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Sample records for accurate preoperative assessment

  1. Preoperative assessment and premedication in paediatrics.

    PubMed

    Lerman, Jerrold

    2013-11-01

    Preoperative assessment and premedication represent important preparatory steps to ensuring a smooth and effective induction of anaesthesia. A thorough review of the child's medical history, previous anaesthetics, medications, allergies and family history is essential to design the optimal anaesthetic for the child and his/her surgery. Risks must be addressed with the parents as appropriate based on the local standards. Preoperative anxiolysis may assume several strategies, with premedication with a pharmacologic agent very common and most successful. This review focuses on the preoperative assessment and premedication for children undergoing elective surgery.

  2. [CT in preoperative assessment of renal tumors?].

    PubMed

    Lanng, C; Bowall, P; Egeblad, M; Meyhoff, H H

    1992-04-13

    The value of CT-scanning as part of the preoperative morphological investigation of patients with renal tumours was calculated in a material of 28 patients. In eight patients, operative treatment was not found to be indicated. In the 20 patients in whom operation was undertaken, the operative and histological findings were compared with the findings on CT-scanning. In cases of disagreement, the CT-scanning findings were reassessed. It was found that interpretation of the CT-scan was accurate in 40% of the cases while minor disagreements were present in 25% but these did not have any significance for the indications for operation. In the remaining 35% considerable disagreement was found between the CT-scan and the operative or histological findings such as invasion of neighbouring organs, cysts interpreted as solid tumours with necrosis and as regards interpretation of the retroperitoneal glands. The present authors consider that CT-scanning provides an important supplement to the conventional morphological investigation of renal tumours with intravenous urography and radiography of the thorax. CT-scanning appears to be preferable to ultrasonic scanning in cases which are difficult to review and where expert interpretation of ultrasonic findings is not available. In addition, routine preoperative biopsy of the tumour guided by ultrasound is recommended together with peroperative biopsy for freeze microscopic examination prior to nephrectomy.

  3. Pancoast tumors: characteristics and preoperative assessment

    PubMed Central

    Panagopoulos, Nikolaos; Leivaditis, Vasilios; Koletsis, Efstratios; Prokakis, Christos; Alexopoulos, Panagiotis; Baltayiannis, Nikolaos; Hatzimichalis, Antonios; Tsakiridis, Kosmas; Zarogoulidis, Konstantinos; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Kesisis, Georgios; Siminelakis, Stavros; Madesis, Athanasios; Dougenis, Dimitrios

    2014-01-01

    Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner’s syndrome (ptosis, miosis, and anhidrosis) and atrophy of the intrinsic hand muscles comprises a clinical entity named as “Pancoast-Tobias syndrome”. Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment. PMID:24672686

  4. Primary leiomyoma of the liver: accurate preoperative diagnosis on liver biopsy

    PubMed Central

    Sousa, Helena T; Portela, Francisco; Semedo, Luis; Furtado, Emanuel; Marinho, Carol; Cipriano, Maria A; Leitão, Maximino C

    2009-01-01

    Primary leiomyoma of the liver is an exceptionally rare tumour in non-immunocompromised patients. Preoperative diagnosis of the lesion is difficult as complete imaging of this type of lesion is scarcely defined and preoperative biopsy was not the practice in previously reported cases. We report a voluminous primary leiomyoma of the liver occurring in a healthy middle-aged woman where a preoperative diagnosis was accurately achieved on biopsy. Because of its size, surgery was undertaken for exclusion of malignancy. A 16-month uneventful follow-up has been completed. We discuss the advantage of a preoperative diagnosis and propose that an imaging-guided liver biopsy should be undertaken, provided malignancy features are absent. This could prevent liver surgery merely for diagnostic purposes. Finally, we report imaging features that have not been previously described, namely on magnetic resonance imaging, which may provide an insight about the nature of this particular lesion and, advantageously, contribute toward a non-invasive diagnosis. PMID:21686574

  5. Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic

    PubMed Central

    Tariq, Hassan; Ahmed, Rafeeq; Kulkarni, Salil; Hanif, Sana; Toolsie, Omesh; Abbas, Hafsa; Chilimuri, Sridhar

    2016-01-01

    Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care. Although there are several constraints in the development of PAT clinics, with increasing awareness about the usefulness of pre-operative risk assessments, growing bodies of literature, and evidence-based guidelines, these clinics are becoming a medical necessity for the improvement of perioperative care. PMID:27812286

  6. An evaluation of factors influencing the assessment time in a nurse practitioner-led anaesthetic pre-operative assessment clinic.

    PubMed

    Hawes, R H; Andrzejowski, J C; Goodhart, I M; Berthoud, M C; Wiles, M D

    2016-03-01

    Elective patients undergoing anaesthetic pre-operative assessment are usually allocated the same period of time with a nurse practitioner, leading to potential inefficiencies in patient flow through the clinic. We prospectively collected data on 8519 patients attending a pre-operative assessment clinic. The data set were split into derivation and validation cohorts. Standard multiple regressions were used to construct a model in the derivation cohort, which was then tested in the validation cohort. Due to missing data, 2457 patients were not studied, leaving 5892 for analysis (3870 in the derivation cohort and 2022 in the validation cohort). The mean (SD) pre-operative assessment time was 46 (12) min. Age, ASA physical status, nurse practitioner and surgical specialty all influenced the time spent in pre-operative assessment. The predictive equations calculated using the derivation cohort, based on age and ASA physical status, correctly estimated duration of consultation to within 20% of the maximum predicted time in 74.2% of the validation cohort. We conclude that if age and ASA physical status are known before the pre-operative assessment consultation, it could allow appointment times to be allocated more accurately.

  7. Preoperative graft assessment in aortocoronary bypass surgery

    PubMed Central

    Tinica, Grigore; Vartic, Cristina Luca; Mocanu, Veronica; Baran, Dana; Butcovan, Doina

    2016-01-01

    Coronary artery bypass graft (CABG) is a surgical procedure able to improve the blood supply to the myocardium. In the present study, the distal segments of grafts taken from the internal thoracic artery (ITA), radial artery (RA) and saphenous vein (SV) for use in aortocoronary bypass surgery were examined. The morphologies of the grafts were investigated in order to draw conclusions concerning their patency and viability. In addition, clinical and laboratory risk factors considered to be significant predictors of lesion severity in graft vessels used in CABGs were investigated. In total, 54 distal graft segments of ITAs, RAs and SVs from 20 men and 6 women aged between 42 and 78 years, were evaluated. Histological analyses were used to visualize graft lesions. Morphometrically, the intimal thickness index (ITI) and luminal narrowing were assessed as an indication of graft patency. The histological changes observed in the graft vessel walls included the presence of distinct atheromatous plaques (fatty streaks in 2 cases) or thickening of the intima (20 cases) and media (17 cases). Morphometric analysis showed that the mean ITI of the vessel conduits was 0.37 in the SVs, 0.95 in the RAs, and 1.66 in the ITAs. No patient had >50% conduit stenosis. By assessing the association between risk factors and graft lesions, it was found that all the patients showed risk factors for atherosclerosis, such as age (61.54%), arterial hypertension (65.38%), hyperlipidemia (65.38%), smoking (34.61%), diabetes mellitus (38.46%) and obesity (15.38%). The presence of pre-existing lesions in bypass grafts may contribute to a reduction in their viability, particularly in the case of venous grafts. Further long-term follow-ups are mandatory to evaluate the consequences of such lesions upon the patency of the grafts. PMID:27446279

  8. Characteristics and Prognostic Significance of Preoperative Magnetic Resonance Imaging-Assessed Circumferential Margin in Rectal Cancer.

    PubMed

    Ma, Xiaoji; Li, Xinxiang; Xu, Linghui; Shi, Debing; Tong, Tong; Huang, Dan; Ding, Ying; Cai, Sanjun; Peng, Junjie

    2015-01-01

    Purpose. To study the characteristics and prognostic significance of preoperative magnetic resonance imaging- (MRI-) assessed circumferential margin (CRM) in rectal cancer. Methods. Patients underwent preoperative high resolution pelvic MRI, followed by resection of primary tumor. The relationship between MRI-assessed CRM and pathological CRM (pCRM) was studied, and survival analysis was used to determine the prognostic significance of MRI-assessed CRM. Results. Of all the 203 patients, the total accuracy of MRI-assessed CRM for predicting involvement of pCRM was 84.2%, sensitivity was 50%, and specificity was 86.8%. Anterior tumors were more possible to assess involvement of CRM by MRI, while the false positive rate was significantly higher than lateral or posterior tumor (87.5% versus 50%, p = 0.0002). The 3-year local recurrence, disease-free survival, and overall survival rates were 35.6%, 58.1%, and 85.2% in patients with involved mrCRM, compared with 8.9%, 78.9%, and 92.3% in patients with clear mrCRM. In multivariate analysis, MRI-assessed CRM found an independent risk factor for local recurrence, with a hazard ratio of 3.49 (p = 0.003). Conclusions. High resolution MRI was accurate to assess CRM preoperatively, while anterior tumor should be assessed more cautiously. Involvement of mrCRM was significantly associated with local recurrence regardless of pCRM status.

  9. The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema.

    PubMed

    Sun, Fangdi; Skolny, Melissa N; Swaroop, Meyha N; Rawal, Bhupendra; Catalano, Paul J; Brunelle, Cheryl L; Miller, Cynthia L; Taghian, Alphonse G

    2016-06-01

    Breast cancer-related lymphedema (BCRL) is a feared outcome of breast cancer treatment, yet the push for early screening is hampered by a lack of standardized quantification. We sought to determine the necessity of preoperative baseline in accounting for temporal changes of upper extremity volume. 1028 women with unilateral breast cancer were prospectively screened for lymphedema by perometry. Thresholds were defined: relative volume change (RVC) ≥10 % for clinically significant lymphedema and ≥5 % including subclinical lymphedema. The first postoperative measurement (pseudo-baseline) simulated the case of no baseline. McNemar's test and binomial logistic regression models were used to analyze BCRL misdiagnoses. Preoperatively, 28.3 and 2.9 % of patients had arm asymmetry of ≥5 and 10 %, respectively. Without baseline, 41.6 % of patients were underdiagnosed and 40.1 % overdiagnosed at RVC ≥ 5 %, increasing to 50.0 and 54.8 % at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, increased weight change between baselines, hormonal therapy, dominant use of contralateral arm, and not receiving axillary lymph node dissection (ALND) were associated with increased risk of underdiagnosis at RVC ≥ 5 %; not receiving regional lymph node radiation was significant at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, not receiving ALND, and dominant use of ipsilateral arm were associated with overdiagnosis at RVC ≥ 5 %; increased pseudo-baseline asymmetry and not receiving ALND were significant at RVC ≥ 10 %. The use of a postoperative proxy even early after treatment results in poor sensitivity for identifying BCRL. Providers with access to patients before surgery should consider the consequent need for proper baseline, with specific strategy tailored by institution. PMID:27154787

  10. Preoperative Planning and Intraoperative Technique for Accurate Translation of a Distal First Metatarsal Osteotomy.

    PubMed

    Wynes, Jacob; Lamm, Bradley M; Andrade, Bijan J; Malay, D Scot

    2016-01-01

    We used preoperative radiographic and intraoperative anatomic measurements to predict and achieve, respectively, the precise amount of capital fragment lateral translation required to restore anatomic balance to the first metatarsophalangeal joint. Correlation was used to relate the amount of capital fragment translation and operative reduction of the first intermetatarsal angle (IMA), hallux abductus angle (HAA), tibial sesamoid position (TSP), metatarsus adductus angle, and first metatarsal length. The mean capital fragment lateral translation was 5.54 ± 1.64 mm, and the mean radiographic reductions included a first IMA of 5.04° ± 2.85°, an HAA of 9.39° ± 8.38°, and a TSP of 1.38 ± 0.9. These changes were statistically (p < .001) and clinically (≥32.55%) significant. The mean reduction of the metatarsus adductus angle was 0.66° ± 4.44° and that for the first metatarsal length was 0.33 ± 7.27 mm, and neither of these were statistically (p = .5876 and 0.1247, respectively) or clinically (≤3.5%) significant. Pairwise correlations between the amount of lateral translation of the capital fragment and the first IMA, HAA, and TSP values were moderately positive and statistically significant (r = 0.4412, p = .0166; r = 0.5391, p = .0025; and r = 0.3729, p = .0463; respectively). In contrast, the correlation with metatarsus adductus and the first metatarsal shortening were weak and not statistically significant (r = 0.2296, p = .2308 and r = -0.2394, p = .2109, respectively). The results of our study indicate that predicted preoperative and executed intraoperative lateral translation of the capital fragment correlates with statistically and clinically significant reductions in the first IMA, HAA, and TSP.

  11. Preoperative Assessment of Cancer Patients with Peritoneal Metastases for Complete Cytoreduction.

    PubMed

    Sugarbaker, Paul H

    2016-09-01

    The purpose of this manuscript is to critically evaluate the preoperative assessments of peritoneal metastases described to date. Recommendations regarding use of current modalities and an assessment of their reliability will be made. PMID:27651688

  12. Improving patient flow in pre-operative assessment

    PubMed Central

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  13. Improving patient flow in pre-operative assessment.

    PubMed

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  14. Anesthesia management during aortic surgery: Preoperative patient assessment.

    PubMed

    Mahlmann, Adrian; Weiss, Norbert

    2016-09-01

    Patients with aortic diseases have a high rate of cardiac, cerebrovascular, or pulmonary comorbidities. Open surgery or endovascular interventions of the aorta are associated with high perioperative cardiac risk. Simple scoring systems for preoperative risk stratification can be used to identify high-risk patients. In these patients, further diagnostic and therapeutic interventions are required to reduce perioperative morbidity and mortality. In contrast, low-risk patients can be identified, who may proceed to intervention without additional cardiopulmonary diagnostic testing. According to evidence-based recommendations in patients at risk, statin therapy should be initiated and beta blockers should be uptitrated preoperatively. Smoking cessation preoperatively reduces perioperative complications and should be encouraged in all patients. PMID:27650337

  15. Comparing the organisational structure of the preoperative assessment clinic at eight university hospitals.

    PubMed

    Edward, G M; Biervliet, J D; Hollmann, M W; Schlack, W S; Preckel, B

    2008-01-01

    The preoperative assessment clinic (PAC) has been implemented in most major hospitals. However, there is no uniformity in the way PACs are organised. We compared the organisational structure of the PACs from all eight university hospitals in The Netherlands, looking at the following variables: number of patients visiting the PAC, staffing of the PAC, opening hours, scheduling, and additional preoperative diagnostic testing. The number of patients seen yearly varies from 7.000 to 13.500. In all clinics, the preoperative assessment was performed by anaesthetists and residents. In five PACs, preoperative assessment was also performed by physician assistants or nurse practitioners. Opening hours varied. Consultations are by appointment, 'walk-in', or a combination of these two. In four clinics additional testing is performed at the PAC itself. This study shows that the organisational structure of the PAC at similar university hospitals varies greatly; this can have important implications when designing a benchmarking process.

  16. Preoperative color Doppler assessment in planning of gluteal perforator flaps.

    PubMed

    Isken, Tonguc; Alagoz, M Sahin; Onyedi, Murat; Izmirli, Hakki; Isil, Eda; Yurtseven, Nagehan

    2009-02-01

    Gluteal artery perforator flaps have gained popularity due to reliability, preservation of the muscle, versatility in flap design without restricting other flap options, and low donor-site morbidity in ambulatory patients and possibility of enabling future reconstruction in paraplegic patients. But the inconstant anatomy of the vascular plexus around the gluteal muscle makes it hard to predict how many perforators are present, what their volume of blood flow and size are, where they exit the overlying fascia, and what their course through the muscle will be. Without any prior investigations, the reconstructive surgeon could be surprised intraoperatively by previous surgical damage, scar formation, or anatomic variants.For these reasons, to confirm the presence and the location of gluteal perforators preoperatively we have used color Doppler ultrasonography. With the help of the color Doppler ultrasonography 26 patients, 21 men and 5 women, were operated between the years 2002 and 2007. The mean age of patients was 47.7 (age range: 7-77 years). All perforator vessels were marked preoperatively around the defect locations. The perforator based flap that will allow primary closure of the donor site and the defect without tension was planned choosing the perforator that showed the largest flow in color Doppler ultrasonography proximally. Perforators were found in the sites identified with color Doppler ultrasonography in all other flaps. In our study, 94.4% flap viability was ensured in 36 perforator-based gluteal area flaps. Mean flap elevation time was 31.9 minutes. We found that locating the perforators preoperatively helps to shorten the operation time without compromising a reliable viability of the perforator flaps, thus enabling the surgeon easier treatment of pressure sores.

  17. Location of residence associated with the likelihood of patient visit to the preoperative assessment clinic

    PubMed Central

    Seidel, Judy E; Beck, Cynthia A; Pocobelli, Gaia; Lemaire, Jane B; Bugar, Jennifer M; Quan, Hude; Ghali, William A

    2006-01-01

    Background Outpatient preoperative assessment clinics were developed to provide an efficient assessment of surgical patients prior to surgery, and have demonstrated benefits to patients and the health care system. However, the centralization of preoperative assessment clinics may introduce geographical barriers to utilization that are dependent on where a patient lives with respect to the location of the preoperative assessment clinic. Methods The association between geographical distance from a patient's place of residence to the preoperative assessment clinic, and the likelihood of a patient visit to the clinic prior to surgery, was assessed for all patients undergoing surgery at a tertiary health care centre in a major Canadian city. The odds of attending the preoperative clinic were adjusted for patient characteristics and clinical factors. Results Patients were less likely to visit the preoperative assessment clinic prior to surgery as distance from the patient's place of residence to the clinic increased (adjusted OR = 0.52, 95% CI 0.44–0.63 for distances between 50–100 km, and OR = 0.26, 95% CI 0.21–0.31 for distances greater than 250 km). This 'distance decay' effect was remarkable for all surgical specialties. Conclusion The present study demonstrates that the likelihood of a patient visiting the preoperative assessment clinic appears to depend on the geographical location of patients' residences. Patients who live closest to the clinic tend to be seen more often than patients who live in rural and remote areas. This observation may have implications for achieving the goals of equitable access, and optimal patient care and resource utilization in a single universal insurer health care system. PMID:16504058

  18. Preoperative assessment and planning of haemodialysis vascular access.

    PubMed

    Lomonte, Carlo; Basile, Carlo

    2015-06-01

    Effective haemodialysis (HD) requires a reliable vascular access (VA). Clinical practice guidelines strongly recommend the arteriovenous fistula (AVF) as the preferred VA in HD patients. The creation of an AVF should be promoted in all eligible patients who choose HD, as it improves outcomes and reduces costs when compared with central venous catheters. Fistula eligibility is a 'work in progress'. Three steps in order to increase the pool of eligible patients can be individualized: (i) process of care, which includes three fundamental items: the VA team, early VA education and timely VA surgery referral; (ii) preoperative evaluation; (iii) surgical strategy. Nephrologists should be able to play a leading and coordinating role of the VA team. They should design a plan that identifies a sequence of options that can be used to provide adequate renal replacement therapy throughout the life span of every end-stage renal disease patient. The main points of this strategy are (i) early vascular education, in which a 'save the vein program' should always be implemented; (ii) timely VA surgery referral and preoperative evaluation: careful examination of arterial and venous beds is mandatory before VA placement; physical examination in addition to colour Doppler ultrasound mapping improves AVF outcomes; (iii) surgical strategy: a successful VA strategy must take into account vascular anatomy, clinical factors and prognosis.

  19. The Role of the Nurse and the Preoperative Assessment in Patient Transitions

    PubMed Central

    MALLEY, ANN; KENNER, CAROLE; KIM, TIFFANY; BLAKENEY, BARBARA

    2015-01-01

    Transitions in care in the perioperative environment are numerous and should be considered high-risk endeavors. The preoperative area is the first transition in care for a surgical patient and should be considered a critical dimension of care transition. The purposes of this study were to identify nursing’s contributions to transitions in care in the perioperative environment and to identify the role of the preoperative assessment in this transition. Qualitative descriptive design was used. Focus groups were conducted with 24 nurses in a 975-bed medical center. The themes that arose in the focus groups were: (1) understanding patient vulnerabilities, (2) multidimensional communication, (3) managing patients’ expectations, and (4) nursing’s role in compensating for gaps. We conclude that the nurse’s role in the preoperative assessment during the transition of preoperative care is that of advocate who identifies the patient’s needs and risk factors that may be affected by the surgical experience. This study suggests that the nursing preoperative assessment can be useful in identifying and defining patients’ risk factors not just for surgery, but for the entire perioperative care trajectory. PMID:26227526

  20. Computed tomography evaluation of the adrenal gland in the preoperative assessment of bronchogenic carcinoma

    SciTech Connect

    Sandler, M.A.; Pearlberg, J.L.; Madrazo, B.L.; Gitschlag, K.F.; Gross, S.C.

    1982-12-01

    One hundred ten patients with proved bronchogenic carcinoma who were undergoing computed tomography (CT) of the thorax also underwent CT of the adrenals to determine the value of routine preoperative assessement of this gland. Sixteen adrenal masses were found in 11 patients. In five patients the adrenals were the only site of metastasis. CT of the adrenals should be performed routinely when the thorax is examined pre-operatively in patients with non-oat-cell bronchogenic carcinoma to improve patient selection for thoractomy.

  1. Preoperative psychological assessment of patients seeking weight-loss surgery: identifying challenges and solutions

    PubMed Central

    Edwards-Hampton, Shenelle A; Wedin, Sharlene

    2015-01-01

    Preoperative psychosocial assessment is the standard of care for patients seeking weight-loss surgery (WLS). However, the assessment procedure varies widely by surgery site. Comprehensive assessments can provide a wealth of information that assists both the patient and the treatment team, anticipate and prepare for challenges associated with extensive behavioral and lifestyle changes that are required postsurgery. In this review, we provide an overview of the purpose of the preoperative psychosocial assessment and domains to be included. Challenges commonly identified in the assessment are discussed, including maladaptive eating behaviors, psychiatric comorbidities, and alcohol use. Potential solutions and approaches to these challenges are provided. Additionally, patient populations requiring special consideration are presented to include adolescents, those with cognitive vulnerabilities, and aging adults. PMID:26604844

  2. Pre-Operative Assessment and Post-Operative Care in Elective Shoulder Surgery

    PubMed Central

    Akhtar, Ahsan; MacFarlane, Robert J; Waseem, Mohammad

    2013-01-01

    Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery. PMID:24093051

  3. What's Normal? Accurately and Efficiently Assessing Menstrual Function.

    PubMed

    Takemoto, Darcie M; Beharry, Meera S

    2015-09-01

    Many young women are unsure of what constitutes normal menses. By asking focused questions, pediatric providers can quickly and accurately assess menstrual function and dispel anxiety and myths. In this article, we review signs and symptoms of normal versus pathologic menstrual functioning and provide suggestions to improve menstrual history taking.

  4. Can blind persons accurately assess body size from the voice?

    PubMed

    Pisanski, Katarzyna; Oleszkiewicz, Anna; Sorokowska, Agnieszka

    2016-04-01

    Vocal tract resonances provide reliable information about a speaker's body size that human listeners use for biosocial judgements as well as speech recognition. Although humans can accurately assess men's relative body size from the voice alone, how this ability is acquired remains unknown. In this study, we test the prediction that accurate voice-based size estimation is possible without prior audiovisual experience linking low frequencies to large bodies. Ninety-one healthy congenitally or early blind, late blind and sighted adults (aged 20-65) participated in the study. On the basis of vowel sounds alone, participants assessed the relative body sizes of male pairs of varying heights. Accuracy of voice-based body size assessments significantly exceeded chance and did not differ among participants who were sighted, or congenitally blind or who had lost their sight later in life. Accuracy increased significantly with relative differences in physical height between men, suggesting that both blind and sighted participants used reliable vocal cues to size (i.e. vocal tract resonances). Our findings demonstrate that prior visual experience is not necessary for accurate body size estimation. This capacity, integral to both nonverbal communication and speech perception, may be present at birth or may generalize from broader cross-modal correspondences. PMID:27095264

  5. Preoperative Assessment of Serum Albumin Level as Risk Factor for Morbidity Following Routine Oncological Surgery.

    PubMed

    Bhuiyan, M U

    2016-04-01

    This cross-sectional observational study was to establish the preoperative assessment of serum albumin level as indicator for morbidity following cancer surgery and to reduce the incidence of related postoperative complications. Therefore this study was undertaken to assess the morbidity associated with low serum level albumin and identify it as a risk factor following cancer surgery in Bangladeshi population. This study included 312 patients with malignancy who were waiting for surgery or within 60 days of postoperative period were enrolled for the study from indoor of surgical oncology department, National Institute of Cancer Research & Hospital (NICR&H), Dhaka, Bangladesh. Then the patients were submitted for further study to evaluate the preoperative fitness in terms of nutritional assessment - both clinical and biological especially serum albumin level. All the clinical (pre & post-operative including complication, if any), investigation findings were recorded accordingly. Statistical correlation was discovered between BMI and morbidity but no statistical correlation was found between WL >10% and major surgical complications of either infectious or noninfectious origin (p=NS). Conversely, a substantial statistical correlation was found between Hb% or albumin <30gm/l and major surgical complications (either infectious or noninfectious) (p<0.001). The serum albumin level below 30gm/l is a significant risk factor for oncological postoperative major complications (MC).

  6. Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment

    PubMed Central

    Kluth, L A; Abdollah, F; Xylinas, E; Rieken, M; Fajkovic, H; Seitz, C; Sun, M; Karakiewicz, P I; Schramek, P; Herman, M P; Becker, A; Hansen, J; Ehdaie, B; Loidl, W; Pummer, K; Lee, R K; Lotan, Y; Scherr, D S; Seiler, D; Ahyai, S A; Chun, F K-H; Graefen, M; Tewari, A; Nonis, A; Bachmann, A; Montorsi, F; Gönen, M; Briganti, A; Shariat, S F

    2014-01-01

    Background: Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status. Methods: We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes. Results: In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1–6 nodes in cT1 and 6–8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively. Conclusions: Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis. PMID:25003663

  7. Evaluation of static and dynamic MRI for assessing response of bone sarcomas to preoperative chemotherapy: Correlation with histological necrosis

    PubMed Central

    Amit, Priyadarshi; Malhotra, Atul; Kumar, Rahul; Kumar, Lokesh; Patro, Dilip Kumar; Elangovan, Sundar

    2015-01-01

    Objectives: Preoperative chemotherapy plays a key role in management of bone sarcomas. Postoperative evaluation of histological necrosis has been the gold standard method of assessing response to preoperative chemotherapy. This study was done to evaluate the efficacy of static and dynamic magnetic resonance imaging (MRI) for assessing response preoperatively. Materials and Methods: Our study included 14 patients (12 osteosarcomas and 2 malignant fibrous histiocytomas) with mean age of 21.8 years, treated with preoperative chemotherapy followed by surgery. They were evaluated with static and dynamic MRI twice, before starting chemotherapy and again prior to surgery. Change in tumor volume and slope of signal intensity - time curve were calculated and correlated with percentage of histological necrosis using Pearson correlation test. Results: The change in dynamic MRI slope was significant (P = 0.001). Also, ≥60% reduction in slope of the curve proved to be an indicator of good histological response [positive predictive value (PPV) =80%]. Change in tumor volume failed to show significant correlation (P = 0.071). Although it showed high negative predictive value (NPV = 85.7%), PPV was too low (PPV = 57.14%). Conclusions: Dynamic MRI correctly predicts histological necrosis after administration of preoperative chemotherapy to bone sarcomas. Hence, it can be used as a preoperative indicator of response to neoadjuvant chemotherapy. On the other hand, volumetric assessment by static MRI is not an effective predictor of histological necrosis. This study proves the superiority of dynamic contrast-enhanced study over volumetric study by MRI. PMID:26288521

  8. Accurate assessment and identification of naturally occurring cellular cobalamins

    PubMed Central

    Hannibal, Luciana; Axhemi, Armend; Glushchenko, Alla V.; Moreira, Edward S.; Brasch, Nicola E.; Jacobsen, Donald W.

    2009-01-01

    Background Accurate assessment of cobalamin profiles in human serum, cells, and tissues may have clinical diagnostic value. However, non-alkyl forms of cobalamin undergo β-axial ligand exchange reactions during extraction, which leads to inaccurate profiles having little or no diagnostic value. Methods Experiments were designed to: 1) assess β-axial ligand exchange chemistry during the extraction and isolation of cobalamins from cultured bovine aortic endothelial cells, human foreskin fibroblasts, and human hepatoma HepG2 cells, and 2) to establish extraction conditions that would provide a more accurate assessment of endogenous forms containing both exchangeable and non-exchangeable β-axial ligands. Results The cobalamin profile of cells grown in the presence of [57Co]-cyanocobalamin as a source of vitamin B12 shows that the following derivatives are present: [57Co]-aquacobalamin, [57Co]-glutathionylcobalamin, [57Co]-sulfitocobalamin, [57Co]-cyanocobalamin, [57Co]-adenosylcobalamin, [57Co]-methylcobalamin, as well as other yet unidentified corrinoids. When the extraction is performed in the presence of excess cold aquacobalamin acting as a scavenger cobalamin (i.e., “cold trapping”), the recovery of both [57Co]-glutathionylcobalamin and [57Co]-sulfitocobalamin decreases to low but consistent levels. In contrast, the [57Co]-nitrocobalamin observed in extracts prepared without excess aquacobalamin is undetectable in extracts prepared with cold trapping. Conclusions This demonstrates that β-ligand exchange occurs with non-covalently bound β-ligands. The exception to this observation is cyanocobalamin with a non-covalent but non-exchangeable− CNT group. It is now possible to obtain accurate profiles of cellular cobalamins. PMID:18973458

  9. Diagnostic Laparoscopy in the Pre-operative Assessment of Patients Undergoing Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancies.

    PubMed

    Seshadri, Ramakrishnan Ayloor; Hemanth Raj E

    2016-06-01

    The introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has led to an improvement in the survival of select patients with peritoneal surface malignancies (PSM). However, it is important to carefully identify patients who will benefit from this procedure and to avoid an unnecessary laparotomy in those who will not. The currently available imaging modalities are unable to accurately predict the peritoneal cancer index (PCI) score or the completeness of cytoreduction. In this article, we review the current status of staging laparoscopy in the assessment of patients with PSM who are planned for CRS & HIPEC. We discuss the patient selection, techniques, complications and efficacy of staging laparoscopy. To summarise, staging laparoscopy is a safe and feasible method of pre-operative assessment of patients with PSM. It has a high sensitivity and positive predictive value in identifying patients who can undergo a complete cytoreduction, thereby preventing many patients from undergoing an unnecessary laparotomy. With the exception of pseudomyxoma peritonei, it should be considered as a part of the routine assessment of patients with PSM who are being considered for CRS & HIPEC. PMID:27065714

  10. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes.

    PubMed

    Kim, Sunghye; Brooks, Amber K; Groban, Leanne

    2015-01-01

    Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age) undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused) to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors - including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility - which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation) to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented.

  11. Prediction of pain in orthodontic patients based on preoperative pain assessment

    PubMed Central

    Zheng, Baoyu; Ren, Manman; Lin, Feiou; Yao, Linjie

    2016-01-01

    Aim To investigate whether pretreatment assessment of experimental pain can predict the level of pain after archwire placement. Methods One hundred and twenty-one general university students seeking orthodontic treatment were enrolled in this study. A cold pressor test was performed to estimate the pain tolerance of subjects before treatment. Self-reported pain intensity was calculated using a 10 cm visual analog scale during the 7 days after treatment. The relationship between pain tolerance and orthodontic pain was analyzed using Spearman’s correlation analysis. Results The maximum mean level of pain intensity occurred at 24 hours after bonding (53.31±16.13) and fell to normal levels at day 7. Spearman’s correlation analysis found a moderate positive association between preoperative pain tolerance and self-reported pain after archwire placement (P<0.01). There was no significant difference in pain intensity between male and female patients at any time point (P>0.05). Conclusion A simple and noninvasive preoperative sensory test (the cold pressor test) was useful in predicting the risk of developing unbearable pain in patients after archwire placement. Self-reported pain after archwire placement decreased as individual pain tolerance increased. PMID:27042019

  12. [The Helsinki Declaration for Patient Safety in Anaesthesiology--preoperative assessment and preparation].

    PubMed

    Fischer, Dania; Byhahn, Christian; Reyher, Christian; Wilke, Hans-Joachim

    2013-06-01

    The Helsinki Declaration offers guidelines for the warranty and improvement of patient safety in Anaesthesiology. The assessment of elective patients and their preoperative optimization plays a key role herein. Individual risk factors and preexisting pathologies have to be identified in order to initiate specific pre- and aftercare and an appropriate monitoring. The measures need to be evidence-based, goal-oriented and efficient. Our recommendations aim at elective adult patients planned for non-cardiac and non-lung-resecting surgery and stress the importance of gathering information from patients, performing physical examinations and arranging further diagnostic customized upon these findings only in contrast to routine testing. They shall spark the formulation or improvement of center-based, interdisciplinary standards of procedure in order to fulfill our great responsibility for the perioperative care of our patients.

  13. The value of the preoperative barium-enema examination in the assessment of pelvic masses

    SciTech Connect

    Gedgaudas, R.K.; Kelvin, F.M.; Thompson, W.M.; Rice, R.P.

    1983-03-01

    The value of the barium-enema examination in the assessment of pelvic masses was studied in 44 patients. Findings from those barium-enema examinations and from pathological specimens from 37 patients who had malignant tumors and seven patients who had endometriosis were retrospectively analyzed to determine if the barium-enema examination is useful in differentiating extrinsic lesions with and without invasion of the colon. None of the 12 patients who had extrinsic lesions had any of the criteria that indicated bowel-wall invasion. These criteria included fixation and serrations of the bowel wall in all patients with invasion, and ulceration and fistulizaton in those patients who had complete transmural invasion. In patients with pelvic masses, the preoperative barium-enema examination may be useful to the surgeon in planning surgery and in preparing the patient for the possibility of partial colectomy or colostomy.

  14. The number of retrieved lymph nodes needed for accurate staging differs based on the presence of preoperative chemoradiation for rectal cancer

    PubMed Central

    Han, Jeonghee; Noh, Gyoung Tae; Yeo, Shen Ann; Cheong, Chinock; Cho, Min Soo; Hur, Hyuk; Min, Byung Soh; Lee, Kang Young; Kim, Nam Kyu

    2016-01-01

    Abstract The aim of this study is to investigate if retrieval of 12 lymph nodes (LNs) is sufficient to avoid stage migration as well as to evaluate the prognostic impact of insufficient LN retrieval in different treatment settings of rectal cancer, particularly in the case of preoperative chemoradiotherapy (pCRT). The data of all patients with biopsy proven rectal adenocarcinoma who underwent curative surgery between January 2005 and December 2012 were analyzed. Univariate and multivariate analyses for oncologic outcomes were performed in LN metastasis or no LN metastasis (LN−) group. Subgroup analyses were performed according to whether a patient had received pCRT. A total of 1825 patients were enrolled into the study. The maximal Chi-square method revealed the minimum number of harvested LNs required to be 12. Univariate and multivariate analyses found LNs ≥ 12 to be an independent prognostic factor for both overall survival (OS) (hazard ratio [HR] = 0.5, 95% confidence intervals [CIs]: 0.3–0.8; P = 0.002) and disease-free survival (DFS) (HR = 0.6, 95% CI: 0.4–0.7; P < 0.001) in the LN− group. In the LN− group, LNs ≥ 12 continued to be a significant prognostic factor both for OS and DFS in the subgroup of patients who did not undergo pCRT. However, in the subgroup of the LN− patients who underwent pCRT, LN ≥ 8 was significant for DFS and OS. Retrieval of LNs ≥ 12 and LNs ≥ 8 should be achieved to obtain accurate staging and optimal treatment for the non-pCRT and pCRT groups in rectal cancer, respectively. PMID:27661032

  15. The number of retrieved lymph nodes needed for accurate staging differs based on the presence of preoperative chemoradiation for rectal cancer.

    PubMed

    Han, Jeonghee; Noh, Gyoung Tae; Yeo, Shen Ann; Cheong, Chinock; Cho, Min Soo; Hur, Hyuk; Min, Byung Soh; Lee, Kang Young; Kim, Nam Kyu

    2016-09-01

    The aim of this study is to investigate if retrieval of 12 lymph nodes (LNs) is sufficient to avoid stage migration as well as to evaluate the prognostic impact of insufficient LN retrieval in different treatment settings of rectal cancer, particularly in the case of preoperative chemoradiotherapy (pCRT).The data of all patients with biopsy proven rectal adenocarcinoma who underwent curative surgery between January 2005 and December 2012 were analyzed. Univariate and multivariate analyses for oncologic outcomes were performed in LN metastasis or no LN metastasis (LN-) group. Subgroup analyses were performed according to whether a patient had received pCRT.A total of 1825 patients were enrolled into the study. The maximal Chi-square method revealed the minimum number of harvested LNs required to be 12. Univariate and multivariate analyses found LNs ≥ 12 to be an independent prognostic factor for both overall survival (OS) (hazard ratio [HR] = 0.5, 95% confidence intervals [CIs]: 0.3-0.8; P = 0.002) and disease-free survival (DFS) (HR = 0.6, 95% CI: 0.4-0.7; P < 0.001) in the LN- group. In the LN- group, LNs ≥ 12 continued to be a significant prognostic factor both for OS and DFS in the subgroup of patients who did not undergo pCRT. However, in the subgroup of the LN- patients who underwent pCRT, LN ≥ 8 was significant for DFS and OS.Retrieval of LNs ≥ 12 and LNs ≥ 8 should be achieved to obtain accurate staging and optimal treatment for the non-pCRT and pCRT groups in rectal cancer, respectively. PMID:27661032

  16. Preoperative airway assessment - experience gained from a multicentre cluster randomised trial and the Danish Anaesthesia Database.

    PubMed

    Nørskov, Anders Kehlet

    2016-05-01

    Difficulties with airway management in relation to general anaesthesia have been a challenge for the anaesthesiologist since the birth of anaesthesia. Massive landmark improvements have been made and general anaesthesia is now regarded as a safe procedure. However, rare, difficult airway management still occurs and it prompts increased risk of morbidity and mortality - especially when not anticipated. Several preoperative risk factors for airway difficulties have been identified, yet none have convincing diagnostic accuracy as stand alone tests. Combining several risk factors increase the predictive value of the test and multivariable risk models have been developed. The Simplified Airway Risk Index (SARI) is a predictive model developed for anticipation of a difficult direct laryngoscopy. However, neither the diagnostic accuracy of the SARI nor of any other model has been tested prospectively and compared with existing practice for airway assessment in a randomised trial setting. The first objective of this thesis was to quantify the proportion of unanticipated difficult intubation and difficult mask ventilation in Denmark. The second objective was to design a cluster randomised trial, using state of the art methodology, in order to test the clinical impact of using the SARI for preoperative airway assessment compared with a clinical judgement based on usual practice for airway assessment. Finally, to test if implementation of the SARI would reduce the proportion of unanticipated difficult intubation compared with usual care for airway assessment. This thesis is based on data from the Danish Anaesthesia Database (DAD). Paper 1 presents an observational cohort study on 188,064 patients who underwent tracheal intubation from 2008 to 2011. Data on the anaesthesiologists' preoperative anticipations of airway difficulties was compared with actual airway management conditions, thus enabling an estimation of the proportion of unanticipated difficulties with intubation

  17. Preoperative Assessment of TERT Promoter Mutation on Thyroid Core Needle Biopsies Supports Diagnosis of Malignancy and Addresses Surgical Strategy.

    PubMed

    Crescenzi, A; Trimboli, P; Modica, D C; Taffon, C; Guidobaldi, L; Taccogna, S; Rainer, A; Trombetta, M; Papini, E; Zelano, G

    2016-03-01

    In the last decade, several molecular markers have been proposed to improve the diagnosis of thyroid nodules. Among these, mutations in the telomerase reverse transcriptase (TERT) promoter have been correlated to malignant tumors, characterized by highest recurrence and decreased patients' survival. This suggests an important role of TERT mutational analysis in the clinical diagnosis and management of thyroid cancer patients. The aim of the study was to demonstrate the adequacy of core needle biopsy (CNB) for the preoperative assessment of TERT mutational status, to reach a more accurate definition of malignancy and a more appropriate surgical planning. Indeed, CNB is gaining momentum for improving diagnosis of thyroid nodules deemed inconclusive by fine needle aspirate (FNA). The study included 50 patients submitted to CNB due to inconclusive FNA report. TERT mutational status was correlated with BRAF mutation, definitive histology, and post-operative TNM staging of the neoplasia. C228T mutation of the TERT promoter was reported in 10% of the papillary carcinomas (PTC) series. When compared with final histology, all cases harboring TERT mutation resulted as locally invasive PTCs. The prevalence of TERT mutated cases was 17.6% among locally advanced PTCs. TERT analysis on CNB allows the assessment of the pathological population on paraffin sections before DNA isolation, minimizing the risk of false negatives due to poor sampling that affects FNA, and gathering aggregate information about morphology and TERT mutational status. Data indicating a worse outcome of the tumor might be used to individualize treatment decision, surgical option, and follow-up design. PMID:25951319

  18. Validation of Pre-operative Patient Self-Assessment of Cardiac Risk for Non-Cardiac Surgery: Foundations for Decision Support

    PubMed Central

    Manaktala, Sharad; Rockwood, Todd; Adam, Terrence J.

    2013-01-01

    Objectives: To better characterize patient understanding of their risk of cardiac complications from non-cardiac surgery and to develop a patient driven clinical decision support system for preoperative patient risk management. Methods: A patient-driven preoperative self-assessment decision support tool for perioperative assessment was created. Patient’ self-perception of cardiac risk and self-report data for risk factors were compared with gold standard preoperative physician assessment to evaluate agreement. Results: The patient generated cardiac risk profile was used for risk score generation and had excellent agreement with the expert physician assessment. However, patient subjective self-perception risk of cardiovascular complications had poor agreement with expert assessment. Conclusion: A patient driven cardiac risk assessment tool provides a high degree of agreement with expert provider assessment demonstrating clinical feasibility. The limited agreement between provider risk assessment and patient self-perception underscores a need for further work including focused preoperative patient education on cardiac risk. PMID:24551384

  19. [Preoperative cardiac assessment before non-cardiac surgery: cardiac risk stratification].

    PubMed

    Iglesias, J F; Sierro, C; Aebischer, N; Vogt, P; Eeckhout, E

    2010-06-01

    Perioperative cardiac events occurring in patients undergoing non-cardiac surgery are a common cause of morbidity and mortality. Current guidelines recommend an individualized approach to preoperative cardiac risk stratification prior to non-cardiac surgery, integrating risk factors both for the patient (active cardiac conditions, clinical risk factors, functional capacity) and for the planned surgery. Preoperative cardiac investigations are currently limited to high-risk patients in whom they may contribute to modify the perioperative management. A multidisciplinary approach to such patients, integrating the general practitioner, is recommended in order to define an individualized peri-operative strategy.

  20. Increasing Accurate Preference Assessment Implementation through Pyramidal Training

    ERIC Educational Resources Information Center

    Pence, Sacha T.; St. Peter, Claire C.; Tetreault, Allison S.

    2012-01-01

    Preference assessments directly evaluate items that may serve as reinforcers, and their implementation is an important skill for individuals who work with children. This study examined the effectiveness of pyramidal training on teachers' implementation of preference assessments. During Experiment 1, 3 special education teachers taught 6 trainees…

  1. Internal Medicine Residents Do Not Accurately Assess Their Medical Knowledge

    ERIC Educational Resources Information Center

    Jones, Roger; Panda, Mukta; Desbiens, Norman

    2008-01-01

    Background: Medical knowledge is essential for appropriate patient care; however, the accuracy of internal medicine (IM) residents' assessment of their medical knowledge is unknown. Methods: IM residents predicted their overall percentile performance 1 week (on average) before and after taking the in-training exam (ITE), an objective and well…

  2. A novel computational method for real-time preoperative assessment of primary dental implant stability.

    PubMed

    Olsen, Sigbjørn; Ferguson, Stephen J; Sigrist, Christian; Fritz, Wolf-Rüdiger; Nolte, Lutz P; Hallermann, Wock; Caversaccio, Marco

    2005-02-01

    A novel methodology which allows for fast and fully automatic structural analysis during preoperative planning for dental implant surgery is presented. This method integrates a fully automatic fast finite element solver within the framework of new concepts in computer-assisted preoperative planning for implant surgery. The planning system including optimized structural planning was validated by experimental results. Nine implants were placed in pig mandibles and mechanically loaded using a testing rig. The resulting displacements were measured and compared with those predicted by numerical analysis during planning. The results show that there were no statistically significant differences (P = 0.65) between the results of the models and the experiments. The results show that fast structural analysis can be integrated with surgical planning software allowing the initial axial implant stability to be predicted in real time during planning. It is believed that such a system could be used to select patients for immediate implant loading and, when further developed, be useful in other areas of preoperative surgical planning. PMID:15642031

  3. Assessment of colloid response by nonlinear optical microscopy after preoperative radiochemotherapy for rectal carcinoma.

    PubMed

    Li, Lianhuang; Chen, Zhifen; Wang, Xingfu; Zhuo, Shuangmu; Li, Hongsheng; Jiang, Weizhong; Guan, Guoxian; Chen, Jianxin

    2015-05-01

    Colloid response is a type of tumor response that occurs after preoperative radiochemotherapy for rectal carcinoma. Given its important influence on survival, the colloid response should be considered when estimating histopathological reactions. Here, multiphoton microscopy (MPM) was applied to evaluate the colloid response ex vivo. This study demonstrated that MPM has the capability to visualize the colloid response in the absence of labels and can, in particular, identify rare residual carcinomatous cells in mucin pools. These results highlight the potential of this nonlinear optical technique as a diagnostic tool for tumor response after neoadjuvant treatment.

  4. FDG PET in preoperative assessment of colorectal liver metastases combining "evidence-based practice" and "technology assessment" methods to develop departmental imaging protocols: should FDG PET be routinely used in the preoperative assessment of patients with colorectal liver metastases?

    PubMed

    Sheehan, John J; Ridge, Carole A; Ward, Emily V M; Duffy, George J; Collins, Conor D; Skehan, Stephen J; Malone, Dermot E

    2007-04-01

    In today's environment of progressively evolving and expensive imaging modalities, radiologists are asked to justify the use of resources to patients, referring physicians, hospital management, and third party payers. With this aim, the radiologist may use "top-down" or "bottom-up" "evidence-based practice" (EBP) techniques. "Top-down" suggests that the practitioner should wait until a higher authority, external to their practice, generates a solution to practice dilemmas (e.g., National Institute for Health and Clinical Excellence [NICE] guidelines). "Bottom-up" however, is based on the theory that the ordinary practitioner is best served by a decentralized approach to problem solving that is internal to their practice. The technology assessment framework modeled by Mackenzie and Dixon comprehensively assesses the effects of imaging using levels of efficacy including diagnostic performance, diagnostic impact, and therapeutic impact, impact on health and cost effectiveness. In this article, we describe how issues regarding new imaging modalities in ordinary radiology practice can be addressed by using stepwise "bottom-up" EBP techniques combined with the technology assessment framework. We also detail how EBP techniques form an integral part of practice-based learning among radiology residents as part of noninterpretive residency training. The following clinical scenario is used: your hospital's chief hepatobiliary surgeon writes to your department regarding the lack of access to 18-fluoro-2-deoxy-D-glucose positron emission tomography in the preoperative assessment of patients with colorectal cancer liver metastases under consideration for hepatic resection. How would you approach this problem? Here is how we would do it.

  5. FDG PET in preoperative assessment of colorectal liver metastases combining "evidence-based practice" and "technology assessment" methods to develop departmental imaging protocols: should FDG PET be routinely used in the preoperative assessment of patients with colorectal liver metastases?

    PubMed

    Sheehan, John J; Ridge, Carole A; Ward, Emily V M; Duffy, George J; Collins, Conor D; Skehan, Stephen J; Malone, Dermot E

    2007-04-01

    In today's environment of progressively evolving and expensive imaging modalities, radiologists are asked to justify the use of resources to patients, referring physicians, hospital management, and third party payers. With this aim, the radiologist may use "top-down" or "bottom-up" "evidence-based practice" (EBP) techniques. "Top-down" suggests that the practitioner should wait until a higher authority, external to their practice, generates a solution to practice dilemmas (e.g., National Institute for Health and Clinical Excellence [NICE] guidelines). "Bottom-up" however, is based on the theory that the ordinary practitioner is best served by a decentralized approach to problem solving that is internal to their practice. The technology assessment framework modeled by Mackenzie and Dixon comprehensively assesses the effects of imaging using levels of efficacy including diagnostic performance, diagnostic impact, and therapeutic impact, impact on health and cost effectiveness. In this article, we describe how issues regarding new imaging modalities in ordinary radiology practice can be addressed by using stepwise "bottom-up" EBP techniques combined with the technology assessment framework. We also detail how EBP techniques form an integral part of practice-based learning among radiology residents as part of noninterpretive residency training. The following clinical scenario is used: your hospital's chief hepatobiliary surgeon writes to your department regarding the lack of access to 18-fluoro-2-deoxy-D-glucose positron emission tomography in the preoperative assessment of patients with colorectal cancer liver metastases under consideration for hepatic resection. How would you approach this problem? Here is how we would do it. PMID:17368206

  6. [Preoperative analysis in rhinoplasty].

    PubMed

    Nguyen, P S; Bardot, J; Duron, J B; Levet, Y; Aiach, G

    2014-12-01

    Preoperative analysis in rhinoplasty consists in analyzing individual anatomical and functional characteristics without losing sight of the initial requirements of the patient to which priority should be given. The examination is primarily clinical but it also uses preoperative photographs taken at specific accurate angles. Detecting functional disorders or associated general pathologies, which will reduce the risk of complications. All of these factors taken into account, the surgeon can work out a rhinoplasty plan which he or she will subsequently explain to the patient and obtain his or her approbation.

  7. Thymic pathologies in myasthenia gravis: a preoperative assessment of CAT scan and nuclear based imaging.

    PubMed

    Jordan, Berit; Kellner, Juliane; Jordan, Karin; Bähre, Manfred; Behrmann, Curd; Zierz, Stephan

    2016-04-01

    Precise diagnostic work up of a suspected thymic pathology in patients with myasthenia gravis (MG) is very important for potential surgical implications and further disease course. In this study the diagnostic value of combined preoperative radiological (CAT scan) and nuclear based imaging (octreotide and thallium scintigraphy) in patients with MG was evaluated. Twenty four patients were included. Histopathology revealed thymoma in nine patients, thymic carcinoma (TC) in one patient, lymphofollicular hyperplasia in seven patients, and involuted thymus in another seven patients. Diagnostic sensitivity for detecting thymoma/TC was 80 % in CAT scan as well as in somatostatin scintigraphy; the combination of both procedures reached 90 %. However, the diagnostic specifity to exclude thymoma in CAT scan was 100 % and in octreotide scintigraphy 85.7 %. Semiquantitative octreotide uptake significantly correlated with histological grading of thymoma/TC (r = 0.764) and histological proliferation rate Ki67 (r = 0.894). Thallium scintigraphy was positive only in one out of four thymoma cases. In this study, somatostatin scintigraphy has been shown to be a useful additional diagnostic technique in detecting thymic malignancies in patients with MG. These results might be especially helpful in patients with late onset MG as these patients are in general no candidates for thymectomy. PMID:26810725

  8. Thymic pathologies in myasthenia gravis: a preoperative assessment of CAT scan and nuclear based imaging.

    PubMed

    Jordan, Berit; Kellner, Juliane; Jordan, Karin; Bähre, Manfred; Behrmann, Curd; Zierz, Stephan

    2016-04-01

    Precise diagnostic work up of a suspected thymic pathology in patients with myasthenia gravis (MG) is very important for potential surgical implications and further disease course. In this study the diagnostic value of combined preoperative radiological (CAT scan) and nuclear based imaging (octreotide and thallium scintigraphy) in patients with MG was evaluated. Twenty four patients were included. Histopathology revealed thymoma in nine patients, thymic carcinoma (TC) in one patient, lymphofollicular hyperplasia in seven patients, and involuted thymus in another seven patients. Diagnostic sensitivity for detecting thymoma/TC was 80 % in CAT scan as well as in somatostatin scintigraphy; the combination of both procedures reached 90 %. However, the diagnostic specifity to exclude thymoma in CAT scan was 100 % and in octreotide scintigraphy 85.7 %. Semiquantitative octreotide uptake significantly correlated with histological grading of thymoma/TC (r = 0.764) and histological proliferation rate Ki67 (r = 0.894). Thallium scintigraphy was positive only in one out of four thymoma cases. In this study, somatostatin scintigraphy has been shown to be a useful additional diagnostic technique in detecting thymic malignancies in patients with MG. These results might be especially helpful in patients with late onset MG as these patients are in general no candidates for thymectomy.

  9. Evaluation of Hemoglobin A1c Criteria to Assess Preoperative Diabetes Risk in Cardiac Surgery Patients

    PubMed Central

    Saberi, Sima; Zrull, Christina A.; Patil, Preethi V.; Jha, Leena; Kling-Colson, Susan C.; Gandia, Kenia G.; DuBois, Elizabeth C.; Plunkett, Cynthia D.; Bodnar, Tim W.; Pop-Busui, Rodica

    2011-01-01

    Abstract Objective Hemoglobin A1c (A1C) has recently been recommended for diagnosing diabetes mellitus and diabetes risk (prediabetes). Its performance compared with fasting plasma glucose (FPG) and 2-h post-glucose load (2HPG) is not well delineated. We compared the performance of A1C with that of FPG and 2HPG in preoperative cardiac surgery patients. Methods Data from 92 patients without a history of diabetes were analyzed. Patients were classified with diabetes or prediabetes using established cutoffs for FPG, 2HPG, and A1C. Sensitivity and specificity of the new A1C criteria were evaluated. Results All patients diagnosed with diabetes by A1C also had impaired fasting glucose, impaired glucose tolerance, or diabetes by other criteria. Using FPG as the reference, sensitivity and specificity of A1C for diagnosing diabetes were 50% and 96%, and using 2HPG as the reference they were 25% and 95%. Sensitivity and specificity for identifying prediabetes with FPG as the reference were 51% and 51%, respectively, and with 2HPG were 53% and 51%, respectively. One-third each of patients with prediabetes was identified using FPG, A1C, or both. When testing A1C and FPG concurrently, the sensitivity of diagnosing dysglycemia increased to 93% stipulating one or both tests are abnormal; specificity increased to 100% if both tests were required to be abnormal. Conclusions In patients before cardiac surgery, A1C criteria identified the largest number of patients with diabetes and prediabetes. For diagnosing prediabetes, A1C and FPG were discordant and characterized different groups of patients, therefore altering the distribution of diabetes risk. Simultaneous measurement of FGP and A1C may be a more sensitive and specific tool for identifying high-risk individuals with diabetes and prediabetes. PMID:21854260

  10. Pre-operative assessment of benign and malignant ovarian tumours using colour Doppler ultrasonography.

    PubMed

    Dasgupta, Shyamal; Malty, Saurav Prakash; Sharma, Partha Pratim; Mukhopadhyay, Amitava; Ghosh, Tarun Kumar

    2010-08-01

    Ultrasonography of 56 women with adenexal masses who were admitted for laparotomy were done mainly by transvaginal route. Though Gray scale morphologic evaluations of masses were done routinely, only colour Doppler imaging criteria were taken into consideration in this study. These are pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), timed average maximal velocity (TAMXV), vessels localisation and dicrotic notch. Histopathological examination was done and considered as gold standard. In 83.78% cases of benign tumour PI is equal or greater than 1, whereas it was less than 1 in 84.21% in malignant ovarian tumour. The sensitivity, specificity, PPV and NPV were respectively 84.21%, 83.78%, 72.72% and 91.11%. RI in benign tumours were equal to or more than 0.4 in 81.08% and less than 0.4 in 68.42% in case of malignant tumours. The sensitivity, specificity, PPV and NPV were respectively 68.42%, 81.08%, 65% and 83.33%. Considering the TAMXV>12 cm/second as a criterion for malignancy the sensitivity, specificity, PPV and NPV were respectively 89.45%, 89.19%, 80.95% and 94.28%, and also considering septal/central localisation of vessels as a criterion for malignancy, it was found the sensitivity, specificity, PPV and NPV were 89.47%, 62.16%, 54.84% and 92% respectively. Considering absence of dicrotic notch for malignant tumours we found sensitivity, specificity, PPV and NPV were 89.47%, 81.08%, 70.83% and 93.75% respectively. The above findings of the PI, TAMXV and dicrotic notch evaluation show most useful was colour Doppler parameters for pre-operative screening for ovarian malignancy in this study.

  11. Preoperative Chemoradiation for Rectal Cancer Using Capecitabine and Celecoxib Correlated With Posttreatment Assessment of Thymidylate Synthase and Thymidine Phosphorylase Expression

    SciTech Connect

    Unger, Keith R.; Romney, Davis A.; Koc, Mehmet; Moskaluk, Christopher A.; Friel, Charles M.; Foley, E.F.; Rich, Tyvin A.

    2011-08-01

    Purpose: Thymidylate synthase (TS) and thymidine phosphorylase (TP) expression have been shown to be predictors of response to therapy. The toxicity, efficacy, surgical morbidity, and immunohistochemical TS and TP expression were assessed in surgical resection specimens after preoperative chemoradiation. Methods and Materials: Twenty patients with clinical stage I to III rectal adenocarcinoma received preoperative chemoradiation and underwent surgical resection 6 weeks later. Results: Posttreatment tumor stages were T1 to T2 and N0 in 30% of patients; T3 to T4 and N0 in 30% of patients; and T1 to T3 and N1 to N2 in 15% of patients. Pathologic complete response (pCR) was evident in 25% and tumor regression occurred in a total of 80% of patients. Anal sphincter-sparing surgery was performed in 80% of cases. Acute and perioperative complications were minimal, with no grade 3/4 toxicity or treatment breaks. Pelvic control was obtained in 90% of patients. With a median follow-up of 65.5 months (range, 8-80 months), the 6-year actuarial survival rate was 75%. Local failure was significantly associated with nonresponse to therapy and with high TS and low TP expression (p = 0.008 and p = 0.04, respectively). Conclusions: The combination of capecitabine, celecoxib, and x-radiation therapy yields excellent response: a 25% pathologic pCR, no acute grade 3/4 toxicity, and minimal surgical morbidity. Nonresponders expressed significantly increased TS levels and decreased TP levels in posttreatment resection specimens compared to responders.

  12. Assessment of Preoperative Liver Function in Patients with Hepatocellular Carcinoma – The Albumin-Indocyanine Green Evaluation (ALICE) Grade

    PubMed Central

    Kokudo, Takashi; Hasegawa, Kiyoshi; Amikura, Katsumi; Uldry, Emilie; Shirata, Chikara; Yamaguchi, Takamune; Arita, Junichi; Kaneko, Junichi; Akamatsu, Nobuhisa; Sakamoto, Yoshihiro; Takahashi, Amane; Sakamoto, Hirohiko; Makuuchi, Masatoshi; Matsuyama, Yutaka; Demartines, Nicolas; Malagó, Massimo; Kokudo, Norihiro; Halkic, Nermin

    2016-01-01

    Background Most patients with hepatocellular carcinoma (HCC) have underlying liver disease, therefore, precise preoperative evaluation of the patient’s liver function is essential for surgical decision making. Methods We developed a grading system incorporating only two variables, namely, the serum albumin level and the indocyanine green retention rate at 15 minutes (ICG R15), to assess the preoperative liver function, based on the overall survival of 1868 patients with HCC who underwent liver resection. We then tested the model in a European cohort (n = 70) and analyzed the predictive power for the postoperative short-term outcome. Results The Albumin-Indocyanine Green Evaluation (ALICE) grading system was developed in a randomly assigned training cohort: linear predictor = 0.663 × log10ICG R15 (%)−0.0718 × albumin (g/L) (cut-off value: -2.20 and -1.39). This new grading system showed a predictive power for the overall survival similar to the Child-Pugh grading system in the validation cohort. Determination of the ALICE grade in Child-Pugh A patients allowed further stratification of the postoperative prognosis. This result was reproducible in the European cohort. Determination of the ALICE grade allowed better prediction of the risk of postoperative liver failure and mortality (ascites: grade 1, 2.1%; grade 2, 6.5%; grade 3, 16.0%; mortality: grade 1, 0%; grade 2, 1.3%; grade 3, 5.3%) than the previously reported model based on the presence/absence of portal hypertension. Conclusions This new grading system is a simple method for prediction of the postoperative long-term and short-term outcomes. PMID:27434062

  13. PRA in Design: Increasing Confidence in Pre-Operational Assessments of Risks (Results of a Joint NASA/NRC Workshop)

    NASA Technical Reports Server (NTRS)

    Youngblood, Robert; Dezfuli, Homayoon; Siu, Nathan

    2010-01-01

    In late 2009, the National Aeronautics and Space Administration (NASA) and the U.S. Nuclear Regulatory Commission (NRC) jointly organized a workshop to discuss technical issues associated with application of risk assessments to early phases of system design. The workshop, which was coordinated by the Idaho National Laboratory, involved invited presentations from a number of PRA experts in the aerospace and nuclear fields and subsequent discussion to address the following questions: (a) What technical issues limit decision-makers' confidence in PRA results, especially at a pre-operational phase of the system life cycle? (b) What is being done to address these issues'? (c) What more can be done ? The workshop resulted in participant observations and suggestions on several technical issues, including the pursuit of non-traditional approaches to risk assessment and the verification and validation of risk models. The workshop participants also identified several important non-technical issues, including risk communication with decision makers, and the integration of PRA into the overall design process.

  14. PRA In Design: Increasing Confidence in Pre-operational Assessments of Risks (Results of a Joint NASA/ NRC Workshop)

    SciTech Connect

    Robert Youngblood

    2010-06-01

    In late 2009, the National Aeronautics and Space Administration (NASA) and the U.S. Nuclear Regulatory Commission (NRC) jointly organized a workshop to discuss technical issues associated with application of risk assessments to early phases of system design. The workshop, which was coordinated by the Idaho National Laboratory, involved invited presentations from a number of PRA experts in the aerospace and nuclear fields and subsequent discussion to address the following questions: (a) What technical issues limit decision-makers’ confidence in PRA results, especially at a preoperational phase of the system life cycle? (b) What is being done to address these issues? (c) What more can be done? The workshop resulted in participant observations and suggestions on several technical issues, including the pursuit of non-traditional approaches to risk assessment and the verification and validation of risk models. The workshop participants also identified several important non-technical issues, including risk communication with decision makers, and the integration of PRA into the overall design process.

  15. Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea

    PubMed Central

    Memtsoudis, Stavros G.; Ramachandran, Satya Krishna; Nagappa, Mahesh; Opperer, Mathias; Cozowicz, Crispiana; Patrawala, Sara; Lam, David; Kumar, Anjana; Joshi, Girish P.; Fleetham, John; Ayas, Najib; Collop, Nancy; Doufas, Anthony G.; Eikermann, Matthias; Englesakis, Marina; Gali, Bhargavi; Gay, Peter; Hernandez, Adrian V.; Kaw, Roop; Kezirian, Eric J.; Malhotra, Atul; Mokhlesi, Babak; Parthasarathy, Sairam; Stierer, Tracey; Wappler, Frank; Hillman, David R.; Auckley, Dennis

    2016-01-01

    The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients’ conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence. PMID:27442772

  16. Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea.

    PubMed

    Chung, Frances; Memtsoudis, Stavros G; Ramachandran, Satya Krishna; Nagappa, Mahesh; Opperer, Mathias; Cozowicz, Crispiana; Patrawala, Sara; Lam, David; Kumar, Anjana; Joshi, Girish P; Fleetham, John; Ayas, Najib; Collop, Nancy; Doufas, Anthony G; Eikermann, Matthias; Englesakis, Marina; Gali, Bhargavi; Gay, Peter; Hernandez, Adrian V; Kaw, Roop; Kezirian, Eric J; Malhotra, Atul; Mokhlesi, Babak; Parthasarathy, Sairam; Stierer, Tracey; Wappler, Frank; Hillman, David R; Auckley, Dennis

    2016-08-01

    The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence. PMID:27442772

  17. Computed tomography of the brain, chest, and abdomen in the preoperative assessment of non-small cell lung cancer.

    PubMed Central

    Grant, D; Edwards, D; Goldstraw, P

    1988-01-01

    The benefit to be gained from carrying out computed tomography of brain and abdomen in addition to the chest has been evaluated retrospectively in 114 consecutive patients with non-small cell lung cancer who, on the basis of history, clinical examination, chest radiography, and bronchoscopy had been considered potentially operable. Computed tomography of the chest showed potentially inoperable tumour in 37 patients, of whom 25 had tumour confined to the chest. Three patients were shown to have malignant disease within the mediastinum and abdomen; five within the mediastinum and brain; and four within the mediastinum, abdomen, and brain. Computed tomography of the abdomen disclosed deposits in nine patients, but in only two were the abnormalities restricted to the abdomen. Computed tomography of the brain showed metastases in 10 patients, of whom only one had metastatic disease confined to the brain. Thus three patients had isolated deposits in the abdomen and brain. In 12 patients the identification of metastases in the abdomen and brain removed the need for mediastinoscopy. Preoperative computed tomography of the abdomen and brain detected occult metastases in 15 patients (13%) in this study. In three patients the extrathoracic abnormality proved the only contraindication to surgery, but in the other 12 it provided valuable corroborative evidence of incurability and facilitated the assessment of the mediastinal abnormality. PMID:2851880

  18. Preoperative assessment tool for the planning of inframammary incision and implant profile in breast augmentation.

    PubMed

    Atiyeh, Bishara S; Dibo, Saad A; Nader, Marie; Papazian, Nazareth J

    2014-10-01

    When using the inframammary access incision for breast augmentation, careful planning is critical to allow the surgeon to set the inframammary fold (IMF) at the most optimal position, minimize scar visibility, and mitigate the main disadvantage of this approach. Current popular evaluation systems for breast augmentation include the High Five and Randquist systems and they base their calculations on inconsistent variables like skin stretch measurements. We propose a simple method that is not dependent on skin stretch measurements to properly determine implant size, profile, and position of the inframammary fold. Excluding digital scans and computer-based systems that are not universally available, the proposed simplified assessment tool was compared to the two most popular manual measuring tools (High Five and Randquist). Twenty-five female volunteers were included in the study. The projected IMF positions over the midsternal line for each measuring tool were recorded on each patient and the sternal notch (SN) to projected IMF distance SN-IMF1 (simplified evaluation system), SN-IMF2 (High Five System), and SN-IMF3 (Randquist system) were compared. The anticipated new IMF position is determined based on the vertical implant dimension and not on breast base width. For most subjects, the differences between the three evaluation systems were minimal. The proposed breast measurement tool constitutes a new, much simpler, and practical method that proved to be successful in our hands. PMID:25060928

  19. Restoration of the root-filled tooth: pre-operative assessment.

    PubMed

    Tait, C M E; Ricketts, D N J; Higgins, A J

    2005-04-01

    This is the first in a series of four papers related to the management of root canal treated teeth. When teeth compromised by extensive restorations become non-vital, suggestions have been given as to how root canal treatment can be carried out with the greatest chance of success. Once root canal treated, either by a previous dentist or by the current dentist, a review of the assessment process that should be carried out prior to placing costly indirect definitive restorations is given. It will be clear that post-retained restorations are mainly reserved for anterior or single-rooted teeth, posterior teeth rarely requiring a post for core retention. The second paper in this series describes the basic tooth preparation that should be carried out prior to placing a post. Depending on the type of post system used, further modifications to tooth preparation may be required and the cementation techniques may also have to be modified. The third paper therefore discusses the various post types, when and how they should be used for optimum results. The final paper addresses reinforcement and restoration of compromised root canals, such as those with immature, open apices, or those that have been over-prepared for previous post-retained restorations.

  20. ASSESSMENT OF BODY FAT IN OBESE PATIENTS PREOPERATIVELY FOR BARIATRIC SURGERY

    PubMed Central

    FERNANDEZ, Mônica; TOIMIL, Rosana Farah; RASSLAN, Zied; ILIAS, Elias Jirjoss; GRADINAR, Ana Lúcia Torloni; MALHEIROS, Carlos Alberto

    2016-01-01

    ABSTRACT Background: The study of body composition in patient candidates for bariatric surgery is directly related to the increase and distribution of body fat in the development of cardiovascular disease. Aim: To correlate anthropometric indicators and bioelectrical impedance in the assessment of body fat in female candidates for bariatric surgery. Methods: Cross-sectional, observational study of 88 women. The weight, height, body mass index and waist circumference data were evaluated in the anthropometric analysis. The body fat was determinate by bioelectrical impedance conducted according to the manufacturer´s recommended technique with a specific severe obesity formula. The patients were divided into two subgroups according to the average waist circumference and body mass index for better analysis of the results. Results: The group had a mean age of 39.7 years (±7.2), average weight of 125.6 kg (±16.2), mean body mass index of 48.7 kg/m2 (±6.4) and the mean waist circumference 137.6 cm (±12.4). Negative and significant relationship between BMI values waist circumference and resistance obtained by bioelectrical impedance ​​were found. By analyzing the two groups the mean BMI and waist circumference, a significant relationship was observed, ie, the higher the degree of obesity less resistance was obtained by bioelectrical impedance. The higher is the obesity the lower is value found for resistance. Conclusion: The increase of anthropometric indicators (BMI and waist circumference) determined reduction in resistance and reactance obtained by bioelectrical impedance analysis in obese women candidates to bariatric surgery. PMID:27683778

  1. Preoperative information management system using wireless PDAs.

    PubMed

    Sawa, Tomohiro; Okahara, Masaharu; Santo, Masayuki; Schmidt, Ulrich; Nakata, Yoshinori; Morita, Shigeho; Ohno-Machado, Lucila

    2003-01-01

    Personal Digital Assistant (PDA) and wireless communication are currently available in clinical settings. We developed wireless PDA software that assists anesthesiologists in pre-operative patient assessment. The device communicates with the hospital information system through a wireless LAN and is equipped with pre-programmed data entry templates for pre-operative assessment. As a preliminary test of the device, we randomly assigned residents in preoperative assessment to an intervention and a control arm and compared the results.

  2. The role of diffusion tensor imaging in establishing the proximity of tumor borders to functional brain systems: implications for preoperative risk assessments and postoperative outcomes.

    PubMed

    Ulmer, John L; Salvan, Carmen V; Mueller, Wade M; Krouwer, Hendrikus G; Stroe, Georgetta O; Aralasmak, Ayse; Prost, Robert W

    2004-12-01

    Diffusion Tensor Imaging (DTI) is a new MRI imaging technique sensitive to directional movements of water molecules, induced by tissue barriers. This provides a new form of contrast that allows the identification of functional white matter tracts within the brain, and has been proposed as a technique suitable for presurgical planning in brain tumor patients. Resection of primary brain tumors improves survival, functional performance, and the effectiveness of adjuvant therapies, provided that surgically-induced neurological deficits can be avoided. Diffusion Tensor Imaging (DTI) has the potential to establish spatial relationships between eloquent white matter and tumor borders, provide information essential to preoperative planning, and improve the accuracy of surgical risk assessments preoperatively. We present our experience in a series of 28 brain tumor patients where the integration of functional magnetic resonance imaging (fMRI) and DTI data was used to determine key anatomic spatial relationships preoperatively. Twice as many functional systems were localized to within 5 mm of tumor borders when DTI and fMRI were utilized for preoperative planning, compared to that afforded by fMRI alone. Our results show that the combined use of fMRI and DTI can provide a better estimation of the proximity of tumor borders to eloquent brain systems sub-serving language, speech, vision, motor and premotor functions. Additionally, a low regional complication rate (4%) observed in our series suggests that preoperative planning with these combined techniques may improve surgical outcomes compared to that previously reported in the literature. Larger studies specifically designed to establish the accuracy and predictive value of DTI in brain tumor patients are warranted to substantiate our preliminary observations.

  3. The accurate assessment of small-angle X-ray scattering data

    SciTech Connect

    Grant, Thomas D.; Luft, Joseph R.; Carter, Lester G.; Matsui, Tsutomu; Weiss, Thomas M.; Martel, Anne; Snell, Edward H.

    2015-01-01

    A set of quantitative techniques is suggested for assessing SAXS data quality. These are applied in the form of a script, SAXStats, to a test set of 27 proteins, showing that these techniques are more sensitive than manual assessment of data quality. Small-angle X-ray scattering (SAXS) has grown in popularity in recent times with the advent of bright synchrotron X-ray sources, powerful computational resources and algorithms enabling the calculation of increasingly complex models. However, the lack of standardized data-quality metrics presents difficulties for the growing user community in accurately assessing the quality of experimental SAXS data. Here, a series of metrics to quantitatively describe SAXS data in an objective manner using statistical evaluations are defined. These metrics are applied to identify the effects of radiation damage, concentration dependence and interparticle interactions on SAXS data from a set of 27 previously described targets for which high-resolution structures have been determined via X-ray crystallography or nuclear magnetic resonance (NMR) spectroscopy. The studies show that these metrics are sufficient to characterize SAXS data quality on a small sample set with statistical rigor and sensitivity similar to or better than manual analysis. The development of data-quality analysis strategies such as these initial efforts is needed to enable the accurate and unbiased assessment of SAXS data quality.

  4. Assessment of quality of life in patients with rectal cancer treated by preoperative radiotherapy: A longitudinal prospective study

    SciTech Connect

    Allal, Abdelkarim S. . E-mail: abdelkarim.allal@hcuge.ch; Gervaz, Pascal; Gertsch, Philippe; Bernier, Jacques; Roth, Arnaud D.; Morel, Philippe; Bieri, Sabine

    2005-03-15

    Purpose: To assess prospectively the quality of life (QOL) of patients treated by preoperative radiotherapy (RT) and surgery for locally advanced rectal cancer. Methods and materials: We studied 53 patients treated with bi-fractionated RT (50 Gy in 40 fractions within 4 weeks) followed at a median interval of 45 days by abdominoperineal resection in 11 patients and low anterior resection in 42 patients. Their QOL was assessed using two self-rating questionnaires developed by the European Organization for Research and Treatment of Cancer (EORTC): one was cancer specific (EORTC QLQ-C30) and one was site specific (EORTC QLQ-C38). The questionnaires were completed before RT and 12-16 months after RT, at which time 17 patients had undergone colostomy. We hypothesized that at least some scores of the various scales would vary between the two analyses. Results: Compared with the pre-RT scores, at 1 year, patients reported statistically significant improvement in their emotional state (median 75 vs. 100, p <0.0001), perspective of the future (67 vs. 100, p = 0.0004), and their global QOL (75 vs. 83, p = 0.0008), as well as a decrease in GI symptoms (13 vs. 0, p = 0.002). However, the sexual dysfunction score increased significantly, particularly in men (17 vs. 83, p = 0.0045), and a trend toward a lower body image score was observed (100 vs. 89, p = 0.068). At 1 year, patients with colostomies reported similar or significantly improved symptom scores for fatigue, pain, GI problems, and sleep disturbance, but no such improvements were observed in patients without stomas. Conclusion: One year after combined treatment for locally advanced rectal cancer, patients exhibited statistically significant improvement in some important QOL outcomes, including global QOL, despite a decrease in sexual function and body image. Any additional improvement in QOL outcome may require refinements in the RT and surgical techniques to reduce late sequelae, particularly sexual dysfunction. Our

  5. Using fatty acids to fingerprint biofilm communities: a means to quickly and accurately assess stream quality.

    PubMed

    DeForest, Jared L; Drerup, Samuel A; Vis, Morgan L

    2016-05-01

    The assessment of lotic ecosystem quality plays an essential role to help determine the extent of environmental stress and the effectiveness of restoration activities. Methods that incorporate biological properties are considered ideal because they provide direct assessment of the end goal of a vigorous biological community. Our primary objective was to use biofilm lipids to develop an accurate biomonitoring tool that requires little expertise and time to facilitate assessment. A model was created of fatty acid biomarkers most associated with predetermined stream quality classification, exceptional warm water habitat (EWH), warm water habitat (WWH), and limited resource (LR-AMD), and validated along a gradient of known stream qualities. The fatty acid fingerprint of the biofilm community was statistically different (P = 0.03) and was generally unique to recognized stream quality. One striking difference was essential fatty acids (DHA, EPA, and ARA) were absent from LR-AMD and only recovered from WWH and EWH, 45 % more in EWH than WWH. Independently testing the model along a stream quality gradient, this model correctly categorized six of the seven sites, with no match due to low sample biomass. These results provide compelling evidence that biofilm fatty acid analysis can be a sensitive, accurate, and cost-effective biomonitoring tool. We conceive of future studies expanding this research to more in-depth studies of remediation efforts, determining the applicable geographic area for the method and the addition of multiple stressors with the possibility of distinguishing among stressors.

  6. Home Circadian Phase Assessments with Measures of Compliance Yield Accurate Dim Light Melatonin Onsets

    PubMed Central

    Burgess, Helen J.; Wyatt, James K.; Park, Margaret; Fogg, Louis F.

    2015-01-01

    Study Objectives: There is a need for the accurate assessment of circadian phase outside of the clinic/laboratory, particularly with the gold standard dim light melatonin onset (DLMO). We tested a novel kit designed to assist in saliva sampling at home for later determination of the DLMO. The home kit includes objective measures of compliance to the requirements for dim light and half-hourly saliva sampling. Design: Participants were randomized to one of two 10-day protocols. Each protocol consisted of two back-to-back home and laboratory phase assessments in counterbalanced order, separated by a 5-day break. Setting: Laboratory or participants' homes. Participants: Thirty-five healthy adults, age 21–62 y. Interventions: N/A. Measurements and Results: Most participants received at least one 30-sec epoch of light > 50 lux during the home phase assessments (average light intensity 4.5 lux), but on average for < 9 min of the required 8.5 h. Most participants collected every saliva sample within 5 min of the scheduled time. Ninety-two percent of home DLMOs were not affected by light > 50 lux or sampling errors. There was no significant difference between the home and laboratory DLMOs (P > 0.05); on average the home DLMOs occurred 9.6 min before the laboratory DLMOs. The home DLMOs were highly correlated with the laboratory DLMOs (r = 0.91, P < 0.001). Conclusions: Participants were reasonably compliant to the home phase assessment procedures. The good agreement between the home and laboratory dim light melatonin onsets (DLMOs) demonstrates that including objective measures of light exposure and sample timing during home saliva sampling can lead to accurate home DLMOs. Clinical Trial Registration: Circadian Phase Assessments at Home, http://clinicaltrials.gov/show/NCT01487252, NCT01487252. Citation: Burgess HJ, Wyatt JK, Park M, Fogg LF. Home circadian phase assessments with measures of compliance yield accurate dim light melatonin onsets. SLEEP 2015;38(6):889–897

  7. Accurate assessment of Congo basin forest carbon stocks requires forest type specific assessments

    NASA Astrophysics Data System (ADS)

    Moonen, Pieter C. J.; Van Ballaert, Siege; Verbist, Bruno; Boyemba, Faustin; Muys, Bart

    2014-05-01

    carbon stocks despite poorer physical and chemical soil properties. Soil organic carbon stocks (0-100cm) did not significantly differ between forest types and were estimated at 109 ± 35 Mg C ha-1. Our results confirm recent findings of significantly lower carbon stocks in the Central Congo Basin as compared to the outer regions and of the importance of local tree height-diameter relationships for accurate carbon stock estimations.

  8. Preoperative mapping of the sensorimotor cortex: comparative assessment of task-based and resting-state FMRI.

    PubMed

    Rosazza, Cristina; Aquino, Domenico; D'Incerti, Ludovico; Cordella, Roberto; Andronache, Adrian; Zacà, Domenico; Bruzzone, Maria Grazia; Tringali, Giovanni; Minati, Ludovico

    2014-01-01

    Resting state fMRI (rs-fMRI) has recently been considered as a possible complement or alternative to task-based fMRI (tb-fMRI) for presurgical mapping. However, evidence of its usefulness remains scant, because existing studies have investigated relatively small samples and focused primarily on qualitative evaluation. The aim of this study is to investigate the clinical usefulness of rs-fMRI in the context of presurgical mapping of motor functions, and in particular to determine the degree of correspondence with tb-fMRI which, while not a gold-standard, is commonly used in preoperative setting. A group of 13 patients with lesions close to the sensorimotor cortex underwent rs-fMRI and tb-fMRI to localize the hand, foot and mouth motor areas. We assessed quantitatively the degree of correspondence between multiple rs-fMRI analyses (independent-component and seed-based analyses) and tb-fMRI, with reference to sensitivity and specificity of rs-fMRI with respect to tb-fMRI, and centre-of-mass distances. Agreement with electro-cortical stimulation (ECS) was also investigated, and a traditional map thresholding approach based on agreement between two experienced operators was compared to an automatic threshold determination method. Rs-fMRI can localize the sensorimotor cortex successfully, providing anatomical specificity for hand, foot and mouth motor subregions, in particular with seed-based analyses. Agreement with tb-fMRI was only partial and rs-fMRI tended to provide larger patterns of correlated activity. With respect to the ECS data available, rs-fMRI and tb-fMRI performed comparably, even though the shortest distance to stimulation points was observed for the latter. Notably, the results of both were on the whole robust to thresholding procedure. Localization performed by rs-fMRI is not equivalent to tb-fMRI, hence rs-fMRI cannot be considered as an outright replacement for tb-fMRI. Nevertheless, since there is significant agreement between the two techniques, rs

  9. The accurate assessment of small-angle X-ray scattering data

    DOE PAGES

    Grant, Thomas D.; Luft, Joseph R.; Carter, Lester G.; Matsui, Tsutomu; Weiss, Thomas M.; Martel, Anne; Snell, Edward H.

    2015-01-23

    Small-angle X-ray scattering (SAXS) has grown in popularity in recent times with the advent of bright synchrotron X-ray sources, powerful computational resources and algorithms enabling the calculation of increasingly complex models. However, the lack of standardized data-quality metrics presents difficulties for the growing user community in accurately assessing the quality of experimental SAXS data. Here, a series of metrics to quantitatively describe SAXS data in an objective manner using statistical evaluations are defined. These metrics are applied to identify the effects of radiation damage, concentration dependence and interparticle interactions on SAXS data from a set of 27 previously described targetsmore » for which high-resolution structures have been determined via X-ray crystallography or nuclear magnetic resonance (NMR) spectroscopy. Studies show that these metrics are sufficient to characterize SAXS data quality on a small sample set with statistical rigor and sensitivity similar to or better than manual analysis. The development of data-quality analysis strategies such as these initial efforts is needed to enable the accurate and unbiased assessment of SAXS data quality.« less

  10. The accurate assessment of small-angle X-ray scattering data

    SciTech Connect

    Grant, Thomas D.; Luft, Joseph R.; Carter, Lester G.; Matsui, Tsutomu; Weiss, Thomas M.; Martel, Anne; Snell, Edward H.

    2015-01-23

    Small-angle X-ray scattering (SAXS) has grown in popularity in recent times with the advent of bright synchrotron X-ray sources, powerful computational resources and algorithms enabling the calculation of increasingly complex models. However, the lack of standardized data-quality metrics presents difficulties for the growing user community in accurately assessing the quality of experimental SAXS data. Here, a series of metrics to quantitatively describe SAXS data in an objective manner using statistical evaluations are defined. These metrics are applied to identify the effects of radiation damage, concentration dependence and interparticle interactions on SAXS data from a set of 27 previously described targets for which high-resolution structures have been determined via X-ray crystallography or nuclear magnetic resonance (NMR) spectroscopy. Studies show that these metrics are sufficient to characterize SAXS data quality on a small sample set with statistical rigor and sensitivity similar to or better than manual analysis. The development of data-quality analysis strategies such as these initial efforts is needed to enable the accurate and unbiased assessment of SAXS data quality.

  11. Assessing the registration of CT-scan data to intraoperative x rays by fusing x rays and preoperative information

    NASA Astrophysics Data System (ADS)

    Gueziec, Andre P.

    1999-05-01

    This paper addresses a key issue of providing clinicians with visual feedback to validate a computer-generated registration of pre-operative and intra-operative data. With this feedback information, the clinician may decide to proceed with a computer-assisted intervention, revert to a manual intervention, or potentially provide information to the computer system to improve the registration. The paper focuses on total hip replacement (THR) surgery, but similar techniques could be applied to other types of interventions or therapy, including orthopedics, neurosurgery, and radiation therapy. Pre-operative CT data is used to plane the surgery (select an implant type, size and precise position), and is registered to intra-operative X-ray images, allowing to execute the plan: mill a cavity with the implant's shape. (Intra-operative X-ray images must be calibrated with respect to the surgical device executing the plan). One novel technique presented in this paper consists of simulating a post-operative X-ray image of the tissue of interest before doing the procedure, by projecting the registered implant onto an intra-operative X- ray image (corrected for distortion or not), providing clinicians with familiar and easy to interpret images. As an additional benefit, this method provides new means for comparing various strategies for registering pre-operative data to the physical space of the operating room.

  12. Indirect assessment of stifle angle for improved accuracy of preoperative planning of tibial osteotomy procedures in dogs.

    PubMed

    Barnes, D C; Owen, M R

    2015-07-25

    To assess reliability of the mechanical axes stifle angle in dogs positioned for radiography with a neutral stifle (neutral stifle angle (nSA)). To investigate radiographic landmarks for assessment of nSA from a collimated radiographic view. One hundred radiographs were taken of normal stifles belonging to 55 skeletally mature medium and large breed dogs, positioned using a repeatable protocol. Radiographs were widely collimated to include the femoral head and the talus. The angle of Blumensaat's line through the intercondylar fossa relative to the Mechanical Axis of the femur (intercondylar fossa angle, IFA), the angle of inclination of a tibial crest tangent line relative to the Mechanical Axis of the tibia (tibial crest angle, TCA) and the tibial plateau angle (TPA) were recorded. Mean nSA was 133.5°. Mean IFA was 155.5°. TCA had a mean of 6.7°. Estimates for nSA were calculated using mean IFA combined with mean TCA (enSA1), mean TPA (enSA2) and the mechanical axis of the tibia (enSA3). Mean percentage error relative was 2.99 per cent for enSA1, 2.82 per cent for enSA2, 1.67 per cent for enSA3. Blumensaat's line provides a consistent radiological feature for assessment of nSA. Assessment of nSA and correction for values varying from 135° may allow more consistent and accurate measurement of patellar tendon angle for presurgical planning.

  13. Long maximal incremental tests accurately assess aerobic fitness in class II and III obese men.

    PubMed

    Lanzi, Stefano; Codecasa, Franco; Cornacchia, Mauro; Maestrini, Sabrina; Capodaglio, Paolo; Brunani, Amelia; Fanari, Paolo; Salvadori, Alberto; Malatesta, Davide

    2015-01-01

    This study aimed to compare two different maximal incremental tests with different time durations [a maximal incremental ramp test with a short time duration (8-12 min) (STest) and a maximal incremental test with a longer time duration (20-25 min) (LTest)] to investigate whether an LTest accurately assesses aerobic fitness in class II and III obese men. Twenty obese men (BMI≥35 kg.m-2) without secondary pathologies (mean±SE; 36.7±1.9 yr; 41.8±0.7 kg*m-2) completed an STest (warm-up: 40 W; increment: 20 W*min-1) and an LTest [warm-up: 20% of the peak power output (PPO) reached during the STest; increment: 10% PPO every 5 min until 70% PPO was reached or until the respiratory exchange ratio reached 1.0, followed by 15 W.min-1 until exhaustion] on a cycle-ergometer to assess the peak oxygen uptake [Formula: see text] and peak heart rate (HRpeak) of each test. There were no significant differences in [Formula: see text] (STest: 3.1±0.1 L*min-1; LTest: 3.0±0.1 L*min-1) and HRpeak (STest: 174±4 bpm; LTest: 173±4 bpm) between the two tests. Bland-Altman plot analyses showed good agreement and Pearson product-moment and intra-class correlation coefficients showed a strong correlation between [Formula: see text] (r=0.81 for both; p≤0.001) and HRpeak (r=0.95 for both; p≤0.001) during both tests. [Formula: see text] and HRpeak assessments were not compromised by test duration in class II and III obese men. Therefore, we suggest that the LTest is a feasible test that accurately assesses aerobic fitness and may allow for the exercise intensity prescription and individualization that will lead to improved therapeutic approaches in treating obesity and severe obesity.

  14. Preoperative flexible bronchoscopy in patients with persistent ground-glass nodule.

    PubMed

    Jhun, Byung Woo; Um, Sang-Won; Suh, Gee Young; Chung, Man Pyo; Kim, Hojoong; Kwon, O Jung; Lee, Kyung Soo; Han, Joungho; Kim, Jhingook

    2015-01-01

    There are no accurate data on the diagnostic value of preoperative flexible bronchoscopy (FB) for persistent ground-glass nodule (GGN) of the lung. We evaluated the value of preoperative FB in patients with suspected GGN-type lung cancer. We retrospectively searched a database for subjects who had 'ground-glass opacity', 'non-solid nodule', 'part-solid nodule', or 'sub-solid nodule' on chest computed tomography reports between February 2004 and March 2012. Patients who had infiltrative ground-glass opacity lesions, mediastinal lymphadenopathy, or pleural effusion, focal ground-glass opacity lesions >3 cm, and were lost to follow-up were excluded. We assessed the diagnostic value of preoperative FB in patients with persistent GGNs who underwent surgical resection. In total, 296 GGNs were evaluated by FB in 264 patients with persistent GGNs who underwent preoperative FB and surgical resection. The median size of the GGNs was 18 mm; 135 (46%) were pure GGN and 161 (54%) were part-solid GGN. No visible tumor or unsuspected endobronchial metastasis was identified by preoperative FB. Only 3 (1%, 3/208) GGNs were identified preoperatively as malignant by bronchial washing cytology; all were part-solid GGNs. No other etiology was identified by FB. Of the GGNs, 271 (91%) were subsequently confirmed as malignant and 25 (9%) were confirmed as benign at surgical resection. Consequently, the overall diagnostic sensitivity and negative predictive value of preoperative FB on a per-nodule basis was 1% (3/271) and 8% (25/293), respectively. The preoperative FB did not change the surgical strategy. Preoperative FB did not add much to the evaluation of persistent GGNs of the lung. Routine preoperative FB may have limited value in surgical candidates with small persistent pure GGNs.

  15. Pre-operative Assessment Enables Early Diagnosis and Recovery of Shoulder Function in Patients with Breast Cancer

    PubMed Central

    Springer, Barbara A.; Levy, Ellen; McGarvey, Charles; Pfalzer, Lucinda A.; Stout, Nicole L; Gerber, Lynn H.; Soballe, Peter W.; Danoff, Jerome

    2010-01-01

    Purpose To determine the extent and time course of upper limb impairment and dysfunction in women being treated for breast cancer, and followed prospectively, using a novel physical therapy surveillance model post-treatment. Patients and Methods Subjects included adult women with newly diagnosed, untreated, unilateral, Stage I to III BC and normal physiological and biomechanical shoulder function. Subjects were excluded if they had a previous history of BC, or prior injury or surgery of the affected upper limb. Measurements included body weight, shoulder ranges of motion (ROM), manual muscle tests, pain levels, upper limb volume, and an upper limb disability questionnaire (ULDQ). Measurements were taken at baseline (pre surgery), and one, three-six, and 12 months post surgery. All subjects received pre-operative education and exercise instruction and specific physical therapy (PT) protocol after surgery including ROM and strengthening exercises. Results All measures of function were significantly reduced one month post surgery, but most recovered to baseline levels by one year post surgery. Some subjects developed signs of lymphedema 3–12 months post surgery, but this did not compromise function. Shoulder abduction, flexion, and external rotation, but not internal rotation ROM, were associated with the ULDQ. Conclusion Most women in this cohort undergoing surgery for BC who receive PT intervention may expect a return to baseline ROM and strength by three months. Those who do not reach baseline, often continue to improve and reach their pre-operative levels by one year post surgery. Lymphedema develops independently of shoulder function three to 12 months post surgery, necessitating continued monitoring. A prospective physical therapy model of surveillance allows for detection of early and later onset of impairment following surgery for BC in this specific cohort of patients. PMID:20054643

  16. New Cardiovascular Risk Factors and Their Use for an Accurate Cardiovascular Risk Assessment in Hypertensive Patients

    PubMed Central

    TAUTU, Oana-Florentina; DARABONT, Roxana; ONCIUL, Sebastian; DEACONU, Alexandru; COMANESCU, Ioana; ANDREI, Radu Dan; DRAGOESCU, Bogdan; CINTEZA, Mircea; DOROBANTU, Maria

    2014-01-01

    Objectives: To analyze the predictive value of new cardiovascular (CV) risk factors for CV risk assessment in the adult Romanian hypertensive (HT) population. Methods: Hypertensive adults aged between 40-65 years of age, identified in national representative SEPHAR II survey were evaluated by anthropometric, BP and arterial stiffness measurements: aortic pulse wave velocity (PWVao), aortic augmentation index (AIXao), revers time (RT) and central systolic blood pressure (SBPao), 12 lead ECGs and laboratory workup. Values above the 4th quartile of mean SBP' standard deviation (s.d.) defined increased BP variability. Log(TG/HDL-cholesterol) defined atherogenic index of plasma (AIP). Serum uric acid levels above 5.70 mg/dl for women and 7.0 mg/dl for males defined hyperuricemia (HUA). CV risk was assessed based on SCORE chart for high CV risk countries. Binary logistic regression using a stepwise likelihood ratio method (adjustments for major confounders and colliniarity analysis) was used in order to validate predictors of high and very high CV risk class. Results: The mean SBP value of the study group was 148.46±19.61 mmHg. Over forty percent of hypertensives had a high and very high CV risk. Predictors of high/very high CV risk category validated by regression analysis were: increased visit-to-visit BP variability (OR: 2.49; 95%CI: 1.67-3.73), PWVao (OR: 1.12; 95%CI: 1.02-1.22), RT (OR: 0.95; 95% CI: 0.93-0.98), SBPao (OR: 1.01; 95%CI: 1.01-1.03) and AIP (OR: 7.08; 95%CI: 3.91-12.82). Conclusion: The results of our study suggests that the new CV risk factors such as increased BP variability, arterial stiffness indices and AIP are useful tools for a more accurate identification of hypertensives patients at high and very high CV risk. PMID:25705267

  17. A Statistical Method for Assessing Peptide Identification Confidence in Accurate Mass and Time Tag Proteomics

    SciTech Connect

    Stanley, Jeffrey R.; Adkins, Joshua N.; Slysz, Gordon W.; Monroe, Matthew E.; Purvine, Samuel O.; Karpievitch, Yuliya V.; Anderson, Gordon A.; Smith, Richard D.; Dabney, Alan R.

    2011-07-15

    High-throughput proteomics is rapidly evolving to require high mass measurement accuracy for a variety of different applications. Increased mass measurement accuracy in bottom-up proteomics specifically allows for an improved ability to distinguish and characterize detected MS features, which may in turn be identified by, e.g., matching to entries in a database for both precursor and fragmentation mass identification methods. Many tools exist with which to score the identification of peptides from LC-MS/MS measurements or to assess matches to an accurate mass and time (AMT) tag database, but these two calculations remain distinctly unrelated. Here we present a statistical method, Statistical Tools for AMT tag Confidence (STAC), which extends our previous work incorporating prior probabilities of correct sequence identification from LC-MS/MS, as well as the quality with which LC-MS features match AMT tags, to evaluate peptide identification confidence. Compared to existing tools, we are able to obtain significantly more high-confidence peptide identifications at a given false discovery rate and additionally assign confidence estimates to individual peptide identifications. Freely available software implementations of STAC are available in both command line and as a Windows graphical application.

  18. Algal productivity modeling: a step toward accurate assessments of full-scale algal cultivation.

    PubMed

    Béchet, Quentin; Chambonnière, Paul; Shilton, Andy; Guizard, Guillaume; Guieysse, Benoit

    2015-05-01

    A new biomass productivity model was parameterized for Chlorella vulgaris using short-term (<30 min) oxygen productivities from algal microcosms exposed to 6 light intensities (20-420 W/m(2)) and 6 temperatures (5-42 °C). The model was then validated against experimental biomass productivities recorded in bench-scale photobioreactors operated under 4 light intensities (30.6-74.3 W/m(2)) and 4 temperatures (10-30 °C), yielding an accuracy of ± 15% over 163 days of cultivation. This modeling approach addresses major challenges associated with the accurate prediction of algal productivity at full-scale. Firstly, while most prior modeling approaches have only considered the impact of light intensity on algal productivity, the model herein validated also accounts for the critical impact of temperature. Secondly, this study validates a theoretical approach to convert short-term oxygen productivities into long-term biomass productivities. Thirdly, the experimental methodology used has the practical advantage of only requiring one day of experimental work for complete model parameterization. The validation of this new modeling approach is therefore an important step for refining feasibility assessments of algae biotechnologies.

  19. Algal productivity modeling: a step toward accurate assessments of full-scale algal cultivation.

    PubMed

    Béchet, Quentin; Chambonnière, Paul; Shilton, Andy; Guizard, Guillaume; Guieysse, Benoit

    2015-05-01

    A new biomass productivity model was parameterized for Chlorella vulgaris using short-term (<30 min) oxygen productivities from algal microcosms exposed to 6 light intensities (20-420 W/m(2)) and 6 temperatures (5-42 °C). The model was then validated against experimental biomass productivities recorded in bench-scale photobioreactors operated under 4 light intensities (30.6-74.3 W/m(2)) and 4 temperatures (10-30 °C), yielding an accuracy of ± 15% over 163 days of cultivation. This modeling approach addresses major challenges associated with the accurate prediction of algal productivity at full-scale. Firstly, while most prior modeling approaches have only considered the impact of light intensity on algal productivity, the model herein validated also accounts for the critical impact of temperature. Secondly, this study validates a theoretical approach to convert short-term oxygen productivities into long-term biomass productivities. Thirdly, the experimental methodology used has the practical advantage of only requiring one day of experimental work for complete model parameterization. The validation of this new modeling approach is therefore an important step for refining feasibility assessments of algae biotechnologies. PMID:25502920

  20. Accurate assessment of mass, models and resolution by small-angle scattering

    PubMed Central

    Rambo, Robert P.; Tainer, John A.

    2013-01-01

    Modern small angle scattering (SAS) experiments with X-rays or neutrons provide a comprehensive, resolution-limited observation of the thermodynamic state. However, methods for evaluating mass and validating SAS based models and resolution have been inadequate. Here, we define the volume-of-correlation, Vc: a SAS invariant derived from the scattered intensities that is specific to the structural state of the particle, yet independent of concentration and the requirements of a compact, folded particle. We show Vc defines a ratio, Qr, that determines the molecular mass of proteins or RNA ranging from 10 to 1,000 kDa. Furthermore, we propose a statistically robust method for assessing model-data agreements (X2free) akin to cross-validation. Our approach prevents over-fitting of the SAS data and can be used with a newly defined metric, Rsas, for quantitative evaluation of resolution. Together, these metrics (Vc, Qr, X2free, and Rsas) provide analytical tools for unbiased and accurate macromolecular structural characterizations in solution. PMID:23619693

  1. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  2. Is photometry an accurate and reliable method to assess boar semen concentration?

    PubMed

    Camus, A; Camugli, S; Lévêque, C; Schmitt, E; Staub, C

    2011-02-01

    Sperm concentration assessment is a key point to insure appropriate sperm number per dose in species subjected to artificial insemination (AI). The aim of the present study was to evaluate the accuracy and reliability of two commercially available photometers, AccuCell™ and AccuRead™ pre-calibrated for boar semen in comparison to UltiMate™ boar version 12.3D, NucleoCounter SP100 and Thoma hemacytometer. For each type of instrument, concentration was measured on 34 boar semen samples in quadruplicate and agreement between measurements and instruments were evaluated. Accuracy for both photometers was illustrated by mean of percentage differences to the general mean. It was -0.6% and 0.5% for Accucell™ and Accuread™ respectively, no significant differences were found between instrument and mean of measurement among all equipment. Repeatability for both photometers was 1.8% and 3.2% for AccuCell™ and AccuRead™ respectively. Low differences were observed between instruments (confidence interval 3%) except when hemacytometer was used as a reference. Even though hemacytometer is considered worldwide as the gold standard, it is the more variable instrument (confidence interval 7.1%). The conclusion is that routine photometry measures of raw semen concentration are reliable, accurate and precise using AccuRead™ or AccuCell™. There are multiple steps in semen processing that can induce sperm loss and therefore increase differences between theoretical and real sperm numbers in doses. Potential biases that depend on the workflow but not on the initial photometric measure of semen concentration are discussed.

  3. Multimodal Quantitative Phase Imaging with Digital Holographic Microscopy Accurately Assesses Intestinal Inflammation and Epithelial Wound Healing.

    PubMed

    Lenz, Philipp; Brückner, Markus; Ketelhut, Steffi; Heidemann, Jan; Kemper, Björn; Bettenworth, Dominik

    2016-01-01

    The incidence of inflammatory bowel disease, i.e., Crohn's disease and Ulcerative colitis, has significantly increased over the last decade. The etiology of IBD remains unknown and current therapeutic strategies are based on the unspecific suppression of the immune system. The development of treatments that specifically target intestinal inflammation and epithelial wound healing could significantly improve management of IBD, however this requires accurate detection of inflammatory changes. Currently, potential drug candidates are usually evaluated using animal models in vivo or with cell culture based techniques in vitro. Histological examination usually requires the cells or tissues of interest to be stained, which may alter the sample characteristics and furthermore, the interpretation of findings can vary by investigator expertise. Digital holographic microscopy (DHM), based on the detection of optical path length delay, allows stain-free quantitative phase contrast imaging. This allows the results to be directly correlated with absolute biophysical parameters. We demonstrate how measurement of changes in tissue density with DHM, based on refractive index measurement, can quantify inflammatory alterations, without staining, in different layers of colonic tissue specimens from mice and humans with colitis. Additionally, we demonstrate continuous multimodal label-free monitoring of epithelial wound healing in vitro, possible using DHM through the simple automated determination of the wounded area and simultaneous determination of morphological parameters such as dry mass and layer thickness of migrating cells. In conclusion, DHM represents a valuable, novel and quantitative tool for the assessment of intestinal inflammation with absolute values for parameters possible, simplified quantification of epithelial wound healing in vitro and therefore has high potential for translational diagnostic use. PMID:27685659

  4. Precise and accurate assessment of uncertainties in model parameters from stellar interferometry. Application to stellar diameters

    NASA Astrophysics Data System (ADS)

    Lachaume, Regis; Rabus, Markus; Jordan, Andres

    2015-08-01

    In stellar interferometry, the assumption that the observables can be seen as Gaussian, independent variables is the norm. In particular, neither the optical interferometry FITS (OIFITS) format nor the most popular fitting software in the field, LITpro, offer means to specify a covariance matrix or non-Gaussian uncertainties. Interferometric observables are correlated by construct, though. Also, the calibration by an instrumental transfer function ensures that the resulting observables are not Gaussian, even if uncalibrated ones happened to be so.While analytic frameworks have been published in the past, they are cumbersome and there is no generic implementation available. We propose here a relatively simple way of dealing with correlated errors without the need to extend the OIFITS specification or making some Gaussian assumptions. By repeatedly picking at random which interferograms, which calibrator stars, and which are the errors on their diameters, and performing the data processing on the bootstrapped data, we derive a sampling of p(O), the multivariate probability density function (PDF) of the observables O. The results can be stored in a normal OIFITS file. Then, given a model m with parameters P predicting observables O = m(P), we can estimate the PDF of the model parameters f(P) = p(m(P)) by using a density estimation of the observables' PDF p.With observations repeated over different baselines, on nights several days apart, and with a significant set of calibrators systematic errors are de facto taken into account. We apply the technique to a precise and accurate assessment of stellar diameters obtained at the Very Large Telescope Interferometer with PIONIER.

  5. [Preoperative assessment of children with fever and common cold: to proceed, or not to proceed, that is the question].

    PubMed

    Miyamoto, Yoshihisa; Ka, Koui

    2013-09-01

    Fever and upper respiratory tract infections (URI) are frequently-encountered preoperative comorbidities. Whether or not to proceed with anesthesia for a child with common cold is still a continuing dilemma for anesthesiologists. We, anesthesiologists often feel uncomfortable in making a decision whether or not to proceed because URI is associated with perioperative respiratory adverse events (PRAEs) and there are no definite rules to proceed with or postpone a case. Most of PRAEs are easily managed by experienced hands; however, laryngospasm or bronchospasm without early detection and immediate treatment would probably result in serious sequelae. Although several factors (e. g., asthma, infancy, endotracheal intubation, airway surgery, parental smoking, and parental confirmation of a URI, etc.) related to PRAEs have been elucidated to date, no one can guess correctly which child will suffer from adverse events. Moreover, because children per se are vulnerable to PRAEs, we cannot reduce the risk to zero even without a URI. Therefore, we should be familiarized with how to cope with PRAEs. In making a decision to proceed with or postpone the case, it is important to take various factors together into account, and the decision ultimately depends on whether or not we feel "Yes, we can". PMID:24063129

  6. Reading Assessment Methods for Middle-School Students: An Investigation of Reading Comprehension Rate and Maze Accurate Response Rate

    ERIC Educational Resources Information Center

    Hale, Andrea D.; Henning, Jaime B.; Hawkins, Renee O.; Sheeley, Wesley; Shoemaker, Larissa; Reynolds, Jennifer R.; Moch, Christina

    2011-01-01

    This study was designed to investigate the validity of four different aloud reading comprehension assessment measures: Maze, comprehension questions, Maze accurate response rate (MARR), and reading comprehension rate (RCR). The criterion measures used in this study were the Woodcock-Johnson III Tests of Achievement (WJ-III ACH) Broad Reading…

  7. Predictive Role of Functional Visceral Fat Activity Assessed by Preoperative F-18 FDG PET/CT for Regional Lymph Node or Distant Metastasis in Patients with Colorectal Cancer

    PubMed Central

    Pahk, Kisoo; Rhee, Seunghong; Kim, Sungeun; Choe, Jae Gol

    2016-01-01

    Objectives To investigate the role of functional visceral fat activity assessed by preoperative F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in colorectal cancer (CRC) for predicting regional lymph node (LN) or distant metastasis. Method We evaluated 131 patients with newly diagnosed CRC. They all underwent pre-operative 18F-FDG PET/CT and surgery. Functional fat activity was measured by maximum standardized uptake value (SUVmax) using 18F-FDG PET/CT. Functional visceral fat activity was measured by SUVmax of visceral fat/SUVmax of subcutaneous fat (V/S) ratio. Mann-Whitney U test, χ2 test, Fisher’s exact test, receiver-operating characteristic (ROC) analysis, Spearrman’s correlation coefficient, and uni- and multivariate logistic regression statistical analyses were done. Results Patients with higher V/S ratio displayed a significantly higher rate of regional LN (p = 0.004) and distant metastasis (p<0.001). In addition, V/S ratio was the only factor that was significantly associated with distant metastasis. An optimal cut-off V/S ratio of 1.88 was proposed for predicting distant metastasis with a sensitivity of 84.6% and specificity of 78.8% (area under the curve: 0.86; p<0.0001) Conclusion Functional visceral fat activity is significantly associated with distant metastasis in CRC patients. Furthermore, V/S ratio can be useful as a complementary factor in predicting distant metastasis. PMID:26862754

  8. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial

    PubMed Central

    Marchand-Maillet, Florence; Baron, Gabriel; Douard, Richard; Béthoux, Jean-Pierre

    2016-01-01

    Objectives To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial). Design Multicenter, two-arm, parallel-group, open-label randomized controlled trial. Setting 11 university hospital ambulatory surgery units in Paris, France. Participants Patients scheduled for ambulatory surgery and able to be reached by telephone. Intervention A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone. Main Outcome Measures Rate of cancellation on the day of surgery or the day before. Results The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state. Conclusions A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes. Trial Registration ClinicalTrials.gov NCT01732159 PMID:26829478

  9. A Descriptive Study Assessing Quality of Life for Adults With a Permanent Ostomy and the Influence of Preoperative Stoma Site Marking.

    PubMed

    Maydick, Diane

    2016-05-01

    Diseases or anomalies of the genitourinary or gastrointestinal tract often require removal of organs and creation of an artificial opening (stoma) to allow for elimination of urine or stool. Preoperative stoma site marking can affect quality of life (QoL). A descriptive study was conducted to assess the relationship between QoL and preoperative stoma site marking in adults with a permanent ostomy. Using convenience sampling methods, 230 eligible participants attending a United Ostomy Association of America conference were invited to complete a survey of demographics regarding age, gender, time since surgeries, and ostomy type and the City of Hope National Medical Center Quality of Life Ostomy Questionnaire. The latter contains 2 sections of 30 and 43 items each that address life impact and quality of life, respectively. The researcher explained the study and provided a study packet to volunteers who were interested in participating. Volunteers were to complete the surveys over a 4-day period while at the conference; the investigator collected all study materials. Inclusion criteria stipulated study participants must be English writing/reading persons at least 18 years of age with a colostomy, ileostomy, or urostomy. All descriptive statistics (means, standard deviation, frequency, and percents) used to describe demographic and surgical history and quantitative data (logistic regression, cross-tabulation, Pearson product moment correlations, and analysis of covariance) used to determine relationships among factors were entered and analyzed using a computer software program. Of the 140 participants who met inclusion criteria and provided data, the majority (85, 60.7%) had their stoma site marked by a wound, ostomy, continence (WOC) nurse. WOC nurse marking was more likely in recent years, and WOC nurse marking was 1.03 times more likely for each year since stoma surgery (M = 13.44, SD = 13.48). Mean QoL was 7.56 (SD = 1.59, range 3.84-10.00) and was positively

  10. A Descriptive Study Assessing Quality of Life for Adults With a Permanent Ostomy and the Influence of Preoperative Stoma Site Marking.

    PubMed

    Maydick, Diane

    2016-05-01

    Diseases or anomalies of the genitourinary or gastrointestinal tract often require removal of organs and creation of an artificial opening (stoma) to allow for elimination of urine or stool. Preoperative stoma site marking can affect quality of life (QoL). A descriptive study was conducted to assess the relationship between QoL and preoperative stoma site marking in adults with a permanent ostomy. Using convenience sampling methods, 230 eligible participants attending a United Ostomy Association of America conference were invited to complete a survey of demographics regarding age, gender, time since surgeries, and ostomy type and the City of Hope National Medical Center Quality of Life Ostomy Questionnaire. The latter contains 2 sections of 30 and 43 items each that address life impact and quality of life, respectively. The researcher explained the study and provided a study packet to volunteers who were interested in participating. Volunteers were to complete the surveys over a 4-day period while at the conference; the investigator collected all study materials. Inclusion criteria stipulated study participants must be English writing/reading persons at least 18 years of age with a colostomy, ileostomy, or urostomy. All descriptive statistics (means, standard deviation, frequency, and percents) used to describe demographic and surgical history and quantitative data (logistic regression, cross-tabulation, Pearson product moment correlations, and analysis of covariance) used to determine relationships among factors were entered and analyzed using a computer software program. Of the 140 participants who met inclusion criteria and provided data, the majority (85, 60.7%) had their stoma site marked by a wound, ostomy, continence (WOC) nurse. WOC nurse marking was more likely in recent years, and WOC nurse marking was 1.03 times more likely for each year since stoma surgery (M = 13.44, SD = 13.48). Mean QoL was 7.56 (SD = 1.59, range 3.84-10.00) and was positively

  11. Role of preoperative breast MRI in ductal carcinoma in situ for prediction of the presence and assessment of the extent of occult invasive component.

    PubMed

    Nori, Jacopo; Meattini, Icro; Giannotti, Elisabetta; Abdulcadir, Dalmar; Mariscotti, Giovanna; Calabrese, Massimo; Angelino, Francesca; Chiesa, Fabio; Saieva, Calogero; Vanzi, Ermanno; Boeri, Cecilia; Bianchi, Simonetta; Sanchez, Luis; Orzalesi, Lorenzo; Casella, Donato; Susini, Tommaso; Livi, Lorenzo

    2014-01-01

    Ductal carcinoma in situ (DCIS) is a common neoplasm that may be associated with focal invasive breast cancer lesions. The aim of our study was to evaluate the role of preoperative magnetic resonance imaging (MRI) in determining occult invasive presence and disease extent in patients with preoperative diagnosis of pure DCIS. We analyzed 125 patients with postoperative pure DCIS (n = 91) and DCIS plus invasive component (n = 34). Diagnostic mammography (MRX) showed a size underestimation rate of 30.4% while MRI showed an overestimation rate of 28.6%. Comparing the mean absolute error between preoperative MRI and MRX evaluations and final disease extent, MRI showed an improved accuracy of 51.2%. In our analysis preoperative breast MRI showed a better accuracy in predicting postoperative pathologic extent of disease, adding strength to the growing evidences that preoperative MRI can lead to a more appropriate management of DCIS patients. PMID:24750509

  12. A statistical method for assessing peptide identification confidence in accurate mass and time tag proteomics.

    PubMed

    Stanley, Jeffrey R; Adkins, Joshua N; Slysz, Gordon W; Monroe, Matthew E; Purvine, Samuel O; Karpievitch, Yuliya V; Anderson, Gordon A; Smith, Richard D; Dabney, Alan R

    2011-08-15

    Current algorithms for quantifying peptide identification confidence in the accurate mass and time (AMT) tag approach assume that the AMT tags themselves have been correctly identified. However, there is uncertainty in the identification of AMT tags, because this is based on matching LC-MS/MS fragmentation spectra to peptide sequences. In this paper, we incorporate confidence measures for the AMT tag identifications into the calculation of probabilities for correct matches to an AMT tag database, resulting in a more accurate overall measure of identification confidence for the AMT tag approach. The method is referenced as Statistical Tools for AMT Tag Confidence (STAC). STAC additionally provides a uniqueness probability (UP) to help distinguish between multiple matches to an AMT tag and a method to calculate an overall false discovery rate (FDR). STAC is freely available for download, as both a command line and a Windows graphical application.

  13. The effect of manipulated and accurate assessment feedback on the self-efficacy of dance students.

    PubMed

    García-Dantas, Ana; Quested, Eleanor

    2015-03-01

    Research undertaken with athletes has shown that lower-evaluated feedback is related to low self-efficacy levels. However, the relationship between teacher feedback and self-efficacy has not been studied in the dance setting. In sports or dance contexts, very few studies have manipulated feedback content to examine its impact on performers' self-efficacy in relation to the execution of a specific movement. Therefore, the aim of this investigation was to explore the effect of manipulated upper, lower, and accurate grade feedback on changes in dancers' self-efficacy levels for the execution of the "Zapateado" (a flamenco foot movement). Sixty-one students (56 female, 5 male, ages 13 to 22 ± 3.25 years) from a Spanish dance conservatory participated in this experimental study. They were randomly divided into four feedback groups: 1. upper-evaluated, 2. objective and informational, 3. lower-evaluated, and 4. no feedback-control. Participants performed three trials during a 1-hour session and completed questionnaires tapping self-efficacy pre-feedback and post-feedback. After each trial, teachers (who were confederates in the study) were first asked to rate their perception of each dancer's competence level at performing the movement according to conventional criteria (scores from 0 to 10). The results were then manipulated, and students accurate, lower-evaluated, or upper-evaluated scores were given. Those in the accurate feedback group reported positive change in self-efficacy, whereas those in the lower-evaluated group showed no significant change in self-efficacy during the course of the trial. Findings call into question the common perception among teachers that it can be motivating to provide students with inaccurate feedback that indicates that the students' performance level is much better or much worse than they actually perceive it to be. Self-efficacy appears most likely to increase in students when feedback is accurate. PMID:25741781

  14. The effect of manipulated and accurate assessment feedback on the self-efficacy of dance students.

    PubMed

    García-Dantas, Ana; Quested, Eleanor

    2015-03-01

    Research undertaken with athletes has shown that lower-evaluated feedback is related to low self-efficacy levels. However, the relationship between teacher feedback and self-efficacy has not been studied in the dance setting. In sports or dance contexts, very few studies have manipulated feedback content to examine its impact on performers' self-efficacy in relation to the execution of a specific movement. Therefore, the aim of this investigation was to explore the effect of manipulated upper, lower, and accurate grade feedback on changes in dancers' self-efficacy levels for the execution of the "Zapateado" (a flamenco foot movement). Sixty-one students (56 female, 5 male, ages 13 to 22 ± 3.25 years) from a Spanish dance conservatory participated in this experimental study. They were randomly divided into four feedback groups: 1. upper-evaluated, 2. objective and informational, 3. lower-evaluated, and 4. no feedback-control. Participants performed three trials during a 1-hour session and completed questionnaires tapping self-efficacy pre-feedback and post-feedback. After each trial, teachers (who were confederates in the study) were first asked to rate their perception of each dancer's competence level at performing the movement according to conventional criteria (scores from 0 to 10). The results were then manipulated, and students accurate, lower-evaluated, or upper-evaluated scores were given. Those in the accurate feedback group reported positive change in self-efficacy, whereas those in the lower-evaluated group showed no significant change in self-efficacy during the course of the trial. Findings call into question the common perception among teachers that it can be motivating to provide students with inaccurate feedback that indicates that the students' performance level is much better or much worse than they actually perceive it to be. Self-efficacy appears most likely to increase in students when feedback is accurate.

  15. SPECT-OPT multimodal imaging enables accurate evaluation of radiotracers for β-cell mass assessments

    PubMed Central

    Eter, Wael A.; Parween, Saba; Joosten, Lieke; Frielink, Cathelijne; Eriksson, Maria; Brom, Maarten; Ahlgren, Ulf; Gotthardt, Martin

    2016-01-01

    Single Photon Emission Computed Tomography (SPECT) has become a promising experimental approach to monitor changes in β-cell mass (BCM) during diabetes progression. SPECT imaging of pancreatic islets is most commonly cross-validated by stereological analysis of histological pancreatic sections after insulin staining. Typically, stereological methods do not accurately determine the total β-cell volume, which is inconvenient when correlating total pancreatic tracer uptake with BCM. Alternative methods are therefore warranted to cross-validate β-cell imaging using radiotracers. In this study, we introduce multimodal SPECT - optical projection tomography (OPT) imaging as an accurate approach to cross-validate radionuclide-based imaging of β-cells. Uptake of a promising radiotracer for β-cell imaging by SPECT, 111In-exendin-3, was measured by ex vivo-SPECT and cross evaluated by 3D quantitative OPT imaging as well as with histology within healthy and alloxan-treated Brown Norway rat pancreata. SPECT signal was in excellent linear correlation with OPT data as compared to histology. While histological determination of islet spatial distribution was challenging, SPECT and OPT revealed similar distribution patterns of 111In-exendin-3 and insulin positive β-cell volumes between different pancreatic lobes, both visually and quantitatively. We propose ex vivo SPECT-OPT multimodal imaging as a highly accurate strategy for validating the performance of β-cell radiotracers. PMID:27080529

  16. [Clinical assessment of a monitor "MedStorm" (Norway) of galvanic skin response correlates with preoperative stress].

    PubMed

    2011-01-01

    Clinical trials were performed by Russian anesthesiologists of pain monitor based on measuring galvanic skin response (skin conductance). 5 pations were studied the monitor showed lower sensitivity to assess the level of analgesia during combined anesthesia which allows to not recommend it for use in clinical practice. PMID:22379919

  17. How to Achieve Accurate Peer Assessment for High Value Written Assignments in a Senior Undergraduate Course

    ERIC Educational Resources Information Center

    Jeffery, Daniel; Yankulov, Krassimir; Crerar, Alison; Ritchie, Kerry

    2016-01-01

    The psychometric measures of accuracy, reliability and validity of peer assessment are critical qualities for its use as a supplement to instructor grading. In this study, we seek to determine which factors related to peer review are the most influential on these psychometric measures, with a primary focus on the accuracy of peer assessment or how…

  18. Self- and peer assessment may not be an accurate measure of PBL tutorial process

    PubMed Central

    Machado, José Lúcio Martins; Machado, Valéria Menezes Peixeiro; Grec, Waldir; Bollela, Valdes Roberto; Vieira, Joaquim Edson

    2008-01-01

    Background Universidade Cidade de São Paulo adopted a problem-based learning (PBL) strategy as the predominant method for teaching and learning medicine. Self-, peer- and tutor marks of the educational process are taken into account as part of the final grade, which also includes assessment of content. This study compared the different perspectives (and grades) of evaluators during tutorials with first year medical students, from 2004 to 2007 (n = 349), from seven semesters. Methods The tutorial evaluation method was comprised of the students' self assessment (SA) (10%), tutor assessment (TA) (80%) and peer assessment (PA) (10%) to calculate a final educational process grade for each tutorial. We compared these three grades from each tutorial for seven semesters using ANOVA and a post hoc test. Results A total of 349 students participated with 199 (57%) women and 150 (42%) men. The SA and PA scores were consistently greater than the TA scores. Moreover, the SA and PA groups did not show statistical difference in any semester evaluated, while both differed from tutor assessment in all semesters (Kruskal-Wallis, Dunn's test). The Spearman rank order showed significant (p < 0.0001) and positive correlation for the SA and PA groups (r = 0.806); this was not observed when we compared TA with PA (r = 0.456) or TA with SA (r = 0.376). Conclusion Peer- and self-assessment marks might be reliable but not valid for PBL tutorial process, especially if these assessments are used for summative assessment, composing the final grade. This article suggests reconsideration of the use of summative assessment for self-evaluation in PBL tutorials. PMID:19038048

  19. Mechanically assisted 3D ultrasound for pre-operative assessment and guiding percutaneous treatment of focal liver tumors

    NASA Astrophysics Data System (ADS)

    Sadeghi Neshat, Hamid; Bax, Jeffery; Barker, Kevin; Gardi, Lori; Chedalavada, Jason; Kakani, Nirmal; Fenster, Aaron

    2014-03-01

    Image-guided percutaneous ablation is the standard treatment for focal liver tumors deemed inoperable and is commonly used to maintain eligibility for patients on transplant waitlists. Radiofrequency (RFA), microwave (MWA) and cryoablation technologies are all delivered via one or a number of needle-shaped probes inserted directly into the tumor. Planning is mostly based on contrast CT/MRI. While intra-procedural CT is commonly used to confirm the intended probe placement, 2D ultrasound (US) remains the main, and in some centers the only imaging modality used for needle guidance. Corresponding intraoperative 2D US with planning and other intra-procedural imaging modalities is essential for accurate needle placement. However, identification of matching features of interest among these images is often challenging given the limited field-of-view (FOV) and low quality of 2D US images. We have developed a passive tracking arm with a motorized scan-head and software tools to improve guiding capabilities of conventional US by large FOV 3D US scans that provides more anatomical landmarks that can facilitate registration of US with both planning and intra-procedural images. The tracker arm is used to scan the whole liver with a high geometrical accuracy that facilitates multi-modality landmark based image registration. Software tools are provided to assist with the segmentation of the ablation probes and tumors, find the 2D view that best shows the probe(s) from a 3D US image, and to identify the corresponding image from planning CT scans. In this paper, evaluation results from laboratory testing and a phase 1 clinical trial for planning and guiding RFA and MWA procedures using the developed system will be presented. Early clinical results show a comparable performance to intra-procedural CT that suggests 3D US as a cost-effective alternative with no side-effects in centers where CT is not available.

  20. Pre-operative assessment of relationship between inferior dental nerve canal and mandibular impacted third molar in Saudi population

    PubMed Central

    Shujaat, S.; Abouelkheir, H.M.; Al-Khalifa, K.S.; Al-Jandan, B.; Marei, H.F.

    2014-01-01

    Objective To study the correlation between the position of the inferior dental (ID) nerve canal and the angulation of impacted mandibular third molars using dental cone beam computed tomography (CBCT). Materials and methods The study considered 100 impactions in 85 patients (60 males, 25 females), for whom an initial panoramic radiographic assessment had revealed that the ID canal and the lower 3rd molar were in close proximity. A CBCT scan of each patient was carried out to assess how the ID nerve canal position influenced the class and position of impaction, angulation of impaction, and bone contact. Results Class I position B impactions were found in the majority of cases, where the position of the ID canal was approximate to the lingual plate and inferior to the 3rd molar (85.7%). The results were statistically significant (p = 0.001). 96% of the ID canals showed bone contact. Of these, 77.1% of ID canals exhibited lingual bone contact, inferior to impaction. The results were statistically significant (p = 0.001). Horizontally angulated impactions were most common in the mandible, and significantly associated with lingual and inferior positioning of the ID canal (76.2%). Conclusions Our sample population most commonly exhibited horizontally angulated class I position B impactions of the mandible. The position of the ID canal significantly influenced the type of impaction and bone contact. PMID:25057230

  1. A correlative imaging based methodology for accurate quantitative assessment of bone formation in additive manufactured implants.

    PubMed

    Geng, Hua; Todd, Naomi M; Devlin-Mullin, Aine; Poologasundarampillai, Gowsihan; Kim, Taek Bo; Madi, Kamel; Cartmell, Sarah; Mitchell, Christopher A; Jones, Julian R; Lee, Peter D

    2016-06-01

    A correlative imaging methodology was developed to accurately quantify bone formation in the complex lattice structure of additive manufactured implants. Micro computed tomography (μCT) and histomorphometry were combined, integrating the best features from both, while demonstrating the limitations of each imaging modality. This semi-automatic methodology registered each modality using a coarse graining technique to speed the registration of 2D histology sections to high resolution 3D μCT datasets. Once registered, histomorphometric qualitative and quantitative bone descriptors were directly correlated to 3D quantitative bone descriptors, such as bone ingrowth and bone contact. The correlative imaging allowed the significant volumetric shrinkage of histology sections to be quantified for the first time (~15 %). This technique demonstrated the importance of location of the histological section, demonstrating that up to a 30 % offset can be introduced. The results were used to quantitatively demonstrate the effectiveness of 3D printed titanium lattice implants.

  2. Three-Dimensional Assessment of Automated Breast Volume Scanner Compared with Handheld Ultrasound in Pre-Operative Breast Invasive Ductal Carcinomas: A Pilot Study of 51 Cases.

    PubMed

    Xu, Chaoli; Wei, Shuping; Xie, Yingdong; Guan, Xiaoxiang; Yang, Bin

    2016-09-01

    The aim of the work described here was to compare the accuracy of conventional handheld ultrasound (HHUS) with that of an automated breast volume scanner (ABVS) in 3-D assessment of pre-operative invasive ductal carcinomas. HHUS and ABVS were used in 51 patients to obtain the largest tumor diameter, tumor volume and tumor surface area. The volumetric measurement was also obtained from ABVS data with medical software. With tumor size and volume on pathology as the gold standard, Bland-Altman analysis was used to compare variability. Correlation coefficients and receiver operating characteristic curves were established for all measurements for T2 classification. The correlation coefficients of all ABVS measurements were stronger than those of HHUS measurements, with the ABVS volumetric measurement significantly different with a higher accuracy of 88.24% (45/51) and predicting T-classification with higher area under the receiver operating characteristic curves (0.936). Therefore, 3-D measurements provide stronger correlations with pathology in tumor size measurement. However, more clinical trials are needed to confirm our findings.

  3. Accurate calculation of binding energies for molecular clusters - Assessment of different models

    NASA Astrophysics Data System (ADS)

    Friedrich, Joachim; Fiedler, Benjamin

    2016-06-01

    In this work we test different strategies to compute high-level benchmark energies for medium-sized molecular clusters. We use the incremental scheme to obtain CCSD(T)/CBS energies for our test set and carefully validate the accuracy for binding energies by statistical measures. The local errors of the incremental scheme are <1 kJ/mol. Since they are smaller than the basis set errors, we obtain higher total accuracy due to the applicability of larger basis sets. The final CCSD(T)/CBS benchmark values are ΔE = - 278.01 kJ/mol for (H2O)10, ΔE = - 221.64 kJ/mol for (HF)10, ΔE = - 45.63 kJ/mol for (CH4)10, ΔE = - 19.52 kJ/mol for (H2)20 and ΔE = - 7.38 kJ/mol for (H2)10 . Furthermore we test state-of-the-art wave-function-based and DFT methods. Our benchmark data will be very useful for critical validations of new methods. We find focal-point-methods for estimating CCSD(T)/CBS energies to be highly accurate and efficient. For foQ-i3CCSD(T)-MP2/TZ we get a mean error of 0.34 kJ/mol and a standard deviation of 0.39 kJ/mol.

  4. Assessing temporal flux of plant hormones in stored processing potatoes using high definition accurate mass spectrometry

    PubMed Central

    Ordaz-Ortiz, José Juan; Foukaraki, Sofia; Terry, Leon Alexander

    2015-01-01

    Plant hormones are important molecules which at low concentration can regulate various physiological processes. Mass spectrometry has become a powerful technique for the quantification of multiple classes of plant hormones because of its high sensitivity and selectivity. We developed a new ultrahigh pressure liquid chromatography–full-scan high-definition accurate mass spectrometry method, for simultaneous determination of abscisic acid and four metabolites phaseic acid, dihydrophaseic acid, 7′-hydroxy-abscisic acid and abscisic acid glucose ester, cytokinins zeatin, zeatin riboside, gibberellins (GA1, GA3, GA4 and GA7) and indole-3-acetyl-L-aspartic acid. We measured the amount of plant hormones in the flesh and skin of two processing potato cvs. Sylvana and Russet Burbank stored for up to 30 weeks at 6 °C under ambient air conditions. Herein, we report for the first time that abscisic acid glucose ester seems to accumulate in the skin of potato tubers throughout storage time. The method achieved a lowest limit of detection of 0.22 ng g−1 of dry weight and a limit of quantification of 0.74 ng g−1 dry weight (zeatin riboside), and was able to recover, detect and quantify a total of 12 plant hormones spiked on flesh and skin of potato tubers. In addition, the mass accuracy for all compounds (<5 ppm) was evaluated. PMID:26504563

  5. Chromatography paper as a low-cost medium for accurate spectrophotometric assessment of blood hemoglobin concentration.

    PubMed

    Bond, Meaghan; Elguea, Carlos; Yan, Jasper S; Pawlowski, Michal; Williams, Jessica; Wahed, Amer; Oden, Maria; Tkaczyk, Tomasz S; Richards-Kortum, Rebecca

    2013-06-21

    Anemia affects a quarter of the world's population, and a lack of appropriate diagnostic tools often prevents treatment in low-resource settings. Though the HemoCue 201+ is an appropriate device for diagnosing anemia in low-resource settings, the high cost of disposables ($0.99 per test in Malawi) limits its availability. We investigated using spectrophotometric measurement of blood spotted on chromatography paper as a low-cost (<$0.01 per test) alternative to HemoCue cuvettes. For this evaluation, donor blood was diluted with plasma to simulate anemia, a micropipette spotted blood on paper, and a bench-top spectrophotometer validated the approach before the development of a low-cost reader. We optimized impregnating paper with chemicals to lyse red blood cells, paper type, drying time, wavelengths measured, and sensitivity to variations in volume of blood, and we validated our approach using patient samples. Lysing the blood cells with sodium deoxycholate dried in Whatman Chr4 chromatography paper gave repeatable results, and the absorbance difference between 528 nm and 656 nm was stable over time in measurements taken up to 10 min after sample preparation. The method was insensitive to the amount of blood spotted on the paper over the range of 5 μL to 25 μL. We created a low-cost, handheld reader to measure the transmission of paper cuvettes at these optimal wavelengths. Training and validating our method with patient samples on both the spectrometer and the handheld reader showed that both devices are accurate to within 2 g dL(-1) of the HemoCue device for 98% and 95% of samples, respectively.

  6. A Cost-Benefit and Accurate Method for Assessing Microalbuminuria: Single versus Frequent Urine Analysis

    PubMed Central

    Hemmati, Roholla; Gharipour, Mojgan; Khosravi, Alireza; Jozan, Mahnaz

    2013-01-01

    Background. The purpose of this study was to answer the question whether a single testing for microalbuminuria results in a reliable conclusion leading costs saving. Methods. This current cross-sectional study included a total of 126 consecutive persons. Microalbuminuria was assessed by collection of two fasting random urine specimens on arrival to the clinic as well as one week later in the morning. Results. In overall, 17 out of 126 participants suffered from microalbuminuria that, among them, 12 subjects were also diagnosed as microalbuminuria once assessing this factor with a sensitivity of 70.6%, a specificity of 100%, a PPV of 100%, a NPV of 95.6%, and an accuracy of 96.0%. The measured sensitivity, specificity, PVV, NPV, and accuracy in hypertensive patients were 73.3%, 100%, 100%, 94.8%, and 95.5%, respectively. Also, these rates in nonhypertensive groups were 50.0%, 100%, 100%, 97.3%, and 97.4%, respectively. According to the ROC curve analysis, a single measurement of UACR had a high value for discriminating defected from normal renal function state (c = 0.989). Urinary albumin concentration in a single measurement had also high discriminative value for diagnosis of damaged kidney (c = 0.995). Conclusion. The single testing of both UACR and urine albumin level rather frequent testing leads to high diagnostic sensitivity, specificity, and accuracy as well as high predictive values in total population and also in hypertensive subgroups. PMID:24455207

  7. The relationship of pre-operative health status to sustained outcome in gastric bypass surgery.

    PubMed

    Lanyon, Richard I; Maxwell, Barbara M; Wershba, Rebecca E

    2014-02-01

    The task of sustaining initial weight loss after gastric bypass surgery has been identified as the area of greatest concern in this intervention. The present study investigated the role of good vs. poor pre-operative health as a moderator variable in identifying useful pre-operative predictors of continued weight loss. Follow-up data at a mean of 12.8 months and again at 3.2 years post-operatively were available for 79 patients on 227 interview variables and four psychological assessment instruments. These measures were studied for their success in predicting continued weight loss over the 1–3-year period separately for patients who were in good and in poor general pre-operative health. Previous findings showed that the overall mean simple weight loss to 12.8 months was 45.61 kg, but additional weight loss to 3.2 years was only 0.28 kg. The good and poor pre-operative health groups differed little on these figures. However, the significant predictors of continued weight loss for good-health patients (high anxiety and distress, low self-esteem, poor eating habits, strong expectations of life improvement, and good achievement and coping skills) were quite different from those for poor-health patients (good psychological health and happiness, strong personal support and life satisfaction, good eating habits, and little knowledge about their health). Thus, pre-operative health status served as a powerful moderator in predicting continued weight loss from pre-operative characteristics. These findings offer a means of making more accurate predictions as to which patients are the best candidates for surgery, and also suggest that different psychological and other interventions should be selected according to pre-operative health status. PMID:24122659

  8. Can script concordance testing be used in nursing education to accurately assess clinical reasoning skills?

    PubMed

    Dawson, Tyia; Comer, Linda; Kossick, Mark A; Neubrander, Judy

    2014-05-01

    The Script Concordance Test (SCT) has been used successfully in medical schools to assess clinical reasoning in medical students, but it has not been widely used in nursing education. The purpose of this study was to provide additional evidence of the validity and reliability of the SCT in evaluating clinical reasoning in nursing students by replicating a previous study. The test was administered to 48 first-year Bachelor of Science in Nursing students. A scoring grid was developed using the aggregate scores method based on the modal responses of 13 panel members. The reliability of the scores was measured by Cronbach's alpha coefficient, and the scores of the students and the panel were compared using a t test. The difference between the panel's and the students' scores was statistically significant, and the reliability of the scores is high. The SCT provides a reliable, standardized, and easy-to-administer method of evaluating clinical reasoning in nursing students.

  9. Accurate assessment of the biodegradation of cationic surfactants in activated sludge reactors (OECD TG 303A).

    PubMed

    Geerts, Roy; van Ginkel, Cornelis G; Plugge, Caroline M

    2015-08-01

    The continuous-fed activated sludge test (OECD TG 303A) was used to predict the removal of cationic surfactants from wastewater in activated sludge plants. However, a method to differentiate between adsorption and biodegradation is not provided in these guidelines. Assessment of removal by biodegradation was possible with analysis of the surfactant present in mixed liquid suspended solids in combination with a simple equation. This equation was derived from the mass balance of the activated sludge unit in steady state. The removal by biodegradation of decylamine, tetradecylamine, octadecylamine, dioctadecylmethylamine and dioctadecyldimethylammonium chloride that have different capacities to adsorb was >99.9%, >99.9%, 98.2%, 94.2%, and 69.0%, respectively. The total removal of all five cationic surfactants from the influent was ≥98.8%. The removal of octadecylamine spiked at different influent concentrations indicated first order kinetics. PMID:25913361

  10. Quick, Accurate, Smart: 3D Computer Vision Technology Helps Assessing Confined Animals’ Behaviour

    PubMed Central

    Calderara, Simone; Pistocchi, Simone; Cucchiara, Rita; Podaliri-Vulpiani, Michele; Messori, Stefano; Ferri, Nicola

    2016-01-01

    Mankind directly controls the environment and lifestyles of several domestic species for purposes ranging from production and research to conservation and companionship. These environments and lifestyles may not offer these animals the best quality of life. Behaviour is a direct reflection of how the animal is coping with its environment. Behavioural indicators are thus among the preferred parameters to assess welfare. However, behavioural recording (usually from video) can be very time consuming and the accuracy and reliability of the output rely on the experience and background of the observers. The outburst of new video technology and computer image processing gives the basis for promising solutions. In this pilot study, we present a new prototype software able to automatically infer the behaviour of dogs housed in kennels from 3D visual data and through structured machine learning frameworks. Depth information acquired through 3D features, body part detection and training are the key elements that allow the machine to recognise postures, trajectories inside the kennel and patterns of movement that can be later labelled at convenience. The main innovation of the software is its ability to automatically cluster frequently observed temporal patterns of movement without any pre-set ethogram. Conversely, when common patterns are defined through training, a deviation from normal behaviour in time or between individuals could be assessed. The software accuracy in correctly detecting the dogs’ behaviour was checked through a validation process. An automatic behaviour recognition system, independent from human subjectivity, could add scientific knowledge on animals’ quality of life in confinement as well as saving time and resources. This 3D framework was designed to be invariant to the dog’s shape and size and could be extended to farm, laboratory and zoo quadrupeds in artificial housing. The computer vision technique applied to this software is innovative in non

  11. Quick, Accurate, Smart: 3D Computer Vision Technology Helps Assessing Confined Animals' Behaviour.

    PubMed

    Barnard, Shanis; Calderara, Simone; Pistocchi, Simone; Cucchiara, Rita; Podaliri-Vulpiani, Michele; Messori, Stefano; Ferri, Nicola

    2016-01-01

    Mankind directly controls the environment and lifestyles of several domestic species for purposes ranging from production and research to conservation and companionship. These environments and lifestyles may not offer these animals the best quality of life. Behaviour is a direct reflection of how the animal is coping with its environment. Behavioural indicators are thus among the preferred parameters to assess welfare. However, behavioural recording (usually from video) can be very time consuming and the accuracy and reliability of the output rely on the experience and background of the observers. The outburst of new video technology and computer image processing gives the basis for promising solutions. In this pilot study, we present a new prototype software able to automatically infer the behaviour of dogs housed in kennels from 3D visual data and through structured machine learning frameworks. Depth information acquired through 3D features, body part detection and training are the key elements that allow the machine to recognise postures, trajectories inside the kennel and patterns of movement that can be later labelled at convenience. The main innovation of the software is its ability to automatically cluster frequently observed temporal patterns of movement without any pre-set ethogram. Conversely, when common patterns are defined through training, a deviation from normal behaviour in time or between individuals could be assessed. The software accuracy in correctly detecting the dogs' behaviour was checked through a validation process. An automatic behaviour recognition system, independent from human subjectivity, could add scientific knowledge on animals' quality of life in confinement as well as saving time and resources. This 3D framework was designed to be invariant to the dog's shape and size and could be extended to farm, laboratory and zoo quadrupeds in artificial housing. The computer vision technique applied to this software is innovative in non

  12. Quick, Accurate, Smart: 3D Computer Vision Technology Helps Assessing Confined Animals' Behaviour.

    PubMed

    Barnard, Shanis; Calderara, Simone; Pistocchi, Simone; Cucchiara, Rita; Podaliri-Vulpiani, Michele; Messori, Stefano; Ferri, Nicola

    2016-01-01

    Mankind directly controls the environment and lifestyles of several domestic species for purposes ranging from production and research to conservation and companionship. These environments and lifestyles may not offer these animals the best quality of life. Behaviour is a direct reflection of how the animal is coping with its environment. Behavioural indicators are thus among the preferred parameters to assess welfare. However, behavioural recording (usually from video) can be very time consuming and the accuracy and reliability of the output rely on the experience and background of the observers. The outburst of new video technology and computer image processing gives the basis for promising solutions. In this pilot study, we present a new prototype software able to automatically infer the behaviour of dogs housed in kennels from 3D visual data and through structured machine learning frameworks. Depth information acquired through 3D features, body part detection and training are the key elements that allow the machine to recognise postures, trajectories inside the kennel and patterns of movement that can be later labelled at convenience. The main innovation of the software is its ability to automatically cluster frequently observed temporal patterns of movement without any pre-set ethogram. Conversely, when common patterns are defined through training, a deviation from normal behaviour in time or between individuals could be assessed. The software accuracy in correctly detecting the dogs' behaviour was checked through a validation process. An automatic behaviour recognition system, independent from human subjectivity, could add scientific knowledge on animals' quality of life in confinement as well as saving time and resources. This 3D framework was designed to be invariant to the dog's shape and size and could be extended to farm, laboratory and zoo quadrupeds in artificial housing. The computer vision technique applied to this software is innovative in non

  13. Avoiding Unnecessary Preoperative Testing.

    PubMed

    Rusk, Matthew H

    2016-09-01

    Given the low-risk nature of cataract surgery, no preoperative testing is indicated unless the patient needs it for another reason. Although electrocardiograms may have a role in preoperative testing in patients at high risk of cardiovascular disease, or if the procedure carries with it significant operative risks, they are often unnecessary. Urinalysis and coagulation studies not should be routine because they have not shown any value in predicting complications. Although these tests are not individually expensive, the aggregate cost is substantial. As good stewards of the medical system, physicians need to use these tests more judiciously. PMID:27542420

  14. Accurate assessment of the impact of salmon farming on benthic sediment enrichment using foraminiferal metabarcoding.

    PubMed

    Pochon, X; Wood, S A; Keeley, N B; Lejzerowicz, F; Esling, P; Drew, J; Pawlowski, J

    2015-11-15

    Assessing the environmental impact of salmon farms on benthic systems is traditionally undertaken using biotic indices derived from microscopic analyses of macrobenthic infaunal (MI) communities. In this study, we tested the applicability of using foraminiferal-specific high-throughput sequencing (HTS) metabarcoding for monitoring these habitats. Sediment samples and physico-chemical data were collected along an enrichment gradient radiating out from three Chinook salmon (Oncorhynchus tshawytscha) farms in New Zealand. HTS of environmental DNA and RNA (eDNA/eRNA) resulted in 1,875,300 sequences that clustered into 349 Operational Taxonomic Units. Strong correlations were observed among various biotic indices calculated from MI data and normalized fourth-root transformed HTS data. Correlations were stronger using eRNA compared to eDNA data. Quantile regression spline analyses identified 12 key foraminiferal taxa that have potential to be used as bioindicator species. This study demonstrates the huge potential for using this method for biomonitoring of fish-farming and other marine industrial activities. PMID:26337228

  15. The role of endoscopic ultrasound on the preoperative T staging of gastric cancer

    PubMed Central

    Han, Chaoqun; Lin, Rong; Shi, Huiying; Liu, Jun; Qian, Wei; Ding, Zhen; Hou, Xiaohua

    2016-01-01

    Abstract Endoscopic ultrasonography (EUS) is used for preoperative assessment of gastric cancer. However, recent studies suggested that EUS staging accuracy is lower than previously thought. We aimed to assess EUS efficacy and image characteristics in preoperative gastric cancer T staging. A retrospective review of clinical and imaging features of 232 gastric carcinoma patients who underwent preoperative EUS assessment of T stage was performed. Only cases with tumor-free resection margin status and no metastases were enrolled. Comparisons of preoperative EUS and postoperative histopathological stagings were also performed to identify vital EUS image features for evaluating gastric carcinoma. EUS accuracy for T staging was 64.2% (149/232) with the highest accuracy for T3 (75.0%). Enlarged lymph nodes, well differentiated histological type and Borrmann IV type were associated with diagnostic accuracy in predicting tumor invasion. Although no factors were associated with overstaging, circumferential lesions ≥1/2, signet ring cell adenocarcinoma, and Borrmann IV type had significantly higher risks of understaging. Gastric wall outer edge irregularity was also an indicator of serosal involvement with a sensitivity of 82.0%. The pancreas and colon were more frequent disease extension sites than previously predicted. Although EUS is likely the best and most accurate option that we have used to stage gastric cancer, the finding that factors including circumferential lesions, signet ring cell adenocarcinoma, and Borrmann IV type carcinoma were more frequently related to incorrect staging warrants attention. PMID:27603347

  16. The role of endoscopic ultrasound on the preoperative T staging of gastric cancer: A retrospective study.

    PubMed

    Han, Chaoqun; Lin, Rong; Shi, Huiying; Liu, Jun; Qian, Wei; Ding, Zhen; Hou, Xiaohua

    2016-09-01

    Endoscopic ultrasonography (EUS) is used for preoperative assessment of gastric cancer. However, recent studies suggested that EUS staging accuracy is lower than previously thought. We aimed to assess EUS efficacy and image characteristics in preoperative gastric cancer T staging.A retrospective review of clinical and imaging features of 232 gastric carcinoma patients who underwent preoperative EUS assessment of T stage was performed. Only cases with tumor-free resection margin status and no metastases were enrolled. Comparisons of preoperative EUS and postoperative histopathological stagings were also performed to identify vital EUS image features for evaluating gastric carcinoma.EUS accuracy for T staging was 64.2% (149/232) with the highest accuracy for T3 (75.0%). Enlarged lymph nodes, well differentiated histological type and Borrmann IV type were associated with diagnostic accuracy in predicting tumor invasion. Although no factors were associated with overstaging, circumferential lesions ≥1/2, signet ring cell adenocarcinoma, and Borrmann IV type had significantly higher risks of understaging. Gastric wall outer edge irregularity was also an indicator of serosal involvement with a sensitivity of 82.0%. The pancreas and colon were more frequent disease extension sites than previously predicted.Although EUS is likely the best and most accurate option that we have used to stage gastric cancer, the finding that factors including circumferential lesions, signet ring cell adenocarcinoma, and Borrmann IV type carcinoma were more frequently related to incorrect staging warrants attention. PMID:27603347

  17. Use of human in vitro skin models for accurate and ethical risk assessment: metabolic considerations.

    PubMed

    Hewitt, Nicola J; Edwards, Robert J; Fritsche, Ellen; Goebel, Carsten; Aeby, Pierre; Scheel, Julia; Reisinger, Kerstin; Ouédraogo, Gladys; Duche, Daniel; Eilstein, Joan; Latil, Alain; Kenny, Julia; Moore, Claire; Kuehnl, Jochen; Barroso, Joao; Fautz, Rolf; Pfuhler, Stefan

    2013-06-01

    Several human skin models employing primary cells and immortalized cell lines used as monocultures or combined to produce reconstituted 3D skin constructs have been developed. Furthermore, these models have been included in European genotoxicity and sensitization/irritation assay validation projects. In order to help interpret data, Cosmetics Europe (formerly COLIPA) facilitated research projects that measured a variety of defined phase I and II enzyme activities and created a complete proteomic profile of xenobiotic metabolizing enzymes (XMEs) in native human skin and compared them with data obtained from a number of in vitro models of human skin. Here, we have summarized our findings on the current knowledge of the metabolic capacity of native human skin and in vitro models and made an overall assessment of the metabolic capacity from gene expression, proteomic expression, and substrate metabolism data. The known low expression and function of phase I enzymes in native whole skin were reflected in the in vitro models. Some XMEs in whole skin were not detected in in vitro models and vice versa, and some major hepatic XMEs such as cytochrome P450-monooxygenases were absent or measured only at very low levels in the skin. Conversely, despite varying mRNA and protein levels of phase II enzymes, functional activity of glutathione S-transferases, N-acetyltransferase 1, and UDP-glucuronosyltransferases were all readily measurable in whole skin and in vitro skin models at activity levels similar to those measured in the liver. These projects have enabled a better understanding of the contribution of XMEs to toxicity endpoints. PMID:23539547

  18. [The preoperative anaesthetic visit].

    PubMed

    Harms, Christoph; Kindler, Christoph H

    2009-07-01

    Anaesthetists often visit their patients in exceptional situations characterised by preoperative anxiety or distress. Therefore, even brief contact with the patient can be considered intense and meaningful. The initial preoperative anaesthetic visit is the beginning of the relationship between patient and anaesthetist, and should help to explain the planned anaesthetic technique. Preoperative anaesthetic visits are intense and last for 20 minutes on average. They should assert a professional approach to the patient's emotions, particularly to preoperative anxiety, and a structured and clear collection of information including the past history of the patient. These visits should also provide information about the anaesthesia itself and instructions for the patient with respect to the perioperative period. Communication about the side effects and risks of anaesthetic techniques, and the discussion of potential alternatives are mandatory. Worldwide, courts of law increasingly require a documented discussion between the anaesthetist and patient based on risk-benefit evidence. Today, there is in general a shift away from decisions made solely by physicians, reflecting an increased respect for the autonomy of the patient towards a model of shared decision-making and informed choice. Ideally, the preoperative visit follows the four key habits of highly effective clinicians, i.e., to rapidly establish a rapport with the patient and provide an agenda for the visit, to explore the patient's perspectives and expectations, to demonstrate empathy, and to focus on the end of the visit with providing information and including the patient in the decision-making process. Visits are then concluded upon obtaining informed consent from the patient. PMID:19565444

  19. How accurate are we at assessing others’ well-being? The example of welfare assessment in horses

    PubMed Central

    Lesimple, Clémence; Hausberger, Martine

    2014-01-01

    Healthcare practitioners such as physicians or nurses often underestimate patients’ well-being impairment (e.g., pain, anxiety) which may lead to undesirable consequences on treatment decisions. Lack of recognition/identification of signals and over-exposure are two reasons invoked, but a combination of factors may be involved. Studying human decoding of animals’ expressions of emotions showed that “identification” to the subject was necessary to decode the other’s internal state. In the present study we wanted to compare caretakers’ reports on the prevalence of stereotypic or abnormal repetitive behaviors, to ethological observations performed by an experienced observer on the same horses in order to test the impact of these different factors. On the first hand, a questionnaire was given hand to hand to the caretakers. On the other hand, the experienced observer spent 18 h observing the horses in each stable. Here we show that caretakers strongly underestimate horses’ expressions of well-being impairment. The caretakers who had a strong concern about their horses’ well-being were also those who reported the more accurately SB/ARB’s prevalence, showing that “identification” to the subject is a primary factor of bad-being signal’s detection. Over-exposure also appeared to be involved as no SB/ARB was reported in stables where most of the horses were performing these abnormal behaviors. Being surrounded by a large population of individuals expressing clear signals of bad-being may change professionals’ perceptions of what are behaviors or expressions of well being. These findings are of primary importance as (1) they illustrate the interest of using human-animal relationships to evaluate humans’ abilities to decode others’ states; (2) they put limitations on questionnaire-based studies of welfare. PMID:24478748

  20. Tumor Volume Changes Assessed by Three-Dimensional Magnetic Resonance Volumetry in Rectal Cancer Patients After Preoperative Chemoradiation: The Impact of the Volume Reduction Ratio on the Prediction of Pathologic Complete Response

    SciTech Connect

    Kang, Jeong Hyun; Kim, Young Chul; Kim, Hyunki; Kim, Young Wan; Hur, Hyuk; Kim, Jin Soo; Min, Byung Soh; Kim, Hogeun; Lim, Joon Seok; Seong, Jinsil; Keum, Ki Chang; Kim, Nam Kyu

    2010-03-15

    Purpose: The aim of this study was to determine the correlation between tumor volume changes assessed by three-dimensional (3D) magnetic resonance (MR) volumetry and the histopathologic tumor response in rectal cancer patients undergoing preoperative chemoradiation therapy (CRT). Methods and Materials: A total of 84 patients who underwent preoperative CRT followed by radical surgery were prospectively enrolled in the study. The post-treatment tumor volume and tumor volume reduction ratio (% decrease ratio), as shown by 3D MR volumetry, were compared with the histopathologic response, as shown by T and N downstaging and the tumor regression grade (TRG). Results: There were no significant differences in the post-treatment tumor volume and the volume reduction ratio shown by 3D MR volumetry with respect to T and N downstaging and the tumor regression grade. In a multivariate analysis, the tumor volume reduction ratio was not significantly associated with T and N downstaging. The volume reduction ratio (>75%, p = 0.01) and the pretreatment carcinoembryonic antigen level (<=3 ng/ml, p = 0.01), but not the post-treatment volume shown by 3D MR (<= 5ml), were, however, significantly associated with an increased pathologic complete response rate. Conclusion: More than 75% of the tumor volume reduction ratios were significantly associated with a high pathologic complete response rate. Therefore, limited treatment options such as local excision or simple observation might be considered after preoperative CRT in this patient population.

  1. A preliminary study of the clinical application of optic pathway diffusion tensor tractography in suprasellar tumor surgery: preoperative, intraoperative, and postoperative assessment.

    PubMed

    Hajiabadi, Mohamadreza; Samii, Madjid; Fahlbusch, Rudolf

    2016-09-01

    OBJECT Visual impairments are the most common objective manifestations of suprasellar lesions. Diffusion tensor imaging (DTI) is a noninvasive MRI modality that depicts the subcortical white matter tracts in vivo. In this study the authors tested the value of visual pathway tractography in comparison with visual field and visual acuity analyses. METHODS This prospective study consisted of 25 patients with progressive visual impairment due to suprasellar mass lesions and 6 control patients with normal vision without such lesions. Visual acuity, visual field, and the optic fundus were examined preoperatively and repeated 1 week and 3 months after surgery. Visual pathway DTI tractography was performed preoperatively, intraoperatively immediately after tumor resection, and 1 week and 3 months after surgery. RESULTS In the control group, pre- and postoperative visual status were normal and visual pathway tractography revealed fibers crossing the optic chiasm without any alteration. In patients with suprasellar lesions, vision improved in 24 of 25. The mean distance between optic tracts in tractography decreased after tumor resection and detectable fibers crossing the optic chiasm increased from 12% preoperatively to 72% postoperatively 3 months after tumor resection, and undetectable fibers crossing the optic chiasm decreased from 88% preoperatively to 27% postoperatively 3 months after tumor resection. Visual improvement after tumor removal 1 week and 3 months after surgery was significantly correlated with the distance between optic tracts in intraoperative tractography (p < 0.01). CONCLUSIONS Visual pathway DTI tractography appears to be a promising adjunct to the standard clinical and paraclinical visual examinations in patients with suprasellar mass lesions. The intraoperative findings, in particular the distance between optic tract fibers, can predict visual outcome after tumor resection. Furthermore, postoperative application of this technique may be useful in

  2. 3D volume assessment techniques and computer-aided design and manufacturing for preoperative fabrication of implants in head and neck reconstruction.

    PubMed

    Patel, Ashish; Otterburn, David; Saadeh, Pierre; Levine, Jamie; Hirsch, David L

    2011-11-01

    Cases in subdisciplines of craniomaxillofacial surgery--corrective jaw surgery, maxillofacial trauma, temporomandibular joint/skull base, jaw reconstruction, and postablative reconstruction-illustrate the ease of use, cost effectiveness, and superior results that can be achieved when using computer-assisted design and 3D volumetric analysis in preoperative surgical planning. This article discusses the materials and methods needed to plan cases, illustrates implementation of guides and implants, and describes postoperative analysis in relation to the virtually planned surgery.

  3. A randomised, single blinded trial, assessing the effect of a two week preoperative very low calorie diet on laparoscopic cholecystectomy in obese patients

    PubMed Central

    Burnand, Katherine M.; Lahiri, Rajiv P.; Burr, Nicholas; Jansen van Rensburg, Lize; Lewis, Michael P.N.

    2016-01-01

    Background Laparoscopic cholecystectomy (LC) can be technically challenging in the obese. The primary aim of the trial was to establish whether following a Very Low Calorie Diet (VLCD) for two weeks pre-operatively reduces operation time. Secondary outcomes included perceived operative difficulty and length of hospital stay. Methods A single-blinded, randomized controlled trial of consecutive patients with symptomatic gallstones and BMI >30 kg/m2 46 patients were randomized to a VLCD or normal diet for two weeks prior to LC. Food diaries were used to document dietary intake. The primary outcome measure was operation time. Secondary outcomes were length of stay, weight change operative complications, day case rates and perceived difficulty of operation. Results The VLCD was well tolerated and had significantly greater preoperative weight loss (3.48 kg vs. 0.98 kg; p < 0.0001). Median operative time was significantly reduced by 6 min in the VLCD group (25 vs. 31 min; p = 0.0096). There were no differences in post-operative complications, length of stay, or day case rates between the groups. Dissection of Calot's triangle was deemed significantly easier in the VLCD group. Conclusion A two week VLCD prior to elective laparoscopic cholecystectomy in obese patients is safe, well tolerated and was shown to significantly reduce pre-operative weight and operative time. Trial registration ISRCTN: 61630192. http://www.isrctn.com/ISRCTN61630192 Trial registration. PMID:27154810

  4. Pre-operative anaemia.

    PubMed

    Clevenger, B; Richards, T

    2015-01-01

    Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

  5. The application of intraoperative transit time flow measurement to accurately assess anastomotic quality in sequential vein grafting

    PubMed Central

    Yu, Yang; Zhang, Fan; Gao, Ming-Xin; Li, Hai-Tao; Li, Jing-Xing; Song, Wei; Huang, Xin-Sheng; Gu, Cheng-Xiong

    2013-01-01

    OBJECTIVES Intraoperative transit time flow measurement (TTFM) is widely used to assess anastomotic quality in coronary artery bypass grafting (CABG). However, in sequential vein grafting, the flow characteristics collected by the conventional TTFM method are usually associated with total graft flow and might not accurately indicate the quality of every distal anastomosis in a sequential graft. The purpose of our study was to examine a new TTFM method that could assess the quality of each distal anastomosis in a sequential graft more reliably than the conventional TTFM approach. METHODS Two TTFM methods were tested in 84 patients who underwent sequential saphenous off-pump CABG in Beijing An Zhen Hospital between April and August 2012. In the conventional TTFM method, normal blood flow in the sequential graft was maintained during the measurement, and the flow probe was placed a few centimetres above the anastomosis to be evaluated. In the new method, blood flow in the sequential graft was temporarily reduced during the measurement by placing an atraumatic bulldog clamp at the graft a few centimetres distal to the anastomosis to be evaluated, while the position of the flow probe remained the same as in the conventional method. This new TTFM method was named the flow reduction TTFM. Graft flow parameters measured by both methods were compared. RESULTS Compared with the conventional TTFM, the flow reduction TTFM resulted in significantly lower mean graft blood flow (P < 0.05); in contrast, yielded significantly higher pulsatility index (P < 0.05). Diastolic filling was not significantly different between the two methods and was >50% in both cases. Interestingly, the flow reduction TTFM identified two defective middle distal anastomoses that the conventional TTFM failed to detect. Graft flows near the defective distal anastomoses were improved substantially after revision. CONCLUSIONS In this study, we found that temporary reduction of graft flow during TTFM seemed to

  6. PET optimization for improved assessment and accurate quantification of {sup 90}Y-microsphere biodistribution after radioembolization

    SciTech Connect

    Martí-Climent, Josep M. Prieto, Elena; Elosúa, César; Rodríguez-Fraile, Macarena; Domínguez-Prado, Inés; Vigil, Carmen; García-Velloso, María J.; Arbizu, Javier; Peñuelas, Iván; Richter, José A.

    2014-09-15

    Purpose: {sup 90}Y-microspheres are widely used for the radioembolization of metastatic liver cancer or hepatocellular carcinoma and there is a growing interest for imaging {sup 90}Y-microspheres with PET. The aim of this study is to evaluate the performance of a current generation PET/CT scanner for {sup 90}Y imaging and to optimize the PET protocol to improve the assessment and the quantification of {sup 90}Y-microsphere biodistribution after radioembolization. Methods: Data were acquired on a Biograph mCT-TrueV scanner with time of flight (TOF) and point spread function (PSF) modeling. Spatial resolution was measured with a{sup 90}Y point source. Sensitivity was evaluated using the NEMA 70 cm line source filled with {sup 90}Y. To evaluate the count rate performance, {sup 90}Y vials with activity ranging from 3.64 to 0.035 GBq were measured in the center of the field of view (CFOV). The energy spectrum was evaluated. Image quality with different reconstructions was studied using the Jaszczak phantom containing six hollow spheres (diameters: 31.3, 28.1, 21.8, 16.1, 13.3, and 10.5 mm), filled with a 207 kBq/ml {sup 90}Y concentration and a 5:1 sphere-to-background ratio. Acquisition time was adjusted to simulate the quality of a realistic clinical PET acquisition of a patient treated with SIR-Spheres{sup ®}. The developed methodology was applied to ten patients after SIR-Spheres{sup ®} treatment acquiring a 10 min per bed PET. Results: The energy spectrum showed the{sup 90}Y bremsstrahlung radiation. The {sup 90}Y transverse resolution, with filtered backprojection reconstruction, was 4.5 mm in the CFOV and degraded to 5.0 mm at 10 cm off-axis. {sup 90}Y absolute sensitivity was 0.40 kcps/MBq in the center of the field of view. Tendency of true and random rates as a function of the {sup 90}Y activity could be accurately described using linear and quadratic models, respectively. Phantom studies demonstrated that, due to low count statistics in {sup 90}Y PET

  7. Role of effective canal diameter in assessing the pre-operative and the post-operative status of patients with bony cranio-vertebral anomalies

    PubMed Central

    Mehrotra, Anant; Srivastava, Arun; Sahu, Rabi N.; Kumar, Raj

    2016-01-01

    Introduction: The effective canal diameter (ECD) for the cranio-vertebral junction is measured from the posterior surface of the dens to the nearest posterior bony structure (foramen magnum or the posterior arch of the atlas). The ECD is the space which is occupied by the buffer space (which can be compromised without producing any signs or symptoms) and the cord itself. We intend to study the role of the ECD (especially in patients with markedly reduced ECD) in producing the symptoms and also the outcome of surgery in patients with bony cranio-vertebral junction (CVJ) anomalies. Materials and Methods: A total of 67 consecutive patients from the period of January 2009 through June 2010 were prospectively included in the study. These patients were operated by a single experienced surgeon (the senior author) at the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. The ECD and the pre-operative Kumar and Kalra score (K and K score) (4) was calculated for all patients. The K and K score was also calculated at the time of discharge, at three months and six months follow-up. The patients were divided into three groups based on the ECD into 5 mm to 10 mm group, 10 mm to 15 mm group, and >15 mm group. Results: There were 53 male (79.1%) patients and 14 female patients (20.9%) with mean age of presentation 27.10 years (±15.01 years) with range of 4-59 years. The duration of symptoms in our series varied from 1-120 months with mean of 23.79 months. The mean effective canal diameter was 9.027 mm (±2.23 mm) with range of 5-16 mm. The mean pre-operative K and K score was 19.27 (±4.19). There were 39 patients who had an ECD between 5 mm to 10 mm, 24 patients with ECD between 10 mm to 15 mm, and 4 patients with ECD more than 15 mm. The correlation coefficients between the effective canal diameter and the pre-operative and the post-operative Kumar and Kalra score at the time of discharge, 3 months and 6 months were 0.404 (P < 0.001), 0.320 (P < 0.008), 0

  8. Role of effective canal diameter in assessing the pre-operative and the post-operative status of patients with bony cranio-vertebral anomalies

    PubMed Central

    Mehrotra, Anant; Srivastava, Arun; Sahu, Rabi N.; Kumar, Raj

    2016-01-01

    Introduction: The effective canal diameter (ECD) for the cranio-vertebral junction is measured from the posterior surface of the dens to the nearest posterior bony structure (foramen magnum or the posterior arch of the atlas). The ECD is the space which is occupied by the buffer space (which can be compromised without producing any signs or symptoms) and the cord itself. We intend to study the role of the ECD (especially in patients with markedly reduced ECD) in producing the symptoms and also the outcome of surgery in patients with bony cranio-vertebral junction (CVJ) anomalies. Materials and Methods: A total of 67 consecutive patients from the period of January 2009 through June 2010 were prospectively included in the study. These patients were operated by a single experienced surgeon (the senior author) at the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. The ECD and the pre-operative Kumar and Kalra score (K and K score) (4) was calculated for all patients. The K and K score was also calculated at the time of discharge, at three months and six months follow-up. The patients were divided into three groups based on the ECD into 5 mm to 10 mm group, 10 mm to 15 mm group, and >15 mm group. Results: There were 53 male (79.1%) patients and 14 female patients (20.9%) with mean age of presentation 27.10 years (±15.01 years) with range of 4-59 years. The duration of symptoms in our series varied from 1-120 months with mean of 23.79 months. The mean effective canal diameter was 9.027 mm (±2.23 mm) with range of 5-16 mm. The mean pre-operative K and K score was 19.27 (±4.19). There were 39 patients who had an ECD between 5 mm to 10 mm, 24 patients with ECD between 10 mm to 15 mm, and 4 patients with ECD more than 15 mm. The correlation coefficients between the effective canal diameter and the pre-operative and the post-operative Kumar and Kalra score at the time of discharge, 3 months and 6 months were 0.404 (P < 0.001), 0.320 (P < 0.008), 0

  9. Can Community Health Workers Report Accurately on Births and Deaths? Results of Field Assessments in Ethiopia, Malawi and Mali

    PubMed Central

    Silva, Romesh; Amouzou, Agbessi; Munos, Melinda; Marsh, Andrew; Hazel, Elizabeth; Victora, Cesar; Black, Robert; Bryce, Jennifer

    2016-01-01

    Introduction Most low-income countries lack complete and accurate vital registration systems. As a result, measures of under-five mortality rates rely mostly on household surveys. In collaboration with partners in Ethiopia, Ghana, Malawi, and Mali, we assessed the completeness and accuracy of reporting of births and deaths by community-based health workers, and the accuracy of annualized under-five mortality rate estimates derived from these data. Here we report on results from Ethiopia, Malawi and Mali. Method In all three countries, community health workers (CHWs) were trained, equipped and supported to report pregnancies, births and deaths within defined geographic areas over a period of at least fifteen months. In-country institutions collected these data every month. At each study site, we administered a full birth history (FBH) or full pregnancy history (FPH), to women of reproductive age via a census of households in Mali and via household surveys in Ethiopia and Malawi. Using these FBHs/FPHs as a validation data source, we assessed the completeness of the counts of births and deaths and the accuracy of under-five, infant, and neonatal mortality rates from the community-based method against the retrospective FBH/FPH for rolling twelve-month periods. For each method we calculated total cost, average annual cost per 1,000 population, and average cost per vital event reported. Results On average, CHWs submitted monthly vital event reports for over 95 percent of catchment areas in Ethiopia and Malawi, and for 100 percent of catchment areas in Mali. The completeness of vital events reporting by CHWs varied: we estimated that 30%-90% of annualized expected births (i.e. the number of births estimated using a FPH) were documented by CHWs and 22%-91% of annualized expected under-five deaths were documented by CHWs. Resulting annualized under-five mortality rates based on the CHW vital events reporting were, on average, under-estimated by 28% in Ethiopia, 32% in

  10. Sewage sludge toxicity assessment using earthworm Eisenia fetida: can biochemical and histopathological analysis provide fast and accurate insight?

    PubMed

    Babić, S; Barišić, J; Malev, O; Klobučar, G; Popović, N Topić; Strunjak-Perović, I; Krasnići, N; Čož-Rakovac, R; Klobučar, R Sauerborn

    2016-06-01

    Sewage sludge (SS) is a complex organic by-product of wastewater treatment plants. Deposition of large amounts of SS can increase the risk of soil contamination. Therefore, there is an increasing need for fast and accurate assessment of SS toxic potential. Toxic effects of SS were tested on earthworm Eisenia fetida tissue, at the subcellular and biochemical level. Earthworms were exposed to depot sludge (DS) concentration ratio of 30 or 70 %, to undiluted and to 100 and 10 times diluted active sludge (AS). The exposure to DS lasted for 24/48 h (acute exposure), 96 h (semi-acute exposure) and 7/14/28 days (sub-chronic exposure) and 48 h for AS. Toxic effects were tested by the measurements of multixenobiotic resistance mechanism (MXR) activity and lipid peroxidation levels, as well as the observation of morphological alterations and behavioural changes. Biochemical markers confirmed the presence of MXR inhibitors in the tested AS and DS and highlighted the presence of SS-induced oxidative stress. The MXR inhibition and thiobarbituric acid reactive substance (TBARS) concentration in the whole earthworm's body were higher after the exposition to lower concentration of the DS. Furthermore, histopathological changes revealed damage to earthworm body wall tissue layers as well as to the epithelial and chloragogen cells in the typhlosole region. These changes were proportional to SS concentration in tested soils and to exposure duration. Obtained results may contribute to the understanding of SS-induced toxic effects on terrestrial invertebrates exposed through soil contact and to identify defence mechanisms of earthworms. PMID:26971513

  11. Assessment of RT-qPCR normalization strategies for accurate quantification of extracellular microRNAs in murine serum.

    PubMed

    Roberts, Thomas C; Coenen-Stass, Anna M L; Wood, Matthew J A

    2014-01-01

    Extracellular microRNAs (miRNAs) are under investigation as minimally-invasive biomarkers for a wide range of disease conditions. We have recently shown in a mouse model of the progressive muscle-wasting condition Duchenne muscular dystrophy (DMD) that a set of highly elevated serum miRNAs reflects the regenerative status of muscle. These miRNAs are promising biomarkers for monitoring DMD disease progression and the response to experimental therapies. The gold standard miRNA detection methodology is Reverse Transcriptase-quantitative Polymerase Chain Reaction (RT-qPCR), which typically exhibits high sensitivity and wide dynamic range. Accurate determination of miRNA levels is affected by RT-qPCR normalization method and therefore selection of the optimal strategy is of critical importance. Serum miRNA abundance was measured by RT-qPCR array in 14 week old mice, and by individual RT-qPCR assays in a time course experiment spanning 48 weeks. Here we utilize these two datasets to assess the validity of three miRNA normalization strategies (a) normalization to the average of all Cq values from array experiments, (b) normalization to a stably expressed endogenous reference miRNA, and (c) normalization to an external spike-in synthetic oligonucleotide. Normalization approaches based on endogenous control miRNAs result in an under-estimation of miRNA levels by a factor of ∼2. An increase in total RNA and total miRNA was observed in dystrophic serum which may account for this systematic bias. We conclude that the optimal strategy for this model system is to normalize to a synthetic spike-in control oligonucleotide.

  12. Negative predictive value of preoperative computed tomography in determining pathologic local invasion, nodal disease, and abdominal metastases in gastric cancer

    PubMed Central

    Kagedan, D.J.; Frankul, F.; El-Sedfy, A.; McGregor, C.; Elmi, M.; Zagorski, B.; Dixon, M.E.; Mahar, A.L.; Vasilevska-Ristovska, J.; Helyer, L.; Rowsell, C.; Swallow, C.J.; Law, C.H.; Coburn, N.G.

    2016-01-01

    Background Before undergoing curative-intent resection of gastric adenocarcinoma (ga), most patients undergo abdominal computed tomography (ct) imaging to determine contraindications to resection (local invasion, distant metastases). However, the ability to detect contraindications is variable, and the literature is limited to single-institution studies. We sought to assess, on a population level, the clinical relevance of preoperative ct in evaluating the resectability of ga tumours in patients undergoing surgery. Methods In a provincial cancer registry, 2414 patients with ga diagnosed during 2005–2008 at 116 institutions were identified, and a primary chart review of radiology, operative, and pathology reports was performed for all patients. Preoperative abdominal ct reports were compared with intraoperative findings and final pathology reports (reference standard) to determine the negative predictive value (npv) of ct in assessing local invasion, nodal involvement, and intra-abdominal metastases. Results Among patients undergoing gastrectomy, the npv of ct imaging in detecting local invasion was 86.9% (n = 536). For nodal metastasis, the npv of ct was 43.3% (n = 450). Among patients undergoing surgical exploration, the npv of ct for intra-abdominal metastases was 52.3% (n = 407). Conclusions Preoperative abdominal ct imaging reported as negative is most accurate in determining local invasion and least accurate in nodal assessment. The poor npv of ct should be taken into account when selecting patients for staging laparoscopy. PMID:27536178

  13. Patterns of Response After Preoperative Intensity-Modulated Radiation Therapy and Capecitabine/Oxaliplatin in Rectal Cancer: Is There Still a Place for Ecoendoscopic Ultrasound?

    SciTech Connect

    Arbea, Leire; Diaz-Gonzalez, Juan A.; Subtil, Jose Carlos; Sola, Josu; Hernandez-Lizoain, Jose Luis; Martinez-Monge, Rafael; Moreno, Marta; Aristu, Javier

    2011-10-01

    Purpose: The main goals of preoperative chemoradiotherapy (CHRT) in rectal cancer are to achieve pathological response and to ensure tumor control with functional surgery when possible. Assessment of the concordance between clinical and pathological responses is necessary to make decisions regarding alternative conservative procedures. The present study evaluates the patterns of response after a preoperative CHRT regimen, and the value of endoscopic ultrasound (EUS) in assessing response. Methods and Materials: A total of 51 EUS-staged T3 to T4 and/or N0 to N+ rectal cancer patients received preoperative CHRT (intensity-modulated radiation therapy and capecitabine/oxaliplatin (XELOX) followed by radical resection. Clinical response was assesed by EUS. Rates of pathological tumor regression grade (TRG) and lymph node (LN) involvement were determined in the surgical specimen. Clinical and pathological responses were compared, and the accuracy of EUS in assessing response was calculated. Results: Twenty-four patients (45%) achieved a major pathological response (complete or >95% pathological response (TRG 3+/4)). Sensitivity, specificity, negative predictive value, and positive predictive value of EUS in predicting pathological T response after preoperative CHRT were 77.8%, 37.5%, 60%, and 58%, respectively. The EUS sensitivity, specificity, negative predictive value, and positive predictive value for nodal staging were 44%, 88%, 88%, and 44%, respectively. Furthermore, EUS after CHRT accurately predicted the absence of LN involvement in 7 of 7 patients (100%) with major pathological response of the primary tumor. Conclusion: Preoperative IMRT with concomitant XELOX induces favorable rates of major pathological response. EUS has a limited ability to predict primary tumor response after preoperative CHRT, but it is useful for accurately determining LN status. EUS may have a potential value in identifying patients with a very low risk of LN involvement in association

  14. Evaluation of HE4, CA-125, Risk of Ovarian Malignancy Algorithm (ROMA) and Risk of Malignancy Index (RMI) in the Preoperative Assessment of Patients with Adnexal Mass

    PubMed Central

    Al Musalhi, Khawla; Al Kindi, Manal; Al Aisary, Faiza; Ramadhan, Fatma; Al Rawahi, Thuraya; Al Hatali, Khalsa; Mula-Abed, Waad-Allah

    2016-01-01

    Objectives To evaluate the validity and compare the performance of cancer antigen-125 (CA-125), human epididymis protein 4 (HE4), the risk of malignancy index (RMI), and the risk of ovarian malignancy algorithm (ROMA) in the diagnosis of ovarian cancer in patients with ovarian lesions discovered during their preoperative work-up investigations. Methods This prospective, cross-sectional study looked at patients who attended the gynecology department at the Royal Hospital, Muscat, from 1 March 2014 to 30 April 2015, for the evaluation of an ovarian lesion. The inclusion criteria included women who underwent surgical intervention and who had a preoperative pelvic ultrasound with laboratory investigation for CA-125 and HE4. The study validated the diagnostic performance of CA-125, RMI, HE4, and ROMA using histopathological diagnosis as the gold standard. Results The study population had a total of 213 cases of various types of benign (77%) and malignant (23%) ovarian tumors. CA-125 showed the highest sensitivity (79%) when looking at the total patient population. When divided by age, the sensitivity was 67% in premenopausal women. In postmenopausal women, CA-125 had lower sensitivity (89%) compared to RMI, HE4, and ROMA (93% each). A high specificity of 90% was found for HE4 in the total patient population, 93% in premenopausal women and 75% in postmenopausal women. CA-125 had the highest specificity (79%) in postmenopausal women. Both CA-125 and RMI were frequently elevated in benign gynecological conditions particularly in endometriosis when compared to HE4 and ROMA. We also studied modifications of the optimal cut-offs for the four parameters. Both CA-125 and RMI showed a significant increase in their specificity if the cut-off was increased to ≥ 60 U/mL for CA-125 and to ≥ 250 for RMI. For HE4, we noted an improvement in its specificity in postmenopausal women when its cut-off was increased to140 pmol/L. Conclusions HE4 and ROMA showed a very high specificity

  15. Evaluation of HE4, CA-125, Risk of Ovarian Malignancy Algorithm (ROMA) and Risk of Malignancy Index (RMI) in the Preoperative Assessment of Patients with Adnexal Mass

    PubMed Central

    Al Musalhi, Khawla; Al Kindi, Manal; Al Aisary, Faiza; Ramadhan, Fatma; Al Rawahi, Thuraya; Al Hatali, Khalsa; Mula-Abed, Waad-Allah

    2016-01-01

    Objectives To evaluate the validity and compare the performance of cancer antigen-125 (CA-125), human epididymis protein 4 (HE4), the risk of malignancy index (RMI), and the risk of ovarian malignancy algorithm (ROMA) in the diagnosis of ovarian cancer in patients with ovarian lesions discovered during their preoperative work-up investigations. Methods This prospective, cross-sectional study looked at patients who attended the gynecology department at the Royal Hospital, Muscat, from 1 March 2014 to 30 April 2015, for the evaluation of an ovarian lesion. The inclusion criteria included women who underwent surgical intervention and who had a preoperative pelvic ultrasound with laboratory investigation for CA-125 and HE4. The study validated the diagnostic performance of CA-125, RMI, HE4, and ROMA using histopathological diagnosis as the gold standard. Results The study population had a total of 213 cases of various types of benign (77%) and malignant (23%) ovarian tumors. CA-125 showed the highest sensitivity (79%) when looking at the total patient population. When divided by age, the sensitivity was 67% in premenopausal women. In postmenopausal women, CA-125 had lower sensitivity (89%) compared to RMI, HE4, and ROMA (93% each). A high specificity of 90% was found for HE4 in the total patient population, 93% in premenopausal women and 75% in postmenopausal women. CA-125 had the highest specificity (79%) in postmenopausal women. Both CA-125 and RMI were frequently elevated in benign gynecological conditions particularly in endometriosis when compared to HE4 and ROMA. We also studied modifications of the optimal cut-offs for the four parameters. Both CA-125 and RMI showed a significant increase in their specificity if the cut-off was increased to ≥ 60 U/mL for CA-125 and to ≥ 250 for RMI. For HE4, we noted an improvement in its specificity in postmenopausal women when its cut-off was increased to140 pmol/L. Conclusions HE4 and ROMA showed a very high specificity

  16. Appraisal of guidelines for pre-operative body wash.

    PubMed

    Edström, Elisabet; Westerberg, Lisa; Henricson, Maria

    The pre-operative body wash is a strategy for reducing post-operative infection. However, there is a lack of knowledge about its importance. The purpose of the present study was to evaluate the quality of guidelines for the pre-operative body wash using the AGREE instrument--35 guidelines containing instructions for the pre-operative body wash or preparation were included. The AGREE instrument was employed to establish a quality assessment framework that facilitated a comparison of the guidelines. The results were based on the six domains of the AGREE instrument, all of which were found to have low adherence. Descriptive statistics were used to present the assessment score. The AGREE instrument is useful for evaluating the quality of clinical guidelines. The development of evidence-based guidelines must include clinical activities. Further research is required to clarify the pre-operative body wash process and how it should be performed to reduce post-operative infection. PMID:25426523

  17. The Utility of Maze Accurate Response Rate in Assessing Reading Comprehension in Upper Elementary and Middle School Students

    ERIC Educational Resources Information Center

    McCane-Bowling, Sara J.; Strait, Andrea D.; Guess, Pamela E.; Wiedo, Jennifer R.; Muncie, Eric

    2014-01-01

    This study examined the predictive utility of five formative reading measures: words correct per minute, number of comprehension questions correct, reading comprehension rate, number of maze correct responses, and maze accurate response rate (MARR). Broad Reading cluster scores obtained via the Woodcock-Johnson III (WJ III) Tests of Achievement…

  18. Preoperative evaluation of patients with obesity and obstructive sleep apnea.

    PubMed

    Cartagena, Rafael

    2005-09-01

    Obesity and obstructive sleep apnea are conditions frequently encountered by the anesthesiologist and may have a significant impact on perioperative outcomes. This article discusses the preoperative evaluation of patients with one or both of these conditions. The goals of the preoperative assessment are to identify issues that can adversely affect the patient. This information is critical to forming an effective plan for the perioperative care of the patient.

  19. Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems.

    PubMed

    Steinberg, Ely L; Segev, Eitan; Drexler, Michael; Ben-Tov, Tomer; Nimrod, Snir

    2016-06-01

    The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders.

  20. Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems.

    PubMed

    Steinberg, Ely L; Segev, Eitan; Drexler, Michael; Ben-Tov, Tomer; Nimrod, Snir

    2016-06-01

    The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders. PMID:27468530

  1. Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging

    PubMed Central

    Akıncı, Muzaffer; Bulut, Serap Pamak; Erözgen, Fazilet; Gürbüzel, Mihriban; Gülşen, Gökçe; Kocakuşak, Ahmet; Gülen, Mehmet; Kaplan, Rafet

    2016-01-01

    Objective Diagnosis of axillary nodal involvement is significant in the management of breast cancer as well as in predicting prognosis. In this prospective study, we evaluated the efficiency of US-guided fine needle aspiration biopsy (FNAB) in preoperative axillary staging of early breast cancer. Material and Methods Between January 2011 and July 2013, 46 women were prospectively enrolled in the study. Ultrasound guided-FNABs for axillary assessment were performed preoperatively. Cytology results were compared with histopathology reports to determine its sensitivity, specificity, negative and positive predictive value and accuracy. Results Nineteen cases that had malignant cytology on FNAB also had axillary involvement in axillary lymph node dissection (ALND) without any false-positive results. The sensitivity and specificity of US-guided FNAB were 63.3% and 100%, respectively. US-guided FNAB was accurate in predicting the status of the axilla in 76.1% of patients. Conclusion Although this technique is favorable due to its minimally invasive nature, it is not as effective as sentinel lymph node biopsy (SLNB) in terms of detecting axillary metastasis preoperatively. The low sensitivity and low accuracy rates decrease the usefulness of the technique. Therefore, it seems that US-guided FNAB alone could not replace SLNB. Nevertheless, combining some other molecular studies may be useful in increasing the technique’s sensitivity. These issues should be determined by comprehensive clinical trials. PMID:27528822

  2. Aggregate versus Individual-Level Sexual Behavior Assessment: How Much Detail Is Needed to Accurately Estimate HIV/STI Risk?

    ERIC Educational Resources Information Center

    Pinkerton, Steven D.; Galletly, Carol L.; McAuliffe, Timothy L.; DiFranceisco, Wayne; Raymond, H. Fisher; Chesson, Harrell W.

    2010-01-01

    The sexual behaviors of HIV/sexually transmitted infection (STI) prevention intervention participants can be assessed on a partner-by-partner basis: in aggregate (i.e., total numbers of sex acts, collapsed across partners) or using a combination of these two methods (e.g., assessing five partners in detail and any remaining partners in aggregate).…

  3. A simple and accurate grading system for orthoiodohippurate renal scans in the assessment of post-transplant renal function

    SciTech Connect

    Zaki, S.K.; Bretan, P.N.; Go, R.T.; Rehm, P.K.; Streem, S.B.; Novick, A.C. )

    1990-06-01

    Orthoiodohippurate renal scanning has proved to be a reliable, noninvasive method for the evaluation and followup of renal allograft function. However, a standardized system for grading renal function with this test is not available. We propose a simple grading system to distinguish the different functional phases of hippurate scanning in renal transplant recipients. This grading system was studied in 138 patients who were evaluated 1 week after renal transplantation. There was a significant correlation between the isotope renographic functional grade and clinical correlates of allograft function such as the serum creatinine level (p = 0.0001), blood urea nitrogen level (p = 0.0001), urine output (p = 0.005) and need for hemodialysis (p = 0.007). We recommend this grading system as a simple and accurate method to interpret orthoiodohippurate renal scans in the evaluation and followup of renal allograft recipients.

  4. Incentives Increase Participation in Mass Dog Rabies Vaccination Clinics and Methods of Coverage Estimation Are Assessed to Be Accurate

    PubMed Central

    Steinmetz, Melissa; Czupryna, Anna; Bigambo, Machunde; Mzimbiri, Imam; Powell, George; Gwakisa, Paul

    2015-01-01

    In this study we show that incentives (dog collars and owner wristbands) are effective at increasing owner participation in mass dog rabies vaccination clinics and we conclude that household questionnaire surveys and the mark-re-sight (transect survey) method for estimating post-vaccination coverage are accurate when all dogs, including puppies, are included. Incentives were distributed during central-point rabies vaccination clinics in northern Tanzania to quantify their effect on owner participation. In villages where incentives were handed out participation increased, with an average of 34 more dogs being vaccinated. Through economies of scale, this represents a reduction in the cost-per-dog of $0.47. This represents the price-threshold under which the cost of the incentive used must fall to be economically viable. Additionally, vaccination coverage levels were determined in ten villages through the gold-standard village-wide census technique, as well as through two cheaper and quicker methods (randomized household questionnaire and the transect survey). Cost data were also collected. Both non-gold standard methods were found to be accurate when puppies were included in the calculations, although the transect survey and the household questionnaire survey over- and under-estimated the coverage respectively. Given that additional demographic data can be collected through the household questionnaire survey, and that its estimate of coverage is more conservative, we recommend this method. Despite the use of incentives the average vaccination coverage was below the 70% threshold for eliminating rabies. We discuss the reasons and suggest solutions to improve coverage. Given recent international targets to eliminate rabies, this study provides valuable and timely data to help improve mass dog vaccination programs in Africa and elsewhere. PMID:26633821

  5. Incentives Increase Participation in Mass Dog Rabies Vaccination Clinics and Methods of Coverage Estimation Are Assessed to Be Accurate.

    PubMed

    Minyoo, Abel B; Steinmetz, Melissa; Czupryna, Anna; Bigambo, Machunde; Mzimbiri, Imam; Powell, George; Gwakisa, Paul; Lankester, Felix

    2015-12-01

    In this study we show that incentives (dog collars and owner wristbands) are effective at increasing owner participation in mass dog rabies vaccination clinics and we conclude that household questionnaire surveys and the mark-re-sight (transect survey) method for estimating post-vaccination coverage are accurate when all dogs, including puppies, are included. Incentives were distributed during central-point rabies vaccination clinics in northern Tanzania to quantify their effect on owner participation. In villages where incentives were handed out participation increased, with an average of 34 more dogs being vaccinated. Through economies of scale, this represents a reduction in the cost-per-dog of $0.47. This represents the price-threshold under which the cost of the incentive used must fall to be economically viable. Additionally, vaccination coverage levels were determined in ten villages through the gold-standard village-wide census technique, as well as through two cheaper and quicker methods (randomized household questionnaire and the transect survey). Cost data were also collected. Both non-gold standard methods were found to be accurate when puppies were included in the calculations, although the transect survey and the household questionnaire survey over- and under-estimated the coverage respectively. Given that additional demographic data can be collected through the household questionnaire survey, and that its estimate of coverage is more conservative, we recommend this method. Despite the use of incentives the average vaccination coverage was below the 70% threshold for eliminating rabies. We discuss the reasons and suggest solutions to improve coverage. Given recent international targets to eliminate rabies, this study provides valuable and timely data to help improve mass dog vaccination programs in Africa and elsewhere.

  6. Feasibility study for image guided kidney surgery: assessment of required intraoperative surface for accurate image to physical space registrations

    NASA Astrophysics Data System (ADS)

    Benincasa, Anne B.; Clements, Logan W.; Herrell, S. Duke; Chang, Sam S.; Cookson, Michael S.; Galloway, Robert L.

    2006-03-01

    Currently, the removal of kidney tumor masses uses only direct or laparoscopic visualizations, resulting in prolonged procedure and recovery times and reduced clear margin. Applying current image guided surgery (IGS) techniques, as those used in liver cases, to kidney resections (nephrectomies) presents a number of complications. Most notably is the limited field of view of the intraoperative kidney surface, which constrains the ability to obtain a surface delineation that is geometrically descriptive enough to drive a surface-based registration. Two different phantom orientations were used to model the laparoscopic and traditional partial nephrectomy views. For the laparoscopic view, fiducial point sets were compiled from a CT image volume using anatomical features such as the renal artery and vein. For the traditional view, markers attached to the phantom set-up were used for fiducials and targets. The fiducial points were used to perform a point-based registration, which then served as a guide for the surface-based registration. Laser range scanner (LRS) obtained surfaces were registered to each phantom surface using a rigid iterative closest point algorithm. Subsets of each phantom's LRS surface were used in a robustness test to determine the predictability of their registrations to transform the entire surface. Results from both orientations suggest that about half of the kidney's surface needs to be obtained intraoperatively for accurate registrations between the image surface and the LRS surface, suggesting the obtained kidney surfaces were geometrically descriptive enough to perform accurate registrations. This preliminary work paves the way for further development of kidney IGS systems.

  7. Incentives Increase Participation in Mass Dog Rabies Vaccination Clinics and Methods of Coverage Estimation Are Assessed to Be Accurate.

    PubMed

    Minyoo, Abel B; Steinmetz, Melissa; Czupryna, Anna; Bigambo, Machunde; Mzimbiri, Imam; Powell, George; Gwakisa, Paul; Lankester, Felix

    2015-12-01

    In this study we show that incentives (dog collars and owner wristbands) are effective at increasing owner participation in mass dog rabies vaccination clinics and we conclude that household questionnaire surveys and the mark-re-sight (transect survey) method for estimating post-vaccination coverage are accurate when all dogs, including puppies, are included. Incentives were distributed during central-point rabies vaccination clinics in northern Tanzania to quantify their effect on owner participation. In villages where incentives were handed out participation increased, with an average of 34 more dogs being vaccinated. Through economies of scale, this represents a reduction in the cost-per-dog of $0.47. This represents the price-threshold under which the cost of the incentive used must fall to be economically viable. Additionally, vaccination coverage levels were determined in ten villages through the gold-standard village-wide census technique, as well as through two cheaper and quicker methods (randomized household questionnaire and the transect survey). Cost data were also collected. Both non-gold standard methods were found to be accurate when puppies were included in the calculations, although the transect survey and the household questionnaire survey over- and under-estimated the coverage respectively. Given that additional demographic data can be collected through the household questionnaire survey, and that its estimate of coverage is more conservative, we recommend this method. Despite the use of incentives the average vaccination coverage was below the 70% threshold for eliminating rabies. We discuss the reasons and suggest solutions to improve coverage. Given recent international targets to eliminate rabies, this study provides valuable and timely data to help improve mass dog vaccination programs in Africa and elsewhere. PMID:26633821

  8. Preoperative blood transfusions for sickle cell disease

    PubMed Central

    Estcourt, Lise J; Fortin, Patricia M; Trivella, Marialena; Hopewell, Sally

    2016-01-01

    Background Sickle cell disease is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. Sickle cell disease can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Surgical interventions are more common in people with sickle cell disease, and occur at much younger ages than in the general population. Blood transfusions are frequently used prior to surgery and several regimens are used but there is no consensus over the best method or the necessity of transfusion in specific surgical cases. This is an update of a Cochrane review first published in 2001. Objectives To determine whether there is evidence that preoperative blood transfusion in people with sickle cell disease undergoing elective or emergency surgery reduces mortality and perioperative or sickle cell-related serious adverse events. To compare the effectiveness of different transfusion regimens (aggressive or conservative) if preoperative transfusions are indicated in people with sickle cell disease. Search methods We searched for relevant trials in The Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to 23 March 2016. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register: 18 January 2016. Selection criteria All randomised controlled trials and quasi-randomised controlled trials comparing preoperative blood transfusion regimens to different regimens or no transfusion in people with sickle cell disease undergoing elective or emergency surgery. There was no restriction by outcomes examined, language or publication status. Data collection and analysis Two authors independently assessed trial eligibility and the risk of bias and extracted data. Main results Three trials with 990 participants were eligible for inclusion in the review. There were no

  9. Pre-operative electrocardiograph examination.

    PubMed Central

    Nash, G. F.; Cunnick, G. H.; Allen, S.; Cook, C.; Turner, L. F.

    2001-01-01

    The leading cause of death following surgery is a cardiac event, and an electrocardiogram is the most common pre-operative test to investigate coronary artery disease. Fifty adults, who required an electrocardiogram, undergoing general surgical procedures, were recruited into this pilot study, which investigated the examination rate of electrocardiographs by doctors pre-operatively. Each tracing was folded in one corner and a paperclip prevented full pre-operative viewing without its removal. Results suggest that 30% of ECGs were not opened and the records of 58% patients overall had no mention of the ECG having been performed. Further analysis showed no correlation with the examination rate of the electrocardiograph with patient age or fitness. If this reflects normal clinical practice, it is sub-optimal use of resources and warrants further audit. PMID:11777129

  10. Pre-operative electrocardiograph examination.

    PubMed

    Nash, G F; Cunnick, G H; Allen, S; Cook, C; Turner, L F

    2001-11-01

    The leading cause of death following surgery is a cardiac event, and an electrocardiogram is the most common pre-operative test to investigate coronary artery disease. Fifty adults, who required an electrocardiogram, undergoing general surgical procedures, were recruited into this pilot study, which investigated the examination rate of electrocardiographs by doctors pre-operatively. Each tracing was folded in one corner and a paperclip prevented full pre-operative viewing without its removal. Results suggest that 30% of ECGs were not opened and the records of 58% patients overall had no mention of the ECG having been performed. Further analysis showed no correlation with the examination rate of the electrocardiograph with patient age or fitness. If this reflects normal clinical practice, it is sub-optimal use of resources and warrants further audit.

  11. A Pre-operative Risk Model for Post-operative Pneumonia following Coronary Artery Bypass Grafting

    PubMed Central

    Strobel, Raymond J.; Liang, Qixing; Zhang, Min; Wu, Xiaoting; Rogers, Mary A. M.; Theurer, Patricia F.; Fishstrom, Astrid B.; Harrington, Steven D.; DeLucia, Alphonse; Paone, Gaetano; Patel, Himanshu J.; Prager, Richard L.; Likosky, Donald S.

    2016-01-01

    Background Post-operative pneumonia is the most prevalent of all hospital-acquired infections following isolated coronary artery bypass grafting (CAB). Accurate prediction of a patient’s risk of this morbid complication is hindered by its low relative incidence. In an effort to support clinical decision-making and quality improvement, we developed a pre-operative prediction model for post-operative pneumonia following CAB. Methods We undertook an observational study of 16,084 patients undergoing CAB between Q3 2011 – Q2 2014 across 33 institutions participating in the Michigan Society of Thoracic and Cardiovascular Surgeons – Quality Collaborative. Variables related to patient demographics, medical history, admission status, comorbid disease, cardiac anatomy and the institution performing the procedure were investigated. Logistic regression via forwards stepwise selection (p < 0.05 threshold) was utilized to develop a risk prediction model for estimating the occurrence of pneumonia. Traditional methods were employed to assess the model’s performance. Results Post-operative pneumonia occurred in 3.30% of patients. Multivariable analysis identified 17 pre-operative factors, including: demographics, laboratory values, comorbid disease, pulmonary and cardiac function, and operative status. The final model significantly predicted the occurrence of pneumonia, and performed well (C-statistic: 0.74). These findings were confirmed via sensitivity analyses by center and clinically important sub-groups. Conclusions We identified 17 readily obtainable pre-operative variables associated with post-operative pneumonia. This model may be used to provide individualized risk estimation and to identify opportunities to reduce a patient’s pre-operative risk of pneumonia through pre-habilitation. PMID:27261082

  12. The Development of Multiple-Choice Items Consistent with the AP Chemistry Curriculum Framework to More Accurately Assess Deeper Understanding

    ERIC Educational Resources Information Center

    Domyancich, John M.

    2014-01-01

    Multiple-choice questions are an important part of large-scale summative assessments, such as the advanced placement (AP) chemistry exam. However, past AP chemistry exam items often lacked the ability to test conceptual understanding and higher-order cognitive skills. The redesigned AP chemistry exam shows a distinctive shift in item types toward…

  13. Bevacizumab with preoperative chemotherapy versus preoperative chemotherapy alone for colorectal cancer liver metastases

    PubMed Central

    Lu, Zhen-Hai; Peng, Jian-Hong; Wang, Fu-Long; Yuan, Yun-Fei; Jiang, Wu; Li, Yu-Hong; Wu, Xiao-Jun; Chen, Gong; Ding, Pei-Rong; Li, Li-Ren; Kong, Ling-Heng; Lin, Jun-Zhong; Zhang, Rong-Xin; Wan, De-Sen; Pan, Zhi-Zhong

    2016-01-01

    Abstract This study aimed to assess the efficacy and safety of bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer in Chinese patients compared with those of preoperative chemotherapy alone. Patients with histologically confirmed liver-only metastatic colorectal cancer were sequentially reviewed, and received either preoperative chemotherapy plus bevacizumab (bevacizumab group, n = 32) or preoperative chemotherapy alone (chemotherapy group, n = 57). Progression-free survival, response rate, liver resection rate, conversion rate, and safety were analyzed. With median follow-up of 28.7 months, progression-free survival was 10.9 months (95% confidence interval: 8.7–13.1 months) in bevacizumab group and 9.9 months (95% confidence interval: 6.8–13.1 months) in chemotherapy group (P = 0.472). Response rates were 59.4% in bevacizumab group and 38.6% in chemotherapy group (P = 0.059). Overall liver resection (R0, R1, and R2) rate was 68.8% in bevacizumab group and 54.4% in chemotherapy group (P = 0.185). Conversion rate was 51.9% in bevacizumab group and 40.4% in chemotherapy group (P = 0.341). No postoperative complication was observed in all patients. Bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer tends to achieve better clinical benefit with controllable safety in Chinese patients. PMID:27583930

  14. [Preoperative fasting guidelines: an update].

    PubMed

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

    2015-03-01

    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery.

  15. Preoperative Psychological Preparation of Children

    PubMed Central

    Güleç, Ersel; Özcengiz, Dilek

    2015-01-01

    Surgery and anaesthesia are significant sources of anxiety for children. In the preoperative period, reducing anxiety helps in preventing the negative consequences that may occur after surgery. The predetermined high-risk children in terms of the development of anxiety play an important role in reducing the negative consequences. Recently featured approaches are modelling and coping techniques, although many techniques are used in the preoperative psychological preparation. The use of computer programs in this area may facilitate important achievements, and it needs to support new studies to be performed. PMID:27366525

  16. Just How Accurate are Your Probabilistic Forecasts? Improving Forecast Quality Assessment in the Presence of Sampling Uncertainty

    NASA Astrophysics Data System (ADS)

    Kang, T. H.; Sharma, A.; Marshall, L. A.

    2015-12-01

    Use of ensemble forecasts as a means of characterising predictive uncertainty has become increasingly common in hydrological and meteorological forecasting. The needs to characterize ensemble forecast quality has encouraged the development of reliable verification tools. Most of the metrics used currently are related to the Brier score, first proposed in 1950. However, the Brier score and its alterations including the decomposition of the Brier score, as well as the Ranked Probability Score, have paid little attention to the difference in the characteristics of the forecasted and sampled probability distributions. This difference, or the error in the probability distribution, can lead to a bias in all existing metrics derived from the Brier score. Similar biases arise where the second moment is different to that observed, or when the observations are scarce and hence difficult to characterise. Therefore, this study suggests simple and reliable measures for the first and second moment bias of the forecasted ensemble and in addition, approaches to analytically estimate the sampling uncertainty of the proposed measures. The proposed approaches are tested through synthetically generated hydrologic forecasts and observations, as well as seasonal forecasts of the El Nino Southern Oscillation issued by the International research Institute for Climate and Society (IRI-ENSO). The results show that the estimated uncertainty range of the first and second moment bias can accurately represent the sampling error under most circumstances in a real forecasting system.

  17. Establishment of an x-ray standard calibration curve by conventional dicentric analysis as prerequisite for accurate radiation dose assessment.

    PubMed

    Beinke, Christina; Braselmann, Herbert; Meineke, Viktor

    2010-02-01

    The dicentric assay was established to carry out cytogenetic biodosimetry after suspected radiation overexposure, including a comprehensive documentation system to record the processing of the specimen, all data, results, and stored information. As an essential prerequisite for retrospective radiation dose assessment, a dose-response curve for dicentric induction by in vitro x-ray irradiation of peripheral blood samples was produced. The accelerating potential was 240 kV (maximum photon energy: 240 keV). A total of 8,377 first-division metaphases of four healthy volunteers were analyzed after exposure to doses ranging from 0.2 to 4.0 Gy at a dose rate of 1.0 Gy min. The background level of aberrations at 0-dose was determined by the analysis of 14,522 first-division metaphases obtained from unirradiated blood samples of 10 healthy volunteers. The dose-response relationship follows a linear-quadratic equation, Y = c + alphaD + betaD, with the coefficients c = 0.0005 +/- 0.0002, alpha = 0.043 +/- 0.006, and beta = 0.063 +/- 0.004. The technical competence and the quality of the calibration curve were assessed by determination of the dose prediction accuracy in an in vitro experiment simulating whole-body exposures within a range of 0.2 to 2.0 Gy. Dose estimations were derived by scoring up to 500-1,000 metaphase spreads or more (full estimation mode) and by evaluating only 50 metaphase spreads (triage mode) per subject. The triage mode was applied by performing manifold evaluations of the full estimation data in order to test the robustness of the curve for triage purposes and to assess possible variations among the estimated doses referring to a single exposure and preparation.

  18. The importance of tissue handling of surgically removed breast cancer for an accurate assessment of the Ki-67 index

    PubMed Central

    Arima, Nobuyuki; Nishimura, Reiki; Osako, Tomofumi; Nishiyama, Yasuyuki; Fujisue, Mamiko; Okumura, Yasuhiro; Nakano, Masahiro; Tashima, Rumiko; Toyozumi, Yasuo

    2016-01-01

    Aim Insufficient attention for the Ki-67 immunohistochemistry has been given to the importance of tissue handling for surgical breast cancer specimens. We sought to investigate the effect of fixation status on the Ki-67. Methods We examined the effect of fixative, time to and duration of fixation using surgical specimens, and finally, compared the paired Ki-67 index in the tumour between core needle and surgical specimen. Results The Ki-67 was significantly higher when 10% neutral buffered formalin was used (p=0.0276). Insufficient fixation caused a drastic reduction in the Ki-67 index (p=0.0177), but not significant in oestrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2). Sixteen hours delayed time to fixation also caused a reduction of the Ki-67 (p=0.0284), but not significant in ER. Prolonged fixation significantly led to a gradual reduction in the Ki-67 in a time-dependent manner, but not in both ER and HER2. Finally, cutting the tumour before fixation improved fixation status and consequently caused an increased level of the Ki-67 index (p=0.0181), which resulted in a strong correlation of the Ki-67 between core needle and surgical specimen (r=0.8595). Conclusions Tissue handling of surgical specimen is critical for assessing the Ki-67 compared with ER and HER2. We should pay more attention to tissue fixation status for the standard assessment of the Ki-67 index. PMID:26420767

  19. Are skinfold-based models accurate and suitable for assessing changes in body composition in highly trained athletes?

    PubMed

    Silva, Analiza M; Fields, David A; Quitério, Ana L; Sardinha, Luís B

    2009-09-01

    This study was designed to assess the usefulness of skinfold (SKF) equations developed by Jackson and Pollock (JP) and by Evans (Ev) in tracking body composition changes (relative fat mass [%FM], absolute fat mass [FM], and fat-free mass [FFM]) of elite male judo athletes before a competition using a 4-compartment (4C) model as the reference method. A total of 18 male, top-level (age: 22.6 +/- 2.9 yr) athletes were evaluated at baseline (weight: 73.4 +/- 7.9 kg; %FM4C: 7.0 +/- 3.3%; FM4C: 5.1 +/- 2.6 kg; and FFM4C: 68.3 +/- 7.3 kg) and before a competition (weight: 72.7 +/- 7.5 kg; %FM4C: 6.5 +/- 3.4%; FM4C: 4.8 +/- 2.6 kg; and FFM4C: 67.9 +/- 7.1 kg). Measures of body density assessed by air displacement plethysmography, bone mineral content by dual energy X-ray absorptiometry, and total-body water by bioelectrical impedance spectroscopy were used to estimate 4C model %FM, FM, and FFM. Seven SKF site models using both JP and Ev were used to estimate %FM, FM, and FFM along with the simplified Ev3SKF site. Changes in %FM, FM, and FFM were not significantly different from the 4C model. The regression model for the SKF in question and the reference method did not differ from the line of identity in estimating changes in %FM, FM, and FFM. The limits of agreement were similar, ranging from -3.4 to 3.6 for %FM, -2.7 to 2.5 kg for FM, and -2.5 to 2.7 kg for FFM. Considering the similar performance of both 7SKF- and 3SKF-based equations compared with the criterion method, these data indicate that either the 7- or 3-site SFK models are not valid to detect %FM, FM, and FFM changes of highly trained athletes. These results highlighted the inaccuracy of anthropometric models in tracking desired changes in body composition of elite male judo athletes before a competition.

  20. Preoperative Oral Carbohydrate Loading in Pancreaticoduodenectomy

    PubMed Central

    Son, Kum-Hee; Kim, So-Young; Cho, Yeong-Ah; Han, Sung-Sik; Park, Sang-Jae

    2016-01-01

    Overnight fasting before elective surgery has been the routine to reduce the risk of pulmonary aspiration. Recently, several international guidelines for preoperative fasting recommend to intake carbohydrate-containing fluids up to 2 to 3 hours before the induction of anesthesia to improve postoperative recovery. Based on the recommendations, we developed a "preoperative carbohydrate diet" provided for the preoperative patients. The purpose of this case report is to share our experience of applying preoperative carbohydrate loading prior to surgery. PMID:27482525

  1. Comparison of Methodologies to Detect Low Levels of Hemolysis in Serum for Accurate Assessment of Serum microRNAs

    PubMed Central

    Shah, Jaynish S.; Soon, Patsy S.; Marsh, Deborah J.

    2016-01-01

    microRNAs have emerged as powerful regulators of many biological processes, and their expression in many cancer tissues has been shown to correlate with clinical parameters such as cancer type and prognosis. Present in a variety of biological fluids, microRNAs have been described as a ‘gold mine’ of potential noninvasive biomarkers. Release of microRNA content of blood cells upon hemolysis dramatically alters the microRNA profile in blood, potentially affecting levels of a significant number of proposed biomarker microRNAs and, consequently, accuracy of serum or plasma-based tests. Several methods to detect low levels of hemolysis have been proposed; however, a direct comparison assessing their sensitivities is currently lacking. In this study, we evaluated the sensitivities of four methods to detect hemolysis in serum (listed in the order of sensitivity): measurement of hemoglobin using a Coulter® AcT diff™ Analyzer, visual inspection, the absorbance of hemoglobin measured by spectrophotometry at 414 nm and the ratio of red blood cell-enriched miR-451a to the reference microRNA miR-23a-3p. The miR ratio detected hemolysis down to approximately 0.001%, whereas the Coulter® AcT diff™ Analyzer was unable to detect hemolysis lower than 1%. The spectrophotometric method could detect down to 0.004% hemolysis, and correlated with the miR ratio. Analysis of hemolysis in a cohort of 86 serum samples from cancer patients and healthy controls showed that 31 of 86 (36%) were predicted by the miR ratio to be hemolyzed, whereas only 8 of these samples (9%) showed visible pink discoloration. Using receiver operator characteristic (ROC) analyses, we identified absorbance cutoffs of 0.072 and 0.3 that could identify samples with low and high levels of hemolysis, respectively. Overall, this study will assist researchers in the selection of appropriate methodologies to test for hemolysis in serum samples prior to quantifying expression of microRNAs. PMID:27054342

  2. [Algorithm for treating preoperative anemia].

    PubMed

    Bisbe Vives, E; Basora Macaya, M

    2015-06-01

    Hemoglobin optimization and treatment of preoperative anemia in surgery with a moderate to high risk of surgical bleeding reduces the rate of transfusions and improves hemoglobin levels at discharge and can also improve postoperative outcomes. To this end, we need to schedule preoperative visits sufficiently in advance to treat the anemia. The treatment algorithm we propose comes with a simple checklist to determine whether we should refer the patient to a specialist or if we can treat the patient during the same visit. With the blood count test and additional tests for iron metabolism, inflammation parameter and glomerular filtration rate, we can decide whether to start the treatment with intravenous iron alone or erythropoietin with or without iron. With significant anemia, a visit after 15 days might be necessary to observe the response and supplement the treatment if required. The hemoglobin objective will depend on the type of surgery and the patient's characteristics.

  3. Rapid and accurate species and genomic species identification and exhaustive population diversity assessment of Agrobacterium spp. using recA-based PCR.

    PubMed

    Shams, M; Vial, L; Chapulliot, D; Nesme, X; Lavire, C

    2013-07-01

    Agrobacteria are common soil bacteria that interact with plants as commensals, plant growth promoting rhizobacteria or alternatively as pathogens. Indigenous agrobacterial populations are composites, generally with several species and/or genomic species and several strains per species. We thus developed a recA-based PCR approach to accurately identify and specifically detect agrobacteria at various taxonomic levels. Specific primers were designed for all species and/or genomic species of Agrobacterium presently known, including 11 genomic species of the Agrobacterium tumefaciens complex (G1-G9, G13 and G14, among which only G2, G4, G8 and G14 still received a Latin epithet: pusense, radiobacter, fabrum and nepotum, respectively), A. larrymoorei, A. rubi, R. skierniewicense, A. sp. 1650, and A. vitis, and for the close relative Allorhizobium undicola. Specific primers were also designed for superior taxa, Agrobacterium spp. and Rhizobiaceace. Primer specificities were assessed with target and non-target pure culture DNAs as well as with DNAs extracted from composite agrobacterial communities. In addition, we showed that the amplicon cloning-sequencing approach used with Agrobacterium-specific or Rhizobiaceae-specific primers is a way to assess the agrobacterial diversity of an indigenous agrobacterial population. Hence, the agrobacterium-specific primers designed in the present study enabled the first accurate and rapid identification of all species and/or genomic species of Agrobacterium, as well as their direct detection in environmental samples.

  4. Pre-operative preparation for otologic surgery: temporal bone simulation

    PubMed Central

    Sethia, Rishabh; Wiet, Gregory J.

    2015-01-01

    Purpose of review The field of temporal bone simulation (TBS) has largely focused on the development and validation of simulators as training and assessment tools. However, as technology has progressed over the years, researchers have envisioned new clinical applications for simulators extending to pre-operative surgical planning and case rehearsal. The purpose of this article is to review the current state of the art in TBS and to highlight recent advancements in the field. Due to space limitations, we will limit our discussion to computer-based virtual reality (VR) simulators. Recent findings A review of the recent literature on TBS revealed very limited application of VR simulators for pre-operative preparation. Current evidence suggests limitations in fidelity preclude successful patient-specific case rehearsal using VR simulation. Further investigation and clinical evaluation are required to validate its use outside of training and skill assessment. Summary This article provides an overview of the current use of VR simulators with emphasis on pre-operative planning. We evaluate the limitations of the technology, and discuss potential areas of improvement for the future. More studies are necessary to assess the value of VR simulation for pre-operative preparation. PMID:26339966

  5. Assessment of gas chromatography time-of-flight accurate mass spectrometry for identification of volatile and semi-volatile compounds in honey.

    PubMed

    Moniruzzaman, M; Rodríguez, I; Ramil, M; Cela, R; Sulaiman, S A; Gan, S H

    2014-11-01

    The performance of gas chromatography (GC) combined with a hybrid quadrupole time-of-flight (QTOF) mass spectrometry (MS) system for the determination of volatile and semi-volatile compounds in honey samples is evaluated. After headspace (HS) solid-phase microextraction (SPME) of samples, the accurate mass capabilities of the above system were evaluated for compounds identification. Accurate scan electron impact (EI) MS spectra allowed discriminating compounds displaying the same nominal masses, but having different empirical formulae. Moreover, the use of a mass window with a width of 0.005 Da provided highly specific chromatograms for selected ions, avoiding the contribution of interferences to their peak areas. Additional information derived from positive chemical ionization (PCI) MS spectra and ion product scan MS/MS spectra permitted confirming the identity of novel compounds. The above possibilities are illustrated with examples of honey aroma compounds, belonging to different chemical classes and containing different elements in their molecules. Examples of compounds whose structures could not be described are also provided. Overall, 84 compounds, from a total of 89 species, could be identified in 19 honey samples from 3 different geographic areas in the world. The suitability of responses measured for selected ions, corresponding to above species, for authentication purposes is assessed through principal components analysis. PMID:25127626

  6. Importance of preoperative marking for minithoracotomy and for internal thoracic artery harvesting in minimally invasive direct coronary artery bypass grafting.

    PubMed

    Hirata, N; Ohtake, S; Sawa, Y; Yoshitatsu, M; Kato, H; Ohkubo, N; Matsuda, H

    2000-01-01

    Minimally invasive direct coronary artery bypass has the potential to cause an anastomotic failure because of a limited exposure of the operative field and the difficulty of internal thoracic artery harvesting. In the present study, the importance of preoperative marking for an accurate minithoracotomy location and a successful internal thoracic artery harvest was assessed. A paperclip was placed on the left nipple and a chest X-ray was performed in the supine position. By aligning the position of the paperclip to the location of the left anterior descending coronary artery from a coronary arteriogram frontal view, the intercostal space for the minithoracotomy was thus determined. Marking the incisional intercostal space during preoperative left internal thoracic arteriography revealed the number and location of the internal thoracic artery branches at the beginning of the harvest. This preoperative marking technique allowed for a more adequate exposure of the operative field and an easier internal thoracic artery harvest which therefore contributed to an improvement in the operative results.

  7. Hysteroscopic myomectomy: techniques and preoperative assessment.

    PubMed

    Casadio, Paolo; Guasina, Francesca; Morra, Ciro; Talamo, Maria T; Leggieri, Concetta; Frisoni, Jessica; Seracchioli, Renato

    2016-04-01

    Even if usually asymptomatic, uterine myomas have been associated with a number of clinical issues such as abnormal uterine bleeding (AUB), heavy menstrual bleeding (HMB), infertility, recurrent pregnancy loss, especially when these masses are submucous. Golden standard treatment for symptomatic submucous fibroids has long been considered their laparotomic removal or a total hysterectomy. The development of endoscopy has made these fibroids accessible and removable from the inner surface of uterus. Hysteroscopy arose as a diagnostic technique, but then it also became an alternative surgical technique for many diseases, offering therapeutic and irreplaceable possibilities of treatment, avoiding major surgery on the one hand, and allowing the correction of pathologies specifically related to female fertility, on the other hand. Excision by slicing has been described as traditional resectoscopic submucosal myomectomy, but today there are new procedures among which the operator can choose, that allow overcoming the initial limitations of the traditional resectoscopic myomectomy in clinical practice. PMID:26928414

  8. Accurate and easy-to-use assessment of contiguous DNA methylation sites based on proportion competitive quantitative-PCR and lateral flow nucleic acid biosensor.

    PubMed

    Xu, Wentao; Cheng, Nan; Huang, Kunlun; Lin, Yuehe; Wang, Chenguang; Xu, Yuancong; Zhu, Longjiao; Du, Dan; Luo, Yunbo

    2016-06-15

    Many types of diagnostic technologies have been reported for DNA methylation, but they require a standard curve for quantification or only show moderate accuracy. Moreover, most technologies have difficulty providing information on the level of methylation at specific contiguous multi-sites, not to mention easy-to-use detection to eliminate labor-intensive procedures. We have addressed these limitations and report here a cascade strategy that combines proportion competitive quantitative PCR (PCQ-PCR) and lateral flow nucleic acid biosensor (LFNAB), resulting in accurate and easy-to-use assessment. The P16 gene with specific multi-methylated sites, a well-studied tumor suppressor gene, was used as the target DNA sequence model. First, PCQ-PCR provided amplification products with an accurate proportion of multi-methylated sites following the principle of proportionality, and double-labeled duplex DNA was synthesized. Then, a LFNAB strategy was further employed for amplified signal detection via immune affinity recognition, and the exact level of site-specific methylation could be determined by the relative intensity of the test line and internal reference line. This combination resulted in all recoveries being greater than 94%, which are pretty satisfactory recoveries in DNA methylation assessment. Moreover, the developed cascades show significantly high usability as a simple, sensitive, and low-cost tool. Therefore, as a universal platform for sensing systems for the detection of contiguous multi-sites of DNA methylation without external standards and expensive instrumentation, this PCQ-PCR-LFNAB cascade method shows great promise for the point-of-care diagnosis of cancer risk and therapeutics.

  9. [Preoperative evaluation, management and outcome in the elderly patient].

    PubMed

    Ueki, Masaaki; Maekawa, Nobuhiro

    2010-09-01

    Two principles should be kept in mind when performing preoperative evaluation of the elderly patient. First, we should suspect the disease processes commonly associated with aging. Second, we should assess the degree of functional reserve of specific, pertinent organ systems. Preoperative risk assessment is focused on detailed review from anamnesis and physical examination together with the assessment of functional status. Especially, it is important to examine the cardiovascular and respiratory functions in the elderly patient. Further, this also includes assessment of consumed drugs, physiological function, cognitive function, competency, availability of social support, and sign of depression. Surgical risk and outcome in the elderly patient depend primarily on four factors: age, the patient's physiological status and coexisting disease, whether the surgery is elective or urgent, and the type of procedures.

  10. Challenge in preoperative diagnosis of retroperitoneal mucinous cyst in a pediatric patient.

    PubMed

    Zhang, Deying; Zhang, Yan; Liu, Xing; Zhu, Jin; Feng, Chuan; Yang, Chunjiang; Wu, Shengde; Liu, Junhong; Hua, Yi; Liu, Feng; Zhang, Nan; Zhang, Yuanyuan; He, Dawei; Lin, Tao; Wei, Guanghui

    2015-01-01

    Mucinous cystic lesions of the retroperitoneum can be either neoplastic or non-neoplastic. It is very important to make a correct diagnosis, or at least, an accurate classification, to proceed with an optimal treatment strategy. In spite of advantage of ultrasound and X-ray image examinations, it is still a challenge to make differential diagnosis of retroperitoneal mucinous cyst from gangliocytoma because both tumors have similar density under the image assessment. In this article, we reported an asymptomatic 8-year-old boy with multiple bronchogenic cysts in both lung and adrenal area on the left side, the latter was considered to be a gangliocytoma preoperatively by ultrasound and computed tomography, but confirmed as bronchogenic cyst by histopathology post laparoscopic resection. The differential diagnosis, imaging features and treatment of bronchogenic cyst are discussed and the relative literatures are reviewed.

  11. Challenge in preoperative diagnosis of retroperitoneal mucinous cyst in a pediatric patient

    PubMed Central

    Zhang, Deying; Zhang, Yan; Liu, Xing; Zhu, Jin; Feng, Chuan; Yang, Chunjiang; Wu, Shengde; Liu, Junhong; Hua, Yi; Liu, Feng; Zhang, Nan; Zhang, Yuanyuan; He, Dawei; Lin, Tao; Wei, Guanghui

    2015-01-01

    Mucinous cystic lesions of the retroperitoneum can be either neoplastic or non-neoplastic. It is very important to make a correct diagnosis, or at least, an accurate classification, to proceed with an optimal treatment strategy. In spite of advantage of ultrasound and X-ray image examinations, it is still a challenge to make differential diagnosis of retroperitoneal mucinous cyst from gangliocytoma because both tumors have similar density under the image assessment. In this article, we reported an asymptomatic 8-year-old boy with multiple bronchogenic cysts in both lung and adrenal area on the left side, the latter was considered to be a gangliocytoma preoperatively by ultrasound and computed tomography, but confirmed as bronchogenic cyst by histopathology post laparoscopic resection. The differential diagnosis, imaging features and treatment of bronchogenic cyst are discussed and the relative literatures are reviewed. PMID:26770607

  12. Somatic Mutation Allelic Ratio Test Using ddPCR (SMART-ddPCR): An Accurate Method for Assessment of Preferential Allelic Imbalance in Tumor DNA

    PubMed Central

    de Smith, Adam J.; Walsh, Kyle M.; Hansen, Helen M.; Endicott, Alyson A.; Wiencke, John K.; Metayer, Catherine; Wiemels, Joseph L.

    2015-01-01

    The extent to which heritable genetic variants can affect tumor development has yet to be fully elucidated. Tumor selection of single nucleotide polymorphism (SNP) risk alleles, a phenomenon called preferential allelic imbalance (PAI), has been demonstrated in some cancer types. We developed a novel application of digital PCR termed Somatic Mutation Allelic Ratio Test using Droplet Digital PCR (SMART-ddPCR) for accurate assessment of tumor PAI, and have applied this method to test the hypothesis that heritable SNPs associated with childhood acute lymphoblastic leukemia (ALL) may demonstrate tumor PAI. These SNPs are located at CDKN2A (rs3731217) and IKZF1 (rs4132601), genes frequently lost in ALL, and at CEBPE (rs2239633), ARID5B (rs7089424), PIP4K2A (rs10764338), and GATA3 (rs3824662), genes located on chromosomes gained in high-hyperdiploid ALL. We established thresholds of AI using constitutional DNA from SNP heterozygotes, and subsequently measured allelic copy number in tumor DNA from 19–142 heterozygote samples per SNP locus. We did not find significant tumor PAI at these loci, though CDKN2A and IKZF1 SNPs showed a trend towards preferential selection of the risk allele (p = 0.17 and p = 0.23, respectively). Using a genomic copy number control ddPCR assay, we investigated somatic copy number alterations (SCNA) underlying AI at CDKN2A and IKZF1, revealing a complex range of alterations including homozygous and hemizygous deletions and copy-neutral loss of heterozygosity, with varying degrees of clonality. Copy number estimates from ddPCR showed high agreement with those from multiplex ligation-dependent probe amplification (MLPA) assays. We demonstrate that SMART-ddPCR is a highly accurate method for investigation of tumor PAI and for assessment of the somatic alterations underlying AI. Furthermore, analysis of publicly available data from The Cancer Genome Atlas identified 16 recurrent SCNA loci that contain heritable cancer risk SNPs associated with a

  13. Preoperative localization of parathyroid adenomas using 4-dimensional computed tomography: a pictorial essay.

    PubMed

    Ellika, Shehanaz; Patel, Suresh; Aho, Todd; Marin, Horia

    2013-08-01

    Accurate preoperative localization is the key to successful parathyroid surgery in the era of minimally invasive parathyroid surgery. This article presents and discusses the embryologic basis of parathyroid gland and ectopic location and different imaging modalities helpful in diagnosing and localizing parathyroid adenomas and/or hyperplasia. We also aim to review the current surgical concepts in treatment of parathyroid adenomas and/or hyperplasia, the utility of 4-dimensional computed tomography for accurate preoperative localization of hyperfunctioning parathyroid glands, imaging classification of adenomas and/or hyperplasia, and, finally, present some of the limitations of 4-dimensional computed tomography.

  14. The Preoperative Patient With a Systolic Murmur

    PubMed Central

    Cowie, Brian

    2015-01-01

    Context: Patients with undifferentiated systolic murmurs present commonly during the perioperative period. Traditional bedside assessment and auscultation has not changed significantly in almost 200 years and relies on interpreting indirect acoustic events as a means of evaluating underlying cardiac pathology. This is notoriously inaccurate, even in expert cardiology hands, since many different valvular and cardiac diseases present with a similar auditory signal. Evidence Acquisition: The data on systolic murmurs, physical examination, perioperative valvular disease in the setting of non-cardiac surgery is reviewed. Results: Significant valvular heart disease increases perioperative risk in major non-cardiac surgery and increases long term patient morbidity and mortality. We propose a more modern approach to physical examination that incorporates the use of focused echocardiography to allow direct visualization of cardiac structure and function. This improves the diagnostic accuracy of clinical assessment, allows rational planning of surgery and anaesthesia technique, risk stratification, postoperative monitoring and appropriate referral to physicians and cardiologists. Conclusions: With a thorough preoperative assessment incorporating focused echocardiography, anaesthetists are in the unique position to enhance their role as perioperative physicians and influence short and long term outcomes of their patients. PMID:26705529

  15. Patterns of Response After Preoperative Treatment in Gastric Cancer

    SciTech Connect

    Diaz-Gonzalez, Juan A.; Rodriguez, Javier; Hernandez-Lizoain, Jose L.; Ciervide, Raquel; Gaztanaga, Miren; San Miguel, Inigo; Arbea, Leire; Aristu, J. Javier; Chopitea, Ana; Martinez-Regueira, Fernando; Valenti, Victor; Garcia-Foncillas, Jesus; Martinez-Monge, Rafael; Sola, Jesus J.

    2011-07-01

    Purpose: To analyze the rate of pathologic response in patients with locally advanced gastric cancer treated with preoperative chemotherapy with and without chemoradiation at our institution. Methods and Materials: From 2000 to 2007 patients were retrospectively identified who received preoperative treatment for gastric cancer (cT3-4/ N+) with induction chemotherapy (Ch) or with Ch followed by concurrent chemoradiotherapy (45 Gy in 5 weeks) (ChRT). Surgery was planned 4-6 weeks after the completion of neoadjuvant treatment. Pathologic assessment was used to investigate the patterns of pathologic response after neoadjuvant treatment. Results: Sixty-one patients were analyzed. Of 61 patients, 58 (95%) underwent surgery. The R0 resection rate was 87%. Pathologic complete response was achieved in 12% of the patients. A major pathologic response (<10% of residual tumor) was observed in 53% of patients, and T downstaging was observed in 75%. Median follow-up was 38.7 months. Median disease-free survival (DFS) was 36.5 months. The only patient-, tumor-, and treatment-related factor associated with pathologic response was the use of preoperative ChRT. Patients achieving major pathologic response had a 3-year actuarial DFS rate of 63%. Conclusions: The patterns of pathologic response after preoperative ChRT suggest encouraging intervals of DFS. Such a strategy may be of interest to be explored in gastric cancer.

  16. The status of and future research into Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: the need of accurate diagnosis, objective assessment, and acknowledging biological and clinical subgroups

    PubMed Central

    Twisk, Frank N. M.

    2014-01-01

    Although Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are used interchangeably, the diagnostic criteria define two distinct clinical entities. Cognitive impairment, (muscle) weakness, circulatory disturbances, marked variability of symptoms, and, above all, post-exertional malaise: a long-lasting increase of symptoms after a minor exertion, are distinctive symptoms of ME. This latter phenomenon separates ME, a neuro-immune illness, from chronic fatigue (syndrome), other disorders and deconditioning. The introduction of the label, but more importantly the diagnostic criteria for CFS have generated much confusion, mostly because chronic fatigue is a subjective and ambiguous notion. CFS was redefined in 1994 into unexplained (persistent or relapsing) chronic fatigue, accompanied by at least four out of eight symptoms, e.g., headaches and unrefreshing sleep. Most of the research into ME and/or CFS in the last decades was based upon the multivalent CFS criteria, which define a heterogeneous patient group. Due to the fact that fatigue and other symptoms are non-discriminative, subjective experiences, research has been hampered. Various authors have questioned the physiological nature of the symptoms and qualified ME/CFS as somatization. However, various typical symptoms can be assessed objectively using standardized methods. Despite subjective and unclear criteria and measures, research has observed specific abnormalities in ME/CFS repetitively, e.g., immunological abnormalities, oxidative and nitrosative stress, neurological anomalies, circulatory deficits and mitochondrial dysfunction. However, to improve future research standards and patient care, it is crucial that patients with post-exertional malaise (ME) and patients without this odd phenomenon are acknowledged as separate clinical entities that the diagnosis of ME and CFS in research and clinical practice is based upon accurate criteria and an objective assessment of characteristic symptoms

  17. Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty

    PubMed Central

    Blikman, T; Rienstra, W; van Raaij, T M; ten Hagen, A J; Dijkstra, B; Zijlstra, W P; Bulstra, S K; van den Akker-Scheek, I; Stevens, M

    2016-01-01

    Introduction Residual pain is a major factor in patient dissatisfaction following total hip arthroplasty or total knee arthroplasty (THA/TKA). The proportion of patients with unfavourable long-term residual pain is high, ranging from 7% to 34%. There are studies indicating that a preoperative degree of central sensitisation (CS) is associated with poorer postoperative outcomes and residual pain. It is thus hypothesised that preoperative treatment of CS could enhance postoperative outcomes. Duloxetine has been shown to be effective for several chronic pain syndromes, including knee osteoarthritis (OA), in which CS is most likely one of the underlying pain mechanisms. This study aims to evaluate the postoperative effects of preoperative screening and targeted duloxetine treatment of CS on residual pain compared with care-as-usual. Methods and analysis This multicentre, pragmatic, prospective, open-label, randomised controlled trial includes patients with idiopathic hip/knee OA who are on a waiting list for primary THA/TKA. Patients at risk for CS will be randomly allocated to the preoperative duloxetine treatment programme group or the care-as-usual control group. The primary end point is the degree of postoperative pain 6 months after THA/TKA. Secondary end points at multiple time points up to 12 months postoperatively are: pain, neuropathic pain-like symptoms, (pain) sensitisation, pain catastrophising, joint-associated problems, physical activity, health-related quality of life, depressive and anxiety symptoms, and perceived improvement. Data will be analysed on an intention-to-treat basis. Ethics and dissemination The study is approved by the local Medical Ethics Committee (METc 2014/087) and will be conducted according to the principles of the Declaration of Helsinki (64th, 2013) and the Good Clinical Practice standard (GCP), and in compliance with the Medical Research Involving Human Subjects Act (WMO). Trial registration number 2013-004313-41; Pre

  18. The assessment of the impact of aviation NOx on ozone and other radiative forcing responses - The importance of representing cruise altitudes accurately

    NASA Astrophysics Data System (ADS)

    Skowron, A.; Lee, D. S.; De León, R. R.

    2013-08-01

    is recommended that future formulations of aircraft NOx emissions focus efforts on the detailed and accurate placement of emissions at cruise altitudes to reduce the uncertainty in future assessments of aviation NOx impacts.

  19. [The randomized study of efficiency of preoperative photodynamic].

    PubMed

    Akopov, A L; Rusanov, A A; Molodtsova, V P; Gerasin, A V; Kazakov, N V; Urtenova, M A; Chistiakov, I V

    2013-01-01

    The authors made a prospective randomized comparison of results of preoperative photodynamic therapy (PhT) with chemotherapy, preoperative chemotherapy in initial unresectable central non-small cell lung cancer in stage III. The efficiency and safety of preoperative therapy were estimated as well as the possibility of subsequent surgical treatment. The research included patients in stage IIIA and IIIB of central non-small cell lung cancer with lesions of primary bronchi and lower section of the trachea, which initially were unresectable, but potentially the patients could be operated on after preoperative treatment. The photodynamic therapy was performed using chlorine E6 and the light of wave length 662 nm. Since January 2008 till December 2011,42 patients were included in the research, 21 patients were randomized in the group for photodynamic therapy and 21--in group without PhT. These groups were compared according to their sex, age, stage of the disease and histological findings. After nonadjuvant treatment the remissions were reached in 19 (90%) patients of the group with PhT and in 16 (76%) patients without PhT and all the patients were operated on. The explorative operations were made on 3 patients out of 16 operated on in the group without PhT (19%). In the group PhT 14 pneumonectomies and 5 lobectomies were perfomed opposite 10 pneumonectomies and 3 lobectomies in group without PhT. The degree of radicalism of resection appears to be reliably higher in the group PhT (RO-89%, R1-11% as against RO-54%, R1-46% in group without PhT), p = 0.038. The preoperative endobronchial PhT conducted with chemotherapy was characterized by efficiency and safety, allowed the surgical treatment and elevated the degree of radicalism of this treatment in selected patients, initially assessed as unresectable. PMID:23808222

  20. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis

    PubMed Central

    Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

    2015-01-01

    Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. PMID:25599300

  1. Bevacizumab with preoperative chemotherapy versus preoperative chemotherapy alone for colorectal cancer liver metastases: a retrospective cohort study.

    PubMed

    Lu, Zhen-Hai; Peng, Jian-Hong; Wang, Fu-Long; Yuan, Yun-Fei; Jiang, Wu; Li, Yu-Hong; Wu, Xiao-Jun; Chen, Gong; Ding, Pei-Rong; Li, Li-Ren; Kong, Ling-Heng; Lin, Jun-Zhong; Zhang, Rong-Xin; Wan, De-Sen; Pan, Zhi-Zhong

    2016-08-01

    This study aimed to assess the efficacy and safety of bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer in Chinese patients compared with those of preoperative chemotherapy alone.Patients with histologically confirmed liver-only metastatic colorectal cancer were sequentially reviewed, and received either preoperative chemotherapy plus bevacizumab (bevacizumab group, n = 32) or preoperative chemotherapy alone (chemotherapy group, n = 57). Progression-free survival, response rate, liver resection rate, conversion rate, and safety were analyzed.With median follow-up of 28.7 months, progression-free survival was 10.9 months (95% confidence interval: 8.7-13.1 months) in bevacizumab group and 9.9 months (95% confidence interval: 6.8-13.1 months) in chemotherapy group (P = 0.472). Response rates were 59.4% in bevacizumab group and 38.6% in chemotherapy group (P = 0.059). Overall liver resection (R0, R1, and R2) rate was 68.8% in bevacizumab group and 54.4% in chemotherapy group (P = 0.185). Conversion rate was 51.9% in bevacizumab group and 40.4% in chemotherapy group (P = 0.341). No postoperative complication was observed in all patients.Bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer tends to achieve better clinical benefit with controllable safety in Chinese patients. PMID:27583930

  2. Preoperative Evaluation of the Surgical Patient.

    PubMed

    O'Donnell, Frederick T

    2016-01-01

    Primary care physicians and specialists are frequently involved in the care of surgical patients. Changes in reimbursement have prompted re-examination of preoperative testing and health care expenditures. Physicians have additional incentives to improve health care delivery and reduce costs. The perioperative surgical home concept involves coordinating all aspects of patient care, including behavioral modifications, during the perioperative period. Evidence-based guidelines on preoperative evaluation are available to assist practitioners in managing cardiovascular disease, and communicating surgical risks. Shared decision making in the preoperative period can improve surgical outcomes and patient satisfaction. PMID:27443045

  3. Evaluation of noninvasive tests for the preoperative staging of carcinoma of the esophagus: a prospective study

    SciTech Connect

    Inculet, R.I.; Keller, S.M.; Dwyer, A.; Roth, J.A.

    1985-12-01

    A prospective study was undertaken to define the usefulness of conventional full-lung linear tomography, radionuclide liver plus spleen and bone scans, and thoracic and abdominal computed tomography for the preoperative staging of carcinoma of the esophagus. Thirty-three patients with carcinoma of the esophagus were studied. The computed tomographic (CT) scan of the thorax and upper abdomen was the single most accurate noninvasive study. With computed tomography, the relationship of the tumor to the tracheobronchial tree was the feature most useful in predicting local resectability. In all patients with the finding of tracheobronchial compression by the tumor, the tumor could not be resected completely. The predictive value of this CT finding in patients with locally unresectable tumor was high (0.83), indicating its usefulness in assessing unresectability. The CT finding of visible separation between tumor mass and tracheobronchial tree was present in 10 of 14 patients with locally resectable tumor (predictive value, 0.63). However, tumor abutting the tracheobronchial tree without compression was a poor predictor of unresectability (predictive value, 0.36). The radionuclide bone scan was the only other noninvasive study to demonstrate a metastasis not evident by CT scan. The combination of chest and abdominal CT scan, bone scan, and bronchoscopy before operation will accurately stage the majority of patients with esophageal cancer but no noninvasive test is of sufficient reliability to exclude patients from operative resection if otherwise indicated.

  4. Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance.

    PubMed

    Truijers, M; Resch, T; Van Den Berg, J C; Blankensteijn, J D; Lönn, L

    2009-08-01

    Endovascular aneurysm repair (EVAR) represents one of the greatest advances in vascular surgery over the past 50 years. In contrast to conventional aneurysm repair, EVAR requires accurate preoperative imaging and stringent postoperative surveillance. Duplex ultrasound (DUS), transesophageal echocardiography, intravascular ultrasound, computed tomography (CT) and magnetic resonance (MR), each provide useful information for patient selection, choice of endograft type and surveillance. Today most interventionists and surgeons will rely on CT or MR to assess aortic morphology, evaluate access artery patency and locate side branch orifices. However, recent developments in cross-sectional imaging, including advanced image postprocessing, multi-modality image fusion and new contrast agents have resulted in improved spatial resolution for preoperative planning. Advanced reconstruction algorithms, like dynamic CTA and MRA, provide valuable information on dynamic changes in aneurysm morphology that might have an important impact on endograft selection. During follow-up, imaging of the graft and aneurysm is of utmost importance to identify patients in need of secondary intervention. This has led to rigorous follow-up protocols including duplex ultrasound and regular CT examinations. The use of these intense follow-up protocols has recently been questioned because of high radiation dose and the frequent use of nephrotoxic contrast agents. New imaging modalities like contrast enhanced DUS, dynamic MR and dual-source CT could reduce radiation dose and obviate the need for nephrotoxic contrast. Up-to-date knowledge of non-invasive vascular imaging and image processing is crucial for EVAR planning and is essential for the development of follow-up programs involving reduced risk of harmful side effects.

  5. Morphological analysis and preoperative simulation of a double-chambered right ventricle using 3-dimensional printing technology.

    PubMed

    Shirakawa, Takashi; Koyama, Yasushi; Mizoguchi, Hiroki; Yoshitatsu, Masao

    2016-05-01

    We present a case of a double-chambered right ventricle in adulthood, in which we tried a detailed morphological assessment and preoperative simulation using 3-dimensional (3D) heart models for improved surgical planning. Polygonal object data for the heart were constructed from computed tomography images of this patient, and transferred to a desktop 3D printer to print out models in actual size. Medical staff completed all of the work processes. Because the 3D heart models were examined by hand, observed from various viewpoints and measured by callipers with ease, we were able to create an image of the complete form of the heart. The anatomical structure of an anomalous bundle was clearly observed, and surgical approaches to the lesion were simulated accurately. During surgery, we used an incision on the pulmonary infundibulum and resected three muscular components of the stenosis. The similarity between the models and the actual heart was excellent. As a result, the operation for this rare defect was performed safely and successfully. We concluded that the custom-made model was useful for morphological analysis and preoperative simulation. PMID:26860990

  6. Morphological analysis and preoperative simulation of a double-chambered right ventricle using 3-dimensional printing technology.

    PubMed

    Shirakawa, Takashi; Koyama, Yasushi; Mizoguchi, Hiroki; Yoshitatsu, Masao

    2016-05-01

    We present a case of a double-chambered right ventricle in adulthood, in which we tried a detailed morphological assessment and preoperative simulation using 3-dimensional (3D) heart models for improved surgical planning. Polygonal object data for the heart were constructed from computed tomography images of this patient, and transferred to a desktop 3D printer to print out models in actual size. Medical staff completed all of the work processes. Because the 3D heart models were examined by hand, observed from various viewpoints and measured by callipers with ease, we were able to create an image of the complete form of the heart. The anatomical structure of an anomalous bundle was clearly observed, and surgical approaches to the lesion were simulated accurately. During surgery, we used an incision on the pulmonary infundibulum and resected three muscular components of the stenosis. The similarity between the models and the actual heart was excellent. As a result, the operation for this rare defect was performed safely and successfully. We concluded that the custom-made model was useful for morphological analysis and preoperative simulation.

  7. Preoperative therapy in locally advanced esophageal cancer

    PubMed Central

    Garg, Pankaj Kumar; Sharma, Jyoti; Jakhetiya, Ashish; Goel, Aakanksha; Gaur, Manish Kumar

    2016-01-01

    Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer (T2 or greater or node positive); however, a high rate of disease recurrence (systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment (preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy (radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.

  8. Prostate cancer nodal oligometastasis accurately assessed using prostate-specific membrane antigen positron emission tomography-computed tomography and confirmed histologically following robotic-assisted lymph node dissection

    PubMed Central

    O’Kane, Dermot B.; Lawrentschuk, Nathan; Bolton, Damien M.

    2016-01-01

    We herein present a case of a 76-year-old gentleman, where prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET-CT) was used to accurately detect prostate cancer (PCa), pelvic lymph node (LN) metastasis in the setting of biochemical recurrence following definitive treatment for PCa. The positive PSMA PET-CT result was confirmed with histological examination of the involved pelvic LNs following pelvic LN dissection. PMID:27141207

  9. Preoperative progressive pneumoperitoneum for giant inguinal hernias.

    PubMed

    Piskin, Turgut; Aydin, Cemalettin; Barut, Bora; Dirican, Abuzer; Kayaalp, Cuneyt

    2010-01-01

    Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient's tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients.

  10. The application of rapid prototyping techniques in cranial reconstruction and preoperative planning in neurosurgery.

    PubMed

    Müller, Adolf; Krishnan, Kartik G; Uhl, Eberhard; Mast, Gerson

    2003-11-01

    The value of rapid prototype models of the skull in our craniofacial and neurosurgical practice was analyzed. Individual skull models of 52 patients were produced by means of rapid prototyping techniques and used in various procedures. Patients were divided into three groups as follows: group I (26 patients) requiring corrective cranioplasty 1) after resection of osseous tumors (15 patients) and 2) with congenital and posttraumatic craniofacial deformities (11 patients), group II (10 patients) requiring reconstructive cranioplasty, and group III (16 patients) requiring planning of difficult skull base approaches. The utility of the stereolithographic models was assessed using the Gillespie scoring system. The esthetic and clinical outcomes were assessed by means of the esthetic outcome score and the Glasgow Outcome Score, respectively. Simulation of osteotomies for advancement plasty and craniofacial reassembly in the model before surgery in group I reduced operating time and intraoperative errors. In group II, the usefulness of the models depended directly on the size and configuration of the cranial defect. The planning of approaches to uncommon and complex skull base tumors (group III) was significantly influenced by the stereolithographic models. The esthetic outcome was pleasing. The indications for the manufacture of individual three-dimensional models could be cases of craniofacial dysmorphism that require meticulous preoperative planning and skull base surgery with difficult anatomical and reconstructive problems. The stereolithographic models provide 1) better understanding of the anatomy, 2) presurgical simulation, 3) intraoperative accuracy in localization of lesions, 4) accurate fabrication of implants, and 5) improved education of trainees. PMID:14600634

  11. Preoperative and Intraoperative Evaluation of the Eustachian Tube in Chronic Ear Surgery.

    PubMed

    Tarabichi, Muaaz; Kapadia, Mustafa

    2016-10-01

    This article discusses the authors' approach to the assessment of the eustachian tube using opening pressure measurement, endoscopic assessment of the protympanic segment of the eustachian tube, and Valsalva computed tomography. A possible algorithm for the evaluation of eustachian tube obstructive disorders is detailed both preoperatively and intraoperatively. PMID:27468635

  12. Preoperative evaluation of the cardiac patient for noncardiac surgery.

    PubMed Central

    Fleisher, L. A.; Barash, P. G.

    1993-01-01

    Perioperative cardiac events continue to represent a significant cause of morbidity in patients undergoing noncardiac surgery. The evaluation of the high risk patient should begin with an assessment of the probability of coronary artery disease and exercise tolerance. Decisions to undergo further evaluation, including noninvasive testing, should be based upon the perioperative morbidity and mortality rate for the planned surgical procedure. In patients with significant coronary artery stenoses and a high probability of perioperative cardiac morbidity, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, and preoperative optimization of hemodynamics in an intensive care unit have all been advocated as means of reducing risk. PMID:7825340

  13. Effectiveness of non-cardiac preoperative testing in non-cardiac elective surgery: a systematic review.

    PubMed

    Johansson, T; Fritsch, G; Flamm, M; Hansbauer, B; Bachofner, N; Mann, E; Bock, M; Sönnichsen, A C

    2013-06-01

    Elective surgery is usually preceded by preoperative diagnostics to minimize risk. The results are assumed to elicit preventive measures or even cancellation of surgery. Moreover, physicians perform preoperative tests as a baseline to detect subsequent changes. This systematic review aims to explore whether preoperative testing leads to changes in management or reduces perioperative mortality or morbidity in unselected patients undergoing elective, non-cardiac surgery. We systematically searched all relevant databases from January 2001 to February 2011 for studies investigating the relationship between preoperative diagnostics and perioperative outcome. Our methodology was based on the manual of the Ludwig Boltzmann Institute for Health Technology Assessment, the Scottish Intercollegiate Guidelines Network (SIGN) handbook, and the PRISMA statement for reporting systematic reviews. One hundred and one of the 25 281 publications retrieved met our inclusion criteria. Three test grid studies used a randomized controlled design and 98 studies used an observational design. The test grid studies show that in cataract surgery and ambulatory surgery, there are no significant differences between patients with indicated preoperative testing and no testing regarding perioperative outcome. The observational studies do not provide valid evidence that preoperative testing is beneficial in healthy adults undergoing non-cardiac surgery. There is no evidence derived from high-quality studies that supports routine preoperative testing in healthy adults undergoing non-cardiac surgery. Testing according to pathological findings in a patient's medical history or physical examination seems justified, although the evidence is scarce. High-quality studies, especially large randomized controlled trials, are needed to explore the effectiveness of indicated preoperative testing.

  14. Does preoperative depression and/or serotonin transporter gene polymorphism predict outcome after laparoscopic cholecystectomy?

    PubMed Central

    Wright, Barry; Aghahoseini, Assad

    2016-01-01

    Objective To determine whether preoperative psychological depression and/or serotonin transporter gene polymorphism are associated with poor outcomes after the common procedure of laparoscopic cholecystectomy. Design Patients undergoing laparoscopic cholecystectomy were genotyped for the serotonin transporter gene 5-HTTLPR polymorphism and assessed for psychological morbidity before and 6 weeks after surgery. The main outcome was postoperative depression; secondary outcomes included fatigue, perceived pain, quality of life and subjective perception about return to usual. Results Full genetic and psychological data were obtained from 273 out of 330 patients consented to the study (82% female). Significantly fewer people with preoperative depression (Beck Depression Inventory (BDI) score >5) had returned to employment (57% vs 86%, p<0.001) or made a full recovery (11% vs 44%, p<0.001) 6 weeks after surgery. Independent predictors for subjective return to usual after surgery included preoperative depression, body mass index and postoperative pain scores. Independent predictors of postoperative depression included preoperative antidepressant use and preoperative depression. SS genotype was associated with use of antidepressants preoperatively and higher anxiety levels after surgery. However, it was not associated with other salient postoperative psychosocial outcomes. Conclusions Depressive psychological morbidity preoperatively, pain and body mass index appear to be important factors in predicting recovery after this common surgical procedure. There may be a place to include preoperative brief psychological screening to enable targeted support. Our results suggest that the serotonin transporter gene is unlikely to be a useful clinical predictor of outcome in this group. Trial registration number ISRCTN40219584. PMID:27601483

  15. Performance assessment of fire-sat monitoring system based on satellite time series for fire danger estimation : the experience of the pre-operative application in the Basilicata Region (Italy)

    NASA Astrophysics Data System (ADS)

    Lanorte, Antonio; Desantis, Fortunato; Aromando, Angelo; Lasaponara, Rosa

    2013-04-01

    This paper presents the results we obtained in the context of the FIRE-SAT project during the 2012 operative application of the satellite based tools for fire monitoring. FIRE_SAT project has been funded by the Civil Protection of the Basilicata Region in order to set up a low cost methodology for fire danger monitoring and fire effect estimation based on satellite Earth Observation techniques. To this aim, NASA Moderate Resolution Imaging Spectroradiometer (MODIS), ASTER, Landsat TM data were used. Novel data processing techniques have been developed by researchers of the ARGON Laboratory of the CNR-IMAA for the operative monitoring of fire. In this paper we only focus on the danger estimation model which has been fruitfully used since 2008 to 2012 as an reliable operative tool to support and optimize fire fighting strategies from the alert to the management of resources including fire attacks. The daily updating of fire danger is carried out using satellite MODIS images selected for their spectral capability and availability free of charge from NASA web site. This makes these data sets very suitable for an effective systematic (daily) and sustainable low-cost monitoring of large areas. The preoperative use of the integrated model, pointed out that the system properly monitor spatial and temporal variations of fire susceptibility and provide useful information of both fire severity and post fire regeneration capability.

  16. Preoperational test report, vent building ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Vent Building Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides Heating, Ventilation, and Air Conditioning (HVAC) for the W-030 Ventilation Building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  17. Volumetric difference evaluation of registered three-dimensional pre-operative and post-operative CT dental data

    PubMed Central

    Economopoulos, TL; Asvestas, PA; Matsopoulos, GK; Molnár, B; Windisch, P

    2012-01-01

    Objective: The purpose of this study is to propose a complete methodology for automatically registering three-dimensional (3D) pre-operative and post-operative CT scan dental volumes as well as to provide a toolset for quantifying and evaluating their volumetric differences. Methods: The proposed methodology was applied to cone beam CT (CBCT) data from 20 patients in order to assess the volume of augmented bone in the alveolar region. In each case, the pre-operative and post-operative data were registered using a 3D affine-based scheme. The performance of the 3D registration algorithm was evaluated by measuring the average distance between the edges of the registered sets. The differences between the registered sets were assessed through 3D subtraction radiography. The volume of the differences was finally evaluated by defining regions of interest in each slice of the subtracted 3D data and by combining all respective slices to model the desired volume of interest. The effectiveness of the algorithm was verified by applying it to several reference standard-shaped objects with known volumes. Results: Satisfactory alignment was achieved as a low average offset of 1.483 ± 1.558 mm was recorded between the edges of the registered sets. Moreover, the estimated volumes closely matched the volumes of the reference objects used for verification, as the recorded volume differences were less than 0.4 mm3 in all cases. Conclusion: The proposed method allows for automatic registration of 3D CBCT data sets and the volumetric assessment of their differences in particular areas of interest. The proposed approach provides accurate volumetric measurements in three dimensions, requiring minimal user interaction. PMID:22241879

  18. Preoperative spirometry before abdominal operations. A critical appraisal of its predictive value.

    PubMed

    Lawrence, V A; Page, C P; Harris, G D

    1989-02-01

    Preoperative spirometry is commonly ordered before abdominal surgery, with the goal of predicting and preventing postoperative pulmonary complications. We assessed the evidence for this practice with a systematic literature search and critical appraisal of published studies. The search identified 135 clinical articles, of which 22 (16%) were actual investigations of the use and predictive value of preoperative spirometry. All 22 studies had important methodological flaws that preclude valid conclusions about the value of screening preoperative spirometry. The available evidence indicates that spirometry's predictive value is unproved. Unanswered questions involve (1) the yield of spirometry, in addition to history and physical examination, in patients with clinically apparent lung disease; (2) spirometry's yield in detecting surgically important occult disease; and (3) its utility, or beneficial effect on patient outcome. Spirometry's full potential for risk assessment in the individual patient has not yet been realized.

  19. Neoadjuvant Therapy in Rectal Cancer - Biobanking of Preoperative Tumor Biopsies

    PubMed Central

    Jo, Peter; Nietert, Manuel; Gusky, Linda; Kitz, Julia; Conradi, Lena C.; Müller-Dornieden, Annegret; Schüler, Philipp; Wolff, Hendrik A.; Rüschoff, Josef; Ströbel, Philipp; Grade, Marian; Liersch, Torsten; Beißbarth, Tim; Ghadimi, Michael B.; Sax, Ulrich; Gaedcke, Jochen

    2016-01-01

    Translational research relies on high-quality biospecimens. In patients with rectal cancer treated preoperatively with radiochemotherapy tissue based analyses are challenging. To assess quality challenges we analyzed tissue samples taken over the last years in a multicenter setting. We retrospectively evaluated overall 197 patients of the CAO/ARO/AIO-94- and 04-trial with locally advanced rectal cancer that were biopsied preoperatively at the University Medical Center Goettingen as well as in 10 cooperating hospitals in Germany. The cellular content of tumor, mucosa, stroma, necrosis and the amount of isolated DNA and RNA as well as the RNA integrity number (RIN) as quality parameters were evaluated. A high RNA yield (p = 2.75e–07) and the content of tumor (p = 0.004) is significantly associated to high RIN-values, whereas a high content of mucosa (p = 0.07) shows a trend and a high amount of necrosis (p = 0.01) is significantly associated with RNA of poor quality. Correlating biopsies from Goettingen and the cooperating centers showed comparable tumor content results. By taking small sized biopsies we could assess a clear correlation between a good RNA quality and a high amount of RNA and tumor cells. These results also indicate that specimens collected at different centers are of comparable quality. PMID:27752113

  20. Preoperative prediction of reversible myocardial asynergy by postexercise radionuclide ventriculography

    SciTech Connect

    Rozanski, A.; Berman, D.; Gray, R.; Diamond, G.; Raymond, M.; Prause, J.; Maddahi, J.; Swan, H.J.; Matloff, J.

    1982-07-22

    Myocardial asynergy is sometimes reversed by coronary bypass, and a noninvasive method of predicting which assess are reversible would be desirable. To assess whether changes in myocardial wall motion observed immediately after exercise can differentiate reversible from nonreversible myocardial asynergy, we evaluated 53 patients by radionuclide ventriculography before and after exercise and again at rest after coronary bypass surgery. Preoperative improvement in wall motion immediately after exercise was highly predictive of the surgical outcome (average chance-corrected agreement, 91 per cent). At surgery the asynergic segments that had improved after exercise were free of grossly apparent epicardial scarring. The accuracy of these predictions for postoperative improvement was significantly greater (P less than 0.01) than that of analysis of Q waves on resting electrocardiography (average chance-corrected agreement, 40 per cent). In contrast, preoperative changes in left ventricular ejection fraction after exercise were not predictive of postoperative resting ejection fraction. We conclude that postexercise radionuclide ventriculography can be used to identify reversible resting myocardial asynergy. This test should prove effective in predicting which patients with myocardial asynergy are most likely to benefit from aortocoronary revascularization.

  1. Dipyridamole-thallium scanning in patients undergoing vascular surgery. Optimizing preoperative evaluation of cardiac risk

    SciTech Connect

    Eagle, K.A.; Singer, D.E.; Brewster, D.C.; Darling, R.C.; Mulley, A.G.; Boucher, C.A.

    1987-04-24

    Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events. Events occurred in eight of 18 patients with reversible defects on preoperative imaging, compared with no events in 43 patients with no thallium redistribution (confidence interval for the risk difference: 0.624, 0.256). The results also suggested that clinical factors might allow identification of a low-risk subset of patients. To test the hypothesis that patients with no evidence of congestive heart failure, angina, prior myocardial infarction, or diabetes do not require further preoperative testing, we evaluated an additional 50 patients having vascular procedures. None of the 23 without the clinical markers had untoward outcomes, while ten of 27 patients with one or more of these clinical markers suffered postoperative ischemic events (confidence interval for the risk difference: 0.592, 0.148). In the clinical high-risk subset, further risk stratification is achieved with dipyridamole-thallium scanning.

  2. A Framework for the Comparative Assessment of Neuronal Spike Sorting Algorithms towards More Accurate Off-Line and On-Line Microelectrode Arrays Data Analysis.

    PubMed

    Regalia, Giulia; Coelli, Stefania; Biffi, Emilia; Ferrigno, Giancarlo; Pedrocchi, Alessandra

    2016-01-01

    Neuronal spike sorting algorithms are designed to retrieve neuronal network activity on a single-cell level from extracellular multiunit recordings with Microelectrode Arrays (MEAs). In typical analysis of MEA data, one spike sorting algorithm is applied indiscriminately to all electrode signals. However, this approach neglects the dependency of algorithms' performances on the neuronal signals properties at each channel, which require data-centric methods. Moreover, sorting is commonly performed off-line, which is time and memory consuming and prevents researchers from having an immediate glance at ongoing experiments. The aim of this work is to provide a versatile framework to support the evaluation and comparison of different spike classification algorithms suitable for both off-line and on-line analysis. We incorporated different spike sorting "building blocks" into a Matlab-based software, including 4 feature extraction methods, 3 feature clustering methods, and 1 template matching classifier. The framework was validated by applying different algorithms on simulated and real signals from neuronal cultures coupled to MEAs. Moreover, the system has been proven effective in running on-line analysis on a standard desktop computer, after the selection of the most suitable sorting methods. This work provides a useful and versatile instrument for a supported comparison of different options for spike sorting towards more accurate off-line and on-line MEA data analysis. PMID:27239191

  3. A Framework for the Comparative Assessment of Neuronal Spike Sorting Algorithms towards More Accurate Off-Line and On-Line Microelectrode Arrays Data Analysis

    PubMed Central

    Pedrocchi, Alessandra

    2016-01-01

    Neuronal spike sorting algorithms are designed to retrieve neuronal network activity on a single-cell level from extracellular multiunit recordings with Microelectrode Arrays (MEAs). In typical analysis of MEA data, one spike sorting algorithm is applied indiscriminately to all electrode signals. However, this approach neglects the dependency of algorithms' performances on the neuronal signals properties at each channel, which require data-centric methods. Moreover, sorting is commonly performed off-line, which is time and memory consuming and prevents researchers from having an immediate glance at ongoing experiments. The aim of this work is to provide a versatile framework to support the evaluation and comparison of different spike classification algorithms suitable for both off-line and on-line analysis. We incorporated different spike sorting “building blocks” into a Matlab-based software, including 4 feature extraction methods, 3 feature clustering methods, and 1 template matching classifier. The framework was validated by applying different algorithms on simulated and real signals from neuronal cultures coupled to MEAs. Moreover, the system has been proven effective in running on-line analysis on a standard desktop computer, after the selection of the most suitable sorting methods. This work provides a useful and versatile instrument for a supported comparison of different options for spike sorting towards more accurate off-line and on-line MEA data analysis. PMID:27239191

  4. [Preoperative diagnosis of incidental carcinoma in multinodular goitre by means of electromagnetic interactions].

    PubMed

    Sacco, Rosario; Innaro, Nadia; Pata, Francesco; Lucisano, Ada Maria; Talarico, Carlo; Aversa, Stefania

    2007-01-01

    In the evaluation of multinodular goitre, finding a malignant neoplasia is often an unexpected result of the histological diagnosis. TRIMprob (Tissue Resonance Interaction Method Probe) is a portable system for non-invasive diagnosis, that utilises the different electromagnetic properties of healthy and pathological tissues, producing a low-power magnetic field that interacts with the molecular structure of tissues. The interference levels are detected by a receiver device and are elaborated with software in a graph consisting of 3 easily interpretable bands. The objective of our study was to assess the usefulness of the TRIMprob system in the preoperative diagnosis of carcinoma in patients with multinodular goitre. Over the period from January 2005 to March 2006 we used TRIMprob to screen 51 patients with a clinical diagnosis of multinodular goitre, later operated on by total thyroidectomy. We then compared the TRIMprob response with the histological diagnosis on the surgical specimen. The TRIMprob results suggested 46 cases compatible with non-malignant goitre and 5 suspected cancers. The final histological diagnosis confirmed these results with 46 cases of multinodular goitre and 5 papillary carcinomas. The sensitivity, specificity and diagnostic accuracy of the procedure were all 100%. On the basis of these preliminary results, TRIMprob seems to be a highly accurate method for the detection of suspected carcinomas in the context of multinodular goitre. If these results are confirmed, new prospects could be opened up in the diagnosis of thyroid diseases.

  5. Preoperative and surveillance MR imaging of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy

    PubMed Central

    2016-01-01

    MR imaging provides considerable advantages for imaging patients with peritoneal tumor. Its inherently superior contrast resolution compared to CT allows MRI to more accurately depict small peritoneal tumors that are often missed on other imaging tests. Combining different contrast mechanisms including diffusion-weighted (DW) MRI and gadolinium-enhanced MRI provides a powerful tool for preoperative and surveillance imaging in patients being considered for cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). PMID:26941984

  6. Preoperatively diagnosed mucocele of the appendix.

    PubMed

    Rojnoveanu, Gh; Ghidirim, Gh; Mishin, I; Vozian, M; Mishina, A

    2014-01-01

    Mucocele of the appendix is an infrequent entity, characterized by distension of the lumen due to accumulation of mucoid substance and is rarely diagnosed preoperatively. If untreated, mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and the histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadeno carcinoma. In this paper, we report a case of an asymptomatic 37-year-old woman in whom mucocele was found on a routine ultrasound examination and preoperative computed tomography scan. Surgery revealed a big appendix measuring 84 mm in length and 40 mm in diameter. The final pathologic diagnosis was simple mucocele.

  7. Effect of behavioral intervention using smartphone application for preoperative anxiety in pediatric patients

    PubMed Central

    Lee, Jong-Hyuk; Jung, Han-Kil; Lee, Gang-geun; Kim, Han-Young; Park, Sun-Gyoo

    2013-01-01

    Background Children and parents experience significant anxiety and distress during the preoperative period. This is important because preoperative anxiety in children is associated with adverse postoperative outcome. So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application, world-widely used. Methods A total 120 patients (aged 1-10 years old) who were scheduled for elective surgery under general anesthesia was included in this randomized controlled trial. We randomized the patients into three groups, with using intravenous (IV) midazolam sedation (M group), with using smartphone application program (S group), and with using low dose IV midazolam plus smartphone application program (SM group). And the child anxiety was assessed using the modified Yale Preoperative Anxiety Scale (mYPAS) at holding area, 5 min after intervention, entrance to operating room. Results In all three groups, mYPAS after intervention were lower than the preoperative holding area (M group 52.8 ± 11.8 vs 41.0 ± 7.0, S group 59.2 ± 17.6 vs 36.4 ± 7.3, SM group 58.3 ± 17.5 vs 26.0 ± 3.4). A comparison of mYPAS scores between each group showed that the S group reduced anxiety lower than M group (P < 0.01), and the SM group exhibited significantly lower anxiety than the two other groups (P < 0.01). Conclusions The preoperative preparation program using smartphone application is simple and customized by individual development that effective in the reduction of preoperative anxiety. PMID:24427456

  8. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    SciTech Connect

    Baldini, Elizabeth H.; Wang, Dian; Haas, Rick L.M.; Catton, Charles N.; Indelicato, Daniel J.; Kirsch, David G.; Roberge, David; Salerno, Kilian; Deville, Curtiland; Guadagnolo, B. Ashleigh; O'Sullivan, Brian; Petersen, Ivy A.; Le Pechoux, Cecile; Abrams, Ross A.; DeLaney, Thomas F.

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy

  9. Implications of preoperative hypoalbuminemia in colorectal surgery

    PubMed Central

    Truong, Adam; Hanna, Mark H; Moghadamyeghaneh, Zhobin; Stamos, Michael J

    2016-01-01

    Serum albumin has traditionally been used as a quantitative measure of a patient’s nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient’s chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery. PMID:27231513

  10. Implications of preoperative hypoalbuminemia in colorectal surgery.

    PubMed

    Truong, Adam; Hanna, Mark H; Moghadamyeghaneh, Zhobin; Stamos, Michael J

    2016-05-27

    Serum albumin has traditionally been used as a quantitative measure of a patient's nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient's chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery. PMID:27231513

  11. Preoperative Planning in Primary Total Knee Arthroplasty.

    PubMed

    Tanzer, Michael; Makhdom, Asim M

    2016-04-01

    Preoperative planning is of paramount importance in primary total knee arthroplasty. A thorough preoperative analysis helps the surgeon envision the operation, anticipate any potential issues, and minimize the risk of premature implant failure. Obtaining a thorough history is critical for appropriate patient selection. The physical examination should evaluate the integrity of the soft tissues, the neurovascular status, range of motion, limb deformity, and the status of the collateral ligaments to help determine the soft-tissue balancing and constraint strategy required. Standard radiographs, with a known magnification, should be obtained for preoperative total knee arthroplasty templating. Routine standing AP, lateral, and skyline radiographs of the knee can help the surgeon plan the bone cuts and tibial slope as well as the implant size and position at the time of surgery. In certain circumstances, such as severe coronal deformities, bone deficiencies, and/or extra-articular deformities, additional measures are frequently necessary to successfully reconstruct the knee. Constrained implants, metal augments, and bone graft must be part of the surgeon's armamentarium. PMID:26990712

  12. Accurate monotone cubic interpolation

    NASA Technical Reports Server (NTRS)

    Huynh, Hung T.

    1991-01-01

    Monotone piecewise cubic interpolants are simple and effective. They are generally third-order accurate, except near strict local extrema where accuracy degenerates to second-order due to the monotonicity constraint. Algorithms for piecewise cubic interpolants, which preserve monotonicity as well as uniform third and fourth-order accuracy are presented. The gain of accuracy is obtained by relaxing the monotonicity constraint in a geometric framework in which the median function plays a crucial role.

  13. Accurate Finite Difference Algorithms

    NASA Technical Reports Server (NTRS)

    Goodrich, John W.

    1996-01-01

    Two families of finite difference algorithms for computational aeroacoustics are presented and compared. All of the algorithms are single step explicit methods, they have the same order of accuracy in both space and time, with examples up to eleventh order, and they have multidimensional extensions. One of the algorithm families has spectral like high resolution. Propagation with high order and high resolution algorithms can produce accurate results after O(10(exp 6)) periods of propagation with eight grid points per wavelength.

  14. Accurate documentation and wound measurement.

    PubMed

    Hampton, Sylvie

    This article, part 4 in a series on wound management, addresses the sometimes routine yet crucial task of documentation. Clear and accurate records of a wound enable its progress to be determined so the appropriate treatment can be applied. Thorough records mean any practitioner picking up a patient's notes will know when the wound was last checked, how it looked and what dressing and/or treatment was applied, ensuring continuity of care. Documenting every assessment also has legal implications, demonstrating due consideration and care of the patient and the rationale for any treatment carried out. Part 5 in the series discusses wound dressing characteristics and selection.

  15. Effect of preoperative shampoos with chlorhexidine or iodophor on emergence of resident scalp flora in neurosurgery.

    PubMed

    Leclair, J M; Winston, K R; Sullivan, B F; O'Connell, J M; Harrington, S M; Goldmann, D A

    1988-01-01

    Wound contamination with endogenous bacterial scalp flora plays an important role in the pathogenesis of postoperative neurosurgical infections. To assess the effect of preoperative antiseptic shampoos on the emergence of resident scalp flora during surgery and subsequent wound contamination, we randomized 151 neurosurgical procedures into four study groups: group A--preoperative shampoos with chlorhexidine, surgical scalp preparation with chlorhexidine; group B--no shampoos, surgical preparation with chlorhexidine; group C--shampoos with iodophor, surgical preparation with iodophor; group D--no shampoos, surgical preparation with iodophor. Quantitative cultures of the scalp were obtained preoperatively and at the end of surgery, and qualitative wound cultures were taken prior to wound closure. Group A had the lowest concentration of bacteria on the scalp both preoperatively and postoperatively (median range = 30 [0-5.7 x 10(5)] and 0 [0-2.5 x 10(3)] respectively). Group A also had significantly fewer positive postoperative scalp cultures (29%) than groups B (51%), C (58%), and D (53%) (P less than 0.05), as well as fewer positive wound cultures (20% v 25%, 42%, and 30% respectively). A density of bacteria on the scalp of greater than 10(2)/4cm2 best predicted the presence of bacteria in the wound. Repeated preoperative shampoos with chlorhexidine reduce intraoperative emergence of resident skin flora and subsequent contamination of the wound.

  16. Effect of preoperative shampoos with chlorhexidine or iodophor on emergence of resident scalp flora in neurosurgery.

    PubMed

    Leclair, J M; Winston, K R; Sullivan, B F; O'Connell, J M; Harrington, S M; Goldmann, D A

    1988-01-01

    Wound contamination with endogenous bacterial scalp flora plays an important role in the pathogenesis of postoperative neurosurgical infections. To assess the effect of preoperative antiseptic shampoos on the emergence of resident scalp flora during surgery and subsequent wound contamination, we randomized 151 neurosurgical procedures into four study groups: group A-preoperative shampoos with chlorhexidine, surgical scalp preparation with chlorhexidine; group B-no shampoos, surgical preparation with chlorhexidine; group C-shampoos with iodophor, surgical preparation with iodophor; group D-no shampoos, surgical preparation with iodophor. Quantitative cultures of the scalp were obtained preoperatively and at the end of surgery, and qualitative wound cultures were taken prior to wound closure. Group A had the lowest concentration of bacteria on the scalp both preoperatively and postoperatively (median range = 30 [0-5.7 x 10(5)] and 0 [0-2.5 x 10(3)] respectively). Group A also had significantly fewer positive postoperative scalp cultures (29%) than groups B (51%), C (58%), and D (53%) (P<0.05), as well as fewer positive wound cultures (20% v 25%, 42%, and 30% respectively). A density of bacteria on the scalp of < 10(2)/4 cm(2) best predicted the presence of bacteria in the wound. Repeated preoperative shampoos with chlorhexidine reduce intraoperative emergence of resident skin flora and subsequent contamination of the wound.

  17. Preoperative risk factor analysis in orthotopic liver transplant-ation with pretransplant artificial liver support therapy

    PubMed Central

    Yuan, Jin-Zhong; Ye, Qi-Fa; Zhao, Ling-Ling; Ming, Ying-Zi; Sun, Hong; Zhu, Shai-Hong; Huang, Zu-Fa; Wang, Min-Min

    2006-01-01

    AIM: To assess the value of pre-transplant artificial liver support in reducing the pre-operative risk factors relating to early mortality after orthotopic liver transplantation (OLT). METHODS: Fifty adult patients with various stages and various etiologies undergoing OLT procedures were treated with molecular adsorbent recycling system (MARS) as preoperative liver support therapy. The study included two parts, the first one is to evaluate the medical effectiveness of single MARS treatment with some clinical and laboratory parameters, which were supposed to be the therapeutical pre-transplant risk factors, the second part is to study the patients undergoing OLT using the regression analysis on preoperative risk factors relating to early mortality (30 d) after OLT. RESULTS: In the 50 patients, the statistically significant improvement in the biochemical parameters was observed (pre-treatment and post-treatment). Eight patients avoided the scheduled Ltx due to significant relief of clinical condition or recovery of failing liver function, 8 patients died, 34 patients were successfully bridged to Ltx, the immediate outcome of this 34 patients within 30d observation was: 28 kept alive and 6 patients died. CONCLUSION: Pre-operative SOFA, level of creatinine, INR, TNF-α, IL-10 are the main preoperative risk factors that cause early death after operation, MARS treatment before transplantion can relieve these factors significantly. PMID:16937506

  18. The use of the essential oil lavandin to reduce preoperative anxiety in surgical patients.

    PubMed

    Braden, Rebecca; Reichow, Susan; Halm, Margo A

    2009-12-01

    Preoperative anxiety is prevalent in surgical patients who may require anxiety medications, thus impacting preoperative teaching and patient satisfaction. No studies were found in a comprehensive search on the effect of essential oils on anxiety in the preoperative setting. The purpose of this experimental study was to investigate whether the essential oil lavandin is more effective than standard care in reducing preoperative anxiety. A convenience sample of 150 adult patients were randomly assigned to either control (standard care), experimental (standard care plus essential oil lavandin), or sham (standard care plus jojoba oil) groups. Visual analog scales were used to assess anxiety on admission and OR transfer. Controlling for baseline anxiety and pain, the lavandin group had significantly lower anxiety on OR transfer, suggesting that lavandin is a simple, low-risk, cost-effective intervention with the potential to improve preoperative outcomes and increase patient satisfaction. Future studies should test the effects of lavandin in the postoperative phase and in specific populations with documented high anxiety.

  19. Influence of preoperative velar closing ratio and lateral wall movement on outcomes of Furlow palatoplasty for velopharyngeal incompetence

    PubMed Central

    Muzaffar, Arshad R; Rice, Gale; Hubbard, Bradley; Killion, Elizabeth

    2014-01-01

    Currently, there is no consensus regarding how to determine the optimal surgical procedure for a patient with velopharyngeal incompetence (VPI) post-primary palate repair. The purpose of the present study was to assess the effect of preoperative velar closing ratio (VCR) and lateral wall movement (LWM) on nasal emission and hypernasality after Furlow double-opposing Z-plasty. A retrospective analysis involving patients with VPI post-primary palatoplasty whose VPI was treated with double-opposing Z-plasty by a single surgeon was performed. Ten consecutive patients with VPI postpalatoplasty were reviewed. Videonasendoscopy, videofluoroscopy and perceptual speech examinations were performed preoperatively and postoperatively. VCR improved from an mean of 0.5 preoperatively (range 0.1 to 0.95) to 0.9 postoperatively (range 0.55 to 1.0). Postoperative mean LWM was 0.5 (range 0.3 to 0.9), unchanged from preoperative ratings. A trend toward an inverse relationship between preoperative VCR and improvement in hypernasality and resolution of nasal emission was observed. No relationship was noted between the degree of preoperative LWM and mean improvement in hypernasality. However, patients with worse preoperative LWM experienced better resolution of nasal emission postoperatively. PMID:25535457

  20. Use of preoperative hypnosis to reduce postoperative pain and anesthesia-related side effects.

    PubMed

    Lew, Michael W; Kravits, Kathy; Garberoglio, Carlos; Williams, Anna Cathy

    2011-01-01

    The purpose of this pilot project was to test the feasibility of hypnosis as a preoperative intervention. The unique features of this study were: (a) use of a standardized nurse-delivered hypnosis protocol, (b) intervention administration immediately prior to surgery in the preoperative holding area, and (c) provision of hypnosis to breast cancer surgery patients receiving general anesthesia. A mixed-method design was used. Data collected from the intervention group and historical control group included demographics, symptom assessments, medication administration, and surgical, anesthesia, and recovery minutes. A semi-structured interview was conducted with the intervention group. A reduction in anxiety, worry, nervousness, sadness, irritability, and distress was found from baseline to postintervention while pain and nausea increased. The results support further exploration of the use of nurse-led preoperative hypnosis. PMID:21867377

  1. Three-dimensional print of a liver for preoperative planning in living donor liver transplantation.

    PubMed

    Zein, Nizar N; Hanouneh, Ibrahim A; Bishop, Paul D; Samaan, Maggie; Eghtesad, Bijan; Quintini, Cristiano; Miller, Charles; Yerian, Lisa; Klatte, Ryan

    2013-12-01

    The growing demand for liver transplantation and the concomitant scarcity of cadaveric livers have increased the need for living donor liver transplantation (LDLT). Ensuring the safety of donors and recipients is critical. The preoperative identification of the vascular and biliary tract anatomy with 3-dimensional (3D) printing may allow better preoperative surgical planning, avert unnecessary surgery in patients with potentially unsuitable anatomy, and thereby decrease the complications of liver transplant surgery. We developed a protocol and successfully 3D-printed synthetic livers (along with their complex networks of vascular and biliary structures) replicating the native livers of 6 patients: 3 living donors and 3 respective recipients who underwent LDLT. To our knowledge, these are the first complete 3D-printed livers. Using standardized preoperative, intraoperative, and postoperative assessments, we demonstrated identical anatomical and geometrical landmarks in the 3D-printed models and native livers.

  2. Accurate and Accidental Empathy.

    ERIC Educational Resources Information Center

    Chandler, Michael

    The author offers two controversial criticisms of what are rapidly becoming standard assessment procedures for the measurement of empathic skill. First, he asserts that assessment procedures which attend exclusively to the accuracy with which subjects are able to characterize other people's feelings provide little or no useful information about…

  3. Metabolic changes assessed by MRS accurately reflect brain function during drug-induced epilepsy in mice in contrast to fMRI-based hemodynamic readouts.

    PubMed

    Seuwen, Aline; Schroeter, Aileen; Grandjean, Joanes; Rudin, Markus

    2015-10-15

    Functional proton magnetic resonance spectroscopy (1H-MRS) enables the non-invasive assessment of neural activity by measuring signals arising from endogenous metabolites in a time resolved manner. Proof-of-principle of this approach has been demonstrated in humans and rats; yet functional 1H-MRS has not been applied in mice so far, although it would be of considerable interest given the many genetically engineered models of neurological disorders established in this species only. Mouse 1H-MRS is challenging as the high demands on spatial resolution typically result in long data acquisition times not commensurable with functional studies. Here, we propose an approach based on spectroscopic imaging in combination with the acquisition of the free induction decay to maximize signal intensity. Highly resolved metabolite maps have been recorded from mouse brain with 12 min temporal resolution. This enabled monitoring of metabolic changes following the administration of bicuculline, a GABA-A receptor antagonist. Changes in levels of metabolites involved in energy metabolism (lactate and phosphocreatine) and neurotransmitters (glutamate) were investigated in a region-dependent manner and shown to scale with the bicuculline dose. GABAergic inhibition induced spectral changes characteristic for increased neurotransmitter turnover and oxidative stress. In contrast to metabolic readouts, BOLD and CBV fMRI responses did not scale with the bicuculline dose indicative of the failure of neurovascular coupling. Nevertheless fMRI measurements supported the notion of increased oxidative stress revealed by functional MRS. Hence, the combined analysis of metabolic and hemodynamic changes in response to stimulation provides complementary insight into processes associated with neural activity.

  4. Metabolic changes assessed by MRS accurately reflect brain function during drug-induced epilepsy in mice in contrast to fMRI-based hemodynamic readouts.

    PubMed

    Seuwen, Aline; Schroeter, Aileen; Grandjean, Joanes; Rudin, Markus

    2015-10-15

    Functional proton magnetic resonance spectroscopy (1H-MRS) enables the non-invasive assessment of neural activity by measuring signals arising from endogenous metabolites in a time resolved manner. Proof-of-principle of this approach has been demonstrated in humans and rats; yet functional 1H-MRS has not been applied in mice so far, although it would be of considerable interest given the many genetically engineered models of neurological disorders established in this species only. Mouse 1H-MRS is challenging as the high demands on spatial resolution typically result in long data acquisition times not commensurable with functional studies. Here, we propose an approach based on spectroscopic imaging in combination with the acquisition of the free induction decay to maximize signal intensity. Highly resolved metabolite maps have been recorded from mouse brain with 12 min temporal resolution. This enabled monitoring of metabolic changes following the administration of bicuculline, a GABA-A receptor antagonist. Changes in levels of metabolites involved in energy metabolism (lactate and phosphocreatine) and neurotransmitters (glutamate) were investigated in a region-dependent manner and shown to scale with the bicuculline dose. GABAergic inhibition induced spectral changes characteristic for increased neurotransmitter turnover and oxidative stress. In contrast to metabolic readouts, BOLD and CBV fMRI responses did not scale with the bicuculline dose indicative of the failure of neurovascular coupling. Nevertheless fMRI measurements supported the notion of increased oxidative stress revealed by functional MRS. Hence, the combined analysis of metabolic and hemodynamic changes in response to stimulation provides complementary insight into processes associated with neural activity. PMID:26166624

  5. Staging of the axilla in breast cancer: accurate in vivo assessment using positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose.

    PubMed Central

    Smith, I C; Ogston, K N; Whitford, P; Smith, F W; Sharp, P; Norton, M; Miller, I D; Ah-See, A K; Heys, S D; Jibril, J A; Eremin, O

    1998-01-01

    OBJECTIVE: To evaluate the ability of positron emission tomography (PET) with 18F-fluoro-2-deoxy-D-glucose (18F-FDG) to determine noninvasively axillary lymph node status in patients with breast cancer. BACKGROUND: The presence of axillary lymph node metastasis is the most important prognostic factor in women with breast cancer. It signifies the presence of occult metastatic disease and indicates the need for adjuvant therapy. The only reliable way in which this important prognostic information may be obtained is by performing axillary dissection, which may be associated with significant complications and delay in discharge from the hospital. PET with 18F-FDG can visualize primary cancers in the breast and metastatic tumor deposits. METHODS: Fifty patients with untreated breast cancer had clinical examination of their axilla performed (graded as positive or negative), followed by PET of the axilla and midthorax. PET data were analyzed blindly and graded as positive or negative, depending on the presence or absence of axillary nodal metastases. Cytopathologic assessment of the axillary nodes was carried out within 1 week of PET, by fine-needle aspiration cytology in 5 patients and axillary dissection in 45; the excised specimens were examined by a single pathologist. RESULTS: The overall sensitivity of PET in 50 patients was 90% and the specificity was 97%. Clinical examination of the same patients had an overall sensitivity of 57% and a specificity of 90%. In the 24 patients with locally advanced breast cancer (T3, T4, TxN2), PET had a sensitivity of 93% and a specificity of 100%. In T1 tumors (seven patients), the sensitivity and specificity were 100%. PET had a high predictive value (>90%) and accuracy (94%) in staging the axilla. CONCLUSIONS: PET is a sensitive and specific method of staging the axilla in patients with breast cancer. It may obviate the need for axillary surgery in women with small primary tumors, define the women likely to benefit from axillary

  6. Preoperational test report, primary ventilation condensate system

    SciTech Connect

    Clifton, F.T.

    1997-01-29

    Preoperational test report for Primary Ventilation Condensate System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides a collection point for condensate generated by the W-030 primary vent offgas cooling system serving tanks AYIOI, AY102, AZIOI, AZI02. The system is located inside a shielded ventilation equipment cell and consists of a condensate seal pot, sampling features, a drain line to existing Catch Tank 241-AZ-151, and a cell sump jet pump. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  7. Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy

    PubMed Central

    Povoski, Stephen P.; Karpeh, Martin S.; Conlon, Kevin C.; Blumgart, Leslie H.; Brennan, Murray F.

    1999-01-01

    Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased

  8. Accurate quantum chemical calculations

    NASA Technical Reports Server (NTRS)

    Bauschlicher, Charles W., Jr.; Langhoff, Stephen R.; Taylor, Peter R.

    1989-01-01

    An important goal of quantum chemical calculations is to provide an understanding of chemical bonding and molecular electronic structure. A second goal, the prediction of energy differences to chemical accuracy, has been much harder to attain. First, the computational resources required to achieve such accuracy are very large, and second, it is not straightforward to demonstrate that an apparently accurate result, in terms of agreement with experiment, does not result from a cancellation of errors. Recent advances in electronic structure methodology, coupled with the power of vector supercomputers, have made it possible to solve a number of electronic structure problems exactly using the full configuration interaction (FCI) method within a subspace of the complete Hilbert space. These exact results can be used to benchmark approximate techniques that are applicable to a wider range of chemical and physical problems. The methodology of many-electron quantum chemistry is reviewed. Methods are considered in detail for performing FCI calculations. The application of FCI methods to several three-electron problems in molecular physics are discussed. A number of benchmark applications of FCI wave functions are described. Atomic basis sets and the development of improved methods for handling very large basis sets are discussed: these are then applied to a number of chemical and spectroscopic problems; to transition metals; and to problems involving potential energy surfaces. Although the experiences described give considerable grounds for optimism about the general ability to perform accurate calculations, there are several problems that have proved less tractable, at least with current computer resources, and these and possible solutions are discussed.

  9. Prognostic significance of preoperative serum CA125, CA19-9 and CEA in gastric carcinoma

    PubMed Central

    Wang, Wei; Chen, Xiao-Long; Zhao, Shen-Yu; Xu, Yu-Hui; Zhang, Wei-Han; Liu, Kai; Chen, Xin-Zu; Yang, Kun; Zhang, Bo; Chen, Zhi-Xin; Chen, Jia-Ping; Zhou, Zong-Guang; Hu, Jian-Kun

    2016-01-01

    The prognostic significance of preoperative serum CA125, CA19-9 and CEA in gastric carcinoma (GC) has been widely reported and is still under debate. Here, we evaluated the prognostic significance of preoperative serum CA125, CA19-9 and CEA in patients with GC. 1692 patients with GC who underwent gastrectomy were divided into the training (from January 2005 to December 2011, n = 1024) and the validation (from January 2012 to December 2013, n = 668) cohorts. Positive groups of CA125 (> 13.72 U/ml), CA19-9 (> 23.36 U/ml) and CEA (> 4.28 ng/ml) were significantly associated with more advanced clinicopathological traits and worse outcomes than that of negative groups (all P < 0.01). In Cox regression analysis, tumor size (P < 0.001, P = 0.005), pTNM stage (P < 0.001, P < 0.001) and CA125 (P = 0.026, P = 0.005) were independent prognostic factors both in two cohorts. Nomograms of these two cohorts based on the number of positive serum tumor markers (NPTM) were more accurate in prognostic prediction than TNM stage alone. Our findings suggested that elevated preoperative serum CA125, CA19-9 and CEA were associated with more advanced clinicopathological traits and less favorable outcomes. In addition, CA125 as an independent prognostic factor should be further investigated. Nomogram based on NPTM could accurately predict the prognosis of GC patients. PMID:27097114

  10. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation.

    PubMed

    Timmerman, L A; Schwartz, M L; Andrews, J R

    1994-01-01

    A prospective study was completed on 25 baseball players with medial side elbow pain. They were evaluated preoperatively with both computed tomography arthrogram and magnetic resonance imaging examinations of the elbow to assess the ulnar collateral ligament. At surgery, 16 of 25 patients had an abnormal ulnar collateral ligament and 9 patients had a normal ulnar collateral ligament. The computed tomography arthrogram detected abnormalities in 12 of the 14 patients with ulnar collateral ligament tearing (sensitivity, 86%). The magnetic resonance imaging scan indicated abnormalities in 8 of 14 patients (sensitivity, 57%). The specificity of the computed tomography arthrogram was 91% and the magnetic resonance imaging was 100%. A newly described "T-sign" was seen on the computed tomography arthrogram in the patients with an undersurface tear of the ulnar collateral ligament. This represented the dye leaking around the detachment of the ulnar collateral ligament from its bony insertion but remaining contained within the intact superficial layer of the ulnar collateral ligament and capsule. Both the computed tomography arthrogram and the magnetic resonance imaging scan were accurate in diagnosing a complete tear of the ulnar collateral ligament preoperatively in all cases. The main advantage of the computed tomography arthrogram was in evaluating the partial undersurface tear.

  11. Preoperative Preparation and Anesthesia for Trabeculectomy

    PubMed Central

    2016-01-01

    ABSTRACT Preoperative preparation should improve the likelihood of successful trabeculectomy surgery. The team can reconsider the appropriateness of the proposed surgery, and steps can be taken to maximize the chance of a good outcome. For example, adjustments to anti-hypertensive or anti-coagulant medications may be made, and topical ocular medications adjusted. Choice of anesthesia technique is of particular relevance to the trabeculectomy patient. Some anesthesia techniques are more likely to have serious complications, and glaucoma patients may be at higher risk of some sight-threatening complications, because the optic nerve is already damaged and vulnerable. Posterior placement of local anesthesia (retrobulbar, peribulbar, posterior sub-Tenon’s techniques) could potentially damage the optic nerve, and thereby cause “wipe-out” of vision. Anesthesia technique may influence the likelihood of vitreous bulge and surgical difficulty. Regarding long-term control of intraocular pressure, there is no good evidence to indicate that any particular anesthesia technique is better than another. There is little high-quality evidence on this topic. The author’s preferred technique for trabeculectomy is subconjunctival-intracameral anesthesia without sedation. How to cite this article: Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10(1):21-35. PMID:27231416

  12. Preoperative embolization of hypervascular skull base tumors.

    PubMed

    Gruber, A; Bavinzski, G; Killer, M; Richling, B

    2000-06-01

    The purpose of the present study is to review the results and complications of preoperative embolization of hypervascular skull base tumors at a neurosurgical center with a team of neurosurgeons cross-experienced in the application of both microsurgery and endovascular techniques. One hundred and twenty-eight endovascular approaches were performed in 66 patients treated for skull base meningiomas (n = 41), paragangliomas of the temporal bone (n = 18), and juvenile nasopharyngeal angiofibromas (n = 7). One death and 2 permanent disabilities were attributable to endovascular therapy. These complications occurred early in our experience (1982-1989) and were related to thromboembolic events rather than complications of transcatheter embolization itself. Our current standard is to perform transfemoral superselective embolizations with either finely corpuscular embolizing substances (PVA particles) or cyanoacrylates (NBCA) under local anesthesia. Using this protocol no embolization-related complications have occurred over the last 9 years. We thus conclude that preoperative embolization of hypervascular skull base tumors can be accomplished safely with the endovascular techniques now available.

  13. Preoperative Therapy for Lower Rectal Cancer and Modifications in Distance From Anal Sphincter

    SciTech Connect

    Gavioli, Margherita Losi, Lorena; Luppi, Gabriele; Iacchetta, Francesco; Zironi, Sandra; Bertolini, Federica; Falchi, Anna Maria; Bertoni, Filippo; Natalini, Gianni

    2007-10-01

    Purpose: To assess the frequency and magnitude of changes in lower rectal cancer resulting from preoperative therapy and its impact on sphincter-saving surgery. Preoperative therapy can increase the rate of preserving surgery by shrinking the tumor and enhancing its distance from the anal sphincter. However, reliable data concerning these modifications are not yet available in published reports. Methods and Materials: A total of 98 cases of locally advanced cancer of the lower rectum (90 Stage uT3-T4N0-N+ and 8 uT2N+M0) that had undergone preoperative therapy were studied by endorectal ultrasonography. The maximal size of the tumor and its distance from the anal sphincter were measured in millimeters before and after preoperative therapy. Surgery was performed 6-8 weeks after therapy, and the histopathologic margins were compared with the endorectal ultrasound data. Results: Of the 90 cases, 82.5% showed tumor downsizing, varying from one-third to two-thirds or more of the original tumor mass. The distance between the tumor and the anal sphincter increased in 60.2% of cases. The median increase was 0.73 cm (range, 0.2-2.5). Downsizing was not always associated with an increase in distance. Preserving surgery was performed in 60.6% of cases. It was possible in nearly 30% of patients in whom the cancer had reached the anal sphincter before the preoperative therapy. The distal margin was tumor free in these cases. Conclusion: The results of our study have shown that in very low rectal cancer, preoperative therapy causes tumor downsizing in >80% of cases and in more than one-half enhances the distance between the tumor and anal sphincter. These modifications affect the primary surgical options, facilitating or making sphincter-saving surgery possible.

  14. A preoperative stress inquiry and a vulnerable US military population.

    PubMed

    Bopp, Eric J; Spence, Dennis L; Burkard, Joseph F

    2013-04-01

    The preoperative setting is fraught with many stressors, often increasing in magnitude as patients progress through the perioperative environment. Individuals exposed to traumatic or threatening environments, such as US military personnel involved in combat operations, may be at increased risk of developing altered mental and physical health conditions. Collectively, this may result in a hyperarousal state significantly amplifying psychological symptoms and magnifying physiological alterations. The purposes of this article are to (1) describe stress-related concepts and preoperative stress, (2) discuss potential risk factors for preoperative stress in the adult surgical population, (3) present various psychological and physiological measures of preoperative stress, (4) explore preoperative stress interventions, and (5) discuss potential implications for future preoperative stress research in high-stressed populations.

  15. Accurate Assessment--Compelling Evidence for Practice

    ERIC Educational Resources Information Center

    Flynn, Regina T.; Anderson, Ludmila; Martin, Nancy R.

    2010-01-01

    Childhood overweight and obesity is a public health concern not just because of its growing prevalence but also for its serious and lasting health consequences. Though height and weight measures are easy to obtain and New Hampshire Head Start sites measure height and weight of their enrollees, there are numerous challenges related to accurate…

  16. Discordance Between Preoperative and Postoperative Bladder Cancer Location: Implications for Partial-Bladder Radiation

    SciTech Connect

    Goldsmith, Benjamin; Tucker, Kai; Conway, Robert Greg; He, Jiwei; Guzzo, Thomas; Bekelman, Justin; Deville, Curtiland; Vapiwala, Neha; Malkowicz, S. Bruce; Christodouleas, John

    2013-03-01

    Purpose: There is strong interest in partial-bladder radiation whether as a boost or definitive therapy to limit long-term toxicity. It is unclear that a standard preoperative examination can accurately identify all sites of disease within the bladder. The purpose of this study was to determine the correlation between preoperative localization of bladder tumors with postoperative findings to facilitate partial-bladder radiation techniques when appropriate. Methods and Materials: We examined patients with clinically staged T1-T4 invasive transitional cell carcinoma (TCC) or TCC with variant histology with no history of radiation or partial cystectomy undergoing radical cystectomy. Patients were scored as “under-detected” if a bladder site was involved with invasive disease (≥T1) at the time of cystectomy, but not identified preoperatively. Patients were additionally scored as “widely under-detected” if they had postoperative lesions that were not identified preoperatively in a given site, nor in any adjacent site. Rates of under-detected and widely under-detected lesions, as well as univariate and multivariate association between clinical variables and under-detection, were evaluated using logistic regression. Results: Among 222 patients, 96% (213/222) had at least 1 area of discordance. Fifty-eight percent of patients were under-detected in at least 1 location, whereas 12% were widely under-detected. Among 24 patients with a single site of disease on preoperative evaluation, 21/24 (88%) had at least 1 under-detected lesion and 14/24 (58%) were widely under-detected. On multivariate analysis, only solitary site of preoperative disease was associated with increased levels of under-detection of invasive disease (OR = 4.161, 95% CI, 1.368-12.657). Conclusion: Our study shows a stark discordance between preoperative and postoperative localization of bladder tumors. From a clinical perspective, incomplete localization of all sites of disease within the bladder

  17. Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT.

    PubMed

    Shin, Sang Soo; Jeong, Yong Yeon; Min, Jung Jun; Kim, Hyeong Rok; Chung, Tae Woong; Kang, Heoung Keun

    2008-01-01

    Accurate preoperative staging is essential in determining the optimal therapeutic planning for individual patients. The computed tomography (CT) in the preoperative staging of colorectal cancer, even if controversial, may be useful for planning surgery and/or neoadjuvant therapy, particularly when local tumor extension into adjacent organs or distant metastases are detected. There have been significant changes in the CT technology with the advent of multi-detector row CT (MDCT) scanner. Advances in CT technology have raised interest in the potential role of CT for detection and staging of colorectal cancer. In recent studies, MDCT with MPR images has shown promising accuracy in the evaluation of local extent and nodal involvement of colorectal cancer. Combined PET/CT images have significant advantages over either alone because it provides both functional and anatomical data. Therefore, it is natural to expect that PET/CT would improve the accuracy of preoperative staging of colorectal cancer. The most significant additional information provided by PET/CT relates to the accurate detection of distant metastases. For the evaluation of patients with colorectal cancer, CT has relative advantages over PET/CT in regard to the depth of tumor invasion through the wall, extramural extension, and regional lymph node metastases. PET/CT should be performed on selected patients with suggestive but inconclusive metastatic lesions with CT. In addition, PET/CT with dedicated CT protocols, such as contrast-enhanced PET/CT and PET/CT colonography, may replace the diagnostic CT for the preoperative staging of colorectal cancer.

  18. Early proximal junctional failure in patients with preoperative sagittal imbalance.

    PubMed

    Smith, Micah W; Annis, Prokopis; Lawrence, Brandon D; Daubs, Michael D; Brodke, Darrel S

    2013-10-01

    Study Type Retrospective review. Introduction Sagittal imbalance has been associated with lower health-related quality of life outcomes, and restoration of imbalance is associated with improved outcomes.123 The long constructs used in adult spinal deformity have potential consequences such as proximal junctional kyphosis (PJK). Clinically, the development of PJK may not be as important as failure of the construct or vertebrae at the proximal end. As PJK does not lead to worse clinical outcomes,45 we define the term early proximal junctional failure (EPJF) as fracture, implant failure, or myelopathy due to stenosis at the upper instrumental vertebra (UIV) or UIV + 1 within 6 months of surgery. Objective The purpose of this study is to report the incidence of EPJF in patients who are sagittally imbalanced preoperatively and to identify risk factors postoperatively that correlate with EPJF using commonly reported sagittal balance parameters. Methods We reviewed 197 patients with preoperative sagittal imbalance by at least one of the following: sagittal vertical axis more than 5 cm, global sagittal alignment more than 45 degrees, pelvic incidence-lumbar lordosis more than 10 degrees, or spine-sacral angle less than 120 degrees. Radiographic measurements also included proximal junctional angle, thoracic kyphosis, lumbar lordosis, pelvic parameters, and sagittal balance parameters/formulas, as well as UIV angle, UIV spinosacral angle, and UIV plumb line to assess as potential risk factors. EPJF incidence was calculated postoperatively for each of the accepted sagittal balance parameters/formulas. Results EPJF was observed in 49 of 197 patients (25%) with preoperative sagittal imbalance and was more common in fusions with UIV in the lower thoracic spine (TS) (35%) than in those with UIV in the upper TS (10%) or lumbar (25%) (p = 0.007). Of the 49 EPJF patients, 16 patients (33%) required revision surgery within the first year, for an overall early revision

  19. Significance of preoperative ultrasound measurement of gallbladder wall thickness.

    PubMed

    Majeski, James

    2007-09-01

    Evaluation of patients with signs and symptoms of biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent cholecystectomy for symptomatic gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with acalculous cholecystitis had acute cholecystitis and 89 per cent had chronic cholecystitis. Every patient with either a thin or thick gallbladder wall with acalculous cholecystitis had a successful laparoscopic cholecystectomy. Three-hundred fifteen patients had a laparoscopic cholecystectomy for calculous cholecystitis. In patients with calculous cholecystitis, 28.3 per cent had acute cholecystitis and 71.7 per cent had chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open cholecystectomy. A preoperative gallbladder ultrasound

  20. Use of preoperative embolization prior to Transplant nephrectomy

    PubMed Central

    Yeast, Carrie; Riley, Julie M.; Holyoak, Joshua; Ross, Gilbert; Weinstein, Stephen; Wakefield, Mark

    2016-01-01

    ABSTRACT Introduction After a failed transplant, management of a non-functional graft with pain or recurrent infections can be challenging. Transplant nephrectomy (TN) can be a morbid procedure with the potential for significant blood loss. Embolization of the renal artery alone has been proposed as a method of reducing complications from an in vivo failed kidney transplant. While this does yield less morbidity, it may not address an infected graft or refractory hematuria or rejection. We elected to begin preoperative embolization to assess if this would help decrease the blood loss and transfusion rate associated with TN. Materials and Methods We performed a retrospective analysis of all patients who underwent non-emergent TN at our institution. Patients who had functioning grafts that later failed were included in analysis. TN was performed for recurrent infections, pain or hematuria. We evaluated for blood loss (EBL) during TN, transfusion rate and length of hospital stay. Results A total of 16 patients were identified. Nine had preoperative embolization or no blood flow to the graft prior to TN. The remaining 7 did not have preoperative embolization. The shortest time from transplant to TN was 8 months and the longest 18 years with an average of 6.3 years. Average EBL for the embolized patients (ETN) was 143.9cc compared to 621.4cc in the non-embolized (NETN) group (p=0.041). Average number of units of blood transfused was 0.44 in the ETN with only 3/9 patients requiring transfusion. The NETN patients had average of 1.29 units transfused with 5/7 requiring transfusion. The length of stay was longer for the ETN (5.4 days) compared to 3.9 in the NETN. No intraoperative complications were seen in either group and only one patient had a postoperative ileus in the NETN. Conclusion Embolization prior to TN significantly decreases the EBL but does not significantly decrease transfusion rate. However, patients do require a significantly longer hospitalization with

  1. Accurate Optical Reference Catalogs

    NASA Astrophysics Data System (ADS)

    Zacharias, N.

    2006-08-01

    Current and near future all-sky astrometric catalogs on the ICRF are reviewed with the emphasis on reference star data at optical wavelengths for user applications. The standard error of a Hipparcos Catalogue star position is now about 15 mas per coordinate. For the Tycho-2 data it is typically 20 to 100 mas, depending on magnitude. The USNO CCD Astrograph Catalog (UCAC) observing program was completed in 2004 and reductions toward the final UCAC3 release are in progress. This all-sky reference catalogue will have positional errors of 15 to 70 mas for stars in the 10 to 16 mag range, with a high degree of completeness. Proper motions for the about 60 million UCAC stars will be derived by combining UCAC astrometry with available early epoch data, including yet unpublished scans of the complete set of AGK2, Hamburg Zone astrograph and USNO Black Birch programs. Accurate positional and proper motion data are combined in the Naval Observatory Merged Astrometric Dataset (NOMAD) which includes Hipparcos, Tycho-2, UCAC2, USNO-B1, NPM+SPM plate scan data for astrometry, and is supplemented by multi-band optical photometry as well as 2MASS near infrared photometry. The Milli-Arcsecond Pathfinder Survey (MAPS) mission is currently being planned at USNO. This is a micro-satellite to obtain 1 mas positions, parallaxes, and 1 mas/yr proper motions for all bright stars down to about 15th magnitude. This program will be supplemented by a ground-based program to reach 18th magnitude on the 5 mas level.

  2. Preoperative localization of parathyroid adenomas: ultrasonography, sestamibi scintigraphy, or both?

    PubMed

    Hajioff, D; Iyngkaran, T; Panagamuwa, C; Hill, D; Stearns, M P

    2004-10-01

    Minimal access techniques are increasingly used to remove parathyroid adenomas. Such surgery depends on accurate preoperative localization but the selection of imaging modality remains controversial. We have reviewed the accuracy of ultrasonography, sestamibi scintigraphy and their combination in 48 cases of primary hyperparathyroidism. Ultrasound had a sensitivity of 64.3% (95% confidence interval 44.1-81.4) and positive predictive value (PPV) of 100% (81.5-100) for correct lateralization. Sestamibi had a sensitivity of 83.3% (69.8-92.5) and PPV of 87.1% (73.7-95.1). The simple combination of ultrasound with sestamibi had a sensitivity of 82.1% (63.1-93.9) and a PPV of 92.0% (74.0-99.0): little different from sestamibi alone. However, if the sestamibi result was disregarded in favour of ultrasonography in discordant cases, the sensitivity reached 96.4% (81.7-99.9) and the PPV was 100% (87.2-100). These results were not dependant on a learning curve or the size of adenoma.

  3. Angio computed tomography preoperative evaluation for anterolateral thigh flap harvesting.

    PubMed

    Ribuffo, Diego; Atzeni, Matteo; Saba, Luca; Milia, Arianna; Guerra, Maristella; Mallarini, Giorgio

    2009-04-01

    The vascular anatomy of the anterolateral thigh flap (ALTF) has many possible variations, and none of the currently used mapping techniques (eg, Echo Color Doppler) gives a thorough knowledge of all details. Among the last generation of angiographic diagnostic techniques, multi detector computed tomography, popularly known as Angio CT, has emerged as an outstanding noninvasive operator independent option, and has been described for deep inferior epigastric perforator and pedicled transverse rectus abdominis muscle planning. This study was conducted to evaluate its usefulness prior to ALTF harvesting.Nine consecutive patients were considered for oral or lower extremity reconstruction with the ALTF. After written informed consent was obtained from all patients, a preoperative Angio-CT study was performed for surgical planning. Accurate identification of septocutaneous or musculocutaneous perforator vessels was achieved and their location, course, and anatomic variations were reported and influenced surgery. Angio CT allows a complete vascular study of the donor area of the ALTF and evaluation of the best perforator vessels before surgery allows surgeons to get an ideal planning of the flap. This imaging method is currently proposed to every patient undergoing ALT flap reconstruction. PMID:19325338

  4. Preoperative Delays in the US Medicare Population With Breast Cancer

    PubMed Central

    Bleicher, Richard J.; Ruth, Karen; Sigurdson, Elin R.; Ross, Eric; Wong, Yu-Ning; Patel, Sameer A.; Boraas, Marcia; Topham, Neal S.; Egleston, Brian L.

    2012-01-01

    Purpose Although no specific delay threshold after diagnosis of breast cancer has been demonstrated to affect outcome, delays can cause anxiety, and surgical waiting time has been suggested as a quality measure. This study was performed to determine the interval from presentation to surgery in Medicare patients with nonmetastatic invasive breast cancer who did not receive neoadjuvant chemotherapy and factors associated with a longer time to surgery. Methods Medicare claims linked to Surveillance, Epidemiology, and End Results data were reviewed for factors associated with delay between the first physician claim for a breast problem and first therapeutic surgery. Results Between 1992 and 2005, 72,586 Medicare patients with breast cancer had a median interval (delay) between first physician visit and surgery of 29 days, increasing from 21 days in 1992 to 32 days in 2005. Women (29 days v 24 days for men; P < .001), younger patients (29 days; P < .001), blacks and Hispanics (each 37 days; P < .001), patients in the northeast (33 days; P < .001), and patients in large metropolitan areas (32 days; P < .001) had longer delays. Patients having breast conservation and mastectomies had adjusted median delays of 28 and 30 days, respectively, with simultaneous reconstruction adding 12 days. Preoperative components, including imaging modalities, biopsy type, and clinician visits, were also each associated with a specific additional delay. Conclusion Waiting times for breast cancer surgery have increased in Medicare patients, and measurable delays are associated with demographics and preoperative evaluation components. If such increases continue, periodic assessment may be required to rule out detrimental effects on outcomes. PMID:23169513

  5. Preoperational test report, recirculation condenser cooling systems

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  6. Preoperative nuclear scans in patients with melanoma

    SciTech Connect

    Au, F.C.; Maier, W.P.; Malmud, L.S.; Goldman, L.I.; Clark, W.H. Jr.

    1984-05-15

    One hundred forty-one liver scans, 137 brain scans, and 112 bone scans were performed in 192 patients with clinical Stage 1 melanoma. One liver scan was interpreted as abnormal; liver biopsy of that patient showed no metastasis. There were 11 suggestive liver scans; three of the patients with suggestive liver scans had negative liver biopsies. The remaining eight patients were followed from 4 to 6 years and none of those patients developed clinical evidence of hepatic metastases. All of the brain scans were normal. Five patients had suggestive bone scans and none of those patients had manifested symptoms of osseous metastases with a follow-up of 2 to 4.5 years. This study demonstrates that the use of preoperative liver, brain and bone scan in the evaluation of patients with clinical Stage 1 melanoma is virtually unproductive.

  7. Pre-operative antiseptic skin preparation.

    PubMed

    Murkin, Claire Elizabeth

    Theatre nurses use antiseptic skin preparation products every day, but little thought seems to be given as to why a surgeon has a particular preference for one antiseptic skin preparation over another - whether it is for its efficacy, safety or application properties. Woodhead et al (2004) states that nurses still work in a ritualistic environment. Rituals are 'any action performed according to custom, without understanding the reasons why it is being practised'. Nursing practice should be evidence-based; nurses should understand the rationale behind the choice of a particular antiseptic, and be knowledgable about the clinical effectiveness of antiseptic's use pre-operatively, to achieve optimum results. This article focuses on the main types of antiseptic skin preparation while highlighting each product's activity and the relevant considerations for choosing the appropriate product for each patient. Theatre staff need to emphasize the importance of skin preparation and the correct application techniques, while educating the scrub team and surgeons with respect to skin preparation.

  8. Pre-operative optimisation of lung function

    PubMed Central

    Azhar, Naheed

    2015-01-01

    The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4–6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function. PMID:26556913

  9. Pre-operative nutrition and carbohydrate loading.

    PubMed

    Kratzing, Caroline

    2011-08-01

    An optimal nutritional state is an important consideration in providing successful operative outcomes. Unfortunately, many aspects of surgery are not constructive to providing this. In addition, the metabolic and immune response to injury induces a catabolic state and insulin resistance, a known risk factor of post-operative complications. Aggressive insulin therapy post-operatively has been shown to reduce morbidity and mortality but similar results can be achieved when insulin resistance is lessened by the use of pre-operative carbohydrate loading. Consuming carbohydrate-containing drinks up to 2 h before surgery has been found to be an effective way to attenuate insulin resistance, minimise protein losses, reduce hospital stays and improve patient comfort without adversely affecting gastric emptying. Enhanced recovery programmes have employed carbohydrate loading as one of several strategies aimed at reducing post-operative stress and improving the recovery process. Studies examining the benefits of these programmes have demonstrated significantly shorter post-operative hospital stays, faster return to normal functions and lower occurrences of surgical complications. As a consequence of the favourable evidence they are now being implemented in many surgical units. Further benefit to post-operative recovery may be found with the use of immune-enhancing diets, i.e. supplementation with n-3 fatty acids, arginine, glutamine and/or nucleotides. These have the potential to boost the immune system, improve wound healing and reduce inflammatory markers. Research exploring the benefits of immunonutrition and solidifying the use of carbohydrate loading is ongoing; however, there is strong evidence to link good pre-operative nutrition and improved surgical outcomes.

  10. The NHLBI-Sponsored Consortium for preclinicAl assESsment of cARdioprotective Therapies (CAESAR): A New Paradigm for Rigorous, Accurate, and Reproducible Evaluation of Putative Infarct-Sparing Interventions in Mice, Rabbits, and Pigs

    PubMed Central

    Jones, Steven P.; Tang, Xian-Liang; Guo, Yiru; Steenbergen, Charles; Lefer, David J.; Kukreja, Rakesh C.; Kong, Maiying; Li, Qianhong; Bhushan, Shashi; Zhu, Xiaoping; Du, Junjie; Nong, Yibing; Stowers, Heather L.; Kondo, Kazuhisa; Hunt, Gregory N.; Goodchild, Traci T.; Orr, Adam; Chang, Carlos C.; Ockaili, Ramzi; Salloum, Fadi N.; Bolli, Roberto

    2014-01-01

    Rationale Despite four decades of intense effort and substantial financial investment, the cardioprotection field has failed to deliver a single drug that effectively reduces myocardial infarct size in patients. A major reason is insufficient rigor and reproducibility in preclinical studies. Objective To develop a multicenter randomized controlled trial (RCT)-like infrastructure to conduct rigorous and reproducible preclinical evaluation of cardioprotective therapies. Methods and Results With NHLBI support, we established the Consortium for preclinicAl assESsment of cARdioprotective therapies (CAESAR), based on the principles of randomization, investigator blinding, a priori sample size determination and exclusion criteria, appropriate statistical analyses, and assessment of reproducibility. To validate CAESAR, we tested the ability of ischemic preconditioning (IPC) to reduce infarct size in three species (at two sites/species): mice (n=22-25/group), rabbits (n=11-12/group), and pigs (n=13/group). During this validation phase, i) we established protocols that gave similar results between Centers and confirmed that IPC significantly reduced infarct size in all species, and ii) we successfully established a multi-center structure to support CAESAR’s operations, including two surgical Centers for each species, a Pathology Core (to assess infarct size), a Biomarker Core (to measure plasma cardiac troponin levels), and a Data Coordinating Center – all with the oversight of an external Protocol Review and Monitoring Committee. Conclusions CAESAR is operational, generates reproducible results, can detect cardioprotection, and provides a mechanism for assessing potential infarct-sparing therapies with a level of rigor analogous to multicenter RCTs. This is a revolutionary new approach to cardioprotection. Importantly, we provide state-of-the-art, detailed protocols (“CAESAR protocols”) for measuring infarct size in mice, rabbits, and pigs in a manner that is

  11. Short-term preoperative octreotide treatment for TSH-secreting pituitary adenoma.

    PubMed

    Fukuhara, Noriaki; Horiguchi, Kentaro; Nishioka, Hiroshi; Suzuki, Hisanori; Takeshita, Akira; Takeuchi, Yasuhiro; Inoshita, Naoko; Yamada, Shozo

    2015-01-01

    Preoperative control of hyperthyroidism in patients with TSH-secreting pituitary adenomas (TSHoma) may avoid perioperative thyroid storm. Perioperative administration of octreotide may control hyperthyroidism, as well as shrink tumor size. The effects of preoperative octreotide treatment were assessed in a large number of patients with TSHomas. Of 81 patients who underwent surgery for TSHoma at Toranomon Hospital between January 2001 and May 2013, 44 received preoperative short-term octreotide. After excluding one patient because of side effects, 19 received octreotide as a subcutaneous injection, and 24 as a long-acting release (LAR) injection. Median duration between initiation of octreotide treatment and surgery was 33.5 days. Octreotide normalized free T4 in 36 of 43 patients (84%) and shrank tumors in 23 of 38 (61%). Length of octreotide treatment did not differ significantly in patients with and without hormonal normalization (p=0.09) and with and without tumor shrinkage (p=0.84). Serum TSH and free T4 concentrations, duration of treatment, incidence of growth hormone (GH) co-secretion, results of octreotide loading tests, form of administration (subcutaneous injection or LAR), tumor volume, and tumor consistency did not differ significantly in patients with and without hormonal normalization and with and without tumor shrinkage. Short-term preoperative octreotide administration was highly effective for TSHoma shrinkage and normalization of excess hormone concentrations, with tolerable side effects. PMID:25273395

  12. The effect of a preoperative education programme on perioperative anxiety in children: an observational study.

    PubMed

    Rice, Mariam; Glasper, Alan; Keeton, Diana; Spargo, Paul

    2008-05-01

    The distress of children at the induction of anesthesia (DAI) is unpleasant for all involved and potentially harmful. Many strategies such as premedication or parental presence at induction have been described to minimize it. A preoperative education programme [the 'Saturday Morning Club' or (SMC)] has been in existence in our institution for a number of years and an observational study of children undergoing day case surgery was undertaken to assess the influence of attendance at the SMC on DAI. Ninety-four children aged between 2 and 16 years of age were included in the study; 21 attended the SMC and 73 did not. Patient anxiety using the modified Yale Preoperative Anxiety Scale was measured by blinded observers on the day ward, in the preoperative waiting room and at induction of anesthesia. Parental anxiety at the same locations was self reported using a visual analogue scale. Attendance at the SMC had a favorable effect on patient anxiety levels in all three locations but only reached statistical significance in the waiting room (P = 0.007, Mann-Whitney U-test). At present there is little evidence to support the use of preoperative education programmes in the UK and further studies are required to determine their benefit. PMID:18384339

  13. Reliability and validity of Korean version of modified: Yale preoperative anxiety scale

    PubMed Central

    Jung, Kyuwhan; Hwang, Jeong-Min; Oh, Ah-Young; Park, Moon Seok; Jeong, Woo-Jin; Kim, Seong-Chan; Jung, Sun-Woo; Sohn, Hyejin; Yoon, Mi-Ok; Jang, Mi-Suk; Moon, Suk-Bae

    2016-01-01

    Purpose The modified Yale Preoperative Anxiety Scale (mYPAS) was developed for evaluating the level of preoperative anxiety in children. The purpose of this study was to develop a Korean version of the mYPAS (K-mYPAS) and to establish its validity and reliability based on the Korean preoperative pediatric patients. Methods K-mYPAS was made through stringent back-translation procedure. Total enrolled 102 patients answered questionnaires of Korean version of State-Trait Anxiety Inventory for Children (K-STAIC), and were videotaped for 2 to 5 minutes before induction of anesthesia. Three observers of experienced psychiatrist, surgeon, and nurse analyzed videotape with K-mYPAS comparing to K-STAIC. The inter- and intraobservers reliability, concurrent and construct validity, sensitivity, specificity, and predictive value were analyzed. Results The value of Cronbach α for interobservers reliability was 0.939 and intraobserver reliability was statistically significant (P < 0.001). Concurrent and construct validity were also statistically significant (P < 0.001 and P < 0.001, respectively). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 81.3%, 91.4%, 81.3%, 91.4%, and 88.2%, respectively. Conclusion The K-mYPAS had good psychometric properties and can be used as a reliable and valid instrument for the assessment of preoperative anxiety in children. PMID:26793692

  14. Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children

    ERIC Educational Resources Information Center

    Wright, Kristi D.; Stewart, Sherry H.; Finley, G. Allen; Buffett-Jerrott, Susan E.

    2007-01-01

    Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination, and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been…

  15. Preoperative embolisation in the management of juvenile nasopharyngeal angiofibroma.

    PubMed

    Palmer, F J

    1989-11-01

    Thirteen cases of juvenile angiofibroma were treated surgically with preoperative embolisation. One case occurred in a female. Embolisation significantly reduced blood loss and allowed complete surgical removal of the tumour in all cases. No significant complications occurred. Preoperative embolisation should be employed routinely in the surgical management of these patients.

  16. Comparison of Preoperative Temporal Bone CT with Intraoperative Findings in Patients with Cholesteatoma

    PubMed Central

    Rogha, Mehrdad; Hashemi, Sayyed Mostafa; Mokhtarinejad, Farhad; Eshaghian, Afrooz; Dadgostar, Alireza

    2014-01-01

    Introduction: Cholesteatoma is traditionally diagnosed by otoscopic examination and treated by surgery. The necessity for imaging in an uncomplicated case is controversial. This study was planned to investigate the usefulness of a preoperative high-resolution computed tomography (HRCT) scan in depicting the status of middle ear structures in the presence of cholesteatoma and also to compare the correspondence between pre- and intraoperative CT findings in patients with cholesteatoma. Materials and Methods: This prospective descriptive study was performed from January 2009 to May 2011 in 36 patients with cholesteatoma who were referred to the Kashani and Al-Zahra Clinics of Otolaryngology. Preoperative high-resolution temporal bone CT scans (axial and coronal views) were carried out and compared with intraoperative findings. Results: Evaluation of 36 patients and their CT scans revealed excellent correlation for sigmoid plate erosion, widening of aditus, and erosion of scutum; good correlation for erosion of malleus and tegmen; moderate correlation for lateral canal fistula (LCF) and erosion of mastoid air cells; and poor correlation for facial nerve dehiscence (FND), incus, and stapes erosion. Conclusion: A preoperative CT scan may be helpful in relation to diagnosis and decision making for surgery in cases of cholesteatoma and ossicular erosion. The CT scan can accurately predict the extent of disease and is helpful for detection of lateral canal fistula, erosions of dural plate, and ossicular erosions. However it is not able to distinguish between cholesteatoma and mucosal disease, facial nerve dehiscency, incus, and stapes erosion. PMID:24505568

  17. Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis

    PubMed Central

    Choi, Seong Chan; Lee, Saem; Choi, Hye Sun; Jang, Jae Woo; Kim, Sung Joo

    2016-01-01

    Purpose To identify and analyze the role of preoperative computed tomography (CT) in patients with tearing symptoms with nasolacrimal duct obstruction (NLDO). Methods We retrospectively reviewed the medical records and CT results on 218 patients who complained of tearing symptoms with NLDO between January 2014 and December 2014. All patients were recruited from Kim's Eye Hospital's outpatient clinic and assessed by clinical history, examination, and CT to evaluate periocular pathology and nasolacrimal drainage system. Patients with abnormal findings assessed by preoperative CT were further reviewed. Results CT was performed on 218 patients (average age, 58.2 ± 11.9 years). Of these, 196 (89.9%) had endonasal dacryocystorhinostomy, 14 (6.4%) declined surgery, and 8 (3.7%) were inoperable due to abnormal CT findings. Soft tissue opacity was the most common finding which 243 cases (85.9%) of 283 obstructed nasolacrimal duct and 89 cases (81.7%) of 109 non-obstructed nasolacrimal duct showed it. Thirty-nine (17.8%) of 218 patients showed either maxillary sinusitis or ethmoidal sinusitis and 32 (14.7%) of 218 patients presented with periocular inflammation. Other abnormal CT findings included septal deviations, previous fractures, masses, and structural abnormalities of nasal cavity. Conclusions Preoperative CT imaging is useful in the assessment of both nasolacrimal drainage and nearby anatomical structures. This information will be helpful in planning surgical interventions and management of NLDO. PMID:27478350

  18. Preoperative Ultrasound Guided Fine Needle Aspiration Cytology of Ovarian Lesions- Is It a Rapid and Effective Diagnostic Modality?

    PubMed Central

    Datta, Saikat; Chaudhuri, Snehamay; Paul, Prabir Chandra; Khandakar, Binny; Mandal, Sonali

    2016-01-01

    Introduction The deep seated ovarian lesions unapproachable by unguided aspiration cytology were easily done under ultrasound guidance. It gave a before hand cytological diagnosis of the lesion to the surgeon determining the modality of treatment for the patient. Aim To find the diagnostic accuracy of the method of ultrasound guided cytological assessment of ovarian lesion. Materials and Methods The study was conducted as a prospective observational study over a period of one year, in hospital setting, where ultrasound guided fine needle aspiration had been used to aspirate ovarian lesions, giving a rapid cytological diagnosis. In 43 sample cases, aspiration of fluid done from ovarian lesions were followed by cyto-centrifugation and staining by May-Grunwald-Giemsa (MGG) and Papanicolaou (Pap) stain providing a cytological opinion regarding benign/malignant nature of the lesion and further categorization. Later the cytological diagnosis was compared with final histopathological diagnosis, taking it as a gold standard. Results The overall sensitivity, specificity, and diagnostic accuracy of ultrasound guided aspiration and cytological analysis were high, 96%, 76.92% and 89.47% respectively as calculated by comparing the cytological diagnosis with histological diagnosis, taking it as gold standard. Conclusion This method has evolved as a highly sensitive, rapid, simple and effective modality for screening and as well as accurate preoperative diagnosis of ovarian lesions. PMID:27134878

  19. Quantitative assessment of preoperative serum thyrotropin level and thyroid cancer

    PubMed Central

    Ai, Zhilong

    2016-01-01

    Thyroid stimulating hormone (TSH) is the major growth factor for thyrocytes, but the pathogenic role of serum TSH in thyroid cancer (TC) is unknown. The association between TSH level and the development of thyroid cancer has been widely evaluated recently. However, the results remain conflicting. To develop an understanding of the relationship between TSH exposure and thyroid cancer, a meta-analysis of 56 studies involving 20227 thyroid cancer cases and 50003 controls with benign thyroid nodule was performed. Overall, significantly increased TSH level was observed in thyroid cancer patients compared with controls (RoM: 1.44, 95% CI: 1.32–1.56, P < 10−5). The pooled analyses also revealed that higher serum TSH level were significantly associated with the size of TC nodule and malignancy as well as lymph node metastasis. Furthermore, significantly increased THS levels were observed preferentially for papillary thyroid cancer when stratified by histological type of tumors. However, the diagnostic value of TSH level for TC might be limited. These results suggest that higher serum TSH concentration is associated with an increased risk of thyroid cancer. PMID:27166998

  20. New strategies for preoperative skin antisepsis.

    PubMed

    Ulmer, Miriam; Lademann, Juergen; Patzelt, Alexa; Knorr, Fanny; Kramer, Axel; Koburger, Torsten; Assadian, Ojan; Daeschlein, Georg; Lange-Asschenfeldt, Bernhard

    2014-01-01

    During the past decades, encouraging progress has been made in the prevention of surgical site infections (SSI). However, as SSI still occur today, strategic prevention measures such as standardized skin antisepsis must be implemented and rigorously promoted. Recent discoveries in skin physiology necessitate the development of novel antiseptic agents and procedures in order to ameliorate their efficacy. In particular, alternate target structures in the skin need to be taken into consideration for the development of the next generation of antiseptics. Recent investigations have shown that a high number of microorganisms are located within and in the close vicinity of the hair follicles. This suggests that these structures are an important reservoir of bacterial growth and activity in human skin. To date, it has not been fully elucidated to what extent conventional liquid antiseptics sufficiently target the hair follicle-related microbial population. Modern technologies such as tissue-tolerable plasma (TTP) have been tested for their potential antiseptic efficiency by reducing the bacterial load in the skin and in the hair follicles. First experiments using liposomes to deliver antiseptics into the hair follicles have been evaluated for their potential clinical application. The present review evaluates these two innovative methods for their efficacy and applicability in preoperative skin antiseptics.

  1. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty

    PubMed Central

    Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M.

    2016-01-01

    Objectives Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. Methods Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. Results Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. Discussion Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients’ perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes. PMID:27583551

  2. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    SciTech Connect

    Rettmann, Maryam E. Holmes, David R.; Camp, Jon J.; Cameron, Bruce M.; Robb, Richard A.; Kwartowitz, David M.; Gunawan, Mia; Johnson, Susan B.; Packer, Douglas L.; Dalegrave, Charles; Kolasa, Mark W.

    2014-02-15

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved

  3. Clinical Parameters Predicting Pathologic Tumor Response After Preoperative Chemoradiotherapy for Rectal Cancer

    SciTech Connect

    Yoon, Sang Min; Kim, Dae Yong Kim, Tae Hyun; Jung, Kyung Hae; Chang, Hee Jin; Koom, Woong Sub; Lim, Seok-Byung; Choi, Hyo Seong; Jeong, Seung-Yong; Park, Jae-Gahb

    2007-11-15

    Purpose: To identify pretreatment clinical parameters that could predict pathologic tumor response to preoperative chemoradiotherapy (CRT) for rectal cancer. Methods and Materials: The study involved 351 patients who underwent preoperative CRT followed by surgery between October 2001 and July 2006. Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and tumor regression. Statistical analyses were performed to identify clinical factors associated with pathologic tumor response. Results: Tumor downstaging (defined as ypT2 or less) was observed in 167 patients (47.6%), whereas tumor regression (defined as Dworak's Regression Grades 3 or 4) was observed in 103 patients (29.3%) and complete regression in 51 patients (14.5%). Multivariate analysis found that predictors of downstaging were pretreatment hemoglobin level (p = 0.045), cN0 classification (p < 0.001), and serum carcinoembryonic antigen (CEA) level (p < 0.001), that predictors of tumor regression were cN0 classification (p = 0.044) and CEA level (p < 0.001), and that the predictor of complete regression was CEA level (p = 0.004). Conclusions: The data suggest that pretreatment CEA level is the most important clinical predictor of pathologic tumor response. It may be of benefit in the selection of treatment options as well as the assessment of individual prognosis.

  4. Effect of Smoking on Joint Replacement Outcomes: Opportunities for Improvement Through Preoperative Smoking Cessation.

    PubMed

    Wright, Erik; Tzeng, Tony H; Ginnetti, Michael; El-Othmani, Mouhanad M; Saleh, Jamal K; Saleh, Jasmine; Lane, J M; Mihalko, William M; Saleh, Khaled J

    2016-01-01

    Because orthopaedic surgeons focus on identifying serious potential complications, such as heart attack, stroke, and deep vein thrombosis, during the preoperative assessment, correctable factors, such as smoking, may be overlooked. Chronic exposure to nicotine has been correlated with perioperative complications that lead to worse outcomes, including decreased patient satisfaction, longer hospitalization periods, and an increased rate of hospital readmission. It has been proven that smoking is a negative risk factor for decreased bone mineral density, which leads to increased fracture risk, heightened pain, postoperative wound and bone healing complications, decreased fusion rates, and postoperative tendon and ligament healing complications. Physician-led preoperative smoking cessation programs that include, but are not limited to, pharmacotherapy plans have been shown to improve primary surgical outcomes and smoking cessation rates. Smoking has detrimental effects on specialty-specific physiology; however, there are many effective options for intervention that can improve primary outcomes. PMID:27049216

  5. Preoperative glucose abnormalities in patients with pancreatic tumours

    PubMed Central

    Durlik, Marek; Kałuża, Bernadetta; Milczarczyk, Alicja; Franek, Edward

    2014-01-01

    Introduction Pancreatic cancer is a neoplasm characterised by poor prognosis. The only effective, possible treatment is radical surgery, but most patients do not qualify for surgery because of delayed diagnosis. Aim To determine if assessment of endocrine pancreatic function could serve as a means of screening for pancreatic cancer. Material and methods This prospective study was conducted on a group of 50 patients diagnosed with pancreatic tumour, who were qualified for surgery. Results From 1.07.2010 to 4.07.2011 a further 50 patients were added to the study group. They had been admitted to the hospital with pancreatic tumours. During the preoperative period, nine of these people had been treated for diabetes, 14 were newly diagnosed with diabetes and 15 had been diagnosed with impaired glucose tolerance, but only 12 had a normal glucose profile. Afterwards, patients underwent the surgical treatment. Histopathological examination revealed that out of the 50 operated patients, 36 suffered from malignant disease, and of these only four had no impaired glucose tolerance before treatment. Conclusions In most cases, patients with pancreatic tumours have impaired glucose tolerance. Screening patients over 50 years of age could speed up diagnosis and surgical treatment. PMID:25061491

  6. Alpha blockade in preoperative preparation of patients with pheochromocytomas.

    PubMed

    Kocak, Savas; Aydintug, Semih; Canakci, Necati

    2002-01-01

    Preoperative preparation in pheochromocytoma is usually performed by alpha-adrenergic blockers. We retrospectively reviewed the efficiency of phenoxybenzamine, prazosin, and doxazosin in preoperative preparation. Phenoxybenzamine was used for preoperative preparation of 21 pheochromocytoma patients, prazosin was used in 11 patients, and doxazosin was used in 17 patients. Intraoperative and early postoperative blood pressure records and postoperative volume replacement records were reviewed. Intraoperative hypertension occurred in 17 patients in the phenoxybenzamine group (81%), eight patients in the prazosin group (73%), and 14 patients in the doxazosin group (82%). There was no statistical difference among the groups (P > 0.05). There was also no significant difference between postoperative blood pressure measurements and the operative and postoperative volume replacements. We have found that there were no significant difference in the operative and postoperative blood pressure and plasma volume control among the three groups. We conclude that pheochromocytoma surgery is safe with any of these preoperative medications.

  7. [Retroperitoneal cystic lymphangioma. Preoperative diagnosis. Apropos of a case].

    PubMed

    Guérin, E; Babin, C; Moulle, P; Barret, F

    1987-11-01

    Retroperitoneal cystic lymphangioma is an uncommon tumor. One case is reported, with surgical confirmation. Authors point out the diagnostic value of ultrasonography and computed tomography in the pre-operative diagnosis.

  8. Target motion predictions for pre-operative planning during needle-based interventions.

    PubMed

    op den Buijs, Jorn; Abayazid, Momen; de Korte, Chris L; Misra, Sarthak

    2011-01-01

    During biopsies, breast tissue is subjected to displacement upon needle indentation, puncture, and penetration. Thus, accurate needle placement requires pre-operative predictions of the target motions. In this paper, we used ultrasound elastography measurements to non-invasively predict elastic properties of breast tissue phantoms. These properties were used in finite element (FE) models of indentation of breast soft tissue phantoms. To validate the model predictions of target motion, experimental measurements were carried out. Breast tissue phantoms with cubic and hemispherical geometries were manufactured and included materials with different elastic properties to represent skin, adipose tissue, and lesions. Ultrasound was used to track the displacement of the target (i.e., the simulated lesion) during indentation. The FE model predictions were compared with ultrasound measurements for cases with different boundary conditions and phantom geometry. Maximum errors between measured and predicted target motions were 12% and 3% for the fully supported and partially supported cubic phantoms at 6.0 mm indentation, respectively. Further, FE-based parameter sensitivity analysis indicated that increasing skin elastic modulus and reducing the target depth location increased the target motion. Our results indicate that with a priori knowledge about the geometry, boundary conditions, and linear elastic properties, indentation of breast tissue phantoms can be accurately predicted with FE models. FE models for pre-operative planning in combination with robotic needle insertions, could play a key role in improving lesion targeting for breast biopsies. PMID:22255554

  9. Procedures and experiences with preoperative skin preparation in Sweden.

    PubMed

    Tunevall, T G

    1988-04-01

    The current situation with preoperative skin preparation in Sweden is described. Patients are given two preoperative washes with chlorhexidine scrub, and are sent to theatre on a clean bed, so no extra linen is required. Wound infection rates are acceptably low, and use of chlorhexidine has also assisted in reduction of infection associated with central venous catheters. Use of chlorhexidine scrub is recommended to help healing of infected wounds.

  10. Prediction of Response to Preoperative Chemoradiotherapy in Rectal Cancer by Multiplex Kinase Activity Profiling

    SciTech Connect

    Folkvord, Sigurd; Flatmark, Kjersti; Dueland, Svein

    2010-10-01

    Purpose: Tumor response of rectal cancer to preoperative chemoradiotherapy (CRT) varies considerably. In experimental tumor models and clinical radiotherapy, activity of particular subsets of kinase signaling pathways seems to predict radiation response. This study aimed to determine whether tumor kinase activity profiles might predict tumor response to preoperative CRT in locally advanced rectal cancer (LARC). Methods and Materials: Sixty-seven LARC patients were treated with a CRT regimen consisting of radiotherapy, fluorouracil, and, where possible, oxaliplatin. Pretreatment tumor biopsy specimens were analyzed using microarrays with kinase substrates, and the resulting substrate phosphorylation patterns were correlated with tumor response to preoperative treatment as assessed by histomorphologic tumor regression grade (TRG). A predictive model for TRG scores from phosphosubstrate signatures was obtained by partial-least-squares discriminant analysis. Prediction performance was evaluated by leave-one-out cross-validation and use of an independent test set. Results: In the patient population, 73% and 15% were scored as good responders (TRG 1-2) or intermediate responders (TRG 3), whereas 12% were assessed as poor responders (TRG 4-5). In a subset of 7 poor responders and 12 good responders, treatment outcome was correctly predicted for 95%. Application of the prediction model on the remaining patient samples resulted in correct prediction for 85%. Phosphosubstrate signatures generated by poor-responding tumors indicated high kinase activity, which was inhibited by the kinase inhibitor sunitinib, and several discriminating phosphosubstrates represented proteins derived from signaling pathways implicated in radioresistance. Conclusions: Multiplex kinase activity profiling may identify functional biomarkers predictive of tumor response to preoperative CRT in LARC.

  11. Blood clotting activation analysis for preoperative differentiation of benign versus malignant ovarian masses.

    PubMed

    Amirkhosravi, Ali; Bigsby, Glenn; Desai, Hina; Rivera-Amaya, Mildred; Coll, Enriqueta; Robles-Carrillo, Liza; Faust, Patricia; Waters, Alane; Meyer, Todd; Reyes, Enriquo; Langer, Florian; Francis, John L

    2013-07-01

    Preoperative evaluation of patients presenting with ovarian masses is challenging, partly due to shortcomings with the commonly used marker, CA-125. Ovarian cancer is associated with systemic coagulation activation. Measurement of D-dimer, serum tissue factor (TF), and the coagulation process as a whole are considered candidates for improving discrimination between benign and malignant ovarian masses. We therefore sought to identify possible benefits by analyzing preoperative coagulation status in conjunction with CA-125 in patients with ovarian masses. Preoperative blood from 95 patients with ovarian masses (75 benign, 20 malignant) and 30 controls was analyzed, prospectively. Thromboelastography served for global hemostatic assessment. Plasma TF antigen and D-dimer were measured by ELISA and microparticle-associated TF activity by thrombin generation assay. TF microparticles were enumerated by flow cytometry. Time to clot formation by thromboelastography was similar between patients having either benign or malignant ovarian tumors. Clot formation rate, clot strength, and coagulation index were significantly increased in patients having malignant versus benign tumors, indicating that thromboelastography differentiated malignant from benign tumors. D-dimer alone differentiated malignant from benign ovarian tumors and also improved differentiation when combined with CA-125. Circulating TF antigen, activity, and TF microparticle numbers, however, failed to differentiate benign from malignant tumors. Significant coagulation activation occurs in women with ovarian malignancies. Plasma D-dimer may help discriminate between patients with benign and malignant tumors. Thromboelastography may also contribute meaningfully when combined with CA-125 in the preoperative evaluation of ovarian masses. Larger studies are needed to assess these possibilities.

  12. Preoperative Planning in Orthopaedic Surgery. Current Practice and Evolving Applications.

    PubMed

    Atesok, Kivanc; Galos, David; Jazrawi, Laith M; Egol, Kenneth A

    2015-12-01

    Preoperative planning is an essential prerequisite for the success of orthopaedic procedures. Traditionally, the exercise has involved the written down, step by step "blueprint" of the surgical procedure. Preoperative planning of the technical aspects of the orthopaedic procedure has been performed on hardcopy radiographs using various methods such as copying the radiographic image on tracing papers to practice the planned interventions. This method has become less practical due to variability in radiographic magnification and increasing implementation of digital imaging systems. Advances in technology along with recognition of the importance of surgical safety protocols resulted in widespread changes in orthopaedic preoperative planning approaches. Nowadays, perioperative "briefings" have gained particular importance and novel planning methods have started to integrate into orthopaedic practice. These methods include using software that enables surgeons to perform preoperative planning on digital radiographs and to construct 3D digital models or prototypes of various orthopaedic pathologies from a patient's CT scans to practice preoperatively. Evidence-to-date suggests that preoperative planning and briefings are effective means of favorably influencing the outcomes of orthopaedic procedures.

  13. The Importance of Patient-Specific Preoperative Factors: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

    PubMed Central

    Jacobs, Jeffrey Phillip; O'Brien, Sean M.; Pasquali, Sara K.; Kim, Sunghee; Gaynor, J. William; Tchervenkov, Christo Ivanov; Karamlou, Tara; Welke, Karl F.; Lacour-Gayet, Francois; Mavroudis, Constantine; Mayer, John E.; Jonas, Richard A.; Edwards, Fred H.; Grover, Frederick L.; Shahian, David M.; Jacobs, Marshall Lewis

    2014-01-01

    Background The most common fonns of risk adjustment for pediatric and congenital heart surgery used today are based mainly on the estimated risk of mortality of the primary procedure of the operation. The goals of this analysis were to assess the association of patient-specific preoperative factors with mortality and to determine which of these preoperative factors to include in future pediatric and congenital cardiac surgical risk models. Methods All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) during 2010 through 2012 were eligible for inclusion. Patients weighing less than 2.5 kg undergoing patent ductus arteriosus closure were excluded. Centers with more than 10% missing data and patients with missing data for discharge mortality or other key variables were excluded. Rates of discharge mortality for patients with or without specific preoperative factors were assessed across age groups and were compared using Fisher's exact test. Results In all, 25,476 operations were included (overall discharge mortality 3.7%, n = 943). The prevalence of common preoperative factors and their associations with discharge mortality were determined. Associations of the following preoperative factors with discharge mortality were all highly significant (p < 0.0001) for neonates, infants, and children: mechanical circulatory support, renal dysfunction, shock, and mechanical ventilation. Conclusions Current STS-CHSD risk adjustment is based on estimated risk of mortality of the primary procedure of the operation as well as age, weight, and prematurity. The inclusion of additional patient-specific preoperative factors in risk models for pediatric and congenital cardiac surgery could lead to increased precision in predicting risk of operative mortality and comparison of observed to expected outcomes. PMID:25262395

  14. Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery – a randomised pilot study

    PubMed Central

    Kulkarni, SR; Fletcher, E; McConnell, AK; Poskitt, KR; Whyman, MR

    2010-01-01

    INTRODUCTION The aim of this pilot study was to assess the effect of pre-operative inspiratory muscle training (IMT) on respiratory variables in patients undergoing major abdominal surgery. PATIENTS AND METHODS Respiratory muscle strength (maximum inspiratory [MIP] and expiratory [MEP] mouth pressure) and pulmonary functions were measured at least 2 weeks before surgery in 80 patients awaiting major abdominal surgery. Patients were then allocated randomly to one of four groups (Group A, control; Group B, deep breathing exercises; Group C, incentive spirometry; Group D, specific IMT). Patients in groups B, C and D were asked to train twice daily, each session lasting 15 min, for at least 2 weeks up to the day before surgery. Outcome measurements were made immediately pre-operatively and postop-eratively. RESULTS In groups A, B and C, MIP did not increase from baseline to pre-operative assessments. In group D, MIP increased from 51.5 cmH2O (median) pre-training to 68.5 cmH2O (median) post-training pre-operatively (P < 0.01). Postoperatively, groups A, B and C showed a fall in MIP from baseline (P < 0.01, P < 0.01) and P = 0.06, respectively). No such significant reduction in postoperative MIP was seen in group D (P = 0.36). CONCLUSIONS Pre-operative specific IMT improves MIP pre-operatively and preserves it postoperatively. Further studies are required to establish if this is associated with reduced pulmonary complications. PMID:20663275

  15. NNLOPS accurate associated HW production

    NASA Astrophysics Data System (ADS)

    Astill, William; Bizon, Wojciech; Re, Emanuele; Zanderighi, Giulia

    2016-06-01

    We present a next-to-next-to-leading order accurate description of associated HW production consistently matched to a parton shower. The method is based on reweighting events obtained with the HW plus one jet NLO accurate calculation implemented in POWHEG, extended with the MiNLO procedure, to reproduce NNLO accurate Born distributions. Since the Born kinematics is more complex than the cases treated before, we use a parametrization of the Collins-Soper angles to reduce the number of variables required for the reweighting. We present phenomenological results at 13 TeV, with cuts suggested by the Higgs Cross section Working Group.

  16. Development and Pilot Evaluation of a Preoperative Briefing Protocol for Cardiovascular Surgery

    PubMed Central

    Henrickson, Sarah E.; Wadhera, Rishi K.; ElBardissi, Andrew W.; Wiegmann, Douglas A.; Sundt, Thoralf M.

    2014-01-01

    Background Pre-procedural briefings have been adopted in many high consequence environments, but have not been widely accepted in medicine. We sought to develop, implement and evaluate a preoperative briefing for cardiovascular surgery. Study Design The preoperative briefing was developed by employing a combined questionnaire and semi-structured focus group approach involving five subspecialties of surgical staff (n = 55). The results from these focus groups were used to design and implement a preoperative briefing protocol. The impact of the preoperative briefing was evaluated by monitoring surgical flow disruptions, circulating nurse trips to the core, time spent in the core, and cost-waste reports before and after implementation of the briefing across 16 cardiac surgery cases. Results Focus group data indicated consensus among surgical staff concerning briefing benefits, duration (5-10 min), location (in the OR), content (procedure, patient, and equipment issues) and potential barriers (e.g.: staff availability). Disagreement arose concerning timing of the brief (before vs. after patient enters) and the role of key participants. Following implementation of the briefing, there was a reduction in total surgical flow disruptions per case (5.4 pre-implementation vs. 2.8 post-implementation, p=.004). Specifically, there was a reduction in per case average of procedural knowledge disruptions (4.1 vs. 2.17, p=.004) and miscommunication events (2.5 vs. 1.17, p=.03), but there was no reduction in disruptions due to equipment preparation (1.19 vs. 1.17, p=.12) nor disruptions due to patient related issues (1.0 vs. 0.5, p=.10). On average, teams that conducted the briefing experienced fewer trips to the core (10 vs. 4.7, p=.004) and spent less time in the core (397.4 seconds vs. 172.3 seconds, p=.006). There was a trend towards decreased waste in teams that were briefed (30% vs. 17%, p=0.15). Conclusion Assessment of the preoperative briefings impact on cardiac surgical

  17. Fenestral otosclerosis: significance of preoperative CT evaluation

    SciTech Connect

    Swartz, J.D.; Faerber, E.N.; Wolfson, R.J.; Marlowe, F.I.

    1984-06-01

    Thirty-five consecutive patients with the clinical diagnosis of fenestral otosclerosis were evaluated with high-resolution computed tomography (CT). Twenty-six were diagnosed as having this disorder by CT evidence of abnormal bony excrescences at or adjacent to the oval window. Sections were also evaluated for evidence of plaque formation elsewhere in the lateral wall of the labyrinth and for surgical obstacles such as an abnormally wide cochlear aqueduct, a high jugular vein, and a dehiscent facial nerve. It is concluded that fenestral otosclerosis may be accurately diagnosed with proper CT techniques.

  18. Experience with the biofragmentable anastomotic ring (BAR) in bowel preoperatively irradiated with 6000 rad

    SciTech Connect

    Croston, J.K.; Jacobs, D.M.; Kelly, P.H.; Feeney, D.A.; Johnston, G.R.; Strom, R.L.; Bubrick, M.P. )

    1990-03-01

    Previous studies from the authors' laboratory using the biodegradable anastomotic ring (BAR) have demonstrated the safety of this device in animals irradiated preoperatively with the equivalent of 5000 rad; sutured, stapled, and BAR anastomoses all had leak rates of 10 percent or less in this setting. This study was undertaken to assess the safety of the BAR after irradiation with the equivalent of 6000 rad. Thirteen mongrel dogs underwent preoperative irradiation to the rectum and rectosigmoid, receiving 6000 rad according to the nominal standard dose equation. After a three-week rest period, each dog underwent anterior resection of the rectosigmoid and anastomosis with the BAR. The anastomoses were evaluated for early and late healing and anastomotic leaks. The results were compared with previous data from the authors' laboratory using an identical model. Radiographic leaks were found in 7 of 10 sutured anastomoses, 8 of 10 stapled anastomoses, and 3 of 13 BAR anastomoses (P less than 0.01). Comparative clinical leaks were 5 of 10 for sutured, 5 of 10 for stapled, and 3 of 13 for BAR anastomoses. These data suggest that the BAR may offer added safety to an anastomosis after preoperative irradiation. Whether this effect is due to the atraumatic technique of placing the device, improved blood flow to the anastomotic margins, or other factors, is still underdetermined.

  19. The role of ultrasound and nuclear medicine methods in the preoperative diagnostics of primary hyperparathyroidism.

    PubMed

    Nieciecki, Michał; Cacko, Marek; Królicki, Leszek

    2015-12-01

    Primary hyperparathyroidism (PH) represents one of the most common endocrine diseases. In most cases, the disorder is caused by parathyroid adenomas. Bilateral neck exploration has been a widely used treatment method for adenomas since the 20's of the twentieth century. In the last decade, however, it has been increasingly replaced by a minimally invasive surgical treatment. Smaller extent, shorter duration and lower complication rate of such a procedure are emphasized. Its efficacy depends on a precise location of parathyroid tissue during the preoperative imaging. Scintigraphy and ultrasound play a major role in the diagnostic algorithms. The efficacy of both methods has been repeatedly verified and compared. The still-current guidelines of the European Association of Nuclear Medicine (2009) emphasize the complementary role of scintigraphy and ultrasonography in the preoperative diagnostics in patients with primary hyperparathyroidism. At the same time, attempts are made to improve both these techniques by implementing new study protocols or innovative technologies. Publications have emerged in the recent years in the field of ultrasonography, whose authors pointed out the usefulness of elastography and contrast media. Nuclear medicine studies, on the other hand, focus mainly on the assessment of new radiotracers used in the positron emission tomography (PET). The aim of this article is to present, based on literature data, the possibilities of ultrasound and scintigraphy in the preoperative diagnostics in patients with primary hyperparathyroidism. Furthermore, the main directions in the development of imaging techniques in PH patients were evaluated.

  20. Preoperative Underweight Patients with Upper Tract Urothelial Carcinoma Survive Less after Radical Nephroureterectomy.

    PubMed

    Kang, Ho Won; Jung, Hae Do; Ha, Yun-Sok; Kim, Tae-Hwan; Kwon, Tae Gyun; Byun, Seok-Soo; Yun, Seok-Joong; Kim, Wun-Jae; Choi, Young Deuk

    2015-10-01

    The prognostic impact of body mass index (BMI) in patients with upper tract urothelial carcinoma (UTUC) is an ongoing debate. Our study aimed to investigate the prognostic role of BMI in patients treated with radical nephroureterectomy (RNU) for UTUC from a multi-institutional Korean collaboration. We retrospectively reviewed data from 440 patients who underwent RNU for UTUC at four institutions in Korea. To avoid biasing the survival estimates, patients who had previous or concomitant muscle-invasive bladder tumors were excluded. BMI was categorized into approximate quartiles with the lowest quartile assigned to the reference group. Kaplan-Meier and multivariate Cox regression analyses were performed to assess the influence of BMI on survival. The lower quartile BMI group showed significantly increased overall mortality (OM) and cancer specific mortality (CSM) compared to the 25%-50% quartiles and upper quartile BMI groups. Kaplan-Meier estimates showed similar results. Based on multivariate Cox regression analysis, preoperative BMI as a continuous variable was an independent predictor for OM and CSM. In conclusion, preoperative underweight patients with UTUC in Korea survive less after RNU. Preoperative BMI may provide additional prognostic information to establish risk factors.

  1. Update of diagnostic preoperative images using low-field interventional MRI for navigation in neurosurgery: rigid-body registration

    NASA Astrophysics Data System (ADS)

    Kavec, Martin; Wikler, David; Phillips, Christophe L. M.; Vigneron, Lara M.; Levivier, Marc; Verly, Jacques G.

    2005-04-01

    This study looks into the rigid-body registration of pre-operative anatomical high field and interventional low field magnetic resonance images (MRI). The accurate 3D registration of these modalities is required to enhance the content of interventional images with anatomical (CT, high field MRI, DTI), functional (DWI, fMRI, PWI), metabolic (PET) or angiography (CTA, MRA) pre-operative images. The specific design of the interventional MRI scanner used in the present study, a PoleStar N20, induces image artifacts, such as ellipsoidal masking and intensity inhomogeneities, which affect registration performance. On MRI data from eleven patients, who underwent resection of a brain tumor, we quantitatively evaluated the effects of artifacts in the image registration process based on a normalized mutual information (NMI) metric criterion. The results show that the quality of alignment of pre-operative anatomical and interventional images strongly depends on pre-processing carried out prior to registration. The registration results scored the highest in visual evaluation only if intensity variations and masking were considered in image registration. We conclude that the alignment of anatomical high field MRI and PoleStar interventional images is the most accurate when the PoleStar's induced image artifacts are corrected for before registration.

  2. Preoperative planning and postoperative evaluation of total hip arthroplasty that takes combined anteversion.

    PubMed

    Imai, Hiroshi; Miyawaki, Joji; Kamada, Tomomi; Takeba, Jun; Mashima, Naohiko; Miura, Hiromasa

    2016-07-01

    The purpose of this study was to investigate whether postoperative combined anteversion (CA) can be kept within the safe zone while using cementless total hip arthroplasty (THA) using the operative technique which prepares the socket first for developmental dysplasia of the hip (DDH), by estimating the anteversion of the metaphyseal fit stem using preoperative three-dimensional (3D) computerized planning and by adjusting the anteversion of the socket using a navigation system that considers CA. Our subjects were 65 patients (65 hips) that had undergone cementless THA for DDH that could be observed for 1 year or more. Clinical assessments were made using the Japanese Orthopaedic Association's (JOA) hip score. For a radiological evaluation, we investigated 3D-planned stem versions, postoperative stem versions, preoperative and postoperative CA, and the relationship between CA and dislocation tendencies with temporary intraoperative reductions. JOA hip scores improved from 52.3 ± 11.4 points to 88.9 ± 8.6 points. CT evaluations revealed that 3D-planned stem versions were strongly correlated with postoperative stem versions (r = 0.80; p < 0.01). Preoperative CA was 50.5° ± 7.2°, and postoperative CA was 41.3° ± 8.6°. Postoperative CA was kept within the safe zone in 61 hips. No intraoperative dislocation tendencies were observed in any hips. By estimating the anteversion of the cementless metaphyseal fit stem using 3D planning preoperatively and adjusting the angle of anteversion of the socket using a navigation system that considers CA intraoperatively, postoperative CA can very frequently be kept within the safe zone, even with cementless THA using the operative technique which prepares the socket first for DDH. PMID:27154291

  3. Prediction of response to preoperative chemoradiotherapy and establishment of individualized therapy in advanced rectal cancer.

    PubMed

    Nakao, Toshihiro; Iwata, Takashi; Hotchi, Masanori; Yoshikawa, Kozo; Higashijima, Jun; Nishi, Masaaki; Takasu, Chie; Eto, Shohei; Teraoku, Hiroki; Shimada, Mitsuo

    2015-10-01

    Preoperative chemoradiotherapy (CRT) has become the standard treatment for patients with locally advanced rectal cancer. However, no specific biomarker has been identified to predict a response to preoperative CRT. The aim of the present study was to assess the gene expression patterns of patients with advanced rectal cancer to predict their responses to preoperative CRT. Fifty-nine rectal cancer patients were subjected to preoperative CRT. Patients were randomly assigned to receive CRT with tegafur/gimeracil/oteracil (S-1 group, n=30) or tegafur-uracil (UFT group, n=29). Gene expression changes were studied with cDNA and miRNA microarray. The association between gene expression and response to CRT was evaluated. cDNA microarray showed that 184 genes were significantly differentially expressed between the responders and the non‑responders in the S-1 group. Comparatively, 193 genes were significantly differentially expressed in the responders in the UFT group. TBX18 upregulation was common to both groups whereas BTNL8, LOC375010, ADH1B, HRASLS2, LOC284232, GCNT3 and ALDH1A2 were significantly differentially lower in both groups when compared with the non-responders. Using miRNA microarray, we found that 7 and 16 genes were significantly differentially expressed between the responders and non-responders in the S-1 and UFT groups, respectively. miR-223 was significantly higher in the responders in the S-1 group and tended to be higher in the responders in the UFT group. The present study identified several genes likely to be useful for establishing individualized therapies for patients with rectal cancer.

  4. Impact of the number of resected lymph nodes on survival after preoperative radiotherapy for esophageal cancer

    PubMed Central

    He, Zhen-Yu; Li, Feng-Yan; Lin, Huan-Xin; Sun, Jia-Yuan; Lin, Hui; Li, Qun

    2016-01-01

    To assess the impact of the number of resected lymph nodes (RLNs) for survival in esophageal cancer (EC) patients treated with preoperative radiotherapy and cancer-directed surgery. The Surveillance Epidemiology and End Results (SEER) database was queried to identify EC patients treated from 1988 to 2012 who had complete data on the number of positive lymph nodes and number of RLNs. Kaplan–Meier survival analysis and Cox regression proportional hazard methods were used to determine factors that significantly impact cause-specific survival (CSS) and overall survival (OS). There were a total of 3,159 patients who received preoperative radiotherapy and cancer-directed surgery. The median number of RLNs was 10 in both patients who received and did not receive preoperative radiotherapy (P = 0.332). Cox regression univariate and multivariate analysis showed that RLN count was a significant prognostic factor for CSS and OS. Patients with 11–71 RLNs had better CSS (hazard ratio [HR] = 0.694, 95% confidence interval [CI]: 0.603–0.799, P < 0.001) and OS (HR = 0.724, 95% CI: 0.636–0.824, P < 0.001) than patients with 1–10 RLNs. The 5-year CSS rates were 39.1% and 44.8% in patients with 1–10 RLNs and 11–71 RLNs, respectively (P < 0.001). The 5-year OS rates were 33.7% and 39.9% in patients with 1–10 RLNs and 11–71 RLNs, respectively (P < 0.001). A higher number of RLNs was associated with better survival by tumor stage and nodal stage (all P < 0.05). RLN count is an independent prognostic factor in EC patients who undergo preoperative radiotherapy and cancer-directed surgery. PMID:26992210

  5. Prognostic Value of Preoperative Coping Strategies for Pain in Patients with Residual Neuropathic Pain after Laminoplasty for Compressive Cervical Myelopathy

    PubMed Central

    2015-01-01

    Study Design Single-center retrospective cohort study. Purpose To clarify the prognostic value of preoperative coping strategies for pain due to compressive cervical myelopathy. Overview of Literature Preoperative physical function, imaging and electrophysiological findings are known predictors of surgical outcomes. However, coping strategies for pain have not been considered. Methods Postoperative questionnaires, concerning health-related quality of life (HRQOL) and daily living activities, were sent to 78 patients with compressive cervical myelopathy who had suffered from neuropathic pain before laminoplasty, and been preoperatively assessed with respect to their physical and mental status and coping strategies for pain. Hierarchical multiple regression analysis was performed to clarify the extent to which the patient's preoperative coping strategies could explain the variance in postoperative HRQOL and activity levels. Results Forty-two patients with residual neuropathic pain after laminoplasty were analyzed by questionnaires (28 men, 14 women; mean age, 62.7±10.2 years; symptom duration, 48.0±66.0 months). The valid response rate was 53.8%. Hierarchical multiple regression analysis showed that preoperative coping strategies, which involved coping self-statements, diverting attention, and catastrophizing, were independently associated with postoperative HRQOL and activity level, and could explain 7% to 11% of their variance. Combinations of the coping strategies for pain and upper/lower motor functions could explain 26% to 36% of the variance in postoperative HRQOL and activity level. Conclusions Preoperative coping strategies for pain are good predictors of postoperative HRQOL and activities of daily living in patients with postoperative residual neuropathic pain due to compressive cervical myelopathy. PMID:26435783

  6. Validation of a virtual preoperative evaluation clinic: a pilot study.

    PubMed

    Zetterman, Corey V; Sweitzer, Bobbie J; Webb, Brad; Barak-Bernhagen, Mary A; Boedeker, Ben H

    2011-01-01

    Patients scheduled for surgery at the Omaha VA Medical Center were evaluated preoperatively via telemedicine. Following the examination, patients filled out a 15 item, 5 point Likert scale questionnaire regarding their opinion of preoperative evaluation in a VTC format. Evaluations were performed under the direction of nationally recognized guidelines and recommendations of experts in the field of perioperative medicine and were overseen by a staff anesthesiologist from the Omaha VA Medical Center. No significant difficulties were encountered by the patient or the evaluator regarding the quality of the audio/visual capabilities of the VTC link and its ability to facilitate preoperative evaluation. 87.5% of patients felt that virtual evaluation would save them travel time; 87.5% felt virtual evaluation could save them money; 7.3% felt uncomfortable using the VTC link; 12.2% felt the virtual evaluation took longer than expected; 70.7% preferred to be evaluated via VTC link; 21.9% were undecided; 9.7% felt they would rather be evaluated face-to-face with 26.8% undecided; 85.0% felt that teleconsultation was as good as being seen at the Omaha surgical evaluation unit; 7.5% were undecided. Our study has shown that effective preoperative evaluation can be performed using a virtual preoperative evaluation clinic; patients are receptive to the VTC format and, in the majority of cases, prefer it to face-to-face evaluation.

  7. Effect of Preoperative Pain on Inferior Alveolar Nerve Block.

    PubMed

    Aggarwal, Vivek; Singla, Mamta; Subbiya, Arunajatesan; Vivekanandhan, Paramasivam; Sharma, Vikram; Sharma, Ritu; Prakash, Venkatachalam; Geethapriya, Nagarajan

    2015-01-01

    The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis. PMID:26650491

  8. Preoperative myocardial ischaemia: its relation to perioperative infarction.

    PubMed Central

    Yousif, H; Davies, G; Westaby, S; Prendiville, O F; Sapsford, R N; Oakley, C M

    1987-01-01

    One hundred consecutive patients undergoing coronary artery bypass surgery were randomly allocated to a preoperative (24 h) intravenous infusion of isosorbide dinitrate (1.5-15 mg/hr) (50 patients) or to placebo (50 patients). The characteristics of the two groups were similar. Evidence of acute myocardial ischaemia was sought by continuous electrocardiographic Holter recordings and acute myocardial infarction by the appearance of new Q waves and increased activity of the creatine kinase MB isoenzyme. Episodes of acute myocardial ischaemia were found in 18% of patients in the control group and in none of those who received isosorbide dinitrate. None the less, the frequency of perioperative myocardial infarction was similar (22% and 18% respectively) in the two groups. Perioperative infarction was significantly more common in women, in patients with unstable angina or poor left ventricular function, in those who had coronary endarterectomy, and in those in whom the aortic clamping time was greater than 50 minutes. These factors may have obscured any effect that prevention of preoperative ischaemia had on perioperative infarction. Preoperative infusion of isosorbide dinitrate eliminated preoperative ischaemia but did not influence the occurrence of perioperative infarction. The probable benefits of prevention of preoperative ischaemia on postoperative left ventricular function, which is a determinant of long term survival, remain to be established. PMID:3304371

  9. Effect of preoperative statin therapy on early postoperative memory impairment after off-pump coronary artery bypass surgery

    PubMed Central

    Das, Sambhunath; Nanda, Sunil K.; Bisoi, Akshya K.; Wadhawan, Ashima N.

    2016-01-01

    Context: Frequent incidence of early postoperative memory impairment (POMI) after cardiac surgery remains a concern because of associated morbidity, impaired quality of life, and increased health care cost. Aim: To assess the effect of preoperative statin therapy on POMI in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Setting and Design: Prospective observational study in a tertiary level hospital. Methods: Sixty patients aged 45–65 years undergoing OPCAB surgery were allocated into two groups of 30 each. Group A patients were receiving statin and Group B patients were not receiving statins. All patients underwent memory function assessment preoperatively after admission to hospital and on the 6th postoperative day using postgraduate institute memory scale. Statistical Analysis: Appropriate tests were applied with SPSS 20 to compare both groups. The value P < 0.05 was considered statistically significant. Multiple regression analysis was performed with confounding factors to determine the effect on memory impairment. Results: Patients in Group A showed significant postoperative deterioration in 6 of the 10 functions and in Group B showed deterioration in 9 of 10 functions tested compared to preoperative scores. Intergroup comparison detected less POMI in Group A compared to Group B and was statistically significant in 8 memory functions. Multiple regression analysis detected statin as an independent factor in preventing memory impairment. Conclusions: Preoperative statin therapy attenuates the early POMI in patients undergoing OPCAB. Future long-term studies will define the efficacy of statin on POMI. PMID:26750672

  10. Preoperative duplex ultrasound parameters predicting male fertility after successful varicocelectomy

    PubMed Central

    Alshehri, Fahad M.; Akbar, Mahboob H.; Altwairgi, Adel K.; AlThaqufi, Omar J.

    2015-01-01

    Objectives: To assess duplex ultrasound (DUS) parameters, and predicti the outcome of varicocele ligation in male infertility. Methods: This retrospective and follow up study was conducted at Dr. Sulaiman Al Habib Hospital, AlQassim, Saudi Arabia between January 2011 and December 2012. Eighty-two patients were selected, who presented with clinical/subclinical varicocele and male infertility. All these patients had DUS of the scrotum and underwent for low ligation varicocelectomy. These patients were followed for a period of 12-24 months after surgery for the occurrence of paternity. We reviewed pre-operative scrotal DUS of these 82 patients for the testicular size and volume, pampiniform veins caliber and duration of reflux in the dilated veins at rest, and after valsalva maneuver. These DUS parameters were correlated with the postoperative paternity rate. Results: Postoperative paternity was achieved in 18 patients (31.6%) with normal-sized testes, and in 3 patients (12%) with small size testes. The positive paternity rate was higher (38.5%) in patients with clinically detected varicocele, compared with only 16.7% of patients with subclinical varicocele (detected by ultrasound only). In addition, postoperative paternity was significantly higher in patients with bilateral varicocele (70.6%), with shunt-type varicocele (71.4%), and patients with a permanent grade of venous reflux (62.5%). Conclusion: Selection of patients for the successful paternity after varicocele repair depends mainly on DUS parameters, which includes normal size testicles with shunt type of bilateral varicocele and continuous reflux. PMID:26620986

  11. A probability score for preoperative prediction of type 2 diabetes remission following RYGB surgery

    PubMed Central

    Still, Christopher D.; Wood, G. Craig; Benotti, Peter; Petrick, Anthony T.; Gabrielsen, Jon; Strodel, William E.; Ibele, Anna; Seiler, Jamie; Irving, Brian A.; Celaya, Melisa P.; Blackstone, Robin; Gerhard, Glenn S.; Argyropoulos, George

    2014-01-01

    BACKGROUND Type 2 diabetes (T2D) is a metabolic disease with significant medical complications. Roux-en-Y gastric bypass (RYGB) surgery is one of the few interventions that remit T2D in ~60% of patients. However, there is no accurate method for predicting preoperatively the probability for T2D remission. METHODS A retrospective cohort of 2,300 RYGB patients at Geisinger Clinic was used to identify 690 patients with T2D and complete electronic data. Two additional T2D cohorts (N=276, and N=113) were used for replication at 14 months following RYGB. Kaplan-Meier analysis was used in the primary cohort to create survival curves until remission. A Cox proportional hazards model was used to estimate the hazard ratios on T2D remission. FINDINGS Using 259 preoperative clinical variables, four (use of insulin, age, HbA1c, and type of antidiabetic medication) were sufficient to develop an algorithm that produces a type 2 diabetes remission (DiaRem) score over five years. The DiaRem score spans from 0 to 22 and was divided into five groups corresponding to five probability-ranges for T2D remission: 0–2 (88%–99%), 3–7 (64%–88%), 8–12 (23%–49%), 13–17 (11%–33%), 18–22 (2%–16%). The DiaRem scores in the replication cohorts, as well as under various definitions of diabetes remission, conformed to the DiaRem score of the primary cohort. INTERPRETATION The DiaRem score is a novel preoperative method for predicting the probability (from 2% to 99%) for T2D remission following RYGB surgery. FUNDING This research was supported by the Geisinger Health System and the National Institutes of Health. PMID:24579062

  12. Preoperative embolization of juvenile angiofibromas of the nasopharynx.

    PubMed

    Pletcher, J D; Newton, T H; Dedo, H H; Norman, D

    1975-01-01

    The juvenile nasopharyngeal angiofibroma is a vascular tumor. Careful and complete removal is challenging because of the brisk bleeding during surgery. The means applied to reduce this blood loss have included preoperative estrogens, ligation of feeding vessels, silicone embolization of feeding vessels, and cryosurgery. We have used preoperative Gelfoam embolization of the internal maxillary artery in seven patients. Our clinical impression of significant reduction in loss of blood was confirmed by comparison with 16 previous patients. The average amount of blood lost in the embolized group was half that of the control group. A study of this type comprises many variables; however, the results do suggest that preoperative embolization of the internal maxillary artery is of advantage in the surgical treatment of juvenile angiofibromas.

  13. Accurate CT-MR image registration for deep brain stimulation: a multi-observer evaluation study

    NASA Astrophysics Data System (ADS)

    Rühaak, Jan; Derksen, Alexander; Heldmann, Stefan; Hallmann, Marc; Meine, Hans

    2015-03-01

    Since the first clinical interventions in the late 1980s, Deep Brain Stimulation (DBS) of the subthalamic nucleus has evolved into a very effective treatment option for patients with severe Parkinson's disease. DBS entails the implantation of an electrode that performs high frequency stimulations to a target area deep inside the brain. A very accurate placement of the electrode is a prerequisite for positive therapy outcome. The assessment of the intervention result is of central importance in DBS treatment and involves the registration of pre- and postinterventional scans. In this paper, we present an image processing pipeline for highly accurate registration of postoperative CT to preoperative MR. Our method consists of two steps: a fully automatic pre-alignment using a detection of the skull tip in the CT based on fuzzy connectedness, and an intensity-based rigid registration. The registration uses the Normalized Gradient Fields distance measure in a multilevel Gauss-Newton optimization framework and focuses on a region around the subthalamic nucleus in the MR. The accuracy of our method was extensively evaluated on 20 DBS datasets from clinical routine and compared with manual expert registrations. For each dataset, three independent registrations were available, thus allowing to relate algorithmic with expert performance. Our method achieved an average registration error of 0.95mm in the target region around the subthalamic nucleus as compared to an inter-observer variability of 1.12 mm. Together with the short registration time of about five seconds on average, our method forms a very attractive package that can be considered ready for clinical use.

  14. What is the role of the oral and maxillofacial department in the preoperative management of patients awaiting cardiac operations?

    PubMed

    Jenkins, G W; Holmes, A; Colman-Nally, J; Mustafa, S

    2015-05-01

    There is limited evidence and guidance on best practice regarding preoperative dental assessments of patients awaiting cardiac operations. To analyse current practice in oral and maxillofacial units across the United Kingdom, we did a telephone survey to find out how these patients are managed. All maxillofacial departments in the United Kingdom were contacted, with a response rate of 77%. Those attached to dental schools were excluded. Most departments did extractions only, and in many, patients were assessed and treated within 7 days of being referred, although this varied. Most units did not offer antibiotic prophylaxis to patients at high risk of infective endocarditis, but some did after advice had been sought from a cardiologist. Respondents in 76% thought that preoperative dental assessments for cardiac patients were an appropriate use of resources. We propose a more integrated pathway for the management of these patients (particularly considering the pressure on time for treatment) that focuses primary and secondary resources accordingly. PMID:25798756

  15. [Research hotspot and progress of preoperative chemoradiotherapy for rectal cancer].

    PubMed

    Peng, Jianhong; Pan, Zhizhong

    2016-06-01

    Preoperative chemoradiotherapy (CRT) has become an important component of comprehensive treatment for rectal cancer. Although local recurrent risk has been remarkably reduced by CRT, distant metastasis remains the main cause of therapeutic failure. Therefore, more and more studies focused on controlling distant metastasis in order to prolong long-term survival. Recently, CRT has achieved certain progression in rectal cancer: (1)Patients with stage T3 should be classified into specific subgroups to formulate individualized treatment regimen. For stage T3a, it is feasible to perform surgery alone or administrate low intensity preoperative CRT; for stage T3b and T3c, conventional preoperative CRT should be performed in order to reduce the risk of recurrence postoperatively. (2)With regard to combined regimen for chemotherapy, oral capecitabine superiors to intravenous bolus 5-fluorouracil (5-FU) and is comparable to continuous intravenous infusion 5-FU with a better safety. Therefore, capecitabine is recommended for older patients and those with poor tolerance to chemotherapy. Compared to single 5-FU concurrent CRT, addition of oxaliplatin into preoperative CRT may result in a higher survival benefit in Chinese patients. As to the application of irinotecan, bevacizumab or cetuximab, unless there are more evidence to confirm their efficacy and safety from randomized controlled trial, they should not be recommended for adding to preoperative CRT routinely. (3)On the optimization in CRT pattern, the application values of induction chemotherapy before concurrent CRT, consolidation chemotherapy after concurrent CRT, neoadjuvant sandwich CRT, neoadjuvant chemotherapy alone and short-course preoperative radiotherapy remain further exploration. (4)On the treatment strategy for clinical complete response (cCR) after CRT, whether "wait and see" strategy is able to be adopted, it is still a hot topic with controversy. PMID:27353093

  16. Minimizing preoperative anxiety with alternative caring-healing therapies.

    PubMed

    Norred, C L

    2000-11-01

    This article reviews holistic caring-healing therapies that may decrease preoperative anxiety for the surgical patient, based on the philosophy and science of caring developed by Jean Watson, RN, PhD, FAAN. Dr Watson reveals a new paradigm emerging in health care that blends the compassion and caring of nursing in harmony with the curative therapies of medicine. Hypnosis, aromatherapy, music, guided imagery, and massage are integrative caring-healing therapies that may minimize preoperative anxiety. Alternative therapies offer a high-touch balance when integrated with high-tech conventional surgical treatments.

  17. Effect of preoperative irradiation on healing of low colorectal anastomoses

    SciTech Connect

    Morgenstern, L.; Sanders, G.; Wahlstrom, E.; Yadegar, J.; Amodeo, P.

    1984-02-01

    The effect of preoperative irradiation on the healing of low colorectal anastomoses was studied experimentally. In 12 dogs in whom preoperative irradiation of 4,000 rads was given before low colorectal stapled anastomosis was performed, anastomotic leakage occurred in 66 percent. More than half of the anastomotic leaks were associated with either severe sepsis or death. In a matched group of control animals that underwent stapled anastomoses without irradiation, no anastomotic complications occurred. The clinical implications of this study are that stapled anastomoses in irradiated colon are at serious risk of anastomotic dehiscence and, therefore, should be protected with a proximal colostomy.

  18. [Importance of preoperative and intraoperative imaging for operative strategies].

    PubMed

    Nitschke, P; Bork, U; Plodeck, V; Podlesek, D; Sobottka, S B; Schackert, G; Weitz, J; Kirsch, M

    2016-03-01

    Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy. PMID:26939896

  19. Impact of preoperative antithrombotic therapy on blood management after implantation of primary total knee arthroplasty

    PubMed Central

    Leitner, Lukas; Musser, Ewald; Kastner, Norbert; Friesenbichler, Jörg; Hirzberger, Daniela; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

    2016-01-01

    Red blood cell concentrates (RCC) substitution after total knee arthroplasty (TKA) is correlated with multifold of complications and an independent predictor for higher postoperative mortality. TKA is mainly performed in elderly patients with pre-existing polymorbidity, often requiring permanent preoperative antithrombotic therapy (PAT). The aim of this retrospective analysis was to investigate the impact of demand for PAT on inpatient blood management in patients undergoing TKA. In this study 200 patients were retrospectively evaluated after TKA for differences between PAT and non-PAT regarding demographic parameters, preoperative ASA score > 2, duration of operation, pre-, and intraoperative hemoglobin level, and postoperative parameters including amount of wound drainage, RCC requirement, and inpatient time. In a multivariate logistic regression analysis the independent influences of PAT, demographic parameters, ASA score > 2, and duration of the operation on RCC demand following TKA were analyzed. Patients with PAT were significantly older, more often had an ASA > 2 at surgery, needed a higher number of RCCs units and more frequently and had lower perioperative hemoglobin levels. Multivariate logistic regression revealed PAT was an independent predictor for RCC requirement. PAT patients are more likely to require RCC following TKA and should be accurately monitored with respect to postoperative blood loss. PMID:27488941

  20. Impact of preoperative antithrombotic therapy on blood management after implantation of primary total knee arthroplasty.

    PubMed

    Leitner, Lukas; Musser, Ewald; Kastner, Norbert; Friesenbichler, Jörg; Hirzberger, Daniela; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

    2016-01-01

    Red blood cell concentrates (RCC) substitution after total knee arthroplasty (TKA) is correlated with multifold of complications and an independent predictor for higher postoperative mortality. TKA is mainly performed in elderly patients with pre-existing polymorbidity, often requiring permanent preoperative antithrombotic therapy (PAT). The aim of this retrospective analysis was to investigate the impact of demand for PAT on inpatient blood management in patients undergoing TKA. In this study 200 patients were retrospectively evaluated after TKA for differences between PAT and non-PAT regarding demographic parameters, preoperative ASA score > 2, duration of operation, pre-, and intraoperative hemoglobin level, and postoperative parameters including amount of wound drainage, RCC requirement, and inpatient time. In a multivariate logistic regression analysis the independent influences of PAT, demographic parameters, ASA score > 2, and duration of the operation on RCC demand following TKA were analyzed. Patients with PAT were significantly older, more often had an ASA > 2 at surgery, needed a higher number of RCCs units and more frequently and had lower perioperative hemoglobin levels. Multivariate logistic regression revealed PAT was an independent predictor for RCC requirement. PAT patients are more likely to require RCC following TKA and should be accurately monitored with respect to postoperative blood loss. PMID:27488941

  1. Poor Preoperative Glycemic Control Is Associated with Dismal Prognosis after Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Korean Multicenter Study

    PubMed Central

    Kang, Sung Gu; Hwang, Eu Chang; Jung, Seung Il; Yu, Ho Song; Chung, Ho Seok; Kang, Taek Won; Kwon, Dong Deuk; Hwang, Jun Eul; Kim, Jun Seok; Noh, Joon Hwa; You, Jae Hyung; Kim, Myung Ki; Oh, Tae Hoon; Seo, Ill Young; Baik, Seung; Kim, Chul-Sung; Kang, Seok Ho; Cheon, Jun

    2016-01-01

    Purpose The purpose of this study is to evaluate the effect of diabetes mellitus (DM) and preoperative glycemic control on prognosis in Korean patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). Materials and Methods A total of 566 patients who underwent RNU at six institutions between 2004 and 2014 were reviewed retrospectively. Kaplan-Meier and Cox regression analyses were performed to assess the association between DM, preoperative glycemic control, and recurrence-free, cancer-specific, and overall survival. Results The median follow-up period was 33.8 months (interquartile range, 41.4 months). A total of 135 patients (23.8%) had DM and 67 patients (11.8%) had poor preoperative glycemic control. Patients with poor preoperative glycemic control had significantly shorter median recurrence-free, cancer-specific, and overall survival than patients with good preoperative glycemic control and non-diabetics (all, p=0.001). In multivariable Cox regression analysis, DM with poor preoperative glycemic control showed association with worse recurrence-free survival (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.31 to 3.90; p=0.003), cancer-specific survival (HR, 2.96; 95% CI, 1.80 to 4.87; p=0.001), and overall survival (HR, 2.13; 95% CI, 1.40 to 3.22; p=0.001). Conclusion Diabetic UTUC patients with poor preoperative glycemic control had significantly worse oncologic outcomes than diabetic UTUC patients with good preoperative glycemic control and non-diabetics. Further investigation is needed to elucidate the exact mechanism underlying the impact of glycemic control on UTUC treatment outcome. PMID:27034146

  2. Profitable capitation requires accurate costing.

    PubMed

    West, D A; Hicks, L L; Balas, E A; West, T D

    1996-01-01

    In the name of costing accuracy, nurses are asked to track inventory use on per treatment basis when more significant costs, such as general overhead and nursing salaries, are usually allocated to patients or treatments on an average cost basis. Accurate treatment costing and financial viability require analysis of all resources actually consumed in treatment delivery, including nursing services and inventory. More precise costing information enables more profitable decisions as is demonstrated by comparing the ratio-of-cost-to-treatment method (aggregate costing) with alternative activity-based costing methods (ABC). Nurses must participate in this costing process to assure that capitation bids are based upon accurate costs rather than simple averages. PMID:8788799

  3. Implications of carotid sinus hypersensitivity following preoperative embolization of a carotid body tumor. An indication for prophylactic intraoperative cardiac pacing.

    PubMed

    Bauer, Ashley M; Smith, Russell B; Thorell, William E

    2014-05-01

    IMPORTANCE Carotid body tumors are rare neoplasms of neural crest origin that are both highly vascularized and locally invasive. Treatment options for these tumors often include surgery with preoperative embolization, which can pose major cardiovascular risk to patients. As demonstrated by this case report, hemodynamic instability following preoperative embolization of a carotid body tumor may indicate severe carotid sinus hypersensitivity and the need for temporary cardiac pacing. OBSERVATIONS This case report describes a man in his early 30s who presented for staged surgical resection of bilateral carotid body tumors with preoperative embolization. After embolization of the second tumor, the patient displayed transient episodes of bradycardia and hypotension, which resolved with medical management. Surgery commenced, and with minimal manipulation intraoperatively, the patient became asystolic and required resuscitation. Following a negative cardiac workup, a temporary pacemaker was implanted, and surgical resection of the tumor was successfully completed. CONCLUSIONS AND RELEVANCE Carotid sinus hypersensitivity is a rare but serious risk of preoperative embolization of carotid body tumors. Postembolization bradycardia or hypotension should be assessed as potential harbingers of carotid sinus hypersensitivity, and the need for temporary intraoperative cardiac pacing should be strongly considered. PMID:24651937

  4. Accurate density functional thermochemistry for larger molecules.

    SciTech Connect

    Raghavachari, K.; Stefanov, B. B.; Curtiss, L. A.; Lucent Tech.

    1997-06-20

    Density functional methods are combined with isodesmic bond separation reaction energies to yield accurate thermochemistry for larger molecules. Seven different density functionals are assessed for the evaluation of heats of formation, Delta H 0 (298 K), for a test set of 40 molecules composed of H, C, O and N. The use of bond separation energies results in a dramatic improvement in the accuracy of all the density functionals. The B3-LYP functional has the smallest mean absolute deviation from experiment (1.5 kcal mol/f).

  5. Preoperative digital mammography imaging in conservative mastectomy and immediate reconstruction

    PubMed Central

    Angrigiani, Claudio; Hammond, Dennis; Nava, Maurizio; Gonzalez, Eduardo; Rostagno, Roman; Gercovich, Gustavo

    2016-01-01

    Background Digital mammography clearly distinguishes gland tissue density from the overlying non-glandular breast tissue coverage, which corresponds to the existing tissue between the skin and the Cooper’s ligaments surrounding the gland (i.e., dermis and subcutaneous fat). Preoperative digital imaging can determine the thickness of this breast tissue coverage, thus facilitating planning of the most adequate surgical techniques and reconstructive procedures for each case. Methods This study aimed to describe the results of a retrospective study of 352 digital mammograms in 176 patients with different breast volumes who underwent preoperative conservative mastectomies. The breast tissue coverage thickness and its relationship with the breast volume were evaluated. Results The breast tissue coverage thickness ranged from 0.233 to 4.423 cm, with a mean value of 1.952 cm. A comparison of tissue coverage and breast volume revealed a non-direct relationship between these factors. Conclusions Preoperative planning should not depend only on breast volume. Flap evaluations based on preoperative imaging measurements might be helpful when planning a conservative mastectomy. Accordingly, we propose a breast tissue coverage classification (BTCC). PMID:26855903

  6. The Role of Preoperative TIPSS to Facilitate Curative Gastric Surgery

    SciTech Connect

    Norton, S.A.; Vickers, J.; Callaway, M.P. Alderson, D.

    2003-08-15

    The use of TIPSS to facilitate radical curative upper gastrointestinal surgery has not been reported. We describe a case in which curative gastric resection was performed for carcinoma of the stomach after a preoperative TIPSS and embolization of a large gastric varix in a patient with portal hypertension.

  7. Comparison of preoperative anxiety in reconstructive and cosmetic surgery patients.

    PubMed

    Sönmez, Ahmet; Bişkin, Nurdan; Bayramiçli, Mehmet; Numanoğlu, Ayhan

    2005-02-01

    Surgery is a serious stressor and a cause of anxiety for the patients. Reconstructive surgery patients are mostly operated on because of certain functional impairment or disability; on the contrary, cosmetic surgery patients do not have any physical impairment and they are operated on because of mostly psychologic reasons. The aim of this study was to compare the anxiety levels in the reconstructive surgery patients and cosmetic surgery patients preoperatively. Thirty-two patients in the reconstructive surgery group and 30 patients in the cosmetic surgery group were included in the study. State Trait Anxiety Inventory was used to measure the anxiety levels in these 2 groups preoperatively. The 2 groups were similar in characteristics such as age, gender distribution, number of previous operations, and trait anxiety scores. Mean state anxiety scores obtained for the reconstructive surgery group was 38.0 +/- 8.7, while it was 44.2 +/- 10.79 for the cosmetic surgery group (t test, degrees of freedom = 60, P = 0.015). This study reveals that preoperative anxiety levels in the cosmetic surgery patients are higher than those of the reconstructive surgery patients. Therefore, adequate preoperative preparation for cosmetic surgery should include attempts to cope with anxiety. Anxiolytics may be used more liberally and professional psychologic assistance may be required.

  8. The Concept of Death in Preoperational Retarded Children.

    ERIC Educational Resources Information Center

    Sternlicht, Manny

    1980-01-01

    Fourteen preoperational retarded boys and girls were interviewed for their concepts of death. Subjects did not have realistic concepts of when they would die, or of the permanence of death, but did have knowledge of how things die. Types of replies subjects made were significantly related to subjects' cognitive level. (Author/RH)

  9. Preoperative evaluation of a patient for abdominal aortic aneurysm repair.

    PubMed Central

    Chonchubhair, A. N.; Cunningham, A. J.

    1998-01-01

    Coexistent cardiovascular disease is common in patients presenting for repair of aortic aneurysms. However, preoperative cardiac evaluation prior to abdominal aortic aneurysm (AAA) surgery remains contentious with significant variations in practice between countries, institutions and individual anesthetists. The following case report raises some everyday issues confronting clinical anesthetists. PMID:10604782

  10. Preoperative diagnosis of colonic angiolipoma: a case report.

    PubMed

    Chen, Yang-Yuan; Soon, Maw-Soan

    2005-08-28

    Angiolipoma, a common benign tumor mostly seen in the subcutaneous tissue, is a rare pathological condition in the gastrointestinal tract that is usually diagnosed postoperatively. In this case report, an angiolipoma was diagnosed preoperatively by imaging (including CT scans, abdominal echo, barium enema, and colonoscopy). This pathology was confirmed postoperatively. Computed tomography scan, abdominal echo, and barium enema images were presented.

  11. Colorectal Stenting: An Effective Therapy for Preoperative and Palliative Treatment

    SciTech Connect

    Jost, Rahel S. Jost, Res; Schoch, Erich; Brunner, Brigit; Decurtins, Marco; Zollikofer, Christoph L.

    2007-06-15

    Purpose. To demonstrate the effectiveness of preoperative and palliative colorectal stent placement in acute colonic obstruction. Methods. Sixty-seven consecutive patients (mean age 67.3 years, range 25-93 years) with clinical and radiological signs of colonic obstruction were treated: 45 (67%) preoperatively and 22 (33%) with a palliative intent. In 59 patients (88%) the obstruction was malignant, while in 8 (12%) it was benign. A total of 73 enteric Wallstents were implanted under combined fluoroscopic/endoscopic guidance. Results. Forty-five patients were treated preoperatively with a technical success rate of 84%, a clinical success rate of 83%, and a complication rate of 16%. Of the 38 patients who were successfully stented preoperatively, 36 (95%) underwent surgery 2-22 days (mean 7.2 days) after stent insertion. The improved general condition and adequate bowel cleansing allowed single-stage tumor resection and primary end-to-end anastomosis without complications in 31 cases (86% of all operations), while only 5 patients had colostomies. Stent placement was used as the final palliative treatment in 22 patients. The technical success rate was 95%, the clinical success rate 72%, and the complication rate relatively high at 67%, caused by reocclusion in most cases. After noninvasive secondary interventions (e.g., tube placement, second stenting, balloon dilatation) the secondary patency of stents was 71% and mean reported survival time after stent insertion was 92 days (range 10-285 days). Conclusion. Preoperative stent placement in acute colonic obstruction is minimally invasive and allows an elective one-stage surgery in most cases. Stent placement also proved a valuable alternative to avoid colostomy in palliation.

  12. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

    PubMed

    Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

    2014-12-01

    Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p < 0.02) and used less narcotic use (average 1.7 tablets, p < 0.02) for the first 36 hours compared with group 1. No statistically significant differences were identified between the two groups with regard to demographics, hours of postoperative cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction.

  13. The Effect of Preoperative Ketorolac on WBC Response and Pain in Laparoscopic Surgery for Endometriosis

    PubMed Central

    2005-01-01

    Surgical stress causes changes in the composition of white blood cells (WBCs). Ketorolac is believed to have analgesic effects and to reduce the stress response and may therefore improve postoperative outcomes. The aim of this study was to assess the effect of preoperative ketorolac on the WBC subsets in patients who had laparoscopic surgery for endometriosis. Fifty patients who had laparoscopic surgery for endometriosis were randomly assigned to one of two groups: the ketorolac group (n = 25) received ketorolac 0.5 mg/kg before the induction of anesthesia, and the control group (n = 25) received saline. White cell count, differential, and pathology studies were done immediately after surgery, on postoperative day 1, and on postoperative day 3. We compared the baseline values within and between the two groups. We also assessed postoperative pain and side effects. The time that elapsed before the first patient request for analgesia, total meperidine dose and VAS (Visual Analog Scale) for postoperative pain were significantly lower in the ketorolac group than in the control group. Compared to the pre- surgical values, there was an increase in total WBC count and percentage of neutrophils, but a decrease in percentages of lymphocytes, monocytes, eosinophils, basophils, and leucocytes. Total WBC count, neutrophils, monocytes, eosinophils and leucocytes showed significant differences between the two groups. The incidences of postoperative side effects, such as nausea, dizziness, headache, and shoulder pain were not different between the groups. Preoperative ketorolac reduced postoperative pain and influenced the WBC response in laparoscopic surgery for endometriosis. PMID:16385658

  14. Preoperative Preparation and Patient Selection for Cytoreductive Surgery and HIPEC.

    PubMed

    Ashvin, Rangole; Nikhilesh, Jain

    2016-06-01

    Peritoneal dissemination is a significant variable affecting long term survival of abdominal cancer patients. A generally accepted clinical point of view is that peritoneal dissemination is tantamount to distant organ metastases. This implies it to be a terminal condition. Current practice dictates that if peritoneal dissemination is observed intraoperatively, the curative therapeutic options are deferred and comprehensive systemic chemotherapy remains the only option with a dismal prognosis. The past few years have generated lot of interest in management of peritoneal carcinomatosis. Prof Paul Sugarbaker has researched, validated and fine-tuned the concept of cytoreductive surgery with peritonectomy procedure (Sugarbaker technique) and perioperative chemotherapy as HIPEC & EPIC. Recognition of a HIPEC centre is based on an infrastructure equipped with basic knowledge of the tumor biology, oncosurgical techniques, technical knowhow for HIPEC administration, intensive care unit etc. There are some aspects which need to be accorded special consideration. Comprehensive therapy of Cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is initiated with exploration and cytoreductive surgery and includes visceral resections and peritonectomy procedure when achieved optimally results in complete, visible resection of all cancer within the abdomen and pelvis. Subsequent to CRS, HIPEC forms an integral part of the surgical procedure. This approach involves conceptual changes in both the route and timing of chemotherapy administration. Patient selection is of utmost importance. The greatest impediment to lasting benefits from intraperitoneal chemotherapy remains an improper patient selection. Currently, there are four important clinical assessments of peritoneal metastasis that need to be used to select patients ie; histopathological type of tumour, radiological distribution of disease, peritoneal cancer index and completeness of cytoreduction

  15. 77 FR 70484 - Preoperational Testing of Onsite Electric Power Systems To Verify Proper Load Group Assignments...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-26

    ... encompass preoperational testing of electrical power systems used to meet current Station Blackout... COMMISSION Preoperational Testing of Onsite Electric Power Systems To Verify Proper Load Group Assignments, Electrical Separation, and Redundancy AGENCY: Nuclear Regulatory Commission. ACTION: Draft regulatory...

  16. Influence of Preoperative Radiation Field on Postoperative Leak Rates in Esophageal Cancer Patients after Trimodality Therapy

    PubMed Central

    Juloori, Aditya; Tucker, Susan L.; Komaki, Ritsuko; Liao, Zhongxing; Correa, Arlene M.; Swisher, Stephen G.; Hofstetter, Wayne L.; Lin, Steven H.

    2014-01-01

    Introduction Postoperative morbidities, such as anastomotic leaks, are common after trimodality therapy (chemoradiation followed by surgery) for esophageal cancer. We investigated for factors associated with an increased incidence of anastomotic leaks. Methods Data from 285 esophageal cancer patients treated from 2000–2011 with trimodality therapy was analyzed. Anastomotic location relative to preoperative radiation field was assessed using postoperative computed tomographic imaging. Logistic regression was used to evaluate for factors associated with any or clinically relevant (CR) (≥ grade 2) leaks. Results Overall anastomotic leak rate was 11% (31/285), and CR leak rate was 6% (17/285). Multivariable analysis identified body mass index (BMI) (OR 1.09, 95%CI 1.00–1.17; OR 1.11, 95%CI 1.01–1.22), three-field surgery (OR 10.01, 95%CI 3.83–26.21; OR 4.83, 95%CI 1.39–16.71), and within radiation field (“in-field”) anastomosis (OR 5.37, 95%CI 2.21–13.04; OR 8.63, 95%CI 2.90–25.65) as independent predictors of both all grade and CR leaks, respectively. While patients with distal esophageal tumors and Ivor-Lewis surgery had the lowest incidence of all grade (6.5%) and CR leaks (4.2%), most of the leaks were associated with the anastomosis constructed within the field of radiation (in-field: 39% and 30% versus out-of-field: 2.6% and 1.0%, respectively, for total and CR leaks, p<0.0001, Fisher’s Exact test). Conclusions Esophagogastric anastomosis placed within the preoperative radiation field was a very strong predictor for anastomotic leaks in esophageal cancer patients treated with trimodality therapy, among other factors. Surgical planning should include a critical evaluation of the preoperative radiation fields to ensure proper anastomotic placement after chemoradiation therapy. PMID:24736077

  17. Minimizing the Risk of Preoperative Brain Injury in Neonates with Aortic Arch Obstruction

    PubMed Central

    Algra, Selma O.; Haas, Felix; Poskitt, Kenneth J.; Groenendaal, Floris; Schouten, Antonius N. J.; Jansen, Nicolaas J. G.; Azakie, Anthony; Gandhi, Sanjiv; Campbell, Andrew; Miller, Steven P.; McQuillen, Patrick S.; de Vries, Linda S.

    2015-01-01

    Objective To determine whether prenatal diagnosis lowers the risk of preoperative brain injury by assessing differences in the incidence of preoperative brain injury across centers. Study design From 2 prospective cohorts of newborns with complex congenital heart disease studied by preoperative cerebral magnetic resonance imaging, one cohort from the University Medical Center Utrecht (UMCU) and a combined cohort from the University of California San Francisco (UCSF) and University of British Columbia (UBC), patients with aortic arch obstruction were selected and their imaging and clinical course reviewed. Results Birth characteristics were comparable between UMCU (n = 33) and UCSF/UBC (n = 54). Patients had a hypoplastic aortic arch with either coarctation/interruption or hypoplastic left heart syndrome. In subjects with prenatal diagnosis, there was a significant difference in the prevalence of white matter injury (WMI) between centers (11 of 22 [50%] at UMCU vs 4 of 30 [13%] at UCSF/UBC; P < .01). Prenatal diagnosis was protective for WMI at UCSF/UBC (13% prenatal diagnoses vs 50% postnatal diagnoses; P < .01), but not at UMCU (50% vs 46%, respectively; P > .99). Differences in clinical practice between prenatally diagnosed subjects at UMCU vs UCSF/UBC included older age at surgery, less time spent in the intensive care unit, greater use of diuretics, less use of total parenteral nutrition (P < .01), and a greater incidence of infections (P = .01). In patients diagnosed postnatally, the prevalence of WMI was similar in the 2 centers (46%at UMCU vs 50% at UCSF/UBC; P > .99). Stroke prevalence was similar in the 2 centers regardless of prenatal diagnosis (prenatal diagnosis: 4.5% at Utrecht vs 6.7% at UCSF/UBC, P = .75; postnatal diagnosis: 9.1% vs 13%, respectively, P > .99). Conclusion Prenatal diagnosis can be protective for WMI, but this protection may be dependent on specific clinical management practices that differ across centers. PMID:25306190

  18. Preoperative biomarkers of tumour vascularity are elevated in patients with glioblastoma multiforme.

    PubMed

    Bennett, Iwan E; Guo, Hui; Kountouri, Nicole; D'abaco, Giovanna M; Hovens, Christopher M; Moffat, Bradford A; Desmond, Patricia; Drummond, Katharine; Kaye, Andrew H; Morokoff, Andrew P

    2015-11-01

    We investigated the correlation between the circulating and imaging biomarkers of tumour vascularity, and examined whether they are prognostic of outcomes in patients with glioblastoma multiforme (GBM). Despite the increasing use of anti-angiogenic agents within neuro-oncology, there are still no validated biomarkers to monitor for a treatment response or relapse. The pre- and postoperative circulating endothelial cell (CEC) and progenitor cell (CEP) levels were assessed. Preoperative perfusion-weighted MRI (PWI) was also performed, and the relative cerebral blood volume (rCBV) histogram statistics of the contrast-enhancing tumour were analysed. A novel PWI parameter (rCBVload) was developed to estimate the total volume of perfused tumour vessels, and it was hypothesised that this parameter would correlate with CEC and CEP concentrations. In total, 24 GBM patients were included. The mean preoperative CEC concentration was significantly higher in GBM patients than the controls (p=0.019), and it then declined significantly postoperatively (p=0.009). The preoperative CEP levels were significantly correlated with the median tumour rCBV (Spearman rank-order coefficient=0.526; p=0.039). Neither CEC nor CEP was correlated with the total tumour vessel volume, as measured by rCBVload. None of the biomarkers that were investigated showed a significant correlation with progression-free or overall survival. We conclude that CEC are potentially useful biomarkers to monitor GBM patients during treatment. We found that CEC are increased in the presence of GBM, and that CEP levels appear to be proportional to tumour vascularity, as measured on PWI. However, in this study, none of the biomarkers of GBM vascularity were highly prognostic of patient outcomes.

  19. Surgical treatment of small cell carcinoma of the lung: advantage of preoperative chemotherapy.

    PubMed

    Wada, H; Yokomise, H; Tanaka, F; Hirata, T; Fukuse, T; Bando, T; Inui, K; Ike, O; Mizuno, H; Hitomi, S

    1995-08-01

    To assess the effect of chemotherapy on postoperative survival of patients with small cell lung carcinoma (SCLC), 46 patients who underwent surgery at Kyoto University between 1976 and 1991 were retrospectively reviewed. Seventeen patients (37.0%) received chemotherapy prior to as well as after surgery (neoadjuvant therapy group), 23 (50.5%) received chemotherapy only after surgery (adjuvant therapy group), and the other six received no chemotherapy (non-chemotherapy group). The 5-year survival rate of patients with c-Stage I or II disease in the neoadjuvant therapy group was as high as 80.0%, which seemed to be higher, although with no statistical significance, than that in the adjuvant therapy group (37.7%, P = 0.10). The 5-year survival rate of patients with c-Stage III (IIIa or IIIb) disease in the neoadjuvant therapy group, although not satisfactory (10.0%), was significantly higher than that in the adjuvant therapy group (0.0%, P = 0.04). No patients in the non-chemotherapy group had survived 5 years. Moreover, multivariate analysis showed that failure to employ preoperative chemotherapy was the strongest prognostic factor causing a poor prognosis (P = 0.01). On the other hand, eight (30.8%) out of 26 patients with c-Stage I or II disease postoperatively proved to have mediastinal lymph node involvement (pN2-3), and two (7.7%) proved to have intrapulmonary metastasis (PM). Considering the advantage of preoperative chemotherapy and the discrepancy between c- and p-stage, sufficient chemotherapy prior to surgery should be employed, and may realize a good prognosis in patients with c-Stage I or II disease. In contrast, patients with c-Stage III disease are not appropriate as candidates for surgery even if preoperative chemotherapy is performed.

  20. Evaluation of preoperative staging for esophageal squamous cell carcinoma

    PubMed Central

    Luo, Lin-Na; He, Long-Jun; Gao, Xiao-Yan; Huang, Xin-Xin; Shan, Hong-Bo; Luo, Guang-Yu; Li, Yin; Lin, Shi-Yong; Wang, Guo-Bao; Zhang, Rong; Xu, Guo-Liang; Li, Jian-Jun

    2016-01-01

    Esophageal squamous cell carcinoma (ESCC) is known for its rapid progression and poor outcomes. China has the highest incidence and mortality in the world. Diagnoses made at early stages and accurate staging are associated with better outcomes, all of which can play a significant role in the selection of treatment protocols. ESCC is staged according to the widely accepted TNM system. Common imaging modalities used in staging ESCC before treatment include endoscopy, computed tomography (CT), positron emission tomography (PET) and magnetic resonance imaging (MRI). Endoscopic ultrasound is useful for staging tumor depth and nodal status. Narrow band imaging is valuable for early stage disease assessment. CT and PET provide additional valuable information regarding node and metastasis staging. The ability of MRI to delineate ESCC is continuously being improved and adds information regarding locoregional status to routine examinations. PMID:27547011

  1. The Prognostic Importance of Patient Pre-Operative Expectations of Surgery for Lumbar Spinal Stenosis.

    ERIC Educational Resources Information Center

    Iversen, Maura D.; Daltroy, Lawren H.; Fossel, Anne H.; Katz, Jeffrey N.

    1998-01-01

    Examines patients (N=257) with lumbar spinal stenosis preoperatively and at six months to relate patient expectation to baseline function and pain and to determine how patient expectations and preoperative function interact to predict postoperative outcomes. Results show that patients with many preoperative expectations, particularly those with…

  2. SPLASH: Accurate OH maser positions

    NASA Astrophysics Data System (ADS)

    Walsh, Andrew; Gomez, Jose F.; Jones, Paul; Cunningham, Maria; Green, James; Dawson, Joanne; Ellingsen, Simon; Breen, Shari; Imai, Hiroshi; Lowe, Vicki; Jones, Courtney

    2013-10-01

    The hydroxyl (OH) 18 cm lines are powerful and versatile probes of diffuse molecular gas, that may trace a largely unstudied component of the Galactic ISM. SPLASH (the Southern Parkes Large Area Survey in Hydroxyl) is a large, unbiased and fully-sampled survey of OH emission, absorption and masers in the Galactic Plane that will achieve sensitivities an order of magnitude better than previous work. In this proposal, we request ATCA time to follow up OH maser candidates. This will give us accurate (~10") positions of the masers, which can be compared to other maser positions from HOPS, MMB and MALT-45 and will provide full polarisation measurements towards a sample of OH masers that have not been observed in MAGMO.

  3. Preoperative Determinants of Patient-reported Pain and Physical Function Levels Following Total Knee Arthroplasty: A Systematic Review

    PubMed Central

    Lungu, E.; Vendittoli, P-A.; Desmeules, F.

    2016-01-01

    Background: A sound knowledge of the determinants of total knee arthroplasty (TKA) outcomes could help in patient selection, preparation and education. We aimed to assess the current status of the literature evaluating preoperative determinants of early and medium term patient-reported pain and disability following TKA. Method: A search in Medline, Pubmed, Embase and CINAHL until October 2014 was undertaken. Selection criteria included: 1- participants undergoing primary unilateral TKA with a follow-up from 6 months to 2 years, 2- validated disease-specific patient-reported outcome measures assessing pain and/or function used as outcome measure and 3- identification of preoperative determinants obtained via multivariate analyses. Risk of bias was assessed using a modified version of the Methodology checklist for prognostic studies. Results: Thirty-three prognostic explanatory studies were included. Mean total score of the methodological quality was 80.7±12.2 %. Sociodemographic and psychosocial determinants included greater socioeconomic deprivation (both studies), greater levels of depression and/or anxiety (7 out of 10 studies) and greater preoperative pain catastrophizing (all 3 studies). Significant clinical determinants included worse pre-operative knee related pain or disability (20 out of 22 studies), presence or greater levels of comorbidity (12 out of 23 studies), back pain (4 out of 5 studies) and lower general health (all 11 studies). Conclusion: Several significant determinants of short to medium-term pain and functional outcomes following TKA have been summarized by studies with moderate-to-high methodological quality. No conclusions can be reached regarding the strength of the associations between significant determinants and TKA results because of heterogeneity of study methodologies and results. Further high-quality research is required. PMID:27398109

  4. Accurate thickness measurement of graphene

    NASA Astrophysics Data System (ADS)

    Shearer, Cameron J.; Slattery, Ashley D.; Stapleton, Andrew J.; Shapter, Joseph G.; Gibson, Christopher T.

    2016-03-01

    Graphene has emerged as a material with a vast variety of applications. The electronic, optical and mechanical properties of graphene are strongly influenced by the number of layers present in a sample. As a result, the dimensional characterization of graphene films is crucial, especially with the continued development of new synthesis methods and applications. A number of techniques exist to determine the thickness of graphene films including optical contrast, Raman scattering and scanning probe microscopy techniques. Atomic force microscopy (AFM), in particular, is used extensively since it provides three-dimensional images that enable the measurement of the lateral dimensions of graphene films as well as the thickness, and by extension the number of layers present. However, in the literature AFM has proven to be inaccurate with a wide range of measured values for single layer graphene thickness reported (between 0.4 and 1.7 nm). This discrepancy has been attributed to tip-surface interactions, image feedback settings and surface chemistry. In this work, we use standard and carbon nanotube modified AFM probes and a relatively new AFM imaging mode known as PeakForce tapping mode to establish a protocol that will allow users to accurately determine the thickness of graphene films. In particular, the error in measuring the first layer is reduced from 0.1-1.3 nm to 0.1-0.3 nm. Furthermore, in the process we establish that the graphene-substrate adsorbate layer and imaging force, in particular the pressure the tip exerts on the surface, are crucial components in the accurate measurement of graphene using AFM. These findings can be applied to other 2D materials.

  5. Accurate thickness measurement of graphene.

    PubMed

    Shearer, Cameron J; Slattery, Ashley D; Stapleton, Andrew J; Shapter, Joseph G; Gibson, Christopher T

    2016-03-29

    Graphene has emerged as a material with a vast variety of applications. The electronic, optical and mechanical properties of graphene are strongly influenced by the number of layers present in a sample. As a result, the dimensional characterization of graphene films is crucial, especially with the continued development of new synthesis methods and applications. A number of techniques exist to determine the thickness of graphene films including optical contrast, Raman scattering and scanning probe microscopy techniques. Atomic force microscopy (AFM), in particular, is used extensively since it provides three-dimensional images that enable the measurement of the lateral dimensions of graphene films as well as the thickness, and by extension the number of layers present. However, in the literature AFM has proven to be inaccurate with a wide range of measured values for single layer graphene thickness reported (between 0.4 and 1.7 nm). This discrepancy has been attributed to tip-surface interactions, image feedback settings and surface chemistry. In this work, we use standard and carbon nanotube modified AFM probes and a relatively new AFM imaging mode known as PeakForce tapping mode to establish a protocol that will allow users to accurately determine the thickness of graphene films. In particular, the error in measuring the first layer is reduced from 0.1-1.3 nm to 0.1-0.3 nm. Furthermore, in the process we establish that the graphene-substrate adsorbate layer and imaging force, in particular the pressure the tip exerts on the surface, are crucial components in the accurate measurement of graphene using AFM. These findings can be applied to other 2D materials.

  6. Asian Rhinoplasty: Preoperative Simulation and Planning Using Adobe Photoshop.

    PubMed

    Kiranantawat, Kidakorn; Nguyen, Anh H

    2015-11-01

    A rhinoplasty in Asians differs from a rhinoplasty performed in patients of other ethnicities. Surgeons should understand the concept of Asian beauty, the nasal anatomy of Asians, and common problems encountered while operating on the Asian nose. With this understanding, surgeons can set appropriate goals, choose proper operative procedures, and provide an outcome that satisfies patients. In this article the authors define the concept of an Asian rhinoplasty-a paradigm shift from the traditional on-top augmentation rhinoplasty to a structurally integrated augmentation rhinoplasty-and provide a step-by-step procedure for the use of Adobe Photoshop as a preoperative program to simulate the expected surgical outcome for patients and to develop a preoperative plan for surgeons.

  7. Preoperative Proton Beam Therapy for Thymoma: A Case Report

    PubMed Central

    Isaka, Mitsuhiro; Nagata, Masashi; Onoe, Tsuyoshi; Murayama, Shigeyuki; Ohde, Yasuhisa

    2015-01-01

    We performed preoperative proton beam therapy for locally advanced thymoma and subsequently achieved complete resection. The patient was 31-year old woman, in whom chest computed tomography revealed a huge mass at the left anterior mediastinum. We diagnosed locally advanced type B3 thymoma. Because of the potential for complications to the lung and heart, definitive photon radiation therapy would have been difficult to administer. Therefore, we performed proton beam therapy, which could be administered within dose limitations. After proton beam therapy, the huge tumor had remarkably decreased in size. We were thereby able to achieve complete resection. As of 24 months after surgery, the patient has not developed any severe adverse events associated with proton beam therapy. Our experience suggests that preoperative proton beam therapy may be an effective modality for reducing tumor size, facilitating complete resection, and preventing toxicity of radiation therapy. PMID:26356685

  8. Combined modality preoperative therapy for unresectable rectal cancer.

    PubMed

    Percarpio, B; Bitterman, J; Sabbath, K; Alfano, F; Ruszkowski, R; Bowen, J

    1992-01-01

    Locally advanced rectal cancer has been a surgical challenge because of fixation of the primary tumor to the boney pelvis or to other pelvic soft tissues. During a 12-month period seven patients with locally advanced adenocarcinoma of the rectum were treated preoperatively with simultaneous pelvic irradiation (4500-5040 cGy) and infusion chemotherapy (5-fluorouracil 1000 mg per m2 per day over 96 hours and mitomycin 10 mg per m2. Tolerance was reasonable and all patients underwent successful resection of the primary lesion. Two patients had a complete response to preoperative combined modality therapy with no cancer found in the surgical specimen. With a short follow-up period, all patients have experienced satisfactory healing and none have suffered local or distant recurrence. The results of this limited series are encouraging for future clinical trials.

  9. Preoperative risk factors in recurrent endometrioma after primary conservative surgery

    PubMed Central

    Chon, Seung Joo; Lee, Seung Hyeong; Choi, Joo Hyun

    2016-01-01

    Objective Endometriosis is a common gynecological disorder caused by ectopic implantation of endometrial glandular and stromal cells outside the uterine cavity. Among several types of endometriosis, endometrioma is the only subtype that could be determined preoperatively using pelvic ultrasonography, and guidelines recommend pathologic confirmation of endometrioma greater than 3 cm in diameter. However, although surgery is performed in cases of endometrioma, endometrioma has a high cumulative rate of recurrence. Therefore, because determining the possibility of recurrence before performance of initial surgery is important, we examined preoperative factors associated with recurrent endometrioma. Methods This was a retrospective, comparative study including 236 patients who visited the outpatient clinic between January 2009 and December 2011. Patients who were pathologically diagnosed with endometrioma were included in this study. They were followed up postoperatively and were divided into two groups according to presence of recurrent endometrioma. Results We examined associations between baseline factors and recurrent endometrioma. In multivariate analysis, dysmenorrhea and cyst septation were statistically significant after adjusting with age, parity, surgical staging and postoperative management. We examined cumulative recurrence free survival within cases of recurrent endometriosis, based on the presence of inner cyst septation. The cumulative recurrence free survival was lower in cases with septation. Conclusion Our study found that recurrent endometrioma is more likely in patients with inner cyst septation and the recurrence occurred within a shorter duration of time than in patients without inner cyst septation on preoperative ultrasonography. Therefore intensive caution and postoperative long term medical therapy would be appropriate in patients with inner cyst septation on preoperative ultrasonography before undergoing primary surgery for endometrioma. PMID

  10. Preoperative embolization of primary bone tumors: A case control study

    PubMed Central

    Jha, Roushan; Sharma, Raju; Rastogi, Shishir; Khan, Shah Alam; Jayaswal, Arvind; Gamanagatti, Shivanand

    2016-01-01

    AIM: To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time. METHODS: Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison. RESULTS: The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications. CONCLUSION: Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume. PMID:27158424

  11. Diagnostic accuracy of preoperative clinical examination in upper limb injuries

    PubMed Central

    Dehghani, Mohammad; Shemshaki, Hamidreza; Eshaghi, Mohammad Amin; Teimouri, Mehdi

    2011-01-01

    Background: Injuries in hands and forearms may cause significant discomfort and disability. Aim: To evaluate the accuracy of preoperative clinical examination in depicting lesions caused by penetrating wounds of hands or forearms. Setting and Design: This prospective study was conducted from August 2006 to September 2009 at Kashani University Hospital, Isfahan University of Medical Sciences, Iran. Materials and Methods: Two hundred and fifty patients with clean penetrating injury to the hand/forearm were enrolled in this study. After patient's data registration, a careful clinical examination and routine exploration without expansion of wound were done by an orthopedic resident. Each tendon was tested at each joint level. Nerves were evaluated with a two-point discrimination test, and arteries were tested with palpable pulses. Surgical exploration was done by a single hand surgeon in operation room. Accuracy of clinical examination was compared to surgical examination. Results: During the study period, 180 (72%) males and 70 (28%) females with mean age of 28±4 years participated. The preoperative examination showed a predominance of the volar zone IV injuries followed by volar zone II, III, thumb zone II, volar zone V and thumb zone III. Despite the enough accuracy of preoperative examinations in dorsal side injuries of hands and forearms (error rate = 8.3%), the preoperative examinations significantly underestimated the amount of damage to soft tissues on the volar side of hands and forearms (error rate = 14%). Conclusions: The precise surgical evaluations should be considered in patients with penetrating injury to the hand or forearm, especially in those with volar side injuries. PMID:22090738

  12. Analysis of estrogen and progesterone receptors on preoperative fine-needle aspirates.

    PubMed

    Frigo, B; Pilotti, S; Zurrida, S; Ermellino, L; Manzari, A; Rilke, F

    1995-01-01

    For 56 cases of carcinoma of the breast, results of the immunocytochemical assay for estrogen and progesterone receptors performed on preoperative fine-needle aspirates were compared with those obtained on scraping material from the same tumors. The value and usefulness of this last analysis was demonstrated in a previous study. The level of agreement between the two cytological techniques was assessed by the k statistic. A high level of agreement was found, with k values of 0.909 and 0.889 for estrogen and progesterone receptors, respectively. The results reported here revealed the reliability of steroid receptor determination on fine-needle aspiration biopsies, provided that sufficient cellularity was available. This technique can replace the open biopsy procedure, in as much as it represents a rapid, almost painless, and easily repeated method for the assessment of the receptor status, and is useful for treatment decisions at any time during the course of the disease.

  13. Preoperative discussion with patients about delirium risk: are we doing enough?

    PubMed

    Tomlinson, Judith H; Partridge, Judith S L

    2016-01-01

    Postoperative delirium is a common complication in the older surgical population, occurring in 10-50 % of cases. It is thought to be more common if an individual is identified as frail. Postoperative delirium is associated with poor outcome including higher mortality rates, prolonged length of hospital stay, increased care needs on discharge and longer term post-traumatic stress disorder. Guidelines from the American Geriatric Society and the National Institute for Health and Care Excellence highlight the importance of risk assessment at the time of the preoperative visit. This enables the perioperative team to plan a care pathway that minimises the risk of delirium occurring postoperatively. Risk assessment also informs a discussion with patient and family regarding their risk, as part of a process of informed patient consent. This is an essential step in conforming to current legal and General Medical Council guidance on the process of consent. PMID:27594990

  14. [Preoperative Management of Patients with Bronchial Asthma or Chronic Bronchitis].

    PubMed

    Hagihira, Satoshi

    2015-09-01

    Bronchial asthma is characterized by chronic airway inflammation. The primary goal of treatment of asthma is to maintain the state of control. According to the Japanese guidelines (JGL2012), long-term management consists of 4 therapeutic steps, and use of inhaled corticosteroids (ICS) is recommended at all 4 steps. Besides ICS, inhalation of long-acting β2-agonist (LABA) is also effective. Recently, omalizumab (a humanized antihuman IgE antibody) can be available for patients with severe allergic asthma. Although there is no specific strategy for preoperative treatment of patients with asthma, preoperative systemic steroid administration seemed to be effective to prevent asthma attack during anesthesia. The most common cause of chronic bronchitis is smoking. Even the respiratory function is within normal limits, perioperative management of patients with chronic bronchitis is often troublesome. The most common problem is their sputum. To minimize perioperative pulmonary complication in these patients, smoking cessation and pulmonary rehabilitation are essential. It is known that more than 1 month of smoking cessation is required to reduce perioperative respiratory complication. However, even one or two weeks of smoking cessation can decrease sputum secretion. In summary, preoperative optimization is most important to prevent respiratory complication in patients with bronchial asthma or chronic bronchitis. PMID:26466493

  15. The preoperative interview. Its effect on perioperative nurses' empathy.

    PubMed

    Alverson, E

    1987-05-01

    Further studies need to be done to determine the impact preoperative visits have on the perioperative nurse's empathy level. The results of this study could be confirmed, or refuted, if a study with more subjects was conducted over a longer period of time. Also, subjects in both the control and experimental groups should be chosen randomly and should be from the same institution. To measure the long-term effect of preoperative visits on empathy levels, a study could be conducted that measures the levels at various times (eg, six months to a year following the first study). Other evaluations of empathy levels, such as observer rating and patient rating, could be used to supplement nurses self-rating scores to avoid using one standard instrument and rating scale. Few conclusions can be drawn from this limited study, but it does help nurses realize that preoperative interviews can help the nurse become more aware of the surgical patient as a human being. This increased awareness may help the nurse function more effectively and efficiently in helping the patient during intraoperative care.

  16. [Possibility of rice porridge for preoperative feeding in children].

    PubMed

    Kushikata, T; Matsuki, A; Murakawa, T; Sato, K

    1996-08-01

    To determine the effect of rice porridge feeding before elective surgery on preoperative gastric fluid pH, volume and starvation, a prospective study was undertaken in pediatric patients. Twenty healthy children ranged in age from 5 to 12 years were allocated randomly to either a fasted or rice porridge group. The children of fasted group (control group) were allowed to take solid food until midnight before the operation. The rice porridge group (study group) patients received a small amount of rice porridge 5 hours 30 minutes before the induction of anesthesia. The patients of both groups were permitted to take clear fluid until 5 hours before the induction of anesthesia. After the induction of anesthesia, gastric fluid was aspirated through an orogastric tube. The mean gastric fluid volume was 0.43 +/- 0.32 ml.kg-1 in the control group and 0.5 +/- 0.6 ml.kg-1 in the study group. The mean gastric fluid pH was 1.43 +/- 0.27 ml.kg-1 in the control group and 1.89 +/- 0.75 ml.kg-1 in the study group. There were no significant differences between the two groups concerning the gastric fluid volume and pH. The patient of the study group complained of less hunger. Preoperative rice porridge feeding is a possible preoperative feeding for pediatric patients.

  17. Preoperative staging of rectal cancer: the MERCURY research project.

    PubMed

    Brown, G; Daniels, I R

    2005-01-01

    The development of a surgical technique that removes the tumour and all local draining nodes in an intact package, namely total mesorectal excision (TME) surgery, has provided the impetus for a more selective approach to the administration of preoperative therapy. One of the most important factors that governs the success of TME surgery is the relationship of tumour to the circumferential resection margin (CRM). Tumour involves the CRM in up to 20% of patients undergoing TME surgery, and results in both poor survival and local recurrence. It is therefore clear that the importance of the decision regarding the use of pre-operative therapy lies with the relationship of the tumour to the mesorectal fascia. In addition, a high-spatial-resolution MRI technique will identify tumours exhibiting other poor prognostic features, namely, extramural spread >5 mm, extramural venous invasion by tumour, nodal involvement, and peritoneal infiltration. The potential benefits of a selective approach using MRI-based selection criteria are evident. That is, over 50% of patients can be treated successfully with primary surgery alone without significant risk of local recurrence or systemic failure. Of the remainder, potentially dramatic improvements may be achieved through the use of intensive and targeted preoperative therapy aimed not only at reducing the size of the primary tumour and rendering potentially irresectable tumour resectable with tumour-free circumferential margins, but also at enabling patients at high risk of systemic failure to benefit from intensive combined modality therapy aimed at eliminating micrometastatic disease. PMID:15865021

  18. Preoperative Breast Magnetic Resonance Imaging and Contralateral Breast Cancer Occurrence Among Older Women With Breast Cancer

    PubMed Central

    Long, Jessica B.; Killelea, Brigid K.; Evans, Suzanne B.; Roberts, Kenneth B.; Silber, Andrea; Gross, Cary P.

    2016-01-01

    Purpose Preoperative magnetic resonance imaging (MRI) detects occult contralateral breast cancers (CBCs) in women with breast cancer, but the impact of detection on long-term CBC events is unclear. We examined whether MRI use decreases the occurrence of CBCs and the detection of stages II to IV disease among women who develop a CBC. Patients and Methods Analyzing the SEER-Medicare database, we assessed overall, synchronous (< 6 months after primary cancer diagnosis), and subsequent (ie, metachronous) stage-specific CBC occurrences in women who were diagnosed with stages I and II breast cancer during 2004-2009 and who were observed through 2011. Results Among 38,971 women with breast cancer, 6,377 (16.4%) received preoperative MRI. After propensity score matching, and compared with women who did not undergo MRI, preoperative MRI use was significantly associated with a higher synchronous CBC detection rate (126.4 v 42.9 per 1,000 person-years, respectively; hazard ratio, 2.85; P < .001) but a lower subsequent CBC detection rate (3.3 v 4.5 per 1,000 person-years, respectively; hazard ratio, 0.68; P = .002). However, the 5-year cumulative incidence of CBC remained significantly higher among women undergoing MRI compared with those not undergoing MRI (7.2% v 4.0%, respectively; P < .001). The analyses of projected CBC events for 10,000 patients who receive MRI indicated that, after a 5-year follow-up, MRI use would detect an additional 192 in situ CBCs (95% CI, 125 to 279) and 120 stage I CBCs (95% CI, 62 to 193) but would not have a significant impact on stages II to IV CBC occurrences (∼ 6; 95% CI, −21 to 47). Conclusion An increased synchronous CBC detection rate, attributable to MRI, was not offset by a decrease of subsequent CBC occurrence among older women with early-stage breast cancer, suggesting that preoperative MRI in women with breast cancer may lead to overdiagnosis. PMID:26628465

  19. Clinical target volume delineation in glioblastomas: pre-operative versus post-operative/pre-radiotherapy MRI

    PubMed Central

    Farace, P; Giri, M G; Meliadò, G; Amelio, D; Widesott, L; Ricciardi, G K; Dall'Oglio, S; Rizzotti, A; Sbarbati, A; Beltramello, A; Maluta, S; Amichetti, M

    2011-01-01

    Objectives Delineation of clinical target volume (CTV) is still controversial in glioblastomas. In order to assess the differences in volume and shape of the radiotherapy target, the use of pre-operative vs post-operative/pre-radiotherapy T1 and T2 weighted MRI was compared. Methods 4 CTVs were delineated in 24 patients pre-operatively and post-operatively using T1 contrast-enhanced (T1PRECTV and T1POSTCTV) and T2 weighted images (T2PRECTV and T2POSTCTV). Pre-operative MRI examinations were performed the day before surgery, whereas post-operative examinations were acquired 1 month after surgery and before chemoradiation. A concordance index (CI) was defined as the ratio between the overlapping and composite volumes. Results The volumes of T1PRECTV and T1POSTCTV were not statistically different (248 ± 88 vs 254 ± 101), although volume differences >100 cm3 were observed in 6 out of 24 patients. A marked increase due to tumour progression was shown in three patients. Three patients showed a decrease because of a reduced mass effect. A significant reduction occurred between pre-operative and post-operative T2 volumes (139 ± 68 vs 78 ± 59). Lack of concordance was observed between T1PRECTV and T1POSTCTV (CI = 0.67 ± 0.09), T2PRECTV and T2POSTCTV (CI = 0.39 ± 0.20) and comparing the portion of the T1PRECTV and T1POSTCTV not covered by that defined on T2PRECTV images (CI = 0.45 ± 0.16 and 0.44 ± 0.17, respectively). Conclusion Using T2 MRI, huge variations can be observed in peritumoural oedema, which are probably due to steroid treatment. Using T1 MRI, brain shifts after surgery and possible progressive enhancing lesions produce substantial differences in CTVs. Our data support the use of post-operative/pre-radiotherapy T1 weighted MRI for planning purposes. PMID:21045069

  20. Preoperative treatment with radiochemotherapy for locally advanced gastroesophageal junction cancer and unresectable locally advanced gastric cancer

    PubMed Central

    Ratosa, Ivica; Oblak, Irena; Anderluh, Franc; Velenik, Vaneja; But-Hadzic, Jasna; Ermenc, Ajra Secerov; Jeromen, Ana

    2015-01-01

    Background. To purpose of the study was to analyze the results of preoperative radiochemotherapy in patients with unresectable gastric or locoregionally advanced gastroesophageal junction (GEJ) cancer treated at a single institution. Patients and methods. Between 1/2004 and 6/2012, 90 patients with locoregionally advanced GEJ or unresectable gastric cancer were treated with preoperative radiochemotherapy at the Institute of Oncology Ljubljana. Planned treatment schedule consisted of induction chemotherapy with 5-fluorouracil and cisplatin, followed by concomitant radiochemotherapy four weeks later. Three-dimensional conformal external beam radiotherapy was delivered by dual energy (6 and 15 MV) linear accelerator in 25 daily fractions of 1.8 Gy in 5 weeks with two additional cycles of chemotherapy repeated every 28 days. Surgery was performed 4–6 weeks after completing radiochemotherapy. Following the surgery, multidisciplinary advisory team reassessed patients for the need of adjuvant chemotherapy. The primary endpoints were histopathological R0 resection rate and pathological response rate. The secondary endpoints were toxicity of preoperative radiochemotherapy and survival. Results. Treatment with preoperative radiochemotherapy was completed according to the protocol in 84 of 90 patients (93.3%). Twenty patients (22.2%) did not undergo the surgery because of the disease progression, serious comorbidity, poor performance status or still unresectable tumour. In 13 patients (14.4%) only exploration was performed because the tumour was assessed as unresectable or diffuse peritoneal carcinomatosis was established. Fifty-seven patients (63.4%) underwent surgery with the aim of complete removal of the tumour. Radical resection was achieved in 50 (55.6%) patients and the remaining seven (7.8%) patients underwent non-radical surgery (R1 in five and R2 in two patients). In this group of patients (n = 57), pathological complete response of tumour was achieved in five

  1. [INTERRELATION BETWEEN THE PREOPERATIVE MORPHOLOGICAL CHARACTERISTICS OF PERIPHERAL BLOOD AND THE QUALITY OF ENGRAFTMENT OF VASCULARIZED ADIPO-FASCIO-CUTANEOUS FLAPS IN RATS].

    PubMed

    Shchudlo, N A; Shchudlo, M M; Sbrodova, L I

    2016-01-01

    The aim of this work was to determine the interrelation between the preoperative blood counts and the quality of vascularized adipo-fascio-cutaneous flap survival. In 10 adult male Wistar rats, a flap with the area of 18 cm2 was formed on the basis of superficial inferior epigastric artery; after a 90 min ischemic period it was replanted. 12 days after operation the quality of flap survival was assessed with computer-assisted planimetry. It was found that the combination of preoperative leukocyte, thrombocyte, neutrophil and eosinophil counts as well as reactive lymphocyte counts close to the maximal reference values increased the probability of epidermolysis. PMID:27487668

  2. [INTERRELATION BETWEEN THE PREOPERATIVE MORPHOLOGICAL CHARACTERISTICS OF PERIPHERAL BLOOD AND THE QUALITY OF ENGRAFTMENT OF VASCULARIZED ADIPO-FASCIO-CUTANEOUS FLAPS IN RATS].

    PubMed

    Shchudlo, N A; Shchudlo, M M; Sbrodova, L I

    2016-01-01

    The aim of this work was to determine the interrelation between the preoperative blood counts and the quality of vascularized adipo-fascio-cutaneous flap survival. In 10 adult male Wistar rats, a flap with the area of 18 cm2 was formed on the basis of superficial inferior epigastric artery; after a 90 min ischemic period it was replanted. 12 days after operation the quality of flap survival was assessed with computer-assisted planimetry. It was found that the combination of preoperative leukocyte, thrombocyte, neutrophil and eosinophil counts as well as reactive lymphocyte counts close to the maximal reference values increased the probability of epidermolysis.

  3. [Pre-operative nutrition support in patients waiting for digestive surgery at Hospital Mateu Orfila (Maó-Menorca)].

    PubMed

    Lluch Taltavull, Josep; Mercadal Orfila, Gabriel; Alcaide Matas, Fernando

    2014-09-01

    Malnutrition is associated with high postoperative morbidity and mortality rates. This pilot study evaluated the effectiveness of a peri-operative nutritional support programme for patients who were about to undergo major gastrointestinal surgery. A high-calorie/high-protein enteral formula was administered peri-operatively to the group of patients at nutritional risk/with malnutrition (NR/MN). In order to assess the effectiveness of the preoperative nutritional intervention, the results were compared to a retrospective control group. Statistically-significant differences were found between the two NR/MN groups in incidence of vomiting; wound infection; hyperglycaemia; death in hospital; length of hospital stay; time in ICU; and administration of TPN. Postoperative progress was found to be better in the group of NR/MN patients supplemented preoperatively with an enteral nutrition formula.

  4. Prediction of recurrence after HCC resection. Faint oily deposits on preoperative Lipiodol-CT of remnant liver tissue.

    PubMed

    Yamamoto, M; Iimuro, Y; Mogaki, M; Kachi, K; Fujii, H; Matsumoto, Y

    1994-07-01

    In trying to clarify the high recurrence rate after removal of small hepatocellular carcinoma (HCC), we assessed the postoperative evolution of minute hepatic Lipiodol deposits which had been diagnosed as artifacts on the preoperative Lipiodol-CT. Of 27 patients with solitary HCC less than 5 cm in diameter, 14 had such Lipiodol deposits in the preoperative CT and 9 of them (64%) developed recurrent tumors. On the other hand, 6 of the 13 patients without deposits (46%) suffered recurrence, but in 5 of these 6 patients the HCC was metachronous multicentric. The cumulative survival rate of the non-deposit group was better than that of the deposit group (p < 0.1). The present study suggested that, even in patients with small HCC, minute concomitant tumors invisible by conventional imaging techniques may exist at the time of surgery. Some of these lesions without sufficient tumor vasculature showing a hypervascular blush on angiography appear to retain small, vague Lipiodol deposits.

  5. Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist.

    PubMed

    Lall, Rishi R; Lall, Rohan R; Hauptman, Jason S; Munoz, Carlos; Cybulski, George R; Koski, Tyler; Ganju, Aruna; Fessler, Richard G; Smith, Zachary A

    2012-11-01

    Spine surgery carries an inherent risk of damage to critical neural structures. Intraoperative neurophysiological monitoring (IONM) is frequently used to improve the safety of spine surgery by providing real-time assessment of neural structures at risk. Evidence-based guidelines for safe and efficacious use of IONM are lacking and its use is largely driven by surgeon preference and medicolegal issues. Due to this lack of standardization, the preoperative sign-in serves as a critical opportunity for 3-way discussion between the neurosurgeon, anesthesiologist, and neuromonitoring team regarding the necessity for and goals of IONM in the ensuing case. This analysis contains a review of commonly used IONM modalities including somatosensory evoked potentials, motor evoked potentials, spontaneous or free-running electromyography, triggered electromyography, and combined multimodal IONM. For each modality the methodology, interpretation, and reported sensitivity and specificity for neurological injury are addressed. This is followed by a discussion of important IONM-related issues to include in the preoperative checklist, including anesthetic protocol, warning criteria for possible neurological injury, and consideration of what steps to take in response to a positive alarm. The authors conclude with a cost-effectiveness analysis of IONM, and offer recommendations for IONM use during various forms of spine surgery, including both complex spine and minimally invasive procedures, as well as lower-risk spinal operations.

  6. Effect of Preoperative Vitamin D Levels on Functional Performance after Total Knee Arthroplasty

    PubMed Central

    Patil, Aniket Machindra; Maniar, Adit Rajesh; Gangaraju, Bharat; Singh, Jaivardhan

    2016-01-01

    Background Low vitamin D levels affects muscle function. Vitamin D and calcium deficiency cause osteomalacic myopathy and poor functional recovery after hip fractures. The relationship of vitamin D and functional performance after total knee arthroplasty (TKA) is not previously reported. Methods Influence of vitamin D on functional performance before and after TKA was reviewed retrospectively in 120 patients. Of these, 64 had vitamin D deficiency (25-hydroxy vitamin D < 30 ng/mL) preoperatively. All 120 patients received vitamin D oral supplementation postoperatively. Functional parameters including Western Ontario and McMaster Osteoarthritis Index (WOMAC), Short-Form Health Survey questionnaire, and Knee Society Score were assessed pre- and postoperatively at 3 months. Results Preoperative function was significantly lower in osteoarthritic patients with vitamin D deficiency (WOMAC score; p = 0.040), but at 3 months all functional scores were similar. Conclusions We concluded that vitamin D deficiency has a negative effect on function in knee osteoarthritic patients. However, postoperative vitamin D supplementation can lead to functional recovery in these patients. Thus, TKA should not be delayed in vitamin D deficient patients; rather supplementation in the postoperative period is preferable to achieve comparable functional outcome at 3 months to patients with vitamin D sufficiency. PMID:27247739

  7. Pre-Operative History of Depression and Cognitive Changes in Bariatric Surgery Patients

    PubMed Central

    Alosco, Michael L.; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D.; Mitchell, James E.; Gunstad, John

    2016-01-01

    Obesity associated cognitive impairments may be partially reversible through bariatric surgery. Depression, a prevalent comorbidity in bariatric surgery candidates, is linked with cognitive impairment and poorer surgical outcomes in other populations. No study has examined the effects of pre-operative depression on cognitive changes in bariatric surgery patients. 67 bariatric surgery patients completed a computerized cognitive test battery prior to surgery and 12-months post-operatively. The Structured Clinical Interview for the DSM-IV Axis I disorders assessed Major Depressive Disorder (MDD). Pre-surgery history of MDD was found in 47.8% of patients, but was not associated with greater baseline cognitive impairments. Repeated measures revealed improved cognitive abilities 12-months after surgery. Pre-surgery history of MDD did not influence post-operative cognitive function. Pre-operative history of MDD did not limit post-operative cognitive improvements. Larger studies with extended follow-ups are needed to clarify our findings and identify factors (e.g., older age) that may modify cognitive changes following surgery. PMID:25222138

  8. Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery

    PubMed Central

    Robleda, Gemma; Sillero-Sillero, Amalia; Puig, Teresa; Gich, Ignasi; Baños, Josep-E

    2014-01-01

    OBJECTIVES: to analyze the relationship between preoperative emotional state and the prevalence and intensity of postoperative pain and to explore predictors of postoperative pain. METHOD: observational retrospective study undertaken among 127 adult patients of orthopedic and trauma surgery. Postoperative pain was assessed with the verbal numeric scale and with five variables of emotional state: anxiety, sweating, stress, fear, and crying. The Chi-squared test, Student's t test or ANOVA and a multivariate logistic regression analysis were used for the statistical analysis. RESULTS: the prevalence of immediate postoperative pain was 28%. Anxiety was the most common emotional factor (72%) and a predictive risk factor for moderate to severe postoperative pain (OR: 4.60, 95% CI 1.38 to 15.3, p<0.05, AUC: 0.72, 95% CI: 0.62 to 0.83). Age exerted a protective effect (OR 0.96, 95% CI: 0.94-0.99, p<0.01). CONCLUSION: preoperative anxiety and age are predictors of postoperative pain in patients undergoing orthopedic and trauma surgery. PMID:25493674

  9. The radiation-induced changes in rectal mucosa: Hyperfractionated vs. hypofractionated preoperative radiation for rectal cancer

    SciTech Connect

    Starzewski, Jacek J.; Pajak, Jacek T.; Pawelczyk, Iwona; Lange, Dariusz; Golka, Dariusz . E-mail: dargolka@wp.pl; Brzeziska, Monika; Lorenc, Zbigniew

    2006-03-01

    Purpose: The purpose of the study was the qualitative and quantitative evaluation of acute radiation-induced rectal changes in patients who underwent preoperative radiotherapy according to two different irradiation protocols. Patients and Methods: Sixty-eight patients with rectal adenocarcinoma underwent preoperative radiotherapy; 44 and 24 patients underwent hyperfractionated and hypofractionated protocol, respectively. Fifteen patients treated with surgery alone served as a control group. Five basic histopathologic features (meganucleosis, inflammatory infiltrations, eosinophils, mucus secretion, and erosions) and two additional features (mitotic figures and architectural glandular abnormalities) of radiation-induced changes were qualified and quantified. Results: Acute radiation-induced reactions were found in 66 patients. The most common were eosinophilic and plasma-cell inflammatory infiltrations (65 patients), erosions, and decreased mucus secretion (54 patients). Meganucleosis and mitotic figures were more common in patients who underwent hyperfractionated radiotherapy. The least common were the glandular architectural distortions, especially in patients treated with hypofractionated radiotherapy. Statistically significant differences in morphologic parameters studied between groups treated with different irradiation protocols were found. Conclusion: The system of assessment is a valuable tool in the evaluation of radiation-induced changes in the rectal mucosa. A greater intensity of regenerative changes was found in patients treated with hyperfractionated radiotherapy.

  10. Physics-based simulation of surgical fields for preoperative strategic planning.

    PubMed

    Nakao, Megumi; Kuroda, Tomohiro; Oyama, Hiroshi; Sakaguchi, Genichi; Komeda, Masashi

    2006-10-01

    Although careful planning of surgical approach is a key for success of surgery, conventional planning and simulation tools cannot support detailed discussion. This issue is derived from the difficulty of estimating complex physical behavior of soft tissues provided by a series of surgical procedures like cutting and deformation. This paper proposes an adaptive physics-based framework that simulates both interactive cutting and accurate deformation on virtual bodies, and performs preoperative planning for supporting strategic discussion. We focus on limited use of the two models: A particle-based model and an FEM-based model considering required quality and performance in different situations. FEM-based deformation of incision accurately produces estimated surgical fields. Based on the framework, a strategic planning system was developed for supporting decision of surgical approach using 3D representation of the surgical fields. We applied clinical CT dataset of an aortic aneurysm case to the system. Some experiments and usability tests confirmed that the system contributes to grasping 3D shape and location of the target organs and performs detailed discussion on patient-specific surgical approaches.

  11. Are routine preoperative CT scans necessary in adult cochlear implantation? Implications for the allocation of resources in cochlear implant programs.

    PubMed

    Kenway, Bruno; Vlastarakos, Petros V; Kasbekar, Anand V; Axon, Patrick R; Donnelly, Neil

    2016-08-01

    Our aim was to critically assess the influence of preoperative computed tomography (CT) scans on implantation decisions for adult cochlear implant candidates. The working hypothesis was that these routine scans might not provide critical additional information in most adult cochlear implant candidates. The charts of 175 adults with unilateral cochlear implantation were reviewed. Preoperative CT scan reports were audited, and scans with reported pathology were examined by an Otologist/ENT Surgeon. Clinic notes and multidisciplinary team meeting summaries were also analyzed to assess whether the results of the radiology report had influenced the decision to implant or the laterality of implantation. Twenty-five of the 175 scans (14.3%) showed an abnormality. Five of those 25 scans showed evidence of previous surgeries already known to the clinicians. Of the remaining 20 scans, 17 showed abnormalities, including wide vestibular aqueducts, Mondini deformities, and varying degrees of otospongiosis, the identification of which can be considered preoperatively helpful. Of the 175 scans, 3 (1.7%) demonstrated abnormalities that influenced the side of implantation or the decision to implant and, therefore, had an impact on treatment. We conclude that a preoperative CT scan seems to have an impact on treatment in only a small percentage of adult cochlear implantees. Hence, it may only need to be performed in patients with a history or clinical suspicion of meningitis or otosclerosis, if the individual was born deaf or became deaf before the age of 16, or if there are other clinical reasons to scan (e.g., otoscopic appearance). The related resources can be allocated to other facets of cochlear implant programs. PMID:27551842

  12. An observational cohort study on pre-operative investigations and referrals: How far are we following recommendations?

    PubMed Central

    Karim, Habib Md Reazaul; Yunus, Md; Bhattacharyya, Prithwis

    2016-01-01

    Background and Aims: Pre-operative investigations are often required to supplement information for risk stratification and assessing reserve for undergoing surgery. Although there are evidence-based recommendations for which investigations should be done, clinical practice varies. The present study aimed to assess the pre-operative investigations and referral practices and compare it with the standard guidelines. Methods: The present observational study was carried out during 2014–appen2015 in a teaching institute after the approval from Institute Ethical Committee. A designated anaesthesiologist collected data from the completed pre-anaesthetic check-up (PAC) sheets. Investigations already done, asked by anaesthesiologists as well as referral services sought were noted and compared with an adapted master table prepared from standard recommendations and guidelines. Data were expressed in frequencies, percentage and statistically analysed using INSTAT software (GraphPad Prism software Inc., La Zolla, USA). Results: Seventy-five out of 352 patients (42.67% male, 57.33% female; American Society of Anesthesiologists physical status I to III) were included in this study. Nearly, all patients attended PAC with at least 5 investigations done. Of them, 89.33% were subjected to at least one unnecessary investigation and 91.67% of the referral services were not required which lead to 3.5 ( SD ±1.64) days loss. Anaesthesiologist-ordered testing was more focused than surgeons. Conclusion: More than two-third of pre-operative investigations and referral services are unnecessary. Anaesthesiologists are relatively more rational in ordering pre-operative tests yet; a lot can be done to rationalise the practice as well as reducing healthcare cost. PMID:27601737

  13. A new computational model for human thyroid cancer enhances the preoperative diagnostic efficacy

    PubMed Central

    Li, Tuo; Sheng, Jianguo; Li, Weiqin; Zhang, Xin; Yu, Hongyu; Chen, Xueyun; Zhang, Jianquan; Cai, Quancai; Shi, Yongquan; Liu, Zhimin

    2015-01-01

    Considering the high rate of missed diagnosis and delayed treatments for thyroid cancer, an effective systematic model for the differential diagnosis is highly needed. Thus we analyzed the data on the clinicopathological characteristics, routine laboratory tests and imaging examinations in a cohort of 13,980 patients with thyroid cancer to establish a new diagnostic model for differentiating thyroid cancer in clinical practice. Here, we randomly selected two-thirds of the population to develop the thyroid malignancy risk scoring system (TMRS) for preoperative differentiation between thyroid cancer and benignant thyroid diseases, and then validated its differential diagnostic power in the rest one-third population. The 18 predictors finally enrolled in the TMRS included male gender, clinical manifestations (fever, neck sore, neck lump, palpitations or sweating), laboratory findings (TSH>1.56mIU/L, FT3>5.85pmol/L, TPOAb>14.97IU/ml, TgAb>48.00IU/ml, Tg>34.59μg/L, Ct>64.00ng/L, and CEA>0.41μg/L), and ultrasound features (tumor number≤ 23mm, site, size, echo texture, margins, and shape of neck lymphnodes). The TMRS is validated to be well-calibrated (P = 0.437) and excellently discriminated (AUC = 0.93, 95% CI [0.92, 0.94]), with an accuracy of 83.2%, a sensitivity of 89.3%, a specificity of 81.5%, positive and negative predictive values of 56.8% and 96.6%, positive and negative likelihood ratios of 4.83 and 0.13 in the development cohort, respectively. The TMRS highlights that this differential diagnostic system could help provide accurate preoperative risk stratification for thyroid cancer, and avoid unnecessary over- and under-treatment for such patients. PMID:26325368

  14. The relevance of preoperative ultrasound cervical mapping in patients with thyroid cancer

    PubMed Central

    Kocharyan, Davit; Schwenter, Frank; Bélair, Manon; Nassif, Edgard

    2016-01-01

    Background Cervical lymph node involvement in thyroid cancer is associated with locoregional recurrence and decreased disease-free survival. Preoperative lymph node mapping helps in planning surgery for neck dissection and improves patient outcomes. We sought to perform a qualitative and quantitative analysis of ultrasound mapping for thyroid cancer and evaluate the clinical importance of this exam in terms of identifying the group of patients who would benefit most from subsequent surgical dissection. Methods We retrospectively reviewed the cases of 263 patients who underwent thyroid surgery between 2009 and 2013. We calculated the positive predictive values (PPVs) of ultrasound mapping of both the lateral and central compartments together and the lateral or central compartment individually. A quantitative analysis was performed by comparing the number of positive lymph nodes at ultrasound imaging with histopathologic evaluation. Results A total of 136 cases of thyroid cancer in 120 patients met the inclusion criteria for ultrasound mapping analysis. The PPVs (and 95% confidence intervals) were 83.82 (0.76–0.89) for the lateral and central compartments, 85.39% (0.76–0.91) for the lateral compartment, and 80.48% (0.7–0.87) for the central compartment. When comparing the positive lymph nodes at ultrasound imaging with histopathologic evaluation, the result was χ2 = 10.33 (p = 0.006). Conclusion This single-institution study indicated that preoperative ultrasound mapping is an accurate imaging procedure for predicting lymphatic spread in differentiated and medullary thyroid cancer. Ultrasound mapping can be used as an efficient tool for surgical planning and prognosis determination, as well as for identifying the group of patients who would benefit most from subsequent surgical intervention. PMID:27007092

  15. Effect of Nerve-Sparing Radical Prostatectomy on Urinary Continence in Patients With Preoperative Erectile Dysfunction

    PubMed Central

    2016-01-01

    Purpose: We aimed to assess whether nerve-sparing radical prostatectomy (nsRP) is associated with improved recovery of urinary continence compared to non–nerve-sparing radical prostatectomy (nnsRP) in patients with localized prostate cancer and preoperative erectile dysfunction. Methods: A total of 360 patients with organ-confined prostate cancer and an International Index of Erectile Function score of less than 17 were treated with nsRP or nnsRP in Seoul St. Mary’s Hospital. Patients who received neoadjuvant or adjuvant androgen deprivation therapy or had a history of prostate-related surgery were excluded. Recovery of urinary continence was assessed at 0, 1, 3, 6, and 12 months. Postoperative recovery of continence was defined as zero pad usage. The association between nerve-sparing status and urinary continence was assessed by using univariate and multivariate Cox regression analyses after controlling for known predictive factors. Results: Urinary continence recovered in 279 patients (77.5%) within the mean follow-up period of 22.5 months (range, 6–123 months). Recovery of urinary continence was reported in 74.6% and 86.4% of patients after nnsRP and nsRP, respectively, at 12 months (P=0.022). All groups had comparable perioperative criteria and had no significant preoperative morbidities. Age, American Society of Anesthesiologists score, and nerve-sparing status were significantly associated with recovery of urinary continence on univariate analysis. On multivariate analysis, age (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.002–1.478; P=0.026) and nerve-sparing status (HR, 0.713; 95% CI, 0.548–0.929; P=0.012) were independently associated with recovery of urinary continence. Conclusions: nsRP, as compared to nnsRP, improves recovery rates of urinary incontinence and decreases surgical morbidity without compromising pathologic outcomes. PMID:27032560

  16. Do preoperative fear avoidance model factors predict outcomes after lumbar disc herniation surgery? A systematic review

    PubMed Central

    2013-01-01

    Background Lumbar disc herniation (LDH) surgery is usually recommended when conservative treatments fail to manage patients’ symptoms. However, many patients undergoing LDH surgery continue to report pain and disability. Preoperative psychological factors have shown to be predictive for postoperative outcomes. Our aim was to systematically review studies that prospectively examined the prognostic value of factors in the Fear Avoidance Model (FAM), including back pain, leg pain, catastrophizing, anxiety, fear-avoidance, depression, physical activity and disability, to predict postoperative outcomes in patients undergoing LDH surgery. Methods We performed a systematic literature review of prospective studies that measured any FAM factors preoperatively to predict postoperative outcomes for patients undergoing LDH surgery. Our search databases included PubMed, CINAHL, and PsycINFO. We assessed the quality of each included study using a certain quality assessment list. Degree of agreement between reviewers on quality assessment was examined. Results related to FAM factors in the included studies were summarized. Results Thirteen prospective studies met our inclusion criteria. Most studies were considered high quality. Heterogeneity was present between the included studies in many aspects. The most common FAM factors examinered were baseline pain, disability and depression. In, general, depression, fear-avoidance behaviors, passive pain coping, and anxiety FAM factors appeared to have negative influence on LDH surgical outcome. Baseline back pain and leg pain appeared to have differing prognostic value on LDH surgical outcomes. Conclusions FAM factors seem to influence LDH surgical outcomes. Patients with high levels of depression, anxiety and fear-avoidance behaviors are more likely to have poor outcomes following LDH surgery. Conversely, high levels of leg pain, but not back pain seem to be predictor for favorable LDH surgery outcome. More research is needed to

  17. [CT assessment of encephalic and suprarenal spread of "operable" pulmonary neoplasms. Preliminary results].

    PubMed

    Volterrani, L; Tucci, E; Maccherini, M; Trusso, M; Forzini, L; Gotti, G

    1989-04-01

    Computed Tomography (CT) was employed to evaluate the incidence of brain and adrenal gland metastases in 74 patients (not-small cell lung cancer) staged for surgery. Nine patients presented one or more asymptomatic brain metastases, 4 adenocarcinomas, 3 epidermoid, 2 adenosquamous. In 6 cases adrenal gland masses were found, only one of which was confirmed as a secondary lesion at biopsy. The authors conclude that brain CT is useful in the preoperative staging of lung cancers, independent of the histology of the primary lesion. An accurate assessment of the utility of CT of the adrenal glands requires a larger sample of patients due to the high incidence of benign adrenal gland masses.

  18. Providing Preoperative Information for Children Undergoing Surgery: A Randomized Study Testing Different Types of Educational Material to Reduce Children's Preoperative Worries

    ERIC Educational Resources Information Center

    Fernandes, S. C.; Arriaga, P.; Esteves, F.

    2014-01-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery.…

  19. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial

    PubMed Central

    Sebag-Montefiore, David; Stephens, Richard J; Steele, Robert; Monson, John; Grieve, Robert; Khanna, Subhash; Quirke, Phil; Couture, Jean; de Metz, Catherine; Myint, Arthur Sun; Bessell, Eric; Griffiths, Gareth; Thompson, Lindsay C; Parmar, Mahesh

    2009-01-01

    Summary Background Preoperative or postoperative radiotherapy reduces the risk of local recurrence in patients with operable rectal cancer. However, improvements in surgery and histopathological assessment mean that the role of radiotherapy needs to be reassessed. We compared short-course preoperative radiotherapy versus initial surgery with selective postoperative chemoradiotherapy. Methods We undertook a randomised trial in 80 centres in four countries. 1350 patients with operable adenocarcinoma of the rectum were randomly assigned, by a minimisation procedure, to short-course preoperative radiotherapy (25 Gy in five fractions; n=674) or to initial surgery with selective postoperative chemoradiotherapy (45 Gy in 25 fractions with concurrent 5-fluorouracil) restricted to patients with involvement of the circumferential resection margin (n=676). The primary outcome measure was local recurrence. Analysis was by intention to treat. This study is registered, number ISRCTN 28785842. Findings At the time of analysis, which included all participants, 330 patients had died (157 preoperative radiotherapy group vs 173 selective postoperative chemoradiotherapy), and median follow-up of surviving patients was 4 years. 99 patients had developed local recurrence (27 preoperative radiotherapy vs 72 selective postoperative chemoradiotherapy). We noted a reduction of 61% in the relative risk of local recurrence for patients receiving preoperative radiotherapy (hazard ratio [HR] 0·39, 95% CI 0·27–0·58, p<0·0001), and an absolute difference at 3 years of 6·2% (95% CI 5·3–7·1) (4·4% preoperative radiotherapy vs 10·6% selective postoperative chemoradiotherapy). We recorded a relative improvement in disease-free survival of 24% for patients receiving preoperative radiotherapy (HR 0·76, 95% CI 0·62–0·94, p=0·013), and an absolute difference at 3 years of 6·0% (95% CI 5·3–6·8) (77·5% vs 71·5%). Overall survival did not differ between the groups (HR 0·91, 95% CI

  20. Preoperative defining system for pancreatic head cancer considering surgical resection

    PubMed Central

    Yang, Seok Jeong; Hwang, Ho Kyoung; Kang, Chang Moo; Lee, Woo Jung

    2016-01-01

    AIM: To provide appropriate treatment, it is crucial to share the clinical status of pancreas head cancer among multidisciplinary treatment members. METHODS: A retrospective analysis of the medical records of 113 patients who underwent surgery for pancreas head cancer from January 2008 to December 2012 was performed. We developed preoperative defining system of pancreatic head cancer by describing “resectability - tumor location - vascular relationship - adjacent organ involvement - preoperative CA19-9 (initial bilirubin level) - vascular anomaly”. The oncologic correlations with this reporting system were evaluated. RESULTS: Among 113 patients, there were 75 patients (66.4%) with resectable, 34 patients (30.1%) with borderline resectable, and 4 patients (3.5%) with locally advanced pancreatic cancer. Mean disease-free survival was 24.8 mo (95%CI: 19.6-30.1) with a 5-year disease-free survival rate of 13.5%. Pretreatment tumor size ≥ 2.4 cm [Exp(B) = 3.608, 95%CI: 1.512-8.609, P = 0.044] and radiologic vascular invasion [Exp(B) = 5.553, 95%CI: 2.269-14.589, P = 0.002] were independent predictive factors for neoadjuvant treatment. Borderline resectability [Exp(B) = 0.222, P = 0.008], pancreatic head cancer involving the pancreatic neck [Exp(B) = 9.461, P = 0.001] and arterial invasion [Exp(B) = 6.208, P = 0.010], and adjusted CA19-9 ≥ 50 [Exp(B) = 1.972 P = 0.019] were identified as prognostic clinical factors to predict tumor recurrence. CONCLUSION: The suggested preoperative defining system can help with designing treatment plans and also predict oncologic outcomes. PMID:27468199

  1. Preoperative fasting: current practice and areas for improvement.

    PubMed

    Falconer, R; Skouras, C; Carter, T; Greenway, L; Paisley, A M

    2014-03-01

    Preoperative fasting aims to increase patient safety by reducing the risk of adverse events during general anaesthesia. However, prolonged fasting may be associated with dehydration, hypoglycaemia and electrolyte imbalance as well as patient discomfort. We aimed to examine compliance with the current best practice guidelines in a large surgical unit and to identify areas for improvement. Adult patients undergoing elective and emergency general, orthopaedic, gynaecology and vascular surgery procedures in the Royal Infirmary of Edinburgh were surveyed over a 3-month period commencing November 2011. A standardised questionnaire was used to collect information on the duration of preoperative fasting and the advice administered by medical and nursing staff. 292 patients were included. Median fast from solids was 13.5 h for elective patients (IQR 11.5-16) and 17.38 h for emergency patients (IQR 13.68-28.5 h). Similarly, the median fast from fluids was 9.36 h for elective patients (IQR 5.38-12.75 h) and 12.97 h for emergency patients (IQR 8.5-16.22 h). The instructions that elective patients received contributed to prolonged fasting times. The median fast for elective patients fully compliant with fasting advice would be 10 h for solids (IQR 8.75-12 h) and 6.25 h (IQR 3.83-9.25 h) for clear fluids. Elective patients fasted for longer than recommended confirming that clinical practice is slow to change. The use of universal fasting instructions and patient choice are factors that unnecessarily prolong preoperative fasting, which however appears to be multifactorial. Service improvement by abbreviation of the observed fasting periods will rely on targeted staff education and effective clinical communication by provision of written information for both elective and emergency surgical patients. The routine use of preoperative nutritional supplements may need to be re-examined when further evidence is available.

  2. Preparing for surgery: this practical workup pinpoints preoperative dangers.

    PubMed

    Kozak, E A

    1993-09-01

    Older patients undergo 20 to 40% of surgical procedures and account for 50% of surgical emergencies. Your presurgical workup can pinpoint potential cardiac, pulmonary, or metabolic problems that could endanger your patient in the operating room. Not everyone needs an extensive cardiac workup. To determine who does, you can use the Goldman criteria to predict the risk for postoperative cardiac complications. Preoperative test selection is based on these predicted risks and on information from the patient history and physical exam. Medication adjustments and discharge planning are important considerations as well.

  3. The value of preoperative functional cortical mapping using navigated TMS.

    PubMed

    Lefaucheur, Jean-Pascal; Picht, Thomas

    2016-04-01

    The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery. PMID:27229765

  4. The value of preoperative functional cortical mapping using navigated TMS.

    PubMed

    Lefaucheur, Jean-Pascal; Picht, Thomas

    2016-04-01

    The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery.

  5. Colonoscopic preoperative localization using submucosal injection of radiolabelled colloid

    PubMed Central

    Cho, Carolyn; Jain, Sanjiv; Pilbeam, Mark; Tait, Noel; Thomson, Andrew

    2008-01-01

    Malignant colonic polyps can be removed endoscopically but surgical resection is sometimes required. However, the polypectomy site can be difficult to locate. Current methods use various tattooing agents, with varying degrees of success. A new technique using pre-operative injection of technetium-99m-labelled antimony colloid, with intraoperative localization using a handheld gamma probe, is described. Although unsuccessful in terms of localizing a previously partially resected polyp, the technique itself proved safe and simple, and has some advantages over other endoscopic approaches. PMID:18629395

  6. Preoperative anxiety management, emergence delirium, and postoperative behavior.

    PubMed

    Banchs, Richard J; Lerman, Jerrold

    2014-03-01

    Preoperative anxiolysis is important for children scheduled for surgery. The nature of the anxiety depends on several factors, including age, temperament, past hospitalizations, and socioeconomic and ethnic backgrounds. A panoply of interventions effect anxiolysis, including parental presence, distraction, and premedication, although no single strategy is effective for all ages. Emergence delirium (ED) occurs after the use of sevoflurane and desflurane in preschool-aged children in the recovery room. Symptoms usually last approximately 15 minutes and resolve spontaneously. The Pediatric Anesthesia Emergence Delirium scale is used to diagnose ED and evaluate therapeutic interventions for ED such as propofol and opioids. PMID:24491647

  7. Pre-operative embolization of juvenile nasopharyngeal angiofibromas.

    PubMed

    Wilms, G; Peene, P; Baert, A L; Dewit, A; Ostyn, F; Plets, C

    1989-12-01

    Pre-operative embolization of juvenile nasopharyngeal angiofibroma was performed in 15 patients. The lesion was supplied by the internal carotid arteries (8 cases), by the internal maxillary artery (15 cases), the accessory meningeal artery (10 cases) and the ascending pharyngeal artery (10 cases). Superselective embolization of the external carotid artery feeders was performed with Ivalon particles, without neurological complications. Good control of per-operative blood loss was noted in 13 out of 15 cases, 2 patients presenting severe per-operative venous bleeding. Recurrence was noted in only one patient, which could be controlled by reembolization.

  8. Mesopancreatic Stromal Clearance Defines Curative Resection of Pancreatic Head Cancer and Can Be Predicted Preoperatively by Radiologic Parameters

    PubMed Central

    Wellner, Ulrich F.; Krauss, Tobias; Csanadi, Agnes; Lapshyn, Hryhoriy; Bolm, Louisa; Timme, Sylvia; Kulemann, Birte; Hoeppner, Jens; Kuesters, Simon; Seifert, Gabriel; Bausch, Dirk; Schilling, Oliver; Vashist, Yogesh K.; Bruckner, Thomas; Langer, Mathias; Makowiec, Frank; Hopt, Ulrich T.; Werner, Martin; Keck, Tobias; Bronsert, Peter

    2016-01-01

    Abstract Pancreatic ductal adenocarcinoma (PDAC) is characterized by a strong fibrotic stromal reaction and diffuse growth pattern. Peritumoral fibrosis is often evident during surgery but only distinguishable from tumor by microscopic examination. The aim of this study was to investigate the role of clearance of fibrotic stromal reaction at the mesopancreatic resection margin as a criterion for radical resection and preoperative assessment of resectability. Mesopancreatic stromal clearance status (S-status) was defined as the presence or absence (S+/S0) of fibrotic stromal reaction at the mesopancreatic resection margin. Detailed retrospective clinicopathologic re-evaluation of margin status and preoperative cross-sectional imaging was performed in a cohort of 91 patients operated for pancreatic head PDAC from 2001 to 2011. Conventional margin positive resection (R+, tumor cells directly at the margin) was found in 36%. However, S-status further divided the margin negative (R0) group into patients with median survival of 14 months versus 31 months (S+ versus S0, P = 0.005). Overall rate of S+ was 53%. S-status and lymph node ratio constituted the only independent predictors of survival. Stranding of the superior mesenteric artery fat sheath was the only independent radiologic predictor of S+ resection, and achieved a 71% correct prediction of S-status. Mesopancreatic stromal clearance is a major determinant of curative resection in PDAC, and preoperative prediction by cross-sectional imaging is possible, setting the basis for a new definition of borderline resectability. PMID:26817896

  9. Molecular Genetic Changes Associated With Colorectal Carcinogenesis Are Not Prognostic for Tumor Regression Following Preoperative Chemoradiation of Rectal Carcinoma

    SciTech Connect

    Zauber, N. Peter Marotta, Steven P.; Berman, Errol; Grann, Alison; Rao, Maithili; Komati, Naga; Ribiero, Kezia; Bishop, D. Timothy

    2009-06-01

    Purpose: Preoperative chemotherapy and radiation has become the standard of care for many patients with rectal cancer. The therapy may have toxicity and delays definitive surgery. It would therefore be desirable to identify those cancers that will not regress with preoperative therapy. We assessed a series of rectal cancers for the molecular changes of loss of heterozygosity of the APC and DCC genes, K-ras mutations, and microsatellite instability, changes that have clearly been associated with rectal carcinogenesis. Methods and Materials: Diagnostic colonoscopic biopsies from 53 patients who received preoperative chemotherapy and radiation were assayed using polymerase chain reaction techniques followed by single-stranded conformation polymorphism and DNA sequencing. Regression of the primary tumor was evaluated using the surgically removed specimen. Results: Twenty-three lesions (45%) were found to have a high degree of regression. None of the molecular changes were useful as indicators of regression. Conclusions: Recognized molecular changes critical for rectal carcinogenesis including APC and DCC loss of heterozygosity, K-ras mutations, and microsatellite instability are not useful as indicators of tumor regression following chemoradiation for rectal carcinoma.

  10. Comparison of the analgesic efficacy of preoperative/postoperative oral dexketoprofen trometamol in third molar surgery: A randomized clinical trial.

    PubMed

    Esparza-Villalpando, Vicente; Chavarria-Bolaños, Daniel; Gordillo-Moscoso, Antonio; Masuoka-Ito, David; Martinez-Rider, Ricardo; Isiordia-Espinoza, Mario; Pozos-Guillen, Amaury

    2016-09-01

    The aim of this study was to compare the efficacy of preoperative and postoperative dexketoprofen trometamol for pain control after third molar surgery. Sixty subjects indicated for impacted mandibular third molar surgery were randomly assigned to two groups: preoperative (group 1, n = 30) and postoperative (group 2, n = 30) administration. Group 1 received 25 mg of dexketoprofen trometamol 30 min before surgery and 1 placebo capsule (same color and size with active drug) immediately after surgery. Group 2 received the placebo capsule 30 min before surgery and 25 mg of dexketoprofen trometamol immediately after surgery. Pain intensity was assessed using a numeric rating scale (NRS) during the first 8 h. The time of the need for a second dose of dexketoprofen trometamol, after the first administration, was recorded. The data were analyzed using mixed-model repeated-measures (MMRM), Wilcoxon rank-sum, and Kaplan-Meier analysis. After the 8 h period, no statistically significant difference was observed in the intensity of pain (MMRM, p = 0.41); and no significant difference in the time for a second dose (p = 0.956). In conclusion, preoperative administration of dexketoprofen trometamol is a reasonable clinical approach that is as effective as conventional postoperative pharmacological treatment, with the advantage of allowing early analgesia before pain develops. (ClinicalTrials.gov: NCT02380001).

  11. Computer methods for automating preoperative dental implant planning: implant positioning and size assignment.

    PubMed

    Galanis, Christos C; Sfantsikopoulos, Michael M; Koidis, Petros T; Kafantaris, Nikolaos M; Mpikos, Pavlos G

    2007-04-01

    The paper presents computer-aided methods that allocate a dental implant and suggest its size, during the pre-operative planning stage, in conformance with introduced optimization criteria and established clinical requirements. Based on computed tomography data of the jaw and prosthesis anatomy, single tooth cases are planned for the best-suited implant insertion at a user-defined region. An optimum implantation axis line is produced and cylindrical implants of various candidate sizes are then automatically positioned, while their occlusal end is leveled to bone ridge, and evaluated. Radial safety margins are used for the assessment of the implant safety distance from neighboring anatomical structures and bone quantity and quality are estimated and taken into consideration. A case study demonstrates the concept and allows for its discussion.

  12. Analysis of circulating tumor cells in patients with triple negative breast cancer during preoperative chemotherapy.

    PubMed

    Lavrov, A V; Zubtsova, Zh I; Zubtsov, D A; Frolova, M A; Ignatova, E O; Skrypnikova, M A; Malysheva, E V; Legchenko, E V; Petrovskii, A V; Utyashev, I A; Tyulyandin, S A; Gol'dshtein, D V

    2014-05-01

    The presence of circulating tumor cells in the blood of patients with triple negative breast cancer (early and locally advanced cancer) before and after preoperative chemotherapy was assessed using expression markers. Before therapy, circulating tumor cells were detected in 5 of 13 (38%) patients with early cancer and in 7 of 17 (41.2%) patients with locally advanced cancer. After therapy, the circulating immune cells were detected in one patient with locally advanced cancer, who had no circulating cells before therapy. The tumor was resistant to chemotherapy and the disease progressed. The detected circulating tumor cells were HER-2-positive, while the primary tumor was HER-2-negative. It was concluded that the circulating immune cells can be a potential marker of the efficiency of therapy and predictors of the disease course, while their phenotype can differ from the phenotype of the primary tumor.

  13. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  14. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  15. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  16. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  17. 38 CFR 4.46 - Accurate measurement.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Accurate measurement. 4... RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.46 Accurate measurement. Accurate measurement of the length of stumps, excursion of joints, dimensions and location of scars with respect...

  18. Preoperative FeNO as a screening indicator of pulmonary complications after abdominal surgery in patients over 60 years old.

    PubMed

    Pi, Xin; Wang, Changsong; Li, Yue; Zheng, Juanjuan; Cui, Yinghua; Guo, Lei; Lin, Ziwei; Zhang, Xin; Li, Enyou

    2015-09-01

    The incidence of pulmonary complications after abdominal surgery is higher than that of cardiac complications. The perioperative factors currently used to assess the risk of postoperative pulmonary complications (PPCs) are imperfect. FeNO is a marker of respiratory system disease related to the airway inflammatory response and bronchial hyperresponsiveness; it may be a new indicator to screen PPCs. A total of 162 patients over 60 years old scheduled for major abdominal surgery under general anesthesia were chosen to measure their preoperative FeNO level. Statistical analyses including the receiver operating characteristic (ROC) and general linear regression were used to analyze the relationships of FeNO with PPCs and other parameters. The medians and quartiles of preoperative FeNO were 14.33 (9.67-21.10) ppb; the geometric mean was 14.25 ppb. Preoperative FeNO correlated to age (P <  0.05), and the coefficient of association was 0.267. ROC curve analysis of FeNO and PPCs resulted in a high probability with an area under the curve of 0.747 (p = 0.001, 95% confidence interval =0.602-0.893). The cut-off level was 30.2 ppb, with 47.06% sensitivity and 93.10% specificity. The positive predictive value of the cut-off was 42.11% and negative predictive value was 93.70%. OR value was 10.83. The magnitude of FeNO in the PPCs group was larger than that in the non-PPCs groups 26.20 (11.55 - 39.20) versus 13.50 (9.55-20.00); p = 0.008). Preoperative FeNO levels may be used to screen the patients over 60 years old undergoing abdominal surgery with a lower probability to suffer PPCs whoes FeNO values less than 30.2 ppb. PMID:25992977

  19. Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer

    PubMed Central

    Nilsson, Hanna; Angerås, Ulf; Bock, David; Börjesson, Mats; Onerup, Aron; Fagevik Olsen, Monika; Gellerstedt, Martin; Haglind, Eva; Angenete, Eva

    2016-01-01

    Objective The aim of our study is to assess the association between preoperative level of activity and recovery after breast cancer surgery measured as hospital stay, length of sick leave and self-assessed physical and mental recovery. Design A prospective cohort study. Setting Patients included were those scheduled to undergo breast cancer surgery, between February and November 2013, at two participating hospitals in the Western Region of Sweden. Participants Patients planned for breast cancer surgery filled out a questionnaire before, as well as at 3 and 6 weeks after the operation. The preoperative level of activity was self-assessed and categorised into four categories by the participants using the 4-level Saltin-Grimby Physical Activity Level Scale (SGPALS). Main outcome measure Our main outcome was postoperative recovery measured as length of sick leave, in-hospital stay and self-assessed physical and mental recovery. Results 220 patients were included. Preoperatively, 14% (31/220) of participants assessed themselves to be physically inactive, 61% (135/220) to exert some light physical activity (PA) and 20% (43/220) to be more active (level 3+4). Patients operated with mastectomy versus partial mastectomy and axillary lymph node dissection versus sentinel node biopsy were less likely to have a short hospital stay, relative risk (RR) 0.88 (0.78 to 1.00) and 0.82 (0.70 to 0.96). More active participants (level 3 or 4) had an 85% increased chance of feeling physically recovered at 3 weeks after the operation, RR 1.85 (1.20 to 2.85). No difference was seen after 6 weeks. Conclusions The above study shows that a higher preoperative level of PA is associated with a faster physical recovery as reported by the patients 3 weeks post breast cancer surgery. After 6 weeks, most patients felt physically recovered, diminishing the association above. No difference was seen in length of sick leave or self-assessed mental recovery between inactive or more active

  20. Preoperative evaluation of activity and function in patients with paralytic scoliosis.

    PubMed

    Larsson, E L; Aaro, S; Ahlinder, P; Oberg, B

    1998-01-01

    Preoperative evaluation of patients with paralytic scoliosis should take into account the consequences of surgery on the every day life of the patient. However, the parameters that are customarily used in these operations relate only to very narrow measures such as the angle of scoliosis or kyphosis. The aim of this study was to introduce a set of instruments appropriate for measuring both function and activities in paralytic scoliosis patients. The study took as its starting point the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH), in which an activity is described at the level of the individual and function at the level of the organ. A consecutive series of 100 paralytic scoliosis patients with 18 different diagnoses were evaluated preoperatively with a set of instruments that had been specially developed at Linköping hospital, in which the variables are classified according to the system used in the ICIDH. The set of instruments included general information and evaluation of activities and function--sitting, balance, weight distribution to sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Barthel and ADL Klein and Bell, care given, time spent resting, and seating supports). The results showed that patients with paralytic scoliosis constitute a heterogeneous group in activities and function. Even when the patients were grouped into four subgroups according to the Scoliosis Research Society Classification, they remained very heterogeneous. However, reaching, Klein and Bell Activities of Daily Living and pain could only evaluate patients who could understand verbal instructions. In those who could not, assessment relied more heavily on measures of function and level of dependence. It was concluded that the choice of assessment must be guided by the patient's ability to understand verbal instructions irrespective of his/her disorder. It is important to use the three levels

  1. Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care.

    PubMed

    Wolfe, Robert M; Pomerantz, Jonathan; Miller, Deborah E; Weiss-Coleman, Rebecca; Solomonides, Tony

    2016-01-01

    The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed. For adults, preoperative screening using the STOP or STOP-Bang questionnaires can help to identify adult patients at increased risk of OSA. In the pediatric setting, a question about snoring should be part of every preoperative examination. For patients with known OSA, continuous positive airway pressure should be continued postoperatively. Continuous pulse oximetry monitoring with an alarm system can help to prevent apneic catastrophes caused by OSA in the postoperative period. PMID:26957384

  2. Preoperative Uterine Artery Embolization (PUAE) Before Uterine Fibroid Myomectomy

    SciTech Connect

    Dumousset, E.; Chabrot, P.; Rabischong, B.; Mazet, N.; Nasser, S.; Darcha, C.; Garcier, J.M.; Mage, G.; Boyer, L.

    2008-05-15

    Purpose. To evaluate the potential of uterine artery embolization to minimize blood loss and facilitate easier removal of fibroids during subsequent myomectomy. Methods. This retrospective study included 22 patients (median age 37 years), of whom at least 15 wished to preserve their fertility. They presented with at least one fibroid (mean diameter 85.6 mm) and had undergone preoperative uterine artery embolization (PUAE) with resorbable gelatin sponge. Results. No complication or technical failure of embolization was identified. Myomectomies were performed during laparoscopy (12 cases) and laparotomy (9 cases). One hysterectomy was performed. The following were noted: easier dissection of fibroids (mean 5.6 per patient, range 1-30); mean intervention time 113 min (range 25-210 min); almost bloodless surgery, with a mean peroperative blood loss of 90 ml (range 0-806 ml); mean hemoglobin pretherapeutically 12.3 g/dl (range 5.9-15.2 g/dl) and post-therapeutically 10.3 g/dl (range 5.6-13.3 g/dl), with no blood transfusion needed. Patients were discharged on day 4 on average and the mean sick leave was 1 month. Conclusion. Preoperative embolization is associated with minimal intraoperative blood loss. It does not increase the complication rate or impair operative dissection, and improves the chances of performing conservative surgery.

  3. Preoperative Embolization of Extra-axial Hypervascular Tumors with Onyx

    PubMed Central

    Fusco, Matthew R.; Salem, Mohamed M.; Reddy, Arra S.; Ogilvy, Christopher S.; Kasper, Ekkehard M.; Thomas, Ajith J.

    2016-01-01

    Objective Preoperative endovascular embolization of intracranial tumors is performed to mitigate anticipated intraoperative blood loss. Although the usage of a wide array of embolic agents, particularly polyvinyl alcohol (PVA), has been described for a variety of tumors, literature detailing the efficacy, safety and complication rates for the usage of Onyx is relatively sparse. Materials and Methods We reviewed our single institutional experience with pre-surgical Onyx embolization of extra-axial tumors to evaluate its efficacy and safety and highlight nuances of individualized cases. Results Five patients underwent pre-surgical Onyx embolization of large or giant extra-axial tumors within 24 hours of surgical resection. Four patients harbored falcine or convexity meningiomas (grade I in 2 patients, grade II in 1 patient and grade III in one patient), and one patient had a grade II hemangiopericytoma. Embolization proceeded uneventfully in all cases and there were no complications. Conclusion This series augments the expanding literature confirming the safety and efficacy of Onyx in the preoperative embolization of extra-axial tumors, underscoring its advantage of being able to attain extensive devascularization via only one supplying pedicle. PMID:27114961

  4. Preoperative thrombocytosis predicts prognosis in stage II colorectal cancer patients

    PubMed Central

    Lee, Yong Sun; Suh, Kwang Wook

    2016-01-01

    Purpose Thrombocytosis is known to be a poor prognostic factor in several types of solid tumors. The prognostic role of preoperative thrombocytosis in colorectal cancer remains limited. The aim of this study is to investigate the prognostic role of preoperative thrombocytosis in stage II colorectal cancer. Methods Two hundred eighty-four patients with stage II colorectal cancer who underwent surgical resection between December 2003 and December 2009 were retrospectively reviewed. Thrombocytosis was defined as platelet > 450 × 109/L. We compared patients with thrombocytosis and those without thrombocytosis in terms of survival. Results The 5-year disease-free survival (DFS) rates were lower in patients with thrombocytosis compared to those without thrombocytosis in stage II colorectal cancer (73.3% vs. 89.6%, P = 0.021). Cox multivariate analysis demonstrated that thrombocytosis (hazard ratio, 2.945; 95% confidence interval, 1.127–7.697; P = 0.028) was independently associated with DFS in patients with stage II colorectal cancer. Conclusion This study showed that thrombocytosis is a prognostic factor predicting DFS in stage II colorectal cancer patients. PMID:27274508

  5. Complete preoperative embolization of hemangioblastoma vessels with Onyx 18.

    PubMed

    Horvathy, Denes B; Hauck, Erik F; Ogilvy, Christopher S; Hopkins, L Nelson; Levy, Elad I; Siddiqui, Adnan H

    2011-03-01

    The authors present a preliminary experience with ethyl-enevinylalcohol copolymer (Onyx) for hemangioblastoma vessel embolization before surgical resection. The patient presented with neck pain, dizziness, blurred vision, vomiting, and loss of balance. Diagnostic imaging revealed a posterior fossa cystic mass with a nodular component. Angiography demonstrated a significant vascular blush with arteriovenous shunting that was characteristic of a hemangioblastoma. Tumor vessels originating off the left posterior inferior cerebellar artery were embolized before surgery using Onyx 18 (ev3, Covidien Vascular Therapies, Mansfield, MA, USA). This resulted in complete obliteration of all tumor vessels, transforming a highly vascular tumor into an avascular mass. A safe and uneventful surgical resection was performed the next day. Onyx is a valuable embolic agent for preoperative hemangioblastoma vessel embolization. Because of its low viscosity, Onyx penetrates deeply into the tumor vasculature and allows complete obliteration of tumor vessels. Risks of the intervention have to be carefully weighed against the benefits. If preoperative embolization is indicated, the use of Onyx should be strongly considered. PMID:21237650

  6. Transnasal endoscopic resection of juvenile nasopharyngeal angiofibroma without preoperative embolization.

    PubMed

    Borghei, Peyman; Baradaranfar, Mohammad Hossein; Borghei, Seyed Hebatodin; Sokhandon, Farnoosh

    2006-11-01

    Juvenile nasopharyngeal angiofibroma (JNA) is a benign, highly vascular, and locally invasive tumor. Because the location of these tumors makes conventional surgery difficult, interest in endoscopic resection is increasing, particularly for the treatment of lesions that do not extend laterally into the infratemporal fossa. We report the results of our series of 23 patients with JNA (stage IIB or lower) who underwent transnasal endoscopic resection under hypotensive general anesthesia without preoperative embolization of the tumor All tumors were successfully excised. The amount of intraoperative blood loss was acceptable. We observed only 1 recurrence, which was diagnosed 19 months postoperatively in a patient with a stage IIB primary tumor. We observed only 3 complications during follow-up-all synechia. We conclude that endoscopic resection of JNAs is safe and effective. The low incidence of recurrence and complications in this series indicates that preoperative embolization may not be necessary for lesions that have not undergone extensive spread; instead, intraoperative bleeding can be adequately controlled with good hypotensive general anesthesia.

  7. Current status of preoperative drainage for distal biliary obstruction.

    PubMed

    Sugiyama, Harutoshi; Tsuyuguchi, Toshio; Sakai, Yuji; Mikata, Rintaro; Yasui, Shin; Watanabe, Yuto; Sakamoto, Dai; Nakamura, Masato; Sasaki, Reina; Senoo, Jun-Ichi; Kusakabe, Yuko; Hayashi, Masahiro; Yokosuka, Osamu

    2015-08-28

    Preoperative biliary drainage (PBD) was developed to improve obstructive jaundice, which affects a number of organs and physiological mechanisms in patients waiting for surgery. However, its role in patients who will undergo pancreaticoduodenectomy for biliary obstruction remains controversial. This article aims to review the current status of the use of preoperative drainage for distal biliary obstruction. Relevant articles published from 1980 to 2015 were identified by searching MEDLINE and PubMed using the keywords "PBD", "pancreaticoduodenectomy", and "obstructive jaundice". Additional papers were identified by a manual search of the references from key articles. Current studies have demonstrated that PBD should not be routinely performed because of the postoperative complications. PBD should only be considered in carefully selected patients, particularly in cases where surgery had to be delayed. PBD may be needed in patients with severe jaundice, concomitant cholangitis, or severe malnutrition. The optimal method of biliary drainage has yet to be confirmed. PBD should be performed by endoscopic routes rather than by percutaneous routes to avoid metastatic tumor seeding. Endoscopic stenting or nasobiliary drainage can be selected. Although more expensive, the use of metallic stents remains a viable option to achieve effective drainage without cholangitis and reintervention. PMID:26328029

  8. [Preoperative fasting 2008: medical behaviour between empiricism and science].

    PubMed

    Weiss, G; Jacob, M

    2008-09-01

    Preoperative fasting aims at minimizing the risk of pulmonary aspiration. However, perioperative safety does not directly increase with the duration of total abstinence from food and liquids. The traditional principle "nil per os from midnight on", is based on insufficient data, overinterpretation and expert opinion. In fact, the total perioperative risk of a clinically relevant regurgitation of gastric content is low. Clear liquids are not stored within the stomach for a long time and in the healthy, a fasting period of 6 h allows the total passage of solid food. Identifying those patients with an increased risk of perioperative aspiration is still difficult. In particular, the impact of pregnancy, adipositas and diabetes, trauma, smoking, opioids and renal insufficiency has not been clarified. This lack of knowledge is reflected by national and international guidelines concerning preoperative fasting, which mention the "patient at risk" without defining it exactly. Abstention from clear liquids 2 h before and of solids 6 h before induction of anesthesia, is becoming increasingly more accepted. Feeding babies with breast milk appears to be tolerated 4 h before anesthesiological procedures.

  9. Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction

    PubMed Central

    Kim, Do Kyung; Hwang, Ji Hye; Park, Won Hah

    2015-01-01

    [Purpose] After an anterior cruciate ligament injury and subsequent reconstruction, quadriceps muscle weakness and disruption of proprioceptive function are common. The purpose of this study was to examine the effects of a 4 weeks preoperative exercise intervention on knee strength power and function post-surgery. [Subjects and Methods] Eighty male patients (27.8±5.7 age), scheduled for reconstruction surgery, were randomly assigned to two groups, the preoperative exercise group (n=40) and a no preoperative exercise group (n=40). The preoperative exercise group participated in a 4-week preoperative and 12-week post-operative programs, while the no preoperative exercise group participated only in the 12-week postoperative exercise program. Isokinetic measured of quadriceps strength were obtained at 4 weeks before and 3 months after surgery. [Results] The knee extensor strength deficits measured at 60°/s and 180°/s was significantly lower in the preoperative exercise group compared with the no preoperative exercise group. At 3 months after surgery, the extensor strength deficit was 28.5±9.0% at 60°/sec and 23.3±9.0% at 180°/sec in the preoperative exercise group, whereas the no preoperative exercise group showed extensor strength deficits of 36.5±10.7% and 27.9±12.6% at 60°/sec and 180°/sec, respectively. The preoperative exercise group demonstrated significant improvement the single-leg hop distance. [Conclusion] Four week preoperative exercise may produce many positive effects post reconstruction surgery, including faster recovery of knee extensor strength and function, as measured by single-leg hop ability. PMID:26504270

  10. Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction.

    PubMed

    Kim, Do Kyung; Hwang, Ji Hye; Park, Won Hah

    2015-09-01

    [Purpose] After an anterior cruciate ligament injury and subsequent reconstruction, quadriceps muscle weakness and disruption of proprioceptive function are common. The purpose of this study was to examine the effects of a 4 weeks preoperative exercise intervention on knee strength power and function post-surgery. [Subjects and Methods] Eighty male patients (27.8±5.7 age), scheduled for reconstruction surgery, were randomly assigned to two groups, the preoperative exercise group (n=40) and a no preoperative exercise group (n=40). The preoperative exercise group participated in a 4-week preoperative and 12-week post-operative programs, while the no preoperative exercise group participated only in the 12-week postoperative exercise program. Isokinetic measured of quadriceps strength were obtained at 4 weeks before and 3 months after surgery. [Results] The knee extensor strength deficits measured at 60°/s and 180°/s was significantly lower in the preoperative exercise group compared with the no preoperative exercise group. At 3 months after surgery, the extensor strength deficit was 28.5±9.0% at 60°/sec and 23.3±9.0% at 180°/sec in the preoperative exercise group, whereas the no preoperative exercise group showed extensor strength deficits of 36.5±10.7% and 27.9±12.6% at 60°/sec and 180°/sec, respectively. The preoperative exercise group demonstrated significant improvement the single-leg hop distance. [Conclusion] Four week preoperative exercise may produce many positive effects post reconstruction surgery, including faster recovery of knee extensor strength and function, as measured by single-leg hop ability.

  11. Accurate Mass Measurements in Proteomics

    SciTech Connect

    Liu, Tao; Belov, Mikhail E.; Jaitly, Navdeep; Qian, Weijun; Smith, Richard D.

    2007-08-01

    To understand different aspects of life at the molecular level, one would think that ideally all components of specific processes should be individually isolated and studied in details. Reductionist approaches, i.e., studying one biological event at a one-gene or one-protein-at-a-time basis, indeed have made significant contributions to our understanding of many basic facts of biology. However, these individual “building blocks” can not be visualized as a comprehensive “model” of the life of cells, tissues, and organisms, without using more integrative approaches.1,2 For example, the emerging field of “systems biology” aims to quantify all of the components of a biological system to assess their interactions and to integrate diverse types of information obtainable from this system into models that could explain and predict behaviors.3-6 Recent breakthroughs in genomics, proteomics, and bioinformatics are making this daunting task a reality.7-14 Proteomics, the systematic study of the entire complement of proteins expressed by an organism, tissue, or cell under a specific set of conditions at a specific time (i.e., the proteome), has become an essential enabling component of systems biology. While the genome of an organism may be considered static over short timescales, the expression of that genome as the actual gene products (i.e., mRNAs and proteins) is a dynamic event that is constantly changing due to the influence of environmental and physiological conditions. Exclusive monitoring of the transcriptomes can be carried out using high-throughput cDNA microarray analysis,15-17 however the measured mRNA levels do not necessarily correlate strongly with the corresponding abundances of proteins,18-20 The actual amount of functional proteins can be altered significantly and become independent of mRNA levels as a result of post-translational modifications (PTMs),21 alternative splicing,22,23 and protein turnover.24,25 Moreover, the functions of expressed

  12. Relationship of preoperative fear, type of coping, and information recevied about surgery to recovery from surgery.

    PubMed

    Sime, A M

    1976-10-01

    This study investigated the relationship of preoperative level of fear, extent of information seeking (coping), and amount of information received about surgery to recovery from surgery. It was hypothesized that a curvilinear relationship would be found between level of preoperative fear and recovery and between extent of information seeking and recovery; it was also hypothesized that amount of preoperative information obtained would interact with extent of information seeking. The subjects were 57 female patients between the ages of 18 and 68 who were schedule for abdominal surgery. The recovery measures consisted of a self-rating of postoperative negative affect (fear, depression, and anger), number of postoperative analgesics and sedatives received, and total number of days to discharge. No curvilinear relationships were found between preoperative level of fear or type of coping and recovery from surgery. Results showed a linear relationship between level of preoperative fear and recovery, with the least favorable recovery associated with high levels of preoperative fear. A significant interaction was found between level of preoperative fear and amount of preoperative information, with high-fear subjects who reported little preoperative information experiencing the least favorable recovery period. The findings are discussed in terms of the parallel response model proposed by Leventhal.

  13. [Preoperative quality of life in women with pathological alteration in breast].

    PubMed

    Tobiasz-Adamczyk, Beata; Zawisza, Katarzyna; Florek, Marzena; Hodorowicz-Zaniewska, Diana

    2013-01-01

    The aim of the study was to assess the similarities or differences in the psychosocial response to primary diagnosis of malicious or benign tumor in breast significantly influenced the quality of life in women in preoperative period. Health-related quality of life has been studied in the preoperative period in the group of 59 patients with malicious tumor and in the group of 130 women with benign tumor in comparison to 126 healthy women. Study was performed using self-administered questionnaire consists of The Rand Mental Health Inventory (three distress scores include depression, anxiety and loss of behavioral or emotional control; two well-being scores include general positive affect and emotional ties), COOP Charts (measuring nine dimensions of QOL), subscale focus on social support was used for the presented analysis; additionally questions concerning demographic and social characteristics of women as well as questions on illness behaviors have been involved. Statistical analysis was performed using multidimensional models of logistic regression. Results based on multidimensional logistic regression models showed higher risk of anxiety (OR=4,0; 95% CI=(1,8; 8,6)), depression(OR=3,0; 95% CI=(1,4; 6,2)) and distress (OR=2,5; 95% CI=(1,2; 5,3)) in women with malicious tumor in comparison to healthy women. Comparatively, higher risk of anxiety (OR=1,8; 95% CI=(1,0; 3,2)) and depression (OR=2,0; 95% CI=(1,2; 3,5)) among women with benign tumor in regard to healthy ones. Further examination of determinants of components of mental health among three analyzed group of women showed that among women with benign tumor higher risk of anxiety (OR=3,5; 95% CL=(1,2; 10,5)), depression (OR=3,2; 95% CI=(1,2;9,1)) and loss of behavioral or emotional control ((OR=4.3; 95% CI=(1,5;12,0)) as well as distress (OR=4,3; 95% CI=(1,5;13,0)) was related with considerable reduction of receiving support. Women with malicious tumor also indicated that slightly reduction of the received

  14. Is there a Role for Preoperative Infusion or Intraoperative Cholangiography?

    PubMed Central

    Lau, W. Y.; Li, Arthur K. C.

    1997-01-01

    Background: There has been a resurgence of interest in recent years in preoperative infusion cholangiography (PIC). The role of routine PIC compared to routine intraoperative cholangiography (IOC) has not been clearly defined. Study design: In our department between 1985 and 1991, 1,042 of 1,576 consecutive patients with biliary calculous disease had elective cholecystectomy: 694 patients were prospectively scheduled for PIC, and 348 patients were randomly allocated to IOC. The patients in the PIC and IOC groups were similar with regard to age, history of biliopancreatic complications, and laboratory findings. The cost of PIC in Sweden is nearly five times greater than the cost of IOC. Results: Satisfactory opacification of the biliary system was obtained in 90.1 and 96.8 percent of patients who underwent PIC and IOC, respectively. Preoperative infusion cholangiography required support by IOC in 19.5 percent of patients. There were no statistically significant differences between the PIC and IOC groups with regard to the incidence (7 percent in both groups) of or positive predictive value (68 and 80 percent, respectively) for bile duct stones, rate of retained stones (6 and 20 percent, respectively), intraoperative (5.6 and 6.3 percent, respectively) or postoperative (13.3 and 15.9 percent, respectively) morbidity, or incidence of bile duct anomalies (0.9 and 0.3 percent, respectively). Median operative time was longer in .patients with (95 minutes) compared to those without (75 minutes) IOC (p<0.001). More postoperative complications occurred after bile duct exploration (26 of 75 patients) compared to cholecystectomy alone (114 of 917 patients, p<0.001). The 30-day mortality was zero. Minor bile duct injuries occurred in two patients (0.2 percent) at cholecystectomy, (one with and one without bile duct exploration). In no patient was the cholangiographic finding of a biliary anomaly crucial for the safe execution of cholecystectomy. Conclusions: In our study, PIC

  15. Small pancreatic cancer with pancreas divisum preoperatively diagnosed by pancreatic juice cytology.

    PubMed

    Obana, Takashi; Fujita, Naotaka; Noda, Yutaka; Kobayashi, Go; Ito, Kei; Horaguchi, Jun; Takasawa, Osamu; Tsuchiya, Takashi; Sawai, Takashi

    2009-01-01

    We present a case of small pancreatic head cancer with pancreas divisum preoperatively diagnosed by pancreatic juice cytology. A 60-year-old woman was referred to our hospital for evaluation of a dilated main pancreatic duct (MPD). A small and poorly reproducible low-echoic lesion in the pancreas was suspected by ultrasonography (US) and endoscopic ultrasonography (EUS). Magnetic resonance cholangiopancreatography (MRCP) failed to visualize the ventral pancreatic duct, and the upstream dorsal pancreatic duct was dilated. Endoscopic retrograde cholangiopancreatography (ERCP) was indicative of pancreas divisum, and complete obstruction of the MPD in the pancreatic head was seen. Cytology of pancreatic juice obtained from the dorsal pancreas after minor papilla sphincterotomy revealed the presence of adenocarcinoma cells. Pancreatoduodenectomy was performed under the diagnosis of pancreatic head cancer with pancreas divisum. Histological examination revealed moderately-differentiated tubular adenocarcinoma 20 mm in diameter, located in the pancreatic head. Dilatation of the dorsal pancreatic duct is sometimes observed in cases with pancreas divisum without the presence of tumors. When pancreatic duct stenosis also exists in such cases, even if a tumor is not clearly visualized by diagnostic imaging, vigorous examinations such as pancreatic juice cytology are recommended to establish an accurate diagnosis.

  16. Prognostic value of preoperative inflammatory response biomarkers in patients with sarcomatoid renal cell carcinoma and the establishment of a nomogram

    PubMed Central

    Gu, Liangyou; Ma, Xin; Li, Hongzhao; Chen, Luyao; Xie, Yongpeng; Zhao, Chaofei; Luo, Guoxiong; Zhang, Xu

    2016-01-01

    To examine the prognostic role of inflammatory response biomarkers in sarcomatoid renal cell carcinoma (sRCC). From January 2004 to May 2015, 103 patients with sRCC were enrolled in this study. Preoperative neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) were analyzed. Besides well-established clinicopathological prognostic factors, we evaluated the prognostic value of this four markers using Kaplan-Meier method and Cox regression models. Additionally, a nomogram was established to predict the prognosis of sRCC patients. Elevated NLR, dNLR and PLR were significantly associated with worse overall survival (OS), nevertheless, elevated LMR showed an adverse effect on reduced OS. Multivariate analysis revealed that NLR (HR = 4.07, 95% CI = 1.50–11.00, P = 0.006) retained as independent factor. Incorporation of the NLR into a prognostic model including T stage, M stage, tumor necrosis and percentage of sarcomatoid generated a nomogram, which accurately predicted OS for sRCC patients. Preoperative NLR may serve as a potential prognostic biomarker in patients with sRCC and may help with clinical decisions about treatment intervention in clinical practice. The proposed nomogram can be used for the prediction of OS in patients with sRCC. PMID:27035802

  17. Effect of High-Grade Pre-operative Knee Laxity on Outcomes of Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Magnussen, Robert A.; Reinke, Emily; Huston, Laura J.; Group, MOON knee; Hewett, Timothy E.; Spindler, Kurt P.

    2015-01-01

    Objectives: Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently assessed through physical examination using the Lachman, pivot-shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. We hypothesized that increased pre-operative knee laxity (Grade 3+ pivot-shift, Lachman > 10mm, or anterior drawer greater than 10mm) are associated with increased risk of revision ACL reconstruction and poorer patient-reported outcomes at two years post-operative. Methods: From an ongoing prospective cohort study, 1394 patients that underwent primary isolated ACL reconstruction within 3 months of injury with autograft tissue without medial collateral, lateral collateral, or posterior cruciate injury requiring treatment or prior contralateral ACL injury were identified. Demographic data, physical examination findings under anesthesia at the time of ACL reconstruction, information regarding meniscus status and treatment, and pre-operative and 2 year post-operative International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score Knee Related Quality of Life subscale (KOOS-QOL), and Marx activity scores were collected. Patients reported by the operating surgeons as having a Lachman or anterior drawer examination at least 10mm greater than the contralateral side were classified as having a high grade Lachman or anterior drawer respectively. Patients reported by the operating surgeon as having a 3+ pivot-shift were classified as having a high-grade pivot-shift. Patients demonstrating high-grade laxity on any of these examinations were classified as having high-grade pre-operative knee laxity. Multiple logistic regression modeling was used to evaluate whether having high-grade pre-operative laxity was associated with increased odds of undergoing revision ACL reconstruction within 2 years of the index procedure, controlling for patient age, sex

  18. Preoperative chemoradiation for locally advanced rectal cancer: comparison of three radiation dose and fractionation schedules

    PubMed Central

    Park, Shin-Hyung; Kim, Jae-Chul

    2016-01-01

    Purpose: The standard radiation dose for patients with locally rectal cancer treated with preoperative chemoradiotherapy is 45–50 Gy in 25–28 fractions. We aimed to assess whether a difference exists within this dose fractionation range. Materials and Methods: A retrospective analysis was performed to compare three dose fractionation schedules. Patients received 50 Gy in 25 fractions (group A), 50.4 Gy in 28 fractions (group B), or 45 Gy in 25 fractions (group C) to the whole pelvis, as well as concurrent 5-fluorouracil. Radical resection was scheduled for 8 weeks after concurrent chemoradiotherapy. Results: Between September 2010 and August 2013, 175 patients were treated with preoperative chemoradiotherapy at our institution. Among those patients, 154 were eligible for analysis (55, 50, and 49 patients in groups A, B, and C, respectively). After the median follow-up period of 29 months (range, 5 to 48 months), no differences were found between the 3 groups regarding pathologic complete remission rate, tumor regression grade, treatment-related toxicity, 2-year locoregional recurrence-free survival, distant metastasis-free survival, disease-free survival, or overall survival. The circumferential resection margin width was a prognostic factor for 2-year locoregional recurrence-free survival, whereas ypN category was associated with distant metastasis-free survival, disease-free survival, and overall survival. High tumor regression grading score was correlated with 2-year distant metastasis-free survival and disease-free survival in univariate analysis. Conclusion: Three different radiation dose fractionation schedules, within the dose range recommended by the National Comprehensive Cancer Network, had no impact on pathologic tumor regression and early clinical outcome for locally advanced rectal cancer. PMID:27306773

  19. Preoperative and Postoperative Range of Motion: A Retrospective Comparison of Two Total Ankle Replacement Systems.

    PubMed

    Brigido, Stephen A; Mulhern, Jennifer L; Wobst, Garrett M; Protzman, Nicole M

    2015-01-01

    The purpose of the present report was to compare the range of motion between a total ankle replacement requiring arched bony resection and a total ankle replacement requiring a flat cut for implantation. We hypothesized that the arched contour would more closely mimic the patient's pre-existing anatomy and increase the range of motion. Pain was evaluated as a secondary outcome. Twenty-eight patients (age 55.95 ± 15.29 years) were included. Of the 28 patients, 14 were treated with an arch cut and 14 with a flat cut. Although no significant difference was found in dorsiflexion between the 2 implant groups (p = .38), preoperative dorsiflexion, body mass index, implant type, and preoperative plantarflexion emerged as significant predictors of postoperative plantarflexion (p = .04). This finding indicates that postoperative plantarflexion was significantly greater in patients treated with an arch cut (30.43° ± 10.01°) than a flat cut (21.79° ± 15.70°, p = .02), when controlling for the other explanatory variables. A statistically significant improvement in pain was observed after total ankle replacement (p < .001). The mean change in pain was similar for the 2 implant groups when statistically controlling for the follow-up duration (p = .09). The findings from the present report suggest that plantarflexion significantly improves after total ankle replacement requiring an arched cut for implantation. Future studies should be designed to control for potentially confounding variables and assess the differences in range of motion after total ankle replacement.

  20. Preoperative serum midkine concentration is a prognostic marker for esophageal squamous cell carcinoma.

    PubMed

    Shimada, Hideaki; Nabeya, Yoshihiro; Tagawa, Masatoshi; Okazumi, Shin-ichi; Matsubara, Hisahiro; Kadomatsu, Kenji; Muramatsu, Takashi; Ikematsu, Shinya; Sakuma, Sadatoshi; Ochiai, Takenori

    2003-07-01

    High preoperative serum midkine concentration is associated with poor survival in patients with esophageal cancer, even after radical surgery, and thus may have prognostic value. Midkine (MK), a heparin-binding growth factor, is expressed in numerous cancer tissues, and serum MK (S-MK) concentrations are increased in patients with various neoplasms. The aim of this study is to evaluate the clinical significance of S-MK in patients with esophageal squamous cell cancer (SCC). S-MK was measured by enzyme-linked immunosorbent assay in 135 healthy controls, 16 patients with benign esophageal disease, and 93 patients with primary esophageal SCC before surgery. The serum concentrations of carcinoembryonic antigen (CEA), SCC antigen (SCC-Ag), and cytokeratin 19 fragment (CYFRA21-1) were also evaluated. All patients with esophageal SCC underwent radical esophagectomy. Tumor MK expression was assessed by immunohistochemistry in 14 fresh tumor specimens. To determine whether S-MK is of value as a prognostic factor, the authors conducted a survival analysis using Cox's proportional hazards model. S-MK values in patients with esophageal SCC were significantly higher than those in healthy controls (417 +/- 342 pg/ml vs. 154 +/- 76 pg/ml, P < 0.001). Using 300 pg/ml as the cut-off value (representing the mean + 2 standard deviations of the S-MK of healthy controls), 61% of patients with esophageal SCC were classified as positive. MK expression by the tumor was significantly associated with high level of S-MK. High S-MK (>/= 300 pg/ml) was associated with tumor size, immunoreactivity and poor survival. Multivariate analysis indicated that S-MK was an independent prognostic factor. S-MK may be a useful tumor marker for esophageal SCC. Increased preoperative S-MK in patients with esophageal SCC is associated with poor survival.

  1. Preoperative Versus Postoperative Radiotherapy in Soft-Tissue Sarcoma: Multi-Institutional Analysis of 821 Patients

    SciTech Connect

    Sampath, Sagus; Schultheiss, Timothy E.; Hitchcock, Ying J.; Randall, R. Lor; Shrieve, Dennis C.; Wong, Jeffrey Y.C.

    2011-10-01

    Purpose: To assess the impact of radiotherapy (RT) sequencing with surgery on overall survival (OS), cause-specific survival (CSS), local failure, and distant failure in soft-tissue sarcoma (STS). Methods and Materials: A retrospective analysis was conducted using the National Oncology Database, a proprietary database of aggregated tumor registries owned by IMPAC Medical Systems (Sunnyvale, CA). Patients with STS of all major anatomic sites who received definitive surgery and either preoperative (preop) or postoperative (postop) RT were included. Patients were also required to have known stage and grade. Prognostic factors for survival were identified using multivariate techniques. Survival was calculated using the Kaplan-Meier method, and compared for statistical significance (p < 0.05) using the log-rank test. Results: A total of 821 patients met inclusion criteria. The median follow-up time was 63 months. Age, stage, histology, gender, tumor size, and RT sequence were independent predictors for OS (p < 0.05). Preop RT was associated with significantly improved OS and CSS compared with postop RT (hazard ratio [HR] = 0.72, 95% confidence interval [CI] 0.56-0.91, p < 0.01, and HR = 0.64, 95% CI 0.46-0.88, p < 0.01, respectively). The 5-year CSS was 79% and 74%, in favor of preop RT (log-rank, p < 0.05). Preop RT was also significantly associated with a reduced risk for local and distant relapse compared with postop RT. Conclusion: Preoperative RT is associated with a reduced cancer-specific mortality compared with postoperative RT in STS. The results of this study may serve as motivation to conduct future prospective studies with larger patient numbers.

  2. Rectal Motion in Patients Receiving Preoperative Radiotherapy for Carcinoma of the Rectum

    SciTech Connect

    Brierley, James D.; Dawson, Laura A.; Sampson, Elliott; Bayley, Andrew; Scott, Sandra; Moseley, Joanne L.; Craig, Timothy; Cummings, Bernard; Dinniwell, Robert; Kim, John J.; Ringash, Jolie; Wong, Rebecca; Brock, Kristy K.

    2011-05-01

    Purpose: To assess the movement of rectum, mesorectum, and rectal primary during a course of preoperative chemoradiotherapy. Methods and Materials: Seventeen patients with Stage II or III rectal cancer had a planning CT scan with rectal contrast before commencement of preoperative chemoradiation. The scan was repeated during Weeks 1, 3, and 5 of chemoradiation. The rectal primary (gross tumor volume), rectum, mesorectum, and bladder were contoured on all four scans. An in-house biomechanical model-based deformable image registration technique, Morfeus, was used to measure the three-dimensional spatial change in these structures after bony alignment. The required planning target volume margin for this spatial change, after bone alignment, was also calculated. Results: Rectal contrast was found to introduce a systematic error in the position of all organs compared with the noncontrast state. The largest change in structures during radiotherapy was in the anterior and posterior directions for the mesorectum and rectum and in the superior and inferior directions for the gross tumor volume. The planning target volume margins required for internal movement for the mesorectum based on the three scans acquired during treatment are 4 mm right, 5 mm left, 7 mm anterior, and 6 mm posterior. For the rectum, values were 8 mm right, 8 mm left, 8 mm anterior, and 9 mm posterior. The greatest movement of the rectum occurred in the upper third. Conclusions: Contrast is no longer used in CT simulation. Assuming bony alignment, a nonuniform margin of 8 mm anteriorly, 9 mm posteriorly, and 8 mm left and right is recommended.

  3. Preoperative evaluation of cardiac risk by means of atrial pacing and thallium 201 scintigraphy

    SciTech Connect

    Stratmann, H.G.; Mark, A.L.; Walter, K.E.; Williams, G.A. )

    1989-10-01

    Atrial pacing and thallium 201 scintigraphy were done in 61 patients with known or suspected coronary artery disease referred for evaluation of cardiac risk before elective vascular surgery. All patients had noncardiac limitations precluding performance of an adequate exercise stress test. Before atrial pacing all were considered to be at low risk of a postoperative cardiac event based on assessment of clinical parameters. Vascular surgery was subsequently performed in 47 patients. In these patients, pacing-induced ST segment depression greater than or equal to 1 mm occurred in 18, a fixed perfusion defect occurred in 11, and a reversible defect occurred in six. Two of the six patients with reversible perfusion defects had preoperative coronary angiography; both had significant coronary artery disease (one or more lesions greater than or equal to 50%). Two patients (one of whom had a reversible perfusion defect) underwent preoperative coronary revascularization and tolerated subsequent vascular surgery well. All other patients received only medical therapy. None of the 47 patients undergoing vascular surgery had a postoperative cardiac event (unstable angina, congestive heart failure, myocardial infarction, or cardiac death). Of the 14 patients in whom vascular surgery was deferred or canceled, surgery was canceled for noncardiac reasons in seven. Six of these seven patients had a normal perfusion scan; none had a reversible perfusion defect or marked (greater than or equal to 2 mm) ST segment depression. No cardiac event occurred during a 3-month period after atrial pacing in any of these patients. Six of the remaining seven patients had reversible perfusion defects.

  4. Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer.

    PubMed

    Long, Eliza E; Van Dam, Jacques; Weinstein, Stefanie; Jeffrey, Brooke; Desser, Terry; Norton, Jeffrey A

    2005-08-01

    Pancreas cancer is the fourth leading cancer killer in adults. Cure of pancreas cancer is dependent on the complete surgical removal of localized tumor. A complete surgical resection is dependent on accurate preoperative and intra-operative imaging of tumor and its relationship to vital structures. Imaging of pancreatic tumors preoperatively and intra-operatively is achieved by pancreatic protocol computed tomography (CT), endoscopic ultrasound (EUS), laparoscopic ultrasound (LUS), and intra-operative ultrasound (IOUS). Multi-detector CT with three-dimensional (3-D) reconstruction of images is the most useful preoperative modality to assess resectability. It has a sensitivity and specificity of 90 and 99%, respectively. It is not observer dependent. The images predict operative findings. EUS and LUS have sensitivities of 77 and 78%, respectively. They both have a very high specificity. Further, EUS has the ability to biopsy tumor and obtain a definitive tissue diagnosis. IOUS is a very sensitive (93%) method to assess tumor resectability during surgery. It adds little time and no morbidity to the operation. It greatly facilitates the intra-operative decision-making. In reality, each of these methods adds some information to help in determining the extent of tumor and the surgeon's ability to remove it. We rely on pancreatic protocol CT with 3-D reconstruction and either EUS or IOUS depending on the tumor location and operability of the tumor and patient. With these modern imaging modalities, it is now possible to avoid major operations that only determine an inoperable tumor. With proper preoperative selection, surgery is able to remove tumor in the majority of patients.

  5. Motor field sensitivity for preoperative localization of motor cortex

    PubMed Central

    Lin, Peter T.; Berger, Mitchel S.; Nagarajan, Srikantan S.

    2014-01-01

    Object In this study the role of magnetic source imaging for preoperative motor mapping was evaluated by using a single-dipole localization method to analyze motor field data in 41 patients. Methods Data from affected and unaffected hemispheres were collected in patients performing voluntary finger flexion movements. Somatosensory evoked field (SSEF) data were also obtained using tactile stimulation. Dipole localization using motor field (MF) data was successful in only 49% of patients, whereas localization with movement evoked field (MEF) data was successful in 66% of patients. When the spatial distribution of MF and MEF dipoles in relation to SSEF dipoles was analyzed, the motor dipoles were not spatially distinct from somatosensory dipoles. Conclusions The findings in this study suggest that single-dipole localization for the analysis of motor data is not sufficiently sensitive and is nonspecific, and thus not clinically useful. PMID:17044563

  6. Effectiveness of preoperative analgesics on postoperative dental pain: a study.

    PubMed Central

    Zacharias, M.; Hunter, K. M.; Baker, A. B.

    1996-01-01

    Patients undergoing extractions of third molar teeth under general anesthesia were given a placebo, diclofenac (a nonsteroidal anti-inflammatory drug) 100 mg, or methadone (an opiate) 10 mg 60 to 90 min prior to surgery, and their pain scores and postoperative medication requirements were measured for 3 days. All patients received local anesthetic blocks and analgesic drugs during the perioperative period. There were no significant differences between the three groups in the pain scores and medication requirements during the period of study. It was concluded that preoperative use of nonsteroidal anti-inflammatory drugs and opiates may not offer a preemptive analgesic effect in patients who have had adequate analgesia during the surgery. Continued use of analgesic drugs during the postoperative period is perhaps more useful for this purpose. There appears to be a higher incidence of vomiting following opiates (methadone), precluding its clinical use in day-care patients. PMID:10323113

  7. Preoperative whole body disinfection--a controlled clinical study.

    PubMed

    Hayek, L J; Emerson, J M

    1988-04-01

    Preoperative whole body washing with chlorhexidine scrub was compared with soap for its effect on prevention of wound infection in clean surgery. Two thousand and fifteen patients were studied using chlorhexidine scrub, placebo or plain soap. The overall infection rate in the control and placebo groups was 12.8% (p less than 0.05) and 11.7% as opposed to 9% (p less than 0.05) in the treated group. Three per cent fewer infections were found in treated 'clean surgery' patients, and the incidence of Staphylococcus aureus infections was reduced from 6% (bar soap) to 3% (chlorhexidine). The saving in bed occupancy from prevention of infection is a significant cost-saving.

  8. Preoperational test report, primary ventilation condenser cooling system

    SciTech Connect

    Clifton, F.T.

    1997-10-29

    This represents the preoperational test report for the Primary Ventilation Condenser Cooling System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system uses a closed chilled water piping loop to provide offgas effluent cooling for tanks AY101, AY102, AZ1O1, AZ102; the offgas is cooled from a nominal 100 F to 40 F. Resulting condensation removes tritiated vapor from the exhaust stack stream. The piping system includes a package outdoor air-cooled water chiller with parallel redundant circulating pumps; the condenser coil is located inside a shielded ventilation equipment cell. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  9. Low anterior anastomotic dehiscence following preoperative irradiation with 6000 rads

    SciTech Connect

    Blake, D.P.; Bubrick, M.P.; Kochsiek, G.G.; Feeney, D.A.; Johnston, G.R.; Strom, R.L.; Hitchcock, C.R.

    1984-03-01

    Twenty mongrel dogs received 6000 rads of irradiation to the rectum and colon using the Nominal Standard Dosage Equation. Three weeks after irradiation each dog underwent anterior resection of the rectosigmoid with reconstruction randomized to either an EEA stapled or a two layer handsewn anastomosis. Each dog was studied digitally and by barium enema at the time of surgery, on the seventh postoperative day, and at autopsy. Five clinically significant leaks and three radiographic leaks occurred in the EEA stapled anastomoses. The handsewn anastomoses had five clinically significant leaks and two radiographic leaks. The data indicate that low anterior resection with either an EEA stapled or handsewn anastomosis cannot be done safely after 6000 rad preoperative irradiation.

  10. Preoperative treatment of a parotid hemangioma with 100% ethyl alcohol

    PubMed Central

    Emsen, Ilteris Murat

    2008-01-01

    Hemangiomas are one of the most common childhood neoplasms, occurring in approximately 12% of infants younger than one year of age. The lesions typically appear shortly after birth, increase in size over the first year and characteristically regress over the next decade. Because hemangiomas can be visible during an important stage of a child’s social development, numerous authors have pursued alternative treatment strategies to avoid or reduce this lengthy involution process. Unfortunately, no effective medical treatment has been reported for children with large, deforming hemangiomas of the parotid gland and overlying cheek. In the present case, a patient with a large parotid hemangioma was treated preoperatively with an intralesional injection of 100% ethyl alcohol solution to reduce the size of the mass. The mass was removed 28 days later with no major postoperative complications. PMID:19949507

  11. Preoperative infusional chemoradiation therapy for stage T3 rectal cancer

    SciTech Connect

    Rich, T.A.; Skibber, J.M.; Ajani, J.A.

    1995-07-15

    To evaluate preoperative infusional chemoradiation for patients with operable rectal cancer. Preoperative chemoradiation therapy using infusional 5-fluorouracil (5-FU), (300 mg/m{sup 2}/day) together with daily irradiation (45 Gy/25 fractions/5 weeks) was administered to 77 patients with clinically Stage T3 rectal cancer. Endoscopic ultrasound confirmed the digital rectal exam in 63 patients. Surgery was performed approximately 6 weeks after the completion of chemoradiation therapy and included 25 abdominoperineal resections and 52 anal-sphincter-preserving procedures. Posttreatment tumor stages were T1-2, N0 in 35%, T3, N0 in 25%, and T1-3, N1 in 11%; 29% had no evidence of tumor. Local tumor control after chemoradiation was seen in 96% (74 out of 77); 2 patients had recurrent disease at the anastomosis site and were treated successfully with abdominoperineal resection. Overall, pelvic control was obtained in 99% (76 out of 77). The survival after chemoradiation was higher in patients without node involvement than in those having node involvement (p = n.s.). More patients with pathologic complete responses or only microscopic foci survived than did patients who had gross residual tumor (p = 0.07). The actuarial survival rate was 83% at 3 years; the median follow-up was 27 months, with a range of 3 to 68 months. Acute, perioperative, and late complications were not more numerous or more severe with chemoradiation therapy than with traditional radiation therapy (XRT) alone. Excellent treatment response allowed two-thirds of the patients to have an anal-sphincter-sparing procedure. Gross residual disease in the resected specimen indicates a poor prognosis, and therapies specifically targeting these patients may improve survival further. 22 refs., 2 figs., 3 tabs.

  12. Predicting Postoperative C5 Palsy Using Preoperative Spinal Cord Rotation.

    PubMed

    Chugh, A Jessey; Gebhart, Jeremy J; Eubanks, Jason D

    2015-09-01

    The development of C5 nerve palsy after cervical decompression surgery has been well documented. The goal of this study was to determine whether preoperative spinal cord rotation could be used as a predictor of C5 palsy in patients who underwent posterior cervical decompression at C4-C6. The authors reviewed the records of 72 patients who had posterior decompression and 77 patients who had anterior decompression. With the patients undergoing anterior decompression used as a control group, magnetic resonance imaging scans were analyzed for area of the spinal cord, anterior-posterior diameter, and cord rotation relative to the vertebral body. The rate of C5 palsy was 7.3%. Average degrees of rotation were 3.83°±2.47° and 3.45°±2.23° in the anterior and posterior groups, respectively. A statistically significant association was detected between degree of rotation and C5 palsy. Point-biserial correlations were 0.58 (P<.001) and 0.60 (P<.001) in the anterior and posterior groups, respectively. With a diagnostic cutoff of 6°, the sensitivity and specificity of identifying patients with C5 palsy in the posterior group were 0.67 (95% confidence interval, 0.24-0.94) and 0.95 (95% confidence interval, 0.86-0.98), respectively. The results suggested that preoperative spinal cord rotation may be a valid predictor of C5 nerve palsy after posterior cervical decompression. With mild rotation defined as less than 6°, moderate rotation as 6° to 10°, and severe rotation as greater than 10°, the prevalence of C5 palsy in the posterior group was 2 of 65 for mild rotation, 3 of 6 for moderate rotation, and 1 of 1 for severe rotation.

  13. Tagged MRI and PET in severe CAD: discrepancy between preoperative inotropic reserve and intramyocardial functional outcome after revascularization.

    PubMed

    Mazzadi, Alejandro N; Janier, Marc F; Brossier, Benjamin; André-Fouët, Xavier; Revel, Didier; Croisille, Pierre

    2004-11-01

    In severe coronary artery disease (CAD), it has been shown that intramyocardial inotropic reserve as assessed with tagged magnetic resonance imaging (MRI) is uniformly distributed among positron emission tomography (PET) patterns reflecting normal or concomitant reductions in perfusion and glucose metabolism. This preliminary study aimed to delineate the relationship between preoperative values of intramyocardial inotropic reserve (in different PET patterns of perfusion and glucose uptake) and intramyocardial functional outcome after surgical revascularization in severe CAD. Twelve patients underwent preoperative tagged MRI (baseline, 10 microg.kg(-1).min(-1) of dobutamine), H2 15O/[18F]fluorodeoxyglucose PET imaging, and postoperative resting tagged MRI. Regional midmyocardial circumferential shortening (Ecc, in %) and PET patterns (normal, match viable, mismatch viable, and infarcted) were assessed in three tagged MRI/PET short-axis slices. Ecc at baseline ranged from 12 +/- 6 to 8 +/- 5 and 4 +/- 4% in normal, match-viable, and infarcted regions, respectively (P <0.05) and was 8 +/- 5% in mismatch-viable regions. Of the 429 regions studied, 187 showed preoperative inotropic reserve with dobutamine, but 238 showed postoperative functional improvement. Postoperative functional improvement was less common in infarcted regions (41 vs. approximately 60% in the other PET patterns), but the extent of improvement was similar among PET patterns (approximately 6%). Postoperative functional improvement occurred in 53% of all (normal, match viable, and mismatch viable) regions without inotropic reserve. In severe CAD, revascularization affords greater intramyocardial functional benefit than expected from the evaluation of intramyocardial inotropic reserve with low-dose dobutamine. Postoperative functional improvement in PET-viable regions without inotropic reserve suggests that factors other than regionally enhanced perfusion contribute to such functional improvement. PMID

  14. Treatment Outcome and Recursive Partitioning Analysis-Based Prognostic Factors in Patients With Esophageal Squamous Cell Carcinoma Receiving Preoperative Chemoradiotherapy

    SciTech Connect

    Kim, Min Kyoung; Kim, Sung- Bae Ahn, Jin Hee; Kim, Yong Hee; Kim, Jong Hoon; Jung, Hwoon Yong; Lee, Gin Hyug; Choi, Kee Don; Song, Ho-Young; Shin, Ji Hoon; Cho, Kyung-Ja; Ryu, Jin-Sook; Park, Seung-Il

    2008-07-01

    Purpose: To analyze the clinical outcomes and devise a prognostic model for patients with operable esophageal carcinoma who underwent preoperative chemoradiotherapy (CRT). Methods and Materials: A total of 269 patients were enrolled into three clinical trials assessing preoperative CRT at our institution. We assessed the significance of the pretreatment and treatment factors with regard to tumor recurrence and long-term survival and used recursive partitioning analysis to create a decision tree. Results: At a median follow-up of 31 months for the surviving patients, the median overall survival of all 180 patients in this study was 31.8 months, and the 5-year overall survival rate was 33.9%. The median event-free survival was 24.1 months, and the 5-year event-free survival rate was 29.3%. Of the 180 patients, 129 (71.7%) also underwent esophagectomy, and the perioperative mortality rate was 7.8%. A pathologic complete response was achieved by 58 patients (45%). The 5-year overall survival rate was 57.1% for patients who attained a pathologic complete response and 22.4% for those with gross residual disease (p = 0.0008). Recursive partitioning analysis showed that female patients who achieved a clinical response and underwent esophagectomy had the most favorable prognosis (p <0.0001). Among the patients who underwent esophagectomy, the group with good performance status, clinical Stage II, and a major pathologic response to CRT had the most favorable prognosis (p = 0.0002). Conclusion: Although preoperative CRT was generally effective and well-tolerated, an individualized approach is necessary to improve outcomes. Strategies to increase the response and reduce treatment failure should be investigated.

  15. Chlorhexidine in methanol for the preoperative cleansing of surgeons' hands: a clinical trial.

    PubMed

    Murie, J A; Macpherson, S G

    1980-10-01

    A clinical trial has shown that a technique of preoperative hand disinfection using a methanolic solution of chlorhexidine is faster, cheaper and more acceptable to users than the conventional aqueous detergent chlorhexidine preoperative scrub regime. The wound infection rate in general surgical patients was not influenced by the method used.

  16. Physiological, psychological and autonomic responses to pre-operative instructions for patients undergoing cardiac surgery.

    PubMed

    Liou, Huey-Ling; Chao, Yann-Fen C; Kuo, Terry B J; Chen, Hsing I

    2008-10-31

    Several studies have reported that the experience may induce emotional reactions before and after surgery. Various Studies have demonstrated that effective pre-operative information reduces stress and anxiety levels. However, little is known about the effect of pre-operative instruction on autonomic responses as measured by heart rate variability (HRV) before cardiac surgery. Ninety-one patients were randomly assigned to video-tape viewing and teaching booklet group. Electrocardiogram was monitored before and after pre-operative instruction. HRV was analyzed with spectral analysis of frequency domains of heart rate and categorized into low and high frequency (LF and HF). After pre-operative instruction, subjects completed a score of perceived stress and helpfulness. In this study, we found that pre-operative instruction with video-tape was similarly effective as teaching booklets on patients' perceived stress, perceived helpfulness and recovery outcomes. The decrease in HF% and increase in LF/HF ratio of HRV indicate a change in sympathovagal balance toward a lower parasympathetic activity after pre-operative instruction in subjects of both groups. However, the perceived helpfulness of pre-operative instruction may often be associated with a relatively less sympathetic activity. Further studies are needed to determine the optimal timing to enhance the positive effects on the sympathovagal balance after pre-operative instruction.

  17. 77 FR 69863 - Antiseptic Patient Preoperative Skin Preparation Products; Public Hearing; Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-21

    ... HUMAN SERVICES Food and Drug Administration Antiseptic Patient Preoperative Skin Preparation Products...-8753, email: AntisepticPreOpPublicMeeting@fda.hhs.gov . Registration: The public hearing is free, and... Patient preoperative skin preparations are over-the-counter (OTC) topical antiseptic drug products used...

  18. [Recurrence and survival rate of advanced gastric cancer after preoperative intraarterial EAP I injection therapy].

    PubMed

    Takeuchi, K; Taniguchi, H; Miyata, K; Koyama, H; Tanaka, H; Ueshima, Y; Okano, S; Oguro, A; Itoh, A; Sawai, K

    1993-08-01

    In our department, curative operations were performed for 32 patients with advanced gastric cancer from April 1989 to August 1990. Preoperative intra-arterial injection therapy with etoposide (100 mg), pirarubicin (20 mg) and cisplatin (20 mg) was given 18 patients. Recurrence and survival rate were investigated. The survival rate of patients with preoperative intra-arterial injection therapy 45 months after operation was 59.2%, while that of patients without preoperative intra-arterial injection therapy was 75.8%. There were no significant differences between these two groups. Three lymph node recurrences were seen in patients with preoperative intra-arterial injection therapy (recurrence rate, 16.7%). Four recurrences were observed in patients without preoperative injection therapy (peritoneal dissemination 2, liver 1, local 1; recurrence rate, 28.6%). We earlier reported that preoperative intra-arterial cisplatin (40 or 60 mg) injection therapy may reduce the incidence of lymph node recurrence and liver metastasis but may not be effective to prevent postoperative peritoneal recurrence, while no peritoneal dissemination was observed in patients with preoperative intra-arterial EAP I injection therapy. Thus, it was concluded that further study of combination and dose of anti-cancer drug may improve effectiveness of preoperative intra-arterial injection therapy for gastric cancer.

  19. The Preoperative Sinus CT: Avoiding a "CLOSE" Call with Surgical Complications.

    PubMed

    O'Brien, William T; Hamelin, Stefan; Weitzel, Erik K

    2016-10-01

    Although functional endoscopic sinus surgery is an effective means of treating patients with recurrent and refractory sinusitis, the procedure is not without risk of serious surgical complications. Preoperative computed tomography (CT) affords radiologists the opportunity to prospectively identify anatomic variants that predispose patients to major surgical complications; however, these critical variants are not consistently evaluated or documented on preoperative imaging reports. The purpose of this review is to illustrate important anatomic variants and landmarks on the preoperative sinus CT with a focus on those that predispose patients to surgical complications. These critical variants and landmarks can be quickly recalled and incorporated into the preoperative imaging report through the use of the mnemonic "CLOSE": Cribriform plate, Lamina papyracea, Onodi cell, Sphenoid sinus pneumatization, and (anterior) Ethmoidal artery. This approach will greatly enhance the value of the preoperative imaging report for referring otolaryngologists and help reduce the risk of surgical complications. (©) RSNA, 2016 Online supplemental material is available for this article. PMID:27643765

  20. Preoperative anxiety in children risk factors and non-pharmacological management.

    PubMed

    Ahmed, Mohammad I; Farrell, Maureen A; Parrish, Katie; Karla, Aman

    2011-06-01

    It is important for anesthesiologists to appreciate the impact of preoperative anxiety in children. Not only does it cause suffering in many children prior to their surgical experience, it has a negative impact on their postoperative recovery and possibly long afterwards. Because of these concerns, continued research is warranted to seek ways of minimizing their fears in the perioperative setting. In this review, we will examine the risk factors for preoperative anxiety, tools for quantifying children and parent's anxiety, and strategies that may play a part in decreasing preoperative anxiety. Variables, which influence preoperative anxiety in children, include their age, temperament, prior hospital experience and parent coping abilities. This review will also explore issues surrounding parental presence during a child's anesthesia induction and how understanding child development can enhance their cooperativeness during the preoperative period, especially during anesthesia induction. Non-pharmacological interventions as a means of decreasing pediatric anxiety will be explored. Finally recent trends and new directions will be touched upon.

  1. Does Preoperative Measurement of Cerebral Blood Flow with Acetazolamide Challenge in Addition to Preoperative Measurement of Cerebral Blood Flow at the Resting State Increase the Predictive Accuracy of Development of Cerebral Hyperperfusion after Carotid Endarterectomy? Results from 500 Cases with Brain Perfusion Single-photon Emission Computed Tomography Study

    PubMed Central

    OSHIDA, Sotaro; OGASAWARA, Kuniaki; SAURA, Hiroaki; YOSHIDA, Koji; FUJIWARA, Shunro; KOJIMA, Daigo; KOBAYASHI, Masakazu; YOSHIDA, Kenji; KUBO, Yoshitaka; OGAWA, Akira

    2015-01-01

    The purpose of the present study was to determine whether preoperative measurement of cerebral blood flow (CBF) with acetazolamide in addition to preoperative measurement of CBF at the resting state increases the predictive accuracy of development of cerebral hyperperfusion after carotid endarterectomy (CEA). CBF at the resting state and cerebrovascular reactivity (CVR) to acetazolamide were quantitatively assessed using N-isopropyl-p-[123I]-iodoamphetamine (IMP)-autoradiography method with single-photon emission computed tomography (SPECT) before CEA in 500 patients with ipsilateral internal carotid artery stenosis (≥ 70%). CBF measurement using 123I-IMP SPECT was also performed immediately and 3 days after CEA. A region of interest (ROI) was automatically placed in the middle cerebral artery territory in the affected cerebral hemisphere using a three-dimensional stereotactic ROI template. Preoperative decreases in CBF at the resting state [95% confidence intervals (CIs), 0.855 to 0.967; P = 0.0023] and preoperative decreases in CVR to acetazolamide (95% CIs, 0.844 to 0.912; P < 0.0001) were significant independent predictors of post-CEA hyperperfusion. The area under the receiver operating characteristic curve for prediction of the development of post-CEA hyperperfusion was significantly greater for CVR to acetazolamide than for CBF at the resting state (difference between areas, 0.173; P < 0.0001). Sensitivity, specificity, and positive- and negative-predictive values for the prediction of the development of post-CEA hyperperfusion were significantly greater for CVR to acetazolamide than for CBF at the resting state (P < 0.05, respectively). The present study demonstrated that preoperative measurement of CBF with acetazolamide in addition to preoperative measurement of CBF at the resting state increases the predictive accuracy of the development of post-CEA hyperperfusion. PMID:25746308

  2. Accurate paleointensities - the multi-method approach

    NASA Astrophysics Data System (ADS)

    de Groot, Lennart

    2016-04-01

    The accuracy of models describing rapid changes in the geomagnetic field over the past millennia critically depends on the availability of reliable paleointensity estimates. Over the past decade methods to derive paleointensities from lavas (the only recorder of the geomagnetic field that is available all over the globe and through geologic times) have seen significant improvements and various alternative techniques were proposed. The 'classical' Thellier-style approach was optimized and selection criteria were defined in the 'Standard Paleointensity Definitions' (Paterson et al, 2014). The Multispecimen approach was validated and the importance of additional tests and criteria to assess Multispecimen results must be emphasized. Recently, a non-heating, relative paleointensity technique was proposed -the pseudo-Thellier protocol- which shows great potential in both accuracy and efficiency, but currently lacks a solid theoretical underpinning. Here I present work using all three of the aforementioned paleointensity methods on suites of young lavas taken from the volcanic islands of Hawaii, La Palma, Gran Canaria, Tenerife, and Terceira. Many of the sampled cooling units are <100 years old, the actual field strength at the time of cooling is therefore reasonably well known. Rather intuitively, flows that produce coherent results from two or more different paleointensity methods yield the most accurate estimates of the paleofield. Furthermore, the results for some flows pass the selection criteria for one method, but fail in other techniques. Scrutinizing and combing all acceptable results yielded reliable paleointensity estimates for 60-70% of all sampled cooling units - an exceptionally high success rate. This 'multi-method paleointensity approach' therefore has high potential to provide the much-needed paleointensities to improve geomagnetic field models for the Holocene.

  3. Accurate Thermal Conductivities from First Principles

    NASA Astrophysics Data System (ADS)

    Carbogno, Christian

    2015-03-01

    In spite of significant research efforts, a first-principles determination of the thermal conductivity at high temperatures has remained elusive. On the one hand, Boltzmann transport techniques that include anharmonic effects in the nuclear dynamics only perturbatively become inaccurate or inapplicable under such conditions. On the other hand, non-equilibrium molecular dynamics (MD) methods suffer from enormous finite-size artifacts in the computationally feasible supercells, which prevent an accurate extrapolation to the bulk limit of the thermal conductivity. In this work, we overcome this limitation by performing ab initio MD simulations in thermodynamic equilibrium that account for all orders of anharmonicity. The thermal conductivity is then assessed from the auto-correlation function of the heat flux using the Green-Kubo formalism. Foremost, we discuss the fundamental theory underlying a first-principles definition of the heat flux using the virial theorem. We validate our approach and in particular the techniques developed to overcome finite time and size effects, e.g., by inspecting silicon, the thermal conductivity of which is particularly challenging to converge. Furthermore, we use this framework to investigate the thermal conductivity of ZrO2, which is known for its high degree of anharmonicity. Our calculations shed light on the heat resistance mechanism active in this material, which eventually allows us to discuss how the thermal conductivity can be controlled by doping and co-doping. This work has been performed in collaboration with R. Ramprasad (University of Connecticut), C. G. Levi and C. G. Van de Walle (University of California Santa Barbara).

  4. Rapid and accurate evaluation of the quality of commercial organic fertilizers using near infrared spectroscopy.

    PubMed

    Wang, Chang; Huang, Chichao; Qian, Jian; Xiao, Jian; Li, Huan; Wen, Yongli; He, Xinhua; Ran, Wei; Shen, Qirong; Yu, Guanghui

    2014-01-01

    The composting industry has been growing rapidly in China because of a boom in the animal industry. Therefore, a rapid and accurate assessment of the quality of commercial organic fertilizers is of the utmost importance. In this study, a novel technique that combines near infrared (NIR) spectroscopy with partial least squares (PLS) analysis is developed for rapidly and accurately assessing commercial organic fertilizers quality. A total of 104 commercial organic fertilizers were collected from full-scale compost factories in Jiangsu Province, east China. In general, the NIR-PLS technique showed accurate predictions of the total organic matter, water soluble organic nitrogen, pH, and germination index; less accurate results of the moisture, total nitrogen, and electrical conductivity; and the least accurate results for water soluble organic carbon. Our results suggested the combined NIR-PLS technique could be applied as a valuable tool to rapidly and accurately assess the quality of commercial organic fertilizers. PMID:24586313

  5. Rapid and accurate evaluation of the quality of commercial organic fertilizers using near infrared spectroscopy.

    PubMed

    Wang, Chang; Huang, Chichao; Qian, Jian; Xiao, Jian; Li, Huan; Wen, Yongli; He, Xinhua; Ran, Wei; Shen, Qirong; Yu, Guanghui

    2014-01-01

    The composting industry has been growing rapidly in China because of a boom in the animal industry. Therefore, a rapid and accurate assessment of the quality of commercial organic fertilizers is of the utmost importance. In this study, a novel technique that combines near infrared (NIR) spectroscopy with partial least squares (PLS) analysis is developed for rapidly and accurately assessing commercial organic fertilizers quality. A total of 104 commercial organic fertilizers were collected from full-scale compost factories in Jiangsu Province, east China. In general, the NIR-PLS technique showed accurate predictions of the total organic matter, water soluble organic nitrogen, pH, and germination index; less accurate results of the moisture, total nitrogen, and electrical conductivity; and the least accurate results for water soluble organic carbon. Our results suggested the combined NIR-PLS technique could be applied as a valuable tool to rapidly and accurately assess the quality of commercial organic fertilizers.

  6. Rapid and Accurate Evaluation of the Quality of Commercial Organic Fertilizers Using Near Infrared Spectroscopy

    PubMed Central

    Wang, Chang; Huang, Chichao; Qian, Jian; Xiao, Jian; Li, Huan; Wen, Yongli; He, Xinhua; Ran, Wei; Shen, Qirong; Yu, Guanghui

    2014-01-01

    The composting industry has been growing rapidly in China because of a boom in the animal industry. Therefore, a rapid and accurate assessment of the quality of commercial organic fertilizers is of the utmost importance. In this study, a novel technique that combines near infrared (NIR) spectroscopy with partial least squares (PLS) analysis is developed for rapidly and accurately assessing commercial organic fertilizers quality. A total of 104 commercial organic fertilizers were collected from full-scale compost factories in Jiangsu Province, east China. In general, the NIR-PLS technique showed accurate predictions of the total organic matter, water soluble organic nitrogen, pH, and germination index; less accurate results of the moisture, total nitrogen, and electrical conductivity; and the least accurate results for water soluble organic carbon. Our results suggested the combined NIR-PLS technique could be applied as a valuable tool to rapidly and accurately assess the quality of commercial organic fertilizers. PMID:24586313

  7. Accurately measuring dynamic coefficient of friction in ultraform finishing

    NASA Astrophysics Data System (ADS)

    Briggs, Dennis; Echaves, Samantha; Pidgeon, Brendan; Travis, Nathan; Ellis, Jonathan D.

    2013-09-01

    UltraForm Finishing (UFF) is a deterministic sub-aperture computer numerically controlled grinding and polishing platform designed by OptiPro Systems. UFF is used to grind and polish a variety of optics from simple spherical to fully freeform, and numerous materials from glasses to optical ceramics. The UFF system consists of an abrasive belt around a compliant wheel that rotates and contacts the part to remove material. This work aims to accurately measure the dynamic coefficient of friction (μ), how it changes as a function of belt wear, and how this ultimately affects material removal rates. The coefficient of friction has been examined in terms of contact mechanics and Preston's equation to determine accurate material removal rates. By accurately predicting changes in μ, polishing iterations can be more accurately predicted, reducing the total number of iterations required to meet specifications. We have established an experimental apparatus that can accurately measure μ by measuring triaxial forces during translating loading conditions or while manufacturing the removal spots used to calculate material removal rates. Using this system, we will demonstrate μ measurements for UFF belts during different states of their lifecycle and assess the material removal function from spot diagrams as a function of wear. Ultimately, we will use this system for qualifying belt-wheel-material combinations to develop a spot-morphing model to better predict instantaneous material removal functions.

  8. Metabolomic analysis of percutaneous fine-needle aspiration specimens of thyroid nodules: Potential application for the preoperative diagnosis of thyroid cancer

    PubMed Central

    Ryoo, Inseon; Kwon, Hyuknam; Kim, Soo Chin; Jung, Seung Chai; Yeom, Jeong A; Shin, Hwa Seon; Cho, Hye Rim; Yun, Tae Jin; Choi, Seung Hong; Sohn, Chul-Ho; Park, Sunghyouk; Kim, Ji-hoon

    2016-01-01

    Thyroid nodules are a very common problem. Since malignant thyroid nodules should be treated surgically, preoperative diagnosis of thyroid cancer is very crucial. Cytopathologic analysis of percutaneous fine-needle aspiration (FNA) specimens is the current gold standard for diagnosing thyroid nodules. However, this method has led to high rates of inconclusive results. Metabolomics has emerged as a useful tool in medical fields and shown great potential in diagnosing various cancers. Here, we evaluated the potential of nuclear magnetic resonance (NMR) analysis of percutaneous FNA specimens for preoperative diagnosis of thyroid cancer. We analyzed metabolome of FNA samples of papillary thyroid carcinoma (n = 35) and benign follicular nodule (n = 69) using a proton NMR spectrometer. The metabolomic profiles showed a considerable discrimination between benign and malignant nodules. Receiver operating characteristic (ROC) curve analysis indicated that seven metabolites could serve as discriminators (area under ROC curve value, 0.64–0.85). These findings demonstrated that NMR analysis of percutaneous FNA specimens of thyroid nodules can be potentially useful in the accurate and rapid preoperative diagnosis of thyroid cancer. PMID:27440433

  9. An evaluation of preoperative ibuprofen for treatment of pain associated with orthodontic separator placement.

    PubMed

    Steen Law, S L; Southard, K A; Law, A S; Logan, H L; Jakobsen, J R

    2000-12-01

    Patients undergoing orthodontic treatment can experience significant levels of pain. This study assessed the effectiveness of preoperative ibuprofen in reducing the incidence and the severity of pain after orthodontic separator placement. Sixty-three adolescent patients (mean age, 13 years) were included in this randomized, double-blind, placebo-controlled, prospective study. Patients were randomly assigned to 1 of 3 experimental conditions: (1) 400 mg of ibuprofen taken orally 1 hour before separator placement and a lactose placebo taken orally immediately after the appointment, (2) a lactose placebo taken orally 1 hour before separator placement and 400 mg of ibuprofen taken orally immediately after the appointment, or (3) a lactose placebo taken orally 1 hour before separator placement and again immediately after the appointment. The patient's level of discomfort was assessed with a visual analog scale at 2, 6, and 24 hours, as well as at 2, 3, and 7 days after placement of the orthodontic separators. An analysis of variance and Duncan's multiple range test revealed that 2 hours after their orthodontic appointment the patients who had taken ibuprofen 1 hour before separator placement had significantly less pain with chewing than did the patients who received either ibuprofen postoperatively or a placebo. Additional measures suggest a trend for less pain for this group of patients. These results support the use of pretreatment ibuprofen for patients requiring analgesics for orthodontic discomfort. Future study of the use of preemptive analgesics in orthodontics is warranted.

  10. Digital multimedia books produced using iBooks Author for pre-operative surgical patient information.

    PubMed

    Briggs, Matthew; Wilkinson, Caroline; Golash, Aprajay

    2014-10-01

    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

  11. Digital multimedia books produced using iBooks Author for pre-operative surgical patient information.

    PubMed

    Briggs, Matthew; Wilkinson, Caroline; Golash, Aprajay

    2014-10-01

    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.

  12. Preoperative endoscopy may reduce the need for revisional surgery for gastro-oesophageal reflux disease following laparoscopic sleeve gastrectomy.

    PubMed

    Madhok, B M; Carr, W R J; McCormack, C; Boyle, M; Jennings, N; Schroeder, N; Balupuri, S; Small, P K

    2016-08-01

    Laparoscopic sleeve gastrectomy is a safe and effective bariatric operation, but postoperative reflux symptoms can sometimes necessitate revisional surgery. Roux-en-Y gastric bypass is the preferred operation in morbidly obese patients with gastro-oesophageal reflux disease. In 2011, we introduced preoperative endoscopy to assess for hiatus hernia or evidence of oesophagitis in conjunction with an assessment of gastro-oesophageal reflux symptoms for all patients undergoing bariatric surgery with a view to avoid sleeve gastrectomy for these patients. A prospectively maintained database was used to identify patients who underwent sleeve gastrectomy before and after we changed the unit policy. The need for revisional surgery in patients with troublesome gastro-oesophageal reflux disease was examined. Prior to 2011, 130 patients underwent sleeve gastrectomy, and 11 (8.5%) of them required conversion to Roux-en-Y gastric bypass for symptomatic reflux disease. Following the policy change, 284 patients underwent sleeve gastrectomy, and to date, only five (1.8%) have required revisional surgery (p = 0.001). Baseline demographics were comparable between the groups, and average follow-up period was 47 and 33 months, respectively, for each group. Preoperative endoscopy and a detailed clinical history regarding gastro-oesophageal reflux symptoms may improve patient selection for sleeve gastrectomy. Avoiding sleeve gastrectomy in patients with reflux disease and/or hiatus hernia may reduce the incidence of revisional surgery. PMID:27400631

  13. Efficacy of stereoscopic visualization and six degrees of freedom interaction in preoperative planning of total hip replacement.

    PubMed

    Testi, Debora; Lattanzi, Riccardo; Benvegnù, Marco; Petrone, Marco; Zannoni, Cinzia; Viceconti, Marco; Toni, Aldo

    2006-09-01

    The aim of this study was to assess the accuracy of a six-degrees-of-freedom application for pre-operative planning of total hip replacement in a virtual reality (VR) environment. A test was performed estimating the system inherent accuracy. The users can move objects in the VR environment with an intrinsic accuracy almost four orders of magnitude greater than the object dimension. A second unambiguous and relevant task was defined to assess the accuracy achievable with the interface in a specific planning task. The results were compared with those obtained with 2D interfaces for both the stem and the cup component. The RMSE was assumed as an indicator of the achievable accuracy. The accuracy of the immersive interface was comparable with that achievable with a standard mouse - monitor interface. The users were consistent using the VR interface, confirming the high usability of the new interface and the steep learning curve of users unfamiliar with the new environment. This study has demonstrated that the application of VR environment for pre-operative planning of total hip replacement may help to shorten the duration of the positioning and to yield consistent results even with first-time users. PMID:16954057

  14. Reducing Unnecessary Preoperative Blood Orders and Costs by Implementing an Updated Institution-specific Maximum Surgical Blood Order Schedule and a Remote Electronic Blood Release System

    PubMed Central

    Frank, Steven M.; Oleyar, Michael J.; Ness, Paul M.; Tobian, Aaron A. R.

    2014-01-01

    Background Using blood utilization data acquired from our anesthesia information management system, an updated institution-specific maximum surgical blood order schedule (MSBOS) was introduced. We evaluate whether the MSBOS, along with a remote electronic blood release system (EBRS), reduced unnecessary preoperative blood orders and costs. Methods At a large academic medical center, data for preoperative blood orders were analyzed for 63,916 surgical patients over a 34-month period. The new MSBOS and the EBRS (Hemosafe®, Haemonetics Corp., Braintree, MA) were introduced mid-way through this time period. We assessed whether these interventions led to reductions in unnecessary preoperative orders and associated costs. Results Among patients having surgical procedures deemed not to require a type and screen or crossmatch (n = 33,216), the percentage of procedures with preoperative blood orders decreased by 38% [from 40.4% (7,167 of 17,740 patients) to 25.0% (3,869 of 15,476 patients), P < 0.001]. Among all hospitalized inpatients, the crossmatch-to-transfusion ratio decreased by 27% (from 2.11 to 1.54; P < 0.001) over the same time period. The proportion of patients who required emergency release uncrossmatched blood increased from 2.2 to 3.1 per 1,000 patients (P = 0.03); however, most of these patients were having emergency surgery. Based on the realized reductions in blood orders, annual costs were reduced by $137,223 ($6.08/patient) for surgical patients, and by $298,966 ($6.20/patient) for all hospitalized patients. Conclusions Implementing institution-specific, updated MSBOS-directed preoperative blood ordering guidelines along with an EBRS results in a substantial reduction in unnecessary orders and costs, with a clinically insignificant increase in requirement for emergency release blood transfusions. PMID:24932853

  15. Preoperative steroid use and the incidence of perioperative complications in patients undergoing craniotomy for definitive resection of a malignant brain tumor.

    PubMed

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

    2015-09-01

    We studied the impact of preoperative steroids on 30 day morbidity and mortality of craniotomy for definitive resection of malignant brain tumors. Glucocorticoids are used to treat peritumoral edema in patients with malignant brain tumors, however, prolonged (⩾ 10 days) use of preoperative steroids as a risk factor for perioperative complications following resection of brain tumors has not been studied comprehensively. Therefore, we identified 4407 patients who underwent craniotomy to resect a malignant brain tumor between 2007 and 2012, who were reported in the National Surgical Quality Improvement Program, a prospectively collected clinical database. Metastatic brain tumors constituted 37.5% (n=1611) and primary malignant gliomas 62.5% (n=2796) of the study population. We used logistic regression to assess the association between preoperative steroid use and perioperative complications before and after 1:1 propensity score matching. Patients who received steroids constituted 22.8% of the population (n=1009). In the unmatched cohort, steroid use was associated with decreased length of hospitalization (odds ratio [OR] 0.7; 95% confidence interval [CI] 0.6-0.8), however, the risk for readmission (OR 1.5; 95% CI 1.2-1.8) was increased. In the propensity score matched cohort (n=465), steroid use was not statistically associated with any adverse outcomes. Patients who received steroids were less likely to stay hospitalized for a protracted period of time, but were more likely to be readmitted after discharge following craniotomy. As an independent risk factor, preoperative steroid use was not associated with any observed perioperative complications. The findings of this study suggest that preoperative steroids do not independently compromise the short term outcome of craniotomy for resection of malignant brain tumors.

  16. Preoperative Quantitative MR Tractography Compared with Visual Tract Evaluation in Patients with Neuropathologically Confirmed Gliomas Grades II and III: A Prospective Cohort Study

    PubMed Central

    Delgado, Anna F.; Nilsson, Markus; Latini, Francesco; Mårtensson, Johanna; Zetterling, Maria; Berntsson, Shala G.; Alafuzoff, Irina; Lätt, Jimmy; Larsson, Elna-Marie

    2016-01-01

    Background and Purpose. Low-grade gliomas show infiltrative growth in white matter tracts. Diffusion tensor tractography can noninvasively assess white matter tracts. The aim was to preoperatively assess tumor growth in white matter tracts using quantitative MR tractography (3T). The hypothesis was that suspected infiltrated tracts would have altered diffusional properties in infiltrated tract segments compared to noninfiltrated tracts. Materials and Methods. Forty-eight patients with suspected low-grade glioma were included after written informed consent and underwent preoperative diffusion tensor imaging in this prospective review-board approved study. Major white matter tracts in both hemispheres were tracked, segmented, and visually assessed for tumor involvement in thirty-four patients with gliomas grade II or III (astrocytomas or oligodendrogliomas) on postoperative neuropathological evaluation. Relative fractional anisotropy (rFA) and mean diffusivity (rMD) in tract segments were calculated and compared with visual evaluation and neuropathological diagnosis. Results. Tract segment infiltration on visual evaluation was associated with a lower rFA and high rMD in a majority of evaluated tract segments (89% and 78%, resp.). Grade II and grade III gliomas had similar infiltrating behavior. Conclusion. Quantitative MR tractography corresponds to visual evaluation of suspected tract infiltration. It may be useful for an objective preoperative evaluation of tract segment involvement. PMID:27190647

  17. Mill profiler machines soft materials accurately

    NASA Technical Reports Server (NTRS)

    Rauschl, J. A.

    1966-01-01

    Mill profiler machines bevels, slots, and grooves in soft materials, such as styrofoam phenolic-filled cores, to any desired thickness. A single operator can accurately control cutting depths in contour or straight line work.

  18. Effect of preoperative mastoid ventilation on tympanoplasty success.

    PubMed

    Metin, Mehmet; Kaptan, Zeynep Kizilkaya; Dogan, Sedat; Yazici, Hasmet; Bayraktar, Cem; Gocmen, Hakan; Samim, Etem Erdal

    2014-01-01

    Purpose. This study was conducted with the aim of investigating the relationship between mastoid air cell volumes and graft success after tympanoplasty. Material and Methods. This study was performed retrospectively with patients undergoing type I tympanoplasty and antrostomy. A total of 57 patients (20-35.09% female and 37-64.91% male) with a mean age of 29.69 ± SD (range 12-56 years) were included in the study. The patients were invited for a control at the 1st, 3rd, and 12th months, and otoscopic examinations and audiometric tests were performed. The temporal bone computed tomography images were screened with the 4800 Dpi optic resolution scanner and transferred to the computer environment in JPG format in order to calculate the mastoid air cell volume, and the volumes were calculated using the Autocad 2007 program. Results. Although, the graft success was determined to be better in the well-ventilated group, no significant difference could be found between the groups in terms of graft success at the 1st, 3rd, and 12th months (P > 0.05). No statistically significant difference could be found between the three groups in terms of the preoperative and postoperative hearing gains (P > 0.05). PMID:25374605

  19. Effect of Preoperative Mastoid Ventilation on Tympanoplasty Success

    PubMed Central

    Metin, Mehmet; Kaptan, Zeynep Kizilkaya; Dogan, Sedat; Yazici, Hasmet; Bayraktar, Cem; Gocmen, Hakan; Samim, Etem Erdal

    2014-01-01

    Purpose. This study was conducted with the aim of investigating the relationship between mastoid air cell volumes and graft success after tympanoplasty. Material and Methods. This study was performed retrospectively with patients undergoing type I tympanoplasty and antrostomy. A total of 57 patients (20–35.09% female and 37–64.91% male) with a mean age of 29.69 ± SD (range 12–56 years) were included in the study. The patients were invited for a control at the 1st, 3rd, and 12th months, and otoscopic examinations and audiometric tests were performed. The temporal bone computed tomography images were screened with the 4800 Dpi optic resolution scanner and transferred to the computer environment in JPG format in order to calculate the mastoid air cell volume, and the volumes were calculated using the Autocad 2007 program. Results. Although, the graft success was determined to be better in the well-ventilated group, no significant difference could be found between the groups in terms of graft success at the 1st, 3rd, and 12th months (P > 0.05). No statistically significant difference could be found between the three groups in terms of the preoperative and postoperative hearing gains (P > 0.05). PMID:25374605

  20. An analysis of a preoperative pediatric autologous blood donation program

    PubMed Central

    Letts, Merv; Perng, Richard; Luke, Brian; Jarvis, James; Lawton, Louis; Hoey, Steve

    2000-01-01

    Objective To determine the efficacy of a pediatric autologous blood donation program. Design A retrospective study of patient charts and blood-bank records. Setting The Children’s Hospital of Eastern Ontario, Ottawa, a tertiary care, pediatric centre. Patients One hundred and seventy-three children who received blood transfusions for a total of 182 procedures between June 1987 and June 1997. Interventions Autologous and homologous blood transfusion required for major surgical intervention, primarily spinal fusion. Main outcome measures Surgeons’ accuracy in predicting the number of autologous blood units required for a given procedure, compliance rate (children’s ability to donate the requested volume of blood), utilization rate of autologous units and rate of allogeneic transfusion. Results The surgeons’ accuracy in predicting the number of autologous units required for a given procedure was 53.8%. The compliance rate of children to donate the requested amount of blood was 80.3%. In children below the standard age and weight criteria for blood donation the compliance rate was 75.5%. The utilization rate of autologous units obtained was 84.4% and the incidence of allogeneic transfusion was 26.6%. Conclusions There was a high rate of compliance and utilization of predonated autologous blood in the children in the study. Preoperative blood donation programs are safe and effective in children, even in those below the standard age and weight criteria of 10 years and 40 kg. PMID:10812347

  1. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration.

    PubMed Central

    Nygren, J; Thorell, A; Jacobsson, H; Larsson, S; Schnell, P O; Hylén, L; Ljungqvist, O

    1995-01-01

    BACKGROUND: Overnight fasting is routine before elective surgery. This may not be the optimal way to prepare for surgical stress, however, because intravenous carbohydrate supplementation instead of fasting has recently been shown to reduce postoperative insulin resistance. In the current study, gastric emptying of a carbohydrate-rich drink was investigated before elective surgery and in a control situation. METHODS: Twelve patients scheduled for elective surgery were randomly given 400 mL of either a carbohydrate-rich drink (285 mOsm/kg, 12.0% carbohydrates, n = 6) or water 4 hours before being anesthetized. Gastric emptying was measured (gamma camera, 99Tcm). Each patient repeated the protocol postoperatively as a control. All values were presented as the mean +/- SEM by means of a nonparametric statistical evaluation. RESULTS: Despite the increased anxiety experienced by patients before surgery (p < 0.005), gastric emptying did not differ between the experimental and control situations. Initially, water emptied more rapidly than carbohydrate. However, after 90 minutes, the stomach was emptied regardless of the solution administered (3.2 +/- 1.1% [mean +/- SEM] remaining in the stomach in the carbohydrate group versus 2.3 +/- 1.2% remaining in the stomach in the water group). CONCLUSIONS: Preoperative anxiety does not prolong gastric emptying. The stomach had been emptied 90 minutes after ingestion of both the carbohydrate-rick drink and water, thereby indicating the possibility of allowing an intake of iso-osmolar carbohydrate-rich fluids before surgery. PMID:8526579

  2. [Preoperative α-receptor block in patients with pheochromocytoma? Against].

    PubMed

    Groeben, H

    2012-06-01

    Perioperative mortality regarding the resection of catecholamine-producing tumors has been markedly improved. This improvement has been attributed to the preoperative treatment with α-receptor blocking agents. An α-receptor block is still recommended prior to the resection of pheochromocytoma or paraganglioma. However, the effect has never been tested in a randomized clinical trial. Despite an assumed effective α-receptor block, many centers report systolic blood pressure increases beyond 200 mmHg. Out of 200 consecutive resections of catecholamine-producing tumors, 73 patients without an α-receptor blockade were treated. There was no significant difference in the maximum systolic blood pressure or in the incidence of hypertensive episodes. There was no correlation between the individual dose of phenoxybenzamine and the maximum blood pressure. Overall it can be concluded that with the improvement of surgical techniques, diagnostic tools and highly effective short acting substances to control hemodynamics intraoperatively, the question must be raised whether a time-consuming, unreliable pretreatment burdened with significant side effects is still required.

  3. Effect of preoperative mastoid ventilation on tympanoplasty success.

    PubMed

    Metin, Mehmet; Kaptan, Zeynep Kizilkaya; Dogan, Sedat; Yazici, Hasmet; Bayraktar, Cem; Gocmen, Hakan; Samim, Etem Erdal

    2014-01-01

    Purpose. This study was conducted with the aim of investigating the relationship between mastoid air cell volumes and graft success after tympanoplasty. Material and Methods. This study was performed retrospectively with patients undergoing type I tympanoplasty and antrostomy. A total of 57 patients (20-35.09% female and 37-64.91% male) with a mean age of 29.69 ± SD (range 12-56 years) were included in the study. The patients were invited for a control at the 1st, 3rd, and 12th months, and otoscopic examinations and audiometric tests were performed. The temporal bone computed tomography images were screened with the 4800 Dpi optic resolution scanner and transferred to the computer environment in JPG format in order to calculate the mastoid air cell volume, and the volumes were calculated using the Autocad 2007 program. Results. Although, the graft success was determined to be better in the well-ventilated group, no significant difference could be found between the groups in terms of graft success at the 1st, 3rd, and 12th months (P > 0.05). No statistically significant difference could be found between the three groups in terms of the preoperative and postoperative hearing gains (P > 0.05).

  4. Oral carbohydrate supplementation reduces preoperative discomfort in laparoscopic cholecystectomy.

    PubMed

    Yildiz, Huseyin; Gunal, Solmaz Eruyar; Yilmaz, Gulsen; Yucel, Safak

    2013-04-01

    The aim of this study was to investigate the effects of oral carbohydrate solution (CHO) on perioperative discomfort, biochemistry, hemodynamics, and patient satisfaction in elective surgery patients under general anesthesia. Sixty cases in ASA I-II group who were planned to have operation under general anesthesia were included in the study. The cases were randomly divided into two groups having 30 subjects in each. The patients in the study group were given CHO in the evening prior to the surgery and 2-3 hr before the anesthesia while routine fasting was applied in the control group. In the study group; 2-3 hr before the surgery; malaise, thirst, hunger, and weakness; just before the surgery malaise, thirst, hunger, and fatigue; 2 hr after the operation thirst, hunger, weakness, and concentration difficulty; 24 hr after the operation malaise and weakness were found significantly lower. Fasting blood glucose (FBG) level was found to be higher in the control group at the 90th min of the operation. Gastric volumes were higher in the control group; gastric pH values were found significantly higher in the study group. The level of anxiety and depression risk rate were found lower in the study group. In conclusion, preoperative CHO reduces perioperative discomfort and improves perioperative well being when compared to overnight fasting.

  5. Effect of preoperative suggestion on postoperative gastrointestinal motility.

    PubMed Central

    Disbrow, E A; Bennett, H L; Owings, J T

    1993-01-01

    Autonomic behavior is subject to direct suggestion. We found that patients undergoing major operations benefit more from instruction than from information and reassurance. We compared the return of intestinal function after intra-abdominal operations in 2 groups of patients: the suggestion group received specific instructions for the early return of gastrointestinal motility, and the control group received an equal-length interview offering reassurance and nonspecific instructions. The suggestion group had a significantly shorter average time to the return of intestinal motility, 2.6 versus 4.1 days. Time to discharge was 6.5 versus 8.1 days. Covariates including duration of operation, amount of intraoperative bowel manipulation, and amount of postoperative narcotics were also examined using the statistical model analysis of covariance. An average savings of $1,200 per patient resulted from this simple 5-minute intervention. In summary, the use of specific physiologically active suggestions given preoperatively in a beleivable manner can reduce the morbidity associated with an intra-abdominal operation by reducing the duration of ileus. PMID:8342264

  6. Implications of late complications from adhesions for preoperative informed consent

    PubMed Central

    Rajab, Taufiek Konrad; Ahmad, Umar Naeem; Kelly, Edward

    2010-01-01

    Summary The process of informed consent is a critical aspect of the doctor–patient relationship. Doctors have a professional duty to provide patients with sufficient information if a treatment is associated with a significant risk. NHS guidelines advise doctors to mention risks that occur more frequently than 1–2% or risks that are serious even if the likelihood is very small. In the case of abdominal and pelvic surgery, risks can broadly be divided into early and late complications. Early complications, such as bleeding and infection, have a close temporal relationship with the operation. Such complications are routinely mentioned during the consent process. In contrast, postoperative adhesions cause changes in the normal anatomy that can adversely affect function many years and even decades after the original operation, leaving patients at lifelong risk for late complications. These late adhesive complications, namely bowel obstruction, mechanical female infertility and chronic pain, are often neglected during the consent process. However, the risks to patients from late adhesive complications are serious and well in excess of the accepted threshold where it could be considered a breach in the duty of care not to inform patients. This is reflected by a number of claims against the NHS based on consent issues regarding late adhesive complications of surgery. Therefore, late complications of surgery from adhesions should be included in the pre-operative consent process. This would decrease litigation costs but more importantly also underpins the doctor–patient relationship. PMID:20610617

  7. An evaluative tool for preoperative planning of brain tumor resection

    NASA Astrophysics Data System (ADS)

    Coffey, Aaron M.; Garg, Ishita; Miga, Michael I.; Thompson, Reid C.

    2010-02-01

    A patient specific finite element biphasic brain model has been utilized to codify a surgeon's experience by establishing quantifiable biomechanical measures to score orientations for optimal planning of brain tumor resection. When faced with evaluating several potential approaches to tumor removal during preoperative planning, the goal of this work is to facilitate the surgeon's selection of a patient head orientation such that tumor presentation and resection is assisted via favorable brain shift conditions rather than trying to allay confounding ones. Displacement-based measures consisting of area classification of the brain surface shifting in the craniotomy region and lateral displacement of the tumor center relative to an approach vector defined by the surgeon were calculated over a range of orientations and used to form an objective function. The objective function was used in conjunction with Levenberg-Marquardt optimization to find the ideal patient orientation. For a frontal lobe tumor presentation the model predicts an ideal orientation that indicates the patient should be placed in a lateral decubitus position on the side contralateral to the tumor in order to minimize unfavorable brain shift.

  8. Preoperative trajectory planning for percutaneous procedures in deformable environments.

    PubMed

    Hamzé, Noura; Peterlík, Igor; Cotin, Stéphane; Essert, Caroline

    2016-01-01

    In image-guided percutaneous interventions, a precise planning of the needle path is a key factor to a successful intervention. In this paper we propose a novel method for computing a patient-specific optimal path for such interventions, accounting for both the deformation of the needle and soft tissues due to the insertion of the needle in the body. To achieve this objective, we propose an optimization method for estimating preoperatively a curved trajectory allowing to reach a target even in the case of tissue motion and needle bending. Needle insertions are simulated and regarded as evaluations of the objective function by the iterative planning process. In order to test the planning algorithm, it is coupled with a fast needle insertion simulation involving a flexible needle model and soft tissue finite element modeling, and experimented on the use-case of thermal ablation of liver tumors. Our algorithm has been successfully tested on twelve datasets of patient-specific geometries. Fast convergence to the actual optimal solution has been shown. This method is designed to be adapted to a wide range of percutaneous interventions. PMID:26629592

  9. Preoperative breast magnetic resonance imaging and contralateral breast cancer occurrence among older women with ductal carcinoma in situ.

    PubMed

    Wang, Shi-Yi; Long, Jessica B; Killelea, Brigid K; Evans, Suzanne B; Roberts, Kenneth B; Silber, Andrea; Gross, Cary P

    2016-07-01

    Although preoperative magnetic resonance imaging (MRI) can detect mammographically occult contralateral breast cancers (CBCs) among women with ductal carcinoma in situ (DCIS), the impact of MRI on the incidence of subsequent CBC events is unclear. We examined whether MRI use decreases CBC occurrences and detection of invasive disease among women who develop a CBC. Utilizing the Surveillance, Epidemiology, and End Results-Medicare dataset, we assessed overall, synchronous (<6 months after primary cancer diagnosis), and subsequent (≥6 months after diagnosis, i.e., metachronous) CBC occurrence in women aged 67-94 years diagnosed with DCIS during 2004-2009, with follow-up through 2011. We applied a matched propensity score approach to compare the stage-specific incidence rate of CBC according to MRI use. Our sample consisted of 9166 beneficiaries, 1258 (13.7 %) of whom received preoperative MRI. After propensity score matching, preoperative MRI use was significantly associated with a higher synchronous CBC detection rate (108.6 vs. 29.7 per 1000 person-years; hazard ratio [HR] = 3.65; p < .001) with no significant differences in subsequent CBC rate (6.7 vs. 6.8 per 1000 person-years; HR = 0.90; p = .71). The 6-year cumulative incidence of any CBC (in situ plus invasive) remained significantly higher among women undergoing MRI, compared with those not undergoing MRI (9 vs. 4 %, p < .001). Women undergoing MRI also had a higher incidence of invasive CBC (4 vs. 3 %, p = .04). MRI use resulted in an increased detection of synchronous CBC but did not prevent subsequent CBC occurrence, suggesting that many of the undetected CBC lesions may not become clinically evident.

  10. Bevacizumab, Capecitabine, Amifostine, and Preoperative Hypofractionated Accelerated Radiotherapy (HypoArc) for Rectal Cancer: A Phase II Study

    SciTech Connect

    Koukourakis, Michael I.; Tsoutsou, Pelagia; Chloropoulou, Pelagia A.; Manolas, Kostantinos; Sivridis, Efthimios

    2011-06-01

    Purpose: Bevacizumab has established therapeutic activity in patients with metastatic colorectal cancer, and anti-vascular endothelial growth factor therapy enhances the activity of radiotherapy in experimental models. We assessed the feasibility and efficacy of preoperative radiochemotherapy combined with bevacizumab in patients with rectal cancer. Methods and Materials: Nineteen patients with radiologic T3 and/or N+ rectal carcinoma were treated with preoperative conformal hypofractionated accelerated radiotherapy (3.4 Gy in 10 consecutive fractions) supported with amifostine (500-1,000 mg daily), capecitabine (600 mg/m{sup 2} twice daily, 5 days per week), and bevacizumab (5 mg/kg every 2 weeks for 2 cycles). Surgery followed 6 weeks after the end of radiotherapy. A cohort of 14 sequential patients treated with the same regimen without bevacizumab was available for comparison. Results: Grade 2 or 3 diarrhea was noted in 7 of 19 patients (36.8%), which was statistically worse than patients receiving the same regimen without bevacizumab (p = 0.01). A higher incidence of Grade 2 or 3 proctalgia was also noted (21.1%) (p = 0.03). Bladder and skin toxicity was negligible. All toxicities regressed completely within 2 weeks after the end of therapy. Pathologic complete and partial response was noted in 7 of 19 cases (36.8%) and 8 of 19 cases (42.1%). Within a median follow-up of 21 months, none of the patients has had late complications develop and only 1 of 18 evaluable cases (5.5%) has had locoregional relapse. Conclusions: Bevacizumab can be safely combined with hypofractionated radiotherapy and capecitabine as a preoperative radiochemotherapy regimen for patients with rectal cancer. The high pathologic complete response rates urges the testing of bevacizumab in randomized studies.

  11. Preoperative breast magnetic resonance imaging and contralateral breast cancer occurrence among older women with ductal carcinoma in situ.

    PubMed

    Wang, Shi-Yi; Long, Jessica B; Killelea, Brigid K; Evans, Suzanne B; Roberts, Kenneth B; Silber, Andrea; Gross, Cary P

    2016-07-01

    Although preoperative magnetic resonance imaging (MRI) can detect mammographically occult contralateral breast cancers (CBCs) among women with ductal carcinoma in situ (DCIS), the impact of MRI on the incidence of subsequent CBC events is unclear. We examined whether MRI use decreases CBC occurrences and detection of invasive disease among women who develop a CBC. Utilizing the Surveillance, Epidemiology, and End Results-Medicare dataset, we assessed overall, synchronous (<6 months after primary cancer diagnosis), and subsequent (≥6 months after diagnosis, i.e., metachronous) CBC occurrence in women aged 67-94 years diagnosed with DCIS during 2004-2009, with follow-up through 2011. We applied a matched propensity score approach to compare the stage-specific incidence rate of CBC according to MRI use. Our sample consisted of 9166 beneficiaries, 1258 (13.7 %) of whom received preoperative MRI. After propensity score matching, preoperative MRI use was significantly associated with a higher synchronous CBC detection rate (108.6 vs. 29.7 per 1000 person-years; hazard ratio [HR] = 3.65; p < .001) with no significant differences in subsequent CBC rate (6.7 vs. 6.8 per 1000 person-years; HR = 0.90; p = .71). The 6-year cumulative incidence of any CBC (in situ plus invasive) remained significantly higher among women undergoing MRI, compared with those not undergoing MRI (9 vs. 4 %, p < .001). Women undergoing MRI also had a higher incidence of invasive CBC (4 vs. 3 %, p = .04). MRI use resulted in an increased detection of synchronous CBC but did not prevent subsequent CBC occurrence, suggesting that many of the undetected CBC lesions may not become clinically evident. PMID:27287780

  12. Preoperative quality of life and surgical outcomes in gynecologic oncology patients: A new predictor of operative risk?

    PubMed Central

    Doll, KM; Snavely, AC; Kalinowski, A; Irwin, DE; Bensen, JT; Bae-Jump, V; Boggess, JF; Soper, JT; Brewster, WR; Gehrig, PA

    2014-01-01

    Objective Quality of life (QoL) for women with gynecologic malignancies is predictive of chemotherapy related toxicity and overall survival but has not been studied in relation to surgical outcomes and hospital readmissions. Our goal was to evaluate the association between baseline, pre-operative QoL measures and 30-day post-operative morbidity and health resource utilization by gynecologic oncology patients. Methods We analyzed prospectively collected survey data from an institution-wide cohort study. Patients were enrolled from 8/2012 – 6/2013 and medical records data was abstracted (demographics, comorbid conditions, and operative outcomes). Responses from several validated health-related QoL instruments were collected. Bivariate tests and multivariable linear and logistic regression models were used to evaluate factors associated with QoL scores. Results Of 182 women with suspected gynecologic malignancies, 152 (84%) were surveyed pre-operatively and 148 (81%) underwent surgery. Uterine (94; 63.5%), ovarian (26; 17.5%), cervical (15; 10%), vulvar/vaginal (8; 5.4%), and other (5; 3.4%) cancers were represented. There were 37 (25%) cases of postoperative morbidity (PM), 18 (12%) unplanned ER visits, 9(6%) unplanned clinic visits, and 17 (11.5%) hospital readmissions(HR) within 30 days of surgery. On adjusted analysis, lower functional well-being scores resulted in increased odds of PM (OR 1.07, 95%CI 1.01-.1.21) and HR (OR 1.11, 95%CI 1.03-1.19). A subjective global assessment score was also strongly associated with HR (OR 1.89, 95%CI 1.14, 3.16). Conclusion Lower pre-operative QoL scores are significantly associated with post-operative morbidity and hospital readmission in gynecologic cancer patients. This relationship may be a novel indicator of operative risk. PMID:24726615

  13. Preoperative CT-based nomogram for predicting overall survival in women with non-endometrioid carcinomas of the uterine corpus

    PubMed Central

    Lakhman, Yulia; Yakar, Derya; Goldman, Debra A.; Katz, Seth S.; Vargas, Hebert A.; Miccò, Maura; Zheng, Junting; Moskowitz, Chaya S.; Soslow, Robert A.; Hricak, Hedvig; Abu-Rustum, Nadeem R.; Sala, Evis

    2016-01-01

    Purpose To develop a preoperative CT-based nomogram for predicting overall survival (OS) in patients with non-endometrioid carcinomas of the uterine corpus. Methods Waiving informed consent, the institutional review board approved this HIPAA-compliant, retrospective study of 193 women with histopathologically proven uterine papillary serous carcinomas (UPSC), uterine clear cell carcinomas (UCCC), and uterine carcinosarcomas (UCS) who underwent primary surgical resection between May 1998 and December 2011, and had a preoperative CT ≤ 6 weeks before surgery. All CT scans were reviewed for local or/and regional tumor extent, presence of pelvic or/and paraaortic adenopathy, and presence of distant metastases. Univariate survival analysis was performed using log-rank test and Cox regression. Variables shown significant by the univariate analysis were evaluated with the multivariable Cox regression analysis and the results were used to create a nomogram for predicting OS. The predictive accuracy of the nomogram was assessed with the concordance probability index (c-index) and a 3-year calibration plot. Results Mean patient age was 67.2 years (range: 49.0–85.9); histology included UPSC (n=116), UCCC (n=27), and UCS (n=50). Median follow-up was 38.1 months (0.9–168.5 months). At multivariate analysis, patient age, ascites, and omental implants on CT were significant adverse predictors of OS and were used to build the nomogram. Concordance index for the nomogram was 0.640±0.028. Conclusion We developed a nomogram with a good concordance probability at predicting OS based on readily available pretreatment clinical and imaging characteristics. This preoperative nomogram has the potential to improve initial treatment planning and patient counseling. PMID:25549782

  14. Prevalence and factors associated with preoperative anxiety in children aged 5-12 years 1

    PubMed Central

    de Moura, Louise Amália; Dias, Iohanna Maria Guimarães; Pereira, Lilian Varanda

    2016-01-01

    Abstract Objective: to estimate the prevalence and factors associated with preoperative anxiety in children who wait for outpatient surgery. Method: cross-sectional analysis of baseline data of a prospective cohort study that investigates the predictors of postoperative pain in children aged 5-12 years submitted to inguinal and umbilical hernia repair. It was selected 210 children, which were interviewed in the preoperative holding area of a general hospital. Anxiety was evaluated using the modified Yale Preoperative Anxiety Scale (mYPAS). Sociodemographic and clinical variables were analyzed as exposure and anxiety (mYPAS final score>30) as outcome. Logistic regression was used to identify factors associated with preoperative anxiety. Results: forty-two percent (42.0%) of children presented preoperative anxiety (CI95%: 35.7%-48.6%), with mean scores equal to 30.1 (SD=8.4). Factors associated with preoperative anxiety were: age group of 5-6 years (OR=2.28; p=0.007) and socioeconomic status classified as class C (OR=2.39; p=0.016). Conclusion: the evaluation of children who wait for outpatient surgery should be multidimensional and comprise information on age and socioeconomic status, in order to help in the identification and early treatment of preoperative anxiety. PMID:27305179

  15. Phonoaudiology guidance in the preoperative period in the head and neck tumors

    PubMed Central

    Scheidt, Grasiella Aparecida Nau; Fleig, Raquel; do Nascimento, Iramar Baptistella

    2013-01-01

    Summary Introduction: The habit of smoking and intake of alcoholic drinks can lead to the incidence of malignant tumors in several areas, including the head or neck. Phonoaudiology is an area of oncology that is always seeking to expand its applications in oncological head and neck cases, with intervention in pre- and post-operative periods and in different clinical fields. Aim: To evaluate and describe the impact of phonoaudiology preoperative guidance in patients, specifically smokers and alcohol drinkers, with head and neck cancer. Methods: Series Study. Interviews were conducted by telephone with 40 individuals diagnosed with malignant head and neck tumors. Questionnaires regarding the use of tobacco and alcohol were administered before and after the phonoaudiology preoperative guidance. Results: Among the 40 individuals who received phonoaudiology preoperative guidance, 26 were smokers before the orientation. Of these 26 individuals, 18 (69.24%) abandoned tobacco dependence, 4 (15.38%) did not quit smoking, and 4 (15.38%) quit smoking for a few months before resuming smoking after receiving phonoaudiology preoperative guidance. Regarding alcohol consumption, 31 individuals ingested alcohol before phonoaudiology preoperative guidance. Of these 31 individuals, 17 (54.84%) abandoned alcohol dependence, 8 (25.81%) did not abstain from alcohol consumption, and 6 (19.35%) resumed alcohol consumption after a period of abstinence after receiving phonoaudiology preoperative guidance. Conclusion: Phonoaudiology preoperative orientations are effective in the treatment of head and neck malignant tumors. PMID:25992003

  16. Clinical significance of preoperative thrombocytosis in patients who underwent radical nephrectomy for nonmetastatic renal cell carcinoma

    PubMed Central

    Choi, Jae Young; Ko, Young Hwii

    2016-01-01

    Purpose The aim of this study was to examine the association of preoperative thrombocytosis with the prognosis of patients with nonmetastatic renal cell carcinoma (RCC). Materials and Methods We conducted a retrospective analysis of 187 patients who underwent a radical nephrectomy for nonmetastatic RCC between July 1997 and June 2009. Thrombocytosis was defined as a platelet count≥400,000 µL, and patients were divided into 2 groups according to presence of preoperative thrombocytosis, and the cancer-specific survival rates and overall survival rates of the 2 groups after radical nephrectomy were compared. Results The mean age of the patients was 56.0±11.7 years and the mean follow-up period was 59.3±42.1 months; there were 20 patients with preoperative thrombocytosis. Thirty patients developed metastases and 9 patients died during the follow-up period. In Kaplan-Meier analysis using a univariate log-rank test, both cancer-specific survival rate (p=0.013) and overall survival rate (p=0.012) showed significant association with preoperative thrombocytosis. Controlling for pathological TNM stage, Fuhrman grade and tumor diameter, the Cox proportional hazards model for cancer-specific survival rates showed that preoperative thrombocytosis was an independent prognostic factor (p=0.025). Conclusions Preoperative thrombocytosis was associated with poorer prognosis in patients with nonmetastatic RCC. Thus, preoperative platelet count may be clinically useful for risk stratification of patients undergoing surgery for nonmetastatic RCC.

  17. [Interest of preoperative lymphoscintigraphy on sentinel lymph node identification in patients with breast cancer].

    PubMed

    Tulpin, L; Morel, O; Akerman, G; Malartic, C; Desfeux, P; Barranger, E

    2008-01-01

    Sentinel lymph node biopsy is nowadays an accepted method of staging breast cancer patients. In case of an injection of radioactive colloid, preoperative lymphoscintigraphy is recommended to establish a lymphatic mapping and to predict the number of sentinel lymph nodes identified during surgery. Preoperative lymphoscintigraphy does not decrease the false-negative rate. However, positive preoperative lymphoscintigraphy significantly improves the identification rate of intraoperative sentinel nodes comparing with negative preoperative lymphoscintigraphy. Detecting extra-axillary sentinel lymph nodes, because of its minimal therapeutic consequences, does not appear to be an indication for preoperative lymphoscintigraphy. Given logistics and cost required, preoperative lymphoscintigraphy should be only performed for patients with a high risk of intraoperative failed localization. In case of negative preoperative lymphoscintigraphy, sentinel lymph node biopsy must be tried because sentinel nodes are still identified in the majority of these patients. Another possibility, with important cost and logistic, should consist in performing a later lymphoscintigraphy on the day after radioactive injection to ameliorate sentinel lymph nodes identification.

  18. Clinical significance of preoperative thrombocytosis in patients who underwent radical nephrectomy for nonmetastatic renal cell carcinoma

    PubMed Central

    Choi, Jae Young; Ko, Young Hwii

    2016-01-01

    Purpose The aim of this study was to examine the association of preoperative thrombocytosis with the prognosis of patients with nonmetastatic renal cell carcinoma (RCC). Materials and Methods We conducted a retrospective analysis of 187 patients who underwent a radical nephrectomy for nonmetastatic RCC between July 1997 and June 2009. Thrombocytosis was defined as a platelet count≥400,000 µL, and patients were divided into 2 groups according to presence of preoperative thrombocytosis, and the cancer-specific survival rates and overall survival rates of the 2 groups after radical nephrectomy were compared. Results The mean age of the patients was 56.0±11.7 years and the mean follow-up period was 59.3±42.1 months; there were 20 patients with preoperative thrombocytosis. Thirty patients developed metastases and 9 patients died during the follow-up period. In Kaplan-Meier analysis using a univariate log-rank test, both cancer-specific survival rate (p=0.013) and overall survival rate (p=0.012) showed significant association with preoperative thrombocytosis. Controlling for pathological TNM stage, Fuhrman grade and tumor diameter, the Cox proportional hazards model for cancer-specific survival rates showed that preoperative thrombocytosis was an independent prognostic factor (p=0.025). Conclusions Preoperative thrombocytosis was associated with poorer prognosis in patients with nonmetastatic RCC. Thus, preoperative platelet count may be clinically useful for risk stratification of patients undergoing surgery for nonmetastatic RCC. PMID:27617313

  19. Providing preoperative information for children undergoing surgery: a randomized study testing different types of educational material to reduce children's preoperative worries.

    PubMed

    Fernandes, S C; Arriaga, P; Esteves, F

    2014-12-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery. The participants were randomly assigned to one of the seven independent conditions that were combined into the following three main groups: an experimental group, which received educational materials with information about surgery and hospitalization (a board game, a video or a booklet); a comparison group, which received entertaining material with the same format type; and a control group, which did not receive any material. Children's preoperative worries and parental anxiety were evaluated after the experimental manipulation. Children who received educational materials were significantly less worried about surgery and hospital procedures than children in the comparison and the control groups, although no statistically differences were found between the type of materials within the experimental group, and no significant effect occurred on parental state anxiety. These results do however support the hypothesis that providing preoperative materials with educational information reduce children's preoperative worries.

  20. Contrast-enhanced ultrasound improves accurate identification of appendiceal mucinous adenocarcinoma in an old patient

    PubMed Central

    Shang, Jing; Ruan, Li-tao; Dang, Ying; Wang, Yun-yue; Song, Yan; Lian, Jie

    2016-01-01

    Abstract Background: Adenocarcinoma of appendiceal origin is far rarer than other colorectal carcinomas and its preoperative diagnosis is challenging. To our knowledge, utility of contrast-enhanced ultrasound (CEUS) to diagnose it is much less. Method: A 61-year-old man presented with abdominal pain in the right lower quadrant for 20 days. In order to fulfill an accurately preoperative diagnosis, he received laboratory and imaging tests such as carcinoembryonic antigen (CEA), computer tomography (CT), CEUS and endoscope. Diagnosis and Intervention: He was initially suspected of suffering appendicitis, while his white blood cell count was normal and carcinoembryonic antigen (CEA) in serum was remarkably increased. Both routine ultrasound and computer tomography (CT) examinations supported suppurative appendicitis. The overall data, however, failed to excluded neoplastic pathology thoroughly. Therefore, CEUS was carried out and showed an inhomogeneous enhancement intra the lesion located in the body of the appendix, which made our consideration of neoplasm. The result of the follow-up biopsy guided by endoscope was consistent with appendiceal tumor. The patient received laparoscopic right hemicolectomy. Histopathology confirmed as well differentiated mucinous adenocarcinoma of appendix origin. His postoperative course was uneventful, and he had a regular diet again without any complaint. Result: Serum CEA was remarkably increased (12.00 ng/mL). Both routine ultrasound and CT examinations supported suppurative appendicitis. However, CEUS examination showed an inhomogeneous enhancement intra the lesion located in the body of the appendix, which made our consideration of neoplasm. The follow-up biopsy guided by endoscope and surgical specimens confirmed as well differentiated mucinous adenocarcinoma of appendix origin. Conclusion: Most mucinous adenocarcinoma mimicking appendicitis results in difficult diagnosis preoperatively. Clinician and radiologist should be

  1. Associations between preoperative functional status and functional outcomes of total joint replacement in the Dominican Republic

    PubMed Central

    Collins, Jamie E.; Ghazinouri, Roya; Alcantara, Luis; Thornhill, Thomas S.; Katz, Jeffrey N.

    2013-01-01

    Objective. In developed countries, the functional status scores of patients with poor preoperative scores undergoing total joint replacement (TJR) improve more following TJR than those for patients with better preoperative scores. However, those with better preoperative scores achieve the best postoperative functional outcomes. We determined whether similar associations exist in a developing country. Methods. Dominican patients undergoing total hip or knee replacement completed WOMAC and SF-36 surveys preoperatively and at 12-month follow-up. Patients were stratified into low-, medium- and high-scoring preoperative groups based on their preoperative WOMAC function scores. We examined the associations between the baseline functional status of these groups and two outcomes—improvement in functional status over 12 months and functional status at 12 months—using analysis of variance with multivariable linear regression. Results. Patients who scored the lowest preoperatively made the greatest gains in function and pain relief following their TJRs. However, there were no significant differences in pain or function at 12-month follow-up between patients who scored low and those who scored high on preoperative WOMAC and SF-36 surveys. Conclusion. Patients with poor preoperative functional status had greater improvement but similar 12-month functional outcomes compared with patients who had a higher level of function before surgery. These results suggest that a policy of focusing scarce resources on patients with worse functional status in developing countries may optimize improvement following TJR without threatening functional outcome. Additional research is needed to confirm these findings in other developing countries and to understand why these associations vary between patients in the Dominican Republic and patients from developed countries. PMID:23748412

  2. Clown intervention to reduce preoperative anxiety in children and parents: a randomized controlled trial.

    PubMed

    Dionigi, Alberto; Sangiorgi, Diego; Flangini, Roberto

    2014-03-01

    This study investigated whether a clown doctor intervention could reduce preoperative anxiety in children hospitalized for minor surgery and in their parents. A randomized controlled trial was conducted with 77 children and 119 parents: the clown group consisted of 52 children accompanied in the preoperating room by their parents (n = 89) and two clowns while the comparison group consisted of children accompanied by the parents only. The clown intervention significantly reduced the children's preoperative anxiety: children benefited from the clown's presence and showed better adjustment than children in the comparison group. Mothers in Comparison Group showed higher anxiety. PMID:23362335

  3. The activated coagulation time of whole blood as a routine pre-operative sceening test.

    PubMed

    Hattersley, P G

    1971-05-01

    Patients with disorders of hemostasis who undergo surgical procedures are in danger of hemorrhage. While the careful medical history remains the most sensitive test of a bleeding tendency, some such patients can give no suggestive history. In three patients with coagulopathy-one with mild classical hemophilia, one with Christmas disease, and one with warfarin toxicity-the abnormality was missed by routine preoperative history but promptly detected by the routine preoperative use of the activated coagulation time (act). Either this test or the activated partial thromboplastin time should be included in the routine preoperative work-up, along with appropriate additional tests of the hemostatic mechanism.

  4. Clown intervention to reduce preoperative anxiety in children and parents: a randomized controlled trial.

    PubMed

    Dionigi, Alberto; Sangiorgi, Diego; Flangini, Roberto

    2014-03-01

    This study investigated whether a clown doctor intervention could reduce preoperative anxiety in children hospitalized for minor surgery and in their parents. A randomized controlled trial was conducted with 77 children and 119 parents: the clown group consisted of 52 children accompanied in the preoperating room by their parents (n = 89) and two clowns while the comparison group consisted of children accompanied by the parents only. The clown intervention significantly reduced the children's preoperative anxiety: children benefited from the clown's presence and showed better adjustment than children in the comparison group. Mothers in Comparison Group showed higher anxiety.

  5. Preoperative study of the surface ECG for the prognosis of atrial fibrillation maze surgery outcome at discharge.

    PubMed

    Hernández, Antonio; Alcaraz, Raúl; Hornero, Fernando; Rieta, José Joaquín

    2014-07-01

    The Cox-maze surgery is an effective procedure for terminating atrial fibrillation (AF) in patients requiring open-heart surgery associated with another heart disease. After the intervention, regardless of the patient's rhythm, all are treated with oral anticoagulants and antiarrhythmic drugs prior to discharge. Furthermore, patients maintaining AF before discharge could also be treated with electrical cardioversion (ECV). In view of this, a preoperative prognosis of the patient's rhythm at discharge would be helpful for optimizing drug therapy planning as well as for advancing ECV therapy. This work analyzes 30 preoperative electrocardiograms (ECGs) from patients suffering from AF in order to predict the Cox-maze surgery outcome at discharge. Two different characteristics of the AF pattern have been studied. On the one hand, the atrial activity (AA) organization, which provides information about the number of propagating wavelets in the atria, was investigated. AA organization has been successfully used in previous studies related to spontaneous reversion of paroxysmal AF and to the outcome of ECV. To assess organization, the dominant atrial frequency (DAF) and sample entropy (SampEn) have been computed. On the other hand, the second characteristic studied was the fibrillatory wave (f-wave) amplitude, which has been demonstrated to be a valuable indicator of the Cox-maze surgery outcome in previous studies. Moreover, this parameter has been obtained through a new methodology, based on computing the f-wave average power (fWP). Finally, all the computed indices were combined in a decision tree in order to improve prediction capability. Results for the DAF yielded a sensitivity (Se), a specificity (Sp) and an accuracy (Acc) of 61.54%, 82.35% and 73.33%, respectively. For SampEn the values were 69.23%, 76.00% and 73.33%, respectively, and for fWP they were 92.31%, 82.35% and 86.67%, respectively. Finally, the decision tree combining the three parameters analyzed

  6. Thymidylate Synthase Gene Polymorphism Affects the Response to Preoperative 5-Fluorouracil Chemoradiation Therapy in Patients With Rectal Cancer

    SciTech Connect

    Hur, Hyuk; Kang, Jeonghyun; Kim, Nam Kyu; Min, Byung Soh; Lee, Kang Young; Shin, Sang Joon; Keum, Ki Chang; Choi, Junjeong; Kim, Hoguen; Choi, Sung Ho; Lee, Mi-Young

    2011-11-01

    Purpose: This study aims to correlate thymidylate synthase (TS) gene polymorphisms with the tumor response to preoperative 5-fluorouracil (5-FU)-based chemoradiation therapy (CRT) in patients with rectal cancer. Methods and Materials: Forty-four patients with rectal cancer treated with 5-FU-based preoperative CRT were prospectively enrolled in this study. Thymidylate synthase expression and TS gene polymorphisms were evaluated in tumor obtained before preoperative CRT and were correlated with the pathologic response, as assessed by histopathologic staging (pTNM) and tumor regression grade. Results: Patients exhibited 2R/3R and 3R/3R tandem repeat polymorphisms in the TS gene. With regard to TS expression in these genotypes, 2R/3RC and 3RC/3RC were defined as the low-expression group and 2R/3RG, 3RC/3RG, and 3RG/3RG as the high-expression group. There was no significant correlation between TS expression and tumor response. There was no significant difference in the tumor response between patients homozygous for 3R/3R and patients heterozygous for 2R/3R. However, 13 of 14 patients in the low-expression group with a G>C single-nucleotide polymorphism (SNP) (2R/3RC [n = 5] or 3RC/3RC [n = 9]) exhibited a significantly greater tumor downstaging rate, as compared with only 12 of 30 patients in the high-expression group without the SNP (2R/3RG [n = 10], 3RC/3RG [n = 9], or 3RG/3RG [n = 11]) (p = 0.001). The nodal downstaging rate was also significantly greater in this low-expression group, as compared with the high-expression group (12 of 14 vs. 14 of 30, p = 0.014). However, there was no significant difference in the tumor regression grade between these groups. Conclusions: This study suggests that SNPs within the TS enhancer region affect the tumor response to preoperative 5-FU-based CRT in rectal cancer.

  7. Bari-Active: A randomized controlled trial of a preoperative intervention to increase physical activity in bariatric surgery patients

    PubMed Central

    Bond, Dale S.; Vithiananthan, Sivamainthan; Thomas, J. Graham; Trautvetter, Jennifer; Unick, Jessica L.; Jakicic, John M.; Pohl, Dieter; Ryder, Beth A.; Roye, G. Dean; Sax, Harry C.; Wing, Rena R.

    2014-01-01

    Background: Habitual physical activity (PA) may help to optimize bariatric surgery outcomes; however objective PA measures show that most patients have low PA preoperatively and make only modest PA changes postoperatively. Patients require additional support to adopt habitual PA. Objectives: Test the efficacy of a preoperative PA intervention (PAI) versus standard pre-surgical care (SC) for increasing daily moderate-to-vigorous PA (MVPA) in bariatric surgery patients. Setting: University Hospital, United States. Methods: Outcomes analysis included 75 participants (86.7% women; 46.0±8.9 years; Body Mass Index [BMI]=45.0±6.5 kg/m2) who were randomly assigned preoperatively to 6 weeks of PAI (n=40) or SC (n=35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome, pre- to post-intervention change in daily bout-related (≥10-min bouts) and total (≥1-minute bouts) MVPA minutes, was assessed objectively via a multi-sensor monitor worn for 7 days at baseline- and post-intervention. Results: Retention was 84% at the post-intervention primary end point. In intent-to-treat analyses with baseline value carried forward for missing data and adjusted for baseline MVPA, PAI achieved a mean increase of 16.6±20.6 minutes/day in bout-related MVPA (baseline: 4.4±5.5 to post-intervention: 21.0±21.4 minutes/day) compared to no change (−0.3±12.7 minutes/day; baseline: 7.9±16.6 to post-intervention: 7.6±11.5 minutes/day) for SC (p=0.001). Similarly, PAI achieved a mean increase of 21.0±26.9 minutes/day in total MVPA (baseline: 30.9±21.2 to post-intervention: 51.9±30.0 minutes/day), whereas SC demonstrated no change (− 0.1±16.3 minutes/day; baseline: 33.7±33.2 to post-intervention: 33.6±28.5 minutes/day) (p=0.001). Conclusions: With behavioral intervention, patients can significantly increase MVPA before bariatric

  8. Combined preoperative and postoperative immunotherapy for murine C1300 neuroblastoma.

    PubMed

    Fowler, C L; Brooks, S P; Rossman, J E; Cooney, D R

    1993-03-01

    Preoperative treatment of murine C1300-neuroblastoma (C1300) with triple immunotherapy using low-dose cyclophosphamide (CY), retinyl palmitate (RP), and interleukin-2 (IL2), followed by tumor resection leads to significant initial tumor control and prolonged survival. However, because long-term tumor recurrence is 67%, the efficacy of continued postoperative immunotherapy is now evaluated. Thirty-two A/J mice with 1 cm subcutaneous C1300 tumors were treated for 13 days with CY-100 mg/kg, intraperitoneally (IP), on day 2 of treatment then 25 mg/kg on day 9, RP-2500 IU IP 2 x/week, and IL2 1.6 x 10(5) U IP BID on days 4 to 9 and 11 to 13. On day 14, mice were divided into five treatment groups: (1) OP (operated-tumor resection, n = 6); (2) OP+CY (resection and postoperative CY, n = 7); (3) OP+CY+RP (resection and postoperative CY+RP, n = 7); (4) OP+CY+RP+IL2 (resection and postoperative CY+RP+IL2, n = 7); and (5) CY+RP+IL2 (continued CY+RP+IL2 with no resection, n = 5). Survival and postoperative tumor recurrence were followed for 60 days. The cure rates were group 1 33% (2/6), group 2 43% (3/7), group 3 29% (2/7), group 4 71% (5/7), and group 5 20% (1/5). After surgery, tumors that recurred did so in 8 to 22 days, with no statistical difference noted between groups. MHC class I antigenic expression of tumors resected on day 14 and recurrent tumors was determined with monoclonal antibodies and flow cytometry. In tumors resected on day 14, class I expression measured by mean fluorescence, was 374.8 +/- 27.40.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Pre-operational safety appraisal Tritiated Scrap Recovery Facility, Mound facility

    SciTech Connect

    Dauby, J.J.; Flanagan, T.M.; Metcalf, L.W.; Rhinehammer, T.B.

    1996-07-01

    The purpose of this report is to identify, assess, and document the hazards which are associated with the proposed operation of the Tritiated Scrap Recovery Facility at Mound Facility. A Pre-operational Safety Appraisal is a requirement as stated in Department of Energy Order 5481.1, Safety Analysis and Review System. The operations to be conducted in the new Tritiated Scrap Waste Recovery Facility are not new, but a continuation of a prime mission of Mound`s i.e. recovery of tritium from waste produced throughout the DOE complex. The new facility is a replacement of an existing process started in the early 1960`s and incorporates numerous design changes to enhance personnel and environmental safety. This report also documents the safety of a one time operation involving the recovery of tritium from material obtained by the Department of Energy from the State of Arizona. This project will involve the processing of 240,000 curies of tritium contained in glass ampoules that were to be used in items such as luminous dial watches. These were manufactured by the now defunct American Atomics Corporation, Tucson, Arizona.

  10. Knowledge, Attitudes, and Practices Related to Preoperative Chemoradiotherapy in Rectal Cancer Patients

    PubMed Central

    Chen, Xingxing; Lin, Ruifang; Li, Huifang; Su, Meng; Zhang, Wenyi; Deng, Xia; Zhang, Ping

    2016-01-01

    Background. The aim of this study is to assess the knowledge, attitudes, and practices related to pre-CRT in patients of stage II/III rectal cancer. Materials and Methods. Questionnaires regarding the knowledge, attitudes, and practices of pre-CRT were mailed to 145 rectal cancer patients in II/III stage between January 2012 and December 2014, and 111 agreed to participate and returned completed questionnaires to the researcher. Logistic regression model was used to compare sociodemographic characteristics, knowledge, and attitude with practice, respectively. Results. A total of 145 patients were approached for interview, of which 111 responded and 48.6% (54) had undergone pre-CRT. Only 31.5% of the participants knew that CRT is a treatment of rectal cancer and 39.6% were aware of the importance of CRT. However, the vast majority of participants (68.5%) expressed a positive attitude toward rectal cancer. Multivariate logistic regression analysis revealed that knowledge level (p = 0.006) and attitudes (p = 0.001) influence the actual practice significantly. Furthermore, age, gender, and income were potential predictors of practice (all p < 0.05). Conclusion. This study shows that, despite the fact that participants had suboptimal level of knowledge on rectal cancer, their attitude is favorable to pre-CRT. Strengthening the professional health knowledge and realizing the importance of attitudes may deepen patients' understanding of preoperative therapy. PMID:27761141

  11. A computational tool for preoperative breast augmentation planning in aesthetic plastic surgery.

    PubMed

    Georgii, Joachim; Eder, Maximilian; Bürger, Kai; Klotz, Sebastian; Ferstl, Florian; Kovacs, Laszlo; Westermann, Rüdiger

    2014-05-01

    Breast augmentation was the most commonly performed cosmetic surgery procedure in 2011 in the United States. Although aesthetically pleasing surgical results can only be achieved if the correct breast implant is selected from a large variety of different prosthesis sizes and shapes available on the market, surgeons still rely on visual assessment and other subjective approaches for operative planning because of lacking objective evaluation tools. In this paper, we present the development of a software prototype for augmentation mammaplasty simulation solely based on 3-D surface scans, from which patient-specific finite-element models are generated in a semiautomatic process. The finite-element model is used to preoperatively simulate the expected breast shapes using physical soft-tissue mechanics. Our approach uses a novel mechanism based on so-called displacement templates, which, for a specific implant shape and position, describe the respective internal body forces. Due to a highly efficient numerical solver we can provide immediate visual feedback of the simulation results, and thus, the software prototype can be integrated smoothly into the medical workflow. The clinical value of the developed 3-D computational tool for aesthetic breast augmentation surgery planning is demonstrated in patient-specific use cases. PMID:24132029

  12. The value of stereolithographic models for preoperative diagnosis of craniofacial deformities and planning of surgical corrections.

    PubMed

    Sailer, H F; Haers, P E; Zollikofer, C P; Warnke, T; Carls, F R; Stucki, P

    1998-10-01

    The purpose of this study was to assess the importance of stereolithographic models (SLMs) for preoperative diagnosis and planning in craniofacial surgery and to examine whether these models offer valuable additional information as compared to normal CT scans and 3D CT images. Craniofacial SLMs of 20 patients with craniomaxillofacial pathology were made. A helical volume CT scan of the anatomic area involved delivered the necessary data for their construction. These were built with an SLA 250 stereolithography apparatus (3D-Systems, Valencia, CA, USA), steered by FORM-IT/DCS software (University of Zurich, Switzerland). The stereolithography models were classified according to pathology, type of surgery and their relevance for surgical planning. Though not objectively measurable, it was beyond doubt that relevant additional information for the surgeon was obtained in cases of hypertelorism, severe asymmetries of the neuro- and viscerocranium, complex cranial synostoses and large skull defects. The value of these models as realistic "duplicates" of complex or rare dysmorphic craniofacial pathology for the purpose of creating a didactic collection should also be emphasized. The models proved to be less useful in cases of consolidated fractures of the periorbital and naso-ethmoidal complex, except where there was major dislocation.

  13. Preoperative imaging of sensorineural hearing loss in pediatric candidates for cochlear implantation.

    PubMed

    Young, Joseph Y; Ryan, Maura E; Young, Nancy M

    2014-01-01

    Cochlear implantation is the only U.S. Food and Drug Administration-approved treatment for children with marked bilateral sensorineural hearing loss. It provides auditory benefits that range from simple sound detection to substantial word understanding. Improved hearing through cochlear implantation has been demonstrated to enhance the rate of language acquisition, enable development of spoken language, and advance literacy in deaf children. Magnetic resonance imaging and computed tomography both have roles in the preoperative assessment of inner-ear abnormalities, cochlear nerve deficiency, and variant anatomy that may affect the decision to implant and the prognosis for auditory improvement and increase the risk for complications. Most cochlear abnormalities may be successfully treated with cochlear implantation, but the presence of a cochlear malformation may increase the risk for intraoperative cerebrospinal fluid leakage and postoperative bacterial meningitis. Eighth-nerve deficiency correlates with poor auditory outcomes and may affect eligibility for cochlear implantation. Another important consideration for implantation is the presence of labyrinthitis ossificans in some children with deafness resulting from bacterial meningitis, which may cause obstruction that limits electrode insertion. Anatomic variations of the facial nerve or middle-ear cavity, which are more common in syndromic patients, may also affect the surgical approach and make implantation difficult.

  14. Open Sinus Lift Surgery and the Importance of Preoperative Cone-Beam Computed Tomography Scan: A Review

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2015-01-01

    Open sinus lift surgery is a form of pre-prosthetic surgery for increasing the quality and quantity of bone in the posterior region of the maxilla. Pre-operative assessment of the maxillary sinus is essential for the success of this surgery. PubMed search was carried out in English language literature for open sinus lift surgery and cone-beam computed tomography (CBCT). The results focused on anatomic variants, vascular anatomy, complications, osteotomy/ostectomy window dimensions and thickness of the Schneiderian Membrane. 59 articles were included in this review. Features other than the height and the width of the residual alveolar ridge that should be evaluated in preoperative CBCT scan include the thickness of the lateral maxillary sinus wall, the presence of the alveolar antral artery and its diameter, the maxillary sinus floor width and angulation, irregularity of sinus floor, intimate relation of Schneiderian membrane with the roots of the adjacent teeth, sinus septum, and the quality of subantral bone. Other conditions that occasionally may be observed in special situations are also explained. More than ten parameters should be checked in evaluating CBCT images of paranasal sinuses other than the width and the length of the residual ridge in the posterior region of the maxilla. Each of them may have a significant impact on the results of the open sinus lift surgery. PMID:26435632

  15. Level of anxiety versus self-care in the preoperative and postoperative periods of total laryngectomy patients 1

    PubMed Central

    Almonacid, Clara Inés Flórez; Ramos, Alfredo Jurado; Rodríguez-Borrego, María-Aurora

    2016-01-01

    Abstract Objective: estimate the prevalence of anxiety in laryngectomy patients in the pre and postoperative periods and its relation with the self-care level. Method: observational research of 40 patients with stage IV laryngeal cancer. Three observations took place: in the preoperative phase, at seven and at 14 days after the surgery; between June 2010 and December 2012. Two self-care levels were defined: self-sufficient and needing help for activities of daily living and treatment-related activities. To assess the anxiety levels, Zigmond's hospital anxiety scale (1983) was used. Results: in the preoperative and postoperative phases, the patients presented high levels of anxiety. Concerning self-care, on average, self-sufficient patients presented lower levels of anxiety than patients who needed help to accomplish activities of daily living and activities deriving from the surgery, without significant differences. Conclusion: anxiety is present at all times in laryngectomy patients and the reduction of the self-care deficit seems to decrease it, without putting a permanent end to it. PMID:27305181

  16. Evaluation of residual cellularity and proliferation on preoperatively treated breast cancer: a comparison between image analysis and light microscopy analysis.

    PubMed

    Corletto, V; Verderio, P; Giardini, R; Cipriani, S; Di Palma, S; Rilke, F

    1998-01-01

    Histopathology has been suggested as a reliable method for tumour reduction evaluation of preoperatively treated breast cancer. Immunocytochemistry can be used to enhance the visibility of residual tumour cellularity and in the evaluation of its proliferative activity. We compared Image Analysis (IA) with Light Microscopy Analysis (LMA) on sections of breast carcinomas treated with preoperative chemo- or chemo/radiotherapy in the evaluation of the Neoplastic Cell Density (NCD) (69 cases) and the Proliferation Index (PI) (35 cases). NCD was expressed as the immunoreactive area to cytokeratin over the total original neoplastic area and PI was expressed as the number of immunostained tumoural nuclei with MIB 1 MoAb over the total of tumoural nuclei. The intraobserver agreement and that between IA and LMA for both indices were estimated by the common (kappa(w)) and the jackknife weighted kappa statistic (kappa(w)). The extent of agreement of each considered category was also assessed by means of the category-specific kappa statistics (kappa(cs)). The intraobserver agreement within LMA for NCD and PI and that between IA and LMA for PI were both satisfactory. Upon evaluation of the NCD, the agreement between IA and LMA showed unsatisfactory results, especially when the ratio between the residual tumour cells and the background was critical.

  17. Evaluation of Residual Cellularity and Proliferation on Preoperatively Treated Breast Cancer: A Comparison between Image Analysis and Light Microscopy Analysis

    PubMed Central

    Corletto, Valentina; Verderio, Paolo; Giardini, Roberto; Cipriani, Sonia; Di Palma, Silvana; Rilke, Franco

    1998-01-01

    Histopathology has been suggested as a reliable method for tumour reduction evaluation of preoperatively treated breast cancer. Immunocytochemistry can be used to enhance the visibility of residual tumour cellularity and in the evaluation of its proliferative activity. We compared Image Analysis (IA) with Light Microscopy Analysis (LMA) on sections of breast carcinomas treated with preoperative chemo‐ or chemo/radiotherapy in the evaluation of the Neoplastic Cell Density (NCD) (69 cases) and the Proliferation Index (PI) (35 cases). NCD was expressed as the immunoreactive area to cytokeratin over the total original neoplastic area and PI was expressed as the number of immunostained tumoural nuclei with MIB1 MoAb over the total of tumoural nuclei. The intraobserver agreement and that between IA and LMA for both indices were estimated by the common (Kw) and the jackknife weighted kappa statistic (K~w). The extent of agreement of each considered category was also assessed by means of the category‐specific kappa statistics (Kcs). The intraobserver agreement within LMA for NCD and PI and that between IA and LMA for PI were both satisfactory. Upon evaluation of the NCD, the agreement between IA and LMA showed unsatisfactory results, especially when the ratio between the residual tumour cells and the background was critical. PMID:9692682

  18. Axillary ultrasound and fine-needle aspiration in preoperative staging of axillary lymph nodes in patients with invasive breast cancer*

    PubMed Central

    Rocha, Rafael Dahmer; Girardi, André Ricardo; Pinto, Renata Reis; de Freitas, Viviane Aguilera Rolim

    2015-01-01

    Objective To propose an algorithm to determine the necessity for ultrasonography-guided fine-needle aspiration (US-FNA) in preoperative axillary lymph node staging of patients with invasive breast cancer. Materials and Methods Prospective study developed at National Cancer Institute. The study sample included 100 female patients with breast cancer referred for axillary staging by US-FNA. Results The overall US-FNA sensitivity was set at 79.4%. The positive predictive value was calculated to be 100%, and the negative predictive value, 69.5%. The US-FNA sensitivity for lymph nodes with normal sonographic features was 0%, while for indeterminate lymph nodes it was 80% and, for suspicious lymph nodes, 90.5%. In the assessment of invasive breast tumors stages T1, T2 and T3, the sensitivity was respectively 69.6%, 83.7% and 100%. US-FNA could avoid sentinel node biopsy in 54% of cases. Conclusion Axillary ultrasonography should be included in the preoperative staging of all patients with invasive breast cancer. The addition of US-FNA in cases of lymph nodes suspicious for malignancy may prevent more than 50% of sentinel lymphadenectomies, significantly shortening the time interval to definitive therapy. PMID:26811550