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Sample records for aggressive surgical management

  1. 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.

  2. Successful management of aggressive fibromatosis of the neck using wide surgical excision: a case report

    PubMed Central

    2011-01-01

    Introduction Aggressive fibromatosis is a benign tumor, thought to arise from deep musculoaponeurotic structures, rarely found in the head or neck. However, when it does occur in the head and neck region, it tends to be more aggressive and associated with significant morbidity, which may be attributed to the vital vascular, neurological or anatomical structures in close proximity. Case presentation We report the case of a 39-year-old Pakistani man who presented with a two-month history of a lump on the right side of his neck. The mass was excised and histopathological analysis revealed a case of aggressive fibromatosis. Conclusion Due to the rarity of the condition no guidelines are available on the indications and extent of each modality. Due to its aggressive behavior and tendency to invade local structures and recur, a multi-modality management strategy is usually employed. On the basis of this case, we suggest that aggressive surgery is a viable management option and may be successfully used as a single modality treatment. PMID:21707981

  3. Improved Survival with Aggressive Surgical Management of Noncandidal Fungal Infections of the Burn Wound

    DTIC Science & Technology

    1982-10-01

    from this study that if the fungal infec- 5. Spebar. M. J.. Pruitt. B. A.: Candidiasis in the hurned patient. J. tion can be recognized and surgically excised, the mor- Trauma. 21: 237-239, 1981. .• I’i I/ A,/* Di:; t iA . _

  4. [Aggressive vertebral hemangiomas: optimization of management tactics].

    PubMed

    Kravtsov, M N; Manukovskiĭ, V A; Zharinov, G M; Kandyba, D V; Tsibirov, A A; Savello, A V; Svistov, D V

    2012-01-01

    Today vertebral hemangioma is not completely understood entity, neither its pathogenesis nor optimal treatment is determined. Nowadays in majority of clinics in this country ineffective radiotherapy remains the first-line treatment. We analyzed results of treatment of 205 patients (286 lesions) with aggressive hemangiomas operated in Department of Neurosurgery of Military Medical Academy and Department of Nuclear Medicine of of Russian Scientific Center of Radiological and Surgical Technologies (Saint-Petersburg, Russia) since 1999 till 2009. Percutaneus vertebroplasty was performed in 167 lesions, radiotherapy was applied in 119 aggressive hemangiomas. Vertebroplasty is more effective for treatment of aggressive hemangiomas in comparison with radiotherapy. Signs of hemangiomas aggression, indications for surgery, and tactics of management were determined. Use of percutaneous vertebroplasty for treatment of aggressive hemangiomas resulted in fast recovery of the patients. This procedure is minimally invasive, it reduces hospital stay and duration of recovery.

  5. Surgical treatment of aggressive vertebral hemangiomas.

    PubMed

    Vasudeva, Viren S; Chi, John H; Groff, Michael W

    2016-08-01

    OBJECTIVE Vertebral hemangiomas are common tumors that are benign and generally asymptomatic. Occasionally these lesions can exhibit aggressive features such as bony expansion and erosion into the epidural space resulting in neurological symptoms. Surgery is often recommended in these cases, especially if symptoms are severe or rapidly progressive. Some surgeons perform decompression alone, others perform gross-total resection, while others perform en bloc resection. Radiation, embolization, vertebroplasty, and ethanol injection have also been used in combination with surgery. Despite the variety of available treatment options, the optimal management strategy is unclear because aggressive vertebral hemangiomas are uncommon lesions, making it difficult to perform large trials. For this reason, the authors chose instead to report their institutional experience along with a comprehensive review of the literature. METHODS A departmental database was searched for patients with a pathological diagnosis of "hemangioma" between 2008 and 2015. Medical records were reviewed to identify patients with aggressive vertebral hemangiomas, and these cases were reviewed in detail. RESULTS Five patients were identified who underwent surgery for treatment of aggressive vertebral hemangiomas during the specified time period. There were 2 lumbar and 3 thoracic lesions. One patient underwent en bloc spondylectomy, 2 patients had piecemeal gross-total resection, and the remaining 2 had subtotal tumor resection. Intraoperative vertebroplasty was used in 3 cases to augment the anterior column or to obliterate residual tumor. Adjuvant radiation was used in 1 case where there was residual tumor as well. The patient who underwent en bloc spondylectomy experienced several postoperative complications requiring additional medical care and reoperation. At an average follow-up of 31 months (range 3-65 months), no patient had any recurrence of disease and all were clinically asymptomatic, except the

  6. 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.

  7. Surgical management of low-grade gliomas.

    PubMed

    Gerard, Carter S; Straus, David; Byrne, Richard W

    2014-08-01

    Low-grade gliomas represent a wide spectrum of intra-axial brain tumors with diverse presentations, radiographic and surgical appearances, and prognoses. While there remains a role for biopsy, a growing body of evidence shows that aggressive surgical resection of low-grade gliomas may improve symptoms, extend progression-free survival (PFS), and even cure a select few patients. With the application of preoperative functional imaging, intraoperative navigation, and cortical stimulation, neurosurgeons are able to perform more complete resections while limiting the risk to patients. In this article, we describe the surgical management and current operative techniques used in the treatment of low-grade gliomas.

  8. [Pathophysiology of aggressive behavior: evaluation and management of pathological aggression].

    PubMed

    Pompili, E; Carlone, C; Silvestrini, C; Nicolò, G

    2016-01-01

    This work aims to define the aggression in all its forms, with notes on management and rapid tranquilization. The pathological aggression is described as a non-homogeneous phenomenon, it is variable in according to social, psychological and biological agents. The distinction of violence between affective aggression and predatory aggression can be functional to the prediction of outcome of any treatment. In general, a pattern of predatory violence tend to match with patients unresponsive and not compliant to treatment, a low probability to predict future violence and, therefore, a difficulty in managing risk. The affective aggressor, however, shows increased probability of treatment response, with more predictability of violent actions in reaction to situations perceived as threatening and, therefore, greater management of future violence risk. Those who act affective violence tend to show a wide range of emotional and cognitive problems, while those who act with predatory patterns show greater inclination to aggression and antisocial behavior. Aggression that occurs in psychiatry mostly appears to be affective, therefore susceptible to modulation through treatments.

  9. Student Aggression: Prevention, Management, and Replacement Training.

    ERIC Educational Resources Information Center

    Goldstein, Arnold P.; And Others

    American society is violent, a fact which is well-reflected in schools. This book, designed specifically for school personnel, presents the primary techniques currently being employed by educators to prevent, manage, and replace student aggression. The volume opens with a description of the origins of aggressive behavior and offers some…

  10. Conservative surgical approach to aggressive benign odontogenic neoplasm: a report of three cases

    PubMed Central

    2015-01-01

    Aggressive benign odontogenic neoplasms have substantial potential to grow to an enormous size with resulting bone deformities, and they often invade adjacent tissues and spread beyond their normal clinical and radiographic margins; as such, they have a high rate of recurrence. Historically, management (conservative versus aggressive) on the basis of clinical, radiographic and/or histopathologic characteristics has been controversial. However, recent advances in the understanding of the biological features of these lesions may provide greater evidence of the benefits of conservative management. Three patients with different complaints and final histopathologic diagnoses were enrolled in the study. All three cases were treated by a single operator with similar conservative surgical procedures. During follow-up, the patients had uneventful secondary healing and bone regeneration, less packing time than previously reported, no clinical or radiographic evidence of recurrence and no apparent deformity. The aggressive behavior of these lesions requires long clinical and radiographic follow-up. Conservative surgical management may be an option to reduce recurrence and morbidity and increase the probability of uneventful secondary healing and bone regeneration. PMID:25741467

  11. Aggressive multiple surgical interventions to pulmonary artery sarcoma.

    PubMed

    Tanaka, Akiko; Shirasaka, Tomonori; Okada, Kenji; Okita, Yutaka

    2015-02-01

    We describe our experience with a patient who had metastasized pulmonary artery sarcoma, but survived 7 years after diagnosis. A 61-year-old man was diagnosed with pulmonary artery intimal sarcoma after resection of metastatic tumours to the bilateral lungs. The primary lesion in the pulmonary artery trunk extending into the bilateral branches was treated by tumour endoarterectomy followed by chemotherapy. He underwent resections of lung metastases two more times before detection of recurrent obstructive pulmonary artery sarcoma 4 years after the tumour endoarterectomy. En bloc resection of the tumour including the pulmonary artery trunk, valve and interventricular septum was performed, and the right ventricular out flow tract was reconstructed with a stentless pulmonary valve and equine pericardium. He died of the disease soon after an operation for metastatic brain tumour 3 years later. Pulmonary artery sarcoma has a dismal prognosis, but aggressively repeated surgical interventions may lengthen survival.

  12. Orthodontic Management in Aggressive Periodontitis.

    PubMed

    Gyawali, Rajesh; Bhattarai, Bhagabat

    2017-01-01

    Aggressive periodontitis is a type of periodontitis with early onset and rapid progression and mostly affecting young adults who occupy a large percentage of orthodontic patients. The role of the orthodontist is important in screening the disease, making a provisional diagnosis, and referring it to a periodontist for immediate treatment. The orthodontist should be aware of the disease not only before starting the appliance therapy, but also during and after the active mechanotherapy. The orthodontic treatment plan, biomechanics, and appliance system may need to be modified to deal with the teeth having reduced periodontal support. With proper force application and oral hygiene maintenance, orthodontic tooth movement is possible without any deleterious effect in the tooth with reduced bone support. With proper motivation and interdisciplinary approach, orthodontic treatment is possible in patients with controlled aggressive periodontitis.

  13. Orthodontic Management in Aggressive Periodontitis

    PubMed Central

    Bhattarai, Bhagabat

    2017-01-01

    Aggressive periodontitis is a type of periodontitis with early onset and rapid progression and mostly affecting young adults who occupy a large percentage of orthodontic patients. The role of the orthodontist is important in screening the disease, making a provisional diagnosis, and referring it to a periodontist for immediate treatment. The orthodontist should be aware of the disease not only before starting the appliance therapy, but also during and after the active mechanotherapy. The orthodontic treatment plan, biomechanics, and appliance system may need to be modified to deal with the teeth having reduced periodontal support. With proper force application and oral hygiene maintenance, orthodontic tooth movement is possible without any deleterious effect in the tooth with reduced bone support. With proper motivation and interdisciplinary approach, orthodontic treatment is possible in patients with controlled aggressive periodontitis. PMID:28299350

  14. Successful surgical drainage and aggressive medical therapy in a preterm neonate with Bacillus cereus meningitis.

    PubMed

    Drazin, Doniel; Lehman, Deborah; Danielpour, Moise

    2010-01-01

    Bacillus cereus meningitis is a rare disease with a very high mortality rate in neonates. The authors present the rare case of a premature infant with B. cereus bacteremia and subsequent intracranial abscesses. In addition to aggressive medical therapy, surgical drainage was performed via a left frontal mini-craniotomy. At 15 months of age, the patient had mild developmental delay, cortical blindness, and sensorineural hearing loss. The clinical case is described and difficulties in the management of B. cereus meningoencephalitis in infants are discussed.

  15. 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.

  16. 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

  17. Surgical management of urolithiasis.

    PubMed

    Durkee, Charles T; Balcom, Anthony

    2006-06-01

    Pediatric patients with urolithiasis present unique challenges. Interventional techniques developed for adult patients have been adopted and adapted to facilitate effective and safe treatment in this population. Management must be stratified and individualized, taking into account the many factors described in this article. Long-term follow-up and metabolic evaluation are essential components of the overall treatment strategy. Interventional management will continue to evolve with progressive refinements in instrumentation and techniques.

  18. 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.

  19. Overview of surgical scar prevention and management.

    PubMed

    Son, Daegu; Harijan, Aram

    2014-06-01

    Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.

  20. Surgical management of ectopic pregnancy.

    PubMed

    Stock, Laura; Milad, Magdy

    2012-06-01

    Surgery remains an acceptable, and sometimes necessary, modality for the treatment of ectopic pregnancy. Laparoscopy is the preferred method of access, yet controversy remains regarding the optimal procedure and postoperative management. Generally, salpingostomy is employed with the goal of maintaining fertility, although data to support this tenet are lacking. In most cases, the decision to perform conservative versus radical surgery is on the basis of the patient's history, her desire for future fertility, and surgical findings. The procedures of salpingostomy and salpingectomy, techniques to prevent and control blood loss at the time of surgery, and surgical options for nontubal ectopic pregnancies are reviewed.

  1. [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.

  2. Surgical Management of Septic Arthritis.

    PubMed

    Mulon, Pierre-Yves; Desrochers, André; Francoz, David

    2016-11-01

    Lameness related to synovial infection needs to be addressed promptly because rapid degradation of the synovial homeostasis results in permanent cartilage alterations detrimental to complete recovery. Diagnosis is based on clinical signs, synovial fluid analysis, and imaging. Commonly affected joints are the fetlock, carpus, tarsus, and stifle; shoulder, elbow, and hip may also be infected. Knowing the source of infection is essential in cases of remote septic arthritis. Antimicrobials should be administered; local delivery systems may be used. Therapy relies on the removal of inflammatory mediators. Pain management is critical throughout the surgical procedures and the recovery period.

  3. Surgical Management of Metastatic Disease.

    PubMed

    Keung, Emily Z; Fairweather, Mark; Raut, Chandrajit P

    2016-10-01

    Sarcomas are rare cancers of mesenchymal cell origin that include many histologic subtypes and molecularly distinct entities. For primary resectable sarcoma, surgery is the mainstay of treatment. Despite treatment, approximately 50% of patients with soft tissue sarcoma are diagnosed with or develop distant metastases, significantly affecting their survival. Although systemic therapy with conventional chemotherapy remains the primary treatment modality for those with metastatic sarcoma, increased survival has been achieved in select patients who receive multimodality therapy, including surgery, for their metastatic disease. This article provides an overview of the literature on surgical management of pulmonary and hepatic sarcoma metastases.

  4. Aggressive bronchoscopic management of plastic bronchitis.

    PubMed

    Preciado, Diego; Verghese, Susan; Choi, Sukgi

    2010-07-01

    Plastic bronchitis or "Bronchitis Plastica" is a rare disease characterized by the formation of thick, tenacious, arborizing mucofibrinous tracheobronchial casts that result in life-threatening airway obstruction and pulmonary failure. We review three children who developed recurrent plastic bronchitis after undergoing a Fontan procedure for single ventricle physiology. Case series of three patients with plastic bronchitis at a tertiary referral children's hospital. All patients required repeated bronchoscopies, one requiring four separate ones over a week's period, for removal of the rigid casts. Extra-corporal membrane oxygenation (ECMO) was needed in two children because of severe respiratory failure. All were also managed with adjunctive intensive medical support. Pulmonary function returned to normal in all children, but recurred 2 months later in one who subsequently expired due to pulmonary failure. Plastic bronchitis is an unusual condition of unknown cause that occurs in multiple clinical settings, but especially in those children who have undergone a Fontan operation. Management of this distressing situation is difficult and early diagnosis and aggressive measures to remove rigid casts combined with intensive medical care are necessary. The intrinsic cardiopulmonary physiology of children with Fontan procedures, including the risk of arrhythmias, hypo-oxygenation, and pulmonary hypertension make this condition even more complex.

  5. Surgical management of the radiated chest wall

    SciTech Connect

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

    1986-04-01

    Fifty consecutive patients with radiation-related problems of the chest wall were treated between 1976 and 1984. There were 40 women and 10 men with an average age of 54 years (range 26 to 78 years). Twenty-three patients had radiation ulcers alone, 20 had recurrent cancer, and 7 had infected median sternotomy wounds. Thirty-six had skeletal resections and 44 had soft-tissue resections. The skeleton was reconstructed with Prolene mesh in 12 patients and with autogenous rib in 3. Sixty-three muscles were transposed in 43 patients. Twelve omental transpositions were performed (8 for primary treatment and 4 for salvage of a failed muscle flap). Hospitalization averaged 20.2 days. There was one operative death (at 29 days). Partial flap necrosis occurred in 10 patients. Mesh was removed in three patients. There were 14 late deaths, most from recurrent tumor. The remaining patients had well-healed wounds and a generally improved quality of life. We conclude that aggressive resection and reliable reconstruction are critical considerations in the surgical management of this perplexing clinical problem.

  6. Aggressive surgical resection for concomitant liver and lung metastasis in colorectal cancer

    PubMed Central

    Lee, Sung Hwan; Kim, Sung Hyun; Lim, Jin Hong; Kim, Sung Hoon; Lee, Jin Gu; Kim, Dae Joon; Choi, Gi Hong; Choi, Jin Sub

    2016-01-01

    Backgrounds/Aims Aggressive surgical resection for hepatic metastasis is validated, however, concomitant liver and lung metastasis in colorectal cancer patients is equivocal. Methods Clinicopathologic data from January 2008 through December 2012 were retrospectively reviewed in 234 patients with colorectal cancer with concomitant liver and lung metastasis. Clinicopathologic factors and survival data were analyzed. Results Of the 234 patients, 129 (55.1%) had synchronous concomitant liver and lung metastasis from colorectal cancer and 36 (15.4%) had metachronous metastasis. Surgical resection was performed in 33 patients (25.6%) with synchronous and 6 (16.7%) with metachronous metastasis. Surgical resection showed better overall survival in both groups (synchronous, p=0.001; metachronous, p=0.028). In the synchronous metastatic group, complete resection of both liver and lung metastatic lesions had better survival outcomes than incomplete resection of two metastatic lesions (p=0.037). The primary site of colorectal cancer and complete resection were significant prognostic factors (p=0.06 and p=0.003, respectively). Conclusions Surgical resection for hepatic and pulmonary metastasis in colorectal cancer can improve complete remission and survival rate in resectable cases. Colorectal cancer with concomitant liver and lung metastasis is not a poor prognostic factor or a contraindication for surgical treatments, hence, an aggressive surgical approach may be recommended in well-selected resectable cases. PMID:27621747

  7. Surgical management of presacral bleeding

    PubMed Central

    Ausobsky, JR; Vowden, P

    2014-01-01

    Introduction Presacral venous bleeding is an uncommon but potentially life threatening complication of rectal surgery. During the posterior rectal dissection, it is recommended to proceed into the plane between the fascia propria of the rectum and the presacral fascia. Incorrect mobilisation of the rectum outside the Waldeyer’s fascia can tear out the lower presacral venous plexus or the sacral basivertebral veins, causing what may prove to be uncontrollable bleeding. Methods A systematic search of the MEDLINE® and Embase™ databases was performed to obtain primary data published in the period between 1 January 1960 and 31 July 2013. Each article describing variables such as incidence of presacral venous bleeding, surgical approach, number of cases treated and success rate was included in the analysis. Results A number of creative solutions have been described that attempt to provide good tamponade of the presacral haemorrhage, eliminating the need for second operation. However, few cases are reported in the literature. Conclusions As conventional haemostatic measures often fail to control this type of haemorrhage, several alternative methods to control bleeding definitively have been described. We propose a practical comprehensive classification of the available techniques for the management of presacral bleeding. PMID:24780015

  8. Clinical and imaging findings in patients with aggressive spinal hemangioma requiring surgical treatment.

    PubMed

    Urrutia, Julio; Postigo, Roberto; Larrondo, Roberto; Martin, Aliro San

    2011-02-01

    Vertebral hemangiomas (VHs) are frequently asymptomatic lesions found incidentally during investigations for other spinal problems. Symptomatic VHs are less common, and there are few reports of compressive VHs in the literature. VHs with aggressive behavior present with low signal intensity on T1-weighted and high signal intensity on T2-weighted MRI. We present a case series of four patients with compressive VH, all of whom were neurologically compromised. Each of the four patients underwent preoperative arterial embolization followed by surgical treatment of their VHs. All patients recovered normal motor function after surgery. At follow-up (average 53 months), one patient had a recurrent tumor requiring reoperation and radiotherapy. Although it is rare, aggressive VH can be a devastating condition. Total surgical resection or subtotal resection with radiotherapy may be warranted.

  9. Surgical Management of Male Voiding Dysfunction.

    PubMed

    Mandeville, Jessica; Mourtzinos, Arthur

    2016-06-01

    Benign prostatic hypertrophy (BPH) is a common cause of voiding dysfunction. BPH may lead to bladder outlet obstruction and resultant troublesome lower urinary tract symptoms. Initial management of BPH and bladder outlet obstruction is typically conservative. However, when symptoms are severe or refractory to medical therapy or when urinary retention, bladder stone formation, recurrent urinary tract infections, or upper urinary tract deterioration occur, surgical intervention is often necessary. Numerous options are available for surgical management of BPH ranging from simple office-based procedures to transurethral operative procedures and even open and robotic surgeries. This article reviews the current, most commonly used techniques available for surgical management of BPH.

  10. Managing aggression in the emergency department: promoting an interdisciplinary approach.

    PubMed

    Rintoul, Yvonne; Wynaden, Dianne; McGowan, Sunita

    2009-04-01

    Incidents of aggression are frequent occurrences in hospitals, particularly the emergency department. Aggression creates instability in the environment, impacts on patient care outcomes and leads to increased levels of stress in staff. Regular exposure to aggression in the workplace can have detrimental effects on health professionals' ongoing quality of life. The emergency department is a gateway to care and is heavily populated 24h a day. Therefore, it is essential that all health professionals are confident and well prepared to manage aggression. Based upon a review of the literature this paper outlines the causes of aggression and provides an interdisciplinary action plan for intervening with aggressive patients in the emergency department. The importance of interdisciplinary ownership and the well planned management of aggression are outlined. When well managed, the impact of aggression can be limited. Stability in the emergency department ensures that health professionals can be responsive to the community's needs for emergency care. This leads to the provision of effective and timely care and a stable work environment for all health professionals.

  11. 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

  12. 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.

  13. Surgical management of traumatic cardiac fistulae

    PubMed Central

    Rogers, Michael A.; Chesler, Elliot; Du Plessis, Louis

    1969-01-01

    Seven cases of traumatic intracardiac lesions following penetrating stab wounds of the heart are presented. The surgical management and complications encountered in these cases are discussed. Images PMID:5348320

  14. [Surgical management of pulmonary aspergilloma].

    PubMed

    Guerra, Miguel; Santos, Nelson; Miranda, José; Carlos Mota, João; Leal, Francisco; Vouga, Luis

    2008-01-01

    After formation of fungus ball in pre-existing cavities, antifungal agents are very hard to control the infection. Surgical resection offers the only realistic chance of a permanent cure for aspergilloma. However, surgical indications are still a controversy because of the high incidence of postoperative complications. The purpose of this study was to evaluate our indications and results in the surgical treatment of aspergilloma, focusing attention on the postoperative complications and risk factors. From 1990 to 2004, 60 patients with mean age of 44.6 (range, 20-69) were submitted to pulmonary surgery for excision of aspergilloma. Forty-one patients (68.3%) were male, 25 patients (41.7%) were smokers and 47 (78.3%) had tuberculosis as the underlying lung disease. The most frequent indication for surgery was haemoptysis (88.3%). The cavities were mainly situated in the upper lobes (85.0%) and in the right lung (68.3%). Approximately half of aspergillomas (56.7%) were classified as complex aspergillomas. The procedures performed were : 7 pneumectomies (11.7%), 3 bilobectomies (5.0%), 42 lobectomies (70.0%), 7 wedge resections (11.7%) and one cavernostomy (1.7%). There were 3 postoperative deaths (5%), and major complications occurred in 16.3% of the patients including: bleeding (n=3) and bronchopleural fistula (n=2). Recurrence rate was 3.3%. Surgical resection of pulmonary aspergilloma is effective in preventing recurrence of hemoptysis. Preoperative preparation of the patient, meticulous surgical technique, asn postoperative care reduced the rate of complications. We recommend early surgical resection of symptomatic cases with reasonable complications.

  15. Surgical management of breast cancer liver metastases

    PubMed Central

    Cassera, Maria A; Hammill, Chet W; Ujiki, Michael B; Wolf, Ronald F; Swanström, Lee L; Hansen, Paul D

    2011-01-01

    Introduction Selected patients with isolated breast cancer liver metastases (BCLM) may benefit from surgical management; however, indications remain unclear and the risks may outweigh the benefits in patients with a generally poor prognosis. Methods Between 1998 and 2006, 17 patients diagnosed with BCLM were considered for surgical management (<4 tumours, tumour <4 cm in diameter and no/stable extrahepatic metastases). Peri-operative and outcomes data were analysed and compared. Results Eight patients were found to have extensive or untreatable disease on staging laparoscopy and intra-operative ultrasound (SL/IOUS). The remaining nine patients underwent surgical management [seven laparoscopic radiofrequency ablations (RFA) and two hepatic resections]. Median length of follow-up for patients treated surgically was 40.0 months, median disease-free survival (DFS) was 32.2 months and median time to disease progression was 17.7 months. Of the eight patients not amenable to surgery, median length of follow-up was 21.8 months. Conclusion SL/IOUS prevented unnecessary laparotomy in half of the patients taken to the operating room for surgical treatment of BCLM. In patients with BCLM, SL/IOUS should be considered standard of care before surgical intervention. The small number of patients and short follow-up may be inadequate to determine the true value of surgical management in this group of patients with BCLM. PMID:21418133

  16. [Non-surgical management after blunt traumatic liver injuries: A review article].

    PubMed

    Noyola-Villalobos, Héctor Faustino; Loera-Torres, Marco Antonio; Jiménez-Chavarría, Enrique; Núñez-Cantú, Olliver; García-Núñez, Luis Manuel; Arcaute-Velázquez, Fernando Federico

    2016-01-01

    Hepatic trauma is a common cause for admissions in the Emergency Room. Currently, non-surgical management is the standard treatment in haemodynamically stable patients with a success rate of around 85 to 98%. This haemodynamic stability is the most important factor in selecting the appropriate patient. Adjuncts in non-surgical management are angioembolisation, image-guided drainage and endoscopic retrograde cholangiopancreatography. Failure in non-surgical management is relatively rare but potentially fatal, and needs to be recognised and aggressively treated as early as possible. The main cause of failure in non-surgical management is persistent haemorrhage. The aim of this paper is to describe current evidence and guidelines that support non-surgical management of liver injuries in blunt trauma.

  17. Surgical Management for Peyronie's Disease.

    PubMed

    Segal, Robert L; Burnett, Arthur L

    2013-04-01

    Peyronie's disease is a common debilitating condition for both men and their partners that results in penile deformity and compromises sexual functioning. While there are a myriad of medical therapeutic options, these have not been demonstrated to correct the deformity and restore sexual function definitively. As such, surgery is the mainstay of treatment for this disease, and multiple surgical approaches may be considered depending on disease characteristics, patient co-morbidity, and findings on preoperative diagnostic testing. The purpose of this review is to highlight the different surgical approaches and different procedures within each approach, and to examine important issues for surgeons to consider for administering the best treatment that restores function while reconciling patient expectations.

  18. Surgical Management for Peyronie's Disease

    PubMed Central

    Segal, Robert L.

    2013-01-01

    Peyronie's disease is a common debilitating condition for both men and their partners that results in penile deformity and compromises sexual functioning. While there are a myriad of medical therapeutic options, these have not been demonstrated to correct the deformity and restore sexual function definitively. As such, surgery is the mainstay of treatment for this disease, and multiple surgical approaches may be considered depending on disease characteristics, patient co-morbidity, and findings on preoperative diagnostic testing. The purpose of this review is to highlight the different surgical approaches and different procedures within each approach, and to examine important issues for surgeons to consider for administering the best treatment that restores function while reconciling patient expectations. PMID:23658860

  19. Surgical management of Ebstein's anomaly.

    PubMed

    Stulak, John M; Dearani, Joseph A; Danielson, Gordon K

    2007-01-01

    Ebstein's malformation is a congenital anomaly of the tricuspid valve and right ventricle. Surgical repair of Ebstein's anomaly improves functional class and exercise tolerance, eliminates right-to-left intracardiac shunting (if present), and reduces the incidence of supraventricular tachyarrhythmias. As a result, quality of life and survival are improved. Because of the variable degree of malformation present, repair is predicated on favorable anatomic factors, most importantly the arrangement of the anterior leaflet of the tricuspid valve. When anatomic derangements threaten a durable tricuspid valve repair, valve replacement with protection of the conduction tissue and right coronary artery should be performed. The vast majority of patients can undergo a biventricular repair. The application of the bidirectional cavopulmonary anastomosis is reserved for patients with poor right ventricular function. Freedom from reoperation after tricuspid valve repair is similar when compared with valve replacement. In the current era, overall early mortality after surgical repair in children and adults has fallen to less than 3% in experienced centers. Surgical treatment of the symptomatic neonate remains a significant challenge, with approaches that include either a biventricular or single ventricle algorithm.

  20. Updates on the Surgical Management of Pediatric Glaucoma.

    PubMed

    Tan, Yar-Li; Chua, Jocelyn; Ho, Ching-Lin

    2016-01-01

    Childhood glaucoma is known to be one of the most challenging conditions to manage. Surgical management is more complicated than in adults because of differences in anatomy from adults along with variations in anatomy caused by congenital and developmental anomalies, wide-ranging pathogenetic mechanisms, a more aggressive healing response, and a less predictable postoperative course. Challenges in postoperative examination and management in less cooperative children and the longer life expectancies preempting the need for future surgeries and reinterventions are also contributing factors. Angle surgery is usually the first-line treatment in the surgical management of primary congenital glaucoma because it has a relatively good success rate with a low complication rate. After failed angle surgery or in cases of secondary pediatric glaucoma, options such as trabeculectomy, glaucoma drainage devices, or cyclodestructive procedures can be considered, depending on several factors such as the type of glaucoma, age of the patient, and the severity and prognosis of the disease. Various combinations of these techniques have also been studied, in particular combined trabeculotomy-trabeculectomy, which has been shown to be successful in patients with moderate-to-advanced disease. Newer nonpenetrating techniques, such as viscocanalostomy and deep sclerectomy, have been reported in some studies with variable results. Further studies are needed to evaluate these newer surgical techniques, including the use of modern minimally invasive glaucoma surgeries, in this special and diverse group of young patients.

  1. Surgical management of pediatric urinary incontinence.

    PubMed

    Dave, Sumit; Salle, Joao Luiz Pippi

    2013-08-01

    The surgical management of pediatric urinary incontinence secondary to neurogenic bladder and congenital anomalies is challenging, and continues to evolve with new surgical innovations. The goal of these surgical procedures is to achieve complete and socially acceptable urinary dryness, while preserving volitional voiding where possible, without causing damage to the upper tracts. This review focuses on recent studies and highlights the pros and cons of these advances, based on our experience. The short-term success in achieving urinary continence has to be tempered with the long-term implications of these reconstructive procedures, about which our knowledge is limited.

  2. Adjuvant therapy after surgical stone management.

    PubMed

    Ferrandino, Michael N; Monga, Manoj; Preminger, Glenn M

    2009-01-01

    The aim of this article was to review the most widely researched adjuvant medical therapies for the surgical management of urolithiasis. Articles were identified and reviewed from PubMed and Medline databases with MeSH headings focusing on the various surgical treatments of urolithiasis and adjuvant therapy. Additional articles were retrieved from references and conference proceedings. Surgical treatments reviewed included shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. Adjuvant therapy was considered medical or complementary therapy as an adjunct to these surgical interventions. Adjuvant therapy for the surgical management of urolithiasis has been documented to increase stone-free rates, reduce stone remission rates, prevent renal damage, and decrease postoperative morbidity. A variety of agents have been studied, ranging from antioxidants to alpha-blockers and to alkalinizing agents. Additionally, there is increasing interest in complementary adjuvant therapy (ie, acupuncture). Adjuvant therapy is a fertile area for research in the surgical management of urolithiasis. The optimal agents have yet to be determined and therefore further investigation is warranted and necessary.

  3. An aggressive group a streptococcal cellulitis of the hand and forearm requiring surgical debridement.

    PubMed

    Bharucha, Neil J; Alaia, Michael J; Paksima, Nader; Christoforou, Dimitrios; Gupta, Salil

    2011-01-03

    Group A streptococcus is responsible for a diverse range of soft tissue infections. Manifestations range from minor oropharyngeal and cellulitic skin infections to more severe conditions such as necrotizing fasciitis and septic shock. Troubling increases in the incidence and the severity of streptococcal infections have been reported over the past 25 years. Cases of streptococcal necrotizing fasciitis have received significant attention in the literature, with prompt surgical debridement being the mainstay of treatment. However, cases of rapidly progressing upper extremity streptococcal cellulitis leading to shock and a subsequent surgical intervention have not been well described. This article presents a case of an 85-year-old woman with a rapidly progressing, erythematous, painful, swollen hand associated with fever, hypotension, and mental status change. Due to a high clinical suspicion for necrotizing fasciitis, the patient was rapidly resuscitated and underwent immediate surgical irrigation and debridement. All intraoperative fascial pathology specimens were negative for necrotizing fasciitis, leading to a final diagnosis of Group A streptococcal cellulitis. Although surgical intervention is not commonly considered in patients with cellulitis, our patient benefited from irrigation and debridement with soft tissue decompression. In cases of necrotizing fasciitis as well as rapidly progressive cellulitis, prompt diagnosis and aggressive treatment may help patients avoid the catastrophic consequences of rapidly progressive group A streptococcal infections.

  4. Systemic moxifloxacin vs amoxicillin/metronidazole adjunct to non-surgical treatment in generalized aggressive periodontitis

    PubMed Central

    Gurgan, Cem-Abdulkadir

    2015-01-01

    Background The objective of this randomized clinical study was to evaluate the effect of systemic administration of moxifloxacin compared to amoxicillin and metronidazole, combined with non-surgical treatment in patients with generalized aggressive periodontitis (GAgP) in a 6-month follow-up. Material and Methods A total of 39 systemically healthy patients with GAgP were evaluated in this randomized clinical trial. Periodontal parameters were recorded at the baseline during the 1st, 3rd and 6th month. Patients received either 400 mg of moxifloxacin per os once daily or 500 mg of metronidazole and 500 mg amoxicillin per os three times daily for 7 days consecutively. Results No significant differences between groups were found in any parameters at the baseline. Both groups led to a statistically significant decrease in all clinical periodontal parameters compared to the baseline (PI, p<0.001 and GI, PD, BOP, CAL, p<0.01). There were no differences between the 1st and 3rd months or the 3rd and 6th months for clinical parameters in the groups. Also, no intergroup difference was observed in any parameters at any time, except the gingival index at 6th months. Conclusions Systemic administration of moxifloxacin as an adjunct to non-surgical treatment significantly improves clinical outcomes and provides comparable clinical improvement with less adverse events to that of combination of amoxicillin and metronidazole in the treatment of GAgP. Key words: Aggressive periodontitis, amoxicillin, metronidazole, moxifloxacin, nonsurgical periodontal debridement. PMID:26034931

  5. Acute and chronic pancreatitis: surgical management.

    PubMed

    Dzakovic, Alexander; Superina, Riccardo

    2012-08-01

    Pancreatitis is becoming increasingly prevalent in children, posing new challenges to pediatric health care providers. Although some general adult treatment paradigms are applicable in the pediatric population, diagnostic workup and surgical management of acute and chronic pancreatitis have to be tailored to anatomic and pathophysiological entities peculiar to children. Nonbiliary causes of acute pancreatitis in children are generally managed nonoperatively with hydration, close biochemical and clinical observation, and early initiation of enteral feeds. Surgical intervention including cholecystectomy or endoscopic retrograde cholangiopancreatography is often required in acute biliary pancreatitis, whereas infected pancreatic necrosis remains a rare absolute indication for pancreatic debridement and drainage via open, laparoscopic, or interventional radiologic procedure. Chronic pancreatitis is characterized by painful irreversible changes of the parenchyma and ducts, which may result in or be caused by inadequate ductal drainage. A variety of surgical procedures providing drainage, denervation, resection, or a combination thereof are well established to relieve pain and preserve pancreatic function.

  6. Surgical Management of Chronic Wounds.

    PubMed

    Johnston, Benjamin R; Ha, Austin Y; Kwan, Daniel

    2016-02-01

    In this article, we outline the important role the surgeon plays in the management of chronic wounds. Debridement and washout are required for grossly infected wounds and necrotizing soft tissue infections. Cutaneous cancers such as squamous cell carcinomas may contribute to chronic wounds and vice versa; if diagnosed, these should be treated with wide local excision. Arterial, venous, and even lymphatic flows can be restored in select cases to enhance delivery of nutrients and removal of metabolic waste and promote wound healing. In cases where vital structures, such as bones, joints, tendons, and nerves, are exposed, vascularized tissue transfers are often required. These tissue transfers can be local or remote, the latter of which necessitates anastomoses of arteries and veins. Pressure sores are managed by relieving pressure, treating acute trauma or infection, and using rotation fasciocutaneous flaps. Lastly, the surgeon must always consider the possibility of osteomyelitis and retained foreign body as etiology for chronic wounds.

  7. Surgical management of bacterial meningitis.

    PubMed Central

    Humphreys, R. P.

    1975-01-01

    A variety of associated lesions may require the neurosurgeon's assistance in the management of bacterial meningitis. As treatment of this infection of the central nervous system proceeds, the surgeon will have to decide about the concurrent or subsequent operative treatment of congenital dysraphic states, paraneural infections, compound fractures or penetrating wounds of thecranium or spine, or infected bypass shunts for cerebrospinal fluid (CSF). In patients with intractable meningitic infections the surgeon may have to insert a ventricular drainage-irrigation system to permit adequate perfusion of the CSF pathways with antibiotic. Hydrocephalus or subdural effusions complicating meningitis may bring the patient to the surgeon long after the infection has been cured. This paper examines these problems and outlines the current principles of management. Images FIG. 1 FIG. 2 PMID:1098760

  8. Surgical management in patient with uveitis

    PubMed Central

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

    2013-01-01

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

  9. [Surgical management of animal bites in children].

    PubMed

    Touzet-Roumazeille, S; Jayyosi, L; Plenier, Y; Guyot, E; Guillard, T; François, C

    2016-10-01

    Children represent a population at risk, because of their short size, their naivety and their attraction to animals. The face and hands are the most specific locations in young children. Wounds are often multiple. In more than half the cases, the child knows the animal, which are dogs and cats by frequency argument. The bite episode occurs mostly when the child is alone with the pet without direct supervision, while playing or stroking the animal. As in all bites, pediatric lesions are infectious, functional and aesthetic emergencies, but the goal of this work was primarily to make a point on principles of surgical management of animal bites in children, highlighting pediatric specificities. Animal bites require psychological, anesthetic and surgical treatment, adapted to the child, in a specialized structure. Hospitalization and general anesthesia are more frequent in children. Any suspicion of mistreatment (and/or abuse) should lead to the child's hospitalization, even if wounds do not justify monitoring in a surgical environment. Emergency surgery is essential to limit functional and aesthetic consequences. The healing capacities of the child and the frequent lack of co-morbidity allow a conservative surgical treatment with suture, repositioning skin flaps and controlled healing in the first place. Immobilization, drainage, and antibiotics will complete the surgery. The healing process, however, leads to a specific management during scar remodeling phase and growth. Psychological care of the child and parents should not be forgotten, and has to start at the same time as surgical treatment at in acute phase.

  10. Collaborative management of a young patient with generalized aggressive periodontitis.

    PubMed

    Sivakumar, Arunachalam; Raju, M A K V; Sunny, James; Cyriac, Rajesh; Bhat, Subraya; Mohandas, Ashil A; Divya, Beemavarapu

    2014-01-01

    What are the orthodontic treatment possibilities, limitations and risks inherent in patients with periodontal disorders, particularly active periodontal disease? This case report describes the interface between orthodontics, periodontics and restorative dentistry in the management of a 25-year-old young man with generalized aggressive periodontitis.

  11. Trends in the surgical management of diverticulitis

    PubMed Central

    Wieghard, Nicole; Geltzeiler, Cristina B.; Tsikitis, Vassiliki L.

    2015-01-01

    Sigmoid diverticulitis is an increasingly common Western disease associated with a high morbidity and cost of treatment. Improvement in the understanding of the disease process, along with advances in the diagnosis and medical management has led to recent changes in treatment recommendations. The natural history of diverticulitis is more benign than previously thought, and current trends favor more conservative, less invasive management. Despite current recommendations of more restrictive indications for surgery, practice trends indicate an increase in elective operations being performed for the treatment of diverticulitis. Due to diversity in disease presentation, in many cases, optimal surgical treatment of acute diverticulitis remains unclear with regard to patient selection, timing, and technical approach in both elective and urgent settings. As a result, data is limited to mostly retrospective and non-randomized studies. This review addresses the current treatment recommendations for surgical management of diverticulitis, highlighting technical aspects and patterns of care. PMID:25608492

  12. Surgical management of necrotizing pancreatitis: an overview.

    PubMed

    Kokosis, George; Perez, Alexander; Pappas, Theodore N

    2014-11-21

    Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15% that reach 30% in case of infection. Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity. This approach is however associated with poor outcomes. Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches. Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds: Delay, Drain and Debride. Patients can be managed in the intensive care unit and any intervention should be delayed. Percutaneous drainage can be utilized first and early in the course of the disease, followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary. Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach. The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.

  13. Surgical management of necrotizing pancreatitis: An overview

    PubMed Central

    Kokosis, George; Perez, Alexander; Pappas, Theodore N

    2014-01-01

    Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15% that reach 30% in case of infection. Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity. This approach is however associated with poor outcomes. Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches. Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds: Delay, Drain and Debride. Patients can be managed in the intensive care unit and any intervention should be delayed. Percutaneous drainage can be utilized first and early in the course of the disease, followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary. Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach. The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease. PMID:25473162

  14. Principles of surgical management of musculoskeletal conditions.

    PubMed

    Venkatesh, Ramakrishnan

    2008-06-01

    Practical procedures for treatment of fractures and dislocations have been used since the time of Hippocrates in fourth century BC. Orthopaedic surgery became a recognized part of surgical treatment since the mid-nineteenth century, but saw major developments with the invention of x-rays and antibiotics in the early part of the twentieth century. Though orthopaedic surgery had started with an interest in the correction of deformities in children, the major musculoskeletal problems facing orthopaedic surgery today relate to osteoarthritis, trauma (including sports injuries), and osteoporosis. The practice of orthopaedic surgery has evolved with technology: advances in engineering and material science and increasing expectations towards faster rehabilitation have moved orthopaedics into the era of joint replacements, arthroscopy, and less invasive surgical procedures. This chapter aims to provide an evidence-based condensed overview of the surgical management for a broad spectrum of musculoskeletal disorders encountered by primary-care clinicians and rheumatologists.

  15. Surgical Management of Multiple Valve Endocarditis Associated with Dialysis Catheter

    PubMed Central

    Sanchez, M.; Castañeda, E.

    2016-01-01

    Endocarditis associated with dialysis catheter is a disease that must be suspected in every patient with hemodialysis who develops fever. Multiple valve disease is a severe complication of endocarditis that needs to be managed in a different way. There is very limited data for treatment and every case must be considered individually. We present a patient with this complication and describe the medical treatment and surgical management. We report the case of a 15-year-old patient with acute renal failure that develops trivalvular endocarditis after the hemodialysis catheter was placed, with multiple positive blood culture for Staphylococcus aureus. Transesophageal echocardiography was done and aortic and tricuspid valvular vegetations and mitral insufficiency were reported. Patient was successfully treated by surgery on the three valves, including aortic valve replacement. There is limited data about the appropriate treatment for multiple valvular endocarditis; it is important to consider this complication in the setting of hemodialysis patients that develop endocarditis and, despite the appropriate treatment, have a torpid evolution. In countries where endovenous drug abuse is uncommon, right sided endocarditis is commonly associated with vascular catheters. Aggressive surgical management should be the treatment of choice in these kinds of patients. PMID:27994895

  16. Comprehensive management of symptomatic and aggressive vertebral hemangiomas.

    PubMed

    Acosta, Frank L; Sanai, Nader; Chi, John H; Dowd, Christopher F; Chin, Cynthia; Tihan, Tarik; Chou, Dean; Weinstein, Philip R; Ames, Christopher P

    2008-01-01

    Conservative surgical strategies are appropriate for most symptomatic hemangiomas causing cord compression without instability or deformity. Even so, complete intralesional spondylectomy following embolization of aggressive vertebral hemangiomas with circumferential vertebral involvement can be safely accomplished. Such a spondylectomy can also prevent recurrence of hemangiomas. Transarterial embolization without decompression is an effective treatment for painful intraosseous hemangiomas. Vertebroplasty is useful for improving pain symptoms, especially when vertebral body compression fracture has occurred in patients without neurological deficit, but is less effective in providing long-term pain relief.

  17. Surgical management of soft tissue sarcomas

    SciTech Connect

    Arlen, M.; Marcove, R.C.

    1987-01-01

    This volume reflects the latest thinking in surgical and adjuvant forms of therapy that can be offered to the sarcoma patient. Based on their analysis of sarcoma patients, the authors stress management based on site of origin, and discuss tumors on and about the shoulder girdle, hip joint, extremity, retroperitoneum, etc. Coverage includes methods for limb preservation; techniques for regional node resection; indications and methods for arterial perfusion, cryosurgery and isotope implantation; pre- and post-operative immunotherapy chemotherapy and radiation therapy.

  18. Surgical management of painful peripheral nerves.

    PubMed

    Elliot, David

    2014-07-01

    This article deals with the classification, assessment, and management of painful nerves of the distal upper limb. The author's preferred surgical and rehabilitation techniques in managing these conditions are discussed in detail and include (1) relocation of end-neuromas to specific sites, (2) division and relocation of painful nerves in continuity (neuromas-in-continuity and scar-tethered nerves) involving small nerves to the same sites, and (3) fascial wrapping of painful nerves in continuity involving larger nerves such as the median and ulnar nerves. The results of these treatments are presented as justification for current use of these techniques.

  19. Frequency, Characteristics and Management of Adolescent Inpatient Aggression

    PubMed Central

    Baeza, Immaculada; Saito, Ema; Amanbekova, Dinara; Ramani, Meena; Kapoor, Sandeep; Chekuri, Raja; De Hert, Marc; Carbon, Maren

    2013-01-01

    Abstract Background Inpatient aggression is a serious challenge in pediatric psychiatry. Methods A chart review study in adolescent psychiatric inpatients consecutively admitted over 24 months was conducted, to describe aggressive events requiring an intervention (AERI) and to characterize their management. AERIs were identified based on specific institutional event forms and/or documentation of as-needed (STAT/PRN) medication administration for aggression, both recorded by nursing staff. Results Among 408 adolescent inpatients (age: 15.2±1.6 years, 43.9% male), 1349 AERIs were recorded, with ≥1 AERI occurring in 28.4% (n=116; AERI+). However, the frequency of AERIs was highly skewed (median 4, range: 1–258). In a logistical regression model, the primary diagnosis at discharge of disruptive behavior disorders and bipolar disorders, history of previous inpatient treatment, length of hospitalization, and absence of a specific precipitant prior to admission were significantly associated with AERIs (R2=0.32; p<0.0001). The first line treatment of patients with AERIs (AERI+) was pharmacological in nature (95.6%). Seclusion or restraint (SRU) was used at least once in 59.4% of the AERI+ subgroup (i.e., in 16.9% of all patients; median within-group SRU frequency: 3). Treatment and discharge characteristics indicated a poorer prognosis in the AERI+ (discharge to residential care AERI+: 22.8%, AERI−: 5.6%, p<0.001) and a greater need for psychotropic polypharmacy (median number of psychotropic medications AERI+: 2; AERI−: 1, p<0.001). Conclusions Despite high rates of pharmacological interventions, SRU continue to be used in adolescent inpatient care. As both of these approaches lack a clear evidence base, and as adolescents with clinically significant inpatient aggression have increased illness acuity/severity and service needs, structured research into the most appropriate inpatient aggression management is sorely needed. PMID:23647136

  20. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma

    PubMed Central

    Mierlo, Camille Van; Pinto, Luis Abegão

    2015-01-01

    ABSTRACT Introduction: Iatrogenic pigment dispersion syndrome generally originates from a repetitive, mechanical trauma to the pigmented posterior epithelium of the iris. This trauma can arise after intraocular surgery, most commonly due to an abnormal contact between the intraocular lens (IOL) and the iris. Whether surgical removal of this primary insult can lead to a successful intraocular pressure (IOP) control remains unclear. Methods: Case-series. Patients with IOP elevation and clinical signs of pigment dispersion were screened for a diagnosis of iatrogenic IOL-related pigment dispersion. Results: Three patients in which the IOL or the IOL-bag complex caused a pigment dispersion through a repetitive iris chafing were selected. In two cases, replacement of a sulcus-based single-piece IOL (patient 1) or a sub-luxated in-the-bag IOL (patient 2) by an anterior-chamber (AC) iris-fixed IOL led to a sustained decrease in IOP. In the third case, extensive iris atrophy and poor anatomical AC parameters for IOL implantation precluded further surgical intervention. Conclusion: IOL-exchange appears to be a useful tool in the management of iatrogenic pigment dispersion glaucoma due to inappropriate IOL implantation. This cause-oriented approach seems to be effective in controlling IOP, but should be offered only if safety criteria are met. How to cite this article: Van Mierlo C, Abegao Pinto L, Stalmans I. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma. J Curr Glaucoma Pract 2015;9(1):28-32. PMID:26997830

  1. Nursing management of aggression in a Singapore emergency department: A qualitative study.

    PubMed

    Tan, Mei Fen; Lopez, Violeta; Cleary, Michelle

    2015-09-01

    In Singapore, anecdotal evidence suggests that nurses are concerned about managing aggressive incidents in the emergency department. In this study, registered nurses' perceptions of managing aggressive patients in an emergency department were explored. Ten registered nurses from the emergency department of an acute public hospital in Singapore were interviewed. Four overarching themes emerged from the thematic analysis: (i) impact of aggressive patients on nurses; (ii) nursing assessment of aggressive behaviors; (iii) nursing management of aggressive behaviors; and (iv) organizational support and responsiveness. Further research is required to better support nurses to deliver optimal care for aggressive patients and achieve positive and effective outcomes.

  2. [Stress urinary incontinence. Its surgical management].

    PubMed

    Neri Ruz, E S; Azcona Arteaga, F J

    1991-10-01

    Ninety eight patients with stress urinary incontinence treated surgically at Central Military Hospital, were studied. We analyzed the risk factors as age, weight, height, parity, menopause age, and previous medical and surgical procedures. They were divided in two groups. The Group I, vaginal approach, with 35 patients and Group II, retropubic surgery, with 63 patients. There were no differences both groups regarding age, weight, height, parity and menopausal age. The most frequent illness associated with stress urinary incontinence, was pelvic floor relaxation. The complications were 17.1% and 33.3%, respectively. The efficacy of Burch is procedure for the management of stress urinary incontinence, with a success rate of 84.1% versus 62.1% in the vaginal approach, was confirmed.

  3. Critical limb ischemia: medical and surgical management.

    PubMed

    Slovut, David Paul; Sullivan, Timothy M

    2008-08-01

    Chronic critical limb ischemia (CLI), defined as > 2 weeks of rest pain, ulcers, or tissue loss attributed to arterial occlusive disease, is associated with great loss of both limb and life. Therapeutic goals in treating patients with CLI include reducing cardiovascular risk factors, relieving ischemic pain, healing ulcers, preventing major amputation, improving quality of life and increasing survival. These aims may be achieved through medical therapy, revascularization, or amputation. Medical therapy includes administration of analgesics, local wound care and pressure relief, treatment of infection, and aggressive therapy to modify atherosclerotic risk factors. For patients who are not candidates for revascularization, and who are unwilling or unable to undergo amputation, treatments such as intermittent pneumatic compression or spinal cord stimulation may offer symptom relief and promote wound healing. Revascularization offers the best option for limb salvage. The decision to perform surgery, endovascular therapy, or a combination of the two modalities ('hybrid' therapy) must be individualized. Patients who are relatively fit and able to withstand the rigors of an open procedure may benefit from the long-term durability of surgical repair. In contrast, frail patients with a limited life expectancy may experience better outcomes with endovascular reconstruction. Hybrid therapy is an attractive option for patients with limited autologous conduit, as it permits complete revascularization with a less extensive procedure, shorter duration of operation, and decreased risk of peri-operative complications. Amputation should be considered for patients who are non-ambulatory, demented, or unfit to undergo revascularization.

  4. Surgical management in primary congenital glaucoma: four debates.

    PubMed

    Chang, Ta C; Cavuoto, Kara M

    2013-01-01

    Primary congenital glaucoma is a worldwide diagnostic and therapeutic challenge. Although medical management is often a temporizing measure, early surgical intervention is the definitive treatment. As the abundance of surgical treatment options continues to expand, the authors will compare and contrast the available options and attempt to provide a consensus on surgical management.

  5. Generalized aggressive periodontitis: microbiological composition and clinical parameters in non-surgical therapy.

    PubMed

    Usin, María M; Tabares, Sandra M; Menso, Julieta; de Albera, Estela R; Sembaj, Adela

    2016-12-01

    The aim of this study was to determine the variations in periodontal parameters and microbiological composition in periodontal pockets at the baseline and 3 and 6 months post treatmentin patients with Generalized Aggressive Periodontitis(GAP) undergoing non surgical periodontal treatment combined with chlorhexidine and systemic antibiotics. Medical and dental history was taken from 10 subjects, average age 30.6±2.7 years, diagnosed with GAP. A non surgical periodontal treatment combined with 0.12% chlorhexidine, 875 mg amoxicillin and 500 mg metronidazole every 12 hours for ten days was conducted. At each visit, the following measurements wererecorded: bacterial plaque (BP), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), hypermobility, and furcation lesions, and a sample of subgingivalplaque was taken from the site of the deepest probing depth of each sextant to identify Porphyromonas gingivalis, Treponemadenticola, Tannerella forsythia, Prevotella intermedia and Aggregatibacter actinomycetemcomitans using molecular biology techniques. After 6 months, the Wilcoxon test showed an increase of 0.97 mm in CAL (p=0.0047) and 2.54 mm in PD(p=0.009). A healthy site was defined as having a PD <5 mm, negative BOP and no pathogenic bacteria detected at 6 months, indicating significant improvement (p=0.008), with OR (95%CI) =4.7 (1.102220.11).With the treatment protocol used in this study, 6 months after treatment, patients had an approximately 4- fold higher possibility of presenting PD <5 mm and periodontal pockets without periodontal pathogenic bacteria.

  6. Inventory management of reusable surgical supplies.

    PubMed

    Diamant, Adam; Milner, Joseph; Quereshy, Fayez; Xu, Bo

    2017-03-08

    We investigate the inventory management practices for reusable surgical instruments that must be sterilized between uses. We study a hospital that outsources their sterilization services and model the inventory process as a discrete-time Markov chain. We present two base-stock inventory models, one that considers stockout-based substitution and one that does not. We derive the optimal base-stock level for the number of reusable instruments to hold in inventory, the expected service level, and investigate the implied cost of a stockout. We apply our theoretical results to a dataset collected from a surgical unit at a large tertiary care hospital specializing in colorectal operations. We demonstrate how to implement our model when determining base-stock levels for future capacity expansion and when considering alternative stockout protocols. Our analysis suggests that the hospital can reduce the number of reusable instrument sets held in inventory if on-site sterilization techniques (e.g., flash sterilization) are employed. Our results will guide future procurement decisions for surgical units based on costs and desired service levels.

  7. Intraoperative Electron Radiotherapy for the Management of Aggressive Fibromatosis

    SciTech Connect

    Roeder, Falk; Timke, Carmen; Oertel, Susanne; Hensley, Frank W.; Bischof, Marc; Muenter, Marc W.; Weitz, Juergen; Buchler, Markus W.; Lehner, Burkhard; Debus, Juergen; Krempien, Robert

    2010-03-15

    Purpose: We analyzed our experience with intraoperative electron radiotherapy (IOERT) followed by moderate doses of external beam radiotherapy (EBRT) after organ-sparing surgery in patients with primary or recurrent aggressive fibromatosis. Methods and Materials: Indication for IOERT and postoperative EBRT as an individual treatment approach to avoid mutilating surgical procedures was seen when complete surgical removal seemed to be unlikely or impossible. A total of 31 lesions in 30 patients were treated by surgery and IOERT with a median dose of 12 Gy. Median age was 31 years (range, 13-59 years). Resection status was close margin in six lesions, microscopically positive in 13, and macroscopically positive in 12. Median tumor size was 9 cm. In all, 25 patients received additional EBRT, with a median dose of 45 Gy (range, 36-54 Gy). Results: After a median follow-up of 32 months (range, 3-139 months), no disease-related deaths occurred. A total of five local recurrences were seen, resulting in actuarial 3-year local control rates of 82% overall and 91% inside the IOERT areas. Trends to improved local control were seen for older age (>31 years) and negative margins, but none of these factors reached significance. Perioperative complications were found in six patients, in particular as wound healing disturbances in five patients and venous thrombosis in one patient. Late toxicity was seen in five patients. Conclusion: Introduction of IOERT into a multimodal treatment approach in patients with aggressive fibromatosis is feasible with low toxicity and yielded good local control rates even in patients with microscopical or gross residual disease.

  8. Surgical management of penetrating pulmonary injuries

    PubMed Central

    Petrone, Patrizio; Asensio, Juan A

    2009-01-01

    Chest injuries were reported as early as 3000 BC in the Edwin Smith Surgical Papyrus. Ancient Greek chronicles reveal that they had anatomic knowledge of the thoracic structures. Even in the ancient world, most of the therapeutic modalities for chest wounds and traumatic pulmonary injuries were developed during wartime. The majority of lung injuries can be managed non-operatively, but pulmonary injuries that require operative surgical intervention can be quite challenging. Recent progress in treating severe pulmonary injuries has relied on finding shorter and simpler lung-sparing techniques. The applicability of stapled pulmonary tractotomy was confirmed as a safe and valuable procedure. Advancement in technology have revolutionized thoracic surgery and ushered in the era of video-assisted thoracoscopic surgery (VATS), providing an alternative method for accurate and direct evaluation of the lung parenchyma, mediastinum, and diaphragmatic injuries. The aim of this article is to describe the incidence of the penetrating pulmonary injuries, the ultimate techniques used in its operative management, as well as the diagnosis, complications, and morbidity and mortality. PMID:19236703

  9. Effects of Human Management Events on Conspecific Aggression in Captive Rhesus Macaques (Macaca mulatta).

    PubMed

    Theil, Jacob H; Beisner, Brianne A; Hill, Ashley E; McCowan, Brenda

    2017-03-01

    Conspecific aggression in outdoor-housed rhesus macaques (Macaca mulatta) at primate research facilities is a leading source of trauma and can potentially influence animal wellbeing and research quality. Although aggression between macaques is a normal part of daily social interactions, human presence might affect the frequency of various behaviors and instigate increases in conspecific aggression. We sought to determine how and which human management events affect conspecific aggression both immediately after an event and throughout the course of a day. From June 2008 through December 2009, we recorded agonistic encounters among macaques living in 7 social groups in large outdoor field cages. Behavioral data were then synchronized with specific management events (for example, feeding, enclosure cleaning, animal catching) that occurred within or near the enclosure. By using an Information Theoretical approach, 2 generalized linear mixed models were developed to estimate the effects of human management events on 1) aggression after individual management events and 2) daily levels of aggression. Univariate analysis revealed an increase in the rate of aggression after a management event occurred. The best predictor of aggression in a cage was the type of management event that occurred. Various factors including the number of daily management events, the total time of management events, the technicians involved, reproductive season, and their interactions also showed significant associations with daily aggression levels. Our findings demonstrate that human management events are associated with an increase in conspecific aggression between rhesus macaques and thus have implications regarding how humans manage primates in research facilities.

  10. Aggressive giant cell lesion of the jaws: a review of management options and report of a mandibular lesion treated with denosumab.

    PubMed

    O'Connell, John Edward; Bowe, Conor; Murphy, Colm; Toner, Mary; Kearns, Gerard J

    2015-11-01

    Giant cell lesions (GCLs), previously referred to as giant cell granulomas, are benign tumors of the jaws of unknown etiology. Surgical management of aggressive GCLs is challenging, as these lesions demonstrate a tendency to recur following surgical removal. In addition, surgical treatment can be associated with significant morbidity. In an attempt to reduce both the extent of morbidity and the recurrence rate following surgery, a number of pharmacologic therapies have been advocated on the basis of assumptions about the predominant cell types and receptors, for the management of these lesions. This report describes the use of denosumab, an agent originally used for its anti-resorptive effects, in the management of an aggressive GCL of the mandible in an older patient, who was unsuitable for extensive surgery and in whom treatment with intralesional triamcinolone had proved unsuccessful. Denosumab may be a viable alternative or adjunct to surgery in the management of GCLs of the jaws.

  11. Non-surgical management of periodontal disease.

    PubMed

    Darby, I

    2009-09-01

    Non-surgical removal of plaque and calculus has been part of the initial phase of the management of patients with gingivitis and periodontitis for decades. It consists of patient motivation and oral hygiene instruction as well as mechanical removal of supra and subgingival plaque deposits. The purpose of this review was to assess recent changes. The article reports on changes in our understanding of plaque as a biofilm, developments in patient plaque control, chemical plaque control and scaling instruments. It also comments on full-mouth disinfection, the use of lasers and host modulation. Modern technology has made removal of microbial deposits by the patient and dental professionals more efficient. However, other advancements need to be used in conjunction with mechanical debridement at this time.

  12. The surgical management of the arthritic hand.

    PubMed Central

    Harrison, S. H.

    1979-01-01

    The surgical management of the arthritic hand is very largely concerned with rheumatoid arthritis and Still's disease and less frequently with psoriatic and degenerative arthritis. In the rheumatoid hand the surgeon may be called upon to intervene at any point in the chain reaction leading to total deformity, performing synovectomies of joints or tendons to relieve pain or prevent further deformity, repairing ruptured tendons, restoring the mechanism of injured joints, and correcting deformities when they have been allowed to occur. The great variety of operations that may be necessary to achieve these ends, with varying degrees of success, are discussed with reference to a personal series of 970 cases and 2002 operations. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 FIG. 5 FIG. 7 FIG. 6 FIG. 8 PMID:420491

  13. Behavioral Management Leads to Reduction in Aggression in a Child and Adolescent Psychiatric Inpatient Unit

    ERIC Educational Resources Information Center

    Dean, Angela J.; Duke, Suzanne G.; George, Michelle; Scott, James

    2007-01-01

    Objective: Aggression is common in children and adolescents admitted to psychiatric inpatient units. Few interventions for reducing aggressive behaviors have been identified. This study aimed to evaluate the impact of a milieu-based behavioral management program on the frequency of aggressive behaviors in a child and adolescent mental health…

  14. Surgical endodontic management of infected lateral canals of maxillary incisors

    PubMed Central

    2015-01-01

    This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment. PMID:25671217

  15. Effects of Human Management Events on Conspecific Aggression in Captive Rhesus Macaques (Macaca mulatta).

    PubMed

    Theil, Jacob; Beisner, Brianne; Hill, Ashley; McCowan, Brenda

    2017-03-02

    Conspecific aggression in outdoor-housed rhesus macaques (Macaca mulatta) at primate research facilities is a leadingsource of trauma and can potentially influence animal wellbeing and research quality. Although aggression between macaquesis a normal part of daily social interactions, human presence might affect the frequency of various behaviors and instigateincreases in conspecific aggression. We sought to determine how and which human management events affect conspecificaggression both immediately after an event and throughout the course of a day. From June 2008 through December 2009, werecorded agonistic encounters among macaques living in 7 social groups in large outdoor field cages. Behavioral data werethen synchronized with specific management events (for example, feeding, enclosure cleaning, animal catching) that occurredwithin or near the enclosure. By using an Information Theoretical approach, 2 generalized linear mixed models were developedto estimate the effects of human management events on 1) aggression after individual management events and 2) dailylevels of aggression. Univariate analysis revealed an increase in the rate of aggression after a management event occurred.The best predictor of aggression in a cage was the type of management event that occurred. Various factors including thenumber of daily management events, the total time of management events, the technicians involved, reproductive season,and their interactions also showed significant associations with daily aggression levels. Our findings demonstrate that humanmanagement events are associated with an increase in conspecific aggression between rhesus macaques and thus haveimplications regarding how humans manage primates in research facilities.

  16. Surgical Management of Unusual Biangular Mandibular Fractures

    PubMed Central

    Autorino, Umberto

    2017-01-01

    Bilateral mandibular angle fractures, while representing a rarity among mandibular fractures, are a huge challenge of complex management for the maxillofacial surgeon. There are still many open questions regarding the ideal management of such fractures, including the following: the removal of the third molar in the fracture line, the best surgical approach, and the fixation methods. In this report the authors present the case of 40-year-old man presenting with a bilateral mandibular angle fracture referred to the Maxillofacial Surgery Department of Turin. Open reduction and internal fixation has been made for both sides. The left side third molar was removed and the internal fixation was achieved through internal fixation with one miniplate according to Champy's technique and transbuccal access for a 4-hole miniplate at the inferior border of the mandible. Right side third molar was not removed and fixation was achieved through intraoral access and positioning of a 4-hole miniplate along the external ridge according to Champy. An optimal reduction was achieved and a correct occlusion has been restored. PMID:28299228

  17. Management Strategies for Aggressive Cushing's Syndrome: From Macroadenomas to Ectopics

    PubMed Central

    Pozza, Carlotta; Graziadio, Chiara; Giannetta, Elisa; Lenzi, Andrea; Isidori, Andrea M.

    2012-01-01

    Cushing's syndrome (CS) is a rare but severe clinical condition represented by an excessive endogenous cortisol secretion and hence excess circulating free cortisol, characterized by loss of the normal feedback regulation and circadian rhythm of the hypothalamic-pituitary axis due to inappropriate secretion of ACTH from a pituitary tumor (Cushing's disease, CD) or an ectopic source (ectopic ACTH secretion, EAS). The remaining causes (20%) are ACTH independent. As soon as the diagnosis is established, the therapeutic goal is the removal of the tumor. Whenever surgery is not curative, management of patients with CS requires a major effort to control hypercortisolemia and associated symptoms. A multidisciplinary approach that includes endocrinologists, neurosurgeons, oncologists, and radiotherapists should be adopted. This paper will focus on traditional and novel medical therapy for aggressive ACTH-dependent CS. Several drugs are able to reduce cortisol levels. Their mechanism of action involves blocking adrenal steroidogenesis (ketoconazole, metyrapone, aminoglutethimide, mitotane, etomidate) or inhibiting the peripheral action of cortisol through blocking its receptors (mifepristone “RU-486”). Other drugs include centrally acting agents (dopamine agonists, somatostatin receptor agonists, retinoic acid, peroxisome proliferator-activated receptor γ “PPAR-γ” ligands) and novel chemotherapeutic agents (temozolomide and tyrosine kinase inhibitors) which have a significant activity against aggressive pituitary or ectopic tumors. PMID:22934113

  18. Surgical Management of Fractures and Tendons.

    PubMed

    Pentecost, Rebecca; Niehaus, Andrew J; Anderson, David E

    2016-11-01

    Long bone fractures and disorders of tendons and ligaments represent a significant proportion of surgical orthopedic cases presented to ruminant veterinarians. The presentation of these patients, their diagnostic work-up, surgical treatment, and expected outcome will be discussed. The outcome of these cases depends largely on the presenting problem; however, accurate diagnosis and prompt surgical intervention can greatly improve the outcome of many of these cases.

  19. [Surgical management of the adult spastic hand].

    PubMed

    Allieu, Y

    2011-06-01

    The adult spastic hand, of varying causes, but dominated by vascular hemiplegia and brain damage, associates motor disorders and problems of tonus. The variety of forms of brain damage explains the wealth and diversity of the symptoms. These symptoms, often the most serious along with cognitive disorders, justify the expression "central neurological hand". Each case is an individual one. The effect on the hands may be unilateral or bilateral with spasticity involving the fingers/thumb/wrist. The clinical evaluation leading to a decision tree must take into account spasticity, retraction and paralysis, for each muscle. When completed by anesthetic motor blocks, spasticity and/or retraction, damage to extrinsic and/or intrinsic muscles of the fingers may be differentiated. This repeated multidisciplinary evaluation makes it possible to distinguish between "non functional hands", "functional hands" and "potentially functional hands". In the first instance, surgery can only improve the esthetic aspect or facilitate nursing. In the second instance, correcting spasticity may improve function. The treatment of spasticity is based on inhibiting spasticity (by injecting botulinum toxin or surgical motor hyponeurotisation) and reinforcing the non-spastic antagonist muscles via tendon transfer or tenodesis. Surgery is indicated to correct muscular retraction and deformities. The functional indications are highly selective and their limited results only allow a "supporting hand" to be constructed at best. The non-functional indications lead to a codified intervention whose results will greatly improve the management of these patients.

  20. Role of adrenal imaging in surgical management

    SciTech Connect

    Lamki, L.M.; Haynie, T.P. )

    1990-03-01

    Adrenal imaging using radiopharmaceuticals is a functional test that can contribute significantly to surgical management and follow-up of patients with either benign or malignant conditions of the adrenal cortex and medulla. Imaging of the cortex is achieved by iodine-131-labeled iodomethyl nor-cholesterol (NP-59), while adrenal medulla imaging can be successfully accomplished by 131I-metaiodobenzylguanidine (MIBG), which localizes in the adrenergic nerve terminal with norepinephrine. Both tests carry high sensitivity and specificity for functional tumors and hyperplasia, and often better than CT scanning. This article reviews the current status and clinical utility of nuclear imaging of the adrenal cortex in congenital hyperplasia, low renin hypertension and aldosteronism, and Cushing's syndrome. Adrenal medulla imaging is reviewed in light of our experience at the University of Texas M.D. Anderson Cancer Center in pheochromocytoma, neuroblastoma, and other neuroectodermal tumors. Investigation of {sup 131}I-MIBG therapy of metastatic tumors of neuroectodermal origin potentially offers a means of at least controlling symptoms of hormonal secretion in these patients. 40 references.

  1. Surgical management of short bowel syndrome.

    PubMed

    Iyer, Kishore R

    2014-05-01

    For patients with short bowel syndrome (SBS), surgery can play an important role in preventing, mitigating, and, in some cases, reversing intestinal failure (IF). During intestinal resection, bowel length should be conserved to the fullest extent possible to avoid dependence on parenteral nutrition (PN). Bowel salvage may be improved by initially preserving tissue of questionable viability and later reevaluating during "second-look" procedures. Once the patient is stabilized, ostomy reversal and recruitment of distal unused bowel should be prioritized whenever feasible. Following progression to IF, surgical management of SBS depends on the symptoms and anatomical characteristics of the individual patient. For carefully selected patients with rapid intestinal transit and dilated bowel, longitudinal intestinal lengthening and tailoring (LILT) and serial transverse enteroplasty (STEP) procedures may provide benefit. Outcomes following STEP and LILT are generally similar, and the choice between these procedures may rest on surgeon preference. For patients with rapid intestinal transit in the absence of bowel dilation, segmental reversal of the small bowel may reduce PN requirements. Intestinal transplantation is the standard of care for patients in whom intestinal rehabilitation attempts have failed and who are at risk of life-threatening complications of PN. Because patients awaiting isolated intestine transplant show increased survival compared with patients awaiting combined intestine-liver transplant, early referral of appropriate patients, before the development of advanced liver disease, is critical to enhancing patient outcomes.

  2. Surgical and nonsurgical management of gallstones.

    PubMed

    Abraham, Sherly; Rivero, Haidy G; Erlikh, Irina V; Griffith, Larry F; Kondamudi, Vasantha K

    2014-05-15

    Cholelithiasis, or gallstones, is one of the most common and costly of all the gastrointestinal diseases. The incidence of gallstones increases with age. At-risk populations include persons with diabetes mellitus, persons who are obese, women, rapid weight cyclers, and patients on hormone therapy or taking oral contraceptives. Most patients are asymptomatic; gallstones are discovered incidentally during ultrasonography or other imaging of the abdomen. Asymptomatic patients have a low annual rate of developing symptoms (about 2% per year). Once symptoms appear, the usual presentation of uncomplicated gallstones is biliary colic, caused by the intermittent obstruction of the cystic duct by a stone. The pain is characteristically steady, is usually moderate to severe in intensity, is located in the epigastrium or right upper quadrant of the abdomen, lasts one to five hours, and gradually subsides. If pain persists with the onset of fever or high white blood cell count, it should raise suspicion for complications such as acute cholecystitis, gallstone pancreatitis, and ascending cholangitis. Ultrasonography is the best initial imaging study for most patients, although additional imaging studies may be indicated. The management of acute biliary colic mainly involves pain control with nonsteroidal anti-inflammatory drugs or narcotic pain relievers. Oral dissolution therapy is usually minimally successful and used only if the patient cannot undergo surgery. Laparoscopic cholecystectomy remains the surgical choice for symptomatic and complicated gallstones, with a shorter hospital stay and shorter convalescence period than open cholecystectomy. Percutaneous cholecystostomy is an alternative for patients who are critically ill with gallbladder empyema and sepsis.

  3. Surgical management of upper lid entropion.

    PubMed Central

    Kemp, E G; Collin, J R

    1986-01-01

    One hundred and eighty-three surgical procedures were conducted on 107 patients over seven years. 91% of the cases of upper lid entropion were corrected satisfactorily with only one operation. It is postulated that this level of success is achieved by grading the degree of surgical intervention according to the clinical established on systematic examination of upper lid entropion. PMID:3741821

  4. The Impact of Teachers' Aggressive Management Techniques on Students' Attitudes to Schoolwork

    ERIC Educational Resources Information Center

    Romi, Shlomo; Lewis, Ramon; Roache, Joel; Riley, Philip

    2011-01-01

    Previous studies have shown that teachers' aggressive classroom management impacts negatively on students. The authors compared student reaction to teachers' use of aggressive management techniques in Australia, China, and Israel. Reactions included distraction negativity toward teachers and perceptions that teachers' responses were unjustified,…

  5. Recent advances in the surgical management of rhinosinusitis

    PubMed Central

    Jaksha, Alexandria F.; Weitzel, Erik K.; Laury, Adrienne M.

    2016-01-01

    Rhinosinusitis affects a significant portion of the US population, and its management imposes a substantial burden on the healthcare system. The treatment of chronic rhinosinusitis includes initial medical management prior to consideration of surgical intervention. However, if surgery does become necessary, several factors must be considered in order to optimize outcomes. This review evaluates surgical patient selection, perioperative medical management, and the extent of operative intervention, with the goal of improving surgical results, decreasing the need for revision surgery, and enhancing the patient’s quality of life. Specific variations in patient genotypes and phenotypes will be further explored with regard to their implications on surgical outcomes. Additionally, the evidence behind pre- and post-operative antibiotic and steroid use will be evaluated. Finally, we will review evolving surgical tools and techniques that are currently being utilized for the treatment of specific subsets of rhinosinusitis. PMID:27746900

  6. Surgical Management of the Pediatric Cochlear Implant Patient.

    ERIC Educational Resources Information Center

    Cohen, Seth M.; Haynes, David S.

    2003-01-01

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

  7. Pediatric Necrotizing Fasciitis: Restitutio Ad Integrum after Early Diagnosis and Aggressive Surgical Treatment

    PubMed Central

    Lemaréchal, Angela; Zundel, Sabine; Szavay, Philipp

    2016-01-01

    Necrotizing fasciitis (NF) is a severe, life-threatening infectious condition. Diagnosis is difficult due to unspecific symptoms yet crucial for favorable outcomes. We report a case of a 1 year old, previously healthy boy, where early suspicion of NF led to prompt aggressive therapy and consecutive restitutio ad integrum. PMID:28035291

  8. Surgical management of abdominal compartment syndrome; indications and techniques

    PubMed Central

    Leppäniemi, Ari

    2009-01-01

    The indications for surgical decompression of abdominal compartment syndrome (ACS) are not clearly defined, but undoubtedly some patients benefit from it. In patients without recent abdominal incisions, it can be achieved with full-thickness laparostomy (either midline, or transverse subcostal) or through a subcutaneous linea alba fasciotomy. In spite of the improvement in physiological variables and significant decrease in IAP, however, the effects of surgical decompression on organ function and outcome are less clear. Because of the significant morbidity associated with surgical decompression and the management of the ensuing open abdomen, more research is needed to better define the appropriate indications and techniques for surgical intervention. PMID:19366442

  9. Surgical perspectives in the management of atrial fibrillation

    PubMed Central

    Kyprianou, Katerina; Pericleous, Agamemnon; Stavrou, Antonio; Dimitrakaki, Inetzi A; Challoumas, Dimitrios; Dimitrakakis, Georgios

    2016-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia and a huge public health burden associated with significant morbidity and mortality. For decades an increasing number of patients have undergone surgical treatment of AF, mainly during concomitant cardiac surgery. This has sparked a drive for conducting further studies and researching this field. With the cornerstone Cox-Maze III “cut and sew” procedure being technically challenging, the focus in current literature has turned towards less invasive techniques. The introduction of ablative devices has revolutionised the surgical management of AF, moving away from the traditional surgical lesions. The hybrid procedure, a combination of catheter and surgical ablation is another promising new technique aiming to improve outcomes. Despite the increasing number of studies looking at various aspects of the surgical management of AF, the literature would benefit from more uniformly conducted randomised control trials. PMID:26839656

  10. Surgical management of moyamoya disease: a review.

    PubMed

    Baaj, Ali A; Agazzi, Siviero; Sayed, Zafar A; Toledo, Maria; Spetzler, Robert F; van Loveren, Harry

    2009-04-01

    Moyamoya disease (MMD) is a progressive, occlusive disease of the distal internal carotid arteries associated with secondary stenosis of the circle of Willis. Symptoms include ischemic infarcts in children and hemorrhages in adults. Bypass of the stenotic vessel(s) is the primary surgical treatment modality for MMD. Superficial temporal artery-to-middle cerebral artery bypass is the most common direct bypass method. Indirect techniques rely on the approximation of vascularized tissue to the cerebral cortex to promote neoangiogenesis. This tissue may be in the form of muscle, pericranium, dura, or even omentum. This review highlights the surgical options available for the treatment of MMD.

  11. Surgical Strategies for Management of Mitral Regurgitation: Recent Evidence from Randomized Controlled Trials.

    PubMed

    Tolis, George; Sundt, Thoralf M

    2015-12-01

    In contrast to mitral regurgitation (MR) caused by structural abnormality of the valve ("primary" MR), about which there is increasing consensus regarding treatment, there is increasing controversy around the management of functional or "secondary" MR, of which "ischemic mitral regurgitation" (IMR) is a common cause. While the trend in the management of primary MR is increasingly aggressive, with wide agreement on the preference for repair over replacement such that debate centers on earlier and earlier repair even among asymptomatic patients, the situation is reversed in the setting of secondary MR with uncertainly beyond the mode of management (repair or replacement) to the value of intervening at all. This is, in part, because the term IMR has been somewhat loosely applied by the medical and surgical communities to include regurgitation secondary to active myocardial ischemia, as well as that resulting from a completed myocardial infarct. As a result, there is considerable variability in reported outcomes of surgical interventions for IMR. In addition, the natural history of IMR is quite adverse-more so than that of many solid organ malignancies-and its surgical treatment has traditionally carried a higher operative mortality than many cardiac surgical procedures, including similar operations for primary MR and incidental coronary artery disease. Added to this, with recent advances in both the medical and surgical treatment of heart failure improving nonoperative outcomes and simultaneously reducing operative risk compared to reports from previous decades, the landscape has been quite dynamic. Here, we review the issues surrounding surgical treatment for IMR, along with available evidence supporting different approaches, to lend an informed perspective on the divergent opinions among experts in this field and guide the appropriate management of the individual patient.

  12. The management of esophageal achalasia: from diagnosis to surgical treatment.

    PubMed

    Dobrowolsky, Adrian; Fisichella, P Marco

    2014-03-01

    The goal of this review is to illustrate our approach to patients with achalasia in terms of preoperative evaluation and surgical technique. Indications, patient selection and management are herein discussed. Specifically, we illustrate the pathogenetic theories and diagnostic algorithm with current up-to-date techniques to diagnose achalasia and its manometric variants. Finally, we focus on the therapeutic approaches available today: medical and surgical. A special emphasis is given on the surgical treatment of achalasia and we provide the reader with a detailed description of our pre and postoperative management.

  13. Mindfulness-Based Program for Management of Aggression Among Youth: A Follow-up Study

    PubMed Central

    Sharma, Manoj Kumar; Sharma, Mahendra P.; Marimuthu, P.

    2016-01-01

    Background: Youth have shown indulgence in various high-risk behaviors and violent activities. Yoga-based approaches have been used for the management of psychological problems. The present work explores the role of mindfulness-based program in the management of aggression among youth. Materials and Methods: Sociodemographic information schedule, Buss-Perry Aggression Questionnaire, and World Health Organization quality of life were administered on 50 subjects in the age range of 18-25 years at pre- and post-mindfulness-based program level. Results: It revealed the presence of feeling of well-being and ability to relax themselves; changes in score of anger, hostility, physical, and verbal aggression; and enhancement of quality of life in the physical and environment domains at 1 month follow-up. Conclusions: Mindfulness-based program has shown changes in aggression expression/control and implies integration of it in available program for the management of aggression among youth. PMID:27335516

  14. Anger & Aggression Management in Young Adolescents: An Experimental Validation of the SCARE Program.

    ERIC Educational Resources Information Center

    Herrmann, D. Scott; McWhirter, J. Jeffries

    2003-01-01

    A study examined the validity of the SCARE program; an anger management program developed with high school students. Adolescents (n=207) exposed to the SCARE program had significantly lower levels of anger and aggression, slightly higher anger control, and lower scores on aggressive and violent attitudes a year after exposure. (Contains…

  15. Effectiveness of an Afterschool-Based Aggression Management Program for Elementary Students

    ERIC Educational Resources Information Center

    Staecker, Emma; Puett, Eli; Afrassiab, Shayda; Ketcherside, Miranda; Azim, Sabiya; Rhodes, Darson; Wang, Anna

    2016-01-01

    A school-community partnership team implemented an aggression management curriculum in an afterschool program as an early-intervention strategy at the upper elementary level. Although statistically significant differences in physical or psychological aggression were not found, the partnership team gained a better understanding of evidence-based…

  16. Differential diagnosis and management of human-directed aggression in dogs.

    PubMed

    Reisner, Ilana R

    2003-03-01

    Canine aggression directed to human beings is a common presenting complaint and requires attention to safety issues and behavior modification to minimize the risks of future aggression. Dogs may bite familiar people, including family members, or unfamiliar people for a variety of reasons. Anxiety plays an important role in aggression regardless of its target or circumstances. Effective management of aggression may include education and safety counseling for owners, lifestyle changes for dogs and owners, avoidance of provocations when possible, and behavior modification to minimize the risk of future bites. Drug therapy may be indicated to facilitate behavior modification or to reduce reactivity in the dog.

  17. Management of pulseless and apneic trauma patients: are aggressive measures justified?

    PubMed

    Lo, Chong-Jeh; Chang, Wen-Ling

    2007-01-01

    This study prospectively examined the care of trauma patients in extremis on presentation to a tertiary medical center between January 2000 and August 31, 2002. There were 144 patients who presented without a pulse or spontaneous respiration and required cardiopulmonary resuscitation (mean age, 41.5+/-2.3 years; male-to-female ratio, 105:39). Successfully resuscitated patients, who were either admitted to the surgical intensive care unit (SICU) or who were taken to the operating room for surgical exploration, had significantly shorter duration of cardiopulmonary resuscitation (14.55+/-1.64 minutes vs. 33.32+/-1.23 minutes; P < 0.001) and received less amounts of epinephrine than those who died in the emergency room (P < 0.05). One hundred sixteen patients died in the emergency room. Nineteen admitted patients died within 24 hours of presentation. Nine patients survived beyond 24 hours and all of them were admitted directly to the SICU for the management of brain injury. Six patients were taken to the operating room for surgical exploration to control the bleeding; all of them died in the operating room or shortly thereafter in the SICU. No patient in this study survived to be discharged. The financial cost of successfully resuscitated patients was significantly higher than that of patients who died in the emergency room (P < 0.001). Instead of insisting on aggressive measures to resuscitate trauma patients in extremis on presentation, the authors suggest we should redirect that fervor toward efforts made to promote trauma awareness and injury prevention programs.

  18. Fibrous Dysplasia: An Overview of Disease Process, Indications for Surgical Management, and a Case Report

    PubMed Central

    Salcedo, Samuel E.; Borad, Vedant; Richards, Sara S.; Workman, Adrienne D.; Ray, Andrea O.

    2015-01-01

    Introduction: First described by Von Recklinghausen in 1891, fibrous dysplasia is a developmental defect of osseous tissue such that bone is produced with an abnormally thin cortex and marrow is replaced with fibrous tissue that demonstrates characteristic ground-glass appearance on x-ray examination. The underlying defect in fibrous dysplasia is a mutation of the GNAS1 gene, which leads to constitutive activation of gene products that preclude the maturation of osteoprogenitor cells and lead to development of abnormal bone matrix, trabeculae, and collagen, produced by undifferentiated mesenchymal cells. There exists a mainly self-limiting form of fibrous dysplasia classified as monostotic, which is characterized by dysplastic bone in a single location that remains relatively stable throughout life and a polyostotic form, which can exhibit aggressive growth placing adjacent structures at risk for compressive sequelae. Methods: We present the surgical management of an unusual case of monostotic fibrous dysplasia, which exhibited aggressive growth with mass effect, and late presentation, both uncharacteristic features for the monostotic form. The authors also performed a comprehensive review of the literature and discuss the disease process, management options, and indications for surgical treatment. Results: An overview of the disease process and management options is presented. The authors also present details of reconstruction in an unusual form of symptomatic monostotic fibrous dysplasia. Conclusion: Conservative management is usually the mainstay of therapy in asymptomatic cases of fibrous dysplasia. In patients fulfilling criteria for surgical management, craniofacial reconstruction offers a viable option in the surgeon's armamentarium, providing good functional and cosmetic outcomes. PMID:25848443

  19. Pharmacological management of persistent hostility and aggression in persons with schizophrenia spectrum disorders: a systematic review.

    PubMed

    Victoroff, Jeff; Coburn, Kerry; Reeve, Alya; Sampson, Shirlene; Shillcutt, Samuel

    2014-01-01

    The incidence of aggressive behaviors is higher among persons with schizophrenia spectrum disorders (SSDs) than among persons without such disorders. This phenomenon represents a risk to the well-being of patients, their families, and society. The authors undertook a systematic review of the English language literature to determine the efficacy of neuropharmacological agents for the management of hostility and aggression among persons with SSDs. The search combined findings from the Medline, EMBASE, and PsycINFO databases. Ninety-two full text articles were identified that reported relevant findings. The American Academy of Neurology criteria were used to determine levels of evidence. Paliperidone-extended release is probably effective for the management of hostility among inpatients with SSDs who have not been preselected for aggression (Level B). Clozapine is possibly more effective than haloperidol for the management of overt aggression and possibly more effective than chlorpromazine for the management of hostility among inpatients with SSDs who have not been preselected for aggression (Level C). Clozapine is also possibly more effective than olanzapine or haloperidol for reducing aggression among selected physically assaultive inpatients (Level C). Adjunctive propranolol, valproic acid, and famotidine are possibly effective for reducing some aspects of hostility or aggression among inpatients with SSDs (Level C). Paliperidone-extended release currently appears to be the agent for the management of hostility among inpatients with SSDs for which there is the strongest evidence of efficacy.

  20. Surgical management of extensive pulmonary artery sarcoma.

    PubMed

    Shehatha, Jaffar; Saxena, Pankaj; Clarke, Belinda; Dunning, John; Konstantinov, Igor E

    2009-04-01

    Primary pulmonary artery sarcoma is a rare tumor that can be misdiagnosed as acute or chronic pulmonary thromboembolic disease. This article reports a patient with a preoperative diagnosis of pulmonary embolism who was found to have an extensive pulmonary artery tumor. Surgical resection of the primary pulmonary artery sarcoma and reconstruction of the central pulmonary arteries, followed by adjuvant chemoradiotherapy, provided significant improvement in his clinical symptoms.

  1. The surgical management of fibrous dysplasia of bone

    PubMed Central

    2012-01-01

    The surgical management of Polyostotic Fibrous Dysplasia (FD) of bone is technically demanding. The most effective methods to manage the associated bone deformity remain unclear. The marked variation in the degree and pattern of bone involvement has made it difficult to acquire data to guide the surgeon’s approach to these patients. In light of the paucity of data, but need for guidance, recognized experts in the management of these patients came together at the National Institutes of Health in Bethesda, Maryland as part of an International meeting to address issues related to fibrous dysplasia of bone to discuss and refine their recommendations regarding the surgical indications and preferred methods for the management of these challenging patients. The specific challenges, recommended approaches, and “lessons learned” are presented in hopes that surgeons faced with typical deformities can be guided in the surgical reconstruction of both children and adults with FD. PMID:22640754

  2. [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

  3. Surgical management of subcutaneous Colletotrichum gloeosporioides

    PubMed Central

    Allton, David R; Parvez, Najma; Ranganath, Sangeetha; Jinadatha, Chetan

    2015-01-01

    A 52-year-old male patient with a history of sarcoidosis and over 10 years of chronic low-dose glucocorticoid use, cirrhosis and type 2 diabetes mellitus presented with two painful, enlarging subcutaneous nodules ultimately identified as Colletotrichum gloeosporioides. Two attempts at needle aspiration of the larger nodule resulted in rapid reaccumulation. Complete surgical excision of both nodules resulted in complete resolution without the use of any concomitant antifungals. Patient had no recurrence at 2 years of follow-up. PMID:25737220

  4. Medical and surgical management of priapism

    PubMed Central

    Cherian, J; Rao, A R; Thwaini, A; Kapasi, F; Shergill, I S; Samman, R

    2006-01-01

    Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Pathologically and clinically, two subtypes are seen—the high flow (non‐ischaemic) variety and the low flow (ischaemic) priapism. The low flow type is more dangerous, as these patients are susceptible to greater complications and the long term recovery of erectile function is dependent on prompt and urgent intervention. Many of the causes of priapism are medical, including pharmacological agents, and as such, priapism should be considered as a medical and surgical emergency. PMID:16461470

  5. Surgical management of third nerve palsy

    PubMed Central

    Singh, Anupam; Bahuguna, Chirag; Nagpal, Ritu; Kumar, Barun

    2016-01-01

    Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell's phenomenon, superior oblique (SO) overaction, and lateral rectus (LR) contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%), trauma (20%), inflammation (13%), aneurysm (7%), and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension), aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles. PMID:27433033

  6. Managing alcohol related aggression in the emergency department (Part I).

    PubMed

    Ferns, Terry; Cork, Alison

    2008-01-01

    Internationally, violence in the emergency department (ED) is of a constant concern to emergency practitioners. Frequently, both original research papers and anecdotal reports emphasise the phenomenon of alcohol related aggression in the ED. In this first paper, we highlight the literatures discussion of alcohol related violence in the emergency department and the potential psychological effects of alcohol intoxication. In the second we offer personal and organisational strategies clinical nursing staff may consider appropriate to minimise the risk of assault when caring for service users projecting alcohol related aggression.

  7. Use of Emdogain enamel matrix proteins in the surgical treatment of aggressive periodontitis.

    PubMed

    Kiernicka, Małgorzata; Owczarek, Barbara; Gałkowska, Ewa; Wysokińska-Miszczuk, Joanna

    2003-01-01

    One of the ways of treating of the aggressive forms of periodontitis is the method of guided tissue regeneration using enamel matrix proteins included in Emdogain preparation. The aim of work was clinical evaluation of the complex treatment of those periodontolyses using the above mentioned material as the implant material. 35 intrabony pockets were operated in 11 patients aged 17-50. The treatment results were described with the use of clinical indices of API and SBI, indices of pockets depth PPD and the loss of the attachment CAL indices before and within the period of 8 to 12 months after the surgeries. The values of the examined features were submitted to statistical analysis using Shapiro-Wilks and Wilcoxon's tests. The treatment that was applied led to extremely statistically significant improvement of the examined parameters.

  8. A surgical approach in the management of mucormycosis in a trauma patient.

    PubMed

    Zahoor, B A; Piercey, J E; Wall, D R; Tetsworth, K D

    2016-11-01

    Mucormycosis as a consequence of trauma is a devastating complication; these infections are challenging to control, with a fatality rate approaching 96% in immunocompromised patients. We present a case where a proactive approach was successfully employed to treat mucormycosis following complex polytrauma. Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proved successful in this instance. In our opinion, mucormycosis in trauma mandates an aggressive surgical approach. This prevents ascending dissemination of mucormycosis and certainly reduces the risk of patient mortality as a direct result. Anti-fungal therapy should be used secondarily as an adjunct together with surgical debridement, or as an alternative when surgical intervention is not feasible.

  9. Surgical management of pancreatic cancer--pancreaticoduodenectomy.

    PubMed

    Donahue, Timothy R; Reber, Howard A

    2015-02-01

    Pancreaticoduodenectomy, the Whipple resection, is a complex operation that is commonly performed for patients with pancreatic ductal adenocarcinoma and other malignant or benign lesions in the head of the pancreas. It can be done with low morbidity and mortality rates, particularly when performed at high-volume hospitals and by high-volume surgeons. While it has been conventionally reserved for patients with early-stage malignant disease, it is being used increasingly for patients with locally extensive tumors who have undergone neoadjuvant therapy and downstaging. This article summarizes the role of pancreaticoduodenectomy for the treatment of patients with pancreatic cancer. It highlights the surgical staging of disease, the technical aspects of the operation and perioperative care, and the oncologic outcome.

  10. [Surgical and non-surgical management of primary hyperparathyroidism:How do calcimimetics work?

    PubMed

    Takeuchi, Yasuhiro

    2017-01-01

    Primary hyperparathyroidism is a common endocrine disease. The first line therapy for the disease is surgical removal of affected parathyroid gland(s). Other therapeutic options with medication are needed to be established, because many of patients with primary hyperparathyroidism have few or no symptoms and are expected to have a long life expectancy without surgery. Cinacalcet as a calcimimetic, bisphosphonates and denosumab are promising candidates for medical management of the disease. Effectiveness and efficiency of these drugs for patients with primary hyperparathyroidism is to be evaluated in comparison with surgical treatment.

  11. Management of refractory atrial fibrillation post surgical ablation

    PubMed Central

    Altman, Robert K.; Proietti, Riccardo; Barrett, Conor D.; Paoletti Perini, Alessandro; Santangeli, Pasquale; Danik, Stephan B.; Di Biase, Luigi

    2014-01-01

    Over the past two decades, invasive techniques to treat atrial fibrillation (AF) including catheter-based and surgical procedures have evolved along with our understanding of the pathophysiology of this arrhythmia. Surgical treatment of AF may be performed on patients undergoing cardiac surgery for other reasons (concomitant surgical ablation) or as a stand-alone procedure. Advances in technology and technique have made surgical intervention for AF more widespread. Despite improvements in outcome of both catheter-based and surgical treatment for AF, recurrence of atrial arrhythmias following initial invasive therapy may occur.Atrial arrhythmias may occur early or late in the post-operative course after surgical ablation. Early arrhythmias are generally treated with prompt electrical cardioversion with or without antiarrhythmic therapy and do not necessarily represent treatment failure. The mechanism of persistent or late occurring atrial arrhythmias is complex, and these arrhythmias may be resistant to antiarrhythmic drug therapy. The characterization and management of recurrent atrial arrhythmias following surgical ablation of AF are discussed below. PMID:24516805

  12. Anticoagulation management in the ambulatory surgical setting.

    PubMed

    Eisenstein, Diana Hill

    2012-04-01

    Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers.

  13. Effect of anger management education on mental health and aggression of prisoner women

    PubMed Central

    Bahrami, Elaheh; Mazaheri, Maryam Amidi; Hasanzadeh, Akbar

    2016-01-01

    Background and Purpose: “Uncontrolled anger” threats the compatible and health of people as serious risk. The effects of weaknesses and shortcomings in the management of anger, from personal distress and destruction interpersonal relationships beyond and linked to the public health problems, lack of compromises, and aggressive behavior adverse outcomes. This study investigates the effects of anger management education on mental health and aggression of prisoner women in Isfahan. Materials and Methods: The single-group quasi-experimental (pretest, posttest) by prisoner women in the central prison of Isfahan was done. Multi-stage random sampling method was used. Initially, 165 women were selected randomly and completed the Buss and Perry Aggression Questionnaire and the General Health Questionnaire-28, and among these, those with scores >78 (the cut point) in aggression scale was selected and among them 70 were randomly selected. In the next step, interventions in four 90 min training sessions were conducted. Posttest was performed within 1-month after the intervention. Data were analyzed using SPSS-20 software. Results: Data analysis showed that anger management training was effective in reducing aggression (P < 0.001) and also had a positive effect on mental health (P < 0.001). Conclusion: According to the importance of aggression in consistency and individual and collective health and according to findings, presented educational programs on anger management is essential for female prisoners. PMID:27512697

  14. 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.

  15. Surgical management of congenital coronary artery fistulas.

    PubMed Central

    Lowe, J E; Oldham, H N; Sabiston, D C

    1981-01-01

    Congenital fistulas are the most common of the coronary arterial malformations and with the widespread use of selective coronary arteriography are being recognized with increasing frequency. Twenty-eight patients with congenital coronary fistulas have been evaluated at the Duke University Medical Center between 1960 and 1981. An additional 258 patients have previously been reported in the literature, making a total of 286 available for review. The right coronary artery is most commonly involved, and the fistulous communication is most often to the right ventricle, right atrium or pulmonary artery. Slightly more than half of the patients with coronary fistulas are symptomatic at the time the diagnosis is made. Surgical correction is strongly recommended to prevent the development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and pulmonary hypertension, as well as coronary aneurysm formation, with subsequent rupture or embolization. There were no operative or late deaths in the patients who underwent operations. Moreover, there have been no recurrent fistulas during a mean follow-up period of ten years. The risks of operative correction appear to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients. Images Fig. 2a. Fig. 2b. Fig. 3. PMID:7283502

  16. Managing alcohol related aggression in the emergency department (Part II).

    PubMed

    Cork, Alison; Ferns, Terry

    2008-04-01

    Violence in the emergency department (ED) is a global problem. In our first paper, we highlighted the potential psychological effects of alcohol intoxication, the literatures discussion of alcohol related violence in the emergency department and the importance of developing positive nurse/service user relationships. In this second paper, we discuss personal and organisational strategies clinical nursing staff may consider appropriate to minimise the risk of assault when caring for service users projecting alcohol related aggression.

  17. Surgical Management of Ear Diseases in Rabbits.

    PubMed

    Csomos, Rebecca; Bosscher, Georgia; Mans, Christoph; Hardie, Robert

    2016-01-01

    Otitis externa and media are frequently diagnosed disorders in rabbits and are particularly common in lop-eared breeds because of the specific anatomy of the ear canal. Medical management for otitis externa and media often provides only a temporary improvement in clinical signs. Surgery by means of partial or total ear canal ablation (PECA or TECA) combined with lateral bulla osteotomy (LBO) represents a feasible approach that is well tolerated and provides a good clinical outcome. Short-term complications associated with PECA/TECA-LBO include facial nerve paralysis and vestibular disease.

  18. Surgical Management of Patulous Eustachian Tube: A Systematic Review

    PubMed Central

    Hussein, Ahmed A.; Adams, Austin; Turner, Justin H.

    2016-01-01

    Objectives Patulous Eustachian tube (PET) is a challenging clinical problem with limited medical and surgical options. The current study systematically reviews the literature to determine the safety and efficacy of surgical treatments for PET. Data Sources Medline, Google Scholar, and Cochrane databases. Methods Studies evaluating the surgical management of PET were extracted based on defined inclusion criteria. Data including surgical techniques, outcomes, and complications were extracted and analyzed. Results 1616 studies were retrieved from the initial search. Fourteen studies comprising a total of 226 patients (253 sides) met inclusion criteria and were evaluated for surgical techniques, patient outcomes and complications. All studies were classified as Level 4 evidence per definition provided by the Oxford Center for Evidence Based Medicine. The most commonly reported techniques were ET plugging (3 studies), PE tube placement (2 studies), and suture ligation (2 studies). Postoperative follow-up ranged from 2 to 60 months (mean, 20.6 months). Outcome measures varied significantly between individual studies, with overall symptom improvement reported at between 22% and 100% (mean 72.4%, 95% CI 62.5% - 81.2%). A low incidence of minor complications was reported in 9 of 14 studies. Conclusions Current literature evaluating the surgical management of PET is limited and comprised entirely of Level 4 studies. Comparisons between techniques were not possible due to the small number of studies and variable outcome measures. Future larger studies evaluating defined outcomes and quality of life measures are needed to determine the comparative efficacy of surgical treatments for this challenging condition. PMID:25646902

  19. Surgical management of urolithiasis in spinal cord injury patients.

    PubMed

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

    2014-06-01

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

  20. Managing Complex Environmental Remediation amidst Aggressive Facility Revitalization Milestones

    SciTech Connect

    Richter Pack, S.

    2008-07-01

    Unlike the final closure projects at Rocky Flats and Fernald, many of the Department of Energy's future CERCLA and RCRA closure challenges will take place at active facilities, such as the Oak Ridge National Laboratory (ORNL) central campus. ORNL has aggressive growth plans for a Research Technology Park and cleanup must address and integrate D and D, soil and groundwater remediation, and on-going and future business plans for the Park. Different planning and tracking tools are needed to support closures at active facilities. To support some large Airport redevelopment efforts, we created tools that allowed the Airline lease-holder to perform environmental remediation on the same schedule as building D and D and new building construction, which in turn allowed them to migrate real estate from unusable to usable within an aggressive schedule. In summary: The FIM and OpenGate{sup TM} spatial analysis system were two primary tools developed to support simultaneous environmental remediation, D and D, and construction efforts at an operating facility. These tools helped redevelopers to deal with environmental remediation on the same schedule as building D and D and construction, thereby meeting their goals of opening gates, restarting their revenue streams, at the same time complying with all environmental regulations. (authors)

  1. Aggression in Tephritidae Flies: Where, When, Why? Future Directions for Research in Integrated Pest Management.

    PubMed

    Benelli, Giovanni

    2014-12-30

    True fruit flies (Diptera: Tephritidae) include over 4000 species, many of which constitute enormous threats to fruit and vegetable production worldwide. A number of Tephritidae are lekking species, forming aggregations in which males fight to defend a small territory where they court females and mate. Male-male contests also occur in non-lekking species, characterized by resource defense polygyny. Tephritidae females display agonistic behavior to maintain single oviposition sites and reduce larval competition for food. Here, how, where, when and why aggressive interactions occur in Tephritidae flies is reviewed. A number of neglected issues deserving further research are highlighted, with a special focus on diel periodicity of aggression, cues evoking aggressive behavior, the role of previous experience on fighting success and the evolution of behavioral lateralization of aggressive displays. In the final section, future directions to exploit this knowledge in Integrated Pest Management, with particular emphasis on enhancement of Sterile Insect Technique and interspecific competitive displacement in the field are suggested.

  2. Mothers' Management of Adolescent Peer Relationships: Associations With Aggressive, Prosocial, and Playful Behavior.

    PubMed

    Gerardy, Haeli; Mounts, Nina S; Luckner, Amy E; Valentiner, David P

    2015-01-01

    The authors examined the relation between adolescents' reports of mothers' management of peer relationships and adolescents' reports of their own aggressive, prosocial, and playful behaviors. The sample comprised 92 adolescents (M age = 15.41 years, SD = 1.81 years) enrolled in a residential summer camp. Higher levels of consulting were related to lower levels of adolescents' relational aggression, physical aggression, playful teasing, and rough-and-tumble play. Higher levels of consulting were related to higher levels of prosocial behavior. Higher levels of guiding were related to higher levels of adolescents' relational aggression and social inclusion. Higher levels of granting access to peers were related to higher levels of adolescents' prosocial behavior and social inclusion. Moderate levels of granting access to peers were related higher levels of playful teasing.

  3. Surgical management of posterior fossa metastases.

    PubMed

    Sunderland, Geraint J; Jenkinson, Michael D; Zakaria, Rasheed

    2016-12-01

    The diagnosis of brain metastases is associated with a poor prognosis reflecting uncontrolled primary disease that has spread to the relative sanctuary of the central nervous system. 20 % of brain metastases occur in the posterior fossa and are associated with significant morbidity. The risk of acute hydrocephalus and potential for sudden death means these metastases are often dealt with as emergency cases. This approach means a full pre-operative assessment and staging of underlying disease may be neglected and a proportion of patients undergo comparatively high risk surgery with little or no survival benefit. This study aimed to assess outcomes in patients to identify factors that may assist in case selection. We report a retrospective case series of 92 consecutive patients operated for posterior fossa metastases between 2007 and 2012. Routine demographic data was collected plus data on performance status, primary cancer site, details of surgery, adjuvant treatment and survival. The only independent positive prognostic factors identified on multivariate analysis were good performance status (if Karnofsky performance score >70, hazard ratio (HR) for death 0.36, 95 % confidence interval (CI) 0.18-0.69), adjuvant whole brain radiotherapy (HR 0.37, 95 % CI 0.21-0.65) and adjuvant chemotherapy where there was extracranial disease and non-synchronous presentation (HR 0.51, 95 % CI 0.31-0.82). Patients presenting with posterior fossa metastases may not be investigated as thoroughly as those with supratentorial tumours. Staging and assessment is essential however, and in the meantime emergencies related to tumour mass effect should be managed with steroids and cerebrospinal fluid diversion as required.

  4. Sublingual ranula: a closer look to its surgical management.

    PubMed

    Mortellaro, Carmen; Dall'Oca, Susanna; Lucchina, Alberta Greco; Castiglia, Antonino; Farronato, Gianpietro; Fenini, Emanuele; Marenzi, Gaetano; Trosino, Oreste; Cafiero, Carlo; Sammartino, Gilberto

    2008-01-01

    Ranulas have been managed by various surgical methods, and the optimal treatment is still controversial. The aim of this study was to analyze a group of 124 surgically treated patients with intraoral ranula to assess 3 different methods: sublingual gland removal combined with the ranula excision, conventional marsupialization, and a variant of the marsupialization technique usually performed in our departments. Recurrence rate was 0% after radical treatment, 25.8% after marsupialization, and 12% after modified marsupialization. We suggest that conservative methods should always be considered as treatment of superficial oral ranulas. The modification of the conventional marsupialization by suturing the edges of the pseudocyst before unroofing of the lesion was demonstrated to be a useful technical strategy that simplifies and accelerates the surgical procedures and probably contributed to preventing recurrences.

  5. Surgical management of major congenital malformations of the ear.

    PubMed

    Chiossone, E

    1985-05-01

    Surgical management of major congenital malformations of the ear is a difficult and complex procedure. The risk of damaging middle and inner ear structures because of their frequently aberrant location, the failure to keep a patent ear canal over the long term, and the difficulty in achieving a good hearing result all challenge the otologic surgeon. The purpose of this study was to analyze the results obtained with a surgical technique developed to prevent postoperative stenosis or total closure of the newly formed auditory meatus and to achieve at least serviceable hearing in the majority of cases. Emphasis is placed on the selection of surgical cases based on a classification that evaluates, through x-ray tomograms, the anatomic relation of the glenoid fossa of the temporomandibular joint to the middle ear space. Anatomic and functional results are presented. Comments are made in regard to different possibilities of reconstruction of the sound conducting mechanism.

  6. Congenital Upper Eyelid Coloboma: Clinical and Surgical Management.

    PubMed

    Ortega Molina, José María; Mora Horna, Eduardo Ramón; Salgado Miranda, Andrés David; Rubio, Rosa; Solans Pérez de Larraya, Ana; Salcedo Casillas, Guillermo

    2015-01-01

    Purpose. The goal was to describe our experience in the surgical management and treatment of four patients with congenital upper eyelid colobomas. Methods. A descriptive, observational, retrospective study was performed including patients with congenital eyelid colobomas referred to Asociación para Evitar la Ceguera en México I.A.P. "Dr. Luis Sánchez Bulnes" between 2004 and 2014 and assessed by the Oculoplastics and Orbit Service. Results. The four cases required surgical treatment of the eyelid defects before one year of age and their evolution was monitored from the time of referral to the present day. One of the patients needed a second surgical procedure to repair the eyelid defect and correct the strabismus. Conclusions. Eyelid colobomas are a potential threat to vision at an early age, which requires close monitoring of the visual development of patients.

  7. Congenital Upper Eyelid Coloboma: Clinical and Surgical Management

    PubMed Central

    Ortega Molina, José María; Mora Horna, Eduardo Ramón; Salgado Miranda, Andrés David; Rubio, Rosa; Solans Pérez de Larraya, Ana; Salcedo Casillas, Guillermo

    2015-01-01

    Purpose. The goal was to describe our experience in the surgical management and treatment of four patients with congenital upper eyelid colobomas. Methods. A descriptive, observational, retrospective study was performed including patients with congenital eyelid colobomas referred to Asociación para Evitar la Ceguera en México I.A.P. “Dr. Luis Sánchez Bulnes” between 2004 and 2014 and assessed by the Oculoplastics and Orbit Service. Results. The four cases required surgical treatment of the eyelid defects before one year of age and their evolution was monitored from the time of referral to the present day. One of the patients needed a second surgical procedure to repair the eyelid defect and correct the strabismus. Conclusions. Eyelid colobomas are a potential threat to vision at an early age, which requires close monitoring of the visual development of patients. PMID:26366313

  8. Surgical management of abdominal and retroperitoneal Castleman's disease

    PubMed Central

    Bucher, Pascal; Chassot, Gilles; Zufferey, Guillaume; Ris, Frederic; Huber, Olivier; Morel, Philippe

    2005-01-01

    Background Abdominal and retroperitoneal Castleman's disease could present either as a localized disease or as a systemic disease. Castleman's disease is a lymphoid hyperplasia related to human Herpes virus type 8, which could have an aggressive behavior, similar to that of malignant lymphoid neoplasm mainly with the systemic type, or a benign one in its localized form. Methods The authors report two cases of localized Castleman's disease in the retroperitoneal space and review the current and recent progress in the knowledge of this atypical disease. Cases presentation The two patients were young healthy women presenting with a hyper vascular peri-renal mass suggestive of malignant tumor. Both have been resected in-toto. One of them had an extensive resection with nephrectomy, while the second had a kidney preserving surgery. Pathological examination revealed localized Castleman's disease and surgical margins were free of disease. Postoperative course was uneventful, and after more than 5-years of follow-up no recurrences have been observed. Conclusion Localized Castleman's disease should be considered when facing a solid hypervascular abdominal or retroperitoneal mass. A better knowledge of this disorder and its characteristic would help surgeon to avoid unnecessarily extensive resection for this benign disorder when dealing with abdominal or retroperitoneal tumors. Surgical resection is curative for the localized form, when complete, while splenectomy could be indicated for the systemic form. PMID:15941478

  9. Surgical resolution of an aggressive iatrogenic root perforation in a maxillary central incisor: a case report with a 4-year follow-up.

    PubMed

    Machado, Ricardo; Agnoletto, Marcelo; Engelke Back, Eduardo Donato Eing; Tomazinho, Luiz Fernando; Paganini, Fabricio Abel; Vansan, Luiz Pascoal

    2017-01-01

    The prognosis of teeth with root perforations depends on several factors, including size, location, and time since occurrence. Root perforations are clinical situations that can be solved by either nonsurgical or surgical approaches. The purpose of this article is to present a case of an aggressive iatrogenic root perforation in a maxillary right central incisor solved surgically using mineral trioxide aggregate (MTA). Even in an unfavorable situation, MTA was able to induce new bone formation and reestablish gingival and periodontal health, as confirmed in follow-up examinations at 2 and 4 years.

  10. Electrolyte derangement in cerebral malaria: a case for a more aggressive approach to the management of hyponatraemia.

    PubMed

    Enwere, G C; Ota, M O; Obaro, S K

    2000-09-01

    Although hyponatraemia has been consistently shown to occur in a large proportion of children with cerebral malaria, no statistical relationship has been established between the incidence of hyponatraemia and that of malaria-attributable mortality. However, hyponatraemia is not a benign state in other conditions (such as meningitis) or in surgical patients, and is likely to add to malarial deaths. The high mortality rate seen among cases of cerebral malaria, despite all efforts to curb it, therefore calls for a more aggressive approach to the management of hyponatraemia. Current methods for the administration of hypotonic saline and isotonic glucose solutions need review. In addition, children admitted with cerebral malaria should have their electrolyte status monitored to identify new or ongoing hyponatraemia. When hyponatraemia is discovered, it should be quickly and actively corrected.

  11. Successful Surgical Management of Retinopathy of Prematurity Showing Rapid Progression despite Extensive Retinal Photocoagulation

    PubMed Central

    Gadkari, Salil S; Kulkarni, Sucheta R; Kamdar, Rushita R; Deshpande, Madan

    2015-01-01

    The management of retinopathy of prematurity (ROP) can be challenging in preterm babies with a gestational age <30 weeks, those with very low birth weight and multiple risk factors (eg., oxygen therapy for respiratory distress, sepsis, neonatal jaundice). A premature infant presented with “hybrid” zone 1 disease in the right eye and aggressive posterior ROP in the left eye. Both eyes were adequately treated with laser photocoagulation; however, the eyes deteriorated and progressed to stage 4 ROP. Both eyes eventually underwent intravitreal bevacizumab followed by lens sparing vitrectomy with good anatomical and visual outcome. Anticipation of progression despite laser photocoagulation in certain clinical scenarios, frequent follow-up and timely surgical intervention is paramount. PMID:26180484

  12. Surgical Management of Recurrent Musculotendinous Hamstring Injury in Professional Athletes

    PubMed Central

    Sonnery-Cottet, Bertrand; Daggett, Matt; Gardon, Roland; Pupim, Barbara; Clechet, Julien; Thaunat, Mathieu

    2015-01-01

    Background: Hamstring injury is the most common muscular lesion in athletes. The conservative treatment is well described, and surgical management is often indicated for proximal tendinous avulsions. To our knowledge, no surgical treatment has been proposed for failure of conservative treatment in musculotendinous hamstring lesions. Purpose: To describe the surgical management of proximal and distal hamstring musculotendinous junction lesions in professional athletes after failure of conservative treatment. Study Design: Case series; Level of evidence, 4. Methods: A consecutive series of 10 professional athletes, including 4 soccer players, 4 rugby players, and 2 handball players, underwent surgical intervention between October 2010 and June 2014 for the treatment of recurrent musculotendinous hamstring injuries. All athletes had failed at least 3 months of conservative treatment for a recurrent musculotendinous hamstring injury. Surgical resection of the musculotendinous scar tissue was performed using a longitudinal muscular suture. Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at the 3-month follow-up, and a final phone interview was completed to determine recurrence of hamstring injury and return to previous level of play. Results: The mean age at surgery was 25.2 years (range, 19-35 years). The musculotendinous hamstring lesions involved 8 semitendinosus and 2 biceps femoris, with 6 injuries located proximally and 4 distally. Conservative treatment lasted a mean 5.1 months (range, 3-9 months) after last recurrence, and the patients had an average of 2.7 (range, 2-5) separate incidents of injury recurrence before surgical intervention was decided upon. At the 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. All 10 patients returned to the same level of play at a mean 3.4 months (range, 2-5 months). At a mean follow-up of 28.7 months, none of the athletes had suffered a recurrence. No surgical

  13. Modified Surgical Techniques for Managing Intraoperative Floppy Iris Syndrome

    PubMed Central

    Charukamnoetkanok, Puwat

    2016-01-01

    Purpose. To report a modified surgical strategy in the management of intraoperative floppy iris syndrome-associated iris prolapse. Methods. Prolapsed iris is left as is and a new corneal incision near the original wound but at a different site is created. Depending on the location of the original incision and the surgeon's preference, this additional incision can be used as a new port for phacoemulsification tip or can be the new site for the iris to securely prolapse, allowing for the surgery to proceed safely. Results. We present 2 cases of iris prolapse and inadequate pupil dilation in patients with IFIS. Along with our modified technique, additional iris retractors were placed to increase the workspace for the phacoemulsification tip. The cataract surgery was performed successfully without further complications in both cases. Conclusion. This surgical technique could be an adjunct to allow the surgeons to expand the armamentarium for the management of IFIS-associated iris prolapse. PMID:27999697

  14. Should I fight or should I flight? How studying insect aggression can help integrated pest management.

    PubMed

    Benelli, Giovanni

    2015-07-01

    Aggression plays a key role all across the animal kingdom, as it allows the acquisition and/or defence of limited resources (food, mates and territories) in a huge number of species. A large part of our knowledge on aggressive behaviour has been developed on insects of economic importance. How can this knowledge be exploited to enhance integrated pest management? Here, I highlight how knowledge on intraspecific aggression can help IPM both in terms of insect pests (with a focus on the enhancement of the sterile insect technique) and in terms of biological control agents (with a focus on mass-rearing optimisation). Then, I examine what implications for IPM can be outlined from knowledge about interspecific aggressive behaviour. Besides predator-pest aggressive interactions predicted by classic biological control, I focus on what IPM can learn from (i) interspecific aggression among pest species (with special reference to competitive displacement), (ii) defensive behaviour exhibited by prey against predaceous insects and (iii) conflicts among predaceous arthropods sharing the same trophic niche (with special reference to learning/sensitisation practices and artificial manipulation of chemically mediated interactions).

  15. Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring.

    PubMed

    Moscote-Salazar, Luis Rafael; M Rubiano, Andres; Alvis-Miranda, Hernando Raphael; Calderon-Miranda, Willem; Alcala-Cerra, Gabriel; Blancas Rivera, Marco Antonio; Agrawal, Amit

    2016-01-01

    Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.

  16. Severe Cranioencephalic Trauma: Prehospital Care, Surgical Management and Multimodal Monitoring

    PubMed Central

    Moscote-Salazar, Luis Rafael; M. Rubiano, Andres; Alvis-Miranda, Hernando Raphael; Calderon-Miranda, Willem; Alcala-Cerra, Gabriel; Blancas Rivera, Marco Antonio; Agrawal, Amit

    2016-01-01

    Traumatic brain injury is a leading cause of death in developed countries. It is estimated that only in the United States about 100,000 people die annually in parallel among the survivors there is a significant number of people with disabilities with significant costs for the health system. It has been determined that after moderate and severe traumatic injury, brain parenchyma is affected by more than 55% of cases. Head trauma management is critical is the emergency services worldwide. We present a review of the literature regarding the prehospital care, surgical management and intensive care monitoring of the patients with severe cranioecephalic trauma.  PMID:27162922

  17. Peer with Intellectual Disabilities as a Mindfulness-Based Anger and Aggression Management Therapist

    ERIC Educational Resources Information Center

    Singh, Nirbhay N.; Lancioni, Giulio E.; Winton, Alan S. W.; Singh, Judy; Singh, Ashvind N. A.; Singh, Angela D. A.

    2011-01-01

    A young man with intellectual disabilities (ID) and mental illness, who had previously been taught to successfully manage his aggressive behavior by using "Meditation on the Soles of the Feet," reported that he shared his mindfulness practice with his peers with ID. When requested by his peers, and without any training as a therapist, he began to…

  18. Reasons for Aggressive Classroom Management and Directions for Change through Teachers' Professional Development Programmes

    ERIC Educational Resources Information Center

    Romi, Shlomo; Salkovsky, Merav; Lewis, Ramon

    2016-01-01

    This investigation was designed to determine whether there are significant relationships between the reasons teachers provide for aggressive classroom management techniques and the type of professional education created to help them reduce their reliance on such techniques. The study reports data from a survey of 192 Australian teachers showing…

  19. Aggression Management Training for Youth in Behaviour Schools: A Quasi-Experimental Study

    ERIC Educational Resources Information Center

    Wheatley, Anna; Murrihy, Rachael; van Kessel, Jacobine; Wuthrich, Viviana; Remond, Louise; Tuqiri, Rebekka; Dadds, Mark; Kidman, Antony

    2009-01-01

    A 16-week, bi-weekly, cognitive behavioural therapy (CBT)-based aggression management training course was conducted with a limited sample of behavioural school students in New South Wales. Attendance, withdrawal and suspension rates over the training period were compared to those of a control period. Parent and teacher feedback, assessed at pre-…

  20. Laryngotracheal stenosis: clinical profile, surgical management and outcome.

    PubMed

    Pookamala, S; Kumar, Rakesh; Thakar, Alok; Venkata Karthikeyan, C; Bhalla, Ashu Seith; Deka, R C

    2014-01-01

    Despite the availability of various surgical options, management of laryngotracheal stenosis (LTS) still remains an enigma. Proper selection of surgical technique in each clinical setting is the key for successful outcome. The purpose of this article is to guide one in selection of appropriate surgical procedures depending upon various stenosis parameters. Aim To record the clinical profile of cases with LTS. To assess the outcome following various surgical interventions based on site, severity, cause of stenosis and to derive conclusions regarding treatment options in various stenosis. Materials and Methods It is a study of 60 cases with chronic LTS. It includes retrospective study of 30 cases treated from 2004 and prospective study of 30 cases from Jan 2007 to Dec 2009. A total of 60 cases with LTS were enrolled in the study. Patients were assessed clinically by eliciting detailed history and analyzing previous records. After assessment of extent of stenosis, they were subjected to surgical interventions (endoscopic/open approach). Outcome after surgical interventions was assessed. Results 60 patients were included in the study, in the age group of 2.5-50 years. There were 46 (77%) male patients and 14 (23%) female patients. Intrinsic trauma, secondary to prolonged intubation was the most common cause of LTS, seen in 23 (38%) cases followed by post traumatic stenosis (strangulation-18 (30%), blunt injury-15 (25%), penetrating neck injury-4 (7%)). Stenosis was divided into 6 types based on subsite involvement. Of which, cervical trachea was the commonest site of involvement (25/60 cases). Majority of cases had fixed vocal cords at presentation (55%), more commonly due to post traumatic injury. 60 cases had undergone a total of 110 surgical procedures (endoscopic-56,open approach-54). In the end, overall decannulation rate is 93.3%. In site wise tracheal stenosis, isolated subglottis, combined glottis and subglottic stenosis had decannulation rate of 100% each and

  1. Modern approaches to non-surgical biofilm management.

    PubMed

    Apatzidou, Danae Anastasia

    2012-01-01

    The subgingival dental plaque is a microbial biofilm consisting of highly variable bacterial microcolonies embedded within a self-produced matrix of extracellular polymeric substance. In contrast to microorganisms growing in a planktonic state, the inhabitants of a biofilm are effectively protected within this dense structure from host defense mechanisms and from therapeutic agents, including antimicrobials. The mechanical removal of the microbial biofilm and the establishment of meticulous plaque control measures comprise the key elements for the success of non-surgical periodontal treatment. Ultrasonic devices are effective in disrupting the biofilm, and carefully remove soft and hard deposits from a root surface with minimal trauma to the tooth structure. Controversies and modern trends in non-surgical periodontal therapy - such as quadrant-wise treatment modalities versus full-mouth approaches, hand-versus power-driven instrumentation, and the time frame of non-surgical periodontal therapy - are discussed here in depth in order to provide an insight into modern approaches to non-surgical biofilm management. Clinical, microbiological and immunological findings following different treatment protocols, in addition to cost-effective benefits of these clinical modalities, are discussed.

  2. Pain assessment and management in surgical nursing: a literature review.

    PubMed

    Bell, Liz; Duffy, Anita

    Although postoperative pain assessment and management is an integral part of surgical nursing practice, it remains ad hoc despite numerous costly empirical research studies. Patients have a right to pain relief; however, the barriers to assessing and managing patient pain in practice have not as yet been overcome. A literature review to establish the main barriers to effective postoperative pain relief in clinical practice was carried out. The findings suggest that time management, and attitudes and beliefs of both patients and nurses are significant factors hampering practice. The authors conclude that future research in this area is futile, and suggest that nurses should focus on auditing their own practice to improve the effectiveness of pain management in practice and enhance standards of care.

  3. Causes and management of aggression and violence in a forensic mental health service: perspectives of nurses and patients.

    PubMed

    Dickens, Geoffrey; Piccirillo, Maria; Alderman, Nick

    2013-12-01

    Nurses' attitudes about the causes and management of aggression affects their choice of intervention. We aimed to compare the attitudes held by patients and staff in a forensic mental health service with the Management of Aggression and Violence Attitudes Scale, and examine the factor validity of the tool in this setting by conducting a prospective comparative questionnaire survey. Staff (n = 72) and patient (n = 98) attitudes differed to a limited extent. Confirmatory factor analysis refuted the previously reported structure of the tool. Exploratory factor analysis suggested three underlying factors related to modifiability of aggression, hands on management, and hands off management. Patients were more optimistic than nurses about the modifiability of aggressive behaviour. Male patients and those with diagnoses other than personality disorder were significantly more likely to agree about modifiability than controls. Forensic inpatients recognize the need for the use of a range of techniques to prevent and manage aggression and violence, but selected groups are most likely to believe that aggression is modifiable. Prevention and management of aggression training should emphasize the modifiability of aggressive behaviour. The development of measures of modifiability and management style would assist in the evaluation of training and would offer new avenues for research.

  4. Surgical management of postpartum haemorrhage: survey of French obstetricians

    PubMed Central

    Bouet, Pierre-Emmanuel; Brun, Stéphanie; Madar, Hugo; Schinkel, Elsa; Merlot, Benjamin; Sentilhes, Loïc

    2016-01-01

    The aim of our study was to assess the theoretical and practical knowledge of French obstetricians about the surgical management of postpartum haemorrhage (PPH). Our study is a national anonymous self-administered survey. A total of 363 obstetricians responded to this questionnaire between December 2013 and April 2014. Questionnaire sent through email to all French obstetricians who are members of either of two federations of hospital-based obstetricians. Answers were collected until the end of June 2014. The main outcome measure was obstetricians’ level of mastery of each surgical technique. The results were analysed descriptively (proportions). Only the 286 questionnaires fully completed were analysed; the complete response rate was 23% (286/1246). In all, 33% (95/286) of the responding obstetricians reported that they had not mastered sufficiently or even at all the technique for bilateral ligation of the uterine arteries, 37% (105/286) for uterine compression suture, 62% (178/286) for ligation of the internal iliac arteries, and 47% (134/286) for emergency peripartum hysterectomy. In all, 18% (52/286) of respondents stated that they had not mastered any of these techniques. Our study shows that a worrisome number of French obstetricians reported insufficient mastery of the surgical techniques for PPH management. PMID:27460158

  5. Ovarian Mature Cystic Teratoma: Challenges of Surgical Management

    PubMed Central

    Sinha, Abha; Ewies, Ayman A. A.

    2016-01-01

    Although ovarian mature cystic teratomas are the commonest adnexal masses occurring in premenopausal women, there are many challenges faced by gynecologists on deciding upon the best surgical management. There is uncertainty, lack of consensus, and variation in surgical practices. This paper critically analyzes various surgical approaches and techniques used to treat these cysts in an attempt to outline a unified guidance. MEDLINE and EMBASE databases were searched in January 2015 with no date limit using the key words “ovarian teratoma” and “ovarian dermoid.” The search was limited to articles in English language, humans, and female. The two authors conducted the search independently. The laparoscopic approach is generally considered to be the gold standard for the management. Oophorectomy should be the standard operation except in younger women with a single small cyst. The risk of chemical peritonitis after contents spillage is extremely rare and can certainly be overcome with thorough peritoneal lavage using warmed fluid. There is a place for surveillance in some selected cases. PMID:27110246

  6. Clinical Characteristics, Surgical Management and Adjuvant Therapy of Patients with Uterine Carcinosarcoma: A Retrospective Case Series

    PubMed Central

    Wallwiener, C.; Hartkopf, A.; Kommoss, S.; Joachim, C.; Wallwiener, M.; Taran, F. A.; Brucker, S.

    2016-01-01

    Purpose: To review a single-center experience over a 27-year period of managing uterine carcinosarcoma (UCS), focusing on surgical practice, adjuvant therapy and clinical outcome. Material and Methods: This was a retrospective study of women with histologically proven UCS treated at the Department of Obstetrics and Gynecology, University of Tübingen, Germany, between 1983 and 2010. Inpatient and outpatient records were reviewed; follow-up and survival data were ascertained. Results: The study population comprised 18 patients with UCS. Primary surgical treatment consisted of total abdominal hysterectomy in 12 patients (67 %) and laparoscopic total hysterectomy in 4 patients (22 %). Bilateral salpingo-oophorectomy was performed in 94 % of patients (17/18). Lymph nodes were evaluated in 15 patients (83 %). Positive pelvic lymph nodes were present in 2 patients (11 %). A total of 17 patients (94 %) received adjuvant therapy. Disease recurred in 7 (39 %) patients of our study group, with no recurrence noted in the 4 patients who underwent laparoscopic surgical staging. Median disease-free survival (DFS) was 48.7 months (95 % CI: 0.0–157.3) and median overall survival (OS) was 49.9 months (95 % CI: 0.0–108.2). The 5-year survival rate was 40 %. Conclusion: UCS is a rare and aggressive uterine neoplasm with high recurrence rates and metastatic potential. Surgical staging consisting of total hysterectomy with bilateral salpingo-oophorectomy and systematic lymphadenectomy is the most important treatment for patients with UCS. Adjuvant radiation therapy appears to decrease pelvic recurrence, but there is a high incidence of distant recurrence, indicating the need for additional systemic treatment. PMID:26941453

  7. Surgical Management of Rhinosinusitis in Onco-Hematological Patients

    PubMed Central

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

    2014-01-01

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

  8. Managing disorder of sexual development surgically: A single center experience

    PubMed Central

    Kumar, Jatinder; Kumar, Vikas; Bhatia, Vijaylakshmi; Dabadghao, Preeti; Chaturvedi, Samit; Kapoor, Rakesh; Ansari, M. S.

    2012-01-01

    Introduction: Ambiguous genitalia are a major cause of parental anxiety and create psychological and social problems to patient, if not managed properly. Here we present our experience in managing patients with ambiguous genitalia. Material and Methods: We retrospectively reviewed clinical records of all patients with ambiguous genitalia managed surgically at out institute between December 1989 and January 2011. Relevant history, clinical examination, investigations and surgical procedures performed were analyzed and results were evaluated in terms of anatomical, functional and psychosexual outcomes. Results: Female pseudohermaphroditism was the most common cause of genital ambiguity in our patients. Male and female genitoplasty was done according to gender of rearing, genital anatomy and parental choice. Twenty six patients (86.6%) reported satisfactory cosmetic outcome and 22 (73.3%) satisfactory functional outcome on long term follow-up. Among the 24 patients diagnosed as male pseudohermaphroditism 14 (82.3%) patient have reported satisfactory cosmetic outcome and 13 (76.4%) have reported satisfactory functional outcome. In patients with mixed gonadal dysgenesis and true hermaphroditism satisfactory cosmetic and functional outcome was seen in 70% patient. Conclusion: Managing patients of genital ambiguity according to gender of rearing, genital anatomy and parental choice carries good prognosis in terms of anatomical, functional and psychosexual outcome. PMID:23204656

  9. Coronary Arteriovenous Fistulas in Adult Patients: Surgical Management and Outcomes

    PubMed Central

    Albeyoglu, Sebnem; Aldag, Mustafa; Ciloglu, Ufuk; Sargin, Murat; Oz, Tugba Kemaloglu; Kutlu, Hakan; Dagsali, Sabri

    2017-01-01

    Objective The aim of this study was to describe the demographic, clinical and anatomic characteristics of coronary arteriovenous fistulas in adult patients who underwent open cardiac surgery and to review surgical management and outcomes. Methods Twenty-one adult patients (12 female, 9 male; mean age: 56.1±7.9 years) who underwent surgical treatment for coronary arteriovenous fistulas were retrospectively included in this study. Coronary angiography, chest X-ray, electrocardiography and transthoracic echocardiography were preoperatively performed in all patients. Demographic and clinical data were also collected. Postoperative courses of all patients were monitored and postoperative complications were noted. Results A total of 25 coronary arteriovenous fistulas were detected in 21 patients; the fistulas originated mainly from left anterior descending artery (n=9, 42.8%). Four (19.4%) patients had bilateral fistulas originating from both left anterior descending and right coronary artery. The main drainage site of coronary arteriovenous fistulas was the pulmonary artery (n=18, 85.7%). Twelve (57.1%) patients had isolated coronary arteriovenous fistulas and 4 (19.4%), concomitant coronary artery disease. Twenty (95.3%) of all patients were symptomatic. Seventeen patients were operated on with and 4 without cardiopulmonary bypass. There was no mortality. Three patients had postoperative atrial fibrillation. One patient had pericardial effusion causing cardiac tamponade who underwent reoperation. Conclusion The decision of surgical management should be made on the size and the anatomical location of coronary arteriovenous fistulas and concomitant cardiac comorbidities. Surgical closure with ligation of coronary arteriovenous fistulas can be performed easily with on-pump or off-pump coronary artery bypass grafting, even in asymptomatic patients to prevent fistula related complications with very low risk of mortality and morbidity.

  10. Prognostic Variables and Surgical Management of Foot Melanoma: Review of a 25-Year Institutional Experience

    PubMed Central

    Rashid, Omar M.; Schaum, Julia C.; Wolfe, Luke G.; Brinster, Nooshin K.; Neifeld, James P.

    2011-01-01

    Introduction. Cutaneous foot melanoma is rare, challenging to manage, and not adequately examined in the literature. This study evaluated the prognostic variables and surgical management of foot melanoma. Materials and Methods. Foot melanoma cases managed at an academic center from 1985 to 2010 were retrospectively reviewed. Results. 46 patients were identified with a broad range of demographic characteristics. Overall recurrence was 32.6%: 19% acral lentiginous, 57% nodular, 66% superficial spreading, 30% melanoma unspecified, 50% severely atypical; 53% ulcerated, 23% nonulcerated; 29% on the dorsum of the foot, 17% heel, 60% ankle, 22% toe, 50% plantar; 0% <1 mm thick, 47% 1–4 mm, 33% >4 mm. 13 had positive nodes, 4 (31%) of whom recurred. Prognostic factors and recurrence did not correlate, and survival was 96% with a median followup of 91 months. Conclusions. Aggressive management of foot melanoma may result in excellent long-term survival even following disease recurrence. PMID:22363851

  11. Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomized trial.

    PubMed

    Piaggesi, A; Schipani, E; Campi, F; Romanelli, M; Baccetti, F; Arvia, C; Navalesi, R

    1998-05-01

    To test the efficacy of surgical treatment of non-infected neuropathic foot ulcers compared to conventional non-surgical management, a group of diabetic outpatients attending our diabetic foot clinic were studied. All patients who came to the clinic for the first time from January to December 1995 inclusive with an uncomplicated neuropathic ulcer were randomized into two groups. Group A received conservative treatment, consisting of relief of weight-bearing, regular dressings; group B underwent surgical excision, eventual debridement or removal of bone segments underlying the lesion and surgical closure. Healing rate, healing time, prevalence of infection, relapse during a 6-month period following intervention and subjective discomfort were assessed. Twenty-four ulcers in 21 patients were treated in group A (17 Type 2 DM/3 Type 1 DM, age 63.24 +/- 13.46 yr, duration of diabetes 18.2 +/- 8.41 yr, HbA1c 9.5 +/- 3.8%) and 22 ulcers in 21 patients in group B (19 Type 2 DM/2 Type 1 DM, age 65.53 +/- 9.87yr, duration of diabetes 16.84 +/- 10.61 yr; HbA1c 8.9 +/- 2.2%). Healing rate was lower (79.2% = 19/24 ulcers) in group A than in group B (95.5% = 21/22 ulcers; p < 0.05), and healing time was longer (128.9 +/- 86.60 days vs 46.73 +/- 38.94 days; p < 0.001). Infective complications occurred significantly more often in group A patients (3/24, 12.5% vs 1/22, 4.5%; p < 0.05), as did relapses of ulcerations (8 vs 3; p < 0.01). There were only two minor perioperative complications in group B patients. Patients reported a higher degree of satisfaction in group B (p < 0.01) as well as lower discomfort (p < 0.05) and restrictions (p < 0.05). Thus surgical treatment of neuropathic foot ulcers in diabetic patients proved to be an effective approach compared to conventional treatment in terms of healing time, complications, and relapses, and can be safely performed in an outpatient setting.

  12. Surgical management of metastatic long bone fractures: principles and techniques.

    PubMed

    Scolaro, John Alan; Lackman, Richard D

    2014-02-01

    Management of metastatic long bone fractures requires identification of the lesion and the use of sound fracture fixation principles to relieve pain and restore function. The treating surgeon must understand the principles of pathologic fracture fixation before initiating treatment. Because these fractures occur in the context of a progressive systemic disease, management typically involves a multidisciplinary approach. When considering surgical stabilization of these fractures, the abnormal (or absent) healing environment associated with diseased bone and the overall condition of the patient must be taken into account. The goal of surgery is to obtain a rigid mechanical construct, which allows for early mobility and weight bearing. This can be achieved using internal fixation with polymethyl methacrylate cement or segmental resection and joint reconstruction. Prosthetic joint arthroplasty is a more reliable means of fracture management when insufficient bone is present for fixation. Prophylactic stabilization of impending pathologic fractures can reduce the morbidity associated with metastatic lesions.

  13. Surgical management of fungal endophthalmitis resulting from fungal keratitis

    PubMed Central

    Gao, Yan; Chen, Nan; Dong, Xiao-Guang; Yuan, Gong-Qiang; Yu, Bin; Xie, Li-Xin

    2016-01-01

    AIM To report the fungal organisms, clinical features, surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis (EFE) secondary to keratitis, and evaluate the role of surgery in the treatment. METHODS The clinical records of 27 patients (27 eyes) with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained. RESULTS There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule, accounting for 56%, 26%, 15% and 2.5%, respectively. Fusarium was identified in 44% (12/27) of the eyes, followed by Aspergillus in 22% (6/27). Posterior segment infection was involved in 78% (21/27) of the patients. The corneal infection was larger than 3 mm ×3 mm in 89% (24/27) of the patients, and 22% (6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes (81.5%) underwent penetrating keratoplasty (PKP), and over half of them (54.5%) were operated within 3d from the onset of antifungal therapy. Fourteen eyes (52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes (55.6%) underwent pars plana vitrectomy (PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60% (9/15), lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes (16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes (18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil

  14. [Vascular "tumors" and the rules of their surgical management].

    PubMed

    Enjolras, O; Deffrennes, D; Borsik, M; Diner, P; Laurian, C

    1998-08-01

    After defining vascular tumors and malformations, formerly called angiomas, the authors adopt the classification of the International Society for the Study of vascular Anomalies. The various groups of malformations, after definition of the subject and the problems raised, are illustrated by a number of clinical cases and the rules of surgical management are discussed. Capillary malformations, formerly called portwine stains, can be treated by dye laser, but sometimes tissue and orthognathic reconstructive surgery in the presence of a skeletal malformation. Lymphatic malformations (lymphangiomas), optimally assessed by CT or MRI, can be treated by a variety of approaches: sclerotherapy, surgery. Venous malformations raise very different problems in the cervicocephalic region and on the limbs and trunk, but always require a multidisciplinary approach with, according to the site, size and repercussions, Ethibloc percutaneous sclerotherapy, embolization, surgery. Arteriovenous malformations require complete surgical treatment, usually preceded by embolization; reconstruction consists of local flaps or skin expansion in simple cases, and revascularized free flaps in difficult cases. If the malformation is cosmetically and functionally acceptable, the authors propose conservative management. The first-line treatment of haemangiomas is pharmacological (corticosteroids, interferon), but surgery may be indicated in two situations: early and late. There is a renewed interest in early surgery, subtended by several factors including cosmetic concerns and the development of new technologies, including the Cavitron. Late surgery retains its classical cosmetic and functional indications. Two key-words dominate the rules of therapeutic management of all types of vascular malformations: a multidisciplinary approach and modesty.

  15. Successful surgical management of ruptured umbilical hernias in cirrhotic patients

    PubMed Central

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

    2015-01-01

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

  16. Airway Management of the Cardiac Surgical Patients: Current Perspective

    PubMed Central

    Choudhury, Arindam; Gupta, Nishkarsh; Magoon, Rohan; Kapoor, Poonam Malhotra

    2017-01-01

    The difficult airway (DA) is a common problem encountered in patients undergoing cardiac surgery. However, the challenge is not only just establishment of airway but also maintaining a definitive airway for the safe conduct of cardiopulmonary bypass from initiation to weaning after surgical correction or palliation, de-airing of cardiac chambers. This review describes the management of the DA in a cardiac theater environment. The primary aims are recognition of DA both anatomical and physiological, necessary preparations for (and management of) difficult intubation and extubation. All patients undergoing cardiac surgery should initially be considered as having potentially DA as many of them have poor physiologic reserve. Making the cardiac surgical theater environment conducive to DA management is as essential as it is to deal with low cardiac output syndrome or acute heart failure. Tube obstruction and/or displacement should be suspected in case of a new onset ventilation problem, especially in the recovery unit. Cardiac anesthesiologists are often challenged with DA while inducing general endotracheal anesthesia. They ought to be familiar with the DA algorithms and possess skill for using the latest airway adjuncts. PMID:28074820

  17. Surgical Management of Severe Colitis in the Intensive Care Unit.

    PubMed

    Halaweish, Ihab; Alam, Hasan B

    2015-12-01

    Severe colitis, an umbrella encompassing several entities, is one of the most common acute gastrointestinal disorders resulting in critical illness. Clostridium difficile infection is responsible for the majority of nosocomial diarrhea with fulminant C difficile colitis (CDC) carrying a high mortality. Optimal outcomes can be achieved by early identification and treatment of fulminant CDC, with appropriate surgical intervention when indicated. Ischemic colitis, on the other hand, is uncommon with a range of etiological factors including abdominal aortic surgery, inotropic drugs, rheumatoid diseases, or often no obvious triggering factor. Most cases resolve with nonsurgical management; however, prompt recognition of full-thickness necrosis and gangrene is crucial for good patient outcomes. Fulminant colitis is a severe disease secondary to progressive ulcerative colitis with systemic deterioration. Surgical intervention is indicated for hemorrhage, perforation, or peritonitis and failure of medical therapy to control the disease. Although, failure of medical management is the most common indication, it can be difficult to define objectively and requires a collaborative multidisciplinary approach. This article proposes some simple management algorithms for these clinical entities, with a focus on critically ill patients.

  18. [A new surgical management of esophageal stenosis without esophagectomy].

    PubMed

    Uchida, Y; Hashimoto, T; Matsumoto, K; Noguchi, T

    1997-11-01

    In many cases, reflux esophagitis following surgical treatment for esophageal stenosis is caused by the recurrence of that after esophagectomy and esophogogastrostomy. We performed a new management without esophagectomy for a 66-year-old man with sliding hiatal hernia and esophageal stenosis induced by reflux esophagitis. A Expanding Metalic Stent (MES) was inserted to the stenotic portion of the esophagus, and then Collis-Nissen's procedure was done through left thoracotomy and phrenotomy. The postoperative course was satisfactory, and no gastroes-ophageal reflux was detected with the use of 24h pH-monitoring of the esophagus after surgery.

  19. Managing Opioid-Tolerant Patients in the Perioperative Surgical Home.

    PubMed

    Wenzel, John T; Schwenk, Eric S; Baratta, Jaime L; Viscusi, Eugene R

    2016-06-01

    Management of acute postoperative pain is important to decrease perioperative morbidity and improve patient satisfaction. Opioids are associated with potential adverse events that may lead to significant risk. Uncontrolled pain is a risk factor in the transformation of acute pain to chronic pain. Balancing these issues can be especially challenging in opioid-tolerant patients undergoing surgery, for whom rapidly escalating opioid doses in an effort to control pain can be associated with increased complications. In the perioperative surgical home model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge.

  20. Surgical management of gingival recession: A clinical update

    PubMed Central

    Alghamdi, Hamdan; Babay, Nadir; Sukumaran, Anil

    2009-01-01

    Gingival recession is defined as the apical migration of the junctional epithelium with exposure of root surfaces. It is a common condition seen in both dentally aware populations and those with limited access to dental care. The etiology of the condition is multifactorial but is commonly associated with underlying alveolar morphology, tooth brushing, mechanical trauma and periodontal disease. Given the high rate of gingival recession defects among the general population, it is imperative that dental practitioners have an understanding of the etiology, complications and the management of the condition. The following review describes the surgical techniques to treat gingival recession. PMID:23960465

  1. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique.

    PubMed

    Kyriazanos, Ioannis D; Manatakis, Dimitrios K; Stamos, Nikolaos; Stoidis, Christos

    2015-01-01

    Wound dehiscence is a serious postoperative complication, with an incidence of 0.5-3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of "intentional open abdomen" was described and both clinical entities share common pathophysiological and clinical pathways ("postoperative open abdominal wall"). Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as "frozen abdomen," where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the "Coliseum technique" for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of "malignant" frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair.

  2. Superior Semicircular Canal Dehiscence Syndrome – Diagnosis and Surgical Management

    PubMed Central

    Palma Diaz, Marite; Cisneros Lesser, Juan Carlos; Vega Alarcón, Alfredo

    2017-01-01

    Introduction Superior semicircular canal dehiscence syndrome was described by Minor et al in 1998. It is a troublesome syndrome that results in vertigo and oscillopsia induced by loud sounds or changes in the pressure of the external auditory canal or middle ear. Patients may present with autophony, hyperacusis, pulsatile tinnitus and hearing loss. When symptoms are mild, they are usually managed conservatively, but surgical intervention may be needed for patients with debilitating symptoms. Objective The aim of this manuscript is to review the different surgical techniques used to repair the superior semicircular canal dehiscence. Data Sources PubMed and Ovid-SP databases. Data Synthesis The different approaches are described and discussed, as well as their limitations. We also review the advantages and disadvantages of the plugging, capping and resurfacing techniques to repair the dehiscence. Conclusions Each of the surgical approaches has advantages and disadvantages. The middle fossa approach gives a better view of the dehiscence, but comes with a higher morbidity than the transmastoid approach. Endoscopic assistance may be advantageous during the middle cranial fossa approach for better visualization. The plugging and capping techniques are associated with higher success rates than resurfacing, with no added risk of hearing loss. PMID:28382131

  3. The surgical team and outcomes management: focus on postoperative ileus.

    PubMed

    Carter, Susan

    2006-04-01

    Postoperative ileus (POI) is defined as the impairment of bowel motility that occurs almost universally after major open abdominal procedures, as well as other abdominal and nonabdominal procedures. For the majority of affected patients, POI generally lasts approximately three to five days, but longer duration is not uncommon. The causes of POI are multifactorial, but can be broadly categorized into two groups: those related to the surgical procedure and those related to pharmacologic interventions (opioids). The fact that POI is generally transient and therefore self-limited should not deter the surgical team from seeking improved ways to mitigate its associated adverse effects, which can be substantial and immensely uncomfortable for the patient, and can have far-reaching implications regarding overall hospitalization costs for many types of surgeries. Optimization of POI management and prevention efforts is a responsibility of all members of the surgical team and can drastically affect the overall clinical outcome of major abdominal surgery. Depending on the individual team member's role, different perspectives and strategies may be used to achieve improved outcomes, including but not limited to hospitalization costs related to care and length of stay, resource utilization, and, perhaps most critically, patient quality of life not only immediately after surgery but also after discharge. The ability to reliably and significantly decrease the duration of POI should be readily recognized as an important objective in the management of this condition. Opioids will continue to be a mainstay of postoperative care regimens, but new agents such as peripherally acting mu-opioid-receptor antagonists may offer a unique clinical advantage by helping to reduce the adverse gastrointestinal effects of opioids while preserving their desired benefits for postoperative analgesia.

  4. First branchial cleft anomalies: presentation, variability and safe surgical management.

    PubMed

    Magdy, Emad A; Ashram, Yasmine A

    2013-05-01

    First branchial cleft (FBC) anomalies are uncommon. The aim of this retrospective clinical study is to describe our experience in dealing with these sporadically reported lesions. Eighteen cases presenting with various FBC anomalies managed surgically during an 8-year period at a tertiary referral medical institution were included. Ten were males (56 %) and eight females (44 %) with age range 3-18 years. Anomaly was right-sided in 12 cases (67 %). None were bilateral. Nine patients (50 %) had prior abscess incision and drainage procedures ranging from 1 to 9 times. Two also had previous unsuccessful surgical excisions. Clinical presentations included discharging tract openings in external auditory canal/conchal bowl (n = 9), periauricular (n = 6), or upper neck (n = 4); cystic postauricular, parotid or upper neck swellings (n = 5); and eczematous scars (n = 9). Three distinct anatomical types were encountered: sinuses (n = 7), fistulas (n = 6), and cysts (n = 5). Complete surgical excision required superficial parotidectomy in 11 patients (61 %). Anomaly was deep to facial nerve (FN) in three cases (17 %), in-between its branches in two (11 %) and superficial (but sometimes adherent to the nerve) in remaining cases (72 %). Continuous intraoperative electrophysiological FN monitoring was used in all cases. Two cases had postoperative temporary lower FN paresis that recovered within 2 months. No further anomaly manifestation was observed after 49.8 months' mean postoperative follow-up (range 10-107 months). This study has shown that awareness of different presentations and readiness to identify and protect FN during surgery is essential for successful management of FBC anomalies. Intraoperative electrophysiological FN monitoring can help in that respect.

  5. Surgical and anesthetic management of patients with mitochondrial dysfunction.

    PubMed

    Edmonds, Joseph L

    2004-09-01

    Mitochondrial diseases are primary defects in bio-energy metabolism. They are a heterogeneous group of diseases. The specific constellation of symptoms that will manifest in the effected individual depends on the type of genetic defect in the mitochondria. The goals of medical management, expressed in a highly simplified fashion, are to maintain a normal acid-base balance and to avoid those medical conditions and situations that add extra stress to a compromised bio-energy production system. Infection is a common stress that may cause a crisis in a patient with mitochondrial dysfunction. Treatment and avoidance of infections is a goal of both medical and surgical management. Common childhood illness such as otitis media, tonsillitis and sinusitis are example of such stress inducing infections.

  6. Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma.

    PubMed

    Moses, Helen; Powers, David; Keeler, Jarrod; Erdmann, Detlev; Marcus, Jeff; Puscas, Liana; Woodard, Charles

    2016-03-01

    The provision of trauma care is a financial burden, continually associated with low reimbursement, and shifts the economic burden to major trauma centers and providers. Meanwhile, the volume of craniomaxillofacial (CMF) trauma and the number of surgically managed facial fractures are unchanged. Past financial analyses of cost and reimbursement for facial trauma are limited to mandibular and midface injuries, consistently revealing low reimbursement. The incurred financial burden also coincides with the changing landscape of health insurance. The goal of this study is to determine the opportunity cost of operative management of facial trauma at our institution. From our CMF database of greater than 3,000 facial fractures, the physician charges, collections, and relative value units (RVUs) for CMF trauma per year from 2007 to 2013 were compared with a general plastic surgery and otolaryngology population undergoing operative management during this same period. Collection rates were analyzed to assess if a significant difference exists between reimbursement for CMF and non-CMF cases. Results revealed a significant difference between the professional collection rate for operative CMF trauma and that for other operative procedures (17.25 vs. 29.61%, respectively; p < 0.0001). The average number of RVUs billed per provider for CMF trauma declines significantly, from greater than 700 RVUs to 300 over the study period, despite a stable volume. Surgical management of CMF trauma generates an unfavorable financial environment. The large opportunity cost associated with offering this service is a potential threat to the sustainability of providing care for this population.

  7. Aggression in Tephritidae Flies: Where, When, Why? Future Directions for Research in Integrated Pest Management

    PubMed Central

    Benelli, Giovanni

    2014-01-01

    True fruit flies (Diptera: Tephritidae) include over 4000 species, many of which constitute enormous threats to fruit and vegetable production worldwide. A number of Tephritidae are lekking species, forming aggregations in which males fight to defend a small territory where they court females and mate. Male-male contests also occur in non-lekking species, characterized by resource defense polygyny. Tephritidae females display agonistic behavior to maintain single oviposition sites and reduce larval competition for food. Here, how, where, when and why aggressive interactions occur in Tephritidae flies is reviewed. A number of neglected issues deserving further research are highlighted, with a special focus on diel periodicity of aggression, cues evoking aggressive behavior, the role of previous experience on fighting success and the evolution of behavioral lateralization of aggressive displays. In the final section, future directions to exploit this knowledge in Integrated Pest Management, with particular emphasis on enhancement of Sterile Insect Technique and interspecific competitive displacement in the field are suggested. PMID:26463064

  8. Surgical Management of Boerhaave's Syndrome in a Tertiary Oesophagogastric Centre

    PubMed Central

    Sutcliffe, Robert P; Forshaw, Matthew J; Datta, Gourab; Rohatgi, Ashish; Strauss, Dirk C; Mason, Robert C; Botha, Abraham J

    2009-01-01

    INTRODUCTION The aim of this study was to review the management and outcome of patients with Boerhaave's syndrome in a specialist centre between 2000–2007. PATIENTS AND METHODS Patients were grouped according to time from symptoms to referral (early, < 24 h; late, > 24 h). The effects of referral time and management on outcomes (oesophageal leak, reoperation and mortality) were evaluated. RESULTS Of 21 patients (early 10; late 11), three were unfit for surgery. Of the remaining 18, immediate surgery was performed in 8/8 referred early and 6/10 referred late. Four patients referred late were treated conservatively. Oesophageal leak (78% versus 12.5%; P < 0.05) and mortality (40% versus 0%; P < 0.05) rates were higher in patients referred late. For patients referred late, mortality was higher in patients managed conservatively (75% versus 17%; not significant). CONCLUSIONS The best outcomes in Boerhaave's syndrome are associated with early referral and surgical management in a specialist centre. Surgery appears to be superior to conservative treatment for patients referred late. PMID:19409144

  9. Medical & Surgical Management of Pelvic Floor Disorders Affecting Defecation

    PubMed Central

    Schey, Ron; Cromwell, John; Rao, Satish S.C.

    2014-01-01

    Pelvic floor disorders that affect stool evacuation include structural (example: rectocele) and functional disorders (example: dyssynergic defecation). Meticulous history, digital rectal examination, and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion and imaging studies such as anal ultrasound, defecography, and static and dynamic MRI can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and lastly surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating dyssynergic defecation. Because dyssynergic defecation may co-exist with conditions such as solitary rectal ulcer syndrome (SRUS), and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic and trans-abdominal approach, stapled transanal rectal resection (STARR), and robotic colon and rectal resections. However, there is lack of well controlled randomized studies and efficacy of these surgical procedures remains to be established. PMID:22907620

  10. Medical and surgical management of pelvic floor disorders affecting defecation.

    PubMed

    Schey, Ron; Cromwell, John; Rao, Satish S C

    2012-11-01

    Pelvic floor disorders that affect stool evacuation include structural (for example, rectocele) and functional disorders (for example, dyssynergic defecation (DD)). Meticulous history, digital rectal examination (DRE), and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion, and imaging studies such as anal ultrasound, defecography, and static and dynamic magnetic resonance imaging (MRI) can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and finally surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating DD. Because DD may coexist with conditions such as solitary rectal ulcer syndrome (SRUS) and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic, and transabdominal approach, stapled transanal rectal resection, and robotic colon and rectal resections. However, there is lack of well-controlled randomized studies and the efficacy of these surgical procedures remains to be established.

  11. Optimal management of Barrett's esophagus: pharmacologic, endoscopic, and surgical interventions.

    PubMed

    Konda, Vani Ja; Dalal, Kunal

    2011-01-01

    Esophageal adenocarcinoma and its precursor, Barrett's esophagus, are rapidly rising in incidence. This review serves to highlight the role of pharmacologic, endoscopic, and surgical intervention in the management of Barrett's esophagus, which requires acid suppression and endoscopic assessment. Treatment with a proton pump inhibitor may decrease acid exposure and delay the progression to dysplasia. Patients who require aspirin for cardioprotection or other indications may also benefit in terms of a protective effect against the development of esophageal cancer. However, without other indications, aspirin is not indicated solely to prevent cancer. A careful endoscopic examination should include assessment of any visible lesions in a Barrett's segment. An expert gastrointestinal pathologist should confirm neoplasia in the setting of Barrett's esophagus. For those patients with high-grade dysplasia or intramucosal carcinoma, careful consideration of endoscopic therapy or surgical therapy must be given. All visible lesions in the setting of dysplasia should be targeted with focal endoscopic mucosal resection for both accurate histopathologic diagnosis and treatment. The remainder of the Barrett's epithelium should be eradicated to address all synchronous and metachronous lesions. This may be done by tissue acquiring or nontissue acquiring means. Radiofrequency ablation has a positive benefit-risk profile for flat Barrett's esophagus. At this time, endoscopic therapy is not indicated for nondysplastic Barrett's esophagus. Esophagectomy is still reserved for selected cases with evidence of lymph node metastasis, unsuccessful endoscopic therapy, or with high-risk features of high-grade dysplasia or intramucosal carcinoma.

  12. Surgical Management in a Patient With Complex Uveitic Glaucoma

    PubMed Central

    Huang, Zhu; Wang, Xiao-Yu; Han, Wei

    2015-01-01

    Abstract Uveitic glaucoma (UG) is secondary glaucoma, present as a clinical challenge in both diagnosis and management. We report a case of complex UG, which initially presented as pupillary block and rupture of the anterior lens capsule. We performed cataract extraction with preservation of posterior capsule. Then, the case turned to aphakic malignant glaucoma. We performed anterior vitrectomy with posterior capsule resection in this case. After the second operation, the patient had a satisfactory recovery. Specifically, ultrasonographic biomicroscopy was useful during the diagnosis process and follow-up period in this case. UG presenting as pupillary block, rupture of the anterior lens capsule, and aqueous misdirection seldom presents in clinical practice. Earlier and more active surgical intervention may be necessary for effective preservation of visual function in complex cases of UG. PMID:26252285

  13. Surgical Management and Scheimpflug Analysis of an Atypical Lens Coloboma

    PubMed Central

    Hernadez-Camarena, Julio C.; Ayup-Arguijo, Eduardo; Chavez-Mondragon, Eduardo; Ramirez-Miranda, Arturo

    2012-01-01

    A lens coloboma is not a true coloboma; it is just a zonular absence that causes a defect in the lens equator and hence a more spherical lens. It can be isolated or in association with iris, choroid or retinal colobomas. Typically the defect is present at the site of the embryonic fissure, but it can be present elsewhere. This congenital defect can cause amblyopia, especially when it is associated with cataract. We describe a case of a 39-year-old male with an atypical coloboma that was managed successfully with phacoemulsification, capsular tension ring and intraocular lens implantation. Scheimpflug image analysis and full ophthalmological assessment were performed. Scheimpflug images demonstrated a notching of the lens equator and an absence of zonulae. During the surgical procedure an ophthalmic viscosurgical device was used to tamponade the vitreous, and after continuous curvilinear capsulorhexis the capsular tension ring was inserted to allow the surgeon to perform a safe phacoemulsification. PMID:23139675

  14. Surgical management of civilian gunshot wounds to the head.

    PubMed

    Bizhan, Aarabi; Mossop, Corey; Aarabi, Judith Ann

    2015-01-01

    Each year close to 20000 Americans are involved in gunshot wounds to the head (GSWH). Over 90% of the victims of GSWH eventually fail to survive and only a meager 5% of the patients have a chance to continue with a useful life. One of the fundamental jobs of providers is to realize who the best candidate for the best possible management is. Recent evidence indicates that a good Glasgow Coma Scale (GCS) score at the time of admission puts such patients at high priority for management. Lack of abnormal pupillary response to light, trajectory of slug away for central gray, and visibility of basal cisterns upgrade the need for utmost care for such a victim. Surgical management is careful attention to involvement of air sinuses and repair of base dura. Patients with diffuse injury should have intraventricular intracranial pressure (ICP) monitoring and if needed a timely decompressive craniectomy. Since close to 2% of patients with penetrating brain injury may harbor a vascular injury, subjects with injuries close to the Sylvian fissure and those with the fragment crossing two dural compartments should have computed tomography angiography and if needed digital subtraction angiography to rule out traumatic intracranial aneurysms. In case of a positive study, these patients should have endovascular management of their vascular injuries in order to prevent catastrophic intracerebral hematomas and permanent deficit. Although supported by class III data, subjects of GSWH need to be on broad spectrum antibiotics for a period of 3-5 days. If cerebrospinal fluid (CSF) fistulas are observed at any time during the patient's hospital course, they should be taken very seriously and appropriate management is needed to prevent deep intracranial infections.

  15. Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

    PubMed Central

    2014-01-01

    Background In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. Methods A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Results Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Conclusions Aggression in acute old age psychiatry inpatient units occurs

  16. McCune–Albright syndrome with craniofacial dysplasia: Clinical review and surgical management

    PubMed Central

    Belsuzarri, Telmo Augusto Barba; Araujo, João Flavio Mattos; Melro, Carlos Alberto Morassi; Neves, Maick Willen Fernandes; Navarro, Juliano Nery; Brito, Leandro Gomes; Pontelli, Luis Otavio Carneiro; de Abreu Mattos, Luis Gustavo; Gonçales, Tiago Fernandes; Zeviani, Wolnei Marques

    2016-01-01

    Background: Fibrous dysplasia (FD) is a benign fibro-osseous lesion related to an abnormal bone development and replacement by fibrous tissue. FD has three clinical patterns namely monostotic, polyostotic, and the McCune–Albright syndrome (MAS). MAS is a rare genetic disorder (about 3% of all FD's) that comprises a triad of polyostotic FD, café-au-lait skin macules, and precocious puberty. MAS can involve the orbit region and cause stenosis in the optic canal, leading the patient to a progressive visual loss. Methods: We reported a case of craniofacial FD in MAS in a 9-year-old male with progressive visual loss, submitted to optic nerve decompression by fronto-orbito-zygomatic approach, with total recovery. A research was made at Bireme, PubMed, Cochrane, LILACS, and MEDLINE with the keywords: FD/craniofacial/McCune–Albright/Optic compression for the clinical review. Results: A clinical review of the disease was made, the multiple, clinical, and surgical management options were presented, and the case report was reported. Conclusion: MAS is a rare disease with a progressive polyostotic FD. Whenever it affects the orbit region, the optic canal, and it is associated with a progressive visual loss, the urgent optic nerve decompression is mandatory, either manually or with a rapid drill. It is known that aggressive approach is associated with less recurrence; it is also associated with worsening of the visual loss in optic nerve decompression. In MAS cases, multiple and less aggressive surgeries seem to be more suitable. PMID:27057395

  17. The use of radiotherapy in the management of follicular cystitis refractory to conservative and surgical management

    PubMed Central

    Trombetta, Mark; Packard, Matthew; Ferrara, Dominic; Werts, E. Day

    2012-01-01

    Follicular cysitis is a proliferative benign lesion which can act locally malignant. Conservative management is best; however, when this fails, surgical resection is necessary up to and including cystectomy in extreme refractory cases. We present a clinical review and our results using radiation in this disease in a woman facing cystectomy. PMID:22826782

  18. Does aggressive and expectant management of severe preeclampsia affect the neurologic development of the infant?

    PubMed Central

    Ertekin, Arif Aktuğ; Kapudere, Bilge; Eken, Meryem Kurek; İlhan, Gülşah; Dırman, Şükriye; Sargın, Mehmet Akif; Deniz, Engin; Karatekin, Güner; Çöğendez, Ebru; Api, Murat

    2015-01-01

    Objective: To compare and evaluate the influences of expectant and aggressive management of severe preeclampsia on the first year neurologic development of the infants in pregnancies between 27 and 34 weeks of pregnancy. Methods: Seventy women with severe preeclampsia between 27 and 34 weeks of gestation were included in the study. 37 patients were managed aggressively (Group 1) and 33 patients were managed expectantly (Group 2). Glucocorticoids, magnesium sulfate infusion and antihypertensive drugs were administered to each group. After glucocorticoid administration was completed Group 1 was delivered either by cesarean section or vaginal delivery. In Group 2 magnesium sulfate infusion was stopped after glucocorticoid administration was completed. Antihypertensive drugs were given, bed rest and intensive fetal monitorization were continued in this group. Results: The average weeks of gestation, one minute and five minute apgar scores and hospitalization time in intensive care unit were similar in both groups (P > 0.05). Three neonatal complications in Group 2 and five in Group 1 were detected according to the Denver Developmental Screening Test-II and one pathologic case was detected in both groups following neurologic examination. Neonatal mortality was seen in seven patients in Group 1 and one in Group 2. There were no significant differences between groups in terms of neonatal mortality and morbidity and maternal morbidity (P > 0.05). The average latency period was 3.45 ± 5.48 days in Group 2 and none in Group 1. Conclusion: There was no significant difference in the first year neurological development of infants whose mothers underwent either expectant and aggressive management for severe preeclampsia. PMID:26770571

  19. Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis.

    PubMed

    Zheng, Xiaozuo; Kang, Kai; Li, Tong; Lu, Bo; Dong, Jiangtao; Gao, Shijun

    2014-12-01

    The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P < 0.05). There was no statistically significant difference between the two treatment groups in frequency of subsequent surgical interventions, percentage of excellent or good subjective opinion, Kujala score, pain score on visual analog scale, and severity of patellofemoral joint osteoarthrosis (P > 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials.

  20. Medical and surgical management of esophageal and gastric motor dysfunction.

    PubMed

    Awad, R A

    2012-09-01

    he occurrence of esophageal and gastric motor dysfunctions happens, when the software of the esophagus and the stomach is injured. This is really a program previously established in the enteric nervous system as a constituent of the newly called neurogastroenterology. The enteric nervous system is composed of small aggregations of nerve cells, enteric ganglia, the neural connections between these ganglia, and nerve fibers that supply effectors tissues, including the muscle of the gut wall. The wide range of enteric neuropathies that includes esophageal achalasia and gastroparesis highlights the importance of the enteric nervous system. A classification of functional gastrointestinal disorders based on symptoms has received attention. However, a classification based solely in symptoms and consensus may lack an integral approach of disease. As an alternative to the Rome classification, an international working team in Bangkok presented a classification of motility disorders as a physiology-based diagnosis. Besides, the Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical high-resolution esophageal pressure topography studies. This review covers exclusively the medical and surgical management of the esophageal and gastric motor dysfunction using evidence from well-designed studies. Motor control of the esophagus and the stomach, motor esophageal and gastric alterations, treatment failure, side effects of PPIs, overlap of gastrointestinal symptoms, predictors of treatment, burden of GERD medical management, data related to conservative treatment vs. antireflux surgery, and postsurgical esophagus and gastric motor dysfunction are also taken into account.

  1. Surgical and interventional management of complications caused by acute pancreatitis.

    PubMed

    Karakayali, Feza Y

    2014-10-07

    Acute pancreatitis is one of the most common gastrointestinal disorders worldwide. It requires acute hospitalization, with a reported annual incidence of 13 to 45 cases per 100,000 persons. In severe cases there is persistent organ failure and a mortality rate of 15% to 30%, whereas mortality of mild pancreatitis is only 0% to 1%. Treatment principles of necrotizing pancreatitis and the role of surgery are still controversial. Despite surgery being effective for infected pancreatic necrosis, it carries the risk of long-term endocrine and exocrine deficiency and a morbidity and mortality rate of between 10% to 40%. Considering high morbidity and mortality rates of operative necrosectomy, minimally invasive strategies are being explored by gastrointestinal surgeons, radiologists, and gastroenterologists. Since 1999, several other minimally invasive surgical, endoscopic, and radiologic approaches to drain and debride pancreatic necrosis have been described. In patients who do not improve after technically adequate drainage, necrosectomy should be performed. When minimal invasive management is unsuccessful or necrosis has spread to locations not accessible by endoscopy, open abdominal surgery is recommended. Additionally, surgery is recognized as a major determinant of outcomes for acute pancreatitis, and there is general agreement that patients should undergo surgery in the late phase of the disease. It is important to consider multidisciplinary management, considering the clinical situation and the comorbidity of the patient, as well as the surgeons experience.

  2. Surgical management of unruptured posterior carotid artery wall aneurysms.

    PubMed

    O'Shaughnessy, Brian A; Getch, Christopher C; Bendok, Bernard R; Batjer, H Hunt

    2003-07-15

    Intracranial aneurysms arising from the posterior wall of the supraclinoid carotid artery are extremely common lesions. The aneurysm dilation typically occurs in immediate proximity to the origin of the posterior communicating artery and, less commonly, the anterior choroidal artery (AChA). Because of the increasingly widespread use of noninvasive neuroimaging methods to evaluate patients believed to harbor cerebral lesions, many of these carotid artery aneurysms are now documented in their unruptured state, prior to occurrence of subarachnoid hemorrhage. Based on these factors, the management of unruptured posterior carotid artery (PCA) wall aneurysms is an important element of any neurosurgical practice. Despite impressive recent advances in endovascular therapy, the placement of microsurgical clips to exclude aneurysms with preservation of all afferent and efferent vasculature remains the most efficacious and durable therapy. To date, an optimal outcome is only achieved when the neurosurgeon is able to combine systematic preoperative neurovascular assessment with meticulous operative technique. In this report, the authors review their surgical approach to PCA wall aneurysms, which is greatly based on the extensive neurovascular experience of the senior author. Focus is placed on their methods of preoperative evaluation and operative technique, with emphasis on neurovascular anatomy and the significance of oculomotor nerve compression. They conclude by discussing surgery-related complications, with a particular focus on intraoperative rupture of aneurysms and their management, and the postoperative ischemic AChA syndrome.

  3. Thru-life impacts of driver aggression, climate, cabin thermal management, and battery thermal management on battery electric vehicle utility

    NASA Astrophysics Data System (ADS)

    Neubauer, Jeremy; Wood, Eric

    2014-08-01

    Battery electric vehicles (BEVs) offer the potential to reduce both oil imports and greenhouse gas emissions, but have a limited utility that is affected by driver aggression and effects of climate-both directly on battery temperature and indirectly through the loads of cabin and battery thermal management systems. Utility is further affected as the battery wears through life in response to travel patterns, climate, and other factors. In this paper we apply the National Renewable Energy Laboratory's Battery Lifetime Analysis and Simulation Tool for Vehicles (BLAST-V) to examine the sensitivity of BEV utility to driver aggression and climate effects over the life of the vehicle. We find the primary challenge to cold-climate BEV operation to be inefficient cabin heating systems, and to hot-climate BEV operation to be high peak on-road battery temperatures and excessive battery degradation. Active cooling systems appear necessary to manage peak battery temperatures of aggressive, hot-climate drivers, which can then be employed to maximize thru-life vehicle utility.

  4. The prognosis of primary intracerebral tumours presenting with epilepsy: the outcome of medical and surgical management.

    PubMed Central

    Smith, D F; Hutton, J L; Sandemann, D; Foy, P M; Shaw, M D; Williams, I R; Chadwick, D W

    1991-01-01

    It is not known whether conservative or early aggressive (resective surgery with or without radiotherapy) management is better for tumours presenting with epilepsy. The prognosis of 560 patients with a clinical and CT diagnosis of intrinsic supratentorial tumour was examined retrospectively. Epilepsy was the first symptom in 164 patients. Histological confirmation of diagnosis was available in 391 (70%) of cases. Median survival was 37 months in the group presenting with epilepsy and six months in those presenting with other symptoms (p less than 0.0001). Patients presenting with epilepsy were more likely to have a normal clinical examination, a non-enhancing low density lesion on CT scan and a low grade tumour. From Cox's stepwise proportional hazards model, significant independent variables adversely affecting prognosis were increasing age, focal neurological signs and enhancing CT lesions at diagnosis, non-resective surgery and male sex. Of those presenting with epilepsy 80 patients had surgical treatment within two months of CT diagnosis. The Cox's model failed to identify any beneficial effects for either early resective surgery or radiotherapy. In primary intracerebral tumours with presentations other than epilepsy, resective surgery and radiotherapy were amongst the important factors associated with prolonged survival. Primary intracerebral tumours presenting with epilepsy are relatively benign and their outcome appears to be chiefly determined by clinical factors. PMID:1744647

  5. Surgical management for squamous cell carcinoma of vulva

    PubMed Central

    Amavi, Ayi Kossigan; Kouadio, Laurent; Adabra, Komlan; Tengue, Kodjo; Tijami, Fouad; Jalil, Abdelouahed

    2016-01-01

    To analyze our surgical management and the result of squamous cell carcinoma (SCC) of vulva. Retrospectively, we collected 38 cases of SCC; 17 cases of them were early SCC and 21 cases were locally advanced. The patients underwent primary surgery. The survival was estimated using Kaplan-Meier analysis and the log rank test. The mean age was 60.78 years. Total vulvectomy was performed in all patients. Superficial and deep incision of bilateral inguinal lymphadenectomy was performed by separates incisions for SCC infiltrating more than 1mm. The average tumor size was 53 mm (10 to 140mm). Morbidity was 42.1%. Lateral resection margin ≥8mm was obtained in 57.1%. Eighteen patients benefited from adjuvant radiotherapy. The follow-up median was 19.4 months (6 to 61.5 month) with 05 recurrences in 12 months. The survival using the Kaplan-Meyer analysis at 5 years, was 62.1% (71.2%N- vs 46.7%N+; p = 0.13). We identified two groups for locally advanced vulva cancer. Primary surgery keeps its place. Neo adjuvant radio chemotherapy followed by surgery is the alternative treatment for locally extensive lesions. PMID:27642483

  6. The Management of Patients after Surgical Treatment of Maxillofacial Tumors

    PubMed Central

    Rolski, D.; Zawadzki, P.; Życińska, K.; Mierzwińska-Nastalska, E.

    2016-01-01

    Morphological and functional disturbances induced by postsurgical defects and loss of tissues in the stomatognathic system due to the treatment of tumors in the maxillofacial region determine the therapeutic needs of patients. The study aimed at clinical and epidemiological evaluation of patients under prosthetic treatment in order to establish the algorithm for rehabilitation. The study group was composed of the patients after midface surgery (45.74%); surgery in a lower part of the face (47.38%); mixed postoperative losses (3.44%); loss of face tissues and surgery in other locations in the head and neck region (3.44%). The supplementary treatment was applied in 69.63% of patients. Clinical and additional examinations were performed to obtain the picture of postoperative loss, its magnitude, and location to plan the strategy of prosthetic rehabilitation. The management algorithm for prosthetic rehabilitation in patients after surgical treatment of maxillofacial neoplasms was based on its division in stages. The location and magnitude of postoperative losses, as well as the implementation of supplementary treatment of the patients after treatment of maxillofacial tumors, influence the planning of prosthetic rehabilitation that plays a key role and facilitates the patients' return to their prior living situation, occupational and family lives. PMID:27747229

  7. Effect of Surgical Periodontal Therapy on Serum C-reactive Protein Levels Using ELISA in Both Chronic and Aggressive Periodontitis Patient

    PubMed Central

    Gupta, Bharat; Patil, Neha; Yadav, Manoj; Tripathi, Shashank; Sinha, Saurabh; Sharma, Saurabh; Gupta, Saurabh

    2015-01-01

    Background Periodontitis can be defined as a local inflammatory process which mediates destruction of periodontal tissues & is triggered by bacterial insult. In periodontal infections, the levels of C reactive proteins are elevated as compared to the levels in a periodontally healthy individual. The study was done to determine the relative levels of serum CRP in aggressive, chronic and periodontally healthy subjects and to evaluate the effect of surgical periodontal therapy on serum C-reactive protein levels. Materials and Methods Serum samples were collected from 150 participants (50 healthy control patients (non-periodontitis), 50 patients with chronic periodontitis and aggressive periodontitis. Serum C- reactive protein levels were assessed by means of immunoturbidimetric assay at baseline for subjects in all the 3 groups and 3 months after completion of surgical therapy. Results The mean baseline C-reactive protein (CRP) concentrations in the Groups I, II and III were 1.65±0.57 mg/L, 3.03±2.14 mg/L and 3.09±2.27 mg/L respectively. After treatment, the mean C-reactive protein (CRP) levels in Groups II and III reduced from 3.03±1.67 mg/L to 1.46±1.67 mg/L and from 3.09±1.21 to 1.43±1.21 mg/L respectively. Similar results were found for probing depth and all indexes in Group II and III after treatment. Also, the mean attachment loss in Groups II and III reduced, so the results were highly significant. Conclusion Successful periodontal treatment results in significant decrease in serum C-reactive protein (CRP) levels in otherwise healthy subjects. PMID:26557605

  8. Surgical management of tetralogy of fallot: in defense of the infundibulum.

    PubMed

    McKenzie, E Dean; Maskatia, Shiraz A; Mery, Carlos

    2013-01-01

    Surgical treatment of the Tetralogy of Fallot (ToF) is one of the great successes of medicine and also a topic of controversy. Different strategies have been proposed, including age-based (neonatal) management strategies as well as anatomic-based management strategies. Regardless of the management strategy entailed, the surgical management of ToF has considerably evolved over the years. As a result, patients can now expect excellent early results with survival approaching 100% for those without genetic syndromes. The goals of current surgical therapy should be to mitigate the late right ventricular (RV) dysfunction that may occur by minimizing the extent of surgical injury during the intial repair. As the surgical techniques continue to advance, the outcomes will continue to improve.

  9. Surgical options for the management of visceral artery aneurysms.

    PubMed

    Van Petersen, A; Meerwaldt, R; Geelkerken, R; Zeebregts, C

    2011-06-01

    Visceral artery aneurysm (VAA) is a rare entity but increased use of abdominal imaging has led to an increased prevalence. Rupture is related to a high mortality rate. Open repair, endovascular treatment and laparoscopic techniques have been described as treatment options. In this systematic review we describe the surgical options for treating VAA. A literature search identified articles focussing on the key issues of visceral artery aneurysms and surgical options using the Pubmed and Cochrane databases. Case reports dominate the literature about VAA. Twenty-seven small case series and ten review articles have been published in the last 20 years concerning the surgical options for VAA. The evidence does not exceed level 3. Surgical treatment is dictated by both patient and aneurysm characteristics. Whether VAA should be treated largely depends upon age, gender, presence of hypertension (e.g. in renal aneurysm), aneurysm size and presentation. Aneurysm size and characteristics, anatomical location and presence of collateral circulation dictate the surgical option to be chosen. The mortality and morbidity rates after elective open repair are low. Literature about surgical options for treating VAA remains scarce. Only a few clinical trials have shown the possibilities and results of open surgical repair. In general, there is no consensus on the surgical treatment of VAA and the highest level of evidence is based upon expert opinions.

  10. Sentinel node biopsy in the surgical management of breast cancer: experience in a general hospital with a dedicated surgical team.

    PubMed

    Merson, M; Fenaroli, P; Gianatti, A; Virotta, G; Giuliano, L G; Bonasegale, A; Bambina, S; Pericotti, S; Guerra, U; Tondini, C

    2004-06-01

    The aims of this study were to analyse the feasibility and accuracy of the sentinel lymph node biopsy (SLNB) procedure as performed in a general hospital compared with the literature results; to report on the organizational aspects of planning surgical time with higher accuracy of pathological analysis; and to verify that there is a real advantage of SLNB in the surgical management of breast cancer. From October 1999 to September 2000, 371 consecutive patients with T1-2N0 breast lesions underwent SLNB. The immunoscintigraphic method of sentinel node identification was the main one used, the blue dye method being used only when the lymphoscintigraphic method was unsuccessful in identifying sentinel nodes. SLNB was done under either general or local anaesthesia, depending on how the surgical procedure was organized and clinically planned. SLNB was successful in 99% of these T1-2N0 breast cancer cases, and in 71% no metastases were found in the sentinel node. In 47% of cases with axillary metastasis only the sentinel node was involved. Nodal involvement was not present in any case of microinvasive or in situ carcinoma. In T1 cancers nodal involvement was present in 21%; in T2 cases the corresponding rate reached 51%. The results obtained with the SLNB procedure at Bergamo Hospital are similar to the literature data. When a dedicated surgical team, the nuclear medicine department and the pathology department work together, a general hospital can provide breast cancer patients with appropriate surgical treatment.

  11. Suicide plus immune gene therapy prevents post-surgical local relapse and increases overall survival in an aggressive mouse melanoma setting.

    PubMed

    Villaverde, Marcela S; Combe, Kristell; Duchene, Adriana G; Wei, Ming X; Glikin, Gerardo C; Finocchiaro, Liliana M E

    2014-09-01

    In an aggressive B16-F10 murine melanoma model, we evaluated the effectiveness and antitumor mechanisms triggered by a surgery adjuvant treatment that combined a local suicide gene therapy (SG) with a subcutaneous genetic vaccine (Vx) composed of B16-F10 cell extracts and lipoplexes carrying the genes of human interleukin-2 and murine granulocyte and macrophage colony stimulating factor. Pre-surgical SG treatment, neither alone nor combined with Vx was able to slow down the fast evolution of this tumor. After surgery, both SG and SG + Vx treatments, significantly prevented (in 50% of mice) or delayed (in the remaining 50%) post-surgical recurrence, as well as significantly prolonged recurrence-free (SG and SG + Vx) and overall median survival (SG + Vx). The treatment induced the generation of a pseudocapsule wrapping and separating the tumor from surrounding host tissue. Both, SG and the subcutaneous Vx, induced this envelope that was absent in the control group. On the other hand, PET scan imaging of the SG + Vx group suggested the development of an effective systemic immunostimulation that enhanced (18)FDG accrual in the thymus, spleen and vertebral column. When combined with surgery, direct intralesional injection of suicide gene plus distal subcutaneous genetic vaccine displayed efficacy and systemic antitumor immune response without host toxicity. This suggests the potential value of the assayed approach for clinical purposes.

  12. Surgical management of gynecomastia: experience of a general surgery center

    PubMed Central

    LONGHEU, A.; MEDAS, F.; CORRIAS, F.; FARRIS, S.; TATTI, A.; PISANO, G.; ERDAS, E.; CALÒ, P.G.

    2016-01-01

    Aim Gynecomastia is a common finding in male population of all ages. The aim of our study was to present our experience and goals in surgical treatment of gynecomastia. Patients and Methods Clinical records of patients affected by gynecomastia referred to our Department of Surgery between September 2008 and January 2015 were analyzed. 50 patients were included in this study. Results Gynecomastia was monolateral in 12 patients (24%) and bilateral in 38 (76%); idiopathic in 41 patients (82%) and secondary in 9 (18%). 39 patients (78%) underwent surgical operation under general anaesthesia, 11 (22%) under local anaesthesia. 3 patients (6%) presented recurrent disease. Webster technique was performed in 28 patients (56%), Davidson technique in 16 patients (32%); in 2 patients (4%) Pitanguy technique was performed and in 4 patients (8%) a mixed surgical technique was performed. Mean surgical time was 80.72±35.14 minutes, median postoperative stay was 1.46±0.88 days. 2 patients (4%) operated using Davidson technique developed a hematoma, 1 patient (2%) operated with the same technique developed hypertrophic scar. Conclusions Several surgical techniques are described for surgical correction of gynecomastia. If performed by skilled general surgeons surgical treatment of gynecomastia is safe and permits to reach satisfactory aesthetic results. PMID:27938530

  13. A Review of Surgical Methods (Excluding Hair Transplantation) and Their Role in Hair Loss Management Today

    PubMed Central

    Sattur, Sandeep S

    2011-01-01

    There is more than one way to manage hair loss surgically. Apart from hair transplantation, there are other techniques which have been used by many to treat baldness. This article attempts to review the surgical methodology and philosophy that have acted as guiding lights in the approach to surgical treatment of baldness over the years and reviews the current role of other techniques in the armamentarium of hair restoration surgeons today. PMID:21976899

  14. Non-surgical periodontal management in scleroderma disease patients.

    PubMed

    Laforgia, A; Corsalini, M; Stefanachi, G; Tafuri, S; Ballini, A; Pettini, F; Di Venere, D

    2016-01-01

    The aim of the present study is to investigate the periodontal status of people with scleroderma and their response to non-surgical treatment protocol aimed at controlling the evolution of the disease. The response to non-surgical periodontal treatment was tested on patients belonging to a scleroderma group and a control group: the data show an improvement of the periodontal conditions of all these patients in response to treatment. When compared on the same diagram, a slight remission of the periodontal disease was obtained in both scleroderma and healthy patients. This highlights the benefit to soft tissues produced by non-surgical periodontal treatment also in patients affected by systemic diseases.

  15. Diabetic foot infections: a team-oriented review of medical and surgical management

    PubMed Central

    Capobianco, Claire M; Stapleton, John J

    2010-01-01

    As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient setting. PMID:22396806

  16. Brain Ischemia in Patients with Intracranial Hemorrhage: Pathophysiological Reasoning for Aggressive Diagnostic Management

    PubMed Central

    Naranjo, Daniel; Arkuszewski, Michal; Rudzinski, Wojciech; Melhem, Elias R.; Krejza, Jaroslaw

    2013-01-01

    Summary Patients with intracranial hemorrhage have to be managed aggressively to avoid or minimize secondary brain damage due to ischemia, which contributes to high morbidity and mortality. The risk of brain ischemia, however, is not the same in every patient. The risk of complications associated with an aggressive prophylactic therapy in patients with a low risk of brain ischemia can outweigh the benefits of therapy. Accurate and timely identification of patients at highest risk is a diagnostic challenge. Despite the availability of many diagnostic tools, stroke is common in this population, mostly because the pathogenesis of stroke is frequently multifactorial whereas diagnosticians tend to focus on one or two risk factors. The pathophysiological mechanisms of brain ischemia in patients with intracranial hemorrhage are not yet fully elucidated and there are several important areas of ongoing research. Therefore, this review describes physiological and pathophysiological aspects associated with the development of brain ischemia such as the mechanism of oxygen and carbon dioxide effects on the cerebrovascular system, neurovascular coupling and respiratory and cardiovascular factors influencing cerebral hemodynamics. Consequently, we review investigations of cerebral blood flow disturbances relevant to various hemodynamic states associated with high intracranial pressure, cerebral embolism, and cerebral vasospasm along with current treatment options. PMID:24355179

  17. Surgical management for Hirschsprung disease: A review for primary care providers.

    PubMed

    Green, Holly L; Rizzolo, Denise; Austin, Mary

    2016-04-01

    Primary care providers may encounter infants and children with Hirschsprung disease, a congenital colonic defect. Although primarily a surgical problem, the disease requires extensive supportive care and a multidisciplinary approach that often extends beyond surgical correction. This article reviews the management of Hirschsprung disease.

  18. The role of lumbar disc replacement in the surgical management of low back pain.

    PubMed

    Freeman, Brian J C

    2012-01-01

    Spinal fusion has long been the standard surgical treatment for degenerative disorders of the spine, but clinical outcomes are often unpredictable. Lumbar disc replacement allows removal of the pain source while preserving motion. This article explores the role of lumbar disc replacement in the surgical management of low back pain.

  19. Managing Irritability and Aggression in Autism Spectrum Disorders in Children and Adolescents

    ERIC Educational Resources Information Center

    Robb, Adelaide S.

    2010-01-01

    Children with autism and autism spectrum disorders have a high rate of irritability and aggressive symptoms. In one study up to 20% of children with autism have symptoms of irritability and aggression including aggression, severe tantrums, and deliberate self injurious behavior (Lecavalier [2006] "J. Autism Dev. Disord." 36:1101-1114.). These…

  20. Selective surgical management of progressive familial intrahepatic cholestasis (Byler's disease).

    PubMed

    Emond, J C; Whitington, P F

    1995-12-01

    Progressive familial intrahepatic cholestasis (PFIC) presents in early childhood with pruritus, jaundice, hepatomegaly, and growth failure. Medical therapy is unsuccessful, with progression from cholestasis to hepatic fibrosis, cirrhosis, and ultimately death before the age of 10 years. Because of evidence that biliary diversion can arrest or reverse progression to hepatic fibrosis, we have used partial biliary diversion (PBD) as primary therapy in PFIC, reserving orthotopic liver transplantation (OLT) for children who have progressive disease or established cirrhosis. Seventeen children with PFIC (aged 2 months to 19 years) have been treated. PBD was performed in eight cases. In these procedures, a 10-cm properistaltic jejunal segment was anastomosed to the side of the gallbladder, terminating as an end stoma for the collection and discard of bile. Eleven patients with hepatic insufficiency (or end-stage cirrhosis) received OLT using standard techniques, at the average age of 4 years. Six of the eight children treated with PBD had complete resolution of clinical symptoms and remain well 1 to 13 years postoperatively. These six patients have conjugated bilirubin values of less than 0.3 mg/dL, normal transaminases, and a serum bile salt concentration of less than 10 nmol/mL. All have had either reversal or no progression of the hepatic fibrosis. Postoperative bleeding complications occurred in two (25%), which required reoperation. One patient had an adhesive intestinal obstruction that was managed surgically 9 months postoperatively. Two patients had no benefit from PBD, and all of them had severe bridging fibrosis (1) or cirrhosis (3). These and nine others with cirrhosis at the time of presentation received orthotopic liver transplantation; of these, eight are alive (1 to 5 years postoperatively). These results show the importance of establishing a correct diagnosis in children with cholestasis. Clinical symptoms often are severe in children with PFIC before the

  1. Two-stage minimally invasive surgical management of colonic gallstone ileus.

    PubMed

    Lujan, Henry J; Bisland, William B

    2010-08-01

    Colonic gallstone ileus is an unusual cause of colonic obstruction. Management of these patients is not standardized and can be challenging. As these patients are often ill and frail at presentation, surgical management needs to be individualized to decrease morbidity and mortality. We report a case that was managed by staged minimally invasive techniques with an excellent outcome.

  2. WSES guidelines for management of Clostridium difficile infection in surgical patients.

    PubMed

    Sartelli, Massimo; Malangoni, Mark A; Abu-Zidan, Fikri M; Griffiths, Ewen A; Di Bella, Stefano; McFarland, Lynne V; Eltringham, Ian; Shelat, Vishal G; Velmahos, George C; Kelly, Ciarán P; Khanna, Sahil; Abdelsattar, Zaid M; Alrahmani, Layan; Ansaloni, Luca; Augustin, Goran; Bala, Miklosh; Barbut, Frédéric; Ben-Ishay, Offir; Bhangu, Aneel; Biffl, Walter L; Brecher, Stephen M; Camacho-Ortiz, Adrián; Caínzos, Miguel A; Canterbury, Laura A; Catena, Fausto; Chan, Shirley; Cherry-Bukowiec, Jill R; Clanton, Jesse; Coccolini, Federico; Cocuz, Maria Elena; Coimbra, Raul; Cook, Charles H; Cui, Yunfeng; Czepiel, Jacek; Das, Koray; Demetrashvili, Zaza; Di Carlo, Isidoro; Di Saverio, Salomone; Dumitru, Irina Magdalena; Eckert, Catherine; Eckmann, Christian; Eiland, Edward H; Enani, Mushira Abdulaziz; Faro, Mario; Ferrada, Paula; Forrester, Joseph Derek; Fraga, Gustavo P; Frossard, Jean Louis; Galeiras, Rita; Ghnnam, Wagih; Gomes, Carlos Augusto; Gorrepati, Venkata; Ahmed, Mohamed Hassan; Herzog, Torsten; Humphrey, Felicia; Kim, Jae Il; Isik, Arda; Ivatury, Rao; Lee, Yeong Yeh; Juang, Paul; Furuya-Kanamori, Luis; Karamarkovic, Aleksandar; Kim, Peter K; Kluger, Yoram; Ko, Wen Chien; LaBarbera, Francis D; Lee, Jae Gil; Leppaniemi, Ari; Lohsiriwat, Varut; Marwah, Sanjay; Mazuski, John E; Metan, Gokhan; Moore, Ernest E; Moore, Frederick Alan; Nord, Carl Erik; Ordoñez, Carlos A; Júnior, Gerson Alves Pereira; Petrosillo, Nicola; Portela, Francisco; Puri, Basant K; Ray, Arnab; Raza, Mansoor; Rems, Miran; Sakakushev, Boris E; Sganga, Gabriele; Spigaglia, Patrizia; Stewart, David B; Tattevin, Pierre; Timsit, Jean Francois; To, Kathleen B; Tranà, Cristian; Uhl, Waldemar; Urbánek, Libor; van Goor, Harry; Vassallo, Angela; Zahar, Jean Ralph; Caproli, Emanuele; Viale, Pierluigi

    2015-01-01

    In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

  3. Surgical Management of Stuttering Ischemic Priapism: A Case Report and Concise Clinical Review

    PubMed Central

    Raslan, M.; Hiew, K.; Hoyle, A.; Ross, D.G.; Betts, C.D.; Maddineni, S.B.

    2016-01-01

    Stuttering priapism is an extremely rare and poorly understood entity. We present a rare case of a 47-year-old Afro-Caribbean gentleman who required proximal shunt procedure to treat his ischemic stuttering priapism after he had failed medical management. We provided a concise review of the literature on the surgical management of ischemic priapism. This case highlighted the importance of prompt surgical intervention in prolonged stuttering priapism to avoid serious psychological and functional complications. PMID:26977408

  4. Surgical management of syringomyelia associated with spinal adhesive arachnoiditis.

    PubMed

    Ohata, K; Gotoh, T; Matsusaka, Y; Morino, M; Tsuyuguchi, N; Sheikh, B; Inoue, Y; Hakuba, A

    2001-01-01

    The authors describe a new surgical technique to minimise the postoperative recurrence of adhesion after microlysis of adhesion to treat syringomyelia associated with spinal adhesive arachnoiditis. A 47 year old male presented with numbness of the lower extremities and urinary disturbance and was demonstrated to have a case of syringomyelia from C1 to T2 which was thought to be secondary to adhesive spinal arachnoiditis related to a history of tuberculous meningitis. Following meticulous microlysis of the adhesions, maximal expansion of a blocked subarachnoid space was performed by expansive duraplasty with a Gore-Tex surgical membrane, expansive laminoplasty and multiple tenting sutures of the Gore-Tex graft. Postoperatively, the syringomyelia had be en completely obliterated and improvement of the symptoms had been also achieved. The technique described may contribute to improvement of the surgical outcome following arachnoid dissection by maintaining continuity of the reconstructed subarachnoid space.

  5. Intravenous Adenosine for Surgical Management of Penetrating Heart Wounds

    PubMed Central

    Kokotsakis, John; Hountis, Panagiotis; Antonopoulos, Nikolaos; Skouteli, Elian; Athanasiou, Thanos; Lioulias, Achilleas

    2007-01-01

    Accurate suturing of penetrating cardiac injuries is difficult. Heart motion, ongoing blood loss, arrhythmias due to heart manipulation, and the near-death condition of the patient can all affect the outcome. Rapid intravenous injection of adenosine induces temporary asystole that enables placement of sutures in a motionless surgical field. Use of this technique improves surgical conditions, and it is faster than other methods. Herein, we describe our experience with the use of intravenous adenosine to successfully treat 3 patients who had penetrating heart wounds. PMID:17420798

  6. [Cervicobrachialgia - an update under special consideration of the surgical management].

    PubMed

    Stienen, M N; Cadosch, D; Fournier, J-Y; Hildebrandt, G; Gautschi, O P

    2012-05-23

    The classic cervicobrachialgia results acutely from cervical nerve root compression by disc herniation or subacutely by radicular compression after progressive spondylotic changes of the cervical spine. The clinical presentation includes local and radiating pain syndromes that can be accompanied by sensorimotor deficits. Besides the medical history and a targeted clinical examination, supplementary radiographic means should be undertaken to confirm diagnosis. If no urgent surgical indication exists, conservative therapy should be initiated. However, with varying results of conservative and surgical therapy, chronic impairment can occur.

  7. [Choice of surgical procedure and management of postoperative incision for anal fistula].

    PubMed

    Chen, Chaowen; Peng, Bo

    2015-12-01

    Anal fistula is a common disease in general surgery. It is difficult to heal without intervention and surgical treatment is the major treatment. Method of surgical treatment and management of postoperative incision are based on features and classifications of anal fistula. Choosing the appropriate approach in accordance with specific conditions of patients can obtain effective healing and proper protection against anal sphincter, along with the improvement of life quality. Comprehensive evaluation on methods of surgical treatment and managements of postoperative incision for anal fistula is presented in this paper.

  8. Mislocated extrauterine intrauterine devices: Diagnosis and surgical management

    PubMed Central

    Kaplanoğlu, Mustafa; Bülbül, Mehmet; Yüce, Tuncay; Kaplanoğlu, Dilek; Aban, Meral

    2015-01-01

    Objective Presentation of the diagnostic and surgical treatment methods of our extrauterine intrauterine device (IUD) cases. Material and Methods We retrospectively evaluated the data of 21 extrauterine IUD cases at our clinic between 2008 and 2010. The symptoms, diagnostic methods, and surgical treatments were evaluated. Results A total of 14 copper and seven levonorgestrel (LNG) IUDs were used. IUD had been inserted during lactation in 71.4% of the patients. The reasons for presentation of patients were unintended pregnancy in 19.05%, pelvic pain in 19.05%, and pelvic pain with vaginal bleeding in 23.8%. IUD in two patients were located the retroperitoneal area. IUD string had not been visible during routine follow-up in 38.1% of the patients. Laparoscopy was performed in 14 patients and laparotomy was performed for dense adhesions in seven patients. Conclusion Extrauterine IUDs can present with various clinical symptoms. Ultrasonography and X-Ray are sufficient for the diagnosis. Surgical removal is needed to prevent possible complications, and the preferred surgical technique in appropriate patients is laparoscopy. PMID:26097391

  9. Surgical management of Aspergillus colonization associated with lung hydatid disease.

    PubMed

    Vasquez, Julio C; Montesinos, Efrain; Rojas, Luis; Peralta, Julio; Delarosa, Jacob; Leon, Juan J

    2008-04-01

    Colonization with Aspergillus sp. usually occurs in previously formed lung cavities. Cystectomy is a widely used surgical technique for hydatid lung disease that can also leave residual cavities and potentially result in aspergilloma. We present two cases of this rare entity and a case with Aspergillus sp. colonization of an existing ruptured hydatid cyst.

  10. Medical and surgical management of uroperitoneum in a foal

    PubMed Central

    Butters, Alyssa

    2008-01-01

    A 4-day-old, male, American paint foal was presented for abdominal distention, respiratory distress, and diarrhea. Bladder rupture and uroperitoneum were diagnosed following abdominal ultrasonography and abdominocentesis. The defect in the dorsocranial part of the bladder wall was surgically repaired. PMID:18481552

  11. Surgical management of hypothalamic hamartomas in patients with gelastic epilepsy.

    PubMed

    Addas, Bassam; Sherman, Elisabeth M S; Hader, Walter J

    2008-09-01

    Gelastic epilepsy (GE) associated with hypothalamic hamartomas (HHs) is now a well-characterized clinical syndrome consisting of gelastic seizures starting in infancy, medically refractory seizures with or without the development of multiple seizure types, and behavioral and cognitive decline. It has been postulated that the development of the HH-GE syndrome is a result of a progressive epileptic encephalopathy or secondary epileptogenesis, which is potentially reversible with treatment of the HH. A variety of surgical options for the treatment of HHs exist, including open and endoscopic procedures, radiosurgery, interstitial radiotherapy, and stereotactic radiofrequency thermocoagulation. Surgical treatment can result in seizure freedom in up to 50% of patients and can be accompanied by significant improvements in behavior, cognition, and quality of life. Partial treatment of HHs may be sufficient to reduce seizure frequency and improve behavior and quality of life with less risk. A component of reversible cognitive dysfunction may be present in some patients with an HH-GE syndrome.

  12. Surgical management of ingrown toenails - an update overdue.

    PubMed

    Richert, Bertrand

    2012-01-01

    For decades, every year sees a wide number of articles about treatment of ingrown toenails. There is still a debate about the cause of this painful condition. Surgical treatments rely on two main approaches: either narrowing the nail plate or debulking the soft tissues. It is up to the surgeon to select the most appropriate approach in each case. All procedures cited in this article have high cure rates as long as they are properly performed. As with all surgical procedures, they are operator dependent. Chemical cautery is the easiest and most versatile technique that may help in almost all instances for lateral ingrowing. For distal embedding and very hypertrophic and exuberant lateral folds, debulking with secondary intention healing is the most effective and easy to perform, with great results.

  13. Multidisciplinary surgical management of Cowden syndrome: Report of a case

    PubMed Central

    Staderini, Edoardo; Gallenzi, Patrizia

    2016-01-01

    Cowden’s Syndrome (CS) is a rare congenital autosomal dominant disorder that affects around 1/200000 patients with an incomplete penetrance and variable expressivity, characterized by alterations in a tumor suppressor gene. A 14-year-old Caucasian male patient came to the attention of the authors complaining of palm nodules, gingival bleeding and painful pedunculated lesions on the lips and on the labial side of anterior sextants. After genetic investigation the final diagnosis of a Cowden Syndrome was made. The lesions were surgically removed under general anesthesia and no clinical signs of recurrence were found three months after surgical excision. Considering the severe symptoms of the syndrome and the strong tendency to malignant development of the associated lesions all clinicians should focus their efforts to the early diagnosis and, when possible, multidisciplinary treatment. Key words:Early diagnosis, multiple hamartoma syndrome, oral papillomatosis, cancer predisposition, case report. PMID:27703620

  14. Ortho-surgical management of condylar hyperplasia: Rare case reports.

    PubMed

    Singh, Virendra; Verma, Ajay; Attresh, Gyanander; Batra, Jitender

    2014-01-01

    Condylar hyperplasia of the mandible is a clinical condition of over-development and growth because of excessive cellular growth of one condylar part of the mandible leading to facial asymmetry, mandibular deviation and enlargement of condyle. The elongation of the condylar neck in turn leads to malocclusion and articular dysfunction. In the past the interceptive and corrective procedures of growth and deformity in condylar hyperplasia were either condylectomy or high condylotomy. However, the deformity ceases after growth is completed. Therefore, other surgical procedures have to be undertaken to correct the manifested deformity of condylar hyperplasia. Further it has to be stressed that no single procedure can completely correct the deformity. So in addition to condylectomy, other orthognathic surgical procedures both on body and ramus and also on maxilla can be undertaken to correct the canting of occlusion. Two rare cases of unilateral hyperplasia encountered in our hospital are presented which required different lines of treatment.

  15. Pituitary adenomas: historical perspective, surgical management and future directions

    PubMed Central

    Theodros, Debebe; Patel, Mira; Ruzevick, Jacob; Lim, Michael; Bettegowda, Chetan

    2016-01-01

    Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on their cell of origin. Epidemiologic studies have documented the incidence of pituitary adenomas within the general population to be as high as 16.7%. A growing body of work has helped to elucidate the pathogenesis of these tumors. Each subtype has been shown to demonstrate unique cellular changes potentially leading to tumorigenesis. Surgical advancements over several decades have included microsurgery and the employment of the endoscope for surgical resection. These advancements increase the likelihood of gross-total resection and have resulted in decreased patient morbidity. PMID:26497533

  16. Surgical management of female SUI: is there a gold standard?

    PubMed

    Cox, Ashley; Herschorn, Sender; Lee, Livia

    2013-02-01

    Many surgical options exist for women with stress urinary incontinence (SUI). The traditional gold standards of Burch retropubic colposuspension and pubovaginal slings are still appropriate treatment options for some patients, but randomized controlled trials have demonstrated that synthetic midurethral slings are just as effective as these traditional procedures but with less associated morbidity. Thus, midurethral slings--inserted via a retropubic or transobturator approach--have become the new gold standard first-line surgical treatment for women with uncomplicated SUI. Retropubic midurethral slings are associated with slightly higher success rates than transobturator slings, but at the cost of more postoperative complications. Pubovaginal slings remain an effective option for women with SUI who have failed other procedures, have had mesh complications, or who require concomitant urethral surgery. Single-incision slings have a number of benefits, including decreased operative times and early return to regular activities, but they are yet to be shown to be as effective as midurethral slings. Both retropubic and transobturator midurethral slings are effective for patients with mixed urinary incontinence, but the overall cure rate is lower than for patients with pure SUI. Based on the literature a new gold standard first-line surgical treatment for women with SUI is the synthetic midurethral sling inserted through a retropubic or transobturator approach [corrected].

  17. Consensus on surgical aspects of managing osteomyelitis in the diabetic foot

    PubMed Central

    Allahabadi, Sachin; Haroun, Kareem B.; Musher, Daniel M.; Lipsky, Benjamin A.; Barshes, Neal R.

    2016-01-01

    Background The aim of this study was to develop consensus statements that may help share or even establish ‘best practices’ in the surgical aspects of managing diabetic foot osteomyelitis (DFO) that can be applied in appropriate clinical situations pending the publication of more high-quality data. Methods We asked 14 panelists with expertise in DFO management to participate. Delphi methodology was used to develop consensus statements. First, a questionnaire elicited practices and beliefs concerning various aspects of the surgical management of DFO. Thereafter, we constructed 63 statements for analysis and, using a nine-point Likert scale, asked the panelists to indicate the extent to which they agreed or disagreed with the statements. We defined consensus as a mean score of greater than 7.0. Results The panelists reached consensus on 38 items after three rounds. Among these, seven provide guidance on initial diagnosis of DFO and selection of patients for surgical management. Another 15 statements provide guidance on specific aspects of operative management, including the timing of operations and the type of specimens to be obtained. Ten statements provide guidance on postoperative management, including wound closure and offloading, and six statements summarize the panelists’ agreement on general principles for surgical management of DFO. Conclusions Consensus statement on the perioperative management of DFO were formed with an expert panel comprised of a variety of surgical specialties. We believe these statements may serve as ‘best practice’ guidelines until properly performed studies provide more robust evidence to support or refute specific surgical management steps in DFO. PMID:27414481

  18. 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

  19. The problem mastoid cavity: medical and surgical management.

    PubMed

    Kinney, S E

    1977-11-01

    The patient with persistent foul drainage from a previously operated-on mastoid cavity has a serious problem that requires aggressive attention from the otologic surgeon. The ear must be carefully evaluated in the office. Careful cleaning of the cavity and effective application of medication will dry up many of these cavities. Revision surgery of the ear requires a systematic approach using all the techniques of modern otologic surgery. This means the use of a post-auricular incision and wide bone removal combined with bone removal combined with obliteration techniques and grafting of the middle ear. This approach was used in 29 ears in 27 patients. Rapid healing and a trouble-free, dry ear was obtained in 26 patients or 90% of the operated-on cases.

  20. Advances in the Surgical Management of Resectable and Borderline Resectable Pancreas Cancer.

    PubMed

    Helmink, Beth A; Snyder, Rebecca A; Idrees, Kamran; Merchant, Nipun B; Parikh, Alexander A

    2016-04-01

    Successful surgical resection offers the only chance for cure in patients with pancreatic cancer. However, pancreatic resection is feasible in less than 20% of the patients. In this review, the current state of surgical management of pancreatic cancer is discussed. The definition of resectability based on cross-sectional imaging and the technical aspects of surgery, including vascular resection and/or reconstruction, management of aberrant vascular anatomy and extent of lymphadenectomy, are appraised. Furthermore, common pancreatic resection-specific postoperative complications and their management are reviewed.

  1. A Mindfulness-Based Strategy for Self-Management of Aggressive Behavior in Adolescents with Autism

    ERIC Educational Resources Information Center

    Singh, Nirbhay N.; Lancioni, Giulio E.; Manikam, Ramasamy; Winton, Alan S. W.; Singh, Ashvind N. A.; Singh, Judy; Singh, Angela D. A.

    2011-01-01

    Some individuals with autism engage in physical aggression to an extent that interferes with not only their quality of life, but also that of their parents and siblings. Behavioral and psychopharmacological treatments have been the mainstay of treatments for aggression in children and adolescents with autism. We evaluated the effectiveness of a…

  2. Patient outcomes following surgical management of multinodular goiter

    PubMed Central

    Lin, Yann-Sheng; Wu, Hsin-Yi; Yu, Ming-Chin; Hsu, Chih-Chieh; Chao, Tzu-Chieh

    2016-01-01

    Abstract Background: the difference in the risk of thyroid malignancy for patients with multinodular goiter (MNG) and solitary nodular goiter (SNG) remains controversial. Although total thyroidectomy (TT) is the current preferred surgical option for MNG, permanent hypothyroidism in these patients may be a concern. Therefore, we discuss whether nontotal thyroidectomy is a reasonable alternative surgical option. Methods: A retrospective cohort study was performed for 1598 consecutive patients who underwent thyroid surgery for nodular goiter between January 2007 and December 2012. Numerous clinical parameters were collected and analyzed. Results: We reviewed 795 patients with MNG and 803 patients with SNG. The prevalence of malignancy on final pathology was significantly higher in the patients with MNG than in the patients with SNG (15.6% vs 10.1%, P = 0.001). However, a multivariate analysis revealed that this difference was insignificant (P = 0.50). Papillary carcinoma was the predominant type in both groups, but papillary microcarcinoma was more frequently found (41.1%) in the patients with MNG. The only multifocal cancers were of the papillary carcinoma histologic type, and the incidence of multifocal papillary carcinoma was significantly higher in the patients with MNG (23.4% vs 7.4%, P = 0.005). Reoperation was not required for the patients who underwent TT for goiter recurrence or incidental carcinoma. The overall rate of recurrence following nontotal thyroidectomy was 12.2%. Among the patients who underwent reoperation for goiter recurrence, 2 (20.0%) were complicated with permanent hypoparathyroidism. Among the patients who underwent a nontotal bilateral thyroidectomy, an average of 56.5% had permanent hypothyroidism. Conclusions: Multinodularity does not increase the risk of thyroid malignancy. However, patients with MNG who develop papillary carcinoma are at an increased risk of cancer multifocality. If a patient can tolerate lifelong thyroid hormone

  3. Melanotic neuroectodermal tumour of infancy: surgical and chemotherapeutic management.

    PubMed

    Murphy, C; Pears, J; Kearns, G J

    2016-08-01

    Melanotic neuroectodermal tumour of infancy (MNTI) is a rare pigmented neoplasm of neural crest origin. It usually presents in the first year of life in the maxilla as a fast growing lesion. We describe the case of a 3-month-old boy who presented with an enlarging swelling of left maxillary alveolus. He was treated with combined surgical and chemotherapy modalities. MNTI is complicated by high recurrence rate, local invasion and malignancy has been reported. This report describes the diagnosis, treatment and follow-up of recurrent MNTI.

  4. Surgical management of vestibular schwannomas after failed radiation treatment.

    PubMed

    Nonaka, Yoichi; Fukushima, Takanori; Watanabe, Kentaro; Friedman, Allan H; Cunningham, Calhoun D; Zomorodi, Ali R

    2016-04-01

    Increasing numbers of patients with vestibular schwannoma (VS) have been treated with focused-beam stereotactic radiation treatment (SRT) including Gamma knife, CyberKnife, X-knife, Novalis, or proton beam therapy. The purpose of this study was to document the incidence of tumor regrowth or symptoms that worsened or first developed following SRT and to discuss surgical strategies for patients who have failed SRT for VS. A consecutive series of 39 patients with SRT failed VS were surgically treated. Clinical symptoms, tumor regrowth at follow-up, intraoperative findings, and surgical outcome were evaluated. There were 15 males and 24 females with a mean age of 51.8 years. Thirty-six patients (92.3%) demonstrated steady tumor growth after SRT. Two (5.1%) patients with slight increase of the mass underwent surgical resection because of development of unbearable facial pain. Symptoms that worsened or newly developed following SRT in this series were deafness (41%), dizziness (35.9%), facial numbness (25.6%), tinnitus (20.5%), facial nerve palsy (7.7%), and facial pain (7.7%). Intraoperative findings demonstrated fibrous changes of the tumor mass, cyst formation, and brownish-yellow or purple discoloration of the tumor capsule. Severe adhesions between the tumor capsule and cranial nerves, vessels, and the brainstem were observed in 69.2%. Additionally, the facial nerve was more fragile and irritable in all cases. Gross total resection (GTR) was achieved in 33.3% of patients, near-total resection (NTR) in 35.9%, and subtotal resection (STR) in 30.8% of patients. New facial nerve palsy was seen in seven patients (19.4%) postoperatively. Our findings suggest that patients with VS who fail SRT with either tumor progression or worsening of clinical symptoms will have an increased rate of adhesions to the neurovascular structures and may have radiation-influenced neuromalacia. Salvage surgery of radiation-failed tumors is more difficult and will have a higher risk of

  5. Successful surgical management of congenital Kasabach-Merritt syndrome.

    PubMed

    Pascal, Sébastien; Bettex, Quentin; Andre, Nicolas; Petit, Philippe; Casanova, Dominique; Degardin, Nathalie

    2017-01-01

    Since the first description of Kasabach-Merritt syndrome (KMS) in 1940, many treatments have been proposed combining pharmacologic and non-pharmacologic approaches, which can be effective on the pathology but can have adverse and unpredictable side-effects with long-term use. Herein we describe the solely surgical treatment of Kasabach-Merritt syndrome in a neonate with a severe and rapidly progressive thrombocytopenia. The patient's condition normalized at 7 days postoperatively, with rapid increase in platelet count and normalization of d-dimer concentration.

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

    PubMed

    Taware, C P; Kulkarni, S R

    1991-01-01

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

  7. Anesthesia and congestive heart failure: pathology, medical, and surgical management.

    PubMed

    Armstrong, Christopher S; Hoover, Jason M; Fox, Charles J; Field, Aaron M; Richards, Todd A; Islam, Sameer R; Kaye, Alan D

    2006-06-01

    Congestive heart failure (CHF) is increasingly being recognized as a health problem in the United States. It is estimated that the lifetime risk for CHF is 1 in 5. The clinical anesthesiologist can expect to see several cases involving patients suffering from CHF. Because of the danger associated with surgery in a patient with CHF, a thorough knowledge of the disorder and the potential effects on the delivery of anesthetics must be considered. In addition, knowledge of the disease process and its manifestations is required for smooth guidance of the patient through the perioperative period. The understanding of current pharmacotherapies, surgical procedures and their implications related to interactions with anesthetics are all discussed.

  8. Ensuring the safety of surgical teams when managing casualties of a radiological dirty bomb.

    PubMed

    Williams, Geraint; O'Malley, Michael; Nocera, Antony

    2010-09-01

    The capacity for surgical teams to ensure their own safety when dealing with the consequences caused by the detonation of a radiological dirty bomb is primarily determined by prior knowledge, familiarity and training for this type of event. This review article defines the associated radiological terminology with an emphasis on the personal safety of surgical team members in respect to the principles of radiological protection. The article also describes a technique for use of hand held radiation monitors and will discuss the identification and management of radiologically contaminated patients who may pose a significant danger to the surgical team.

  9. [The development of strategic management of high-tech surgical medical care].

    PubMed

    Nechaev, V S; Krasnov, A V

    2013-01-01

    The high-tech surgical medical care is one of the most effective types of medical care in Russia. However high-tech surgical treatment very often is inaccessible for patients. The development of basics of strategic management of high-tech surgical care makes it possible to enhance availability of this type of care and to shorten the gap between volumes of rendered care and population needs. This approach can be resulted in decrease of disability and mortality of the most prevalent diseases of cardio-vascular diseases, malignant neoplasms, etc. The prerequisites can be developed to enhance life quality and increase longevity of population.

  10. The surgical management and treatment of metastatic lesions in the proximal femur

    PubMed Central

    Feng, Helin; Wang, Jin; Xu, Jianfa; Chen, Wei; Zhang, Yingze

    2016-01-01

    Abstract Review current treatments of metastatic lesions in the proximal femur. We reviewed published literature related to diagnosis and surgical treatments and summarized current treatment options. Surgical management mainly consist of internal fixation, hip replacement, and percutaneous femoroplasty (PFP) which has been newly applied in clinical practice. An appropriate series of treatments is necessary for patients to avoid the occurrence of paraplegia and prolong survival time. PMID:27428183

  11. Surgical Management of Neurovascular Bundle in Uterine Fibroid Pseudocapsule

    PubMed Central

    Malvasi, Antonio; Hurst, Brad S.; Tsin, Daniel A.; Davila, Fausto; Dominguez, Guillermo; Dell'edera, Domenico; Cavallotti, Carlo; Negro, Roberto; Gustapane, Sarah; Teigland, Chris M.; Mettler, Liselotte

    2012-01-01

    The uterine fibroid pseudocapsule is a fibro-neurovascular structure surrounding a leiomyoma, separating it from normal peripheral myometrium. The fibroid pseudocapsule is composed of a neurovascular network rich in neurofibers similar to the neurovascular bundle surrounding a prostate. The nerve-sparing radical prostatectomy has several intriguing parallels to myomectomy. It may serve either as a useful model in modern fibroid surgical removal, or it may accelerate our understanding of the role of the fibrovascular bundle and neurotransmitters in the healing and restoration of reproductive potential after intracapsular myomectomy. Surgical innovations, such as laparoscopic or robotic myomectomy applied to the intracapsular technique with magnification of the fibroid pseudocapsule surrounding a leiomyoma, originated from the radical prostatectomy method that highlighted a careful dissection of the neurovascular bundle to preserve sexual functioning after prostatectomy. Gentle uterine leiomyoma detachment from the pseudocapsule neurovascular bundle has allowed a reduction in uterine bleeding and uterine musculature trauma with sparing of the pseudocapsule neuropeptide fibers. This technique has had a favorable impact on functionality in reproduction and has improved fertility outcomes. Further research should determine the role of the myoma pseudocapsule neurovascular bundle in the formation, growth, and pathophysiological consequences of fibroids, including pain, infertility, and reproductive outcomes. PMID:22906340

  12. Clinical and surgical management of unilateral prepubertal gynecomastia

    PubMed Central

    Ferraro, Giuseppe Andrea; De Francesco, Francesco; Romano, Tiziana; Grandone, Anna; D’Andrea, Francesco; Miraglia Del Giudice, Emanuele; Perrone, Laura; Nicoletti, Gianfranco

    2014-01-01

    INTRODUCTION Gynecomastia is the benign proliferation of the glandular tissue in the male breast. This condition is thought to be caused by the imbalance between estrogen action relative to androgen action at the breast tissue level. Bilateral gynecomastia is frequently found in the neonatal period, early in puberty, and with increasing age. Prepubertal unilateral gynecomastia in the absence of endocrine abnormalities is extremely rare, with only a few cases in literature. PRESENTATION OF CASE We present an otherwise healthy boy of 12 years old with unilateral breast masses. No abnormalities were found on ultrasonography and on all endocrine parameters. Treatment consisted in a new “modified” Webster technique. DISCUSSION The results confirmed validity of this technique in terms of esthetic and functional results, and patient satisfaction. Atypical presentations of gynecomastia are often not recognized. The main pathophysiology of gynecomastia is alteration in the balance between the stimulatory effect of estrogen and the inhibitory effects of androgens on the development of the breast. If there is no causal treatment, surgical resection is the therapy of first choice. CONCLUSION The exact mechanism of unilateral gynecomastia formation in our case is unclear. The evaluation of unilateral gynecomastia can therefore be complex. In conclusion, the surgical treatment of unilateral gynecomastia requires an individual approach, based on an appropriate diagnostic algorithm. PMID:25437663

  13. Surgical Management of Calcified Hydatid Cysts of the Liver

    PubMed Central

    Tzardinoglou, E.; Kosmidis, Ch.; Katsohis, K.; Aletras, O.

    1999-01-01

    Hydatid disease of the liver is still a major cause of morbidity in Greece. Beside the common complications of rupture and suppuration, calcification of the hepatic cysts represent a not well studied, less frequent and sometimes difficult surgical problem. In the present study 75 cases with calcified symptomatic liver echinococcosis were operated on in the 1st Propedeutic Surgical Clinic between 1964 to 1996. Twenty-eight patients were male and 47 female with ages from 23 to 78 years. The diagnosis was based mainly on the clinical picture and radiological studies. In 5 cases the operative method was cystopericystectomy. We performed evacuation of the cystic cavity and partial pericystectomy and primary closure of the residual cavity in 6 cases, omentoplasty or filling of the residual cavity with a piece of muscle of the diaphragm in 4 cases and external drainage by closed tube, in 60 cases. In 12 of those with drainage, after a period of time, a second operation with easy, removal of most of the calcareous wall plaques was performed. The mortality rate was 2%. Our results could be considered satisfactory. In the calcified parasitic cysts of the liver the proposed technique is cystopericystectomy. An alternative procedure is pericystectomy and drainage with a “planned” reoperation with a bloodless, due to intervening inflammation, chiseling of the calcification. PMID:10468117

  14. Current Surgical Options for the Management of Pediatric Glaucoma

    PubMed Central

    Morales, Jose; Al Shahwan, Sami; Al Odhayb, Sami; Al Jadaan, Ibrahim; Edward, Deepak P.

    2013-01-01

    Currently, there are numerous choices for the treatment of pediatric glaucoma depending on the type of glaucoma, the age of the patient, and other particularities of the condition discussed in this review. Traditionally, goniotomy and trabeculotomy ab externo have been the preferred choices of treatment for congenital glaucoma, and a variety of adult procedures adapted to children have been utilized for other types of pediatric glaucoma with variable results and complications. More recently, seton implantations of different types have become more popular to use in children, and newer techniques have become available including visualized cannulation and opening of Schlemm's canal, deep sclerectomy, trabectome, and milder more directed cyclodestructive procedures such as endolaser and transcleral diode laser cyclophotocoagulation. This paper reviews the different surgical techniques currently available, their indications, results, and most common complications to allow the surgeon treating these conditions to make a more informed choice in each particular case. Although the outcome of surgical treatment in pediatric glaucoma has improved significantly, its treatment remains challenging. PMID:23738051

  15. Child abuse. An update on surgical management in 256 cases.

    PubMed Central

    Caniano, D A; Beaver, B L; Boles, E T

    1986-01-01

    In the period January 1982-July 1984, 1512 cases of suspected child abuse were evaluated in the emergency department of a major children's hospital, of which 256 (17%) required hospitalization. Failure-to-thrive with caloric malnutrition was present in 66 (26%), burns in 56 (22%), central nervous system injury in 53 (22%), soft tissue trauma in 21 (8%), ingestions in 20 (8%), skeletal injury in 15 (6%), neglect of an underlying disease in 10 (4%), sexual abuse in nine (3%), near-drowning in four (1%), and abdominal trauma in two (1%). Two-thirds of the children required surgical care and one-third of the surgical group needed operations. The majority of the patients were toddlers between 18 and 36 months of age. A long hospitalization occurred with a mean stay of 9.3 days. Mortality was 7% for the entire group, but children with central nervous system injury had a much higher mortality (26%) and morbidity (21%). PMID:3947158

  16. Surgical Management of Rectus Femoris Avulsion Among Professional Soccer Players

    PubMed Central

    Sonnery-Cottet, Bertrand; Barbosa, Nuno Camelo; Tuteja, Sanesh; Gardon, Roland; Daggett, Matt; Monnot, Damien; Kajetanek, Charles; Thaunat, Mathieu

    2017-01-01

    Background: Rectus femoris injuries are common among athletes, especially in kicking sports such as soccer; however, proximal rectus femoris avulsions in athletes are a relatively rare entity. Purpose/Hypothesis: The purpose of this study was to describe and report the results of an original technique of surgical excision of the proximal tendon remnant followed by a muscular suture repair. Our hypothesis was that this technique limits the risk of recurrence in high-level athletes and allows for rapid recovery without loss of quadriceps strength. Study Design: Case series; Level of evidence, 4. Methods: Our retrospective series included 5 players aged 31.8 ± 3.9 years with acute proximal rectus femoris avulsion injuries who underwent a surgical resection of the proximal tendon between March 2012 and June 2014. Four of these players had recurrent rectus femoris injuries in the 9 months before surgery, while 1 player had surgery after a first injury. Mean follow-up was 18.2 ± 12.6 months, and minimum follow-up was 9 months. We analyzed the age, sex distribution, physical examination outcomes, type and mechanism of injury, diagnosis, treatment and complications during surgery, postoperative follow-up, and time to return to play. The Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at 3-month follow-up, and isokinetic tests were performed before return to sports. A telephone interview was completed to determine the presence of recurrence at an average follow-up of 18.2 months. Results: At 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. Return to the previous level of play occurred at a mean of 15.8 ± 2.6 weeks after surgery, and none of the athletes suffered a recurrence. Isokinetic test results were comparable between both sides. Conclusion: The surgical treatment of proximal rectus femoris avulsions, consisting of resection of the tendinous part of the muscle, is a reliable and safe technique allowing a

  17. [Surgical management of urinary and fecal incontinence in neurological sphincter disorders of children and adolescents].

    PubMed

    Lemelle, J L; Barthelme, H; Schmitt, M

    1999-01-01

    The management of urinary and fecal incontinence in children and adolescents with neurogenic disorders related to congenital or acquired conditions was frequently considered to be of secondary importance compared with orthopaedic complications. The improvement of artificial urinary sphincter and continent urinary diversion techniques allowed to establish for each case an individual plan considering overall, abilities and voiding dysfunction as well as renal complications. Antegrade colonic enema has greatly improved the quality of life of children with fecal incontinence or intractable constipation. Surgical management requires a large contribution by the patients and their closest relatives and complete information about goals, advantages and obligations of surgical management. Surgical principles for bladder augmentation, bladder neck reconstruction and continent urinary diversion are presented and discussed according to data in the recent literature and the author's clinical experience.

  18. Surgical Management of Early Endometrial Cancer: An Update and Proposal of a Therapeutic Algorithm

    PubMed Central

    Falcone, Francesca; Balbi, Giancarlo; Di Martino, Luca; Grauso, Flavio; Salzillo, Maria Elena; Messalli, Enrico Michelino

    2014-01-01

    In the last few years technical improvements have produced a dramatic shift from traditional open surgery towards a minimally invasive approach for the management of early endometrial cancer. Advancement in minimally invasive surgical approaches has allowed extensive staging procedures to be performed with significantly reduced patient morbidity. Debate is ongoing regarding the choice of a minimally invasive approach that has the most effective benefit for the patients, the surgeon, and the healthcare system as a whole. Surgical treatment of women with presumed early endometrial cancer should take into account the features of endometrial disease and the general surgical risk of the patient. Women with endometrial cancer are often aged, obese, and with cardiovascular and metabolic comorbidities that increase the risk of peri-operative complications, so it is important to tailor the extent and the radicalness of surgery in order to decrease morbidity and mortality potentially derivable from unnecessary procedures. In this regard women with negative nodes derive no benefit from unnecessary lymphadenectomy, but may develop short- and long-term morbidity related to this procedure. Preoperative and intraoperative techniques could be critical tools for tailoring the extent and the radicalness of surgery in the management of women with presumed early endometrial cancer. In this review we will discuss updates in surgical management of early endometrial cancer and also the role of preoperative and intraoperative evaluation of lymph node status in influencing surgical options, with the aim of proposing a management algorithm based on the literature and our experience. PMID:25063051

  19. Surgical management of early endometrial cancer: an update and proposal of a therapeutic algorithm.

    PubMed

    Falcone, Francesca; Balbi, Giancarlo; Di Martino, Luca; Grauso, Flavio; Salzillo, Maria Elena; Messalli, Enrico Michelino

    2014-07-26

    In the last few years technical improvements have produced a dramatic shift from traditional open surgery towards a minimally invasive approach for the management of early endometrial cancer. Advancement in minimally invasive surgical approaches has allowed extensive staging procedures to be performed with significantly reduced patient morbidity. Debate is ongoing regarding the choice of a minimally invasive approach that has the most effective benefit for the patients, the surgeon, and the healthcare system as a whole. Surgical treatment of women with presumed early endometrial cancer should take into account the features of endometrial disease and the general surgical risk of the patient. Women with endometrial cancer are often aged, obese, and with cardiovascular and metabolic comorbidities that increase the risk of peri-operative complications, so it is important to tailor the extent and the radicalness of surgery in order to decrease morbidity and mortality potentially derivable from unnecessary procedures. In this regard women with negative nodes derive no benefit from unnecessary lymphadenectomy, but may develop short- and long-term morbidity related to this procedure. Preoperative and intraoperative techniques could be critical tools for tailoring the extent and the radicalness of surgery in the management of women with presumed early endometrial cancer. In this review we will discuss updates in surgical management of early endometrial cancer and also the role of preoperative and intraoperative evaluation of lymph node status in influencing surgical options, with the aim of proposing a management algorithm based on the literature and our experience.

  20. Surgical management of an abdominal abscess in a Malayan tapir.

    PubMed

    Lambeth, R R; Dart, A J; Vogelnest, L; Dart, C M; Hodgson, D R

    1998-10-01

    A captive Malayan tapir was observed to have inappetence, weight loss, signs of depression, mild dehydration and diarrhoea. Haematological and serum biochemical tests showed anaemia, hypoproteinaemia, hyperfibrinogenaemia and neutrophilia with a left shift. Ultrasonic examination of the abdomen under anaesthesia revealed a well-encapsulated abscess. The abscess was marsupialised to the ventral body wall. Culture of the pus produced a mixed bacterial growth. Antimicrobial therapy was based on bacterial sensitivity results. Follow-up ultrasonic examinations showed resolution of the abscess. Ninety-one days after surgery the tapir began regurgitating food and water. An abscess originating from the stomach and occluding the lumen of the duodenum was identified at surgery. The abscess ruptured during surgical manipulations and the tapir was euthanased.

  1. 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.

  2. 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.

  3. Brainstem cavernous malformations: Natural history versus surgical management.

    PubMed

    Walcott, Brian P; Choudhri, Omar; Lawton, Michael T

    2016-10-01

    While brainstem cavernous malformations were once considered inoperable, improvements in patient selection, surgical exposures, intraoperative MRI-guidance, MR tractography, and neurophysiologic monitoring have resulted in good outcomes in the majority of operated patients. In a consecutive series of 104 patients with brainstem cavernous malformations, only 14% of patients experienced cranial nerve or motor dysfunction that was worse at late follow-up, relative to their preoperative condition. Outcomes were predicted by several factors, including larger lesion size, lesions that crossed the midline, the presence of a developmental venous anomaly, older age, and greater time interval from lesion hemorrhage to surgery. The 14% of patients who experienced a persistent neurological deficit as a result of surgery, while substantial from any perspective, compares favorably with the risks of observation based on a recent meta-analysis. Curative resection is a safe and effective treatment for brainstem cavernous malformations that will prevent re-hemorrhage in symptomatic patients.

  4. [Antiplatelet agents and anticoagulants: management of the anticoagulated surgical patient].

    PubMed

    Llau, Juan V; Ferrandis, Raquel; López Forte, Cristina

    2009-06-01

    Among the drugs most widely consumed by patients are both antiplatelet agents (aspirin, clopidogrel, ticlopidine) and anticoagulants (acenocoumarol, warfarin, low molecular weight heparin, fondaparinux). The use of these drugs in the perioperative period is an essential concern in patient care due to the need to balance the risk of bleeding against thrombotic risk (arterial or venous), which is increased in surgical patients. The present review highlights three main aspects. Firstly, withdrawal of antiplatelet agents is recommended between 1 week and 10 days before surgery to minimize perioperative bleeding. However, this practice has been questioned because patients without the required antiplatelet coverage may be at greater risk of developing cardiac, cerebral or peripheral vascular complications. Therefore, the recommendation of systematic antiplatelet withdrawal for a specific period should be rejected. Currently, risks should be evaluated on an individual basis to minimize the time during which the patient remains without adequate antiplatelet protection. Secondly, thromboprophylaxis is required in most surgical patients due to the high prevalence of venous thromboembolic disease. This implies the use of anticoagulants and the practice of regional anesthesia has been questioned in these patients. However, with the safety recommendations established by the various scientific societies, this practice has been demonstrated to be safe. Finally, "bridge therapy" in patients anticoagulated with acenocoumarol should be performed on an individual basis rather than systematically without taking into account the thrombotic risks of each patient. The perioperative period involves high arterial and venous thrombotic risk and the optimal use of antiplatelet agents and anticoagulants should be a priority to minimize this risk without increasing hemorrhagic risk. Multidisciplinary consensus is essential on this matter.

  5. Diabetic foot infections: stepwise medical and surgical management.

    PubMed

    Armstrong, David G; Lipsky, Benjamin A

    2004-06-01

    Foot complications are common among diabetic patients; foot ulcers are among the more serious consequences. These ulcers frequently become infected, with potentially disastrous progression to deeper spaces and tissues. If not treated promptly and appropriately, diabetic foot infections can become incurable or even lead to septic gangrene, which may require foot amputation. Diagnosing infection in a diabetic foot ulcer is based on clinical signs and symptoms of inflammation. Properly culturing an infected lesion can disclose the pathogens and provide their antibiotic susceptibilities. Specimens for culture should be obtained after wound debridement to avoid contamination and optimise identification of pathogens. Staphylococcus aureus is the most common isolate in these infections; the increasing incidence of methicillin-resistant S. aureus over the past two decades has further complicated antibiotic treatment. While chronic infections are often polymicrobial, many acute infections in patients not previously treated with antibiotics are caused by a single pathogen, usually a gram-positive coccus. We offer a stepwise approach to treating diabetic foot infections. Most patients must first be medically stabilised and any metabolic aberrations should be addressed. Antibiotic therapy is not required for uninfected wounds but should be carefully selected for all infected lesions. Initial therapy is usually empirical but may be modified according to the culture and sensitivity results and the patient's clinical response. Surgical intervention is usually required in cases of retained purulence or advancing infection despite optimal medical therapy. Possible additional indications for surgical procedures include incision and drainage of an abscess, debridement of necrotic material, removal of any foreign bodies, arterial revascularisation and, when needed, amputation. Most foot ulcers occur on the plantar surface of the foot, thus requiring a plantar incision for any drainage

  6. Study on Surgical Management of Post Burn Hand Deformities

    PubMed Central

    Ahmed, Firdos; Jash, Prabir Kumar; Gupta, Madhumita; Suba, Santanu

    2015-01-01

    Context Functionality of the hands is the major determinants of the quality of life in burns survivors. If contractures or scarring affect the dominant hand, as they do on most occasions, the vocation and there by the economic status of the patient suffer. Aim The aim of this study is to evaluate the different surgical procedures for resurfacing after release of post-burn hand contractures in terms of functional recovery and aesthetic outcome. Settings and Design It’s a prospective, non-randomised study of 50 patients admitted and undergoing surgical reconstructive procedures for post burn hand contractures in our plastic surgery department. Materials and Methods Resurfacing procedures were done according to type of contracture with individualisation for each case. All cases were followed up with physiotherapy and splinting advices. Functional and aesthetic outcome and recurrence of contracture for each procedure was noted at 6 months. Results Forty seven percent of the cases were reconstructed with skin grafting, 30% cases with Z plasties and 23% with flap coverage. Split thickness skin grafts (STSG) and full thickness graft (FTSG) reconstructed cases had good recovery of joint mobility in 43% and 75% of cases respectively. Reconstructive procedures were aesthetically acceptable to the patients in 63%, 75% and 94% of STSG, FTSG and Z plasty cases respectively. Recurrence was seen in 17% of STSG done cases. Conclusion Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z plasties with proper planning gives maximum length gain with no donor morbidity as other procedures. Postoperative physiotherapy and splinting is must for better outcome in all cases. PMID:26435994

  7. Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma: A Review of the Literature with Updates on Surgical Management

    PubMed Central

    Plateroti, Pasquale; Plateroti, Andrea Maria; Abdolrahimzadeh, Solmaz; Scuderi, Gianluca

    2015-01-01

    Pseudoexfoliation syndrome (PES) is a systemic disorder caused by progressive accumulation of extracellular material over various tissues. PES usually determines increased intraocular pressure, changes in the anatomical aspects of the optic nerve, and visual field alterations leading to the diagnosis of pseudoexfoliation glaucoma (PEG). Use of topical medical treatment usually leads to poor results in terms of long-term follow-up but many surgical techniques, such as Argon Laser or Selective Laser Trabeculoplasty, have been proposed for the management of PEG affected patients. The present paper is a review on the pseudoexfoliation syndrome and pseudoexfoliation glaucoma with an update on surgical management. PMID:26605078

  8. Surgical management of urinary stones with abnormal kidney anatomy.

    PubMed

    Ergin, Giray; Kirac, Mustafa; Unsal, Ali; Kopru, Burak; Yordam, Mustafa; Biri, Hasan

    2017-04-01

    In spite of the fact that urologic surgical techniques used by urologists are becoming more and more minimally invasive and easier because of developing technologies, surgical approaches for the urinary stones in kidneys with abnormal anatomy are still confusing. The objective of this article is to determine the treatment options in these kidneys. For this purpose, between 2005 and 2015, we retrospectively evaluated patients operated for urolithiasis with various congenital renal anomalies in five referral urology clinics in our country. Of the 178 patients (110 male, 60 female), 96 had horseshoe kidneys, 42 had pelvic ectopic kidneys (PEKs), and 40 had isolated rotation anomalies (IRAs) of the kidney. We evaluated the patients for stone-free rate (SFR), mean operation time, mean hospitalization time, and complication rate. In horseshoe kidney, SFRs for retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups were 72.2% and 90%, respectively. In PEKs, these rates were 83.6% and 100% for RIRS and laparoscopic pyelolithotomy, respectively. SFRs in kidneys with IRA were 75% for RIRS and 83.3% for PNL. The mean operation time for RIRS and PNL groups in horseshoe kidney was 40.5±11.2 minutes and 74.5±19.3 minutes, respectively. In PEKs, these times were 52.1±19.3 minutes and 53.1±24.3 minutes for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 48.7±14.4 minutes for RIRS and 53.2±11.3 minutes for PNL. Mean hospitalization times for RIRS and PNL groups in horseshoe kidneys were 1.4±0.7 days and 2.2±1.4 days, respectively. In PEKs, these times were 2.7±1.8 days and 1.9±0.4 days for RIRS and laparoscopic pyelolithotomy, respectively. Mean operation time in kidneys with IRA was 1.5±0.9 days for RIRS and 1.8±0.6 days for PNL. The results of our study showed that RIRS could be used in all of types of abnormal kidneys with small- and medium-sized renal calculi safely and satisfactorily.

  9. A comparison of the Ameroid constrictor versus ligation in the surgical management of single extrahepatic portosystemic shunts.

    PubMed

    Murphy, S T; Ellison, G W; Long, M; Van Gilder, J

    2001-01-01

    Twenty-two dogs were managed surgically for a single extrahepatic portosystemic shunt; 12 with surgical ligation and 10 with an Ameroid constrictor. Utilization of the Ameroid constrictor significantly decreased surgery time to approximately half that of the ligation technique. A decreased intraoperative and postoperative complication rate was noted with the Ameroid constrictor group. Follow-up evaluation demonstrated comparable efficacy when comparing surgical techniques. The Ameroid constrictor offered a surgical occlusion technique for management of a single extra-hepatic portosystemic shunt that was equally effective to ligation while shortening surgical time and minimizing the risks that are commonly associated with ligation of the shunting vessel.

  10. Surgical Management of Urologic Trauma and Iatrogenic Injuries.

    PubMed

    Zinman, Leonard N; Vanni, Alex J

    2016-06-01

    Genitourinary trauma usually occurs in the setting of multisystem trauma, accounting for approximately 10% of all emergency department admissions. Timely evaluation and management of the trauma patient have the potential to minimize urologic morbidity and mortality. New imaging modalities and a growing emphasis on nonoperative expectant management of both upper and lower urinary tract injuries have changed the field of urologic trauma. Concomitant injury to both the upper and the lower urinary tract is rare, but careful evaluation is critical to identify these devastating injuries.

  11. Management of critically ill surgical patients Case reports.

    PubMed

    Mangiante, Gerardo; Padoan, Roberto; Mengardo, Valentina; Bencivenga, Maria; de Manzoni, Giovanni

    2016-01-01

    The acute abdomen (AA) still remains a challenging situation for surgeons. New pathological conditions have been imposed to our attention in this field in recent years. The definition of abdominal compartmental syndrome (ACS) in surgical practice and the introduction of new biological matrices, with the concepts of tension-free (TS) repair of incisional hernias, prompted us to set up new therapeutic strategies for the treatment of patients with AA. Thus we reviewed the cases of AA that we observed in recent years in which we performed a laparostomy in order to prevent or to treat an ACS. They are all cases of acute abdomen (AA), but from different origin, including chronic diseases, as in the course of inflammatory bowel disease (IBD), and acute pancreatitis. In all the cases, the open abdominal cavity was covered with a polyethylene sheet. The edges of the wound were sutured to the plastic sheet, and a traction exerted by a device that causes a negative pressure was added. This method was adopted in several cases without randomization, and resulted in excellent patient's outcomes.

  12. Pathogenesis of nodular goiter and its implications for surgical management

    SciTech Connect

    Teuscher, J.; Peter, H.J.; Gerber, H.; Berchtold, R.; Studer, H.

    1988-01-01

    Despite sufficient iodine supply, goiter continues to be of considerable surgical significance in formerly endemic countries. It now appears that iodine deficiency and increased thyrotropin stimulation are not the only causes of goiter. Xenotransplantation of human thyroid tissue onto nude mice allowed study of the regulation of growth and function in human goiter tissue. Grafts of human thyroid tissue growing in nude mice could be shown to react to endogenous mouse thyrotropic stimulation and suppression. /sup 131/I autoradiographs of xenotransplanted goiter tissue showed as marked a heterogeneity as did the original goitrous tissue prior to transplantation. There was no firm correlation between the morphologic appearance of a follicle and its iodine metabolism. Scintigraphically cold and hot goiter tissue differed from each other quantitatively but not qualitatively; i.e., both hot and cold tissue were composed of metabolically active and nonactive follicles. Iodine organification was not completely suppressible by thyroxine treatment; this indicates autonomous functional activity. The distribution of proliferating tissue labeled by /sup 3/H-thymidine did not parallel the distribution of functionally active tissue labelled by /sup 131/I. Thyroxine treatment did not completely inhibit /sup 3/H-thymidine incorporation, indicating autonomous growth. Thus, our pathogenetic concept of goiter formation is based on three mainstays: (1) goiter heterogeneity, (2) autonomy of growth and function, and (3) dissociation of growth and function in human goiter tissue. Thus, the surgeon dealing with goiter ought to remove all pathologically altered tissue, i.e., nodular tissue, irrespective of its appearance on scintiscans.

  13. Surgical management of mandibular condylar hyperplasia type 1

    PubMed Central

    Morales-Ryan, Carlos A.; García-Morales, Patricia; Perez, Daniel

    2009-01-01

    This study compared outcomes of two surgical methods for patients diagnosed with active condylar hyperplasia type 1. Group 1 (n = 12) was treated with orthognathic surgery only, while group 2 (n = 42) was treated with high condylectomies, articular disc repositioning, and orthognathic surgery. There was no statistically significant difference between the two groups for maximum incisal opening, lateral excursions, and subjective jaw function before surgery. Group 2 showed more active presurgical mandibular growth (P < 0.05). At long-term follow up, no differences were found in lateral excursions and subjective jaw function. Group 2 showed a greater increase in maximum incisal opening (P < 0.01) and stability (P < 0.05) at long-term follow-up. All of the patients in group 1 grew back into skeletal and occlusal Class III relationships requiring secondary intervention, whereas all patients in group 2 remained stable in a Class I skeletal and occlusal relationship. Thus, patients with active condylar hyperplasia treated with high condylectomy, articular disc repositioning, and orthognathic surgery had stable, predictable outcomes compared with those treated with orthognathic surgery only. The high condylectomy effectively arrests disproportionate mandibular growth while maintaining normal jaw function. PMID:19865502

  14. Conservative and surgical management of pancreatic trauma in adult patients

    PubMed Central

    Menahem, Benjamin; Lim, Chetana; Lahat, Eylon; Salloum, Chady; Osseis, Michael; Lacaze, Laurence; Compagnon, Philippe; Pascal, Gerard

    2016-01-01

    Background The management of pancreatic trauma is complex. The aim of this study was to report our experience in the management of pancreatic trauma. Methods All patients hospitalized between 2005 and 2013 for pancreatic trauma were included. Traumatic injuries of the pancreas were classified according to the American Association for Surgery of Trauma (AAST) in five grades. Mortality and morbidity were analyzed. Results A total of 30 patients were analyzed (mean age: 38±17 years). Nineteen (63%) patients had a blunt trauma and 12 (40%) had pancreatic injury ≥ grade 3. Fifteen patients underwent exploratory laparotomy and the other 15 patients had nonoperative management (NOM). Four (13%) patients had a partial pancreatectomy [distal pancreatectomy (n=3) and pancreaticoduodenectomy (n=1)]. Overall, in hospital mortality was 20% (n=6). Postoperative mortality was 27% (n=4/15). Mortality of NOM group was 13% (n=2/15) in both cases death was due to severe head injury. Among the patients who underwent NOM, three patients had injury ≥ grade 3, one patient had a stent placement in the pancreatic duct and two patients underwent endoscopic drainage of a pancreatic pseudocyst. Conclusions Operative management of pancreatic trauma leads to a higher mortality. This must not be necessarily related to the pancreas injury alone but also to the associated injuries including liver, spleen and vascular trauma which may cause impaired outcome more than pancreas injury. PMID:28124001

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

    PubMed

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

    2013-07-01

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

  16. Snakebite in Korea: A Guideline to Primary Surgical Management

    PubMed Central

    Kwon, Sung Min; Oh, Jin Rok; Han, Byung Keun; Lee, Kang Hyung; Kim, Jae Hyun

    2015-01-01

    Purpose Snakebite is an emergency which causes local symptoms such as pain and edema around the bite. Systemic symptoms may also develop, such as dizziness or renal failure, and may even cause death. The purpose of this research was to assess the validity and safety of snakebite protocol for surgery when treating snakebite patients. Materials and Methods Retrospective research was performed on patients who were admitted after being treated at the emergency center from January 2008 to December 2012. When necessary, debridement was also performed, and 46 of 111 patients (41.4%) underwent debridement. Those who had received debridement without antivenom administration due to a positive skin reaction test were classified as group A, and group B received antivenom and delayed debridement. We reviewed the emergency and admission charts of the patients in each group and recorded and compared their age, sex, bite site, severity of local and general symptoms, time to receive antivenin, and complications. Results Of the ten patients (21.7%) in group A, two (66.6%) developed cellulites, and one of them experienced skin necrosis, resulting in a skin graft. In group B, there were 36 patients (78.2%), 19 (52.7%) of whom developed cellulitis. Skin necrosis occurred in two patients, and one of these patients received a skin graft. Compartment syndrome was found in one patient, and fasciotomy and a skin graft were performed. Conclusion The treatment protocol implemented to treat snakebite patients admitted to the emergency center during this research was safely and properly followed during surgical treatment. PMID:26256993

  17. Surgical management of medically refractory epilepsy in patients with polymicrogyria

    PubMed Central

    Wang, Doris D.; Knox, Renatta; Rolston, John D.; Englot, Dario J.; Barkovich, A. James; Tihan, Tarik; Auguste, Kurtis I.; Knowlton, Robert C.; Cornes, Susannah B.; Chang, Edward F.

    2017-01-01

    Objective Polymicrogyria (PMG) is a malformation of cortical development characterized by formation of an excessive number of small gyri. Sixty percent to 85% of patients with PMG have epilepsy that is refractory to medication, but surgical options are usually limited. We characterize a cohort of patient with polymicrogyria who underwent epilepsy surgery and document seizure outcomes. Methods A retrospective study of all patients with PMG who underwent epilepsy surgery (focal seizure foci resection and/or hemispherectomy) at our center was performed by review of all clinical data related to their treatment. Results We identified 12 patients (7 males and 5 female) with mean age of 18 (ranging from 3 months to 44 years) at time of surgery. Mean age at seizure onset was 8 years, with the majority (83%) having childhood onset. Six patients had focal, five had multifocal, and one patient had diffuse PMG. Perisylvian PMG was the most common pattern seen on magnetic resonance imaging (MRI). Eight patients had other cortical malformations including hemimegalencephaly and cortical dysplasia. Scalp electroencephalography (EEG) often showed diffuse epileptic discharges that poorly lateralized but were focal on intracranial electrocorticography (ECoG). Eight patients underwent seizure foci resection and four underwent hemispherectomy. Mean follow-up was 7 years (ranging from one to 19 years). Six patients (50%) were seizure-free at last follow-up. One patient had rare seizures (Engel class II). Three patients were Engel class III, having either decreased seizure frequency or severity, and two patients were Engel class IV. Gross total resection of the PMG cortex trended toward good seizure control. Significance Our study shows that even in patients with extensive or bilateral PMG malformations, some may still be good candidates for surgery because the epileptogenic zone may involve only a portion of the malformation. Intracranial ECoG can provide additional localizing

  18. Managing dentoalveolar surgical procedures in patients taking new oral anticoagulants.

    PubMed

    Sivolella, Stefano; De Biagi, Marleen; Brunello, Giulia; Berengo, Mario; Pengo, Vittorio

    2015-09-01

    The development of new orally administered anticoagulants, such as dabigatran, rivaroxaban, and apixaban, in the past few years has focused on avoiding some of the drawbacks associated with warfarin. This work aims to illustrate the main features of the most commonly used new oral anticoagulants, reviewing the current literature on the management of patients taking these drugs and needing oral and implant surgery, and discussing the currently proposed related guidelines.

  19. [Combined surgical and oncological management of colorectal liver metastases].

    PubMed

    Bergenfeldt, Magnus; Jensen, Benny Vittrup

    2008-04-14

    Isolated colorectal liver metastases should be referred for multispecialist management at a liver centre. Long-time survival is possible after resection and adjuvant therapy. If unresectable, newer chemotherapy with oxaliplatin, irinitecan, bevacizumab and cetuximab may result in a median survival > 20 months. Selected patients may be down-staged and resected with good long-time survival. Bilateral, multiple and large metastases can also be treated by complex combinations of portal vein embolization/ligature, staged resections and local (radiofrequency) ablation.

  20. Diagnosis and Surgical Management of Nonsyndromic Nine Supernumerary Teeth and Leong's Tubercle

    PubMed Central

    Cruz, Christiane V.; Soares, Andrea L.; Braga, David N.; Costa, Marcelo C.

    2016-01-01

    Nonsyndromic multiple supernumerary teeth (ST) and Leong's tubercle are a condition with a very low prevalence and a multidisciplinary approach is required to restore function and aesthetics. So, this case report aimed at presenting a rare case of nonsyndromic nine supernumerary teeth and Leong's tubercle in a pediatric patient, without any evident familial history, showing its diagnosis and surgical management. PMID:27066278

  1. Evaluation and surgical management of the gallstone ileus. A single center experience.

    PubMed

    Safioleas, M; Stamatakos, M; Spyrakos, C; Safioleas, P; Chatzikonstantinou, C; Iannescu, R; Safioleas, C

    2008-01-01

    Gallstone ileus representing 1-4% of all bowel obstructions cholelithiasis. Impaction of a gallstone in the human of the bowel is a surgical emergency. Relief of the obstruction is the treatment of choice, but controversy exists regarding the repair of the fistula and cholecystectomy. Our experience in the management of gallstone ileus is presented in the following article.

  2. Strategy of Surgical Management of Peripheral Neuropathy Form of Diabetic Foot Syndrome in Ghana

    PubMed Central

    Rdeini, W. M.; Agbenorku, P.; Mitish, V. A.

    2014-01-01

    Introduction. Foot disorders such as ulceration, infection, and gangrene which are often due to diabetes mellitus are some major causes of morbidity and high amputation. Aim. This study aims to use a group of methods for the management of diabetic foot ulcers (DFU) in order to salvage the lower limb so as to reduce the rate of high amputations of the lower extremity. Materials and Methods. A group of different advanced methods for the management of DFU such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done at 3 different hospitals where the treatments were given. Results. Fifty-four patients with type 2 diabetes mellitus were enrolled in the current study: females n = 37 (68.51%) and males n = 17 (31.49%) with different stages of PEDIS classification. They underwent different methods of surgical management: debridement, vacuum therapy (some constructed from locally used materials), and skin grafting giving good and fast results. Only 4 had below knee amputations. Conclusion. Using advanced surgical wound management including reconstructive plastic surgical procedures, it was possible to reduce the rate of high amputations of the lower limb. PMID:25152815

  3. Tamponade in the surgical management of retinal detachment.

    PubMed

    Vaziri, Kamyar; Schwartz, Stephen G; Kishor, Krishna S; Flynn, Harry W

    2016-01-01

    Despite treatment advances, rhegmatogenous retinal detachment (RD) can have poor visual outcomes even with prompt and appropriate therapy. Pars plana vitrectomy is a leading management modality for the treatment of RD. This procedure is generally accompanied by the use of internal tamponade. Various gases and silicone oils may yield beneficial outcomes. Heavy silicone oils have been approved in some European nations but are not available in the USA. Different tamponade agents have unique benefits and risks, and choice of the agent should be individualized according to the characteristics of the patient and RD, as well as perioperative and postoperative factors.

  4. Gradenigo's syndrome--surgical management in a child.

    PubMed

    Humayun, Hassan Nabeel; Akhtar, Shabbir; Ahmed, Shakeel

    2011-04-01

    Otits media is a common problem. Some of its complications that were seen frequently in the preantibiotic era are rare today. We report a case of an 8 year boy who presented with earache, retro-orbital pain and diplopia secondary to a sixth nerve palsy--Gradenigo's syndrome. In this syndrome infection from the middle ear spreads medially to the petrous apex of the temporal bone. Work-up includes CT scan of the temporal bones. Timely management with intravenous antibiotics (+ surgery) is needed to prevent intra-cranial complications.

  5. Tamponade in the surgical management of retinal detachment

    PubMed Central

    Vaziri, Kamyar; Schwartz, Stephen G; Kishor, Krishna S; Flynn, Harry W

    2016-01-01

    Despite treatment advances, rhegmatogenous retinal detachment (RD) can have poor visual outcomes even with prompt and appropriate therapy. Pars plana vitrectomy is a leading management modality for the treatment of RD. This procedure is generally accompanied by the use of internal tamponade. Various gases and silicone oils may yield beneficial outcomes. Heavy silicone oils have been approved in some European nations but are not available in the USA. Different tamponade agents have unique benefits and risks, and choice of the agent should be individualized according to the characteristics of the patient and RD, as well as perioperative and postoperative factors. PMID:27041988

  6. Protocol in managing oral surgical patients taking dabigatran.

    PubMed

    Breik, O; Cheng, A; Sambrook, Pj; Goss, An

    2014-09-01

    New anticoagulants are being introduced into the market. These drugs are orally administered, have predictable pharmacokinetics and dose response, do not require monitoring and have an acceptable safety profile when used appropriately, and so avoid many of the disadvantages and possible complications of warfarin and heparin. Dabigatran is the most widely used, and has been approved by the Therapeutic Goods Administration. The use of dabigatran will likely increase in the coming years, and so it is important for dentists to be aware of its mechanism of action, the possible complications, and how to reverse the bleeding if it occurs. This review discusses dabigatran and reports on our experience of five cases, and provides practical clinical advice on how to manage patients on dabigatran who require dental treatment, particularly extractions.

  7. Surgical management of inflammatory bowel disease in China: a systematic review of two decades

    PubMed Central

    Yu, Qiao; Lian, Lei; Ng, Siew chien; Zhang, Shenghong; Chen, Zhihui; Zhang, Yanyan; Qiu, Yun; Chen, Baili; He, Yao; Zeng, Zhirong; Ben-Horin, Shomron; Song, Xinming

    2016-01-01

    Background/Aims The past decades have seen increasing incidence and prevalence of inflammatory bowel disease (IBD) in China. This article aimed to summarize the current status and characteristics of surgical management for IBD in China. Methods We searched PubMed, Embase, and Chinese databases from January 1, 1990 to July 1, 2014 for all relevant studies on the surgical treatment IBD in China. Eligible studies with sufficient defined variables were further reviewed for primary and secondary outcome measures. Results A total of 74 studies comprising 2,007 subjects with Crohn's disease (CD) and 1,085 subjects with ulcerative colitis (UC) were included. The percentage of CD patients misdiagnosed before surgery, including misdiagnosis as appendicitis or UC, was 50.8%±30.9% (578/1,268). The overall postoperative complication rate was 22.3%±13.0% (267/1,501). For studies of UC, the overall postoperative complication rate was 22.2%±27.9% (176/725). In large research centers (n>50 surgical cases), the rates of emergency operations for CD (P=0.032) and in-hospital mortalities resulting from both CD and UC were much lower than those in smaller research centers (n≤50 surgical cases) (P=0.026 and P <0.001, respectively). Regarding the changes in CD and UC surgery over time, postoperative complications (P=0.045 for CD; P=0.020 for UC) and postoperative in-hospital mortality (P=0.0002 for CD; P=0.0160 for UC) both significantly improved after the year 2010. Conclusions The surgical management of IBD in China has improved over time. However, the rates of misdiagnosis and postoperative complications over the past two decades have remained high. Large research centers were found to have relatively better capacity for surgical management than the smaller ones. Higher quality prospective studies are needed in China. PMID:27799883

  8. PEMFs: new post-surgical management in dentristry

    NASA Astrophysics Data System (ADS)

    Tonetti, Luca

    2014-01-01

    Aim of study: the possible effects on dental postsurgical management using small and not invasive devices: RecoveryRx or ActiPatch producted by Bioelectronics company (USA) Materials and methods: review of literature using searching engines Keywords: PEMFs, postsurgical treatment, pain, wound healing, RecoveryRx, ActiPatch Results: Pulsed Electro Magnetic Fields have been used extensively for decades for many conditions and medical disciplines. Imperceptible cell dysfunction that is not corrected early can lead to disease. Fine-tuning can be done daily in only minutes, using pulsed electromagnetic fields (PEMFs). In addition, when there is a known imbalance (when symptoms are present) or there is a known disease or condition, PEMF treatments, used either alone or along with other therapies, can often help cells rebalance dysfunction faster. It is seen in literature that RecoveryRX and ActiPatch improve the cell metabolism, rebalance the membrane potential difference, improve the circulation and the oxigenation of the tissues, acceleration of osteogenesis, acceleration repair of soft tissues, reduce pain. Conclusion: the RecoveryRX and ActiPatch devices could improve the postsurgical healing reducing the patient discomfort.

  9. Pharmacological Management of Agitation and Aggression in an Adolescent with Autism

    ERIC Educational Resources Information Center

    Kratochvil, Christopher J.; Findling, Robert L.; McDougle, Christopher J.; Scahill, Lawrence; Hamarman, Stephanie

    2005-01-01

    This article provides an "autism vignette" and then poses an evaluative question to several autism specialists, documenting their varied responses to the scenario and question posed. A 13-year-old boy with autism and severe mental retardation presented to the inpatient psychiatric unit due to a recent increase in agitation and physical aggression.…

  10. Management of Aggression in a Male-Dominated Culture: Samoan Migrant Women in Distress.

    ERIC Educational Resources Information Center

    Lazar, Ineke Maria

    "Spirit possession" of Samoan women is a subconscious channel for venting aggression in a male-dominated society. Research conducted in the Los Angeles Samoan community which retains many of its traditional Samoan values showed that authority and allocation of resources are vested in men; women take care of children and home and are…

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

    PubMed

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

    2012-01-01

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

  12. Conservative Management of Invasive Placentation: Two Cases with Different Surgical Approaches.

    PubMed

    Fay, Emily E; Norquist, Barbara; Jolley, Jennifer; Hardesty, Melissa

    2016-04-01

    Background When placenta accreta complicates a delivery, the typical management is to perform a cesarean hysterectomy. Other management strategies, including leaving the placenta in situ, have been attempted and supported in some cases. This may allow for an interval hysterectomy, which can potentially decrease average blood loss and/or allow a minimally invasive approach to the hysterectomy. Cases We present two cases of women with invasive placentation managed conservatively with interval hysterectomy. One woman was managed with robotic-assisted laparoscopic surgery and the other with an open surgical approach. Conclusion These cases highlight the successful use of conservative management for invasive placentation in two stable patients and showcase the novel use of a robotic-assisted laparoscopic surgery for management of invasive placentation.

  13. Conservative Management of Invasive Placentation: Two Cases with Different Surgical Approaches

    PubMed Central

    Fay, Emily E.; Norquist, Barbara; Jolley, Jennifer; Hardesty, Melissa

    2016-01-01

    Background When placenta accreta complicates a delivery, the typical management is to perform a cesarean hysterectomy. Other management strategies, including leaving the placenta in situ, have been attempted and supported in some cases. This may allow for an interval hysterectomy, which can potentially decrease average blood loss and/or allow a minimally invasive approach to the hysterectomy. Cases We present two cases of women with invasive placentation managed conservatively with interval hysterectomy. One woman was managed with robotic-assisted laparoscopic surgery and the other with an open surgical approach. Conclusion These cases highlight the successful use of conservative management for invasive placentation in two stable patients and showcase the novel use of a robotic-assisted laparoscopic surgery for management of invasive placentation. PMID:27294007

  14. Operating room data management: improving efficiency and safety in a surgical block

    PubMed Central

    2013-01-01

    Background European Healthcare Systems are facing a difficult period characterized by increasing costs and spending cuts due to economic problems. There is the urgent need for new tools which sustain Hospitals decision makers work. This project aimed to develop a data recording system of the surgical process of every patient within the operating theatre. The primary goal was to create a practical and easy data processing tool to give hospital managers, anesthesiologists and surgeons the information basis to increase operating theaters efficiency and patient safety. Methods The developed data analysis tool is embedded in an Oracle Business Intelligence Environment, which processes data to simple and understandable performance tachometers and tables. The underlying data analysis is based on scientific literature and the projects teams experience with tracked data. The system login is layered and different users have access to different data outputs depending on their professional needs. The system is divided in the tree profile types Manager, Anesthesiologist and Surgeon. Every profile includes subcategories where operators can access more detailed data analyses. The first data output screen shows general information and guides the user towards more detailed data analysis. The data recording system enabled the registration of 14.675 surgical operations performed from 2009 to 2011. Results Raw utilization increased from 44% in 2009 to 52% in 2011. The number of high complexity surgical procedures (≥120 minutes) has increased in certain units while decreased in others. The number of unscheduled procedures performed has been reduced (from 25% in 2009 to 14% in 2011) while maintaining the same percentage of surgical procedures. The number of overtime events decreased in 2010 (23%) and in 2011 (21%) compared to 2009 (28%) and the delays expressed in minutes are almost the same (mean 78 min). The direct link found between the complexity of surgical procedures, the number

  15. 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

  16. Modern surgical management of breast cancer therapy related upper limb and breast lymphoedema.

    PubMed

    Leung, Nelson; Furniss, Dominic; Giele, Henk

    2015-04-01

    Breast cancer is the commonest cancer in the UK. Advances in breast cancer treatment means that the sequelae of treatment are affecting more women and for a longer duration. Lymphoedema is one such sequela, with wide-ranging implications, from serious functional and psychological effects at the individual level to wider economic burdens to society. Breast cancer-related lymphoedema is principally managed by conservative therapy comprising compression garments and manual decongestive massage. This approach is effective for early stages of lymphoedema, but it is not curative and the effectiveness depends on patient compliance. Early surgical approaches were ablative, gave significant morbidity and hence, reserved for the most severe cases of refractory lymphoedema. However, recent non-ablative reconstructive surgical approaches have seen a revival of interest in the prevention or surgical management of breast cancer-related lymphoedema. This review examines the modern surgical techniques for the treatment of breast cancer-related lymphoedema. Liposuction reduces the volume and symptoms of lymphedema, but requires continual compressive therapy to avoid recurrence. Lymphatic reconstruction or bypass techniques including lymph node transfer (inguinal nodes are transferred to the affected limb), lymphatico-lymphatic bypass (lymphatics bypass the axilla using a lymph vessel graft reconstructing lymphatic flow from arm to neck) and lymphaticovenous anastomoses (lymphatics in the arm are joined to the venous system aiding lymph drainage) show promise in reducing lymphedema significantly. Further research is required, including into the role of primary lymphaticovenous anastomoses in the prevention of lymphedema at the time of axillary dissection.

  17. 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.

  18. Medical and Surgical Management of Postpartum Hemorrhage in a Woman with Factor XIII Deficiency

    PubMed Central

    Srey, Krisna; Canales, Alexander; Kiffin, Chauniqua; Ashmawy, Yessin

    2016-01-01

    Factor XIII deficiency is a rare inherited coagulopathy. Factor XIII is the last clotting factor in the coagulation cascade to insure strength and stability to fibrin clots. Without this enzyme, the fibrous clot is unstable and nonresistant to fibrinolysis. Gravid women with this congenital disease are especially at risk for complications including miscarriages and hemorrhage without appropriate interventions. We present a case of a woman in her 20s with Factor XIII deficiency who was treated with cryoprecipitate and had a successful normal spontaneous vaginal delivery; subsequently, patient suffered from postpartum hemorrhage and consumptive coagulopathy due to consumption of Factor XIII, requiring emergency surgical intervention. Intraoperative management was challenged by an ethical dilemma involving the patient's religious beliefs about not receiving blood. This paper will discuss the mechanism of Factor XIII and the medical and surgical management involved with this patient. PMID:27635271

  19. Liver tumours in children: current surgical management and role of transplantation.

    PubMed

    Millar, A J W

    2014-11-01

    This article reviews the current surgical management of liver tumours in children in the light of improved chemotherapy, surgical techniques and outcomes from transplantation. It is a principle of management that complete removal of a tumour must be achieved for cure. Neoadjuvant chemotherapy may downstage advanced local disease to enable safe curative tumour resection. When this is not achievable, transplant is indicated. Conventional indications for transplant are unresectable stages 3 and 4 tumours confined to the liver. With the realisation that lifelong immunosuppressive therapy has considerable adverse consequences, there has been a recent trend towards extreme and 'acrobatic' liver resection to avoid transplantation, but still obtain a cure. The current literature is reviewed in the light of these trends and our own experience.

  20. Surgical Management of Perforated Gastrointestinal Posttransplantation Lymphoproliferative Disorder After Heart Transplantation

    PubMed Central

    Osawa, Hideki; Uemura, Mamoru; Nishimura, Junichi; Hata, Taishi; Takemasa, Ichiro; Mizushima, Tsunekazu; Yamamoto, Hirofumi; Doki, Yuichiro; Mori, Masaki

    2015-01-01

    Posttransplantation lymphoproliferative disorder (PTLD) is a relatively rare and life-threatening complication after organ transplantation. From 1999 to 2012, 45 adult patients underwent heart transplantation at our hospital. Two of the patients developed PTLD after transplantation and required emergency surgery due to intestinal perforation. These cases were informative regarding the adequate surgical management of such cases. Both cases revealed Epstein-Barr virus-related PTLD. The optimal treatment of PTLD remains controversial, and PTLD with gastrointestinal perforation could be critical because the patients are already debilitated and immunocompromised after transplantation. Therefore, the nonspecific abdominal symptoms can be diagnostic for PTLD, and proper surgical intervention should be performed immediately. We present these two suggestive and rare cases in regard to the management of perforation with PTLD and a review of literature. PMID:25692442

  1. Fall prevention practices in adult medical-surgical nursing units described by nurse managers.

    PubMed

    Shever, Leah L; Titler, Marita G; Mackin, Melissa Lehan; Kueny, Angela

    2011-04-01

    The purpose of this article was to describe nursing practices (e.g., assessment, interventions) around fall prevention, as perceived by nurse managers in adult, medical-surgical nursing units. One hundred forty nurse managers from 51 hospitals from across the United States participated. Descriptive frequencies are used to describe nurse manager responses. The most commonly used fall risk assessment tool was the Morse Fall Risk Assessment Tool (40%). The most common fall prevention interventions included bed alarms (90%), rounds (70%), sitters (68%), and relocating the patient closer to the nurses' station (56%). Twenty-nine percent of nurse managers identified physical restraints as an intervention to prevent falls whereas only 10% mentioned ambulation. No nurse manager identified that RN hours per patient-day were adjusted to prevent falls or fall-related injuries. More work is needed to build systems that ensure evidence-based nursing interventions are consistently applied in acute care.

  2. [Modern methods of comprehensive management of patients with varicose disease relapsing after surgical interventions].

    PubMed

    Gavrilenko, A V; Vakhrat'ian, P E

    2012-01-01

    Despite progress achieved by Russian phlebology in diagnosis and treatment of lower-limb varicose disease, the latter remains the most commonly encountered pathology of the vascular bed. Treatment for varicose disease includes a series of unsolved as yet problems, the main of which being a relapse of varicose disease after surgical interventions. The authors share herein their experience gained in using comprehensive methods while managing varicose disease relapses, also describing the technique of the procedures performed and analysing certain technical variants thereof.

  3. An update on the surgical management of pterygium and the role of loteprednol etabonate ointment

    PubMed Central

    Sheppard, John D; Mansur, Arnulfo; Comstock, Timothy L; Hovanesian, John A

    2014-01-01

    Pterygium, a sun-related eye disease, presents as wing-shaped ocular surface lesions that extend from the bulbar conjunctiva onto the cornea, most commonly on the nasal side. Pterygia show characteristic histological features that suggest that inflammation plays a prominent role in their initial pathogenesis and recurrence. Appropriate surgery is the key to successful treatment of pterygia, but there is also a rationale for the use of anti-inflammatory agents to reduce the rate of recurrence following surgery. Multiple surgical techniques have been developed over the last two millennia, but these initially had little success, due to high rates of recurrence. Current management strategies, associated with lower recurrence rates, include bare sclera excision and various types of grafts using tissue glues. Adjunctive therapies include mitomycin C and 5-fluorouracil, as well as the topical ocular steroid loteprednol etabonate, which has been shown to have a lower risk of elevated intraocular pressure than have the other topical ocular steroids. Here, the surgical management of pterygium is presented from a historical perspective, and current management techniques, including the appropriate use of various adjunctive therapies, are reviewed, along with an illustrative case presentation and a discussion of the conjunctival forceps designed to facilitate surgical management. Despite thousands of years of experience with this condition, there remains a need for a more thorough understanding of pterygium and interventions to reduce both its incidence and postsurgical recurrence. Until that time, the immediate goal is to optimize surgical practices to ensure the best possible outcomes. Loteprednol etabonate, especially the ointment formulation, appears to be a safe and effective component of the perioperative regimen for this complex ocular condition, although confirmatory prospective studies are needed. PMID:24966664

  4. Surgical management of neuroma pain: a prospective follow-up study.

    PubMed

    Stokvis, Annemieke; van der Avoort, Dirk-Jan J C; van Neck, Johan W; Hovius, Steven E R; Coert, J Henk

    2010-12-01

    Painful neuromas can cause severe loss of function and have great impact on the daily life of patients. Surgical management remains challenging; despite improving techniques, success rates are low. To accurately study the success of surgical neuroma treatment and factors predictive of outcome, a prospective follow-up study was performed. Between 2006 and 2009, pre- and post-operative questionnaires regarding pain (VAS, McGill), function (DASH), quality of life (SF-36), symptoms of psychopathology (SCL-90), epidemiologic determinants and other outcome factors were sent to patients surgically treated for upper extremity neuroma pain. Pain scores after diagnostic nerve blocks were documented at the outpatient clinic before surgery. Thirty-four patients were included, with an average follow up time of 22 months. The mean VAS score decreased from 6.8 to 4.9 after surgery (p<0.01), 19 (56%) of patients were satisfied with surgical results. Upper extremity function improved significantly (p=0.001). Neuroma patients had significantly lower quality of life compared to a normal population. Employment status, duration of pain and CRPS symptoms were found to be prognostic factors. VAS scores after diagnostic nerve block were predictive of post-operative VAS scores (p=0.001). Furthermore, smoking was significantly related to worse outcome (relative risk: 2.10). The results could lead to improved patient selection and treatment strategies. If a diagnostic nerve block is ineffective in relieving pain, patients will most likely not benefit from surgical treatment. Patients should be encouraged to focus on activity and employment instead of their symptoms. Smoking should be discouraged in patients who will undergo surgical neuroma treatment.

  5. The evolution of the diminishing role of extrapleural pneumonectomy in the surgical management of malignant pleural mesothelioma

    PubMed Central

    Azzouqa, Abdel-Ghani; Stevenson, James P

    2016-01-01

    Malignant pleural mesothelioma is an uncommon and aggressive thoracic malignancy that is rarely curable, even when multimodality therapy is used. Systemic chemotherapy is the primary treatment for the majority of patients with this disease; however, surgical resection may benefit a subset of patients with early-stage disease. The surgical approach that offers the best outcomes remains an area of controversy, with data from retrospective comparisons being the only guide. Historically, extrapleural pneumonectomy (EPP) has been the standard procedure, carrying with it a cost of significant morbidity and impact on quality of life that has raised questions regarding its routine application. Over the past two decades as surgical techniques have been refined and survival data with EPP in large case series have been reported, the paradigm has evolved toward the use of lung-sparing pleural resections such as pleurectomy/decortication (P/D) and extended P/D. The identification of patients who may benefit from EPP over pleurectomy has proven problematic, and the larger question regarding the impact of any type of surgical intervention on outcomes for pleural mesothelioma patients is still an area of investigation. Uniform treatment approaches have been difficult to develop due to the relatively small numbers of patients with this disease, the use of a staging system that does not readily identify those who may benefit from more aggressive therapy, and the institutional biases that have resulted from the growth of multimodality centers of excellence. PMID:27932892

  6. Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management

    PubMed Central

    Panteliadis, Pavlos; Nagra, Navraj S.; Edwards, Kimberley L.; Behrbalk, Eyal; Boszczyk, Bronek

    2016-01-01

    Study Design  Narrative review. Objective  The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. Methods  The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term “spondylolysis AND athlete.” The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. Results  Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. Conclusion  There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis. PMID:27556003

  7. The Surgical Approach to Differentiated Thyroid Cancer

    PubMed Central

    Nixon, Iain

    2015-01-01

    The incidence of thyroid cancer is increasing rapidly. A large percentage of new cases identified fall into a low-risk category. As the incidence has increased, clinical experience has confirmed that the majority of patients will have excellent outcomes and that those at risk of doing badly can be reliably identified. Treatment for thyroid cancer is predominantly surgical. The decision about how aggressively this disease should be managed has remained controversial due to the excellent outcomes irrespective of the nature of surgical procedure chosen. This article reviews the developments in our understanding of the biology of thyroid cancer and the evidence that supports the approach to management. PMID:26918146

  8. Alternative Approach to the Management of Postoperative Pain after Pediatric Surgical Procedures

    PubMed Central

    Souza, Juliana; Santos-Pinto, Lourdes; Pansani, Cyneu

    2014-01-01

    ABSTRACT Aim: This paper reports two clinical cases in which the application of low-level laser therapy (LLLT) enhanced the postoperative symptoms after pediatric surgical procedures. Background: The uses of novel technologies allow more comfort to the patients and ensure a rapid procedure, and LLLT application has shown a positive effect in the prevention of discomfort after invasive procedures. Case description: Low-level laser therapy protocol was applied after surgical removal of supernumerary tooth and frenectomy resulting in less swallow and pain with no need of medication intake. Conclusion: The laser application was well accepted by both children and parents and showed a clinical efficiency in the follow-up examinations beyond the satisfactory quality of wound healing. Clinical significance: The LLLT approach is an excellent adjuvant therapy resource for delivery an optimal postoperative after surgical procedures in children. How to cite this article: Paschoal M, Souza J, Santos-Pinto L, Pansani C. Alternative Approach to the Management of Postoperative Pain after Pediatric Surgical Procedures. Int J Clin Pediatr Dent 2014;7(2):125-129. PMID:25356012

  9. Diagnosis and surgical management of breast cancer metastatic to the spine

    PubMed Central

    Ju, Derek G; Yurter, Alp; Gokaslan, Ziya L; Sciubba, Daniel M

    2014-01-01

    Breast cancer is the most common malignancy and the second leading cause of death in Western women. Breast cancer most commonly metastasizes to the bone and has a particular affinity with the spine, accounting for 2/3 of osseous metastases discovered. With significant improvements in cancer therapies, the number of patients at risk for symptomatic spinal metastases is likely to increase. Patients may suffer from intractable pain and neurological dysfunction, negatively influencing their quality of life. Timely diagnosis of patients is crucial and has been aided by several breakthrough advances in imaging techniques which aid in detection, staging, and follow-up of bone metastases. Breast metastases are usually responsive to hormonal therapy and pharmacologic interventions, but skeletal metastases often require surgical intervention. The treatments are palliative but goals include the preserving or restoring neurologic function, ensuring spinal stability, and relieving pain. Advances in surgical techniques and instrumentation have allowed more effective decompression and stabilization of the spine, and with the support of recent evidence the trend has shifted towards using more advanced surgical options in appropriately selected patients. In this review, the clinical presentation, diagnosis, patient selection, and surgical management of breast cancer metastatic to the spine are discussed. PMID:25114843

  10. Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons.

    PubMed

    Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier

    2014-10-01

    There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals.

  11. Challenges of Endoscopic Management of Pancreaticobiliary Complications in Surgically Altered Gastrointestinal Anatomy

    PubMed Central

    Wai, Tin Moe; Kim, Eun Young

    2016-01-01

    Pancreaticobiliary complications following various surgical procedures, including liver transplantation, are not uncommon and are important causes of morbidity and mortality. Therapeutic endoscopy plays a substantial role in these patients and can help to avoid the need for reoperation. However, the endoscopic approach in patients with surgically altered gastrointestinal (GI) anatomy is technically challenging because of the difficulty in entering the enteral limb to reach the target orifice to manage pancreaticobiliary complications. Additional procedural complexity is due to the need of special devices and accessories to obtain successful cannulation and absence of an elevator in forward-viewing endoscopes, which is frequently used in this situation. Once bilioenteric anastomosis is reached, the technical success rates achieved in expert hands approach those of patients with intact GI anatomy. The success of endoscopic therapy in patients with surgically altered GI anatomy depends on multiple factors, including the expertise of the endoscopist, understanding of postoperative anatomic changes, and the availability of suitable scopes and accessories for endoscopic management. In this issue of Clinical Endoscopy, the focused review series deals with pancreatobiliary endoscopy in altered GI anatomy such as bilioenteric anastomosis and post-gastrectomy. PMID:27894188

  12. [Outcomes of surgical management of retinopathy of prematurity--an overview].

    PubMed

    Kuprjanowicz, Leszek; Kubasik-Kładna, Katarzyna; Modrzejewska, Monika

    2014-01-01

    According to the guidelines by the ETROP (Early Treatment for Retinopathy of Prematurity) study group, laser therapy is the gold standard in the treatment of retinopathy of prematurity. However, progression of the disease is seen in 12% of eyes despite the treatment. Since there is no causal treatment, new therapies of retinopathy of prematurity, are continually sought, such as anti-VEGF agents, beta-blockers, or insulin-like growth factor gene therapy. In cases with concomitant retinal detachment, surgery is performed. The standard therapy for retinopathy of prematurity stages 4-5 involves pars plicata vitrectomy and lensectomy (stage 5), ab externo surgery (scleral buckling) and lens-sparing vitrectomy (some cases of stage 4). Classic vitrectomy with lensectomy is reserved only for cases with advanced retinal tractions, retina-lens apposition or for cases of intraoperative lens damage during the lens-sparing vitrectomy. The ab externo surgery does not eliminate vitreous tractions, but it stabilises the neovascular membrane activity (transforming it into a scar). The indication for this type of operation is stage 4 retinopathy of prematurity with peripheral proliferations, except for the posterior--aggressive form of retinopathy of prematurity. Many papers have been published on combined therapy involving vitrectomy and conservative treatment. In conclusion, optimal timing of surgical intervention is difficult to determine in stages 4 and 5, because the anatomical and functional outcomes in stage 5 are unfavourable. Both, ab externo surgery and vitrectomy tend to produce poor macular vision in eyes with advanced retinopathy of prematurity, therefore surgical intervention at stage 4 just before the local macular retinal detachment provides better anatomical and functional outcomes.

  13. A Third Surgically Managed Ectopic Pregnancy after Two Salpingectomies Involving the Opposite Tube

    PubMed Central

    Deguchi, Yoko; Horiuchi, Yuko; Ino, Kazuhiko; Furukawa, Kenichi

    2017-01-01

    Recurrent ectopic pregnancy in a remnant fallopian tube after ipsilateral salpingectomy is clinically rare. We report the extremely rare case of a third recurrent ectopic pregnancy after two previous salpingectomy procedures involving the opposite tube. A 26-year-old woman, gravida 3 para 0, experienced three ectopic pregnancies brought about by natural conception, all of which were treated surgically (right partial salpingectomy, right remnant tube resection, and left total salpingectomy). During the two salpingectomy procedures involving the right tube, the patency of the intact left tube was intraoperatively confirmed with indigo carmine. The most appropriate surgical intervention should be discussed when managing recurrent ectopic pregnancies. It might be necessary to perform total salpingectomy to reduce the risk of future recurrence on the remaining tube. PMID:28116193

  14. Surgical Management of Symptomatic Extensor Digitorum Brevis Manus: A Proposed Algorithm for Treatment.

    PubMed

    Waterman, Brian R; Dunn, John C; Kusnezov, Nicholas; Romano, David; Pirela-Cruz, Miguel A

    2015-10-01

    First described in 1734, the extensor digitorum brevis manus (EDBM) is an anomalous extensor muscle found in the dorsum of the wrist and hand. Extensor muscle variants of the hand are not uncommon, and EDBM has an estimated reported incidence of approximately 2%. Although few extensor muscle variants become clinically significant, there is a paucity of literature discussing these anatomic variants, with most reports arising from cadaveric studies or isolated case series. Similarly, there are few established indications for surgical treatment of EDBM. In this case report, we describe the successful treatment of a young patient with persistently symptomatic anomalous extensor tendon with surgical excision and propose an algorithm for management after failure of conservative measures.

  15. Misdiagnosis and Quality of Management in Paediatric Surgical Patients Referred to a Tertiary Care Hospital

    PubMed Central

    Cazares-Rangel, Joel; Zalles-Vidal, Cristian; Davila-Perez, Roberto

    2014-01-01

    Background: The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care. Aim: Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management. Design: Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment. Setting: Third level care hospital, Mexico City. Participants: Newborn to adolescents referred to Paediatric Surgery Department. Intervention(s): None. Main Outcome Measure(s): Misdiagnosis and quality of management prior to being referred. Result: Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first-or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management. Conclusion: We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible. PMID:24959495

  16. [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.

  17. Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units

    PubMed Central

    Angel, Clay; Brooks, Kristen; Fourie, Julie

    2016-01-01

    Context Delirium is common among inpatients aged 65 years and older and is associated with multiple adverse consequences, including increased length of stay (LOS). However, delirium is frequently unrecognized and poorly understood. At one hospital, baseline management of delirium on medical-surgical units varied greatly, and psychiatric consultations focused exclusively on crisis management. Objective To implement a multidisciplinary program for rapid identification and proactive management of patients with delirium on medical-surgical units. Design A pilot from September 2010 to July 2012 included 920 unique patients, of whom 470 were seen by the delirium management team. A delirium management team included a redesigned role for consulting psychiatrists and a new clinical nurse specialist role; the team provided assistance with diagnosis and recommendations for nonpharmacologic and pharmacologic management of delirium. Multidisciplinary education focused on delirium identification and management and nurses’ use of appropriate assessment tools. Electronic health record functions supported accurate problem list coding, referrals to the team, and standardized documentation. Main Outcome Measure Length of stay. Results During the study period, average LOS in the target population decreased from 8.5 days to 6.5 days (p = 0.001); average LOS for the Medical Center remained stable. Compared with patients whose delirium was diagnosed during the baseline period, patients who received a delirium diagnosis during the pilot period had a higher illness burden and were likelier to have a history of delirium and diagnosed dementia. Conclusion Program implementation was associated with reduced LOS among older inpatients with delirium. The delirium team is an effective model that can be quickly implemented with few additional resources. PMID:27644045

  18. Process benchmarking appraisal of surgical decompression of spinal cord following traumatic cervical spinal cord injury: opportunities to reduce delays in surgical management.

    PubMed

    Furlan, Julio C; Tung, Kayee; Fehlings, Michael G

    2013-03-15

    Prior pre-clinical and clinical studies indicate that early decompression of the spinal cord (≤ 24 h post-trauma) may have benefits regarding clinical outcomes and neurological recovery after spinal cord injury (SCI). This study examines the benchmarking of management of patients with acute traumatic cervical SCI in order to determine the potential barriers and ideal timelines for each step to early surgical decompression. We reviewed patient charts and the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS) forms regarding the time and reasons for delay of each step in the management of patients with SCI. The reasons for delays were classified into: 1) health care-related ("extrinsic") factors and 2) patient-related ("intrinsic") factors. The cases were grouped into patients who underwent early surgical decompression of spinal cord (early-surgery group) and individuals who underwent later decompression (later-surgery group). Whereas both groups showed comparable time periods related to intrinsic factors, patients in the early surgery group had a significantly shorter time period associated with extrinsic factors when compared with the later surgery group. Both groups were comparable regarding pre-hospital time, time in a second general hospital prior to transfer to a spine center, and time in the trauma emergency department. Patients in the early surgery group had a significantly shorter waiting time, shorter waiting time for assessment by a spine surgeon, and a shorter waiting time for a surgical decision than did the later surgery group. Our benchmarking analysis suggests that health-related factors are key determinants of the timing from SCI to spinal cord decompression. Time in the general hospital and time of waiting for a surgical decision were the most important causes of delay of surgical spinal cord decompression. Early surgery is possible in the vast majority of the cases.

  19. The Simpson grading revisited: aggressive surgery and its place in modern meningioma management.

    PubMed

    Gousias, Konstantinos; Schramm, Johannes; Simon, Matthias

    2016-09-01

    OBJECTIVE Recent advances in radiotherapy and neuroimaging have called into question the traditional role of aggressive resections in patients with meningiomas. In the present study the authors reviewed their institutional experience with a policy based on maximal safe resections for meningiomas, and they analyzed the impact of the degree of resection on functional outcome and progression-free survival (PFS). METHODS The authors retrospectively analyzed 901 consecutive patients with primary meningiomas (716 WHO Grade I, 174 Grade II, and 11 Grade III) who underwent resections at the University Hospital of Bonn between 1996 and 2008. Clinical and treatment parameters as well as tumor characteristics were analyzed using standard statistical methods. RESULTS The median follow-up was 62 months. PFS rates at 5 and 10 years were 92.6% and 86.0%, respectively. Younger age, higher preoperative Karnofsky Performance Scale (KPS) score, and convexity tumor location, but not the degree of resection, were identified as independent predictors of a good functional outcome (defined as KPS Score 90-100). Independent predictors of PFS were degree of resection (Simpson Grade I vs II vs III vs IV), MIB-1 index (< 5% vs 5%-10% vs >10%), histological grade (WHO I vs II vs III), tumor size (≤ 6 vs > 6 cm), tumor multiplicity, and location. A Simpson Grade II rather than Grade I resection more than doubled the risk of recurrence at 10 years in the overall series (18.8% vs 8.5%). The impact of aggressive resections was much stronger in higher grade meningiomas. CONCLUSIONS A policy of maximal safe resections for meningiomas prolongs PFS and is not associated with increased morbidity.

  20. Treatment of Aggressive Prolactin-Secreting Pituitary Adenomas with Adjuvant Temozolomide Chemotherapy: A Review

    PubMed Central

    Cruz, Aurora S; Benkers, Tara; Rostad, Steven; Broyles, Frances Broyles; Yuen, Kevin; Mayberg, Marc

    2016-01-01

    Most prolactin-secreting pituitary adenomas demonstrate slow growth and are effectively managed with medical/surgical therapy. Rarely, these tumors can behave aggressively with rapid growth and invasion of local tissues, and are refractory to medical, surgical, or radio-surgical therapies. We report a case of a prolactin-secreting adenoma in a young woman, which became progressively aggressive and refractory to usual treatment modalities, but responded to treatment with the chemotherapeutic agent temozolomide. In addition, we review the literature for treatment of refractory adenomas with temozolomide. The clinical and pathologic characteristics of aggressive prolactin-secreting adenomas are reviewed, as well as their response to dopamine agonists, surgery, radiotherapy, and chemotherapy. PMID:27489751

  1. Surgical management of fractures of the acetabulum: the Sheffield experience 1976-1994.

    PubMed

    Hull, J B; Raza, S A; Stockley, I; Elson, R A

    1997-01-01

    Of 56 acetabular fractures treated in Sheffield between 1976 and 1994, 43 fractures in 40 patients underwent open reduction and internal fixation. This paper reviews the surgically managed fractures with emphasis on the quality of operative reduction and outcome, in particular the development of degenerative osteoarthritis leading to total hip replacement. A good clinical result following operative management was seen to correlate closely with a near perfect reduction; in contrast, all cases with a poor reduction underwent joint replacement in the follow-up period. The relatively few cases managed at a major referral centre in this series suggest that either the incidence of acetabular fracture is low in the area or that only a proportion of cases are referred from the surrounding district general hospitals.

  2. Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability.

    PubMed

    Ng, Choong; Bialocerkowski, Andrea; Hinman, Rana

    2007-06-01

    Background  Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives  Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy  A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria  Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2 years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40 years or older, or had multidirectional instability or other concomitant

  3. Staphylococcus aureus-Related Diabetic Osteomyelitis: Medical or Surgical Management? A French and Spanish Retrospective Cohort.

    PubMed

    Lesens, Olivier; Desbiez, Françoise; Theïs, Clément; Ferry, Tristant; Bensalem, Maryse; Laurichesse, Henri; Tauveron, Igor; Beytout, Jean; Aragón Sánchez, Javier

    2015-09-01

    Staphylococcus aureus is the main cause of diabetic foot osteomyelitis (DFO) and can be treated medically or by surgery. We investigated the outcome of consecutive patients with a diagnosis of S aureus DFO retrospectively in 4 hospitals according to the type of management, medical (including debridement at bedside) or surgical. The outcome was classified as either favorable or failure (relapse, impaired wound healing, or amputation). Seventy-four patients with S aureus DFO, including 26 with methicillin-resistant S aureus, were included with a mean duration of follow-up of 21 ± 1 months. As part of the initial treatment, 47% underwent bone surgery followed with a short course of antibiotic. Others were treated with antibiotic therapy alone with bedside debridement. The outcome was favorable for 84% of these patients, with similar rates in the surgical and medical groups (80% vs 87%, P > .05). Patients in the medical group were less frequently hospitalized (49% vs 94%, P < .001) and had a shorter length of hospital stay (17 ± 3 vs 50 ± 12 days, P = .004). Patients in the surgery group received a shorter course of antibiotic therapy (10 ± 2 vs 11 ± 1 weeks, P = .001) with fewer side effects (9% vs 33%, P = .01). The type of management was not associated with subsequent new episode of noncontiguous DFO, which developed in 32% of cases. In conclusion, except significant differences in duration of hospitalization and antibiotic therapy, medical and surgical management of S aureus DFO had similar outcomes with a cure rate >80%.

  4. Characteristics of Pseudoaneurysms in Northern India; Risk Analysis, Clinical Profile, Surgical Management and Outcome

    PubMed Central

    Lone, Hafeezulla; Ganaie, Farooq Ahmad; Lone, Ghulam Nabi; Dar, Abdul Majeed; Bhat, Mohammad Akbar; Singh, Shyam; Parra, Khursheed Ahmad

    2015-01-01

    Objective: To determine the risk factors, clinical characteristics, surgical management and outcome of pseudoaneurysm secondary to iatrogenic or traumatic vascular injury. Methods: This was a cross-sectional study being performed in department of cardiovascular and thoracic surgery skims soura during a 4-year period. We included all the patients referring to our center with primary diagnosis of pseudoaneurysm. The pseudoaneurysm was diagnosed with angiography and color Doppler sonography. The clinical and demographic characteristics were recorded and the risk factors were identified accordingly. Patients with small swelling (less than 5-cm) and without any complication were managed conservatively. They were followed for progression and development of complications in relation to swelling. Others underwent surgical repair and excision. The outcome of the patients was also recorded. Results: Overall we included 20 patients with pseudoaneurysm. The mean age of the patients was 42.1±0.6 years. Among them there were 11 (55%) men and 9 (45%) women. Nine (45%) patients with end stage renal disease developed pseudoaneurysm after inadvertent femoral artery puncture for hemodialysis; two patients after interventional cardiology procedure; one after femoral embolectomy; one developed after fire arm splinter injury and one formed femoral artery related pseudoaneurysm after drainage of right inguinal abscess. The most common site of pseudoaneurysm was femoral artery followed by brachial artery. Overall surgical intervention was performed in 17 (85%) patients and 3 (15%) were managed conservatively. Conclusion: End stage renal disease is a major risk factor for pseudoaneurysm formation. Coagulopathy, either therapeutic or pathological is also an important risk factor. Patients with these risk factors need cannulation of venous structures for hemodialysis under ultrasound guide to prevent inadvertent arterial injury. Patients with end stage renal disease who sustain inadvertent

  5. Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?-a prospective clinical study of 15 cases.

    PubMed

    Babu, Lokesh; Jain, Manoj Kumar; Ramesh, C; Vinayaka, N

    2013-09-01

    The purpose of this three-year, prospective, follow-up study was to evaluate whether aggressive gap arthroplasty is essential in the management of ankylosis of the temporomandibular joint (TMJ). Fifteen patients were treated by the creation of a minimal gap of 5-8mm and insertion of an interpositional gap arthroplasty using the temporalis fascia. Eleven patients had unilateral coronoidectomy and 4 bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of 3 years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. The patients were aged between 7 and 29 years (mean (SD) age 20 (8) years). Preoperative maximal incisal opening was 0-2mm in 8 cases and 2-9mm in 9. Postoperatively adequate mouth opening of 30-40mm was achieved in all cases, with no recurrence or relevant malocclusion during 3-year follow up. However, patients will be followed up for 10 years. Aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ. Minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence.

  6. Intradural Intramedullary Mixed Type Hemangioma: Optimizing the Surgical Management through Intraoperative Neurophysiological Monitoring

    PubMed Central

    Rahyussalim, Ahmad Jabir; Situmeang, Adrian; Safri, Ahmad Yanuar; Fadhly, Zulfa Indah K.

    2015-01-01

    Intradural intramedullary mixed type hemangioma is a rare histotype of primary spinal cord tumors, though it can carry a severe clinical burden leading to limb dysfunction or motor and sensory disturbances. Timely intervention with radical resection is the hallmark of treatment but achieving it is not an easy task even for experienced neurosurgeons. We herein present an exemplificative case presenting with sudden paraplegia in which total resection was achieved under intraoperative neurophysiology monitoring. A thorough discussion on the operative technique and the role of neuromonitoring in allowing a safe surgical management of primary spinal cord tumors is presented. PMID:26839729

  7. Large Plunging Ranula Presenting as Isolated Neck Swelling: Steps in Diagnosis and Surgical Steps in Management

    PubMed Central

    Malik, Neelima A.; Patil, Pankaj; Chapi, Mouneshkumar Devendrappa

    2015-01-01

    Ranula is a salivary gland cyst which typically present as localized superficial swelling over the floor of mouth. Complex or plunging ranulas develop when the mucus extravasation extends through or around the mylohyoid muscle, deeper into the neck, and present with neck lump along with or without swelling over floor of mouth. We report a case of large plunging ranula presenting as an isolated large neck mass in a 38-year-old female patient. The steps in diagnosis and surgical steps in management of the pathology are systematically described. PMID:26266141

  8. Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.

    PubMed

    Bickell, Michael; Beilan, Jonathan; Wallen, Jared; Wiegand, Lucas; Carrion, Rafael

    2016-11-01

    This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described.

  9. Conservative surgical management of in situ subungual melanoma: long-term follow-up*

    PubMed Central

    Anda-Juárez, Mariana Catalina De; Martínez-Velasco, María Abril; Fonte-Ávalos, Verónica; Toussaint-Caire, Sonia; Domínguez-Cherit, Judith

    2016-01-01

    Subungual melanoma represents 20% of all melanomas in Hispanic population. Here, we report the outcome of 15 patients with in situ subungual melanoma treated with resection of the nail unit with a 5-mm margin without amputation, followed up for 55.93 ± 43.08 months. The most common complications included inclusion cysts and nail spicules. We found no evidence of local or distant recurrences at the last visit of our follow up. Functional outcome was good, with only one patient reporting persistent mild pain. These results support functional, non-amputative surgical management of in situ subungual melanomas. PMID:28099619

  10. Hematologic and surgical management of the dental patient with plasminogen activator deficiency.

    PubMed

    Scheitler, L E; Hart, N; Phillips, G; Weinberg, J B

    1988-12-01

    Anticoagulation therapy is used to treat patients with a variety of hemostatic disorders in an attempt to prevent thrombus formation. A thorough understanding of the patient's medical history is essential before dental treatment that may require alteration of this anticoagulation therapy. Alteration of anticoagulation therapy should be undertaken only after consultation with the patient's physician because some patients are at greater risk than others for thrombus formation or hemorrhage. This case of a 29-year-old man with plasminogen activator deficiency illustrates how consultation can result in a coordinated treatment plan for medical and dental management formulated to help ensure safe surgical treatment for these medically compromised patients.

  11. Successful Multistaged Surgical Management of Secondary Aortoesophageal Fistula With Graft Infection.

    PubMed

    Afifi, Rana O; Mushtaq, Harith H; Sandhu, Harleen K; Khalil, Kamal; Safi, Hazim J; Estrera, Anthony L

    2016-06-01

    Secondary aortoenteric fistula is a rare and dreaded complication of aortic graft replacement. This case demonstrates successful management of a patient with thoracic aortic graft infection resulting in aortoesophageal fistula and the feasibility of combined endovascular approach as a temporary measure to stabilize the patient in extremis, followed by a definitive surgical repair. The patient had a remote history of descending aortic repair and an emergent thoracic endovascular aortic repair for upper gastrointestinal bleeding 2 months ago. We performed a three-staged operation involving extraanatomic bypass, total infected aortic graft excision, and primary closure of the esophageal perforation with muscle flap coverage, from which he eventually recovered.

  12. Peri- and intra-operative management of the goat during acute surgical experimentation.

    PubMed

    Flaherty, Devin C; Hoxha, Besim; Nelson, Shirley; Sun, Jie; Gurji, Hunaid; Simecka, Jerry W; Mallet, Robert T; Olivencia-Yurvati, Albert H; Daniels, Egeenee Q

    2010-03-01

    Goats are used as animal models for surgery and trauma research. The authors discuss appropriate methods for induction of anesthetics, intubation and surgical maintenance of the goat during acute experimentation. Risks imposed by the Q fever pathogen Coxiella burnetii are described, as well as measures that have proven effective in minimizing zoonotic transmission of this pathogen to laboratory personnel. With appropriate knowledge of its applications, peri- and intra-operative management and limitations, the goat is a suitable animal model for a variety of biomedical research applications.

  13. Teacher Classroom Management Practices: Effects on Disruptive or Aggressive Student Behavior

    ERIC Educational Resources Information Center

    Oliver, Regina M.; Wehby, Joseph H.; Reschly, Daniel J.

    2011-01-01

    Despite the large research base grounded in behavioral theory for strategies to increase appropriate behavior and prevent or decrease inappropriate behavior in the classroom, a systematic review of multi-component universal classroom management research is necessary to establish the effects of teachers' universal classroom management approaches.…

  14. Posterior-Only Circumferential Decompression and Reconstruction in the Surgical Management of Lumbar Vertebral Osteomyelitis

    PubMed Central

    Skovrlj, Branko; Guzman, Javier Z.; Caridi, John; Cho, Samuel K.

    2015-01-01

    Study Design Case report. Objective The purpose of this report is to discuss the surgical management of lumbar vertebral osteomyelitis with a spinal epidural abscess (SEA) and present a single-stage, posterior-only circumferential decompression and reconstruction with instrumentation using an expandable titanium cage and without segmental nerve root sacrifice as an option in the treatment of this disease process. Methods We report a 42-year-old man who presented with 3 days of low back pain and chills who rapidly decompensated with severe sepsis following admission. Magnetic resonance imaging of his lumbosacral spine revealed intramuscular abscesses of the left paraspinal musculature and iliopsoas with SEA and L4 vertebral body involvement. The patient failed maximal medical treatment, which necessitated surgical treatment as a last resort for infectious source control. He underwent a previously undescribed procedure in the setting of SEA: a single-stage, posterior-only approach for circumferential decompression and reconstruction of the L4 vertebral body with posterior segmental instrumented fixation. Results After the surgery, the patient's condition gradually improved; however, he suffered a wound dehiscence necessitating a surgical exploration and deep wound debridement. Six months after the surgery, the patient underwent a revision surgery for adjacent-level pseudarthrosis. At 1-year follow-up, the patient was pain-free and off narcotic pain medication and had returned to full activity. Conclusion This patient is the first reported case of lumbar osteomyelitis with SEA treated surgically with a single-stage, posterior-only circumferential decompression and reconstruction with posterior instrumentation. Although this approach is more technically challenging, it presents another viable option for the treatment of lumbar vertebral osteomyelitis that may reduce the morbidity associated with an anterior approach. PMID:26835214

  15. Posterior-Only Circumferential Decompression and Reconstruction in the Surgical Management of Lumbar Vertebral Osteomyelitis.

    PubMed

    Skovrlj, Branko; Guzman, Javier Z; Caridi, John; Cho, Samuel K

    2016-02-01

    Study Design Case report. Objective The purpose of this report is to discuss the surgical management of lumbar vertebral osteomyelitis with a spinal epidural abscess (SEA) and present a single-stage, posterior-only circumferential decompression and reconstruction with instrumentation using an expandable titanium cage and without segmental nerve root sacrifice as an option in the treatment of this disease process. Methods We report a 42-year-old man who presented with 3 days of low back pain and chills who rapidly decompensated with severe sepsis following admission. Magnetic resonance imaging of his lumbosacral spine revealed intramuscular abscesses of the left paraspinal musculature and iliopsoas with SEA and L4 vertebral body involvement. The patient failed maximal medical treatment, which necessitated surgical treatment as a last resort for infectious source control. He underwent a previously undescribed procedure in the setting of SEA: a single-stage, posterior-only approach for circumferential decompression and reconstruction of the L4 vertebral body with posterior segmental instrumented fixation. Results After the surgery, the patient's condition gradually improved; however, he suffered a wound dehiscence necessitating a surgical exploration and deep wound debridement. Six months after the surgery, the patient underwent a revision surgery for adjacent-level pseudarthrosis. At 1-year follow-up, the patient was pain-free and off narcotic pain medication and had returned to full activity. Conclusion This patient is the first reported case of lumbar osteomyelitis with SEA treated surgically with a single-stage, posterior-only circumferential decompression and reconstruction with posterior instrumentation. Although this approach is more technically challenging, it presents another viable option for the treatment of lumbar vertebral osteomyelitis that may reduce the morbidity associated with an anterior approach.

  16. MYC-driven aggressive B-cell lymphomas: biology, entity, differential diagnosis and clinical management

    PubMed Central

    Cai, Qingqing; Medeiros, L. Jeffrey; Xu, Xiaolu; Young, Ken H.

    2015-01-01

    MYC, a potent oncogene located at chromosome locus 8q24.21, was identified initially by its involvement in Burkitt lymphoma with t(8;14)(q24;q32). MYC encodes a helix-loop-helix transcription factor that accentuates many cellular functions including proliferation, growth and apoptosis. MYC alterations also have been identified in other mature B-cell neoplasms and are associated with aggressive clinical behavior. There are several regulatory factors and dysregulated signaling that lead to MYC up-regulation in B-cell lymphomas. One typical example is the failure of physiological repressors such as Bcl6 or BLIMP1 to suppress MYC over-expression. In addition, MYC alterations are often developed concurrently with other genetic alterations that counteract the proapoptotic function of MYC. In this review, we discuss the physiologic function of MYC and the role that MYC likely plays in the pathogenesis of B-cell lymphomas. We also summarize the role MYC plays in the diagnosis, prognostication and various strategies to detect MYC rearrangement and expression. PMID:26416427

  17. A Comparison of the Effectiveness of a Game Informed Online Learning Activity and Face to Face Teaching in Increasing Knowledge about Managing Aggression in Health Settings

    ERIC Educational Resources Information Center

    McKenzie, Karen

    2013-01-01

    The present study compared the impact of face to face teaching with a short online game informed learning activity on health participants' knowledge about, and confidence in, managing aggressive situations. Both forms of teaching resulted in a significant increase in participants' knowledge and confidence. Face to face training led to…

  18. Staged surgical management of hypoplastic left heart syndrome: a single institution 12 year experience

    PubMed Central

    McGuirk, S P; Griselli, M; Stumper, O F; Rumball, E M; Miller, P; Dhillon, R; de Giovanni, J V; Wright, J G; Barron, D J; Brawn, W J

    2006-01-01

    Objective To describe a 12 year experience with staged surgical management of the hypoplastic left heart syndrome (HLHS) and to identify the factors that influenced outcome. Methods Between December 1992 and June 2004, 333 patients with HLHS underwent a Norwood procedure (median age 4 days, range 0–217 days). Subsequently 203 patients underwent a bidirectional Glenn procedure (stage II) and 81 patients underwent a modified Fontan procedure (stage III). Follow up was complete (median interval 3.7 years, range 32 days to 11.3 years). Results Early mortality after the Norwood procedure was 29% (n  =  95); this decreased from 46% (first year) to 16% (last year; p < 0.05). Between stages, 49 patients died, 27 before stage II and 22 between stages II and III. There were one early and three late deaths after stage III. Actuarial survival (SEM) was 58% (3%) at one year and 50% (3%) at five and 10 years. On multivariable analysis, five factors influenced early mortality after the Norwood procedure (p < 0.05). Pulmonary blood flow supplied by a right ventricle to pulmonary artery (RV‐PA) conduit, arch reconstruction with pulmonary homograft patch, and increased operative weight improved early mortality. Increased periods of cardiopulmonary bypass and deep hypothermic circulatory arrest increased early mortality. Similar factors also influenced actuarial survival after the Norwood procedure. Conclusion This study identified an improvement in outcome after staged surgical management of HLHS, which was primarily attributable to changes in surgical technique. The RV‐PA conduit, in particular, was associated with a notable and independent improvement in early and actuarial survival. PMID:15939721

  19. A review of the surgical management of breast cancer: plastic reconstructive techniques and timing implications.

    PubMed

    Rosson, Gedge D; Magarakis, Michael; Shridharani, Sachin M; Stapleton, Sahael M; Jacobs, Lisa K; Manahan, Michele A; Flores, Jaime I

    2010-07-01

    The oncologic management of breast cancer has evolved over the past several decades from radical mastectomy to modern-day preservation of chest and breast structures. The increased rate of mastectomies over recent years made breast reconstruction an integral part of the breast cancer management. Plastic surgery now offers patients a wide variety of reconstruction options from primary closure of the skin flaps to performance of microvascular and autologous tissue transplantation. Well-coordinated partnerships between surgical oncologists, plastic surgeons, and patients address concerns of tumor control, cosmesis, and patients' wishes. The gamut of breast reconstruction options is reviewed, particularly noting state-of-the-art techniques, as well as the advantages and disadvantages of various timing modalities.

  20. Pre-operative Identification and Surgical Management of the Appendiceal Mucocele: A Case Report.

    PubMed

    Lynch, Kevin; Cho, Sung; Andres, Robert; Knight, Jennifer; Con, Jorge

    2016-01-01

    An appendiceal mucocele (AM) is an uncommon differential in the patient being evaluated for acute appendicitis. Although often asymptomatic, AMs can clinically mimic acute appendicitis, and preoperative distinction between these processes facilitates optimal management. We report the case of a 60-year-old male with an AM presenting with nausea and periumbilical pain radiating to the right lower quadrant. Literature relevant to the diagnosis and treatment of AMs is reviewed, with emphasis on diagnosis through radiographic imaging and surgical management. Abdominal CT scan or ultrasound are useful in identifying AMs preoperatively. A decision to perform a right hemicolectomy should be influenced by the criteria reported by Gonzalez-Moreno. The safety of the laparoscopic resection relative to an open appendectomy is debated.

  1. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia.

    PubMed

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or "tongue-tie" is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort.

  2. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia

    PubMed Central

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or “tongue-tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort. PMID:25598942

  3. Implications for managed care for improving outcomes in Parkinson's disease: balancing aggressive treatment with appropriate care.

    PubMed

    Chen, Jack J

    2011-10-01

    Disability in Parkinson's disease (PD) is due not only to progressive impairment in balance, gait, and motor-related tasks, but also to several nonmotor symptoms affecting autonomic, neuropsychiatric, and sensory functions. The prevalence of PD in the United States is rising due to the expanding elderly population. Direct medical costs associated with PD are significant and influenced by level of disability and associated complexity of management. As new treatments are made available, reevaluation of treatment benefits and paradigms is warranted, for both motor and nonmotor symptoms of PD, to better manage outcomes. In addition to evaluation of symptomatic therapies for PD, attention to advances in disease-modifying therapies and to management of nonmotor symptoms should be an integral component of PD surveillance in the managed care environment.

  4. The Ghanaian surgical nurse and postoperative pain management: a clinical ethnographic insight.

    PubMed

    Aziato, Lydia; Adejumo, Oluyinka

    2014-03-01

    Nurses form an indispensable part of the clinical team that manages postoperative pain (POP). Within a particular clinical context, nurses perceive and respond to pain based on specific factors. This study aimed at illuminating the perceptions and responses of Ghanaian surgical nurses regarding their patients' POP. It also identified the factors that influenced nurses' pain responses. A focused ethnography was used, and data were collected through individual interviews. Sampling was performed purposively to include junior, senior, day, and night nurses who cared for surgical patients. Concurrent data analysis was performed and data were saturated with 12 individual interviews. The findings indicated that nurses perceived POP as an individual phenomenon, and nurses responded to patients' pain by administering analgesics and by using nonpharmacologic measures. Factors that influenced the nurses' response were individual factors, such as commitment, discretion, fear of addiction, and organizational factors, such as organizational laxity and challenges of teamwork. The study recommended that nurses should be educated, supported, and encouraged to ensure pain relief after surgery and that they should see pain relief as a priority postoperative care to avert the negative repercussions of poorly managed POP.

  5. Surgical versus conservative management of adult intussusception: Case series and review

    PubMed Central

    Aydin, Nail; Roth, Andrew; Misra, Subhasis

    2016-01-01

    Introduction Intussusception is the telescoping of a segment of bowel into its adjacent segment. It is a known cause of abdominal pain in the pediatric population, however, it is rare in the adult. Adults do not always present with the typical symptoms seen in young children, making the clinical diagnosis more difficult. The etiology of adult intussusception can be idiopathic, benign, or malignant. Diagnosis is most accurately made with computed tomography, which is sensitive in detecting intussusception as well as potential lead points. Presentation of cases This study presents four adult patients with intussusception. The first three patients are adults with idiopathic intussusception and no evidence of a lead point. The fourth case involves intussusception secondary to a jejunal carcinoid tumor which was treated surgically. Each case has unique features in terms of length and number of intussusceptions, duration of symptoms, and recurrence. Discussion Surgical treatment was once argued to be universally appropriate for adult intussusceptions; however, with increased use of advanced imaging, newer literature is demonstrating that this is not true in all cases. Idiopathic intussusception presents with nonspecific symptoms and can be managed with supportive care when the history and clinical picture indicate low probability of a neoplasm. Conclusion This study aims to raise awareness to the potential diagnosis and management of intussusceptions, particularly the symptomatic idiopathic type in the young adult. PMID:26859872

  6. The medical antigravity suit for management of surgically uncontrollable bleeding associated with abdominal pregnancy.

    PubMed

    Sandberg, E C; Pelligra, R

    1983-07-01

    Three patients with abdominal pregnancy have been treated at Stanford University Hospital in recent years. Common to each was surgically uncontrolled hemorrhage for which circumferential pneumatic compression (supplied by a medical antigravity suit) was used to stop the bleeding. In each patient, the hemostatic effect of treatment was dramatic. In published accounts of the use of the garment in other severely hemorrhaging patients, the effects have been similarly dramatic and equally successful. These observations lead to a compelling consideration in regard to optimum management of patients with abdominal pregnancy. If our experience is confirmed by others, optimum management in abdominal pregnancy hereafter should regularly and routinely include removal of the placenta at the primary operation. This approach would anticipate use of the medical antigravity suit to provide hemostasis if surgically uncontrollable bleeding is encountered. Theoretically, the complications and long-term morbidity associated with retention of the placenta would be eliminated by this means while the previous disadvantage of placental removal, the potential for exsanguinating hemorrhage, would be circumvented.

  7. Wills Eye Hospital and surgical network: successful pre-positioning strategies for payment reduction and managed care pressures.

    PubMed

    Kessler, D M

    2001-01-01

    Through strategic clinical diversification, political activism, and bold expansion, Wills Eye Hospital, a teaching specialty surgical hospital, survives ravages of sudden onslaughts of managed care payment reductions while maintaining autonomy. Slack inpatient resources were re-utilized to create unique programs attractive to regional managed care organizations. Advocacy and lobbying for short-term favorable treatment from Medicare bought the Hospital valuable time and positioning. Building out a regional network of ambulatory surgical centers assures the growth and access to market required for Wills to maintain its autonomy in a managed care contracting environment.

  8. Metabolic syndrome in South Asian immigrants: more than low HDL requiring aggressive management.

    PubMed

    Dodani, Sunita; Henkhaus, Rebecca; Wick, Jo; Vacek, James; Gupta, Kamal; Dong, Lei; Butler, Merlin G

    2011-03-16

    Aggressive clinical and public health interventions have resulted in significant reduction in coronary artery disease (CAD) worldwide. However, South Asian immigrants (SAIs) exhibit the higher prevalence of CAD and its risk factors as compared with other ethnic populations. The objective of the current study is to assess the prevalence of metabolic syndrome (MS), its association with high density Lipoprotein (HDL) function, Apo lipoprotein A-I (APOA1) gene polymorphisms, and sub-clinical CAD using common carotid intima-media thickness (CCA-IMT) as a surrogate marker. A community-based cross-sectional study was conducted on SAIs aged 35-65 years. Dysfunctional/pro-inflammatory (Dys-HDL) was determined using novel cell free assay and HDL inflammatory index. Six intronic APOA1 gene polymorphisms were analyzed by DNA sequencing. According to the International Diabetes Federation definition, MS prevalence was 29.7% in SAIs without CAD and 26% had HDL inflammatory index ≥ 1 suggesting pro-inflammatory Dys-HDL. Six novel APOA1 single nucleotide polymorphisms (SNPs) were analyzed with logistic regression, three SNPs (G2, G3, and G5) were found to be significantly associated with MS (p = 0.039, p = 0.038, p = 0.054). On multi-variate analysis, MS was significantly associated with BMI > 23 (P = 0.005), Apo-A-I levels (p = 0.01), and Lp [a] (p < 0.0001). SAIs are known to be at a disproportionately high risk for CAD that may be attributed to a high burden for MS. There is need to explore and understand non-traditional risk factors with special focus on Dys-HDL, knowing that SAIs have low HDL levels. Large prospective studies are needed to further strengthen current study results.

  9. Barriers to the optimal rehabilitation of surgical cancer patients in the managed care environment: an administrator's perspective.

    PubMed

    Germain, Pamela

    2007-04-01

    Ensuring that surgical cancer patients obtain optimal rehabilitation care (defined here as all care provided post-operatively following cancer surgery) can be challenging because of the fragmented nature of the U.S. healthcare delivery and payment systems. In the managed care environment, surgical cancer patients' access to rehabilitation care is likely to vary by type of health insurance plan, by setting, by type of provider, and by whether care is provided in-network or out-of-network. The author of this article, who negotiates managed care contracts for the Roswell Park Cancer Institute (RPCI), gives examples of strategies used with some success by RPCI to collaborate with local payers to ensure that surgical cancer patients get optimal rehabilitation care, especially as they make the transition from hospital to outpatient care. She suggests that further collaborations of healthcare providers, payers, consumers, and policymakers are needed to help ensure optimal rehabilitation care for surgical cancer patients.

  10. Aggressive Behavior

    MedlinePlus

    ... Listen Español Text Size Email Print Share Aggressive Behavior Page Content Article Body My child is sometimes very aggressive. What is the best ... once they are quiet and still reinforces this behavior, so your child learns that time out means “quiet and still.” ...

  11. Signaling aggression.

    PubMed

    van Staaden, Moira J; Searcy, William A; Hanlon, Roger T

    2011-01-01

    From psychological and sociological standpoints, aggression is regarded as intentional behavior aimed at inflicting pain and manifested by hostility and attacking behaviors. In contrast, biologists define aggression as behavior associated with attack or escalation toward attack, omitting any stipulation about intentions and goals. Certain animal signals are strongly associated with escalation toward attack and have the same function as physical attack in intimidating opponents and winning contests, and ethologists therefore consider them an integral part of aggressive behavior. Aggressive signals have been molded by evolution to make them ever more effective in mediating interactions between the contestants. Early theoretical analyses of aggressive signaling suggested that signals could never be honest about fighting ability or aggressive intentions because weak individuals would exaggerate such signals whenever they were effective in influencing the behavior of opponents. More recent game theory models, however, demonstrate that given the right costs and constraints, aggressive signals are both reliable about strength and intentions and effective in influencing contest outcomes. Here, we review the role of signaling in lieu of physical violence, considering threat displays from an ethological perspective as an adaptive outcome of evolutionary selection pressures. Fighting prowess is conveyed by performance signals whose production is constrained by physical ability and thus limited to just some individuals, whereas aggressive intent is encoded in strategic signals that all signalers are able to produce. We illustrate recent advances in the study of aggressive signaling with case studies of charismatic taxa that employ a range of sensory modalities, viz. visual and chemical signaling in cephalopod behavior, and indicators of aggressive intent in the territorial calls of songbirds.

  12. Aggression and Withdrawal Related Behavior within Conflict Management Progression in Preschool Boys with Language Impairment

    ERIC Educational Resources Information Center

    Horowitz, Laura; Westlund, Karolina; Ljungberg, Tomas

    2007-01-01

    Objective: This study examined conflict behavior in naturalistic preschool settings to better understand the role of non-affiliative behavior and language in conflict management. Method: Free-play at preschool was filmed among 20 boys with typically developing language (TL) and among 11 boys with Language Impairment (LI); the boys 4-7 years old.…

  13. Adjunctive Use of Appetite Suppressant Medications for Improved Weight Management in Bariatric Surgical Patients.

    PubMed

    Jester; Wittgrove; Clark

    1996-10-01

    BACKGROUND: Patients who undergo bariatric surgery sometimes experience late onset or weight gain, when they lapse into negative eating patterns, which adversely affect weight management. Long-term weight management is a process, with a surgical foundation, and requiring adjunctive strategies for best results. We sought to determine if appetite suppressant medications could be safely incorporated into a comprehensive program of weight management. METHODS: Subjects were at least 18 months postoperative, were accessible for weekly follow-up, and weighed at least 9 kg more than their ideal body weight. Phentermine and fenfluramine were prescribed in combination, at the lowest dose necessary to achieve comfortable appetite suppression. RESULTS: Weight losses ranged from 4.5 to 22.7 kg, over a 12-week course of treatment, corresponding to 8-65% of excess body weight. Most side-effects were minor, and did not require cessation of treatment. Two patients discontinued treatment due to side-effects which were unacceptable to them. CONCLUSION: Phentermine and fenfluramine are a safe and useful adjunct to a comprehensive program of weight management.

  14. Product and equipment strategies for surgical services.

    PubMed

    Mauro, C

    1995-07-01

    One of the most difficult challenges a materiel manager can face is designing different programs to support materiel management services for specific clinical and ancillary areas of the hospital. While basic service standards for purchasing and logistic services should exist for all areas, a large part of how effective a materiel management department is depends on customized program development. In other words, fine tuning services to major customers, such as the Operating Room, can mean the difference between simply filling supply orders and aggressive cost control. This article reviews how Baystate Medical Center (Springfield, MA) maintains consistency in standardizing materiel services while adapting to the requirements of individual departments, such as Surgical Services.

  15. Surgical management of dysphagia and airway obstruction in patients with prominent ventral cervical osteophytes.

    PubMed

    Carlson, Matthew L; Archibald, David J; Graner, Darlene E; Kasperbauer, Jan L

    2011-03-01

    Large projecting ventral cervical osteophytes are associated with senile degenerative skeletal disease, post-traumatic osteophytogenesis, and diffuse idiopathic skeletal hyperostosis (DISH). The vast majority of patients with cervical osteophytes are asymptomatic. However, in a small subset this condition may lead to upper aerodigestive compromise manifesting as dysphagia and/or airway obstruction. Conservative medical therapy is usually sufficient, but patients with intractable disease may require surgical intervention, including tracheostomy, feeding tube placement, or osteophytectomy. A retrospective chart review was performed on all patients who presented to a tertiary referral center over a decade (1998-2008) with complaints of dysphagia and/or respiratory compromise and underwent osteophytectomy for treatment of recalcitrant symptoms. A total of nine patients met criteria. Six patients were diagnosed with DISH, two with trauma-associated osteophytogenesis, and one with senile degenerative vertebral disease. The mean age was 68 years and included seven males and two females. All patients had symptoms of dysphagia and two had simultaneous airway complaints. All patients underwent an anterolateral approach for osteophyte decompression, one of which required concurrent tracheostomy. Following surgery, 100% of patients had significant improvement in dysphagia and respiratory complaints. Eight of nine patients returned to an unrestricted diet and only one required postoperative abstinence from bulky foods; both patients with additional airway complaints were successfully decannulated after surgery. Degenerative conditions and DISH may lead to osteophyte-associated dysphagia and/or airway complaints. Surgical decompression through osteophytectomy is an effective alternative to tracheostomy and feeding tube in carefully selected patients and should be considered for surgically fit patients who fail conservative medical management.

  16. Surgical Management in Elderly Patients with Tuberculous Spondylodiscitis: Ten Year Mortality Audit Study

    PubMed Central

    Kothari, Manish Kundanmal; Tikoo, Agnivesh; Nene, Abhay Madhusudan

    2016-01-01

    Study Design Retrospective study. Purpose To evaluate the factors affecting immediate postoperative mortality in elderly patients with tuberculous spondylodiscitis. Overview of Literature Treatment of spinal tuberculosis in the elderly involves consideration of age and co-morbidities, and often leads to an extended conservative management. Surgical intervention in these patients becomes a complex decision. There are no studies on risk factors of mortality in surgically treated elderly with tuberculous spondylodiscitis. Methods Two hundred and seventy-six patients with spondylodiscitis were operated between 2005 and 2015. 20 consecutive patients over 70 years of age with and proven tuberculosis who met the inclusion/exclusion criteria were included. Demographic, clinical and radiological profile data with operative details of instrumentation, blood loss, surgical duration, and mortality were noted. There were 20 patients (6 males, 14 females) with a mean age of 73.5 years. The patients were divided into those with mortality (M) and those who survived (non-mortality, NM). Various variables were statistically tested for immediate postoperative medical complications and mortality. Results There were four mortalities (20%). Age, sex, number of medical co-morbidities, American Society of Anaesthesiologists grade, Frankel grade C or worse, number of vertebrae involved, number of levels fused, blood loss and operative time did not have statistically significant impact on immediate postoperative mortality. Only preoperative immobility duration was statistically higher in the M group (p=0.016) than in the NM group. Conclusions Preoperative immobility is associated with immediate postoperative mortality in elderly patients with spinal tuberculosis undergoing surgery. The findings identify preoperative immobility as a risk factor for mortality, which could contribute to a more detailed prognostic discussion between surgeon and patient before surgery. PMID:27790320

  17. Determining the need for team-based training in delirium management: A needs assessment of surgical healthcare professionals.

    PubMed

    Sockalingam, Sanjeev; Tehrani, Hedieh; Kacikanis, Anna; Tan, Adrienne; Hawa, Raed; Anderson, Ruthie; Okrainec, Allan; Abbey, Susan

    2015-01-01

    The high incidence of delirium in surgical units is a serious quality concern, given its impact on morbidity and mortality. While successful delirium management depends upon interdisciplinary care, training needs for surgical teams have not been studied. A needs assessment of surgical units was conducted to determine perceived comfort in managing delirium, and interprofessional training needs for team-based care. We administered a survey to 106 General Surgery healthcare professionals (69% response rate) with a focus on attitudes towards delirium and team management. Although most respondents identified delirium as important to patient outcomes, only 61% of healthcare professionals indicated that a team-based approach was always observed in practice. Less than half had a clear understanding of their role in delirium care, while just over half observed team communication of delirium care plans during handover. This is the first observation of clear gaps in perceived team performance in a General Surgery setting.

  18. How does definition of 'complete resection' conduct surgical management of non-small cell lung cancer?

    PubMed

    Kutlu, Cemal Asim; Olgac, Guven

    2006-10-01

    The term 'complete resection' is traditionally defined as a desired surgical procedure if a considerable survival benefit is anticipated in patients with NSCLC. From a surgeon's viewpoint, it is therefore of great importance in patient selection for thoracotomy. In this setting, one might assume that well-known definitions of Naruke and Mountain with different meanings would subsequently result in a number of conflicting influences. As a result, patient selection criteria for surgery, the role and reliability of invasive staging procedures and futile thoracotomy rates are unavoidably conducted by the definition preferred. Interpretation of the outcomes from the series with different attitudes may also be misleading. Thus, outset of the surgical management of NSCLC should be based on the definition and preferences associated with complete resection. To conclude, if we could depict a universally accepted definition of complete resection which could also easily be attributable to the existing guidelines; contribution of surgery would have been more clearly outlined among other treatment modalities. This will in turn, not only eliminate most of the confusion that a surgeon might have in his/her mind regarding the matter, but might also provide a more stronger evidence for the role of surgery in the long term.

  19. Morbid Obesity—The New Pandemic: Medical and Surgical Management, and Implications for the Practicing Gastroenterologist

    PubMed Central

    Cello, John P; Rogers, Stanley J

    2013-01-01

    The gastroenterologist, whether in academic or clinical practice, must face the reality that an increasingly large percentage of adult patients are morbidly obese. Morbid obesity is associated with significant morbidity and mortality including enhanced morbidity from cardiovascular, cerebrovascular, hepatobiliary and colonic diseases. Most of these associated diseases are actually preventable. Based on the 1991 NIH consensus conference criteria, for most patients with a body mass index (BMI=weight in kilograms divided by the height in meters squared) of 40 or more, or for patients with a BMI of 35 or more and significant health complications, surgery may be the only reliable option. Currently in the United States, over 250,000 bariatric surgical procedures are being performed annually. The practicing gastroenterologist in every community, large and small, must be familiar with the various surgical procedures together with their associated anatomic changes. These changes may dramatically increase the prevalence of nutritional deficiencies and profoundly alter the clinical and endoscopic approaches to diagnosis and management. PMID:23739585

  20. Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases

    PubMed Central

    Trummer, M; Flaschka, G; Tillich, M; Homann, C; Unger, F; Eustacchio, S

    2001-01-01

    OBJECTIVE—Synovial cysts of the vertebral facet joints are a source of nerve root compression. Different surgical procedures are in use, but no consensus has been formed so far as to which method should be used in synovial cysts. To clarify the role of surgical management, the efficacy of operative procedures and factors influencing the outcome in our own series of 19 patients treated between 1994and 1998 were analysed.
METHODS—Nineteen patients with a mean age of 65 years underwent surgery for medically intractable radicular pain or neurological deficits caused by synovial cysts. The patients' records were retrospectively analysed for neurological deficits, cysts diameter, operative approach, segmental hypermobility, and clinical outcome; CT and MRI were analysed for additional degenerative changes.
RESULTS—In 17 patients an excellent result and in two patients a good postoperative result was achieved. Twelve patients were found to have hypermobility of the facet joints and six had spondylolisthesis. There was no correlation between cyst diameter, operative approach, and outcome. No intraoperative or postoperative complications occurred.
CONCLUSIONS—Age and hypermobility may play a part in the aetiology of facet joint synovial cysts. As all operative strategies showed equally good clinical outcome, total excision via a small flavectomy as the least invasive approach should be considered therapy of choice in patients with cysts causing neurological deficits.

 PMID:11118251

  1. [Neuroanesthetic management for surgical clipping of a ruptured cerebral aneurysm: clinical practice guidelines].

    PubMed

    Ingelmo Ingelmo, I; Carmona Aurioles, J; Rama-Maceiras, P; Fàbregas Julià, N; Hernández-Palazón, J

    2010-12-01

    Subarachnoid hemorrhage due to spontaneous rupture of a cerebral aneurysm is associated with high rates of morbidity and mortality and requires multidisciplinary treatment. The debate on surgical vs endovascular treatment continues, although short-term clinical outcomes and survival rates are better after endovascular treatment. In Spain, a strong trend toward reduced use of clipping has been noted, and neuroanesthetists are less often called on to provide anesthesia in this setting. Our intervention, however, can be decisive. The neuroscience working group of the Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor has developed guidelines for managing anesthesia in these procedures. Based on a national survey and a systematic review of the literature, the recommendations emphasize the importance of ensuring appropriate intracranial conditions, treating complications, and taking steps to protect against cerebral hemorrhage.

  2. Management of patients with psoriasis treated with biological drugs needing a surgical treatment.

    PubMed

    Fabiano, Antonella; De Simone, Clara; Gisondi, Paolo; Piaserico, Stefano; Lasagni, Claudia; Pellacani, Giovanni; Conti, Andrea

    2014-11-01

    Tumor necrosis factor alpha (TNF-α) is a cytokine that plays a critical role in inflammatory and immune processes and in the control of infections and sepsis. Data on the perioperative management of patients treated with biologic drugs are limited and mainly in patients with rheumatoid arthritis (RA) and inflammatory bowel disease (IBD). This retrospective study assesses variations in the incidence of side effects between psoriatic patients who temporarily discontinue or continue biological therapy before surgical treatment. Despite the immunosuppressive risk, our results suggest that postoperative complications are not influenced by the suspension of biologic therapies. As TNF-α plays a role in promoting collagen synthesis and wound healing, we suggest that anti-TNFs should be discontinued before major surgery, whereas for minor surgery, the lower rates of infections favor anti-TNF-α continuation, particularly since suspending anti-TNF therapy is known to induce psoriasis relapse.

  3. Surgical management of chylopericardium and chylothorax in a patient with Behçet's disease.

    PubMed

    Al Jaaly, Emad; Baig, Kamran; Patni, Ravi; Anderson, John; Haskard, Dorian O

    2011-01-01

    Behçet's syndrome is a chronic multisystem inflammatory disease characterised classically by recurrent oral and genital ulcers with ocular lesions. It can affect blood vessels of all sizes, but involves veins more commonly than arterie. The presence of chylothorax in Behçet's syndrome is rare, with only a few cases cited in the literature. The most likely pathogenesis is SVC thrombosis with obstruction of the orifice of the thoracic duct resulting in leakage of chyle from the pleural lymphatics into the pleural space. The majority of the previously reported cases were managed medically without surgical intervention. We believe that this report describes the first use of surgery to ligate the thoracic duct and create a pericardial window in a Behçet's syndrome with chylothorax and chylopericardium.

  4. Ureteroscopy for management of stone disease: an up to date on surgical technique and disposable devices.

    PubMed

    Torricelli, Fabio C; Marchini, Giovanni S; Pedro, Renato N; Monga, Manoj

    2016-12-01

    The surgical management of urinary stone disease developed substantially over the past decades and advanced minimally invasive techniques have been successfully introduced into clinical practice. Retrograde ureteroscopy and ureterorrenoscopy have become the first-line option for treatment of ureteral and renal stones worldwide with high success rates allied with a low morbidity profile. In this review, we will discuss some key points in ureteroscopy for stone disease, such as the access to upper urinary tract, including balloon and catheter dilation; how to choose and use some disposable devices (hydrophilic versus PTFE guide wires, ureteral catheters, and laser fiber setting); and lastly present and compare different techniques for kidney or ureteral stone treatment (dusting versus basketing).

  5. Surgical management of very late paravalvular leaks after mitral valve replacement: a single institutional experience

    PubMed Central

    Zhu, Jiasi; Sin, Yoong Kong; Chua, Yeow Leng

    2016-01-01

    Most mitral paravalvular leaks (PVLs) occur during the first year after mitral valve replacement (MVR). This report describes the surgical management of 6 patients who developed very late mitral PVLs. The median interval between MVR and initial diagnosis of PVL was 16.5 years. All patients presented with congestive cardiac failure and haemolytic anaemia. The median EuroSCORE II was 9.5%. Two patients (33%) had failed attempts at transcatheter closure. Five patients underwent suture repair of the PVL. One patient underwent MVR after removal of the previous prosthesis. No in-hospital mortalities occurred. At latest follow-up (median 3.3 years), 5 patients (83%) were asymptomatic with no residual PVL. Haemolytic anaemia persisted in 1 patient with a mild residual PVL. PVL occurring decades after MVR is a rare but serious complication. Reoperative surgery can be performed in these high-risk patients with satisfactory early and midterm outcomes. PMID:27747034

  6. Seasonal trends in intrapack aggression of captive wolves (Canis lupus) and wolf-dog crosses: implications for management in mixed-subspecies exhibits.

    PubMed

    Mehrkam, Lindsay R; Thompson, Roger K R

    2015-01-01

    Mixed-species exhibits are becoming increasingly common in the captive management of a wide range of species. Systematic evaluations of enclosures consisting of multiple subspecies, however, are relatively infrequent. The aim of this study was to measure seasonal trends in aggressive behaviors within a captive pack of wolves and wolf-dog crosses in a sanctuary setting. The frequency of intrapack social behaviors occurring within scan-sampling intervals was recorded for wolves and wolf-dog crosses during autumn, winter, and spring (2008-2009). Both subspecies displayed distinct seasonal trends in aggression. Wolf-dog crosses exhibited overall higher levels of aggression than wolves, although these instances were mostly noncontact and no significant differences were observed in the relative frequencies of aggressive behaviors between subspecies during any season. These findings suggest that wolves and wolf-dog crosses may be housed successfully given continuous behavioral monitoring, and these findings represent the first empirical account of wolf-dog cross behavior directly compared to wolves. Future studies should be conducted with similar packs to determine if this dynamic is universal. Such research will aid in the development of management and welfare strategies for captive facilities that provide permanent residences for wolves and wolf-dog crosses.

  7. Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus - Eastern Hepatobiliary Surgical Hospital consensus statement.

    PubMed

    Cheng, Shuqun; Yang, Jiamei; Shen, Feng; Zhou, Weiping; Wang, Yi; Cong, Wenming; Yang, Guang Shun; Cheng, Hongyan; Hu, Heping; Gao, Chunfang; Guo, Jia; Li, Aijun; Meng, Yan; Jiang, Xiaoqing; Yang, Yefa; Qian, Guojun; Luo, Ming; Hu, Bing; Man, Xiaobo; Zhang, Baohua; Su, Changqing; Zhou, Feiguo; Li, Nan; Shi, Jie; Wang, Meng; Zheng, Yaxin; Guo, Weixing; Sun, Juxian; Wang, Hongyang; Lau, Wan-Yee; Wu, Meng-Chao

    2016-06-28

    Hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus (PVTT) is associated with poor prognosis, early recurrence of HCC, and limited treatment options. Current guidelines do not have standardized diagnostic and treatment modalities, thus creating a need for a multidisciplinary treatment model for standardization of the treatment. Eastern Hepatobiliary Surgical Hospital (China) convened two working parties of experts from all the departments, to consolidate the current evidence, prevailing vision for the future, and experience of the practicing clinicians engaged in HCC management, so as to develop a consensus for PVTT diagnosis and treatment according to the GRADE system. Based on the quality of the existing evidence and the strength of recommendations, the consensus statements were categorized into 3 evidence levels (A/B/C) and 5 classes (I/II/IIa/IIb/III).The panel discussed and provided clarity on the management and research options in the field of HCC with PVTT. In addition, the panel also assessed the quality of the cited studies and assigned grades to the recommendation statements. Among the group of experts, there was excellent agreement with regard to effective diagnosis and treatment of HCC with PVTT. The recommendations of this consensus will provide guidance to physicians and clinical researchers on the effective management of HCC with PVTT.

  8. Surgical management of hydrocephalus secondary to intraventricular hemorrhage in the preterm infant.

    PubMed

    Christian, Eisha A; Melamed, Edward F; Peck, Edwin; Krieger, Mark D; McComb, J Gordon

    2016-03-01

    OBJECT Posthemorrhagic hydrocephalus (PHH) in the preterm infant remains a major neurological complication of prematurity. The authors first described insertion of a specially designed low-profile subcutaneous ventricular catheter reservoir for temporary management of hydrocephalus in 1983. This report presents the follow-up experience with the surgical management of PHH in this population and describes outcomes both in infants who were stable for permanent shunt insertion and those initially temporized with a ventricular reservoir (VR) prior to permanent ventriculoperitoneal (VP)/ventriculoatrial (VA) shunt placement. METHODS A retrospective review was undertaken of the medical records of all premature infants surgically treated for posthemorrhagic hydrocephalus (PHH) between 1997 and 2012 at Children's Hospital Los Angeles. RESULTS Over 14 years, 91 preterm infants with PHH were identified. Fifty neonates received temporizing measures via a VR that was serially tapped for varying time periods. For the remaining 41 premature infants, VP/VA shunt placement was the first procedure. Patients with a temporizing measure as their initial procedure had undergone CSF diversion significantly earlier in life than those who had permanent shunting as the initial procedure (29 vs 56 days after birth, p < 0.01). Of the infants with a VR as their initial procedure, 5/50 (10%) did not undergo subsequent VP/VA shunt placement. The number of shunt revisions and the rates of loculated hydrocephalus and shunt infection did not statistically differ between the 2 groups. CONCLUSIONS Patients with initial VR insertion as a temporizing measure received a CSF diversion procedure significantly earlier than those who received a permanent shunt as their initial procedure. Otherwise, the outcomes with regard to shunt revisions, loculated hydrocephalus, and shunt infection were not different for the 2 groups.

  9. Situational Analysis of Essential Surgical Care Management in Iran Using the WHO Tool

    PubMed Central

    Kalhor, Rohollah; Keshavarz Mohamadi, Nastaran; Khalesi, Nader; Jafari, Mehdi

    2016-01-01

    Background: Surgery is an essential component of health care, yet it has usually been overlooked in public health across the world. Objectives: This study aimed to perform a situational analysis of essential surgical care management at district hospitals in Iran. Materials and Methods: This research was a descriptive and cross-sectional study performed at 42 first-referral district hospitals of Iran in 2013. The World Health Organization (WHO) Tool for the situational analysis of emergency and essential care was used for data collection in four domains of facilities and equipment, human resources, surgical interventions, and infrastructure. Data analysis was conducted using simple descriptive statistical methods. Results: In this study, 100% of the studied hospitals had oxygen cylinders, running water, electricity, anesthesia machines, emergency departments, archives of medical records, and X-ray machines. In 100% of the surveyed hospitals, specialists in surgery, anesthesia, and obstetrics and gynecology were available as full-time staff. Life-saving procedures were performed in the majority of the hospitals. Among urgent procedures, neonatal surgeries were conducted in 14.3% of the hospitals. Regarding non-urgent procedures, acute burn management was conducted in 38.1% of the hospitals. Also, a few other procedures such as cricothyrotomy and foreign body removal were performed in 85.7% of the hospitals. Conclusions: The results indicated that suitable facilities and equipment, human resources, and infrastructure were available in the district hospitals in Iran. These findings showed that there is potential for the district hospitals to provide care in a wider spectrum. PMID:27437121

  10. The microbial community shifts of subgingival plaque in patients with generalized aggressive periodontitis following non-surgical periodontal therapy: a pilot study.

    PubMed

    Han, Jing; Wang, Peng; Ge, Shaohua

    2017-02-07

    The object of this study is to characterize the bacterial community of subgingival plaque of two subjects with generalized aggressive periodontitis (GAgP) pre- and post-treatment. We picked two patients with GAgP and used high-throughput 16S rDNA sequencing. V4 hypervariable region was picked for PCR amplification of subgingival samples. Then, the PCR products were sequenced through Illumina MiSeq platform. One month after therapy, both the clinical features and periodontal parameters improved obviously. Moreover, the composition and structure of subgingival bacterial community changed after initial periodontal therapy. Also, the composition of the subgingival microbiota was highly individualized among different patients. Bacteroidetes, Spirochaetes and Fusobacteria were related to pathogenicity of GAgP while Actinobacteria and Proteobacteria seemed associated with clinical symptoms resolution. In this study, we found the subgingival bacterial community was high in species richness but dominated by a few species or phylotypes, with significant shifts of microbiota that occurred after treatment. This study demonstrated the shift of the subgingival bacterial community before and after treatment by high-throughput 16S rDNA sequencing, and provided a concise method for analysis of microbial community for periodontal diseases.

  11. Surgical management for upper urinary tract transitional cell carcinoma (UUT-TCC): a systematic review.

    PubMed

    Rai, Bhavan Prasad; Shelley, Mike; Coles, Bernadette; Somani, Bhaskar; Nabi, Ghulam

    2012-11-01

    Surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC) has significantly changed over the past two decades. Data for several new surgical techniques, including nephron-sparing surgery (NSS), is emerging. The study systematically reviewed the literature comparing (randomised and observational studies) surgical and oncological outcomes for various surgical techniques MEDLINE, EMBASE, Cochrane Library, CINAHL, British Nursing Index, AMED, LILACS, Web of Science, Scopus, Biosis, TRIP, Biomed Central, Dissertation Abstracts, ISI proceedings, and PubMed were searched to identify suitable studies. Data were extracted from each identified paper independently by two reviewers (B.R. and B.S.) and cross checked by a senior member of the team. The data analysis was performed using the Cochrane software Review manager version 5. Comparable data from each study was combined in a meta-analysis where possible. For dichotomous data, odds ratios with 95% confidence intervals (CIs) were estimated based on the fixed-effects model and according to an intention-to-treat analysis. If the data available were deemed not suitable for a meta-analysis it was described in a narrative fashion. One randomised control trial (RCT) and 19 observational studies comparing open nephroureterectomy (ONU) and laparoscopic NU (LNU) were identified. The RCT reported the LNU group to have statistically significantly less blood loss (104 vs 430 mL, P < 0.001) and mean time to discharge (2.30 vs 3.65 days, P < 0.001) than the ONU group. At a median follow-up of 44 months, the overall 5-year cancer-specific survival (CSS; 89.9 vs 79.8%) and 5-year metastasis-free survival rates (77.4 vs 72.5%) for the ONU were better than for LNU, respectively, although not statistically significant. A meta-analysis of the observational studies favoured LNU group for lower urinary recurrence (P < 0.001) and distant metastasis. The meta-analyses for local recurrence for the two groups were comparable

  12. Surgical management of medulla oblongata hemangioblastomas in one institution: an analysis of 62 cases

    PubMed Central

    Liu, Xuesong; Zhang, Yuekang; Hui, Xuhui; You, Chao; Yuan, Fang; Chen, Wenjing; Zhang, Si

    2015-01-01

    Object: Hemangioblastomas of the central nervous system are highly vascularized benign tumors. When the tumors are located in the medulla oblongata, intraoperative bleeding can make the surgical procedure very difficult. Preoperative embolism has been performed in cases of hemangioblastoma in recent decades. However, the complications of the embolization can result in fatal consequences, especially when the lesions are located in the brainstem. In recent years, selectively blocking the suspicious feeding arteries of the tumors during operation in conjunction with intraoperative neurophysiological monitoring has been performed in the Department of Neurosurgery at the West China Hospital. The purpose of this study is to review all cases that underwent this surgical management and to evaluate their outcomes. Method: Between 2003 and 2014, 62 patients (36 female and 26 male, mean age 35.6 years) underwent microsurgery resection of 67 medulla oblongata hemangioblastomas. The suspicious feeding arteries were identified preoperatively by CTA or DSA. During the operation, the suspicious feeding arteries were blocked selectively by motor evoked potential (MEP) and somatosensory evoked potential monitoring (SEP). Based on the retrospectively review of the clinical records and outpatient long-term follow-up visits, their clinical courses were analyzed. Functional outcomes were evaluated according to the classification of McCormick and the Karnofsky Performance Scale. Result: The maximum tumor diameter ranged from 0.8 to 5.1 cm (mean, 2.9 cm). Total tumor resection was achieved in 60 patients. Sixty-one tumors were removed en bloc, and the other six were resected in a piecemeal fashion. The mean follow-up period was 47 months. During the follow-up period, 34 patients remained neurologically stable, 27 patients recovered to a better status and 16 patients developed new transient neurological dysfunction. One patient died. Karnofsky performance scale scores were 100 in 14

  13. Surgical management of accidentally displaced mandibular third molar into the pterygomandibular space: a case report.

    PubMed

    Huang, I-Yueh; Chen, Chao-Ming; Chang, Sung-Wen; Yang, Chia-Fu; Chen, Chung-Ho; Chen, Chun-Min

    2007-07-01

    Surgical removal of the mandibular third molar is a regular surgical procedure in dental clinics, and like all operations, it may have some complications, such as infection, bleeding, nerve injuries, trismus and so on. An accidentally displaced lower third molar is a relatively rare complication, but may cause severe tissue injury and medicolegal problems. As few papers and cases have been published on this topic, we report this case to remind dentists on ways to prevent and manage this complication. The patient, a 28-year-old male, had his right lower mandibular third molar extraction in January 2006. The dentist resected the crown and attempted to remove the root but found that it had suddenly disappeared from the socket. Assuming that the root had been suctioned out he closed the wound. The patient was not followed up regularly because he studied abroad. About 3 months later, the patient felt a foreign body sensation over his right throat, and visited a local hospital in Australia. He was told after a computed tomography (CT) scan that there was a root-like radio-opaque image in the pterygomandibular space. The patient came to our hospital for further examination and management in June 2006. We rechecked with both Panorex and CT and confirmed the location of the displaced root. Surgery for retrieving the displaced root was performed under general anesthesia by conventional method without difficulty, and the wound healed uneventfully except for a temporary numbness of the right tongue. This case reminds us that the best way to prevent a displaced mandibular third molar is to evaluate the condition of the tooth carefully preoperatively, select adequate instruments and technique, and take good care during extraction. If an accident does occur, dentists should decide whether to retrieve it immediately by themselves or refer the case to an oral and maxillofacial surgeon, and should not try to remove the displaced root without proper assurance. Localization with

  14. Functional reconstruction after subtotal glossectomy in the surgical treatment of an uncommon and aggressive neoplasm in this location: Primary malignant melanoma in the base of the tongue

    PubMed Central

    Manzano-Solo-de-Zaldívar, Damián; Moreno-Sánchez, Manuel; Hernández-Vila, Cristina; Ramírez-Pérez, Francisco-Alejandro; González-Ballester, David; Ruíz-Laza, Luis; González-García, Raúl; Monje-Gil, Florencio

    2014-01-01

    Primary malignant melanoma of the oral cavity is a rare neoplasm, especially on the tongue. We report a case of mucosal melanoma at the base of the tongue, an extremely rare location (only about 30 cases have been reported in literature). The extension study doesn´t revealed distant metastatic lesions. The patient was treated by subtotal glossectomy and bilateral functional neck dissection. Tongue is one of the most difficult structures to reconstruct, because of their central role in phonation, swallowing and airway protection. The defect was reconstructed with anterolateral thigh free flap. Surgical treatment was supplemented with adjuvant immunotherapy. The post-operative period was uneventful. At present, 24 months after surgery, patient is asymptomatic, there isn´t evidence of recurrence of melanoma and he hasn´t any difficulty in swallowing or phonation. Key words:Malignant mucosal melanoma, anterolateral thigh free flap, phonation, swallowing. PMID:25593674

  15. Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: a retrospective observational study

    PubMed Central

    Vinluan, Jessele; Retegan, Claudia; Chen, Andrew; Beiles, Charles Barry

    2014-01-01

    Objective Clinical management issues are contributory factors to mortality. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM), an educational peer-review process for surgeons, to discover differences in the incidence of these issues between surgical specialties in order to focus attention to areas of care that might be improved. Design This study used retrospectively analysed observational data from VASM. Clinical management issues between eight specialties were assessed using χ2 analysis. Data sources VASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria. Results A total of 2946 specific clinical issues as deficiencies of care were reported. 15% of cases had significant issues of care. The most common clinical management issue was the delay in delivery of treatment. Other clinical issues included the quality of communication and documentation, preoperative and postoperative care, adverse events and protocol issues. There were significant differences in issues between specialties. Conclusions The clinical management issues presented across surgical specialties were similar; however, five issues of clinical care differed significantly in frequency across surgical specialties. The three main issues varying among specialties were complications after operation, communication and postoperative care. Addressing these clinical management issues via the peer-review process may impact positively on patient care. PMID:24980043

  16. Conservative surgical management of necrotic tissues following meningococcal sepsis: case report of a child treated with hyperbaric oxygen.

    PubMed

    Takac, Ines; Kvolik, Slavica; Divkovic, Dalibor; Kalajdzic-Candrlic, Jasenka; Puseljic, Silvija; Izakovic, Senka

    2010-01-01

    This article presents the case of a 5-month-old infant, who survived a fulminant meningococcal sepsis with purpura fulminans, septic shock and severe DIC with gastrointestinal bleeding. Amputation and reconstructive surgery were considered to treat the multiple skin and limb necroses at high risk of superinfection, but the surgical intervention was delayed due to the extremely doubtful outcome. On Day 10 after the onset of the disease, a hemodynamic improvement was achieved. The baby overcame early critical period, but was still in poor general condition. The hyperbaric oxygenation (HBO2) as adjuvant therapy was started in the monoplace chamber using the following protocol: from first through fifth day 45 minutes twice a day on 1.5 atmosphere absolute (ATA); after a two-day break, once a day on 1.8 ATA for 60 minutes. During 52 HBO2 treatments multiple areas of necrotic skin and subcutaneous tissue, together with fingertips and toes, detached spontaneously. All wounds healed without reinfections. An increased oxygen concentration during HBO2 therapy promoted spontaneous wound healing. Bacterial superinfection was not observed in numerous low-perfused lesions. Since repeated anesthesia and surgical interventions were not needed, a final invalidity was minimized. To the best of our knowledge, this is the first report on the successful conservative surgical treatment of this mutilating disease without aggressive reconstructive surgery in an infant with the help of HBO2.

  17. Role of Recipient-site Preparation Techniques and Post-operative Wound Dressing in the Surgical Management of Vitiligo

    PubMed Central

    Al-Hadidi, Nour; Griffith, James L; Al-Jamal, Mohammed S; Hamzavi, Iltefat

    2015-01-01

    Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below. PMID:26157306

  18. Evaluating lingual carcinoma for surgical management: what does volumetric measurement with MRI offer?

    PubMed Central

    Boland, P W; Watt-Smith, S R; Pataridis, K; Alvey, C; Golding, S J

    2010-01-01

    MRI plays a crucial but under utilized role in the surgical management of lingual squamous cell carcinoma (SCC). Measurement of three-dimensional tumour volume (TV) has the potential to guide management of clinically negative cervical lymph nodes and address deficiencies in current TNM staging criteria This work studied the value of MRI-measured TV as a predictor of 2 year disease-related survival (DRS) and disease-free survival (DFS), as well as occult cervical lymph node metastasis (OM) in lingual cancer. TV was determined by manually segmenting the tumour contour in each image slice and using the resulting pixel value to calculate the three-dimensional extent of disease. TV was also compared with the more established measure of tumour thickness (TT) Significant differences in DRS (χ2(1) = 7.7, Hazard ratio (HR) = 7.3, p = 0.005) and DFS (χ2(1) = 5.6, HR = 4.3, p = 0.02) at two years were found using a cut-off of 8 cm3. Similarly, a significant relationship between TV and occult cervical lymph node metastasis was discovered using a 3 cm3 cut-off (OR = 6.7, p = 0.02, Fisher's Exact Test). PMID:20965903

  19. The clinical utility of QSM: disease diagnosis, medical management, and surgical planning.

    PubMed

    Eskreis-Winkler, Sarah; Zhang, Yan; Zhang, Jingwei; Liu, Zhe; Dimov, Alexey; Gupta, Ajay; Wang, Yi

    2017-04-01

    Quantitative susceptibility mapping (QSM) is an MR technique that depicts and quantifies magnetic susceptibility sources. Mapping iron, the dominant susceptibility source in the brain, has many important clinical applications. Herein, we review QSM applications in the diagnosis, medical management, and surgical treatment of disease. To assist in early disease diagnosis, QSM can identify elevated iron levels in the motor cortex of amyotrophic lateral sclerosis patients, in the substantia nigra of Parkinson's disease (PD) patients, in the globus pallidus, putamen, and caudate of Huntington's disease patients, and in the basal ganglia of Wilson's disease patients. Additionally, QSM can distinguish between hemorrhage and calcification, which could prove useful in tumor subclassification, and can measure microbleeds in traumatic brain injury patients. In guiding medical management, QSM can be used to monitor iron chelation therapy in PD patients, to monitor smoldering inflammation of multiple sclerosis (MS) lesions after the blood-brain barrier (BBB) seals, to monitor active inflammation of MS lesions before the BBB seals without using gadolinium, and to monitor hematoma volume in intracerebral hemorrhage. QSM can also guide neurosurgical treatment. Neurosurgeons require accurate depiction of the subthalamic nucleus, a tiny deep gray matter nucleus, prior to inserting deep brain stimulation electrodes into the brains of PD patients. QSM is arguably the best imaging tool for depiction of the subthalamic nucleus. Finally, we discuss future directions, including bone QSM, cardiac QSM, and using QSM to map cerebral metabolic rate of oxygen. Copyright © 2016 John Wiley & Sons, Ltd.

  20. Implant-associated mycobacterium tuberculosis infection following surgical management of fractures: a retrospective observational study.

    PubMed

    Mahale, Y J; Aga, N

    2015-09-01

    In this retrospective observational cohort study, we describe 17 patients out of 1775 treated for various fractures who developed mycobacterium tuberculosis (MTB) infection after surgery. The cohort comprised 15 men and two women with a mean age of 40 years (24 to 70). A total of ten fractures were open and seven were closed. Of these, seven patients underwent intramedullary nailing of a fracture of the long bone, seven had fractures fixed with plates, two with Kirschner-wires and screws, and one had a hemiarthroplasty of the hip with an Austin Moore prosthesis. All patients were followed-up for two years. In all patients, the infection resolved, and in 14 the fractures united. Nonunion was seen in two patients one of whom underwent two-stage total hip arthroplasty (THA) and the other patient was treated using excision arthoplasty. Another patient was treated using two-stage THA. With only sporadic case reports in the literature, MTB infection is rarely clinically suspected, even in underdeveloped and developing countries, where pulmonary and other forms of TB are endemic. In developed countries there is also an increased incidence among immunocompromised patients. In this paper we discuss the pathogenesis and incidence of MTB infection after surgical management of fractures and suggest protocols for early diagnosis and management.

  1. Out-of-Hospital Surgical Airway Management: Does Scope of Practice Equal Actual Practice?

    PubMed Central

    Furin, Molly; Kohn, Melissa; Overberger, Ryan; Jaslow, David

    2016-01-01

    Introduction Pennsylvania, among other states, includes surgical airway management, or cricothyrotomy, within the paramedic scope of practice. However, there is scant literature that evaluates paramedic perception of clinical competency in cricothyrotomy. The goal of this project is to assess clinical exposure, education and self-perceived competency of ground paramedics in cricothyrotomy. Methods Eighty-six paramedics employed by four ground emergency medical services agencies completed a 22-question written survey that assessed surgical airway attempts, training, skills verification, and perceptions about procedural competency. Descriptive statistics were used to evaluate responses. Results Only 20% (17/86, 95% CI [11–28%]) of paramedics had attempted cricothyrotomy, most (13/17 or 76%, 95% CI [53–90%]) of whom had greater than 10 years experience. Most subjects (63/86 or 73%, 95% CI [64–82%]) did not reply that they are well-trained to perform cricothyrotomy and less than half (34/86 or 40%, 95% CI [30–50%]) felt they could correctly perform cricothyrotomy on their first attempt. Among subjects with five or more years of experience, 39/70 (56%, 95% CI [44–68%]) reported 0–1 hours per year of practical cricothyrotomy training within the last five years. Half of the subjects who were able to recall (40/80, 50% 95% CI [39–61%]) reported having proficiency verification for cricothyrotomy within the past five years. Conclusion Paramedics surveyed indicated that cricothyrotomy is rarely performed, even among those with years of experience. Many paramedics felt that their training in this area is inadequate and did not feel confident to perform the procedure. Further study to determine whether to modify paramedic scope of practice and/or to develop improved educational and testing methods is warranted. PMID:27330674

  2. Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery

    PubMed Central

    Karlakki, S.; Brem, M.; Giannini, S.; Khanduja, V.; Stannard, J.; Martin, R.

    2013-01-01

    Objectives The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which one can apply new technologies that can minimise complications. One such technology is the use of negative pressure wound therapy to manage and accelerate healing of the closed incisional wound (incisional NPWT). Methods We undertook a literature review of this emerging indication to identify evidence within orthopaedic surgery and other surgical disciplines. Literature that supports our current understanding of the mechanisms of action was also reviewed in detail. Results A total of 33 publications were identified, including nine clinical study reports from orthopaedic surgery; four from cardiothoracic surgery and 12 from studies in abdominal, plastic and vascular disciplines. Most papers (26 of 33) had been published within the past three years. Thus far two randomised controlled trials – one in orthopaedic and one in cardiothoracic surgery – show evidence of reduced incidence of wound healing complications after between three and five days of post-operative NPWT of two- and four-fold, respectively. Investigations show that reduction in haematoma and seroma, accelerated wound healing and increased clearance of oedema are significant mechanisms of action. Conclusions There is a rapidly emerging literature on the effect of NPWT on the closed incision. Initiated and confirmed first with a randomised controlled trial in orthopaedic trauma surgery, studies in abdominal, plastic and vascular surgery with high rates of complications have been reported recently. The evidence from single-use NPWT devices is accumulating. There are no large randomised studies yet in reconstructive joint replacement. Cite this article: Bone Joint Res 2013;2:276–84. PMID:24352756

  3. Patient Education Self-Management During Surgical Recovery: Combining Mobile (iPad) and a Content Management System

    PubMed Central

    Moradkhani, Anilga; Douglas, Kristin S. Vickers; Prinsen, Sharon K.; Fischer, Erin N.; Schroeder, Darrell R.

    2014-01-01

    Abstract Objective: The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and “just-in-time” education to older patients following cardiac surgery. Subjects and Methods: Patients were provided with iPad® (Apple®, Cupertino, CA) tablets that delivered educational modules as part of a daily “to do” list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers. Results: A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use. Conclusions: We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and “just-in-time” education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models. PMID:24443928

  4. Surgical Management of Malignant Pleural Mesothelioma: Impact of Surgery on Survival and Quality of Life—Relation to Chemotherapy, Radiotherapy, and Alternative Therapies

    PubMed Central

    Papaspyros, Sotiris

    2014-01-01

    Introduction. Malignant pleural mesothelioma (MPM) is an aggressive cancer arising from pleural mesothelium. Surgery aims to either cure the disease or control the symptoms. Two surgical procedures exist: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). In this systematic review we assess current evidence on safety and efficacy of surgery. Methods. Five electronic databases were reviewed from January 1990 to January 2013. Studies were selected according to a predefined protocol. Primary endpoint was overall survival. Secondary endpoints included quality of life, disease-free survival, disease recurrence, morbidity, and length of hospital stay. Results. Sixteen studies were included. Median survival ranged from 8.1 to 32 months for P/D and from 6.9 to 46.9 months for EPP. Perioperative mortality was 0%–9.8% and 3.2%–12.5%, respectively. Perioperative morbidity was 5.9%–55% for P/D and 10%–82.6% for EPP. Average length of stay was 7 days for P/D and 9 days for EPP. Conclusion. Current evidence cannot definitively answer which procedure (EPP or P/D) is more beneficial in terms of survival and operative risks. This systematic review suggests that surgery in the context of trimodality therapy offers acceptable perioperative outcomes and long-term survival. Centres specialising in MPM management have better results. PMID:24624305

  5. Implementation of a novel emergency surgical unit significantly improves the management of gallstone pancreatitis

    PubMed Central

    Kulendran, M; Liasis, L; Qurashi, K; Sen, M; Gould, S

    2015-01-01

    Introduction Emergency surgery is changing rapidly with a greater workload, early subspecialisation and centralisation of emergency care. We describe the impact of a novel emergency surgical unit (ESU) on the definitive management of patients with gallstone pancreatitis (GSP). Methods A comparative audit was undertaken for all admissions with GSP before and after the introduction of the ESU over a six-month period. The impact on compliance with British Society of Gastroenterology (BSG) guidelines was assessed. Results Thirty-five patients were treated for GSP between December 2013 and May 2014, after the introduction of the ESU. This was twice the nationally reported average for a UK trust over a six-month period. All patients received definitive management for their GSP and 100% of all suitable patients received treatment during the index admission or within two weeks of discharge. This was a significantly greater proportion than that prior to the introduction of the ESU (57%, p=0.0001) as well as the recently reported national average (34%). The mean length of total inpatient stay was reduced significantly after the ESU was introduced from 13.7 ± 4.7 days to 7.8 ± 2.1 days (p=0.03). The mean length of postoperative stay also fell significantly from 6.7 ± 2.6 days to 1.8 ± 0.8 days (p=0.001). Conclusions A dedicated ESU following national recommendations for emergency surgery care by way of using dedicated emergency surgeons and a streamlined protocol for common presentations has been shown by audit of current practice to significantly improve the management of patients presenting to a busy district general hospital with GSP. PMID:26263941

  6. Surgical management of breast cancer in China: A 15-year single-center retrospective study of 18,502 patients.

    PubMed

    Huang, Nai-Si; Liu, Meng-Ying; Chen, Jia-Jian; Yang, Ben-Long; Xue, Jing-Yan; Quan, Chen-Lian; Mo, Miao; Liu, Guang-Yu; Shen, Zhen-Zhou; Shao, Zhi-Min; Wu, Jiong

    2016-11-01

    .Mastectomy remains the most prevalent surgical modality used to manage early stage breast cancer in China, although the utilization of BCS has increased in the past decade. However, surgical management was not a prognostic factor for RFS. The selection of appropriate patients depended on the assessment of multiple clinicopathological factors, which is essential for making surgical decisions.

  7. Transperineal aggressive angiomyxoma.

    PubMed

    Pereira, Pedro; Melo Abreu, Elisa; Cunha, Teresa Margarida; Rolim, Inês

    2017-04-11

    A 45-year-old woman with a history of total hysterectomy with adnexal preservation for uterine leiomyomas presented to our hospital with a right gluteal palpable mass, which she first noticed 6 months before and had progressively enlarged since then.Radiological studies revealed a 14 cm lesion with translevator growth that displaced rather than invaded adjacent structures, with a peculiar whorled pattern on T2-weighted MRI, which enhanced following gadolinium administration. CT-guided biopsy was performed, and in conjunction with imaging features the diagnosis of an aggressive angiomyxoma was assumed and confirmed following surgical excision.

  8. Surgical considerations in the management of combined radiation blast injury casualties caused by a radiological dirty bomb.

    PubMed

    Williams, Geraint; O'Malley, Michael

    2010-09-01

    The capacity for surgical teams to respond appropriately to the consequences caused by the detonation of a radiological dirty bomb will be determined by prior knowledge, familiarity and training for this type unique terrorist event. This paper will focus on the surgical aspects of this scenario with particular emphasis on the management of combined trauma-radiological injury. The paper also describes some of the more serious explosion-contamination incidents from nuclear industrial sources, summarises learning points and parallels taken from these scenarios in relation to subject of a radiological dirty bomb and describes the likely radioactive substances involved.

  9. Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach.

    PubMed

    Jingarwar, Mahesh; Pathak, Anuradha; Bajwa, Navroop Kaur; Kalaskar, Ritesh

    2015-01-01

    This paper reports case of pediatric localized gingival recession (LGR) in mandibular anterior region which was treated by using new innovative surgical approach, i.e. combination of frenectomy and vestibular extension. These interceptive surgeries not only gained sufficient width of attached gingival but also lower the attachment of labial frenum. How to cite this article: Jingarwar M, Pathak A, Bajwa NK, Kalaskar R. Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach. Int J Clin Pediatr Dent 2015;8(3):224-226.

  10. Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach

    PubMed Central

    Pathak, Anuradha; Bajwa, Navroop Kaur; Kalaskar, Ritesh

    2015-01-01

    ABSTRACT This paper reports case of pediatric localized gingival recession (LGR) in mandibular anterior region which was treated by using new innovative surgical approach, i.e. combination of frenectomy and vestibular extension. These interceptive surgeries not only gained sufficient width of attached gingival but also lower the attachment of labial frenum. How to cite this article: Jingarwar M, Pathak A, Bajwa NK, Kalaskar R. Vestibular Extension along with Frenectomy in Management of Localized Gingival Recession in Pediatric Patient: A New Innovative Surgical Approach. Int J Clin Pediatr Dent 2015;8(3):224-226. PMID:26604542

  11. Surgical management of acromegaly: Long term functional outcome analysis and assessment of recurrent/residual disease

    PubMed Central

    Banerji, Deepu; Das, Nitu K.; Sharma, Siddhiraj; Jindal, Yogesh; Jain, Vijendra K.; Behari, Sanjay

    2016-01-01

    Context: Functional growth hormone producing adenomas have long-term deleterious effects on the visual apparatus, the cardiovascular and musculoskeletal systems, and often predispose to malignancies. Since persistence of acromegaly affects outcome and quality of life, therapeutic interventions become mandatory. Aim: This study represents an analysis of long-term clinical and endocrinal outcome of 115 patients of acromegaly after surgical management. Setting and Design: Tertiary care retrospective study. Materials and Methods: One hundred and fifteen patients (male:female ratio: 1:1.09) with acromegalic features were studied. Apart from acromegalic features, their main clinical presentation also included headache, diminution of vision, field defects, ptosis, irregular menstruation, diabetes insipidus, diabetes mellitus and hypertension. Six of them presented with apoplexy. Their preoperative endocrinal evaluation included basal and suppressed growth hormone (GH), prolactin and thyroid levels. On the basis of axial and coronal CT scan or multiplanar MR imaging or both, the tumors were classified according to their suprasellar and parasellar extension (Hardy's grade). Transnasal trans-sphenoidal surgery (TSS) (n = 37) and sublabial, rhinoseptal TSS (n = 72) were the preferred approaches. Six patients with significant parasellar extensions underwent trans-cranial explorations. The patients were followed up at 6 and 12 weeks and then at 6 monthly intervals. Hormonal and CT/MR evaluation were also done. Attainment of random GH value less than 2.5 µg/L, and the nadir GH value after oral glucose tolerance test (OGTT) less than 1 µg/L were used as the criteria of cure. Findings: The patients were preoperatively in Hardy's tumor grade 0 (29), A (21), A+E (3), B (21), B+E (5), C (9), C+E (10), D (1) D+E (11), E (5), respectively. One hundred and one patients were available for follow-up (FU; median FU duration: 84 months; range: 6 to 132 months). Surgical cure was achieved

  12. Trisomy 18: A single-center evaluation of management trends and experience with aggressive obstetric or neonatal intervention.

    PubMed

    Subramaniam, Akila; Jacobs, Adam P; Tang, Ying; Neely, Cherry; Philips, Joseph B; Biggio, Joseph R; Robin, Nathaniel H; Edwards, Rodney K

    2016-04-01

    We conducted a retrospective cohort study including all prenatal and postnatal diagnoses of trisomy 18 (T18) from 2004 to 2014 at a single tertiary referral center in the southern United States to evaluate the natural history and perinatal outcomes associated with T18 over the past decade. We analyzed pregnancy outcome, mode of delivery, and for live-births, the number and types of neonatal interventions, and characterized interventions as aggressive or non-aggressive. Survival analyses were conducted based on mode of delivery and aggressive compared to non-aggressive interventions. A total of 167 cases of T18 were identified, 150 with available records. There were 141 (94.0%) with full T18; the remainder had mosaicism (1.3%), a translocation (0.7%), or an isochromosome 18 (4.0%). Most diagnoses were prenatal (73.3%, n = 110). Of the 150 patients, there were 54 live births: 21 (38.9%) delivered vaginally, 32 (59.3%) delivered by cesarean, and mode of delivery could not be ascertained for one. Median duration of survival was 12 days (interquartile range 3-90 days). Over time, there were no changes toward increased intervention (obstetric or neonatal). For the 49 neonates who received some intervention, there was no significant difference in survival time between neonates receiving aggressive (n = 36, median survival 24 days, interquartile range 6-247) and non-aggressive (n = 13, median survival 30 days, interquartile range 8-148) intervention (P = 0.90). There was similarly no difference in neonatal survival based on mode of delivery (P = 0.79). Survival of infants with T18 is not improved with aggressive obstetric or neonatal care.

  13. The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility.

    PubMed

    Everett, T C; Morgan, P J; Brydges, R; Kurrek, M; Tregunno, D; Cunningham, L; Chan, A; Forde, D; Tarshis, J

    2017-03-01

    Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole-team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later. Medical management and teamwork were quantified via percentage adherence to key processes and the Team Emergency Assessment Measure, respectively. In the initial session, medical management was not improved by the presence of a checklist (56% without checklist vs. 62% with checklist; p = 0.50). In the retention session, teams performed significantly worse without the checklists (36% without checklist vs. 60% with checklist; p = 0.04). We did not observe a change in non-technical skills in the presence of a checklist in either the initial or retention sessions (68% without checklist vs. 69% with checklist (p = 0.94) and 69% without checklist vs. 65% with checklist (p = 0.36), respectively). Critical events checklists do not improve medical management or teamwork during simulated operating theatre crises in an ambulatory surgical daycare setting.

  14. Comparative study of glyceryl trinitrate ointment versus surgical management of chronic anal fissure.

    PubMed

    Tauro, Leo Francis; Shindhe, Vittal V; Aithala, P Sathyamoorthy; Martis, John J S; Shenoy, H Divakar

    2011-08-01

    Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity. Standard surgical treatment even though available, may require long hospital stay and sometimes have worrying complications like anal incontinence. So non-surgical treatment, Glyceryl Trinitrate has been shown to be an effective for chronic anal fissure. It decreases anal tone and ultimately heals the anal fissure. The present study is the attempt to know the efficacy of 0.2% Glyceryl Trinitrate ointment in the treatment of chronic anal fissure and to compare the effectiveness of 0.2% Glyceryl Trinitrate ointment (GTN) versus fissurectomy with lateral internal sphincterotomy (LIS) and fissurectomy with posterior internal sphincterotomy (PIS) in the management of chronic anal fissure. This is a prospective comparative study of management of chronic anal fissure done in our hospital during the period of one and half year from October 2005 to March 2007. Thirty patients treated with 0.2% Glyceryl Trinitrate ointment and 30 patients treated with fissurectomy and lateral internal sphincterotomy and 30 patients treated with posterior internal sphincterotomy, for chronic anal fissure were selected for study. A single brand of 0.2% Glyceryl Trinitrate ointment (Nitrogesic) used for trial arm. Dose of administration was 1.5 cm to 2 cm in the anal canal with device provided by manufacturers of the proprietary preparation and applied twice a daily for 12 weeks. Patients were followed up for 12 weeks and thereafter evaluated for relief of symptoms in all three groups. Observations were recorded at 2 weeks; 6 weeks and 12 weeks of follow up period, regarding symptoms like pain and bleeding during defecation, healing of CAF and also for side effects like headache in GTN group and flatus, fecal incontinence in surgical groups. Data collected in proforma and analyzed. Study revealed CAF was more in male 59 patients (66%) than the female 31 patients (34%), the ratio being 1: 0.52. The

  15. Surgical management of gingival overgrowth associated with Cowden sydrome: a case report and current understanding.

    PubMed

    Feitosa, Daniela da Silva; Santamaria, Mauro Pedrine; Casati, Márcio Zaffalon; Sallum, Enilson Antonio; Nociti Júnior, Francisco Humberto; de Toledo, Sérgio

    2011-05-01

    Cowden syndrome, also known as multiple hamartoma syndrome, is a rare autosomal dominant disorder characterized by multiple hamartomas and a high risk of development of malignancy. Oral findings, such as papillomatous lesions and fibromas, are common features; however, a periodontal phenotype has not been reported previously. Therefore, this report presents a case of gingival overgrowth associated with Cowden syndrome, its successful surgical management, and the 12-month follow-up results. Additionally, we discuss the implications for clinicians. A 23-year-old woman was referred to the Department of Periodontics, Piracicaba Dental School, presenting with generalized gingival overgrowth. A detailed dental and medical history and clinical examination confirmed the systemic diagnosis of Cowden syndrome. Histology, radiographs, and clinical data document the entire clinical approach and follow-up. Clinically, there were minor signs of recurrence of gingival overgrowth in a 12-month period after gingivectomy; however, papular lesions reappeared in keratinized gingiva immediately after healing. No signs of bone loss related to the systemic condition were observed radiographically. Histologically, a dense connective tissue with a moderate chronic inflammatory infiltrate and epithelial acanthosis, which is characteristic of gingival hyperplasia, were demonstrated. Gingival overgrowth may occur as an oral phenotype related to Cowden syndrome and can be successfully treated by means of external bevel gingivectomy, followed by regular maintenance therapy, contributing to the patient's well-being, both functionally and esthetically.

  16. Long Term Results of Innovative Procedure in Surgical Management of Chronic Lymphedema

    PubMed Central

    Mousavi, Seyed R.

    2016-01-01

    Background: Lymphedema is the result of impaired lymphatic drainage by the affected organ. This abnormality can be primary or secondary. Different operative approaches have been introduced to treat chronic lymphedema. Materials and Methods: This retrospective study included 816 patients who were diagnosed with chronic lower extremity lymphedema and did not respond to non-operative management for at least six months. Data was collected over 25 years, between March 1987 and March 2013. Doppler ultrasonography of the deep venous system was routinely undertaken in all patients to confirm patency. The patients underwent surgery and their progress was followed for at least one year postoperatively. Results: All patients were operated by the suggested technique and long term fallow-up which is a modified form of the Homan’s technique. The outcome was excellent, and 89.2% of patients were free of complication and 2% had poor results. The most common complication was wound seroma and wound infection. Conclusion: The long term results and considering the difficulties associated with the treatment of chronic lymphedema and the variety of surgical options, our method achieved excellent results, and may be proposed for the standard operative procedure for treating intractable forms of this disease. PMID:27990192

  17. Surgical management of dural arteriovenous fistulas of the transverse-sigmoid sinus in 42 patients.

    PubMed

    Eftekhar, Behzad; Morgan, Michael Kerin

    2013-04-01

    A retrospective study was performed to analyse a prospectively collected database from a single surgeon (M.K.M.) of transverse-sigmoid sinus dural arteriovenous fistulas (DAVF) between 1991 and August 2011. During the study period, 144 patients with 160 DAVF were managed. Sixty-five of the DAVF were located in the transverse-sigmoid sinus and 42 were treated with surgery, or embolisation and surgery. All patients who underwent surgery were symptomatic with retrograde cortical venous drainage. The average follow-up period was 18months (range, 2-82months). Total elimination of the DAVF was achieved in all instances, including two patients (5%) who required further surgery after postoperative cerebral angiography showed that some venous drainage had persisted after the first operation. There was no new permanent neurological deficit or mortality attributable to surgery. Our institutional experience shows that in selected patients with transverse-sigmoid sinus DAVF, the involved sinus can be surgically resected with a high success rate and it is as safe as many alternative options. We suggest that this definitive treatment option should be offered to patients, and the outcome should be compared to other treatment modalities.

  18. Surgical management of subaortic stenosis in patients with single ventricle and transposition of the great vessels.

    PubMed

    Newfeld, E A; Nikaidoh, H

    1987-09-01

    Subaortic stenosis can develop in patients with single ventricle and transposition of the great vessels. Its presence increases the risk of septation or Fontan repair, and reports of surgical management have indicated high mortality. This report describes the results of an approach that includes direct resection of the stenosis via an aortotomy, and delay of the Fontan repair to a later date. Nine children with single ventricle underwent surgery for subaortic stenosis from 1968 to 1984. Three deaths occurred postoperatively from ventricular dysfunction in patients who underwent either conduit bypass (one patient) or repair via ventriculotomy (two patients). Of the six long-term survivors, one infant underwent ventriculotomy and subaortic resection, and the last five patients had subaortic resection via an aortotomy without any other simultaneous procedure. Avoidance of ventriculotomy and decreased cardiopulmonary bypass time lowers the risk of stenosis repair in the presence of a hypertrophied ventricle. Fontan repair after some regression of the ventricular hypertrophy is recommended, and has been accomplished in one patient to date. All patients repaired via aortotomy are alive and well 1 to 6 years postoperatively.

  19. Surgical management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.

    PubMed

    Farnell, Michael B

    2008-03-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by papillary growths within the pancreatic ductal system that are at risk for undergoing malignant transformation. Main duct IPMN carries a significant risk of malignancy, and operation is recommended regardless of the presence of symptoms. The risk of malignancy is much lower for side branch IPMN, and current evidence suggests that, in the absence of symptoms, mural nodules, positive cytology, or cyst size less than 3 cm, observation is warranted. When operation is indicated, targeted pancreatic resection with frozen-section analysis of margins is recommended. Pancreatoduodenectomy or distal pacreatectomy is appropriate for the majority. Only in about 10% of patients is the disease so diffuse at presentation that total pancreatectomy is necessary. Survival following pancreatic resection for noninvasive IPMN is excellent. The risk of recurrence following pancreatic resection for invasive IPMN is significant. Surveillance is warranted both for patients subjected to pancreatic resection and for those under observation with side branch IPMN. Much is yet to be learned regarding this neoplasm, and surgical management remains in evolution.

  20. Proatlas segmentation anomalies: Surgical management of five cases and review of the literature

    PubMed Central

    Muthukumar, Natarajan

    2016-01-01

    Objective: Proatlas segementation anomalies are due to defective re-segmentation of the proatlas sclerotome. These anomalies of the craniovertebral junction are rare and have multiple presentations. The aim of this study is to report this author's personal experience in managing five of these patients with different radiological findings necessitating different surgical strategies and to provide a brief review of the relevant literature. Materials and Methods: Five patients, all in the second decade of life were treated between 2010 and 2013. There were three males and two females. All the patients presented with spastic quadriparesis and/or cerebellar signs. Patients underwent plain radiographs, MRI and CT of the craniovertebral junction. CT of the cranioveretebral junction was the key to the diagnosis of this anomaly. Postoperatively, patients were assessed with plain radiographs and CT in all patients and MRI in one. Results: Two patients underwent craniovertebral realignment with occipitocervical fixation, two patients underwent C1-C2 fixation using Goel-Harms technique and one patient underwent craniovertebral realignment with C1-C2 fixation using spacers in the atlanatoaxial joint and foramen magnum decompression. All patients improved during follow up. Conclusions: Proatlas segmentation defects are rare anomalies of the craniovertebral junction. Routine use of thin section CT of the craniovertebral junction and an awareness of this entity and its multivarious presentations are necessary for clinicians dealing with abnormalities of the craniovertebral junction. PMID:27195027

  1. Review of the investigation and surgical management of resectable ampullary adenocarcinoma

    PubMed Central

    Askew, James; Connor, Saxon

    2013-01-01

    Background Ampullary adenocarcinoma is considered to have a better prognosis than either pancreatic or bile duct adenocarcinoma. Pancreaticoduodenectomy is associated with significant mortality and morbidity. Some recent publications have advocated the use of endoscopic papillectomy for the treatment of early ampullary adenocarcinoma. This article reviews investigations and surgical treatment options of ampullary tumours. Methods A systematic review of English-language articles was carried out using an electronic search of the Ovid MEDLINE (from 1996 onwards), PubMed and Cochrane Database of Systematic Reviews databases to identify studies related to the investigation and management of ampullary tumours. Results Distinguishing between ampullary adenoma and adenocarcinoma is challenging given the inaccuracy of endoscopic biopsy, for which high false negative rates of 25–50% have been reported. Endoscopic ultrasound is the most accurate method for local staging of ampullary lesions, but distinguishing between T1 and T2 adenocarcinomas is difficult. Lymph node metastasis occurs early in the disease process; it is lowest for T1 tumours, but the risk is still high at 8–45%. Case reports of successful endoscopic resection and transduodenal ampullectomy of T1 adenocarcinomas have been published, but their duration of follow-up is limited. Conclusions Optimal staging should be used to distinguish between ampullary adenoma and adenocarcinoma. Pancreaticoduodenectomy remains the treatment of choice for all ampullary adenocarcinomas. PMID:23458317

  2. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery.

    PubMed

    Ahn, Soon-Hyun; Hong, Hyun Jun; Kwon, Soon Young; Kwon, Kee Hwan; Roh, Jong-Lyel; Ryu, Junsun; Park, Jun Hee; Baek, Seung-Kuk; Lee, Guk Haeng; Lee, Sei Young; Lee, Jin Choon; Chung, Man Ki; Joo, Young Hoon; Ji, Yong Bae; Hah, Jeong Hun; Kwon, Minsu; Park, Young Min; Song, Chang Myeon; Shin, Sung-Chan; Ryu, Chang Hwan; Lee, Doh Young; Lee, Young Chan; Chang, Jae Won; Jeong, Ha Min; Cho, Jae-Keun; Cha, Wonjae; Chun, Byung Joon; Choi, Ik Joon; Choi, Hyo Geun; Lee, Kang Dae

    2017-03-01

    Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.

  3. Stab wound to the intramedullary spinal cord: Presurgical and surgical management options for a retained blade to optimize neurological preservation

    PubMed Central

    Agarwal, Prateek; Burke, John F.; Abdullah, Kalil G.; Piazza, Matthew; Smith, Brian P.; Thawani, Jayesh P.; Malhotra, Neil R.

    2016-01-01

    Background: We present a rare case of an intraparenchymal nonmissile penetrating spinal injury (NMPSI) occurring at the T11 level in a patient presenting without neurological deficit. Case Description: The patient sustained a knife wound that penetrated the lamina without incurring bony injury and entered the spinal cord at the T11 level. During surgery, the intramedullary penetration of the cord was confirmed, and following surgical removal of the knife, the patient fully recovered without losing any neurological function. Conclusions: The surgical management of NMPSI in patients who are neurologically intact is controversial. Here, we report surgical excision of a knife that penetrated the spinal cord at the T11 level, without the patient incurring further neurological deterioration. PMID:28144493

  4. Fucntional and Radiological Outcome of Surgical Management of Acetabular Fractures in Tertiary Care Hospital

    PubMed Central

    Taufiq, Intikhab; Najjad, Muhammad Kazim Raheem; Khan, Naveed; Zia, Osama Bin

    2016-01-01

    Purpose Acetabular fractures are mainly caused by trauma and the incidence is rising in developing countries. Initially these fractures were managed conservatively, due to lack of specialized and dedicated acetabulum surgery centres. Our aim is to study the radiological and functional outcomes of surgical management of acetabular fractures in tertiary care hospital. Materials and Methods Total 50 patients were enrolled. The patients with acetabular fractures were enrolled between the years 2012 to 2014. Patients were evaluated clinically with Harris hip score (HHS) and radiologically with Matta outcome grading. The factors examined include age, gender, fracture pattern, time between injury and surgery, initial displacement and quality of reduction on the final outcome. Results There were 34 males and 16 females. Mean age was 44.20±11.65 years while mean duration of stay was 9.28±2.36 days. Duration of follow-up was 24 months. Most common mechanism of injury was motor vehicle accident (n=37, 74.0%). Open reduction and internal fixation of fractures were performed using reconstruction plates. Mean HHS at 24 months was 82.36±8.55. The clinical outcome was acceptable (excellent or good) in 35 (70.0%) cases and not acceptable (fair or poor) in 15 (30.0%) cases. The radiological outcome was anatomical in 39 (78.0%) cases, congruent in 5 (10.0%) cases, incongruent in 6 (12.0%) cases. Conclusion Study results indicated that mechanism of injury, time between injury and surgery, initial degree of displacement and quality of reduction had significant effect on functional as well as radiological outcome. PMID:28097111

  5. Surgical management of Stenson’s duct injury by using double J stent urethral catheter

    PubMed Central

    Aloosi, Suha N.; Khoshnaw, Najmaddin; Ali, Shakhawan M.; Muhammad, Belal A.

    2015-01-01

    Background Parotid duct or gland injury can be caused by assault with a knife, bottle, electrical-saw, road traffic accident, or rarely gunshot and fractures of the facial skeleton. The injury can be in the form of laceration, ductal exposure, total cutting, or crushing of the duct. These conditions are difficult to diagnose because of complex anatomy and variable forms of the injury. A successful management of parotid duct injuries depends on early diagnosis and appropriate intervention; improper surgery may lead to complications such as sialocele or salivary fistula Case report A 27-years-old man was presented to the maxillofacial unit, complaining of bleeding over the right side of his face after accidental exposure to a chain-saw three hours before admission. On examination, a 6 cm deep lacerated wound was found over the right buccal area, suspecting facial nerve-buccal branch and parotid duct injury. Under general anesthesia the parotid duct injury diagnosed, microsurgical anastomosis of the cut-ends of the parotid duct performed using the double J catheter. Sutures and JJ stent removed seven and twenty postoperative days respectively. After a proper supportive treatment a complete healing of the duct was obtained with normal amount of saliva. Conclusions Herein, we described an easy yet efficient technique in management of parotid duct injury using a JJ stent which is often used for urethra. We think that use of JJ stent is a valuable technique to be used in the diagnosis and surgical repair of the parotid duct during traumatic facial and/or parotid injuries. PMID:26555062

  6. Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint.

    PubMed

    Masters, Kim J; Bellonci, Christopher; Bernet, William; Arnold, Valerie; Beitchman, Joseph; Benson, R Scott; Bukstein, Oscar; Kinlan, Joan; McClellan, Jon; Rue, David; Shaw, Jon A; Stock, Saundra

    2002-02-01

    This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.

  7. Summary of the practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions with special reference to seclusion and restraint.

    PubMed

    Masters, K J; Bellonci, C; Bernet, W; Arnold, V; Beitchman, J; Benson, S; Bukstein, O; Kinlan, J; McClellan, J; Rue, D; Shaw, J A; Stock, S; Kroeger, K

    2001-11-01

    This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.

  8. An aggressive multidisciplinary approach reduces mortality in rhinocerebral mucormycosis

    PubMed Central

    Palejwala, Sheri K.; Zangeneh, Tirdad T.; Goldstein, Stephen A.; Lemole, G. Michael

    2016-01-01

    Background: Rhinocerebral mucormycosis occurs in immunocompromised hosts with uncontrolled diabetes, solid organ transplants, and hematologic malignancies. Primary disease is in the paranasal sinuses but often progresses intracranially, via direct extension or angioinvasion. Rhinocerebral mucormycosis is rapidly fatal with a mortality rate of 85%, even when maximally treated with surgical debridement, antifungal therapy, and correction of underlying processes. Methods: We performed a retrospective chart review of patients with rhinocerebral mucormycosis from 2011 to 2014. These patients were analyzed for symptoms, surgical and medical management, and outcome. We found four patients who were diagnosed with rhinocerebral mucormycosis. All patients underwent rapid aggressive surgical debridement and were started on antifungal therapy on the day of diagnosis. Overall, we observed a mortality rate of 50%. Results: An early aggressive multidisciplinary approach with surgical debridement, antifungal therapy, and correction of underlying disease have been shown to improve survivability in rhinocerebral mucormycosis. Conclusion: A multidisciplinary approach to rhinocerebral mucormycosis with otolaryngology, neurosurgery, and ophthalmology, infectious disease and medical intensivists can help reduce mortality in an otherwise largely fatal disease. Even despite these measures, outcomes remain poor, and a high index of suspicion must be maintained in at-risk populations, in order to rapidly execute a multifaceted approach. PMID:27280057

  9. Variability in the surgical management of carpal tunnel syndrome: implications for the effective use of healthcare resources.

    PubMed

    ElMaraghy, Amr; Devereaux, Moira W

    2009-01-01

    Medicine has been said to be as much art as science, where physicians invoke their individual skills and judgment to address the unique aspects of each presenting patient. Yet to what extent should physicians exercise their own discretion in determining the use rates of hospital resources? This article examines the results of a study on surgeon use of surgical setting and anesthetic technique for carpal tunnel release (CTR) surgery - a simple, low-risk surgical procedure that can be performed in either a formal operating room or a minor surgical setting, using local, regional or general anesthetic. The selected combination of surgical setting and anesthetic technique employed by a surgeon has not been standardized and can significantly impact both patient outcomes and administrative healthcare costs for hospital resources, equipment and pharmaceuticals. While a certain amount of variability in surgical management is necessary to allow clinicians to practise their "art," policy makers have an opportunity to standardize some surgeon practices to control costs, particularly when those practices are found to be as strongly influenced by the subjective attitudes of individual surgeons as by evidence-based science and economics.

  10. Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

    PubMed Central

    2009-01-01

    Background Hospitals have a critically important role in the management of mass causality incidents (MCI), yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations. Methods The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission. Results From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%), pelvic injuries (11.5%), thoracic injuries (5.0%) and major amputations (3.1%). The mean cut to suture time was 130 min (IQR 65-165 min). Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00), ISS ≥ 35 (OR 2,94), hemoglobin level ≤ 8 mg/dL (OR 1,40), pulse rate on hospital admission < 40 or > 120/min (OR 1,39), blood pressure on hospital admission < 90 mmHg (OR 1,35), prehospital infusion volume ≥ 2000 ml (OR 1,34), GCS ≤ 8 (OR 1,32) and anisocoria (OR 1,28) on-scene. Conclusions The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI. PMID:20149987

  11. [Acute extremity ischemia based on the popliteal artery aneurysm thrombosis--combined thrombolytic and surgical management].

    PubMed

    Danek, T; Janousek, R; Havlícek, K

    2006-03-01

    Authors present their experience with combined trombolytic-surgical treatment of acute ischaemia of low extremity based on trombosis of popliteal artery aneurysm. This treatment was performed in three patients. Authors compare results of intraarterial catheter pharmacological trombolysis of infrapopliteal arteries with indirect surgical trombolysis.

  12. [Kocher-Langenbeck approach in the surgical management of posterior wall fractures of the acetabulum].

    PubMed

    Fernández-Palomo, L J

    2016-01-01

    Surgical treatment of acetabular fractures is indicated in displaced cases in order to restore and stabilize the hip joint and the pelvic ring integrity. Posterior structure fractures must be treated through posterior pelvic surgical approaches. The Kocher-Langenbeck is the most recommended approach for the majority of posterior acetabular fractures.

  13. Endoscopic management of patients with post-surgical leaks involving the gastrointestinal tract: A large case series

    PubMed Central

    Caruso, Angelo; Cellini, Carlo; Sica, Mariano; Zullo, Angelo; Mirante, Vincenzo Giorgio; Bertani, Helga; Frazzoni, Marzio; Mutignani, Massimiliano; Galloro, Giuseppe; Conigliaro, Rita

    2016-01-01

    Background Post-surgical anastomotic leaks often require a re-intervention, are associated with a definite morbidity and mortality, and with relevant costs. We described a large series of patients with different post-surgical leaks involving the gastrointestinal tract managed with endoscopy as initial approach. Methods This was a retrospective analysis of prospectively collected cases with anastomotic leaks managed with different endoscopic approaches (with surgical or radiological drainage when needed) in two endoscopic centres during 5 years. Interventions included: (1) over-the-scope clip (OTSC) positioning; (2) placement of a covered self-expanding metal stent (SEMS); (3) fibrin glue injection (Tissucol); and (4) endo-sponge application, according to both the endoscopic feature and patient’s status. Results A total of 76 patients underwent endoscopic treatment for a leak either in the upper (47 cases) or lower (29 cases) gastrointestinal tract, and the approach was successful in 39 (83%) and 22 (75.9%) patients, respectively, accounting for an overall 80.3% success rate. Leak closure was achieved in 84.9% and 78.3% of patients managed by using a single or a combination of endoscopic devices. Overall, leak closure failed in 15 (19.7%) patients, and the surgical approach was successful in all 14 patients who underwent re-intervention, whilst one patient died due to sepsis at 7 days. Conclusions Our data suggest that an endoscopic approach, with surgical or radiological drainage when needed, is successful and safe in the majority of patients with anastomotic gastrointestinal leaks. Therefore, an endoscopic treatment could be attempted before resorting to more invasive, costly and risky re-intervention.

  14. No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study

    PubMed Central

    Farquhar, Jaclyn; Almahrabi, Yahya; Slobogean, Gerard; Slobogean, Bronwyn; Garraway, Naisan; Simons, Richard K.; Hameed, S. Morad

    2016-01-01

    Background Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols. Methods Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols. We compared short- and long-term outcomes between these cohorts. Results Our patient cohorts were well matched for age, sex, injury severity scores and abbreviated injury scores. The nonoperatively managed group had significantly better outcomes than the surgical group in terms of ventilator days (3.1 v. 6.1, p = 0.012), length of stay in the intensive care unit (3.7 v. 7.4 d, p = 0.009), total hospital length of stay (16.0 v. 21.9 d, p = 0.044) and rates of pneumonia (22% v. 63%, p = 0.004). There were no significant differences in long-term outcomes, such as chest pain or dyspnea. Conclusion Although considerable enthusiasm surrounds surgical fixation of flail chest injuries, our analysis does not immediately validate its universal implementation, but rather encourages the use of modern, multidisciplinary, nonoperative strategies. The role of rib fracture fixation in the modern era of chest wall trauma management should ultimately be defined by prospective, randomized trials. PMID:27438051

  15. Prevention and management of postoperative delirium among older patients on an orthopedic surgical unit: a best practice implementation project.

    PubMed

    Sykes, Pamela K

    2012-01-01

    Delirium is an acute state of confusion that is often seen in older patients after major orthopedic surgical procedures. It is associated with increased costs of care, morbidity, delayed functional recovery, and prolonged hospital stay. Identification of predictive risk factors, early diagnosis and treatment, and implementation of environmental controls can minimize the impact of postoperative delirium. This project measured pre- and post intervention compliance with best practice in the prevention and management of postoperative delirium.

  16. Surgical management of cutaneous infection caused by atypical mycobacteria after penetrating injury: the hidden dangers of horticulture.

    PubMed

    Holland, J; Smith, C; Childs, P A; Holland, A J

    1997-02-01

    We identified two patients in a 12-month period who presented with cutaneous infection and secondary lymph node involvement from atypical mycobacterial infection after minor gardening injuries. One patient had a coinfection with Nocardia asteroides. Both patients required multiple surgical interventions, despite appropriate antibiotic therapy, before resolution of the disease. The course of the infection was characterized by chronic relapses with complete healing at 12 to 18 months after the original injury. The identification and management of this clinical problem are reviewed.

  17. A contemporary, single-institutional experience of surgical versus expectant management of congenital heart disease in trisomy 13 and 18 patients.

    PubMed

    Costello, John P; Weiderhold, Allison; Louis, Clauden; Shaughnessy, Conner; Peer, Syed M; Zurakowski, David; Jonas, Richard A; Nath, Dilip S

    2015-06-01

    The objective of this study was to examine a large institutional experience of patients with trisomy 13 and trisomy 18 in the setting of comorbid congenital heart disease and present the outcomes of surgical versus expectant management. It is a retrospective single-institution cohort study. Institutional review board approved this study. Thirteen consecutive trisomy 18 patients and three consecutive trisomy 13 patients (sixteen patients in total) with comorbid congenital heart disease who were evaluated by our institution's Division of Cardiovascular Surgery between January 2008 and December 2013 were included in the study. The primary outcome measures evaluated were operative mortality (for patients who received surgical management), overall mortality (for patients who received expectant management), and total length of survival during follow-up. Of the thirteen trisomy 18 patients, seven underwent surgical management and six received expectant management. With surgical management, operative mortality was 29 %, and 80 % of patients were alive after a median follow-up of 116 days. With expectant management, 50 % of patients died before hospital discharge. Of the three patients with trisomy 13, one patient underwent surgical management and two received expectant management. The patient who received surgical management with complete repair was alive at last follow-up over 2 years after surgery; both patients managed expectantly died before hospital discharge. Trisomy 13 and trisomy 18 patients with comorbid congenital heart disease can undergo successful cardiac surgical intervention. In this population, we advocate that nearly all patients with cardiovascular indications for operative congenital heart disease intervention should be offered complete surgical repair over palliative approaches for moderately complex congenital cardiac anomalies.

  18. [Temporary occlusion in surgical management of intracranial aneurysm. Report of 54 cases].

    PubMed

    Samaha, E; Rizk, T; Nohra, G; Mohasseb, G; Okais, N

    1999-03-01

    Temporary arterial occlusion (TAO) is commonly used in the surgery of intracranial giant aneurysms. Its usefulness and safety in the surgical management of all cases of aneurysms remains to be proved. We report a series of 54 patients operated on for an intracranial aneurysm with the use of TAO. Among the 27 patients, admitted before the 4th day following post subarachnoid hemorrhage with I or II on WFNS score clinically, 24 had early aneurysm surgery. The size of the aneurysm was small in 16 cases, medium in 22, large in 13 and giant in 3 cases. The protocol proposed by Batjer in 1988 for large and giant aneurysms (etomidate, normotention and hypervolemia) was used without any electrophysiological monitoring. All patients underwent a post-operative cerebral CT scan to evaluate the incidence of a cerebral ischemia. Serial transcranial doppler was used to evaluate the severity of vasospasm. Clinical results were assessed using the GOS. TAO was elective in 51 patients and done after peroperative aneurysm rupture in 3 patients. The duration of TAO was less than 5 mn in 25 patients, between 5 and 10 min in 12, between 10 and 15 in 11, between 15 and 20 in 5 and more than 20 min in one patient. The last one developed a reversible neurological deficit secondary to ischemia attribuated to TAO. Intracranial aneurysm peroperative rupture was noted in 3 patients, clinical vasospam in 13 patients. These results allow us to recommend the routine use of TAO in the surgery of intracranial aneurysm. When application time is limited and cerebral protection used, TAO is safe. It decreases the risk of intraoperative rupture from a 18% rate in literature to 4.2% in our present experience and the risk of symptomatic vasospasm is not increased.

  19. Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion

    PubMed Central

    Acosta, Stefan

    2014-01-01

    Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase. Most patients have acute superior mesenteric artery (SMA) occlusion, and a large proportion of these patients will develop peritonitis prior to mesenteric revascularization, and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia, and to perform bowel resections. The establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal revascularization. This review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA occlusion. Explorative laparotomy needs to be performed first. Curative treatment is based upon intestinal revascularization followed by bowel resection. If no vascular imaging has been carried out, SMA angiography is performed. In case of embolic occlusion of the SMA, open embolectomy is performed followed by angiography. In case of thrombotic occlusion, the occlusive lesion can be recanalized retrograde from an exposed SMA, the guidewire snared from either the femoral or brachial artery, and stented with standard devices from these access sites. Bowel resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy, leaving definitive bowel reconstructions to a planned second look laparotomy, according to the principles of damage control surgery. Patients with peritonitis secondary to acute SMA occlusion should be managed by both the general and vascular surgeon, and a hybrid revascularization approach is of utmost importance to improve outcomes. PMID:25110423

  20. Increasing preoperative dislocations and total time of dislocation affect surgical management of anterior shoulder instability

    PubMed Central

    Denard, Patrick J.; Dai, Xuesong; Burkhart, Stephen S.

    2015-01-01

    Purpose: Our purpose was to determine the relationship between number of preoperative shoulder dislocations and total dislocation time and the need to perform bone deficiency procedures at the time of primary anterior instability surgery. Our hypothesis was that need for bone deficiency procedures would increase with the total number and hours of dislocation. Materials and Methods: A retrospective review was performed of primary instability surgeries performed by a single surgeon. Patients with <25% glenoid bone loss were treated with an isolated arthroscopic Bankart repair. Those who also had an engaging Hill-Sachs lesion underwent arthroscopic Bankart repair with remplissage. Patients with >25% glenoid bone loss were treated with Latarjet reconstruction. Number of dislocations and total dislocation time were examined for their relationship with the treatment method. Results: Ten arthroscopic Bankart repairs, 13 arthroscopic Bankart plus remplissage procedures, and 9 Latarjet reconstructions were available for review. Total dislocations (P = 0.012) and total hours of dislocation (P = 0.019) increased from the Bankart, to the remplissage, to the Latarjet groups. Patients with a total dislocation time of 5 h or more were more likely to require a Latarjet reconstruction (P = 0.039). Patients with only 1 preoperative dislocation were treated with an isolated Bankart repair in 64% (7 of 11) of cases, whereas those with 2 or more dislocations required a bone loss procedure in 86% (18 of 21) of cases (P = 0.013). Conclusion: Increasing number of dislocations and total dislocation time are associated with the development of glenoid and humeral head bony lesions that alter surgical management of anterior shoulder instability. The necessity for the addition of a remplissage to an arthroscopic Bankart repair or the use of a Latarjet reconstruction increases with only 1 recurrent dislocation. Level of evidence: Level III, retrospective comparative study. PMID:25709237

  1. Surgical management of maxillary and premaxillary osteomyelitis in a reticulated python (Python reticulatus).

    PubMed

    Latney, La'Toya V; McDermott, Colin; Scott, Gregory; Soltero-Rivera, Maria M; Beguesse, Kyla; Sánchez, Melissa D; Lewis, John R

    2016-05-01

    CASE DESCRIPTION A 1-year-old reticulated python (Python reticulatus) was evaluated because of a 2-week history of wheezing and hissing. CLINICAL FINDINGS Rostral facial cellulitis and deep gingival pockets associated with missing rostral maxillary teeth were evident. Tissues of the nares were swollen, resulting in an audible wheeze during respiration. Multiple scars and superficial facial wounds attributed to biting by live prey were apparent. Radiographic examination revealed bilateral, focal, rostral maxillary osteomyelitis. TREATMENT AND OUTCOME Wound irrigation, antimicrobials, and anti-inflammatory drug treatment resulted in reduced cellulitis. A 3-week regimen that included empirical antimicrobial treatment and improved husbandry resulted in resolution of the respiratory sounds and partial healing of bite wounds, but radiographic evaluation revealed progressive maxillary osteomyelitis. Microbial culture of blood yielded scant gram-positive cocci and Bacillus spp, which were suspected sample contaminants. Bilateral partial maxillectomies were performed; microbial culture and histologic examination of resected bone confirmed osteomyelitis with gram-positive cocci. Treatment with trimethoprim-sulfamethoxazole was initiated on the basis of microbial susceptibility tests. Four months later, follow-up radiography revealed premaxillary osteomyelitis; surgery was declined, and treatment with trimethoprim-sulfamethoxazole was reinstituted. Eight months after surgery, the patient was reevaluated because of recurrent clinical signs; premaxillectomy was performed, and treatment with trimethoprim-sulfamethoxazole was prescribed on the basis of microbial culture of bone and microbial susceptibility testing. Resolution of osteomyelitis was confirmed by CT 11 months after the initial surgery. CONCLUSIONS AND CLINICAL RELEVANCE Focal maxillectomies and premaxillectomy were successfully performed in a large python. Surgical management and appropriate antimicrobial treatment

  2. The surgical management of osteochondroma on the ventral surface of the scapula.

    PubMed

    Fageir, Mazin M; Edwards, Max R; Addison, Anthony K

    2009-11-01

    Hereditary multiple exostosis is an autosomal dominant disorder characterized by the formation of multiple cartilaginous osteochondromata in the immature skeleton. Indications for operative intervention include mechanical dysfunction of a joint or tendon relating to the size of the lesion, and sarcomatous change. Ventral scapular osteochondromas have been reported to cause mechanical symptoms and should be considered as a differential to a 'winged' scapula. The surgical treatment of such lesions has not widely been reported in the orthopaedic literature. We report the surgical treatment of two osteochondroma from the ventral surface of the scapula in a 16-year-old girl. Preoperative evaluation, imaging, surgical technique and outcome are discussed. Ventral scapular osteochondroma can be successfully treated using the straightforward surgical technique described.

  3. Long-term outcome after surgical and endovascular management of true and false subclavian artery aneurysms.

    PubMed

    Zehm, Sarah; Chemelli, Andreas; Jaschke, Werner; Fraedrich, Gustav; Rantner, Barbara

    2014-06-01

    Subclavian artery aneurysm is a rare but serious disease due to the risk of thrombosis, embolization, rupture and compression of adjacent structures. Treatment consists of surgical and endovascular techniques. Up to now few long-term follow-up results have been reported. In our study the results from 15 patients treated for subclavian artery aneurysms were evaluated. Eleven patients underwent open surgical reconstruction, four patients were treated endovascularly. After a mean follow-up period of 77 months (83 months for the open surgical group, 38 months for the endovascular group), 10 of 11 open surgical reconstructions and all primarily implanted stent grafts were patent. Secondary intervention was necessary in two patients. Thirty-day mortality for both treatment groups was 0%. Subclavian artery aneurysm-related symptoms disappeared in six out of 10 patients after the treatment. Long-term outcomes with good technical results, patency rates and low periprocedural morbidity could be shown in both treatment groups.

  4. Surgical management of Gorlin syndrome: a 4-decade experience using local excision technique.

    PubMed

    Griner, Devan; Sutphin, Daniel; Sargent, Larry A

    2015-04-01

    Basal cell nevus syndrome (aka Gorlin syndrome, Gorlin-Goltz syndrome, nevoid basal cell carcinoma syndrome, and fifth phacomatosis) is a rare but well-described autosomal dominant condition with variable penetrance. We present a female patient who has been successfully treated using local surgical excision and diligent skin surveillance for more than 4 decades, demonstrating that simple local incision is an efficacious and reasonable surgical alternative that may circumvent the specialization and expense of Mohs technique.

  5. Surgical and traumatic wound infections, cellulitis, and myositis in horses.

    PubMed

    Adam, Emma N; Southwood, Louise L

    2006-08-01

    Surgical site infections (SSIs) and traumatic wound management remain challenging clinical scenarios. The prevention of SSIs involves meticulous surgical technique and aftercare. Traumatic wounds require thorough evaluation to assess the involvement of synovial structures and radiographs to check for fractures. Chronic wounds can require a biopsy and histologic evaluation to obtain a diagnosis, because many underlying pathologic processes grossly appear similar but different treatment regimens are required. Early recognition and diagnosis of cellulitis and myositis enable the rapid aggressive intervention necessary for a positive outcome. Any delay in diagnosis and treatment increases the complication and mortality rates and makes these conditions difficult to treat successfully.

  6. Surgical management of scalp arterio-venous malformation and scalp venous malformation: An experience of eleven cases

    PubMed Central

    Chowdhury, Forhad Hossain; Haque, Mohammod Raziul; Kawsar, Khandkar Ali; Sarker, Mainul Haque; Momtazul Haque, A. F. M.

    2013-01-01

    Aims: Scalp arterio-venous malformation (AVM) and scalp venous malformation (SVM) are rare conditions that usually need surgical treatment. Here, we have reported our experience of the surgical management of such lesions with a short review of the literature. Materials and Methods: In this prospective study, 11 patients with scalp AVM and SVM, who underwent surgical excision of lesion in our hospital from 2006 to 2012, were included. All suspected high-flow AVM were investigated with the selective internal and external carotid digital subtraction angiogram (DSA) ± computed tomography (CT) scan of brain with CT angiogram or magnetic resonance imaging (MRI) of brain with MR angiogram, and all suspected low-flow vascular malformation (VM) was investigated with MRI of brain + MR angiogram. Eight were high-flow and three were low-flow VM. Results: All lesions were successfully excised. Scalp cosmetic aspects were acceptable in all cases. There was no major post-operative complication or recurrence till last follow-up. Conclusions: With preoperative appropriate surgical planning, scalp AVM and SVM can be excised without major complication. PMID:23960313

  7. Surgical management of morbidity due to lymphatic filariasis: the usefulness of a standardized international clinical classification of hydroceles.

    PubMed

    Capuano, G P; Capuano, C

    2012-03-01

    The objective of this work is to evaluate the usefulness of a standardized clinical classification of hydroceles in lymphatic filariasis endemic countries to guide their surgical management. 64 patients with hydroceles were operated in 2009-2010, in Level II hospitals (WHO classification), during two visits to Fiji, by the same mobile surgical team. The number of hydroceles treated was 83. We developed and evaluated a much needed clinical classification of hydroceles based on four criteria: Type (uni/bilateral); Side (left/right); Stage of enlargement of the scrotum rated from I to VI; Grade of burial of the penis rated from 0 to 4. It lead to the conclusion that 1) A Stage I or II hydrocele, associated with Grade 0 or 1 penis burial could be considered a "Simple Hydrocele". The surgical treatment is simple with no anticipated early complication. WHO Level II of health care structure seems adapted. 2) A Stage III or IV hydrocele associated with Grade 2, 3 or 4 penis burial could be considered a "Complicated Hydrocele". The operation is longer, more complicated and the possibility of occurrence of complications seems greater. A level III health care facility would be more adapted under the normal functioning of the health system. We conclude that a standardized clinical classification of hydroceles based on the Stage of enlargement of the scrotum and the Grade of burial of the penis appears to be a useful tool to guide the decision about the level of care and the surgical technique required. We use the same classification for penoscrotal lymphoedema. A decision tree is presented for the management of hydroceles in lymphatic filariasis endemic countries which could usefully complement the "Algorithm for management of scrotal swelling" proposed by WHO in 2002. An international classification system of hydroceles would also allow standardization and facilitate study design and comparisons of their results.

  8. Oesophageal trauma: incidence, diagnosis, and management.

    PubMed Central

    Triggiani, E; Belsey, R

    1977-01-01

    The clinical manifestations, diagnosis, and surgical treatment of 110 cases of oesophageal trauma, admitted under the care of one surgical team between 1949 and 1973, are reviewed. The importance of early diagnosis and an aggressive surgical approach in the management of a potentially lethal situation are stressed. In our opinion, spontaneous rupture of the oesophagus, instrumental perforation, open and closed traumatic lesions, and postoperative anastomotic leaks are, as far as diagnosis and management are concerned, different aspects of the same desperate surgical problem. Oesophageal trauma is accompanied by a high morbidity and mortality rate if diagnosis and treatment are delayed. Perforations of the cervical oesophagus may be treated conservatively. Intrathoracic perforations demand an aggressive surgical appraoch; only exteriorisation followed by reconstruction at a later date offers a reasonable chance to save the life of the patient and ultimately restore continuity. PMID:882938

  9. Surgical Brain Metastases: Management and Outcome Related to Prognostic Indexes: A Critical Review of a Ten-Year Series

    PubMed Central

    Caroli, Manuela; Di Cristofori, Andrea; Lucarella, Francesca; Raneri, Fabio Angelo; Portaluri, Francesco; Gaini, Sergio Maria

    2011-01-01

    Brain metastasis are the most common neoplastic lesions of the nervous system. Many cancer patients are diagnosed on the basis of a first clinical presentation of cancer on the basis of a single or multiple brain lesions. Brain metastases are manifestations of primary disease progression and often determine a poor prognosis. Not all patients with a brain metastases undergo surgery: many are submitted to alternative or palliative treatments. Management of patients with brain metastases is still controversial, and many studies have been developed to determine which is the best therapy. Furthermore, management of patients operated for a brain metastasis is often difficult. Chemotherapy, stereotactic radiosurgery, panencephalic radiation therapy, and surgery, in combination or alone, are the means most commonly used. We report our experience in the management of a ten-year series of surgical brain metastasis and discuss our results in the preoperative and postoperative management of this complex condition. PMID:22084749

  10. Aggression on inpatient units: Clinical characteristics and consequences.

    PubMed

    Renwick, Laoise; Stewart, Duncan; Richardson, Michelle; Lavelle, Mary; James, Karen; Hardy, Claire; Price, Owen; Bowers, Len

    2016-08-01

    Aggression and violence are widespread in UK Mental Health Trusts, and are accompanied by negative psychological and physiological consequences for both staff and other patients. Patients who are younger, male, and have a history of substance use and psychosis diagnoses are more likely to display aggression; however, patient factors are not solely responsible for violence, and there are complex circumstances that lead to aggression. Indeed, patient-staff interactions lead to a sizeable portion of aggression and violence on inpatient units, thus they cannot be viewed without considering other forms of conflict and containment that occur before, during, and after the aggressive incident. For this reason, we examined sequences of aggressive incidents in conjunction with other conflict and containment methods used to explore whether there were particular profiles to aggressive incidents. In the present study, 522 adult psychiatric inpatients from 84 acute wards were recruited, and there were 1422 incidents of aggression (verbal, physical against objects, and physical). Cluster analysis revealed that aggressive incident sequences could be classified into four separate groups: solo aggression, aggression-rule breaking, aggression-medication, and aggression-containment. Contrary to our expectations, we did not find physical aggression dominant in the aggression-containment cluster, and while verbal aggression occurred primarily in solo aggression, physical aggression also occurred here. This indicates that the management of aggression is variable, and although some patient factors are linked with different clusters, these do not entirely explain the variation.

  11. Surgical management and follow-up of lateral skull base tumors: An 8-year review

    PubMed Central

    Kong, Jie; Yang, Hong-Yu; Wang, Yu-Fan; Yang, Hui-Jun; Shen, Shi-Yue; Wang, Feng

    2017-01-01

    The purpose of the present article was to describe the diagnostic evaluation of, and surgical approaches to, lateral skull base tumors (LSBTs). The study is a retrospective review of 21 patients diagnosed with tumors that involve lateral skull base (8 with malignant diseases and 13 with benign lesions) who were surgically treated during a 8-year period. The transparotid-transmandibular (38%) was the most commonly performed surgical procedure, followed by the transmandibular (24%), the transmaxillary (24%), the transcervical approach (10%) and the combined approach (4%). The surgical procedures were uneventful and there were no postoperative mortalities. Complications were encountered in 12 cases, and morbidity was not remarkable during the perioperative stages. After an average follow-up of 46 months, only 1 of 14 patients with benign diseases had a recurrence following the resection of a pleomorphic adenoma. Of 7 patients with malignant tumors, 5 are alive with no evidence of disease. The majority of the benign lateral skull base tumors can be removed surgically with a low rate of complications and recurrence. However, malignant neoplasms carry a poor prognosis and a low rate of disease-free survival. PMID:28357097

  12. Conservative Surgical Management of Stage I Bisphosphonate-Related Osteonecrosis of the Jaw

    PubMed Central

    Vescovi, Paolo; Merigo, Elisabetta; Meleti, Marco; Manfredi, Maddalena; Nammour, Samir; Mergoni, Giovanni; Bagan, Jose V.

    2014-01-01

    Purpose. To report the efficacy of conservative surgical treatment for stage I bisphosphonate-related osteonecrosis of the jaw (BRONJ). Materials and Methods. This study reports the clinical outcomes of 63 patients treated for BRONJ stage I (according to Ruggiero's staging system) at the Oral Pathology and Laser-Assisted Surgery Unit of the University of Parma between January 2004 and January 2011. Surgical interventions were performed, under local analgesia, in patients unresponsive for a period of six months to noninvasive treatments such as cycles of local or systemic antibacterial therapy combined or not to low level laser therapy, ozone therapy, or Hyperbaric Oxygen Therapy. All interventions were performed after the consultation of oncologist or physician. Results. In our experience, conservative surgical treatment is associated with the highest number of BRONJ healed sites in stage I disease. Complete healing was observed in 92.6% of sites surgically treated. Conclusions. This study confirms that treatment of patients affected by minimal bone exposition, (stage I of BRONJ), through conservative surgical strategies, possibly with laser, may result in a high control of the disease in the long term. PMID:24648841

  13. Transiliac Osteotomy in Surgical Management of Pelvic Post-Traumatic Malunions

    PubMed Central

    Lu, Shun; Wu, Junwei; Fu, Baisheng; Dong, Jinlei; Yang, Yongliang; Xin, Maoyuan; Wang, Guodong; He, Tong-Chuan; Zhou, Dongsheng

    2016-01-01

    Abstract While uncommon, post-traumatic pelvic malunions present reconstructive challenges and are associated with significant disability and financial burden. A transiliac osteotomy is a surgical technique useful to correct certain types of pelvic fracture malunions, and is only used when the correction of a limb-length discrepancy is the primary goal. This study aims to present our experience with this technique in the treatment of post-traumatic pelvic malunions. Eight patients who underwent transiliac osteotomies for post-traumatic pelvic malunions at our department from 2006 to 2011 were included in this study. We reviewed the clinical and radiographic results of these patients. By the time of their last follow-up, all osteotomy sites and iliac bone graft had healed with no evidence of internal fixation failure. Of the 3 patients who complained of preoperative posterior pain, 2 reported an improvement. All 8 patients noted the resolution of their lower back pain. At the time of their final follow-up, 4 patients could walk normally, 2 had a slight limp without a cane, 1 patient used a cane to help with standing and walking, and the final felt limited during ambulation with a cane. Limb-lengthening relative to preoperative measurements was 2.86 cm (2.2–3.0 cm) at the time of the last follow-up. Two patients were able to return to their previous jobs, 4 patients changed their jobs or engaged in light manual labor while the final 2 were able to perform activities of daily living but were unable to participate in work or labor. Three patients reported being “extremely satisfied” with their outcomes, 3 were “satisfied,” and 2 were “unsatisfied.” A transiliac osteotomy can be used to manage selected cases of post-traumatic pelvic malunions that are unable to be corrected with a traditional release and osteotomy. However, in these cases the correction of limb-length discrepancies should be the primary reconstructive goal. PMID:27043674

  14. A proposed algorithm for multimodal liver trauma management from a surgical trauma audit in a western European trauma center.

    PubMed

    Di Saverio, S; Sibilio, A; Coniglio, C; Bianchi, E; Biscardi, A; Villani, S; Gordini, G; Tugnoli, G

    2014-11-01

    Management of liver trauma is challenging and may vary widely given the heterogeneity of liver injuries' anatomical configuration, the hemodynamic status, the settings and resources available. Perhaps the use of non-operative management (NOM) may have potential drawbacks and the role of damage control surgery (DCS) and angioembolization represents a major evolving concept.1 Most severe liver trauma in polytrauma patients accounts for a significant morbidity and mortality. Major liver trauma with extensive parenchymal injury and uncontrollable bleeding is therefore a challenge for the trauma team. However a safe and effective surgical hemostasis and a carefully planned multidisciplinary approach can improve the outcome of severe liver trauma. The technique of perihepatic packing, according to DCS approach, is often required to achieve fast, early and effective control of hemorrhage in the highest grades of liver trauma and in unstable patients. A systematic and standardized technique of perihepatic packing may contribute to improve hemostatic efficacy and overall outcomes if wisely combined in a stepwise "sandwich" multimodal approach. DCS philosophy evolved alongside with damage control resuscitation (DCR) in the management of trauma patients, requiring close interaction between surgery and resuscitation. Therefore, as a result of a combined surgical and critical care clinical audit activity in our western European trauma center, a practical algorithm for multimodal sequential management of liver trauma has been developed based on a historical cohort of 253 liver trauma patients and subsequently validated on a prospective cohort of 135 patients in the period 2010-2013.

  15. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle

    PubMed Central

    Schade, Valerie L.; Andersen, Charles A.

    2015-01-01

    Acute Charcot neuroarthropathy of the foot and ankle presents with the insidious onset of a unilateral acutely edematous, erythematous, and warm lower extremity. The acute stages are typically defined as Eichenholtz Stage 1, or Stage 0, which was first described by Shibata et al. in 1990. The ultimate goal of treatment is maintenance of a stable, plantigrade foot which can be easily shod, minimizing the risk of callus, ulceration, infection, and amputation. The gold standard of treatment is non-weight-bearing immobilization in a total contact cast. Surgical intervention remains controversial. A review of the literature was performed to provide an evidenced-based approach to the conservative and surgical management of acute Charcot neuroarthropathy of the foot and ankle. PMID:25795102

  16. Interpositional carotid artery bypass strategies in the surgical management of aneurysms and tumors of the skull base.

    PubMed

    Liu, James K; Couldwell, William T

    2003-03-15

    Cerebral revascularization is an important component in the surgical management of complex skull base tumors and aneurysms. Patients who harbor complex aneurysms that cannot be clipped directly and in whom parent vessel occlusion cannot be tolerated may require cerebrovascular bypass surgery. In cases in which skull base tumors encase the carotid artery (CA) and a resection is desired, a cerebrovascular bypass may be necessary in planned CA occlusion or sacrifice. In this review the authors discuss options for performing high-flow anterograde interposition CA bypass for lesions of the skull base. The authors review three important bypass techniques involving saphenous vein grafts: the cervical-to-petrous internal carotid artery (ICA), petrous-to-supraclinoid ICA, and cervical-to-supraclinoid ICA bypass. These revascularization techniques are important tools in the surgical treatment of complex aneurysms and tumors of the skull base and cavernous sinus.

  17. Novel surgical management of spinal adhesive arachnoiditis by arachnoid microdissection and ventriculo-subarachnoid shunting.

    PubMed

    Mitsuyama, Tetsuryu; Asamoto, Shunji; Kawamata, Takakazu

    2011-12-01

    Spinal cord tethering and cerebrospinal fluid (CSF) flow disturbance are two major features in the pathophysiology of spinal adhesive arachnoiditis. We hypothesized that insufficient CSF supply to the surgically untethered spinal cord may be one of the causes of the typical post-operative recurrent extensive lesion. We report a patient with extensive spinal adhesive arachnoiditis, who was successfully treated using a novel surgical technique consisting of two procedures. First, microdissection of the thickened adherent arachnoid was performed to resolve spinal cord tethering. Next, a ventriculo-subarachnoid shunt was placed to provide sufficient flow of CSF. Clinical improvement was sustained for at least 22 months after surgery. The present surgical procedure may improve clinical outcome in patients with longitudinally extensive spinal adhesive arachnoiditis.

  18. Surgical management of fibrotic encapsulation of the fluocinolone acetonide implant in CAPN5-associated proliferative vitreoretinopathy

    PubMed Central

    Tlucek, Paul S; Folk, James C; Sobol, Warren M; Mahajan, Vinit B

    2013-01-01

    Objective To review fibrosis of fluocinolone acetonide (FA) implants in subjects with CAPN5 autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV). Methods A retrospective case series was assembled from ADNIV patients in which there was fibrotic encapsulation of a fluocinolone acetonide implant. CAPN5 genotypes and surgical repair techniques were reviewed. Results Two eyes of two ADNIV patients developed a fibrotic capsule over the fluocinolone acetonide implant. Both patients had Stage IV disease. Patient A had a c.731T > C mutation in the CAPN5 gene and patient B had a c.728G > T mutation. The fibrotic membrane was surgically excised and the implant function was restored. Conclusion The exuberant fibrotic response in later stages of ADNIV may be resistant to local immunosuppression with steroids. Surgical excision of fibrotic membranes over FA implants can reestablish local steroid delivery in cases of severe proliferative vitreoretinopathy. PMID:23785231

  19. Surgical management of maxillomandibular advancement in sleep apnea patients: specific technical considerations.

    PubMed

    Gilon, Y; Raskin, S; Heymans, O; Poirrier, R

    2001-01-01

    Maxillomandibular advancement is an integral part of the surgical treatment of patients suffering from obstructive sleep apnea. A number of publications report its efficacy and have attempted to define predictive success criteria. However, few authors have shown an interest in the surgical specificity of this intervention and in the difficulties that can be encountered, which differ from those seen in conventional orthognathic surgery. In this article, a series of patients treated with maxillomandibular osteotomy to correct obstructive sleep apnea syndrome (n = 17) are compared with patients who underwent surgery for the correction of dentofacial disharmonies (n = 33). Observations emphasized the importance of respecting a strict surgical and postsurgical protocol to avoid any technical traps linked to maxillomandibular advancement, both in preoperative simulations and during and after surgery. Results concerning sleep parameters will be the subject of a future publication.

  20. Hair epilation versus surgical excision as primary management of pilonidal disease in the pediatric population.

    PubMed

    Bütter, Andreana; Hanson, Melissa; VanHouwelingen, Lisa; Merritt, Neil; Seabrook, Jamie

    2015-06-01

    Pilonidal disease is a chronic, acquired inflammatory process of the skin due to entrapped hair at the natal cleft. Reported recurrence rates are as high as 30%, and recurrence has been attributed to persistent hair near the surgical site. Although conservative measures, such as meticulous hair control and improved perineal hygiene, have been shown to be effective, these techniques typically require much effort on behalf of the patient. Laser hair epilation (LE) might solve this issue of poor patient compliance while helping patients to avoid surgical excision. In this article, we discuss recurrence rates of pilonidal disease in children treated with LE versus surgical excision in relation to findings from our institution between 2005 and 2013 as well as patient satisfaction with the treatment method.

  1. An MRP system for surgical linen management at a large hospital.

    PubMed

    O'Neill, L; Murphy, M; Gray, D; Stoner, T

    2001-02-01

    Materials Requirements Planning (MRP) has been used extensively in manufacturing and other industries to improve on-time delivery and to reduce costs. In this paper, we illustrate how an MRP-type system was developed to monitor surgical linen at a large teaching hospital. We also describe a bar-code scanning 'tag and recapture' study to estimate total inventory. The hospital implemented several changes based upon our recommendations that resulted in time savings and a smoother flow of materials throughout the surgical linen supply chain.

  2. Surgical Management of Musculoskeletal Injuries after 2015 Nepal Earthquake: Our Experience

    PubMed Central

    Vaishya, Raju; Vijay, Vipul; Hussaini, Mustafa; Singh, Harsh

    2015-01-01

    We report our experience of handling 80 major musculoskeletal injuries in a brief span of three days immediately after the major earthquake of Nepal in April 2015. Planning, proper utilization of resources, and prioritizing the patients for surgical intervention is highlighted. The value of damage control by orthopaedics in these disasters is discussed. Timely and appropriate surgical treatment by a skilled orthopaedic team not only can save these injured limbs but also the lives of the victims of a major disaster. PMID:26430580

  3. 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 ...

  4. 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 ...

  5. 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.

  6. Bilateral ureteric obstruction during in vitro fertilisation therapy in a patient with complex surgically managed Crohn's disease.

    PubMed

    Khoo, Christopher Charles; Ahluwalia, Nikhil; Grace, Jan; Sahai, Arun

    2016-11-24

    A 37-year-old woman receiving in vitro fertilisation (IVF) treatment presented with lethargy, fevers and anuria. Her background included complex surgically managed Crohn's disease and mild right-sided hydronephrosis (with no evidence of obstruction on MAG3 renogram). On examination, she had a distended abdomen with generalised tenderness. Blood tests revealed an acute kidney injury and confirmed sepsis. She was found to have bilateral ureteric obstruction with worsening of the right-sided hydronephrosis and new-onset left-sided hydronephrosis secondary to bilateral ovarian masses, diagnosed as mild ovarian hyperstimulation syndrome (OHSS). She was initially managed with fluid resuscitation, bilateral nephrostomies, antibiotics and supportive management of mild OHSS. She made a good recovery and was discharged after placement of antegrade stents and removal of nephrostomies. On follow-up, following resolution of ovarian hyperstimulation, she has been diagnosed with a right-sided distal ureteric stricture and is awaiting reconstruction. Her left ureteric stent has been removed.

  7. Surgical management of giant Brunner's gland hamartoma: case report and literature review

    PubMed Central

    Stewart, Zoe A; Hruban, Ralph H; Fishman, Elliot F; Wolfgang, Christopher L

    2009-01-01

    Brunner's gland hamartomas (BGH) are uncommon benign tumors of the duodenum forming mature Brunner's glands. We report here an unusual case of a giant BGH that was not amenable to endoscopic or surgical local resection thus requiring a pancreaticoduodenectomy for extirpation. The relevant literature is discussed. PMID:19725968

  8. Differences in Surgical Management of Corneal Perforations, Measured over Six Years

    PubMed Central

    Krysik, Katarzyna; Lyssek-Boron, Anita; Jankowska-Szmul, Judyta; Wylegala, Edward A.

    2017-01-01

    Purpose. To report the surgical approach, anatomical and functional results, and complications in the group of patients with corneal perforation. Materials and Methods. 247 eyes with corneal perforation were operated on between January 2010 and July 2016. The three surgical procedures, dependent on size and location of perforation, were performed: full-sized penetrating keratoplasty, corneoscleral patch graft, and anterior lamellar keratoplasty. The eyes underwent the minimum 6-month follow-up visit. Results. Between January 2010 and July 2016, 247 surgeries were performed: 116 penetrating keratoplasties, 117 corneoscleral patch grafts, and 14 anterior lamellar keratoplasties. More than one procedure was necessary in 32 eyes. Final improvement of the visual acuity, within a gain of 2 or more lines with the Snellen test, was achieved in 56 operated eyes. To achieve better final visual acuity, 75 eyes required successive surgical treatment. Complications of the surgery comprised persistent epithelial defect, glaucoma or ocular hypertension, corneal oedema, graft melting, loose corneal sutures, reinfection, anterior synechiae and fibrinoid membranes, and endophthalmitis. In 26 eyes, the treatment failure was reported. Conclusions. There is no one general-purpose surgical technique to treat corneal perforations. The complex nature of this pathology remains the individual, careful but also very distinct and multifactorial approach. PMID:28326192

  9. Correlation Between Femoral Neck Shaft Angle and Surgical Management in Trainees With Femoral Neck Stress Fractures.

    PubMed

    Chalupa, Robyn L; Rivera, Jessica C; Tennent, David J; Johnson, Anthony E

    2016-01-01

    The most common overuse injury leading to medical discharge of military recruits is a stress fracture. One of the high-risk stress fractures is of the lateral femoral neck which risks osteonecrosis of the femoral head, the need for arthroplasty and permanent disability. To prevent fracture progression early surgical intervention is recommended. Surgical repairs are performed in about 25% of cases of femoral neck stress fractures at military treatment facilities. Hip geometry is an important intrinsic risk for stress fractures. Loads in the average loading direction will not cause a fracture, but loads of extreme magnitude or extreme orientation may. The purpose of this study was to determine if, in the presence of femoral neck stress fracture, there is a correlation between femoral neck shaft angle, surgical treatment and outcomes. The results of this study suggest there is no correlation between return to full military duty rates, treatment, femoral neck shaft angle or fracture grade on MRI. Patients who underwent surgical fixation had greater fracture grade and pain than those that did not have surgery. Individuals who did not return to duty tended to have higher pain scores at initial evaluation.

  10. Surgical management of pleomorphic adenoma of parotid gland in elderly patients: role of morphological features.

    PubMed

    Guerra, Germano; Testa, Domenico; Montagnani, Stefania; Tafuri, Domenico; Salzano, Francesco Antonio; Rocca, Aldo; Amato, Bruno; Salzano, Giovanni; Dell'Aversana Orabona, Giovanni; Piombino, Pasquale; Motta, Gaetano

    2014-01-01

    The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the Pleomorphic adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly these tumors occur mostly in females. These benign tumors are composed of epithelial and myoepithelial cells that are arranged with various morphological patterns and subtypes. The classification of these tumors is also based on the amount and nature of the stroma. In literature there is an almost complete consensus that, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called "capsule" but there is disagreement about the form, extension and thickness of this layer. The treatment is surgical and there are two main different surgical approaches: an enucleation (local dissection) or so-called subtotal superficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristics of PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules and pseudopodia in the different subtypes are important for the choice of surgical treatment and the first explanation for tumor recurrence. In our study we describe a morphological features of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by a surgical "enucleation like" method called nucleoresection.

  11. Late outcomes for the surgical management of absent pulmonary valve syndrome in infants

    PubMed Central

    Hu, Renjie; Zhang, Haibo; Xu, Zhiwei; Liu, Jinfen; Su, Zhaokang; Ding, Wenxiang

    2013-01-01

    OBJECTIVES Absent pulmonary valve syndrome (APVS) is a rare cardiac malformation that is usually associated with aneurysmal dilatation of pulmonary arteries and respiratory distress. The surgical mortality of neonates and infants with APVS has decreased tremendously, from 60% in 1980s to 10–20% recently. This study retrospectively reviews surgical outcomes of our 10-year experience in patients with APVS. METHODS From 2002 to 2012, 42 patients with APVS underwent surgical correction. Thirty-seven patients had APVS as a variant of tetralogy of Fallot, 4 with double outlet right ventricle and 1 with ventricular septal defect. Respiratory distress was present in 12 infants. Four patients needed continuous positive airway pressure and 5 required intubation with mechanical ventilation before surgery. RESULTS There was no hospital death and 3 late deaths. The mean follow-up time was 62.71 ± 34.31 months. Significant differences were found in the duration of postoperative ventilation between patients with or without respiratory distress (P = 0.009) and patients with left or right aortic arch (P = 0.012). The Kaplan–Meier curve indicated that overall survival at 5 and 10 years was 92.4%. The survival rates between patients with or without respiratory distress were 72.7 and 100%, respectively (P = 0.003). Overall mortality was associated with longer cardiopulmonary bypass time (P = 0.004) and lower weight at operation (P = 0.042). There were no significant differences in survival and postoperative data such as the duration of ventilation or intensive care unit stay and New York Heart Association class among the three methods of right ventricular outflow tract (RVOT) reconstruction. CONCLUSIONS Surgical treatment of APVS has got favourable outcomes in terms of mortality and reoperation rate. Different methods of RVOT reconstruction do not affect the surgical outcome. Patients required long-term follow-up for postoperative respiratory complications secondary to persistent

  12. Pancreatic fistula following pancreatoduodenectomy. Evaluation of different surgical approaches in the management of pancreatic stump. Literature review.

    PubMed

    Conzo, G; Gambardella, C; Tartaglia, E; Sciascia, V; Mauriello, C; Napolitano, S; Orditura, M; De Vita, F; Santini, L

    2015-09-01

    Pancreatoduodenectomy is the gold standard operation for malignant and benign diseases of the pancreas and periampullary region. Even if improvements in intensive care management and surgical technique have dramatically reduced postoperative mortality after pancreatic surgery, morbidity remains high (30-50%), also in specialized pancreatic units. In order to reduce postoperative complications, particularly pancreatic fistula, different surgical techniques and their modifications have been proposed. In order to determine the better management of the pancreatic stump after pancreatoduodenectomy, the Authors analysed and compared derivative - pancreaticojejunal, pancreaticogastrostomy - vs no-derivative technique - pancreatic stump closure (duct ligation or mechanical suture, duct occlusion by fibrin glue or cyanoacrylate). A systematic research of the English literature, including major meta-analysis articles, clinical randomized trials, retrospective studies and systematic reviews was performed, analysing the risk factors and the incidence of short-medium term postoperative complications. Up to now, even if derivative procedures are preferred as gold standard the best method to deal a pancreatic stump is still controversial and remains matter of research. Pancreatic surgeons must have more than one technique for managing the pancreatic remnant.

  13. Surgical Management of Pseudophakic Malignant Glaucoma via Anterior Segment-Peripheral Iridectomy Capsulo-Hyaloidectomy and Anterior Vitrectomy

    PubMed Central

    Basgil Pasaoglu, Isıl; Altan, Cigdem; Bayraktar, Sukru; Satana, Banu; Basarir, Berna

    2012-01-01

    Purpose. To describe our surgical technique in the management of pseudophakic malignant glaucoma refractory to conventional treatment. Methods. Two pseudophakic eyes with malignant glaucoma underwent peripheral iridectomy, lens capsulectomy, hyaloidectomy, and anterior vitrectomy through a clear corneal incision by using a vitreous cutter. Results. Prompt resolution of malignant glaucoma was achieved in both cases and no recurrence was observed during postoperative followup of five months. Conclusions. An anterior segment surgeon can treat pseudophakic malignant glaucoma successfully by using a vitreous cutter inserted through a corneal incision and performing peripheral iridectomy, capsulo-hyaloidectomy, and anterior vitrectomy. PMID:23097730

  14. Novel anaesthetic approach for surgical access and haemodynamic management during off-pump coronary artery bypass through a left thoracotomy.

    PubMed

    Maddali, Madan Mohan; Al-Jadidi, Abdullah M; Zacharias, Sunny

    2012-01-01

    For myocardial revascularization on a beating heart through a thoracotomy, a properly deployed endobronchial blocker (EBB) provides ideal conditions for surgical access. In addition, adequate volume replacement to achieve optimal cardiac performance is a primary goal of haemodynamic management in patients undergoing off-pump coronary artery bypass grafting. To achieve both these ends, this case report describes the combined use of a left-sided EBB along with a volumetric pulmonary artery catheter in a patient who underwent a successful off-pump coronary artery bypass surgery through an anterolateral thoracotomy.

  15. Joint issues – conflicts of interest, the ASR hip and suggestions for managing surgical conflicts of interest

    PubMed Central

    2014-01-01

    Background Financial and nonfinancial conflicts of interest in medicine and surgery are troubling because they have the capacity to skew decision making in ways that might be detrimental to patient care and well-being. The recent case of the Articular Surface Replacement (ASR) hip provides a vivid illustration of the harmful effects of conflicts of interest in surgery. Discussion We identify financial and nonfinancial conflicts of interest experienced by surgeons, hospitals and regulators in the ASR case. These conflicts may have impacted surgical advice, decision-making and evidence gathering with respect to the ASR prosthesis, and contributed to the significant harms experienced by patients in whom the hip was implanted. Drawing on this case we explore shortcomings in the standard responses to conflicts of interest – disclosure and recusal. We argue disclosure is necessary but by no means sufficient to address conflicts of interest. Using the concept of recusal we develop remedies including second opinions and third party consent which may be effective in mitigating conflicts, but their implementation introduces new challenges. Summary Deployment of the ASR hip is a case of surgical innovation gone wrong. As we show, there were multiple conflicts of interest involved in the introduction of the ASR hip into practice and subsequent attempts to gloss over the mounting body of evidence about its lack of safety and effectiveness. Conflicts of interest in surgery are often not well managed. We suggest strategies in this paper which can minimise the conflicts of interest associated with surgical innovation. PMID:25128372

  16. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery

    PubMed Central

    Ahn, Soon-Hyun; Hong, Hyun Jun; Kwon, Soon Young; Kwon, Kee Hwan; Roh, Jong-Lyel; Ryu, Junsun; Park, Jun Hee; Baek, Seung-Kuk; Lee, Guk Haeng; Lee, Sei Young; Lee, Jin Choon; Chung, Man Ki; Joo, Young Hoon; Ji, Yong Bae; Hah, Jeong Hun; Kwon, Minsu; Park, Young Min; Song, Chang Myeon; Shin, Sung-Chan; Ryu, Chang Hwan; Lee, Doh Young; Lee, Young Chan; Chang, Jae Won; Jeong, Ha Min; Cho, Jae-Keun; Cha, Wonjae; Chun, Byung Joon; Choi, Ik Joon; Choi, Hyo Geun; Lee, Kang Dae

    2017-01-01

    Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers. PMID:28043099

  17. Management of surgical splenorenal shunt-related hepatic myelopathy with endovascular interventional techniques.

    PubMed

    Wang, Mao-Qiang; Liu, Feng-Yong; Duan, Feng

    2012-12-21

    We present a case with hepatic myelopathy (HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques. A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt. A portal venogram identified a widened patent splenorenal shunt. We used an occlusion balloon catheter initially to occlude the shunt. Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength. We then used an Amplatzer vascular plug (AVP) to enable closure of the shunt. During the follow up period of 7 mo, the patient experienced significant clinical improvement and normalization of blood ammonia, without any complications. Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.

  18. The role of radionuclide imaging in the surgical management of primary hyperparathyroidism.

    PubMed

    Hindié, Elif; Zanotti-Fregonara, Paolo; Tabarin, Antoine; Rubello, Domenico; Morelec, Isabelle; Wagner, Tristan; Henry, Jean-François; Taïeb, David

    2015-05-01

    Primary hyperparathyroidism is a frequent and potentially debilitating endocrine disorder for which surgery is the only curative treatment. The modalities of parathyroid surgery have changed over the last 2 decades, as conventional bilateral neck exploration is no longer the only surgical approach. Parathyroid scintigraphy plays a major role in defining the surgical strategy, given its ability to orient a targeted (focused) parathyroidectomy and to recognize ectopic locations or multiglandular disease. This review, which represents a collaborative effort between nuclear physicians, endocrinologists, and endocrine surgeons, emphasizes the importance of performing imaging before any surgery for primary hyperparathyroidism, even in the case of conventional bilateral neck exploration. We discuss the advantages and drawbacks of targeted parathyroidectomy and the performance of various scintigraphic protocols to guide limited surgery. We also discuss the optimal strategy to localize the offending gland before reoperation for persistent or recurrent hyperparathyroidism. Finally, we describe the potential applications of novel PET tracers, with special emphasis on (18)F-fluorocholine.

  19. DIAGNOSIS AND MEDICAL AND SURGICAL MANAGEMENT OF CHRONIC INFECTIOUS FIBRINOUS PLEURITIS IN AN OKAPI (OKAPIA JOHNSTONI).

    PubMed

    Franzen, Dana; Lamberski, Nadine; Zuba, Jeffery; Richardson, G Lynn; Fischer, A T; Rantanen, Norman W

    2015-06-01

    A 10-yr-old female okapi (Okapia johnstoni) at the San Diego Zoo Safari Park was evaluated for intermittent malaise, inappetence, occasional cough, abdominal splinting, and licking at both flanks. Physical examination revealed tachypnea, tachycardia, and fluid sounds on thoracic auscultation. Transthoracic ultrasound showed multiple uniform, anechoic filled structures in the right and left pleural space. Surgical exploration of the thoracic cavity revealed bilateral, mature, fibrous, compartmentalizing adhesions between the visceral and parietal pleura, confirming a diagnosis of chronic, infectious, fibrinous pleuritis. The suspected etiology was occult aspiration pneumonia secondary to historical episodes of regurgitation associated with general anesthesia. Culture of the pleural fluid and fibrous adhesions grew Trueperella (Arcanobacterium) pyogenes, Arcanobacterium haemolyticum, and few Fusobacterium species. Treatment consisted of chest-tube placement to establish drainage, thoracic lavage, unilateral surgical debridement, and long-term antibiotics. The animal made a complete clinical recovery over 7 mo.

  20. Motion Sensors to Assess and Monitor Medical and Surgical Management of Parkinson Disease.

    PubMed

    Lieber, Bryan; Taylor, Blake E S; Appelboom, Geoff; McKhann, Guy; Connolly, E Sander

    2015-08-01

    Patients with Parkinson disease (PD) often suffer from a resting tremor, bradykinesia, rigidity, postural instability, and gait difficulty. Determining a patient's candidacy for deep-brain stimulation (DBS) surgery and tracking their clinical response postoperatively requires that the frequency, duration, and severity of these symptoms be characterized in detail. Conventional means of assessing these symptoms, however, rely heavily on patient self-reporting, which often fails to provide the necessary level of detail. Wearable accelerometers are a novel tool that can detect and objectively characterize these movement abnormalities in both the clinical setting and the patient's home environment. In this article, we review the role of accelerometers in surgical candidate selection, recording and predicting falls, recording and predicting freezing of gait, evaluating surgical outcomes, and evaluating postoperative recovery and in altering DBS settings. Although accelerometry has yet to make it into the mainstream clinic, there is great promise for this technology in monitoring Parkinson patients.

  1. Posttraumatic progressive cubitus varus deformity managed by lateral column shortening: A novel surgical technique.

    PubMed

    Srivastava, Amit; Jain, Anil-Kumar; Dhammi, Ish Kumar; Haq, Rehan-Ul

    2016-08-01

    The outward angulation of elbow with supinated forearm is cubitus varus deformity. This deformity is often seen as sequelae of malunited supracondylar fracture of humerus in paediatric age group of 5e8 years. The deformity is usually non-progressive, but in cases of physeal injury or congenital bony bar formation in the medial condyle of humerus, the deformity is progressive and can be grotesque in appearance. Various types of osteotomies are defined for standard non-progressive cubitus varus deformity, while multiple surgeries are required for progressive deformity until skeletal maturity. In this study we described a novel surgical approach and osteotomy of distal humerus in a 5 years old boy having grotesque progressive cubitus varus deformity, achieving good surgical outcome.

  2. A Rare Case of Endolymphatic Sac Tumour: Clinicopathologic Study and Surgical Management

    PubMed Central

    Ferri, Emanuele; Amadori, Maurizio; Armato, Enrico; Pavon, Ida

    2014-01-01

    Objective. Endolymphatic sac tumor (ELST) is a rare neoplasm arising from the intrapetrous portion of the endolymphatic sac, either isolated or in association with the von Hippel-Lindau disease. We report a sporadic case of ELST with an overview of the literature and a discussion of clinic-radiological, histopathologic, and surgical findings. Case Report. A young woman presented with a progressive hearing loss in the left ear. Otoscopy showed a reddish, bleeding hypotympanic mass. CT demonstrated an expansile lytic mastoid lesion extending to the middle ear, with bone erosion. MRI confirmed a lesion of increased signal on T1-weighted sequences. The patient underwent a canal wall-down tympanoplasty with complete removal of the tumor. Histopathology was consistent with a papillary ELST. Immunohistochemistry was positive for cytokeratin and chromogranin A. Conclusion. This paper highlights the rarity of ELST, the need for an accurate neuroradiological and immunohistochemical study at the early stages, and the timeliness of surgical treatment. PMID:24991442

  3. Hypertrophic Cardiomyopathy (HCM): How Flow Analysis May Drive Medical Management and Surgical Approach

    NASA Astrophysics Data System (ADS)

    Abraham, Theodore P.

    2011-11-01

    Hypertrophic Cardiomyopathy (HCM) is the most common inherited heart disease and occurs in 1 in 500 persons worldwide regardless of race, age and gender. It is the most common cause of sudden death in the young and also causes heart failure and cardiac arrhythmias. The primary anatomic abnormality is thickening of certain walls, or sometimes global thickening of the left or right ventricle. The patterns of thickening along with increased ventricular stiffness lead to suboptimal ventricular filling and inefficient ejection of blood from the ventricle. Treatment for HCM can be medical or surgical. The choice of therapy is driven by the presence and severity of outflow obstruction. Flow analysis could provide sophisticated information about outflow and inflow ventricular dynamics. These flow dynamics features may enable better medical choices and provide information that would allow superior surgical planning. Associate Professor of Medicine & Director, Hypertrophic Cardiomyopathy Clinic

  4. Diagnosis and surgical management of flexor digitorum accessorius longus-induced tarsal tunnel syndrome.

    PubMed

    Wittmayer, Brian C; Freed, Lewis

    2007-01-01

    The flexor digitorum accessorius longus is a rare muscular occurrence in the lower extremity. It has been reported as an etiology of tarsal tunnel syndrome through prior case reports. By means of individual case study, we revisit flexor digitorum accessorius longus as a cause of tarsal tunnel syndrome. This case study discusses diagnosis along with surgical treatment of tarsal tunnel syndrome induced by the presence of flexor digitorum accessorius longus.

  5. [Surgical safety cheklist at the management of the hybrid operating room].

    PubMed

    Cherkashin, M A; Berezina, N A; Kuplevatsky, V I; Serov, A V; Mefodovsky, A A

    2016-01-01

    An essential aspect of the work of the operating room is the provision of safety of both the patient and staff. The organization of the activity of the surgical service requires serious elaboration of each of its stage, as well as standardization in using various validated instruments. When speaking of a hybrid operating room with the use of intraoperative magnetic resonance tomography, such an approach becomes not merely a recommendation but rather forced and justified necessity. Simultaneous use of various technologies of imaging and treatment with the engagement of physicians of various specialties requires especially thorough control. A generally accepted international standard of the work of the operating block is the use of checklists, and since 2008 the initiative of the World Health Organization "Safe Surgery Saves Lives" has globally been working to promote implementation of the WHO Surgical Safety Checklists (SSCL) to the real clinical practice. The intraoperative MR-diagnostic stage dictates rigid requirements for proper inventory of ferromagnetic and nonmagnetic surgical tools, verified logistics, and routing of the patient in the conditions of high and extremely high (1.5-3.0 T) magnetic field. A separate and not less important problem is anaesthesiological support during MRT. In order to optimise the patient's movements and adequate monitoring of his/her safety inside the operating department, the authors have modified the standard WHO Surgical Safety Checklist. Implementation of the modified checklist for the MRT-equipped hybrid operating room should improve the control over the processes, as well as increase safety of both the patient and personnel.

  6. Management of Oro-antral Communication and Fistula: Various Surgical Options

    PubMed Central

    Khandelwal, Pulkit; Hajira, Neha

    2017-01-01

    Oro-antral communication and fistula can occur as a result of inadequate and improper treatment. Inadvertent communication with the maxillary sinus can occur during certain surgical procedures in the maxillary posterior region. Though, spontaneous healing may occur in defects which are smaller than 2 mm but larger communications require immediate attention and should be treated without delay, in order to avoid sinusitis and further complications leading to patient discomfort. PMID:28289607

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

    PubMed

    Monroe, Heidi; Plylar, Peggy; Krugman, Mary

    2014-01-01

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

  8. Surgical management of Eagle's syndrome: an approach to shooting craniofacial pain.

    PubMed

    Kumai, Yoshihiko; Hamasaki, Tadashi; Yumoto, Eiji

    2016-10-01

    Eagle's syndrome (ES) and glossopharyngeal neuralgia (GPN) display very similar symptoms preoperatively. The objective of this study is to determine the surgical outcome of intraoral resection of the styloid process (IRSP) for ES, and to observe preoperative findings and treatment outcome of our cases presenting shooting craniofacial pain. In total, 14 symptomatic patients who presented with typical shooting craniofacial pain, had a styloid process longer than 25 mm, and underwent surgical intervention or medication alone from 2011 to 2015 were involved. They were divided into two groups: Group I included eight patients who underwent surgery following 3 months of medication failure, and Group II included six patients who received medication alone. Preoperative physical, radiographic findings and surgical outcomes were examined. In Group I patients, six cases received IRSP and five of those six cases experienced complete relief from symptoms and were confirmed as ES. Two other cases in Group I received microvascular decompression. One showed complete relief from symptoms, and was confirmed as GPN. The other case showed recurrence 1 year postoperatively, received IRSP with complete relief from symptoms, and was confirmed as ES. In Group II, three cases experienced complete relief from symptoms with 3 months of medication alone. IRSP is an effective treatment for ES. There was no clear difference in the preoperative findings for ES and GPN, suggesting the difficulty in making a preoperative differential diagnosis between the two conditions. Close cooperation between ENT and neurosurgery surgeons is needed.

  9. Results of surgical management in 92 consecutive patients with Zollinger-Ellison syndrome.

    PubMed

    Bonfils, S; Landor, J H; Mignon, M; Hervoir, P

    1981-12-01

    Hospital records and follow-up information on 92 patients with surgically proven Zollinger-Ellison syndrome have been reviewed, and data relating to symptomatology, age and sex incidence, pathologic findings, and early and late results of surgical procedures have been summarized. The postoperative mortality rate was 15%, and was adversely affected by previous peptic ulcer surgery, by the necessity of urgent operation for complications of peptic ulcer, and by employment of a procedure that failed to control acid secretion. Thirteen patients were found to have primary gastrinomas of the duodenum and an additional 13 patients had islet cell hyperplasia without evidence of frank neoplasm; prognosis in these two groups appears to be particularly favorable. Despite the current availability of effective nonoperative measures for control of gastric hypersecretion, surgical exploration is warranted in all patients to determine location and extent of tumor and to attempt to control the ulcer diathesis by resection of tumor. Long-term therapy with H2 receptor antagonists is advised for patients whose hypersecretory state has not been alleviated by tumor resection or whose gastrinoma cannot be removed. Total gastrectomy is still indicated in patients whose tumors are not amenable to resection and who are resistant to, or cannot follow, a rigid medical regimen.

  10. Results of surgical management in 92 consecutive patients with Zollinger-Ellison syndrome.

    PubMed Central

    Bonfils, S; Landor, J H; Mignon, M; Hervoir, P

    1981-01-01

    Hospital records and follow-up information on 92 patients with surgically proven Zollinger-Ellison syndrome have been reviewed, and data relating to symptomatology, age and sex incidence, pathologic findings, and early and late results of surgical procedures have been summarized. The postoperative mortality rate was 15%, and was adversely affected by previous peptic ulcer surgery, by the necessity of urgent operation for complications of peptic ulcer, and by employment of a procedure that failed to control acid secretion. Thirteen patients were found to have primary gastrinomas of the duodenum and an additional 13 patients had islet cell hyperplasia without evidence of frank neoplasm; prognosis in these two groups appears to be particularly favorable. Despite the current availability of effective nonoperative measures for control of gastric hypersecretion, surgical exploration is warranted in all patients to determine location and extent of tumor and to attempt to control the ulcer diathesis by resection of tumor. Long-term therapy with H2 receptor antagonists is advised for patients whose hypersecretory state has not been alleviated by tumor resection or whose gastrinoma cannot be removed. Total gastrectomy is still indicated in patients whose tumors are not amenable to resection and who are resistant to, or cannot follow, a rigid medical regimen. PMID:7030236

  11. Wire internal fixation: an obsolete, yet valuable method for surgical management of facial fractures

    PubMed Central

    Bouletreau, Pierre; Konsem, Tarcissus; Traoré, Ibraïma; Coulibaly, Antoine Toua; Ouédraogo, Dieudonné

    2014-01-01

    In some developing countries wire is still widely used in facial fractures internal fixation. This study presents the effectiveness and complications of wire osteosynthesis in a university teaching hospital in Burkina Faso and discusses some of its other benefits and disadvantages. Notes of 227 patients with facial fractures treated by wire internal fixation at department of stomatology and maxillofacial surgery of CHU Souro Sanou, Burkina Faso between 2006 and 2010 are reviewed retrospectively. A satisfactory treatment outcome was recorded in 91.2% of the 227 patients. Complications occurred in 8.8% of the patients who had operative site infection (3.1%), malocclusion (1.8%), sensory disturbance (1.8), facial asymmetry (1.3%), delayed bone union (0.9%) or enophtalmos (0.4%). The overall complications rate was 7.4% after mandibular osteosynthesis, 6.9% after Le Fort osteosynthesis and 6.5% after zygoma osteosynthesis. Post operative infections occurred irrespective to the surgical site. The other complications were more specific to the surgical site. Wire internal fixation may be a reasonable alternative for the surgical treatment of non-comminuted facial fractures and those without bone substance loss, in the setting of limited resources. PMID:25237416

  12. Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression.

    PubMed Central

    Langmayr, J J; Ortler, M; Dessl, A; Twerdy, K; Aichner, F; Felber, S

    1995-01-01

    Spinal cord compression due to extradural and subdural haemorrhage is a neurosurgical emergency. Differences in clinical presentation in relation to localisation of the haematoma, value of MRI as a diagnostic tool, surgical treatment, and prognosis were investigated in a retrospective case series of eight patients with extradural (n = four) and subdural (n = four) haematomas. Results of MRI were compared with operative findings and proved to be of high sensitivity in defining the type of bleeding and delineating craniocaudal extension and ventrodorsal location. Surgical treatment by decompressive laminectomy, haematoma evacuation, and postoperative high dose corticosteroids resulted in resolution of symptoms in five patients and improvement in the clinical situation in two patients. One patient with a chronic subdural haematoma had a second operation because of arachnoidal adhesions. One patient presented with a complete cord transection syndrome due to an acute subdural haematoma and remained paraplegic. It is concluded that prompt, reliable, and non-invasive diagnosis by MRI leads to efficient surgical treatment and a favourable outcome in this rare condition. Images PMID:7561928

  13. Subscapularis Transthoracic Versus Posterolateral Approaches in the Surgical Management of Upper Thoracic Tuberculosis

    PubMed Central

    Lin, Bin; Shi, Ji-Sheng; Zhang, Hai-Shen; Xue, Chao; Zhang, Bi; Guo, Zhi-Min

    2015-01-01

    Abstract The objective of the present study was to evaluate the clinical, radiological, and functional outcomes of a subscapularis transthoracic surgical approach and a posterolateral surgical approach with debridement, bone graft fusion, and internal fixation for the treatment of upper thoracic tuberculosis. There is currently debate over the best surgical approach for the treatment of upper thoracic tuberculosis. Traditionally, the subscapularis transthoracic approach has been preferred; however, the posterolateral approach has gained popularity in the past few years. A prospective, consecutive cohort of 43 upper thoracic tuberculosis patients with a mean age of 39 years (range: 20–52 years) was followed up for a minimum of 12 months (range: 12–60 months). Patients were randomly divided into 2 groups. Group A (n = 21) was treated by the subscapularis transthoracic approach and group B (n = 22) was treated by the posterolateral approach. All cases were evaluated for clinical, radiological, and functional outcomes. Intraoperative blood loss, operative duration, intraoperative and postoperative complications, hospital stay, the cure rate, fusion time, and the Frankel scale were used for clinical and functional evaluation, whereas the kyphosis angle was used for radiological evaluation. Grafted bones were fused by 10 months in all cases. There was no statistically significant difference between groups before surgery in terms of gender, age, segmental tuberculosis, erythrocyte sedimentation rate (ESR), Frankel scale, or Cobb's angle (P > 0.05). The average operative duration for Group B was lower than that of Group A. There were no significant differences in intraoperative blood loss, intraoperative and postoperative complications, hospital stay, grafted bone fusion time, or cure rate between groups (P > 0.05). The Cobb's angle correction rate for group B (68.5%) was significantly better than that of group A (30.9%). The neurological score showed

  14. 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. ...

  15. Complete Surgical Excision Is Essential for the Management of Patients With Breast Implant–Associated Anaplastic Large-Cell Lymphoma

    PubMed Central

    Clemens, Mark W.; Medeiros, L. Jeffrey; Butler, Charles E.; Hunt, Kelly K.; Fanale, Michelle A.; Horwitz, Steven; Weisenburger, Dennis D.; Liu, Jun; Morgan, Elizabeth A.; Kanagal-Shamanna, Rashmi; Parkash, Vinita; Ning, Jing; Sohani, Aliyah R.; Ferry, Judith A.; Mehta-Shah, Neha; Dogan, Ahmed; Liu, Hui; Thormann, Nora; Di Napoli, Arianna; Lade, Stephen; Piccolini, Jorge; Reyes, Ruben; Williams, Travis; McCarthy, Colleen M.; Hanson, Summer E.; Nastoupil, Loretta J.; Gaur, Rakesh; Oki, Yasuhiro; Young, Ken H.

    2016-01-01

    Purpose Breast implant–associated anaplastic large-cell lymphoma (BI-ALCL) is a rare type of T-cell lymphoma that arises around breast implants. The optimal management of this disease has not been established. The goal of this study is to evaluate the efficacy of different therapies used in patients with BI-ALCL to determine an optimal treatment approach. Patients and Methods In this study, we applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, including 50 previously reported in the literature and 37 unreported. A Prentice, Williams, and Peterson model was used to assess the rate of events for each therapeutic intervention. Results The median and mean follow-up times were 45 and 30 months, respectively (range, 3 to 217 months). The median overall survival (OS) time after diagnosis of BI-ALCL was 13 years, and the OS rate was 93% and 89% at 3 and 5 years, respectively. Patients with lymphoma confined by the fibrous capsule surrounding the implant had better event-free survival (EFS) and OS than did patients with lymphoma that had spread beyond the capsule (P = .03). Patients who underwent a complete surgical excision that consisted of total capsulectomy with breast implant removal had better OS (P = .022) and EFS (P = .014) than did patients who received partial capsulectomy, systemic chemotherapy, or radiation therapy. Conclusion Surgical management with complete surgical excision is essential to achieve optimal EFS in patients with BI-ALCL. PMID:26628470

  16. Combined surgical and endovascular management of a giant fusiform PCA aneurysm in a pediatric patient. A case report.

    PubMed

    Shin, S H; Choi, I S; Thomas, K; David, C A

    2013-06-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

  17. Comparison by objective parameters in patients with chronic rhinosinusitis managed medically and surgically (with and without powered instruments)

    PubMed Central

    Behera, Samarendra; Patro, Sourabha K.; Gupta, Ashok K.

    2016-01-01

    Objective: To compare mucociliary clearance time and quality of life in patients who underwent sinus surgery using conventional and powered instruments, and in patients who were treated nonsurgically. Methods: A total of 151 patients with chronic rhinosinusitis were included. Fifty-four patients were treated conservatively, 48 patients were managed surgically by using conventional instruments and 49 patients were managed by using a microdebrider. Kupferberg nasal endoscopy grades, 20-item Sino-Nasal Outcome Test scores, Lund-Mackay scores, and mucociliary clearance time were analyzed. Results: On comparison among the groups, it was found that there was a significant difference between group A (nonsurgically treated) compared with group B (surgery by conventional means) or group C (surgery with microdebrider) in nasal endoscopic grades, Lund-Mackay scores, 20-item Sino-Nasal Outcome Test scores, and mucociliary clearance time. However, in comparison between groups B and C, there was no statistically significant difference. Conclusion: Mucociliary clearance time tended to recover after starting treatment for chronic rhinosinusitis both after conservative treatment and after surgical treatment. Surgery provided better improvement in different objective scores in chronic rhinosinusitis. There exists no statistical difference in parameters independent of the instrument used for surgery. PMID:28107141

  18. Manual ventilation therapy and aggressive potassium supplementation in the management of respiratory failure secondary to severe hypokalaemia in a cat with exocrine pancreatic insufficiency.

    PubMed

    Daste, Thomas; Dossin, Olivier; Reynolds, Brice S; Aumann, Marcel

    2014-04-01

    A domestic shorthair cat was referred for progressive muscle weakness and dyspnoea. The cat had a 2-month history of severe weight loss, small intestinal diarrhoea, polyphagia and polyuria/polydipsia. Biochemical analysis and venous blood gas evaluation revealed severe hypokalaemia [1.7 mmol/l; reference interval (RI): 3.5-5.1 mmol/l] and hypoventilation (partial pressure of carbon dioxide = 68 mmHg; RI: 34-38 mmHg). Aggressive potassium supplementation was initiated. The cat was manually ventilated until serum potassium increased to 3 mmol/l. A diagnosis of exocrine pancreatic insufficiency (EPI) was made based on clinical signs and serum feline trypsin-like immunoreactivity (0.1 μg/l; RI: 12-82 μg/l). Medical management of the EPI resulted in clinical recovery.

  19. A comparison of the effectiveness of a game informed online learning activity and face to face teaching in increasing knowledge about managing aggression in health settings.

    PubMed

    McKenzie, Karen

    2013-12-01

    The present study compared the impact of face to face teaching with a short online game informed learning activity on health participants' knowledge about, and confidence in, managing aggressive situations. Both forms of teaching resulted in a significant increase in participants' knowledge and confidence. Face to face training led to significantly greater increases in knowledge but was equivalent in terms of confidence. Both forms of teaching were rated positively, but face to face teaching received significantly higher ratings than the online activity. The study suggests that short online game informed learning activities may offer an effective alternative for health professional training where face to face training is not possible. Further research is needed on the longer term impact of both types of training on practice.

  20. A UK wide cohort study describing management and outcomes for infants with surgical Necrotising Enterocolitis

    PubMed Central

    Allin, Benjamin; Long, Anna-May; Gupta, Amit; Knight, Marian; Lakhoo, Kokila; Kazmierski, Marcin; Kenny, Simon; Lopes, Joana; Cusick, Eleri; Parsons, Gilian; McCabe, Amanda; Upadhyaya, Manasvi; Walker, Gregor; Coppi, Paulo De; Besarovic, Sania; Thakkar, Hemanshoo; Tullie, Lucinda; Sutcliffe, Jonathan; Eradi, Bala; Ross, Andrew; Maphango, Nomsa; Motiwale, Sandeep; Salloum, Adnan; Pardy, Caroline; Waly, Ramy; Charlesworth, Paul; Craigie, Ross; Lall, Anupam; Lindley, Richard; Johal, Navroop; Njere, Ike; Mortell, Alan; Nandi, Bip; Jones, Abigail; Fouad, Dina; tan, Yew-Wei; Kufeji, Dorothy; Stanwell, Joanna; Lakshminarayanan, Bhanu; Burge, David; Wetherill, Charlotte; Niyogi, Anindya; Parsons, Chris; Doyle, Miriam; Turner, Alex; Yardley, Ian; Shrestha, Ram; Mullassery, Dhanya; Paramalingham, Saravankumar; Ragazzi, Simone

    2017-01-01

    The Royal College of Surgeons have proposed using outcomes from necrotising enterocolitis (NEC) surgery for revalidation of neonatal surgeons. The aim of this study was therefore to calculate the number of infants in the UK/Ireland with surgical NEC and describe outcomes that could be used for national benchmarking and counselling of parents. A prospective nationwide cohort study of every infant requiring surgical intervention for NEC in the UK was conducted between 01/03/13 and 28/02/14. Primary outcome was mortality at 28-days. Secondary outcomes included discharge, post-operative complication, and TPN requirement. 236 infants were included, 43(18%) of whom died, and eight(3%) of whom were discharged prior to 28-days post decision to intervene surgically. Sixty infants who underwent laparotomy (27%) experienced a complication, and 67(35%) of those who were alive at 28 days were parenteral nutrition free. Following multi-variable modelling, presence of a non-cardiac congenital anomaly (aOR 5.17, 95% CI 1.9–14.1), abdominal wall erythema or discolouration at presentation (aOR 2.51, 95% CI 1.23–5.1), diagnosis of single intestinal perforation at laparotomy (aOR 3.1 95% CI 1.05–9.3), and necessity to perform a clip and drop procedure (aOR 30, 95% CI 3.9–237) were associated with increased 28-day mortality. These results can be used for national benchmarking and counselling of parents. PMID:28128283

  1. Clinical Features and Surgical Management of Spinal Osteoblastoma: A Retrospective Study in 18 Cases

    PubMed Central

    Hou, Shuxun; Mao, Ningfang; Yu, Shunzhi; Hou, Tiesheng

    2013-01-01

    Objectives To investigate the clinical manifestation and surgical outcome of spinal osteoblastoma. Methods From June 2006 to July 2011, 18 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 11 males and 7 females with an average age of 27.5 years(range, 16-38 years). The tumors were located at C5 in 7, C6 in 6, C7 in 3, C6-T1 1 in 1 and T11 in 1. Based on WBB classification, 16 were 1-3 or 10-12 and 2 were 4-9 and 1-3. 18 operations had been performed with en bloc resection. A posterior approach was used for 16 patients, and a combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 13 patients. We used visual analogue scales (VAS) to evaluate the change of pain before and after the operation, and the McCormick System to assess functional status of the spine. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones. Results All cases were followed up for 24-80 months (average, 38.4 months). The average surgical time was 120.8 minutes (range, 80-220 minutes), with the average intraoperative blood loss of 520 ml (range, 300-1200 ml). During the follow-up period, the VAS grade reduced from 6.46±1.32 to 2.26±1.05 (P <0.05). 15 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up. Conclusions Spinal osteoblastoma has its own specific radiographic features. There is some recurrence in simple curettage of tumor lesion. The thoroughly en bloc resection of tumor or spondylectomy, bone fusion and strong in Ter fixation are the key points for successful surgical treatment. PMID:24058612

  2. Surgical management of high cervical disc prolapse associated with basilar invagination--two case reports.

    PubMed

    Goel, Atul; Phalke, Umesh; Cacciola, Francesco; Muzumdar, Dattatraya

    2004-03-01

    C3-4 cervical disc prolapse was associated with basilar invagination and short neck in a 21-year-old man and additionally with an extensive Klippel-Feil abnormality and fusion of multiple cervical vertebrae in a 32-year-old man. The transoral surgical route was adopted for cervical discectomy in the latter case and an additional odontoidectomy in the former case. Interbody plate and screw fixation was carried out in the patient with Klippel-Feil abnormality. Both the patients were relieved of symptoms and remained asymptomatic at follow up. Simultaneous fixation procedure is not mandatory after transoral surgery in patients with basilar invagination.

  3. Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma

    PubMed Central

    Coskun, H. Hakan; Medina, Jesus E.; Robbins, K. Thomas; Silver, Carl E.; Strojan, Primož; Teymoortash, Afshin; Pellitteri, Phillip K.; Rodrigo, Juan P.; Stoeckli, Sandro J.; Shaha, Ashok R.; Suçrez, Carlos; Hartl, Dana M.; de Bree, Remco; Takes, Robert P.; Hamoir, Marc; Pitman, Karen T.; Rinaldo, Alessandra; Ferlito, Alfio

    2016-01-01

    Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach. PMID:24623715

  4. [High risk infective endocarditis embolism during pregnancy: Medical or surgical management?].

    PubMed

    Echeverría, Luis Eduardo; Figueredo, Antonio; Gómez, Juan Carlos; Salazar, Leonardo Alberto; Rodriguez, Jaime Alberto; Pizarro, Camilo Ernesto; Riaño, Carlos Eduardo; Perroni, Addy; Cuadros, Alba Lucía; Villamizar, María Cristina; Suárez, Edwin Uriel

    2013-01-01

    A 22-year-old pregnant woman was seen at 14 weeks of pregnancy for infective endocarditis with a vegetation of 15 mm and wide mobility, which affected the native mitral valve accompanied by severe valvular insufficiency. Antibiotic treatment was given for 4 weeks despite the embolism risk. Due to persistence of vegetation size and after considering the fetal and maternal risk, the surgical procedure was favored. We decided to perform valvuloplasty and removal of lesion at 18 weeks of pregnancy. Fetal protection techniques were used and a bioprosthesis was placed before attempting a repair. The postoperative follow-up was satisfactory, achieving a successful birth by cesarean section at 30 weeks.

  5. Staged approach for surgical management of external iliac vein aneurysm associated with traumatic femoral arteriovenous fistula.

    PubMed

    Vasquez, Julio C; Montesinos, Efrain; DeLarosa, Jacob; Leon, Juan J

    2009-12-01

    Aneurysms of the iliac vein are rare. They can occur in association with arteriovenous fistulae located elsewhere. Here, we present a 30-year-old man who developed a large left external iliac vein aneurysm in association with a chronic traumatic arteriovenous fistula in the left thigh. Less than 25 cases of iliac vein aneurysms have been reported in the last 40 years. The presentation and treatment of this condition has been heterogeneous. We suggest that adequate surgical treatment can be offered in a staged approach: aneurysm resection with reconstruction should be done first, followed by closure of the arteriovenous fistula 6 months later.

  6. Surgical Management of Giant Genital Condyloma Acuminata by Using Double Keystone Flaps

    PubMed Central

    Mochtar, Chaidir A.; Hamid, Agus Rizal A. H.; Sukasah, Chaula L.

    2016-01-01

    Condyloma acuminata in the external genitalia (genital warts) is a sexually transmitted disease that is often caused by human papillomavirus (HPV). We report a case of giant genital condyloma acuminata in a 35-year-old male patient with HIV comorbidity treated by wide surgical excision. Excision defect was covered with split thickness skin graft (STSG) and double keystone flaps. There was no complication after surgery. Ten months following surgery, there was no new condyloma lesion and the patient had normal voiding and erectile functions. PMID:27974988

  7. Normative influences on aggression in urban elementary school classrooms.

    PubMed

    Henry, D; Guerra, N; Huesmann, R; Tolan, P; VanAcker, R; Eron, L

    2000-02-01

    We report a study aimed at understanding the effects of classroom normative influences on individual aggressive behavior, using samples of 614 and 427 urban elementary school children. Participants were assessed with measures of aggressive behavior and normative beliefs about aggression. We tested hypotheses related to the effects of personal normative beliefs, descriptive classroom norms (the central tendency of classmates' aggressive behavior), injunctive classroom normative beliefs (classmates' beliefs about the acceptability of aggression), and norm salience (student and teacher sanctions against aggression) on longitudinal changes in aggressive behavior and beliefs. injunctive norms affected individual normative beliefs and aggression, but descriptive norms had no effect on either. In classrooms where students and teachers made norms against aggression salient, aggressive behavior diminished over time. Implications for classroom behavior management and further research are discussed.

  8. The role of electron microscopy in the management of surgical patients.

    PubMed Central

    Kuzela, D C; True, L D; Eiseman, B

    1982-01-01

    This report records a 12-month experience with 49 neoplasms submitted to the hospital pathologists for electron microscopic (EM) diagnosis as a part of routine clinical surgical practice. Twenty-five specimens were from a private community hospital and 24 from a university hospital. In 40 of 49 cases (82%), EM confirmed a tentative light microscopic (LM) diagnosis. In 11 of these 40 cases, EM provided a more specific histogenetic diagnosis than was possible by LM. In three cases (6%), EM corrected the original LM diagnosis. In two cases EM did resolve a diagnostic dilemma. EM is a beneficial adjunct to the correct diagnosis of selected tumors. Although in general EM does not help differentiate benign from malignant tumors, it is helpful in identifying the cell of origin of poorly differentiated neoplasma. A more precise histogenetic diagnosis was judged to be clinically helpful in 56% of th cases studied in this experience. EM is a relatively inexpensive ($115-250) and prompt (three to five days) adjunct to surgical care. It should be routinely available to the practicing surgeon for help in determining the cell type of confusing tumors. EM is no longer simply a research tool. Images Fig. 1a. Fig. 1b. Fig. 2a. Fig. 2b. Fig. 3a. Fig. 3b. Fig. 4a. Fig. 4b. Fig. 5a. Fig. 5b. Fig. 6a. Fig. 6b. Fig. 7a. Fig. 7b. PMID:7055377

  9. [Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures].

    PubMed

    Cazeneuve, J F; Leborgne, J M; Kermad, K; Hassan, Y

    2002-12-01

    Reflex sympathetic dystrophy is a major complication following surgical treatment of fractures of the distal radius. Its pathogenesis is related to lipid peroxidation which damages vascular endothelial cells, increasing capillary permeability. Vitamin C is a natural antioxidant. The authors have made a comparative study of two groups of patients with isolated closed displaced fractures of the distal radius, which were reduced and stabilized by intrafocal pinning. Group 1 included 100 patients who were treated from 1995 until 1998 and who did not receive any vitamin C supplementation; group 2 included 95 patients who were treated from 1999 to 2002 and who received daily administration of one gram vitamin C orally during 45 days, starting on the day of fracture. The incidence of reflex sympathetic dystrophy was five time times lower in group 2 (2.1% versus 10%). This is in line with previous observations and lends credit to the value of vitamin C administration as a prophylactic measure to prevent the occurrence of reflex sympathetic dystrophy in patients who undergo surgical treatment of a displaced fracture of the distal radius.

  10. Optimal Surgical Management of Severe Ischemic Mitral Regurgitation: To Repair or to Replace?

    PubMed Central

    Perrault, Louis P.; Moskowitz, Alan J.; Kron, Irving L.; Acker, Michael A.; Miller, Marissa A.; Horvath, Keith A.; Thourani, Vinod H.; Argenziano, Michael; D'Alessandro, David A.; Blackstone, Eugene H.; Moy, Claudia S.; Mathew, Joseph P.; Hung, Judy; Gardner, Timothy J.; Parides, Michael K.

    2013-01-01

    Background Ischemic mitral regurgitation (MR), a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. Methods and Results This paper describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic (CT) Surgical Trials Network. This paper addresses challenges in selecting a feasible primary endpoint, characterizing the target population (including the degree of MR), and analytical challenges in this high mortality disease. Conclusions The paper concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life and cardiac physiology in therapeutic decision-making. PMID:22054660

  11. Surgical salvage of acquired lung lesions in extremely premature infants.

    PubMed

    Sacks, Greg D; Chung, Katherine; Jamil, Kevin; Garg, Meena; Dunn, James C Y; DeUgarte, Daniel A

    2014-05-01

    Acquired neonatal lung lesions including pneumatoceles, cystic bronchopulmonary dysplasia, and pulmonary interstitial emphysema can cause extrinsic mediastinal compression, which may impair pulmonary and cardiac function. Acquired lung lesions are typically managed medically. Here we report a case series of three extremely premature infants with acquired lung lesions. All three patients underwent aggressive medical management and ultimately required tube thoracostomies. These interventions were unsuccessful and emergency thoracotomies were performed in each case. Two infants with acquired pneumatoceles underwent unroofing of the cystic structure and primary repair of a bronchial defect. The third infant with pulmonary interstitial emphysema, arising from cystic bronchopulmonary dysplasia, required a middle lobectomy for severe and diffuse cystic disease. When medical management fails, tube thoracostomy can be attempted, leaving surgical intervention for refractory cases. Surgical options include oversewing a bronchial defect in the setting of a bronchopleural fistula or lung resection in cases of an isolated expanding lobe.

  12. Canine aggression toward unfamiliar people and dogs.

    PubMed

    Haug, Lore I

    2008-09-01

    Aggression toward unfamiliar dogs and people is a common problem arising most commonly from fear and territoriality. A number of factors contribute to its development, including socialization deficits, hormones, and genetic and neurophysiologic components. These factors are discussed in this article, as are management and behavior modification approaches for controlling aggression.

  13. [The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease].

    PubMed

    Bakhach, J; Sentucq-Rigal, J; Mouton, P; Boileau, R; Panconi, B; Guimberteau, J-C

    2006-02-01

    The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease. The De Quervain tenosynovitis is an inadequacy into the first extensor compartment between the osteo-fibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons. This is generally expressed by a tenderness on the radial side of the wrist over the radial styloid process. The medical management consists on corticoids infiltrations of the first extensor compartment, the avoidance of repetitive and stress movements of the first ray with the use of a rest splint. The surgical approach is considered with the recurrence of the painful symptoms. This well-known pathology is reputated to require a simple section of the pulley. Our post-operative complications have been reported in the literature of this classical surgical solution. These complications concern an incomplete release of the extensor pollicis brevis and the abductor pollicis longus tendons particularly when an extensor sub-compartment exists and was overlooked, an irritation of the collateral branches of the sensitive radial nerve or the occurrence of a nevroma after a nerve injury and the most serious complication is a palmar subluxation of the extensor tendons which can occur with the thumb extended and the wrist flexed. In rare cases, this subluxation can be really painful and requires a surgical management with secondary reconstruction of the pulley. This reconstruction necessitates distal pedicle flaps from the dorsal retinaculum or the brachioradialis tendon. To prevent these complications, Codega and Kapandji described techniques of reconstruction of the pulley after its release. More recently, Le Viet reported a procedure using the anterior flap of the pulley; fixed to the dermis it will work as a barrier and maintain the tendons sliding on the radial styloid groove. These techniques require to divide

  14. Application of energy-based technologies and topical hemostatic agents in the management of surgical hemostasis.

    PubMed

    Sileshi, Bantayehu; Achneck, Hardean; Ma, Liqiao; Lawson, Jeffrey H

    2010-01-01

    Achieving intraoperative hemostasis is essential for excellent surgical outcomes. A variety of methods, ranging from mechanical tools and energy-based technologies to topical hemostatic agents, are available to the modern surgeon. Given that bleeding develops from different origins, from small discrete bleeding or venous oozing to arterial hemorrhage, different tools and agents have different efficacy in specific situations. In this article, we review the mechanism by which currently available hemostatic tools and agents stop bleeding and give recommendations for their use during surgery. Furthermore, the costs of the various methods are presented, allowing the provider to choose not only the most potent but also the most cost-effective treatment modality in each situation.

  15. Congenital cystic eye: from prenatal diagnosis to therapeutic management and surgical treatment.

    PubMed

    Morselli, Paolo G; Morellini, Andrea; Sgarzani, Rossella; Ghi, Tullio; Galassi, Ercole

    2011-01-01

    Only 28 cases of congenital cystic eye have been reported in the literature. The main issue in such cases is differential diagnosis between this malformation and different cystic malformations and masses of the orbital cavity and eyeball, the most common of which is microphthalmia with cyst. Both malformations arise from incomplete closure of the fetal optic vesicle in different stages of embryonic development. We present a case of congenital cystic eye, associated with coloboma and corneal dermoid of the fellow eye and with left brachiocephaly, discussing differential diagnosis with microphthalmia with cyst and illustrating the treatment we planned and performed. The patient first underwent a surgical excision of the left corneal dermoid, then a resection of the right orbital cyst. The last step was to perform a craniotomy and cranial vault remodeling. All the operations were planned and performed using a team approach. The team comprised an ophthalmologist, a plastic surgeon, and a neurosurgeon, and the result was a successful outcome.

  16. Surgical management of parotid salivary duct rupture secondary to non-iatrogenic trauma in a dog

    PubMed Central

    YOON, Hun-Young; MIN, Byong-Su; KIM, Sun-Young; LEE, Da-Eun; KIM, Jung-Hyun

    2016-01-01

    A 3-year-old French bulldog presented for evaluation of recurrent swelling and a fistula on the right cheek after a dog fight. A large volume of serous fluids was identified on the wound immediately after atropine drops. A diagnosis of parotid salivary duct rupture secondary to trauma was made. On surgical exploration, the thickened proximal segment of the severed duct was identified and circumferentially double ligated with 3–0 silk. No evidence of swelling and normal appearance of the parotid salivary gland were identified 4 months postoperative recheck. No further problems were noted 10 months postoperatively phone-call. To the author’s knowledge, this is the first reported case of successful proximal parotid duct ligation of parotid salivary duct rupture secondary to non-iatrogenic trauma. PMID:27666341

  17. Surgical management of recurrent Cushing's disease in pregnancy: A case report

    PubMed Central

    Abbassy, Mahmoud; Kshettry, Varun R.; Hamrahian, Amir H.; Johnston, Philip C.; Dobri, Georgianna A.; Avitsian, Rafi; Woodard, Troy D.; Recinos, Pablo F.

    2015-01-01

    Background: Cushing's disease is a condition rarely encountered during pregnancy. It is known that hypercortisolism is associated with increased maternal and fetal morbidity and mortality. When hypercortisolism from Cushing's disease does occur in pregnancy, the impact of achieving biochemical remission on fetal outcomes is unknown. We sought to clarify the impact of successful surgical treatment by presenting such a case report. Case Description: A 38-year-old pregnant woman with recurrent Cushing's disease after 8 years of remission. The patient had endoscopic transsphenoidal of her pituitary adenoma in her 18th week of pregnancy. The patient had postoperative biochemical remission and normal fetal outcome with no maternal complications. Conclusion: Transsphenoidal surgery for Cushing's disease can be performed safely during the second trimester of pregnancy. PMID:26682090

  18. Surgical management of acute quadriceps tendon rupture (a case report with literature review)

    PubMed Central

    Ennaciri, Badr; Montbarbon, Eric; Beaudouin, Emmanuel

    2015-01-01

    Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long period of tendon weakening by statin therapy, hypertension and diabetes. The repair has consisted on end-to-end Krackow sutures associated with bone suture to the proximal pole of the patella. Surgeons and emergency physicians must think to this form of extensor apparatus rupture, because early diagnosis leads to early treatment and to best outcomes. PMID:26958106

  19. Surgical management of burn flexion and extension contractures of the toes.

    PubMed

    Chang, Jessica B; Kung, Theodore A; Levi, Benjamin; Irwin, Todd; Kadakia, Anish; Cederna, Paul S

    2014-01-01

    Burn contracture of the toes is a devastating sequela of thermal injury to the foot. Without proper treatment of toe burn contractures, patients suffer from significant functional and social limitations, including difficulties with activities of daily living. The authors classify the severity of toe burn scar contractures (TBSCs) by considering important characteristics of the deformity and tailor definitive surgical treatment based on the individual needs of the patient's condition. A retrospective review was performed on 20 patients who underwent a total of 32 reconstructive operations involving 275 TBSC procedures from 2000 to 2010. Multiple clinical, functional, and anatomic criteria were used to describe each patient's contracture as mild, moderate, or severe. Mild TBSC involved scarring of the superficial tissues only with no functional impairment; these were treated with scar release or local tissue rearrangement. Moderate TBSC involved soft tissue shortages requiring skin grafts and occasional closed joint capsulotomy. Severe TBSC caused the greatest impairment in function and involved burn injury to deeper structures. For these difficult contractures, a patient-specific technique was paramount to optimal reconstruction. There were six, three, and 11 patients with mild, moderate, and severe TBSC, respectively. The mean number of primary procedures per toe increased with increasing burn complexity from 1.1 procedures for mild, 1.5 for moderate, and 1.8 for severe groups, with severe TBSC undergoing more primary procedures overall (13.7 in severe vs 2.8 in mild TBSC). Complication rates per toe were highest for severe TBSC (59.0%). Only severe TBSC received secondary operations, and overall contracture recurrence was 35%. An individualized surgical approach based on TBSC severity is recommended for addressing burn contracture of the toes. Careful analysis of the clinical, functional, and anatomic characteristics of the burned foot determines the severity of

  20. The surgical management of spinal deformity in children with a Fontan circulation: The development of an algorithm for treatment.

    PubMed

    Evans, S; Ramasamy, A; Marks, D S; Spilsbury, J; Miller, P; Tatman, A; Gardner, A C

    2014-01-01

    The management of spinal deformity in children with univentricular cardiac pathology poses significant challenges to the surgical and anaesthetic teams. To date, only posterior instrumented fusion techniques have been used in these children and these are associated with a high rate of complications. We reviewed our experience of both growing rod instrumentation and posterior instrumented fusion in children with a univentricular circulation. Six children underwent spinal corrective surgery, two with cavopulmonary shunts and four following completion of a Fontan procedure. Three underwent growing rod instrumentation, two had a posterior fusion and one had spinal growth arrest. There were no complications following surgery, and the children undergoing growing rod instrumentation were successfully lengthened. We noted a trend for greater blood loss and haemodynamic instability in those whose surgery was undertaken following completion of a Fontan procedure. At a median follow-up of 87.6 months (interquartile range (IQR) 62.9 to 96.5) the median correction of deformity was 24.2% (64.5° (IQR 46° to 80°) vs 50.5° (IQR 36° to 63°)). We believe that early surgical intervention with growing rod instrumentation systems allows staged correction of the spinal deformity and reduces the haemodynamic insult to these physiologically compromised children. Due to the haemodynamic changes that occur with the completed Fontan circulation, the initial scoliosis surgery should ideally be undertaken when in the cavopulmonary shunt stage.

  1. Successful management of a pregnant woman with a TSH secreting pituitary adenoma with surgical and medical therapy.

    PubMed

    Chaiamnuay, Sumapa; Moster, Mark; Katz, M Richard; Kim, Young Nam

    2003-09-01

    We described a 39-yr-old asian female who was initially diagnosed with prolactinoma and presented with increase nervousness and weight loss. Laboratory evaluation revealed an inappropriately normal TSH level with elevated free T4, total T3, alpha-subunit and prolactin level. The alpha-subunit/TSH molar ratio was 4. MRI showed a macroadenoma extending to the suprasellar cistern. Treatment was begun with propylthiouracil and bromocriptine. After 5 months of therapy, she became pregnant. At 27 weeks of gestation, she developed headache and decreased visual acuity in her left eye. MRI showed a slightly increase in tumor size compressing the optic chaiasm. Transphenoid macroadenectomy was performed with immediate relief of the visual field abnormality. At 39 weeks gestation a baby with no malformations was delivered. This is the second case report of TSH secreting pituitary adenoma which was exarcerbated during pregnancy. In contrast to the first case, our case was managed with both surgical and medical approach. The judicious use of both medical and surgical therapy can result in a successful outcome to mother and fetus in a patient with TSH secreting pituitary adenoma.

  2. Endometrial fluid associated with Essure implants placed before in vitro fertilization: Considerations for patient counseling and surgical management

    PubMed Central

    Walsh, David J; Jones, Christopher A; Wood, Samuel H

    2015-01-01

    Essure (Bayer) received approval from the U.S. Food and Drugs Administration as a permanent non-hormonal contraceptive implant in November 2002. While the use of Essure in the management of hydrosalpinx prior to in vitro fertilization (IVF) remains off-label, it has been used specifically for this purpose since at least 2007. Although most published reports on Essure placement before IVF have been reassuring, clinical experience remains limited, and no randomized studies have demonstrated the safety or efficacy of Essure in this context. In fact, no published guidelines deal with patient selection or counseling regarding the Essure procedure specifically in the context of IVF. Although Essure is an irreversible birth control option, some patients request the surgical removal of the implants for various reasons. While these patients could eventually undergo hysterectomy, at present no standardized technique exists for simple Essure removal with conservation of the uterus. This article emphasizes new aspects of the Essure procedure, as we describe the first known association between the placement of Essure implants and the subsequent development of fluid within the uterine cavity, which resolved after the surgical removal of both devices. PMID:26473113

  3. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus

    PubMed Central

    Patel, N. K.; Griffiths, D.; Athanasiou, T.; Gupte, C. M.; Reilly, P.

    2016-01-01

    Objectives The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes. Methods A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed. Results Seven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009). Conclusion This meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria. Cite this article: S. Sabharwal, N. K. Patel, D

  4. Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care.

    PubMed

    Harris, Lisa H; Dalton, Vanessa K; Johnson, Timothy R B

    2007-05-01

    Early pregnancy failure and induced abortion are often managed differently, even though safe uterine evacuation is the goal in both. Early pregnancy failure is commonly treated by curettage in operating room settings in anesthetized patients. Induced abortion is most commonly managed by office vacuum aspiration in awake or sedated patients. Medical evidence does not support routine operating room management of early pregnancy failure. This commentary reviews historical origins of these different care standards, explores political factors responsible for their perpetuation, and uses experience at University of Michigan to dramatize the ways in which history, politics, and biomedicine intersect to produce patient care. The University of Michigan initiated office uterine evacuations for early pregnancy failure treatment. Patients previously went to the operating room. These changes required faculty, staff, and resident education. Our efforts blurred the lines between spontaneous and induced abortion management, improved patient care and better utilized hospital resources.

  5. Original Solution for Middle Ear Implant and Anesthetic/Surgical Management in a Child with Severe Craniofacial Dysmorphism

    PubMed Central

    Bianchin, Giovanni; Tribi, Lorenzo; Reverzani, Aronne; Formigoni, Patrizia; Polizzi, Valeria

    2015-01-01

    We describe the novel solution adopted in positioning middle ear implant in a child with bilateral congenital aural atresia and craniofacial dysmorphism that have posed a significant challenge for the safe and correct management of deafness. A five-year-old child, affected by a rare congenital disease (Van Maldergem Syndrome), suffered from conductive hearing loss. Conventional skin-drive bone-conduction device, attached with a steel spring headband, has been applied but auditory restoration was not optimal. The decision made was to position Vibrant Soundbridge, a middle ear implant, with an original surgical application due to hypoplasia of the tympanic cavity. Intubation procedure was complicated due to child craniofacial deformities. Postoperative hearing rehabilitation involved a multidisciplinary team, showing improved social skills and language development. PMID:26491591

  6. Non-surgical management of paraesthesia and pain associated with endodontic sealer extrusion into the mandibular canal.

    PubMed

    Froes, Fabiana Gama Benevides; Miranda, Aguida Maria Menezes Aguiar; Abad, Ernani da Costa; Riche, Fernanda Nehme; Pires, Fábio Ramôa

    2009-12-01

    The aim of this report was to present a case of endodontic sealer extrusion into the mandibular canal in a 42-year-old woman. The patient was referred to the Endodontology and Stomatology Clinics, School of Dentistry, Estácio de Sá University, complaining of 5-day duration intense spontaneous pain and paraesthesia, both arising after an endodontic intervention. Conventional radiographs and computed tomography of the mandible showed the presence of radiopacities inside the right mandibular canal. History and these radiographs confirmed extrusion of endodontic sealer. Treatment included an anti-inflammatory drug, completion of endodontic treatment and follow up. The patient reported gradual improvement, becoming asymptomatic after 2 months. Radiographs 30 months after initial examination revealed partial resorption of the foreign material. In conclusion, iatrogenic extrusion of endodontic materials should be included in differential diagnosis of endodontic pain and can sometimes be managed through non-surgical interventions in some cases.

  7. The surgical management of benign and malignant thyroid neoplasms in Marshall Islanders exposed to hydrogen bomb fallout.

    PubMed

    Dobyns, B M; Hyrmer, B A

    1992-01-01

    On March 1, 1954, a serious fallout accident occurred during the United States atomic testing program at Bikini in the Trust Territory of the Pacific Islands. Following the detonation of a large thermonuclear device (known as Bravo) an unexpected shift in winds resulted in deposition of radioactive debris on several inhabited atolls in the Marshall Islands. During the early post-detonation period military, sea, and air surveys traced the hottest portion of the parabolic cloud as it drifted in an ever widening pattern of diminishing concentration eastward and southeast of Bikini. The center of the cloud passed North of the Rongelap Atoll, which was the nearest inhabited atoll. This report concerns the development of thyroid lesions, the special circumstances encountered during thyroid surgery, and the results of the surgical management of benign and malignant lesions that were subsequently encountered in this population.

  8. Multidisciplinary management of hepatocellular carcinoma with portal vein tumor thrombus – Eastern Hepatobiliary Surgical Hospital consensus statement

    PubMed Central

    Cheng, Shuqun; Yang, Jiamei; Shen, Feng; Zhou, Weiping; Wang, Yi; Cong, Wenming; Yang, Guang shun; Cheng, Hongyan; Hu, Heping; Gao, Chunfang; Guo, Jia; Li, Aijun; Meng, Yan; Jiang, Xiaoqing; Yang, Yefa; Qian, Guojun; Luo, Ming; Hu, Bing; Man, Xiaobo; Zhang, Baohua; Su, Changqing; Zhou, Feiguo; Li, Nan; Shi, Jie; Wang, Meng; Zheng, Yaxin; Guo, Weixing; Sun, Juxian; Wang, Hongyang; Lau, Wan-yee; Wu, Meng-chao

    2016-01-01

    Hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus (PVTT) is associated with poor prognosis, early recurrence of HCC, and limited treatment options. Current guidelines do not have standardized diagnostic and treatment modalities, thus creating a need for a multidisciplinary treatment model for standardization of the treatment. Eastern Hepatobiliary Surgical Hospital (China) convened two working parties of experts from all the departments, to consolidate the current evidence, prevailing vision for the future, and experience of the practicing clinicians engaged in HCC management, so as to develop a consensus for PVTT diagnosis and treatment according to the GRADE system. Based on the quality of the existing evidence and the strength of recommendations, the consensus statements were categorized into 3 evidence levels (A/B/C) and 5 classes (I/II/IIa/IIb/III). The panel discussed and provided clarity on the management and research options in the field of HCC with PVTT. In addition, the panel also assessed the quality of the cited studies and assigned grades to the recommendation statements. Among the group of experts, there was excellent agreement with regard to effective diagnosis and treatment of HCC with PVTT. The recommendations of this consensus will provide guidance to physicians and clinical researchers on the effective management of HCC with PVTT. PMID:27027235

  9. 'Salvage Treatment' of Aggressive Giant Cell Tumor of Bones with Denosumab.

    PubMed

    Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2015-07-01

    Giant cell tumor of the bone (GCTB) presents as a lytic lesion of epiphyseometaphyseal regions of the long bones usually during the second to the fourth decade with female predilection. Histologically, they are formed of neoplastic mononuclear cells with a higher receptor activator of nuclear factor kappa-B ligand (RANKL) expression responsible for the aggressive osteolytic nature of the tumour. RANKL helps in the formation and functioning of osteoclasts. A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts. Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible. Denosumab may play a crucial role, especially in the management of such difficult lesions. We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy.

  10. 'Salvage Treatment' of Aggressive Giant Cell Tumor of Bones with Denosumab

    PubMed Central

    Vaishya, Raju; Vijay, Vipul

    2015-01-01

    Giant cell tumor of the bone (GCTB) presents as a lytic lesion of epiphyseometaphyseal regions of the long bones usually during the second to the fourth decade with female predilection. Histologically, they are formed of neoplastic mononuclear cells with a higher receptor activator of nuclear factor kappa-B ligand (RANKL) expression responsible for the aggressive osteolytic nature of the tumour. RANKL helps in the formation and functioning of osteoclasts. A newer molecule, Denosumab, is a monoclonal antibody directed against RANKL and thus prevents the formation and function of osteoclasts. Management of refractory, multicentric, recurrent, or metastatic GCTB remains challenging as achieving a tumor-free margin surgically is not always possible. Denosumab may play a crucial role, especially in the management of such difficult lesions. We present three cases of locally aggressive GCTB (involving proximal humerus, sacrum, and proximal femur) that were treated and responded very well to Denosumab therapy. PMID:26251767

  11. Anesthetic Management of a Surgical Patient with Chronic Renal Tubular Acidosis Complicated by Subclinical Hypothyroidism

    PubMed Central

    Yamazaki, Haruyuki; Yasumura, Rie; Wada, Kosuke

    2016-01-01

    A 53-year-old man with chronic renal tubular acidosis and subclinical hypothyroidism underwent lower leg amputation surgery under general anesthesia. Perioperative acid-base management in such patients poses many difficulties because both pathophysiologies have the potential to complicate the interpretation of capnometry and arterial blood gas analysis data; inappropriate correction of chronic metabolic acidosis may lead to postoperative respiratory deterioration. We discuss the management of perioperative acidosis in order to achieve successful weaning from mechanical ventilation and promise a complete recovery from anesthesia. PMID:27648310

  12. Renal Angiomyolipoma in Pregnancy: Surgical Management with Fetal Preservation - Approach in a Developing Setting

    PubMed Central

    Ugwumba, Fred O.; Nnakenyi, Emeka F.; Okafor, Okechukwu C.; Onuh, Augustine C.; Ezechukwu, Paschalina C.; Urube, Sunday

    2016-01-01

    Renal angiomyolipomas (RAML) are uncommon benign renal tumours that are associated with a tendency to rupture resulting in sometimes-torrential retroperitoneal hemorrhage as the Wunderlich syndrome or as severe potentially exsanguinating hematuria. When hemorrhage from RAML occurs in pregnancy it presents a unique challenge requiring timely and appropriately adapted intervention with the goal of preventing fatality, preserving renal function as well as preventing fetal loss if possible. We report the management of severe bleeding from RAML in pregnancy and highlight the need to adopt a management strategy that suits the practice environment and offers the patient standard and enduring care. PMID:28176962

  13. Surgical management of squamous cell vulvar cancer without clitoris, urethra or anus involvement.

    PubMed

    Kaban, Alpaslan; Kaban, Işık; Afşar, Selim

    2017-05-01

    Vulvar cancers, which constitute 5% of all gynecologic cancers, are the fourth most common female genital cancers, preceded by uterine, ovarian and cervical cancers. The treatment methods employed for vulvar cancers have changed over the years, with previously applied radical surgical approaches, such as en bloc resection, being gradually suspended in favor of treatment approaches that require dissection of less tissue. While the removal of less tissue, which today's approaches have focused on, prevents morbidity, this method seems to result in higher risks of recurrence. It is therefore important that the balance between preventing the recurrence of the disease and forefending against postoperative complications and vulvar deformity be properly understood. As a working assumption, if patients with vulvar cancer are diagnosed at an early stage, properly evaluated and administered appropriate treatment, the most positive results can be obtained. This paper aims to highlight this assumption and demonstrate, through the provision of actual data, how to plan the treatment approach for patients who are diagnosed early. Statements extracted from the National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2016 Sub-Committees on vulvar squamous cell carcinoma and articles by the European Society of Gynaecological Oncology (ESGO) regarding Vulvar Cancer Recommendations were used to obtain updated information.

  14. Surgical management of symptomatic T8 vertebral hemangioma: case report and review of the literature.

    PubMed

    Tucer, Bulent; Ekici, Mehmet Ali; Menku, Ahmet; Koc, Rahmi Kemal; Guclu, Bulent

    2013-01-01

    Vertebral hemangiomas are benign vascular lesions of the vertebral column; only 0.9-1.2% of all vertebral hemangiomas cause spinal cord compression. We report a 34-year-old female who was admitted to the neurosurgery clinic with a history of back pain, poor quality of life and easy fatigability for 1.5 years. Her medical history revealed a fall from a height of 2 meters 1.5 years ago. Neurology examination revealed bilateral hypoesthesia below the T8 level and hyperactive deep tendon reflexes in her left leg. Computed tomography scan of the thoracic spine showed T8 vertebral hemangioma, and magnetic resonance imaging showed a T8 hemangioma compressing the spinal cord. Surgical intervention was planned and T8 total laminectomy was performed. The tumor extending into the anterior spinal cord was resected, and T8 vertebroplasty with short segment posterior stabilization and fusion was performed. We aimed to present a new treatment approach for symptomatic vertebral hemangiomas and reviewed the relevant literature.

  15. Chondromyxoid Fibroma of the Skull Base and Calvarium: Surgical Management and Literature Review

    PubMed Central

    Yaghi, Nasser Khaled; DeMonte, Franco

    2016-01-01

    Chondromyxoid fibroma (CMF) is an exceedingly rare tumor that represents less than 1% of all primary bone neoplasms. Occurrence in the facial and cranial bones is extremely rare and frequently misdiagnosed. Case Reports We report two cases of CMF, one in the sphenoclival skull base and the other involving the parietal bone in two young female patients. Excision was performed in both cases. Presenting symptoms, treatment, and follow-up are reported. Methods A retrospective review of the literature on cranial CMF was performed. The location, demographics, presenting symptoms, and treatment of all calvarial and skull base CMF cases published since 1990 are summarized. Discussion In our literature review, we found 67 published cases of cranial CMF. Mean age of all calvarial and skull base CMFs at diagnosis was 38.2 years old. Of the cases affecting the cranium, the sinonasal structures were most commonly involved. To our knowledge we report only the second case of CMF involving the parietal bone published in an English-language journal. Total resection is the best treatment, and should be the goal of surgical intervention. Curettage results in high recurrence rates. Radiotherapy in the setting of subtotal resection or recurrence cannot be definitively recommended and needs further investigation. PMID:26929898

  16. ANALYSIS OF THE SEGMENTAL IMPACTION OF FEMORAL HEAD FOLLOWING AN ACETABULAR FRACTURE SURGICALLY MANAGED

    PubMed Central

    Guimarães, Rodrigo Pereira; Kaleka, Camila Cohen; Cohen, Carina; Daniachi, Daniel; Keiske Ono, Nelson; Honda, Emerson Kiyoshi; Polesello, Giancarlo Cavalli; Riccioli, Walter

    2015-01-01

    Objective: Correlate the postoperative radiographic evaluation with variables accompanying acetabular fractures in order to determine the predictive factors for segmental impaction of femoral head. Methods: Retrospective analysis of medial files of patients submitted to open reduction surgery with internal acetabular fixation. Within approximately 35 years, 596 patients were treated for acetabular fractures; 267 were followed up for at least two years. The others were excluded either because their follow up was shorter than the minimum time, or as a result of the lack of sufficient data reported on files, or because they had been submitted to non-surgical treatment. The patients were followed up by one of three surgeons of the group using the Merle d'Aubigné and Postel clinical scales as well as radiological studies. Results: Only tow studied variables-age and amount of postoperative reductionshowed statistically significant correlation with femoral head impaction. Conclusions: The quality of reduction-anatomical or with up to 2mm residual deviation-presents a good radiographic evolution, reducing the potential for segmental impaction of the femoral head, a statistically significant finding. PMID:27004191

  17. Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach

    PubMed Central

    Rovlias, Aristedis; Theodoropoulos, Spyridon; Papoutsakis, Dimitrios

    2015-01-01

    Background: Chronic subdural hematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice which carries a most favorable prognosis. However, because of the advanced age and medical problems of patients, surgical therapy is frequently associated with various complications. This study evaluated the clinical features, radiological findings, and neurological outcome in a large series of patients with CSDH. Methods: A classification and regression tree (CART) technique was employed in the analysis of data from 986 patients who were operated at Asclepeion General Hospital of Athens from January 1986 to December 2011. Burr holes evacuation with closed system drainage has been the operative technique of first choice at our institution for 29 consecutive years. A total of 27 prognostic factors were examined to predict the outcome at 3-month postoperatively. Results: Our results indicated that neurological status on admission was the best predictor of outcome. With regard to the other data, age, brain atrophy, thickness and density of hematoma, subdural accumulation of air, and antiplatelet and anticoagulant therapy were found to correlate significantly with prognosis. The overall cross-validated predictive accuracy of CART model was 85.34%, with a cross-validated relative error of 0.326. Conclusions: Methodologically, CART technique is quite different from the more commonly used methods, with the primary benefit of illustrating the important prognostic variables as related to outcome. Since, the ideal therapy for the treatment of CSDH is still under debate, this technique may prove useful in developing new therapeutic strategies and approaches for patients with CSDH. PMID:26257985

  18. Surgical management of patients with the Marfan syndrome and dilatation of the ascending aorta.

    PubMed

    McDonald, G R; Schaff, H V; Pyeritz, R E; McKusick, V A; Gott, V L

    1981-02-01

    Until recently, surgical correction of Marfan defects of the aortic root has been undertaken with some hesitancy because of the high perioperative risk. The Division of Medical Genetics at Johns Hopkins follows about 300 patients with the Marfan syndrome, and during the past 8 years 13 of these were referred to the senior author (V.L.G.) for aortic valve replacement and repair of the ascending aorta. Preoperatively, four of the 13 patients were in New York Heart Association (NYHA) Class IV (3/4 required emergency operation), three patients were in Class III, and six were in Class II. The aortic diameter at the mid-valve level ranged from 5.3 cm to 8.2 cm on M-mode echocardiography. The first two patients received a separate Björk-Shiley prosthesis and a woven Teflon graft and the last 11 patients had a composite valve-graft with direct coronary implantation. There were no hospital deaths. Follow-up ranges from 6 months to 8.1 years and is complete for all 13 patients (mean of 23 months). Two late deaths occurred 2 and 20 months postoperatively from presumed arrhythmia and two late deaths occurred at 4 and 6 months from endocarditis. The actuarial survival rate at 3 years is 61%. Some pathologists claim that the incidence of dissection of the aorta does not increase with increasing aortic dilatation in the Marfan patient. Six of our 13 patients, however, had aortic dissection at the time of surgery (two DeBakey Type I, three Type II, and one Type III). With the low hospital mortality that can now be achieved in the Marfan patient, and with the relatively high incidence of clinically unrecognized dissection, we fell that strong consideration should be given to earlier prophylactic repair in these patients. Operation may be indicated even in the asymptomatic Marfan patient with an aortic root diameter greater than 5.5 cm.

  19. Ionized calcium concentration in horses with surgically managed gastrointestinal disease: 147 cases (1988-1990).

    PubMed

    Dart, A J; Snyder, J R; Spier, S J; Sullivan, K E

    1992-10-15

    Packed cell volume, total plasma protein, serum sodium, potassium, and ionized Ca2+ concentrations, and blood pH were determined at the time of admission and following surgery in 147 horses with acute abdominal crisis. Horses were allotted to 3 categories on the basis of the surgical lesion: (1) nonstrangulating obstruction of the ascending or descending colon (category A, n = 76), (2) strangulating and nonstrangulating infarction of the cecum or ascending colon (category B, n = 37), and (3) strangulating and nonstrangulating infarction of the small intestine (category C, n = 25). Horses with low serum ionized Ca2+ concentration following surgery were given 23% calcium gluconate (100 to 300 ml) IV to effect, and ionized Ca2+ concentration was determined following treatment. The serum ionized Ca2+ concentrations of horses in categories A, B, and C before and after surgery were lower than our normal laboratory reference range. Prior to surgery, serum ionized Ca2+ concentration measured from horses in category B and C was lower than that in horses in category A. There was no difference in ionized Ca2+ concentration in serum samples obtained before surgery in horses from category B and C, and in serum samples obtained following surgery. There was a decrease in ionized Ca2+ concentration during surgery in horses in category A. There was no change between preoperative and postoperative ionized Ca2+ concentration in the samples obtained from horses in category B and C. After calcium gluconate administration, all horses with low serum ionized Ca2+ after surgery had concentrations within our normal range. Measurement of serum ionized Ca2+ in horses with an acute abdominal crisis is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. [Motives and interpersonal functions of aggression].

    PubMed

    Ohbuchi, K

    1987-06-01

    In this review, the author theoretically and empirically examined motives and interpersonal functions of aggression. A factor-analysis of Averill's questionnaire items on anger revealed that motives involved in aggressive responses were clustered into two groups: the hostile and the instrumental. It was also clarified that an individual is likely to engage in aggression particularly when some hostile motives are evoked. Concerning the interpersonal functions, the author proposed that aggression might serve four principal goals. (1) Aggression can be generated as an avoidance response to an aversive stimulus, such as frustration, annoyance, or pain, and so on. It depends on the severity of the stimulus. It was however emphasized that aggression is also mediated by social cognition, such as an attribution of intent to a harm-doer. (2) Aggression can be used as a means of coercing the other person into doing something. An individual is likely to use such a power strategy if he/she is lacking in self-confidence or a perspective for influencing the target person by more peaceful strategies. (3) Aggression can be interpreted as a punishment when it is directed toward a transgressor. In this case, aggression is motivated by restoration of a social justice, and thus its intensity is determined by the perceived moral responsibility of the transgressor. Further, it was indicated that aggression is intensified if it is justified as a sanctional conduct against the immoral. (4) Aggression can be also evoked when an individual's social identity is threatened. It was suggested that impression management motives are involved in aggression by an unexpected finding that the presence of audience or the identifiability rather facilitated retaliative aggression. The aggression-inhibition effect of apology was also explained in terms of impression management. In conclusion, it was presented that aggression is a behavioral strategy as an attempt to resolve interpersonal conflicts