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Sample records for adequate surgical margin

  1. Surgical margins in breast conservation.

    PubMed

    Chiappa, Corrado; Rovera, Francesca; Corben, Adriana Dionigi; Fachinetti, Anna; De Berardinis, Valentina; Marchionini, Valentina; Rausei, Stefano; Boni, Luigi; Dionigi, Gianlorenzo; Dionigi, Renzo

    2013-01-01

    Breast cancer is the most common tumor affecting women worldwide. Breast-conserving therapy (BCT) followed by irradiation nowadays is the treatment of choice for early-stage disease; there is no difference in long-term survival between mastectomy and BCT combined with external radiotherapy. A positive margin is associated with increased risk of local recurrences after BCT for invasive breast cancer and ductal carcinoma in situ. The exact definition of an adequate surgical margin after breast cancer resection has long been debated among physicians and represents an area of considerable variation in clinical practice. There is a lack of standardization in the pathology methods of margin evaluation, which yields little consensus regarding what constitutes an adequate negative margin. As a consequence, patient management varies widely based on the threshold that surgeons accept for adequate margins and the subsequent need for re-excision. We analyze and discuss recent literature about this topic both from the pathological and from the surgical point of view.

  2. Optimizing Surgical Margins in Breast Conservation

    PubMed Central

    Ananthakrishnan, Preya; Balci, Fatih Levent; Crowe, Joseph P.

    2012-01-01

    Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy,) include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future. PMID:23304479

  3. Surgical Margins and Its Evaluation in Oral Cancer: A Review

    PubMed Central

    Annavajjula, Saileela

    2014-01-01

    The main surgical goal while treating cancer is to remove all local malignant disease with no residual malignant cells left. Overall benefits of achieving negative resection margins in terms of disease free local recurrence and overall survival has been discussed in many studies. The quantity of normal tissue to be removed during surgical procedure has not been standardised. Local recurrence can also occur among tumours with extensive histological demonstration of adequate resection margins. Oral cavity, submandibular region, tonsil and pharynx are the sites which have high chances of recurrence, even after showing negative margins. Therefore, the current approaches for histological risk assessment and various methods of evaluation of the surgical margins with their limitations are briefed in the present article. PMID:25386547

  4. Elements for adequate informed consent in the surgical context.

    PubMed

    Abaunza, Hernando; Romero, Klaus

    2014-07-01

    Given a history of atrocities and violations of ethical principles, several documents and regulations have been issued by a wide variety of organizations. They aim at ensuring that health care and clinical research adhere to defined ethical principles. A fundamental component was devised to ensure that the individual has been provided the necessary information to make an informed decision regarding health care or participation in clinical research. This article summarizes the history and regulations for informed consent and discusses suggested components for adequate consent forms for daily clinical practice in surgery as well as clinical research.

  5. Treatment of Pigmented Basal Cell Carcinoma with 3 mm Surgical Margin in Asians.

    PubMed

    Lin, Shang-Hung; Cheng, Yu-Wen; Yang, Yi-Chien; Ho, Ji-Chen; Lee, Chih-Hung

    2016-01-01

    Background. In Asians, most basal cell carcinomas (BCCs) are pigmented with clear borders. The consensus of 4 mm surgical margin for BCC largely depends on studies in nonpigmented BCCs in Caucasians. However, little is known about recurrences of pigmented BCCs with a narrower surgical margin. We aimed to investigate 5-year recurrence of BCCs, either pigmented or nonpigmented, in Taiwanese with 3 mm surgical margin. Materials and Methods. 143 patients with BCC (M/F = 66/77, average 64 years) were confirmed pathologically from 2002 to 2013. Based on the pathological margin (>1 mm, ≤1 mm, and involved), patients were categorized into the complete excision group (n = 77), histology with close proximity group (n = 43), and unclear surgical margin group (n = 23). Results. Among 143 cases, 105 were pigmented. With standard 3 mm excision, there were 7 recurrences, with 6 of them from nonpigmented BCC group. Logistic regression showed that pigmentation was associated with lower recurrence. Interestingly, 5-year recurrence of completely excised and histology with close proximity BCC (0/77 versus 1/43) was not different statistically. Conclusions. A 3 mm surgical margin is adequate for pigmented BCC. A "wait and see" approach rather than further wide excision is appropriate for BCC with <1 mm free margin.

  6. Intraoperative ultrasound control of surgical margins during partial nephrectomy

    PubMed Central

    Alharbi, Feras M.; Chahwan, Charles K.; Le Gal, Sophie G.; Guleryuz, Kerem M.; Tillou, Xavier P.; Doerfler, Arnaud P.

    2016-01-01

    Aims: To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. Subjects and Methods: This study was conducted for patients undergoing partial nephrectomy (PN) with T1–T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. Results: In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. Conclusions: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist. PMID:28057986

  7. Surgical margins and handling of soft-tissue sarcoma in extremities: a clinical practice guideline

    PubMed Central

    Kandel, R.; Coakley, N.; Werier, J.; Engel, J.; Ghert, M.; Verma, S.

    2013-01-01

    Questions In limb salvage surgery for extremity soft-tissue sarcoma (sts), what is an adequate surgical margin? What is the appropriate number of samples to take from the margins of a surgical resection specimen? What is the appropriate handling of surgical resection specimens? Background Surgery is the primary treatment for extremity sts. The combination of radiotherapy with surgery allows for limb salvage by using radiation to biologically “sterilize” microscopic extensions of tumour and to spare neurovascular and osseous structures. Adjuvant chemotherapy in sts—except for rhabdomyosarcoma and Ewing sarcoma—continues to be controversial. Methods The medline and embase databases (1975 to June 2011) and the Cochrane Library were searched for pertinent studies. The Web sites of the main guideline organizations and the American Society of Clinical Oncology conference proceedings (2007–2010) were also searched. Results and Conclusions Thirty-three papers, including four guidelines, one protocol, and one abstract, were eligible for inclusion. The data suggest that patients with clear margins have a better prognosis, but no prospective studies have indicated how wide margins should be. In limb-salvage surgery for extremity sts, the procedure should be planned to achieve a clear margin. However, to preserve functionality, surgery may result in a very close (<1 cm) or even microscopically positive margin. In this circumstance, the use of preoperative or postoperative radiation should be considered. No studies described the optimal number of tissue sections required to assess adequacy of excision nor the appropriate handling of surgical resection specimens. The Sarcoma Disease Site Group made its recommendations based on expert opinion and consensus. PMID:23737694

  8. [Incidence of primary malignant lesions in clinically benign teratoma: on the problem of adequate surgical procedure].

    PubMed

    Kindermann, G; Jung, E M; Maassen, V; Bise, K

    1996-08-01

    The Problem of an Adequate Surgical Approach: Frequency of malignant teratomas is, according to the literature, 2%-10%. Examining 194 own cases (1983-1993) it was 1.5%. We found one squamous cell carcinoma (0.5%). Additionally we found 2 immature teratomas (1%). We point out the different biological behaviour of malignant mature teratomas and immature teratomas. We agree with the majority of authors that the method of choice is the intact removal of all teratomas without iatrogen rupture or contamination of the abdominal cavity by contents of the teratoma. This adequate surgical procedure can and should be performed by laparotomy or laparoscopy with endobag. The often practised method of cutting open the cyst during laparoscopy, sucking off the contents or cutting the teratoma into pieces, has been proven to lead to implantation and worsening the prognosis in case of a malignant teratoma. Even the rinsing of the abdominal cavity, usually carried out with this method, could not compensate always for the disadvantage of this "dirty" endoscopical method compared with usual oncological standards. This is pointed out by case reports in the literature and the first analysis of a German survey with early-follow-up of 192 laparoscopically managed ovarian malignancies [11a]. The principle of intact removal of every teratoma should again be kept in mind.

  9. Towards a personalized surgical margin for breast conserving surgery-Implications of field cancerization in local recurrence.

    PubMed

    Lebya, Katarina; Garcia-Smith, Randi; Swaminathan, Radha; Jones, Anna; Russell, John; Joste, Nancy; Bisoffi, Marco; Trujillo, Kristina

    2017-02-01

    The amount of normal tissue that should be excised during breast conserving surgery is widely debated. Tissue adjacent to breast tumors, although histologically normal, possesses many of the molecular abnormalities found in tumor tissues. Here, we propose that the ideal physical distance for a surgical margin may not be universal. Rather, an adequate surgical margin likely varies from patient to patient, depending on the biology of the tissue that remains after surgery. J. Surg. Oncol. 2017;115:109-115. © 2017 Wiley Periodicals, Inc.

  10. Marking excision margins of surgical specimens by silver impregnation.

    PubMed

    Feit, J

    2005-07-01

    Marking excision margins of surgical specimens by silver impregnation has several advantages over commonly used Indian ink: during the slicing the tissue preserves its natural color, the staining is permanent, and the pigment does not smudge over cutting surfaces. The pigment is clearly visible in tissue sections. The tissue specimen is shortly dipped into a 10% water solution of argent nitrate (AgNO3 with HNO3). After slicing, the tissue specimens are developed in common black & white developer for several seconds and paraffin processed as usual. The method is suitable for formaldehyde fixed as well as fresh tissue specimens.

  11. Defining the distal margin of rectal cancer for surgical planning

    PubMed Central

    Kato, Takashi; Tanaka, Jun-Ichi

    2017-01-01

    Accurate measurement of the distal rectal tumor margin is essential in selecting the appropriate surgical procedure. However, there is no standard measurement method. The National Cancer Institute consensus group recommends use of the anal verge (AV) as a landmark, and the European Society of Gastrointestinal and Abdominal Radiology recommends use of the anorectal ring (ARR). In addition, whether measurements should be made on double contrast barium enema (BE) radiographs or magnetic resonance (MR) images remains controversial. We measured the distal tumor margin on both BE and MR images obtained preoperatively from 52 patients who underwent sphincter-saving resection for rectal cancer. The distances from the distal end of the tumor to the AV and the ARR were measured on both types of images, and the variability was investigated by Bland-Altman analysis. The mean distance from the tumor to the AV was 8.9 cm on the BE radiographs and 7.7 cm on the MR images (P=0.013). The mean distances to the ARR were 6.8 and 5.6 cm, respectively (P=0.070). Significant proportional bias was shown as the measured distances increased, the difference between the BE- and magnetic resonance imaging (MRI)-based measurements increased. Use of one or the other landmark did not affect selection of the appropriate surgical procedure. We conclude that an approximate 1-cm underestimation should be taken into account when MRI-based measurement of the distal rectal tumor margin is used to choose between sphincter-saving resection and abdominoperineal resection. PMID:28280625

  12. Study to Determine Adequate Margins in Radiotherapy Planning for Esophageal Carcinoma by Detailing Patterns of Recurrence After Definitive Chemoradiotherapy

    SciTech Connect

    Button, Michael R. Morgan, Carys A.; Croydon, Elizabeth S.; Roberts, S. Ashley; Crosby, Thomas D.L.

    2009-03-01

    Purpose: To ascertain the adequacy of radiotherapy (RT) margins by studying the relapse patterns after definitive chemoradiotherapy for carcinoma of the esophagus. Methods and Materials: We performed a retrospective study assessing the first site of disease relapse after definitive chemoradiotherapy that included four 3-weekly cycles of cisplatin and continuous infusion 5-fluorouracil, with conformal RT (50 Gy in 25 fractions) concurrent with Cycles 3 and 4. The RT planning target volume was the endoscopic ultrasonography/computed tomography-defined gross tumor volume with 1.5-cm lateral and 3-cm superoinferior margins. Results: A total of 145 patients were included. Their average age was 65.4 years, 45% had adenocarcinoma, 61% had lower third esophageal tumors, and 75% had Stage III-IVA disease. After RT, of 142 patients, 85 (60%) had evidence of relapse at a median follow-up of 18 months. The relapse was local (within the RT field) in 55; distant (metastatic) in 13, and a combination of local and distant in 14. The local relapse rates were not influenced by tumor stage, lymph node status, or disease length. Three patients developed a relapse in regions adjacent to the RT fields; however, it is unlikely that larger field margins would have been clinically acceptable or effective in these cases. The median overall survival was 15 months. Conclusion: The gross tumor volume-planning target volume margins in this study appeared adequate. Future efforts to improve outcomes using definitive chemoradiotherapy should be directed toward reducing the high rates of in-field and distant relapses.

  13. Delivering surgical training in the People's Republic of China: are current mechanisms adequate?

    PubMed

    Wan, Yizhou Carl; Wan, Yize Isalina

    2008-12-01

    The need for comprehensive surgical care for China's vast population is evident in improving patient treatment outcomes. Rapid economic development has meant that China has become a developing country with a unique opportunity to formulate and strategise training of its surgeons to build a firm foundation for the advancement of clinical surgery and the surgical sciences. Currently deployed within the three-tiered health care system, surgical training in China is complex. Medical school education is variable in duration from 3-8 years yet the possibility of surgical training is not open to all graduates. Postgraduate training, known as Standard Surgical Training (SST) lasts for approximately five years and is separated into two phases by the central government, however there is no central regulation of the training progression and certification is organised at a local level. Academic requirements are high and research output is mandatory at higher level training, with doctorates able to fast-track through surgical training. There are major concerns with equality and disparity in training resources and opportunities as well as actually addressing clinical needs of local patient populations. Despite this, surgical training in China is undergoing constant development and its future will prove important observations of international medical education strategies.

  14. Zero positive surgical margins after radical prostatectomy: is the end in sight.

    PubMed

    Skarecky, Douglas W; Brenner, Mattew; Rajan, Sudhir; Rodriguez, Esequiel; Narula, Navneet; Melgoza, Frank; Ahlering, Thomas E

    2008-11-01

    Positive surgical margins represents incomplete resection by the surgeon, and the elimination of positive margins represents the only clinical feature during radical prostatectomy that can lead directly to improved cancer outcomes. The introduction of new robot-assisted technology and technical refinements has led to declines of positive surgical margins. Although margins induced by incomplete cancer resection by the surgeon have been reduced for organ-confined disease, the 'Holy Grail' of zero margins is not yet attainable in prostatectomy, and is more problematic in cancer that has penetrated beyond the prostate. Intraoperative frozen biopsies are imprecise. The union of real-time optical coherence tomography technology of the da Vinci robotic platform for identification of positive margin sites, and technical advances with wider excisions during surgery may provide promise for further reduction of surgical margins to zero.

  15. Spatially Offset Raman Spectroscopy for Surgical Margin Evaluation During Breast Conserving Therapy

    DTIC Science & Technology

    2011-02-01

    Autofluorescence and diffuse reflectance spectroscopy and spectral imaging for breast margin analysis, Lasers in Surgery and Medicine, 42(1), 15-23...and A. Mahadevan-Jansen, “Autofluorescence and diffuse reflectance spectroscopy and spectral imaging for breast surgical margin analysis,” Lasers

  16. Surgical margins in the genomic era: The Hayes Martin Lecture, 2012.

    PubMed

    Wolf, Gregory T

    2012-11-01

    One of the highest honors of one's career is to be asked to address colleagues, mentors, and students who represent the world's leading health professionals dedicated to reducing the morbidity and mortality associated with head and neck cancer. Hayes Martin would certainly share this feeling of honor and humility in having a lecture given in his name on the occasion of the Eighth International Conference on Head and Neck Cancer. I am so very pleased to share with you some thoughts on the assessment, adequacy, and application of surgical resection margins in an era in which personalized surgery and molecular medicine will have a major impact on patient outcomes. My thoughts about surgical margins have evolved over nearly 40 years of performing surgical resections for cancer. A discussion of margins may seem somewhat mundane to many of you; however, I hope to provide a futuristic and somewhat theoretical view of how surgical margin issues will relate to the personalization of modern head and neck cancer treatment and how the biology of the tumor microenvironment may be instructive in the application of our surgical approaches. This is particularly relevant because of the rapid expansion of functional surgical approaches utilizing minimally invasive endoscopic resections and robotic techniques that may not achieve the same wide oncologic margins that have been emphasized historically.(1,2) Proper selection of patients for such procedures is critical if we are to improve overall treatment results.

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

    PubMed Central

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

    2015-01-01

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

  18. In vivo intra-operative breast tumor margin detection using a portable OCT system with a handheld surgical imaging probe

    NASA Astrophysics Data System (ADS)

    Erickson-Bhatt, Sarah J.; Nolan, Ryan; Shemonski, Nathan D.; Adie, Steven G.; Putney, Jeffrey; Darga, Donald; McCormick, Daniel T.; Cittadine, Andrew; Marjanovic, Marina; Chaney, Eric J.; Monroy, Guillermo L.; South, Fredrick; Carney, P. Scott; Cradock, Kimberly A.; Liu, Z. George; Ray, Partha S.; Boppart, Stephen A.

    2014-02-01

    Breast-conserving surgery is a frequent option for women with stage I and II breast cancer, and with radiation treatment, can be as effective as a mastectomy. However, adequate margin detection remains a challenge, and too often additional surgeries are required. Optical coherence tomography (OCT) provides a potential method for real-time, high-resolution imaging of breast tissue during surgery. Intra-operative OCT imaging of excised breast tissues has been previously demonstrated by several groups. In this study, a novel handheld surgical probe-based OCT system is introduced, which was used by the surgeon to image in vivo, within the tumor cavity, and immediately following tumor removal in order to detect the presence of any remaining cancer. Following resection, study investigators imaged the excised tissue with the same probe for comparison. We present OCT images obtained from over 15 patients during lumpectomy and mastectomy surgeries. Images were compared to post-operative histopathology for diagnosis. OCT images with micron scale resolution show areas of heterogeneity and disorganized features indicative of malignancy, compared to more uniform regions of normal tissue. Video-rate acquisition shows the inside of the tumor cavity as the surgeon sweeps the probe along the walls of the surgical cavity. This demonstrates the potential of OCT for real-time assessment of surgical tumor margins and for reducing the unacceptably high re-operation rate for breast cancer patients.

  19. Pancreatic Cancer Surgical Resection Margins: Molecular Assessment by Mass Spectrometry Imaging

    PubMed Central

    Eberlin, Livia S.; Zare, Richard N.; Tibshirani, Robert; Longacre, Teri A.; Jalali, Moe; Norton, Jeffrey A.; Poultsides, George A.

    2016-01-01

    Background Surgical resection with microscopically negative margins remains the main curative option for pancreatic cancer; however, in practice intraoperative delineation of resection margins is challenging. Ambient mass spectrometry imaging has emerged as a powerful technique for chemical imaging and real-time diagnosis of tissue samples. We applied an approach combining desorption electrospray ionization mass spectrometry imaging (DESI-MSI) with the least absolute shrinkage and selection operator (Lasso) statistical method to diagnose pancreatic tissue sections and prospectively evaluate surgical resection margins from pancreatic cancer surgery. Methods and Findings Our methodology was developed and tested using 63 banked pancreatic cancer samples and 65 samples (tumor and specimen margins) collected prospectively during 32 pancreatectomies from February 27, 2013, to January 16, 2015. In total, mass spectra for 254,235 individual pixels were evaluated. When cross-validation was employed in the training set of samples, 98.1% agreement with histopathology was obtained. Using an independent set of samples, 98.6% agreement was achieved. We used a statistical approach to evaluate 177,727 mass spectra from samples with complex, mixed histology, achieving an agreement of 81%. The developed method showed agreement with frozen section evaluation of specimen margins in 24 of 32 surgical cases prospectively evaluated. In the remaining eight patients, margins were found to be positive by DESI-MSI/Lasso, but negative by frozen section analysis. The median overall survival after resection was only 10 mo for these eight patients as opposed to 26 mo for patients with negative margins by both techniques. This observation suggests that our method (as opposed to the standard method to date) was able to detect tumor involvement at the margin in patients who developed early recurrence. Nonetheless, a larger cohort of samples is needed to validate the findings described in this study

  20. Surgical margins in breast-conserving therapy: current trends and future prospects.

    PubMed

    Sanguinetti, Alessandro; Lucchini, Roberta; Santoprete, Stefano; Bistoni, Giovanni; Avenia, Stefano; Triola, Roberto; Avenia, Nicola

    2013-01-01

    Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse effects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher “a priori” risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radio-guided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.

  1. A new method of assessing the surgical margin in rectal carcinoma—using nonlinear optical microscopy

    NASA Astrophysics Data System (ADS)

    Li, Lianhuang; Chen, Zhifen; Kang, Deyong; Deng, Tongxin; Jiang, Liwei; Zhou, Yi; Liu, Xing; Jiang, Weizhong; Zhuo, Shuangmu; Guan, Guoxian; Chi, Pan; Chen, Jianxin

    2016-06-01

    Nowadays, surgical resection is still the most effective treatment strategy for rectal carcinoma and one of the most important factors affecting whether the operation is successful or not is the surgical margin determination, especially in the distal rectal carcinoma which should take the sphincter-preserving issue into consideration. However, until recently no reliable evaluation method has been developed for this purpose. There are some shortcomings in intraoperative negative surgical margin assessment such as either lack of enough detailed information of biological tissues or the fact that it is time-consuming. Multiphoton microscopy (MPM)—nonlinear optical microscopy, which is based on the nonlinear optical process two-photon excited fluorescence (TPEF) and second harmonic generation (SHG), has the ability to label freely and noninvasively visualize tissue micro-architecture at the sub-cellular level. The advantage of providing high contrast and high resolution biomedical image in real time makes MPM have a wide range of applications in life sciences. In this study, we introduced MPM to identify the boundary between normal and abnormal rectal tissues. MPM images clearly exhibit biological tissue microstructure and its morphological changes in the regions of our interest, which enable it to determine the surgical margin in rectal carcinoma. It can be foreseen that once MPM imaging system is used in clinical examination, it will greatly improve the accuracy of surgical resection.

  2. X-ray coherent scatter imaging for surgical margin detection: a Monte Carlo study

    NASA Astrophysics Data System (ADS)

    Lakshmanan, Manu N.; Kapadia, Anuj J.; Harrawood, Brian P.; Brady, David; Samei, Ehsan

    2014-03-01

    Instead of having the entire breast removed (a mastectomy), breast cancer patients often receive a breast con- serving surgery (BCS) for removal of only the breast tumor. If post-surgery analysis reveals ta missed margin around the tumor tissue excised through the BCS procedure, the physician must often call the patient back for another surgery, which is both difficult and risky for the patient. If this "margin detection" could be performed during the BCS procedure itself, the surgical team could use the analysis to ensure that all tumor tissue was removed in a single surgery, thereby potentially reducing the number of call backs from breast cancer surgery. We describe here a potential technique to detect surgical tumor margins in breast cancer using x-ray coherent scatter imaging. In this study, we demonstrate the imaging ability of this technique using Monte Carlo simulations.

  3. Evaluation of overall setup accuracy and adequate setup margins in pelvic image-guided radiotherapy: Comparison of the male and female patients

    SciTech Connect

    Laaksomaa, Marko; Kapanen, Mika; Tulijoki, Tapio; Peltola, Seppo; Hyödynmaa, Simo; Kellokumpu-Lehtinen, Pirkko-Liisa

    2014-04-01

    We evaluated adequate setup margins for the radiotherapy (RT) of pelvic tumors based on overall position errors of bony landmarks. We also estimated the difference in setup accuracy between the male and female patients. Finally, we compared the patient rotation for 2 immobilization devices. The study cohort included consecutive 64 male and 64 female patients. Altogether, 1794 orthogonal setup images were analyzed. Observer-related deviation in image matching and the effect of patient rotation were explicitly determined. Overall systematic and random errors were calculated in 3 orthogonal directions. Anisotropic setup margins were evaluated based on residual errors after weekly image guidance. The van Herk formula was used to calculate the margins. Overall, 100 patients were immobilized with a house-made device. The patient rotation was compared against 28 patients immobilized with CIVCO's Kneefix and Feetfix. We found that the usually applied isotropic setup margin of 8 mm covered all the uncertainties related to patient setup for most RT treatments of the pelvis. However, margins of even 10.3 mm were needed for the female patients with very large pelvic target volumes centered either in the symphysis or in the sacrum containing both of these structures. This was because the effect of rotation (p ≤ 0.02) and the observer variation in image matching (p ≤ 0.04) were significantly larger for the female patients than for the male patients. Even with daily image guidance, the required margins remained larger for the women. Patient rotations were largest about the lateral axes. The difference between the required margins was only 1 mm for the 2 immobilization devices. The largest component of overall systematic position error came from patient rotation. This emphasizes the need for rotation correction. Overall, larger position errors and setup margins were observed for the female patients with pelvic cancer than for the male patients.

  4. Surgical Margins and the Risk of Local-Regional Recurrence After Mastectomy Without Radiation Therapy

    SciTech Connect

    Childs, Stephanie K.; Chen Yuhui; Duggan, Margaret M.; Golshan, Mehra; Pochebit, Stephen; Wong, Julia S.; Bellon, Jennifer R.

    2012-12-01

    Purpose: Although positive surgical margins are generally associated with a higher risk of local-regional recurrence (LRR) for most solid tumors, their significance after mastectomy remains unclear. We sought to clarify the influence of the mastectomy margin on the risk of LRR. Methods and Materials: The retrospective cohort consisted of 397 women who underwent mastectomy and no radiation for newly diagnosed invasive breast cancer from 1998-2005. Time to isolated LRR and time to distant metastasis (DM) were evaluated by use of cumulative-incidence analysis and competing-risks regression analysis. DM was considered a competing event for analysis of isolated LRR. Results: The median follow-up was 6.7 years (range, 0.5-12.8 years). The superficial margin was positive in 41 patients (10%) and close ({<=}2 mm) in 56 (14%). The deep margin was positive in 23 patients (6%) and close in 34 (9%). The 5-year LRR and DM rates for all patients were 2.4% (95% confidence interval, 0.9-4.0) and 3.5% (95% confidence interval, 1.6-5.3) respectively. Fourteen patients had an LRR. Margin status was significantly associated with time to isolated LRR (P=.04); patients with positive margins had a 5-year LRR of 6.2%, whereas patients with close margins and negative margins had 5-year LRRs of 1.5% and 1.9%, respectively. On univariate analysis, positive margins, positive nodes, lymphovascular invasion, grade 3 histology, and triple-negative subtype were associated with significantly higher rates of LRR. When these factors were included in a multivariate analysis, only positive margins and triple-negative subtype were associated with the risk of LRR. Conclusions: Patients with positive mastectomy margins had a significantly higher rate of LRR than those with a close or negative margin. However, the absolute risk of LRR in patients with a positive surgical margin in this series was low, and therefore the benefit of postmastectomy radiation in this population with otherwise favorable

  5. Video-rate structured illumination microscopy (VR-SIM) for rapid assessment of fresh surgical margins

    NASA Astrophysics Data System (ADS)

    Tulman, David B.; Wang, Mei; Kimbrell, Hillary Z.; Sholl, Andrew B.; Elfer, Katherine N.; Schlichenmeyer, Tyler C.; Mandava, Sree; Lee, Benjamin R.; Lacey, Michelle; Brown, J. Quincy

    2015-07-01

    Intra-operative surgical margin assessment by pathology is labor-intensive and time-consuming and is not practically capable of sampling the entire specimen. Positive surgical margins (PSMs), or tumor extending to the surface of the excised specimen, are associated with increased tumor recurrence and are accepted as poor independent prognostic indicators. Considering the PSM rate is high for patients with prostate and kidney cancer, residual tumor following radical prostatectomy and partial nephrectomy remains a significant problem. To address the unmet clinical need for an imaging tool that can provide sub-cellular resolution images of large areas of excised surgical specimens in an intra-operative timeframe, we have developed a video rate structured illumination microscopy (VR-SIM) system. We conducted a clinical trial using VR-SIM to create gigapixel mosaics of entire margin surfaces for each specimen. In the ongoing study, 5 patients undergoing radical prostatectomy and 4 patients undergoing partial nephrectomy participated to have digital images of their surgical specimens reviewed in comparison to the pathology report. The surfaces of the intact, excised specimens were imaged in an appropriate timeframe and showed visualization of histopathologically relevant structures.

  6. Factors affecting surgical margin recurrence after hepatectomy for colorectal liver metastases

    PubMed Central

    Akyuz, Muhammet; Aucejo, Federico; Quintini, Cristiano; Miller, Charles; Fung, John

    2016-01-01

    Background Hepatic recurrence after resection of colorectal liver metastasis (CLM) occurs in 50% of patients during follow-up, with 2.8% to 13.9% presenting with surgical margin recurrence (SMR). The aim of this study is to analyze factors that related to SMR in patients with CLM undergoing hepatectomy. Methods Demographics, clinical and survival data of patients who underwent hepatectomy were identified from a prospectively maintained, institutional review board (IRB)-approved database between 2000 and 2012. Statistical analysis was performed using univariate Kaplan Meier and Cox proportional hazard model. Results There were 85 female and 121 male patients who underwent liver resection for CLM. An R0 resection was performed in 157 (76%) patients and R1 resection in 49. SMR was detected in 32 patients (15.5%) followed up for a median of 29 months (range, 3–121 months). A half of these patients had undergone R1 (n=16) and another half R0 resection (n=16). Tumor size, preoperative carcinoembryonic antigen (CEA) level and margin status were associated with SMR on univariate analysis. On multivariate analysis, a positive surgical margin was the only independent predictor of SMR. The receipt of adjuvant chemotherapy did not affect margin recurrence. SMR was an independent risk factor associated with worse disease-free (DFS) and overall survival (OS). Conclusions This study shows that SMR, which can be detected in up to 15.5% of patients after liver resection for CLM, adversely affects DFS and OS. The fact that a positive surgical margin was the only predictive factor for SMR in these patients underscores the importance of achieving negative margins during hepatectomy. PMID:27294032

  7. Hyperspectral Imaging for Cancer Surgical Margin Delineation: Registration of Hyperspectral and Histological Images.

    PubMed

    Lu, Guolan; Halig, Luma; Wang, Dongsheng; Chen, Zhuo Georgia; Fei, Baowei

    2014-03-12

    The determination of tumor margins during surgical resection remains a challenging task. A complete removal of malignant tissue and conservation of healthy tissue is important for the preservation of organ function, patient satisfaction, and quality of life. Visual inspection and palpation is not sufficient for discriminating between malignant and normal tissue types. Hyperspectral imaging (HSI) technology has the potential to noninvasively delineate surgical tumor margin and can be used as an intra-operative visual aid tool. Since histological images provide the ground truth of cancer margins, it is necessary to warp the cancer regions in ex vivo histological images back to in vivo hyperspectral images in order to validate the tumor margins detected by HSI and to optimize the imaging parameters. In this paper, principal component analysis (PCA) is utilized to extract the principle component bands of the HSI images, which is then used to register HSI images with the corresponding histological image. Affine registration is chosen to model the global transformation. A B-spline free form deformation (FFD) method is used to model the local non-rigid deformation. Registration experiment was performed on animal hyperspectral and histological images. Experimental results from animals demonstrated the feasibility of the hyperspectral imaging method for cancer margin detection.

  8. Utility of dermoscopy for demarcation of surgical margins in Mohs micrographic surgery*

    PubMed Central

    Suzuki, Heliane Sanae; Serafini, Sérgio Zuñeda; Sato, Maurício Shigueru

    2014-01-01

    BACKGROUND Skin cancer is the most common malignancy and can be treated in various ways. One treatment modality is Mohs micrographic surgery. Due to the increasing incidence of skin cancer in the last decades, there is a need for improvement of the Mohs technique to optimize its effectiveness. OBJECTIVE The aim of this study was to evaluate the use of dermoscopy to guide demarcation of Mohs micrographic surgery margins and ascertain whether this method can reduce operative time and, therefore, reduce surgical morbidity and cost. METHODS AND MATERIALS The sample comprised 44 patients who underwent Mohs micrographic surgery, allocated into two groups: the control group and the intervention group. In the latter, surgical margins were guided by dermoscopy. RESULTS There were no statistically significant differences between the two groups by chi-square analysis (p = 0.399). CONCLUSION Although outcomes were similar in the two groups, demonstrating that dermoscopy does not help in the demarcation of surgical margins for Mohs micrographic surgery, the study provides a practical proposal for improvement of the Mohs technique. PMID:24626646

  9. Significance and management of positive surgical margins at the time of radical prostatectomy

    PubMed Central

    Silberstein, Jonathan L.; Eastham, James A.

    2014-01-01

    Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique. PMID:25378825

  10. Towards intraoperative surgical margin assessment and visualization using bioimpedance properties of the tissue

    NASA Astrophysics Data System (ADS)

    Khan, Shadab; Mahara, Aditya; Hyams, Elias S.; Schned, Alan; Halter, Ryan

    2015-03-01

    Prostate cancer (PCa) has a high 10-year recurrence rate, making PCa the second leading cause of cancer-specific mortality among men in the USA. PCa recurrences are often predicted by assessing the status of surgical margins (SM) with positive surgical margins (PSM) increasing the chances of biochemical recurrence by 2-4 times. To this end, an SM assessment system using Electrical Impedance Spectroscopy (EIS) was developed with a microendoscopic probe. This system measures the tissue bioimpedance over a range of frequencies (1 kHz to 1MHz), and computes a Composite Impedance Metric (CIM). CIM can be used to classify tissue as benign or cancerous. The system was used to collect the impedance spectra from excised prostates, which were obtained from men undergoing radical prostatectomy. The data revealed statistically significant (p<0.05) differences in the impedance properties of the benign and tumorous tissues, and between different tissue morphologies. To visualize the results of SM-assessment, a visualization tool using da Vinci stereo laparoscope is being developed. Together with the visualization tool, the EIS-based SM assessment system can be potentially used to intraoperatively classify tissues and display the results on the surgical console with a video feed of the surgical site, thereby augmenting a surgeon's view of the site and providing a potential solution to the intraoperative SM assessment needs.

  11. Significance and management of positive surgical margins at the time of radical prostatectomy.

    PubMed

    Silberstein, Jonathan L; Eastham, James A

    2014-10-01

    Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique.

  12. Effects of the antituberculous drug ethambutol on zinc absorption, turnover and distribution in rats fed diet marginal and adequate in zinc

    SciTech Connect

    King, A.B.; Schwartz, R.

    1987-04-01

    Ethambutol, (CH/sub 3/CH/sub 2/-CH(CH/sub 2/OH)-NH-CH/sub 2/)/sub 2/ (EMB), is an oral antituberculous agent that is administered therapeutically over extended time periods. It has chelating properties and may affect mineral metabolism. Male weanling Sprague-Dawley rats received 0, 400 or 600 mg EMB per kilogram body weight daily by gavage for 30 d. They were fed a casein-based diet with either adequate (49 ppm) or marginal (11 ppm) zinc. Both adequate-Zn (AZn) and marginal-Zn (MZn) rats receiving EMB showed alopecia and dose-dependent reductions in feed intake, weight gain and feed efficiency. None of these changes was seen in rats fed the MZn diet without EMB. Serum and tissue zinc levels were similar in rats not receiving EMB, regardless of the dietary zinc level. Serum zinc was consistently lower in AZn and MZn rats receiving EMB than in rats without EMB. Apparent zinc absorption, measured by /sup 65/Zn balance, was higher in AZn rats receiving EMB than in AZn rats without EMB. Thus, changes in absorption could not account for lower serum zinc levels in EMB-treated rats. However, /sup 65/Zn turnover was also higher in EMB groups. This suggests that EMB may have increased urinary zinc losses resulting in reduced circulating zinc and a consequent increase in zinc absorption.

  13. 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.

  14. Gigapixel surface imaging of radical prostatectomy specimens for comprehensive detection of cancer-positive surgical margins using structured illumination microscopy

    PubMed Central

    Wang, Mei; Tulman, David B.; Sholl, Andrew B.; Kimbrell, Hillary Z.; Mandava, Sree H.; Elfer, Katherine N.; Luethy, Samuel; Maddox, Michael M.; Lai, Weil; Lee, Benjamin R.; Brown, J. Quincy

    2016-01-01

    Achieving cancer-free surgical margins in oncologic surgery is critical to reduce the need for additional adjuvant treatments and minimize tumor recurrence; however, there is a delicate balance between completeness of tumor removal and preservation of adjacent tissues critical for normal post-operative function. We sought to establish the feasibility of video-rate structured illumination microscopy (VR-SIM) of the intact removed tumor surface as a practical and non-destructive alternative to intra-operative frozen section pathology, using prostate cancer as an initial target. We present the first images of the intact human prostate surface obtained with pathologically-relevant contrast and subcellular detail, obtained in 24 radical prostatectomy specimens immediately after excision. We demonstrate that it is feasible to routinely image the full prostate circumference, generating gigapixel panorama images of the surface that are readily interpreted by pathologists. VR-SIM confirmed detection of positive surgical margins in 3 out of 4 prostates with pathology-confirmed adenocarcinoma at the circumferential surgical margin, and furthermore detected extensive residual cancer at the circumferential margin in a case post-operatively classified by histopathology as having negative surgical margins. Our results suggest that the increased surface coverage of VR-SIM could also provide added value for detection and characterization of positive surgical margins over traditional histopathology. PMID:27257084

  15. Gigapixel surface imaging of radical prostatectomy specimens for comprehensive detection of cancer-positive surgical margins using structured illumination microscopy

    NASA Astrophysics Data System (ADS)

    Wang, Mei; Tulman, David B.; Sholl, Andrew B.; Kimbrell, Hillary Z.; Mandava, Sree H.; Elfer, Katherine N.; Luethy, Samuel; Maddox, Michael M.; Lai, Weil; Lee, Benjamin R.; Brown, J. Quincy

    2016-06-01

    Achieving cancer-free surgical margins in oncologic surgery is critical to reduce the need for additional adjuvant treatments and minimize tumor recurrence; however, there is a delicate balance between completeness of tumor removal and preservation of adjacent tissues critical for normal post-operative function. We sought to establish the feasibility of video-rate structured illumination microscopy (VR-SIM) of the intact removed tumor surface as a practical and non-destructive alternative to intra-operative frozen section pathology, using prostate cancer as an initial target. We present the first images of the intact human prostate surface obtained with pathologically-relevant contrast and subcellular detail, obtained in 24 radical prostatectomy specimens immediately after excision. We demonstrate that it is feasible to routinely image the full prostate circumference, generating gigapixel panorama images of the surface that are readily interpreted by pathologists. VR-SIM confirmed detection of positive surgical margins in 3 out of 4 prostates with pathology-confirmed adenocarcinoma at the circumferential surgical margin, and furthermore detected extensive residual cancer at the circumferential margin in a case post-operatively classified by histopathology as having negative surgical margins. Our results suggest that the increased surface coverage of VR-SIM could also provide added value for detection and characterization of positive surgical margins over traditional histopathology.

  16. Detection of breast positive surgical margins with fluorescence-guided microscopy imaging (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Iftimia, Nicusor V.; Preda, Dorin; Park, Jesung; Antalek, Mitchell

    2016-03-01

    We present a novel technology based on a high sensitivity/specificity cancer targeting agent and of a novel fluorescence-guided microscopy (FGM) scheme for intraoperative assessment of surgical margins in breast cancer patients. Cancer cells are targeted using an optically silent peptide substrate coupled to a near infrared (NIR) fluorochrome that is cleaved by highly mediated breast cancer enzymes, like urokinase-type plasminogen activator (uPA), to become highly fluorescent when excited by a NIR laser beam. A FGM instrument is used to localize cancer-suspect areas on the lumpectomy specimen and visualize tissue morphology at the sub-cellular scale, such that a trained pathologist can read these images in real-time and confirm or rule-out cancer presence. The proposed technology will enable efficient assessment of surgical specimens during surgery, when it is mostly needed, and therefore help the clinician to determine if additional tissue excision is needed or not. The preliminary testing of this technology on breast surgical specimens will be discussed.

  17. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center.

    PubMed

    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J

    2012-02-01

    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3

  18. In vitro histological evaluation of the surgical margins made by different laser wavelengths in tongue tissues

    PubMed Central

    Azevedo, Ana-Salvaterra; Ferreira, Fernando; Delgado, Maria-Leonor; Garcês, Fernanda; Carreira, Sofia; Martins, Marco; Suarez-Quintanilla, Juan

    2016-01-01

    Background Lasers have become standard tools for the surgical treatment of oral lesions. The purpose of this study is to determine the surgical margins and histologically evaluate the tissue thermal effects induced by different types of surgical instruments. Material and Methods Cuts were made in pork tongues’ mucosa with different lasers (Er:YAG at 2W with and without air / water spray and at 4W with and without air / water spray; CO2 at 3.5W and 7W in pulsed mode and at 7W in continuous mode; the diode laser at 3.5W and boost 3.5W in pulsed mode; Nd:YAG at 6W, 40Hz and electroscalpel at 5W and conventional scalpel as control. Macroscopic and microscopic morphological changes were evaluated. Results The results of this study showed that the surgical instruments that caused greater tissue damage extension were: the Nd:YAG laser (670.68μm), the diode 3.5W and boost PW (626.82μm), the CO2 7W CW (571.18μm), the CO2 at 7W PW (485.45μm), the diode 3.5W PW (456.15μm), the electroscalpel (409.57μm) and lastly the CO2 laser 3.5W PW (306.19μm) and Er:YAG (74.66μm) laser, regardless of power, mode or air / water spray used. An association between the Tissue Damage Extension and the Degree of Carbonization (r = 0.789; P = 0.01), and an association between the Tissue Damage Extension and Regularity of the Incision were found (r = -, 299; P = 0.01). Conclusions The results of this study suggest that lasers can be used in soft tissues biopsies of the oral cavity, enabling a correct histopathological analysis, as long as the biological effects of each laser type are considered. The Er:YAG laser revealed its potential for biopsies of the oral mucosa ensuring a successful histological evaluation and the CO2 laser at 3,5W in pulsed mode presented itself as the best choice for surgeries with hemostasis. Key words:CO2 laser, diode laser, Er:YAG laser, laser surgery, Nd:YAG laser, oral mucosa, thermal effect. PMID:27703606

  19. Impact of surgical margin status on prostate-cancer-specific mortality

    PubMed Central

    Chalfin, Heather J.; Dinizo, Michael; Trock, Bruce J.; Feng, Zhaoyong; Partin, Alan W.; Walsh, Patrick C.; Humphreys, Elizabeth; Han, Misop

    2013-01-01

    OBJECTIVE To examine the relative impact of a positive surgical margin (PSM) and other clinicopathological variables on prostate-cancer-specific mortality (PCSM) in a large retrospective cohort of patients undergoing radical prostatectomy (RP). PATIENTS AND METHODS Between 1982 and 2011, 4569 men underwent RP performed by a single surgeon. Of the patient population, 4461 (97.6%) met all the inclusion criteria. The median (range) age was 58 (33–75) years and the median prostate-specific antigen (PSA) was 5.4 ng/mL; RP Gleason score was ≤6 in 2834 (63.7%), 7 in 1351 (30.3%), and 8–10 in 260 (6.0%) patients; PSMs were found in 462 (10.4%) patients. Cox proportional hazards models were used to determine the impact of a PSM on PCSM. RESULTS At a median (range) follow-up of 10 years (1–29), 187 men (4.3%) had died from prostate cancer. The 20-year prostate-cancer-specific survival rate was 75% for those with a PSM and 93% for those without. Compared with those with a negative surgical margin, men with a PSM were more likely to be older (median age 60 vs 58 years) and to have undergone RP in the pre-PSA era (36.6% vs 11.8%). Additionally, they were more likely to have a higher PSA level (median 7.6 vs 5.2 ng/mL), a Gleason score of ≥7 (58.7% vs 33.7%), and a non-organ-confined tumour (90.9% vs 30.6% [P < 0.001 for all]). In a univariate model for PCSM, PSM was highly significant (hazard ratio [HR] 5.0, 95% confidence interval [CI] 3.7–6.7, P < 0.001). In a multivariable model, adjusting for pathological variables and RP year, PSM remained an independent predictor of PCSM (HR 1.4, 95% CI 1.0–1.9, P = 0.036) with a modest effect relative to RP Gleason score (HR 5.7–12.6) and pathological stage (HR 2.2–11.0 [P < 0.001]). CONCLUSION Although a PSM has a statistically significant adverse effect on prostate-cancer-specific survival in multivariable analysis, Gleason grade and pathological stage were stronger predictors. PMID:22788795

  20. A comparative analysis of primary and secondary Gleason pattern predictive ability for positive surgical margins after radical prostatectomy.

    PubMed

    Sfoungaristos, S; Kavouras, A; Kanatas, P; Polimeros, N; Perimenis, P

    2011-01-01

    To compare the predictive ability of primary and secondary Gleason pattern for positive surgical margins in patients with clinically localized prostate cancer and a preoperative Gleason score ≤ 6. A retrospective analysis of the medical records of patients undergone a radical prostatectomy between January 2005 and October 2010 was conducted. Patients' age, prostate volume, preoperative PSA, biopsy Gleason score, the 1st and 2nd Gleason pattern were entered a univariate and multivariate analysis. The 1st and 2nd pattern were tested for their ability to predict positive surgical margins using receiver operating characteristic curves. Positive surgical margins were noticed in 56 cases (38.1%) out of 147 studied patients. The 2nd pattern was significantly greater in those with positive surgical margins while the 1st pattern was not significantly different between the 2 groups of patients. ROC analysis revealed that area under the curve was 0.53 (p=0.538) for the 1st pattern and 0.60 (p=0.048) for the 2nd pattern. Concerning the cases with PSA <10 ng/ml, it was also found that only the 2nd pattern had a predictive ability (p=0.050). When multiple logistic regression analysis was conducted it was found that the 2nd pattern was the only independent predictor. The second Gleason pattern was found to be of higher value than the 1st one for the prediction of positive surgical margins in patients with preoperative Gleason score ≤ 6 and this should be considered especially when a neurovascular bundle sparing radical prostatectomy is planned, in order not to harm the oncological outcome.

  1. Pancreatic Neuroendocrine Tumors With Involved Surgical Margins: Prognostic Factors and the Role of Adjuvant Radiotherapy

    SciTech Connect

    Arvold, Nils D.; Willett, Christopher G.; Fernandez-del Castillo, Carlos; Ryan, David P.; Ferrone, Cristina R.; Clark, Jeffrey W.; Blaszkowsky, Lawrence S.; Deshpande, Vikram; Niemierko, Andrzej; Allen, Jill N.; Kwak, Eunice L.; Wadlow, Raymond C.; Zhu, Andrew X.; Warshaw, Andrew L.; Hong, Theodore S.

    2012-07-01

    Purpose: Pancreatic neuroendocrine tumors (pNET) are rare neoplasms associated with poor outcomes without resection, and involved surgical margins are associated with a worse prognosis. The role of adjuvant radiotherapy (RT) in these patients has not been characterized. Methods and Materials: We retrospectively evaluated 46 consecutive patients with positive or close (<1 mm) margins after pNET resection, treated from 1983 to 2010, 16 of whom received adjuvant RT. Median RT dose was 50.4 Gy in 1.8-Gy fractions; half the patients received concurrent chemotherapy with 5-fluorouracil or capecitabine. No patients received adjuvant chemotherapy. Cox multivariate analysis (MVA) was used to analyze factors associated with overall survival (OS). Results: Median age at diagnosis was 56 years, and 52% of patients were female. Median tumor size was 38 mm, 57% of patients were node-positive, and 11% had a resected solitary liver metastasis. Patients who received RT were more likely to have larger tumors (median, 54 mm vs. 30 mm, respectively, p = 0.002) and node positivity (81% vs. 33%, respectively, p = 0.002) than those not receiving RT. Median follow-up was 39 months. Actuarial 5-year OS was 62% (95% confidence interval [CI], 41%-77%). In the group that did not receive RT, 3 patients (10%) experienced local recurrence (LR) and 5 patients (18%) developed new distant metastases, while in the RT group, 1 patient (6%) experienced LR and 5 patients (38%) developed distant metastases. Of all recurrences, 29% were LR. On MVA, male gender (adjusted hazard ratio [AHR] = 3.81; 95% CI, 1.21-11.92; p = 0.02) and increasing tumor size (AHR = 1.02; 95% CI, 1.01-1.04; p = 0.007) were associated with decreased OS. Conclusions: Long-term survival is common among patients with involved-margin pNET. Despite significantly worse pathologic features among patients receiving adjuvant RT, rates of LR between groups were similar, suggesting that RT might aid local control, and merits further

  2. Resection Margin and Survival in 2368 Patients Undergoing Hepatic Resection for Metastatic Colorectal Cancer: Surgical Technique or Biologic Surrogate?

    PubMed Central

    Sadot, Eran; Koerkamp, Bas Groot; Leal, Julie N.; Shia, Jinru; Gonen, Mithat; Allen, Peter J.; DeMatteo, Ronald P.; Kingham, T. Peter; Kemeny, Nancy; Blumgart, Leslie H.; Jarnagin, William R.; D’Angelica, Michael I.

    2015-01-01

    OBJECTIVE The impact of margin width on overall survival (OS) in the context of other prognostic factors after resection for colorectal liver metastases (CRLM) is unclear. We evaluated the relationship between resection margin and OS utilizing high-resolution histologic distance measurements. METHODS A single institution prospectively maintained database was queried for all patients who underwent an initial complete resection of CRLM between 1992–2012. R1 resection was defined as tumor cells at the resection margin (0 mm). R0 resection was further divided into 3 groups: 0.1–0.9 mm, 1–9 mm, ≥ 10mm. RESULTS A total of 4915 liver resections were performed at MSKCC between 1992 and 2012, from which 2368 patients were included in the current study. Half of the patients presented with synchronous disease, 43% had solitary metastasis, and the median tumor size was 3.4cm. With a median follow-up for survivors of 55 months, the median OS of the R1, 0.1–0.9 mm, 1–9 mm, and ≥ 10mm groups were 32, 40, 53, and 56 months, respectively (p < 0.001). Compared to R1 resection, all margin widths, including submillimeter margins correlated with prolonged OS (p < 0.05). The association between the margin width and OS remained significant when adjusted for all other clinicopathologic prognostic factors. CONCLUSIONS Resection margin width is independently associated with OS. Wide margins should be attempted whenever possible. However, resection should not be precluded if narrow margins are anticipated, as submillimeter margin clearance is associated with improved survival. The prolonged OS observed with submillimeter margins is likely a microscopic surrogate for the biologic behavior of a tumor rather than the result of surgical technique. PMID:26258316

  3. Ambient Ionization Mass Spectrometry for Cancer Diagnosis and Surgical Margin Evaluation

    PubMed Central

    Ifa, Demian R.; Eberlin, Livia S.

    2017-01-01

    Background There is a clinical need for new technologies that would enable rapid disease diagnosis based on diagnostic molecular signatures. Ambient ionization mass spectrometry has revolutionized the means by which molecular information can be obtained from tissue samples in real time and with minimal sample pretreatment. New developments in ambient ionization techniques applied to clinical research suggest that ambient ionization mass spectrometry will soon become a routine medical tool for tissue diagnosis. Content This review summarizes the main developments in ambient ionization techniques applied to tissue analysis, with focus on desorption electrospray ionization mass spectrometry, probe electrospray ionization, touch spray, and rapid evaporative ionization mass spectrometry. We describe their applications to human cancer research and surgical margin evaluation, highlighting integrated approaches tested for ex vivo and in vivo human cancer tissue analysis. We also discuss the challenges for clinical implementation of these tools and offer perspectives on the future of the field. Summary A variety of studies have showcased the value of ambient ionization mass spectrometry for rapid and accurate cancer diagnosis. Small molecules have been identified as potential diagnostic biomarkers, including metabolites, fatty acids, and glycerophospholipids. Statistical analysis allows tissue discrimination with high accuracy rates (>95%) being common. This young field has challenges to overcome before it is ready to be broadly accepted as a medical tool for cancer diagnosis. Growing research in new, integrated ambient ionization mass spectrometry technologies and the ongoing improvements in the existing tools make this field very promising for future translation into the clinic. PMID:26555455

  4. Investigation of the potential of Raman spectroscopy for oral cancer detection in surgical margins.

    PubMed

    Cals, Froukje L J; Bakker Schut, Tom C; Hardillo, José A; Baatenburg de Jong, Robert J; Koljenović, Senada; Puppels, Gerwin J

    2015-10-01

    The poor prognosis of oral cavity squamous cell carcinoma (OCSCC) patients is associated with residual tumor after surgery. Raman spectroscopy has the potential to provide an objective intra-operative evaluation of the surgical margins. Our aim was to understand the discriminatory basis of Raman spectroscopy at a histological level. In total, 127 pseudo-color Raman images were generated from unstained thin tissue sections of 25 samples (11 OCSCC and 14 healthy) of 10 patients. These images were clearly linked to the histopathological evaluation of the same sections after hematoxylin and eosin-staining. In this way, Raman spectra were annotated as OCSCC or as a surrounding healthy tissue structure (i.e., squamous epithelium, connective tissue (CT), adipose tissue, muscle, gland, or nerve). These annotated spectra were used as input for linear discriminant analysis (LDA) models to discriminate between OCSCC spectra and healthy tissue spectra. A database was acquired with 88 spectra of OCSCC and 632 spectra of healthy tissue. The LDA models could distinguish OCSCC spectra from the spectra of adipose tissue, nerve, muscle, gland, CT, and squamous epithelium in 100%, 100%, 97%, 94%, 93%, and 75% of the cases, respectively. More specifically, the structures that were most often confused with OCSCC were dysplastic epithelium, basal layers of epithelium, inflammation- and capillary-rich CT, and connective and glandular tissue close to OCSCC. Our study shows how well Raman spectroscopy enables discrimination between OCSCC and surrounding healthy tissue structures. This knowledge supports the development of robust and reliable classification algorithms for future implementation of Raman spectroscopy in clinical practice.

  5. Does Breast Magnetic Resonance Imaging Combined With Conventional Imaging Modalities Decrease the Rates of Surgical Margin Involvement and Reoperation?

    PubMed Central

    Lai, Hung-Wen; Chen, Chih-Jung; Lin, Ying-Jen; Chen, Shu-Ling; Wu, Hwa-Koon; Wu, Yu-Ting; Kuo, Shou-Jen; Chen, Shou-Tung; Chen, Dar-Ren

    2016-01-01

    Abstract The objective of this study was to assess whether preoperative breast magnetic resonance imaging (MRI) combined with conventional breast imaging techniques decreases the rates of margin involvement and reexcision. Data on patients who underwent surgery for primary operable breast cancer were obtained from the Changhua Christian Hospital (CCH) breast cancer database. The rate of surgical margin involvement and the rate of reoperation were compared between patients who underwent conventional breast imaging modalities (Group A: mammography and sonography) and those who received breast MRI in addition to conventional imaging (Group B: mammography, sonography, and MRI). A total of 1468 patients were enrolled in this study. Among the 733 patients in Group A, 377 (51.4%) received breast-conserving surgery (BCS) and 356 (48.6%) received mastectomy. Among the 735 patients in Group B, 348 (47.3%) received BCS and 387 (52.7%) received mastectomy. There were no significant differences in operative method between patients who received conventional imaging alone and those that received MRI and conventional imaging (P = 0.13). The rate of detection of pathological multifocal/multicentric breast cancer was markedly higher in patients who received preoperative MRI than in those who underwent conventional imaging alone (14.3% vs 8.6%, P < 0.01). The overall rate of surgical margin involvement was significantly lower in patients who received MRI (5.0%) than in those who received conventional imaging alone (9.0%) (P < 0.01). However, a significant reduction in rate of surgical margin positivity was only observed in patients who received BCS (Group A, 14.6%; Group B, 6.6%, P < 0.01). The overall BCS reoperation rates were 11.7% in the conventional imaging group and 3.2% in the combined MRI group (P < 0.01). There were no significant differences in rate of residual cancer in specimens obtained during reoperation between the 2 preoperative imaging groups

  6. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins.

    PubMed

    Tan, Puay Hoon; Cheng, Liang; Srigley, John R; Griffiths, David; Humphrey, Peter A; van der Kwast, Theodore H; Montironi, Rodolfo; Wheeler, Thomas M; Delahunt, Brett; Egevad, Lars; Epstein, Jonathan I

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.

  7. The utility of margin-reflex distance in determining the type of surgical intervention for congenital blepharoptosis

    PubMed Central

    Ural, Ozlem; Mocan, Mehmet Cem; Dolgun, Anıl; Erdener, Ugur

    2016-01-01

    Aims: To evaluate the utility of margin-reflex distance (MRD) as an alternative to levator function (LF) in choosing the appropriate surgical procedure for congenital blepharoptosis. Settings and Design: This was a retrospective, observational study. Subjects and Methods: Records of patients with simple (dystrophic) congenital ptosis who were operated and followed for ≥6 months postoperatively and whose outcomes were deemed as successful were evaluated in the study. Success was defined as a MRD at the last postoperative visit of ≥3 mm. In all cases, levator resection was performed when LF was >4 mm and frontalis suspension when LF was ≤4 mm. Statistical Analysis Used: For statistical evaluations, LF was accepted as the gold standard parameter for deciding on the surgical intervention, and the optimum cutoff point for initial MRD was determined as the point at which sensitivity and specificity was highest at the receiving operating curve for the selection of surgical procedure. Results: Of one hundred and three eyes of ninety patients (44 female/46 male), levator resection was used in 44.7% and frontalis suspension in 55.3%. When the optimum cutoff point for MRD was determined as 0.5 mm, the sensitivity was 71%, specificity was 86%, and the area under the curve that represented the discriminative power of this parameter was found to be 0.826. Conclusion: The MRD at the cutoff point of 0.5 mm may be used as an alternative to LF to determine the type of surgical intervention in patients with congenital blepharoptosis whose LF cannot be reliably obtained in clinical evaluations. PMID:27905338

  8. Multispectral visualization of surgical safety-margins using fluorescent marker seeds

    PubMed Central

    Chin, Patrick TK; Beekman, Chantal AC; Buckle, Tessa; Josephson, Lee; van Leeuwen, Fijs WB

    2012-01-01

    Optical guidance provided by luminescent marker seeds may be suitable for intraoperative determination of appropriate resection margins. In phantom studies we compared the tissue penetration of several organic dyes and inorganic particles (quantum dots; QDs) after incorporation in experimental marker seeds. The tissue penetration of (near infra-) red organic dyes was much better than the penetration of dyes and QDs with an emission in the visible range. By combining 3 dyes in a single marker seed we were able to distinguish four depth ranges. The difference in tissue penetration between the dyes and QDS enabled depth estimation via a ‘traffic light’ approach. PMID:23133810

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

    PubMed

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

    2015-01-01

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

  10. Imaging of surgical margin in pancreatic metastasis using two-photon excited fluorescence microscopy

    NASA Astrophysics Data System (ADS)

    Chen, Jing; Hong, Zhipeng; Chen, Hong; Chen, Youting; Xu, Yahao; Zhu, Xiaoqin; Zhuo, Shuangmu; Shi, Zheng; Chen, Jianxin

    2014-09-01

    Two-photon excited fluorescence (TPEF) microscopy, has become a powerful tool for imaging unstained tissue samples at subcellular level in biomedical research. The purpose of this study was to determine whether TPEF imaging of histological sections without H-E staining can be used to identify the boundary between normal pancreas and pancreatic metastasis from renal cell carcinoma (RCC). The typical features such as the significant increase of cancerous nests, the absence of pancreatic ductal, the appearance of cancer cells were observed to present the boundary between normal pancreas and pancreatic metastasis from RCC. These results correlated well with the corresponding histological outcomes. With the advent of clinically miniaturized TPEF microscopy and integrative endoscopy, TPEF microscopy has the potential application on surgical location of pancreatic metastasis from RCC in the near future.

  11. [The role of a positive surgical margin after retropubic radical prostatectomy in prognosis of recurrent prostatic cancer].

    PubMed

    Veliev, E I; Petrov, S B; Loran, O B

    2005-01-01

    To estimate the occurrence of positive surgical margins (SM) in conduction of radical retropubic prostatectomy and SM role in development of the recurrence, we studied 216 surgical patients with prostatic cancer aged 41 to 73 years. Stages T2a,b, T3a, T1 and T3b were detected in 41.8, 35.6, 18.7 and 3.9% patients, respectively. A positive SM was verified in 68 of 193 (35.2%) patients. Of them, 36 (52.9%) patients had a focal (a single or short SM), while 32 (47.1%) patients had a long SM. The recurrence occurred in 31 (16.1%) cases, primarily in a long SM. In SM-free patients (group 1) one-year survival was 82% being very close to that in group 2 with a focal SM (83%). The differences between the groups were also minimal by three-year survival (75 and 73.6%, respectively). Thus, recurrence-free survival in the focal process and a short SM differs by three-year survival in the groups insignificantly. The period between month 12 and 24 is most risky in respect to recurrences in a short SM. Patients with a long SM had maximal number of prostatic cancer recurrences.

  12. The relation of gingival thickness to dynamics of gingival margin position pre- and post-surgically

    PubMed Central

    Vandana, Kharidhi Laxman; Gupta, Ira

    2016-01-01

    Background: To evaluate the gingival margin position (GMP) before and after open flap debridement in different gingival thickness (GT). Materials and Methods: Twenty-seven healthy patients with moderate to advanced adult periodontitis were included in a randomized control clinical trial. A calibrated UNC-15 periodontal probe, an occlusal onlay stent was used for clinical measurements recorded at baseline, 3 month, 6 month, and 16 month. The changes in the GMP were studied at midbuccal (Mi-B), mesiobuccal (MB), and distobuccal sites. GT was measured presurgically, transgingivally at Mi-B and interdental sites, divided into 2 groups: Group 1 (thin) and Group 2 (thick). Results: In GT of ≤1 mm group, the statistically significant apical shift of GMP led to gingival recession at all study sites in the early postsurgical period of 1 and 3 months. During 6 and 16 months, the apical shift of GMP coincided with the Chernihiv Airport at Mi-B site (6 months), MB site (16 months). The gingival recession was obvious at Mi-B sites (16 months). In the GT of >1 mm, the statistically significant apical shift of GMP did not cause gingival recession at any sites throughout postsurgical (1, 3, 6, and 16 months) period. Conclusion: Thin gingiva showed apical shift of GMP leading to gingival recession as compared to thick gingiva postsurgically. PMID:27143829

  13. [The rate and location of the positive surgical margin and its role in predicting recurrence of prostatic cancer].

    PubMed

    Veliev, E I; Petrov, S B; Loran, O B

    2004-01-01

    To estimate the rate of positive surgical margin (SM) in radical retropubic prostatectomy and its role in emergence of prostatic cancer (PC) recurrence, we operated 216 PC patients aged 41 to 73 years. Most of the patients had clinical stages T2a,b (41.8%) or T3a (35.6%). Stages T1 and T3b were in 18.7 and 3.9% patients, respectively.A positive SM was registered in 68 of 193 patients (35.2%). Thirty six (52.9%) patients had a focal (solitary or short) SM, thirty two (47.1%) had a long SM. The recurrence occurred in 31 (16.1%) patients who, as a rule, had long SM. Recurrence-free one-year survival in 104 patients who had no SM reached 82%, in 34 patients with focal SM (group 2) it was 83%. Such three-year survival in group 1 and 2 was 75 and 73.6%, respectively. Thus, recurrence-free survival in organ-limited process and short SM differed little within 3 years. The period between 12 and 24 months of follow-up is most risky in relation to detection of recurrence in short SM. The group of patients with long SM had maximal number of recurrences.

  14. TM1-IR680 peptide for assessment of surgical margin and lymph node metastasis in murine orthotopic model of oral cancer

    PubMed Central

    Suganya S., Annie A.; Kochurani, K. J.; Nair, Madhumathy G.; Louis, Jiss Maria; Sankaran, Santhosh; Rajagopal, R.; Kumar, K. Santhosh; Abraham, Parvin; P. G., Balagopal; Sebastian, Paul; Somananthan, Thara; Maliekal, Tessy Thomas

    2016-01-01

    Treatment outcome after surgical removal in oral carcinoma is poor due to inadequate methodologies available for marking surgical margins. Even though some methodologies for intraoperative margin assessment are under clinical and preclinical trials for other solid tumours, a promising modality for oral cancer surgery is not developed. Fluorescent-based optical imaging using Near Infrared (NIR) dyes tagged to tumour specific target will be an optimal tool for this purpose. One such target, Gastrin Releasing Peptide Receptor (GRPR) was selected for the study, and its binding peptide, TM1-IR680, was tested for its efficacy for surgical margin prediction in murine orthotopic model of oral cancer, derived from primary samples. Here, for the first time in a preclinical analysis, we show that the size and margin of oral cancer can be predicted, as revealed by 3D-imaging. Interestingly, the peptide was sensitive enough to detect lymph nodes that harboured dispersed tumour cells before colonization, which was impossible to identify by conventional histopathology. We recommend the use of TM1-NIR dyes alone or in combination with other technologies to improve the clinical outcome of oral cancer surgery. PMID:27827443

  15. Does Breast Magnetic Resonance Imaging Combined With Conventional Imaging Modalities Decrease the Rates of Surgical Margin Involvement and Reoperation?: A Case-Control Comparative Analysis.

    PubMed

    Lai, Hung-Wen; Chen, Chih-Jung; Lin, Ying-Jen; Chen, Shu-Ling; Wu, Hwa-Koon; Wu, Yu-Ting; Kuo, Shou-Jen; Chen, Shou-Tung; Chen, Dar-Ren

    2016-05-01

    The objective of this study was to assess whether preoperative breast magnetic resonance imaging (MRI) combined with conventional breast imaging techniques decreases the rates of margin involvement and reexcision.Data on patients who underwent surgery for primary operable breast cancer were obtained from the Changhua Christian Hospital (CCH) breast cancer database. The rate of surgical margin involvement and the rate of reoperation were compared between patients who underwent conventional breast imaging modalities (Group A: mammography and sonography) and those who received breast MRI in addition to conventional imaging (Group B: mammography, sonography, and MRI).A total of 1468 patients were enrolled in this study. Among the 733 patients in Group A, 377 (51.4%) received breast-conserving surgery (BCS) and 356 (48.6%) received mastectomy. Among the 735 patients in Group B, 348 (47.3%) received BCS and 387 (52.7%) received mastectomy. There were no significant differences in operative method between patients who received conventional imaging alone and those that received MRI and conventional imaging (P = 0.13). The rate of detection of pathological multifocal/multicentric breast cancer was markedly higher in patients who received preoperative MRI than in those who underwent conventional imaging alone (14.3% vs 8.6%, P < 0.01). The overall rate of surgical margin involvement was significantly lower in patients who received MRI (5.0%) than in those who received conventional imaging alone (9.0%) (P < 0.01). However, a significant reduction in rate of surgical margin positivity was only observed in patients who received BCS (Group A, 14.6%; Group B, 6.6%, P < 0.01). The overall BCS reoperation rates were 11.7% in the conventional imaging group and 3.2% in the combined MRI group (P < 0.01). There were no significant differences in rate of residual cancer in specimens obtained during reoperation between the 2 preoperative imaging groups (Group A, 50

  16. Management of surgical margins after endoscopic laser surgery for early glottic cancers: a multicentric evaluation in French-speaking European countries.

    PubMed

    Fakhry, Nicolas; Vergez, Sébastien; Babin, Emmanuel; Baumstarck, Karine; Santini, Laure; Dessi, Patrick; Giovanni, Antoine

    2015-06-01

    The aim of this study was to evaluate the practices of ENT surgeons for the management of surgical margins after endoscopic laser surgery for early glottic cancers. A questionnaire was sent to different surgeons managing cancers of the larynx in France, Belgium and Switzerland. A descriptive and comparative analysis of practices across centers was performed. Sixty-nine surgeons completed the questionnaire (58 in France, 10 in Belgium and 1 in Switzerland). In case of very close or equivocal resection margins after definitive histological examination, 67 % of surgeons perform close follow-up, 28 % further treatment and 5 % had no opinion. Factors resulting in a significant change in the management of equivocal or very close margins were: the country of origin (p = 0.011), the specialty of the multidisciplinary team leader (p = 0.001), the fact that radiation equipment is located in the same center (p = 0.027) and the access to IMRT technique (p = 0.027). In case of positive resection margins, 80 % of surgeons perform further treatment, 15 % surveillance, and 5 % had no opinion. The only factor resulting in a significant change in the management of positive margins was the number of cancers of the larynx treated per year (p = 0.011). It is important to spare, on one hand equivocal or very close margins and on the other hand, positive margins. Postoperative management should be discussed depending on intraoperative findings, patient, practices of multidisciplinary team, and surgeon experience. This management remains non-consensual and writing a good practice guideline could be useful.

  17. Optical characterization of lesions and identification of surgical margins in pancreatic metastasis from renal cell carcinoma by using two-photon excited fluorescence microscopy

    NASA Astrophysics Data System (ADS)

    Chen, Jing; Hong, Zhipeng; Chen, Hong; Chen, Youting; Xu, Yahao; Zhu, Xiaoqin; Zhuo, Shuangmu; Shi, Zheng; Chen, Jianxin

    2014-11-01

    Two-photon excited fluorescence (TPEF) microscopy has become a powerful instrument for imaging unstained tissue samples in biomedical research. The purpose of this study was to determine whether TPEF imaging of histological sections without hematoxylin-eosin (H-E) stain can be used to characterize lesions and identify surgical margins in pancreatic metastasis from renal cell carcinoma (RCC). The specimens of a pancreatic metastasis from RCC, as well as a primary RCC from a patient, were examined by TPEF microscopy and compared with their corresponding H-E stained histopathological results. The results showed that high-resolution TPEF imaging of unstained histological sections of pancreatic metastasis from RCC can reveal that the typical morphology of the tissue and cells in cancer tissues is different from the normal pancreas. It also clearly presented histopathological features of the collagenous capsule, which is an important boundary symbol to identify normal and cancerous tissue and to instruct surgical operation. It indicated the feasibility of using TPEF microscopy to make an optical diagnosis of lesions and identify the surgical margins in pancreatic metastasis from RCC.

  18. Effect of positive surgical margins on biochemical failure, biochemical recurrence-free survival, and overall survival after radical prostatectomy: median long-term results.

    PubMed

    Huri, Emre; Aydogmus, Yasin; Doluoglu, Omer Gokhan; Dadali, Mumtaz; Karakan, Tolga; Emir, Levent; Germiyanoglu, Cankon

    2014-10-01

    The aim of this study was to investigate the median long-term effects of positive surgical margin (PSM) and other prognostic factors on biochemical recurrence-free survival, overall survival, and biochemical failure in patients who underwent radical prostatectomy. Our study included 121 patients with pT2-3N0 disease treated between March 2006 and August 2012. The patients were divided into two groups: those with PSM and those with negative surgical margin (NSM). We analyzed the age, clinical and pathological stages, preoperative and postoperative Gleason scores, duration of the follow-up, adjuvant chemo-/radiotherapy, biochemical failure, biochemical recurrence-free survival, and overall survival in these patients. PSM was found in 25 (20%) patients, whereas 96 patients had NSM. The median follow-up time was 46.6 months (range 12-72 months) for the PSM group and 48.3 months (range 7-149 months) for the NSM group. The biochemical failure rate was 24% in the PSM group and 8.3% in the NSM group (p = 0.029). The biochemical recurrence-free survival was found as 76% in the PSM group and 91.7% in the NSM group. The difference between the groups was not statistically significant (p = 0.06). The overall survival was 100% in both groups. The surgical margins of the radical prostatectomy material is an important pathological indicator for biochemical failure at mid long-term follow-up. We did not find any effect of PSM on overall survival or biochemical recurrence-free survival.

  19. High-grade Prostatic Adenocarcinoma Present in a Single Biopsy Core is Associated With Increased Extraprostatic Extension, Seminal Vesicle Invasion, and Positive Surgical Margins at Prostatectomy

    PubMed Central

    Chaux, Alcides; Fajardo, Daniel A.; Gonzalez-Roibon, Nilda; Partin, Alan W.; Eisenberger, Mario; DeWeese, Theodore L.; Netto, George J.

    2012-01-01

    OBJECTIVE To evaluate the pathologic outcome of prostate-specific antigen-screened patients with high-grade (Gleason score ≥ 8) prostate cancer limited to 1 biopsy core, without clinical evidence of disease. METHODS Ninety-two patients with only 1 biopsy core with cancer and treated by radical prostatectomy were divided into 4 groups according to the biopsy Gleason score: 3 + 3 = 6 (23 cases), 3 + 4 = 7 (25 cases), 4 + 3 = 7 (20 cases), and ≥8 (24 cases). RESULTS Cases with Gleason score ≥8 showed a significantly higher proportion of extraprostatic extension (50%), positive surgical margins (21%), and seminal vesicle invasion (12%) when compared with the other groups. Patients with Gleason score ≥8 in the biopsy had a 25-fold increased in the odds ratio for extraprostatic extension in the prostatectomy. The incidence of extraprostatic extension was higher in those with prostatic cancer involving ≥50% of one core (88%) compared with cases involving <50% (32%). CONCLUSION In patients with prostate cancer limited to 1 biopsy core, the presence of Gleason score ≥8 significantly increased the incidence of extraprostatic extension, positive surgical margins, and seminal vesicle invasion. The odds ratio was substantially higher in patients with ≥50% of Gleason ≥8 in the biopsy core. These data might be taken into account for proper clinical management of this set of patients. PMID:22173174

  20. Tri-modal confocal margin screening for the presence of residual squamous cell carcinoma in Mohs surgical excisions

    NASA Astrophysics Data System (ADS)

    Bar, Anna; Snavely, Nicholas; Chen, Nathaniel; Jacques, Steven; Gareau, Daniel S.

    2012-03-01

    Screening cancer in excision margins may be done with confocal microscopy to save time and cost over the gold standard histopathology (H&E). However, diagnostic accuracy requires sufficient contrast. Reflectance mode enables detection of large (>500um) nodular tumors. Enhanced nuclear contrast with acridine orange fluorescence mode additionally enables detection of tiny (<50um) basal cell carcinomas. Here, we present a novel combination of three modes to detect squamous cell carcinoma (SCC). Accurate screening of SCC requires eosin fluorescence, reflectance and acridine orange fluorescence to enable contrast for cytoplasm, collagen and nuclei respectively. Combining these signals replicates H&E for rapid clinical translation.

  1. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    SciTech Connect

    Moran, Meena S.; Schnitt, Stuart J.; Giuliano, Armando E.; Harris, Jay R.; Khan, Seema A.; Horton, Janet; Klimberg, Suzanne; Chavez-MacGregor, Mariana; Freedman, Gary; Houssami, Nehmat; Johnson, Peggy L.; Morrow, Monica

    2014-03-01

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  2. The Surgical Treatment of Mycetoma

    PubMed Central

    Suleiman, Suleiman Hussein; Wadaella, EL Sammani; Fahal, Ahmed Hassan

    2016-01-01

    Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors’ experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan. PMID:27336736

  3. Recommended guidelines for submission, trimming, margin evaluation, and reporting of tumor biopsy specimens in veterinary surgical pathology.

    PubMed

    Kamstock, D A; Ehrhart, E J; Getzy, D M; Bacon, N J; Rassnick, K M; Moroff, S D; Liu, S M; Straw, R C; McKnight, C A; Amorim, R L; Bienzle, D; Cassali, G D; Cullen, J M; Dennis, M M; Esplin, D G; Foster, R A; Goldschmidt, M H; Gruber, A D; Hellmén, E; Howerth, E W; Labelle, P; Lenz, S D; Lipscomb, T P; Locke, E; McGill, L D; Miller, M A; Mouser, P J; O'Toole, D; Pool, R R; Powers, B E; Ramos-Vara, J A; Roccabianca, P; Ross, A D; Sailasuta, A; Sarli, G; Scase, T J; Schulman, F Y; Shoieb, A M; Singh, K; Sledge, D; Smedley, R C; Smith, K C; Spangler, W L; Steficek, B; Stromberg, P C; Valli, V E; Yager, J; Kiupel, M

    2011-01-01

    Neoplastic diseases are typically diagnosed by biopsy and histopathological evaluation. The pathology report is key in determining prognosis, therapeutic decisions, and overall case management and therefore requires diagnostic accuracy, completeness, and clarity. Successful management relies on collaboration between clinical veterinarians, oncologists, and pathologists. To date there has been no standardized approach or guideline for the submission, trimming, margin evaluation, or reporting of neoplastic biopsy specimens in veterinary medicine. To address this issue, a committee consisting of veterinary pathologists and oncologists was established under the auspices of the American College of Veterinary Pathologists Oncology Committee. These consensus guidelines were subsequently reviewed and endorsed by a large international group of veterinary pathologists. These recommended guidelines are not mandated but rather exist to help clinicians and veterinary pathologists optimally handle neoplastic biopsy samples. Many of these guidelines represent the collective experience of the committee members and consensus group when assessing neoplastic lesions from veterinary patients but have not met the rigors of definitive scientific study and investigation. These questions of technique, analysis, and evaluation should be put through formal scrutiny in rigorous clinical studies in the near future so that more definitive guidelines can be derived.

  4. Motion tracking to enable pre-surgical margin mapping in basal cell carcinoma using optical imaging modalities: initial feasibility study using optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Duffy, M.; Richardson, T. J.; Craythorne, E.; Mallipeddi, R.; Coleman, A. J.

    2014-02-01

    A system has been developed to assess the feasibility of using motion tracking to enable pre-surgical margin mapping of basal cell carcinoma (BCC) in the clinic using optical coherence tomography (OCT). This system consists of a commercial OCT imaging system (the VivoSight 1500, MDL Ltd., Orpington, UK), which has been adapted to incorporate a webcam and a single-sensor electromagnetic positional tracking module (the Flock of Birds, Ascension Technology Corp, Vermont, USA). A supporting software interface has also been developed which allows positional data to be captured and projected onto a 2D dermoscopic image in real-time. Initial results using a stationary test phantom are encouraging, with maximum errors in the projected map in the order of 1-2mm. Initial clinical results were poor due to motion artefact, despite attempts to stabilise the patient. However, the authors present several suggested modifications that are expected to reduce the effects of motion artefact and improve the overall accuracy and clinical usability of the system.

  5. Long-term treatment outcome after only popliteal lymph node dissection for nodal metastasis in malignant melanoma of the heel: the only "interval node" dissection can be an adequate surgical treatment.

    PubMed

    Tanaka, Kentaro; Mori, Hiroki; Okazaki, Mutsumi; Nishizawa, Aya; Yokozeki, Hiroo

    2013-01-01

    We present a patient with malignant melanoma on his heel. Wide local excision was performed, along with sentinel lymph node biopsy of the inguinal and popliteal lesions. The primary site was clear of tumor at all margins; the inguinal nodes were negative, but the popliteal node was positive for metastatic melanoma. Only radical popliteal lymph node dissection was performed. The patient went on to receive adjuvant chemoimmunotherapy. There was no recurrence or complication until the long-term followup. Popliteal drainage from below the knee is uncommon, and the rate of popliteal-positive and inguinal-negative cases is estimated to be less than 1% of all melanomas. There is no established evidence about how to treat lymph nodes in these cases. Because we considered popliteal nodes as a regional, not interval, lymph node basin, only popliteal lymph node dissection was performed, and good postoperative course was achieved. The first site of drainage is the sentinel node, and the popliteal node can be a sentinel node. The inguinal node is not a sentinel node in all lower extremity melanomas. This case illustrates the importance of individual detailed investigation of lymphatic drainage patterns from foot to inguinal and popliteal nodes.

  6. Margins: a status report from the Annual Meeting of the American Society of Breast Surgeons.

    PubMed

    Harness, Jay K; Giuliano, Armando E; Pockaj, Barbara A; Downs-Kelly, Erinn

    2014-10-01

    Since the emergence of breast conserving surgery (BCS) as an alternative to mastectomy in the 1980's, there has been little consensus on what constitutes acceptable margins for cases of invasive breast cancer, how best to evaluate margins in the operating room, or an understanding of the challenging process of margin assessment by pathologists. The program committee for the 15th Annual Meeting of The American Society of Breast Surgeons organized a plenary session to discuss the latest thinking and guidelines for these important issues. The SSO/ASTRO Consensus Guideline on Margins for BCS was an important focus of discussion. The SSO/ASTRO consensus panelists concluded that "no ink on tumor" is an adequate surgical margin for BCS in patients with invasive breast cancers. Intraoperative strategies to decrease the incidence of positive margins include intraoperative localization techniques (wire-localization, ultrasound, radioactive seed) and intraoperative margin assessments with specimen radiography, imprint cytology, and frozen section. Studies also demonstrate the positive effect of shave margins with or without intraoperative margin assessment. The College of American Pathologists protocols for breast specimen margin evaluation consider multiple variables that can impact the proper assessment of margins. These variables include: tissue fixation time, specimen orientation, cold ischemia time, leaking ink, specimen pancaking and others that surgeons need to be aware of. Determining when "enough is enough" should not only be the application of guidelines and national standards, but also a multidisciplinary discussion between breast cancer specialists for what is right for the individual patient's unique circumstances.

  7. [Marginalization and health. Introduction].

    PubMed

    Yunes, J

    1992-06-01

    sanitation. The concept of "epidemiologic heterogeneity" characterizes a pathological structure in which the poor suffer from illnesses transmitted in the air, contamination by human wastes, and malnutrition, and the wealthy suffer from disorders typical of the western industrialized countries. The poor also suffer from limited accessibility and poor quality of health care. In both Latin America and Europe, the groups most in need of adequate services have the least probability of receiving them. In most Latin American countries, the institutional configuration of health services reinforces the inequities and constitutes a mechanism of marginalization. The solution to the problem of marginalization i health and access to services will require political action, which in turn will need to be specifically adapted to the circumstances of each marginal group.

  8. A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst: delineation of surgical margins and reconstruction with bilateral rectus abdominis myocutaneous free flaps.

    PubMed

    Ota, Y; Karakida, K; Watanabe, D; Miyasaka, M; Tsukinoki, K

    1998-10-01

    A case of central carcinoma of the mandible arising from a recurrent odontogenic keratocyst is reported. A 38-year-old man was admitted to the Tokai University Hospital due to postoperative infection of a recurrent odontogenic keratocyst of the left mandible. He had had a cystectomy for an odontogenic keratocyst 4 years ago. The lesion revealed bony destruction of the mandible with worm-eating shaped margins with extension to the facial skin. A biopsy specimen revealed squamous cell carcinoma. The mandible was resected with facial skin and the sublingual space was dissected to preserve the lingual nerve. The oral and the facial resections were reconstructed with a titanium plate and bilateral rectus abdominis myocutaneous free flaps. The plate was removed due to infection around the margins and readjustment of the flaps was conducted 5 months after the surgery. He has not had a local relapse, metastasis, or incisional hernia for 8 months following surgery. Good occlusion has been attained by the residual mandible, and he is able to eat without any problems.

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

    PubMed Central

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

    2013-01-01

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

  10. Surgical guides (patient-specific instruments) for pediatric tibial bone sarcoma resection and allograft reconstruction.

    PubMed

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

    2013-01-01

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

  11. Two stage surgical procedure for root coverage.

    PubMed

    George, Anjana Mary; Rajesh, K S; Hegde, Shashikanth; Kumar, Arun

    2012-07-01

    Gingival recession may present problems that include root sensitivity, esthetic concern, and predilection to root caries, cervical abrasion and compromising of a restorative effort. When marginal tissue health cannot be maintained and recession is deep, the need for treatment arises. This literature has documented that recession can be successfully treated by means of a two stage surgical approach, the first stage consisting of creation of attached gingiva by means of free gingival graft, and in the second stage, a lateral sliding flap of grafted tissue to cover the recession. This indirect technique ensures development of an adequate width of attached gingiva. The outcome of this technique suggests that two stage surgical procedures are highly predictable for root coverage in case of isolated deep recession and lack of attached gingiva.

  12. Maintaining plant safety margins

    SciTech Connect

    Bergeron, P.A.

    1989-01-01

    The Final Safety Analysis Report Forms the basis of demonstrating that the plant can operate safely and meet all applicable acceptance criteria. In order to assure that this continues through each operating cycle, the safety analysis is reexamined for each reload core. Operating limits are set for each reload core to assure that safety limits and applicable acceptance criteria are not exceeded for postulated events within the design basis. These operating limits form the basis for plant operation, providing barriers on various measurable parameters. The barriers are refereed to as limiting conditions for operation (LCO). The operating limits, being influenced by many factors, can change significantly from cycle to cycle. In order to be successful in demonstrating safe operation for each reload core (with adequate operating margin), it is necessary to continue to focus on ways to maintain/improve existing safety margins. Existing safety margins are a function of the plant type (boiling water reactor/pressurized water reactor (BWR/PWR)), nuclear system supply (NSSS) vendor, operating license date, core design features, plant design features, licensing history, and analytical methods used in the safety analysis. This paper summarizes the experience at Yankee Atomic Electric Company (YAEC) in its efforts to provide adequate operating margin for the plants that it supports.

  13. Marginal Matter

    NASA Astrophysics Data System (ADS)

    van Hecke, Martin

    2013-03-01

    All around us, things are falling apart. The foam on our cappuccinos appears solid, but gentle stirring irreversibly changes its shape. Skin, a biological fiber network, is firm when you pinch it, but soft under light touch. Sand mimics a solid when we walk on the beach but a liquid when we pour it out of our shoes. Crucially, a marginal point separates the rigid or jammed state from the mechanical vacuum (freely flowing) state - at their marginal points, soft materials are neither solid nor liquid. Here I will show how the marginal point gives birth to a third sector of soft matter physics: intrinsically nonlinear mechanics. I will illustrate this with shock waves in weakly compressed granular media, the nonlinear rheology of foams, and the nonlinear mechanics of weakly connected elastic networks.

  14. 21 CFR 1404.900 - Adequate evidence.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 1404.900 Adequate evidence. Adequate evidence means information sufficient...

  15. 21 CFR 1404.900 - Adequate evidence.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Adequate evidence. 1404.900 Section 1404.900 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 1404.900 Adequate evidence. Adequate evidence means information sufficient...

  16. Marginality principle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Soil is a fragile resource supplying many goods and services. Given the diversity of soil across the world and within a landscape, there are many different capacities among soils to provide the basic soil functions. Marginality of soils is a difficult process to define because the metrics to define ...

  17. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  18. The cerebellopontine angle: does the translabyrinthine approach give adequate access?

    PubMed

    Fagan, P A; Sheehy, J P; Chang, P; Doust, B D; Coakley, D; Atlas, M D

    1998-05-01

    A long-standing but unfounded criticism of the translabyrinthine approach is the misperception that this approach does not give adequate access to the cerebellopontine angle. Because of what is perceived as limited visualization and operating space within the cerebellopontine angle, some surgeons still believe that the translabyrinthine approach is inappropriate for large acoustic tumors. In this study, the surgical access to the cerebellopontine angle by virtue of the translabyrinthine approach is measured and analyzed. The parameters are compared with those measured for the retrosigmoid approach. This series objectively confirms that the translabyrinthine approach offers the neurotologic surgeon a shorter operative depth to the tumor, via a similar-sized craniotomy. This permits superior visualization by virtue of a wider angle of surgical access. Such access is achieved with the merit of minimal cerebellar retraction.

  19. 5 CFR 919.900 - Adequate evidence.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Adequate evidence. 919.900 Section 919.900 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 919.900 Adequate...

  20. Duodenal adenocarcinoma: Advances in diagnosis and surgical management

    PubMed Central

    Cloyd, Jordan M; George, Elizabeth; Visser, Brendan C

    2016-01-01

    Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma (DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multi-institutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles. PMID:27022448

  1. Asbestos/NESHAP adequately wet guidance

    SciTech Connect

    Shafer, R.; Throwe, S.; Salgado, O.; Garlow, C.; Hoerath, E.

    1990-12-01

    The Asbestos NESHAP requires facility owners and/or operators involved in demolition and renovation activities to control emissions of particulate asbestos to the outside air because no safe concentration of airborne asbestos has ever been established. The primary method used to control asbestos emissions is to adequately wet the Asbestos Containing Material (ACM) with a wetting agent prior to, during and after demolition/renovation activities. The purpose of the document is to provide guidance to asbestos inspectors and the regulated community on how to determine if friable ACM is adequately wet as required by the Asbestos NESHAP.

  2. Funding the Formula Adequately in Oklahoma

    ERIC Educational Resources Information Center

    Hancock, Kenneth

    2015-01-01

    This report is a longevity, simulational study that looks at how the ratio of state support to local support effects the number of school districts that breaks the common school's funding formula which in turns effects the equity of distribution to the common schools. After nearly two decades of adequately supporting the funding formula, Oklahoma…

  3. Justice and Surgical Innovation: The Case of Robotic Prostatectomy.

    PubMed

    Hutchison, Katrina; Johnson, Jane; Carter, Drew

    2016-09-01

    Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations.

  4. Surgical bleeding in microgravity

    NASA Technical Reports Server (NTRS)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

    1993-01-01

    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  5. Study Suggests Smaller Melanoma Excision Margins May Be Option for Some Patients

    Cancer.gov

    A randomized controlled trial of patients with stage IIA–C cutaneous melanoma thicker than 2-mm found that a 2-cm surgical resection margin is sufficient and is as safe for patients as a 4-cm margin.

  6. Intraoperative targeted optical imaging: a guide towards tumor-free margins in cancer surgery.

    PubMed

    Orbay, Hakan; Bean, Jero; Zhang, Yin; Cai, Weibo

    2013-01-01

    Over the last several decades, development of various imaging techniques such as computed tomography, magnetic resonance imaging, and positron emission tomography greatly facilitated the early detection of cancer. Another important aspect that is closely related to the survival of cancer patients is complete tumor removal during surgical resection. The major obstacle in achieving this goal is to distinguish between tumor tissue and normal tissue during surgery. Currently, tumor margins are typically assessed by visual assessment and palpation of the tumor intraoperatively. However, the possibility of microinvasion to the surrounding tissues makes it difficult to determine an adequate tumor-free excision margin, often forcing the surgeons to perform wide excisions including the healthy tissue that may contain vital structures. It would be ideal to remove the tumor completely, with minimal safety margins, if surgeons could see precise tumor margins during the operation. Molecular imaging with optical techniques can visualize the tumors via fluorophore conjugated probes targeting tumor markers such as proteins and enzymes that are upregulated during malignant transformation. Intraoperative use of this technique may facilitate complete excision of the tumor and tumor micromasses located beyond the visual capacity of the naked eye, ultimately improving the clinical outcome and survival rates of cancer patients.

  7. Structural design/margin assessment

    NASA Technical Reports Server (NTRS)

    Ryan, R. S.

    1993-01-01

    Determining structural design inputs and the structural margins following design completion is one of the major activities in space exploration. The end result is a statement of these margins as stability, safety factors on ultimate and yield stresses, fracture limits (fracture control), fatigue lifetime, reuse criteria, operational criteria and procedures, stability factors, deflections, clearance, handling criteria, etc. The process is normally called a load cycle and is time consuming, very complex, and involves much more than structures. The key to successful structural design is the proper implementation of the process. It depends on many factors: leadership and management of the process, adequate analysis and testing tools, data basing, communications, people skills, and training. This process and the various factors involved are discussed.

  8. Approach to the surgical management of resectable gastric cancer.

    PubMed

    Quadri, Humair S; Hong, Young K; Al-Refaie, Waddah B

    2016-04-01

    The rates of gastric cancer, which is the third leading cause of cancer-related deaths worldwide, vary depending on geographic location. Margin-negative gastrectomy and adequate lymphadenectomy (removal of ≥15 lymph nodes) are the cornerstones of multimodal treatment for operable gastric cancer. Diagnostic laparoscopy should be included in the armamentarium for newly diagnosed gastric cancer in order to overcome the limitations of cross-sectional imaging in identifying sub-radiographic hepatic or peritoneal metastases. The benefit of surgical therapy is enhanced by at least 13% when it is integrated with multimodal therapy: either surgery followed by adjuvant chemoradiotherapy or surgery with perioperative systemic therapy. This multidisciplinary approach to treatment will continue to be an evolving paradigm, especially with the emergence of systemic and targeted therapies.

  9. Approach to the surgical management of resectable gastric cancer.

    PubMed

    Quadri, Humair S; Hong, Young K; Al-Refaie, Waddah B

    2016-03-01

    The rates of gastric cancer, which is the third leading cause of cancer-related deaths worldwide, vary depending on geographic location. Margin-negative gastrectomy and adequate lymphadenectomy (removal of ≥15 lymph nodes) are the cornerstones of multimodal treatment for operable gastric cancer. Diagnostic laparoscopy should be included in the armamentarium for newly diagnosed gastric cancer in order to overcome the limitations of cross-sectional imaging in identifying sub-radiographic hepatic or peritoneal metastases. The benefit of surgical therapy is enhanced by at least 13% when it is integrated with multimodal therapy: either surgery followed by adjuvant chemoradiotherapy or surgery with perioperative systemic therapy. This multidisciplinary approach to treatment will continue to be an evolving paradigm, especially with the emergence of systemic and targeted therapies.

  10. Serum thyroglobulin reference intervals in regions with adequate and more than adequate iodine intake.

    PubMed

    Wang, Zhaojun; Zhang, Hanyi; Zhang, Xiaowen; Sun, Jie; Han, Cheng; Li, Chenyan; Li, Yongze; Teng, Xiaochun; Fan, Chenling; Liu, Aihua; Shan, Zhongyan; Liu, Chao; Weng, Jianping; Teng, Weiping

    2016-11-01

    The purpose of this study was to establish normal thyroglobulin (Tg) reference intervals (RIs) in regions with adequate and more than adequate iodine intake according to the National Academy of Clinical Biochemistry (NACB) guidelines and to investigate the relationships between Tg and other factors.A total of 1317 thyroid disease-free adult subjects (578 men, 739 nonpregnant women) from 2 cities (Guangzhou and Nanjing) were enrolled in this retrospective, observational study. Each subject completed a questionnaire and underwent physical and ultrasonic examination. Serum Tg, thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), Tg antibody (TgAb), and urinary iodine concentration (UIC) were measured. Reference groups were established on the basis of TSH levels: 0.5 to 2.0 and 0.27 to 4.2 mIU/L.The Tg RIs for Guangzhou and Nanjing were 1.6 to 30.0 and 1.9 to 25.8 ng/mL, respectively. No significant differences in Tg were found between genders or among different reference groups. Stepwise linear regression analyses showed that TgAb, thyroid volume, goiter, gender, age, and TSH levels were correlated with Tg.In adults from regions with adequate and more than adequate iodine intake, we found that Tg may be a suitable marker of iodine status; gender-specific Tg RI was unnecessary; there was no difference between Tg RIs in regions with adequate and more than adequate iodine intake; and the TSH criterion for selecting the Tg reference population could follow the local TSH reference rather than 0.5 to 2.0 mIU/L.

  11. Serum thyroglobulin reference intervals in regions with adequate and more than adequate iodine intake

    PubMed Central

    Wang, Zhaojun; Zhang, Hanyi; Zhang, Xiaowen; Sun, Jie; Han, Cheng; Li, Chenyan; Li, Yongze; Teng, Xiaochun; Fan, Chenling; Liu, Aihua; Shan, Zhongyan; Liu, Chao; Weng, Jianping; Teng, Weiping

    2016-01-01

    Abstract The purpose of this study was to establish normal thyroglobulin (Tg) reference intervals (RIs) in regions with adequate and more than adequate iodine intake according to the National Academy of Clinical Biochemistry (NACB) guidelines and to investigate the relationships between Tg and other factors. A total of 1317 thyroid disease-free adult subjects (578 men, 739 nonpregnant women) from 2 cities (Guangzhou and Nanjing) were enrolled in this retrospective, observational study. Each subject completed a questionnaire and underwent physical and ultrasonic examination. Serum Tg, thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), Tg antibody (TgAb), and urinary iodine concentration (UIC) were measured. Reference groups were established on the basis of TSH levels: 0.5 to 2.0 and 0.27 to 4.2 mIU/L. The Tg RIs for Guangzhou and Nanjing were 1.6 to 30.0 and 1.9 to 25.8 ng/mL, respectively. No significant differences in Tg were found between genders or among different reference groups. Stepwise linear regression analyses showed that TgAb, thyroid volume, goiter, gender, age, and TSH levels were correlated with Tg. In adults from regions with adequate and more than adequate iodine intake, we found that Tg may be a suitable marker of iodine status; gender-specific Tg RI was unnecessary; there was no difference between Tg RIs in regions with adequate and more than adequate iodine intake; and the TSH criterion for selecting the Tg reference population could follow the local TSH reference rather than 0.5 to 2.0 mIU/L. PMID:27902589

  12. Adequate mathematical modelling of environmental processes

    NASA Astrophysics Data System (ADS)

    Chashechkin, Yu. D.

    2012-04-01

    In environmental observations and laboratory visualization both large scale flow components like currents, jets, vortices, waves and a fine structure are registered (different examples are given). The conventional mathematical modeling both analytical and numerical is directed mostly on description of energetically important flow components. The role of a fine structures is still remains obscured. A variety of existing models makes it difficult to choose the most adequate and to estimate mutual assessment of their degree of correspondence. The goal of the talk is to give scrutiny analysis of kinematics and dynamics of flows. A difference between the concept of "motion" as transformation of vector space into itself with a distance conservation and the concept of "flow" as displacement and rotation of deformable "fluid particles" is underlined. Basic physical quantities of the flow that are density, momentum, energy (entropy) and admixture concentration are selected as physical parameters defined by the fundamental set which includes differential D'Alembert, Navier-Stokes, Fourier's and/or Fick's equations and closing equation of state. All of them are observable and independent. Calculations of continuous Lie groups shown that only the fundamental set is characterized by the ten-parametric Galilelian groups reflecting based principles of mechanics. Presented analysis demonstrates that conventionally used approximations dramatically change the symmetries of the governing equations sets which leads to their incompatibility or even degeneration. The fundamental set is analyzed taking into account condition of compatibility. A high order of the set indicated on complex structure of complete solutions corresponding to physical structure of real flows. Analytical solutions of a number problems including flows induced by diffusion on topography, generation of the periodic internal waves a compact sources in week-dissipative media as well as numerical solutions of the same

  13. Surgical smoke evacuation systems.

    PubMed

    1997-04-01

    Surgical smoke evacuation systems are high-flow vacuum sources used to capture, at the surgical site, the smoke aerosols and gases generated during the use of lasers and electrosurgical units (ESUs). In this study, we evaluated 16 evacuation systems, from 10 suppliers, designed and marketed for use in the operating room for general surgery. For our testing, we focused on the performance of the systems (particularly their ability to capture smoke particles under simulated surgical conditions) and their ease of use and quality of construction. We also examined the projected costs of each system over a seven-year life cycle. We rated the systems separately for two different evacuation applications (1) general-purpose applications, for which the system would, in many cases, be used with a handheld nozzle (the traditional capture device used with these systems), and (2) ESU-pencil-based evacuation applications only, for which the system would always be used with a pencil-based wand. (We report on ESU-pencil-based smoke evacuation wands in a separate Evaluation in this issue.) While we found most units to be Acceptable, we did rate two units Acceptable-Not Recommended for both applications and one unit Unacceptable for general-purpose applications. In addition to our findings for the evaluated models, this study features several sections providing generic information and guidance about smoke evacuation technology. The Technology Overview describes the basics: what these systems do and how they do it. The Technology Management Guide, "Clearing the Air-Should Surgical Smoke Be Evacuated?," discusses the issues healthcare facilities should consider when determining whether, when, and how surgical smoke should be evacuated. Finally, the Selection, Purchasing, and Use Guide offers guidance on how facilities can most effectively implement this technology, from identifying models that will meet their needs to ensuring that the systems are used properly to provide adequate staff

  14. [Clinical to planning target volume margins in prostate cancer radiotherapy].

    PubMed

    Ramiandrisoa, F; Duvergé, L; Castelli, J; Nguyen, T D; Servagi-Vernat, S; de Crevoisier, R

    2016-10-01

    The knowledge of inter- and intrafraction motion and deformations of the intrapelvic target volumes (prostate, seminal vesicles, prostatectomy bed and lymph nodes) as well as the main organs at risk (bladder and rectum) allow to define rational clinical to planning target volume margins, depending on the different radiotherapy techniques and their uncertainties. In case of image-guided radiotherapy, prostate margins and seminal vesicles margins can be between 5 and 10mm. The margins around the prostatectomy bed vary from 10 to 15mm and those around the lymph node clinical target volume between 7 and 10mm. Stereotactic body radiotherapy allows lower margins, which are 3 to 5mm around the prostate. Image-guided and stereotactic body radiotherapy with adequate margins allow finally moderate or extreme hypofractionation.

  15. [Surgical treatment of rectal cancer].

    PubMed

    Vergara-Fernández, O; Salinas-Aragón, L E; Camacho-Mauries, D; Medina-Franco, H

    2010-01-01

    Rectal affection accounts for 30% of colorectal cancer. The standard of treatment is surgical resection, which often is curative. For superior and middle-rectal involvement, low anterior resection (LAR) is the preferred procedure. For tumors involving the lower portion of the rectum, abdominoperineal resection (APR) or LAR are the options of treatment, depending on sphincter involvement. The main surgical objective is to achieve a R0 resection with an appropriated total mesorrectal excision, greater number of lymph nodes and negative distal and radial margins. These surgical parameters have been used as quality indicators and have prognostic implications in terms of overall and disease-free survival. Total mesorectal excision with preservation of hypogastric nerves has shown a reduction in rates of sexual and bladder dysfunction as well as lower local recurrence. At specialized centers such procedures are performed by minimal invasive surgery; however the number of meta-analysis is scarce.

  16. Ocean margins workshop

    SciTech Connect

    1990-12-31

    The Department of Energy (DOE) is announcing the refocusing of its marine research program to emphasize the study of ocean margins and their role in modulating, controlling, and driving Global Change phenomena. This is a proposal to conduct a workshop that will establish priorities and an implementation plan for a new research initiative by the Department of Energy on the ocean margins. The workshop will be attended by about 70 scientists who specialize in ocean margin research. The workshop will be held in the Norfolk, Virginia area in late June 1990.

  17. Current strategies for the restoration of adequate lordosis during lumbar fusion.

    PubMed

    Barrey, Cédric; Darnis, Alice

    2015-01-18

    Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery.

  18. Current strategies for the restoration of adequate lordosis during lumbar fusion

    PubMed Central

    Barrey, Cédric; Darnis, Alice

    2015-01-01

    Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

  19. Epithelial and Stromal Spectral Imaging for Rapid Surgical Margin Analysis

    DTIC Science & Technology

    2012-03-01

    for key diagnostic classes. The optical system samples mesoscopic tissue volumes; therefore, microscopic segmentation of glandular , stromal and...heterogeneous, but imaging-pathology correlates revealed that this variation had a spatial pattern that reflected the organization of glandular structures...characterized by marked expansion of glandular units by neo-plastic cells, compressing (but not invading) the surrounding stromal environment

  20. Epithelial and Stromal Spectral Imaging for Rapid Surgical Margin Analysis

    DTIC Science & Technology

    2013-03-01

    cancer (orange). (f) Corresponding immunohistochemical measures of percent stroma, epithelium and fat, and CD31- positive, CD105-positive vascular...density and area. A b [HbT] % O2 % H2O % Epithelium -0.06 -0.37 0.27 -0.11 -0.21 % Stroma 0.06 0.33 -0.28 0.09 0.25 % Fat -0.02 -0.01 0.21 0.02...scattering slope was observed to better localize suspicious fibro- glandular lesions. The scattering slope was likely under-valued by the limitations

  1. Epithelial and Stromal Spectral Imaging for Rapid Surgical Margin Analysis

    DTIC Science & Technology

    2011-03-01

    oxygenated and deoxygenated hemoglobin, beta carotene and blood break-down products in a tissue, while simultaneously extracting scattering features in...fluorescence), so that the most diagnostically discriminating and robust parameters could be identified and optimized during data collection. Note that beta ... carotene is a member of the carotenoids and gives fat its highly pigmented, yellow color; we hope that its absorption spectra will improve

  2. [Stomata--surgical standards].

    PubMed

    Wagner, M; Malayeri, V; Seiler, C A; Candinas, D

    2003-01-01

    The placement of an intestinal stoma is still a common procedure despite the recent advantages in intestinal surgery. It is mandatory to apply meticulously sound surgical principles in order to achieve good results. Nevertheless, intestinal stomas are envisioned with a high perioperative morbidity which is mostly caused by surgical inadequacy. This can lead to considerable problems in management of the stoma in the long term and ultimately will affect quality of life of the patient. The cumulative morbidity can be given by 50% with prolaps, hernia, stenosis and necrosis as well as stoma retraction being the most relevant. In contrast, an adequate intestinal stoma will positively affect the quality of life of the patient. The availability of devices developed by the industry and the inauguration of a professional service in certain hospitals simplified the management of patients with a stoma. This significantly improved the standards of care especially regarding preoperative preparation and postoperative management. Thus, most patients are able to maintain an active and socially integrated life with minimal physical and psychical limitations.

  3. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 31 2011-07-01 2011-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of...

  4. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 31 2014-07-01 2014-07-01 false Adequate file search. 716.25 Section 716.25 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) TOXIC SUBSTANCES CONTROL ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of...

  5. "Something Adequate"? In Memoriam Seamus Heaney, Sister Quinlan, Nirbhaya

    ERIC Educational Resources Information Center

    Parker, Jan

    2014-01-01

    Seamus Heaney talked of poetry's responsibility to represent the "bloody miracle", the "terrible beauty" of atrocity; to create "something adequate". This article asks, what is adequate to the burning and eating of a nun and the murderous gang rape and evisceration of a medical student? It considers Njabulo Ndebele's…

  6. 40 CFR 716.25 - Adequate file search.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Adequate file search. 716.25 Section... ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in the location(s) where the...

  7. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 2 2013-07-01 2013-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain the administrative resources necessary to perform all of the program functions including...

  8. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 2 2014-07-01 2014-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain the administrative resources necessary to perform all of the program functions including...

  9. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain the administrative resources necessary to perform all of the program functions including...

  10. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 2 2011-07-01 2011-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain the administrative resources necessary to perform all of the program functions including...

  11. 40 CFR 51.354 - Adequate tools and resources.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 2 2012-07-01 2012-07-01 false Adequate tools and resources. 51.354... Requirements § 51.354 Adequate tools and resources. (a) Administrative resources. The program shall maintain the administrative resources necessary to perform all of the program functions including...

  12. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated if...

  13. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated if...

  14. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated if...

  15. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated if...

  16. 9 CFR 305.3 - Sanitation and adequate facilities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated if...

  17. 21 CFR 201.5 - Drugs; adequate directions for use.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Drugs; adequate directions for use. 201.5 Section 201.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL LABELING General Labeling Provisions § 201.5 Drugs; adequate directions for use....

  18. RISK-INFORMED SAFETY MARGIN CHARACTERIZATION

    SciTech Connect

    Nam Dinh; Ronaldo Szilard

    2009-07-01

    The concept of safety margins has served as a fundamental principle in the design and operation of commercial nuclear power plants (NPPs). Defined as the minimum distance between a system’s “loading” and its “capacity”, plant design and operation is predicated on ensuring an adequate safety margin for safety-significant parameters (e.g., fuel cladding temperature, containment pressure, etc.) is provided over the spectrum of anticipated plant operating, transient and accident conditions. To meet the anticipated challenges associated with extending the operational lifetimes of the current fleet of operating NPPs, the United States Department of Energy (USDOE), the Idaho National Laboratory (INL) and the Electric Power Research Institute (EPRI) have developed a collaboration to conduct coordinated research to identify and address the technological challenges and opportunities that likely would affect the safe and economic operation of the existing NPP fleet over the postulated long-term time horizons. In this paper we describe a framework for developing and implementing a Risk-Informed Safety Margin Characterization (RISMC) approach to evaluate and manage changes in plant safety margins over long time horizons.

  19. Marginal Zone Lymphoma

    MedlinePlus

    ... zone lymphomas are a group of indolent (slow-growing) NHL B-cell lymphomas, which account for approximately 12 percent of all B-cell lymphomas. The median age for diagnosis is 65 years old. There are three types of marginal zone lymphoma: ...

  20. Splenic marginal zone lymphoma.

    PubMed

    Piris, Miguel A; Onaindía, Arantza; Mollejo, Manuela

    Splenic marginal zone lymphoma (SMZL) is an indolent small B-cell lymphoma involving the spleen and bone marrow characterized by a micronodular tumoral infiltration that replaces the preexisting lymphoid follicles and shows marginal zone differentiation as a distinctive finding. SMZL cases are characterized by prominent splenomegaly and bone marrow and peripheral blood infiltration. Cells in peripheral blood show a villous cytology. Bone marrow and peripheral blood characteristic features usually allow a diagnosis of SMZL to be performed. Mutational spectrum of SMZL identifies specific findings, such as 7q loss and NOTCH2 and KLF2 mutations, both genes related with marginal zone differentiation. There is a striking clinical variability in SMZL cases, dependent of the tumoral load and performance status. Specific molecular markers such as 7q loss, p53 loss/mutation, NOTCH2 and KLF2 mutations have been found to be associated with the clinical variability. Distinction from Monoclonal B-cell lymphocytosis with marginal zone phenotype is still an open issue that requires identification of precise and specific thresholds with clinical meaning.

  1. Predicting service life margins

    NASA Technical Reports Server (NTRS)

    Egan, G. F.

    1971-01-01

    Margins are developed for equipment susceptible to malfunction due to excessive time or operation cycles, and for identifying limited life equipment so monitoring and replacing is accomplished before hardware failure. Method applies to hardware where design service is established and where reasonable expected usage prediction is made.

  2. NASA Smart Surgical Probe Project

    NASA Technical Reports Server (NTRS)

    Mah, Robert W.; Andrews, Russell J.; Jeffrey, Stefanie S.; Guerrero, Michael; Papasin, Richard; Koga, Dennis (Technical Monitor)

    2002-01-01

    Information Technologies being developed by NASA to assist astronaut-physician in responding to medical emergencies during long space flights are being employed for the improvement of women's health in the form of "smart surgical probe". This technology, initially developed for neurosurgery applications, not only has enormous potential for the diagnosis and treatment of breast cancer, but broad applicability to a wide range of medical challenges. For the breast cancer application, the smart surgical probe is being designed to "see" a suspicious lump, determine by its features if it is cancerous, and ultimately predict how the disease may progress. A revolutionary early breast cancer detection tool based on this technology has been developed by a commercial company and is being tested in human clinical trials at the University of California at Davis, School of Medicine. The smart surgical probe technology makes use of adaptive intelligent software (hybrid neural networks/fuzzy logic algorithms) with the most advanced physiologic sensors to provide real-time in vivo tissue characterization for the detection, diagnosis and treatment of tumors, including determination of tumor microenvironment and evaluation of tumor margins. The software solutions and tools from these medical applications will lead to the development of better real-time minimally-invasive smart surgical probes for emergency medical care and treatment of astronauts on long space flights.

  3. Region 9: Arizona Adequate Letter (10/14/2003)

    EPA Pesticide Factsheets

    This is a letter from Jack P. Broadben,. Director, to Nancy Wrona and Dennis Smith informing them that Maricopa County's motor vehicle emissions budgets in the 2003 MAGCO Maintenance Plan are adequate for transportation conformity purposes.

  4. Region 6: Texas Adequate Letter (4/16/2010)

    EPA Pesticide Factsheets

    This letter from EPA to Texas Commission on Environmental Quality determined 2021 motor vehicle emission budgets for nitrogen oxides (NOx) and volatile organic compounds (VOCs) for Beaumont/Port Arthur area adequate for transportation conformity purposes

  5. Region 2: New Jersey Adequate Letter (5/23/2002)

    EPA Pesticide Factsheets

    This April 22, 2002 letter from EPA to the New Jersey Department of Environmental Protection determined 2007 and 2014 Carbon Monoxide (CO) Mobile Source Emissions Budgets adequate for transportation conformity purposes and will be announced in the Federal

  6. Region 8: Colorado Adequate Letter (10/29/2001)

    EPA Pesticide Factsheets

    This letter from EPA to Colorado Department of Public Health and Environment determined Denvers' particulate matter (PM10) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes.

  7. Region 1: New Hampshire Adequate Letter (8/12/2008)

    EPA Pesticide Factsheets

    This July 9, 2008 letter from EPA to the New Hampshire Department of Environmental Services, determined the 2009 Motor Vehicle Emissions Budgets (MVEBs) are adequate for transportation conformity purposes and will be announced in the Federal Register (FR).

  8. Region 8: Colorado Adequate Letter (1/20/2004)

    EPA Pesticide Factsheets

    This letter from EPA to Colorado Department of Public Health and Environment determined Greeleys' Carbon Monoxide (CO) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes and will be announced in the FR.

  9. Region 8: Utah Adequate Letter (6/10/2005)

    EPA Pesticide Factsheets

    This letter from EPA to Utah Department of Environmental Quality determined Salt Lake Citys' and Ogdens' Carbon Monoxide (CO) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes.

  10. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may certify an application, the Administrator must...

  11. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may certify an application, the Administrator must...

  12. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may certify an application, the Administrator must...

  13. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may certify an application, the Administrator must...

  14. 15 CFR 970.404 - Adequate exploration plan.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... ENVIRONMENTAL DATA SERVICE DEEP SEABED MINING REGULATIONS FOR EXPLORATION LICENSES Certification of Applications § 970.404 Adequate exploration plan. Before he may certify an application, the Administrator must...

  15. Region 6: New Mexico Adequate Letter (8/21/2003)

    EPA Pesticide Factsheets

    This is a letter from Carl Edlund, Director, to Alfredo Santistevan regarding MVEB's contained in the latest revision to the Albuquerque Carbon Monoxide State Implementation Plan (SIP) are adequate for transportation conformity purposes.

  16. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... contained in a system of records are adequately trained to protect the security and privacy of such records..., by degaussing or by overwriting with the appropriate security software, in accordance...

  17. 4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... require access to and use of records contained in a system of records are adequately trained to protect... with the appropriate security software, in accordance with regulations of the Archivist of the...

  18. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... contained in a system of records are adequately trained to protect the security and privacy of such records..., by degaussing or by overwriting with the appropriate security software, in accordance...

  19. 4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... require access to and use of records contained in a system of records are adequately trained to protect... with the appropriate security software, in accordance with regulations of the Archivist of the...

  20. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... contained in a system of records are adequately trained to protect the security and privacy of such records..., by degaussing or by overwriting with the appropriate security software, in accordance...

  1. 10 CFR 1304.114 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... contained in a system of records are adequately trained to protect the security and privacy of such records..., by degaussing or by overwriting with the appropriate security software, in accordance...

  2. 4 CFR 200.14 - Responsibility for maintaining adequate safeguards.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... require access to and use of records contained in a system of records are adequately trained to protect... with the appropriate security software, in accordance with regulations of the Archivist of the...

  3. Region 9: Nevada Adequate Letter (3/30/2006)

    EPA Pesticide Factsheets

    This is a letter from Deborah Jordan, Director, to Leo M. Drozdoff regarding Nevada's motor vehicle emissions budgets in the 2005 Truckee Meadows CO Redesignation Request and Maintenance Plan are adequate for transportation conformity decisions.

  4. Surgical innovation: the ethical agenda

    PubMed Central

    Broekman, Marike L.; Carrière, Michelle E.; Bredenoord, Annelien L.

    2016-01-01

    Abstract The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation. Although the call for evidence-based practice in surgery is increasingly high on the agenda, most surgeons feel that the format of the randomized controlled trial is not suitable for surgery. Innovation in surgery has aspects of, but should be distinguished from both research and clinical care and raises its own ethical challenges. To answer the question “What are the main ethical aspects of surgical innovation?”, we systematically searched PubMed and Embase. Papers expressing an opinion, point of view, or position were included, that is, normative ethical papers. We included 59 studies discussing ethical aspects of surgical innovation. These studies discussed 4 major themes: oversight, informed consent, learning curve, and vulnerable patient groups. Although all papers addressed the ethical challenges raised by surgical innovation, surgeons hold no uniform view of surgical innovation, and there is no agreement on the distinction between innovation and research. Even though most agree to some sort of oversight, they offer different alternatives ranging from the formation of new surgical innovation committees to establishing national registries. Most agree that informed consent is necessary for innovative procedures and that surgeons should be adequately trained to assure their competence to tackle the learning curve problem. All papers agree that in case of vulnerable patients, alternatives must be found for the informed consent procedure. We suggest that the concept of the learning health care system might provide guidance for thinking about surgical innovation. The underlying rationale of the learning health care system is to improve the quality of health care by embedding research within clinical care. Two aspects of a learning health

  5. Actively stressed marginal networks.

    PubMed

    Sheinman, M; Broedersz, C P; MacKintosh, F C

    2012-12-07

    We study the effects of motor-generated stresses in disordered three-dimensional fiber networks using a combination of a mean-field theory, scaling analysis, and a computational model. We find that motor activity controls the elasticity in an anomalous fashion close to the point of marginal stability by coupling to critical network fluctuations. We also show that motor stresses can stabilize initially floppy networks, extending the range of critical behavior to a broad regime of network connectivities below the marginal point. Away from this regime, or at high stress, motors give rise to a linear increase in stiffness with stress. Finally, we demonstrate that our results are captured by a simple, constitutive scaling relation highlighting the important role of nonaffine strain fluctuations as a susceptibility to motor stress.

  6. Regulatory requirements for providing adequate veterinary care to research animals.

    PubMed

    Pinson, David M

    2013-09-01

    Provision of adequate veterinary care is a required component of animal care and use programs in the United States. Program participants other than veterinarians, including non-medically trained research personnel and technicians, also provide veterinary care to animals, and administrators are responsible for assuring compliance with federal mandates regarding adequate veterinary care. All program participants therefore should understand the regulatory requirements for providing such care. The author provides a training primer on the US regulatory requirements for the provision of veterinary care to research animals. Understanding the legal basis and conditions of a program of veterinary care will help program participants to meet the requirements advanced in the laws and policies.

  7. Marginality of Transfer Commuter Students.

    ERIC Educational Resources Information Center

    Kodama, Corinne Maekawa

    2002-01-01

    Examines marginality issues facing transfer commuter students attending a mid-Atlantic university and what student characteristics relate to their sense of marginality. Results showed that transfer students have few sources of on-campus support, which may lead to their feelings of marginality. Results were particularly true for woman and Asian…

  8. Amphetamine margin in sports

    SciTech Connect

    Laties, V.G.; Weiss, B.

    1981-10-01

    The amphetamines can enhance athletic performance. That much seem clear from the literature, some of which is reviewed here. Increases in endurance have been demonstrated in both humans and rats. Smith and Beecher, 20 years ago, showed improvement of running, swimming, and weight throwing in highly trained athletes. Laboratory analogs of such performances have also been used and similar enhancement demonstrated. The amount of change induced by the amphetamines is usually small, of the order of a few percent. Nevertheless, since a fraction of a percent improvement can make the difference between fame and oblivion, the margin conferred by these drugs can be quite important.

  9. East Africa continental margins

    SciTech Connect

    Bosellini, A.

    1986-01-01

    New well data from Somalia, together with the history of sea-floor spreading in the Indian Ocean derived from magnetic anomalies, show that the East African margins from latitude 15/sup 0/S into the Gulf of Aden comprise four distinct segments that formed successively by the southward drift of Madagascar from Somalia during the Middle to Late Jurassic and Early Cretaceous, by the northeastward drift of India along the Owen Transform during the Late Cretaceous and Paleocene, and by the opening of the Gulf of Aden during the Neogene.

  10. Pellucid marginal corneal degeneration.

    PubMed

    Krachmer, J H

    1978-07-01

    Pellucid marginal degeneration of the cornea is a bilateral, clear, inferior, peripheral corneal-thinning disorder. Protrusion of the cornea occurs above a band of thinning, which is located 1 to 2 mm from the limbus and measures 1 to 2 mm in width. American ophthalmologists are generally not familiar with the condition because most of the literature concerning pellucid degeneration is European. Four cases are described. This condition is differentiated from other noninflammatory cornel-thinning disorders such as keratoconus, keratoglobus, keratotorus, and posterior keratoconus. It is also differentiated from peripheral corneal disorders associated with inflammation such as Terrien's peripheral corneal degeneration, Mooren's ulcers, and ulcers from connective tissue disease.

  11. New sensitive marginal oscillator

    NASA Astrophysics Data System (ADS)

    Rahf, L.

    1981-09-01

    A new type of a sensitive marginal oscillator has been developed for the determination of high magnetic inductions by means of nuclear magnetic resonance. Obtaining a high sensitivity with this measuring principle demands a soft behavior of the oscillator which is a particular feature of the circuit presented. It is shown that this behavior is due to the fact that a very weak positive feedback is established by the inner capacitances of the single field effect transistor used in the circuit. Optimal values for the operation parameters are calculated.

  12. Test to Determine Margin-to-Failure for Hy-100 Steel with Undermatched Welds

    SciTech Connect

    K.R. Arpin; T.F. Trimble

    2003-04-01

    This test program was undertaken to determine the flaw tolerance and to quantify the strength margin-to-failure of high yield strength steel fillet welded specimens. The tests demonstrate adequate margin-to-failure for HY-100 specimens fabricated with matched welding systems. In the use of high yield (HY) steel materials in designs required to accommodate rapidly applied dynamic loads, the concern was raised where the possibility of decreased flaw tolerance and premature failure by unstable ductile tearing could limit their use. Tests were developed and conducted to demonstrate adequate margin-to-failure in HY-100 fillet and partial penetration welded structures. In addition, inelastic analytical predictions were performed to assess the accuracy of such predictive tools compared to actual test data. Results showed that adequate margin-to-failure exists when using matched welding systems.

  13. Micro-surgical endodontics.

    PubMed

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  14. Comparability and Reliability Considerations of Adequate Yearly Progress

    ERIC Educational Resources Information Center

    Maier, Kimberly S.; Maiti, Tapabrata; Dass, Sarat C.; Lim, Chae Young

    2012-01-01

    The purpose of this study is to develop an estimate of Adequate Yearly Progress (AYP) that will allow for reliable and valid comparisons among student subgroups, schools, and districts. A shrinkage-type estimator of AYP using the Bayesian framework is described. Using simulated data, the performance of the Bayes estimator will be compared to…

  15. 13 CFR 107.200 - Adequate capital for Licensees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... operate actively in accordance with your Articles and within the context of your business plan, as... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Adequate capital for Licensees. 107.200 Section 107.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL...

  16. 13 CFR 107.200 - Adequate capital for Licensees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... operate actively in accordance with your Articles and within the context of your business plan, as... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Adequate capital for Licensees. 107.200 Section 107.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL...

  17. Is the Stock of VET Skills Adequate? Assessment Methodologies.

    ERIC Educational Resources Information Center

    Blandy, Richard; Freeland, Brett

    In Australia and elsewhere, four approaches have been used to determine whether stocks of vocational education and training (VET) skills are adequate to meet industry needs. The four methods are as follows: (1) the manpower requirements approach; (2) the international, national, and industry comparisons approach; (3) the labor market analysis…

  18. Do Beginning Teachers Receive Adequate Support from Their Headteachers?

    ERIC Educational Resources Information Center

    Menon, Maria Eliophotou

    2012-01-01

    The article examines the problems faced by beginning teachers in Cyprus and the extent to which headteachers are considered to provide adequate guidance and support to them. Data were collected through interviews with 25 school teachers in Cyprus, who had recently entered teaching (within 1-5 years) in public primary schools. According to the…

  19. 13 CFR 108.200 - Adequate capital for NMVC Companies.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Companies. 108.200 Section 108.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company § 108.200 Adequate capital for NMVC Companies. You must meet the requirements of §§ 108.200-108.230 in order...

  20. 13 CFR 108.200 - Adequate capital for NMVC Companies.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Companies. 108.200 Section 108.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company § 108.200 Adequate capital for NMVC Companies. You must meet the requirements of §§ 108.200-108.230 in order...

  1. 13 CFR 108.200 - Adequate capital for NMVC Companies.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Companies. 108.200 Section 108.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company § 108.200 Adequate capital for NMVC Companies. You must meet the requirements of §§ 108.200-108.230 in order...

  2. 13 CFR 108.200 - Adequate capital for NMVC Companies.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Companies. 108.200 Section 108.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company § 108.200 Adequate capital for NMVC Companies. You must meet the requirements of §§ 108.200-108.230 in order...

  3. 13 CFR 108.200 - Adequate capital for NMVC Companies.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Companies. 108.200 Section 108.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company § 108.200 Adequate capital for NMVC Companies. You must meet the requirements of §§ 108.200-108.230 in order...

  4. Understanding Your Adequate Yearly Progress (AYP), 2011-2012

    ERIC Educational Resources Information Center

    Missouri Department of Elementary and Secondary Education, 2011

    2011-01-01

    The "No Child Left Behind Act (NCLB) of 2001" requires all schools, districts/local education agencies (LEAs) and states to show that students are making Adequate Yearly Progress (AYP). NCLB requires states to establish targets in the following ways: (1) Annual Proficiency Target; (2) Attendance/Graduation Rates; and (3) Participation…

  5. 34 CFR 200.13 - Adequate yearly progress in general.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false Adequate yearly progress in general. 200.13 Section 200.13 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE...

  6. 34 CFR 200.13 - Adequate yearly progress in general.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 1 2013-07-01 2013-07-01 false Adequate yearly progress in general. 200.13 Section 200.13 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE...

  7. Region 9: Arizona Adequate Letter (11/1/2001)

    EPA Pesticide Factsheets

    This is a letter from Jack P. Broadbent, Director, Air Division to Nancy Wrona and James Bourney informing them of the adequacy of Revised MAG 1999 Serious Area Carbon Monoxide Plan and that the MAG CO Plan is adequate for Maricopa County.

  8. Surgical innovation as sui generis surgical research.

    PubMed

    Lotz, Mianna

    2013-12-01

    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  9. Iberian Atlantic Margins Group investigates deep structure of ocean margins

    NASA Astrophysics Data System (ADS)

    The Iberian Atlantic Margins Group; Banda, Enric; Torne, Montserrat

    With recent seismic reflection data in hand, investigators for the Iberian Atlantic Margins project are preparing images of the deep continental and oceanic margins of Iberia. In 1993, the IAM group collected near vertical incidence seismic reflection data over a total distance of 3500 km along the North and Western Iberian Margins, Gorringe Bank Region and Gulf of Cadiz (Figure 1). When combined with data on the conjugate margin off Canada, details of the Iberian margin's deep structure should aid in distinguishing rift models and improve understanding of the processes governing the formation of margins.The North Iberian passive continental margin was formed during a Permian to Triassic phase of extension and matured during the early Cretaceous by rotation of the Iberian Peninsula with respect to Eurasia. From the late Cretaceous to the early Oligocene period, Iberia rotated in a counterclockwise direction around an axis located west of Lisbon. The plate boundary between Iberia and Eurasia, which lies along the Pyrenees, follows the north Spanish marginal trough, trends obliquely in the direction of the fossil Bay of Biscay triple junction, and continues along the Azores-Biscay Rise [Sibuet et al., 1994]. Following the NE-SW convergence of Iberia and Eurasia, the reactivation of the North Iberian continental margin resulted in the formation of a marginal trough and accretionary prism [Boillot et al., 1971].

  10. Realistic respiratory motion margins for external beam partial breast irradiation

    SciTech Connect

    Conroy, Leigh; Quirk, Sarah; Smith, Wendy L.

    2015-09-15

    described. It was found that the currently used respiratory margin of 5 mm in partial breast irradiation may be overly conservative for many 3DCRT PBI patients. Amplitude alone was found to be insufficient to determine patient-specific margins: individual respiratory trace shape and baseline drift both contributed to the dosimetric target coverage. With respiratory coaching, individualized respiratory margins smaller than the full extent of motion could reduce planning target volumes while ensuring adequate coverage under respiratory motion.

  11. 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.

  12. Simulation-based surgical education.

    PubMed

    Evgeniou, Evgenios; Loizou, Peter

    2013-09-01

    The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators.

  13. Marginally Stable Nuclear Burning

    NASA Technical Reports Server (NTRS)

    Strohmayer, Tod E.; Altamirano, D.

    2012-01-01

    Thermonuclear X-ray bursts result from unstable nuclear burning of the material accreted on neutron stars in some low mass X-ray binaries (LMXBs). Theory predicts that close to the boundary of stability oscillatory burning can occur. This marginally stable regime has so far been identified in only a small number of sources. We present Rossi X-ray Timing Explorer (RXTE) observations of the bursting, high- inclination LMXB 4U 1323-619 that reveal for the first time in this source the signature of marginally stable burning. The source was observed during two successive RXTE orbits for approximately 5 ksec beginning at 10:14:01 UTC on March 28, 2011. Significant mHz quasi- periodic oscillations (QPO) at a frequency of 8.1 mHz are detected for approximately 1600 s from the beginning of the observation until the occurrence of a thermonuclear X-ray burst at 10:42:22 UTC. The mHz oscillations are not detected following the X-ray burst. The average fractional rms amplitude of the mHz QPOs is 6.4% (3 - 20 keV), and the amplitude increases to about 8% below 10 keV.This phenomenology is strikingly similar to that seen in the LMXB 4U 1636-53. Indeed, the frequency of the mHz QPOs in 4U 1323-619 prior to the X-ray burst is very similar to the transition frequency between mHz QPO and bursts found in 4U 1636-53 by Altamirano et al. (2008). These results strongly suggest that the observed QPOs in 4U 1323-619 are, like those in 4U 1636-53, due to marginally stable nuclear burning. We also explore the dependence of the energy spectrum on the oscillation phase, and we place the present observations within the context of the spectral evolution of the accretion-powered flux from the source.

  14. Army General Fund Adjustments Not Adequately Documented or Supported

    DTIC Science & Technology

    2016-07-26

    statements were unreliable and lacked an adequate audit trail. Furthermore, DoD and Army managers could not rely on the data in their accounting...risk that AGF financial statements will be materially misstated and the Army will not achieve audit readiness by the congressionally mandated...and $6.5 trillion in yearend adjustments made to Army General Fund data during FY 2015 financial statement compilation. We conducted this audit in

  15. Evolution of Devonian carbonate-shelf margin, Nevada

    USGS Publications Warehouse

    Morrow, J.R.; Sandberg, C.A.

    2008-01-01

    The north-trending, 550-km-long Nevada segment of the Devonian carbonate-shelf margin, which fringed western North America, evidences the complex interaction of paleotectonics, eustasy, biotic changes, and bolide impact-related influences. Margin reconstruction is complicated by mid-Paleozoic to Paleogene compressional tectonics and younger extensional and strike-slip faulting. Reports published during the past three decades identify 12 important events that influenced development of shelf-margin settings; in chronological order, these are: (1) Early Devonian inheritance of Silurian stable shelf inargin, (2) formation of Early to early Middle 'Devonian shelf-margin basins, (3) propradation of later Middle Devonian shelf margin, (4) late Middle Devonian Taghanic ondap and continuing long-term Frasnian transgression, (5) initiation of latest Middle Devonian to early Frasnian proto-Antler orogenic forebulge, (6) mid-Frasnian Alamo Impact, (7) accelerated development of proto-Antler forebulge and backbulge Pilot basin, (8) global late Frasnian sentichatovae sea-level rise, (9) end-Frasnian sea-level fluctuations and ensuing mass extinction, (10) long-term Famennian regression and continept-wide erosion, (11) late Famennian emergence: of Ahtler orogenic highlands, and (12) end-Devonian eustatic sea-level fall. Although of considerable value for understanding facies relationships and geometries, existing standard carbonate platform-margin models developed for passive settings else-where do not adequately describe the diverse depositional and, structural settings along the Nevada Devonian platform margin. Recent structural and geochemical studies suggest that the Early to Middle Devonian-shelf-margin basins may have been fault-bound and controlled by inherited Precambrian structure. Subsequently, the migrating latest Middle to Late Devonian Antler orogenic forebulge exerted a dominant control on shelf-margin position, morphology, and sedimentation. ??Geological Society of

  16. MRI can determine the adequate area for debridement in the case of Fournier's gangrene.

    PubMed

    Yoneda, Akira; Fujita, Fumihiko; Tokai, Hirotaka; Ito, Yuichiro; Haraguchi, Masashi; Tajima, Yoshitsugu; Kanematsu, Takashi

    2010-01-01

    A 57-year-old man was transferred to our hospital because of gluteal pain. His right buttock had flare and swelling. Complete blood count showed leukocytosis, and renal failure was evident. Pelvic computed tomography (CT) revealed that the abscess, including gas, was widespread into the hypodermal tissue of the right buttock. Fournier's gangrene had been suspected, and immediate drainage was performed on the right buttock. The symptom and the condition improved rapidly, but on the day after the operation, the patient became drowsy and fell into endotoxic shock. Magnetic resonance imaging (MRI) revealed strong inflammation along the entire fascia of the right femur and necrotizing fasciitis. MRI was very useful for identification of the necrotic range. Immediately, an emergency operation was performed; 3 wide incisions were made on the right thigh and crus for drainage. The patient was cared for intensively under a sedated condition, and irrigation and debridement were repeated every day. Culture of the pus revealed mixed infection of Escherichia coli and anaerobic bacteria, and a large quantity of antimicrobial drug was used. The inflammatory reaction decreased, and the patient's general condition tentatively improved. With Fournier's gangrene, initiating adequate surgical and medical treatment is essential. Therefore, MRI should be used in the early exact diagnosis of this disease to obtain knowledge of the extent of necrosis and to determine the adequate area for debridement.

  17. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy

    PubMed Central

    Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G.; Russo, Paul; Thompson, R. Houston; Uzzo, Robert G.; Wood, Christopher G.; Gill, Inderbir S.

    2016-01-01

    Context A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. Objective To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). Evidence acquisition A literature review was conducted. Evidence synthesis Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Conclusions Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. Patient summary In this report

  18. Abortion - surgical - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  19. MRI-Based Assessment of Safe Margins in Tumor Surgery

    PubMed Central

    Bellanova, Laura; Schubert, Thomas; Cartiaux, Olivier; Lecouvet, Frédéric; Galant, Christine; Banse, Xavier; Docquier, Pierre-Louis

    2014-01-01

    Introduction. In surgical oncology, histological analysis of excised tumor specimen is the conventional method to assess the safety of the resection margins. We tested the feasibility of using MRI to assess the resection margins of freshly explanted tumor specimens in rats. Materials and Methods. Fourteen specimen of sarcoma were resected in rats and analysed both with MRI and histologically. Slicing of the specimen was identical for the two methods and corresponding slices were paired. 498 margins were measured in length and classified using the UICC classification (R0, R1, and R2). Results. The mean difference between the 498 margins measured both with histology and MRI was 0.3 mm (SD 1.0 mm). The agreement interval of the two measurement methods was [−1.7 mm; 2.2 mm]. In terms of the UICC classification, a strict correlation was observed between MRI- and histology-based classifications (κ = 0.84, P < 0.05). Discussion. This experimental study showed the feasibility to use MRI images of excised tumor specimen to assess the resection margins with the same degree of accuracy as the conventional histopathological analysis. When completed, MRI acquisition of resected tumors may alert the surgeon in case of inadequate margin and help advantageously the histopathological analysis. PMID:24701131

  20. Ivory Coast-Ghana margin: model of a transform margin

    SciTech Connect

    Mascle, J.; Blarez, E.

    1987-05-01

    The authors present a marine study of the eastern Ivory Coast-Ghana continental margins which they consider one of the most spectacular extinct transform margins. This margin has been created during Early-Lower Cretaceous time and has not been submitted to any major geodynamic reactivation since its fabric. Based on this example, they propose to consider during the evolution of the transform margin four main and successive stages. Shearing contact is first active between two probably thick continental crusts and then between progressively thinning continental crusts. This leads to the creation of specific geological structures such as pull-apart graben, elongated fault lineaments, major fault scarps, shear folds, and marginal ridges. After the final continental breakup, a hot center (the mid-oceanic ridge axis) is progressively drifting along the newly created margin. The contact between two lithospheres of different nature should necessarily induce, by thermal exchanges, vertical crustal readjustments. Finally, the transform margin remains directly adjacent to a hot but cooling oceanic lithosphere; its subsidence behavior should then progressively be comparable to the thermal subsidence of classic rifted margins.

  1. Planning 4-Dimensional Computed Tomography (4DCT) Cannot Adequately Represent Daily Intrafractional Motion of Abdominal Tumors

    SciTech Connect

    Ge, Jiajia; Santanam, Lakshmi; Noel, Camille; Parikh, Parag J.

    2013-03-15

    Purpose: To evaluate whether planning 4-dimensional computed tomography (4DCT) can adequately represent daily motion of abdominal tumors in regularly fractionated and stereotactic body radiation therapy (SBRT) patients. Methods and Materials: Intrafractional tumor motion of 10 patients with abdominal tumors (4 pancreas-fractionated and 6 liver-stereotactic patients) with implanted fiducials was measured based on daily orthogonal fluoroscopic movies over 38 treatment fractions. The needed internal margin for at least 90% of tumor coverage was calculated based on a 95th and fifth percentile of daily 3-dimensional tumor motion. The planning internal margin was generated by fusing 4DCT motion from all phase bins. The disagreement between needed and planning internal margin was analyzed fraction by fraction in 3 motion axes (superior-inferior [SI], anterior-posterior [AP], and left-right [LR]). The 4DCT margin was considered as an overestimation/underestimation of daily motion when disagreement exceeded at least 3 mm in the SI axis and/or 1.2 mm in the AP and LR axes (4DCT image resolution). The underlying reasons for this disagreement were evaluated based on interfractional and intrafractional breathing variation. Results: The 4DCT overestimated daily 3-dimensional motion in 39% of the fractions in 7 of 10 patients and underestimated it in 53% of the fractions in 8 of 10 patients. Median underestimation was 3.9 mm, 3.0 mm, and 1.7 mm in the SI axis, AP axis, and LR axis, respectively. The 4DCT was found to capture irregular deep breaths in 3 of 10 patients, with 4DCT motion larger than mean daily amplitude by 18 to 21 mm. The breathing pattern varied from breath to breath and day to day. The intrafractional variation of amplitude was significantly larger than intrafractional variation (2.7 mm vs 1.3 mm) in the primary motion axis (ie, SI axis). The SBRT patients showed significantly larger intrafractional amplitude variation than fractionated patients (3.0 mm vs 2

  2. Local antimicrobial administration for prophylaxis of surgical site infections.

    PubMed

    Huiras, Paul; Logan, Jill K; Papadopoulos, Stella; Whitney, Dana

    2012-11-01

    Despite a lack of consensus guidelines, local antibiotic administration for prophylaxis of surgical site infections is used during many surgical procedures. The rationale behind this practice is to provide high antibiotic concentrations at the site of surgery while minimizing systemic exposure and adverse effects. Local antibiotic administration for surgical site prophylaxis has inherent limitations in that antibiotics are applied after the incision is made, rather than the current standard for surgical site prophylaxis that recommends providing adequate antibiotic concentrations at the site before the incision. The efficacy and safety of local application of antibiotics for surgical site prophylaxis have been assessed in different types of surgery with a variety of antibiotic agents and methods of application. We identified 22 prospective, randomized, controlled trials that evaluated local application of antibiotics for surgical site prophylaxis. These trials were subsequently divided and analyzed based on the type of surgical procedure: dermatologic, orthopedic, abdominal, colorectal, and cardiothoracic. Methods of local application analyzed included irrigations, powders, ointments, pastes, beads, sponges, and fleeces. Overall, there is a significant lack of level I evidence supporting this practice for any of the surgical genres evaluated. In addition, the literature spans several decades, and changes in surgical procedures, systemic antibiotic prophylaxis, and microbial flora make conclusions difficult to determine. Based on available data, the efficacy of local antibiotic administration for the prophylaxis of surgical site infections remains uncertain, and recommendations supporting this practice for surgical site prophylaxis cannot be made.

  3. Osteotomy and osteosynthesis in complex segmental genioplasty with double surgical guide

    PubMed Central

    Assis, Adriano; Olate, Sergio; Asprino, Luciana; de Moraes, Márcio

    2014-01-01

    Chin osteotomy is used in esthetic and functional procedure; genioplasty shows different surgical options as lineal osteotomy, curved osteotomy, segmental osteotomy and others for different conditions of the face. This communication shows the use of two surgical guides used in a patient with extremely facial asymmetry; the surgical plan was realized in a stereolithographic biomodel. The first surgical guide was used for osteotomy and the second surgical guide was used for putting the plate, previously bent, and for segmented osteotomy in the planned position on the biomodel; this technique showed adequate adaptation and security in this extremely asymmetric case. The potential use of this surgical guide was discussed. PMID:24995074

  4. Influence of close resection margins on local recurrence and disease-specific survival in oral and oropharyngeal carcinoma.

    PubMed

    Wong, Ling Siew; McMahon, Jeremy; Devine, John; McLellan, Douglas; Thompson, Ewen; Farrow, Adrian; Moos, Khursheed; Ayoub, Ashraf

    2012-03-01

    There is a lack of consistency among published reports in the definition of what constitutes close resection margins (1-5mm) in the surgical treatment of oral and oropharyngeal squamous cell carcinoma (SCC). Our aim was to define what would constitute close resection margins in predicting local recurrence and disease-specific survival. The study comprised 192 previously untreated patients with oral and oropharyngeal SCC who were recruited at the Southern General Hospital, Glasgow, from 2001 to 2007 with a minimum follow-up of 2 years. Resection was the primary treatment and the surgical margins were recorded for all patients. Statistical analyses were aided by the Statistical Package for the Social Sciences, version 15.0, and MedCalc software. The status of the surgical margins was evaluated using a receiver operating characteristic (ROC) curve to define the cut-off point. Cox's proportional hazard model was used to establish predictive factors for local recurrence and disease-specific survival. Of 192 patients, 23 (12%) had involved margins (<1.0mm), 107 (56%) had close margins (1.0-2.0mm (16.1%); 2.1-3.0mm (12%); 3.1-4.0mm (10.4%); 4.1-5.0mm (17.2%), and 62 (32.3%) had clear margins (>5mm). No predictive cut-off point was found that related close surgical margins to local recurrence. However, there was a significant adverse association between surgical margins ≤1.6mm and disease-specific survival. In recommending postoperative adjuvant treatment for oral and oropharyngeal SCC, we suggest that surgical margins within 2mm should be considered as the cut-off. However, other clinical and pathological prognostic factors should also be taken into consideration when recommending further treatment.

  5. Genetic modification of preimplantation embryos: toward adequate human research policies.

    PubMed

    Dresser, Rebecca

    2004-01-01

    Citing advances in transgenic animal research and setbacks in human trials of somatic cell genetic interventions, some scientists and others want to begin planning for research involving the genetic modification of human embryos. Because this form of genetic modification could affect later-born children and their offspring, the protection of human subjects should be a priority in decisions about whether to proceed with such research. Yet because of gaps in existing federal policies, embryo modification proposals might not receive adequate scientific and ethical scrutiny. This article describes current policy shortcomings and recommends policy actions designed to ensure that the investigational genetic modification of embryos meets accepted standards for research on human subjects.

  6. Quantifying dose to the reconstructed breast: Can we adequately treat?

    SciTech Connect

    Chung, Eugene; Marsh, Robin B.; Griffith, Kent A.; Moran, Jean M.; Pierce, Lori J.

    2013-04-01

    To evaluate how immediate reconstruction (IR) impacts postmastectomy radiotherapy (PMRT) dose distributions to the reconstructed breast (RB), internal mammary nodes (IMN), heart, and lungs using quantifiable dosimetric end points. 3D conformal plans were developed for 20 IR patients, 10 autologous reconstruction (AR), and 10 expander-implant (EI) reconstruction. For each reconstruction type, 5 right- and 5 left-sided reconstructions were selected. Two plans were created for each patient, 1 with RB coverage alone and 1 with RB + IMN coverage. Left-sided EI plans without IMN coverage had higher heart Dmean than left-sided AR plans (2.97 and 0.84 Gy, p = 0.03). Otherwise, results did not vary by reconstruction type and all remaining metrics were evaluated using a combined AR and EI dataset. RB coverage was adequate regardless of laterality or IMN coverage (Dmean 50.61 Gy, D95 45.76 Gy). When included, IMN Dmean and D95 were 49.57 and 40.96 Gy, respectively. Mean heart doses increased with left-sided treatment plans and IMN inclusion. Right-sided treatment plans and IMN inclusion increased mean lung V{sub 20}. Using standard field arrangements and 3D planning, we observed excellent coverage of the RB and IMN, regardless of laterality or reconstruction type. Our results demonstrate that adequate doses can be delivered to the RB with or without IMN coverage.

  7. The Marginal Teacher: A Step-by-Step Guide to Fair Procedures for Identification and Dismissal. Second Edition.

    ERIC Educational Resources Information Center

    Lawrence, C. Edward; Vachon, Myra K.; Leake, Donald O.; Leake, Brenda H.

    This work provides sample letters, charts, timelines, and checklists, to help principals adequately prepare for possible teacher dismissal. Chapter 1, "Describing the Marginal Teacher," lists traits common to marginal teachers. Chapter 2, "Establishing the Teacher Evaluation Process," presents a monthly timeline for assessing…

  8. Surgical Lasers In Gynecology

    NASA Astrophysics Data System (ADS)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  9. Prostate cancer between prognosis and adequate/proper therapy

    PubMed Central

    Grozescu, T; Popa, F

    2017-01-01

    Knowing the indolent, non-invasive nature of most types of prostate cancer, as well as the simple fact that the disease seems more likely to be associated with age rather than with other factors (50% of men at the age of 50 and 80% at the age of 80 have it [1], with or without presenting any symptom), the big challenge of this clinical entity was to determine severity indicators (so far insufficient) to guide the physician towards an adequate attitude in the clinical setting. The risk of over-diagnosing and over-treating many prostate cancer cases (indicated by all the major European and American studies) is real and poses many question marks. The present paper was meant to deliver new research data and to reset the clinical approach in prostate cancer cases. PMID:28255369

  10. [New surgical treatment options for bone tumors].

    PubMed

    Andreou, D; Henrichs, M P; Gosheger, G; Nottrott, M; Streitbürger, A; Hardes, J

    2014-11-01

    Primary bone neoplasms can be classified into benign, locally/aggressive and rarely metastasizing and malignant tumors. Patients with benign tumors usually undergo surgical treatment in cases of local symptoms, mainly consisting of pain or functional deficits due to compression of important anatomical structures, such as nerves or blood vessels. Locally/aggressive and rarely metastasizing tumors exhibit an infiltrative growth pattern, so that surgical treatment is necessary to prevent further destruction of bone leading to local instability. Finally, the surgical treatment of malignant tumors is, with few exceptions, considered to be a prerequisite for long-term survival, either alone or in combination with systemic chemotherapy. Whereas the main objective of surgery in the treatment of benign tumors is relief of local symptoms with a minimum amount of damage to healthy tissue and minimizing the risk of local recurrence while ensuring bone stability in locally aggressive and rarely metastasizing tumors, the primary goal in the operative treatment of bone sarcomas is the resection of the tumor with clear surgical margins followed by defect reconstruction and the preservation of function. This review examines the current developments in the surgical treatment of primary bone neoplasms with respect to the management of the tumors and novel reconstructive options.

  11. Barriers to adequate prenatal care utilization in American Samoa

    PubMed Central

    Hawley, Nicola L; Brown, Carolyn; Nu’usolia, Ofeira; Ah-Ching, John; Muasau-Howard, Bethel; McGarvey, Stephen T

    2013-01-01

    Objective To describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Methods Using data from prenatal clinic records, women (n=692) were categorized according to the Adequacy of Prenatal Care Utilization Index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way Analysis of Variance (ANOVA) and independent samples t-tests. Results Between 2001 and 2008 85.4% of women received inadequate prenatal care. Parity (P=0.02), maternal unemployment (P=0.03), and both parents being unemployed (P=0.03) were negatively associated with the timing of prenatal care initation. Giving birth in 2007–2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 versus 25.12 weeks; P<0.01) and improved adequacy of received services (95.04% versus 83.8%; P=0.02). Conclusion The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007–2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population. PMID:24045912

  12. A Nomogram to Predict Adequate Lymph Node Recovery before Resection of Colorectal Cancer

    PubMed Central

    Zhang, Zhen-yu; Li, Cong; Gao, Wei; Yin, Xiao-wei; Luo, Qi-feng; Liu, Nan; Basnet, Shiva; Dai, Zhen-ling; Ge, Hai-yan

    2016-01-01

    Increased lymph node count (LNC) has been associated with prolonged survival in colorectal cancer (CRC), but the underlying mechanisms are still poorly understood. The study aims to identify new predictors and develop a preoperative nomogram for predicting the probability of adequate LNC (≥ 12). 501 eligible patients were retrospectively selected to identify clinical-pathological factors associated with LNC ≥ 12 through univariate and multivariate logistic regression analyses. The nomogram was built according to multivariate analyses of preoperative factors. Model performance was assessed with concordance index (c-index) and area under the receiver operating characteristic curve (AUC), followed by internal validation and calibration using 1000-resample bootstrapping. Clinical validity of the nomogram and LNC impact on stage migration were also evaluated. Multivariate analyses showed patient age, CA19-9, circulating lymphocytes, neutrophils, platelets, tumor diameter, histology and deposit significantly correlated with LNC (P < 0.05). The effects were marginal for CEA, anemia and CRC location (0.05 < P < 0.1). The multivariate analyses of preoperative factors suggested decreased age, CEA, CA19-9, neutrophils, proximal location, and increased platelets and diameter were significantly associated with increased probability of LNC ≥ 12 (P < 0.05). The nomogram achieved c-indexes of 0.75 and 0.73 before and after correction for overfitting. The AUC was 0.75 (95% CI, 0.70–0.79) and the clinically valid threshold probabilities were between 10% and 60% for the nomogram to predict LNC < 12. Additionally, increased probability of adequate LNC before surgery was associated with increased LNC and negative lymph nodes rather than increased positive lymph nodes, lymph node ratio, pN stages or AJCC stages. Collectively, the results indicate the LNC is multifactorial and irrelevant to stage migration. The significant correlations with preoperative circulating markers may

  13. [Health, marginality and regional development].

    PubMed

    Urbina-Fuentes, M; Narro-Robles, J; Wolpert-Barraza, E; Meljem-Moctezuma, J

    1996-01-01

    The paper discusses the close link between marginality, regional development and health. In order to do so, reference is made to some health indicators like nutrition, causes of death and health infrastructure within the low as well as the high marginality areas. The paper also presents the strategies that the Ministry of Health has established to assist the population living in the high marginality areas. It specifies the related activities that are being carried out through the national institutes of health and the sanitary regulation offices.

  14. Optical assessment of tumor resection margins in the breast

    PubMed Central

    Brown, J. Quincy; Bydlon, Torre M.; Richards, Lisa M.; Yu, Bing; Kennedy, Stephanie A.; Geradts, Joseph; Wilke, Lee G.; Junker, Marlee; Gallagher, Jennifer; Barry, William; Ramanujam, Nimmi

    2011-01-01

    Breast conserving surgery, in which the breast tumor and surrounding normal tissue are removed, is the primary mode of treatment for invasive and in situ carcinomas of the breast, conditions that affect nearly 200,000 women annually. Of these nearly 200,000 patients who undergo this surgical procedure, between 20–70% of them may undergo additional surgeries to remove tumor that was left behind in the first surgery, due to the lack of intra-operative tools which can detect whether the boundaries of the excised specimens are free from residual cancer. Optical techniques have many attractive attributes which may make them useful tools for intra-operative assessment of breast tumor resection margins. In this manuscript, we discuss clinical design criteria for intra-operative breast tumor margin assessment, and review optical techniques appied to this problem. In addition, we report on the development and clinical testing of quantitative diffuse reflectance imaging (Q-DRI) as a potential solution to this clinical need. Q-DRI is a spectral imaging tool which has been applied to 56 resection margins in 48 patients at Duke University Medical Center. Clear sources of contrast between cancerous and cancer-free resection margins were identified with the device, and resulted in an overall accuracy of 75% in detecting positive margins. PMID:21544237

  15. Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours

    PubMed Central

    Putta, Tharani; Gibikote, Sridhar; Madhuri, Vrisha; Walter, Noel

    2016-01-01

    Summary Background It is imperative that bone tumour margin and extent of tumour involvement are accurately assessed pre-operatively in order for the surgeon to attain a safe surgical margin. In this study, we comprehensively assessed each of the findings that influence surgical planning, on various MRI sequences and compared them with the gold standard – pathology. Material/Methods In this prospective study including 21 patients with extremity bone tumours, margins as seen on various MRI sequences (T1, T2, STIR, DWI, post-gadolinium T1 FS) were measured and biopsies were obtained from each of these sites during the surgical resection. The resected tumour specimen and individual biopsy samples were studied to assess the true tumour margin. Margins on each of the MRI sequences were then compared with the gold standard – pathology. In addition to the intramedullary tumour margin, we also assessed the extent of soft tissue component, neurovascular bundle involvement, epiphyseal and joint involvement, and the presence or absence of skip lesions. Results T1-weighted imaging was the best sequence to measure tumour margin without resulting in clinically significant underestimation or overestimation of the tumour extent (mean difference of 0.8 mm; 95% confidence interval between −0.9 mm to 2.5 mm; inter-class correlation coefficient of 0.998). STIR and T1 FS post-gadolinium imaging grossly overestimated tumour extent by an average of 16.7 mm and 16.8 mm, respectively (P values <0.05). Post-gadolinium imaging was better to assess joint involvement while T1 and STIR were the best to assess epiphyseal involvement. Conclusions T1-weighted imaging was the best sequence to assess longitudinal intramedullary tumour extent. We suggest that osteotomy plane 1.5 cm beyond the T1 tumour margin is safe and also limits unwarranted surgical bone loss. However, this needs to be prospectively proven with a larger sample size. PMID:28058070

  16. Surgical Treatment of Corneal Ectasia with Motowa's Trephine and Selective Suturing Technique

    PubMed Central

    Al-Motowa, Saeed; Al-Harby, Mosa

    2016-01-01

    A 40-year-old male presented with bilateral ectasia, contact lens intolerance, and astigmatism >10 D in both eyes. The patient had end-stage pellucid marginal degeneration that warranted surgical treatment. We present a unique surgical technique to stabilize the cornea, minimize astigmatism, improve vision and corneal status, and avoid penetrating keratoplasty. PMID:27994396

  17. [Surgical Medical Meetings in the Mexican Social Security Institute: 17 years of existence].

    PubMed

    Dávila-Torres, Javier; Cruz-Vega, Felipe; Loría-Castellanos, Jorge; Franco-Bey, Rubén; Quiroz-Vasquez, Laura; Cruz-Flores, Priscila

    2014-01-01

    The Surgical Medical Meetings Program aims to make highly specialized medical services to the marginalized rural population. Surgical Medical Encounters highlight the experience and results of an innovative strategy characterized by continuous improvement and the desire to continue transcending health for the most vulnerable populations. During 17 years of its inception, it is interesting to describe the evolution and achievements of the program.

  18. American Pediatric Surgical Association

    MedlinePlus

    ... Curricula Membership + Members Join APSA Careers Surgical Practice Management In Memoriam About APSA + APSA Mission Awards APSA Leadership Committees Alliances APSA Foundation Third-Party Advertising Disclaimer ...

  19. Incontinence Treatment: Surgical Treatments

    MedlinePlus

    ... Bowel Incontinence Signs & Symptoms Symptoms of Incontinence Diarrhea Treatment Lifestyle Changes Dietary Tips Medication Bowel Management Biofeedback Surgical Treatments Newer Treatment Options Tips on Finding a Doctor ...

  20. Marginalized Discourses and Scientific Literacy.

    ERIC Educational Resources Information Center

    Norman, Obed

    1998-01-01

    Focuses on the marginalized discourses that have arisen to oppose the racism, sexism, and classism espoused and advocated by mainstream science since its institutionalization up until the first half of the 20th century. Contains 39 references. (Author/PVD)

  1. Steel Industry Marginal Opportunity Analysis

    SciTech Connect

    none,

    2005-09-01

    The Steel Industry Marginal Opportunity Analysis (PDF 347 KB) identifies opportunities for developing advanced technologies and estimates both the necessary funding and the potential payoff. This analysis determines what portion of the energy bandwidth can be captured through the adoption of state-of-the-art technology and practices. R&D opportunities for addressing the remainder of the bandwidth are characterized and plotted on a marginal opportunity curve.

  2. Systemic Crisis of Civilization: In Search for Adequate Solution

    NASA Astrophysics Data System (ADS)

    Khozin, Grigori

    In December 1972 a jumbo jet crashed in the Florida Everglades with the loss of 101 lives. The pilot, distracted by a minor malfunction, failed to note until too late the warning signal that - correctly - indicated an impending disaster. His sudden, astonished cry of Hey, what happening here? were his last words 1. Three decades after this tragic episode, as the Humankind approaches the threshold of the third Millennium, the problem of adequate reaction to warning signals of different nature and of distinguishing minor malfunctions in everyday life of society, in economy and technology as well as in evolution of biosphere from grave threats to the world community and the phenomenon of life on our planet remains crucial to human survival and the future of Civilization. Rational use of knowledge and technology available to the world community remains in this context the corner stone of discussions on the destiny of the intelligent life both on the planet Earth and in the Universe (the fact of intelligent life in the Universe is to be detected by the Humankind)…

  3. ENSURING ADEQUATE SAFETY WHEN USING HYDROGEN AS A FUEL

    SciTech Connect

    Coutts, D

    2007-01-22

    Demonstration projects using hydrogen as a fuel are becoming very common. Often these projects rely on project-specific risk evaluations to support project safety decisions. This is necessary because regulations, codes, and standards (hereafter referred to as standards) are just being developed. This paper will review some of the approaches being used in these evolving standards, and techniques which demonstration projects can implement to bridge the gap between current requirements and stakeholder desires. Many of the evolving standards for hydrogen-fuel use performance-based language, which establishes minimum performance and safety objectives, as compared with prescriptive-based language that prescribes specific design solutions. This is being done for several reasons including: (1) concern that establishing specific design solutions too early will stifle invention, (2) sparse performance data necessary to support selection of design approaches, and (3) a risk-adverse public which is unwilling to accept losses that were incurred in developing previous prescriptive design standards. The evolving standards often contain words such as: ''The manufacturer shall implement the measures and provide the information necessary to minimize the risk of endangering a person's safety or health''. This typically implies that the manufacturer or project manager must produce and document an acceptable level of risk. If accomplished using comprehensive and systematic process the demonstration project risk assessment can ease the transition to widespread commercialization. An approach to adequately evaluate and document the safety risk will be presented.

  4. DARHT -- an adequate EIS: A NEPA case study

    SciTech Connect

    Webb, M.D.

    1997-08-01

    In April 1996 the US District Court in Albuquerque ruled that the Dual Axis Radiographic Hydrodynamic Test (DARHT) Facility Environmental Impact Statement (EIS), prepared by the Los Alamos Area Office, US Department of Energy (DOE), was adequate. The DARHT EIS had been prepared in the face of a lawsuit in only 10 months, a third of the time usually allotted for a DOE EIS, and for only a small fraction of the cost of a typical DOE EIS, and for only a small fraction of the cost of a typical DOE EIS. It subject was the first major facility to be built in decades for the DOE nuclear weapons stockpile stewardship program. It was the first EIS to be prepared for a proposal at DOE`s Los Alamos National Laboratory since 1979, and the first ever prepared by the Los Alamos Area Office. Much of the subject matter was classified. The facility had been specially designed to minimize impacts to a nearby prehistoric Native American ruin, and extensive consultation with American Indian Pueblos was required. The week that the draft EIS was published Laboratory biologists identified a previously unknown pair of Mexican spotted owls in the immediate vicinity of the project, bringing into play the consultation requirements of the Endangered Species Act. In spite of these obstacles, the resultant DARHT EIS was reviewed by the court and found to meet all statutory and regulatory requirements; the court praised the treatment of the classified material which served as a basis for the environmental analysis.

  5. Dose Limits for Man do not Adequately Protect the Ecosystem

    SciTech Connect

    Higley, Kathryn A.; Alexakhin, Rudolf M.; McDonald, Joseph C.

    2004-08-01

    It has been known for quite some time that different organisms display differing degrees of sensitivity to the effects of ionizing radiations. Some microorganisms such as the bacterium Micrococcus radiodurans, along with many species of invertebrates, are extremely radio-resistant. Humans might be categorized as being relatively sensitive to radiation, and are a bit more resistant than some pine trees. Therefore, it could be argued that maintaining the dose limits necessary to protect humans will also result in the protection of most other species of flora and fauna. This concept is usually referred to as the anthropocentric approach. In other words, if man is protected then the environment is also adequately protected. The ecocentric approach might be stated as; the health of humans is effectively protected only when the environment is not unduly exposed to radiation. The ICRP is working on new recommendations dealing with the protection of the environment, and this debate should help to highlight a number of relevant issues concerning that topic.

  6. Surgical ethics and the challenge of surgical innovation.

    PubMed

    Angelos, Peter

    2014-12-01

    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  7. Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients.

    PubMed

    Dennison, Cheryl R; McEntee, Mindy L; Samuel, Laura; Johnson, Brandon J; Rotman, Stacey; Kielty, Alexandra; Russell, Stuart D

    2011-01-01

    Heart failure (HF) patients with inadequate health literacy are at increased risk for poor self-care and negative health outcomes such as hospital readmission. The purpose of the present study was to examine the prevalence of inadequate health literacy, the reliability of the Dutch HF Knowledge Scale (DHFKS) and the Self-care of Heart Failure Index (SCHFI), and the differences in HF knowledge, HF self-care, and 30-day readmission rate by health literacy level among patients hospitalized with HF. The convenience sample included adults (n = 95) admitted to a large, urban, teaching hospital whose primary diagnosis was HF. Measures included the Short Test of Functional Health Literacy in Adults, the DHFKS, the SCHFI, and readmission at 30 days after discharge. The sample was 59 ± 14 years in age, 51% male, and 67% African American; 35% had less than a high school education, 35% were employed, 73% lived with someone who helps with their HF care, and 16% were readmitted within 30 days of index admission. Health literacy was inadequate for 42%, marginal for 19%, and adequate for 39%. Reliability of the DHFKS and SCHFI scales was comparable to prior reports. Mean knowledge score was 11.43 ± 2.26; SCHFI subscale scores were 56.82 ± 17.12 for maintenance, 63.64 ± 18.29 for management, and 65.02 ± 16.34 for confidence. Those with adequate health literacy were younger and had higher education level, HF knowledge scores, and HF self-care confidence compared with those with marginal or inadequate health literacy. Self-care maintenance and management scores and 30-day readmission rate did not differ by health literacy level. These findings demonstrate the high prevalence of inadequate and marginal health literacy and that health literacy is an important consideration in promoting HF knowledge and confidence in self-care behaviors, particularly among older adults and those with less than a high school education.

  8. The surgical conservation of the neuropathic foot.

    PubMed Central

    Warren, A. G.

    1989-01-01

    Basic surgical principles applied when caring for neuropathic limbs can result in the maintenance or restoration of a useful ulcer-free limb. It is possible to help many patients with neuropathy to become ulcer-free and to remain ulcer-free and mobile, with surgical procedures. Recommended methods of management are briefly outlined. These include the débridement of the osteomyelitic, metatarsal head in order to save the adjacent toe, removal of bony irregularities that predispose to ulceration, and the use of wedge osteotomies and arthrodeses to improve the functional shape of the affected foot. The emphasis is on the removal of high pressure points from the weight-bearing surface and to increase the total area available for weight-bearing. Adequate rest and protection are essential, and include the use of splints or total contact plaster casts in all cases of ulceration of weight-bearing surfaces. All patients with reduced sensory perception should learn daily self-examination and care to reduce the chances of recurrent ulceration. Healing after surgical reconstruction will occur, and the healed tissues, if adequately cared for, will maintain their integrity for years. Images fig. 1 fig. 2 fig. 3 fig. 4 fig. 5 fig. 6 fig. 7 fig. 8 fig. 9 fig. 10 PMID:2549839

  9. Surgical Technology Program Guide.

    ERIC Educational Resources Information Center

    Georgia Univ., Athens. Dept. of Vocational Education.

    This surgical technology program guide presents the standard curriculum for technical institutes in Georgia. The curriculum addresses the minimum competencies for a surgical technology program. The program guide is designed to relate primarily to the development of those skills needed by individuals in the field to provide services in the…

  10. [Surgical site infections].

    PubMed

    Sganga, Gabriele

    2014-01-01

    Surgical site infections (SSIs) are recognized as a common surgical complication, occurring in about 2-5% of all surgical procedures. SSIs represent the third most frequent nosocomial infection, accounting for 14-16% of all infections observed in hospitalized patients and up to 38% of those observed among surgical patients. Knowledge of incidence, epidemiology, classification, process of wound healing, and pathogenesis of surgical site infection is of great importance. Given the high economic burden that infections provoke, beyond the increased morbidity and mortality, it appears mandatory to improve our tools in order to reduce their incidence, as a reduction of only 0.1% can result in a considerable saving of economic resources to be allocated to other activities, such as screening and prevention programs.

  11. On Adequate Comparisons of Antenna Phase Center Variations

    NASA Astrophysics Data System (ADS)

    Schoen, S.; Kersten, T.

    2013-12-01

    One important part for ensuring the high quality of the International GNSS Service's (IGS) products is the collection and publication of receiver - and satellite antenna phase center variations (PCV). The PCV are crucial for global and regional networks, since they introduce a global scale factor of up to 16ppb or changes in the height component with an amount of up to 10cm, respectively. Furthermore, antenna phase center variations are also important for precise orbit determination, navigation and positioning of mobile platforms, like e.g. the GOCE and GRACE gravity missions, or for the accurate Precise Point Positioning (PPP) processing. Using the EUREF Permanent Network (EPN), Baire et al. (2012) showed that individual PCV values have a significant impact on the geodetic positioning. The statements are further supported by studies of Steigenberger et al. (2013) where the impact of PCV for local-ties are analysed. Currently, there are five calibration institutions including the Institut für Erdmessung (IfE) contributing to the IGS PCV file. Different approaches like field calibrations and anechoic chamber measurements are in use. Additionally, the computation and parameterization of the PCV are completely different within the methods. Therefore, every new approach has to pass a benchmark test in order to ensure that variations of PCV values of an identical antenna obtained from different methods are as consistent as possible. Since the number of approaches to obtain these PCV values rises with the number of calibration institutions, there is the necessity for an adequate comparison concept, taking into account not only the numerical values but also stochastic information and computational issues of the determined PCVs. This is of special importance, since the majority of calibrated receiver antennas published by the IGS origin from absolute field calibrations based on the Hannover Concept, Wübbena et al. (2000). In this contribution, a concept for the adequate

  12. [Sinaloa: the geography of marginalization].

    PubMed

    Aguayo Hernandez, J R

    1993-01-01

    Sinaloa's State Population Program for 1993-98 contains the objective of promoting integration of demographic criteria into the planning process. The action program calls for establishing indicators of economic and social inequality so that conditions of poverty and margination can be identified. To further these goals, the State Population Council used data from the National Population Council project on regional inequality and municipal margination in Mexico to analyze margination at the state level. Nine indicators of educational status, housing conditions, spatial distribution, and income provide information that allows the definition of municipios and regions that should receive priority in economic and social development programs. The index of municipal margination (IMM) is a statistical summary of the nine indicators, which are based on information in the 1990 census. As of March 1990, 9.9% of Sinaloa's population over age 15 was illiterate and 37.4% had incomplete primary education. 91.0% had electricity, but 18.7% lacked indoor toilet facilities and 19.4% had no piped water. 23.7% of houses had dirt floors. 60% of households were crowded, defined as having more than two persons per bedroom. 43.5% of the state population lived in localities with fewer than 5000 inhabitants, where service delivery is difficult and costly. 55.6% of the economically active population was judged to earn less than the amount needed to satisfy essential needs. All except one municipio bordering the Pacific ocean had low or very low indicators of margination, while all those in the sierra had a medium or high degree of margination. Sinaloa's statewide IMM was eighteenth among Mexico's 32 federal entities, with Chiapas showing the highest degree of margination and the Federal District the lowest.

  13. Are Vancomycin Trough Concentrations Adequate for Optimal Dosing?

    PubMed Central

    Youn, Gilmer; Jones, Brenda; Jelliffe, Roger W.; Drusano, George L.; Rodvold, Keith A.; Lodise, Thomas P.

    2014-01-01

    The current vancomycin therapeutic guidelines recommend the use of only trough concentrations to manage the dosing of adults with Staphylococcus aureus infections. Both vancomycin efficacy and toxicity are likely to be related to the area under the plasma concentration-time curve (AUC). We assembled richly sampled vancomycin pharmacokinetic data from three studies comprising 47 adults with various levels of renal function. With Pmetrics, the nonparametric population modeling package for R, we compared AUCs estimated from models derived from trough-only and peak-trough depleted versions of the full data set and characterized the relationship between the vancomycin trough concentration and AUC. The trough-only and peak-trough depleted data sets underestimated the true AUCs compared to the full model by a mean (95% confidence interval) of 23% (11 to 33%; P = 0.0001) and 14% (7 to 19%; P < 0.0001), respectively. In contrast, using the full model as a Bayesian prior with trough-only data allowed 97% (93 to 102%; P = 0.23) accurate AUC estimation. On the basis of 5,000 profiles simulated from the full model, among adults with normal renal function and a therapeutic AUC of ≥400 mg · h/liter for an organism for which the vancomycin MIC is 1 mg/liter, approximately 60% are expected to have a trough concentration below the suggested minimum target of 15 mg/liter for serious infections, which could result in needlessly increased doses and a risk of toxicity. Our data indicate that adjustment of vancomycin doses on the basis of trough concentrations without a Bayesian tool results in poor achievement of maximally safe and effective drug exposures in plasma and that many adults can have an adequate vancomycin AUC with a trough concentration of <15 mg/liter. PMID:24165176

  14. Is clinical measurement of anatomic axis of the femur adequate?

    PubMed

    Wu, Chi-Chuan

    2017-03-23

    Background and purpose - The accuracy of using clinical measurement from the anterior superior iliac spine (ASIS) to the center of the knee to determine an anatomic axis of the femur has rarely been studied. A radiographic technique with a full-length standing scanogram (FLSS) was used to assess the adequacy of the clinical measurement. Patients and methods - 100 consecutive young adult patients (mean age 34 (20-40) years) with chronic unilateral lower extremity injuries were studied. The pelvis and intact contralateral lower extremity images in the FLSS were selected for study. The angles between the tibial axis and the femoral shaft anatomic axis (S-AA), the piriformis anatomic axis (P-AA), the clinical anatomic axis (C-AA), and the mechanical axis (MA) were compared between sexes. Results - Only the S-AA and C-AA angles were statistically significantly different in the 100 patients (3.6° vs. 2.8°; p = 0.03). There was a strong correlation between S-AA, P-AA, and C-AA angles (r > 0.9). The average intersecting angle between MA and S-AA in the femur in the 100 patients was 5.5°, and it was 4.8° between MA and C-AA. Interpretation - Clinical measurement of an anatomic axis from the ASIS to the center of the knee may be an adequate and acceptable method to determine lower extremity alignment. The optimal inlet for antegrade femoral intramedullary nailing may be the lateral edge of the piriformis fossa.

  15. Surgical correction of an aberrant right subclavian artery in a dog

    PubMed Central

    Yoon, Hun-Young; Jeong, Soon-wuk

    2011-01-01

    A diagnosis of an aberrant right subclavian artery was made in a 3-month-old Boston terrier. Surgical correction was performed after confirming adequate collateral circulation. Reports of surgical correction and evaluation of the perioperative thoracic limb blood pressure are rare in dogs. PMID:22467968

  16. [Metastatic disease of the liver: surgical perspective].

    PubMed

    Mercado, M A; Medina, H; Rossano, A; Acosta, E; Rodríguez, M; Chan, C; Orozco, H

    1997-01-01

    Approximately half of patients with colorectal cancer will develop hepatic metastases and it is estimated that up to 10% of that group will have resectable liver disease. Surgical resection remains the first line treatment option of metastatic liver tumors and has yielded a 20 to 40% five year survival rate. Selection of appropriate patients for resection is critical to a successful outcome. The best results are obtained in patients with isolated metastases. Factors that are associated with a poorer results are the presence of four or more lesions or a surgical margin less than 1 cm. Endocrine metastases can be resected in a palliative fashion but each case has to be individualized. This is also true for non colorectal-nonendocrine metastases. For this tumors the experience is anecdotal and confined to limited reported series. Adjuvant treatment (infusional chemotherapy and chemoembolization) can also have a role in treatment as well as cryotherapy.

  17. Maximum margin Bayesian network classifiers.

    PubMed

    Pernkopf, Franz; Wohlmayr, Michael; Tschiatschek, Sebastian

    2012-03-01

    We present a maximum margin parameter learning algorithm for Bayesian network classifiers using a conjugate gradient (CG) method for optimization. In contrast to previous approaches, we maintain the normalization constraints on the parameters of the Bayesian network during optimization, i.e., the probabilistic interpretation of the model is not lost. This enables us to handle missing features in discriminatively optimized Bayesian networks. In experiments, we compare the classification performance of maximum margin parameter learning to conditional likelihood and maximum likelihood learning approaches. Discriminative parameter learning significantly outperforms generative maximum likelihood estimation for naive Bayes and tree augmented naive Bayes structures on all considered data sets. Furthermore, maximizing the margin dominates the conditional likelihood approach in terms of classification performance in most cases. We provide results for a recently proposed maximum margin optimization approach based on convex relaxation. While the classification results are highly similar, our CG-based optimization is computationally up to orders of magnitude faster. Margin-optimized Bayesian network classifiers achieve classification performance comparable to support vector machines (SVMs) using fewer parameters. Moreover, we show that unanticipated missing feature values during classification can be easily processed by discriminatively optimized Bayesian network classifiers, a case where discriminative classifiers usually require mechanisms to complete unknown feature values in the data first.

  18. The northern Egyptian continental margin

    NASA Astrophysics Data System (ADS)

    Badawy, Ahmed; Mohamed, Gad; Omar, Khaled; Farid, Walid

    2015-01-01

    Africa displays a variety of continental margin structures, tectonics and sedimentary records. The northern Egyptian continental margin represents the NE portion of the North African passive continental margin. Economically, this region is of great importance as a very rich and productive hydrocarbon zone in Egypt. Moreover, it is characterized by remarkable tectonic setting accompanied by active tectonic processes from the old Tethys to recent Mediterranean. In this article, seismicity of the northern Egyptian continental margin has been re-evaluated for more than 100-years and the source parameters of three recent earthquakes (October 2012, January 2013 and July 2013) have been estimated. Moment tensor inversions of 19th October 2012 and 17th January 2013 earthquakes reveal normal faulting mechanism with strike-slip component having seismic moment of 3.5E16 N m and 4.3E15 N m respectively. The operation of the Egyptian National Seismic Network (ENSN) since the end of 1997 has significantly enhanced the old picture of earthquake activity across northern Egyptian continental margin whereas; the record-ability (annual rate) has changed from 2-events/year to 54-event/year before and after ENSN respectively. The spatial distribution of earthquakes foci indicated that the activity tends to cluster at three zones: Mediterranean Ridge (MR), Nile Cone (NC) and Eratosthenes Seamount (ERS). However, two seismic gaps are reported along Levant Basin (LEV) and Herodotus Basin (HER).

  19. Atlantic marginal basins of Africa

    SciTech Connect

    Moore, G.T.

    1988-02-01

    The over 10,000-km long Atlantic margin of Africa is divisible into thirty basins or segments of the margin that collectively contain over 18.6 x 10/sup 6/ km/sup 3/ of syn-breakup and post-breakup sediments. Twenty of these basins contain a sufficiently thick volume of sediments to be considered prospects. These basins lie, at least partially, within the 200 m isobath. The distribution of source rocks is broad enough to give potential to each of these basins. The sedimentation patterns, tectonics, and timing of events differ from basin to basin and are related directly to the margin's complex history. Two spreading modes exist: rift and transform. Rifting dates from Late Triassic-Early Jurassic in the northwest to Early Cretaceous south of the Niger Delta. A complex transform fault system separated these two margins. Deep-water communication between the two basins became established in the middle Cretaceous. This Mesozoic-Cenozoic cycle of rifting and seafloor spreading has segmented the margin and where observable, basins tend to be bounded by these segments.

  20. Supply versus demand: a review of application trends to Canadian surgical training programs.

    PubMed

    Austin, Ryan E; Wanzel, Kyle R

    2015-04-01

    Despite increases in medical school enrolment, applications to surgical residency programs in Canada have been in decline over the past decade, with an increasing number of unmatched surgical residency positions. We examined the current status of surgical residency in Canada and analyzed application trends (2002–2013) for surgical training programs across Canada. Our findings suggest that most undergraduate medical schools across Canada are having difficulty fostering interest in surgical careers. We propose that a lack of adequate early exposure to the surgical specialties during undergraduate training is a critical factor. Moving forward, we must examine how the best-performing institutions and surgical programs have maintained interest in pursuing surgical careers and adapt our recruitment methods to both maintain and grow future interest. As Mary Engelbreit said, "If you don't like something, change it; if you can't change it, change the way you think about it."

  1. Surgical hand antisepsis: the evidence.

    PubMed

    Tanner, Judith

    2008-08-01

    For 150 years members of the surgical team have been washing their hands with solutions designed to remove micro-organisms and therefore reduce surgical site infections in patients. This article discusses the evidence surrounding aspects of surgical hand antisepsis.

  2. Multiscale Surgical Telerobots

    SciTech Connect

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  3. Marginal Comment: Reservations about "Murder at the Margin."

    ERIC Educational Resources Information Center

    Dimand, Mary Ann

    1991-01-01

    Reexamines the use of the novel, "Murder at the Margin," in college and high school economics instruction. Identifies errors in the book's application of economic principles. Explores the novel's approach to the "prisoner's dilemma" and the making of choices. Concludes that despite problems, the book remains valuable to…

  4. [Surgical and therapeutic treatment of acute pancreatitis].

    PubMed

    Sandakov, P Ia; Samartsev, V A; Mineev, D A

    2014-01-01

    It was analyzed the features of different forms of acute pancreatitis in 1001 patients including 324 cases with pancreatonecrosis and 245 patients with middle severity of disease. It was shown that monitoring of patients' condition and destructive process in pancreas by using of modified SOFA-scale and evaluation of sonographic signs of inflammation are advisable. Flow indicators including resistance index and the maximum flow velocity in celiac trunk and superior mesenteric artery represented severity of gland's destruction. Sonographic investigation revealed small-focal pancreonecrosis. It allows to differentiate medical tactics. Surgical treatment was performed in 582 patients. Efficiency of surgical treatment is determined by diagnostic methods, timely sanation of destructive focuses of pancreas, abdominal cavity, retroperitoneal fiber, adequate drainage and mini-invasive techniques using in case of purulent complications. The main prognostic factors of development of complications and adverse outcomes are determined.

  5. The Versatile Lid Crease Approach to Upper Eyelid Margin Rotation.

    PubMed

    Cruz, Antonio A V; Akaishi, Patricia M S; Al-Dufaileej, Mohammed; Galindo-Ferreiro, Alicia

    2015-01-01

    Lid margin rotational procedures have been used to correct cicatricial trachomatous entropion since the 19(th) century. There are two basic types of surgeries used for lid margin rotation. The first type is based on through-and-through approach combining tarsotomy and the use of sutures on the anterior lamella. The second type of surgery was suggested by Trabut, who proposed a tarsal advancement by posterior approach. We demonstrate that using a lid crease incision combines the basic mechanisms of the anterior and posterior approaches and in addition, addresses a variety of lid problems commonly found in the aged population with cicatricial entropion. After tarsal plate exposure, a tarsotomy through conjunctiva is performed as described by Trabut. Then, instead of using external sutures secured by bolsters, internal absorbable sutures can be used to simultaneously advance the distal tarsal fragment and exert strong tension on the marginal orbicularis muscle. Sixty lids of 40 patients underwent surgery with a lid crease incision. The follow-up ranged from 1 to 12 months (mean 3.0 months ± 2.71). Forty percent of the patients (24 lids) had more than 3 months of follow-up. Adequate margin rotation was achieved in all lids but one that showed a medial eyelash touching the cornea.

  6. The Use of Rewards in Motivating Marginal Members of the Work Force.

    ERIC Educational Resources Information Center

    Porter, Lyman W.

    This paper deals with the use of rewards for on-the-job motivation toward better attendance and performance of marginal workers (those who have not been employed on a regular basis but who are presumed to be capable of becoming adequate workers). Possible rewards are 1) financial (wage increases and fringe benefits); 2) interpersonal (social…

  7. Estimation Of TMDLs And Margin Of Safety Under Conditions Of Uncertainty

    EPA Science Inventory

    In TMDL development, an adequate margin of safety (MOS) is required in the calculation process to provide a cushion needed because of uncertainties in the data and analysis. Current practices, however, rarely factor analysis' uncertainty in TMDL development and the MOS is largel...

  8. Surgical management of hemorrhoids.

    PubMed

    Agbo, S P

    2011-07-01

    Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding.

  9. Biocompatibility of surgical implants

    NASA Technical Reports Server (NTRS)

    Kaelble, D. H.

    1979-01-01

    Method of selecting biocompatible materials for surgical implants uses fracture mechanic relationships and surface energies of candidate materials in presence of blood plasma. Technique has been used to characterize 190 materials by parameters that reflect their biocompatibility.

  10. Smart surgical tool

    NASA Astrophysics Data System (ADS)

    Huang, Huan; Yang, Lih-Mei; Bai, Shuang; Liu, Jian

    2015-02-01

    A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

  11. Smart surgical tool.

    PubMed

    Huang, Huan; Yang, Lih-Mei; Bai, Shuang; Liu, Jian

    2015-02-01

    A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

  12. Correlation of the Vocal Fold Vibratory Pattern to the Post-Operative Surgical Wound in the Porcine Model.

    DTIC Science & Technology

    1992-02-15

    functional layers within the vocal folds. To do this, videostroboscopy (VS) and electroglottography ( EGG ) were used to record glottal function during...of air is formed as the lower margin opens first , followed by opening of the upper margin and release of the puff. This fluid-like movement is defined...normal laryngeal anatomy. The first surgical procedure on the right true vocal fold utilized microsurgical instruments. The surgical incision and/or

  13. Field grading in capacitor margins

    NASA Astrophysics Data System (ADS)

    Springer, T. E.; Sarjeant, W. J.; Nunnally, W. C.

    1981-06-01

    Some of the results of modeling electric fields in the margin of a bogey plastic film liquid impregnant capacitor are presented where effects of foil edge shape, different impregnants, and grading wires are examined. It is concluded that placement tolerance and connection problems make grading wires impractical and that folded foil edges are still the best solution to field grading.

  14. Defining an adequate sample of earlywood vessels for retrospective injury detection in diffuse-porous species.

    PubMed

    Arbellay, Estelle; Corona, Christophe; Stoffel, Markus; Fonti, Patrick; Decaulne, Armelle

    2012-01-01

    Vessels of broad-leaved trees have been analyzed to study how trees deal with various environmental factors. Cambial injury, in particular, has been reported to induce the formation of narrower conduits. Yet, little or no effort has been devoted to the elaboration of vessel sampling strategies for retrospective injury detection based on vessel lumen size reduction. To fill this methodological gap, four wounded individuals each of grey alder (Alnus incana (L.) Moench) and downy birch (Betula pubescens Ehrh.) were harvested in an avalanche path. Earlywood vessel lumina were measured and compared for each tree between the injury ring built during the growing season following wounding and the control ring laid down the previous year. Measurements were performed along a 10 mm wide radial strip, located directly next to the injury. Specifically, this study aimed at (i) investigating the intra-annual duration and local extension of vessel narrowing close to the wound margin and (ii) identifying an adequate sample of earlywood vessels (number and intra-ring location of cells) attesting to cambial injury. Based on the results of this study, we recommend analyzing at least 30 vessels in each ring. Within the 10 mm wide segment of the injury ring, wound-induced reduction in vessel lumen size did not fade with increasing radial and tangential distances, but we nevertheless advise favoring early earlywood vessels located closest to the injury. These findings, derived from two species widespread across subarctic, mountainous, and temperate regions, will assist retrospective injury detection in Alnus, Betula, and other diffuse-porous species as well as future related research on hydraulic implications after wounding.

  15. Defining an Adequate Sample of Earlywood Vessels for Retrospective Injury Detection in Diffuse-Porous Species

    PubMed Central

    Arbellay, Estelle; Corona, Christophe; Stoffel, Markus; Fonti, Patrick; Decaulne, Armelle

    2012-01-01

    Vessels of broad-leaved trees have been analyzed to study how trees deal with various environmental factors. Cambial injury, in particular, has been reported to induce the formation of narrower conduits. Yet, little or no effort has been devoted to the elaboration of vessel sampling strategies for retrospective injury detection based on vessel lumen size reduction. To fill this methodological gap, four wounded individuals each of grey alder (Alnus incana (L.) Moench) and downy birch (Betula pubescens Ehrh.) were harvested in an avalanche path. Earlywood vessel lumina were measured and compared for each tree between the injury ring built during the growing season following wounding and the control ring laid down the previous year. Measurements were performed along a 10 mm wide radial strip, located directly next to the injury. Specifically, this study aimed at (i) investigating the intra-annual duration and local extension of vessel narrowing close to the wound margin and (ii) identifying an adequate sample of earlywood vessels (number and intra-ring location of cells) attesting to cambial injury. Based on the results of this study, we recommend analyzing at least 30 vessels in each ring. Within the 10 mm wide segment of the injury ring, wound-induced reduction in vessel lumen size did not fade with increasing radial and tangential distances, but we nevertheless advise favoring early earlywood vessels located closest to the injury. These findings, derived from two species widespread across subarctic, mountainous, and temperate regions, will assist retrospective injury detection in Alnus, Betula, and other diffuse-porous species as well as future related research on hydraulic implications after wounding. PMID:22761707

  16. The rat adequately reflects human responses to exercise in blood biochemical profile: a comparative study

    PubMed Central

    Goutianos, Georgios; Tzioura, Aikaterini; Kyparos, Antonios; Paschalis, Vassilis; Margaritelis, Nikos V; Veskoukis, Aristidis S; Zafeiridis, Andreas; Dipla, Konstantina; Nikolaidis, Michalis G; Vrabas, Ioannis S

    2015-01-01

    Animal models are widely used in biology and the findings of animal research are traditionally projected to humans. However, recent publications have raised concerns with regard to what extent animals and humans respond similar to physiological stimuli. Original data on direct in vivo comparison between animals and humans are scarce and no study has addressed this issue after exercise. We aimed to compare side by side in the same experimental setup rat and human responses to an acute exercise bout of matched intensity and duration. Rats and humans ran on a treadmill at 86% of maximal velocity until exhaustion. Pre and post exercise we measured 30 blood chemistry parameters, which evaluate iron status, lipid profile, glucose regulation, protein metabolism, liver, and renal function. ANOVA indicated that almost all biochemical parameters followed a similar alteration pattern post exercise in rats and humans. In fact, there were only 2/30 significant species × exercise interactions (in testosterone and globulins), indicating different responses to exercise between rats and humans. On the contrary, the main effect of exercise was significant in 15/30 parameters and marginally nonsignificant in other two parameters (copper, P = 0.060 and apolipoprotein B, P = 0.058). Our major finding is that the rat adequately mimics human responses to exercise in those basic blood biochemical parameters reported here. The physiological resemblance of rat and human blood responses after exercise to exhaustion on a treadmill indicates that the use of blood chemistry in rats for exercise physiology research is justified. PMID:25677548

  17. SU-E-J-188: Theoretical Estimation of Margin Necessary for Markerless Motion Tracking

    SciTech Connect

    Patel, R; Block, A; Harkenrider, M; Roeske, J

    2015-06-15

    Purpose: To estimate the margin necessary to adequately cover the target using markerless motion tracking (MMT) of lung lesions given the uncertainty in tracking and the size of the target. Methods: Simulations were developed in Matlab to determine the effect of tumor size and tracking uncertainty on the margin necessary to achieve adequate coverage of the target. For simplicity, the lung tumor was approximated by a circle on a 2D radiograph. The tumor was varied in size from a diameter of 0.1 − 30 mm in increments of 0.1 mm. From our previous studies using dual energy markerless motion tracking, we estimated tracking uncertainties in x and y to have a standard deviation of 2 mm. A Gaussian was used to simulate the deviation between the tracked location and true target location. For each size tumor, 100,000 deviations were randomly generated, the margin necessary to achieve at least 95% coverage 95% of the time was recorded. Additional simulations were run for varying uncertainties to demonstrate the effect of the tracking accuracy on the margin size. Results: The simulations showed an inverse relationship between tumor size and margin necessary to achieve 95% coverage 95% of the time using the MMT technique. The margin decreased exponentially with target size. An increase in tracking accuracy expectedly showed a decrease in margin size as well. Conclusion: In our clinic a 5 mm expansion of the internal target volume (ITV) is used to define the planning target volume (PTV). These simulations show that for tracking accuracies in x and y better than 2 mm, the margin required is less than 5 mm. This simple simulation can provide physicians with a guideline estimation for the margin necessary for use of MMT clinically based on the accuracy of their tracking and the size of the tumor.

  18. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies

    PubMed Central

    Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Ramirez-Fuentes, Cristina; Leal-Blanquet, Joan; Gelber, Pablo E; Monllau, Joan Carles

    2017-01-01

    Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented. PMID:28251062

  19. Key Aspects of Health Policy Development to Improve Surgical Services in Uganda

    PubMed Central

    Luboga, Sam; Galukande, Moses; Mabweijano, Jacqueline; Jayaraman, Sudha

    2010-01-01

    Recently, surgical services have been gaining greater attention as an integral part of public health in low-income countries due to the significant volume and burden of surgical conditions, growing evidence of the cost-effectiveness of surgical intervention, and global disparities in surgical care. Nonetheless, there has been limited discussion of the key aspects of health policy related to surgical services in low-income countries. Uganda, like other low-income sub-Saharan African countries, bears a heavy burden of surgical conditions with low surgical output in health facilities and significant unmet need for surgical care. To address this lack of adequate surgical services in Uganda, a diverse group of local stakeholders met in Kampala, Uganda, in May 2008 to develop a roadmap of key policy actions that would improve surgical services at the national level. The group identified a list of health policy priorities to improve surgical services in Uganda. The priorities were classified into three areas: (1) human resources, (2) health systems, and (3) research and advocacy. This article is a critical discussion of these health policy priorities with references to recent literature. This was the first such multidisciplinary meeting in Uganda with a focus on surgical services and its output may have relevance to health policy development in other low-income countries planning to improve delivery of surgical services. PMID:20730430

  20. Clinical study of imaging skin cancer margins using polarized light imaging

    NASA Astrophysics Data System (ADS)

    Samatham, Ravikant; Lee, Ken; Jacques, Steven L.

    2012-02-01

    Skin cancer is most commons type of cancer in United States that occur on sun-exposed cosmetically sensitive areas like face, neck, and forearms. Surgical excision of skin cancer is challenging as more than one-third the actual margins extend beyond the clinically determined margins. Polarized light camera (polCAM) provides images of the superficial layers of the tissue with enhanced contrast which was used to image skin cancer margins. In a NIH-funded pilot study polCAM was used to image skin cancer in patients undergoing Mohs micrographic surgery for skin cancer. Polarized light imaging utilizes the polarization properties of light to create an image of a lesion comprised only of light scattering from the superficial layers of the skin which yields a characteristic "fabric pattern" of the putative lesion and the surrounding normal tissue. In several case studies conducted with a system developed for the clinic, we have found that skin cancer disrupts this fabric pattern, allowing the doctor a new means of identifying the margins of the lesion. Data is acquired before the patient underwent surgery. The clinically determined skin cancer margins were compared with margins determined by examination of the polCAM images. The true margins were provided by the dermatophathologist on examination of the frozen sections. Our initial data suggests that the contrast due to polarization changes associated with cancerous lesions can elucidate margins that were not recognized by the surgeon under normal conditions but were later confirmed by the pathologist.

  1. [Change of attitude in the surgical treatment of lung metastases].

    PubMed

    Czeyda-Pommersheim, Ferenc; Kovács, Tibor; Sulyok, Zoltán; Farkas, Emil; Besznyák, István; Köves, István

    2004-12-01

    There has been no major change in surgical technique of lung metastasectomy till the last decades. In the latest years the variety of diagnostic tools and methods grew significantly. There are more chemotherapy possibilities and more palliative surgical techniques (VATS, ITP, RFTA) to treat certain types of lung metastases. Based on data of the International Registry of Lung Metastases the most important prognostic factor for metastasectomy is how radical the procedure was (clear resection margin). The more aggressive approach (even pneumonectomy for R0 resection) is becoming more popular.

  2. 3D Surgical Simulation

    PubMed Central

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

    2009-01-01

    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  3. The Effects of Postoperative Activity on Subcuranious Tissue Oxygen Tension and Blood Flow in Orthopedic Surgical Patients

    DTIC Science & Technology

    1993-06-01

    killing common surgical infection organisms as Staphylococcus aureus, E coli, Serratia marcescens, Klebsiella pneumoniae, Proteus vulgaris , and...healing of wounded tissue is the maintenance of adequate tissue oxygenation. Abundant molecular oxygen must be present for cellular processes of oxidative

  4. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  5. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  6. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  7. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  8. 21 CFR 801.5 - Medical devices; adequate directions for use.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Medical devices; adequate directions for use. 801... (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for use means directions under which the layman can use a device...

  9. Appositional bone formation in marginal defects at implants.

    PubMed

    Botticelli, Daniele; Berglundh, Tord; Buser, Daniel; Lindhe, Jan

    2003-02-01

    In a previous experiment, it was demonstrated that a wide marginal defect around an implant can heal with a high degree of osseointegration. The present experiment was performed to evaluate the degree and quality of de novo bone formation and osseointegration in marginal defects adjacent to submerged titanium implants. All mandibular premolars and 1st molars were extracted in four Labrador dogs. Four experimental sites were identified in the right side of the mandible. In two sites, custom-made implants with a sandblasted, large grit, acid-etched (SLA) surface were installed without further ostectomy (control sites). In the two remaining sites (test sites), a specially designed step drill was used to widen the marginal 5 mm of the canal. A barrier membrane was used to cover the implants in the defect sites. All implants were submerged. One month later, an identical procedure, including site preparation and implant installation, was performed in the left side of the mandible. Two months following the first implant installation procedure, biopsies were collected and prepared for sectioning. Ostectomy and implant installation in the control location resulted in a series of bone tissue alterations which eventually allowed newly formed bone to establish contact with the SLA surface. The marginal defect lateral to the implant in the test locations gradually became filled with newly formed bone. De novo bone formation started within the walls of the surgically prepared defect. Bone-to-implant contact was first established in the apical portion of the gap. This new bone tissue was in the coronal direction continuous with a dense, non-mineralized 'implant attached' soft tissue which, over time, also became mineralized to increase the height of the zone of bone-to-implant contact. The results suggest that healing of a wide marginal defect around an implant is characterized by appositional bone growth from the lateral and apical bone walls of the defect.

  10. [Marginality, ethnic groups and health].

    PubMed

    Corretger, J M; Fortuny, C; Botet, F; Valls, O

    1992-06-01

    Main marginated ethnic groups in Span are to be found among gypsies and 3rd world immigrants. The first group include about 250,000 persons and the second group more tan half a million people. Their origins and their being past of the less fortunate social layers made them a group of health risk. Pediatric pathologies are those favored by socio-economic shortcomings as well as hygienic-sanitary deficiencies. Imported pediatric pathologies have a small incident.

  11. Robotic surgical simulation.

    PubMed

    Liss, Michael A; McDougall, Elspeth M

    2013-01-01

    Robotic surgery has undergone exponential growth and has ever developing utilization. The explosion of new technologies and regulation have led to challenges in training surgeons who desire this skill set. We review the current state of robotic simulation and incorporation of simulation into surgical training curricula. In addition to the literature review, results of a questionnaire survey study of 21 expert and novice surgeons attending a Urologic Robotic Oncology conference using 3 different robotic skill simulation devices are discussed. An increasing number of robotic surgery simulators have had some degree of validation study of their use in surgical education curricula and proficiency testing. Although simulators are advantageous, confirmation of construct and predictive validity of robotic simulators and their reliability as a training tool will be necessary before they are integrated into the surgical credentialing process.

  12. Surgical reconstruction of TMJ.

    PubMed

    Ramil Novo, V M; Garcìa, A G; Berini Aytès, L; Escoda, C G

    1999-01-01

    Certain situations and pathological processes that arise with temporomandibular joint destruction can only be resolved with surgical reconstructive procedures in order to attempt a functional and anatomical rehabilitation of this joint. Many of these situations can be surgically treated with the patient's own autologous tissues. However, in some patients reconstruction is complex and the use of autologous tissues is unadvisable whereas reconstruction utilizing alloplastic materials may be an appropriate alternative. The following report describes 4 clinical cases in which autologous grafts or Christensen joint prosthesis are employed in temporomandibular joint reconstruction.

  13. Surgical treatment for epilepsy

    PubMed Central

    Engel, Jerome; Wiebe, Samuel; Radhakrishnan, Kurupath; Palmini, André

    2016-01-01

    Surgical treatment for epilepsy remains highly underutilized: in the United States, there has been no increase in the number of surgical procedures performed annually since 19901; for most patients referred, the average duration of epilepsy is 22 years2; and there has been no change in this delay to surgery3, despite two randomized controlled trials4, 5 and an American Academy of Neurology practice parameter that recommended surgery as the treatment of choice for medically refractory temporal lobe epilepsy6. This session addressed issues relevant to increasing the availability of epilepsy surgery, particularly in countries with limited resources.

  14. CTV to PTV in cervical cancer: From static margins to adaptive radiotherapy.

    PubMed

    Sun, R; Mazeron, R; Chargari, C; Barillot, I

    2016-10-01

    Intensity-modulated radiotherapy (IMRT) is increasingly used in order to minimize the gastrointestinal, genitourinary, and hematological toxicity in cervical and uterine cancers. However, the benefit of this high-precision approach is detracted by the margins applied to the clinical target volume (CTV) to generate the planning tumor volume (PTV), taking into account tumor and surrounding organs movements, deformations, and volume changes. Adequate PTV margins should be large enough to prevent geographical misses, but not excessive, which might end the benefit from IMRT. The objectives of this review were: (a) to present the evidence available for the determination of CTV-PTV margin for uterine cancers; (b) to highlight the impact of these margins in the context of adaptive radiotherapy; and (c) to discuss the role of the PTV concept in intracavitary brachytherapy.

  15. Surgical Instrument Restraint in Weightlessness

    NASA Technical Reports Server (NTRS)

    Campbell, Mark R.; Dawson, David L.; Melton, Shannon; Hooker, Dona; Cantu, Hilda

    2000-01-01

    Performing a surgical procedure during spaceflight will become more likely with longer duration missions in the near future. Minimal surgical capability has been present on previous missions as the definitive medical care time was short and the likelihood of surgical events too low to justify surgical hardware availability. Early demonstrations of surgical procedures in the weightlessness of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. The consideration of human ergonomics also has more impact in weightlessness than in the conventionall-g environment. Three methods of surgical instrument restraint - a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST) were evaluated in parabolic flight surgical procedures. The Minor Surgical Kit was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in weightlessness. Important factors in this surgical restraint system include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomical efficiency.

  16. Trends in the Surgical Correction of Gynecomastia

    PubMed Central

    Brown, Rodger H.; Chang, Daniel K.; Siy, Richard; Friedman, Jeffrey

    2015-01-01

    Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using arthroscopic morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results. PMID:26528088

  17. Surgical wound care -- closed

    MedlinePlus

    ... around the incision increases or becomes thick, tan, green, or yellow, or smells bad (pus). Also call if your temperature is above 100°F (37.7°C) for more than 4 hours. Alternative Names Surgical incision care; Closed wound care References Leong M, Phillips LG. ...

  18. Surgical wound care - open

    MedlinePlus

    Surgical incision care; Open wound care ... your wound again with sutures, you need to care for it at home, since it may take ... Your health care provider will tell you how often to change your dressing . To prepare for the dressing change: Clean your ...

  19. [Optimizing surgical hand disinfection].

    PubMed

    Kampf, G; Kramer, A; Rotter, M; Widmer, A

    2006-08-01

    For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.

  20. Silenced, Silence, Silent: Motherhood in the Margins

    ERIC Educational Resources Information Center

    Carpenter, Lorelei; Austin, Helena

    2007-01-01

    This project explores the experiences of women who mother children with ADHD. The authors use the metaphor of the text and the margin. The text is the "motherhood myth" that describes a particular sort of "good" mothering. The margin is the space beyond that text. This marginal space is inhabited by some or all of the mothers they spoke with, some…

  1. [Erosive marginal keratitis due to pilocarpine allergy].

    PubMed

    Radian, A B

    1999-01-01

    In 3 patients under local pilocarpine medication, corneal marginal infiltration and limbic ulcerations were noted that were typical for allergic marginal keratitis. A classical allergic conjunctivitis was present in every case. They healed after pilocarpine instillations were suspended and local corticosteroids together with oral antihistaminic drugs were applied. Marginal allergic erosions of the cornea is another form of secondary complication in patients using pilocarpine.

  2. Marginal Costs and Formula-Based Funding.

    ERIC Educational Resources Information Center

    O'Connor, Ellen

    Marginal cost is the cost of producing an additional unit. In higher education, one marginal cost would be cost of educating an additional student. Formula-based budget determination for public higher education is usually based on average cost per student. This study estimates marginal cost and compares it with average cost. There are several…

  3. 17 CFR 31.18 - Margin calls.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Margin calls. 31.18 Section 31....18 Margin calls. (a) No leverage transaction merchant shall liquidate a leverage contract because of... after contact is effected in which to respond to a margin call. Twenty-four hours, excluding...

  4. Investigation of platelet margination phenomena at elevated shear stress.

    PubMed

    Zhao, Rui; Kameneva, Marina V; Antaki, James F

    2007-01-01

    Thrombosis is a common complication following the surgical implantation of blood contacting artificial organs. Platelet transport, which is an important process of thrombosis and strongly modulated by flow dynamics, has not been investigated under the shear stress level associated with these devices, which may range from tens to several hundred Pascal.The current research investigated platelet transport within blood under supra-physiological shear stress conditions through a micro flow visualization approach. Images of platelet-sized fluorescent particles in the blood flow were recorded within microchannels (2 cm x 100 microm x 100 microm). The results successfully demonstrated the occurrence of platelet-sized particle margination under shear stresses up to 193 Pa, revealing a platelet near-wall excess up to 8.7 near the wall (within 15 microm) at the highest shear stress. The concentration of red blood cells was found to influence the stream-wise development of platelet margination which was clearly observed in the 20% Ht sample but not the 40% Ht sample. Shear stress had a less dramatic effect on the margination phenomenon than did hematocrit. The results imply that cell-cell collision is an important factor for platelet transport under supra-physiologic shear stress conditions. It is anticipated that these results will contribute to the future design and optimization of artificial organs.

  5. Towards intraoperative assessment of tumor margins in breast surgery using optical coherence elastography (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Kennedy, Brendan F.; Wijesinghe, Philip; Allen, Wes M.; Chin, Lixin; Latham, Bruce; Saunders, Christobel M.; Sampson, David D.

    2016-03-01

    Surgical excision of tumor is a critical factor in the management of breast cancer. The most common surgical procedure is breast-conserving surgery. The surgeon's goal is to remove the tumor and a rim of healthy tissue surrounding the tumor: the surgical margin. A major issue in breast-conserving surgery is the absence of a reliable tool to guide the surgeon in intraoperatively assessing the margin. A number of techniques have been proposed; however, the re-excision rate remains high and has been reported to be in the range 30-60%. New tools are needed to address this issue. Optical coherence elastography (OCE) shows promise as a tool for intraoperative tumor margin assessment in breast-conserving surgery. Further advances towards clinical translation are limited by long scan times and small fields of view. In particular, scanning over sufficient areas to assess the entire margin in an intraoperative timeframe has not been shown to be feasible. Here, we present a protocol allowing ~75% of the surgical margins to be assessed within 30 minutes. To achieve this, we have incorporated a 65 mm-diameter (internal), wide-aperture annular piezoelectric transducer, allowing the entire surface of the excised tumor mass to be automatically imaged in an OCT mosaic comprised of 10 × 10 mm tiles. As OCT is effective in identifying adipose tissue, our protocol uses the wide-field OCT to selectively guide subsequent local OCE scanning to regions of solid tissue which often present low contrast in OCT images. We present promising examples from freshly excised human breast tissue.

  6. Continental margin tectonics - Forearc processes

    SciTech Connect

    Lundberg, N.; Reed, D.L. )

    1991-01-01

    Recent studies of convergent plate margins and the structural development of forearc terranes are summarized in a critical review of U.S. research from the period 1987-1990. Topics addressed include the geometry of accretionary prisms (Coulomb wedge taper and vertical motion in response to tectonic processes), offscraping vs underplating or subduction, the response to oblique convergence, fluids in forearc settings, the thermal framework and the effects of fluid advection, and serpentinite seamounts. Also included is a comprehensive bibliography for the period.

  7. Three-dimensional marginal separation

    NASA Technical Reports Server (NTRS)

    Duck, Peter W.

    1988-01-01

    The three dimensional marginal separation of a boundary layer along a line of symmetry is considered. The key equation governing the displacement function is derived, and found to be a nonlinear integral equation in two space variables. This is solved iteratively using a pseudo-spectral approach, based partly in double Fourier space, and partly in physical space. Qualitatively, the results are similar to previously reported two dimensional results (which are also computed to test the accuracy of the numerical scheme); however quantitatively the three dimensional results are much different.

  8. Marginal Lands: Concept, Assessment and Management

    SciTech Connect

    Kang, Shujiang; Post, Wilfred M; West, Tristram O.; Bandaru, Vara Prasad; Izaurralde, Dr. R. Cesar; Wang, Dali; Nichols, Dr Jeff A

    2013-01-01

    Marginal lands have received wide attention for their potential to improve food security and support bioenergy production. However, environmental, ecosystem service, and sustainability concerns have been widely raised over the use of marginal land. Knowledge of the extent, location, and quality of marginal lands as well as their assessment and management are limited and diverse. This paper provides a review of the historical development of marginal concept, its application and assessment. Limitations and priority research needs of marginal land assessment and management were discussed.

  9. Dynamics of the continental margins

    SciTech Connect

    Not Available

    1990-11-01

    On 18--20 June 1990, over 70 oceanographers conducting research in the ocean margins of North America attended a workshop in Virginia Beach, Virginia. The purpose of the workshop was to provide the Department of Energy with recommendations for future research on the exchange of energy-related materials between the coastal and interior ocean and the relationship between the ocean margins and global change. The workshop was designed to optimize the interaction of scientists from specific research disciplines (biology, chemistry, physics and geology) as they developed hypotheses, research questions and topics and implementation plans. The participants were given few restraints on the research they proposed other than realistic time and monetary limits. The interdisciplinary structure of the meeting promoted lively discussion and creative research plans. The meeting was divided into four working groups based on lateral, vertical, air/sea and sediment/water processes. Working papers were prepared and distributed before the meeting. During the meeting the groups revised the papers and added recommendations that appear in this report, which was reviewed by an Executive Committee.

  10. Using laser irradiation for the surgical treatment of periodontal disease

    NASA Astrophysics Data System (ADS)

    Vieru, Rozana D.; Lefter, Agafita; Herman, Sonia

    2002-10-01

    In the marginal pr ogressive profound periodontities, we associated low level laser therapy (LLLT) to the classical surgical treatment with implant of biovitroceramics. From a total of 50 patients, 37 where irradiated with the laser. We used a diode laser, =830 nm, energy density up to 2 J cm2, in Nogier pulsed mode. The laser treatment is used in a complex of therapeutic procedures: odontal, local anti-inflammatory -- as well as in the cabinet and at home --, prosthetic, and for the morphologic and functional rebalancing. The immediate effects where: an evolution without bleeding and without post-surgical complications, as can appear at the patients who didn't benefit of laser irradiation (hematom, pain, functional alteration in the first post-surgical week). Operated tissue is recovering faster. The percentage of recurrences decreases and the success depends less on the biological potential and the immunity of each individual.

  11. Challenges in evaluating surgical innovation

    PubMed Central

    Ergina, Patrick L; Cook, Jonathan A; Blazeby, Jane M; Boutron, Isabelle; Clavien, Pierre-Alain; Reeves, Barnaby C; Seiler, Christoph M

    2010-01-01

    Research on surgical interventions is associated with several methodological and practical challenges of which few, if any, apply only to surgery. However, surgical evaluation is especially demanding because many of these challenges coincide. In this report, the second of three on surgical innovation and evaluation, we discuss obstacles related to the study design of randomised controlled trials and non-randomised studies assessing surgical interventions. We also describe the issues related to the nature of surgical procedures—for example, their complexity, surgeon-related factors, and the range of outcomes. Although difficult, surgical evaluation is achievable and necessary. Solutions tailored to surgical research and a framework for generating evidence on which to base surgical practice are essential. PMID:19782875

  12. [Surgical scrub: evaluation of its adequacy in preventing biological risks in surgery: I. Its use in surgery].

    PubMed

    Paz, M S; Lacerda, R A; Monteiro, C E; da Conceição, V P

    2000-03-01

    The study elaborated approaches for adequate use of the surgical scrub and it evaluated, through systematized observation, the performance of the surgical team during the surgery. The adopted procedure was very valid, allowing to recognize positive and problematic aspects. Except the protecting glasses, all the other components of the surgical scrub were used. The subject located in the use form, where caps and masks were more problematic among anaesthesists and circulate nurses; apron and gloves among surgeons and, mainly, scrub nurses.

  13. System Guidelines for EMC Safety-Critical Circuits: Design, Selection, and Margin Demonstration

    NASA Technical Reports Server (NTRS)

    Lawton, R. M.

    1996-01-01

    Demonstration of safety margins for critical points (circuits) has traditionally been required since it first became a part of systems-level Electromagnetic Compatibility (EMC) requirements of MIL-E-6051C. The goal of this document is to present cost-effective guidelines for ensuring adequate Electromagnetic Effects (EME) safety margins on spacecraft critical circuits. It is for the use of NASA and other government agencies and their contractors to prevent loss of life, loss of spacecraft, or unacceptable degradation. This document provides practical definition and treatment guidance to contain costs within affordable limits.

  14. An Increase in Consuming Adequately Iodized Salt May Not Be Enough to Rectify Iodine Deficiency in Pregnancy in an Iodine-Sufficient Area of China

    PubMed Central

    Wang, Zhifang; Zhu, Wenming; Mo, Zhe; Wang, Yuanyang; Mao, Guangming; Wang, Xiaofeng; Lou, Xiaoming

    2017-01-01

    Universal salt iodization (USI) has been implemented for two decades in China. It is crucial to periodically monitor iodine status in the most vulnerable population, such as pregnant women. A cross-sectional study was carried out in an evidence-proved iodine-sufficient province to evaluate iodine intake in pregnancy. According to the WHO/UNICEF/ICCIDD recommendation criteria of adequate iodine intake in pregnancy (150–249 µg/L), the median urinary iodine concentration (UIC) of the total 8159 recruited pregnant women was 147.5 µg/L, which indicated pregnant women had iodine deficiency at the province level. Overall, 51.0% of the total study participants had iodine deficiency with a UIC < 150 µg/L and only 32.9% of them had adequate iodine. Participants living in coastal areas had iodine deficiency with a median UIC of 130.1 µg/L, while those in inland areas had marginally adequate iodine intake with a median UIC of 158.1 µg/L (p < 0.001). Among the total study participants, 450 pregnant women consuming non-iodized salt had mild-moderate iodine deficiency with a median UIC of 99.6 µg/L; 7363 pregnant women consuming adequately iodized salt had a lightly statistically higher median UIC of 151.9 µg/L, compared with the recommended adequate level by the WHO/UNICEF/ICCIDD (p < 0.001). Consuming adequately iodized salt seemed to lightly increase the median UIC level, but it may not be enough to correct iodine nutrition status to an optimum level as recommended by the WHO/UNICEF/ICCIDD. We therefore suggest that, besides strengthening USI policy, additional interventive measure may be needed to improve iodine intake in pregnancy. PMID:28230748

  15. Surgical Treatment of Epilepsy

    PubMed Central

    Miller, John W.; Hakimian, Shahin

    2013-01-01

    Purpose of Review: This article outlines indications for neurosurgical treatment of epilepsy, describes the presurgical workup, summarizes surgical approaches, and details expected risks and benefits. Recent Findings: There is class I evidence for the efficacy of temporal lobectomy in treating intractable seizures, and accumulating documentation that successful surgical treatment reverses much of the disability, morbidity, and excess mortality of chronic epilepsy. Summary: Chronic, uncontrolled focal epilepsy causes progressive disability and increased mortality, but these can be reversed with seizure control. Vigorous efforts to stop seizures are warranted. If two well-chosen and tolerated medication trials do not achieve seizure control, an early workup for epilepsy surgery should be arranged. If this workup definitively identifies the brain region from which the seizures arise, and this region can be removed with a low risk of disabling neurologic deficits, neurosurgery will have a much better chance of stopping seizures than further medication trials. PMID:23739107

  16. Spacecraft surgical scrub system

    NASA Technical Reports Server (NTRS)

    Abbate, M.

    1980-01-01

    Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

  17. Mentoring in surgical training.

    PubMed

    Rashid, Prem; Narra, Maruthi; Woo, Henry

    2015-04-01

    Surgical mentors have helped trainees develop fulfilling and academically productive careers, while supervisors are formally assigned to impart skills and oversee training. This paper reviews the comparative roles of the supervisor and mentor and how they overlap, while exploring the impact of the 'unknown' mentor. While the supervisor's role in directing the student is formally recognized, the mentee will personally select a mentor who successfully models the career and life balance to which the mentee aspires. The unknown mentor is known only to the mentee. The mentee's commitment to communicating with both mentor and supervisor is crucial to success. Better processes can be used to guide the mentor relationship. Confusion between the two roles - mentor and supervisor - is due to their complementary nature as well as an overlap in roles. Both remain essential to the growth and development of the surgical trainee. The unknown mentor could give detached advice and guidance to the student, while acting as a positive role model.

  18. The Human Right to Adequate Housing: A Tool for Promoting and Protecting Individual and Community Health

    PubMed Central

    Thiele, Bret

    2002-01-01

    The human right to adequate housing is enshrined in international law. The right to adequate housing can be traced to the Universal Declaration of Human Rights, which was unanimously adopted by the world community in 1948. Since that time, the right to adequate housing has been reaffirmed on numerous occasions and further defined and elaborated. A key component of this right is habitability of housing, which should comply with health and safety standards. Therefore, the right to adequate housing provides an additional tool for advocates and others interested in promoting healthful housing and living conditions and thereby protecting individual and community health. PMID:11988432

  19. Surgical Tourniquets in Orthopaedics

    DTIC Science & Technology

    2009-12-01

    Petit described a new screw- like device that tightened a belt to stop arterial blood flow1. With the advent of general anesthesia, Joseph Lister was the...were rated 92% effective and non- pneumatic tourniquets were rated 79% effective33. However, the use of non-pneumatic Petit ( belt ) tourni- quets and...and pressure gradients typically produced by a modern pneumatic surgical tourniquet cuff (A); a non- pneumatic, non-elastic, belt -type military

  20. Surgical management of neurofibromatosis.

    PubMed

    Parsons, Colin M; Canter, Robert J; Khatri, Vijay P

    2009-01-01

    Neurofibromatoses are a complex set of genetic diseases with a wide spectrum of clinical manifestations. Life-threatening complications may develop as the result of tumor progression. Surgical intervention is the only effective means of treatment for progressive pain, disfigurement, functional compromise, and malignancy. In the future, molecular advances should allow for the development of targeted therapies to treat patients who have neurofibromatosis in addition to those who have sporadic tumors. Tumor profiling should allow us to guide therapies and predict responses.

  1. Guideline implementation: Surgical attire.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-02-01

    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  2. Attached gingiva: histology and surgical augmentation.

    PubMed

    Oh, Se-Lim

    2009-01-01

    The keratinized attached gingiva provides the periodontium with increased resistance to external injury, contributes to the stabilization of the gingival margin, and aids in dissipating physiological forces exerted by the muscular fibers of the alveolar mucosa on the gingival tissues. Increasing attached gingiva should be strongly considered in cases where the patient's plaque control is compromised. The apically positioned flap, free gingival graft, and subepithelial connective tissue graft are the most common surgical procedures used for augmenting the zone of attached gingiva effectively and predictably. The newly obtained keratinized gingiva can be maintained for a long period; in addition, these periodontal procedures halt the progression of gingival recession and could lead to gaining more keratinized gingiva from creeping attachment after the surgery. This article reviews the biology of attached gingiva and presents cases related to the functional role of periodontal plastic surgery.

  3. Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

    SciTech Connect

    Demirci, Senem; Broadwater, Gloria; Marks, Lawrence B.; Clough, Robert; Prosnitz, Leonard R.

    2012-07-01

    Purpose: To evaluate treatment results and prognostic factors, especially margin status and molecular subtype, in early-stage breast cancer patients treated with breast conservation therapy (BCT). Methods and Materials: The records of 1,058 Stage I or II breast cancer patients treated with BCT (surgical excision plus radiotherapy) at Duke University Medical Center, Durham, North Carolina, from 1985-2005 were retrospectively reviewed. Conventional receptor analyses were used as surrogate markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal like). Actuarial estimates of overall survival (OS), cause-specific survival (CSS), failure-free survival, and locoregional control (LRC) were computed by use of Kaplan-Meier plots. We analyzed prognostic variables for significance using Cox proportional hazards univariate and multivariate analysis. The study was approved by the Duke University Medical Center Institutional Review Board. Results: The median age of the patients was 56 years (range, 18-89 years). Of the patients, 80% had T1 disease and 66% N0 disease pathologically. With a median follow-up of 9.8 years, an in-breast recurrence developed in 53 patients and 10 patients had nodal failure. For all patients, the 10-year CSS rate was 94%; LRC rate, 94%; and failure-free survival rate, 88%. Luminal A patients had a CSS rate of 95% and LRC rate of 99%. Basal-type patients appeared to do worse, with regard to both CSS rate (74%) and LRC rate (76%), but the numbers were small and the difference was not statistically significant. LRC rates of patients with negative margins (widely negative, close, and extent of margin not known) were virtually identical (93%, 96%, and 94%, respectively). Those with positive margins appeared to fare slightly worse based on LRC rate (88%), but again, the numbers were small and the difference was not statistically significant. Conclusions: BCT remains the treatment of choice for early-stage breast cancer

  4. Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy.

    PubMed Central

    Willett, C G; Lewandrowski, K; Warshaw, A L; Efird, J; Compton, C C

    1993-01-01

    A retrospective review of the pathology and clinical course of 72 patients undergoing resection of carcinoma of the head of the pancreas was undertaken to identify the frequency of tumor involvement at standard surgical transection margins (stomach, duodenum, pancreas, and bile duct) as well as the peripancreatic soft tissue margin and the potential clinical significance of these findings. Of 72 patients undergoing resection, 37 patients (51%) were found to have tumor extension to the surgical margins. The most commonly involved margin was peripancreatic soft tissue (27 patients) followed by pancreatic transection line (14 patients) and bile duct transection line (4 patients). For 37 patients with tumor present at a resection margin, there were no survivors beyond 41 months. No difference in survival or local control was seen between 14 patients receiving postoperative radiation therapy and 5-fluorouracil (5-FU) compared with 23 patients not receiving additional treatment. In contrast, the 5-year actuarial survival and local control of 35 patients undergoing resection without tumor invasion to a resection margin was 22% and 43%, respectively. The 5-year survival and local control of 16 patients receiving adjuvant radiation therapy and 5-FU was 29% and 42%, respectively, whereas these figures were 18% and 31% for 19 patients not receiving adjuvant therapy (p > 0.10). Because residual local tumor after resection is common, preoperative radiation therapy may be beneficial in this disease. It should minimize the risk of dissemination during operative manipulation and facilitate a curative resection by promoting tumor regression. Because local failure rates approach 60% after resection and adjuvant therapy even in cases having clear resection margins, intraoperative radiation therapy to the tumor bed at the time of resection also might be considered. Protocols evaluating the feasibility and efficacy of preoperative radiation therapy and resection with intraoperative

  5. Spectrally Encoded Confocal Microscopy (SECM) for Diagnosing of Breast Cancer in Excision and Margin Specimens

    PubMed Central

    Brachtel, Elena F.; Johnson, Nicole B.; Huck, Amelia E.; Rice-Stitt, Travis L.; Vangel, Mark G.; Smith, Barbara L.; Tearney, Guillermo J.; Kang, Dongkyun

    2016-01-01

    A large percentage of breast cancer patients treated with breast conserving surgery need to undergo multiple surgeries due to positive margins found during post-operative margin assessment. Carcinomas could be removed completely during the initial surgery and additional surgery avoided if positive margins can be determined intra-operatively. Spectrally-encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technology that has a potential to rapidly image the entire surgical margin at sub-cellular resolution and accurately determine margin status intra-operatively. In this paper, in order to test feasibility of using SECM for intra-operative margin assessment, we have evaluated the diagnostic accuracy of SECM for detecting various types of breast cancers. Forty-six surgically-removed breast specimens were imaged with a SECM system. Side-by-side comparison between SECM and histologic images showed that SECM images can visualize key histomorphologic patterns of normal/benign and malignant breast tissues. Small (500 µm × 500 µm) spatially-registered SECM and histologic images (n=124 for each) were diagnosed independently by three pathologists with expertise in breast pathology. Diagnostic accuracy of SECM for determining malignant tissues was high, average sensitivity of 0.91, specificity of 0.93, positive predictive value of 0.95, and negative predictive value of 0.87. Intra-observer agreement and inter-observer agreement for SECM were also high, 0.87 and 0.84, respectively. Results from this study suggest that SECM may be developed into an intra-operative margin assessment tool for guiding breast cancer excisions. PMID:26779830

  6. Surgical simulation using virtual reality technology: design, implementation, and implications.

    PubMed

    Merril, J R; Preminger, G M; Babayan, R; Roy, R T; Merril, G L

    1994-01-01

    Atremendous demand exists for enhancing the way by which physicians learn new invasive procedures. Appropriate education in new medical and surgical procedures is often outpaced by the desire of physicians to incorporate a procedure in their practice. Computerized surgical simulations have the potential for improving surgical morbidy and mortality. Studies have shown that, for a wide range of diagnostic and therapeutic procedures, doctors doing their first few to several dozen cases are much more likely to make a greater number of errors. This phenomenon has been referred to as 'the learning curve'. Adequate proctoring of learners by experienced surgeons is cumbersome, as there are few surgeons experienced to proctor their colleagues. It is difficult for physicians, particularly those in rural areas, to travel to larger medical centers for training. The requirement also places a burden on experts who could become overwhelmed with proctoring requests, in addition to leaving their clinical responsibilities.

  7. Marginally compact hyperbranched polymer trees.

    PubMed

    Dolgushev, M; Wittmer, J P; Johner, A; Benzerara, O; Meyer, H; Baschnagel, J

    2017-03-29

    Assuming Gaussian chain statistics along the chain contour, we generate by means of a proper fractal generator hyperbranched polymer trees which are marginally compact. Static and dynamical properties, such as the radial intrachain pair density distribution ρpair(r) or the shear-stress relaxation modulus G(t), are investigated theoretically and by means of computer simulations. We emphasize that albeit the self-contact density diverges logarithmically with the total mass N, this effect becomes rapidly irrelevant with increasing spacer length S. In addition to this it is seen that the standard Rouse analysis must necessarily become inappropriate for compact objects for which the relaxation time τp of mode p must scale as τp ∼ (N/p)(5/3) rather than the usual square power law for linear chains.

  8. Prevention of retained surgical items.

    PubMed

    Feldman, David L

    2011-01-01

    Reduction in retained surgical items is an important part of any operating room patient-safety effort. Any item used in an operation can result in a retained surgical item, but sponges are the most frequent and the abdomen is the most common location. Retained sponges can cause significant morbidity, and the costs associated with both prevention and treatment of retained surgical items, including legal costs, can be considerable. This review will examine counting, teamwork, radiography, and new technology as methods used to prevent retained surgical items. Even though none of these techniques individually is likely to completely prevent retained surgical items, when used together the numbers can be reduced.

  9. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT... and Adequate Veterinary Care § 2.40 Attending veterinarian and adequate veterinary care (dealers and... veterinary care to its animals in compliance with this section. (1) Each dealer and exhibitor shall employ...

  10. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE... adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall provide adequate veterinary care to its animals in compliance with this section: (1) Each research facility...

  11. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 24 2014-07-01 2014-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The...

  12. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 25 2013-07-01 2013-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The...

  13. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The...

  14. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 25 2012-07-01 2012-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The...

  15. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The...

  16. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Adequate financial records, statistical data, and....568 Adequate financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination...

  17. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Adequate financial records, statistical data, and....568 Adequate financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination...

  18. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Adequate financial records, statistical data, and....568 Adequate financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination...

  19. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Assurances of adequate capacity and services. 438... Improvement Access Standards § 438.207 Assurances of adequate capacity and services. (a) Basic rule. The State... provides supporting documentation that demonstrates that it has the capacity to serve the...

  20. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Assurances of adequate capacity and services. 438... Improvement Access Standards § 438.207 Assurances of adequate capacity and services. (a) Basic rule. The State... provides supporting documentation that demonstrates that it has the capacity to serve the...

  1. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Assurances of adequate capacity and services. 438... Improvement Access Standards § 438.207 Assurances of adequate capacity and services. (a) Basic rule. The State... provides supporting documentation that demonstrates that it has the capacity to serve the...

  2. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Assurances of adequate capacity and services. 438... Improvement Access Standards § 438.207 Assurances of adequate capacity and services. (a) Basic rule. The State... provides supporting documentation that demonstrates that it has the capacity to serve the...

  3. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian and adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall provide adequate veterinary care to its animals in compliance with this section: (1) Each research facility...

  4. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian and adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall provide adequate veterinary care to its animals in compliance with this section: (1) Each research facility...

  5. The feasibility of producing adequate feedstock for year–round cellulosic ethanol production in an intensive agricultural fuelshed

    USGS Publications Warehouse

    Uden, Daniel R.; Mitchell, Rob B.; Allen, Craig R.; Guan, Qingfeng; McCoy, Tim D.

    2013-01-01

    To date, cellulosic ethanol production has not been commercialized in the United States. However, government mandates aimed at increasing second-generation biofuel production could spur exploratory development in the cellulosic ethanol industry. We conducted an in-depth analysis of the fuelshed surrounding a starch-based ethanol plant near York, Nebraska that has the potential for cellulosic ethanol production. To assess the feasibility of supplying adequate biomass for year-round cellulosic ethanol production from residual maize (Zea mays) stover and bioenergy switchgrass (Panicum virgatum) within a 40-km road network service area of the existing ethanol plant, we identified ∼14,000 ha of marginally productive cropland within the service area suitable for conversion from annual rowcrops to switchgrass and ∼132,000 ha of maize-enrolled cropland from which maize stover could be collected. Annual maize stover and switchgrass biomass supplies within the 40-km service area could range between 429,000 and 752,000 metric tons (mT). Approximately 140–250 million liters (l) of cellulosic ethanol could be produced, rivaling the current 208 million l annual starch-based ethanol production capacity of the plant. We conclude that sufficient quantities of biomass could be produced from maize stover and switchgrass near the plant to support year-round cellulosic ethanol production at current feedstock yields, sustainable removal rates and bioconversion efficiencies. Modifying existing starch-based ethanol plants in intensive agricultural fuelsheds could increase ethanol output, return marginally productive cropland to perennial vegetation, and remove maize stover from productive cropland to meet feedstock demand.

  6. Major surgical complications from minor urological procedures.

    PubMed Central

    Eke, N.

    2000-01-01

    Some urological procedures are regarded as minor or simple. As a result, these may be delegated to trainee surgeons to do. Occasionally nonmedical persons embark on some of the procedures such as male circumcision. Published serious complications from urological procedures considered minor or simple were identified from a Medline search (1966 through 1999) and reference lists of relevant publications. The operations regarded as minor were carried out by medical personnel of all grades as well as by nonmedical persons. The complications can be classified as mutilatory, infective, hemorrhagic, or obstructive. Although the mutilatory complications affect mainly procedures on the penis, infective and hemorrhagic complications affect almost all the procedures. Tumor implantation has occurred along needle biopsy tracts. Although many of the complications are not related to technique or competence, a plea is made for the awareness of their occurrence to encourage preventive strategies. Adequate training of surgical personnel remains essential worldwide. PMID:10976176

  7. Evaluating Marginal Policy Changes and the Average Effect of Treatment for Individuals at the Margin.

    PubMed

    Carneiro, Pedro; Heckman, James J; Vytlacil, Edward

    2010-01-01

    This paper develops methods for evaluating marginal policy changes. We characterize how the effects of marginal policy changes depend on the direction of the policy change, and show that marginal policy effects are fundamentally easier to identify and to estimate than conventional treatment parameters. We develop the connection between marginal policy effects and the average effect of treatment for persons on the margin of indifference between participation in treatment and nonparticipation, and use this connection to analyze both parameters. We apply our analysis to estimate the effect of marginal changes in tuition on the return to going to college.

  8. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... of maintaining adequate technical, physical, and security safeguards to prevent...

  9. 45 CFR 1159.15 - Who has the responsibility for maintaining adequate technical, physical, and security safeguards...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... adequate technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of... of maintaining adequate technical, physical, and security safeguards to prevent...

  10. The 5-year survival following the marginal resection of a primary leiomyosarcoma of the distal femur and a stump fracture.

    PubMed

    Plath, J; Gurk, S; Strophal, G; Johnson, M; Jansson, V

    2001-09-01

    In this case, we present a 5-year follow-up of a 3-fault-affected primary leiomyosarcoma of the distal femur (spontaneous fracture treated by osteosynthesis; marginal resection; stump fracture after adequate trauma) with an extended local recurrence but without metastasis.

  11. [Surgical approaches in rhinoplasty].

    PubMed

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

    2014-12-01

    In the first step of rhinoplasty, the surgical approach will expose through different types of incisions and dissection planes the osteocartilaginous framework of the nasal pyramid prior to performing actions to reduce or increase the latter. This exposure can be performed by a closed approach or by an external approach--the choice depends on the type of nose and the habits of the surgeon. Far from being opposites, closed and external approaches are complementary and should be known and mastered by surgeons performing rhinoplasty.

  12. Assessment of seismic margin calculation methods

    SciTech Connect

    Kennedy, R.P.; Murray, R.C.; Ravindra, M.K.; Reed, J.W.; Stevenson, J.D.

    1989-03-01

    Seismic margin review of nuclear power plants requires that the High Confidence of Low Probability of Failure (HCLPF) capacity be calculated for certain components. The candidate methods for calculating the HCLPF capacity as recommended by the Expert Panel on Quantification of Seismic Margins are the Conservative Deterministic Failure Margin (CDFM) method and the Fragility Analysis (FA) method. The present study evaluated these two methods using some representative components in order to provide further guidance in conducting seismic margin reviews. It is concluded that either of the two methods could be used for calculating HCLPF capacities. 21 refs., 9 figs., 6 tabs.

  13. On the Marginal Stability of Glassy Systems

    NASA Astrophysics Data System (ADS)

    Yan, Le; Baity-Jesi, Marco; Müller, Markus; Wyart, Matthieu

    2015-03-01

    In various glassy systems that are out of equilibrium, like spin glasses and granular packings, the dynamics appears to be critical: avalanches involving almost the whole system could happen. A recent conceptual breakthrough argues that such glassy systems sample the ensemble of marginal stable states, which inevitably results into critical dynamics. However, it is unclear how the marginal stability is dynamically guaranteed. We investigate this marginal stability assumption by studying specifically the critical athermal dynamics of the Sherrington-Kirkpatrick model. We discuss how a pseudo-gap in the density distribution of local fields characterizing the marginal stability arises dynamically.

  14. American surgical biographies.

    PubMed

    Rutkow, I M

    1987-12-01

    Finding adequate biographical data on a given surgeon can cause great difficulty because of the lack of a single source containing biographies of these people. This article provides short biographies of 15 American surgeons of the 18th, 19th, and early 20th centuries: Henry Jacob Bigelow, Joseph Decatur Bryant, Gurdon Buck, John Murray Carnochan, John Syng Dorsey, George Michael Edebohls, Christian Fenger, George Ryerson Fowler, Arpad Geza Charles Gerster, William Gibson, Frank Hastings Hamilton, William Tod Helmuth, Andrew Jackson Howe, Joseph Pancoast, and John Allan Wyeth.

  15. Multi-organ resection for locally advanced adrenocortical cancer: surgical strategy and literature review

    PubMed Central

    GUIDA, F.; CLEMENTE, M.; VALVANO, L.; NAPOLITANO, C.

    2015-01-01

    Adrenocortical carcinoma (ACC) is a rare and aggressive endocrine malignancy with an estimated worldwide incidence of 0.5–2 per million/year. Complete surgical removal of ACC represents the current treatment of choice for this tumor. A disease-free resection margin (R0) is an important predictor of long-term survival: surgery is demanding and must be performed by a highly experienced surgical team. We report the surgical strategy adopted in a patient with locally advanced ACC and virilization to obtain a R0 resection. PMID:26712261

  16. Using Histopathology Breast Cancer Data to Reduce Clinical Target Volume Margins at Radiotherapy

    SciTech Connect

    Stroom, Joep Schlief, Angelique; Alderliesten, Tanja; Peterse, Hans; Bartelink, Harry; Gilhuijs, Kenneth

    2009-07-01

    Purpose: This study aimed to quantify the incidence and extension of microscopic disease around primary breast tumors in patients undergoing breast-conserving therapy (BCT), focusing on a potential application to reduce radiotherapy boost volumes. Methods and Materials: An extensive pathology tumor-distribution study was performed using 38 wide local excision specimens of BCT patients. Specimen orientation was recorded and microscopic findings reconstructed to assess the incidence of microscopic disease around the macroscopic tumor. A model of disease spread was built, showing probability of disease extension outside a treated volume (P{sub out,vol}). The model was applied in 10 new BCT patients. Taking asymmetry of tumor excision into account, new asymmetric margins for the clinical target volume of the boost (CTV{sub boost}) were evaluated that minimize the volume without increasing P{sub out,TTV} (TTV being total treated volume: V{sub surgery} + CTV{sub boost}). Potential reductions in CTV{sub boost} and TTV were evaluated. Results: Microscopic disease beyond the tumor boundary occurred isotropically at distances > 1 cm (intended surgical margin) and > 1.5 cm (intended TTV margin) in 53% and 36% of the excision specimens, respectively. In the 10 prospective patients, the average P{sub out,TTV} was, however, only 16% due to larger surgical margins than intended in some directions. Asymmetric CTV{sub boost} margins reduced the CTV{sub boost} and TTV by 27% (20 cc) and 12% (21 cc) on average, without compromising tumor coverage. Conclusions: Microscopic disease extension may occur beyond the current CTV{sub boost} in approximately one sixth of patients. An asymmetric CTV{sub boost} that corrects for asymmetry of the surgical excision has the potential to reduce boost volumes while maintaining tumor coverage.

  17. [Surgical management of primary bone cancer].

    PubMed

    Anract, Philippe

    2009-01-01

    Patients with primary bone malignancies must be treated by specialized multidisciplinary teams composed of pathologists, surgeons, orthopedists, oncologists, radiologists and radiotherapists, all with experience in the diagnosis and treatment of these tumors. If a malignancy is suspected, the biopsy must also be performed in such a center. Biopsy is part of the treatment and must be done by a senior surgeon, before starting specific treatment. Indeed, inappropriate biopsy can compromise the patient's functional prognosis and sometimes the vital outcome. The biopsy can be done percutaneously under radiological control with a True-cut needle or a trocart to obtain cores of pathological tissue. The pathologist must be well-versed in bone disorders. Open surgical biopsy is preferable for primary bone tumors, especially when a cartilaginous tumor is suspected. A short incision is used, situated on the same approach as that which will be used for surgical resection of the tumor, so that the biopsy scar is excised along with the tumor, in a single block. Surgical treatment of primary bone malignancies requires extensive resection, i.e. excision of the affected bone segment and any invaded soft tissues, as a single block, without breaching the tumor, and preserving a peripheral margin of healthy tissue. In most cases, reconstruction is necessary to preserve the function of the resected region. It is based on standard orthopedic techniques, namely osteosynthesis, bone grafts (autografts and allografts), prostheses of variable size, or a combination of prostheses and allografts (composite reconstruction). Amputation is only indicated if conservative resection is impossible. It has been shown that conservative resection, now possible in about 80% of cases, does not reduce the survival chances of patients with osteosarcoma. The indications for amputation include massive tumors invading vessels and nerves, resection of which would leave the limb non functional, as sell as tumor

  18. One-year assessment of surgical outcomes in Class III patients using cone beam computed tomography

    PubMed Central

    de Paula, L.K.; de Oliveira Ruellas, A.C.; Paniagua, B.; Styner, M.; Turvey, T.; Zhu, H.; Wang, J.; Cevidanes, L.H.S.

    2014-01-01

    The purpose of this study was to apply a novel method to evaluate surgical outcomes at 1 year after orthognathic surgery for Class III patients undergoing two different surgical protocols. Fifty patients divided equally into two groups (maxillary advancement only and combined with mandibular setback) had cone beam computed tomography (CBCT) scans taken pre-surgery, at splint removal, and at 1-year post-surgery. An automatic cranial base superimposition method was used to register, and shape correspondence was applied to assess, the overall changes between pre-surgery and splint removal (surgical changes) and between splint removal and 1-year post-surgery at the end of orthodontic treatment (post-surgical adaptations). Post-surgical maxillary adaptations were exactly the same for both groups, with 52% of the patients having changes >2 mm. Approximately half of the post-surgical changes in the maxilla for both groups were vertical. The two-jaw group showed significantly greater surgical and post-surgical changes in the ramus, chin, and most of the condylar surfaces (P < 0.05). Post-surgical adaptation on the anterior part of the chin was also more significant in the two-jaw group (P < 0.05). Regardless of the type of surgery, marked post-surgical adaptations were observed in the regions evaluated, which explain the adequate maxillary–mandibular relationship at 1-year post-surgery on average, with individual variability. PMID:23403336

  19. Minimally invasive surgical technique for tethered surgical drains

    PubMed Central

    Hess, Shane R; Satpathy, Jibanananda; Waligora, Andrew C; Ugwu-Oju, Obinna

    2017-01-01

    A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

  20. Storm tracks near marginal stability

    NASA Astrophysics Data System (ADS)

    Ambaum, Maarten; Novak, Lenka

    2015-04-01

    The variance of atmospheric storm tracks is characterised by intermittent bursts of activity interspersed with relatively quiescent periods. Most of the poleward heat transport by storm tracks is due to a limited number of strong heat flux events, which occur in a quasi-periodic fashion. This behaviour is in contradiction with the usual conceptual model of the storm tracks, which relies on high growth rate background flows which then spawn weather systems that grow in an exponential or non-normal fashion. Here we present a different conceptual model of the atmospheric storm tracks which is built on the observation that, when including diabatic and other dissipative effects, the storm track region is in fact most of the time marginally stable. The ensuing model is a nonlinear oscillator, very similar to Volterra-Lotka predator-prey models. We demonstrate the extensions of this model to a stochastically driven nonlinear oscillator. The model produces quasi-periodic behaviour dominated by intermittent heat flux events. Perhaps most surprisingly, we will show strong evidence from re-analysis data for our conceptual model: the re-analysis data produces a phase-space plot that is very similar indeed to the phase-space plot for our nonlinear oscillator model.

  1. Thyroid Nodules and Thyroid Cancer: Surgical Aspects

    PubMed Central

    Clark, Orlo H.

    1980-01-01

    Patients with thyroid nodules must be treated selectively because these nodules develop far more frequently than does thyroid cancer. A thorough clinical history, family history and history of radiation, as well as an accurate physical examination, are very important in determining whether surgical treatment is indicated. Thyroid function tests, a radioactive isotope scan, a thyroid echogram and fine-needle biopsy are also useful. Although there is considerable debate concerning the amount of thyroid tissue that should be removed at operation, the minimal procedure for a “cold,” solid thyroid nodule is a total thyroid lobectomy and isthmectomy. This is the treatment of choice for patients with occult papillary thyroid carcinoma. Partial lobectomy is to be discouraged. Near total or total thyroidectomy should be considered for all other patients with differentiated thyroid cancer. Many factors influence the prognosis of patients with thyroid cancer including age, sex, type of thyroid cancer, invasion, symptoms, lymph node metastasis, metastasis to distant sites, extent of the surgical procedure, and use of radioactive iodine and thyroid hormone. With adequate treatment, the prognosis for differentiated thyroid carcinoma is excellent. PMID:7222643

  2. Best strategy for cerebral protection in arch surgery - antegrade selective cerebral perfusion and adequate hypothermia

    PubMed Central

    Mohr, Friedrich W.; Etz, Christian D.

    2013-01-01

    Aortic arch surgery remains a complex surgical operation that necessitates specific neuroprotection strategies. Various approaches, such as hypothermic circulatory arrest (HCA), retrograde cerebral perfusion, and antegrade selective cerebral perfusion (aSCP), have each enjoyed periods of popularity. However, while the overall surgical approach tend to favour HCA with aSCP, technical factors, such as perfusion site, perfusate temperature and flow rate and pH management, have not been conclusively elucidated. The optimal extent of hypothermia during circulatory arrest is also unclear, particularly with recent partiality for warmer temperatures. The following perspective details the preferred surgical practice for cerebral protection in aortic arch surgery, based on existing evidence. PMID:23977602

  3. Inferential Processing among Adequate and Struggling Adolescent Comprehenders and Relations to Reading Comprehension

    PubMed Central

    Barth, Amy E.; Barnes, Marcia; Francis, David J.; Vaughn, Sharon; York, Mary

    2015-01-01

    Separate mixed model analyses of variance (ANOVA) were conducted to examine the effect of textual distance on the accuracy and speed of text consistency judgments among adequate and struggling comprehenders across grades 6–12 (n = 1203). Multiple regressions examined whether accuracy in text consistency judgments uniquely accounted for variance in comprehension. Results suggest that there is considerable growth across the middle and high school years, particularly for adequate comprehenders in those text integration processes that maintain local coherence. Accuracy in text consistency judgments accounted for significant unique variance for passage-level, but not sentence-level comprehension, particularly for adequate comprehenders. PMID:26166946

  4. Using Multitheory Model of Health Behavior Change to Predict Adequate Sleep Behavior.

    PubMed

    Knowlden, Adam P; Sharma, Manoj; Nahar, Vinayak K

    The purpose of this article was to use the multitheory model of health behavior change in predicting adequate sleep behavior in college students. A valid and reliable survey was administered in a cross-sectional design (n = 151). For initiation of adequate sleep behavior, the construct of behavioral confidence (P < .001) was found to be significant and accounted for 24.4% of the variance. For sustenance of adequate sleep behavior, changes in social environment (P < .02), emotional transformation (P < .001), and practice for change (P < .001) were significant and accounted for 34.2% of the variance.

  5. Surgical Scar Revision: An Overview

    PubMed Central

    Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh

    2014-01-01

    Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods. PMID:24761092

  6. Tumor margin detection using optical biopsy techniques

    NASA Astrophysics Data System (ADS)

    Zhou, Yan; Liu, Cheng-hui; Li, Jiyou; Li, Zhongwu; Zhou, Lixin; Chen, Ke; Pu, Yang; He, Yong; Zhu, Ke; Li, Qingbo; Alfano, Robert R.

    2014-03-01

    The aim of this study is to use the Resonance Raman (RR) and fluorescence spectroscopic technique for tumor margin detection with high accuracy based on native molecular fingerprints of breast and gastrointestinal (GI) tissues. This tumor margins detection method utilizes advantages of RR spectroscopic technique in situ and in real-time to diagnose tumor changes providing powerful tools for clinical guiding intraoperative margin assessments and postoperative treatments. The tumor margin detection procedures by RR spectroscopy were taken by scanning lesion from center or around tumor region in ex-vivo to find the changes in cancerous tissues with the rim of normal tissues using the native molecular fingerprints. The specimens used to analyze tumor margins include breast and GI carcinoma and normal tissues. The sharp margin of the tumor was found by the changes of RR spectral peaks within 2 mm distance. The result was verified using fluorescence spectra with 300 nm, 320 nm and 340 nm excitation, in a typical specimen of gastric cancerous tissue within a positive margin in comparison with normal gastric tissues. This study demonstrates the potential of RR and fluorescence spectroscopy as new approaches with labeling free to determine the intraoperative margin assessment.

  7. Marginalization in Random Nonlinear Neural Networks

    NASA Astrophysics Data System (ADS)

    Vasudeva Raju, Rajkumar; Pitkow, Xaq

    2015-03-01

    Computations involved in tasks like causal reasoning in the brain require a type of probabilistic inference known as marginalization. Marginalization corresponds to averaging over irrelevant variables to obtain the probability of the variables of interest. This is a fundamental operation that arises whenever input stimuli depend on several variables, but only some are task-relevant. Animals often exhibit behavior consistent with marginalizing over some variables, but the neural substrate of this computation is unknown. It has been previously shown (Beck et al. 2011) that marginalization can be performed optimally by a deterministic nonlinear network that implements a quadratic interaction of neural activity with divisive normalization. We show that a simpler network can perform essentially the same computation. These Random Nonlinear Networks (RNN) are feedforward networks with one hidden layer, sigmoidal activation functions, and normally-distributed weights connecting the input and hidden layers. We train the output weights connecting the hidden units to an output population, such that the output model accurately represents a desired marginal probability distribution without significant information loss compared to optimal marginalization. Simulations for the case of linear coordinate transformations show that the RNN model has good marginalization performance, except for highly uncertain inputs that have low amplitude population responses. Behavioral experiments, based on these results, could then be used to identify if this model does indeed explain how the brain performs marginalization.

  8. 17 CFR 242.403 - Required margin.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 17 Commodity and Securities Exchanges 3 2011-04-01 2011-04-01 false Required margin. 242.403 Section 242.403 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer...

  9. 17 CFR 242.403 - Required margin.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Required margin. 242.403 Section 242.403 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer...

  10. Dependency and Marginality in Kingston, Jamaica.

    ERIC Educational Resources Information Center

    Clarke, Colin G.

    1983-01-01

    Kingston, capital of Jamaica, has been molded by three institutions: colonialism, the sugar plantation, and slavery. It has an enormous marginal population living in permanent poverty and not absorbable into the labor force. This marginality, fundamentally related to dependent capitalism, sustains itself by keeping wages low. (CS)

  11. Marginal Utility and Convex Indifference Curves.

    ERIC Educational Resources Information Center

    Jackson, A.A.

    1981-01-01

    Reviews discussion of the relationship between marginal utility and indifference curves which has been presented in recent issues of "Economics." Concludes that indifference analysis does not embody the assumptions of marginal utility theory and that there is no simple relationship between these concepts that does not entail unacceptable…

  12. Marginal Costing Techniques for Higher Education.

    ERIC Educational Resources Information Center

    Allen, Richard; Brinkman, Paul

    The techniques for calculating marginal costs in higher education are examined in detail. Marginal costs, as defined in economics, is the change in total cost associated with producing one additional unit of output. In higher education, the most frequently selected unit of output is a full-time-equivalent student or, alternatively, a student…

  13. Marginal Ice Zone: Biogeochemical Sampling with Gliders

    DTIC Science & Technology

    2014-09-30

    Figure 3. Map of 2014 IBRV Araon Arctic cruise study area, indicating CTD, XCTD, sea- ice caps , and helicopter...1 DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. Marginal Ice Zone: Biogeochemical Sampling with Gliders...distribution of phytoplankton and particulate organic carbon in the Arctic under the ice and in the marginal ice zone, as well as to understand feedbacks

  14. Academic Prediction and the Marginal Student.

    ERIC Educational Resources Information Center

    Ludenia, Krista

    This study tried to determine whether (1) the ACT composite score, (2) high school percentile rank (HSPR), or (3) a combination of these were good predictors of academic success in college for the marginal student. The marginal student was defined as one not meeting standard admission requirements, but one whose ACT scores indicated some…

  15. Challenges of Forward Naval Surgical Support for Maritime Forces.

    PubMed

    Chong, Si Jack; Jiang, Lei; Chow, Wei-En

    2015-08-01

    The emphasis of naval operations has shifted from conventional naval warfare since World War II to Operations Other than War such as Peace Support Operations and Humanitarian Aid and Disaster Relief. Maritime forces are increasingly deployed in distant areas of operations such as the Somali Basin and Gulf of Aden for longer durations, in a possibly higher threat environment against nonconventional threats such as in counter piracy operations. There is therefore a need to balance the challenges of providing adequate forward naval surgical support with limitations in medical manpower, logistics as well as the need for a suitable surgical platform for these deployments. This article aims to share the Republic of Singapore Navy's experience in overcoming some of these challenges. This includes the ability to deploy surgical containers onboard the Landing Ship Tank and Civil Resource vessels, and the ability to convert existing spaces onboard the endurance class Landing Ship Tank and other platforms such as the formidable class Frigate into surgical facilities. The key success factors such as the development of deep expertise in naval operational medicine, operationalization of third generation surgical stores, and enhanced interoperability among maritime forces will also be highlighted.

  16. High Rate of Positive Circumferential Resection Margins Following Rectal Cancer Surgery: A Call to Action

    PubMed Central

    Rickles, Aaron S.; Dietz, David W.; Chang, George J.; Wexner, Steven D.; Berho, Mariana E.; Remzi, Feza H.; Greene, Frederick L.; Fleshman, James W.; Abbas, Maher A.; Peters, Walter; Noyes, Katia; Monson, John R.T.; Fleming, Fergal J.

    2017-01-01

    Objective To identify predictors of positive circumferential resection margin following rectal cancer resection in the United States. Background Positive circumferential resection margin is associated with a high rate of local recurrence and poor morbidity and mortality for rectal cancer patients. Prior study has shown poor compliance with national rectal cancer guidelines, but whether this finding is reflected in patient outcomes has yet to be shown. Methods Patients who underwent resection for stage I-III rectal cancer were identified from the 2010-2011 National Cancer Database. The primary outcome was a positive circumferential resection margin. The relationship between patient, hospital, tumor, and treatment-related characteristics was analyzed using bivariate and multivariate analysis. Findings A positive circumferential resection margin was noted in 2,859 (17.2%) of the 16,619 patients included. Facility location, clinical T and N stage, histologic type, tumor size, tumor grade, lymphovascular invasion, perineural invasion, type of operation, and operative approach were significant predictors of positive circumferential resection margin on multivariable analysis. Total proctectomy had nearly a 30% increased risk of positive margin compared to partial proctectomy (OR 1.293, 95%CI 1.185-1.411) and a laparoscopic approach had nearly 22% less risk of a positive circumferential resection margin compared to an open approach (OR 0.882, 95%CI 0.790-0.985). Interpretation Despite advances in surgical technique and multimodality therapy, rates of positive circumferential resection margin remain high in the United States. Several tumor and treatment characteristics were identified as independent risk factors, and advances in rectal cancer care are necessary to approach the outcomes seen in other countries. PMID:26473651

  17. A review of surgical nutrition.

    PubMed

    Moyes, L H; McKee, R F

    2008-02-01

    Malnutrition remains a common problem in surgical patients and is associated with significant morbidity and mortality. It is imperative that all surgical patients undergo nutritional screening on admission to highlight malnourished or at risk patients and implement a nutritional plan. Nutrition can be delivered by oral supplements, enteral or parenteral feeding, the route depending on an individual's requirements and surgical condition. Enteral feeding has largely been regarded as superior to parenteral feeding, as it is cheaper, safer and "more physiological" but studies show this is not always the case. This article reviews the basics of surgical nutrition and assesses the evidence supporting enteral versus parenteral nutrition.

  18. [The advent of surgical gloves].

    PubMed

    Germain, M A

    2003-09-01

    The advent of surgical gloves had a double evolution. Evolution of the material: cecum of a sheep, cotton, silk, leather, rubber. Originally introduced to protect theatre staff's hands from corrosive solutions, subsequent use was to protect the patient from contamination by theatre staff. Many surgeons contributed to the evolution of the surgical gloves. The use of gloves was truly part of an evolutionary process than a discovery. The turning of surgical gloves is now incontestable, and their use more and more important. Surgical gloves must secure a crossing protections between surgeon and patient.

  19. Region 8: Colorado Lamar and Steamboat Springs Adequate Letter (11/12/2002)

    EPA Pesticide Factsheets

    This letter from EPA to Colorado Department of Public Health and Environment determined Lamar and Steamboat Springs particulate matter (PM10) maintenance plan for Motor Vehicle Emissions Budgets adequate for transportation conformity purposes

  20. 75 FR 5893 - Suspension of Community Eligibility for Failure To Maintain Adequate Floodplain Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-05

    ... To Maintain Adequate Floodplain Management Regulations AGENCY: Federal Emergency Management Agency... floodplain management regulations meeting minimum requirements under the National Flood Insurance Program... they have brought their floodplain management regulations into compliance with the NFIP...

  1. Region 9: California Adequate / Inadequate Letter Attachment (5/30/2008)

    EPA Pesticide Factsheets

    This is a document that states that it has been found adequate for transportation conformitypurposes certain 8-hour ozone and PM2.5 motor vehicleemissions budgets in the 2007 South Coast StateImplementation Plan.

  2. Tophi - surgical treatment.

    PubMed

    Słowińska, Iwona; Słowiński, Radosław; Rutkowska-Sak, Lidia

    2016-01-01

    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A "clinical mask" suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient's life improved significantly.

  3. Tophi – surgical treatment

    PubMed Central

    Słowińska, Iwona; Słowiński, Radosław

    2016-01-01

    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A “clinical mask” suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient’s life improved significantly. PMID:27994273

  4. Surgical education in Mexico.

    PubMed

    Cervantes, Jorge

    2010-05-01

    Surgical education in Mexico basically follows the same model as in the United States, with a selection process resembling the matching program. There is a 4-year training period during which residents in their third year spend 4 months as the sole surgeon in a rural community. During the senior year they are entitled to an elective period in a place of their choosing. After completion of the 4 years, residents have to present a thesis and undergo an oral examination before getting a university diploma. They are then encouraged to pass the written and oral examination of the Mexican Board of Surgery before they are fully certified to enter practice in a public or private hospital.

  5. Stylohyoid syndrome: surgical approach.

    PubMed

    Valerio, Claudia Scigliano; Peyneau, Priscila Dias; de Sousa, Andréia Cruz Pires Ribeiro; Cardoso, Fábio Oliveira; de Oliveira, Davidson Rodarte Félix; Taitson, Paulo Franco; Manzi, Flávio Ricardo

    2012-03-01

    The best-known cervicopharyngeal pain is Eagle syndrome, in which symptomatic elongation of the stylomandibular process occurs and may be accompanied by stylohyoid ligament calcification. Among the causes of elongation of the styloid process, the following may be mentioned: history of trauma, styloid ligament calcification, and formation of bony tissue in the insertion of the styloid ligament. When there is no history of trauma or surgery, it is called the stylohyoid syndrome. In the current study, the clinical case of 34-year-old woman is reported, complaining of pain in the region of the neck, without any history of neck surgery or trauma. A panoramic radiograph and computed tomographic scan showed bilateral elongation of the styloid process. Extraoral surgical intervention was the treatment of choice. It is important to point out that dentists should be aware of this condition to contribute to a better diagnosis and therapeutic procedure.

  6. Surgical Responses of Medial Rectus Muscle Recession in Thyroid Eye Disease-Related Esotropia.

    PubMed

    Lyu, In Jeong; Lee, Ju-Yeun; Kong, Mingui; Park, Kyung-Ah; Oh, Sei Yeul

    2016-01-01

    We evaluate the surgical outcomes and surgical responses of medial rectus muscle (MR) recession patients with thyroid eye disease (TED)-related esotropia (ET). The surgical dose-response curves 1 week postoperatively and at the final visit were analyzed. Univariable and multivariable linear regression analyses were applied to investigate factors influencing surgical dose-response. A total of 43 patients with TED-related ET that underwent MR recession were included. The final success rate was 86.0% and the rate of undercorrection was 14.0%. The surgical dose-response curves of TED-related ET showed a gentle slope compared with those of standard surgical tables. In the univariable model, simultaneous vertical rectus muscle recession was the only significant factor influencing surgical dose-response of MR recession in TED-related ET (β = -0.397, P = 0.044). In a model adjusted for age, sex, type of surgery, and preoperative horizontal angle of deviation, simultaneous vertical rectus muscle recession showed marginal significance (β = -0.389, P = 0.064). The surgical dose-response curve of TED-related ET was unique. Simultaneous vertical rectus muscle recession was associated with increased surgical dose-response in TED-related ET.

  7. Surgical Responses of Medial Rectus Muscle Recession in Thyroid Eye Disease-Related Esotropia

    PubMed Central

    Lyu, In Jeong; Lee, Ju-Yeun; Kong, Mingui; Park, Kyung-Ah; Oh, Sei Yeul

    2016-01-01

    We evaluate the surgical outcomes and surgical responses of medial rectus muscle (MR) recession patients with thyroid eye disease (TED)-related esotropia (ET). The surgical dose-response curves 1 week postoperatively and at the final visit were analyzed. Univariable and multivariable linear regression analyses were applied to investigate factors influencing surgical dose-response. A total of 43 patients with TED-related ET that underwent MR recession were included. The final success rate was 86.0% and the rate of undercorrection was 14.0%. The surgical dose-response curves of TED-related ET showed a gentle slope compared with those of standard surgical tables. In the univariable model, simultaneous vertical rectus muscle recession was the only significant factor influencing surgical dose-response of MR recession in TED-related ET (β = -0.397, P = 0.044). In a model adjusted for age, sex, type of surgery, and preoperative horizontal angle of deviation, simultaneous vertical rectus muscle recession showed marginal significance (β = -0.389, P = 0.064). The surgical dose-response curve of TED-related ET was unique. Simultaneous vertical rectus muscle recession was associated with increased surgical dose-response in TED-related ET. PMID:26796354

  8. Individual and contextual determinants of adequate maternal health care services in Kenya.

    PubMed

    Achia, Thomas N O; Mageto, Lillian E

    2015-01-01

    This study aimed to examine individual and community level factors associated with adequate use of maternal antenatal health services in Kenya. Individual and community level factors associated with adequate use of maternal health care (MHC) services were obtained from the 2008-09 Kenya Demographic and Health Survey data set. Multilevel partial-proportional odds logit models were fitted using STATA 13.0 to quantify the relations of the selected covariates to adequate MHC use, defined as a three-category ordinal variable. The sample consisted of 3,621 women who had at least one live birth in the five-year period preceding this survey. Only 18 percent of the women had adequate use of MHC services. Greater educational attainment by the woman or her partner, higher socioeconomic status, access to medical insurance coverage, and greater media exposure were the individual-level factors associated with adequate use of MHC services. Greater community ethnic diversity, higher community-level socioeconomic status, and greater community-level health facility deliveries were the contextual-level factors associated with adequate use of MHC. To improve the use of MHC services in Kenya, the government needs to design and implement programs that target underlying individual and community level factors, providing focused and sustained health education to promote the use of antenatal, delivery, and postnatal care.

  9. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique

    PubMed Central

    Rodrigues, Ian AS; Shah, Brinda; Goyal, Saurabh

    2017-01-01

    ABSTRACT Aim We present a novel surgical technique for repair of persistent and symptomatic cyclodialysis clefts refractory to conservative or minimally invasive treatment. Background Numerous surgical techniques have been described to close cyclodialysis clefts. The current standard approach involves intraocular repair of cyclodialysis clefts underneath a full-thickness scleral flap. Technique Our technique employs intraoperative use of a direct gonioscope to guide a nonpenetrating surgical repair. Subsequently, a significantly less invasive, nonpenetrating technique utilizing a partial-thickness scleral flap can be performed that reduces potential risks associated with intraocular surgery. The direct gonioscope is also used for confirmation of adequate surgical closure of the cyclodialysis cleft prior to completion of surgery. This technique has been successfully carried out to repair traumatic chronic cyclodialysis clefts associated with hypotony in two patients. There were no significant adverse events as a result of using this technique. Conclusion The novel technique described increases the likelihood of successful and permanent repair of cyclodialysis clefts with resolution of symptoms associated with hypotony, through direct intraoperative visualization of the cleft. Clinical significance Gonioscopically guided nonpenetrating cyclodialysis cleft repair offers significant benefits over previously described techniques. Advantages of our technique include gonioscopic cleft visualization, enabling accurate localization of the area requiring repair, and subsequent confirmation of adequate closure of the cleft. Using a partial-thickness scleral flap is also less invasive and reduces risks associated with treatment of this potentially challenging complication of ocular trauma. How to cite this article Rodrigues IAS, Shah B, Goyal S, Lim S. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017

  10. Management of Temporomandibular Joint Reankylosis in Syndromic Patients Corrected with Joint Prostheses: Surgical and Rehabilitation Protocols

    PubMed Central

    Clauser, Luigi C.; Consorti, Giuseppe; Elia, Giovanni; Tieghi, Riccardo; Galiè, Manlio

    2013-01-01

    Temporomandibular joint ankylosis (TMJA) is a severe disorder described as an intracapsular union of the disc-condyle complex to the temporal articular surface with bony fusion. The management of this disability is challenging and rarely based on surgical and rehabilitation protocols. We describe the treatment in two young adults affected by Goldenhar syndrome and Pierre Robin sequence with reankylosis after previous surgical treatments. There are three main surgical procedures for the treatment of TMJA: gap arthroplasty, interpositional arthroplasty, and joint reconstruction. Various authors have described reankylosis as a frequent event after treatment. Treatment failure could be associated with surgical errors and/or inadequate intensive postoperative physiotherapy. Surgical treatment should be individually tailored and adequate postoperative physiotherapy protocol is mandatory for success. PMID:24624260

  11. Traffic in the operating room: a review of factors influencing air flow and surgical wound contamination.

    PubMed

    Pokrywka, Marian; Byers, Karin

    2013-06-01

    Surgical wound contamination leading to surgical site infection can result from disruption of the intended airflow in the operating room (OR). When personnel enter and exit the OR, or create unnecessary movement and traffic during the procedure, the intended airflow in the vicinity of the open wound becomes disrupted and does not adequately remove airborne contaminants from the sterile field. An increase in the bacterial counts of airborne microorganisms is noted during increased activity levels within the OR. Researchers have studied OR traffic and door openings as a determinant of air contamination. During a surgical procedure the door to the operating room may be open as long as 20 minutes out of each surgical hour during critical procedures involving implants. Interventions into limiting excessive movement and traffic in the OR may lead to reductions in surgical site infections in select populations.

  12. Evaluating Surgical Margins with Optical Spectroscopy and Spectral Imaging Following Breast Cancer Resection

    DTIC Science & Technology

    2009-08-01

    riboflavin (peak at 520 nm ) over rhodam ine ( peak at 560 nm ), with each layer also includ ing polystyrene m icrospheres to act as optical scat terers... riboflavin (520 nm) and rhodamine (560 nm) for layered phantom as the angle between excitation and detection leg polarizers changes (legend in upper...ked eye. It is also som ewhat difficult to see in the reflectance im age in Figure 4B, but it sho ws up as a very distinct blue- colored region in

  13. Marginal and happy? The need for uniqueness predicts the adjustment of marginal immigrants.

    PubMed

    Debrosse, Régine; de la Sablonnière, Roxane; Rossignac-Milon, Maya

    2015-12-01

    Marginalization is often presented as the strategy associated with the worst adjustment for immigrants. This study identifies a critical variable that buffers marginal immigrants from the negative effects of marginalization on adjustment: The need for uniqueness. In three studies, we surveyed immigrants recruited on university campuses (n = 119, n = 116) and in the field (n = 61). Among marginal immigrants, a higher need for uniqueness predicted higher self-esteem (Study 1), affect (Study 2), and life satisfaction (Study 3), and marginally higher happiness (Study 2) and self-esteem (Study 3). No relationship between the need for uniqueness and adjustment was found among non-marginal immigrants. The adaptive value of the need for uniqueness for marginal immigrants is discussed.

  14. Training of breast surgical oncologists.

    PubMed

    Teshome, Mediget; Kuerer, Henry M

    2016-06-01

    Breast surgical oncology is a defined sub-specialty of general surgery with focus on the surgical management of breast disease and malignancy within a multidisciplinary context. Much of the training of breast surgical oncologists in the United States exists within a fellowship training structure with oversight and approval by the Society of Surgical Oncology (SSO). Rapid continuous changes in breast oncology practice have further substantiated dedicated expertise in breast surgical oncology. Training programs are structured to develop proficiency in fellows for advanced surgical techniques and clinical decision-making as well as exposure to the multidisciplinary aspects of breast cancer management. Components of a successful program include an intense multidisciplinary curriculum, engagement in clinical research and attention to strong mentorship. National curriculum and training requirements as well as supplemental resources assist in standardizing the fellowship experience. As surgical training and the field of breast oncology continues to evolve, so do fellowship training programs to ensure high quality breast surgical oncologists equipped to deliver high quality evidence based patient care while continuing to drive future research and trainee education.

  15. Marginal peri-implantitis due to occlusal overload. A case report.

    PubMed

    Uribe, Roberto; Peñarrocha, Miguel; Sanchis, Jose María; García, Oscar

    2004-01-01

    The etiology of marginal peri-implantitis describes an infectious factor and a biomechanical factor resulting from occlusal overload. Clinical and experimental articles oriented to the biomechanical factor are scarce, so as the studies about the histology associated to periimplantitis. We present a case of marginal peri-implantitis on an implant in the mandibular molar zone caused by occlusal overload, which led to an osseous defect on the marginal crest. The treatment was composed of occlusal adjustment, removal of contaminated surgical tissue, and autogenous bone graft, which varies from the common treatment of infectious peri-implantitis. Histologic analysis of peri-implantitis tissue reveals a juxtaepithelial lympho-plasmocytorious infiltrate and a central zone of dense fibro-connective tissue with scanty inflammatory cells, which differs from the chronic inflammatory tissue associated with infectious peri-implantitis. Clinical and radiographic followup control after 12 months evidenced the remission of the symptoms and bone regeneration on the marginal crest. We consider that in the treatment of marginal peri-implantitis, it is necessary to continue the studies on the histological differences between the infectious types and those that are caused by occlusal overload.

  16. Primary cutaneous marginal zone B-cell lymphoma: clinical and histological aspects.

    PubMed

    Khaled, A; Sassi, S; Fazaa, B; Ben Hassouna, J; Ben Romdhane, K; Kamoun, M R

    2009-02-01

    According to the WHO-EORTC classification of cutaneous lymphomas, primary cutaneous marginal zone B-cell lymphoma are now well characterized. We report here a case of primary cutaneous marginal zone B-cell lymphoma in a 51 year-old man in which the diagnosis was made using both histology and immunopathology. The patient had no remarkable medical history, no history of either acute inflammation or insect bite, and presented with a 5 cm solitary asymptomatic erythematous firm, multinodular and infiltrated plaque on the back for 12 months. Histological examination and immunohistochemical study of a cutaneous biopsy provided a differential diagnosis between B cell lymphoma and lymphocytoma cutis. Full body work up revealed no signs of extracutaneous dissemination. The patient underwent surgical excision of the nodule. Histological examination showed a histological and immunophenotyping profile typical of primary cutaneous marginal zone B-cell lymphoma. The lesion was completely excised with clear margins and no recurrence occurred after a 12 month-follow-up period. Primary cutaneous marginal zone B-cell lymphoma are low-grade lymphomas that have an indolent course and a high tendency to recur. They should be differentiated from lymphocytoma cutis and from the other types of cutaneous B cell lymphomas that have a different course and prognosis.

  17. [Usage of marginal organs for liver transplantation: a way around the critical organ shortage?].

    PubMed

    Pratschke, S; Loehe, F; Graeb, C; Jauch, K W; Angele, M K

    2009-04-01

    The transplantation of marginal organs or those meeting the so-called extended donor criteria (EDC) is today a significant option to alleviate the low availability or organs and to increase the number of transplantation which in turn is -accompanied by a lower mortality among wait-ing-list patients. However such an extension of the spender pool carries the risks of an increased incidence of organ dysfuntions and a higher recipient mortality. This situation presents an ethical problem when marginal organs are accepted for transplantation because the anticipated mortality for the individual recipient cannot be determined. The transplantation of marginal organs from -donors with a high MELD score seems to be linked to a higher mortality. In particular, the combina-tions of high donor age and long ischaemic time or advanced donor age and hepatitis C infection in the recipient are definitively associated with a significantly poorer organ survival rate. In view of the serious lack of organs, efforts should be made, for example, by shortening of the is-chae-mic time and the development of therapeutic strategies, to improve the function and increase the number of usable marginal organs and thus to increase pool of donor organs. The refusal of marginal organs on the basis of individual EDC without consideration of the status of recipient does not seem to be adequate.

  18. Surgical infection in art.

    PubMed

    Meakins, J L

    1996-12-01

    The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.

  19. Surgical force detection probe

    NASA Technical Reports Server (NTRS)

    Tcheng, Ping; Roberts, Paul; Scott, Charles; Prass, Richard

    1991-01-01

    The development progress of a precision electro-mechanical instrument which allows the detection and documentation of the forces and moment applied to human tissue during surgery (under actual operation room conditions), is reported. The pen-shaped prototype probe which measures 1/2 inch in diameter and 7 inches in length was fabricated using an aerodynamic balance. The aerodynamic balance, a standard wind tunnel force and moment sensing transducer, measures the forces and the moments transmitted through the surgeon's hand to the human tissue during surgery. The prototype probe which was fabricated as a development tool was tested successfully. The final version of the surgical force detection probe will be designed based on additional laboratory tests in order to establish the full scale loads. It is expected that the final product will require a simplified aerodynamic balance with two or three force components and one moment component with lighter full scale loads. A signal conditioner was fabricated to process and display the outputs from the prototype probe. This unit will be interfaced with a PC-based data system to provide automatic data acquisition, data processing, and graphics display. The expected overall accuracy of the probe is better than one percent full scale.

  20. Temporal lobe arteriovenous malformations: anatomical subtypes, surgical strategy, and outcomes

    PubMed Central

    Canals, Andreu Gabarrós; Rodríguez-Hernández, Ana; Young, William L.; Lawton, Michael T.

    2014-01-01

    Object Descriptions of temporal lobe arteriovenous malformations (AVMs) are inconsistent. To standardize reporting, the authors blended existing descriptions in the literature into an intuitive classification with 5 anatomical subtypes: lateral, medial, basal, sylvian, and ventricular. The authors’ surgical experience with temporal lobe AVMs was reviewed according to these subtypes. Methods Eighty-eight patients with temporal lobe AVMs were treated surgically. Results Lateral temporal lobe AVMs were the most common (58 AVMs, 66%). Thirteen AVMs (15%) were medial, 9 (10%) were basal, and 5 (6%) were sylvian. Ventricular AVMs were least common (3 AVMs, 3%). A temporal craniotomy based over the ear was used in 64%. Complete AVM resection was achieved in 82 patients (93%). Four patients (5%) died in the perioperative period (6 in all were lost to follow-up); 71 (87%) of the remaining 82 patients had good outcomes (modified Rankin Scale scores 0–2); and 68 (83%) were unchanged or improved after surgery. Conclusions Categorization of temporal AVMs into subtypes can assist with surgical planning and also standardize reporting. Lateral AVMs are the easiest to expose surgically, with circumferential access to feeding arteries and draining veins at the AVM margins. Basal AVMs require a subtemporal approach, often with some transcortical dissection through the inferior temporal gyrus. Medial AVMs are exposed tangentially with an orbitozygomatic craniotomy and transsylvian dissection of anterior choroidal artery and posterior cerebral artery feeders in the medial cisterns. Medial AVMs posterior to the cerebral peduncle require transcortical approaches through the temporooccipi tal gyrus. Sylvian AVMs require a wide sylvian fissure split and differentiation of normal arteries, terminal feeding arteries, and transit arteries. Ventricular AVMs require a transcortical approach through the inferior temporal gyrus that avoids the Meyer loop. Surgical results with temporal lobe

  1. Wholesale marginal prices in competitive generation markets

    SciTech Connect

    Perez-Arriaga, I.J.; Meseguer, C.

    1997-05-01

    Wholesale marginal electricity prices are being used in several actual competitive generation markets worldwide, both to remunerate generators and to charge consumption. These prices must account not only for energy, but also for guarantee of supply in the long and the short term. This paper: (a) provides a sound conceptual and quantitative foundation for wholesale pricing based on generation services, where any existing restrictions in operation or planning in real power markets are accounted for, (b) clearly establishes the relationship between short term marginal costs, long term marginal costs and optimal wholesale electricity prices, and (c) identifies the reasons for mismatches in cost recovery with marginal generation prices. The theoretical results are verified with a detailed realistic power system model.

  2. Mental Depreciation and Marginal Decision Making

    PubMed

    Heath; Fennema

    1996-11-01

    We propose that individuals practice "mental depreciation," that is, they implicitly spread the fixed costs of their expenses over time or use. Two studies explore how people spread fixed costs on durable goods. A third study shows that depreciation can lead to two distinct errors in marginal decisions: First, people sometimes invest too much effort to get their money's worth from an expense (e.g., they may use a product a lot to spread the fixed expense across more uses). Second, people sometimes invest too little effort to get their money's worth: When people add a portion of the fixed cost to the current costs, their perceived marginal (i.e., incremental) costs exceed their true marginal costs. In response, they may stop investing because their perceived costs surpass the marginal benefits they are receiving. The latter effect is supported by two field studies that explore real board plan decisions by university students.

  3. Energy margins in dynamic object manipulation

    PubMed Central

    Shen, Tian; Sternad, Dagmar

    2012-01-01

    Many tasks require humans to manipulate dynamically complex objects and maintain appropriate safety margins, such as placing a cup of coffee on a coaster without spilling. This study examined how humans learn such safety margins and how they are shaped by task constraints and changing variability with improved skill. Eighteen subjects used a manipulandum to transport a shallow virtual cup containing a ball to a target without losing the ball. Half were to complete the cup transit in a comfortable target time of 2 s (a redundant task with infinitely many equivalent solutions), and the other half in minimum time (a nonredundant task with one explicit cost to optimize). The safety margin was defined as the ball energy relative to escape, i.e., as an energy margin. The first hypothesis, that subjects converge to a single strategy in the minimum-time task but choose different strategies in the less constrained target-time task, was not supported. Both groups developed individualized strategies with practice. The second hypothesis, that subjects decrease safety margins in the minimum-time task but increase them in the target-time task, was supported. The third hypothesis, that in both tasks subjects modulate energy margins according to their execution variability, was partially supported. In the target-time group, changes in energy margins correlated positively with changes in execution variability; in the minimum-time group, such a relation was observed only at the end of practice, not across practice. These results show that when learning a redundant object manipulation task, most subjects increase their safety margins and shape their movement strategies in accordance with their changing variability. PMID:22592302

  4. Geomorphology of the Iberian Continental Margin

    NASA Astrophysics Data System (ADS)

    Maestro, Adolfo; López-Martínez, Jerónimo; Llave, Estefanía; Bohoyo, Fernando; Acosta, Juan; Hernández-Molina, F. Javier; Muñoz, Araceli; Jané, Gloria

    2013-08-01

    The submarine features and processes around the Iberian Peninsula are the result of a complex and diverse geological and oceanographical setting. This paper presents an overview of the seafloor geomorphology of the Iberian Continental Margin and the adjacent abyssal plains. The study covers an area of approximately 2.3 million km2, including a 50 to 400 km wide band adjacent to the coastline. The main morphological characteristics of the seafloor features on the Iberian continental shelf, continental slope, continental rise and the surrounding abyssal plains are described. Individual seafloor features existing on the Iberian Margin have been classified into three main groups according to their origin: tectonic and/or volcanic, depositional and erosional. Major depositional and erosional features around the Iberian Margin developed in late Pleistocene-Holocene times and have been controlled by tectonic movements and eustatic fluctuations. The distribution of the geomorphological features is discussed in relation to their genetic processes and the evolution of the margin. The prevalence of one or several specific processes in certain areas reflects the dominant morphotectonic and oceanographic controlling factors. Sedimentary processes and the resulting depositional products are dominant on the Valencia-Catalán Margin and in the northern part of the Balearic Promontory. Strong tectonic control is observed in the geomorphology of the Betic and the Gulf of Cádiz margins. The role of bottom currents is especially evident throughout the Iberian Margin. The Galicia, Portuguese and Cantabrian margins show a predominance of erosional features and tectonically-controlled linear features related to faults.

  5. The Continental Margins Program in Georgia

    USGS Publications Warehouse

    Cocker, M.D.; Shapiro, E.A.

    1999-01-01

    From 1984 to 1993, the Georgia Geologic Survey (GGS) participated in the Minerals Management Service-funded Continental Margins Program. Geological and geophysical data acquisition focused on offshore stratigraphic framework studies, phosphate-bearing Miocene-age strata, distribution of heavy minerals, near-surface alternative sources of groundwater, and development of a PC-based Coastal Geographic Information System (GIS). Seven GGS publications document results of those investigations. In addition to those publications, direct benefits of the GGS's participation include an impetus to the GGS's investigations of economic minerals on the Georgia coast, establishment of a GIS that includes computer hardware and software, and seeds for additional investigations through the information and training acquired as a result of the Continental Margins Program. These addtional investigations are quite varied in scope, and many were made possible because of GIS expertise gained as a result of the Continental Margins Program. Future investigations will also reap the benefits of the Continental Margins Program.From 1984 to 1993, the Georgia Geologic Survey (GGS) participated in the Minerals Management Service-funded Continental Margins Program. Geological and geophysical data acquisition focused on offshore stratigraphic framework studies, phosphate-bearing Miocene-age strata, distribution of heavy minerals, near-surface alternative sources of groundwater, and development of a PC-based Coastal Geographic Information System (GIS). Seven GGS publications document results of those investigations. In addition to those publications, direct benefits of the GGS's participation include an impetus to the GGS's investigations of economic minerals on the Georgia coast, establishment of a GIS that includes computer hardware and software, and seeds for additional investigations through the information and training acquired as a result of the Continental Margins Program. These additional

  6. Importance of adequate exercise in the detection of coronary heart disease by radionuclide ventriculography

    SciTech Connect

    Brady, T.J.; Thrall, J.H.; Lo, K.; Pitt, B.

    1980-12-01

    Rest and exercise radionuclide ventriculograms were obtained on 77 symptomatic patients without prior documented coronary artery disease (CAD). Coronary artery disease was present by angiograms in 48. Radionuclide ventriculography (RNV) was abnormal in 41 patients (overall sensitivity 85%). In 29 patients with normal coronary arteries, RNV was normal in 24 (specificity 83%). To determine if the exercise level affects sensitivity, the studies were graded for adequacy of exercise. It was considered adequate if patients developed (a) chest pain, or (b) ST segment depression of at least 1 mm, or (c) if they achieved a pressure rate product greater than 250. Among the 48 patients with coronary artery disease, 35 achieved adequate exercise. Thirty-three had an abnormal RNV (sensitivity 94%). In 13 patients who failed to achieve adequate exercise, RNV was abnormal in eight (sensitivity of only 62%). Some patients with coronary artery disease may have a normal ventricular response at inadequate levels of stress.

  7. [Prevention of ocular complications of herpes zoster ophthalmicus by adequate treatment with acyclovir].

    PubMed

    Borruat, F X; Buechi, E R; Piguet, B; Fitting, P; Zografos, L; Herbort, C P

    1991-05-01

    We compared the frequency of severe ocular complications secondary to Herpes Zoster Ophthalmicus (HZO) in 232 patients. They were divided into three groups: 1) patients without treatment (n = 164); 2) patients treated adequately (n = 48) with acyclovir (ACV; 5 x 800 mg/d orally and ophthalmic ointment 5 x /d for a minimum of 7 days, given within three days after skin eruption); and, 3) patients treated inadequately (n = 20) with ACV (only topical treatment, insufficient doses, interrupted treatment, delayed treatment). Patients with no treatment or with inadequate treatments showed the same frequency of severe ocular complications (21% (34/164) and 25% (5/20), respectively). In contrast, when adequate treatment of ACV was given complications occurred in only 4% (2/48) of cases. This study emphasizes the need for prompt (within three days after skin eruption) and adequate (5 x 800 mg/d for at least 7 days) treatment of ACV to prevent the severe complications of HZO.

  8. Referral to pediatric surgical specialists.

    PubMed

    Klein, Michael D

    2014-02-01

    The American Academy of Pediatrics, with the collaboration of the Surgical Sections of the American Academy of Pediatrics, has created referral recommendations intended to serve as voluntary practice parameters to assist general pediatricians in determining when and to whom to refer their patients for pediatric surgical specialty care. It is recognized that these recommendations may be difficult to implement, because communities vary in terms of access to major pediatric medical centers. Limited access does not negate the value of the recommendations, however, because the child who needs specialized surgical and anesthetic care is best served by the skills of the appropriate pediatric surgical team. Major congenital anomalies, malignancies, major trauma, and chronic illnesses (including those associated with preterm birth) in infants and children should be managed by pediatric medical subspecialists and pediatric surgical specialists at pediatric referral centers that can provide expertise in many areas, including the pediatric medical subspecialties and surgical specialties of pediatric radiology, pediatric anesthesiology, pediatric pathology, and pediatric intensive care. The optimal management of the child with complex problems, chronic illness, or disabilities requires coordination, communication, and cooperation of the pediatric surgical specialist with the child's primary care pediatrician or physician.

  9. A mandibular surgical training model.

    PubMed

    Leser, Casey P; Jepsen, Shawn A

    2008-01-01

    Performing surgical procedures on the mandible can present many challenges due to the anatomy and the limited access available to the various areas of the mandibular arch. The experience of the surgeon and the complexity of the surgery must be considered before attempting treatment. A static mandibular training model provides dentists with the opportunity to practice multiple surgical procedures to develop the skills that are necessary to treat patients competently and comprehensively. The mandible's unique anatomy presents a number of challenges when performing surgical procedures. A surgical model that makes it possible to practice multiple techniques benefits the surgeon by building the confidence to attempt more complex surgical procedures and thus provide patients with additional treatment options. This mandibular surgical model serves as a learning tool and provides an avenue for learning different surgical techniques that may be performed in various areas of the mandible. A number of procedures can be performed on the model, including the extraction of third molars, incision and drainage of a vestibular/buccal swelling, excisional biopsy of intrabony lesions, tori removal, initial implant alignment procedures, and suturing/flap designs. A number of these procedures can be performed on one model.

  10. [Motor nerves of the face. Surgical and radiologic anatomy of facial paralysis and their surgical repair].

    PubMed

    Vacher, C; Cyna-Gorse, F

    2015-10-01

    Motor innervation of the face depends on the facial nerve for the mobility of the face, on the mandibular nerve, third branch of the trigeminal nerve, which gives the motor innervation of the masticator muscles, and the hypoglossal nerve for the tongue. In case of facial paralysis, the most common palliative surgical techniques are the lengthening temporalis myoplasty (the temporal is innervated by the mandibular nerve) and the hypoglossal-facial anastomosis. The aim of this work is to describe the surgical anatomy of these three nerves and the radiologic anatomy of the facial nerve inside the temporal bone. Then the facial nerve penetrates inside the parotid gland giving a plexus. Four branches of the facial nerve leave the parotid gland: they are called temporal, zygomatic, buccal and marginal which give innervation to the cutaneous muscles of the face. Mandibular nerve gives three branches to the temporal muscles: the anterior, intermediate and posterior deep temporal nerves which penetrate inside the deep aspect of the temporal muscle in front of the infratemporal line. The hypoglossal nerve is only the motor nerve to the tongue. The ansa cervicalis, which is coming from the superficial cervical plexus and joins the hypoglossal nerve in the submandibular area is giving the motor innervation to subhyoid muscles and to the geniohyoid muscle.

  11. Recurrence rate of basal cell carcinoma with positive histopathological margins and related risk factors*

    PubMed Central

    Lara, Fernanda; Santamaría, Jesus Rodriguez; Garbers, Luiz Eduardo Fabricio de Melo

    2017-01-01

    BACKGROUND The best way to approach surgically removed basal cell carcinoma with positive histopathological margins is a controversial issue. Some authors believe that the more appropriate treatment is an immediate reoperation while others prefer a periodic follow up. The rates of recurrence are variable in literature, between 10% and 67%. OBJECTIVE To define the recurrence rate of basal cell carcinoma with positive margins after surgery. Secondarily, identify morphological aspects that can suggest a more frequent tumoral recurrence. METHODS This was a retrospective and observational study made by analysis of medical records of 487 patients between January 2003 and December 2009 in Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR). From 402 basal cell carcinomas surgically treated, 41 fulfilled inclusion criteria and were evaluated for five years or more. Recurrence rate of these tumors was analyzed in all patients and clinical characteristics such as sex, age, tumor size, tumor site, ulceration, and histological type were evaluated in order to find if they were related to more common tumoral recurrence. RESULTS The rate of positive margins after surgery was 12.18%. There were five cases of tumoral recurrence in the observation group and three cases in the re-excision group. Tumor size, site, histological type, ulceration and type of positive margin did not differ statistically between groups. It was not possible to consider if these factors were important in recurrence rates. STUDY LIMITATIONS Ideally, a prospective study with a larger sample would be more accurate. CONCLUSION The treatment of choice in basal cell carcinoma with positive margins must be individualized to reduce recurrence rates. PMID:28225958

  12. The basins on the Argentine continental margin

    SciTech Connect

    Urien, C.M.

    1996-08-01

    After the stabilization of the central Gondwana Craton, orogenic belts were accreted, as a result of convergence events and an extensive passive margin developed in southwestern Gondwana. Thermal subsidence in Parana, Karoo-Ventania basins and the Late Paleozoic-Early Mesozoic rifts, were modified by the Gondwana breakup and the South Atlantic opening. Early Paleozoic marine transgressions deposited the Table Mountain Group in Ventania. In southwestern Patagonia foreland clastics were deposited. Magmatic arcs and marine units indicate a tectonic trough was formed, alternating with continental sequences, over Late Paleozoic metamorphics and intrusives, resulting from plastered terrains along the Gondwana margin. In Patagonia, Permo-Carboniferous continental and glacio marine clastics infill the basins, while in Ventania, paralic sequences, grade from neritic to continental to the northeast, extending beneath the continental margin. The Triassic-Jurassic rift basins progressed onto regional widespread acid lavas and were infilled by lagoonal organic-rich sequences. Early drift phase built basins transverse to the margin, with fluvio-lacustrine sequences: Salado, Colorado, Valdes-Rawson, San Julian and North Malvinas intracratonic basins, which underwent transtensional faulting. Post-Oxfordian to Neocomian brackish sequences, onlapped the conjugate basins during the margin`s drift, with petroleum systems, as in Austral and Malvinas. In the Valanginian, basic extrusions commenced to form on the continental border, heralding the oceanic phase. Due to thermal subsidence, offlaping sediments prograded onto the remaining half-grabens. Several petroleum systems, proven and hypothetical, are identified in this region.

  13. Surgical Stress Abrogates Pre-Existing Protective T Cell Mediated Anti-Tumor Immunity Leading to Postoperative Cancer Recurrence.

    PubMed

    Ananth, Abhirami A; Tai, Lee-Hwa; Lansdell, Casey; Alkayyal, Almohanad A; Baxter, Katherine E; Angka, Leonard; Zhang, Jiqing; Tanese de Souza, Christiano; Stephenson, Kyle B; Parato, Kelley; Bramson, Jonathan L; Bell, John C; Lichty, Brian D; Auer, Rebecca C

    2016-01-01

    Anti-tumor CD8+ T cells are a key determinant for overall survival in patients following surgical resection for solid malignancies. Using a mouse model of cancer vaccination (adenovirus expressing melanoma tumor-associated antigen (TAA)-dopachrome tautomerase (AdDCT) and resection resulting in major surgical stress (abdominal nephrectomy), we demonstrate that surgical stress results in a reduction in the number of CD8+ T cell that produce cytokines (IFNγ, TNFα, Granzyme B) in response to TAA. This effect is secondary to both reduced proliferation and impaired T cell function following antigen binding. In a prophylactic model, surgical stress completely abrogates tumor protection conferred by vaccination in the immediate postoperative period. In a clinically relevant surgical resection model, vaccinated mice undergoing a positive margin resection with surgical stress had decreased survival compared to mice with positive margin resection alone. Preoperative immunotherapy with IFNα significantly extends survival in surgically stressed mice. Importantly, myeloid derived suppressor cell (MDSC) population numbers and functional impairment of TAA-specific CD8+ T cell were altered in surgically stressed mice. Our observations suggest that cancer progression may result from surgery-induced suppression of tumor-specific CD8+ T cells. Preoperative immunotherapies aimed at targeting the prometastatic effects of cancer surgery will reduce recurrence and improve survival in cancer surgery patients.

  14. Broadband inversion of 1J(CC) responses in 1,n-ADEQUATE spectra.

    PubMed

    Reibarkh, Mikhail; Williamson, R Thomas; Martin, Gary E; Bermel, Wolfgang

    2013-11-01

    Establishing the carbon skeleton of a molecule greatly facilitates the process of structure elucidation, both manual and computer-assisted. Recent advances in the family of ADEQUATE experiments demonstrated their potential in this regard. 1,1-ADEQUATE, which provides direct (13)C-(13)C correlation via (1)J(CC), and 1,n-ADEQUATE, which typically yields (3)J(CC) and (1)J(CC) correlations, are more sensitive and more widely applicable experiments than INADEQUATE and PANACEA. A recently reported modified pulse sequence that semi-selectively inverts (1)J(CC) correlations in 1,n-ADEQUATE spectra provided a significant improvement, allowing (1)J(CC) and (n)J(CC) correlations to be discerned in the same spectrum. However, the reported experiment requires a careful matching of the amplitude transfer function with (1)J(CC) coupling constants in order to achieve the inversion, and even then some (1)J(CC) correlations could still have positive intensity due to the oscillatory nature of the transfer function. Both shortcomings limit the practicality of the method. We now report a new, dual-optimized inverted (1)J(CC) 1,n-ADEQUATE experiment, which provides more uniform inversion of (1)J(CC) correlations across the range of 29-82 Hz. Unlike the original method, the dual optimization experiment does not require fine-tuning for the molecule's (1)J(CC) coupling constant values. Even more usefully, the dual-optimized version provides up to two-fold improvement in signal-to-noise for some long-range correlations. Using modern, cryogenically-cooled probes, the experiment can be successfully applied to samples of ~1 mg under favorable circumstances. The improvements afforded by dual optimization inverted (1)J(CC) 1,n-ADEQUATE experiment make it a useful and practical tool for NMR structure elucidation and should facilitate the implementation and utilization of the experiment.

  15. In vivo reflectance confocal microscopy of shave biopsy wounds: feasibility of intra-operative mapping of cancer margins

    PubMed Central

    Scope, A; Mahmood, U; Gareau, DS; Kenkre, M; Lieb, JA; Nehal, KS; Rajadhyaksha, M

    2010-01-01

    Background Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in-vivo. Topical application of Aluminum Chloride (AlCl3) enhances contrast in RCM images by brightening nuclei. Objective To investigate feasibility of RCM imaging of shave biopsy wounds using AlCl3 as a contrast agent. Methods AlCl3 staining was optimized, in terms of concentration versus immersion time, on excised tissue ex-vivo. RCM imaging protocol was tested in patients undergoing shave biopsies. The RCM images were retrospectively analyzed and compared to the corresponding histopathology. Results For 35% AlCl3, routinely used for hemostasis in clinic, minimum immersion time was determined to be 1 minute. We identified 3 consistent patterns of margins on RCM mosaic images by varying depths: epidermal margins, peripheral dermal margins, and deep dermal margins. Tumour islands of basal cell carcinoma were identified at peripheral or deep dermal margins, correlating on histopathology with aggregates of neoplastic basaloid cells. Atypical cobblestone or honeycomb pattern were identified at the epidermal margins, correlating with a proliferation of atypical keratinocytes extending to biopsy margins. Conclusions RCM imaging of shave biopsy wounds is feasible and demonstrates the future possibility of intra-operative mapping in surgical wounds. PMID:20874785

  16. Self-reported segregation experience throughout the life course and its association with adequate health literacy.

    PubMed

    Goodman, Melody S; Gaskin, Darrell J; Si, Xuemei; Stafford, Jewel D; Lachance, Christina; Kaphingst, Kimberly A

    2012-09-01

    Residential segregation has been shown to be associated with health outcomes and health care utilization. We examined the association between racial composition of five physical environments throughout the life course and adequate health literacy among 836 community health center patients in Suffolk County, NY. Respondents who attended a mostly White junior high school or currently lived in a mostly White neighborhood were more likely to have adequate health literacy compared to those educated or living in predominantly minority or diverse environments. This association was independent of the respondent's race, ethnicity, age, education, and country of birth.

  17. Self-reported segregation experience throughout the life course and its association with adequate health literacy

    PubMed Central

    Gaskin, Darrell J.; Si, Xuemei; Stafford, Jewel D.; Lachance, Christina; Kaphingst, Kimberly A.

    2012-01-01

    Residential segregation has been shown to be associated with health outcomes and health care utilization. We examined the association between racial composition of five physical environments throughout the life course and adequate health literacy among 836 community health center patients in Suffolk County, NY. Respondents who attended a mostly White junior high school or currently lived in a mostly White neighborhood were more likely to have adequate health literacy compared to those educated or living in predominantly minority or diverse environments. This association was independent of the respondent’s race, ethnicity, age, education, and country of birth. PMID:22658579

  18. Surgical Site Infections

    PubMed Central

    Kleinman, Ken; Huang, Susan S.; Murphy, Michael V.; Yokoe, Deborah S.; Platt, Richard

    2017-01-01

    Background: Surgical site infection (SSI) rates are publicly reported as quality metrics and increasingly used to determine financial reimbursement. Objective: To evaluate the volume-outcome relationship as well as the year-to-year stability of performance rankings following coronary artery bypass graft (CABG) surgery and hip arthroplasty. Research Design: We performed a retrospective cohort study of Medicare beneficiaries who underwent CABG surgery or hip arthroplasty at US hospitals from 2005 to 2011, with outcomes analyzed through March 2012. Nationally validated claims-based surveillance methods were used to assess for SSI within 90 days of surgery. The relationship between procedure volume and SSI rate was assessed using logistic regression and generalized additive modeling. Year-to-year stability of SSI rates was evaluated using logistic regression to assess hospitals’ movement in and out of performance rankings linked to financial penalties. Results: Case-mix adjusted SSI risk based on claims was highest in hospitals performing <50 CABG/year and <200 hip arthroplasty/year compared with hospitals performing ≥200 procedures/year. At that same time, hospitals in the worst quartile in a given year based on claims had a low probability of remaining in that quartile the following year. This probability increased with volume, and when using 2 years’ experience, but the highest probabilities were only 0.59 for CABG (95% confidence interval, 0.52–0.66) and 0.48 for hip arthroplasty (95% confidence interval, 0.42–0.55). Conclusions: Aggregate SSI risk is highest in hospitals with low annual procedure volumes, yet these hospitals are currently excluded from quality reporting. Even for higher volume hospitals, year-to-year random variation makes past experience an unreliable estimator of current performance. PMID:27517331

  19. [Surgical rehabilitation of stomal disease].

    PubMed

    La Torre, F; Persico Stella, L; Nicolai, A P; Nicastro, A; Gasparrini, M; de Anna, L; Lucidi, V; Montori, A

    1997-10-01

    The Authors report their experience in the surgical rehabilitation of patients with complicated ileo- or colostomy. Mechanical and psychosocial implications as well as different rehabilitative methods are discussed. The results of a surgical protocol in the treatment of stomal diseases observed in 63 patients are herein reported. In 14 patients the surgical treatment was performed in general anaesthesia, while in 49 local anaesthesia was used. The latter was better tolerated by the patients. In conclusion, surgery should play a major role in this rehabilitation protocol, either in terms of prevention or definitive treatment.

  20. Surgical education through video broadcasting.

    PubMed

    Nagengast, Eric S; Ramos, Margarita S; Sarma, Hiteswar; Deshpande, Gaurav; Hatcher, Kristin; Magee, William P; Campbell, Alex

    2014-09-01

    Surgical training is facing new obstacles. As advancements in medicine are made, surgeons are expected to know more and to be able to perform more procedures. In the western world, increasing restrictions on residency work hours are adding a new hurdle to surgical training. In low-resource settings, a low attending-to-resident ratio results in limited operative experience for residents. Advances in telemedicine may offer new methods for surgical training. In this article, the authors share their unique experience using live video broadcasting of surgery for educational purposes at a comprehensive cleft care center in Guwahati, India.

  1. Surgical Skills Beyond Scientific Management

    PubMed Central

    Whitfield, Nicholas

    2015-01-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  2. Surgical research using national databases.

    PubMed

    Alluri, Ram K; Leland, Hyuma; Heckmann, Nathanael

    2016-10-01

    Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations. The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

  3. Surgical research using national databases

    PubMed Central

    Leland, Hyuma; Heckmann, Nathanael

    2016-01-01

    Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations. The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research. PMID:27867945

  4. Analysis of the Blood Consumption for Surgical Programs

    PubMed Central

    Begic, Dzenana; Mujicic, Ermina; Coric, Jozo; Zec, Svjetlana Loga; Zunic, Lejla

    2016-01-01

    Introduction: Transfusion is an activity that assures sufficient supply of blood and blood components to treat the sick and injured. In transfusion departments is necessary to timely provide adequate amounts of blood and blood products for various surgical procedures. Material and methods: To determine the total amount of preoperative requirements (BT/AB and BT/AB/MT) for blood and blood products in surgical departments of General Hospital “Prim. Dr. Abdulah Nakas” in the period from June 1, 2014 – December 31, 2014 and analyze the requirements for blood in relation to surgical procedures, surgical discipline, period, age and gender of patients. To determine the maximum consumption levels surgeries. Results: The total amount of preoperative requirements for blood and blood products in surgical departments amounted to 927. Almost the same number of requests with a slightly higher percentage was in December and October and the lowest in June. The average age of patients was 52.2±20.1 years with the youngest patient aged 9 and the oldest at the age of 97 years. Women were more prevalent with 686 or 74% of the time compared to men. The largest number of requests for surgery elective cesarean section 208 (22.5%) with delivery wards, then for surgery or hip replacement 98 (10.6%). Maximum consumption for surgical operations Hysterectomy totalis abdominals 15 doses of blood. Conclusion: The largest number of requests were for elective cesarean section 208 (22.5%) with delivery wards, then for surgery or hip replacement with 98 (10.6%). Maximum consumed doses had gynecology surgery at Hysterectomy totalis abdominals 15 doses of blood, then orthopedics surgery at Primary hip prosthesis 11 doses. PMID:27703282

  5. Surgical education and training in Australia and New Zealand.

    PubMed

    Collins, John P; Civil, Ian D; Sugrue, Michael; Balogh, Zsolt; Chehade, Mellick J

    2008-10-01

    Surgical education for medical students in Australia and New Zealand is provided by 19 universities in Australia and 2 in New Zealand. One surgical college is responsible for managing the education, training, assessment, and professional development programs for surgeons throughout both countries. The specialist surgical associations and societies act as agents of the college in the delivery of these programs, the extent of which varies among specialties. Historically, surgical training was divided into basic and specialist components with selection required for each part. In response to a number of factors, a new surgical education and training program has been developed. The new program incorporates a single merit-based national selection directly into the candidate's specialty of choice. The existing curriculum for each of the nine specialties has been remodeled to a competence-based format in line with the competence required to undertake the essential roles of a surgeon. New standards and criteria have been produced for accreditation of health care facilities used for training. A new basic surgical skills education and training course has been developed, with simulation playing an increasing role in all courses. Trainees' progress is assessed by workplace-based assessment and formal examinations, including an exit examination. The sustained production of sufficient competent surgeons to meet societal needs encompasses many challenges including the recruitment of appropriate graduates and the availability of adequate educational and clinical resources to train them. Competence-based training is an attractive educational philosophy, but its implementation has brought its own set of issues, many of which have yet to be resolved.

  6. Comparison of Actual Surgical Outcomes and 3D Surgical Simulations

    PubMed Central

    Tucker, Scott; Cevidanes, Lucia; Styner, Martin; Kim, Hyungmin; Reyes, Mauricio; Proffit, William; Turvey, Timothy

    2009-01-01

    Purpose The advent of imaging software programs have proved to be useful for diagnosis, treatment planning, and outcome measurement, but precision of 3D surgical simulation still needs to be tested. This study was conducted to determine if the virtual surgery performed on 3D models constructed from Cone-beam CT (CBCT) can correctly simulate the actual surgical outcome and to validate the ability of this emerging technology to recreate the orthognathic surgery hard tissue movements in 3 translational and 3 rotational planes of space. Methods Construction of pre- and post-surgery 3D models from CBCTs of 14 patients who had combined maxillary advancement and mandibular setback surgery and 6 patients who had one-piece maxillary advancement surgery was performed. The post-surgery and virtually simulated surgery 3D models were registered at the cranial base to quantify differences between simulated and actual surgery models. Hotelling T-test were used to assess the differences between simulated and actual surgical outcomes. Results For all anatomic regions of interest, there was no statistically significant difference between the simulated and the actual surgical models. The right lateral ramus was the only region that showed a statistically significant, but small difference when comparing two- and one-jaw surgeries. Conclusions Virtual surgical methods were reliably reproduced, oral surgery residents could benefit from virtual surgical training, and computer simulation has the potential to increase predictability in the operating room. PMID:20591553

  7. The geodynamics of the Levant margin

    NASA Astrophysics Data System (ADS)

    Ben-Avraham, Z.

    2006-12-01

    The Levant continental margin, offshore Israel, Lebanon and Syria, is usually defined as a passive margin that was formed through rifting processes. During the formation two major continental fragments are assumed to separate from the northern edge of the Afro-Arabian plate to form the Levant basin: the Tauride and Eratosthenes blocks. Today an oceanic crust and, in places, a very thin continental crust are present between the Levant margin and Eratosthenes seamount. The margin can be divided into two distinct provinces that are separated by the Carmel Structure, which extends from seawards to the northwest across the continental shelf and slope. The preservation of segmentation, both in the shallow and in the deep structure, insinuates that the two segments were formed through different continental breakup processes, which continue to dictate the style of sediment accumulation. The nature and development of the continental margin offshore Israel were the subject of numerous studies, which suggest that the southern Levant segment (south of the Carmel Structure) was formed through continental rifting processes. In contrast, the northern segment, from the Carmel structure northwards and offshore southern Lebanon, was hardly studied before. Recent studies however indicate that the northern segment shows a strong similarity to classical transform margins in the world. In view of the new classification of the northern Levant margin a modified scenario is suggested for: (a) the initial stages in which the Levant margin was formed; and (b) the present day structural differences between the two segments of the margin. At present, the northern Levant continental margin is being reactivated by transpressional faulting of the marine continuation of the Carmel fault which bends northward at the base of the continental slope due to the rheological discontinuity in this region. This fault system coincides with the sharp continental-oceanic crustal transition, and acts as an

  8. Surgical innovation: the ethical agenda: A systematic review.

    PubMed

    Broekman, Marike L; Carrière, Michelle E; Bredenoord, Annelien L

    2016-06-01

    The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation.Although the call for evidence-based practice in surgery is increasingly high on the agenda, most surgeons feel that the format of the randomized controlled trial is not suitable for surgery. Innovation in surgery has aspects of, but should be distinguished from both research and clinical care and raises its own ethical challenges.To answer the question "What are the main ethical aspects of surgical innovation?", we systematically searched PubMed and Embase. Papers expressing an opinion, point of view, or position were included, that is, normative ethical papers.We included 59 studies discussing ethical aspects of surgical innovation. These studies discussed 4 major themes: oversight, informed consent, learning curve, and vulnerable patient groups. Although all papers addressed the ethical challenges raised by surgical innovation, surgeons hold no uniform view of surgical innovation, and there is no agreement on the distinction between innovation and research. Even though most agree to some sort of oversight, they offer different alternatives ranging from the formation of new surgical innovation committees to establishing national registries. Most agree that informed consent is necessary for innovative procedures and that surgeons should be adequately trained to assure their competence to tackle the learning curve problem. All papers agree that in case of vulnerable patients, alternatives must be found for the informed consent procedure.We suggest that the concept of the learning health care system might provide guidance for thinking about surgical innovation. The underlying rationale of the learning health care system is to improve the quality of health care by embedding research within clinical care. Two aspects of a learning health care system might

  9. The study of gunshot wounds in surgical pathology.

    PubMed

    Murphy, G K

    1980-06-01

    Both the laboratory and the pathologist are frequently involved in medicolegal cases. A relatively infrequent though important example is the case involving study of gunshot wounds in surgical pathology. Procedures for the proper gross and microscopic examination of gunshot wound specimens have been documented in the literature, and are briefly reviewed. A protocol for documenting the chain of custody for physical evidence recovered in these cases must be strictly observed in each department of surgical pathology. A large hospital's surgical pathology files contained 70 gunshot wound cases for 1969-1978. Review employing Adelson's reference work revealed correct microscopic findings and diagnosis in 90% of specimens, the 11 errors all failures to recognize gunpowder residue in tissues. There were nine specimens of physical evidence. Two errors were made in the gross examination of these specimens, and despite a chain-of-custody protocol pathologists failed to adequately document 44% of them. The surgical pathologist has available ample resources for studying gunshot wound specimens. Using them he can correctly interpret most cases, at the same time fulfilling his medicolegal obligations.

  10. Centrifugal Compressor Surge Margin Improved With Diffuser Hub Surface Air Injection

    NASA Technical Reports Server (NTRS)

    Skoch, Gary J.

    2002-01-01

    Aerodynamic stability is an important parameter in the design of compressors for aircraft gas turbine engines. Compression system instabilities can cause compressor surge, which may lead to the loss of an aircraft. As a result, engine designers include a margin of safety between the operating line of the engine and the stability limit line of the compressor. The margin of safety is typically referred to as "surge margin." Achieving the highest possible level of surge margin while meeting design point performance objectives is the goal of the compressor designer. However, performance goals often must be compromised in order to achieve adequate levels of surge margin. Techniques to improve surge margin will permit more aggressive compressor designs. Centrifugal compressor surge margin improvement was demonstrated at the NASA Glenn Research Center by injecting air into the vaned diffuser of a 4:1-pressure-ratio centrifugal compressor. Tests were performed using injector nozzles located on the diffuser hub surface of a vane-island diffuser in the vaneless region between the impeller trailing edge and the diffuser-vane leading edge. The nozzle flow path and discharge shape were designed to produce an air stream that remained tangent to the hub surface as it traveled into the diffuser passage. Injector nozzles were located near the leading edge of 23 of the 24 diffuser vanes. One passage did not contain an injector so that instrumentation located in that passage would be preserved. Several orientations of the injected stream relative to the diffuser vane leading edge were tested over a range of injected flow rates. Only steady flow (nonpulsed) air injection was tested. At 100 percent of the design speed, a 15-percent improvement in the baseline surge margin was achieved with a nozzle orientation that produced a jet that was bisected by the diffuser vane leading edge. Other orientations also improved the baseline surge margin. Tests were conducted at speeds below the

  11. Time-gated optical imaging to detect positive prostate cancer margins

    NASA Astrophysics Data System (ADS)

    Lin, Zi-Jing; Alexandrakis, George; Patel, Nimit; Shen, Jinhui; Tang, Liping; Liu, Hanli

    2009-02-01

    Laparoscopic radical prostatectomy (LRP) has revolutionized the surgical treatment of prostate cancer. This procedure permits complete removal of the prostate and seminal vesicles while minimizing pain and recovery time. However, the laparoscopic approach greatly limits the surgeon's tactile sensation during the procedure. This is particularly true with robot-assisted LRP where no tactile feedback is available forcing the surgeon to rely solely on visual cues. The surgeon and pathologist perform intraoperative frozen section pathologic analysis of a few select tissue fragments, but this is time consuming and costly. Concrete conclusions based on such samples are unreliable as they do not reflect the entire surgical margin status. In this case a conservative approach might dictate removal of more marginal material than necessary, thereby compromising the important nerve-sparing aspects of the procedure. In this study, we demonstrate the feasibility of using multi-modal time-gated optical imaging, i.e. time-resolved light reflectance and auto-fluorescence life-time imaging performed by an ICCD (Intensified Charge-Coupled Device) imaging system to enable clinicians to detect positive tumor margins with high sensitivity and specificity over the prostate. Results from animal experiments present the potential of identifying differences in optical signals between prostate cancer and control tissues. Results also show that the use of classification algorithms can identify cancerous regions with high sensitivity and specificity.

  12. Preclinical evaluation of nuclear morphometry and tissue topology for breast carcinoma detection and margin assessment.

    PubMed

    Nyirenda, Ndeke; Farkas, Daniel L; Ramanujan, V Krishnan

    2011-04-01

    Prevention and early detection of breast cancer are the major prophylactic measures taken to reduce the breast cancer related mortality and morbidity. Clinical management of breast cancer largely relies on the efficacy of the breast-conserving surgeries and the subsequent radiation therapy. A key problem that limits the success of these surgeries is the lack of accurate, real-time knowledge about the positive tumor margins in the surgically excised tumors in the operating room. This leads to tumor recurrence and, hence, the need for repeated surgeries. Current intraoperative techniques such as frozen section pathology or touch imprint cytology severely suffer from poor sampling and non-optimal detection sensitivity. Even though histopathology analysis can provide information on positive tumor margins post-operatively (~2-3 days), this information is of no immediate utility in the operating rooms. In this article, we propose a novel image analysis method for tumor margin assessment based on nuclear morphometry and tissue topology and demonstrate its high sensitivity/specificity in preclinical animal model of breast carcinoma. The method relies on imaging nuclear-specific fluorescence in the excised surgical specimen and on extracting nuclear morphometric parameters (size, number, and area fraction) from the spatial distribution of the observed fluorescence in the tissue. We also report the utility of tissue topology in tumor margin assessment by measuring the fractal dimension in the same set of images. By a systematic analysis of multiple breast tissues specimens, we show here that the proposed method is not only accurate (~97% sensitivity and 96% specificity) in thin sections, but also in three-dimensional (3D) thick tissues that mimic the realistic lumpectomy specimens. Our data clearly precludes the utility of nuclear size as a reliable diagnostic criterion for tumor margin assessment. On the other hand, nuclear area fraction addresses this issue very

  13. [Biliary ileum and surgical emergency].

    PubMed

    Rassu, P C; Bronzino, P; Cassinelli, G; La Spisa, C; Cuneo, A; Partipilo, F; Rusca, I; Stanizzi, T

    2003-01-01

    The Authors report a case of intestinal occlusion due to a gallstone migrated in jejunum and, with a review of the literature, stress the difficult decision making for surgical timing in a critical patient.

  14. Surgical treatment of cranial neuralgias.

    PubMed

    Franzini, Angelo; Ferroli, Paolo; Messina, Giuseppe; Broggi, Giovanni

    2010-01-01

    The most common types of cranial neuralgias amenable to surgical therapeutic options are trigeminal neuralgia and glossopharyngeal neuralgia, the former having an approximate incidence of 5/100000 cases per year and the latter of 0.05/100000 cases per year. Surgical therapy of these pathological conditions encompasses several strategies, going from ablative procedures to neurovascular decompression, to radiosurgery. The choice of the most appropriate surgical option (which must be taken into account when all conservative treatments have proven to be unsuccessful) has to take into account many factors, the most important ones being neuroradiological evidence of a neurovascular conflict, severity of symptoms, the age and clinical history of the patient, and the patient's overall medical condition. In this chapter we report our experience with the treatment of trigeminal and glossopharyngeal neuralgia, describing the surgical procedures performed and reviewing the most recent aspects on this subject in the past literature.

  15. Treatment of surgical wound dehiscence.

    PubMed

    Candido, Luiz Claudio

    2002-06-01

    Surgical exploration of cavities, sinuses, and specific antibiotic therapy are fundamental for the control fo cutaneous infection. Topical treatment will vary based on evaluation of the lesion, experience of the health care team, and the environment.

  16. Surgical treatment of uterine sarcoma.

    PubMed

    Nam, Joo-Hyun

    2011-12-01

    Uterine sarcomas are rare, heterogeneous malignant tumours of several histologic types originating from mesenchymal tissues of the uterus. The most common histologic types are carcinosarcoma, leiomyosarcoma, and endometrial stromal sarcoma, accounting for 90% of uterine sarcomas. To date, no effective treatment has been found to achieve a high rate of cure or prolong survival. Although complete surgical excision of the tumour is the only curative treatment modality, the rarity of these tumours and their diversity of histologic types have precluded the development of standard surgical strategies. Surgery may also be optimal for recurrent uterine sarcomas, but indications for secondary surgical treatment have not been established. Here, we describe recent changes in, and updates of, the surgical treatment of the three most common types of malignant uterine sarcomas.

  17. 75 FR 69648 - Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-15

    ... ENERGY Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers... designed to hold firmly in place. 10 CFR Part 830 imposes a requirement that a documented safety analysis... provide guidance on meeting the requirements imposed by DOE Order 5480.23, Nuclear Safety Analysis...

  18. 42 CFR 413.24 - Adequate cost data and cost finding.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    .... Adequate data capable of being audited is consistent with good business concepts and effective and efficient management of any organization, whether it is operated for profit or on a nonprofit basis. It is a... contract for services (for example, a management contract), directly assigning the costs to the...

  19. Prenatal zinc supplementation of zinc-adequate rats adversely affects immunity in offspring

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We previously showed that zinc (Zn) supplementation of Zn-adequate dams induced immunosuppressive effects that persist in the offspring after weaning. We investigated whether the immunosuppressive effects were due to in utero exposure and/or mediated via milk using a cross-fostering design. Pregnant...

  20. Towards Defining Adequate Lithium Trials for Individuals with Mental Retardation and Mental Illness.

    ERIC Educational Resources Information Center

    Pary, Robert J.

    1991-01-01

    Use of lithium with mentally retarded individuals with psychiatric conditions and/or behavior disturbances is discussed. The paper describes components of an adequate clinical trial and reviews case studies and double-blind cases. The paper concludes that aggression is the best indicator for lithium use, and reviews treatment parameters and…

  1. ADEQUATE SHELTERS AND QUICK REACTIONS TO WARNING: A KEY TO CIVIL DEFENSE.

    PubMed

    LYNCH, F X

    1963-11-08

    Case histories collected by investigators in Japan during 1945 illustrate both the effectiveness of shelters and the dangers inherent in apathy of the population, which suffered needless casualties by ignoring air raid warnintgs. Adequate shelters and immediate response to warnings are essential to survival in nuclear attack.

  2. Perceptions of Teachers in Their First Year of School Restructuring: Failure to Make Adequate Yearly Progress

    ERIC Educational Resources Information Center

    Moser, Sharon

    2010-01-01

    The 2007-2008 school year marked the first year Florida's Title I schools that did not made Adequate Yearly Progress (AYP) for five consecutive years entered into restructuring as mandated by the "No Child Left Behind Act" of 2001. My study examines the perceptions of teacher entering into their first year of school restructuring due to…

  3. 45 CFR 1182.15 - Institute responsibility for maintaining adequate technical, physical, and security safeguards to...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... record systems. These security safeguards shall apply to all systems in which identifiable personal data... data and automated systems shall be adequately trained in the security and privacy of personal data. (4... technical, physical, and security safeguards to prevent unauthorized disclosure or destruction of manual...

  4. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Adequate financial records, statistical data, and... financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination of costs payable by...

  5. Effect of tranquilizers on animal resistance to the adequate stimuli of the vestibular apparatus

    NASA Technical Reports Server (NTRS)

    Maksimovich, Y. B.; Khinchikashvili, N. V.

    1980-01-01

    The effect of tranquilizers on vestibulospinal reflexes and motor activity was studied in 900 centrifuged albino mice. Actometric studies have shown that the tranquilizers have a group capacity for increasing animal resistance to the action of adequate stimuli to the vestibular apparatus.

  6. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  7. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  8. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  9. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Attending...

  10. The Relationship between Parental Involvement and Adequate Yearly Progress among Urban, Suburban, and Rural Schools

    ERIC Educational Resources Information Center

    Ma, Xin; Shen, Jianping; Krenn, Huilan Y.

    2014-01-01

    Using national data from the 2007-08 School and Staffing Survey, we compared the relationships between parental involvement and school outcomes related to adequate yearly progress (AYP) in urban, suburban, and rural schools. Parent-initiated parental involvement demonstrated significantly positive relationships with both making AYP and staying off…

  11. Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children?

    PubMed

    Godrich, Stephanie L; Lo, Johnny; Davies, Christina R; Darby, Jill; Devine, Amanda

    2017-01-03

    Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD) (i.e., food availability, access, and utilisation dimensions) and adequate vegetable consumption among children living in regional and remote Western Australia (WA). Caregiver-child dyads (n = 256) living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23). A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria (p ≤ 0.20) for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed (p = 0.007), promotion (p = 0.017), location of food outlets (p = 0.027), and price (p = 0.043). Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned) are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing.

  12. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian and adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall...

  13. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Research Facilities § 2.33 Attending veterinarian and adequate veterinary care. (a) Each research facility shall have an attending veterinarian who shall...

  14. Identifying the Factors Impacting the Adequately Yearly Progress Performance in the United States

    ERIC Educational Resources Information Center

    Hsieh, Ju-Shan

    2013-01-01

    The NCLB (No Child Left Behind Act) specifies that states must develop AYP (adequate yearly progress) statewide measurable objectives for improved achievement by all students, including economically disadvantaged students, students from minority races, students with disabilities, and students with limited English proficiency. By the 2013-2014…

  15. 42 CFR 438.207 - Assurances of adequate capacity and services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Assurances of adequate capacity and services. 438.207 Section 438.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and...

  16. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 36 Parks, Forests, and Public Property 1 2011-07-01 2011-07-01 false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Denali National Park...

  17. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Denali National Park...

  18. 76 FR 51041 - Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood Donors; Public Workshop

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-17

    ... HUMAN SERVICES Food and Drug Administration Hemoglobin Standards and Maintaining Adequate Iron Stores in... workshop. The Food and Drug Administration (FDA) is announcing a public workshop entitled: ``Hemoglobin... discuss blood donor hemoglobin and hematocrit qualification standards in the United States, its impact...

  19. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... adequate and well-controlled studies of a new animal drug is to distinguish the effect of the new animal... with one or more controls to provide a quantitative evaluation of drug effects. The protocol and the... for special circumstances. Examples include studies in which the effect of the new animal drug is...

  20. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... adequate and well-controlled studies of a new animal drug is to distinguish the effect of the new animal... with one or more controls to provide a quantitative evaluation of drug effects. The protocol and the... for special circumstances. Examples include studies in which the effect of the new animal drug is...

  1. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... adequate and well-controlled studies of a new animal drug is to distinguish the effect of the new animal... with one or more controls to provide a quantitative evaluation of drug effects. The protocol and the... for special circumstances. Examples include studies in which the effect of the new animal drug is...

  2. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... adequate and well-controlled studies of a new animal drug is to distinguish the effect of the new animal... with one or more controls to provide a quantitative evaluation of drug effects. The protocol and the... for special circumstances. Examples include studies in which the effect of the new animal drug is...

  3. 21 CFR 514.117 - Adequate and well-controlled studies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... adequate and well-controlled studies of a new animal drug is to distinguish the effect of the new animal... with one or more controls to provide a quantitative evaluation of drug effects. The protocol and the... for special circumstances. Examples include studies in which the effect of the new animal drug is...

  4. 30 CFR 227.801 - What if a State does not adequately perform a delegated function?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... delegated function? 227.801 Section 227.801 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT DELEGATION TO STATES Performance Review § 227.801 What if a State does not adequately perform a delegated function? If your performance of the delegated function does...

  5. Science Education as a Contributor to Adequate Yearly Progress and Accountability Programs

    ERIC Educational Resources Information Center

    Judson, Eugene

    2010-01-01

    The No Child Left Behind (NCLB) Act requires states to measure the adequate yearly progress (AYP) of each public school and local educational agency (LEA) and to hold schools and LEAs accountable for failing to make AYP. Although it is required that science be assessed in at least three grades, the achievement results from science examinations are…

  6. 42 CFR 417.568 - Adequate financial records, statistical data, and cost finding.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Adequate financial records, statistical data, and... financial records, statistical data, and cost finding. (a) Maintenance of records. (1) An HMO or CMP must maintain sufficient financial records and statistical data for proper determination of costs payable by...

  7. Understanding the pelvic pain mechanism is key to find an adequate therapeutic approach.

    PubMed

    Van Kerrebroeck, Philip

    2016-06-25

    Pain is a natural mechanism to actual or potential tissue damage and involves both a sensory and an emotional experience. In chronic pelvic pain, localisation of pain can be widespread and can cause considerable distress. A multidisciplinary approach is needed in order to fully understand the pelvic pain mechanism and to identify an adequate therapeutic approach.

  8. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 36 Parks, Forests, and Public Property 1 2012-07-01 2012-07-01 false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Denali National Park...

  9. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 1 2014-07-01 2014-07-01 false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Denali National Park...

  10. 36 CFR 13.960 - Who determines when there is adequate snow cover?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 36 Parks, Forests, and Public Property 1 2013-07-01 2013-07-01 false Who determines when there is adequate snow cover? 13.960 Section 13.960 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Denali National Park...

  11. Human milk feeding supports adequate growth in infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Despite current nutritional strategies, premature infants remain at high risk for extrauterine growth restriction. The use of an exclusive human milk-based diet is associated with decreased incidence of necrotizing enterocolitis (NEC), but concerns exist about infants achieving adequate growth. The ...

  12. Adequate Yearly Progress for Students with Emotional and Behavioral Disorders through Research-Based Practices

    ERIC Educational Resources Information Center

    Vannest, Kimberly J.; Temple-Harvey, Kimberly K.; Mason, Benjamin A.

    2009-01-01

    Because schools are held accountable for the academic performance of all students, it is important to focus on academics and the need for effective teaching practices. Adequate yearly progress, a method of accountability that is part of the No Child Left Behind Act (2001), profoundly affects the education of students who have emotional and…

  13. Influenza 2005-2006: vaccine supplies adequate, but bird flu looms.

    PubMed

    Mossad, Sherif B

    2005-11-01

    Influenza vaccine supplies appear to be adequate for the 2005-2006 season, though delivery has been somewhat delayed. However, in the event of a pandemic of avian flu-considered inevitable by most experts, although no one knows when it will happen-the United States would be woefully unprepared.

  14. How Much and What Kind? Identifying an Adequate Technology Infrastructure for Early Childhood Education. Policy Brief

    ERIC Educational Resources Information Center

    Daugherty, Lindsay; Dossani, Rafiq; Johnson, Erin-Elizabeth; Wright, Cameron

    2014-01-01

    To realize the potential benefits of technology use in early childhood education (ECE), and to ensure that technology can help to address the digital divide, providers, families of young children, and young children themselves must have access to an adequate technology infrastructure. The goals for technology use in ECE that a technology…

  15. Nutritional screening in surgical patients.

    PubMed

    Thompson, J S; Burrough, C A; Green, J L; Brown, G L

    1984-03-01

    Routine nutritional screening of patients admitted to the surgical services confirms a substantial prevalence of malnutrition. Identification of the malnourished patient and the patient who is likely to become malnourished should be done as early as possible in the hospital stay and usually requires only simple, readily available parameters. Nutritional screening is only the first step in the optimal nutritional management of surgical patients. This information should be used to determine the need for further nutritional assessment, the appropriate consultation, and nutritional therapy.

  16. Innovation in pediatric surgical education.

    PubMed

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

  17. Surgical Treatment for Falcotentorial Meningiomas

    PubMed Central

    Hong, Chang Ki; Hong, Je Beom; Park, Hunho; Moon, Ju Hyung; Chang, Jong Hee; Lee, Kyu Sung

    2016-01-01

    Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment. In this study, we describe our surgical strategy for falcotentorial meningiomas and provide a review of our experience. PMID:27189300

  18. Aesthetic Surgical Crown Lengthening Procedure

    PubMed Central

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A.; Shibli, Jamil A.; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. PMID:26609452

  19. Intermittent exotropia: Surgical treatment strategies

    PubMed Central

    Kelkar, Jai Aditya; Gopal, Santhan; Shah, Rachana B; Kelkar, Aditya S

    2015-01-01

    Surgical management of intermittent exotropias (IXTs) is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered. PMID:26458472

  20. Surgical exposures of the hand.

    PubMed

    Watt, Andrew J; Chung, Kevin C

    2014-11-01

    Surgical approaches to the hand are commonly executed in the treatment of fractures, ligament injuries, and less commonly in the resection of bony tumors. Careful design and execution of these surgical approaches translates into superior functional and aesthetic outcomes. We have provided a thorough review of commonly used approaches to the hand by evaluating each of these approaches in the context of core principles including safety, versatility, preservation of stability, and aesthetic outcomes.

  1. Surgical mortality score: risk management tool for auditing surgical performance.

    PubMed

    Hadjianastassiou, Vassilis G; Tekkis, Paris P; Poloniecki, Jan D; Gavalas, Manolis C; Goldhill, David R

    2004-02-01

    Existing methods of risk adjustment in surgical audit are complex and costly. The present study aimed to develop a simple risk stratification score for mortality and a robust audit tool using the existing resources of the hospital Patient Administration System (PAS) database. This was an observational study for all patients undergoing surgical procedures over a two-year period, at a London university hospital. Logistic regression analysis was used to determine predictive factors of in-hospital mortality, the study outcome. Odds ratios were used as weights in the derivation of a simple risk-stratification model-the Surgical Mortality Score (SMS). Observed-to-expected mortality risk ratios were calculated for application of the SMS model in surgical audit. There were 11,089 eligible cases, under five surgical specialties (maxillofacial, orthopedic, renal transplant/dialysis, general, and neurosurgery). Incomplete data were 3.7% of the total, with no evidence of systematic underreporting. The SMS model was well calibrated [Hosmer-Lemeshow C-statistic: development set (3.432, p = 0.33), validation set (6.359, p = 0.10) with a high discriminant ability (ROC areas: development set [0.837, S.E.=0.013] validation set [0.816, S.E. = 0.016]). Subgroup analyses confirmed that the model can be used by the individual specialties for both elective and emergency cases. The SMS is an accurate risk- stratification model derived from existing database resources. It is simple to apply as a risk-management, screening tool to detect aberrations from expected surgical outcomes and to assist in surgical audit.

  2. Crustal structure of the Nova Scotia margin and implications for the Moroccan margin conjugate

    NASA Astrophysics Data System (ADS)

    Wu, Y.; Louden, K. E.; Jackson, R.; Dehler, S.; Funck, T.

    2003-04-01

    The Nova Scotia margin is located at a transition from volcanic margins in the south to non-volcanic margins in the north along the Eastern Atlantic continental margin system. South of the Nova Scotia margin, seaward dipping reflections (SDR) and a high-velocity lower crustal layer are observed across the ocean-continent transition (OCT), indicative of volcanic margins. North of the Nova Scotia margin, no SDR is observed and thin crust overlies serpentinized mantle across the OCT. Along the Nova Scotia margin, an SDR sequence is observed but only on the southern-most part neighboring Georges Bank. The East Coast Magnetic Anomaly, possibly related to an igneous wedge, extends further to the north but disappears south of the Scotian Basin. In order to understand the crustal structure of this transition from volcanic to non-volcanic margin, three wide-angle seismic reflection/refraction (WAR/R) profiles were acquired across the full width of the Nova Scotia margin in 2001, to delineate the crustal features from continental crust to oceanic crust. The northern profile (Line 1) crosses the Scotian Basin and coincides with existing multi-channel seismic reflection (MCS) profile 89-1; the middle profile (Line 2) crosses the Lahave Platform and coincides with MCS profiles 88-1 and 88-1a; and the southern profile (Line 3) crosses the southwestern part of the margin. Preliminary results for the middle WAR/R profile indicate that serpentinized mantle is observed below the OCT, possibly overlain by thin oceanic crust. Oceanic crust is about 6 km thick, 1-2 km thicker than that of the northern profile. This indicates increasing volcanism and magma generation from the northern to the southern parts of the margin. WAR/R profiles were collected across the conjugate NW-Moroccan margin in 2001, one of which is 60 km to the north of Line 1 in the plate reconstruction at the time of rifting. Similar amounts of crustal extension and widths of transitional crust are shown along these

  3. Reconstructing Rodinia by Fitting Neoproterozoic Continental Margins

    USGS Publications Warehouse

    Stewart, John H.

    2009-01-01

    Reconstructions of Phanerozoic tectonic plates can be closely constrained by lithologic correlations across conjugate margins by paleontologic information, by correlation of orogenic belts, by paleomagnetic location of continents, and by ocean floor magmatic stripes. In contrast, Proterozoic reconstructions are hindered by the lack of some of these tools or the lack of their precision. To overcome some of these difficulties, this report focuses on a different method of reconstruction, namely the use of the shape of continents to assemble the supercontinent of Rodinia, much like a jigsaw puzzle. Compared to the vast amount of information available for Phanerozoic systems, such a limited approach for Proterozoic rocks, may seem suspect. However, using the assembly of the southern continents (South America, Africa, India, Arabia, Antarctica, and Australia) as an example, a very tight fit of the continents is apparent and illustrates the power of the jigsaw puzzle method. This report focuses on Neoproterozoic rocks, which are shown on two new detailed geologic maps that constitute the backbone of the study. The report also describes the Neoproterozoic, but younger or older rocks are not discussed or not discussed in detail. The Neoproterozoic continents and continental margins are identified based on the distribution of continental-margin sedimentary and magmatic rocks that define the break-up margins of Rodinia. These Neoproterozoic continental exposures, as well as critical Neo- and Meso-Neoproterozoic tectonic features shown on the two new map compilations, are used to reconstruct the Mesoproterozoic supercontinent of Rodinia. This approach differs from the common approach of using fold belts to define structural features deemed important in the Rodinian reconstruction. Fold belts are difficult to date, and many are significantly younger than the time frame considered here (1,200 to 850 Ma). Identifying Neoproterozoic continental margins, which are primarily

  4. The synrift subsidence deficit at rifted margins

    NASA Astrophysics Data System (ADS)

    Reston, T.

    2009-04-01

    Across rifted margins, the prerift continental crust thins from ~ 30 km, reaching zero at the continent-ocean transition (COT) beyond which either oceanic crust or unroofed mantle forms top basement. As a result of the crustal thinning, considerable subsidence is both expected and observed. However at several margins, subsidence appears to have occurred largely after rather than during rifting. Examples of such behaviour described in the literature include the West Iberia margin, the salt basins of the South Atlantic, and the Exmouth Plateau margin. This synrift subsidence deficit can be explained by crustal depth-dependent stretching, in which much of the crust is withdrawn after the end of rifting, but considerable problems arise with this model. They can however also be explained at magma-rich margins by thermal uplift during rifting, the addition of igneous intrusions to the lithosphere during rifting, and the partial depletion of the mantle. At magma-poor margins, mantle serpentinization has a similar effect, although as serpentinization can only occur once the entire curst has become brittle, this is likely to be important only at high degrees of stretching. An alternative explanation may be the influx of asthenosphere warmer than the relatively cool sublithospheric mantle observed beneath several continents and which is one explanation for the lack of melt at many rifted margins. These different models would thus imply some modification to the McKenzie model for lithospheric stretching, arising because of the geodynamic processes accompanying continental breakup. But it is also possible that synrift subsidence has been systematically underestimated if local water level was substantially below global sealevel. The presence of thick evaporites at many rifted margins indicates that this was true at the end of rifting. As rifting leading to continental breakup by definition occurs within a continent, it may be expected that the rift initially develops isolated

  5. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report.

    PubMed

    Gollapalli, Rajesh Babu; Naiman, Ana Nusa; Merry, David

    2015-07-01

    Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

  6. Lithospheric growth at margins of cratons

    NASA Astrophysics Data System (ADS)

    Snyder, D. B.

    2002-09-01

    Deep seismic reflection profiles collected across Proterozoic-Archean margins are now sufficiently numerous to formulate a consistent hypothesis of how continental nuclei grow laterally to form cratonic shields. This picture is made possible both because the length of these regional profiles spans all the tectonic elements of an orogen on a particular cratonic margin and because of their great depth range. Key transects studied include the LITHOPROBE SNORCLE 1 transect and the BABEL survey, crossing the Slave and Baltic craton margins, respectively. In most cases, the older (Archean) block appears to form a wedge of uppermost mantle rock embedded into the more juvenile (Proterozoic) block by as much as 100-200 km at uppermost mantle depths and Archean lithosphere is therefore more laterally extensive at depth than at the surface. Particularly bright reflections along the Moho are cited as evidence of shear strain within a weak, low-viscosity lower crustal channel that lies along the irregular top of the indenting wedge. The bottom of the wedge is an underthrust/subduction zone, and associated late reversal in subduction polarity beneath the craton margin emerges as a common characteristic of these margins although related arc magmatism may be minor.

  7. Theory of margination in confined multicomponent suspensions

    NASA Astrophysics Data System (ADS)

    Henriquez Rivera, Rafael; Sinha, Kushal; Graham, Michael

    2015-11-01

    In blood flow, leukocytes and platelets tend to segregate near the vessel walls; this is known as margination. Margination of leukocytes and platelets is important in physiological processes, medical diagnostics and drug delivery. A mechanistic theory is developed to describe flow-induced segregation in confined multicomponent suspensions of deformable particles such as blood. The theory captures the essential features of margination by describing it in terms of two key competing processes in these systems at low Reynolds number: wall-induced migration and hydrodynamic pair collisions. The theory also includes the effect of physical properties of the deformable particles and molecular diffusion. Several regimes of segregation are identified, depending on the value of a ``margination parameter'' M. Moreover, there is a critical value of M below which a sharp ``drainage transition'' occurs: one component is completely depleted from the bulk flow to the vicinity of the walls. Direct hydrodynamic simulations also display this transition in suspensions where the components differ in size or flexibility. The developed mechanistic theory leads to substantial insight into the origins of margination and will help in guiding development of new technologies involving multicomponent suspensions. This work was supported by NSF grant CBET-1436082.

  8. Passive margins: A model of formation

    NASA Astrophysics Data System (ADS)

    Le Pichon, Xavier; Sibuet, Jean-Claude

    1981-05-01

    The stretching model of McKenzie is applied to the formation of passive continental margins, assuming local isostatic equilibrium. We present the quantitative implications of the model; we then discuss its fit to the IPOD data on the Armorican and Galicia continental margins of the northeast Atlantic. The amount of brittle stretching observed in the upper 8 km of the prestretched continental crust reaches a maximum value of about 3. This large amount of thinning is comparable to the thinning of the whole continental crust observed by seismic refraction measurements and required by the model for the whole lithosphere. This agreement suggests that the simple stretching model is a good first approximation to the actual physical process of formation of the margin. It is thus possible to compute simply the thermal evolution of the margin and to discuss its petrological consequences. It is also possible to obtain a quantitative reconstruction of the edge of the continent prior to breakup. Finally, the large slope of the base of the lithosphere during the formation of the margin results in a force similar but opposite to the `ridge-push' force acting on accreting plate boundaries.

  9. Abrupt plate accelerations shape rifted continental margins.

    PubMed

    Brune, Sascha; Williams, Simon E; Butterworth, Nathaniel P; Müller, R Dietmar

    2016-08-11

    Rifted margins are formed by persistent stretching of continental lithosphere until breakup is achieved. It is well known that strain-rate-dependent processes control rift evolution, yet quantified extension histories of Earth's major passive margins have become available only recently. Here we investigate rift kinematics globally by applying a new geotectonic analysis technique to revised global plate reconstructions. We find that rifted margins feature an initial, slow rift phase (less than ten millimetres per year, full rate) and that an abrupt increase of plate divergence introduces a fast rift phase. Plate acceleration takes place before continental rupture and considerable margin area is created during each phase. We reproduce the rapid transition from slow to fast extension using analytical and numerical modelling with constant force boundary conditions. The extension models suggest that the two-phase velocity behaviour is caused by a rift-intrinsic strength--velocity feedback, which can be robustly inferred for diverse lithosphere configurations and rheologies. Our results explain differences between proximal and distal margin areas and demonstrate that abrupt plate acceleration during continental rifting is controlled by the nonlinear decay of the resistive rift strength force. This mechanism provides an explanation for several previously unexplained rapid absolute plate motion changes, offering new insights into the balance of plate driving forces through time.

  10. Non-surgical management of erectile dysfunction.

    PubMed

    Levy, A; Crowley, T; Gingell, C

    2000-03-01

    Erectile dysfunction is a common and distressing medical condition that is now highly amenable to treatment almost irrespective of the cause. Safe, non-surgical treatments with unequivocal efficacy are psychological therapy, intracorporeal injection of vasoactive drugs, transurethral vasodilators and oral sildenafil, all of which have been reported to have a 50-70% overall response rate. Vacuum constriction devices are acceptable for some, usually older patients and oral yohimbine is thought to have marginal efficacy. Local creams to induce or enhance erectile function are currently being investigated. There is no place for androgen supplementation unless the patient is profoundly hypogonadal. Treatment of hyperprolactinaemia is very effective but is a rare cause of erectile dysfunction. As intercourse may entail an unfamiliar level of physical activity, it is sensible to ensure that the patient is able to climb a flight or two of stairs comfortably without provoking undue breathlessness or chest pain and to provide suitable advice about technique before commencing treatment. Once it is clear to the patients that erectile dysfunction can be satisfactorily overcome, the long-term use of treatments to do so tends to wane. Thus, although the prospect of effective treatment for what had been for many a distressing life sentence has the potential to place new demands on the health service, there is no evidence that restrictions on prescribing will prove economically rational.

  11. Normalized fluorescence lifetime imaging for tumor identification and margin delineation

    NASA Astrophysics Data System (ADS)

    Sherman, Adria J.; Papour, Asael; Bhargava, Siddharth; Taylor, Zach; Grundfest, Warren S.; Stafsudd, Oscar M.

    2013-03-01

    Fluorescence lifetime imaging microscopy (FLIM) is a technique that has been proven to produce quantitative and qualitative differentiation and identification of substances with good specificity and sensitivity based on lifetime extracted information. This technique has shown the ability to also differentiate between a wide range of tissue types to identify malignant from benign tissue in vivo and ex vivo. However, the complexity, long duration and effort required to generate this information has limited the adoption of these techniques in a clinical setting. Our group has developed a time-resolved imaging system (patent pending) that does not require the extraction of lifetimes or use of complex curve fitting algorithms to display the needed information. The technique, entitled Lifetime Fluorescence Imaging (LFI, or NoFYI), converts fluorescence lifetime decay information directly into visual contrast. Initial studies using Fluorescein and Rhodamine-B demonstrated the feasibility of this approach. Subsequent studies demonstrated the ability to separate collagen and elastin powders. The technique uses nanosecond pulsed UV LEDs at 375 nm for average illumination intensities of ~4.5 μW on the tissue surface with detection by a gated CCD camera. To date, we have imaged 11 surgical head and neck squamous cell carcinoma and brain cancer biopsy specimens including 5 normal and 6 malignant samples. Images at multiple wavelengths clearly demonstrate differentiation between benign and malignant tissue, which was later confirmed by histology. Contrast was obtained between fluorophores with 35 μm spatial resolution and an SNR of ~30 dB allowing us to clearly define tumor margins in these highly invasive cancers. This method is capable of providing both anatomical and chemical information for the pathologist and the surgeon. These results suggest that this technology has a possible role in identifying tumors in tissue specimens and detecting tumor margins

  12. Deep anterior lamellar keratoplasty for pellucid marginal degeneration***

    PubMed Central

    Al-Torbak, Abdullah A.

    2012-01-01

    Purpose To present the surgical outcomes of deep anterior lamellar keratoplasty (DALK) for pellucid marginal degeneration (PMD). Methods A retrospective review was performed in 16 eyes of 16 patients who underwent DALK at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between January 1, 2006 and December 30, 2009. Baring of Descemet’s membrane (DM) during DALK was achieved in 8 (50%) eyes; residual stroma was left intraoperatively in the remaining 8 (50%) eyes. The big bubble technique was performed in 10 (62.5%) eyes and manual dissection was performed in the remaining 6 (37.5%) eyes. Visual acuity (LogMAR notation), intraocular pressure, intraoperative complications and postoperative graft status were assessed. Results The mean follow up was 14.6 ± 8.2 months (range 6–35 months). The mean overall age was 31.4 ± 9.6 years (range, 19–50 years). Visual acuity increased statistically significantly from 0.9 ± 0.3 (range 0.5–1.6) preoperatively to 0.4 ± 0.2 (range 0.0–0.7) at last follow-up (p < 0.0001). There was a statistically significant improvement in postoperative sphere, cylinder, and spherical equivalent (p < 0.035, p < 0.001, and p < 0.02, respectively) compared to preoperative. Postoperative visual acuity was not statistically significantly related to gender, type of surgical technique, and baring or perforation of DM. The main graft-related complication was graft–host vascularization (2/16 eyes). Conclusion DALK reduces severe corneal astigmatism and results in good visual and refractive outcomes and is an effective alternative for patients with PMD. PMID:23964180

  13. A comparison of marginal odds ratio estimators.

    PubMed

    Loux, Travis M; Drake, Christiana; Smith-Gagen, Julie

    2017-02-01

    Uses of the propensity score to obtain estimates of causal effect have been investigated thoroughly under assumptions of linearity and additivity of exposure effect. When the outcome variable is binary relationships such as collapsibility, valid for the linear model, do not always hold. This article examines uses of the propensity score when both exposure and outcome are binary variables and the parameter of interest is the marginal odds ratio. We review stratification and matching by the propensity score when calculating the Mantel-Haenszel estimator and show that it is consistent for neither the marginal nor conditional odds ratio. We also investigate a marginal odds ratio estimator based on doubly robust estimators and summarize its performance relative to other recently proposed estimators under various conditions, including low exposure prevalence and model misspecification. Finally, we apply all estimators to a case study estimating the effect of Medicare plan type on the quality of care received by African-American breast cancer patients.

  14. [Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours].

    PubMed

    Dembinski, Rolf; Kauczok, Jens; Deisz, Robert; Pallua, Norbert; Marx, Gernot

    2012-09-01

    Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial wound care comprises topical treatment of less severely injured skin and surgical debridement of severely burned areas. The first 24 hours of intensive care are focused on calculated fluid delivery to provide stable hemodynamics and avoid progression of local edema formation. In the further course wound treatment with split-thickness skin grafts is the major aim of surgical therapy. Critical care is focused on the avoidance of complications like infections and ventilator associated lung injury. Therefore, lung-protective ventilation strategies, weaning and sedation protocols, and early enteral nutrition are important cornerstones of the treatment.

  15. Combined orthodontic-surgical approach in the treatment of impacted maxillary canines: three clinical cases

    PubMed Central

    SPUNTARELLI, M.; CECCHETTI, F.; ARCURI, L.; TESTI, D.; MELONE, P.; BIGELLI, E.; GERMANO, F.

    2015-01-01

    SUMMARY Impaction of maxillary canine is a relatively frequent orthodontic anomaly which could represent fuctional and aesthetic problems for patients. Nowadays, the conventional technique to impacted canines consists of a combined orthodontic and surgical approach, aimed to guide cuspids at the center of the alveolar ridge in a stable position and surrounded by healthy hard and soft tissues. This article presents three cases studies with different combined surgical-orthodontic approaches for the treatment of infraosseous impacted canines. An impacted maxillary canine could be guided, after adequate space is created orthodontically, to the center of the ridge through an orthodontic traction directly applied to the crown of impacted cuspid. Several surgical techniques have been proposed to expose the crown of impacted tooth. Location (buccal or palatal side) of impactation and depth influence surgical approach in order to obtain best aesthetic and functional results. PMID:27555906

  16. Performance assessment of an RFID system for automatic surgical sponge detection in a surgery room.

    PubMed

    Dinis, H; Zamith, M; Mendes, P M

    2015-01-01

    A retained surgical instrument is a frequent incident in medical surgery rooms all around the world, despite being considered an avoidable mistake. Hence, an automatic detection solution of the retained surgical instrument is desirable. In this paper, the use of millimeter waves at the 60 GHz band for surgical material RFID purposes is evaluated. An experimental procedure to assess the suitability of this frequency range for short distance communications with multiple obstacles was performed. Furthermore, an antenna suitable to be incorporated in surgical materials, such as sponges, is presented. The antenna's operation characteristics are evaluated as to determine if it is adequate for the studied application over the given frequency range, and under different operating conditions, such as varying sponge water content.

  17. Risk Informed Margins Management as part of Risk Informed Safety Margin Characterization

    SciTech Connect

    Curtis Smith

    2014-06-01

    The ability to better characterize and quantify safety margin is important to improved decision making about Light Water Reactor (LWR) design, operation, and plant life extension. A systematic approach to characterization of safety margins and the subsequent margin management options represents a vital input to the licensee and regulatory analysis and decision making that will be involved. In addition, as research and development in the LWR Sustainability (LWRS) Program and other collaborative efforts yield new data, sensors, and improved scientific understanding of physical processes that govern the aging and degradation of plant SSCs needs and opportunities to better optimize plant safety and performance will become known. To support decision making related to economics, readability, and safety, the Risk Informed Safety Margin Characterization (RISMC) Pathway provides methods and tools that enable mitigation options known as risk informed margins management (RIMM) strategies.

  18. Subglacial hydrology and ice stream margin locations

    NASA Astrophysics Data System (ADS)

    Perol, Thibaut; Rice, James R.; Platt, John D.; Suckale, Jenny

    2015-07-01

    Fast-flowing ice streams in West Antarctica are separated from the nearly stagnant ice in the adjacent ridge by zones of highly localized deformation known as shear margins. It is presently uncertain what mechanisms control the location of shear margins and possibly allow them to migrate. In this paper we show how subglacial hydrological processes can select the shear margin location, leading to a smooth transition from a slipping to a locked bed at the base of an ice stream. Our study uses a two-dimensional thermomechanical model in a cross section perpendicular to the direction of flow. We confirm that the intense straining at the shear margins can generate large temperate regions within the deforming ice. Assuming that the melt generated in the temperate ice collects in a drainage channel at the base of the margin, we show that a channel locally decreases the pore pressure in the subglacial till. Therefore, the basal shear strength just outside the channel, assuming a Coulomb-plastic rheology, can be substantially higher than that inferred under the majority of the stream. Results show that the additional basal resistance produced by the channel lowers the stress concentrated on the locked portion of the bed. Matching the model to surface velocity data, we find that shear margins are stable when the slipping-to-locked bed transition occurs less than 500 m away from a channel operating at an effective pressure of 200 kPa and for a hydraulic transmissivity equivalent to a basal water film of order 0.2 mm thickness.

  19. The effect of wide resection margin in patients with intrahepatic cholangiocarcinoma

    PubMed Central

    Ma, Ka Wing; Cheung, Tan To; She, Wong Hoi; Chok, Kenneth S.H.; Chan, Albert Chi Yan; Ng, Irene Oi Lin; Chan, See Ching; Lo, Chung Mau

    2016-01-01

    Abstract Introduction: Prognosis of intrahepatic cholangiocarcinoma (ICC) remained poor despite the multitude advancement of medical care. Resection margin status is one of the few modifiable factors that a surgeon could possibly manipulate to alter the disease outcome. However, the significance of margin status and margin width is still controversial. This study serves to further elucidate the role of them. Method: This is a retrospective cohort from the Queen Mary Hospital, The University of Hong Kong. Consecutive patients diagnosed to have ICC and with surgical resection performed in curative intent were retrieved, while patients with cholangiohepatocellular carcinoma, Klaskin tumor, tumor of extrahepatic bile duct, and uncertain tumor pathology were excluded. Results: From 1991 to 2013, there were 107 patients underwent hepatectomy for ICC. Gender predilection was not observed with 58 males and 49 females, median age of the patients was 61. The median tumor size was 6 cm and most of them (43%) were moderately differentiated adenocarcinoma. Clear resection margin were achieved in 95 patients (88.8%) and the median margin width was 0.5 cm. The hospital length of stay and operative mortality were 11 days and 3%, respectively. The disease-free survival and overall survival were 17.5 and 25.1 months, respectively. Multivariate analysis showed that margin width was an independent factor associated with disease-free survival (P = 0.015, 95% confidence interval [CI] 0.4–0.9). Subgroup analysis in patients with solitary tumor showed that margin width is an independent factor affecting overall survival (P = 0.048; odds ratio: 0.577; 95% CI: 0.334–0.996). Discriminant analysis showed that the overall survival increased from 36 to 185 months when margin width was >0.9 cm (P = 0.025) in patients with solitary tumor. Conclusion: Aggressive resection to achieve resection margin of at least 1 cm maximizes chance of cure in patients with early ICC. PMID:27428200

  20. Max-Margin-Based Discriminative Feature Learning.

    PubMed

    Li, Changsheng; Liu, Qingshan; Dong, Weishan; Wei, Fan; Zhang, Xin; Yang, Lin

    2016-12-01

    In this brief, we propose a new max-margin-based discriminative feature learning method. In particular, we aim at learning a low-dimensional feature representation, so as to maximize the global margin of the data and make the samples from the same class as close as possible. In order to enhance the robustness to noise, we leverage a regularization term to make the transformation matrix sparse in rows. In addition, we further learn and leverage the correlations among multiple categories for assisting in learning discriminative features. The experimental results demonstrate the power of the proposed method against the related state-of-the-art methods.

  1. Possible novel agents in marginal zone lymphoma.

    PubMed

    Zinzani, Pier Luigi; Broccoli, Alessandro

    Efficacy, safety and mechanisms of action of novel agents in marginal zone lymphoma patients, both with a nodal and extranodal presentation, are reviewed. Data on lenalidomide, bortezomib and (90)yttrium-ibrutumomab tiuxetan are obtained from trials specifically designed for patients affected by marginal zone lymphoma and with various disease presentations. The role of targeted agents, such as obinutuzumab, ibrutinib and idelalisib, and of some very new drugs (venetoclax, copanlisib, ublituximab and TGR-1202) is also discussed, taking into account the most relevant experiences in patients with indolent non-Hodgkin's lymphomas. A glance to some possible drug combinations will also be provided, along with an update of the most relevant ongoing trials.

  2. Monitoring the critically ill surgical patient.

    PubMed Central

    Holliday, R L; Doris, P J

    1979-01-01

    Critically ill surgical patients account for approximately half the patients in an active multidisciplinary critical care unit. Hypovolemia and sepsis are common in such patients and affect a number of organ systems. Monitoring these systems provides therapeutically relevant information that may decrease morbidity and improve patient survival. Circulatory hemodynamics may be assessed by direct measurement of the arterial blood pressure, central venous and pulmonary artery pressure monitoring and cardiac output determination; the data thus obtained are valuable in guiding fluid replacement in the hypovolemic individual. The respiratory status may be assessed by bedside spirometry and measurement of arterial blood gas tensions to gauge pulmonary function and the need for assisted ventilation. Renal dysfunction is common in such patients; careful analysis of both urine and blood may identify prerenal as opposed to renal and postrenal factors. Monitoring of the gastrointestinal tract, especially for hemorrhage, is important. Finally, careful attention to nutritional status and provision of adequate protein and energy intake by mouth or by vein is a vital component of the optimal care of these patients. PMID:115566

  3. 17 CFR 242.405 - Withdrawal of margin.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer Margin Requirements for Security Futures § 242.405 Withdrawal of margin. (a) By the customer. Except as otherwise... account after such withdrawal is sufficient to satisfy the required margin for the security futures...

  4. Wide-field optical coherence micro-elastography for intraoperative assessment of human breast cancer margins

    PubMed Central

    Allen, Wes M.; Chin, Lixin; Wijesinghe, Philip; Kirk, Rodney W.; Latham, Bruce; Sampson, David D.; Saunders, Christobel M.; Kennedy, Brendan F.

    2016-01-01

    Incomplete excision of malignant tissue is a major issue in breast-conserving surgery, with typically 20 - 30% of cases requiring a second surgical procedure arising from postoperative detection of an involved margin. We report advances in the development of a new intraoperative tool, optical coherence micro-elastography, for the assessment of tumor margins on the micro-scale. We demonstrate an important step by conducting whole specimen imaging in intraoperative time frames with a wide-field scanning system acquiring mosaicked elastograms with overall dimensions of ~50 × 50 mm, large enough to image an entire face of most lumpectomy specimens. This capability is enabled by a wide-aperture annular actuator with an internal diameter of 65 mm. We demonstrate feasibility by presenting elastograms recorded from freshly excised human breast tissue, including from a mastectomy, lumpectomies and a cavity shaving. PMID:27867721

  5. The use of marginal-suboptimal donor organs: a practical solution for organ shortage.

    PubMed

    Abouna, George M

    2004-01-01

    The demand for organ transplantation has been rapidly increasing as a result of rising incidence of end-stage organ failure while the supply of cadaver organs from "ideal" or optimal donors has remained low and inadequate to meet the increasing demand. Yet many so called "marginal" or "suboptimal" organs have been discarded by many centers when many patients die each day while on the waiting list. In this review important data from our experience and that of several other centers have confirmed that using such marginal organs can provide a viable solution to organ shortage. Such organs include those from donors > 55 years, children < 5 years, diabetics, non-heart beating cadavers, and organs with extended preservation. Such organs can be successfully used with appropriate surgical techniques and immunosuppression protocols and the supply of donor organs can be increased by 25% to 30%.

  6. The concept of adequate causation and Max Weber's comparative sociology of religion.

    PubMed

    Buss, A

    1999-06-01

    Max Weber's The Protestant Ethic and the Spirit of Capitalism, studied in isolation, shows mainly an elective affinity or an adequacy on the level of meaning between the Protestant ethic and the 'spirit' of capitalism. Here it is suggested that Weber's subsequent essays on 'The Economic Ethics of World Religions' are the result of his opinion that adequacy on the level of meaning needs and can be verified by causal adequacy. After some introductory remarks, particularly on elective affinity, the paper tries to develop the concept of adequate causation and the related concept of objective possibility on the basis of the work of v. Kries on whom Weber heavily relied. In the second part, this concept is used to show how the study of the economic ethics of India, China, Rome and orthodox Russia can support the thesis that the 'spirit' of capitalism, although it may not have been caused by the Protestant ethic, was perhaps adequately caused by it.

  7. Ensuring smokers are adequately informed: reflections on consumer rights, manufacturer responsibilities, and policy implications

    PubMed Central

    Chapman, S; Liberman, J

    2005-01-01

    The right to information is a fundamental consumer value. Following the advent of health warnings, the tobacco industry has repeatedly asserted that smokers are fully informed of the risks they take, while evidence demonstrates widespread superficial levels of awareness and understanding. There remains much that tobacco companies could do to fulfil their responsibilities to inform smokers. We explore issues involved in the meaning of "adequately informed" smoking and discuss some of the key policy and regulatory implications. We use the idea of a smoker licensing scheme—under which it would be illegal to sell to smokers who had not demonstrated an adequate level of awareness—as a device to explore some of these issues. We also explore some of the difficulties that addiction poses for the notion that smokers might ever voluntarily assume the risks of smoking. PMID:16046703

  8. A computational model for estimating tumor margins in complementary tactile and 3D ultrasound images

    NASA Astrophysics Data System (ADS)

    Shamsil, Arefin; Escoto, Abelardo; Naish, Michael D.; Patel, Rajni V.

    2016-03-01

    Conventional surgical methods are effective for treating lung tumors; however, they impose high trauma and pain to patients. Minimally invasive surgery is a safer alternative as smaller incisions are required to reach the lung; however, it is challenging due to inadequate intraoperative tumor localization. To address this issue, a mechatronic palpation device was developed that incorporates tactile and ultrasound sensors capable of acquiring surface and cross-sectional images of palpated tissue. Initial work focused on tactile image segmentation and fusion of position-tracked tactile images, resulting in a reconstruction of the palpated surface to compute the spatial locations of underlying tumors. This paper presents a computational model capable of analyzing orthogonally-paired tactile and ultrasound images to compute the surface circumference and depth margins of a tumor. The framework also integrates an error compensation technique and an algebraic model to align all of the image pairs and to estimate the tumor depths within the tracked thickness of a palpated tissue. For validation, an ex vivo experimental study was conducted involving the complete palpation of 11 porcine liver tissues injected with iodine-agar tumors of varying sizes and shapes. The resulting tactile and ultrasound images were then processed using the proposed model to compute the tumor margins and compare them to fluoroscopy based physical measurements. The results show a good negative correlation (r = -0.783, p = 0.004) between the tumor surface margins and a good positive correlation (r = 0.743, p = 0.009) between the tumor depth margins.

  9. Back to Basics: Surgical Skin Antisepsis.

    PubMed

    Spruce, Lisa

    2016-01-01

    The fundamental basis for preventing surgical site infections is the antiseptic preparation of the skin at the surgical site. All perioperative nurses must learn this skill. The goal of surgical skin antisepsis, frequently referred to as prepping the skin, is to remove soil and transient (ie, temporary) microorganisms living on the skin that could pose a risk for surgical site infections. This Back to Basics article examines the origin of surgical skin antisepsis and the steps perioperative nurses should take to provide the patient with an aseptic surgical site before any surgical or other invasive procedure.

  10. Surgical Pearl on Reconstructing Surgical Defects of the Nasal Tip

    PubMed Central

    César, Artur; Barros, Ana; Santos, Paulo; Azevedo, Filomena

    2016-01-01

    Repairing surgical defects of the nasal tip is challenging, mainly because of the lack of freely mobile skin available peripherally. The Peng flap is a one-stage cutaneous flap that circumvents this difficulty by recruiting skin from the nasal dorsum and sidewall regions. The design produces a tridimensional shape perfectly adapted to the configuration of the nasal tip and allows for an inconspicuous closure of the defect. We present three examples of full-thickness skin defects involving the nasal tip, reconstructed using a modified version of the Peng flap, and present the experience at our department with this surgical technique. PMID:27942370

  11. Myth 19: Is Advanced Placement an Adequate Program for Gifted Students?

    ERIC Educational Resources Information Center

    Gallagher, Shelagh A.

    2009-01-01

    Is it a myth that Advanced Placement (AP) is an adequate program for gifted students? AP is so covered with myths and assumptions that it is hard to get a clear view of the issues. In this article, the author finds the answer about AP by looking at current realties. First, AP is hard for gifted students to avoid. Second, AP never was a program…

  12. Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children?

    PubMed Central

    Godrich, Stephanie L.; Lo, Johnny; Davies, Christina R.; Darby, Jill; Devine, Amanda

    2017-01-01

    Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD) (i.e., food availability, access, and utilisation dimensions) and adequate vegetable consumption among children living in regional and remote Western Australia (WA). Caregiver-child dyads (n = 256) living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23). A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria (p ≤ 0.20) for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed (p = 0.007), promotion (p = 0.017), location of food outlets (p = 0.027), and price (p = 0.043). Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned) are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing. PMID:28054955

  13. Surgical treatment for male prolactinoma

    PubMed Central

    Song, Yi-Jun; Chen, Mei-Ting; Lian, Wei; Xing, Bing; Yao, Yong; Feng, Ming; Wang, Ren-Zhi

    2017-01-01

    Abstract A total of 184 cases of surgically treated male prolactinoma were analyzed retrospectively to summarize the outcome of this surgical intervention. We analyzed the general characteristics, clinical manifestations, hormone levels, imaging features, preoperative treatments, surgical outcomes, pathology results, and follow-up records for all included patients. The most common clinical manifestations included sexual dysfunction (47.4%), headache (55.9%), and visual disturbance (46.7%). Serum prolactin levels ranged from 150 to 204,952 ng/mL. Tumor size varied from 6 to 70 mm. Pituitary adenomas grew in a parasellar pattern with visual deficits occurring 40.7% of the time. After surgical therapy, 88.6% of patients achieved symptom relief, and 98.4% experienced an immediate postoperative decline in prolactin level. Fifty-seven patients (31.0%) achieved initial remission, and 26 patients (45.6%) experienced recurrence. Hence, our results suggest that in male prolactinoma characterized by a large pituitary diameter and high serum prolactin level, tumor size predicts the degree of gross resection. The prognostic predictors included preoperative tumor growth pattern and Ki-67 index. Citation: Yi-jun S, Mei-ting C, Wei L, Bing X, Yong Y, Ming F, Ren-zhi W. (2016) Surgical treatment for male prolactinoma: a retrospective study of 184 cases PMID:28079813

  14. On the Evolution of Glaciated Continental Margins

    NASA Astrophysics Data System (ADS)

    Sverre Laberg, Jan; Rydningen, Tom Arne; Safronova, Polina A.; Forwick, Matthias

    2016-04-01

    Glaciated continental margins, continental margins where a grounded ice sheet repeatedly has been at or near the shelf break, are found at both northern and southern high-latitudes. Their evolution are in several aspects different from their low-latitude counterparts where eustatic sea-level variations possess a fundamental control on their evolution and where fluvial systems provide the main sediment input. From studies of the Norwegian - Barents Sea - Svalbard and NE Greenland continental margins we propose the following factors as the main control on the evolution of glaciated continental margins: 1) Pre-glacial relief controlling the accommodation space, 2) Ice sheet glaciology including the location of fast-flowing ice streams where source area morphology exerts a fundamental control, 3) Composition of the glacigenic sediments where the clay content in previous studies have been found to be important, and 4) Sea-level controlled both by eustacy and isostacy. From three case studies, 1) the western Barents Sea, 2) part of the North Norwegian (Troms), and 3) the Mid-Norwegian margin, the influence on these factors for the sea-floor morphology, sedimentary processes of the continental slope - deep sea and continental margin architecture are discussed. The pre-glacial relief of the mid-Norwegian and Troms margins relates to the onset of rifting and plate break-up from the early Cenozoic while for the SW Barents Sea, plate shear was followed by rifting. A wide zone of extended continental crust occurs offshore mid-Norway while this zone is much narrower offshore Troms leading to a more pronounced pre-glacial relief. Regarding sediment delivery and ice sheet glaciology the western Barents Sea exemplifies very high sediment input corresponding to an estimated average erosion of the source area of ~0.4 mm/yr (SW Barents Sea), much of which is related to subglacial erosion of Mesozoic - Cenozoic sedimentary rocks from large paleo-ice streams. The mid-Norwegian margin

  15. Global risk assessment of aflatoxins in maize and peanuts: are regulatory standards adequately protective?

    PubMed

    Wu, Felicia; Stacy, Shaina L; Kensler, Thomas W

    2013-09-01

    The aflatoxins are a group of fungal metabolites that contaminate a variety of staple crops, including maize and peanuts, and cause an array of acute and chronic human health effects. Aflatoxin B1 in particular is a potent liver carcinogen, and hepatocellular carcinoma (HCC) risk is multiplicatively higher for individuals exposed to both aflatoxin and chronic infection with hepatitis B virus (HBV). In this work, we sought to answer the question: do current aflatoxin regulatory standards around the world adequately protect human health? Depending upon the level of protection desired, the answer to this question varies. Currently, most nations have a maximum tolerable level of total aflatoxins in maize and peanuts ranging from 4 to 20ng/g. If the level of protection desired is that aflatoxin exposures would not increase lifetime HCC risk by more than 1 in 100,000 cases in the population, then most current regulatory standards are not adequately protective even if enforced, especially in low-income countries where large amounts of maize and peanuts are consumed and HBV prevalence is high. At the protection level of 1 in 10,000 lifetime HCC cases in the population, however, almost all aflatoxin regulations worldwide are adequately protective, with the exception of several nations in Africa and Latin America.

  16. Global Risk Assessment of Aflatoxins in Maize and Peanuts: Are Regulatory Standards Adequately Protective?

    PubMed Central

    Wu, Felicia

    2013-01-01

    The aflatoxins are a group of fungal metabolites that contaminate a variety of staple crops, including maize and peanuts, and cause an array of acute and chronic human health effects. Aflatoxin B1 in particular is a potent liver carcinogen, and hepatocellular carcinoma (HCC) risk is multiplicatively higher for individuals exposed to both aflatoxin and chronic infection with hepatitis B virus (HBV). In this work, we sought to answer the question: do current aflatoxin regulatory standards around the world adequately protect human health? Depending upon the level of protection desired, the answer to this question varies. Currently, most nations have a maximum tolerable level of total aflatoxins in maize and peanuts ranging from 4 to 20ng/g. If the level of protection desired is that aflatoxin exposures would not increase lifetime HCC risk by more than 1 in 100,000 cases in the population, then most current regulatory standards are not adequately protective even if enforced, especially in low-income countries where large amounts of maize and peanuts are consumed and HBV prevalence is high. At the protection level of 1 in 10,000 lifetime HCC cases in the population, however, almost all aflatoxin regulations worldwide are adequately protective, with the exception of several nations in Africa and Latin America. PMID:23761295

  17. Oil & gas in the 1990`s and beyond: Adequate supplies, growing demand, flat prices

    SciTech Connect

    Kennedy, J.L.

    1995-06-01

    Long term petroleum market fundamentals are clear: supplies are adequate and world demand will continue to grow steadily. Adequate supplies insure that prices will not increase significantly, on average, till the end of the 1990`s, probably much beyond. Despite plentiful supply and modest price increases, there will be peaks and valleys in the price graph as productive capacity is used up, then expanded. Tens of billions of dollars will be needed over the next decade to expand producing capacity. World oil consumption will increase at about 1.5% per year, at least for the next decade. Demand in Asia and Latin America will grow several times faster than this average world rate. World natural gas demand will grow at more then 2% per year well past 2000. Oil and gas companies around the world have changed the way they operate to survive the market realities of the 1990`s. restructuring, outsourcing, and partnering will continue as increasing costs and flat prices squeeze profits. Energy use patterns will change. Fuel and other product specifications will change. Market shares of oil and gas will shift. But opportunities abound in this new market environment. Growing markets always provide opportunities. Technology has helped operators dramatically lower finding, developing, and producing costs. The petroleum age is far from being over. Growing markets, adequate supply, affordable products, and a 60% market share. Those are the signs of an industry with a bright future.

  18. A test for adequate wastewater treatment based on glutathione S transferase isoenzyme profile.

    PubMed

    Grammou, A; Samaras, P; Papadimitriou, C; Papadopoulos, A I

    2013-04-01

    Discharge to the environment of treated or non-treated municipal wastewater imposes several threats to coastal and estuarine ecosystems which are difficult to assess. In our study we evaluate the use of the isoenzyme profile of glutathione S transferase (GST) in combination with the kinetic characteristics of the whole enzyme and of heme peroxidase, as a test of adequate treatment of municipal wastewater. For this reason, Artemia nauplii were incubated in artificial seawater prepared by wastewater samples, such as secondary municipal effluents produced by a conventional activated sludge unit and advanced treated effluents produced by the employment of coagulation, activated carbon adsorption and chlorination as single processes or as combined ones. Characteristic changes of the isoenzyme pattern and the enzymes' kinetic properties were caused by chlorinated secondary municipal effluent or by secondary non-chlorinated effluent. Advanced treatment by combination of coagulation and/or carbon adsorption resulted to less prominent changes, suggesting more adequate treatment. Our results suggest that GST isoenzyme profile in combination with the kinetic properties of the total enzyme family is a sensitive test for the evaluation of the adequateness of the treatment of reclaimed wastewater and the reduction of potentially harmful compounds. Potentially, it may offer a 'fingerprint' characteristic of a particular effluent and probably of the treatment level it has been subjected.

  19. Does the method of resection affect the margins of tumours in the oral cavity? Prospective controlled study in pigs.

    PubMed

    George, Katherine S; Hyde, Nicholas C; Wilson, Philip; Smith, Graham I

    2013-10-01

    It is important to obtain tumour-free resection margins in patients with oral cancer. Pathological processing is known to cause tissue to shrink, which affects the reported margins, and it is postulated that the method of resection also has an effect. We marked standardised simulated lesions on the tongues of 15 live anaesthetised pigs and divided each lesion into four equal sections. They were resected each with a margin of 10mm using cutting diathermy, coagulative diathermy, Harmonic scalpel, and a conventional scalpel. After processing, the excision margins were measured. With cutting diathermy and coagulative diathermy, shrinkage of the soft tissues was minimal relative to the margin of the simulated lesion compared with the Harmonic scalpel (p=0.001) and conventional scalpel (p=0.001). Cutting diathermy and coagulative diathermy caused significant thermal damage (p=0.001). The method of resection affects the surgical margin. Diathermy resulted in thermal injury and denaturing of the underlying muscle, but there was less tissue contraction than when the Harmonic scalpel and conventional scalpel were used. The ethics committee approved the study, which was undertaken in a registered European Scientific Institute in Hamburg.

  20. Melanoma in Situ Treated with Topical Imiquimod for Management of Persistently Positive Margins: A Review of Treatment Methods

    PubMed Central

    Fan, Qing; Cohen, Stephanie; John, Becky; Riker, Adam I.

    2015-01-01

    Background Imiquimod is a topical cream approved by the US Food and Drug Administration for treatment of superficial basal cell carcinoma, actinic keratosis, and genital-perianal warts. Its successful use in patients with persistently positive margins of melanoma in situ (MIS) after surgical excision has been previously reported. Case Report A 75-year-old female presented with a primary melanoma that was removed through an elliptical excision with 1 cm margins. Pathology revealed 3 involved margins with residual MIS without an invasive component. After a second operation removed an additional 1 cm margin, pathology revealed 2 positive margins with residual MIS. Rather than undergoing a third excision, the patient decided to pursue a nonsurgical approach with topical imiquimod, and at the 4-month follow-up examination, the incision was completely healed with no clinical evidence of tumor recurrence. Conclusion A nonsurgical approach with 5% topical imiquimod cream applied along the incision was utilized. In specific patient populations, the use of imiquimod is a reasonable alternative approach for the management of persistently positive MIS margins. Long-term follow-up is necessary to assess for evidence of recurrence and the ultimate success of this nonsurgical approach. PMID:26730231

  1. A multicentre study of the evidence for customized margins in photon breast boost radiotherapy

    PubMed Central

    Mukesh, Mukesh B; Donovan, Ellen M; Kirby, Anna M; Haviland, Joanne S; Jena, Raj; Yarnold, John; Baker, Angela; Dean, June; Eagle, Sally; Mayles, Helen; Griffin, Claire; Perry, Rosalind; Poynter, Andrew; Coles, Charlotte E; Evans, Philip M

    2016-01-01

    Objective: To determine if subsets of patients may benefit from smaller or larger margins when using laser setup and bony anatomy verification of breast tumour bed (TB) boost radiotherapy (RT). Methods: Verification imaging data acquired using cone-beam CT, megavoltage CT or two-dimensional kilovoltage imaging on 218 patients were used (1574 images). TB setup errors for laser-only setup (dlaser) and for bony anatomy verification (dbone) were determined using clips implanted into the TB as a gold standard for the TB position. Cases were grouped by centre-, patient- and treatment-related factors, including breast volume, TB position, seroma visibility and surgical technique. Systematic (Σ) and random (σ) TB setup errors were compared between groups, and TB planning target volume margins (MTB) were calculated. Results: For the study population, Σlaser was between 2.8 and 3.4 mm, and Σbone was between 2.2 and 2.6 mm, respectively. Females with larger breasts (p = 0.03), easily visible seroma (p ≤ 0.02) and open surgical technique (p ≤ 0.04) had larger Σlaser. Σbone was larger for females with larger breasts (p = 0.02) and lateral tumours (p = 0.04). Females with medial tumours (p < 0.01) had smaller Σbone. Conclusion: If clips are not used, margins should be 8 and 10 mm for bony anatomy verification and laser setup, respectively. Individualization of TB margins may be considered based on breast volume, TB and seroma visibility. Advances in knowledge: Setup accuracy using lasers and bony anatomy is influenced by patient and treatment factors. Some patients may benefit from clip-based image guidance more than others. PMID:26585543

  2. Surgical Management of Pericardial Diseases.

    PubMed

    Johnston, Douglas R

    Disease of the pericardium represents a relatively rare indication for cardiac surgery, and there exist no widely accepted guidelines for surgical management. As such, the surgical approach to the pericardium has relied largely on institutional experience with a slow evolution based on published studies. In particular, management of pericardial constriction has varied widely from surgeon to surgeon and institution to institution, in large part due to a perception of inherent high risk to the procedure. This review covers the current practice of surgery for disease of the pericardium, with particular focus on the evolution of indications for pericardiectomy, new applications in inflammatory or relapsing pericarditis, and the progressive refinement in surgical technique and operative planning which have led to significantly improved outcomes in experienced centers.

  3. [Surgical treatment of duodenal ulcer].

    PubMed

    Lese, M; Naghi, I; Pop, C

    2001-01-01

    The medical and endoscopic treatment of duodenal ulcer are decreasing the frequency of surgical treatment in this disease. The authors study the operations performed for duodenal ulcer within the period 1989-1999 in the County Hospital Baia Mare. The decrease of the rate of surgical interventions is the pure effect of the medical treatment, as long as the endoscopic treatment is not yet available in our service. The rate of ulcer--induced perforations remained, however, unmodified (48% of total operatory indications), as well as the postoperative morbidity and--mortality (18% respectively 9%). The last category seems not to be influenced by the type of chosen surgical procedure, but by the patient's age, duration of the disease, and associated pathology.

  4. Surgical Treatment of Facial Paralysis

    PubMed Central

    2009-01-01

    The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (<3 weeks duration), intermediate duration facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy. PMID:19434284

  5. Nutrition support in surgical oncology.

    PubMed

    Huhmann, Maureen B; August, David A

    2009-01-01

    This review article, the second in a series of articles to examine the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients, evaluates the evidence related to the use of nutrition support in surgical oncology patients. Cancer patients develop complex nutrition issues. Nutrition support may be indicated in malnourished cancer patients undergoing surgery, depending on individual patient characteristics. As with the first article in this series, this article provides background concerning nutrition issues in cancer patients, as well as discusses the role of nutrition support in the care of surgical cancer patients. The goal of this review is to enrich the discussion contained in the clinical guidelines as they relate to recommendations made for surgical patients, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequently published studies.

  6. [Surgical management of chronic pancreatitis].

    PubMed

    Regimbeau, Jean-Marc; Dumont, Frédéric; Yzet, Thierry; Chatelain, Denis; Bartoli, Eacute Ric; Brazier, Franck; Bréhant, Olivier; Dupas, Jean-Louis; Mauvais, François; Delcenserie, Richard

    2007-01-01

    Surgical indications for chronic pancreatitis can be schematically separated into five main groups: pain, effects of fibrosis on adjacent organs, the consequences of main pancreatic duct rupture above an obstruction, and suspected cancer. Finally surgery is also indicated in patients who cannot undergo endoscopic procedures (no accessible papilla) or who have too recently undergone this procedure. Surgical procedures include derivation (pancreatic, cystic, biliary) or mixed procedures combining derivation/resection or pancreatic resection. Finally splanchnicectomy can be discussed. Whatever the indication, surgical treatment must meet several goals: the approach to surgery must be multidisciplinary, surgery must be associated with low morbidity and mortality, preserve as much endocrine function as possible, improve quality of life, and be evaluated in the long term, as well as prospectively if possible. We clarify some important points about the management of patients with chronic pancreatitis before discussing the various treatments in detail.

  7. Fluid handling 2: Surgical applications

    NASA Technical Reports Server (NTRS)

    Billica, Roger; Young, John; Rushing, Doug; Kizzee, Victor D.

    1991-01-01

    The methods proposed for managing fluids and particulate debris during minor surgery on Space Station Freedom (SSF) were investigated and demonstrated. A KC-135 parabolic flight test was performed, in which the flight followed the standard 40 parabola profile with 20 to 25 seconds in near-zero gravity in each parabola. The equipment (suction and laminar flow device) was evaluated. While this equipment performed satisfactorily previously in the dental simulation, the purpose of the current flight was to reconfigure the equipment in support of a minor surgical situation in order to evaluate its efficacy and establish clear requirements for the actual flight hardware. To accomplish the study the Health Maintenance Facility medical restraint system was deployed as for surgical use and mannequin suture arm was restrained to its surface. The surgical area was established as for performing minor surgery with standard tray and suture instruments employed.

  8. Thinking on the Margin: A Classroom Experiment

    ERIC Educational Resources Information Center

    Bangs, Joann

    2009-01-01

    One of the most important concepts being taught in principles classes is the idea of "thinking on the margin." It can also be one of the most difficult to get across. One of the most telling examples, according to this author, comes in trying to get students to learn the profit maximizing condition for perfectly competitive firms. She…

  9. 12 CFR 349.9 - Margin requirements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... depository institution engaging, or offering to engage, in retail forex transactions must collect from each retail forex customer an amount of margin not less than: (1) Two percent of the notional value of the retail forex transaction for major currency pairs and 5 percent of the notional value of the retail...

  10. 12 CFR 48.9 - Margin requirements.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., in retail forex transactions must collect from each retail forex customer an amount of margin not less than: (1) Two percent of the notional value of the retail forex transaction for major currency pairs and 5 percent of the notional value of the retail forex transaction for all other currency...

  11. 12 CFR 48.9 - Margin requirements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., in retail forex transactions must collect from each retail forex customer an amount of margin not less than: (1) Two percent of the notional value of the retail forex transaction for major currency pairs and 5 percent of the notional value of the retail forex transaction for all other currency...

  12. 12 CFR 48.9 - Margin requirements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., in retail forex transactions must collect from each retail forex customer an amount of margin not less than: (1) Two percent of the notional value of the retail forex transaction for major currency pairs and 5 percent of the notional value of the retail forex transaction for all other currency...

  13. 12 CFR 349.9 - Margin requirements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... depository institution engaging, or offering to engage, in retail forex transactions must collect from each retail forex customer an amount of margin not less than: (1) Two percent of the notional value of the retail forex transaction for major currency pairs and 5 percent of the notional value of the retail...

  14. 12 CFR 240.9 - Margin requirements

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... required. A banking institution engaging, or offering to engage, in retail forex transactions must collect from each retail forex customer an amount of margin not less than: (1) Two percent of the notional value of the retail forex transaction for major currency pairs and 5 percent of the notional value...

  15. 12 CFR 349.9 - Margin requirements.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... depository institution engaging, or offering to engage, in retail forex transactions must collect from each retail forex customer an amount of margin not less than: (1) Two percent of the notional value of the retail forex transaction for major currency pairs and 5 percent of the notional value of the retail...

  16. Keeping Academically Marginal Youth in School.

    ERIC Educational Resources Information Center

    Alpert, Geoffrey; Dunham, Roger

    1986-01-01

    From among factors theoretically considered relevant to preventing school dropouts, empirical procedures identified five variables that predicted most of the variance among marginal youth: (1) extent of misbehavior in school; (2) belief in school's relevance to employment; (3) feelings of success in school; (4) parental monitoring of behavior; (5)…

  17. Young People Speaking Back from the Margins

    ERIC Educational Resources Information Center

    Smyth, John

    2010-01-01

    The diminished educational opportunities and subsequent life chances of many marginalized young people have been dramatic, even to the point of being catastrophic. But they are not hapless victims, nor are they passive recipients of deficit categories like "at riskness", placed upon them by the media, politicians, agencies, and some…

  18. Negative Stress Margins - Are They Real?

    NASA Technical Reports Server (NTRS)

    Raju, Ivatury S.; Lee, Darlene S.; Mohaghegh, Michael

    2011-01-01

    Advances in modeling and simulation, new finite element software, modeling engines and powerful computers are providing opportunities to interrogate designs in a very different manner and in a more detailed approach than ever before. Margins of safety are also often evaluated using local stresses for various design concepts and design parameters quickly once analysis models are defined and developed. This paper suggests that not all the negative margins of safety evaluated are real. The structural areas where negative margins are frequently encountered are often near stress concentrations, point loads and load discontinuities, near locations of stress singularities, in areas having large gradients but with insufficient mesh density, in areas with modeling issues and modeling errors, and in areas with connections and interfaces, in two-dimensional (2D) and three-dimensional (3D) transitions, bolts and bolt modeling, and boundary conditions. Now, more than ever, structural analysts need to examine and interrogate their analysis results and perform basic sanity checks to determine if these negative margins are real.

  19. 5TH BIOTECHNOLOGICAL INVESTIGATIONS OCEAN MARGINS PROGRAM

    SciTech Connect

    DR. ARTURO MASSOL, PROGRAM CHAIR; DR. ROSA BUXEDA, PROGRAM CO-CHAIR

    2004-01-08

    BI-OMP supports DOE's mission in Climate Change Research. The program provides the fundamental understanding of the linkages between carbon and nitrogen cycles in ocean margins. Researchers are providing a mechanistic understanding of these cycles, using the tools of modern molecular biology. The models that will allow policy makers to determine safe levels of greenhouse gases for the Earth System.

  20. Second Language Learners' Use of Marginal Glosses

    ERIC Educational Resources Information Center

    O'Donnell, Mary E.

    2012-01-01

    The use of marginal reading glosses by 18 second language (L2) learners is examined through a quantitative and qualitative analysis of audiotaped think-aloud protocols. How these readers interact with the glosses is identified and divided into five categories or gloss interactions. Examples from each are presented. The primary research question…