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1

Nanotechnology Applications in Surgical Oncology  

PubMed Central

Surgery is currently the most effective and widely used procedure in treating human cancers, and the single most important predictor of patient survival is a complete surgical resection. Major opportunities exist to develop new and innovative technologies that could help the surgeon to delineate tumor margins, to identify residual tumor cells and micrometastases, and to determine if the tumor has been completely removed. Here we discuss recent advances in nanotechnology and optical instrumentation, and how these advances can be integrated for applications in surgical oncology. A fundamental rationale is that nanometer-sized particles such as quantum dots and colloidal gold have functional and structural properties that are not available from either discrete molecules or bulk materials. When conjugated with targeting ligands such as monoclonal antibodies, peptides, or small molecules, these nanoparticles can be used to target malignant tumor cells and tumor microenvironments with high specificity and affinity. In the “mesoscopic” size range of 10–100 nm, nanoparticles also have large surface areas for conjugating to multiple diagnostic and therapeutic agents, opening new possibilities in integrated cancer imaging and therapy. PMID:20059343

Singhal, Sunil; Nie, Shuming; Wang, May D.

2010-01-01

2

Risk prediction tools in surgical oncology.  

PubMed

Healthcare has increasingly focused on patient engagement and shared decision-making. Decision aids can promote engagement and shared decision making by providing patients and their providers with care options and outcomes. This article discusses decision aids for surgical oncology patients. Topics include: short-term risk prediction following surgery, long-term risk prediction of survival and recurrence, the combination of short- and long-term risk prediction to help guide treatment choice, and decision aid usability, transparency, and accessibility. PMID:24975865

Kinnier, Christine V; Asare, Elliot A; Mohanty, Sanjay; Paruch, Jennifer L; Rajaram, Ravi; Bilimoria, Karl Y

2014-10-01

3

[Quality assurance in head and neck surgical oncology].  

PubMed

In patients' management affected by head and neck cancers, surgery takes a major place with radiotherapy and chemotherapy. An updating of the surgical techniques available, and validated indications seems useful to harmonize the head and neck oncological surgery practices and so optimize its safety. A focus on the quality assurance in head and neck surgical oncology is proposed. PMID:24886901

Vergez, Sébastien; Jegoux, Franck; Dolivet, Gilles; Morinière, Sylvain

2014-05-01

4

Primary prevention of venous thromboembolism in medical and surgical oncology patients  

Microsoft Academic Search

Recent data suggest that patients with a malignancy have a seven-fold increased risk for venous thromboembolism (VTE) compared with those without cancer, suggesting that these patients may benefit from thromboprophylaxis. Mechanisms for the prevention of thromboembolism can be divided into two broad categories: mechanical and pharmacological. Although generally used in combination with pharmacotherapy, little evidence exists for the efficacy of

A Young

2010-01-01

5

Journal of Surgical Oncology Quantitative Comparison of Surgical Margin Histology Following Excision  

E-print Network

Journal of Surgical Oncology Quantitative Comparison of Surgical Margin Histology Following, and histological effect were compared on the same breast tissue cut with each excision instrument. A probability

Kummel, Andrew C.

6

Optimizing Reconstruction of Oncologic Sternectomy Defects Based on Surgical Outcomes  

PubMed Central

Background The optimal strategy for oncologic sternectomy reconstruction has not been well characterized. We hypothesized that the major factors driving the reconstructive strategy for oncologic sternectomy include the need for skin replacement, extent of the bony sternectomy defect, and status of the internal mammary vessels. Study Design We reviewed consecutive oncologic sternectomy reconstructions performed at The University of Texas MD Anderson Cancer Center over a 10-year period. Regression models analyzed associations between patient, defect, and treatment factors and outcomes in order to identify patient and treatment selection criteria. We developed a generalized management algorithm based on these data. Results Forty-nine consecutive patients underwent oncologic sternectomy reconstruction (mean follow-up = 18±23 months). More sternectomies were partial (74%) rather than total/sub-total (26%). Most defects (N=40, 82%) required skeletal reconstruction. Pectoralis muscle flaps were most commonly employed for sternectomies with intact overlying skin (64%) and infrequently used when a presternal skin defect was present (36%; p=0.06). Free flaps were more often used for total/sub-total versus partial sternectomy defects (75% vs. 25%, respectively; p=0.02). Complication rates for total/sub-total sternectomy and partial sternectomy were equivalent (46% vs. 44%, respectively; p=0.92). Conclusions Despite more extensive sternal resections, total/sub-total sternectomies resulted in equivalent postoperative complications when combined with the appropriate soft tissue reconstruction. Good surgical and oncologic outcomes can be achieved with defect-characteristic-matched reconstructive strategies for these complex oncologic sternectomy resections. PMID:23619320

Butterworth, James; Garvey, Patrick B; Baumann, Donald P; Zhang, Hong; Rice, David C; Butler, Charles E

2014-01-01

7

Oocyte cryopreservation in oncological patients.  

PubMed

The use of chemotherapy and radiotherapy in oncological patients may reduce their reproductive potential. Sperm cryopreservation has been already used in men affected by neoplastic disease. Oocyte cryopreservation might be an important solution for these patients at risk of losing ovarian function. A program of oocyte cryopreservation for oncological patients is also present in our center. From June 1996 to January 2000, 18 patients awaiting chemotherapy and radiotherapy for neoplastic disease were included in our oocyte cryopreservation program. Our experience documents that oocyte storage may be a concrete and pragmatic alternative for oncological patients. The duration of oocyte storage does not seem to interfere with oocyte survival as pregnancies occurred even after several years of gamete cryopreservation in liquid nitrogen. PMID:15041124

Porcu, Eleonora; Fabbri, Raffaella; Damiano, Giuseppe; Fratto, Rosita; Giunchi, Susanna; Venturoli, Stefano

2004-04-01

8

ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology.  

PubMed

Parenteral nutrition offers the possibility of increasing or ensuring nutrient intake in patients in whom normal food intake is inadequate and enteral nutrition is not feasible, is contraindicated or is not accepted by the patient. These guidelines are intended to provide evidence-based recommendations for the use of parenteral nutrition in cancer patients. They were developed by an interdisciplinary expert group in accordance with accepted standards, are based on the most relevant publications of the last 30 years and share many of the conclusions of the ESPEN guidelines on enteral nutrition in oncology. Under-nutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis and, per se, responsible for excess morbidity and mortality. Many indications for parenteral nutrition parallel those for enteral nutrition (weight loss or reduction in food intake for more than 7-10 days), but only those who, for whatever reason cannot be fed orally or enterally, are candidates to receive parenteral nutrition. A standard nutritional regimen may be recommended for short-term parenteral nutrition, while in cachectic patients receiving intravenous feeding for several weeks a high fat-to-glucose ratio may be advised because these patients maintain a high capacity to metabolize fats. The limited nutritional response to the parenteral nutrition reflects more the presence of metabolic derangements which are characteristic of the cachexia syndrome (or merely the short duration of the nutritional support) rather than the inadequacy of the nutritional regimen. Perioperative parenteral nutrition is only recommended in malnourished patients if enteral nutrition is not feasible. In non-surgical well-nourished oncologic patients routine parenteral nutrition is not recommended because it has proved to offer no advantage and is associated with increased morbidity. A benefit, however, is reported in patients undergoing hematopoietic stem cell transplantation. Short-term parenteral nutrition is however commonly accepted in patients with acute gastrointestinal complications from chemotherapy and radiotherapy, and long-term (home) parenteral nutrition will sometimes be a life-saving maneuver in patients with sub acute/chronic radiation enteropathy. In incurable cancer patients home parenteral nutrition may be recommended in hypophagic/(sub)obstructed patients (if there is an acceptable performance status) if they are expected to die from starvation/under nutrition prior to tumor spread. PMID:19477052

Bozzetti, F; Arends, J; Lundholm, K; Micklewright, A; Zurcher, G; Muscaritoli, M

2009-08-01

9

Limitations of claims and registry data in surgical oncology research.  

PubMed

Studies based on large population-based data sets, such as administrative claims data and tumor registry data, have become increasingly common in surgical oncology research. These data sets can be acquired relatively easily, and they offer larger sample sizes and improved generalizability compared with institutional data. There are, however, significant limitations that must be considered in the analysis and interpretation of such data. Invalid conclusions can result when insufficient attention is paid to issues such as data quality and depth, potential sources of bias, missing data, type I error, and the assessment of statistical significance. This article reviews some important limitations of population-based data sets and the methods used to analyze them. The candid reporting of these issues in the literature and an increased awareness among surgical oncologists of these limitations will ensure that population-based studies in the surgical oncology literature achieve high standards of methodological quality and clinical utility. PMID:17987343

Nathan, Hari; Pawlik, Timothy M

2008-02-01

10

Robot-Assisted Radical Hysterectomy for Cervical Cancer: Review of Surgical and Oncological Outcomes  

PubMed Central

Robot-assisted procedures are being increasingly incorporated in gynaecologic oncology. Several studies have confirmed the feasibility and safety of robotic radical hysterectomy for selected patients with early-stage cervical cancer. It has been demonstrated that robotic radical hysterectomy offers an advantage over other surgical approaches with regard to operative time, blood loss, and hospital stay. Also initial evidences concerning oncological outcomes seem to confirm the equivalence to traditional open technique. Despite the fact that costs of robotic system are still high, they could be partially offset by several health-related and social benefits: less pain, faster dismissal, and return to full activity than other surgical approaches. The development of robotic technology may facilitate the spread of minimally invasive surgery in gynaecological oncology, overcoming some drawbacks of laparoscopic technique for challenging intervention such as radical hysterectomy. Further studies are needed to evaluate overall and disease-free survival of this technique and associated morbidity after adjuvant therapies. PMID:22111022

Renato, Seracchioli; Mohamed, Mabrouk; Serena, Solfrini; Giulia, Montanari; Giulia, Ferrini; Giulia, Giovanardi; Diego, Raimondo; Riccardo, Schiavina

2011-01-01

11

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

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.

Patel, Rakesh R. [Department of Radiation Oncology, University of Wisconsin Hospital and Clinics, Madison, WI (United States)], E-mail: patel@humonc.wisc.edu; Christensen, Michael E.; Hodge, C. Wesley; Adkison, Jarrod B.; Das, Rupak K. [Department of Radiation Oncology, University of Wisconsin Hospital and Clinics, Madison, WI (United States)

2008-03-15

12

The ON-Q pain management system in elective gynecology oncologic surgery: Management of postoperative surgical site pain compared to intravenous patient-controlled analgesia  

PubMed Central

Objective The goal of this study was to compare postoperative surgical site pain in gynecologic cancer patients who underwent elective extended lower midline laparotomy and managed their pain with either the ON-Q pain management system (surgical incision site pain relief system, ON-Q pump) or an intravenous patient-controlled analgesia pump (IV PCA). Methods Twenty gynecologic cancer patients who underwent elective extended lower midline laparotomy were divided into two groups. One group received a 72-hour continuous wound perfusion of the local anesthetic ropivacaine (0.5%, study group) into the supraperitoneal layer of the abdominal incision through the ON-Q pump. The other group received intravenous infusion pump of patient-controlled analgesia (fentanyl citrate 20 mg/mL · kg+ondansetron hydrochloride 16 mg/8 mL+normal saline). Postoperative pain was assessed immediately and at 6, 24, 48, 72, and 96 hours after surgery using the visual analogue scale. Results Postoperative surgical site pain scores at 24, 48, and 72 hours after surgery were lower in the ON-Q group than the IV PCA group. Pain scores at 24 hours and 48 hours after surgery were significantly different between the two groups (P=0.023, P<0.001). Overall painkiller administration was higher in the ON-Q group but this difference was not statistically significant (5.1 vs. 4.3, P=0.481). Conclusion This study revealed that the ON-Q pain management system is a more effective approach than IV PCA for acute postoperative surgical site pain relief after extended lower midline laparotomy in gynecologic cancer patients. PMID:24327987

Chung, Dawn; Lee, Yoo Jin; Jo, Mi Hyun; Park, Hyun Jong; Lim, Ga Won; Cho, Hanbyoul; Nam, Eun Ji; Kim, Sang Wun; Kim, Jae Hoon; Kim, Young Tae

2013-01-01

13

POSTOPERATIVE COMPLICATIONS IN THE ONCOLOGY DOG PATIENT  

Microsoft Academic Search

Summary Objective: to investigate post0operative complications in the dogs' oncology patients Design : retrospective study of the 211 canines with cancer. Intervention: curative, palliative, or cytoreductive surgery. Results: after 211 oncology surgery 17 per cent complications were assessed; wound complication (30.5%), excessive pain (25%), hypothermia (22%), and sinus tachycardia (11%) of the total complications. Conclusion: common complications registered after the

C. IGNA; A. SALA; LARISA SCHUSZLER; M. SAB?U; C. LUCA

2009-01-01

14

Chemotherapy, early surgical reassessment, and hyperfractionated abdominal radiotherapy in stage III ovarian cancer: Results of a gynecologic oncology group study  

Microsoft Academic Search

Purpose: To determine outcomes and treatment toxicities in patients with optimal (?1 cm residual) Stage III ovarian carcinoma treated with three courses of cisplatin-cyclophosphamide, surgical reassessment (SRA), and hyperfractionated whole abdonimal irradiation (WAI).Methods and Materials: Forty-two eligible patients entered this prospective Phase II study conducted by the Gynecologic Oncology Group (GOG). Disease characteristics were as follows: age range, 32–76 years

Marcus E. Randall; Rolland J. Barrett; Nick M. Spirtos; Eva Chalas; Howard D. Homesley; Samuel L. Lentz; Mark Hanna

1996-01-01

15

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

PubMed Central

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

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

2009-01-01

16

Plastic Surgery for the Oncological Patient  

PubMed Central

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

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

2014-01-01

17

Perioperatory pain in oncological patient - physiopathological and therapeutical implications  

PubMed Central

Perioperatory pain in oncological patients represents a witness of anesthetic-surgical aggression, frequently exacerbated by the complementary radio-chemotherapy and also a predictive factor for postoperatory evolution. The objectivation of perioperative pain by scales of clinical evaluation does not offer a certain and objective quantification; so, the dosing of some hormonal and acute phase inflammation mediators could realize a more realistic projection. Clinical and biological correlation can offer a support for an adequate and well-balanced treatment. Divinum est sedare dolorum Blessed are those who treat pain. Galen

Diaconu, C; Pantis, C; Cirimbei, C; Bordea, C; Blidaru, A

2014-01-01

18

Improving patient safety in radiation oncology  

SciTech Connect

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.

Hendee, William R.; Herman, Michael G. [Medical College of Wisconsin, P.O. Box 7319, Rochester, Minnesota 55901 (United States); Department of Radiation Oncology, Desk R, Mayo Clinic, 200 First St. SW Rochester, Minnesota 55905 (United States)

2011-01-15

19

EDUCATIONAL SECTION: risk analysis in surgical oncology-part I: concepts and tools.  

PubMed

All clinical procedures invoke risk. Many interventions in cancer management carry a particularly high element of risk, expressed through morbidity and premature death. Formal risk analysis is a discipline which is fundamental to engineering, to finance, to the airline industry and many other sectors of public life. Clinical risk analysis involves risk prediction, risk management and risk avoidance. Risk analysis is rarely invoked or taught in the clinical sciences, and management appraisals on individual patients almost never include a formal estimate of risk. Clinical decisions tend to be guided by qualitative judgements, and by the personality interactions of patients and clinicians. A formal evaluation of risk on a case by case and procedural basis might reduce morbidity and cost in surgical oncology practice. This article introduces the concepts, the spectrum and history of risk analysis and the tools for risk prediction. PMID:11034813

Rew, D A

2000-09-01

20

NCI-CCR Pediatric Oncology Branch: Neuro-Oncology Section: Patient Consultations  

Cancer.gov

Skip to Main Content CCR Home | About CCR | CCR Intranet Main Navigation Referrals For Patients For Physicians For Prospective Trainees For Scientists News Quick Links Home Referring a Patient Patients and Families Scientific Programs - Neuro-Oncology

21

Incorporating Fertility Preservation into the Care of Young Oncology Patients  

PubMed Central

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

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

2010-01-01

22

Participation in surgical oncology clinical trials: gender-, race/ethnicity-, and age-based disparities. | accrualnet.cancer.gov  

Cancer.gov

Researchers determined the enrollment fraction (EF), defined as the number of trial enrollees in Cancer Therapeutics Evaluation Program (CTEP) studies divided by the estimated U.S. cancer cases in each demographic group from the period 2000-2002. Women comprised 83.95% of the participants in NCI-sponsored trials, due to the fact that 74.66% of enrollees to surgical oncology trials participated in large breast cancer studies. African-American and Hispanic patients were underrepresented in NCI-sponsored surgical trials relative to their proportion of cancer incidence.

23

Comparison of laparoscopy and laparotomy for the management of early-stage ovarian cancer: surgical and oncological outcomes  

PubMed Central

Objective To investigate the surgical and oncological outcomes of laparoscopic surgery compared with laparotomy for the treatment of early-stage ovarian cancer. Methods Data from patients who underwent surgical management for early-stage ovarian cancer between 2006 and 2012 were retrospectively reviewed. All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of a total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, and peritoneal cytology. Results Seventy-seven patients who underwent laparoscopic surgery (24 patients) or laparotomy (53 patients) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The mean operation time was shorter and the estimated blood loss was lower in the laparoscopy group than in the laparotomy group, though the differences were not statistically significant (193 min vs. 224 min, p=0.127; 698 mL vs. 973 mL, p=0.127). There were no differences in the intraoperative or postoperative complications. During a mean follow-up period of 31 months, tumor recurrence occurred in 4 patients: 2 (8.3%) in the laparoscopy group and 2 (3.8%) in the laparotomy group. The mean disease-free survival was 59 months after laparoscopy and 66 months after laparotomy (p=0.367). Conclusion Laparoscopic surgery seems to be adequate and feasible for the treatment of early-stage ovarian cancer with comparable results to laparotomy in terms of the surgical outcomes and oncological safety. PMID:24761214

Koo, Yu-Jin; Kim, Jung-Eun; Kim, Young-Hwa; Hahn, Ho-Suap; Lee, In-Ho; Kim, Tae-Jin; Lee, Ki-Heon; Shim, Jae-Uk

2014-01-01

24

[Gastric stump carcinoma--a surgical and oncological challenge].  

PubMed

Gastric stump carcinoma after gastric surgery for benign disease is now widely recognized as a distinct clinical entity. An electronic literature search was performed in the MEDLINE database to identify relevant studies concerning epidemiology, prognosis, treatment, aetiology and pathology of gastric stump carcinoma. The references reported in these studies were used to complete the literature search. It can be assumed that approximately 10 % of patients who had undergone a distal gastric resection for benign disease will develop a carcinoma in the gastric remnant about 15 to 20 years after the primary procedure. The incidence is reported to be higher in males and following Billroth II resection. The site of tumour growth is predominantly in the anastomotic area, but may occur anywhere in the stump. Enterogastric reflux, achlorhydria, bacterial overgrowth, and genetic factors appear to be the major factors involved in the aetiopathogenesis of the gastric stump cancer. Unfortunately, a significant proportion of patients presents with synchronous metastases. Clinical symptoms are mainly attributed to locally advanced tumour growth. Surgical therapy comprises total removal of the gastric remnant and the jejunal segment including modified lymphadenectomy (D2 lymphadenectomy and jejunal mesentery). Surveillance of patients with endoscopy and multiple biopsies should be initiated from the tenth postoperative year and may provide the means to diagnose tumours at an early stage. PMID:21887665

Meyer, F; Benedix, F; Garlipp, B; Lippert, H; Meyer, L

2011-09-01

25

Protecting Pediatric Oncology Patients From Influenza  

PubMed Central

Influenza is a common respiratory pathogen. Its severity can be unpredictable, but people with chronic illness are at increased risk of severe infection, complications, and death from influenza. This review examines evidence to support various strategies to protect pediatric oncology patients from influenza-related morbidity. Influenza vaccination should be considered standard. Additional evidence-supported measures include antiviral treatment, antiviral prophylaxis, cohorting of patients, and hospital infection control measures. Data from other high-risk populations support the vaccination of family members, double-dose or high-dose vaccination, and the use of barrier methods. These measures have the potential to optimize patient outcomes because there will be fewer treatment interruptions for acute illness. These strategies can also protect patients from prolonged hospitalizations and morbidity related to influenza. PMID:23370325

Kersun, Leslie S.; Reilly, Anne F.; Coffin, Susan E.

2013-01-01

26

Incidental pelvic lesions in the oncology patient  

PubMed Central

Abstract The identification of an incidental (i.e. unexpected and asymptomatic) lesion can create a dilemma for the clinician and radiologist. The incidental abnormality may represent metastatic disease, a second primary malignancy or a benign lesion. The diagnosis and management of such incidental findings will depend in part on the clinical setting, the pathology and stage of underlying primary malignancy and the imaging features of the incidental abnormality. This article reviews the diagnosis and management of incidental pelvic lesions in the oncology patient. PMID:22186028

Riddell, A.M.

2011-01-01

27

Oncological and functional results after the surgical treatment of parotid cancer.  

PubMed

The objective of this study was to analyze the oncological and functional outcomes after the surgical treatment of parotid cancer. We reviewed 80 primary parotid carcinomas retrospectively. A superficial parotidectomy was performed in 10 patients; 27 patients underwent total parotidectomy and 43 patients underwent radical parotidectomy. A facial-facial nerve anastomosis was chosen for the facial nerve reconstruction in eight patients, while an interpositional graft was selected in 24 patients. The overall N-positive rate of pathology was 21.3%. The rate of occult metastasis was 8.1%. High-grade carcinoma and lymphovascular emboli were independent factors for nodal metastasis. The 5-year disease-free survival and overall survival rates were 79.7% and 78.8%, respectively. Preoperative facial nerve palsy and extraparenchymal invasion were the independent factors associated with poor disease-free survival. Of the 41 patients in the facial nerve preservation group, 13 (31.7%) had transient facial nerve paresis. In the facial nerve sacrifice group of 39 cases, (sub)total recovery (House-Brackmann grade I/II) occurred in 14 (35.9%), partial recovery (House-Brackmann grade III/IV) in 13 (33.3%), and no recovery (House-Brackmann grade V) in 12 (30.8%). Facial nerve palsy upon presentation and extraparenchymal invasion indicate a grave prognosis. Facial nerve function after proper reconstruction is tolerable. PMID:25444479

Chung, E-J; Lee, S-H; Baek, S-H; Kwon, K-H; Chang, Y-J; Rho, Y-S

2015-01-01

28

Cutaneous side effects of chemotherapy in pediatric oncology patients.  

PubMed

Pediatric oncology patients can present with various skin lesions related to both primary disease and immunosuppressive treatments. This study aimed to evaluate the cutaneous side effects of chemotherapy in pediatric oncology patients. Sixty-five pediatric oncology patients who were scheduled to undergo chemotherapy from May 2011 to May 2013 were included in the study. Three patients were excluded from the results, as 2 patients died during treatment and 1 patient withdrew from the study; therefore, a total of 62 patients were evaluated for mucocutaneous findings. Patients were grouped according to their oncological diagnoses and a statistical analysis was performed. There was no statistical significance in the incidence of cutaneous side effects of chemotherapy among the different diagnostic groups. Awareness among dermatologists of the possible cutaneous side effects of chemotherapy in pediatric patients and their causes can promote early diagnosis and treatment in this patient population. PMID:25671440

Ceylan, Can; Kantar, Mehmet; Tuna, Arzu; Ertam, Ilgen; Aksoylar, Serap; Günayd?n, Asl?; Çetingül, Nazan

2015-01-01

29

Percentage of Surgical Patients Receiving Recommended Care  

MedlinePLUS

... Up Sign In Sign Out Percentage of Surgical Patients Receiving Recommended Care This is a composite measure ... The composite measure is the proportion of surgical patients who receive all appropriate processes of care, as ...

30

ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology.  

PubMed

Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where normal food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in cancer patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards, are based on all relevant publications since 1985 and were discussed and accepted in a consensus conference. Undernutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis. EN should be started if undernutrition already exists or if food intake is markedly reduced for more than 7-10 days. Standard formulae are recommended for EN. Nutritional needs generally are comparable to non-cancer subjects. In cachectic patients metabolic modulators such as progestins, steroids and possibly eicosapentaenoic acid may help to improve nutritional status. EN is indicated preoperatively for 5-7 days in cancer patients undergoing major abdominal surgery. During radiotherapy of head/neck and gastrointestinal regions dietary counselling and ONS prevent weight loss and interruption of radiotherapy. Routine EN is not indicated during (high-dose) chemotherapy. PMID:16697500

Arends, J; Bodoky, G; Bozzetti, F; Fearon, K; Muscaritoli, M; Selga, G; van Bokhorst-de van der Schueren, M A E; von Meyenfeldt, M; Zürcher, G; Fietkau, R; Aulbert, E; Frick, B; Holm, M; Kneba, M; Mestrom, H J; Zander, A

2006-04-01

31

Ethical Aspects of Patient Information in Radiation Oncology  

Microsoft Academic Search

Background: While legal aspects of patient information in radiotherapy are often discussed in clinical literature, ethical aspects are mainly a topic of debate only in bioethical literature. Nevertheless, patient information about radiation oncology has many ethical implications which must be considered in order to provide an optimal patient care. Therefore, this publication describes these ethical aspects from a clinical perspective.

Christof Schäfer; Manfred Herbst

2003-01-01

32

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.

33

The importance of pharmacist providing patient education in oncology.  

PubMed

The world's increasing diversity requires health care professionals to adjust delivery methods of teaching to accommodate different cultural values and beliefs. The ability to communicate effectively across languages and various cultural practices directly affects patient education outcomes. Pharmacist should be aware of varying modalities and considerations when counseling a patient diagnosed with cancer and undergoing chemotherapy. In more recent years, the medical profession has seen an increase in patient outcomes due to using the multidisciplinary team approach and has benefited by implementing Medication Therapy Management (MTM) programs at various institutions. For the clinical pharmacist, this would mean documentation for these services should be precise and accurate based on the specific patients needs. There are several factors involved in the care and therapy of the patient with cancer. Clinical oncology pharmacist should be aware of the ever-changing role in oncology and be able to implement new practices at their facility for better patient outcomes. PMID:25540194

Avery, Mia; Williams, Felecia

2015-02-01

34

Image-Guided Drainage of Pericardial Effusions in Oncology Patients  

Microsoft Academic Search

The purpose of this study was to report our clinical experience with image-guided drainage of pericardial effusions in oncology\\u000a patients. IRB approval was obtained for this retrospective, HIPAA-compliant study. From November 2002 to January 2008, 40\\u000a patients underwent 43 image-guided drainages of pericardial effusions. The medical records were reviewed to analyze the technical\\u000a aspects of the procedures, complications, and clinical

Alda Tam; Joe E. Ensor; Holly Snyder; Sanjay Gupta; Jean-Bernard Durand; Michael J. Wallace

2009-01-01

35

Doctor–patient relationship in oncologic radiology  

PubMed Central

Progress in medicine and changes in our society have led to an increasing number of patients with cancer and a change in the doctor–patient relationship. Patients rights are now defined in several countries by laws. The course of cancer involves numerous imaging examinations in which the radiologist is primarily involved. It is often the radiologist who discovers abnormalities and who must break the news to the patient. This task is made all the more difficult by the radiologist’s lack of specific training in the management of difficult situations such as announcing bad news. There is a high risk of inappropriate responses that can have a seriously damaging effect on the patient’s state of mind. Even with the best intentions, it can be very profitable to review and improve our relational modalities and to more effectively meet the patient’s increasing demand for information. The radiologist’s technical know-how is not sufficient, as he must also be able to give just the right amount of information based on his clinical competence, and his relationship with patients while respecting their wishes and their rights. PMID:16361141

Ollivier, L; Leclère, J; Dolbeault, S; Neuenschwander, S

2005-01-01

36

[Principal infections in the oncology patient: practical treatment].  

PubMed

Infectious complications are one of the most important causes of morbi-mortality in oncology patients. Neutropenia is the most important risk factor for developing infection in the oncology patient. Although the highest mortalities continue to be associated with infections due to enterobacterias and Pseudomonas aeruginosa, the frequency of infections due to gram-positives is higher. Deep fungic infections, like those produced by resistant or infrequent bacteria usually occur in late periods of protracted neutropenias. In recent years different studies have shown the efficiency of antibiotic patterns in monotherapy in the treatment of the neutropenic patient with fever. Cellular immunosuppression is not usually as relevant as neutropenia in oncology patients without complications. However, the use of high doses of steroids in some patients and above all the use of purine analogues and monoclonal antibodies has changed this situation in recent years. With these patients it is recommendable to use prophylactic measures directed against Cytomegalovirus, Varicela-zoster virus, P.carinii (or jirovecii) and fungic infections. Bacteraemia associated with endovascular catheterisation is the principal cause of bacteraemia in these patients, above all due to gram-positive micro-organisms. In case of infection, it is always advisable to remove the catheter. However, under certain circumstances, where the placing of a new catheter might be risky given the patient's characteristics and where there are agents of low virulence (e.g. coagulase-negative staphylococcus), a conservative treatment can be tried. A persistence of fever or bacteraemia following removal of the catheter should lead to suspicion of the presence of a deep infection, fundamentally suppurated thrombophlebitis or endocarditis. An adequate understanding of the infectious complications in these patients and their correct treatment and prevention are decisive in reducing the high mortality associated with these clinical manifestations. PMID:15723102

Fortún, J

2004-01-01

37

Enterocolic lymphocytic phlebitis: an oncologic surgical resection without a preoperative pathologic diagnosis  

PubMed Central

A patient with complaints of an abdominal (mesenteric) mass is presented. Differential diagnosis included neoplastic processes, such as malignant lymphoma, desmoid tumour, a carcinoid or a gastro-intestinal stromal cell tumour. An oncological resection was performed. Despite the malignant appearance of the tumour no malignancy was found with histopathological examination. Vasculitic lesions were seen in venous structures, resembling veno-occlusive disease with signs of recanalization and with the presence of inflammatory cells, mainly lymphocytes. A diagnosis of enterocolic lymphocytic phlebitis was made. This benign condition can mimic malignancy, necessitating a wide excision, also because obtaining a pre-operative histopathological diagnosis is hardly possible. PMID:24876508

Huiberts, Astrid A.M.; Donkervoort, Sandra C.; Blok, Willem L.; Blaauwgeers, Hans L.G.

2014-01-01

38

Interventional Radiology and the Care of the Oncology Patient  

PubMed Central

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

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

2011-01-01

39

[Psychology and ethics of care of oncology patients].  

PubMed

The author discusses the necessity of perception of the uniqueness of oncological patients and the necessity to treat all their dimensions (physical, social, mental and spiritual). She analyzes the concept of total pain according to Cecilia Saunders who discusses the mentioned dimensions of man. Total pain is made up of mutually linked components which are difficult to separate: physical pain, social pain, emotional pain, and spiritual pain. Contemporary alarming statistics provide evidence that in many patients suffering is not alleviated correctly. One of the important reasons of failure is also failure of health workers as regards knowledge of the complexity of suffering. PMID:15633401

Munzarová, M

2001-08-01

40

Robotic surgery in urological oncology: patient care or market share?  

PubMed

Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered. PMID:25535000

Kaye, Deborah R; Mullins, Jeffrey K; Carter, H Ballentine; Bivalacqua, Trinity J

2015-01-01

41

Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients  

PubMed Central

OBJECTIVE: Pediatric oncology patients are frequently managed with central lines as outpatients, and these lines confer significant morbidity in this immune-compromised population. We aimed to investigate whether a multidisciplinary, central line maintenance care bundle reduces central line–associated bloodstream infections (CLABSIs) and bacteremias in ambulatory pediatric oncology patients. METHODS: We conducted an interrupted time-series study of a maintenance bundle concerning all areas of central line care. Each of 3 target groups (clinic staff, homecare agency nurses, and patient families) (1) received training on the bundle and its importance, (2) had their practice audited, and (3) were shown CLABSI rates through graphs, in-service training, and bulletin boards. CLABSI and bacteremia person-time incidence rates were collected for 23 months before and 24 months after beginning the intervention and were compared by using a Poisson regression model. RESULTS: The mean CLABSI rate decreased by 48% from 0.63 CLABSIs per 1000 central line days at baseline to 0.32 CLABSIs per 1000 central line days during the intervention period (P = .005). The mean bacteremia rate decreased by 54% from 1.27 bacteremias per 1000 central line days at baseline to 0.59 bacteremias per 1000 central line days during the intervention period (P < .001). CONCLUSIONS: Implementation of a multidisciplinary, central line maintenance care bundle significantly reduced CLABSI and bacteremia person-time incidence rates in ambulatory pediatric oncology patients with central lines. Further research is needed to determine if maintenance care bundles reduce ambulatory CLABSIs and bacteremia in other adult and pediatric populations. PMID:24101764

Bundy, David G.; Chen, Allen R.; Milstone, Aaron M.; Colantuoni, Elizabeth; Pehar, Miriana; Herpst, Cynthia; Fratino, Lisa; Miller, Marlene R.

2013-01-01

42

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

PubMed Central

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

Povolotskaya, Natalia; Woolas, Robert; Brinkmann, Dirk

2015-01-01

43

Anticoagulation in the Older Surgical Patient  

Microsoft Academic Search

\\u000a This chapter covers the delicate balance of the use of anticoagulation in older surgical patients, including those undergoing\\u000a cardiothoracic (CT) surgery, and those with existing prosthetic valves who undergo other surgeries. Increasing age, alone,\\u000a augments the risk of thromboembolic events in addition to comorbidities commonly seen in older patients (prior stroke, diabetes,\\u000a atrial fibrillation and cancer). Older patients are also

M. Kate Elfrey; Susan J. Zieman

44

Ethics and genomic medicine, how to navigate decisions in surgical oncology.  

PubMed

Using genetic information to make medical decisions and tailor treatments to individuals will likely provide major benefits and become an important part of health care. Surgical oncologists must ethically apply scientific genetic information in a complex and evolving environment to the benefit of their patients. In this review we address ethical issues associated with: indications for genetic testing, informed consent for testing and therapy, confidentiality, targeted therapy, prophylactic surgery, and genetic testing in children. PMID:25183289

Devon, Karen M; Lerner-Ellis, Jordan P; Ganai, Sabha; Angelos, Peter

2015-01-01

45

Adverse events in surgical patients in Australia  

Microsoft Academic Search

Objective. To determine the adverse event (AE) rate for surgical patients in Australia. Design. A two-stage retrospective medical record review was conducted to determine the occurrence of AEs in hospital admissions. Medical records were screened for 18 criteria and positive records were reviewed by two medical officers using a structured questionnaire. Setting. Admissions in 1992 to 28 randomly selected hospitals

A. K. KABLE; R. W. GIBBERD; A. D. SPIGELMAN

2002-01-01

46

Acceptable hematocrit levels in surgical patients  

Microsoft Academic Search

The ready availability of blood and blood components has resulted in a liberal use of blood transfusions; however, the transfusion of blood is still associated with significant risks for the recipient. The appearance of the acquired immunodeficiency syndrome and the evidence that homologous blood can induce immunosuppression and thereby impair the host resistance of surgical patients has led to a

K. F. W. Messmer

1987-01-01

47

Caregivers' perception of drug administration safety for pediatric oncology patients.  

PubMed

Medication errors (MEs) are reported to be between 1.5% and 90% depending on many factors, such as type of the institution where data were collected and the method to identify the errors. More significantly, the risk for errors with potential for harm is 3 times higher for children, especially those receiving chemotherapy. Few studies have been published on averting such errors with children and none on how caregivers perceive their role in preventing such errors. The purpose of this study was to evaluate pediatric oncology patient's caregivers' perception of drug administration safety and their willingness to be involved in averting such errors. A cross-sectional design was used to study a nonrandomized sample of 100 caregivers of pediatric oncology patients. Ninety-six of the caregivers surveyed were well informed about the medications their children receive and were ready to participate in error prevention strategies. However, an underestimation of potential errors uncovered a high level of "trust" for the staff. Caregivers echoed their apprehension for being responsible for potential errors. Caregivers are a valuable resource to intercept medication errors. However, caregivers may be hesitant to actively communicate their fears with health professionals. Interventions that aim at encouraging caregivers to engage in the safety of their children are recommended. PMID:24569227

Harris, Nariman; Badr, Lina Kurdahi; Saab, Raya; Khalidi, Aziza

2014-01-01

48

Prevention of VTE in Nonorthopedic Surgical Patients  

PubMed Central

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

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

2012-01-01

49

Management of surgical patients with bleeding disorders.  

PubMed

Invasive procedures for patients with bleeding disorders require planning on the part of the health care team. The patient population affected involves those with hereditary bleeding disorders, such as von Willebrand disease or hemophilia; in addition, patients who use antithrombotic drugs must be considered and their care managed. The choice of treatment depends on a number of factors, including the procedure planned, the type and severity of the disorder, and the age and morbidity of the patient. The indications, dosing, and timing of presurgical and surgical interventions will be reviewed, as well as special considerations for vascular access devices. PMID:24583938

Kauffman, Judy

2014-01-01

50

[Surgical treatment of patients with colostoma].  

PubMed

Results of treatment of postcolostomy patients are analyzed. In 74.7% cases colostoma was created due to tumor of the rectum or colon, in 6.5% -- due to diverticulosis, in 3.5% -- due to nonspecific ulcerative colitis, Krohn's and other diseases. Complications were diagnosed in 15.2% patients. Surgical treatment was carried out in 714 (43.6%) patients, 568 (79.5%) of them underwent reconstructive surgeries, 146 (20.4%) were operated for stoma complications. New methods of rectal stump preparation for surgery were used: method of differentiation of rectal stump and urether during surgeries, methods of delayed anastomosis. Laparoscopic mobilization of the colon during reconstructive surgeries led to a decrease of surgical trauma and number of complications. PMID:15477824

Timerbulatov, V M; Afanas'ev, S N; Ga?nutdinov, F M; Mekhdiev, D I; Galimov, O V; Kuliapin, A V; Galliamov, A Kh; Akhmerov, R R

2004-01-01

51

Role of culture of postoperative drainage fluid in the prediction of infection of the surgical site after major oncological operations of the head and neck.  

PubMed

Infection of the surgical site after major oncological operations of the head and neck increases mortality and morbidity. The aim of this prospective pilot study was to assess the efficacy of culturing the exudate from the drain after cervical neck dissection to see if it predicted such infection. We studied 40/112 patients with squamous cell cancer of the head and neck who were treated during the last two years and met our inclusion criteria. Six patients developed infections (15%). Reconstruction with pedicled rather than local or microvascular flaps, duration of operation of over 7 hours, the presence of a tracheostomy, and bilateral neck dissection were considered risk factors (p=0.01). Culture of drainage fluid on postoperative day 3 that grew no pathogens predicted that the site would not become infected, with a negative predictive value of 96%. PMID:25534399

Candau-Alvarez, A; Linares-Sicilia, M J; Dean-Ferrer, A; Pérez-Navero, J L

2015-02-01

52

Intravenous lipids in adult surgical patients.  

PubMed

Parenteral nutrition is considered an essential element of the perioperative management of surgical patients. It is recommended in patients who require nutritional therapy but in whom the enteral route is contraindicated, not recommended or non-feasible. The new generation of lipid emulsions (LEs) based on olive and fish oils are safe and may improve clinical outcome in surgical patients. The increased provision of n-3 polyunsaturated fatty acids in fish oil-containing LEs seems to be associated with fewer infectious complications and shorter ICU and hospital stays following major abdominal surgery. Increased provision of olive oil in the absence of fish oil may also exert beneficial effects, but a clear conclusion on this is limited due to the low number of available studies. Hence, at the moment, the evidence supports the use of n-3-polyunsaturated fatty acid-enriched LEs as a part of the parenteral nutrition regimen for selected groups of patients, such as those with major surgical trauma or those undergoing extended resections or liver transplantation. PMID:25471807

Klek, Stanislaw; Waitzberg, Dan L

2015-01-01

53

Illness perception differences between Russian- and Hebrew-speaking Israeli oncology patients.  

PubMed

Illness perception influences health and illness behaviors. This study was designed to estimate illness perception differences between Russian-speaking and Hebrew-speaking Israeli oncology patients. Changes in illness perception associated with time spent in Israel among Russian-speaking patients were also evaluated. Additionally, we evaluated differences in illness perception of patients exposed to Chernobyl's consequences. A total of 144 oncology patients (77 Hebrew-speaking, 67 Russian-speaking) completed personal data questionnaires and The illness perception questionnaire revised, translated into Russian for this study. Significantly more Russian-speaking oncology patients perceived their illness as chronic and having negative consequences on life (p < .01). Russian-speaking oncology patients tend to have a more negative perception of cancer compared to Hebrew-speaking patients. Time spent in Israel may create more positive perceptions of cancer among these patients. No illness perception differences were found concerning Chernobyl consequences. PMID:24492913

Popov, Nadia; Heruti, Irit; Levy, Sigal; Lulav-Grinwald, Doron; Bar-Sela, Gil

2014-03-01

54

Positive patient experiences in an Australian integrative oncology centre  

PubMed Central

Background The purpose of this study was to explore the experiences of cancer patients’ utilising complementary and integrative therapies (CIT) within integrative oncology centres across Western Australia. Methods Across four locations 135 patients accessed CIT services whilst undergoing outpatient medical treatment for cancer. Of the 135 patients, 66 (61?±?12 y; female n?=?45; male n?=?21) agreed to complete a personal accounts questionnaire consisting of open-ended questions designed to explore patients’ perceptions of CIT. All results were transcribed into nVivo (v9) and using thematic analysis, key themes were identified. Results Of the 66 participants, 100% indicated they would “recommend complementary therapies to other patients” and 92% stated “CIT would play a significant role in their future lifestyle”. A mean score of 8?±?1 indicated an improvement in participants’ perception of wellbeing following a CIT session. Three central themes were identified: empowerment, support and relaxation. Fourteen sub-themes were identified, with all themes clustered into a framework of multifaceted views held by cancer patients in relation to wellbeing, role of significant others and control. Conclusions Exploration of patients’ experiences reveals uniformly positive results. One of the key merits of the environment created within the centres is patients are able to work through their cancer journey with an increased sense of empowerment, without placing them in opposition to conventional medical treatment. In order to effectively target integrative support services it is crucial to explore the experiences of patients in their own words and use those forms of expression to drive service delivery. PMID:24886476

2014-01-01

55

How has acute oncology improved care for patients?  

PubMed Central

A United Kingdom–wide appreciation of the systemic failings of emergency cancer care led to the creation of a new subspecialty, acute oncology. It was meant to bridge the gap between admitting teams, oncology, and palliative care, providing support to manage the symptoms of cancer, the side effects of cancer treatment, and people presenting with cancer of unknown primary origin. This article identifies the reasons for the creation of acute oncology and explores various models for this aspect of cancer care worldwide. With health care budgets static and demand increasing, the article also identifies ways in which acute oncology can contribute to an efficient and caring health system. PMID:24940096

Navani, V.

2014-01-01

56

Guidelines on Vaccinations in Paediatric Haematology and Oncology Patients  

PubMed Central

Objective. Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. Patients and Methods. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. Results and Conclusion. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity. PMID:24868544

Cesaro, Simone; Giacchino, Mareva; Fioredda, Francesca; Barone, Angelica; Battisti, Laura; Bezzio, Stefania; Frenos, Stefano; De Santis, Raffaella; Livadiotti, Susanna; Marinello, Serena; Zanazzo, Andrea Giulio; Caselli, Désirée

2014-01-01

57

Outcomes of endometrial cancer patients undergoing surgery with gynecologic oncology involvement  

Microsoft Academic Search

OBJECTIVE:This study was undertaken to compare the outcomes of patients with endometrial cancer who had primary surgery with gynecologic oncology involvement at university or community hospitals.METHODS:The study population consisted of all patients who had primary surgery for endometrial cancer with involvement of the attending physicians of the Division of Gynecologic Oncology. The patients were divided into two groups based on

Michael L Pearl; Jeannine A Villella; Fidel A Valea; Paul A DiSilvestro; Eva Chalas

2002-01-01

58

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

PubMed Central

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

2011-01-01

59

Oncology Nursing Minimum Data Set (ONMDS): can we hypothesize a set of prevalent Nursing Sensitive Outcomes (NSO) in cancer patients?  

PubMed Central

Background The nursing minimum data set (NMDS) was created in 1977 in the United States to collect uniform standardised data that could be comparable among different nursing areas or patients. So far, in the literature, an NMDS in an oncology setting has not yet been described. Considering an oncology nursing minimum data set (ONMDS), which data could be chosen to define this tool regarding cancer patient care? Material and methods At the European Institute of Oncology (IEO), 20 experienced oncology nurses representing surgical, medical, and critical areas participated in a nursing record working group. All nurses followed an educational course on NMDS, and they shared clinical experiences to find which data common among different areas could be useful to care. To identify these data, nurses considered three issues: what is nursing care for nurses in the IEO? What is the nurses’ responsibility in the IEO? What is the organisational nursing model in the IEO? Nurses in the IEO are autonomous in decision making and recognised by patients and by a multi-professional team; the organisational nursing model is primary nursing with patient-centred care. Nursing data must therefore show the quality and results of this care. With this in mind, the working group decided to orient the ONMDS toward nursing-sensitive outcomes (NSOs), meeting also with psychologists, physiotherapists, and dieticians. Nurses analysed Oncology Nursing Society outcomes, and through focus groups, experiential meetings, role playing, and case studies, they integrated them with other NSOs. Results The ONMDS is composed of 49 NSOs recognised as the most common and frequent oncologic outcomes regardless of the treatment that the patient undergoes. These outcomes were clustered into 15 categories. The categories are: gastrointestinal outcomes, genitourinary outcomes, respiratory outcomes, skin outcomes, fluid and electrolyte balance outcomes, neurological outcomes, security, functional status, vascular access outcomes, nutritional status, pain, psychosocial discomfort, activities of daily living (ADL), instrumental activities daily living (IADL), and self-care outcomes. Conclusions Efforts to identify an ONMDS based on NSOs allow us to develop an tool that can standardise language, assessment, and intervention, but overall could be used to measure nursing care. To evaluate these potentialities, the ONMDS was introduced into nursing records, and it was tested with a pre–post research study. PMID:24009644

Milani, A; Mauri, S; Gandini, S; Magon, G

2013-01-01

60

Herbal product use by hispanic surgical patients.  

PubMed

We hypothesized that the use of herbal products is highly prevalent in Hispanic surgical patients on both sides of the U.S./México border. One hundred fifteen patients were interviewed in El Paso and 112 in Ciudad Juárez from December 2001 to June 2002. This prospective, randomized study evaluated patients aged 18 years or older that were scheduled for surgery. Sixty-two per cent of our sample in the United States and 81 per cent of patients in Mexico reported using herbal products in the past year. About 58 per cent of patients in the United States and 49 per cent in Mexico rated the products as "excellent" in treating their conditions. Ninety-two percent of U.S, and 93 per cent of Mexican patients did not inform their physician of their herbal use. Preoperative assessment of patients did not include inquiries about herbal products in either hospital. With the growing use of herbal products and because most users do not inform their physician, there is increasing concern related to the possible occurrence of herbal-related adverse events during and after surgery. The fact that health care personnel did not inquire about herbal product use before surgery is an added concern. PMID:15757062

Rivera, José O; Chaudhuri, Kallol; González-Stuart, Armando; Tyroch, Alan; Chaudhuri, Swapna

2005-01-01

61

Surgical Management of the Pediatric Cochlear Implant Patient.  

ERIC Educational Resources Information Center

This article discusses the surgical management of children receiving cochlear implants. It identifies preoperative considerations to select patients likely to benefit, contraindications, some new surgical techniques, complications, special considerations (otitis media, meningitis, head growth, inner ear malformations, and cochlear obstruction).…

Cohen, Seth M.; Haynes, David S.

2003-01-01

62

Triage of high-risk surgical patients for intensive care  

Microsoft Academic Search

Patients who undergo high-risk non-cardiac surgical procedures represent a large proportion of admissions to intensive care units (ICUs) in the developed world [1]. Ideally, surgeons, anesthesiologists, and intensivists admitting surgical patients to ICUs target the patients who will benefi t most from this highest level of postoperative care. However, accurately identifying which patients are at high risk of complications or

Julia B Sobol; Hannah Wunsch

2011-01-01

63

Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public  

Microsoft Academic Search

SummaryBackground Euthanasia and physician-assisted suicide are pressing public issues. We aimed to collect empirical data on these controversial interventions, particularly on the attitudes and experiences of oncology patients.Methods We interviewed, by telephone with vignette-style questions, 155 oncology patients, 355 oncologists, and 193 members of the public to assess their attitudes and experiences in relation to euthanasia and physician-assisted suicide.Findings About

E. J Emanuel; E. R Daniels; D. L Fairclough; B. R Clarridge

1996-01-01

64

The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery  

PubMed Central

A prospective observational study was conducted on patients undergoing posterior lumbar spine surgery for degenerative spinal disorders. The study purpose was to evaluate the effect of wait time to surgery on patient derived generic and disease specific functional outcome following surgery. A prolonged wait to surgery may adversely affect surgical outcome. Although there is literature on the effect of wait time to surgery in surgical fields such as oncology, cardiac, opthamologic, and total joint arthroplasty, little is known regarding the effect of wait time to surgery as it pertains to the spinal surgical population. Consecutive patients undergoing elective posterior lumbar spinal surgery for degenerative disorders were recruited. Short-Form 36 and Oswestry disability questionnaires were administered (pre-operatively, and at 6 weeks, 6 months, and 1 year post-operatively). Patients completed a questionnaire regarding their experience with the wait time to surgery. The study cohort consisted of 70 patients with follow-up in 53/70 (76%). Time intervals from the onset of patient symptoms to initial consultation by family physician through investigations, spinal surgical consultation and surgery were quantified. Time intervals were compared to patient specific improvements in reported outcome following surgery using Cox Regression analysis. The effect of patient and surgical parameters on wait time was evaluated using the median time as a reference for those patients who had either a longer or shorter wait. Significant improvements in patient derived outcome were observed comparing post-operative to pre-operative baseline scores. The greatest improvements were observed in aspects relating to physical function and pain. A longer wait to surgery was associated with less improvement in outcome following surgery (SF-36 domains of BP, GH, RP, VT). A longer wait time to surgery negatively influences the results of posterior lumbar spinal surgery for degenerative conditions as quantified by patient derived functional outcome measures. The parameters of pain severity and physical aspects of function appear to be the most significantly affected. PMID:17701060

Braybrooke, Jason; Ahn, Henry; Gallant, Aimee; Ford, Michael; Bronstein, Yigel; Finkelstein, Joel

2007-01-01

65

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

PubMed Central

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

Shaikh, ZS; Krueper, S; Malins, TJ

2011-01-01

66

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

Microsoft Academic Search

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 group. Narrative analysis of art and interview data revealed

Johanna Czamanski-Cohen

2012-01-01

67

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

ERIC Educational Resources Information Center

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…

Czamanski-Cohen, Johanna

2012-01-01

68

Retrospective Review of Gynecologic Oncology Patients with Therapy-Induced Neutropenic Fever  

Microsoft Academic Search

We reviewed the course and outcome of gynecologic oncology patients with neutropenic fever (NF), and identified low-risk patients who might be candidates for outpatient management. Charts from patients with the discharge diagnosis of NF from 1990 to 1994 were reviewed for variables related to the febrile neutropenic episode. Outcome was evaluated in terms of the duration of neutropenia, length of

D. Scott McMeekin; Catherine Gazzaniga; Michael Berman; Philip DiSaia; Alberto Manetta

1996-01-01

69

Oncology Nurses' Teaching and Support for Suicidal Patients  

Microsoft Academic Search

Although the nursing literature contains many references to the nurses' teaching, support, and advocacy functions, the consumer and other health care professional literature suggests that the potential importance of nurses in these roles is not widely accepted. In a secondary analysis, we examined nurses' interventions for teaching and support in survey of a random sample of oncology nurses in a

Sharon M. Valente

2007-01-01

70

A bedside food cart as an alternate food service for acute and palliative oncological patients  

Microsoft Academic Search

Patients with advanced cancer experience various problems with eating, and their meals should be tailored to meet their specific needs. Two methods of food service were compared in a shared acute oncology\\/palliative care unit; an electrical food cart allowing patients to select their food types and portions at the bedside, and a traditional food tray delivery service that relied on

Patti Pietersma; Sandra Follett-Bick; Brenda Wilkinson; Nancy Guebert; Kim Fisher; Jose Pereira

2003-01-01

71

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

ERIC Educational Resources Information Center

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)

Arnowitz, Edward; And Others

1983-01-01

72

[Identification of surgical patients for therapy with activated Drotrecogin alfa].  

PubMed

There is uncertainty whether surgical patients with severe sepsis have a benefit from therapy with Drotrecogin alfa (activated). In the PROWESS and ENHANCE studies 4,068 patients were included and 3,228 were treated with Drotrecogin alfa (activated). Approximately 28% of the PROWESS patients and 41% of the ENHANCE patients were surgical patients. The subgroup of surgical patients showed the same benefit from therapy with Drotrecogin alfa (activated) as the overall cohort. The relative risk was 0.9 (95% CI 0.7-1.25, absolute risk reduction 3.2%). Patients with intraabdominal infections have a special benefit and here the relative risk was 0.7 (95% CI 0.5-1.0, absolute risk reduction 9.1%). Serious bleeding was more frequent in patients treated with Drotrecogin alfa (activated): 2.4-3.6% vs. 1.0% in the placebo group. In surgical patients bleeding was not more frequent than in non-surgical patients (3.1% vs. 2.1%, difference not significant). Surgical patients with severe sepsis, especially with peritonitis, should receive therapy with Drotrecogin alfa (activated), if severely ill. PMID:16607516

Utzolino, S; Baier, P; Hopt, U T

2006-06-01

73

Caring for head and neck oncology patients. Does social support lead to better quality of life?  

PubMed Central

OBJECTIVE: To determine whether social support contributes to better quality of life and psychological state of head and neck oncology patients. DESIGN: A structured questionnaire, administered orally to patients face-to-face, with specific questions about demographic and medical information and social support and two standardized scales; a cancer-specific quality of life scale and a depression scale. SETTING: Head and Neck Oncology Clinic, an institutional referral centre providing ambulatory care at the Camp Hill Medical Centre in Halifax, NS. PARTICIPANTS: Forty-five head and neck oncology patients (33 men, 12 women) who came for follow-up appointments at the clinic. One person did not complete the interview. Fifty patients were approached, but five were not included: one died before the interview, and four agreed to participate but were prevented by transportation or timing problems. MAIN OUTCOME MEASURES: Scores on the Functional Living Index-Cancer Scale and the Center for Epidemiologic Studies Depression scale. RESULTS: Four main factors predicted quality of life: satisfaction with family physician support, severity of cancer, sex of patient, and type of cancer. Three important predictors of psychological state were loss of appetite, family physician support, and sex of patient. CONCLUSION: Social support, particularly from family physicians, contributes greatly to better quality of life and psychological state for head and neck oncology patients. PMID:8828874

Mathieson, C. M.; Logan-Smith, L. L.; Phillips, J.; MacPhee, M.; Attia, E. L.

1996-01-01

74

The versatility of the pedicled vertical rectus abdominis myocutaneous flap in oncologic patients  

Microsoft Academic Search

Purpose  The vertical rectus abdominis muscle (VRAM) flap is considered a safe and simple option to cover defects of the trunk and\\u000a proximal thigh. Detailed long-time follow-up studies in oncologic patients including complications and donor site morbidity\\u000a are rare. In this study, complications and donor site morbidity were analysed.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Data of 78 consecutive patients with oncologic disease, having received VRAM flaps,

Adrien Daigeler; Maria Simidjiiska-Belyaeva; Daniel Drücke; Ole Goertz; Tobias Hirsch; Christian Soimaru; Marcus Lehnhardt; Hans-Ulrich Steinau

75

Patient-centered outcomes in surgical andorthodontic treatment  

Microsoft Academic Search

Patient-centered health care has two characteristics: it is closely congruent with and responsive to the patient's wants, needs, and preferences, and it considers the psychological, social, cultural, and economic dimensions of the patient in addition to physical findings. The ultimate benefit to the patient has always been a primary concern of clinicians providing coordinated orthodontic and orthognathic surgical treatment. However,

Ceib Phillips

1999-01-01

76

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

PubMed

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

Laranjeira, Carlos António

2007-01-01

77

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

Microsoft Academic Search

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

Rama Sapir; Raphael Catane; Bella Kaufman; Ruti Isacson; Amiel Segal; Simon Wein; Nathan I. Cherny

2000-01-01

78

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

ERIC Educational Resources Information Center

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…

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

2013-01-01

79

NCI-CCR Pediatric Oncology Branch - Patients and Families, Support Services  

Cancer.gov

As part of the comprehensive care provided at the Pediatric Oncology Branch of the National Cancer Institute, we provide a wide range of psychosocial support services to address the social, psychological, emotional, and practical facets of pediatric cancer and to support patients and families while they are enrolled in clinical research protocols.

80

An investigation into the spiritual needs of neuro-oncology patients from a nurse perspective  

PubMed Central

Background Spiritual needs of cancer patients should be assessed and discussed by healthcare professionals. Neurosurgical nurses need to be able to assess and support neuro-oncology patients with their spiritual needs from diagnosis and throughout their hospital stay. Methods Data were collected through questionnaires using a Critical Incident Technique (CIT) from neurosurgical nurses, findings were analysed using thematic analysis. Results Nurses reported some awareness of their patients’ spiritual needs during their stay on neurosurgical units although some used expressions approximating what could be described as spiritual needs. Patients’ spiritual needs were identified as: need to talk about spiritual concerns, showing sensitivity to patients’ emotions, responding to religious needs; and relatives’ spiritual needs included: supporting them with end of life decisions, supporting them when feeling being lost and unbalanced, encouraging exploration of meaning of life, and providing space, time and privacy to talk. Participants appeared largely to be in tune with their patients’ spiritual needs and reported that they recognised effective strategies to meet their patients’ and relatives’ spiritual needs. However, the findings also suggest that they don’t always feel prepared to offer spiritual support for neuro-oncology patients. Conclusions There is a need for healthcare professionals to provide spiritual care for neuro-oncology patients and their relatives. Although strategies were identified that nurses can use to support patients with spiritual needs further research is required to explore how effective nurses are at delivering spiritual care and if nurses are the most appropriate professionals to support neuro-oncology patients with spiritual care. PMID:23374999

2013-01-01

81

End-of-life care of the geriatric surgical patient.  

PubMed

Providing end-of-life care is a necessity for nearly all health care providers and especially those in surgical fields. Most surgical practices will involve caring for geriatric patients and those with life-threatening or terminal illnesses where discussions about end-of-life decision making and goals of care are essential. Understanding the differences between do not resuscitate (DNR), palliative care, hospice care, and symptom management in patients at the end of life is a critical skill set. PMID:25459551

Peschman, Jacob; Brasel, Karen J

2015-02-01

82

Preoperative trans-jugular porto-systemic shunt for oncological gastric surgery in a cirrhotic patient  

PubMed Central

Abdominal surgery in cirrhotic patients with portal hypertension is associated with high incidence of disease and mortality. In these patients, oncological gastric procedures with lymph-nodes dissection show much higher complication rates than in normotensive portal vein patients. Thus, normalization of portal vein pressure may be a favorable determinant factor to reduce complications. We report a case of a patient with hepatitis C virus-related hepatic cirrhosis, esophageal varices, portal hypertension and gastric cancer. We demonstrated the efficacy of a preoperative trans-jugular porto-systemic shunt to perform oncological radical resection more safely. We retained preoperative the trans-jugular porto-systemic shunt in the patients with elevated portal pressure and gastric cancer to perform a gastrectomy more safely and to decrease morbidity and mortality of these cases. PMID:25624736

Liverani, Andrea; Solinas, Luigi; Di Cesare, Tatiana; Velari, Luca; Neri, Tiziano; Cilurso, Francesco; Favi, Francesco; Bizzarri, Giancarlo

2015-01-01

83

Surgical treatment in bronchiectasis: analysis of 166 patients  

Microsoft Academic Search

Background: Bronchiectasis is usually caused by pulmonary infections and bronchial obstruction. It is still a serious problem in developing countries as our country. We reviewed the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis. Patients and methods: Between 1990 and 2000, 166 patients (92 female and 74 male patients) underwent pulmonary resection for bronchiectasis. The mean age

Hakan Kutlay; Ayten Kay? Cang?r; Serkan Enön; Ekber ?ah?n; Murat Akal; Adem Güngör; Nez?h Özdem?r; ?evket Kavukçu

2002-01-01

84

A randomized controlled trial of early oral analgesia in gynecologic oncology patients undergoing intra-abdominal surgery  

Microsoft Academic Search

OBJECTIVE:To evaluate the safety and efficacy of early oral analgesia after intra-abdominal surgery in gynecologic oncology patients.METHODS:Over a 2.5-year period, 227 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early oral versus traditional parenteral analgesia. All patients initially received parenteral morphine via a patient-controlled analgesia (PCA) pump with a basal dose of 0.5 mg\\/h

Michael L Pearl; Dayna L McCauley; Jill Thompson; Linda Mahler; Fidel A Valea; Eva Chalas

2002-01-01

85

Outbreak of Vancomycin-Resistant Enterococcus Colonization Among Pediatric Oncology Patients  

PubMed Central

OBJECTIVE To detect the burden of vancomycin-resistant Enterococcus (VRE) colonization among pediatric oncology patients and to determine risk factors for VRE acquisition. DESIGN Retrospective case-control study. SETTING The Children’s Hospital of Philadelphia. PATIENTS Pediatric oncology patients hospitalized from June 2006 through December 2007. METHODS Prevalence surveys revealed an increased VRE burden among pediatric oncology patients. For the case-control study, the 16 case patients were pediatric oncology patients who had 1 stool sample negative for VRE at screening before having a stool sample positive for VRE at screening; the 62 control patients had 2 consecutive screenings in which stool samples were negative for VRE. Case and control patients were matched on the duration of the interval between screens. Analyses were performed to determine the association between multiple exposures and VRE acquisition. RESULTS The prevalence survey revealed that 5 (9.6%) of 52 patients had unsuspected VRE colonization at the time of hospitalization. Multivariate analysis identified a lack of empirical contact precautions (odds ratio [OR], 17.16 [95% confidence interval {CI}, 1.49–198.21]; P = .02) and the presence of a gastrointestinal device (OR, 4.03 [95% CI, 1.04–15.56]; P = .04) as significant risk factors for acquisition of VRE. Observations in the interventional radiology department revealed that staff could not access the portions of the electronic medical record in which isolation precautions were documented. Simple interventions that granted access and that trained interventional radiology staff to review the need for precautions, coupled with enhanced infection control practices, interrupted ongoing transmission and reduced the proportion of VRE screens that were positive to 15 (1.2%) of 1,270. CONCLUSIONS Inadequate communication with regard to infection control precautions can increase the risk of transmission of epidemiologically important organisms, particularly when patients receive care at multiple clinic locations. Adherence to infection control practices across the spectrum of care may limit the spread of resistant organisms. PMID:19239375

Nolan, Sheila M.; Gerber, Jeffrey S.; Zaoutis, Theoklis; Prasad, Priya; Rettig, Susan; Gross, Kimberly; McGowan, Karin L.; Reilly, Anne F.; Coffin, Susan E.

2010-01-01

86

Surgical and oncology trials for rectal cancer: who will participate? | accrualnet.cancer.gov  

Cancer.gov

Patients, surgeons, and oncologists were asked whether they would be willing to enter one of five randomized controlled trials for rectal cancer. Patients’ willingness to participate was consistently low (19%-32%). Colorectal surgeons and medical and radiation oncologists also reported low levels of potential participation. The overwhelming reason for refusing to enter each trial was a dislike of the randomization process, followed by the effect of treatment on quality of life.

87

Salvage Pelvic Lymph Node Dissection in Recurrent Prostate Cancer: Surgical and Early Oncological Outcome  

PubMed Central

Methodology. Seventeen patients with prostate-specific antigen (PSA) rise following local treatment for prostate cancer with curative intent underwent open or minimally invasive salvage pelvic lymph node dissection (SLND) for oligometastatic disease (<4 synchronous metastases) or as staging prior to salvage radiotherapy. Biochemical recurrence after complete biochemical response (cBR) was defined as 2 consecutive PSA increases >0,2?ng/mL; and after incomplete biochemical response as 2 consecutive PSA rises. Newly found metastasis on imaging defined clinical progression (CP). Palliative androgen deprivation therapy (ADT) was initiated if >3 metastases were detected or if patients became symptomatic. Kaplan-Meier statistics were applied. Results. Clavien-Dindo grade 1, 2, 3a, and 3b complications were seen in 6, 1, 1, and 2 patients, respectively. Median follow-up time was 22 months. Among 13 patients treated for oligometastatic disease, 8 (67%) had a PSA decline, with 3 patients showing cBR. Median PSA progression-free survival (FS) was 4.1 months and median CP-FS 7 months. Three patients started ADT, resulting in a 2-year ADT-FS rate of 79.5%. Conclusion. SLND is feasible, but postoperative complication rate seems higher than that for primary LND. Biochemical and clinical response duration is limited, but as part of an oligometastatic treatment regime it can defer palliative ADT. PMID:25695051

Van Praet, Charles; Lumen, Nicolaas; Ost, Piet; Fonteyne, Valérie; De Meerleer, Gert; Lambert, Bieke; Delrue, Louke; De Visschere, Pieter; Villeirs, Geert; Decaestecker, Karel

2015-01-01

88

Salvage pelvic lymph node dissection in recurrent prostate cancer: surgical and early oncological outcome.  

PubMed

Methodology. Seventeen patients with prostate-specific antigen (PSA) rise following local treatment for prostate cancer with curative intent underwent open or minimally invasive salvage pelvic lymph node dissection (SLND) for oligometastatic disease (<4 synchronous metastases) or as staging prior to salvage radiotherapy. Biochemical recurrence after complete biochemical response (cBR) was defined as 2 consecutive PSA increases >0,2?ng/mL; and after incomplete biochemical response as 2 consecutive PSA rises. Newly found metastasis on imaging defined clinical progression (CP). Palliative androgen deprivation therapy (ADT) was initiated if >3 metastases were detected or if patients became symptomatic. Kaplan-Meier statistics were applied. Results. Clavien-Dindo grade 1, 2, 3a, and 3b complications were seen in 6, 1, 1, and 2 patients, respectively. Median follow-up time was 22 months. Among 13 patients treated for oligometastatic disease, 8 (67%) had a PSA decline, with 3 patients showing cBR. Median PSA progression-free survival (FS) was 4.1 months and median CP-FS 7 months. Three patients started ADT, resulting in a 2-year ADT-FS rate of 79.5%. Conclusion. SLND is feasible, but postoperative complication rate seems higher than that for primary LND. Biochemical and clinical response duration is limited, but as part of an oligometastatic treatment regime it can defer palliative ADT. PMID:25695051

Claeys, Tom; Van Praet, Charles; Lumen, Nicolaas; Ost, Piet; Fonteyne, Valérie; De Meerleer, Gert; Lambert, Bieke; Delrue, Louke; De Visschere, Pieter; Villeirs, Geert; Decaestecker, Karel

2015-01-01

89

Effect of Opiates, Anesthetic Techniques, and Other Perioperative Factors on Surgical Cancer Patients  

PubMed Central

Background Opioid pharmacotherapy is often used to treat cancer pain. However, morphine and other opioid-like substance use in patients with cancer may have significant adverse consequences, including the suppression of both innate and acquired immune responses. Although studies have examined the possibility that regional anesthesia attenuates the immunosuppressive response of surgery, the effects of morphine and other opioid-related substances on tumor progression remain unknown. Methods This article presents an evidence-based review of the influence of opioids and anesthetic technique on the immune system in the context of cancer recurrence. The review focuses on the field of regional anesthesia and the setting of surgical oncologic procedures. The method for perioperative pain management and the technique of anesthesia chosen for patients in cancer surgery were explored. Results General anesthetics have been indicated to suppress both cell-mediated immunity and humoral immunity. Evidence suggests that intravenous opioids suppress the immune system. However, the mechanisms by which anesthetics and analgesics inhibit the immune system are not understood. Compared with the alternatives, regional analgesia offers reduced blood loss and superior postoperative analgesia. Because of these advantages, the use of regional analgesia has increased in oncologic surgeries. Conclusion Immune responses from all components of the immune system, including both the humoral and cell-mediated components, appear to be suppressed by anesthetics and analgesics. The clinical anesthesiologist should consider these factors in the application of technique, especially in cancer surgery. PMID:24940132

Kaye, Alan David; Patel, Nayan; Bueno, Franklin Rivera; Hymel, Brad; Vadivelu, Nalini; Kodumudi, Gopal; Urman, Richard D.

2014-01-01

90

Patterns of death among patients treated at a Department of Medical Oncology in Spain  

Microsoft Academic Search

Introduction. Despite significant advances in the palliative care of cancer patients with terminal disease, a considerable proportion\\u000a of them still die at hospital. The causes of this fact are multiple including sociocultural, familial, and sanitary reasons.\\u000a \\u000a \\u000a Material and methods. A retrospective study was performed on the place and cause of death among patients treated at a Department of Medical Oncology

Jorge Aparicio Urtasun; Roberto Díaz Beveridge; Pedro López Tendero; Lorena Pellín Ariño; Ángel Guerrero Zotano; Laura Palomar Abad; Jorge Molina Saera; Ángel Segura Huerta; Joaquín Montalar Salcedo

2004-01-01

91

Platelet Antibodies and Fever: Their Association in Multitransfused Patients with Hemato-Oncological Diseases  

Microsoft Academic Search

SummaryThe posttransfusion platelet increment depends significantly on the clinical condition of the patient and the presence of platelet-reactive antibodies. We prospectively determined the development of platelet-reactive antibodies in weekly intervals at the time of chemotherapy in 17 multitransfused patients with hemato-oncological diseases. Sera were tested by both the MAIPA technique and the lymphocytotoxicity test (LCT) for antiplatelets against HLA class

M. Kurz; B. Eichelberger; H. Greinix; P. Höcker; P. Kahls; P. Knöbl; W. R. Mayr; S. Panzer

1999-01-01

92

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

PubMed Central

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

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

93

A randomized controlled trial of a regular diet as the first meal in gynecologic oncology patients undergoing intraabdominal surgery  

Microsoft Academic Search

OBJECTIVE:To prospectively evaluate the safety and efficacy of a regular diet as the first meal after intraabdominal surgery in gynecologic oncology patients.METHODS:During a 20-month period, 254 gynecologic oncology patients undergoing intraabdominal surgery were enrolled in a randomized controlled trial of a clear liquid diet compared with a regular diet as the first postoperative meal. All patients received their first meal

Michael L Pearl; Martina Frandina; Linda Mahler; Fidel A Valea; Paul A DiSilvestro; Eva Chalas

2002-01-01

94

A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra-abdominal Surgery  

Microsoft Academic Search

Objective: To evaluate the safety and efficacy of early oral feeding after intra-abdominal surgery in gynecologic oncology patients.Methods: During a 1-year period, 200 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early compared with traditional oral postoperative feeding. Patients allocated to early postoperative oral feeding began a clear liquid diet on the first postoperative

Michael L Pearl; Fidel A Valea; Margaret Fischer; Linda Mahler; Eva Chalas

1998-01-01

95

The epidemiological characteristics of zygomatic complex fractures: A comparison between the surgically and non-surgically treated patients  

PubMed Central

Introduction: This retrospective study is aimed at the documentation of a more complete view of epidemiological data with particular focus on the characteristics of the surgically and non-surgically treated patients with zygomatic complex fractures. Materials and Methods: A total of 133 surgically and 150 non-surgically patients were treated with zygomatic complex fractures in VU University medical center Amsterdam from January 2007 to January 2012 were analyzed. These patient groups were further subdivided into displaced or non-displaced fractures and compared with each other according to age, gender and trauma etiology. Results: The mean age of all 286 patients was 42.8 years (standard deviation [SD: ±19.8]). Surgically and non-surgically treated patients differed in presentation with a significantly overall higher age of females, especially within the non-surgically treated patient group with displaced fractures (mean age of 59.5 years, SD: ±27.4). The mean ages of males from the different subgroups were more consistent with the overall mean age. The main causes were traffic accidents, whereas the contribution of falls and assaults depended on age group, gender, treatment management and even fracture displacement. Conclusions: This report provides us important epidemiological data of all patients with zygomatic complex fractures. The non-surgically treated patient group contained patients of higher age, more females and a fall-related cause, compared to the surgically treated patient group. The surgically treated patient group showed the same epidemiological characteristics as were demonstrated in previous studies. PMID:24665179

Salentijn, Erik Gerrit; Boffano, Paolo; Boverhoff, Jolanda; van den Bergh, Bart; Forouzanfar, Tymour

2013-01-01

96

Perioperative Glucose Control and Infection Risk in Older Surgical Patients  

PubMed Central

The aging of the U.S. population is leading to an increasing number of surgical procedures performed on older adults. At the same time, the quality of medical care is being more closely scrutinized. Surgical site infection is a widely-assessed outcome. Evidence suggests that strict perioperative serum glucose control among patients with or without diabetes can lower the risk of these infections, but it is unclear whether this control should be applied to older surgical patients. In this clinical review, we discuss current research on perioperative serum glucose management for cardiothoracic, orthopedic, and general/colorectal surgery. In addition, we summarize clinical recommendations and quality-of-care process indicators provided by surgical, diabetes, and geriatric medical organizations. PMID:25431751

Mody, Lona

2014-01-01

97

Patient-centered care in cancer treatment programs: the future of integrative oncology through psychoeducation.  

PubMed

The reciprocal relationship between the mind and body has been a neglected process for improving the psychosocial care of cancer patients. Emotions form an important link between the mind and body. They play a fundamental role in the cognitive functions of decision-making and symptom control. Recognizing this relationship is important for integrative oncology. We define psychoeducation as the teaching of self-evaluation and self-regulation of the mind-body process. A gap exists between research evidence and implementation into clinical practice. The patients' search for self-empowerment through the pursuit of complementary therapies may be a surrogate for inadequate psychoeducation. Integrative oncology programs should implement psychoeducation that helps patients to improve both emotional and cognitive intelligence, enabling them to better negotiate cancer treatment systems. PMID:25531048

Garchinski, Christina M; DiBiase, Ann-Marie; Wong, Raimond K; Sagar, Stephen M

2014-12-01

98

[Ethical aspects of treatment in patients with advanced oncologic diseases].  

PubMed

Ethical aspects of treatment are discussed from the aspect of medical objectives and the doctor-patient relationship. The authors draws attention to various dangers of incorrect approaches which may ensue for the patient: unnecessary and excessively burdening antitumourous treatment, inadequate treatment--in particular of pain, queer views on palliative treatment, a paternalistic approach of the physician with insufficient respect for the patient's wishes, inadequate information provided to the patient, "abuse" of patients for different experimental treatments etc. The author discusses in detail the double effect principle and draws attention to classification of means into ordinary and extraordinary with regard to the patient's own evaluation. PMID:12197401

Munzarová, M

2002-07-01

99

Aetiology of epilepsy in surgically treated patients in China  

Microsoft Academic Search

The aim of this retrospective, multicenter clinical study was to evaluate the aetiology of epilepsy in surgically treated patients in China. The detailed clinical records of all intractable partial epilepsy (IPE) were reviewed in five tertiary referral centres from June 1991 to June 2000. 1650 patients (927 males, 723 females) were recruited. 41.4% had aetiological factors, including the histories of

Bo Xiao; Zhi-Ling Huang; He Zhang; Yun-Sheng Liu; Xian-Rui Yuan; Ning Zhang; Jing-He Li; Xiao-Yi Wang; Dong Zhou; Wei-Ping Liao; Wei-Wei Wang; Bo-Min Sun

2004-01-01

100

Determination of complication rate of PICC lines in oncological patients  

Microsoft Academic Search

OBJECTIVE: To determine the complication rate of (PICCs) peripherally inserted central catheters in cancer patients with a 1 year prospective cohort study.METHODS: All PICCs inserted in adult cancer patients in Radiology Department of The Aga Khan University Hospital were followed prospectively till removed or patient expired and pattern of complications noted.RESULTS: One hundred and fourty six PICCs were inserted over

Ghulam Haider; Shiyam Kumar; Basit Salam; Nehal Masood; Asim Jamal; Yasmeen Abdul Rasheed

2009-01-01

101

Antibacterial honey (Medihoney®) for wound care of immunocompromised pediatric oncology patients  

PubMed Central

The physiologic process of wound healing is impaired and prolonged in paediatic patients receiving chemotherapy. Due to profound immunosuppression, wound infection can easily spread and act as the source of sepsis. Referring to in vitro studies, which confirmed the antibacterial potency of special honey preparations against typical isolates of nosocomially acquired wound infections (including MRSA and VRE) and considering the encouraging reports from other groups, Medihoney™ has now been used in wound care at the Department of Pediatric Oncology, Children's Hospital, University of Bonn for three years. Supplemented with exemplary clinical data from pediatric oncology patients, this presentation reviews the scientific background and our promising experience with Medihoney™ in wound care issues at our institution. PMID:20204081

Simon, Arne; Sofka, Kai; Wieszniewsky, Gertrud; Blaser, Gisela

2006-01-01

102

Antibacterial honey (Medihoney) for wound care of immunocompromised pediatric oncology patients.  

PubMed

The physiologic process of wound healing is impaired and prolonged in paediatic patients receiving chemotherapy. Due to profound immunosuppression, wound infection can easily spread and act as the source of sepsis. Referring to in vitro studies, which confirmed the antibacterial potency of special honey preparations against typical isolates of nosocomially acquired wound infections (including MRSA and VRE) and considering the encouraging reports from other groups, Medihoney has now been used in wound care at the Department of Pediatric Oncology, Children's Hospital, University of Bonn for three years. Supplemented with exemplary clinical data from pediatric oncology patients, this presentation reviews the scientific background and our promising experience with Medihoney in wound care issues at our institution. PMID:20204081

Simon, Arne; Sofka, Kai; Wieszniewsky, Gertrud; Blaser, Gisela

2006-01-01

103

Oral-dental concerns of the pediatric oncology patient  

SciTech Connect

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.

Lawson, K.

1989-01-01

104

What matters to the patient is what really matters: ?quality in oncology nursing.  

PubMed

Reflecting on the 40th anniversary of the Oncology Nursing Society led me to recall my own 30-plus years in nursing and how, as a new graduate nurse, almost all oncology care was delivered in the inpatient setting. In my first few years of practice, I mixed my patients' chemotherapy in a medicine room without a ventilated hood and administered those medications without personal protective equipment or the independent RN double checks that have become standard to safe practice today. Through advances in science, tools are now in place to test and make changes, measure impact, and sustain improvements over time. Through advancements in nursing science and oncology research, the ability to treat and cure many cancers and to manage the symptoms and side effects of treatment has improved. Those improvements extend survival; enhance quality of life; and keep patients, staff, and practice environments safer than ever before. In addition, the human side of care has advanced with respect to the quality of interactions with patients and families. Some call this the art of nursing. I call it the essence of our practice. Increasingly, nurses are able to name specific interventions, measure impact, and document outcomes of this so-called art. It is to this human side of our practice that I dedicate this column.?. PMID:25840377

Gross, Anne H

2015-04-01

105

Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients  

Microsoft Academic Search

Introduction  The efficacy and feasibility of laparoscopic resection for rectal cancer has been proved, but the results of prospective,\\u000a randomized studies are not yet available. Here we present a prospective observational study evaluating oncological and clinical\\u000a outcome after laparoscopic surgery in patients with rectal cancer.\\u000a \\u000a \\u000a \\u000a Patients and Methods  Between January 1998 and March 2005, 225 patients with rectal adenocarcinoma underwent laparoscopic surgery

Ayman Agha; Alois Fürst; Johanna Hierl; Igors Iesalnieks; Gabriel Glockzin; Matthias Anthuber; Karl-Walter Jauch; Hans J. Schlitt

2008-01-01

106

Oncologic imaging  

SciTech Connect

This text is devoted to the goal of integrating medical imaging into the field of oncology. This book serves as a guide to the appropriate selection and sequencing of the vast array of imaging techniques currently available. Contents: Staging and classification of cancers; Imaging strategies for oncologic diagnosis and staging; Brain and spinal cord neoplasms; The upper aerodigestive tract: cervical lymph node metastases; Thoracic neoplasms; Esophageal cancer; Malignant neoplasms of the pancreas, the liver, and biliary tract; Prostate cancer; Gynecological neoplasms; Hodgkin's disease and the non-Hodgkin's lymphomas; Tumors of the skeletal system; Pediatric oncology; Computed tomography and radiation therapy treatment planning; Contributions of interventional radiology to diagnosis and management of the cancer patient; The impact of future technology on oncologic diagnosis.

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

1985-01-01

107

Surgical indications and optimization of patients for resectable esophageal malignancies  

PubMed Central

Esophageal cancer is a devastating diagnosis with very dire long-term survival rates. This is largely due to its rather insidious progression, which leads to most patients being diagnosed with advanced disease. Recently, however, a greater understanding of the pathogenesis of esophageal malignancies has afforded surgeons and oncologists with new opportunities for intervention and management. Coupled with improvements in imaging, staging, and medical therapies, surgeons have continued to enhance their knowledge of the nuances of esophageal resection, which has resulted in the development of minimally invasive approaches with similar overall oncologic outcomes. This marriage of more efficacious induction therapy and diminished morbidity after esophagectomy offers new promise to patients diagnosed with this aggressive form of cancer. The following review will highlight these most recent advances and will offer insight into our own approach to patients with resectable esophageal malignancy. PMID:24624289

Grimm, Joshua C.; Valero, Vicente

2014-01-01

108

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

PubMed Central

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

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

2013-01-01

109

Hematologic issues in the geriatric surgical patient.  

PubMed

Geriatric patients are at higher risk for hemorrhagic complications after surgery and traumatic injuries. The geriatric population is more likely to take anticoagulant or antiplatelet medications. Chronic disease, autoimmune disease, and nutritional deficiencies can lead to coagulation factor and platelet disorders. One must be familiar with the current anticoagulant and antiplatelet medications, their mechanism of action, and reversal agents to properly care for this group of patients. The new oral anticoagulants do not have Food and Drug Administration (FDA) approved reversal agents, but known procoagulant agents with other FDA indications may be effective. PMID:25459547

Van, Philbert Y; Schreiber, Martin A

2015-02-01

110

Oncology patients' and professional nurses' perceptions of important nurse caring behaviors  

PubMed Central

Background Caring is the essence of nursing. Caring to be meaningful needs to be based on mutual agreement between nurses and patients as to what constitutes nurse caring behaviors. As a result, healthcare professional can enhance patients' satisfaction of care by providing appropriate caring behavior. However, previous research that combined multiple types of patients, nurses and institutions demonstrated disagreement in prioritizing important behaviors. This paper reports a study that aimed at determining the caring behaviors which oncology patients and oncology nurses perceive to be the most important. Methods This study is a comparative descriptive design that was conducted in an Iranian oncology centre. Convenience sampling was used to recruit 200 patients and 40 nurses to take part in the study. Data were collected over a period of 4 months in 2009 using the Caring Assessment Questionnaire, developed by Larson. Caring behaviors (n = 57) were ranked on a 5-point Likert-type scale and ordered in six subscales: "Being accessible", "Explains and facilitates", "Comforts", "Anticipates", "Trusting relationship", "Monitors and follows through". The data were analyzed using SPSS software version 13.0. The overall mean was calculated for each subscale to determine the rank distribution of the subscales. The nonparametric Mann-Whitney U test analysis of variables was used to compare patients' and nurses' scores on subscales. Results The results demonstrate that both groups considered the same order of importance of caring, the high ranking of "Monitors and Follows through and "Being Accessible" and the low ranking of "Comforts" and "Trusting Relationships". Also, Patients only ranked "Being accessible" (p = 0.04) and "Explains and facilitates" (p = 0.03) higher than nurses. Conclusions The oncology patients and nurses perceived highly physical aspects of caring and the results provide for nurses to be aware of the need, during their interactions with patients, to validate the effect their intended caring has upon patients. By so doing and with further refinement of the concept of caring for nursing in studies such as this, the practical aim of making patients feel cared for can be achieved. PMID:20550677

2010-01-01

111

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

PubMed Central

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

2012-01-01

112

Moving CLABSI Prevention Beyond the ICU: Risk Factors in Pediatric Oncology Patients  

PubMed Central

Background and Objective Central line-associated bloodstream infections (CLABSIs) frequently complicate the use of central venous catheters (CVCs) among pediatric patients with cancer. Our objectives were to describe the microbiology and identify risk factors for hospital-onset CLABSI in this patient population. Design Retrospective case-control study. Setting Oncology and stem cell transplant units of a freestanding, 396-bed quaternary care pediatric hospital. Participants Case subjects (N=54) were patients with a diagnosis of malignancy and/or stem cell transplant recipients with CLABSI occurring during admission. Controls (N=108) were identified using risk set sampling of hospitalizations among patients with a CVC, matched on date of admission. Methods Multivariate conditional logistic regression was used to identify independent predictors of CLABSI. Results The majority of CLABSI isolates were Gram-positive bacteria (58%). The most frequently isolated organism was Enterococcus faecium, and 6 of 9 isolates were resistant to vancomycin. In multivariate analyses, independent risk factors for CLABSI included platelet transfusion within the prior week (odds ratio [OR], 10.90 [95% confidence interval {CI}, 3.02–39.38], P<0.001) and CVC placement within the previous month (<1 week vs. ?1 month: OR, 11.71 [95% CI, 1.98–69.20], P=0.02; ?1 week and <1 month vs. ?1 month: OR, 7.37 [95% CI, 1.85–29.36], P=0.004). Conclusions Adjunctive measures to prevent CLABSI among pediatric oncology patients may be most beneficial in the month following CVC insertion and in patients requiring frequent platelet transfusions. Vancomycin-resistant enterococci may be an emerging cause of CLABSI in hospitalized pediatric oncology patients and are unlikely to be treated by typical empiric antimicrobial regimens. PMID:22011534

Kelly, Matthew; Conway, Margaret; Wirth, Kathleen; Potter-Bynoe, Gail; Billett, Amy L.; Sandora, Thomas J.

2014-01-01

113

Evaluation of Suspected Deep Venous Thrombosis in Oncologic Patients  

Microsoft Academic Search

Impedance plethysmography (IPG) and duplex scanning with color flow Doppler were performed in 100 consecutive high-risk patients with clinically suspected deep venous thrombosis. Risk factors included recent surgery (

Deborah L. Keefe; Nancy Roistacher; Mary Kathryn Pierri

1994-01-01

114

Patient Oncology Research Tracking System (PORTS) | accrualnet.cancer.gov  

Cancer.gov

This tracking system is intended for small to medium clinical research sites and organizations that participate in NCI or NIH- sponsored clinical research trials. The tool addresses patient enrollment information management and NCI report forms completion. It can also be used for in-house research.

115

Patient-Reported Outcomes Are Changing the Landscape in Oncology Care: Challenges and Opportunities for Payers  

PubMed Central

Background A patient-reported outcome (PRO) is a subjective report that comes from a patient without interpretation by a clinician. Because of the increasingly significant role of PROs in the development and evaluation of new medicines, the US Food and Drug Administration (FDA) issued a formal guidance to describe how PRO instruments will be reviewed and evaluated with respect to claims in approved medical product labeling. Meanwhile, PROs continue to appear in oncology clinical trials more frequently; however, it is unclear how payers and policymakers can use PRO data in the context of decision-making for cancer treatments. Objective The objective of this article is to discuss the challenges and opportunities of incorporating oncology-related PRO data into payer decision-making. Discussion Payer concerns with PRO instruments are often related to issues regarding measurement, relevance, quality, and interpretability of PROs. Payers may dismiss PROs that do not independently predict improved outcomes. The FDA guidance released in 2009 demonstrates, as evidenced by the case of ruxolitinib, how PRO questionnaires can be generated in a relevant, trustworthy, and meaningful way, which provides an opportunity for payers and policy decision makers to focus on how to use PRO data in their decision-making. This is particularly relevant in oncology, where a recent and sizable number of clinical trials include PRO measures. Conclusion As an increasing number of oncology medications enter the market with product labeling claims that contain PRO data, payers will need to better familiarize themselves with the opportunities associated with PRO questionnaires when making coverage decisions. PRO measures will continue to provide valuable information regarding the risk–benefit profile of novel agents. As such, PRO measures may provide evidence that should be considered in payers' decisions and discussions; however, the formal role of PROs and the pertinence of PROs in decision-making has yet to be understood. PMID:24991362

Zagadailov, Erin; Fine, Michael; Shields, Alan

2013-01-01

116

Assessing the spiritual needs and practices of oncology patients in Turkey.  

PubMed

The purpose of this study was to assess the oncology patients' spiritual needs and activities. Besides, the study was to provide clinical evaluation of the feasibility and usefulness of the Patients Spiritual Needs Assessment Scale. This descriptive and cross-sectional study was performed by using a demographic and spiritual practices questionnaire, the Turkish version of the Patients Spiritual Needs Assessment Scale. The results of our study demonstrated that the most common spiritual needs of patients with cancer were "to address issues before death and dying" (100%), "feel a sense of peace and contentment" (94.8%), and "for companionship" (93.5%). Spiritually assessing a patient with cancer requires knowledge of how spiritual needs may manifest and how to talk with a client about his or her spiritual needs. These findings can help nurses to begin this process of providing spiritual care for patients with cancer. PMID:25658933

Dedeli, Ozden; Yildiz, Emel; Yuksel, Safak

2015-01-01

117

Surgical Management of Urolithiasis in Patients after Urinary Diversion  

PubMed Central

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

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

2014-01-01

118

Mannose-binding lectin (MBL) as prognostic factor in paediatric oncology patients.  

PubMed

Deficiency of mannose-binding lectin (MBL) has been suggested to influence duration of febrile neutropenia and prognosis in paediatric oncology patients. However, there is no consensus on the definition of MBL deficiency. In a cohort of children with cancer, we investigated (i) how to determine MBL deficiency and (ii) whether MBL is a prognostic factor for disease severity. In 222 paediatric oncology patients, 92 healthy children and 194 healthy adults, MBL plasma levels and MBL2 genotype (wild-type: A, variant: O) were determined. Event-free survival (EFS), overall survival (OS) and paediatric intensive care unit (PICU) admissions were recorded prospectively. In febrile neutropenic patients admitted to the PICU, disease severity was assessed by clinical, microbiological and laboratory parameters. An optimal cut-off value for MBL deficiency was determined to be < 0·20 µg/ml. Wild-type MBL2 genotype patients, including the XA/XA haplotype, had increased MBL levels compared to healthy individuals. MBL deficiency was associated with decreased EFS (P = 0·03), but not with need for PICU admission. A trend for a twice increased frequency of septic shock (80% versus 38%, P = 0·14), multiple organ failure (40% versus 17%, P = 0·27) and death (40% versus 21%, P = 0·27) was observed in the absence of microbiological findings. MBL deficiency was associated with decreased EFS and possibly with an increased severity of disease during PICU admission after febrile neutropenia in the absence of any association with microbiological findings. These findings suggest prognosis to be worse in MBL-deficient compared to MBL-sufficient paediatric oncology patients. PMID:21488869

Frakking, F N J; Brouwer, N; Dolman, K M; van Woensel, J B M; Caron, H N; Kuijpers, T W; van de Wetering, M D

2011-07-01

119

Mannose-binding lectin (MBL) as prognostic factor in paediatric oncology patients  

PubMed Central

Deficiency of mannose-binding lectin (MBL) has been suggested to influence duration of febrile neutropenia and prognosis in paediatric oncology patients. However, there is no consensus on the definition of MBL deficiency. In a cohort of children with cancer, we investigated (i) how to determine MBL deficiency and (ii) whether MBL is a prognostic factor for disease severity. In 222 paediatric oncology patients, 92 healthy children and 194 healthy adults, MBL plasma levels and MBL2 genotype (wild-type: A, variant: O) were determined. Event-free survival (EFS), overall survival (OS) and paediatric intensive care unit (PICU) admissions were recorded prospectively. In febrile neutropenic patients admitted to the PICU, disease severity was assessed by clinical, microbiological and laboratory parameters. An optimal cut-off value for MBL deficiency was determined to be < 0·20 µg/ml. Wild-type MBL2 genotype patients, including the XA/XA haplotype, had increased MBL levels compared to healthy individuals. MBL deficiency was associated with decreased EFS (P = 0·03), but not with need for PICU admission. A trend for a twice increased frequency of septic shock (80% versus 38%, P = 0·14), multiple organ failure (40% versus 17%, P = 0·27) and death (40% versus 21%, P = 0·27) was observed in the absence of microbiological findings. MBL deficiency was associated with decreased EFS and possibly with an increased severity of disease during PICU admission after febrile neutropenia in the absence of any association with microbiological findings. These findings suggest prognosis to be worse in MBL-deficient compared to MBL-sufficient paediatric oncology patients. PMID:21488869

Frakking, F N J; Brouwer, N; Dolman, K M; van Woensel, J B M; Caron, H N; Kuijpers, T W; van de Wetering, M D

2011-01-01

120

Surgical errors and risks – the head and neck cancer patient  

PubMed Central

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

Harréus, Ulrich

2013-01-01

121

Prospective Identification of Risk Factors for Wound Infection After Lower Extremity Oncologic Surgery  

Microsoft Academic Search

Background: Surgical site infections (SSI) are frequent causes of morbidity and mortality after orthopaedic oncologic procedures. This\\u000a study was conducted to identify the surgical site infection rate following a lower extremity or pelvic procedure and assess\\u000a the risk factors for acquiring SSI by direct observation of orthopaedic oncology patients’ wounds at a comprehensive cancer\\u000a center.\\u000a \\u000a \\u000a Methods: One hundred ten consecutive

Carol D. Morris; Kent Sepkowitz; Claudette Fonshell; Neil Margetson; Janet Eagan; Jeremy Miransky; Patrick J. Boland; John Healey

2003-01-01

122

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

PubMed

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

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

2014-08-01

123

Practice and Effectiveness of Outpatient Psycho-Oncological Counseling for Cancer Patients  

PubMed Central

Objective: Because of various types of psychological distress, cancer patients are encouraged to attend outpatient psycho-oncological and psychosocial counseling. The aim of this prospective study was an analysis of the impact and success of existing counseling resources. Methods: All cancer patients who had applied at a central counseling center were given a standardized questionnaire (FBK-R23), designed to assess the type and degree of cancer patients' difficulties prior to their first counseling session. Additionally, the psychological condition of the patients was assessed psycho-oncologically by a third party (PO-Bado). After at least 2 and no more than 5 sessions, patients underwent both self-evaluation and third-party assessment, using the same instruments. Results: During the period from September 2008 and August 2009, we looked at a total of 447 people seeking counseling, including 186 family members (42%), 33 professional caregivers (7%), and 228 patients (51%). Out of the 228 patients, 48 attended our counseling sessions personally and 20 of these additionally completed the second questionnaire. Counseling led to only a tendency toward improvement, on average, of total psychological distress (p=0.08). In individual areas - for example, “Social Distress” and “Everyday Limitations”- no change could be measured. Only the problem area identified as “Information Deficit” was improved, on average, after 3 counseling sessions (p=0.008). Conclusion: Our results indicate that while short-term counseling has no concrete effect on the improvement of a patient's psychological well-being, these support sessions do serve to decrease the patient's so-called “Information Deficit”, thereby bringing about an indirect improvement in the sufferer's psychological state. The course of treatment offered should be determined according to the patient's needs. In order to ensure that even the very sickest of the tumor patient group seek outreach groups, we must target this particular group with additional evaluative questions. Further studies must determine whether short-term counseling or other counseling strategies are most effective. PMID:20842233

Goerling, Ute; Tagmat, Deniz; Muffler, Elvira; Schramm, Nancy; Wernecke, Klaus-Dieter; Schlag, Peter M.

2010-01-01

124

Is the clinical use of cannabis by oncology patients advisable?  

PubMed

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

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

2014-06-01

125

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

SciTech Connect

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.

Le, Tien, E-mail: tle@ottawahospital.on.c [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa, Ontario (Canada); Menard, Chantal [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa, Ontario (Canada); Samant, Rajiv; Choan, E. [Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario (Canada); Hopkins, Laura; Faught, Wylam; Fung-Kee-Fung, Michael [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa, Ontario (Canada)

2009-11-01

126

Hypercapnia Improves Tissue Oxygenation in Morbidly Obese Surgical Patients  

PubMed Central

Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (FIO2) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean, but has not been evaluated in obese patients. We thus tested the hypothesis that mild hypercapnia markedly improves tissue oxygenation in morbidly obese patients given FIO2 80% during major abdominal surgery. Thirty obese patients (body mass index 61.5±17 kg/m2) scheduled for open gastric bypass were randomly assigned to normocapnia (n=15, end-tidal PCO2 35 mmHg) or hypercapnia (n=15, end-tidal PCO2 50 mmHg); FIO2 was 80%. Anesthetic management and other confounding factors were controlled. Tissue oxygen tension was measured subcutaneously at the upper arm using a polarographic probe in a silastic tonometer. Demographic characteristics, cardiovascular measurements, and PaO2 (222±48 versus 230±68 mmHg in normocapnic versus hypercapnic; mean±SD, P=0.705) were comparable in the groups. Tissue oxygen tension, however, was greater in hypercapnic than in normocapnic patients (78±31 versus 56±13 mmHg, P=0.029). Mild hypercapnia increased tissue oxygenation by an amount believed to be clinically important and could potentially reduce the risk of surgical wound infection in morbidly obese patients. PMID:16931680

Hager, Helmut; Reddy, Dayakar; Mandadi, Goutham; Pulley, Debra; Eagon, J Chris; Sessler, Daniel I; Kurz, Andrea

2006-01-01

127

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

PubMed Central

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

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

2015-01-01

128

Management of fractures in a geriatric surgical patient.  

PubMed

Trauma is an increasingly common problem in geriatric patients; fractures are frequent among the elderly. Life expectancy continues to rise. Advances in medical care allow people to live longer and better lives. Medications, surgical advances (treatment for coronary artery disease, coronary bypass grafting), and joint replacement surgery can be safely performed in elderly patients. Thus, geriatric patients are no longer confined to a life of inactivity. They are out of their homes and interacting in the community, exercising and leading active lives. Thus, they are more likely to become injured and present to trauma centers for care. PMID:25459546

Tinubu, Jide; Scalea, Thomas M

2015-02-01

129

Quality of life in patients with ulcerative colitis treated surgically  

PubMed Central

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

Koz?owska, Katarzyna A.; Krokowicz, Piotr

2014-01-01

130

Surgical treatment of patients with unruptured intracranial aneurysms.  

PubMed

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

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

2015-01-01

131

Surgical management of urolithiasis in spinal cord injury patients.  

PubMed

Urolithiasis is a common condition in patients with spinal cord injury (SCI). Surgical management of stones in this population is more challenging and associated with lower clearance rates than the general population. The rate of complications - specifically infectious complications - is also high due to the chronic bacterial colonization. Shock wave lithotripsy (SWL) has a low clearance rate of 44-73 %. Percutaneous nephrolithotripsy is indicated for larger nephrolithiasis, but multiple procedures may be required to clear the stones. Ureteroscopy has been associated with low success rates because of difficulty in obtaining ureteral access. Historically, bladder stones were managed with open surgery or SWL. Recently, good results have been reported with the combination of endoscopic and laparoscopic techniques. Surgical management of urolithiasis in patients with SCI should be performed in high-volume centers in light of the technical challenges and higher rate of perioperative complications. PMID:24740271

Nabbout, Philippe; Slobodov, Gennady; Culkin, Daniel J

2014-06-01

132

Preoperative recombinant human erythropoietin in anemic surgical patients  

Microsoft Academic Search

Preoperative anemia in a surgical patient predisposes to poor outcomes and allogeneic blood transfusions. As an alternative to transfusions, pharmacologic management of preoperative anemia with recombinant human erythropoietin (rHuEPO) has been well studied in many different types of surgery. rHuEPO, when used alone or in combination with preoperative autologous blood donation before elective surgery, stimulates erythropoiesis and helps to avoid

Terri G Monk

2004-01-01

133

Evaluation and management of patients with heart disease and cancer: cardio-oncology.  

PubMed

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 new systemic treatments has decreased cancer-related mortality. Effective cancer therapies, however, can result in short- and long-term comorbidities that can decrease the net clinical gain by affecting quality of life and survival. In particular, cardiovascular complications of cancer treatments can have a profound effect on the health of patients with cancer 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 patients with cancer 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

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

2014-09-01

134

[Indications to surgical treatment of patients with peptic ulcer disease].  

PubMed

The aim of this investigation is to study the influence of eradication of Helicobacter pylori (Hp) on the results of conservative treatment of patients with ulcer. The results of treatment of 216 patients with peptic ulcer disease (I gr.--152 patients with noncomplicated peptic ulcer disease and II gr.--64 patients with complications of disease) were analyzed. To diagnose Hp infection (13)C-UBT and RUT of biopsy material were used. I gr.--patients received antibacterial treatment. In II gr.: in presence of absolute indications--surgical method was used (16 patients) with additional antibacterial treatment of Hp infection after surgery and in relative indications to surgery (48 patients)--antibacterial treatment was used initially. 1 month after conservative treatment (in part of patients--1 year after Hp eradication also) (13)C-UBT were used to control Hp eradication, as endoscopy--to control ulcer healing. In I gr.: all 152 patients (97,4% of investigated, early nontreated patients with noncomplicated ulcers) were Hp positive; in II gr.--62 from 64 (96,9%). In I gr.: efficiency of primary course of eradication therapy was 91,4% and came to 99,3% after repeated treatment (in II gr.--89,1% and 100% respectively). In I gr.--in 1 patient, the resistance to antibacterial treatment was revealed and eradication of Hp infection and ulcer healing were not achieved. In II gr.--epithelization and scarring of ulcer was revealed by control endoscopy in all cases except one case of prepyloric callous ulcer (Hp was eradicated in all of them). Thus, in complicated cases of peptic ulcer disease, only in presence of absolute indications, surgery is necessity. In presence of relative indications to surgery Hp eradication therapy is indicate initially. Only in cases of resistant to treatment ulcers, as ulcers nonhealing or recurring after Hp was eradicated, must be a relative indications to surgical treatment. PMID:18487682

Girdaladze A M; Mosidze, B A; Elisabedashvili, G V; Bolkvadze, T Dzh; Dzhorbenadze, T A

2008-04-01

135

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

PubMed Central

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

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

2014-01-01

136

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

PubMed

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

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

1999-10-01

137

Sleep Habits and Symptoms in Male Medical and Surgical Patients  

PubMed Central

A questionary survey of symptoms and sleep habits at home among 100 adult male medical and surgical patients showed that the duration of sleep at night was similar to that reported for the general population, decreasing with age from 20 to 50 years and increasing again after 60 years. The duration of daytime sleep increased with age. The degree of sleep disturbance in different patients was compared in terms of the total duration of sleep and the time spent lying awake in bed at night. Increasing age, ischaemic heart disease, and neurotic illness were the main factors associated with long-term disturbances. PMID:5428715

Johns, M. W.; Egan, P.; Gay, T. J. A.; Masterton, J. P.

1970-01-01

138

Psychosocial support for patients in pediatric oncology: the influences of parents, schools, peers, and technology.  

PubMed

The diagnosis and treatment of pediatric cancer can be associated with profound psychosocial changes in the life of young patients. Although nurses, physicians, and other health care professionals are important sources of support, psychosocial support is also available through parents, schools, and peers. This article presents a review of the literature on how parents, schools, and peers affect the coping and adjustment of young patients with cancer and critically reviews interventions directed at improving functioning in these areas. Special attention is paid to recent interventions that exploit technology such as video games, CD-ROMs, and the Internet to provide creative new forms of support for patients in pediatric oncology. Existing research on both technological and interpersonal forms of intervention and support shows promising results, and suggestions for further study are provided. PMID:14567564

Suzuki, Lalita K; Kato, Pamela M

2003-01-01

139

Allowing and assisting patients to die: the perspectives of oncology practitioners.  

PubMed

The moral distinctions between prolonging life, allowing for a dignified death, and assisting patients to die (hastening death) are troublesome to health practitioners. On 26 June 1997 the United States Supreme Court ruled that individuals do not have a constitutional right to physician-assisted suicide, but that individual states can legislate their preferences. Given this ruling it becomes important to ascertain the opinions of practitioners caring for persons who are at the end of their life. The data from interviews with 11 nurses and 10 physicians, who practice in the field of oncology, revealed issues associated with the care of dying persons. How health professionals integrated their perspectives of science/data with their perspectives on persons and personal goals affected the vigour with which they would institute treatment for the terminal patient. Further, ethical uncertainty dominated the decision making of all participants in this study when they were confronted with the question of assisting/hastening patients' dying. PMID:10499218

Pierce, S F

1999-09-01

140

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

PubMed Central

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.

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

2015-01-01

141

Palliative care in pediatric hematological oncology patients: experience of a tertiary hospital  

PubMed Central

Objective To evaluate the approach to palliative care for hematological oncology patients in the pediatric ward of a tertiary hospital. Methods This was a retrospective, descriptive study of 29 hematological oncology patients who died between 2009 and 2011. Data regarding the approach and prevalence of pain, prevalence of other symptoms, multidisciplinary team participation, communication between staff and family and limited invasive therapy were collected from the medical records. Results Twenty-seven (93.1%) patients displayed disease progression unresponsive to curative treatment. The median age at death was ten years old. Pain was the most prevalent symptom with all patients who reported pain receiving analgesic medications. The majority took weak (55.2%) and/or strong (65.5%) opioids. The patients were followed by pediatricians and a pediatric hematologist/oncologist. Participation of other professionals was also documented: 86.2% were followed by social services and 69% by psychologists, among others. There were explicit descriptions of limitation of invasive therapy in the medical records of 26 patients who died with disease progression. All these decisions were shared with the families. Conclusion Although the hospital where this study was conducted does not have a specialized team in pediatric palliative care, it meets all the requirements for developing a specific program. The importance of approaching pain and other prevalent symptoms in children with cancer involving a comprehensive multidisciplinary team is evident. Discussions were had with most of the families on limiting invasive therapy, but no record of a well-defined and coordinated treatment plan for palliative care was found. PMID:25453649

Valadares, Maria Thereza Macedo; Mota, Joaquim Antônio César; de Oliveira, Benigna Maria

2014-01-01

142

Successful surgical management of ruptured umbilical hernias in cirrhotic patients.  

PubMed

Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual, but potentially life-threatening complication, with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair. Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites. We present a retrospective analysis of our centre's experience over the last 6 years. Our cohort consisted of 11 consecutive patients (median age: 53 years, range: 36-63 years) with advanced hepatic cirrhosis and refractory ascites. Appropriate patient resuscitation and optimisation with intravenous fluids, prophylactic antibiotics and local measures was instituted. One failed attempt for conservative management was followed by a successful primary repair. In all cases, with one exception, a primary repair with non-absorbable Nylon, interrupted sutures, without mesh, was performed. The perioperative complication rate was 25% and the recurrence rate 8.3%. No mortality was recorded. Median length of hospital stay was 14 d (range: 4-31 d). Based on our experience, the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period, provided that meticulous patient optimisation is performed. PMID:25780312

Chatzizacharias, Nikolaos A; Bradley, J Andrew; Harper, Simon; Butler, Andrew; Jah, Asif; Huguet, Emmanuel; Praseedom, Raaj K; Allison, Michael; Gibbs, Paul

2015-03-14

143

Successful surgical management of ruptured umbilical hernias in cirrhotic patients  

PubMed Central

Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual, but potentially life-threatening complication, with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair. Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites. We present a retrospective analysis of our centre’s experience over the last 6 years. Our cohort consisted of 11 consecutive patients (median age: 53 years, range: 36-63 years) with advanced hepatic cirrhosis and refractory ascites. Appropriate patient resuscitation and optimisation with intravenous fluids, prophylactic antibiotics and local measures was instituted. One failed attempt for conservative management was followed by a successful primary repair. In all cases, with one exception, a primary repair with non-absorbable Nylon, interrupted sutures, without mesh, was performed. The perioperative complication rate was 25% and the recurrence rate 8.3%. No mortality was recorded. Median length of hospital stay was 14 d (range: 4-31 d). Based on our experience, the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period, provided that meticulous patient optimisation is performed. PMID:25780312

Chatzizacharias, Nikolaos A; Bradley, J Andrew; Harper, Simon; Butler, Andrew; Jah, Asif; Huguet, Emmanuel; Praseedom, Raaj K; Allison, Michael; Gibbs, Paul

2015-01-01

144

Surgical Management of Rhinosinusitis in Onco-Hematological Patients  

PubMed Central

Objectives In onco-hematological diseases, the incidence of paranasal sinuses infection dramatically increase and requires a combination of medical and surgical therapy. Balloon dilatation surgery (DS) is a minimally invasive, tissue preserving procedure. The study evaluates the results of DS for rhinosinusitis in immunocompromised patients. Methods A retrospective chart review was conducted in 110 hematologic patients with rhinosinusitis. Twenty-five patients were treated with DS technique and 85 patients with endoscopic sinus surgery (ESS). We considered the type of anesthesia and the extent of intra- and postoperative bleeding. Patients underwent Sino-Nasal Outcome Test (SNOT-20) to evaluate changes in subjective symptoms and global patient assessment (GPA) questionnaire to value patient satisfaction. Results Local anesthesia was employed in 8 cases of DS and in 15 of ESS. In 50 ESS patients, an anterior nasal packing was placed and in 12 cases a repacking was necessary. In the DS group, nasal packing was required in 8 cases and in 2 cases a repacking was placed (P=0.019 and P=0.422, respectively). The SNOT-20 change score showed significant improvement of health status in both groups. However the DS group showed a major improvement in 3 voices: need to blow nose, runny nose, and facial pain/pressure. The 3-month follow-up GPA questionnaire showed an higher satisfaction of DS group. Conclusion Balloon DS represents a potentially low aggressive treatment and appears to be relatively safe and effective in onco-hematologic patients. All these remarks may lead the surgeon to consider a larger number of candidates for surgical procedure. PMID:25436050

Di Girolamo, Stefano; Di Mauro, Roberta; Giacomini, Piergiorgio; Cantonetti, Maria

2014-01-01

145

The effectiveness of a participatory program on fall prevention in oncology patients.  

PubMed

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, 68 participants were recruited at a medical centre in Taiwan. A 20-min fall prevention program was given to patients. A questionnaire was used to evaluate the effectiveness of program after on day 3 of intervention. The data of fall incidence rates were collected from hospital record. Fall incidences with and without the program were used to compare the effectiveness of intervention. The patients' knowledge and self-efficacy of fall prevention are better than after intervention. A statistically significant difference in fall incidence rate was observed with (0.0%) and without (19.3%) the program. Our findings suggest that the fact of the bedside is that the most risk for falling in hospital must be communicated to the hospitalized patients. Educating patients about fall prevention and activities associated with falling increases their awareness of the potential of falling and promoting patient safety. PMID:25492057

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

2015-04-01

146

Using patient-reported outcomes in clinical oncology practice: benefits, challenges and next steps.  

PubMed

Measuring patient outcomes such as health-related quality-of-life in clinical practice can provide opportunities for patient monitoring and management. Well-validated instruments are available and studies have shown that such information is acceptable to - even valued by - patients and their clinicians. However, despite such general acceptance of the idea and, as demonstrated in feasibility studies, such systematic reporting occurs rarely in oncology practice in the USA and many challenges to widespread adoption exist. These challenges include limitations in knowledge about how best to interpret individual patient-reported outcomes and clinician, patient-related and health system issues. The way forward does not lie simply in urging clinicians to add patient-reported measurement to other tasks that are part of everyday practice. Rather, new information infrastructures and technologies, combined with redesign of care, are more likely to embed the routine use of patient-reported outcomes. In addition to taking vital signs and performing laboratory tests, such information can better provide a timely response to patient needs. PMID:20528542

Donaldson, Molla

2006-02-01

147

Effects of oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders  

PubMed Central

Pretherapy sperm cryopreservation in young men is currently included in good clinical practice guidelines for cancer patients. The aim of this paper is to outline the effects of different oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders, based on an 8-year experience of the Cryopreservation Centre of a large public hospital. Two hundred and sixty-one patients with testicular neoplasia and 219 patients with lymphoproliferative disorders who underwent chemotherapy and/or radiotherapy and pretherapy semen cryopreservation were evaluated. Sperm and hormonal parameters (follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, inhibin B levels) were assessed prior to and 6, 12, 18, 24 and 36 months after the end of cancer treatment. At the time of sperm collection, baseline FSH level and sperm concentration were impaired to a greater extent in patients with malignant testicular neoplasias than in patients with lymphoproliferative disorders. Toxic effects on spermatogenesis were still evident at 6 and 12 months after the end of cancer therapies, while an improvement of seminal parameters was observed after 18 months. In conclusion, an overall increase in sperm concentration was recorded about 18 months after the end of cancer treatments in the majority of patients, even if it was not possible to predict the evolution of each single case ‘a priori'. For this reason, pretherapy semen cryopreservation should be considered in all young cancer patients. PMID:23542137

Di Bisceglie, Cataldo; Bertagna, Angela; Composto, Emanuela R; Lanfranco, Fabio; Baldi, Matteo; Motta, Giovanna; Barberis, Anna M; Napolitano, Emanuela; Castellano, Elena; Manieri, Chiara

2013-01-01

148

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

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…

Beisecker, Analee E.; And Others

1994-01-01

149

Risk group criteria for tailoring adjuvant treatment in patients with endometrial cancer: a validation study of the Gynecologic Oncology Group criteria  

PubMed Central

Objective The purpose of this study is to validate the Gynecologic Oncology Group (GOG) criteria for adjuvant treatment in a different cohort of patients and to evaluate the simplified risk criteria predicting the prognosis and tailoring adjuvant treatment in patients with surgically staged endometrial cancer. Methods We performed a retrospective analysis of 261 consecutive patients with surgically staged endometrial cancer between January 2000 and February 2013. All patients had complete staging procedures and were surgically staged according to the 2009 International Federation of Gynecology and Obstetrics staging system. Clinical and pathologic data were obtained from medical records. We designed the simplified risk criteria for adjuvant treatment according to the risk factors associated with survival. The patients were divided into low and low-intermediate, high-intermediate, and high-risk groups according to the GOG criteria and simplified criteria and their survivals were compared. Receiver-operating characteristic curve analysis was used to evaluate the prognostic significance of both criteria. Results Median follow-up time was 48 months (range, 10 to 122 months). According to the GOG criteria, we identified 197 low and low-intermediate risk patients, 20 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. Using the simplified risk criteria, we identified 189 low and low-intermediate risk patients, 28 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. The performance of the simplified criteria (area under the curve [AUC]=0.829 and 0.916 for disease recurrences and deaths, respectively) was as good as the GOG criteria (AUC=0.836 and 0.921 for disease recurrences and deaths, respectively). Conclusion The simplified criteria may be easily applicable and offer useful information for planning strategy of adjuvant treatment in patients with surgically staged endometrial cancer as the GOG criteria. PMID:25376915

Kong, Tae Wook; Paek, Jiheum; Lee, Yonghee; Chun, Mison; Ryu, Hee-Sug

2015-01-01

150

Accuracy of the oncology patients information system in a regional cancer centre.  

PubMed

This study was designed to evaluate the accuracy of the Oncology Patient Information Systems (OPIS) database for patients with breast cancer and lymphoma. We conducted a detailed individual patient chart review of patients with lymphoma or breast cancer who were seen in consultation by an oncologist between July 1991 and June 1995. Information extracted directly from the patients' clinic charts was compared with information captured in the OPIS database with respect to demographics, staging, histological diagnosis, treatment, relapse status, date of relapse and survival. OPIS database failed to capture 14.4% and 23.4% of lymphoma and breast cancer patients seen over the four-year period. When compared to the clinic charts there were differences in staging in 31.5% and 8.1%, relapse status in 27.6% and 7.2%, and date of relapse in 56.4% and 14.7% of lymphoma and breast cancer patients respectively. The deficiencies and inaccuracies in the OPIS database emphasize the need for caution in basing administrative, policy, or practice decisions on this database. PMID:11748476

Yau, Jonathan C; Chan, Arlene; Eapen, Tamina; Oirourke, Keith; Eapen, Libni

2002-01-01

151

Medical problems of surgical patients. Hypertension and ischaemic heart disease.  

PubMed Central

Pre-existing disease in the form of hypertension or ischaemic heart disease may increase morbidity and mortality in patients presenting for anaesthesia and surgery. The interaction of these two cardiovascular conditions in relation to anaesthesia has been studied in a series of 115 patients. The results did not support the view that antihypertensive drugs and beta-receptor blocking agents should be withdrawn before anaesthesia and surgery. The main cause for concern in providing anaesthesia for these patients is that sympathetic nervous activation induced either by anaesthetic manoeuvres or by surgical stimulation may lead to reflex cardiovascular responses which, by increasing myocardial oxygen demand, lead to episodes of myocardial ischaemia. In this respect beta-receptor blocking drugs appear to have a protective effect on the ischaemic myocardium. PMID:10825

Prys-Roberts, C.

1976-01-01

152

[Surgical treatment of patients with paraesophageal and mixed hiatal hernias].  

PubMed

During the years from 1948-90, we operated on 112 patients with paraesophageal and mixed hiatal hernias. One hundred patients who had been operated on up to the year 1988 were followed up over a long period. Preoperatively gastroesophageal reflux occurred in 52%, hemorrhage in 18%, riding ulcer in 7%, and incarceration and obstruction in 9%. Up to the beginning of the seventies, hiatoraphy and gastropexy were carried out. In these patients, the checking showed the occurrence of the relapse of hernias in 47%, reflux in 43% and subjective complaints in 26%. This finding induced us to change the surgical procedure and, in the following years, we performed hiatoraphy, fundoplicatio, fundophrenopexy and anterior gastropexy. The checking showed a decrease in the occurrence of the relapse of hernias to 21%, gastroesophageal reflux to 9% and subjective complaints to 10%. The period of the follow-up ranged from 1 to 19 years. The operative letality was 3%. PMID:1838888

Duda, M; Dlouhý, M; Gryga, A; Rocek, V; Köcher, M; Herman, J

1991-01-01

153

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

SciTech Connect

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.

Ge Jin [Perelman School of Medicine at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)] [Perelman School of Medicine at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Fishman, Jessica [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States) [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Annenberg School for Communication at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Vapiwala, Neha [Abramson Comprehensive Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States) [Abramson Comprehensive Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Li, Susan Q.; Desai, Krupali [Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)] [Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Xie, Sharon X. [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)] [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Mao, Jun J., E-mail: maoj@uphs.upenn.edu [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Abramson Comprehensive Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)

2013-01-01

154

Surgical complications after kidney transplantation: different impacts of immunosuppression, graft function, patient variables, and surgical performance.  

PubMed

The population of kidney transplant (KTx) recipients often has complex medical and immunological conditions. Surgical complications (SCs) contribute to the increasing morbidity and costs in these patients. We analyzed the risk factors for SC in 405 KTx patients treated using defined immunosuppressive regimens according to their clinical and immunological risk profile: (1) standard immunosuppression (SIS) with IL-2 receptor mAb, CNI, and (a) mycophenolic acid (MPA) or (b) mTOR inhibitor; and (2) more intense immunosuppression (IIS) with (a) ATG or (b) the additional use of plasma exchange and B- and T-cell-depleting agents. In a mixed effects logistic regression model, we identified the following risk factors for SC: male gender, diabetes, and post-operative dialysis. No difference was found between the patients who received SIS with MPA and those who received mTOR inhibitors. The risk of suffering complications with IIS increases with age. In addition to IIS, diabetes was a risk for wound healing disorders. Therapeutic anticoagulation and a third or subsequent retransplantation increased the rate of bleeding. We did not identify immunosuppression or patient demographics as risk factors for lymphoceles or ureter complications; however, we demonstrated that the surgeon had a significant impact on severe complications, especially those of the ureter. PMID:25598053

Koch, Martina; Kantas, Alexandros; Ramcke, Katja; Drabik, Anna I; Nashan, Björn

2015-03-01

155

Surgical management of cleft lip in pedo-patients.  

PubMed

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

Taware, C P; Kulkarni, S R

1991-01-01

156

Non invasive ventilation in cardio-surgical patients.  

PubMed

Non invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic respiratory failure, has also found a wide application in the postoperative period. The expanding indications to the transcatheter treatment of diseased left heart valves have led to an increase in cardiac interventional and diagnostic procedures in severely fragile cardiac patients. As an essential part of post cardiac surgery care is ventilatory support, NIV use has expanded to cardiosurgical patients. The objective of this study was to investigate the application and the results of preventive and curative NIV in patients after cardiac surgery. Despite limited data and the necessity of randomized trials, the NIV should be considered in selected patients with postoperative acute respiratory failure as a tool to both prevent and treat acute respiratory failure following patient weaning from mechanical ventilation and tracheal extubation. The knowledge and the real time assessment of the possible effects of positive pressure ventilation on cardiopulmonary interactions in the clinical scenario of cardiac surgery will prompt the intensivists to tailor the respiratory support by non invasive ventilation to the individual patient. The influence on the cardiovascular system of positive pressure and volume delivered through the airways, which can be highly favorable on the impaired left heart and less favorable on the diseased right heart, should be considered when applying NIV in a cardio-surgical patient. As a consequence, the application of NIV in this setting requires an expertly skilled team, continuous hemodynamic monitoring and echocardiographic assessment. PMID:21709660

Guarracino, F; Ambrosino, N

2011-07-01

157

Patient satisfaction about using patient controlled analgesia in managing pain post surgical intervention.  

PubMed

Management of postoperative pain using patient controlled analgesia (PCA) has increased for its proven advantages over conventional methods of pain control. The purpose of this study was to investigate patients' satisfaction about using PCA post surgical intervention among patients at Saudi health care settings. A cross-sectional, descriptive correlational design was used to collect data from patients using PCA post surgical interventions. The analysis showed that patients had a moderate to high level of perception about efficacy of PCA, and had a moderate level of knowledge about PCA use and its function. The duration of using a PCA pump, patients' age, gender, marital status, educational level, type of surgery, and their work status were significant predictors (F 7, 76 = 5.13, p < .001; R (2)= 0.59). PCA offers patients with an individualized analgesic therapy that meets the patients' demand of pain control. The implications for nurses and medical staff are discussed. PMID:23729021

Ratrout, Hamza F; Hamdan-Mansour, Ayman M; Seder, Samer S; Salim, Wisam M

2014-08-01

158

Orthotopic kidney transplant: a valid surgical alternative for complex patients.  

PubMed

Kidney transplant is the best alternative of treatment for patients with end-stage renal disease (ESRD). At present, a significant part of patients admitted to waiting list are older and have previous transplants or severe vascular atheromatosis. In these cases, orthotopic kidney transplant (OKT) could be an option. The aim of the study is to present our results with this technique in terms of surgical steps, complications, and outcomes. Between January 1977 and August 2014, 1549 kidney transplants were performed in our transplant unit. Nine of them were OKT and were performed according to principles described by Gil-Vernet. All data were reviewed retrospectively. Nine OKTs were performed in seven males and two females, with a mean age of 49.3 years (range 24-67). Donor mean age was 40.5 (18.5-62.5) and the follow-up mean time was of 91.8 months (8-226). Seven cases were first transplants and two were third transplants, all of them from deceased donors. Indication for the OKT was an unsuitable iliac region in six (66.6%) and abnormalities in the low urinary tract or urinary diversions in three (33.3%). Delayed graft function (DGF) was present in 22.2% (2/9). Three patients (33.3%) developed early surgical complications: one bleeding (Clavien IIIb), one arterial thrombosis (IIIb), and one pancreatic leak (IIIb). Two patients (25%) had late complications: one ureteral stricture (IIIb) and one reflux nephropathy (IIIa). Mean serum creatinine after OKT was 1.7, 1.5, and 1.8 mg/dl at 1 month, 1 year, and 5 years, respectively. Mean graft survival was 80.7 months (range 0-226). At present, three patients are alive with functioning graft, three patients died with functioning graft, two patients returned to dialysis many years after the transplant, and one lost the graft due to an arterial thrombosis in the early postoperative course. OKT is a valid option for patients with unsuitable iliac regions such as those with third transplants, severe atheromatosis, or vena cava thrombosis. It is also an option for those patients with urinary diversions. Functional results are good, although it is a technique not exempted from complications. Two thirds of the patients have a long-term survival of the graft, and a third of the patients die with functioning graft. PMID:25404184

Hevia, Vital; Gómez, Victoria; Álvarez, Sara; Díez-Nicolás, Víctor; Fernández, Ana; Burgos, Francisco Javier

2015-01-01

159

Patient Participation in Surgical Treatment Decision Making from the Patients' Perspective: Validation of an Instrument  

PubMed Central

The aim of this paper is to describe the development of a new, brief, easy-to-administer self-reported instrument designed to assess patient participation in decision making in surgical treatment. We describe item generation, psychometric testing, and validity of the instrument. The final scale consisted of four factors: information dissemination (5 items), formulation of options (4 items), integration of information (4 items), and control (3 items). The analysis demonstrated a reasonable level of construct validity and reliability. The instrument applies to patients in surgical wards and can be used to identify the health services that are being provided and the areas that could strengthen patient participation. PMID:22830010

Heggland, Liv-Helen; Øgaard, Torvald; Mikkelsen, Aslaug; Hausken, Kjell

2012-01-01

160

Page 3 Cutting-edge Medical, Surgical, and Radiation Approaches and Genetic Findings in Colorectal Cancer  

E-print Network

Clinical Trials and Advanced Surgical and Radiation Therapies for Upper Gastrointestinal and Gastric for patients. Gastrointestinal Oncology AdvancesFall 2010 #12;2 | Gastrointestinal Oncology Advances 1-877-DFCI-BWH · www.dfbwcc.org Gastrointestinal Cancer Center Faculty This update highlights the latest developments

Liu, Xiaole Shirley

161

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

ERIC Educational Resources Information Center

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)

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

1985-01-01

162

Barriers to Accessing Quality Health Care for Cancer Patients: A Survey of Members of the Association of Oncology Social Work  

Microsoft Academic Search

The present article reports data from a cross-sectional survey of members of the Association of Oncology Social Work (AOSW) completed in May 2006. The purpose of the survey was to gather information on AOSW members' practice roles, the clients they serve, and their views on barriers cancer patients face in obtaining quality cancer care. The survey instrument was a self-administered

Mary Ann Burg; Brad Zebrack; Katherine Walsh; Peter Maramaldi; Jung-Won Lim; Kathryn M. Smolinski; Kim Lawson

2010-01-01

163

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

PubMed

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

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

2014-03-01

164

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

PubMed Central

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

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

2014-01-01

165

Oncology clinicians' defenses and adherence to communication skills training with simulated patients: an exploratory study.  

PubMed

The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N=31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6 months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29)?=5.26, p=0.03, d=0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10-12 participants) and have a minimal duration of at least 3 days in order to be effective. Several systematic reviews evaluated the impact of CST on clinicians' communication skills [9-11]. Effectiveness of CST can be assessed by two main approaches: participant-based and patient-based outcomes. Measures can be self-reported, but, according to Gysels et al. [10], behavioral assessment of patient-physician interviews [12] is the most objective and reliable method for measuring change after training. Based on 22 studies on participants' outcomes, Merckaert et al. [9] reported an increase of communication skills and participants' satisfaction with training and changes in attitudes and beliefs. The evaluation of CST remains a challenging task and variables mediating skills improvement remain unidentified. We recently thus conducted a study evaluating the impact of CST on clinicians' defenses by comparing the evolution of defenses of clinicians participating in CST with defenses of a control group without training [13]. Defenses are unconscious psychological processes which protect from anxiety or distress. Therefore, they contribute to the individual's adaptation to stress [14]. Perry refers to the term "defensive functioning" to indicate the degree of adaptation linked to the use of a range of specific defenses by an individual, ranging from low defensive functioning when he or she tends to use generally less adaptive defenses (such as projection, denial, or acting out) to high defensive functioning when he or she tends to use generally more adaptive defenses (such as altruism, intellectualization, or introspection) [15, 16]. Although several authors have addressed the emotional difficulties of oncology clinicians when facing patients and their need to preserve themselves [7, 17, 18], no research has yet been conducted on the defenses of clinicians. For example, repeated use of less adaptive defenses, such as denial, may allow the clinician to avoid or reduce distress, but it also diminishes his ability to respond to the patient's emotions, to identify and to respon

Bernard, Mathieu; de Roten, Yves; Despland, Jean-Nicolas; Stiefel, Friedrich

2012-06-01

166

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

PubMed Central

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

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

2010-01-01

167

Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer  

PubMed Central

Objective Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. Methods This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. Results Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. Conclusion Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity. PMID:25872893

Bleu, Géraldine; Merlot, Benjamin; Boulanger, Loïc; Vinatier, Denis; Kerdraon, Olivier; Collinet, Pierre

2015-01-01

168

Learning from disaster: ?patient safety and the role of oncology nurses.  

PubMed

When the Oncology Nursing Society (ONS) was almost exactly half its present age, in November 1994, a Boston Globe health columnist named Betsy Lehman was admitted to the Dana-Farber Cancer Institute in Boston, Massachusetts, to receive an investigational regimen for breast cancer. Her treatment ended in disaster. In one of the most notorious patient safety failures of modern times, Lehman was given severe overdoses of cyclophosphamide during a four-day period. On each of those four days, nurses, physicians, and pharmacists at Dana-Farber failed to notice that Lehman was receiving doses four times greater than the intended amount (Aspden, Wolcott, Bootman, & Cronenwett, 2007). Lehman died of cyclophosphamide toxicity on December 3, 1994.?. PMID:25840380

Glenn, David G

2015-04-01

169

Elective introduction to oncology.  

PubMed

Since 1974, the St. George Medical Society, a component of the American Cancer Society's Philadelphia Division's Professional Education Program, has sponsored paid summer clinical and research fellowships for Philadelphia medical students completing their first year. Six lectures at the student level are presented throughout the year. Students run a single society, elect officers, and select site and speakers under the guidance of the St. George Medical Society Subcommittee. Faculty from six medical schools and individual faculty preceptors donate time to provide a one-on-one summer experience in medical oncology, surgical oncology, gynecologic oncology, radiation oncology, pathology, and cancer-related research in university hospitals, community hospitals, and private offices. Financial support is provided by directed donations. Currently 50 clinical fellowships are offered. Since its inception, over 750 "fellowships" have been awarded, and over 3,000 students have attended the lectures. The program successfully provides a voluntary one-on-one introduction to clinical oncology in a reproducible format. PMID:8489907

Axelrod, R S; Lowney, K

1993-01-01

170

Thromboprophylaxis in non-surgical patients: who, when and how?  

PubMed

Because of the serious lack of useable, relevant information, most recommendations for prevention of thrombosis in non-surgical patients are extrapolations from much larger clinical trials experienced in surgery. Directly relevant evidence comes predominantly from very small randomized trials, many of them open label and carried out more than 20 years before the introduction of more recent and important changes in clinical care that may have substantially reduced the baseline thrombosis risk. In these early studies, low-dose heparin and low-molecular-weight heparins prevented subclinical deep vein thrombosis in ischaemic stroke, myocardial infarction and among elderly medical inpatients. Although it is likely that these drugs also prevent subclinical deep vein thrombosis after spinal cord injury or other major trauma, and when patients require intensive medical care, the supporting evidence in these circumstances comes mainly from cohort studies and poorly controlled comparisons. In contrast, the heparins have not reduced mortality or demonstrably prevented pulmonary embolism after ischaemic stroke or among elderly medical inpatients in large and well-conducted clinical endpoint trials, from which no clinically important benefit could be demonstrated. From analyses it is suggested that such benefit is probably more difficult to demonstrate for medical than for surgical patients. In the absence of sufficient information that is specific to medical patients, various forms of prophylaxis known to be effective in surgery will continue to be applied in high-risk individuals. After venous thromboembolism, it now appears that the best duration of oral anticoagulant therapy to prevent a recurrence is determined to a greater extent by whether the thrombotic episode was idiopathic or triggered by a clinically recognizable cause, whether it was transient or continuing, and whether the deep vein thrombosis was extensive, limited to the calf veins or was a first or recurrent event. PMID:10069765

Gallus, A S; Nurmohamed, M; Nurmohammed, M; Kearon, C; Prins, M

1998-01-01

171

Optical instruments havebecomewell integrated into the surgical setting to visualize tissue and improve patient outcome. Surgical microscopes and loupes magnify tissue to help  

E-print Network

and improve patient outcome. Surgical microscopes and loupes magnify tissue to help prevent iatrogenic injury is performed with the aid of surgical microscopesand loupesto magnify the surgical field (2 with a radial-imaging, flexible catheter- endoscope (11), as well as a handheld surgical probe and laparoscope

Boppart, Stephen

172

[Results of surgical treatment in patients with pulmonary tuberculosis].  

PubMed

The results of examination and treatment were analyzed in 647 patients operated on for pulmonary tuberculoma (PT) in 1990-2004. A pathological lung process was revealed in 47.0 +/- 0.3% cases on referral and in 53.0 +/- 0.3% at prophylactic fluorography. There were 157 (24.3 +/- 0.2%) bacteria-isolating patients; of them 39 (24.8 +/- 0.4%) had drug-resistant Mycobacterium tuberculosis. With changes being revealed in the lung, the clinical diagnosis of PT was initially diagnosed in 161 (24.9 +/- 0.2%) patients. Infiltrative pulmonary tuberculosis was diagnosed in most cases (353 patients or 54.6 +/- 0.3%) and transformation of the process to a tuberculoma was noted during further treatment. A total of 647 patients underwent 653 operations. The absolute majority of operations (n = 546 or 83.6 +/- 0.4%) was represented by partial (or economic) lung resections. On pathohistological study, single and multiple tuberculomas were diagnosed in 364 (55.7 +/- 0.3%) and 289 (44.3 +/- 0.3%) patients, respectively. The tuberculomas were in the phase of decay and contamination in 425 (65.1 +/- 65.1 +/- 0.3%) and 311 (47.6 +/- 0.3%) patients, respectively. Postoperative complications were recorded in 36 (5.5 +/- 0.1%) patients. The efficiency of surgical treatment was 99.7% (0.15 +/- 0.02% mortality) and 92.1% in the immediate and postoperative periods, respectively. PMID:18080531

Didenko, G V

2007-01-01

173

The role of mannose-binding lectin (MBL) in paediatric oncology patients with febrile neutropenia.  

PubMed

Children with cancer often have fever during chemotherapy-induced neutropenia, but only some develop serious infectious complications. Mannose-binding lectin (MBL) deficiency might increase infection susceptibility in these children. MBL genotype and phenotype were prospectively determined in 110 paediatric oncology patients. During febrile neutropenia, MBL concentrations were measured longitudinally in time. MBL genotype and phenotype were correlated to clinical and laboratory parameters. Structural exon-1 MBL2 mutations and the LX promoter polymorphism lead to deficient MBL concentrations. The capacity to increase MBL concentrations during febrile neutropenia was associated with MBL2 genotype. Infectious parameters did not differ between MBL-deficient and MBL-sufficient neutropenic children (n = 66). In contrast, MBL-sufficient patients had a greater risk of Intensive Care admittance (Relative Risk 1.6, 95% Confidence Interval 1.3-2.0, P = 0.04). MBL-deficient neutropenic children did not have more severe infections. However, most patients (61%) were severely neutropenic (<100 cells/microL), compromising the opsonophagocytic effector function of MBL. MBL substitution might still be beneficial in patients with phagocytic activity. PMID:16517152

Frakking, F N J; van de Wetering, M D; Brouwer, N; Dolman, K M; Geissler, J; Lemkes, B; Caron, H N; Kuijpers, T W

2006-05-01

174

Assessment of oral mucositis in adult and pediatric oncology patients: an evidence-based approach.  

PubMed

Oral mucositis is a frequent side effect of cancer treatment and can lead to delayed treatment, reduced treatment dosage, altered nutrition, dehydration, infections, xerostomia, pain, and higher healthcare costs. Mucositis is defined as "inflammatory lesions of the oral and/or gastrointestinal tract caused by high-dose cancer therapies. Alimentary tract mucositis refers to the expression of mucosal injury across the continuum of oral and gastrointestinal mucosa, from the mouth to the anus" (Peterson, Bensadoun, & Roila, 2008, p. ii122). Evidence demonstrates that oral mucositis is quite distressing for patients. In addition, the majority of oncology nurses are unaware of available guidelines related to the care of oral mucositis. A multidisciplinary Oral Mucositis Committee was formed by the University of Iowa Hospitals and Clinics to develop evidence-based prevention and treatment strategies for adult and pediatric oncology patients experiencing oral mucositis. The first step was implementing an evidence-based nursing oral assessment. The Iowa Model was used to guide this evidence-based practice initiative. The Oral Assessment Guide (OAG) is reliable and valid, feasible, and sensitive to changing conditions. The OAG was piloted on an Adult Leukemia and Bone Marrow Transplant Unit leading to modification and adaptation. The pilot evaluation found 87% of patients had an abnormal oral assessment involving all categories in the tool. Nursing questionnaires showed that staff (8/23; 35% response) felt they were able to identify at risk patients using the OAG (3.3; 1-4 scale), and the tool accurately identifies mucosal changes (2.9; 1-4 scale). A knowledge assessment found nurses correctly identified OAG components 63% of the time. Unlike results from a national survey, most University of Iowa Hospitals and Clinics nurses (63%) were aware of national guidelines for prevention and treatment of oral mucositis. Developing an evidence-based nursing policy and updating documentation systems was done before implementation occurred. Computer-based and printed educational materials were developed for nursing staff caring for oncology patients. Team members were responsible for facilitating adoption in clinical areas. After organizational roll out, the nursing assessment was documented in all patients 87% of the time, and 99% for inpatients. The highest risk population, head and neck cancer patients receiving radiation, had documentation in 88% of audited visits. Other clinics required further work. Changing the system to the electronic medical record created an additional need for integration of the evidence-based practice with housewide documentation of oral assessment being completed 60.9% of the time. Use of an evidence-based assessment is the first step in a comprehensive program to reduce a common and highly distressing side effect of cancer treatment. Nursing documentation of oral assessment is well integrated on inpatient units. Opportunities for improvement remain in ambulatory care. Multidisciplinary team collaborations to expand evidence-based assessment and research questions generated from this work will be shared. PMID:20863028

Farrington, Michele; Cullen, Laura; Dawson, Cindy

2010-01-01

175

Global radiation oncology waybill  

PubMed Central

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

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

2013-01-01

176

The influence of race on the attitudes of radiation oncology patients towards clinical trial enrollment. | accrualnet.cancer.gov  

Cancer.gov

In this study of radiation oncology patients, whites and non-whites had similar rates of enrollment in clinical trials and expressed similar levels of interest in clinical trials. However, significant differences in attitudes towards clinical trials between whites and nonwhites were found. These differences reflect findings in other studies that there is a lack of trust of the medical establishment by nonwhite patients and this lack of trust affects enrollment.

177

Breakthrough filamentous fungal infections in pediatric hematopoetic stem cell transplant and oncology patients receiving caspofungin  

PubMed Central

BACKGROUND: Caspofungin is an echinocandin class antifungal medication that is commonly used empirically in immunocompromised patients at high risk for invasive fungal disease. OBJECTIVE: To describe the clinical characteristics of breakthrough fungal infections in pediatric hematopoetic stem cell transplant recipients, and oncology and hematology patients receiving caspofungin. METHODS: A five-year retrospective review, from 2004 through 2008, of all cases of proven invasive filamentous fungal infection of children admitted to The Hospital for Sick Children (Toronto, Ontario) was conducted. A breakthrough infection was defined as new onset of symptoms that were later proven to be due to an invasive mold infection on day 3 or later after initiation of caspofungin therapy. RESULTS: Six confirmed positive cultures (Aspergillus fumigatus [two cases], Aspergillus niger, Fusarium oxysporum, Alternaria infectoria and Rhizomucor pusillus) met the criteria for breakthrough filamentous mold infection while on caspofungin therapy. Underlying immunocompromising conditions included acute lymphoblastic leukemia (two cases), acute myeloid leukemia (two cases), Burkitt’s lymphoma and aplastic anemia. Four of the patients underwent a hematopoetic stem cell transplant. All patients received a lipid amphotericin B product as part of their treatment for breakthrough infection. Five patients also received voriconazole and one received posaconazole. Four of the six patients died and two responded with a clinical and microbiological cure. DISCUSSION: There are few descriptions of breakthrough fungal infections in pediatric patients receiving caspofungin. The six cases presented here, all microbiologically proven, are likely only a fraction of the total number of possible breakthrough invasive fungal infections that occured over the study period. CONCLUSION: Clinicians must remain aware that breakthrough fungal infections by species not covered by particular antifungals, including caspofungin, do occur and may have poor outcomes. PMID:24294271

Morris, Shaun K; Allen, Upton D; Gupta, Sumit; Richardson, Susan E

2012-01-01

178

77 FR 25179 - Patient Safety Organizations: Voluntary Relinquishment From Surgical Safety Institute  

Federal Register 2010, 2011, 2012, 2013, 2014

...Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment...Surgical Safety Institute of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of...

2012-04-27

179

Surgical transposition of the ovaries: Imaging findings in 14 patients  

SciTech Connect

Pelvic radiation therapy for cervical or vaginal cancer often leads to ovarian failure. To remove the ovaries from the radiation portal and preserve their function, they can be transposed to the lateral abdomen. Serial imaging studies in 14 patients who had undergone ovarian transposition (five bilateral, nine unilateral) were reviewed. Images obtained included 32 CT scans, 20 sonograms, and one MR image. Most transposed ovaries were located along the paracolic gutters near the iliac crests, creating an extrinsic mass effect on adjacent bowel. Detection of surgical clips on the ovary on CT scans allowed confident recognition of all 19 transposed ovaries. Cysts in the transposed ovaries, noted on most imaging studies, did not correlate with complications of pain or hormonal dysfunction. In one case, a large physiologic cyst in a transposed ovary distorted the cecum and was mistaken for a mucocele of the appendix. In another case, a large ovarian cyst was thought to be tumor recurrence or a lymphocele. These findings indicate that although the transposed ovaries can be recognized on CT scans by the surgical clips attached to the ovaries, the appearance of the ovary does not predict reliably the development of complications.

Kier, R.; Chambers, S.K. (Yale Univ. School of Medicine, New Haven, CT (USA))

1989-11-01

180

Surgical techniques for smile restoration in patients with Möbius syndrome.  

PubMed

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

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

2013-10-01

181

Surgical techniques for smile restoration in patients with Möbius syndrome  

PubMed Central

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

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

2013-01-01

182

[Small unilocular hepatocellular carcinoma (0 < 5 cm) in patients with liver cirrhosis. Early diagnosis, surgical indications, resection and prognosis].  

PubMed

In 151 (17.5%) of 861 patients with liver cirrhosis regularly screened by sonography and determination of alpha-fetoprotein a hepatocellular carcinoma (HCC) was detected. Diagnosis was verified by sonographically guided fine needle puncture and exceptionally by laparoscopy and direct puncture. In 34 patients (22.5%) selection criteria for operation were a tumour diameter under 5 cm, no central localisation in the liver and at least 5 mm distant from the main structures; furthermore multilocular HCC and intra- and extrahepatic metastases were contraindications. Additionally Child-Pugh-classification should be A + B and urea synthesis rate 6 g per day. 27 patients (80%) had esophagogastric varices seen at endoscopy and 20 (59%) had bleeding episodes from varices managed endoscopically or surgically. Types of surgical resections were segmentectomy [17], bisegmentectomy [10] and oncologically defined wedge resections [7] using controlled hypotension and interrupted occlusion of the hepatoduodenal ligament. 4 patients (11.8%) died within 30 days of liver failure [3] and sepsis [1]. All patients could be followed up for eleven years: 18 patients died after 1.5-10 years of liver failure, tumour recurrence or second tumour and a cause not associated with HCC, 12 patients are living. Kaplan-Meier survival curves show that survival at 5 years is 50% and at 10 years 34%. The main indicators for a good prognosis were clinically the HBsAG-activity, the Child-Pugh-classification and the application of autologous blood, pathologic-anatomically the classification and grading and histologically the absence of vascular invasion, absence of satellites and a number of mitoses under 7 in the visual field. For tumour recurrence dysplasia is of positive influence.--Liver resection remains the most widely used therapeutic option for treatment of HCC in cirrhosis. The early and long-term results can be improved by early diagnosis, strict selection of patients for operation and the use of well defined clinical, pathological and histological criteria. PMID:10960974

Paquet, K J; Lazar, A; Heine, W P; Jachmann-Jahn, V

2000-01-01

183

The SURgical PAtient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis  

Microsoft Academic Search

BACKGROUND: Surgical site infection (SSI) is an adverse event in which a close relation between process of care and outcome has been demonstrated: administration of antibiotic prophylaxis decreases the risk of SSI. In our tertiary referral centre, a SURgical PAtient Safety System (SURPASS) checklist was developed and implemented. This multidisciplinary checklist covers the entire surgical pathway and includes, among other

Eefje N de Vries; Lucia Dijkstra; Susanne M Smorenburg; R Peter Meijer; Marja A Boermeester

2010-01-01

184

Molecular diagnosis of culture negative infective endocarditis: clinical validation in a group of surgically treated patients  

Microsoft Academic Search

Objective: To assess the clinical validity of polymerase chain reaction (PCR) based molecular methods in the microbiological diagnosis of culture negative infective endocarditis in a group of surgically treated patients. Design: Retrospective case-control study. Setting: Reference cardiovascular surgical centre. Patients and samples: 15 culture negative patients with infective endocarditis classified according to Duke criteria, with 17 heart valve samples; 13

M Grijalva; R Horváth; M Dendis; J Benedík

2003-01-01

185

76 FR 65885 - Medicare Program; Changes to the Ambulatory Surgical Centers Patient Rights Conditions for Coverage  

Federal Register 2010, 2011, 2012, 2013, 2014

...Changes to the Ambulatory Surgical Centers Patient Rights Conditions for Coverage; Reform...Changes to the Ambulatory Surgical Centers Patient Rights Conditions for Coverage AGENCY...conditions for coverage (CfC) to allow patient rights information to be provided to...

2011-10-24

186

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.

187

Measurement of Cardiac Index by Transpulmonary Thermodilution Using an Implanted Central Venous Access Port: A Prospective Study in Patients Scheduled for Oncologic High-Risk Surgery  

PubMed Central

Background Transpulmonary thermodilution allows the measurement of cardiac index for high risk surgical patients. Oncologic patients often have a central venous access (port-a-catheter) for chronic treatment. The validity of the measurement by a port-a-catheter of the absolute cardiac index and the detection of changes in cardiac index induced by fluid challenge are unknown. Methods We conducted a monocentric prospective study. 27 patients were enrolled. 250 ml colloid volume expansions for fluid challenge were performed during ovarian cytoreductive surgery. The volume expansion-induced changes in cardiac index measured by transpulmonary thermodilution by a central venous access (CIcvc) and by a port-a-catheter (CIport) were recorded. Results 23 patients were analyzed with 123 pairs of measurements. Using a Bland and Altman for repeated measurements, the bias (lower and upper limits of agreement) between CIport and CIcvc was 0.14 (?0.59 to 0.88) L/min/m2. The percentage error was 22%. The concordance between the changes in CIport and CIcvc observed during volume expansion was 92% with an r?=?0.7 (with exclusion zone). No complications (included sepsis) were observed during the follow up period. Conclusions The transpulmonary thermodilution by a port-a-catheter is reliable for absolute values estimation of cardiac index and for measurement of the variation after fluid challenge. Trial Registration clinicaltrials.gov NCT02063009 PMID:25136951

Suria, Stéphanie; Wyniecki, Anne; Eghiaian, Alexandre; Monnet, Xavier; Weil, Grégoire

2014-01-01

188

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

PubMed Central

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

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

2012-01-01

189

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

PubMed

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

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

2013-03-01

190

Surgical vs. non-surgical treatment in women with pelvic floor dysfunction: Patient-centered goals at one year  

PubMed Central

Objective In women with pelvic floor dysfunction (PFD), we assessed the degree to which treatment (surgical vs. non-surgical) was associated with achievement of patient-centered goals, satisfaction with care, and quality of life. Study design Prospective cohort. Between September 2003 and December 2004 we recruited women during their first referral visit for PFD treatment at our outpatient Urogynecology Clinic. At the first visit, women enumerated up to five personal treatment goals, and “anchored” each goal by anticipating best and worst possible outcomes. At 12 month follow-up, women were asked to indicate their level of goal attainment (?2, worst outcome; +2, best outcome). At baseline and follow-up, women completed short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) (range 0–100, high scores indicating greater impact or distress). Patients indicated level of treatment satisfaction on a 4 level ordinal scale. Results Of the 127 study participants with complete data, 46 (36.2 %) were managed surgically and 81 (63.8%) non surgically. There were no major demographic differences between the two groups in terms of age, race, weight, prior PFD surgery, and vaginal parity. The surgical group was more likely to have received baseline diagnosis of pelvic organ prolapse (80 % vs 60 %, p = 0.0259), and be post-menopausal (89 % vs 72 %, p = 0.0261). There were no significant differences in the distribution of goal type (symptom relief, activity, self image, general health) by treatment status (p = 0.1074). Using logistic regression to adjust for age and baseline diagnosis, surgically managed patients at one year were significantly more likely to report complete primary goal attainment (odds ratio (OR) = 4.42; p = 0.0154) and complete treatment satisfaction (OR = 6.12; p = 0.0109). For all participants, one-year IIQ-7 and UDI-6 scores were significantly correlated with primary goal attainment scores. Conclusions In this non-randomized, prospective analysis, surgically managed patients with PFD had higher one-year self-described complete goal attainment and satisfaction scores compared with non-surgically managed patients. Goal attainment scores correlated with disease-specific quality of life. Patient-centered outcomes should be incorporated in multi-center prospective research trials for pelvic floor disorders, and incorporated into clinical practice to inform treatment plans. PMID:18423762

Hullfish, Kathie L.; Bovbjerg, Viktor E.; Gurka, Matthew J.; Steers, William D.

2009-01-01

191

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

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.

Cellai, Enrico [Department of Radiation Oncology, Florence University Hospital, Florence, Italy, A.O. Careggi, Florence (Italy); Frata, Paolo [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); Magrini, Stefano M. [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy)]. E-mail: magrini@med.unibs.it; Paiar, Fabiola [Department of Radiation Oncology, Florence University Hospital, Florence, Italy, A.O. Careggi, Florence (Italy); Barca, Raffaella [Department of Radiation Oncology, Florence University Hospital, Florence, Italy, A.O. Careggi, Florence (Italy); Fondelli, Simona [Department of Radiation Oncology, Florence University Hospital, Florence, Italy, A.O. Careggi, Florence (Italy); Polli, Caterina [Department of Radiation Oncology, Florence University Hospital, Florence, Italy, A.O. Careggi, Florence (Italy); Livi, Lorenzo [Department of Radiation Oncology, Florence University Hospital, Florence, Italy, A.O. Careggi, Florence (Italy); Bonetti, Bartolomea [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); Vitali, Elisabetta [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); De Stefani, Agostina [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); Buglione, Michela [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); Biti, Gianpaolo [Department of Radiation Oncology, Florence University Hospital, Florence (Italy); A.O. Careggi, Florence (Italy)

2005-12-01

192

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

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.

Frata, Paolo [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); Cellai, Enrico [Department of Radiation Oncology, Florence University Hospital, A.O. Careggi, Florence (Italy); Magrini, Stefano M. [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy)]. E-mail: magrini@med.unibs.it; Bonetti, Bartolomea [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); Vitali, Elisabetta [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); Tonoli, Sandro [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); Buglione, Michela [Department of Radiation Oncology, Brescia University Hospital, Istituto del Radio 'O. Alberti', Brescia (Italy); Paiar, Fabiola [Department of Radiation Oncology, Florence University Hospital, A.O. Careggi, Florence (Italy); Barca, Raffaella [Department of Radiation Oncology, Florence University Hospital, A.O. Careggi, Florence (Italy); Fondelli, Simona [Department of Radiation Oncology, Florence University Hospital, A.O. Careggi, Florence (Italy); Polli, Caterina [Department of Radiation Oncology, Florence University Hospital, A.O. Careggi, Florence (Italy); Livi, Lorenzo [Department of Radiation Oncology, Florence University Hospital, A.O. Careggi, Florence (Italy); Biti, Gianpaolo [Department of Radiation Oncology, Florence University Hospital, A.O. Careggi, Florence (Italy)

2005-12-01

193

Development of a system to detect surgical material retained in the patients during operation  

Microsoft Academic Search

The retained materials during surgical procedures lead to serious complications for the patients all over the world, and can even cause death. Nowadays, even though various methods and commercial products have been developed in order to prevent surgical teams from unintentionally leaving materials inside patients, a satisfactory success level could not be achieved. The main aim of this study is

B. Yar?kkas?; I. C. Koçum; B. Y?lmaz

2010-01-01

194

Practical tips for surgical research: how to optimize patient recruitment. | accrualnet.cancer.gov  

Cancer.gov

Surgeons are often patients’ initial point of contact about surgical studies. Surgeons conducting clinical research need to consider the issues involved in patient recruitment and plan strategies to minimize and avoid recruitment difficulties. In this article, strategies are suggested to avoid common pitfalls in recruitment to surgical trials.

195

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

SciTech Connect

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.

McConnell, T.S. [Univ. of New Mexico, Albuquerque, NM (United States); Dobin, S.M. [Oregon Health Sciences Univ., Portland, OR (United States)

1994-09-01

196

Advances in patient-derived tumor xenografts: from target identification to predicting clinical response rates in oncology.  

PubMed

Most oncology compounds entering clinical development have passed stringent preclinical pharmacology evaluation criteria. However, only a small fraction of experimental agents induce meaningful antitumor activities in the clinic. Low predictability of conventional preclinical pharmacology models is frequently cited as a main reason for the unusually high clinical attrition rates of therapeutic compounds in oncology. Therefore, improvement in the predictive values of preclinical efficacy models for clinical outcome holds great promise to reduce the clinical attrition rates of experimental compounds. Recent reports suggest that pharmacology studies conducted with patient derived xenograft (PDX) tumors are more predictive for clinical outcome compared to conventional, cell line derived xenograft (CDX) models, in particular when therapeutic compounds were tested at clinically relevant doses (CRDs). Moreover, the study of the most malignant cell types within tumors, the tumor initiating cells (TICs), relies on the availability of preclinical models that mimic the lineage hierarchy of cells within tumors. PDX models were shown to more closely recapitulate the heterogeneity of patient tumors and maintain the molecular, genetic, and histological complexity of human tumors during early stages of sequential passaging in mice, rendering them ideal tools to study the responses of TICs, tumor- and stromal cells to therapeutic intervention. In this commentary, we review the progress made in the development of PDX models in key areas of oncology research, including target identification and validation, tumor indication search and the development of a biomarker hypothesis that can be tested in the clinic to identify patients that will benefit most from therapeutic intervention. PMID:24950467

Rosfjord, Edward; Lucas, Judy; Li, Gang; Gerber, Hans-Peter

2014-09-15

197

Complementary and alternative medicine use in pediatric oncology patients in eastern Turkey.  

PubMed

The use of complementary and alternative medicines (CAM) among children with cancer is becoming increasingly popular. Therefore, it is important to gain insight into the prevalence and factors related to the use of CAM. This study presents findings from a study of parents of 88 children with cancer who were receiving or had received conventional therapy for treatment of childhood cancer at a pediatric oncology unit in eastern Turkey. The findings indicated that 48.9% of the respondents reported the use of 1 or more CAM therapies. The most commonly used modality was herbal products such as herbal tea and herbal meal, mostly stinging nettle (Urtica dioica). The findings of this study indicate that CAM users were children who were an average of 3 years older than nonuser children and that CAM use was more prevalent among the children who had been diagnosed with cancer for a longer time than nonusers. There were no significant difference between users and nonusers regarding sociodemographic characteristics (such as age education level, economic status), hopelessness score of parents, gender of child, and treatment status. Healthcare providers should remain informed about the benefits and adverse effects of complementary and alternative therapies to discuss treatment options with patients and their families and to monitor treatment efficacy. PMID:17235218

Gözüm, Sebahat; Arikan, Duygu; Büyükavci, Mustafa

2007-01-01

198

NCI-CCR Pediatric Oncology Branch - Patients and Families, New to NIH: Frequently Asked Questions  

Cancer.gov

Traveling to a new hospital can be stressful. We hope the information provided here will answer your questions before your first visit to the Pediatric Oncology Branch, located within the NIH Clinical Center.

199

Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study  

Microsoft Academic Search

BackgroundIntellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients.MethodsA nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly

Jui-An Lin; Chien-Chang Liao; Chuen-Chau Chang; Hang Chang; Ta-Liang Chen

2011-01-01

200

Low-grade mucosa-associated lymphoid tissue lymphoma: a retrospective analysis of 97 patients by the Hellenic Cooperative Oncology Group (HeCOG)  

Microsoft Academic Search

Background: The aim was to examine characteristics and treatment results of patients with mucosa-associated lymphoid tissue (MALT) non-Hodgkin's lymphomas. Patients and methods: Epidemiological and clinical features of 97 patients with MALT lymphoma from the Hellenic Cooperative Oncology Group registry were analysed retrospectively for their prognostic significance in progression- free survival (PFS) and overall survival (OS). Comparisons were made between patients

G. Papaxoinis; G. Fountzilas; D. Rontogianni; M. A. Dimopoulos; N. Pavlidis; C. Tsatalas; D. Pectasides; N. Xiros; T. Economopoulos

2008-01-01

201

Surgical management of vesicoureteral reflux in pediatric patients  

Microsoft Academic Search

Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. The current indications for the surgical correction of VUR depend on the presence or absence of renal scars. If no scars are present, primary ureteral reimplantation is only indicated in high-grade bilateral VUR, whereas in the presence of renal scars surgical correction is indicated

Axel Heidenreich; Enver Özgur; Tanja Becker; Gerald Haupt

2004-01-01

202

Meaningful patient representation informing Canada’s cancer drug funding decisions: views of patient representatives on the Pan-Canadian Oncology Drug Review  

PubMed Central

In this interview with the patient representatives on the Expert Review Committee (perc) of the Pan-Canadian Oncology Drug Review (pcodr), those representatives offer their views about how to be a valuable contributing member of Canada’s national cancer drug funding recommendation committee. The article seeks to inform readers, and especially clinicians, about pcodr from the perspective of the patient representatives. PMID:25302034

Hoch, J.S.; Brown, M.B.; McMahon, C.; Nanson, J.; Rozmovits, L.

2014-01-01

203

Surgical Approaches to the Oral Cavity Primary and Neck  

SciTech Connect

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.

Shah, Jatin P. [Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)], E-mail: shahj@mskcc.org

2007-10-01

204

The 2014 society of surgical oncology susan g. Komen for the cure symposium: triple-negative breast cancer.  

PubMed

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

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

2015-03-01

205

Music reduces stress and anxiety of patients in the surgical holding area.  

PubMed

Many patients in the Surgical Holding Area become stressed and anxious. In a hospital setting music reduces patients' anxiety. This study determined that music can reduce the anxiety and stress of patients in the Surgical Holding Area. In this study, one group of subjects listed to music while a second group did not. Subjects who listened to music while in the Surgical Holding Area had significantly less stress and anxiety than did those who did not listen to music. Both groups spent similar lengths of time in the Surgical Holding Area. The results strongly suggest that if music were available to all patients in the Surgical Holding Area, most would select this option, and they would experience less anxiety. PMID:7707258

Winter, M J; Paskin, S; Baker, T

1994-12-01

206

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

PubMed Central

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

Sternick, Edward S.

2011-01-01

207

Using baldrige performance excellence program approaches in the pursuit of radiation oncology quality care, patient satisfaction, and workforce commitment.  

PubMed

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

Sternick, Edward S

2011-01-01

208

The oncology palliative care clinic at the Princess Margaret Cancer Centre: an early intervention model for patients with advanced cancer.  

PubMed

Several recently published randomized controlled trials have demonstrated the benefits of early palliative care involvement for patients with advanced cancer. In the oncology outpatient setting, palliative care clinics are an ideal site for the provision of early, collaborative support, which can be maintained throughout the cancer trajectory. Despite this, access to ambulatory palliative care clinics is limited, even at tertiary cancer centres. Existing programs for outpatient palliative care are variable in scope and are not well described in the literature. We describe the development and expansion of an outpatient palliative care clinic at the Princess Margaret Cancer Centre, Toronto, Canada, demonstrating how the clinic functions at a local and regional level. This clinic served as the intervention for a recent large cluster-randomized trial of early palliative care. The model for this service can be adapted by other palliative care programs that aim to provide early, integrated oncology care. PMID:25281230

Hannon, Breffni; Swami, Nadia; Pope, Ashley; Rodin, Gary; Dougherty, Elizabeth; Mak, Ernie; Banerjee, Subrata; Bryson, John; Ridley, Julia; Zimmermann, Camilla

2015-04-01

209

Clinical use of pulse rates to determine daily energy expenditures in trauma and surgical patients.  

PubMed

This study was conducted to establish practical application by using pulse rates to determine resting energy expenditures in trauma and surgical patients. A continuous flow gas analyzer measured energy expenditures and a cardiotachometer/recorder determined pulse rates simultaneously. The study consisted of 18 normal subjects as controls, seven surgical patients (totaling 36 samples), a combination of the seven surgical and three trauma patients (totaling 23 samples). The group of seven surgical patients had a correlation coefficient of 0.531 when comparing pulse rate/min with kcal/m2/hr, and this was the best correlation among the group population studied. An attempt to establish a single regression line from individual patients showed no significant correlation, with the exception of two surgical patients. Of the total number of patient samples, we found no significant correlation between pulse rate and energy expenditures. Independently, Andrews (Am J Clin Nutr 24:1139-1147, 1971) and Payne (Am J Clin Nutr 24:1164-1170, 1971) suggested that there are multiple variables such as stroke volume, state of physical training, etc., that affect the outcome of such data. In this study, our variables were more extensive with respect to the severity of injuries and varying degrees of surgical procedures. The study concluded that there is no practical clinical use of pulse rates in determining daily resting energy expenditures of surgical or trauma patients. PMID:7201533

Dennis, R S; Long, C L; Hall, T; Blakemore, W S

1982-01-01

210

Manipulations of the metabolic response for management of patients with severe surgical illness: review.  

PubMed

The metabolic response to severe surgical illness is complex and varied. Much recent laboratory and clinical research has focused on increasing our understanding of the metabolic response and the development of new therapies designed to modify this response. Antiinflammatory agents can target harmful aspects of the metabolic response; the immune system can be stimulated; and anabolic factors can be used in an attempt to enhance recovery. The nutritional support of the surgical patient remains crucial, but the effects of new additives are being studied in a variety of surgical conditions. As yet, few of these "novel" agents have found an established role in the management of surgical patients. This review focuses on many "novel" agents or those that do not yet have a clearly defined role in surgical illness. Clinical trials in the areas of severe sepsis, major surgical trauma, and major elective surgery have been emphasized. PMID:10773122

Connolly, A B; Vernon, D R

2000-06-01

211

Impact of proton beam availability on patient treatment schedule in radiation oncology.  

PubMed

Proton beam therapy offers unique physical properties with potential for reduced toxicity and better patient care. There is an increased interest in radiation oncology centers to acquire proton therapy capabilities. The operation of a proton treatment center is quite different than a photon-based clinic because of the more complex technology involved, as well as the single proton beam source serving multiple treatment rooms with no backup source available. There is limited published data which investigates metrics that can be used to determine the performance of a proton facility. The purpose of this study is to evaluate performance metrics of Indiana University Cyclotron Operations (IUCO), including availability, mean time between failures, and mean time to repair, and to determine how changes in these metrics impact patient treatments. We utilized a computerized maintenance management system to log all downtime occurrences and servicing operations for the facility. These data were then used to calculate the availability as well as the mean time between failures and mean time to repair. Impact on patient treatments was determined by analyzing delayed and missed treatments, which were recorded in an electronic medical record and database maintained by the therapists. The availability of the IUCO proton beam has been increasing since beginning of operation in 2003 and averaged 96.9% for 2009 through 2011. The mean time between failures and mean time to repair were also determined and correlated with improvements in the maintenance and operating procedures of the facility, as well as environmental factors. It was found that events less than 15 minutes in duration have minimal impact on treatment delays, while events lasting longer than one hour may result in missed treatments. The availability of the proton beam was more closely correlated with delayed than with missed treatments, demonstrating the utility and limitations of the availability metric. In conclusion, we suggest that the availability metric and other performance parameters, such as the mean time between failures and the mean time to repair, should be used in combination with downtime impact on patient treatments in order to adequately evaluate the operational success of a proton therapy facility. PMID:23149788

Miller, Eric D; Derenchuk, Vladimir; Das, Indra J; Johnstone, Peter A S

2012-01-01

212

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

PubMed

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

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

2015-04-01

213

Non-surgical treatment of early breast cancer: techniques on the way.  

PubMed

Trials are still on the way to evaluate different non-surgical techniques to treat early breast cancer with achieving maximum oncological control and aesthetic outcome. Also these techniques can help old patients to bypass surgical and radiation complications and facilitate the treatment of early breast cancer with minimum side effects. PMID:25207205

Hamza, Alaa; Elrefaey, Shymaa

2014-08-01

214

Non-surgical treatment of early breast cancer: techniques on the way  

PubMed Central

Trials are still on the way to evaluate different non-surgical techniques to treat early breast cancer with achieving maximum oncological control and aesthetic outcome. Also these techniques can help old patients to bypass surgical and radiation complications and facilitate the treatment of early breast cancer with minimum side effects. PMID:25207205

Elrefaey, Shymaa

2014-01-01

215

Uterine Papillary Serous Carcinoma: Evaluation of Long-Term Survival in Surgically Staged Patients  

Microsoft Academic Search

Objective.Earlier studies have demonstrated that the uterine papillary serous carcinoma (UPSC) variant of endometrial carcinoma has a high recurrence rate, even when disease is apparently confined to the uterus. The current study evaluated survival in patients with surgically staged UPSC.Methods.Patients with UPSC were identified from surgical pathology files and charts were retrospectively reviewed. Only patients who had undergone a TAH–BSO,

Jeffrey Grice; Marit Ek; Benjamin Greer; Wui-Jin Koh; Howard G. Muntz; Joanna Cain; Hisham Tamimi; Keith Stelzer; David Figge; Barbara A. Goff

1998-01-01

216

Catheter culture as a guide in the management of infection in the critically ill surgical patient.  

PubMed

Results of a bacteriologic study of 194 intravascular catheters inserted in 56 critically ill surgical patients showed that with strict adherence to aseptic insertion techniques and proper care, catheter contamination could be reduced to a minimum, and catheter-induced septicemia could be avoided. Our findings in septic patients showed that in the critically ill surgical patients, routine bacteriologic studies of intravascular catheters helped in anticipation and diagnosis of sepsis as well as selection of appropriate antiobiotic therapy. PMID:7386997

Kholoussy, A M; Sufian, S; Pavlides, C; Matsumoto, T

1980-05-01

217

Clinical review: How to optimize management of high-risk surgical patients  

Microsoft Academic Search

For many patients optimal perioperative care may require little or no additional medical management beyond that given by the anaesthetist and surgeon. However, the continued existence of a group of surgical patients at high risk for morbidity and mortality indicates an ongoing need to identify such patients and deliver optimal care throughout the perioperative period. A group of patients exists

Rupert M Pearse; Andrew Rhodes; R Michael Grounds

2004-01-01

218

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

SciTech Connect

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.

Simone, Charles B. [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States); Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States)], E-mail: simonec@mail.nih.gov; Vapiwala, Neha; Hampshire, Margaret K.; Metz, James M. [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States)

2008-09-01

219

Reoperation Rate in Patients with a Continent Urinary Diversion or Neobladder Is Influenced by the Oncological or Functional Indication for Cystectomy  

Microsoft Academic Search

Purpose: Continent urinary diversion following a cystectomy has become a standard procedure in suitable patients, because of its potentially favorable aspects. Reports concerning long-term complications necessitating reoperation are mainly based on patients with cystectomy for carcinoma. We reviewed the reoperation rate in patients with a continent diversion for both oncological and interstitial cystitis. Materials and Methods: A retrospective study was

Bart B. Nieuwkamer; Rob F. M. Bevers; Henk W. Elzevier; Nico J. D. Nagelkerke; Ron Wolterbeek; Guus A. B. Lycklama à Nijeholt

2009-01-01

220

Surgical treatment of stress urinary incontinence and severe pelvic organ relaxation in the medically compromised elderly patient using local anesthesia  

Microsoft Academic Search

Objective: To describe the technique and complications of vaginal repair of advanced pelvic organ prolapse and the use of tension-free vaginal tape (TVT) using intravenous sedation and local anesthesia for patients with concomitant severe vaginal prolapse and stress urinary incontinence.Methods: A retrospective review of the surgical records of 15 patients was performed. Patient demographics, surgical procedure, surgical time, estimated blood

Robert D. Moore; Stephen Speights; John R. Miklos

2000-01-01

221

Astrocytomas of the cerebral peduncle in children: surgical experience in seven patients  

Microsoft Academic Search

Objects. Cerebral peduncle tumors are rare in childhood but often consist of benign astrocytomas. Surgical resection, however, is considered to be detrimental because of the highly sensitive neural structures. These tumors are often treated by radiation therapy (RT). We resected such tumors in seven patients, whom we then followed up without adjuvant therapy. The surgical approach and postoperative course are

Tadanori Tomita; Ricardo F. Cortes

2002-01-01

222

[Bone metastases or an insufficiency fracture? Oncology patients reporting pain or showing bone abnormalities on a scan].  

PubMed

A 71-year-old patient reported pain in the left hip 14 months after treatment with radiotherapy for a ypT3N1M0 rectal carcinoma, and a 61-year-old patient reported pain in the lower back with radiation to the buttocks 8 months after radiotherapy for a ypT3N2M0 rectal carcinoma. In both patients the initial diagnosis considered was bone metastasis. After MRI and nuclear bone scans, however, diagnoses of insufficiency fractures of the acetabulum and sacroiliac (SI) joints, respectively, were made. Insufficiency fractures of the SI joints or acetabula are a frequent complication of radiotherapy and should be considered in all oncology patients who present with sudden onset of back pain or lower back pain after radiotherapy. A MRI scan is the initial investigation of choice. Treatment is conservative, with analgesia and physiotherapy. Prognosis is good; symptoms disappear within 1 year in almost all patients. PMID:23841929

Meerveld-Eggink, Aafke; Bollen, Thomas L; Wijrdeman, Harm K; Los, Maartje

2013-01-01

223

Robert R. Shaw, MD: thoracic surgical hero, Afghanistan medical pioneer, champion for the patient, never a surgical society president.  

PubMed

Dr Robert R. Shaw arrived in Dallas to practice Thoracic Surgery in 1937, as John Alexander's 7th Thoracic Surgical Resident from Michigan University Medical Center. Dr Shaw's modus operandi was, "You can accomplish almost anything, if you don't care who gets the credit." He was a remarkable individual who cared the most about the patient and very little about getting credit for himself. From 1937 to 1970, Dr Shaw established one of the largest lung cancer surgical centers in the world in Dallas, Texas. It was larger than M.D. Anderson and Memorial Sloan-Kettering Hospitals put together regarding the surgical treatment of lung cancer patients. To accomplish this, he had the help of Dr Donald L. Paulson, who trained at the Mayo Clinic and served as Chief of Thoracic Surgery at Brook Army Hospital during the Second World War. Following the War, because of his love for Texas, he ended up as a partner of Dr Shaw in Dallas. Together, they pursued the development of this very large surgical lung cancer center. Dr Shaw and his wife Ruth went to Afghanistan with Medico multiple times to teach men modern cardiac and thoracic surgery. They also served as consultants on Medico's Ship of Hope in Africa. Dr Shaw initiated multiple new operations including: 1) resection of Pancoast's cancer of the lung after preoperative irradiation; 2) upper lobe of the lung bronchoplasty, reattaching (and saving) the lower lobe to prevent the "disabling" pneumonectomy; and 3) resections of pulmonary mucoid impaction of the lung in asthmatics. Because of his humility and giving "the credit to others," Dr Shaw was never President of a major medical or surgical association. PMID:22632518

Urschel, Harold C; Urschel, Betsey Bradley

2012-06-01

224

A Phase I Study to Assess the Feasibility and Oncologic Safety of Axillary Reverse Mapping in Breast Cancer Patients  

PubMed Central

BACKGROUND Axillary reverse mapping (ARM) is a novel technique to preserve upper extremity lymphatics that may reduce the incidence of lymphedema after axillary lymph node dissection. Early reports have suggested that ARM lymph nodes do not contain metastatic disease from breast cancer; however, these studies were conducted in early stage patients with low likelihood of lymph node metastasis. This study reported a phase 1 trial conducted in patients with cytologically documented axillary metastasis undergoing axillary lymph node dissection to determine the feasibility and oncologic safety of ARM. METHODS Thirty patients, 23 (77%) of whom received preoperative therapy (chemotherapy in 22 patients and hormonal therapy in 1 patient), were enrolled. Blue dye was injected in the upper inner ipsilateral arm. The presence of blue lymphatics was noted, and blue lymph nodes were sent separately for pathologic evaluation. RESULTS The average time between blue dye injection and axillary exposure was 35 minutes (range, 15–60 minutes). Blue lymphatics were identified in 21 patients (70%) and blue lymph nodes in 15 patients (50%). The median number of ARM lymph nodes was 1 (range, 0–3 lymph nodes) and the median number of axillary lymph nodes was 26 (range, 6–47 lymph nodes). Axillary metastases were noted in 60% (18 of 30) of patients. Of 11 patients who had axillary metastasis and at least 1 ARM lymph node identified, 2 (18%) had metastasis to the ARM lymph node. CONCLUSIONS ARM appears to be a feasible technique with which to identify upper arm lymphatics during axillary surgery. However, the high prevalence of disease involving ARM lymph nodes in this small cohort suggested that preservation of these lymphatics is not oncologically safe in women with documented axillary lymph node metastasis from breast cancer. PMID:20336790

Bedrosian, Isabelle; Babiera, Gildy V.; Mittendorf, Elizabeth A.; Kuerer, Henry M.; Pantoja, Laura; Hunt, Kelly K.; Krishnamurthy, Savitri; Meric-Bernstam, Funda

2015-01-01

225

Imatinib (Gleevec®) Reduces Cancer Recurrence in Patients with Surgically Removed GIST  

Cancer.gov

Patients with localized gastrointestinal stromal tumors (GIST) who took imatinib (Gleevec®) after surgical removal of the primary tumor were less likely to have a recurrence of their cancer, according to findings presented at the 2007 ASCO meeting in Chicago.

226

Panniculectomy and Supraumbilical Vertical Midline Incisions in Morbidly Obese Gynecologic Oncology Patients  

Microsoft Academic Search

Background: We reviewed the outcomes of panniculectomy and supraumbilical vertical midline incisions in morbidly obese women undergoing gynecologic operations.Study Design: Medical records were reviewed for 62 morbidly obese women with a large dependent pannus who underwent gynecologic operations on the Gynecologic Oncology Service at the State University of New York at Stony Brook between May 1990 and July 1997. Thirty-five

Michael L Pearl; Fidel A Valea; Eva Chalas

1998-01-01

227

Identifying oncological emergencies.  

PubMed

Prompt identification and treatment of life-threatening oncological conditions is of utmost importance and should always be included in the differential diagnosis. Oncological emergencies can have a myriad of presentations ranging from mechanical obstruction due to tumor growth to metabolic conditions due to abnormal secretions from the tumor. Notably, hematologic and infectious conditions may complicate the presentation of oncological emergencies. Advanced testing and imaging is generally required to recognize these serious presentations of common malignancies. Early diagnosis and treatment of these conditions can significantly affect the patient's clinical outcome. PMID:23873016

Guddati, Achuta K; Kumar, Nilay; Segon, Ankur; Joy, Parijat S; Marak, Creticus P; Kumar, Gagan

2013-01-01

228

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

PubMed Central

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

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

2014-01-01

229

[Enterosorption in the treatment of chronic kidney failure in patients with surgical diseases of the kidneys].  

PubMed

Enterosgel was used in 89 patients with different stages of renal failure treated surgically and medically. It is concluded that isolated or complex detoxication using enterosgel is a perspective approach in the treatment of patients with surgical renal diseases complicated by chronic renal failure. The use of enterosorption in the preoperative period allows to perform operative intervention in situations when infusion treatment by traditional methods was not sufficient. PMID:1441347

Vozianov, A F; Kolesnik, N A; Samodumova, I M

1992-02-01

230

Experiences of patients with cancer and their nurses on the conditions of spiritual care and spiritual interventions in oncology units  

PubMed Central

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

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

2015-01-01

231

Preoperative Prevalence of Staphylococcus aureus in Cardiothoracic and Neurological Surgical Patients  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA) is a global cause of both hospital and community-acquired infection. This retrospective, observational study determined the prevalence of MRSA carriers in cardiothoracic and neurological surgical patients presenting to an outpatient preoperative assessment center in Columbus, OH. Aggressive skin and soft-tissue infection may be caused by MRSA with potentially fatal complications. Cardiothoracic and neurological surgical patients are at high risk for surgical-site infection. Results indicated that 4.25% of the sample carried MRSA and 25.25% carried methicillin-sensitive S. aureus. PMID:25405147

Kapoor, Ritu; Barnett, Christopher J.; Gutmann, Rebecca M.; Yildiz, Vedat O.; Joseph, Nicholas C.; Stoicea, Nicoleta; Reyes, Stephan; Rogers, Barbara M.

2014-01-01

232

[Quality of life, social and psychological rehabilitation of surgical patients with vulvar cancer].  

PubMed

A questionnaire was used to evaluate quality of life of surgical patients with vulvar cancer (stages Ia-Iva). Overall and 5-year survival after combined and surgical treatment (combination of epidermato-fascial plasty unrestricted by closure of wound defects with adjacent tissues) was 86.05 +/- 3.2%, relapse-free--97.3% and 45.08 +/- 3.5% 57.1 +/- 4.1%, respectively, (p < or = 0.05) in group 1. Screening showed that surgical patients need more as far as quality of life and social rehabilitation are concerned. PMID:21598709

Cherenkov, V G; Aleksandrova, I V

2011-01-01

233

Locoregional Therapies and Surgical Oncology  

Microsoft Academic Search

The natural history of solid neoplasms starts as a confined disease in a specific anatomical area. This period varies greatly\\u000a in length and involves carcinoma in situ as well as the stage I–II of the disease. In localized disease surgery is the mainstay.\\u000a Radiotherapy can play a curative role in specific situations, but in general, together with chemotherapy it is

Carlo Riccardo Rossi; Alessandro Comandone; Andrea Veltri

234

Phase II trial of R115777 (NSC #70818) in patients with advanced colorectal cancer: A Southwest Oncology Group study  

Microsoft Academic Search

Summary  \\u000a Purpose: The purpose of this Phase II multi-institutional trial was to determine the efficacy and toxicity of R115777 in previously\\u000a untreated patients with metastatic colorectal carcinoma. Patients and methods: Patients were required to have histologically confirmed colorectal cancer with distant metastatic disease that was not surgically\\u000a curable. They could not have received prior chemotherapy for metastatic disease. R115777 was

Robert P. Whitehead; Sheryl McCoy; John S. Macdonald; Saul E. Rivkin; Marcus A. Neubauer; Shaker R. Dakhil; Heinz-Josef Lenz; Michael S. Tanaka; James L. Abbruzzese

2006-01-01

235

Results of high-risk neutropenia therapy of hematology–oncology patients in a university hospital in Uruguay  

PubMed Central

Background Febrile neutropenia is an important cause of mortality and morbidity in hematology–oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia. Methods A retrospective cohort study (2011–2012) was conducted of patients with high-risk neutropenia in a hematology–oncology service. Results Forty-four episodes of 17 patients with a median age of 48 years (range: 18–78 years) were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia isolated from blood being the most prevalent (81.3%). Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%. Conclusion The high rate of gram-negative bacilli resistant to piperacillin/tazobactam (front-line antibiotics in our protocol) and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol. PMID:25638764

Boada Burutaran, Matilde; Guadagna, Regina; Grille, Sofia; Stevenazzi, Mariana; Guillermo, Cecilia; Diaz, Lilian

2014-01-01

236

The Digital Patient Push Using Location to Streamline the Surgical Journey S. Mukherjee1  

E-print Network

, Security, Efficiency, Wireless, Patient. INTRODUCTION Wireless technology (WiFi) is now becoming pervasiveThe Digital Patient Push ­ Using Location to Streamline the Surgical Journey S. Mukherjee1 , K-h.peng@aston.ac.uk Abstract: This paper introduces a patient information management system that uses location tracking of Wi

Peng, Xiaohong

237

Minor oral surgical procedures in patients on oral anticoagulants — a controlled study  

Microsoft Academic Search

Background: Patients on therapeutic anticoagulation are at risk of bleeding from minor oral surgical sites. When the anticoagulant regime is modified to prevent the risk of bleeding, this at the same time predisposes the patient to risks of the medical condition for which they are being treated. Methods: A total of 70 patients who were on warfarin treatment requiring minor

PD Cannon; VT Dharmar

2003-01-01

238

Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging  

Microsoft Academic Search

BACKGROUND. Breast magnetic resonance imaging (MRI) is a developing technique for the evaluation of patients with primary breast carcinoma. The authors assessed the impact of preoperative breast MRI on surgical management. METHODS. The current study was a retrospective review of 267 patients with primary breast tumors who had MRI studies prior to undergoing definitive surgery. RESULTS. Two hundred sixty-seven patients

Isabelle Bedrosian; Rosemarie Mick; Susan G. Orel; Mitchell Schnall; Carol Reynolds; Francis R. Spitz; Linda S. Callans; Gordon P. Buzby; Ernest F. Rosato; Douglas L. Fraker; Brian J. Czerniecki

2003-01-01

239

Factors affecting ED length-of-stay in surgical critical care patients  

Microsoft Academic Search

To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation of factors that might be associated

Barbara Davis; Sara Sullivan; Amy Levine; John Dallara

1995-01-01

240

[Psychology of patient management: evaluation and quality assurance of psychosocial management in pediatric oncology].  

PubMed

Since the introduction of health-care reform in Germany, quality assurance of inpatient care is required. In paediatric oncology this also includes quality assurance measures of psycho-social care. Care Psychology deals with the development, testing and continual improvement of high-quality psycho-social care. Based on clinical experience, scientific knowledge and ascertained requirements a handbook and manual of service delivery of psycho-social care is formulated and tested in everyday practice. Service performance analyses are carried out, and verified improvements are re-tested in practice. This, as well as additional attempts, should lead to total quality management (TQM) of psycho-social care in paediatric oncology according to the criteria of the European Foundation of Quality Management (EFQM). PMID:9156631

Kusch, M; Labouvie, H; Jäger, R S; Bode, U

1997-02-01

241

Adjunctive use of monthly physician questionnaires for surveillance of surgical site infections after hospital discharge and in ambulatory surgical patients: Report of a seven-year experience  

Microsoft Academic Search

We report our experience with the use of monthly physician questionnaires, in conjunction with traditional in-house monitoring, for surveillance of surgical site infections (SSIs) in inpatients after hospital discharge and in ambulatory surgical patients (i.e., those not requiring perioperative hospitalization) over a 7-year period (July 1988 to June 1995) involving 156,977 surgical procedures. The mean annual response rate was 73%

Farrin A. Manian; Lynn Meyer

1997-01-01

242

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

PubMed Central

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

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

2014-01-01

243

Facial aesthetic surgical goals in patients of different cultures.  

PubMed

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

Rowe-Jones, Julian M

2014-08-01

244

Relevant content for a patient-reported outcomes questionnaire for use in oncology clinical practice: Putting doctors and patients on the same page  

Microsoft Academic Search

Purpose  To investigate relevant patient-reported outcome (PRO) domains for oncology clinical practice.\\u000a \\u000a \\u000a \\u000a Methods  We conducted cross-sectional semi-structured telephone interviews with patients with breast and prostate cancer and clinicians.\\u000a Using open-ended questions followed by structured prompts of PRO domains, subjects were asked what they currently discuss\\u000a during visits and which topics are relevant for a clinical practice PRO. For each domain, we calculated

Claire F. SnyderRoxanne; Roxanne E. Jensen; Gail Geller; Michael A. Carducci; Albert W. Wu

2010-01-01

245

Case management in oncology rehabilitation (CAMON): The effect of case management on the quality of life in patients with cancer after one year of ambulant rehabilitation. A study protocol for a randomized controlled clinical trial in oncology rehabilitation  

Microsoft Academic Search

Background  Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness\\u000a of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management\\u000a wants to support the complex information needs of the patients in addition to the segmented structure of the

Irene Bachmann-Mettler; Claudia Steurer-Stey; Oliver Senn; Mathyas Wang; Katarina Bardheci; Thomas Rosemann

2011-01-01

246

Multidisciplinary Health Care Professionals' Perceptions of the Use and Utility of a Symptom Assessment System for Oncology Patients  

PubMed Central

Purpose: Despite growing implementation of electronic symptom assessment in oncology settings, few studies have described how standardized symptom assessment can enhance multidisciplinary care. The Edmonton Symptom Assessment System (ESAS) is a validated measure of symptom burden that has been adopted by Ontario's cancer centers to assess symptoms for patients with cancer. This study examines the perceived value of the ESAS among clinical teams and barriers to its use in enhancing multidisciplinary care. Methods: Self-completed surveys were administered online to clinical teams at various disease-site clinics at a cancer center in Ontario, Canada. Results: One hundred twenty-eight nurses, oncology physicians, and allied health professions completed the survey. The majority of nurses (89%), physicians (55%), and other providers (57%) reported referring to ESAS in clinic either “always” or “most of the time.” Many of those who either “never” or “rarely” looked at ESAS scores reported finding it more efficient to talk to the patient or do their own assessment to determine symptom issues. Although most of the nurses and allied health professions found the ESAS to enhance patient care, help patients to articulate their symptom issues, and facilitate follow-up with patients with past symptom issues, only approximately half of the physicians agreed with these statements. Conclusion: Variable adoption of the ESAS by physicians may limit its potential to improve both interprofessional communication and comprehensive symptom control. To encourage consistent use, a symptom assessment system needs to be complementary to the perceived roles of all multidisciplinary team members, including physicians. PMID:21532805

Bainbridge, Daryl; Seow, Hsien; Sussman, Jonathan; Pond, Greg; Martelli-Reid, Lorraine; Herbert, Carole; Evans, William

2011-01-01

247

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

SciTech Connect

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.

Movsas, Benjamin [Radiation Oncology, Henry Ford Health System, Detroit, MI (United States)]. E-mail: bmovsas1@hfhs.org; Scott, Charles [RTOG Headquarters, Philadelphia, PA (United States); Watkins-Bruner, Deborah [Fox Chase Cancer Center, Philadelphia, PA (United States)

2006-07-01

248

Treatment modalities in primary gastric lymphoma: the effect of rituximab and surgical treatment. A study by the Anatolian Society of Medical Oncology  

PubMed Central

Aim of the study Gastrointestinal lymphoma is the most common type of extranodal lymphoma and commonly involved site is the stomach. We have compared the superiority between treatment modalities for primary gastric lymphoma and we want to investigate efficacy of rituximab in gastric lymphoma. Material and methods Between April 2002 and December 2011, 146 patients with a histologically confirmed primary gastric lymphoma, initially diagnosed at eight different Cancer Centers within Turkey were evaluated retrospectively. According to the treatment modality, the patients were divided into chemotherapy (CT) alone, chemotherapy and radiotherapy (CRT), surgery and chemotherapy (SCT), surgery along with chemotherapy and radiotherapy (SCRT), and surgery (S) alone groups. Results Median follow-up period was 25.5 months. The 5-year EFS (event free survival) and OS (overall survival) rates for the patients were 55% and 62.3% respectively. In Log rank analysis of OS and EFS, we have identified levels of albumin and hemoglobine, IPI score, stage at diagnosis as factors influencing survival. In multivariate analysis of OS and EFS, only albumin and stage at diagnosis were factors independently contributing to survival. There was no statistically significant difference in terms of survival between different treatment modalities (p = 0.707 in EFS and p = 0.124 in OS). In analysis of patients treated with chemotherapy alone, there was no a statistically significant difference in terms of EFS and OS between chemotherapy regimens with or without rituximab in localized and advanced stage groups (p = 0.264 and p = 0.639). There was no statistical difference in survival rate (EFS and OS) between surgical or non-surgical treatment modalities for localized/advanced stage gastric lymphoma groups (p = 0.519 / p = 0.165). Conclusions There are several treatment options due to similar results in different treatment modalities. Also benefit of rituximab treatment in gastric lymphoma is still a controversial subject. Additional prospective trials are definitely required in order to clarify use of rituximab in treatment of extranodal gastric lymphoma. PMID:25258586

Sener, Cihan; Uyeturk, Ummugul; Seker, Mesut; Tastekin, Didem; Tonyali, Onder; Balakan, Ozan; Yazici, Omer Kemal; Urakci, Zuhat; Isikdogan, Abdurrahman; Ozdemir, Nuriye; Inal, Ali; Kaplan, Muhammed Ali; Suner, Ali; Dal, Sinan; Uncu, Dogan; Gumus, Mahmut; Boruban, Melih Cem; Oksuzoglu, Berna; Ayyildiz, Orhan; Benekli, Mustafa

2014-01-01

249

Preoperative and preooperative issuesin the orthopaedic surgical patient  

Microsoft Academic Search

Elderly patients account for most cases of hip fracture, total hip replacement, and total knee replacement surgery. Although surgery in the elderly is associated with greater risk than in younger patients, this risk is due primarily to comorbidities and not to the normal aging process. Careful preoperative evaluation is required and should focus on optimizing the status of patients' chronic

Fred H. Rubin

2002-01-01

250

Aneurysms of the innominate artery: Surgical treatment of 27 patients  

Microsoft Academic Search

Purpose: Aneurysms of the innominate artery (AIA) are widely considered to be a rare entity. We describe our experience with AIAs in the last three decades. Methods: From October 1973 to October 2000, we operated on 27 patients with an AIA. The underlying cause of aneurysm was Takayasu's disease in 7 patients, degenerative disease in 6 patients, syphilis in 5

Edouard Kieffer; Laurent Chiche; Fabien Koskas; Amine Bahnini

2001-01-01

251

Self-performed glansectomy and surgical repair by a nonpsychotic patient on androgen replacement therapy  

PubMed Central

Genital self-amputation in men is a rare condition. We report an interesting case of penile self-amputation that was performed and surgically repaired by a nonpsychotic patient who was enrolled in a clinical trial for androgen replacement therapy. Using sterile technique for amputation of the glans penis and using cotton thread to suture the wound, the patient was able to avoid hemorrhage and infection. This is the first reported case of androgen therapy–induced penile self-amputation with patient-performed surgical reconstruction using primitive instruments. PMID:19672432

Roth, Kirk; Izard, Jason; Beiko, Darren

2009-01-01

252

Access to Cancer Services for Rural Colorectal Cancer Patients  

ERIC Educational Resources Information Center

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.…

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

253

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

SciTech Connect

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.

Huang Shaohui [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); O'Sullivan, Brian; Waldron, John [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON (Canada); Lockwood, Gina [Department of Biostatistics, Princess Margaret Hospital, Toronto, ON (Canada); Bayley, Andrew; Kim, John [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Cummings, Bernard [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON (Canada); Dawson, Laura A.; Hope, Andrew; Cho, John [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Witterick, Ian [Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON (Canada); Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Chen, Eric X. [Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Ringash, Jolie, E-mail: Jolie.Ringash@rmp.uhn.on.c [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada)

2011-01-01

254

The pros and cons of endovascular and open surgical treatments for patients with acute limb ischemia.  

PubMed

The present review addresses the pros and cons of the current, wide variety of therapeutic options available for the treatment of acute limb ischemia (ALI). Despite five prospective randomized controlled trials comparing catheter directed thrombolysis and open surgical revascularization, no single treatment strategy can yet be considered optimal for patients with ALI. This report includes 20 years of published data to evaluate the efficacy and safety profile of thrombolytic agents and adjunctive endovascular techniques when compared to open surgical revascularization. PMID:25573443

Branco, B C; Montero-Baker, M F; Mills, J L

2015-06-01

255

Risks and risk-analysis for the development of pressure ulcers in surgical patients  

Microsoft Academic Search

With prevalence figures of 13% for university hospitals and 23% for general hospitals, pressure ulcers are a major health care issue in The Netherlands. Pressure ulcers in surgical patients are frequently encountered, as is illustrated by reported incidence rates up to 66%. The number of patients at risk will probably also grow, due to an ageing population. In an extensive

Bastiaan Paul Johan Aart Keller

2006-01-01

256

Bone metastases from renal cell carcinoma: patient survival after surgical treatment  

Microsoft Academic Search

BACKGROUND: Surgery is the primary treatment of skeletal metastases from renal cell carcinoma, because radiation and chemotherapy frequently are not effecting the survival. We therefore explored factors potentially affecting the survival of patients after surgical treatment. METHODS: We retrospectively reviewed 101 patients operatively treated for skeletal metastases of renal cell carcinoma between 1980 and 2005. Overall survival was calculated using

Andreas Fottner; Melinda Szalantzy; Lilly Wirthmann; Michael Stähler; Andrea Baur-Melnyk; Volkmar Jansson; Hans Roland Dürr

2010-01-01

257

Self-performed glansectomy and surgical repair by a nonpsychotic patient on androgen replacement therapy  

Microsoft Academic Search

Genital self-amputation in men is a rare condition. We report an interesting case of penile self-amputation that was performed and surgically repaired by a nonpsychotic patient who was enrolled in a clinical trial for androgen replacement therapy. Using sterile technique for amputation of the glans penis and using cotton thread to suture the wound, the patient was able to avoid

Kirk Roth; Jason Izard; Darren Beiko

2009-01-01

258

Surgical Repair of Chronic Complete Hamstring Tendon Rupture in the Adult Patient  

Microsoft Academic Search

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 non-operative treatment. The diagnosis was made quite easily on clinical grounds and was confirmed at surgery. Surgical

Mervyn J. Cross; Ronald Vandersluis; David Wood; Margaret Banff

1998-01-01

259

Excellent long-term survival of 170 patients with Waldenström's macroglobulinemia treated in private oncology practices and a university hospital.  

PubMed

The purpose of this study was to compare treatment and outcome of patients with Waldenström's macroglobulinemia (WM) in four private oncology practices (PP) and a university hospital (UH) in southwest Germany. We retrospectively reviewed the charts of all patients with WM of the last two decades of four PP in Mannheim, Heidelberg, Karlsruhe, and Speyer and the Department of Hematology of the University of Heidelberg. One hundred seventy patients could be identified, 74 from PP, 96 from the UH. Median age was 63.3 years. Patients from PP were older (median 65.3 vs. 62.5 years, p?=?0.01). Only 54 % of patients from PP have received treatment during the observation time, as compared to 78.1 % of the UH (p?patients have received rituximab, as compared to 62.6 % of the patients of the UH (p?patients of PP have received bendamustine, as compared to only 8 % of the patients of the UH (p?patients from the UH compared to PP (median 13.7 vs. 52.9 months, p?=?0.05). A trend towards a better overall survival was observed for patients treated with a rituximab-containing first-line regimen. The International Prognostic Scoring System for WM had significant prognostic value. Median overall survival was 25.0 years and did not differ between PP and UH. Despite different treatment strategies between PP and UH today overall survival of patients with WM is excellent, and better than previously reported. PMID:22895554

Hensel, M; Brust, J; Plöger, C; Schuster, D; Memmer, M L; Franz-Werner, J; Feustel, H-P; Karcher, A; Fuxius, S; Mosthaf, F A; Rieger, M; Ho, A D; Witzens-Harig, M

2012-12-01

260

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

PubMed Central

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

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

2013-01-01

261

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

PubMed Central

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

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

262

Emergency surgical admissions in patients aged more than 80 years: a study over four decades.  

PubMed Central

BACKGROUND: The proportion of older patients in the community is rising. The aim of this study was to determine the trend in emergency surgical admissions in patients over 80 years of age in 1997 compared with the previous three decades. PATIENTS AND METHODS: Data were obtained on all patients over 80 years of age admitted as general surgical emergencies in 1997 to the Royal Berkshire and Battle Hospitals, Reading, UK. Reasons for admission, management, mortality and duration of hospital stay were recorded and compared with results from 1966, 1976 and 1989. RESULTS: During 1997, 4807 patients over the age of 80 years were admitted as emergencies to all specialities. Of these, 447 (9.3%) were surgical. This compares with 122 in 1966, 248 in 1976 and 339 in 1989. Emergency surgical workload in patients over 80 years of age had increased from 6.2% in 1966 to 12% in 1997. A random sample of 261 patients was analysed. In-patient mortality was 13.8% in 1997 compared with 21.8% for 1976 and 22.4% for 1989. Median length of stay was 8 days (range, 0-41 days) for 1997 and 1989 compared with 14 days in 1976. Twenty-four patients either needed admission to other specialities or need not have been admitted as emergencies at all and were classified as inappropriate admissions to the general surgical ward. CONCLUSIONS: The trend of increased number of patients over the age of 80 years being admitted as emergencies to general surgery continues through four decades. There has been a decrease in mortality and length of stay since 1966, but no decrease in length of stay in 1997 compared with 1989. Avoiding inappropriate admissions would result in a significant improvement in bed utilisation for elective surgery and help to reduce waiting lists. PMID:11103155

Menon, K. V.; Young, F. M.; Galland, R. B.

2000-01-01

263

Clinical Oncology Assistantship Program for Medical Students.  

ERIC Educational Resources Information Center

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…

Neilan, Barbara A.; And Others

1985-01-01

264

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

PubMed Central

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

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

2014-01-01

265

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

PubMed

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

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

2014-08-10

266

Preoperative Assessment of Surgical Risk in Oncogeriatric Patients  

Microsoft Academic Search

Cancer is a prevalent disease in our aging population; however, few oncologists are familiar with caring for oncogeriatric patients. Surgery is presently the treat- ment of choice for most solid tumors, but it is frequently delivered in a suboptimal way in this patient subsetting. Undertreatment is often justified with the concern of an unsustainable toxicity, while overtreatment can be related

RICCARDO A. AUDISIO; WALTER E. LONGO; ANDREW P. Z BAR; DANIEL POPE

267

Colloquial descriptions of body image in older surgical patients  

Microsoft Academic Search

Major surgery and associated experiences in critical care settings affect patients’ perceptions of their body images. This paper discusses several colloquial terms related to body image used in interviews by elderly patients following major surgery for abdominal aortic aneurysm. The terms ‘badly failed, and well mended’, and ‘out of sorts’, and ‘in tune with my body’ recurred. These referred to

Pat Deeny; Michael Kirk-Smith

2000-01-01

268

The SURgical PAtient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis  

PubMed Central

Background Surgical site infection (SSI) is an adverse event in which a close relation between process of care and outcome has been demonstrated: administration of antibiotic prophylaxis decreases the risk of SSI. In our tertiary referral centre, a SURgical PAtient Safety System (SURPASS) checklist was developed and implemented. This multidisciplinary checklist covers the entire surgical pathway and includes, among other items, administration of antibiotic prophylaxis before induction of anaesthesia. The aim of this study was to determine the effect of SURPASS implementation on timing of antibiotic prophylaxis. Methods A retrospective analysis was performed on two cohorts of patients: one cohort of surgical patients that underwent surgery before implementation of the checklist and a comparable cohort after implementation. The interval between administration of antibiotic prophylaxis and incision was compared between the two cohorts. Results A total of 772 surgical procedures were included. More than half of procedures were gastro-intestinal; others were vascular, trauma and hernia repair procedures. After implementation, the checklist was used in 81.4% of procedures. The interval between administration of antibiotic prophylaxis and incision increased from 23.9 minutes before implementation of SURPASS to 29.9 minutes after implementation (p = 0.047). In procedures where the checklist was used, the interval increased to 32.9 minutes (p = 0.004). The proportion of patients that did not receive antibiotics until after the incision decreased significantly. Conclusion The use of the SURPASS checklist leads to better compliance with regard to the timing of antibiotic prophylaxis administration. PMID:20388204

2010-01-01

269

Anti-HLA alloantibodies in surgical patients refractory to platelet transfusion.  

PubMed

Alloimmune platelet refractoriness (alloPR) among actively bleeding surgical patients with thrombocytopenia represents a life-threatening problem. Here we present three cases in which surgical bleeding was complicated by life-threatening thrombocytopenia and alloPR. We demonstrate that the human leukocyte antigens (HLA) antibodies associated with alloPR are broadly reactive and in high concentration, are not removed by hemodilution, and are not absorbed by transfusion of multiple doses of platelet concentrates. HLA alloPR may be under-recognized among surgical patients. Research is needed to develop pre-operative screening methods that will identify patients in need of specialized platelet support using HLA compatible donor products. PMID:24816643

Peña, Jeremy Ryan A; Saidman, Susan L; Girouard, Timothy C; Meister, Erin; Dzik, Walter H; Makar, Robert S

2014-09-01

270

[Patient's point of view on surgical innovations: for less traumatic surgery and enhanced recovery].  

PubMed

Surgical innovations (associating LESS, NOTES, robotics, images software and Fast-track surgery) will allow a less and less invasive surgery. While these advances could be view as surgical or industrial marketing, or compared to the laparoscopic revolution, they simply answer patients' demand in a society changing its standard regarding: medical care, body image, recovery and rehabilitation. We will in this paper, according to results of a Google Survey analyzing population expectations of surgery, evaluate the interest of these surgical innovations. While, these innovations at least in part answers patients expectation, their therapeutic validity will have to be proved. It is our job, to foresee the future of surgery in accordance with health care system needs and patients expectation for adequate implementation of these innovations. PMID:20672685

Bucher, P; Pugin, F; Ostermann, S; Morel, P

2010-06-23

271

Conservative Surgical Treatment of Infected Ulceration of the First Metatarsophalangeal Joint With Osteomyelitis in Diabetic Patients.  

PubMed

Ulceration of the plantar aspect of the first metatarsophalangeal joint is a common localization in the diabetic foot. Conservative treatment of this lesion is a challenging problem, performed through the soft tissues and osseous debridement. The present study included a cohort of 28 patients affected by diabetes mellitus and a first ray lesion penetrating the bone. After surgical debridement with removal of the infected bone, we positioned antibiotic-loaded bone cement and stabilized the treated area with an external fixator. All patients with critical limb ischemia had their vascular disease treated before the procedure. The mean follow-up was 12.2 ± 6.9 months. Four patients developed a relapse of the ulceration after the procedure. In the postoperative period, 1 patient (3.57%) developed dehiscence of the surgical site and underwent a second procedure. In the follow-up period, 2 patients (7.14%) experienced bone cement dislocation. In 1 of these patients, a new ulceration was observed dorsally to the surgical site. The approach was surgical revision with bone cement replacement and stabilization with a new external fixator. In the other patient, given the absence of ulcerations, the cement was removed, and arthrodesis with internal stabilization using 2 cannulated screws was performed. One patient (3.57%), who had developed a relapse of ulceration after recurrent critical ischemia, underwent a percutaneous revascularization procedure and transmetatarsal amputation. During the follow-up period, no ulceration recurrences, transfer ulcerations, shoe fit problems, or gait abnormalities were detected in the other 24 patients. Our study presents the results of a technique requiring a 1-stage surgical approach to a relatively common problem, which is often difficult to solve. PMID:25249400

Dalla Paola, Luca; Carone, Anna; Morisi, Claudio; Cardillo, Sara; Pattavina, Marco

2014-09-20

272

Cavitational Ultrasonic Surgical Aspiration for the Treatment of Vaginal Intraepithelial Neoplasia  

Microsoft Academic Search

Objective. The aim of this study is to determine whether cavitational ultrasonic surgical aspiration (CUSA) is effective and safe for treating vaginal intraepithelial neoplasia (VAIN).Methods. We conducted a retrospective chart review of 46 patients who were treated with CUSA for VAIN in a single gynecologic oncology practice between 1981 and 1999.Results. At initial presentation, 39% of treated patients had grade

Jubilee B. Robinson; Charlotte C. Sun; Diane Bodurka-Bevers; Dwight D. Im; Neil B. Rosenshein

2000-01-01

273

Surveillance of hospital-acquired central line-associated bloodstream infections in pediatric hematology-oncology patients: lessons learned, challenges ahead.  

PubMed

Across 36 US pediatric oncology centers, 576 central line-associated bloodstream infections (CLABSIs) were reported over a 21-month period. Most infections occurred in those with leukemia and/or profound neutropenia. The contribution of viridans streptococci infections was striking. Study findings depict the contemporary epidemiology of CLABSIs in hospitalized pediatric cancer patients. PMID:23388370

Gaur, Aditya H; Bundy, David G; Gao, Cuilan; Werner, Eric J; Billett, Amy L; Hord, Jeff D; Siegel, Jane D; Dickens, David; Winkle, Cindi; Miller, Marlene R

2013-03-01

274

Surgical Management for Early-Stage Bilateral Breast Cancer Patients in China  

PubMed Central

Background The aim of this study was to investigate the current surgical management strategy for bilateral breast cancer (BBC) patients and to assess the changes in this strategy in China. Methods This is a retrospective review of all patients with early-stage BBC who underwent surgical treatment at the Fudan University Shanghai Cancer Center between June 2007 and June 2014. Results A total of 15,337 patients with primary breast cancer were identified. Of these patients, 218 (1.5%) suffered from synchronous bilateral breast cancer (sBBC), and 296 (2.0%) suffered from metachronous bilateral breast cancer (mBBC). Patients with a lobular carcinoma component, those with estrogen receptor-positive cancer, and those with an accompanying sclerosing adenosis in the affected breast tended to develop BBC. The rates of bilateral mastectomy, breast conserving therapy, reconstruction, and combined surgeries were 86.2%, 6.4%, 3.7%, and 3.7%, respectively, for patients with sBBC and 81.1%, 4.4%, 3.0%, and 11.5%, respectively, for patients with mBBC. The interval between bilateral cancers, age at first diagnosis of breast cancer, histopathological type, and stage have significant impacts on the choice of surgery for patients with BBC. Conclusions Bilateral mastectomy was the dominant surgical management for patients with BBC in China, despite the increased application of breast reconstruction surgery observed in recent years. Bilateral prosthetic breast reconstruction was the ideal choice for patients with sBBC. Chinese surgeons should take responsibility for patient education and inform their patients about their surgical options. PMID:25874699

Xue, Jing-yan; Quan, Chen-lian; Tan, Yu-long; Liu, Guang-yu; Shao, Zhi-min; Wu, Jiong

2015-01-01

275

Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia  

Microsoft Academic Search

Aim:To evaluate the outcome of repetitive micro-surgical testicular sperm extraction (mTESE) attempts in non-obstructive azoospermia (NOA) cases, in relation to patients' initial testicular histology results.Methods:A total of 68 patients with NOA in whom mTESE had been performed in previous intracytoplasmic sperm injection (ICSI) attempts were reviewed.Results:Among the 68 patients with NOA, the first mTESE yielded mature sperm for ICSI in

Halit Talas; Onder Yaman; Kaan Aydos

2007-01-01

276

Aztreonam plus piperacillin--empiric treatment of neutropenic fever in gynecology-oncology patients receiving cisplatin-based chemotherapy.  

PubMed

Antibiotic therapy must be instituted promptly and on an empiric basis in neutropenic patients. We evaluated the efficacy of a combined antibiotic regimen of monobactam (aztreonam) and antipseudomonal penicillin (piperacillin) in treating neutropenic fever episodes in gynecologic-oncology patients receiving cisplatin-based chemotherapy. A retrospective analysis of response to this regimen was performed. The rationale of this combination is the lack of nephrotoxicity and ototoxicity in patients who are or were previously treated with other nephrotoxic/ototoxic agents like cisplatin. A total of 19 courses of this regimen was administered to 13 patients with neutropenic fever following a complete fever work-up. Aztreonam (1-2gr q8h) plus piperacillin (4gr q8h) were administered intravenously for 6-8 days. Blood cultures were positive in four febrile episodes, and urine cultures were positive in seven. Gram negative organisms accounted for all positive cultures. The cultured organism showed in-vitro sensitivity to at least one of the drugs in all positive isolates. Clinical response with defervescence was noted during therapy in 18/19 courses (94.7%). Although the two drugs share a common bactericidal mechanism they were found to be highly active in this subgroup of patients. A double blind prospective evaluation of this empiric combination is warranted. PMID:9611050

Fishman, A; Chowers, M; Altaras, M; Beyth, Y; Lang, R

1998-01-01

277

Improving surgical patient flow in a congested recovery area  

E-print Network

The recent movement in healthcare reform requires hospitals to care for more patients while simultaneously reducing costs. Medical institutions can no longer afford to simply add beds and hire staff to increase capacity. ...

Schwartz, Trevor A

2012-01-01

278

Surgical treatment of jaw osteonecrosis in "Krokodil" drug addicted patients.  

PubMed

Retrospective study of jaw osteonecrosis treatment in patients using the "Krokodil" drug from 2009 to 2013. On the territory of the former USSR countries there is widespread use of a self-produced drug called "Krokodil". Codeine containing analgesics ("Sedalgin", "Pentalgin" etc), red phosphorus (from match boxes) and other easily acquired chemical components are used for synthesis of this drug, which used intravenously. Jaw osteonecrosis develops as a complication in patients who use "Krokodil". The main feature of this disease is jawbone exposure in the oral cavity. Surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". 40 "Krokodil" drug addict patients with jaw osteonecrosis were treated. Involvement of maxilla was found in 11 patients (27.5%), mandible in 21 (52.5%), both jaws in 8 (20%) patients. 35 Lesions were found in 29 mandibles and 21 lesions in 19 maxillas. Main factors of treatment success are: cessation of "Krokodil" use in the pre- (minimum 1 month) and postoperative period and osteonecrosis area resection of a minimum of 0.5 cm beyond the visible borders of osteonecrosis towards the healthy tissues. Surgery was not delayed until sequestrum formation. In the mandible marginal or segmental resection (with or without TMJ exarticulation) was performed. After surgery recurrence of disease was seen in 8 (23%) cases in the mandible, with no cases of recurrence in the maxilla. According to our experience in this case series, surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". Cessation of drug use and jaw resection minimize the rate of recurrences in such patients. PMID:24969764

Poghosyan, Yuri M; Hakobyan, Koryun A; Poghosyan, Anna Yu; Avetisyan, Eduard K

2014-12-01

279

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

PubMed Central

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

2014-01-01

280

Cooperative group clinical trials in general thoracic surgery: report from the 2012 Robert Ginsberg Clinical Trials Meeting of the General Thoracic Surgical Club.  

PubMed

At the 25th Annual General Thoracic Surgical Club meeting in March 2012, the major cooperative groups presented updates on clinical trials at the Robert Ginsberg Clinical Trials Meeting. There were 57 members in attendance. Representatives from the Radiation Treatment Oncology Group (RTOG), American College of Surgeons Oncology Group (ACOSOG), Cancer and Leukemia Group B (CALGB), Southwest Oncology Group (SWOG), National Cancer Institute of Canada Clinical Trials Group (NCIC), and the Eastern Cooperative Oncology Group (ECOG) presented an overview of trials currently accruing or in development. These include oncologic trials that thoracic surgeons are currently accruing patients to in North America. The purpose of this review is to centralize the information to assist surgeons enrolling patients into oncologic clinical trials in thoracic surgery. PMID:23336898

Allen, Mark S; Wigle, Dennis A

2013-02-01

281

Multimodal approach to blood conservation in the surgical patient.  

PubMed

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

Nwosu, A D

2015-01-01

282

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

SciTech Connect

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.

Siddiqui, Farzan [Department of Radiation Oncology, Henry Ford Health System, Detroit, MI (United States); Pajak, Thomas F. [Statistical Headquarters, Radiation Therapy Oncology Group, Philadelphia, PA (United States); Watkins-Bruner, Deborah [University of Pennsylvania School of Nursing, Philadelphia, PA (United States); Konski, Andre A. [Fox Chase Cancer Center, Philadelphia, PA (United States); Coyne, James C. [Abramson Family Cancer Research Institute, Philadelphia, PA (United States); Gwede, Clement K. [H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (United States); Garden, Adam S. [University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Spencer, Sharon A. [Department of Radiation Oncology, Wallace Tumor Institute, Birmingham, AL (United States); Jones, Christopher [Radiological Associates of Sacramento, Sacramento, CA (United States); Movsas, Benjamin [Department of Radiation Oncology, Henry Ford Health System, Detroit, MI (United States)], E-mail: bmovsas1@hfhs.org

2008-02-01

283

[Selection of a rational method of surgical treatment of patients with proximal femoral fractures].  

PubMed

In the military hospital of traumatology and orthopaedics, Military Medical Academy from 2007 to 2009, was operated on 88 patients with fractures of the proximal femur, whose average age was 77.4 +/- 3.8 years. Selection of the optimal surgical procedure was performed according to the type of fracture of the proximal femur and bone quality (presence or absence of osteoporosis and its degree of severity). In addition, when choosing a surgical treatment to take into account patients' age, time elapsed since injury, general condition, the presence and severity of manifestations related diseases, as well as the patient's request for quality of life. Excellent functional results in this clinical group were obtained in 19.4% patients, good--in 16.1% patients, satisfactory--in 25.8% cases and 38.7% victims were regarded as unsatisfactory. PMID:21770324

Shapovalov, V M; Khominets, V V; Mikha?lov, S V; Shakun, D A

2011-04-01

284

Malignant melanoma in elderly patients: biological, surgical and medical issues.  

PubMed

Malignant melanoma is an aggressive tumor with a poor prognosis for patients with advanced disease. Over the last decades, its incidence and mortality has increased in elderly population, impacting significantly on healthcare costs, considering the increase in average age of the world population. Older age is recognized as an independent poor prognostic factor for melanoma, but the scientific community now is wondering if elderly melanoma patients have worse outcome because they are not receiving the same treatment as their younger counterparts. This article summarizes current data on elderly melanoma prevention and early detection and its subsequent management, underling the differences observed between older and younger patients. It also describes age-associated alterations in immunity and how these may impact on anti-melanoma response. PMID:25248282

Russo, Alessia E; Ferraù, Francesco; Antonelli, Giovanna; Priolo, Domenico; McCubrey, James A; Libra, Massimo

2015-01-01

285

[Surgical tactics in acute cholecystitis in old patients].  

PubMed

Based on some characteristic features of the clinical course of acute cholecystitis and large number of its destructive forms in aged persons, it is recommended to operate patients of this group during 24-28 hours after their admission. 216 aged and senile patients with acute cholecystitis were operated upon, the postoperative mortality being 9.7%. Cholecystectomy is considered to be the operation of choice. In the appropriate indications this operation was associated with drainage of the common bile duct. Cholecystostomy was performed in 10.6%. PMID:1216391

Guzeev, A I

1975-12-01

286

Explaining the amount of care needed by hospitalised surgical patients: a prospective time and motion study  

PubMed Central

Background Hospitals provide care for patients with a variety of diseases, co-morbidities and complications. The actual amount of care these patients need is unclear. Given the recent developments such as ageing, multi-morbidity and budgetary restraints, a practical explanatory model would avail healthcare professionals and managers in determining the demand and costs for clinical care. Methods Six surgical wards in a Dutch university hospital participated in this prospective time and motion study. Surgeons, nurses and paramedics recorded the time spent on patient care 24/7 by means of PDAs. The investigators extracted possible determining characteristics from a previous systematic review and expert focus group. Total amount of care needed by the patients was expressed as costs involved in medical and nursing time, surgical interventions and diagnostics. Afterwards the investigators applied linear regression analysis to detect significant independent characteristics. Results 174 Surgical patients were monitored during their hospital stay. Characteristics significantly influencing the consumed amount of care were: medication during hospitalisation, complications, co-morbidity, medical specialty, age, as well as undergoing surgery and length of stay. Median costs for care were €8.446 per patient admission. Conclusions The investigators developed a model that explains the total demand and costs of care needed for surgical patients in a university hospital. The input for this instrument can be derived from readily available data in hospital databases. This makes it a relatively easy instrument to help healthcare professionals and managers appreciate the amount of care needed on (surgical) wards and may be used to appreciate trends in time. PMID:23379756

2013-01-01

287

Surgical Outcomes after Total Colectomy with Ileorectal Anastomosis in Patients with Medically Intractable Slow Transit Constipation  

PubMed Central

Purpose The aim of this study was to evaluate outcomes of a total colectomy with ileorectal anastomosis in patients with slow transit constipation. Methods A retrospective review of 37 consecutive patients with slow transit constipation who underwent a total colectomy between 1994 and 2008 was undertaken. Preoperative and postoperative Wexner's constipation scores were collected and used to evaluate the outcomes after surgical treatment. Also patients' postoperative satisfaction scores were collected using a 4-point scale. Results The 37 patients consisted of 31 women and 6 men, with a median age of 41 years (range, 17 to 71 years). Pre- and post-operative Wexner's scores were collected from 33 patients (89.1%), and the mean preoperative Wexner's score was 19.3 (range, 11 to 24), which decreased to an average post-operative score of 2.3 (range, 0 to 8). Neither intraoperative complications nor postoperative mortalities were noted. Five patients (13.5%) had early postoperative complications, and the most common complication was postoperative ileus (10.8%). Seven patients (18.9%) had late postoperative complications, and postoperative ileus (10.8%) was also the most common. Twenty seven of 33 patients were satisfied with their surgical outcome (81.8%). Conclusion A total colectomy with ileorectal anastomosis might be an effective surgical procedure with acceptable morbidity to treat medically intractable slow transit constipation. PMID:21980588

Sohn, Guiyun; Kim, Chan Wook; Kwak, Jae Young; Jang, Tae Young; Kim, Kyung Ho; Yang, Song Soo; Yoon, Yong Sik; Lim, Seok-Byung; Kim, Jin Cheon

2011-01-01

288

[Indications and surgical therapy of thyroid gland diseases--analysis of 725 operated patients].  

PubMed

Diseases of the thyroid gland are an important part of elective surgical procedures. The adequate surgical therapy is at present standardized and requires a permanent qualitative control to reduce avoidable complications. The relation between men and women in our patients (n = 725) was 1 to 5. The mean age was 51.2 years. 10% (n = 79) of the patients were hyperthyroid. 646 patients had benign disease; and 79 patients were found to have malignancy of the thyroid gland. The most common indication for an operation was bilateral multinodular goitre (n = 325) in combination with a cold nodule (n = 123), in 79 patients latent hyperthyroidism or Morbus Basedow (n = 22). Struma nodosa with retrosternal extension (n = 49), recurrence of goitre (n = 34), thyroiditis (n = 12) and dystopic goitre (n = 2) were rare in these patients. Patients with malignancy of the thyroid gland were always treated by thyroidectomy or completed thyroidectomy with lymphnode dissection. In the cases of benign disease the surgical methods were variable, although the bilateral subtotal resection (n = 413) predominated. While doing so the radical resection of parenchyma with a persistent functioning remnant of goitre of 5 cm3 was favoured. The resulting postoperative complications are discussed. An endocrinological appropriate follow-up of the patients is necessary. PMID:9542026

Steinert, M; Friedrich, T; Keitel, R; Sattler, B; Schönfelder, M

1998-01-01

289

Low molecular heparin (Enoxaparin) as an alternative treatment of acute deep venous thrombosis in gynecologic oncology patients.  

PubMed

While heparin has been the standard treatment in established deep vein thrombosis (DVT), it carries associated potential hazards of hemorrhage and induction of thrombocytopenia. Enoxaparin (Rhone-Poulenc Rorer Pharm. Inc., France) is a low molecular weight heparin which has antithrombotic properties, and has been demonstrated effective in prophylaxis of DVT, apparently without severe treatment related bleeding complications. Six patients with genital malignancies, presenting with Doppler sonography confirmed deep venous thrombosis, were treated with Enoxaparin. A uniform dosage of 2 mg/kg/day in two divided doses was administered subcutaneously for 10 days during hospitalization and then continued on an out-patient basis. The clinical symptoms of venous thromboses diminished in all six patients. Enoxaparin represents an effective treatment of DVT, with the potential advantage of a lessening hemorrhagic complications. With administration of low molecular heparin, the activated partial thromboplastin time (aPTT) is not dramatically altered, making laboratory monitoring unnecessary. Our clinical findings demonstrate an easily applied therapy for gynecologic oncology patients, which is potentially safer to use, less costly, and less dependent on laboratory monitoring than the normal regimen. PMID:8933832

Fishman, A; Altaras, M; Klein, Z; Aviram, R; Beyth, Y

1996-01-01

290

Flow Simulation to Enable Patient Specific Virtual Surgical Planning  

NASA Astrophysics Data System (ADS)

The current paradigm for interventional and surgery planning for the treatment of cardiovascular disease relies exclusively on diagnostic imaging data to define the present state of the patient, empirical data to evaluate the efficacy of prior treatments for similar patients, and the judgement of the surgeon to decide on a preferred treatment. The individual variability and inherent complexity of human biological systems is such that diagnostic imaging and empirical data alone are insufficient to predict the outcome of a given treatment for an individual patient. We have proposed a new paradigm of predictive medicine in which the physician utilizes computational tools to construct and evaluate a combined anatomic/physiologic model to predict differential changes in blood flow for alternative treatment plans for an individual patient. Ideally, these systems would provide an integrated set of image segmentation, geometric solid modeling, automatic finite element mesh generation, computational mechanics and scientific visualization tools accessible through an intuitive human-computer interface. In this talk we focus on the flow simulation aspects of this project. Error estimators for transient flow analyses have been developed and implemented to focus computational resources on the areas where they may have provide the greatest improvement. We will describe these error estimators and apply them to adaptive as well as uniform refinement simulations and compare the accuracy and performance to available experimental data in porcine bypass models that have been carried out specifically for this purpose.

Jansen, Kenneth; Taylor, Charles; Mueller, Jens

2003-11-01

291

Anaemia in the older surgical patient: a review of prevalence, causes, implications and management.  

PubMed

This review provides the clinician with a summary of the causes, implications and potential treatments for the management of anaemia in the older surgical patient. The prevalence of anaemia increases with age and is frequently identified in older surgical patients. Anaemia is associated with increased postoperative morbidity and mortality. Allogenic blood transfusion is commonly used to treat anaemia but involves inherent risks and may worsen outcomes. Various strategies for the correction of pre- and postoperative anaemia have evolved. These include correction of nutritional deficiencies and the use of intravenous iron and erythropoesis stimulating therapy. Clear differences exist between the elective and emergency surgical populations and the translation of research findings into these individual clinical settings requires more work. This should lead to a standardized approach to the management of this frequently encountered clinical scenario. PMID:23759887

Partridge, Judith; Harari, Danielle; Gossage, Jessica; Dhesi, Jugdeep

2013-07-01

292

Improving pain management in orthopedic surgical patients with opioid tolerance.  

PubMed

As increasing numbers of the baby boomer generation seek health care, nursing staff educated in the evidence-based practice process can make significant contributions to successful patient outcomes. Health care providers who anticipate the approaching perfect storm in health care and thoughtfully plan, collaborate, and incorporate evidence-based practice methods will be well prepared to improve the quality of care, realize cost savings, and meet the challenges ahead. PMID:25155539

Doi, Kathleen; Shimoda, Rosanne; Gibbons, Gregory

2014-09-01

293

Establishing the surgical nurse liaison role to improve patient and family member communication.  

PubMed

Having clear personal communication with a surgical patient's family members decreases the anxiety and increases patient and family member satisfaction. Perioperative team members at one East Coast community hospital implemented a new approach to communication in the perioperative area to address patient satisfaction after patient survey scores declined in the areas of communication and calming fears. An additional consideration was the facility's plan to move to a new facility in which the surgical department would be split across two floors. A literature review revealed that adding a surgical nurse liaison can increase patient, family member, and staff member satisfaction. The administration approved creation of the position, with duties that included managing the waiting area, facilitating interaction between physicians and patients' family members, and assisting with family visits to the perianesthesia unit. After implementation of this position, results of surveys showed increases in patient satisfaction. One year after the position was established, staff members reported they were happy with the position as well. PMID:24766921

Herd, Hope A; Rieben, Melissa A

2014-05-01

294

Cost of Opioid-Related Adverse Drug Events in Surgical Patients  

Microsoft Academic Search

Opioids have demonstrated efficacy and often are drugs of choice in the management of postoperative pain. However, their use is often limited by adverse drug events (ADEs). The objective of this study was to determine the ADE rate in adult surgical patients who received opioids and the impact of opioid ADEs on length of stay (LOS), costs, and mortality. A

Gary M Oderda; R. Scott Evans; James Lloyd; Arthur Lipman; Connie Chen; Michael Ashburn; John Burke; Matthew Samore

2003-01-01

295

The Effectiveness of Adjunctive Hypnosis with Surgical Patients: A Meta-Analysis  

Microsoft Academic Search

Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, fo- cused on specific outcome domains (e.g., patients' self- reported pain), and rarely address the impact of differ- ent modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assess- ing the beneficial

Guy H. Montgomery; Daniel David; Gary Winkel; Jeffrey H. Silverstein; Dana H. Bovbjerg

2002-01-01

296

Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation  

Microsoft Academic Search

BACKGROUND: Using crude mortality and morbidity rates for comparing outcomes can be misleading. The aim of the present study was to compare the outcome of various surgical modalities without and with risk adjustment using Physiologic and Operative Severity Scoring for the enUmeration of Mortality and morbidity (POSSUM) score in cases of ileal perforations. METHODS: Prospective study on 125 patients of

Ravindra Singh Mohil; Tanveer Singh; Satyavrat Arya; Dinesh Bhatnagar

2008-01-01

297

Word search performance for diagnoses of equine surgical colics in free-text electronic patient records  

Microsoft Academic Search

The objectives of the current project were to: (1) identify limitations of search sensitivity and positive predictive value (PPV) for free-text surgical diagnoses included in electronic patient records maintained at the University of California, Davis, Veterinary Medical Teaching Hospital (VMTH), (2) develop procedural or programmable recommendations for removing these limitations, and (3) provide guidelines for effective search strategies for users

Leah Estberg; James T Case; Richard F Walters; Robert D Cardiff; Larry D Galuppo

1998-01-01

298

The effects of surgical stress and psychological stress on the immune function of operative cancer patients  

Microsoft Academic Search

Surgical resection of solid tumors provides a major opportunity for cure in many patients, but unfortunately can also increase the risk of metastases by spilling of tumor cells into the circulation. Moreover, surgery has been shown to result in immunological changes including an impaired natural killer cell cytotoxicity (NKCC). This immunosuppression can be. intensified by supportive cares such as anaesthesia

G. Van Der Pompe; M. H. Antoni; C. J. Heijnen

1998-01-01

299

[Surgical treatment of rectal neoplasms in the very old patient].  

PubMed

Efforts and results of curative and palliative treatment of rectum carcinoma in the very aged (more than 75 years old) are shown by a follow-up study including 212 patients operated in our clinic. Establishing an absolute indication for radical resection of the malignant tumor the contraindications in this collective are pointed out. There is practically no difference between the results of curative and palliative treatment of rectum carcinoma in the very aged regarding letality and morbidity if contraindications are strictly considered and accurate pre- and postoperative treatment is guaranteed. PMID:89997

Michel, D; Fux, H D

1979-07-26

300

The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery  

Microsoft Academic Search

A prospective observational study was conducted on patients undergoing posterior lumbar spine surgery for degenerative spinal\\u000a disorders. The study purpose was to evaluate the effect of wait time to surgery on patient derived generic and disease specific\\u000a functional outcome following surgery. A prolonged wait to surgery may adversely affect surgical outcome. Although there is\\u000a literature on the effect of wait

Jason Braybrooke; Henry Ahn; Aimee Gallant; Michael Ford; Yigel Bronstein; Joel Finkelstein; Albert Yee

2007-01-01

301

Advancing medical-surgical nursing practice: improving management of the changing patient condition.  

PubMed

Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls. PMID:25407973

Monroe, Heidi; Plylar, Peggy; Krugman, Mary

2014-01-01

302

Clinical review: Goal-directed therapy in high risk surgical patients  

Microsoft Academic Search

ABSTRACT: A small group of patients account for the majority of peri-operative morbidity and mortality. These 'high-risk' patients have a poor outcome due to their inability to meet the oxygen transport demands imposed on them by the nature of the surgical response during the peri-operative period. It has been shown that by targeting specific haemodynamic and oxygen transport goals at

Nicholas Lees; Mark Hamilton; Andrew Rhodes

2009-01-01

303

Surgical treatment of multiple hydatid cysts in the liver of a pediatric patient.  

PubMed

Multiple hydatid cysts in the liver rarely occur in the pediatric population. Here, we present the case of a 16-year-old girl who presented with six hydatid cysts in the liver. The cysts were surgically removed and all found to be infertile. Interestingly, the patient had post-operative eosinophilia. From this experience, we conclude that individualized treatment is necessary for patients with multiple hydatid cysts. PMID:25561565

Lv, Hailong; Jiang, Yufeng; Liu, Guisheng; Zhang, Shijie; Peng, Xinyu

2015-03-01

304

Vitamin K concentrations in the plasma and liver of surgical patients1'2  

Microsoft Academic Search

Vitamin K deficiency has been reported in patients who were treated with antibiotics and placed on poor diets after surgery. High-performance liquid chromatography (HPLC) was used to study the influence of dietary intake on vitamin K concentrations in surgical patients (n = 22). Plasma phylloquinone decreased rapidly from 1. 19 ± 0.16 to 0.47 ± 0. 12 nmol\\/L (1± SEM,

Yuji Usui; Hiroshi Tanimura; Naohiko Nishimura; Nobuaki Kobayashi; Toyotake Okanoue; Kazue Ozawa

305

Oral Health Status of Chinese Paediatric and Adolescent Oncology Patients with Chemotherapy in Hong Kong: a Pilot Study  

PubMed Central

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

Kung, A.Y.H; Zhang, S; Zheng, L.W; Wong, G.H.M; Chu, C.H

2015-01-01

306

Adjunctive use of monthly physician questionnaires for surveillance of surgical site infections after hospital discharge and in ambulatory surgical patients: report of a seven-year experience.  

PubMed

We report our experience with the use of monthly physician questionnaires, in conjunction with traditional in-house monitoring, for surveillance of surgical site infections (SSIs) in inpatients after hospital discharge and in ambulatory surgical patients (i.e., those not requiring perioperative hospitalization) over a 7-year period (July 1988 to June 1995) involving 156,977 surgical procedures. The mean annual response rate was 73% and did not change significantly from year to year (range, 71% to 75%), but the proportion of surgical procedures covered by returned surveys increased during the study period from 75% to 81% in inpatients and from 78% to 86% in ambulatory surgical patients (p < 0.0001 for both comparisons). Of 1051 SSIs identified, 231 (22%) were identified solely by the survey: 16% of SSIs in inpatients after discharge and 66% of SSIs in ambulatory surgical patients. Of 787 cases meeting the criteria for SSI on the basis of in-house surveillance and listed on returned questionnaires, 366 (47%) were not marked as SSIs by the responding surgeons. We conclude that since its implementation in 1988, monthly physician surveys at our medical center continue to contribute significantly to identification of otherwise undetected SSIs. However, monthly questionnaires should only complement, not replace, traditional in-house surveillance. PMID:9343622

Manian, F A; Meyer, L

1997-10-01

307

[Long-term follow-up of patients surgically treated for para-esophageal and mixed hiatal hernias. Experiences with more than 100 surgical patients].  

PubMed

During the years from 1948-1990, we operated on 112 patients with paraesophageal and mixed hiatal hernias. One hundred patients who had been operated up to the year 1988 were followed up over a long period. Preoperatively, gastroesophageal reflux occurred in 52%, hemorrhage in 18%, riding ulcer in 7%, and incarceration and obstruction in 9%. Up to the beginning of the seventies, hiatoraphy and gastropexy were carried out. In these patients, the checking showed the occurrence of the relapse of hernias in 47%, reflux in 43% and subjective complaints in 26%. This finding induced us to change the surgical procedure and, in the following years, we performed hiatorhaphy, fundoplicato, fundophrenopexy and anterior gastropexy. The checking showed a decrease in the occurrence of the relapse of hernias to 21%, gastroesophageal reflux to 9% and subjective complaints to 10%. The period of the follow-up ranged from 1 to 19 years. The operative letality was 3%. PMID:1927089

Duda, M; Dlouhý, M; Gryga, A; Rocek, V; Herman, J

1991-01-01

308

Bladder augmentation and urinary diversion in patients with neurogenic bladder: surgical considerations.  

PubMed

In patients with a neurogenic bladder, the primary goal is preservation of renal function and prevention of urinary tract infection, with urinary continence as the secondary goal. After failure of conservative treatment (clean intermittent catheterisation and pharmacotherapy) urinary diversion should be considered. In this review, the surgical options with their advantages and disadvantages are discussed. In patients with a hyper-reflexive, small-capacity and/or low-compliance bladder with normal upper urinary tract, bladder augmentation (bowel segments/ureter) is an option. To those who are unable to perform clean intermittent catheterisation via urethra, a continent cutaneous stoma can be offered. In patients with irreparable sphincter defects a continent cutaneous diversion is an option. For patients who are not suitable for a continent diversion (incompliant±chronic renal failure), a colonic conduit for incontinent diversion is preferred. Surgical complications specific to urinary diversion include: ureterointestinal stenosis, stomal stenosis, stone formation, bladder perforation, and shunt infection and obstruction. Surgical revision is required in around one third of patients. Careful lifelong follow-up of these patients is necessary, as some of these complications can occur late. PMID:22264521

Stein, Raimund; Schröder, Annette; Thüroff, Joachim W

2012-04-01

309

Lived experiences and challenges of older surgical patients during hospitalization for cancer: An ethnographic fieldwork  

PubMed Central

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

Høybye, Mette Terp

2014-01-01

310

Clinical effect of a positive surgical margin after hepatectomy on survival of patients with intrahepatic cholangiocarcinoma  

PubMed Central

Background Several unfavorable prognostic factors have been proposed for peripheral cholangiocarcinoma (PCC) in patients undergoing hepatectomy, including gross type of tumor, vascular invasion, lymph node metastasis, a high carbohydrate antigen 19-9 level, and a positive resection margin. However, the clinical effect of a positive surgical margin on the survival of patients with PCC after hepatectomy still needs to be clarified due to conflicting results. Methods A total of 224 PCC patients who underwent hepatic resection with curative intent between 1977 and 2007 were retrospectively reviewed. Eighty-nine patients had a positive resection margin, with 62 having a microscopically positive margin and 27 a grossly positive margin (R2). The clinicopathological features, outcomes, and recurrence pattern were compared with patients with curative hepatectomy. Results PCC patients with hepatolithiasis, periductal infiltrative or periductal infiltrative mixed with mass-forming growth, higher T stage, and more advanced stage tended to have higher positive resection margin rates after hepatectomy. PCC patients who underwent curative hepatectomy had a significantly higher survival rate than did those with a positive surgical margin. When PCC patients underwent hepatectomy with a positive resection margin, the histological grade of the tumor, nodal positivity, and chemotherapy significantly affected overall survival. Locoregional recurrence was the most common pattern of recurrence. Conclusion A positive resection margin had an unfavorable effect on overall survival in PCC patients undergoing hepatectomy. In these patients, the prognosis was determined by the biology of the tumor, including differentiation and nodal positivity, and chemotherapy increased overall survival. PMID:25552905

Yeh, Chun-Nan; Hsieh, Feng-Jen; Chiang, Kun-Chun; Chen, Jen-Shi; Yeh, Ta-Sen; Jan, Yi-Yin; Chen, Miin-Fu

2015-01-01

311

Prevention of bleeding and hemorrhagic complications in surgical patients with inherited factor VII deficiency.  

PubMed

Inherited factor VII (FVII) deficiency is a rare autosomal recessive hemorrhagic disorder. The major clinical symptoms include: bleeding from the oral cavity, epistaxis, menorrhagia, spontaneous hemarthros, bleeding to the gastrointestinal tract and central nervous system, and perioperative bleeding. The aim of this study was to present our experience in preventing bleeding and hemorrhagic disorders in surgical patients with inherited FVII deficiency by using recombinant activated FVIIa (rFVIIa), and with prothrombin complex concentrates (PCCs). In 2002-2011, 17 patients with inherited FVII deficiency underwent surgery. Thirteen patients had isolated FVII deficiency below 10%, and four patients 10-25. To prevent bleeding and hemorrhagic complications, we administered small single doses of rFVIIa (Novo-Seven) at 12-h intervals to 15 patients on surgery day and on day 1 following surgery, then every 24?h; PCCs were administered (Prothromplex, Beriplex) to two patients. No symptoms of bleeding, hemorrhagic or thromboembolic complications were observed in the perioperative and 1-month observation period in surgical patients treated with rFVIIa. One patient treated with PCC (Prothromplex) developed distal deep vein thrombosis on postoperative day 7. The results suggest that small, single, every 12-h doses of rFVIIa (NovoSeven) and in next days after surgery one time every 24?h are well tolerated and effective for prevention of thromboembolic, bleeding and hemorrhagic complications in FVII-deficient patients. Antithrombotic prophylaxis with low-molecular-weight heparin should be applied in patients using PCCs. PMID:25688458

Wiszniewski, Adam; Szczepanik, Andrzej; Misiak, Andrzej; Bykowska, Ksenia; Szopi?ski, Piotr

2015-04-01

312

Does Duration of Preoperative Sciatica Impact Surgical Outcomes in Patients with Lumbar Disc Herniation?  

PubMed Central

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

Ghayem Hasankhani, Ebrahim; Khanzadeh, Reza

2014-01-01

313

Chronobiology, cognitive function and depressive symptoms in surgical patients.  

PubMed

Biological rhythms are essential for the regulation of many life processes. Disturbances of the circadian rhythm are known to affect human health, performance and well-being and the negative consequences are numerous and widespread. Cognitive dysfunction, fatigue, pain, sleep disturbances and mood disorders, such as anxiety and depression, are common problems arising around the time of surgery or in the course of a cancer diagnosis and subsequent treatment period. The importance of investigating prevention or treatment possibilities in these populations is significant due to the extent of the problems and the derived consequences on morbidity and mortality. Genetic predisposition to these problems is also an issue in focus. In this thesis we initially investigated whether the specific clock gene genotype PER(5/5) was associated with the development of postoperative cognitive dysfunction one week after non-cardiac surgery. We did not find any association, although this could have been due to the size of the study. Yet, if PER3(5/5) is associated with a higher incidence of postoperative cognitive dysfunction, the risk seems to be only modestly increased and by less than 10%. Melatonin is a hormone with well-known chronobiotic and hypnotic effects. In addition, exogenous melatonin is also known to have anxiolytic, analgesic, antidepressant and positive cognitive effects. Based on the lack of studies investigating these effects of melatonin, we conducted the MELODY trial in which we investigated the effect of 6 mg oral melatonin on depressive symptoms, anxiety, sleep, cognitive function and fatigue in patients with breast cancer in a three month time period after surgery. Melatonin had an effect on reducing the risk of developing depressive symptoms and also increased sleep efficiency perioperatively and total sleep time postoperatively. No effect was found on anxiety, sleep quality, sleepiness, general well-being or pain, however melatonin seemed to positively influence the ability to complete trial participation compared to placebo. Postoperative cognitive dysfunction was not a problem in this limited population. With regard to safety in our study, melatonin treatment for three months did not cause any serious adverse effects. Finally, we systematically reviewed the literature on the prophylactic or therapeutic effect of melatonin for depression or depressive symptoms in adult patients and assessed the safety of melatonin in these studies. The quantity, size and quality of trials investigating this question were not high and there was no clear evidence of an effect, although some studies were positive. In conclusion, further research is warranted with regard to the prophylactic effect and treatment effect of melatonin in depression, depressive symptoms, cognitive disturbances and symptom clusters of cancer patients in general. In addition, more hypothesis-generating studies with regard to the genetic heritability of POCD are needed. PMID:25186550

Hansen, Melissa Voigt

2014-09-01

314

Can cone-beam computed tomography superimposition help orthodontists better understand relapse in surgical patients?  

PubMed

This case report describes the interdisciplinary treatment of a 19-year-old Brazilian man with a Class I malocclusion, a hyperdivergent profile, an anterior open bite, and signs of temporomandibular joint internal derangement. The treatment plan included evaluation with a temporomandibular joint specialist and a rheumatologist, orthodontic appliances, and maxillomandibular surgical advancement with counterclockwise rotation. Cone-beam computed tomography images were taken before and after surgery at different times and superimposed at the cranial base to assess the changes after orthognathic surgery and to monitor quantitatively the internal derangement of the temporomandibular joints and surgical relapse. Our protocol can improve the orthodontist's understanding of surgical instability, demonstrate the clinical value of cone-beam computed tomography analysis beyond the multiplanar reconstruction, and guide patient management for the best outcome possible. PMID:25439215

Porciúncula, Guilherme Machado; Koerich, Leonardo; Eidson, Lindsey; Gandini Junior, Luiz Gonzaga; Gonçalves, João Roberto

2014-11-01

315

Surgical Management of Mitral Regurgitation in Patients with Marfan Syndrome during Infancy and Early Childhood  

PubMed Central

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

Kim, Eung Re; Kim, Woong-Han; Choi, Eun Seok; Cho, Sungkyu; Jang, Woo Sung; Kim, Yong Jin

2015-01-01

316

Indication for surgical treatment in patients with adolescent Idiopathic Scoliosis – a critical appraisal  

PubMed Central

A recent literature search of the pertinent publications in the field revealed that there is poor evidence that would support surgical intervention in patients with Adolescent Idiopathic Scoliosis (AIS). With complications estimated to exceed 50% over a lifetime, surgical intervention is unwarranted in the ‘Adolescent Idiopathic Scoliosis’ AIS population. In the relatively benign population of patients with AIS, according to the findings in literature, we may conclude that the long-term outcome of surgery for AIS creates a more negative end result over the course of a lifetime than the natural history of the condition itself. As a result, surgeons electing to recommend surgery are strongly advised to openly discuss and inform patients of the long-term probability of potential complications occurring after spinal fusion surgery, and document their explanations accordingly. PMID:23705983

2013-01-01

317

Asymptomatic right ventricular dysfunction in surgically repaired adult tetralogy of fallot patients  

PubMed Central

Background: Right ventricular (RV) dysfunction after surgical repair of Tetralogy of Fallot (TOF) is often asymptomatic and may be detected by tissue Doppler imaging (TDI). The severity of RV dysfunction is more after intracardiac repair with transannular patch (TAP). Methods: One hundred seventy-three adult patients who have undergone surgical repair for TOF were prospectively analyzed for RV function using 2D echocardiography and TDI. RV function was compared between patients who have undergone intracardiac repair with and without TAP. Results: In both the patient sub-groups, TDI derived myocardial performance index (MPI) and myocardial velocities were abnormal even when 2D echocardiography derived RV functional area change was normal. TDI derived MPI was significantly higher (0.5 ± 0.1 vs. 0.4 ± 0 P < 0.001) and Systolic tricuspid annular velocity (Sa) (9.2 ± 1.3 vs. 10.8 ± 1.6 P < 0.001) was significantly lower in the TAP group. Older age at surgery and severity of pulmonary regurgitation on follow-up were among the significant predictors of TDI derived MPI. Conclusions: Asymptomatic RV dysfunction in surgically repaired adult TOF atients can be detected by TDI. Extent of RV dysfunction was significantly greater with patients requiring TAP, in those operated at older age, and in patients with severe pulmonary regurgitation. PMID:23626431

Nair, Krishna Kumar Mohanan; Ganapathi, Sanjay; Sasidharan, Bijulal; Thajudeen, Anees; Pillai, Harikrishnan Sivadasan; Tharakan, Jaganmohan; Titus, Thomas; Kumaran, Ajitkumar Valaparambil; Sivasubramonian, Sivasankaran; Krishnamoorthy, Kavassery Mahadevan

2013-01-01

318

A survey to evaluate patients’ perspective concerning e-mail in an oncology practice  

Microsoft Academic Search

Purpose: Use of e-mail to improve physician-patient communication is becoming increasingly widespread, however, little research has been done to evaluate patients’ interest and concerns regarding this technology. The goals of this study were to (1) evaluate the effectiveness of e-mail for communication between patients and their oncologist and (2) assess from the perspective of the patient the accessibility and usefulness

C. S. Katzen; A. P. Dicker

2001-01-01

319

[Using arts therapies in psycho-oncology: evaluation of an exploratory study implemented in an out-patient setting].  

PubMed

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

Schiltz, L; Zimoch, A

2013-01-01

320

Oncology patients' and professional nurses' perceptions of important nurse caring behaviors  

Microsoft Academic Search

BACKGROUND: Caring is the essence of nursing. Caring to be meaningful needs to be based on mutual agreement between nurses and patients as to what constitutes nurse caring behaviors. As a result, healthcare professional can enhance patients' satisfaction of care by providing appropriate caring behavior. However, previous research that combined multiple types of patients, nurses and institutions demonstrated disagreement in

Vahid Zamanzadeh; Roghaieh Azimzadeh; Azad Rahmani; Leila Valizadeh

2010-01-01

321

Modeling Plus MRI Data Characterize Brain Tumors in Patients | Physical Sciences in Oncology  

Cancer.gov

Patients diagnosed with glioblastoma, the most aggressive form of brain cancer, routinely undergo MRI scanning prior to receiving treatment. Now, an international team of investigators has developed a mathematical modeling technique that can translate the data from pretreatment MRI scans into patient-specific rates of tumor growth and metastasis that may find use in tailoring therapy to meet the needs of each patient.

322

Thinking in three's: changing surgical patient safety practices in the complex modern operating room.  

PubMed

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

Gibbs, Verna C

2012-12-14

323

Breath analysis in non small cell lung cancer patients after surgical tumour resection.  

PubMed

Exhaled volatile organic compounds (VOCs), mainly aliphatic and aromatic hydrocarbons, have been proposed as a diagnostic test for early lung cancer detection, but the effect of lung cancer surgical re-moval on exhaled VOCs pattern has never been specifically addressed. The aim of this study was to compare VOC levels measured in non small cell lung cancer (NSCLC) patients before surgery (T0), one month (T1) and 3 years (T2) after surgical removal of tumour. In order to better understand the pathophysiological meaning of exhaled aromatic hydrocarbons, the same exhaled biomarkers were also assessed in cancerous and macroscopically unaffected lung tissue samples collected during surgical operation. Exhaled breath was collected in a specially designed Teflon bulb trapping the last 150 ml of a single slow vital capacity. After solid phase micro-extraction, VOCs were analysed in gas chromatography-mass spectrometry. VOC levels were unaffected by surgical removal, except for isoprene, whose concentration was significantly reduced. Three years after surgical operation, some VOCs significantly changed from baseline: in particular, we noted a decrease in isoprene and benzene concentrations, whereas the levels of pentane, toluene and ethylbenzene were increased in comparison with baseline values. Finally, lung tissue analysis showed that all aromatic hydrocarbons, except xylenes, were significantly higher in cancerous than in unaffected tissue. This study showed that surgical operation can influence the concentration of some exhaled VOCs opening a new scenario in the use of exhaled VOCs in lung cancer patients, not only for diagnostic but also for follow up purposes. PMID:18924311

Poli, Diana; Goldoni, Matteo; Caglieri, Andrea; Ceresa, Giorgia; Acampa, Olga; Carbognani, Paolo; Rusca, Michele; Corradi, Massimo

2008-01-01

324

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

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

Calderón, Jorge; Campla, Cristóbal; D’Aguzan, Nicole; Barraza, Soledad; Padilla, Oslando; Sánchez, Cesar; Palma, Silvia; González, Matías

2014-01-01

325

Utilitarian prioritization of radiation oncology patients based on maximization of population tumour control  

NASA Astrophysics Data System (ADS)

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.

Ebert, M. A.; Li, W.; Jennings, L.; Kearvell, R.; Bydder, S.

2013-06-01

326

Interprofessional patient-centred practice in oncology teams: utopia or reality?  

PubMed

Abstract 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

Bilodeau, Karine; Dubois, Sylvie; Pepin, Jacinthe

2015-03-01

327

Common Features in Patients With Superior Canal Dehiscence Declining Surgical Treatment  

PubMed Central

Background Superior canal dehiscence (SCD) is a benign condition in which a surgical treatment may be considered depending on the patients’ tolerance of their symptoms. In this study, we aim to identify driving factors behind the patients’ choice of a surgical management over watchful waiting. Methods Sixty-two patients with cochlear and/or vestibular symptoms and a temporal bone high-resolution CT (HRCT) scan showing SCD were included in the study. All patients have been offered either surgical management or watchful waiting. Results Of these, 28 elected surgery and 34 declined it. The operated group showed more cochlear (6.6 vs. 2.4) symptoms than the non-operated group (P < 0.001) except for hypoacousis, but no significant difference (P = 0.059) was found for the number of vestibular symptoms between both groups (3.4 vs. 1.1). Footstep and eating hyperacousis were both present in 57.1% of operated vs. 3% of non-operated patients (P < 0.001). Oscillopsia with effort and with walking was found in 50% and 35.7% of operated patients, respectively, but none in the non-operated group (P < 0.001). Hearing tuning fork at malleolus and Valsalva and pneumatic speculum induced vertigo showed a statistically significant difference between the two groups (P = 0.003, P < 0.001, P = 0.010 respectively). Cervical vestibular-evoked myogenic potential (cVEMP) thresholds, air and bone conduction thresholds, and mean air-bone gap (ABG) were similar in the two populations (P > 0.05). The average dehiscence size was 4.7 mm (2.0 - 8.0 mm) and 3.8 mm (1.3 - 7.7 mm) in the operated and non-operated patients, respectively (P = 0.421). Conclusions The natures of cochleovestibular signs and symptoms were shown to be key factors in patients’ choice of a surgical management whereas paraclinical tests seem to be less significant in the patients’ decision for a surgical treatment. PMID:25780478

Benamira, Lina Zahra; Maniakas, Anastasios; Alzahrani, Musaed; Saliba, Issam

2015-01-01

328

Fuchs endothelial corneal dystrophy: clinical characteristics of surgical and nonsurgical patients  

PubMed Central

Purpose To review the patient and clinical characteristics of patients with Fuchs endothelial corneal dystrophy (FECD). Methods Review of records for every patient who presented to the Bascom Palmer Eye Institute between 2003 and 2009 whose visit was coded for endothelial corneal dystrophy (International Classification of Diseases, Ninth Revision [ICD9] 371.57), bullous keratopathy (ICD9 371.23), or who underwent a corneal surgery with or without cataract extraction. Demographic, clinical, and ancillary testing data were collected from the time of presentation, diagnosis, and follow-up, and the use, timing, and type of surgical interventions was documented, with 6-month and final visual acuities recorded. Results A total of 2,370 charts were included in this study, of which 966 patients had a diagnosis of FECD. Of these, 197 patients (21%) received a corneal transplantation procedure. The surgery most often performed was penetrating keratoplasty with or without cataract extraction (66%), followed by endothelial keratoplasty with or without cataract extraction (34%). The risk factors for surgery include worse visual acuity at presentation (20/60 Snellen visual acuity in surgical patients versus 20/40 Snellen visual acuity in nonsurgical patients, P<0.001), greater average central corneal thickness (635 ?m versus 592 ?m, P<0.001), loss of visual acuity over time (two lines lost versus zero lines lost, P<0.001), increasing age (P<0.001), and male sex (P=0.008). Over half of patients (52%) did not receive surgery despite poor vision. Conclusion During this time period, FECD did not have a consistent pattern for management or treatment, and despite advances in surgical techniques, most patients were still managed without surgery. PMID:25228793

Goldberg, Roger A; Raza, Sabri; Walford, Eric; Feuer, William J; Goldberg, Jeffrey L

2014-01-01

329

Surgical treatment outcomes of patients with bilateral warthin tumors in the parotid gland.  

PubMed

We describe the treatment outcomes of patients with bilateral Warthin tumors in the parotid gland according to surgical methods. The medical records of ten patients with bilateral Warthin tumors in the parotid gland who underwent surgery between 2004 and 2011 were retrospectively reviewed. Ten patients were included in the study and 13 parotidectomies were performed. Patients with bilateral Warthin tumors in the parotid gland were divided into three groups according to the surgical methods used to treat these individuals. In group 1, the patients were closely observed without undergoing contralateral parotidectomy after unilateral parotidectomy. In group 2, the patients underwent concurrent bilateral parotidectomies. In group 3, the patient underwent contralateral parotidectomy 2 months after unilateral parotidectomy was performed. The overall rate of transient facial nerve dysfunction was 31%. Our findings suggest that concurrent superficial parotidectomy may be an appropriate method for treating bilateral Warthin tumors in the parotid gland, at least for desired patients. The symptoms of this type of tumor and physical examination findings are frequently non-specific and present in the unilateral parotid gland. Therefore, a high degree of discernment is needed and imaging techniques are essential for the determining the correct pre-operative diagnosis. PMID:24533403

Lee, Dong Hoon; Yoon, Tae Mi; Lee, Joon Kyoo; Lim, Sang Chul

2014-01-01

330

Outcome of GreenLight HPS laser therapy in surgically high-risk patients.  

PubMed

The aims of this study are to present our experience with GreenLight HPS laser in the treatment of benign prostatic hyperplasia (BPH) and evaluate the outcomes of laser therapy in surgically high-risk patients. This study included a total of 132 patients who were treated for BPH by using GreenLight HPS laser between August 2008 and December 2010 by the same operator. These patients were further divided into five subgroups: group A (age ? 80 years), group B (prostate volume ? 80 ml), group C (American Society of Anesthesiologists score?=?3), group D (anticoagulant use), and group E (non-A, non-B, non-C, and non-D patients). Data on International Prostate Symptom Score, maximum flow rate (Q max), post-void residual urine, and quality-of-life score were evaluated at baseline and at 1, 12, and 24 months after surgery. The result showed that group B patients required a longer lasing time during surgery. In addition, longer post-operative catheterization time and hospital stay were noted in groups B, C, and D patients. Statistically significant improvements were noted post-operatively for all functional parameters in all groups. The proportion of secondary surgery was significantly higher in group B patients. No major complication was observed in all groups. This suggested that GreenLight HPS laser is safe and effective in the treatment of surgically high-risk patients. PMID:23179309

Chen, Chien Hsu; Lin, Shung Eing; Chiang, Po Hui

2013-09-01

331

Quality of life in patients submitted to surgical treatment for minor salivary gland neoplasms.  

PubMed

This study was aimed at assessing the quality of life in patients submitted to surgical treatment for minor salivary gland neoplasms (MSGN). Twelve patients (10 women and 2 men, mean age: 49.4 years) with histopathologic diagnosis of pleomorphic adenoma (PA, 3 cases), polymorphous low-grade adenocarcinoma (PLGA, 2 cases), cystic adenoid carcinoma (CAC, 4 cases), and muco-epidermoid carcinoma (MEC, 3 cases) were evaluated. All of them were treated by surgical excision; patients with CAC received radiotherapy as well. The patients quality of life was evaluated through a self-administered questionnaire concerning their physical well-being, emotional status, normal daily activities, and family relationships. The results showed that patients with MEC--the youngest among all patients--reported a significantly greater worsening of their physical well-being and emotional status after treatment as compared with patients treated for PA (P<0.05), and also of their functional activities as compared with those treated for PA and PLGA (P<0.05). In conclusion, age of development of the neoplasm and type of disease produce more impact on patients quality of life than does the therapys degree of aggression. PMID:18060267

Hirota, Sílvio Kenji; Penha, Sibele Sarti; Lehn, Carlos Neutzling; Sugaya, Norberto Nobuo; Migliari, Dante Antônio

2007-01-01

332

A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection  

ERIC Educational Resources Information Center

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…

McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

2010-01-01

333

Surgical outcomes of Korean ulcerative colitis patients with and without colitis-associated cancer  

PubMed Central

AIM: To determine the clinicopathologic characteristics of surgically treated ulcerative colitis (UC) patients, and to compare the characteristics of UC patients with colitis-associated cancer (CAC) to those without CAC. METHODS: Clinical data on UC patients who underwent abdominal surgery from 1980 to 2013 were collected from 11 medical institutions. Data were analyzed to compare the clinical features of patients with CAC and those of patients without CAC. RESULTS: Among 415 UC patients, 383 (92.2%) underwent total proctocolectomy, and of these, 342 (89%) were subjected to ileal pouch-anal anastomosis. CAC was found in 47 patients (11.3%). Adenocarcinoma was found in 45 patients, and the others had either neuroendocrine carcinoma or lymphoma. Comparing the UC patients with and without CAC, the UC patients with CAC were characteristically older at the time of diagnosis, had longer disease duration, underwent frequent laparoscopic surgery, and were infrequently given preoperative steroid therapy (P < 0.001-0.035). During the 37 mo mean follow-up period, the 3-year overall survival rate was 82.2%. CONCLUSION: Most Korean UC patients experience early disease exacerbation or complications. Approximately 10% of UC patients had CAC, and UC patients with CAC had a later diagnosis, a longer disease duration, and less steroid treatment than UC patients without CAC. PMID:25834319

Yoon, Yong Sik; Cho, Yong Beom; Park, Kyu Joo; Baik, Seung Hyuk; Yoon, Sang Nam; Ryoo, Seung-Bum; Lee, Kil Yeon; Kim, Hungdai; Lee, Ryung-Ah; Yu, Chang Sik

2015-01-01

334

Acute and long-term survival in chronically critically ill surgical patients: a retrospective observational study  

PubMed Central

Introduction Various cohort studies have shown that acute (short-term) mortality rates in unselected critically ill patients may have improved during the past 15 years. Whether these benefits also affect acute and long-term prognosis in chronically critically ill patients is unclear, as are determinants relevant to prognosis. Methods We conducted a retrospective analysis of data collected from March 1993 to February 2005. A cohort of 390 consecutive surgical patients requiring intensive care therapy for more than 28 days was analyzed. Results The intensive care unit (ICU) survival rate was 53.6%. Survival rates at one, three and five years were 61.8%, 44.7% and 37.0% among ICU survivors. After adjustment for relevant covariates, acute and long-term survival rates did not differ significantly between 1993 to 1999 and 1999 to 2005 intervals. Acute prognosis was determined by disease severity during ICU stay and by primary diagnosis. However, only the latter was independently associated with long-term prognosis. Advanced age was an independent prognostic determinant of poor short-term and long-term survival. Conclusion Acute and long-term prognosis in chronically critically ill surgical patients has remained unchanged throughout the past 12 years. After successful surgical intervention and intensive care, long-term outcome is reasonably good and is mainly determined by age and underlying disease. PMID:17504535

Hartl, Wolfgang H; Wolf, Hilde; Schneider, Christian P; Küchenhoff, Helmut; Jauch, Karl-Walter

2007-01-01

335

Surgical versus conservative treatment for displaced proximal humeral fractures in elderly patients: a meta-analysis  

PubMed Central

Purpose: Treatment strategies for complex displaced proximal humeral fractures (DPHF) in elderly patients remain controversial. This meta-analysis was performed to compare the benefits and risks of surgical or conservative methods for these patients. Methods: Pubmed, Cochrane library and EMBASE were systematically searched for randomized controlled trials (RCTs) from their establishment to June 2013. Researches on surgical/conservative treatment for complex displaced proximal humeral fractures in elderly patients were selected. Methodological quality of included studies was evaluated by the Physiotherapy Evidence Database (PEDro) scale. Outcome measurements were Constant score, DASH (disabilities of the arm, shoulder and hand), postoperative complications and quality of life (QoL). The meta-analysis was performed with software Stata 12.0. Results: Six RCTs with 272 patients were included and analyzed. Fix studies with a PEDro score of 6 or more were of high quality. The differences in QoL (WMD 0.43, 95% CI (0.12, 0.74)) and postoperative complications (RR 2.06, 95% CI (1.45, 2.93)) were statistically significant between operative and conservative treatment. There was no statistically significant difference in Constant score (WMD 0.06, 95% CI (-0.20, 0.31)) and DASH (WMD 0.33, 95% CI (-0.70, 0.04)). Conclusion: Despite the small improvement of QoL, surgical treatments did not significantly improve the functional outcome including Constant score and DASH. Instead, surgical treatment for displaced proximal humeral fractures in elderly patients led to higher incidence of postoperative complications. PMID:25663957

Fu, Tao; Xia, Chengyan; Li, Zonghuan; Wu, Hua

2014-01-01

336

A pilot clinical study of Class III surgical patients facilitated by improved accelerated osteogenic orthodontic treatments.  

PubMed

Objective: To evaluate if the improved accelerated osteogenic orthodontics (IAOO) procedure could speed Class III surgical patients' preoperative orthodontic treatment duration and, if yes, to what extent. This study was also designed to determine whether or not an IAOO procedure affects the tooth-moving pattern during extraction space closure. Materials and Methods: The samples in this study consisted of 24 Class III surgical patients. Twelve skeletal Class III surgery patients served as an experimental group (group 1) and the others as a control group (group 2). Before treatment, the maxillary first premolars were removed. For group 1, after the maxillary dental arch was aligned and leveled (T2), IAOO procedures were performed in the maxillary alveolar bone. Except for this IAOO procedure in group 1, all 24 patients experienced similar combined orthodontic and orthognathic treatment. Study casts of the maxillary dentitions were made before orthodontic treatment (T1) and after extraction space closure (T3). All of the casts were laser scanned, and the amount of movement of the maxillary central incisor, canine, and first molar, as well as arch widths, were digitally measured and analyzed by using the three-dimensional model superimposition method. Results: The time durations T3-T2 were significantly reduced in group 1 by 8.65 ± 2.67 months and for T3-T1 were reduced by 6.39 ± 2.00 months (P < .001). Meanwhile, the tooth movement rates were all higher in group 1 (P < .05). There were no significant differences in the amount of teeth movement in the sagittal, vertical, and transverse dimensions between the two groups (P > .05). Conclusion: The IAOO can reduce the surgical orthodontic treatment time for the skeletal Class III surgical patient by more than half a year on average. The IAOO procedures do not save anchorage. PMID:25347045

Wu, JiaQi; Jiang, JiuHui; Xu, Li; Liang, Cheng; Bai, YunYang; Zou, Wei

2014-10-27

337

Minimally Invasive Surgery in Gynecologic Oncology  

PubMed Central

Minimally invasive surgery has been utilized in the field of obstetrics and gynecology as far back as the 1940s when culdoscopy was first introduced as a visualization tool. Gynecologists then began to employ minimally invasive surgery for adhesiolysis and obtaining biopsies but then expanded its use to include procedures such as tubal sterilization (Clyman (1963), L. E. Smale and M. L. Smale (1973), Thompson and Wheeless (1971), Peterson and Behrman (1971)). With advances in instrumentation, the first laparoscopic hysterectomy was successfully performed in 1989 by Reich et al. At the same time, minimally invasive surgery in gynecologic oncology was being developed alongside its benign counterpart. In the 1975s, Rosenoff et al. reported using peritoneoscopy for pretreatment evaluation in ovarian cancer, and Spinelli et al. reported on using laparoscopy for the staging of ovarian cancer. In 1993, Nichols used operative laparoscopy to perform pelvic lymphadenectomy in cervical cancer patients. The initial goals of minimally invasive surgery, not dissimilar to those of modern medicine, were to decrease the morbidity and mortality associated with surgery and therefore improve patient outcomes and patient satisfaction. This review will summarize the history and use of minimally invasive surgery in gynecologic oncology and also highlight new minimally invasive surgical approaches currently in development. PMID:23997959

Mori, Kristina M.; Neubauer, Nikki L.

2013-01-01

338

Spiritual assessment: a patient-centered approach to oncology social work practice.  

PubMed

Spirituality is central to many people's lives, yet social workers often defer discussing the topic with patients. Their avoidance can be linked to the lack of training on how to speak with patients about spiritual matters (Lemmer, 2010) With further education, clinical social workers are empowered to assess this significant aspect of the patient's cancer experience as they progress along the illness continuum. The social worker's comfort and familiarity with spiritual assessment, spiritual language, and various forms of religious and/or spiritual practices will improve their clinical work with patients who have chronic cancer by providing insight to guide appropriate social work interventions designed to enhance spiritual well-being. PMID:24405239

Stewart, Melissa

2014-01-01

339

Improving the outcomes in oncological colorectal surgery.  

PubMed

During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication. PMID:25253944

van Vugt, Jeroen L A; Reisinger, Kostan W; Derikx, Joep P M; Boerma, Djamila; Stoot, Jan H M B

2014-09-21

340

Improving the outcomes in oncological colorectal surgery  

PubMed Central

During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication. PMID:25253944

van Vugt, Jeroen LA; Reisinger, Kostan W; Derikx, Joep PM; Boerma, Djamila; Stoot, Jan HMB

2014-01-01

341

Patient Perspectives on Post-Discharge Surgical Site Infections: Towards a Patient-Centered Mobile Health Solution  

PubMed Central

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

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

342

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.

343

Antibiotic Prophylaxis and Incisional Surgical Site Infection Following Colorectal Cancer Surgery: An Analysis of 330 Cases  

Microsoft Academic Search

Objective: To evaluate the rate of incisional surgical site infection (SSI) following colorectal cancer surgery in a university hospital and to determine whether duration of prophylactic antibiotic administration can affect the development of this complication. Material and Method: The medical records of 330 patients with colorectal cancer undergoing elective oncological resection between 2003 and 2006 at Siriraj Hospital were reviewed.

Varut Lohsiriwat; Darin Lohsiriwat

2009-01-01

344

Investigation of realistic PET simulations incorporating tumor patient's specificity using anthropomorphic models: Creation of an oncology database  

SciTech Connect

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/.

Papadimitroulas, Panagiotis; Efthimiou, Nikos; Nikiforidis, George C.; Kagadis, George C. [Department of Medical Physics, School of Medicine, University of Patras, Rion, GR 265 04 (Greece)] [Department of Medical Physics, School of Medicine, University of Patras, Rion, GR 265 04 (Greece); Loudos, George [Department of Biomedical Engineering, Technological Educational Institute of Athens, Ag. Spyridonos Street, Egaleo GR 122 10, Athens (Greece)] [Department of Biomedical Engineering, Technological Educational Institute of Athens, Ag. Spyridonos Street, Egaleo GR 122 10, Athens (Greece); Le Maitre, Amandine; Hatt, Mathieu; Tixier, Florent; Visvikis, Dimitris [Medical Information Processing Laboratory (LaTIM), National Institute of Health and Medical Research (INSERM), 29609 Brest (France)] [Medical Information Processing Laboratory (LaTIM), National Institute of Health and Medical Research (INSERM), 29609 Brest (France)

2013-11-15

345

Recruiting Terminally Ill Patients into Non-Therapeutic Oncology Studies: views of Health Professionals  

PubMed Central

Background Non-therapeutic trials in which terminally ill cancer patients are asked to undergo procedures such as biopsies or venipunctures for research purposes, have become increasingly important to learn more about how cancer cells work and to realize the full potential of clinical research. Considering that implementing non-therapeutic studies is not likely to result in direct benefits for the patient, some authors are concerned that involving patients in such research may be exploitive of vulnerable patients and should not occur at all, or should be greatly restricted, while some proponents doubt whether such restrictions are appropriate. Our objective was to explore clinician-researcher attitudes and concerns when recruiting patients who are in advanced stages of cancer into non-therapeutic research. Methods We conducted a qualitative exploratory study by carrying out open-ended interviews with health professionals, including physicians, research nurses, and study coordinators. Interviews were audio-recorded and transcribed. Analysis was carried out using grounded theory. Results The analysis of the interviews unveiled three prominent themes: 1) ethical considerations; 2) patient-centered issues; 3) health professional issues. Respondents identified ethical issues surrounding autonomy, respect for persons, beneficence, non-maleficence, discrimination, and confidentiality; bringing to light that patients contribute to science because of a sense of altruism and that they want reassurance before consenting. Several patient-centered and health professional issues are having an impact on the recruitment of patients for non-therapeutic research. Facilitators were most commonly associated with patient-centered issues enhancing communication, whereas barriers in non-therapeutic research were most often professionally based, including the doctor-patient relationship, time constraints, and a lack of education and training in research. Conclusions This paper aims to contribute to debates on the overall challenges of recruiting patients to non-therapeutic research. This exploratory study identified general awareness of key ethical issues, as well as key facilitators and barriers to the recruitment of patients to non-therapeutic studies. Due to the important role played by clinicians and clinician-researchers in the recruitment of patients, it is essential to facilitate a greater understanding of the challenges faced; to promote effective communication; and to encourage educational research training programs. PMID:23216847

2012-01-01

346

Effects of referral bias on surgical outcomes: a population-based study of surgical patients 90 years of age or older.  

PubMed

During the 11-year period 1975 through 1985, 1,063 surgical procedures were performed on 795 Mayo Clinic patients 90 years of age or older. Preoperative conditions, surgical setting, and perioperative morbidity and mortality were analyzed in a comparison of the local residents of Olmsted County, Minnesota (N = 224), with patients from outside the county but within 250 miles (N = 456) or referrals from a distance of 250 miles or further (N = 115). In comparison with non-Olmsted County patients, Olmsted County patients were generally older, had more preoperative chronic diseases, and underwent more emergency operations. Patients who had traveled 250 miles or more to the Mayo Clinic were more likely to be men and referred for cancer-related surgical procedures. The risks of major morbidity and mortality within 48 hours postoperatively were increased in patients with more preoperative chronic diseases and those undergoing emergency procedures, characteristics most common in Olmsted County patients. Because of differences in these factors between groups, perioperative risks averaged over our entire patient series underestimated risks that would be expected from a population-based cohort such as Olmsted County residents. In general, data from tertiary medical centers probably do not accurately reflect overall practice or outcomes in community settings. PMID:2402160

Warner, M A; Hosking, M P; Lobdell, C M; Offord, K P; Melton, L J

1990-09-01

347

Cancer-related neuropathic pain in out-patient oncology clinics: a European survey  

PubMed Central

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

2013-01-01

348

A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting  

PubMed Central

Background Despite growing interest and urges by leading experts for the routine collection of patient reported outcome (PRO) measures in all general care patients, and in particular cancer patients, there has not been an updated comprehensive review of the evidence regarding the impact of adopting such a strategy on patients, service providers and organisations in an oncologic setting. Methods Based on a critical analysis of the three most recent systematic reviews, the current systematic review developed a six-method strategy in searching and reviewing the most relevant quantitative studies between January 2000 and October 2011 using a set of pre-determined inclusion criteria and theory-based outcome indicators. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to rate the quality and importance of the identified publications, and the synthesis of the evidence was conducted. Results The 27 identified studies showed strong evidence that the well-implemented PROs improved patient-provider communication and patient satisfaction. There was also growing evidence that it improved the monitoring of treatment response and the detection of unrecognised problems. However, there was a weak or non-existent evidence-base regarding the impact on changes to patient management and improved health outcomes, changes to patient health behaviour, the effectiveness of quality improvement of organisations, and on transparency, accountability, public reporting activities, and performance of the health care system. Conclusions Despite the existence of significant gaps in the evidence-base, there is growing evidence in support of routine PRO collection in enabling better and patient-centred care in cancer settings. PMID:23758898

2013-01-01

349

New Applications of Radioguided Surgery in Oncology  

PubMed Central

OBJECTIVE: To report oncological cases (excluding those related to breast cancer) for which radioguided surgery has been used in combination with the Radioguided Occult Lesion Localization technique. INTRODUCTION: Radioguided surgery enables a surgeon to identify lesions or tissues that have been preoperatively marked with radioactive substances. The Radioguided Occult Lesion Localization technique has been widely used to identify the sentinel lymph node and occult lesions in patients with breast cancer. However, few studies have reported the use of this technique for non-breast cancer pathologies. METHODOLOGY: In all cases, injection of Technecium-99m sulfur colloid was performed, directly inside or near by the suspicious lesion, guided by ultrasound or computed tomography, up to 36 hours prior to the surgical procedure. Intraoperative lesion detection was carried out using a gamma-probe. RESULTS: We report five oncology cases in which preoperative markings of the lesions were carried out using the Radioguided Occult Lesion Localization technique. The patients presented with the following: recurrence of renal cell carcinoma, cervical recurrence of papillary carcinoma of the thyroid, recurrence of retroperitoneal sarcoma, lesions of the popliteal fossa, and recurrence of rhabdomyosarcoma of a thigh. In each case, the lesions that were marked preoperatively were ultimately successfully excised. CONCLUSIONS: Radioguided surgery has proven to be a safe and effective alternative for the management of oncology patients. The Radioguided Occult Lesion Localization technique can be useful in selected cases where suspect lesions may be difficult to identify intraoperatively, due to their dimensions or anatomical location. The procedure allows for more conservative excisions and reduces the surgery-related morbidity. PMID:19488604

Bitencourt, Almir Galvão Vieira; Lima, Eduardo Nóbrega Pereira; Pinto, Paula Nicole Vieira; Martins, Eduardo Bruno Lobato; Chojniak, Rubens

2009-01-01

350

Cortisol and antidiuretic hormone responses to stress in cardiac surgical patients  

Microsoft Academic Search

The hormonal responses to anaesthesia and cardiac surgery were studied in patients undergoing valve or coronary bypass surgery.\\u000a Marked increases in antidiuretic hormone levels as a result of surgical stress were seen, and were of approximately equal\\u000a magnitude in both groups. Although both groups also showed marked increases in plasma cortisol levels in response to operations,\\u000a this response appeared to

Yasu Oka; Shigeharu Wakayama; Tsutomu Oyama; Louis R. Orkin; Ronald M. Becker; M. Donald Blaufox; Robert W. M. Frater

1981-01-01

351

Contractile function of the myocardium with prolonged hypokinesia in patients with surgical tuberculosis  

NASA Technical Reports Server (NTRS)

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.

Zakutayeva, V. P.; Matiks, N. I.

1978-01-01

352

Surgical Decision Making for the Elderly Patients in Severe Head Injuries  

PubMed Central

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

Shim, Jae-Jun; Yoon, Seok-Man; Oh, Jae-Sang; Bae, Hack-Gun; Doh, Jae-Won

2014-01-01

353

[Surgical indication and problems of patients aged over 70 years with unruptured aneurysms].  

PubMed

Surgical indication and problems of patients aged over 70 years with unruptured aneurysms were investigated. Clinical features of eighteen cases of unruptured cerebral aneurysms were analyzed. The location of the cerebral aneurysms were in the internal carotid artery in five cases, in the middle cerebral artery in ten cases, in the anterior cerebral artery in 2 cases and in the basilar artery in 1 case. The size of the aneurysms was less than 10 mm in diameter in 17 cases and giant in one case. Treatment of these aneurysms was classified into two groups as follows; the conservative treatment group (four cases) and the surgical treatment group (14 cases). The therapeutic results of the conservative group were good recovery in 2 cases, and death in 2 cases. On the other hand, the results of surgical group were good recovery in 12 cases and fair in 2 cases. Operative complications were recognized in two cases. Consciousness disturbance and left hemiparesis was recognized in one case. Right hemiparesis was recognized in the another case. Postoperative MR imagings or CT scan presented small cerebral infarctions in the corona radiata in both cases. The cause of infarction was thought to be the occlusion of lenticulostriate arteries. From these data, in patients aged over 70 years with unruptured cerebral aneurysms, surgery should be considered not only from the aspect of aneurysmal size and its site, but also from the aspect of cerebral blood flow of the patient. PMID:10396734

Niwa, J; Tanigawara, T; Kubota, T; Chiba, M; Akiyama, Y; Inamura, S

1999-06-01

354

The location of surgical care for rural patients with rectal cancer: patterns of treatment and patient perspectives  

PubMed Central

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

Nostedt, Michelle C.; McKay, Andrew M.; Hochman, David J.; Wirtzfeld, Debrah A.; Yaffe, Clifford S.; Yip, Benson; Silverman, Richard; Park, Jason

2014-01-01

355

Prognostic factors for surgically managed patients with stage II non-small cell lung cancer  

PubMed Central

Background: To investigate the prognostic factors in surgically managed patients with stage II non-small cell lung cancer. Material and methods: A retrospective analysis of clinical data of surgically managed 93 patients with stage II non-small cell lung cancer in our hospital between May 2005 and November 2009 was conducted, and prognostic factors that may impact the postoperative 5-year survival rate were statistically analyzed. Results: Univariable survival analysis showed that new TNM staging, total number of dissected lymph nodes, number of dissected N1 and N2 lymph nodes and N1 lymph groups, metastasis rate of N1 lymph nodes, and 10th group of lymph nodes metastatic or not, were related to the postoperative 5-year survival rate in the patients. Multivariable survival analysis showed that the metastasis rate of N1 lymph nodes and 10th group of lymph nodes metastatic or not were independent prognostic factors for the postoperative 5-year survival rate in the patients. Conclusion: When patients with stage II non-small cell lung cancer are treated with surgery, the total number of dissected lymph nodes greater than 6, the number of dissected N1 lymph nodes over 5, N2 over 2, and the number of dissected N1 groups over 3, may improve their postoperative 5-year survival rate. The metastasis rate of N1 lymph nodes over 50%, and the metastasis of the 10th group of lymph nodes imply poor prognosis of the patients.

Wang, Liming; Liu, Yang; Xu, Shun

2015-01-01

356

Factors affecting ED length-of-stay in surgical critical care patients.  

PubMed

To determine what patient characteristics are associated with prolonged emergency department (ED) length-of-stay (LOS) for surgical critical care patients, the charts of 169 patients admitted from the ED directly to the operating room (OR) or intensive care unit (ICU) during a 6-week period in 1993 were reviewed. The ED record was reviewed for documentation of factors that might be associated with prolonged ED LOS, such as use of computed tomographic (CT), radiology special procedures, and the number of plain radiographs and consultants. ED LOS was considered to be the time from triage until a decision was made to admit the patient. Using a Cox proportional hazards model, use of CT and special procedures were the strongest independent predictors of prolonged ED length-of-stay. The number of plain radiographs and consultants had only a minimal effect. Use of a protocol-driven trauma evaluation system was associated with a shorter ED LOS. In addition to external factors that affect ED overcrowding, ED patient management decisions may also be associated with prolonged ED length-of-stay. Such ED-based factors may be more important in surgical critical care patients, whose overall ED LOS is affected more by the length of the ED work-up rather than the time spent waiting for a ICU bed or operating suite. PMID:7662048

Davis, B; Sullivan, S; Levine, A; Dallara, J

1995-09-01

357

[Surgical treatment of obstructive urinary tract diseases in patients with pulmonary tuberculosis].  

PubMed

The paper presents the data of an examination of 92 patients [males (59-64.1%) and females (33-35.9%)] with active pulmonary tuberculosis concurrent with obstructive urinary tract diseases of various etiology. The patients' age ranged from 39 to 90 years (mean 58.2 +/- 2.5 years). Seventy-six (82.0%) patients suffered from infiltrative tuberculosis; 12 (13.0%) and 4 (4.3%) patients had cavernous and fibrocavernous tuberculosis, respectively. A relationship was found between pulmonary tuberculosis and obstructive urinary tract diseases leading to uniform changes in the upper urinary tract. The use of currently available methods for examination and treatment to eliminate infra- and supravesical obstruction permits performance of surgical interventions in patients with active pulmonary tuberculosis. PMID:15532465

Iagafarova, R K; Zuban', O N; Iashkin, D V; Levashev, Iu N

2004-01-01

358

Subjective Follow-up of Patients from a Surgical Intensive Therapy Ward  

PubMed Central

One-hundred consecutive patients who had been treated in the surgical intensive therapy ward completed a form recording their impressions of their stay. Most patients had a reasonable idea of how long they had spent in the ward and few remembered being in pain or excessively worried by any of the procedures carried out. Those who had been artificially ventilated had little recollection of this period; most either did not realize that their breathing had been artificially maintained or had no idea of the duration of ventilatory support. Very few of the patients who had tracheal suction via endotracheal or tracheostomy tubes were unduly worried by this, but 60% of the patients who needed nasopharyngeal suction to help sputum clearance had been considerably worried by this. Most of the patients were very pleased with the medical and nursing attention they had received and did not find the “intensive” nature of their care unduly disturbing. PMID:4098972

Hewitt, P. B.

1970-01-01

359

[Therapeutic education in oncology: involving patient in the management of cancer].  

PubMed

The notion of therapeutic education was only recently introduced in cancer. Although the term is commonly used, no standard definition exists for the concept and principles of therapeutic education and its efficacy remains to be assessed. Therapeutic education is complementary to the healthcare approach and aims to get the patients more involved in their disease and the treatment decision-making process. This discipline, placed at the interface of human and social sciences, was first developed for the management of chronic diseases (diabetes, asthma). It derives from the principle that involving patients in their own care and management can help them better adjust to life with a chronic disease. The lengthening survival time of cancer patients, which contributes to making cancer a chronic disease, as well as changes in the patient-caregiver relationship contribute to the development of therapeutic education in cancer. Pilot studies, conducted principally in the United States, evaluating the side effects of chemotherapy and the management of pain, have demonstrated that such educational programs could improve patient quality of life and decrease the side effects of treatments. The success of these programs depends on several parameters: taking into account patient's opinion in the elaboration and preparation of the programs; involving skilled multidisciplinary teams engaged in iterative educational actions; having recourse to methodological tools to evaluate the impact of implemented programs. Consistent with the World Health Organization guidelines, research should be conducted in France in order to elaborate and implement cancer-specific education programs and evaluate their potential benefit. Patient education programs on pain, fatigue, nutrition and treatment compliance are currently being developed at Saint-Etienne Regional Resource Centre for cancer information, prevention and education, within the framework of the Canceropole Lyon Auvergne Rhône-Alpes. PMID:17371769

Pérol, David; Toutenu, Pauline; Lefranc, Anne; Régnier, Véronique; Chvetzoff, Gisèle; Saltel, Pierre; Chauvin, Franck

2007-03-01

360

Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis.  

PubMed

Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 ((90)Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of (90)Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters' VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined (90)Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure. PMID:23132540

Oztemür, Zekeriya; Bulut, Okay; Korkmaz, Murat; Gölge, Umut Hatay; Oztürk, Hayati; Tezeren, Gündüz; Günayd?n, Ilhan

2013-05-01

361

Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients.  

PubMed

Three hundred six consecutively treated surgical patients with obstructive sleep apnea syndrome were evaluated from a group of 415 patients. One hundred nine patients were excluded because they failed to obtain a postoperative polysomnogram or were lost to followup. All patients received a physical examination, cephalometric analysis, fiberoptic examination, and polysomnography before treatment to document OSAS and determine the areas of obstruction. A two-phase surgical protocol was used for the reconstruction of the upper airway. Phase I surgery consisted of a uvulopalatopharyngoplasty (UPPP) for palatal obstruction and genioglossus advancement with hyoid myotomy-suspension for base of tongue obstruction. Failures of phase I were offered phase 2 reconstruction, which consisted of maxillary-mandibular advancement osteotomy. One hundred twenty-one patients were treated with nasal continuous positive airway pressure (CPAP) before surgery and this was the primary method of evaluating surgical success. Results were reported on the polysomnogram performed a minimum of 6 months after surgery and compared to the preoperative polysomnogram and the second night nasal CPAP study. The polysomnographic results included respiratory disturbance index (RDI), lowest oxyhemoglobin saturation (LSAT), and sleep architecture parameters. Surgery was considered a success if it was equivalent to nasal CPAP or the postoperative RDI was less than 20 with normal oxygenation. The overall success rate, which included patients that dropped from the protocol, was 76.5%, with a mean followup of 9.3 months (SD, 6.7). The preoperative RDI, nasal CPAP RDI, and postoperative RDI were 55.8 (SD, 26.7), 7.2 (SD, 5.4), and 9.2 (SD, 7.5), respectively.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8441535

Riley, R W; Powell, N B; Guilleminault, C

1993-02-01

362

A targeted e-learning program for surgical trainees to enhance patient safety in preventing surgical infection  

Microsoft Academic Search

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.\\u000aMETHODS: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An educational Web site was developed targeting deficiencies highlighted in the

Seamus M McHugh; Mark Corrigan; Borislav D Dimitrov; Seamus Cowman; Sean Tierney; Hilary Humphreys; Arnold DK Hill

2010-01-01

363

Prevention and treatment of surgical site infection in HIV-infected patients  

PubMed Central

Background Surgical site infection (SSI) are the third most frequently reported nosocomial infection, and the most common on surgical wards. HIV-infected patients may increase the possibility of developing SSI after surgery. There are few reported date on incidence and the preventive measures of SSI in HIV-infected patients. This study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients. And we also explored the preventive measures. Methods A retrospective study of SSI was conducted in 242 HIV-infected patients including 17 patients who combined with hemophilia from October 2008 to September 2011 in Shanghai Public Health Clinical Center. SSI were classified according to Centers for Disease Control and Prevention (CDC) criteria and identified by bedside surveillance and post-discharge follow-up. Data were analyzed using SPSS 16.0 statistical software (SPSS Inc., Chicago, IL). Results The SSI incidence rate was 47.5% (115 of 242); 38.4% incisional SSIs, 5.4% deep incisional SSIs and 3.7% organ/space SSIs. The SSI incidence rate was 37.9% in HIV-infected patients undergoing abdominal operation. Patients undergoing abdominal surgery with lower preoperative CD4 counts were more likely to develop SSIs. The incidence increased from 2.6% in clean wounds to 100% in dirty wounds. In the HIV-infected patients combined with hemophilia, the mean preoperative albumin and postoperative hemoglobin were found significantly lower than those in no-SSIs group (P<0.05). Conclusions SSI is frequent in HIV-infected patients. And suitable perioperative management may decrease the SSIs incidence rate of HIV-infected patients. PMID:22583551

2012-01-01

364

Policy issues related to the rehabilitation of the surgical cancer patient.  

PubMed

Four policy challenges that face the rehabilitation community in providing services to surgical cancer patients are reviewed: (1) achieving capacity to meet the complex rehabilitation needs of a growing population of cancer patients and long-term survivors; (2) identifying effective models for delivering cancer rehabilitation services; (3) understanding complex insurance coverage and payment policies and determining their effects on access to rehabilitation services; and (4) investing in clinical and health services research to guide rehabilitation practice. Recommendations are made to increase the recognition of cancer rehabilitation as an essential component of cancer survivors' care, improve access to appropriate rehabilitation services, and accelerate the pace of cancer rehabilitation research. PMID:17372933

Hewitt, Maria; Maxwell, Stephanie; Vargo, Mary M

2007-04-01

365

The importance of cleanrooms for the treatment of haemato-oncological patients  

PubMed Central

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

Matoušková, Ivanka

2012-01-01

366

Surgical treatment of patients with kidney and bladder cancer in case of severe concomitant cardiovascular diseases.  

PubMed

It was operated 17 patients with kidney and bladder cancer against the background of severe concomitant coronary artery disease (52.9%), aortic aneurysm (35.3%) or combination of coronary artery disease with Leriche syndrome (5.9%) or hemodynamically significant stenosis of internal carotid artery (5.9%). Patients were operated for the period from 1998 to 2012. All patients were male at the age from 39 to 80 years (mean 62.1 years). The first stage of kidney cancer was diagnosed in 8 (53.3%) patients, the second stage - in 1 (6.7%) patient, the third stage - in 2 (13.3%) patients and the fourth stage was observed in 4 (26.7%) patients. Bladder cancer had 1 and 2 stages. Simultaneous operations were performed in 3 (17.6%) patients. 12 (70.6%) patients were operated consequentially. Surgery for kidney cancer was not done in 2 (11.8%) of 17 patients because of patient death after coronary bypass surgery or patient refusal of surgery after carotid arteries stenting. Intraoperative and postoperative complications have been developed in 9 (52.9%) of 17 patients. 2 (11.8%) patients died. The complications frequency and mortality after simultaneous operations were 25% (1 of 4) and 0. These parameters were 57.1% (8 of 14) and 14.3% respectively in case of consequent tactics. It was not observed myocardial infarction and aortic aneurysm rupture after surgeries for kidney and bladder cancer. Overall 1, 3, 5 - year survival of patients with kidney cancer and severe concomitant cardiovascular diseases was 100%, 73.3% and 52.4% respectively. It was concluded that surgical treatment of severe concomitant coronary artery disease and aortic aneurysm in patients with kidney and bladder cancer decreases risk of myocardial infarction and aortic aneurysm rupture in intraoperative and postoperative periods. PMID:25327739

Davydov, M I; Akchurin, R S; Gerasimov, S S; Belov, Yu V; Matveev, V B; Brand, Ya B; Cheban, O I

2014-01-01

367

Effect of surgical incision management on wound infections in a poststernotomy patient population.  

PubMed

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

Grauhan, Onnen; Navasardyan, Artashes; Tutkun, Baris; Hennig, Felix; Müller, Peter; Hummel, Manfred; Hetzer, Roland

2014-06-01

368

Denosumab in patients with cancer-a surgical strike against the osteoclast.  

PubMed

Elucidation of the molecular pathways underlying bone turnover has revealed potential therapeutic targets, including receptor activator of nuclear factor-?B ligand (RANKL), which is a mediator of osteoclast formation, function and survival. Denosumab is a fully human monoclonal antibody that binds to and inhibits RANKL. This agent has been developed for use in patients with early-stage and advanced-stage cancer, as well as for the treatment of osteoporosis, and can prevent bone loss and reduce fragility fractures in both types of disease. In the bone metastasis setting, several large phase III studies have shown that denosumab is more effective than bisphosphonates, namely zoledronic acid, in reducing skeletal morbidity arising from a wide range of tumors. In addition, a remarkable activity of denosumab has been demonstrated in giant-cell tumors of the bone. Subsequent studies of denosumab have demonstrated that it can delay bone metastasis in patients with castration-resistant prostate cancer; adjuvant studies in patients with breast cancer are in progress. This Review critically explores the emerging role of denosumab in maintaining bone health in the oncology setting, and discusses the factors that are likely to influence the choice between bisphosphonates and denosumab in clinical practice. PMID:22231759

Brown, Janet E; Coleman, Robert E

2012-02-01

369

NCI-CCR Pediatric Oncology Branch - Patients and Families, Other Resources  

Cancer.gov

The NIH Children’s School was established in 1953 to instruct school-age patients of the Clinical Center. The School’s goal is to maintain the continuity of education between the student’s home school and the NIH children’s school.

370

Violent Behavior in Cancer Patients--A Rarely Addressed Phenomenon in Oncological Treatment  

ERIC Educational Resources Information Center

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…

Grube, Michael

2012-01-01

371

A new emergency in oncology: Bone metastases in breast cancer patients (Review)  

PubMed Central

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

IBRAHIM, TONI; MERCATALI, LAURA; AMADORI, DINO

2013-01-01

372

Rotational assisted endoscopic retrograde cholangiopancreatography in patients with reconstructive gastrointestinal surgical anatomy  

PubMed Central

AIM: To evaluate the success rates of performing therapy utilizing a rotational assisted enteroscopy device in endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy patients. METHODS: Between June 1, 2009 and November 8, 2012, we performed 42 ERCPs with the use of rotational enteroscopy for patients with altered anatomy (39 with gastric bypass Roux-en-Y, 2 with Billroth II gastrectomy, and 1 with hepaticojejunostomy associated with liver transplant). The indications for ERCP were: choledocholithiasis: 13 of 42 (30.9%), biliary obstruction suggested on imaging: 20 of 42 (47.6%), suspected sphincter of Oddi dysfunction: 4 of 42 (9.5%), abnormal liver enzymes: 1 of 42 (2.4%), ascending cholangitis: 2 of 42 (4.8%), and bile leak: 2 of 42 (4.8%). All procedures were completed with the Olympus SIF-Q180 enteroscope and the Endo-Ease Discovery SB overtube produced by Spirus Medical. RESULTS: Successful visualization of the major ampulla was accomplished in 32 of 42 procedures (76.2%). Cannulation of the bile duct was successful in 26 of 32 procedures reaching the major ampulla (81.3%). Successful therapeutic intervention was completed in 24 of 26 procedures in which the bile duct was cannulated (92.3%). The overall intention to treat success rate was 64.3%. In terms of cannulation success, the intention to treat success rate was 61.5%. Ten out of forty two patients (23.8%) required admission to the hospital after procedure for abdominal pain and nausea, and 3 of those 10 patients (7.1%) had a diagnosis of post-ERCP pancreatitis. The average hospital stay was 3 d. CONCLUSION: It is reasonable to consider an attempt at rotational assisted ERCP prior to a surgical intervention to alleviate biliary complications in patients with altered surgical anatomy.

Zouhairi, Majed El; Watson, James B; Desai, Svetang V; Swartz, David K; Castillo-Roth, Alejandra; Haque, Mahfuzul; Jowell, Paul S; Branch, Malcolm S; Burbridge, Rebecca A

2015-01-01

373

Percutaneous pelvic osteotomy in cerebral palsy patients: Surgical technique and indications  

PubMed Central

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

Canavese, Federico; Rousset, Marie; Samba, Antoine; de Coulon, Geraldo

2013-01-01

374

Toxocarosis and putative DRESS syndrome in an oncological patient: a case report.  

PubMed

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

Wutte, Nora; Palfner, Michael; Auer, Herbert; Ruckenbauer, Gerald; Valentin, Thomas; Seeber, Katharina; Aberer, Werner; Krause, Robert; Hoenigl, Martin

2014-04-01

375

Consensus strategy to quantitate malignant cells in myeloma patients is validated in a multicenter study. Belgium-Dutch Hematology-Oncology Group  

Microsoft Academic Search

Recently the Belgium-Dutch Hematology-Oncology group initiated a\\u000a multicenter study to evaluate whether myeloma patients treated with\\u000a intensive chemotherapy benefit from additional peripheral stem cell\\u000a transplantation. To determine treatment response accurately, we decided to\\u000a quantitate malignant cells. To test a consensus quantitation strategy, 5\\u000a centers independently determined the immunoglobulin heavy chain sequences\\u000a of patient tumor cells and developed allele-specific oligonucleotides\\u000a (ASO)

P. Willems; P. Veenhuizen; H. Lokhorst; J. Guikema; L. Groothuis; P. Sonneveld; R. Raymakers; T. B. Jong; H. Kok; E. Mensink; A. Bloem; E. Vellenga; Schoot van der E; N. Bos; O. Verhagen; C. Segeren; E. A. C. Wiemer

2000-01-01

376

Surgical outcome in patients with cervical ossified posterior longitudinal ligament: A single institutional experience  

PubMed Central

Objective: Ossification of the posterior longitudinal ligament (OPLL) is a complex multi-factorial disease process having both metabolic and biomechanical factors. The role of surgical intervention as well as the choice of approach weather anterior or posterior is ambiguous. The objective of this study was to assess the surgical out come and post operative functional improvement in patients with cervical OPLL at a tertiary care centre. Patients and Methods: This prospective study included 63 patients of cervical OPLL who underwent either anterior and/or posterior surgeries in Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad between June 2009 to May 2011. Patient's data including age, sex, pre and post operative functional status, radiographic findings and OPLL subtypes were recorded and analyzed over a follow up ranging up to minimum two years. Results: The mean age of the patients was 51.1 (range 30-80 years) involving 14 women and 49 men. Out of 63 patients, 14 patients underwent surgery by anterior approach (corpectomy and fusion) and all of them improved (P = 0.52). 49 patients underwent surgery by posterior approach where decompressive laminectomy was performed in 40, laminectomy with instrumentation was done in 5, laminoplasty was done in 3 and 1 patient underwent both anterior and posterior surgeries. Of those who underwent posterior surgery, 40 patients improved, 7 remained the same as their preoperative status (who were having signal intensity changes on T2W MRI) and 2 patients deteriorated in the immediate post operative period and then showed gradual improvement. All the patients were followed up for 24 months. The mean pre-operative Nurick grade was 2.82 which later on improved to 2.03 post surgery (P < 0.05). Minor complications included wound infections in two patients (1.26%). Conclusions: Anterior cervical decompression and reconstruction is a safe and appropriate treatment for cervical spondylitic myelopathy in the setting of single or two level OPLL. Laminectomy or laminoplasty is indicated in patients with preserved cervical lordosis having three or more levels of involvement. Younger patients with good pre operative functional status and less than 2 levels of involvement have better outcome following anterior surgery. PMID:25685216

Kommu, Rao; Sahu, B. P.; Purohit, A. K.

2014-01-01

377

Introduction to pediatric oncology  

SciTech Connect

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.

McWhirter, W.R.; Masel, J.P.

1987-01-01

378

Surgical Outcomes after Traumatic Vertebral Fractures in Patients with Ankylosing Spondylitis  

PubMed Central

Objective Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies. Methods Between January 2003 and December 2013, 12 patients with 13 fractures with neurological complications were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. Results A total of 9 cervical and 4 thoracolumbar fractures were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 7 fractures were associated with a hyperextension mechanism. 10 cases resulted in a fracture by minor trauma. Posttraumatic neurological deficits were demonstrated in 11 cases and neurological improvement after surgery was observed in 5 of these cases. Conclusions Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status. PMID:25328647

An, Seong-Bae; Kim, Keung-Nyun; Chin, Dong-Kyu; Kim, Keun-Su; Cho, Yong-Eun

2014-01-01

379

Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients  

PubMed Central

Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive. PMID:22947496

2012-01-01

380

Surgical Approach and Laser Applications in BRONJ Osteoporotic and Cancer Patients  

PubMed Central

Bisphosphonates-related Osteonecrosis of the Jaw (BRONJ) has been reported with increasing frequency in literature over last years, but its therapy is still a dilemma. One hundred ninety patients affected by BRONJ were observed between January 2004 and November 2011 and 166 treated sites were subdivided in five groups on the basis of the therapeutical approach (medical or surgical, traditional or laser-assisted approach, with or without Low Level Laser Therapy (LLLT)). Clinical success has been defined for each treatment performed as clinical improvement or complete mucosal healing. Combination of antibiotic therapy, conservative surgery performed with Er:YAG laser and LLLT applications showed best results for cancer and noncancer patients. Nonsurgical approach performed on 69 sites induced an improvement in 35 sites (50.7%) and the complete healing in 19 sites (27.5%), while surgical approach on 97 sites induced an improvement in 84 sites (86.6%) and the complete healing in 78 sites (80.41%). Improvement and healing were recorded in 31 (81.5%) and 27 (71.5%) out of the 38 BRONJ sites treated in noncancer patients and in 88 (68.75%) and in 69 (53.9%) out of the 128 in cancer patients. PMID:22645701

Vescovi, Paolo; Merigo, Elisabetta; Meleti, Marco; Manfredi, Maddalena; Fornaini, Carlo; Nammour, Samir

2012-01-01

381

Surgical repair of rectovaginal fistulas in patients with Crohn's disease: transvaginal approach.  

PubMed

The surgical management of rectovaginal fistulas complicating Crohn's disease has been associated with unacceptably high failure rates. We sought to modify the available surgical techniques to provide a solution to this challenging problem. Between December 1983 and January 1990, 14 patients with Crohn's disease underwent repair of a rectovaginal fistula. A modified transvaginal approach was employed by the authors. A diverting loop ileostomy was performed on all patients, either as the initial step in the staged management of intractable perianal disease or concurrent with the repair of the rectovaginal fistula. The fistula was completely eradicated in 13 of the 14 women and did not recur during the mean follow-up period of 55.0 months (range, 3-77 months). Intestinal continuity was reestablished in these 13 patients within 6 months after the initial fistula repair. One patient with a very low-lying fistula constituted our only failure. We have found the transvaginal method preferable to the transanal approach because of the relative ease in raising the vaginal flap as compared with a flap of fibrotic and inflamed anorectal mucosa. On the basis of this study, we conclude that a modified transvaginal approach is an effective method for repair of rectovaginal fistulas secondary to Crohn's disease. PMID:1855419

Sher, M E; Bauer, J J; Gelernt, I

1991-08-01

382

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

PubMed

Corynebacterium (C.) macginleyi is a gram positive, lipophilic rod, usually considered a colonizer of skin and mucosal surfaces. Several reports have associated C. macginleyi with ocular infections, such as conjunctivitis and endophthalmitis. However, even if rare, extraocular infections from C. macginleyi may occur, especially among immunocompromised patients and patients with indwelling medical devices. We report herein the first case of surgical site infection by C. macginleyi after orthopaedic surgery for the correction of kyphoscoliosis in a patient with neurofibromatosis type 1. Our patient developed a nodular granulomatous lesion of about two centimetres along the surgical scar, at the level of C4-C5, with purulent discharge and formation of a fistulous tract. Cervical magnetic resonance imaging showed the presence of a two-centimetre fluid pocket in the subcutaneous tissue. Several swabs were collected from the borders of the lesion as well as from the exudate, with isolation of C. macginleyi. The isolate was susceptible to beta-lactams, cotrimoxazole, linezolid, and glycopeptides but resistant to quinolones, third-generation cephalosporins, and erythromycin. Two 30-day courses of antibiotic therapy with amoxicillin/clavulanate (1?g three times/day) and cotrimoxazole (800/160?mg twice a day) were administered, obtaining a complete healing of the lesion. PMID:23819079

Cacopardo, Bruno; Stefani, Stefania; Cardì, Francesco; Cardì, Carlo; Pinzone, Marilia Rita; Nunnari, Giuseppe

2013-01-01

383

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

PubMed Central

Corynebacterium (C.) macginleyi is a gram positive, lipophilic rod, usually considered a colonizer of skin and mucosal surfaces. Several reports have associated C. macginleyi with ocular infections, such as conjunctivitis and endophthalmitis. However, even if rare, extraocular infections from C. macginleyi may occur, especially among immunocompromised patients and patients with indwelling medical devices. We report herein the first case of surgical site infection by C. macginleyi after orthopaedic surgery for the correction of kyphoscoliosis in a patient with neurofibromatosis type 1. Our patient developed a nodular granulomatous lesion of about two centimetres along the surgical scar, at the level of C4-C5, with purulent discharge and formation of a fistulous tract. Cervical magnetic resonance imaging showed the presence of a two-centimetre fluid pocket in the subcutaneous tissue. Several swabs were collected from the borders of the lesion as well as from the exudate, with isolation of C. macginleyi. The isolate was susceptible to beta-lactams, cotrimoxazole, linezolid, and glycopeptides but resistant to quinolones, third-generation cephalosporins, and erythromycin. Two 30-day courses of antibiotic therapy with amoxicillin/clavulanate (1?g three times/day) and cotrimoxazole (800/160?mg twice a day) were administered, obtaining a complete healing of the lesion. PMID:23819079

Cacopardo, Bruno; Stefani, Stefania; Cardì, Francesco; Cardì, Carlo; Nunnari, Giuseppe

2013-01-01

384

Geographic and socioeconomic determinants of participation by elderly patients in surgical oncology trials | accrualnet.cancer.gov  

Cancer.gov

Stewart JH, Russell GB, Howard-McNatt MM, Petro RM, Levine EA, Bell RA. Wake Forest School of Medicine, Winston-Salem, NC; Wake Forest University Baptist Medical Center, Winston-Salem, NC; Wake Forest School of Medicine, Maya Angelou Center for Health Equity, Winston-Salem, NC.. 2012 ASCO Annual Meeting, J Clin Oncol 30, 2012 (suppl abstr 6127). 2012 Jun 01. 2012 Jun 05. Chicago, IL.

385

Surgical creation of aortopulmonary window in selected patients with pulmonary atresia with poorly developed aortopulmonary collaterals and hypoplastic pulmonary arteries  

Microsoft Academic Search

Objective: The morphologic characteristics of the pulmonary circulation vary widely in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals. Although we favor single-stage unifocalization and complete repair as the procedure of choice, a subgroup of patients who meet specific criteria have been treated with initial surgical creation of an aortopulmonary window. Methods: Eighteen patients who were considered

Mark D. Rodefeld; V. Mohan Reddy; Lenardo D. Thompson; Sam Suleman; Phillip C. Moore; David F. Teitel; Frank L. Hanley

2002-01-01

386

The Influence of Nightingale Rounding by the Liaison Nurse on Surgical Patient Families With Attention to Differing Cultural Needs  

Microsoft Academic Search

This article is a tribute to Florence Nightingale whose book Notes on Nursing was published 150 years ago in 1860. Nightingale was a proponent of rounding on patients to ensure their environment contributed to healing. Patients and their families experience greater satisfaction when a registered nurse rounds on them. The liaison nurse provides the connection between a surgical patient and

Priscilla E. Neils

2010-01-01

387

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum  

PubMed Central

This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric?=?0–21; adult 17–99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation. PMID:24506826

2014-01-01

388

Digital multimedia books produced using iBooks Author for pre-operative surgical patient information.  

PubMed

Presenting patients with medical information and ensuring informed consent can be difficult due to patients with varying levels of literacy, physical and mental disabilities and spoken languages. Patients obtaining information from external sources, such as the internet, can also be problematic as the information can be irrelevant, inaccurate or misleading. A patient satisfaction study was performed in order to assess the effectiveness of using ebooks in order to communicate pre and post surgical information to neurosurgical patients. 3 digital books were produced using iBooks Author (a free desktop publishing program designed by Apple) including ACDF (anterior cervical discectomy and fusion), lumbar laminectomy and lumbar discectomy. Each book contained written information organised into sections and chapters along with an array of multimedia elements including 3D animations, interactive diagrams, 3D models of anatomy and patient experience videos. 32 volunteer patients were then presented with the digital books via an iPad during their preoperative assessment and then asked to complete a questionnaire. The results demonstrated a demand for this type of digital presentation of medical information and also showed patients no longer felt the need to seek further information from external sources. PMID:25390936

Briggs, Matthew; Wilkinson, Caroline; Golash, Aprajay

2014-10-01

389

[The surgical treatment of patients with lung cancer and severe cardiovascular disorders].  

PubMed

During the period of 1991--2010 yy 51 patients with lung cancrs were operated on the severe cardiovascular diseases (IHD -- 90%; critical carotid stenosis -- 6%; tricuspidal valve failure -- 2% and the combination of the IHD and aortic valve failure -- 2%). Lung cancer steged I in 17 (33.3%) patients, II in 15 (29.4%); III - in 16 (31.4%) and IV in 3 (5.9%) patients. 33 patients of 51 were radically operated on lung cancer, palliative resections were performed in 3; trial thoracotomies were performed in 2 patients. 8 (15.7%) patients were operated on simultaneously. The complicated postoperative period was registered in 22 (57.9%) patients of 38 with exitus lethalis in 2 cases. The complication rate after simultaneous operation was 62.5% with lethality of 12.5%, whereas by the consecutive operations the complication rate was 56.7% with lethality of 3.3%, Nevertheless, surgical correction of the severe concurrent cardiovascular pathology flares the range of operable patients with lung cancer. PMID:22968499

Davydov, M I; Akchurin, R S; Gerasimov, S S; Brand, Ia B; Dolgov, I M

2012-01-01

390

Surgical correction of microstomia in a patient with antilaminin 332 mucous membrane pemphigoid.  

PubMed

Microstomia is a term used to describe a small oral aperture. Most of the reported cases are caused by scar contracture after facial trauma, burn injury, and tumor excision. We experienced a rare case of microstomia in a patient with antilaminin 332 mucous membrane pemphigoid, which was an acquired autoimmune disease and showed blisters and erosive lesions mainly on the mucous membranes. The patient had recurrent aphthous stomatitis and presented microstomia caused by scar contracture of oral mucosa. We surgically corrected microstomia by 5-flap Z-plasty for commissuroplasty and 2 Z-plasty of both upper and lower lips for an enlargement of oral aperture. The patient could achieve an enough oral aperture and was satisfied with the result. There was no recurrence of microstomia for 2 years. PMID:23486114

Sato, Hideyoshi; Toriyama, Kazuhiro; Yagi, Shunjiro; Takanari, Keisuke; Takama, Hiroyuki; Sawada, Masaki; Hashimoto, Takashi; Kamei, Yuzuru

2014-05-01

391

Impact of surgical shape on blood flow pattern for patient specific coronary artery bypass graft (CABG) surgery  

NASA Astrophysics Data System (ADS)

We present a numerical framework for studying blood flow patterns in patients who have undergone coronary artery bypass surgeries. We use a stabilized finite element framework for performing blood flow simulations. Specialized lumped parameter boundary conditions for the coronary arteries, aorta and its branches are utilized. Computational models of CABG patients are constructed from CT scan images. A comprehensive study of how surgical shape affects hemodynamics in patient-specific CABG surgery has not been performed till date. The objective of this work is to study the effect of surgical geometry on blood flow pattern, especially downstream and in the proximity of the suture locations of the bypass graft. Quantities such as energy efficiency, wall shear stresses and its gradients and oscillatory shear index are extracted and compared for different surgical shapes in a systematic fashion. A framework and results for robust optimization of bypass graft anastomoses in unsteady flow will be presented. Implications of surgical geometry on graft patency will be discussed.

Sankaran, Sethuraman; Marsden, Alison

2010-11-01

392

Adverse Clinical and Economic Outcomes Attributable to Methicillin Resistance among Patients with Staphylococcus aureus Surgical Site Infection  

Microsoft Academic Search

Data for 479 patients were analyzed to assess the impact of methicillin resistance on the outcomes of patients with Staphylococcus aureus surgical site infections (SSIs). Patients infected with methicillin-resistant S. aureus (MRSA) had a greater 90-day mortality rate than did patients infected with methicillin-susceptible S. aureus (MSSA; adjusted odds ratio, 3.4; 95% confidence interval, 1.5-7.2). Patients infected with MRSA had

John J. Engemann; Yehuda Carmeli; Sara E. Cosgrove; Vance G. Fowler; Melissa Z. Bronstein; Sharon L. Trivette; Jane P. Briggs; Daniel J. Sexton; Keith S. Kaye

2003-01-01

393

Surgical Correction Is Ineffective for Improvement of Dyssynergic Defecation in Patients With Rectal Prolapse  

PubMed Central

Background/Aims The patients with rectal prolapse suffer from not only a prolapse rectum but also associated dysfunction. However, most surgical techniques are successful regarding the prolapse, but either do not solve or even worsen defecation dysfunction. The purpose of this study was to investigate the functional and physiological results after surgical correction in patients with rectal prolapse. Methods This study is a retrospective review of a single-institution experience. Patients with rectal prolapse who underwent anorectal manometry before and after Delorme's procedure were included. The primary outcomes measured were improvement of clinical symptoms and physiologic study. Results Consecutive 19 patients with rectal prolapse (17 females, mean age of 68.1 ± 10.8 years) underwent anorectal manometry before and after Delorme's procedure. The two most prevalent symptoms before operation were rectal tenesmus (15/19, 78.9%) and excessive straining (13/19, 68.4%). The two most prevalent symptoms after operation were rectal tenesmus (14/19, 73.6%) and excessive straining (13/19, 68.4%). No significant differences in resting anal pressure, squeezing anal pressure, defecation index, and rectal sense were found postoperatively. However, vector asymmetry index before surgery was higher than that after surgery (35.0 vs. 32.0, P = 0.018). Ten patients (52.5%) had type I dyssynergic defecation before surgery. No improvement of dyssynergic pattern occurred after surgery. Conclusions In conclusion, dyssynergic defecation was not improved after reduction of rectal prolapse in patients with rectal prolapse. Further study about combination treatment with biofeedback therapy in these subgroups may be necessary. PMID:23350052

Park, Seon-Young; Cho, Sung-Bum; Park, Chang-Hwan; Joo, Jae-Kyun; Joo, Young-Eun; Kim, Hyun-Soo; Choi, Sung-Kyu

2013-01-01

394

Endoscopic ultrasound-guided biliary intervention in patients with surgically altered anatomy  

PubMed Central

AIM: To evaluate the efficacy of endoscopic ultrasound guided biliary drainage (EUS-BD) in patients with surgically altered anatomies. METHODS: We performed a search of the MEDLINE database for studies published between 2001 to July 2014 reporting on EUS-BD in patients with surgically altered anatomy using the terms “EUS drainage” and “altered anatomy”. All relevant articles were accessed in full text. A manual search of the reference lists of relevant retrieved articles was also performed. Only full-text English papers were included. Data regarding age, gender, diagnosis, method of EUS-BD and intervention, type of altered anatomy, technical success, clinical success, and complications were extracted and collected. Anatomic alterations were categorized as: group 1, Billroth?I; group 2, Billroth II; group 4, Roux-en-Y with gastric bypass; and group 3, all other types. RESULTS: Twenty three articles identified in the literature search, three reports were from the same group with different numbers of cases. In total, 101 cases of EUS-BD in patients with altered anatomy were identified. Twenty-seven cases had no information and were excluded. Seventy four cases were included for analysis. Data of EUS-BD in patients categorized as group 1, 2 and 4 were limited with 2, 3 and 6 cases with EUS-BD done respectively. Thirty four cases with EUS-BD were reported in group 3. The pooled technical success, clinical success, and complication rates of all reports with available data were 89.18%, 91.07% and 17.5%, respectively. The results are similar to the reported outcomes of EUS-BD in general, however, with limited data of EUS-BD in patients with altered anatomy rendered it difficult to draw a firm conclusion. CONCLUSION: EUS-BD may be an option for patients with altered anatomy after a failed endoscopic-retrograde-cholangiography in centers with expertise in EUS-BD procedures in a research setting. PMID:25789101

Siripun, Aroon; Sripongpun, Pimsiri; Ovartlarnporn, Bancha

2015-01-01

395

'Thinking outside the box': complementary and alternative therapies use in paediatric oncology patients.  

PubMed

The aim of this study was to determine the prevalence of complementary and alternative medicine (CAM) use among children with cancer who had received or were receiving treatment at a large hospital in the UK, including the identification of the most commonly used therapies and parental motives for doing so. Using a cross-sectional survey design, questionnaires were sent to parents of paediatric patients diagnosed with cancer. Of the 49 respondents, 32.7% reported using some type of CAM. The most commonly used therapies included multivitamins, aromatherapy massage, diets and music as therapy. Most children had used more than one therapy. Many of the factors that motivated parents to use CAM were related to helping or supporting their child's medical treatment. The main benefits identified from using CAM included increased confidence, pain relief and relaxation. The longer the time since diagnosis the more children tended to use CAM. The reasons for parents not using CAM included the child doing well and therefore not seeing the need for CAM use; not being aware of CAM; CAM not being offered and lack of information available. Parents identified a need for more information to be available both at ward level and for information about CAM to be discussed by medical staff, particularly at the start of treatment. The results indicate that CAM is frequently used by children and young people with cancer and that their use plays a substantial role in helping children through their conventional cancer treatment. PMID:15003744

Molassiotis, Alexander; Cubbin, Denise

2004-03-01

396

Diffusion of Surgical Innovations, Patient Safety, and Minimally Invasive Radical Prostatectomy  

PubMed Central

IMPORTANCE Surgical innovations disseminate in the absence of coordinated systems to ensure their safe integration into clinical practice, potentially exposing patients to increased risk for medical error. OBJECTIVE To investigate associations of patient safety with the diffusion of minimally invasive radical prostatectomy (MIRP) resulting from the development of the da Vinci robot. DESIGN, SETTING, AND PARTICIPANTS A cohort study of 401 325 patients in the Nationwide Inpatient Sample who underwent radical prostatectomy during MIRP diffusion between January 1, 2003, and December 31, 2009. MAIN OUTCOMES AND MEASURES We used Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs), which measure processes of care and surgical provider performance. We estimated the prevalence of MIRP among all prostatectomies and compared PSI incidence between MIRP and open radical prostatectomy in each year during the study. We also collected estimates of MIRP incidence attributed to the manufacturer of the da Vinci robot. RESULTS Patients who underwent MIRP were more likely to be white (P = .004), have fewer comorbidities (P = .02), and have undergone surgery in higher-income areas (P = .005). The incidence of MIRP was substantially lower than da Vinci manufacturer estimates. Rapid diffusion onset occurred in 2006, when MIRP accounted for 10.4% (95% CI, 10.2-10.7) of all radical prostatectomies in the United States. In 2005, MIRP was associated with an increased adjusted risk for any PSI (adjusted odds ratio, 2.0; 95% CI, 1.1-3.7; P = .02) vs open radical prostatectomy. Stratification by hospital status demonstrated similar patterns: rapid diffusion onset among teaching hospitals occurred in 2006 (11.7%; 95% CI, 11.3-12.0), with an increased risk for PSI for MIRP in 2005 (adjusted odds ratio, 2.7; 95% CI, 1.4-5.3; P = .004), and onset among nonteaching hospitals occurred in 2008 (27.1%; 95% CI, 26.6-27.7), with an increased but nonsignificant risk for PSI in 2007 (adjusted odds ratio, 2.0; 95% CI, 0.8-5.2; P = .14). CONCLUSIONS AND RELEVANCE During its initial national diffusion, MIRP was associated with diminished perioperative patient safety. To promote safety and protect patients, the processes by which surgical innovations disseminate into clinical practice require refinement. PMID:24990549