Science.gov

Sample records for surgical oncology patients

  1. Current Management of Surgical Oncologic Emergencies

    PubMed Central

    Bosscher, Marianne R. F.; van Leeuwen, Barbara L.; Hoekstra, Harald J.

    2015-01-01

    Objectives For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. Method A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. Results In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. Conclusion In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy. PMID:25933135

  2. Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients

    PubMed Central

    Al-Niaimi, Ahmed N.; Ahmed, Mostafa; Burish, Nikki; Chackmakchy, Saygin A.; Seo, Songwon; Rose, Stephen; Hartenbach, Ellen; Kushner, David M.; Safdar, Nasia; Rice, Laurel; Connor, Joseph

    2015-01-01

    Objective SSI rates after gynecologic oncology surgery vary from 5% to 35%, but are up to 45% in patients with diabetes mellitus (DM). Strict postoperative glucose control by insulin infusion has been shown to lower morbidity, but not specifically SSI rates. Our project studied continuous postoperative insulin infusion for 24 h for gynecologic oncology patients with DM and hyperglycemia with a target blood glucose of <139 mL/dL and a primary outcome of the protocol's impact on SSI rates. Methods We compared SSI rates retrospectively among three groups. Group 1 was composed of patients with DM whose blood glucose was controlled with intermittent subcutaneous insulin injections. Group 2 was composed of patients with DM and postoperative hyperglycemia whose blood glucose was controlled by insulin infusion. Group 3 was composed of patients with neither DM nor hyperglycemia. We controlled for all relevant factors associated with SSI. Results We studied a total of 372 patients. Patients in Group 2 had an SSI rate of 26/135 (19%), similar to patients in Group 3 whose rate was 19/89 (21%). Both were significantly lower than the SSI rate (43/148, 29%) of patients in Group 1. This reduction of 35% is significant (p = 0.02). Multivariate analysis showed an odd ratio = 0.5 (0.28–0.91) in reducing SSI rates after instituting this protocol. Conclusions Initiating intensive glycemic control for 24 h after gynecologic oncology surgery in patients with DM and postoperative hyperglycemia lowers the SSI rate by 35% (OR = 0.5) compared to patients receiving intermittent sliding scale insulin and to a rate equivalent to non-diabetics. PMID:25263249

  3. The Prevalence of HIV in Cancer Patients at the Surgical Oncology Unit of Donka University Hospital of Conakry (Guinea)

    PubMed Central

    Traore, Bangaly; Bah, Thierno Souleymane; Traore, Fode Amara; Sow, Mamadou Saliou; Diane, Solomana; Keita, Mamady; Cisse, Mohamed; Koulibaly, Moussa; Camara, Naby Daouda

    2015-01-01

    Aim. To determine the prevalence of HIV infection among patients seen at the surgical oncology unit of Donka (Conakry, Guinea). Method. We conducted a retrospective and descriptive study of HIV infection in cancer patients from May 2007 to December 2012. Social characteristics (age, gender, marital status, and education) and immune status (HIV type, CD4 count) were reviewed. Results. Out of 2598 cancer patients, 54 (2.1%) tested positive for HIV. There were 11 (20.4%) defining AIDS and 43 (79.6%) nondefining AIDS cancers. The most frequent cancers were breast (14) (26.0%), non-Hodgkin lymphoma (6) (11.1%), liver (6) (11.1%), eye and annexes (6) (11.1%), and cervical cancer (5) (9.3%). These patients were female in 34 (63.0%) and had a median age of 39 years and body mass index was 20,3?Kg/m2. They were unschooled in 40 (74.1%) and married in 35 (64.8%). CD4 count showed a median of 317?cells/mL. Antiretroviral treatment was performed in 40 (74.1%). Conclusion. HIV prevalence is higher in patients in our unit of surgical oncology. Breast cancer was the most common in this association. A national survey of a large sample is needed to determine the true prevalence and impact of HIV on cancer prognosis. PMID:26770197

  4. [The evolution of surgical and functional operability in thoracic oncology].

    PubMed

    Parshin, V D; Belov, Iu V; Komarov, R N; Bazarov, D V; Parshin, V V; Babaev, M A; Podaliak, D G

    2012-01-01

    The authors own the experience of 4157 operations on the reason of malignant lung tumors, of them 429 (10.3%) operations were combined. The extracorporeal membrane oxygenation is considered to be reasonable by extended thoracic resections. Surgical lung volume reduction by emphysema shows good functional results, which allows to use its principles in oncologic patients with low functional repiratory reserves. The overall multidisciplinary approach in thoracic oncology allows better treatment results and gives hope to the earlier inoperable patients. PMID:22968497

  5. Surgical Technique Refinements in Head and Neck Oncologic Surgery

    PubMed Central

    Liu, Jeffrey C.; Shah, Jatin P.

    2010-01-01

    The head and neck region poses a challenging arena for oncologic surgery. Diseases and their treatment can affect a myriad of functions, including sight, hearing, taste, smell, breathing, speaking, swallowing, facial expression and appearance. This review discusses several areas where refinements in surgical techniques have led to improved patient outcomes. This includes surgical incisions, neck lymphadenectomy, transoral laser microsurgery, minimally invasive thyroid surgery, and the use of vascularized free flaps for oromandibular reconstruction. PMID:20512941

  6. Intraoperative OCT in Surgical Oncology

    NASA Astrophysics Data System (ADS)

    South, Fredrick A.; Marjanovic, Marina; Boppart, Stephen A.

    The global incidence of cancer is rising, putting an increasingly heavy burden upon health care. The need to effectively detect and treat cancer is one of the most significant problems faced in health care today. Effective cancer treatment typically depends upon early detection and, for most solid tumors, successful removal of the cancerous tumor tissue via surgical procedures. Difficulties arise when attempting to differentiate between normal and tumor tissue during surgery. Unaided visual examination of the tissue provides only superficial, low-resolution information and often with little visual contrast. Many imaging modalities widely used for cancer screening and diagnostics are of limited use in the operating room due to low spatial resolution. OCT provides cellular resolution allowing for more precise localization of the tumor tissue. It is also relatively inexpensive and highly portable, making it well suited for intraoperative applications.

  7. Repeat Partial Nephrectomy: Surgical, Functional and Oncological Outcomes

    PubMed Central

    Shuch, Brian; Linehan, W. Marston; Bratslavsky, Gennady

    2011-01-01

    Purpose of Review The greater utilization of partial nephrectomy and ablative procedures has increased the incidence of patients presenting with local renal recurrence. The choice to either perform a partial or radical nephrectomy in these situations can be a challenging decision. Recent Findings Repeat and salvage partial nephrectomy, while challenging and potentially associated with increased complications, offers patients the ability to maintain excellent renal functional outcomes and promising oncologic outcomes at intermediate follow up. Summary Surgeons should be familiar with the surgical complications and the functional and oncologic outcomes of re-operative nephron-sparing surgery. Recent data and outcome analysis support utilization of these procedures in patients presenting with either local recurrence or de novo lesions in the ipsilateral kidney. PMID:21788903

  8. A phase II trial of a surgical protocol to decrease the incidence of wound complications in obese gynecologic oncology patients

    PubMed Central

    Novetsky, Akiva P.; Zighelboim, Israel; Guntupalli, Saketh R.; Ioffe, Yevgeniya J.M.; Kizer, Nora T.; Hagemann, Andrea R.; Powell, Matthew A.; Thaker, Premal H.; Mutch, David G.; Massad, L. Stewart

    2014-01-01

    Objectives Obese women have a high incidence of wound separation after gynecologic surgery. We explored the effect of a prospective care pathway on the incidence of wound complications. Methods Women with a body mass index (BMI)?30kg/m2 undergoing a gynecologic procedure by a gynecologic oncologist via a vertical abdominal incision were eligible. The surgical protocol required: skin and subcutaneous tissues to be incised using a scalpel or cutting electrocautery, fascial closure using #1 polydioxanone suture, placement of a 7mm Jackson-Pratt drain below Camper’s fascia, closure of Camper’s fascia with 3-0 plain catgut suture and skin closure with staples. Wound complication was defined as the presence of either a wound infection or any separation. Demographic and perioperative data were analyzed using contingency tables. Univariable and multivariable regression models were used to identify predictors of wound complications. Patients were compared using a multivariable model to a historical group of obese patients to assess the efficacy of the care pathway. Results 105 women were enrolled with a median BMI of 38.1. Overall, 39 (37%) had a wound complication. Women with a BMI of 30–39.9 kg/m2 had a significantly lower risk of wound complication as compared to those with a BMI >40 kg/m2 (23% vs 59%, p<0.001). After controlling for factors associated with wound complications the prospective care pathway was associated with a significantly decreased wound complication rate in women with BMI<40kg/m2 (OR 0.40, 95% C.I.: 0.18–0.89). Conclusion This surgical protocol lead to a decreased rate of wound complications among women with BMI 30–39.9 kg/m2. PMID:24952366

  9. Making cancer visible - Dyes in surgical oncology.

    PubMed

    Yap, Kiryu K; Neuhaus, Susan J

    2016-03-01

    Dyes share an intricate relationship with oncology. Dyes can cause cancer as chemical carcinogens, but can also be harnessed against cancer when used as diagnostic and therapeutic agents. Histopathology, imaging, and newer molecular diagnostics all rely on dyes, and their use in sentinel lymph node biopsies and intra-operative imaging has helped drive a paradigm shift in cancer surgery towards minimally-invasive and organ sparing approaches with enhanced resection accuracy. As therapeutic agents, the cytotoxicity of specific dyes can be employed in direct chemo-ablation or in photodynamic therapy. The same agent can have dual functionalities in cancer detection and treatment, in a novel field known as theranostics. This is facilitated by newer generation dyes conjugated with tumour-targeting probes such as antibodies, and these bio-conjugate agents can also incorporate nanotechnology or radio-isotopes. Further advances will be closely aligned with our increasing understanding of molecular oncology, and will form a new generation of cancer detection and treatment agents that promote precision medicine for cancer. Dyes and their roles have evolved and been reinvented, but they remain relevant as ever. This review explores the fascinating history of dyes, and their place in the state-of-the-art of oncology. PMID:26979638

  10. The use of videotaped lectures in surgical oncology fellowship education.

    PubMed

    Arredondo, M A; Busch, E; Douglass, H O; Petrelli, N J

    1994-01-01

    A video library of surgical oncology topics was initiated in 1991 as an educational forum for fellows in a surgical oncology training program. First-year and second-year fellows presented formal medical lectures on specific surgical oncology topics that were based on a comprehensive literature review. An abstract of the discussion, a list of references, and a copy of the presented slides were submitted at the time of presentation of each lecture. The lectures were videotaped in front of an audience made up of faculty and fellows of the Department of Surgical Oncology, The videotapes were subsequently edited to incorporate the presented slides, and these versions were shown separately to allow critique of presentation style and content by the faculty and the fellows within the Department. Nineteen videotaped presentations from academic years 1991-1992 and 1992-1993 were evaluated. These videotaped lectures are an informational resource, and, of equal importance, they provide an assessible record for self-analysis of lecturing technique and effectiveness. PMID:7522507

  11. Quality assurance in surgical oncology. Colorectal cancer as an example.

    PubMed

    Gunnarsson, Ulf

    2003-02-01

    Quality assurance in surgical oncology is a field of growing importance. National, regional and local systems have been built up in many countries. Often the quality assurance projects are linked to different registers. The advantage of such a link is the possibility of obtaining population-based data from unselected health care institutions. Few discussions of results from such projects have been published. Quality assurance of colorectal cancer surgery implies the development and use of systems for improvement all the way from detection of the cancer to the outcome as survival and patient satisfaction. To achieve this we must know what methods are being used and the outcome of our treatments. Designing processes for improvement necessitates careful planning, including decisions about end-points. Some crucial issues are discussed step-by-step in the present paper. In addition to auditing and providing collegial feedback, quality assurance is a tool for closing the gap between clinical practice and evidence based medicine and for creating new evidences as well as monitoring the introduction of new techniques and their effects. PMID:12559084

  12. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC—UK gynaecological oncology surgical outcomes and complications)

    PubMed Central

    Iyer, R; Gentry-Maharaj, A; Nordin, A; Burnell, M; Liston, R; Manchanda, R; Das, N; Desai, R; Gornall, R; Beardmore-Gray, A; Nevin, J; Hillaby, K; Leeson, S; Linder, A; Lopes, A; Meechan, D; Mould, T; Varkey, S; Olaitan, A; Rufford, B; Ryan, A; Shanbhag, S; Thackeray, A; Wood, N; Reynolds, K; Menon, U

    2015-01-01

    Background: There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study. Methods: Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I–V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications. Results: Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ?3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II–V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05). Conclusions: This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk. PMID:25535730

  13. Clinical Outcome Analysis in 'High-Risk' Versus 'Low-Risk' Patients Eligible For National Surgical Adjuvant Breast and Bowel B-39/Radiation Therapy Oncology Group 0413 Trial: Five-Year Results

    SciTech Connect

    Patel, Rakesh R. Christensen, Michael E.; Hodge, C. Wesley; Adkison, Jarrod B.; Das, Rupak K.

    2008-03-15

    Purpose: To report the local control and overall survival outcomes after lumpectomy followed by accelerated partial breast irradiation in high-risk patients as defined by the current inclusion criteria for the National Surgical Adjuvant Breast and Bowel B-39/Radiation Therapy Oncology Group 0413 Intergroup trial. Methods and Materials: Between 2000 and 2005, 273 women with early-stage breast cancer were treated using either multicatheter interstitial brachytherapy (n = 247) or MammoSite (n = 26). Patients received 32-34 Gy in 8-10 twice-daily fractions using high-dose-rate {sup 192}Ir brachytherapy. All patients met the initial inclusion criteria for the Intergroup trial and were separated into two groups: high-risk patients (representing the cohort that remained eligible for the Intergroup trial) who satisfied one or more of the 'high-risk' criteria (age <50 years, estrogen receptor negative, and/or positive lymph nodes; n = 90), and low-risk patients who comprised the remainder of the cohort (n = 183). The outcomes of the two cohorts were analyzed and compared. Results: The median follow-up of the entire cohort was 48.5 months. No significant difference was found in outcomes at 5 years between the low- and high-risk groups, with a local control rate of 97.8% vs. 93.6%, crude local recurrence rate of 2.2% (n = 4) vs. 4.4% (n = 4), and overall survival rate of 92.1% vs. 89.5%, respectively. Conclusion: At 5 years, no statistically significant difference was found in outcomes for patients deemed to be at greater risk in the current National Surgical Adjuvant Breast and Bowel B-39/Radiation Therapy Oncology Group 0413 Intergroup trial. These clinical data support the inclusion of this 'high-risk' population in this important ongoing study.

  14. [Rethinking clinical research in surgical oncology. From comic opera to quality control].

    PubMed

    Evrard, Serge

    2016-01-01

    The evidence base for the effectiveness of surgical interventions is relatively poor and data from large, randomized prospective studies are rare with often a poor quality. Many efforts have been made to increase the number of high quality randomized trials in surgery and theoretical proposals have been put forward to improve the situation, but practical implementation of these proposals is seriously lacking. The consequences of this policy are not trivial; with very few patients included in surgical oncology trials, this represents wasted opportunity for advances in cancer treatment. In this review, we cover the difficulties inherent to clinical research in surgical oncology, such as quality control, equipoise, accrual, and funding and promote alternative designs to the randomized controlled trial. Although the classic randomized controlled trial has a valid but limited place in surgical oncology, other prospective designs need to be promoted as a new deal. This new deal not only implicates surgeons but also journal editors, tender jury, as well as regulatory bodies to cover legal gaps currently surrounding surgical innovation. PMID:26610367

  15. Thyroid Disorders in the Oncology Patient

    PubMed Central

    Hartmann, Kari

    2015-01-01

    Thyroid disease and cancer diagnoses are common conditions likely to coexist. Optimal management requires appropriate diagnostic testing and consideration of a number of factors, including overall health status and prognosis. Hypothyroidism and hyperthyroidism can lead to a number of symptoms that may affect not only quality of life but can interfere with the patient’s ability to tolerate cancer treatment. Imaging studies performed for cancer staging can identify incidental structural abnormalities in the thyroid, which should be assessed with dedicated neck ultrasonography and possibly fine-needle aspiration. Incidental thyroid cancer is most often less urgent than the patient’s presenting malignancy and can be addressed surgically when appropriate in the context of other treatments (i.e., chemotherapy). Providers working in an oncology setting, as well as primary care providers, should be aware of medications that are associated with hormonal abnormalities. Any patient with a history of neck or brain radiation therapy is at risk of developing hypothyroidism and possibly other endocrinopathies. Complex or very ill patients may benefit from a multidisciplinary approach that utilizes the experience of a knowledgeable endocrinologist. PMID:26649243

  16. Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm.

    PubMed

    Boggess, John F

    2007-01-01

    Robotic surgical platforms were first developed with telesurgery in mind. Conceptualized by NASA and the military to provide surgical expertise to remote locations, some telesurgical success has been documented, but progress has been held back by communication bandwidth limitations. Telepresence surgery, where the surgeon is in proximity to the patient but is provided with an ergonomic console equipped with three-dimensional vision and autonomous control of wristed laparoscopic surgical instruments and energy sources, has shown efficacy first in cardiac and then urologic cancer surgery. Interest is currently focused on the application of this technology in the field of gynecology, with techniques being described to perform simple hysterectomy, myomectomy, tubal anastomosis, and pelvic reconstruction procedures. This article will review the application of robotic- and computer-assisted surgery in the specialty of gynecologic oncology. PMID:25484936

  17. Training in surgical oncology - the role of VR simulation.

    PubMed

    Lewis, T M; Aggarwal, R; Rajaretnam, N; Grantcharov, T P; Darzi, A

    2011-09-01

    There have been dramatic changes in surgical training over the past two decades which have resulted in a number of concerns for the development of future surgeons. Changes in the structure of cancer services, working hour restrictions and a commitment to patient safety has led to a reduction in training opportunities that are available to the surgeon in training. Simulation and in particular virtual reality (VR) simulation has been heralded as an effective adjunct to surgical training. Advances in VR simulation has allowed trainees to practice realistic full length procedures in a safe and controlled environment, where mistakes are permitted and can be used as learning points. There is considerable evidence to demonstrate that the VR simulation can be used to enhance technical skills and improve operating room performance. Future work should focus on the cost effectiveness and predictive validity of VR simulation, which in turn would increase the uptake of simulation and enhance surgical training. PMID:21605972

  18. Surgical care quality and oncologic outcome after D2 gastrectomy for gastric cancer

    PubMed Central

    Mrena, Johanna; Mattila, Anne; Böhm, Jan; Jantunen, Ismo; Kellokumpu, Ilmo

    2015-01-01

    AIM: To examine the quality of surgical care and long-term oncologic outcome after D2 gastrectomy for gastric cancer. METHODS: From 1999 to 2008, a total of 109 consecutive patients underwent D2 gastrectomy without routine pancreaticosplenectomy in a multimodal setting at our institution. Oncologic outcomes together with clinical and histopathologic data were analyzed in relation to the type of surgery performed. Staging was carried out according to the Union for International Cancer Control criteria of 2002. Patients were followed-up for five years at the outpatient clinic. The primary measure of outcome was long-term survival with the quality of surgery as a secondary outcome measure. Clinical data were retrospectively collected from the patient records, and causes of death were obtained from national registries. RESULTS: A total of 109 patients (58 men) with a mean age of 67.4 ± 11.2 years underwent total gastrectomy or gastric resection with D2 lymph node dissection. The tumor stage distribution was as follows: stage?I, (27/109) 24.8%; stage II, (31/109) 28.4%; stage III, (41/109) 37.6%; and stage IV, (10/109) 9.2%. Forty patients (36.7%) received chemotherapy or chemoradiotherapy. The five-year overall survival rate for all 109 patients was 45.0%, and was 47.1% for the 104 patients treated with curative R0 resection. The five-year disease-specific survival rates were 53.0% and 55.8%, respectively. In a multivariate analysis, body mass index and tumor stage were independent prognostic factors for overall survival (both P < 0.01), whereas body mass index, tumor stage, tumor site, Lauren classification, and lymph node invasion were prognostic factors for cancer-specific survival (all P < 0.05). Postoperative 30-d mortality was 1.8% and 30-d, surgical (including three anastomotic leaks, two of which were treated conservatively), and general morbidities were 26.6%, 12.8%, and 14.7%, respectively. CONCLUSION: D2 dissection is a safe surgical option for gastric cancer, providing quality surgical care and long-term oncologic outcomes that are in line with current Western standards. PMID:26715812

  19. Non-surgical oncology – Guidelines on Parenteral Nutrition, Chapter 19

    PubMed Central

    Arends, J.; Zuercher, G.; Dossett, A.; Fietkau, R.; Hug, M.; Schmid, I.; Shang, E.; Zander, A.

    2009-01-01

    Reduced nutritional state is associated with unfavourable outcomes and a lower quality of life in patients with malignancies. Patients with active tumour disease frequently have insufficient food intake. The resting energy expenditure in cancer patients can be increased, decreased, or remain unchanged compared to predicted values. Tumours may result in varying degrees of systemic pro-inflammatory processes with secondary effects on all significant metabolic pathways. Therapeutic objectives are to stabilise nutritional state with oral/enteral nutrition and parenteral nutrition (PN) and thus to prevent or reduce progressive weight loss. The maintenance or improvement of quality of life, and the increase in the effectiveness and a reduction in the side-effects of antitumor therapy are further objectives. Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered. The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase. PMID:20049066

  20. [Geriatric intervention in oncology for elderly patients].

    PubMed

    Saint-Jean, O; LeGuen, J

    2015-10-01

    Half of all cancers occur in patients older than 70 years. National cancer plans in France promote the emergence of geriatric oncology, whose aim is that every elder cancer patient receives a pertinent treatment, according to his frailty. Geriatric intervention has been evaluated in various conditions or patients since 30 years. Meta-analysis has shown the benefits on autonomy and mortality. But benefits are related to the organization of geriatric care, especially when integrated care is provided. Literature on geriatric oncology is relatively poor. But it is certain that a geriatric comprehensive assessment provided a lot of important information for the care of cancer patients, leading to a modification of cancer treatment in many cases. Randomized trials will soon begin to evaluate the benefits of geriatric integrated care for elder cancer patients, in terms of mortality and quality of life. Actually, in oncogeriatic coordination units, pilot organizations are developed for the satisfaction of patients and professionals. PMID:26344438

  1. Repeat Partial Nephrectomy on the Solitary Kidney: Surgical, Functional, and Oncologic Outcomes

    PubMed Central

    Liu, Nick W.; Khurana, Kiranpreet; Sudarshan, Sunil; Pinto, Peter A.; Linehan, W. Marston; Bratslavsky, Gennady

    2010-01-01

    Purpose To examine the outcomes of patients with recurrent or de novo renal lesions treated with repeat partial nephrectomy on a solitary kidney. Methods We reviewed the records of patients who underwent nephron-sparing surgeries at the NCI from 1989 to 2008. Patients were included in the analysis if they underwent a repeat partial nephrectomy on a solitary kidney. Perioperative, functional, and oncologic outcomes were assessed. Functional outcomes were evaluated using the MDRD equation for eGFR. Oncologic efficacy was examined by the need for subsequent repeat renal surgery and development of metastatic disease. Results Twenty-five patients were included in the analysis. The median number of tumors resected was 4; with median EBL of 2,400ml, and median operative time of 8.5 hours. Perioperative complications occurred in 52% of the cases and included one mortality, and the loss of 3 renal units. There was a decline in eGFR (p<0.01) on the first follow up visit within 3 months after surgery, but at the 1 year follow up, the difference was not significant (p=0.12). Surgical interventions were recommended to eight patients (38%) for recurrent or de-novo tumors at a median time of 36 months, while metastasis-free survival of the cohort at an average of 57 months (range 3–196, median 50 months) was 95%. Conclusions Repeat partial nephrectomy for patients with a solitary kidney is a high risk alternative. Although the complication rates are high and there is a modest decline in renal function, most patients remain free from dialysis with acceptable oncologic outcomes at intermediate follow up. PMID:20299057

  2. Plastic Surgery for the Oncological Patient

    PubMed Central

    Daigeler, Adrien; Harati, Kamran; Kapalschinski, Nicolai; Goertz, Ole; Hirsch, Tobias; Lehnhardt, Marcus; Kolbenschlag, Jonas

    2014-01-01

    The therapy of oncological patients has seen tremendous progress in the last decades. For most entities, it has been possible to improve the survival as well as the quality of life of the affected patients. To supply optimal cancer care, a multidisciplinary approach is vital. Together with oncologists, radiotherapists and other physicians, plastic surgeons can contribute to providing such care in all stages of treatment. From biopsies to the resection of advanced tumors, the coverage of the resulting defects and even palliative care, plastic surgery techniques can help to improve survival and quality of life as well as mitigate negative effects of radiation or the problems arising from exulcerating tumors in a palliative setting. This article aims to present the mentioned possibilities by illustrating selected cases and reviewing the literature. Especially in oncological patients, restoring their quality of life with the highest patient safety possible is of utmost importance. PMID:25593966

  3. Improving patient safety in radiation oncology

    SciTech Connect

    Hendee, William R.; Herman, Michael G.

    2011-01-15

    Beginning in the 1990s, and emphasized in 2000 with the release of an Institute of Medicine report, healthcare providers and institutions have dedicated time and resources to reducing errors that impact the safety and well-being of patients. But in January 2010 the first of a series of articles appeared in the New York Times that described errors in radiation oncology that grievously impacted patients. In response, the American Association of Physicists in Medicine and the American Society of Radiation Oncology sponsored a working meeting entitled ''Safety in Radiation Therapy: A Call to Action''. The meeting attracted 400 attendees, including medical physicists, radiation oncologists, medical dosimetrists, radiation therapists, hospital administrators, regulators, and representatives of equipment manufacturers. The meeting was cohosted by 14 organizations in the United States and Canada. The meeting yielded 20 recommendations that provide a pathway to reducing errors and improving patient safety in radiation therapy facilities everywhere.

  4. Observations on surgical oncology and the Livre blanc.

    PubMed

    O'Higgins, Niall; Kroon, Bin B R

    2002-02-01

    A high standard of surgical care is the most crucial factor in determining outcome for the great majority of patients with solid malignant tumours. Although acknowledged by most experts this fact is insufficiently recognised by the medical community, by health administrators, by the lay public or by political decision-makers. Difficulty in appreciating the importance of quality in surgery may have come about because of the changing role of the surgeon in cancer care. While remaining the most important instrument in curative cancer treatment, surgery has been joined by other modalities active against malignant disease. PMID:11895754

  5. Nuclear oncology: From genotype to patient care

    SciTech Connect

    1997-12-31

    Nuclear medicine is the medical specialty best suited to translate the exploding body of knowledge obtained from research in genetics and molecular biology into the care of patients. This fourth annual nuclear oncology conference will address how this can be done and how positron emission tomography (PET) and single photon emission tomography (SPECT) can be used in the care of patients with cancer or with increased genetic risk of developing cancer. The course will include illustrative patient studies showing how PET and SPECT can help in diagnosis, staging and treatment planning and monitoring of patients with cancer.

  6. Influenza vaccination in oncology patients.

    PubMed

    Baluch, Aliyah; Pasikhova, Yanina

    2013-12-01

    It is well established that the immunological response to the seasonal trivalent influenza vaccine is attenuated in cancer patients. Furthermore, rates of seroprotection and seroconversion vary by malignancy type and are higher in patients with solid tumors, as compared either with those with hematologic malignancies or with allogeneic hematopoietic stem cell recipients. In 2009, a novel influenza strain prompted development of new vaccines and evaluation of alternative dosing strategies in an attempt to increase the rates of seroconversion in immunocompromised patients, further complicating this issue. Recent literature has demonstrated that the use of myeloablative chemotherapy regimens and biologics is correlated with decreased immunogenicity and response to influenza vaccines. Much debate still exists as to the optimal timing of influenza vaccination. Delaying vaccination from 1 week following standard chemotherapy up to 6 months following rituximab is increasingly supported by studies in this heterogeneous population. PMID:24258350

  7. Minimally invasive surgery for endometrial cancer: Does operative start time impact surgical and oncologic outcomes?

    PubMed Central

    Slaughter, Katrina N.; Frumovitz, Michael; Schmeler, Kathleen M.; Nick, Alpa M.; Fleming, Nicole D.; dos Reis, Ricardo; Munsell, Mark F.; Westin, Shannon N.; Soliman, Pamela T.; Ramirez, Pedro T.

    2014-01-01

    Objective Recent literature in ovarian cancer suggests differences in surgical outcomes depending on operative start time. We sought to examine the effects of operative start time on surgical outcomes for patients undergoing minimally invasive surgery for endometrial cancer. Methods A retrospective review was conducted of patients undergoing minimally invasive surgery for endometrial cancer at a single institution between 2000 and 2011. Surgical and oncologic outcomes were compared between patients with an operative start time before noon and those with a surgical start time after noon. Results A total of 380 patients were included in the study (245 with start times before noon and 135 with start times after noon). There was no difference in age (p=0.57), number of prior surgeries (p=0.28), medical comorbidities (p=0.19), or surgical complexity of the case (p=0.43). Patients with surgery starting before noon had lower median BMI than those beginning after noon, 31.2 vs. 35.3 respectively (p=0.01). No significant differences were observed for intraoperative complications (4.4% of patients after noon vs. 3.7% of patients before noon, p=0.79), estimated blood loss (median 100 cc vs. 100 cc, p=0.75), blood transfusion rates (7.4% vs. 8.2%, p=0.85), conversion to laparotomy (12.6% vs. 7.4%, p=0.10). There was no difference in operative times between the two groups (198 minutes vs. 216.5 minutes, p=0.10). There was no association between operative start time and postoperative non-infectious complications (11.9% vs. 11.0%, p=0.87), or postoperative infections (17.8% vs. 12.3%, p=0.78). Length of hospital stay was longer for surgeries starting after noon (median 2 days vs. 1 day, p=0.005). No differences were observed in rates of cancer recurrence (12.6% vs. 8.8%, p=0.39), recurrence-free survival (p=0.97), or overall survival (p=0.94). Conclusion Our results indicate equivalent surgical outcomes and no increased risk of postoperative complications regardless of operative start time in minimally invasive endometrial cancer staging, despite longer length of hospital stay for surgeries beginning after noon. PMID:24945591

  8. [Oncology].

    PubMed

    Aapro, Matti S

    2009-02-01

    The American Society for Clinical Oncology (ASCO) determined that there were twelve major advances in medical oncology last year. Endocrine-responsive breast cancer benefits from tamoxifen or an aromatase inhibitor taken for more than five years. Zoledronic acid, a bisphosphonate, reduces the risk of breast cancer recurrence in premenopausal women undergoing hormonal-suppression therapy. Bevacizumab was for use in combination with paclitaxel in patients with metastatic breast cancer Cetuximab added to chemotherapy of non-small cell lung cancer patients increased survival by up to 21%. Adjuvant gemcitabine doubled disease-free survival in pancreas cancer. Adjuvant pegylated interferon cuts the risk of recurrent melanoma by 18%. Bendamustine abolishes signs of activity of chronic lymphocytic leukemia in 30% of patients. The HPV vaccine--now approved for prevention of cervical cancer--might have a role in preventing oral cancers and a review of 45 studies showed that oral contraceptives reduce the risk of ovarian cancer. PMID:19271650

  9. Incorporating fertility preservation into the care of young oncology patients.

    PubMed

    Redig, Amanda J; Brannigan, Robert; Stryker, Steven J; Woodruff, Teresa K; Jeruss, Jacqueline S

    2011-01-01

    As the number of cancer survivors continues to increase, oncologists are faced with the challenge of providing cancer therapy to patients who may 1 day want to have children. Yet, gonadotoxic cancer treatments can compromise future fertility, either temporarily or permanently. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients' wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy. This commentary provides an overview of the range of fertility preservation options currently available and under development, using case-based discussions to illustrate ways in which fertility preservation can be incorporated into oncology care. Cases involving breast cancer, testicular cancer, and rectal cancer are described to illustrate fertility issues experienced by male and female patients, as well as to provide examples of strategies for modifying surgical, medical, and radiation therapy to spare fertility. Current guidelines in oncology and reproductive medicine are also reviewed to underscore the importance of communicating fertility preservation options to young patients with cancer. PMID:21235031

  10. Optimising surgical management of elderly cancer patients

    PubMed Central

    Ramesh, Hodigere Sripathy Jois; Pope, Daniel; Gennari, Roberto; Audisio, Riccardo A

    2005-01-01

    Background Elderly population is on rise. It is an ethical dilemma how aggressive one should be when it comes to treat cancer in elderly. Presumed fear of increased postoperative morbidity and mortality has resulted in delivery of sub-optimal cancer surgery. Methods In this review article we visit physiology of the aged, tools available to assess surgical risks in oncogeriatric patients, and current practice in the management of common cancers encountered in surgical oncology, with the view of increasing awareness on optimising surgical management of senior patients with cancer. A pubmed search for cancer, surgery, elderly, was carried out. Results Cancer is on rise with increasing age predominantly affecting breast, gastrointestinal tract and lung. Increasingly more surgeons are offering surgery to elderly cancer patient but selection bias is prevalent. Available data reflect short and long-term outcome of cancer surgery in elderly is not greatly different to that of younger patient. Declining physiological reserve along with inability to respond adequately to physiological stress are salient age related changes. Comprehensive Geriatric Assessment (CGA) is not tested in surgical patient. There is need for a tool to define individualised operative risk. Preoperative assessment of cancer in elderly is designed to offer this information based on functional status of an individual utilising currently available tools of risk assessment. Conclusion All elderly cancer patients should be offered optimal treatment depending on their functional status not on chronological age. Oncogeriatric patient would benefit from dedicated multidisciplinary approach. Recruitment of elderly cancer patients to more clinical trials is needed to enhance our knowledge and to offer optimum treatment to this unique subgroup. PMID:15788092

  11. Incorporating Fertility Preservation into the Care of Young Oncology Patients

    PubMed Central

    Redig, Amanda J.; Brannigan, Robert; Stryker, Steven J.; Woodruff, Teresa K.; Jeruss, Jacqueline S.

    2010-01-01

    As the number of cancer survivors continues to increase, oncologists are faced with the challenge of providing cancer therapy to patients who may one day want to have children. Yet gonadotoxic cancer treatments can compromise future fertility, either temporarily or permanently. There are established means of preserving fertility prior to cancer treatment, specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy, and thus patients’ wishes regarding future fertility and the available fertility preservation alternatives should be discussed prior to the initiation of therapy. This commentary provides an overview of the range of fertility preservation options currently available and under development, and utilizes case-based discussions to illustrate ways in which fertility preservation can be incorporated into oncology care. Cases involving breast cancer, testicular cancer, and rectal cancer are described to illustrate fertility issues experienced by male and female patients, as well as to provide examples of strategies for modifying surgical, medical, and radiation therapy in order to spare fertility. Current guidelines in oncology and reproductive medicine are also reviewed to underscore the importance of communicating fertility preservation options to young patients with cancer. PMID:21235031

  12. Nutritional assessment of surgical patients.

    PubMed

    Brown, C S; Stegman, M R

    1988-10-01

    In order to test the sensitivity and specificity of the East Orange Nutritional Screening Form (EONSF), nutritional assessments were performed on a random sample of 10% of general medical/surgical admissions at a large midwestern veteran's administration hospital. Patients were followed until discharge to determine if they met the standard criteria of additional nutritional support. The tool correctly identified patients at nutritional risk (sensitivity) 95% of the time and patients not at nutritional risk (specificity) 89% of the time. It proved to be an effective, low-cost tool for identifying patients at risk and for planning appropriate nutritional strategies. PMID:3146037

  13. The evolution of an integrated timeline for oncology patient healthcare.

    PubMed Central

    Bui, A. A.; Aberle, D. R.; McNitt-Gray, M. F.; Cardenas, A. F.; Goldin, J.

    1998-01-01

    The introduction of computers in the medical environment has contributed to the proliferation of medical data, often making it difficult to consolidate information on a single patient. In patients with complex medical problems, such as oncology patients, the lack of data integration can negatively impact on patient care. This paper presents an infrastructure for the creation of an integrated multimedia timeline that automatically combines patient information from distributed hospital information sources, and creates a visual summary of pertinent events in a patient's medical history. In this prototype, we focus on oncology patients under treatment for advanced cancers. Images Figure 1 PMID:9929203

  14. Percentage of Surgical Patients Receiving Recommended Care

    MedlinePLUS

    ... Recommended Care Percentage of Surgical Patients Receiving Recommended Care This is a composite measure based on individual ... Age Group Percentage of Surgical Patients Receiving Recommended Care by Age Group uzrc-9bvr Download these data » ...

  15. Percentage of Surgical Patients Receiving Recommended Care

    MedlinePLUS

    ... Recommended Care Percentage of Surgical Patients Receiving Recommended Care This is a composite measure based on individual ... Age Group Percentage of Surgical Patients Receiving Recommended Care by Age Group uzrc-9bvr Download these data » ...

  16. Abdominal surgical emergencies in patients with advanced cancer.

    PubMed

    Dumont, F; Goéré, D; Honoré, C; Elias, D

    2015-12-01

    Abdominal emergency in an advanced oncologic setting is defined as an acute life-threatening abdominal pathology in a patient with incurable cancer. These include bowel obstruction, infections and, more rarely, hemorrhage. To benefit the patient, surgery should both increase the survival and improve the quality of life. These two goals are of equal importance and must be achieved together. This is difficult because these patients are frail, often malnourished and have a poor performance status. They also have a high risk of post-operative morbidity and mortality, a major risk of symptom recurrence and a limited life expectancy. For patients near the end-of-life, a therapeutic decision for surgical intervention must respect ethical and legal standards. This review reports the surgical outcomes and median survival of these patients, specifies rules that must be known and respected, and presents non-operative interventional alternatives. PMID:26548722

  17. ENDOSCOPIC ASSESSMENT OF BLADDER TUMOURS: Accuracy of Endoscopic Staging and Grading with Fiberoptic and Digital Cystoscopes Michael A.S. Jewett, Karen Hersey, Kamal Mattar, Mischel G. Neill, Ethan Grober, Raquel Lopez, Anushiya Sathiananthan, Gina Lockwood, Andrew Evans, Emily Seto and Neil Fleshner Department of Surgical Oncology/Urology, Pathology and Medical Engineering

    Cancer.gov

    GENITOURINARY ONCOLOGY BIOMARKER RESEARCH Karen Chadwick1 , Ken Evans3, Andrew Evans2, Neil Fleshner1 The Departments of Surgical Oncology (Urology)1 and Pathology2, the University Health Network and the Ontario Cancer BioMarker Network3 ABSTRACT The genitourinary (GU) oncology division at Princess Margaret Hospital (PMH) has developed a site-specific BioBank to serve as a central repository for biospecimens obtained from patients attending out-patient clinics within the division.

  18. What is integrative oncology and can it help my patients?

    PubMed

    Pineda, Mario Javier; Singh, Diljeet K

    2012-06-01

    Integrative oncology lends itself to the comprehensive practice of gynecologic oncology with multiple tools and interventions that can impact on QoL and survival. However, there remains a paucity of well-designed, well-powered randomized control trials on various CAM modalities for gynecologic cancer patients. The reasons for the lack of level 1 evidence include the nascent state of integrative medicine as a science, the limitations on CAM funding, the relative lack of integration of CAM practitioners into the oncology community, and absence of strict regulation of herbs and supplements by the US FDA. The use of CAM as adjunctive therapies will likely continue given the patient-driven trends to date, and given the evidence for at least safety and potentially efficacy, our patients deserve our willingness to use all possible approaches to improving their outcomes. Continued evolution of our ability to specifically measure and describe QoL will further our ability to hone in on domains most important to patients and their survival and allow practitioners to make patient-specific recommendations. Multimodal programs that include physical activity, stress management, and diet have the potential to address demonstrated deficits in PWB and FWB in ovarian cancer patients which suggests a model of collaborative gynecologic oncology care). Integrative oncology represents a holistic approach to patient care whose goal is maximization of patient quantity and quality of life. Patients can achieve this optimal outcome through the synergy of conventional care, integrative modalities, lifestyle modifications, and supportive care. Refer to Table 4 for a listing of integrated medicine Internet resources. PMID:22640716

  19. Suicide ideation among oncologic patients in a Spanish ward.

    PubMed

    Diaz-Frutos, D; Baca-Garcia, E; Mahillo-Fernandez, I; Garcia-Foncillas, J; Lopez-Castroman, J

    2016-04-01

    Oncologic patients are exposed to a higher risk of suicidal behaviors than the general population. In this study, we aim to examine the severity of suicidal ideation in a sample of oncologic patients considering different psychological and clinical features. We interviewed 202 inpatients receiving curative or palliative treatment in a medical oncology ward of a Spanish hospital during the period 2012-2014. A complete assessment of psychosocial factors, cancer diagnoses (lung, colon rectum, and genitourinary system), and suicidal behaviors were made during admission, including validated questionnaires about depression, anxiety, personality, quality of life, body image, life threatening events, hopelessness, and suicidal ideation. The characteristics of inpatients with high and low suicidal ideation were retrospectively compared. A logistic regression model was constructed to examine the relationship between the significant factors retained after the univariate analyses. One of every four patients (n = 51; 25.24%) presented high scores of suicidal ideation. Logistic regression analyses retained depression (OR = 3.55; 95% CI = 1.25-11.68; p = .016), hopelessness (OR = 8.78; 95% CI = 3.44-25.88; p ? .001), personality (OR = .44; 95% CI = .2-.96; p = .038), and advanced age (OR = 2.60; 95% CI = 1.18-5.98; p = .016) as the main risk factors for high suicidal ideation. Suicidal ideation was frequent among oncologic patients. These patients should receive closer monitoring, especially, when old, retired, or severely depressed. PMID:26109239

  20. The impact of physician posture during oncology patient encounters.

    PubMed

    Gupta, Arjun; Harris, Samar; Naina, Harris V

    2015-06-01

    Non-verbal communication is an important component of the physician-patient interaction. Oncology patients face specific emotional and psychological issues requiring additional physician emotional support. Multiple studies in oncology patients have revealed that patients perceive physicians seated during the medical interview to be more compassionate, caring, and likely to spend more time with the patients. These are all associated with improved patient outcomes. Barriers to sitting may be due to those imposed by time, space, and reduced perceived benefit of sitting by the physician. Although a sitting posture alone is unlikely to compensate for poor communication skills, assessing patient preference to physician posture, and following their preference, can be a simple way of improving communication, and thus patient outcomes, especially in oncology patients. The widespread introduction of the electronic medical record (EMR) system over the last decade has added a "third wheel" to the original dyadic physician-patient relationship. Physician posture and eye gaze towards to the EMR and its components has a deleterious effect on communication. Appropriate training and sensitization in this regard should be provided for physicians. PMID:25757904

  1. Possibly Impossible Patients: Management of Difficult Behavior in Oncology Outpatients

    PubMed Central

    Peteet, John R.; Meyer, Fremonta L.; Miovic, Michael K.

    2011-01-01

    Angry, threatening, or otherwise disruptive behavior by patients can interfere with necessary oncologic treatment, sometimes to the point of rendering continued care impossible. We offer oncology clinicians guidance in dealing with difficult outpatients by discussing the differential diagnosis and multidisciplinary management of treatment-disrupting behavior in the ambulatory oncology setting. We review the existing literature on dealing with difficult patients and present clinical experience at a comprehensive cancer center where a formalized, institutional process for responding to disruptive outpatients has been developed. A structured, multidisciplinary approach to deal with difficult behavior in oncology outpatients can improve care and staff morale. Staff using this approach can identify causes of treatment-disrupting behavior, develop and implement appropriate behavior plans, facilitate communication, address mental health issues, and ensure that decisions to terminate a relationship with a patient are ethical, clinically justified, and supported by due process. In the future, clinical recommendations and institutional guidelines for dealing with difficult patients should be evaluated with more structured, quantitative research. PMID:22043189

  2. [Surgical treatment of neoplasms in geriatric patients].

    PubMed

    Piccolomini, A; Brandi, C; Vuolo, G; Verre, L; Roviello, F; Di Cosmo, L; Carli, A

    1994-04-01

    The Authors report their experience in the surgical management of cancer in the aged (over 65 year old patients), during the period 1988-1992 at the Istituto Policattedra di Scienze Chirurgiche, University of Siena. They consider colon and rectum, breast, stomach, pancreas and biliary tract neoplasms in relation to site, staging, emergency or delayed surgical treatment, and early postoperative results. Finally, they outline the frequently encountered problems in treating old patients and the most appropriate surgical approach. PMID:8086303

  3. Delirium in Older Surgical Patients Threatens Recovery

    MedlinePLUS

    ... news/fullstory_154547.html Delirium in Older Surgical Patients Threatens Recovery Sudden confusion is a postoperative complication ... 2015 (HealthDay News) -- Preventing postsurgical delirium in older patients can help ensure a successful recovery, a new ...

  4. Quality of Pharmaceutical Care in Surgical Patients

    PubMed Central

    de Boer, Monica; Ramrattan, Maya A.; Boeker, Eveline B.; Kuks, Paul F. M.; Boermeester, Marja A.; Lie-A-Huen, Loraine

    2014-01-01

    Background Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. Objective To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. Methods For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. Results Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%). Conclusions This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced. PMID:25006676

  5. [Surgical risk in patients with liver disease].

    PubMed

    Jakab, Ferenc

    2013-06-01

    The author draws attention on the importance surgical risk analysis from patient's safety point of view. Recently the development in quality assurance affected surgical practice as well, hence determination and evaluation of surgical risk are more exactly defined. This resulted in a significant decrease in mortality during surgical interventions on the liver despite a wider indication and increased numbers, recently. Importantly, surgical risk is much higher in patients with liver disease compared to patients with normal liver. The risk of surgical interventions for liver diseases (HCC, tumor) in patients with diffuse liver diseases (cirrhosis, chronic hepatitis, ALD) can be expressed numerically. For many years the Child-Turcotte-Pugh stadium could have been determined by using actual laboratory values. Recently the "50-50 rule" or more frequently the MELD score -- originally used in the practice of liver transplantation -- mean objective expression of surgical risk. Treatment optimalisation can reduce surgical risk, selected on the basis of risk analysis in multidisciplinary settings, which focus on the need of liver surgeons. PMID:23782599

  6. [Patient information duties in radiation oncology].

    PubMed

    Pourel, N; Py, B; Safran, D

    2014-10-01

    Patient information duties are a basic task of radiation oncologists in their daily practice. This article is essentially a factsheet on legal obligations, the value of written informed consent and information documents that ought to be given to patient. PMID:25201635

  7. Drug repurposing in oncology-patient and health systems opportunities.

    PubMed

    Bertolini, Francesco; Sukhatme, Vikas P; Bouche, Gauthier

    2015-12-01

    In most countries, healthcare service budgets are not likely to support the current explosion in the cost of new oncology drugs. Repurposing the large arsenal of approved, non-anticancer drugs is an attractive strategy to offer more-effective options to patients with cancer, and has the substantial advantages of cheaper, faster and safer preclinical and clinical validation protocols. The potential benefits are so relevant that funding of academically and/or independently driven preclinical and clinical research programmes should be considered at both national and international levels. To date, successes in oncology drug repurposing have been limited, despite strong evidence supporting the use of many different drugs. A lack of financial incentives for drug developers and limited drug development experience within the non-profit sector are key reasons for this lack of success. We discuss these issues and offer solutions to finally seize this opportunity in the interest of patients and societies, globally. PMID:26483297

  8. Osteointegration in oncologic patients: a case report

    PubMed Central

    Carini, Fabrizio; Bucalo, Concetta; Saggese, Vito; Monai, Dario; Porcaro, Gianluca

    2012-01-01

    Summary Objective the present case report aims at illustrating how implant-prosthetic rehabilitation in patients with oral cancer resection aids to improve their quality of life. Material and methods a patient with verrucous squamous cell carcinoma of the mandible was treated with surgery and rehabilitation with three interforaminal dental implants and Toronto bridge. Three years after treatment, because of cancer recurrence, a segment of jaw and one of the three mandibular implants were removed. The histological examination showed healthy bone contact to implant surface, despite proximity to the neoplastic area. Results the case shows the maintainance of the osseointegration implants despite the cancer recurrence in the same area. Conclusions endosseous implants represent a useful and valid tool for the prosthetic rehabilitation of cancer patients. Long-term effects of implant-prosthetic rehabilitation in patients with cancer still need to be verified. It would be interesting to confirm the data obtained by numerical studies of representative samples. PMID:23285321

  9. [Complementary medicine use in oncology patients].

    PubMed

    Inglin, S; Amsler, S; Arigoni, F; Burton-Jeangros, C; Pargoux-Vallade, C; Sappino, A-P

    2008-05-21

    Through an anonymized questionnaire we assessed the prevalence of complementary and alternative medicine (CAM) use in a series of cancer patients treated at the Geneva University Hospitals. 152 among the 300 sollicitated patients responded and 39 (26.5%) recognized to use CAM, particularly young, and moderate to highly educated patients. Patients justify their use of CAM to maximize caring ressources, to achieve physical or psychic relief. Most of them recognize to share these therapeutic options with their doctor. Satisfaction with traditional medicine as well as ignorance of CAM are the main arguments provided by non users. The specificity of our hospital context in which results were collected and the lack of a common and popular definition of CAM remain the main limitations of our enquiry. PMID:18616209

  10. Training and certification of the surgical oncologist.

    PubMed

    Berman, Russell S; Weigel, Ronald J

    2014-12-01

    Surgical Oncology has evolved as a distinct subspecialty of General Surgery with a well-defined curriculum focused on surgical care of the cancer patient, specific areas of clinical and basic science research focus and specialty journals dedicated to the discipline. The Society of Surgical Oncology (SSO), originally formed as the James Ewing Society, has provided leadership in developing training programs in Surgical Oncology and for three decades has been involved in the approval and oversight of Surgical Oncology training programs. Over this time, Surgical Oncology Fellowship training has expanded and in 2013 there were 103 applicants for 56 fellowship positions in 21 programs. The basic tenants of Surgical Oncology training has remained devoted to the core principles of multidisciplinary care, surgical management of cancer patients and a focus on education in research, clinical trials, community outreach, patient advocacy and leadership in oncology. With the maturation of Surgical Oncology as a separate specialty, Surgical Oncology training programs are now accredited by the Accreditation Council on Graduate Medical Education (ACGME) and graduates of the programs will soon be offered subspecialty certification in Complex General Surgical Oncology (CGSO) by the American Board of Surgery, which has created a component Surgical Oncology Board (SOB). Similar expansion has occurred in other specialty areas including an expansion of Breast Fellowships, which are still being approved by the SSO. In the 2013 SSO Breast Oncology Match, there were 67 applicants for 54 positions in 39 Breast Fellowship programs. Continued advances in cancer biology and technology will challenge us to evolve training programs in Surgical Oncology to produce surgeons capable of advancing the multidisciplinary care of cancer patients. PMID:25841526

  11. Radiographic Characteristics of Adrenal Masses in Oncologic Patients

    PubMed Central

    Lee, Ji Hyun; Kim, Eun Ky; Hong, A Ram; Roh, Eun; Bae, Jae Hyun; Kim, Jung Hee; Shin, Chan Soo; Kim, Seong Yeon

    2016-01-01

    Background We aimed to assess the usefulness of pre-contrast Hounsfield unit (HU) and mass size on computed tomography to differentiate adrenal mass found incidentally in oncologic patients. Methods From 2000 to 2012, 131 oncologic patients with adrenal incidentaloma were reviewed retrospectively. Receiver operating characteristic (ROC) curves were applied to determine the optimal cut-off value of the mean HU and size for detecting adrenal metastasis. Results The median age was 18 years, and 80 patients were male. The initial mass size was 18 mm, and 71 (54.2%) of these were on the left side. A bilateral adrenal mass was found in 11 patients (8.4%). Biochemically functional masses were observed in 9.2% of patients. Thirty-six out of 119 patients with nonfunctional masses underwent adrenalectomy, which revealed metastasis in 13. The primary cancers were lung cancer (n=4), renal cell carcinoma (n=2), lymphoma (n=2), hepatocellular carcinoma (n=2), breast cancer (n=1), and others (n=2). The area under the curve for the size and HU for clinically suspicious metastasis were 0.839 (95% confidence interval [CI], 0.761 to 0.900; P<0.001) and 0.959 (95% CI, 0.898 to 0.988; P<0.001), respectively. The cut-off value to distinguish between metastasis and benign masses were 22 mm for size and 20 for HU. Conclusion ROC curve results suggest that pre-contrast HU >20 can be used as a diagnostic reference to suggest metastasis in oncologic patients with adrenal masses. PMID:26676336

  12. Clinical Pharmacology in the Adolescent Oncology Patient

    PubMed Central

    Veal, Gareth J.; Hartford, Christine M.; Stewart, Clinton F.

    2010-01-01

    Numerous studies have documented that adolescents and young adults (AYAs) experience a significant cancer burden as well as significant cancer mortality compared with other age groups. The reasons for the disparate outcomes of AYAs and other age groups are not completely understood and are likely to be multifactorial, including a range of sociodemographic issues unique to these individuals as well as differences between adolescents, younger pediatric patients, and adults in the pharmacology of anticancer agents. Because adolescence is a period of transition from childhood to early adulthood, numerous physical, physiologic, cognitive, and behavioral changes occur during this time. In this review, we provide an overview of the unique developmental physiology of the adolescent and explain how these factors and the behavioral characteristics of adolescents may affect the pharmacology of anticancer agents in this patient population. Finally, we describe examples of studies that have assessed the relation between drug disposition and age, focusing on the AYA age group. PMID:20439647

  13. Implementation of a Robotic Surgical Program in Gynaecological Oncology and Comparison with Prior Laparoscopic Series

    PubMed Central

    Povolotskaya, Natalia; Woolas, Robert; Brinkmann, Dirk

    2015-01-01

    Background. Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Method. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. Results. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2?min compared to 126.3?min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3?min in robotic group and 176.5?min in laparoscopic group. RH + BPLND surgical time was similar, 263.6?min (robotic arm) and 264.0?min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention (Clavien-Dindo classification grade 2/3) was higher in the robotic arm (22.7%) compared to the laparoscopic approach (4.5%). The readmission rate was higher in the robotic group (18.2%) compared to the laparoscopic group (4.5%). The return to theatre in the robotic group was 18.2% and 4.5% in laparoscopic group. Uncomplicated robotic surgery hospital stay appeared to be shorter, 1.3 days compared to the uncomplicated laparoscopic group, 2.5 days. There was no conversion to the open procedure in either arm. Estimated blood loss in all cases was less than 100?mL in both groups. Conclusion. Robotic surgery is comparable to laparoscopic surgery in blood loss; however, the hospital stay in uncomplicated cases appears to be longer in the laparoscopic arm. Surgical robotic time is equivalent to laparoscopic in complex cases but may be longer in cases not requiring lymph node dissection. The robotic surgery team learning curve may be associated with higher rate of morbidity. Further research on the benefits to the surgeon is needed to clarify the whole picture of this versatile novel surgical approach. PMID:25785195

  14. Interventional Radiology and the Care of the Oncology Patient

    PubMed Central

    O'Neill, Siobhan B.; O'Connor, Owen J.; Ryan, Max F.; Maher, Michael M.

    2011-01-01

    Interventional Radiology (IR) is occupying an increasingly prominent role in the care of patients with cancer, with involvement from initial diagnosis, right through to minimally invasive treatment of the malignancy and its complications. Adequate diagnostic samples can be obtained under image guidance by percutaneous biopsy and needle aspiration in an accurate and minimally invasive manner. IR techniques may be used to place central venous access devices with well-established safety and efficacy. Therapeutic applications of IR in the oncology patient include local tumour treatments such as transarterial chemo-embolisation and radiofrequency ablation, as well as management of complications of malignancy such as pain, organ obstruction, and venous thrombosis. PMID:22091374

  15. Post-surgical therapeutic approaches to glioblastoma patients submitted to biopsy (BA) or "partial" resection (PR): the possibilities to treat also them without renunciations. Study from the Brescia Neuro-Oncology Group.

    PubMed

    Buglione, Michela; Borghetti, Paolo; Pedretti, Sara; Triggiani, Luca; Fontanella, Marco Maria; Spena, Giannantonio; Grisanti, Salvatore; Liserre, Roberto; Poliani, Luigi Pietro; Gipponi, Stefano; Spiazzi, Luigi; Magrini, Stefano Maria

    2015-10-01

    The extent of surgery predicts overall survival (OS) in patients treated for glioblastoma (GBM). The therapeutic approach after partial resection (PR) or biopsy alone (BA) is not clearly defined. This retrospective analysis was therefore planned to analyse clinical features, treatment and survival of patients undergoing PR or BA. We analysed the clinical/therapeutic features and the outcome of 232 patients submitted to BA/PR and treated with radiotherapy (RT) with/without chemotherapy. Two subgroups (pre- and post-Temozolomide-era) were identified. The BA/PR ratio did not change with the accrual periods. In the TMZ-era, 50 % of the patients had chemotherapy; "small" volume, hypo-fractionated and "low" dose RT (<54 Gy) were delivered to 93, 38 and 44 % of the patients; corresponding values for the previous period were 4, 28, 11 and 2 % (P < 0.001). Better two-year OS was evident in the TMZ-era (18 vs 7 %); PR and chemotherapy affected OS in patients treated with hypo-fractionated, low doses RT (P = 0.02, 0.04). Limited volume, more often MRI-based, and "short" RT treatments were given mostly to unfavourably selected patients, without compromising the results of the whole group. This strategy, combined with an increased use of chemotherapy, resulted in reduced treatment burden, in an improved 2-year OS rate and prospectively in better quality of life, even in this prognostically worse subset of glioma patients. PMID:25773653

  16. The role of the physiotherapy in the plastic surgery patients after oncological breast surgery

    PubMed Central

    Sandrin, Fabio

    2014-01-01

    Introduction Breast cancer is the disease which causes the greatest concern among women worldwide, with an estimated 1,152,161 new cases each year. The improvement of surgical techniques, neoadjuvant and adjuvant treatment enhance the survival time and recovery of these patients. As surgery is the first choice for the treatment of breast neoplasms reconstructive surgery has become an important procedure helping to reconstruct the mutilation after radical or conservative breast surgery. The objective of this article is to review the scientific literature and examine the available data regarding the role of physiotherapy in patients who undergo plastic reconstruction after oncological breast surgery, including suggestions on how physiotherapy could be applied in that population. Materials and methods Our review was obtained by searching the PubMed (National Library of Medicine, USA) and LILACS (Latin American and Caribbean Health Sciences) databases. Terms applied concerned physiotherapy and breast reconstructive surgery. The time of limit for our search was from 1995 until the present date. Results Fourteen articles were included in our review that matched our search criteria. Conclusions Physiotherapy is a field that still needs evidence based on daily routine and studies in the oncological physiotherapy field. Evaluation should be standardized and rehabilitation techniques used are empirical and should be researched in patients who undergo plastic reconstruction after breast surgery. The lack of post-surgery exercise protocols makes it difficult to analyse the patient’s evolution and makes it a challenge to investigate the true role of physiotherapy in this population. PMID:25083493

  17. Outcome of the Gynecologic Oncology Patients Surveillance Network Program.

    PubMed

    Suprasert, Prapaporn; Suwansirikul, Songkiat; Charoenkwan, Kittipat; Cheewakriangkrai, Chalong; Suwansirikul, Songkiat

    2015-01-01

    The gynecologic oncology patients surveillance network program was conducted with the collaboration of 5 provincial hospitals located in the north of Thailand (Chiang Rai, Lamphun Nan, Phayao and Phrae). The aim was to identify ways of reducing the burden and the cost to the gynecologic cancer patients who needed to travel to the tertiary care hospital for follow up. The clinical data of each patient was transferred to the provincial hospital by the internet via the website www.gogcmu.or.th. All the general gynecologists who participated in this project attended the training course set up for the program. From January 2011 to February 2014, 854 patients who were willing to have their next follow-up at the network hospitals close to their home were enrolled this project. Almost of them were residents in Chiang Rai province and the most common disease was cervical cancer. After the project had been running for 1 year, 604 of the enrolled patients and 21 health-care personnel who had participated in this project were interviewed to assess its success. Some 85.3% of the patients and 100% of the health-care personnel were satisfied with this project. However, 60 patients had withdrawn, the most common reason being the lack of confidence in the follow up at the local provincial hospital. In conclusion, it is possible to initiate a gynecologic oncology patients' surveillance network program and the initiation could reduce the problems associated with and the cost the patients incurred as they journeyed to the tertiary care hospital. PMID:26163612

  18. Electronic patient-reported outcome systems in oncology clinical practice.

    PubMed

    Bennett, Antonia V; Jensen, Roxanne E; Basch, Ethan

    2012-01-01

    Patient-reported outcome (PRO) questionnaires assess topics a patient can report about his or her own health. This includes symptoms (eg, nausea, fatigue, diarrhea, pain, or frequent urination), physical functioning (eg, difficulty climbing stairs or difficulty fastening buttons), and mental health (eg, anxiety, fear, or worry). Electronic PRO (ePRO) systems are used in oncology clinical care because of 1) their ability to enhance clinical care by flagging important symptoms and saving clinicians time; 2) the availability of standardized methods for creating and implementing PROs in clinics; and 3) the existence of user-friendly platforms for patient self-reporting like tablet computers and automated telephone surveys. Many ePRO systems can provide actionable links to clinical care such as summary reports in a patient's electronic medical record and real-time e-mail alerts to providers when patients report acute needs. This review presents 5 examples of ePRO systems currently in use in oncology practice. These systems support multiple clinical activities, including assessment of symptoms and toxicities related to chemotherapy and radiation, postoperative surveillance, and symptom management during palliative care and hospice. Patient self-reporting is possible both at clinical visits and between visits over the Internet or by telephone. The implementation of an ePRO system requires significant resources and expertise, as well as user training. ePRO systems enable regular monitoring of patient symptoms, function, and needs, and can enhance the efficiency and quality of care as well as communication with patients. PMID:22811342

  19. The 2013 Society of Surgical Oncology Susan G. Komen for the Cure Symposium: MRI in breast cancer: where are we now?

    PubMed

    McLaughlin, Sarah; Mittendorf, Elizabeth A; Bleicher, Richard J; McCready, David R; King, Tari A

    2014-01-01

    Magnetic resonance imaging (MRI) has been widely applied in the contemporary management of patients with breast cancer and as a screening tool for those at increased risk; however, prospective evidence that the use of breast MRI improves patient outcomes remains limited to screening of known BRCA mutation carriers or women at increased risk based on a strong family history. Despite this, the role of MRI in the routine evaluation of the newly diagnosed breast cancer patient remains a subject of much debate, with widely divergent views on the value of MRI in selecting local therapy. The application of MRI in patients undergoing neoadjuvant therapy is an area of active investigation, with several potential benefits, including predicting response to therapy. We review the current state of the literature on the topics of MRI for screening, MRI and short-term surgical outcomes, MRI and long-term surgical outcomes, and MRI and neoadjuvant chemotherapy as presented at the 2013 Society of Surgical Oncology Susan G. Komen for the Cure Symposium, 9 March 2013. PMID:24145992

  20. Thromboprophylaxis in non-surgical cancer patients.

    PubMed

    Cohen, Alexander T; Gurwith, Meredith M P; Dobromirski, Mark

    2012-04-01

    Acutely ill medical patients with cancer and cancer patients requiring non-surgical therapy are considered as non-surgical cancer patients and are at moderate to high risk of venous thromboembolism (VTE): approximately 10-30% of these patients may develop asymptomatic or symptomatic deep-vein thrombosis (DVT) or pulmonary embolism (PE), and the latter is a leading contributor to deaths in hospital. Other medical conditions associated with a high risk of VTE include cardiac disease, respiratory disease, inflammatory bowel disease, rheumatological and infectious diseases. Pre-disposing risk factors in non-surgical cancer patients include a history of VTE, immobilisation, history of metastatic malignancy, complicating infections, increasing age, obesity hormonal or antiangiogenic therapies, thalidomide and lenalidomide therapy. Heparins, both unfractionated (UFH) and low molecular weight heparin (LMWH) and fondaparinux have been shown to be effective agents in prevention of VTE in the medical setting with patients having a history of cancer. UFH and LMWH along with semuloparin also have a role in outpatients with cancer receiving chemotherapy. However, it has not yet been possible to demonstrate a significant effect on mortality rates in this population. UFH has a higher rate of bleeding complications than LMWH. Thromboprophylaxis has been shown to be effective in medical patients with cancer and may have an effect on cancer outcomes. Thromboprophylaxis in patients receiving chemotherapy remains controversial and requires further investigation. There is no evidence for the use of aspirin, warfarin or mechanical methods. We recommend either LMWH, or fondaparinux for the prevention of VTE in cancer patients with acute medical illnesses and UFH for those with significant severe renal impairment. For ambulatory cancer patients undergoing chemotherapy we recommend LMWH or semuloparin. These are safe and effective agents in the thromboprophylaxis of non-surgical cancer patients. PMID:22682125

  1. Complementary and Alternative Medicine (CAM) use by Malaysian oncology patients.

    PubMed

    Farooqui, Maryam; Hassali, Mohamed Azmi; Abdul Shatar, Aishah Knight; Shafie, Asrul Akmal; Seang, Tan Boon; Farooqui, Muhammad Aslam

    2012-05-01

    The current study sought to evaluate Malaysian oncology patients' decision making about the use of Complementary and Alternative Medicine (CAM) for the management of their care. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified four central themes: Conceptualizing CAM, the decision making process; rationale given for selecting or rejecting CAM and barriers to CAM use. Participants generally used the term 'traditional medicine', referred to locally as 'ubat kampung', meaning medicine derived from 'local traditions'. Mixed reactions were shown concerning the effectiveness of CAM to cure cancer and the slow progression of CAM results and treatment costs were cited as major barriers to CAM use. Concerns regarding safety and efficacy of CAM in ameliorating cancer as well as potential interactions with conventional therapies highlighted the importance of patients' knowledge about cancer treatments. PMID:22500849

  2. Implanted Cardiac Defibrillator Care in Radiation Oncology Patient Population

    SciTech Connect

    Gelblum, Daphna Y. Amols, Howard

    2009-04-01

    Purpose: To review the experience of a large cancer center with radiotherapy (RT) patients bearing implantable cardiac defibrillators (ICDs) to propose some preliminary care guidelines as we learn more about the devices and their interaction with the therapeutic radiation environment. Methods and Materials: We collected data on patients with implanted ICDs treated with RT during a 2.5-year period at any of the five Memorial Sloan-Kettering clinical campuses. Information regarding the model, location, and dose detected from the device, as well as the treatment fields, fraction size, and treatment energy was collected. During this time, a new management policy for these patients had been implemented requiring treatment with low-energy beams (6 MV) and close surveillance of the patients in partnership with their electrophysiologist, as they received RT. Results: During the study period, 33 patients were treated with an ICD in place. One patient experienced a default of the device to its initial factory setting that was detected by the patient hearing an auditory signal from the device. This patient had initially been treated with a 15-MV beam. After this episode, his treatment was replanned to be completed with 6-MV photons, and he experienced no further events. Conclusion: Patients with ICDs and other implanted computer-controlled devices will be encountered more frequently in the RT department, and proper management is important. We present a policy for the safe treatment of these patients in the radiation oncology environment.

  3. [Subcutaneously inserted central intravascular devices in the pediatric oncology patient: can we minimize their infection].

    PubMed

    Tardáguila, A R; Del Cañizo, A; Santos, M M; Fanjul, M; Corona, C; Zornoza, M; Parente, A; Carrera, N; Beléndez, C; Cerdá, J; Saavedra, J; Molina, E; García-Casillas, M A; Peláez, D

    2011-10-01

    Long-term indwelling central venous access devices are frequently used in pediatric patients. Their main complication is infection, that can even mean their removal. We try to identify the risk factors really involved in this complication and in their removal. We have made a retrospective review of 120 oncologic pediatric patients who received a central venous device between 2003 and 2009. We searched for epidemiologic, clinic, microbiologic and surgical risk factors. We made a comparative data analysis among: GROUP A, children who suffered device infection, GROUP B the others. Group A was divided into early infection (first month after implantation)/late infection, removed/not removed. Data were analized with statistical program SPSS. 29 suffered from leukemia, 19 from lymphoma and the main part, 72, from solid tumour. 31% experienced infection (GROUP A), being early in the 36% of them. 16% had to be withdrawn. Data analysis revealed statistical association with the age (p=0.015) and with the reception of chemiotherapic treatment the week before the surgical insertion. The rest of the studied factors did not revealed a real association, but could be guess a relationship among infection and leukemia, subclavian catheters, those patients whose deviced was introduced using a guide over a previous catheter and also transplanted. Related to early infection the only associateon founded was with the subclavian access (p=0.018). In conclusion, in our serie long-term central venous access infection was more frequent in the younger patients and also in those who had received chemotherapy the week before the catheter implantation. The tendency towards infection in leukemia, transplanted and subclavian carriers has to be studied in a prospective way with a larger number of oncologic children. PMID:23155633

  4. Supracricoid laryngectomies: oncological and functional results for 152 patients.

    PubMed

    Leone, C A; Capasso, P; Russo, G; D'Errico, P; Cutillo, P; Orabona, P

    2014-10-01

    The purpose of this study was to evaluate the oncological and functional outcomes in patients who underwent supracricoid laryngectomies with a crico-hyoidopexy (SCL-CHP) or a crico-hyoido-epiglottopexy (SCL-CHEP) for the treatment of primary and reccurent laryngeal cancer. A retrospective study was conducted on 152 consecutive patients seen from January 1996 to December 2006. Overall survival (OS) and disease-free survival (DFS) were analysed using the Kaplan-Meier method, and were compared according to the type of surgery and clinical stage of the tumour. The mean period before decannulation, nasogastric tube (NGT) removal and recovery of a normal diet and speech were evaluated, and statistical analyses were performed regarding the association with the type of surgery and arytenoidectomy. The median follow-up period was 49.9 months (range: 10-110 months). The 3- and 5-year OS were 87.5 and 83.5%, respectively, and 3- and 5-year DFS were 78.3 and 73.7%, respectively. For patients with early stages tumours, the 5-year OS and DFS were 92.3 and 84.6% respectively, whereas for patients with locally advanced stage tumours, the OS and DFS were 74.3 and 62.2%, respectively. Significant differences in OS and DFS for patients who had early or locally advanced cancers were found (p = 0.0004 and p = 0.0032, respectively). The rate of overall local control was 92.1%, while the mean period until decannulation or NGT removal was 25.1 and 16.6 days, respectively. The mean period until NGT removal was significantly different according to the type of surgery (p = 0.0001) and whether arytenoidectomy was performed (p = 0.0001). The reliable oncological and functional results of SCL for early and locally advanced laryngeal cancers are confirmed by our series of patients. PMID:25709147

  5. Human Rhinovirus C Infections in Pediatric Hematology and Oncology Patients

    PubMed Central

    Loria, Carolina; Domm, Jennifer A.; Halasa, Natasha B.; Heitman, Elizabeth; Miller, E. Kathryn; Xu, Meng; Saville, Benjamin R.; Frangoul, Haydar; Williams, John V.

    2014-01-01

    Background Children with cancer and hematopoietic stem cell transplant (HSCT) recipients are at high risk for common viral infections. We sought to define the viral etiology of acute respiratory infections (ARI) and identify risk factors. Methods Nasal wash samples were collected from pediatric hematology-oncology patients and HSCT recipients with ARI during the 2003–2005 winter seasons. Real-time RT-PCR was performed to detect influenza A (Flu A), influenza B, respiratory syncytial virus (RSV), parainfluenzaviruses (PIV) 1–3, human metapneumovirus (MPV), and human rhinoviruses (HRV). HRV specimens were sequenced and genotyped. Results Seventy-eight samples from 62 children were included. Viruses were detected in 31 of 78 samples (40%). HRV were detected most frequently, in 16 (52%) including 5 HRV type C (HRVC); followed by 7 (22%) RSV, 5 (16%) Flu A, 4 (13%) MPV and 2 (6%) PIV2. There was a trend toward higher risk of viral infection for children in daycare. Only 8% of the study children had received infuenza vaccine. Conclusions HRV, including the recently discovered HRVC, are an important cause of infection in pediatric oncology and HSCT patients. Molecular testing is superior to conventional methods and should be standard of care, since HRV are not detected by conventional methods. PMID:25377237

  6. Urinary tract infections in surgical patients.

    PubMed

    Ramanathan, Rajesh; Duane, Therese M

    2014-12-01

    Catheter-associated urinary tract infections (CAUTI) are common in surgical patients. CAUTI are associated with adverse patient outcomes, and negatively affects public safety reporting and reimbursement. Inappropriate catheter use and prolonged catheter duration are major risk factors for CAUTI. CAUTI pathogenesis and treatment are complicated by the presence of biofilms. Prevention strategies include accurate identification and tracking of CAUTIs, and the development of institutional guidelines for the appropriate use, duration, alternatives, and removal of indwelling urinary catheters. PMID:25440128

  7. [Transketolase activity and thiamine diphosphate content in oncological patients].

    PubMed

    Trebukhina, R V; Tumanov, V N; Avde?chik, L A; Bobko, I N; Tsabenko, I I

    1983-01-01

    In blood of patients with cancer of stomach and mammary gland total thiamin content was measured by means of fluorimetric procedure, thiamindiphosphate (TDP)--by an enzymatic method, activity of transketolase was estimated in presence or in absence of TDP. Concentration of total thiamin in blood of healthy persons was 7.65 +/- 0.40 micrograms/100 ml; thiamindiphosphate--5.06 micrograms/100 ml activity of transketolase was 11.59 +/- 0.23 mmol/l. The "TDP" -effect was altered from 4% to 12%. In blood of oncological patients the concentration of total thiamin was 4.47 +/- 0.35 micrograms/100 ml and that of thiamindiphosphate 3.09 +/- 0.27 micrograms/100 ml, i.e. they were decreased by 40%. The transketolase activity was decreased by 20% (9.40 +/- 0.37 mmol/l); the "TDP" -effect was altered from 5% to 42%. PMID:6649520

  8. Prevention of VTE in Nonorthopedic Surgical Patients

    PubMed Central

    Garcia, David A.; Wren, Sherry M.; Karanicolas, Paul J.; Arcelus, Juan I.; Heit, John A.; Samama, Charles M.

    2012-01-01

    Background: VTE is a common cause of preventable death in surgical patients. Methods: We developed recommendations for thromboprophylaxis in nonorthopedic surgical patients by using systematic methods as described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: We describe several alternatives for stratifying the risk of VTE in general and abdominal-pelvic surgical patients. When the risk for VTE is very low (< 0.5%), we recommend that no specific pharmacologic (Grade 1B) or mechanical (Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE (∼1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE (∼3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE (∼6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava filter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. PMID:22315263

  9. Nutrition management of geriatric surgical patients.

    PubMed

    Dudrick, Stanley J

    2011-08-01

    Surgery in geriatric patients is accompanied by increases in morbidity and mortality, increases in functional abnormalities and poor outcomes, and increases in severe malnutrition, compared with surgery of similar magnitude in nongeriatric patients. Hospitalized elderly patients are at significant risk of presenting with, or developing, protein-energy and other nutrient deficiencies. However, nutritional assessment of older geriatric patients, 65 to 100 years of age, is a challenging task because of lack of adequate age-specific reference data in this diverse and heterogeneous population. Dietary counseling and conscientious, aggressive nutritional support are required for optimal metabolic and surgical care of this age group. PMID:21787973

  10. [From the surgical field to the microscope. A new tool to identify the lymph node specimens in oncologic surgery].

    PubMed

    Molnár, F Tamás; Horváth, Ors Péter; Farkas, László; Gerlinger, Imre; Pajor, László; Kelemen, Dezsô; Kalmár Nagy, Károly; Tizedes, György; Pavlovics, Gábor; Bódis, József; Gocze, Péter; Szekeres, György

    2011-02-01

    Oncologic surgery and pTNM staging require systemic removal of the locoregional lymphnodes. While the optimal extent and therapeutical and/or prognostic value of the lymphadenectomy/sampling are debated organ by organ and (sub)speciality by (sub)speciality, relevance of the lymphnode sytem-tumor concept itself is beyond doubt. Loss of information and existence of traps on the "surgical field-microscope" pathway is an international phenomenon, calling for solution. An integrated sterile and disposable lymphnode tray system is presented here for applications in the different fields of cancer surgery of the upper GI tract, retroperitoneum (gynecology, urology) and ear-nose-throat surgery. PMID:21330257

  11. Development of an electronic radiation oncology patient information management system.

    PubMed

    Mandal, Abhijit; Asthana, Anupam Kumar; Aggarwal, Lalit Mohan

    2008-01-01

    The quality of patient care is critically influenced by the availability of accurate information and its efficient management. Radiation oncology consists of many information components, for example there may be information related to the patient (e.g., profile, disease site, stage, etc.), to people (radiation oncologists, radiological physicists, technologists, etc.), and to equipment (diagnostic, planning, treatment, etc.). These different data must be integrated. A comprehensive information management system is essential for efficient storage and retrieval of the enormous amounts of information. A radiation therapy patient information system (RTPIS) has been developed using open source software. PHP and JAVA script was used as the programming languages, MySQL as the database, and HTML and CSF as the design tool. This system utilizes typical web browsing technology using a WAMP5 server. Any user having a unique user ID and password can access this RTPIS. The user ID and password is issued separately to each individual according to the person's job responsibilities and accountability, so that users will be able to only access data that is related to their job responsibilities. With this system authentic users will be able to use a simple web browsing procedure to gain instant access. All types of users in the radiation oncology department should find it user-friendly. The maintenance of the system will not require large human resources or space. The file storage and retrieval process would be be satisfactory, unique, uniform, and easily accessible with adequate data protection. There will be very little possibility of unauthorized handling with this system. There will also be minimal risk of loss or accidental destruction of information. PMID:19052391

  12. [SURGICAL TREATMENT OF PATIENTS WITH URETERAL RUPTURES].

    PubMed

    Komjakov, B K; Guliev, B G

    2015-01-01

    The aim of the study was to analyze the causes of ureteral ruptures and the types surgical procedures used for their management. Over the period from 2006 to 2014, 7 patients with ureteral ruptures underwent surgical treatment in the Mechnikov N-WSMU clinic. All of them were males aged 50 to 71 years. In all cases, the ureter was injured during ureteroscopy and contact lithotripsy. In two patients the right ureter was cut off at the border of the upper and middle third, in four--at 3-4 cm below pyeloureteral segment, one patient diagnosed with a complete separation of the ureter from the kidney pelvis. Patients, who have suffered a detachment of the ureter in other hospitals, previously underwent surgical exploration of the retroperitoneal space, drainage of the kidney by pyelonephrostomy (5) and ureterocutaneostomy (1). In a case of a patient with an injury that occurred in our clinic, laparoscopic nephrectomy with autologous renal transplantation was carried out. Five patients with extended ureter defects underwent ileo-ureteroplasty. The patient with left ureterocutaneostomy underwent nephrovesical bypass. Patency of the upper urinary tract and kidney function were restored in all patients, all of them were relieved from external drains. The duration of the intestinal plastic averaged 160 minutes, laparoscopic nephrectomy with autologous transplantation--210 min and nephrovesical bypass--110 min. Blood transfusion was required only in autologous graft patient. The ureteral rupture is a serious complication of ureteral endourological procedures in upper urinary tract. It requires such complicated reconstructive operations as autologous transplantation of the kidney or intestinal ureteroplasty. PMID:26390553

  13. Surgical management and perioperative morbidity of patients with primary borderline ovarian tumor (BOT)

    PubMed Central

    2013-01-01

    Background Surgery is the cornerstone for clinical management of patients with borderline ovarian tumors (BOT). As these patients have an excellent overall prognosis, perioperative morbidity is the critical point for decision making when the treatment strategy is developed and the primary surgical approach is defined. Methods Clinical and surgical parameters of patients undergoing surgery for primary BOT at our institutions between 1993 and 2008 were analyzed with regard to perioperative morbidity depending on the surgical approach (laparotomy vs. laparoscopy). Results A total of 105 patients were analyzed (44 with primary laparoscopy [42%], 61 with primary laparotomy [58%]). Complete surgical staging was achieved in 33 patients at primary surgical approach (31.4%) frequently leading to formal indication of re-staging procedures. Tumor rupture was significantly more frequent during laparoscopy compared to laparotomy (29.5% vs. 13.1%, p?=?0.038) but no other intraoperative complications were seen in laparoscopic surgery in contrast to 7 of 61 laparotomies (0% vs. 11.5%, p?=?0.020). Postoperative complication rates were similar in both groups (19.7% vs. 18.2%, p?=?0.848). Conclusions Irrespective of the surgical approach, surgical management of BOT has acceptable rates of perioperative complications and morbidity. Choice of initial surgical approach can therefore be made independent of complication-concerns. As the recently published large retrospective AGO ROBOT study observed similar oncologic outcome for both approaches, laparoscopy can be considered for staging of patients with BOT if this appears feasible. An algorithm for the surgical management of BOT patients has been developed. PMID:23837881

  14. The Process of Oncology Nurse Practitioner Patient Navigation: A Pilot Study.

    PubMed

    Johnson, Frances

    2016-04-01

    Oncology nurse practitioner (ONP) patient navigators may improve clinical outcomes. However, no standard measures of the process of oncology patient navigation or of related clinical outcomes exist, and research in this area is limited. The exploratory pilot study detailed in this article used grounded theory and interviews with three ONPs to define the processes employed by ONP patient navigators in caring for patients with cancer.
. PMID:26991716

  15. Surgical jejunostomy in aspiration risk patients.

    PubMed Central

    Weltz, C R; Morris, J B; Mullen, J L

    1992-01-01

    One hundred patients underwent laparotomy for independent jejunal feeding tube placement. Neurologic disease was present in 50%, and obtundation (28) and oropharyngeal dysmotility (25) were the most common indications for enteral feeding. The post-pyloric route was chosen because of aspiration risk in almost all (94%) patients. Postoperative (30-day) mortality rate was 21%, because of cardiopulmonary failure in most (18). One death resulted directly from aspiration of tube feeds. Two surgical complications required reoperation: one wound dehiscence and one small bowel obstruction. Four wound infections occurred. Two patients underwent reoperation after tube removal, and four tubes required fluoroscopically guided reinsertion for peritubular drainage (2), removal (1), and occlusion (1). Aspiration pneumonia was present in 18 patients preoperatively and in eight postoperatively. None of the patients with feeding-related preoperative aspiration pneumonia (13) had a recurrence while fed by jejunostomy. Three patients developed postoperative aspiration pneumonia before initiation of jejunostomy feedings. Jejunostomy may be performed with low morbidity rate and substantial reduction of feeding-related aspiration pneumonia, and is the feeding route of choice in aspiration risk patients. PMID:1546899

  16. Safety of pull-type and introducer percutaneous endoscopic gastrostomy tubes in oncology patients: a retrospective analysis

    PubMed Central

    2011-01-01

    Background Percutaneous endoscopic gastrostomy (PEG) allows long-term tube feeding. Safety of pull-type and introducer PEG placement in oncology patients with head/neck or oesophageal malignancies is unknown. Methods Retrospective analysis of 299 patients undergoing PEG tube placement between January 2006 and December 2008 revealed 57 oncology patients. All patients with head/neck or oesophageal malignancy were treated with chemo- and radiotherapy. In case of high-grade stenosis introducer Freka® Pexact PEG tube was placed (n = 24) and in all other patients (n = 33) conventional pull-type PEG tube. Short-term complications and mortality rates were compared. Results Patients' characteristics and clinical status were comparable in both groups. Short-term complications were encountered in 11/24 (48%) introducer PEG patients as compared to only 4/33 (12%) pull-type PEG patients (P < 0.05). Accidental removal of the introducer PEG tube occurred in 4/24 (17%) with need for surgical intervention in 1 vs. 0/33 (0%, P < 0.05). Wound infection occurred in 3/24 (12%) leading to septic shock and admission to intensive care unit (ICU) in 1 vs. 3/33 (9%, NS). Finally, 3/24 gastrointestinal perforations (12%) resulted from a difficult placement procedure vs. 1/33 (3%), leading to urgent surgical intervention and admission to ICU. Two introducer PEG patients died at ICU, resulting in an overall mortality rate of 8% vs. 0% (P = 0.091). Conclusion The introducer Freka® Pexact PEG procedure for long-term tube feeding may lead to significantly higher complication and mortality rates in patients with head/neck or oesophageal malignancies treated with chemo- and radiotherapy. It is suggested to use the conventional pull-type PEG tube placement in this group of patients, if possible. PMID:21410958

  17. Improving oncologic outcomes for colorectal cancer at high risk for local-regional recurrence with novel surgical techniques.

    PubMed

    Sugarbaker, Paul H

    2016-02-01

    Despite innovation in surgical technology, colorectal adenocarcinoma is a disease process with a risk of local and regional progression of disease. This article seeks to identify patients with primary disease who are at high risk for minimal residual disease from cancer spread after resection. These are the patients who will profit from novel perioperative surgical treatments that will improve the clearance and containment of cancer cells disseminated prior to or at the time of the adenocarcinoma resection. Clinical factors that identify these patients at high risk for local recurrence and peritoneal metastases are presented. Data regarding novel surgical techniques that include perioperative cancer chemotherapy to provide more optimal treatment are described. The perioperative timing of the revised surgical options is emphasized. PMID:26643935

  18. Surgical Guides (Patient-Specific Instruments) for Pediatric Tibial Bone Sarcoma Resection and Allograft Reconstruction

    PubMed Central

    Bellanova, Laura; Paul, Laurent; Docquier, Pierre-Louis

    2013-01-01

    To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI) and computerized tomography (CT) were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument) that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis. PMID:23533326

  19. Surgical patients travel longer distances than non-surgical patients to receive care at a rural hospital in Mozambique

    PubMed Central

    Faierman, Michelle L.; Anderson, Jamie E.; Assane, Americo; Bendix, Peter; Vaz, Fernando; Rose, John A.; Funzamo, Carlos; Bickler, Stephen W.; Noormahomed, Emilia V.

    2015-01-01

    Background Surgical care is increasingly recognised as an important component of global health delivery. However, there are still major gaps in knowledge related to access to surgical care in low-income countries. In this study, we compare distances travelled by surgical patients with patients seeking other medical services at a first-level hospital in rural Mozambique. Methods Data were collected on all inpatients at Hospital Rural de Chókwè in rural Mozambique between 20 June 2012 and 3 August 2012. Euclidean distances travelled by surgical versus non-surgical patients using coordinates of each patient's city of residence were compared. Data were analysed using ArcGIS 10 and STATA. Results In total, 500 patients were included. Almost one-half (47.6%) lived in the city where the hospital is based. By hospital ward, the majority (62.0%) of maternity patients came from within the hospital's city compared with only 35.2% of surgical patients. The average distance travelled was longest for surgical patients (42 km) compared with an average of 17 km for patients on all other wards. Conclusions Patients seeking surgical care at this first-level hospital travel farther than patients seeking other services. While other patients may have access to at community clinics, surgical patients depend more heavily on the services available at first-level hospitals. PMID:25135818

  20. Resecting diffuse low-grade gliomas to the boundaries of brain functions: a new concept in surgical neuro-oncology.

    PubMed

    Duffau, H

    2015-12-01

    The traditional dilemma making surgery for diffuse low-grade gliomas (DLGGs) challenging is underlain by the need to optimize tumor resection in order to significantly increase survival versus the risk of permanent neurological morbidity. Development of neuroimaging led neurosurgeons to achieve tumorectomy according to the oncological limits provided by preoperative or intraoperative structural and metabolic imaging. However, this principle is not coherent, neither with the infiltrative nature of DLGGs nor with the limited resolution of current neuroimaging. Indeed, despite technical advances, MRI still underestimates the actual spatial extent of gliomas, since tumoral cells are present several millimeters to centimeters beyond the area of signal abnormalities. Furthermore, cortical and subcortical structures may be still crucial for brain functions despite their invasion by this diffuse tumoral disease. Finally, the lack of reliability of functional MRI has also been demonstrated. Therefore, to talk about "maximal safe resection" based upon neuroimaging is a non-sense, because oncological MRI does not show the tumor and functional MRI does not show critical neural pathways. This review proposes an original concept in neuro-oncological surgery, i.e. to resect DLGG to the boundaries of brain functions, thanks to intraoperative electrical mapping performed in awake patients. This paradigmatic shift from image-guided resection to functional mapping-guided resection, based upon an accurate study of brain connectomics and neuroplasticity in each patient throughout tumor removal has permitted to solve the classical dilemma, by increasing both survival and quality of life in DLGG patients. With this in mind, brain surgeons should also be neuroscientists. PMID:25907410

  1. Serotonin syndrome: take a closer look at the unwell surgical patient

    PubMed Central

    Shaikh, ZS; Krueper, S; Malins, TJ

    2011-01-01

    This article describes the sequence of acute clinical deterioration seen in a head and neck oncology patient who developed serotonin syndrome perioperatively. It highlights the clinical dilemma that can be encountered when a septic picture masks the onset of serotonin syndrome and reinforces the importance of awareness of the potential interactions and side effects associated with drugs that surgeons prescribe. We discuss the pathophysiology, causal factors, clinical presentation and diagnosis of serotonin syndrome as well as highlighting some of the dilemmas that this condition presents in the surgical setting. PMID:22041229

  2. Patient-Reported Outcomes and Survivorship in Radiation Oncology: Overcoming the Cons

    PubMed Central

    Siddiqui, Farzan; Liu, Arthur K.; Watkins-Bruner, Deborah; Movsas, Benjamin

    2014-01-01

    Purpose Although patient-reported outcomes (PROs) have become a key component of clinical oncology trials, many challenges exist regarding their optimal application. The goal of this article is to methodically review these barriers and suggest strategies to overcome them. This review will primarily focus on radiation oncology examples, will address issues regarding the “why, how, and what” of PROs, and will provide strategies for difficult problems such as methods for reducing missing data. This review will also address cancer survivorship because it closely relates to PROs. Methods Key articles focusing on PROs, quality of life, and survivorship issues in oncology trials are highlighted, with an emphasis on radiation oncology clinical trials. Publications and Web sites of various governmental and regulatory agencies are also reviewed. Results The study of PROs in clinical oncology trials has become well established. There are guidelines provided by organizations such as the US Food and Drug Administration that clearly indicate the importance of and methodology for studying PROs. Clinical trials in oncology have repeatedly demonstrated the value of studying PROs and suggested ways to overcome some of the key challenges. The Radiation Therapy Oncology Group (RTOG) has led some of these efforts, and their contributions are highlighted. The current state of cancer survivorship guidelines is also discussed. Conclusion The study of PROs presents significant benefits in understanding and treating toxicities and enhancing quality of life; however, challenges remain. Strategies are presented to overcome these hurdles, which will ultimately improve cancer survivorship. PMID:25113760

  3. The Effectiveness of a Participatory Program on Fall Prevention in Oncology Patients

    ERIC Educational Resources Information Center

    Huang, Li-Chi; Ma, Wei-Fen; Li, Tsai-Chung; Liang, Yia-Wun; Tsai, Li-Yun; Chang, Fy-Uan

    2015-01-01

    Falls are known to be one of the most common in patient adverse events. A high incidence of falls was reported on patients with cancer. The purpose of this study was to explore the effect of a participatory program on patient's knowledge and self-efficacy of fall prevention and fall incidence in an oncology ward. In this quasi-experimental study,…

  4. The Use of Art in the Medical Decision-Making Process of Oncology Patients

    ERIC Educational Resources Information Center

    Czamanski-Cohen, Johanna

    2012-01-01

    The introduction of written informed consent in the 1970s created expectations of shared decision making between doctors and patients that has led to decisional conflict for some patients. This study utilized a collaborative, intrinsic case study approach to the decision-making process of oncology patients who participated in an open art therapy…

  5. The Use of Art in the Medical Decision-Making Process of Oncology Patients

    ERIC Educational Resources Information Center

    Czamanski-Cohen, Johanna

    2012-01-01

    The introduction of written informed consent in the 1970s created expectations of shared decision making between doctors and patients that has led to decisional conflict for some patients. This study utilized a collaborative, intrinsic case study approach to the decision-making process of oncology patients who participated in an open art therapy…

  6. Cooling in Surgical Patients: Two Case Reports

    PubMed Central

    Gurreebun, Bibi F.; Zipitis, Christos S.; Edi-Osagie, Ngozi E.; Dady, Ian M.; Sylvan, Axel

    2014-01-01

    Moderate induced hypothermia has become standard of care for children with peripartum hypoxic ischaemic encephalopathy. However, children with congenital abnormalities and conditions requiring surgical intervention have been excluded from randomised controlled trials investigating this, in view of concerns regarding the potential side effects of cooling that can affect surgery. We report two cases of children, born with congenital conditions requiring surgery, who were successfully cooled and stabilised medically before undergoing surgery. Our first patient was diagnosed after birth with duodenal atresia after prolonged resuscitation, while the second had an antenatal diagnosis of left-sided congenital diaphragmatic hernia and suffered an episode of hypoxia at birth. They both met the criteria for cooling and after weighing the pros and cons, this was initiated. Both patients were medically stabilised and successfully underwent therapeutic hypothermia. Potential complications were investigated for and treated as required before they both underwent surgery successfully. We review the potential side effects of cooling, especially regarding coagulation defects. We conclude that newborns with conditions requiring surgery need not be excluded from therapeutic hypothermia if they might benefit from it. PMID:24551469

  7. [Surgical treatment of patients with severe fecal incontinence].

    PubMed

    Frolov, S A; Titov, A Iu; Poletov, N N; Kostarev, I V; Fomenko, O Iu

    2014-01-01

    The objective of the study is improvement of clinical and functional results of surgical treatment of patients with severe fecal incontinence. 79 patients with complete fecal incontinence were included in the study. The technique of surgical intervention was choosed in depending on the localization of structural and functional disorders of the rectum closing apparatus. Complex treatment in pre-operative and post-operative periods was directed on the improvement of functional results. Long-term results (6-24 months) were traced in 63 patients after surgical treatment and complex post-operative rehabilitation. Good and satisfactory results were identified in 57 (90.5%) patients, unsatisfactory results - in 6 (9.5%) patients. Choice of surgical technique in depending on the localization of structural and functional disorders of the rectum closing apparatus and combination of surgical correction with complex functional rehabilitation allow to increase treatment efficiency. Also it improves closing function in the most patients. PMID:24816384

  8. Fertility Protection in Female Oncology Patients: How Should Patients Be Counseled?

    PubMed Central

    Findeklee, S.; Lotz, L.; Heusinger, K.; Hoffmann, I.; Dittrich, R.; Beckmann, M. W.

    2015-01-01

    Protecting the fertility of patients with oncologic disease is becoming more and more important, as fulfilling the wish to have children is increasingly occurring at a later stage in life and long-term survival rates after cancer are continuing to improve. A number of fertility-preserving options exist. In addition to techniques which have been around for some time such as medical ovarian suppression, ovarian transposition, and organ-preserving surgery, there are other, more recent, innovative methods which have developed over the last few years such as cryopreservation of oocytes or ovarian tissue transplantation after completing cancer therapy. As every procedure has its specific advantages and disadvantages, informed patient consent is essential. The physicianʼs aim must be to select the optimal procedure for each patient. The extent of patientsʼ information about the options to preserve fertility in women with oncologic disease remains limited. One of the main reasons for this is that clinicians are not sure how to inform patients about existing procedures and methods. The aim of this review article is to provide help in clinical practice. PMID:26726265

  9. Servier's pipeline in oncology: moving from research to patients.

    PubMed

    Therasse, Patrick; Abastado, Jean-Pierre

    2016-03-01

    Patrick Therasse and Jean-Pierre Abastado speak to Roshaine Gunawardana, Managing Commissioning Editor: Patrick Therasse is an MD, PhD who has focused his career on drug development in oncology. He is currently the Head of Oncology Development for Servier. Before working for Servier, he worked 8 years for GlaxoSmithKline Vaccines as Vice President, Head of Global Clinical Development for immunotherapeutics. He started his career at the European Organization for Research and Treatment of Cancer (EORTC) as a research fellow and then served as Director of the EORTC Research Center for 11 years. He has worked in all fields of oncology with a long track record of publications mainly in the field of breast cancer and methodological research. He is most well known for developing new Response Criteria In Solid Tumours (RECIST), the reference for response assessment in cancer clinical trials since 2000. His areas of expertise encompass Phase I-III drug development with small molecules or active/passive immunotherapy and translational research. Jean-Pierre Abastado is an immuno-oncologist in charge of the R&D in Oncology at Servier, where he is Director of the Therapeutic Innovation Pole in Oncology. He conducted his professional career between various academic and industrial institutions. He was trained at Ecole Polytechnique (Paris), prepared his PhD on Major Histocompatibility Complex (MHC) at the Pasteur Institute, and made a postdoctoral training at NIH (Bethesda, MD, USA). He studied T-cell activation in the Immunology department of the Pasteur Institute and at the CNRS. He was Vice President, Chief Scientific Officer of IDM-Pharma, a company specialized in cell therapy against cancer. Before joining Servier, he headed the Laboratory of Tumour Immunology within the Singapore Immunology Network (SIgN) where his team studied the tumor immune microenvironment. He has served on the Editorial board of several journals and in the Scientific Advisory Board of several biotech companies. He has authored more than 120 peer-reviewed publications. PMID:26764971

  10. Group Therapy with Patients in the Waiting Room of an Oncology Clinic.

    ERIC Educational Resources Information Center

    Arnowitz, Edward; And Others

    1983-01-01

    Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

  11. Severe Skin Toxicity in Pediatric Oncology Patients Treated with Voriconazole and Concomitant Methotrexate

    PubMed Central

    van Eijkelenburg, Natasha K. A.; Huitema, Alwin D. R.; Schellens, Jan H. M.; Schouten-van Meeteren, Antoinette Y. N.

    2013-01-01

    We report the occurrence of skin toxicities in pediatric oncology patients on concomitant treatment with voriconazole and methotrexate (MTX). Of 23 patients who received this combination, 11 patients suffered from cheilitis and/or photosensitivity. In contrast, only in 1 of 9 patients who received voriconazole without MTX was photosensitivity observed. A mechanism of action was not able to be identified. We describe two cases with severe skin toxicities. Caution is warranted when using voriconazole and concomitant MTX. PMID:23571545

  12. Pelvic colorectal recurrence: crucial role of radiologists in oncologic and surgical treatment options

    PubMed Central

    Georgiou, P.A.; Tekkis, P.P.

    2011-01-01

    Abstract Radical resection is the only potential cure for patients with locally advanced primary and recurrent rectal cancer and is considered curative only when the histologic margins are clear of tumour. Early diagnosis of the disease is essential as it increases the likelihood of a potentially curative resection and prevention of dissemination. Clinical examination, tumour markers and radiologic modalities such as ultrasonography, computed tomography, magnetic resonance imaging and positron emission tomography are routinely used in an effort to accurately stage these patients and provide useful information for the selection of patients for further treatment/management. This review describes the methods of staging patients with locally advanced primary and recurrent rectal cancer prior to surgery emphasizing the role that radiologists have in this process. PMID:22186112

  13. The WHO surgical safety checklist: survey of patients’ views

    PubMed Central

    Russ, Stephanie Jane; Rout, Shantanu; Caris, Jochem; Moorthy, Krishna; Mayer, Erik; Darzi, Ara; Sevdalis, Nick; Vincent, Charles

    2014-01-01

    Background Evidence suggests that full implementation of the WHO surgical safety checklist across NHS operating theatres is still proving a challenge for many surgical teams. The aim of the current study was to assess patients’ views of the checklist, which have yet to be considered and could inform its appropriate use, and influence clinical buy-in. Method Postoperative patients were sampled from surgical wards at two large London teaching hospitals. Patients were shown two professionally produced videos, one demonstrating use of the WHO surgical safety checklist, and one demonstrating the equivalent periods of their operation before its introduction. Patients’ views of the checklist, its use in practice, and their involvement in safety improvement more generally were captured using a bespoke 19-item questionnaire. Results 141 patients participated. Patients were positive towards the checklist, strongly agreeing that it would impact positively on their safety and on surgical team performance. Those worried about coming to harm in hospital were particularly supportive. Views were divided regarding hearing discussions around blood loss/airway before their procedure, supporting appropriate modifications to the tool. Patients did not feel they had a strong role to play in safety improvement more broadly. Conclusions It is feasible and instructive to capture patients’ views of the delivery of safety improvements like the checklist. We have demonstrated strong support for the checklist in a sample of surgical patients, presenting a challenge to those resistant to its use. PMID:25038036

  14. Surgical Risk and Comorbidity in Older Urologic Patients.

    PubMed

    Townsend, Nicole T; Robinson, Thomas N

    2015-11-01

    Almost two-thirds of urology operations are performed in patients 65 years and older. Older adults are at higher risk for complications and mortality compared with their younger counterparts. There are 2 primary methods to quantify surgical risk in these patients, frailty measurement and organ/comorbidity-based surgical risk calculators. A frailty assessment can be used to independently forecast the risk of postoperative complications. A paradigm shift in the preoperative assessment of the geriatric patient has occurred, which emphasizes the evaluation of frailty over more traditional surgical risk assessment, which uses comorbidities and single end-organ dysfunction to define risk. PMID:26476118

  15. [The experience of the "oncologic patient": (re)conceptualizing the informative act].

    PubMed

    Laranjeira, Carlos António

    2007-01-01

    The adaptation of the patient to the conditions of chronic illness makes the information given to the patient one of the most powerful strategies, capable of contributing to a change in the social representation of the patient, from that of a mere clinical case to that of a holistic being. The objective of this study was to investigate the scientific work published in periodicals indexed by the Medline and Lilacs databases between 1990 and 2006 as to the informative act and the different forms in which information is provided to oncology patients. This analysis of the literature led to the conclusion that there has been an increase in the volume of publications, underlining the role of the oncology patient as a catalyst for new strategies for psychosocial adjustment and revealing her key role through her status as a 'professional patient'. PMID:18472547

  16. Use of Psychosocial Services Increases after a Social Worker-Mediated Intervention in Gynecology Oncology Patients

    ERIC Educational Resources Information Center

    Abbott, Yuko; Shah, Nina R.; Ward, Kristy K.; McHale, Michael T.; Alvarez, Edwin A.; Saenz, Cheryl C.; Plaxe, Steven C.

    2013-01-01

    The purpose of this study was to determine whether the introduction of psychosocial services to gynecologic oncology outpatients by a social worker increases service use. During the initial six weeks (phase I), patients were referred for psychosocial services by clinic staff. During the second six weeks (phase II), a nurse introduced available…

  17. Hormonal and metabolic changes in oncology patients subjected to general hyperthermia and ways for their correction

    NASA Astrophysics Data System (ADS)

    Prohkorova, V. I.; Mashevskii, A. A.; Lappo, S. V.; Tsyrus', T. P.; Abramovich, M. S.

    1996-05-01

    Hormonal-metabolic changes in oncology patients subjected to general hyperthermia (GHT) result in enhancement of free-radical oxidation and accumulation of endotoxins under the conditions of violation of their targeted transport to detoxication. A pathogenesis-matched stress-limiting program is developed that allows optimization of the GHT treatment.

  18. Use of Psychosocial Services Increases after a Social Worker-Mediated Intervention in Gynecology Oncology Patients

    ERIC Educational Resources Information Center

    Abbott, Yuko; Shah, Nina R.; Ward, Kristy K.; McHale, Michael T.; Alvarez, Edwin A.; Saenz, Cheryl C.; Plaxe, Steven C.

    2013-01-01

    The purpose of this study was to determine whether the introduction of psychosocial services to gynecologic oncology outpatients by a social worker increases service use. During the initial six weeks (phase I), patients were referred for psychosocial services by clinic staff. During the second six weeks (phase II), a nurse introduced available…

  19. Clinical Experience of Patients Referred to a Multidisciplinary Cardiac Oncology Clinic: An Observational Study.

    PubMed

    Sulpher, Jeffrey; Mathur, Shrey; Graham, Nadine; Crawley, Freya; Turek, Michele; Johnson, Christopher; Stadnick, Ellamae; Law, Angeline; Wentzell, Jason; Dent, Susan

    2015-01-01

    Cardiotoxicity is the second leading cause of long-term morbidity and mortality among cancer survivors. The purpose of this retrospective observational study is to report on the clinical and cardiac outcomes in patients with early stage and advanced cancer who were referred to our multidisciplinary cardiac oncology clinic (COC). A total of 428 patients were referred to the COC between October 2008 and January 2013. The median age of patients at time of cancer diagnosis was 60. Almost half of patients who received cancer therapy received first-line chemotherapy alone (169, 41.7%), of which 84 (49.7%) were exposed to anthracyclines. The most common reasons for referral to the cardiac oncology clinic were decreased LVEF (34.6%), prechemotherapy assessment (11.9%), and arrhythmia (8.4%). A total of 175 (40.9%) patients referred to the COC were treated with cardiac medications. The majority (331, 77.3%) of patients were alive as of January 2013, and 93 (21.7%) patients were deceased. Through regular review of cardiac oncology clinic referral patterns, management plans, and patient outcomes, we aim to continuously improve delivery of cardiac care to our patient population and optimize cardiac health. PMID:26300917

  20. Clinical Experience of Patients Referred to a Multidisciplinary Cardiac Oncology Clinic: An Observational Study

    PubMed Central

    Sulpher, Jeffrey; Mathur, Shrey; Graham, Nadine; Crawley, Freya; Turek, Michele; Johnson, Christopher; Stadnick, Ellamae; Law, Angeline; Wentzell, Jason; Dent, Susan

    2015-01-01

    Cardiotoxicity is the second leading cause of long-term morbidity and mortality among cancer survivors. The purpose of this retrospective observational study is to report on the clinical and cardiac outcomes in patients with early stage and advanced cancer who were referred to our multidisciplinary cardiac oncology clinic (COC). A total of 428 patients were referred to the COC between October 2008 and January 2013. The median age of patients at time of cancer diagnosis was 60. Almost half of patients who received cancer therapy received first-line chemotherapy alone (169, 41.7%), of which 84 (49.7%) were exposed to anthracyclines. The most common reasons for referral to the cardiac oncology clinic were decreased LVEF (34.6%), prechemotherapy assessment (11.9%), and arrhythmia (8.4%). A total of 175 (40.9%) patients referred to the COC were treated with cardiac medications. The majority (331, 77.3%) of patients were alive as of January 2013, and 93 (21.7%) patients were deceased. Through regular review of cardiac oncology clinic referral patterns, management plans, and patient outcomes, we aim to continuously improve delivery of cardiac care to our patient population and optimize cardiac health. PMID:26300917

  1. From Patient-Specific Mathematical Neuro-Oncology to Precision Medicine

    PubMed Central

    Baldock, A. L.; Rockne, R. C.; Boone, A. D.; Neal, M. L.; Hawkins-Daarud, A.; Corwin, D. M.; Bridge, C. A.; Guyman, L. A.; Trister, A. D.; Mrugala, M. M.; Rockhill, J. K.; Swanson, K. R.

    2013-01-01

    Gliomas are notoriously aggressive, malignant brain tumors that have variable response to treatment. These patients often have poor prognosis, informed primarily by histopathology. Mathematical neuro-oncology (MNO) is a young and burgeoning field that leverages mathematical models to predict and quantify response to therapies. These mathematical models can form the basis of modern “precision medicine” approaches to tailor therapy in a patient-specific manner. Patient-specific models (PSMs) can be used to overcome imaging limitations, improve prognostic predictions, stratify patients, and assess treatment response in silico. The information gleaned from such models can aid in the construction and efficacy of clinical trials and treatment protocols, accelerating the pace of clinical research in the war on cancer. This review focuses on the growing translation of PSM to clinical neuro-oncology. It will also provide a forward-looking view on a new era of patient-specific MNO. PMID:23565501

  2. A Review of the Prevalence and Impact of Multiple Symptoms in Oncology Patients

    PubMed Central

    Kim, Jung-Eun Esther; Dodd, Marylin J.; Aouizerat, Bradley E.; Jahan, Thierry; Miaskowski, Christine

    2009-01-01

    Findings from several studies suggest that oncology patients undergoing active treatment experience multiple symptoms and that these symptoms can have a negative effect on patient outcomes. However, no systematic review has summarized the findings from studies that assessed multiple symptoms in these patients. Therefore, the purposes of this review were to: 1) compare and contrast the characteristics of the three most commonly used instruments to measure multiple symptoms; 2) summarize the prevalence rates for multiple symptoms in studies of oncology patients receiving active treatment; 3) describe the relationships among selected demographic, disease, and treatment characteristics and multiple symptoms; and 4) describe the relationships between the occurrence of multiple symptoms and patient outcomes (i.e., functional status, quality of life). Only 18 studies were found that met the inclusion criteria for this review. The majority of the studies were cross-sectional with sample sizes that ranged from 26 to 527. Approximately 40% of patients experienced more than one symptom. However, little is known about the relationships between demographic and clinical characteristics and the occurrence of multiple symptoms. Findings from this review suggest that the occurrence of multiple symptoms is associated with decreased functional status and quality of life. However, given the large number of oncology patients who undergo active treatment each year, additional research is warranted on the prevalence and impact of multiple symptoms. Only when this descriptive research is completed with homogenous samples of patients in terms of cancer diagnoses and treatments can intervention studies for multiple symptoms be developed and tested. PMID:19019626

  3. 2014 President's plenary international psycho-oncology society: moving toward cancer care for the whole patient.

    PubMed

    Bultz, Barry D; Travado, Luzia; Jacobsen, Paul B; Turner, Jane; Borras, Josep M; Ullrich, Andreas W H

    2015-12-01

    The International Psycho-oncology Society (IPOS) has just celebrated its 30th anniversary. The growth of psychosocial oncology has been exponential, and this relatively new field is becoming a core service that focuses on prevention, reducing the burden of cancer, and enhancing the quality of life from time of diagnosis, through treatment, survivorship, and palliative care. Looking back over the past 30 years, we see that cancer care globally has evolved to a new and higher standard. Today, 'cancer care for the whole patient' is being accomplished with an evidence-based model that addresses psychosocial needs and integrates psycho-oncology into the treatment and care of patients. The President's Plenary Session in Lisbon, Portugal, highlighted the IPOS Mission of promoting global excellence in psychosocial care of people affected by cancer through our research, public policy, advocacy, and education. The internationally endorsed IPOS Standard of Quality Cancer Care, for example, clearly states the necessity of integrating the psychosocial domain into routine care, and that distress should be measured as the sixth vital sign after temperature, blood pressure, pulse, respiratory rate, and pain. The plenary paper also discussed the global progress being made in Europe, North America, and Australia in providing quality cancer care for the whole patient. Collaborative partnerships between IPOS and organizations such as the European Partnership Action Against Cancer and the World Health Organization are essential in building capacity for the delivery of high-quality psycho-oncology services in the future. Copyright © 2015 John Wiley & Sons, Ltd. PMID:25963279

  4. Use of an electronic patient-reported outcome measurement system to improve distress management in oncology

    PubMed Central

    Smith, Sophia K.; Rowe, Krista; Abernethy, Amy P.

    2014-01-01

    Objective Management of patient distress is a critical task in cancer nursing and cancer practice. Here we describe two examples of how an electronic patient-reported outcome (ePRO) measurement system implemented into routine oncology care can practically aid clinical and research tasks related to distress management. Methods Tablet personal computers were used to routinely complete a standardized ePRO review of systems surveys at point of care during every encounter in the Duke Oncology outpatient clinics. Two cases of use implementation are explored: (1) triaging distressed patients for optimal care, and (2) psychosocial program evaluation research. Results Between 2009 and 2011, the ePRO system was used to collect information during 17,338 Duke Oncology patient encounters. The system was used to monitor patients for psychosocial distress employing an electronic clinical decision support algorithm, with 1,952 (11.3%) referrals generated for supportive services. The system was utilized to examine the efficacy of a psychosocial care intervention documenting statistically significant improvements in distress, despair, fatigue, and quality of life (QOL) in 50 breast cancer patients. Significance of results ePRO solutions can guide best practice management of cancer patient distress. Nurses play a key role in implementation and utilization. PMID:24128592

  5. Endoscopic laser therapy of erosive-ulcerous and inflammatory damages of patients in oncological hospital

    NASA Astrophysics Data System (ADS)

    Efimov, Oleg N.; Kuvshinov, Yu. P.; Poddubny, Boris K.; Kartasheva, E. O.; Ungiadze, G. V.; Ponomarev, Igor V.; Mazurov, S. T.

    1996-01-01

    The results of laser therapy present in 374 patients with erosive-ulcerous and inflammatory damages of respiratory organs and of gastro-intestinal tract after oncological operations. Two types of laser namely endoscopic laser on the basis of He-Ne and Cu laser were used as sources of radiation. It was shown high therapeutic effectiveness of laser therapy. This method may be recommended for the above-mentioned category of the patients.

  6. “Il Corpo Ritrovato”: Dermocosmetological Skin Care Project for the Oncologic Patient

    PubMed Central

    Fabbrocini, G.; Romano, M. C.; Cameli, N.; Mariano, M.; Pastore, F.; Annunziata, M. C.; Mazzella, C.; De Vita, Valerio; Mauriello, Maria Chiara; Monfrecola, G.

    2011-01-01

    Neoplastic disease and its therapeutic options have a huge impact on the patient's quality of life from both the emotional and the working point of view. The project “Il Corpo Ritrovato” aims at creating an interdisciplinary network of physicians to improve the quality of life of the oncologic patient, focusing on such important aspects as dermocosmetological skin care but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention. PMID:22084736

  7. Surgical management in patient with uveitis

    PubMed Central

    Murthy, Somasheila I; Pappuru, Rajeev Reddy; Latha, K Madhavi; Kamat, Sripathi; Sangwan, Virender S

    2013-01-01

    Surgery in the management of uveitis can be divided based on indication: either for therapeutic or can be for diagnostic purposes or to manage complications. The commonest indications include: Visual rehabilitation: surgery for removal of cataract, band keratopathy, corneal scars, pupillary membranes, removal of dense vitreous membranes, management of complications: anti-glaucoma surgery, vitreous hemorrhage, retinal detachment and chronic hypotony and diagnostic: aqueous tap, vitreous biopsy, tissue biopsy (iris, choroid). In this review, we shall describe the surgical technique for visual rehabilitation and for management of complications. PMID:23803480

  8. Methods for the postoperative management of the thoracic oncology patients: lessons from the clinic.

    PubMed

    Leuzzi, Giovanni; Facciolo, Francesco; Pastorino, Ugo; Rocco, Gaetano

    2015-12-01

    Oncological thoracic surgery comprises challenging procedures not only from a surgical point of view but also regarding the postoperative management. The most significant procedures performed for malignancy are those requiring resection of the lung, the pleura, the esophagus, mediastinal structures, the chest wall and airways. Especially after major procedures, postoperative complications occur frequently and usually require a multidisciplinary approach involving thoracic surgeons, anesthesiologists, pulmonologist, physiotherapists and oncologists. Thus, a proper postoperative management is as important as the surgical procedure to achieve the best outcome following surgery. In this article, we provide an overview of the basic principles for management of postoperative imaging and drain system and review the main postoperative complications following thoracic surgery, focusing also on new strategies to prevent them. PMID:26536136

  9. Community Oncology Medical Homes: Physician-Driven Change to Improve Patient Care and Reduce Costs.

    PubMed

    Waters, Teresa M; Webster, Jennifer A; Stevens, Laura A; Li, Tao; Kaplan, Cameron M; Graetz, Ilana; McAneny, Barbara L

    2015-11-01

    Although the patient-centered medical home is a well-established model of care for primary care providers, adoption by specialty providers has been relatively limited. Recently, there has been particular interest in developing specialty medical homes in medical oncology because of practice variation, care fragmentation, and high overall costs of care. In 2012, the Center for Medicare and Medicaid Innovation awarded Innovative Oncology Business Solutions a 3-year grant for their Community Oncology Medical Home (COME HOME) program to implement specialty medical homes in seven oncology practices across the country. We report our early experience and lessons learned.Through September 30, 2014, COME HOME has touched 16,353 unique patients through triage encounters, patient education visits, or application of clinical pathways. We describe the COME HOME model and implementation timeline, profile use of key services, and report patient satisfaction. Using feedback from practice sites, we highlight patient-centered innovations and overall lessons learned.COME HOME incorporates best practices care driven by triage and clinical pathways, team-based care, active disease management, enhanced access and care, as well as financial support for the medical home infrastructure. Information technology plays a central role, supporting both delivery of care and performance monitoring. Volume of service use has grown steadily over time, leveling out in second quarter 2014. The program currently averages 1,265 triage encounters, 440 extended hours visits, and 655 patient education encounters per month.COME HOME offers a patient-centered model of care to improve quality and continuity of care. PMID:26220931

  10. Relationship between pediatric oncology nurses' management of patients' symptoms and job satisfaction.

    PubMed

    Rheingans, Jennifer I

    2008-01-01

    The purpose of this article is to describe the results of a study examining the relationship between nurses' management of pediatric oncology patients' symptoms and job satisfaction. Surveys were mailed to a national sample of pediatric oncology nurses to assess the presence of symptoms in their patients, the nurses' distress from the patients' symptoms, the interventions used to manage the symptoms, the perceived effectiveness of the interventions, and the nurses' job satisfaction. Based on the stress response sequence model, study hypotheses proposed that nurses' symptom management affects nurses' distress and, in turn, job satisfaction. Hierarchical regression analyses were used to evaluate the hypotheses and study model. Results demonstrated that both the number of nursing interventions and the perceived effectiveness of nursing interventions were significant as mediators in predicting nurses' distress. The overall study model contributed significantly in predicting overall job satisfaction. PMID:18780897

  11. Toward strategies for cost containment in surgical patients.

    PubMed Central

    Drucker, W R; Gavett, J W; Kirshner, R; Messick, W J; Ingersoll, G

    1983-01-01

    The University of Rochester, Department of Surgery, in response to an experimental community-wide limit on hospital budgets, studied high-cost general surgical patients as a potential source of leverage for containment of hospital costs. It was found that a small number of patients impact significantly on hospital costs. In 1980, 3935 patients at Strong Memorial Hospital (SMH) had at least one contact with a general surgical patient care or intensive care unit; 261 patients (6.6%) had total 1980 charges of more than $20,000 each. They contributed 32% of the total of both general surgical charges and patient days. A subset of 2021 patients was selected to represent more precisely the general surgical patient. The 85 high-cost patients (4.2%) of this subset were chosen for intensive study. These patients generated a significant and disproportionate per cent of total (2021) general surgical charges (26.8%) and hospital days (27.6%). Average total charges were more than 8 times those of the complementary general surgical subset (1936). Nineteen of the 85 patients (22.3%) died in the hospital and 42 patients (49.4%) were dead within 2 1/2 years. Forty patients (of the 85) were then further identified as "complex", based on multiple, usually unrelated, illnesses and multiple annual admissions. Tending to be elderly with poor prognoses, 60% of them had died by April 1983. The major criterion of complexity was the lack of a well-focused medical problem; the cure for one problem simply relinquished primacy to another. A parallel study of hospital ancillary procedures disclosed a similar high-cost pattern. Of approximately 4000 ancillary procedures, 100 (2.5%) had annual charges of $100,000 or over, accounting for two-thirds of total 1980 ancillary charges. Roughly 20% of a single patient's ordered procedures accounted for 80% of the patient's ancillary charges, thus allowing concentrated study of a relatively small number of charges. Means for cost containment may be applied logically to the high-cost patient and particularly toward the complex patient. The complex patient is especially suited for consideration, since it is postulated that these patients are endemic to all general hospitals and to all clinical services. Strategies to be developed should include: 1) a managerial system in which physicians have an incentive to contain costs, 2) an online data system, 3) an accurate, efficient way to identify prospective high-cost and complex patients and, 4) awareness by physicians, patients, and society that less expensive modes of diagnosis and therapy are an appropriate response to rationed health resources. PMID:6412640

  12. Frequency of and predictors for withholding patient safety concerns among oncology staff: a survey study.

    PubMed

    Schwappach, D L B; Gehring, K

    2015-05-01

    Speaking up about patient safety is vital to avoid errors reaching the patient and to improve a culture of safety. This study investigated the prevalence of non-speaking up despite concerns for safety and aimed to identify predictors for withholding voice among healthcare professionals (HCPs) in oncology. A self-administered questionnaire assessed safety concerns, speaking up beliefs and behaviours among nurses and doctors from nine oncology departments. Multiple regression analysis was used to identify predictors for withholding safety concerns. A total of 1013 HCPs returned the completed survey (response rate 65%). Safety concerns were common among responders. Fifty-four per cent reported to recognise their colleagues making potentially harmful errors at least sometimes. A majority of responders reported at least some episodes of withholding concerns about patient safety. Thirty-seven per cent said they remained silent at least once when they had information that might have helped prevent an incident. Respondents believed that a high level of interpersonal, communication and coping skills are necessary to speak up about patient safety issues at their workplace. Higher levels of perceived advocacy for patient safety and psychological safety significantly decreased the frequency of withholding voice. Remaining silent about safety concerns is a common phenomenon in oncology. Improved strategies are needed to support staff in effective communication and make cancer care safer. PMID:25287114

  13. Oral-dental concerns of the pediatric oncology patient

    SciTech Connect

    Lawson, K.

    1989-01-01

    One of the main concerns of all disciplines in health care today is maintaining the patient's quality of life and comfort during cancer therapy. Oral complications resulting from radiation or chemotherapy can be expected in a large percentage of patients. Conducting a dental evaluation and performing treatment before therapy can help prevent or lessen potential complications. With preventive care and fewer infections, the patient will be able to communicate with friends and family, and optimum care and comfort can be provided.

  14. The patient-centered medical home in oncology: from concept to reality.

    PubMed

    Page, Ray D; Newcomer, Lee N; Sprandio, John D; McAneny, Barbara L

    2015-01-01

    In recent years, the cost of providing quality cancer care has been subject to an epic escalation causing concerns on the verge of a health care crisis. Innovative patient-management models in oncology based on patient-centered medical home (PCMH) principles, coupled with alternative payments to traditional fee for service (FFS), such as bundled and episodes payment are now showing evidence of effectiveness. These efforts have the potential to bend the cost curve while also improving quality of care and patient satisfaction. However, going forward with FFS alternatives, there are several performance-based payment options with an array of financial risks and rewards. Most novel payment options convey a greater financial risk and accountability on the provider. Therefore, the oncology medical home (OMH) can be a way to mitigate some financial risks by sharing savings with the payer through better global care of the patient, proactively preventing complications, emergency department (ED) visits, and hospitalizations. However, much of the medical home infrastructure that is required to reduced total costs of cancer care comes as an added expense to the provider. As best-of-practice quality standards are being elucidated and refined, we are now at a juncture where payers, providers, policymakers, and other stakeholders should work in concert to expand and implement the OMH framework into the variety of oncology practice environments to better equip them to assimilate into the new payment reform configurations of the future. PMID:25993243

  15. The role of mannose binding lectin on fever episodes in pediatric oncology patients.

    PubMed

    Fekete, Ferenc; Fadgyas, Balázs; Papp, Éva; Szilágyi, Ágnes; Prohászka, Zoltán; Müller, Brigitta; Kovács, Gábor

    2016-01-01

    Despite significant changes in pediatric oncological therapy, mortality is still high, mainly due to infections. Complement system as an ancient immune defense against microorganisms plays a significant role in surmounting infections, therefore, deficiency of its components may have particular importance in malignancies. The present paper assesses the effect of promoter (X/Y) and exon 1 (A/0) polymorphisms of the MBL2 gene altering mannose binding lectin (MBL) serum level in pediatric oncological patients with febrile neutropenia. Furthermore, frequency distribution of MBL2 alleles in children with malignancies and age-matched controls was analysed. Fifty-four oncohematological patients and 53 children who had undergone pediatric surgery were enrolled into this retrospective study. No significant differences were found in the frequency of MBL2 alleles between the hemato-oncologic and control group. The average duration of fever episodes was significantly shorter (p = 0.035) in patients carrying genotypes (AY/AY and AY/AX) that encode normal MBL level, compared to individuals with genotypes associated with lower functional MBL level (AX/AX, AY/0, AX/0, or 0/0) (days, median (IQ range) 3.7(0-5.4) vs. 5.0(3.8-6.6), respectively). In conclusion, our data suggest that MBL2 genotypes may influence the course of febrile neutropenia in pediatric patients with malignancies, and may contribute to clarification of the importance of MBL in infections. PMID:26433879

  16. [Modern detoxication methods in surgical patients].

    PubMed

    Dudenko, F I; Pliashkevich, A V; Zuev, A S; Tolkachev, A N

    1991-07-01

    The therapeutic possibilities of peritoneal dialysis, hemodialysis, and hemo- and lymphosorption in the treatment of the intoxication syndrome were studied in 786 patients. The causes of the intoxication syndrome were as follows: postoperative peritonitis (98), acute renal insufficiency of various etiology (493), acute hepatorenal insufficiency with exogenous poisoning (178), diffuse purulent peritonitis (11), pancreatogenic peritonitis (6). Enzymatic lavage and peritoneal dialysis were applied in 98 patients, hemodialysis methods in 493, hemosorption was conducted 360 times in 178 patients and lymphosorption in 17 patients. The efficacy of the modern methods of detoxification of the organism was demonstrated, which was evaluated from the patients' improved general condition, improvement of the values of hemodynamics, concentration of toxic metabolites and middle-mass molecules in the blood, and the results of the paramecium test. PMID:1921199

  17. Transesophageal Echocardiography for the Noncardiac Surgical Patient

    PubMed Central

    Rebel, Annette; Klimkina, Oksana; Hassan, Zaki-Udin

    2012-01-01

    Transesophageal echocardiography (TEE) has been established as a very valuable asset for patient monitoring during cardiac surgery. The value of perioperative TEE for patients undergoing noncardiac surgery is less clear. This article reviews the technical aspects of TEE and comments on the potential benefit of using TEE as a monitoring modality apart from cardiac surgery. Based on patient's comorbidities and/or injury pattern, TEE is a fast and minimally invasive approach to obtain important hemodynamic information, especially useful in a hemodynamically unstable patient. However, certain requirements for the use of the technique are necessary, most important the development of sufficient echocardiographic skills by the anesthesiologists. Indications, skill requirements, and possible complications of the technique are reviewed. PMID:23102000

  18. [Psychological support of cancer patients in the oncological consultation].

    PubMed

    Stiefel, Friedrich; Rousselle, Ingrid; Guex, Patrice; Bernard, Mathieu

    2007-09-01

    Due to its life threatening character, a cancer diagnosis represents an existential rupture, disturbing an individual's life trajectory perceived beforehand as a continuum. As a consequence, a patient's physical, psychological, social and spiritual equilibrium may be disturbed, calling for a support by clinicians, which surpasses biomedical treatment. A key element of support relies on patient-centered communication, which not only demands technical skills, but also a reflective approach on interpersonal factors which shape the relationship, on the choice and the idealized representation of the clinician's profession as well as its limits. This article summarizes main aspects of patient-physician communication and our experience as teachers of the so-called Communication Skills Training. It provides a review on research in progress in this field and finally indicates other elements of support, which contribute to the < narrative reconstruction > of the patient facing the rupture induced by cancer. PMID:17878106

  19. Stepwise surgical approach to equinocavovarus in patients with cerebral palsy.

    PubMed

    Won, Sung Hun; Kwon, Soon Sun; Chung, Chin Youb; Lee, Kyoung Min; Lee, In Hyeok; Jung, Ki Jin; Moon, Sang Young; Chung, Myung Ki; Park, Moon Seok

    2016-03-01

    This study investigated the radiologic results of a stepwise surgical approach to equinocavovarus in 24 patients with cerebral palsy and determined the extent to which each procedure affected radiographic parameters using a linear mixed model. The anteroposterior talus-first metatarsal and anteroposterior talonavicular coverage angles were improved. The calcaneal pitch angle, tibiocalcaneal angle, lateral talus-first metatarsal angle, and naviculocuboid overlap were also improved. The Dwyer sliding osteotomy affected the tibiocalcaneal angle, whereas first metatarsal dorsal wedge osteotomy improved the calcaneal pitch angle and lateral first metatarsal angle. The stepwise surgical approach is effective for correction of equinocavovarus in cerebral palsy patients. PMID:26529433

  20. Informal Financial Assistance for Patients With a Hematological Malignancy: Implications for Oncology Social Work Practice.

    PubMed

    McGrath, Pam

    2015-01-01

    The article presents original research findings on informal financial assistance for hematological patients; that is, the gifts from family, friends, and communities that help patients cope with the financial hardship associated with cancer. The qualitative study involved interviews with 45 hematology patients that were audio-recorded, transcribed, coded, and then thematically analyzed. The findings examine the differing perspectives that individuals and families bring to the notion of informal financial aid, provide examples of individuals who require and receive informal financial assistance, and conclude with descriptions of those who require informal financial assistance but it is not available. The implications of the findings for oncology social work practice are explored. PMID:26671243

  1. Immunotherapy of gram-negative infections in oncological patients.

    PubMed

    Glauser, M P

    1989-09-01

    While it is widely recognized that gram-negative bacteria (GNB) are a leading cause of morbidity and mortality among patients whose immune defenses are compromised both by their underlying malignancy as well as by its treatment, efforts to prevent or to treat such infections by immunological means have been hampered for several reasons. First, the natural anatomical barriers are often disrupted either by the tumor itself, by the chemotherapeutic agents, or, as recognized more recently, by viral (herpetic) or fungal infections, so that entrance of the gram-negative flora into the host tissue and blood stream is greatly facilitated. Efforts to diminish the bacterial load by means of oral decontamination, be it selective or not, to prevent such ingress have brought limited success. Second, active immunization is not likely to elicit a useful response in these patients, so that mainly passive immunotherapy has been considered and studied. However, since the most immunocompromised cancer patients are very often leucopenic, the opsono-phagocytic function of passively administered antibodies is not likely to help the patients to get rid of the invading gram-negative bacteria. This latter observation has been particularly well established in the case of Pseudomonas aeruginosa infections in leukemic patients (Young LS, Stevens P, Ingram J. J Clin Invest 1975, 56, 850-861). PMID:2680515

  2. Neuro-oncological patients admitted in intensive-care unit: predictive factors and functional outcome.

    PubMed

    Tabouret, E; Boucard, C; Devillier, R; Barrie, M; Boussen, S; Autran, D; Chinot, O; Bruder, N

    2016-03-01

    The prognosis of oncology patients admitted to the intensive care unit (ICU) is considered poor. Our objective was to analyze the characteristics and predictive factors of death in the ICU and functional outcome following ICU treatment for neuro-oncology patients. A retrospective study was conducted on all patients with primary brain tumor admitted to our institutional ICU for medical indications. Predictive impact on the risk of death in the ICU was analyzed as well as the functional status was evaluated prior and following ICU discharge. Seventy-one patients were admitted to the ICU. ICU admission indications were refractory seizures (41 %) and septic shock (17 %). On admission, 16 % had multi-organ failure. Ventilation was necessary for 41 % and catecholamines for 13 %. Twenty-two percent of patients died in the ICU. By multivariate analysis, predictive factors associated with an increased risk of ICU death were: non-neurological cause of admission [p = 0.045; odds ratio (OR) 5.405], multiple organ failure (p = 0.021; OR 8.027), respiratory failure (p = 0.006; OR 9.615), and hemodynamic failure (p = 0.008; OR 10.111). In contrast, tumor type (p = 0.678) and disease control status (p = 0.380) were not associated with an increased risk of ICU death. Among the 35 evaluable patients, 77 % presented with a stable or improved Karnofsky performance status following ICU hospitalization compared with the ongoing status before discharge. In patients with primary brain tumor admitted to the ICU, predictive factors of death appear to be similar to those described in non-oncology patients. ICU hospitalization is generally not associated with a subsequent decrease in the functional status. PMID:26608523

  3. Patients’ experience of important factors in the healthcare environment in oncology care

    PubMed Central

    Browall, Maria; Koinberg, Ingalill; Falk, Hanna; Wijk, Helle

    2013-01-01

    Background and objective The aim of this study was to describe what factors of the healthcare environment are perceived as being important to patients in oncology care. Design A qualitative design was adopted using focus group interviews. Setting and participants The sample was 11 patients with different cancer diagnoses in an oncology ward at a university hospital in west Sweden. Results Analysis of the patients’ perceptions of the environment indicated a complex entity comprising several aspects. These came together in a structure consisting of three main categories: safety, partnership with the staff, and physical space. The care environment is perceived as a complex entity, made up of several physical and psychosocial aspects, where the physical factors are subordinated by the psychosocial factors. It is clearly demonstrated that the patients’ primary desire was a psychosocial environment where they were seen as a unique person; the patients wanted opportunities for good encounters with staff, fellow patients, and family members, supported by a good physical environment; and the patients valued highly a place to withdraw and rest. Conclusions This study presents those attributes that are valued by cancer patients as crucial and important for the support of their well-being and functioning. The results show that physical aspects were subordinate to psychosocial factors, which emerged strongly as being the most important in a caring environment. PMID:23924604

  4. Patients’ awareness of the surgical risks of smoking

    PubMed Central

    Bottorff, Joan L.; Seaton, Cherisse L.; Lamont, Sonia

    2015-01-01

    Objective To describe the smoking patterns of patients receiving elective surgery and their knowledge about the benefits of smoking cessation to inform and strengthen support for patients to quit smoking in order to optimize surgical outcomes. Design Patients who had elective surgery were screened for smoking status, and eligible patients completed a telephone survey. Setting Two regional hospitals in northern British Columbia. Participants Of 1722 patients screened, 373 reported smoking before surgery. Of these, 161 (59.0% women) completed a telephone survey. Main outcome measures Patient smoking cessation, knowledge of the perioperative risks of smoking, use of resources, and health care provider advice and assistance. Results Participants included 66 men and 95 women (mean [SD] age of 51.9 [14.0] years). In total, 7.5% of these patients quit smoking in the 8 weeks before their surgeries, although an additional 38.8% reduced their smoking. Only about half of the patients surveyed were aware that continuing to smoke increased their surgical risks. Further, only half of the patients surveyed reported being advised to quit before their surgeries by a health care professional. Few were using the provincial resources available to support smoking cessation (eg, QuitNow), and 39.6% were unaware of the provincial program to cover the cost of smoking cessation aids (eg, nicotine gum or patches), yet 62.7% of respondents were thinking about quitting smoking. Conclusion Many surgical patients in northern British Columbia who smoked were unaware of the perioperative risks of smoking and the cessation support available to them. An opportunity exists for all health care professionals to encourage more patients to quit in order to optimize their surgical outcomes.

  5. Herbaspirillum Species Bacteremia in a Pediatric Oncology Patient?

    PubMed Central

    Ziga, Edward D.; Druley, Todd; Burnham, Carey-Ann D.

    2010-01-01

    Herbaspirillum species, an organism commonly found in soil, has only recently been linked to disease in humans. We report Herbaspirillum bacteremia in a 2-year-old female patient following a hematopoietic stem cell transplant for relapsed acute lymphoblastic leukemia. PMID:20739483

  6. FASTING ABBREVIATION AMONG PATIENTS SUBMITTED TO ONCOLOGIC SURGERY: SYSTEMATIC REVIEW

    PubMed Central

    PINTO, Andressa dos Santos; GRIGOLETTI, Shana Souza; MARCADENTI, Aline

    2015-01-01

    Introduction The abbreviation of perioperative fasting among candidates to elective surgery have been associated with shorter hospital stay and decreased postoperative complications. Objective To conduct a systematic review from randomized controlled trials to detect whether the abbreviation of fasting is beneficial to patients undergoing cancer surgery compared to traditional fasting protocols. Method A literature search was performed in electronic databases: MEDLINE (PubMed), SciELO, EMBASE and Cochrane, without time restriction. Were used the descriptors: "preoperative fasting", "cancer", "diet restriction" and "perioperative period". Randomized trials were included in adults of both sexes, with diagnosis of cancer. Exclusion criteria were: use of parenteral nutrition and publications in duplicate. All analyzes, selections and data extraction were done blinded manner by independent evaluators. Results Four studies were included, with a total of 150 patients, 128 with colorectal cancer and 22 gastric cancer. The articles were published from 2006 to 2013. The main outcome measures were heterogeneous, which impaired the unification of the results by means of meta-analysis. Compared to traditional protocols, patients undergoing fasting abbreviation with the administration of fluids containing carbohydrates had improvements in glycemic parameters (fasting glucose and insulin resistance), inflammatory markers (interleukin 6 and 10) and indicators of malnutrition (grip strength hand and CRP/albumin ratio), and shorter hospital stay. The methodological quality of the reviewed articles, however, suggests that the results should be interpreted with caution. Conclusions The abbreviation of perioperative fasting in patients with neoplasm appears to be beneficial. PMID:25861075

  7. Obesity-related insulin resistance: implications for the surgical patient.

    PubMed

    Tewari, N; Awad, S; Macdonald, I A; Lobo, D N

    2015-11-01

    In healthy surgical patients, preoperative fasting and major surgery induce development of insulin resistance (IR). IR can be present in up to 41% of obese patients without diabetes and this can rise in the postoperative period, leading to an increased risk of postoperative complications. Inflammation is implicated in the aetiology of IR. This review examines obesity-associated IR and its implications for the surgical patient. Searches of the Medline and Science Citation Index databases were performed using various key words in combinations with the Boolean operators AND, OR and NOT. Key journals, nutrition and metabolism textbooks and the reference lists of key articles were also hand searched. Adipose tissue has been identified as an active endocrine organ and the chemokines secreted as a result of macrophage infiltration have a role in the pathogenesis of IR. Visceral adipose tissue appears to be the most metabolically active, although results across studies are not consistent. Results from animal and human studies often provide conflicting results, which has rendered the pursuit of a common mechanistic pathway challenging. Obesity-associated IR appears, in part, to be related to inflammatory changes associated with increased adiposity. Postoperatively, the surgical patient is in a proinflammatory state, so this finding has important implications for the obese surgical patient. PMID:26028059

  8. Aspirin increases the risk of venous thromboembolism in surgical patients.

    PubMed

    Barmparas, Galinos; Jain, Monica; Mehrzadi, Devorah; Melo, Nicolas; Chung, Rex; Bloom, Matthew; Ley, Eric J; Margulies, Daniel R

    2014-10-01

    The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE. PMID:25264630

  9. [Surgical intervention in patients with malignant glioma].

    PubMed

    Kostron, Herwig; Rössler, Karl

    2006-06-01

    Glial tumors occur at an incidence from 2 to 10/ 100.000 (Japan vs. Sweden) and building up to 50 % of all patients suffering from brain tumors. 50 % of those are again malignant gliomas Grade III and Grade IV. Despite all therapeutic approaches the median survival for glioblastomas is 15 months and for anaplastic gliomas Grade III 30 months. After diagnosis, preferably by MRI, a neurosurgical procedure is performed under microsurgical guidelines mostly by means of neuronavigation and intraoperative guidance. Depending on the preoperative diagnosis and localisation of the pathologic lesion an open craniotomy or a stereotactic biopsy is performed. This allows the histological verification and decompression and cytoreduction. A gros total safe removal preserving neurological function is the most important goal of surgery. Tumor removal in eloquent areas such as speech area is performed under local anesthesia as an awake operation. Age, Karnofsky performance status, histology as well as radical removal have a significant influence on overall survival. Adjuvant radiotherapy and chemotherapy with Temozolemide have further improved the outcome significantly. The 2-year survival has reached 28 % in most recent studies. Further experimental therapies in controlled trials, such as intratumoral convection-enhanced instillation of immunotoxins and radiopeptids, photodynamic therapy and direct instillation of new formulations of chemotherapeutic drugs (e. g. nanoparticles) are promising new approaches. New developments in the treatment of patients harboring malignant brain tumors allow an individual neurooncological treatment concept to be established to enhance overall survival and quality of life. PMID:16944364

  10. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer—IMIGASTRIC

    PubMed Central

    Desiderio, Jacopo; Jiang, Zhi-Wei; Nguyen, Ninh T; Zhang, Shu; Reim, Daniel; Alimoglu, Orhan; Azagra, Juan-Santiago; Yu, Pei-Wu; Coburn, Natalie G; Qi, Feng; Jackson, Patrick G; Zang, Lu; Brower, Steven T; Kurokawa, Yukinori; Facy, Olivier; Tsujimoto, Hironori; Coratti, Andrea; Annecchiarico, Mario; Bazzocchi, Francesca; Avanzolini, Andrea; Gagniere, Johan; Pezet, Denis; Cianchi, Fabio; Badii, Benedetta; Novotny, Alexander; Eren, Tunc; Leblebici, Metin; Goergen, Martine; Zhang, Ben; Zhao, Yong-Liang; Liu, Tong; Al-Refaie, Waddah; Ma, Junjun; Takiguchi, Shuji; Lequeu, Jean-Baptiste; Trastulli, Stefano; Parisi, Amilcare

    2015-01-01

    Introduction Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. Methods and analysis A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. Ethics and dissemination This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. Trial registration number NCT02325453; Pre-results. PMID:26482769

  11. [Croatian guidelines for perioperative enteral nutrition of surgical patients].

    PubMed

    Zeli?, Marko; Bender, Darija Vranesi?; Keleci?, Dina Ljubas; Zupan, Zeljko; Cicvari?, Tedi; Maldini, Branka; Durut, Iva; Raheli?, Velimir; Skegro, Mate; Majerovi?, Mate; Perko, Zdravko; Susti?, Alan; Madzar, Tomislav; Kovaci?, Borna; Kekez, Tihomir; Krznari?, Zeljko

    2014-01-01

    Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals. PMID:25327004

  12. Surgical Management of Stone Disease in Patient with Primary Hyperoxaluria

    PubMed Central

    Carrasco, Alonso; Granberg, Candace F.; Gettman, Matthew T.; Milliner, Dawn S.; Krambeck, Amy E.

    2015-01-01

    Objectives To present our experience with surgical management of nephrolithiasis in patients with primary hyperoxaluria (PH). Methods A retrospective chart review from 1994–2012 was perform to identify patients with diagnosis of PH. Results A total of 14 patients with PH were identified with median follow-up of 18.6 years (range: 0.9–51). Median age at initial symptom and subsequent diagnosis were 6.7 years (range: 1.1–35.5) and 0.42 years (range: 0–33.25), respectively. Patients underwent a total of 54 procedures at our institution including: ureteroscopy 27 (50%), percutaneous nephrolithotomy 15 (28%), shock wave lithotripsy 8 (15%), and combined procedures 4 (7%). Overall non-intraparenchymal stone free rate after first, second, and third procedure(s) were 59%, 76%, and 78%, respectively. On average 1.6 procedures (range: 1–4) were required to rid patients of symptomatic stones, which subsequently afforded them a mean of 3.62 years (range: 0.25–21.5) without the need of additional intervention. There were 6 Clavien grade ? III complications in 4 patients, including immediate postoperative ESRD in 3. Conclusions Despite optimal medical and surgical management, patients experience recurrent acute stone events requiring multiple urologic interventions. Significant complications such as ESRD can occur secondary to surgical intervention. PMID:25733260

  13. [Systemic enzymotherapy as a method of prophylaxis of postradiation complications in oncological patients].

    PubMed

    Hubarieva, H O; Kindzel's'ky?, L P; Ponomar'ova, O V; Udatova, T V; Shpil'ova, S I; Smolanka, I I; Korovin, S I; Ivankin, V S

    2000-01-01

    Set out in the paper are results of treatment of those patients with carcinoma of the lung, uterine cervix, hysterocarcinoma, breast cancer, malignant thymomas, malignant non-Hodgkin's lymphomas, and lymphogranulematosis having been administered combined, chemoradiation or radiation treatments against the background of a complex of accompanying therapy involving systemic enzymotherapy. Polyenzymic drugs were found to be capable of improving results of treatment of acute radiation reactions and preventing postradiation fibrous changes in the lungs, skin, fatty tissue, soft tissue, liver, kidneys. Thus, systemic enzymotherapy is capable of improving the quality of life and results of treatment of oncological patients. PMID:16786662

  14. Anesthetic Implications of Obesity in the Surgical Patient

    PubMed Central

    Dority, Jeremy; Hassan, Zaki-Udin; Chau, Destiny

    2011-01-01

    The obese patient presents many challenges to both anesthesiologist and surgeon. A good understanding of the pathophysiologic effects of obesity and its anesthetic implications in the surgical setting is critical. The anesthesiologist must recognize increased risks and comorbidities inherent to the obese patient and manage accordingly, optimizing multisystem function in the perioperative period that leads to successful outcomes. Addressed from an organ systems approach, the purpose of this review is to provide surgical specialists with an overview of the anesthetic considerations of obesity. Minimally invasive surgery for the obese patient affords improved analgesia, postoperative pulmonary function, and shorter recovery times at the expense of a more challenging intraoperative anesthetic course. The physiologic effects of laparoscopy are discussed in detail. Although laparoscopy's physiologic effects on various organ systems are well recognized, techniques provide means for compensation and reversing such effects, thereby preserving good patient outcomes. PMID:23204937

  15. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013.

    PubMed

    Papamichael, D; Audisio, R A; Glimelius, B; de Gramont, A; Glynne-Jones, R; Haller, D; Köhne, C-H; Rostoft, S; Lemmens, V; Mitry, E; Rutten, H; Sargent, D; Sastre, J; Seymour, M; Starling, N; Van Cutsem, E; Aapro, M

    2015-03-01

    Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Europe and worldwide, with the peak incidence in patients >70 years of age. However, as the treatment algorithms for the treatment of patients with CRC become ever more complex, it is clear that a significant percentage of older CRC patients (>70 years) are being less than optimally treated. This document provides a summary of an International Society of Geriatric Oncology (SIOG) task force meeting convened in Paris in 2013 to update the existing expert recommendations for the treatment of older (geriatric) CRC patients published in 2009 and includes overviews of the recent data on epidemiology, geriatric assessment as it relates to surgery and oncology, and the ability of older CRC patients to tolerate surgery, adjuvant chemotherapy, treatment of their metastatic disease including palliative chemotherapy with and without the use of the biologics, and finally the use of adjuvant and palliative radiotherapy in the treatment of older rectal cancer patients. An overview of each area was presented by one of the task force experts and comments invited from other task force members. PMID:25015334

  16. Factors Influencing Same-day Hospital Discharge and Risk Factors for Readmission After Robotic Surgery in the Gynecologic Oncology Patient Population

    PubMed Central

    Rivard, Colleen; Casserly, Kelly; Anderson, Mary; Isaksson Vogel, Rachel; Teoh, Deanna

    2015-01-01

    Study Objective To determine the factors that allow for a safe outpatient robotic-assisted minimally invasive gynecologic oncology surgery procedure. Design Retrospective chart review (Canadian Task Force classification II-1). Setting University hospital. Patients All patients (140) undergoing robotic-assisted minimally invasive surgery with the gynecologic oncology service from January 1, 2013, to December 31, 2013. Interventions Risk factors for unsuccessful discharge within 23 hours of surgery and same-day discharge were assessed using logistic regression models. Measurements and Main Results All patients were initially scheduled for same-day discharge. The outpatient surgery group was defined by discharge within 23 hours of the surgery end time, and a same-day surgery subgroup was defined by discharge before midnight on the day of surgery. One hundred fifteen (82.1%) were successfully discharged within 23 hours of surgery, and 90 (64.3%) were discharged the same day. The median hospital stay was 5.3 hours (range, 1–48 hours). Unsuccessful discharge within 23 hours was associated with a preoperative diagnosis of lung disease and intraoperative complications; unsuccessful same-day discharge was associated with older age and later surgery end time. Only 2 patients (1.4%) were readmitted to the hospital within 30 days of surgery. Conclusions Outpatient robotic-assisted minimally invasive surgery is safe and feasible for most gynecologic oncology patients and appears to have a low readmission rate. Older age, preoperative lung disease, and later surgical end time were risk factors for prolonged hospital stay. These patients may benefit from preoperative measures to facilitate earlier discharge. PMID:25304856

  17. Integrative oncology for breast cancer patients: introduction of an expert-based model

    PubMed Central

    2012-01-01

    Background Malignant breast neoplasms are among the most frequent forms of cancer in the Western world. Conventional treatment of breast cancer may include surgery, hormonal therapy, chemotherapy, radiation and/or immunotherapy, all of which are often accompanied by severe side effects. Complementary and alternative medicine (CAM) treatments have been shown to be effective in alleviating those symptoms. Furthermore, with patient survival rates increasing, oncologists, psychologists and other therapists have to become more sensitive to the needs of cancer survivors that go beyond than the mere alleviation of symptoms. Many CAM methods are geared to treat the patient in a holistic manner and thus are also concerned with the patient’s psychological and spiritual needs. Discussion The use of certain CAM methods may become problematic when, as frequently occurs, patients use them indiscriminately and without informing their oncologists. Herbal medicines and dietary supplements, especially, may interfere with primary cancer treatments or have other detrimental effects. Thus, expertise in this highly specialized field of integrative medicine should be available to patients so that they can be advised about the benefits and negative effects of such preparations and practices. Being a beneficial combination of conventional and CAM care, integrative oncology makes possible the holistic approach to cancer care. The concept of integrative oncology for breast cancer is jointly practiced by the Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, academic teaching hospital of the University of Duisburg-Essen, and the Breast Center at Kliniken Essen-Mitte in Germany. This model is introduced here; its scope is reviewed, and its possible implications for the practice of integrative medicine are discussed. Summary Evidence-based integrative care is crucial to the field of oncology in establishing state-of-the-art care for breast cancer patients. PMID:23170989

  18. LONG-TERM OUTCOMES IN ELDERLY SURGICAL PATIENTS

    PubMed Central

    Deiner, Stacie; Silverstein, Jeffrey H.

    2011-01-01

    Anesthesia has developed to the point where long term outcomes are important endpoints. Elderly patients are becoming an increasingly large part of most surgical practices, consistent with demographic shifts. Long term outcomes are particularly important for this group. In this review, we discuss functional outcomes in the elderly. We describe the areas of cognitive change and frailty, both of which are specific to the elderly. We also discuss prevention of surgical infections and emerging evidence around hemodynamic alterations in the operating room and their impact on long term outcomes. PMID:22238042

  19. Is the clinical use of cannabis by oncology patients advisable?

    PubMed

    Bar-Sela, Gil; Avisar, Adva; Batash, Ron; Schaffer, Moshe

    2014-06-01

    The use of the cannabis plant for various medical indications by cancer patients has been rising significantly in the past few years in several European countries, the US and Israel. The increase in use comes from public demand for the most part, and not due to a scientific basis. Cannabis chemistry is complex, and the isolation and extraction of the active ingredient remain difficult. The active agent in cannabis is unique among psychoactive plant materials, as it contains no nitrogen and, thus, is not an alkaloid. Alongside inconclusive evidence of increased risks of lung and head and neck cancers from prolonged smoking of the plant produce, laboratory evidence of the anti-cancer effects of plant components exists, but with no clinical research in this direction. The beneficial effects of treatment with the plant, or treatment with medicine produced from its components, are related to symptoms of the disease: pain, nausea and vomiting, loss of appetite and weight loss. The clinical evidence of the efficacy of cannabis for these indications is only partial. However, recent scientific data from studies with THC and cannabidiol combinations report the first clinical indication of cancer-related pain relief. The difficulties of performing research into products that are not medicinal, such as cannabis, have not allowed a true study of the cannabis plant extract although, from the public point of view, such studies are greatly desirable. PMID:24606496

  20. Surgical Management of Urolithiasis in Patients after Urinary Diversion

    PubMed Central

    Zhong, Wen; Yang, Bicheng; He, Fang; Wang, Liang; Swami, Sunil; Zeng, Guohua

    2014-01-01

    Objective To present our experience in surgical management of urolithiasis in patients after urinary diversion. Patients and Methods Twenty patients with urolithiasis after urinary diversion received intervention. Percutaneous nephrolithotomy, percutaneous based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy and open operation were performed in 8, 3, 2, 6, and 1 patients, respectively. The operative finding and complications were retrospectively collected and analyzed. Results The mean stone size was 4.5±3.1 (range 1.5–11.2) cm. The mean operation time was 82.0±11.5 (range 55–120) min. Eighteen patients were rendered stone free with a clearance of 90%. Complications occurred in 3 patients (15%). Two patients (10%) had postoperative fever greater than 38.5°C, and one patient (5%) suffered urine extravasations from percutaneous tract. Conclusions The percutaneous based procedures, including percutaneous nephrolithotomy, antegrade ureteroscopy with semi-rigid ureteroscope or flexible ureteroscope from percutaneous tract, and percutaneous pouch lithotripsy, provides a direct and safe access to the target stones in patients after urinary diversion, and with high stone free rate and minor complications. The surgical management of urolithiasis in patients after urinary diversion requires comprehensive evaluation and individualized consideration depending upon the urinary diversion type, stone location, stone burden, available resource and surgeon experience. PMID:25360621

  1. Delivering care to oncology patients in the community: an innovative integrated approach.

    PubMed

    Hanan, Terry; Mullen, Louise; Laffoy, Marie; O'Toole, Eve; Richmond, Janice; Wynne, Mary

    2014-08-01

    A community oncology nursing programme was developed in Ireland between the hospital and community health services for patients receiving systemic cancer therapy, in response to a service need. A robust evaluation of the pilot programme was undertaken, which found that defined clinical procedures traditionally undertaken in hospitals were safely undertaken in the patient's home with no adverse effects. There was a dramatic decrease in hospital attendances for these defined clinical procedures, and hospital capacity was consequently freed up. Patients valued having aspects of their care delivered at home and reported that it improved their quality of life, including reduced hospital visits and travel time. Community nurses expanded their scope of practice and became partners with oncology day-ward nurses in caring for these patients. Community nurses developed the competence and confidence to safely deliver cancer care in the community. This initiative shows that defined elements of acute cancer care can be safely delivered in the community so long as the training and support are provided. The findings and recommendations of the evaluation resulted in university accreditation and approval for national roll-out of the programme. Integration of services between primary and secondary care is a key priority. This innovative programme is a good example of shared integrated care that benefits both patients and health-care providers. PMID:25089749

  2. Assessment of Telemedicine in Surgical Education and Patient Care

    PubMed Central

    Demartines, Nicolas; Mutter, Didier; Vix, Michel; Leroy, Joël; Glatz, Dieter; Rösel, Fritz; Harder, Felix; Marescaux, Jacques

    2000-01-01

    Objective To analyze the value of teleconferencing for patient care and surgical education by assessing the activity of an international academic network. Summary Background Data The uses of telemedicine include teleeducation, training, and consulting, and surgical teams are now involved, sharing diagnostic information and opinions without the need for travel. However, the value of telematics in surgery remains to be assessed. Methods During a 2-year period, weekly surgical teleconferences were held among six university hospitals in four European countries. To assess the accuracy of telediagnosis for surgical cases, 60 randomly selected cases were analyzed by a panel of surgeons. Participants’ opinions were analyzed by questionnaire. Results Seventy teleconferences (50 lectures and 271 case presentations) were held. Ninety-five of the 114 participants (83.3%) completed the final questionnaire. Eighty-six percent rated the surgical activity as good or excellent, 75.7% rated the scientific level as good or excellent, 55.8% rated the daily clinical activity as good or excellent, and 28.4% rated the manual surgical technique as good or excellent. The target organ was identified in all the cases; the organ structure and pathology were considered well defined in 93.3%, and the fine structure was considered well defined in 58.3%. Diagnosis was accurate in 17 cases (28.3%), probable in 25 (41.7%), possible but uncertain in 16 (26.7%), and not possible in 2 cases (3.3%). Discussion among the remote sites increased the rate of valuable therapeutic advice from 55% of cases before the discussion to 95% after the discussion. Eighty-six percent of the surgeons expressed satisfaction with telematics for medical education and patient care. Conclusions Participant satisfaction was high, transmission of clinical documents was accurate, and the opportunity to discuss case documentation and management significantly improved diagnostic potential, resulting in an accuracy rate of up to 95%. Teleeducation and teleconsultation in surgery appear to be beneficial. PMID:10674622

  3. Risk factors and prognosis of hypoalbuminemia in surgical septic patients

    PubMed Central

    Sun, Jia-Kui; Sun, Fang; Wang, Xiang; Yuan, Shou-Tao; Zheng, Shu-Yun

    2015-01-01

    The aim of this study was to investigate the risk factors of hypoalbuminemia and effects of different albumin levels on the prognosis of surgical septic patients. We preformed a retrospective clinical study including 135 adult patients from September 2011 to June 2014. The albumin levels and severity markers were recorded during the first 48 h after enrollment, and logistic regression analyses were used to determine the risk factors. The outcomes of patients with different albumin levels were also compared. The acute physiology and chronic health evaluation II (APACHE II) score (OR 1.786, 95% CI [1.379–2.314], P < 0.001), C-reactive protein (CRP) (OR 1.016, 95% CI [1.005–1.027], P = 0.005), and blood lactate (OR 1.764, 95% CI [1.141–2.726], P = 0.011) were established as the independent risk factors of hypoalbuminemia in patients with surgical sepsis. The severity markers and outcomes of patients with albumin levels ?20 g/L were significantly worse than that of 21–25 g/L and ?26 g/L, whereas the latter two groups had similar prognosis. Every 1 g/L decrease of albumin level below the optimal cut-off (23 g/L) was associated with a 19.4% increase in hospital mortality and a 28.7% increase in the incidence of multiple organ dysfunction syndrome. In conclusion, APACHE II score (?14.5), CRP (?34.25 mg/L), and blood lactate (?.35 mmol/L) were established as the independent risk factors of hypoalbuminemia in the early stage of surgical sepsis. Patients with baseline albumin level ?20 g/L had worse prognosis than that of albumin level ?21 g/L. Albumin levels were negatively correlated the prognosis of surgical sepsis when below about 23 g/L. PMID:26557421

  4. Surgical treatment of liver metastases in patients with neuroendocrine tumors

    PubMed Central

    Saeed, Ahmad; Buell, Joseph F

    2013-01-01

    Liver metastases occur in 75% to 80% of patients with neuroendocrine tumors (NETs), and are considered significant adverse prognostic indicators. Management of NETs liver metastases is challenging and requires aggressive therapy. Currently, there are many therapeutic options for metastatic NETs. However, there is considerable controversy regarding the optimal management. Although complete surgical resection remains the optimal therapy, a variety of other minimally invasive surgical and medical options are available, this includes thermal ablative techniques (e.g., radiofrequency ablation, microwave ablation, cryotherapy), embolization using transcatheter embolization, chemoembolization, or radioembolization, and medical therapy (e.g., chemotherapy, biotherapy with somatostatin analogues and interferon). Currently there is no evidence-based data directly comparing surgical versus alternative liver-directed treatment options. An aggressive surgical approach, coupled with additional liver-directed procedures is often recommended as it extends the overall survival. Optimal patient care should be directed by a multidisciplinary team to assure that all treatment options are explored for decision-making while treating this aggressive disease. PMID:25332951

  5. Surgical treatment of liver metastases in patients with neuroendocrine tumors.

    PubMed

    Saeed, Ahmad; Buell, Joseph F; Kandil, Emad

    2013-04-01

    Liver metastases occur in 75% to 80% of patients with neuroendocrine tumors (NETs), and are considered significant adverse prognostic indicators. Management of NETs liver metastases is challenging and requires aggressive therapy. Currently, there are many therapeutic options for metastatic NETs. However, there is considerable controversy regarding the optimal management. Although complete surgical resection remains the optimal therapy, a variety of other minimally invasive surgical and medical options are available, this includes thermal ablative techniques (e.g., radiofrequency ablation, microwave ablation, cryotherapy), embolization using transcatheter embolization, chemoembolization, or radioembolization, and medical therapy (e.g., chemotherapy, biotherapy with somatostatin analogues and interferon). Currently there is no evidence-based data directly comparing surgical versus alternative liver-directed treatment options. An aggressive surgical approach, coupled with additional liver-directed procedures is often recommended as it extends the overall survival. Optimal patient care should be directed by a multidisciplinary team to assure that all treatment options are explored for decision-making while treating this aggressive disease. PMID:25332951

  6. Assessing Interpersonal and Communication Skills in Radiation Oncology Residents: A Pilot Standardized Patient Program

    SciTech Connect

    Ju, Melody; Berman, Abigail T.; Hwang, Wei-Ting; LaMarra, Denise; Baffic, Cordelia; Suneja, Gita; Vapiwala, Neha

    2014-04-01

    Purpose: There is a lack of data for the structured development and evaluation of communication skills in radiation oncology residency training programs. Effective communication skills are increasingly emphasized by the Accreditation Council for Graduate Medical Education and are critical for a successful clinical practice. We present the design of a novel, pilot standardized patient (SP) program and the evaluation of communication skills among radiation oncology residents. Methods and Materials: Two case scenarios were developed to challenge residents in the delivery of “bad news” to patients: one scenario regarding treatment failure and the other regarding change in treatment plan. Eleven radiation oncology residents paired with 6 faculty participated in this pilot program. Each encounter was scored by the SPs, observing faculty, and residents themselves based on the Kalamazoo guidelines. Results: Overall resident performance ratings were “good” to “excellent,” with faculty assigning statistically significant higher scores and residents assigning lower scores. We found inconsistent inter rater agreement among faculty, residents, and SPs. SP feedback was also valuable in identifying areas of improvement, including more collaborative decision making and less use of medical jargon. Conclusions: The program was well received by residents and faculty and regarded as a valuable educational experience that could be used as an annual feedback tool. Poor inter rater agreement suggests a need for residents and faculty physicians to better calibrate their evaluations to true patient perceptions. High scores from faculty members substantiate the concern that resident evaluations are generally positive and nondiscriminating. Faculty should be encouraged to provide honest and critical feedback to hone residents' interpersonal skills.

  7. The impact of surgical outcome after pancreaticoduodenectomy in elderly patients

    PubMed Central

    2011-01-01

    Background The elderly population has increased in many countries. Indications for cancer treatment in elderly patients have expanded, because surgical techniques and medical management have improved remarkably. Pancreaticoduodenectomy (PD) requires high-quality techniques and perioperative management methods. If it is possible for elderly patients to withstand an aggressive surgery, age should not be considered a contraindication for PD. Appropriate preoperative evaluation of elderly patients will lead to their safer management. The purpose of the present study was to evaluate the safety of PD in patients older than 75 years and to show the influence of advanced age on the morbidity and mortality associated with this operation. Patients and methods Subjects were 98 patients who underwent PD during the time period from April 2005 to April 2011. During this study, 31 patients were 75 years of age or older (group A), and the other 67 patients were less than 75 years old (group B). Preoperative demographic and clinical data, surgical procedure, pathologic diagnosis, postoperative course and complication details were collected prospectively and they were analyzed in two group. Results There was no statistical difference between patient groups in terms of gender, comorbidity, preoperative drainage, diagnosis, or laboratory data. Preoperative albumin values were lower in group A (P = 0.04). The mean surgical time in group A was 408.1 ± 73.47 min. Blood loss and blood transfusion were not significantly different between both groups. There was no statistical differences in mortality rate (P = 0.14), morbidity rate (P = 0.43), and mean length of hospital stay (P = 0.22) between both groups. Long-term survival was also no statistically significant difference between the two groups using the log-rank test (P = 0.10). Conclusion It cannot be ignored that the elderly population is getting larger. We must investigate the management of elderly patients after PD and prepare further for more experiences of PD. If appropriate surgical management is provided to elderly patients, we suggest that PD will lead to no adverse effects after surgery, and PD can be performed safely in elderly patients. We conclude that age should not be a contraindication to PD. PMID:21906398

  8. Surgical Options for Drug-Refractory Overactive Bladder Patients

    PubMed Central

    Starkman, Jonathan S; Smith, Christopher P; Staskin, David R

    2010-01-01

    Overactive bladder (OAB) is a symptom complex of urinary frequency, urinary urgency, and nocturia, with or without urgency incontinence. This syndrome is idiopathic in most instances without clearly defined pathophysiology. Studies clearly show that OAB negatively impacts health-related quality of life and impairs daily functioning in a large proportion of patients. Despite recent advances in drug delivery and improved tolerability of antimuscarinic drug class, a large percentage of patients remain refractory to conventional pharmacological therapy for this chronic condition. There are several unique and effective treatments that are available for this difficult population. We review the various surgical options within the urological armamentarium to treat patients with refractory OAB. PMID:20811558

  9. Pain Management Issues for the Geriatric Surgical Patient.

    PubMed

    McKeown, Jason L

    2015-09-01

    Adequate treatment of pain is of utmost importance in making uncomplicated the perioperative course for geriatric surgical patients. Effective analgesia reduces morbidity, improves patient and family satisfaction, and is a natural expectation of high-quality care. Pain treatment in older adults is more complicated than in younger counterparts, and great consideration must be given to age-related changes in physiology and pharmacokinetics. Pain treatment must be individualized based on each patient's profile. Side effects must be minimized and organ toxicity avoided. When complications occur they may be more severe, and treatment must be prompt. Alternative plans for analgesia must be readily enacted. PMID:26315638

  10. ADDUCTOR POLLICIS MUSCLE AS PREDICTOR OF MALNUTRITION IN SURGICAL PATIENTS

    PubMed Central

    de MELO, Camila Yandara Sousa Vieira; da SILVA, Silvia Alves

    2014-01-01

    Background In the compromised nutritional status, there is excessive skeletal muscle loss and decreased inflammatory response, contributing to increased morbidity and mortality and length of stay. Aim To estimate the prevalence of malnutrition by measuring adductor pollicis muscle using cutoffs for surgical patients suggested in the literature. Methods Cross-sectional study with 151 patients scheduled for elective surgical procedure. Nutritional assessment was performed by classical anthropometric measurements: arm circumference, triceps skinfold thickness, arm muscle circumference, corrected arm muscle area, BMI and percentage of weight loss and the extent of the adductor pollicis muscle in both hands. Results The prevalence of malnutrition in patients was high. A significant association between nutritional diagnosis according to the measures of adductor pollicis muscle and arm circumference, BMI and triceps skinfold thickness but there was no association with arm muscular circumference, arm muscular area or percentage of weight loss. Conclusion The adductor pollicis muscle has proved to be a good method to diagnose muscle depletion and malnutrition in surgical patients. PMID:24676291

  11. Quality of life in patients with ulcerative colitis treated surgically

    PubMed Central

    Koz?owska, Katarzyna A.; Krokowicz, Piotr

    2014-01-01

    Introduction Ulcerative colitis belongs to the group of inflammatory bowel diseases. The specific symptoms and chronic nature of the disease significantly affect the quality of patients’ lives. Quality-of-life assessment helps to define its determining factors as well as the efficiency of surgical procedures. Aim Quality-of-life evaluation of patients with ulcerative colitis treated surgically. Material and methods A retrospective review was carried out on 35 patients with ulcerative colitis, who were treated surgically in the Clinic of General and Colorectal Surgery, University of Medical Sciences in Poznan. The research tools used to assess the quality of life consisted of: the Inflammatory Bowel Disease Questionnaire, a Polish version of the Short Form Health Survey-36, and a questionnaire. Results The mean of the IBDQ scale was 152.51, and the median was 161. In this scale, a higher score indicates better quality of life. The situation in the subjective SF-36 scale is reversed: a lower score indicates better quality of life. The mean of the SF-36 was 115.94, and the median was 58. Many discrepancies in the field (e.g. the influence of determining factors) create a niche for further studies. Conclusions Moreover, quality-of-life evaluation may lead to better patient care, understanding their problems or treatment modifications, and finally may become a kind of therapy efficiency parameter. PMID:25276253

  12. Colorectal cancer in aged patients. Toward the routine treatment through laparoscopic surgical approach

    PubMed Central

    VECCHIO, R.; MARCHESE, S.; FAMOSO, F.; LA CORTE, F.; MARLETTA, S.; LEANZA, G.; ZANGHÌ, G.; LEANZA, V.; INTAGLIATA, E.

    2015-01-01

    Aim Colorectal cancer is one of the most common malignancies in general population. The incidence seems to be higher in older age. Surgery remains the treatment of choice and laparoscopic approach offers numerous benefits. We report our personal experience in elderly patients operated on for colorectal cancer with laparoscopic resection. Patients and methods From January 2003 to September 2013, out of 160 patients aged 65 years or older and operated with minimally invasive techniques, 30 cases affected by colorectal cancer and operated on with laparoscopic approach were analyzed in this study. Results Male/female ratio was 1.35 and mean age 72 years. Constipation, weight loss, anemia and rectal bleeding were the most commonly reported symptoms. Lesions involved descending-sigmoid colon in 53% of cases, rectum in 37% and ascending colon in 10%. Among laparoscopic colorectal operations laparoscopic left colectomy was the most frequently performed, followed by right colectomy, abdominoperineal resection and Hartmann procedure. Operative times ranged from 3 to 5 hours depending on surgical procedure performed. Mean hospital stay was 6 days (range 4–9). Conversion to open approach occurred only in a case of laparoscopic right colectomy (3%) for uncontrolled bleeding. A single case of mortality was reported. In two cases (7%) anastomotic leakage was observed, conservatively treated in one patient and requiring reoperation in the other one. Conclusions Laparoscopic colorectal surgery is feasible and effective for malignancies in elderly population offering several advantages including immunologic and oncologic ones. However an experienced surgical team is essential in reducing risks and complications. PMID:25827663

  13. Violent behavior in cancer patients--a rarely addressed phenomenon in oncological treatment.

    PubMed

    Grube, Michael

    2012-07-01

    Dealing with violent cancer patients can be particularly challenging. The purpose of this study was to collect data on the frequency, quality, and underlying variables affecting violent behavior as well as to examine the role played by this behavior in the premature interruption of treatment. A total of 388 cancer inpatients were examined by liaison psychiatrists. The data were assessed using the Staff Observation Aggression Scale (SOAS-R) and Psycho-Oncological Basic Documentation (PO-BADO); the quality of psychiatric disturbances was measured with a three-level rating according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria. Nineteen of 388 patients (4.9%) displayed violent behavior. The variable "cognitive limitations" was clearly associated with aggressive behavior. The interaction factor "constantly bedfast, nonterminal phase, and strong feelings of helplessness or subjection," was associated with aggressive behavior as a trend statistically. Eight of 19 inpatients showing aggressive behavior were prematurely released from the treatment facility. In a multivariate model the association of the variable "aggressive behavior" to premature interruption of treatment with unfinished diagnosis and therapy was weighted rather strong. Despite their methodological limitations, these results suggest that members of oncological teams should be able to identify violent behavior and its precursors at an early stage as important factors, which may decrease patient cooperation. PMID:22767207

  14. Evaluation and Management of Patients With Heart Disease and Cancer: Cardio-Oncology

    PubMed Central

    Herrmann, Joerg; Lerman, Amir; Sandhu, Nicole P.; Villarraga, Hector R.; Mulvagh, Sharon L.; Kohli, Manish

    2014-01-01

    The care for patients with cancer has advanced greatly over the past decades. A combination of earlier cancer diagnosis and greater use of traditional and novel systemic treatments has decreased cancer-related mortality. Effective cancer therapies, however, can result in short- and long-term co-morbidities that can decrease the net clinical gain by impacting quality of life and survival. In particular, cardiovascular complications of cancer treatments can have a profound impact on the health of cancer patients and are more common among those with recognized or unrecognized underlying cardiovascular diseases. A new discipline termed “cardio-oncology” has thus evolved to address the cardiovascular needs of cancer patients and optimize their care in a multidisciplinary approach. This review provides a brief introduction and background on this emerging field and then focuses on its practical aspects including: cardiovascular risk assessment and prevention before cancer treatment, cardiovascular surveillance and therapy during cancer treatment, and cardiovascular monitoring and management after cancer therapy. The content of this review is based on a literature search of PubMed between January 1, 1960, and February 1, 2014 using the search terms cancer, cardiomyopathy, cardiotoxicity, cardio-oncology, chemotherapy, heart failure, and radiation. PMID:25192616

  15. Surgical treatment of patients with unruptured intracranial aneurysms.

    PubMed

    Chen, S F; Kato, Y; Sinha, R; Kumar, A; Watabe, T; Imizu, S; Oda, J; Oguri, D; Sano, H; Hirose, Y

    2015-01-01

    We present our experience with elective microsurgical clipping of unruptured intracranial aneurysms (UIA) and analyze this management. A total of 150 patients with UIA were reviewed and data were collected with regard to age, sex, presence of symptoms, location and size of the aneurysms, surgical complications and postoperative 1 year outcomes. Aneurysm size was assessed either by three-dimensional CT angiography or digital subtraction angiogram. Glasgow Outcome Scale was used to assess clinical outcomes. One hundred and fifty patients with 165 aneurysms were treated in this series. The mean size of the UIA was 5.6mm. Eighty aneurysms (48.5%) were less than 5mm in size, and 73 (44.2%) were from 5 to 10mm. Ten (6.1%) of the aneurysms were large and two (1.2%) were giant. One hundred and forty-three were asymptomatic and seven were symptomatic before surgery. The outcome was good in 147 patients (98%), and only three patients (2%) had a treatment-related unfavorable outcome. Five patients experienced transient neurological deficits and one patient experienced permanent neurological deficits. Overall 98.7% of the treated aneurysms were satisfactorily obliterated. Wound complications were seen only in three patients. In conclusion, UIA pose a significant challenge for neurosurgeons, where a delicate balance between benefits and possible risks must be weighed. If the requisite expertise is available, they can be treated surgically with low morbidity and a good outcome at specialized neurovascular centers. PMID:25443084

  16. Longitudinal Assessments of Quality of Life in Endometrial Cancer Patients: Effect of Surgical Approach and Adjuvant Radiotherapy

    SciTech Connect

    Le, Tien; Menard, Chantal; Samant, Rajiv; Choan, E.; Hopkins, Laura; Faught, Wylam; Fung-Kee-Fung, Michael

    2009-11-01

    Purpose: Adjuvant radiotherapy (RT) is often considered for endometrial cancer. We studied the effect of RT and surgical treatment on patients' quality of life (QOL). Methods and Materials: All patients referred to the gynecologic oncology clinics with biopsy findings showing endometrial cancer were recruited. QOL assessments were performed using the European Organization for Research and Treatment of Cancer QOL questionnaire-C30, version 3. Assessments were obtained at study entry and at regular 3-month intervals for a maximum of 2 years. Open-ended telephone interviews were done every 6 months. Linear mixed regression models were built using QOL domain scores as dependent variables, with the predictors of surgical treatment and adjuvant RT type. Results: A total of 40 patients were recruited; 80% of the surgeries were performed by laparotomy. Significant improvements were seen in most QOL domains with increased time from treatment. Adjuvant RT resulted in significantly more severe bowel symptoms and improvement in insomnia compared with conservative follow-up. No significant adverse effect from adjuvant RT was seen on the overall QOL. Bowel symptoms were significantly increased in patients treated with laparotomy compared with laparoscopy in the patients treated with whole pelvic RT. Qualitatively, about one-half of the patients noted improvements in their overall QOL during follow-up, with easy fatigability the most prevalent. Conclusion: No significant adverse effect was seen on patients' overall QOL with adjuvant pelvic RT after the recovery period. The acute adverse effects on patients' QOL significantly improved with an increasing interval from diagnosis.

  17. Smart CO2 laser surgical system based on autodyne monitoring of laser-evaporated biotissues: first results in oncology

    NASA Astrophysics Data System (ADS)

    Dmitriev, A. K.; Varev, G. A.; Konovalov, A. N.; Kortunov, V. N.; Panchenko, V. Y.; Reshetov, I. V.; Matorin, O. V.; Maiboroda, V. F.; Ul'yanov, V. A.

    2005-08-01

    New method based on techniques of self-induced autodyne effect for diagnostics and control of laser-tissue evaporation by radiation of high-frequency pumped waveguide CO2 laser is developed. This method is used for creation of feed-back for smart CO2 laser surgical system of "Lancet" series. The results of medical testing of the smart laser surgical system are presented.

  18. Surgical site infection rates in dialysis patients undergoing endovascular procedures.

    PubMed

    Urbanes, Aris Q; Litchfield, Terry; Graham, Kevin; Hutyra, Carolyn A

    2015-10-01

    A surgical site infection (SSI) is an infection related to surgery that develops within 30 days after an operation or within 1 year of implant placement. Postoperative SSIs are the most common health-care-associated infections, occurring in up to 5% of surgical patients. Endovascular surgical procedures related to vascular access are common in the dialysis population and may cause SSIs. A large outpatient vascular access system developed and implemented a surveillance program to measure and monitor SSIs in their population. The health-care surveillance system extended to 76 ambulatory care centers across the United States and Puerto Rico. Based on a recorded 92,880 patient encounters, the surveillance system tabulated 12,541 valid patient survey responses documenting self-reported symptoms of infection within a 30-day postoperative period. The SSI rate was tabulated based on the presence of two or more specified indicators of infection: antibiotics, pus, dehiscence, pain, warmth, and swelling. Patients undergoing interventional procedures received surveys at discharge. Data were collected and analyzed using SPSS software. Survey analysis indicated a less than 3% superficial incisional SSI rate in hemodialysis patients undergoing endovascular procedures. The SSI rate for clean wound procedures is generally 2% or less. These data indicate that dialysis patients undergoing interventional procedures in vascular access centers may have a slightly greater risk of developing SSIs due to the presence of additional risk factors including obesity, diabetes, and age. This study was limited by a set of loose diagnostic criteria self-reported by patients, which may have overestimated the prevalence of infection. SSIs are a serious medical problem associated with increased morbidity and mortality and increased medical care costs. All providers should consider an active surveillance program following endovascular procedures given the comorbidities associated with the dialysis population. PMID:26448384

  19. Keeping patients safe: an interventional hand hygiene study at an oncology center.

    PubMed

    Siegel, Jeanne H; Korniewicz, Denise M

    2007-10-01

    Healthcare-associated infections (HCIs) continue to affect patient morbidity and mortality and contribute to the rising cost of health care. Factors associated with the rise of HCIs in patients with cancer may include an increase in antimicrobial resistance and treatment effects of radiation and chemotherapeutic agents. Infection control and prevention practices can decrease infection rates among patients with cancer. In an effort to reduce HCIs and increase awareness, an interventional study was conducted at an oncology center to investigate hand hygiene compliance of healthcare professionals before and after the introduction of a handheld sanitizer spray. Although healthcare professionals had a positive response to the spray, it did not improve compliance rates. PMID:17962172

  20. Factors Influencing Communication Between the Patients with Cancer and their Nurses in Oncology Wards

    PubMed Central

    Zamanzadeh, Vahid; Rassouli, Maryam; Abbaszadeh, Abbas; Nikanfar, Alireza; Alavi-Majd, Hamid; Ghahramanian, Akram

    2014-01-01

    Aims: The purpose of this study was to demonstrate the factors influencing nurse-patient communication in cancer care in Iran. Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in oncology wards of hospitals in Tabriz. Data was collected through purposive sampling by semi-structured deep interviews with nine patients, three family members and five nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control. Results: The main theme of the research emerged as “three-factor effects” that demonstrates all the factors related to the patient, nurse, and the organization and includes three categories of “Patient as the center of communication”, “Nurse as a human factor”, and “Organizational structures”. The first category consists of two sub-categories of “Imposed changes by the disease” and the “patient's particular characteristics”. The second category includes sub-categories of “sense of vulnerability” and “perception of professional self: Pre-requisite of patient-centered communication”. The third category consists of the sub-categories of “workload and time imbalance”, “lack of supervision”, and “impose duties in context of neglecting nurse and patient needs”. Characteristics of the patients, nurses, and care environment seemed to be the influential factors on the communication. Conclusions: In order to communicate with cancer patients effectively, changes in philosophy and culture of the care environment are essential. Nurses must receive proper trainings which meet their needs and which focus on holistic and patient-centered approach. PMID:24600177

  1. Suicidal thoughts in cancer patients: clinical experience in psycho-oncology.

    PubMed

    Akechi, T; Kugaya, A; Okamura, H; Nakano, T; Okuyama, T; Mikami, I; Shima, Y; Yamawaki, S; Uchitomi, Y

    1999-10-01

    Because cancer is a life-threatening illness, its impact on the patient's emotional well-being, such as suicidal thoughts, has become a significant problem in public health as well as in clinical oncology. Factors such as the pain and hopelessness are suggested as making cancer patients more vulnerable to suicide. On the other hand, euthanasia and physician-assisted suicide are now important medical and social issues all over the world. However, little is known about the relationship between the characteristics of cancer patients and suicidal thoughts. The present study investigated the characteristics of patients who were referred to the Psychiatry Division, National Cancer Center Hospital East, due to risk of suicide or suicide attempts. Fourteen patients were referred, representing 3.9% of all consultations. Most of these patients suffered from advanced cancer and poor physical functioning. The most frequent psychiatric diagnosis was mood disorder (57%), and the next was delirium (29%). In patients with mood disorders (8 cases), suicidal thoughts disappeared after psychiatric treatment in 5 cases, but not in 3 cases. Those three patients survived a significantly shorter time than the others after psychiatric consultation. These empirical data might indicate that most suicidal thoughts experienced by cancer patients are not rational, and a careful evaluation, including psychiatric assessment, should be conducted in such patients. PMID:10595681

  2. Generating patient-specific pulmonary vascular models for surgical planning

    NASA Astrophysics Data System (ADS)

    Murff, Daniel; Co-Vu, Jennifer; O'Dell, Walter G.

    2015-03-01

    Each year in the U.S., 7.4 million surgical procedures involving the major vessels are performed. Many of our patients require multiple surgeries, and many of the procedures include "surgical exploration". Procedures of this kind come with a significant amount of risk, carrying up to a 17.4% predicted mortality rate. This is especially concerning for our target population of pediatric patients with congenital abnormalities of the heart and major pulmonary vessels. This paper offers a novel approach to surgical planning which includes studying virtual and physical models of pulmonary vasculature of an individual patient before operation obtained from conventional 3D X-ray computed tomography (CT) scans of the chest. These models would provide clinicians with a non-invasive, intricately detailed representation of patient anatomy, and could reduce the need for invasive planning procedures such as exploratory surgery. Researchers involved in the AirPROM project have already demonstrated the utility of virtual and physical models in treatment planning of the airways of the chest. Clinicians have acknowledged the potential benefit from such a technology. A method for creating patient-derived physical models is demonstrated on pulmonary vasculature extracted from a CT scan with contrast of an adult human. Using a modified version of the NIH ImageJ program, a series of image processing functions are used to extract and mathematically reconstruct the vasculature tree structures of interest. An auto-generated STL file is sent to a 3D printer to create a physical model of the major pulmonary vasculature generated from 3D CT scans of patients.

  3. Clinical and Oncological Value of Preoperative BMI in Gastric Cancer Patients: A Single Center Experience

    PubMed Central

    Voglino, Costantino; Di Mare, Giulio; Ferrara, Francesco; De Franco, Lorenzo; Roviello, Franco; Marrelli, Daniele

    2015-01-01

    Introduction. The impact of preoperative BMI on surgical outcomes and long-term survival of gastric cancer patients was investigated in various reports with contrasting results. Materials & Methods. A total of 378 patients who underwent a surgical resection for primary gastric cancer between 1994 and 2011 were retrospectively studied. Patients were stratified according to BMI into a normal group (<25, group A), an overweight group (25–30, group B), and an obesity group (≥30, group C). These 3 groups were compared according to clinical-pathological characteristics, surgical treatment, and long-term survival. Results. No significant correlations between BMI and TNM (2010), UICC stage (2010), Lauren's histological type, surgical results, lymph node dissection, and postoperative morbidity and mortality were observed. Factors related to higher BMI were male gender (P < 0.05), diabetes (P < 0.001), and serum blood proteins (P < 0.01). A trend to fewer lymph nodes retrieved during gastrectomy with lymphadenectomy in overweight patients (B and C groups) was observed, although not statistically significant. There was no difference in overall survival or disease-specific survival between the three groups. Conclusion. According to our data, BMI should not be considered a significant predictor of postoperative complications or long-term result in gastric cancer patients. PMID:25759721

  4. Readability of American Online Patient Education Materials in Urologic Oncology: a Need for Simple Communication

    PubMed Central

    Pruthi, Amanda; Nielsen, Matthew E.; Raynor, Mathew C.; Woods, Michael E.; Wallen, Eric M.; Smith, Angela B.

    2014-01-01

    Objectives To determine readability levels of reputable cancer and urologic websites addressing bladder, prostate, kidney and testicular cancers. Methods Online patient education materials (PEMs) for bladder, prostate, kidney and testicular malignancies were evaluated from the American Cancer Society, American Society of Clinical Oncology (ASCO), National Cancer Institute (NCI), Urology Care Foundation (AUA-UCF), Bladder Cancer Advocacy Network (BCAN), Prostate Cancer Foundation (PCF), Kidney Cancer Association (KCA), and Testicular Cancer Resource Center (TCRC). Grade level was determined using several readability indices, and analyses were performed based on cancer type, website, and content area (general, causes, risk factors and prevention, diagnosis and staging, treatment, and post-treatment). Results Estimated grade level of online PEMs ranged from 9.2 to 14.2 with an overall mean of 11.7. Websites for kidney cancer had the least difficult readability (11.3) and prostate cancer had the most difficult readability (12.1). Among specific websites, the most difficult readability levels were noted for the AUA-UCF website for bladder and prostate cancer and the KCA and TCRC for kidney and testes cancer. Readability levels within content areas varied based on disease and website. Conclusion Online PEMs in urologic oncology are written at a level above the average American reader. Simplification of these resources are necessary to improve patient understanding of urologic malignancy. PMID:25623686

  5. [Polymorphism of glucose intolerance and insulin resistance susceptibility genes in oncological patients].

    PubMed

    Ulybina, Iu M; Imianitov, E N; Vasil'ev, D A; Bershte?n, L M

    2008-01-01

    Glucose intolerance and insulin resistance belong to the group of leading risk factors for breast (BC) and endometrial cancer (EC). Differences in the intensity of association of these endocrine disturbances with BC and EC may at least partly be explained by non-identity in polygenic nature of the mentioned hormone-metabolic shifts and oncological diseases themselves as well. In this study, which included 105 healthy postmenopausal women and 301 female cancer patients (110 BC and 191 EC) without overt diabetes mellitus, we compared the frequency of the following genetic polymorphisms: insulin receptor substrate-1, IRS Gly972Arg; leptin receptor, LEPR Lys109Arg and Gln223Arg; mitochondrial uncoupling protein-2, UCP2_866G/A; and gene ND3 of mitochondrial DNA, mtDNA 10398A/G. Genotyping was performed with allele-specific real-time PCR. According to data received, certain genetic markers associated with impaired glucose tolerance and/or insulin resistance (namely, leptin receptor genotypes 223 Gln/Arg and Gln/Gln) are revealed in oncological patients more often than in females without cancer. Other markers (like genotype UCP2 866AA and polymorphism mtDNA 10398A) appeared to be relatively more frequent in EC than in BC providing one of the interpretations for the lower insulin sensitivity and higher incidence of carbohydrate metabolism disturbances in the first of these two diseases. PMID:19140314

  6. Impact of non-oncological factors on tumor recurrence after liver transplantation in hepatocellular carcinoma patients.

    PubMed

    Gu, Xiang-Qian; Zheng, Wei-Ping; Teng, Da-Hong; Sun, Ji-San; Zheng, Hong

    2016-03-01

    Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver and is one of the leading causes of cancer-related death worldwide. Liver transplantation (LT) has become one of the best curative therapeutic options for patients with HCC, although tumor recurrence after LT is a major and unaddressed cause of mortality. Furthermore, the factors that are associated with recurrence are not fully understood, and most previous studies have focused on the biological properties of HCC, such as the number and size of the HCC nodules, the degree of differentiation, the presence of hepatic vascular invasion, elevated serum levels of alpha-fetoprotein, and the tumor stage outside of the Milan criteria. Thus, little attention has been given to factors that are not directly related to HCC (i.e., "non-oncological factors"), which have emerged as predictors of tumor recurrence. This review was performed to assess the effects of non-oncological factors on tumor recurrence after LT. The identification of these factors may provide new research directions and clinical strategies for the prophylaxis and surveillance of tumor recurrence after LT, which can help reduce recurrence and improve patient survival. PMID:26973413

  7. Impact of non-oncological factors on tumor recurrence after liver transplantation in hepatocellular carcinoma patients

    PubMed Central

    Gu, Xiang-Qian; Zheng, Wei-Ping; Teng, Da-Hong; Sun, Ji-San; Zheng, Hong

    2016-01-01

    Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver and is one of the leading causes of cancer-related death worldwide. Liver transplantation (LT) has become one of the best curative therapeutic options for patients with HCC, although tumor recurrence after LT is a major and unaddressed cause of mortality. Furthermore, the factors that are associated with recurrence are not fully understood, and most previous studies have focused on the biological properties of HCC, such as the number and size of the HCC nodules, the degree of differentiation, the presence of hepatic vascular invasion, elevated serum levels of alpha-fetoprotein, and the tumor stage outside of the Milan criteria. Thus, little attention has been given to factors that are not directly related to HCC (i.e., “non-oncological factors”), which have emerged as predictors of tumor recurrence. This review was performed to assess the effects of non-oncological factors on tumor recurrence after LT. The identification of these factors may provide new research directions and clinical strategies for the prophylaxis and surveillance of tumor recurrence after LT, which can help reduce recurrence and improve patient survival. PMID:26973413

  8. Aspergillus Infections in Transplant and Non-Transplant Surgical Patients

    PubMed Central

    Guidry, Christopher; Politano, Amani; Rosenberger, Laura; McLeod, Matthew; Hranjec, Tjasa; Sawyer, Robert

    2014-01-01

    Background: Aspergillus infections are associated commonly with immunocompromised states, such as transplantation and hematologic malignant disease. Although Aspergillus infections among patients having surgery occur primarily in transplant recipients, they are found in non-recipients of transplants, and have a mortality rate similar to that seen among transplant recipients. Methods: We conducted a retrospective analysis of a prospective data base collected from 1996 to 2010, in which we identified patients with Aspergillus infections. We compared demographic data, co-morbidities, and outcomes in non-transplant patients with those in abdominal transplant recipients. Continuous data were evaluated with the Student t-test, and categorical data were evaluated through ?2 analysis. Results: Twenty-three patients (11 transplant patients and 12 non-transplant patients) were identified as having had Aspergillus infections. The two groups were similar with regard to their demographics and co-morbidities, with the exceptions of their scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II), of 23.6±8.1 points for transplant patients vs. 16.8±6.1 points for non-transplant patients (p=0.03); Simplified Acute Physiology Score (SAPS) of 16.6±8.3 points vs. 9.2±4.1 points, respectively (p=0.02); steroid use 91.0% vs. 25.0%, respectively (p=0.003); and percentage of infections acquired in the intensive care unit (ICU) 27.3% vs. 83.3%, respectively (p=0.01). The most common site of infection in both patient groups was the lung. The two groups showed no significant difference in the number of days from admission to treatment, hospital length of stay following treatment, or mortality. Conclusions: Although Aspergillus infections among surgical patients have been associated historically with solid-organ transplantation, our data suggest that other patients may also be susceptible to such infections, especially those in an ICU who are deemed to be critically ill. This supports the idea that critically ill surgical patients exist in an immunocompromised state. Surgical intensivists should be familiar with the diagnosis and treatment of Aspergillus infections even in the absence of an active transplant program. PMID:24799182

  9. Thoracic wall defects: surgical management of 205 consecutive patients

    SciTech Connect

    Pairolero, P.C.; Arnold, P.G.

    1986-07-01

    In this article, we review our experience during the past 9 years with 205 consecutive thoracic wall reconstructions. The 100 female and 105 male patients ranged in age from 12 to 85 years (mean, 53.4 years). One hundred fourteen patients had thoracic wall tumors, 56 had radiation necrosis, 56 had infected median sternotomy wounds, and 8 had costochondritis. Twenty-nine of these patients had combinations of the aforementioned conditions. One hundred seventy-eight patients underwent skeletal resection. A mean of 5.4 ribs were resected in 142 patients. Total or partial sternectomies were performed in 60. Skeletal defects were closed with prosthetic material in 66 patients and with autogenous ribs in 12. One hundred sixty-eight patients underwent 244 muscle flap procedures: 149 pectoralis major, 56 latissimus dorsi, 14 rectus abdominis, 13 serratus anterior, 8 external oblique, 2 trapezius, and 2 advancement of diaphragm. The omentum was transposed in 20 patients. The mean number of operations per patient was 1.9 (range, 1 to 8). The mean duration of hospitalization was 16.5 days. One perioperative death occurred (at 29 days). Four patients required tracheostomy. During a mean follow-up of 32.4 months, there were 49 late deaths, predominantly due to malignant disease. All 204 patients who were alive 30 days after operation had excellent surgical results at last follow-up examination or at the time of death due to causes unrelated to the reconstructive procedure.

  10. Surgical options for patients with Lennox-Gastaut syndrome.

    PubMed

    Douglass, Laurie M; Salpekar, Jay

    2014-09-01

    Despite ongoing investigation into pharmacologic treatments for Lennox-Gastaut syndrome (LGS), outcomes for chronic administration of medications remain disappointing. In many instances LGS is treatment refractory, resulting in poor prognoses that include intellectual disability, persisting seizures, and psychiatric conditions. For patients with treatment resistance to other modalities for LGS, a further option is surgical intervention. Evaluation for surgery should involve interictal electroencephalogram (EEG), magnetic resonance imaging (MRI) analysis, and age-appropriate neuropsychological/developmental assessment. Resective surgery, where seizure foci are removed, successfully controls seizures in many cases, particularly where lesionectomy or lobar resections are appropriate. Recent studies of resective surgery on individuals with LGS show promising results, with a high percentage of patients having improved seizure control. Corpus callosotomy is a palliative surgical approach that aims at controlling potentially injurious seizures, for example, atonic or drop seizures, by preventing the bilateral spread of epileptic activity. Once associated with a high risk for morbidity and mortality, microsurgical techniques and surgery limited to the anterior region of the callosum have greatly diminished complications of corpus callosotomy surgery. Vagus nerve stimulation, another palliative procedure, offers rates of seizure improvement similar to those of corpus callosotomy, with the exception of atonic seizure for which corpus callosotomy may lead to a greater reduction. Recent advances in surgical techniques offer encouraging options for treatment of LGS. PMID:25284034

  11. Bacterial bloodstream infections and antimicrobial susceptibility pattern in pediatric hematology/oncology patients after anticancer chemotherapy

    PubMed Central

    Al-Mulla, Naima A; Taj-Aldeen, Saad J; El Shafie, Sittana; Janahi, Mohammed; Al-Nasser, Abdullah A; Chandra, Prem

    2014-01-01

    Purpose Bloodstream infections in pediatric hematology and oncology represent a major problem worldwide, but this has not been studied in Qatar. In this study, we investigated the burden of infection and the resistance pattern in the bacterial etiology, in the only tertiary pediatric hematology and oncology center in Qatar. Methods All pediatric cancer patients (n=185) were evaluated retrospectively during the period 2004–2011; a total of 70 (38%) patients were diagnosed with bloodstream infections. Bacterial etiology was determined, along with their susceptibility patterns. Neutropenia, duration of neutropenia, fever, duration of fever, and C-reactive protein (CRP) were evaluated throughout the study. Results A total of 70 patients (38%) were diagnosed with acute leukemias, lymphomas, solid tumors, or brain tumors; those patients experienced 111 episodes of bacteremia. The most common Gram-positive (n=64 [55%]) isolates were Staphylococcus epidermidis (n=26), Staphylococcus hominis (n=9), and Staphylococcus haemolyticus (n=7), and the common Gram-negative (n=52 [45%]) isolates were Klebsiella pneumoniae (n=14), Pseudomonas aeruginosa (n=10), and Escherichia coli (n=7). There was a significant association observed between fever with positive blood culture and different types of cancer (P=0.035). The majority of bacteremia (n=68 [61.3%]) occurred in nonneutropenic episodes. Elevated values of CRP (≥5 mg/L) were detected in 82 (95.3%) episodes and were negatively correlated with absolute neutrophil count (ANC) (r=−0.18; P=0.248) among all cases. However, the infection-related fatality rate was 2.2% (n=4), with three caused by Gram-negative pathogens. Multidrug resistant organisms were implicated in 33 (28.4%) cases and caused three of the mortality cases. Conclusion Multidrug resistant organisms cause mortality in pediatric cancer patients. Investigation of antimicrobial susceptibility of these organisms may guide successful antimicrobial therapy and improve the surveillance and quality of pediatric malignancy care. PMID:25395866

  12. Implementation of a Central Line Maintenance Care Bundle in Hospitalized Pediatric Oncology Patients

    PubMed Central

    Chen, Allen R.; Bundy, David G.; Colantuoni, Elizabeth; Fratino, Lisa; Drucis, Kim M.; Panton, Stephanie Y.; Kokoszka, Michelle; Budd, Alicia P.; Milstone, Aaron M.; Miller, Marlene R.

    2012-01-01

    OBJECTIVE: To investigate whether a multidisciplinary, best-practice central line maintenance care bundle reduces central line-associated blood stream infection (CLABSI) rates in hospitalized pediatric oncology patients and to further delineate the epidemiology of CLABSIs in this population. METHODS: We performed a prospective, interrupted time series study of a best-practice bundle addressing all areas of central line care: reduction of entries, aseptic entries, and aseptic procedures when changing components. Based on a continuous quality improvement model, targeted interventions were instituted to improve compliance with each of the bundle elements. CLABSI rates and epidemiological data were collected for 10 months before and 24 months after implementation of the bundle and compared in a Poisson regression model. RESULTS: CLABSI rates decreased from 2.25 CLABSIs per 1000 central line days at baseline to 1.79 CLABSIs per 1000 central line days during the intervention period (incidence rate ratio [IRR]: 0.80, P = .58). Secondary analyses indicated CLABSI rates were reduced to 0.81 CLABSIs per 1000 central line days in the second 12 months of the intervention (IRR: 0.36, P = .091). Fifty-nine percent of infections resulted from Gram-positive pathogens, 37% of patients with a CLABSI required central line removal, and patients with Hickman catheters were more likely to have a CLABSI than patients with Infusaports (IRR: 4.62, P = .02). CONCLUSIONS: A best-practice central line maintenance care bundle can be implemented in hospitalized pediatric oncology patients, although long ramp-up times may be necessary to reap maximal benefits. Further research is needed to determine if this CLABSI rate reduction can be sustained and spread. PMID:22945408

  13. The critically-ill pediatric hemato-oncology patient: epidemiology, management, and strategy of transfer to the pediatric intensive care unit.

    PubMed

    Demaret, Pierre; Pettersen, Geraldine; Hubert, Philippe; Teira, Pierre; Emeriaud, Guillaume

    2012-01-01

    Cancer is a leading cause of death in children. In the past decades, there has been a marked increase in overall survival of children with cancer. However, children whose treatment includes hematopoietic stem cell transplantation still represent a subpopulation with a higher risk of mortality. These improvements in mortality are accompanied by an increase in complications, such as respiratory and cardiovascular insufficiencies as well as neurological problems that may require an admission to the pediatric intensive care unit where most supportive therapies can be provided. It has been shown that ventilatory and cardiovascular support along with renal replacement therapy can benefit pediatric hemato-oncology patients if promptly established. Even if admissions of these patients are not considered futile anymore, they still raise sensitive questions, including ethical issues. To support the discussion and potentially facilitate the decision-making process, we propose an algorithm that takes into account the reason for admission (surgical versus medical) and the hemato-oncological prognosis. The algorithm then leads to different types of admission: full-support admission, "pediatric intensive care unit trial" admission, intensive care with adapted level of support, and palliative intensive care. Throughout the process, maintaining a dialogue between the treating physicians, the paramedical staff, the child, and his parents is of paramount importance to optimize the care of these children with complex disease and evolving medical status. PMID:22691690

  14. Pediatric oncology nurses' attitudes related to discussing fertility preservation with pediatric cancer patients and their families.

    PubMed

    Vadaparampil, Susan T; Clayton, Heather; Quinn, Gwendolyn P; King, Lindsey M; Nieder, Michael; Wilson, Crystal

    2007-01-01

    This study explores nurses' attitudes toward the discussion of fertility preservation (FP) with pediatric cancer patients and their families. A cross-sectional survey was administered to attendees of a pediatric oncology conference. Of the 115 nurses who responded and comprised the study sample, most reported discussing risks of infertility or FP patients' families, that boys younger than 18 years should not be given erotic materials during semen collection, and difficulty locating FP facilities. The 3 patient factors most likely to encourage the discussion of FP are the patient being recently married or engaged, the patient asking about FP, and availability of patient education materials. While the results indicate that nurses do not regularly discuss FP with their patients, nurses perceive such discussion as being within their scope of practice. Therefore, with appropriate intervention, nurses may play a key role in facilitating discussions regarding FP with patients and families. PMID:17827491

  15. Selected surgical managements in snoring and obstructive sleep apnea patients

    PubMed Central

    Olszewska, Ewa; Rutkowska, Justyna; Czajkowska, Aneta; Rogowski, Marek

    2012-01-01

    Summary Background The diagnostic process and the surgical procedures in patients with snoring and obstructive sleep apnea syndrome (OSAS) are crucial. The aim of this study was to assess the efficacy of surgical treatment in snoring and OSAS patients. Material/Methods A precise laryngological examination and screening polysomnography (Poly-Mesam) were performed in all patients with mild, moderate and severe OSAS before and 6 months after surgery. The patients completed questionnaires concerning their complaints. We included patients qualified to septoplasty, laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP) and radiofrequency-induced thermotherapy of the tongue base (RITT). Outcome evaluation of surgery was performed on the basis of data received from follow-up laryngological examinations, selected parameters obtained from the Poly-Mesam test and follow-up questionnaires. Results In most cases we observed improvement, defined as decreasing some sleep parameters, such as a respiratory disturbance index (RDI), by more than 50%, decreasing the loudness of snoring, decreasing the number of hypopneas, and obtaining better blood saturation values. After UPPP we noticed changes in retropalatal space, soft palate dimensions and uvula-posterior pharyngeal wall distance. In the postoperative period we did not observe severe complications. In some cases we found short-lived palatal deficiency after UPPP. Patients after RITT experienced discomfort and throat pain lasting from 2 to 4 days. In 2 patients we observed swelling of the tongue base, which decreased after few days. Conclusions Surgery in OSAS contributes to normalization of some sleep parameters. The majority of patients experienced improvement after surgery. PMID:22207114

  16. Merging Children’s Oncology Group Data with an External Administrative Database Using Indirect Patient Identifiers: A Report from the Children’s Oncology Group

    PubMed Central

    Li, Yimei; Hall, Matt; Fisher, Brian T.; Seif, Alix E.; Huang, Yuan-Shung; Bagatell, Rochelle; Getz, Kelly D.; Alonzo, Todd A.; Gerbing, Robert B.; Sung, Lillian; Adamson, Peter C.; Gamis, Alan; Aplenc, Richard

    2015-01-01

    Purpose Clinical trials data from National Cancer Institute (NCI)-funded cooperative oncology group trials could be enhanced by merging with external data sources. Merging without direct patient identifiers would provide additional patient privacy protections. We sought to develop and validate a matching algorithm that uses only indirect patient identifiers. Methods We merged the data from two Phase III Children’s Oncology Group (COG) trials for de novo acute myeloid leukemia (AML) with the Pediatric Health Information Systems (PHIS). We developed a stepwise matching algorithm that used indirect identifiers including treatment site, gender, birth year, birth month, enrollment year and enrollment month. Results from the stepwise algorithm were compared against the direct merge method that used date of birth, treatment site, and gender. The indirect merge algorithm was developed on AAML0531 and validated on AAML1031. Results Of 415 patients enrolled on the AAML0531 trial at PHIS centers, we successfully matched 378 (91.1%) patients using the indirect stepwise algorithm. Comparison to the direct merge result suggested that 362 (95.7%) matches identified by the indirect merge algorithm were concordant with the direct merge result. When validating the indirect stepwise algorithm using the AAML1031 trial, we successfully matched 157 out of 165 patients (95.2%) and 150 (95.5%) of the indirectly merged matches were concordant with the directly merged matches. Conclusions These data demonstrate that patients enrolled on COG clinical trials can be successfully merged with PHIS administrative data using a stepwise algorithm based on indirect patient identifiers. The merged data sets can be used as a platform for comparative effectiveness and cost effectiveness studies. PMID:26606521

  17. The Patient Protection and Affordable Care Act: what every provider of gynecologic oncology care should know.

    PubMed

    Duska, Linda R; Engelhard, Carolyn L

    2013-06-01

    The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancer care, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs. PMID:23500090

  18. Patient-Physician Communication About Complementary and Alternative Medicine in a Radiation Oncology Setting

    SciTech Connect

    Ge Jin; Fishman, Jessica; Annenberg School for Communication at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania ; Vapiwala, Neha; Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania ; Li, Susan Q.; Desai, Krupali; Xie, Sharon X.; Mao, Jun J.

    2013-01-01

    Purpose: Despite the extensive use of complementary and alternative medicine (CAM) among cancer patients, patient-physician communication regarding CAM therapies remains limited. This study quantified the extent of patient-physician communication about CAM and identified factors associated with its discussion in radiation therapy (RT) settings. Methods and Materials: We conducted a cross-sectional survey of 305 RT patients at an urban academic cancer center. Patients with different cancer types were recruited in their last week of RT. Participants self-reported their demographic characteristics, health status, CAM use, patient-physician communication regarding CAM, and rationale for/against discussing CAM therapies with physicians. Multivariate logistic regression was used to identify relationships between demographic/clinical variables and patients' discussion of CAM with radiation oncologists. Results: Among the 305 participants, 133 (43.6%) reported using CAM, and only 37 (12.1%) reported discussing CAM therapies with their radiation oncologists. In multivariate analyses, female patients (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.21-0.98) and patients with full-time employment (AOR 0.32, 95% CI 0.12-0.81) were less likely to discuss CAM with their radiation oncologists. CAM users (AOR 4.28, 95% CI 1.93-9.53) were more likely to discuss CAM with their radiation oncologists than were non-CAM users. Conclusions: Despite the common use of CAM among oncology patients, discussions regarding these treatments occur rarely in the RT setting, particularly among female and full-time employed patients. Clinicians and patients should incorporate discussions of CAM to guide its appropriate use and to maximize possible benefit while minimizing potential harm.

  19. Surgical management of cleft lip in pedo-patients.

    PubMed

    Taware, C P; Kulkarni, S R

    1991-01-01

    The Present article describes in short etiology of cleft lip and cleft palate. With this in-born defect, patient develops crucial problems with feeding, phonation, overall growth and development of affected and allied soft and hard tissue structures. This in turn results in deformity and asymmetry which is going to affect functional requirements as well as aesthetic outlook. Hence it really becomes mandatory to correct this defect surgically as early as possible, at stipulated timings so as to avoid present and future anticipated problems. PMID:1820390

  20. Distribution and determinants of patient satisfaction in oncology: A review of the literature.

    PubMed

    Lis, Christopher G; Rodeghier, Mark; Gupta, Digant

    2009-01-01

    Cancer is one of the leading causes of morbidity and mortality in the United States. It places considerable mental, physical, and emotional stress on patients and requires them to make major adjustments in many key areas of their lives. As a consequence, the demands on health care providers to satisfy the complex care needs of cancer patients increase manifold. Of late, patient satisfaction has been recognized as one of the key indicators of health care quality and is now being used by health care institutions for monitoring health care improvement programs, gaining accreditation, and marketing strategies. The patient satisfaction information is also being used to compare and benchmark hospitals, identify best-performance institutions, and discover areas in need of improvement. However, the existing literature on patient satisfaction with the quality of cancer care they receive is inconsistent and heterogeneous because of differences in study designs, questionnaires, study populations, and sample sizes. The aim of this review was therefore to systematically evaluate the available information on the distribution and determinants of patient satisfaction in oncology. PMID:19936172

  1. Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.

    ERIC Educational Resources Information Center

    Beisecker, Analee E.; And Others

    1994-01-01

    Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

  2. Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.

    ERIC Educational Resources Information Center

    Beisecker, Analee E.; And Others

    1994-01-01

    Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

  3. Improving drug chart documentation in elective surgical patient admissions.

    PubMed Central

    Thompson, Alice

    2014-01-01

    National Institute for Health and Care Excellence (NICE) guidelines state that all healthcare organisations should put policies in place for medication reconciliation on admission. At Croydon University Hospital a medication history had previously been taken in Foundation Year 1 (FY1) preoperative clinics. However, when these clinics were deemed unnecessary, this opportunity for drug chart documentation was lost, along with an awareness of this responsibility among the FY1s. As a result patients were being admitted to wards without adequate drug chart documentation which resulted in a serious untoward incident occurring. This project aimed to increase awareness among FY1s of this responsibility and as a result increase drug chart documentation in postoperative elective surgical patients. The drug charts of 40 postoperative elective surgical patients admitted to all surgical wards were reviewed over a 2 week period. 12.5% (4/32) of patients taking regular medication had these correctly prescribed, with ‘high risk medication omissions’ found in 7.5% (3/40). Documentation of an allergy status was absent in 17.5% (7/40) of patients, including 5% (2/40) of whom had a known drug allergy. To create awareness of this responsibility, first, a presentation was given to the FY1s, second, posters to prompt action were placed on the elective surgical wards, and finally, the Director of Medical Education emailed the FY1s reiterating these facts. We then reviewed the drug charts of 45 elective postoperative patients over a 2 week period following these interventions. The results showed: correct prescription of regular medications improved to 48% (16/33); ‘high risk medication omissions’ reduced to 4% (2/45); documentation of allergy status on the drug charts increased to 87% (39/45); failure to document a known drug allergy on the drug chart fell to 2% (1/45); and patients with a ‘high risk medication omission’ or an undocumented known drug allergy decreased from 12.5% (5/40) to 7 % (3/45). This study has highlighted an area in which medication reconciliation and drug chart documentation were inadequate, and posed a risk to patient safety. Interventions designed to educate the FY1s and inform them of their responsibility improved standards in regular medication prescription and allergy documentation. However, leaving the onus with the FY1s was not enough to achieve adequate drug chart documentation. Further project cycles may therefore require the implementation of a step within the patient admission protocol in the preoperative ward that requires the nursing staff to contact the team's doctor when the patient arrives in hospital to ensure satisfactory drug chart documentation. In addition, collaboration with the pharmacists could also allow a ‘best possible medication history’ to be taken on the day of admission and thus reduce risk to patient safety.

  4. Evaluation of Nosocomial Infection in Patients at hematology-oncology ward of Dr. Sheikh children’s hospital

    PubMed Central

    Ghassemi, A; Farhangi, H; Badiee, Z; Banihashem, A; Mosaddegh, MR

    2015-01-01

    Background Infections in critical care unit are high, and they are serious hospital problems. Infections acquired during the hospital stay are generally called nosocomial infections, initially known as infections arising after 48 h of hospital admission. The mostfrequent nosocomial infections (urinary, respiratory, gastroenteritis and blood stream infection) were common in patients at hospital.The aim was to study, the current status of nosocomial infection, rate of infection among hospitalized children at hematology-oncology ward of Dr. Sheikh children’s hospital, Mashhad, Iran. Materials and Methods Data were collected from 200 patient's records presented with symptoms of nosocomial infection at hematology-oncology ward of Dr. Sheikh children’s hospital from March 2014 to September 2014. Descriptive statistics using percentage was calculated. Results Incidence of nosocomial infections inpatients athematology-oncology ward was 31% (62/200). Of which 69.35% (43/62) blood stream infection being the most frequent; followed by 30.64% (19/62) was urinary tract infection (UTI), and the most common blood culture isolate was been Staphylococcus epidermidis 18 (41.86%), andour study showed that large numbers ofnosocomial UTIs causing by Gram‑negative bacteria. Conclusion This study showed blood stream infection and UTI are the common nosocomial infections among patients athematology-oncology ward. Early recognition of infections and short term use of invasive devices along with proper infection control procedures can significantly decrease the incidence of nosocomial infections in patients. PMID:26985350

  5. Effects of Video Games on the Adverse Corollaries of Chemotherapy in Pediatric Oncology Patients: A Single-Case Analysis.

    ERIC Educational Resources Information Center

    Kolko, David J.; Rickard-Figueroa, Jorge L.

    1985-01-01

    Assessed effects of video games on adverse corollaries of chemotherapy in three pediatric oncology patients. Results indicated that access to video games resulted in reduction in the number of anticipatory symptoms experienced and observed, as well as a diminution in the aversiveness of chemotherapy side effects. (Author/NRB)

  6. Quality of life after different oncologic interventions in head and neck cancer patients.

    PubMed

    Mücke, Thomas; Koschinski, Janett; Wolff, Klaus-Dietrich; Kanatas, Anastasios; Mitchell, David A; Loeffelbein, Denys J; Deppe, Herbert; Rau, Andrea

    2015-11-01

    Patient reported outcomes following head and neck cancer are of great importance, given the functional, psychological, and social impacts of the disease and its treatment. In addition, not only is the number of publications on health-related quality of life (HRQOL) increasing in a variety of specialties, but there is also a growing awareness of the potential role of HRQOL in practice. Therefore, we aimed to investigate the HRQOL of head and neck cancer patients following different oncologic interventions, using an internationally established test. In this cross-sectional study, we included three different groups of 32 patients each. Participants had histologically confirmed invasive oral squamous cell carcinoma (OSCC) in the anterior floor of the mouth. Group allocation was based on treatment modality, as follows: only surgery (group 1), operation and adjuvant radiotherapy (XRT) (group 2), and the additional presence of osteoradionecrosis (ORN) (group 3). All patients were questioned about their HRQOL, using the standardized University of Washington Quality of Life Questionnaire (UW-QOL). Surveys for groups 1 and 2 were conducted at least 24 months after the end of tumor-related treatment, in cases of ORN (group 3) 12 months after completion of disease-related treatment. A total of 96 patients were included into this study. The mean age was 62.79 ± 8.93 years. The patients in groups 1 and 2 revealed a reduced quality of life, of a greater magnitude after radiation therapy. Patients felt that radiotherapy was much worse than surgery; however, half of the patients stated that they would repeat radiation therapy if necessary. The subjective evaluation of the HRQOL after surgery and radiotherapy was a valuable instrument for assessing the rehabilitation of patients in the context of their function and quality of life. Radiation therapy can be considered a trigger of functional limitations and emotional distress that contributes to decreased HRQOL in patients with head and neck cancer. PMID:26421469

  7. Radical cystectomy for bladder cancer: oncologic outcome in 271 Chinese patients.

    PubMed

    Zhang, Zhi-Ling; Dong, Pei; Li, Yong-Hong; Liu, Zhuo-Wei; Yao, Kai; Han, Hui; Qin, Zi-Ke; Zhou, Fang-Jian

    2014-03-01

    Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months (range, 0.2-139.1 months). Thirty-day mortality was (1.4%). The 5-year recurrence-free survival, cancer-specific survival (CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1-T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease (81.4% vs. 34.9%, P < 0.001). For the 38 patients (14%) with lymph node involvement, the 5-year CSS rate was 27.7%-significantly lower than that of patients without lymph node metastasis (P < 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor (98.1% vs. 68.1%, P < 0.001). Multivariate Cox regression showed that patient age (hazard ratio, 2.045; P = 0.013) and T category (hazard ratio, 2.213; P < 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy. PMID:23958053

  8. [COMPARATIVE ANALYSIS OF POSITIVE SURGICAL MARGIN RATES IN PATIENTS UNDERGOING ROBOT- ASSISTED OR RETROPUBIC RADICAL PROSTATECTOMY FOR PROSTATE CANCER].

    PubMed

    Veliev, E L; Sokolov, E A; Loran, O B

    2015-01-01

    The issue of comparative evaluation of oncological and functional outcomes of robot-assisted radical prostatectomy (RARP) and radical retropubic prostatectomy (RRP) is widely discussed in the international literature. A key point in studying the oncological efficacy of both techniques is a comparative evaluation of positive surgical margin (PSM) rates as one of the main prognostic factors influencing the further course of prostate cancer. Available data so far are inconsistent, which prompted us to conduct our own research. A retrospective analysis was performed in two groups of patients who underwent RARP (n = 63) and RRP (n = 116) from January 2014 to April 2015. Despite a general trend towards lower PSM rates in RARP group compared to RRP group (12.7 and 21.6%, respectively, p = 0.09), no significant differences were found in the stratification of patients in both groups depending on the risk of prostate cancer progression and pathological stage. These data show the potential equality of the two methods regarding intraoperative control of resection margins. PMID:26665764

  9. Psychosocial and legal aspects of oncological treatment in patients with cognitive impairment

    PubMed Central

    Kuśnierkiewicz, Maria; Kędziora, Justyna; Jaroszyk-Pawlukiewicz, Joanna; Nowak-Jaroszyk, Monika

    2013-01-01

    With society getting older and affected by many diseases, more and more people suffer from severe cognitive disorders. As practice shows, the legal situations of such people is often problematic. This is due to a number of factors, such as short time since the deterioration of patient's condition, initial symptoms ignored, social prejudice towards the idea of incapacitation or taking decisions for a patient, complicated procedures and, sometimes, insufficient knowledge of legal regulations. Cognitive disorders also occur in patients treated for cancer. To be effective, oncological treatment needs to be started as early as possible. This, however, does not meet the criteria of sudden threat to life. The present article relates to both the psychosocial and legal aspects of care of people suffering from intense disorders of memory, attention, problem solving, executive functions, and other. Surely, physicians know how to handle patients with the above dysfunctions. However, legal procedures aimed to protect patients’ rights are often unclear and time consuming. In practice, this often amounts to a dilemma whether to treat or follow the applicable law. Certainly, solutions in this regard should be clearer and better adapted to the needs arising from specific treatment needs of particular groups of patients. PMID:24936334

  10. Prosthetic rehabilitation in post-oncological patients: Report of two cases

    PubMed Central

    Brauner, Edoardo; Cassoni, Andrea; Battisti, Andrea; Bartoli, Davina; Valentini, Valentino

    2010-01-01

    Summary Prosthetic rehabilitation in post-oncologic patients after bone reconstruction are not substantially different than those of patients affected by severe atrophia of upper or lower jaw after bone reconstruction. Aim of this paper is to evaluate the possibilities of prosthetic rehabilitation on these patients and to present our method. Prosthesis-based oral rehabilitation of such tumor cases rapresents a challenge. The report analyses two cases of patients who underwent ablative oral surgery. Both have received a fibula free vascularised flap. The first was rehabilitated with a removable prosthesis fixed on the residual teeth, while the second with an implant supported prosthesis. In case of carcinoma resection of the oral mucosa, the removable prosthesis guarantees a simplification in dental care operations. On the other hand, irradiated mucosa is frequentely unable to tolerate the friction created by the acrylic base. However, the fixed prosthesis can limit the view during follow-up controls. In our school, according to all exposed reasons, we consider the implant supported overdenture prosthesis to be the best choice for those patients. PMID:22238701

  11. [Osteonecrosis of the mandible induced by intravenous bisphosphonates in oncological patients].

    PubMed

    Carvalho, Ana; Amaral Mendes, Rui; Carvalho, Davide; Carvalho, João F C

    2008-01-01

    Bisphosphonates are synthetic analogs of inorganic pyrophosphate, which are not only potent inhibitors of osteoclast-mediated bone resorption, but also present an important inhibitory activity of angiogenesis. Bisphosphonates become, since 1996, the standard of care in the management of patients with osteoporoses as well as bone metabolism alterations associated with neoplasias. In 2003 the first case-reports of bisphosphonate induced osteonecrosis of the jaws were published. The authors report 2 new cases of patients with osteonecrosis induced by bisphosphonates. Case 1: Seventy one years-old male patient, undergoing standard antineoplastic therapy and bisphosphonates due to multiple myeloma 4 years ago was referred to an oral surgeon because of bone exposure, after dental extraction. Case 2: Seventy years-old female patient undergoing treatment with bisphosphonates for adenocarcinoma of the breast was referred to an appointment of oral surgery due to bony exposure. The increasing incidence of this new entity, its physiopathological mechanisms and the nonexistence of consensual and evidence-based treatments, calls for a special attention on prevention, with special emphasis on a careful clinical examination of the oral cavity previously to the establishment of a therapeutic approach with intravenous bisphosphonates in oncological patients. PMID:19187694

  12. Global radiation oncology waybill

    PubMed Central

    Muñoz-Garzón, Victor; Rovirosa, Ángeles; Ramos, Alfredo

    2013-01-01

    Background/aim Radiation oncology covers many different fields of knowledge and skills. Indeed, this medical specialty links physics, biology, research, and formation as well as surgical and clinical procedures and even rehabilitation and aesthetics. The current socio-economic situation and professional competences affect the development and future or this specialty. The aim of this article was to analyze and highlight the underlying pillars and foundations of radiation oncology, indicating the steps implicated in the future developments or competences of each. Methods This study has collected data from the literature and includes highlights from discussions carried out during the XVII Congress of the Spanish Society of Radiation Oncology (SEOR) held in Vigo in June, 2013. Most of the aspects and domains of radiation oncology were analyzed, achieving recommendations for the many skills and knowledge related to physics, biology, research, and formation as well as surgical and clinical procedures and even supportive care and management. Results Considering the data from the literature and the discussions of the XVII SEOR Meeting, the “waybill” for the forthcoming years has been described in this article including all the aspects related to the needs of radiation oncology. Conclusions Professional competences affect the development and future of this specialty. All the types of radio-modulation are competences of radiation oncologists. On the other hand, the pillars of Radiation Oncology are based on experience and research in every area of Radiation Oncology. PMID:24416572

  13. Diagnosis and treatment of primary CNS lymphoma in immunocompetent patients: guidelines from the European Association for Neuro-Oncology.

    PubMed

    Hoang-Xuan, Khê; Bessell, Eric; Bromberg, Jacoline; Hottinger, Andreas F; Preusser, Matthias; Rudà, Roberta; Schlegel, Uwe; Siegal, Tali; Soussain, Carole; Abacioglu, Ufuk; Cassoux, Nathalie; Deckert, Martina; Dirven, Clemens M F; Ferreri, Andrés J M; Graus, Francesc; Henriksson, Roger; Herrlinger, Ulrich; Taphoorn, Martin; Soffietti, Riccardo; Weller, Michael

    2015-07-01

    The management of primary CNS lymphoma is one of the most controversial topics in neuro-oncology because of the complexity of the disease and the very few controlled studies available. In 2013, the European Association of Neuro-Oncology created a multidisciplinary task force to establish evidence-based guidelines for immunocompetent adults with primary CNS lymphoma. In this Review, we present these guidelines, which provide consensus considerations and recommendations for diagnosis, assessment, staging, and treatment of primary CNS lymphoma. Specifically, we address aspects of care related to surgery, systemic and intrathecal chemotherapy, intensive chemotherapy with autologous stem-cell transplantation, radiotherapy, intraocular manifestations, and management of elderly patients. The guidelines should aid clinicians in their daily practice and decision making, and serve as a basis for future investigations in neuro-oncology. PMID:26149884

  14. The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches

    PubMed Central

    Alshameeri, Zeiad A.; Katam, Krishnaiah; Alsamaq, Mohammed; Sonsale, Paresh

    2012-01-01

    Introduction: Clavicle fractures represent 2.5% of fractures in adults and almost 44% of shoulder injuries. The treatment is usually non-surgical with good results; however, significantly displaced fractures can be associated with high non-union rate and therefore many would advocate surgical fixation. This is traditionally carried out by direct approach over the clavicle but an infraclavicular approach has also been used for clavicular fixation. The aim of this study was to identify the main indications for surgical intervention at our unit and patient satisfaction following surgery. We also wanted to compare the direct and the infraclavicular surgical approaches in relation to the outcome of surgical intervention. Materials and Methods: Retrospective study looking at all the clavicle fractures managed surgically over 5 years at our department. Information relating to surgical indication, surgical approach, complications, outcome, patient satisfaction, and oxford shoulder score were collected. Results: A total of 35 patients were identified, the majority were males (n = 25) and most (n = 29) were working at the time of injury. The commonest indication for surgery was displacement with shortening (n = 16). The infraclavicular approach was used in the majority of patients (n = 21), the rest (n = 14) had direct incision. Evidence of radiological and union was achieved in all patients after an average of 13 (8-24) weeks. There were no major complications but minor complications were reported in 28% and 19% of cases with direct and infraclavicular approaches, respectively. Plates were removed from six symptomatic patients; infraclavicular (n = 2) and direct approach (n = 4). Four asymptomatic plates were removed on patients’ requests. All patients returned to work (after an average 2.6 months), had good oxford shoulder score between 12-20, regardless of the surgical approach used. All patients except one would recommend it to a friend. Conclusion: Our study showed excellent surgical outcome for displaced clavicle fractures supported by the high union rate, good oxford shoulder score, high return to work rate, and good patient's satisfaction. The number of minor complications and symptomatic metal work removal was less in the infraclavicular approach. PMID:23204761

  15. Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service.

    PubMed

    Sapir, R; Catane, R; Kaufman, B; Isacson, R; Segal, A; Wein, S; Cherny, N I

    2000-11-01

    The purpose of this study was to evaluate ambulatory cancer patients' knowledge of their diagnosis and stage, their expectations of medical and nursing staff, and issues related to communication with the professional staff. A structured interview was conducted with each of 103 consecutive cancer patients attending the Oncology Day Hospital of the Shaare Zedek Medical Center. There were 77 women and 26 men, and their median age was 56 (18-86) years. Their religious status was elicited: 48% described themselves as religious, 25% as traditional, and 27% as secular. According to their physicians, 41 were in remission, 11 had stable disease, 47 had progressive disease and in 4 the disease status was unknown. Patients tended to underestimate the status of their disease: among those with progressive disease, 36% stated that their disease was stable or in remission. Overwhelmingly, patients expected that their oncologists should be patient and skilled in diagnostic procedures (98%), tactful, considerate and therapeutically skilled (90-95%), and skilled in the management of pain and the psychosocial consequences of cancer (75-85%). When there is bad news to be transmitted, 92% of patients indicated that they would want disclosure, while 6% indicated that they would want the news withheld from them but passed on to their family members. Most patients were very satisfied with the clarity of the information they received about their disease (85%) and the sensitivity with which it was transmitted (90%). Although 88% of patients reported that they relied on their oncologist for therapeutic decision making, 45% indicated that they had sought a second opinion and 32% reported seeking the opinion of a rabbinical medical broker. Almost all, 97%, of patients indicated that they felt comfortable seeking advice from their oncologist, and the oncologist was the staff member most often sought out for both information (69%) and support (66%). The data indicate high patient expectations of nursing and medical oncology staff members' skills and behaviors. Despite expressing a high level of satisfaction, a substantial percentage of patients had an inaccurate understanding of their disease status. PMID:11094990

  16. Barriers to recruitment for surgical trials in head and neck oncology: A survey of trial investigators. | accrualnet.cancer.gov

    Cancer.gov

    Three head and neck cancers trials in the United Kingdom were examined to identify barriers to recruitment at the planned rate. The primary barriers were patient preference for one study arm and aversion to randomization. The complexity of patient information, which often was not appropriate to socioeconomic status and English proficiency of the targeted patients, also served as a barrier.

  17. Rapid Reduction of Central Line Infections in Hospitalized Pediatric Oncology Patients Through Simple Quality Improvement Methods

    PubMed Central

    Choi, Sung W.; Chang, Lawrence; Hanauer, David A.; Shaffer-Hartman, Jackie; Teitelbaum, Daniel; Lewis, Ian; Blackwood, Alex; Akcasu, Nur; Steel, Janell; Christensen, Joy; Niedner, Matthew F.

    2013-01-01

    Background Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs. Materials and Methods CLA-BSI rates were analyzed within a single-institution’s PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit’s safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes. Results The pre-intervention CLA-BSI incidence was 2.92 per 1000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1000-PD (p<0.004). Early on, blood and marrow transplant (BMT) patients had a three-fold higher CLA-BSI rate compared to non-BMT patients (p<0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention. Conclusions By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained. PMID:22522576

  18. 3D surgical planning in patients affected by lipodystrophy.

    PubMed

    Pérez-Carrasco, J A; Acha, B; Gómez-Cia, T; Lopez-Garcia, R A; Delgado, Carlos; Serrano, C

    2015-03-01

    Lipodystrophy is a pathological condition characterized by the focal or general absence of adipose tissue. Surgeons reset the patient's surface contours using injectable materials to recreate a normal physical appearance. However, due to difficulties in preoperative planning and intraoperative assessment, about 15% of the surgical procedures involved are reinterventions to improve volume or symmetry. This increases the need for an available, efficient tool capable of providing the surgeon with a good estimation of the volumes to be injected before the intervention proper begins. This work describes a virtual reality-based application for the surgical planning of facial lipodystrophy correction (FLIC). The tool uses points selected interactively by the surgeon to compute a curve that delimits the surface area to be operated on. It then automatically computes an estimated natural reconstructed surface and the quantity of volume that needs to be implanted during the intervention. Experiments have been carried out in which the filling volumes estimated using FLIC and ZBrush software were compared with the real volumes injected by the surgeon. ICCs higher than 0.97 indicate that there were no significant differences between the respective measurements, thus validating the tool proposed in this paper. PMID:25618746

  19. Surgical techniques for smile restoration in patients with Möbius syndrome

    PubMed Central

    Ortiz-Rincones, María A.; Suárez-Gorrin, Fabiola

    2013-01-01

    Möbius syndrome is a congenital condition, the etiology when is not associated with misoprostol is not well defined. Signs and symptoms include difficulty swallowing, speech problems, drooling, strabismus, limitation of eye movement and more importantly, the facial blankness that these individuals have, result of the facial paralysis, due to atrophy of the cranial nerves that are involved in this condition. The ability to express emotions is affected and are considered “children without a smile.” There is currently no treatment to solvent the birth defects, the treatment options for reduce these alterations is the surgical option that has as main objective to restore muscle function through various techniques, used as required, the possibilities of applying them, is taking into consideration the outcome of the procedure to execute. Among the surgical techniques used mainly: the lengthening myoplasty of the temporal muscle,muscle transfers, cross-facial grafting, neurorrhaphy and nerve transposition, of which latter are the best performers, giving the patient a more natural, in as far as regards expression and function. Key words:Möbius syndrome, surgery, smile, facial nerve, muscle transfer, transfer nerve, temporalis muscle. PMID:24455082

  20. Surgical techniques for smile restoration in patients with Möbius syndrome.

    PubMed

    Morales-Chávez, Mariana; Ortiz-Rincones, María A; Suárez-Gorrin, Fabiola

    2013-10-01

    Möbius syndrome is a congenital condition, the etiology when is not associated with misoprostol is not well defined. Signs and symptoms include difficulty swallowing, speech problems, drooling, strabismus, limitation of eye movement and more importantly, the facial blankness that these individuals have, result of the facial paralysis, due to atrophy of the cranial nerves that are involved in this condition. The ability to express emotions is affected and are considered "children without a smile." There is currently no treatment to solvent the birth defects, the treatment options for reduce these alterations is the surgical option that has as main objective to restore muscle function through various techniques, used as required, the possibilities of applying them, is taking into consideration the outcome of the procedure to execute. Among the surgical techniques used mainly: the lengthening myoplasty of the temporal muscle,muscle transfers, cross-facial grafting, neurorrhaphy and nerve transposition, of which latter are the best performers, giving the patient a more natural, in as far as regards expression and function. Key words:Möbius syndrome, surgery, smile, facial nerve, muscle transfer, transfer nerve, temporalis muscle. PMID:24455082

  1. Age- Related Toxicity in Patients with Rhabdomyosarcoma: A Report from the Children’s Oncology Group

    PubMed Central

    Altaf, Sadaf; Enders, Felicity; Lyden, Elizabeth; Donaldson, Sarah S.; Rodeberg, David; Arndt, Carola

    2014-01-01

    On the Fourth Intergroup Rhabdomyosarcoma study, older children experienced excessive neurotoxicity whereas younger children had increased myelosuppression. The purpose of this study was to determine whether the same pattern of toxicity was seen on the successor study when use of growth factor was required and dosing of chemotherapy was different by performing a retrospective cohort analysis on patients treated on Children’s Oncology Group protocol D9803. Toxicity data were analyzed by stratifying children into four age groups. The frequency of grade 3/4 neurotoxicity, myelosuppression, infection and mucositis was predicted for each age group. The cumulative doses of vincristine and cyclophosphamide administered were measured as percent of protocol- prescribed dose. Adolescents (age 15+) were more likely to experience neurotoxicity compared to younger patients (OR 3.6, P< 0.0001). There was no difference in myelosuppression, infection or mucositis. The mean percent protocol-prescribed doses administered for vincristine and cyclophosphamide did not differ much by age group. Adolescents experienced more neurotoxicity with vincristine compared to younger patients. No differences in other toxicities were observed between age groups. Since adolescents received at least 85% of protocol prescribed doses of vincristine, it is difficult to attribute the poorer survival in this age group to inadequate protocol delivered therapy. PMID:24936741

  2. Prognostic factors of overall survival in renal cancer patients – single oncological center study

    PubMed Central

    Sandheim, Marek; Jakubowski, Jacek; Juszczak, Kajetan; Stelmach, Andrzej Wojciech

    2013-01-01

    Introduction The clinical course of renal cancer remains difficult to predict. Attempts to appoint new independent prognostic factors (IPFs) and comparisons of already identified ones among populations are inevitable to develop more effective prognostic instruments. The aim of this study was to evaluate IPFs of overall survival in a given population of patients with renal cancer. Materials and methods Retrospective analysis of 148 patients with renal cancer treated at the Oncological Institute in Cracow from 2000 to 2007 was performed. Mean follow–up was 51 months. Using the log–rang test, a group of clinicopathological and biochemical features was analyzed in respect to their influence on overall survival. Results were presented as Kaplan–Meier curves. Final identification of IPFs was made by multivariate Cox regression analysis. Results Overall survival rate at 1, 2, and 5–year follow–up was 58.8%, 38.2%, and 21.4%, respectively. The set of identified IPFs consisted of performance status, smoking history, hemoglobin concentration, anatomical staging, tumor grade, and the presence of microvascular invasion. It was confirmed that only nephrectomy increases significantly overall survival. Conclusions Apart from smoking history, the role of all other IPFs identified in our study is well documented in the literature. Smoking history seems to be a new IPF with strong negative impact on survival in patients with RCC. PMID:24707365

  3. Impact of metabolic syndrome in surgical patients: should we bother?

    PubMed

    Tzimas, P; Petrou, A; Laou, E; Milionis, H; Mikhailidis, D P; Papadopoulos, G

    2015-08-01

    Clinicians inevitably encounter patients who meet the diagnostic criteria for the metabolic syndrome (MetS); these criteria include central obesity, hypertension, atherogenic dyslipidaemia, and hyperglycaemia. Regardless of the variations in its definition, MetS may be associated with adverse outcomes in patients undergoing both cardiac and non-cardiac surgery. There is a paucity of data concerning the anaesthetic management of patients with MetS, and only a few observational (mainly retrospective) studies have investigated the association of MetS with perioperative outcomes. In this narrative review, we consider the impact of MetS on the occurrence of perioperative adverse events after cardiac and non-cardiac surgery. Metabolic syndrome has been associated with higher rates of cardiovascular, pulmonary, and renal perioperative events and wound infections compared with patients with a non-MetS profile. Metabolic syndrome has also been related to increased health service costs, prolonged hospital stay, and a greater need for posthospitalization care. Therefore, physicians should be able to recognize the MetS in the perioperative period in order to formulate management strategies that may modify any perianaesthetic and surgical risk. However, further research is needed in this field. PMID:26109210

  4. Patient-reporting improves estimates of postoperative complication rates: a prospective cohort study in gynaecological oncology

    PubMed Central

    Iyer, R; Gentry-Maharaj, A; Nordin, A; Liston, R; Burnell, M; Das, N; Desai, R; Gornall, R; Beardmore-Gray, A; Hillaby, K; Leeson, S; Linder, A; Lopes, A; Meechan, D; Mould, T; Nevin, J; Olaitan, A; Rufford, B; Ryan, A; Shanbhag, S; Thackeray, A; Wood, N; Reynolds, K; Menon, U

    2013-01-01

    Background: Most studies use hospital data to calculate postoperative complication rates (PCRs). We report on improving PCR estimates through use of patient-reporting. Methods: A prospective cohort study of major surgery performed at 10 UK gynaecological cancer centres was undertaken. Hospitals entered the data contemporaneously into an online database. Patients were sent follow-up letters to capture postoperative complications. Grade II–V (Clavien–Dindo classification) patient-reported postoperative complications were verified from hospital records. Postoperative complication rate was defined as the proportion of surgeries with a Grade II–V postoperative complication. Results: Patient replies were received for 1462 (68%) of 2152 surgeries undertaken between April 2010 and February 2012. Overall, 452 Grade II–V (402 II, 50 III–V) complications were reported in 379 of the 1462 surgeries. This included 172 surgeries with 200 hospital-reported complications and 231 with 280 patient-reported complications. All (100% concordance) 36 Grade III–V and 158 of 280 (56.4% concordance) Grade II patient-reported complications were verified on hospital case-note review. The PCR using hospital-reported data was 11.8% (172 out of 1462; 95% CI 11–14), patient-reported was 15.8% (231 out of 1462; 95% CI 14–17.8), hospital and verified patient-reported was 19.4% (283 out of 1462; 95% CI 17.4–21.4) and all data were 25.9% (379 out of 1462; 95% CI 24–28). After excluding Grade II complications, the hospital and patient verified Grade III–V PCR was 3.3% (48 out of 1462; 95% CI 2.5–4.3). Conclusion: This is the first prospective study of postoperative complications we are aware of in gynaecological oncology to include the patient-reported data. Patient-reporting is invaluable for obtaining complete information on postoperative complications. Primary care case-note review is likely to improve verification rates of patient-reported Grade II complications. PMID:23846170

  5. Medical Expertise and Patient Involvement: A Multiperspective Qualitative Observation Study of the Patient’s Role in Oncological Decision Making

    PubMed Central

    Ritter, Peter; Wäscher, Sebastian; Vollmann, Jochen; Schildmann, Jan

    2014-01-01

    Background. Decision making in oncology poses intricate ethical questions because treatment decisions should account not only for evidence-based standards but also for the patient’s individual values and preferences. However, there is a scarcity of empirical knowledge about patient involvement in oncological decision making. Methods. Direct, nonparticipant observation was used as a qualitative research method to gain an understanding of the interplay between medical expertise and patient participation in oncological decision making. Based on a multiperspective approach, observations were performed in three settings (tumor conference, ward round, and outpatient clinic) in the oncology department of a German university hospital. The observation transcripts were analyzed using central features of qualitative data analysis. Results. Major differences were identified regarding the decision-making processes in the three settings related to the patient’s presence or absence. When the patient was absent, his or her wishes were cited only irregularly; however, patients actively advanced their wishes when present. Preselection of treatments by physicians was observed, narrowing the scope of options that were finally discussed with the patient. Dealing with decisions about risky treatments was especially regarded as part of the physician’s professional expertise. Conclusion. The study reveals aspects of decision making for cancer patients that have been underexposed in the empirical and theoretical literature so far. Among these are the relevance of structural aspects for the decisions made and the practice of preselection of treatment options. It should be further discussed how far medical expertise reaches and whether therapeutic decisions can be made without consulting the patient. PMID:24760711

  6. Escalation of Oncologic Services at the End of Life Among Patients With Gynecologic Cancer at an Urban, Public Hospital

    PubMed Central

    Wu, Eijean; Rogers, Anna; Ji, Lingyun; Sposto, Richard; Church, Terry; Roman, Lynda; Tripathy, Debu; Lin, Yvonne G.

    2015-01-01

    Purpose: Use of oncology-related services is increasingly scrutinized, yet precisely which services are actually rendered to patients, particularly at the end of life, is unknown. This study characterizes the end-of-life use of medical services by patients with gynecologic cancer at a safety-net hospital. Methods: Oncologic history and metrics of medical use (eg, hospitalizations, chemotherapy infusions, procedures) for patients with gynecologic oncology who died between December 2006 and February 2012 were evaluated. Mixed-effect regression models were used to test time effects and construct usage summaries. Results: Among 116 subjects, cervical cancer accounted for the most deaths (42%). The median age at diagnosis was 55 years; 63% were Hispanic, and 65% had advanced disease. Only 34% died in hospice care. The median times from do not resuscitate/do not intubate documentation and from last therapeutic intervention to death were 9 days and 55 days, respectively. Significant time effects for all services (eg, hospitalizations, diagnostics, procedures, treatments, clinic appointments) were detected during the patient's final year (P < .001), with the most dramatic changes occurring during the last 2 months. Patients with longer duration of continuity of care used significantly fewer resources toward the end of life. Conclusion: To our knowledge, this is the first report enumerating medical services obtained by patients with gynecologic cancer in a large, public hospital during the end of life. Marked changes in interventions in the patient's final 2 months highlight the need for cost-effective, evidence-based metrics for delivering cancer care. Our data emphasize continuity of care as a significant determinant of oncologic resource use during this critical period. PMID:25604595

  7. Surgical aspects in the treatment of patients with testicular cancer.

    PubMed

    Richie, J P

    1991-12-01

    We sit at a crossroads in the therapeutic treatment of patients with low-stage testicular cancer. The luxury of effective chemotherapy has allowed achievement of virtually 100% survival rates in patients with low-stage testicular cancer. The goal of urologists and oncologists in concert should be to minimize the long-term morbidity and to reduce the amount of therapy necessary to achieve these high survival rates. Patients with a low risk of lymphatic or disseminated metastases, such as those with low-stage tumors, without vascular invasion and with favorable histologic features (teratoma), are clearly candidates for observation protocols to be carried out in well-defined centers. It should be emphasized, however, that observation needs to be an active surveillance program for a minimum of 2 to 3 years after orchiectomy, with frequent chest roentgenography, tumor marker studies, and CT scanning. In the majority of patients with low-stage tumors, however, modified retroperitoneal lymph node dissection allows definitive staging, thus allowing treatment with a lesser amount of chemotherapy. Patients with bulky stage II disease require chemotherapy in hopes of avoiding the need for retroperitoneal lymph node dissection. In the group of patients with stage II disease with minimal retroperitoneal involvement (less than 3 cm in maximal diameter, stage IIA), approximately half of the patients can be treated by surgical approaches alone, although half will require postoperative chemotherapy. Testicular cancer at this time is one of the most successfully treated solid tumors. Although diagnostic tools are available, successful diagnosis still relies upon suspicion and physical findings. Staging techniques have improved but still have vast limitations, especially in patients with low-stage disease. By careful application of multimodal therapy, long-term survival and cure are likely in the majority of patients. Continued long-term observation is necessary, however, especially in patients with residual teratoma that has been resected. As we look to the 1990s, emphasis can be placed on finding less morbid treatments yet still maintaining the high success rates enjoyed in the treatment of this once nearly uniformly fatal tumor. PMID:1663937

  8. Sexual Function of Endometrial Cancer Patients Enrolled on the Gynecologic Oncology Group LAP2 Study

    PubMed Central

    Carter, Jeanne; Huang, Helen; Chase, Dana M; Walker, Joan L.; Cella, David; Wenzel, Lari

    2012-01-01

    Objectives To present responses to sexual function items contained within the quality of life (QOL) survey of the Gynecologic Oncology Group (GOG) LAP2 study, to investigate associations between sexual function and other factors such as relationship quality and body image), and to explore patterns of response in endometrial cancer patients. Methods Participants enrolled on the LAP2 QOL study arm completed a self-report QOL survey, which contained sexual function items, before surgery, and at 1, 3, 6-weeks and 6-months post surgery. Responses to sexual function questions were classified into three patterns—responder, intermittent responder and non-responder—based on whether the sexual function items were answered when the QOL survey was completed. Results Of 752 patients who completed the QOL survey, 225 completed the sexual function items within the QOL survey, 224 responded intermittently, and 303 did not respond at all. No significant differences of sexual function were found between the patients randomized to laparoscopy compared to laparotomy. Among those who responded completely or intermittently, sexual function scores declined after surgery and recovered to pre-surgery levels at 6 months. Sexual function was positively associated with better quality of relationship (P<0.001), body image (P<0.001), and QOL (P<0.001), and negatively associated with fear of sex (P<0.001). Conclusion Our findings suggest that younger patients, those who were married, and those who had quality relationships were more likely to answer the sexual function items and have better quality of sexual function. Factors such as age, relationship quality, body image, and pain may place women with endometrial cancer at risk for sexual difficulties in the immediate recovery period; however, sexual function improved by 6-months postoperatively in our cohort of early-stage endometrial cancer patients. PMID:23095778

  9. Experiences of Pediatric Oncology Patients and Their Parents at End of Life: A Systematic Review.

    PubMed

    Montgomery, Kathleen; Sawin, Kathleen J; Hendricks-Ferguson, Verna L

    2016-03-01

    Improvement in pediatric palliative and end-of-life care has been identified as an ongoing research priority. The child and parent experience provides valuable information to guide how health care professionals can improve the transition to end of life and the care provided to children and families during the vulnerable period. The purpose of this systematic review was to describe the experience of pediatric oncology patients and their parents during end of life, and identify gaps to be addressed with interventions. A literature search was completed using multiple databases, including CINAHL, PubMed, and PsycInfo. A total of 43 articles were included in the review. The analysis of the evidence revealed 5 themes: symptom prevalence and symptom management, parent and child perspectives of care, patterns of care, decision making, and parent and child outcomes of care. Guidelines for quality end-of-life care are needed. More research is needed to address methodological gaps that include the pediatric patient and their sibling's experience. PMID:26219300

  10. Reproductive health in the adolescent and young adult cancer patient: an innovative training program for oncology nurses.

    PubMed

    Vadaparampil, Susan T; Hutchins, Nicole M; Quinn, Gwendolyn P

    2013-03-01

    In 2008, approximately 69,200 adolescents and young adults (AYAs) were diagnosed with cancer, second only to heart disease for males in this age group. Despite recent guidelines from professional organizations and clinical research that AYA oncology patients want information about reproductive health topics and physician support for nurses to address these issues with patients, existing research finds few oncology nurses discuss this topic with patients due to barriers such as lack of training. This article describes an innovative eLearning training program, entitled Educating Nurses about Reproductive Issues in Cancer Healthcare. The threefold purpose of this article is to: (1) highlight major reproductive health concerns relevant to cancer patients, (2) describe the current status of reproductive health and oncology communication and the target audience for the training, and (3) present a systematic approach to curriculum development, including the content analysis and design stages as well as the utilization of feedback from a panel of experts. The resulting 10-week curriculum contains a broad-based approach to reproductive health communication aimed at creating individual- and practice-level change. PMID:23225072

  11. Reproductive Health in the Adolescent and Young Adult Cancer Patient: An Innovative Training Program for Oncology Nurses

    PubMed Central

    Vadaparampil, Susan T.; Hutchins, Nicole M.; Quinn, Gwendolyn P.

    2012-01-01

    In 2008, approximately 69,200 AYAs were diagnosed with cancer, second only to heart disease for males in this age group. Despite recent guidelines from professional organizations and clinical research that AYA oncology patients want information about reproductive health topics and physician support for nurses to address these issues with patients, existing research finds few oncology nurses discuss this topic with patients due to barriers such as lack of training. This article describes an innovative eLearning training program, entitled Educating Nurses about Reproductive Issues in Cancer Healthcare (ENRICH). The threefold purpose of this article is to: (1) highlight major reproductive health concerns relevant to cancer patients, (2) describe the current status of reproductive health and oncology communication and the target audience for the training, and (3) present a systematic approach to curriculum development, including the content analysis and design stages as well as the utilization of feedback from a panel of experts. The resulting 10-week curriculum contains a broad-based approach to reproductive health communication aimed at creating individual- and practice-level change. PMID:23225072

  12. The 2014 Society of Surgical Oncology Susan G. Komen for the Cure Symposium: triple-negative breast cancer.

    PubMed

    Newman, Lisa A; Reis-Filho, Jorge S; Morrow, Monica; Carey, Lisa A; King, Tari A

    2015-03-01

    Triple-negative breast cancer (TNBC) is an operational term that refers to a heterogeneous collection of breast cancers lacking expression of estrogen receptor (ER), progesterone receptor, and HER2. These tumors account for 12-17 % of all breast cancers, preferentially affect young women, are more frequent in women of African and Hispanic descent, and are enriched in the population of patients diagnosed with "interval cancers." TNBCs account for the majority of breast cancers arising in BRCA1 germline mutation carriers (approximately 80%), and approximately 11-16% of all TNBCs harbor BRCA1 or BRCA2 germline mutations. Well-known risk factors for ER-positive cancers, such as reproductive history and hormonal factors, do not appear to have the same correlations for TNBC, and histologic risk factors for TNBC have not been identified. Patients with TNBC have a higher risk of both local and distant recurrence, but this is not mitigated by bigger surgery, and standard criteria should be used to select the approach to local therapy in these patients. Although platinum drugs have shown promise in the treatment of TNBC, standard chemotherapy remains the standard of care outside of a clinical trial. PMID:25527230

  13. An mHealth system for toxicity monitoring of paediatric oncological patients using Near Field Communication technology.

    PubMed

    Duregger, Katharina; Hayn, Dieter; Morak, Jurgen; Ladenstein, Ruth; Schreier, Gunter

    2015-08-01

    Home-based monitoring might be useful to reduce the burden of long-lasting oncological treatment for children. Current telemonitoring applications focus on chronic diseases or elderly people. Based on the workflow for different stakeholders and the identification of parameters important in paediatric oncology, we developed a prototype of a smartphone-based telehealth system using Near Field Communication technology for monitoring paediatric neuroblastoma patients at home. The parameters blood pressure, heart rate, temperature, body weight, C-reactive protein, white blood cell count, wellbeing, pain level, nausea level and skin alterations could be monitored using a smartphone, a designated app, point-of-care measurement devices and a smart-poster containing RFID tags. The system has been designed to increase the quality of life for paediatric cancer patients. As a future step, a clinical trial is currently being planned to evaluate the system in clinical setting. PMID:26737866

  14. Improving Care in Pediatric Neuro-oncology Patients: An Overview of the Unique Needs of Children With Brain Tumors.

    PubMed

    Fischer, Cheryl; Petriccione, Mary; Donzelli, Maria; Pottenger, Elaine

    2016-03-01

    Brain tumors represent the most common solid tumors in childhood, accounting for almost 25% of all childhood cancer, second only to leukemia. Pediatric central nervous system tumors encompass a wide variety of diagnoses, from benign to malignant. Any brain tumor can be associated with significant morbidity, even when low grade, and mortality from pediatric central nervous system tumors is disproportionately high compared to other childhood malignancies. Management of children with central nervous system tumors requires knowledge of the unique aspects of care associated with this particular patient population, beyond general oncology care. Pediatric brain tumor patients have unique needs during treatment, as cancer survivors, and at end of life. A multidisciplinary team approach, including advanced practice nurses with a specialty in neuro-oncology, allows for better supportive care. Knowledge of the unique aspects of care for children with brain tumors, and the appropriate interventions required, allows for improved quality of life. PMID:26245798

  15. Radical radiotherapy for early glottic cancer: Results in a series of 1087 patients from two Italian radiation oncology centers. I. The case of T1N0 disease

    SciTech Connect

    Cellai, Enrico; Frata, Paolo; Magrini, Stefano M. . E-mail: magrini@med.unibs.it; Paiar, Fabiola; Barca, Raffaella; Fondelli, Simona; Polli, Caterina; Livi, Lorenzo; Bonetti, Bartolomea; Vitali, Elisabetta; De Stefani, Agostina; Buglione, Michela; Biti, Gianpaolo

    2005-12-01

    Purpose: To retrospectively evaluate local control rates, late damage incidence, functional results, and second tumor occurrence according to the different patient, tumor, and treatment features in a large bi-institutional series of T1 glottic cancer. Methods and Materials: A total of 831 T1 glottic cancer cases treated consecutively with radical intent at the Florence University Radiation Oncology Department (FLO) and at the Radiation Oncology Department of University of Brescia-Istituto del Radio 'O. Alberti' (BS) were studied. Actuarial cumulative local control probability (LC), disease-specific (DSS), and overall survival (OS) rates have been calculated and compared in the different clinical and therapeutic subgroups with both univariate and multivariate analysis. Types of relapse and their surgical salvage have been evaluated, along with the functional results of treatment. Late damage incidence and second tumor cumulative probability (STP) have been also calculated. Results: In the entire series, 3-, 5-, and 10-year OS was equal to 86%, 77%, and 57%, respectively. Corresponding values for LC were 86%, 84%, and 83% and for DSS 96%, 95%, and 93%, taking into account surgical salvage of relapsed cases. Eighty-seven percent of the patients were cured with function preserved. Main determinants of a worse LC at univariate analysis were: male gender, earlier treatment period, larger tumor extent, anterior commissure involvement, and the use of Cobalt 60. At multivariate analysis, only gender, tumor extent, anterior commissure involvement, and beam type retained statistical significance. Higher total doses and larger field sizes are significantly related (logistic regression) with a higher late damage incidence. Scatterplot analysis of various combinations of field dimensions and total dose showed that field dimensions >35 and <49 cm{sup 2}, together with doses of >65 Gy, offer the best local control results together with an acceptably low late damage incidence. Twenty-year STP was equal to 23%, with second tumor deaths being more frequent than larynx cancer deaths (67 of 831 vs. 46/831). Conclusion: The results of this study support the opinion, suggested by some international guidelines, that radiotherapy is standard treatment for T1 glottic cancer. Better results are obtained in patients with less extended disease and with 4-6 MV photon beams. The use of doses in excess of 65 Gy and of field sizes of 36-49 cm{sup 2} is probably the best technical choice available. Late damage is infrequent, but careful follow-up is warranted to detect early not only relapses (because conservative salvage surgery is feasible), but also second malignant tumors, which constitute the main cause of death in these patients and are potentially curable.

  16. Radical radiotherapy for early glottic cancer: Results in a series of 1087 patients from two Italian radiation oncology centers. II. The case of T2N0 disease

    SciTech Connect

    Frata, Paolo; Cellai, Enrico; Magrini, Stefano M. . E-mail: magrini@med.unibs.it; Bonetti, Bartolomea; Vitali, Elisabetta; Tonoli, Sandro; Buglione, Michela; Paiar, Fabiola; Barca, Raffaella; Fondelli, Simona; Polli, Caterina; Livi, Lorenzo; Biti, Gianpaolo

    2005-12-01

    Purpose: To retrospectively evaluate local control rates, late damage incidence, functional results, and second-tumor occurrence according to the different patient, tumor, and treatment features in a large bi-institutional series of T2 glottic cancer. Methods and Materials: A total of 256 T2 glottic cancer cases treated consecutively with radical intent at the Florence University Radiation Oncology Department (FLO) and at the Radiation Oncology Department of University of Brescia, Istituto del Radio 'O. Alberti' (BS) were studied. Cumulative probability of local control (LC), disease-specific survival (DSS), and overall survival (OS) rates were calculated and compared in the different clinical and therapeutic subgroups by both univariate and multivariate analysis. Types of relapse and their surgical salvage were evaluated, along with the functional results of treatment. Late-damage incidence and second-tumor cumulative probability (STP) were also calculated. Results: In the entire series, 3-year, 5-year, and 10-year OS rates were, respectively, 73%, 59%, and 37%. Corresponding values for cumulative LC probability were 73%, 73%, and 70% and for DSS, 89%, 86%, and 85%, taking into account surgical salvage of relapsed cases. Seventy-three percent of the patients were cured with function preserved. Main determinants of a worse LC at univariate analysis were larger tumor extent and impaired cord mobility. At multivariate analysis, the same factors retained statistical significance. Twenty-year STP was 23%, with second-tumor deaths less frequent than larynx cancer deaths (20 of 256 vs. 30 of 256). Incidence of late damage was higher in the first decade of accrual (22%) than in the last decade (10%, p = 0.03); the same was true for severe late damage (9% vs. 1.8%). Conclusion: Present-day radical radiotherapy can be considered a standard treatment for T2 glottic cancer. Better results are obtained in patients with less extended disease. Late damage is relatively infrequent, but a careful follow-up is warranted for early detection not only of relapses (because salvage surgery is feasible) but also of second malignant tumors, which constitute a relevant but not the leading cause of death in these patients and are potentially curable.

  17. Analysis of non-clonal chromosome abnormalities observed in hematologic malignancies among Southwest Oncology Group patients

    SciTech Connect

    McConnell, T.S.; Dobin, S.M.

    1994-09-01

    From 1987-1994, the Southwest Oncology Group Cytogenetics Committee reviewed 1571 studies in 590 adult patient cases with ALL, AML, CML or CLL. These were analyzed for the presence of clinically important non-clonal abnormalities (NCA). Abnormalities were defined as non-clonal if one metaphase had a structural abnormality or an extra chromosome. Chromosome loss was not analyzed due to the possibility of random loss. In 72 cases (12%) comprising 136 studies, at least one NCA was observed. In 21 of these cases (29%), NCAs consisted of obvious clonal evolution or instability, and thus were not included in the analysis. At least one structural NCA was observed in which the abnormality differed from the mainline in 36 (50%) patients. Seventeen of the 36 cases had a normal mode. Nineteen of the 36 patients had an abnormal or normal/abnormal mode. At least one numerical NCA was found in 15 cases (21%). Fifteen cases (21%) contained at least one marker chromosome. Several cases involved NCA in more than one of the above divisions. NCAs could be classified into several categories: (1){open_quotes}the clone to come{close_quotes}, (2) evolving clones which then disappeared, (3) NCAs with putative clinical importance that never became clonal, (4) NCAs during remission identical to the preceding clonal abnormality, (5) NCAs which indicated clonal evolution or instability. Examples include one metaphase with t(9;22) or del(20q) or inv(16) or +8 which either preceded or followed clonal findings of the same aberration. Such findings should be communicated to the clinician.

  18. Surgical innovation-enhanced quality and the processes that assure patient/provider safety: A surgical conundrum.

    PubMed

    Bruny, Jennifer; Ziegler, Moritz

    2015-12-01

    Innovation is a crucial part of surgical history that has led to enhancements in the quality of surgical care. This comprises both changes which are incremental and those which are frankly disruptive in nature. There are situations where innovation is absolutely required in order to achieve quality improvement or process improvement. Alternatively, there are innovations that do not necessarily arise from some need, but simply are a new idea that might be better. All change must assure a significant commitment to patient safety and beneficence. Innovation would ideally enhance patient care quality and disease outcomes, as well stimulate and facilitate further innovation. The tensions between innovative advancement and patient safety, risk and reward, and demonstrated effectiveness versus speculative added value have created a contemporary "surgical conundrum" that must be resolved by a delicate balance assuring optimal patient/provider outcomes. This article will explore this delicate balance and the rules that govern it. Recommendations are made to facilitate surgical innovation through clinical research. In addition, we propose options that investigators and institutions may use to address competing priorities. PMID:26653169

  19. Surgical complications associated with primary closure in patients with diabetic foot osteomyelitis

    PubMed Central

    García-Morales, Esther; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; Cecilia-Matilla, Almudena; García-Álvarez, Yolanda; Beneit-Montesinos, Juan Vicente

    2012-01-01

    Background The aim of this study was to determine the incidence of complications associated with primary closure in surgical procedures performed for diabetic foot osteomyelitis compared to those healed by secondary intention. In addition, further evaluation of the surgical digital debridement for osteomyelitis with primary closure as an alternative to patients with digital amputation was also examined in our study. Methods Comparative study that included 46 patients with diabetic foot ulcerations. Surgical debridement of the infected bone was performed on all patients. Depending on the surgical technique used, primary surgical closure was performed on 34 patients (73.9%, Group 1) while the rest of the 12 patients were allowed to heal by secondary intention (26.1%, Group 2). During surgical intervention, bone samples were collected for both microbiological and histopathological analyses. Post-surgical complications were recorded in both groups during the recovery period. Results The average healing time was 9.9±SD 8.4 weeks in Group 1 and 19.1±SD 16.9 weeks in Group 2 (p=0.008). The percentage of complications was 61.8% in Group 1 and 58.3% in Group 2 (p=0.834). In all patients with digital ulcerations that were necessary for an amputation, a primary surgical closure was performed with successful outcomes. Discussion Primary surgical closure was not associated with a greater number of complications. Patients who received primary surgical closure had faster healing rates and experienced a lower percentage of exudation (p=0.05), edema (p<0.001) and reinfection, factors that determine the delay in wound healing and affect the prognosis of the surgical outcome. Further research with a greater number of patients is required to better define the cases for which primary surgical closure may be indicated at different levels of the diabetic foot. PMID:23050062

  20. Prognostic Inflammation Score in Surgical Patients with Colorectal Cancer

    PubMed Central

    2015-01-01

    Several inflammatory markers have been investigated as prognostic parameters in a variety of cancer population with mostly favorable results. This study aimed to verify the significance of common inflammatory markers as prognostic variables and assess whether a selective combination of them as prognostic inflammation score (PIS) could further improve their prognostic values in surgical patients with colorectal cancer (CRC). A total of 265 patients who had undergone curative resection of CRC were reviewed retrospectively. Preoperative levels of inflammatory markers such as serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and neutrophil/lymphocyte ratio (NLR) were assessed by uni- and multivariate survival analysis with disease-free (DFS) and disease-specific survival (DSS). PIS was constructed with a selective combination of inflammatory markers which were independently significant. On univariate analysis, CRP, ESR, and NLR were significantly associated with DFS and DSS. On multivariate analysis, CRP and NLR were independently significant prognostic variables for DSS and DFS respectively (P=0.013, P=0.021). When PIS was constructed with combination of CRP and NLR, it was independently and significantly associated with both DFS and DSS (P=0.006, P=0.010). Furthermore, PIS was superior to CRP for DSS (HR=15.679 vs. HR=5.183), and NLR for DFS in terms of prognosticating power (HR=4.894 vs. HR=2.687). When PIS is constructed with combination of CRP and NLR, it is a potentially significant prognostic variable associated with poor survival regardless pathologic prognostic variables in patients with CRC after curative resection. PMID:26713054

  1. Prognostic Inflammation Score in Surgical Patients with Colorectal Cancer.

    PubMed

    Seong, Moo-Kyung

    2015-12-01

    Several inflammatory markers have been investigated as prognostic parameters in a variety of cancer population with mostly favorable results. This study aimed to verify the significance of common inflammatory markers as prognostic variables and assess whether a selective combination of them as prognostic inflammation score (PIS) could further improve their prognostic values in surgical patients with colorectal cancer (CRC). A total of 265 patients who had undergone curative resection of CRC were reviewed retrospectively. Preoperative levels of inflammatory markers such as serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and neutrophil/lymphocyte ratio (NLR) were assessed by uni- and multivariate survival analysis with disease-free (DFS) and disease-specific survival (DSS). PIS was constructed with a selective combination of inflammatory markers which were independently significant. On univariate analysis, CRP, ESR, and NLR were significantly associated with DFS and DSS. On multivariate analysis, CRP and NLR were independently significant prognostic variables for DSS and DFS respectively (P=0.013, P=0.021). When PIS was constructed with combination of CRP and NLR, it was independently and significantly associated with both DFS and DSS (P=0.006, P=0.010). Furthermore, PIS was superior to CRP for DSS (HR=15.679 vs. HR=5.183), and NLR for DFS in terms of prognosticating power (HR=4.894 vs. HR=2.687). When PIS is constructed with combination of CRP and NLR, it is a potentially significant prognostic variable associated with poor survival regardless pathologic prognostic variables in patients with CRC after curative resection. PMID:26713054

  2. Complementary and alternative medicine use by gynecologic oncology patients in Turkey.

    PubMed

    Nazik, Ev?en; Nazik, Hakan; Api, Murat; Kale, Ahmet; Aksu, Meltem

    2012-01-01

    The use of complementary and alternative medicines (CAM) among women with gynecologic cancer is becoming increasingly popular. Therefore, it is important to gain insight into the prevalence and factors related to the use of CAM. The aim of this study was to assess the use of CAM in women with gynecologic cancer. This is a descriptive cross-sectional study. Data were obtained from 67 gynecological cancer patients at gynecologic oncology clinic of a hospital in Turkey between October 2009 to December 2010 using a questionnaire developed specifically for this study. The instrument included questions on socio-demographic information, disease specifics and complementary and alternative medicine usage. On the basis of women's responses, all participants were divided into 2 groups: CAM users and nonusers. The findings indicated that 61.2% of the women reported the use of 1 or more CAM therapies. There were no significant differences in the sociodemographic and clinical characteristics between CAM users and nonusers (P <0.05). The most frequently used CAM method was herbal therapy (90.2%) and the second was prayer (41.5%). The main sources of information about CAM were informal (friends/ family members). A considerable proportion (56.1%) of CAM users had discussed their CAM use with their physicians or nurses. Turkish women with gynecologic cancer frequently use CAM in addition to standard medical therapy. Nurses/ oncologists caring for women with gynecologic cancer should initiate a dialogue about usage of CAM, discussing the potential adverse effects of CAM and the patient's therapeutic goals. PMID:22502670

  3. Characteristics of surgical patients receiving inappropriate empiric antimicrobial therapy

    PubMed Central

    Davies, Stephen W.; Efird, Jimmy T.; Guidry, Christopher A.; Hranjec, Tjasa; Metzger, Rosemarie; Swenson, Brian R.; Sawyer, Robert G.

    2015-01-01

    BACKGROUND Inappropriate antibiotics have been observed to result in an increased duration of antibiotic treatment and hospital length of stay, development of multidrug-resistant organisms, and mortality rate compared with appropriate antibiotic treatment. Few studies have evaluated independent risk factors associated with inappropriateness. The purpose of this study was to identify independent predictors of inappropriate, empiric antimicrobial therapy for the treatment of severe sepsis. METHODS This was a retrospective analysis of a prospectively maintained database of all surgical/trauma patients admitted to a tertiary care center from 1996 to 2007 and treated for sepsis. “Appropriate” empiric antibiotic treatment was determined by sensitivity testing. Demographics and comorbidities, infection sites, infection organisms, and outcomes between strata were compared. Differences in outcome were estimated using relative risk and 95% confidence intervals for correlated data. RESULTS A total of 2,855 patients (7,158 infections) were identified. Independent predictors of inappropriate, empiric antimicrobial therapy for the treatment of severe sepsis included site of infection and organism type. Severity of illness, age, medical conditions, and community versus health care–associated infections were not associated with inappropriate therapy. Although inappropriate empiric therapy was associated with a longer length of stay and duration of antimicrobial use, it did not result in higher mortality. CONCLUSION Our study observed that inappropriate empiric antibiotic selection is related to site of infection and pathogen. Other clinical variables do not appear to predict inappropriateness of antibiotic treatment. Efforts should be focused on early broad-spectrum therapy and more rapid microbiologic methods. LEVEL OF EVIDENCE Therapeutic/care management study, level II. PMID:25051386

  4. Surgical Management of Complicated Colon Cancer.

    PubMed

    Lee-Kong, Steven; Lisle, David

    2015-12-01

    The management of complicated colon cancer (locally invasive, obstructed, or perforated cancers) can pose diagnostic and therapeutic challenges to surgical management. Adherence to traditional surgical oncologic principles must often be balanced with the patients' clinical presentation and other parameters. While the goal of an R0 (no residual microscopic disease) resection must always be kept in mind, situations sometimes arise which can make this difficult to achieve. Recognition of complicated disease and availability of varied therapeutic modalities is important to ensure favorable patient outcomes. This review will discuss the surgical management of complicated colon cancer, with special focus on locally advanced disease. PMID:26648793

  5. Comparative Oncology Program

    Cancer.gov

    SYNOPSIS OF THE NCI COMPARATIVE ONCOLOGY TRIAL CONSORTIUM A central mission of the Center for Cancer Research (CCR), National Cancer Institute (NCI) is the development and delivery of novel cancer treatment strategies for cancer patients. A significant hu

  6. Medical Oncology Service

    Cancer.gov

    The Medical Oncology Service of the Center for Cancer Research (CCR), National Cancer Institute (NCI), is a part of the National Institutes of Health, the world's largest medical research institution, operated by the U.S. federal government. Patients who

  7. Medical Oncology Service

    Cancer.gov

    Training The Medical Oncology Fellowship Program provides both clinical and research training opportunities for each fellow during this 3-year program. All fellows spend their first year in a clinical setting, caring for patients. In the second and third

  8. [Surgical treatment of patients suffering esophageal cancer and stomach cancer spreading to the esophagus using abdominocervical access].

    PubMed

    Saienko, V F; Miasoiedov, S D; Andreieshchev, S A; Kondratenko, P M; Umanets', M S; Fediuchek, A S; Stadil'na, T Ie; Prysiazhniuk, D A

    2006-10-01

    Radical operative interventions using abdominocervical access were performed in 145 patients for esophageal and gastroesophageal cancer. Of them in 99 (68.3%) patients isoperistaltic esophagoplasty was performed: in 54 (54.5%)--using isoperistaltic tube, formatted from gastric big curvature, in 23 (23.2%)--portion of jejunum, in 18 (18.2%)--portion of colon and in 4 (4.1%)--ileocecal angle. Retrosternal way of transplant transposition toward the neck was choused in 86 (86.9%) patients, via the resected esophagus bed--in 10 (10.1%) and subcutaneous one, presternal--in 3 (3%). Postoperative mortality had constituted 10.3%. For locally advanced cancer, affecting thoracic esophagus or gastroesophageal one the performance of subtotal-total esophageal resection is indicated. Application of abdominocervical access owes essential advantages for the patient and surgeon, comparing with lateral thoracotomy, because it secures less traumatic, adequately wide and visually controlled approach to mediastinal structures in esophageal cancer, and is characterized by oncological loyalty and surgical utility. PMID:17269397

  9. Using Baldrige Performance Excellence Program Approaches in the Pursuit of Radiation Oncology Quality Care, Patient Satisfaction, and Workforce Commitment

    PubMed Central

    Sternick, Edward S.

    2011-01-01

    The Malcolm Baldrige National Quality Improvement Act was signed into law in 1987 to advance US business competitiveness and economic growth. Administered by the National Institute of Standards and Technology, the Act created the Baldrige National Quality Program, recently renamed the Baldrige Performance Excellence Program. The comprehensive analytical approaches referred to as the Baldrige Healthcare Criteria, are very well-suited for the evaluation and sustainable improvement of radiation oncology management and operations. A multidisciplinary self-assessment approach is used for radiotherapy program evaluation and development in order to generate a fact-based, knowledge-driven system for improving quality of care, increasing patient satisfaction, enhancing leadership effectiveness, building employee engagement, and boosting organizational innovation. This methodology also provides a valuable framework for benchmarking an individual radiation oncology practice's operations and results against guidelines defined by accreditation and professional organizations and regulatory agencies. PMID:22655229

  10. Measured dose rate constant from oncology patients administered 18F for positron emission tomography

    SciTech Connect

    Quinn, Brian; Holahan, Brian; Aime, Jean; Humm, John; St Germain, Jean; Dauer, Lawrence T.

    2012-10-15

    Purpose: Patient exposure rate measurements verify published patient dose rate data and characterize dose rates near 2-18-fluorodeoxyglucose ({sup 18}F-FDG) patients. A specific dose rate constant based on patient exposure rate measurements is a convenient quantity that can be applied to the desired distance, injection activity, and time postinjection to obtain an accurate calculation of cumulative external radiation dose. This study reports exposure rates measured at various locations near positron emission tomography (PET) {sup 18}F-FDG patients prior to PET scanning. These measurements are normalized for the amount of administered activity, measurement distance, and time postinjection and are compared with other published data. Methods: Exposure rates were measured using a calibrated ionization chamber at various body locations from 152 adult oncology patients postvoid after a mean uptake time of 76 min following injection with a mean activity of 490 MBq {sup 18}F-FDG. Data were obtained at nine measurement locations for each patient: three near the head, four near the chest, and two near the feet. Results: On contact with, 30 cm superior to and 30 cm lateral to the head, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.482 (0.511), 0.135 (0.155), and 0.193 (0.223) {mu}Sv/MBq h, respectively. On contact with, 30 cm anterior to, 30 cm lateral to and 1 m anterior to the chest, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.623 (0.709), 0.254 (0.283), 0.190 (0.218), and 0.067 (0.081) {mu}Sv/MBq h respectively. 30 cm inferior and 30 cm lateral to the feet, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.024 (0.022) and 0.039 (0.044) {mu}Sv/MBq h, respectively. Conclusions: The measurements for this study support the use of 0.092 {mu}Sv m{sup 2}/MBq h as a reasonable representation of the dose rate anterior from the chest of patients immediately following injection. This value can then be reliably scaled to the desired time and distance for planning and staff dose evaluation purposes. At distances closer than 1 m, a distance-specific dose rate constant of 0.367 {mu}Sv/MBq h at 30 cm is recommended for accurate calculations. An accurate patient-specific dose rate constant that accounts for patient-specific variables (e.g., distribution and attenuation) will allow an accurate evaluation of the dose rate from a patient injected with an isotope rather than simply utilizing a physical constant.

  11. Can you ask? We just did! Assessing sexual function and concerns in patients presenting for initial gynecologic oncology consultation

    PubMed Central

    Kennedy, Vanessa; Abramsohn, Emily; Makelarski, Jennifer; Barber, Rachel; Wroblewski, Kristen; Tenney, Meaghan; Lee, Nita Karnik; Yamada, S. Diane; Lindau, Stacy Tessler

    2015-01-01

    Objectives To describe patterns of response to, and assess sexual function and activity elicited by, a self-administered assessment incorporated into a new patient intake form for gynecologic oncology consultation. Methods A cross-sectional study of patients presenting to a single urban academic medical center between January 2010 and September 2012. New patients completed a self-administered intake form, including six brief sexual activity and function items. These items, along with abstracted medical record data, were descriptively analyzed. Logistic regression was used to assess the association between sexual activity and function and disease status, adjusting for age. Results Median age was 50 years (range 18–91, N = 499); more than half had a final diagnosis of cancer. Most patients completed all sex-related items on the intake form; 98% answered at least one. Among patients who were sexually active in the prior 12 months (57% with cancer, 64% with benign disease), 52% indicated on the intake form having, during that period, a sexual problem lasting several months or more. Of these, 15% had physician documentation of the sexual problem. Eighteen women were referred for care. Providers reported no patient complaints about the inclusion of sexual items on the intake form. Conclusions Nearly all new patients presenting for gynecologic oncology consultation answered self-administered items to assess sexual activity and function. Further study is needed to determine the role of pretreatment identification of sexual function concerns in improving sexual outcomes associated with cancer diagnosis and treatment. PMID:25582823

  12. Oncologic imaging

    SciTech Connect

    Bragg, D.G.; Rubin, P.; Youker, J.E.

    1985-01-01

    This book presents papers on nuclear medicine. Topics considered include the classification of cancers, oncologic diagnosis, brain and spinal cord neoplasms, lymph node metastases, the larynx and hypopharynx, thyroid cancer, breast cancer, esophageal cancer, bladder cancer, tumors of the skeletal system, pediatric oncology, computed tomography and radiation therapy treatment planning, and the impact of future technology on oncologic diagnosis.

  13. FDG PET and Split-Bolus Multi-Detector Row CT Fusion Imaging in Oncologic Patients: Preliminary Results.

    PubMed

    Scialpi, Michele; Palumbo, Isabella; Gravante, Sabrina; Buresta, Tommaso; D'Andrea, Alfredo; Pierotti, Luisa; Palumbo, Barbara

    2016-03-01

    Purpose To assess the incremental value of split-bolus multidetector computed tomography (CT) combined with fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for follow-up of oncologic patients. Materials and Methods The institutional ethics committee approved the use of this protocol. Thirty-eight oncologic patients who underwent FDG PET/unenhanced multidetector CT and split-bolus multidetector CT for restaging were investigated retrospectively. The split-bolus CT protocol included imaging during the hepatic arterial and portal venous phases in one scan. Software was used for fusion of the independently acquired FDG PET and split-bolus CT data, and fused datasets were compared with FDG PET/unenhanced CT data. The standard of reference for diagnosis of lesions in all patients was a combination of histologic results (if available), clinical results (medical history, physical examination, and laboratory test results), and the results of follow-up imaging (conventional CT, magnetic resonance imaging, and/or ultrasonography) for at least 6 months. Descriptive statistics were used. Results Fifty-nine true-positive lesions were identified with fused FDG PET/split-bolus CT; 41 were concordant and detected with both split-bolus CT and PET/unenhanced CT, 16 with split-bolus CT only, and two with PET/unenhanced CT. Two different false-positive lesions were identified with PET/unenhanced CT and PET/split-bolus CT. Furthermore, in 20 of 38 (53%) patients, FDG PET/split-bolus CT allowed detection of important additional findings (n = 40) not detected at FDG PET/unenhanced CT. Both the tumor-related findings (n = 13, 32.5%) and the non-tumor-related findings (n = 27, 67.5%) were important to the clinical treatment of these patients. Conclusion Fused FDG PET/split-bolus multidetector CT provides additional information compared with FDG PET/unenhanced multidetector CT in oncologic patients. (©) RSNA, 2015. PMID:26361222

  14. Comparative Study of Peroneal Tenosynovitis as the Complication of Intraarticular Calcaneal Fracture in Surgically and Non-Surgically Treated Patients

    PubMed Central

    Bahari Kashani, Mahmoud; Kachooei, Amir Reza; Ebrahimi, Hengameh; Peivandi, Mohammad Taghi; Amelfarzad, Sara; Bekhradianpoor, Nastoor; Azami, Mehran; Fatehi, Amirreza; Bahari Kashani, Golsa

    2013-01-01

    Background Calcaneus has the most fracture prevalence among tarsal bones. About 3/4 of calcaneal fractures are intra-articular fractures with displacement. The majority of calcaneal fractures occur in 21 - 35 year old young men, and that are mostly active people, these fractures cause complete disability for 15 months. Moreover, inappropriate treatment leads to lots of social and economical damages. Objectives In this study we compared the incidence and the severity of peroneal tenosynovitis as a complication of non-operative and operative treatment of intra-articular calcaneal fractures. In this study, some other complications of this fracture were also analyzed and the prevalence of the complication was higher in non-operated patients. Patients and Methods A total of 140 patients with intra-articular calcaneal fracture were analyzed prospectively. These patients were divided into 2 groups: operated group and non-operated group. Results In non-operated group (56 patients), 22 patients were complicated by peroneal tenosynovitis. In operated group (84 patients), 8 patients had the same complication. Statistical analysis revealed that the prevalence, and the severity of this complication in the mentioned groups had a meaningful difference. The results in operated group were much better than the non-operated one. Conclusions Although some of the orthopedic surgeons are not interested to manage these fractures surgically and most of them treat these cases conservatively (casting, etc.), in most displaced intra-articular calcaneal fractures, surgical treatment is the method of choice. Moreover, in non-surgical treatment the prevalence of these complications among the patients is more and as a result, inevitable social, occupational and familial damages occur. PMID:24693362

  15. Surgical Approaches to the Oral Cavity Primary and Neck

    SciTech Connect

    Shah, Jatin P.

    2007-10-01

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

  16. Actigraphy for measurements of sleep in relation to oncological treatment of patients with cancer: a systematic review.

    PubMed

    Madsen, Michael T; Huang, Chenxi; Gögenur, Ismail

    2015-04-01

    Sleep disturbances are a prevalent and disabling problem for patients with cancer. Sleep disturbances are present throughout the cancer trajectory, especially during oncological treatment. Previously sleep disturbances have primarily been quantified with subjective rating scales. Actigraphy is an easy to use, non-invasive method for objective measurement of sleep. We systematically reviewed the literature for studies using actigraphy to measure sleeping habits of patients with cancer, undergoing oncological treatment. Our study furthermore reviewed studies with interventions designed to reduce sleep disturbances in the patient population. 19 studies were included in the final review of which 13 had a descriptive study design and six included some kind of intervention. The studies were primarily performed in patients with breast cancer undergoing chemotherapy. We found that sleep disturbances are prevalent, and persistent in patients with cancer. The sleep disturbances seem to be aggravated by chemotherapy treatment and accumulate as the treatment continues. Sleep disturbances need further attention among clinicians working with patients with cancer. PMID:25155183

  17. SU-F-18C-06: Prospective Patient Evaluation of Iterative Reconstruction in Radiation Oncology

    SciTech Connect

    Price, R; Vance, S; Cattaneo, R; Schultz, L; Elshaikh, M; Chetty, I; Glide-Hurst, C

    2014-06-15

    Purpose: This work incorporates iterative reconstruction (IR) into a dose reduction study to characterize image quality metrics, delineation, and dosimetric assessment, with the goal of reducing imaging dose in Radiation Oncology. Methods: Three-dimensional noise power spectrum (NPS) analysis characterized noise magnitude/texture (120 kVp, 50–200 mAs, IR levels 1–6 yielding noise reduction of 0.89–0.55 compared to filtered backprojection (FBP)). Task-specific Modulation Transfer Functions (MTFtask) were characterized across varied subject contrasts. A prospective dose reduction study (500 to 150 mAs) was conducted for 12 patients (43 inter-fraction CTs) for high-dose rate brachytherapy. Three physicians performed qualitative image assessment between full-dose FBP (FD-FBP, 500 mAs), low-dose FBP (LD-FBP, 150–250 mAs), and low-dose IRL5-6 (LD-IR) scans for image noise, cuff/bladder interface detectability, spatial resolution, texture, and segmentation confidence. Comparisons between LD-FBP and LD-IR were conducted for the following metrics: delineation (bladder and rectum evaluated via overlap indices (OI) and Dice similarity coefficients (DSC)), noise, boundary changes, dose calculation, and digitally reconstructed radiographs (DRRs). Results: NPS showed ∼50% reduction in noise magnitude and ∼0.1 1/mm spatial frequency shift with IRL6. The largest MTFtask decrease between FBP and IR was 0.08 A.U. Qualitative patient image evaluation revealed LD-IR was equivalent or slightly worse than FD-FBP, and superior to LD-FBP for all metrics except low contrast interface and texture. The largest CT number discrepancy from FBP occurred at a bone/tissue interface using IRL6 (−1.2 ± 4.9 HU (range: −17.6 – 12.5 HU)). No significant contour differences (OIs and DSCs = 0.85 – 0.95) and dose calculation discrepancy (<0.02%) were observed. DRRs preserved anatomical detail and demonstrated <2% difference in intensity between LD-FBP and LD-IRL6. Conclusion: While phantom analysis showed slight noise texture differences with IR, patient results revealed that image quality, contouring ability, and dosimetric parameters were not adversely affected, thus support integrating IR into treatment planning. Research supported in part by a grant from Philips HealthCare.

  18. Patient-Specific Surgical Outcomes Assessment Using Population-Based Data Analysis for Risk Model Development

    PubMed Central

    AbuSalah, Ahmad M.; Melton, Genevieve B.; Adam, Terrence J.

    2012-01-01

    Optimal surgical planning and decision making surrounding surgical interventions requires patient-specific risk assessment which incorporates patient pre-operative clinical assessment and clinical literature. In this paper, we utilized population-based data analysis to construct surgical outcome predictive models for spinal fusion surgery using hospital, patient and admission characteristics. We analyzed population data from the Nationwide Inpatient Sample (NIS) –a nationally representative database– to identify data elements affecting inpatient mortality, length of stay, and disposition status for patients receiving spinal fusion surgery in the years 2004–2008. In addition to outcomes assessment, we want to make the analytic model results available to clinicians and researchers for pre-operative surgical risk assessment, hospital resource allocation, and hypothesis generation for future research without an individual patient data management burden. Spinal fusion was the selected prototype procedure due to it being a high volume and typically inpatient procedure where patient risk factors will likely affect clinical outcomes. PMID:23304385

  19. EARLY ORAL RE-FEEDING ON ONCOLOGY PATIENTS SUBMITTED TO GASTRECTOMY FOR GASTRIC CANCER

    PubMed Central

    LAFFITTE, Andressa Madalozo; POLAKOWSKI, Camila Brandão; KATO, Massakazu

    2015-01-01

    Background: There is no advantage in maintaining patients on oral fasting after gastrointestinal elective resection. The early feeding up to 48 h can be beneficial, because it reduces infectious complications and hospital stay. Aim: Evaluate the evolution and tolerance of early oral diet in postoperative period after gastrectomy for gastric cancer. Methods: Anthropometric assessment was performed on the day of surgery, weight, height, body mass index and weight loss were measured. Acceptance of diet was evaluated as food intake (amount accepted) and gastrointestinal symptoms such as nausea, vomiting, constipation, diarrhea, abdominal distension, postoperative complications and hospital stay. Results: The sample consisted of 23 patients, 17 with partial gastrectomy and six with total gastrectomy. In the assessment of nutritional status 9% were malnourished, 54.5% normal weight, 9% overweight and 27.2% obese, but 54% had weight loss. There was good acceptance of the diet in 96,9% of the sample. Nausea and abdominal distension were present in 4,3% and 65.2% constipation. Surgical complications according to the Clavien scalle, 13% had grade V, 4.3% grade IIIA, 8.7% grade I and 73% did not have complications. The length of hospital stay was 5±2.2 days. Conclusion: Early postoperative re-feeding in total and partial gastrectomy was well tolerated by patients. PMID:26537147

  20. Internet-Based Survey Evaluating Use of Pain Medications and Attitudes of Radiation Oncology Patients Toward Pain Intervention

    SciTech Connect

    Simone, Charles B. Vapiwala, Neha; Hampshire, Margaret K.; Metz, James M.

    2008-09-01

    Purpose: Pain is a common symptom among cancer patients, yet many patients do not receive adequate pain management. Few data exist quantifying analgesic use by radiation oncology patients. This study evaluated the causes of pain in cancer patients and investigated the reasons patients fail to receive optimal analgesic therapy. Methods and Materials: An institutional review board-approved, Internet-based questionnaire assessing analgesic use and pain control was posted on the OncoLink (available at (www.oncolink.org)) Website. Between November 2005 and April 2006, 243 patients responded. They were predominantly women (73%), white (71%), and educated beyond high school (67%) and had breast (38%), lung (6%), or ovarian (6%) cancer. This analysis evaluated the 106 patients (44%) who underwent radiotherapy. Results: Of the 106 patients, 58% reported pain from their cancer treatment, and 46% reported pain directly from their cancer. The pain was chronic in 51% and intermittent in 33%. Most (80%) did not use medication to manage their pain. Analgesic use was significantly less in patients with greater education levels (11% vs. 36%, p = 0.002), with a trend toward lower use by whites (16% vs. 32%, p 0.082) and women (17% vs. 29%, p = 0.178). The reasons for not taking analgesics included healthcare provider not recommending medication (87%), fear of addiction or dependence (79%), and inability to pay (79%). Participants experiencing pain, but not taking analgesics, pursued alternative therapies for relief. Conclusions: Many radiation oncology patients experience pain from their disease and cancer treatment. Most study participants did not use analgesics because of concerns of addiction, cost, or failure of the radiation oncologist to recommend medication. Healthcare providers should have open discussions with their patients regarding pain symptoms and treatment.

  1. Use of Transversus Abdominis Plane (TAP) Blocks for Pain Management in Elderly Surgical Patients.

    PubMed

    Sammons, Gay; Ritchey, William

    2015-11-01

    Elderly patients who require surgical interventions often have multiple comorbidities that complicate their intraoperative and postoperative care. Surgical team members should consider all potential problems that elderly patients may experience and base perioperative care on their assessment. This article discusses the use of the transversus abdominis plane (TAP) block in elderly patients undergoing surgical procedures to relieve pain and reduce the use of narcotics or sedatives during the immediate and extended postoperative recovery period. By reducing postoperative pain and the use of sedatives and narcotics, the TAP block improves pain management and helps reduce the incidence of postoperative delirium, pneumonia, urinary retention, and falls. PMID:26514706

  2. Psychosocial status of patients randomly assigned to medical or surgical therapy for chronic stable angina.

    PubMed

    Brown, J S; Rawlinson, M E

    1979-09-01

    Aspects of social and psychologic functioning are compared for 51 patients randomly assigned to surgical or medical management of chronic stable angina. No differences were found between the two groups in work status, social activity, adequacy of family functioning, perceived health, life satisfaction, memory span, extent of anxiety, hypochondriasis and hysteria. However, surgically treated patients were significantly less depressed and more likely to report improvement in health and family functioning after the initiation of treatment. It is concluded that the psychologic and social outcomes appear slightly more favorable in patients treated surgically than in those treated medically. PMID:314234

  3. Anesthesia and perioperative management of colorectal surgical patients – specific issues (part 2)

    PubMed Central

    Patel, Santosh; Lutz, Jan M.; Panchagnula, Umakanth; Bansal, Sujesh

    2012-01-01

    Colorectal surgery carries significant morbidity and mortality, which is associated with an enormous use of healthcare resources. Patients with pre-existing morbidities, and those undergoing emergency colorectal surgery due to complications such as perforation, obstruction, or ischemia / infarction are at an increased risk for adverse outcomes. Fluid therapy in emergency colorectal surgical patients can be challenging as hypovolemic and septic shock may coexist. Abdominal sepsis is a serious complication and may be diagnosed during pre-, intra-, or postoperative periods. Early suspicion and recognition of medical and / or surgical complications are essential. The critical care management of complicated colorectal surgical patients require collaborative and multidisciplinary efforts. PMID:22869934

  4. Prospective Comparison of Stereotactic Core Biopsy and Surgical Excision as Diagnostic Procedures for Breast Cancer Patients

    PubMed Central

    Morrow, Monica; Venta, Luz; Stinson, Tamy; Bennett, Charles

    2001-01-01

    Objective To determine whether stereotactic core biopsy (SCNB) is the diagnostic method of choice for all mammographic abnormalities requiring tissue sampling. Summary Background Data Stereotactic core needle biopsy decreases the cost of diagnosis, but its impact on the number of surgical procedures needed to complete local therapy has not been studied in a large, unselected patient population. Methods A total of 1,852 mammographic abnormalities in 1,550 consecutive patients were prospectively categorized for level of cancer risk and underwent SCNB or diagnostic needle localization and surgical excision. Diagnosis, type of cancer surgery, and number of surgical procedures to complete local therapy were obtained from surgical and pathology databases. Results The malignancy rate was 24%. Surgical biopsy patients were older, more likely to have cancer, and more likely to be treated with breast-conserving therapy than those in the SCNB group. For all types of lesions, regardless of degree of suspicion, patients diagnosed by SCNB were almost three times more likely to have one surgical procedure. However, for patients treated with lumpectomy alone, the number of surgical procedures and the rate of negative margins did not differ between groups. Conclusions Stereotactic core needle biopsy is the diagnostic procedure of choice for most mammographic abnormalities. However, for patients undergoing lumpectomy without axillary surgery, it is an extra invasive procedure that does not facilitate obtaining negative margins. PMID:11303136

  5. Molecular Detection of Minimal Residual Cancer in Surgical Margins of Head and Neck Cancer Patients

    PubMed Central

    Graveland, A. Peggy; de Maaker, Michiel; Braakhuis, Boudewijn J. M.; de Bree, Remco; Eerenstein, Simone E. J.; Bloemena, Elisabeth; Leemans, C. René; Brakenhoff, Ruud H.

    2009-01-01

    A great disappointment in head and neck cancer surgery is that 10–30% of head and neck squamous cell carcinoma (HNSCC) patients develop local recurrences despite histopathologically tumor-free surgical margins. These recurrences result from either minimal residual cancer (MRC) or preneoplastic lesions that remain behind after tumor resection. Distinguishing MRC from preneoplasic lesions is important to tailor postoperative radiotherapy more adequately. Here we investigated the suitability of quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) using human Ly-6D (hLy-6D) transcripts as molecular marker to detect MRC in surgical margins. Submucosal samples of deep surgical margins were collected from 18 non-cancer control patients and 67 HNSCC patients of whom eight had tumor-positive surgical margins. The samples were analyzed with hLy-6D qRT-PCR, and the data were analyzed in relation to the clinicohistological parameters. A significant difference was shown between the group of patients with histopathological tumor-positive surgical margins and the non-cancer control group (p < 0.001), and the group of patients with histopathological tumor-free surgical margins (p = 0.001). This study shows a novel approach for molecular analysis of deep surgical margins in head and neck cancer surgery. The preliminary data of this approach for detection of MRC in deep margins of HNSCC patients are promising. PMID:19633367

  6. Surgical technique for treatment of concomitant grade II MCL lesion in patients with ACL rupture.

    PubMed

    Blanke, Fabian; Vonwehren, Lutz; Pagenstert, Geert; Valderrabano, Victor; Majewski, Martin

    2015-09-01

    Combined lesions of anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are frequent in athletes. While surgical treatment of ACL injury is mandatory treatment regime of concomitant grade II MCL lesions remains unclear with tendency to surgical intervention. Standardized surgical technique is lacking. Present study wants to introduce surgical technique for treatment of concomitant grade II MCL lesion and report short term outcome results. 5 Patients with acute ACL rupture and grade II MCL-lesion were included. All patients received surgical treatment of concomitant MCL lesion by distinct surgical technique and ACL reconstruction. We evaluated valgus instability, anterior instability and range of motion (ROM) according to international knee documentation commitee (IKDC) and Lysholm?Score both preoperative and after 6, 16 weeks and 9 months postoperative. All Patients showed excellent clinical results at final follow-up. Valgus and anterior stability could be restored in all patients. 1 patient (20%) lost 15° in flexion of ROM at final follow up. However in all 5 patients (100%) the findings were graded as normal or nearly nor-mal according to IKDC knee examination form. Lysholm-Score averaged 94,6. Therefore presented surgical technique improved both, valgus and anterior stability, and led to excellent short term results at final follow up. PMID:26435239

  7. 2009 Pandemic Influenza A (H1N1) Virus Infection in Pediatric Oncology and Hematopoietic Stem Cell Transplantation Patients

    PubMed Central

    Cost, Carrye; Brock, Evangeline; Adams-Huet, Beverley; Siegel, Jane D.; Ardura, Monica I.

    2010-01-01

    Background Pediatric oncology and hematopoietic stem cell transplantation (HSCT) patients are at high risk for influenza infection and its associated complications. Little is known about infection with novel 2009 influenza A (H1N1) in this population. Procedure Prospective laboratory surveillance identified all children with positive influenza test results from 4/27/09-12/5/09. 2009 H1N1 infection was confirmed by PCR subtyping; cases in which subtyping was not performed were considered probable. Medical records of all pediatric oncology and HSCT cases were reviewed. Results Thirty children with cancer or HSCT had laboratory-confirmed influenza A. Patients with ALL (18), CNS tumors (4), CML (1), Ewing sarcoma (1), Hodgkin lymphoma (1), LCH (1), severe aplastic anemia (1), and HSCT (3), had confirmed (5) and probable (25) H1N1 by rapid (22; 73%), DFA (4; 13%), or RVP (4; 13%) assays. Most frequent presenting signs and symptoms were fever (93%; median 38.6°C), cough (97%), and rhinorrhea (83%). Ten patients required hospitalization for a median of 5 days, most commonly for fever and neutropenia (8). Imaging demonstrated lower respiratory tract involvement in 3 patients. There were no concomitant bacteremias; one patient had rhinovirus co-infection. Three patients required ICU care; 1 developed ARDS, multi-organ failure, and died after 5 days. Chemotherapy was delayed in 5 patients. Oseltamivir was administered to 28 patients; 1 patient developed an oseltamivir-resistant strain and was treated with zanamivir. Conclusions 2009 influenza A H1N1 infection in children with cancer and HSCT is mild in most patients, but can lead to serious complications. PMID:20973099

  8. Evaluating the usefulness of patient education materials on surgical site infection: a systematic assessment.

    PubMed

    Zellmer, Caroline; Zimdars, Peggy; Parker, Sarah; Safdar, Nasia

    2015-02-01

    Patient education is important for the prevention of surgical site infections (SSIs). The usefulness of available patient education materials is unclear. Using a validated evaluation tool, the Patient Education Materials Assessment Tool, we systematically assessed patient education materials for SSI. We found that available materials performed poorly, and further research is needed in this area. PMID:25541334

  9. Differential effect of zoledronic acid on normal trabecular and cortical bone density in oncologic patients with bone metastases

    PubMed Central

    Quattrocchi, Carlo C.; Dell'Aia, Paola; Errante, Yuri; Occhicone, Filomena; Longo, Daniela; Virzì, Vladimir; Tonini, Giuseppe; Napoli, Nicola; Santini, Daniele; Beomonte Zobel, Bruno

    2012-01-01

    Purpose To evaluate bone density changes at the level of normal bone and bone metastases after zoledronic acid (ZA) treatment in oncologic patients. Materials and methods We retrospectively evaluated 72 consecutive adult patients with histologically confirmed solid tumors with at least 1 newly diagnosed bone metastatic lesion. Bone metastases were diagnosed by bone scans and confirmed with computed tomography (CT). Patients received intravenous ZA, 4 mg, by 15-min infusion every 28 day through a peripheral or a central venous access and were monitored for at least 3 months and a maximum of 24 months. Bone density was determined at the level of bone metastases and at the level of normal trabecular and cortical bone using a ROI-based approach. Results A significant increase was demonstrated at the level of normal trabecular bone of the calvarium and the femoral neck. No significant increase of density was observed at the level of the normal cortical bone. Bone metastases showed a significant increase in CT density as compared to baseline up to 24 months after zoledronic acid. Conclusion We have found that long term treatment with ZA increases trabecular bone density in oncologic patients whereas normal cortical bone changes are not detectable. PMID:26909251

  10. Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient.

    PubMed

    Moug, S J; Stechman, M; McCarthy, K; Pearce, L; Myint, P K; Hewitt, J

    2016-03-01

    Introduction Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. Methods This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes. Results Frailty is present in 25% of the older surgical population. Using frailty-scoring tools, frailty was associated with a significantly longer hospital stay and higher mortality at 30 and 90 days after admission to an acute surgical unit. Cognitive impairment is present in a high number of older acute surgical patients (approximately 70%), whilst acute onset cognitive impairment, termed delirium, is documented in 18%. However, patients with delirium had significantly longer hospital stays and higher in-hospital mortality than those with cognitive impairment. Conclusions Improved knowledge of frailty and delirium by the emergency surgeon allows the specialised needs of older surgical patients to be taken into account. Early recognition, and consideration of minimally invasive surgery or radiological intervention alongside potentially transferable successful elective interventions such as comprehensive geriatric assessment, may help to improve short- and long-term patient outcomes in this vulnerable population. PMID:26890834

  11. Therapeutic scrapbooking: a technique to promote positive coping and emotional strength in parents of pediatric oncology patients.

    PubMed

    McCarthy, Paula G; Sebaugh, Jill Genone

    2011-01-01

    Therapeutic scrapbooking is an intervention being used with parents and caregivers of children with cancer. The purpose of the group is to promote hopefulness, mobilize internal strengths, and thereby enhance the parents' and caregivers' coping abilities to benefit pediatric oncology patients. Facilitators, licensed in medical social work, provide a safe environment for participants to verbalize their stories and share their distress. Scrapbooking is a "normal" activity without the negative stigma that a "support group" may carry, minimizing the reluctance to attend this supportive group. Outcome measurements indicate this therapeutic intervention achieves positive results. PMID:21391072

  12. Surgical strategy for intracranial dermoid and epidermoid tumors: An experience with 33 Patients

    PubMed Central

    Lynch, Jose Carlos; Aversa, Antônio; Pereira, Celestino; Nogueira, Jânio; Gonçalves, Mariangela; Lopes, Hélio

    2014-01-01

    Background: The aim of this paper is to report on our surgical strategy and technique and to identify the best management for intracranial dermoids and epidermoids tumors (IDETs). Methods: We retrospectively reviewed 33 consecutive patients (14 males and 19 females; mean age at surgery, 37.9 years) with pathologically confirmed IDETs who underwent surgical resection, with mean follow-up of 7.2 years. Results: Gross total tumor removal was achieved in 24 cases (72.7%) with zero surgical mortality and a recurrence rate of 9%. Conclusions: The surgical strategies used in this group of patients enabled total removal of most tumors without surgical mortality and with low morbidity and recurrence rates, proving to be safe and effective. PMID:25558422

  13. Perioperative nurses' knowledge of indicators for pressure ulcer development in the surgical patient population.

    PubMed

    Lupear, Susan Krauser; Overstreet, Maria; Krau, Stephen D

    2015-06-01

    Despite focused attention to improve the quality and safety of patient care, and the financial impact pressure ulcers (PUs) can have on a health care provider or institution, evidence supports that PUs continue to occur in other patient populations during admission to the hospital. An example of a patient population in which evidence indicates that the development of PUs occurs, is patients who have a surgical procedure. The article discusses a project designed to identify potential knowledge deficits among perioperative nurses of indicators for PU development in the surgical patient population. PMID:25999080

  14. Surgical management of the patient with invasive carcinoma discovered at reduction mammoplasty.

    PubMed

    Rudolph, Raymond; Niedbala, Angela R

    2003-11-01

    The diagnosis of invasive carcinoma presents a surgical dilemma when discovered incidentally at breast reduction mammoplasty. Subsequent surgical and therapeutic management for such cases have not been established. Although management and treatment may vary according to patient preference, a review of the literature of the past four decades yielded scant discussion of the topic. We describe two cases of occult breast carcinomas that were not evident on preoperative breast screening, but were discovered on the pathology exam of reduction mammoplasty specimen. The purpose of our publication is to recommend a surgical approach for the patient in such a situation. PMID:14627265

  15. Development of an Integrated Subspecialist Multidisciplinary Neuro-oncology Service

    PubMed Central

    Price, Stephen J; Guilfoyle, Mathew; J Jefferies, Sarah; Harris, Fiona; Oberg, Ingela; G Burnet, Neil; Santarius, Thomas; Watts, Colin

    2013-01-01

    Traditionally, the poor outcome for patients with malignant brain tumours led to therapeutic nihilism. In turn, this resulted in lack of interest in neurosurgical oncology subspecialisation, and less than ideal patient pathways. One problem of concern was the low rate of tumour resection. Between 1997 and 2006, 685 treated glioblastomas were identified. In the first four years only 40% of patients underwent tumour resection, rising to 55% in the last four years. Before revision of the pathway, the median length of hospital stay was 8 days, and 35% of patients received the results of their histology outside of a clinic setting. A pathway of care was established, in which all patients were discussed pre-operatively in an MDT meeting and then directed into a new surgical neuro-oncology clinic providing first point of contact. This limited the number of surgeons operating on adult glioma patients and aided recruitment into research studies. Now, three consultant neurosurgeons run this service, easily fulfilling IOG requirement to spend >50% of programmed activities in neuro-oncology. Nursing support has been critical to provide an integrated service. This model has allowed increased recruitment to clinical trials. The introduction of this service led to an increase in patients discussed pre-operatively in an MDT (66% rising to 87%; P=0.027), an increase in the rate of surgical resection (from 40% to 80%) and more patients being admitted electively (from 25% to 80%; P<0.001). There was a reduction in the median length of stay (8 days reduced to 4.5 days; P<0.001). For the cohort of GBM patients that went on to have chemoradiotherapy we improved median survival to 18 months, with 35% of patients alive at two years, comparable to international outcomes. Implementing a specialist neurosurgical oncology service begins with understanding the patient care pathway. Our patients have benefitted from the culture of subspecialisation and the excellent inter-disciplinary working relationships that have been developed.

  16. Basic Principles in Oncology

    NASA Astrophysics Data System (ADS)

    Vogl, Thomas J.

    The evolving field of interventional oncology can only be considered as a small integrative part in the complex area of oncology. The new field of interventional oncology needs a standardization of the procedures, the terminology, and criteria to facilitate the effective communication of ideas and appropriate comparison between treatments and new integrative technology. In principle, ablative therapy is a part of locoregional oncological therapy and is defined either as chemical ablation using ethanol or acetic acid, or thermotherapies such as radiofrequency, laser, microwave, and cryoablation. All these new evolving therapies have to be exactly evaluated and an adequate terminology has to be used to define imaging findings and pathology. All the different technologies and evaluated therapies have to be compared, and the results have to be analyzed in order to improve the patient outcome.

  17. Relationship between outpatients' perceptions of physicians' communication styles and patients' anxiety levels in a Japanese oncology setting.

    PubMed

    Takayama, T; Yamazaki, Y; Katsumata, N

    2001-11-01

    For life-threatening illnesses such as cancer that require a long-term treatment regimen, communication is particularly important between doctors and patients. While it is assumed that the more serious the illness, the greater the need to relieve patients' anxiety, physicians' communication styles can directly influence patients' anxiety levels. The purpose of this study was to examine the relationship between outpatients' perceptions of physicians' communication styles and the patients' anxiety levels in oncology settings. Patient anxiety level was measured using the State Trait Anxiety Inventory before and after the consultation. The Perceived Physician's Communication Style Scale was developed in this study. Analysis of responses to the scale resulted in four factors--"acceptive", "patient-centered", "attentive", and "facilitative"--of the physician's communication style and explained 63.7% of the variance. The inter-correlation for overall scale items was 0.95. Patient satisfaction with the medical encounter was also measured to validate the physician's communication style scale. Moderate correlation between the physician's communication style and satisfaction was observed and confirms the relationship between a favorable communication style and a patient's satisfaction. After the consultation, the patients' anxiety levels dropped 5.0 +/- 1.5 points (p<0.001), and the physician's communication style was shown in many cases to be linked to patient anxiety levels after the consultation. The effect of the physician's communication style on patients' post-consultation anxiety levels was small among the patients with an advanced disease status. Also, the findings showed that patients' post-consultation anxiety levels remained low even among those patients with unfavorable examination results if the patients evaluated their physician's communication style as high. This study suggested that the physician's communication style is important not only for moderating patients' anxiety, but could also be helpful for moderating physicians' own stress levels when communicating bad news to patients. PMID:11676404

  18. Differences in demographic, clinical, and symptom characteristics and quality of life outcomes among oncology patients with different types of pain.

    PubMed

    Posternak, Victoria; Dunn, Laura B; Dhruva, Anand; Paul, Steven M; Luce, Judith; Mastick, Judy; Levine, Jon D; Aouizerat, Bradley E; Hammer, Marylin; Wright, Fay; Miaskowski, Christine

    2016-04-01

    The purposes of this study, in oncology outpatients receiving chemotherapy (n = 926), were to: describe the occurrence of different types of pain (ie, no pain, only noncancer pain [NCP], only cancer pain [CP], or both CP and NCP) and evaluate for differences in demographic, clinical, and symptom characteristics, and quality of life (QOL) among the 4 groups. Patients completed self-report questionnaires on demographic and symptom characteristics and QOL. Patients who had pain were asked to indicate if it was or was not related to their cancer or its treatment. Medical records were reviewed for information on cancer and its treatments. In this study, 72.5% of the patients reported pain. Of the 671 who reported pain, 21.5% reported only NCP, 37.0% only CP, and 41.5% both CP and NCP. Across the 3 pain groups, worst pain scores were in the moderate to severe range. Compared with the no pain group, patients with both CP and NCP were significantly younger, more likely to be female, have a higher level of comorbidity, and a poorer functional status. In addition, these patients reported: higher levels of depression, anxiety, fatigue, and sleep disturbance; lower levels of energy and attentional function; and poorer QOL. Patients with only NCP were significantly older than the other 3 groups. The most common comorbidities in the NCP group were back pain, hypertension, osteoarthritis, and depression. Unrelieved CP and NCP continue to be significant problems. Oncology outpatients need to be assessed for both CP and NCP conditions. PMID:26683234

  19. Could Harmonic Scalpel (Ultracision®) be considered the best device in surgical treatment of vulvar cancer of patients with implanted pace-maker? Proposal and rationale

    PubMed Central

    Gizzo, Salvatore; Andrisani, Alessandra; Ancona, Emanuele; Quaranta, Michela; Vitagliano, Amerigo; Noventa, Marco; Nardelli, Giovanni Battista; Ambrosini, Guido

    2015-01-01

    Vulvar cancer (VC) represents about 4% of gynecologic malignancies, its incidence increases with age and peak incidence is found between 70-79 years. In cases of locally advanced disease surgery is often required and radical vulvectomy, with or without mono-bilateral inguino-femoral lymphadenectomy, is standard management. Various devices have been implemented in gynecological surgery in an attempt to minimize or avoid frequent intra/postoperative complications linked to energy use, unfortunately the majority of these devices require monopolar or bipolar energy. Ultracision® represents a unique surgical device capable of performing both cutting and coagulation at different intensities without use of electric energy. The use of Ultracision® in the radical treatment of VC has advantages both in terms of intraoperative and postoperative complications responsible for the reduction of surgical time and blood loss, complete tissue removal according to oncological criteria, diminished desensitization of peripheral areas and reduction of wound complications. These advantages have been widely demonstrated and contribute to making Ultracision® a cost-effective option in the routine treatment of patients affected by vulvar cancer especially when considering its safety in cardiopathic patients with implanted pacemaker. If the impressive results achieved in radical vulvar surgery will be confirmed, scalpel use could be proposed as routine for surgery of the routinely in surgical approach of vulvar and perineal area, in both benign and malignant disease. PMID:26309660

  20. Impact of the difference in surgical site on the physique in gastrointestinal tract cancer patients.

    PubMed

    Hara, Tsuyoshi; Kubo, Akira; Kogure, Eisuke; Ishii, Takaya

    2016-01-01

    [Purpose] The purpose of the present study was to observe physical function, physique (only BMI), and nutrition status (evaluated by serum albumin levels) from before surgery to after discharge among perioperative patients with gastrointestinal tract cancer and to examine the effect of difference in surgical site (i.e., stomach, colon, and rectum) in these patients. [Subjects and Methods] The study subjects were 70 patients who underwent surgical treatment for gastrointestinal tract cancer [36 males and 34 females, aged 59.3 ± 11.4 years (mean ± SD)]. The subjects were classified into three levels according to surgical site (stomach, colon, and rectum). We evaluated patients' physical function, physique, and nutrition status in the three points: before surgery, after surgery, and after discharge. The 6-minute walk distance was measured for physical function. Body mass index was measured for physique. The serum albumin level was measured for nutrition status. [Results] Significant declines in 6-minute walk distance, body mass index, and serum albumin were observed after surgery among the study subjects. In addition, a significant decline in body mass index was observed after discharge compared with before surgery. Regarding body mass index, a significant interaction between surgical site and evaluation times was observed for ANOVA. [Conclusion] These results suggest that BMI after discharge is significantly less than that before surgery and that body mass index changes from before surgery to after surgery are efficacy the difference of surgical site in patients who undergo surgical treatment for gastrointestinal tract cancer. PMID:26957730

  1. Facial aesthetic surgical goals in patients of different cultures.

    PubMed

    Rowe-Jones, Julian M

    2014-08-01

    The purpose of facial aesthetic surgery is to improve the patient's psychological well-being. To achieve this, the surgeon must understand the patient's body image and their aesthetic and psychological expectations. These factors must be judged in the context of their cultural background. The patient's cultural values must also be understood to optimize the doctor-patient relationship. PMID:25049120

  2. Rare multiple primary malignancies among surgical patients—a single surgical unit experience

    PubMed Central

    Carlomagno, Nicola; Santangelo, Michele L; Mastromarino, Rossella; Calogero, Armando; Dodaro, Concetta; Renda, Andrea

    2014-01-01

    Background A remarkable number of patients presents with multiple primary malignancies (MPM) over their lifetimes. In most cases inherited syndromes, iatrogenic, or viral factors are implicated, while in some cases it is not possible to ascertain a clear aetiopathogenesis. Methods Starting from a series of 315 patients with MPM, we focused our attention on those with extremely infrequent combinations of tumours. We retrospectively analysed patients’ characteristics, type of first and second tumour and the interval between the two tumours. We made a comparison between our own data and data from surveillance, epidemiology, and end results cancer registries, the largest global series on this topic. Results Six patients presented with unusual associations, namely, central nervous system (CNS)/colon, testis/stomach, colon/CNS, CNS/kidney, uterus/soft tissue, and bone/breast. The median age was 50.5 years at the diagnosis of second neoplasm and the male:female ratio was 1:1. All six patients underwent surgery for both tumours. The median interval between the first and the second tumour was 11.3 years (range 1–36 years). Five patients were given chemotherapy as adjuvant systemic treatment, and two of them with CNS tumours also received radiotherapy. Discussion We analysed the behaviour of these rare tumours as first and second neoplasms. More frequent combinations and possible aetiological factors were evaluated. Conclusions Follow-up for patients recovering from a first tumour must be strict, as there is the risk of developing MPM, even after a long time period. Advancement in biomolecular knowledge and cooperation among different specialists are strongly needed to reduce mortality related to MPM and to foresee their occurrence. PMID:24966890

  3. Different Clinical Utility of Oropharyngeal Bacterial Screening prior to Percutaneous Endoscopic Gastrostomy in Oncological and Neurological Patients

    PubMed Central

    Dastych, Milan; Senkyrik, Michal; Pavlik, Tomas; Prokesova, Jitka; Jecmenova, Marketa; Dolina, Jiri; Hep, Ales

    2014-01-01

    Background. The aim of this study was to monitor oropharyngeal bacterial colonization in patients indicated for percutaneous endoscopic gastronomy (PEG). Methods. Oropharyngeal swabs were obtained from patients prior to PEG placement. A development of peristomal infection was evaluated. The analysis of oropharyngeal and peristomal site pathogens was done. Results. Consecutive 274 patients referred for PEG due to neurological disorder or cancer completed the study. Oropharyngeal colonization with pathogens was observed in 69% (190/274), dominantly in the neurologic subgroup of patients (P < 0.001). Peristomal infection occurred in 30 (10.9%) of patients and in 57% of them the correlation between oropharyngeal and peristomal agents was present. The presence of oropharyngeal pathogens was assessed as an important risk factor for the development of peristomal infection only in oncological patients (OR = 8.33, 95% CI: 1.66–41.76). Despite a high prevalence of pathogens in neurological patients, it did not influence the risk of peristomal infection with the exception for methicillin resistant Staphylococcus aureus (MRSA) carriers (OR 4.5, 95% CI: 1.08–18.76). Conclusion. During oropharyngeal microbial screening prior to the PEG insertion, the detection of pathogens may be a marker of the increased risk of peristomal infection in cancer patients only. In neurological patients the benefit of the screening is limited to the detection of MRSA carriers. PMID:25243153

  4. Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice

    PubMed Central

    Hofstede, Stefanie N.; Marang-van de Mheen, Perla J.; Vliet Vlieland, Thea P. M.; van den Ende, Cornelia H. M.; Nelissen, Rob G. H. H.; van Bodegom-Vos, Leti

    2016-01-01

    Introduction International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. Materials and Methods We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. Results Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included “People in my environment had positive experiences with a surgery” (facilitator for education about OA), and “Advice of people in my environment to keep on moving” (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were “Lack of knowledge about guideline” (barrier for lifestyle advice), “Agreements/ deliberations with primary care” and “Easy communication with a dietician” (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. Conclusions Strategies to improve non-surgical treatment use in orthopaedic practice should be targeted at changing the beliefs of orthopedic surgeons, communication with other OA care providers and involving patient’s environment in OA treatment. PMID:26799974

  5. Functional evaluation of patients with surgically treated terrible triad of the elbow

    PubMed Central

    Brigato, Rafael Mulatti; Mouraria, Guilherme Grisi; Kikuta, Fernando Kenji; Coelho, Sérgio de Paula; Cruz, Márcio Alves; Zoppi, Américo

    2015-01-01

    OBJECTIVES: To evaluate the functional outcome of patients with surgically treated terrible triad of the elbow. METHODS: A retrospective evaluation was performed using the MEPS score (Mayo Elbow Performance Score) of patients diagnosed with terrible triad of the elbow who underwent surgical treatment. RESULTS: 14 patients (nine men and five women) and 15 elbows (one bilateral case) were evaluated. A MEPS average score of 78 points and 86% good and excellent results was obtained. As complications, we had one case of infection and three of neuropraxia of the ulnar nerve. CONCLUSION: The patients had stable elbow with good function, however with reduced range of motion. Level of Evidence IV, Case Series. PMID:26207090

  6. Surgical management of osteonecrosis of the femoral head in patients with sickle cell disease

    PubMed Central

    Kamath, Atul F; McGraw, Michael H; Israelite, Craig L

    2015-01-01

    Sickle cell disease is a known risk factor for osteonecrosis of the hip. Necrosis within the femoral head may cause severe pain, functional limitations, and compromise quality of life in this patient population. Early stages of avascular necrosis of the hip may be managed surgically with core decompression with or without autologous bone grafting. Total hip arthroplasty is the mainstay of treatment of advanced stages of the disease in patients who have intractable pain and are medically fit to undergo the procedure. The management of hip pathology in sickle cell disease presents numerous medical and surgical challenges, and the careful perioperative management of patients is mandatory. Although there is an increased risk of medical and surgical complications in patients with sickle cell disease, total hip arthroplasty can provide substantial relief of pain and improvement of function in the appropriately selected patient. PMID:26601059

  7. Right-to-try laws and individual patient "compassionate use" of experimental oncology medications: A call for improved provider-patient communication.

    PubMed

    Hoerger, Michael

    2016-02-01

    The U.S. Food and Drug Administration's Expanded Access program allows patients with life-threatening diagnoses, such as advanced cancer, to use experimental medications without participating in clinical research (colloquially, "Compassionate Use"). Sixteen U.S. states recently passed "right-to-try" legislation aimed at promoting Expanded Access. Acknowledging popular support, Expanded Access could undermine clinical trials that benefit public health. Moreover, existing norms in oncologic care, for example, often lead patients to pursue intense treatments near the end of life, at the expense of palliation, and improved communication about the risks and benefits of Expanded Access would more often discourage its use. PMID:26313583

  8. Pretreatment factors significantly influence quality of life in cancer patients: A Radiation Therapy Oncology Group (RTOG) analysis

    SciTech Connect

    Movsas, Benjamin . E-mail: bmovsas1@hfhs.org; Scott, Charles; Watkins-Bruner, Deborah

    2006-07-01

    Purpose The purpose of this analysis was to assess the impact of pretreatment factors on quality of life (QOL) in cancer patients. Methods and Materials Pretreatment QOL (via Functional Assessment of Cancer Therapy [FACT], version 2) was obtained in 1,428 patients in several prospective Radiation Therapy Oncology Group (RTOG) trials including nonmetastatic head-and-neck (n = 1139), esophageal (n = 174), lung (n = 51), rectal (n = 47), and prostate (n = 17) cancer patients. Clinically meaningful differences between groups were defined as a difference of 1 standard error of measurement (SEM). Results The mean FACT score for all patients was 86 (20.7-112) with SEM of 5.3. Statistically significant differences in QOL were observed based on age, race, Karnofsky Performance Status, marital status, education level, income level, and employment status, but not by gender or primary site. Using the SEM, there were clinically meaningful differences between patients {<=}50 years vs. {>=}65 years. Hispanics had worse QOL than whites. FACT increased linearly with higher Karnofsky Performance Status and income levels. Married patients (or live-in relationships) had a better QOL than single, divorced, or widowed patients. College graduates had better QOL than those with less education. Conclusion Most pretreatment factors meaningfully influenced baseline QOL. The potentially devastating impact of a cancer diagnosis, particularly in young and minority patients, must be addressed.

  9. Use of Disinfection Cap to Reduce Central-Line-Associated Bloodstream Infection and Blood Culture Contamination Among Hematology-Oncology Patients.

    PubMed

    Kamboj, Mini; Blair, Rachel; Bell, Natalie; Son, Crystal; Huang, Yao-Ting; Dowling, Mary; Lipitz-Snyderman, Allison; Eagan, Janet; Sepkowitz, Kent

    2015-12-01

    OBJECTIVE In this study, we examined the impact of routine use of a passive disinfection cap for catheter hub decontamination in hematology-oncology patients. SETTING A tertiary care cancer center in New York City METHODS In this multiphase prospective study, we used 2 preintervention phases (P1 and P2) to establish surveillance and baseline rates followed by sequential introduction of disinfection caps on high-risk units (HRUs: hematologic malignancy wards, hematopoietic stem cell transplant units and intensive care units) (P3) and general oncology units (P4). Unit-specific and hospital-wide hospital-acquired central-line-associated bloodstream infection (HA-CLABSI) rates and blood culture contamination (BCC) with coagulase negative staphylococci (CONS) were measured. RESULTS Implementation of a passive disinfection cap resulted in a 34% decrease in hospital-wide HA-CLABSI rates (combined P1 and P2 baseline rate of 2.66-1.75 per 1,000 catheter days at the end of the study period). This reduction occurred only among high-risk patients and not among general oncology patients. In addition, the use of the passive disinfection cap resulted in decreases of 63% (HRUs) and 51% (general oncology units) in blood culture contamination, with an estimated reduction of 242 BCCs with CONS. The reductions in HA-CLABSI and BCC correspond to an estimated annual savings of $3.2 million in direct medical costs. CONCLUSION Routine use of disinfection caps is associated with decreased HA-CLABSI rates among high-risk hematology oncology patients and a reduction in blood culture contamination among all oncology patients. Infect. Control Hosp. Epidemiol. 2015;36(12):1401-1408. PMID:26394849

  10. Impact of the difference in surgical site on the physique in gastrointestinal tract cancer patients

    PubMed Central

    Hara, Tsuyoshi; Kubo, Akira; Kogure, Eisuke; Ishii, Takaya

    2016-01-01

    [Purpose] The purpose of the present study was to observe physical function, physique (only BMI), and nutrition status (evaluated by serum albumin levels) from before surgery to after discharge among perioperative patients with gastrointestinal tract cancer and to examine the effect of difference in surgical site (i.e., stomach, colon, and rectum) in these patients. [Subjects and Methods] The study subjects were 70 patients who underwent surgical treatment for gastrointestinal tract cancer [36 males and 34 females, aged 59.3 ± 11.4 years (mean ± SD)]. The subjects were classified into three levels according to surgical site (stomach, colon, and rectum). We evaluated patients’ physical function, physique, and nutrition status in the three points: before surgery, after surgery, and after discharge. The 6-minute walk distance was measured for physical function. Body mass index was measured for physique. The serum albumin level was measured for nutrition status. [Results] Significant declines in 6-minute walk distance, body mass index, and serum albumin were observed after surgery among the study subjects. In addition, a significant decline in body mass index was observed after discharge compared with before surgery. Regarding body mass index, a significant interaction between surgical site and evaluation times was observed for ANOVA. [Conclusion] These results suggest that BMI after discharge is significantly less than that before surgery and that body mass index changes from before surgery to after surgery are efficacy the difference of surgical site in patients who undergo surgical treatment for gastrointestinal tract cancer.

  11. Investigational tests and treatments performed in terminal stage cancer patients in two weeks before death: Turkish oncology group (TOG) study.

    PubMed

    Türker, ?brahim; Kömürcü, ?eref; Ar?can, Ali; Doruk, Hatice; Özy?lkan, Özgür; Co?kun, Hasan ?enol; Colak, Dil?en; Üçgül Çavu?o?lu, Emel; Ata, Alper; Sezer, Ahmet; Ye?il Ç?nk?r, Havva; ?enler, Filiz Cay; Arpac?, Fikret

    2014-12-01

    Although more palliative care is necessary for terminally ill cancer patients, excess investigational tests, invasive procedures, and treatments are given instead. Between November 2009 and December 2013, six hundred and twenty-four patients with end-stage cancer who were died at inpatient setting evaluated retrospectively. Patients' characteristics, sites of tumor and metastasis, tests and invasive procedures, treatments performed in the last 2 weeks before death were collected from the hospital files and analyzed. Median age of 624 patients was 58 (range 16-96) years. More than half of the patients (370, 59.3%) were men. The most frequent cancer sites were gastrointestinal (GI) system (32.2%), lung (24.0%), and breast (11.1%). Frequent metastatic sites were liver (34.8%), bone (31.5%), lung (23.3%), and/or brain (16.9%). Causes of death were respiratory failure, infections, and/or liver failure in 49.9, 23.9, and 19.4% of patients, respectively. Radiological tests performed in the last 2 weeks before death were ultrasonography, computed tomography, magnetic resonance imaging, bone scan in 25.6, 16.3, 11.4, and 3.8% of patients, respectively. Treatments received were intravenous (i.v) serum infusion, blood transfusion, total parenteral nutrition (TPN), human albumin infusion in 55.9, 44.1, 34.9, and 9.5% of patients, respectively. Invasive procedures such as invasive pain relief, terminal sedation, and chemotherapy performed in 12.6, 4.4, and 10.0% of patients, respectively. Central venous catheter application, paracentesis, thoracentesis, and GI endoscopy were applied in 41.7, 9.8, 5.6, and 3.4% of the patients, respectively. Radiological tests, invasive procedures, TPN, and human albumin transfusion were used excessively in terminal stage cancer patients in our medical oncology inpatient clinics. Invasive pain relief and terminal sedation were still underused in our cancer clinics. There is an urgent need in developing national palliative care program to improve the understanding of end-of-life care in our medical oncology clinics. PMID:25412940

  12. Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients

    PubMed Central

    2014-01-01

    Background Patients undergoing emergency surgery have a high risk for surgical complications and death. The Clavien-Dindo classification has been developed and validated in elective general surgical patients, but has not been validated in emergency surgical patients. The aim of the current study was to evaluate the Clavien-Dindo classification of surgical complications in emergency surgical patients and to study preoperative factors for risk stratification that should be included into a database of surgical complications. Methods A cohort of 444 consecutive patients having emergency general surgery during a three-month period was retrospectively analyzed. Surgical complications were classified according to the Clavien-Dindo classification. Preoperative risk factors for complications were studied using logistic regression analysis. Results Preoperatively 37 (8.3%) patients had organ dysfunctions. Emergency surgical patients required a new definition for Grade IV complications (organ dysfunctions). Only new onset organ dysfunctions or complications that significantly contributed to worsening of pre-operative organ dysfunctions were classified as grade IV complications. Postoperative complications developed in 115 (25.9%) patients, and 14 (3.2%) patients developed grade IV complication. Charlson comorbidity index, preoperative organ dysfunction and the type of surgery predicted postoperative complications. Conclusions The Clavien-Dindo classification of surgical complications can be used in emergency surgical patients but preoperative organ dysfunctions should be taken into account when defining postoperative grade IV complications. For risk stratification patients’ comorbidities, preoperative organ dysfunctions and the type of surgery should be taken into consideration. PMID:25075222

  13. Impact of total activity variation in 18F-FDG injected with the overall PET image quality in oncology patients

    NASA Astrophysics Data System (ADS)

    Hishar, H.; Fathinul Fikri, A. S.; Salasiah, M.; Noramaliza, M. N.; Abdul Jalil, N.

    2013-05-01

    The preliminary study aims to investigate whether variation on dose activity 18F-FDG will influence the overall PET image quality in oncology patients. This is a retrospective analysis of 10 oncology patients who were injected with an average of 337.40 ± 38.43 MBq of 18F-FDG for PET/CT whole body examination. Patients were divided into 2 groups based on total activity of 18F-FDG injected: less than 333 MBq (302.96±12.65 MBq) (group 1) and more than 333 MBq (371.85±14.00 MBq) (group 2). Multiple Image Projection (MIP) PET images were scored visually by two qualified nuclear radiologists using a two-point scoring scale (poor and excellent). The agreement between radiologists was analysed using kappa measure of agreement (K). The prediction on poor-to-excellent PET image by the total activity of 18F-FDG injected was analysed using a Chi-squared test (x2). A p value of < 0.05 was considered significant. Agreement on PET image scoring was substantial, with a kappa value of 0.737. However, the prediction of the PET image quality by the total activity injected has been found to be insignificant (p > 0.05). Therefore, there is no strong evidence suggest that the dose injected will influence the PET image quality. Hence, it is recommended to use low-dosed of 18F-FDG technique as it also potentially yields a comparable PET image and reduces radiation burden to the patients.

  14. DISPARITIES IN PEDIATRIC ONCOLOGY PATIENT EDUCATION AND LINGUISTIC RESOURCES: RESULTS OF A NATIONAL SURVEY OF PEDIATRIC ONCOLOGISTS

    PubMed Central

    Slone, Jeremy S; Self, Elizabeth; Friedman, Debra; Heiman, Harry

    2013-01-01

    Background Extensive patient and family education is required at the time of a new diagnosis of pediatric cancer yet ittle data exist regarding the availability and linguistic competency of new cancer diagnosis education provided by pediatric oncology institutions. Procedure Using the American Society of Pediatric Hematology/Oncology (ASPHO) membership list, a web-based survey was conducted among a cohort of pediatric oncologists to determine pediatric oncologists’ assessment of institutional resources for new cancer diagnosis education and the availability of linguistically appropriate education. Results Of 1,294 ASPHO members sent email survey invitations, 573 (44.3%) responded with 429 meeting eligibility criteria. Oncologists at academic institutions reported their institutions had more availability of resources for new diagnosis education compared with those from non-academic institutions (Mean 78.6 vs. 74.3; 0 [not at all] – 100 [well equipped]; p=0.05). The mean score increased with volume of new cancer diagnoses/year: small (<75) = 73.4; medium (75 – 149) = 76.7; large (≥ 150) = 84.5 (p <0.001). Oncologists at large volume institutions reported more availability of an established patient education protocol (50.8% vs. 38.1%, p <0.001) and increased use of dedicated non-physician staff (79.9% vs. 66.1%, p=0.02), but less use of websites for patient education (17.2% vs. 33.3%, p=0.001). Availability of linguistically appropriate education improved with increasing institution size: small (76.4), medium (82.3) and large (84.0) patient volume (p <0.011). Conclusion According to pediatric oncologists, a disparity in educational and linguistic resources for new pediatric cancer diagnosis education exists depending on institution type and size. PMID:24167088

  15. Surgical robotics for patient safety in the perioperative environment: realizing the promise.

    PubMed

    Fuji Lai; Louw, Deon

    2007-06-01

    Surgery is at a crossroads of complexity. However, there is a potential path toward patient safety. One such course is to leverage computer and robotic assist techniques in the reduction and interception of error in the perioperative environment. This white paper attempts to facilitate the road toward realizing that promise by outlining a research agenda. The paper will briefly review the current status of surgical robotics and summarize any conclusions that can be reached to date based on existing research. It will then lay out a roadmap for future research to determine how surgical robots should be optimally designed and integrated into the perioperative workflow and process. Successful movement down this path would involve focused efforts and multiagency collaboration to address the research priorities outlined, thereby realizing the full potential of surgical robotics to augment human capabilities, enhance task performance, extend the reach of surgical care, improve health care quality, and ultimately enhance patient safety. PMID:17558011

  16. Unusual case of a surgically treated ACL tear in a 4-year-old patient.

    PubMed

    Astur, Diego Costa; Castro, Saulo; Bernardes, Adilio; Cohen, Moises

    2015-01-01

    Anterior cruciate ligament injury in children is an increasingly common disease. We report a rare case of surgical treatment of a 4-year-old patient who presented with an anterior cruciate ligament tear after a high-energy trauma followed by chronic spontaneous subluxation during knee flexion and extension. An extra-articular ligamental reconstruction technique was performed and the child is clinically well 4?years after surgery. Historically, non-surgical treatment has been the main treatment option, however, the indication for surgical reconstruction is increasing as we better understand the histological characteristics of the immature skeleton. PMID:26346958

  17. Patterns of Care in Elderly Head-and-Neck Cancer Radiation Oncology Patients: A Single-Center Cohort Study

    SciTech Connect

    Huang Shaohui; O'Sullivan, Brian; Waldron, John; Lockwood, Gina; Bayley, Andrew; Kim, John; Cummings, Bernard; Dawson, Laura A.; Hope, Andrew; Cho, John; Witterick, Ian; Chen, Eric X.; Ringash, Jolie

    2011-01-01

    Purpose: To compare the patterns of care for elderly head-and-neck cancer patients with those of younger patients. Methods and Materials: A retrospective review was conducted of all new mucosal head-and-neck cancer referrals to radiation oncology between July 1, 2003 and December 31, 2007 at our institution. The clinical characteristics, treatment pattern, tolerance, and outcomes were compared between the elderly (aged {>=}75 years) and younger (aged <75 years) cohorts. Results: A total of 2,312 patients, including 452 (20%) elderly and 1,860 (80%) younger patients, were studied. The elderly patients were more likely to be women (36% vs. 27%, p <.01) and to have other malignancies (23% vs. 13%, p <.01), Stage I or II disease (38% vs. 32%, p <.01), and N0 status (56% vs. 42%, p <.01). Treatment was less often curative in intent (79% vs. 93%, p <.01). For the 1,487 patients who received definitive radiotherapy (RT), no differences were found between the elderly (n = 238) and younger (n = 1,249) patients in treatment interruption, completion, or treatment-related death. Within the subset of 760 patients who received intensified treatment (concurrent chemoradiotherapy or hyperfractionated accelerated RT), no difference was seen between the elderly (n = 46) and younger (n = 714) patients in treatment interruption, completion, or treatment-related death. After a median follow-up of 2.5 years, the 2-year cause-specific survival rate after definitive RT was 72% (range, 65-78%) for the elderly vs. 86% (range, 84-88%) for the younger patients (p <.01). Conclusion: Elderly head-and-neck cancer patients exhibited different clinical characteristics and experienced different patterns of care from younger patients. Although age itself was an adverse predictor of cause-specific survival, its effect was modest. Elderly patients selected for definitive RT or intensified RT showed no evidence of impaired treatment tolerance.

  18. Patient-specific mathematical neuro-oncology: using a simple proliferation and invasion tumor model to inform clinical practice.

    PubMed

    Jackson, Pamela R; Juliano, Joseph; Hawkins-Daarud, Andrea; Rockne, Russell C; Swanson, Kristin R

    2015-05-01

    Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor associated with a poor median survival of 15-18 months, yet there is wide heterogeneity across and within patients. This heterogeneity has been the source of significant clinical challenges facing patients with GBM and has hampered the drive toward more precision or personalized medicine approaches to treating these challenging tumors. Over the last two decades, the field of Mathematical Neuro-oncology has grown out of desire to use (often patient-specific) mathematical modeling to better treat GBMs. Here, we will focus on a series of clinically relevant results using patient-specific mathematical modeling. The core model at the center of these results incorporates two hallmark features of GBM, proliferation [Formula: see text] and invasion (D), as key parameters. Based on routinely obtained magnetic resonance images, each patient's tumor can be characterized using these two parameters. The Proliferation-Invasion (PI) model uses [Formula: see text] and D to create patient-specific growth predictions. The PI model, its predictions, and parameters have been used in a number of ways to derive biological insight. Beyond predicting growth, the PI model has been utilized to identify patients who benefit from different surgery strategies, to prognosticate response to radiation therapy, to develop a treatment response metric, and to connect clinical imaging features and genetic information. Demonstration of the PI model's clinical relevance supports the growing role for it and other mathematical models in routine clinical practice. PMID:25795318

  19. Surgical treatment of giant cardiac aneurysm with pseudoaneurysm in a colon carcinoma patient

    PubMed Central

    Al?alaldeh, Mohammad; K?l?ç, Ismail Do?u; Emrecan, Bilgin

    2015-01-01

    Left ventricular pseudoaneurysm is a rare and lethal condition associated with a high risk of rapid enlargement and rupture. It develops after transmural myocardial infarction (MI), cardiac surgery, trauma, or infection. When a left ventricular pseudoaneurysm is detected, surgical repair is recommended due to the high possibility of rupture. In this report, we present surgical treatment of a giant cardiac pseudoaneurysm that occurred after MI in a colon carcinoma patient. PMID:26336500

  20. Clinical Oncology Assistantship Program for Medical Students.

    ERIC Educational Resources Information Center

    Neilan, Barbara A.; And Others

    1985-01-01

    The Clinical Oncology Assistantship Program at the University of Arkansas for Medical Sciences is described, along with student reactions to the program. The summer elective program involves cancer lectures (one week) and clinical exposure (nine weeks) in medical, surgical, and pediatric oncology services, as well as self-directed learning…

  1. Clinical Oncology Assistantship Program for Medical Students.

    ERIC Educational Resources Information Center

    Neilan, Barbara A.; And Others

    1985-01-01

    The Clinical Oncology Assistantship Program at the University of Arkansas for Medical Sciences is described, along with student reactions to the program. The summer elective program involves cancer lectures (one week) and clinical exposure (nine weeks) in medical, surgical, and pediatric oncology services, as well as self-directed learning…

  2. VAC therapy for wound management in patients with contraindications to surgical treatment.

    PubMed

    Negosanti, Luca; Sgarzani, Rossella; Nejad, Parissa; Pinto, Valentina; Tavaniello, Beatrice; Palo, Stefano; Oranges, Carlo Maria; Fabbri, Erich; Michelina, Veronica Vietti; Zannetti, Guido; Morselli, Paolo Giovanni; Cipriani, Riccardo

    2012-01-01

    The treatment of complex wounds often requires multiple surgical debridement and eventually reconstruction with skin grafts or flaps, under local or general anesthesia. When the patient's general conditions contraindicate surgical procedures, topical negative pressure with vacuum assisted closure (VAC)) device can achieve wound healing with reduction of healing time and simpler management. We treated with VAC device four patients with complex wounds and important contraindications to surgery. In all the patients, we used VAC device with common protocol of topical negative pressure. The healing was obtained in a period variable between 18 and 40 days; the results were satisfactory in three cases, one patient developed an aesthetically unpleasant scar. We present our experience to propose VAC when surgical procedures are contraindicated. PMID:22913447

  3. One more brick in the wall of protective ventilation in surgical patients

    PubMed Central

    Filho, Roberto Rabello

    2015-01-01

    On June 14, 2015, Ladha and colleagues published an article in the BMJ entitled “Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study”, which investigated the effects of intraoperative protective ventilation on major postoperative respiratory complications. This study used data of over 69,265 patients in order to investigate patients over the age of 18 who underwent a non-cardiac surgical procedure between January 2007 and August 2014 and required general anesthesia with endotracheal intubation. The investigators found that intraoperative protective ventilation was associated with a decreased risk of postoperative respiratory complications. This study raises important questions about the ventilatory management of surgical patients. PMID:26734648

  4. Promoting sleep in the adult surgical intensive care unit patients to prevent delirium.

    PubMed

    Hata, Rose K L; Han, Lois; Slade, Jill; Miyahira, Asa; Passion, ChristyAnne; Ghows, Maimona; Izumi, Kara; Yu, Mihae

    2014-09-01

    Ensuring adequate sleep for hospitalized patients is important for reducing stress, improving healing, and decreasing episodes of delirium. The purpose of this project was to implement a Sleep Program for stable patients in the surgical intensive care unit, thereby changing sleep management practices and ensuring quality of care using an evidence-based practice approach. Improving patient satisfaction with sleep by 28 percentage points may be attributed to a standardized process of providing a healing environment for patients to sleep. PMID:25155537

  5. Nutritional support of surgical patients with inflammatory bowel disease.

    PubMed

    Wagner, I Janelle; Rombeau, John L

    2011-08-01

    Patients with inflammatory bowel disease (IBD) in need of surgery are often malnourished, which in turn increases the risk for postoperative complications. Malnutrition in IBD patients who must undergo surgery is due to the disordered activity of the diseased intestine, decreased dietary intake, and adverse effects of potent medications. IBD operations predispose patients to both macronutrient and micronutrient deficiencies. If the gut can be used safely it is the preferential route for feeding, though preoperative and postoperative parenteral nutrition remains a viable alternative for severely malnourished patients. New nutrient therapies include immunonutrition, fish oils, and probiotics. PMID:21787968

  6. [Surgical rehabilitation in patients with zygomatic orbital fractures and orbital floor fractures].

    PubMed

    Khomutinnikova, N E; Durnovo, E A; Mishina, N V

    2013-01-01

    The study presents the results of surgical management of 65 patients with zygomatico-orbital complex and orbital floor fractures according to a self-designed technique using polymer implants Reperen. Being a method of choice the technique reduces treatment time, promotes good esthetic results, reduces complication rate, and contributes to a patient's quality life improvement. PMID:24429787

  7. [Complications and risks of abdominal diseases in old surgical patients (author's transl)].

    PubMed

    Mlynek, H J; Hartig, W; Schenker, U; Winiecki, P; Breitfeld, P; Bulling, J; Gabriel, H P; Teucher, A

    1977-01-01

    732 patients older than 70 years suffering from abdominal diseases were studied regarding postoperative complications and mortality. The rate of complications in connection with surgical procedures corresponds to that of younger patients. But complication depending on organs and organ systems impaired by age and pre-existing diseases were found in higher percentage. PMID:68638

  8. Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization?

    PubMed Central

    Guclu-Gunduz, Arzu; Bilgin, Sevil; Köse, Nezire; Oruckaptan, Hakan

    2012-01-01

    Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality: Group 1, Hunt and Hess grade ? II and surgical clipping; Group 2, Hunt and Hess grade ? II and endovascular embolization; Group 3, Hunt and Hess grade ? III and surgical clipping; Group 4, Hunt and Hess grade ? III and endovascular embolization. Level of consciousness was evaluated using the Glasgow Coma Scale, functional status using the Glasgow Outcome Scale, level of the mobility using the Mobility Scale for acute stroke patients, and independence in activities of daily living using the Barthel Index. After early physiotherapy, the level of consciousness and functional status improved significantly in Groups 1, 3, and 4; mobility improved significantly in all groups; and independence in activities of daily living improved significantly in Groups 1 and 3. At discharge, Groups 1 and 2 had better functional status than Groups 3 and 4. Level of consciousness, functional status, mobility and independence in activities of daily living improved after early physiotherapy. These findings suggest that early physiotherapy improved the prognosis of patients with cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients with a worse clinical status at presentation had a poorer functional status at discharge. The outcome of physiotherapy was not affected by whether surgical clipping or endovascular embolization was chosen for treatment of the aneurysm. PMID:25624817

  9. Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization.

    PubMed

    Guclu-Gunduz, Arzu; Bilgin, Sevil; Köse, Nezire; Oruckaptan, Hakan

    2012-08-25

    Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality: Group 1, Hunt and Hess grade ? II and surgical clipping; Group 2, Hunt and Hess grade ? II and endovascular embolization; Group 3, Hunt and Hess grade ? III and surgical clipping; Group 4, Hunt and Hess grade ? III and endovascular embolization. Level of consciousness was evaluated using the Glasgow Coma Scale, functional status using the Glasgow Outcome Scale, level of the mobility using the Mobility Scale for acute stroke patients, and independence in activities of daily living using the Barthel Index. After early physiotherapy, the level of consciousness and functional status improved significantly in Groups 1, 3, and 4; mobility improved significantly in all groups; and independence in activities of daily living improved significantly in Groups 1 and 3. At discharge, Groups 1 and 2 had better functional status than Groups 3 and 4. Level of consciousness, functional status, mobility and independence in activities of daily living improved after early physiotherapy. These findings suggest that early physiotherapy improved the prognosis of patients with cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients with a worse clinical status at presentation had a poorer functional status at discharge. The outcome of physiotherapy was not affected by whether surgical clipping or endovascular embolization was chosen for treatment of the aneurysm. PMID:25624817

  10. Patient anxiety and surgical difficulty in impacted lower third molar extractions: a prospective cohort study.

    PubMed

    Aznar-Arasa, L; Figueiredo, R; Valmaseda-Castellón, E; Gay-Escoda, C

    2014-09-01

    Encountering patients who are fearful and anxious is common in dental practice and these factors can increase the complexity of dental procedures. A prospective cohort study was performed to assess whether patient anxiety influences the difficulty of impacted lower third molar extraction and to identify other predictive factors of surgical difficulty; 102 extractions done under local anaesthesia were assessed. Several preoperative variables were recorded (demographic, anatomical, and surgical) and patient anxiety was assessed through the use of various questionnaires. Extraction difficulty was measured using the operation time (OT) and a 100-mm visual analogue scale (difficulty VAS) completed by the surgeon. Patients with deep impacted third molars that required bone removal and tooth sectioning showed higher levels of preoperative anxiety. Significant correlations were found between questionnaire scores and the surgical difficulty (OT and difficulty VAS). OT was also related to age, depth of impaction, third molar angulations, proximity of the third molar roots to the mandibular canal, hard and soft tissue coverage, and the need to perform an ostectomy and tooth sectioning. Impacted lower third molar extraction is significantly more difficult in anxious patients. Other demographic, radiological, and surgical factors were also found to be significantly related to the surgical difficulty. PMID:24837553

  11. Patient views on financial relationships between surgeons and surgical device manufacturers

    PubMed Central

    Camp, Mark W.; Gross, Allan E.; McKneally, Martin F.

    2015-01-01

    Background Over the past decade, revelations of inappropriate financial relationships between surgeons and surgical device manufacturers have challenged the presumption that surgeons can collaborate with surgical device manufacturers without damaging public trust in the surgical profession. We explored postoperative Canadian patients’ knowledge and opinions about financial relationships between surgeons and surgical device manufacturers. Methods This complex issue was explored using qualitative methods. We conducted semistructured face-to-face interviews with postoperative patients in follow-up arthroplasty clinics at an academic hospital in Toronto, Canada. Interviews were audiotaped, transcribed and analyzed. Patient-derived concepts and themes were uncovered. Results We interviewed 33 patients. Five major themes emerged: 1) many patients are unaware of the existence of financial relationships between surgeons and surgical device manufacturers; 2) patients approve of financial relationships that support innovation and research but are opposed to relationships that involve financial incentives that benefit only the surgeon and the manufacturer; 3) patients do not support disclosure of financial relationships during the consent process as it may shift focus away from the more important risks; 4) patients support oversight at the professional level but reject the idea of government involvement in oversight; and 5) patients entrust their surgeons to make appropriate patient-centred choices. Conclusion This qualitative study deepens our understanding of financial relationships between surgeons and industry. Patients support relationships with industry that provide potential benefit to current or future patients. They trust our ability to self-regulate. Disclosure combined with appropriate oversight will strengthen public trust in professional collaboration with industry. PMID:26384147

  12. Surgical mortality in patients more than 80 years of age.

    PubMed

    Khan-Kheil, A M; Khan, H N

    2016-03-01

    Introduction Patients aged >80 years account for a considerable proportion of the population admitted to hospital under general surgeons. We aimed to establish the prevalence of mortality in patients aged >80 years who underwent emergency general, vascular and urological surgery within a 13-month period at a large teaching hospital in the UK. Materials and methods A retrospective analysis was carried out of all patients aged ?80 years admitted on acute on-call emergency under general, vascular or urological surgeons. Patient demographics (including comorbidities and sex) were recorded. American Society of Anesthesiologists scores were reviewed from anaesthetic records. The outcome measure was 30-day mortality for those who had undergone emergency general, vascular or urological surgery. Results A total of 4,069 patients were admitted under general, vascular and urological surgeons during the study period. Of these patients, 521 were aged >80 years. Sixty-three patients underwent emergency surgery and 12 died <30 days after surgery (mortality = 19%). The most common procedure was laparotomy (20 cases). The most common co-morbidity was cardiac disease, which included hypertension, ischaemic heart disease, and hypercholesterolemia. A considerable proportion of patients also had malignant disease and arthritis. Conclusions The present study suggests that emergency surgery should not be denied to subjects aged >80 years based on age alone. Mortality varies according to the type of emergency procedure. Mortality was highest after laparotomy and vascular surgery whereas, for more routine procedures such as hernia repair and abscess drainage, survival was almost 100% after 30 days. PMID:26672811

  13. [Choice of surgical treatment in patients with acute destructive pancreatitis].

    PubMed

    Belik, B M; Chernov, V N; Alibekov, A Z

    2015-01-01

    Medical and diagnostic algorithm in patients with pancreatic necrosis is developed. It takes into consideration features and expansion of necrotic process in retroperitoneal space, objective severity of patients' condition according to SAPS scale and inflammatory process according to serum procalcitonin concentration. Comparative analysis revealed that the use of developed algorithm improves results of treatment. PMID:26271419

  14. Surgical management of patients with severe head injuries.

    PubMed

    Pieper, D R; Valadka, A B; Marsh, C

    1996-05-01

    Minutes can make the difference between life and death when patients with severe head injuries require surgery. Subdural, epidural, and intracerebral hematomas and cerebral contusions and gunshot wounds are the pathologic entities encountered most frequently during emergency surgery in patients with severe head injuries. Neurosurgical team members frequently use hyperventilation, mannitol and barbiturates, and sophisticated monitoring modalities to manage patients with severe head injuries during and after surgery. Although monitoring a patient's intracranial pressure (ICP) through a ventriculostomy catheter remains the most widely used gauge of cerebral metabolism, neurosurgical teams also are using fiber-optic ICP monitoring catheters, cerebral blood flow measurement probes, microdialysis catheters, jugular venous oxygen saturation catheters, and brain oxygen content measurement electrodes. Coordinated teamwork by perioperative nurses, neurosurgeons, anesthesia care providers, and emergency department staff members helps ensure the best possible outcomes for patients who require surgery for management of severe head injuries. PMID:8712808

  15. Is there a Relationship between Patient Satisfaction and Favorable Surgical Outcomes?

    PubMed Central

    Tevis, Sarah E.; Kennedy, Gregory D.; Kent, K. Craig

    2015-01-01

    Summary Satisfaction of patients with their health care is gaining importance as a measure of hospital quality due to public reporting of these values and an increasing connection between hospital reimbursement and scores on the current tool to measure satisfaction, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. We found that high hospital and surgical volume and low rates of risk-adjusted mortality are associated with high patient satisfaction. However, other favorable patient outcomes are not consistently associated with positive satisfaction scores on HCAHPS. Contributors to patients' perceptions of their care are likely multifactorial and not related just to outcomes traditionally assessed by surgeons or hospitals. Moving in a direction of patient centered care, with a focus on increased understanding and involvement of patients in the care process, will likely strengthen the relationship between surgical outcomes and patient satisfaction. PMID:26299501

  16. Identifying Health Literacy and Health System Navigation Needs Among Rural Cancer Patients: Findings from the Rural Oncology Literacy Enhancement Study (ROLES)

    PubMed Central

    Martinez-Donate, Ana P.; Halverson, Julie; Simon, Norma-Jean; Strickland, Jeanne Schaaf; Trentham-Dietz, Amy; Smith, Paul D.; Linskens, Rebecca; Wang, Xinyi

    2013-01-01

    Rural residence is associated with disparities in cancer-related outcomes. Guided by the Chronic Care Model (CCM), the Rural Oncology Literacy Enhancement Study (ROLES) assessed health literacy and patient navigation needs among rural cancer patients. A mixed methods (qualitative and quantitative) approach was used, including: in-depth interviews, health literacy assessments, and phone surveys with cancer patients (N=53) from 5 oncology clinics in rural Wisconsin; focus groups and selfadministered surveys with staff (N=41) in these clinics. Within four dimensions of the CCM (community resources, self-management support, delivery system design, and decision support), this study uncovered multiple unmet navigation needs, health literacy limitations, and barriers to quality cancer care. System-level implementation of patient navigation and health literacy best practices could contribute to improved cancer care and patient outcomes among rural populations. Further research identifying effective interventions that reduce cancer disparities among rural cancer patients is necessary. PMID:23813542

  17. Surgical Outcomes in Patients with High Spinal Instability Neoplasm Score Secondary to Spinal Giant Cell Tumors

    PubMed Central

    Elder, Benjamin D.; Sankey, Eric W.; Goodwin, C. Rory; Kosztowski, Thomas A.; Lo, Sheng-Fu L.; Bydon, Ali; Wolinsky, Jean-Paul; Gokaslan, Ziya L.; Witham, Timothy F.; Sciubba, Daniel M.

    2015-01-01

    Study Design Retrospective review. Objective To describe the surgical outcomes in patients with high preoperative Spinal Instability Neoplastic Score (SINS) secondary to spinal giant cell tumors (GCT) and evaluate the impact of en bloc versus intralesional resection and preoperative embolization on postoperative outcomes. Methods A retrospective analysis was performed on 14 patients with GCTs of the spine who underwent surgical treatment prior to the use of denosumab. A univariate analysis was performed comparing the patient demographics, perioperative characteristics, and surgical outcomes between patients who underwent en bloc marginal (n = 6) compared with those who had intralesional (n = 8) resection. Results Six patients underwent en bloc resections and eight underwent intralesional resection. Preoperative embolization was performed in eight patients. All patients were alive at last follow-up, with a mean follow-up length of 43 months. Patients who underwent en bloc resection had longer average operative times (p = 0.0251), higher rates of early (p = 0.0182) and late (p = 0.0389) complications, and a higher rate of surgical revision (p = 0.0120). There was a 25% (2/8 patients) local recurrence rate for intralesional resection and a 0% (0/6 patients) local recurrence rate for en bloc resection (p = 0.0929). Conclusions Surgical excision of spinal GCTs causing significant instability, assessed by SINS, is associated with high intraoperative blood loss despite embolization and independent of resection method. En bloc resection requires a longer operative duration and is associated with a higher risk of complications when compared with intralesional resection. However, the increased morbidity associated with en bloc resection may be justified as it may minimize the risk of local recurrence. PMID:26835198

  18. Facial Nerve Paralysis in Patients With Chronic Ear Infections: Surgical Outcomes and Radiologic Analysis

    PubMed Central

    Choi, Jin Woong

    2015-01-01

    Objectives The purpose of this study was to investigate the clinical features, radiologic findings, and treatment outcomes in patients of facial nerve paralysis with chronic ear infections. And we also aimed to evaluate for radiologic sensitivities on facial canal, labyrinth and cranial fossa dehiscences in middle ear cholesteatomas. Methods A total of 13 patients were enrolled in this study. Medical records were retrospectively reviewed for clinical features, radiologic findings, surgical findings, and recovery course. In addition, retrospective review of temporal bone computed tomography (CT) and operative records in 254 middle ear cholesteatoma patients were also performed. Results Of the 13 patients, eight had cholesteatomas in the middle ear, while two patients exhibited external auditory canal cholesteatomas. Chronic suppurative otitis media, petrous apex cholesteatoma and tuberculous otitis media were also observed in some patients. The prevalence of facial paralysis in middle ear cholesteatoma patients was 3.5%. The most common involved site of the facial nerve was the tympanic segment. Labyrinthine fistulas and destruction of cranial bases were more frequently observed in facial paralysis patients than nonfacial paralysis patients. The radiologic sensitivity for facial canal dehiscence was 91%. The surgical outcomes for facial paralysis were relatively satisfactory in all patients except in two patients who had petrous apex cholesteatoma and requiring conservative management. Conclusion Facial paralyses associated with chronic ear infections were observed in more advanced lesions and the surgical outcomes for facial paralysis were relatively satisfactory. Facial canal dehiscences can be anticipated preoperatively with high resolution CTs. PMID:26330915

  19. External Dacryocystorhinostomy: Characteristics and Surgical Outcomes in Patients with and without Previous Dacryocystitis

    PubMed Central

    Rabina, Gilad; Golan, Shani; Neudorfer, Meira; Leibovitch, Igal

    2013-01-01

    Objective. To compare pre- and postoperative characteristics and surgical success rates of patients with and without previous episodes of dacryocystitis, who underwent external dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO). Methods. The medical files of all patients who underwent external DCR between 2006 and 2011 in our institution were reviewed. The retrieved data of patients with and without previous episodes of dacryocystitis were compared. Surgical success was determined by postoperative followup of at least 6 months. Results. A total of 185 patients with NLDO underwent external DCR of whom 152 (100 females and 52 males, mean age 67 ± 15 years) met the inclusion criteria. Sixty had previous episodes of dacryocystitis and 92 did not. Left-side obstruction was more common than right-side obstruction among patients with previous episodes of dacryocystitis (48.3% versus 31.7%, resp., P = 0.031). Glaucoma patients were significantly more likely to develop dacryocystitis than patients without glaucoma (P = 0.002). The success rate of external DCR was 94.4% for patients with previous episodes of dacryocystitis and 86.7% for patients without (P = 0.337). Conclusions. The surgical outcomes of external DCR in patients with or without a previous episode of dacryocystitis were similar. Patients with glaucoma and NLDO had a significantly higher risk of developing dacryocystitis. PMID:24455195

  20. The optimal organization of gynecologic oncology services: a systematic review

    PubMed Central

    Fung-Kee-Fung, M.; Kennedy, E.B.; Biagi, J.; Colgan, T.; D’Souza, D.; Elit, L.M.; Hunter, A.; Irish, J.; McLeod, R.; Rosen, B.

    2015-01-01

    Background A system-level organizational guideline for gynecologic oncology was identified by a provincial cancer agency as a key priority based on input from stakeholders, data showing more limited availability of multidisciplinary or specialist care in lower-volume than in higher-volume hospitals in the relevant jurisdiction, and variable rates of staging for ovarian and endometrial cancer patients. Methods A systematic review assessed the relationship of the organization of gynecologic oncology services with patient survival and surgical outcomes. The electronic databases medline and embase (ovid: 1996 through 9 January 2015) were searched using terms related to gynecologic malignancies combined with organization of services, patterns of care, and various facility and physician characteristics. Outcomes of interest included overall or disease-specific survival, short-term survival, adequate staging, and degree of cytoreduction or optimal cytoreduction (or both) for ovarian cancer patients by hospital or physician type, and rate of discrepancy in initial diagnoses and intraoperative consultation between non-specialist pathologists and gyne-oncology–specialist pathologists. Results One systematic review and sixteen additional primary studies met the inclusion criteria. The evidence base as a whole was judged to be of lower quality; however, a trend toward improved outcomes with centralization of gynecologic oncology was found, particularly with respect to the gynecologic oncology care of patients with advanced-stage ovarian cancer. Conclusions Improvements in outcomes with centralization of gynecologic oncology services can be attributed to a number of factors, including access to specialist care and multidisciplinary team management. Findings of this systematic review should be used with caution because of the limitations of the evidence base; however, an expert consensus process made it possible to create recommendations for implementation. PMID:26300679

  1. [Comparative results of surgical treatment of patients with morbid obesity].

    PubMed

    Iudin, V A; Sazhin, V P; Mel'nikov, A A; Osipov, V V; Usachev, I A; Ivanov, V V; Mel'nikova, I A

    2014-01-01

    It was performed a comparative analysis of treatment of 62 patients who were operated for morbid obesity. Patients were divided into 3 groups depending on kind of surgery: jejunal-iliac intestinal bypass, restrictive operations and combined operations. The complications in early postoperative period were diagnosed in 16.6% of patients after jejunal-iliac intestinal bypass and in 10% of patients after combined operations. Regardless of the kind of surgery there was rapid reduction of the body mass in the first year of observation with gradual increase of weight by an average of 5% in the subsequent period. The highest rate of weight loss by the second year was revealed after combined operations (up to 73.4%). Thus it was 1.1 times more than after jejunal-iliac intestinal bypass and 1.3 times more than after restrictive operations. PMID:25589182

  2. Clinical-surgical treatment of temporomandibular joint disorder in a psoriatic arthritis patient

    PubMed Central

    2013-01-01

    Introduction Condylotomy is a surgical procedure that has been used as an option to treat temporomandibular disorder (TMD) patients. This technique has the advantage of avoiding intra-capsular alterations that might be found involving other surgical procedures. Its use, even when unilateral, has positive effect on treatment of both joints. Methods In order to better evaluate the benefits of a clinical-surgical treatment for TMD, the present report describes the case of a psoriatic arthritis patient. The case was clinically characterized by dental malloclusion, and imaging exams showed joint degeneration of the right mandibular condyle. The patient was treated by condylotomy technique after a prosthetic oral rehabilitation. Results No clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 16 months after surgery. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening. Conclusion The present study suggests that condylotomy can be considered as a valid option for the management of TMD, since it has low surgical morbidity and favorable clinical outcomes. In this case, the patient had a medical diagnosis of systemic disease presenting general pain and pain at the temporomandibular joint (TMJ), in addition of causal agent of TMD (dental malloclusion). The difficulty of finding a single etiology (malocclusion vs. systemic disease) did not exclude the indication of a clinical-surgical treatment to re-establish the balance of TMJ. PMID:23556553

  3. Systematic review and meta-analysis of the association between frailty and outcome in surgical patients.

    PubMed

    Oakland, K; Nadler, R; Cresswell, L; Jackson, D; Coughlin, P A

    2016-02-01

    Introduction Frailty is becoming increasingly prevalent in the elderly population although a lack of consensus regarding a clinical definition hampers comparison of clinical studies. More elderly patients are being assessed for surgical intervention but the effect of frailty on surgical related outcomes is still not clear. Methods A systematic literature search for studies prospectively reporting frailty and postoperative outcomes in patients undergoing surgical intervention was performed with data collated from a total of 12 studies. Random effects meta-analysis modelling was undertaken to estimate the association between frailty and mortality rates (in-hospital and one-year), length of hospital stay and the need for step-down care for further rehabilitation/nursing home placement. Results Frailty was associated with a higher in-hospital mortality rate (pooled odds ratio [OR]: 2.77, 95% confidence interval [CI]: 1.62-4.73), a higher one-year mortality rate (pooled OR: 1.99, 95% CI: 1.49-2.66), a longer hospital stay (pooled mean difference: 1.05 days, 95% CI: 0.02-2.07 days) and a higher discharge rate to further rehabilitation/step-down care (pooled OR: 5.71, 95% CI: 3.41-9.55). Conclusions The presence of frailty in patients undergoing surgical intervention is associated with poorer outcomes with regard to mortality and return to independence. Further in-depth studies are required to identify factors that can be optimised to reduce the burden of frailty in surgical patients. PMID:26741674

  4. Psychological modulation in patients surgically intervened for gastroesophageal reflux disease.

    PubMed

    Lara, F J Pérez; Carranque, G; Oehling, H; Hernández, J M; Oliva, H

    2014-08-01

    Gastroesophageal reflux disease (GERD) has been related with certain psychological dimensions. The influence of mood, emotional intelligence, and perceived quality of life on clinical symptoms and outcome of antireflux surgery was evaluated in GERD patients with and without hiatal hernia. The study included 61 patients who were diagnosed with GERD between 2003 and 2008: 16 of them without hiatal hernia (group A) and 45 of them with hiatal hernia (group B). All of these patients had undergone laparoscopic antireflux surgery. Patients were clinically examined and evaluated with the following instruments: Short Form (SF)-36 Health Survey, Gastrointestinal Quality of Life Index, Hospital Anxiety and Depression (HAD) Scale, and Trait Meta-Mood Scale (TMMS)-24. Proportions were compared by using the chi-squared test; averages were compared by using the Student's t-test (with Bonferroni's correction). In general, our patients intervened for GERD showed results lower than normal or close to the lower limit of normal in the administered tests. Patients in the group without hernia were younger (P < 0.001) and with lower American Society of Anaesthesiologists risk. They showed higher scores in the SF-36 dimensions: Physical Functioning, Physical Role and Emotional Role, and lower scores in the Social Role (P < 0.001). They showed lower scores in the Emotional dimension of Gastrointestinal Quality of Life Index (P = 0.0068) and worse results in the Hospital Anxiety and Depression subscales of Anxiety (P < 0.001) and Depression (not significant). Men in the group without hernia showed higher scores than men in the group with hernia in the TMMS subscales corresponding to Emotional Clarity and Emotional Repair (P < 0.001). Women in the group with hernia showed higher scores than women in the group without hernia regarding Emotional Clarity (P = 0.0012). GERD patients showed poor results in all the tests, and patients without hiatal hernia compared with patients with hernia showed higher levels of anxiety, which interfered with their social life. Moreover, they showed lower tolerance to stress and higher frustration, fear, and worry. On the basis of such unfavorable phychoemotional results observed with GERD patients (especially those without hernia) in the different tests, we propose that improving our knowledge of the psychological profile of GERD patients - particularly those without hiatal hernia - could help in designing individualized medical and psychological therapies and increase success rates. PMID:23121479

  5. Surgical management of isolated popliteus tendon injuries in paediatric patients.

    PubMed

    Liu, Joseph N; Rebolledo, Brian J; Warren, Russell F; Green, Daniel W

    2016-03-01

    Isolated popliteus avulsion injuries are a rare occurrence, especially in the skeletally immature population. Two cases of isolated popliteus tendon avulsion injuries in paediatric patients were identified and successfully managed with suture anchor reattachment of the avulsed fragment in the anatomic position. The objective of this case report is to raise awareness of orthopaedic surgeons to the rarely encountered isolated popliteus tendon injury that can occur in paediatric patients. Level of evidence Expert opinion, Level V. PMID:26856317

  6. Muscle chemistry of critically ill surgical patients and the effects of a course of intravenous nutrition.

    PubMed

    King, R F; Collins, J P; Morgan, D B; Hill, G L

    1978-07-01

    The water, electrolyte and nitrogen contents of muscle were measured in 15 critically ill surgical patients before and after a course (approximately 2 weeks) of intravenous nutrition and in 8 normal individuals. The muscle from the surgical patients contained a significantly increased ratio of water to fat-free dry weight (P less than 0.01) due to an increase in the proportion of extracellular to intracellular water, and this was not corrected by intravenous nutrition. These changes could be due to an accumulation of extracellular fluid alone or to a loss of cell cytoplasm or a loss of whole muscle fibres. Intracellular chemistry was normal in the ill surgical patients and was not changed by intravenous nutrition. PMID:96905

  7. Multimodal approach to blood conservation in the surgical patient.

    PubMed

    Nwosu, A D

    2015-01-01

    Allogeneic blood remains a scarce and expensive resource, even as the risks of disease transmission and other complications associated with blood transfusion are well known. Blood conservation, however, is a quality-of-care concept that transcends these and other known and unknown complications of transfusion, to involve a gamut of strategies meant to prevent exposure of patients to allogeneic blood. In urging a halt to incessant allogeneic blood transfusion, we report three cases to highlight the benefits of multimodal multidisciplinary collaboration in blood conservation. The three patients were chosen on account of either religious objection to any blood transfusion or the likelihood of exposure to several units of allogeneic blood. The blood conservation plan proposed for each patient was discussed with the respective surgeon and patient. Multimodal multidisciplinary approach to blood conservation utilising combination of strategies best suited for each individual patient will remarkably reduce the exposure of patients to allogeneic blood thereby ensuring better use of the scarce resource, and and preventing potential clinical complications and spiritual trespass of Jehovah's Witnesses. PMID:25772930

  8. Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

    PubMed Central

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

    2014-01-01

    Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon and careful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon’s experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon’s experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM. PMID:25114861

  9. Cultural differences in spiritual care: findings of an Israeli oncologic questionnaire examining patient interest in spiritual care

    PubMed Central

    2014-01-01

    Background As professional spiritual care (chaplaincy) is introduced to new cultures worldwide, it bears examining which elements of screening and care are universal and, for those elements showing cultural difference, to study them in each culture. No quantitative spiritual care patient study had previously been done in Israel. Our objectives were twofold: 1) to examine who wants spiritual care in Israel, including demographic and clinical variables, and to compare against other results worldwide to further develop universal screening protocols 2) to see what patients want from spiritual care specifically in the Israeli setting. Methods Self-administered patient questionnaire examining spirituality/religiosity, interest in spiritual care (subdivided by type of care), and key demographic, social, and clinical data. The study setting was an Israeli oncology center at which spiritual care had been recently introduced. Results Data from 364 oncology patient questionnaires found 41% interest in spiritual care, as compared to 35%-54% in American studies. Having previously been visited by a spiritual caregiver predicted patient interest in further spiritual care (AOR 2.4, 95% CI 1.2-4.6), suggesting that the new service is being well-received. Multivariate stepwise logistic regression analysis identified additional predictors of openness to receiving spiritual care: self-describing as somewhat/very spiritual vs. not spiritual (adjusted odds ratio [AOR] 3.9 and 6.3, 95% CI 1.8-8.6 and 2.6-15.1) or traditional/religious vs. secular (AOR 2.2 and 2.1, 95% CI 1.3-3.6 and 1.1-4.0); and receiving one visit a week or less from family and friends (AOR 5.6, 95% CI 2.1-15.1). These findings are in line with previous American studies, suggesting universality across cultures that could be utilized in screening. Differences in demographic data and medical condition were not significant predictors of patient interest, suggesting a cultural difference, where age and education were predictors in the American context. Levels of interest in explicitly religious or spiritual support such as prayer or addressing religious/spiritual questions were much lower than in other cultures. Conclusions Results illustrate the demand for and satisfaction with the new Israeli service. The cross-cultural comparison found both culture-dependent and possibly universal predictors of patient interest, and found lower interest in Israel for explicitly religious/spiritual types of support. PMID:24708816

  10. High-frequency ultrasound in carpal tunnel syndrome: assessment of patient eligibility for surgical treatment

    PubMed Central

    Urbanik, Andrzej

    2015-01-01

    Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical) are essential for optimal patient management. Aim The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment. Material and methods The study involved 62 patients (50 women and 12 men, aged 28–70, mean age 55.2) with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confirm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS. Results US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confirmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm2 (min. 12 mm2, max. 31 mm2). Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%). Increased nerve vascularity on the transverse section was present in 50 patients (80.65%). Conclusions Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy. PMID:26673415

  11. Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients.

    PubMed

    Zhan, Rucai; Li, Xueen; Li, Xingang

    2016-02-01

    Objective To assess the safety and effectiveness of the endoscopic endonasal transsphenoidal approach (EETA) for apoplectic pituitary adenoma. Design A retrospective study. Setting Qilu Hospital of Shandong University; Brain Science Research Institute, Shandong University. Participants Patients admitted to Qilu Hospital of Shandong University who were diagnosed with an apoplectic pituitary tumor and underwent EETA for resection of the tumor. Main Outcome Measures In total 45 patients were included in a retrospective chart review. Data regarding patient age, sex, presentation, lesion size, surgical procedure, extent of resection, clinical outcome, and surgical complications were obtained from the chart review. Results In total, 38 (92.7%) of 41 patients with loss of vision obtained visual remission postoperatively. In addition, 16 patients reported a secreting adenoma, and postsurgical hormonal levels were normal or decreased in 14 patients. All other symptoms, such as headache and alteration of mental status, recovered rapidly after surgery. Two patients (4.4%) incurred cerebrospinal fluid leakage. Six patients (13.3%) experienced transient diabetes insipidus (DI) postoperatively, but none of these patients developed permanent DI. Five patients (11.1%) developed hypopituitarism and were treated with replacement of hormonal medicine. No cases of meningitis, carotid artery injury, or death related to surgery were reported. Conclusion EETA offers a safe and effective surgical option for apoplectic pituitary tumors and is associated with low morbidity and mortality. PMID:26949589

  12. Access to Cancer Services for Rural Colorectal Cancer Patients

    ERIC Educational Resources Information Center

    Baldwin, Laura-Mae; Cai, Yong; Larson, Eric H.; Dobie, Sharon A.; Wright, George E.; Goodman, David C.; Matthews, Barbara; Hart, L. Gary

    2008-01-01

    Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.…

  13. Access to Cancer Services for Rural Colorectal Cancer Patients

    ERIC Educational Resources Information Center

    Baldwin, Laura-Mae; Cai, Yong; Larson, Eric H.; Dobie, Sharon A.; Wright, George E.; Goodman, David C.; Matthews, Barbara; Hart, L. Gary

    2008-01-01

    Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.…

  14. Low Paraoxonase 1 Activity Predicts Mortality in Surgical Patients with Sepsis

    PubMed Central

    Jelic-Ivanovic, Zorana; Stefanovic, Aleksandra; Palibrk, Ivan; Kalaba, Zdravko; Stojanovic, Marina; Simic-Ogrizovic, Sanja

    2014-01-01

    Introduction. State of severe oxidative stress is encountered in sepsis. Paraoxonase 1 (PON1) protects against oxidative stress but also undergoes inactivation upon that condition. We investigated PON1 activity in surgical patients with sepsis in relation to oxidative stress status, inflammation, disease severity, and survival. Methods. Prospective observational study. Sixty-nine surgical patients with sepsis were compared to 69 age/sex matched healthy controls. PON1 paraoxonase and diazoxonase activities, selected biochemical, hematological and oxidative stress parameters were measured on admission to ICU and 24, 48, 72, and 96 hours later. Disease severity scores were calculated daily. Results. Septic patients had significantly lower PON1 activities compared to control group at all time points. PON1 activities had good capacity to differentiate septic patients from healthy controls. Low PON1 activities were associated with higher disease severity scores and higher risk of death. Correlation between PON1 activity and markers of inflammation failed to reach significance. Decrease in PON1 activity was correlated with an increase in reducing components in plasma. Conclusion. Our study demonstrated lower PON1 activity in surgical patients with sepsis compared to healthy controls. PON1 activity also reflected severity of the disease. Low PON1 activity was associated with higher mortality of surgical patients with sepsis. PMID:24665146

  15. [Current Surgical Treatment for Patients with Hypoplastic Left Heart Syndrome, from the Viewpoint of Emergent Operation].

    PubMed

    Ide, Yujiro; Sakamoto, Kisaburo

    2015-07-01

    Hypoplastic left heart syndrome (HLHS) is one of the most challenging congenital heart defects which require surgical interventions during neonatal period. Since the 1st successful surgical repair was reported by Norwood et al. more than 30 years ago, some modifications in surgical maneuver [e. g. introduction of right ventricule (RV)-pulmonary artery (PA) shunt] and improvement of perioperative management have brought better outcome for this patient cohort. Recent years our institute have changed the treatment strategy from primary Norwood operation during neonatal period to bilateral PA banding and subsequent Norwood operation during early infantile (we call it as "rapid 2 stage Norwood operation"). Indeed, the introduction of this new strategy has lead to earlier hemodynamic stabilization after Norwood operation. Although these operations are performed electively for most of HLHS patients, emergent operations are necessary if they have restrictive inter-atrial communication with sever pulmonary congestion, or if their patent ductus arteriosus (PDA) s tend to close in spite of prostagrandine infusion, or if pulmonary over circulation develops so rapidly. Recently more than half of HLHS patients are diagonosed in fetal. The advances in fetal diagnosis allow us to find the patients earlier and to assess the severity of the disease. Most of HLHS patients who required emergent operation just after their birth are diagnosed in fetal. However, their surgical outcome is unsatisfactory so far. Treatment for these HLHS patients has become the next challenge. PMID:26197906

  16. Outcome and Complications in Surgical Treatment of Lumbar Stenosis or Spondylolisthesis in Geriatric Patients

    PubMed Central

    Lee, Jin-Young; Moon, Seong-Hwan; Suh, Bo-Kyung; Yang, Myung Ho

    2015-01-01

    Development of anesthesiology and improvement of surgical instruments enabled aggressive surgical treatment even in elderly patients, who require more active physical activities than they were in the past. However, there are controversies about the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. The purpose of this study is to review the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. MEDLINE search on English-language articles was performed. There were 39685 articles from 1967 to 2013 regarding spinal disease, among which 70 dealt with geriatric lumbar surgery. Eighteen out of 70 articles dealt with geriatric lumbar surgery under the diagnosis of spinal stenosis or spondylolisthesis. One was non-randomized prospective, and other seventeen reports were retrospective. One non-randomized prospective and twelve out of seventeen retrospective studies showed that old ages did not affect the clinical outcomes. One non-randomized prospective and ten of seventeen retrospective studies elucidated postoperative complications: some reports showed that postoperative complications increased in elderly patients, whereas the other reports showed that they did not increase. Nevertheless, most complications were minor. There were two retrospective studies regarding the mortality. Mortality which was unrelated to surgical procedure increased, but surgical procedure-related mortality did not increase. Surgery as a treatment option in the elderly patients with the spinal stenosis or spondylolisthesis may be reasonable. However, there is insufficient evidence to make strong recommendations regarding spinal surgery for geriatric patients with spinal stenosis and spondylolisthesis. PMID:26256960

  17. Pretreatment Quality of Life Predicts for Locoregional Control in Head and Neck Cancer Patients: A Radiation Therapy Oncology Group Analysis

    SciTech Connect

    Siddiqui, Farzan; Pajak, Thomas F.; Watkins-Bruner, Deborah; Konski, Andre A.; Coyne, James C.; Gwede, Clement K.; Garden, Adam S.; Spencer, Sharon A.; Jones, Christopher; Movsas, Benjamin

    2008-02-01

    Purpose: To analyze the prospectively collected health-related quality-of-life (HRQOL) data from patients enrolled in two Radiation Therapy Oncology Group randomized Phase III head and neck cancer trials (90-03 and 91-11) to assess their value as an independent prognostic factor for locoregional control (LRC) and/or overall survival (OS). Methods and Materials: HRQOL questionnaires, using a validated instrument, the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H and N), version 2, were completed by patients before the start of treatment. OS and LRC were the outcome measures analyzed using a multivariate Cox proportional hazard model. Results: Baseline FACT-H and N data were available for 1,093 patients and missing for 417 patients. No significant difference in outcome was found between the patients with and without baseline FACT-H and N data (p = 0.58). The median follow-up time was 27.2 months for all patients and 49 months for surviving patients. Multivariate analyses were performed for both OS and LRC. Beyond tumor and nodal stage, Karnofsky performance status, primary site, cigarette use, use of concurrent chemotherapy, and altered fractionation schedules, the FACT-H and N score was independently predictive of LRC (but not OS), with p = 0.0038. The functional well-being component of the FACT-H and N predicted most significantly for LRC (p = 0.0004). Conclusions: This study represents, to our knowledge, the largest analysis of HRQOL as a prognostic factor in locally advanced head and neck cancer patients. The results of this study have demonstrated the importance of baseline HRQOL as a significant and independent predictor of LRC in patients with locally advanced head and neck cancer.

  18. Surgical options for the young patient with glenohumeral arthritis

    PubMed Central

    Barlow, Jonathan D.; Abboud, Joseph

    2016-01-01

    Young patients with glenohumeral arthritis are an ongoing treatment challenge. They typically have high demands of their shoulders, require long-term durability due to their young age, and often have altered local anatomy, through their disease process (instability arthropathy, juvenile rheumatoid arthritis, etc.) or from previous surgery (capsulorraphy arthropathy, chondrolysis, etc.). Workup to evaluate underlying causes of early arthritis, and to exclude infectious causes are necessary. When nonoperative management fails, arthroscopic debridement, hemiarthroplasty (isolated, with glenoid reaming, or with biological interposition), and total shoulder arthroplasty are treatment options available to the treating surgeon. Debridement or hemiarthroplasty can provide pain relief for a subset of patients, but results have not been reproducible across the literature and have not been durable over time. Total shoulder arthroplasty provides the most reliable pain relief, but long-term glenoid loosening and wear continue to lead to high revision rates in this patient population. PMID:26980987

  19. [Surgical results in intracranial meningioma in middle-aged and elderly patients].

    PubMed

    Samoshenkov, G S; Gabibov, G A

    1989-01-01

    The work analyses the results of surgical treatment of intracranial meningiomas in 250 patients of elderly and old age during a 20-year period (1967-86). The number of surgical interventions in patients with this disease has grown. The use of microsurgical methods, and the advancements in anesthesiology and resuscitation made it possible to raise the radical character of the operation and reduce postoperative mortality. Postoperative hemorrhage with the formation of intracranial hematomas, edematous-hemorrhagic softening in the zone of the operative intervention, and exacerbation of concomitant diseases were the main causes of death in the postoperative period. PMID:2816189

  20. [Results of surgical treatment in 558 patients with carcinoma of the rectum (author's transl)].

    PubMed

    Köle, W; Ertl, M

    1980-05-15

    Reviewing 558 patients with carcinoma of the rectum the symptomatology and diagnosis, the different surgical methods and especially the indication for amputation and resection are discussed. Although only 5.5% of 344 (61.6) patients, who had a radical surgical treatment (mortality rate 6.9%), were classified as Dukes A cases, 118 (34.3%) were cured for at least 5 years. The importance of early diagnosis and radical surgery strictly according to the principles of either amputation or resection are stressed. Local techniques in suitable cases are described also. PMID:7434790

  1. Lesson in psycho-oncology.

    PubMed

    Holland, Jimmie C

    2002-01-01

    As a new subspecialty of oncology, psycho-oncology's emergent role reflects the growing interest and concern over the past 25 years, on the part of both oncologists and the general public, in the psychological, behavioral, and social factors related to cancer prevention and treatment. Today, total care of cancer patients must include concern for psychosocial well-being and management of distress must be fully integrated with the other aspects of the patient's treatment plan. Prevention efforts are rooted in the willingness and ability of individuals to change lifestyle and risk behaviors, and this has to be elucidated by research in psycho-oncology. Further, psycho-oncology advances theory and practice related to the effects of cancer on psychological function and provides expertise in the prevention of cancer. Thus, psycho-oncology has a unique role to play in cancer treatment and prevention. PMID:19266677

  2. Assessment of Serologic Immunity to Diphtheria-Tetanus-Pertussis After Treatment of Korean Pediatric Hematology and Oncology Patients

    PubMed Central

    Kwon, Hyo Jin; Lee, Jae-Wook; Chung, Nak-Gyun; Cho, Bin; Kim, Hack-Ki

    2012-01-01

    The aim of this study was to investigate the diphtheria-tetanus-pertussis antibody titers after antineoplastic treatment and to suggest an appropriate vaccination approach for pediatric hemato-oncologic patients. A total of 146 children with either malignancy in remission after cessation of therapy or bone marrow failure were recruited. All children had received routine immunization including diphtheria-tetanus-acellular pertussis vaccination before diagnosis of cancer. The serologic immunity to diphtheria, tetanus and pertussis was classified as: completely protective, partially protective, or non-protective. Non-protective serum antibody titer for diphtheria, tetanus and pertussis was detected in 6.2%, 11.6%, and 62.3% of patients, respectively, and partial protective serum antibody titer for diphtheria, tetanus and pertussis was seen in 37%, 28.1%, and 8.9% of patients. There was no significant correlation between the severity of immune defect and age, gender or underlying disease. Revaccination after antineoplastic therapy showed significantly higher levels of antibody for each vaccine antigen. Our data indicates that a large proportion of children lacked protective serum concentrations of antibodies against diphtheria, tetanus, and pertussis. This suggests that reimmunization of these patients is necessary after completion of antineoplastic treatment. Also, prospective studies should be undertaken with the aim of devising a common strategy of revaccination. PMID:22219618

  3. Improving neuro-oncological patients care: basic and practical concepts for nurse specialist in neuro-rehabilitation

    PubMed Central

    2012-01-01

    Background Neuro-oncological population well expresses the complexity of neurological disability due to the multiple neurological deficits that affect these patients. Moreover, due to the therapeutical opportunities survival times for patients with brain tumor have increased and more of these patients require rehabilitation care. The figure of nurse in the interdisciplinary specialty of neurorehabilitation is not clearly defined, even if their role in this setting is recognized as being critical and is expanding. The purpose of the study is to identify the standard competencies for neurorehabilitation nurses that could be taught by means of a specialization course. Methods A literature review was conducted with preference given to works published between January 2000 and December 2008 in English. The search strategy identified 523 non-duplicated references of which 271 titles were considered relevant. After reviewing the abstracts, 147 papers were selected and made available to a group of healthcare professionals who were requested to classify them in few conceptual main areas defining the relative topics. Results The following five main areas were identified: clinical aspects of nursing; nursing techniques; nursing methodology; relational and organisational models; legal aspects of nursing. The relative topics were included within each area. As educational method a structured course based on lectures and practical sessions was designed. Also multi-choices questions were developed in order to evaluate the participants’ level of knowledge, while a semi-structured interview was prepared to investigate students’ satisfaction. Conclusions Literature shows that the development of rehabilitation depends on the improvement of scientific and practical knowledge of health care professionals. This structured training course could be incorporated into undergraduate nursing education programmes and also be inserted into continuing education programmes for graduate nurses. Developing expertise in neuro-rehabilitation for nurses, will be critical to improve overall care and care management of patients with highly complex disabilities as patients affected by brain tumors. The next step will be to start discussing, at the level of scientific societies linked to the field of neurorehabilitation and oncology, the development of a specialisation course in neurorehabilitation nursing. PMID:23031446

  4. Experiences of patients with cancer and their nurses on the conditions of spiritual care and spiritual interventions in oncology units

    PubMed Central

    Rassouli, Maryam; Zamanzadeh, Vahid; Ghahramanian, Akram; Abbaszadeh, Abbas; Alavi-Majd, Hamid; Nikanfar, Alireza

    2015-01-01

    Background: Although nurses acknowledge that spiritual care is part of their role, in reality, it is performed to a lesser extent. The purpose of the present study was to explore nurses’ and patients’ experiences about the conditions of spiritual care and spiritual interventions in the oncology units of Tabriz. Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in the oncology units of hospitals in Tabriz. Data were collected through purposive sampling by conducting unstructured interviews with 10 patients and 7 nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control. Results: Three categories emerged from the study: (1) “perceived barriers for providing spiritual care” including “lack of preparation for spiritual care,” “time and space constraints,” “unprofessional view,” and “lack of support”; (2) “communication: A way for Strengthening spirituality despite the limitations” including “manifestation of spirituality in the appearances and communicative behaviors of nurses” and “communication: Transmission of spiritual energy”; and (3) “religion-related spiritual experiences” including “life events as divine will and divine exam,” “death as reincarnation,” “trust in God,” “prayer/recourse to Holy Imams,” and “acceptance of divine providence.” Although nurses had little skills in assessing and responding to the patients’ spiritual needs and did not have the organizational and clergymen's support in dealing with the spiritual distress of patients, they were the source of energy, joy, hope, and power for patients by showing empathy and compassion. The patients and nurses were using religious beliefs mentioned in Islam to strengthen the patients’ spiritual dimension. Conclusions: According to the results, integration of spiritual care in the curriculum of nursing is recommended. Patients and nurses can benefit from organizational and clergymen's support to cope with spiritual distress. Researchers should provide a framework for the development of effective spiritual interventions that are sensitive to cultural differences. PMID:25709687

  5. Triaging early-stage lung cancer patients into non-surgical pathways: who, when, and what?

    PubMed Central

    Kong, Feng-Ming (Spring)

    2015-01-01

    More lung cancer patients are being diagnosed at an earlier stage due to improved diagnostic imaging techniques, a trend that is expected to accelerate with the dissemination of lung cancer screening. Surgical resection has always been considered the standard treatment for patients with early-stage non-small cell lung cancer (NSCLC). However, non-surgical treatment options for patients with early-stage NSCLC have evolved significantly over the past decade with many new and exciting alternative treatments now available. These alternative treatments include radiofrequency ablation (RFA), microwave ablation (MWA), percutaneous cryoablation therapy (PCT), photodynamic therapy (PDT) and external beam radiation therapy (EBRT), including stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy. We describe the established alternatives to surgical resection, their advantages and disadvantages, potential complications and efficacy. We then describe the optimal treatment approach for patients with early-stage NSCLC based on tumor operability, size and location. Finally, we discuss future directions and whether any alternative therapies will challenge surgical resection as the treatment of choice for patients with operable early-stage lung cancer. PMID:26380185

  6. [Definition and outline on geriatric oncology].

    PubMed

    Terret, C; Droz, J-P

    2009-11-01

    Geriatric oncology is the concept for management of elderly cancer patients. It is an equal approach of the health status problems and of cancer in a patient considered as a whole. Therefore it is not a subspecialty but a practice which can be translated in the elderly cancer patient's care. The treatment of cancer is based on the same principles than this of younger patients; recommendations used are those of the scientific oncological societies. Health problems of elderly patients are screened by specific tools. Patients without major health problems are managed by the oncological team in the routine; those for whom screening have demonstrated problems are first evaluated in the geriatrics setting and then oncological decisions are adapted to the patient situation. Decisions are made in specific geriatric oncology conferences. Specific clinical trials are required to build an Evidence Based Medicine background. Geriatric oncology teaching programs are warranted. PMID:20123506

  7. [Endoscopic-retrograde cholangiopancreatography in patients with surgical modification of anatomy].

    PubMed

    Albert, J G; Ulrich, F; Zeuzem, S; Sarrazin, C

    2010-08-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is an essential element in treating disease of the bilio-pancreatic system. In some patients, access to the bile ducts is limited due to operatively altered anatomy. The aim of this review is to illustrate the endoscopic procedure in these patients. We present the available evidence and comment on our approach to ERCP in patients with surgical modification of anatomy. In conclusion, conventional side-viewing or forward-viewing endoscopes allow one to access the biliary system in most patients with Billroth-II or partial pancreaticoduodenectomy. By use of balloon enteroscopy, biliary intervention in spite of surgical reconstruction with a long limb - such as Roux-en-Y gastrojejunostomy or hepaticojejunostomy and gastric bypass for obesity - has become feasible in many cases. Adaption of accessory devices to balloon-assisted enteroscopes permits therapeutic interventions in these patients. PMID:20687021

  8. Relevance of Imaging Examinations in the Surgical Planning of Patients with Bowel Endometriosis

    PubMed Central

    Trippia, Carlos H.; Zomer, Monica T.; Terazaki, Carlos R.T.; Martin, Rafael L.S.; Ribeiro, Reitan; Kondo, William

    2016-01-01

    Endometriosis is a benign gynecologic disease characterized by the presence of endometrial tissue outside the uterine cavity. The complexity of the disease results from its multiple clinical presentations, the multifocal pattern of distribution of the lesions, the presence of extra pelvic sites of the disease (mainly affecting the urinary and the intestinal tracts), and the difficulty in the preoperative diagnosis (by means of imaging studies) and in the surgical treatment. The preoperative mapping of the lesions, either by ultrasound or by magnetic resonance imaging, allows for an adequate surgical planning and a better preoperative patient counseling, especially in those women with deep infiltrating endometriosis affecting the bowel. Also, the choice of the surgical team that is going to perform the procedure may be based on the preoperative workup. In this paper, we highlight the important findings that should be described in the imaging examination reports for the preoperative workup of patients with deep infiltrating endometriosis of the intestine. PMID:26917983

  9. Surgical-orthodontic management of bilateral multiple impactions in non-syndromic patient

    PubMed Central

    Agrawal, Jiwanasha Manish; Agrawal, Manish Suresh; Nanjannawar, Lalita Girish

    2013-01-01

    Several surgical and orthodontic treatment options are available to disimpact the impacted teeth. But the closed eruption technique has the best long-term prognosis. The tooth is surgically exposed, an attachment is bonded to it, flap is resutured over it and an orthodontic extrusive force is delivered to bring the tooth into occlusion. This case report presents a case with multiple impacted teeth in which no syndrome or systemic conditions were detected. A 20-year-old female patient reported for orthodontic treatment with chief complaint of multiple unerupted permanent teeth and retained primary teeth. Radiographic examination revealed impacted 14, 15, 24, 25, 33, 34, 43 and 44. Surgical exposure of the impacted teeth was done after extraction of retained primary teeth. Forced eruption of these teeth was done by applying traction with closed eruption technique. After careful treatment planning followed by guided eruption of impacted teeth, patient finished with a significantly improved functional and aesthetic result. PMID:23329714

  10. Clinical Characteristics, Surgical Management and Adjuvant Therapy of Patients with Uterine Carcinosarcoma: A Retrospective Case Series

    PubMed Central

    Wallwiener, C.; Hartkopf, A.; Kommoss, S.; Joachim, C.; Wallwiener, M.; Taran, F. A.; Brucker, S.

    2016-01-01

    Purpose: To review a single-center experience over a 27-year period of managing uterine carcinosarcoma (UCS), focusing on surgical practice, adjuvant therapy and clinical outcome. Material and Methods: This was a retrospective study of women with histologically proven UCS treated at the Department of Obstetrics and Gynecology, University of Tübingen, Germany, between 1983 and 2010. Inpatient and outpatient records were reviewed; follow-up and survival data were ascertained. Results: The study population comprised 18 patients with UCS. Primary surgical treatment consisted of total abdominal hysterectomy in 12 patients (67 %) and laparoscopic total hysterectomy in 4 patients (22 %). Bilateral salpingo-oophorectomy was performed in 94 % of patients (17/18). Lymph nodes were evaluated in 15 patients (83 %). Positive pelvic lymph nodes were present in 2 patients (11 %). A total of 17 patients (94 %) received adjuvant therapy. Disease recurred in 7 (39 %) patients of our study group, with no recurrence noted in the 4 patients who underwent laparoscopic surgical staging. Median disease-free survival (DFS) was 48.7 months (95 % CI: 0.0–157.3) and median overall survival (OS) was 49.9 months (95 % CI: 0.0–108.2). The 5-year survival rate was 40 %. Conclusion: UCS is a rare and aggressive uterine neoplasm with high recurrence rates and metastatic potential. Surgical staging consisting of total hysterectomy with bilateral salpingo-oophorectomy and systematic lymphadenectomy is the most important treatment for patients with UCS. Adjuvant radiation therapy appears to decrease pelvic recurrence, but there is a high incidence of distant recurrence, indicating the need for additional systemic treatment. PMID:26941453

  11. Disparities in Oncologic Surgery

    PubMed Central

    Weeks, Jane C.; Stain, Steven C.

    2014-01-01

    Surgical oncology is one of the most frequently studied surgical specialties with regard to disparities in quality of care. There is variation in the care received according to nonclinical factors such as age, race and ethnicity, education, income, and even geographic region. Differences exist with regard to who gets treatment, what treatment is received, and the outcomes of those treatments. Although the existence of such disparities is no longer in doubt, the etiology is still being investigated. Ongoing research and quality improvement initiatives move beyond the mere description of existing disparities in one of three ways: (1) identifying and understanding the factors that lead to disparities; (2) advancing available methods to measure and track disparities; and (3) developing an approach to improvement. In this article, we start out by offering a framework to describe potential factors that lead to disparities, using examples from surgical oncology. We then describe the approaches to measuring and tracking disparities that are being used in research and quality improvement. Finally, we attempt to illustrate how all of these factors interact and offer some potential strategies to close the gap and alleviate disparities within the discipline. PMID:18197450

  12. Traumeel S in preventing and treating mucositis in young patients undergoing SCT: a report of the Children's Oncology Group.

    PubMed

    Sencer, S F; Zhou, T; Freedman, L S; Ives, J A; Chen, Z; Wall, D; Nieder, M L; Grupp, S A; Yu, L C; Sahdev, I; Jonas, W B; Wallace, J D; Oberbaum, M

    2012-11-01

    Mucositis can be a serious complication of hematopoietic SCT (HSCT). A previous phase II trial in 32 children undergoing HSCT reported a beneficial effect of the homeopathic remedy Traumeel S. The Children's Oncology Group sought to replicate the results in a multi-institutional trial. The study was an international multi-center, double-blind, randomized trial comparing Traumeel with placebo in patients aged 3-25 years undergoing myeloablative HSCT. Traumeel/placebo was started on Day -1 as a five-time daily mouth rinse. Efficacy of the treatment was assessed using the modified Walsh scale for mucositis, scored daily from Day -1 to 20 days after HCST. The main outcome was the sum of Walsh scale scores (area-under-the-curve (AUC)) over this period. Other outcomes included narcotic use, days of total parenteral feeding, days of nasogastric feeding and adverse events. In 181 evaluable patients, there was no statistical difference in mucositis (AUC) in the Traumeel group (76.7) compared with placebo (67.3) (P=0.13). There was a trend towards less narcotic usage in the Traumeel patients. No statistically beneficial effect from Traumeel was demonstrated for mucositis. We could not confirm that Traumeel is an effective treatment for mucositis in children undergoing HSCT. PMID:22504933

  13. Perceived roles of oncology nursing.

    PubMed

    Lemonde, Manon; Payman, Naghmeh

    2015-01-01

    The Canadian Association of Nurses in Oncology (CANO) Standards of Care (2001) provides a framework that delineates oncology nursing roles and responsibilities. The purpose of this study was to explore how oncology nurses perceive their roles and responsibilities compared to the CANO Standards of Care. Six focus groups were conducted and 21 registered nurses (RNs) from a community-based hospital participated in this study. Transcripts were analyzed using qualitative inductive content analysis. Three themes were identified: (1) Oncology nurses perceive a gap between their defined roles and the reality of daily practice, as cancer care becomes more complex and as they provide advanced oncology care to more patients while there is no parallel adaptation to the health care system to support them, such as safe staffing; (2) Oncology nursing, as a specialty, requires sustained professional development and leadership roles; and (3) Oncology nurses are committed to providing continuous care as a reference point in the health care team by fostering interdisciplinary collaboration andfacilitating patient's navigation through the system. Organizational support through commitment to appropriate staffing and matching scope ofpractice to patient needs may lead to maximize the health and well-being of nurses, quality of patient care and organizational performance. PMID:26897865

  14. Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy - a prospective study

    PubMed Central

    Cheung, W. Y.; Arvinte, D.; Wong, Y. W.; Luk, K. D.K.

    2007-01-01

    Cervical spondylotic myelopathy is a common clinical problem. No study has examined the pattern of neurological recovery after surgical decompression. We conducted a prospective study on the pattern of neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy. Patients suffering from cervical spondylotic myelopathy and requiring surgical decompression from January 1995 to December 2000 were prospectively included. Upper limbs, lower limbs and sphincter functions were assessed using the Japanese Orthopaedic Association (JOA) score. Assessment was done before the operation, at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly after surgery. Results were analysed with the t-test. Differences with P-values less than 0.05 were regarded as statistically significant. Fifty-five patients were included. The average follow-up period was 53 months. Thirty-nine patients (71%) had neurological improvement after the operation with a mean recovery rate of 55%. The JOA score improved after surgery, reaching statistical significance at 3 months and a plateau at 6 months. Thirty-six patients (65%) had improvement of upper limb function. Twenty-four patients (44%) had improvement of lower limb function. Eleven patients (20%) had improvement of sphincter function. The recovery rate of upper limb function was 37%, of lower limb function was 23% and of sphincter function was 17%. Surgical decompression worked well in patients with cervical spondylotic myelopathy. Seventy-one percent of patients had neurological improvement after the operation. The neurological recovery reached a plateau at 6 months after the operation. The upper limb function had the best recovery, followed by lower limb and sphincter functions. PMID:17235616

  15. Does surgical sympathectomy improve clinical outcomes in patients with refractory angina pectoris?

    PubMed

    Holland, Luke C; Navaratnarajah, Manoraj; Taggart, David P

    2016-04-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In patients with angina pectoris refractory to medical therapy, does surgical sympathectomy improve clinical outcomes? A total of 528 papers were identified using the search protocol described, of which 6 represented the best evidence to answer the clinical question. There were 5 case series and 1 prospective cohort study. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 of the case series demonstrated an improvement in symptoms, exercise tolerance or quality of life in patients undergoing surgical sympathectomy. An early case series investigating an open approach had a high morbidity and mortality rate, but the 4 other series used a minimally invasive technique and had low morbidity and zero perioperative mortality rates. The cohort study compared surgical sympathectomy with transmyocardial laser revascularization (TMR) and concluded TMR to be superior. However, this study looked only at unilateral sympathectomy, whereas all 5 case series focused on bilateral surgery. We conclude that the best currently available evidence does suggest that patients report an improvement in their symptoms and quality of life following surgical sympathectomy, but the low level of this evidence does not allow for a statistically proved recommendation. PMID:26787727

  16. 76 FR 65885 - Medicare Program; Changes to the Ambulatory Surgical Centers Patient Rights Conditions for Coverage

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-24

    ... rule (75 FR 21207) in the Federal Register entitled, ``Medicare Programs; Ambulatory Surgical Centers... November 18, 2008 Hospital Outpatient PPS Update for CY 2009 final rule (73 FR 68502), which contained a Cf...: Standard medical practice requires the ASC surgeon to systematically document the patient's medical...

  17. Patient Care Doesn't Suffer When Surgical Residents Work More: Study

    MedlinePLUS

    ... 2, 2016 TUESDAY, Feb. 2, 2016 (HealthDay News) -- Long hours for surgical residents don't seem to put patients at risk when the doctors-in-training are allowed to work longer shifts, a new study finds. In fact, ...

  18. [Intraperitoneal chemotherapy with CDDP for patients with peritoneal recurrent gastric cancer following surgical intervention].

    PubMed

    Takiguchi, Nobuhiro; Nabeya, Yoshihiro; Ikeda, Atsushi; Kainuma, Osamu; Soda, Hiroaki; Cho, Akihiro; Tonooka, Toru; Saito, Hiroshige; Yanagibashi, Hiroo; Arimitsu, Hidehito; Kobayashi, Ryousuke; Chibana, Tomofumi; Tokoro, Yukinari; Nagata, Matsuo; Yamamoto, Hiroshi

    2014-11-01

    We evaluated the efficacy of intraperitoneal chemotherapy with cisplatin (CDDP) for peritoneal recurrent gastric cancer following surgical intervention. Twelve patients were enrolled. The combination systemic chemotherapy was S-1 or S-1 plus paclitaxel (S-1+PTX). PTX was administered intravenously at 80 mg/m² on day S-1 and 15. S-1 was administered at 80 mg/ m²/ day for 7 consecutive days, followed by 7 days of rest, and the cycle was repeated. CDDP was administered intraperitoneally at 40 mg/body on day 8. This treatment was repeated every 4 weeks until disease progression was diagnosed. The survival time(ST)and time to treatment failure(TTF)were estimated. The surgical interventions were gastrectomy in 3 patients, colostomy in 8 patients, and enterostomy in 1 patient. Overall, the median TTF and ST were 294 days and 455 days, respectively. When stratified by surgical method and combination chemotherapy, the median TTF and ST were not statistically significant. However, when stratified by performance status (PS), the median TTF was 352 days for patients with PS 0 and 218 days for those with PS 1, 2 (p=0.0029), whereas the median ST was 553 days for patients with PS 0 and 331 days for those with PS 1, 2 (p=0.0198). In conclusion, the data suggest that intraperitoneal CDDP chemotherapy with systemic chemotherapy is effective for the treatment of extensive peritoneal recurrent gastric cancer, especially in patients with good PS. PMID:25731217

  19. Oral Health Status of Chinese Paediatric and Adolescent Oncology Patients with Chemotherapy in Hong Kong: a Pilot Study

    PubMed Central

    Kung, A.Y.H; Zhang, S; Zheng, L.W; Wong, G.H.M; Chu, C.H

    2015-01-01

    Aim: To study the oral health status of Chinese children and adolescents undergoing chemotherapy in Hong Kong. Method: All Chinese children and adolescent oncology patients aged 18 or below attending the Children's Centre for Cancer and Blood Disease at a hospital for chemotherapy were invited and parental consent was sought before they were accepted into the study. The study comprised of 1) a parental questionnaire, 2) the collection of medical history and 3) a clinical examination for tooth decay (caries) and mucosal status. Results: A total of 69 patients were invited, and they all participated in this study. Their mean age was 9.2±5.0 and 44 (64%) were males. Twenty-six patients (38%) had no caries experience (DMFT and/or dmft = 0). Higher caries experience was detected in participants that were not born in Hong Kong, had completed active chemotherapy, participated in school dental care service and whose parents had low educational levels. There were 41 patients with active chemotherapy, 24 of whom were diagnosed with acute leukaemia, 5 with haematological malignancies other than leukaemia and 11 with solid tumours. Antimetabolites, cytotoxic antibiotics, alkylating agents and plant alkaloids were administered in 49%, 32%, 24% and 22% of them, respectively. Twenty-six (63%) patients showed no mucosal complications. The most common oral complication was oral mucositis (24%) followed by petechiae (10%). Conclusion: About two-thirds of paediatric and adolescent cancer patients had caries experience, which was more common among those who had completed chemotherapy. Oral mucositis followed by petechiae were the two most common complications of receiving chemotherapy. PMID:25674168

  20. The importance of a travel history in the preoperative assessment of an elective surgical patient.

    PubMed

    Shao, Emily Han; Hayes, Ellen Martina; Khwaja, Haris A; Efthimiou, Evangelos

    2011-01-01

    The authors present the case of a 43-year-old gentleman who was admitted for an elective surgical removal of an eroded gastric band. The patient reported no medical concerns and other than a mild anaemia of haemoglobin of 10.6, his preoperative assessment was non-significant. Postoperatively, the patient spiked temperatures on multiple occasions. When a travel history was subsequently taken, the patient revealed he had returned from Nigeria the night before his elective surgery. The patient tested positive for Plasmodium falciparum malaria for which he was successfully managed with oral quinine and doxycycline, and recuperated well both from malaria and the surgery. P falciparum malaria is a medical emergency and increases the morbidity and mortality of anaesthesia and surgery. Travel histories are not currently routinely taken as part of the preoperative assessment for elective surgical admissions; the authors argue that it should become a mandatory part. PMID:22674102

  1. Triple pathological findings in a surgically amenable patient with mesial temporal lobe epilepsy?

    PubMed Central

    Tong, Fumin; Jewells, Valerie; Trembath, Dimitri G.; Hadar, Eldad; Shin, Hae Won

    2015-01-01

    Mesial temporal sclerosis (MTS) is a well-recognized cause of intractable epilepsy; however, coexistence with focal cortical dysplasia (FCD) is less common. Middle fossa epidermoid cysts are rare and may involve the temporal lobe. Most epidermoids are clinically silent, slow-growing, and seldom associated with overt symptomatology, including seizures. We describe a patient with multiple comorbidities including left MTS and a large epidermoid cyst involving the left quadrigeminal plate cistern compressing upon the cerebellar vermis and tail of the left hippocampus, resulting in refractory left temporal lobe epilepsy. The patient underwent left anterior temporal lobectomy. The surgical pathology demonstrated a third pathological finding of left temporal FCD type Ia. The patient has been seizure-free since the surgery. This case provides additional information with regard to the understanding of epileptogenicity and surgical planning in patients with MTS and epidermoid cysts. PMID:26288757

  2. Stress in pediatric oncology nurses.

    PubMed

    Hecktman, Hillary Michelle

    2012-01-01

    Although the onset of physiological and emotional stress can greatly affect outcomes for a child with cancer, the focus of this review targets pediatric oncology nurses and their daily occupation-related stress. Literature currently exists that discusses the etiology of stress in the oncology work environment as well as coping strategies and their effects on pediatric oncology nurses' stress levels. To date, however, no literature review has been assembled to comprehensively address practice implications and provide recommendations for pediatric oncology staff nurses. This review of literature seeks to provide a general overview of stress experienced in the pediatric oncology work environment and supportive interventions to decrease negative outcomes such as compassion fatigue and burnout. Recommendations and conclusions are made based on existing interventions, thus creating a framework for future research to be conducted to compare the effectiveness of these measures and optimize patient experiences through caregiver well-being. PMID:23087251

  3. STUDY ON THE APPLICABILITY OF THE MODIFIED TOKUHASHI SCORE IN PATIENTS WITH SURGICALLY TREATED VERTEBRAL METASTASIS

    PubMed Central

    Mattana, Jeferson Luis; Freitas, Rosyane Rena de; Mello, Glauco José Pauka; Neto, Mário Armani; Freitas Filho, Geraldo de; Ferreira, Carolina Bega; Novaes, Carolina

    2015-01-01

    To present the results obtained from surgical treatment of patients with vertebral metastases, comparing them with the modified Tokuhashi score in order to validate the applicability of this score for prognostic predictions and for choosing surgical treatments. Methods: This was a retrospective study on 157 patients treated surgically for spinal metastasis in Erastus Gaertner Hospital in Curitiba. The Tokuhashi score was applied retrospectively to all the patients. The patients' actual survival time was compared with the expected survival time using the Tokuhashi score. Results: There were 82 females and 75 males. The most frequent location of the primary tumor was the breast. The thoracic region was involved in 66.2%, lumbar region in 65.6%, cervical region in 15.9% and sacral region in 12.7%. All the patients underwent surgical treatment. The most frequent indication for treatment was intractable pain (89.2%). There was partial or complete improvement in a majority of the cases (52.2%). Out of 157 cases studied, 86.6% died. The maximum survival time was 13.6 years, the minimum was 3 days and the mean was 13.2 months. The following frequencies of Tokuhashi scores were found among the operated cases: up to 8 points, 111 cases; 9-11 points, 43 cases; and 12-15 points, three cases. The mean survival time in months for all 157 patients according to the Tokuhashi score was: 0-8 points, 15.4 months; 9-11 points, 11.4 months; and 12-15 points, 12 months. Conclusion: Unlike the nonsurgical approach recommended by Tokuhashi for patients with lower scores, this group in our study was sent for surgery, with better results than those of non-operated patients reported by Tokuhashi.

  4. A primer for achieving glycemic control in the cardiac surgical patient.

    PubMed

    McDonnell, Marie E; Alexanian, Sara M; White, Lynn; Lazar, Harold L

    2012-07-01

    Maintaining glycemic control (blood glucose <180 mg/dL) has been shown to reduce morbidity and enhance long-term survival in patients with diabetes mellitus following coronary artery bypass graft (CABG) surgery. In this review we present a management strategy to achieve perioperative glycemic control in all patients undergoing CABG surgery, with and without diabetes mellitus, designed to achieve compliance with current Surgical Care Improvement Project (SCIP) and Society of Thoracic Surgeons (STS) guidelines. PMID:22640228

  5. Integrative oncology: an overview.

    PubMed

    Deng, Gary; Cassileth, Barrie

    2014-01-01

    Integrative oncology, the diagnosis-specific field of integrative medicine, addresses symptom control with nonpharmacologic therapies. Known commonly as "complementary therapies" these are evidence-based adjuncts to mainstream care that effectively control physical and emotional symptoms, enhance physical and emotional strength, and provide patients with skills enabling them to help themselves throughout and following mainstream cancer treatment. Integrative or complementary therapies are rational and noninvasive. They have been subjected to study to determine their value, to document the problems they ameliorate, and to define the circumstances under which such therapies are beneficial. Conversely, "alternative" therapies typically are promoted literally as such; as actual antitumor treatments. They lack biologic plausibility and scientific evidence of safety and efficacy. Many are outright fraudulent. Conflating these two very different categories by use of the convenient acronym "CAM," for "complementary and alternative therapies," confuses the issue and does a substantial disservice to patients and medical professionals. Complementary and integrative modalities have demonstrated safety value and benefits. If the same were true for "alternatives," they would not be "alternatives." Rather, they would become part of mainstream cancer care. This manuscript explores the medical and sociocultural context of interest in integrative oncology as well as in "alternative" therapies, reviews commonly-asked patient questions, summarizes research results in both categories, and offers recommendations to help guide patients and family members through what is often a difficult maze. Combining complementary therapies with mainstream oncology care to address patients' physical, psychologic and spiritual needs constitutes the practice of integrative oncology. By recommending nonpharmacologic modalities that reduce symptom burden and improve quality of life, physicians also enable patients to play a role in their care. Critical for most patients, this also improves the physician-patient relationship, the quality of cancer care, and the well-being of patients and their families. PMID:24857081

  6. Conflicting Priorities in Social Legislation and Medicine: Gynaeco-oncology Patients and their Right to Participate in Society

    PubMed Central

    Simoes, E.; Graf, J.; Wallwiener, D.; Brucker, S.

    2015-01-01

    Due to the declining mortality rates, malignant diseases have gained a chronic character for many gynaeco-oncology patients. The patients can expect to participate in social life and to an increasing extent in professional life for longer lengths of time. Promotion of rehabilitation and participation is an issue of the German 9th Social Security Code that explicitly places a focus on women. This is mainly of relevance for tumour patients with regard to assessment of the degree of severe disability, to compensate for disease-induced impairments and the possibilities for improving the participation of the afflicted subjects, especially by means of protective rights in professional life. Indeed, tumour patients do sometimes find themselves confronted with conflicting priorities between the entitlements guaranteed by social legislation and the compensation conferred by the health-care services, which can then be avoided when the facts are sufficiently known. For this purpose, the physician must be fully aware of the legal situation. The present article provides an overview of the procedures and reference points for appraisals. Patients need partners among their responsible physicians to help in the assertion of their claims. From the physician?s side it is necessary to classify the reported complaints within the ever increasing knowledge about the direct side effects and the long-term side effects of cancer therapies. Against the background of an often life-long mental stress and the uncertain risk of recurrence, it should also be considered whether the concept of healing probation is in support of the targets of long-term disease management and social reintegration, also in the interest of society in general. PMID:26556909

  7. Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel.

    PubMed

    Bensadoun, René-Jean; Humbert, Phillipe; Krutman, Jean; Luger, Thomas; Triller, Raoul; Rougier, André; Seite, Sophie; Dreno, Brigitte

    2013-01-01

    Skin reactions due to radiotherapy and chemotherapy are a significant problem for an important number of cancer patients. While effective for treating cancer, they disturb cutaneous barrier function, causing a reaction soon after initiation of treatment that impacts patient quality of life. Managing these symptoms with cosmetics and nonpharmaceutical skin care products for camouflage or personal hygiene may be important for increasing patient self-esteem. However, inappropriate product choice or use could worsen side effects. Although recommendations exist for the pharmaceutical treatment of skin reactions, there are no recommendations for the choice or use of dermatologic skin care products for oncology patients. The present guidelines were developed by a board of European experts in dermatology and oncology to provide cancer care professionals with guidance for the appropriate use of non-pharmaceutical, dermocosmetic skin care management of cutaneous toxicities associated with radiotherapy and systemic chemotherapy, including epidermal growth factor inhibitors and monoclonal antibodies. The experts hope that these recommendations will improve the management of cutaneous side effects and hence quality of life for oncology patients. PMID:24353440

  8. Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel

    PubMed Central

    Bensadoun, René-Jean; Humbert, Phillipe; Krutman, Jean; Luger, Thomas; Triller, Raoul; Rougier, André; Seite, Sophie; Dreno, Brigitte

    2013-01-01

    Skin reactions due to radiotherapy and chemotherapy are a significant problem for an important number of cancer patients. While effective for treating cancer, they disturb cutaneous barrier function, causing a reaction soon after initiation of treatment that impacts patient quality of life. Managing these symptoms with cosmetics and nonpharmaceutical skin care products for camouflage or personal hygiene may be important for increasing patient self-esteem. However, inappropriate product choice or use could worsen side effects. Although recommendations exist for the pharmaceutical treatment of skin reactions, there are no recommendations for the choice or use of dermatologic skin care products for oncology patients. The present guidelines were developed by a board of European experts in dermatology and oncology to provide cancer care professionals with guidance for the appropriate use of non-pharmaceutical, dermocosmetic skin care management of cutaneous toxicities associated with radiotherapy and systemic chemotherapy, including epidermal growth factor inhibitors and monoclonal antibodies. The experts hope that these recommendations will improve the management of cutaneous side effects and hence quality of life for oncology patients. PMID:24353440

  9. Utilitarian prioritization of radiation oncology patients based on maximization of population tumour control

    NASA Astrophysics Data System (ADS)

    Ebert, M. A.; Li, W.; Jennings, L.; Kearvell, R.; Bydder, S.

    2013-06-01

    An objective method for establishing patient prioritization in the context of a radiotherapy waiting list is investigated. This is based on a utilitarian objective, being the greatest probability of local tumour control in the population of patients. A numerical simulation is developed and a clinical patient case-mix is used to determine the influence of the characteristics of the patient population on resulting optimal patient scheduling. With the utilitarian objective, large gains in tumour control probability (TCP) can be achieved for individuals or cohorts by prioritizing patients for that fraction of the patient population with relatively small sacrifices in TCP for a smaller fraction of the population. For a waiting list in steady state with five patients per day commencing treatment and leaving the list (and so with five patients per day entering the list), and a mean wait time of 35 days and a maximum of 90 days, optimized wait times ranged from a mean of one day for patients with tumour types with short effective doubling times to a mean of 66.9 days for prostate cancer patients. It is found that, when seeking the optimal daily order of patients on the waiting list in a constrained simulation, the relative rather than absolute value of TCP is the determinant of the resulting optimal waiting times. An increase in the mean waiting time mostly influences (increases) the optimal waiting times of patients with fast-growing tumours. The proportional representation of groups (separated by tumour type) in the patient population has an influence on the resulting distribution of optimal waiting times for patients in those groups, though has only a minor influence on the optimal mean waiting time for each group.

  10. Factors predicting surgical resection in patients with intrahepatic cholangiocarcinoma and cirrhosis.

    PubMed

    Li, Hao; Wu, Jin-shu; Wang, Xin-tian; Lv, Pin; Gong, Lian-sheng; Liu, Gong; Tian, Bu-ning; Li, Ya-yong; Jiang, Bo

    2014-08-01

    Here, we investigate the potential factors that affect the outcome of patients with intrahepatic cholangiocarcinomas (ICC) and cirrhosis. We retrospectively reviewed the clinical data and pathological features of 58 patients with ICC and cirrhosis who underwent liver resection between July 2000 and March 2008, and analyzed the prognostic risk factors by means of univariate and multivariate analyses. The overall morbidity and mortality were 40% and 3.3%, respectively. The overall median survival was 24 months, and the 1-, 3-, and 5-year actuarial survival rates were 53%, 18%, and 10%, respectively. Univariate analysis showed that Child-Pugh classification, hypoalbuminemia, vascular invasion, lymphnodes metastasis, tumor-nodes-metastasis (TNM) staging system, positive surgical margins, and high perioperative blood transfusion volumes were all significantly associated with poor survival. Multivariate analysis confirmed that hypoalbuminemia, vascular invasion, positive surgical margins, and high perioperative blood transfusion volume were survival related, with hazard ratios (HR) of 2.58, 3.12, 3.57, and 1.98, respectively. Surgical resection is an effective treatment for patients affected by ICC and cirrhosis. Predictive factors, including hypoalbuminemia, vascular invasion, positive surgical margins, and high perioperative blood transfusion volumes are all related to poor survival. PMID:24476002

  11. Surgical errors and risks – the head and neck cancer patient

    PubMed Central

    Harréus, Ulrich

    2013-01-01

    Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery. PMID:24403972

  12. Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: A single center experience

    PubMed Central

    Ong, Marc; Guang, Tan Yu; Yang, Tan Kok

    2015-01-01

    AIM: To determine predisposing factors leading to surgical delay in elderly patients with acute abdominal conditions and its impact on surgical outcomes. METHODS: A retrospective review of a total of 144 patients aged 60 years and older who had undergone emergency abdominal surgery between 2010 and 2013 at a regional general hospital was analysed. The operations analysed were limited to perforated or gangrenous viscus and strangulated hernia. Patient demographic features, time taken to obtain a computed tomography scan, time taken to surgery and the impact on postoperative morbidity and mortality were analysed. RESULTS: The mean age was 70.5 ± 9.1 years and median time taken to surgery was 9 h. The overall mortality and complication rates (Clavien Dindo 3 and above) were 9% and 13.1% respectively. Diabetes mellitus was a significant predisposing factor which had an impact on surgical delays. Delays in surgery more than 24 h led to higher complication rates at 38.9% (P = 0.003), with multivariate analysis confirming it as an independent factor. Delays in obtaining a computed tomography (CT) scan was also shown to result in higher complication rates (Clavien Dindo 3 and above). CONCLUSION: Delays in performing emergency surgery in elderly lead to higher complication rates. Obtaining CT scans early also may facilitate prompt diagnosis of certain abdominal emergencies where presentation is more equivocal and this may lead to improved surgical outcomes. PMID:26425270

  13. Does Duration of Preoperative Sciatica Impact Surgical Outcomes in Patients with Lumbar Disc Herniation?

    PubMed Central

    Ghayem Hasankhani, Ebrahim; Khanzadeh, Reza

    2014-01-01

    Background. In lumbar disc herniation, most authors recommend nonoperative treatment for the first few weeks of presentation, but what about the upper limit of this golden period? The aim of this study is to assess the effect of preoperative sciatica duration on surgical outcome of lumbar disc herniation. Methods. We retrospectively evaluated 240 patients (124 males and 116 females) with a mean age of 36.4 ± 5.9 years (range 16 to 63) surgically treated due to primary stable L4-L5 disc herniation. The patients were placed into two groups: with more and less than 12-month duration of preoperative sciatalgia. Disability and pain were measured by Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). Wilcoxon test and Mann-Whitney U test were used for statistical analysis. Results. Total mean duration of preoperative sciatalgia and follow-up period were 13.3 months (range 2 to 65) and 33.7 ± 5.1 months (range 24 to 72), respectively. Comparison between the groups showed that duration of preoperative sciatalgia either less or more than 12 months did not affect the surgical outcomes significantly. Conclusions. More or less than 12-month duration of preoperative sciatalgia may not affect the surgical outcomes of simple lumbar disc herniation in the patients undergoing discectomy. PMID:24616807

  14. Does duration of preoperative sciatica impact surgical outcomes in patients with lumbar disc herniation?

    PubMed

    Omidi-Kashani, Farzad; Ghayem Hasankhani, Ebrahim; Kachooei, Amir Reza; Rahimi, Mohammad Dawood; Khanzadeh, Reza

    2014-01-01

    Background. In lumbar disc herniation, most authors recommend nonoperative treatment for the first few weeks of presentation, but what about the upper limit of this golden period? The aim of this study is to assess the effect of preoperative sciatica duration on surgical outcome of lumbar disc herniation. Methods. We retrospectively evaluated 240 patients (124 males and 116 females) with a mean age of 36.4 ± 5.9 years (range 16 to 63) surgically treated due to primary stable L4-L5 disc herniation. The patients were placed into two groups: with more and less than 12-month duration of preoperative sciatalgia. Disability and pain were measured by Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). Wilcoxon test and Mann-Whitney U test were used for statistical analysis. Results. Total mean duration of preoperative sciatalgia and follow-up period were 13.3 months (range 2 to 65) and 33.7 ± 5.1 months (range 24 to 72), respectively. Comparison between the groups showed that duration of preoperative sciatalgia either less or more than 12 months did not affect the surgical outcomes significantly. Conclusions. More or less than 12-month duration of preoperative sciatalgia may not affect the surgical outcomes of simple lumbar disc herniation in the patients undergoing discectomy. PMID:24616807

  15. Implementing a Daily Maintenance Care Bundle to Prevent Central Line-Associated Bloodstream Infections in Pediatric Oncology Patients.

    PubMed

    Duffy, Elizabeth A; Rodgers, Cheryl C; Shever, Leah L; Hockenberry, Marilyn J

    2015-01-01

    Eliminating central line-associated bloodstream infection (CLABSI) is a national priority. Central venous catheter (CVC) care bundles are composed of a series of interventions that, when used together, are effective in preventing CLABSI. A CVC daily maintenance care bundle includes procedural guidelines for hygiene, dressing changes, and access as well as specific timeframes. Failure to complete one of the components of the care bundle predisposes the patient to a bloodstream infection. A nurse-led multidisciplinary team implemented and, for six months, sustained a daily maintenance care bundle for pediatric oncology patients. This quality improvement project focused on nursing staffs' implementation of the daily maintenance care bundle and the sustainment of the intervention. The project used a pre-post program design to evaluate outcomes of CVC daily maintenance care bundle compliancy and CLABSI. A statistically significant increase between the pre- and post-assessments of the compliance was noted with the CVC daily maintenance care bundle. CLABSI infection rates decreased during the intervention. Strategies to implement practice change and promote sustainability are discussed. PMID:25643972

  16. [Using arts therapies in psycho-oncology: evaluation of an exploratory study implemented in an out-patient setting].

    PubMed

    Schiltz, L; Zimoch, A

    2013-01-01

    According to the state-of-the-art in health psychology and psycho-oncology, a cancerous disease, as well as the accompanying medical treatments, is a source ofintense emotional stress. As feelings of insecurity and anxiety are likely to induce negative effects on immune defences, those effects may overlap with the cancerous disease and complicate its evolution. As arts therapies tend to favour the imaginary and symbolic elaboration of the tensions of daily life, as well as the re appropriation of one's body and personal history, different artistic mediations may occupy an important function in the psychological follow-up of the patient. Following an exploratory study in a hospital, we carried out an action-research in an out-patient setting during six moths. The arts therapeutic treatment comprehended alternatively drawing and writing sessions while listening to music, opening tracks for a thorough verbal elaboration. The evaluation was based on psychometric scales (HADS and MDBF), rating scales for the pictorial and literary production and a semi-structured interview. According to the results of the quantitative analyses, based on non parametric statistical procedures for small groups and non metric data, as well as to the qualitative content analyses, arts therapies could become a valuable treating measure within a multidisciplinary bio-psycho-social approach. PMID:23808110

  17. Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

    PubMed Central

    Shehadi, Joseph A.; Suk, Ian; Suki, Dima; Maldaun, Marcos V. C.; McCutcheon, Ian E.; Nader, Remi; Theriault, Richard; Rhines, Laurence D.; Gokaslan, Ziya L.

    2007-01-01

    Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic disease who underwent spinal surgery. Pre- and postoperative pain levels (visual analog scale [VAS]), analgesic medication usage, and modifed Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients (2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory. Of the 11 patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which (75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery), and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented. In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain relief and preservation or improvement of neurological function with an acceptably low rate of complications. PMID:17406908

  18. Interprofessional patient-centred practice in oncology teams: utopia or reality?

    PubMed

    Bilodeau, Karine; Dubois, Sylvie; Pepin, Jacinthe

    2015-03-01

    Studies on interprofessional practice usually report professionals' viewpoints and document organizational, procedural and relational factors influencing that practice. Considering the importance of interprofessional patient-centred (IPPC) practice, it seems necessary to describe it in detail in an actual context of care, from the perspective of patients, their families and health-care professionals. The goal of this study was to describe IPPC practice throughout the continuum of cancer care. A qualitative multiple case study was completed with two interprofessional teams from a Canadian teaching hospital. Interviews were conducted with patients, their families and professionals, and observation was carried out. Three themes were illustrated by current team practice: welcoming the person as a unique individual, but still requiring the patient to comply; the paradoxical coexistence of patient-centred discourse and professional-centred practice; and triggering team collaboration with the culmination of the patient's situation. Several influential factors were described, including the way the team works; the physical environment; professionals' and patients'/family members' stance on the collaboration; professionals' stance on patients and their families; and patients' stance on professionals. Finally, themes describing the desired IPPC practice reflect the wish of most participants to be more involved. They were: providing support in line with the patient's experience and involvement; respecting patients by not imposing professionals' values and goals; and consistency and regularity in the collaboration of all members. PMID:25070427

  19. A Comparison of Patient Controlled Epidural Analgesia With Intravenous Patient Controlled Analgesia for Postoperative Pain Management After Major Gynecologic Oncologic Surgeries: A Randomized Controlled Clinical Trial

    PubMed Central

    Moslemi, Farnaz; Rasooli, Sousan; Baybordi, Ali; Golzari, Samad E.J.

    2015-01-01

    Background: Postoperative pain after major open gynecologic surgeries requires appropriate pain management. Objectives: This study aimed at comparing perioperative patient controlled epidural analgesia (PCEA) and patient controlled intravenous analgesia (PCA) after gynecologic oncology surgeries. Patients and Methods: In this clinical trial study, 90 patients with American society of anesthesiologists (ASA) class I or II scheduled for gynecologic oncologic surgeries were randomly allocated to two groups (45 patients each group) to receive: patient-controlled epidural analgesia with bupivacaine and fentanyl (PCEA group), or patient controlled intravenous analgesia (IV PCA group) with fentanyl, pethidine and ondansetron. Postoperative pain was assessed over 48 hours using the visual analog scale (VAS). The frequency of rescue analgesia was recorded. Occurrence of any concomitant events such as nausea, vomiting, ileus, purities, sedation and respiratory complications were recorded postoperatively. Results: There were no statistically significant differences in demographic data including; age, weight, ASA physical status, duration of surgery, intraoperative bleeding, and the amount of blood transfusion (P > 0.05), between the two studied groups. Severity of postoperative pain was not significantly different between the two groups (P > 0.05); however, after first patient mobilization, pain was significantly lower in the epidural group than the IV group (P < 0.001). There was no significant difference between the two groups regarding the incidence of complications such as nausea, vomiting, purities or ileus (P > 0.05). Nevertheless, the incidence and severity of sedation was significantly higher in the IV group (P < 0.001). Respiratory depression was higher in the IV group than the epidural group; this difference, however, was not significant (P = 0.11). In the epidural group, only 10 patients (22.2%) had mild and transient lower extremities parenthesis. Conclusions: Both intravenous and epidural analgesic techniques with combination of analgesics provide proper postoperative pain control after major gynecologic cancer surgeries without any significant complications. Regarding lower sedative and respiratory depressant effects of epidural analgesia, it seems that this method is a safer technique for postoperative pain relief in these patients. PMID:26587406

  20. A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection

    ERIC Educational Resources Information Center

    McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

    2010-01-01

    Introduction: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. Methods: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An…

  1. A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection

    ERIC Educational Resources Information Center

    McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

    2010-01-01

    Introduction: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. Methods: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An…

  2. Prevalence of emotional symptoms in Chilean oncology patients before the start of chemotherapy: potential of the distress thermometer as an ultra-brief screening instrument

    PubMed Central

    Calderón, Jorge; Campla, Cristóbal; D’Aguzan, Nicole; Barraza, Soledad; Padilla, Oslando; Sánchez, Cesar; Palma, Silvia; González, Matías

    2014-01-01

    Emotional distress (ED) is greater for oncology patients in comparison with the general population, and this has implications for the quality of life of the patient and his/her family, adherence to the treatment, and eventually, survivorship. In general, the detection of these symptoms is low, which explains the need for detection systems appropriate to the clinical reality of the oncology team. The objective of this study is to evaluate for the first time the usefulness of an ultra-brief screening instrument [distress thermometer (DT)], in a group of Chilean oncology patients. A total of 166 outpatients were evaluated at the Cancer Center of the Pontificia Universidad Católica de Chile, before starting chemotherapy. Two screening instruments were applied: Hospital Anxiety and Depression Scale (HADS) and DT. The application of HADS resulted in a prevalence of 32.7% of anxiety symptoms (HADS-A ≥ 8), 15.7% of depression symptoms (HADS-D ≥ 8), and 39.8% had a total score of HADS-T ≥ 11. The DT resulted in the prevalence of 32.5% of distress or ED (DT ≥ 5). The validity of the DT was evaluated as a screening tool in comparison with HADS, observing, in relation to the anxiety scale (HADS-A), a sensitivity of 88.9% and specificity of 78.4% (DT ≥ 4); depression (HADS-D), a sensitivity of 69.2% and specificity of 74.3% (DT ≥ 5); and in relation to the total scale (HADS-T), a sensitivity of 68.2% and specificity of 73.0% (DT ≥ 4). This study demonstrates the elevated prevalence of emotional symptoms in Chilean oncology patients, before the start of chemotherapy, and confirms the potential of the DT as a brief screening instrument with easy application. The DT will allow the clinician to increase the detection threshold in the Chilean oncology population, intervene in a timely manner, and contribute to the comprehensive handling of the oncology patient without affecting the time needed for assistance. PMID:24966889

  3. Characteristics of patients with hypoplastic thumb: a prospective study of 51 patients with the results of surgical treatment.

    PubMed

    Abdel-Ghani, Hisham; Amro, Sherif

    2004-03-01

    The aim of this study was to characterize a group of patients with hypoplasia of the thumb, classifying them, describing the associated anomalies and to evaluate the results of surgical treatment of such cases. Thumb hypoplasia is a complex and heterogeneous congenital disorder that is detrimental to hand functions. The characteristics of patients with these anomalies are not well described in the literature. A prospective study on 51 patients with 82 hypoplastic thumbs was done. All the patients' data regarding their personal, family, pregnancy and developmental histories were recorded. All the patients were exposed to thorough clinical examination with genetic assessment and radiological examination including abdominal ultrasonography and echocardiography when requested by the paediatrician. The cases were classified using the modified Blauth classification into five types and we added the five-fingered hand. Surgical treatment was performed for 26 hands in 18 patients and the postoperative results were recorded with an average duration of follow-up of 38.6 months. Of the 51 patients, there was a positive consanguinity in 23.5%. Eighty-six per cent were found to have associated anomalies. Type V thumb hypoplasia was the most common type followed by type IV, with type I being the least common. All the patients' parents were satisfied with the results of surgical treatment and noticed improvement of the performance of the operated hands in the daily activities. We detected some anomalies that have never been described before or described as case reports only; such as lacunar skull, congenital facial palsy and toe amputation; we also described familial radial side dysplasia with variable presentation of congenital anomalies of the thumb in the families. In addition, we think that the five-fingered hand should be added to the classification of thumb hypoplasia. Our study agrees with the literature regarding the distribution of different types of hypoplasia of the thumb, the incidence of associated anomalies and the results of surgical treatment. PMID:15076593

  4. Thinking in three's: Changing surgical patient safety practices in the complex modern operating room

    PubMed Central

    Gibbs, Verna C

    2012-01-01

    The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won’t ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR. PMID:23239908

  5. Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression.

    PubMed Central

    Langmayr, J J; Ortler, M; Dessl, A; Twerdy, K; Aichner, F; Felber, S

    1995-01-01

    Spinal cord compression due to extradural and subdural haemorrhage is a neurosurgical emergency. Differences in clinical presentation in relation to localisation of the haematoma, value of MRI as a diagnostic tool, surgical treatment, and prognosis were investigated in a retrospective case series of eight patients with extradural (n = four) and subdural (n = four) haematomas. Results of MRI were compared with operative findings and proved to be of high sensitivity in defining the type of bleeding and delineating craniocaudal extension and ventrodorsal location. Surgical treatment by decompressive laminectomy, haematoma evacuation, and postoperative high dose corticosteroids resulted in resolution of symptoms in five patients and improvement in the clinical situation in two patients. One patient with a chronic subdural haematoma had a second operation because of arachnoidal adhesions. One patient presented with a complete cord transection syndrome due to an acute subdural haematoma and remained paraplegic. It is concluded that prompt, reliable, and non-invasive diagnosis by MRI leads to efficient surgical treatment and a favourable outcome in this rare condition. Images PMID:7561928

  6. Value of PCR in surgically treated patients with staphylococcal infective endocarditis: a 4-year retrospective study.

    PubMed

    Zaloudíková, B; Němcová, E; Pol, J; Sorm, Z; Wurmová, S; Novotná, K; Vaněrková, M; Holá, V; Růžička, F; Dušek, L; Němec, P; Freiberger, T

    2012-06-01

    The aim of the study was to establish a diagnostic value for broad-range polymerase chain reaction (br-PCR) and staphylococci-specific multiplex PCR (ssm-PCR) performed on surgical material from patients with staphylococcal infective endocarditis (IE). Data were analysed retrospectively from 60 patients with suspected staphylococcal IE and 59 controls who were surgically treated at three cardiosurgery centres over 4 years. Both PCR tests showed high agreement and could be aggregated. In patients with definite and rejected IE, the clinical sensitivity and specificity of PCR reached 89 and 95%, respectively. Tissue culture (TC) and PCR agreed with blood culture (BC) in 29% and 67% of IE cases. TC helped to determine aetiology in five BC negative cases while PCR aided in nine cases. Out of 52 patients with conclusive staphylococcal IE, 40 were diagnosed with S. aureus and 12 with coagulase-negative staphylococci. PCR was shown to be highly superior to TC in confirming preoperative diagnosis of IE. In addition to aid in culture negative patients, PCR helped to establish or refine aetiology in inconclusive cases. We suggest that simultaneous br-PCR and ssm-PCR performed on surgical material together with histopathology could significantly increase the performance of current Duke criteria. PMID:21964590

  7. Efficacies of surgical treatments based on Harris hip score in elderly patients with femoral neck fracture

    PubMed Central

    Liang, Chengwei; Yang, Fengjian; Lin, Weilong; Fan, Yongqian

    2015-01-01

    Aim: To compare the efficacies of four surgical treatments, i.e., total hip arthroplasty (THA), internal fixation (IF), hemiarthroplasty (HA), and artificial femoral head replacement (artificial FHR), by performing a network meta-analysis based on Harris hip score (HHS) in elderly patients with femoral neck fracture. Methods: In strict accordance with specific inclusion and exclusion criteria, randomized controlled trails (RCTs) were screened and selected from a larger group of studies that were retrieved through a comprehensive search of scientific literature databases, further complimented by manual search. The resultant high-quality data from final selected studies were analyzed using Stata 12.0 software. Results: A total of 3680 studies were initially retrieved from database search, and 15 RCTs were eventually incorporated into this meta-analysis, containing 1781 elderly patients who had undergone various surgical treatments for femoral neck fracture (THA group = 604; HA group = 604; IF group = 495; artificial FHR group = 78). Our major result revealed a statistically significant difference in HHS of femoral neck fracture when HA and IF groups were compared with THA. No differences were detected in the HHS of femoral neck fracture undergoing artificial FHR and THA. The surface under the cumulative ranking curves (SUCRA) value of HHS, in elderly patients with femoral neck fracture after surgery, revealed that IF has the highest value. Conclusions: The current network meta-analysis results suggest that IF is the superlative surgical procedure for femoral neck fracture patients, and IF significantly improves the HHS in femoral neck fracture patients. PMID:26221216

  8. Treatment of pneumothorax as a complication of long-term central venous port placement in oncology patients. An observational study.

    PubMed

    Biffi, R; Pozzi, S; Cenciarelli, S; Zambelli, M; Andreoni, B

    2001-01-01

    Background and purpose.In percutaneous placement of central venous catheters an inadvertent, direct lesion of the lung parenchyma can occur. This is a cause of iatrogenic pneumothorax, whose incidence is approximately 1 to 4%, largely dependent on the experience of the operator, the site of venipuncture and proba-bly the technique employed. Initial treatment currently ranges from observation alone to formal tube-thoracostomy. In an attempt to define the best initial treatment, if any, we reviewed our personal series and contributions from the literature. As a result we have produced a flow-chart proposing a rational treatment of this frequent complication. Patients and Methods.One thousand four hundred twenty-one ports were placed in patients at the Department of Surgery of the European Institute of Oncology in Milan through an infraclavicular standardized percutaneous subclavian approach. They were placed during the 60-month period from January 1, 1996 to December 31, 2000 for long-term chemotherapy treatment of solid tumours. Chest upright X-rays were obtained post-operatively in all cases to check the correct position of the catheter tip and the presence of pneumothorax. Results.Twenty-two patients out of 1421 (1.54%) experienced a radiologically-proven pneumothorax, ranging from 5 to 70% of the affected pleural space. Sixteen patients out of 22 (72.7%) with minor portions of affected pleural space received simple observation. In these patients the most common finding was an uncomplicated tachycardia (more than 100 beats/min); 8 of them did not complain of any symptoms. Six patients (27.2%) un-derwent an additional procedure (3 tube-thoracostomies and 3 aspirations of the pleural space), claiming symptoms of chest pain and various degrees of dyspnea. Tube thoracostomy was mainly adopted at the beginning of our experience, and in patients with a severe degree of pleural involvement (55 to 70% of the pleural space). Aspiration, instead, was used more recently and in patients with varying degrees of pleural space involved, ranging from 40 to 60%. Conclusions.Looking at our own series and literature data, patients with iatrogenic pneumothorax following central venous cannulation who do not have a severe underlying pulmonary disease can be reassured, at the time of diagnosis, that surgery is usually unnecessary and tube thoracostomy is rarely needed. Simple aspiration of the pleural air by means of a central venous catheter inserted percutaneously into the pleural space under local anesthesia should be considered, even if the amount of affected pleural space is more than 50%, before opting for a formal tube-thoracostomy using small-bore tubes. PMID:17638275

  9. Results of Surgical Treatment on Benign Anal Diseases in Korean HIV-Positive Patients

    PubMed Central

    2014-01-01

    Perianal diseases are the most common reasons for surgery in HIV-positive patients. This study aimed to evaluate the outcomes of these surgical procedures in Korean patients, focusing on wound healing and postoperative complications. Retrospective analysis was performed on 72 HIV-positive patients who underwent surgery by a single surgeon for benign anal disease between 1998 and 2011. Of these, 68.1% (49/72) of patients received surgery for condyloma acuminata, 19.4% (14/72) for anal fistulas, 6.9% (5/72) for hemorrhoids, and 5.6% (4/72) for perianal abscesses. Patients with condyloma acuminata received surgical excision with electrical coagulation, and all wounds healed completely within 3 months, though 16.3% (8/49) of these patients experienced recurrence. Twelve of the 49 patients (24.5%) who were treated for condyloma acuminata underwent simultaneous operations for concomitant anal fistulas (n = 6), hemorrhoids (n = 4), and perianal abscesses (n = 2). Overall, 3 postoperative complications developed following a total of 94 procedures, and there was no significant increase in complication rate for patients with a low CD4+ T-cell count ( < 200/µL) compared to those with a higher count. The results demonstrate favorable results following perianal surgery in HIV-positive Korean patients. PMID:25246745

  10. Quality of dying in head and neck cancer patients: the role of surgical palliation.

    PubMed

    Chan, Jimmy Yu Wai; To, Victor Shing Howe; Wong, Stanley Tien Sze; Wei, William Ignace

    2013-02-01

    To study the role of surgery for symptom palliation in patients with advanced head and neck malignancy. Between 2000 and 2011, patients with locoregionally advanced cancer in the head and neck region, who chose surgical palliation for symptom control, were studied retrospectively. During the study period, 52 patients were included. The index tumour included carcinoma of the maxilla (23.1 %), tongue (19.2 %), larynx/hypopharynx (15.4 %), post-radiation sarcoma (11.5 %), primary sarcoma (11.5 %), carcinoma of the lower alveolus (11.5 %), nasal mucosal melanoma (3.9 %) and metastatic tumour in the head and neck region (3.9 %). The major symptoms included bleeding (53.9 %), tumour pain (19.2 %), dysphagia (11.5 %), non-healing ulcerations (7.7 %), airway obstruction (5.8 %) and pathological fracture of the mandible (1.9 %). Ligation of the carotid artery was performed in 10 patients, complete resection of tumour in 35, and surgical debulking of the tumour in 7 patients. Mean survival of the patients was 5.6 months. The majority of the patients achieved satisfactory and persistent control of symptoms. One patient died from pneumonia during the hospital stay, and the rest were discharged after a mean duration of 16.4 days. In selected patients, surgery is effective in palliating symptoms which are otherwise difficult to manage. Detailed planning and good communication is the key to success in improving the quality of dying. PMID:22669270

  11. Surgical Management of Mitral Regurgitation in Patients with Marfan Syndrome during Infancy and Early Childhood

    PubMed Central

    Kim, Eung Re; Kim, Woong-Han; Choi, Eun Seok; Cho, Sungkyu; Jang, Woo Sung; Kim, Yong Jin

    2015-01-01

    Background Mitral regurgitation is one of the leading causes of cardiovascular morbidity in pediatric patients with Marfan syndrome. The purpose of this study was to contribute to determining the appropriate surgical strategy for these patients. Methods From January 1992 to May 2013, six patients with Marfan syndrome underwent surgery for mitral regurgitation in infancy or early childhood. Results The median age at the time of surgery was 47 months (range, 3 to 140 months) and the median follow-up period was 3.6 years (range, 1.3 to 15.5 years). Mitral valve repair was performed in two patients and four patients underwent mitral valve replacement with a mechanical prosthesis. There was one reoperation requiring valve replacement for aggravated mitral regurgitation two months after repair. The four patients who underwent mitral valve replacement did not experience any complications related to the prosthetic valve. One late death occurred due to progressive emphysema and tricuspid regurgitation. Conclusion Although repair can be an option for some patients, it may not be durable in infantile-onset Marfan syndrome patients who require surgical management during infancy or childhood. Mitral valve replacement is a feasible treatment option for these patients. PMID:25705592

  12. Retracted: Factors affecting hospital readmission rates for breast cancer patients in Western Australia.

    PubMed

    Martin, Michael A; Meyricke, Ramona; O'Neill, Terry; Roberts, Steven

    2007-01-17

    By this notice, the Editor and the Publisher of the Journal of Surgical Oncology retract from publication the following article: "Factors Affecting Hospital Readmission Rates for Breast Cancer Patients in Western Australia," Michael A. Martin, Ramona Meyricke, Terry O'Neill, and Steven Roberts, Journal of Surgical Oncology, Published online January 17, 2007, DOI: 10.1002/jso.20742. The article has been formally deemed a duplicate submission. The Editor and the Publisher of the Journal of Surgical Oncology regret the occurrence of this unfortunate incident. PMID:17230541

  13. Non surgical predicting factors for patient satisfaction after third molar surgery

    PubMed Central

    Balaguer-Martí, José-Carlos; Aloy-Prósper, Amparo; Peñarrocha-Oltra, David

    2016-01-01

    Background In the third molar surgery, it is important to focus not only on surgical skills, but also on patient satisfaction. Classically studies have been focused on surgery and surgeon’s empathy, but there are non-surgical factors that may influence patient satisfaction. Material and Methods A cross-sectional study was performed on 100 patients undergoing surgical extractions of impacted mandibular third molars treated from October 2013 to July 2014 in the Oral Surgery Unit of the University of Valencia. A questionnaire (20 questions) with a 10-point Likert scale was provided. The questionnaire assessed the ease to find the center, the ease to get oriented within the center, the burocratic procedures, the time from the first visit to the date of surgical intervention, waiting time in the waiting room, the comfort at the waiting room, the administrative staff (kindness and efficiency to solve formalities), medical staff (kindness, efficiency, reliability, dedication), personal data care, clarity in the information received (about the surgery, postoperative care and resolution of the doubts), available means and state of facilities. Outcome variables were overall satisfaction, and recommendation of the center. Statistical analysis was made using the multiple linear regression analysis. Results Significant correlations were found between all variables and overall satisfaction. The multiple regression model showed that the efficiency of the surgeon and the clarity of the information were statistically significant to overall satisfaction and recommendation of the center. The kindness of the administrative staff, available means, the state of facilities and the comfort at the waiting room were statistically significant to the recommendation of the center. Conclusions Patient satisfaction directly depends on the efficiency of the surgeon and clarity of the clinical information received about the procedure. Appreciation of these predictive factors may help clinicians to provide optimal care for impacted third molar surgery patients. Key words:Patient satisfaction, third molar, questionnaire. PMID:26827054

  14. Optimizing Patient Preparation and Surgical Experience Using eHealth Technology

    PubMed Central

    Forshaw, Kristy; Carey, Mariko; Robinson, Sancha; Kerridge, Ross; Proietto, Anthony; Sanson-Fisher, Rob

    2015-01-01

    With population growth and aging, it is expected that the demand for surgical services will increase. However, increased complexity of procedures, time pressures on staff, and the demand for a patient-centered approach continue to challenge a system characterized by finite health care resources. Suboptimal care is reported in each phase of surgical care, from the time of consent to discharge and long-term follow-up. Novel strategies are thus needed to address these challenges to produce effective and sustainable improvements in surgical care across the care pathway. The eHealth programs represent a potential strategy for improving the quality of care delivered across various phases of care, thereby improving patient outcomes. This discussion paper describes (1) the key functions of eHealth programs including information gathering, transfer, and exchange; (2) examples of eHealth programs in overcoming challenges to optimal surgical care across the care pathway; and (3) the potential challenges and future directions for implementing eHealth programs in this setting. The eHealth programs are a promising alternative for collecting patient-reported outcome data, providing access to credible health information and strategies to enable patients to take an active role in their own health care, and promote efficient communication between patients and health care providers. However, additional rigorous intervention studies examining the needs of potential role of eHealth programs in augmenting patients’ preparation and recovery from surgery, and subsequent impact on patient outcomes and processes of care are needed to advance the field. Furthermore, evidence for the benefits of eHealth programs in supporting carers and strategies to maximize engagement from end users are needed. PMID:26330206

  15. [Remarks on the physician-patient relationship with cancer patients. Prerequisites, function, and goal of so-called Balint groups in an internal-oncological department].

    PubMed

    Meerwein, F; Kauf, S; Schneider, G

    1976-01-01

    Drawing on their experience with their own cancer patients and with the Balint Group in the Oncological Department of Zürich's University Hospital, the authors describe the special problems arising in the doctor-patient relationship in this field. They show how the diagnosis of cancer can give rise to a feeling of sudden and complete object loss in the patient, thereby confronting the doctor with his own fear of death. The mobilization of archaic defence mechanisms in both the doctor and the patients can lead to an insoluble double-blind situation unless the doctor is able to give up his defence position and thus make it possible for the patient to give up his own fear of death and to accept the nature of his illness. The authors show how the doctor can break through the isolation of the patient in whose body-ego an archaic bad inner-object has been activated by the cancer, and build up good inner objects for him again. In the last chapter Winnicott's idea the "intermediate area" is shown to shed a new light on the phenomenon of redenial or belief in immortality. PMID:961096

  16. Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

    PubMed Central

    Fu, YT Nancy; Hong, Thomas; Round, Andrew; Bressler, Brian

    2014-01-01

    AIM: To evaluate the impact of medical therapy on Crohn’s disease patients undergoing their first surgical resection. METHODS: We retrospectively evaluated all patients with Crohn’s disease undergoing their first surgical resection between years 1995 to 2000 and 2005 to 2010 at a tertiary academic hospital (St. Paul’s Hospital, Vancouver, Canada). Patients were identified from hospital administrative database using the International Classification of Diseases 9 codes. Patients’ hospital and available outpatient clinic records were independently reviewed and pertinent data were extracted. We explored relationships among time from disease diagnosis to surgery, patient phenotypes, medication usage, length of small bowel resected, surgical complications, and duration of hospital stay. RESULTS: Total of 199 patients were included; 85 from years 1995 to 2000 (cohort A) and 114 from years 2005 to 2010 (cohort B). Compared to cohort A, cohort B had more patients on immunomodulators (cohort A vs cohort B: 21.4% vs 56.1%, P < 0.0001) and less patients on 5-aminosalysilic acid (53.6% vs 29.8%, P = 0.001). There was a shift from inflammatory to stricturing and penetrating phenotypes (B1/B2/B3 38.8% vs 12.3%, 31.8% vs 45.6%, 29.4% vs 42.1%, P < 0.0001). Both groups had similar median time to surgery. Within cohort B, 38 patients (33.3%) received anti-tumor necrosis factor (TNF) agent. No patient in cohort A was exposed to anti-TNF agent. Compared to patients not on anti-TNF agent, ones exposed were younger at diagnosis (anti-TNF vs without anti-TNF: A1/A2/A3 39.5% vs 11.8%, 50% vs 73.7%, 10.5% vs 14.5%, P = 0.003) and had longer median time to surgery (90 mo vs 48 mo, P = 0.02). Combination therapy further extended median time to surgery. Using time-dependent multivariate Cox proportional hazard model, patients who were treated with anti-TNF agents had a significantly higher risk to surgery (adjusted hazard ratio 3.57, 95%CI: 1.98-6.44, P < 0.0001) compared to those without while controlling for gender, disease phenotype, smoking status, and immunomodulator use. CONCLUSION: Significant changes in patient phenotypes and medication exposures were observed between the two surgical cohorts separated by a decade. PMID:25206286

  17. Surgical Outcomes of Laparoscopic Liver Resection in Elderly Patients: A Comparative Study From a Single Center.

    PubMed

    Uchida, Hiroki; Iwashita, Yukio; Watanabe, Kiminori; Takayama, Hiroomi; Kawasaki, Takahide; Yada, Kazuhiro; Ohta, Masayuki; Kitano, Seigo; Inomata, Masafumi

    2015-08-01

    The life expectancy continues to gradually increase worldwide. Laparoscopic liver resection (LLR) was recently reported to be a relatively safe procedure for treatment of liver disease because of the development of new techniques and instruments. The aim of this study was to evaluate the surgical outcomes of elderly patients who underwent LLR. Of these 61 patients who underwent LLR in our institute from January 2010 through April 2014, 21 were aged 75 years and above (group E), and 40 were aged below 75 years (group NE). Patient characteristics were retrospectively analyzed between the 2 groups. The results showed that patient characteristics were similar between the 2 groups, although the incidence of hypertension was significantly greater among patients in group E. There were no significant differences in the incidence of postoperative complications or length of hospital stay between the 2 groups. In conclusion, LLR for elderly patients was a feasible procedure compared with nonelderly patients. PMID:26121548

  18. Detection of serum cytokines before and after pharmacological and surgical treatment in patients with cystic echinococcosis.

    PubMed

    Naik, M I; Tenguria, R K; Haq, E

    2016-01-01

    Human cystic echinococcosis (CE), caused by Echinococcus granulosus, is one of the most important and widespread parasitic zoonoses. One of the problems that can be encountered after treating CE patients is the risk of post-surgical relapses or treatment failure, thus a long-term clinical and serological follow-up is required to evaluate the success or failure of therapy. In the present study immunological markers have been identified to indicate the effectiveness of pharmacological and surgical treatments. The relationship between serum cytokine levels and the outcome of chemotherapy and surgery was evaluated in 50 patients with CE. Serum interleukin (IL)-4, IL-10 and interferon-gamma (IFN-γ) concentrations were determined by enzyme-linked immunosorbent assay (ELISA) before and after pharmacological and surgical treatment. Serum cytokine levels of IL-4, IL-10 and IFN-γ were elevated in a significant proportion of patients during the active stage of disease. IL-4, IL-10 and IFN-γ were measurable in 41 (82%), 37 (74%) and 25 (50%) patients before the treatment. Clinical and radiological assessment of patients 2 years after pharmacological treatment has shown that 48 of 50 patients responded to treatment. IL-4 and IL-10 levels were decreased significantly (P< 0.05) in these patients. Conversely, patients who did not respond showed high levels of IL-4 and IL-10 and undetectable levels of IFN-γ. Hence these results suggest that serum IL-4 and IL-10 detection may be useful in the follow-up of patients with CE. PMID:25726962

  19. Surgical smoke.

    PubMed

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

    2009-10-01

    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown. PMID:19892630

  20. Cancer-related neuropathic pain in out-patient oncology clinics: a European survey

    PubMed Central

    2013-01-01

    Background Although pain is frequently experienced by patients with cancer, it remains under-treated. The primary aim of this study was to estimate the prevalence of cancer-related neuropathic pain (CRNP) in patients with chronic pain who attended an outpatient clinic for standard care in Europe (irrespective of the reason or stage of the cancer). The secondary aims of this study were to characterise pain and cancer in patients with CRNP (including treatment) and to evaluate the usefulness of the painDETECT (PD-Q) screening tool to help physicians identify a potential neuropathic component of cancer-related pain. Methods An observational, non-interventional, cross-sectional, multi-centre study of adult patients with cancer using patient and physician case report forms (CRFs). Patients with CRNP were identified by physicians’ clinical assessments after examining the completed PD-Q. Results A total of 951 patients visiting outpatient clinics across Europe were enrolled in this study between August 2010 and July 2011. Of these, 310 patients (32.60%; 95% confidence interval 29.62, 35.58) were identified as having CRNP. Twenty-nine of 39 (74.4%) physicians who completed the CRF relating to the PD-Q considered it a useful tool to help detect CRNP in daily practice and 28 of 39 (71.8%) indicated that they would use this tool in the future for most or some of their patients. Data from physicians before and after review of the completed PD-Qs showed a shift in clinical opinion (either to positive CRNP diagnosis [yes] or negative CRNP diagnosis [no]) in respect of 142 patients; about half of which (74) were categorised with an initial diagnosis of unknown. Opinions also shifted from a no to a yes diagnosis in 10 patients and from a yes to a no diagnosis in 51 patients. Conclusions Approximately one-third of adults with cancer experiencing chronic pain attending outpatient clinics as part of routine care were considered to have CRNP in the opinion of the physicians after considering scores on the PD-Q. While physicians did not consider the PD-Q to be a useful tool for all patients, shifts in diagnosis before and after the use of this tool indicate that it may help physicians identify CRNP, especially where there is initial uncertainty. PMID:24200014

  1. Investigation of realistic PET simulations incorporating tumor patient's specificity using anthropomorphic models: Creation of an oncology database

    SciTech Connect

    Papadimitroulas, Panagiotis; Efthimiou, Nikos; Nikiforidis, George C.; Kagadis, George C.; Loudos, George; Le Maitre, Amandine; Hatt, Mathieu; Tixier, Florent; Visvikis, Dimitris

    2013-11-15

    Purpose: The GATE Monte Carlo simulation toolkit is used for the implementation of realistic PET simulations incorporating tumor heterogeneous activity distributions. The reconstructed patient images include noise from the acquisition process, imaging system's performance restrictions and have limited spatial resolution. For those reasons, the measured intensity cannot be simply introduced in GATE simulations, to reproduce clinical data. Investigation of the heterogeneity distribution within tumors applying partial volume correction (PVC) algorithms was assessed. The purpose of the present study was to create a simulated oncology database based on clinical data with realistic intratumor uptake heterogeneity properties.Methods: PET/CT data of seven oncology patients were used in order to create a realistic tumor database investigating the heterogeneity activity distribution of the simulated tumors. The anthropomorphic models (NURBS based cardiac torso and Zubal phantoms) were adapted to the CT data of each patient, and the activity distribution was extracted from the respective PET data. The patient-specific models were simulated with the Monte Carlo Geant4 application for tomography emission (GATE) in three different levels for each case: (a) using homogeneous activity within the tumor, (b) using heterogeneous activity distribution in every voxel within the tumor as it was extracted from the PET image, and (c) using heterogeneous activity distribution corresponding to the clinical image following PVC. The three different types of simulated data in each case were reconstructed with two iterations and filtered with a 3D Gaussian postfilter, in order to simulate the intratumor heterogeneous uptake. Heterogeneity in all generated images was quantified using textural feature derived parameters in 3D according to the ground truth of the simulation, and compared to clinical measurements. Finally, profiles were plotted in central slices of the tumors, across lines with heterogeneous activity distribution for visual assessment.Results: The accuracy of the simulated database was assessed against the original clinical images. The PVC simulated images matched the clinical ones best. Local, regional, and global features extracted from the PVC simulated images were closest to the clinical measurements, with the exception of the size zone variability and the mean intensity values, where heterogeneous tumors showed better reproducibility. The profiles on PVC simulated tumors after postfiltering seemed to represent the more realistic heterogeneous regions with respect to the clinical reference.Conclusions: In this study, the authors investigated the input activity map heterogeneity in the GATE simulations of tumors with heterogeneous activity distribution. The most realistic heterogeneous tumors were obtained by inserting PVC activity distributions from the clinical image into the activity map of the simulation. Partial volume effect (PVE) can play a crucial role in the quantification of heterogeneity within tumors and have an important impact on applications such as patient follow-up during treatment and assessment of tumor response to therapy. The development of such a database incorporating patient anatomical and functional variability can be used to evaluate new image processing or analysis algorithms, while providing control of the ground truth, which is not available when dealing with clinical datasets. The database includes all images used and generated in this study, as well as the sinograms and the attenuation phantoms for further investigation. It is freely available to the interested reader of the journal at http://www.med.upatras.gr/oncobase/.

  2. Surgical repair of chronic complete hamstring tendon rupture in the adult patient.

    PubMed

    Cross, M J; Vandersluis, R; Wood, D; Banff, M

    1998-01-01

    Complete rupture of the hamstring tendons in the adult is a rare injury. This report discusses complete rupture of the hamstring tendons in nine patients treated by late operative repair. All patients were referred from outside centers for a second opinion after failed nonoperative treatment. The diagnosis was made quite easily on clinical grounds and was confirmed at surgery. Surgical treatment in all cases consisted of reattachment of the hamstring tendons to the origin on the ischium, and in all cases it was necessary to perform neurolysis of the sciatic nerve. Good results were achieved in all cases, at follow-up all patients were satisfied with the surgery. PMID:9850779

  3. SURGICAL TREATMENT OF UNSTABLE PELVIC RING FRACTURE IN SKELETALLY IMMATURE PATIENTS

    PubMed Central

    Guimarães, Joao Antonio Matheus; de Souza Portes Meirelles, Ricardo; Júnior, Luiz Augusto Peçanha Tavares; Goldsztajn, Flávio; Rocha, Tito; Mendes, Pedro Henrique Barros

    2015-01-01

    Objectives: To present the outcomes from definitive surgical treatment for unstable fractures of the pelvic ring in children undergoing surgical reduction and stabilization. Methods: We studied 10 patients with immature skeletons who suffered unstable fractures of the pelvic ring and were treated between March 2004 and January 2008. The study was retrospective, based on clinical and radiographic evaluations. Results: The mean age at the time of the trauma was 8.8 years (2 to 13 years). Seven patients were female and three was male. There were eight cases of trauma caused by being run over, and one case each of a motorcycle accident and falling from a height. Five patients had other associated injuries such as fractures of the clavicle, femoral diaphysis, proximal humerus, lower leg bones, olecranon and bladder injury. All the patients evaluated showed an excellent clinical outcome. The pelvic asymmetry before surgery ranged from 0.7 to 2.9 cm (mean 1.45 cm), and dropped to values between 0.2 and 0.9 cm (mean 0.39 cm) after reduction. In no case was any change observed in pelvic asymmetry measured in the immediate postoperative period and at the end of follow-up. Conclusion: Pelvic ring fractures in skeletally immature patients are rare and surgical treatment is unusual. Several authors have questioned conservative treatment because of the complications encountered. Bone remodeling does not seem enough to cause an improvement in pelvic asymmetry, and this justifies the choice of surgical treatment for reduction and correction of pelvic ring deformities.

  4. Higher Plasma Pyridoxal Phosphate Is Associated with Increased Antioxidant Enzyme Activities in Critically Ill Surgical Patients

    PubMed Central

    Cheng, Chien-Hsiang; Huang, Shih-Chien; Chiang, Ting-Yu; Wong, Yueching

    2013-01-01

    Critically ill patients experience severe stress, inflammation and clinical conditions which may increase the utilization and metabolic turnover of vitamin B-6 and may further increase their oxidative stress and compromise their antioxidant capacity. This study was conducted to examine the relationship between vitamin B-6 status (plasma and erythrocyte PLP) oxidative stress, and antioxidant capacities in critically ill surgical patients. Thirty-seven patients in surgical intensive care unit of Taichung Veterans General Hospital, Taiwan, were enrolled. The levels of plasma and erythrocyte PLP, serum malondialdehyde, total antioxidant capacity, and antioxidant enzyme activities (i.e., superoxide dismutase (SOD), glutathione S-transferase, and glutathione peroxidase) were determined on the 1st and 7th days of admission. Plasma PLP was positively associated with the mean SOD activity level on day 1 (r = 0.42, P < 0.05), day 7 (r = 0.37, P < 0.05), and on changes (Δ (day 7 − day 1)) (r = 0.56, P < 0.01) after adjusting for age, gender, and plasma C-reactive protein concentration. Higher plasma PLP could be an important contributing factor in the elevation of antioxidant enzyme activity in critically ill surgical patients. PMID:23819116

  5. Quality analysis of patient information on surgical treatment of haemorrhoids on the internet

    PubMed Central

    D’Souza, ND

    2013-01-01

    Introduction Haemorrhoids are the most common benign condition seen by colorectal surgeons. At clinic appointments, advice given about lifestyle modification or surgical interventions may not be understood fully by patients. Patients may use the internet for further research into their condition. However, the quality of such information has not been investigated before. This study assessed the quality of patient information on surgical treatment of haemorrhoids on the internet. Methods Four searches were carried out using the search terms ‘surgery for haemorrhoids’ and ‘surgery for piles’ on two search engines (Google and Yahoo). The first 50 results for each search were assessed. Sites were evaluated using the DISCERN instrument. Results In total, 200 websites were assessed, of which 144 fulfilled the inclusion criteria. Of these, 63 (44%) were sponsored by herbal remedies for haemorrhoids. Eighty-nine (62%) mentioned conservative treatment options but eleven (8%) did not include surgery in their treatment options. Only 38 sites (27%) mentioned recurrence of haemorrhoids following surgery and 28 sites (20%) did not list any complications. Overall, 19 websites (14%) were judged as being of high quality, 66 (45%) as moderate quality and 58 (40%) as low quality. Conclusions The quality of information on the internet is highly variable and a significant proportion of websites assessed are poor. The majority of websites are sponsored by private companies selling alternative treatments for haemorrhoids. Clinicians should be prepared to advise their patients which websites can provide high-quality information on the surgical treatment of haemorrhoids. PMID:23838496

  6. Lived experiences and challenges of older surgical patients during hospitalization for cancer: An ethnographic fieldwork

    PubMed Central

    Høybye, Mette Terp

    2014-01-01

    This paper explores the lived experiences of older surgical patients’ (aged 74 years and older) experienced challenges during a brief admission to hospital. Age, gender, polypharmacy, and the severity of illness are also factors known to affect the hospitalization process. For an ethnographic study using participant observation and interviews, surgical cancer patients (n = 9, aged 74 years and older) were recruited during admission to a Danish teaching hospital. Using ethnographic strategies of participant observation and interviews, each patient was followed through the course of 1 day during their stay at the hospital. Interviews were carried out with all patients during this time. Three areas of concern were identified as prominent in the patients’ experiences and challenges during their short hospital stay: teeth and oral cavity, eating in a hospital setting, and medication during hospitalization. Short-term hospitalization requires focused collaboration between staff and patient concerning individual challenges from their teeth and oral cavity as support of nutritional needs during surgical treatment for cancer. PMID:24559546

  7. Oncologic Impact of Fewer Than 12 Lymph Nodes in Patients Who Underwent Neoadjuvant Chemoradiation Followed by Total Mesorectal Excision for Locally Advanced Rectal Cancer

    PubMed Central

    Kim, Woo Ram; Han, Yoon Dae; Cho, Min Soo; Hur, Hyuk; Min, Byung Soh; Lee, Kang Young; Kim, Nam Kyu

    2015-01-01

    Abstract A minimum of 12 harvested lymph nodes (hLNs) are recommended in colorectal cancer. However, a paucity of hLNs is frequently presented after preoperative chemoradiation (pCRT) in rectal cancer and the significance of this is still uncertain. The aim of this study is to analyze the impact of hLNs on long-term oncologic outcomes. A total of 302 patients with locally advanced rectal cancer who underwent pCRT and curative resection between 1989 and 2009 were reviewed. Patients were categorized into 2 groups according to the number of hLNs: <12 versus ?12 LN. The 2 groups were compared with respect to 5-year disease-free and overall survival. The optimal number or ratio of hLNs was investigated in subgroup analysis according to LN status. The median follow-up was 57 months. Patient characteristics other than age did not differ between the 2 groups. The group with <12 LNs had more favorable ypTNM and ypN stage than those with ?12 LNs. However, the long-term oncologic outcomes were not significantly different between the 2 groups. In subgroup analysis of ypN(?), the group with <5 hLNs had the most favorable oncologic outcomes. In ypN(+) cases, a higher LN ratio tended to be associated with poorer 5-year overall survival. The paucity of hLNs in locally advanced rectal cancer after chemoradiation did not imply poor oncologic outcomes in this study. In addition, <5 hLNs in ypN(?) patients could reflect a good tumor response rather than suboptimal radicality. PMID:26181550

  8. Recruiting minority cancer patients into cancer clinical trials: a pilot project involving the Eastern Cooperative Oncology Group and the National Medical Association. | accrualnet.cancer.gov

    Cancer.gov

    This paper may be useful for researchers interested in enhancing their interactions with community physicians and increasing the number of minority patients referred to clinical trials. It describes a study conducted by the Eastern Cooperative Oncology Group (ECOG) in collaboration with the National Medical Association (NMA) to better understand barriers and solutions to African-American (AA) accrual and to test several recommended low-cost strategies.

  9. Detection of Small Pulmonary Nodules with Ultrashort Echo Time Sequences in Oncology Patients by Using a PET/MR System.

    PubMed

    Burris, Nicholas S; Johnson, Kevin M; Larson, Peder E Z; Hope, Michael D; Nagle, Scott K; Behr, Spencer C; Hope, Thomas A

    2016-01-01

    Purpose To investigate the utility of a free-breathing ultrashort echo time (UTE) sequence for the evaluation of small pulmonary nodules in oncology patients by using a hybrid positron emission tomography (PET)/magnetic resonance (MR) imaging system and to compare the nodule detection rate between UTE and a conventional three-dimensional gradient-recalled-echo (GRE) technique. Materials and Methods In this HIPAA-compliant, institutional review board-approved prospective study, 82 pulmonary nodules were identified in eight patients with extrathoracic malignancies. Patients underwent free-breathing UTE and dual-echo three-dimensional GRE imaging of the lungs in a hybrid PET/MR imaging unit immediately after clinical PET/computed tomography (CT). CT was considered the reference standard for nodule detection. Two reviewers identified nodules and obtained measurements on MR images. The McNemar test was used to evaluate differences in nodule detection rate between MR techniques, and interrater agreement was assessed by using Bland-Altman plots. Results Mean nodule diameter ± standard deviation was 6.2 mm ± 2.7 (range, 3-17 mm). The detection rate was higher for UTE imaging than for dual-echo GRE imaging for nodules of at least 4 mm (82% vs 34%, respectively; P < .001), with the largest difference in detection noted in the 4-8-mm nodule group (79% vs 21%, P < .001). UTE imaging displayed a higher detection rate than dual-echo GRE imaging for nodules without fluorodeoxyglucose avidity (68% vs 22%, respectively; P < .001). Interrater reliability of nodule detection with MR imaging was high (? = 0.90 for UTE imaging and ? = 0.92 for dual-echo GRE imaging). Conclusion A free-breathing UTE sequence has high sensitivity for the detection of small pulmonary nodules (4-8 mm) and outperformed a three-dimensional dual-echo GRE technique for the detection of small, non-fluorodeoxyglucose-avid nodules. (©) RSNA, 2015. PMID:26133050

  10. Catheter-associated bloodstream infections in pediatric hematology-oncology patients: factors associated with catheter removal and recurrence.

    PubMed

    Adler, Amos; Yaniv, Isaac; Solter, Ester; Freud, Enrique; Samra, Zmira; Stein, Jerry; Fisher, Salvador; Levy, Itzhak

    2006-01-01

    The aims of this study were to analyze the factors associated with antibiotic failure leading to tunneled central venous catheter (CVC) removal during catheter-associated bloodstream infections (CABSIs) and with recurrence and reinfection in children with cancer. All cases of CABSI in patients attending the Department of Pediatric Hematology-Oncology between November 2000 and November 2003 were reviewed. A total of 207 episodes of CABSI, including multiple episodes involving the same catheter, were identified in 146 of 410 tunneled CVCs (167 Hickman, 243 implantable ports). The most common organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in 96 (46%) episodes. Hypotension, persistent bacteremia, previous stem cell transplantation, multiple CABSIs in the same CVC, exit-site infection, inappropriate empiric antibiotic therapy, and Candida infection were all significantly associated with increased risk of catheter removal (P < 0.05, odds ratios 7.81, 1.14, 2.22, 1.93, 3.04, 2.04 and 24.53, respectively). There were 12 episodes of recurrent infection, all except 1 caused by CONS (odds ratio 20.5, P = 0.006). Inappropriate empiric therapy, especially in implantable ports, was the only mutable risk factor for antibiotic failure. Because CONS was the predominant isolate in these devices, adding glycopeptides to the empiric therapy for suspected implantable-port CABSI might decrease the removal rate. This issue should be explored in future controlled trials. PMID:16394888

  11. Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

    PubMed Central

    Eggspuehler, Andreas; Grob, Dieter; Porchet, Francois; Jeszenszky, Dezsö; Dvorak, Jiri

    2007-01-01

    A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objective of this study was to determine the sensitivity and specificity of MIOM techniques used to monitor conus medullaris, cauda equina and nerve root function during lumbosacral decompression surgery. MIOM has increasingly become important to monitor ascending and descending pathways, giving immediate feedback information regarding any neurological deficit during the decompression and stabilisation procedure in the lumbosacral region. Intraoperative spinal- and cortical-evoked potentials, combined with continuous EMG- and motor-evoked potentials of the muscles, were evaluated and compared with postoperative clinical neurological changes. A total of 409 consecutive patients with lumbosacral spinal stenosis with or without instability were monitored by MIOM during the entire surgical procedure. A total of 388 patients presented true-negative findings while two patients presented false negative and 1 patient false-positive findings. Eighteen patients presented true-positive findings where neurological deficit after the operation was intraoperatively predicted. Of the 18 true-positive findings, 12 patients recovered completely; however, 6 patients recovered only partially. The sensitivity of MIOM applied during decompression and fusion surgery of the lumbosacral region was calculated as 90%, and the specificity was calculated as 99.7%. On the basis of the results of this study, MIOM is an effective method of monitoring the conus medullaris, cauda equina and nerve root function during surgery at the lumbosacral junctions and might reduce postoperative surgical-related complications and therefore improve the long-term results. PMID:17912559

  12. Obstructive Sleep Apnea in Patients Undergoing Endoscopic Surgical Repair of Cerebrospinal Fluid Rhinorrhea†‡§¶

    PubMed Central

    Fleischman, Gitanjali M.; Ambrose, Emily C.; Rawal, Rounak B.; Huang, Benjamin Y.; Ebert, Charles S.; Rodriguez, Kenneth D.; Zanation, Adam M.; Senior, Brent A.

    2014-01-01

    OBJECTIVE To examine the relationship between Cerebrospinal Fluid (CSF) Rhinorrhea and Obstructive Sleep Apnea (OSA). STUDY DESIGN Retrospective chart-review of patients who underwent surgical repair of encephaloceles and/or CSF rhinorrhea at a tertiary medical center over a 12 year period. METHODS Pertinent demographic, clinical and surgical data including age, sex, medical and surgical history was obtained. Patients were classified by etiology of CSF leak into a spontaneous leak group and a non-spontaneous leak group, which included patients with documented trauma, malignancy, or known iatrogenic injury. RESULTS We retrospectively identified126 patients who underwent repair of encephalocele or CSF rhinorrhea. Of these, 70 (55.5%) were found to have a spontaneous etiology, while 56 (44.4%) had a non-spontaneous cause. Patients with spontaneous CSF rhinorrhea were more likely than their non-spontaneous counterparts to have a diagnosis of obstructive sleep apnea (OSA, 30.0% versus 14.3%, p=0.0294) and radiographic evidence of an empty sella on MRI (55.4% vs. 24.3%, p=0.0027). Overall, patients in the spontaneous CSF rhinorrhea group were more likely to be female compared to the non-spontaneous group (84.3% versus 41.1% female, P=0.0001). CONCLUSIONS Our study shows that patients with spontaneous CSF rhinorrhea are significantly more likely to have a diagnosis of OSA compared to those with non-spontaneous causes of CSF leaks, or to the general population (incidence of 1-5% in various population studies). Given the known association between OSA and intracranial hypertension (ICH), it may be prudent to screen all patients with spontaneous CSF rhinorrhea for symptoms of OSA as well as for ICH, and vice versa. PMID:24591190

  13. Qualitative approach to patient-reported outcomes in oncology: protocol of a French study

    PubMed Central

    Orri, Massimiliano; Sibeoni, Jordan; Labey, Mathilde; Bousquet, Guilhem; Verneuil, Laurence; Revah-Levy, Anne

    2015-01-01

    Introduction The past decade has been characterised by movement from a doctor-centred to a patient-centred approach to treatment outcomes, in which doctors try to see the illness through their patients’ eyes. Patients, family members and doctors are the three participants in cancer care, but their perspectives about what have been helpful during cancer treatment have never simultaneously and explicitly compared in the same qualitative study. The aim of this study project is to explore patients’ perspectives about the care they receive, as well as families’ and doctors’ perspectives about what have been helpful for the patient. These three points of view will be compared and contrasted in order to analyse the convergences and divergences in these perspectives. Methods and analysis This is a national multicentre qualitative study. Participants will be constituted by three different subsamples: (1) patients with cancer (skin, breast, urological and lung cancers), (2) their relatives, and (3) their referring physicians. Recruitment will follow the purposive sample technique, and the final sample size will be determined by data saturation. Data will be collected through open-ended semistructured interviews and independently analysed with NVivo V.10 software by three researchers according to the principles of Interpretative Phenomenological Analysis. Ethics and dissemination The research protocol received approval from the University Paris Descartes review board (IRB number: 20140600001072), and participants will provide written consent. To the best of our knowledge, this is the first study to focus on the simultaneous exploration of the separate points of view of patients, families and doctors about the care received during the cancer care journey. We expect that our findings will help to improve communication and relationships between doctors, patients and families. Comparison of these three points of view will provide information about the convergences and divergences of these perspectives and how to address the needs of all three groups. PMID:26163035

  14. Surgical treatment of osseous metastases in patients with renal cell carcinoma.

    PubMed

    Dürr, H R; Maier, M; Pfahler, M; Baur, A; Refior, H J

    1999-10-01

    Forty-five patients who underwent surgical treatment for osseous metastases secondary to renal cell carcinoma between 1980 and 1998 were reviewed. The diagnosis was confirmed histologically in all patients. The mean age of the 34 men was 61.5 +/- 9 years and of the 11 women 55.2 +/- 17.6 years. The most common locations of the metastases were the spine (15 patients), the pelvis (eight patients), and the femur (11 patients). In 21 patients, the renal cell carcinoma was diagnosed when the osseous metastasis was detected. The time from diagnosis of the primary tumor to metastasis in the remaining patients ranged from 0 to 23 years (mean, 3 +/- 5 years). At presentation, 19 patients had a singular lesion. Nine patients had multiple osseous metastases and 17 patients had additional visceral involvement. In seven patients, a wide or radical resection was done; in 35 patients, a palliative procedure was done; and in three patients, only a diagnostic procedure was done. For the whole group, the survival was 49% after 1 year, 39% after 2 years, and 15% after 5 years. Only the extent of the disease and the latency period between primary tumor diagnosis and first detection of osseous metastasis could be identified as independent factors of survival. Nine patients with solitary metastasis to the bone more than 12 months after resection of the primary tumor showed a 5-year survival of 54%. PMID:10546626

  15. Patient-specific model of a scoliotic torso for surgical planning

    NASA Astrophysics Data System (ADS)

    Harmouche, Rola; Cheriet, Farida; Labelle, Hubert; Dansereau, Jean

    2013-03-01

    A method for the construction of a patient-specific model of a scoliotic torso for surgical planning via inter-patient registration is presented. Magnetic Resonance Images (MRI) of a generic model are registered to surface topography (TP) and X-ray data of a test patient. A partial model is first obtained via thin-plate spline registration between TP and X-ray data of the test patient. The MRIs from the generic model are then fit into the test patient using articulated model registration between the vertebrae of the generic model's MRIs in prone position and the test patient's X-rays in standing position. A non-rigid deformation of the soft tissues is performed using a modified thin-plate spline constrained to maintain bone rigidity and to fit in the space between the vertebrae and the surface of the torso. Results show average Dice values of 0:975 +/- 0:012 between the MRIs following inter-patient registration and the surface topography of the test patient, which is comparable to the average value of 0:976 +/- 0:009 previously obtained following intra-patient registration. The results also show a significant improvement compared to rigid inter-patient registration. Future work includes validating the method on a larger cohort of patients and incorporating soft tissue stiffness constraints. The method developed can be used to obtain a geometric model of a patient including bone structures, soft tissues and the surface of the torso which can be incorporated in a surgical simulator in order to better predict the outcome of scoliosis surgery, even if MRI data cannot be acquired for the patient.

  16. Surgical Therapy of Cervical Spine Fracture in Patients With Ankylosing Spondylitis.

    PubMed

    Ma, Jun; Wang, Ce; Zhou, Xuhui; Zhou, Shengyuan; Jia, Lianshun

    2015-11-01

    The present study aimed to explore surgical treatments and assess the effects based on the features of cervical spine fracture in patients with ankylosing spondylitis (AS) and to summarize the experiences in perioperative management. Retrospective analysis was performed in 25 AS patients with cervical spine fracture treated in our hospital from January 2011 to December 2013. The patients were divided according to fracture segments, including 4 cases at C4 to C5, 8 cases at C5 to C6, and 13 cases at C6 to C7. Among them, 12 belonged to I type, 5 to II type, and 8 to III type based on the improved classification method for AS cervical spine fracture. The Subaxial Cervical Spine Injury Classification score for these patients was 7.2?±?1.3, and the assessment of their neurological function states showed 6 patients (24%) were in American Spinal Injury Association (ASIA) A grade, 1 (4%) in ASIA B grade, 3 (12%) in ASIA C grade, 12 (48%) in ASIA D grade, and 3 (12%) in ASIA E grade. Surgical methods contained simple anterior approach alone, posterior approach alone, and combined posterior-anterior or anterior-posterior approach. The average duration of patients' hospital stay was 38.6?±?37.6, and the first surgical methods were as follows: anterior approach alone on 6 cases, posterior surgery alone on 9 cases, and combined posterior-anterior or anterior-posterior approach on 10 patients. The median segments of fixation and fusion were 4.1?±?1.4 sections. Thirteen patients developed complications. During 2 to 36 months of postoperative follow-up, 1 patient died of respiratory failure caused by pulmonary infections 2 months after leaving hospital. At the end of the follow-up, bone graft fusion was achieved in the rest of patients, and obvious looseness or migration of internal fixation was not observed. In addition, the preoperative neurological injury in 12 patients (54.5%) was also alleviated in different levels. AS cervical spine fracture, an unstable fracture, should be treated with operation, and satisfactory effects will be achieved after the individualized surgical treatment according to the improved classification method for AS cervical spine fracture. PMID:26554765

  17. Prosthodontic and surgical management of a completely edentulous patient with a severe class III skeletal maxillomandibular relationship: a clinical report.

    PubMed

    Ashy, Linah M; Sukotjo, Cortino

    2013-08-01

    This article describes a multidisciplinary approach combining surgical and prosthodontic treatment of a completely edentulous patient who presented with a severe skeletal class III relationship and was diagnosed as American College of Prosthodontists Prosthodontic Diagnostic Index (ACP PDI) class IV. The use of a complete denture serving as diagnostic tool, surgical guide, and definitive restoration is presented. Computer-aided surgical simulation was used to achieve an accurate diagnostic and surgical plan. Maxillary Lefort class I and mandibular sagittal split osteotomy surgical treatment was performed to correct arch discrepancy. The surgical procedure demonstrated a clinically acceptable maxillomandibular relationship and stability. The patient was satisfied with the esthetics and demonstrated improved oral function following prosthesis insertion. PMID:23551986

  18. Post-operative care to promote recovery for thoracic surgical patients: a nursing perspective.

    PubMed

    Yeung, Wilfred Wai Kit

    2016-02-01

    The change in patient population leads to an inevitable transformation among the healthcare system. Over the past decades, thoracic surgical technique has been evolving from conventional open thoracotomy to minimally invasive video assisted thoracoscopic surgery (VATS). Thoracic nursing team of Prince of Wales Hospital (PWH) grows together with the evolution and aims at providing holistic and quality care to patients require thoracic operation. In order to enhance patient post-operative recovery, few strategies have been implemented including early mobilization, staff training and clinical audit. On the other hand, nursing case management approach was proved to be a cost-effective method in managing patients. It is also suitable for thoracic patients, especially for those who are suffering from thoracic neoplasm. It is believed that, the introduction of nursing case management approach would provide a better holistic care to the thoracic patients. PMID:26941973

  19. Post-operative care to promote recovery for thoracic surgical patients: a nursing perspective

    PubMed Central

    2016-01-01

    The change in patient population leads to an inevitable transformation among the healthcare system. Over the past decades, thoracic surgical technique has been evolving from conventional open thoracotomy to minimally invasive video assisted thoracoscopic surgery (VATS). Thoracic nursing team of Prince of Wales Hospital (PWH) grows together with the evolution and aims at providing holistic and quality care to patients require thoracic operation. In order to enhance patient post-operative recovery, few strategies have been implemented including early mobilization, staff training and clinical audit. On the other hand, nursing case management approach was proved to be a cost-effective method in managing patients. It is also suitable for thoracic patients, especially for those who are suffering from thoracic neoplasm. It is believed that, the introduction of nursing case management approach would provide a better holistic care to the thoracic patients. PMID:26941973

  20. Surgical Outcome of Ahmed Valve Implantation in Mexican Patients with Neovascular Glaucoma

    PubMed Central

    Lazcano-Gomez, Gabriel; Jimenez-Roman, Jesus; Hernandez-Garciadiego, Carlos

    2014-01-01

    ABSTRACT Purpose: To describe clinical results of Ahmed glaucoma valve implantation in Mexican patients with neovascular glaucoma (NVG). Materials and methods: We reviewed records of 60 eyes of 60 patients with NVG who underwent Ahmed valve implantation, with a follow-up period of 1 year. We identified successful and failed cases and compared baseline and follow-up characteristics to identify possible differences between both groups. Results: We classified 36 eyes (60%) as successful and 24 (40%) as failed cases. We found a significant difference in success rate in patients who had a hypertensive phase at any time during the follow-up period (OR = 5.15, CI = 1.49-20.15, p = 0.004). Patients in the success group showed a statistically significant decrease in the number of glaucoma medications 1 year after surgery (p <0.0001). We found a statistically significant difference in success rate in patients who had preoperative best corrected visual acuity (BCVA) better than logmar 0.70 (odds ratio 4.31, CI = 1.1-19.3, p = 0.03086). Conclusion: A hypertensive postoperative phase and a preoperative BCVA worse or equal to 20/100 seem to be risk factors for Ahmed valve surgical failure in patients with NVG. How to cite this article: Hernandez-Oteyza A, Lazcano-Gomez G, Jimenez-Roman J, Hernandez-Garciadiego C. Surgical Outcome of Ahmed Valve Implantation in Mexican Patients with Neovascular Glaucoma. J Curr Glaucoma Pract 2014;8(3):86-90.

  1. Surgical Audit of Patients with Ileal Perforations Requiring Ileostomy in a Tertiary Care Hospital in India

    PubMed Central

    Verma, Hemkant; Pandey, Siddharth; Sheoran, Kapil Dev; Marwah, Sanjay

    2015-01-01

    Introduction. Ileal perforation peritonitis is a frequently encountered surgical emergency in the developing countries. The choice of a procedure for source control depends on the patient condition as well as the surgeon preference. Material and Methods. This was a prospective observational study including 41 patients presenting with perforation peritonitis due to ileal perforation and managed with ileostomy. Demographic profile and operative findings in terms of number of perforations, site, and size of perforation along with histopathological findings of all the cases were recorded. Results. The majority of patients were male. Pain abdomen and fever were the most common presenting complaints. Body mass index of the patients was in the range of 15.4–25.3 while comorbidities were present in 43% cases. Mean duration of preoperative resuscitation was 14.73 + 13.77 hours. Operative findings showed that 78% patients had a single perforation; most perforations were 0.6–1 cm in size and within 15 cm proximal to ileocecal junction. Mesenteric lymphadenopathy was seen in 29.2% patients. On histopathological examination, nonspecific perforations followed by typhoid and tubercular perforations respectively were the most common. Conclusion. Patients with ileal perforations are routinely seen in surgical emergencies and their demography, clinical profile, and intraoperative findings may guide the choice of procedure to be performed. PMID:26247059

  2. [Surgical devices].

    PubMed

    Ruhin, B; Zamojciowna, N; Louvel, B; Goudot, P

    2011-02-01

    Surgical devices mean the whole surgical department i.e., working space, useful tools for its good process and respect of its rules for the users. That working space obeys to strict rules relating to its conception, its building or the behaviour of people in that space. Working tools (furniture, material and surgical tools) have to respect requirements of the surgical team and the patients. The local rules respect will warrant optimal quality and efficiency. We will successively present architectural imperative rules and will detail arrangement of the surgeons preparing room and the real surgical space. PMID:21276996

  3. Surgical treatment of hepatic cystic echinococcosis in patients co-infected with HIV/AIDS.

    PubMed

    Ran, B; Shao, Y; Guo, Y; Yimiti, Y; Aji, T; Jia, J; Shayiding, P; Jiang, T; Cheng, L; Li, J; McManus, D P; Zhang, W; Wen, H

    2016-01-01

    Co-infections of cystic echinococcosis (CE) and HIV/AIDS is rare. We report four CE cases that were HIV positive. Three out of the four patients underwent a surgical operation to remove the hydatid cysts in their livers. The operation confirmed that in two of the cases their cysts had ruptured. These patients were given 3 months of albendazole after the operation. Follow-up showed they were remarkably improved in term of their health, although they were still HIV antibody positive 6 months after surgical treatment. Interestingly, the treatment remarkably increased their CD4+ cell population. We showed that surgery is suitable for treating hepatic cystic echinococcosis with HIV/AIDS co-infection. PMID:25779910

  4. Patient Perspectives on Post-Discharge Surgical Site Infections: Towards a Patient-Centered Mobile Health Solution

    PubMed Central

    Sanger, Patrick C.; Hartzler, Andrea; Han, Sarah M.; Armstrong, Cheryl A. L.; Stewart, Mark R.; Lordon, Ross J.; Lober, William B.; Evans, Heather L.

    2014-01-01

    Background Post-discharge surgical site infections (SSI) are a major source of morbidity, expense and anxiety for patients. However, patient perceptions about barriers experienced while seeking care for post-discharge SSI have not been assessed in depth. We explored patient experience of SSI and openness to a mobile health (mHealth) wound monitoring “app” as a novel solution to address this problem. Methods Mixed method design with semi-structured interviews and surveys. Participants were patients who had post-discharge surgical wound complications after undergoing operations with high risk of SSI, including open colorectal or ventral hernia repair surgery. The study was conducted at two affiliated teaching hospitals, including an academic medical center and a level 1 trauma center. Results From interviews with 13 patients, we identified 3 major challenges that impact patients' ability to manage post-discharge surgical wound complications, including required knowledge for wound monitoring from discharge teaching, self-efficacy for wound monitoring at home, and accessible communication with their providers about wound concerns. Patients found an mHealth wound monitoring application highly acceptable and articulated its potential to provide more frequent, thorough, and convenient follow-up that could reduce post-discharge anxiety compared to the current practice. Major concerns with mHealth wound monitoring were lack of timely response from providers and inaccessibility due to either lack of an appropriate device or usability challenges. Conclusions Our findings reveal gaps and frustrations with post-discharge care after surgery which could negatively impact clinical outcomes and quality of life. To address these issues, we are developing mPOWEr, a patient-centered mHealth wound monitoring application for patients and providers to collaboratively bridge the care transition between hospital and home. PMID:25436912

  5. Contractile function of the myocardium with prolonged hypokinesia in patients with surgical tuberculosis

    NASA Technical Reports Server (NTRS)

    Zakutayeva, V. P.; Matiks, N. I.

    1978-01-01

    The changes in the myocardial contractile function with hypokinesia in surgical tuberculosis patients are discussed. The phase nature of the changes is noted, specifically the changes in the various systoles, diastole, and other parts of the cardiac cycle. The data compare these changes during confinement in bed with no motor activity to and with a return to motor activity after leaving the in-bed regimen.

  6. Can Robotic Thyroidectomy Be Performed Safely in Thyroid Carcinoma Patients?

    PubMed Central

    Chai, Young Jun; Youn, Yeo-Kyu

    2014-01-01

    Since the adoption of the Da Vinci robotic system for remote access thyroid surgery, robotic thyroidectomy (RT) has become a popular surgical option for patients who want to avoid neck scars. Surgeons in South Korea pioneered this surgical technique and have reported successful outcomes. Although many studies have reported that RT is a feasible and safe therapeutic alternative, concerns over the surgical and oncological safety of RT remain. This article reviews the advantages and disadvantages of RT and compares the surgical safety and oncological completeness of RT with conventional open thyroidectomy. PMID:25309779

  7. The importance of cleanrooms for the treatment of haemato-oncological patients

    PubMed Central

    Matoušková, Ivanka

    2012-01-01

    The main purpose of cleanrooms in health care centres is to prevent hospital infections or leakage of a highly infectious agent (the source of haemorrhagic fevers, SARS, etc.) into the ambient environment and subsequently possibly threatening other individuals. Patients with haematological malignancies or after autologous or allogeneic haematopoietic stem cell transplantation (HSCT) rank among immunosuppressed individuals. Prolonged and deep neutropenia is considered a key risk factor of the occurrence of an exogenous infection. One of the possibilities of preventing an exogenous infection in these patients is to place them in a “cleanroom” for the crucial period of time. Cleanrooms are intensive care units with reverse isolation. The final part of the general article below provides an overview of the technology and types of cleanrooms for immunosuppressed patients in compliance with the current recommendations and technical standards. PMID:23788892

  8. Risk Assessment of BRONJ in Oncologic Patients Treated with Bisphosphonates: Follow-Up to 18 Months

    PubMed Central

    Vitali, Lucia; Nori, Alessandra; Berlin, Ricarda Sara; Mazur, Marta; Orsini, Giovanna; Putignano, Angelo

    2014-01-01

    Objectives. Bisphosphonates related osteonecrosis of the jaw (BRONJ) is a pathological condition characterized by bone exposure or latent infection in patients treated with the drug. The aim of the study is to monitor the BRONJ level of risk health in patients with cancer, according to a preventive clinical protocol, which is firstly aimed at reducing risk factors such as the periodontal infections. Materials and Methods. 10 patients participated in the protocol and were evaluated at baseline and after 3 and 18 months of treatment with bisphosphonates, through full mouth plaque and bleeding scores (FMPS and FMBS), clinical attachment level (CAL) measurement, and the occurrence of osteonecrosis. Results. The mean plaque and bleeding were reduced and the CAL has not shown significant changes and in no cases was there manifestation of BRONJ. Conclusion. The protocol proved crucial for the maintenance of good oral health conditions by eliminating the risk of BRONJ during the observation period. PMID:25258628

  9. Evaluation of a Model for Glycemic Prediction in Critically Ill Surgical Patients

    PubMed Central

    Pappada, Scott M.; Cameron, Brent D.; Tulman, David B.; Bourey, Raymond E.; Borst, Marilyn J.; Olorunto, William; Bergese, Sergio D.; Evans, David C.; Stawicki, Stanislaw P. A.; Papadimos, Thomas J.

    2013-01-01

    We evaluated a neural network model for prediction of glucose in critically ill trauma and post-operative cardiothoracic surgical patients. A prospective, feasibility trial evaluating a continuous glucose-monitoring device was performed. After institutional review board approval, clinical data from all consenting surgical intensive care unit patients were converted to an electronic format using novel software. This data was utilized to develop and train a neural network model for real-time prediction of serum glucose concentration implementing a prediction horizon of 75 minutes. Glycemic data from 19 patients were used to “train” the neural network model. Subsequent real-time simulated testing was performed in 5 patients to whom the neural network model was naive. Performance of the model was evaluated by calculating the mean absolute difference percent (MAD%), Clarke Error Grid Analysis, and calculation of the percent of hypoglycemic (?70 mg/dL), normoglycemic (>70 and <150 mg/dL), and hyperglycemic (?150 mg/dL) values accurately predicted by the model; 9,405 data points were analyzed. The models successfully predicted trends in glucose in the 5 test patients. Clark Error Grid Analysis indicated that 100.0% of predictions were clinically acceptable with 87.3% and 12.7% of predicted values falling within regions A and B of the error grid respectively. Overall model error (MAD%) was 9.0% with respect to actual continuous glucose modeling data. Our model successfully predicted 96.7% and 53.6% of the normo- and hyperglycemic values respectively. No hypoglycemic events occurred in these patients. Use of neural network models for real-time prediction of glucose in the surgical intensive care unit setting offers healthcare providers potentially useful information which could facilitate optimization of glycemic control, patient safety, and improved care. Similar models can be implemented across a wider scale of biomedical variables to offer real-time optimization, training, and adaptation that increase predictive accuracy and performance of therapies. PMID:23894489

  10. Evaluation of a model for glycemic prediction in critically ill surgical patients.

    PubMed

    Pappada, Scott M; Cameron, Brent D; Tulman, David B; Bourey, Raymond E; Borst, Marilyn J; Olorunto, William; Bergese, Sergio D; Evans, David C; Stawicki, Stanislaw P A; Papadimos, Thomas J

    2013-01-01

    We evaluated a neural network model for prediction of glucose in critically ill trauma and post-operative cardiothoracic surgical patients. A prospective, feasibility trial evaluating a continuous glucose-monitoring device was performed. After institutional review board approval, clinical data from all consenting surgical intensive care unit patients were converted to an electronic format using novel software. This data was utilized to develop and train a neural network model for real-time prediction of serum glucose concentration implementing a prediction horizon of 75 minutes. Glycemic data from 19 patients were used to "train" the neural network model. Subsequent real-time simulated testing was performed in 5 patients to whom the neural network model was naive. Performance of the model was evaluated by calculating the mean absolute difference percent (MAD%), Clarke Error Grid Analysis, and calculation of the percent of hypoglycemic (?70 mg/dL), normoglycemic (>70 and <150 mg/dL), and hyperglycemic (?150 mg/dL) values accurately predicted by the model; 9,405 data points were analyzed. The models successfully predicted trends in glucose in the 5 test patients. Clark Error Grid Analysis indicated that 100.0% of predictions were clinically acceptable with 87.3% and 12.7% of predicted values falling within regions A and B of the error grid respectively. Overall model error (MAD%) was 9.0% with respect to actual continuous glucose modeling data. Our model successfully predicted 96.7% and 53.6% of the normo- and hyperglycemic values respectively. No hypoglycemic events occurred in these patients. Use of neural network models for real-time prediction of glucose in the surgical intensive care unit setting offers healthcare providers potentially useful information which could facilitate optimization of glycemic control, patient safety, and improved care. Similar models can be implemented across a wider scale of biomedical variables to offer real-time optimization, training, and adaptation that increase predictive accuracy and performance of therapies. PMID:23894489

  11. Patient reported outcomes in pediatric oncology practice: suggestions for future usage by parents and pediatric oncologists.

    PubMed

    Schepers, S A; Engelen, V E; Haverman, L; Caron, H N; Hoogerbrugge, P M; Kaspers, G J L; Egeler, R M; Grootenhuis, M A

    2014-09-01

    Several studies in adults have shown patient reported outcomes (PROs) to be effective in enhancing patient-physician communication and discussion of Health Related Quality of Life outcomes. Although less studied, positive results have been demonstrated in children. A PRO-intervention needs to be feasible in clinical practice to be successful. In the current study, 74 parents of children who successfully completed their cancer treatment and 21 pediatric oncologists (POs) evaluated a PRO-intervention and gave recommendations for future use in their practice. Most parents and POs suggested PROs to be an important part of standard care, starting during treatment, with an assessment frequency of every 3 months. PMID:24648289

  12. Perioperative Care Coordination Measurement: A Tool to Support Care Integration of Pediatric Surgical Patients.

    PubMed

    Ferrari, Lynne R; Ziniel, Sonja I; Antonelli, Richard C

    2016-03-01

    The relationship of care coordination activities and outcomes to resource utilization and personnel costs has been evaluated for a number of pediatric medical home practices. One of the first tools designed to evaluate the activities and outcomes for pediatric care coordination is the Care Coordination Measurement Tool (CCMT). It has become widely used as an instrument for health care providers in both primary and subspecialty care settings. This tool enables the user to stratify patients based on acuity and complexity while documenting the activities and outcomes of care coordination. We tested the feasibility of adapting the CCMT to a pediatric surgical population at Boston Children's Hospital. The tool was used to assess the preoperative care coordination activities. Care coordination activities were tracked during the interval from the date the patient was scheduled for a surgical or interventional procedure through the day of the procedure. A care coordination encounter was defined as any task, whether face to face or not, supporting the development or implementation of a plan of care. Data were collected to enable analysis of 5675 care coordination encounters supporting the care provided to 3406 individual surgical cases (patients). The outcomes of care coordination, as documented by the preoperative nursing staff, included the elaboration of the care plan through patient-focused communication among specialist, facilities, perioperative team, and primary care physicians in 80.5% of cases. The average time spent on care coordination activities increased incrementally by 30 minutes with each additional care coordination encounter for a surgical case. Surgical cases with 1 care coordination encounter took an average of 35.7 minutes of preoperative care coordination, whereas those with ≥4 care coordination encounters reported an average of 121.6 minutes. We successfully adapted and implemented the CCMT for a pediatric surgical population and measured nonface-to-face, nonbillable encounters performed by perioperative nursing staff. The care coordination activities integrated into the preoperative process include elaboration of care plans and identification and remediation of discrepancies. Capturing the activities and outcomes of care coordination for preoperative care provides a framework for quality improvement and enables documentation of the value of nonface-to-face perioperative nursing encounters that comprise care coordination. PMID:26517234

  13. Short- and long-term surgical follow-up of the postbariatric surgery patient.

    PubMed

    Frank, Paul; Crookes, Peter F

    2010-03-01

    Follow-up of the large numbers of patients undergoing bariatric surgery poses problems for surgical programs and for internists who care for morbidly obese patients. Early surgical follow up is concentrated on the perioperative period to ensure healing and care for any surgical complications. It is especially important to treat persistent vomiting to avoid thiamine deficiency. Subsequently, monitoring weight loss and resolution of comorbidities assumes more importance. Identification and management of nutritional deficiencies and other unwanted consequences of surgery may become the responsibility of internists if the patient no longer attends the office of the operating surgeon. The long-term goal is to avoid weight regain and deficiencies, especially of protein, iron and vitamin B12, and calcium and vitamin D. Abdominal pain and gastrointestinal dysfunction should be investigated promptly to exclude or confirm such conditions as small bowel obstruction or gallstones. Good communication between bariatric surgeons and internal medicine specialists is essential for early and accurate identification of problems arising from bariatric surgery. PMID:20202586

  14. Violent Behavior in Cancer Patients--A Rarely Addressed Phenomenon in Oncological Treatment

    ERIC Educational Resources Information Center

    Grube, Michael

    2012-01-01

    Dealing with violent cancer patients can be particularly challenging. The purpose of this study was to collect data on the frequency, quality, and underlying variables affecting violent behavior as well as to examine the role played by this behavior in the premature interruption of treatment. A total of 388 cancer inpatients were examined by…

  15. Oncology Nursing Education: Nursing Students' Commitment of "Presence" with the Dying Patient and the Family.

    ERIC Educational Resources Information Center

    Walsh, Sandra M.; Hogan, Nancy S.

    2003-01-01

    Following a chaplain's lecture on the end of life, nursing students wrote reaction papers on appropriate ways to support dying patients and their families. Six processes emerged, including the core concept of the nurse's presence at the bedside. (Contains 23 references.) (SK)

  16. A new emergency in oncology: Bone metastases in breast cancer patients (Review)

    PubMed Central

    IBRAHIM, TONI; MERCATALI, LAURA; AMADORI, DINO

    2013-01-01

    Breast cancer (BC) is the most common tumour in females and as a result, the management of such patients is a major public health issue. A high percentage of BC patients develop bone metastases (BMs), occasionally even several years following the initial diagnosis. BMs are responsible for high morbidity and a reduced quality of life with the onset of various clinical complications defined as skeletal-related events (SREs), including pathological fractures, spinal cord compression, hypercalcaemia, bone marrow infiltration and severe bone pain, requiring palliative radiotherapy. Such complications reduce functional independence and quality of life, decrease survival rates and increase healthcare costs. The current treatment for metastatic BC aims to achieve meaningful clinical responses, an improved quality of life, long-term remission, prolonged survival and in a small percentage of cases, a complete cure. The treatment of this malignancy has become progressively complex, including well-known antitumour agents or bone-targeted molecules aimed at preventing bone complications and improving patient quality of life and the treatment outcome of a multidisciplinary programme. The importance of a multi disciplinary approach in the management of BMs is also widely accepted. The major complication of BMs are SREs which are responsible for reducing prognoses and patient quality of life and are correlated with high rates of hospitalisation with the subsequent social and economic consequences. For these reasons, it is crucial to prevent where possible or to identify and treat SREs promptly in an attempt to mitigate the ever-increasing clinical and economic burden. PMID:24137321

  17. Attitudes of Medical Students Toward Psychiatric, Oncologic, and General Medical Patients.

    ERIC Educational Resources Information Center

    Wachtel, Alan; And Others

    1985-01-01

    The variables affecting ratings of the importance of biopsychosocial versus biomedical assessments are examined. It was hypothesized that students would perceive the relative importance of biomedical and biopsychosocial assessments differentially based on the diagnoses of the patients and the students' level of training. (MLW)

  18. Violent Behavior in Cancer Patients--A Rarely Addressed Phenomenon in Oncological Treatment

    ERIC Educational Resources Information Center

    Grube, Michael

    2012-01-01

    Dealing with violent cancer patients can be particularly challenging. The purpose of this study was to collect data on the frequency, quality, and underlying variables affecting violent behavior as well as to examine the role played by this behavior in the premature interruption of treatment. A total of 388 cancer inpatients were examined by…

  19. Status and Perspectives of Clinical Modes in Surgical Patients With Lung Cancer

    PubMed Central

    Lai, Yutian; Du, Heng; Wang, Xin; Shen, Cheng; Huang, Jian; Li, Weiming; Che, Guowei

    2016-01-01

    Abstract To investigate the association between the clinical characteristics and clinical modes of surgically treated lung cancer patients, we conducted a retrospective study with 1097 lung cancer patients receiving pulmonary resection between 2012 and 2013. A physical examination or screening (PES) group (n?=?267) and a symptomatic (SY) group (n?=?830) were established depending on the new clinical mode (sequence of physical examination, early detection and sequential medical treatment) and the conventional mode (hospitalization due to occurrence of relevant symptoms), respectively. A higher proportion of patients referred to our unit directly form a junior medical unit is found in PES group (43.8%, 117/267 vs 13.6%, 113/830) (P?patients in PES group spent <1 months from detection or first medical visit to diagnosis compared with 15.4% (128/830) patient in SY group (P?patients versus SY patients received video-assisted thoracoscopic surgery (VATS) resection (67.8%, 183/267 vs 42.6%, 352/830; P?patients versus SY patients chose sublobar resection (16.9%, 45/267 vs 7.6%, 63/830; P?patients versus SY patients are at stage 0 or I (64.4%, 172/267 vs 40.7%, 338/830; P?surgical treatment, early tumor detection via PES may contribute to significantly higher proportions of early-stage lung cancer, use of VATS pulmonary resection, and sublobectomy as well as lower complication rate. PMID:26765424

  20. Surgical Decision Making for the Elderly Patients in Severe Head Injuries

    PubMed Central

    Shim, Jae-Jun; Yoon, Seok-Man; Oh, Jae-Sang; Bae, Hack-Gun; Doh, Jae-Won

    2014-01-01

    Objective Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. Methods We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3-8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. Results Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. Conclusion Ethical training and developing decision-making skills are necessary including shared decision making. PMID:25024822

  1. Assessment of bleeding during minor oral surgical procedures and extraction in patients on anticoagulant therapy

    PubMed Central

    Jimson, S.; Amaldhas, Julius; Jimson, Sudha; Kannan, I.; Parthiban, J.

    2015-01-01

    Introduction: The risk of postoperative hemorrhage from oral surgical procedures has been a concern in the treatment of patients who are receiving long-term anticoagulation therapy. A study undertaken in our institution to address questions about the amount and severity of bleeding associated with minor outpatient oral surgery procedures by assessing bleeding in patients who did not alter their anticoagulant regimen. Subjects and Methods: Eighty-three patients receiving long-term anticoagulant therapy visited Department of Oral and Maxillofacial Surgery from May 2010 to October 2011 for extractions and minor oral surgical procedures. Each patient was required to undergo preoperative assessment of prothrombin time (PT) and measurement of the international normalized ratio. Fifty-six patients with preoperative PT values within the therapeutic range 3–4 were included in the study. The patients’ age ranged between 30 and 75 years. Application of surgispon was done following the procedure. Extraction of teeth performed with minimal trauma to the surrounding tissues, the socket margins sutured, and sutures removed after 5 days. Results: There was no significant incidence of prolonged or excessive hemorrhage and wound infection and the healing process was normal. PMID:26015691

  2. Use and wear of anti-embolism stockings: a clinical audit of surgical patients.

    PubMed

    Miller, Julie A

    2011-02-01

    The objective of this study was to determine if anti-embolism stockings are fitted and worn according to evidence-based guidelines in surgical patients. The methodology is that an observational study was undertaken during January and February, 2010. An audit tool was constructed for the recording of information on a variety of parameters relating to the correct fitting and wearing of anti-embolism stockings. The results show that eighty surgical patients were audited with a mean age of 66 years. Of these, 72.5% were ambulatory; 38.75% of patients had incorrect presentation of their stockings; 29% were fitted with the incorrect size for limb measurement and 70% of patients reported not receiving any information regarding the reason for anti-embolism stocking use. Written information was not received by 100% of participants. For 82.5% of participants deep vein thrombosis (DVT) risk was not recorded. The garment size fitted (and/or limb measurement) was not recorded for 100% of patients. Daily routine skin inspection was noted for 29%. The findings of this study showed that anti-embolism stockings were not fitted and worn according to evidence-based guidelines. The author recommends a new recording tool be developed to ensure consistency of assessment and documentation regarding risk assessment, contraindications identification, and education and monitoring of patients wearing anti-embolism stockings. PMID:21251225

  3. Surgical Treatment of Inferior Vena Cava Tumor Thrombus in Patients with Renal Cell Carcinoma

    PubMed Central

    Kim, Hyangkyoung; Moon, Ki-Myung; Cho, Yong-Pil; Song, Cheryn; Kim, Chung-Soo; Ahn, Hanjong

    2010-01-01

    Radical nephrectomy with inferior vena cava (IVC) thrombectomy remains the most effective therapeutic option in patients with renal cell carcinoma and IVC tumor thrombus. Cephalic extension of the thrombus is closely related to perioperative morbidity. We purposed to design a safe and successful surgical strategy through a review of our surgical experience and treatment results in 35 patients (male:female=28:7, mean age=56 yr [32-77]) who underwent IVC thrombectomy with radical nephrectomy between January 1997 and December 2006. The limit of tumor extension was level I in 10 patients (28.6%), level II in 17 (48.6%), and level III and IV in 4 patients each (11.4%). Liver mobilization with hepatic vascular exclusion was performed in 12 patients and cardiopulmonary bypass in 7. Thirty-two primary closures, 2 patch closures, and 1 graft interposition were performed. One patient underwent simultaneous pulmonary embolectomy because of an operative pulmonary embolism. There was no operative mortality, and the overall survival at 5-yr was 50.8%. Complete thrombus removal without tumor fragmentation under long venotomy on fully exposed involved IVC is recommended for successful result in a bloodless operative field. The applicability of liver mobilization, hepatic vascular exclusion, and cardiopulmonary bypass, can be determined by the level of thrombus. PMID:20052355

  4. Patient-tailored conservative surgical treatment of invasive uterine cervical squamous cell carcinoma. A review.

    PubMed

    Menczer, J

    2013-08-01

    The aim of this paper was to review currently available data regarding the results of a more conservative, patient-tailored surgical approach in selected cases of early invasive uterine squamous cell carcinoma (SCC). A PubMed search of investigations in the English language published from January 2000 to September 2012 containing the terms conservative surgery, conservative treatment, trachelectomy, parametrectomy, lymphadenectomy, sentinel lymph node biopsy and fertility sparing surgery in combination with SCC was made. Conization only is optimal for women with stage Ia1 disease mainly in tumors without lymph vascular space involvement (LVSI). In stage Ib1 patients interested to maintain reproductive capacity, vaginal or abdominal radical trachelectomy are the procedures of choice. Patients with small tumors (<2 cm), no deep invasion, no LVSI, and negative pelvic nodes are at very low risk of parametrial involvement and parametrectomy may be omitted in them. Such patients may benefit from less radical surgery and may be candidates for simple hysterectomy, simple trachelectomy, or conization with pelvic lymphadenectomy. Sentinel lymph node (SLN) biopsy is apparently a good predictor of node metastases and allows the performance of lymphadenectomy only in SLN positive cases. Thus lymphadenectomy may also be omitted in some patients. In young women with locally advanced tumors, neoadjuvant chemotherapy followed by fertility-sparing surgery may also be a feasible treatment. A more conservative, patient-tailored surgical approach in selected cases of early SCC is possible resulting in lower morbidity and preservation of fertility without compromising the outcome. PMID:24051940

  5. The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology.

    PubMed

    Pohlenz, P; Klatt, J; Schmelzle, R; Li, L

    2013-09-01

    Mortality is a rare but disastrous complication of microvascular head and neck reconstruction. The investigators attempt to identify the procedure-related mortality cases and analyse the causes of death. A retrospective analysis of 804 consecutive free flap procedures during a 19-year period was performed and fatal cases were identified (n=42 deaths). Multivariate logistic regression was employed to determine the association of in-hospital mortality with patient-related characteristics. The 30-day post-operative mortality rate was 1% (8 out of 804 patients), and the in-hospital mortality rate (post-operative deaths in-hospital before or after the 30th post-operative day without discharge) was 5.2% (42 out of 804 patients). Cancer recurrence and metastases related pneumonia were the most common causes of death (n=26, 62%), followed by cardiac, pulmonary, infectious and hepatic/renal aetiologies. Logistic regression analysis revealed that patients with stage IV disease and an operation time of >9h were significantly associated with post-operative mortality. Malignancy-related conditions were the most common causes of death following free flap transfer for head and neck reconstruction. For patients with stage IV head and neck cancer, this aggressive surgical approach should be cautiously justified due to its association with post-operative mortality. To shorten the operation time, experienced microsurgical operation teams are necessary. PMID:23369783

  6. Surgical Correction of Congenital Heart Disease in the Adult: Experience with 139 Patients

    PubMed Central

    Leidenfrost, Ronald D.; Weldon, Clarence S.

    1978-01-01

    Patients over 18 years of age who have undergone a surgical correction of a congenital cardiac malformation during the period 1968 through 1977 have been reviewed. Those patients with calcific aortic stenosis which was thought, but not proved, to have arisen in a congenitally malformed aortic valve, were excluded from the review. Patients with cystic medial necrosis of the aorta were similarly excluded. There were 139 patients in the series (age range from 18 years to 67 years). The most common defects were those involving the intra-atrial septum and the related great veins, 50%. Abnormalities involving the great arteries including patent ductus arteriosus and coarctation of the aorta accounted for 19%. Common defects of conal development including ventricular septal defects and Tetralogy of Fallot malformations accounted for 15%. Valvular abnormalities including pulmonic stenosis, aortic valve abnormalities and Ebstein's malformation of tricuspid valve accounted for 11.5%. Complex congenital malformations were relatively uncommon, 4%. There were two patients with a combination of acquired and congenital heart disease. There were two operative deaths in the series, both occurring in patients with complex forms of congenital heart disease (multiple ventricular septal defects, double outlet right ventricle). There were two additional postoperative hospital deaths, one occurring following repair of an atrial septal defect from massive pulmonary embolus, and another occurring six weeks following a Fontan procedure performed for tricuspid atresia. Thus, the hospital mortality for the series was 2.9%. This reviewed series reveals the incidence of operable congenital heart defects appearing in an adult cardiac surgical practice and demonstrates that surgical repair can be accomplished with a satisfactory low mortality rate. PMID:697429

  7. Social Media and Oncology: The Past, Present, and Future of Electronic Communication Between Physician and Patient.

    PubMed

    Lewis, Mark A; Dicker, Adam P

    2015-10-01

    The relationship between patient and physician is in flux with the advent of electronic media that are advancing and enhancing communication. We perform a retrospective, current, and forward-looking examination of the technologies by which information is exchanged within the healthcare community. The evolution from e-mail and listservs to blogs and the modern social networks is described, with emphasis on the advantages and pitfalls of each medium, especially in regard to maintaining the standards of privacy and professionalism to which doctors are held accountable. We support the use of contemporary platforms like Twitter and Facebook for physicians to establish themselves as trustworthy online sources of medical knowledge, and anticipate ongoing collaboration between researchers, patients, and their advocates in trial design and accrual. PMID:26433557

  8. Introduction to pediatric oncology

    SciTech Connect

    McWhirter, W.R.; Masel, J.P.

    1987-01-01

    This book covers the varied and complex aspects of management in pediatric oncology. Emphasis is placed on a team approach and on establishing and maintaining an individualized, humanistic relationships with the patient. Numerous illustrations show modern imaging techniques that are proving most valuable in the investigation of suspected or confirmed childhood cancer. Physical and psychological side effects of short-term and long-term treatment are also discussed.

  9. Toxocarosis and putative DRESS syndrome in an oncological patient: a case report.

    PubMed

    Wutte, Nora; Palfner, Michael; Auer, Herbert; Ruckenbauer, Gerald; Valentin, Thomas; Seeber, Katharina; Aberer, Werner; Krause, Robert; Hoenigl, Martin

    2014-04-01

    Toxocarosis is a parasitic infection caused by Toxocara canis or Toxocara cati. Their definite hosts are the domestic dog and cat, where their adult forms live within the lumen of the small intestine. In humans, infective larvae hatch after ingestion of eggs, but the juvenile stages fail to develop into mature adult worms. Instead, they migrate through the body with the potential to affect virtually every body site. DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is a serious cutaneous drug reaction, which also involves other organ systems. We report on a 45-year-old man who was admitted with fever up to 40?°C, skin rash and pruritus not responding to amoxicillin/clavulanic acid. Laboratory results showed a slightly elevated white blood cell count, with 62?% eosinophils. History revealed contact to roaming cats. Travel history was unremarkable. Extensive diagnostic workup was performed, and the patient was finally diagnosed with DRESS syndrome, responded to systemic corticosteroid therapy and was discharged. Serology for Toxocara came back positive a few days later. Stool was again sent for microscopy and was found positive for Giardia lamblia, which was treated with a 5-day course of metronidazole. The patient had again developed rash and eosinophilia (62?%). Total immunoglobulin (Ig)E was 1,689 U/l (normal limit: patient had no further complaints. Although generalized exanthema due to Toxocara has not yet been described in literature, toxocarosis is known to cause a wide spectrum of cutaneous manifestations. Whether our patient had both, a drug reaction with eosinophilia and systemic symptoms and a parasitic infection, or whether a hypersensitivity reaction to Toxocara antigen was mimicking a DRESS syndrome remains unclear. PMID:24249317

  10. Systems oncology: towards patient-specific treatment regimes informed by multiscale mathematical modelling.

    PubMed

    Powathil, Gibin G; Swat, Maciej; Chaplain, Mark A J

    2015-02-01

    The multiscale complexity of cancer as a disease necessitates a corresponding multiscale modelling approach to produce truly predictive mathematical models capable of improving existing treatment protocols. To capture all the dynamics of solid tumour growth and its progression, mathematical modellers need to couple biological processes occurring at various spatial and temporal scales (from genes to tissues). Because effectiveness of cancer therapy is considerably affected by intracellular and extracellular heterogeneities as well as by the dynamical changes in the tissue microenvironment, any model attempt to optimise existing protocols must consider these factors ultimately leading to improved multimodal treatment regimes. By improving existing and building new mathematical models of cancer, modellers can play important role in preventing the use of potentially sub-optimal treatment combinations. In this paper, we analyse a multiscale computational mathematical model for cancer growth and spread, incorporating the multiple effects of radiation therapy and chemotherapy in the patient survival probability and implement the model using two different cell based modelling techniques. We show that the insights provided by such multiscale modelling approaches can ultimately help in designing optimal patient-specific multi-modality treatment protocols that may increase patients quality of life. PMID:24607841

  11. Dysfunction of mechanical heart valve prosthesis: experience with surgical management in 48 patients

    PubMed Central

    Ma, Wei-Guo; Hou, Bin; Abdurusul, Adiljan; Gong, Ding-Xu; Tang, Yue; Chang, Qian; Xu, Jian-Ping

    2015-01-01

    Background Dysfunction of mechanical heart valve prostheses is an unusual but potentially lethal complication after mechanical prosthetic valve replacement. We seek to report our experience with mechanical valve dysfunction regarding etiology, surgical techniques and early outcomes. Methods Clinical data of 48 patients with mechanical valve dysfunction surgically treated between October 1996 and June 2011 were analyzed. Results Mean age was 43.7±10.9 years and 34 were female (70.8%). The median interval from primary valve implantation to dysfunction was 44.5 months (range, 1 hour to 20 years). There were 21 emergent and 27 elective reoperations. The etiology was thrombosis in 19 cases (39.6%), pannus in 12 (25%), thrombosis and pannus in 11 (22.9%), improper disc orientation in 2 (4.1%), missing leaflet in 1 (2.1%), excessively long knot end in 1 (2.1%), endogenous factor in 1 (2.1%) and unidentified in 1 (2.1%). Surgical procedure was mechanical valve replacement in 37 cases (77.1%), bioprosthetic valve replacement in 7 (14.9%), disc rotation in 2 (4.2%) and excision of excessive knot end in 1 (2.1%). Early deaths occurred in 7 patients (14.6%), due to low cardiac output in 3 (6.3%), multi-organ failure in 2 (4.2%) and refractory ventricular fibrillation in 2 (4.2%). Complications occurred in 10 patients (20.8%). Conclusions Surgical management of mechanical valve dysfunction is associated with significant mortality and morbidity. Earlier identification and prompt reoperation are vital to achieving better clinical outcomes. The high incidence of thrombosis in this series highlights the need for adequate anticoagulation and regular follow-up after mechanical valve replacement. PMID:26793354

  12. The location of surgical care for rural patients with rectal cancer: patterns of treatment and patient perspectives

    PubMed Central

    Nostedt, Michelle C.; McKay, Andrew M.; Hochman, David J.; Wirtzfeld, Debrah A.; Yaffe, Clifford S.; Yip, Benson; Silverman, Richard; Park, Jason

    2014-01-01

    Background Where cancer patients receive surgical care has implications on policy and planning and on patients’ satisfaction and outcomes. We conducted a population-based analysis of where rectal cancer patients undergo surgery and a qualitative analysis of rectal cancer patients’ perspectives on location of surgical care. Methods We reviewed Manitoba Cancer Registry data on patients with colorectal cancer (CRC) diagnosed between 2004 and 2006. We interviewed rural patients with rectal cancer regarding their preferences and the factors they considered when deciding on treatment location. Interview data were analyzed using a grounded theory approach. Results From 2004 to 2006, 2086 patients received diagnoses of CRC in Manitoba (colon: 1578, rectal: 508). Among rural patients (n = 907), those with rectal cancer were more likely to undergo surgery at an urban centre than those with colon cancer (46.5% v. 28.8%, p < 0.001). Twenty rural patients with rectal cancer participated in interviews. We identified 3 major themes from the interview data: the decision-maker, treatment factors and personal factors. Participants described varying input into referral decisions, and often they did not perceive a choice regarding treatment location. Treatment factors, including surgeon factors and hospital factors, were important when considering treatment location. Personal factors, including travel, support, accommodation, finances and employment, also affected participants’ treatment experiences. Conclusion A substantial proportion of rural patients with rectal cancer undergo surgery at urban centres. The reasons are complex and only partly related to patient choice. Further studies are required to better understand cancer system access in geographically dispersed populations and to support cancer patients through the decision-making and treatment processes. PMID:25421082

  13. Surgical Orthodontic Treatment for Open Bite in Noonan Syndrome Patient: A Case Report.

    PubMed

    Kawakami, Masayoshi; Yamamoto, Kazuhiko; Shimomura, Tadahiro; Kirita, Tadaaki

    2016-03-01

    Noonan syndrome, characterized by short stature, facial anomalies, and congenital heart defects, may also be associated with hematopoietic disorders. Craniofacial anomalies in affected patients include hypertelorism and severe open bite associated with masticatory dysfunction. We treated a Noonan syndrome patient with a skeletal open bite. Surgical orthodontic treatment including two-jaw surgery established a good occlusal relationship after correction of severe anemia. Both upper and lower incisors were moved to upright positions, while clockwise rotation of the palatal plane and decreased mandibular plane angle were accomplished. Lower masticatory activity may affect posttreatment occlusion in such cases. PMID:25575339

  14. [SURGICAL TREATMENT OF ELDERLY AND SENILE PATIENTS FOR AFFECTION OF CARDIAC VALVES].

    PubMed

    Sudus, A V

    2015-09-01

    Operations on the open heart, of them in 62 (32.9%)--the valves prosthesis, were conducted on the base of Clinical Treatment-Diagnosis Centre "Simedgroup" of Ivano-Frankivskiy National Medical University in 2012 - 2015 yrs in 188 patients. Hemodynamically significant failures of a mitral valve and/or the aortal valve were considered as indications for the operative treatment conduction. Combined surgical treatment--the valve prosthesis and coronary shunting--were conducted in coincident ischemic heart disease. More durable rehabilitation is needed for elderly and senile patients. PMID:26817086

  15. The Effect of Race on Outcomes of Surgical or Non-surgical Treatment of Patients in the Spine Patient Outcomes Research Trial (SPORT)

    PubMed Central

    Schoenfeld, Andrew J.; Lurie, Jon D.; Zhao, Wenyan; Bono, Christopher M.

    2012-01-01

    Study Design Retrospective review of the data collected prospectively through the Spine Patient Outcomes Research Trial (SPORT). Objective Determine the effect that race or ethnicity had on outcomes following spine surgery in the three arms of SPORT. Summary of Background Data There is a dearth of research regarding the effect of race or ethnicity on outcome following treatment for spinal disorders. Methods All participants from the three arms of the SPORT were evaluated in an as-treated analysis with patients categorized as white, black, or other. Baseline and operative characteristics of the groups were compared using the chi-square test and ANOVA. Differences in the changes between baseline and 1-, 2-, 3-, and 4-year time-points in the operative and non-operative treatments were evaluated with a mixed effects longitudinal regression model and differences between racial groups were compared with a multiple degrees of freedom Wald test. Results Included were 2,427 patients (85% white, 8% black, 7% other). Surgery was performed on 67% of white patients, 54% of blacks, and 68% of others. Whites and others were significantly more likely to undergo surgery than blacks (67% and 68% vs 54%, p=0.003). Complications and the risk of additional surgeries were not significantly different between racial groups. Regardless of race, all patients improved more with surgical management than with nonoperative treatment for all outcome measures at all time-points. The average 4-year area- under-the-curve results revealed surgical and non-operative treatment resulted in statistically significant improvement in whites relative to blacks for BP (p<0.001), SF (p<0.001), and ODI (p<0.001). No significant differences were appreciated in treatment effect for primary outcome measures or self-rated progress across racial groups. Conclusion These results illustrate important differences between racial groups in terms of response to spine care. While there were quantitative differences between groups, these findings are not necessarily indications of healthcare disparities. PMID:22842539

  16. Comparative Oncology Program

    Cancer.gov

    The Comparative Oncology Trials Consortium (COTC) is an active network of twenty academic comparative oncology centers, centrally managed by the NIH-NCI-Center for Cancer Research's Comparative Oncology Program, that functions to design and execute clinic

  17. [Factitious diseases in oncology].

    PubMed

    Reich, Michel; Clermont, Amélie; Amela, Éric; Kotecki, Nuria

    2015-12-01

    Factitious diseases and pathomimias and particularly Munchausen's syndrome, due to their rarity, are poorly diagnosed by medical teams working in oncology. Consequences can be serious and result in unadapted surgery or non justified implementation of chemotherapy and radiotherapy regimens. These patients simulate diseases in order to attract medical attention. They might become belligerent and are likely to promptly discharge themselves from hospital if they do not get the desired attention or are unmasked. With two following case reports and literature review, we would like to alert clinicians about difficulties encountered in diagnosis and management of factitious disorders. When faced with this diagnosis, the patient will tend to deny reality and break contact with the medical team who exposed him. Medical peregrinating behavior surrounded by conflicts with medical team, past psychiatric illness, history of working in the medical and paramedical field and social isolation can guide the diagnosis. Somaticians and especially surgeons working in the oncologic field must remain vigilant about this diagnosis and collaborate with either the psycho-oncologic team or the consultation-liaison psychiatric team. Some recommendations for medical professionals how to cope with these patients will be suggested. PMID:26597474

  18. Art Therapy with an Oncology Care Team

    ERIC Educational Resources Information Center

    Nainis, Nancy A.

    2005-01-01

    Oncology nurses are particularly vulnerable to "burnout" syndrome due to the intensity of their work and the ongoing losses they experience while providing oncology care to their patients. High levels of stress in the workplace left untended lead to high job turnover, poor productivity, and diminished quality of care for patients. Attention to…

  19. The Incidence of Peripheral Catheter-Related Thrombosis in Surgical Patients

    PubMed Central

    Leung, Amy; Heal, Clare; Banks, Jennifer; Abraham, Breanna; Capati, Gian; Pretorius, Casper

    2016-01-01

    Background. Central venous catheters and peripherally inserted central catheters are well established risk factors for upper limb deep vein thrombosis. There is limited literature on the thrombosis rates in patients with peripheral catheters. A prospective observational study was conducted to determine the incidence of peripheral catheter-related thrombosis in surgical patients. Methods. Patients deemed high risk for venous thrombosis with a peripheral catheter were considered eligible for the study. An ultrasound was performed on enrolment into the study and at discharge from hospital. Participants were reviewed twice a day for clinical features of upper limb deep vein thrombosis during their admission and followed up at 30 days. Results. 54 patients were included in the study. The incidence of deep vein thrombosis and superficial venous thrombosis was 1.8% and 9.2%, respectively. All cases of venous thrombosis were asymptomatic. Risk factor analysis was limited by the low incidence of thrombosis. Conclusion. This study revealed a low incidence of deep vein thrombosis in surgical patients with peripheral catheters (1.8%). The study was underpowered; therefore the association between peripheral catheters and thrombosis is unable to be established. Future studies with larger sample sizes are required to determine the association between peripheral catheters and thrombosis.

  20. Long-term Surgical Outcomes of Epiretinal Membrane in Patients with Retinitis Pigmentosa

    PubMed Central

    Ikeda, Yasuhiro; Yoshida, Noriko; Murakami, Yusuke; Nakatake, Shunji; Notomi, Shoji; Hisatomi, Toshio; Enaida, Hiroshi; Ishibashi, Tatsuro

    2015-01-01

    Macular complications such as an epiretinal membrane (ERM), a cystoid macular edema and a macular hole lead to unexpected central vision impairment especially for patients with retinitis pigmentosa (RP). To evaluate the long-term surgical outcomes of pars plana vitrectomy (PPV) for ERM in patients with RP, we retrospectively reviewed the charts of a consecutive series of 10 RP patients who underwent PPV for ERM at Kyushu University Hospital. Visual acuity (VA) testing, a fundus examination, and an optical coherence tomography (OCT) analysis were conducted. The standard PPV using three sclerotomies was performed for ERM. PPV was performed in 12 eyes of 10 patients. One eye was excluded from the outcome assessment due to short period observation (18 months). There was no significantly deleterious change from the baseline to final VA between the operation eyes and the fellow eyes (P?=?0.19). Moreover, morphological improvement was obtained in 9 of 11 eyes based on OCT. Our present data suggest that PPV may be tolerable in the management for ERM in RP patients over the long-term. Furthermore, the appearance of the ellipsoid zone was an important factor in the prediction of visual outcome and determination of surgical indication. PMID:26268934

  1. Relationship between physical activity and function in elderly patients discharged after surgical treatment for gastrointestinal cancer

    PubMed Central

    Hara, Tsuyoshi; Kubo, Akira

    2015-01-01

    [Purpose] The purpose of the present study was to observe changes in physical activity (PA) from before surgery to after discharge among elderly patients with gastrointestinal cancer and to examine the relationships between PA, function, and physique after discharge in these patients. [Subjects and Methods] The study participants were 18 elderly patients who underwent surgical treatment for gastrointestinal cancer [10 males and 8 females, aged 71.4 ± 4.2?years (mean ± SD)]. We evaluated patients’ PA, function, and physique before surgery and after discharge. Calorie consumption as calculated using the International Physical Activity Questionnaire (IPAQ) short version was measured for PA. Isometric knee extension force (IKEF), the timed up and go test (TUGT), and the 6-minute walk distance (6MWD) were measured for function. The body mass index (BMI) was calculated for physique. [Results] Significant declines in PA and BMI were observed after discharge among the study participants. In addition, a significant correlation between PA and IKEF was observed in the discharge phase. [Conclusion] These results suggest that PA after discharge is significantly less than that before surgery and related to the functioning of the lower extremities in the same period in elderly patients who undergo surgical treatment for gastrointestinal cancer. PMID:26504327

  2. Effect of surgical incision management on wound infections in a poststernotomy patient population.

    PubMed

    Grauhan, Onnen; Navasardyan, Artashes; Tutkun, Baris; Hennig, Felix; Müller, Peter; Hummel, Manfred; Hetzer, Roland

    2014-06-01

    Skin breakdown and infiltration of skin flora are key causative elements in poststernotomy wound infections. We hypothesised that surgical incision management (SIM) using negative pressure wound therapy over closed surgical incisions for 6-7?days would reduce wound infections in a comprehensive poststernotomy patient population. 'All comers' undergoing median sternotomy at our institution were analysed prospectively from 1 September to 15 October 2013 (study group, n?=?237) and retrospectively from January 2008 to December 2009 (historical control group, n?=?3508). The study group had SIM (Prevena™ Therapy) placed immediately after skin suturing and applied at -125 mmHg for 6-7?days, whereas control group received conventional sterile wound tape dressings. Primary endpoint was wound infection within 30 days. Study group had a significantly lower infection rate than control group: 1·3% (3 patients) versus 3·4% (119 patients), respectively (P?patients (98·7%). SIM over clean, closed incisions for the first 6-7 postoperative days significantly reduced the incidence of wound infection after median sternotomy. Based on these data SIM may be cost-effective in patients undergoing cardiac surgery. PMID:24851729

  3. Surgical Treatment of Calcaneal Avulsion Fracture in Elderly Patients Using Cannulated Cancellous Screws and Titanium Wire.

    PubMed

    Miyamura, Satoshi; Ota, Haruka; Okamoto, Michio; Namba, Jiro; Yamamoto, Koji

    2016-01-01

    Avulsion fractures of the calcaneus are relatively uncommon and are seen most frequently in elderly or osteoporotic patients. A surgical method that avoids displacement of the avulsed fragment after fixation has not been developed. We report the cases of 3 patients (a 73-year-old male, an 85-year-old male, and an 81-year-old female) treated by open reduction and internal fixation using titanium wire and cannulated cancellous screws. The posterior approach was used by way of a vertical midline incision. The fracture was fixed with 2 screws, and then a titanium wire was passed through the holes of the cannulated screws. A small incision on the lateral side of planter was added for the exit and return of the wire. The wire knot was bent inside the proximal Achilles tendon bursa in 2 patients and was directed to the plantar side in 1 to avoid irritation. Bony union was achieved without repeat displacement of the fragment in all 3 patients. Normal ankle function was restored, and the patients recovered the activities of daily living almost to the original level. Although an additional plantar incision is required, this surgical technique provides strong internal fixation. PMID:26440932

  4. Bezoar in a Pediatric Oncology Patient Treated with Coca-Cola.

    PubMed

    Naramore, Sara; Virojanapa, Amy; Bell, Moshe; Jhaveri, Punit N

    2015-01-01

    A bezoar is a mass of indigestible material. Bezoars can present with a gradual onset of non-specific gastrointestinal symptoms including abdominal pain, nausea and vomiting. However, bezoars can result in more serious conditions such as intestinal bleeding or obstruction. Without quick recognition, particularly in susceptible individuals, the diagnosis and treatment can be delayed. Currently resolution is achieved with enzymatic dissolution, endoscopic fragmentation or surgery. We describe, to our knowledge, the first pediatric patient with lymphoma to have had a bezoar treated with Coca-Cola. PMID:26269699

  5. Bezoar in a Pediatric Oncology Patient Treated with Coca-Cola

    PubMed Central

    Naramore, Sara; Virojanapa, Amy; Bell, Moshe; Jhaveri, Punit N.

    2015-01-01

    A bezoar is a mass of indigestible material. Bezoars can present with a gradual onset of non-specific gastrointestinal symptoms including abdominal pain, nausea and vomiting. However, bezoars can result in more serious conditions such as intestinal bleeding or obstruction. Without quick recognition, particularly in susceptible individuals, the diagnosis and treatment can be delayed. Currently resolution is achieved with enzymatic dissolution, endoscopic fragmentation or surgery. We describe, to our knowledge, the first pediatric patient with lymphoma to have had a bezoar treated with Coca-Cola. PMID:26269699

  6. Percutaneous pelvic osteotomy in cerebral palsy patients: Surgical technique and indications

    PubMed Central

    Canavese, Federico; Rousset, Marie; Samba, Antoine; de Coulon, Geraldo

    2013-01-01

    AIM: To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy. METHODS: Twenty-one non-ambulatory children and adolescents (22 hips) were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct progressive hip subluxation and acetabular dysplasia. The age, gender, Gross Motor Function Classification System level, side(s) of operated hip, total time of follow-up, immediate post-operative immobilization, complications, and the need for revision surgery were recorded for all patients. RESULTS: Seventeen patients (81%) were classified as GMFCS level IV, and 4 (19%) patients were classified as GMFCS level V. At the time of surgery, the mean age was 10.3 years (range: 4-15 years). The mean Reimers’ migration percentage improved from 63% (range: 3%-100%) pre-operatively to 6.5% (range: 0%-70%) at the final follow-up (P < 0.05). The mean acetabular angle (AA) improved from 34.1° (range: 19°-50°) pre-operatively to 14.1° (range: 5°-27°) (P < 0.05). Surgical correction of MP and AA was comparable in hips with open (n = 14) or closed (n = 8) triradiate cartilage (P < 0.05). All operated hips were pain-free at the time of the final follow-up visit, although one patient had pain for 6 mo after surgery. We did not observe any cases of bone graft dislodgement or avascular necrosis of the femoral head. CONCLUSION: Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with similar outcomes to those of standard techniques. This method allows for less muscle stripping and blood loss and a shorter operating time. PMID:24147263

  7. QUALITY OF LIFE, PAIN, ANXIETY AND DEPRESSION IN PATIENTS SURGICALLY TREATED WITH CANCER OF RECTUM

    PubMed Central

    SANTOS, Letácio José Freire; GARCIA, João Batista dos Santos; PACHECO, Jairo Sousa; VIEIRA, Érica Brandão de Morais; dos SANTOS, Alcione Miranda

    2014-01-01

    Background The rectum cancer is associated with high rates of complications and morbidities with great impact on the lives of affected individuals. Aim To evaluate quality of life, pain, anxiety and depression in patients treated for medium and lower rectum cancer, submitted to surgical intervention. Methods A descriptive cross-sectional study. Eighty-eight records of patients with medium and lower rectum cancer, submitted to surgical intervention were selected, and enrolled. Forty-seven patients died within the study period, and the other 41 were studied. Question forms EORTC QLQ-C30 and EORTC QLQ-CR38 were used to assess quality of life. Pain evaluation was carried out using the Visual Analogical Scale, depression and anxiety were assessed through Depression Inventories and Beck's Anxiety, respectively. The correlation between pain intensity, depression and anxiety was carried out, and between these and the EORTC QLQ-C30 General Scale for Health Status and overall quality of life, as well as the EORTC QLQ-CR38 functional and symptom scales. Results Of the 41 patients of the study, 52% presented pain, depression in 47%, and anxiety in 39%. There was a marking positive correlation between pain intensity and depression. There was a moderate negative correlation between depression and general health status, and overall quality of life as well as pain intensity with the latter. There was a statistically significant negative correlation between future depression perspective and sexual function, and also a strong positive correlation between depression and sexual impairments. A positive correlation between anxiety and gastro-intestinal problems, both statistically significant, was observed. Conclusion Evaluation scales showed detriment on quality life evaluation, besides an elevated incidence of pain, depression, and anxiety; a correlation among these, and factors which influence on the quality of life of post-surgical medium and lower rectum cancer patients was observed. PMID:25004285

  8. Discussing life expectancy with surgical patients: Do patients want to know and how should this information be delivered?

    PubMed Central

    Clarke, Michael G; Kennedy, Katherine P; MacDonagh, Ruaraidh P

    2008-01-01

    Background Predicted patient life expectancy (LE) and survival probability (SP), based on a patient's medical history, are important components of surgical decision-making and informed consent. The objective of this study was to assess patients' interpretation of and desire to know information relating to LE, in addition to establishing the most effective format for discussion. Methods A cross sectional survey of 120 patients (mean age = 68.7 years, range 50–90 years), recruited from general urological and surgical outpatient clinics in one District General and one Teaching hospital in Southwest England (UK) was conducted. Patients were included irrespective of their current diagnosis or associated comorbidity. Hypothetical patient case scenarios were used to assess patients' desire to know LE and SP, in addition to their preferred presentation format. Results 58% of patients expressed a desire to know their LE and SP, if it were possible to calculate, with 36% not wishing to know either. Patients preferred a combination of numerical and pictorial formats in discussing LE and SP, with numerical, verbal and pictorial formats alone least preferred. 71% patients ranked the survival curve as either their first or second most preferred graph, with 76% rating facial figures their least preferred. No statistically significant difference was noted between sexes or educational backgrounds. Conclusion A proportion of patients seem unwilling to discuss their LE and SP. This may relate to their current diagnosis, level of associated comorbidity or degree of understanding. However it is feasible that by providing this information in a range of presentation formats, greater engagement in the shared decision-making process can be encouraged. PMID:18554419

  9. Scoliosis in patients with Prader Willi Syndrome – comparisons of conservative and surgical treatment

    PubMed Central

    Weiss, Hans-Rudolf; Goodall, Deborah

    2009-01-01

    In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS. Types of participants included: patients with scoliosis and PWS. Type of intervention: surgery. Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles. Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70° and some of which improved. If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees) conservatively, this treatment seems to have fewer complications than surgical treatments. The results of our retrospective study of nine patients demonstrate that scoliosis in this entity plays only a minor role and surgery is unnecessary when high quality conservative management exists. There is lack of the long follow-up studies in post-surgical cases in patients with PWS and scoliosis. The rate of complications of spinal fusion in patients with PWS and scoliosis is very high and the death rates have been found to be higher than in patients with Adolescent Idiopathic Scoliosis (AIS). The long-term side-effects of the intervention are detrimental, so that the risk-benefit ratio favours the conservative approaches over spinal fusion surgery. PMID:19419581

  10. [Cryptococcus Neoformans Var. Gattii meningoencephalitis with cryptococcoma in an immunocompetent patient successfully treated by surgical resection].

    PubMed

    Inada, Taku; Imamura, Hirotoshi; Kawamoto, Michi; Sekiya, Hiroaki; Imai, Yukihiro; Tani, Shoichi; Adachi, Hidemitsu; Ishikawa, Tatsuya; Mineharu, Yohei; Asai, Katsunori; Ikeda, Hiroyuki; Ogura, Takenori; Shibata, Teishiki; Beppu, Mikiya; Agawa, Yuji; Shimizu, Kanpei; Sakai, Nobuyuki; Kikuchi, Haruhiko

    2014-02-01

    Cryptococcosis is a fungal infection, which mainly invades the lungs and central nervous system. In Japan, most cases of cryptococcosis are caused by Cryptococcus neoformans(C. neoformans). Until now, only three cases which the infectious agent was Cryptococcus neoformans var. gattii(C. gattii)have been reported. As compared with cryptococcosis caused by C. neoformans, which is often observed in immunocompromised hosts, cryptococcosis caused by C. gattii occurs predominantly in immunocompetent hosts and is resistant to antifungal drugs. Here, we report a case of refractory cerebral cryptococcoma that was successfully treated by surgical resection of the lesions. A 33-year-old man with no medical history complained of headache, hearing disturbance, and irritability. Pulmonary CT showed a nodular lesion in the left lung. Cerebrospinal fluid examination with Indian ink indicated cryptococcal meningitis, and PCR confirmed infection with C. gattii. C. gattii is usually seen in the tropics and subtropics. Since this patient imported trees and soils from abroad to feed stag beetles, parasite or fungal infection was, as such, suspected. Although he received 2 years of intravenous and intraventricular antifungal treatment, brain cryptococcomas were formed and gradually increased. Because of the refractory clinical course, the patient underwent surgical resection of the cerebral lesions. With continuation of antifungal drugs for 6 months after the surgeries, Cryptococcus could not be cultured from cerebrospinal fluid, and no lesions were seen on MR images. If cerebral cryptococcosis responds poorly to antifungal agents, surgical treatment of the cerebral lesion should be considered. PMID:24501185

  11. Occurrence of Deep Vein Thrombosis among Hospitalized Non-Surgical Japanese Patients

    PubMed Central

    Hanzawa, Kazuhiko; Ota, Satoshi; Nakamura, Mashio; Sato, Koichi; Ikura, Maiko; Suzuki, Takeo; Kaise, Toshihiko; Nakajima, Hiromu; Ito, Masaaki

    2015-01-01

    Objective: To estimate the frequency of deep vein thrombosis (DVT) among non-surgical inpatients, and to evaluate the D-dimer assay as a screening tool for DVT. Methods: Subjects were non-surgical inpatients aged 20 years or older who had been bedridden for at least 24 hours and had moderate-to-high risk factors for DVT. We assessed the presence of DVT by venous ultrasonography. Patients who received a diagnosis of venous thromboembolism (VTE) before admission, who had symptoms or findings of VTE at admission, or who had surgery or trauma within the past 3 months before admission were excluded. Results: DVT was confirmed in 96 of 525 patients (18.3%). In a logistic regression analysis, longer duration of hospitalization, higher D-dimer value, and history of cancer surgery were significantly associated with the occurrence of DVT. The D-dimer assay showed high sensitivity (96.1%) and high negative predictive value (97.6%). Conclusion: Non-surgical inpatients with a long-term hospitalization or history of cancer surgery have a risk for DVT, and need to be considered for added DVT preventive measures as recommended in the prevention guidelines. In addition, the D-dimer assay is beneficial for the screening of DVT in medical practice. PMID:26421068

  12. Temporal trends in the surgical outcomes of patients with breast cancer

    PubMed Central

    2012-01-01

    Background The incidence of breast cancer has been increasing in Japan over the past three decades, and it is the currently the most common malignancy in Japan. This study investigated the temporal trends of the surgical outcomes in patients with breast cancer. Methods We evaluated 543 consecutive patients who underwent breast-cancer resection between 1980 and 2009. The temporal trends in the surgical outcome and clinicopathological features were evaluated separately for the periods covering 1980 to 1989, 1990 to 1999, and 2000 to 2009. Results The number of patients who underwent resection during these three respective periods were 133, 176, and 234, respectively. All patients were women. The percentage of patients at stages 0 or 1 was 63.2%, 58.5%, and 43.6%, respectively, during the three periods. The mean diameter of tumors in each period was 38, 29, and 30 mm, respectively. The percentage of tumors with positive ER expression was 62.5%, 64.3%, and 69.7%, respectively. In terms of surgical procedures, the use of Halsted’s radical mastectomy decreased during each period: from 40.6% of cases to 8.5% and then to 0.4%, while the proportion of breast-conserving therapies increased, from 0% to 12.5%, and finally to 35.9%. The postoperative 10-year survival rates during the three periods were 75.9%, 83.5%, and 84.9%, respectively. The 10-year survival rates of patients with stage II disease during the three periods were 66.2%, 75.7%, and 90.7%, respectively. The prognosis of stage III disease in the three periods also showed a tendency toward improvement, increasing from 37.8% to 64.2%, and finally to 84.5%. Conclusion The survival of patients with stage II and III disease has improved during the past 30 years. Along with the recent advances in drug therapy, the surgical treatment has become less invasive, often because of drug therapy-related modifications. PMID:22697184

  13. The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.

    PubMed

    Fuchshuber, Pascal R; Greif, William; Tidwell, Chantal R; Klemm, Michael S; Frydel, Cheryl; Wali, Abdul; Rosas, Efren; Clopp, Molly P

    2012-01-01

    The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year. This article summarizes briefly the history of NSQIP and how its report on surgical outcomes can be used for performance improvement within a hospital system. In particular, it describes how to drive performance improvement with NSQIP data using the example of postoperative respiratory complications--a major factor of postoperative mortality. In addition, this article explains the benefit of a collaborative of several participating NSQIP hospitals and describes how to develop a "playbook" on the basis of an outcome improvement project. PMID:22529758

  14. What Does a Hospital Survey on Patient Safety Reveal About Patient Safety Culture of Surgical Units Compared With That of Other Units?

    PubMed

    Shu, Qin; Cai, Miao; Tao, Hong-Bing; Cheng, Zhao-Hui; Chen, Jing; Hu, Yin-Huan; Li, Gang

    2015-07-01

    The objective of this study was to examine the strengths and weaknesses of surgical units as compared with other units, and to provide an opportunity to improve patient safety culture in surgical settings by suggesting targeted actions using Hospital Survey on Patient Safety Culture (HSOPSC) investigation.A Hospital Survey on Patient Safety questionnaire was conducted to physicians and nurses in a tertiary hospital in Shandong China. 12 patient safety culture dimensions and 2 outcome variables were measured.A total of 23.5% of respondents came from surgical units, and 76.5% worked in other units. The "overall perceptions of safety" (48.1% vs 40.4%, P?surgical units were higher than those of other units. However, the communication openness (38.7% vs 42.5%, P?surgical units was lower than in other units. Medical workers in surgical units reported more events than those in other units, and more respondents in the surgical units assess "patient safety grade" to be good/excellent. Three dimensions were considered as strengths, whereas 5 other dimensions were considered to be weaknesses in surgical units. Six dimensions have potential to aid in improving events reporting and patient safety grade. Appropriate working times will also contribute to ensuring patient safety. Medical staff with longer years of experience reported more events.Surgical units outperform the nonsurgical ones in overall perception of safety and the number of events reported but underperform in the openness of communication. Four strategies, namely deepening the understanding about patient safety of supervisors, narrowing the communication gap within and across clinical units, recruiting more workers, and employing the event reporting system and building a nonpunitive culture, are recommended to improve patient safety in surgical units in the context of 1 hospital. PMID:26166083

  15. What Does a Hospital Survey on Patient Safety Reveal About Patient Safety Culture of Surgical Units Compared With That of Other Units?

    PubMed Central

    Shu, Qin; Cai, Miao; Tao, Hong-bing; Cheng, Zhao-hui; Chen, Jing; Hu, Yin-huan; Li, Gang

    2015-01-01

    Abstract The objective of this study was to examine the strengths and weaknesses of surgical units as compared with other units, and to provide an opportunity to improve patient safety culture in surgical settings by suggesting targeted actions using Hospital Survey on Patient Safety Culture (HSOPSC) investigation. A Hospital Survey on Patient Safety questionnaire was conducted to physicians and nurses in a tertiary hospital in Shandong China. 12 patient safety culture dimensions and 2 outcome variables were measured. A total of 23.5% of respondents came from surgical units, and 76.5% worked in other units. The “overall perceptions of safety” (48.1% vs 40.4%, P < 0.001) and “frequency of events reported” (63.7% vs 60.7%, P = 0.001) of surgical units were higher than those of other units. However, the communication openness (38.7% vs 42.5%, P < 0.001) of surgical units was lower than in other units. Medical workers in surgical units reported more events than those in other units, and more respondents in the surgical units assess “patient safety grade” to be good/excellent. Three dimensions were considered as strengths, whereas 5 other dimensions were considered to be weaknesses in surgical units. Six dimensions have potential to aid in improving events reporting and patient safety grade. Appropriate working times will also contribute to ensuring patient safety. Medical staff with longer years of experience reported more events. Surgical units outperform the nonsurgical ones in overall perception of safety and the number of events reported but underperform in the openness of communication. Four strategies, namely deepening the understanding about patient safety of supervisors, narrowing the communication gap within and across clinical units, recruiting more workers, and employing the event reporting system and building a nonpunitive culture, are recommended to improve patient safety in surgical units in the context of 1 hospital. PMID:26166083

  16. Surgical treatment for brain metastases: Prognostic factors and survival in 309 patients with regard to patient age.

    PubMed

    Stark, A M; Stöhring, C; Hedderich, J; Held-Feindt, J; Mehdorn, H M

    2011-01-01

    Brain metastases are the most common intracranial tumors. Overall, the only accepted prognostic factors are patient age and performance status. However, several other factors are considered before surgery. We performed a retrospective analysis of 309 patients who underwent surgical resection of newly diagnosed brain metastases between 1994 and 2004. Univariate survival analysis revealed age, performance status, extracranial metastases, complete resection, radiotherapy and re-craniotomy as prognostic indicators. Multivariate analysis determined that patient age, performance status, extracranial metastases, radiotherapy and re-craniotomy are independent factors of prolonged survival. We statistically estimated the age threshold separating patients with favorable outcomes from those with unfavorable prognoses. Using the Kaplan-Meier analysis this threshold can be set at 65 years. Multivariate analysis of patients >65 years revealed the presence of co-morbidities, the number of brain metastases, post-operative performance status and radiotherapy as independent prognostic factors. PMID:20851611

  17. [Surgical technique of aortic valve replacement for small aortic annulus in elderly patients].

    PubMed

    Hata, T; Fujiwara, K; Furukawa, H; Tsushima, Y; Yoshitaka, H; Kuinose, M; Minami, H; Ishida, A; Tamura, K; Totsugawa, T; Kanemitsu, H; Ozawa, M

    2006-04-01

    Recent reports have shown that aortic valve replacement in elderly patients over 65 years with atherosclerotic aortic stenosis and a small aortic annulus is possible by using a small sized bioprosthesis (Carpentier-Edwards pericardial valve). Here we present out surgical technique. Firstly, the native calcified aortic valve was removed completely to gain total exposure of the surrounding aortic root and sinus of Valsalva like Bentall procedure. Secondly, a small sized bioprosthesis was implanted with intermittent noneverting mattress 2-0 sutures with spaghetti and small polytetrafluoroethylene (PTFE) felt. Aortic annulus is the dilated by inserting Hegar dilator sizing from 25 to 27 mm. Therefore, aortic valve replacement for small aortic annulus in intra- or supra-annular position should be easily accomplished. Good surgical results and hemodynamic state were achieved in 25 consecutive cases using this technique. PMID:16613145

  18. [Oncological care according Alfred Schütz].

    PubMed

    Popim, Regina Célia; Boemer, Magali Roseira

    2005-01-01

    The study was realized among oncological nurses in their daily work routine and aimed to understand these professionals' subjective action, starting from their relation with patients, adopting a phenomenological reference framework based on the ideas of Alfred Schütz. The question: what does working in oncological care mean to you? Please describe, was used to collect statements, which were analyzed and clarified the typical action of a nurse caregiver in this daily routine. The study revealed that oncological care implies dealing with humans in a fragile situation; requires a relationship of affectivity; is care delivery that entails the genesis of professional burnout. Care delivery in oncology is highly complex, requiring a professional competence that goes beyond the technical-scientific sphere. Nursing professionals need to seek strategies which enable them to face the fatigue they are submitted to in their work. PMID:16308624

  19. [The use of allografts in the surgical treatment of patients with infected vascular prostheses].

    PubMed

    Locati, P M; Gallo, E; Costantini, E; Campanati, B; Socrate, A M; Lanza, G; Morlacchi, E; Costantini, S

    1998-01-01

    The article is devoted to analysis of surgical treatment of patients with such a dangerous complication as infection of the vascular prosthesis. The authors have performed 25 operations for substituting the infected prostheses for allografts. In 18 patients the infected prostheses were located in the aorto-iliac segment, in 5 patients in the femoro-popliteal segment, 1 patient had it in the aorta, and 1 in the subclavian segment. The prostheses were removed and a simultaneous revascularization was made. The authors make a conclusion that it is very expedient to use alloprostheses as a protective measure against persistent or recidivating infections. The allografts have both early and long-term resistance to infection. PMID:9751993

  20. [Surgical treatment of inguinal hernia using a nylon mesh. Original technic apropos of a series of 208 surgically treated patients].

    PubMed

    Frank, P

    1984-10-01

    The author describes an original surgical technique to cure inguinal hernias by means of a nylon mesh. Drawing his conclusions from 208 cases he has operated on, he explains the indications of his technique and indicates the results he has obtained. This material if perfectly well tolerated and the rate of recurrence is very low, lower than two percent. PMID:6511828

  1. SM-04PROPHYLACTIC ANTIEPILEPTIC DRUGS DO NOT REDUCE SEIZURE RATES IN SURGICAL BRAIN TUMOR PATIENTS

    PubMed Central

    Lockney, Dennis; Walch, Frank; Vaziri, Sasha; Rahman, Maryam; Murad, Gregory

    2014-01-01

    Though no clear evidence supports seizure prophylaxis in patients with cerebral tumors, prophylactic use of anti-epileptic drugs (AEDs) for patients undergoing tumor surgery is common practice. A retrospective chart review was performed of 609 consecutive patients from 2010-2013 who underwent surgery for brain neoplasms at the University of Florida. Patients who did not present with seizures preoperatively were divided into supratentorial and infratentorial groups. There were 357 patients with supratentorial tumors with 297 (83.2%) receiving AEDs post-operatively and 60 (16.8%) not receiving AEDs. From surgery to last follow-up, one patient (2%) in the non-AED group had a seizure and 15 (6.2%) in the AED group had seizures (p = 0.487). There were 129 patients with infratentorial tumors, with 32 (24.8%) receiving AEDs and 97 (75.2%) not receiving AEDs. In the post-operative period, one patient (1.2%) in the non-AED group had a seizure and zero in the AED group had a seizure (p = 1). 16 (5.4%) patients in the supratentorial group and 3 (9.4%) patients in the infratentorial group on AEDs experienced toxicity related to AEDs. At discharge, 254 patients (85.5%) with supratentorial tumors without seizures remained on AEDs. At last follow up, 129 patients (53.8%) with supratentorial tumors remained on AEDs despite no seizures. AEDs do not significantly reduce post-operative seizures in surgical brain tumor patients in this analysis. Additionally, once a patient is prescribed an AED, discontinuation of AED therapy is unlikely, even if the patient remains seizure free.

  2. Long term oncologic outcomes of a Phase II trial of neoadjuvant chemohormonal therapy followed by radical prostatectomy for patients with clinically localized, high-risk prostate cancer

    PubMed Central

    Silberstein, Jonathan L.; Poon, Stephen A.; Sjoberg, Daniel D.; Maschino, Alexandra C.; Vickers, Andrew J; Bernie, Aaron; Konety, Badrinath R.; Kelly, W. Kevin; Eastham, James A

    2014-01-01

    Purpose To determine long-term oncologic outcomes of radical prostatectomy (RP) after neoadjuvant chemo-hormonal therapy for clinically localized, high-risk prostate cancer. Methods In this phase II multicenter trial of patients with high-risk prostate cancer (PSA>20ng/ml, Gleason ≥8, or clinical stage ≥T3), androgen deprivation therapy (goserelin acetate depot) and paclitaxel, carboplatin and estramustine were administered prior to RP. We report the long-term oncologic outcomes of these patients and compared them to a contemporary cohort who met oncologic inclusion criteria but received RP only. Results Thirty-four patient