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Sample records for accurate preoperative localization

  1. Preoperative transcutaneous electrical nerve stimulation for localizing superficial nerve paths.

    PubMed

    Natori, Yuhei; Yoshizawa, Hidekazu; Mizuno, Hiroshi; Hayashi, Ayato

    2015-12-01

    During surgery, peripheral nerves are often seen to follow unpredictable paths because of previous surgeries and/or compression caused by a tumor. Iatrogenic nerve injury is a serious complication that must be avoided, and preoperative evaluation of nerve paths is important for preventing it. In this study, transcutaneous electrical nerve stimulation (TENS) was used for an in-depth analysis of peripheral nerve paths. This study included 27 patients who underwent the TENS procedure to evaluate the peripheral nerve path (17 males and 10 females; mean age: 59.9 years, range: 18-83 years) of each patient preoperatively. An electrode pen coupled to an electrical nerve stimulator was used for superficial nerve mapping. The TENS procedure was performed on patients' major peripheral nerves that passed close to the surgical field of tumor resection or trauma surgery, and intraoperative damage to those nerves was apprehensive. The paths of the target nerve were detected in most patients preoperatively. The nerve paths of 26 patients were precisely under the markings drawn preoperatively. The nerve path of one patient substantially differed from the preoperative markings with numbness at the surgical region. During surgery, the nerve paths could be accurately mapped preoperatively using the TENS procedure as confirmed by direct visualization of the nerve. This stimulation device is easy to use and offers highly accurate mapping of nerves for surgical planning without major complications. The authors conclude that TENS is a useful tool for noninvasive nerve localization and makes tumor resection a safe and smooth procedure. PMID:26420473

  2. Preoperative Localization and Surgical Margins in Conservative Breast Surgery

    PubMed Central

    Corsi, F.; Sorrentino, L.; Bossi, D.; Sartani, A.; Foschi, D.

    2013-01-01

    Breast-conserving surgery (BCS) is the treatment of choice for early breast cancer. The adequacy of surgical margins (SM) is a crucial issue for adjusting the volume of excision and for avoiding local recurrences, although the precise definition of an adequate margins width remains controversial. Moreover, other factors such as the biological behaviour of the tumor and subsequent proper systemic therapies may influence the local recurrence rate (LRR). However, a successful BCS requires preoperative localization techniques or margin assessment techniques. Carbon marking, wire-guided, biopsy clips, radio-guided, ultrasound-guided, frozen section analysis, imprint cytology, and cavity shave margins are commonly used, but from the literature review, no single technique proved to be better among the various ones. Thus, an association of two or more methods could result in a decrease in rates of involved margins. Each institute should adopt its most congenial techniques, based on the senologic equipe experience, skills, and technologies. PMID:23986868

  3. Preoperative localization of parathyroid lesion: diagnostic usefulness of color doppler ultrasonography

    PubMed Central

    mohammadi, Afshin; Moloudi, Farzad; Ghasemi-rad, Mohammad

    2012-01-01

    Introduction Recently, minimally invasive parathyroidectomy (MIP) has been developed and is gaining popularity among surgeons. For this reason, preoperative localization is playing an important role to detect the precise location of the affected gland and to increase the success rate. Material and methods From June 2007 to June 2011, 56 consecutive patients (11 men and 45 women) with primary or secondary hyperparathyroidism in our center underwent Gray scale, color Doppler and 99m-Tc MIBI scan prior to operative management of parathyroid lesions. Results The sensitivity, specificity and accuracy of US and MIBI scan for pHPT was 88%, 94%, 91% and 70%, 100% and 85% respectively. In patients with sHPT, the sensitivity, specificity and accuracy of US and MIBI scan was 54%, 93%, 76% and 25%, 100% and 72.9% respectively. The overall sensitivity of combined US and MIBI scan in pHPT and sHPT was 97% and 45% respectively. The overall sensitivity, specificity and accuracy of CDUS in diagnosis of parathyroid lesions in pHPT and sHPT is 97%, 100%, 98.6% and 62%, 100% and 83% respectively. Conclusion The overall sensitivity and specificity of US and MIBI in preoperative localization of parathyroid adenoma in sHPT is lower than pHPT and performing CDUS can increases the overall sensitivity and specificity of imaging methods in accurate localization of parathyroid lesion. PMID:22328952

  4. 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

  5. The role of preoperative ultrasonography, computed tomography, and sestamibi scintigraphy localization in secondary hyperparathyroidism

    PubMed Central

    Lee, Jae Bok; Kim, Woo Young

    2015-01-01

    Purpose The role of preoperative localization studies is controversial in surgery of secondary hyperparathyroidism (sHPT). The aim of study was to evaluate the accuracy of preoperative ultrasonography (USG), CT, and 99mTc sestamibi scintigraphy (MIBI) in localizing enlarged parathyroid glands and to find the impact of correct localization in successful parathyroidectomy. Methods We compared operative findings with the preoperative localization of ultrasonography, computerized tomography and sestamibi scintigraphy in 109 patients with sHPT and identified well-visualized locations of abnormal parathyroid glands by evaluating the sensitivity of each imaging study with regard to typical locations of glands. We investigated the effect of preoperative imaging localization on the surgical outcomes by measuring the intraoperative parathyroid hormone (ioPTH) decrement for positive or negative imaging localization. Results USG (91.5%) had the highest sensitivity and MIBI (56.1%) had the lowest among 3 modalities. The sensitivity of combined USG and CT (95.0%) was the highest among combined 2 modalities. The combination of all 3 modalities (95.4%) had the highest sensitivity among the combinations of modalities. The reduction of ioPTH in patients with positive imaging localization (86.6%) was greater than negative imaging localization (84.2%), with no significant difference (P = 0.586). The recurrence or persistence of sHPT was not correlated with preoperative imaging localization (19 patients in negative, 16 in positive; P = 0.14). Conclusion Preoperative imaging localization contributed to surgical success but not to surgical outcomes. The combination of ioPTH measurement with imaging localization might be valuable for better surgical results in sHPT. PMID:26665124

  6. 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

  7. Refining Preoperative Therapy for Locally Advanced Rectal Cancer

    Cancer.gov

    In the PROSPECT trial, patients with locally advanced, resectable rectal cancer will be randomly assigned to receive either standard neoadjuvant chemoradiation therapy or neoadjuvant FOLFOX chemotherapy, with chemoradiation reserved for nonresponders.

  8. Complications associated with preoperative radiation therapy and Iodine-125 brachytherapy for localized prostatic carcinoma

    SciTech Connect

    Flanigan, R.C.; Patterson, J.; Mendiondo, O.A.; Gee, W.F.; Lucas, B.A.; McRoberts, J.W.

    1983-08-01

    Twenty-five consecutive patients with localized adenocarcinoma of the prostate treated with 1,050 rad preoperative radiation therapy and Iodine-125 seed brachytherapy are reviewed. Significant long-term postoperative complications included radiation cystitis (12%), radiation proctitis (4%), genital and leg edema (12%), stress incontinence (8%), total incontinence (4%), and impotence (26%). Complications occurred in 75 per cent of patients who received additional postoperative radiation. Improved staging with CT scan, lymphangiography, and Chiba needle biopsy of any possibly abnormal lymph nodes provided excellent preoperative staging with only 1 patient (6%) upstaged at surgery to Stage D1.

  9. Preoperative chemoradiotherapy followed by transanal local excision for T3 distal rectal cancer: A case report

    PubMed Central

    YEO, SEUNG-GU

    2016-01-01

    Local excision (LE) for rectal cancer is currently indicated for selected T1 stage tumors. However, preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer not only improves local disease control, but also leads to a decrease in the stage and size of the primary mural tumor, along with a decrease in the risk of regional lymphadenopathy. The present study reports the outcome of a patient with T3N0M0 rectal cancer who was treated with LE following preoperative CRT. The distal pole of the tumor was located 2 cm from the anal verge. Preoperative pelvic radiotherapy of 50.4 Gy was administered in 28 fractions. Chemotherapy using 5-fluorouracil and leucovorin was administered during the first and last weeks of radiotherapy. The tumor response to CRT, was found to be marked at 7 weeks after CRT completion, and a complete response was presumed clinically. Transanal full-thickness LE was performed, and pathological examination revealed the absence of residual cancer cells. After 30 months of close follow-up, the patient was alive with no evidence of disease, and treatment-associated severe toxicities were not observed. Although a longer follow-up period is required, this case report suggests that LE may also be a feasible alternative treatment for T3 rectal cancer, which exhibits a marked response to preoperative CRT, particularly in elderly and comorbid patients contraindicated for radical surgery, or patients who are reluctant to undergo sphincter-ablation surgery. PMID:27073466

  10. Thallium-pertechnetate subtraction scanning in the preoperative localization of an ectopic undescended parathyroid gland.

    PubMed

    Frydman, James; Bianco, Jesus; Drezner, Marc; Chen, Herbert

    2004-09-01

    Although bilateral exploration is highly effective in the treatment of primary hyperparathyroidism, minimally invasive parathyroidectomy has evolved into the procedure of choice when a single parathyroid lesion can be localized preoperatively. In this article, we discuss the utilization of thallium-pertechnetate subtraction scanning (TPSS) after technetium Tc-99m sestamibi scintigraphy failed to localize an ectopic parathyroid adenoma. Subsequently, radioguided resection of an undescended parathyroid adenoma inferior to the left submandibular gland was performed with surgical cure after a single procedure. This case report illustrates the importance of TPSS as a second-line modality in preoperative adenoma localization, thereby using minimally invasive techniques to successfully treat this patient's primary hyperparathyroidism. PMID:15311119

  11. Detection and accurate localization of harmonic chipless tags

    NASA Astrophysics Data System (ADS)

    Dardari, Davide

    2015-12-01

    We investigate the detection and localization properties of harmonic tags working at microwave frequencies. A two-tone interrogation signal and a dedicated signal processing scheme at the receiver are proposed to eliminate phase ambiguities caused by the short signal wavelength and to provide accurate distance/position estimation even in the presence of clutter and multipath. The theoretical limits on tag detection and localization accuracy are investigated starting from a concise characterization of harmonic backscattered signals. Numerical results show that accuracies in the order of centimeters are feasible within an operational range of a few meters in the RFID UHF band.

  12. Preoperative therapy for local-regional gastric cancer: rationale and review of trials.

    PubMed

    Ajani, J A; Yao, J C

    2000-05-01

    The standard approach for patients with local-regional gastric carcinoma is an attempted surgical resection to achieve a "curative resection" (also called an R0 resection) with adequate lymph node dissection. Western patients, who often get suboptimal surgery and have a high incidence of regional lymph node involvement, remain at higher risk of local and systemic relapse after an R0 resection than most Japanese patients. Numerous postoperative adjuvant therapy trials have not yet established an advantage for these patients. Thus in the West, the concept of preoperative therapy is appealing. The preoperative approach can potentially result in downstaging (or downsizing) of the primary tumor and, therefore, increasing the rate of R0 resection. Investigators are still refining the treatment strategies and defining ideal patient population for this approach. Undoubtedly, properly designed prospective randomized trials will be needed to establish any advantage with this approach. A number of newer agents hold a great deal of promise. PMID:10895184

  13. Efficient and Accurate Indoor Localization Using Landmark Graphs

    NASA Astrophysics Data System (ADS)

    Gu, F.; Kealy, A.; Khoshelham, K.; Shang, J.

    2016-06-01

    Indoor localization is important for a variety of applications such as location-based services, mobile social networks, and emergency response. Fusing spatial information is an effective way to achieve accurate indoor localization with little or with no need for extra hardware. However, existing indoor localization methods that make use of spatial information are either too computationally expensive or too sensitive to the completeness of landmark detection. In this paper, we solve this problem by using the proposed landmark graph. The landmark graph is a directed graph where nodes are landmarks (e.g., doors, staircases, and turns) and edges are accessible paths with heading information. We compared the proposed method with two common Dead Reckoning (DR)-based methods (namely, Compass + Accelerometer + Landmarks and Gyroscope + Accelerometer + Landmarks) by a series of experiments. Experimental results show that the proposed method can achieve 73% accuracy with a positioning error less than 2.5 meters, which outperforms the other two DR-based methods.

  14. Intensity-Modulated Radiation Therapy With Concurrent Chemotherapy as Preoperative Treatment for Localized Gastric Adenocarcinoma

    SciTech Connect

    Chakravarty, Twisha; Crane, Christopher H.; Ajani, Jaffer A.; Mansfield, Paul F.; Briere, Tina M.; Beddar, A. Sam; Mok, Henry; Reed, Valerie K.; Krishnan, Sunil; Delclos, Marc E.; Das, Prajnan

    2012-06-01

    Purpose: The goal of this study was to evaluate dosimetric parameters, acute toxicity, pathologic response, and local control in patients treated with preoperative intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy for localized gastric adenocarcinoma. Methods: Between November 2007 and April 2010, 25 patients with localized gastric adenocarcinoma were treated with induction chemotherapy, followed by preoperative IMRT and concurrent chemotherapy and, finally, surgical resection. The median radiation therapy dose was 45 Gy. Concurrent chemotherapy was 5-fluorouracil and oxaliplatin in 18 patients, capecitabine in 3, and other regimens in 4. Subsequently, resection was performed with total gastrectomy in 13 patients, subtotal gastrectomy in 7, and other surgeries in 5. Results: Target coverage, expressed as the ratio of the minimum dose received by 99% of the planning target volume to the prescribed dose, was a median of 0.97 (range, 0.92-1.01). The median V{sub 30} (percentage of volume receiving at least 30 Gy) for the liver was 26%; the median V{sub 20} (percentage of volume receiving at least 20 Gy) for the right and left kidneys was 14% and 24%, respectively; and the median V{sub 40} (percentage of volume receiving at least 40 Gy) for the heart was 18%. Grade 3 acute toxicity developed in 14 patients (56%), including dehydration in 10, nausea in 8, and anorexia in 5. Grade 4 acute toxicity did not develop in any patient. There were no significant differences in the rates of acute toxicity, hospitalization, or feeding tube use in comparison to those in a group of 50 patients treated with preoperative three-dimensional conformal radiation therapy with concurrent chemotherapy. R0 resection was obtained in 20 patients (80%), and pathologic complete response occurred in 5 (20%). Conclusions: Preoperative IMRT for gastric adenocarcinoma was well tolerated, accomplished excellent target coverage and normal structure sparing, and led to appropriate

  15. Preoperative induction therapy for locally advanced thymic tumors: a retrospective analysis using the ChART database

    PubMed Central

    Wei, Yucheng; Gu, Zhitao; Fu, Jianhua; Tan, Liejie; Zhang, Peng; Han, Yongtao; Chen, Chun; Zhang, Renquan; Li, Yin; Chen, Keneng; Chen, Hezhong; Liu, Yongyu; Cui, Youbing; Wang, Yun; Pang, Liewen; Yu, Zhentao; Zhou, Xinming; Liu, Yangchun; Liu, Yuan

    2016-01-01

    Background To evaluate the role of preoperative induction therapy on prognosis of locally advanced thymic malignancies. Methods Between 1994 and 2012, patients received preoperative induction therapies (IT group) in the Chinese Alliance for Research in Thymomas (ChART) database, were compared with those having surgery directly after preoperative evaluation (DS group). All tumors receiving induction therapies were locally advanced (clinically stage III–IV) before treatment and those turned out to be in pathological stage I and II were considered downstaged by induction. Clinical pathological characteristics were retrospectively analyzed. To more accurately study the effect of induction therapies, stage IV patients were then excluded. Only stage I-III tumors in the IT group and stage III cases in the DS group were selected for further comparison in a subgroup analysis. Results Only 68 (4%) out of 1,713 patients had induction therapies, with a R0 resection of 67.6%, 5-year recurrence of 44.9%, and 5- and 10-year overall survivals (OS) of 49.7% and 19.9%. Seventeen patients (25%) were downstaged after induction. Significantly more thymomas were downstaged than thymic carcinomas (38.7% vs. 13.9%, P=0.02). Tumors downstaged after induction had significantly higher 5-year OS than those not downstaged (93.8% vs. 35.6%, P=0.013). For the subgroup analysis when stage IV patients were excluded, 5-year OS was 85.2% in the DS group and 68.1% in the IT group (P=0.000), although R0 resection were similar (76.4% vs. 73.3%, P=0.63). However, 5-year OS in tumors downstaged after induction (93.8%) was similar to those in the DS group (85.2%, P=0.438), both significantly higher than those not downstaged after induction (35.6%, P=0.000). Conclusions Preoperative neoadjuvant therapy have been used only occasionally in locally advanced thymic malignances. Effective induction therapy leading to tumor downstaging may be beneficial for potentially unresectable diseases, especially in

  16. Local Debonding and Fiber Breakage in Composite Materials Modeled Accurately

    NASA Technical Reports Server (NTRS)

    Bednarcyk, Brett A.; Arnold, Steven M.

    2001-01-01

    A prerequisite for full utilization of composite materials in aerospace components is accurate design and life prediction tools that enable the assessment of component performance and reliability. Such tools assist both structural analysts, who design and optimize structures composed of composite materials, and materials scientists who design and optimize the composite materials themselves. NASA Glenn Research Center's Micromechanics Analysis Code with Generalized Method of Cells (MAC/GMC) software package (http://www.grc.nasa.gov/WWW/LPB/mac) addresses this need for composite design and life prediction tools by providing a widely applicable and accurate approach to modeling composite materials. Furthermore, MAC/GMC serves as a platform for incorporating new local models and capabilities that are under development at NASA, thus enabling these new capabilities to progress rapidly to a stage in which they can be employed by the code's end users.

  17. Comparison of 5-fluorouracil/leucovorin and capecitabine in preoperative chemoradiotherapy for locally advanced rectal cancer

    SciTech Connect

    Kim, Dae Yong; Jung, Kyung Hae . E-mail: khjung@ncc.re.kr; Kim, Tae Hyun; Kim, Duck-Woo; Chang, Hee Jin; Jeong, Jun Yong; Kim, Young Hoon; Son, Seok-Hyun; Yun, Tak; Hong, Chang Won; Sohn, Dae Kyung; Lim, Seok-Byung; Choi, Hyo Seong; Jeong, Seung-Yong; Park, Jae-Gahb

    2007-02-01

    Purpose: To describe our experience with a bolus injection of 5-fluorouracil and leucovorin (FL) vs. capecitabine in terms of radiologic and pathologic findings in preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer. Methods: The study enrolled 278 patients scheduled for preoperative CRT using two protocols with different chemotherapeutic regimens. Pelvic radiotherapy (50.4 Gy) was delivered concurrently with FL (n = 145) or capecitabine (n = 133). Surgery was performed 6 weeks after CRT completion. Tumor responses to CRT were measured using both radiologic and pathologic examination. Magnetic resonance volumetry was performed at the initial workup and just before surgery after completion of preoperative CRT. Post-CRT pathology tests were used to determine tumor stage and regression. Results: Radiologic examination showed that tumor volume decreased by 68.2% {+-} 20.5% in the FL group and 68.3% {+-} 22.3% in the capecitabine group (p = 0.970). Postoperative pathologic T stage determination showed that downstaging occurred in 44.3% of FL and 49.9% of capecitabine patients (p = 0.571). The tumor regression grades after CRT were Grade 1 (minimal response) in 22.6% and 21.0%, Grade 2 (moderate response) in 53.2% and 50.0%, Grade 3 (near-complete response) in 12.9% and 12.9%, and Grade 4 (complete response) in 11.3% and 16.1% of the FL and capecitabine groups, respectively (p = 0.758). Conclusion: In the present study, the radiologic and pathologic findings did not reveal significant differences in short-term tumor responses between preoperative FL and capecitabine CRT for locally advanced rectal cancer. Long-term results and a prospective randomized trial are needed.

  18. Accurate inference of local phased ancestry of modern admixed populations.

    PubMed

    Ma, Yamin; Zhao, Jian; Wong, Jian-Syuan; Ma, Li; Li, Wenzhi; Fu, Guoxing; Xu, Wei; Zhang, Kui; Kittles, Rick A; Li, Yun; Song, Qing

    2014-01-01

    Population stratification is a growing concern in genetic-association studies. Averaged ancestry at the genome level (global ancestry) is insufficient for detecting the population substructures and correcting population stratifications in association studies. Local and phase stratification are needed for human genetic studies, but current technologies cannot be applied on the entire genome data due to various technical caveats. Here we developed a novel approach (aMAP, ancestry of Modern Admixed Populations) for inferring local phased ancestry. It took about 3 seconds on a desktop computer to finish a local ancestry analysis for each human genome with 1.4-million SNPs. This method also exhibits the scalability to larger datasets with respect to the number of SNPs, the number of samples, and the size of reference panels. It can detect the lack of the proxy of reference panels. The accuracy was 99.4%. The aMAP software has a capacity for analyzing 6-way admixed individuals. As the biomedical community continues to expand its efforts to increase the representation of diverse populations, and as the number of large whole-genome sequence datasets continues to grow rapidly, there is an increasing demand on rapid and accurate local ancestry analysis in genetics, pharmacogenomics, population genetics, and clinical diagnosis. PMID:25052506

  19. 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

  20. Pre-operative radionuclide localization of intracerebral lesions: a five-year experience.

    PubMed

    Wheeler, J G; Coakham, H B; Russell, T; Smith, P A

    1987-06-01

    Intracerebral lesions demonstrated by computerized tomography usually require histological confirmation to determine subsequent management. Tissue samples are generally obtained by craniotomy or burr hole biopsy; either procedure can prove negative if a lesion is small, deep, or very superficial. Pre-operative imaging and localization reduce biopsy failures. Before the introduction of this straight forward radionuclide technique, our biopsy success rate using conventional localization methods was 88%. In a 5-year period, 200 patients underwent pre-operative radionuclide localization, with an improvement in the overall biopsy success rate to 92.7% (95.5% for lesions which took up radionuclide). Patients have benefitted from reduced operating time and improved post-operative recovery rates. About 85% of all intracerebral lesions may be expected to accumulate radionuclide. However in our series, 93.2% were sufficiently well visualized for a siting marker to be placed with confidence. Within this group, low grade astrocytomas (Kernohan Grades I and II) showed a predictably low incidence of imaging (30.8%). For the majority of lesions which present difficulties in biopsy due to size or site, the radionuclide method is a simple procedure which increases the chance of obtaining positive tissue with the minimum of surgical intervention. PMID:3696626

  1. Preoperative Treatment of Locally Advanced Rectal Cancer: Assets and Drawbacks of Short Course and Long Course in Clinical Practice.

    PubMed

    Ngan, Samuel Y

    2016-07-01

    Preoperative short-course radiotherapy and preoperative long-course chemoradiotherapy are the standards of care for high-risk rectal cancer in different parts of the world. Both treatments are effective in local control and carry a low morbidity. The advantage of short course is its simplicity, whereas long course has the advantage of downsizing tumors thus increasing the chance of sphincter preservation. Although 2 randomized trials comparing short course and long course have been performed, the better form of preoperative treatment remains a subject of discussion. This article reviews the evidence supporting each approach, and it discusses their relative merits and future directions. PMID:27238469

  2. Could preoperative short-course radiotherapy be the treatment of choice for localized advanced rectal carcinoma?

    PubMed

    Ciria, Juan Pablo; Eguiguren, Mikel; Cafiero, Sergio; Uranga, Intza; Diaz de Cerio, Ivan; Querejeta, Arrate; Urraca, Jose Maria; Minguez, Julian; Guimon, Elena; Puertolas, Jose Ramón

    2015-01-01

    Short-course preoperative radiotherapy (RT) is widely used in northern Europe for locally advanced resectable rectal cancer, but its role in the era of advanced imaging techniques is uncertain. Here, we reviewed articles and abstracts on SCRT published from 1974 through 2013 with the goal of identifying patients who might be best suited for short-course RT. We included relevant articles comparing surgery with or without preoperative radiation published before and after the advent of total mesorectal excision. We also analyzed two randomized trials directly comparing short-course RT with conventionally fractionated chemoradiation (the Polish Colorectal Study Group and the Trans-Tasman Radiation Oncology Group) that compared short-course RT with conventional chemoradiotherapy. We conclude from our review that short-course RT can be generally applied for operable rectal cancer and produces high rates of pelvic control with acceptable toxicity; it reduces local recurrence rates but does not increase overall survival. SCRT seems to be best used for tumors considered "low risk," i.e., those that are >5 cm from the anal margin, without circumferential margin involvement, and involvement of fewer than 4 lymph nodes. Whether sequential chemotherapy can further improve outcomes remains to be seen, as does the best time for surgery (immediately or 6-8 weeks after RT). We further recommend that selection of patients for short-course RT should be based on findings from magnetic resonance imaging or transrectal ultrasonography. PMID:25535578

  3. Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein.

    PubMed Central

    Ishikawa, O; Ohigashi, H; Imaoka, S; Furukawa, H; Sasaki, Y; Fujita, M; Kuroda, C; Iwanaga, T

    1992-01-01

    This retrospective study attempted to determine the indications for extended pancreatectomy for locally advanced carcinoma of the pancreas, in terms of postoperative prognosis. An extended pancreatectomy with portal vein or superior mesenteric vein (PV/SMV) resection and regional lymphadenectomy was performed in 35 of 50 consecutive cancers that extended into the retroperitoneal spaces and involved the PV or SMV. Among the many background factors in the 35 resected specimens, the degree of PV/SMV invasion by the cancer was most closely associated with prognosis, despite resection of all involved PV/SMV. This factor generally correlated with the preoperative findings on the portal phase of superior mesenteric arteriograph. In 17 selected patients in whom PV/SMV invasion had been angiographically both semicircular or less and 1.2 cm (1.4 cm on the film) or less in length, the 3-year survival rate was 59%. This survival rate was significantly higher than the 29% 3-year survival rate in all 35 patients (p less than 0.05). Conversely, among the 18 patients in whom invasion was angiographically either beyond semicircular or more than 1.2 cm (1.4 cm on the film) in length, there were no 1.5-year survivors, and this result was even worse than that of 15 nonresectable cases. Based on postoperative survival, the degrees of PV/SMV invasion on preoperative angiography (narrowing pattern and length) are good indicators for aggressive pancreatectomy for locally advanced pancreatic cancer. Images FIG. 2. PMID:1543394

  4. Caveolin-1 as a Prognostic Marker for Local Control After Preoperative Chemoradiation Therapy in Rectal Cancer

    SciTech Connect

    Roedel, Franz Capalbo, Gianni; Roedel, Claus; Weiss, Christian

    2009-03-01

    Purpose: Caveolin-1 is a protein marker for caveolae organelles and has an essential impact on cellular signal transduction pathways (e.g., receptor tyrosine kinases, adhesion molecules, and G-protein-coupled receptors). In the present study, we investigated the expression of caveolin-1 in patients with rectal adenocarcinoma and correlated its expression pattern with the risk for disease recurrences after preoperative chemoradiation therapy (CRT) and surgical resection. Methods and Materials: Caveolin-1 mRNA and protein expression were evaluated by Affymetrix microarray analysis (n = 20) and immunohistochemistry (n = 44) on pretreatment biopsy samples of patients with locally advanced adenocarcinoma of the rectum, and were correlated with clinical and histopathologic characteristics as well as with 5-year rates of local failure and overall survival. Results: A significantly decreased median caveolin-1 intracellular mRNA level was observed in tumor biopsy samples as compared with noncancerous mucosa. Individual mRNA levels and immunohistologic staining, however, revealed an overexpression in 7 of 20 patients (35%) and 17 of 44 patients (38.6%), respectively. Based on immunohistochemical evaluation, local control rates at 5 years for patients with tumors showing low caveolin-1 expression were significantly better than for patients with high caveolin-1-expressing carcinoma cells (p = 0.05; 92%, 95% confidence interval [95% CI] = 82-102% vs. 72%, 95% CI = 49-84%). A low caveolin-1 protein expression was also significantly related to an increased overall survival rate (p = 0.05; 45%, 95% CI 16-60% vs. 82%, 95% CI = 67-97%). Conclusion: Caveolin-1 may provide a novel prognostic marker for local control and survival after preoperative CRT and surgical resection in rectal cancer.

  5. Evaluation of conventional imaging techniques on preoperative localization in primary hyperparathyroidism

    PubMed Central

    Ozkaya, Mesut; Elboga, Umut; Sahin, Ertan; Kalender, Ebuzer; Korkmaz, Hakan; Demir, H. Deniz; Celen, Y. Zeki; Erkılıç, Suna; Gökalp, Avni; Maralcan, Göktürk

    2015-01-01

    We aimed to evaluate the diagnostic and preoperative localization capacity of 99 mTc methoxyisobutylnitrile (MIBI) parathyroid scintigraphy and ultrasonography (USG) in enlarged parathyroid glands in the primary hyperparathyroidism (pHPT), as well as the relationship between the success rate of these techniques and biochemical values. We retrospectively evaluated 39 patients with clinical and biological evidence of pHPT who referred to the university hospital for MIBI parathyroid scintigraphy. Patients were examined with USG and double-phase MIBI parathyroid scintigraphy for the detection of enlarged parathyroid glands. Preoperative serum intact parathyroid hormone (iPTH) levels, calcium (Ca), phosphate and alkaline phosphatase measurements were obtained. A total of 45 parathyroid lesions in 39 patients were reviewed. Thirty-four patients had a single adenoma and five patients with multi-gland disease had 11 abnormal parathyroid glands including three adenomas, whereas the remaining 8 glands showed hyperplasia. The overall sensitivities of MIBI parathyroid scintigraphy, USG, and combined techniques were 85.3%, 72.5% and 90.4%, respectively; the positive predictive values (PPV) were 89.7%, 85.2%, and 92.6%, respectively. The most successful approach for detection of enlarged parathyroid glands in hyperparathyroidism is the concurrent application of USG and MIBI parathyroid scintigraphy modalities. The concomitance of thyroid diseases decreases the sensitivity of both MIBI parathyroid scintigraphy and USG in enlarged parathyroid glands. PMID:25725146

  6. Original technique for preoperative preparation of patients and intraoperative localization of parathyroid adenomas.

    PubMed

    Pasta, V; Monteleone, F; Del Vecchio, L; Iacobelli, S; Urciuoli, P; D'Orazi, V

    2015-01-01

    Surgical approach of single parathyroid adenoma treatment is turning to a less invasive surgery, allowing us to obtain better aesthetic results, reduction of duration of surgical operation, reduction of post-operative morbidity and hospital stay. Tc99m-sestaMIBI scintigraphy is mainly performed for preoperative localization of parathyroid adenomas. Our technique is instead based on the possibility to inhibit the interference of Tc99m-sestaMIBI uptake of the thyroid gland by means of the administration of Lugol's solution. Indeed, to confirm the identification and removal of the hyperfunctional parathyroid, it is accepted as adequate an ex vivo radioactivity count of the adenoma 20% or 40% greater than the value of the post-excisional background radioactivity, in association or not with intraoperative measurement of PTH. This method allows us to perform surgery with no timetable restriction, and to clearly distinguish the radioactivity of parathyroid adenoma from that of the surrounding tissues and thyroid gland. PMID:26188752

  7. Radiation Dose-Response Model for Locally Advanced Rectal Cancer After Preoperative Chemoradiation Therapy

    SciTech Connect

    Appelt, Ane L.; Ploen, John; Vogelius, Ivan R.; Bentzen, Soren M.; Jakobsen, Anders

    2013-01-01

    Purpose: Preoperative chemoradiation therapy (CRT) is part of the standard treatment of locally advanced rectal cancers. Tumor regression at the time of operation is desirable, but not much is known about the relationship between radiation dose and tumor regression. In the present study we estimated radiation dose-response curves for various grades of tumor regression after preoperative CRT. Methods and Materials: A total of 222 patients, treated with consistent chemotherapy and radiation therapy techniques, were considered for the analysis. Radiation therapy consisted of a combination of external-beam radiation therapy and brachytherapy. Response at the time of operation was evaluated from the histopathologic specimen and graded on a 5-point scale (TRG1-5). The probability of achieving complete, major, and partial response was analyzed by ordinal logistic regression, and the effect of including clinical parameters in the model was examined. The radiation dose-response relationship for a specific grade of histopathologic tumor regression was parameterized in terms of the dose required for 50% response, D{sub 50,i}, and the normalized dose-response gradient, {gamma}{sub 50,i}. Results: A highly significant dose-response relationship was found (P=.002). For complete response (TRG1), the dose-response parameters were D{sub 50,TRG1} = 92.0 Gy (95% confidence interval [CI] 79.3-144.9 Gy), {gamma}{sub 50,TRG1} = 0.982 (CI 0.533-1.429), and for major response (TRG1-2) D{sub 50,TRG1} and {sub 2} = 72.1 Gy (CI 65.3-94.0 Gy), {gamma}{sub 50,TRG1} and {sub 2} = 0.770 (CI 0.338-1.201). Tumor size and N category both had a significant effect on the dose-response relationships. Conclusions: This study demonstrated a significant dose-response relationship for tumor regression after preoperative CRT for locally advanced rectal cancer for tumor dose levels in the range of 50.4-70 Gy, which is higher than the dose range usually considered.

  8. 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

  9. Effectiveness of endoscopic clipping and computed tomography gastroscopy for the preoperative localization of gastric cancer

    PubMed Central

    Jeong, Sang-Ho; Bae, Kyungsoo; Ha, Chang-Youn; Lee, Ok-Jae; Jung, Woon-Tae; Choi, Sang-Kyung; Hong, Soon-Chan; Jung, Eun-Jung; Ju, Young-Tae; Jeong, Chi-Young; Ha, Woo-Song

    2013-01-01

    Purpose Before laparoscopic gastrectomy for gastric cancer can be planned, it is very important to know the precise location of the tumor. The aim of this study was to evaluate 3 methods of predicting the exact location of the tumor: preoperative gastrofibroscopy (GFS), preoperative computed tomography gastroscopy (CT), and intraoperative gastroscopy-guided laparoscopy (Lap). Methods In this study, 15 patients were prospectively identified, and endoscopic clips were preoperatively placed on the proximal 1 cm of the tumor, at the angle on the greater curvature and opposite the angle on the greater curvature. The distances between the pylorus and the proximal tumor clip (PT), the angle clip (PA), the greater curvature clip (PG), and the gastroesophageal junction were measured by preoperative GFS, preoperative CT, intraoperative Lap, and visual inspection (Vis). Results PT, PA, and PG values measured by preoperative GFS differed significantly from the Vis values (P < 0.01). However, preoperative CT measurements of PT, PA, and PG did not differ from the Vis values (P = 0.78, P = 0.48, and P = 0.53, respectively). Intraoperative Lap and Vis PT values differed by only 1.1 cm on an average (P = 0.10), but PA and PG values varied by 1.9 and 3.4 cm, respectively (P = 0.01 for both). Conclusion Endoscopic clipping combined with preoperative CT gastroscopy is more useful than preoperative GFS for preoperatively predicting the location of early gastric cancers and will be helpful for planning laparoscopic gastrectomy. PMID:23396626

  10. Preoperative irradiation, lymphadenectomy, and 125iodine implantation for patients with localized carcinoma of the prostate

    SciTech Connect

    DeLaney, T.F.; Shipley, W.U.; O'Leary, M.P.; Biggs, P.J.; Prout, G.R. Jr.

    1986-10-01

    Fifty-four patients with clinically and surgically localized prostatic carcinoma were treated with low-dose preoperative irradiation (1050 cGy), pelvic lymphadenectomy, and interstitial /sup 125/Iodine implantation. The follow-up range is 2 to 9 years with a median follow-up of 5 years. Overall local tumor control is 92%. Actuarial 5-year survival is 86% and the actuarial disease-free survival at 5 years is 73%. Patients with poorly differentiated tumors have a significantly worse actuarial survival (62%) at 5 years than patients with well (95%) or moderately well differentiated tumors (93%), p = 0.04. Disease-free survival at 5 years was influenced by grade: well (100%), moderate (60%), and poor (48%), p = 0.03. Multivariate regression analysis indicates that only the degree of differentiation (p = 0.05) significantly impacts on survival. Both degree of differentiation (p = 0.04) and nodal status (p = 0.03) significantly influence disease-free survival. Potency has been maintained in 71% of patients potent at the time of implantation. Late reactions have been acceptable to date: bladder outlet obstruction (13%), mild proctitis (13%), cystourethritis (6%), incontinence (2%), and prostatic calculi (2%).

  11. Accurate Measurements of the Local Deuterium Abundance from HST Spectra

    NASA Technical Reports Server (NTRS)

    Linsky, Jeffrey L.

    1996-01-01

    An accurate measurement of the primordial value of D/H would provide a critical test of nucleosynthesis models for the early universe and the baryon density. I briefly summarize the ongoing HST observations of the interstellar H and D Lyman-alpha absorption for lines of sight to nearby stars and comment on recent reports of extragalactic D/H measurements.

  12. Phase II study of preoperative paclitaxel/cisplatin with radiotherapy in locally advanced esophageal cancer

    SciTech Connect

    Kim, Dong W.; Blanke, Charles D.; Wu, Huiyun; Shyr, Yu; Berlin, Jordan; Beauchamp, R. Daniel; Chakravarthy, Bapsi . E-mail: bapsi.chak@vanderbilt.edu

    2007-02-01

    Purpose: Preoperative paclitaxel-based chemoradiotherapy may improve the response rates and survival in patients with localized esophageal cancer. We evaluated paclitaxel-based induction chemoradiotherapy in patients with localized esophageal cancer to determine its feasibility, clinical response, pathologic response, and overall survival. Methods and Materials: Between 1995 and 1998, 50 patients were enrolled in this study. At study entry, patients were categorized as either resectable or unresectable according to evaluation by an experienced thoracic surgeon. All patients were treated with paclitaxel 175 mg/m{sup 2} and cisplatin 75 mg/m{sup 2} on Day 1, 29 with radiotherapy to 3,000 cGy in 15 fractions. Resectable patients underwent esophagectomy 4 weeks later. Postoperatively, patients received two cycles of paclitaxel 175 mg/m{sup 2} on Day 1 and 5-fluorouracil 350 mg/m{sup 2} and leucovorin 300 mg on Days 1-3, given every 28 days. Patients who were deemed unsuitable for resection from the outset continued radiotherapy to a total dose of 6,000 cGy. Results: Of the 50 patients, all began neoadjuvant chemoradiotherapy, 40 patients underwent surgery, and 25 patients completed postoperative chemotherapy. A pathologic complete response was seen in 7 patients (17.5%). Patients with a pathologic response had a median survival of 32.4 months vs. 14.4 months for nonresponders (p <0.001). Patients with a clinical response had a median survival of 25.2 months compared with 15.6 months for nonresponders (p = 0.002). At a median follow up of 19.8 months (range 2.4-100.8), the median survival was 20.4 months and the 3-year overall survival rate was 23.2%. Conclusion: Although preoperative cisplatin/paclitaxel with 3,000 cGy was tolerable, this multimodality regimen did not appear to be superior to standard cisplatin/5-fluorouracil-containing regimens and its use is not recommended.

  13. Preoperative embolization versus local hemostatic agents in surgery of hypervascular spinal tumors

    PubMed Central

    Ptashnikov, Dmitry; Mikhaylov, Dmitry; Masevnin, Sergei

    2014-01-01

    Background Currently, there is no consensus about how to reduce the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular spinal tumors, such as aggressive hemangioma, multiple myeloma, plasmacytoma, metastasis of renal cell carcinoma. Methods A retrospective study of 110 patients, operated in our institute was held in the period between 2003 and 2013. There were 69 male and 41 female patients with extradural hypervascular spinal tumor. The study included 61 patients with metastasis of renal cell carcinoma, 27 with multiple myeloma, 15 with plasmacytoma and 7 with aggressive hemangioma. The first group included 57 patients who underwent preoperative tumor embolization. The second group consisted of 53 patients, which were treated surgically using intraoperative local hemostatic agents. We performed 2 types of treatment options: palliative decompression and total spondylectomy. The first group was divided into two subgroups: 30 patients with palliative decompression (1PD) and 27 with total spondylectomy (1TS). In the second group there were: 28 patients with palliative decompression (2PD) and 25 with total spondylectomy (2TS). The parameters under evaluation were the blood loss volume, drainage loss, operation time, hemoglobin level, possible complications and time of hospital stay. Results The average intraoperative blood loss for all embolized patients was slightly less than in subgroups with local hemostatic agents. No significant difference in blood loss volume was found between groups 1PD and 2PD (p > 0.05). In groups 1TS and 2TS, we did get significant difference (p < 0.05). Statistically significant difference in the average drainage loss was found between two methods of hemostasis in both subgroups (p < 0.05). The operation time was not significantly different between groups. Postoperative hemoglobin level reduce is almost equal in both groups of patients. Postoperative complications were also nearly equal in the groups. The

  14. Original technique for preoperative preparation of patients and intraoperative localization of parathyroid adenomas

    PubMed Central

    PASTA, V.; MONTELEONE, F.; DEL VECCHIO, L.; IACOBELLI, S.; URCIUOLI, P.; D’ORAZI, V.

    2015-01-01

    Surgical approach of single parathyroid adenoma treatment is turning to a less invasive surgery, allowing us to obtain better aesthetic results, reduction of duration of surgical operation, reduction of post-operative morbidity and hospital stay. Tc99m-sestaMIBI scintigraphy is mainly performed for preoperative localization of parathyroid adenomas. Our technique is instead based on the possibility to inhibit the interference of Tc99m-sestaMIBI uptake of the thyroid gland by means of the administration of Lugol’s solution. Indeed, to confirm the identification and removal of the hyperfunctional parathyroid, it is accepted as adequate an ex vivo radioactivity count of the adenoma 20% or 40% greater than the value of the post-excisional background radioactivity, in association or not with intraoperative measurement of PTH. This method allows us to perform surgery with no timetable restriction, and to clearly distinguish the radioactivity of parathyroid adenoma from that of the surrounding tissues and thyroid gland. PMID:26188752

  15. Effects of Preoperative Local Estrogen in Postmenopausal Women With Prolapse: A Randomized Trial

    PubMed Central

    Good, Meadow M.; Roshanravan, Shayzreen M.; Shi, Haolin; Schaffer, Joseph I.; Singh, Ravinder J.; Word, R. Ann

    2014-01-01

    Context: Pelvic organ prolapse (POP) increases in prevalence with age; recurrence after surgical repair is common. Objective: The objective of the study was to determine the effects of local estrogen treatment on connective tissue synthesis and breakdown in the vaginal wall of postmenopausal women planning surgical repair of POP. Design: This was a randomized trial. Setting: The study was conducted at an academic tertiary medical center. Patients or Other Participants: Postmenopausal women with a uterus and symptomatic anterior and/or apical prolapse at stage 2 or greater participated in the study. Intervention: Estrogen (Premarin) or placebo cream for 6 weeks preoperatively was the intervention. Main Outcome Measures: Full-thickness anterior apical vaginal wall biopsies were obtained at the time of hysterectomy and analyzed for mucosa and muscularis thickness, connective tissue synthesis, and degradation. Serum levels of estrone and 17β-estradiol were analyzed at baseline and the day of surgery using highly sensitive liquid chromatography-tandem mass spectrometry. Results: Fifteen women per group (n = 30 total) were randomized; 13 per group underwent surgery. Among drug-adherent participants (n = 8 estrogen, n = 13 placebo), epithelial and muscularis thickness was increased 1.8- and 2.7-fold (P = .002 and P =.088, respectively) by estrogen. Collagen types 1α1 and 1α2 mRNA increased 6.0- and 1.8-fold in the vaginal muscularis (P < .05 for both); collagen type Ia protein increased 9-fold in the muscularis (P = .012), whereas collagen III was not changed significantly. MMP-12 (human macrophage elastase) mRNA was suppressed in the vaginal mucosa from estrogen-treated participants (P = .011), and matrix metalloprotease-9 activity was decreased 6-fold in the mucosa and 4-fold in the muscularis (P = .02). Consistent with menopausal norms, serum estrone and 17β-estradiol were low and did not differ among the two groups. Conclusions: Vaginal estrogen application for 6

  16. Imaging Factors That Influence Surgical Margins After Preoperative 125I Radioactive Seed Localization of Breast Lesions: Comparison With Wire Localization

    PubMed Central

    Dryden, Mark J.; Dogan, Basak E.; Fox, Patricia; Wang, Cuiyan; Black, Dalliah M.; Hunt, Kelly; Yang, Wei Tse

    2016-01-01

    Objective The objective of this study was to compare the potential Influence of imaging variables on surgical margins after preoperative radioactive seed localization (RSL) and wire localization (WL) techniques. Materials and Methods A total of 565 women with 660 breast lesions underwent RSL or WL between May 16, 2012, and May 30, 2013. Patient age, lesion type (mass, calcifications, mass with associated calcifications, other), lesion size, number of seeds or wires used, surgical margin status (close positive or negative margins), and reexcision and mastectomy rates were recorded. Results Of 660 lesions, 127 (19%) underwent RSL and 533 (81%) underwent WL pre-operatively. Mean lesion size was 1.8 cm in the RSL group and 1.8 cm in the WL group (p = 0.35). No difference in lesion type was identified in the RSL and WL groups (p = 0.63). RSL with a single seed was used in 105 of 127 (83%) RSLs compared with WL with a single wire in 349 of 533 (65%) WLs (p = 0.0003). The number of cases with a close positive margin was similar for RSLs (26/127, 20%) and WLs (104/533, 20%) (p = 0.81). There was no difference between the RSL group and the WL group in close positive margin status (20% each, p = 0.81), reexcision rates (20% vs 16%, respectively; p = 0.36), or mastectomy rates (6% each, p = 0.96). Lesions containing calcifications were more likely to require more than one wire (odds ratio [OR], 4.44; 95% CI, 2.8–7.0) or more than one seed (OR, 7.03; 95% CI, 1.6–30.0) when compared with masses alone (p < 0.0001). Increasing lesion size and the presence of calcifications were significant predictors of positive margins, whereas the use of more than one wire or seed was not (OR, 0.9; 95% CI, 0.5–1.5) (p = 0.75). Conclusion Close positive margin, reexcision, and mastectomy rates remained similar in the WL group and RSL group. The presence of calcifications and increasing lesion size increased the odds of a close positive margin in both the WL and RSL groups, whereas the use

  17. Epidermal growth factor receptor as a predictor of tumor downstaging in locally advanced rectal cancer patients treated with preoperative chemoradiotherapy

    SciTech Connect

    Kim, Jun-Sang . E-mail: k423j@cnu.ac.kr; Kim, Jin-Man; Li, Shengjin; Yoon, Wan-Hee; Song, Kyu-Sang; Kim, Ki-Hwan; Yeo, Seung-Gu; Nam, Ji Sook; Cho, Moon-June

    2006-09-01

    Purpose: To examine retrospectively whether levels of epidermal growth factor receptor (EGFR) expression can predict tumor downstaging after preoperative chemoradiotherapy in patients with locally advanced rectal cancer. Methods and Materials: A total of 183 patients with rectal cancer (cT3-T4 or N+) were enrolled in this study. Preoperative chemoradiotherapy consisted of 50.4 Gy of pelvic radiation with concurrent 5-fluorouracil and leucovorin bolus intravenous chemotherapy in 94 patients or oral capecitabine and leucovorin in 89 patients. EGFR expression in pretreatment paraffin-embedded tumor biopsy specimens was assessed by immunohistochemistry. EGFR expression was determined from the intensity and extent of staining. Tumor downstaging was defined as a reduction of at least one T-stage level. Results: Tumor downstaging occurred in 97 patients (53%), and the tumors showed a pathologic complete response in 27 patients (15%). Positive EGFR expression was observed in 140 (76%) of 183 patients. EGFR expression levels were low in 113 patients (62%) and high in 70 patients (38%). On logistic regression analysis, the significant predictive factor for increased tumor downstaging was a low level of EGFR expression and preoperative chemotherapy using oral capecitabine (odds ratio, 0.437; p 0.012 vs. odds ratio, 3.235; p < 0.001, respectively). Conclusion: A high level of EGFR expression may be a significant predictive molecular marker for decreased tumor downstaging after preoperative chemoradiotherapy in locally advanced rectal cancer.

  18. Accurate localization of needle entry point in interventional MRI.

    PubMed

    Daanen, V; Coste, E; Sergent, G; Godart, F; Vasseur, C; Rousseau, J

    2000-10-01

    In interventional magnetic resonance imaging (MRI), the systems designed to help the surgeon during biopsy must provide accurate knowledge of the positions of the target and also the entry point of the needle on the skin of the patient. In some cases, this needle entry point can be outside the B(0) homogeneity area, where the distortions may be larger than a few millimeters. In that case, major correction for geometric deformation must be performed. Moreover, the use of markers to highlight the needle entry point is inaccurate. The aim of this study was to establish a three-dimensional coordinate correction according to the position of the entry point of the needle. We also describe a 2-degree of freedom electromechanical device that is used to determine the needle entry point on the patient's skin with a laser spot. PMID:11042649

  19. Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial

    PubMed Central

    FOxTROT Collaborative Group

    2012-01-01

    Summary Background Preoperative (neoadjuvant) chemotherapy and radiotherapy are more effective than similar postoperative treatment for oesophageal, gastric, and rectal cancers, perhaps because of more effective micrometastasis eradication and reduced risk of incomplete excision and tumour cell shedding during surgery. The FOxTROT trial aims to investigate the feasibility, safety, and efficacy of preoperative chemotherapy for colon cancer. Methods In the pilot stage of this randomised controlled trial, 150 patients with radiologically staged locally advanced (T3 with ≥5 mm invasion beyond the muscularis propria or T4) tumours from 35 UK centres were randomly assigned (2:1) to preoperative (three cycles of OxMdG [oxaliplatin 85 mg/m2, l-folinic acid 175 mg, fluorouracil 400 mg/m2 bolus, then 2400 mg/m2 by 46 h infusion] repeated at 2-weekly intervals followed by surgery and a further nine cycles of OxMdG) or standard postoperative chemotherapy (12 cycles of OxMdG). Patients with KRAS wild-type tumours were randomly assigned (1:1) to receive panitumumab (6 mg/kg; every 2 weeks with the first 6 weeks of chemotherapy) or not. Treatment allocation was through a central randomisation service using a minimised randomisation procedure including age, radiological T and N stage, site of tumour, and presence of defunctioning colostomy as stratification variables. Primary outcome measures of the pilot phase were feasibility, safety, and tolerance of preoperative therapy, and accuracy of radiological staging. Analysis was by intention to treat. This trial is registered, number ISRCTN 87163246. Findings 96% (95 of 99) of patients started and 89% (85 of 95) completed preoperative chemotherapy with grade 3–4 gastrointestinal toxicity in 7% (seven of 94) of patients. All 99 tumours in the preoperative group were resected, with no significant differences in postoperative morbidity between the preoperative and control groups: 14% (14 of 99) versus 12% (six of 51) had

  20. Simultaneous Multiple Preoperative Localizations of Small Pulmonary Lesions Using a Short Hook Wire and Suture System

    SciTech Connect

    Iguchi, Toshihiro Hiraki, Takao Gobara, Hideo Fujiwara, Hiroyasu Matsui, Yusuke; Sugimoto, Seiichiro Toyooka, Shinichi Oto, Takahiro Miyoshi, Shinichiro; Kanazawa, Susumu

    2015-08-15

    PurposeThe aim of the study was to retrospectively evaluate simultaneous multiple hook wire placement outcomes before video-assisted thoracoscopic surgery (VATS).Materials and MethodsThirty-eight procedures were performed on 35 patients (13 men and 22 women; mean age, 59.9 years) with 80 lung lesions (mean diameter 7.9 mm) who underwent simultaneous multiple hook wire placements for preoperative localizations. The primary endpoints were technical success, complications, procedure duration, and VATS outcome; secondary endpoints included comparisons between technical success rates, complication rates, and procedure durations of the 238 single-placement procedures performed. Complications were also evaluated.ResultsIn 35 procedures including 74 lesions, multiple hook wire placements were technically successful; in the remaining three procedures, the second target placement was aborted because of massive pneumothorax after the first placement. Although complications occurred in 34 procedures, no grade 3 or above adverse event was observed. The mean procedure duration was 36.4 ± 11.8 min. Three hook wires dislodged during patient transport to the surgical suite. Seventy-four successfully marked lesions were resected. Six lesions without hook wires were successfully resected after detection by palpation with an additional mini-thoracotomy or using subtle pleural changes as a guide. The complication rates and procedure durations of multiple-placement procedures were significantly higher (P = 0.04) and longer (P < 0.001) than those in the single-placement group, respectively, while the technical success rate was not significantly different (P = 0.051).ConclusionsSimultaneous multiple hook wire placements before VATS were clinically feasible, but increased the complication rate and lengthened the procedure time.

  1. Use of preoperative localization of adenomas of the parathyroid glands by thallium-technetium subtraction scintigraphy, high-resolution ultrasonography and computed tomography

    SciTech Connect

    Roses, D.F.; Sudarsky, L.A.; Sanger, J.; Raghavendra, B.N.; Reede, D.L.; Blum, M.

    1989-02-01

    Thirty-six patients with primary hyperparathyroidism were studied preoperatively by thallium-201 and technetium-99m pertechnetate subtraction (Tl-201/Tc-99m) scintigraphy, high-resolution real time ultrasonography and computed tomographic (CT) scanning. None of the patients had had previous surgical treatment of the parathyroid or thyroid glands. All of the patients underwent systematic bilateral exploration of the neck. All of the patients were successfully explored and 41 abnormal parathyroid glands were identified. Five patients had two adenomas. In six instances, adenomas were identified in ectopic anatomic sites. The sensitivity of correctly localizing the abnormal glands with these techniques was 49 per cent for the Tl-201/Tc-99m scintigraphy, 34 per cent for ultrasonography and 41 per cent for CT scanning. The Tl-201/Tc-99m scintigrams detected two of the six ectopically located adenomas, CT detected one, while ultrasound detected none. The five patients with multiple adenomas were not accurately identified as having multiple gland enlargement by any of these studies. Therefore, preoperative localization studies with these three techniques did not provide reliable information for initial bilateral exploration of the neck.

  2. A simplified technique for tumor localization using preoperative endoscopic clipping and radio-opaque markers during totally laparoscopic gastrectomy.

    PubMed

    Kim, Beom Su; Yook, Jeong Hwan; Kim, Byung Sik; Jung, Hwoon-Yong

    2014-12-01

    Tumor localization during intracorporeal anastomosis after totally laparoscopic distal gastrectomy (TLDG) is challenging. The aim of this study was to assess the simplicity and feasibility of locating tumors in the stomach using radio-opaque markers and preoperative endoscopic clipping. The intra- and postoperative findings of 29 patients who underwent TLDG with intracorporeal anastomosis between January 2012 and March 2013 were reviewed. Preoperative endoscopic clips were applied just proximal to the tumor by specialized endoscopists, and surgical gauze with an attached radio-opaque marker (3 mm × 60 mm) was prepared. The marker was fixed to either the anterior or posterior of the stomach, above the predicted site of the tumor, using suture ties. Portable abdominal radiography was used during the laparoscopic surgery, and the stomach was resected using guidance by the radiomarker. The radio-opaque marker and the endoscopic clips were clearly visible by intraoperative abdominal radiography. All patients received curative resection. No complications or deaths were encountered. The mean distance between the endoscopic clips and the radiomarker by portable intraoperative radiography was 21.3 ± 18.3 mm, whereas the actual in situ mean distance was 20.7 ± 17.6 mm. This difference was not statistically significant (P > 0.05). It is imperative that preoperative endoscopic clips are applied just proximal to the tumor by specialized endoscopists. The use of a radio-opaque marker is a simple and feasible way to locate tumors during totally laparoscopic gastrectomy. PMID:25513928

  3. Clinicopathological evaluation of pre-operative chemoradiotherapy with S-1 as a treatment for locally advanced oral squamous cell carcinoma

    PubMed Central

    KAWANO, SHINTARO; ZHENG, YANQUN; OOBU, KAZUNARI; MATSUBARA, RYOTA; GOTO, YUICHI; CHIKUI, TORU; YOSHITAKE, TADAMASA; KIYOSHIMA, TAMOTSU; JINNO, TEPPEI; MARUSE, YASUYUKI; MITATE, EIJI; KITAMURA, RYOJI; TANAKA, HIDEAKI; TOYOSHIMA, TAKESHI; SUGIURA, TSUYOSHI; NAKAMURA, SEIJI

    2016-01-01

    The administration of pre-operative chemotherapy with S-1 and concurrent radiotherapy at a total dose of 30 Gy was clinicopathologically evaluated as a treatment for locally advanced oral squamous cell carcinoma (OSCC) in the present study. The participants comprised 81 patients with OSCC, consisting of 29 patients with stage II disease, 12 patients with stage III disease and 40 patients with stage IV disease. All patients received a total radiation dose of 30 Gy in daily fractions of 2 Gy, 5 times a week, for 3 weeks, and the patients were concurrently administered S-1 at a dose of 80–120 mg, twice daily, over 4 consecutive weeks. Radical surgery was performed in all cases at 2–6 weeks subsequent to the end of pre-operative chemoradiotherapy. The most common adverse event was oropharyngeal mucositis, but this was transient in all patients. No severe hematological or non-hematological toxicities were observed. The clinical and histopathological response rates were 70.4 and 75.3%, respectively. Post-operatively, local failure developed in 6 patients (7.4%) and neck failure developed in 2 patients (2.5%). Distant metastases were found in 7 patients (8.6%). The overall survival rate, disease-specific survival rate and locoregional control rate at 5 years were 87.7, 89.9 and 90.6%, respectively. Locoregional recurrence occurred more frequently in patients that demonstrated a poor histopathological response compared with patients that demonstrated a good response (P<0.01). These results indicate that pre-operative S-1 chemotherapy with radiotherapy at a total dose of 30 Gy is feasible and effective for patients with locally advanced OSCC, and that little or no histopathological response may be a risk factor for locoregional recurrence in this treatment. PMID:27123119

  4. Minimally invasive radio-guided surgery for primary hyperparathyroidism: From preoperative to intraoperative localization imaging.

    PubMed

    Rubello, D; Kapse, N; Grassetto, G; Massaro, A; Al-Nahhas, A

    2010-12-01

    The introduction and successful implementation of minimally invasive radio-guided parathyroidectomy (MIRP) has revolutionized the surgical approach to remove parathyroid adenomas. A prerequisite for such success is an accurate localization of the offending adenoma. To achieve this goal, a multimodality approach is commonly employed using a combination of anatomical and functional imaging. Of the anatomical cross-sectional techniques, ultrasonography is the most widely available but is operator-dependent and has reduced sensitivity, specially in the presence of thyroid nodules. Similarly, computed tomography and magnetic resonance imaging have low sensitivities but provide value in detecting retrotracheal, retro-oesophageal and mediastinal adenomas. Functional imaging with ⁹⁹(m)Tc-Sestamibi is currently the most vital imaging procedure in this respect with variable protocols including dual-phase and dual isotope imaging. The sensitivity and specificity can improve by acquiring in single photon emission tomography (SPECT) mode and using co-registration with low dose CT to provide anatomical data (SPECT/CT). The current recommended approach is the combination of functional imaging with ⁹⁹(m)Tc-Sestamibi and high-resolution ultrasound (US), supplemented with intraoperative gamma probe in certain cases and quick persurgical measurement of parathyroid hormone. This review aims to explore the utility of various imaging modalities, alone and in combination, in detecting parathyroid adenoma and facilitating the current approach of MIRP. PMID:20846640

  5. Optimal time interval between capecitabine intake and radiotherapy in preoperative chemoradiation for locally advanced rectal cancer

    SciTech Connect

    Yu, Chang Sik; Kim, Tae Won; Kim, Jong Hoon . E-mail: jhkim2@amc.seoul.kr; Choi, Won Sik; Kim, Hee Cheol; Chang, Heung Moon; Ryu, Min Hee; Jang, Se Jin; Ahn, Seung Do; Lee, Sang-wook; Shin, Seong Soo; Choi, Eun Kyung; Kim, Jin Cheon

    2007-03-15

    Purpose: Capecitabine and its metabolites reach peak plasma concentrations 1 to 2 hours after a single oral administration, and concentrations rapidly decrease thereafter. We performed a retrospective analysis to find the optimal time interval between capecitabine administration and radiotherapy for rectal cancer. Methods and Materials: The time interval between capecitabine intake and radiotherapy was measured in patients who were treated with preoperative radiotherapy and concurrent capecitabine for rectal cancer. Patients were classified into the following groups. Group A1 included patients who took capecitabine 1 hour before radiotherapy, and Group B1 included all other patients. Group B1 was then subdivided into Group A2 (patients who took capecitabine 2 hours before radiotherapy) and Group B2. Group B2 was further divided into Group A3 and Group B3 with the same method. Total mesorectal excision was performed 6 weeks after completion of chemoradiation and the pathologic response was evaluated. Results: A total of 200 patients were enrolled in this study. Pathologic examination showed that Group A1 had higher rates of complete regression of primary tumors in the rectum (23.5% vs. 9.6%, p = 0.01), good response (44.7% vs. 25.2%, p = 0.006), and lower T stages (p = 0.021) compared with Group B1; however, Groups A2 and A3 did not show any improvement compared with Groups B2 and B3. Multivariate analysis showed that increases in primary tumors in the rectum and good response were only significant when capecitabine was administered 1 hour before radiotherapy. Conclusion: In preoperative chemoradiotherapy for rectal cancer, the pathologic response could be improved by administering capecitabine 1 hour before radiotherapy.

  6. Preoperative Chemoradiation With Cetuximab, Irinotecan, and Capecitabine in Patients With Locally Advanced Resectable Rectal Cancer: A Multicenter Phase II Study

    SciTech Connect

    Kim, Sun Young; Hong, Yong Sang; Kim, Dae Yong; Kim, Tae Won; Kim, Jee Hyun; Im, Seok Ah; Lee, Keun Seok; Yun, Tak; Jeong, Seung-Yong; Choi, Hyo Seong; Lim, Seok-Byung; Chang, Hee Jin; Jung, Kyung Hae

    2011-11-01

    Purpose: To evaluate the efficacy and safety of preoperative chemoradiation with cetuximab, irinotecan, and capecitabine in patients with rectal cancer. Methods and Materials: Forty patients with locally advanced, nonmetastatic, and mid- to lower rectal cancer were enrolled. Radiotherapy was delivered at a dose of 50.4 Gy/28 fractions. Concurrent chemotherapy consisted of an initial dose of cetuximab of 400 mg/m{sup 2} 1 week before radiotherapy, and then cetuximab 250 mg/m{sup 2}/week, irinotecan 40 mg/m{sup 2}/week for 5 consecutive weeks and capecitabine 1,650 mg/m{sup 2}/day for 5 days a week (weekdays only) from the first day during radiotherapy. Total mesorectal excision was performed within 6 {+-} 2 weeks. The pathologic responses and survival outcomes were evaluated as study endpoints, and an additional KRAS mutation analysis was performed. Results: In total, 39 patients completed their planned preoperative chemoradiation and underwent R0 resection. The pathologic complete response rate was 23.1% (9/39), and 3 patients (7.7%) showed near total regression of tumor. The 3-year disease-free and overall survival rates were 80.0% and 94.7%, respectively. Grade 3/4 toxicities included leukopenia (4, 10.3%), neutropenia (2, 5.1%), anemia (1, 2.6%), diarrhea (2, 5.1%), fatigue (1, 2.6%), skin rash (1, 2.6%), and ileus (1, 2.6%). KRAS mutations were found in 5 (13.2%) of 38 patients who had available tissue for testing. Clinical outcomes were not significantly correlated with KRAS mutation status. Conclusions: Preoperative chemoradiation with cetuximab, irinotecan, and capecitabine was active and well tolerated. KRAS mutation status was not a predictive factor for pathologic response in this study.

  7. Role of preoperative localization and intraoperative localization maneuvers including intraoperative PTH assay determination for patients with persistent or recurrent hyperparathyroidism.

    PubMed

    Alexander, H Richard; Chen, Clara C; Shawker, Thomas; Choyke, Peter; Chan, Teresa J; Chang, Richard; Marx, Stephen J

    2002-11-01

    Patients with recurrent or persistent primary hyperparathyroidism have increased operative risk because of scarring in the operative field and the frequent presence of an ectopic gland. Preoperative imaging studies will identify the hyperfunctioning parathyroid gland in the majority of circumstances. The best types or combination of imaging tests has not been definitely established. However, because of their wide availability and demonstrated sensitivity, US and sestamibi scans are most commonly obtained. Based on the clinical setting, additional tests including CT or MRI may be useful. In circumstances when the noninvasive imaging modalities are inconclusive, invasive imaging tests including selective angiography venous sampling and/or direct fine needle aspiration should be used. IOUS, MIRP, and intraoperative PTH determination are useful adjuncts to the safe and successful conduct of reoperative parathyroid surgery: however, the benefit of the routine use of these modalities in reoperative parathyroid surgery has yet to be critically determined. PMID:12412790

  8. Preoperative Intensity Modulated Radiation Therapy and Chemotherapy for Locally Advanced Vulvar Carcinoma: Analysis of Pattern of Relapse

    SciTech Connect

    Beriwal, Sushil; Shukla, Gaurav; Shinde, Ashwin; Heron, Dwight E.; Kelley, Joseph L.; Edwards, Robert P.; Sukumvanich, Paniti; Richards, Scott; Olawaiye, Alexander B.; Krivak, Thomas C.

    2013-04-01

    Purpose: To examine clinical outcomes and relapse patterns in locally advanced vulvar carcinoma treated using preoperative chemotherapy and intensity modulated radiation therapy (IMRT). Methods and Materials: Forty-two patients with stage I-IV{sub A} (stage I, n=3; stage II, n=13; stage III, n=23; stage IV{sub A}, n=3) vulvar cancer were treated with chemotherapy and IMRT via a modified Gynecological Oncology Group schema using 5-fluorouracil and cisplatin with twice-daily IMRT during the first and last weeks of treatment or weekly cisplatin with daily radiation therapy. Median dose of radiation was 46.4 Gy. Results: Thirty-three patients (78.6%) had surgery for resection of vulva; 13 of these patients also had inguinal lymph node dissection. Complete pathologic response was seen in 48.5% (n=16) of these patients. Of these, 15 had no recurrence at a median time of 26.5 months. Of the 17 patients with partial pathological response, 8 (47.1%) developed recurrence in the vulvar surgical site within a median of 8 (range, 5-34) months. No patient had grade ≥3 chronic gastrointestinal/genitourinary toxicity. Of those having surgery, 8 (24.2%) developed wound infections requiring debridement. Conclusions: Preoperative chemotherapy/IMRT was well tolerated, with good pathologic response and clinical outcome. The most common pattern of recurrence was local in patients with partial response, and strategies to increase pathologic response rate with increasing dose or adding different chemotherapy need to be explored to help further improve outcomes.

  9. Transfissural Route Used for Preoperative Localization of Small Pulmonary Lesions with a Short Hook Wire and Suture System

    SciTech Connect

    Iguchi, Toshihiro Hiraki, Takao Gobara, Hideo Fujiwara, Hiroyasu Matsui, Yusuke; Sugimoto, Seiichiro Toyooka, Shinichi Oto, Takahiro Miyoshi, Shinichiro; Kanazawa, Susumu

    2015-02-15

    PurposeWe retrospectively evaluated the results of the transfissural route for preoperative localization with a short hook wire and suture system for video-assisted thoracoscopic surgery (VATS).MethodsEleven patients with 11 tumors underwent CT-guided transfissural placement of a hook wire before VATS. This route was selected for all patients, because the distance between the tumor and interlobar fissure was much shorter than the required distance traversed using the conventional approach. Complications were evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0.ResultsThe hook wire was successfully placed using the transfissural route in all but one case. Of these ten successful placements, two tumors needed a second puncture for optimal placement, because the CT scan showed that the first hook wire was not properly placed in the lung. In one patient, we did not attempt replacement after the first placement was incorrect. In ten successful procedures, the mean distance traversed in the parenchyma of the unaffected lung lobe was 27.9 mm. The distance between the pleura and placed hook wire was significantly shorter than the estimated distance between the pleura and hook wire using the conventional route (mean 16.3 vs. 40.9 mm; P = 0.0002). Grade 1 adverse events occurred (11 pneumothoraxes and 4 pulmonary hemorrhages). No grade 2 or higher adverse event was observed.ConclusionsThe transfissural route used for preoperative localization before VATS is useful for selected patients because this route may allow for more limited lung parenchyma resection.

  10. Phase I Study of Preoperative Chemoradiation With S-1 and Oxaliplatin in Patients With Locally Advanced Resectable Rectal Cancer

    SciTech Connect

    Hong, Yong Sang; Lee, Jae-Lyun; Park, Jin Hong; Kim, Jong Hoon; Yoon, Sang Nam; Lim, Seok-Byung; Yu, Chang Sik; Kim, Mi-Jung; Jang, Se-Jin; Lee, Jung Shin; Kim, Jin Cheon; Kim, Tae Won

    2011-03-01

    Purpose: To perform a Phase I study of preoperative chemoradiation (CRT) with S-1, a novel oral fluoropyrimidine, plus oxaliplatin in patients with locally advanced rectal cancer, to determine the maximum tolerated dose and the recommended dose. Methods and Materials: Radiotherapy was delivered to a total of 45 Gy in 25 fractions and followed by a coned-down boost of 5.4 Gy in 3 fractions. Concurrent chemotherapy consisted of a fixed dose of oxaliplatin (50 mg/m{sup 2}/week) on Days 1, 8, 22, and 29 and escalated doses of S-1 on Days 1-14 and 22-35. The initial dose of S-1 was 50 mg/m{sup 2}/day, gradually increasing to 60, 70, and 80 mg/m{sup 2}/day. Surgery was performed within 6 {+-} 2 weeks. Results: Twelve patients were enrolled and tolerated up to Dose Level 4 (3 patients at each dose level) without dose-limiting toxicity. An additional 3 patients were enrolled at Dose Level 4, with 1 experiencing a dose-limiting toxicity of Grade 3 diarrhea. Although maximum tolerated dose was not attained, Dose Level 4 (S-1 80 mg/m{sup 2}/day) was chosen as the recommended dose for further Phase II studies. No Grade 4 toxicity was observed, and Grade 3 toxicities of leukopenia and diarrhea occurred in the same patient (1 of 15, 6.7%). Pathologic complete responses were observed in 2 of 15 patients (13.3%). Conclusions: The recommended dose of S-1 was determined to be 80 mg/m{sup 2}/day when combined with oxaliplatin in preoperative CRT, and a Phase II trial is now ongoing.

  11. Accurate TOA-Based UWB Localization System in Coal Mine Based on WSN

    NASA Astrophysics Data System (ADS)

    Cheng, Guangliang

    Over the last years, there has been a great deal of interest in Ultra Wideband (UWB) wireless communication and Wireless Sensor Networks(WSN), especially following the proposing of the internet of things by the MIT (Massachusetts Institute of Technology) in 1999, hich is also result in an increasing research on UWB and WSN applications. This article mainly introduced the accurate UWB Localization System based on WSN in coal mine. Firstly, we briefly introduced UWB and WSN Localization technology. Secondly, the advantages and disadvantages of the previous personnel localization technology in coal mine was analyzed and contrasted, and then the suitable personnel localization system in coal mine based on UWB signal and TOA estimate positioning scheme are presented. At last the rationality and feasibility of this scheme was proved through the simulation results.

  12. A localized basis that allows fast and accurate second order Moller-Plesset calculations

    SciTech Connect

    Subotnik, Joseph E.; Head-Gordon, Martin

    2004-10-27

    We present a method for computing a basis of localized orthonormal orbitals (both occupied and virtual), in whose representation the Fock matrix is extremely diagonal-dominant. The existence of these orbitals is shown empirically to be sufficient for achieving highly accurate MP@ energies, calculated according to Kapuy's method. This method (which we abbreviate KMP2), which involves a different partitioning of the n-electron Hamiltonian, scales at most quadratically with potential for linearity in the number of electrons. As such, we believe the KMP2 algorithm presented here could be the basis of a viable approach to local correlation calculations.

  13. Primary Tumor Necrosis Predicts Distant Control in Locally Advanced Soft-Tissue Sarcomas After Preoperative Concurrent Chemoradiotherapy

    SciTech Connect

    MacDermed, Dhara M.; Miller, Luke L.; Peabody, Terrance D.; Simon, Michael A.; Luu, Hue H.; Haydon, Rex C.; Montag, Anthony G.; Undevia, Samir D.

    2010-03-15

    Purpose: Various neoadjuvant approaches have been evaluated for the treatment of locally advanced soft-tissue sarcomas. This retrospective study describes a uniquely modified version of the Eilber regimen developed at the University of Chicago. Methods and Materials: We treated 34 patients (28 Stage III and 6 Stage IV) with locally advanced soft-tissue sarcomas of an extremity between 1995 and 2008. All patients received preoperative therapy including ifosfamide (2.5 g/m2 per day for 5 days) with concurrent radiation (28 Gy in 3.5-Gy daily fractions), sandwiched between various chemotherapy regimens. Postoperatively, 47% received further adjuvant chemotherapy. Results: Most tumors (94%) were Grade 3, and all were T2b, with a median size of 10.3 cm. Wide excision was performed in 29 patients (85%), and 5 required amputation. Of the resected tumor specimens, 50% exhibited high (>=90%) treatment-induced necrosis and 11.8% had a complete pathologic response. Surgical margins were negative in all patients. The 5-year survival rate was 42.3% for all patients and 45.2% for Stage III patients. For limb-preservation patients, the 5-year local control rate was 89.0% and reoperation was required for wound complications in 17.2%. The 5-year freedom-from-distant metastasis rate was 53.4% (Stage IV patients excluded), and freedom from distant metastasis was superior if treatment-induced tumor necrosis was 90% or greater (84.6% vs. 19.9%, p = 0.02). Conclusions: This well-tolerated concurrent chemoradiotherapy approach yields excellent rates of limb preservation and local control. The resulting treatment-induced necrosis rates are predictive of subsequent metastatic risk, and this information may provide an opportunity to guide postoperative systemic therapies.

  14. [Strategies for preoperative downsizing in patients with local nonresectable pancreatic cancer].

    PubMed

    Combs, S E; Habermehl, D; Werner, J; Büchler, M W; Debus, J

    2011-11-01

    In about 30-40% of all patients with pancreatic cancer a locally advanced lesion without distant metastases is found at primary diagnosis and the tumor is mostly nonresectable due to the close vicinity to blood vessels. Neoadjuvant treatment strategies, such as neoadjuvant radiochemotherapy offer the possibility to achieve substantial tumor reduction so that secondary resectability can be achieved. Therefore, treatment decisions should be made in an interdisciplinary context. In the future, innovative study protocols as well as novel radiation modalities, such as carbon ions can open new horizons in the treatment of this patient population. Additionally, molecular markers may help to stratify patients for different treatment schedules. PMID:22008845

  15. [Two Cases of Curative Resection of Locally Advanced Rectal Cancer after Preoperative Chemotherapy].

    PubMed

    Mitsuhashi, Noboru; Shimizu, Yoshiaki; Kuboki, Satoshi; Yoshitomi, Hideyuki; Kato, Atsushi; Ohtsuka, Masayuki; Shimizu, Hiroaki; Miyazaki, Masaru

    2015-11-01

    Reports of conversion in cases of locally advanced colorectal cancer have been increasing. Here, we present 2 cases in which curative resection of locally advanced rectal cancer accompanied by intestinal obstruction was achieved after establishing a stoma and administering chemotherapy. The first case was of a 46-year-old male patient diagnosed with upper rectal cancer and intestinal obstruction. Because of a high level of retroperitoneal invasion, after establishing a sigmoid colostomy, 13 courses of mFOLFOX6 plus Pmab were administered. Around 6 months after the initial surgery, low anterior resection for rectal cancer and surgery to close the stoma were performed. Fourteen days after curative resection, the patient was discharged from the hospital. The second case was of a 66-year-old male patient with a circumferential tumor extending from Rs to R, accompanied by right ureter infiltration and sub-intestinal obstruction. After establishing a sigmoid colostomy, 11 courses of mFOLFOX6 plus Pmab were administered. Five months after the initial surgery, anterior resection of the rectum and surgery to close the stoma were performed. Twenty days after curative resection, the patient was released from the hospital. No recurrences have been detected in either case. PMID:26805302

  16. Bevacizumab in the pre-operative treatment of locally advanced rectal cancer: A systematic review

    PubMed Central

    Fornaro, Lorenzo; Caparello, Chiara; Vivaldi, Caterina; Rotella, Virginia; Musettini, Gianna; Falcone, Alfredo; Baldini, Editta; Masi, Gianluca

    2014-01-01

    Despite advances in the management of patients with locally advanced, non-metastatic rectal adenocarcinoma (LARC), prognosis remains largely unsatisfactory due to a high rate of distant relapse. In fact, currently available neoadjuvant protocols, represented by fluoropyrimidine-based chemo-radiotherapy (CT-RT) or short-course RT, together with improved surgical techniques, have largely reduced the risk of local relapse, with limited impact on distant recurrence. Available results of phase III trials with additional cytotoxic agents combined with standard CT-RT are disappointing, as no significant reduction in the risk of recurrence has been demonstrated. In order to improve the control of micrometastatic disease, integrating targeted agents into neoadjuvant treatment protocols thus offers a rational approach. In particular, the antiangiogenic agent bevacizumab has demonstrated synergistic activity with both CT and RT in pre-clinical and clinical models, and thus may represent a suitable companion in the neoadjuvant treatment of LARC. Preliminary results of phase I-II clinical studies are promising and suggest potential clinical parameters and molecular predictive biomarkers useful for patient selection: treatment personalization is indeed the key in order to maximize the benefit while reducing the risk of more complex neoadjuvant treatment schedules. PMID:24876730

  17. A case of successful preoperative chemotherapy with cisplatin and irinotecan followed by curative-intent surgery for locally advanced thymic carcinoma.

    PubMed

    Suzuki, Shigeki; Horio, Hirotoshi; Hato, Tai; Harada, Masahiko; Okuma, Yusuke; Hishima, Tsunekazu

    2013-03-01

    The optimal chemotherapy for thymic carcinoma has yet to be determined based on clinical evidence because of the rarity of this pathological entity. We report the case of a patient with locally advanced thymic carcinoma in whom radical excision was achieved with intensive preoperative chemotherapy followed by curative-intent surgery. A 59-year-old woman was diagnosed with Masaoka-Koga stage III thymic cancer showing squamous cell carcinoma histology. Invasion to the ascending aorta and left brachiocephalic vein was suspected from imaging, so preoperative chemotherapy with three cycles of cisplatin and irinotecan was administered. Partial response to chemotherapy was achieved and the residual tumor was completely resected with subsequent surgery. Histopathological examination of the resected specimen demonstrated stage II thymic carcinoma. The patient has shown no evidence of recurrence or surgical complications as of 46 months after completing preoperative chemotherapy. PMID:22760255

  18. An in vivo evaluation of the change in the pulpal oxygen saturation after administration of preoperative anxiolytics and local anesthesia.

    PubMed

    P Shetty, Krishna; V Satish, Sarvepalli; Kilaru, Krishnarao; Chakravarthi Ponangi, Kalyana; M Luke, Alexander; Neshangi, Srisha

    2016-01-01

    Background. Given the influence of systemic blood pressure on pulpal blood flow, anxiolytics prescribed may alter the pulpal blood flow along with the local anesthetic solution containing a vasoconstrictor. This study evaluated the impact of preoperative anxiolytics and vasoconstrictors in local anesthetic agents on pulpal oxygen saturation. Methods. Thirty anxious young healthy individuals with a mean age of 24 years were randomly selected using the Corah's Dental Anxiety Scale (DAS). After checking the vital signs the initial pulpal oxygen saturation (initial SpO2) was measured using a pulse oximeter. Oral midzolam was administered at a dose of 7.5 mg. After 30 min, the vital signs were monitored and the pulpal oxygen saturation (anxiolytic SpO2) was measured. A total of 1.5 mL of 2% lidocaine with 1:200000 epinephrine was administered as buccal infiltration anesthesia and 10 min the final pulpal oxygen saturation (L.A SpO2) was measured. Results. The mean initial (SpO2) was 96.37% which significantly decreased to 90.76% (SpO2) after the administration of the anxiolytic agent. This drop was later accentuated to 85.17% (SpO2) after administration of local anesthetic solution. Statistical significance was set at P<0.0001. Conclusion. High concentrations of irritants may permeate dentin due to a considerable decrease in the pulpal blood flow from crown or cavity preparation. Therefore, maintaining optimal blood flow during restorative procedures may prevent pulpal injury. PMID:27092212

  19. An in vivo evaluation of the change in the pulpal oxygen saturation after administration of preoperative anxiolytics and local anesthesia

    PubMed Central

    P. Shetty, Krishna; V. Satish, Sarvepalli; Kilaru, Krishnarao; Chakravarthi Ponangi, Kalyana; M. Luke, Alexander; Neshangi, Srisha

    2016-01-01

    Background. Given the influence of systemic blood pressure on pulpal blood flow, anxiolytics prescribed may alter the pulpal blood flow along with the local anesthetic solution containing a vasoconstrictor. This study evaluated the impact of preoperative anxiolytics and vasoconstrictors in local anesthetic agents on pulpal oxygen saturation. Methods. Thirty anxious young healthy individuals with a mean age of 24 years were randomly selected using the Corah’s Dental Anxiety Scale (DAS). After checking the vital signs the initial pulpal oxygen saturation (initial SpO2) was measured using a pulse oximeter. Oral midzolam was administered at a dose of 7.5 mg. After 30 min, the vital signs were monitored and the pulpal oxygen saturation (anxiolytic SpO2) was measured. A total of 1.5 mL of 2% lidocaine with 1:200000 epinephrine was administered as buccal infiltration anesthesia and 10 min the final pulpal oxygen saturation (L.A SpO2) was measured. Results. The mean initial (SpO2) was 96.37% which significantly decreased to 90.76% (SpO2) after the administration of the anxiolytic agent. This drop was later accentuated to 85.17% (SpO2) after administration of local anesthetic solution. Statistical significance was set at P<0.0001. Conclusion. High concentrations of irritants may permeate dentin due to a considerable decrease in the pulpal blood flow from crown or cavity preparation. Therefore, maintaining optimal blood flow during restorative procedures may prevent pulpal injury. PMID:27092212

  20. Accurate Energies and Orbital Description in Semi-Local Kohn-Sham DFT

    NASA Astrophysics Data System (ADS)

    Lindmaa, Alexander; Kuemmel, Stephan; Armiento, Rickard

    2015-03-01

    We present our progress on a scheme in semi-local Kohn-Sham density-functional theory (KS-DFT) for improving the orbital description while still retaining the level of accuracy of the usual semi-local exchange-correlation (xc) functionals. DFT is a widely used tool for first-principles calculations of properties of materials. A given task normally requires a balance of accuracy and computational cost, which is well achieved with semi-local DFT. However, commonly used semi-local xc functionals have important shortcomings which often can be attributed to features of the corresponding xc potential. One shortcoming is an overly delocalized representation of localized orbitals. Recently a semi-local GGA-type xc functional was constructed to address these issues, however, it has the trade-off of lower accuracy of the total energy. We discuss the source of this error in terms of a surplus energy contribution in the functional that needs to be accounted for, and offer a remedy for this issue which formally stays within KS-DFT, and, which does not harshly increase the computational effort. The end result is a scheme that combines accurate total energies (e.g., relaxed geometries) with an improved orbital description (e.g., improved band structure).

  1. Distributed Pedestrian Detection Alerts Based on Data Fusion with Accurate Localization

    PubMed Central

    García, Fernando; Jiménez, Felipe; Anaya, José Javier; Armingol, José María; Naranjo, José Eugenio; de la Escalera, Arturo

    2013-01-01

    Among Advanced Driver Assistance Systems (ADAS) pedestrian detection is a common issue due to the vulnerability of pedestrians in the event of accidents. In the present work, a novel approach for pedestrian detection based on data fusion is presented. Data fusion helps to overcome the limitations inherent to each detection system (computer vision and laser scanner) and provides accurate and trustable tracking of any pedestrian movement. The application is complemented by an efficient communication protocol, able to alert vehicles in the surroundings by a fast and reliable communication. The combination of a powerful location, based on a GPS with inertial measurement, and accurate obstacle localization based on data fusion has allowed locating the detected pedestrians with high accuracy. Tests proved the viability of the detection system and the efficiency of the communication, even at long distances. By the use of the alert communication, dangerous situations such as occlusions or misdetections can be avoided. PMID:24008284

  2. Distributed pedestrian detection alerts based on data fusion with accurate localization.

    PubMed

    García, Fernando; Jiménez, Felipe; Anaya, José Javier; Armingol, José María; Naranjo, José Eugenio; de la Escalera, Arturo

    2013-01-01

    Among Advanced Driver Assistance Systems (ADAS) pedestrian detection is a common issue due to the vulnerability of pedestrians in the event of accidents. In the present work, a novel approach for pedestrian detection based on data fusion is presented. Data fusion helps to overcome the limitations inherent to each detection system (computer vision and laser scanner) and provides accurate and trustable tracking of any pedestrian movement. The application is complemented by an efficient communication protocol, able to alert vehicles in the surroundings by a fast and reliable communication. The combination of a powerful location, based on a GPS with inertial measurement, and accurate obstacle localization based on data fusion has allowed locating the detected pedestrians with high accuracy. Tests proved the viability of the detection system and the efficiency of the communication, even at long distances. By the use of the alert communication, dangerous situations such as occlusions or misdetections can be avoided. PMID:24008284

  3. Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision.

    PubMed

    Zuo, Zhi-Gui; Zhang, Xiu-Feng; Wang, Hao; Liu, Qi-Zhi; Ye, Xing-Zhao; Xu, Chang; Wu, Xiang-Bin; Cai, Jian-Hui; Zhou, Zhen-Hua; Li, Jin-Lei; Song, Hua-Yu; Luo, Zu-Qiang; Li, Peng; Ni, Shi-Chang; Jiang, Lei

    2016-03-01

    Although the absolute number of positive lymph nodes (LNs) has been established as 1 of the most important prognostic factors in rectal cancers, many researchers have proposed that the lymph node ratio (LNR) may have better predicted outcomes. We conducted a retrospective study to compare the predictive ability of LNR and ypN category in rectal cancer.A total of 264 locally advanced rectal cancer (LARC) patients who underwent preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) between 2005 and 2012 were reviewed. All patients were categorized into 3 groups or patients with metastatic LNs were categorized into 2 groups according to the LNR. The prognostic effect on overall survival (OS) and disease-free survival (DFS) was evaluated.With a median follow-up of 45 months, the OS and DFS were 68.4% and 59.3% for the entire cohort, respectively. The respective 5-year OS and DFS rates for the 3 groups (LNR = 0, 0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were as follows: 83.2%, 72.6%, and 49.4% (P < 0.001) and 79.5%, 57.3%, and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that LNR and differentiation, but not the number of positive LNs, had independent prognostic value for OS (hazard ratio [HR] = 2.328, 95% confidence interval [CI]: 1.850-4.526, P < 0.001) and DFS (HR = 3.004, 95% CI: 1.616-5.980, P < 0.001). As for patients with positive LNs, the respective 5-year OS and DFS rates for the 2 groups (0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were 72.6% and 49.4% (P < 0.001) and 57.3% and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that only LNR was an independent factor for OS (HR = 3.214, 95% CI: 1.726-5.986, P < 0.001) and DFS (HR = 4.230, 95% CI: 1.825-6.458, P < 0.001). Subgroups analysis demonstrated that the ypN category had no impact on survival whereas increased LNR was a significantly prognostic indicator for worse survival in the LNs

  4. Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision

    PubMed Central

    Zuo, Zhi-Gui; Zhang, Xiu-Feng; Wang, Hao; Liu, Qi-Zhi; Ye, Xing-Zhao; Xu, Chang; Wu, Xiang-Bin; Cai, Jian-Hui; Zhou, Zhen-Hua; Li, Jin-Lei; Song, Hua-Yu; Luo, Zu-Qiang; Li, Peng; Ni, Shi-Chang; Jiang, Lei

    2016-01-01

    Abstract Although the absolute number of positive lymph nodes (LNs) has been established as 1 of the most important prognostic factors in rectal cancers, many researchers have proposed that the lymph node ratio (LNR) may have better predicted outcomes. We conducted a retrospective study to compare the predictive ability of LNR and ypN category in rectal cancer. A total of 264 locally advanced rectal cancer (LARC) patients who underwent preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) between 2005 and 2012 were reviewed. All patients were categorized into 3 groups or patients with metastatic LNs were categorized into 2 groups according to the LNR. The prognostic effect on overall survival (OS) and disease-free survival (DFS) was evaluated. With a median follow-up of 45 months, the OS and DFS were 68.4% and 59.3% for the entire cohort, respectively. The respective 5-year OS and DFS rates for the 3 groups (LNR = 0, 0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were as follows: 83.2%, 72.6%, and 49.4% (P < 0.001) and 79.5%, 57.3%, and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that LNR and differentiation, but not the number of positive LNs, had independent prognostic value for OS (hazard ratio [HR] = 2.328, 95% confidence interval [CI]: 1.850–4.526, P < 0.001) and DFS (HR = 3.004, 95% CI: 1.616–5.980, P < 0.001). As for patients with positive LNs, the respective 5-year OS and DFS rates for the 2 groups (0 < LNR ≤ 0.20, and 0.20 < LNR ≤ 1.0) were 72.6% and 49.4% (P < 0.001) and 57.3% and 33.5% (P < 0.001), respectively. Multivariate analysis revealed that only LNR was an independent factor for OS (HR = 3.214, 95% CI: 1.726–5.986, P < 0.001) and DFS (HR = 4.230, 95% CI: 1.825–6.458, P < 0.001). Subgroups analysis demonstrated that the ypN category had no impact on survival whereas increased LNR was a significantly prognostic indicator for worse

  5. Preoperative Capecitabine and Pelvic Radiation in Locally Advanced Rectal Cancer-Is it Equivalent to 5-FU Infusion Plus Leucovorin and Radiotherapy?

    SciTech Connect

    Chan, Alexander K.; Wong, Alfred O.; Jenken, Daryl A.

    2010-04-15

    Purpose: The aim of this retrospective case-matching study was to compare the treatment outcomes and acute toxicity of preoperative radiotherapy (RT) with capecitabine vs. preoperative RT with intermittent 5-fluorouracil (5-FU) infusion, leucovorin, and mitomycin C in rectal cancer. Methods and Materials: We matched 34 patients who were treated with preoperative concurrent capecitabine and 50 Gy of RT by their clinical T stage (T3 or T4) and the tumor location (<=7 cm or >7 cm from the anal verge) with another 68 patients who were treated with preoperative intermittent 5-FU infusion, leucovorin, mitomycin C, and 50 Gy of RT for a comparison of the pathologic tumor response, local control, distant failure, and survival rates. Results: The pathologic complete response rate was 21% with capecitabine and 18% with 5-FU and leucovorin (p = 0.72). The rate of T downstaging after chemoradiation was 59% for both groups. The rate of sphincter-sparing resection was 38% after capecitabine plus RT and 43% after 5-FU plus RT (p = 0.67). At 3 years, there was no significant difference in the local control rate (93% for capecitabine and 92% for 5-FU and leucovorin), relapse-free rate (74% for capecitabine and 73% for 5-FU and leucovorin), or disease-specific survival rate (86% for capecitabine and 77% for 5-FU and leucovorin). The acute toxicity profile was comparable, with little Grade 3 and 4 toxicity. Conclusions: When administered with concurrent preoperative RT, both capecitabine and intermittent 5-FU infusion with leucovorin modulation provided comparable pathologic tumor response, local control, relapse-free survival, and disease-specific survival rates in rectal cancer.

  6. Near-infrared phase cancellation instrument for fast and accurate localization of fluorescent heterogeneity

    NASA Astrophysics Data System (ADS)

    Chen, Yu; Mu, Chenpeng; Intes, Xavier; Blessington, Dana; Chance, Britton

    2003-07-01

    Near-infrared (NIR) diffuse optical imaging has become a promising method for noninvasive in vivo detection of breast cancer with intrinsic chromophores. Recent developments in molecular specific targeting fluorescent contrast agents offer high tumor to normal tissue contrast, and are capable of selectively labeling various precancer/cancer signatures, thus enhancing both the sensitivity and specificity of cancer detection. To detect a subsurface tumor labeled by fluorescent contrast agents, we have developed a phase cancellation imaging system for fast localization of fluorescent object embedded several centimeters deep inside the turbid media. The instrument is a frequency domain (50 MHz) phase modulation system with dual out-of-phase sources. The excitation wavelength is 780 nm and the fluorescence photons are collected through an 830±10 nm band-pass filter. Localization of fluorescent objects inside the scattering media is accurate using a phase cancellation device. The localization error for a 5 mm diameter sphere filled with 1 nanomole fluorescent dye and 3 cm deep inside the turbid media is about 2 mm. The accuracy of the localization suggests that this system could be helpful in guiding clinical fine-needle biopsy, and would benefit the early detection of breast tumors.

  7. Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: A multicentric phase II study

    SciTech Connect

    Valentini, Vincenzo . E-mail: vvalentini@rm.unicatt.it; Morganti, Alessio G.; Gambacorta, M. Antonietta; Mohiuddin, Mohammed; Doglietto, G. Battista; Coco, Claudio; De Paoli, Antonino; Rossi, Carlo; Di Russo, Annamaria; Valvo, Francesca; Bolzicco, Giampaolo; Dalla Palma, Maurizio

    2006-03-15

    Purpose: The combination of irradiation and total mesorectal excision for rectal carcinoma has significantly lowered the incidence of local recurrence. However, a new problem is represented by the patient with locally recurrent cancer who has received previous irradiation to the pelvis. In these patients, local recurrence is very often not easily resectable and reirradiation is expected to be associated with a high risk of late toxicity. The aim of this multicenter phase II study is to evaluate the response rate, resectability rate, local control, and treatment-related toxicity of preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis. Methods and Materials: Patients with histologically proven pelvic recurrence of rectal carcinoma, with the absence of extrapelvic disease or bony involvement and previous pelvic irradiation with doses {<=}55 Gy; age {>=}18 years; performance status (PS) (Karnofsky) {>=}60, and who gave institutional review board-approved written informed consent were treated by preoperative chemoradiation. Radiotherapy was delivered to a planning target volume (PTV2) including the gross tumor volume (GTV) plus a 4-cm margin, with a dose of 30 Gy (1.2 Gy twice daily with a minimum 6-h interval). A boost was delivered, with the same fractionation schedule, to a PTV1 including the GTV plus a 2-cm margin (10.8 Gy). During the radiation treatment, concurrent chemotherapy was delivered (5-fluorouracil, protracted intravenous infusion, 225 mg/m{sup 2}/day, 7 days per week). Four to 6 weeks after the end of chemoradiation, patients were evaluated for tumor resectability, and, when feasible, surgical resection of recurrence was performed between 6-8 weeks from the end of chemoradiation. Adjuvant chemotherapy was prescribed to all patients, using Raltitrexed, 3 mg/square meter (sm), every 3 weeks, for a total of 5 cycles. Patients were staged using the computed tomography (CT)-based F

  8. Accurate localization of in-body medical implants based on spatial sparsity.

    PubMed

    Pourhomayoun, Mohammad; Jin, Zhanpeng; Fowler, Mark L

    2014-02-01

    Wearable and implantable wireless communication devices have in recent years gained increasing attention for medical diagnostics and therapeutics. In particular, wireless capsule endoscopy has become a popular method to visualize and diagnose the human gastrointestinal tract. Estimating the exact position of the capsule when each image is taken is a very critical issue in capsule endoscopy. Several approaches have been developed by researchers to estimate the capsule location. However, some unique challenges exist for in-body localization, such as the severe multipath issue caused by the boundaries of different organs, inconsistency of signal propagation velocity and path loss parameters inside the human body, and the regulatory restrictions on using high-bandwidth or high-power signals. In this paper, we propose a novel localization method based on spatial sparsity. We directly estimate the location of the capsule without going through the usual intermediate stage of first estimating time-of-arrival or received-signal strength, and then a second stage of estimating the location. We demonstrate the accuracy of the proposed method through extensive Monte Carlo simulations for radio frequency emission signals within the required power and bandwidth range. The results show that the proposed method is effective and accurate, even in massive multipath conditions. PMID:24108709

  9. An Effective Preoperative Three-Dimensional Radiotherapy Target Volume for Extremity Soft Tissue Sarcoma and the Effect of Margin Width on Local Control

    SciTech Connect

    Kim, Bo Kyong; Chen, Yen-Lin E.; Kirsch, David G.; Goldberg, Saveli I.; Kobayashi, Wendy; Kung, Jong Hyun; Wolfgang, John A.; Doppke, Karen

    2010-07-01

    Purpose: There is little information on the appropriate three-dimensional (3D) preoperative radiotherapy (XRT) volume for extremity soft-tissue sarcomas (STS). We retrospectively analyzed the pattern of local failure (LF) to help elucidate optimal field design. Methods and Materials: We analyzed the 56 patients who underwent computed tomography-planned XRT for Stage I to III extremity STS between June 2000 and December 2006. Clinical target volume (CTV) included the T1 post-gadolinium-defined gross tumor volume with 1- to 1.5-cm radial and 3.5-cm longitudinal margins. Planning target volume expansion was 5 to 7 mm, and {>=}95% of dose was delivered to the planning target volume. Preoperative XRT was 44 to 50.4 Gy (median, 50). Postoperative boost of 10 to 20 Gy was given to 12 patients (6 with positive and 6 with close margins). Results: Follow-up ranged from 15 to 76 months (median, 41 months). The 5-year local control, freedom from distant metastasis, disease-free survival, and overall survival were 88.5%, 80.0%, 77.5% and 82.8%, respectively. Three patients (all with positive margin) experienced local failure (LF) as first relapse (2 isolated, 1 with distant failure), and 2 additional patients (all with margin<1 mm) had late LF after distant metastasis. The LFs were within the CTV in 3 patients and within and also extending beyond the CTV in 2 patients. Conclusions: These target volume definitions appear to be appropriate for most patients. No local recurrences were observed with surgical margins {>=}1 mm, and it appears that these may be adequate for patients with extremity STS treated with preoperative radiotherapy.

  10. Matrix metalloproteinase-9 expression correlated with tumor response in patients with locally advanced rectal cancer undergoing preoperative chemoradiotherapy

    SciTech Connect

    Unsal, Diclehan . E-mail: diclehan@yahoo.com; Uner, Aytug; Akyurek, Nalan; Erpolat, Petek; Dursun, Ayse; Pak, Yucel

    2007-01-01

    Purpose: To analyze whether the expression of matrix metalloproteinases (MMPs) and their tissue inhibitors are associated with tumor response to preoperative chemoradiotherapy in rectal cancer patients. Methods and Materials: Forty-four patients who had undergone preoperative chemoradiotherapy were evaluated retrospectively. Treatment consisted of pelvic radiotherapy and two cycles of 5-fluorouracil plus leucovorin. Surgery was performed 6-8 weeks later. MMP-2, MMP-9, and tissue inhibitors of metalloproteinase-1 and -2 expression was analyzed by immunohistochemistry of the preradiation biopsy and surgical specimens. The intensity and extent of staining were evaluated separately, and a final score was calculated by multiplying the two scores. The primary endpoint was the correlation of expression with tumor response, with the secondary endpoint the effect of chemoradiotherapy on the expression. Results: Preoperative treatment resulted in downstaging in 20 patients (45%) and no clinical response in 24 (55%). The pathologic tumor response was complete in 11 patients (25%), partial in 23 (52%), and none in 10 (23%). Positive MMP-9 staining was observed in 20 tumors (45%) and was associated with the clinical nodal stage (p = 0.035) and the pathologic and clinical response (p < 0.0001). The staining status of the other markers was associated with neither stage nor response. The overall pathologic response rate was 25% in MMP-9-positive patients vs. 52% in MMP-9-negative patients (p = 0.001). None of the 11 patients with pathologic complete remission was MMP-9 positive. Conclusions: Matrix metalloproteinase-9 expression correlated with a poor tumor response to preoperative chemoradiotherapy in rectal carcinoma patients.

  11. Accurate moving cast shadow suppression based on local color constancy detection.

    PubMed

    Amato, Ariel; Mozerov, Mikhail G; Bagdanov, Andrew D; Gonzàlez, Jordi

    2011-10-01

    This paper describes a novel framework for detection and suppression of properly shadowed regions for most possible scenarios occurring in real video sequences. Our approach requires no prior knowledge about the scene, nor is it restricted to specific scene structures. Furthermore, the technique can detect both achromatic and chromatic shadows even in the presence of camouflage that occurs when foreground regions are very similar in color to shadowed regions. The method exploits local color constancy properties due to reflectance suppression over shadowed regions. To detect shadowed regions in a scene, the values of the background image are divided by values of the current frame in the RGB color space. We show how this luminance ratio can be used to identify segments with low gradient constancy, which in turn distinguish shadows from foreground. Experimental results on a collection of publicly available datasets illustrate the superior performance of our method compared with the most sophisticated, state-of-the-art shadow detection algorithms. These results show that our approach is robust and accurate over a broad range of shadow types and challenging video conditions. PMID:21435975

  12. Preoperative Short-Course Concurrent Chemoradiation Therapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer: A Phase 2 Multicenter Study (KROG 10-01)

    SciTech Connect

    Yeo, Seung-Gu; Oh, Jae Hwan; Kim, Dae Yong; Baek, Ji Yeon; Kim, Sun Young; Park, Ji Won; Kim, Min Ju; Chang, Hee Jin; Kim, Tae Hyun; Lee, Jong Hoon; Jang, Hong Seok; Kim, Jun-Gi; Lee, Myung Ah; Nam, Taek-Keun

    2013-05-01

    Purpose: A prospective phase 2 multicenter trial was performed to investigate the efficacy and safety of preoperative short-course concurrent chemoradiation therapy (CRT) followed by delayed surgery for patients with locally advanced rectal cancer. Methods and Materials: Seventy-three patients with cT3-4 rectal cancer were enrolled. Radiation therapy of 25 Gy in 5 fractions was delivered over 5 consecutive days using helical tomotherapy. Concurrent chemotherapy was administered on the same 5 days with intravenous bolus injection of 5-fluorouracil (400 mg/m{sup 2}/day) and leucovorin (20 mg/m{sup 2}/day). After 4 to 8 weeks, total mesorectal excision was performed. The primary endpoint was the pathologic downstaging (ypStage 0-I) rate, and secondary endpoints included tumor regression grade, tumor volume reduction rate, and toxicity. Results: Seventy-one patients completed the planned preoperative CRT and surgery. Downstaging occurred in 20 (28.2%) patients, including 1 (1.4%) with a pathologic complete response. Favorable tumor regression (grade 4-3) was observed in 4 (5.6%) patients, and the mean tumor volume reduction rate was 62.5 ± 21.3%. Severe (grade ≥3) treatment toxicities were reported in 27 (38%) patients from CRT until 3 months after surgery. Conclusions: Preoperative short-course concurrent CRT followed by delayed surgery for patients with locally advanced rectal cancer demonstrated poor pathologic responses compared with conventional long-course CRT, and it yielded considerable toxicities despite the use of an advanced radiation therapy technique.

  13. 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

  14. A Vasculature-Targeting Regimen of Pre-Operative Docetaxel with or without Bevacizumab for Locally Advanced Breast Cancer

    PubMed Central

    Baar, Joseph; Silverman, Paula; Lyons, Janice; Fu, Pingfu; Abdul-Karim, Fadi; Ziats, Nicholas; Wasman, Jay; Hartman, Paul; Jesberger, John; Dumadag, Leda; Hohler, Erin; Leeming, Rosemary; Shenk, Robert; Chen, Helen; McCrae, Keith; Dowlati, Afshin; Remick, Scot C.; Overmoyer, Beth

    2009-01-01

    Purpose Taxanes have effects on angiogenesis causing difficulties in separating biologic effects of chemotherapy from those due to angiogenesis inhibitors. This randomized phase II trial was designed to evaluate the additional biomarker effect on angiogenesis when bevacizumab is added to docetaxel. Experimental Design Patients with inoperable breast cancer were randomized to either 2 cycles of preoperative docetaxel (D) 35 mg/m2 IV weekly for 6 weeks, followed by a 2 week break; or docetaxel with bevacizumab 10 mg/kg IV every other week for a total of 16 weeks (DB). Plasma and serum markers of endothelial damage, DCE-MRI and tumor microvessel density were assessed prior to treatment and at the end of each preoperative cycle. Results 49 patients were randomized (DB = 24; D = 25). There was no difference in overall clinical response, progression-free survival or overall survival. VEGF increased during treatment; more so with DB (P < 0.0001). VCAM-1 also increased (P < 0.0001); more so with DB (P = 0.069). ICAM increased (P = 0.018) and E-selectin decreased (P = 0.006) overall. Baseline levels of VCAM-1 and E-selectin correlated with clinical response by univariate analysis. DCE-MRI demonstrated a greater fall in tumor perfusion calculated by IAUC90 in DB (P = 0.024). DCE-MRI also demonstrated an overall decrease in tumor volume (P=0.012). Conclusion Bevacizumab plus docetaxel caused a greater increase in VEGF and VCAM-1, and a greater reduction in tumor perfusion by DCE-MRI compared with docetaxel. Clinical outcomes of inoperable breast cancer were predicted by changes in VCAM-1 and E-selectin. PMID:19417018

  15. Initial Stage Affects Survival Even After Complete Pathologic Remission is Achieved in Locally Advanced Esophageal Cancer: Analysis of 70 Patients With Pathologic Major Response After Preoperative Chemoradiotherapy

    SciTech Connect

    Kim, Min Kyoung; Cho, Kyung-Ja; Park, Seung-Il; Kim, Yong Hee; Kim, Jong Hoon; Song, Ho-Young; Shin, Ji Hoon; Jung, Hwoon Yong; Lee, Gin Hyug; Choi, Kee Don; Song, Ho June; Ryu, Jin-Sook; Kim, Sung-Bae

    2009-09-01

    Purpose: To analyze outcomes and factors predictive for recurrence and survival in patients with operable esophageal carcinoma who achieved pathologic complete response (PCR) or microscopic residual disease (MRD) after preoperative chemoradiotherapy (CRT). Materials and Methods: Outcomes were assessed in 70 patients with locally advanced esophageal cancer who achieved pathologic major response (53 with PCR and 17 with MRD) after preoperative CRT. Results: At a median follow-up of 38.6 months for surviving patients, 17 of 70 patients (24.3%) experienced disease recurrence and 31 (44.3%) died. Clinical stage (II vs III; p = 0.013) and pathologic response (PCR vs. MRD; p = 0.014) were independent predictors of disease recurrence. Median overall survival (OS) was 99.6 months (95% CI, 44.1-155.1 months) and the 5-year OS rate was 57%. Median recurrence-free survival (RFS) was 71.5 months (95% CI, 39.5-103.6 months) and the 5-year RFS rate was 51.3%. Median OS of patients with Stage II and Stage III disease was 108.8 months and 39.9 months, respectively, and the 5-year OS rates were 68.2% and 27.0%, respectively (p = 0.0003). In a subgroup of patients with PCR, median OS and RFS were also significantly different according to clinical stage. Multivariate analysis showed that clinical stage was an independent predictor of RFS (p = 0.01) and OS (p = 0.008). Conclusions: Even though patients achieved major response after preoperative CRT, pretreatment clinical stage is an important prognostic marker for recurrence and survival. Patients with MRD have an increased recurrence risk but similar survival compared with patients achieved PCR.

  16. Preoperative Chemoradiation With Irinotecan and Capecitabine in Patients With Locally Advanced Resectable Rectal Cancer: Long-Term Results of a Phase II Study

    SciTech Connect

    Hong, Yong Sang; Kim, Dae Yong; Lim, Seok-Byung; Choi, Hyo Seong; Jeong, Seung-Yong; Jeong, Jun Yong; Sohn, Dae Kyung; Kim, Dae-Hyun; Chang, Hee Jin; Park, Jae-Gahb; Jung, Kyung Hae

    2011-03-15

    Purpose: Preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer has shown benefit over postoperative CRT; however, a standard CRT regimen has yet to be defined. We performed a prospective concurrent CRT Phase II study with irinotecan and capecitabine in patients with locally advanced rectal cancer to investigate the efficacy and safety of this regimen. Methods and Materials: Patients with locally advanced, nonmetastatic, and mid-to-lower rectal cancer were enrolled. Radiotherapy was delivered in 1.8-Gy daily fractions for a total of 45 Gy in 25 fractions, followed by a coned-down boost of 5.4 Gy in 3 fractions. Concurrent chemotherapy consisted of 40 mg/m{sup 2} of irinotecan per week for 5 consecutive weeks and 1,650 mg/m{sup 2} of capecitabine per day for 5 days per week (weekdays only) from the first day of radiotherapy. Total mesorectal excision was performed within 6 {+-} 2 weeks. The pathologic responses and survival outcomes were included for the study endpoints. Results: In total, 48 patients were enrolled; 33 (68.7%) were men and 15 (31.3%) were women, and the median age was 59 years (range, 32-72 years). The pathologic complete response rate was 25.0% (11 of 44; 95% confidence interval, 12.2-37.8) and 8 patients (18.2% [8 of 44]) showed near-total tumor regression. The 5-year disease-free and overall survival rates were 75.0% and 93.6%, respectively. Grade 3 toxicities included leukopenia (3 [6.3%]), neutropenia (1 [2.1%]), infection (1 [2.1%]), alanine aminotransferase elevation (1 [2.1%]), and diarrhea (1 [2.1%]). There was no Grade 4 toxicity or treatment-related death. Conclusions: Preoperative CRT with irinotecan and capecitabine with treatment-free weekends showed very mild toxicity profiles and promising results in terms of survival.

  17. KRAS Mutation Status and Clinical Outcome of Preoperative Chemoradiation With Cetuximab in Locally Advanced Rectal Cancer: A Pooled Analysis of 2 Phase II Trials

    SciTech Connect

    Kim, Sun Young; Shim, Eun Kyung; Yeo, Hyun Yang; Baek, Ji Yeon; Hong, Yong Sang; Kim, Dae Yong; Kim, Tae Won; Kim, Jee Hyun; Im, Seock-Ah; Jung, Kyung Hae; Chang, Hee Jin

    2013-01-01

    Purpose: Cetuximab-containing chemotherapy is known to be effective for KRAS wild-type metastatic colorectal cancer; however, it is not clear whether cetuximab-based preoperative chemoradiation confers an additional benefit compared with chemoradiation without cetuximab in patients with locally advanced rectal cancer. Methods and Materials: We analyzed EGFR, KRAS, BRAF, and PIK3CA mutation status with direct sequencing and epidermal growth factor receptor (EGFR) and Phosphatase and tensin homolog (PTEN) expression status with immunohistochemistry in tumor samples of 82 patients with locally advanced rectal cancer who were enrolled in the IRIX trial (preoperative chemoradiation with irinotecan and capecitabine; n=44) or the ERBIRIX trial (preoperative chemoradiation with irinotecan and capecitabine plus cetuximab; n=38). Both trials were similarly designed except for the administration of cetuximab; radiation therapy was administered at a dose of 50.4 Gy/28 fractions and irinotecan and capecitabine were given at doses of 40 mg/m{sup 2} weekly and 1650 mg/m{sup 2}/day, respectively, for 5 days per week. In the ERBIRIX trial, cetuximab was additionally given with a loading dose of 400 mg/m{sup 2} on 1 week before radiation, and 250 mg/m{sup 2} weekly thereafter. Results: Baseline characteristics before chemoradiation were similar between the 2 trial cohorts. A KRAS mutation in codon 12, 13, and 61 was noted in 15 (34%) patients in the IRIX cohort and 5 (13%) in the ERBIRIX cohort (P=.028). Among 62 KRAS wild-type cancer patients, major pathologic response rate, disease-free survival and pathologic stage did not differ significantly between the 2 cohorts. No mutations were detected in BRAF exon 11 and 15, PIK3CA exon 9 and 20, or EGFR exon 18-24 in any of the 82 patients, and PTEN and EGFR expression were not predictive of clinical outcome. Conclusions: In patients with KRAS wild-type locally advanced rectal cancer, the addition of cetuximab to the chemoradiation with

  18. Localizer: fast, accurate, open-source, and modular software package for superresolution microscopy.

    PubMed

    Dedecker, Peter; Duwé, Sam; Neely, Robert K; Zhang, Jin

    2012-12-01

    We present Localizer, a freely available and open source software package that implements the computational data processing inherent to several types of superresolution fluorescence imaging, such as localization (PALM/STORM/GSDIM) and fluctuation imaging (SOFI/pcSOFI). Localizer delivers high accuracy and performance and comes with a fully featured and easy-to-use graphical user interface but is also designed to be integrated in higher-level analysis environments. Due to its modular design, Localizer can be readily extended with new algorithms as they become available, while maintaining the same interface and performance. We provide front-ends for running Localizer from Igor Pro, Matlab, or as a stand-alone program. We show that Localizer performs favorably when compared with two existing superresolution packages, and to our knowledge is the only freely available implementation of SOFI/pcSOFI microscopy. By dramatically improving the analysis performance and ensuring the easy addition of current and future enhancements, Localizer strongly improves the usability of superresolution imaging in a variety of biomedical studies. PMID:23208219

  19. Improved Object Localization Using Accurate Distance Estimation in Wireless Multimedia Sensor Networks

    PubMed Central

    Ur Rehman, Yasar Abbas; Tariq, Muhammad; Khan, Omar Usman

    2015-01-01

    Object localization plays a key role in many popular applications of Wireless Multimedia Sensor Networks (WMSN) and as a result, it has acquired a significant status for the research community. A significant body of research performs this task without considering node orientation, object geometry and environmental variations. As a result, the localized object does not reflect the real world scenarios. In this paper, a novel object localization scheme for WMSN has been proposed that utilizes range free localization, computer vision, and principle component analysis based algorithms. The proposed approach provides the best possible approximation of distance between a wmsn sink and an object, and the orientation of the object using image based information. Simulation results report 99% efficiency and an error ratio of 0.01 (around 1 ft) when compared to other popular techniques. PMID:26528919

  20. Phase I Trial of Neoadjuvant Preoperative Chemotherapy With S-1 and Irinotecan Plus Radiation in Patients With Locally Advanced Rectal Cancer

    SciTech Connect

    Sato, Takeo; Kokuba, Yukihito; Koizumi, Wasaburo; Hayakawa, Kazushige; Okayasu, Isao; Watanabe, Masahiko

    2007-12-01

    Purpose: To determine the maximum tolerated dose (MTD) and recommended dose (RD) of irinotecan combined with preoperative chemoradiotherapy with S-1 in patients with locally advanced rectal cancer. Patients and Methods: We gave preoperative radiotherapy (total dose, 45 Gy) to 23 patients with locally advanced (T3/T4) rectal cancer. Concurrently, S-1 was given orally at a fixed dose of 80 mg/m{sup 2}/day on Days 1-5, 8-12, 22-26, and 29-33, and irinotecan was given as a 90-min continuous i.v. infusion on Days 1, 8, 22, and 29. The dose of irinotecan was initially 40 mg/m{sup 2}/day and gradually increased to determine the MTD and RD of this regimen. Results: Among the 4 patients who received 90 mg/m{sup 2} irinotecan, 2 had Grade 4 neutropenia and 1 had Grade 3 diarrhea. Because dose-limiting toxicity (DLT) occurred in 3 of the 4 patients, 90 mg/m{sup 2} irinotecan was designated as the MTD. Consequently, 80 mg/m{sup 2} irinotecan was given to 7 additional patients, with no DLT, and this was considered the RD. Of the patients who received irinotecan at the RD or lower doses, 6 (31.6%) had a complete pathologic response (Grade 3) and 9 (47.4%) underwent sphincter-preserving surgery. Conclusions: With our new regimen, the MTD of irinotecan was 90 mg/m{sup 2}, and the RD of irinotecan for Phase II studies was 80 mg/m{sup 2}. Although our results are preliminary, this new neoadjuvant chemoradiotherapy was considered safe and active, meriting further investigation in Phase II studies.

  1. A Phase II Trial of Neoadjuvant Preoperative Chemoradiotherapy With S-1 Plus Irinotecan and Radiation in Patients With Locally Advanced Rectal Cancer: Clinical Feasibility and Response Rate

    SciTech Connect

    Sato, Takeo; Ozawa, Heita; Hatate, Kazuhiko; Onosato, Wataru; Naito, Masanori; Nakamura, Takatoshi; Ihara, Atsushi; Koizumi, Wasaburo; Hayakawa, Kazushige; Okayasu, Isao; Yamashita, Keishi; Watanabe, Masahiko

    2011-03-01

    Purpose: We aimed to validate our hypothesis that a preoperative chemoradiotherapy regimen with S-1 plus irinotecan is feasible, safe, and active for the management of locally advanced rectal cancer in a single-arm Phase II setting. Methods and Materials: Eligible patients had previously untreated, locally advanced rectal adenocarcinoma. Radiotherapy was administered in fractions of 1.8Gy/d for 25 days. S-1 was administered orally in a fixed daily dose of 80mg/m{sup 2} on Days 1 to 5, 8 to 12, 22 to 26, and 29 to 33. Irinotecan (80mg/m{sup 2}) was infused on Days 1, 8, 22, and 29. Four or more weeks after the completion of the treatment, total mesorectal excision with lateral lymph node dissection was performed. The primary endpoint was the rate of completing treatment in terms of feasibility. The secondary endpoints were the response rate and safety. Results: We enrolled 43 men and 24 women in the study. The number of patients who completed treatment was 58 (86.6%). Overall, 46 patients (68.7%) responded to treatment and 24 (34.7%) had a complete histopathologic response. Three patients had Grade 3 leukopenia, and another three patients had Grade 3 neutropenia. Diarrhea was the most common type of nonhematologic toxicity: 3 patients had Grade 3 diarrhea. Conclusions: A preoperative regimen of S-1, irinotecan, and radiotherapy to the rectum was feasible, and it appeared safe and effective in this nonrandomized Phase II setting. It exhibited a low incidence of adverse events, a high rate of completion of treatment, and an extremely high rate of pathologic complete response.

  2. PSI: a comprehensive and integrative approach for accurate plant subcellular localization prediction.

    PubMed

    Liu, Lili; Zhang, Zijun; Mei, Qian; Chen, Ming

    2013-01-01

    Predicting the subcellular localization of proteins conquers the major drawbacks of high-throughput localization experiments that are costly and time-consuming. However, current subcellular localization predictors are limited in scope and accuracy. In particular, most predictors perform well on certain locations or with certain data sets while poorly on others. Here, we present PSI, a novel high accuracy web server for plant subcellular localization prediction. PSI derives the wisdom of multiple specialized predictors via a joint-approach of group decision making strategy and machine learning methods to give an integrated best result. The overall accuracy obtained (up to 93.4%) was higher than best individual (CELLO) by ~10.7%. The precision of each predicable subcellular location (more than 80%) far exceeds that of the individual predictors. It can also deal with multi-localization proteins. PSI is expected to be a powerful tool in protein location engineering as well as in plant sciences, while the strategy employed could be applied to other integrative problems. A user-friendly web server, PSI, has been developed for free access at http://bis.zju.edu.cn/psi/. PMID:24194827

  3. Local explicitly correlated second-order perturbation theory for the accurate treatment of large molecules.

    PubMed

    Adler, Thomas B; Werner, Hans-Joachim; Manby, Frederick R

    2009-02-01

    A local explicitly correlated LMP2-F12 method is described that can be applied to large molecules. The steep scaling of computer time with molecular size is reduced by the use of local approximations, the scaling with respect to the basis set size per atom is improved by density fitting, and the slow convergence of the correlation energy with orbital basis size is much accelerated by the introduction of terms into the wave function that explicitly depend on the interelectronic distance. The local approximations lead to almost linear scaling of the computational effort with molecular size without much affecting the accuracy. At the same time, the domain error of conventional LMP2 is removed in LMP2-F12. LMP2-F12 calculations on molecules of chemical interest involving up to 80 atoms, 200 correlated electrons, and 2600 contracted Gaussian-type orbitals, as well as several reactions of large biochemical molecules are reported. PMID:19206957

  4. Oxaliplatin Plus Dual Inhibition of Thymidilate Synthase During Preoperative Pelvic Radiotherapy for Locally Advanced Rectal Carcinoma: Long-Term Outcome

    SciTech Connect

    Avallone, Antonio; Delrio, Paolo; Pecori, Biagio; Tatangelo, Fabiana; Petrillo, Antonella; Scott, Nigel; Marone, Pietro; Aloi, Luigi; Sandomenico, Claudia; Lastoria, Secondo; Iaffaioli, Vincenzo Rosario; Scala, Dario; Iodice, Giovanni; Budillon, Alfredo; Comella, Pasquale

    2011-03-01

    Purpose: To assess the safety and efficacy of oxaliplatin (OXA) plus dual inhibition of thymidilate synthase during preoperative pelvic radiotherapy (RT) in patients with poor prognosis for rectal carcinoma. Methods and Materials: Sixty-three patients with the following characteristics, a clinical (c) stage T4, cN1-2, or cT3N0 of {<=}5 cm from the anal verge and/or with a circumferential resection margin (CRM) of {<=}5 mm (by magnetic resonance imaging), received three biweekly courses of chemotherapy with OXA, 100 mg/m{sup 2}; raltitrexed (RTX), 2.5 mg/m{sup 2} on day 1, and 5-fluorouracil (5-FU), 900 mg/m{sup 2} (31 patients) or 800 mg/m{sup 2} (32 patients); levo-folinic acid (LFA), 250 mg/m{sup 2} on day 2, during pelvic RT (45 Gy). Pathologic response was defined as complete pathological response (ypCR), major (tumor regression grade(TRG) 2 to 3, with ypCRM-ve and ypN-ve) or minor or no response (TRG4 to -5, or ypCRM+ve, or ypN+ve). Adjuvant 5-FU/LFA regimen was given in cases of cT4, ypN+ve, or ypCRM+ve. Results: Overall, neutropenia (40%) and diarrhea (13%) were the most common grade {>=}3 toxicities, and tolerability was better with a 5-FU dose reduction. No significant difference in pathologic response was seen according 5-FU dosage: overall, a ypCR was obtained in 24 (39%) patients, and a major response in 20 (32%) patients. The 5-year probability of freedom from recurrence was 80% (95% confidence interval, 68%-92%); it was 56% for the minor/no response group, while it was around 90% for both the ypCR and the major response group. Conclusions: OXA, RTX, and 5-FU/LFA administered during pelvic RT produced promising early and long-term results in rectal carcinoma patients with poor prognosis. The postoperative treatment strategy applied in our study supports the risk-adapted approach in postoperative management.

  5. Accurate axial localization by conical diffraction beam shaping generating a dark-helix PSF

    NASA Astrophysics Data System (ADS)

    Fallet, Clement; Lassalle, Astrid; Dubois-Delumeau, Maxime; Sirat, Gabriel Y.

    2016-02-01

    We present here a new PSF-shaping technique using biaxial crystals to generate a highly z-dependent distribution in single molecule localization microscopy (SMLM). This distribution features two zeros of intensity that rotate together with defocus. This PSF features similarities to the double-helix introduced by Moerner and Piestun and thus has been dubbed dark-helix since we track zeros of intensity. Preliminary numerical studies based on Cramer-Rao Lower Bound (CRLB) show that this PSF has the potential to obtain up to 20nm localization precision. This PSF can be easily generated by a very simple, monolithic add-on added in front of the detection camera. Additionally, the PSF remains of the approximate size of the Airy PSF, the x-y localization precision is not substantially affected and no trade-off is required. The xy compacity of the PSF also enables theoretically a higher density of emitters than the double-helix which spreads on a larger scale. Limiting factors for SMLM such as loss of photons, complexity and robustness will be discussed and considerations about the practical implementation of such techniques will be given.

  6. Efficient Approximation of Head-Related Transfer Functions in Subbands for Accurate Sound Localization

    PubMed Central

    Marelli, Damián; Baumgartner, Robert; Majdak, Piotr

    2015-01-01

    Head-related transfer functions (HRTFs) describe the acoustic filtering of incoming sounds by the human morphology and are essential for listeners to localize sound sources in virtual auditory displays. Since rendering complex virtual scenes is computationally demanding, we propose four algorithms for efficiently representing HRTFs in subbands, i.e., as an analysis filterbank (FB) followed by a transfer matrix and a synthesis FB. All four algorithms use sparse approximation procedures to minimize the computational complexity while maintaining perceptually relevant HRTF properties. The first two algorithms separately optimize the complexity of the transfer matrix associated to each HRTF for fixed FBs. The other two algorithms jointly optimize the FBs and transfer matrices for complete HRTF sets by two variants. The first variant aims at minimizing the complexity of the transfer matrices, while the second one does it for the FBs. Numerical experiments investigate the latency-complexity trade-off and show that the proposed methods offer significant computational savings when compared with other available approaches. Psychoacoustic localization experiments were modeled and conducted to find a reasonable approximation tolerance so that no significant localization performance degradation was introduced by the subband representation. PMID:26681930

  7. Phase II Trial of Preoperative Irinotecan-Cisplatin Followed by Concurrent Irinotecan-Cisplatin and Radiotherapy for Resectable Locally Advanced Gastric and Esophagogastric Junction Adenocarcinoma

    SciTech Connect

    Rivera, Fernando; Galan, Maica; Tabernero, Josep; Cervantes, Andres; Vega-Villegas, M. Eugenia; Gallego, Javier; Laquente, Berta; Rodriguez, Edith; Carrato, Alfredo; Escudero, Pilar; Massuti, Bartomeu; Alonso-Orduna, Vicente; Cardenal, Adelaida; Saenz, Alberto; Giralt, Jordi; Yuste, Ana Lucia

    2009-12-01

    Purpose: To determine in a Phase II trial whether preoperative irinotecan-cisplatin (IC) followed by concurrent IC therapy and radiotherapy (IC/RT) improved outcome in patients with resectable, locally advanced gastric adenocarcinoma (GC) or esophagogastric junction cancer (EGJC). Patients and Methods: Patients with resectable Stage II-IV, M0 GC or EGJC made up the study population. The primary endpoint was pathologic complete response (pCR). Two courses of IC (irinotecan, 65mg/m{sup 2}; cisplatin, 30mg/m{sup 2} on Days 1 and 8 every 21 days) were given. Patients without progression then received IC/RT, consisting of daily radiotherapy (45Gy) with concurrent IC (irinotecan, 65mg/m{sup 2}; cisplatin, 30mg/m{sup 2} on Days 1, 8, 15, and 22). Surgical resection was performed, if feasible, 5-8 weeks after the end of radiotherapy. Results: Twenty-three patients were included in the study: 10 with EGJC and 13 with GC. Two patients (9%) achieved pCR. The incidences of Grade 3-4 toxicities were as follows: IC: neutropenia 35% (febrile 13%), anemia 22%, diarrhea 22%, emesis 8%; IC/RT: neutropenia 52% (febrile 5%), asthenia 19%, anemia 9%, emesis 9%, diarrhea 5%, cardiotoxicity 5%. No patients died during IC or IC/RT. R0 resection was achieved in 15 patients (65%). Median survival was 14.5 months, and the actuarial 2-year survival rate was 35%. Conclusions: Preoperative IC followed by IC/RT resulted in moderate response and resection rates with mild toxicity in patients with GC and EGJC.

  8. LOCUSTRA: accurate prediction of local protein structure using a two-layer support vector machine approach.

    PubMed

    Zimmermann, Olav; Hansmann, Ulrich H E

    2008-09-01

    Constraint generation for 3d structure prediction and structure-based database searches benefit from fine-grained prediction of local structure. In this work, we present LOCUSTRA, a novel scheme for the multiclass prediction of local structure that uses two layers of support vector machines (SVM). Using a 16-letter structural alphabet from de Brevern et al. (Proteins: Struct., Funct., Bioinf. 2000, 41, 271-287), we assess its prediction ability for an independent test set of 222 proteins and compare our method to three-class secondary structure prediction and direct prediction of dihedral angles. The prediction accuracy is Q16=61.0% for the 16 classes of the structural alphabet and Q3=79.2% for a simple mapping to the three secondary classes helix, sheet, and coil. We achieve a mean phi(psi) error of 24.74 degrees (38.35 degrees) and a median RMSDA (root-mean-square deviation of the (dihedral) angles) per protein chain of 52.1 degrees. These results compare favorably with related approaches. The LOCUSTRA web server is freely available to researchers at http://www.fz-juelich.de/nic/cbb/service/service.php. PMID:18763837

  9. Improved highly accurate localized motion imaging for monitoring high-intensity focused ultrasound therapy

    NASA Astrophysics Data System (ADS)

    Qu, Xiaolei; Azuma, Takashi; Sugiyama, Ryusuke; Kanazawa, Kengo; Seki, Mika; Sasaki, Akira; Takeuchi, Hideki; Fujiwara, Keisuke; Itani, Kazunori; Tamano, Satoshi; Takagi, Shu; Sakuma, Ichiro; Matsumoto, Yoichiro

    2016-07-01

    Visualizing an area subjected to high-intensity focused ultrasound (HIFU) therapy is necessary for controlling the amount of HIFU exposure. One of the promising monitoring methods is localized motion imaging (LMI), which estimates coagulation length by detecting the change in stiffness. In this study, we improved the accuracy of our previous LMI by dynamic cross-correlation window (DCCW) and maximum vibration amount (MVA) methods. The DCCW method was used to increase the accuracy of estimating vibration amplitude, and the MVA method was employed to increase signal–noise ratio of the decrease ratio at the coagulated area. The qualitative comparison of results indicated that the two proposed methods could suppress the effect of noise. Regarding the results of the quantitative comparison, coagulation length was estimated with higher accuracy by the improved LMI method, and the root-mean-square error (RMSE) was reduced from 2.51 to 1.69 mm.

  10. Association Between the Cytogenetic Profile of Tumor Cells and Response to Preoperative Radiochemotherapy in Locally Advanced Rectal Cancer

    PubMed Central

    González-González, María; Garcia, Jacinto; Alcazar, José A.; Gutiérrez, María L.; Gónzalez, Luis M.; Bengoechea, Oscar; Abad, María M.; Santos-Briz, Angel; Blanco, Oscar; Martín, Manuela; Rodríguez, Ana; Fuentes, Manuel; Muñoz-Bellvis, Luis; Orfao, Alberto; Sayagues, Jose M.

    2014-01-01

    Abstract Neoadjuvant radiochemotherapy to locally advanced rectal carcinoma patients has proven efficient in a high percentage of cases. Despite this, some patients show nonresponse or even disease progression. Recent studies suggest that different genetic alterations may be associated with sensitivity versus resistance of rectal cancer tumor cells to neoadjuvant therapy. We investigated the relationship between intratumoral pathways of clonal evolution as assessed by interphase fluorescence in situ hybridization (51 different probes) and response to neoadjuvant radiochemotherapy, evaluated by Dworak criteria in 45 rectal cancer tumors before (n = 45) and after (n = 31) treatment. Losses of chromosomes 1p (44%), 8p (53%), 17p (47%), and 18q (38%) and gains of 1q (49%) and 13q (75%) as well as amplification of 8q (38%) and 20q (47%) chromosomal regions were those specific alterations found at higher frequencies. Significant association (P < 0.05) was found between alteration of 1p, 1q, 11p, 12p, and 17p chromosomal regions and degree of response to neoadjuvant therapy. A clear association was observed between cytogenetic profile of the ancestral tumor cell clone and response to radiochemotherapy; cases presenting with del(17p) showed a poor response to neoadjuvant treatment (P = 0.03), whereas presence of del(1p) was more frequently observed in responder patients (P = 0.0002). Moreover, a significantly higher number of copies of chromosomes 8q (P = 0.004), 13q (P = 0.003), and 20q (P = 0.002) were found after therapy versus paired pretreatment rectal cancer samples. Our results point out the existence of an association between tumor cytogenetics and response to neoadjuvant therapy in locally advanced rectal cancer. Further studies in larger series of patients are necessary to confirm our results. PMID:25474426

  11. Association between the cytogenetic profile of tumor cells and response to preoperative radiochemotherapy in locally advanced rectal cancer.

    PubMed

    González-González, María; Garcia, Jacinto; Alcazar, José A; Gutiérrez, María L; Gónzalez, Luis M; Bengoechea, Oscar; Abad, María M; Santos-Briz, Angel; Blanco, Oscar; Martín, Manuela; Rodríguez, Ana; Fuentes, Manuel; Muñoz-Bellvis, Luis; Orfao, Alberto; Sayagues, Jose M

    2014-11-01

    Neoadjuvant radiochemotherapy to locally advanced rectal carcinoma patients has proven efficient in a high percentage of cases. Despite this, some patients show nonresponse or even disease progression. Recent studies suggest that different genetic alterations may be associated with sensitivity versus resistance of rectal cancer tumor cells to neoadjuvant therapy. We investigated the relationship between intratumoral pathways of clonal evolution as assessed by interphase fluorescence in situ hybridization (51 different probes) and response to neoadjuvant radiochemotherapy, evaluated by Dworak criteria in 45 rectal cancer tumors before (n = 45) and after (n = 31) treatment. Losses of chromosomes 1p (44%), 8p (53%), 17p (47%), and 18q (38%) and gains of 1q (49%) and 13q (75%) as well as amplification of 8q (38%) and 20q (47%) chromosomal regions were those specific alterations found at higher frequencies. Significant association (P < 0.05) was found between alteration of 1p, 1q, 11p, 12p, and 17p chromosomal regions and degree of response to neoadjuvant therapy. A clear association was observed between cytogenetic profile of the ancestral tumor cell clone and response to radiochemotherapy; cases presenting with del(17p) showed a poor response to neoadjuvant treatment (P = 0.03), whereas presence of del(1p) was more frequently observed in responder patients (P = 0.0002). Moreover, a significantly higher number of copies of chromosomes 8q (P = 0.004), 13q (P = 0.003), and 20q (P = 0.002) were found after therapy versus paired pretreatment rectal cancer samples. Our results point out the existence of an association between tumor cytogenetics and response to neoadjuvant therapy in locally advanced rectal cancer. Further studies in larger series of patients are necessary to confirm our results. PMID:25474426

  12. Phase I Trial of Preoperative Hypofractionated Intensity-Modulated Radiotherapy with Incorporated Boost and Oral Capecitabine in Locally Advanced Rectal Cancer

    SciTech Connect

    Freedman, Gary M. . E-mail: G_Freedman@FCCC.edu; Meropol, Neal J.; Sigurdson, Elin R.; Hoffman, John; Callahan, Elaine; Price, Robert; Cheng, Jonathan; Cohen, Steve; Lewis, Nancy; Watkins-Bruner, Deborah; Rogatko, Andre; Konski, Andre

    2007-04-01

    Purpose: To determine the safety and efficacy of preoperative hypofractionated radiotherapy using intensity-modulated radiotherapy (IMRT) and an incorporated boost with concurrent capecitabine in patients with locally advanced rectal cancer. Methods and Materials: The eligibility criteria included adenocarcinoma of the rectum, T3-T4 and/or N1-N2 disease, performance status 0 or 1, and age {>=}18 years. Photon IMRT and an incorporated boost were used to treat the whole pelvis to 45 Gy and the gross tumor volume plus 2 cm to 55 Gy in 25 treatments within 5 weeks. The study was designed to escalate the dose to the gross tumor volume in 5-Gy increments in 3-patient cohorts. Capecitabine was given orally 825 mg/m{sup 2} twice daily for 7 days each week during RT. The primary endpoint was the maximal tolerated radiation dose, and the secondary endpoints were the pathologic response and quality of life. Results: Eight patients completed RT at the initial dose level of 55 Gy. The study was discontinued because of toxicity-six Grade 3 toxicities occurred in 3 (38%) of 8 patients. All patients went on to definitive surgical resection, and no patient had a pathologically complete response. Conclusion: This regimen, using hypofractionated RT with an incorporated boost, had unacceptable toxicity despite using standard doses of capecitabine and IMRT. Additional research is needed to determine whether IMRT is able to reduce the side effects during and after pelvic RT with conventional dose fractionation.

  13. Preoperative 3-Tesla Multiparametric Endorectal Magnetic Resonance Imaging Findings and the Odds of Upgrading and Upstaging at Radical Prostatectomy in Men With Clinically Localized Prostate Cancer

    SciTech Connect

    Hegde, John V.; Chen, Ming-Hui; Mulkern, Robert V.; Fennessy, Fiona M.; D'Amico, Anthony V.; Tempany, Clare M.C.

    2013-02-01

    Purpose: To investigate whether 3-T esla (3T) multiparametric endorectal MRI (erMRI) can add information to established predictors regarding occult extraprostatic or high-grade prostate cancer (PC) in men with clinically localized PC. Methods and Materials: At a single academic medical center, this retrospective study's cohort included 118 men with clinically localized PC who underwent 3T multiparametric erMRI followed by radical prostatectomy, from 2008 to 2011. Multivariable logistic regression analyses in all men and in 100 with favorable-risk PC addressed whether erMRI evidence of T3 disease was associated with prostatectomy T3 or Gleason score (GS) 8-10 (in patients with biopsy GS {<=}7) PC, adjusting for age, prostate-specific antigen level, clinical T category, biopsy GS, and percent positive biopsies. Results: The accuracy of erMRI prediction of extracapsular extension and seminal vesicle invasion was 75% and 95%, respectively. For all men, erMRI evidence of a T3 lesion versus T2 was associated with an increased odds of having pT3 disease (adjusted odds ratio [AOR] 4.81, 95% confidence interval [CI] 1.36-16.98, P=.015) and pGS 8-10 (AOR 5.56, 95% CI 1.10-28.18, P=.038). In the favorable-risk population, these results were AOR 4.14 (95% CI 1.03-16.56), P=.045 and AOR 7.71 (95% CI 1.36-43.62), P=.021, respectively. Conclusions: Three-Tesla multiparametric erMRI in men with favorable-risk PC provides information beyond that contained in known preoperative predictors about the presence of occult extraprostatic and/or high-grade PC. If validated in additional studies, this information can be used to counsel men planning to undergo radical prostatectomy or radiation therapy about the possible need for adjuvant radiation therapy or the utility of adding hormone therapy, respectively.

  14. Distribution of high-stability 10 GHz local oscillator over 100 km optical fiber with accurate phase-correction system.

    PubMed

    Wang, Siwei; Sun, Dongning; Dong, Yi; Xie, Weilin; Shi, Hongxiao; Yi, Lilin; Hu, Weisheng

    2014-02-15

    We have developed a radio-frequency local oscillator remote distribution system, which transfers a phase-stabilized 10.03 GHz signal over 100 km optical fiber. The phase noise of the remote signal caused by temperature and mechanical stress variations on the fiber is compensated by a high-precision phase-correction system, which is achieved using a single sideband modulator to transfer the phase correction from intermediate frequency to radio frequency, thus enabling accurate phase control of the 10 GHz signal. The residual phase noise of the remote 10.03 GHz signal is measured to be -70  dBc/Hz at 1 Hz offset, and long-term stability of less than 1×10⁻¹⁶ at 10,000 s averaging time is achieved. Phase error is less than ±0.03π. PMID:24562233

  15. Accurate and Efficient Calculation of van der Waals Interactions Within Density Functional Theory by Local Atomic Potential Approach

    SciTech Connect

    Sun, Y. Y.; Kim, Y. H.; Lee, K.; Zhang, S. B.

    2008-01-01

    Density functional theory (DFT) in the commonly used local density or generalized gradient approximation fails to describe van der Waals (vdW) interactions that are vital to organic, biological, and other molecular systems. Here, we propose a simple, efficient, yet accurate local atomic potential (LAP) approach, named DFT+LAP, for including vdW interactions in the framework of DFT. The LAPs for H, C, N, and O are generated by fitting the DFT+LAP potential energy curves of small molecule dimers to those obtained from coupled cluster calculations with single, double, and perturbatively treated triple excitations, CCSD(T). Excellent transferability of the LAPs is demonstrated by remarkable agreement with the JSCH-2005 benchmark database [P. Jurecka et al. Phys. Chem. Chem. Phys. 8, 1985 (2006)], which provides the interaction energies of CCSD(T) quality for 165 vdW and hydrogen-bonded complexes. For over 100 vdW dominant complexes in this database, our DFT+LAP calculations give a mean absolute deviation from the benchmark results less than 0.5 kcal/mol. The DFT+LAP approach involves no extra computational cost other than standard DFT calculations and no modification of existing DFT codes, which enables straightforward quantum simulations, such as ab initio molecular dynamics, on biomolecular systems, as well as on other organic systems.

  16. A conservative finite volume scheme with time-accurate local time stepping for scalar transport on unstructured grids

    NASA Astrophysics Data System (ADS)

    Cavalcanti, José Rafael; Dumbser, Michael; Motta-Marques, David da; Fragoso Junior, Carlos Ruberto

    2015-12-01

    In this article we propose a new conservative high resolution TVD (total variation diminishing) finite volume scheme with time-accurate local time stepping (LTS) on unstructured grids for the solution of scalar transport problems, which are typical in the context of water quality simulations. To keep the presentation of the new method as simple as possible, the algorithm is only derived in two space dimensions and for purely convective transport problems, hence neglecting diffusion and reaction terms. The new numerical method for the solution of the scalar transport is directly coupled to the hydrodynamic model of Casulli and Walters (2000) that provides the dynamics of the free surface and the velocity vector field based on a semi-implicit discretization of the shallow water equations. Wetting and drying is handled rigorously by the nonlinear algorithm proposed by Casulli (2009). The new time-accurate LTS algorithm allows a different time step size for each element of the unstructured grid, based on an element-local Courant-Friedrichs-Lewy (CFL) stability condition. The proposed method does not need any synchronization between different time steps of different elements and is by construction locally and globally conservative. The LTS scheme is based on a piecewise linear polynomial reconstruction in space-time using the MUSCL-Hancock method, to obtain second order of accuracy in both space and time. The new algorithm is first validated on some classical test cases for pure advection problems, for which exact solutions are known. In all cases we obtain a very good level of accuracy, showing also numerical convergence results; we furthermore confirm mass conservation up to machine precision and observe an improved computational efficiency compared to a standard second order TVD scheme for scalar transport with global time stepping (GTS). Then, the new LTS method is applied to some more complex problems, where the new scalar transport scheme has also been coupled to

  17. Preoperative Imaging for Clinical Staging Prior to Radical Cystectomy.

    PubMed

    Hugen, Cory M; Duddalwar, Vinay; Daneshmand, Siamak

    2016-09-01

    The importance of patient selection for quality outcomes following radical cystectomy is critical. Clinical staging is one of the key elements necessary for patient selection, and staging relies on accurate preoperative imaging. Many imaging modalities are available and have been utilized for preoperative staging with published operating characteristics. In this update, we review recently published literature for advances in preoperative imaging prior to radical cystectomy. PMID:27432379

  18. Potential of Baseline Computed Tomography to Predict Long-Term Survival of Patients With Locally Advanced Esophageal Cancer Treated With Preoperative Chemotherapy

    PubMed Central

    Wang, Zhi-Long; Chen, Ying; Li, Xiao-Ting; Chen, Ke-Neng; Sun, Ying-Shi

    2016-01-01

    Abstract In this study, we evaluated the efficacy of baseline computed tomography (CT) signs and postoperative TN stages on survival of patients with advanced esophageal squamous cell carcinoma with preoperative chemotherapy. Consecutive patients (n = 130) with preoperative chemotherapy and radical esophagectomy from January 2006 to December 2011 were enrolled in this study retrospectively. Pathological T and N stages were confirmed by surgery. Baseline CT signs of tumor length, tumor thickness, outer membrane features, total number of lymph node (tLN), short diameter of the largest lymph node (SDL), and clinical T and N stages were measured. Eight-year overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan–Meier and Cox proportional hazards regression analyses to determine associations between baseline CT signs and survival outcomes. Kaplan–Meier analysis showed that tLN number, largest LN short axis diameter, pT, and pN stages all correlated with OS significantly. And the total tLN number, SDL and pN stages significantly correlated with DFS. In Cox analyses, total tLN number (>6) and pN stage were significantly associated with OS (hazard ratio [HR]: 1.55 [95% CI, 1.13–2.11, P = 0.006] and HR: 1.49 [95% CI, 1.17–1.90, P = 0.001], respectively). Cox regression analysis showed that OS index was predictive of 1- to 3-year survival. Total number of lymph node in baseline CT provides equal efficiency compared to pN stages in the prediction of 8-year long-term survival outcomes for advanced esophageal squamous cell carcinoma patients with preoperative chemotherapy. PMID:27149488

  19. Potential of Baseline Computed Tomography to Predict Long-Term Survival of Patients With Locally Advanced Esophageal Cancer Treated With Preoperative Chemotherapy: A Retrospective Cohort Study.

    PubMed

    Wang, Zhi-Long; Chen, Ying; Li, Xiao-Ting; Chen, Ke-Neng; Sun, Ying-Shi

    2016-05-01

    In this study, we evaluated the efficacy of baseline computed tomography (CT) signs and postoperative TN stages on survival of patients with advanced esophageal squamous cell carcinoma with preoperative chemotherapy. Consecutive patients (n = 130) with preoperative chemotherapy and radical esophagectomy from January 2006 to December 2011 were enrolled in this study retrospectively. Pathological T and N stages were confirmed by surgery. Baseline CT signs of tumor length, tumor thickness, outer membrane features, total number of lymph node (tLN), short diameter of the largest lymph node (SDL), and clinical T and N stages were measured. Eight-year overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier and Cox proportional hazards regression analyses to determine associations between baseline CT signs and survival outcomes. Kaplan-Meier analysis showed that tLN number, largest LN short axis diameter, pT, and pN stages all correlated with OS significantly. And the total tLN number, SDL and pN stages significantly correlated with DFS. In Cox analyses, total tLN number (>6) and pN stage were significantly associated with OS (hazard ratio [HR]: 1.55 [95% CI, 1.13-2.11, P = 0.006] and HR: 1.49 [95% CI, 1.17-1.90, P = 0.001], respectively). Cox regression analysis showed that OS index was predictive of 1- to 3-year survival. Total number of lymph node in baseline CT provides equal efficiency compared to pN stages in the prediction of 8-year long-term survival outcomes for advanced esophageal squamous cell carcinoma patients with preoperative chemotherapy. PMID:27149488

  20. Long-Term Follow-Up of Preoperative Pelvic Radiation Therapy and Concomitant Boost Irradiation in Locally Advanced Rectal Cancer Patients: A Multi-Institutional Phase II Study (KROG 04-01)

    SciTech Connect

    Lee, Jong Hoon; Kim, Dae Yong; Nam, Taek-Keun; Yoon, Sei-Chul; Lee, Doo Seok; Park, Ji Won; Oh, Jae Hwan; Chang, Hee Jin; Yoon, Mee Sun; Jeong, Jae-Uk; Jang, Hong Seok

    2012-11-15

    Purpose: To perform a prospective phase II study to investigate the efficacy and safety of preoperative pelvic radiation therapy and concomitant small-field boost irradiation with 5-fluorouracil and leucovorin for 5 weeks in locally advanced rectal cancer patients. Methods and Materials: Sixty-nine patients with locally advanced, nonmetastatic, mid-to-lower rectal cancer were prospectively enrolled. They had received preoperative chemoradiation therapy and total mesorectal excision. Pelvic radiation therapy of 43.2 Gy in 24 fractions plus concomitant boost radiation therapy of 7.2 Gy in 12 fractions was delivered to the pelvis and tumor bed for 5 weeks. Two cycles of 5-fluorouracil and leucovorin were administered for 3 days in the first and fifth week of radiation therapy. The pathologic response, survival outcome, and treatment toxicity were evaluated for the study endpoints. Results: Of 69 patients, 8 (11.6%) had a pathologically complete response. Downstaging rates were 40.5% for T classification and 68.1% for N classification. At the median follow-up of 69 months, 36 patients have been followed up for more than 5 years. The 5-year disease-free survival (DFS) and overall survival rates were 66.0% and 75.3%, respectively. Higher pathologic T (P = .045) and N (P = .032) classification were significant adverse prognostic factors for DFS, and high-grade histology was an adverse prognostic factor for both DFS (P = .025) and overall survival (P = .031) on the multivariate analysis. Fifteen patients (21.7%) experienced grade 3 or 4 acute toxicity, and 7 patients (10.1%) had long-term toxicity. Conclusion: Preoperative pelvic radiation therapy with concomitant boost irradiation with 5-fluorouracil and leucovorin for 5 weeks showed acceptable acute and long-term toxicities. However, the benefit of concomitant small-field boost irradiation for 5 weeks in rectal cancer patients was not demonstrated beyond conventional irradiation for 6 weeks in terms of tumor response and

  1. A Phase II study of preoperative radiotherapy and concomitant weekly irinotecan in combination with protracted venous infusion 5-fluorouracil, for resectable locally advanced rectal cancer

    SciTech Connect

    Navarro, Matilde . E-mail: mnavarrogarcia@ico.scs.es; Dotor, Emma; Rivera, Fernando; Sanchez-Rovira, Pedro; Vega-Villegas, Maria Eugenia; Cervantes, Andres; Garcia, Jose Luis; Gallen, Manel; Aranda, Enrique

    2006-09-01

    Purpose: The aim of this study was to evaluate the efficacy and tolerance of preoperative chemoradiotherapy (CRT) with irinotecan (CPT-11) and 5-fluorouracil (5-FU) in patients with resectable rectal cancer. Methods and Materials: Patients with resectable T3-T4 rectal cancer and Eastern Cooperative Oncology Group performance status <2 were included. CPT-11 (50 mg/m{sup 2} weekly) and 5-FU (225 mg/m{sup 2}/day continuous infusion, 5 days/week) were concurrently administered with radiation therapy (RT) (45 Gy, 1.8 Gy/day, 5 days/week), during 5 weeks. Results: A total of 74 patients were enrolled: mean age, 59 years (20-74 years; SD, 11.7). Planned treatment was delivered to most patients (median relative dose intensity for both drugs was 100%). Grade 3/4 lymphocytopenia occurred in 35 patients (47%), neutropenia in 5 (7%), and anemia in 2 (3%). Main Grade 3 nonhematologic toxicities were diarrhea (14%), asthenia (9%), rectal mucositis (8%), and abdominal pain (8%). Of the 73 resected specimens, 13.7% (95% confidence interval [CI], 6.8-23.7) had a pathologic complete response and 49.3% (95% CI, 37.4-61.3) were downstaged. Additionally, 66.7% (95% CI, 51.1-80.0) of patients with ultrasound staged N1/N2 disease had no pathologic evidence of nodal involvement after CRT. Conclusions: This preoperative CRT schedule has been shown to be effective and feasible in a large population of patients with resectable rectal cancer.

  2. [Present status of preoperative staging and contemplation on preoperative precision staging for gastric cancer].

    PubMed

    Zhu, Zhenggang

    2016-02-25

    The aim of the preoperative staging of gastric cancer was to evaluate the depth of tumor infiltration (T-stage), the extent or number of metastasized lymph nodes (N-stage), and distant metastasis (M-stage) before surgery, to develop an optimal therapeutic scheme for the patients with gastric cancer. Traditional methods of preoperative staging for gastric cancer are usually imaging diagnostic techniques, such as endoscopic ultrasonography (EUS), CT scan, magnetic resonance imaging (MRI) and laparoscopic exploration. At present, the accuracy of preoperative TNM staging of gastric cancer can generally reach 70% to 85% with significant clinical benefit. The accurate preoperative staging for cancer patients can have a major role in determining the final clinical outcome and in predicting the prognosis. According to the concept of "precision medicine", to achieve "preoperative precision staging of gastric cancer", the application of imaging diagnostic techniques must be combined with the analysis of individual genetic information or tumor molecular pathological classification, which should be based on research of the disease genomics, proteomics and metabolomics. In this article, we provide a review of results on preoperative staging of gastric cancer in recent years, and we also discuss how to think about the "preoperative precision staging of gastric cancer", with special emphasis on the potential of molecular imaging techniques, circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA), molecular targets for tumor targeting therapy and molecular pathological classification, etc. in judging bio-molecular behavior of gastric cancer before surgery. PMID:26831874

  3. Predicting Accurate Electronic Excitation Transfer Rates via Marcus Theory with Boys or Edmiston-Ruedenberg Localized Diabatization

    SciTech Connect

    Subotnik, Joseph E.; Vura-Weis, Josh; Sodt, Alex J.; Ratner, Mark A.

    2010-05-06

    We model the triplet-triplet energy-transfer experiments from the Closs group [Closs, G. L.; et al. J. Am. Chem. Soc. 1988, 110, 2652.] using a combination of Marcus theory and either Boys or Edmiston-Ruedenberg localized diabatization, and we show that relative and absolute rates of electronic excitation transfer may be computed successfully. For the case where both the donor and acceptor occupy equatorial positions on a rigid cyclohexane bridge, we find βcalc = 2.8 per C-C bond, compared with the experimental value βexp = 2.6. This work highlights the power of using localized diabatization methods as a tool for modeling nonequilibrium processes.

  4. One dimensional P wave velocity structure of the crust beneath west Java and accurate hypocentre locations from local earthquake inversion

    SciTech Connect

    Supardiyono; Santosa, Bagus Jaya

    2012-06-20

    A one-dimensional (1-D) velocity model and station corrections for the West Java zone were computed by inverting P-wave arrival times recorded on a local seismic network of 14 stations. A total of 61 local events with a minimum of 6 P-phases, rms 0.56 s and a maximum gap of 299 Degree-Sign were selected. Comparison with previous earthquake locations shows an improvement for the relocated earthquakes. Tests were carried out to verify the robustness of inversion results in order to corroborate the conclusions drawn out from our reasearch. The obtained minimum 1-D velocity model can be used to improve routine earthquake locations and represents a further step toward more detailed seismotectonic studies in this area of West Java.

  5. An accurate locally active memristor model for S-type negative differential resistance in NbOx

    NASA Astrophysics Data System (ADS)

    Gibson, Gary A.; Musunuru, Srinitya; Zhang, Jiaming; Vandenberghe, Ken; Lee, James; Hsieh, Cheng-Chih; Jackson, Warren; Jeon, Yoocharn; Henze, Dick; Li, Zhiyong; Stanley Williams, R.

    2016-01-01

    A number of important commercial applications would benefit from the introduction of easily manufactured devices that exhibit current-controlled, or "S-type," negative differential resistance (NDR). A leading example is emerging non-volatile memory based on crossbar array architectures. Due to the inherently linear current vs. voltage characteristics of candidate non-volatile memristor memory elements, individual memory cells in these crossbar arrays can be addressed only if a highly non-linear circuit element, termed a "selector," is incorporated in the cell. Selectors based on a layer of niobium oxide sandwiched between two electrodes have been investigated by a number of groups because the NDR they exhibit provides a promisingly large non-linearity. We have developed a highly accurate compact dynamical model for their electrical conduction that shows that the NDR in these devices results from a thermal feedback mechanism. A series of electrothermal measurements and numerical simulations corroborate this model. These results reveal that the leakage currents can be minimized by thermally isolating the selector or by incorporating materials with larger activation energies for electron motion.

  6. 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

  7. Preoperative Laboratory Testing.

    PubMed

    Bock, Matthias; Fritsch, Gerhard; Hepner, David L

    2016-03-01

    Routine preoperative testing is not cost-effective, because it is unlikely to identify significant abnormalities. Abnormal findings from routine testing are more likely to be false positive, are costly to pursue, introduce a new risk, increase the patient's anxiety, and are inconvenient to the patient. Abnormal findings rarely alter the surgical or anesthetic plan, and there is usually no association between perioperative complications and abnormal laboratory results. Incidental findings and false positive results may lead to increased hospital visits and admissions. Preoperative testing needs to be done based on a targeted history and physical examination and the type of surgery. PMID:26927738

  8. The Preoperative Neurological Evaluation

    PubMed Central

    Probasco, John; Sahin, Bogachan; Tran, Tung; Chung, Tae Hwan; Rosenthal, Liana Shapiro; Mari, Zoltan; Levy, Michael

    2013-01-01

    Neurological diseases are prevalent in the general population, and the neurohospitalist has an important role to play in the preoperative planning for patients with and at risk for developing neurological disease. The neurohospitalist can provide patients and their families as well as anesthesiologists, surgeons, hospitalists, and other providers guidance in particular to the patient’s neurological disease and those he or she is at risk for. Here we present considerations and guidance for the neurohospitalist providing preoperative consultation for the neurological patient with or at risk of disturbances of consciousness, cerebrovascular and carotid disease, epilepsy, neuromuscular disease, and Parkinson disease. PMID:24198903

  9. Phase I-II Trial of Concurrent Capecitabine and Oxaliplatin With Preoperative Intensity-Modulated Radiotherapy in Patients With Locally Advanced Rectal Cancer

    SciTech Connect

    Aristu, Jose Javier Arbea, Leire; Rodriguez, Javier; Hernandez-Lizoain, Jose Luis; Sola, Jesus Javier; Moreno, Marta M.D.; Azcona, Juan Diego; Diaz-Gonzalez, Juan Antonio; Garcia-Foncillas, Jesus Miguel; Martinez-Monge, Rafael

    2008-07-01

    Purpose: To identify the maximal tolerated dose level of preoperative intensity-modulated radiotherapy combined with capecitabine and oxaliplatin and to evaluate the efficacy. Patients and Methods: Patients with rectal T3-T4 and/or N0-N+ rectal cancer received capecitabine 825 mg/m{sup 2} twice daily Monday through Friday and oxaliplatin 60 mg/m{sup 2} intravenously on Days 1, 8, and 15, concurrently with intensity-modulated radiotherapy. The radiation dose was increased in 5.0-Gy steps in cohorts of 3 patients starting from 37.5 Gy in 15 fractions (dose level [DL] 1). DL2 and DL3 were designed to reach 42.5 Gy in 17 fractions and 47.5 Gy in 19 fractions, respectively. Results: No dose-limiting toxicity was observed at DL1 or DL2. Of the 3 patients treated at DL3, 1 presented with Grade 3 diarrhea, which was considered a dose-limiting toxicity, and 3 additional patients were added. Of the 6 patients treated at DL3, no new dose-limiting toxicities were observed, and DL3 was identified as the recommended dose in this study. Eight additional patients were treated at 47.5 Gy. Grade 2 proctitis was the most frequent adverse event (40%); Grade 3 diarrhea occurred in 2 patients (10%). All patients underwent surgery, and 17 patients (85%) underwent R0 resection. Four patients (20%) presented with a histologic response of Grade 4, 11 (55%) with Grade 3+, 2 (15%) with Grade 3, and 2 patients (10%) with Grade 2. Conclusion: The maximal tolerated dose in this study was 47.5 Gy. The high rates of pathologic response of Grade 3+ and 4 must be confirmed through the accrual of new patients in the Phase II study.

  10. Efficient and accurate local approximations to coupled-electron pair approaches: An attempt to revive the pair natural orbital method

    NASA Astrophysics Data System (ADS)

    Neese, Frank; Wennmohs, Frank; Hansen, Andreas

    2009-03-01

    Coupled-electron pair approximations (CEPAs) and coupled-pair functionals (CPFs) have been popular in the 1970s and 1980s and have yielded excellent results for small molecules. Recently, interest in CEPA and CPF methods has been renewed. It has been shown that these methods lead to competitive thermochemical, kinetic, and structural predictions. They greatly surpass second order Møller-Plesset and popular density functional theory based approaches in accuracy and are intermediate in quality between CCSD and CCSD(T) in extended benchmark studies. In this work an efficient production level implementation of the closed shell CEPA and CPF methods is reported that can be applied to medium sized molecules in the range of 50-100 atoms and up to about 2000 basis functions. The internal space is spanned by localized internal orbitals. The external space is greatly compressed through the method of pair natural orbitals (PNOs) that was also introduced by the pioneers of the CEPA approaches. Our implementation also makes extended use of density fitting (or resolution of the identity) techniques in order to speed up the laborious integral transformations. The method is called local pair natural orbital CEPA (LPNO-CEPA) (LPNO-CPF). The implementation is centered around the concepts of electron pairs and matrix operations. Altogether three cutoff parameters are introduced that control the size of the significant pair list, the average number of PNOs per electron pair, and the number of contributing basis functions per PNO. With the conservatively chosen default values of these thresholds, the method recovers about 99.8% of the canonical correlation energy. This translates to absolute deviations from the canonical result of only a few kcal mol-1. Extended numerical test calculations demonstrate that LPNO-CEPA (LPNO-CPF) has essentially the same accuracy as parent CEPA (CPF) methods for thermochemistry, kinetics, weak interactions, and potential energy surfaces but is up to 500

  11. Quantum dynamics of two quantum dots coupled through localized plasmons: An intuitive and accurate quantum optics approach using quasinormal modes

    NASA Astrophysics Data System (ADS)

    Ge, Rong-Chun; Hughes, Stephen

    2015-11-01

    We study the quantum dynamics of two quantum dots (QDs) or artificial atoms coupled through the fundamental localized plasmon of a gold nanorod resonator. We derive an intuitive and efficient time-local master equation, in which the effect of the metal nanorod is taken into consideration self-consistently using a quasinormal mode (QNM) expansion technique of the photon Green function. Our efficient QNM technique offers an alternative and more powerful approach over the standard Jaynes-Cummings model, where the radiative decay, nonradiative decay, and spectral reshaping effect of the electromagnetic environment is rigorously included in a clear and transparent way. We also show how one can use our approach to compliment the approximate Jaynes-Cummings model in certain spatial regimes where it is deemed to be valid. We then present a study of the quantum dynamics and photoluminescence spectra of the two plasmon-coupled QDs. We first explore the non-Markovian regime, which is found to be important only on the ultrashort time scale of the plasmon mode which is about 40 fs. For the field free evolution case of excited QDs near the nanorod, we demonstrate how spatially separated QDs can be effectively coupled through the plasmon resonance and we show how frequencies away from the plasmon resonance can be more effective for coherently coupling the QDs. Despite the strong inherent dissipation of gold nanoresonators, we show that qubit entanglements as large as 0.7 can be achieved from an initially separate state, which has been limited to less than 0.5 in previous work for weakly coupled reservoirs. We also study the superradiance and subradiance decay dynamics of the QD pair. Finally, we investigate the rich quantum dynamics of QDs that are incoherently pumped, and study the polarization dependent behavior of the emitted photoluminescence spectrum where a double-resonance structure is observed due to the strong photon exchange interactions. Our general quantum plasmonics

  12. Accurate quantification of local changes for carotid arteries in 3D ultrasound images using convex optimization-based deformable registration

    NASA Astrophysics Data System (ADS)

    Cheng, Jieyu; Qiu, Wu; Yuan, Jing; Fenster, Aaron; Chiu, Bernard

    2016-03-01

    Registration of longitudinally acquired 3D ultrasound (US) images plays an important role in monitoring and quantifying progression/regression of carotid atherosclerosis. We introduce an image-based non-rigid registration algorithm to align the baseline 3D carotid US with longitudinal images acquired over several follow-up time points. This algorithm minimizes the sum of absolute intensity differences (SAD) under a variational optical-flow perspective within a multi-scale optimization framework to capture local and global deformations. Outer wall and lumen were segmented manually on each image, and the performance of the registration algorithm was quantified by Dice similarity coefficient (DSC) and mean absolute distance (MAD) of the outer wall and lumen surfaces after registration. In this study, images for 5 subjects were registered initially by rigid registration, followed by the proposed algorithm. Mean DSC generated by the proposed algorithm was 79:3+/-3:8% for lumen and 85:9+/-4:0% for outer wall, compared to 73:9+/-3:4% and 84:7+/-3:2% generated by rigid registration. Mean MAD of 0:46+/-0:08mm and 0:52+/-0:13mm were generated for lumen and outer wall respectively by the proposed algorithm, compared to 0:55+/-0:08mm and 0:54+/-0:11mm generated by rigid registration. The mean registration time of our method per image pair was 143+/-23s.

  13. [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

  14. The Role of Dual-Time Combined 18-Fluorideoxyglucose Positron Emission Tomography and Computed Tomography in the Staging and Restaging Workup of Locally Advanced Rectal Cancer, Treated With Preoperative Chemoradiation Therapy and Radical Surgery

    SciTech Connect

    Capirci, Carlo Rubello, Domenico; Pasini, Felice; Galeotti, Fabrizio; Bianchini, Enzo; Del Favero, Giuseppe; Panzavolta, Riccardo; Crepaldi, Giorgio; Rampin, Lucia; Facci, Enzo; Gava, Marcello; Banti, Elena; Marano, Gianfranco

    2009-08-01

    Purpose: In patients with locally advanced rectal cancer (LARC) staging and, after preoperative chemo-radiation therapy (CRT), restaging workup could be useful to tailor therapeutic approaches. Fluorine-18-fluorodeoxyglucose positron emission tomography ([{sup 18}F]FDG-PET) is a promising tool for monitoring the effect of antitumor therapy. This study was aimed to evaluate the possible role of dual time sequential FDG-PET scans in the staging and restaging workup of LARC. Methods and Materials: Eighty-seven consecutive patients with LARC were enrolled. CRT consisted of external-beam intensified radiotherapy (concurrent boost), with concomitant chemotherapy PVI 5-FU (300mg/m{sup 2}/day) followed 8-10 weeks later by surgery. All patients underwent [{sup 18}F]FDG-PET/CT before and 5-6 weeks later after the completion of CRT. Measurements of FDG uptake (SUV{sub max}), and percentage of SUV{sub max} difference (Response Index = RI) between pre- and post-CRT [{sup 18}F]FDG-PET scans were evaluated. Results: Six of 87 patients were excluded due to protocol deviation. Following CRT, 40/81 patients (49%) were classified as responders according to Mandard's criteria (TRG1-2). The mean pre-CRT SUV{sub max} was significantly higher than post-CRT (15.8, vs 5.9; p < 0.001). The mean RI was significantly higher in responders than in nonresponder patients (71.3% vs 38%; p = 0.0038). Using a RI cut-off of 65% for defining response to therapy, the following parameters have been obtained: 84.5% sensitivity, 80% specificity, 81.4% positive predictive value, 84.2% negative predictive value, and 81% overall accuracy. Conclusion: These results suggest the potential role of [{sup 18}F]FDG-PET in the restaging workup after preoperative CRT in LARC. RI seems the best predictor to identify CRT response.

  15. Infusional 5-Fluorouracil and ZD1839 (Gefitinib-Iressa) in Combination With Preoperative Radiotherapy in Patients With Locally Advanced Rectal Cancer: A Phase I and II Trial (1839IL/0092)

    SciTech Connect

    Valentini, Vincenzo; De Paoli, Antonino; Gambacorta, Maria Antonietta Mantini, Giovanna; Ratto, Carlo; Vecchio, Fabio Maria; Barbaro, Brunella; Innocente, Roberto; Rossi, Carlo; Boz, Giovanni; Barba, Maria Cristina; Frattegiani, Alessandro; Lupattelli, Marco; Doglietto, Giovan Battista

    2008-11-01

    Purpose: To report the final data of a Phase I and II study (1839IL/0092) on the combination of an anti-epidermal growth factor receptor drug (gefitinib), infusional 5-fluorouracil, and preoperative radiotherapy in locally advanced, resectable rectal cancer. Methods and Materials: Patients received 45 Gy in the posterior pelvis plus a boost of 5.4 Gy on the tumor and corresponding mesorectum. Infusional 5-fluorouracil (5-FU) and gefitinib (250 and 500 mg/day) were delivered during all radiotherapy course. An IORT boost of 10 Gy was allowed. The main endpoints of the study were to establish dose-limiting toxicity (DLT) and to evaluate the rate of pathologic response according to the tumor regression grade (TRG) Mandard score. Results: A total of 41 patients were enrolled. The DLT was not reached in the 6 patients enrolled in the dose-escalation part of the study. Of the 33 patients in the Phase II, TRG 1 was recorded in 10 patients (30.3%) and TRG 2 in 7 patients (21.2 %); overall 17 of 33 patients (51.5%) had a favorable endpoint. Overall, Grade 3+ toxicity was recorded in 16 patients (41%); these included Grade 3+ gastrointestinal toxicity in 8 patients (20.5%), Grade 3+ skin toxicity in 6 (15.3%), and Grade 3+ genitourinary toxicity in 4 (10.2%). A dose reduction of gefitinib was necessary in 24 patients (61.5%). Conclusions: Gefitinib can be associated with 5-FU-based preoperative chemoradiation at the dose of 500 mg without any life-threatening toxicity and with a high pCR (30.3%). The relevant rate of Grade 3 gastrointestinal toxicity suggests that 250 mg would be more tolerable dose in a neaoadjuvant approach with radiotherapy and infusional 5-FU.

  16. Strategy for accurate liver intervention by an optical tracking system

    PubMed Central

    Lin, Qinyong; Yang, Rongqian; Cai, Ken; Guan, Peifeng; Xiao, Weihu; Wu, Xiaoming

    2015-01-01

    Image-guided navigation for radiofrequency ablation of liver tumors requires the accurate guidance of needle insertion into a tumor target. The main challenge of image-guided navigation for radiofrequency ablation of liver tumors is the occurrence of liver deformations caused by respiratory motion. This study reports a strategy of real-time automatic registration to track custom fiducial markers glued onto the surface of a patient’s abdomen to find the respiratory phase, in which the static preoperative CT is performed. Custom fiducial markers are designed. Real-time automatic registration method consists of the automatic localization of custom fiducial markers in the patient and image spaces. The fiducial registration error is calculated in real time and indicates if the current respiratory phase corresponds to the phase of the static preoperative CT. To demonstrate the feasibility of the proposed strategy, a liver simulator is constructed and two volunteers are involved in the preliminary experiments. An ex-vivo porcine liver model is employed to further verify the strategy for liver intervention. Experimental results demonstrate that real-time automatic registration method is rapid, accurate, and feasible for capturing the respiratory phase from which the static preoperative CT anatomical model is generated by tracking the movement of the skin-adhered custom fiducial markers. PMID:26417501

  17. Lesions entirely removed during stereotactic biopsy: preoperative localization on the basis of mammographic landmarks and feasibility of freehand technique--initial experience.

    PubMed

    Brenner, R J

    2000-02-01

    Seven patients with mammographic lesions entirely removed at percutaneous core needle biopsy that required wider excision underwent freehand localization of the site of the prior lesion with orthogonal and reproducible mammographic landmarks to guide needle placement. Successful excision was accomplished in all cases, as evidenced by similar histopathologic findings, fibrin bands or collagen, and core needle biopsy tract at microscopy. PMID:10671616

  18. 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

  19. Preoperative biliary drainage.

    PubMed

    Saxena, Payal; Kumbhari, Vivek; Zein, Mohamad E L; Khashab, Mouen A

    2015-01-01

    The role of preoperative biliary drainage (PBD) in patients with distal or proximal biliary obstruction secondary to resectable tumors has been a matter for debate. A review of the literature using Medline, Embase and Cochrane databases was undertaken for studies evaluating routes of drainage (endoscopic or percutaneous) and stent types (plastic or metal) in patients with resectable disease. Preoperative biliary drainage is indicated for relief of symptomatic jaundice, cholangitis, patients undergoing neoadjuvant therapy or those patients where surgery may be delayed. Endoscopic methods are preferred over percutaneous methods because of lower complication rates. In patients with proximal biliary obstruction, PBD should be guided by imaging studies to aid in selective biliary cannulation for unilateral drainage in order to reduce the risk of cholangitis in undrained liver segments. PMID:25293587

  20. Local Skin Warming Enhances Color Duplex Imaging of Cutaneous Perforators.

    PubMed

    Li, Haizhou; Du, Zijing; Xie, Feng; Zan, Tao; Li, QingFeng

    2015-07-01

    The perforator flap is one of the most useful techniques in reconstructive surgery. The operative procedure for these flaps will be greatly simplified if accurate localization of the course of the perforator can be preoperatively confirmed. However, small vessels with diameters less than 0.5 mm cannot be readily traced with conventional imaging techniques. Local skin warming temporarily increases cutaneous blood flow and vasodilation. In this study, we established a local skin warming procedure, and performed this before color duplex imaging to improve preoperative perforator mapping and enable precise flap design. PMID:23903089

  1. Computed Tomography Angiography for Preoperative Thoracoabdominal Flap Planning.

    PubMed

    O'Malley, Ryan B; Robinson, Tracy J; Kozlow, Jeffrey H; Liu, Peter S

    2016-01-01

    Mastectomy rates have increased, coinciding with more advanced reconstruction options. Deep inferior epigastric perforator (DIEP) flaps decrease abdominal donor site morbidity, but require considerable technical expertise. Preoperative computed tomography angiography (CTA) can accurately demonstrate DIEA anatomy and perforator courses, facilitating preoperative planning and flap design, allowing for more targeted intraoperative microdissection. Patients who undergo CTA before DIEP flap have better clinical outcomes with shorter operative times and hospital length of stay, which can decrease overall associated health care costs. Future directions include selected imaging of the thoracic anatomy and recipient vasculature, allowing for additional preoperative planning and customization. PMID:26654396

  2. Preoperative prediction of neurovascular bundle involvement of localized prostate cancer by combined T2 and diffusion-weighted imaging of magnetic resonance imaging, number of positive biopsy cores, and Gleason score.

    PubMed

    Naiki, Taku; Okamura, Takehiko; Nagata, Daisuke; Mori, Yuji; Kawai, Noriyasu; Ogawa, Kumiko; Akita, Hidetoshi; Hashimoto, Yoshihiro; Tozawa, Keiichi; Kohri, Kenjiro

    2011-01-01

    Because recovery of erectile function and avoidance of positive surgical margins are important but competing outcomes with prostate cancer therapy, the decision to preserve or resect a neurovascular bundle (NVB) during laparoscopic radical prostatectomy (LRP) should be firmly based on information concerning the presence and location of extracapsular extension. In the current retrospective study, the propriety of actual decisions was assessed using preoperative magnetic resonance imaging (MRI), combining T2-weighted imaging (T2WI) with diffusion-weighted imaging (DWI), the apparent diffusion coefficient (ADC), numbers of positive biopsy cores, tumor volume and the Gleason score. MRI before prostate biopsy was performed in 35 patients who underwent LRP for clinically localized prostate cancer. A single radiologist retrospectively assessed whether the tumor localization, capsular penetration, seminal vesicle invasion, NVB involvement, and MRI findings correlated with the postoperative histological results. With the postoperative specimens, 83 lesions demonstrated a Gleason score of 6 or more. Using T2WI with and without DWI and ADC, 39 and 27 of 54 lesions were correctly identified, respectively, the difference being significant. For cancers in the transitional zone, using a threshold Gleason score of 3 or greater, sensitivity was also significantly higher for T2+DWI+ADC than for T2WI alone. Of 35 patients, using all available clinical information (biopsy results including Gleason score, tumor location, percentage of positive biopsy cores, and the percentage of tumor-involved core tissue), we found that the preoperative and postoperative staging were concordant in 25 cases. There is no universal consensus for nerve-sparing LRP; therefore, we performed an additional analysis using simplified clinically defined selection criteria (PSA level >15ng/mL, cT2, less than two positive biopsy scores in the unilateral lobe and less than 30% tumor volume, and a Gleason score of 6

  3. The double-helix point spread function enables precise and accurate measurement of 3D single-molecule localization and orientation

    PubMed Central

    Backlund, Mikael P.; Lew, Matthew D.; Backer, Adam S.; Sahl, Steffen J.; Grover, Ginni; Agrawal, Anurag; Piestun, Rafael; Moerner, W. E.

    2014-01-01

    Single-molecule-based super-resolution fluorescence microscopy has recently been developed to surpass the diffraction limit by roughly an order of magnitude. These methods depend on the ability to precisely and accurately measure the position of a single-molecule emitter, typically by fitting its emission pattern to a symmetric estimator (e.g. centroid or 2D Gaussian). However, single-molecule emission patterns are not isotropic, and depend highly on the orientation of the molecule’s transition dipole moment, as well as its z-position. Failure to account for this fact can result in localization errors on the order of tens of nm for in-focus images, and ~50–200 nm for molecules at modest defocus. The latter range becomes especially important for three-dimensional (3D) single-molecule super-resolution techniques, which typically employ depths-of-field of up to ~2 μm. To address this issue we report the simultaneous measurement of precise and accurate 3D single-molecule position and 3D dipole orientation using the Double-Helix Point Spread Function (DH-PSF) microscope. We are thus able to significantly improve dipole-induced position errors, reducing standard deviations in lateral localization from ~2x worse than photon-limited precision (48 nm vs. 25 nm) to within 5 nm of photon-limited precision. Furthermore, by averaging many estimations of orientation we are able to improve from a lateral standard deviation of 116 nm (~4x worse than the precision, 28 nm) to 34 nm (within 6 nm). PMID:24817798

  4. Stereotactic hypofractionated accurate radiotherapy of the prostate (SHARP), 33.5 Gy in five fractions for localized disease: First clinical trial results

    SciTech Connect

    Madsen, Berit L. . E-mail: ronblm@vmmc.org; Hsi, R. Alex; Pham, Huong T.; Fowler, Jack F.; Esagui, Laura C.; Corman, John

    2007-03-15

    Purpose: To evaluate the feasibility and toxicity of stereotactic hypofractionated accurate radiotherapy (SHARP) for localized prostate cancer. Methods and Materials: A Phase I/II trial of SHARP performed for localized prostate cancer using 33.5 Gy in 5 fractions, calculated to be biologically equivalent to 78 Gy in 2 Gy fractions ({alpha}/{beta} ratio of 1.5 Gy). Noncoplanar conformal fields and daily stereotactic localization of implanted fiducials were used for treatment. Genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated by American Urologic Association (AUA) score and Common Toxicity Criteria (CTC). Prostate-specific antigen (PSA) values and self-reported sexual function were recorded at specified follow-up intervals. Results: The study includes 40 patients. The median follow-up is 41 months (range, 21-60 months). Acute toxicity Grade 1-2 was 48.5% (GU) and 39% (GI); 1 acute Grade 3 GU toxicity. Late Grade 1-2 toxicity was 45% (GU) and 37% (GI). No late Grade 3 or higher toxicity was reported. Twenty-six patients reported potency before therapy; 6 (23%) have developed impotence. Median time to PSA nadir was 18 months with the majority of nadirs less than 1.0 ng/mL. The actuarial 48-month biochemical freedom from relapse is 70% for the American Society for Therapeutic Radiology and Oncology definition and 90% by the alternative nadir + 2 ng/mL failure definition. Conclusions: SHARP for localized prostate cancer is feasible with minimal acute or late toxicity. Dose escalation should be possible.

  5. Which preoperative respiratory evaluation?

    PubMed

    Zraier, S; Haouache, H; Dhonneur, G

    2014-01-01

    The preoperative respiratory evaluation aims at predicting the occurrence of postoperative respiratory complications (PORC), such as: atelectasis, pulmonary infection (bronchitis and pneumonia), acute ventilatory distress, pleural effusion, prolonged mechanical ventilation, exacerbation of chronic respiratory disease and bronchospasm. The incidence of (PORC) all surgeries combined is 6.8%. Individual surgical and anesthetic factors are impacting on the occurrence of PORC. Simple scores, including anamnestic data, clinical examination and some biological parameters were validated to assess the risk of PORC depending on the type of surgery. Data from standard pulmonary function tests (PFT) is of little use to estimate the individual risk of PORC. Most of the time, PFT abnormal parameters only confirm the clinical assessment of the severity of the illness. PFT may however be useful to confirm an improvement in the clinical condition of the patient related to the preoperative preparation. Specialized EFR, including standardized testing efforts are sometimes required in the case of lung reduction surgery. These specialized explorations can predict lung function and post-interventional pulmonary oxygenation and ensure that these are viable. PMID:25168302

  6. Accurate and Fully Automatic Hippocampus Segmentation Using Subject-Specific 3D Optimal Local Maps Into a Hybrid Active Contour Model

    PubMed Central

    Gkontra, Polyxeni; Daras, Petros; Maglaveras, Nicos

    2014-01-01

    Assessing the structural integrity of the hippocampus (HC) is an essential step toward prevention, diagnosis, and follow-up of various brain disorders due to the implication of the structural changes of the HC in those disorders. In this respect, the development of automatic segmentation methods that can accurately, reliably, and reproducibly segment the HC has attracted considerable attention over the past decades. This paper presents an innovative 3-D fully automatic method to be used on top of the multiatlas concept for the HC segmentation. The method is based on a subject-specific set of 3-D optimal local maps (OLMs) that locally control the influence of each energy term of a hybrid active contour model (ACM). The complete set of the OLMs for a set of training images is defined simultaneously via an optimization scheme. At the same time, the optimal ACM parameters are also calculated. Therefore, heuristic parameter fine-tuning is not required. Training OLMs are subsequently combined, by applying an extended multiatlas concept, to produce the OLMs that are anatomically more suitable to the test image. The proposed algorithm was tested on three different and publicly available data sets. Its accuracy was compared with that of state-of-the-art methods demonstrating the efficacy and robustness of the proposed method. PMID:27170866

  7. Ring polymer molecular dynamics fast computation of rate coefficients on accurate potential energy surfaces in local configuration space: Application to the abstraction of hydrogen from methane

    NASA Astrophysics Data System (ADS)

    Meng, Qingyong; Chen, Jun; Zhang, Dong H.

    2016-04-01

    To fast and accurately compute rate coefficients of the H/D + CH4 → H2/HD + CH3 reactions, we propose a segmented strategy for fitting suitable potential energy surface (PES), on which ring-polymer molecular dynamics (RPMD) simulations are performed. On the basis of recently developed permutation invariant polynomial neural-network approach [J. Li et al., J. Chem. Phys. 142, 204302 (2015)], PESs in local configuration spaces are constructed. In this strategy, global PES is divided into three parts, including asymptotic, intermediate, and interaction parts, along the reaction coordinate. Since less fitting parameters are involved in the local PESs, the computational efficiency for operating the PES routine is largely enhanced by a factor of ˜20, comparing with that for global PES. On interaction part, the RPMD computational time for the transmission coefficient can be further efficiently reduced by cutting off the redundant part of the child trajectories. For H + CH4, good agreements among the present RPMD rates and those from previous simulations as well as experimental results are found. For D + CH4, on the other hand, qualitative agreement between present RPMD and experimental results is predicted.

  8. Accurate and Fully Automatic Hippocampus Segmentation Using Subject-Specific 3D Optimal Local Maps Into a Hybrid Active Contour Model.

    PubMed

    Zarpalas, Dimitrios; Gkontra, Polyxeni; Daras, Petros; Maglaveras, Nicos

    2014-01-01

    Assessing the structural integrity of the hippocampus (HC) is an essential step toward prevention, diagnosis, and follow-up of various brain disorders due to the implication of the structural changes of the HC in those disorders. In this respect, the development of automatic segmentation methods that can accurately, reliably, and reproducibly segment the HC has attracted considerable attention over the past decades. This paper presents an innovative 3-D fully automatic method to be used on top of the multiatlas concept for the HC segmentation. The method is based on a subject-specific set of 3-D optimal local maps (OLMs) that locally control the influence of each energy term of a hybrid active contour model (ACM). The complete set of the OLMs for a set of training images is defined simultaneously via an optimization scheme. At the same time, the optimal ACM parameters are also calculated. Therefore, heuristic parameter fine-tuning is not required. Training OLMs are subsequently combined, by applying an extended multiatlas concept, to produce the OLMs that are anatomically more suitable to the test image. The proposed algorithm was tested on three different and publicly available data sets. Its accuracy was compared with that of state-of-the-art methods demonstrating the efficacy and robustness of the proposed method. PMID:27170866

  9. A non-rigid point matching method with local topology preservation for accurate bladder dose summation in high dose rate cervical brachytherapy

    NASA Astrophysics Data System (ADS)

    Chen, Haibin; Zhong, Zichun; Liao, Yuliang; Pompoš, Arnold; Hrycushko, Brian; Albuquerque, Kevin; Zhen, Xin; Zhou, Linghong; Gu, Xuejun

    2016-02-01

    GEC-ESTRO guidelines for high dose rate cervical brachytherapy advocate the reporting of the D2cc (the minimum dose received by the maximally exposed 2cc volume) to organs at risk. Due to large interfractional organ motion, reporting of accurate cumulative D2cc over a multifractional course is a non-trivial task requiring deformable image registration and deformable dose summation. To efficiently and accurately describe the point-to-point correspondence of the bladder wall over all treatment fractions while preserving local topologies, we propose a novel graphic processing unit (GPU)-based non-rigid point matching algorithm. This is achieved by introducing local anatomic information into the iterative update of correspondence matrix computation in the ‘thin plate splines-robust point matching’ (TPS-RPM) scheme. The performance of the GPU-based TPS-RPM with local topology preservation algorithm (TPS-RPM-LTP) was evaluated using four numerically simulated synthetic bladders having known deformations, a custom-made porcine bladder phantom embedded with twenty one fiducial markers, and 29 fractional computed tomography (CT) images from seven cervical cancer patients. Results show that TPS-RPM-LTP achieved excellent geometric accuracy with landmark residual distance error (RDE) of 0.7  ±  0.3 mm for the numerical synthetic data with different scales of bladder deformation and structure complexity, and 3.7  ±  1.8 mm and 1.6  ±  0.8 mm for the porcine bladder phantom with large and small deformation, respectively. The RDE accuracy of the urethral orifice landmarks in patient bladders was 3.7  ±  2.1 mm. When compared to the original TPS-RPM, the TPS-RPM-LTP improved landmark matching by reducing landmark RDE by 50  ±  19%, 37  ±  11% and 28  ±  11% for the synthetic, porcine phantom and the patient bladders, respectively. This was achieved with a computational time of less than 15 s in all cases

  10. A non-rigid point matching method with local topology preservation for accurate bladder dose summation in high dose rate cervical brachytherapy.

    PubMed

    Chen, Haibin; Zhong, Zichun; Liao, Yuliang; Pompoš, Arnold; Hrycushko, Brian; Albuquerque, Kevin; Zhen, Xin; Zhou, Linghong; Gu, Xuejun

    2016-02-01

    GEC-ESTRO guidelines for high dose rate cervical brachytherapy advocate the reporting of the D2cc (the minimum dose received by the maximally exposed 2cc volume) to organs at risk. Due to large interfractional organ motion, reporting of accurate cumulative D2cc over a multifractional course is a non-trivial task requiring deformable image registration and deformable dose summation. To efficiently and accurately describe the point-to-point correspondence of the bladder wall over all treatment fractions while preserving local topologies, we propose a novel graphic processing unit (GPU)-based non-rigid point matching algorithm. This is achieved by introducing local anatomic information into the iterative update of correspondence matrix computation in the 'thin plate splines-robust point matching' (TPS-RPM) scheme. The performance of the GPU-based TPS-RPM with local topology preservation algorithm (TPS-RPM-LTP) was evaluated using four numerically simulated synthetic bladders having known deformations, a custom-made porcine bladder phantom embedded with twenty one fiducial markers, and 29 fractional computed tomography (CT) images from seven cervical cancer patients. Results show that TPS-RPM-LTP achieved excellent geometric accuracy with landmark residual distance error (RDE) of 0.7  ±  0.3 mm for the numerical synthetic data with different scales of bladder deformation and structure complexity, and 3.7  ±  1.8 mm and 1.6  ±  0.8 mm for the porcine bladder phantom with large and small deformation, respectively. The RDE accuracy of the urethral orifice landmarks in patient bladders was 3.7  ±  2.1 mm. When compared to the original TPS-RPM, the TPS-RPM-LTP improved landmark matching by reducing landmark RDE by 50  ±  19%, 37  ±  11% and 28  ±  11% for the synthetic, porcine phantom and the patient bladders, respectively. This was achieved with a computational time of less than 15 s in all cases

  11. 2D/3D Image fusion for accurate target localization and evaluation of a mask based stereotactic system in fractionated stereotactic radiotherapy of cranial lesions

    SciTech Connect

    Jin, J.-Y.; Ryu, Samuel; Faber, Kathleen; Mikkelsen, Tom; Chen Qing; Li Shidong; Movsas, Benjamin

    2006-12-15

    The purpose of this study was to evaluate the accuracy of a two-dimensional (2D) to three-dimensional (3D) image-fusion-guided target localization system and a mask based stereotactic system for fractionated stereotactic radiotherapy (FSRT) of cranial lesions. A commercial x-ray image guidance system originally developed for extracranial radiosurgery was used for FSRT of cranial lesions. The localization accuracy was quantitatively evaluated with an anthropomorphic head phantom implanted with eight small radiopaque markers (BBs) in different locations. The accuracy and its clinical reliability were also qualitatively evaluated for a total of 127 fractions in 12 patients with both kV x-ray images and MV portal films. The image-guided system was then used as a standard to evaluate the overall uncertainty and reproducibility of the head mask based stereotactic system in these patients. The phantom study demonstrated that the maximal random error of the image-guided target localization was {+-}0.6 mm in each direction in terms of the 95% confidence interval (CI). The systematic error varied with measurement methods. It was approximately 0.4 mm, mainly in the longitudinal direction, for the kV x-ray method. There was a 0.5 mm systematic difference, primarily in the lateral direction, between the kV x-ray and the MV portal methods. The patient study suggested that the accuracy of the image-guided system in patients was comparable to that in the phantom. The overall uncertainty of the mask system was {+-}4 mm, and the reproducibility was {+-}2.9 mm in terms of 95% CI. The study demonstrated that the image guidance system provides accurate and precise target positioning.

  12. A Study to Test the Feasibility of Determining Whether Classified Want Ads in Daily Newspapers Are an Accurate Reflection of Local Labor Markets and of Significant Use to Employers and Job Seekers. Final Report.

    ERIC Educational Resources Information Center

    Olympus Research Corp., Salt Lake City, UT.

    The report summarizes findings of a detailed study to test the feasibility of determining whether want ads in daily newspapers are (1) an accurate reflection of local labor markets and (2) of significant use to employers and job seekers. The study found that want ads are a limited source of information about local labor markets. They are of some…

  13. Some properties of negative cloud-to-ground flashes from observations of a local thunderstorm based on accurate-stroke-count studies

    NASA Astrophysics Data System (ADS)

    Zhu, Baoyou; Ma, Ming; Xu, Weiwei; Ma, Dong

    2015-12-01

    Properties of negative cloud-to-ground (CG) lightning flashes, in terms of number of strokes per flash, inter-stroke intervals and the relative intensity of subsequent and first strokes, were presented by accurate-stroke-count studies based on all 1085 negative flashes from a local thunderstorm. The percentage of single-stroke flashes and stroke multiplicity evolved significantly during the whole life cycle of the study thunderstorm. The occurrence probability of negative CG flashes decreased exponentially with the increasing number of strokes per flash. About 30.5% of negative CG flashes contained only one stroke and number of strokes per flash averaged 3.3. In a subset of 753 negative multiple-stroke flashes, about 41.4% contained at least one subsequent stroke stronger than the corresponding first stroke. Subsequent strokes tended to decrease in strength with their orders and the ratio of subsequent to first stroke peaks presented a geometric mean value of 0.52. Interestingly, negative CG flashes of higher multiplicity tended to have stronger initial strokes. 2525 inter-stroke intervals showed a more or less log-normal distribution and gave a geometric mean value of 62 ms. For CG flashes of particular multiplicity geometric mean inter-stroke intervals tended to decrease with the increasing number of strokes per flash, while those intervals associated with higher order strokes tended to be larger than those associated with low order strokes.

  14. Time-Accurate Local Time Stepping and High-Order Time CESE Methods for Multi-Dimensional Flows Using Unstructured Meshes

    NASA Technical Reports Server (NTRS)

    Chang, Chau-Lyan; Venkatachari, Balaji Shankar; Cheng, Gary

    2013-01-01

    With the wide availability of affordable multiple-core parallel supercomputers, next generation numerical simulations of flow physics are being focused on unsteady computations for problems involving multiple time scales and multiple physics. These simulations require higher solution accuracy than most algorithms and computational fluid dynamics codes currently available. This paper focuses on the developmental effort for high-fidelity multi-dimensional, unstructured-mesh flow solvers using the space-time conservation element, solution element (CESE) framework. Two approaches have been investigated in this research in order to provide high-accuracy, cross-cutting numerical simulations for a variety of flow regimes: 1) time-accurate local time stepping and 2) highorder CESE method. The first approach utilizes consistent numerical formulations in the space-time flux integration to preserve temporal conservation across the cells with different marching time steps. Such approach relieves the stringent time step constraint associated with the smallest time step in the computational domain while preserving temporal accuracy for all the cells. For flows involving multiple scales, both numerical accuracy and efficiency can be significantly enhanced. The second approach extends the current CESE solver to higher-order accuracy. Unlike other existing explicit high-order methods for unstructured meshes, the CESE framework maintains a CFL condition of one for arbitrarily high-order formulations while retaining the same compact stencil as its second-order counterpart. For large-scale unsteady computations, this feature substantially enhances numerical efficiency. Numerical formulations and validations using benchmark problems are discussed in this paper along with realistic examples.

  15. 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

  16. NRG Oncology Radiation Therapy Oncology Group 0822: A Phase 2 Study of Preoperative Chemoradiation Therapy Using Intensity Modulated Radiation Therapy in Combination With Capecitabine and Oxaliplatin for Patients With Locally Advanced Rectal Cancer

    SciTech Connect

    Hong, Theodore S.; Moughan, Jennifer; Garofalo, Michael C.; Bendell, Johanna; Berger, Adam C.; Oldenburg, Nicklas B.E.; Anne, Pramila Rani; Perera, Francisco; Jabbour, Salma K.; Nowlan, Adam; DeNittis, Albert; Crane, Christopher

    2015-09-01

    Purpose: To evaluate the rate of gastrointestinal (GI) toxicity of neoadjuvant chemoradiation with capecitabine, oxaliplatin, and intensity modulated radiation therapy (IMRT) in cT3-4 rectal cancer. Methods and Materials: Patients with localized, nonmetastatic T3 or T4 rectal cancer <12 cm from the anal verge were enrolled in a prospective, multi-institutional, single-arm study of preoperative chemoradiation. Patients received 45 Gy with IMRT in 25 fractions, followed by a 3-dimensional conformal boost of 5.4 Gy in 3 fractions with concurrent capecitabine/oxaliplatin (CAPOX). Surgery was performed 4 to 8 weeks after the completion of therapy. Patients were recommended to receive FOLFOX chemotherapy after surgery. The primary endpoint of the study was acute grade 2 to 5 GI toxicity. Seventy-one patients provided 80% probability to detect at least a 12% reduction in the specified GI toxicity with the treatment of CAPOX and IMRT, at a significance level of .10 (1-sided). Results: Seventy-nine patients were accrued, of whom 68 were evaluable. Sixty-one patients (89.7%) had cT3 disease, and 37 (54.4%) had cN (+) disease. Postoperative chemotherapy was given to 42 of 68 patients. Fifty-eight patients had target contours drawn per protocol, 5 patients with acceptable variation, and 5 patients with unacceptable variations. Thirty-five patients (51.5%) experienced grade ≥2 GI toxicity, 12 patients (17.6%) experienced grade 3 or 4 diarrhea, and pCR was achieved in 10 patients (14.7%). With a median follow-up time of 3.98 years, the 4-year rate of locoregional failure was 7.4% (95% confidence interval [CI]: 1.0%-13.7%). The 4-year rates of OS and DFS were 82.9% (95% CI: 70.1%-90.6%) and 60.6% (95% CI: 47.5%-71.4%), respectively. Conclusion: The use of IMRT in neoadjuvant chemoradiation for rectal cancer did not reduce the rate of GI toxicity.

  17. A Review of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer

    PubMed Central

    Li, Yi; Wang, Ji; Ma, Xiaowei; Tan, Li; Yan, Yanli; Xue, Chaofan; Hui, Beina; Liu, Rui; Ma, Hailin; Ren, Juan

    2016-01-01

    Neoadjuvant chemoradiotherapy has become the standard treatment for locally advanced rectal cancer. Neoadjuvant chemoradiotherapy not only can reduce tumor size and recurrence, but also increase the tumor resection rate and anus retention rate with very slight side effect. Comparing with preoperative chemotherapy, preoperative chemoradiotherapy can further reduce the local recurrence rate and downstage. Middle and low rectal cancers can benefit more from neoadjuvant chemradiotherapy than high rectal cancer. It needs to refine the selection of appropriate patients and irradiation modes for neoadjuvant chemoradiotherapy. Different therapeutic reactions to neoadjuvant chemoradiotherapy affect the type of surgical techniques, hence calling for the need of much attention. Furthermore, many problems such as accurate staging before surgery, selection of suitable neoadjuvant chemoradiotherapy method, and sensitivity prediction to preoperative radiotherapy need to be well settled. PMID:27489505

  18. Preoperative Evaluation with fMRI of Patients with Intracranial Gliomas

    PubMed Central

    Kapsalakis, Ioannis Z.; Kapsalaki, Eftychia Z.; Gotsis, Efstathios D.; Verganelakis, Dimitrios; Toulas, Panagiotis; Hadjigeorgiou, Georgios; Chung, Indug; Fezoulidis, Ioannis; Papadimitriou, Alexandros; Robinson, Joe Sam; Lee, Gregory P.; Fountas, Kostas N.

    2012-01-01

    Introduction. Aggressive surgical resection constitutes the optimal treatment for intracranial gliomas. However, the proximity of a tumor to eloquent areas requires exact knowledge of its anatomic relationships to functional cortex. The purpose of our study was to evaluate fMRI's accuracy by comparing it to intraoperative cortical stimulation (DCS) mapping. Material and Methods. Eighty-seven patients, with presumed glioma diagnosis, underwent preoperative fMRI and intraoperative DCS for cortical mapping during tumor resection. Findings of fMRI and DCS were considered concordant if the identified cortical centers were less than 5 mm apart. Pre and postoperative Karnofsky Performance Scale and Spitzer scores were recorded. A postoperative MRI was obtained for assessing the extent of resection. Results. The areas of interest were identified by fMRI and DCS in all participants. The concordance between fMRI and DCS was 91.9% regarding sensory-motor cortex, 100% for visual cortex, and 85.4% for language. Data analysis showed that patients with better functional condition demonstrated higher concordance rates, while there also was a weak association between tumor grade and concordance rate. The mean extent of tumor resection was 96.7%. Conclusions. Functional MRI is a highly accurate preoperative methodology for sensory-motor mapping. However, in language mapping, DCS remains necessary for accurate localization. PMID:22848821

  19. 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.

  20. [Preoperative chemoradiotherapy for resectable lower rectal cancer].

    PubMed

    Takase, Shiro; Kamigaki, Takashi; Yamashita, Kimihiro; Nakamura, Tetsu; Nishimura, Hideki; Sasaki, Ryohei

    2009-11-01

    To suppress local recurrence and preserve sphincter function, we performed preoperative chemoradiotherapy( CRT) of rectal cancer. Sixteen patients with lower advanced rectal cancer received tegafur/uracil/calcium folinate+RT followed by curative resection with lateral lymph node dissection 2-8 weeks later. The male/female ratio was found to be 11:5 (41-75 years old) and the CRT was feasible for all patients. There were 11-PR and 5-SD according to RECIST criteria, and lower isotope accumulation was observed for all primary tumors in FDG-PET study. After CRT, all patients received R0 curative resection (11 APR, 2 LAR, 1 Hartmann and 1 ISR). On pathological study, 3 patients showed complete response. Surgical complications including pelvic infection, delayed a wound healing and deep venous thrombosis, etc. In conclusion, preoperative CRT of advanced rectal cancer could potentially be useful for local control and sphincter saving, however, it is necessary to manage specific surgical complications due to radiation. PMID:20037306

  1. [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. PMID:25443866

  2. [Artificial nutrition and preoperative fasting].

    PubMed

    Francq, B; Sohawon, S; Perlot, I; Sekkat, H; Noordally, S O

    2012-01-01

    Preoperative fasting is a currently adopted measure since Mendelson's report pertaining to aspiration pneumonia as a cause of death following general anesthesia. From a metabolic point of view fasting is detrimental because surgery in itself causes a state of hypercatabolism and hyperglycemia as a result of insulinresistance. Preoperative fasting has become almost obsolete in certain elective surgical procedures. In these cases the use of clear liquids is now well established and this paper focuses on the safe use of clear fluids, postoperative insulinresistance, patient comfort and postoperative outcome as well as its effect on the length of stay. PMID:22812052

  3. 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

  4. 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

  5. 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

  6. FFTF preoperational survey. Program report

    SciTech Connect

    Twitty, B.L.; Bicehouse, H.J.

    1980-12-01

    The FFTF will become operational with criticality early in 1980. This facility is composed of the test reactor, fuel examination cells, expended fuel storage systems and fuel handling systems. The reactor and storage systems are sodium-cooled with the heat load dumped to the ambient air through heat exchangers. In order to assure that the operation of the FFTF has minimal impact on the environment, a monitoring program has been established. Prior to operation of a new facility, a preoperational environmental survey is required. It is the purpose of this report to briefly describe the environmental survey program and to provide the background data obtained during the preoperational phase of the survey program. Nine stations in the program of particular importance to FFTF are discussed in detail with results of monitoring given. No unexplained trends were noted.

  7. [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. PMID:26320341

  8. The value of preoperative planning.

    PubMed

    Graves, Matt L

    2013-10-01

    "Better to throw your disasters into the waste paper basket than to consign your patients to the scrap heap" has been a proverb of Jeff Mast, one of the greatest fracture and deformity surgeons in the history of our specialty. Stated slightly more scientifically, one of the major values of simulation is that it allows one to make mistakes in a consequence-free environment. Preoperative planning is the focus of this article. The primary goal is not to provide you with a recipe of how to steps. Rather, the primary goal of this article is to explain why preoperative planning should be standard, to clarify what should be included, and to provide examples of what can happen when planning is ignored. At the end of this, we should all feel the need to approach fracture care more intellectually with forethought, both in our own practices and in our educational system. PMID:23880563

  9. [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

  10. Preoperative radiotherapy for rectal adenocarcinoma: Which are strong prognostic factors?

    SciTech Connect

    Chapet, Olivier . E-mail: ochapet@med.umich.edu; Romestaing, Pascale; Mornex, Francoise; Souquet, Jean-Christophe; Favrel, Veronique; Ardiet, Jean-Michel; D'Hombres, Anne; Gerard, Jean-Pierre

    2005-04-01

    Purpose: This retrospective 12-year study evaluated the prognostic value of initial and postoperative staging of rectal tumors. Methods and Materials: Between 1985 and 1996, 297 patients were treated with preoperative radiotherapy (39 Gy in 13 fractions) and surgery for Stage T2-T4N0-N1M0 rectal adenocarcinoma. Pretreatment staging included a clinical examination and endorectal ultrasonography (EUS) since 1988. Clinical staging was performed by digital rectal examination and rigid proctoscopy. EUS was performed in 236 patients. Postoperative staging was performed by examination of the pathologic specimen. Results: The median follow-up was 49 months. The overall 5-year survival rate was 67%, with a local failure rate of 9%. The rate of sphincter preservation was 65%. The clinical examination findings were strong prognostic factor for both cT stage (p < 0.001) and cN stage (p < 0.006) but had poor specificity for cN stage (only 25 lymph nodes detected). In both univariate and multivariate analyses, EUS had a statistically significant prognostic value for uT (p < 0.014) but not for uN (p < 0.47) stage. In contrast, pT and pN stages were strong prognostic factors (p < 0.001 and p < 0.001, respectively). Conclusion: Pretreatment staging, including clinical examination and EUS, seemed accurate enough to present a high prognostic value for the T stage. EUS was insufficient to stage lymph node involvement. Owing to its lack of specificity, uN stage was not a reliable prognostic factor. An improvement in N staging is necessary and essential. Despite downstaging, postoperative staging remained a very strong prognostic factor for both T and N stages.

  11. 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.

  12. 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

  13. 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

  14. A versatile phenomenological model for the S-shaped temperature dependence of photoluminescence energy for an accurate determination of the exciton localization energy in bulk and quantum well structures

    NASA Astrophysics Data System (ADS)

    Dixit, V. K.; Porwal, S.; Singh, S. D.; Sharma, T. K.; Ghosh, Sandip; Oak, S. M.

    2014-02-01

    Temperature dependence of the photoluminescence (PL) peak energy of bulk and quantum well (QW) structures is studied by using a new phenomenological model for including the effect of localized states. In general an anomalous S-shaped temperature dependence of the PL peak energy is observed for many materials which is usually associated with the localization of excitons in band-tail states that are formed due to potential fluctuations. Under such conditions, the conventional models of Varshni, Viña and Passler fail to replicate the S-shaped temperature dependence of the PL peak energy and provide inconsistent and unrealistic values of the fitting parameters. The proposed formalism persuasively reproduces the S-shaped temperature dependence of the PL peak energy and provides an accurate determination of the exciton localization energy in bulk and QW structures along with the appropriate values of material parameters. An example of a strained InAs0.38P0.62/InP QW is presented by performing detailed temperature and excitation intensity dependent PL measurements and subsequent in-depth analysis using the proposed model. Versatility of the new formalism is tested on a few other semiconductor materials, e.g. GaN, nanotextured GaN, AlGaN and InGaN, which are known to have a significant contribution from the localized states. A quantitative evaluation of the fractional contribution of the localized states is essential for understanding the temperature dependence of the PL peak energy of bulk and QW well structures having a large contribution of the band-tail states.

  15. Preoperative multidisciplinary treatment with hyperthermia for soft tissue sarcoma.

    PubMed

    Makihata, E; Kuroda, M; Kawai, A; Ozaki, T; Sugihara, S; Inoue, H; Joja, I; Asaumi, J; Kawasaki, S; Hiraki, Y

    1997-04-01

    We report the results of phase I/II studies of preoperative multidisciplinary treatment of 14 patients with soft tissue sarcoma using hyperthermia from November 1990 to April 1995. The preoperative treatment was conducted with thermo-radio-chemotherapy in 11 cases of stage III, and with thermo-radiotherapy as well as thermo-chemotherapy in three cases of stages I and II. Hyperthermia was carried out twice a week with totals ranging from 4 to 14 times (average: 8.4 times); each session lasted 60 min. Radiotherapy was administered four or five times per week, and the dose was 1.8 2Gy/fraction, with a total of 30-40 Gy in a four week period. Chemotherapy was mainly in the form of MAID regimen (2-mercaptoethanesulphonic acid (mesna), adriamycin, ifosfamide and dacarbazine). The tumors were surgically resected in all patients after completing the preoperative treatment. The efficacy rate, as expressed by the percentage of either tumors in which reduction rate was 50% or more, or tumors for which post-treatment contrast enhanced CT image revealed low density volumes occupying 50% or more of the total mass, was 71% (ten of the 14 tumors). The mean tumor necrosis rate in the resected specimens was 78%. The tumor necrosis rate was significantly high (P < 0.05) in patients whose Time > or = 42 degrees C was of long duration. Postoperative complications were observed in six patients; among these, two patients developed wound infection that required surgical treatment as a complication of surgery performed in the early stage following the preoperative treatment. After a mean postoperative follow-up of 27 months, distant metastasis occurred in four patients resulting in three fatalities. The three-year cumulative survival rate was 64.3%. No local recurrence was observed in any patient during the follow-up, thus confirming our hypothesis that preoperative multidisciplinary treatment has an excellent local efficacy. We think that it would be valuable to conduct, at many

  16. The Role of Preoperative Evaluation for Congenital Methemoglobinemia

    PubMed Central

    Kuş, Alparslan; Berk, Derya; Hoşten, Tülay; Gürkan, Yavuz; Solak, Mine; Toker, Kamil

    2014-01-01

    Preoperative care includes a clinical examination before invasive or non-invasive interventions for anaesthesia/analgesia and is the responsibility of the anaesthesiologists. Methemoglobinemia should be considered, as well as cardiac, pulmonary, and peripheral circulatory disorders in patients with central cyanosis and low oxygen saturation despite treatment with sufficient oxygen during anaesthesia. Methemoglobinemia is a serious clinical condition, associated with increased blood methemoglobin levels characterized by clinical signs, such as cyanosis and hypoxia due to lack of oxygen-carrying capacity. Here, we present our anaesthesia management in a patient with unnoticed congenital methemoglobinemia during preoperative evaluation, in whom clinical signs of methemoglobinemia developed after local anaesthesia administration before the surgery. PMID:27366424

  17. Preoperative radiotherapy for colorectal cancer.

    PubMed Central

    Higgins, G A; Conn, J H; Jordan, P H; Humphrey, E W; Roswit, B; Keehn, R J

    1975-01-01

    In a prospective randomized trial, 700 patients with a confirmed histological diagnosis of adenocarcinoma of the rectum or rectosigmoid were randomized to receive radiotherapy prior to operation (2000 to 2500 rads in two weeks) or surgery alone. Five year observed survival in the 453 patients on whom "curative" resection was possible was 48.5% in the X-ray treated group compared with 38.8% in controls, while in the 305 having low lying lesions requiring abdominoperineal resection, survival in the treated group was 46.9% compared with 34.3% in controls. Although suggestive of a treatment benefit, neither is considered statistically significant. Histologically positive lymph nodes were found in 41.2% of the control group and in only 27.8% of the patients receiving radiotherapy. Reveiw of all patients who died during the study shows a consistently lower death rate from cancer in the radiotherapy group. Although this study suggests a treatment benefit from preoperative radiotherapy, further studies now in progress by this group and others are necessary to determine the optimal dose regimen. PMID:805571

  18. Effects of comfort warming on preoperative patients.

    PubMed

    Wagner, Doreen; Byrne, Michelle; Kolcaba, Katharine

    2006-09-01

    THERMAL COMFORT IS ONE DIMENSION of overall patient comfort, and it usually is addressed by covering the patient with warmed cotton blankets. WARMING HELPS A PATIENT maintain normothermia and appears to decrease patient anxiety. AN STUDY WAS CONDUCTED in a preoperative setting to compare the effects of preoperative warming with warmed cotton blankets versus patient-controlled warming gowns on patients' perceptions of thermal comfort and anxiety. BOTH WARMING INTERVENTIONS had a positive effect on patients' thermal comfort and sense of well-being. Patients who used the patient-controlled warming gown also experienced a significant reduction in preoperative anxiety. PMID:17004666

  19. [Preoperative assessment for extended hepatic resection].

    PubMed

    Martin, David; Roulin, Didier; Takamune, Yamaguchi; Demartines, Nicolas; Halkic, Nermin

    2016-06-15

    The number of major hepatectomy performed for the treatment of primary or secondary liver cancer has increased over the past two decades. By definition, a major hepatectomy includes the resection of at least three liversegments. Advances in anesthesiology, surgical and radiological techniques and perioperative management allowed a broad patient selection with increased security. Every case must be discussed in multidisciplinary tumor board, and preoperative assessment should include biological, volumetric and functional hepatic parameters. In case of preoperative insufficient liver volume, portal vein embolization allows increasing the size of liver remnant. This paper aims describing preoperative work-up. PMID:27487623

  20. 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

  1. Measuring Interfractional and Intrafractional Motion With Cone Beam Computed Tomography and an Optical Localization System for Lower Extremity Soft Tissue Sarcoma Patients Treated With Preoperative Intensity-Modulated Radiation Therapy

    SciTech Connect

    Dickie, Colleen I.; Parent, Amy L.; Chung, Peter W.M.; Catton, Charles N.; Craig, Tim; Griffin, Anthony M.; Panzarella, Tony; Ferguson, Peter C.; Wunder, Jay S.; Bell, Robert S.; Sharpe, Michael B.; O'Sullivan, Brian

    2010-12-01

    Purpose: To evaluate inter- and intrafractional motion and rotational error for lower extremity soft tissue sarcoma patients by using cone beam computed tomography (CBCT) and an optical localization system. Methods and Materials: Thirty-one immobilized patients received CBCT image-guided intensity-modulated radiation therapy. Setup deviations of >3 mm from the planned isocenter were corrected. A second CBCT acquired before treatment delivery was registered to the planning CT to estimate interfractional setup error retrospectively. Interfractional error and rotational error were calculated in the left-right (LR), superoinferior (SI), and anteroposterior (AP) dimensions. Intrafractional motion was assessed by calculating the maximum relative displacement of optical localization system reflective markers placed on the patient's surface, combined with pre- and postfraction CBCT performed for 17 of the 31 patients once per week. The overall systematic error (SE) and random error (RE) were calculated for the interfractional and intrafractional motion for planning target volume margin calculation. Results: The standard deviation (SD) of the interfractional RE was 1.9 mm LR, 2.1 mm SI, and 1.8 mm AP, and the SE SD was 0.6 mm, 1.2 mm, and 0.7 mm in each dimension, respectively. The overall rotation (inter- and intrafractional) had an RE SD of 0.8{sup o} LR, 1.7{sup o} SI, and 0.7{sup o} AP and an SE SD of 1.1{sup o} LR, 1.3{sup o} SI, and 0.3{sup o} AP. The SD of the overall intrafractional RE was 1.6 mm LR, 1.6 mm SI, and 1.4 mm AP, and the SE SD was 0.7 mm AP, 0.6 mm SI, and 0.6 mm AP. Conclusions: A uniform 5-mm planning target volume margin was quantified for lower extremity soft tissue sarcoma patients and has been implemented clinically for image-guided intensity-modulated radiation therapy.

  2. Preoperative telemedicine evaluation of surgical mission patients: should we use it routinely?

    PubMed

    Latifi, Rifat; Mora, Francisco; Bekteshi, Flamur; Rivera, Renato

    2014-01-01

    Low-cost telemedicine is a viable and secure tool for preoperative evaluation of surgical mission patients. It increases efficiency and optimizes the use of existing resources. More specifically, it helps ensure an accurate assessment of patients before the surgical team arrives, reduces on-site prescreening time, and decreases the number of surgical candidates on the waiting list. Routine use of telemedicine in surgical missions most likely would reduce preoperative times and the number of operations canceled at the last minute. Moreover, it may be effectively used for long-term follow-up care, including the management of any postoperative complications. PMID:24552027

  3. Preoperative Antibiotics and Mortality in the Elderly

    PubMed Central

    Silber, Jeffrey H.; Rosenbaum, Paul R.; Trudeau, Martha E.; Chen, Wei; Zhang, Xuemei; Lorch, Scott A.; Kelz, Rachel Rapaport; Mosher, Rachel E.; Even-Shoshan, Orit

    2005-01-01

    Objective and Background: It is generally thought that the use of preoperative antibiotics reduces the risk of postoperative infection, yet few studies have described the association between preoperative antibiotics and the risk of dying. The objective of this study was to determine whether preoperative antibiotics are associated with a reduced risk of death. Methods: We performed a multivariate matched, population-based, case-control study of death following surgery on 1362 Pennsylvania Medicare patients between 65 and 85 years of age undergoing general and orthopedic surgery. Cases (681 deaths within 60 days from hospital admission) were randomly selected throughout Pennsylvania using claims from 1995 and 1996. Models were developed to scan Medicare claims, looking for controls who did not die and who were the closest matches to the previously selected cases based on preoperative characteristics. Cases and their controls were identified, and charts were abstracted to define antibiotic use and obtain baseline severity adjustment data. Results: For general surgery, the odds of dying within 60 days were less than half in those treated with preoperative antibiotics within 2 hours of incision as compared with those without such treatment: (odds ratio = 0.44; 95% confidence interval, 0.32–0.60), P < 0.0001). For orthopedic surgery, no significant mortality reduction was observed (OR = 0.85; 95% confidence interval, 0.54–1.32; P < 0.464). Interpretation: Preoperative antibiotics are associated with a substantially lower 60-day mortality rate in elderly patients undergoing general surgery. In patients who appear to be comparable, the risk of death was half as large among those who received preoperative antibiotics. PMID:15973108

  4. Statistical analysis of accurate prediction of local atmospheric optical attenuation with a new model according to weather together with beam wandering compensation system: a season-wise experimental investigation

    NASA Astrophysics Data System (ADS)

    Arockia Bazil Raj, A.; Padmavathi, S.

    2016-07-01

    Atmospheric parameters strongly affect the performance of Free Space Optical Communication (FSOC) system when the optical wave is propagating through the inhomogeneous turbulent medium. Developing a model to get an accurate prediction of optical attenuation according to meteorological parameters becomes significant to understand the behaviour of FSOC channel during different seasons. A dedicated free space optical link experimental set-up is developed for the range of 0.5 km at an altitude of 15.25 m. The diurnal profile of received power and corresponding meteorological parameters are continuously measured using the developed optoelectronic assembly and weather station, respectively, and stored in a data logging computer. Measured meteorological parameters (as input factors) and optical attenuation (as response factor) of size [177147 × 4] are used for linear regression analysis and to design the mathematical model that is more suitable to predict the atmospheric optical attenuation at our test field. A model that exhibits the R2 value of 98.76% and average percentage deviation of 1.59% is considered for practical implementation. The prediction accuracy of the proposed model is investigated along with the comparative results obtained from some of the existing models in terms of Root Mean Square Error (RMSE) during different local seasons in one-year period. The average RMSE value of 0.043-dB/km is obtained in the longer range dynamic of meteorological parameters variations.

  5. A computerized morphometric evaluation of x-ray films for preoperative planning of hip arthroplasty.

    PubMed

    Baruffaldi, F; Cianci, R; Fabbri, F; Mulazzani, M; Fanton, F; Toni, A; Affatato, S; Giunti, A

    1994-01-01

    Methods for measuring metric size on radiograms constitute an instrument of proven utility. For example, when preoperatively evaluating hip arthroplasty the diameter of the medullary canal and the cervicodiaphyseal angle, must be measured in order to determine the center of rotation of the femoral head, and to establish the flare index of the diaphyseal canal. These results may be obtained by using a computer-controlled graphic table to place the coordinates for the areas of greater anatomical and physiological importance on the radiologic image. Thus, a calculation of distances, anatomical axes and angles is obtained immediately, accurately defining the morphometry of the joint. In this study, the anteroposterior preoperative radiographic views of 87 femurs in 84 patients were evaluated by this method. The values provided by the morphometric analysis were then related to sex, age and weight. The diaphyseal canal was classified by typology for the preoperative planning of hip arthroplasty. PMID:7842840

  6. Estimation of operative line of resection using preoperative image and nonrigid registration.

    PubMed

    Lee, Jong-Ha; Won, Chang-Hee; Kong, Seong-Gon

    2008-01-01

    Even though accurate diagnosis of organs is done using preoperative images such as CT or MRI, these information are not directly used in the operating room, because organs are nonrigid and their shapes change with time. In this paper, we propose to obtain an intraoperative image of an open organ and fuse the image with a preoperative image. The intraoperative image is obtained from a three-dimensional laser scanner. The registration of preoperative image to the intraoperative image can relate the information from the preoperative image to the open organ in the operating room. We do this by registering preoperative images to intraoperative images. An algorithm based on Robust Point Matching method is developed for this nonrigid image registration problem. We also propose a new metric called Non Overlapping Ratio to determine the registration error. The experiments demonstrate that the proposed method is capable of achieving region of interest estimation within 1.51 mm mean distance error and 0.66% Non Overlapping Ratio. PMID:19163585

  7. Three-Dimensional Surface Imaging and the Continuous Evolution of Preoperative and Postoperative Assessment in Rhinoplasty.

    PubMed

    Lekakis, Garyfalia; Claes, Peter; Hamilton, Grant S; Hellings, P W

    2016-02-01

    During the preoperative assessment in rhinoplasty, the surgeon takes a thorough history, performs a complete examination by assessing functional and aesthetic aspects of the nose, obtains a clear understanding of the patient's wishes, conducts facial analysis based on standardized photography, and communicates to the patient the goals and pitfalls of surgery. Computer imaging or morphing of the preoperative pictures of the nose has drawn a lot of interest in the last decade, and it is a sign of evolution of the preoperative consultation. Technological advances, also in the context of rhinoplasty, have led to the development of three-dimensional (3D) imaging techniques, and have completely revolutionized the way that surgeons manage their patients preoperatively and evaluate postoperative results today. The accurate 3D surface imaging aids the surgeon to communicate with the patient adequately before surgery, to set an appropriate surgical plan, and to measure the shape and volume changes of the patient's nose that result from the intervention. The present review provides an analysis on the current knowledge of 3D surface imaging in rhinoplasty derived from the literature, and highlights future directions of preoperative and postoperative assessment in the field. PMID:26862969

  8. A Solid-State 95Mo NMR and Computational Investigation of Dodecahedral and Square Antiprismatic Octacyanomolybdate(IV) Anions: Is the Point-Charge Approximation an Accurate Probe of Local Symmetry?

    SciTech Connect

    Forgeron, Michelle A.; Wasylishen, Roderick E.

    2006-06-21

    Solid-state 95Mo NMR spectroscopy is shown to be an efficient and effective tool for analyzing the diamagnetic octacyanomolybdate(IV) anions, Mo(CN)8 4-, of approximate dodecahedral, D2d, and square antiprismatic, D4d, symmetry. The sensitivity of the Mo magnetic shielding (?) and electric field gradient (EFG) tensors to small changes in the local structure of these anions allows the approximate D2d and D4d Mo(CN)8 4- anions to be readily distinguished. The use of high applied magnetic fields, 11.75, 17.63 and 21.1 T, amplifies the overall sensitivity of the NMR experiment and enables more accurate characterization of the Mo ? and EFG tensors. Although the magnitudes of the Mo ? and EFG interactions are comparable for the D2d and D4d Mo(CN)8 4- anions, the relative values and orientations of the principal components of the Mo ? and EFG tensors give rise to 95Mo NMR line shapes that are significantly different at the fields utilized here. Quantum chemical calculations of the Mo ? and EFG tensors, using zeroth-order regular approximation density functional theory (ZORA DFT) and restricted Hartree-Fock (RHF) methods, have also been carried out and are in good agreement with experiment. The most significant and surprising result from the DFT and RHF calculations is a significant EFG at Mo for an isolated Mo(CN)8 4- anion possessing an ideal square antiprismatic structure; this is contrary to the point-charge approximation, PCA, which predicts a zero EFG at Mo for this structure.

  9. 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.

  10. Preoperational test report, primary ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  11. Preoperative intensity modulated radiation therapy for retroperitoneal sarcoma.

    PubMed

    El-Bared, Nancy; Taussky, Daniel; Mehiri, Selma; Patocskai, Erika; Roberge, David; Donath, David

    2014-06-01

    The use of intensity modulated radiation therapy (IMRT) has allowed for the administration of high doses to retroperitoneal sarcomas (RSTS) while limiting toxicity to adjacent organs. The purpose of our study is to assess the outcome and toxicities of patients with RSTS treated with neo-adjuvant external beam radiation (EBRT) therapy using IMRT. This is a retrospective study of 21 patients treated with preoperative IMRT for primary or recurrent RSTS between 2005 and 2011. Overall survival (OS) and local recurrence free survival (LRFS) were computed using the Kaplan-Meier method (log-rank test). Acute and chronic toxicities were assessed using the CTCAE v. 3 criteria. The actuarial 2 and 3-year OS was 66% for both and the 5-year OS was 51%. As for LRFS it was 57% at 2 and 3-year and 51% for the 5-year LRFS. Factors predictive for local control were microscopically negative margins (p = 0.022), a median tumor diameter <15 cm (p = 0.007) and pathology of liposarcoma (p = 0.021). Furthermore, patients treated for recurrent disease fared worse (p = 0.04) in local control than patients treated for primary disease. As for OS, patients treated for Grade 1 histology had a better outcome (p 5 0.05). EBRT was generally well tolerated. Acute gastrointestinal (GI) Grade 1 or 2 toxicities occurred in 33% of patients and one patient had unexplained post-radiation Grade 2 fever that resolved after tumor resection. As for chronic toxicities 24% of our patients presented Grade 1 GI toxicity and one patient presented Grade 3 small bowel stenosis not clearly due to radiation toxicity. Despite the location and volume of the tumors treated, preoperative IMRT was very well tolerated in our patients with retroperitoneal sarcoma. Unfortunately local recurrences remain common and dose escalation is to be considered. PMID:23919397

  12. Preoperative Intensity Modulated Radiation Therapy for Retroperitoneal Sarcoma

    PubMed Central

    El-Bared, Nancy; Taussky, Daniel; Mehiri, Selma; Patocskai, Erika; Roberge, David; Donath, David

    2014-01-01

    The use of intensity modulated radiation therapy (IMRT) has allowed for the administration of high doses to retroperitoneal sarcomas (RSTS) while limiting toxicity to adjacent organs. The purpose of our study is to assess the outcome and toxicities of patients with RSTS treated with neo-adjuvant external beam radiation (EBRT) therapy using IMRT. This is a retrospective study of 21 patients treated with preoperative IMRT for primary or recurrent RSTS between 2005 and 2011. Overall survival (OS) and local recurrence free survival (LRFS) were computed using the Kaplan-Meier method (log-rank test). Acute and chronic toxicities were assessed using the CTCAE v. 3 criteria. The actuarial 2 and 3-year OS was 66% for both and the 5-year OS was 51%. As for LRFS it was 57% at 2 and 3-year and 51% for the 5-year LRFS. Factors predictive for local control were microscopically negative margins (p = 0.022), a median tumor diameter <5 cm (p = 0.007) and pathology of liposarcoma (p = 0.021). Furthermore, patients treated for recurrent disease fared worse (p = 0.04) in local control than patients treated for primary disease. As for OS, patients treated for Grade 1 histology had a better outcome (p = 0.05). EBRT was generally well tolerated. Acute gastrointestinal (GI) Grade 1 or 2 toxicities occurred in 33% of patients and one patient had unexplained post-radiation Grade 2 fever that resolved after tumor resection. As for chronic toxicities 24% of our patients presented Grade 1 GI toxicity and one patient presented Grade 3 small bowel stenosis not clearly due to radiation toxicity. Despite the location and volume of the tumors treated, preoperative IMRT was very well tolerated in our patients with retroperitoneal sarcoma. Unfortunately local recurrences remain common and dose escalation is to be considered. PMID:23919397

  13. 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

  14. Grading More Accurately

    ERIC Educational Resources Information Center

    Rom, Mark Carl

    2011-01-01

    Grades matter. College grading systems, however, are often ad hoc and prone to mistakes. This essay focuses on one factor that contributes to high-quality grading systems: grading accuracy (or "efficiency"). I proceed in several steps. First, I discuss the elements of "efficient" (i.e., accurate) grading. Next, I present analytical results…

  15. Advantages of the Papillon protocol in the preoperative treatment of rectal carcinoma.

    PubMed

    Klimberg, V S; Langston, J D; Maners, A; Gocio, J C; Hutchins, L F; Lang, N P; Westbrook, K C; Broadwater, J R

    1992-11-01

    Standard treatment for advanced rectal carcinoma currently includes surgery, radiotherapy, and chemotherapy. Although there are theoretic advantages to preoperative irradiation, it is often not performed because of the prolonged delay of surgery and the purported increase in perioperative complications. A pilot study was undertaken at our institution to evaluate a treatment protocol advocated by Dr. Papillon that offers a shorter treatment time and less patient morbidity than conventional preoperative therapy for rectal carcinoma. Twenty patients with rectal cancer underwent the preoperative regimen that consisted of 3,000 cGy delivered in 10 fractions over 12 days with concomitant 5-fluorouracil and mitomycin-C. Complications were acceptable. Local recurrence was lower than in most reported trials, and survival rates were comparable. Additional benefits of the protocol include lower radiation morbidity to the patient and a decreased delay between diagnosis and surgery. PMID:1443366

  16. Prognosis Can Be Predicted More Accurately Using Pre- and Postchemoradiotherapy Carcinoembryonic Antigen Levels Compared to Only Prechemoradiotherapy Carcinoembryonic Antigen Level in Locally Advanced Rectal Cancer Patients Who Received Neoadjuvant Chemoradiotherapy

    PubMed Central

    Sung, SooYoon; Son, Seok Hyun; Kay, Chul Seung; Lee, Yoon Suk

    2016-01-01

    Abstract We aimed to evaluate the prognostic value of a change in the carcinoembryonic antigen (CEA) level during neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer. A total of 110 patients with clinical T3/T4 or node-positive disease underwent nCRT and curative total mesorectal resection from February 2006 to December 2013. Serum CEA level was measured before nCRT, after nCRT, and then again after surgery. A cut-off value for CEA level to predict prognosis was determined using the maximally selected log-rank test. According to the test, patients were classified into 3 groups, based on their CEA levels (Group A: pre-CRT CEA ≤3.2; Group B: pre-CRT CEA level >3.2 and post-CRT CEA ≤2.8; and Group C: pre-CRT CEA >3.2 and post-CRT CEA >2.8). The median follow-up time was 31.1 months. The 3-year disease-free survival (DFS) rates of Group A and Group B were similar, while Group C showed a significantly lower 3-year DFS rate (82.5% vs. 89.5% vs. 55.1%, respectively, P = 0.001). Other clinicopathological factors that showed statistical significance on univariate analysis were pre-CRT CEA, post-CRT CEA, tumor distance from the anal verge, surgery type, downstage, pathologic N stage, margin status and perineural invasion. The CEA group (P = 0.001) and tumor distance from the anal verge (P = 0.044) were significant prognostic factors for DFS on multivariate analysis. Post-CRT CEA level may be a useful prognostic factor in patients whose prognosis cannot be predicted exactly by pre-CRT CEA levels alone in the neoadjuvant treatment era. Combined pre-CRT CEA and post-CRT CEA levels enable us to predict prognosis more accurately and determine treatment and follow-up policies. Further large-scale studies are necessary to validate the prognostic value of CEA levels. PMID:26962798

  17. 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

  18. 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.

  19. Focused parathyroidectomy without intra-operative parathormone monitoring: The value of PTH assay in preoperative ultrasound guided fine needle aspiration washout

    PubMed Central

    Kuzu, Fatih; Arpaci, Dilek; Cakmak, Guldeniz Karadeniz; Emre, Ali Ugur; Elri, Tarik; Ilikhan, Sevil Uygun; Bahadir, Burak; Bayraktaoglu, Taner

    2016-01-01

    Background The accurate identification of hyperfunctioning parathyroid (HP) gland is the only issue for definitive surgical treatment in primary hyperparathyroidism (pHPT). Various imaging and operative techniques have been proposed to confirm the localization of the diseased gland. Nevertheless, none of these methods proved to be the gold standard. The presented study aimed to assess the value of parathyroid hormone assay in preoperative ultrasound guided fine needle aspiration (FNA)-PTH washout fluid to verify the correct localisation for focused parathyroidectomy without intra-operative PTH monitoring. Material and Methods The retrospective analysis of 57 patients with pHPT who underwent FNA-PTH was conducted from a prospective database. Biochemical assessment together with radiological (ultrasonography) and nuclear (MIBI scan) imaging was reviewed. Associations between FNA-PTH washout values and localization technics were evaluated and compared in terms of operative findings. Results Focused parathyroidectomy without intraoperative PTH monitoring was performed to 45 patients with high FNA-PTH values. The median largest diameter of the target parathyroid lesion identified by ultrasonography was 13 mm (range, 6 to 36). The median serum PTH level was 190 pg/mL (range, 78 to 1709; reference range, 15 to 65) whereas the median washout PTH was 2500 pg/mL (range, 480 to 3389). According to operative findings high FNA-PTH levels correctly identified parathyroid adenoma in 40 cases (89% of sensitivity and 100% of specificity and positive predictive value) whereas MIBI scan localized the lesion in 36 of these cases (80% of sensitivity). Conclusions The higher level of PTH in preoperative ultrasound guided FNA washout is a considerable data to predict the correct localization of HP, particularly in circumstances of greater values than the serum PTH level. However, although its specificity is high, in cases of coexisting nodular thyroid disease, associated additional HP

  20. Preoperative Evaluation: Estimation of Pulmonary Risk.

    PubMed

    Lakshminarasimhachar, Anand; Smetana, Gerald W

    2016-03-01

    Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care. PMID:26927740

  1. 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

  2. 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

  3. Effects of deformable registration algorithms on the creation of statistical maps for preoperative targeting in deep brain stimulation procedures

    NASA Astrophysics Data System (ADS)

    Liu, Yuan; D'Haese, Pierre-Francois; Dawant, Benoit M.

    2014-03-01

    Deep brain stimulation, which is used to treat various neurological disorders, involves implanting a permanent electrode into precise targets deep in the brain. Accurate pre-operative localization of the targets on pre-operative MRI sequence is challenging as these are typically located in homogenous regions with poor contrast. Population-based statistical atlases can assist with this process. Such atlases are created by acquiring the location of efficacious regions from numerous subjects and projecting them onto a common reference image volume using some normalization method. In previous work, we presented results concluding that non-rigid registration provided the best result for such normalization. However, this process could be biased by the choice of the reference image and/or registration approach. In this paper, we have qualitatively and quantitatively compared the performance of six recognized deformable registration methods at normalizing such data in poor contrasted regions onto three different reference volumes using a unique set of data from 100 patients. We study various metrics designed to measure the centroid, spread, and shape of the normalized data. This study leads to a total of 1800 deformable registrations and results show that statistical atlases constructed using different deformable registration methods share comparable centroids and spreads with marginal differences in their shape. Among the six methods being studied, Diffeomorphic Demons produces the largest spreads and centroids that are the furthest apart from the others in general. Among the three atlases, one atlas consistently outperforms the other two with smaller spreads for each algorithm. However, none of the differences in the spreads were found to be statistically significant, across different algorithms or across different atlases.

  4. An 80-gene set to predict response to preoperative chemoradiotherapy for rectal cancer by principle component analysis

    PubMed Central

    EMPUKU, SHINICHIRO; NAKAJIMA, KENTARO; AKAGI, TOMONORI; KANEKO, KUNIHIKO; HIJIYA, NAOKI; ETOH, TSUYOSHI; SHIRAISHI, NORIO; MORIYAMA, MASATSUGU; INOMATA, MASAFUMI

    2016-01-01

    Preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer not only improves the postoperative local control rate, but also induces downstaging. However, it has not been established how to individually select patients who receive effective preoperative CRT. The aim of this study was to identify a predictor of response to preoperative CRT for locally advanced rectal cancer. This study is additional to our multicenter phase II study evaluating the safety and efficacy of preoperative CRT using oral fluorouracil (UMIN ID: 03396). From April, 2009 to August, 2011, 26 biopsy specimens obtained prior to CRT were analyzed by cyclopedic microarray analysis. Response to CRT was evaluated according to a histological grading system using surgically resected specimens. To decide on the number of genes for dividing into responder and non-responder groups, we statistically analyzed the data using a dimension reduction method, a principle component analysis. Of the 26 cases, 11 were responders and 15 non-responders. No significant difference was found in clinical background data between the two groups. We determined that the optimal number of genes for the prediction of response was 80 of 40,000 and the functions of these genes were analyzed. When comparing non-responders with responders, genes expressed at a high level functioned in alternative splicing, whereas those expressed at a low level functioned in the septin complex. Thus, an 80-gene expression set that predicts response to preoperative CRT for locally advanced rectal cancer was identified using a novel statistical method. PMID:27123272

  5. 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

  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. [Surgical treatment and localization techniques in primary hyperparathyroidism].

    PubMed

    Marazuela, Mónica; Domínguez-Gadea, Luis; Manuel Bravo-Linfante, José; Larrañaga, Eduardo

    2009-04-01

    Parathyroidectomy is the only definitive cure for primary hyperparathyroidism (PHPT). While bilateral neck exploration has been the conventional surgical approach and the mainstay of therapy, recent advances in technology have revolutionized the field, making a focused or minimally invasive approach to parathyroidectomy a reality. This change has taken place because of the development of accurate preoperative localization techniques able to select patients who have single-gland parathyroid disease (single adenoma) and can be managed by a minimally invasive parathyroidectomy. Currently, the most reliable and practical diagnostic procedure is (99m)TC-sestamibi parathyroid scintigraphy, using different protocols depending on the institution's logistics and experience (classical dual-phase, oblique projections, various subtraction techniques and/or single photon-emission computed tomography or SPECT). Ultrasound has emerged as a complementary technique in the preoperative evaluation of PHPT, which can be used when scintigraphy is negative or as a confirmatory test. When these procedures fail to identify the enlarged gland, other non-invasive procedures such as computed tomographic scanning or magnetic resonance imaging are used in selected cases. A variety of surgical techniques have been employed to achieve a safe and effective minimally invasive procedure. These techniques include mini-incision unilateral parathyroid exploration and endoscopic, video-assisted and radio-guided parathyroidectomy. With optimized preoperative mapping, the success rate of these less invasive techniques equals that of the traditional bilateral approach. This review summarizes the imaging techniques and rationale for preoperative localization studies that are used before parathyroidectomy, as well as the current surgical approaches. PMID:19627757

  8. 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.

  9. Accurate measurement of time

    NASA Astrophysics Data System (ADS)

    Itano, Wayne M.; Ramsey, Norman F.

    1993-07-01

    The paper discusses current methods for accurate measurements of time by conventional atomic clocks, with particular attention given to the principles of operation of atomic-beam frequency standards, atomic hydrogen masers, and atomic fountain and to the potential use of strings of trapped mercury ions as a time device more stable than conventional atomic clocks. The areas of application of the ultraprecise and ultrastable time-measuring devices that tax the capacity of modern atomic clocks include radio astronomy and tests of relativity. The paper also discusses practical applications of ultraprecise clocks, such as navigation of space vehicles and pinpointing the exact position of ships and other objects on earth using the GPS.

  10. 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.

  11. 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

  12. Preoperative breast marking in reduction mammaplasty.

    PubMed

    Gasperoni, C; Salgarello, M

    1987-10-01

    A simple method of preoperative marking for reduction mammaplasty is described. This method may be used in macromastias when the technique chosen implies a postoperative scar with the shape of an inverted T. The marking sequence follows standard steps, but the drawing is always different because it is a consequence of the shape of the breast. This marking method reduces the chance of making mistakes due to excessive personal evaluations or to the use of standard drawing patterns that may be not suitable for all breast shapes. PMID:3688776

  13. Preoperational test report, recirculation ventilation systems

    SciTech Connect

    Clifton, F.T.

    1997-11-11

    This represents a preoperational test report for Recirculation Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102 and supports the ability to exhaust air from each tank. Each system consists of a valved piping loop, a fan, condenser, and moisture separator; equipment is located inside each respective tank farm in its own hardened building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  14. [Intestinal stoma: preoperative and postoperative management].

    PubMed

    Soravia, C; Beyeler, S; Lataillade, L

    2005-03-01

    The aim of this review is to present the management and indications of intestinal stomas. A stoma induces a body image alteration with important familial and social consequences. A preoperative visit to the stoma nurse prevents technical and/or psychological complications. Stoma nurses, surgeons and general practionners work together to help the patient in his/her new life. New stoma devices have also contributed to improve quality of life. Social and sexual activity can be maintain despite intestinal stoma with appropriate education. PMID:15828375

  15. Drug Combinations in Preoperative Chemoradiation for Rectal Cancer.

    PubMed

    Glynne-Jones, Rob; Carvalho, Carlos

    2016-07-01

    Preoperative radiotherapy has an accepted role in reducing the risk of local recurrence in locally advanced resectable rectal cancer, particularly when the circumferential resection margin is breached or threatened, according to magnetic resonance imaging. Fluoropyrimidine-based chemoradiation can obtain a significant down-sizing response and a curative resection can then be achieved. Approximately, 20% of the patients can also obtain a pathological complete response, which is associated with less local recurrences and increased survival. Patients who achieve a sustained complete clinical response may also avoid radical surgery. In unresectable or borderline resectable tumors, around 20% of the patients still fail to achieve a sufficient down-staging response with the current chemoradiation schedules. Hence, investigators have aspired to increase pathological complete response rates, aiming to improve curative resection rates, enhance survival, and potentially avoid mutilating surgery. However, adding additional cytotoxic or biological agents have not produced dramatic improvements in outcome and often led to excess surgical morbidity and higher levels of acute toxicity, which effects on compliance and in the global efficacy of chemoradiation. PMID:27238473

  16. Positive Surgical Margins in Soft Tissue Sarcoma Treated With Preoperative Radiation: Is a Postoperative Boost Necessary?

    SciTech Connect

    Al Yami, Ali; Griffin, Anthony M.; Ferguson, Peter C.; Catton, Charles N.; Chung, Peter W.M.

    2010-07-15

    Purpose: For patients with an extremity soft tissue sarcoma (STS) treated with preoperative radiotherapy and surgically excised with positive margins, we retrospectively reviewed whether a postoperative radiation boost reduced the risk of local recurrence (LR). Methods and Materials: A total of 216 patients with positive margins after resection of an extremity STS treated between 1986 and 2003 were identified from our institution's prospectively collected database. Patient demographics, radiation therapy parameters including timing and dose, classification of positive margin status, reasons for not administering a postoperative boost, and oncologic outcome were collected and evaluated. Results: Of the 216 patients with a positive surgical margin, 52 patients were treated with preoperative radiation therapy alone (50 Gy), whereas 41 received preoperative radiation therapy plus a postoperative boost (80% received 16 Gy postoperatively for a total of 66 Gy). There was no difference in baseline tumor characteristics between the two groups. Six of 52 patients in the group receiving preoperative radiation alone developed a LR compared with 9 of 41 in the boost group. Five-year estimated LR-free survivals were 90.4% and 73.8%, respectively (p = 0.13). Conclusions: We found that including the postoperative radiation boost after preoperative radiation and a margin-positive excision did not provide an advantage in preventing LR for patients treated with external beam radiotherapy. Given that higher radiation doses placed patients at greater risk for late complications such as fracture, fibrosis, edema, and joint stiffness, judicious avoidance of the postoperative boost while maintaining an equivalent rate of local control can reduce the risk of these difficult-to-treat morbidities.

  17. Preoperative carbohydrate nutrition reduces postoperative nausea and vomiting compared to preoperative fasting

    PubMed Central

    Yilmaz, Neslihan; Çekmen, Nedim; Bilgin, Ferruh; Erten, Ela; Özhan, Mehmet Özhan; Coşar, Ahmet

    2013-01-01

    Background: The aim of this prospective, randomized, single-blinded study was to compare the effects of a carbohydrate drink 400 mL given 2 h before the surgery with preoperative overnight fasting on the gastric pH and residual volume, postoperative nausea and vomiting (PONV) and antiemetic consumption in patients undergoing laparoscopic cholecystectomy. Materials And Methods: Forty American Society of Anesthesiologists physical status I-II patients who underwent elective laparoscopic cholecystectomy. Randomized, prospective, controlled study, Gulhane Medical Faculty and Guven Hospital Department of Anesthesiology and Reanimation. Patients were randomly assigned into two groups: Pre-operative carbohydrate drink group (group C, n = 20) and preoperative fasting group (group F, n = 20). Group C was given a 400 mL carbohydrate drink 2 h before to the surgery. The patients of group F were fasted 8 h before the surgery. Both groups were operated under general anesthesia with volatile anesthetics. Results: Hemodynamic parameters, demographic data, gastric acidity and residual volumes were similar for both groups. No complications were observed. PONV and antiemetic consumption was lower in group C compared to group F (P = 0.001). Patient's satisfaction was higher in group C (P < 0.001). Conclusion: This study showed that pre-operative carbohydrate drink may be used safely and also improves patient's satisfaction and comfort in patients undergoing laparoscopic cholecystectomy. PMID:24497851

  18. 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.

  19. Preoperative transarterial Embolisation in bone tumors

    PubMed Central

    Gupta, Pankaj; Gamanagatti, Shivanand

    2012-01-01

    Bone tumors include a variety of lesions, both primary and metastatic. The treatment modalities for bone tumors vary with the individual lesion, but in general surgical excision is the treatment of choice with other adjunctive therapies. However, surgery for many bone tumors is complex due to several factors including tumor bulk, vascularity, vicinity to vital structures and potentially inaccessible location of the lesion. Transarterial Embolisation (TAE) is one of the important adjuvant treatment modalities and in some cases it may be the primary and curative treatment. Preoperative TAE has proved to be effective in both primary and metastatic bone tumors. It reduces tumor vascularity and intraoperative blood loss, the need for blood transfusion and associated complications, allows better definition of tissue planes at surgery affording more complete excision, and hence reduced recurrence. Preoperative chemoEmbolisation has also been shown to increase the sensitivity of some tumors to subsequent chemotherapy and radiotherapy. There are several techniques and embolic agents available for this purpose, but the ultimate aim is to achieve tumor devascularization. In this review, we discuss the techniques including the choice of embolic agent, application to individual lesions and potential complications. PMID:22761978

  20. [Preoperative oral hydration for pregnant women].

    PubMed

    Okutomi, Toshiyuki; Kato, Rie

    2011-07-01

    Preoperative oral hydration is an important component of "enhanced recovery after surgery" strategies. This was originally developed for patients undergoing colon surgery. The Obstetric Anesthesia Practice Guideline issued by American Society of Anesthesiologists states that intake of minimum amount of clear fluid 2 hours prior to surgery may be safe. However, anesthesiologists have to consider physiological changes that parturients undergo during pregnancy, such as increased risk of aspiration and impaired glucose tolerance. We also have to consider the potential effect of glucose loading on neonates. Mothers are more likely to develop ketosis by glucose loading. It also stimulates insulin release in the fetus, which can result in neonatal hypoglycemia. In addition, sodium overloading may deteriorate intra-vascular dehydration and cause lung edema to mothers. On the other hand, oral hydration can alleviate a sense of thirst and increase maternal satisfaction. Our data showed that maternal urinal ketone body at delivery tended to decrease with oral hydration during labor. Moreover, some articles suggest that oral hydration may improve utero-placental perfusion. Therefore, we have to balance risks and benefits of oral hydration in parturients. Further investigations are needed among this specific subgroup of patients in order to establish the safe application of preoperative oral hydration. PMID:21800658

  1. Preoperative radiotherapy in gastric cancer: CTV definition for conformal therapy according to tumor location.

    PubMed

    Cellini, Francesco; Valentini, Vincenzo; Pacelli, Fabio; D'Ugo, Domenico; Mantini, Giovanna; Balducci, Mario; Gambacorta, Maria Antonietta; Nori, Stefania

    2003-01-01

    In the past radiation oncologists had not a major interest in the treatment of gastric cancer, but the positive outcomes of the Intergroup Study (INT-0116) supported the role of locoregional control in promoting better survival. To reduce the toxicity and the risk of residual disease in locally advanced tumors after surgery,a preoperative approach was tentatively considered. The aim of this manuscript is to define the location of nodal area at risk for cancer involvement according to the tumor location (cardias, corpus, antrum) on CT images to help the radiotherapist in the contouring process of the CTV for preoperative conformal treatment of gastric cancer. The analysis of both the percentage of nodal involvement detected at surgery and of the site of recurrence after radical surgery can direct to the areas to be considered at risk with its contouring on CT. Preoperative conformal-three dimensional radiotherapy of gastric cancer requires clear and well defined contouring guide-lines to allow the evaluation of clinical outcomes and the analysis if the area at risk for recurrence has changed after the preoperative approach. PMID:15018320

  2. 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

  3. Jejunioleal Bypass Procedures in Morbid Obesity: Preoperative Psychological Findings

    ERIC Educational Resources Information Center

    Webb, Warren W.; And Others

    1976-01-01

    Seventy patients who averaged 155 percent overweight and requested jejunioleal bypass surgery as a treatment intervention for morbid obesity were studied preoperatively for prominent psychological characteristics. (Author)

  4. 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. PMID:26684961

  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. 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

  7. 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

  8. Phosphatidylinositol 3-kinase CB association with preoperative radiotherapy response in rectal adenocarcinoma

    PubMed Central

    Yu, Wei-Dong; Peng, Yi-Fan; Pan, Hong-Da; Wang, Lin; Li, Kun; Gu, Jin

    2014-01-01

    AIM: To examine the correlation of phosphatidylinositol 3-kinase (PIK3) CB expression with preoperative radiotherapy response in patients with stage II/III rectal adenocarcinoma. METHODS: PIK3CB immunoexpression was retrospectively assessed in pretreatment biopsies from 208 patients with clinical stage II/III rectal adenocarcinoma, who underwent radical surgery after 30-Gy/10-fraction preoperative radiotherapy. The relation between PIK3CB expression and tumor regression grade, clinicopathological characteristics, and survival time was statistically analyzed. Western blotting and in vitro clonogenic formation assay were used to detect PIK3CB expression in four colorectal cancer cell lines (HCT116, HT29, LoVo, and LS174T) treated with 6-Gy ionizing radiation. Pharmacological assays were used to evaluate the therapeutic relevance of TGX-221 (a PIK3CB-specific inhibitor) in the four colorectal cancer cell lines. RESULTS: Immunohistochemical staining indicated that PIK3CB was more abundant in rectal adenocarcinoma tissues with poor response to preoperative radiotherapy. High expression of PIK3CB was closely correlated with tumor height (P < 0.05), ypT stage (P < 0.05), and high-degree tumor regression grade (P < 0.001). High expression of PIK3CB was a potential prognostic factor for local recurrence-free survival (P < 0.05) and metastasis-free survival (P < 0.05). High expression of PIK3CB was also associated with poor therapeutic response and adverse outcomes in rectal adenocarcinoma patients treated with 30-Gy/10-fraction preoperative radiotherapy. In vitro, PIK3CB expression was upregulated in all four colorectal cancer cell lines concurrently treated with 6-Gy ionizing radiation, and the PIK3CB-specific inhibitor TGX-221 effectively inhibited the clonogenic formation of these four colorectal cancer cell lines. CONCLUSION: PIK3CB is critically involved in response to preoperative radiotherapy and may serve as a novel target for therapeutic intervention. PMID:25473181

  9. Usefulness of Preoperative Assessment of Perigastric Vascular Anatomy by Dynamic Computed Tomography for Laparoscopic Gastrectomy

    PubMed Central

    Osaki, Tomohiro; Saito, Hiroaki; Murakami, Yuki; Miyatani, Kozo; Kuroda, Hirohiko; Matsunaga, Tomoyuki; Fukumoto, Youji; Ikeguchi, Masahide

    2015-01-01

    Background Laparoscopic surgery requires a more detailed understanding of local anatomy than does conventional open surgery. The aim of this study was to examine the usefulness of dynamic computed tomography (D-CT) for identification of the location of the left gastric vein (LGV) and existence of the aberrant left hepatic artery (ALHA) compared with conventional enhanced computed tomography (E-CT). Methods Sixty-eight patients underwent laparoscopic-assisted gastrectomy (LAG). E-CT and D-CT were performed in 32 and 36 patients, respectively, and three-dimensional computed tomographic angiography (3D-CTA) was performed in addition to D-CT. The location of the LGV and existence of the ALHA were confirmed during LAG, and these results were compared with those determined preoperatively by CT imaging. Results The location of the LGV as detected by preoperative E-CT and D-CT was consistent with that identified during LAG in 28 (87.5%) and 31 (88.9%) patients, respectively, with no statistical differences. The existence of the ALHA as detected by preoperative E-CT and D-CT was consistent with that identified during gastrectomy in 24 (75%) and 36 (100%) patients, respectively, with a statistical difference (P = 0.005). Furthermore, the type of ALHA could be identified in 10 of 12 patients (83.3%) by D-CT. Conclusion D-CT can produce excellent images of the vascular supply, and thus undoubtedly contributes to the preoperative planning of LAG. Preoperative D-CT might be an informative tool with which to help overcome the disadvantages of LAG. PMID:26740734

  10. 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. PMID:21781358

  11. Background parenchymal enhancement in preoperative breast MRI

    PubMed Central

    Kohara, Satoko; Ishigaki, Satoko; Satake, Hiroko; Kawamura, Akiko; Kawai, Hisashi; Kikumori, Toyone; Naganawa, Shinji

    2015-01-01

    ABSTRACT We aimed to assess the influence of background parenchymal enhancement (BPE) on surgical planning performed using preoperative MRI for breast cancer evaluation. Between January 2009 and December 2010, 91 newly diagnosed breast cancer patients (mean age, 55.5 years; range, 30−88 years) who underwent preoperative bilateral breast MRI followed by planned breast conservation therapy were retrospectively enrolled. MRI was performed to assess the tumor extent in addition to mammography and breast ultrasonography. BPE in the contralateral normal breast MRI at the early dynamic phase was visually classified as follows: minimal (n=49), mild (n=27), moderate (n=7), and marked (n=8). The correlations between the BPE grade and age, menopausal status, index tumor size, changes in surgical management based on MRI results, positive predictive value (PPV) of MRI, and surgical margins were assessed. Patients in the strong BPE groups were significantly younger (p=0.002) and generally premenopausal (p<0.001). Surgical treatment was not changed in 67 cases (73.6%), while extended excision and mastectomy were performed in 12 cases (13.2%), each based on additional lesions on MRI. Six of 79 (7.6%) patients who underwent breast conservation therapy had tumor-positive resection margins. In cases where surgical management was changed, the PPV for MRI-detected foci was high in the minimal (91.7%) and mild groups (66.7%), and 0% in the moderate and marked groups (p=0.002). Strong BPE causes false-positive MRI findings and may lead to overly extensive surgery, whereas MRI may be beneficial in select patients with weak BPE. PMID:26412883

  12. 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…

  13. Preoperative diagnosis of double gallbladder: a case report.

    PubMed

    Buluş, Hakan; Koyuncu, Ahmet; Coşkun, Ali

    2012-04-01

    Gallbladder duplication is a rare congenital anomaly of the biliary system. There are no specific symptoms for diagnosis. We present the case of a double gallbladder, which was diagnosed preoperatively. A laparoscopic cholecystectomy was performed successfully. We discuss that the preoperative diagnosis of this anomaly is especially important to prevent possible surgical complications and repeated laparotomies. PMID:22706748

  14. Utility of preoperative imaging in evaluating colorectal liver metastases declines over time

    PubMed Central

    Yang, Simon; Hongjinda, Sermsak; Hanna, Sherif S; Gallinger, Steven; Wei, Alice C; Kiss, Alex; Law, Calvin

    2010-01-01

    Objectives Reports on the sensitivity and accuracy of contrast-enhanced helical computed tomography (HCT) in the preoperative evaluation of colorectal liver metastases (CLM) have been conflicting. Few studies have controlled for and reported on the time interval between HCT and eventual surgery. Methods A multi-institution, retrospective review of consecutive patients who underwent hepatic resection for CLM from January 1999 to September 2004 was conducted. Data regarding lesion characteristics and resectability were extracted from radiology reports, operative findings and histopathological records. Findings in HCT were evaluated according to their sensitivity for detecting CLM and ability to predict resectability. Results A total of 217 consecutive patients who underwent hepatic resection for CLM were identified. The overall sensitivity of HCT for detection of CLM was 83.2%. Prolonged time between imaging and surgery was a negative predictor for HCT sensitivity in univariate and multivariate analysis (P < 0.001). In predicting resectability, preoperative HCT was accurate 77.0% of the time. The time interval to surgery was negatively correlated with HCT prediction accuracy in univariate and multivariate analyses (P < 0.001). Conclusions The utility of HCT as a preoperative tool to evaluate CLM is inversely proportional to the time interval between imaging and surgery. This may explain conflicting reports of the accuracy of HCT in the current literature. PMID:20961368

  15. Hemostatic status in liver transplantation: association between preoperative procoagulants/anticoagulants and postoperative hemorrhaging/thrombosis.

    PubMed

    Akamatsu, Nobuhisa; Sugawara, Yasuhiko; Nakazawa, Akiko; Nishioka, Yujiro; Kaneko, Junichi; Aoki, Taku; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Kokudo, Norihiro

    2015-02-01

    The delicate rebalanced hemostatic status of liver transplant recipients may lead to both hemorrhagic and thrombotic tendencies in this population. The aim of this study was to investigate the association between pretransplant procoagulants/anticoagulants and posttransplant bleeding and thrombosis among living donor liver transplant recipients. The study subjects were 403 consecutive recipients with chronic liver disease. Perioperative variables, including preoperative values for procoagulants and anticoagulants, were assessed to determine their association with posttransplant hemorrhaging and thrombosis. There were 35 hemorrhagic complications (9%) and 21 thrombotic complications (5%). In logistic regression analyses, a higher Model for End-Stage Liver Disease score (P = 0.01) and a lower fibrinogen value (P < 0.001) were independently associated with hemorrhaging, whereas only a lower protein C value (P < 0.001) was independently associated with thrombosis. In a receiver operating characteristic analysis, a low preoperative protein C value (with the most accurate cutoff value being 25%) was a reliable predictor of thrombotic complications after liver transplantation (area under the curve = 0.921, P < 0.001, sensitivity = 0.9, specificity = 0.8). In conclusion, the decreases in both procoagulants and anticoagulants in liver transplant recipients may additively result in a delicate hemostatic balance and predispose patients to both hemorrhagic and thrombotic complications. A lower preoperative protein C value (<25%) was demonstrated to be a significant and reliable predictor of postoperative thrombotic complications in liver transplant recipients. PMID:25370801

  16. Liver surgery perspective: from pre-operative surgery planning to intra-operative image guided operation

    NASA Astrophysics Data System (ADS)

    Li, Senhu; Lennon, Brian T.; Waite, Jon M.; Clements, Logan W.; Scherer, Mike A.; Stefansic, Jim D.

    2009-10-01

    Liver cancer represents a major health care problem in the world, especially in China and several countries in Southeast Asia. The most effective treatment is through tumor resection. To improve the outcome of surgery, a combination of preoperative planning and intra operative image guided liver surgery (IGLS) system has been developed at Pathfinder Therapeutics, Inc. The preoperative planning subsystem (Linasys® PlaniSight®) is user-oriented and applies several novel algorithms on image segmentation and modeling, which allows the user to build various organ and tumor models with anticipated resection planes in less than 30 minutes. The surgeons can analyze the patient-specific case and set up surgical protocols. This information in image space can then be transferred into physical space through our intra operative image guided liver surgery system (Linasys® SurgSight®) based on modifications of existing surface registration algorithms, allowing surgeons to perform more accurate resections after preoperative planning. This tool gives surgeons a better understanding of vessel structure and tumor locations within the liver parenchyma during the surgery. Our ongoing clinical trial shows that it greatly facilitates liver resection operation and it is expected to improve the surgery outcome and create more candidates for surgery.

  17. Preoperative imaging of liver metastases. Comparison of angiography, CT scan, and ultrasonography.

    PubMed Central

    Gunvén, P; Makuuchi, M; Takayasu, K; Moriyama, N; Yamasaki, S; Hasegawa, H

    1985-01-01

    Thirty-one patients with mostly colorectal cancer metastases to the liver had preoperative selective/superselective angiograms (24 cases), computed tomography (CT) [26 cases, mostly enhanced by contrast administered by a peripheral vein (9), the common hepatic artery (9), or the portal vein (5)], and ultrasonography (26 cases). Intraoperative ultrasonography and palpation and examination of the resected specimens revealed 113 tumors. CT detected almost half of the masses smaller than 1 cm, and ultrasonography and angiography about one-third of lesions 1-2 cm in size. Ultrasonography was less powerful for examination of the posterior segment of the liver. CT and ultrasonography placed the tumors into subsegments more accurately than did angiography. Almost 40% of the preoperative plans had to be changed: in two-thirds by extended resections and in one-third by a change from curative to palliative intent. Most changes were due to extrahepatic tumor growth, often within areas screened before surgery. The use of all three imaging modalities for liver metastases is recommended for preoperative planning. PMID:3901943

  18. 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

  19. 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

  20. Sphincter-preserving surgery after preoperative radiochemotherapy for T3 low rectal cancers

    PubMed Central

    BAI, XUE; LI, SHIYONG; YU, BO; SU, HONG; JIN, WEISEN; CHEN, GANG; DU, JUNFENG; ZUO, FUYI

    2012-01-01

    The aim of this study was to evaluate the feasibility and the effectiveness of preoperative radiochemotherapy followed by total mesorectal excision (TME) and sphincter-preserving procedures for T3 low rectal cancer. Patients with rectal cancer and T3 tumors located within 1–6 cm of the dentate line received preoperative radiochemotherapy. Concurrent 5-fluorouracil-based radiochemotherapy was used. Radical resection with TME and sphincter-preserving procedures were performed during the six to eight weeks following radiotherapy. Survival was analyzed using the Kaplan-Meier method. The anal function was evaluated using the Wexner score. The clinical response rate was 83.5%, overall downstaging of T classification was 75.3% and pathological complete response was 15.3%. The anastomotic fistula rate was 4.7%. A median follow-up of 30 months showed the local recurrence rate to be 4.7% and the distant metastasis rate to be 5.9%. The three-year overall survival rate was 87%. The degree of anal incontinence as measured using the Wexner score decreased over time, and the anal sphincter function in the majority of patients gradually improved. Preoperative radiochemotherapy was found to improve tumor downstaging, reduces local recurrence, increase the sphincter preservation rate, and is therefore of benefit to patients with T3 low rectal cancer. PMID:22783445

  1. Radical cystectomy at Roswell Park Memorial Institute. Preoperative and post operative observations.

    PubMed

    Eisenkraft, S; Pontes, J E

    1984-01-01

    Between January 1979 and March 1983, 63 consecutive patients underwent cystectomy and urinary diversion for primary carcinoma of the bladder at Roswell Park Memorial Institute (RPMI). Fifty-five patients had transitional cell carcinoma, 6 squamous cell carcinoma and 2 adenocarcinoma of the bladder. Twelve patients with bladder cancer were found to have adenocarcinoma of the prostate on the pathological specimen. Preoperative radiation was given to 41 patients. Thirty-six patients received 4000 rads preoperatively followed by radical cystectomy, 5 patients received 2000 rads. Thirteen patients received 6000 rads as curative treatment and underwent salvage cystectomy and colon conduit because of failure. There was no operative mortality. Severe complications in the early postoperative period occurred in 19 instances, some patients having more than one complication. Late complications necessitating surgical correction occurred in 5 patients. Although radical cystectomy is effective in controlling the local disease, most patients still died of metastatic transitional cell carcinoma. PMID:6483919

  2. Initially unresectable rectal adenocarcinoma treated with preoperative irradiation and surgery

    SciTech Connect

    Mendenhall, W.M.; Million, R.R.; Bland, K.I.; Pfaff, W.W.; Copeland, E.M. 3d.

    1987-01-01

    This is an analysis of 23 patients with clinically and/or surgically unresectable adenocarcinoma of the rectum on initial evaluation who were treated with preoperative irradiation and surgery between March 1970 and April 1981. All patients have had follow-up for at least 5 years. Five patients (22%) had exploratory laparotomy and diverting colostomy before irradiation. All patients were irradiated with megavoltage equipment to the pelvis at 180 rad/fraction, continuous-course technique. Total doses ranged from 3500 to 6000 rad with a mean of 4800 rad and a median of 5000 rad. All patients had surgery 2-11 weeks (mean: 4.9 weeks; median: 4 weeks) after radiation therapy. Twelve patients (52%) had lesions that were incompletely resected because of positive margins (7 patients), distant metastasis (1 patient), or both (4 patients). All of these patients died of cancer within 5 years of treatment. Eleven patients had an apparent complete excision of their rectal cancer; six patients (55%) subsequently had a local recurrence. The 5-year absolute survival rate for patients who had complete resection was 18% (2 of 11 patients). The 5-year absolute and determinate survival rates for the entire study were 9% (2 of 23 patients) and 9% (2 of 22 patients), respectively. One patient (in the incomplete resection group) died after operation secondary to sepsis and diffuse intravascular coagulation.

  3. Preoperative optimization of the vascular surgery patient.

    PubMed

    Zhan, Henry T; Purcell, Seth T; Bush, Ruth L

    2015-01-01

    It is well known that patients who suffer from peripheral (noncardiac) vascular disease often have coexisting atherosclerotic diseases of the heart. This may leave the patients susceptible to major adverse cardiac events, including death, myocardial infarction, unstable angina, and pulmonary edema, during the perioperative time period, in addition to the many other complications they may sustain as they undergo vascular surgery procedures, regardless of whether the procedure is performed as an open or endovascular modality. As these patients are at particularly high risk, up to 16% in published studies, for postoperative cardiac complications, many proposals and algorithms for perioperative optimization have been suggested and studied in the literature. Moreover, in patients with recent coronary stents, the risk of non-cardiac surgery on adverse cardiac events is incremental in the first 6 months following stent implantation. Just as postoperative management of patients is vital to the outcome of a patient, preoperative assessment and optimization may reduce, and possibly completely alleviate, the risks of major postoperative complications, as well as assist in the decision-making process regarding the appropriate surgical and anesthetic management. This review article addresses several tools and therapies that treating physicians may employ to medically optimize a patient before they undergo noncardiac vascular surgery. PMID:26170688

  4. 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

  5. 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

  6. Multimodality assessment of esophageal cancer: preoperative staging and monitoring of response to therapy.

    PubMed

    Kim, Tae Jung; Kim, Hyae Young; Lee, Kyung Won; Kim, Moon Soo

    2009-01-01

    Esophageal cancer is a leading cause of cancer mortality worldwide. Complete resection of esophageal cancer and adjacent malignant lymph nodes is the only potentially curative treatment. Accurate preoperative staging and assessment of therapeutic response after neoadjuvant therapy are crucial in determining the most suitable therapy and avoiding inappropriate attempts at curative surgery. Computed tomography (CT) is recommended for initial imaging following confirmation of malignancy at pathologic analysis, primarily to rule out unresectable or distant metastatic disease. With the advent of multidetector CT, use of thin sections and multiplanar reformation allows more accurate staging of esophageal cancer. Endoscopic ultrasonography (US) is the best modality for determining the depth of tumor invasion and presence of regional lymph node involvement. Combined use of fine-needle aspiration and endoscopic US can improve assessment of lymph node involvement. Positron emission tomography (PET) is useful for assessment of distant metastases but is not appropriate for detecting and staging primary tumors. PET may also be helpful in restaging after neoadjuvant therapy, since it allows identification of early response to treatment and detection of interval distant metastases. Each imaging modality has its advantages and disadvantages; therefore, CT, endoscopic US, and PET should be considered complementary modalities for preoperative staging and therapeutic monitoring of patients with esophageal cancer. PMID:19325056

  7. 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.

  8. Reducing preoperative fasting time: A trend based on evidence

    PubMed Central

    de Aguilar-Nascimento, José Eduardo; Dock-Nascimento, Diana Borges

    2010-01-01

    Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma. Various randomized trials and meta-analyses have consistently shown that is safe to reduce the preoperative fasting time with a carbohydrate-rich drink up to 2 h before surgery. Benefits related to this shorter preoperative fasting include the reduction of postoperative gastrointestinal discomfort and insulin resistance. New formulas containing amino acids such as glutamine and other peptides are being studied and are promising candidates to be used to reduce preoperative fasting time. PMID:21160851

  9. Diversity in preoperative-assessment data collection, a literature review.

    PubMed

    Ahmadian, Leila; Cornet, Ronald; van Klei, Wilton A; de Keizer, Nicolette F

    2008-01-01

    The appropriate anesthetic techniques and care during and after operation rely on data gathered during the preoperative assessment. Because various people are involved, standardization of this process is important. This paper provides a systematic literature review about which data items are collected in the preoperative assessment. Thirty-two relevant articles were found by PubMed search. To categorize data SNOMED CT concepts are used, resulting in 13 categories totaling 540 data items. The two largest categories of data were "past history of clinical finding", and "physical examination procedure" with 251 and 75 data items respectively. Our study showed a high diversity of data items in the preoperative assessment. Because of the diversity of patients and treatment options available one undisputed preoperative assessment data set is hard to define. However, to solve the problem of exchangeability of the information at least anesthesiologists should use a same core set of data. PMID:18487719

  10. Preoperative patient assessment: a review of the literature and recommendations.

    PubMed Central

    Barnard, N. A.; Williams, R. W.; Spencer, E. M.

    1994-01-01

    The aims of preoperative assessment of patients are outlined, and the role of clinical and laboratory testing is defined. Following a review of the literature, guidelines for requesting such investigations are suggested. PMID:7979066

  11. Preoperative assessment and optimization in periampullary and pancreatic cancer.

    PubMed

    Myatra, S; Divatia, J V; Jibhkate, B; Barreto, G S; Shrikhande, S V

    2011-01-01

    Perioperative management of pancreatic and periampullary cancer poses a considerable challenge to the pancreatic surgeon, anesthesiologist, and the intensive care team. The preoperative surgical evaluation of a pancreatic lesion aims to define the nature of the lesion (malignant or benign), stage the tumor, and to determine resectability or other non-surgical treatment options. Patients are often elderly and may have significant comorbidities and malnutrition. Obstructive jaundice may lead to coagulopathy, infection, renal dysfunction, and adverse outcomes. Routine preoperative biliary drainage can result in higher complication rates, and metal stents may be preferred over plastic stents in selected patients with resectable disease. Judicious use of antibiotics and maintaining fluid volume preoperatively can reduce the incidence of infection and renal dysfunction, respectively. Perioperative fluid therapy with hemodynamic optimization using minimally invasive monitoring may help improve outcomes. Careful patient selection, appropriate preoperative evaluation and optimization can greatly contribute to a favorable outcome after major pancreatic resections. PMID:21248439

  12. 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

  13. Improving pre-operative medicines reconciliation

    PubMed Central

    Brunswicker, Annemarie; Yogarajah, Amieth

    2014-01-01

    An audit of 143 surgical admissions showed that only 30% of general surgery and urology patients have complete medication charts on the day of surgery prior to going to theatre, compared to 94% of orthopaedic patients. This was despite having been seen previously in the pre-operative assessment clinic (POAC). These patients went to the wards post-operatively, where many then missed doses of their life-sustaining medications. Orthopaedic patients see a prescribing pharmacist in POAC who undertakes medicines reconciliation; this is performed by junior doctors for surgical patients. We designed three interventions to improve drug chart completion by junior doctors, and gathered prospective data for 22 weeks in the POAC. We also recorded attendance of junior doctors in the POAC and reasons for absence. Daily and weekly percentages of drug chart completion were plotted on a run chart. The baseline completion rate was 43%. This rose to 45% after the first and second interventions, and 51% after the third intervention. However, the completion rate remained markedly below our target of 94%. Junior doctors attended only 44% of POACs. They reported being “too busy to attend” 41% of the time, and could not be contacted on 11% of occasions. Junior doctors reported that they were unable to attend to both unwell inpatients and the POAC, the latter seeming less of a priority. This was despite a rota allocating doctors to attend POAC sessions free from clinical or teaching commitments. We were unable to increase the rate of drug chart completion with the resources available. We therefore recommend the employment of prescribing pharmacists in the POAC for general surgery and urology patients.

  14. Surgery for Locally Advanced T4 Rectal Cancer: Strategies and Techniques.

    PubMed

    Helewa, Ramzi M; Park, Jason

    2016-06-01

    Locally advanced T4 rectal cancer represents a complex clinical condition that requires a well thought-out treatment plan and expertise from multiple specialists. Paramount in the management of patients with locally advanced rectal cancer are accurate preoperative staging, appropriate application of neoadjuvant and adjuvant treatments, and, above all, the provision of high-quality, complete surgical resection in potentially curable cases. Despite the advanced nature of this disease, extended and multivisceral resections with clear margins have been shown to result in good oncological outcomes and offer patients a real chance of cure. In this article, we describe the assessment, classification, and multimodality treatment of primary locally advanced T4 rectal cancer, with a focus on surgical planning, approaches, and outcomes. PMID:27247535

  15. How to accurately bypass damage

    PubMed Central

    Broyde, Suse; Patel, Dinshaw J.

    2016-01-01

    Ultraviolet radiation can cause cancer through DNA damage — specifically, by linking adjacent thymine bases. Crystal structures show how the enzyme DNA polymerase η accurately bypasses such lesions, offering protection. PMID:20577203

  16. Mastectomy following preoperative chemotherapy. Strict operative criteria control operative morbidity.

    PubMed

    Broadwater, J R; Edwards, M J; Kuglen, C; Hortobagyi, G N; Ames, F C; Balch, C M

    1991-02-01

    The surgical morbidity associated with aggressive preoperative chemotherapy in 106 patients with advanced primary breast cancer who had chemotherapy followed by mastectomy was examined. These patients were compared with a group of 91 consecutive patients who had mastectomy without preoperative chemotherapy. Strict operative criteria were used to determine the timing of mastectomy following chemotherapy. Wound infection rates were no different in the preoperative chemotherapy group compared to the mastectomy-alone groups (7% versus 4%; p = 0.62). The incidence of wound necrosis was similar (11% versus 6%; p = 0.29). Seroma formation was decreased significantly in the preoperative chemotherapy group compared to the mastectomy-alone group (15% versus 28%; p = 0.04). Intensive preoperative chemotherapy did not delay the reinstitution of postoperative treatment (30% versus 20%; p = 0.27). However, when delay in instituting postoperative chemotherapy was more than 30 days, there was a significant decrease in overall survival rate (p = 0.04). This study provides evidence that intensive preoperative chemotherapy and mastectomy can be performed without increased morbidity. Furthermore it is important to institute systemic chemotherapy within 30 days of mastectomy to achieve maximum survival. PMID:1992938

  17. Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer

    PubMed Central

    INOUE, YASUHIRO; SAIGUSA, SUSUMU; HIRO, JUNICHIRO; TOIYAMA, YUJI; ARAKI, TOSHIMITSU; TANAKA, KOJI; MOHRI, YAUSHIKO; KUSUNOKI, MASATO

    2016-01-01

    Preoperative chemoradiotherapy (CRT) with total mesorectal excision (TME) is the widely accepted treatment for rectal cancer (RC) in Western countries. However, there remains controversy as to whether preoperative CRT is useful in tumors that extend beyond the mesorectum, including metastasis to the lateral pelvic lymph nodes (LPLN). The aim of this study was to assess the prognostic significance of LPLN enlargement in patients with RC who receive preoperative CRT followed by TME without LPLN dissection. We evaluated the prognostic effect of radiographic LPLN enlargement before and after CRT, as well as the patients' clinicopathological and genetic profiles. Of the 104 patients investigated, pretreatment imaging identified 19 (18%) as LPLN-positive (>7 mm in diameter). Of these 19 patients, 7 (37%) exhibited LPLN downsizing to <7 mm following CRT. The median follow-up period was 52 months. The 5-year cancer-specific survival (CSS) or relapse-free survival (RFS) did not differ significantly between patients who did and those who did not have positive LPLN on pretreatment imaging. However, LPLN that remained positive after CRT were significantly associated with poorer 5-year CSS (73 vs. 84%, respectively; P=0.0052) and RFS (32 vs. 78%, respectively; P=0.0264). None of the patients whose LPLN were downsized to <7 mm following CRT developed recurrence; however, those with positive LPLN after CRT had a 55% higher recurrence rate, characterized by delayed local recurrence, a pattern that may be affected by certain chemokines. In conclusion, changes in initially positive LPLN (>7 mm) may predict the prognosis of patients with RC who receive preoperative CRT-TME. LPLN positivity after CRT was associated with shorter CSS and RFS. Strategies to improve patient survival may include selective LPLN dissection or more aggressive multimodality therapy. PMID:27313860

  18. 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.

  19. Accurate Evaluation of Quantum Integrals

    NASA Technical Reports Server (NTRS)

    Galant, David C.; Goorvitch, D.

    1994-01-01

    Combining an appropriate finite difference method with Richardson's extrapolation results in a simple, highly accurate numerical method for solving a Schr\\"{o}dinger's equation. Important results are that error estimates are provided, and that one can extrapolate expectation values rather than the wavefunctions to obtain highly accurate expectation values. We discuss the eigenvalues, the error growth in repeated Richardson's extrapolation, and show that the expectation values calculated on a crude mesh can be extrapolated to obtain expectation values of high accuracy.

  20. Adoption of Preoperative Radiation Therapy for Rectal Cancer From 2000 to 2006: A Surveillance, Epidemiology, and End Results Patterns-of-Care Study

    SciTech Connect

    Mak, Raymond H.; McCarthy, Ellen P.; Das, Prajnan; Hong, Theodore S.; Mamon, Harvey J.

    2011-07-15

    Purpose: The German rectal study determined that preoperative radiation therapy (RT) as a component of combined-modality therapy decreased local tumor recurrence, increased sphincter preservation, and decreased treatment toxicity compared with postoperative RT for rectal cancer. We evaluated the use of preoperative RT after the presentation of the landmark German rectal study results and examined the impact of tumor and sociodemographic factors on receiving preoperative RT. Methods and Materials: In total, 20,982 patients who underwent surgical resection for T3-T4 and/or node-positive rectal adenocarcinoma diagnosed from 2000 through 2006 were identified from the Surveillance, Epidemiology, and End Results tumor registries. We analyzed trends in preoperative RT use before and after publication of the findings from the German rectal study. We also performed multivariate logistic regression to identify factors associated with receiving preoperative RT. Results: Among those treated with RT, the proportion of patients treated with preoperative RT increased from 33.3% in 2000 to 63.8% in 2006. After adjustment for age; gender; race/ethnicity; marital status; Surveillance, Epidemiology, and End Results registry; county-level education; T stage; N stage; tumor size; and tumor grade, there was a significant association between later year of diagnosis and an increase in preoperative RT use (adjusted odds ratio, 1.26/y increase; 95% confidence interval, 1.23-1.29). When we compared the years before and after publication of the German rectal study (2000-2003 vs. 2004-2006), patients were more likely to receive preoperative RT than postoperative RT in 2004-2006 (adjusted odds ratio, 2.35; 95% confidence interval, 2.13-2.59). On multivariate analysis, patients who were older, who were female, and who resided in counties with lower educational levels had significantly decreased odds of receiving preoperative RT. Conclusions: After the publication of the landmark German rectal

  1. The value of routine preoperative chest roentgenograms in infants and children

    SciTech Connect

    Farnsworth, P.B.; Steiner, E.; Klein, R.M.; SanFilippo, J.A.

    1980-08-01

    The charts and routine preoperative roentgenograms of 350 children admitted for elective pediatric surgery were analyzed to evaluate the clinical importance of routine preoperative chest roentgenograms. This analysis, and a review of the literature, should indicate that routine preoperative roentgenograms for elective pediatric surgery are unnecessary. Indications for selected preoperative roentgenograms based on patients' history and clinical findings are enumerated.

  2. Successful Preoperative Chemoembolization in the Treatment of a Giant Malignant Phyllodes Tumor.

    PubMed

    Hashimoto, Kazuki; Mimura, Hidefumi; Arai, Yasunori; Doi, Masatomo; Kojima, Yasuyuki; Tsugawa, Koichiro; Nakajima, Yasuo

    2016-07-01

    The malignant phyllodes tumor is a relatively rare neoplasm and has not previously been a therapeutic target of interventional radiology. Herein, we report a successful case of preoperative chemoembolization of a giant malignant phyllodes tumor. The objective was to achieve sufficient tumor shrinkage before surgery to avoid the requirement for skin grafting after resection. Intra-arterial epirubicin infusion and subsequent embolization with Embosphere Microspheres (BioSphere Medical, Rockland, MA, USA) was undertaken three times over the course of 6 weeks and was well tolerated. The patient underwent surgery without skin grafting. Neither local recurrence nor distant metastasis was observed at 6 months after surgery. PMID:26916453

  3. Preoperative indicators of clinical outcome following stereotaxic pallidotomy.

    PubMed

    Kazumata, K; Antonini, A; Dhawan, V; Moeller, J R; Alterman, R L; Kelly, P; Sterio, D; Fazzini, E; Beric, A; Eidelberg, D

    1997-10-01

    We assessed the utility of preoperative clinical assessment and functional brain imaging with 18F-fluorodeoxyglucose (FDG) and positron emission tomography (PET) in predicting the clinical outcome of stereotaxic pallidotomy for the treatment of advanced Parkinson's disease (PD). Twenty-two PD patients undergoing posteroventral pallidotomy were assessed preoperatively with the Core Assessment Program for Intracerebral Transplantation (CAPIT) ratings measured on and off levodopa; quantitative FDG/PET was also performed before surgery. Preoperative clinical and metabolic measurements were correlated with changes in off-state CAPIT ratings determined 3 months after surgery. Clinical outcome following pallidotomy was also correlated with intraoperative measures of spontaneous pallidal single-unit activity as well as postoperative MRI measurements of lesion volume and location. We found that unilateral pallidotomy resulted in variable clinical improvement in off-state CAPIT scores for the contralateral limbs (mean change 30.9 +/- 15.5%). Postoperative MRI revealed that pallidotomy lesions were comparable in location and volume across the patients. Clinical outcome following surgery correlated significantly with preoperative measures of CAPIT score change with levodopa administration (r = 0.60, p < 0.005) and with preoperative FDG/PET measurements of lentiform glucose metabolism (r = 0.71, p < 0.0005). Operative outcome did not correlate with intraoperative measures of spontaneous pallidal neuronal firing rate. We conclude that preoperative measurements of lentiform glucose metabolism and levodopa responsiveness may be useful indicators of motor improvement following pallidotomy. Both preoperative quantitative measures, either singly or in combination, may be helpful in selecting optimal candidates for surgery. PMID:9339694

  4. Effect of Preoperative Pain on Inferior Alveolar Nerve Block

    PubMed Central

    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

  5. Role of preoperative embolization for intradural spinal hemangioblastomas.

    PubMed

    Ampie, Leonel; Choy, Winward; Khanna, Ryan; Smith, Zachary A; Dahdaleh, Nader S; Parsa, Andrew T; Bloch, Orin

    2016-02-01

    Spinal hemangioblastomas (HB) are relatively rare neoplasms with a high degree of vascularity. Therapy for symptomatic tumors involves total resection when possible. Due to the enriched blood supply of these neoplasms, there is a high risk of significant intraoperative blood loss, which can lead to perioperative complications. Preoperative embolization of HB has been suggested to reduce blood loss and operative morbidity, but its use remains controversial. Data on the risks and benefits of preoperative embolization for this tumor remains limited. We identified and analyzed all 29 reported cases of preoperative embolization of intradural spinal HB within the literature. There were 18 men and nine women, and patients ranged from 24 to 61 years of age. Mean tumor size was 3.5 cm. Cervical and thoracic location was most common, accounting for 48.3% and 20% of cases, respectively. Complications from embolization and surgery were minimal, with no deaths or permanent neurological morbidity. Minimal intraoperative bleeding and excellent rates of gross total resection were reported with preoperative embolization. However, outcomes from microsurgery alone from historical series have similarly reported excellent outcomes. While there is no established standard, preoperative embolization should be reserved for particularly high risk patients with risk of intraoperative bleeding. PMID:26585384

  6. 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

  7. 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

  8. 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

  9. Five Fractions of Radiation Therapy Followed by 4 Cycles of FOLFOX Chemotherapy as Preoperative Treatment for Rectal Cancer

    SciTech Connect

    Myerson, Robert J.; Tan, Benjamin; Hunt, Steven; Olsen, Jeffrey; Birnbaum, Elisa; Fleshman, James; Gao, Feng; Hall, Lannis; Kodner, Ira; Lockhart, A. Craig; Mutch, Matthew; Naughton, Michael; Picus, Joel; Rigden, Caron; Safar, Bashar; Sorscher, Steven; Suresh, Rama; Wang-Gillam, Andrea; Parikh, Parag

    2014-03-15

    Background: Preoperative radiation therapy with 5-fluorouracil chemotherapy is a standard of care for cT3-4 rectal cancer. Studies incorporating additional cytotoxic agents demonstrate increased morbidity with little benefit. We evaluate a template that: (1) includes the benefits of preoperative radiation therapy on local response/control; (2) provides preoperative multidrug chemotherapy; and (3) avoids the morbidity of concurrent radiation therapy and multidrug chemotherapy. Methods and Materials: Patients with cT3-4, any N, any M rectal cancer were eligible. Patients were confirmed to be candidates for pelvic surgery, provided response was sufficient. Preoperative treatment was 5 fractions radiation therapy (25 Gy to involved mesorectum, 20 Gy to elective nodes), followed by 4 cycles of FOLFOX [5-fluorouracil, oxaliplatin, leucovorin]. Extirpative surgery was performed 4 to 9 weeks after preoperative chemotherapy. Postoperative chemotherapy was at the discretion of the medical oncologist. The principal objectives were to achieve T stage downstaging (ypT < cT) and preoperative grade 3+ gastrointestinal morbidity equal to or better than that of historical controls. Results: 76 evaluable cases included 7 cT4 and 69 cT3; 59 (78%) cN+, and 7 cM1. Grade 3 preoperative GI morbidity occurred in 7 cases (9%) (no grade 4 or 5). Sphincter-preserving surgery was performed on 57 (75%) patients. At surgery, 53 patients (70%) had ypT0-2 residual disease, including 21 (28%) ypT0 and 19 (25%) ypT0N0 (complete response); 24 (32%) were ypN+. At 30 months, local control for all evaluable cases and freedom from disease for M0 evaluable cases were, respectively, 95% (95% confidence interval [CI]: 89%-100%) and 87% (95% CI: 76%-98%). Cases were subanalyzed by whether disease met requirements for the recently activated PROSPECT trial for intermediate-risk rectal cancer. Thirty-eight patients met PROSPECT eligibility and achieved 16 ypT0 (42%), 15 ypT0N0 (39%), and 33 ypT0-2 (87

  10. Prognostic Value of Preoperatively Obtained Clinical and Laboratory Data in Predicting Survival Following Orthotopic Liver Transplantation

    PubMed Central

    Cuervas-Mons, Valentin; Millan, Isabel; Gavaler, Judith S.; Starzl, Thomas E.; Van Thiel, David H.

    2010-01-01

    Twenty-seven clinical and laboratory data and the subsequent clinical course of 93 consecutive adult patients who underwent orthotopic liver transplantation for various chronic advanced liver diseases were analyzed retrospectively to assess the risk factors of early major bacterial infection and death after the procedure. Forty-one patients (44%) had early major bacterial infection during hospitalization for orthotopic liver transplantation. The mortality rate was 70.7% in patients with early major bacterial infection and was 7.7% in patients without early major bacterial infection (p < 0.001). Total serum bilirubin, total white blood cell count and polymorphonuclear cell count, IgG (all p < 0.05) and plasma creatinine level (p < 0.001) were higher in patients that developed early major bacterial infection than in those who did not. By step-wise discriminant analysis, the strongest risk factor for early major bacterial infection was the serum creatinine level, which achieved an accuracy of 69% for a creatinine level greater than 1.58 mg per dl. Seven variables (ascites, hepatic encephalopathy, elevated white blood and polymorphonuclear cell count, decreased helper to suppressor T cell ratio and elevated plasma creatinine and bilirubin levels) were associated with a significant increased risk for death. A step-wise discriminant analysis of these seven factors resulted in the demonstration of serum creatinine as the greatest risk factor for mortality. A preoperative serum creatinine either less than or greater than 1.72 mg per dl accurately predicts survival or death, respectively, in 79% of cases. These data suggest that the baseline preoperative serum creatinine level provides the best indication of the short-term prognosis after liver transplantation than does any other preoperatively obtained index of the patient’s status. PMID:3530947

  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. The effects of Pycnogenol(®) on colon anastomotic healing in rats given preoperative irradiation.

    PubMed

    Değer, K Cumhur; Şeker, Ahmet; Özer, Ilter; Bostancı, E Birol; Dalgıç, Tahsin; Akmansu, Müge; Ekinci, Özgür; Erçin, Uğur; Bilgihan, Ayşe; Akoğlu, Musa

    2013-01-01

    Pycnogenol(®) has excellent radical scavenging properties and enhances the production of antioxidative enzymes which contributes to the anti-inflammatory effect of the extract. Irradiation delivered to the abdominal region, typically results in severe damage to the intestinal mucosa. The effects of ionizing radiation are mediated by the formation of free radicals through radiolysis. Irradiation has local effects on tissues. These local effects of irradiation on the bowel are believed to involve a two-stage process which includes both short and long term components. In our study we aimed to investigate the short term effects of Pycnogenol(®) on the healing of colon anastomoses in irradiated bowel. Sixty male Wistar-Albino rats were used in this study. There were three groups: Group I, control group (n = 20); group II which received preoperative irradiation (n = 20); group III which received per oral Pycnogenol(®) before irradiation (n = 20). Only segmeter colonic resection and anastomosis was performed to the control group (Group I). The other groups (Group II, III) underwent surgery on the 5th day after pelvic irradiation. On postoperative days 3 and 7, half of the rats in each group were sacrificed and then relaparotomy was performed. There was no statistical difference between groups with respect to biochemical parameters. Bursting pressure was significantly higher in the Control and Group III compared with the Group II. In conclusion, the present study showed that preoperative irradiation effect negatively on colonic anastomoses in rats by means of mechanical parameters and administration of Pycnogenol(®) preoperatively ameliorates this unfavorable effect. PMID:23791893

  13. Nonpalpable thyroid carcinoma: clinical controversies on preoperative selection.

    PubMed

    Carpi, Angelo; Nicolini, Andrea; Casara, Dario; Rubello, Domenico; Rosa Pelizzo, Maria

    2003-06-01

    This article emphasizes some controversies concerning the preoperative selection of nonpalpable thyroid tumors. The prevalence of occult thyroid carcinoma in surgical series (1.8-10%) is not higher than in autopsy thyroid series (2.7-24%). The prevalence of occult thyroid carcinoma in thyroid glands examined in the same institution by ultrasound, for a clinical thyroid abnormality or for investigation of other neck structures without clinically evident or suspected thyroid disease, varies from 3% to 8% and is very similar independent of the fact that a thyroid abnormality is or is not the indication for ultrasonography. These data suggest that the presence of a thyroid disease is not a risk factor for harboring an occult thyroid carcinoma (except for C-cell hyperplasia in the rare case of MEN 2 syndromes). As it is not cost effective to examine all the nonpalpable lesions with fine-needle aspiration (FNA) guided by ultrasounds, it is necessary to define to which extent ultrasound is useful in selecting those lesions to be examined cytologically by FNA. The use of ultrasound to select these lesions is very controversial. Ultrasound-guided cytologic diagnosis of nonpalpable nodules is not as accurate as in the case of palpable nodules. Sampling of material adequate for cytologic analysis depends on the lesion size; it is 64% for a 0.7-cm lesion and it increases to 86.7% for a mean size of 1.1 cm. For the diagnosis of occult thyroid carcinomas (< or =1 cm), sensitivity is 35.8% and false-negative results are 49.3%. Nonpalpable nodules with a size of 1.5 cm represent an absolute indication to perform an ultrasound-guided FNA because this is the size limit for dividing thyroid nodules in probably innocuous or potentially dangerous categories and because the cytologic diagnosis of nodules of this size is sufficiently reliable. For the smaller incidentally discovered thyroid nodules following ultrasound, physicians should discuss with the patient whether and when to

  14. Preoperative surgical marking: a case of seeing double.

    PubMed

    Rughani, Milap; Kokkinakis, Michail; Davison, Marc

    2010-01-01

    Preoperative marking is an integral part of the care of patients undergoing surgical procedures. It occurs on a daily basis in hospitals and involves all members of the healthcare staff and the patient. Incorrect marking or errors can lead to devastating consequences for the patient and staff involved. We present an unusual case of seeing double arrows on a patient undergoing emergency orthopaedic surgery, despite standard preoperative marking procedures. This was recognised in the anaesthetic room and the correct site was confirmed. We aim to highlight this specific problem and remind all involved in preoperative marking of the dangers of a mirror imprint, thereby avoiding seeing double in the anaesthetic or operating room. PMID:22315636

  15. 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

  16. 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

  17. Long-term results and complications of preoperative radiation in the treatment of rectal cancer

    SciTech Connect

    Reed, W.P.; Garb, J.L.; Park, W.C.; Stark, A.J.; Chabot, J.R.; Friedmann, P.

    1988-02-01

    A retrospective study of 149 patients with rectal cancer diagnosed between 1972 and 1979 was undertaken to compare survival, disease-free survival, recurrence sites, and long-term complications of 40 patients who received 4000 to 4500 rads of preoperative adjuvant radiotherapy (radiation group) with those of 109 patients treated by resection alone (control group). After a mean follow-up of 84 months and 99 months, respectively, survival of the irradiated patients was significantly better than that of controls (68% versus 52%, p less than 0.05). Disease-free survival of those patients rendered free of disease by treatment was also superior for the irradiated group (84% versus 57%, p less than 0.005). Local recurrence without signs of distant metastases developed only one-third as often in irradiated patients (6% versus 18%). Distant metastases, alone or in combination with local recurrence, were also less common after radiation (12% versus 27%). Second primary tumors developed in 15% and 10% of the respective groups, a difference that was not statistically significant. When we consider the survival benefit of preoperative radiation therapy, long-term complications were relatively mild. Delayed healing of the perineum was noted in two irradiated patients. Persistent diarrhea was severe enough to warrant treatment in only one case, and one patient required a colostomy for intestinal obstruction from pelvic fibrosis.

  18. [A Case Report of a Pathological Complete Response of Rectal Cancer to Preoperative Chemoradiotherapy with Tegafur].

    PubMed

    Morikawa, Tatsuya; Teraishi, Fuminori; Shima, Yasuo; Iwata, Jun

    2016-03-01

    We report the case of a patient with advanced rectal cancer who achieved a pathological complete response to preoperative chemoradiotherapy (CRT). A 65-year-old man was diagnosed as having a two-thirds circumferential well-to moderately differentiated tumor (Rb-P, type 2). To control local recurrence, we treated the patient with CRT. Radiotherapy was administered in fractions of 2 Gy/day (total, 40 Gy). Concurrently, S-1 was administered orally at a fixed daily dose of 80 mg/m2 for 20 days. Withdrawal and/or dose reduction of S-1 was not necessary in spite of Grade 1 or 2 toxic effects, including diarrhea and periproctitis, occurring on day 7. Laparoscopic abdominoperineal resection was performed 6 weeks after the final dose of chemotherapy was administered. The histopathological regression grade was Grade 3. No recurrence was detected on enhanced CT more than 5 years after surgery. This case suggests that the regimen was both effective and tolerated, and that preoperative chemoradiotherapy may be effective for tumor suppression to prevent local recurrence. PMID:27067861

  19. 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.

  20. [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

  1. Prognostic significance of preoperative fibrinogen in patients with colon cancer

    PubMed Central

    Sun, Zhen-Qiang; Han, Xiao-Na; Wang, Hai-Jiang; Tang, Yong; Zhao, Ze-Liang; Qu, Yan-Li; Xu, Rui-Wei; Liu, Yan-Yan; Yu, Xian-Bo

    2014-01-01

    AIM: To investigate the prognostic significance of preoperative fibrinogen levels in colon cancer patients. METHODS: A total of 255 colon cancer patients treated at the Affiliated Tumor Hospital of Xinjiang Medical University from June 1st 2005 to June 1st 2008 were enrolled in the study. All patients received radical surgery as their primary treatment method. Preoperative fibrinogen was detected by the Clauss method, and all patients were followed up after surgery. Preoperative fibrinogen measurements were correlated with a number of clinicopathological parameters using the Student t test and analysis of variance. Survival analyses were performed by the Kaplan-Meier method and Cox regression modeling to measure 5-year disease-free survival (DFS) and overall survival (OS). RESULTS: The mean preoperative fibrinogen concentration of all colon cancer patients was 3.17 ± 0.88 g/L. Statistically significant differences were found between preoperative fibrinogen levels and the clinicopathological parameters of age, smoking status, tumor size, tumor location, tumor-node-metastasis (TNM) stage, modified Glasgow prognostic scores (mGPS), white blood cell (WBC) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA) levels. Univariate survival analysis showed that TNM stage, tumor cell differentiation grade, vascular invasion, mGPS score, preoperative fibrinogen, WBC, NLR, PLR and CEA all correlated with both OS and DFS. Alpha-fetoprotein (AFP) and body mass index correlated only with OS. Kaplan-Meier analysis revealed that both OS and DFS of the total cohort, as well as of the stage II and III patients, were higher in the hypofibrinogen group compared to the hyperfibrinogen group (all P < 0.05). In contrast, there was no significant difference between OS and DFS in stage I patients with low or high fibrinogen levels. Cox regression analysis indicated preoperative fibrinogen levels, TNM stage, mGPS score, CEA, and

  2. Single incision laparoscopic surgery approach for obscure small intestine bleeding localized by CT guided percutaneous injection of methylene blue

    PubMed Central

    Martinez, Juan Carlos; Thomas, Jamie L.; Lukaszczyk, John J.

    2014-01-01

    INTRODUCTION Traditionally, localization of small intestine sources of obscure gastrointestinal bleeding has been a challenge. Advances in the field of endoscopy with the introduction of capsule endoscopy and radiographic imaging with computed tomography angiography and visceral angiography have facilitated more accurate visualization of the small intestine. If a bleeding lesion is identified on angiography and surgery is indicated, the use of methylene blue for enteric mapping is very effective to aid intraoperative localization of the culprit. However, when this is not an option, more invasive surgical techniques are required. PRESENTATION OF CASE We present a new technique used in a patient with angiodysplasia of the small intestine, in where preoperative localization was done using percutaneous computed tomography (CT) guided injection of methylene blue dye. This allowed us to perform a single incision laparoscopic small intestine resection of the culprit. PMID:25460480

  3. Recent development of optical coherence tomography for preoperative diagnosis of esophageal malignancies

    PubMed Central

    Uno, Kaname; Koike, Tomoyuki; Shimosegawa, Tooru

    2015-01-01

    Endoscopic diagnosis with histological evidence is necessary to decide the best strategy for treating esophageal squamous cell carcinoma and Barrett’s-associated neoplasia, and the recent development of endoscopic technologies have made possible real-time information of malignant hallmarks. We focused on the development of optical coherence tomography (OCT), the only technology that can depict real-time cross-sectional images with high resolution. With the improvements in image resolution, acquisition rate and demonstrable area of three-dimensional devices with Doppler capability, OCT imaging was shown to enable visualization of structural/functional alterations in the mucosal/submucosal tissue of the esophagus, resulting in more accurate preoperative diagnosis of such malignancies. Moreover, it approved to be useful for targeting malignant areas for biopsy and treatment as well as for predicting the treatment effects. Therefore, further development of this technology is expected to overcome the current clinical issues in management strategies of esophageal malignancies. PMID:26240688

  4. Recent development of optical coherence tomography for preoperative diagnosis of esophageal malignancies.

    PubMed

    Uno, Kaname; Koike, Tomoyuki; Shimosegawa, Tooru

    2015-07-25

    Endoscopic diagnosis with histological evidence is necessary to decide the best strategy for treating esophageal squamous cell carcinoma and Barrett's-associated neoplasia, and the recent development of endoscopic technologies have made possible real-time information of malignant hallmarks. We focused on the development of optical coherence tomography (OCT), the only technology that can depict real-time cross-sectional images with high resolution. With the improvements in image resolution, acquisition rate and demonstrable area of three-dimensional devices with Doppler capability, OCT imaging was shown to enable visualization of structural/functional alterations in the mucosal/submucosal tissue of the esophagus, resulting in more accurate preoperative diagnosis of such malignancies. Moreover, it approved to be useful for targeting malignant areas for biopsy and treatment as well as for predicting the treatment effects. Therefore, further development of this technology is expected to overcome the current clinical issues in management strategies of esophageal malignancies. PMID:26240688

  5. 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

  6. 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

  7. 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

  8. 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.

  9. The preoperative evaluation prevent the postoperative complications of thyroidectomy

    PubMed Central

    Huang, Chien-Feng; Jeng, Yachung; Chen, Kuo-Dong; Yu, Ji-Kuen; Shih, Chao-Ming; Huang, Shih-Ming; Lee, Chen-Hsen; Chou, Fong-Fu; Shih, Ming-Lang; Jeng, Kee-Ching; Chang, Tzu-Ming

    2014-01-01

    Objective Thyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications. Methods A nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics. Results Eighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR) = 0.5 and 0.65, [95% confidence interval (CI) 0.331–0.768 and 0.459–0.911], P = 0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393–0.763 and 1.356–3.4], P < 0.001 and 0.0012, respectively. Conclusions The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations

  10. Prognostic Value of MicroRNAs in Preoperative Treated Rectal Cancer

    PubMed Central

    Azizian, Azadeh; Epping, Ingo; Kramer, Frank; Jo, Peter; Bernhardt, Markus; Kitz, Julia; Salinas, Gabriela; Wolff, Hendrik A.; Grade, Marian; Beißbarth, Tim; Ghadimi, B. Michael; Gaedcke, Jochen

    2016-01-01

    Background: Patients with locally advanced rectal cancer are treated with preoperative chemoradiotherapy followed by surgical resection. Despite similar clinical parameters (uT2-3, uN+) and standard therapy, patients’ prognoses differ widely. A possible prediction of prognosis through microRNAs as biomarkers out of treatment-naïve biopsies would allow individualized therapy options. Methods: Microarray analysis of 45 microdissected preoperative biopsies from patients with rectal cancer was performed to identify potential microRNAs to predict overall survival, disease-free survival, cancer-specific survival, distant-metastasis-free survival, tumor regression grade, or nodal stage. Quantitative real-time polymerase chain reaction (qPCR) was performed on an independent set of 147 rectal cancer patients to validate relevant miRNAs. Results: In the microarray screen, 14 microRNAs were significantly correlated to overall survival. Five microRNAs were included from previous work. Finally, 19 miRNAs were evaluated by qPCR. miR-515-5p, miR-573, miR-579 and miR-802 demonstrated significant correlation with overall survival and cancer-specific survival (p < 0.05). miR-573 was also significantly correlated with the tumor regression grade after preoperative chemoradiotherapy. miR-133b showed a significant correlation with distant-metastasis-free survival. miR-146b expression levels showed a significant correlation with nodal stage. Conclusion: Specific microRNAs can be used as biomarkers to predict prognosis of patients with rectal cancer and possibly stratify patients’ therapy if validated in a prospective study. PMID:27092493

  11. Phase II Study of Preoperative Helical Tomotherapy With a Simultaneous Integrated Boost for Rectal Cancer

    SciTech Connect

    Engels, Benedikt; Tournel, Koen; Everaert, Hendrik; Hoorens, Anne; Sermeus, Alexandra; Christian, Nicolas; Storme, Guy; Verellen, Dirk; De Ridder, Mark

    2012-05-01

    Purpose: The addition of concomitant chemotherapy to preoperative radiotherapy is considered the standard of care for patients with cT3-4 rectal cancer. The combined treatment modality increases the complete response rate and local control (LC), but has no impact on survival or the incidence of distant metastases. In addition, it is associated with considerable toxicity. As an alternative strategy, we explored prospectively, preoperative helical tomotherapy with a simultaneous integrated boost (SIB). Methods and Materials: A total of 108 patients were treated with intensity-modulated and image-guided radiotherapy using the Tomotherapy Hi-Art II system. A dose of 46 Gy, in daily fractions of 2 Gy, was delivered to the mesorectum and draining lymph nodes, without concomitant chemotherapy. Patients with an anticipated circumferential resection margin (CRM) of less than 2 mm, based on magnetic resonance imaging, received a SIB to the tumor up to a total dose of 55.2 Gy. Acute and late side effects were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results: A total of 102 patients presented with cT3-4 tumors; 57 patients entered the boost group and 51 the no-boost group. One patient in the no-boost group developed a radio-hypersensitivity reaction, resulting in a complete tumor remission, a Grade 3 acute and Grade 5 late enteritis. No other Grade {>=}3 acute toxicities occurred. With a median follow-up of 32 months, Grade {>=}3 late gastrointestinal and urinary toxicity were observed in 6% and 4% of the patients, respectively. The actuarial 2-year LC, progression-free survival and overall survival were 98%, 79%, and 93%. Conclusions: Preoperative helical tomotherapy displays a favorable acute toxicity profile in patients with cT3-4 rectal cancer. A SIB can be safely administered in patients with a narrow CRM and resulted in a promising LC.

  12. Preoperative Radiation Therapy With Concurrent Capecitabine, Bevacizumab, and Erlotinib for Rectal Cancer: A Phase 1 Trial

    SciTech Connect

    Das, Prajnan; Eng, Cathy; Rodriguez-Bigas, Miguel A.; Chang, George J.; Skibber, John M.; You, Y. Nancy; Maru, Dipen M.; Munsell, Mark F.; Clemons, Marilyn V.; Kopetz, Scott E.; Garrett, Christopher R.; Shureiqi, Imad; Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H.

    2014-02-01

    Purpose: The goal of this phase 1 trial was to determine the maximum tolerated dose (MTD) of concurrent capecitabine, bevacizumab, and erlotinib with preoperative radiation therapy for rectal cancer. Methods and Materials: Patients with clinical stage II to III rectal adenocarcinoma, within 12 cm from the anal verge, were treated in 4 escalating dose levels, using the continual reassessment method. Patients received preoperative radiation therapy with concurrent bevacizumab (5 mg/kg intravenously every 2 weeks), erlotinib, and capecitabine. Capecitabine dose was increased from 650 mg/m{sup 2} to 825 mg/m{sup 2} orally twice daily on the days of radiation therapy; erlotinib dose was increased from 50 mg orally daily in weeks 1 to 3, to 50 mg daily in weeks 1 to 6, to 100 mg daily in weeks 1 to 6. Patients underwent surgery at least 9 weeks after the last dose of bevacizumab. Results: A total of 19 patients were enrolled, and 18 patients were considered evaluable. No patient had grade 4 acute toxicity, and 1 patient had grade 3 acute toxicity (hypertension). The MTD was not reached. All 18 evaluable patients underwent surgery, with low anterior resection in 7 (39%), proctectomy with coloanal anastomosis in 4 patients (22%), posterior pelvic exenteration in 1 (6%), and abdominoperineal resection in 6 (33%). Of the 18 patients, 8 (44%) had pathologic complete response, and 1 had complete response of the primary tumor with positive nodes. Three patients (17%) had grade 3 postoperative complications (ileus, small bowel obstruction, and infection). With a median follow-up of 34 months, 1 patient developed distant metastasis, and no patient had local recurrence or died. The 3-year disease-free survival was 94%. Conclusions: The combination of preoperative radiation therapy with concurrent capecitabine, bevacizumab, and erlotinib was well tolerated. The pathologic complete response rate appears promising and may warrant further investigation.

  13. Reducing radiation dose without compromising image quality in preoperative perforator flap imaging with CTA using ASIR technology.

    PubMed

    Niumsawatt, Vachara; Debrotwir, Andrew N; Rozen, Warren Matthew

    2014-01-01

    Computed tomographic angiography (CTA) has become a mainstay in preoperative perforator flap planning in the modern era of reconstructive surgery. However, the increased use of CTA does raise the concern of radiation exposure to patients. Several techniques have been developed to decrease radiation dosage without compromising image quality, with varying results. The most recent advance is in the improvement of image reconstruction using an adaptive statistical iterative reconstruction (ASIR) algorithm. We sought to evaluate the image quality of ASIR in preoperative deep inferior epigastric perforator (DIEP) flap surgery, through a direct comparison with conventional filtered back projection (FBP) images. A prospective review of 60 consecutive ASIR and 60 consecutive FBP CTA images using similar protocol (except for radiation dosage) was undertaken, analyzed by 2 independent reviewers. In both groups, we were able to accurately identify axial arteries and their perforators. Subjective analysis of image quality demonstrated no statistically significant difference between techniques. ASIR can thus be used for preoperative imaging with similar image quality to FBP, but with a 60% reduction in radiation delivery to patients. PMID:25058789

  14. Reducing Radiation Dose Without Compromising Image Quality in Preoperative Perforator Flap Imaging With CTA Using ASIR Technology

    PubMed Central

    Niumsawatt, Vachara; Debrotwir, Andrew N.; Rozen, Warren Matthew

    2014-01-01

    Computed tomographic angiography (CTA) has become a mainstay in preoperative perforator flap planning in the modern era of reconstructive surgery. However, the increased use of CTA does raise the concern of radiation exposure to patients. Several techniques have been developed to decrease radiation dosage without compromising image quality, with varying results. The most recent advance is in the improvement of image reconstruction using an adaptive statistical iterative reconstruction (ASIR) algorithm. We sought to evaluate the image quality of ASIR in preoperative deep inferior epigastric perforator (DIEP) flap surgery, through a direct comparison with conventional filtered back projection (FBP) images. A prospective review of 60 consecutive ASIR and 60 consecutive FBP CTA images using similar protocol (except for radiation dosage) was undertaken, analyzed by 2 independent reviewers. In both groups, we were able to accurately identify axial arteries and their perforators. Subjective analysis of image quality demonstrated no statistically significant difference between techniques. ASIR can thus be used for preoperative imaging with similar image quality to FBP, but with a 60% reduction in radiation delivery to patients. PMID:25058789

  15. 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.

  16. [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

  17. Resting-State Blood Oxygen Level-Dependent Functional MRI: A Paradigm Shift in Preoperative Brain Mapping.

    PubMed

    Leuthardt, Eric C; Allen, Monica; Kamran, Mudassar; Hawasli, Ammar H; Snyder, Abraham Z; Hacker, Carl D; Mitchell, Timothy J; Shimony, Joshua S

    2015-01-01

    Currently, functional magnetic resonance imaging (fMRI) facilitates a preoperative awareness of an association of an eloquent region with a tumor. This information gives the neurosurgeon helpful information that can aid in creating a surgical strategy. Typically, task-based fMRI has been employed to preoperatively localize speech and motor function. Task-based fMRI depends on the patient's ability to comply with the task paradigm, which often is impaired in the setting of a brain tumor. This problem is overcome by using resting-state fMRI (rs-fMRI) to localize function. rs-fMRI measures spontaneous fluctuations in the blood oxygen level-dependent (BOLD) signal, representing the brain's functional organization. In a neurosurgical context, it allows noninvasive simultaneous assessment of multiple large-scale distributed networks. Compared with task-related fMRI, rs-fMRI provides more comprehensive information on the functional architecture of the brain and is applicable in settings where task-related fMRI may provide inadequate information or could not be performed. Taken together, rs-fMRI substantially expands the preoperative mapping capability in efficiency, effectiveness, and scope. In this article, a brief introduction into rs-fMRI processing methods is followed by a detailed discussion on the role rs-fMRI plays in presurgical planning. PMID:26784290

  18. New Perspectives on Predictive Biomarkers of Tumor Response and Their Clinical Application in Preoperative Chemoradiation Therapy for Rectal Cancer.

    PubMed

    Kim, Nam Kyu; Hur, Hyuk

    2015-11-01

    Preoperative chemoradiation therapy (CRT) is the standard treatment for patients with locally advanced rectal cancer (LARC) and can improve local control and survival outcomes. However, the responses of individual tumors to CRT are not uniform and vary widely, from complete response to disease progression. Patients with resistant tumors can be exposed to irradiation and chemotherapy that are both expensive and at times toxic without benefit. In contrast, about 60% of tumors show tumor regression and T and N down-staging. Furthermore, a pathologic complete response (pCR), which is characterized by sterilization of all tumor cells, leads to an excellent prognosis and is observed in approximately 10-30% of cases. This variety in tumor response has lead to an increased need to develop a model predictive of responses to CRT in order to identify patients who will benefit from this multimodal treatment. Endoscopy, magnetic resonance imaging, positron emission tomography, serum carcinoembryonic antigen, and molecular biomarkers analyzed using immunohistochemistry and gene expression profiling are the most commonly used predictive models in preoperative CRT. Such modalities guide clinicians in choosing the best possible treatment options and the extent of surgery for each individual patient. However, there are still controversies regarding study outcomes, and a nomogram of combined models of future trends is needed to better predict patient response. The aim of this article was to review currently available tools for predicting tumor response after preoperative CRT in rectal cancer and to explore their applicability in clinical practice for tailored treatment. PMID:26446626

  19. New Perspectives on Predictive Biomarkers of Tumor Response and Their Clinical Application in Preoperative Chemoradiation Therapy for Rectal Cancer

    PubMed Central

    Hur, Hyuk

    2015-01-01

    Preoperative chemoradiation therapy (CRT) is the standard treatment for patients with locally advanced rectal cancer (LARC) and can improve local control and survival outcomes. However, the responses of individual tumors to CRT are not uniform and vary widely, from complete response to disease progression. Patients with resistant tumors can be exposed to irradiation and chemotherapy that are both expensive and at times toxic without benefit. In contrast, about 60% of tumors show tumor regression and T and N down-staging. Furthermore, a pathologic complete response (pCR), which is characterized by sterilization of all tumor cells, leads to an excellent prognosis and is observed in approximately 10-30% of cases. This variety in tumor response has lead to an increased need to develop a model predictive of responses to CRT in order to identify patients who will benefit from this multimodal treatment. Endoscopy, magnetic resonance imaging, positron emission tomography, serum carcinoembryonic antigen, and molecular biomarkers analyzed using immunohistochemistry and gene expression profiling are the most commonly used predictive models in preoperative CRT. Such modalities guide clinicians in choosing the best possible treatment options and the extent of surgery for each individual patient. However, there are still controversies regarding study outcomes, and a nomogram of combined models of future trends is needed to better predict patient response. The aim of this article was to review currently available tools for predicting tumor response after preoperative CRT in rectal cancer and to explore their applicability in clinical practice for tailored treatment. PMID:26446626

  20. Predict amine solution properties accurately

    SciTech Connect

    Cheng, S.; Meisen, A.; Chakma, A.

    1996-02-01

    Improved process design begins with using accurate physical property data. Especially in the preliminary design stage, physical property data such as density viscosity, thermal conductivity and specific heat can affect the overall performance of absorbers, heat exchangers, reboilers and pump. These properties can also influence temperature profiles in heat transfer equipment and thus control or affect the rate of amine breakdown. Aqueous-amine solution physical property data are available in graphical form. However, it is not convenient to use with computer-based calculations. Developed equations allow improved correlations of derived physical property estimates with published data. Expressions are given which can be used to estimate physical properties of methyldiethanolamine (MDEA), monoethanolamine (MEA) and diglycolamine (DGA) solutions.

  1. 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.

  2. Preoperative Lateralization Modalities for Cushing Disease: Is Dynamic Magnetic Resonance Imaging or Cavernous Sinus Sampling More Predictive of Intraoperative Findings?

    PubMed Central

    Sun, Hai; Yedinak, Chris; Ozpinar, Alp; Anderson, Jim; Dogan, Aclan; Delashaw, Johnny; Fleseriu, Maria

    2015-01-01

    Objective To analyze whether cavernous sinus sampling (CSS) and dynamic magnetic resonance imaging (dMRI) are consistent with intraoperative findings in Cushing disease (CD) patients. Design Retrospective outcomes study. Setting Oregon Health & Science University; 2006 and 2013. Participants A total of 37 CD patients with preoperative dMRI and CSS to confirm central adrenocorticotropic hormone (ACTH) hypersecretion. Patients were 78% female; mean age was 41 years (at diagnosis), and all had a minimum of 6 months of follow-up. Main Outcome Measures Correlations among patient characteristics, dMRI measurements, CSS results, and intraoperative findings. Results All CSS indicated presence of CD. Eight of 37 patients had no identifiable tumor on dMRI. Three of 37 patients had no tumor at surgery. dMRI tumor size was inversely correlated with age (rs = − 0.4; p = 0.01) and directly correlated to intraoperative lateralization (rs = 0.3; p < 0.05). Preoperative dMRI was directly correlated to intraoperative lateralization (rs = 0.5; p < 0.002). CSS lateralization showed no correlation with intraoperative findings (rs = 0.145; p = 0.40) or lateralization observed on preoperative dMRI (rs = 0.17; p = 0.29). Postoperative remission rate was 68%. Conclusion dMRI localization was most consistent with intraoperative findings; CSS results were less reliable. Results suggest that small ACTH-secreting tumors continue to pose a challenge to reliable preoperative localization. PMID:26225305

  3. Preoperative management of giant retroperitoneal schwannoma: A case report and review of the literature

    PubMed Central

    CHEN, WEI; DANG, CHENGXUE; ZHU, KUN; LI, KANG

    2016-01-01

    Schwannomas rarely occur in the retroperitoneum, and are normally not aggressive. Preoperative diagnosis is difficult and the surgeon may confront blood vessels, nerves or organs damage, since the intra-operative findings are various. The diagnosis and treatment of malignant schwannomas in the retroperitoneum are even more challenging. In addition, the prognosis of malignant schwannomas is extremely poor. The present study reports the case of a 52-year-old woman who presented with a 6-month history of an abdominal mass in the left lower quadrant. The local doctor determined a preliminary diagnosis of abdominal giant tumor and referred the patient to the First Affiliated Hospital, Medical School of Xi'an Jiaotong University, (Xi'an, China). Following discussion, the patient underwent a surgical resection. Low-grade malignant schwannoma was diagnosed following histological examination. No evidence of recurrence or any other complication was observed at the 18-month follow-up examination. The present study reports a case of giant retroperitoneal schwannoma (RS), and includes a literature review in order to provide an overview of the diagnosis, treatment and prognosis of RS and discuss preoperative management strategies for the disease. PMID:27313735

  4. 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

    ... COMMISSION Preoperational Testing of Onsite Electric Power Systems To Verify Proper Load Group Assignments... for public comment draft regulatory guide (DG), DG-1294, ``Preoperational Testing of On-Site Electric... encompass preoperational testing of electrical power systems used to meet current Station...

  5. 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…

  6. Preoperative Predictors of Pain Following Total Knee Arthroplasty

    PubMed Central

    Noiseux, Nicolas O.; Callaghan, John J.; Clark, Charles R.; Zimmerman, M. Bridget; Sluka, Kathleen A.; Rakel, Barbara A.

    2014-01-01

    Total knee arthroplasty has provided dramatic improvements in function and pain for the majority of patients with knee arthritis, yet a significant proportion of patients remain dissatisfied with their results. We performed a prospective analysis of 215 patients undergoing TKA who underwent a comprehensive array of evaluations to discover whether any preoperative assessment could predict high pain scores and functional limitations postoperatively. Patients with severe pain with a simple knee range-of-motion test prior to TKA had a 10x higher likelihood of moderate to severe pain at 6 months. A simple test of pain intensity with active flexion and extension preoperatively was a significant predictor of postoperative pain at 6 months after surgery. Strategies to address this particular patient group may improve satisfaction rates of TKA. PMID:24630598

  7. Preoperative cardiovascular investigations in liver transplant candidate: An update

    PubMed Central

    Sehgal, Lalit; Srivastava, Piyush; Pandey, Chandra Kant; Jha, Amit

    2016-01-01

    Cardiovascular complications are a major cause of morbidity and mortality in patients with end-stage liver disease (ESLD) undergoing liver transplantation. Identifying candidates at the highest risk of postoperative cardiovascular complications is the cornerstone for optimizing the outcome. Ischaemic heart disease contributes to major portion of cardiovascular complications and therefore warrants evaluation in the preoperative period. Patients of ESLD usually demonstrate increased cardiac output, compromised ventricular response to stress, low systemic vascular resistance and occasionally bradycardia. Despite various recommendations for preoperative evaluation of cardiovascular disease in liver transplant candidates, a considerable controversy on screening methodology persists. This review critically focuses on the rapidly expanding body of evidence for diagnosis and risk stratification of cardiovascular disorder in liver transplant candidates. PMID:26962249

  8. The concept of death in preoperational retarded children.

    PubMed

    Sternlicht, M

    1980-12-01

    Fourteen preoperational retarded boys and girls (mean MA = 6-4), as classified by the failure to pass three conservation tasks, were interviewed for their concepts of death, with Koocher's (1973) study used as a model. Each S was asked, "What makes things die?" "How can you make dead things come back to life?" "When will you die?" and "What will happen then?" It was found that the preoperational retarded Ss did not have realistic concepts of when they will die, or of the permanence of death. They did, however, have realistic notions of how things die. It was also found that the types of replies made to these questions were related to their cognitive level (p less than .01). PMID:7205203

  9. Essential elements of the preoperative breast reconstruction evaluation.

    PubMed

    Cheng, Angela; Losken, Albert

    2015-04-01

    A plethora of options exist for breast reconstruction and preoperative evaluation must be thorough to lead to a successful outcome. We review multiple components of the preoperative assessment including the patient's history, goals, imaging, and key elements of the physical exam. Consideration for tumor biology, staging, need or response to chemotherapy or radiation therapy is important in deciding on immediate versus delayed reconstruction. It is also important to consider the patient's anatomy, breast size and whether the reconstruction will be unilateral or bilateral. The reconstructive surgeon must accommodate all these factors to consider partial or complete mastectomy defects and guide the patient to the most appropriate reconstructive technique whether it be an oncoplastic reduction mammoplasty, expander-based reconstruction, immediate implant reconstruction, or immediate versus delayed autologous tissue reconstruction such as the deep inferior epigastric artery perforator (DIEP)/transverse rectus abdominis muscle (TRAM), latissimus, transverse upper gracilis (TUG)/profunda femoris artery perforator (PAP), or gluteal artery perforator (GAP) flaps. PMID:26005641

  10. Accurate ab Initio Spin Densities

    PubMed Central

    2012-01-01

    We present an approach for the calculation of spin density distributions for molecules that require very large active spaces for a qualitatively correct description of their electronic structure. Our approach is based on the density-matrix renormalization group (DMRG) algorithm to calculate the spin density matrix elements as a basic quantity for the spatially resolved spin density distribution. The spin density matrix elements are directly determined from the second-quantized elementary operators optimized by the DMRG algorithm. As an analytic convergence criterion for the spin density distribution, we employ our recently developed sampling-reconstruction scheme [J. Chem. Phys.2011, 134, 224101] to build an accurate complete-active-space configuration-interaction (CASCI) wave function from the optimized matrix product states. The spin density matrix elements can then also be determined as an expectation value employing the reconstructed wave function expansion. Furthermore, the explicit reconstruction of a CASCI-type wave function provides insight into chemically interesting features of the molecule under study such as the distribution of α and β electrons in terms of Slater determinants, CI coefficients, and natural orbitals. The methodology is applied to an iron nitrosyl complex which we have identified as a challenging system for standard approaches [J. Chem. Theory Comput.2011, 7, 2740]. PMID:22707921

  11. Preoperative easily misdiagnosed telangiectatic osteosarcoma: clinical–radiologic–pathologic correlations

    PubMed Central

    Gao, Zhen-Hua; Yin, Jun-Qiang; Liu, Da-Wei; Meng, Quan-Fei

    2013-01-01

    Abstract Purpose: To describe the clinical, imaging, and pathologic characteristics and diagnostic methods of telangiectatic osteosarcoma (TOS) for improving the diagnostic level. Materials and methods: The authors retrospectively reviewed patient demographics, serum alkaline phosphatase (AKP) levels, preoperative biopsy pathologic reports, pathologic materials, imaging findings, and treatment outcomes from 26 patients with TOS. Patient images from radiography (26 cases) and magnetic resonance (MR) imaging (22 cases) were evaluated by 3 authors in consensus for intrinsic characteristics. There were 15 male and 11 female patients in the study, with an age of 9–32 years (mean age 15.9 years). Results: Eighteen of 26 patients died of lung metastases within 5 years of follow-up. The distal femur was affected more commonly (14 cases, 53.8%). Regarding serum AKP, normal (8 cases) or mildly elevated (18 cases) levels were found before preoperative chemotherapy. Radiographs showed geographic bone lysis without sclerotic margin (26 cases), cortical destruction (26 cases), periosteal new bone formation (24 cases), soft-tissue mass (23 cases), and matrix mineralization (4 cases). The aggressive radiographic features of TOS simulated the appearance of conventional high-grade intramedullary osteosarcoma, though different from aneurysmal bone cyst. MR images demonstrated multiple big (16 cases) or small (6 cases) cystic spaces, fluid-fluid levels (14 cases), soft-tissue mass (22 cases), and thick peripheral and septal enhancement (22 cases). Nine of 26 cases were misdiagnosed as aneurysmal bone cysts by preoperative core-needle biopsy, owing to the absence of viable high-grade sarcomatous cells in the small tissue samples. Conclusion: The aggressive growth pattern with occasional matrix mineralization, and multiple big or small fluid-filled cavities with thick peripheral, septal, and nodular tissue surrounding the fluid-filled cavities are characteristic imaging features of

  12. 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

  13. 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

  14. Stage-to-Stage Comparison of Preoperative and Postoperative Chemoradiotherapy for T3 Mid or Distal Rectal Cancer

    SciTech Connect

    Yeo, Seung-Gu; Kim, Dae Yong; Park, Ji Won; Choi, Hyo Seong; Oh, Jae Hwan; Kim, Sun Young; Chang, Hee Jin; Kim, Tae Hyun; Sohn, Dae Kyung

    2012-02-01

    Purpose: To investigate, in a comparative analysis, the prognostic implications of postchemoradiotherapy (post-CRT) pathologic stage (ypStage) vs. postoperative pathologic stage (pStage) in rectal cancer. Methods and Materials: Between May 2001 and December 2006, 487 patients with T3 mid or distal rectal cancer were analyzed retrospectively. Concurrent CRT was administered preoperatively (n = 364, 74.7%) or postoperatively (n = 123, 25.3%). The radiation dose was 50.4 Gy in 28 fractions. All patients underwent a total mesorectal excision and received adjuvant chemotherapy. Disease-free survival (DFS) was estimated using the Kaplan-Meier method. Differences in DFS, stratified by ypStage and pStage, were compared using the log-rank test. Results: For surviving patients, the median follow-up period was 68 months (range, 12-105 months). The 5-year local recurrence-free survival rate was not different, at 95.3% and 92.1% in preoperative and postoperative CRT groups, respectively (p = 0.402), but the 5-year distant metastasis-free survival rate was significantly different, at 81.6% (preoperative CRT) vs. 65.4% (postoperative CRT; p = 0.001). The 5-year DFS rate of 78.8% in the preoperative CRT group was significantly better than the 63.0% rate in the postoperative CRT group (p = 0.002). Post-CRT pathologic Stage 0-I occurred in 42.6% (155 of 364) of the patients with preoperative CRT. The 5-year DFS rates were 90.2% (ypStage 0-I), 83.5% (ypStage II), 77.3% (pStage II), 58.6% (ypStage III), and 54.7% (pStage III). The DFS rate of ypStage 0-I was significantly better than that of ypStage II or pStage II. Post-CRT pathologic Stage II and III had similar DFS, compared with pStage II and III, respectively. Conclusions: Disease-free survival predicted by each ypStage was similar to that predicted by the respective pStage. Improved DFS with preoperative vs. postoperative CRT was associated with the ypStage 0-I group that showed a similarly favorable outcome to pStage I rectal

  15. Total ankle arthroplasty with severe preoperative varus deformity.

    PubMed

    Hanselman, Andrew E; Powell, Brian D; Santrock, Robert D

    2015-04-01

    Advancements in total ankle arthroplasty (TAA) over the past several decades have led to improved patient outcomes and implant survivorship. Despite these innovations, many implant manufacturers still consider a preoperative coronal plane deformity greater than 10° a relative contraindication to TAA. Without proper intraoperative alignment, these implants may experience abnormal wear and hardware failure. Correcting these deformities, often through the use of soft tissue procedures and/or osteotomies, not only increases the difficulty of a case, but also the intraoperative time and radiation exposure. The authors report a case in which a 54-year-old man with a severe right ankle varus deformity of 29° underwent successful TAA using the INBONE II Prophecy total ankle system (Wright Medical Technology, Inc, Memphis, Tennessee) and additional soft tissue reconstruction. Intraoperatively, the patient's coronal deformity was corrected to 1.8°. At 8 months postoperatively, the patient ambulated without restriction and had substantial improvement in validated patient outcome scores, specifically the Academy of Orthopaedic Surgeons Foot and Ankle Module and the Short Form Health Survey-12 This unique report documents the first time that this particular implant, with an exclusive preoperative computed tomography-derived patient-specific guide, has been used effectively for a severe preoperative varus deformity greater than 20° without the need for an osteotomy. Future studies should be directed toward the prospective evaluation of different total ankle implant systems and their outcomes with severe coronal plane deformity, specifically computed tomography-derived patient-specific guided implants. PMID:25901630

  16. Preoperative skin disinfection methodologies for reducing prosthetic joint infections.

    PubMed

    Banerjee, Samik; Kapadia, Bhaveen H; Mont, Michael A

    2014-08-01

    Surgical site infections following lower extremity total joint arthroplasty procedures remain a substantial economic burden to the patient, the treating institution, and the health care system. The complexity of these surgical procedures creates the potential for various patient- or surgery-related risk factors for infection. Although there is much literature regarding the use of many preventative methods, a consensus regarding the true efficacy and application of such practices is generally not available. In this review, we reviewed the preoperative skin disinfection methodologies that have been used for reducing periprosthetic infections following lower extremity total joint arthroplasty. Currently, cumulative evidence suggests that preoperative chlorhexidine baths or chlorhexidine-impregnated wipes may reduce the colonization of pathogenic organisms on the skin. In addition, multiple showers or topical applications of chlorhexidine may lead to more substantial reduction in colony counts. Advanced preoperative whole-body cleaning with chlorhexidine-containing cloths rather than site-specific application may confer additional advantages. Further randomized controlled trials with carefully planned protocols and endpoints are needed to determine if this conclusively leads to reduction in the rate of surgical site infections. PMID:24622912

  17. [Tonsillectomy in children: preoperative evaluation of risk factors].

    PubMed

    Stuck, B A; Genzwürker, H V

    2008-05-01

    Tonsillectomy is one of the most frequently performed surgical procedures in children and is associated with a relatively high risk of postoperative complications. The question often arises whether paediatric obstructive sleep apnoea should be diagnosed with preoperative sleep testing and whether preoperative coagulation tests should be performed in every child undergoing tonsillectomy. In order to answer these questions, the relevant German and English literature was analysed. Adenotonsillectomy in childhood usually resolves the underlying sleep-related breathing disorder. Nevertheless, especially in children with clinical risk factors such as severe sleep apnoea, obesity or craniofacial malformation, respiratory complications should be expected in the postoperative phase. Routine sleep tests prior to tonsillectomy are neither necessary nor practical for preoperative evaluation. Inherited coagulation disorders have only a limited effect on the occurrence of postoperative bleeding and the predictive value of routine coagulation tests is limited. As long as a thorough clinical history is negative, routine coagulation tests are not helpful or necessary prior to tonsillectomy in children. PMID:18311551

  18. Evolution of Preoperative Rhinoplasty Consult by Computer Imaging.

    PubMed

    Lekakis, Garyfalia; Claes, Peter; Hamilton, Grant S; Hellings, P W

    2016-02-01

    The preoperative consultation in rhinoplasty involves a multitude of actions that are mandatory for the decision-making process: history taking with attention to the symptoms and specific requests of the patient, clinical evaluation of the aesthetics, the functional status of the nose and the patients' motivation for surgery, and acquisition of standardized preoperative photographs. During the last decade, computer imaging or morphing of the preoperative pictures of the nose has become much more common. This part of the consultation allows the surgeon and patient to reach a mutually agreeable set of expectations by demonstrating the planned outcome of rhinoplasty and describing the objectives of surgery. The evolving literature on computer imaging supports that the benefits for both the patients and surgeons seem to outweigh the risks. Indeed, morphing enables the surgeon to precisely explain to the patients the goal of surgery, and to postpone or even cancel surgery in the group of patients that do not appear satisfied with the proposed changes. In addition, patients may feel more prepared for surgery and have a more realistic view of the outcome of the intervention. Presently, computer imaging is progressing from 2D to 3D models, optimizing the surgeons' capacity to perform morphing in the most advantageous manner for both parties. The current review provides a state-of-the art analysis on morphing in rhinoplasty, putting morphing into a historic and relevant perspective in clinical practice. PMID:26862968

  19. [The evaluation of preoperative anesthetic visit in our hospital].

    PubMed

    Adachi, Y; Watanabe, K; Satoh, T

    1999-09-01

    The preoperative visit by an anesthetist has been thought to be important for the assessment of patient and to communicate with them. However, there are few reports on the visit in Japan until now. The effect of preoperative anesthetic visit in our hospital was estimated by interviewing patients just before surgery who had received a visit by their anesthetist. The answers from sequential 346 scheduled surgical patients for 8 weeks were obtained. Only 72 patients were able to recall the name of their anesthetists. About half of patients believed that anesthetist just had put the patient to sleep and relieved them from pain. We measured the number of treatments each patient could remember that had been explained by the anesthetist on the visit, and found it was unexpectedly small at the interview. These data suggest that our preoperative visit may not be satisfying in view of making good relationship between patients and anesthetists, and educating patients for recent anesthesia. We should make an effort to educate the patients about up-to-date and reasonable anesthesia. PMID:10513187

  20. Psychologists in preoperative programmes for children undergoing surgery.

    PubMed

    Cuzzocrea, Francesca; Costa, Sebastiano; Gugliandolo, Maria Cristina; Larcan, Rosalba

    2016-06-01

    This study aimed to verify whether psychologists and game activities could reduce preoperative anxiety and promote compliance in paediatric patients. More specifically, we sought to evaluate whether it would be better to propose contextualized games or just distracting activities. A total of 104 children undergoing surgery were assigned to the following 4 conditions of treatment: (1) contextual games and psychological accompaniment, (2) only contextual games, (3) distracting activities, and (4) only psychological accompaniment. Observed children's anxiety was assessed using modified Yale Preoperative Anxiety Scale and compliant behaviours with modified form of Induction Compliance Checklist. Children in the first condition (complete intervention - contextual games and psychological accompaniment) were less anxious and more cooperative in the preoperative period and during the induction of anaesthesia than in the other three conditions. In particular, contextual activities (second condition) were found to be more efficient than psychological accompaniment (fourth condition), whereas the worst condition was proposing only distracting activities (third condition). In order to help young hospitalized patients in paediatric surgery structures, it is necessary to propose games that can prepare them for what will happen as well as the support of a psychologist. PMID:25469004

  1. Preoperative planning for DIEP breast reconstruction: early experience of the use of computerised tomography angiography with VoNavix 3D software for perforator navigation.

    PubMed

    Pacifico, M D; See, M S; Cavale, N; Collyer, J; Francis, I; Jones, M E; Hazari, A; Boorman, J G; Smith, R W

    2009-11-01

    The deep inferior epigastric perforator (DIEP) flap is normally the first choice in breast reconstruction; however, due to the considerable vascular anatomical variation and the learning curve for the procedure, muscle-sparing transverse rectus abdominis musculocutaneous (TRAM) flaps are still frequently performed to reduce the rate of complications. Accurate preoperative investigation of the perforators would allow better operative preparation and possibly shorten the learning curve. In an effort to increase accuracy of preoperative planning and to aid preoperative decision-making in free abdominal flap breast reconstruction, we have acquired the use of VoNavix, software that creates three dimensional images from computerised tomography angiography (CTA) data. The use of the VoNavix software for analysis of CTA provides superior imaging that can be viewed in theatre. It, together with CTA, enables decisions to be made preoperatively, including: which side to raise the flap; whether to aim for a medial or lateral row perforator; whether to take a segment of muscle and whether to expect an easy or difficult dissection. We have now performed over 60 free abdominal flap breast reconstructions aided with CTA, and 10 of these cases also used VoNavix technology. This paper presents our initial experience with the use of this software, illustrated with three patient examples. The advantages and disadvantages are discussed. PMID:18708309

  2. 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. PMID:17069000

  3. Preoperative CT evaluation of adrenal glands in non-small cell bronchogenic carcinoma

    SciTech Connect

    Nielsen, M.E. Jr.; Heaston, D.K.; Dunnick, N.R.; Korobkin, M.

    1982-08-01

    Preoperative chest computed tomographic (CT) scans in 84 patients with biopsy-proven non-small cell bronchogenic carcinoma were reviewed. At least one adrenal gland was visualized in 70 of these. Evidence of a solid adrenal mass was present in 18 (14.5%) glands in 15 (21.4%) patients. Percutaneous needle aspiration under CT guidance confirmed metastatic malignancy in the four patients who were biopsied. Because the documented presence of adrenal metastases in non-small cell lung cancer makes surgical resection or local irradiation inappropriate, it is recommended that both adrenal glands in their entirety be specifically included whenever a staging chest CT examination is performed in patients with such tumors. Percutaneous needle biopsy for pathologic confirmation of the nature of solid adrenal masses discovered in this process is also useful.

  4. Preoperational test report, cross-site transfer system integrated test (POTR-007)

    SciTech Connect

    Pacquet, E.A.

    1998-04-02

    This report documents the results obtained during the performance of Preoperational Test POTP-007, from December 12, 1997 to March 27, 1998. The main objectives were to demonstrate the operation of the following Cross-Site Transfer System components: Booster pumps P-3125A and P-3125B interlocks and controls, both local and remote; Booster pump P-3125A and P-3125B and associated variable speed drives VSD-1 and VSD-2 performance in both manual and automatic modes; and Water filling, circulation, venting and draining of the transfer headers (supernate and slurry line). As described in reference 1, the following components of the Cross-Site Transfer System that would normally be used during an actual waste transfer, are not used in this specific test: Water Flush System; Valving and instrumentation associated with the 241-SY-A valve pit jumpers; and Valving and instrumentation associated with the 244-A lift station.

  5. Planned preoperative radiation therapy vs. definitive radiotherapy for advanced laryngeal carcinoma

    SciTech Connect

    Kazem, I.; van den Broek, P.

    1984-10-01

    In the period 1970-1980 inclusive, 191 patients with T3T4 laryngeal carcinoma (glottic: 63 and supraglottic: 128) received either definitive radiation therapy (RT) (60-65 Gy in 6-7 weeks) or planned preoperative radiation therapy (25 Gy in 5 equal daily fractions of 5 Gy) followed by laryngectomy with or without neck dissection (RT + S). Selection for RT vs. RT + S was based on medical operability and/or patient's refusal to undergo surgery. All patients are evaluable with minimum of 2 years observation. Crude 5 and 10-year survival probability for 32 patients with glottic localization who received RT is 55% and 38% vs. 65% and 65% respectively for 31 treated with RT + S. For 52 patients with supraglottic site who received RT, the 5 and 10-year survival is 44% and 44% vs. 82% and 60% for 76 patients treated with RT + S.

  6. Specimen histology after one or two preoperative CF-252 implants for bulky stage IB cervical cancer

    SciTech Connect

    Maruyama, Y.; van Nagell, J.R.; Feola, J.M.; Beach, J.L.; Yoneda, J.; Donaldson, E.; Gallion, H.; Rowley, K.; Powell, D.

    1987-10-01

    Using hysterectomy specimens obtained 1 month after Cf-252 neutron brachytherapy plus fractionated radiotherapy, we determined the fraction of positive and negative specimens with neutron dose for bulky Stage IB cervical cancers. The specimens obtained and studied after an initial Cf-252 insertion when the sources were newer and less decayed were more frequently negative for histological evidence of cancer than after the sources had decayed and 2 insertions were needed. After two insertions to deliver a therapeutic dose preoperatively the specimens were more frequently positive. When a larger initial dose was delivered to the tumor a larger proportion of negative specimens was noted. The size of neutron dose fraction was important to local tumor clearance and to rendering the specimens negative as well as schedule in use.

  7. Learning curve of endorectal ultrasonography in preoperative staging of rectal carcinoma

    PubMed Central

    LIU, ZUO-LIANG; ZHOU, TONG; LIANG, XIAO-BO; MA, JUN-JIE; ZHANG, GUANG-JUN

    2014-01-01

    Accurate preoperative staging of rectal carcinoma is essential for optimal treatment. This study was designed to evaluate the accuracy and learning curve of endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. We retrospectively analyzed the records of patients with rectal carcinoma who underwent preoperative ERUS followed by curative surgery at the Shanxi Province Tumor Hospital between January, 2007 and March, 2010. The patients were divided into three groups, namely A, B and C, depending on whether the examination was performed between January and December, 2007, between January and December, 2008 or between January, 2009 and March, 2010, respectively. Five physicians with no prior experience in ERUS performed the examinations. We compared the ERUS staging with the pathological findings using the tumor-node-metastasis (TNM) classification. The accuracy of ERUS in T and N staging after each additional consecutive 20 patients was calculated for physicians D, E and F. A total of 319 patients underwent ERUS prior to surgery. There were 38 patients in group A, 135 in group B and 146 in group C. Two of the five physicians performed only 47 of the 319 examinations, whereas the remaining 272 patients were examined by physicians D (n=162), E (n=64) and F (n=46). The overall accuracy in assessing the extent of rectal wall invasion (T) was 67%, with 16% of the cases overstaged and 17% understaged and the accuracy in assessing nodal involvement (N) was 66%, with 11% of the cases overstaged and 23% understaged. The total T and N staging accuracy of physicians D, E and F was 75 and 72%; 59 and 59%; and 50 and 52%, respectively. For physicians D, E and F, the accuracy of T and N staging after each additional 20 patients was calculated and the curve of the accuracy reached a plateau after physician D completed 80 cases. Therefore, ERUS is a valuable tool for assessing the depth of tumor invasion and it appears that after ~80 cases a physician may

  8. Learning curve of endorectal ultrasonography in preoperative staging of rectal carcinoma.

    PubMed

    Liu, Zuo-Liang; Zhou, Tong; Liang, Xiao-Bo; Ma, Jun-Jie; Zhang, Guang-Jun

    2014-11-01

    Accurate preoperative staging of rectal carcinoma is essential for optimal treatment. This study was designed to evaluate the accuracy and learning curve of endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. We retrospectively analyzed the records of patients with rectal carcinoma who underwent preoperative ERUS followed by curative surgery at the Shanxi Province Tumor Hospital between January, 2007 and March, 2010. The patients were divided into three groups, namely A, B and C, depending on whether the examination was performed between January and December, 2007, between January and December, 2008 or between January, 2009 and March, 2010, respectively. Five physicians with no prior experience in ERUS performed the examinations. We compared the ERUS staging with the pathological findings using the tumor-node-metastasis (TNM) classification. The accuracy of ERUS in T and N staging after each additional consecutive 20 patients was calculated for physicians D, E and F. A total of 319 patients underwent ERUS prior to surgery. There were 38 patients in group A, 135 in group B and 146 in group C. Two of the five physicians performed only 47 of the 319 examinations, whereas the remaining 272 patients were examined by physicians D (n=162), E (n=64) and F (n=46). The overall accuracy in assessing the extent of rectal wall invasion (T) was 67%, with 16% of the cases overstaged and 17% understaged and the accuracy in assessing nodal involvement (N) was 66%, with 11% of the cases overstaged and 23% understaged. The total T and N staging accuracy of physicians D, E and F was 75 and 72%; 59 and 59%; and 50 and 52%, respectively. For physicians D, E and F, the accuracy of T and N staging after each additional 20 patients was calculated and the curve of the accuracy reached a plateau after physician D completed 80 cases. Therefore, ERUS is a valuable tool for assessing the depth of tumor invasion and it appears that after ~80 cases a physician may

  9. The importance of accurate atmospheric modeling

    NASA Astrophysics Data System (ADS)

    Payne, Dylan; Schroeder, John; Liang, Pang

    2014-11-01

    This paper will focus on the effect of atmospheric conditions on EO sensor performance using computer models. We have shown the importance of accurately modeling atmospheric effects for predicting the performance of an EO sensor. A simple example will demonstrated how real conditions for several sites in China will significantly impact on image correction, hyperspectral imaging, and remote sensing. The current state-of-the-art model for computing atmospheric transmission and radiance is, MODTRAN® 5, developed by the US Air Force Research Laboratory and Spectral Science, Inc. Research by the US Air Force, Navy and Army resulted in the public release of LOWTRAN 2 in the early 1970's. Subsequent releases of LOWTRAN and MODTRAN® have continued until the present. Please verify that (1) all pages are present, (2) all figures are correct, (3) all fonts and special characters are correct, and (4) all text and figures fit within the red margin lines shown on this review document. Complete formatting information is available at http://SPIE.org/manuscripts Return to the Manage Active Submissions page at http://spie.org/submissions/tasks.aspx and approve or disapprove this submission. Your manuscript will not be published without this approval. Please contact author_help@spie.org with any questions or concerns. The paper will demonstrate the importance of using validated models and local measured meteorological, atmospheric and aerosol conditions to accurately simulate the atmospheric transmission and radiance. Frequently default conditions are used which can produce errors of as much as 75% in these values. This can have significant impact on remote sensing applications.

  10. 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

  11. 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

  12. 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.

  13. Multimodal Spatial Calibration for Accurately Registering EEG Sensor Positions

    PubMed Central

    Chen, Shengyong; Xiao, Gang; Li, Xiaoli

    2014-01-01

    This paper proposes a fast and accurate calibration method to calibrate multiple multimodal sensors using a novel photogrammetry system for fast localization of EEG sensors. The EEG sensors are placed on human head and multimodal sensors are installed around the head to simultaneously obtain all EEG sensor positions. A multiple views' calibration process is implemented to obtain the transformations of multiple views. We first develop an efficient local repair algorithm to improve the depth map, and then a special calibration body is designed. Based on them, accurate and robust calibration results can be achieved. We evaluate the proposed method by corners of a chessboard calibration plate. Experimental results demonstrate that the proposed method can achieve good performance, which can be further applied to EEG source localization applications on human brain. PMID:24803954

  14. Multimodal spatial calibration for accurately registering EEG sensor positions.

    PubMed

    Zhang, Jianhua; Chen, Jian; Chen, Shengyong; Xiao, Gang; Li, Xiaoli

    2014-01-01

    This paper proposes a fast and accurate calibration method to calibrate multiple multimodal sensors using a novel photogrammetry system for fast localization of EEG sensors. The EEG sensors are placed on human head and multimodal sensors are installed around the head to simultaneously obtain all EEG sensor positions. A multiple views' calibration process is implemented to obtain the transformations of multiple views. We first develop an efficient local repair algorithm to improve the depth map, and then a special calibration body is designed. Based on them, accurate and robust calibration results can be achieved. We evaluate the proposed method by corners of a chessboard calibration plate. Experimental results demonstrate that the proposed method can achieve good performance, which can be further applied to EEG source localization applications on human brain. PMID:24803954

  15. Detecting Cancer Quickly and Accurately

    NASA Astrophysics Data System (ADS)

    Gourley, Paul; McDonald, Anthony; Hendricks, Judy; Copeland, Guild; Hunter, John; Akhil, Ohmar; Capps, Heather; Curry, Marc; Skirboll, Steve

    2000-03-01

    We present a new technique for high throughput screening of tumor cells in a sensitive nanodevice that has the potential to quickly identify a cell population that has begun the rapid protein synthesis and mitosis characteristic of cancer cell proliferation. Currently, pathologists rely on microscopic examination of cell morphology using century-old staining methods that are labor-intensive, time-consuming and frequently in error. New micro-analytical methods for automated, real time screening without chemical modification are critically needed to advance pathology and improve diagnoses. We have teamed scientists with physicians to create a microlaser biochip (based upon our R&D award winning bio-laser concept)1 which evaluates tumor cells by quantifying their growth kinetics. The key new discovery was demonstrating that the lasing spectra are sensitive to the biomolecular mass in the cell, which changes the speed of light in the laser microcavity. Initial results with normal and cancerous human brain cells show that only a few hundred cells -- the equivalent of a billionth of a liter -- are required to detect abnormal growth. The ability to detect cancer in such a minute tissue sample is crucial for resecting a tumor margin or grading highly localized tumor malignancy. 1. P. L. Gourley, NanoLasers, Scientific American, March 1998, pp. 56-61. This work supported under DOE contract DE-AC04-94AL85000 and the Office of Basic Energy Sciences.

  16. Detecting cancer quickly and accurately

    NASA Astrophysics Data System (ADS)

    Gourley, Paul L.; McDonald, Anthony E.; Hendricks, Judy K.; Copeland, G. C.; Hunter, John A.; Akhil, O.; Cheung, D.; Cox, Jimmy D.; Capps, H.; Curry, Mark S.; Skirboll, Steven K.

    2000-03-01

    We present a new technique for high throughput screening of tumor cells in a sensitive nanodevice that has the potential to quickly identify a cell population that has begun the rapid protein synthesis and mitosis characteristic of cancer cell proliferation. Currently, pathologists rely on microscopic examination of cell morphology using century-old staining methods that are labor-intensive, time-consuming and frequently in error. New micro-analytical methods for automated, real time screening without chemical modification are critically needed to advance pathology and improve diagnoses. We have teamed scientists with physicians to create a microlaser biochip (based upon our R&D award winning bio- laser concept) which evaluates tumor cells by quantifying their growth kinetics. The key new discovery was demonstrating that the lasing spectra are sensitive to the biomolecular mass in the cell, which changes the speed of light in the laser microcavity. Initial results with normal and cancerous human brain cells show that only a few hundred cells -- the equivalent of a billionth of a liter -- are required to detect abnormal growth. The ability to detect cancer in such a minute tissue sample is crucial for resecting a tumor margin or grading highly localized tumor malignancy.

  17. Towards an accurate bioimpedance identification

    NASA Astrophysics Data System (ADS)

    Sanchez, B.; Louarroudi, E.; Bragos, R.; Pintelon, R.

    2013-04-01

    This paper describes the local polynomial method (LPM) for estimating the time-invariant bioimpedance frequency response function (FRF) considering both the output-error (OE) and the errors-in-variables (EIV) identification framework and compare it with the traditional cross— and autocorrelation spectral analysis techniques. The bioimpedance FRF is measured with the multisine electrical impedance spectroscopy (EIS) technique. To show the overwhelming accuracy of the LPM approach, both the LPM and the classical cross— and autocorrelation spectral analysis technique are evaluated through the same experimental data coming from a nonsteady-state measurement of time-varying in vivo myocardial tissue. The estimated error sources at the measurement frequencies due to noise, σnZ, and the stochastic nonlinear distortions, σZNL, have been converted to Ω and plotted over the bioimpedance spectrum for each framework. Ultimately, the impedance spectra have been fitted to a Cole impedance model using both an unweighted and a weighted complex nonlinear least square (CNLS) algorithm. A table is provided with the relative standard errors on the estimated parameters to reveal the importance of which system identification frameworks should be used.

  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. Tumor Volume Reduction Rate Measured by Magnetic Resonance Volumetry Correlated With Pathologic Tumor Response of Preoperative Chemoradiotherapy for Rectal Cancer

    SciTech Connect

    Yeo, Seung-Gu; Kim, Dae Yong; Kim, Tae Hyun; Jung, Kyung Hae; Hong, Yong Sang; Chang, Hee Jin; Park, Ji Won; Lim, Seok-Byung; Choi, Hyo Seong; Jeong, Seung-Yong

    2010-09-01

    Purpose: To determine whether the tumor volume reduction rate (TVRR) measured using three-dimensional region-of-interest magnetic resonance volumetry correlates with the pathologic tumor response after preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer. Methods and Materials: The study included 405 patients with locally advanced rectal cancer (cT3-T4) who had undergone preoperative CRT and radical proctectomy. The tumor volume was measured using three-dimensional region-of-interest magnetic resonance volumetry before and after CRT but before surgery. We analyzed the correlation between the TVRR and the pathologic tumor response in terms of downstaging and tumor regression grade (TRG). Downstaging was defined as ypStage 0-I (ypT0-T2N0M0), and the TRG proposed by Dworak et al. was used. Results: The mean TVRR was 65.0% {+-} 22.3%. Downstaging and complete regression occurred in 167 (41.2%) and 58 (14.3%) patients, respectively. The TVRRs according to ypT classification (ypT0-T2 vs. ypT3-T4), ypN classification (ypN0 vs. ypN1-N2), downstaging (ypStage 0-I vs. ypStage II-III), good regression (TRG 3-4 vs. TRG 1-2), and complete regression (TRG 4 vs. TRG 1-3) were all significantly different (p <.05). When the TVRR was categorized into three groups (<60%, 60-80%, and >80%), the rates of ypT0-T2, ypN0, downstaging, and good regression were all significantly greater for patients with a TVRR of {>=}60%, as was the complete regression rate for patients with a TVRR >80% (p <.05). Conclusion: The TVRR measured using three-dimensional region-of-interest magnetic resonance volumetry correlated significantly with the pathologic tumor response in terms of downstaging and TRG after preoperative CRT for locally advanced rectal cancer.

  20. 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...

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. Is there a case for selective, rather than routine, preoperative laryngoscopy in thyroid surgery?

    PubMed Central

    González-Sánchez, Carmen; Aguilera-Molina, Yari Yuritzi; Rozo-Coronel, Orlando; Estévez-Alonso, José Santiago; Muñoz-Herrera, Ángel

    2015-01-01

    Background According to some authors, routine preoperative laryngoscopy should be the standard of care in all patients undergoing thyroid surgery. The rationale for this approach is (I) the risk that a patient has a preoperative vocal cord palsy (VCP) without symptoms; (II) the presence of VCP preoperatively is suggestive of invasive malignancy; (III) it is relevant for the use of intraoperative nerve monitoring; and (IV) surgical strategy may be better defined if a paralysed vocal cord is detected preoperatively. Methods This is a review of studies of patients who underwent routine preoperative laryngoscopy to anticipate preoperative VCP and that evaluated related risk factors, including previous surgery, voice function complaints, and a diagnosis of malignancy. The estimated risk of sustaining preoperative VCF in the absence of these factors was determined. The relevant current guidelines from different professional bodies are also addressed. Results The level of evidence that supports routine preoperative laryngoscopy is weak. The risk of harboring preoperative VCP in the absence of previous neck or other risk-related surgery, advanced malignancy or voice symptoms is very low (0.5% of cases). Conclusions Selective rather than routine use of preoperative laryngoscopy may be acceptable provided that the risk of undetected paralysis is as low as can be reasonably ascertained from the available literature. PMID:25713775

  6. The Role of Registration in Accurate Surgical Guidance

    PubMed Central

    Fitzpatrick, J. Michael

    2016-01-01

    Registration is presented as the central issue of surgical guidance. The focus is on the accuracy of approaches employed today, all of which use pre-operative images to guide surgery on rigid anatomy. The three most well established approaches to guidance—the stereotactic frame, point fiducials, and surface matching—are examined in detail, along with two new approaches based on microstereotactic frames. It is shown that each method relies on the registration of points in the image to corresponding points in the operating room, and therefore that the error patterns associated with point registration are similar for all of them. Three types of registration error—fiducial localization error (FLE), fiducial registration error (FRE), and target registration error (TRE) are highlighted, as well as two additional guidance errors—target localization error, and total targeting error, the latter of which is the overall error of the guidance system. Statistical relationships between TRE and FLE, between FRE and FLE, and among TRE, TLE and TTE are given. Finally some myths concerning fiducial registration are highlighted. PMID:20718266

  7. The role of registration in accurate surgical guidance.

    PubMed

    Fitzpatrick, J M

    2010-01-01

    Registration is presented as the central issue of surgical guidance. The focus is on the accuracy of approaches employed today, all of which use pre-operative images to guide surgery on rigid anatomy. The three most well-established approaches to guidance, namely the stereotactic frame, point fiducials, and surface matching, are examined in detail, together with two new approaches based on microstereotactic frames. It is shown that each method relies on the registration of points in the image to corresponding points in the operating room, and therefore that the error patterns associated with point registration are similar for all of them. Three types of registration error, namely fiducial localization error (FLE), fiducial registration error (FRE), and target registration error (TRE), are highlighted, as well as two additional guidance errors, namely target localization error and total targeting error, the latter of which is the overall error of the guidance system. Statistical relationships between TRE and FLE, between FRE and FLE, and between TRE, TLE, and TTE are given. Finally some myths concerning fiducial registration are highlighted. PMID:20718266

  8. Induction therapy for locally advanced thymoma.

    PubMed

    Riely, Gregory J; Huang, James

    2010-10-01

    Thymomas are the most frequently encountered tumors of the mediastinum and often present with either localized or locally advanced disease. The prognosis in thymoma has been consistently shown to correspond to the invasiveness of the tumor (as represented by the Masaoka stage of the tumor) and the completeness of surgical resection. Because treatment with a variety of different chemotherapy regimens has demonstrated radiographic response rates greater than 50% in patients with advanced thymoma, a number of investigators have explored the use of preoperative (induction, neoadjuvant) therapy for patients with locally advanced thymoma. In this review, we summarize the published experience with preoperative therapy for thymoma and discuss ongoing clinical trials exploring multimodality therapy for treatment of locally advanced thymoma. PMID:20859127

  9. Preoperative weight gain might increase risk of gastric bypass surgery

    PubMed Central

    Istfan, Nawfal W.; Anderson, Wendy A.; Apovian, Caroline M.; Hess, Donald T.; Forse, Armour R.

    2014-01-01

    Background Weight loss improves the cardiovascular and metabolic risk associated with obesity. However, insufficient data are available about the health effects of weight gain, separate from the obesity itself. We sought to determine whether the changes in body weight before open gastric bypass surgery (OGB) would have a significant effect on the immediate perioperative hospital course. Methods A retrospective chart review of 100 consecutive patients was performed to examine the effects of co-morbidities and body weight changes in the immediate preoperative period on the hospital length of stay and the rate of admission to the surgical intensive care unit (SICU). Results Of our class III obese patients undergoing OGB, 95% had ≥1 co-morbid condition and an overall SICU admission rate of 18%. Compared with the patients with no perioperative SICU admission, the patients admitted to the SICU had a greater degree of insulin resistance (homeostatic model analysis–insulin resistance 10.8 ± 1.3 versus 5.9 ± 0.5, P = .001), greater serum triglyceride levels (225 ± 47 versus 143 ± 8 mg/dL, P = .003), and had gained more weight preoperatively (.52 ± .13 versus .06 ± .06 lb/wk, P = .003). The multivariate analyses showed that preoperative weight gain was a risk factor for a longer length of stay and more SICU admissions lasting ≥3 days, as were a diagnosis of sleep apnea and an elevated serum triglyceride concentration. Conclusion The results of the present retrospective study suggest that weight gain increases the risk of perioperative SICU admission associated with OGB, independent of the body mass index. Sleep apnea and elevated serum triglyceride levels were also important determinants of perioperative morbidity. In view of the increasing epidemic of obesity and the popularity of bariatric surgical procedures, we propose that additional clinical and metabolic research focusing on the understanding of the complex relationship among obesity, positive energy

  10. Preoperative patient assessment: Identifying patients at high risk.

    PubMed

    Boehm, O; Baumgarten, G; Hoeft, A

    2016-06-01

    Postoperative mortality remains alarmingly high with a mortality rate ranging between 0.4% and 4%. A small subgroup of multimorbid and/or elderly patients undergoing different surgical procedures naturally confers the highest risk of complications and perioperative death. Therefore, preoperative assessment should identify these high-risk patients and stratify them to individualized monitoring and treatment throughout all phases of perioperative care. A "tailored" perioperative approach might help further reduce perioperative morbidity and mortality. This article aims to elucidate individual morbidity-specific risks. It further suggests approaches to detect patients at the risk of perioperative complications. PMID:27396802

  11. The effect of preoperative warming on patients' postoperative temperatures.

    PubMed

    Cooper, Shauna

    2006-05-01

    Many perioperative clinicians encounter difficulty in preventing hypothermia in surgical patients. One intervention to prevent perioperative hypothermia is the use of forced-air warming. Although forced-air warming is used most frequently in the intraoperative area, prewarming patients with forced-air warming systems before induction of anesthesia may be enough to prevent hypothermia throughout the surgical procedure, allowing patients to arrive in the postanesthesia care unit in a normothermic state. A review of the literature on preoperative forced-air warming is provided, and the effect of prewarming on postoperative patient temperatures is discussed. PMID:16722285

  12. 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

  13. Rhinoplasty: clinical categorization as a practical preoperative guide.

    PubMed

    Thomas, J R; McKinney, J

    1985-12-01

    As progressively more individuals desire rhinoplasty, facial surgeons are experiencing a wider spectrum of potential patients. The young woman in her late teens and 20s once made up the majority of the rhinoplasty case load. Now, the patients desiring aesthetic and reconstructive nasal surgery represent all stages of life. We have divided the patient population into five categories based principally on the special requirements of inherent chronologic differences. This typing system guides rhinoplastic surgeons in dealing with a variety of age groups of both sexes. These categories are useful in defining differences in technique and as an adjunct to preoperative evaluation. PMID:4071177

  14. 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

  15. [Endoluminal echography in rectal cancer--preoperative staging and postoperative control].

    PubMed

    Tankova, L; Kadnian, Kh; Draganov, V; Damianov, D; Damianov, N; Penchev, P; Gegova, A

    2003-01-01

    The aim of this study is to determine the diagnostic potential of endoluminal echography and the pitfalls sources in the preoperative staging and postoperative follow-up in patients with rectal cancer. 245 patients with rectal carcinoma are evaluated during 10 years period (Jan. 1993-Jan. 2002 years). 96 patients are monitored in the early and late postoperative periods for the early detection of local recurrence as well as for the anorectal physiology assessment after low anterior rectal resection or coloanal anastomosis. Lineal transducer UST-657-5MHz (Aloka 620) and 10MHz miniprobe are applied. The accuracy for T-staging is 84% and for N-staging is 82%. The local recurrence is detected in 21 patients, on average 12.6 months after curative surgery. The local recurrence is more often in cases of lymph node involvement as well as if some specific echographic features for extramural vascular invasion are present. Endoluminal echography provides individual therapeutic management and postoperative control in patients with rectal cancer. PMID:15641546

  16. Significance of Cox-2 expression in rectal cancers with or without preoperative radiotherapy

    SciTech Connect

    Pachkoria, Ketevan; Zhang Hong; Adell, Gunnar; Jarlsfelt, Ingvar; Sun Xiaofeng . E-mail: xiao-feng.sun@ibk.liu.se

    2005-11-01

    Purpose: Radiotherapy has reduced local recurrence of rectal cancers, but the result is not satisfactory. Further biologic factors are needed to identify patients for more effective radiotherapy. Our aims were to investigate the relationship of cyclooxygenase-2 (Cox-2) expression to radiotherapy, and clinicopathologic/biologic variables in rectal cancers with or without radiotherapy. Methods and Materials: Cox-2 expression was immunohistochemically examined in distal normal mucosa (n = 28), in adjacent normal mucosa (n = 107), in primary cancer (n = 138), lymph node metastasis (n = 30), and biopsy (n = 85). The patients participated in a rectal cancer trial of preoperative radiotherapy. Results: Cox-2 expression was increased in primary tumor compared with normal mucosa (p < 0.0001), but there was no significant change between primary tumor and metastasis. Cox-2 positivity was or tended to be related to more p53 and Ki-67 expression, and less apoptosis (p {<=} 0.05). In Cox-2-negative cases of either biopsy (p = 0.01) or surgical samples (p = 0.02), radiotherapy was related to less frequency of local recurrence, but this was not the case in Cox-2-positive cases. Conclusion: Cox-2 expression seemed to be an early event involved in rectal cancer development. Radiotherapy might reduce a rate of local recurrence in the patients with Cox-2 weakly stained tumors, but not in those with Cox-2 strongly stained tumors.

  17. Combination of preoperative platelet/lymphocyte and neutrophil/lymphocyte rates and tumor-related factors to predict lymph node metastasis in patients with gastric cancer

    PubMed Central

    Pang, Wenyang; Lou, Neng; Jin, Cancan; Hu, Changyuan; Arvine, Chandoo; Shen, Xian

    2016-01-01

    Objective Lymph node (LN) metastasis is widely accepted as a poor prognosis indicator in patients with gastric cancer. An accurate preoperative prediction of LN status is of crucial importance for the planning treatment. The aim of the present study was to assess the predictive value of the preoperative platelet/lymphocyte (PLR) and neutrophil/lymphocyte rates (NLR) on the LN metastasis in gastric cancer patients and to develop a new preoperative score system to predict LN metastasis. Patients and methods A total of 492 operable patients with gastric cancer were enrolled in our study. The clinical utility of the PLR and NLR was evaluated by receiver operating characteristic (ROC) curves. The logistic analysis was used to identify the independent parameters associated with LN metastasis. Then, a score system including those independent parameters that can be detected preoperatively was established, which was also tested by an ROC curve. Results The ideal cutoff values for predicting LN metastasis were 1.59 for NLR and 155.67 for PLR according to the ROC curve. Multivariate analyses showed that both PLR and NLR are significantly associated with LN metastasis independent of depth of invasion, lymphatic invasion, macroscopic type, and tumor size. The area under the ROC curve of the score system was 0.830 (95% confidence interval 0.782–0.878), showing a reliable ability to evaluate the status of nodal involvement. Conclusion Preoperative PLR and NLR are useful biomarkers to predict LN metastasis and the score system in our study may serve as a reliable instrument to predict LN metastasis in gastric cancer patients. PMID:26854795

  18. The effect of preoperative chemoradiotherapy on lymph nodes harvested in TME for rectal cancer

    PubMed Central

    2013-01-01

    Background Adequate lymph nodes resection in rectal cancer is important for staging and local control. This retrospective analysis single center study evaluated the effect of neoadjuvant chemoradiation on the number of lymph nodes in rectal carcinoma, considering some clinicopathological parameters. Methods A total of 111 patients undergone total mesorectal excision for rectal adenocarcinoma from July 2005 to May 2012 in our center were included. No patient underwent any prior pelvic surgery or radiotherapy. Chemoradiotherapy was indicated in patients with rectal cancer stage II or III before chemoradiation. Results One-hundred and eleven patients were considered. The mean age was 67.6 yrs (range 36 – 84, SD 10.8). Fifty (45.0%) received neoadjuvant therapy before resection. The mean number of removed lymph nodes was 13.6 (range 0–39, SD 7.3). In the patients who received neoadjuvant therapy the number of nodes detected was lower (11.5, SD 6.5 vs. 15.3, SD 7.5, p = 0.006). 37.4% of patients with preoperative chemoradiotherapy had 12 or more lymph nodes in the specimen compared to the 63.6% of those who had surgery at the first step (p: 0.006). Other factors associated in univariate analysis with lower lymph nodes yield included stage (p 0.005) and grade (p 0.0003) of the tumour. Age, sex, tumor site, type of operation, surgeons and pathologists did not weight upon the number of the removed lymph nodes. Conclusion In TME surgery for rectal cancer, preoperative CRT results into a reduction of lymph nodes yield in univariate analisys and linear regression. PMID:24246069

  19. 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

  20. 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

  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 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. PMID:26034588

  3. 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

  4. Preoperative Prediction of Aortic Insufficiency During Ventricular Assist Device Treatment.

    PubMed

    Imamura, Teruhiko; Kinugawa, Koichiro

    2016-01-01

    Survival rate in patients with stage D heart failure has improved significantly owing to the development of continuous flow left ventricular assist devices (LVAD), but aortic insufficiency (AI) still remains one of the major unsolved complications that impairs patient quality of life. There are no established treatments for AI, and preoperative prediction and prevention of AI is needed. The opening of a native aortic valve (AV) is a sufficient condition for prevention of AI, and improvement of LV ejection fraction due to LV reverse remodeling (LVRR) is essential to open a native AV. Preoperative insufficient β-blocker treatment and pulsatile flow LVAD usage are keys for LVRR, opening of an AV, and prevention of AI. The second mechanism that leads to AI is remodeling of the aortic root and degeneration of a native AV, which results from reduced pulse pressure during LVAD support. Centrifugal or pulsatile flow LVAD usage has an advantage in terms of preserving pulsatility, and may prevent AI compared with an axial pump. There is less probability of avoiding AI with sufficient β-blocker treatment, and these patients may be good candidates for concomitant surgical intervention to a native AV at the time of LVAD implantation. PMID:26742702

  5. Motion of the kidney between preoperative and intraoperative positioning.

    PubMed

    Schneider, Caitlin; Nguan, Christopher; Longpre, Michelle; Rohling, Robert; Salcudean, Septimiu

    2013-06-01

    For many laparoscopic surgical procedures, the preoperative images are taken with the patient in a different position than that in which the surgery is performed. The organ shift between positions can affect surgical image guidance, as the organ shifts can complicate image registration. In particular, for partial nephrectomy, the standard clinical approach requires supine preoperative computed tomography, while the surgery is performed in the flank position. We studied ten subjects in both supine and flank positions. Rigid registration was used to determine the relative motion of the kidneys, using the spine as a pose-independent landmark. Our results showed that the kidney can move as much as 46.5 mm as a result of a supine-to-flank change in patient position, and rotate as much as 25°. From the results, significant kidney motion occurs due to the change of patient position from supine to flank. These changes warrant further study to understand and model the patient specific motion. PMID:23322758

  6. 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.

  7. 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

  8. Current status of preoperative drainage for distal biliary obstruction

    PubMed Central

    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

    2015-01-01

    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

  9. [Preoperative management to reduce morbidity and mortality of hip fracture].

    PubMed

    Ferré, F; Minville, V

    2011-10-01

    Hip femur is extremely common in the elderly and is one of the most common reasons for admission in trauma care. The main reported causes of death after hip fracture were cardiovascular (29%), neurological (20%) and pulmonary. Large epidemiological studies have shown a relatively small decrease in mortality for 20 years despite an active approach to medical and surgical management. Yet 57% of deaths occurring within 30 days post-surgery are preventable because they are not related to a pre-existing disease. Preoperative management to optimize these patients could help to reduce morbidity and mortality and is thus a crucial issue. The anesthesia consultation is used to evaluate the perioperative risk, treat pain, manage treatment and stabilize the patient. An operative delay of more than 48hours after admission increases mortality. This period should not be prolonged by unnecessary investigations that will not change the perioperative management. The preoperative period is a key moment because it allows to choose the anesthetic technique. Even if this choice is controversial, continuous spinal anesthesia (titrated) do not modify the cardiovascular and neurological physiological balance of these precarious patients. PMID:21945704

  10. Essential elements of the preoperative breast reconstruction evaluation

    PubMed Central

    Cheng, Angela

    2015-01-01

    A plethora of options exist for breast reconstruction and preoperative evaluation must be thorough to lead to a successful outcome. We review multiple components of the preoperative assessment including the patient’s history, goals, imaging, and key elements of the physical exam. Consideration for tumor biology, staging, need or response to chemotherapy or radiation therapy is important in deciding on immediate versus delayed reconstruction. It is also important to consider the patient’s anatomy, breast size and whether the reconstruction will be unilateral or bilateral. The reconstructive surgeon must accommodate all these factors to consider partial or complete mastectomy defects and guide the patient to the most appropriate reconstructive technique whether it be an oncoplastic reduction mammoplasty, expander-based reconstruction, immediate implant reconstruction, or immediate versus delayed autologous tissue reconstruction such as the deep inferior epigastric artery perforator (DIEP)/transverse rectus abdominis muscle (TRAM), latissimus, transverse upper gracilis (TUG)/profunda femoris artery perforator (PAP), or gluteal artery perforator (GAP) flaps. PMID:26005641

  11. Association of Preoperative Biliary Drainage with Postoperative Morbidity after Pancreaticoduodenectomy

    PubMed Central

    Liu, Chang; Lu, Jian-Wen; Du, Zhao-Qing; Liu, Xue-Min; Lv, Yi; Zhang, Xu-Feng

    2015-01-01

    Background. The advantages or disadvantages of preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) remain unclear. Methods. A prospectively maintained database was queried for 335 consecutive patients undergoing standard PD surgery between 2009 and 2013. Clinical data and postoperative complications of the 47 patients receiving PBD and 288 patients with early surgery were compared. A matching analysis was also performed between patients receiving or not receiving PBD (no-PBD). Results. The indication for PBD was severe obstructive jaundice (81%) and cholangitis (26%) at the time of PBD. 47 PBD patients had higher bilirubin level than 288 no-PBD patients preoperatively (363.2 μmol/L versus 136.0 μmol/L, p < 0.001). Although no significant difference of any complications could be observed between the two groups, positive intraoperative bile culture and wound infection seemed to be moderately increased in PBD compared to no-PBD patients (p = 0.084 and 0.183, resp.). In the matched-pair comparison, the incidence of wound infection was three times higher in PBD than no-PBD patients (14.9% versus 4.3%, p = 0.080). Conclusions. PBD seems to moderately increase the risk of postoperative wound and bile duct infection. Therefore, PBD should be selectively performed prior to PD. PMID:26798333

  12. Preoperative mechanical preparation of the colon: the patient's experience

    PubMed Central

    Jung, Barbel; Lannerstad, Olof; Påhlman, Lars; Arodell, Malin; Unosson, Mitra; Nilsson, Erik

    2007-01-01

    Background Preoperative mechanical bowel preparation can be questioned as standard procedure in colon surgery, based on the result from several randomised trials. Methods As part of a large multicenter trial, 105 patients planned for elective colon surgery for cancer, adenoma, or diverticulitis in three hospitals were asked to complete a questionnaire regarding perceived health including experience with bowel preparation. There were 39 questions, each having 3 – 10 answer alternatives, dealing with food intake, pain, discomfort, nausea/vomiting, gas distension, anxiety, tiredness, need of assistance with bowel preparation, and willingness to undergo the procedure again if necessary. Results 60 patients received mechanical bowel preparation (MBP) and 45 patients did not (No-MBP). In the MBP group 52% needed assistance with bowel preparation and 30% would consider undergoing the same preoperative procedure again. In the No-MBP group 65 % of the patients were positive to no bowel preparation. There was no significant difference between the two groups with respect to postoperative pain and nausea. On Day 4 (but not on Days 1 and 7 postoperatively) patients in the No-MBP group perceived more discomfort than patients in the MBP group, p = 0.02. Time to intake of fluid and solid food did not differ between the two groups. Bowel emptying occurred significantly earlier in the No-MBP group than in the MBP group, p = 0.03. Conclusion Mechanical bowel preparation is distressing for the patient and associated with a prolonged time to first bowel emptying. PMID:17480223

  13. 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.

  14. 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

  15. Histological differences between preoperative chemoradiotherapy and chemotherapy for rectal cancer: a clinicopathological study.

    PubMed

    Sakuyama, Naoki; Kojima, Motohiro; Kawano, Shingo; Akimoto, Tetsuo; Saito, Norio; Ito, Masaaki; Ochiai, Atsushi

    2016-05-01

    Pathological studies on the different histological effects between neoadjuvant chemotherapy (NAC) and preoperative chemoradiation therapy (preoperative CRT) have not been performed. The purpose of this study is to elucidate the histological differences in tissue received from NAC and preoperative CRT for rectal cancer to evaluate whether a pathological assessment method used after CRT can be applied for NAC. One hundred and thirty-eight patients were enrolled in this study; 88 patients underwent their operations after preoperative CRT or NAC, and 50 patients underwent surgery only. Residual tumor area was measured using morphometry software and we compared the stromal component of myofibroblasts, immune cells, and vasculature to elucidate the difference of therapeutic effect between them. The grade of reduction after preoperative CRT was more prominent than that seen in NAC. Also, ypT downstaging was more prominent in preoperative CRT than in NAC, and ypN downstaging was more frequent in NAC than in preoperative CRT. Preoperative CRT showed more marked myofibroblasts and fewer immune cells than did NAC, which indicates different effects on the cancer microenvironment. Our histological results suggest different effects between NAC and preoperative CRT on tumor tissue. The best assessment method available for a variable therapeutic protocol should be further investigated. PMID:27112135

  16. Localization of liver tumors in freehand 3D laparoscopic ultrasound

    NASA Astrophysics Data System (ADS)

    Shahin, O.; Martens, V.; Besirevic, A.; Kleemann, M.; Schlaefer, A.

    2012-02-01

    The aim of minimally invasive laparoscopic liver interventions is to completely resect or ablate tumors while minimizing the trauma caused by the operation. However, restrictions such as limited field of view and reduced depth perception can hinder the surgeon's capabilities to precisely localize the tumor. Typically, preoperative data is acquired to find the tumor(s) and plan the surgery. Nevertheless, determining the precise position of the tumor is required, not only before but also during the operation. The standard use of ultrasound in hepatic surgery is to explore the liver and identify tumors. Meanwhile, the surgeon mentally builds a 3D context to localize tumors. This work aims to upgrade the use of ultrasound in laparoscopic liver surgery. We propose an approach to segment and localize tumors intra-operatively in 3D ultrasound. We reconstruct a 3D laparoscopic ultrasound volume containing a tumor. The 3D image is then preprocessed and semi-automatically segmented using a level set algorithm. During the surgery, for each subsequent reconstructed volume, a fast update of the tumor position is accomplished via registration using the previously segmented and localized tumor as a prior knowledge. The approach was tested on a liver phantom with artificial tumors. The tumors were localized in approximately two seconds with a mean error of less than 0.5 mm. The strengths of this technique are that it can be performed intra-operatively, it helps the surgeon to accurately determine the location, shape and volume of the tumor, and it is repeatable throughout the operation.

  17. Multigrid time-accurate integration of Navier-Stokes equations

    NASA Technical Reports Server (NTRS)

    Arnone, Andrea; Liou, Meng-Sing; Povinelli, Louis A.

    1993-01-01

    Efficient acceleration techniques typical of explicit steady-state solvers are extended to time-accurate calculations. Stability restrictions are greatly reduced by means of a fully implicit time discretization. A four-stage Runge-Kutta scheme with local time stepping, residual smoothing, and multigridding is used instead of traditional time-expensive factorizations. Some applications to natural and forced unsteady viscous flows show the capability of the procedure.

  18. Preoperative chemoradiation of locally advanced T3 rectal cancer combined with an endorectal boost

    SciTech Connect

    Jakobsen, Anders . E-mail: andjac@vgs.vejleamt.dk; Mortensen, John P.; Bisgaard, Claus; Lindebjerg, Jan; Hansen, Johnny W.; Rafaelsen, Soren R.

    2006-02-01

    Purpose: To investigate the effect and feasibility of concurrent radiation and chemotherapy combined with endorectal brachytherapy in T3 rectal cancer with complete pathologic remission as end point. Methods and Materials: The study included 50 patients with rectal adenocarcinoma. All patients had T3 tumor with a circumferential margin 0-5 mm on a magnetic resonance imaging scan. The radiotherapy was delivered by a technique including two planning target volumes. Clinical target volume 1 (CTV1) received 60 Gy/30 fractions, and CTV2 received 48.6 Gy/27 fractions. The tumor dose was raised to 65 Gy with endorectal brachytherapy 5 Gy/1 fraction to the tumor bed. On treatment days, the patients received uracil and tegafur 300 mg/m2 concurrently with radiotherapy. Results: Forty-eight patients underwent operation. Histopathologic tumor regression was assessed by the Tumor Regression Grade (TRG) system. TRG1 was recorded in 27% of the patients, and a further 27% were classified as TRG2. TRG3 was found in 40%, and 6% had TRG4. The toxicity was low. Conclusion: The results indicate that high-dose radiation with concurrent chemotherapy and endorectal brachytherapy is feasible with a high rate of complete response, but further trials are needed to define its possible role as treatment option.

  19. Accurate orbit propagation with planetary close encounters

    NASA Astrophysics Data System (ADS)

    Baù, Giulio; Milani Comparetti, Andrea; Guerra, Francesca

    2015-08-01

    We tackle the problem of accurately propagating the motion of those small bodies that undergo close approaches with a planet. The literature is lacking on this topic and the reliability of the numerical results is not sufficiently discussed. The high-frequency components of the perturbation generated by a close encounter makes the propagation particularly challenging both from the point of view of the dynamical stability of the formulation and the numerical stability of the integrator. In our approach a fixed step-size and order multistep integrator is combined with a regularized formulation of the perturbed two-body problem. When the propagated object enters the region of influence of a celestial body, the latter becomes the new primary body of attraction. Moreover, the formulation and the step-size will also be changed if necessary. We present: 1) the restarter procedure applied to the multistep integrator whenever the primary body is changed; 2) new analytical formulae for setting the step-size (given the order of the multistep, formulation and initial osculating orbit) in order to control the accumulation of the local truncation error and guarantee the numerical stability during the propagation; 3) a new definition of the region of influence in the phase space. We test the propagator with some real asteroids subject to the gravitational attraction of the planets, the Yarkovsky and relativistic perturbations. Our goal is to show that the proposed approach improves the performance of both the propagator implemented in the OrbFit software package (which is currently used by the NEODyS service) and of the propagator represented by a variable step-size and order multistep method combined with Cowell's formulation (i.e. direct integration of position and velocity in either the physical or a fictitious time).

  20. 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

  1. 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

  2. Preoperative Scintigrams to Identify the Sentinel Lymph Node in Breast Cancer: a Waste of Time?

    PubMed

    Sharma, N; Pinto, A; Notghi, A; Sintler, M

    2015-12-01

    Sentinel lymph node biopsy (SLNB) remains the gold standard for assessing axillary node status in breast cancer. Preoperative scintigrams have been used to identify the sentinel lymph node (SLN); however, their use is controversial. Studies suggest they add little to successful SLN detection in theatre, immediately prior to node excision. They have been associated with high false negatives, time expense, patient dissatisfaction, and unnecessary costs. The aim of the present study was to evaluate the diagnostic accuracy of scintigrams in comparison to intraoperative SLN identification techniques. This study included all patients undergoing a SLNB for breast cancer from April 2010 to 2011. Scintigram reports, operation notes, and histology results were analyzed. Mann-Whitney U and chi-squared tests were used for statistical analysis of data. Two hundred nineteen female patients with a median age of 59.6 years (24.0-89.9 years) were included in this study. Scintigram was performed in 185 and not in 34 patients due to time constraints. Combined γ-probe and Isosulfan blue dye for SLN detection (intraoperative methods) have an identification rate of 98.2 % (p = 0.005), compared to 92.4 % (p = 0.088) from scintigrams alone. Scintigrams confer no additional advantage to the operating surgeon for successful SLN detection and excision in theatre. Intraoperative SLN identification is more accurate and reliable. Routine scintigram use is unjustified and should be withdrawn from current practice. PMID:27011606

  3. Sensitivity and specificity of stroboscopy in preoperative differentiation of dysplasia from early invasive glottic carcinoma.

    PubMed

    El-Demerdash, A; Fawaz, S A; Sabri, S M; Sweed, Ahmed; Rabie, H

    2015-05-01

    Leukoplakia is a descriptive clinical term designating a white patch or plaque of the mucosa and must be complemented by histology, which can range from simple totally benign keratosis with or without atypia up to invasive carcinoma. The aim of this study is to evaluate the accuracy of videostroboscopy in preoperative differentiation of early invasive glottic carcinoma from intraepithelial atypia and dysplasia. 46 patients with a total of 60 leukoplakia lesions on the vocal folds were included in the study. Videostroboscopy was used to divide them into two groups based on preservation of the mucosal wave and this was correlated with the final pathology after treatment. The sensitivity and specificity of videostroboscopy in predicting invasive nature of the lesions based on absence or reduction of the mucosal wave were 96.8 and 92.8 %, respectively, with an overall accuracy of 95 %. We suggest that routine application of videostroboscopy can be an important, simple, non-invasive tool, to achieve, in a single procedure, proper and accurate evaluation of glottic leukoplakia. PMID:25649284

  4. Analysis of Preoperative Detection for Apex Prostate Cancer by Transrectal Biopsy

    PubMed Central

    Sazuka, Tomokazu; Imamoto, Takashi; Namekawa, Takeshi; Utsumi, Takanobu; Yanagisawa, Mitsuru; Kawamura, Koji; Kamiya, Naoto; Suzuki, Hiroyoshi; Ueda, Takeshi; Ota, Satoshi; Nakatani, Yukio; Ichikawa, Tomohiko

    2013-01-01

    Background. The aim of this study was to determine concordance rates for prostatectomy specimens and transrectal needle biopsy samples in various areas of the prostate in order to assess diagnostic accuracy of the transrectal biopsy approach, especially for presurgical detection of cancer in the prostatic apex. Materials and Methods. From 2006 to 2011, 158 patients whose radical prostatectomy specimens had been evaluated were retrospectively enrolled in this study. Concordance rates for histopathology results of prostatectomy specimens and needle biopsy samples were evaluated in 8 prostatic sections (apex, middle, base, and transitional zones bilaterally) from 73 patients diagnosed at this institution, besides factors for detecting apex cancer in total 118 true positive and false negative apex cancers. Results. Prostate cancer was found most frequently (85%) in the apex of all patients. Of 584 histopathology sections, 153 (49%) from all areas were false negatives, as were 45% of apex biopsy samples. No readily available preoperative factors for detecting apex cancer were identified. Conclusions. In Japanese patients, the most frequent location of prostate cancer is in the apex. There is a high false negative rate for transrectal biopsy samples. To improve the detection rate, transperitoneal biopsy or more accurate imaging technology is needed. PMID:23533779

  5. Incorporating a Gaussian model at the catheter tip for improved registration of preoperative surface models

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Holmes, D. R., III; Packer, D. L.; Robb, R. A.

    2011-03-01

    Atrial fibrillation is a common cardiac arrhythmia in which aberrant electrical activity cause the atria to quiver which results in irregular beating of the heart. Catheter ablation therapy is becoming increasingly popular in treating atrial fibrillation, a procedure in which an electrophysiologist guides a catheter into the left atrium and creates radiofrequency lesions to stop the arrhythmia. Typical visualization tools include bi-plane fluoroscopy, 2-D ultrasound, and electroanatomic maps, however, recently there has been increased interest in incorporating preoperative surface models into the procedure. Typical strategies for registration include landmark-based and surface-based methods. Drawbacks of these approaches include difficulty in accurately locating corresponding landmark pairs and the time required to sample surface points with a catheter. In this paper, we describe a new approach which models the catheter tip as a Gaussian kernel and eliminates the need to collect surface points by instead using the stream of continuosly tracked catheter points. We demonstrate the feasibility of this technique with a left atrial phantom model and compare the results with a standard surface based approach.

  6. Saturation biopsy improves preoperative Gleason scoring of prostate cancer.

    PubMed

    Kahl, Philip; Wolf, Susanne; Adam, Alexander; Heukamp, Lukas Carl; Ellinger, Jörg; Vorreuther, Roland; Solleder, Gerold; Buettner, Reinhard

    2009-01-01

    We evaluated the differences between conventional needle biopsy (CB) and saturation biopsy (SB) techniques with regard to the prediction of Gleason score, tumor stage, and insignificant prostate cancer. Data from a total number of 240 patients were analyzed. The main group, consisting of 185 patients, was diagnosed according to a saturation prostate needle biopsy protocol (SB), by which more than 12 cores were taken per biopsy. The control group was diagnosed using CB, by which 12 or less than 12 cores were taken per biopsy (n=55). In the main group, the Gleason score of the biopsy was confirmed in 19.5%, in the control group in 23.5% according to the prostatectomy specimen (p=0.50). Upgrading after the operation was found in 56.7% in the main group and in 60% in the control group (p=0.24). Downgrading after the operation was found in 23.9% in the main group and in 16.3% in the control group (p=0.24). If the Gleason score of the postoperative specimens differed by only one point from the biopsy, we considered this a minor deviation. In the main group, 59% of the carcinomas were preoperatively classified correctly or revealed minor deviation in Gleason scores. In contrast, only 47% of the carcinomas in the control group were assessed correctly or with minor deviation in Gleason scores. Thus, the main group demonstrated a better rate of preoperative prediction in tumor grading assessed by Gleason score (p=0.05). In addition, the Gleason scores of both protocols were assigned to three groups (Gleason <7; Gleason 7; Gleason >7), and the group changes from the biopsy to the prostatectomy specimen were found to be significantly more frequent in the CB group (p=0.04). There was no significant difference between the two types of biopsy techniques regarding tumor stage or the detection of insignificant carcinomas. The advantage of the extensive prostate needle biopsy technique (SB) is a better preoperative prediction of the Gleason score as well as the risk groups with

  7. Clinical utility of BOLD fMRI in preoperative work-up of epilepsy

    PubMed Central

    Ganesan, Karthik; Ursekar, Meher

    2014-01-01

    Surgical techniques have emerged as a viable therapeutic option in patients with drug refractory epilepsy. Pre-surgical evaluation of epilepsy requires a comprehensive, multiparametric, and multimodal approach for precise localization of the epileptogenic focus. Various non-invasive techniques are available at the disposal of the treating physician to detect the epileptogenic focus, which include electroencephalography (EEG), video-EEG, magnetic resonance imaging (MRI), functional MRI including blood oxygen level dependent (BOLD) techniques, single photon emission tomography (SPECT), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Currently, non-invasive high-resolution MR imaging techniques play pivotal roles in the preoperative detection of the seizure focus, and represent the foundation for successful epilepsy surgery. BOLD functional magnetic resonance imaging (fMRI) maps allow for precise localization of the eloquent cortex in relation to the seizure focus. This review article focuses on the clinical utility of BOLD (fMRI) in the pre-surgical work-up of epilepsy patients. PMID:24851002

  8. Expression of the p73 protein in rectal cancers with or without preoperative radiotherapy

    SciTech Connect

    Pfeifer, Daniella; Gao Jingfang; Adell, Gunnar; Sun Xiaofeng . E-mail: xiasu@ibk.liu.se

    2006-07-15

    Purpose: To investigate p73 expression in normal mucosa, primary tumor, and metastasis in relation to radiotherapy (RT) response and clinicopathologic/biologic variables in rectal cancers. Methods and Materials: p73 was immunohistochemically examined on biopsies (unirradiated, n = 102), distant (from the large bowel, n = 82), and adjacent (adjacent to primary tumor, n = 89) normal mucosa samples, primary tumors (n = 131), and lymph node metastasis (n = 32) from rectal cancer patients participating in a clinical trial of preoperative RT. Seventy-four patients received surgery alone and 57 received additional RT. Results: Cytoplasmic p73 was increased in the primary tumor compared with the distant or adjacent mucosa (p {<=} 0.0001). Nuclear (p = 0.02) and cytoplasmic (p = 0.003) p73 was higher in irradiated distant mucosa samples than in unirradiated ones, and nuclear p73 tended to be increased in irradiated primary tumors compared with unirradiated ones (p = 0.06). p73 was positively related to cyclooxygenase-2 expression in irradiated tumors (p = 0.03). p73-negative tumors tended to have a lower local recurrence after RT compared with unirradiated cases (p 0.06). Conclusions: Normal epithelial cells seem more sensitive to RT than tumor cells regarding p73 expression. Patients with p73-negative rectal tumors may have a lower risk of local recurrence after RT.

  9. Automatic pose initialization for accurate 2D/3D registration applied to abdominal aortic aneurysm endovascular repair

    NASA Astrophysics Data System (ADS)

    Miao, Shun; Lucas, Joseph; Liao, Rui

    2012-02-01

    Minimally invasive abdominal aortic aneurysm (AAA) stenting can be greatly facilitated by overlaying the preoperative 3-D model of the abdominal aorta onto the intra-operative 2-D X-ray images. Accurate 2-D/3-D registration in 3-D space makes the 2-D/3-D overlay robust to the change of C-Arm angulations. By far, the 2-D/3-D registration methods based on simulated X-ray projection images using multiple image planes have been shown to be able to provide satisfactory 3-D registration accuracy. However, one drawback of the intensity-based 2-D/3-D registration methods is that the similarity measure is usually highly non-convex and hence the optimizer can easily be trapped into local minima. User interaction therefore is often needed in the initialization of the position of the 3-D model in order to get a successful 2-D/3-D registration. In this paper, a novel 3-D pose initialization technique is proposed, as an extension of our previously proposed bi-plane 2-D/3-D registration method for AAA intervention [4]. The proposed method detects vessel bifurcation points and spine centerline in both 2-D and 3-D images, and utilizes landmark information to bring the 3-D volume into a 15mm capture range. The proposed landmark detection method was validated on real dataset, and is shown to be able to provide a good initialization for 2-D/3-D registration in [4], thus making the workflow fully automatic.

  10. Fast and Accurate Data Extraction for Near Real-Time Registration of 3-D Ultrasound and Computed Tomography in Orthopedic Surgery.

    PubMed

    Brounstein, Anna; Hacihaliloglu, Ilker; Guy, Pierre; Hodgson, Antony; Abugharbieh, Rafeef

    2015-12-01

    Automatic, accurate and real-time registration is an important step in providing effective guidance and successful anatomic restoration in ultrasound (US)-based computer assisted orthopedic surgery. We propose a method in which local phase-based bone surfaces, extracted from intra-operative US data, are registered to pre-operatively segmented computed tomography data. Extracted bone surfaces are downsampled and reinforced with high curvature features. A novel hierarchical simplification algorithm is used to further optimize the point clouds. The final point clouds are represented as Gaussian mixture models and iteratively matched by minimizing the dissimilarity between them using an L2 metric. For 44 clinical data sets from 25 pelvic fracture patients and 49 phantom data sets, we report mean surface registration accuracies of 0.31 and 0.77 mm, respectively, with an average registration time of 1.41 s. Our results suggest the viability and potential of the chosen method for real-time intra-operative registration in orthopedic surgery. PMID:26365924

  11. CT staging and preoperative assessment of resectability for thymic epithelial tumors

    PubMed Central

    Shen, Yan; Gu, Zhitao; Ye, Jianding; Mao, Teng; Chen, Wenhu

    2016-01-01

    Background The aim of this study was to determine the computed tomography (CT) features potentially helpful for accurate staging and predicting resectability of thymic epithelial tumors (TET). Methods One hundred and thirty-eight consecutive TET patients undergoing surgical resection from April 2010 to November 2011 were prospectively entered into a database. All patients were staged according to the Masaoka-Koga staging system. The relationship between CT features with tumor staging and complete resection was reviewed after surgery. Results Surgico-pathological staging was stage I in 63, stage II in 32, stage III in 32, and stage IV in 11 patients. Preoperative CT staging was highly consistent with postoperative surgico-pathological staging (Kappa =0.525). Tumor shape, contour, enhancement, with or without invasion of the adjacent structures (mediastinal fat, mediastinal pleura, lung, pericardium, mediastinal vessels, phrenic nerve), and presence of pleural, pericardial effusionor intrapulmonary metastasis were correlated with Masaoka-Koga staging (P<0.05). However, tumor size, internal density or presence of calcification was not associated with staging (P>0.05). Tumor size, presence of calcification and mediastinal lymph node enlargement were not correlated with complete tumor resection (P>0.05). Tumor shape, contour, internal density, enhancement pattern, and invasion of adjacent structures were related to complete resection of the primary tumor in univariate analysis (P<0.05). However, upon multivariate logistic regression, only absence of artery systems invasion was predictive of complete resection (P<0.05). Conclusions Clinical staging of TET could be accurately evaluated with CT features including tumor shape, contour, enhancement pattern, with or without invasion of adjacent structures, and presence of pleural, pericardial effusion or intrapulmonary metastasis. Absence of arterial system invasion on CT was the only predictive feature for predicting

  12. A prospective study of the efficacy of magnetic resonance spectroscopy imaging for predicting locally advanced prostate cancer

    PubMed Central

    Razi, Ali; Parizi, Mehdi Kardoust; Kazemeini, Seid Mohammad; Abedi, Akbar

    2015-01-01

    Objective: To evaluate the efficacy of magnetic resonance spectroscopy imaging (MRSI) for predicting locally advanced prostate cancer (PC). Materials and methods: Between April 2009 and July 2012, 80 consecutive patients with clinically localized PC had undergone endorectal MRSI before radical retropubic prostatectomy. Clinicopathological parameters, including age, preoperative prostate-specific antigen (PSA), Gleason score (GS) at biopsy, perinural invasion at biopsy, prostate weight at surgery, GS of surgical specimen, and pathological staging were recorded. The MRSI findings were compared with the histopathological findings of the radical prostatectomy. The diagnostic accuracy measures consisting of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of MRSI, and other variables in the diagnosis of locally advanced PC (Pathology Stages pT3a, pT3b, or pT4) were evaluated. Results: Sensitivity, specificity, PPV, and NPV of MRSI in detecting locally advanced PC is 42.4%, 93.6%, 82.3%, and 69.8%, respectively [area under the receiver operating characteristic (ROC) curve=0.658, p value <0.0001]. MRSI, cancer-positive core percentage at biopsy, and GS at biopsy are more accurate factors among all the predictive variables in predicting locally advanced PC. Conclusion: MRSI may be considered as a complementary diagnostic modality with high specificity and moderate sensitivity in predicting locally advanced PC. Combination of this modality with other predictive factors helps the surgeon and patient to select an appropriate treatment strategy. PMID:26328204

  13. 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.

  14. Different preoperative approaches for acute lumber spinal fractures

    PubMed Central

    Tian, Lu-Feng; Yuan, Yan-Sheng; Li, En-Hui; Wang, Lei

    2015-01-01

    To compare the long and short term effectiveness of different preoperative approaches for lumber spinal fractures and finds a better surgical method for the disease. Follow up records of 144 patients received hyperbaric oxygen therapy or methylprednisolone infusion within 8 hours after the lubmer spinal injury were analyzed. Postoperative outcome immediately and 3, 6, 12, 36 months after the surgery were compared to evaluate the effectiveness two different approaches. The results indicated that there are no significant differences regarding age, sexual proportion, body mass index (BMI), visual analogue scale of pain (VAS) score as well as Frankel scores before the surgery, and significant differences VAS score as well as Frankel scores immediately after the surgery. In conclusion, hyperbaric oxygen therapy within 8 hours after the injury can be more effective than methylprednisolone infusion in patients with lumber spinal injury. PMID:26309686

  15. C-018H Pre-Operational Baseline Sampling Plan

    SciTech Connect

    Guzek, S.J.

    1993-08-20

    The objective of this task is to field characterize and sample the soil at selected locations along the proposed effluent line routes for Project C-018H. The overall purpose of this effort is to meet the proposed plan to discontinue the disposal of contaminated liquids into the Hanford soil column as described by DOE (1987). Detailed information describing proposed transport pipeline route and associated Kaiser Engineers Hanford Company (KEH) preliminary drawings (H288746...755) all inclusive, have been prepared by KEH (1992). The information developed from field monitoring and sampling will be utilized to characterize surface and subsurface soil along the proposed C-018H effluent pipeline and it`s associated facilities. Potentially existing contaminant levels may be encountered therefore, soil characterization will provide a construction preoperational baseline reference, develop personnel safety requirements, and determine the need for any changes in the proposed routes prior to construction of the pipeline.

  16. Klatskin tumor: Diagnosis, preoperative evaluation and surgical considerations.

    PubMed

    Molina, Víctor; Sampson, Jaime; Ferrer, Joana; Sanchez-Cabus, Santiago; Calatayud, David; Pavel, Mihai Calin; Fondevila, Constantino; Fuster, Jose; García-Valdecasas, Juan Carlos

    2015-11-01

    Hiliar cholangiocarcinoma is the most common type of cholangiocarcinoma, an represent around 10% of all hepatobiliary tumors. It is an aggressive malignancy, resectable in around 47% of the patients at diagnosis. Complete resection is the most effective and only potentially curative therapy, with a survival rate of less than 12 months in unresectable cases. Axial computerized tomography and magnetic resonance are the most useful image techniques to determine the surgical resectability. Clinically, jaundice and pruritus are the most common symptoms at diagnosis;preoperative biliary drainage is recommended using endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography. Surgery using extended liver resections with an en bloc resection of the liver with vascular reconstruction is the technique with the highest survival. Complete resection with histologically negative resection margins (R0), nodal involvement and metastases are the most important prognostic factors. PMID:26298684

  17. [Evaluation of a preoperative virtual tour for parents and children].

    PubMed

    Tourigny, Jocelyne; Chartrand, Julie

    2009-03-01

    A Canadian pediatric center has set a preoperative virtual tour on its website. This tour was evaluated by a descriptive study, in terms of utilization, efficacy and usefulness. The tour was utilized by 49.6% of the 123 families. Children of these families had a significant increase in knowledge from Time I (preop clinic) to Time 2 (day of surgery). Children and youth who did not use the tour reported themselves as more anxious the day of surgery but not significantly. There was no significant change in parents. The internet is a useful tool in families' preparation but cannot replace a direct interaction. Other researches are necessary in order to evaluate the impact of this type of preparation on the quality of care and on the child's recovery. PMID:19388414

  18. [Preoperative evaluation and perioperative prevention of infectious diseases].

    PubMed

    Moriyama, Kiyoshi

    2010-09-01

    Preoperative evaluation of infectious diseases in patients for elective and non-elective surgery is important for the anesthesiologists not only to rule out the patient's state of illness, but also to prevent transmission of infectious diseases in healthcare settings. To prevent transmission of infectious diseases in healthcare settings, Center for Disease Control published guidelines that consist of standard precaution and transmission-based precautions. In the face of exposure to known infectious diseases, certain post exposure prophylaxis has been established, especially against exposure to human immunodeficiency virus and hepatitis B virus. There are also growing interests in perioperative prevention of surgical site infection, since World Health Organization has published surgical safety checklist with the slogan "Safe surgery saves life". Anesthesiologists need to have knowledge on the prevention of surgical site infection especially on antibiotic prophylaxis, because it starts in the operating room. PMID:20857671

  19. Ultrasound in preoperative evaluation for dialysis-access placement.

    PubMed

    Wilson, Nicole A; Shenoy, Surendra

    2014-01-01

    US vessel mapping for vascular access creation has evolved as standard practice in the preoperative evaluation of an ESRD patient. The best yield from this technology is when it is used to compliment physical examination and viewed in realtime by the operating physician. It is important to evaluate both arterial and venous systems during vessel mapping. While minimum diameters have been associated with an increased chance of maturation of an AV access, the quality of the vessel wall also plays an important role in maturation. US has a distinct advantage of being a noninvasive modality that can evaluate both structural and functional aspects of vessels that play an important role in access maturation. PMID:25040792

  20. An Overview of Preoperative Glucose Evaluation, Management, and Perioperative Impact

    PubMed Central

    Sheehy, Ann M.; Gabbay, Robert A.

    2009-01-01

    Perioperative hyperglycemia is a common phenomenon affecting patients both with and without a known prior history of diabetes. Despite an exponential rise in publications and studies of inpatient hyperglycemia over the last decade, many questions still exist as to what defines optimal care of these patients. Initial enthusiasm for tight glycemic control has waned as the unanticipated reality of hypoglycemia and mortality has been realized in some prospective studies. The recent dramatic modification of national practice guidelines to endorse more modest inpatient glycemic targets highlights the dynamic nature of current knowledge as the next decade approaches. This review discusses perioperative hyperglycemia and the categories of patients affected by it. It reviews current recommendations for ambulatory diabetes screening and its importance in preoperative patient care. Finally, it concludes with a review of current practice guidelines, as well as a discussion of future direction and goals for inpatient perioperative glycemic control. PMID:20144379

  1. Pre-Operative Image-based Segmentation of the Cranial Nerves and Blood Vessels in Microvascular Decompression: Can we Prevent Unnecessary Explorations?

    PubMed Central

    Dolati, P; Golby, A; Eichberg, D; Abolfotoh, M; Dunn, IF; Mukundan, S; Hulou, MM; Al-Mefty, O

    2016-01-01

    Objectives This study was conducted to validate the accuracy of image-based pre-operative segmentation using the gold standard endoscopic and microscopic findings for localization and pre-operative diagnosis of the offensive vessel. Patients and Methods Fourteen TN and 6 HS cases were randomly selected. All patients had 3T MRI, which included thin-sectioned 3D space T2, 3D Time of Flight and MPRAGE Sequences. Imaging sequences were loaded in BrainLab iPlanNet and fused. Individual segmentation of the affected cranial nerves and the compressing vascular structure was performed by a neurosurgeon, and the results were compared with the microscopic and endoscopic findings by two blinded neurosurgeons. For each case, at least three neurovascular landmarks were targeted. Each segmented neurovascular element was validated by manual placement of the navigation probe over each target, and errors of localization were measured in mm. Results All patients underwent retro-sigmoid craniotomy and MVD using both microscope and endoscope. Based on image segmentation, the compressing vessel was identified in all cases except one, which was also negative intraoperatively. Perfect correspondence was found between image-based segmentation and endoscopic and microscopic images and videos (Dice coefficient of 1). Measurement accuracy was 0.45+/-0.21 mm (mean +/-SD). Conclusion Image-based segmentation is a promising method for pre-operative identification and localization of offending blood vessels causing HFS and TN. Using this method may prevent some unnecessary explorations on especially atypical cases with no vascular contacts. However, negative pre-operative image segmentation may not preclude one from exploration in classic cases of TN or HFS. A multicenter study with larger number of cases is recommended. PMID:26476700

  2. [Subjective verbal methods in preoperative measurement of anxiety].

    PubMed

    Höfling, S; Hutner, G; Ott, H; Fichte, K; Doenicke, A

    1988-06-01

    The role of preoperative anxiety in perioperative adaptation is viewed in two different ways. Janis suggested that anxiety is a drive that evokes the cognitive work of worrying. Leventhal stresses the importance of coping behavior for adaptation, while anxiety may or may not accompany this coping process. Both theories have empirical support. The aim of this study was to determine whether both theories could show empirical support because the scientists chose different methods: Janis used interviews, Leventhal and Lazarus anxiety scales. The study analyzed the pre- and postoperative emotional reactions of surgical patients with three different methods of anxiety measurement: an anxiety scale, a fear thermometer, and a psychoanalytic interview (Gottschalk-Gleser content analysis method). The different methods were compared and related to the adaptation behavior (Table 3). The data showed a clear interaction between the selected methods and respective theories about the effects of preoperative anxiety on intra- and postoperative adaptation. The anxiety scales showed no correlation with adaptation behavior (blood pressure and heart rate during surgery; postoperative pain medication) and were not related to the anxiety scores obtained from the interview (content analysis). On the other hand, the interview anxiety measurements showed a clear relationship between separation anxiety (and also shame anxiety), physiological excitement during surgery (increase in heart rate), and postoperative medication (increased analgesics and tranquilizers). The patients who worried about the risks of surgery (Verletzungsangst, see Fig. 3) had very good perioperative adjustment, so that the quality of anxiety measured in the interview was very important for the prediction of adaptation. PMID:3407901

  3. Effects of Preoperative Clarithromycin Administration in Patients with Nasal Polyposis

    PubMed Central

    Perić, A; Baletić, N; Milojević, M; Sotirović, J; Živić, L; Perić, AV; Vojvodić, D

    2014-01-01

    ABSTRACT Objective: In recent years, various investigators have shown considerable interest in the use of macrolide antibiotics for treatment of chronic rhinosinusitis and nasal polyposis. The aim of this study was to evaluate the clinical effects of preoperative long-term, low-dose clarithromycin administration in patients with nasal polyposis. Methods: Eighty nasal polyp patients (42 non-atopic and 38 atopic) were included in this prospective, non-placebo controlled investigation and randomized equally to either the combined clarithromycin-surgical or surgical group. Forty patients received 500 mg of clarithromycin daily for eight weeks, and, after evaluation, they were treated by functional endoscopic sinus surgery (FESS). The other 40 patients were treated only surgically. The nasal symptom scores and endoscopic scores after macrolide treatment/surgical treatment, and after six and 12 months of follow-up were evaluated. Results: After clarithromycin therapy, we found improvement in symptom scores in 25/40, and improvement in endoscopic scores in 19/40 patients. We found no significant difference in nasal symptom score between allergic and non-allergic patients regarding the outcome to macrolide (p = 0.352) or surgical treatment (p = 0.396). When we compared differences between endoscopic scores at the time points of 12 months and six months postoperatively (ESt12 minus ESt6), we found statistically lower differences in the clarithromycin-surgery group than in the surgery group (p = 0.006). Conclusion: Preoperative clarithromycin administration postponed nasal polyp relapse after FESS. Allergies have no influence on the clinical efficacy of clarithromycin therapy and on the efficacy of FESS. PMID:25867579

  4. Evaluation of Biologic Effective Dose and Schedule of Fractionation for Preoperative Radiotherapy for Rectal Cancer: Meta-Analyses and Meta-Regression;Rectal cancer; Preoperative radiotherapy; Biologic effective dose; Meta-analysis

    SciTech Connect

    Arruda Viani, Gustavo; Stefano, Eduardo Jose; Vendito Soares, Francisco; Afonso, Sergio Luis

    2011-07-15

    Purpose: To evaluate whether the risk of local recurrence depends on the biologic effective dose (BED) or fractionation dose in patients with resectable rectal cancer undergoing preoperative radiotherapy (RT) compared with surgery alone. Methods and Materials: A meta-analysis of randomized controlled trials (RCTs) was performed. The MEDLINE, Embase, CancerLit, and Cochrane Library databases were systematically searched for evidence. To evaluate the dose-response relationship, we conducted a meta-regression analysis. Four subgroups were created: Group 1, RCTs with a BED >30 Gy{sub 10} and a short RT schedule; Group 2, RCTs with BED >30 Gy{sub 10} and a long RT schedule; Group 3, RCTs with BED {<=}30 Gy{sub 10} and a short RT schedule; and Group 4, RCTs with BED {<=}30 Gy{sub 10} and a long RT schedule. Results: Our review identified 21 RCTs, yielding 9,097 patients. The pooled results from these 21 randomized trials of preoperative RT showed a significant reduction in mortality for groups 1 (p = .004) and 2 (p = .03). For local recurrence, the results were also significant in groups 1 (p = .00001) and 2 (p = .00001).The only subgroup that showed a greater sphincter preservation (SP) rate than surgery was group 2 (p = .03). The dose-response curve was linear (p = .006), and RT decreased the risk of local recurrence by about 1.7% for each Gy{sub 10} of BED. Conclusion: Our data have shown that RT with a BED of >30 Gy{sub 10} is more efficient in reducing local recurrence and mortality rates than a BED of {<=}30 Gy{sub 10}, independent of the schedule of fractionation used. A long RT schedule with a BED of >30 Gy{sub 10} should be recommended for sphincter preservation.

  5. Factors Associated with Preoperative Magnetic Resonance Imaging Use among Medicare Beneficiaries with Nonmetastatic Breast Cancer.

    PubMed

    Henderson, Louise M; Weiss, Julie; Hubbard, Rebecca A; O'Donoghue, Cristina; DeMartini, Wendy B; Buist, Diana S M; Kerlikowske, Karla; Goodrich, Martha; Virnig, Beth; Tosteson, Anna N A; Lehman, Constance D; Onega, Tracy

    2016-01-01

    Preoperative breast magnetic resonance imaging (MRI) use among Medicare beneficiaries with breast cancer has substantially increased from 2005 to 2009. We sought to identify factors associated with preoperative breast MRI use among women diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer (IBC). Using Surveillance, Epidemiology, and End Results and Medicare data from 2005 to 2009 we identified women ages 66 and older with DCIS or stage I-III IBC who underwent breast-conserving surgery or mastectomy. We compared preoperative breast MRI use by patient, tumor and hospital characteristics stratified by DCIS and IBC using multivariable logistic regression. From 2005 to 2009, preoperative breast MRI use increased from 5.9% to 22.4% of women diagnosed with DCIS and 7.0% to 24.3% of women diagnosed with IBC. Preoperative breast MRI use was more common among women who were younger, married, lived in higher median income zip codes and had no comorbidities. Among women with IBC, those with lobular disease, smaller tumors (<1 cm) and those with estrogen receptor negative tumors were more likely to receive preoperative breast MRI. Women with DCIS were more likely to receive preoperative MRI if tumors were larger (>2 cm). The likelihood of receiving preoperative breast MRI is similar for women diagnosed with DCIS and IBC. Use of MRI is more common in women with IBC for tumors that are lobular and smaller while for DCIS MRI is used for evaluation of larger lesions. PMID:26511204

  6. Use of Molecular Imaging to Predict Clinical Outcome in Patients With Rectal Cancer After Preoperative Chemotherapy and Radiation

    SciTech Connect

    Konski, Andre Li Tianyu; Sigurdson, Elin; Cohen, Steven J.; Small, William; Spies, Stewart; Yu, Jian Q.; Wahl, Andrew; Stryker, Steven; Meropol, Neal J.

    2009-05-01

    Purpose: To correlate changes in 2-deoxy-2-[18F]fluoro-D-glucose (18-FDG) positron emission tomography (PET) (18-FDG-PET) uptake with response and disease-free survival with combined modality neoadjuvant therapy in patients with locally advanced rectal cancer. Methods and Materials: Charts were reviewed for consecutive patients with ultrasound-staged T3x to T4Nx or TxN1 rectal adenocarcinoma who underwent preoperative chemoradiation therapy at Fox Chase Cancer Center (FCCC) or Robert H. Lurie Comprehensive Cancer Center of Northwestern University with 18-FDG-PET scanning before and after combined-modality neoadjuvant chemoradiation therapy . The maximum standardized uptake value (SUV) was measured from the tumor before and 3 to 4 weeks after completion of chemoradiation therapy preoperatively. Logistic regression was used to analyze the association of pretreatment SUV, posttreatment SUV, and % SUV decrease on pathologic complete response (pCR), and a Cox model was fitted to analyze disease-free survival. Results: A total of 53 patients (FCCC, n = 41, RLCCC, n = 12) underwent pre- and postchemoradiation PET scanning between September 2000 and June 2006. The pCR rate was 31%. Univariate analysis revealed that % SUV decrease showed a marginally trend in predicting pCR (p = 0.08). In the multivariable analysis, posttreatment SUV was shown a predictor of pCR (p = 0.07), but the test results did not reach statistical significance. None of the investigated variables were predictive of disease-free survival. Conclusions: A trend was observed for % SUV decrease and posttreatment SUV predicting pCR in patients with rectal cancer treated with preoperative chemoradiation therapy. Further prospective study with a larger sample size is warranted to better characterize the role of 18-FDG-PET for response prediction in patients with rectal cancer.

  7. Epigenetic Regulation of KLHL34 Predictive of Pathologic Response to Preoperative Chemoradiation Therapy in Rectal Cancer Patients

    SciTech Connect

    Ha, Ye J.; Kim, Chan W.; Roh, Seon A.; Cho, Dong H.; Park, Jong L.; Kim, Seon Y.; Kim, Jong H.; Choi, Eun K.; Kim, Yong S.; Kim, Jin C.

    2015-03-01

    Purpose: Prediction of individual responsiveness to preoperative chemoradiation therapy (CRT) is urgently needed in patients with poorly responsive locally advanced rectal cancer (LARC). Methods and Materials: Candidate methylation genes associated with radiosensitivity were identified using a 3-step process. In the first step, genome-wide screening of methylation genes was performed in correlation with histopathologic tumor regression grade in 45 patients with LARC. In the second step, the methylation status of selected sites was analyzed by pyrosequencing in 67 LARC patients, including 24 patients analyzed in the first step. Finally, colorectal cancer cell clones with stable KLHL34 knockdown were generated and tested for cellular sensitivity to radiation. Results: Genome-wide screening identified 7 hypermethylated CpG sites (DZIP1 cg24107021, DZIP1 cg26886381, ZEB1 cg04430381, DKK3 cg041006961, STL cg00991794, KLHL34 cg01828474, and ARHGAP6 cg07828380) associated with preoperative CRT responses. Radiosensitivity in patients with hypermethylated KLHL34 cg14232291 was confirmed by pyrosequencing in additional cohorts. Knockdown of KLHL34 significantly reduced colony formation (KLHL34 sh#1: 20.1%, P=.0001 and KLHL34 sh#2: 15.8%, P=.0002), increased the cytotoxicity (KLHL34 sh#1: 14.8%, P=.019 and KLHL34 sh#2: 17.9%, P=.007) in LoVo cells, and increased radiation-induced caspase-3 activity and the sub-G1 population of cells. Conclusions: The methylation status of KLHL34 cg14232291 may be a predictive candidate of sensitivity to preoperative CRT, although further validation is needed in large cohorts using various cell types.

  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. Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean

    PubMed Central

    Bradshaw, Prisca; Hariharan, Seetharaman; Chen, Deryk

    2016-01-01

    Objectives: Patients with high anxiety states in the preoperative period often have more intense postoperative pain, despite adequate pain control during the intraoperative period. This study aimed to determine the relationship between the preoperative psychological status and the pain experienced postoperatively in a sample of Caribbean patients. Design and methods: A prospective study was conducted in elective surgical adult patients at a teaching hospital in the Caribbean. Patients’ preoperative psychological status was assessed using Hospital Anxiety and Depression Scale (HADS), and a preoperative ‘expected’ pain score was recorded. Postoperatively, ‘observed’ pain scores at 4 and 24 hours and the maximum pain score during 24 hours were recorded. Demographic data and clinical details including data regarding postoperative analgesia were collected. Expected and observed pain scores were compared between patients with and without anxiety and depression. Results: A total of 304 patients were enrolled. The overall prevalence of anxiety and depression was 43% and 27%, respectively, based on the HADS scores. There were significant associations between the postoperative pain scores and factors such as preoperative anxiety and depression (HADS) scores, preoperative expected pain scores, patient educational level, presence of preoperative pain and surgical duration. Age, gender, ethnicity and type of anaesthesia did not impact postoperative pain scores. Conclusion: The presence of preoperative anxiety and depression as indicated by HADS score may significantly influence postoperative pain. Other factors such as educational level, presence of preoperative pain and surgical duration may also impact postoperative pain. Some of these factors may be modifiable and must be addressed in the preoperative period. PMID:27551421

  10. 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

  11. 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.

  12. Remote balance weighs accurately amid high radiation

    NASA Technical Reports Server (NTRS)

    Eggenberger, D. N.; Shuck, A. B.

    1969-01-01

    Commercial beam-type balance, modified and outfitted with electronic controls and digital readout, can be remotely controlled for use in high radiation environments. This allows accurate weighing of breeder-reactor fuel pieces when they are radioactively hot.

  13. Understanding the Code: keeping accurate records.

    PubMed

    Griffith, Richard

    2015-10-01

    In his continuing series looking at the legal and professional implications of the Nursing and Midwifery Council's revised Code of Conduct, Richard Griffith discusses the elements of accurate record keeping under Standard 10 of the Code. This article considers the importance of accurate record keeping for the safety of patients and protection of district nurses. The legal implications of records are explained along with how district nurses should write records to ensure these legal requirements are met. PMID:26418404

  14. Accurate and robust estimation of camera parameters using RANSAC

    NASA Astrophysics Data System (ADS)

    Zhou, Fuqiang; Cui, Yi; Wang, Yexin; Liu, Liu; Gao, He

    2013-03-01

    Camera calibration plays an important role in the field of machine vision applications. The popularly used calibration approach based on 2D planar target sometimes fails to give reliable and accurate results due to the inaccurate or incorrect localization of feature points. To solve this problem, an accurate and robust estimation method for camera parameters based on RANSAC algorithm is proposed to detect the unreliability and provide the corresponding solutions. Through this method, most of the outliers are removed and the calibration errors that are the main factors influencing measurement accuracy are reduced. Both simulative and real experiments have been carried out to evaluate the performance of the proposed method and the results show that the proposed method is robust under large noise condition and quite efficient to improve the calibration accuracy compared with the original state.

  15. Light Field Imaging Based Accurate Image Specular Highlight Removal

    PubMed Central

    Wang, Haoqian; Xu, Chenxue; Wang, Xingzheng; Zhang, Yongbing; Peng, Bo

    2016-01-01

    Specular reflection removal is indispensable to many computer vision tasks. However, most existing methods fail or degrade in complex real scenarios for their individual drawbacks. Benefiting from the light field imaging technology, this paper proposes a novel and accurate approach to remove specularity and improve image quality. We first capture images with specularity by the light field camera (Lytro ILLUM). After accurately estimating the image depth, a simple and concise threshold strategy is adopted to cluster the specular pixels into “unsaturated” and “saturated” category. Finally, a color variance analysis of multiple views and a local color refinement are individually conducted on the two categories to recover diffuse color information. Experimental evaluation by comparison with existed methods based on our light field dataset together with Stanford light field archive verifies the effectiveness of our proposed algorithm. PMID:27253083

  16. Scintigraphic localization of bone lesions during surgery.

    PubMed

    Harcke, H T; Conway, J J; Tachdjian, M O; Dias, L S; Noble, H B; MacEwen, G D; Weiss, S

    1985-01-01

    Nuclear medicine provides several methods for increasing the accuracy of surgical removal of bone lesions with focally increased uptake. In this paper, three intraoperative procedures are discussed: remote control by imaging, intraoperative control by imaging, and intraoperative control by scintillation probe. All techniques require preoperative injection of bone imaging tracer. Remote operative control calls for a gamma camera to mark the skin over the lesion prior to surgery, providing optimal preoperative localization and imaging of the excised lesion to ensure complete removal. Intraoperative control procedures require that a portable camera or a scintillation probe be used in the operating room; these permit direct monitoring of localization and resection. Our experience with 18 procedures performed on 15 patients suggests that these techniques are worthy of continued use. PMID:3158078

  17. High preoperative serum globulin in rectal cancer treated with neoadjunctive chemoradiation therapy is a risk factor for poor outcome

    PubMed Central

    Li, Qingguo; Meng, Xianke; Liang, Lei; Xu, Ye; Cai, Guoxiang; Cai, Sanjun

    2015-01-01

    An elevated serum albumin (ALB) and albumin/globulin ratio (AGR) has been reported to be associated with a favorable prognosis for certain malignancies; however, little is known about the prognostic significance of globulin (GLB) in rectal cancer treated with neoadjuvant chemoradiation therapy (NCRT). The purpose of this study was to evaluate whether GLB analysis could predict the prognosis of patients received NCRT. A retrospective cohort of 293 locally advanced rectal cancer patients receiving NCRT followed by radical surgery was recruited between January 2006 and December 2012 at Fudan University Shanghai Cancer Center. Levels for preoperative GLB and ALB were obtained and used to calculate the AGR. Survival analysis was used to evaluate the predictive value of GLB. X-tile program determined 28.50, 36.20 and 1.20 as optimal cut-off value for GLB, ALB and AGR in terms of survival. Univariate and multivariate analysis revealed that low GLB levels were significantly associated with favorable rectal cancer-specific survival (RCSS) (P < 0.05). Conversely, low ALB levels were associated with a significantly worse RCSS (P = 0.010). Collectively, high preoperative GLB level was a significantly unfavorable factor for rectal cancer patients treated with NCRT. This easily obtained variable may serve as a valuable marker to predict the outcomes of such patient population. PMID:26609491

  18. Gender-based analysis of esophageal cancer patients undergoing preoperative chemoradiation: differences in presentation and therapy outcome.

    PubMed

    Rohatgi, P R; Correa, A M; Swisher, S G; Wu, T T; Liao, Z; Komaki, R; Walsh, G L; Vaporciyan, A A; Lee, J H; Rice, D C; Roth, J A; Ajani, J A

    2006-01-01

    The purpose of this study was to identify gender-dependent differences in presentation at baseline and therapy outcome in esophageal carcinoma patients treated with preoperative chemoradiotherapy (CTRT). We stratified patients according to gender and statistically compared pretreatment clinical stage, post-CTRT effect on carcinoma in the resected specimen, overall survival (OS), and patterns of failure. Of the 235 patients who underwent preoperative CTRT, 203 were men and 32 were women. Carcinomas in women correlated significantly with clinical stage II classification (78%vs. 55%) while cancers in men correlated significantly with clinical stage III classification (39%vs. 16%; P = 0.02). Carcinomas in women also correlated significantly with lower clinical N classification; more women had cN0 (52%) compared to men (28%; P = 0.01). Similarly, in the surgical specimens, more women had pN0 (78%) compared to men (64%; P = 0.06). At a median follow-up of 37 months, 10% more women than men remain alive (63%vs. 53%; P = 0.3). Distant metastases-free survival time was longer for women than men. Our results suggest that localized esophageal carcinoma is diagnosed in more advanced stages in men than in women. The reasons for these differences remain unclear and further expansion of these observations and study of biologic differences that might exist are warranted. PMID:16722991

  19. Diffusion tensor imaging for anatomical localization of cranial nerves and cranial nerve nuclei in pontine lesions: initial experiences with 3T-MRI.

    PubMed

    Ulrich, Nils H; Ahmadli, Uzeyir; Woernle, Christoph M; Alzarhani, Yahea A; Bertalanffy, Helmut; Kollias, Spyros S

    2014-11-01

    With continuous refinement of neurosurgical techniques and higher resolution in neuroimaging, the management of pontine lesions is constantly improving. Among pontine structures with vital functions that are at risk of being damaged by surgical manipulation, cranial nerves (CN) and cranial nerve nuclei (CNN) such as CN V, VI, and VII are critical. Pre-operative localization of the intrapontine course of CN and CNN should be beneficial for surgical outcomes. Our objective was to accurately localize CN and CNN in patients with intra-axial lesions in the pons using diffusion tensor imaging (DTI) and estimate its input in surgical planning for avoiding unintended loss of their function during surgery. DTI of the pons obtained pre-operatively on a 3Tesla MR scanner was analyzed prospectively for the accurate localization of CN and CNN V, VI and VII in seven patients with intra-axial lesions in the pons. Anatomical sections in the pons were used to estimate abnormalities on color-coded fractional anisotropy maps. Imaging abnormalities were correlated with CN symptoms before and after surgery. The course of CN and the area of CNN were identified using DTI pre- and post-operatively. Clinical associations between post-operative improvements and the corresponding CN area of the pons were demonstrated. Our results suggest that pre- and post-operative DTI allows identification of key anatomical structures in the pons and enables estimation of their involvement by pathology. It may predict clinical outcome and help us to better understand the involvement of the intrinsic anatomy by pathological processes. PMID:24998855

  20. Prognostic Implication of Preoperative Behavior Changes in Patients with Primary High-Grade Meningiomas

    PubMed Central

    2014-01-01

    High-grade meningiomas are rare extra-axial tumors, frequently causing brain invasion and prominent brain edema. Patients harboring high-grade meningiomas occasionally present with behavior changes. Data about frequency and prognostic importance of preoperative behavior changes in patients with high-grade meningiomas is missing. 86 patients with primary high-grade meningiomas were analyzed. Statistical analysis was performed to determine correlation of preoperative behavior changes with tumor location, preoperative brain edema, tumor cleavability, tumor grade, Ki67 proliferation index, and microscopic brain invasion. Survival analysis was performed. 30 (34.9%) patients presented with preoperative behavior changes. These changes were more frequent with male patients (P = 0.066) and patients older than 55 years (P = 0.018). They correlated with frontal location (P = 0.013), tumor size (P = 0.023), microscopic brain invasion (P = 0.015), and brain edema (P = 0.006). Preoperative behavior changes did not correlate with duration of symptoms, tumor cleavability, tumor malignancy grade, and Ki67 proliferation index. They were not significantly related to overall survival or recurrence-free survival of patients with primary high-grade meningiomas. Preoperative behavior changes are frequent in patients harboring primary high-grade meningiomas. They correlate with tumor size, microscopic brain invasion, and brain edema. Preoperative behavior changes do not predict prognosis in patients with primary high-grade meningiomas. PMID:24578632

  1. 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

  2. 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.

  3. Does Preoperative Weight Change Predict Postoperative Weight Loss After Laparoscopic Sleeve Gastrectomy?

    PubMed Central

    Lane, Aaron E.; Mangieri, Christopher W.; Choi, Yong U.; Faler, Byron J.

    2015-01-01

    Background: Some institutions and insurance companies mandate a preoperative weight loss regimen prior to bariatric surgery. Previous studies suggest little to no correlation between preoperative and postoperative weight loss for laparoscopic Roux-en-Y gastric bypass (RNYGB). This study examined the impact of preoperative weight change for patients undergoing laparoscopic sleeve gastrectomy (LSG). Materials and Methods: A retrospective analysis was performed on patients undergoing LSG at the authors' institution from 2010 to 2012. Patients were grouped based on preoperative weight gain or loss. The correlation between preoperative BMI change and postoperative BMI change was studied, as well as length of surgery. Results: Of 141 patients with 1-year follow-up, 72 lost, six maintained, and 64 gained weight preoperatively. Percentage of excess BMI loss at 1 year was not statistically different between those who lost weight and those who gained weight. Percent change in BMI from initial visit to surgery does not correlate with change in BMI at 1 year postoperatively or with length of surgery. Conclusions: Preoperative weight loss is not a reliable predictor of postoperative weight loss or shorter operative time after LSG. Potential patients who otherwise meet indications for LSG should not be denied based on inability to lose weight. PMID:26421248

  4. Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables

    PubMed Central

    de Souza-Santos, Jadson A.; Martins-Filho, Paulo R.; da Silva, Luiz C.; de Oliveira e Silva, Emanuel D.; Gomes, Ana C.

    2013-01-01

    Objective: This paper investigates the relationship between preoperative findings and short-term outcome in third molar surgery. Study design: A prospective study was carried out involving 80 patients who required 160 surgical extractions of impacted mandibular third molars between January 2009 and December 2010. All extractions were performed under local anesthesia by the same dental surgeon. Swelling and maximal inter-incisor distance were measured at 48 h and on the 7th day postoperatively. Mean visual analogue pain scores were determined at four different time periods. Results: One-hundred eight (67.5%) of the 160 extractions were performed on male subjects and 52 (32.5%) were performed on female subjects. Median age was 22.46 years. The amount of facial swelling varied depending on gender and operating time. Trismus varied depending on gender, operating time and tooth sectioning. The influence of age, gender and operating time varied depending on the pain evaluation period (p < 0.05). Conclusions: Short-term outcomes of third molar operations (swelling, trismus and pain) differ depending on the patients’ characteristics (age, gender and body mass index). Moreover, surgery characteristics such as operating time and tooth sectioning were also associated with postoperative variables. Key words:Third molar extraction, pain, swelling, trismus, postoperative findings, prediction. PMID:23229245

  5. A Phase I Trial of Preoperative Partial Breast Radiotherapy: Patient Selection, Target Delineation, and Dose Delivery

    PubMed Central

    Blitzblau, Rachel C.; Arya, Ritu; Yoo, Sua; Baker, Jay A.; Chang, Zheng; Palta, Manisha; Duffy, Eileen; Horton, Janet K.

    2015-01-01

    Purpose Diffusion of accelerated partial breast irradiation (APBI) into clinical practice is limited by the need for specialized equipment and training. The accessible external beam technique yields unacceptable complication rates, likely due to large post-operative target volumes. We designed a phase I trial evaluating preoperative radiotherapy to the intact tumor utilizing widely available technology. Methods Patients received 15, 18, or 21Gy in a single fraction to the breast tumor plus margin. Magnetic resonance imaging (MRI) was used in conjunction with standard computed tomography (CT)-based planning to identify contrast enhancing tumor. Skin markers and an intra-tumor biopsy marker were utilized for verification during treatment. Results MRI imaging was critical for target delineation as not all breast tumors were reliably identified on CT scan. Breast shape differences were consistently seen between CT and MRI but did not impede image registration or tumor identification. Target volumes were markedly smaller than historical post-operative volumes and normal tissue constraints were easily met. A biopsy marker within the breast proved sufficient for set up localization. Conclusions This single fraction linear-accelerator based ABPI approach can be easily incorporated at most treatment centers. In vivo targeting may improve accuracy and can reduce the dose to normal tissues. PMID:25834942

  6. Preoperative corneal astigmatism among adult patients with cataract in Northern Nigeria

    PubMed Central

    Isyaku, Mohammed; Ali, Syed A; Hassan, Sadiq

    2014-01-01

    The prevalence and nature of corneal astigmatism among patients with cataract has not been well-documented in the resident African population. This retrospective study was undertaken to investigate preexisting corneal astigmatism in adult patients with cataract. We analyzed keratometric readings acquired by manual Javal-Schiotz keratometry before surgery between January 1, 2011 and December 31, 2011. There were 3,169 patients (3286 eyes) aged between 16 and 110 years involved with a Male to female ratio of 1.4:1. Mean keratometry in diopters was K1 = 43.99 and K2 = 43.80. Mean corneal astigmatism was 1.16 diopter and a majority (45.92%) of eyes had astigmatism between 1.00 and 1.99 diopters. Two-thirds of the eyes (66.9%) in this study had preoperative corneal astigmatism equal to or above 1.00 diopter. Findings will help local cataract surgeons to estimate the potential demand for toric intraocular lenses. PMID:25494254

  7. Transzygomatic approach for the resection of large condylar osteochondromas using computer-assisted preoperative planning.

    PubMed

    Ye, Z-X; Yang, C; Chen, M-J

    2016-09-01

    The purpose of this study was to evaluate the outcomes of patients with large osteochondromas (OCs) treated via transzygomatic approach for exposure and local resection. All patients with large OCs treated by transzygomatic approach from 2006 through 2014 were investigated. The inclusion criteria were (1) condylar OC of exogenous type; (2) a mass that could be treated only via transzygomatic approach, as assessed using computer-assisted preoperative planning. The preliminary results evaluated included recurrence, joint form and function, occurrence of facial deformity, facial nerve function, and the condition of the zygomatic arch fixation. Other parameters assessed included tumour size and location and the length of follow-up. Ten patients with OCs were included in this study. All masses were located anteromedial to the condyle; the average maximal diameter was 33.15mm. During follow-up (average 28.5 months), the average maximum inter-incisal opening increased from 25.4mm to 32.0mm. Nine patients recovered without recurrence, a change in occlusion, secondary deformity, or nerve dysfunction. One patient had severe disc perforation and condylar resorption. The transzygomatic approach is applicable for the resection of large condylar OCs protruding anteromedially into the infratemporal space. Surgical simulations may help to identify the indications for this approach and to design the surgery. PMID:27131594

  8. Postoperative Stereotactic Radiosurgery Without Whole-Brain Radiation Therapy for Brain Metastases: Potential Role of Preoperative Tumor Size

    SciTech Connect

    Hartford, Alan C.; Paravati, Anthony J.; Spire, William J.; Li, Zhongze; Jarvis, Lesley A.; Fadul, Camilo E.; Erkmen, Kadir; Friedman, Jonathan; Gladstone, David J.; Hug, Eugen B.; Roberts, David W.; Simmons, Nathan E.

    2013-03-01

    Purpose: Radiation therapy following resection of a brain metastasis increases the probability of disease control at the surgical site. We analyzed our experience with postoperative stereotactic radiosurgery (SRS) as an alternative to whole-brain radiotherapy (WBRT), with an emphasis on identifying factors that might predict intracranial disease control and overall survival (OS). Methods and Materials: We retrospectively reviewed all patients through December 2008, who, after surgical resection, underwent SRS to the tumor bed, deferring WBRT. Multiple factors were analyzed for time to intracranial recurrence (ICR), whether local recurrence (LR) at the surgical bed or “distant” recurrence (DR) in the brain, for time to WBRT, and for OS. Results: A total of 49 lesions in 47 patients were treated with postoperative SRS. With median follow-up of 9.3 months (range, 1.1-61.4 months), local control rates at the resection cavity were 85.5% at 1 year and 66.9% at 2 years. OS rates at 1 and 2 years were 52.5% and 31.7%, respectively. On univariate analysis (preoperative) tumors larger than 3.0 cm exhibited a significantly shorter time to LR. At a cutoff of 2.0 cm, larger tumors resulted in significantly shorter times not only for LR but also for DR, ICR, and salvage WBRT. While multivariate Cox regressions showed preoperative size to be significant for times to DR, ICR, and WBRT, in similar multivariate analysis for OS, only the graded prognostic assessment proved to be significant. However, the number of intracranial metastases at presentation was not significantly associated with OS nor with other outcome variables. Conclusions: Larger tumor size was associated with shorter time to recurrence and with shorter time to salvage WBRT; however, larger tumors were not associated with decrements in OS, suggesting successful salvage. SRS to the tumor bed without WBRT is an effective treatment for resected brain metastases, achieving local control particularly for tumors up to

  9. Preoperative radiotherapy for rectal cancer: a comparative study of quality control adherence at two cancer hospitals in Spain and Poland

    PubMed Central

    Fundowicz, Magdalena; Macia, Miguel; Marin, Susanna; Bogusz-Czerniewicz, Marta; Konstanty, Ewelina; Modolel, Ignaci; Malicki, Julian; Guedea, Ferran

    2014-01-01

    Background We performed a clinical audit of preoperative rectal cancer treatment at two European radiotherapy centres (Poland and Spain). The aim was to independently verify adherence to a selection of indicators of treatment quality and to identify any notable inter-institutional differences. Methods A total of 162 patients, in Catalan Institute of Oncology (ICO) 68 and in Greater Poland Cancer Centre (GPCC) 94, diagnosed with locally advanced rectal cancer and treated with preoperative radiotherapy or radio-chemotherapy were included in retrospective study. A total of 7 quality control measures were evaluated: waiting time, multidisciplinary treatment approach, portal verification, in vivo dosimetry, informed consent, guidelines for diagnostics and therapy, and patient monitoring during treatment. Results Several differences were observed. Waiting time from pathomorphological diagnosis to initial consultation was 31 (ICO) vs. 8 (GPCC) days. Waiting time from the first visit to the beginning of the treatment was twice as long at the ICO. At the ICO, 82% of patient experienced treatment interruptions. The protocol for portal verification was the same at both institutions. In vivo dosimetry is not used for this treatment localization at the ICO. The ICO utilizes locally-developed guidelines for diagnostics and therapy, while the GPCC is currently developing its own guidelines. Conclusions An independent external clinical audit is an excellent approach to identifying and resolving deficiencies in quality control procedures. We identified several procedures amenable to improvement. Both institutions have since implemented changes to improve quality standards. We believe that all radiotherapy centres should perform a comprehensive clinical audit to identify and rectify deficiencies. PMID:24991212

  10. 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

  11. 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

  12. 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

  13. Meniscal allograft transplantation: preoperative assessment, surgical considerations, and clinical outcomes.

    PubMed

    Mascarenhas, Randy; Yanke, Adam B; Frank, Rachel M; Butty, Davietta C; Cole, Brian J

    2014-12-01

    The purpose of this review is to characterize the preoperative assessment of meniscal allograft transplantation (MAT) candidates, to detail MAT surgical techniques, and to evaluate current clinical outcome data on MAT. The MAT candidate is typically less than 50 years old and has a history of knee injury, previous meniscus surgery, and persistent pain. Physical exam generally reveals knee pain with joint line tenderness with normal radiographs and magnetic resonance imaging demonstrating the postmeniscectomized state. There are several common surgical techniques used for transplantation, with fixation achieved through sutures, bony fixation, or a combination of the two. Concomitant procedures such as anterior cruciate ligament reconstruction, osteotomy, and other cartilage procedures are commonly performed. The available short- and long-term studies of clinical outcomes of MAT are variable and difficult to effectively compare due to heterogeneity of the study population and available treatment techniques. In addition, there are no published randomized controlled trials. However, recent reviews and cohort studies of clinical outcomes following MAT have shown that whether performed in isolation or performed with concomitant articular cartilage, realignment, or soft tissue reconstruction procedures MAT outcomes have been acceptable with the majority of studies reporting improved clinical outcomes regardless of the scoring system employed. MAT has proven to be a safe and effective technique in reducing knee pain and improving function in the symptomatic meniscal deficient knee. Evaluation of long-term clinical outcomes is necessary as is evaluation of meniscal replacement alternatives. PMID:24951950

  14. 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

  15. MRI for the preoperative evaluation of femoroacetabular impingement.

    PubMed

    Li, Angela E; Jawetz, Shari T; Greditzer, Harry G; Burge, Alissa J; Nawabi, Danyal H; Potter, Hollis G

    2016-04-01

    Femoroacetabular impingement (FAI) refers to a condition characterized by impingement of the femoral head-neck junction against the acetabular rim, often due to underlying osseous and/or soft tissue morphological abnormalities. It is a common cause of hip pain and limited range of motion in young and middle-aged adults. Hip preservation surgery aims to correct the morphological variants seen in FAI, thereby relieving pain and improving function, and potentially preventing early osteoarthritis. The purpose of this article is to review the mechanisms of chondral and labral injury in FAI to facilitate an understanding of patterns of chondrolabral injury seen on MRI. Preoperative MRI evaluation of FAI should include assessment of osseous morphologic abnormalities, labral tears, cartilage status, and other associated compensatory injuries of the pelvis. As advanced chondral wear is the major relative contraindication for hip preservation surgery, MRI is useful in the selection of patients likely to benefit from surgery. Teaching points • The most common anatomical osseous abnormalities predisposing to FAI include cam and pincer lesions. • Morphological abnormalities, labral lesions, and cartilage status should be assessed. • In cam impingement, chondral wear most commonly occurs anterosuperiorly.• Pre-existing advanced osteoarthritis is the strongest predictor of poor outcomes after FAI surgery. • Injury to muscles and tendons or other pelvic structures can coexist with FAI. PMID:26715128

  16. 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

  17. 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

  18. Preoperative portal vein embolization for hepatocellular carcinoma: Consensus and controversy

    PubMed Central

    Aoki, Taku; Kubota, Keiichi

    2016-01-01

    Thirty years have passed since the first report of portal vein embolization (PVE), and this procedure is widely adopted as a preoperative treatment procedure for patients with a small future liver remnant (FLR). PVE has been shown to be useful in patients with hepatocellular carcinoma (HCC) and chronic liver disease. However, special caution is needed when PVE is applied prior to subsequent major hepatic resection in cases with cirrhotic livers, and volumetric analysis of the liver segments in addition to evaluation of the liver functional reserve before PVE is mandatory in such cases. Advances in the embolic material and selection of the treatment approach, and combined use of PVE and transcatheter arterial embolization/chemoembolization have yielded improved outcomes after PVE and major hepatic resections. A novel procedure termed the associating liver partition and portal vein ligation for staged hepatectomy has been gaining attention because of the rapid hypertrophy of the FLR observed in patients undergoing this procedure, however, application of this technique in HCC patients requires special caution, as it has been shown to be associated with a high morbidity and mortality even in cases with essentially healthy livers. PMID:27028706

  19. Inverted Meckel's diverticulum preoperatively diagnosed using double-balloon enteroscopy.

    PubMed

    Takagaki, Kosuke; Osawa, Satoshi; Ito, Tatsuhiro; Iwaizumi, Moriya; Hamaya, Yasushi; Tsukui, Hiroe; Furuta, Takahisa; Wada, Hidetoshi; Baba, Satoshi; Sugimoto, Ken

    2016-05-01

    An inverted Meckel's diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel's diverticulum, who was preoperatively diagnosed using double-balloon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel's diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel's diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition. PMID:27158212

  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. Pre-operative drilling simulation method for dental implant treatment.

    PubMed

    Arataki, Tomohiko; Furuya, Yoshitaka; Ito, Taichi; Miyashita, Yuko; Shimamura, Ichiro; Yajima, Yasutomo

    2007-02-01

    The position, depth and direction of implant placement are often planned based on evaluation of radiographs and study casts. Insertion planned in such a manner may not be adequate for precise and safe surgery in some cases due to inadequate working clearance in the oral cavity. In order to obtain high initial stability and ensure osseointegration at the implant-bone interface, careful and precise drilling must be performed at the implant placement site. Therefore, we propose the necessity of evaluating the operability of implant treatment-devices prior to surgery. The amount of handling space needed during implant placement surgery was determined. The results showed that for implants with a length of 7-18 mm, a vertical distance of as much as 50-60 mm was required, depending on the implant platform. These results suggest the necessity of pre-operative drilling simulation in each individual. Handling space was measured with angled heads and probes fabricated on a trial basis for pre-surgical drilling simulation in the oral cavity. We believe that these instruments may be clinically useful in estimating the amount of handling space required prior to surgery and ensuring precise implant placement. Evaluation of the intra-oral environment for handling of treatment devices should be included in the pre-surgical intra-oral evaluation of dental implant cases to avoid changes in treatment planning due to intra-oral interference during the course of surgery. PMID:17721064

  2. On the importance of having accurate data for astrophysical modelling

    NASA Astrophysics Data System (ADS)

    Lique, Francois

    2016-06-01

    The Herschel telescope and the ALMA and NOEMA interferometers have opened new windows of observation for wavelengths ranging from far infrared to sub-millimeter with spatial and spectral resolutions previously unmatched. To make the most of these observations, an accurate knowledge of the physical and chemical processes occurring in the interstellar and circumstellar media is essential.In this presentation, I will discuss what are the current needs of astrophysics in terms of molecular data and I will show that accurate molecular data are crucial for the proper determination of the physical conditions in molecular clouds.First, I will focus on collisional excitation studies that are needed for molecular lines modelling beyond the Local Thermodynamic Equilibrium (LTE) approach. In particular, I will show how new collisional data for the HCN and HNC isomers, two tracers of star forming conditions, have allowed solving the problem of their respective abundance in cold molecular clouds. I will also present the last collisional data that have been computed in order to analyse new highly resolved observations provided by the ALMA interferometer.Then, I will present the calculation of accurate rate constants for the F+H2 → HF+H and Cl+H2 ↔ HCl+H reactions, which have allowed a more accurate determination of the physical conditions in diffuse molecular clouds. I will also present the recent work on the ortho-para-H2 conversion due to hydrogen exchange that allow more accurate determination of the ortho-to-para-H2 ratio in the universe and that imply a significant revision of the cooling mechanism in astrophysical media.

  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. PMID:5087876

  4. The Activated Coagulation Time of Whole Blood as a Routine Pre-Operative Screening Test

    PubMed Central

    Hattersley, Paul G.

    1971-01-01

    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. PMID:5087876

  5. A highly accurate interatomic potential for argon

    NASA Astrophysics Data System (ADS)

    Aziz, Ronald A.

    1993-09-01

    A modified potential based on the individually damped model of Douketis, Scoles, Marchetti, Zen, and Thakkar [J. Chem. Phys. 76, 3057 (1982)] is presented which fits, within experimental error, the accurate ultraviolet (UV) vibration-rotation spectrum of argon determined by UV laser absorption spectroscopy by Herman, LaRocque, and Stoicheff [J. Chem. Phys. 89, 4535 (1988)]. Other literature potentials fail to do so. The potential also is shown to predict a large number of other properties and is probably the most accurate characterization of the argon interaction constructed to date.

  6. Positive margins prediction in breast cancer conservative surgery: Assessment of a preoperative web-based nomogram.

    PubMed

    Alves-Ribeiro, Lídia; Osório, Fernando; Amendoeira, Isabel; Fougo, José Luís

    2016-08-01

    Margin status of the surgical specimen has been shown to be a prognostic and risk factor for local recurrence in breast cancer surgery. It has been studied as a topic of intervention to diminish reoperation rates and reduce the probability of local recurrence in breast conservative surgery (BCS). This study aims to validate the Dutch BreastConservation! nomogram, created by Pleijhus et al., which predicts preoperative probability of positive margins in BCS. Patients with diagnosis of breast cancer stages cT1-2, who underwent BCS at the Breast Center of São João University Hospital (BC-CHSJ) in 2013-2014, were included. Association and correlation were evaluated for clinical, radiological, pathological and surgical variables. Multivariable logistic regression and ROC curves were used to assess nomogram parameters and discrimination. In our series of 253 patients, no associations were found between margin status and other studied variables (such as age or family history of breast cancer), except for weight (p-value = 0.045) and volume (p-value = 0.012) of the surgical specimen. Regarding the nomogram, a statistically significant association was shown between cN1 status and positive margins (p-value = 0.014). No differences were registered between the scores of patients with positive versus negative margins. Discrimination analysis showed an AUC of 0.474 for the basic and 0.508 for the expanded models. We cannot assume its external validation or its applicability to our cohort. Further studies are needed to determine the validity of this nomogram and achieve a broader view of currently available tools. PMID:27326978

  7. Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas

    SciTech Connect

    Bossi, Alberto . E-mail: alberto.bossi@uz.kuleuven.ac.be; De Wever, Ivo; Van Limbergen, Erik; Vanstraelen, Bianca

    2007-01-01

    Purpose: Preoperative external-beam radiation therapy (preop RT) in the management of Retroperitoneal Liposarcomas (RPLS) typically involves the delivery of radiation to the entire tumor mass: yet this may not be necessary. The purpose of this study is to evaluate a new strategy of preop RT for RPLS in which the target volume is limited to the contact area between the tumoral mass and the posterior abdominal wall. Methods and Materials: Between June 2000 and Jan 2005, 18 patients with the diagnosis of RPLS have been treated following a pilot protocol of pre-op RT, 50 Gy in 25 fractions of 2 Gy/day. The Clinical Target Volume (CTV) has been limited to the posterior abdominal wall, region at higher risk for local relapse. A Three-Dimensional conformal (3D-CRT) and an Intensity Modulated (IMRT) plan were generated and compared; toxicity was reported following the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events v3.0. Results: All patients completed the planned treatment and the acute toxicity was tolerable: 2 patients experienced Grade 3 and 1 Grade 2 anorexia while 2 patients developed Grade 2 nausea. IMRT allows a better sparing of the ipsilateral and the contralateral kidney. All tumors were successfully resected without major complications. At a median follow-up of 27 months 2 patients developed a local relapse and 1 lung metastasis. Conclusions: Our strategy of preop RT is feasible and well tolerated: the rate of resectability is not compromised by limiting the preop CTV to the posterior abdominal wall and a better critical-structures sparing is obtained with IMRT.

  8. Accurate Anisotropic Fast Marching for Diffusion-Based Geodesic Tractography

    PubMed Central

    Jbabdi, S.; Bellec, P.; Toro, R.; Daunizeau, J.; Pélégrini-Issac, M.; Benali, H.

    2008-01-01

    Using geodesics for inferring white matter fibre tracts from diffusion-weighted MR data is an attractive method for at least two reasons: (i) the method optimises a global criterion, and hence is less sensitive to local perturbations such as noise or partial volume effects, and (ii) the method is fast, allowing to infer on a large number of connexions in a reasonable computational time. Here, we propose an improved fast marching algorithm to infer on geodesic paths. Specifically, this procedure is designed to achieve accurate front propagation in an anisotropic elliptic medium, such as DTI data. We evaluate the numerical performance of this approach on simulated datasets, as well as its robustness to local perturbation induced by fiber crossing. On real data, we demonstrate the feasibility of extracting geodesics to connect an extended set of brain regions. PMID:18299703

  9. Sestamibi (99mTc) scan as a single localization modality in primary hyperparathyroidism and factors impacting its accuracy

    PubMed Central

    Alabdulkarim, Yousof; Nassif, Edgard

    2010-01-01

    Background The proper localization of a hypersecreting parathyroid gland is of vital importance for successful unilateral neck exploration (UNE) and parathyroidectomy. Aim: In this study we aim to evaluate the (99mTc) sestamibi parathyroid scan as a single localizing modality, and we also assess its relation to the weight of the gland and to the preoperative parathyroid hormone (PTH) levels. Patients and Methods: We reviewed 170 patients from our hospital (Notre-Dame hospital) from 2005 to 2008, with a mean age of 56.6 years and a female to male ratio of 3.3:1. With primary hyperparathyroidism, all of them had (99mTc) sestamibi parathyroid scan for the localization of the parathyroid adenoma. Preoperative and postoperative PTH levels were recorded. The histopathology reports confirmed the diagnosis and weight of the diseased gland, which were recorded every time. The results were analyzed and correlated with the sestamibi results, to evaluate its accuracy. Results: Seventy-eight patients (41%) of the 170 had an exact match (EM) sestamibi results, 81 (51.6%) had a partial match, and only 11 patients were reported as mismatch. Analyzing the mean weight of the gland in each group between matching (EM, PM) versus mismatch resulted in a mean difference of 0.823 g (1.05 and 0.247 g, respectively) P = 0.045. Hyperplasia to adenoma ratio was more in the partial matching group (18.5%) versus the exact matching group (7.6%). Finally the mean PTH level was higher in the EM group (28.8 pmol/L) compared to the mismatch group (10.1 pmol/L) P = 0.02. Overall sensitivity and specificity for the (99 mTc) sestamibi in our data was 98.1 and 97%, respectively. Conclusion: (99mTc) sestamibi is a highly accurate test that can be employed as a single localizing modality for identifying a hypersecreting parathyroid, a UNE, or a parathyroidectomy. The weight of the gland plays an important role in the accuracy of the test, as also the preoperative PTH levels. PMID:20844661

  10. Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery.

    PubMed

    Zhao, Ze-Rui; Lau, Rainbow W H; Ng, Calvin S H

    2016-03-01

    Management of pulmonary nodules in terms of diagnosis and intraoperative localization can be challenging, especially in the minimal invasive video-assisted thoracoscopic surgery (VATS) approach, and may be even more difficult with single port VATS with limited access. The ability to localize small lesions intraoperatively is particularly important for excisional biopsy for diagnostic frozen section, as well as to guide sublobar resection. Some of the common techniques to aid localization include preoperative percutaneous hookwire localization, colour dye or radio-dye labelling injection of the nodule or adjacent site to allowing visualization or detection by radioactive counter intraoperatively. The use of hybrid operating room (OR) for intraoperative localization of lung nodules was first reported in 2013, and was called image guided VATS (iVATS). Subsequently, we have expanded the iVATS application for single port VATS major lung resection of small or ground-glass opacity lesions. By performing an on-table cone-beam CT scan, real-time and accurate assessment of the pulmonary lesion can be made, which can aid the localization process. Other types of physical or colour marker that can be deployed percutaneously in the hybrid OR immediate before surgery can enhance haptic feedback and sensitivity of digital palpation, as well as provide a radiopaque nidus for radiological confirmation. In the past decade, the electromagnetic navigation bronchoscopy (ENB) technology had developed into a useful adjunct technology for the localization of peripheral lung nodules by injection of marking agent or deployment of fiducial to the lesion through the endobronchial route causing much lower marking agent diffusion and artefacts. Recently, the combination of hybrid OR and ENB for lung nodule localization and marking has further increased the accuracy and applicability of the technology. The article will be exploring the latest development of the above approaches to lung nodule

  11. Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery

    PubMed Central

    Zhao, Ze-Rui; Lau, Rainbow W. H.

    2016-01-01

    Management of pulmonary nodules in terms of diagnosis and intraoperative localization can be challenging, especially in the minimal invasive video-assisted thoracoscopic surgery (VATS) approach, and may be even more difficult with single port VATS with limited access. The ability to localize small lesions intraoperatively is particularly important for excisional biopsy for diagnostic frozen section, as well as to guide sublobar resection. Some of the common techniques to aid localization include preoperative percutaneous hookwire localization, colour dye or radio-dye labelling injection of the nodule or adjacent site to allowing visualization or detection by radioactive counter intraoperatively. The use of hybrid operating room (OR) for intraoperative localization of lung nodules was first reported in 2013, and was called image guided VATS (iVATS). Subsequently, we have expanded the iVATS application for single port VATS major lung resection of small or ground-glass opacity lesions. By performing an on-table cone-beam CT scan, real-time and accurate assessment of the pulmonary lesion can be made, which can aid the localization process. Other types of physical or colour marker that can be deployed percutaneously in the hybrid OR immediate before surgery can enhance haptic feedback and sensitivity of digital palpation, as well as provide a radiopaque nidus for radiological confirmation. In the past decade, the electromagnetic navigation bronchoscopy (ENB) technology had developed into a useful adjunct technology for the localization of peripheral lung nodules by injection of marking agent or deployment of fiducial to the lesion through the endobronchial route causing much lower marking agent diffusion and artefacts. Recently, the combination of hybrid OR and ENB for lung nodule localization and marking has further increased the accuracy and applicability of the technology. The article will be exploring the latest development of the above approaches to lung nodule

  12. Accurate pointing of tungsten welding electrodes

    NASA Technical Reports Server (NTRS)

    Ziegelmeier, P.

    1971-01-01

    Thoriated-tungsten is pointed accurately and quickly by using sodium nitrite. Point produced is smooth and no effort is necessary to hold the tungsten rod concentric. The chemically produced point can be used several times longer than ground points. This method reduces time and cost of preparing tungsten electrodes.

  13. Complication avoidance with pre-operative screening: insights from the Seattle spine team.

    PubMed

    Buchlak, Quinlan D; Yanamadala, Vijay; Leveque, Jean-Christophe; Sethi, Rajiv

    2016-09-01

    Complication rates for complex adult lumbar scoliosis surgery are unacceptably high. Standardized preoperative evaluation protocols have been shown to significantly reduce the likelihood of a spectrum of negative outcomes associated with complex adult lumbar scoliosis surgery. To increase patient safety and reduce complication risk, an entire medical and surgical team should work together to care for adult lumbar scoliosis patients. This article describes preoperative patient evaluation strategies with a particular focus on adult lumbar scoliosis surgery involving six or more levels of spinal fusion. Domains considered include recent preoperative evaluation literature, predictive risk modeling, the appropriate management of medical conditions, and the composition and activities of a multidisciplinary conference review team. An evidence-based comprehensive systematic preoperative surgical evaluation process is described. PMID:27260267

  14. Utility of Discography as a Preoperative Diagnostic Tool for Intradural Lumbar Disc Herniation

    PubMed Central

    Toyoda, Hiromitsu; Terai, Hidetomi; Dohzono, Sho; Hori, Yusuke; Nakamura, Hiroaki

    2016-01-01

    Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH. PMID:27559461

  15. Preoperational Environmental Survey for the Spent Nuclear Fuel (SNF) Project Facilities

    SciTech Connect

    MITCHELL, R.M.

    2000-09-28

    This document represents the report for environmental sampling of soil, vegetation, litter, cryptograms, and small mammals at the Spent Nuclear Fuel Project facilities located in 100 K and 200 East Areas in support of the preoperational environmental survey.

  16. Preoperational Environmental Survey for the Spent Nuclear Fuel (SNF) Project Facilities

    SciTech Connect

    MITCHELL, R.M.

    2000-10-12

    This document represents the report for environmental sampling of soil, vegetation, litter, cryptograms, and small mammals at the Spent Nuclear Fuel Project facilities located in 100 K and 200 East Areas in support of the preoperational environmental survey.

  17. Prevention and intervention strategies to alleviate preoperative anxiety in children: a critical review.

    PubMed

    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 associated with the display of a number of maladaptive behaviors postsurgery, including postoperative pain, sleeping disturbances, parent-child conflict, and separation anxiety. For these reasons, researchers have sought out interventions to treat or prevent childhood preoperative anxiety and possibly decrease the development of negative behaviors postsurgery. Such interventions include sedative premedication, parental presence during anesthetic induction, behavioral preparation programs, music therapy, and acupuncture. The present article reviews the existing research on the various modes of intervention for preoperative anxiety in children. Clinical implications and future directions are discussed. PMID:17179531

  18. Utility of Discography as a Preoperative Diagnostic Tool for Intradural Lumbar Disc Herniation.

    PubMed

    Matsumoto, Tomiya; Toyoda, Hiromitsu; Terai, Hidetomi; Dohzono, Sho; Hori, Yusuke; Nakamura, Hiroaki

    2016-08-01

    Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH. PMID:27559461

  19. Use of pre-operative steroids in liver resection: a systematic review and meta-analysis

    PubMed Central

    Richardson, Arthur J; Laurence, Jerome M; Lam, Vincent WT

    2014-01-01

    Background By attenuating the systemic inflammatory response to major surgery, the pre-operative administration of steroids may reduce the incidence of complications. Methods A systematic review was conducted to identify randomized controlled trials (RCT) comparing pre-operative steroid administration with placebo during a liver resection. Meta-analyses were performed. Results Five RCTs were identified including a total of 379 patients. Pre-operative steroids were associated with statistically significant reductions in the levels of serum bilirubin and interleukin 6 (IL-6) on post-operative day one. There was a trend towards a lower incidence of post-operative complications and prothrombin time (PT), but this did not reach statistical significance. Conclusion Pre-operative steroids may be associated with a clinically significant benefit in liver resection. PMID:23461716

  20. Preoperative Identification of a Perforator Using Computed Tomography Angiography and Metal Clip Marking in Perforator Flap Reconstruction

    PubMed Central

    Lee, Jung Woo; Kim, Han Kyeol; Kim, Sin Rak; Han, Yea Sik

    2015-01-01

    In perforator flap reconstruction, vascular mapping using preoperative computed tomography (CT) angiography is widely used to confirm the existence and location of an appropriate perforator. This study proposes a rapid, accurate, and convenient method for marking the perforator location on the skin surface. For 12 patients who underwent perforator flap reconstruction between November 2011 and November 2013, metal clips were fixed on the skin surface at the anticipated perforator locations, which were decided using a handheld Doppler. CT angiography was used to compare the location between the metal clip and the actual perforator. The metal clip was moved and repositioned, if needed, on the basis of the CT images. The locations of the appropriate perforator and the metal clip, which were observed during the surgery, were then compared. In CT angiography, the mean distance between the metal clip and the perforator was 3±3.9 mm, and the mean distance that was measured during surgery was 0.8±0.8 mm. In conclusion, we report a simple, rapid, and precise technique to indicate the accurate location of the appropriate perforator on the skin surface. PMID:25606494

  1. A survey of pre-operative fasting regimens before regional ophthalmic anaesthesia in three regions of the United Kingdom.

    PubMed

    Morris, E A; Mather, S J

    1999-12-01

    A postal and telephone survey of the practice of fasting before regional ophthalmic anaesthesia with and without sedation was sent to 50 hospitals in three regions of the United Kingdom. Responses were received from 100% of hospitals. In most hospitals (58%), local anaesthetic blocks were performed by both surgeons and anaesthetists, with surgeons alone providing ophthalmic anaesthesia in only 14%. Eighty-six per cent of hospitals surveyed had a formal policy regarding pre-operative fasting, with 44% allowing patients to eat and drink freely until their operation. In those hospitals where a fast was imposed, the most common fasting periods were 6 h for food and 2 h for fluids. Twenty-six per cent of respondents would be prepared to give intravenous sedation to a non-fasted patient during eye surgery: small doses of benzodiazepine were the most frequently suggested method. National evidence-based guidelines for ophthalmic regional anaesthesia are needed. PMID:10594423

  2. Pre-operative diclofenac HPβCD for pain control of needle biopsy in musculoskeletal neoplasm: preliminary results

    PubMed Central

    D’Arienzo, Antonio; Beltrami, Giovanni; Mancini, Daniele; Scoccianti, Guido; Cuomo, Pierluigi; Muratori, Francesco; Matera, Davide; Ippolito, Massimiliano; Mondanelli, Nicola; Frenos, Filippo; Totti, Francesca; Capanna, Rodolfo

    2015-01-01

    Summary Needle biopsy is the main standard method used for diagnosis of musculoskeletal tumors of the limbs and superficial trunk. Pain control during this procedure is through the use of Local Anaestetic (L.A.). In order to achieve a complete pain control in our cases, recently we started using diclofenac HPβCD 50 mg via s.c. preoperativly. We present the clinical results of a non-randomized study of two eterogeneous groups of patients: “Experimental” Group (1): diclofenac HPβCD 50 mg via s.c. one hour before surgical procedure, local anesthesia and ev. diclofenac HPβCD 50 mg via s.c. 12 hours postoperative; “Conventional” Group (2): local anesthesia and ev. postoperative tramadol 100 mg via oral for pain control. In October 2014, at the Department of Orthopedic Oncology and Reconstructive Surgery of Florence, 37 musculoskeletal biopsies for a bone or a soft tissue lesion were performed. Exclusion criteria for this study were: known allergies to lidocaine, diclofenac, tramadol; known gastric or duodenal ulcers; known gastrointestinal bleed or perforation; refusal of the patients to collaborate. For one or more of these reasons, 6 patients were excluded from this study. In the Group 1, 10 patients (59%) referred no pain during the surgical procedure (8/14 biopsies on soft tissue and 2/3 on bone). In 5 cases (29%) no exacerbation of previous chronic pain, and in 2 cases (12%) a progression of local pain after biopsy (average 1 points higher in the VAS). In Group 2, only 6 patients (42%) did not have any pain during the procedure, 4 (29%) no exacerbation of previous chronic pain and 4 (29%) a progression of local pain (average 2 points higher in the VAS). Despite similar results in both Groups, Group 1 seemed to have a mild better control of perioperative pain. The use of diclofenac HPβCD 50 mg preoperative seems to be a rational approach for minimizing perioperative pain and the preliminary data of our study seem encouraging. Obviously many bias are

  3. Differential Network Analysis Applied to Preoperative Breast Cancer Chemotherapy Response

    PubMed Central

    Warsow, Gregor; Struckmann, Stephan; Kerkhoff, Claus; Reimer, Toralf; Engel, Nadja; Fuellen, Georg

    2013-01-01

    In silico approaches are increasingly considered to improve breast cancer treatment. One of these treatments, neoadjuvant TFAC chemotherapy, is used in cases where application of preoperative systemic therapy is indicated. Estimating response to treatment allows or improves clinical decision-making and this, in turn, may be based on a good understanding of the underlying molecular mechanisms. Ever increasing amounts of high throughput data become available for integration into functional networks. In this study, we applied our software tool ExprEssence to identify specific mechanisms relevant for TFAC therapy response, from a gene/protein interaction network. We contrasted the resulting active subnetwork to the subnetworks of two other such methods, OptDis and KeyPathwayMiner. We could show that the ExprEssence subnetwork is more related to the mechanistic functional principles of TFAC therapy than the subnetworks of the other two methods despite the simplicity of ExprEssence. We were able to validate our method by recovering known mechanisms and as an application example of our method, we identified a mechanism that may further explain the synergism between paclitaxel and doxorubicin in TFAC treatment: Paclitaxel may attenuate MELK gene expression, resulting in lower levels of its target MYBL2, already associated with doxorubicin synergism in hepatocellular carcinoma cell lines. We tested our hypothesis in three breast cancer cell lines, confirming it in part. In particular, the predicted effect on MYBL2 could be validated, and a synergistic effect of paclitaxel and doxorubicin could be demonstrated in the breast cancer cell lines SKBR3 and MCF-7. PMID:24349128

  4. Differential network analysis applied to preoperative breast cancer chemotherapy response.

    PubMed

    Warsow, Gregor; Struckmann, Stephan; Kerkhoff, Claus; Reimer, Toralf; Engel, Nadja; Fuellen, Georg

    2013-01-01

    In silico approaches are increasingly considered to improve breast cancer treatment. One of these treatments, neoadjuvant TFAC chemotherapy, is used in cases where application of preoperative systemic therapy is indicated. Estimating response to treatment allows or improves clinical decision-making and this, in turn, may be based on a good understanding of the underlying molecular mechanisms. Ever increasing amounts of high throughput data become available for integration into functional networks. In this study, we applied our software tool ExprEssence to identify specific mechanisms relevant for TFAC therapy response, from a gene/protein interaction network. We contrasted the resulting active subnetwork to the subnetworks of two other such methods, OptDis and KeyPathwayMiner. We could show that the ExprEssence subnetwork is more related to the mechanistic functional principles of TFAC therapy than the subnetworks of the other two methods despite the simplicity of ExprEssence. We were able to validate our method by recovering known mechanisms and as an application example of our method, we identified a mechanism that may further explain the synergism between paclitaxel and doxorubicin in TFAC treatment: Paclitaxel may attenuate MELK gene expression, resulting in lower levels of its target MYBL2, already associated with doxorubicin synergism in hepatocellular carcinoma cell lines. We tested our hypothesis in three breast cancer cell lines, confirming it in part. In particular, the predicted effect on MYBL2 could be validated, and a synergistic effect of paclitaxel and doxorubicin could be demonstrated in the breast cancer cell lines SKBR3 and MCF-7. PMID:24349128

  5. Rigid 2D/3D registration of intraoperative digital x-ray images and preoperative CT and MR images

    NASA Astrophysics Data System (ADS)

    Tomazevic, Dejan; Likar, Bostjan; Pernus, Franjo

    2002-05-01

    This paper describes a novel approach to register 3D computed tomography (CT) or magnetic resonance (MR) images to a set of 2D X-ray images. Such a registration may be a valuable tool for intraoperative determination of the precise position and orientation of some anatomy of interest, defined in preoperative images. The registration is based solely on the information present in 2D and 3D images. It does not require fiducial markers, X-ray image segmentation, or construction of digitally reconstructed radiographs. The originality of the approach is in using normals to bone surfaces, preoperatively defined in 3D MR or CT data, and gradients of intraoperative X-ray images, which are back-projected towards the X-ray source. The registration is then concerned with finding that rigid transformation of a CT or MR volume, which provides the best match between surface normals and back projected gradients, considering their amplitudes and orientations. The method is tested on a lumbar spine phantom. Gold standard registration is obtained by fidicual markers attached to the phantom. Volumes of interest, containing single vertebrae, are registered to different pairs of X-ray images from different starting positions, chosen randomly and uniformly around the gold standard position. Target registration errors and rotation errors are in order of 0.3 mm and 0.35 degrees for the CT to X-ray registration and 1.3 mm and 1.5 degrees for MR to X-ray registration. The registration is shown to be fast and accurate.

  6. Magnification rate of digital panoramic radiographs and its effectiveness for pre-operative assessment of dental implants

    PubMed Central

    Kim, Y-K; Park, J-Y; Kim, S-G; Kim, J-S; Kim, J-D

    2011-01-01

    Objectives The purpose of this study was to determine the accuracy and effectiveness of digital panoramic radiographs for pre-operative assessment of dental implants. Methods We selected 86 patients (221 implants) and calculated the length of the planned implant based on the distance between a selection of critical anatomical structures and the alveolar crest using the scaling tools provided in the digital panoramic system. We analysed the magnification rate and the difference between the actual inserted implant length and planned implant length according to the location of the implant placement and the clarity of anatomical structures seen in the panoramic radiographs. Results There was no significant difference between the planned implant length and actual inserted implant length (P > 0.05). The magnification rate of the width and length of the inserted implants, seen in the digital panoramic radiographs, was 127.28 ± 13.47% and 128.22 ± 4.17%, respectively. The magnification rate of the implant width was largest in the mandibular anterior part and there was a significant difference in the magnification rate of the length of implants between the maxilla and the mandible (P < 0.05). When the clarity of anatomical structures seen in the panoramic radiographs is low, the magnification rate of the width of the inserted implants is significantly higher (P < 0.05), but there is no significant difference between the planned implant length and actual inserted implant length according to the clarity of anatomical structures (P < 0.05). Conclusions Digital panoramic radiography can be considered a simple, readily available and considerably accurate pre-operative assessment tool in the vertical dimension for dental implant therapy. PMID:21239569

  7. Preoperative Steroid Use and the Risk of Infectious Complications After Neurosurgery

    PubMed Central

    Merkler, Alexander E.; Saini, Vaishali; Kamel, Hooman; Stieg, Philip E.

    2014-01-01

    Background and Purpose: The association between preoperative corticosteroid use and infectious complications after neurosurgical procedures is unclear. We aim to determine whether corticosteroids increase the risk of infectious complications after neurosurgery. Methods: We examined the association between preoperative corticosteroid use and postoperative infectious complications in a cohort of adults who underwent a neurosurgical procedure between 2005 and 2010 at centers participating in the National Surgical Quality Improvement Program. Corticosteroid use was defined as at least 10 days of oral or parental therapy in the 30 days prior to surgery. Our primary outcome was a composite of any infectious complications occurring within 30 days of surgery. We used propensity score analysis to examine the independent association between preoperative corticosteroid use and postoperative infections. Results: Among 26 634 neurosurgical procedures, 1228 (4.61%, 95% confidence interval [CI], 4.36-4.86) were preceded by preoperative corticosteroid use and 1469 (5.52%; 95% CI, 5.24-5.79) were followed by postoperative infections. In a propensity score analysis controlling for comorbidities, illness severity, and preexisting preoperative infections, corticosteroid use was independently associated with subsequent postoperative infections (odds ratio, 1.38; 95% CI, 1.11-1.70). Our results were unchanged in sensitivity analyses controlling for central nervous system tumors or active treatment with chemotherapy. Conclusion: Our results suggest that preoperative corticosteroid use is associated with an increased risk of infectious complications after neurosurgery. These findings may aid physicians with preoperative treatment decisions and risk stratification. Future randomized trials are needed to guide preoperative use of corticosteroids in this population. PMID:24707336

  8. Preoperative platelet transfusions and perioperative red blood cell requirements in patients with thrombocytopenia undergoing noncardiac surgery

    PubMed Central

    Warner, Matthew A.; Jia, Qing; Clifford, Leanne; Wilson, Gregory; Brown, Michael J.; Hanson, Andrew C.; Schroeder, Darrell R.; Kor, Daryl J.

    2016-01-01

    BACKGROUND Perioperative hemorrhage impacts patient outcomes and health care resource utilization, yet the risks of transfusion therapies are significant. In patients with preoperative thrombocytopenia, the effects of prophylactic preoperative platelet (PLT) transfusion on perioperative bleeding complications remain uncertain. STUDY DESIGN AND METHODS This is a retrospective cohort study of noncardiac surgical patients between January 1, 2008, and December 31, 2011. Propensity-adjusted analyses were used to evaluate associations between preoperative thrombocytopenia, preoperative PLT transfusion, and the outcomes of interest, with a primary outcome of perioperative red blood cell (RBC) transfusion. RESULTS A total of 13,978 study participants were included; 860 (6.2%) had a PLT count of not more than 100 × 109/L with 71 (8.3%) receiving PLTs preoperatively. Administration of PLTs was associated with higher rates of perioperative RBC transfusion (66.2% vs. 49.1%, p 0.0065); however, in propensity-adjusted analysis there was no significant difference between groups (odds ratio [OR] [95% confidence interval {95% CI}], 1.68 [0.95–2.99]; p =0.0764]. Patients receiving PLTs had higher rates of intensive care unit (ICU) admission (OR [95% CI], 1.95 [1.10–3.46]; p =0.0224) and longer hospital lengths of stay (estimate [95% bootstrap CI], 7.2 [0.8–13.9] days; p =0.0006) in propensity-adjusted analyses. CONCLUSION Preoperative PLT transfusion did not attenuate RBC requirements in patients with thrombocytopenia undergoing noncardiac surgery. Moreover, preoperative PLT transfusion was associated with increased ICU admission rates and hospital duration. These findings suggest that more conservative management of preoperative thrombocytopenia may be warranted. PMID:26559936

  9. Preoperative Nutritional Status and The Impact on Radical Cystectomy Recovery: An International Comparative Study.

    PubMed

    Jensen, Bente Thoft; Dalbagni, Guido; Borre, Michael; Love-Retinger, Nora

    2016-01-01

    In radical cystectomy, under-nutrition is common and has detrimental physiological and clinical effects, which can lead to increased complications and prolonged recovery. This article compares measurements and outcomes across continents in this patient population with advanced bladder cancer. The association of preoperative nutritional risk, nutritional status, and length of stay is equal across continents, and the results promote increased clinical awareness that women at severe risk should be identified preoperatively. PMID:27501594

  10. Preoperative hypnotherapy in the management of a child with anticipatory nausea and vomiting.

    PubMed

    Mackenzie, A; Frawley, G P

    2007-10-01

    A six-year-old boy with oesophageal strictures secondary to neonatal repair of oesophageal atresia and requiring six to eight weekly oesophageal dilatations by bouginage developed anticipatory nausea and vomiting. This was effectively managed by a course of preoperative hypnotherapy over four sessions. Resolution of anticipatory nausea and vomiting occurred along with cessation of postoperative nausea and vomiting. This case supports early intervention with preoperative hypnotherapy in children with anticipatory nausea and vomiting that has not responded to other measures. PMID:17933170

  11. Phase II Study of Preoperative Concurrent Chemoradiation Therapy With S-1 in Patients With T4 Oral Squamous Cell Carcinoma

    SciTech Connect

    Nomura, Tomoko; Murakami, Ryuji; Toya, Ryo; Teshima, Keiko; Nakahara, Aya; Hirai, Toshinori; Hiraki, Akimitsu; Nakayama, Hideki; Yoshitake, Yoshihiro; Ota, Kazutoshi; Obayashi, Takehisa; Yamashita, Yasuyuki; Oya, Natsuo; Shinohara, Masanori

    2010-04-15

    Purpose: To determine the feasibility and efficacy of preoperative concurrent chemoradiation therapy (CCRT) with S-1, an oral fluoropyrimidine derivative, in patients with T4 oral squamous cell carcinoma (SCC). Methods and Materials: Only patients with histologically proven T4 oral SCC were included. Radiotherapy (total dose, 30 Gy) was delivered in 2-Gy daily fractions over a period of 3 weeks. Concurrently, S-1 (80 mg/m{sup 2}/day) was administered orally twice daily for 14 consecutive days. Results: We enrolled 46 patients. All underwent radiotherapy as planned; however, oral S-1 was discontinued in 3 patients who manifested acute toxicity. Grade 3 toxicities were mucositis (20%), anorexia (9%), and neutropenia (4%). We encountered no Grade 4 adverse events or serious postoperative morbidity requiring surgical intervention. After CCRT, 32 of the 46 patients underwent radical resection; in 17 (53%) of the operated patients, the pathologic response was complete. During follow-up ranging from 7 to 58 months (median, 22 months), tumor control failed in 5 (16%) of the 32 operated patients; there were 3 local and 2 regional failures. Of the 14 non-operated patients, 8 (57%) manifested local (n = 7) or regional failure (n = 1). The 3-year overall survival rate for all 46 patients was 69%; it was significantly higher for operated than for non-operated patients (82% vs. 48%; p = 0.0288). Conclusion: Preoperative CCRT with S-1 is feasible and effective in patients with T4 oral SCC. Even in inoperable cases, CCRT with S-1 provides adequate tumor control.

  12. Three-Dimensional Analysis of Recurrence Patterns in Rectal Cancer: The Cranial Border in Hypofractionated Preoperative Radiotherapy Can Be Lowered

    SciTech Connect

    Nijkamp, Jasper; Kusters, Miranda; Beets-Tan, Regina G.H.; Martijn, Hendrik; Beets, Geerard L.; Velde, Cornelis J.H. van de; Marijnen, Corrie A.M.

    2011-05-01

    Purpose: The aim of this study was to determine whether and where the radiotherapy (RT) clinical target volume (CTV) could be reduced in short-course preoperative treatment of rectal cancer patients. Methods and Materials: Patients treated in the Dutch total mesorectal excision trial, with a local recurrence were analyzed. For 94 (25 who underwent radiation therapy 69 who did not) of 114 patients with a local recurrence, the location of the recurrence was placed in a three-dimensionalthree (3D) model. The data in the 3D model were correlated to the clinical trial data to distinguish a group of patients eligible for CTV reduction. Effects of CTV reduction on dose to the small bowel was tested retrospectively in a dataset of 8 patients with three-field conformal plans and intensity-modulated RT (IMRT). Results: The use of preoperative RT mainly reduces anastomotic, lateral, and perineal recurrences. In patients without primary nodal involvement, no recurrences were found cranially of the S2-S3 interspace, irrespective of the delivery of RT. In patients without primary nodal involvement and a negative circumferential resection margin (CRM), only one recurrence was found cranial to the S2-S3 interspace. With a cranially reduced CTV to the S2-S3 interspace, over 60% reduction in absolute small bowel exposure at dose levels from 15 to 35 Gy could be achieved with three-field conventional RT, increasing to 80% when IMRT is also added. Conclusions: The cranial border of the CTV can safely be lowered for patients without expected nodal or CRM involvement, yielding a significant reduction of dose to the small bowel. Therefore, a significant reduction of acute and late toxicity can be expected.

  13. Accurate estimation of sigma(exp 0) using AIRSAR data

    NASA Technical Reports Server (NTRS)

    Holecz, Francesco; Rignot, Eric

    1995-01-01

    During recent years signature analysis, classification, and modeling of Synthetic Aperture Radar (SAR) data as well as estimation of geophysical parameters from SAR data have received a great deal of interest. An important requirement for the quantitative use of SAR data is the accurate estimation of the backscattering coefficient sigma(exp 0). In terrain with relief variations radar signals are distorted due to the projection of the scene topography into the slant range-Doppler plane. The effect of these variations is to change the physical size of the scattering area, leading to errors in the radar backscatter values and incidence angle. For this reason the local incidence angle, derived from sensor position and Digital Elevation Model (DEM) data must always be considered. Especially in the airborne case, the antenna gain pattern can be an additional source of radiometric error, because the radar look angle is not known precisely as a result of the the aircraft motions and the local surface topography. Consequently, radiometric distortions due to the antenna gain pattern must also be corrected for each resolution cell, by taking into account aircraft displacements (position and attitude) and position of the backscatter element, defined by the DEM data. In this paper, a method to derive an accurate estimation of the backscattering coefficient using NASA/JPL AIRSAR data is presented. The results are evaluated in terms of geometric accuracy, radiometric variations of sigma(exp 0), and precision of the estimated forest biomass.

  14. Efficacy of Acupuncture in Reducing Preoperative Anxiety: A Meta-Analysis

    PubMed Central

    Bae, Hyojeong; Bae, Hyunsu; Min, Byung-Il; Cho, Seunghun

    2014-01-01

    Background. Acupuncture has been shown to reduce preoperative anxiety in several previous randomized controlled trials (RCTs). In order to assess the preoperative anxiolytic efficacy of acupuncture therapy, this study conducted a meta-analysis of an array of appropriate studies. Methods. Four electronic databases (MEDLINE, EMBASE, CENTRAL, and CINAHL) were searched up to February 2014. In the meta-analysis data were included from RCT studies in which groups receiving preoperative acupuncture treatment were compared with control groups receiving a placebo for anxiety. Results. Fourteen publications (N = 1,034) were included. Six publications, using the State-Trait Anxiety Inventory-State (STAI-S), reported that acupuncture interventions led to greater reductions in preoperative anxiety relative to sham acupuncture (mean difference = 5.63, P < .00001, 95% CI [4.14, 7.11]). Further eight publications, employing visual analogue scales (VAS), also indicated significant differences in preoperative anxiety amelioration between acupuncture and sham acupuncture (mean difference = 19.23, P < .00001, 95% CI [16.34, 22.12]). Conclusions. Acupuncture therapy aiming at reducing preoperative anxiety has a statistically significant effect relative to placebo or nontreatment conditions. Well-designed and rigorous studies that employ large sample sizes are necessary to corroborate this finding. PMID:25254059

  15. Preoperative drainage for malignant biliary strictures: is it time for self-expanding metallic stents?

    PubMed

    Roque, Jason; Ho, Shiaw-Hooi; Goh, Khean-Lee

    2015-01-01

    Palliation of jaundice improves the general health of the patient and, therefore, surgical outcomes. Because of the complexity and location of strictures, especially proximally, drainage has been accompanied by increased morbidity due to sepsis. Another concern is the provocation of an inflammatory and fibrotic reaction around the area of stent placement. Preoperative biliary drainage with self-expanding metallic stent (SEMS) insertion can be achieved via a percutaneous method or through endoscopic retrograde cholangiopancreatography. A recently published multicenter randomized Dutch study has shown increased morbidity with preoperative biliary drainage. A Cochrane meta-analysis has also shown a significantly increased complication rate with preoperative drainage. However, few of these studies have used a SEMS, which allows better biliary drainage. No randomized controlled trials have compared preoperative deployment of SEMS versus conventional plastic stents. The outcomes of biliary drainage also depend on the location of the obstruction, namely the difficulty with proximal compared to distal strictures. Pathophysiologically, palliation of jaundice will benefit all patients awaiting surgery. However, preoperative drainage often results in increased morbidity because of procedure-related sepsis. The use of SEMS may change the outcome of preoperative biliary drainage dramatically. PMID:25674520

  16. The unfavorable nature of preoperative delirium in elderly hip fractured patients.

    PubMed

    Adunsky, Abraham; Levy, Rami; Heim, Michael; Mizrahi, Eliyahu; Arad, M

    2003-01-01

    The onset of delirium is frequent in elderly patients who sustain hip fractures. The purpose of this study was to characterize different patterns of preoperative and postoperative delirium, to study factors associated with preoperative delirium and to evaluate the possible different outcome of these patients. This retrospective study comprised 281 elderly patients with hip fractures undergoing surgical fixation. Data collection included age, sex, length of stay, type of fracture, cognitive status by mini mental state examination (MMSE), assessment of possible delirium by the confusion assessment method (CAM) and functional outcome assessed by functional independence measure (FIM). A database search was conducted to identify whether delirium onset occurred prior to or following surgery. About 31% of the total sample developed delirium. Delirious patients tended to be more disabled (P = 0.03) and cognitively impaired (P = 0.018), compared with non-delirious patients. Most delirious cases (53%) had their onset in the preoperative period. Patients with preoperative delirium were older (P = 0.03), had a lower prefracture mobility (P < 0.01), impaired cognition (P = 0.04) and showed an adverse functional outcome in terms of FIM score. Regression analysis showed that prefracture dementia, prefracture mobility and low MMSE scores were strongly associated with higher probability of having preoperative delirium, with no additional effect of other variables. It is concluded that preoperative delirium should be viewed as a separate entity with unfavorable nature and adverse outcome. Careful preventive measures and better treating strategies should be employed to avoid this clinical condition. PMID:12849100

  17. Transthoracic echocardiography may be useful for preoperative cardiac evaluation of gynaecological patients undergoing routine surgery.

    PubMed

    Shrestha, B; Pradhan, P; Shakya, G R; Giri, A; Regmi, R; Dhungel, S

    2012-12-01

    Echocardiography has been an integral noninvasive tool for [preoperative] cardiac evaluation that provides with echocardiographic details which may also be useful to perioperative clinicians to tailor their anesthetic deliberation while dealing with preoperative patients. The objective of this study is preoperative evaluation of routine gynecological patients echocardiographically after being referred from respective internists or anesthesiologists. This was a prospective, nonrandomized study of elective 68 cases who underwent echocardiographic evaluation preoperatively from 15th July 2009 to 14th July 2012. The mean age of the patients was 52.1 +/- 10.3 years with the age range of 30-79 years. Valvular heart disease was the most common echocardiographic finding (129.4%) followed by left ventricular diastolic dysfunction, LVDD (48.5%) and left ventricular hypertrophy (22.1%). Systolic dysfunction was detected in 2.9% of patients and pulmonary arterial hypertension in 2.9% patients. Amongst patients referred after preoperative anaesthetic evaluation, patients had different cardiac lesions echocardiographically. Preoperative echocardiographic evaluation may provide important cardiac informations and values which might be employed by perioperative physicians to tailor their treatment. PMID:24579536

  18. Preoperative Concurrent Radiation Therapy and Chemotherapy for Bulky Stage IB2, IIA, and IIB Carcinoma of the Uterine Cervix With Proximal Parametrial Invasion

    SciTech Connect

    Huguet, Florence; Cojocariu, Oana-Maria; Levy, Pierre; Lefranc, Jean-Pierre; Darai, Emile; Jannet, Denis; Ansquer, Yan; Lhuillier, Pierre-Eugene; Benifla, Jean-Louis; Seince, Nathalie; Touboul, Emmanuel

    2008-12-01

    Purpose: To evaluate toxicity, local tumor control, and survival after preoperative chemoradiation for operable bulky cervical carcinoma. Methods and Materials: Between December 1991 and July 2006, 92 patients with operable bulky stage IB2, IIA, and IIB cervical carcinoma without pelvic or para-aortic nodes on pretreatment imaging were treated. Treatment consisted of preoperative external beam pelvic radiation therapy (EBRT) and concomitant chemotherapy (CT) during the first and fourth weeks of radiation combining 5-fluorouracil and cisplatin. The pelvic radiation dose was 40.5 Gy over 4.5 weeks. EBRT was followed by low-dose rate uterovaginal brachytherapy with a total dose of 20 Gy in 62 patients. After a median rest period of 44 days, all patients underwent Class II modified radical hysterectomy with bilateral pelvic lymphadenectomy. Thirty patients who had not received preoperative uterovaginal brachytherapy underwent postoperative low-dose-rate vaginal brachytherapy at a dose of 20 Gy. The mean follow-up was 46 months. Results: Pathologic residual tumor was observed in 43 patients. After multivariate analysis, additional preoperative uterovaginal brachytherapy was the single significant predictive factor for pathologic complete response rate (p = 0.019). The 2- and 5-year disease-free survival (DFS) rates were 80.4% and 72.2%, respectively. Pathologic residual cervical tumor was the single independent factor decreasing the probability of DFS (p = 0.020). Acute toxicities were moderate. Two severe ureteral complications requiring surgical intervention were observed. Conclusions: Concomitant chemoradiation followed by surgery for operable bulky stage I-II cervical carcinoma without clinical lymph node involvement can be used with acceptable toxicity. Pathologic complete response increases the probability of DFS.

  19. Feedback about More Accurate versus Less Accurate Trials: Differential Effects on Self-Confidence and Activation

    ERIC Educational Resources Information Center

    Badami, Rokhsareh; VaezMousavi, Mohammad; Wulf, Gabriele; Namazizadeh, Mahdi

    2012-01-01

    One purpose of the present study was to examine whether self-confidence or anxiety would be differentially affected by feedback from more accurate rather than less accurate trials. The second purpose was to determine whether arousal variations (activation) would predict performance. On Day 1, participants performed a golf putting task under one of…

  20. Feedback about more accurate versus less accurate trials: differential effects on self-confidence and activation.

    PubMed

    Badami, Rokhsareh; VaezMousavi, Mohammad; Wulf, Gabriele; Namazizadeh, Mahdi

    2012-06-01

    One purpose of the present study was to examine whether self-confidence or anxiety would be differentially affected byfeedback from more accurate rather than less accurate trials. The second purpose was to determine whether arousal variations (activation) would predict performance. On day 1, participants performed a golf putting task under one of two conditions: one group received feedback on the most accurate trials, whereas another group received feedback on the least accurate trials. On day 2, participants completed an anxiety questionnaire and performed a retention test. Shin conductance level, as a measure of arousal, was determined. The results indicated that feedback about more accurate trials resulted in more effective learning as well as increased self-confidence. Also, activation was a predictor of performance. PMID:22808705

  1. New model accurately predicts reformate composition

    SciTech Connect

    Ancheyta-Juarez, J.; Aguilar-Rodriguez, E. )

    1994-01-31

    Although naphtha reforming is a well-known process, the evolution of catalyst formulation, as well as new trends in gasoline specifications, have led to rapid evolution of the process, including: reactor design, regeneration mode, and operating conditions. Mathematical modeling of the reforming process is an increasingly important tool. It is fundamental to the proper design of new reactors and revamp of existing ones. Modeling can be used to optimize operating conditions, analyze the effects of process variables, and enhance unit performance. Instituto Mexicano del Petroleo has developed a model of the catalytic reforming process that accurately predicts reformate composition at the higher-severity conditions at which new reformers are being designed. The new AA model is more accurate than previous proposals because it takes into account the effects of temperature and pressure on the rate constants of each chemical reaction.

  2. Accurate colorimetric feedback for RGB LED clusters

    NASA Astrophysics Data System (ADS)

    Man, Kwong; Ashdown, Ian

    2006-08-01

    We present an empirical model of LED emission spectra that is applicable to both InGaN and AlInGaP high-flux LEDs, and which accurately predicts their relative spectral power distributions over a wide range of LED junction temperatures. We further demonstrate with laboratory measurements that changes in LED spectral power distribution with temperature can be accurately predicted with first- or second-order equations. This provides the basis for a real-time colorimetric feedback system for RGB LED clusters that can maintain the chromaticity of white light at constant intensity to within +/-0.003 Δuv over a range of 45 degrees Celsius, and to within 0.01 Δuv when dimmed over an intensity range of 10:1.

  3. Accurate mask model for advanced nodes

    NASA Astrophysics Data System (ADS)

    Zine El Abidine, Nacer; Sundermann, Frank; Yesilada, Emek; Ndiaye, El Hadji Omar; Mishra, Kushlendra; Paninjath, Sankaranarayanan; Bork, Ingo; Buck, Peter; Toublan, Olivier; Schanen, Isabelle

    2014-07-01

    Standard OPC models consist of a physical optical model and an empirical resist model. The resist model compensates the optical model imprecision on top of modeling resist development. The optical model imprecision may result from mask topography effects and real mask information including mask ebeam writing and mask process contributions. For advanced technology nodes, significant progress has been made to model mask topography to improve optical model accuracy. However, mask information is difficult to decorrelate from standard OPC model. Our goal is to establish an accurate mask model through a dedicated calibration exercise. In this paper, we present a flow to calibrate an accurate mask enabling its implementation. The study covers the different effects that should be embedded in the mask model as well as the experiment required to model them.

  4. Accurate guitar tuning by cochlear implant musicians.

    PubMed

    Lu, Thomas; Huang, Juan; Zeng, Fan-Gang

    2014-01-01

    Modern cochlear implant (CI) users understand speech but find difficulty in music appreciation due to poor pitch perception. Still, some deaf musicians continue to perform with their CI. Here we show unexpected results that CI musicians can reliably tune a guitar by CI alone and, under controlled conditions, match simultaneously presented tones to <0.5 Hz. One subject had normal contralateral hearing and produced more accurate tuning with CI than his normal ear. To understand these counterintuitive findings, we presented tones sequentially and found that tuning error was larger at ∼ 30 Hz for both subjects. A third subject, a non-musician CI user with normal contralateral hearing, showed similar trends in performance between CI and normal hearing ears but with less precision. This difference, along with electric analysis, showed that accurate tuning was achieved by listening to beats rather than discriminating pitch, effectively turning a spectral task into a temporal discrimination task. PMID:24651081

  5. Two highly accurate methods for pitch calibration

    NASA Astrophysics Data System (ADS)

    Kniel, K.; Härtig, F.; Osawa, S.; Sato, O.

    2009-11-01

    Among profiles, helix and tooth thickness pitch is one of the most important parameters of an involute gear measurement evaluation. In principle, coordinate measuring machines (CMM) and CNC-controlled gear measuring machines as a variant of a CMM are suited for these kinds of gear measurements. Now the Japan National Institute of Advanced Industrial Science and Technology (NMIJ/AIST) and the German national metrology institute the Physikalisch-Technische Bundesanstalt (PTB) have each developed independently highly accurate pitch calibration methods applicable to CMM or gear measuring machines. Both calibration methods are based on the so-called closure technique which allows the separation of the systematic errors of the measurement device and the errors of the gear. For the verification of both calibration methods, NMIJ/AIST and PTB performed measurements on a specially designed pitch artifact. The comparison of the results shows that both methods can be used for highly accurate calibrations of pitch standards.

  6. Accurate modeling of parallel scientific computations

    NASA Technical Reports Server (NTRS)

    Nicol, David M.; Townsend, James C.

    1988-01-01

    Scientific codes are usually parallelized by partitioning a grid among processors. To achieve top performance it is necessary to partition the grid so as to balance workload and minimize communication/synchronization costs. This problem is particularly acute when the grid is irregular, changes over the course of the computation, and is not known until load time. Critical mapping and remapping decisions rest on the ability to accurately predict performance, given a description of a grid and its partition. This paper discusses one approach to this problem, and illustrates its use on a one-dimensional fluids code. The models constructed are shown to be accurate, and are used to find optimal remapping schedules.

  7. Accurate Guitar Tuning by Cochlear Implant Musicians

    PubMed Central

    Lu, Thomas; Huang, Juan; Zeng, Fan-Gang

    2014-01-01

    Modern cochlear implant (CI) users understand speech but find difficulty in music appreciation due to poor pitch perception. Still, some deaf musicians continue to perform with their CI. Here we show unexpected results that CI musicians can reliably tune a guitar by CI alone and, under controlled conditions, match simultaneously presented tones to <0.5 Hz. One subject had normal contralateral hearing and produced more accurate tuning with CI than his normal ear. To understand these counterintuitive findings, we presented tones sequentially and found that tuning error was larger at ∼30 Hz for both subjects. A third subject, a non-musician CI user with normal contralateral hearing, showed similar trends in performance between CI and normal hearing ears but with less precision. This difference, along with electric analysis, showed that accurate tuning was achieved by listening to beats rather than discriminating pitch, effectively turning a spectral task into a temporal discrimination task. PMID:24651081

  8. Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious?

    PubMed Central

    Glynne-Jones, R; Grainger, J; Harrison, M; Ostler, P; Makris, A

    2006-01-01

    Neoadjuvant chemotherapy (NACT) is a term originally used to describe the administration of chemotherapy preoperatively before surgery. The original rationale for administering NACT or so-called induction chemotherapy to shrink or downstage a locally advanced tumour, and thereby facilitate more effective local treatment with surgery or radiotherapy, has been extended with the introduction of more effective combinations of chemotherapy to include reducing the risks of metastatic disease. It seems logical that survival could be lengthened, or organ preservation rates increased in resectable tumours by NACT. In rectal cancer NACT is being increasingly used in locally advanced and nonmetastatic unresectable tumours. Randomised studies in advanced colorectal cancer show high response rates to combination cytotoxic therapy. This evidence of efficacy coupled with the introduction of novel molecular targeted therapies (such as Bevacizumab and Cetuximab), and long waiting times for radiotherapy have rekindled an interest in delivering NACT in locally advanced rectal cancer. In contrast, this enthusiasm is currently waning in other sites such as head and neck and nasopharynx cancer where traditionally NACT has been used. So, is NACT in rectal cancer a real advance or just history repeating itself? In this review, we aimed to explore the advantages and disadvantages of the separate approaches of neoadjuvant, concurrent and consolidation chemotherapy in locally advanced rectal cancer, drawing on theoretical principles, preclinical studies and clinical experience both in rectal cancer and other disease sites. Neoadjuvant chemotherapy may improve outcome in terms of disease-free or overall survival in selected groups in some disease sites, but this strategy has not been shown to be associated with better outcomes than postoperative adjuvant chemotherapy. In particular, there is insufficient data in rectal cancer. The evidence for benefit is strongest when NACT is administered

  9. An accurate registration technique for distorted images

    NASA Technical Reports Server (NTRS)

    Delapena, Michele; Shaw, Richard A.; Linde, Peter; Dravins, Dainis

    1990-01-01

    Accurate registration of International Ultraviolet Explorer (IUE) images is crucial because the variability of the geometrical distortions that are introduced by the SEC-Vidicon cameras ensures that raw science images are never perfectly aligned with the Intensity Transfer Functions (ITFs) (i.e., graded floodlamp exposures that are used to linearize and normalize the camera response). A technique for precisely registering IUE images which uses a cross correlation of the fixed pattern that exists in all raw IUE images is described.

  10. Accurate maser positions for MALT-45

    NASA Astrophysics Data System (ADS)

    Jordan, Christopher; Bains, Indra; Voronkov, Maxim; Lo, Nadia; Jones, Paul; Muller, Erik; Cunningham, Maria; Burton, Michael; Brooks, Kate; Green, James; Fuller, Gary; Barnes, Peter; Ellingsen, Simon; Urquhart, James; Morgan, Larry; Rowell, Gavin; Walsh, Andrew; Loenen, Edo; Baan, Willem; Hill, Tracey; Purcell, Cormac; Breen, Shari; Peretto, Nicolas; Jackson, James; Lowe, Vicki; Longmore, Steven

    2013-10-01

    MALT-45 is an untargeted survey, mapping the Galactic plane in CS (1-0), Class I methanol masers, SiO masers and thermal emission, and high frequency continuum emission. After obtaining images from the survey, a number of masers were detected, but without accurate positions. This project seeks to resolve each maser and its environment, with the ultimate goal of placing the Class I methanol maser into a timeline of high mass star formation.

  11. Accurate phase-shift velocimetry in rock.

    PubMed

    Shukla, Matsyendra Nath; Vallatos, Antoine; Phoenix, Vernon R; Holmes, William M

    2016-06-01

    Spatially resolved Pulsed Field Gradient (PFG) velocimetry techniques can provide precious information concerning flow through opaque systems, including rocks. This velocimetry data is used to enhance flow models in a wide range of systems, from oil behaviour in reservoir rocks to contaminant transport in aquifers. Phase-shift velocimetry is the fastest way to produce velocity maps but critical issues have been reported when studying flow through rocks and porous media, leading to inaccurate results. Combining PFG measurements for flow through Bentheimer sandstone with simulations, we demonstrate that asymmetries in the molecular displacement distributions within each voxel are the main source of phase-shift velocimetry errors. We show that when flow-related average molecular displacements are negligible compared to self-diffusion ones, symmetric displacement distributions can be obtained while phase measurement noise is minimised. We elaborate a complete method for the production of accurate phase-shift velocimetry maps in rocks and low porosity media and demonstrate its validity for a range of flow rates. This development of accurate phase-shift velocimetry now enables more rapid and accurate velocity analysis, potentially helping to inform both industrial applications and theoretical models. PMID:27111139

  12. Accurate Molecular Polarizabilities Based on Continuum Electrostatics

    PubMed Central

    Truchon, Jean-François; Nicholls, Anthony; Iftimie, Radu I.; Roux, Benoît; Bayly, Christopher I.

    2013-01-01

    A novel approach for representing the intramolecular polarizability as a continuum dielectric is introduced to account for molecular electronic polarization. It is shown, using a finite-difference solution to the Poisson equation, that the Electronic Polarization from Internal Continuum (EPIC) model yields accurate gas-phase molecular polarizability tensors for a test set of 98 challenging molecules composed of heteroaromatics, alkanes and diatomics. The electronic polarization originates from a high intramolecular dielectric that produces polarizabilities consistent with B3LYP/aug-cc-pVTZ and experimental values when surrounded by vacuum dielectric. In contrast to other approaches to model electronic polarization, this simple model avoids the polarizability catastrophe and accurately calculates molecular anisotropy with the use of very few fitted parameters and without resorting to auxiliary sites or anisotropic atomic centers. On average, the unsigned error in the average polarizability and anisotropy compared to B3LYP are 2% and 5%, respectively. The correlation between the polarizability components from B3LYP and this approach lead to a R2 of 0.990 and a slope of 0.999. Even the F2 anisotropy, shown to be a difficult case for existing polarizability models, can be reproduced within 2% error. In addition to providing new parameters for a rapid method directly applicable to the calculation of polarizabilities, this work extends the widely used Poisson equation to areas where accurate molecular polarizabilities matter. PMID:23646034

  13. Accurate phase-shift velocimetry in rock

    NASA Astrophysics Data System (ADS)

    Shukla, Matsyendra Nath; Vallatos, Antoine; Phoenix, Vernon R.; Holmes, William M.

    2016-06-01

    Spatially resolved Pulsed Field Gradient (PFG) velocimetry techniques can provide precious information concerning flow through opaque systems, including rocks. This velocimetry data is used to enhance flow models in a wide range of systems, from oil behaviour in reservoir rocks to contaminant transport in aquifers. Phase-shift velocimetry is the fastest way to produce velocity maps but critical issues have been reported when studying flow through rocks and porous media, leading to inaccurate results. Combining PFG measurements for flow through Bentheimer sandstone with simulations, we demonstrate that asymmetries in the molecular displacement distributions within each voxel are the main source of phase-shift velocimetry errors. We show that when flow-related average molecular displacements are negligible compared to self-diffusion ones, symmetric displacement distributions can be obtained while phase measurement noise is minimised. We elaborate a complete method for the production of accurate phase-shift velocimetry maps in rocks and low porosity media and demonstrate its validity for a range of flow rates. This development of accurate phase-shift velocimetry now enables more rapid and accurate velocity analysis, potentially helping to inform both industrial applications and theoretical models.

  14. Sagittal synostosis: I. Preoperative morphology of the skull.

    PubMed

    Guimarães-Ferreira, José; Gewalli, Fredrik; David, Lisa; Darvann, Tron A; Hermann, Nuno V; Kreiborg, Sven; Friede, Hans; Lauritzen, Claes G K

    2006-01-01

    The aim of this study was to characterise the preoperative morphology of the skull in sagittal synostosis in an objective and quantified way. The shapes of the skulls of 105 patients with isolated premature synostosis of the sagittal suture (SS group) were studied and compared with those of a control group of 72 children with unilateral incomplete cleft lip (UICL). A standardised radiocephalometric technique was used to obtain the images. A modification of a method developed by Kreiborg was used to analyse the radiocephalograms, which included the digitisation of 88 landmarks in the calvaria, skull base, and orbit (42 in the lateral and 46 in the frontal projections), the production of plots of mean shape for each group, and the intergroup comparison of a series of 81 variables (linear distance between selected landmarks, and angles defined by groups of three landmarks). Data from a subgroup of 66 patients aged 5 to 8 months were further compared to age-matched normative data in terms of seven angular and linear calvarial, cranial base and orbital variables. In a comparative analysis of the mean lateral plots, the foreheads of the study group (SS) had a more pronounced anterior slope and were also more convex. The vertex area was located more anteriorly, and was less convex. The occipital curvature was more prominent. Analysis of the mean frontal plots revealed a lack in convexity and lateral projection of the upper parietal regions, as well as a lower location of the line of maximum skull width. Comparison of the mean values of an SS subgroup to age-matched normative data showed a longer (p<0.001) and narrower skull (p<0.001) and a greater interorbital distance (p<0.001). The cranial base angle, the sella to nasion, and sella to basion lengths did not differ significantly. Sagittal synostosis is characterised by an extensive deformity of the cranial vault, with an essentially normal cranial base. The widened interorbital distance is probably related to

  15. 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

  16. Preoperative Preparation and Patient Selection for Cytoreductive Surgery and HIPEC.

    PubMed

    Ashvin, Rangole; Nikhilesh, Jain

    2016-06-01

    . Patients undergoing HIPEC surgery face the usual physiological insults of a major surgery in addition to the thermal stress secondary to intraperitoneal administration of heated chemotherapy agent. A team approach of everyone involved in care of these patients is known to improve patient outcomes. It has also been observed that with the necessary preoperative & perioperative steps, the morbidity and mortality for this treatment can be brought down as comparable to any other major abdominal surgeries. PMID:27065711

  17. 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

  18. High Frequency QRS ECG Accurately Detects Cardiomyopathy

    NASA Technical Reports Server (NTRS)

    Schlegel, Todd T.; Arenare, Brian; Poulin, Gregory; Moser, Daniel R.; Delgado, Reynolds

    2005-01-01

    High frequency (HF, 150-250 Hz) analysis over the entire QRS interval of the ECG is more sensitive than conventional ECG for detecting myocardial ischemia. However, the accuracy of HF QRS ECG for detecting cardiomyopathy is unknown. We obtained simultaneous resting conventional and HF QRS 12-lead ECGs in 66 patients with cardiomyopathy (EF = 23.2 plus or minus 6.l%, mean plus or minus SD) and in 66 age- and gender-matched healthy controls using PC-based ECG software recently developed at NASA. The single most accurate ECG parameter for detecting cardiomyopathy was an HF QRS morphological score that takes into consideration the total number and severity of reduced amplitude zones (RAZs) present plus the clustering of RAZs together in contiguous leads. This RAZ score had an area under the receiver operator curve (ROC) of 0.91, and was 88% sensitive, 82% specific and 85% accurate for identifying cardiomyopathy at optimum score cut-off of 140 points. Although conventional ECG parameters such as the QRS and QTc intervals were also significantly longer in patients than controls (P less than 0.001, BBBs excluded), these conventional parameters were less accurate (area under the ROC = 0.77 and 0.77, respectively) than HF QRS morphological parameters for identifying underlying cardiomyopathy. The total amplitude of the HF QRS complexes, as measured by summed root mean square voltages (RMSVs), also differed between patients and controls (33.8 plus or minus 11.5 vs. 41.5 plus or minus 13.6 mV, respectively, P less than 0.003), but this parameter was even less accurate in distinguishing the two groups (area under ROC = 0.67) than the HF QRS morphologic and conventional ECG parameters. Diagnostic accuracy was optimal (86%) when the RAZ score from the HF QRS ECG and the QTc interval from the conventional ECG were used simultaneously with cut-offs of greater than or equal to 40 points and greater than or equal to 445 ms, respectively. In conclusion 12-lead HF QRS ECG employing

  19. Is Preoperative Chemoradiotherapy Beneficial for Sphincter Preservation in Low-Lying Rectal Cancer Patients?

    PubMed Central

    Park, In Ja; Yu, Chang Sik; Lim, Seok-Byung; Lee, Jong Lyul; Kim, Chan Wook; Yoon, Yong Sik; Park, Seong Ho; Kim, Jin Cheon

    2016-01-01

    Abstract The present study explored the benefit of preoperative chemoradiotherapy (PCRT) for sphincter preservation in locally advanced low-lying rectal cancer patients who underwent stapled anastomosis, especially in those with deep and narrow pelvises determined by magnetic resonance imaging. Patients with locally advanced low-lying rectal cancer (≤5 cm from the anal verge) who underwent stapled anastomosis were included. Patients were categorized into two groups (PCRT+ vs. PCRT–) according to PCRT application. Patients in the PCRT+ group were matched to those in the PCRT– group according to potential confounding factors (age, gender, clinical stage, and body mass index) for sphincter preservation. Sphincter preservation, permanent stoma, and anastomosis-related complications were compared between the groups. Pelvic magnetic resonance imaging was used to measure 12 dimensions representing pelvic cavity depth and width with which deep and narrow pelvis was defined. The impact of PCRT on sphincter preservation and permanent stoma in pelvic dimensions defined as deep and narrow pelvis was evaluated, and factors associated with sphincter preservation and permanent stoma were analyzed. One hundred sixty-six patients were one-to-one matched between the PCRT+ and PCRT− groups. Overall, sphincter-saving surgery was performed in 66.3% and the rates were not different between the 2 groups. Anastomotic complications and permanent stoma occurred nonsignificantly more frequently in the PCRT+ group. PCRT was not associated with higher rate of sphincter preservation in all pelvic dimensions defined as deep and narrow pelvis, while PCRT was related to higher rate of permanent stoma in shorter transverse diameter and interspinous distance. On logistic regression analysis, PCRT was not shown to influence both sphincter preservation and permanent stoma, while longer transverse diameter and interspinous distance were associated with lower rate of permanent stoma. PCRT had

  20. Placental localization in abdominal pregnancy using technetium-99m-labeled red blood cells

    SciTech Connect

    Martin, B.; Payan, J.M.; Jones, J.S.; Buse, M.G. )

    1990-06-01

    In a patient with third trimester abdominal pregnancy with fetal demise, technetium-99m-labeled erythrocytes ({sup 99m}Tc-RBCs) localized the placenta preoperatively, after nonvisualization by ultrasonography and arteriography. Extrauterine placental localization by blood-pool imaging may be useful when ultrasound fails.

  1. Preoperative education for lumbar radiculopathy: A survey of US spine surgeons

    PubMed Central

    Louw, Adriaan; Butler, David S.; Diener, Ina; Puentedura, Emilio J.

    2012-01-01

    Background We sought to determine current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Methods An online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured information on demographics, content, delivery methods, utilization, and importance of preoperative education as rated by surgeons. Descriptive statistics were used to describe the current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Results Of 200 surgeons, 89 (45% response rate) responded to the online survey. The majority (64.2%) provide preoperative education informally during the course of clinical consultation versus a formal preoperative education session. The mean time from the decision to undergo surgery to the date of surgery was 33.65 days. The highest rated educational topics are surgical procedure (96.3%), complications (96.3%), outcomes/expectations (93.8%), anatomy (92.6%), amount of postoperative pain expected (90.1%), and hospital stay (90.1%). Surgeons estimated spending approximately 20% of the preoperative education time specifically addressing pain. Seventy-five percent of the surgeons personally provide the education, and nearly all surgeons (96.3%) use verbal communication with the use of a spine model. Conclusions Spine surgeons believe that preoperative education is important and use a predominantly biomedical approach in preparing patients for surgery. Larger studies are needed to validate these findings. PMID:25694882

  2. 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

  3. A Genomic Alternative to Identify Medullary Thyroid Cancer Preoperatively in Thyroid Nodules with Indeterminate Cytology

    PubMed Central

    Monroe, Robert J.; Traweek, S. Thomas; Lanman, Richard B.; Kennedy, Giulia C.

    2016-01-01

    Background: The use of calcitonin screening for the rare medullary thyroid cancer (MTC) is controversial due to questions of efficacy, accuracy, and cost-effectiveness. This study reports the results of a large prospective validation using a machine-trained algorithm (MTC Classifier) to preoperatively identify MTC in fine-needle aspiration biopsies in lieu of calcitonin measurements. Methods: Cytology analysis on a prospective consecutive series of 50,430 thyroid nodule biopsies yielded a total of 7815 indeterminate (Bethesda categories III/IV) cases, which were tested with the MTC classifier. A prospective, consecutively submitted series of 2673 Bethesda III–VI cases with cytology determined locally was also evaluated. RNA was isolated and tested for the MTC Classifier using microarrays. Results: Forty-three cases were positive by the MTC Classifier among 10,488 tested nodules (0.4%), consistent with the low prevalence of MTC. Of these, all but one was histologically or biochemically confirmed as MTC, yielding a positive predictive value (PPV) of 98%. Of the positive cases, only 19 (44%) had been specifically suspected of MTC by cytology, highlighting the limitations of light microscopy to detect this disease. Three surgically confirmed MTC cases that were detected by the MTC Classifier had low basal serum calcitonin values, indicating these would have been missed by traditional calcitonin screening methods. A pooled analysis of three independent validation sets demonstrates high test sensitivity (97.9%), specificity (99.8%), PPV (97.9%), and negative predictive value (99.8%). Conclusions: A clinical paradigm is proposed, whereby cytologically indeterminate thyroid nodules being tested for common malignancies using gene expression can be simultaneously tested for MTC using the same genomic assay at no added cost. PMID:26992356

  4. Prognosis of Esophageal Cancer Patients With Pathologic Complete Response After Preoperative Concurrent Chemoradiotherapy

    SciTech Connect

    Park, Jae Won; Kim, Jong Hoon; Choi, Eun Kyung; Lee, Sang-wook; Yoon, Sang Min; Song, Si Yeol; Lee, Yu Sun; Kim, Sung Bae; Park, Seung il; Ahn, Seung Do

    2011-11-01

    Purpose: To define failure patterns and predictive factors in esophageal cancer patients who had a pathologic complete response (pCR) after preoperative concurrent chemoradiotherapy (PCRT). Methods and Materials: We performed a retrospective analysis of 61 esophageal cancer patients who were enrolled in prospective studies and showed pCR after PCRT. All of the patients had squamous cell carcinoma. Of the patients, 40 were treated with hyperfractionated radiotherapy (4,560 cGy in 28 fractions) with 5-fluorouracil (5-FU) and cisplatin (FP), and 21 patients received conventional fractionation radiotherapy with capecitabine and cisplatin (XP). Results: The median follow-up time was 45.2 months (range, 6.5-162.3 months). The 5-year overall survival (OS) and disease-free survival rates (DFS) were 60.2% and 80.4%, respectively. In univariate analysis, age and lymph node (LN) metastasis were poor prognostic factors for OS, and pretreatment weight loss (>2 kg) was a poor prognostic factor for DFS. In multivariate analysis, lymph node metastasis and pretreatment weight loss were independent prognostic factors for OS and DFS. Nine patients (15%) had disease recurrence. Of the nine patients, 5 patients had locoregional failure, 1 patients had distant metastasis, and 3 patients had distant and locoregional failure. In-field failure occurred in 5 patients; out-of-field failure occurred in 1 patient; both in-field and out-of-field failure occurred in 2 patients; and both marginal and out-of-field failure occurred in 1 patient. Conclusions: Even in pCR patients, the most common failure site was within the radiation field, which suggests that more efficient local treatment is needed. Tumor recurrence was more common in patients with older age and with pretreatment weight loss.

  5. Wound Complications in Preoperatively Irradiated Soft-Tissue Sarcomas of the Extremities

    SciTech Connect

    Rosenberg, Lewis A.; Esther, Robert J.; Erfanian, Kamil; Green, Rebecca; Kim, Hong Jin; Sweeting, Raeshell; Tepper, Joel E.

    2013-02-01

    Purpose: To determine whether the involvement of plastic surgery and the use of vascularized tissue flaps reduces the frequency of major wound complications after radiation therapy for soft-tissue sarcomas (STS) of the extremities. Methods and Materials: This retrospective study evaluated patients with STS of the extremities who underwent radiation therapy before surgery. Major complications were defined as secondary operations with anesthesia, seroma/hematoma aspirations, readmission for wound complications, or persistent deep packing. Results: Between 1996 and 2010, 73 patients with extremity STS were preoperatively irradiated. Major wound complications occurred in 32% and secondary operations in 16% of patients. Plastic surgery closed 63% of the wounds, and vascularized tissue flaps were used in 22% of closures. When plastic surgery performed closure the frequency of secondary operations trended lower (11% vs 26%; P=.093), but the frequency of major wound complications was not different (28% vs 38%; P=.43). The use of a vascularized tissue flap seemed to have no effect on the frequency of complications. The occurrence of a major wound complication did not affect disease recurrence or survival. For all patients, 3-year local control was 94%, and overall survival was 72%. Conclusions: The rates of wound complications and secondary operations in this study were very similar to previously published results. We were not able to demonstrate a significant relationship between the involvement of plastic surgery and the rate of wound complications, although there was a trend toward reduced secondary operations when plastic surgery was involved in the initial operation. Wound complications were manageable and did not compromise outcomes.

  6. The role of targeted agents in preoperative chemoradiation for rectal cancer.

    PubMed

    Wadlow, Raymond C; Ryan, David P

    2010-08-01

    In the United States, randomized trials have established preoperative chemoradiation as the standard of care for patients with locally advanced rectal cancer. Pathologic complete response (pCR) rates occur in 10% to 16% of patients and have been shown to be correlated with both disease-free and overall survival. Therefore, recent efforts incorporating newer cytotoxic and molecularly targeted agents into chemoradiotherapy regimens have reported the pCR rate to be a surrogate marker of clinical outcomes. Substitution of oral fluoropyrimidines, including capecitabine, for infusional 5-fluorouracil reportedly generated pCR rates of up to 32% in phase 2 studies, but definitive evaluation awaits results from the National Surgical Adjuvant Breast and Bowel Project (NSABP) R-04 trial. Similarly, regimens incorporating irinotecan generated pCR rates as high as 38%, but to the authors' knowledge have not been evaluated in randomized trials. In contrast, 2 large randomized trials reported that the addition of weekly oxaliplatin to fluoropyrimidine-based chemoradiation led to an increase in grade 3/4 toxicity but no difference in pCR rates. Early phase trials evaluating the anti-epidermal growth factor receptor (EGFR) antibody cetuximab in combination with chemoradiation reported modest pCR rates of 5% to 12%, and efforts have focused on identifying biomarkers of response including EGFR copy number, k-ras mutational status, and both serum and tumor-specific expression of EGFR ligands. Finally, incorporation of the anti-vascular endothelial growth factor antibody bevacizumab into chemoradiation appears to be safe and feasible, with initial studies reporting a