide). Results A total of 62 endovascular procedures were performed in 57 patients from the public healthcare system. Hospital and endovascular supplies expenses were significantly higher as compared to the amount paid by the Unified Health System (SUS - Sistema Único de Saúde) in two out of three disease groups studied. Among outpatients, the average interval between appointment and surgery was 15 days and, in hospitalized patients 7 days. All procedures were successful with no conversion to open surgery. The new contrast medium studied - carbon dioxide – was effective and cheaper. Conclusion The waiting time for patients between indication and accomplishment of surgery was significantly reduced. Public-private partnerships can speed up care of patients from public health services, and generate and improve scientific knowledge. PMID:25295457

  10. Gastric cancer surgery in elderly patients.

    Science.gov (United States)

    Gretschel, Stephen; Estevez-Schwarz, Lope; Hünerbein, Michael; Schneider, Ulrike; Schlag, Peter M

    2006-08-01

    To investigate the value of individual risk-adapted therapy in geriatric patients, we performed a consecutive analysis of 363 patients undergoing potentially curative surgery for gastric cancer. All patients underwent extensive preoperative workup to assess surgical risk. The following criteria were evaluated in 3 age groups (75 years): comorbidity, tumor characteristics, type of resection, postoperative morbidity and mortality, recurrence rate, overall survival, and disease-free survival. There was an increased rate of comorbidity in the higher age groups (51% vs 76% vs 83%; PPatient selection and risk-adapted surgery in elderly patients can result in acceptable therapeutic results comparable to younger patients. Limited surgery in elderly gastric cancer patients with high comorbidity does not necessarily compromise oncological outcome.

  11. Recommended protocol for failed back surgery syndrome

    Directory of Open Access Journals (Sweden)

    Fakhr Tabatabaei SA

    1996-06-01

    Full Text Available Failed back surgery syndrome (FBSS is many a times an intractable problem confronted in patients with surgical disease of lumbar spine and at the same time is a pressing problem for the physicians as well. This clinical entity is defined as continuation of pain in the lumbar region and lower extremities following surgery of the lumbar spine. Knowledge of the etiological factors and their prevention is the best line of treatment to overcome the evolution of this syndrome. During this study, which was conducted in Imam Khomeini hospital Tehran from the year 1989 till 1990, 43 out of 114 patients developed "FBSS". 23 cases responded to conservative treatment and psychotherapy whereas medical treatment failed to achieve fruitful results in the rest. The latter underwent extensive radiological investigations and repeat surgery. According to this study, we recommend that in the initial management of these patients. The surgeon should observe the dictum of "5-mis" to overcome and minimize the "FBSS" entity

  12. THE RESULTS OF URGENT CORONARY ANGIOGRAPHY AND STENTING IN THE ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    Vasiliy Davydkin

    2016-07-01

    Full Text Available The acute coronary syndrome is a major cause of hospitalization and high mortality rates. For many there have been ongoing debates years over the treatment method choice and various diagnostic methods. The purpose of the research is to investigate the diagnostic capabilities of emergency coronary angiography and efficacy of transluminal balloon angioplasty with stenting for acute coronary syndrome with lifting and without ST elevation. Results In patients with ACS with ST-segment elevation myocardial contractility was better after thrombolytic therapy, which is appropriate over the first 2 hours of the onset of anginal pain. However, in the group of the patients with ACS with ST-segment elevation violations of local contractility was more common than in the group of patients with ACS without ST-segment elevation. In both groups of patients with ACS the risk of unfavorable outcome did not depend on the number of affected vessels, but on a variant of the syndrome (elevation or without ST elevation. In patients with ACS with ST-segment elevation was significantly more frequently identified hemodynamically significant stenosis of the arteries. In ACS without ST-segment elevation no statistically significant difference in myocardial contractility and risk of unfavorable outcome on the scale of GRACE in groups with single and biarterial coronary disease not obtained. In the case of significant stenoses diagnosed through emergency coronary angiography, emergency balloon angioplasty with stenting is indicated. When there is technical impossibility of angioplasty (excessive tortuosity, occlusion, stenosis of the left main coronary artery, etc., it is advisable to perform emergency bypass surgery. Discussion and Conclusions The analysis of the treatment results it revealed that timely percutaneous transluminal coronary angioplasty with stenting in combination with thrombolytic therapy has contributed significantly to improving not only contractility, but

  13. 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.

  14. Permanent hypoparathyroidism after completion total thyroidectomy as a second surgery: How do we avoid it?

    Science.gov (United States)

    Ito, Yasuhiro; Kihara, Minoru; Kobayashi, Kaoru; Miya, Akihiro; Miyauchi, Akira

    2014-01-01

    A permanent hypoparathyroidism is a problematic complication of total thyroidectomy. In this study, we investigated its incidence and how to avoid it at the time of completion total thyroidectomy after hemithyroidectomy. Eight of the 154 patients who underwent completion total thyroidectomy as the second surgery (5%) after hemithyroidectomy (two-surgery group) showed a permanent hypothyroidism. Patients without parathyroid autotransplantation either at initial or second surgery were more likely to show a permanent hypoparathyroidism. In the subset of 74 patients in two-surgery group, who underwent bilateral central dissection, 6 (8%) had a permanent hypoparathyroidism. The incidence was higher than those in control group who underwent total thyroidectomy with bilateral central dissection at one time, which was 2%. However, all 6 patients showing a permanent hypoparathyroidsm underwent bilateral central dissection in initial surgery and none of the patients who underwent bilateral central dissection in twice had a permanent hypoparathyroidism. Taken together, we can conclude that 1) in initial surgery of hemithyroidectomy, we have to carefully search the parathyroid glands and if dissected, they should retrieved and autotransplanted to save the patients from a permanent hypoparathyroidism when they undergo second surgery in future, and 2) hemithyroidectomy with bilateral central dissection significantly increases the risk of permanent hypoparathyroidism and only ipsilateral dissection is better when we do not perform total thyroidectomy.

  15. The Potentially Fatal Ogilvie's Syndrome in Lateral Transpsoas Access Surgery: A Multi-Institutional Experience with 2930 Patients.

    Science.gov (United States)

    Januszewski, Jacob; Keem, Sean K; Smith, William; Beckman, Joshua M; Kanter, Adam S; Oskuian, Rod J; Taylor, William; Uribe, Juan S

    2017-03-01

    Ogilvie's syndrome (OS) is a relatively uncommon pathology characterized by significant colonic dilation in the absence of mechanical obstruction. If unrecognized and untreated, cecal perforation resulting in a mortality rate of 25%-71% may occur. It is a potentially underdiagnosed condition in the lateral transpsoas approach population because of its uncommon nature and imitation of other well-known pathologies. Two thousand nine hundred and thirty patients from 6 separate institutions were retrospectively reviewed since 2007 and screened for OS. All patients underwent a minimum of single-level lateral transpsoas fusion. Diagnostic criteria included signs of a postoperative paralytic ileus combined with abdominal computed tomography showing a cecal diameter greater than 9 cm. Treatment modalities and outcomes were recorded. Eight cases (0.22%) of OS were diagnosed at 6 separate institutions. Most institutions recorded more than 350 lateral access procedures. Four cases were initially diagnosed as a routine postoperative ileus; however, they failed conservative therapy and underwent abdominal CT imaging. Neostigmine treatment was required for 1 patient in the intensive care unit setting, and 3 patients were managed conservatively without complications. Four other patients demonstrated bowel perforation at least 48 hours after surgery and required laparotomy with diversion ileostomy. Ogilvie's syndrome is a rare but potentially fatal complication that can mimic a postoperative ileus. It is likely underdiagnosed in the lateral transpsoas approach population because of its uncommon nature and a high index of suspicion should remain. Neostigmine can be administered safely under close observation with immediate and successful outcomes. Patients with perforation require urgent laparotomy and primary repair. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Less extensive surgery compared to extensive surgery

    DEFF Research Database (Denmark)

    Lauszus, Finn F; Petersen, Astrid Christine; Neumann, Gudrun

    2014-01-01

    in postmenopausal women was associated with surgery including hysterectomy and bilateral oophorectomy (pcarcinoma was found 138 times (95% CI: 48, 275) more prevalent than the expected rate. CONCLUSION......: The survival of women was better in AGCT than in epithelial ovarian tumor. Age and type of surgery, besides stage, influenced survival. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the recommended treatment with advancing age. At younger age less extensive surgery was associated...

  17. Secondary care intervals before and after the introduction of urgent referral guidelines for suspected cancer in Denmark: a comparative before-after study

    DEFF Research Database (Denmark)

    Larsen, M. B.; Hansen, R. P.; Hansen, D. G.

    2013-01-01

    the association between the secondary care interval and urgent referral remains scarce. The aim of this study was to analyse how the secondary care interval changed after the introduction of urgent referral. Methods: This was a retrospective population-based study of 6,518 incident cancer patients based...

  18. Chance of surgery in adult congenital heart disease.

    Science.gov (United States)

    Verheugt, Carianne L; Uiterwaal, Cuno Spm; Vaartjes, Ilonca; van der Velde, Enno T; Zomer, A C; Meijboom, Folkert J; Pieper, Petronella G; Post, Marco C; Vliegen, Hubert W; Hazekamp, Mark G; Grobbee, Diederick E; Mulder, Barbara Jm

    2017-08-01

    Background Young patients with congenital heart disease reaching adulthood face mandatory transition to adult cardiology. Their new cardiologist needs to assess the chances of major future events such as surgery. Using a large national registry, we assessed if patient characteristics at the age of 18 years could predict the chance of congenital heart surgery in adulthood. Design and methods Of 10,300 patients from the CONCOR national registry, we used general patient characteristics at age 18 years, underlying congenital heart defect, history of complications, and interventions in childhood as potential predictors of congenital heart surgery occurring from age 18 years up to age 40 and 60 years. Cox regression was used to calculate hazard ratios with 95% confidence intervals. Analyses were performed separately for all congenital heart surgery and for valvular surgery alone. Results Altogether 2427 patients underwent congenital heart surgery after age 18 years, 1389 of whom underwent valvular surgery. Underlying heart defect, male sex, multiple defects, childhood endocarditis, supraventricular arrhythmia, aortic complications and paediatric cardiovascular surgery, independently predicted adult congenital heart surgery. The mean chance of congenital heart surgery was 22% up to age 40 and 43% up to age 60 years; individual chances spanned from 9-68% up to age 40 and from 19-93% up to age 60 years. Conclusion At the time of transition from paediatric to adult cardiology, an easily obtainable set of characteristics of patients with congenital heart disease can meaningfully inform cardiologists about the patient's individual chance of surgery in adulthood. Our findings warrant validation in other cohorts.

  19. Factors contributing to migraine headache surgery failure and success.

    Science.gov (United States)

    Larson, Kelsey; Lee, Michelle; Davis, Janine; Guyuron, Bahman

    2011-11-01

    The purpose of this study was to identify factors that contribute to migraine headache surgery failure and success. A retrospective chart review was conducted of patients who underwent surgery for migraine headaches performed by the senior author (B.G.) and had at least 11 months of follow-up. The study population included three groups: migraine surgery success, improvement, and failure. Thirty-six unique data points were collected for each patient. A total of 169 patients met inclusion criteria. Of these, 66 patients comprised the migraine surgery success group (S, complete elimination of migraine headaches); 67 comprised the migraine surgery improvement group (I, >50 percent reduction in migraine frequency, intensity, or duration); and 36 comprised the migraine surgery failure group (F, I, p=0.02), migraine frequency (SI, p=0.003; S>F, p=0.04), history of head or neck injury (SI, p=0.02), increased intraoperative bleeding (SF, p=0.0006; I>F, p=0.0004), site II (S>F, p=0.015), single operative site (SI, p=0.05; S>F, p=0.04). Factors associated with migraine surgery failure include increased intraoperative bleeding and surgery on fewer trigger sites. Factors associated with migraine surgery success are older age of migraine onset, higher rate of visual symptoms versus improvement group, surgery at site I or II, and deactivating all four operative sites. Risk, III.

  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. 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

  2. [Surgery for Wolff-Parkinson-White syndrome. Cuban experience].

    Science.gov (United States)

    Carballido Pérez, J; Dorticos, F; Zayas, R; Dorantes, M; Sainz, H; Tain, J

    1990-01-01

    Surgery is a recent approach in the treatment of arrhythmias. The first successful surgery of this type was the interruption of the accessory pathway in a patient suffering from the Wolff Parkinson White syndrome. In 25 consecutive patients who underwent surgery, 28 accessory AV pathways were identified with classical endocardial and epicardial mapping. Only three patients experienced recurrence of preexcitation without symptoms; one patient had AV block; and another patient died. In all cases we successfully used either an endocardial or an epicardial approach. The purpose of this paper is to report the Cuban experience with this procedure.

  3. Antegrade versus retrograde cerebral perfusion in relation to postoperative complications following aortic arch surgery for acute aortic dissection type A.

    Science.gov (United States)

    Apostolakis, Efstratios; Koletsis, Efstratios N; Dedeilias, Panagiotis; Kokotsakis, John N; Sakellaropoulos, George; Psevdi, Argini; Bolos, Konstantin; Dougenis, Dimitrios

    2008-01-01

    Aortic arch surgery is impossible without the temporary interruption of brain perfusion and therefore is associated with high incidence of neurologic injury. The deep hypothermic circulatory arrest (HCA), in combination with antegrade or retrograde cerebral perfusion (RCP), is a well-established method of brain protection in aortic arch surgery. In this retrospective study, we compare the two methods of brain perfusion. From 1998 to 2006, 48 consecutive patients were urgently operated for acute type A aortic dissection and underwent arch replacement under deep hypothermic circulatory arrest (DHCA). All distal anastomoses were performed with open aorta, and the arch was replaced totally in 15 cases and partially in the remaining 33 cases. Our patient cohort is divided into those protected with antegrade cerebral perfusion (ACP) (group A, n = 23) and those protected with RCP (group B, n = 25). No significant difference was found between groups A and B with respect to cardiopulmonary bypass-time, brain-ischemia time, cerebral-perfusion time, permanent neurologic dysfunction, and mortality. The incidence of temporary neurologic dysfunction was 16.0% for group A and 43.50% for group B (p = 0.04). The mean extubation time was 3.39 +/- 1.40 days for group A and 4.96 +/- 1.83 days for group B (p = 0.0018). The mean ICU-stay was 4.4 +/- 2.3 days for group A and 6.9 +/- 2.84 days for group B (p = 0.0017). The hospital-stay was 14.38 +/- 4.06 days for group A and 19.65 +/- 6.91 days for group B (p = 0.0026). The antegrade perfusion seems to be related with significantly lower incidence of temporary neurological complications, earlier extubation, shorter ICU-stay, and hospitalization, and hence lower total cost.

  4. The efficacy of a smoking cessation programme in patients undergoing elective surgery - a randomised clinical trial

    DEFF Research Database (Denmark)

    Azodi, O. Sadr; Lindstrom, D.; Adami, J.

    2009-01-01

    orthopaedic and general surgery, to smoking cessation intervention and control group. The intervention group underwent a programme initiated, on average, 4 weeks prior to surgery with weekly meetings or telephone counselling and were provided with free nicotine replacement therapy (NRT). The control group...

  5. Parental education predicts change in intelligence quotient after childhood epilepsy surgery

    NARCIS (Netherlands)

    Meekes, J.; Schooneveld, M.M.J. van; Braams, O.B.; Jennekens, A.; Rijen, P.C. van; Hendriks, M.P.H.; Braun, K.P.J.; Nieuwenhuizen, O. van

    2015-01-01

    Objective: To know whether change in the intelligence quotient (IQ) of children who undergo epilepsy surgery is associated with the educational level of their parents. Methods: Retrospective analysis of data obtained from a cohort of children who underwent epilepsy surgery between January 1996 and

  6. 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

  7. 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

  8. Preoperative Lifestyle Intervention in Bariatric Surgery: A Randomized Clinical Trial

    Science.gov (United States)

    Kalarchian, Melissa A.; Marcus, Marsha D.; Courcoulas, Anita P.; Cheng, Yu; Levine, Michele D.

    2015-01-01

    Background Studies of the impact of pre-surgery weight loss and lifestyle preparation on outcomes following bariatric surgery are needed. Objective To evaluate whether a pre-surgery behavioral lifestyle intervention improves weight loss through 24-months post-surgery. Setting Bariatric Center of Excellence at a large, urban medical center. Methods Candidates for bariatric surgery were randomized to a 6-month behavioral lifestyle intervention or to 6 months of usual pre-surgical care. The lifestyle intervention consisted of 8 weekly face-to-face sessions followed by 16 weeks of face-to-face and telephone sessions prior to surgery; the intervention also included 3 monthly telephone contacts after surgery. Assessments were conducted at 6-, 12- and 24-months post-surgery. Results Participants who underwent surgery (n = 143) were 90.2% female and 86.7% White. Average age was 44.9 years, and average BMI was 47.5 kg/m2 at study enrollment. At follow-up, 131 (91.6%), 126 (88.1%), 117 (81.8%) patients participated in the 6-, 12- and 24 month assessments, respectively. Percent weight loss from study enrollment to 6- and 12-months post-surgery was comparable for both groups, but at 24-months post-surgery, the lifestyle group had significantly smaller percent weight loss than the usual care group (26.5% vs. 29.5%, respectively, p = 0.02). Conclusions Pre-surgery lifestyle intervention did not improve weight loss at 24 months post-surgery. Findings raise questions about the utility and timing of adjunctive lifestyle interventions for bariatric surgery patients. PMID:26410538

  9. Uji Ketahanan Beberapa Varietas Dan Pengaruh Jarak Tanam Terhadap Penyakit Karat Daun (Puccinia Polysora Underw) Pada Tanaman Jagung (Zea Mays L.)

    OpenAIRE

    Aditya, Sukma

    2013-01-01

    Sukma Aditya, "Some Resistance Test Plant Varieties and Influence Distance Against Disease Leaf Rust (Puccinia polysora Underw) In the Corn Plantation (Zea mays l.) In the Lowlands". Supervised by Dr. Ir. Hasanuddin, MS, and Ir. Mukhtar Pinem Iskandar, M. Agr. This study aims to determine the resistance of some varieties of maize (Zea mays L.) and plant spacing influence on leaf rust disease (Puccinia polysora Underw.) In the lowlands. Research conducted in the village of Tanjung Selamat, Med...

  10. Pulmonary embolism in spine surgery: a comparison of combined anterior/posterior approach versus posterior approach surgery.

    Science.gov (United States)

    Kim, Han Jo; Kepler, Christopher; Cunningham, Matthew; Rawlins, Bernard; Boachie-Adjei, Oheneba

    2011-01-15

    retrospective review. to determine if Anterior/Posterior Combined approach spine surgery is associated with an increased risk of pulmonary embolism (PE) compared to Posterior Only approach surgery. combined anterior/posterior approach spine surgery is associated with a significantly increased risk for PE. However, it is uncertain if there is any difference in risk between combined approaches versus a posterior-only approach. a prospective cohort of patients who underwent anterior/posterior combined approach spine surgery from January 2002 to January 2006 was compared to a retrospective cohort of consecutive patients who underwent posterior only approach spine surgery from September2007 to September 2008. Patient demographics, medical history, body-mass indexes, type of surgery, length of surgery, transfusions, and instrumented vertebral levels were collected from hospital and office records. Hospital records were used to identify patients who developed PE based on diagnosis by spiral CT scan. CT scans were only performed when a patient's clinical picture raised suspicion of PE. Fisher exact test for significance, χ test and odds ratios were used for analysis. a total of 119 patients were included in the study: 63 patients underwent posterior approach spine surgery and 66 patients underwent combined anterior/posterior approach surgery. One patient (1.6%) developed PE after posterior approach surgery while 5 patients (7.5%) developed PE in the combined approach group. Those undergoing combined approaches were 5.08 times more likely to suffer from PE, but this increase was not significant (P = 0.208). Overall, increased risk for PE was associated with the number of levels fused (P = 0.006), total blood loss (P = 0.029), and number of units transfused (P = 0.030). The combined approach was associated with older age (P spine surgery is associated with an increased risk for pulmonary embolism compared to posterior only approaches. However, regardless of the surgical

  11. Histopathological findings in brain tissue obtained during epilepsy surgery

    NARCIS (Netherlands)

    Blü mcke, I.; Spreafico, R.; Haaker, G.; Coras, R.; Kobow, K.; Bien, C.G.; Pfä fflin, M.; Elger, C.; Widman, G.; Schramm, J.; Becker, A.; Braun, K.P.J.; Leijten, F.S.S.; Baayen, J.C.; Aronica, E.; Chassoux, F.; Hamer, H.; Stefan, H.; Rö ssler, K.; Thom, M.; Walker, M.C.; Sisodiya, S.M.; Duncan, J.S.; McEvoy, A.W.; Pieper, T.; Holthausen, H.; Kudernatsch, M.; Meencke, H.J.; Kahane, P.; Schulze-Bonhage, A.; Zentner, J.; Heiland, D.; Urbach, H.; Steinhoff, B.J.; Bast, T.; Tassi, L.; Lo Russo, G.; Ozkara, C.; Oz, B.; Krsek, P.; Vogelgesang, S.; Runge, U.; Lerche, H.; Weber, Y.; Honavar, M.; Pimentel, J.; Arzimanoglou, A.; Ulate-Campos, A.; Noachtar, S.; Hartl, E.; Schijns, O.E.M.G.; Guerrini, R.; Barba, C.; Jacques, T.S.; Cross, J.H.; Feucht, M.; Mü hlebner, A.; Grunwald, T.; Trinka, E.; Winkler, P.A.; Gil-Nagel, A.; Toledano Delgado, R.; Mayer, T.; Lutz, M.; Zountsas, B.; Garganis, K.; Rosenow, F.; Hermsen, A.; Ö rtzen, T.J. von; Diepgen, T.L.; Avanzini, G.; Aparicio, J.; Bento, C.; Beckervordersandforth, J.; Buccoliero, A.M.; Cabral, P.; Chamadoira, C.; Colon, A.; Chabardè s, S.; Carpenter, S.; Czech, T.; Dressler, A.; Deleo, F.; Dí lio, A.; Dings, J.; Devaux, B.; De Tisi, J.; De Bellescize, J.; Ebner, A.; Franke, K.; Groeppel, G.; Giordano, F.; Gozzo, F.; Garbelli, R.; Guenot, M.; Garcí a‐ Morales, I.; Gó mez‐ Angulo, J.C.; Garcia, G.; Hainfellner, J.A.; Hö fler, J.; Hoogland, G.; Hendriks, M.P.H.; Hofman, P.; Harding, B.; Huppertz, H.J.; Herms, J.; Hilkman, D.M.W.; Hamelin, S.; Idema, S.; Jansen, F.E.; Jahodova, A.; Keeley, A.; Kalss, G.; Kudr, M.; Kroell, J.; Kokkinos, V.; Keo Kosal, P.; Kalbhenn, T.; Leitinger, M.; Landré , E.; Melo Pires, M.; Matas, A.; Mann, M.W.; Ostrowsky‐ Coste, K.; Prinz, M.; Puttinger, G.; Peraud, A.; Rangel Pinho, R.; Romero, C.; Rego, R.; Rouhl, R.; Ryvlin, P.; Rumia, J.; Rampp, S.; Scholl, T.; Schulz, R.; Stone, T.J.; Streichenberger, N.; Tisdall, M.; Turak, B.; Taipa, R.; Uzan, M.; Kranen‐ Mastenbroek, V. van; Varlet, P.; Vlooswijk, M.C.G.; Wagner, L.; Weis, S.

    2017-01-01

    Background: Detailed neuropathological information on the structural brain lesions underlying seizures is valuable for understanding drug-resistant focal epilepsy. Methods: We report the diagnoses made on the basis of resected brain specimens from 9523 patients who underwent epilepsy surgery for

  12. Amputation Surgery in a Secondary Healthcare Facility in Nigeria ...

    African Journals Online (AJOL)

    ... our experience in amputation surgery over a ten – year period in a secondary healthcare facility in sub- Saharan Africa. A retrospective study of 117 patients that underwent amputation in the facility between January 1998 and December 2007. Trauma remains the commonest indication for amputation in our environment.

  13. Near-infrared spectroscopy during peripheral vascular surgery

    DEFF Research Database (Denmark)

    Eiberg, J P; Schroeder, T V; Vogt, K C

    1997-01-01

    Near-infrared spectroscopy was performed perioperatively on the dorsum of the foot in 14 patients who underwent infrainguinal bypass surgery using a prosthesis or the greater saphenous vein. Dual-wavelength continuous light spectroscopy was used to assess changes in tissue saturation before, during...... that near-infrared spectroscopy is appropriate for perioperative monitoring during vascular grafting....

  14. Histopathological findings in brain tissue obtained during epilepsy surgery

    NARCIS (Netherlands)

    Blumcke, I.; Spreafico, R.; Haaker, G.; Coras, Roland; Kobow, K.; Bien, Christian G.; Pfäfflin, M.; Elger, C.E.; Widman, G.; Schramm, J.; Becker, A.; Braun, K. P.; Leijten, F.; Baayen, Johannes C; Aronica, E.; Chassoux, F.; Hamer, H.M.; Stefan, H.; Rössler, K.; Thom, M.; Walker, M. C.; Sisodiya, Sanjay M.; Duncan, J.S.; McEvoy, A. W.; Pieper, T.; Holthausen, Hans; Kudernatsch, M.; Meencke, H. J.; Kahane, P.; Schulze-Bonhage, A.; Zentner, J.; Heiland, D. H.; Urbach, H.; Steinhoff, Bernhard J; Bast, Thomas; Tassi, L.; Russo, Maria Giovanna; Özkara, Cigdem; Oz, B.; Krsek, Pavel; Vogelgesang, S.; Runge, U.; Lerche, H.; Weber, Y.G.; Honavar, M.; Pimentel, J.; Arzimanoglou, A.; Ulate-Campos, A.; Noachtar, S.; Hartl, E.; Schijns, Olaf E M G; Guerrini, R.; Barba, C.; Jacques, T.S.; Cross, J. Helen; Feucht, Martha; Mühlebner, Angelika; Grunwald, T.; Trinka, Eugen; Winkler, P. A.; Gil-Nagel, Antonio; Toledano Delgado, R.; Mayer, T. E.; Lutz, M.B.; Zountsas, B.; Garganis, K.; Rosenow, F.; Hermsen, Mario A J A; Von Oertzen, T. J.; Diepgen, T. L.; Avanzini, G.

    2017-01-01

    BACKGROUND: Detailed neuropathological information on the structural brain lesions underlying seizures is valuable for understanding drug-resistant focal epilepsy. METHODS: We report the diagnoses made on the basis of resected brain specimens from 9523 patients who underwent epilepsy surgery for

  15. Histopathological Findings in Brain Tissue Obtained during Epilepsy Surgery

    NARCIS (Netherlands)

    Blumcke, Ingmar; Spreafico, Roberto; Haaker, Gerrit; Coras, Roland; Kobow, Katja; Bien, Christian G.; Pfäfflin, Margarete; Elger, Christian; Widman, Guido; Schramm, Johannes; Becker, Albert; Braun, Kees P.; Leijten, Frans; Baayen, Johannes C.; Aronica, Eleonora; Chassoux, Francine; Hamer, Hajo; Stefan, Hermann; Rössler, Karl; Thom, Maria; Walker, Matthew C.; Sisodiya, Sanjay M.; Duncan, John S.; McEvoy, Andrew W.; Pieper, Tom; Holthausen, Hans; Kudernatsch, Manfred; Meencke, H. Joachim; Kahane, Philippe; Schulze-Bonhage, Andreas; Zentner, Josef; Heiland, Dieter H.; Urbach, Horst; Steinhoff, Bernhard J.; Bast, Thomas; Tassi, Laura; Lo Russo, Giorgio; Özkara, Cigdem; Oz, Buge; Krsek, Pavel; Vogelgesang, Silke; Runge, Uwe; Lerche, Holger; Weber, Yvonne; Honavar, Mrinalini; Pimentel, José; Arzimanoglou, Alexis; Ulate-Campos, Adriana; Noachtar, Soheyl; Hartl, Elisabeth; Schijns, Olaf; Guerrini, Renzo; Barba, Carmen; Jacques, Thomas S.; Cross, J. Helen; Feucht, Martha; Mühlebner, Angelika; Grunwald, Thomas; Trinka, Eugen; Winkler, Peter A.; Gil-Nagel, Antonio; Toledano Delgado, Rafael; Mayer, Thomas; Lutz, Martin; Zountsas, Basilios; Garganis, Kyriakos; Rosenow, Felix; Hermsen, Anke; von Oertzen, Tim J.; Diepgen, Thomas L.; Avanzini, Giuliano; Aparicio, Javier; Bento, Conceição; Beckervordersandforth, Jan; Buccoliero, Annamaria; Cabral, Pedro; Chamadoira, Clara; Colon, Albert; Chabardès, Stéphan; Carpenter, Stirling; Czech, Thomas; Dressler, Anastasia; Deleo, Francesco; Dílio, Alves; Dings, Jim; Devaux, Bertrand; de Tisi, Jane; de Bellescize, Julitta; Ebner, Alois; Franke, Kerstin; Groeppel, Gudrun; Giordano, Flavio; Gozzo, Francesca; Garbelli, Rita; Guenot, Marc; García‐Morales, Irene; Gómez‐Angulo, Juan Carlos; Garcia, Gemma; Hainfellner, Johannes A.; Höfler, Julia; Hoogland, Govert; Hendriks, Marc; Hofman, Paul; Harding, Brian; Huppertz, Hans‐Jürgen; Herms, Jochen; Hilkman, Danny M. W.; Hamelin, Sophie; Idema, Sander; Jansen, Floor E.; Jahodova, Alena; Keeley, Angus; Kalss, Gudrun; Kudr, Martin; Kroell, Judith; Kokkinos, Vasileios; Keo Kosal, Pascale; Kalbhenn, Thilo; Leitinger, Markus; Landré, Elisabeth; Melo Pires, Manuel; Matas, Andreia; Mann, Michael W.; Ostrowsky‐Coste, Karine; Prinz, Marco; Puttinger, Gertraud; Peraud, Aurelia; Rangel Pinho, Rui; Romero, Clara; Rego, Ricardo; Rouhl, Rob; Ryvlin, Philippe; Rumia, Jordi; Rampp, Stefan; Scholl, Theresa; Schulz, Reinhard; Stone, Thomas J.; Streichenberger, Nathalie; Tisdall, Martin; Turak, Baris; Taipa, Ricardo; Uzan, Mustafa; van Kranen‐Mastenbroek, Vivianne; Varlet, Pascale; Vlooswijk, Marielle; Wagner, Louis; Weis, Serge

    2017-01-01

    Detailed neuropathological information on the structural brain lesions underlying seizures is valuable for understanding drug-resistant focal epilepsy. We report the diagnoses made on the basis of resected brain specimens from 9523 patients who underwent epilepsy surgery for drug-resistant seizures

  16. Combined Cataract and Glaucoma Surgery: An assessment of 68 ...

    African Journals Online (AJOL)

    Methods: A retrospective review of the case notes of patients who underwent combined glaucoma and cataract surgery with lens implantation in a private eye centre, The Eye Foundation Hospital, was carried out, using the following parameters: age, pre-operative intraocular pressure (IOP), post-operative intraocular ...

  17. Effect of Pregnancy on Adverse Outcomes After General Surgery.

    Science.gov (United States)

    Moore, Hunter B; Juarez-Colunga, Elizabeth; Bronsert, Michael; Hammermeister, Karl E; Henderson, William G; Moore, Ernest E; Meguid, Robert A

    2015-07-01

    The literature regarding the occurrence of adverse outcomes following nonobstetric surgery in pregnant compared with nonpregnant women has conflicting findings. Those differing conclusions may be the result of inadequate adjustment for differences between pregnant and nonpregnant women. It remains unclear whether pregnancy is a risk factor for postoperative morbidity and mortality of the woman after general surgery. To compare the risk of postoperative complications in pregnant vs nonpregnant women undergoing similar general surgical procedures. In this retrospective cohort study, data were obtained from the American College of Surgeons' National Surgical Quality Improvement Program participant user file from January 1, 2006, to December 31, 2011. Propensity-matched females based on 63 preoperative characteristics were matched 1:1 with nonpregnant women undergoing the same operations by general surgeons. Operations performed between January 1, 2006, and December 31, 2011, were analyzed for postoperative adverse events occurring within 30 days of surgery. Rates of 30-day postoperative mortality, overall morbidity, and 21 individual postoperative complications were compared. The unmatched cohorts included 2764 pregnant women (50.5% underwent emergency surgery) and 516,705 nonpregnant women (13.2% underwent emergency surgery) undergoing general surgery. After propensity matching, there were no meaningful differences in all 63 preoperative characteristics between 2539 pregnant and 2539 nonpregnant patients (all standardized differences, general surgical operations. General surgery appears to be as safe for pregnant women as it is for nonpregnant women.

  18. Is Bariatric Surgery a Prophylaxis for Pelvic Floor Disorders?

    Science.gov (United States)

    Pomian, Andrzej; Majkusiak, Wojciech; Lisik, Wojciech; Tomasik, Paweł; Horosz, Edyta; Zwierzchowska, Aneta; Kociszewski, Jacek; Barcz, Ewa

    2017-12-18

    Obesity is one of the well-documented risk factors of pelvic floor disorders (PFDs). The PFDs include urinary and fecal incontinence (UI, FI) and pelvic organ prolapse (POP). Surgery-induced weight loss improves different kinds of incontinence as well as POP symptoms. However, there is a lack of evidence how bariatric surgery influences pelvic floor anatomy and function in women without previous PFDs and whether it may be concerned as PFD prophylaxis tool. The present analysis is a prospective, non-randomized case-control study from January 2014 to September 2017. Participants underwent pelvic floor ultrasound examination with bladder neck position estimation at rest, during levator ani tension, and at Valsalva maneuver before surgery and 12-18 months after. Pelvic organ prolapse quantification (POPQ) > 2 stage and PFD complaints were the exclusion criteria. Fifty-nine patients underwent bariatric surgery (57 sleeve gastrectomy and 2 gastric bypass). Mean BMI decreased from 43.8 ± 5.9 to 29 ± 4.6 kg/m 2 after surgery (p elevation at tension after weight loss. Bariatric surgery is associated with a betterment of bladder neck position at rest, tension, and Valsalva maneuver in women without PFDs. We postulate that bariatric surgery may be a tool for PFD prevention. It does not improve levator ani function and does not limit bladder neck mobility, which implicates that it has no influence on preexisting pelvic dysfunction.

  19. Force modeling for incision surgery into tissue with haptic application

    Science.gov (United States)

    Kim, Pyunghwa; Kim, Soomin; Choi, Seung-Hyun; Oh, Jong-Seok; Choi, Seung-Bok

    2015-04-01

    This paper presents a novel force modeling for an incision surgery into tissue and its haptic application for a surgeon. During the robot-assisted incision surgery, it is highly urgent to develop the haptic system for realizing sense of touch in the surgical area because surgeons cannot sense sensations. To achieve this goal, the force modeling related to reaction force of biological tissue is proposed in the perspective on energy. The force model describes reaction force focused on the elastic feature of tissue during the incision surgery. Furthermore, the force is realized using calculated information from the model by haptic device using magnetorheological fluid (MRF). The performance of realized force that is controlled by PID controller with open loop control is evaluated.

  20. Surgery for Stress Urinary Incontinence

    Science.gov (United States)

    ... Surgery for Stress Urinary Incontinence Page Navigation ▼ ACOG Pregnancy Book Surgery for Stress Urinary Incontinence Patient Education FAQs Surgery for Stress Urinary Incontinence Patient Education ...

  1. A prospective study to assess the value of MMP-9 in improving the appropriateness of urgent referrals for colorectal cancer

    Directory of Open Access Journals (Sweden)

    Hobbs Richard FD

    2006-10-01

    Full Text Available Abstract Background Bowel cancer is common and is a major cause of death. Most people with bowel symptoms who meet the criteria for urgent referral to secondary care will not be found to have bowel cancer, and some people who are found to have cancer will have been referred routinely rather than urgently. If general practitioners could better identify people who were likely to have bowel cancer or conditions that may lead to bowel cancer, the pressure on hospital clinics may be reduced, enabling these patients to be seen more quickly. Increased levels of an enzyme called matrix metalloproteinase 9 (MMP-9 have been found to be associated with such conditions, and this can be measured from a blood sample. This study aims to find out whether measuring MMP-9 levels could improve the appropriateness of urgent referrals for patients with bowel symptoms. Methods People aged 18 years or older referred to a colorectal clinic will be asked to complete a questionnaire about symptoms, recent injuries or chronic illnesses (these can increase the level of matrix metalloproteinases and family history of bowel cancer. A blood sample will be taken from people who consent to take part to assess MMP-9 levels, and the results of examination at the clinic and/or investigations arising from the clinic visit will be collected from hospital records. The accuracy of MMP-9 will be assessed by comparing the MMP-9 level with the resulting diagnosis. The combination of factors (e.g. symptoms and MMP-9 level that best predict a diagnosis of malignancy (invasive disease or polyps will be determined. Discussion Although guidelines are in place to facilitate referrals to colorectal clinics, symptoms alone do not adequately distinguish people with malignancy from people with benign conditions. This study will establish whether MMP-9 could assist this process. If this were the case, measurement of MMP-9 levels could be used by general practitioners to assist in the identification

  2. A heuristic approach to nurse scheduling in hospital units with non-stationary, urgent demand, and a fixed staff size.

    Science.gov (United States)

    Isken, M W; Hancock, W M

    1991-01-01

    We present a practical approach to personnel scheduling problems arising in hospital units with demand that is of an urgent nature, cannot be backlogged, and is highly dependent on the time of day. A simple rounding heuristic is combined with a simulated annealing algorithm to obtain near-optimal solutions to large linear integer programming models of these personnel scheduling problems in a reasonable amount of time on a personal computer. The models are designed to complement the current state-of-the-art of commercially available hospital staff scheduling systems.

  3. [Thymus surgery in a general surgery department].

    Science.gov (United States)

    Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

    2005-01-01

    Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

  4. [Nutritional deficiencies after bariatric surgery: why they happen?].

    Science.gov (United States)

    Bordalo, Lívia A; Mourão, Denise Machado; Bressan, Josefina

    2011-12-01

    Nutritional deficiencies following bariatric surgery are commonly reported in scientific literature on surgery and nutrition. It has been estimated that approximately 400,000 large obeses underwent bariatric surgery in 2010. The surgery technique and consequent altered gastrointestinal function done will particularly imply in variations on those deficiencies and health complications. A systematic review of several database was done from 1978 until 2010, using as keywords protein and micronutrients deficiencies, related to bariatric surgery. The better understand of these studies can provide an important improvement on this obese therapy, assuring a successful and health weight loss maintenance for long term. Therefore, this review provides a significant contribution about this topic, pointing several ways on the nutritional intervention and management of those patients.

  5. Fetal monitoring during nonobstetric surgery: revisiting guidelines: a case report.

    Science.gov (United States)

    Rothschild, Tod J; Morel, Bruce; Pace, Benjamin; Fuks, Aleksandr M

    2015-01-01

    Nonobstetric surgery during pregnancy is not an infrequent occurrence. Guidelines for fetal monitoring during nonobstetric surgery are limited. We describe a case of appendectomy during third trimester, complicated by in utero fetal demise (IUFD). A 30-year-old, Caucasian woman underwent open appendectomy for suspected acute appendicitis. The procedure was complicated by IUFD. Fetal monitoring was done prior to but not during surgery. Guidelines for fetal monitoring were revised, recommending continuous electronic fetal monitoring when possible during third trimester nonobstetric surgery after appropriate patient counseling. A subsequent series of 5 uncomplicated appendectomies demonstrated no difficulty in implementing these guidelines. Continuous electronic fetal monitoring during third trimester nonobstetric surgery should be available and implemented after appropriate patient counseling. This approach reduces the risk of fetal mortality.

  6. Lumbar Spine Surgery in Patients with Parkinson Disease.

    Science.gov (United States)

    Schroeder, Joshua E; Hughes, Alexander; Sama, Andrew; Weinstein, Joseph; Kaplan, Leon; Cammisa, Frank P; Girardi, Federico P

    2015-10-21

    Parkinson disease is the second most common neurodegenerative condition. The literature on patients with Parkinson disease and spine surgery is limited, but increased complications have been reported. All patients with Parkinson disease undergoing lumbar spine surgery between 2002 and 2012 were identified. Patients' charts, radiographs, and outcome questionnaires were reviewed. Parkinson disease severity was assessed with use of the modified Hoehn and Yahr staging scale. Complications and subsequent surgeries were analyzed. Risk for reoperation was assessed. Ninety-six patients underwent lumbar spine surgery. The mean patient age was 63.0 years. The mean follow-up duration was 30.1 months. The Parkinson disease severity stage was Parkinson disease severity stage of ≥3 (p Parkinson disease is good, with improvement of spine-related pain. A larger prospective study is warranted. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  7. Weight Loss Surgery

    Science.gov (United States)

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you ... caused by obesity. There are different types of weight loss surgery. They often limit the amount of food ...

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... administer local anesthesia, all forms of sedation and general anesthesia. Click here to find out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft ...

  9. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Extractions and ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  10. Preparing for Surgery

    Science.gov (United States)

    ... FAQs Preparing for Surgery Page Navigation ▼ ACOG Pregnancy Book Preparing for Surgery Patient Education FAQs Preparing for ... the person who is in charge of giving anesthesia and checking its effects. What can I do ...

  11. Laparoscopic Spine Surgery

    Science.gov (United States)

    ... Global Affairs and Humanitarian Efforts Log In Laparoscopic Spine Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Laparoscopic Spine Surgery Your spine surgeon has determined that you ...

  12. Heart valve surgery

    Science.gov (United States)

    ... techniques are used: Percutaneous surgery (through the skin) Robot-assisted surgery If your surgeon can repair your ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  13. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... by a trained surgeon with specialized education and training. Click here to find out more. Extractions and ... Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, bone and ...

  14. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ...

  15. Cosmetic ear surgery

    Science.gov (United States)

    Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... Cosmetic ear surgery may be done in the surgeon's office, an outpatient clinic, or a hospital. It can be performed under ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Jaw Surgery Download Download the ebook for further information Corrective jaw, or orthognathic surgery is performed by ... your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided here is not intended as a substitute ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Lip/Palate and Craniofacial Surgery A cleft lip may require one or more surgeries depending on the ... are not uncommon. Individuals with a TMJ disorder may experience a variety of symptoms, such as earaches, ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Facial Injury / Trauma Surgery Facial trauma injuries include fractures of the upper and lower jaws and the ... Facial Injury / Trauma Surgery Facial trauma injuries include fractures of the upper and lower jaws and the ...

  20. Abdominal wall surgery

    Science.gov (United States)

    Cosmetic surgery of the abdomen; Tummy tuck; Abdominoplasty ... Most of the time, this surgery is an elective or cosmetic procedure because it is an operation you choose to have. It is not usually needed for health reasons. Cosmetic abdomen repair ...