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Sample records for cystectomy single-institution revision

  1. A Retrospective Analysis of Ventriculoperitoneal Shunt Revision Cases of a Single Institute

    PubMed Central

    Park, Man-Kyu; Kim, Myungsoo; Park, Ki-Su; Park, Seong-Hyun; Hwang, Jeong-Hyun

    2015-01-01

    Objective Ventriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. To study the differences of VP shunt complications between children and adults, we analyzed shunt revision surgery performed at our hospital during the past 10 years. Methods Patients who had undergone shunt revision surgery from January 2001 to December 2010 were evaluated retrospectively by chart review about age distribution, etiology of hydrocephalus, and causes of revision. Patients were grouped into below and above 20 years old. Results Among 528 cases of VP shunt surgery performed in our hospital over 10 years, 146 (27.7%) were revision surgery. Infection and obstruction were the most common causes of revision. Fifty-one patients were operated on within 1 month after original VP shunt surgery. Thirty-six of 46 infection cases were operated before 6 months after the initial VP shunt. Incidence of shunt catheter fracture was higher in younger patients compared to older. Two of 8 fractured catheters in the younger group were due to calcification and degradation of shunt catheters with fibrous adhesion to surrounding tissue. Conclusion The complications of VP shunts were different between children and adults. The incidence of shunt catheter fracture was higher in younger patients. Degradation of shunt catheter associated with surrounding tissue calcification could be one of the reasons of the difference in facture rates. PMID:26113963

  2. International Robotic Radical Cystectomy Consortium: A way forward.

    PubMed

    Raza, Syed Johar; Field, Erinn; Kibel, Adam S; Mottrie, Alex; Weizer, Alon Z; Wagner, Andrew; Hemal, Ashok K; Scherr, Douglas S; Schanne, Francis; Gaboardi, Franco; Wu, Guan; Peabody, James O; Koauk, Jihad; Redorta, Joan Palou; Pattaras, John G; Rha, Koon-Ho; Richstone, Lee; Balbay, M Derya; Menon, Mani; Hayn, Mathew; Stoeckle, Micheal; Wiklund, Peter; Dasgupta, Prokar; Pruthi, Raj; Ghavamian, Reza; Khan, Shamim; Siemer, Stephan; Maatman, Thomas; Wilson, Timothy; Poulakis, Vassilis; Wilding, Greg; Guru, Khurshid A

    2014-07-01

    Robot-assisted radical cystectomy (RARC) is an emerging operative alternative to open surgery for the management of invasive bladder cancer. Studies from single institutions provide limited data due to the small number of patients. In order to better understand the related outcomes, a world-wide consortium was established in 2006 of patients undergoing RARC, called the International Robotic Cystectomy Consortium (IRCC). Thus far, the IRCC has reported its findings on various areas of operative interest and continues to expand its capacity to include other operative modalities and transform it into the International Radical Cystectomy Consortium. This article summarizes the findings of the IRCC and highlights the future direction of the consortium.

  3. Temporal trends in conduit urinary diversion with concomitant cystectomy for benign indications: a population-based analysis

    PubMed Central

    Brown, Elizabeth Timbrook; Osborn, David; Mock, Stephen; Ni, Shenghua; Graves, Amy J.; Milam, Laurel; Milam, Douglas; Kaufman, Melissa; Dmochowski, Roger; Reynolds, W. Stuart

    2016-01-01

    Objectives To describe national trends in cystectomy at the time of urinary diversion for benign indications. Multiple practice patterns exist regarding the necessity of concomitant cystectomy with urinary diversion for benign end-stage lower urinary tract dysfunction. Beyond single institution reports, limited data is available to describe how concurrent cystectomy is employed on a national level. Methods A representative sample of patients undergoing urinary diversion for benign indications with or without concurrent cystectomy was identified from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998–2011. Using multivariate logistic regression models, we identified hospital and patient-level characteristics associated with concomitant cystectomy with urinary diversion. Results There was an increase in the proportion of concomitant cystectomy at the time of urinary diversion from 20% to 35% (p<0.001) between 1998 and 2011. The increase in simultaneous cystectomy over time occurred at teaching hospitals (vs. community hospitals), in older patients, in male patients, in the Medicare population (vs. private insurance and Medicaid), and in those with certain diagnoses. Conclusions There has been an overall increase in the use of cystectomy at the time of urinary diversion for benign indications on a national level, though the indications driving this clinical decision appear inconsistent. PMID:27374730

  4. Laparoscopic radical and partial cystectomy

    PubMed Central

    Challacombe, Ben J.; Rose, Kristen; Dasgupta, Prokar

    2005-01-01

    Radical cystectomy remains the standard treatment for muscle invasive organ confined bladder carcinoma. Laparoscopic radical cystoprostatectomy (LRC) is an advanced laparoscopic procedure that places significant demands on the patient and the surgeon alike. It is a prolonged procedure which includes several technical steps and requires highly developed laparoscopic skills including intra-corporeal suturing. Here we review the development of the technique, the indications, complications and outcomes. We also examine the potential benefits of robotic-assisted LRC and explore the indications and technique of laparoscopic partial cystectomy. PMID:21206662

  5. Preoperative irradiation and cystectomy for bladder cancer.

    PubMed

    Smith, J A; Batata, M; Grabstald, H; Sogani, P C; Herr, H; Whitmore, W F

    1982-03-01

    Between 1971 and 1974, 101 patients at Memorial Sloan-Kettering Cancer Center underwent planned integrated treatment for bladder cancer with 2000 rads by megavoltage delivered to the whole pelvis over five consecutive days followed by radical cystectomy within a week. The overall five-year survival rate was 39%; the hospital mortality rate was 2%. In the pelvis alone tumor recurred in 9% of the patients. These results support other studies demonstrating the efficacy of this and other regimens of preoperative irradiation and cystectomy.

  6. Single-session laparoscopic cystectomy and nephroureterectomy

    PubMed Central

    Chłosta, Piotr; Myślak, Marek; Herlinger, Grzegorz; Dobroński, Piotr; Kryst, Piotr; Drewa, Tomasz

    2012-01-01

    Patients with high grade and/or muscle invasive bladder cancer and with concomitant diseases of the upper urinary tract, e.g. urothelial tumors (transitional cell carcinoma – TCC) or afunctional hydronephrotic kidneys, may be candidates for simultaneous cystectomy and nephroureterectomy. Although the progress in laparoscopic techniques made these procedures feasible and safe, they are still technically demanding so only experienced surgeons can perform them. The aim of the study is to report our experience with laparoscopic simultaneous en bloc resection of the urinary bladder together with unilateral or bilateral nephroureterectomy in patients with TCC. Our material consists of three cases operated on in three centers between 2002 and 2011. After having completed bilateral (1 case) or unilateral (2 cases) nephroureterectomy, we performed radical cystectomy with pelvic lymph node dissection. All the specimens, including the kidneys, ureters, bladder, and reproductive organs in the female, were collected in endobags and were retrieved en bloc using hypogastric incision in the male patient and the vaginal route in the female patients. The demographic and perioperative information was collected and analyzed. All procedures were completed laparoscopically without the need of conversion to open surgery. No major intra- or postoperative complications were observed. Only 1 patient suffered from prolonged lymphatic leakage. From our experience we can conclude that single-session laparoscopic cystectomy and nephroureterectomy are technically feasible and safe, and may be offered for the treatment of selected cases of TCC of the urinary tract. PMID:23837100

  7. Nutritional Predictors of Complications Following Radical Cystectomy

    PubMed Central

    Johnson, David C.; Riggs, Stephen B.; Nielsen, Matthew E.; Matthews, Jonathan E.; Woods, Michael E.; Wallen, Eric M.; Pruthi, Raj S.; Smith, Angela B.

    2016-01-01

    Purpose To determine the impact of preoperative nutritional status on the development of surgical complications following cystectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Methods We performed a retrospective review of the NSQIP 2005–2012 Participant Use Data Files. ACS-NSQIP collects data on 135 variables, including pre- and intraoperative data and 30-day post-operative complications and mortality on all major surgical procedures at participating institutions. Preoperative albumin (<3.5 or >3.5 g/dl), weight loss 6 months before surgery (>10%), and BMI were identified as nutritional variables within the database. The overall complication rate was calculated and predictors of complications were identified using multivariable logistic regression models. Results 1,213 patients underwent cystectomy for bladder cancer between 2005–2012. The overall 30-day complication rate was 55.1% (n=668). While 14.7% (n=102) had a preoperative albumin <3.5 g/dL, 3.4% had >10% weight loss in the 6 months prior to surgery, and the mean BMI was 28 kg/m2. After controlling for age, sex, medical comorbidities, medical resident involvement, operation year, operative time and prior operation, only albumin <3.5g/dl was a significant predictor of experiencing a postoperative complication (p=0.03). This remained significant when albumin was evaluated as a continuous variable (p=0.02) Conclusions Poor nutritional status measured by serum albumin is predictive of an increased rate of surgical complications following radical cystectomy. This finding supports the importance of preoperative nutritional status in this population and highlights the need for the development of effective nutritional interventions in the preoperative setting. PMID:25240535

  8. Revising.

    ERIC Educational Resources Information Center

    Wyman, Linda, Ed.

    1983-01-01

    In focusing on recursive writing, the nine articles in this journal issue suggest that student writing should be taken seriously. The first article states that revision should occur throughout the writing process while the second discusses how to invite writers to become active readers of their own texts. The third article presents methods of…

  9. Panniculectomy and Cystectomy: An Approach to the Morbidly Obese Patient

    PubMed Central

    Turner, Robert M.; Gusenoff, Jeffrey A.; Correa, Andres F.; Jacobs, Bruce L.; Davies, Benjamin J.

    2016-01-01

    The obese patient undergoing radical cystectomy faces a unique set of challenges. We present the case of a 68-year-old gentleman who presented to our institution with Bacillus Calmette-Guerin refractory disease, a body mass index of 38.5, and a large pannus. The present paper describes our technique for performing radical cystectomy with ileal conduit urinary diversion and concomitant panniculectomy. We discuss the impact of obesity on patients undergoing radical cystectomy and how this may be mitigated by panniculectomy. PMID:27195168

  10. Management of the male urethra after cystectomy.

    PubMed

    White, Shawn E; Malkowicz, S Bruce

    2010-08-01

    Approximately 70,000 new cases of bladder cancer are diagnosed yearly, of which 52,000 are male patients. In 2009 there were approximately 14,000 deaths attributed to bladder cancer, 10,000 of which were men. Approximately 40% to 45% of all cases are high-grade tumors with half of these being muscle-invasive tumors at the time of diagnosis. With the preponderance of men in this population, there is a need for clear management strategies regarding the retained urethra in those men undergoing radical cystectomy. This article reviews the incidence of urothelial carcinoma in the retained urethra, risk factors for the development of urethral urothelial carcinoma, surveillance strategies, treatment modalities, and outcomes following intervention.

  11. Current Status of Robot-Assisted Radical Cystectomy: What is the Real Benefit?

    PubMed

    Takenaka, Atsushi

    2015-09-01

    In recent years, robot-assisted radical cystectomy has received attention worldwide as a useful procedure that helps to overcome the limitations of open radical cystectomy. We compared the surgical technique, perioperative and oncological outcomes, and learning curve of robot-assisted radical cystectomy with those of open radical cystectomy. The indications for robot-assisted radical cystectomy are identical to those of open radical cystectomy. Relative contraindications are due to patient positioning in the Trendelenburg position for long periods. Urinary diversion is performed either extracorporeally with a small skin incision or intracorporeally with a totally robotic-assisted maneuver. Accordingly, robot-assisted radical cystectomy can be performed safely with an acceptable operative time, little blood loss, and low transfusion rates. The lymph node yield and positive surgical margin rate were not significantly different between robot-assisted radical cystectomy and open radical cystectomy. The survival rates after robot-assisted radical cystectomy are estimated to be similar to that after open radical cystectomy. However, the recurrence pattern is different between robot-assisted radical cystectomy and open radical cystectomy, i.e., extrapelvic lymph node recurrence and peritoneal carcinomatosis were more frequently found in patients who underwent robot-assisted radical cystectomy than in those who underwent open radical cystectomy. Further validation is necessary to prove the feasibility of oncological control. A steep learning curve is one of the benefits of the new technique. The experience of only 50 robot-assisted radical prostatectomies is a minimum requirement for performing feasible robot-assisted radical cystectomy, and surgeons who have performed only 30 surgeries can reach an acceptable level of quality for robot-assisted radical cystectomy.

  12. Incidence of Venous Thromboembolism in Patients Undergoing Major Hip Surgeries at a Single Institution: A Prospective Study

    PubMed Central

    Yamanaka, Yasuhiro; Ito, Hiroshi

    2016-01-01

    Background: Venous thoromboembolism (VTE) is one of the most significant complications after hip surgeries. Many studies have been reported about the incidence of VTE after THA, but a small number of reports were found concerning Periacetabular osteotomy, Revision THA and Surgery for hip fracture postoperatively. Furthermore, there exists no comparative study of the incidence of VTE among major hip surgeries at a single institution. We reported the incidence of VTE among hip surgeries performed at a single institution. Methods: A total of 820 Hip surgeries were performed at same institution. The procedures included 420 hips that underwent primary total hip arthroplasties (THA), 91 revision or removal of total hip arthroplasties (Revision THA), 144 periacetabular osteotomy (PAO) and 165 surgery for hip fracture (SHF) between 2006 and 2012. VTE was detected by Multidetector computed tomography (MDCT) that scanned 768 cases and by ultrasound that scanned 52cases postoperative 10-14 days. Results: The overall incidence of VTE was 12.2% (100 of 820). The incidence of VTE after THA was 13.1% (55 of 420), Revision THA was 13.2% (12 of 91), PAO was 2.1% (3 of 144) and SHF was 18.1% (30 of 165). The incidence of VTE was significantly higher in SHF than in PAO. Conclusion: This data indicates that the incidence of VTE after PAO is significantly lower than SHF and relatively lower than THA and Revision THA. A younger age and non-invasion of the bone marrow of the femur may have affected the result. Prophylaxis therapy was effective especially on SHF. PMID:27499823

  13. Cystoscopic-assisted partial cystectomy: description of technique and results

    PubMed Central

    Gofrit, Ofer N; Shapiro, Amos; Katz, Ran; Duvdevani, Mordechai; Yutkin, Vladimir; Landau, Ezekiel H; Zorn, Kevin C; Hidas, Guy; Pode, Dov

    2014-01-01

    Background Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimizing damage to the rest of the bladder. Methods During the study period, 30 patients underwent partial cystectomy for invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopy was done and the light of the cystoscope was pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy. Results Patients who underwent partial cystectomy using the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3±1.5 cm versus 3.11±1.18 cm, P=0.032). Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088). Overall, disease-specific and disease-free survival rates were similar. Conclusion The use of a flexible cystoscope during partial cystectomy is a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method. PMID:25368846

  14. What should be the patient’s preference regarding the choice of hospital in the case of radical cystectomy? Evaluation of early complications after open radical cystectomy in a medium and high volume setting in one hospital

    PubMed Central

    Mani, Jens; Vallo, Stefan; Brandt, Maximilian P; Gust, Kilian M; Bartsch, Claudia; Daechert, Johannes; Tsaur, Igor; Bartsch, Georg; Haferkamp, Axel

    2016-01-01

    Purpose This study compares early complications after cystectomy and urinary diversion (UD) stratified by the surgical focus and case load of two different department chairpersons in a single institution in two time periods. Creating clear data about complications that can affect the quality of life is an important tool for patients to decide whether and where to perform this extensive surgery. Hypothesis A team of surgeons with a clear focus on pelvic surgery leads to lower complication rates in radical cystectomy. Materials and methods Radical cystectomy was performed in two separate time periods under the patronage of two different chairmen in the same university hospital. The patient data were analyzed retrospectively and the complications 30 days after surgery were assessed using the Clavien–Dindo classification. Results Statistical analysis showed a significant difference in the severity of complications between the two time periods, A and B, in total (P<0.001). When placing patients into subgroups, significantly more complications in period A were also seen concerning sex (male, P<0.001; female, P=0.003), age (<70 years, P<0.001; >70 years, P≤50.001) tumor grade (low grade, P<0.001; high grade, P≤0.001), and UD (ileal conduit, P<0.001; neobladder, P<0.001). In a multivariable analysis, age (P=0.031) and type of UD (P=0.028) were determined as independent predictors for complications in period A. When joining the two periods together, the type of UD (P=0.0417), age (P=0.041), and the time periods (A/B) (P<0.001) show a significant association with the presence of complications. Conclusion This study compares for the first time surgical complications in two time periods with different case load and surgical focus in one department. Categorization shows that patients should prefer radical cystectomy in centers of excellence or a high-volume hospital in order to keep complications at the lowest possible level and thus have the highest benefit for oncologic

  15. Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy.

    PubMed

    Mmeje, Chinedu O; Martin, Aaron D; Nunez-Nateras, Rafael; Parker, Alexander S; Thiel, David D; Castle, Erik P

    2013-02-01

    Bladder cancer is the fourth and ninth most common malignancy in males and females, respectively, in the U.S. and one of the most costly cancers to manage. With the current economic condition, physicians will need to become more aware of cost-effective therapies for the treatment of various malignancies. Robot-assisted radical cystectomy (RARC) is the latest minimally invasive surgical option for muscle-invasive bladder cancer. Current reports have shown less blood loss, a shorter hospital stay, and a lower morbidity with RARC, as compared with the traditional open radical cystectomy (ORC), although long-term oncologic results of RARC are still maturing. There are few studies that have assessed the cost outcomes of RARC as compared with ORC. Currently, ORC appears to offer a direct cost advantage due to the high purchase and maintenance cost of the robotic platform, although when the indirect costs of complications and extended hospital stay with ORC are considered, RARC may be less expensive than the traditional open procedure. In order to accurately evaluate the cost effectiveness of RARC versus ORC, prospective randomized trials between the two surgical techniques with long-term oncologic efficacy are needed.

  16. Barium appendicitis: A single institution review in Japan

    PubMed Central

    Katagiri, Hideki; Lefor, Alan Kawarai; Kubota, Tadao; Mizokami, Ken

    2016-01-01

    AIM To review clinical experience with barium appendicitis at a single institution. METHODS A retrospective review of patients admitted with a diagnosis of acute appendicitis, from January 1, 2013 to December 31, 2015 was performed. Age, gender, computed tomography (CT) scan findings if available, past history of barium studies, pathology, and the presence of perforation or the development of complications were reviewed. If the CT scan revealed high density material in the appendix, the maximum CT scan radiodensity of the material is measured in Hounsfield units (HU). Barium appendicitis is defined as: (1) patients diagnosed with acute appendicitis; (2) the patient has a history of a prior barium study; and (3) the CT scan shows high density material in the appendix. Patients who meet all three criteria are considered to have barium appendicitis. RESULTS In total, 396 patients were admitted with the diagnosis of acute appendicitis in the study period. Of these, 12 patients (3.0%) met the definition of barium appendicitis. Of these 12 patients, the median CT scan radiodensity of material in the appendix was 10000.8 HU, ranging from 3066 to 23423 HU (± 6288.2). In contrast, the median CT scan radiodensity of fecaliths in the appendix, excluding patients with barium appendicitis, was 393.1 HU, ranging from 98 to 2151 HU (± 382.0). The CT scan radiodensity of material in the appendices of patients with barium appendicitis was significantly higher than in patients with nonbarium fecaliths (P < 0.01). CONCLUSION Barium appendicitis is not rare in Japan. Measurement of the CT scan radiodensity of material in the appendix may differentiate barium appendicitis from routine appendicitis. PMID:27721929

  17. Risk of Fracture After Radical Cystectomy and Urinary Diversion for Bladder Cancer

    PubMed Central

    Gupta, Amit; Atoria, Coral L.; Ehdaie, Behfar; Shariat, Shahrokh F.; Rabbani, Farhang; Herr, Harry W.; Bochner, Bernard H.; Elkin, Elena B.

    2014-01-01

    Purpose Radical cystectomy and urinary diversion may cause chronic metabolic acidosis, leading to long-term bone loss in patients with bladder cancer. However, the risk of fractures after radical cystectomy has not been defined. We assessed whether radical cystectomy and intestinal urinary diversion are associated with increased risk of fracture. Patients and Methods Population-based study using SEER-Medicare–linked data from 2000 through 2007 for patients with stage 0-III bladder cancer. We evaluated the association between radical cystectomy and risk of fracture at any site, controlling for patient and disease characteristics. Results The cohort included 50,520 patients, of whom 4,878 had cystectomy and urinary diversion. The incidence of fracture in the cystectomy group was 6.55 fractures per 100 person-years, compared with 6.39 fractures per 100 person-years in those without cystectomy. Cystectomy was associated with a 21% greater risk of fracture (adjusted hazard ratio, 1.21; 95% CI, 1.10 to 1.32) compared with no cystectomy, controlling for patient and disease characteristics. There was no evidence of an interaction between radical cystectomy and age, sex, comorbidity score, or cancer stage. Conclusion Patients with bladder cancer who have radical cystectomy and urinary diversion are at increased risk of fracture. PMID:25185104

  18. Robotic-assisted laparoscopic partial cystectomy for symptomatic urachal hamartoma

    PubMed Central

    Shepler, Richard; Zuckerman, Jack M.; Troyer, Dean; Malcolm, John B.

    2016-01-01

    We report a case of an urachal hamartoma in a 30-year-old African American woman. The urachal lesion was excised with a robotic-assisted laparoscopic partial cystectomy. Pathologic analysis revealed cysts, smooth muscle, and ciliated epithelium consistent with a hamartoma. The patient recovered without complication. This case highlights an unusual pathology that is infrequently reported following urachal remnant excision. PMID:27011882

  19. Status of integrated irradiation and cystectomy for bladder cancer.

    PubMed

    Whitmore, W F; Batata, M

    1984-11-01

    The rationale and representative results of integrated irradiation and cystectomy for bladder cancer are reviewed and an hypothesis regarding the mechanism and benefits of such treatment formulated. The basis for uncertainty regarding the value of preoperative irradiation is outlined and a perspective on the resolution of this uncertainty provided.

  20. Laparoscopic Radical Cystectomy in the Elderly – Results of a Single Center LRC only Series

    PubMed Central

    Hermans, Tom J. N.; Fossion, Laurent M. C. L.; Verhoeven, Rob; Horenblas, Simon

    2016-01-01

    ABSTRACT Objective: To compare outcome of laparoscopic radical cystectomy (LRC) with ileal conduit in 22 elderly (≥75 years) versus 51 younger (<75 years) patients. Materials and Methods: Analysis of prospectively gathered data of a single institution LRC only series was performed. Selection bias for LRC versus non-surgical treatments was assessed with data retrieved from the Netherlands Cancer Registry. Results: Median age difference between LRC groups was 9.0 years. (77.0 versus 68.0 years). Both groups had similar surgical indications, body mass index and gender distribution. Charlson Comorbidity Index score was 3 versus 4 in ≥50% of younger and elderly patients. Median operative time (340 versus 341 min) and estimated blood loss (<500 versus >500mL) did not differ between groups. Median total hospital stay was 12.0 versus 14.0 days for younger and elderly patients. Grade I-II 90-d complication rate was higher for elderly patients (68 versus 43%, p=0.05). Grade III-V 90-d complication rate was equal for both groups (23 versus 29%, p=0.557). 90-d mortality rate was higher for elderly patients (14 versus 4%, p=0.157). Median follow-up was 40.0 months for younger and 57.0 months for elderly patients. Estimated overall and cancer-specific survival at 5years. was 46% versus 35% and 64% versus 64% for younger and elderly patients respectively. Conclusions: Our results suggest that LRC is feasible in elderly patients, where a non-surgical treatment is usually favoured. PMID:27532116

  1. Ileocolic neobladder post-cystectomy: continence and potency.

    PubMed

    Marshall, F F; Mostwin, J L; Radebaugh, L C; Walsh, P C; Brendler, C B

    1991-03-01

    Incontinence and impotence are 2 of the primary complications associated with total bladder reconstruction after cystectomy for carcinoma. These and other features are addressed in 25 patients who underwent total neobladder reconstruction following cystectomy for transitional cell carcinoma. Of these patients 20 had a urethral anastomosis. No patient had to wear a pad or device. Enuresis was rare. When the radical cystoprostatectomy population was contrasted with a radical prostatectomy patient population, continence was achieved more rapidly in the neobladder group. Potency was maintained in 15 of 21 (71%) evaluable patients. This ileocolic neobladder produces a large volume and low pressure, and provides excellent day and night continence. With preservation of the neurovascular bundle potency can be maintained in the majority of patients.

  2. Total Psoas Area Predicts Complications following Radical Cystectomy

    PubMed Central

    Lyon, Timothy D.; Farber, Nicholas J.; Chen, Leo C.; Fuller, Thomas W.; Davies, Benjamin J.; Gingrich, Jeffrey R.; Hrebinko, Ronald L.; Maranchie, Jodi K.; Taylor, Jennifer M.; Tarin, Tatum V.

    2015-01-01

    Purpose. To determine whether total psoas area (TPA), a simple estimate of muscle mass, is associated with complications after radical cystectomy. Materials and Methods. Patients who underwent radical cystectomy at our institution from 2011 to 2012 were retrospectively identified. Total psoas area was measured on preoperative CT scans and normalized for patient height. Multivariable logistic regression was used to determine whether TPA was a predictor of 90-day postoperative complications. Overall survival was compared between TPA quartiles. Results. 135 patients were identified for analysis. Median follow-up was 24 months (IQR: 6–37 months). Overall 90-day complication rate was 56% (75/135). TPA was significantly lower for patients who experienced any complication (7.8 cm2/m2 versus 8.8 cm2/m2, P = 0.023) and an infectious complication (7.0 cm2/m2 versus 8.7 cm2/m2, P = 0.032) than those who did not. On multivariable analysis, TPA (adjusted OR 0.70 (95% CI 0.56–0.89), P = 0.003) and Charlson comorbidity index (adjusted OR 1.34 (95% CI 1.01–1.79), P = 0.045) were independently associated with 90-day complications. TPA was not a predictor of overall survival. Conclusions. Low TPA is associated with infectious complications and is an independent predictor of experiencing a postoperative complication following radical cystectomy. PMID:26798336

  3. Extended partial cystectomy with augmentation cystoplasty in urachal adenocarcinoma: An oncologically favorable but underutilized alternative to radical cystectomy

    PubMed Central

    Valsangkar, Rohan Satish; Rizvi, Syed J.; Goyal, Niraj K.

    2016-01-01

    Partial/extended partial cystectomy (EPC) is the most common surgery done for localized urachal malignancies. However, sometimes, after EPC, patients may be left with small bladder remnant, reconstruction of which will result in very small capacity bladder with resultant severe storage voiding symptoms. We report a case of urachal adenocarcinoma, in which when a small bladder remnant was left post-EPC, instead of proceeding with radical cystectomy (RC) and neobladder (the standard alternative), bladder augmentation was done with good oncological and voiding outcome. Augmentation cystoplasty has many advantages over neobladder and we suggest it as an oncologically comparable alternative to RC with neobladder, which has been underutilized in urachal malignancies as we found on literature review. PMID:27453665

  4. Refining Patient Selection for Neoadjuvant Chemotherapy before Radical Cystectomy

    PubMed Central

    Culp, Stephen H.; Dickstein, Rian J.; Grossman, H. Barton; Pretzsch, Shanna M.; Porten, Sima; Daneshmand, Siamak; Cai, Jie; Groshen, Susan; Siefker-Radtke, Arlene; Millikan, Randall E.; Czerniak, Bogdan; Navai, Neema; Wszolek, Matthew F.; Kamat, Ashish M.; Dinney, Colin P. N.

    2014-01-01

    Purpose We evaluated the survival of patients with muscle invasive bladder cancer undergoing radical cystectomy without neoadjuvant chemotherapy to confirm the utility of existing clinical tools to identify low risk patients who could be treated with radical cystectomy alone and a high risk group most likely to benefit from neoadjuvant chemotherapy. Materials and Methods We identified patients with muscle invasive bladder cancer who underwent radical cystectomy without neoadjuvant chemotherapy at our institution between 2000 and 2010. Patients were considered high risk based on the clinical presence of hydroureteronephrosis, cT3b-T4a disease, and/or histological evidence of lymphovascular invasion, micropapillary or neuroendocrine features on transurethral resection. We evaluated survival (disease specific, progression-free and overall) and rate of pathological up staging. An independent cohort of patients from another institution was used to confirm our findings. Results We identified 98 high risk and 199 low risk patients eligible for analysis. High risk patients exhibited decreased 5-year overall survival (47.0% vs 64.8%) and decreased disease specific (64.3% vs 83.5%) and progression-free (62.0% vs 84.1%) survival probabilities compared to low risk patients (p <0.001). Survival outcomes were confirmed in the validation subset. On final pathology 49.2% of low risk patients had disease up staged. Conclusions The 5-year disease specific survival of low risk patients was greater than 80%, supporting the distinction of high risk and low risk muscle invasive bladder cancer. The presence of high risk features identifies patients with a poor prognosis who are most likely to benefit from neoadjuvant chemotherapy, while many of those with low risk disease can undergo surgery up front with good expectations and avoid chemotherapy associated toxicity. PMID:23911605

  5. Which Should Be the Preferred Technique During Laparoscopic Ovarian Cystectomy.

    PubMed

    Sahin, Cagdas; Akdemir, Ali; Ergenoglu, Ahmet Mete; Ozgurel, Banu; Yeniel, Ahmet Ozgur; Taskiran, Dilek; Sendag, Fatih

    2017-03-01

    The aim of the present study was to determine the long-term effects of different laparoscopic hemostatic techniques on ovarian reserve after ovarian cystectomy. Ninety patients with unilateral ovarian cysts were recruited and randomly distributed into 2 groups. Laparoscopic stripping cystectomy was performed in all patients. Afterward, cystectomy hemostasis was achieved via hemostatic suture or bipolar electrocoagulation. Serum levels of anti-Müllerian hormone (AMH) were determined preoperatively and postoperatively at 1, 3, and 12 months, and patients were evaluated for residual ovarian volume, antral follicle count, and pregnancy. The statistical difference was determined between the 2 groups in terms of AMH levels at 3 months (hemostatic suture group = 3.17 ± 3.40 vs bipolar electrocoagulation group = 2.38 ± 2.57, P = .006) and 12 months (hemostatic suture group = 3.71 ± 3.09 vs bipolar electrocoagulation group = 2.78 ± 2.85, P = .005). In addition, in the hemostatic suture group, there was no statistically significant difference between preoperative and postoperative AMH levels ( P = .165) and between the postoperative antral follicle count ( P = .779) and the residual ovarian volume ( P = .248), whereas in the bipolar electrocoagulation group, postoperative AMH levels were lower than preoperative levels ( P = .028) and postoperative residual ovarian volumes at 3 and 12 months were lower than those at 1 month ( P = .001). Nonetheless, pregnancy rates were not significantly different ( P = .546). Bipolar electrocoagulation is more destructive compared with hemostatic suture. However, the ovarian reserve does not decrease further during the follow-up period.

  6. Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.

    PubMed

    Chan, Yvonne; Fisher, Patrick; Tilki, Derya; Evans, Christopher P

    2016-04-01

    To summarise the current literature on the diagnosis and management of urethral recurrence (UR) after radical cystectomy (RC), as UR after RC is rare but associated with high mortality. With the recently increased use of orthotopic bladder substitution and the questionable benefit of prophylactic urethrectomy, identification of patients at high risk of UR, management of the remnant urethra, and treatment of UR become critical questions. A review of the PubMed database from 1980 to 2014 was performed to identify studies evaluating recurrent urothelial cancer of the urethra after RC. The search terms used included 'urethral recurrence', 'cystectomy' or 'cystoprostatectomy'. Selected studies provided information on the type of urinary diversion performed, the incidence of UR, and the time to UR. Incidence of UR after RC ranges from 1% to 8% with most recurrences occurring within the first 2 years after surgery. Increased risk of UR is associated with involvement of the prostate, tumour multifocality, bladder neck involvement, and cutaneous diversion. The median overall survival after UR ranges from 6 to 54 months and the 5-year disease-specific survival after UR is reported to be between zero and 83%. UR remains a relatively rare event. Current literature suggests that urethral wash cytology may be useful in patients with intermediate- to high-risk of recurrence to enable early detection of non-invasive disease, which may be amenable to conservative therapy before urethrectomy.

  7. Radical cystectomy with or without prior irradiation in the treatment of bladder cancer.

    PubMed

    Whitmore, W F; Batata, M A; Ghoneim, M A; Grabstald, H; Unal, A

    1977-01-01

    This is a summary presentation on certain aspects of an experience with the use of radical cystectomy with or without prior irradiation in the treatment of selected patients with bladder cancer at the Memorial Sloan-Kettering Cancer Center.

  8. The July Effect in Radical Cystectomy: Mortality, Morbidity, and Efficiency

    PubMed Central

    Zuk, Keegan; Jensen, Derek; Gills, Jessie; Wyre, Hadley; Holzbeierlein, Jeffrey M.; Lopez-Corona, Ernesto; Lee, Eugene K.

    2016-01-01

    Background: The “July effect” is the potential effect that new and recently promoted residents have on patient care during the first months of the academic year. Literature suggests that the July effect may worsen patient outcomes and lead to systemic inefficiencies. Objective: We evaluate the July effect on mortality, morbidity, and efficiency outcomes in patients undergoing radical cystectomy. Methods: A chart review was performed in patients who underwent radical cystectomy between January 2008 and April 2012. Demographic information was abstracted from patient charts and outcomes compared between operations performed in July, September, and November (first month of each resident’s university rotation) to the remainder of the year. Outcomes of interest included mortality, complications, and markers of efficiency (operative time, length of hospital stay, and estimated blood loss). Results: Two hundred and fifty one patients were included in the analysis. There were no major differences in mortality or morbidity between the July, September, November group and the rest of the year. Multivariable analysis demonstrates a trend for operations performed in the months of July, September, and November to be associated with longer OR times 2.06 (0.99–4.27), p = 0.053. Length of hospital stay and estimated blood loss were no different between the two groups. Conclusions: These data demonstrate no increase in mortality or morbidity during the early academic period. Additionally, while there is a trend for OR time to be longer in the early group, length of hospital stay and estimated blood loss were no different. These data may be used as an impetus to continue to investigate technical/clinical teaching practices, strategies to assess resident progression, and to initiate protocols to support residents early in the academic year in efforts to prevent inefficiencies. PMID:28035324

  9. Comparison of postoperative acute kidney injury between ileal conduit and neobladder urinary diversions after radical cystectomy

    PubMed Central

    Joung, Kyoung-Woon; Kong, Yu-Gyeong; Yoon, Syn-Hae; Kim, Yeon Ju; Hwang, Jai-Hyun; Hong, Bumsik; Kim, Young-Kug

    2016-01-01

    Abstract Ileal conduit and neobladder urinary diversions are frequently performed after radical cystectomy. However, complications after radical cystectomy may be different according to the type of urinary diversion. Acute kidney injury (AKI) is a common complication after surgery and increases costs, morbidity, and mortality of hospitalized patients. This study was performed to compare the incidence of postoperative AKI between ileal conduit and neobladder urinary diversions after radical cystectomy. All consecutive patients who underwent radical cystectomy in 2004 to 2014 in a single tertiary care center were identified. The patients were divided into the ileal conduit and ileal neobladder groups. Preoperative variables, including demographics, cancer-related data and laboratory values, as well as intraoperative data and postoperative outcomes, including AKI, intensive care unit admission rate, and the duration of hospital stay, were evaluated between the groups. Postoperative AKI was defined according to the Kidney Disease: Improving Global Outcome criteria. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences. After performing 1:1 propensity score matching, the ileal conduit and ileal neobladder groups each included 101 patients. The overall incidence of AKI after radical cystectomy was 30.7% (62 out of 202) and the incidences did not significantly differ between the groups (27 [26.7%], ileal conduit group vs 35 [34.7%], ileal neobladder group, P = 0.268). Intraoperative data, intensive care unit admission rate, and the duration of hospital stay were not significantly different between the groups. Postoperative AKI did not significantly differ between ileal conduit and neobladder urinary diversions after radical cystectomy. This finding provides additional information useful for appropriate selection of the urinary diversion type in conjunction with radical cystectomy

  10. Venous thromboembolism after radical cystectomy: Experience with screening ultrasonography

    PubMed Central

    Murray, Katie M.; Parker, William; Stephany, Heidi; Redger, Kirk; Mirza, Moben; Lopez-Corona, Ernesto; Holzbeierlein, Jeffrey M.; Lee, Eugene K.

    2015-01-01

    Objectives To detect the incidence of immediate postoperative deep vein thrombosis (DVT) using screening lower extremity ultrasonography (US) in patients undergoing radical cystectomy (RC) and to determine the rate of symptomatic pulmonary embolism (PE) after RC and identify risk factors for venous thromboembolic (VTE) events in a RC population. Patients and methods We performed a retrospective review of prospective data collected on patients who underwent RC between July 2008 and January 2012. These patients underwent screening US at 2/3 days after RC to determine the rate of asymptomatic DVT. A chart review was completed to identify those who had a symptomatic PE. Univariate and multivariable analysis was used to identify risk factors associated with DVT, PE and total VTE events. Results In all, 221 patients underwent RC and asymptomatic DVT was identified in 21 (9.5%) on screening US. Nine (4.5%) developed symptomatic PE at a median of 9 days, of which no patients had positive lower extremity US postoperatively. Increased length of hospital stay, increased estimated blood loss, and lower body mass index were linked to risk of PE, and only a previous history of DVT was associated with postoperative DVT. Conclusion Patients who undergo RC are at high-risk for thromboembolic events and multimodal prophylaxis should be administered. Clinicians should be especially vigilant in those who demonstrate factors associated with higher risk for VTE events. PMID:26966592

  11. The Use of Transanal Hemorrhoidal Dearterialization for Treatment of Hemorrhoid Disease at a Single Institution.

    PubMed

    Haskins, Ivy N; Holzmacher, Jeremy; Obias, Vincent; Agarwal, Samir

    2016-12-01

    Transanal hemorrhoidal dearterialization (THD) is a relatively new, minimally invasive approach for the treatment of hemorrhoid disease. Despite increasing use of this procedure, there remains scarce United States-based data on the perioperative variables affected by this surgical technique. This article details the experience with THD at a single institution. This is a single-institution study that includes consecutive patients that underwent THD at George Washington University from November 2011 to April 2014. After Institutional Review Board approval, retrospective chart review was performed. Patient demographic information, preoperative management of hemorrhoid disease, and quality of life indicators after THD were collected for all patients. A total of 96 patients underwent THD during the period of investigation. A majority of the patients were male and all patients had grade II or III hemorrhoids. Most patients who underwent THD presented with rectal bleeding. Four patients required postoperative admission to the hospital for pain control, eight patients experienced constipation postoperatively, and one patient had recurrence of their hemorrhoid disease at 30-day follow-up. No patients required admission to the hospital for postoperative hemorrhage and none experienced urinary retention or incontinence of flatus or stool. THD is a feasible alternative to Ferguson hemorrhoidectomy for the surgical treatment of grade II and III hemorrhoidal disease. Future prospective studies are needed to help improve patient selection for each respective surgical approach.

  12. Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute

    PubMed Central

    Cho, Bo Ra; Han, Jae Won; Kim, Tae Hyun; Han, Ae Ra; Hur, Sung Eun; Lee, Sung Ki

    2017-01-01

    Objective Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. Methods We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. Results SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m2, respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. Conclusion Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery. PMID:28217669

  13. Clinical outcome of partial cystectomy for transitional cell carcinoma of the canine bladder.

    PubMed

    Marvel, S J; Séguin, B; Dailey, D D; Thamm, D H

    2017-02-20

    Canine transitional cell carcinoma (TCC) of the bladder has historically been treated with a combination of chemotherapy, cyclooxygenase inhibitors and radiation therapy. While surgery has been used to treat TCC of the bladder, its efficacy has yet to be established. Thirty-seven client owned dogs that underwent partial cystectomy +/- various nonsurgical treatments for TCC were retrospectively evaluated. The overall median progression-free interval (PFI) was 235 days and the median survival time (ST) was 348 days. Prognostic factors identified on univariate analysis significant for ST were age, tumor location, full thickness excision and frequency of piroxicam administration. Prognostic factors significant for PFI were full thickness excision and frequency of piroxicam administration. The median ST with partial cystectomy and daily piroxicam therapy, with or without chemotherapy, was 772 days. Dogs with non-trigonal bladder TCC treated with full thickness partial cystectomy and daily piroxicam (+/- chemotherapy) may have improved outcome compared to dogs treated with medical therapy.

  14. A comparative study of two preoperative radiation regimens with cystectomy for bladder cancer.

    PubMed

    Whitmore, W F; Batata, M A; Hilaris, B S; Reddy, G N; Unal, A; Ghoneim, M A; Grabstald, H; Chu, F

    1977-09-01

    This report surveys the results of two programs of preoperative irradiation with radical cystectomy for bladder cancer in 205 patients. Irradiating the true pelvis to 4000 rads in 4 weeks with radical cystectomy after 6 weeks was implemented in 119 patients (Group 1) from 1959 to 1965; 2000 rads given in 1 week to the true pelvis and radical cystectomy within the following week was implemented in 86 patients (Group 2) from 1966 to 1970. Determinate survival without evidence of recurrence at 5 years was 43% in Group 1 and 42% in Group 2. Mortality with recurrence of bladder cancer in 5 or more years was 44% in group 1 and 42% in group 2. Pelvic complications occurred in 13% of group 1 and 9% of group 2.

  15. Helicobacter pylori infection and thrombocytopenia: a single-institution experience in Mexico.

    PubMed

    Estrada-Gómez, Roberto A; Parra-Ortega, Israel; Martínez-Barreda, Carlos; Ruiz-Argüelles, Guillermo J

    2007-01-01

    The association between gastrointestinal H. pylori infection and thrombocytopenia was studied in a single institution in Mexico, over a 5-year period. In 99 individuals with H. pylori infection, the prevalence of thrombocytopenia was 14%, whereas in 23 consecutive patients with chronic refractory thrombocytopenic purpura, the prevalence of H. pylori infection was 60%, this figure being similar to that informed in the general population of Mexico (66%); the association between thrombocytopenia and H. pylori infection was not significant. In 14 patients who were found to have both thrombocytopenia and H. pylori infection, eradication treatment was given and the platelet count recovered in three. It is not still clear if detection of H. pylori infection should be routinely included in the initial workup of chronic thrombocytopenia.

  16. Alvimopan in an Enhanced Recovery Program Following Radical Cystectomy

    PubMed Central

    Hamilton, Zach; Parker, Will; Griffin, Josh; Isaacson, Tanner; Mirza, Moben; Wyre, Hadley; Holzbeierlein, Jeffrey; Lee, Eugene K.

    2015-01-01

    Abstract Background: Radical cystectomy (RC) carries a high complication rate, including post-operative ileus. Alvimopan is an FDA approved peripherally acting μ-opioid receptor antagonist that has shown favorable results for improved recovery of gastro-intestinal function resulting in decreased hospital length of stay. Many enhanced recovery pathways (ERP) have been published demonstrating improved outcomes with decreased hospital stay and morbidity. Objective: We evaluated the addition of alvimopan to an ERP in patients undergoing RC. Methods: Patients undergoing RC at our institution during the implementation phase of alvimopan to our established ERP were retrospectively reviewed. Effect of alvimopan as it related to the use of nasogastric tubes, time to initiation of regular diet, and length of hospital stay was assessed using Chi-squared and Student’s T-tests. Linear regression was performed for univariate analysis and binary logistic regression was performed as a multivariate assessment of the effect of alvimopan. Results: Between July 2011 and January 2013, 80 patients were identified who underwent RC under the ERP (34 alvimopan and 46 standard care). Age, sex, neoadjuvant chemotherapy, surgical technique (open vs. robotic), and type of urinary diversion were not different between groups. Alvimopan was associated with a reduction in mean time to regular diet (5.3 vs 4.1 days, p <  0.01) and a reduction in mean length of hospital stay (6.9 vs 5.7 days, p = 0.01). After controlling for other variables, alvimopan usage predicted for shorter time to regular diet and total hospital stay. Conclusions: Alvimopan may help to improve time to regular diet and decrease hospital stay in patients on an enhanced recovery pathway. PMID:27398398

  17. Effects of thyroid cystectomy for primary hyperparathyroidism on immune function

    PubMed Central

    Yin, Xiangdang; Hu, Liang; Wang, Xiaochun

    2016-01-01

    Objective: To evaluate the effects of thyroid cystectomy for primary hyperparathyroidism on immune function. Methods: Ninety-two patients with parathyroid cysts complicated with primary hyperparathyroidism were randomly divided into a treatment group and a control group (n=46). The treatment group received endoscopic thyroidectomy through the anterior chest wall via the areolar approach, and the control group was treated with conventional open thyroidectomy. Results: The two groups had similar immune function indices as well as thyroid hormone, serum calcium and phosphorus levels before surgery (P>0.05). After surgery, FT3 and FT4 levels significantly increased in both groups, whereas that of TSH significantly decreased (P<0.05). The levels of the two groups differed significantly on the postoperative 5th day (P<0.05). NK%, CD3+%, CD4+% and CD8+%, which significantly fluctuated on the postoperative 1st day in both groups (P<0.05), were basically recovered on the postoperative 5th day in the treatment group that had significantly different outcomes from those of the control group (P<0.05). On the postoperative 1st and 5th days, the treatment group had significantly lower serum calcium level and significantly higher serum phosphorus level than those of the control group (P<0.05). The surgeries were successfully performed for all patients. During three months of follow-up, the treatment group was significantly less prone to complications such as surgical site infection, recurrent laryngeal nerve injury, parathyroid crisis and hoarseness than the control group (P<0.05). Conclusion: For treatment of primary hyperparathyroidism, endoscopic thyroidectomy through the anterior chest wall via the areolar approach decreased the incidence rate of complications, as well as promoted the recovery of serum calcium and phosphorous levels, probably by only mildly affecting immune function and thyroid hormone levels. PMID:27022378

  18. Experimental supratrigonal cystectomy: II--Evaluation of urinary calculi, infection, and bladder dysfunction in the pathogenesis of renal failure.

    PubMed

    Barros, Milton; Martinelli, Reinaldo; Rocha, Heonir

    2008-01-01

    The objective of this study was to evaluate the role of urolithiasis, infection, and bladder dysfunction in the pathogenesis of renal failure in rats subjected to supratrigonal cystectomy. One group of Sprague-Dawley rats was submitted to supratrigonal cystectomy, a second to cystectomy during which a suspension of Proteus mirabilis was injected into the bladder stump, and a third to sham surgery (controls). The animals were sacrificed two months after surgery. Blood pressure and serum urea and creatinine were measured before surgery and at sacrifice when a careful inspection of the urinary tract was performed to determine the presence of hydronephrosis and calculi. Microbiological analyses were performed on urine aspirated from the bladder and on the kidneys. Significant differences were found between values of systolic blood pressure and serum urea and creatinine recorded prior to the surgical procedure and those recorded at sacrifice in each group except the control group. Renal failure was present in all animals subjected to cystectomy. Urinary calculi were documented in 5/10 animals subjected to cystectomy only and in all rats inoculated with P. mirabilis. Hypertension was documented in 43.75% of animals subjected to cystectomy. Pyelonephritis was diagnosed only in animals with urinary calculi, in each of which urine culture was also positive. No cases of renal failure, hypertension, calculi, and/or pyelonephritis were detected in the sham group. The findings of this study indicate that kidney failure in rats subjected to supratrigonal cystectomy is related to the severe bladder dysfunction induced by the surgical procedure.

  19. Systematic review of perioperative outcomes and complications after open, laparoscopic and robot-assisted radical cystectomy.

    PubMed

    Palazzetti, A; Sanchez-Salas, R; Capogrosso, P; Barret, E; Cathala, N; Mombet, A; Prapotnich, D; Galiano, M; Rozet, F; Cathelineau, X

    2016-11-28

    Radical cystectomy and regional lymph node dissection is the standard treatment for localized muscle-invasive and for high-risk non-muscle-invasive bladder cancer, and represents one of the main surgical urologic procedures. The open surgical approach is still widely adopted, even if in the last two decades efforts have been made in order to evaluate if minimally invasive procedures, either laparoscopic or robot-assisted, might show a benefit compared to the standard technique. Open radical cystectomy is associated with a high complication rate, but data from the laparoscopic and robotic surgical series failed to demonstrate a clear reduction in post-operative complication rates compared to the open surgical series. Laparoscopic and robotic radical cystectomy show a reduction in blood loss, in-hospital stay and transfusion rates but a longer operative time, while open radical cystectomy is typically associated with a shorter operative time but with a longer in-hospital admission and possibly a higher rate of high grade complications.

  20. Intraneobladder Hem-o-Lok Migration with Stone Formation after Orthotopic Neobladder Cystectomy.

    PubMed

    Shu-Xiong, Zeng; Zhen-Sheng, Zhang; Xiao-Wen, Yu; Hui-Zhen, Li; Xin, Lu; Ying-Hao, Sun; Chuan-Liang, Xu

    2014-01-01

    Introduction. Laparoscopic and robot-assisted laparoscopic surgery are widely performed in urology field, so Hem-o-Lok clips are thus extensively used in the laparoscopic procedures. We describe the first case of Hem-o-Lok clip which migrated into the neobladder with calculus formation 26 months after laparoscopic orthotopic neobladder cystectomy, which causes symptoms of gross hematuria and frequent urination. Case Presentation. A 57-year-old man with T2a muscle invasive bladder cancer underwent laparoscopic orthotopic sigmoid neobladder reconstruction after cystectomy which was complicated by intestinal anastomosis leak and peritoneal abscess requiring transverse colostomy and drainage 15 days postoperatively. Twenty-six months after cystectomy, he complained of gross hematuria and frequent urination. Computerized tomography and plain pelvic X-ray revealed a stone measuring approximately 2.8 cm in diameter in the neobladder. During cystoscopy, a closed whitish Hem-o-Lok clip was seen in the center of the calculi. No anastomotic leak or neoplasm was found during cystoscopy. Conclusion. Hem-o-Lok clip migration into the bladder after laparoscopic orthotopic neobladder cystectomy is a rare complication; the first reported case in the literature. To prevent Hem-o-Lok clip migration, it is recommended to avoid extensive use of Hem-o-Lok clip close to anastomosis site, and any loose Hem-o-Lok clip should be retrieved before closure.

  1. Bladder cancer in men and women treated by radiation therapy and/or radical cystectomy.

    PubMed

    Batata, M A; Chu, F C; Hilaris, B S; Whitmore, W F; Kim, Y S; Lee, M Z

    1981-07-01

    Four-hundred fifty-one patients with bladder cancer, 348 men and 103 women, were treated by radiation therapy and/or radical cystectomy during the last two decades at Memorial Sloan-Kettering Cancer Center. Radical cystectomy alone was the treatment in 98 men and 39 women. Radical radiation therapy to an average tumor dose of 6,000 rad in six weeks was given to 79 men and 30 women +/- one year before salvage cystectomy was done for recurrent or persistent tumors. Planned preoperative irradiation was delivered to the true pelvis either 4,000 rad in four weeks in 95 men and 24 women or 2,000 rad in one week in 76 men and 10 women +/- six weeks and two days, respectively, before radical cystectomy. Over-all survival and recurrence results in both sexes were similar, 40 per cent of men and 36 per cent of women were alive at five years without recurrence, 45 per cent of men and 48 per cent of women died in five or more years with local and/or distant recurrences, and 21 per cent of men and 15 per cent of women died before five years from causes other than cancer recurrence. Higher five-year survival for high clinical stage B2 to D1 tumors was noted similarly in the irradiated men (30 per cent) and women (37 per cent) than in the cystectomy alone patients (19 per cent in men and 4 per cent in women). Similar survival rates (52 to 57 per cent) were observed in men and women with low clinical stage O to B1 tumors treated with or without irradiation.

  2. Poor Hematopoietic Stem Cell Mobilizers in Multiple Myeloma: a Single Institution Experience.

    PubMed Central

    Ruiz-Delgado, Guillermo J.; López-Otero, Avril; Hernandez-Arizpe, Ana; Ramirez-Medina, Aura; Ruiz-Argüelles., Guillermo J.

    2010-01-01

    In a single institution, in a group of 28 myeloma patients deemed eligible for autologous transplant, stem cell mobilization was attempted using filgrastim: 26 individuals were given 31 autografts employing 1–4 (median three) apheresis sessions, to obtain a target stem cell dose of 1 x 106 CD34 +ve viable cells / Kg of the recipient. The median number of grafted CD34 cells was 7.56 x 106 / Kg of the recipient; the range being 0.92 to 14.8. By defining as poor mobilizers individuals in which a cell collection of < 1 x 106 CD34 viable cells / Kg was obtained, a subset of eight poor mobilizers was identified; in two patients the autograft was aborted because of an extremely poor CD34 +ve cell yield (< 0.2 x 106 CD34 +ve viable cells / Kg of the recipient) after four apheresis sessions. The long-term overall survival of the patients grafted with > 1 x 106 CD34 +ve viable cells / Kg was better (80% at 80 months) than those grafted with < 1 x 106 CD34 +ve viable cells / Kg (67% at 76 months). Methods to improve stem cell mobilization are needed and may result in obtaining better results when autografting multiple myeloma patients. PMID:21415967

  3. In pursuit of the graft-versus-myeloma effect: a single institution experience.

    PubMed

    Galo-Hooker, Evelyn Gisella; Ruiz-Delgado, Guillermo José; Zamora-Ortiz, Gabriela; Velazquez-Sanchez-de-Cima, Sara; Ruiz-Arguelles, Guillermo José

    2013-03-01

    Partly because of a potential graft-versus-myeloma effect, allogeneic stem cell transplantation is a potentially curative treatment modality in patients with multiple myeloma (MM). Initial attempts have been hampered by the high transplant-related mortality in this setting. With a reduction of toxicity, allogeneic transplant approaches with reduced-intensity conditioning (RIC) have been utilized, although they are subjected to continued disease progression and relapse following transplantation. We analyze here the experience of allografting four patients with MM in a single institution, along a 16-year period in which a total of 152 individuals were allografted, using an RIC regimen; three of the patients have had previous autografts. All patients engrafted successfully and a graft-versus-myeloma effect was shown in all of them. One patient relapsed in the face of graft-versus-host disease (GVHD). Three patients have died (two as a result of GVHD) and one is alive with a limited form of chronic GVHD. The graft-versus-myeloma effect can be induced by means of allogeneic transplantation but the morbidity and mortality associated with the procedure leads into a relatively small proportion of MM patients being cured.

  4. A simplified method for stem cell autografting in multiple myeloma: a single institution experience.

    PubMed

    López-Otero, A; Ruiz-Delgado, G J; Ruiz-Argüelles, G J

    2009-12-01

    In a 14-year period in a single institution 31 autografts were performed in 26 patients with multiple myeloma (MM), using a simplified and affordable autografting procedure: conducting the grafts on an outpatient basis and avoiding stem cell freezing. Autografts were started on an outpatient basis in all instances, but four patients were admitted to the hospital. Median time to achieve more than 0.5 x 10(9)/l granulocytes was 27 days, whereas median time to recover above 20 x 10(9)/l plts was 37 days. CR was achieved in 19 cases and a very good partial response in 6 cases. The 100-day mortality was 9.6%. The overall median post-transplant survival has not been reached, being above 76 months, whereas the 76-month survival is 80%. The median cost of each procedure was US$ 15 000. Survival results were substantially better than those of historical control in a group of patients treated in the same institution with melphalan/prednisone. It is concluded that high-dose therapy rescued with a simplified autologous stem cell graft is a valid, useful and affordable therapeutic option for patients with MM, even with economical restraints.

  5. Malignant salivary gland tumours of the larynx: a single institution review.

    PubMed

    Karatayli-Ozgursoy, S; Bishop, J A; Hillel, A T; Akst, L M; Best, S R

    2016-08-01

    Malignant salivary gland tumours of the larynx are very rare, with limited reports of clinical outcomes. We present the decade-long experience of a single institution. A 10-year retrospective chart review of a tertiary head and neck cancer centre was performed. Index patients were identified from a review of a pathology database, and reviewed by a head and neck pathologist. Patient demographics, presenting signs and symptoms, treatment modalities and clinical outcomes were extracted from electronic medical records. Six patients were included, with an age range of 44 to 69. All six had malignant laryngeal salivary gland tumours. Pathologies included: three adenoid cystic carcinoma (2 supraglottic, 1 subglottic), one mucoepidermoid carcinoma (supraglottic), one epithelial-myoepithelial carcinoma (supraglottic) and one adenocarcinoma (transglottic). All were treated with surgery (2 endolaryngeal, 4 open) and five of six with the addition of adjuvant therapy (4 radiotherapy, 1 concurrent chemoradiation). One patient had smoking history; no patients had significant alcohol history. With 4.5 years of median follow-up, none of the patients has had recurrence or local/distant metastasis. Salivary gland tumours of the larynx present in mid to late-age, and can be successfully managed with a multi-modality approach, resulting in excellent local and regional control rates.

  6. Poor hematopoietic stem cell mobilizers in multiple myeloma: a single institution experience.

    PubMed

    Ruiz-Delgado, Guillermo J; López-Otero, Avril; Hernandez-Arizpe, Ana; Ramirez-Medina, Aura; Ruiz-Argüelles, Guillermo J

    2010-06-21

    In a single institution, in a group of 28 myeloma patients deemed eligible for autologous transplant, stem cell mobilization was attempted using filgrastim: 26 individuals were given 31 autografts employing 1-4 (median three) apheresis sessions, to obtain a target stem cell dose of 1 x 10(6) CD34 +ve viable cells / Kg of the recipient. The median number of grafted CD34 cells was 7.56 x 10(6) / Kg of the recipient; the range being 0.92 to 14.8. By defining as poor mobilizers individuals in which a cell collection of < 1 x 10(6) CD34 viable cells / Kg was obtained, a subset of eight poor mobilizers was identified; in two patients the autograft was aborted because of an extremely poor CD34 +ve cell yield (< 0.2 x 10(6) CD34 +ve viable cells / Kg of the recipient) after four apheresis sessions. The long-term overall survival of the patients grafted with > 1 x 10(6) CD34 +ve viable cells / Kg was better (80% at 80 months) than those grafted with < 1 x 10(6) CD34 +ve viable cells / Kg (67% at 76 months). Methods to improve stem cell mobilization are needed and may result in obtaining better results when autografting multiple myeloma patients.

  7. Tumors of the foot and ankle: a single-institution experience.

    PubMed

    Azevedo, Cristina P; Casanova, José M; Guerra, Marta G; Santos, António L; Portela, Maria I; Tavares, Paulo F

    2013-01-01

    Tumors of the foot and ankle are rare, and the particular clinicopathologic features, therapeutic approach, and outcomes in this setting are not well established. From January 2000 to December 2010, 72 patients with primary musculoskeletal tumors of the foot and ankle, both benign and malignant, were treated at a single institution. Of the 72 patients, 56% were female. The median age was 52 years. Of the 72 tumors, 62 (86.11%) were located in the foot and 10 were located in the ankle; 63 (87.5%) were soft tissue tumors and 9 (12.5%) were bone tumors. Overall, 56 (78%) were benign tumors and 16 (22%) were malignant tumors. The most frequent soft tissue and bone diagnosis was giant cell tumor. The median follow-up period was 49 months. The vast majority of the tumors were located in the foot. Benign tumors were dominant, outnumbering malignant tumors by more than 3 to 1. The diversity of the histologic benign types was evident, with giant cell tumor, angiomyoma, and lipoma the most frequent. Regarding the malignant tumors, a clear male predominance was present, the median age was 45 years, and the most frequent tumor was synoviosarcoma. The 9-year overall and disease-free survival rate was 65% and 40%, respectively.

  8. A single institution report of 19 hepatocellular carcinoma patients with bile duct tumor thrombus

    PubMed Central

    Chotirosniramit, Anon; Liwattanakun, Akkaphod; Lapisatepun, Worakitti; Ko-iam, Wasana; Sandhu, Trichak; Junrungsee, Sunhawit

    2017-01-01

    Background Obstructive jaundice caused due to bile duct tumor thrombus (BDTT) in a hepatocellular carcinoma (HCC) patient is an uncommon event. This study reports our clinical experiences and evaluates the outcomes of HCC patients with BDTT in a single institution. Methods A retrospective review of 19 HCC patients with secondary obstructive jaundice caused due to BDTT during a 15-year period was conducted. Results At the time of diagnosis, 14 (73.7%) patients had obstructive jaundice. Eighteen (94.7%) patients were preoperatively suspected of “obstruction of the bile duct”. Sixteen patients (84.2%) underwent a hepatectomy with curative intent, while two patients underwent removal of BDTT combined with biliary decompression and another patient received only palliative care as his liver reserve and general condition could not tolerate the primary tumor resection. The overall early recurrence (within 1 year) after hepatectomy occurred in more than half (9/16, 56.3%) of our patients. The 1-year survival rate of patients was 75% (12/16). The longest disease-free survival time was >11 years. Conclusion Identification of HCC patients with obstructive jaundice is clinically important because proper treatment can offer an opportunity for a cure and favorable long-term survival. PMID:28331844

  9. Are Historically Black Colleges and Universities (HBCUs) in the United States a Single Institutional Group? Evidence from Educational Outcomes

    ERIC Educational Resources Information Center

    Simms, Kathryn; Bock, Sara

    2014-01-01

    Historically Black Colleges and Universities (HBCUs) have been studied consistently as a single institutional group. However, at least ostensibly, HBCUs are relatively heterogeneous. Consequently, we evaluated the homogeneity of three educational outcomes that have been recognized as potentially distinguishing features of HBCUs (i.e., STEM major,…

  10. Diverticulectomy in the Management of Intradiverticular Bladder Tumors: A Twelve-Year Experience at a Single Institution.

    PubMed

    Bourgi, Ali; Ayoub, Elias; Merhej, Sleiman

    2016-01-01

    Purpose. In this retrospective case review we analyze the outcomes of patients treated for intradiverticular bladder tumors (IDT). Materials and Methods. A retrospective case review was done between January 2002 and May 2014 in Hotel-Dieu de France hospital. The series included 17 patients diagnosed with IDT, all males with a mean age of 49.8 years. Results. One patient was treated with tumor resection and adjuvant BCG instillation with no recurrence on follow-up cystoscopies and urine cytologies. 64% of patients were treated by diverticulectomy. Mean follow-up time was 38.7 months. At the end of the follow-up, 81% were disease-free. One patient had a radical cystectomy 6 months after diverticulectomy for recurrent high grade tumor; another one had a nodal metastasis 10 months after diverticulectomy and was managed with chemotherapy. 29% of patients were treated with radical cystectomy. Mean follow-up time was 28.4 months. No recurrence was documented on annual CT scans. Conclusions. Our data support a conservative approach for tumors confined to the bladder diverticulum, even in high grade or in the presence of CIS provided complete removal is feasible and close follow-up is ensured.

  11. Five-year survivors of brain metastases: A single-institution report of 32 patients

    SciTech Connect

    Chao, Samuel T.; Barnett, Gene H.; Liu, Stephanie W.; Reuther, Alwyn M.; Toms, Steven A.; Vogelbaum, Michael A.; Videtic, Gregory; Suh, John H. . E-mail: suhj@ccf.org

    2006-11-01

    Purpose: To report on 32 patients who survived {>=}5 years from brain metastases treated at a single institution. Methods and Materials: The records of 1288 patients diagnosed with brain metastases between 1973 and 1999 were reviewed. Patients were treated with whole-brain radiation therapy (WBRT), surgery, and/or stereotactic radiosurgery (SRS). Thirty-two (2.5%) {>=}5-year survivors were identified. Factors contributing to long-term survival were identified. Results: Median survival was 9.3 years for {>=}5-year survivors. Seven of these patients lived {>=}10 years. Female gender was the only patient characteristic that correlated with better survival (p = 0.0369). When these patients were compared with <5-year survivors, age <65 years (p = 0.0044), control of the primary at diagnosis (p = 0.0052), no systemic disease (p = 0.0012), recursive partitioning analysis (RPA) Class 1 (p = 0.0002 with Class 2; p = 0.0022 with Class 3), and single brain metastasis (p = 0.0018) were associated with long-term survival in the univariate logistic regression model. In the multivariate model, RPA Class 1 compared with Class 2 (OR = 0.39, p = 0.0196), surgery (OR = 0.16, p < 0.0001), and SRS (OR = 0.41, p = 0.0188) were associated with long-term survival. Conclusions: For patients with good prognostic factors such as young age, good RPA characteristics and single metastasis, treatment with surgery or SRS offers the best chance for long-term survival.

  12. Brachytherapy or Conformal External Radiotherapy for Prostate Cancer: A Single-Institution Matched-Pair Analysis

    SciTech Connect

    Pickles, Tom; Keyes, Mira; Morris, W. James

    2010-01-15

    Purpose: In the absence of randomized study data, institutional case series have shown brachytherapy (BT) to produce excellent biochemical control (bNED) in patients with localized prostate cancer compared with alternative curative treatments. This study was designed to overcome some of the limitations of case series studies by using a matched-pair design in patients treated contemporaneously with BT and external beam radiation therapy (EBRT) at a single institution. Methods and Materials: Six hundred one eligible patients treated between 1998 and 2001 were prospectively followed up in our institutional databases and matched on a 1:1 basis for the following known prognostic variables: prostate-specific antigen (PSA) level, Gleason score, T stage, the use and duration of neoadjuvant androgen deprivation therapy, and the percentage of positive tissue core samples. Two hundred seventy-eight perfect matches of patients (139 in each group) with low- and intermediate-risk cancer were further analyzed. bNED (Phoenix definition) was the primary endpoint. Other endpoints were toxicity, PSA kinetics, and the secondary use of androgen deprivation therapy. Results: The 5-year bNED rates were 95% (BT) and 85% (EBRT) (p < 0.001). After 7 years, the BT bNED result was unchanged, but the rate in EBRT patients had fallen to 75%. The median posttreatment PSA nadirs were 0.04 ng/mL (BT) and 0.62 ng/mL (EBRT, p < 0.001), which predicted a higher ongoing treatment failure rate in association with EBRT use than with BT use. Late urinary toxicity and rectal/bowel toxicity were worse in patients treated with BT and EBRT, respectively. Conclusions: BT for both low-risk and selected intermediate-risk cancers achieves exceptional cure rates. Even with dose escalation, it will be difficult for EBRT to match the proven track record of BT seen over the past decade.

  13. Incidence, clinical features, and treatment of familial moyamoya in pediatric patients: a single-institution series.

    PubMed

    Gaillard, Jonathan; Klein, Jennifer; Duran, Daniel; Storey, Armide; Scott, R Michael; Kahle, Kristopher; Smith, Edward R

    2017-03-10

    OBJECTIVE Limited data exist on familial moyamoya in children. The purpose of this study was to characterize presentation and outcomes of pediatric moyamoya patients who have relatives diagnosed with moyamoya. METHODS The authors performed a single-institution retrospective analysis of a case series including all surgically treated children with moyamoya with first- or second-degree relatives with moyamoya. Clinical and radiographic characteristics were analyzed, along with surgical outcomes. RESULTS A total of 537 patients underwent surgery for moyamoya during the study period. Eighteen of those patients (3.4% of the total series) had moyamoya and a family history of moyamoya and were included in this study. Of these 18 patients, 14 were non-twin siblings, and the remaining 4 represented 2 pairs of identical (affected) twins. The presentation was predominantly ischemic (72%), but 4 patients (33%) were asymptomatic when they were found to have moyamoya. Bilateral disease was present in 13 patients (72%). Radiographic stroke prevalence (67%), Suzuki grade (3.3), and angiographic findings were comparable to findings in nonfamilial moyamoya patients. Thirty revascularization procedures were performed, with a 3.3% operative stroke rate per hemisphere and no new strokes in an average follow-up period of 4.5 years. CONCLUSIONS In a North American surgical series, familial moyamoya existed in 3.4% of cases, and was distinguished by manifesting in a broad range of ethnic groups, with a higher proportion of male patients and increased rates of asymptomatic and unilateral disease in comparison to nonfamilial moyamoya. Screening indications remain controversial and the current data are used to suggest guidelines. Surgical therapy is warranted, effective, and durable in these patients, but patients should be carefully selected.

  14. Impact of preoperative imaging on surgical approach for primary hyperparathyroidism: Data from single institution in India

    PubMed Central

    Kaur, Parjeet; Gattani, Raghav; Singhal, Alka Ashmita; Sarin, Deepak; Arora, Sowrabh Kumar; Mithal, Ambrish

    2016-01-01

    Context: Preoperative localization of parathyroid adenoma is essential in deciding the surgical approach of parathyroidectomy. Aim: To describe clinical and biochemical profile, evaluate preoperative imaging modalities and surgical approach in patients with primary hyperparathyroidism (PHPT). Methodology: This was a retrospective study conducted at the single institution. All patients who underwent evaluation and surgery for PHPT from 2011 to 2015 were included in the study. Results: A total of 100 patients underwent surgery for PHPT. Mean (standard deviation) age was 51.6 (15.9) years with female to male ratio of 1.7:1. Forty patients had severe symptoms, and sixty had mild to moderate symptoms. The sensitivity of technetium-99m hexakis (2-methoxyisobutylisonitrile) (MIBI) scan and ultrasonography (USG) neck in identifying abnormal parathyroid gland was 93% (93/100) and 98% (98/100), respectively. The MIBI scan results of 90/93 (96.7%) patients corresponded with their surgical findings whereas preoperative USG findings of 96/98 patients (98%) showed correlation with operative findings. Intraoperative intact parathyroid hormone (IOPTH) levels at 10 min postexcision were measured in forty patients (minimally invasive parathyroidectomy = 38, bilateral neck exploration = 1, and unilateral neck exploration = 1). All patients except two had <50% fall in IOPTH. Adenoma weight was positively correlated with preoperative intact PTH. Conclusion: We found that USG has higher sensitivity (98%) than MIBI scan (93%) in localizing abnormal parathyroid gland. Moreover, USG had a higher preoperative localization accuracy (93%) than MIBI scan (90%), allowing to choose an appropriate surgical approach. A higher proportion of patients (60%) had mild/asymptomatic form of PHPT. PMID:27730071

  15. Surgical management of Wilms tumor with intravascular extension: a single-institution experience.

    PubMed

    Aspiazu, Diego; Fernandez-Pineda, Israel; Cabello, Rosa; Ramirez, Gema; Alvarez-Madrid, Antonio; De Agustin, Juan Carlos

    2012-02-01

    The purpose of this study was to retrospectively analyze the clinical presentation, treatment, and outcomes of children with Wilms tumor (WT) and intravascular extension who were treated at a single institution. A retrospective review was conducted of medical records of all children with Wilms tumor and intravascular extension treated at Virgen del Rocio Children's Hospital between 1992 and 2010. Seven patients (median age 3.4 years, range 2-8.1 years) were identified. At diagnosis, 6 of the 7 patients (85.7%) presented with tumor thrombus that reached the right atrium (RA) and 1 patient with infrahepatic inferior vena cava (IVC) thrombus. All patients received neoadjuvant chemotherapy (SIOP 2001 protocol) with vincristine, doxorubicin, and actinomycin D. Regression of the intravascular extension of the tumor was documented in all patients. Postchemotherapy level of extension was suprahepatic IVC in 1 patient, infrahepatic IVC in 2 patients, renal vein (RV) in 1 patient, and RA in 3 patients. Nephrectomy and thrombectomy were performed in all cases, requiring cardiopulmonary bypass for the 4 patients who presented with suprahepatic IVC and RA thrombus. The other 3 patients with infrahepatic IVC and RV involvement underwent cavotomy and thrombus extraction. Computed tomography, ultrasonography, and echocardiography were used for diagnosis and follow-up. All patients remain disease-free with a median follow-up of 6.3 years (range, 2-19 years). Neoadjuvant chemotherapy for WT with intravascular extension may facilitate the resection by decreasing the extent of the tumor thrombus. Cardiopulmonary bypass is indicated for suprahepatic IVC and RA involvement. Accurate diagnostic imaging is necessary.

  16. Late-Presenting Congenital Diaphragmatic Hernia in Children: The Experience of Single Institution in Korea

    PubMed Central

    Kim, Dong Jin

    2013-01-01

    Purpose Late-presenting congenital diaphragmatic hernia (CDH) beyond the neonatal period is rare and often misdiagnosed, with delayed treatment. Materials and Methods We retrospectively reviewed our experience with late-presenting CDH over 30 years at a single institution to determine the characteristics of late-presenting CDH for early diagnosis. Results Seven patients had operations due to late-presenting CHD in our institution over 30 years. The patients' ages ranged from 2.5 months to 16 years. There were six boys and one girl. Five hernias were left-sided, one was right-sided and one was a retrosternal hernia. All patients had normal intestinal rotation. Non-specific gastrointestinal or respiratory symptoms and signs were usually presented. Intestinal malrotations were absent; therefore, only organs adjacent to the defect or relatively movable organs such as the small bowel and transverse colon were herniated. Two cases were accompanied by stomach herniation with the volvulus and liver, respectively. The duration from presentation to diagnosis varied from 5 days to 1 year. Diagnoses were made by chest X-ray, upper gastrointestinal series and chest computed tomography. All patients underwent primary repair with interrupted non-absorbable sutures by a transabdominal approach. None had postoperative complications. The follow-up period in six patients ranged from 4 months to 20 years (median 3.8 years). There was no recurrence in any of the patients on follow-up. Conclusion A high index of suspicion is important for the diagnosis of late-presenting CDH because it can be a life-threatening condition such as CDH with a gastric volvulus. Early diagnosis and appropriate treatment can lead to a good prognosis. PMID:23918563

  17. Transfusion Related Acute Lung Injury (TRALI): A Single Institution Experience of 15 Years.

    PubMed

    Kumar, Ramesh; Sedky, Mohammed Jaber; Varghese, Sunny Joseph; Sharawy, Osama Ebrahim

    2016-09-01

    Transfusion related acute Lung injury (TRALI) though a serious blood transfusion reaction with a fatality rate of 5-25 % presents with acute respiratory distress with hypoxaemia and noncardiac pulmonary oedema within 6 h of transfusion. In non fatal cases, it may resolve within 72 h or earlier. Although reported with an incidence of 1:5000, its true occurrence is rather unknown. Pathogenesis is believed to be related to sequestration and adhesion of neutrophils to the pulmonary capillary endothelium and its activation leading to its destruction and leaks. The patient's underlying condition, anti-neutrophil antibody in the transfused donor plasma and certain lipids that accumulate in routinely stores blood and components are important in its aetiopathogenesis. Patient's predisposing conditions include haematological malignancy, major surgery (especially cardiac), trauma and infections. The more commonly incriminated products include fresh frozen plasma (FFP), platelets (whole blood derived and apheresis), whole blood and Packed RBC. Occasional cases involving cryoprecipitate and Intravenous immunoglobulin (IVig) have also been reported. We present a 15 year single institution experience of TRALI, during which we observed 9 cases among 170,871 transfusions, giving an incidence of 1:19,000. We did not encounter cases of haematological malignancy or cardiac surgery in our TRALI patients. Among the blood products, that could be related to TRALI in our patients included solitary cases receiving cryoprecipitate, IVIg, and recombinant Factor VII apart from platelets and FFP. All patients were treated with oxygen support. Six patients required mechanical ventilation. Off label hydrocortisone was given to all patients. There were no cases of fatality among our patients.

  18. Endourologic Management of Upper Tract Transitional Cell Carcinoma following Cystectomy and Urinary Diversion

    PubMed Central

    Tomaszewski, Jeffrey John; Smaldone, Marc Christopher; Ost, Michael Cecil

    2009-01-01

    Traditionally, nephroureterectomy is the gold standard therapy for upper tract recurrence of transitional cell carcinoma (TCC) following cystectomy and urinary diversion. With advances in endoscopic equipment and improvements in technique, conservative endourologic management via a retrograde or antegrade approach is technically feasible with acceptable outcomes in patients with bilateral disease, solitary renal units, chronic renal insufficiency, or significant medical comorbidities. Contemporary studies have expanded the utility of these techniques to include low-grade, low-volume disease in patients with a normal contralateral kidney. The aim of this report is to review the current outcomes of conservative management for upper tract disease and discuss its application and relevance in patients following cystectomy with lower urinary tract reconstruction. PMID:19125199

  19. Pregnancy Outcome, and Adhesion Formation and Reformation after Laparoscopic Cystectomy of Ovarian Endmetriomas

    PubMed

    Gurgan; Yarali

    1996-08-01

    Unilateral or bilateral cystectomy for endometriomas was performed in 90 infertile women. Using a multipuncture technique, a cortical incision was made on the medial aspect of the ovary with sharp-tipped unipolar coagulation. Cystectomy was performed by stripping the cyst capsule from the normal ovarian cortex with the aid of atraumatic grasping forceps. If the capsule removal was incomplete due to technical difficulties, the remaining capsular fragments were vaporized with the carbon dioxide laser. Endometriosis implants elsewhere in the pelvis were vaporized and adhesions, if present, were lysed. The ovarian cortex was closed with a few interrupted 6-0 polyglactin sutures using extracorporeal knot technique. A second-look laparoscopy was performed in 25 patients to evaluate adhesion formation, reformation, postoperative crude pregnancy rates, and factors that would predict conception.

  20. Orthotopic ileal neobladder in female patients after radical cystectomy: 2-year experience.

    PubMed

    Cancrini, A; De Carli, P; Fattahi, H; Pompeo, V; Cantiani, R; Von Heland, M

    1995-03-01

    We describe a surgical technique to conserve urinary continence in 7 women who underwent radical cystectomy with construction of an orthotopic ileal neobladder for infiltrating bladder carcinoma. The selection of the patients and the surgical procedure to preserve the anatomical and functional integrity of the female urethra are described. Followup ranged from 7 to 28 months. There were no postoperative deaths or serious clinical complications. The urinary continence rate was 100% during the day and 71% at night with micturition at regular 3-hour intervals. The vesical capacity varied from 250 to 400 cc and pressure at maximum capacity from 10 to 25 cm. water. Urinary flow was satisfactory and the urethral pressure profile showed a normal sphincteric mechanism at rest. Two patients died of metastases at 14 and 8 months postoperatively, and 5 are alive and disease-free. We believe that these results confirm the possibility of obtaining micturition in women via the urethra following radical cystectomy.

  1. Robotic radical cystectomy: where are we today, where will we be tomorrow?

    PubMed

    Richards, Kyle A; Kader, Karim; Hemal, Ashok K

    2010-11-16

    While open radical cystectomy remains the gold-standard treatment for muscle-invasive bladder cancer and high-risk non-muscle invasive disease, robotic assisted radical cystectomy (RARC) has been gaining popularity over the past decade. The robotic approach has the potential advantages of less intraoperative blood loss, shorter hospital stay, less post-operative narcotic requirement, quicker return of bowel function, and earlier convalescence with an acceptable surgical learning curve for surgeons adept at robotic radical prostatectomy. While short to intermediate term oncologic results from several small RARC series are promising, bladder cancer remains a potentially lethal malignancy necessitating long-term follow-up. This article aims to review the currently published literature, important technical aspects of the operation, oncologic and functional outcomes, and the future direction of RARC.

  2. Prediction of mortality after radical cystectomy for bladder cancer by machine learning techniques.

    PubMed

    Wang, Guanjin; Lam, Kin-Man; Deng, Zhaohong; Choi, Kup-Sze

    2015-08-01

    Bladder cancer is a common cancer in genitourinary malignancy. For muscle invasive bladder cancer, surgical removal of the bladder, i.e. radical cystectomy, is in general the definitive treatment which, unfortunately, carries significant morbidities and mortalities. Accurate prediction of the mortality of radical cystectomy is therefore needed. Statistical methods have conventionally been used for this purpose, despite the complex interactions of high-dimensional medical data. Machine learning has emerged as a promising technique for handling high-dimensional data, with increasing application in clinical decision support, e.g. cancer prediction and prognosis. Its ability to reveal the hidden nonlinear interactions and interpretable rules between dependent and independent variables is favorable for constructing models of effective generalization performance. In this paper, seven machine learning methods are utilized to predict the 5-year mortality of radical cystectomy, including back-propagation neural network (BPN), radial basis function (RBFN), extreme learning machine (ELM), regularized ELM (RELM), support vector machine (SVM), naive Bayes (NB) classifier and k-nearest neighbour (KNN), on a clinicopathological dataset of 117 patients of the urology unit of a hospital in Hong Kong. The experimental results indicate that RELM achieved the highest average prediction accuracy of 0.8 at a fast learning speed. The research findings demonstrate the potential of applying machine learning techniques to support clinical decision making.

  3. Enumerating pelvic recurrence following radical cystectomy for bladder cancer: A Canadian multi-institutional study

    PubMed Central

    Eapen, Libni J.; Jones, Edward; Kassouf, Wassim; Lambert, Carole; Morgan, Scott C.; Moussa, Madeleine; Nam, Robert; Parliament, Matthew; Russell, Laurie; Saad, Fred; Siemens, D. Robert; Souhami, Luis; Szumacher, Ewa; Tyldesley, Scott; Xu, Yan; Zbieranowski, Ingrid; Breau, Rodney H.; Belanger, Eric; Black, Peter; Estey, Eric; Bowan, Julie; Bora, Bishwajit; Brundage, Michael; Chung, Peter; Fleshner, Neil; Evans, Andrew; Bauman, Glenn; Izawa, Jonathan; Davidson, Chris; Brimo, Fadi

    2016-01-01

    Introduction: We aimed to enumerate the rate of pelvic recurrence following radical cystectomy at university-affiliated hospitals in Canada. Methods: Canadian, university-affiliated hospitals were invited to participate. They were asked to identify the first 10 consecutive patients undergoing radical cystectomy starting January 1, 2005, who had urothelial carcinoma stages pT3/T4 N0-2 M0. The first 10 consecutive cases starting January 1, 2005 who met these criteria were the patients submitted by that institution with information regarding tumour stage, age, number of nodes removed, and last known clinical status in regard to recurrence and patterns of failure. Results: Of the 111 patients, 80% had pT3 and 20% pT4 disease, with 62% being node-negative, 14% pN1, and 27% pN2; 57% had 10 or more nodes removed. Cumulative incidence of pelvic relapse was 40% among the entire group Conclusions: This review demonstrates a high rate of pelvic tumour recurrence following radical cystectomy for pT3/T4 urothelial cancer. PMID:27217852

  4. Radiation therapy before cystectomy in the management of patients with bladder cancer.

    PubMed

    Batata, M A; Chu, F C; Hilaris, B S; Kim, Y; Lee, M; Chang, B; Whitmore, W F

    1982-01-01

    During the preceding two decades, 309 patients with bladder cancer were treated by irradiation before cystectomy at the Memorial Sloan-Kettering Cancer Center. A radical tumour dose averaging 6000 cGy (rad) in six weeks was given to 104 patients who underwent radical cystectomy +/- one year later for persistent or recurrent cancer. Pre-operative pelvic irradiation was planned in 205 patients who received either 4000 cGy in four weeks (119) or 2000 cGy in one week (86) and underwent radical cystectomy after +/- six weeks and two days, respectively. The determinate five-year survival rates (41-43%) were similar with the three irradiation regimes; mortality under five years was mainly due to cancer recurrence locally and/or distally. Incidence of recurrence with radiation-induced stage reduction (21%) was lower, especially within the pelvis, than with no stage reduction (51%). Treatment results with planned pre-operative irradiation, especially in high stage tumours, were more favourable with the shorter 2000 cGy regimen of high fractional doses than with the conventionally fractionated 4000 cGy regimen.

  5. Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort

    PubMed Central

    Corradi, Renato B.; Galvão, Gustavo Jaime Climaco; Oliveira, Gabriel M.; Carneiro, Vinicius F.; Miconi, Wadson Gomes; Salles, Paulo Guilherme Oliveira; Cabral, Walter Luiz Ribeiro; Corradi, Carlos; Salazar, Andre Lopes Lopes

    2016-01-01

    ABSTRACT Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity. PMID:27286104

  6. Orthotopic urinary diversion after radical cystectomy in treatment of muscle invasive bladder cancer.

    PubMed

    Jovan, Hadži-Djokić; Vladan, Andrejević; Tomislav, Pejčić; Miodrag, Aćimović; Uroš, Babić; Miodrag, Stanić; Zoran, Džamić

    2014-01-01

    Surgical treatment of invasive carcinoma of the bladder in males includes total cystectomy removal of the prostate, seminal vesicles, and the distal parts of the urethers and the pelvic lymph node dissection as well. At this moment it is not possible to recommend a particular type of urinary diversion, but today in clinical practice commonly used derivative are ileal orthotopic neobladder as the continent one and ileal conduit as non-continent urinary diversion. Continent urinary diversion after radical cystectomy are the result of the application of technological innovation in surgery, but also knowledge, imagination and skill of well trained urologist. This type of operation significantly improves the quality of life in patients who underwent radical cystectomy, and the proposal is to operate whenever there is a possibility for this type of procedure. Also it is very important, during surgery to respect oncological principles, of complete removal of tumorous tissue and that the functional principle of ensur- ing that the patients have daytime and also nighttime continence later on after the surgery.

  7. Bladder preservation in non-metastatic muscle-invasive bladder cancer (MIBC): a single-institution experience.

    PubMed

    Gerardi, Marianna A; Jereczek-Fossa, Barbara A; Zerini, Dario; Surgo, Alessia; Dicuonzo, Samantha; Spoto, Ruggero; Fodor, Cristiana; Verri, Elena; Rocca, Maria Cossu; Nolè, Franco; Muto, Matteo; Ferro, Matteo; Musi, Gennaro; Bottero, Danilo; Matei, Deliu V; De Cobelli, Ottavio; Orecchia, Roberto

    2016-01-01

    The aim of this study is to access the feasibility, toxicity profile, and tumour outcome of an organ preservation curative approach in non-metastatic muscle-invasive bladder cancer. A retrospective analysis was conducted on patients affected by M0 bladder cancer, who refused cystectomy and were treated with a curative approach. The standard bladder preservation scheme included maximal transurethral resection of bladder tumour (TURBT) and combination of radiotherapy and platin-based chemotherapy, followed by endoscopic evaluation, urine cytology, and instrumental evaluation. Thirteen patients fulfilled the inclusion criteria. TNM stage was cT2cN0M0 and cT2cNxM0, in 12 and one patients, respectively. All patients had transitional cell cancer. Twelve patients completed the whole therapeutic programme (a bimodal treatment without chemotherapy for one patient). Median follow-up is 36 months. None of the patients developed severe urinary or intestinal acute toxicity. In 10 patients with a follow-up > 6 months, no cases of severe late toxicity were observed. Response evaluated in 12 patients included complete response and stable disease in 11 patients (92%), and one patient (8%), respectively. At the time of data analysis (March 2016), 10 patients (77%) are alive with no evidence of disease, two patients (15%) died for other reasons, and one patient has suspicious persistent local disease. The trimodality approach, including maximal TURBT, radiotherapy, and chemotherapy for muscle-invasive bladder cancer, is well-tolerated and might be considered a valid and feasible option in fit patients who refuse radical cystectomy.

  8. Spanning the genomics era: the vital role of a single institution biorepository for childhood cancer research over a decade

    PubMed Central

    Zhou, Li

    2015-01-01

    The ‘genomics era’ is considered to have begun with the commencement of the Human Genome Project. As translational genomic studies can only be established when human tissue samples are available for analysis, biospecimens are now proven to be an essential element for their success. During the genomics era the necessity for more extensive biobanking infrastructure has been highlighted. With the increased number of genomic studies into cancer, it is considered that the availability of biospecimens will become the rate limiting step. Despite the efforts in international biobanking, translational genomics is hampered when there low numbers of biospecimens for a particular rare diseases and is most apparent for paediatric cancer. As there is a call for biobanking practice to be responsive to the current experimental needs of the time and for more expansive systems of tissue procurement to be established we have asked the question what role does a single institution biorepository play in the current highly networked world of translational genomics. Here we describe such a case. The Tumour Bank at The Children’s Hospital at Westmead (TB-CHW) in the western suburbs of Sydney was formally established in 1998 as a key resource for translational paediatric cancer research. During the genomics era, we show that the TB-CHW has developed into a key biospecimen repository for the cancer research community, during which time it has increasingly found itself having a vital role in the establishment of translational genomics for paediatric cancer. Here we detail metrics that demonstrate how as a single institution biorepository, the TB-CHW has been a strong participant in the advancement of translational genomics throughout the genomics era. This paper describes the significant contribution of a single institutional hospital embedded tumour biobank to the genomic research community. Despite the increased stringencies placed on biobanking practice, the TB-CHW has shown that a

  9. Hirschsprung's disease: 13 years' experience in 112 patients from a single institution.

    PubMed

    Pini Prato, Alessio; Gentilino, Valerio; Giunta, Camilla; Avanzini, Stefano; Parodi, Stefano; Mattioli, Girolamo; Martucciello, Giuseppe; Jasonni, Vincenzo

    2008-02-01

    Although Hirschsprung's disease is curable, a low mortality and a certain morbidity have been described by several authors. We will present our experience with the treatment of Hirschsprung's disease at Gaslini Children's Hospital. All patients who underwent a pull-through procedure since January 1993 were included. Data were obtained from a comprehensive questionnaire and from the revision of the notes. The results were subsequently described and compared with regard to age and length of aganglionosis. A total of 151 patients underwent a pull-through. One hundred and twelve of these patients completed the forms and were reviewed. Eighty patients had a classic form, 22 an ultralong. Complications occurred in 28 patients (25%). Postoperative enterocolitis was complained by 25 patients (13% colonic and 59% ultralong forms) and constipation by 15 (equally distributed). Excellent to good continence was experienced by 84% of patients with classic forms and by 68% of patients with ultralong forms. A clear improving trend during growth was evident for patients with ultralong forms. Psychological self-acceptance, patients' perspective and cosmetic results proved to be significantly better for patients with classic forms of the disease. Our study confirmed the complications and long-term sequelae that patients with Hirschsprung's can experience. Early diagnosis can minimise morbidity and mortality and prompt and adequate treatment can reduce the incidence of postoperative complications. The parents should be acknowledged regarding the progressive improvements of function that patients gain during growth, particularly in case of ultralong forms, thus strengthening the need for continuative care and close follow-up.

  10. Robot-assisted radical cystectomy with intracorporeal neobladder diversion: The Karolinska experience

    PubMed Central

    Collins, Justin W.; Sooriakumaran, P.; Sanchez-Salas, R.; Ahonen, R.; Nyberg, T.; Wiklund, N. P.; Hosseini, A.

    2014-01-01

    Introduction: The aim of this report is to describe our surgical technique of totally intracorporeal robotic assisted radical cystectomy (RARC) with neobladder formation. Materials and Methods: Between December 2003 and March 2013, a total of 147 patients (118 male, 29 female) underwent totally intracorporeal RARC for urinary bladder cancer. We also performed a systematic search of Medline, Embase and PubMed databases using the terms RARC, robotic cystectomy, robot-assisted, totally intracorporeal RARC, intracorporeal neobladder, intracorporeal urinary diversion, oncological outcomes, functional outcomes, and complication rates. Results: The mean age of our patients was 64 years (range 37-87). On surgical pathology 47% had pT1 or less disease, 27% had pT2, 16% had pT3 and 10% had pT4. The mean number of lymph nodes removed was 21 (range 0-60). 24% of patients had lymph node positive dAQ1isease. Positive surgical margins occurred in 6 cases (4%). Mean follow-up was 31 months (range 4-115 months). Two patients (1.4%) died within 90 days of their operation. Using Kaplan-Meier analysis, overall survival and cancer specific survival at 60 months was 68% and 69.6%, respectively. 80 patients (54%) received a continent diversion with totally intracorporeal neobladder formation. In the neobladder subgroup median total operating time was 420 minutes (range 265-760). Daytime continence and satisfactory sexual function or potency at 12 months ranged between 70-90% in both men and women. Conclusions: Our experience with totally intracorporeal RARC demonstrates acceptable oncological and functional outcomes that suggest this is a viable alternative to open radical cystectomy. PMID:25097318

  11. Comparison of anesthetic management and outcomes of robot-assisted versus open radical cystectomy.

    PubMed

    Trentman, Terrence L; Fassett, Sharon L; McGirr, Dustin; Anderson, Brad; Chang, Yu-Hui H; Nateras, Rafael Nunez; Castle, Erik P; Rosenfeld, David M

    2013-09-01

    Robot-assisted cystectomy surgery may be advantageous for patients. The purpose of this study was to compare anesthetic management and outcomes in patients undergoing robot-assisted versus open radical cystectomy. In a retrospective review of 256 cystectomy procedures, procedure duration, blood loss, respiratory parameters, recovery room opiate consumption, pain scores and antiemetic use in the recovery room, and hospital length of stay were compared. After exclusions, 96 robot-assisted and 102 open procedures were analyzed. Anesthesia and surgery duration were significantly longer in the robot-assisted group, while the length of hospital stay was significantly shorter in the robot-assisted group: 7.1 ± 5.8 versus 9.8 ± 5.03 days, p = 0.0005. Estimated blood loss was 601.8 ± 491.4 ml in the open group versus 257.7 ± 164.3 ml in the robot-assisted group, p < 0.0001. Recovery room opiate consumption was significantly less in the robot-assisted group: 9.5 ± 8.9 versus 12.6 ± 9.9 mg (morphine equivalents), p = 0.02. The highest recorded respiratory rate was significantly higher in the robot-assisted group, as was the highest recorded peak airway pressure. Among patients with arterial blood gas data, the highest arterial partial pressure of CO2 was significantly greater in the robot-assisted group than in the open surgery group: 42.6 ± 5.6 versus 37.4 ± 4.8 mmHg CO2, p = 0.0001. Surgeons and anesthesia providers can expect robot-assisted radical cystectomy surgery to last longer than traditional open surgery, but to be associated with less pain and blood loss. Positioning and abdominal insufflation for robot-assisted surgery may contribute to ventilation challenges.

  12. Inflammatory Myofibroblastic Tumor of the Bladder: 2 Rare Cases Managed with Laparoscopic Partial Cystectomy

    PubMed Central

    Oliveira, Rita; Ferrito, Fernando; Gomes, Carrasquinho

    2016-01-01

    Two cases of inflammatory myofibroblastic tumor (IMT) of the bladder are reported here. Both patients were male and presented with macroscopic hematuria; in the first case terminal hematuria was associated with irritative voiding symptoms. The second case was a smoker with hematuria unresponsive to medical treatment and anemia. Clinical presentation, pathological features, treatment, and prognosis are discussed. Due to rarity of this pathological condition, there are no guidelines concerning treatment and follow-up. We present our follow-up scheme and highlight the use of laparoscopic partial cystectomy as a successful treatment approach. PMID:27974989

  13. Laparoscopic radical cystectomy: neobladder or ileal conduit, debate still goes on

    PubMed Central

    Drewa, Tomasz; Olejniczak, Pawel; Chlosta, Piotr L.

    2014-01-01

    Objective To compare the pre, intra, and post–operative data between ileal conduit and neobladder urinary diversions during laparoscopic radical cystectomy(LRC). Material and methods Between 2006 and 2011, 63 patients who underwent LRC and urinary diversion had their data input prospectively into a database and said data used for the analysis. The outcome comparators were the patient demographics, operative time, conversion rate, blood loss, transfusion rate, morphine analgesic requirement, length of hospital stay, complication rates, follow up, and quality of life assessments. A Mantel–Haenszel test was used for dichotomous data and an inverse variance method was used for continuous data. P values less than 0.5 were considered significant Results Thirty–nine patients (60 ±7.11 years) had ileal conduits and 24 patients (57 ±8.68 years) had neobladder urinary diversion. No difference was found (P >0.05) regarding age, BMI, smoking history, TURBT pathology result, blood loss, blood transfusion requirement, conversion rates, length of hospital stay, morphine requirement, complications, or follow–up and quality of life. The neobladder groups did have more previous abdominal operations and had significantly longer operative time. Conclusions We found no difference between either types of diversion in all comparative aspects except that the neobladder had longer operative times. This is the first comparative study between ileal conduit and neobladder urinary diversion after laparoscopic radical cystectomy and can pose as a bench mark for future comparisons. PMID:24982773

  14. A comprehensive guide to perioperative management and operative technique for robotic cystectomy with intracorporeal urinary diversion.

    PubMed

    Tan, Wei Shen; Lamb, Benjamin W; Sridhar, Ashwin; Briggs, Timothy P; Kelly, John D

    2017-02-27

    Robotic-assisted radical cystectomy (RARC) represents an evolution of open radical cystectomy (ORC) with the aim of reducing patient morbidity and improving return to normal function, whilst maintaining oncological equivalence. RARC is gaining popularity, especially in high-volume centres, although there remains a lack of level 1 evidence to demonstrate any superiority of RARC over ORC. All previously reported studies that randomised ORC and RARC have utilised a technique for RARC requiring a conversion to open surgery for urinary diversion. Conversion to open surgery invariably masks the benefits of a truly minimally invasive approach. Moreover, such studies tend to report a small sample size, likely reflecting early surgical experience that may contribute to the lack of observed benefit. Nonetheless, it is established that short-term oncological outcomes following RARC are comparable to those after ORC. It is likely that the benefits of RARC are only observed in cases wherein intracorporeal urinary diversion (iRARC) is performed by a surgical team with high volume experience, which will minimise morbidity and maximise early return to normal function. In this review, we will discuss a holistic approach to iRARC, including patient selection, perioperative optimisation, the surgical technique for iRARC with urinary diversion reconstruction, the use of enhanced recovery protocol, oncological outcomes and perioperative complications.

  15. AB047. Clinic therapeutic effect of sigmoid orthotopic neobladder after radical cystectomy

    PubMed Central

    Zhang, Jin; Li, Ranwei; Li, Shengwen

    2016-01-01

    Objective To investigate the clinic therapeutic effect of sigmoid orthotopic neobladder after radical cystectomy. Methods Sixteen patients with invasive bladder cancer (all males; age range from 53 to 75 years) were admitted and underwent radical cystectomy and sigmoid orthotopic neobladder. Results The 16 patients were hospitalized for 37 to 62 d, with an average of 51 d. All the 16 patients were followed up for a mean of 26 months (range from 5 months to 6 years). The serum creatinine and blood urea nitrogen levels were both in the normal range without acidosis in all the cases. No cases had unilateral ureteral urine reflux during cystography. Of the 16 patients 14 cases (87.5%) achieved continence during daytime; 6 cases (37.5%) were incontinent at night, but all of them could control urination by being woken up at night. The capacity of the neobladder was 245 to 380 mL with an average of 316 mL and the maximal pressure of the neobladder during filling was 28 to 57 cmH2O (1 cmH2O =0.098 kPa) with an average of 39 cmH2O. Conclusions As an operation the sigmoid orthotopic neobladder can be performed easily without serious postoperative complications and more reliable results. This operation may be generally applied in clinical practice.

  16. Contractual Revision.

    ERIC Educational Resources Information Center

    Engel, Mary F.; Sawyer, Thomas M.

    Contractual revision promotes cooperation between teachers and tutors and, being student initiated, provides a method to increase student control over the revision process and encourage students to communicate their strengths and weaknesses in writing to their teachers or tutors. The contractual revision process requires students to form contracts…

  17. Comparing long term impact on ovarian reserve between laparoscopic ovarian cystectomy and open laprotomy for ovarian endometrioma

    PubMed Central

    2013-01-01

    Objective To compare the long term impact on ovarian reserve between laparoscopic ovarian cystectomy with bipolar electrocoagulation and laparotomic cystectomy with suturing for ovarian endometrotic cyst. Patient and method(s) 121 patients with benign ovarian endometroitic cysts were randomised to either laparoscopic ovarian cystectomy using bipolar electrocoagulation (61 patients) or laparotomic ovarian cystectomy using sutures (60 patients). Serum follicle-stimulating hormone, Antimullerian hormon, Basal antral follicle Count, mean ovarian diameter, and ovarian stromal blood flow velocity were measured at 6, 12 and 18 months after surgery and compared in both groups. Result(s) A statistically significant increase of serum FSH was found in the laproscopic bipolar group at 6-, 12 and 18-month postoperativly compared to open laparotomy suture group. Also, a statistically significant decrease of the mean AMH value occurred in laproscopic bipolar group at 6-, 12 and 18-month follow- up compared to open laparotomy suture group. Basal antral follicle number, mean ovarian diameter and peak systolic velocity were significantly decreased during the 6-, 12,18 -month follow-up in laproscopic bipolar group compared to open laparotomy suture group. Conclusion(s) After laproscopic ovarian cystecomy for endometrioma all pareameter of ovarian reseve are significantly decreased on long term follow up as compared to open laprotomy. PMID:24180348

  18. Diabetes and elevated urea level predict for uretero-ileal stricture after radical cystectomy and ileal conduit formation

    PubMed Central

    Hoag, Nathan; Papa, Nathan; Beharry, Bhawanie Koonj; Lawrentschuk, Nathan; Chiu, Danny; Sengupta, Shomik; Bolton, Damien

    2017-01-01

    Introduction Benign uretero-ileal anastomotic stricture is a significant complication following radical cystectomy and ileal conduit urinary diversion after radical cystectomy. We examined risk factors for stricture formation to predict those at greatest stricture risk. Methods A retrospective chart review was conducted for patients undergoing radical cystectomy and ileal conduit diversion between 2002 and 2012. Demographic data and patient variables were analyzed to determine risk factors for uretero-ileal stricture using multivariate logistic regression. Results Over the study period, 133 patients underwent cystectomy and ileal conduit formation, with 14 (10.5%) developing uretero-ileal anastomotic stricture. Diabetes and elevated serum urea level (defined as >7.1 mmol/L) were associated with increased risk for development of uretero-ileal stricture (odds ratio 4.31 and 4.28, respectively; p<0.05 for each). Conclusions In this patient cohort, diabetes and elevated serum urea level were predictive for the development of uretero-ileal anastomotic stricture. Further prospective study with larger patient samples is required. PMID:28360953

  19. A novel clinicopathological analysis of early stage ovarian Sertoli-Leydig cell tumors at a single institution

    PubMed Central

    Nam, Seon Mi; Kim, Jee Whan; Eoh, Kyung Jin; Kim, Hye Min; Lee, Jung Yun; Nam, Eun Ji; Kim, Sunghoon; Kim, Sang Wun

    2017-01-01

    Objective To evaluate the clinical and pathologic characteristics of patients who were diagnosed with ovarian Sertoli-Leydig cell tumors (SLCTs) in a single institution. Methods The medical records of 11 patients who were pathologically diagnosed with SLCTs beginning in 1995 in a single institute was reviewed. Results The median patient age was 31 years (range, 16 to 70 years). Patient International Federation of Gynecology and Obstetrics stages were IA, IC, and IIB in 3 (27.3%), 6 (54.5%), and 2 (18.2%) patients, respectively. Six patients (54.5%) had grade 3 tumors, 3 patients (27.3%) had grade 2 tumors, and 1 patient (9.1%) had a grade 1 tumor. Four patients without children underwent fertility-sparing surgery, and 7 patients had full staging surgery, including a hysterectomy and bilateral salpingo-oophorectomy, with a laparoscopic approach used in 3. Eight patients underwent pelvic lymph node dissection, and 8 patients were administered adjuvant chemotherapy consisting of bleomycin, etoposide, and cisplatin in 6 cases, a modified bleomycin, etoposide, and cisplatin regimen in 1 case, and a combined paclitaxel and cisplatin regimen in 1 case. Two patients died of disease and were re-diagnosed with Sertoli form endometrioid carcinoma. The other patients remain alive without recurrence at the time of reporting. Conclusion Our findings suggest that regardless of tumor stage or grade, ovarian SLCT patients have a good prognosis. Close observation and unilateral salpingo-oophorectomy would be beneficial for women who still wish to have children, while hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy would be the optimal treatment in other cases. Furthermore, meticulous pathologic diagnosis is needed to develop a precise treatment strategy. PMID:28217670

  20. Carcinoma of the urinary bladder T/sub 3/N/sub x/M/sub o/ treated by preoperative irradiation followed by simple cystectomy

    SciTech Connect

    Van Der Werf-Messing, B.H.P.; Friedell, G.H.; Menon, R.S.; Hop, W.C.J.; Wassif, S.B.

    1982-11-01

    One hundred eighty-three patients with bladder cancer category, T/sub 3/N/sub x/M/sub o/ (the diameter of the primary exceeding 5 cm), were treated by preoperative 40 Gy and simple cystectomy. Using only pretreatment information, the group with the best prognosis was characterized by a T/sub 3A/-growth with a normal intravenous pyelography, with about a 75% cure rate. Before cystectomy, after irradiation the combination of a clinically assessed radiation-downstaged growth (T/sub 40GY/<3) with normal urography, predicted the best chance of cure at about 80%. After cystectomy was performed, the best prognostic group could be most correctly identified: those patients with both microscopic downstaging of the primary (''P''/sub <3/) and no vascular invasion in the cystectomy specimen (CV-) combined with normal urography had an 81% chance of cure. This most favorable group constitutes 45% of all patients.

  1. Carcinoma of the urinary bladder T/sub 3/N/sub X/M/sub O/ treated by preoperative irradiation followed by simple cystectomy

    SciTech Connect

    van der Werf-Messing, B.H.P.; Friedell, G.H.; Menon, R.S.; Hop, W.C.J.; Wassif, S.B.

    1982-11-01

    One hundred eighty-three patients with bladder cancer category, T/sub 3/N/sub X/M/sub O/ (the diameter of the primary exceeding 5 cm), were treated by preoperative 40 Gy and simple cystectomy. Using only pretreatment information, the group with the best prognosis was characterized by a T/sub 3A/-growth with a normal intravenous pyelography, with a 75% cure rate. Before cystectomy, after irradiation the combination of clinically assessed radiation-downstaged growth (T/sub 40GY/<3) with normal urography, predicted the best chance of cure at about 80%. After cystectomy was performed, the best prognostic group could be most correctly identified: those patients with both microscopic downstaging of the primary (''P''/sub <3/) and no vascular invasion in the cystectomy specimen (CV - ) combined with normal urography had an 81% chance of cure. This most favorable group constitutes 45% of all patients.

  2. Novel Closing Method Using Subcutaneous Continuous Drain for Preventing Surgical Site Infections in Radical Cystectomy

    PubMed Central

    Hirose, Yasuhiko; Ando, Ryosuke; Nakane, Akihiro; Etani, Toshiki; Iida, Keitaro; Akita, Hidetoshi; Okamura, Takehiko; Kohri, Kenjiro

    2014-01-01

    To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat. PMID:24734201

  3. Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience

    PubMed Central

    Feng, Lang; Song, Jian; Wu, Menghua; Tian, Ye; Zhang, Daoxin

    2016-01-01

    ABSTRACT Objective: This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients. Patients and Methods: A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed. Results: A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05). Conclusions: ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients. PMID:27564274

  4. Diagnostic accuracy of hexaminolevulinate in a cohort of patients undergoing radical cystectomy.

    PubMed

    Pagliarulo, Vincenzo; Stefano, Alba; Gallone, Maria Filomena; Di Stasi, Savino; Cormio, Luigi; Petitti, Tommasangelo; Buscarini, Maurizio; Minafra, Paolo; Carrieri, Giuseppe

    2017-02-01

    Purpose To compare the accuracy of white light cystoscopy (WLC) and blue light cystoscopy (BLC) in a cohort of patients undergoing radical cystectomy (RC) for previously resected urothelial bladder cancer (UCB). Patients and methods A cohort of patients undergoing RC received WLC and BLC prior radical surgery. To evaluate the residual tumor rate, the bladder was inspected after its removal and normal appearing mucosa sampled for histologic analysis. Lesions detected under WLC, BLC, or both, as well as biopsy samples from normal appearing mucosa, were all recorded separately. Results Starting 2011, 64 patients underwent WLC and BLC prior cystectomy. Overall, 540 tissue samples were collected during cystoscopy and from normal appearing mucosa. Residual disease was found in 31/64 (48.4%) patients, including 27 (42.1%) cases of CIS. The accuracy of BLC was much higher than WLC, both in the diagnosis of any residual disease (87.1% vs 32.3%, and 87.9% vs 51.5%, for sensitivity and specificity, respectively), as of CIS only (92.6% vs 29.6% and 83.8% vs 51.4%). We further evaluated the diagnostic accuracy as a result of the analysis on all specimens collected during the study. A total of 535 specimens were analyzed, and 58 specimens with residual disease were found, including 48 CIS foci. Again, detection rates and measures of accuracy were much better for BLC vs WLC, both overall (86.2% vs 31%, and 98.3% vs 93.3%, for sensitivity and specificity, respectively), and when CIS only was considered (89.6% vs 31.2% and 96.9% vs 92.8%). Conclusions Although BLC missed 12.9% of positive patients, and 7.4% of those with CIS, the agreement between BLC diagnostic accuracy and the definitive pathology was very robust.

  5. America Revising.

    ERIC Educational Resources Information Center

    Marty, Myron

    1982-01-01

    Reviews Frances FitzGerald's book, "America Revised," and discusses FitzGerald's critique of recent revisions in secondary-level U.S. history textbooks. The author advocates the implementation of a core curriculum for U.S. history which emphasizes political and local history. (AM)

  6. A Comparison of the LigaSure and Harmonic Scalpel in Thyroid Surgery: A Single Institution Review

    PubMed Central

    Zarebczan, Barbara; Mohanty, Devi; Chen, Herbert

    2010-01-01

    Background Over the last few years many surgeons have begun to utilize the LigaSure device or Harmonic scalpel to perform thyroid surgery. Several papers have demonstrated the benefits of these devices over traditional hand-tying techniques. The purpose of this study was to examine our institution’s experience with the LigaSure device and Harmonic scalpel during thyroid surgery and to compare mean operative times and complications associated with each device. Methods A retrospective chart review was performed on all patients who underwent thyroid surgery using either the LigaSure device or Harmonic scalpel at a single institution between December 2005 and August 2009. Charts were reviewed for patient demographics, mean operative time, length of stay, and complications such as transient recurrent laryngeal nerve injury, hypocalcemia, and hematoma formation. Results Two hundred and thirty-one patients were included in the study, of whom 123 underwent total thyroidectomy and 108 underwent lobectomy. There was a significant decrease in the operative time for both thyroidectomies and lobectomies when the Harmonic scalpel was utilized. In regard to complications, there was no statistically significant difference in the number of transient and permanent recurrent laryngeal nerve injuries, percentage of patients developing hypocalcemia, or in the rate of hematoma development. Conclusion In this study, there was no difference in the rate of complications between the two devices. However, the use of the Harmonic scalpel significantly decreased operative time for both thyroidectomies and thyroid lobectomies when compared to the LigaSure device. PMID:20853030

  7. CyberKnife stereotactic radiosurgery for the treatment of symptomatic vertebral hemangiomas: a single-institution experience.

    PubMed

    Zhang, Michael; Chen, Yi-Ren; Chang, Steven D; Veeravagu, Anand

    2017-01-01

    OBJECTIVE Symptomatic vertebral hemangiomas (SVHs) are a very rare pathology that can present with persistent pain or neurological deficits that warrant surgical intervention. Given the relative rarity and difficulty in assessment, the authors sought to present a dedicated series of SVHs treated using stereotactic radiosurgery (SRS) to provide insight into clinical decision making. METHODS A retrospective review of a single institution's experience with hypofractionated radiosurgery for SVH from 2004 to 2011 was conducted to determine the clinical and radiographic outcomes following SRS treatment. The authors report and analyze the treatment course of 5 patients with 7 lesions, 2 of which were treated primarily by SRS. RESULTS Of the 5 patients studied, 4 presented with a chief complaint of pain refractory to conservative measures. Three patients reported dysesthesias, and 2 reported upper-extremity weakness. Following radiosurgery, 4 of 5 patients exhibited improvement in their primary symptoms (3 for pain and 1 for weakness), achieving a clinical response after a mean period of 1 year. In 2 cases there was 20%-40% reduction in lesion size in the most responsive dimension as noted on images. All treatments were well tolerated. CONCLUSIONS SRS for SVH is a safe and feasible treatment strategy, comparable to prior radiotherapy studies, and in select cases may successfully confer delayed decompressive effects. Additional investigation will determine future patient selection and how conformal SRS treatment can best be administered.

  8. t(8;21) (q22;q22) acute myelogenous leukemia in Mexico: a single institution experience.

    PubMed

    Ruiz-Argüelles, Guillermo J; Morales-Toquero, Amelia; Manzano, Carlos; Ruiz-Delgado, Guillermo J; Jaramillo, Patricia; Gonzalez-Carrillo, Martha L; Reyes-Núñez, Virginia

    2006-08-01

    We analyze the prevalence and clinical features of a group of patients with t(8;21) (q22;q22) acute myeloblastic leukemia, identified in a single institution in México over a 10-year period. Fifteen patients presented at the Centro de Hematología y Medicina Interna de Puebla from February 1995 to August 2005; only nine were treated and followed in the institution. Median age was 24 years, (range 7-49); there was only one male. According to the French-American-British (FAB) morphological classification of leukemia, the morphology was M2 in four cases, M4 in three cases, M3 in one case and M0 in one. In addition to the myeloid markers, lymphoid markers were identified in 6 patients. Patients were induced to remission with combined chemotherapy and three subsequently underwent bone marrow transplantation (BMT). The median overall and disease-free survival has not been reached, being above 3390 days, the probability of survival at this time was 73%. In this single-center experience in México, we found that the t(8;21) (q22;q22) variant of leukemia was more frequent than in Caucasian populations, that the co-expression of lymphoid markers in the blast cells is very frequent and that this malignancy is associated with a relatively good prognosis.

  9. Impact of stage and comorbidities on five-year survival after radical cystectomy in Poland: single centre experience

    PubMed Central

    Dybowski, Bartosz; Ossoliński, Krzysztof; Ossolińska, Anna; Peller, Michał; Radziszewski, Piotr

    2015-01-01

    Introduction Long-term outcomes of patients treated for invasive bladder cancer in Poland are poorly documented in the literature. Impact of various clinical parameters on their survival is even less well studied. Radical cystectomy is a major surgery, so the patients’ condition can be equally important as cancer stage. The aim of the study was to assess 5-year overall survival (OS) after cystectomy and impact of comorbidity on OS in a single Polish academic centre. Material and methods Clinical data of all patients who underwent cystectomy in years 2004-2006 for urothelial cancer were retrospectively reviewed. Survival status was determined at least 5 years after surgery. Pathological variables, comorbidities, surgery delay and complications were evaluated as potential predictors of OS. Kaplan-Meier estimates of the survival function as well as Cox proportional hazards models were utilized. Results Thirty-day, 1-year and 5-year OS for 63 patients was 98.4%, 58.7% and 31.7%, respectively. None of the investigated parameters were significantly related to five-year OS. However, a composite parameter consisting of stage, diabetes status and postoperative course was found as a significant predictor. Five-year OS in 16 patients with pT1-2 and without diabetes and without post-operative complications was higher than in the remaining 47 patients (56% vs. 23%; P = 0.02). Conclusions Five-year OS in our group was lower than in most published international series but concordant with a previous Polish report. Improvement in survival after radical cystectomy may be expected when early diagnosis will be accompanied by optimal care of patients with diabetes mellitus and avoidance of postoperative complications. PMID:26568866

  10. Laparoscopic Cystectomy In-a-Bag of an Intact Cyst: Is It Feasible and Spillage-Free After All?

    PubMed Central

    Detorakis, Stelios; Vlachos, Dimitrios; Athanasiou, Stavros; Grigoriadis, Themistoklis; Domali, Aikaterini; Chatzipapas, Ioannis; Stamatakis, Emmanuel; Mousiolis, Athanasios; Patrikios, Apostolos; Antsaklis, Aris; Loutradis, Dimitrios; Protopapas, Athanasios

    2016-01-01

    This prospective study was conducted to assess the feasibility of laparoscopic cystectomy of an intact adnexal cyst performed inside a water proof endoscopic bag, aiming to avoid intraperitoneal spillage in case of cyst rupture. 102 patients were recruited. Two of them were pregnant. In 8 of the patients the lesions were bilateral, adding up to a total of 110 cysts involved in our study. The endoscopic sac did not rupture in any case. Mean diameter of the cysts was 5.7 cm (range: 2.3–10.5 cm). In 75/110 (68.2%) cases, cystectomy was completed without rupture, whereas in the remaining 35/110 (31.8%) cases the cyst ruptured. Minimal small spillage occurred despite every effort only in 8/110 (7.2%) cases with large (>8 cm) cystic teratomas. There were no intraoperative or postoperative complications. We concluded that laparoscopic cystectomy in-a-bag of an intact cyst is feasible and oncologically safe for cystic tumors with a diameter < 8 cm. Manipulation of larger tumors with the adnexa into the sac may be more difficult, and in such cases previous puncture and evacuation of the cyst contents should be considered. PMID:27099793

  11. Single Fraction Versus Fractionated Linac-Based Stereotactic Radiotherapy for Vestibular Schwannoma: A Single-Institution Experience

    SciTech Connect

    Collen, Christine; Ampe, Ben; Gevaert, Thierry; Moens, Maarten; Linthout, Nadine; De Ridder, Mark; Verellen, Dirk; D'Haens, Jean; Storme, Guy

    2011-11-15

    Purpose: To evaluate and compare outcomes for patients with vestibular schwannoma (VS) treated in a single institution with linac-based stereotactic radiosurgery (SRS) or by fractionated stereotactic radiotherapy (SRT). Methods and Materials: One hundred and nineteen patients (SRS = 78, SRT = 41) were treated. For both SRS and SRT, beam shaping is performed by a mini-multileaf collimator. For SRS, a median single dose of 12.5 Gy (range, 11-14 Gy), prescribed to the 80% isodose line encompassing the target, was applied. Of the 42 SRT treatments, 32 treatments consisted of 10 fractions of 3-4 Gy, and 10 patients received 25 sessions of 2 Gy, prescribed to the 100% with the 95% isodose line encompassing the planning target volume. Mean largest tumor diameter was 16.6 mm in the SRS and 24.6 mm in the SRT group. Local tumor control, cranial nerve toxicity, and preservation of useful hearing were recorded. Any new treatment-induced cranial nerve neuropathy was scored as a complication. Results: Median follow-up was 62 months (range, 6-136 months), 5 patients progressed, resulting in an overall 5-year local tumor control of 95%. The overall 5-year facial nerve preservation probability was 88% and facial nerve neuropathy was statistically significantly higher after SRS, after prior surgery, for larger tumors, and in Koos Grade {>=}3. The overall 5-year trigeminal nerve preservation probability was 96%, not significantly influenced by any of the risk factors. The overall 4-year probability of preservation of useful hearing (Gardner-Robertson score 1 or 2) was 68%, not significantly different between SRS or SRT (59% vs. 82%, p = 0.089, log rank). Conclusion: Linac-based RT results in good local control and acceptable clinical outcome in small to medium-sized vestibular schwannomas (VSs). Radiosurgery for large VSs (Koos Grade {>=}3) remains a challenge because of increased facial nerve neuropathy.

  12. Pharyngocutaneous fistula after total laryngectomy: A single-institution experience, 2001–2012☆,☆☆

    PubMed Central

    Benson, Eleni M.; Hirata, Richard M.; Thompson, Carol B.; Ha, Patrick K.; Fakhry, Carole; Saunders, John R.; Califano, Joseph A.; Arnaoutakis, Demetri; Levine, Marshall; Tang, Mei; Neuner, Geoffrey; Messing, Barbara P.; Blanco, Ray G.F.

    2015-01-01

    Purpose The purpose of this study was to determine the incidence of and risk factors for pharyngocutaneous fistula in patients undergoing total laryngectomy at a single institution. Materials and methods The records of 59 patients undergoing primary or salvage total laryngectomy at our institution from 2001 to 2012 were retrospectively reviewed. Data collected included patient, tumor and treatment characteristics, and surgical technique. Risk factors were analyzed for association with pharyngocutaneous fistula formation. Results Twenty patients (34%) developed fistulas. Preoperative tracheostomy (OR 4.1; 95% CI 1.3–13 [p = 0.02]) and low postoperative hemoglobin (OR 9.1; 95% CI 1.1–78 [p = 0.04]) were associated with fistula development. Regarding surgical technique, primary sutured closure of the total laryngectomy defect had the lowest fistula rate (11%). In comparison, primary stapled closure and pectoralis onlay flap over primary closure had nonsignificantly increased fistula rates (43%, OR 6.0; 95% CI 1.0–37.3 [p = 0.06] and 25%, OR 2.7; 95% CI 0.4–23.9 [p = 0.38], respectively). Pectoralis flap incorporated into the suture line had a significantly increased fistula rate (50%, OR 7.1; 95% CI 1.4–46 [p = 0.02]). After stratification for salvage status, patient comorbidities were associated with fistula in non-salvage cases whereas disease-related characteristics were associated with fistula in salvage cases. Fistula development was associated with increased length of hospital stay (p < 0.001) and increased time before oral diet initiation (p < 0.001). Conclusions Pharyngocutaneous fistula is a common complication of total laryngectomy. Preoperative tracheostomy, postoperative hemoglobin, and surgical technique are important in determining the risk of fistula. PMID:25245411

  13. Radiotherapy in late elderly (aged 75 or older) patients with paranasal sinus carcinoma: a single institution experience.

    PubMed

    Doi, Hiroshi; Kitajima, Kazuhiro; Tanooka, Masao; Terada, Tomonori; Noguchi, Kazuma; Takada, Yasuhiro; Fujiwara, Masayuki; Ishikura, Reiichi; Kamikonya, Norihiko; Hirota, Shozo

    2016-12-01

    The purpose of our study was to assess the feasibility of radiotherapy (RT) for locally advanced paranasal sinus carcinomas in late elderly patients (aged ≥75 years) from a single institution in Japan. From 2000 to 2015, we retrospectively analyzed 14 patients (11 maxillary and 3 ethmoid sinus carcinoma patients) who underwent RT for pathologically confirmed paranasal sinus carcinomas. RT was performed without unexpected cessations. Two patients, however, developed Grade 3 mucositis. The median follow-up duration was 13 months (range 2-54 months). The 1- and 2-year overall survival (OS) rates were 81.8 and 54.5 %, respectively. The local response rate after the initial treatment was 85.7 %. The 1- and 2-year progression-free survival (PFS) rates were 46.2 and 24.8 %, respectively. Univariate analysis of different clinicopathological parameters was conducted to identify associations with OS and PFS. We demonstrated that intensity modulated radiation therapy (IMRT) of >60 Gy with concomitant intra-arterial (cisplatin-based) infusion chemoradiotherapy led to improved OS and PFS rates, although no statistical significance was observed. Moreover, none of the squamous cell carcinoma (SCC) patients who received 33 fractions of 66 Gy in IMRT died during the median follow-up period of 13 months (range 12-25 months). In conclusion, RT with concomitant intra-arterial (cisplatin-based) infusion chemoradiotherapy can be considered an effective, well-tolerated, and feasible treatment option for late elderly patients with paranasal sinus carcinomas. In addition, >60 Gy of RT in IMRT led to improved survival outcomes in elderly paranasal sinus carcinoma patients.

  14. Allogenic stem cell transplantation as salvage therapy for patients relapsing after autologous transplantation: experience from a single institution.

    PubMed

    Martínez, C; Carreras, E; Rovira, M; Urbano-Ispizua, A; Esteve, J; Fernández-Avilés, F; Perales, M; Rives, S; Gómez, M; Montserrat, E

    2001-05-01

    The prognosis of patients relapsing after an autologous transplant (autoSCT) is very poor. Allogenic stem cell transplantation (alloSCT) offers the possibility of curing some of these patients, at the cost, however, of a high transplant related mortality (TRM). The aim of this study was to analyze the outcome of 14 consecutive patients with hematologic malignancies, from a single institution, who underwent alloSCT for progressive disease after autoSCT. Patients had relapsed at a median of 11.5 months (range 2-72) after autoSCT and they underwent alloSCT at a median of 25.5 months (range 7-73) from the first transplant. Ten patients received HLA-identical related peripheral blood progenitor cells, three patients underwent matched-unrelated donor marrow transplants, and one patient received a mismatched related transplant. Conditioning regimens consisted of total body irradiation plus cyclophosphamide (n=5) or melphalan (n=1), or high-dose combination chemotherapy (n=8). Cyclosporin A and methotrexate were administered as graft-versus-host disease (GVHD) prophylaxis. Eight patients (57%) developed grade II-IV acute GVHD. All evaluable patients (n=6) presented extensive chronic GVHD. Overall survival at 1 year was 16% (median 3.5 months, 95% CI 0.7-10.3). Ten patients (71%) died from transplant related complications at a median of 3.5 months (range 0.7-11). Only one patient died of recurrent disease. Three patients remain alive and in complete remission at the time of this report (4, 20 and 20 months, respectively). In conclusion, alloSCT offers the possibility of a sustained control of the disease in some patients who relapse after an autoSCT. However, the procedure is associated with a high transplant-related mortality. Better results might be obtained by carefully selecting patients and by reducing the intensity of the preparative regimen.

  15. Adaptive Planning in Intensity-Modulated Radiation Therapy for Head and Neck Cancers: Single-Institution Experience and Clinical Implications

    SciTech Connect

    Ahn, Peter H.; Chen, Chin-Cheng; Ahn, Andrew I.; Hong, Linda; Scripes, Paola G.; Shen Jin; Lee, Chen-Chiao; Miller, Ekeni; Kalnicki, Shalom; Garg, Madhur K.

    2011-07-01

    Purpose: Anatomic changes and positional variability during intensity-modulated radiation therapy (IMRT) for head and neck cancer can lead to clinically significant dosimetric changes. We report our single-institution experience using an adaptive protocol and correlate these changes with anatomic and positional changes during treatment. Methods and Materials: Twenty-three sequential head and neck IMRT patients underwent serial computed tomography (CT) scans during their radiation course. After undergoing the planning CT scan, patients underwent planned rescans at 11, 22, and 33 fractions; a total of 89 scans with 129 unique CT plan combinations were thus analyzed. Positional variability and anatomic changes during treatment were correlated with changes in dosimetric parameters to target and avoidance structures between planning CT and subsequent scans. Results: A total of 15/23 patients (65%) benefited from adaptive planning, either due to inadequate dose to gross disease or to increased dose to organs at risk. Significant differences in primary and nodal targets (planning target volume, gross tumor volume, and clinical tumor volume), parotid, and spinal cord dosimetric parameters were noted throughout the treatment. Correlations were established between these dosimetric changes and weight loss, fraction number, multiple skin separations, and change in position of the skull, mandible, and cervical spine. Conclusions: Variations in patient positioning and anatomy changes during IMRT for head and neck cancer can affect dosimetric parameters and have wide-ranging clinical implications. The interplay between random positional variability and gradual anatomic changes requires careful clinical monitoring and frequent use of CT- based image-guided radiation therapy, which should determine variations necessitating new plans.

  16. Klebsiella pneumoniae Carbapenemase (KPC)-Producing K. pneumoniae at a Single Institution: Insights into Endemicity from Whole-Genome Sequencing

    PubMed Central

    Stoesser, Nicole; Sheppard, Anna E.; Pankhurst, Louise; Giess, Adam; Yeh, Anthony J.; Didelot, Xavier; Turner, Stephen D.; Sebra, Robert; Kasarskis, Andrew; Peto, Tim; Crook, Derrick; Sifri, Costi D.

    2015-01-01

    The global emergence of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) multilocus sequence type ST258 is widely recognized. Less is known about the molecular and epidemiological details of non-ST258 K. pneumoniae in the setting of an outbreak mediated by an endemic plasmid. We describe the interplay of blaKPC plasmids and K. pneumoniae strains and their relationship to the location of acquisition in a U.S. health care institution. Whole-genome sequencing (WGS) analysis was applied to KPC-Kp clinical isolates collected from a single institution over 5 years following the introduction of blaKPC in August 2007, as well as two plasmid transformants. KPC-Kp from 37 patients yielded 16 distinct sequence types (STs). Two novel conjugative blaKPC plasmids (pKPC_UVA01 and pKPC_UVA02), carried by the hospital index case, accounted for the presence of blaKPC in 21/37 (57%) subsequent cases. Thirteen (35%) isolates represented an emergent lineage, ST941, which contained pKPC_UVA01 in 5/13 (38%) and pKPC_UVA02 in 6/13 (46%) cases. Seven (19%) isolates were the epidemic KPC-Kp strain, ST258, mostly imported from elsewhere and not carrying pKPC_UVA01 or pKPC_UVA02. Using WGS-based analysis of clinical isolates and plasmid transformants, we demonstrate the unexpected dispersal of blaKPC to many non-ST258 lineages in a hospital through spread of at least two novel blaKPC plasmids. In contrast, ST258 KPC-Kp was imported into the institution on numerous occasions, with other blaKPC plasmid vectors and without sustained transmission. Instead, a newly recognized KPC-Kp strain, ST941, became associated with both novel blaKPC plasmids and spread locally, making it a future candidate for clinical persistence and dissemination. PMID:25561339

  17. Deferasirox treatment for myelodysplastic syndromes: "real-life" efficacy and safety in a single-institution patient population.

    PubMed

    Breccia, Massimo; Finsinger, Paola; Loglisci, Giuseppina; Federico, Vincenzo; Santopietro, Michelina; Colafigli, Gioia; Petrucci, Luigi; Salaroli, Adriano; Serrao, Alessandra; Latagliata, Roberto; Alimena, Giuliana

    2012-09-01

    We here describe a single-institution experience on 40 patients with myelodysplastic syndromes (MDS) consecutively treated with deferasirox at the dose of 10-30 mg/kg/day according to Consensus Guidelines on Iron Chelation Therapy, outside of clinical trials. Serum ferritin (SF) was measured monthly, and safety assessment included monitoring of adverse events during treatment and of liver and renal parameters. Median SF at baseline of the 40 patients was 2,878 ng/ml. Median dose of deferasirox was 1,125 mg/day. At a median follow-up of 12 months of treatment, there was a significant reduction in SF from baseline, the median value being 1,400 ng/ml (p = 0.001). Interruptions due to toxicity were recorded in 40 % of patients: most common adverse events were diarrhoea (five patients, 12.5 %) and skin rash (four patients, 10 %). Seven patients had increased serum creatinine values >33 % above baseline, but there were no progressive increases. Four patients (three refractory anaemia and one refractory anaemia with excess blasts type 1) had a reduction of transfusion requirement (from a median of 5 to 1 unit/month) according to International Working Group 2006 criteria, with mean Hb value increasing from 8.5 to 10.5 g/dl, and mean Hb improvement being 2 g/dl (p = 0.02). No increased toxicity was noted when deferasirox was used concomitantly with azacitidine (eight patients who were intermediate 2 International Prognostic Scoring System risk) or lenalidomide (two patients with del(5q)). In conclusion, the oral iron chelator deferasirox is effective and safe when used in MDS patients with transfusion requirement, also if administered concomitantly with other drugs.

  18. [Compartment syndrome in bilateral lower legs after total cystectomy: a case report].

    PubMed

    Sumiyoshi, Takayuki; Utsunomiya, Noriaki; Segawa, Takehiko; Muguruma, Koei; Ichikawa, Koichi; Kawakita, Mutsushi

    2011-02-01

    We report a case of compartment syndrome in bilateral lower legs after total cystectomy with urethrectomy and ileal conduit diversion. A 64-year-old man who had diabetes mellitus for 20 years underwent an operation for invasive bladder cancer. He was placed in the lithotomy position and both lower legs were protected with an elastic stocking and intermittent pneumatic compression for prevention of deep vein thrombosis during the operation. Seven hours postoperatively, he complained of bilateral calf pain. Eleven hours postoperatively, skin redness, swelling, movement and sensory disorder of bilateral lower legs were found. Contrasting computed tomography (CT) of lower legs showed the swelling of bilateral soleus muscles and gastrocnemius muscles without any contrasting effect. Creatinine phosphokinase (CPK) increased to 46, 740 IU/l and the intramuscular pressure was 50 mmHg. He was diagnosed with compartment syndrome, in bilateral lower legs and emergent fasciotomy was performed. Bilateral calf pain was improved immediately after fasciotomy and could walk on his own after rehabilitation. Lower leg compartment syndrome is an uncommon disease but may require lower leg amputation or result in death if the treatment is delayed. Urologists should recognize this disease as a complication after prolonged operation in the lithotomy position.

  19. Prognostic value of vascular mimicry in patients with urothelial carcinoma of the bladder after radical cystectomy.

    PubMed

    Zhou, Lin; Chang, Yuan; Xu, Le; Hoang, Son Tung Nguyen; Liu, Zheng; Fu, Qiang; Lin, Zongming; Xu, Jiejie

    2016-11-15

    Vascular mimicry (VM) refers to the plasticity of aggressive cancer cells forming de novo vascular networks, which promoted tumor metastasis. The aim of this study was evaluate the impact of VM on recurrence-free survival (RFS) in urothelial carcinoma of the bladder (UCB). Records from 202 patients treated with radical cystectomy (RC) for UCB at Zhongshan Hospital between 2002 and 2014 were reviewed. The presence of VM was identified by CD31-PAS double staining. Positive VM staining occurred in 19.3% (39 of 202) UCB cases, and it was associated with increased risks of recurrence (Log-Rank p<0.001). VM was identified as an independent prognostic factor (p=0.002). In the cohort with MIBC, patients with VM negative got CSS benefit from the use of ACT (p = 0.048). As for lung metastasis, the combination of VM and TNM stage (AUC 0.792) showed a better prognostic value than TNM stage alone (AUC 0.748, p = 0.008) or VM alone (AUC 0.714, p = 0.023). Vascular mimicry could be a potential prognosticator for recurrence-free survival in patients with UCB after RC. Vascular mimicry seems to predict risk of developing lung metastases after RC. The presence of VM identified a subgroup of patients with MIBC who appeared to benefit from adjuvant chemotherapy.

  20. Prognostic value of vascular mimicry in patients with urothelial carcinoma of the bladder after radical cystectomy

    PubMed Central

    Hoang, Son Tung Nguyen; Liu, Zheng; Fu, Qiang; Lin, Zongming; Xu, Jiejie

    2016-01-01

    Vascular mimicry (VM) refers to the plasticity of aggressive cancer cells forming de novo vascular networks, which promoted tumor metastasis. The aim of this study was evaluate the impact of VM on recurrence-free survival (RFS) in urothelial carcinoma of the bladder (UCB). Records from 202 patients treated with radical cystectomy (RC) for UCB at Zhongshan Hospital between 2002 and 2014 were reviewed. The presence of VM was identified by CD31-PAS double staining. Positive VM staining occurred in 19.3% (39 of 202) UCB cases, and it was associated with increased risks of recurrence (Log-Rank p<0.001). VM was identified as an independent prognostic factor (p=0.002). In the cohort with MIBC, patients with VM negative got CSS benefit from the use of ACT (p = 0.048). As for lung metastasis, the combination of VM and TNM stage (AUC 0.792) showed a better prognostic value than TNM stage alone (AUC 0.748, p = 0.008) or VM alone (AUC 0.714, p = 0.023). Vascular mimicry could be a potential prognosticator for recurrence-free survival in patients with UCB after RC. Vascular mimicry seems to predict risk of developing lung metastases after RC. The presence of VM identified a subgroup of patients with MIBC who appeared to benefit from adjuvant chemotherapy. PMID:27776348

  1. The role of adjuvant chemotherapy following cystectomy for invasive bladder cancer: a prospective comparative trial.

    PubMed

    Skinner, D G; Daniels, J R; Russell, C A; Lieskovsky, G; Boyd, S D; Nichols, P; Kern, W; Sakamoto, J; Krailo, M; Groshen, S

    1991-03-01

    We assigned 91 patients with deeply invasive, pathological stage P3, P4 or N+ and Mo transitional cell carcinoma of the bladder (with or without squamous or glandular differentiation) to adjuvant chemotherapy or to observation after radical cystectomy and pelvic lymph node dissection. For most patients chemotherapy was planned as 4 courses at 28-day intervals of 100 mg./M.2 cisplatin, 60 mg./M.2 doxorubicin and 600 mg./M.2 cyclophosphamide. A significant delay was shown in the time to progression (p = 0.0010) with 70% of the patients assigned to chemotherapy free of disease at 3 years compared to 46% in the observation group. Median survival time for patients in the chemotherapy group was 4.3 years compared to 2.4 years in the observation group (p = 0.0062). In addition to treatment groups, important prognostic factors included age, gender and lymph node status. The number of involved lymph nodes was the single most important variable. We recommend adjuvant chemotherapy for patients with invasive transitional cell carcinoma after definitive surgical resection.

  2. Core binding factor acute myeloid leukemia (CBF-AML) in México: a single institution experience.

    PubMed

    Ruiz-Delgado, Guillermo J; Macías-Gallardo, Julio; Lutz-Presno, Julia; Garcés-Eisele, Javier; Hernández-Arizpe, Ana; Montes-Montiel, Maryel; Ruiz-Argüelles, Guillermo J

    2011-01-01

    Twenty one patients with CBF-AML presented prospectively in the Centro de Hematología y Medicina Interna de Puebla (Puebla, México) between February 1995 and March 2010, 14 with the t(8;21)(q22;q22) and 7 with the inv(16)(p13;q22)/t(16;16)(p13;q22); they represent 13% of all cases of AML. The median age of the patients was 24 years (range 1 to 61). Seven of 14 patients with t(8;21)(q22;q22) had an M2 morphology whereas 3/7 with the inv(16) had an M4 morphology; in addition to the myeloid markers identified by flow-cytometry (surface CD13, surface CD33, and cytoplasmic myeloperoxidase) lymphoid markers were identified in the blast cells of 8/14 cases of the t(8;21) patients, but in no patient with the inv(16). Nineteen patients were treated with combined chemotherapy and 16 (84%) achieved a complete molecular remission. Seven patients were auto or allografted. Relapses presented in 10/16 patients. The median probability of overall survival (OS) has not been reached being above 165 months, whereas the 165-month probability of OS and leukemia-free survival was 52%; despite a tendency for a better outcome of patients with the t(8;21), there were no significant differences in survival of patients with either the t(8;21) or the inv(16). In this single institution experience in México, we found that the CBF variants of AML have a similar prevalence as compared with Caucasian populations, that the co-expression of lymphoid markers in the blast cells was frequent in the t(8;21) and that these two AML subtypes were associated with a relatively good long-term prognosis. Further studies are needed to describe with more detail the precise biological features of these molecular subtypes of acute leukemia.

  3. Revision Rhinoplasty.

    PubMed

    Loyo, Myriam; Wang, Tom D

    2016-01-01

    Revision rhinoplasty is one of the most challenging operations the facial plastic surgeon performs given the complex 3-dimensional anatomy of the nose and the psychological impact it has on patients. The intricate interplay of cartilages, bone, and soft tissue in the nose gives it its aesthetic and function. Facial harmony and attractiveness depends greatly on the nose given its central position in the face. In the following article, the authors review common motivations and anatomic findings for patients seeking revision rhinoplasty based on the senior author's 30-year experience with rhinoplasty and a review of the literature.

  4. Novel Simulation Model of Non-Muscle Invasive Bladder Cancer: A Platform for a Virtual Randomized Trial of Conservative Therapy vs. Cystectomy in BCG Refractory Patients.

    PubMed

    Patel, Sanjay; Dinh, Tuan; Noah-Vanhoucke, Joyce; Rengarajan, Badri; Mayo, Kevin; Clark, Peter E; Kamat, Ashish M; Lee, Cheryl T; Sexton, Wade J; Steinberg, Gary D

    2015-10-26

    Introduction: There have been no randomized controlled trials (RCTs) evaluating the clinical or economic benefit of mitomycin C intravesical therapy vs. radical cystectomy in patients with high-risk non-muscle invasive bladder cancer (NMIBC). We used the Archimedes computational model to simulate RCT comparing radical cystectomy versus intravesical mitomycin C (MMC) therapy to evaluate the clinical and economic outcomes for BCG-refractory NMIBC as well demonstrate the utility of computer based models to simulate a clinical trial. Methods: The Archimedes model was developed to generate a virtual population using the Surveillance Epidemiology and End Results database, other clinical trials, and expert opinions. Patients selected were diagnosed with NMIBC (cystectomy vs. 2) MMC induction intravesical therapy. Clinical (progression, overall survival, and disease specific survival) and economic outcomes were reported. Results: A total of 1300 virtual patients were evaluation. Progression to MIBC in the MMC treatment arm was 30% over the lifetime. Disease specific death at 5 years was 1.6% and 8.7% for the immediate cystectomy and MMC treatment arms respectively; while, overall death was 17.8% and 23.8% at 5 years. Over a 5-year period the average cost of immediate cystectomy was $64,675 vs $68,517 in the MMC arm. Conclusion: Immediate radical cystectomy after BCG failure for NMIBC has improved survival and is more cost-effective when compared to those undergoing MMC. Simulation of clinical trials using computational models similar to the Archimedes model can overcome shortcomings of real-world clinical trials and may prove useful in the face of current medical cost-conscious era.

  5. Risk Prediction Models of Locoregional Failure After Radical Cystectomy for Urothelial Carcinoma: External Validation in a Cohort of Korean Patients

    SciTech Connect

    Ku, Ja Hyeon; Kim, Myong; Jeong, Chang Wook; Kwak, Cheol; Kim, Hyeon Hoe

    2014-08-01

    Purpose: To evaluate the predictive accuracy and general applicability of the locoregional failure model in a different cohort of patients treated with radical cystectomy. Methods and Materials: A total of 398 patients were included in the analysis. Death and isolated distant metastasis were considered competing events, and patients without any events were censored at the time of last follow-up. The model included the 3 variables pT classification, the number of lymph nodes identified, and margin status, as follows: low risk (≤pT2), intermediate risk (≥pT3 with ≥10 nodes removed and negative margins), and high risk (≥pT3 with <10 nodes removed or positive margins). Results: The bootstrap-corrected concordance index of the model 5 years after radical cystectomy was 66.2%. When the risk stratification was applied to the validation cohort, the 5-year locoregional failure estimates were 8.3%, 21.2%, and 46.3% for the low-risk, intermediate-risk, and high-risk groups, respectively. The risk of locoregional failure differed significantly between the low-risk and intermediate-risk groups (subhazard ratio [SHR], 2.63; 95% confidence interval [CI], 1.35-5.11; P<.001) and between the low-risk and high-risk groups (SHR, 4.28; 95% CI, 2.17-8.45; P<.001). Although decision curves were appropriately affected by the incidence of the competing risk, decisions about the value of the models are not likely to be affected because the model remains of value over a wide range of threshold probabilities. Conclusions: The model is not completely accurate, but it demonstrates a modest level of discrimination, adequate calibration, and meaningful net benefit gain for prediction of locoregional failure after radical cystectomy.

  6. Symplastic glomus tumor of the urinary bladder treated by robot-assisted partial cystectomy: a case report and literature review.

    PubMed

    Palmisano, Franco; Gadda, Franco; Spinelli, Matteo G; Maggioni, Marco; Rocco, Bernardo; Montanari, Emanuele

    2017-01-16

    Glomus tumors arising in the urinary bladder are extremely rare, and only two cases have been reported in the English Literature. We present a case of a 58-year-old man with an asymptomatic mass of the anterior wall of the bladder that measured 2.5 × 2.5 cm. Endoscopic excision was performed, and the tumor was diagnosed as symplastic glomus tumor. The patient finally underwent robotic-assisted partial cystectomy, and he remains healthy without any recurrence to date.After reviewing this case and previous reports, we analyzed the clinicopathologic features and treatment options for this rare neoplasm.

  7. Femtosecond laser ablation of porcine intestinal mucosa: potential autologous transplant for segmental cystectomy

    NASA Astrophysics Data System (ADS)

    Higbee, Russell G.; Irwin, Bryan S.; Nguyen, Michael N.; Zhang, Yuanyuan; Warren, William L.

    2005-04-01

    Nearly 80% of patients with newly diagnosed bladder cancer present with superficial bladder tumors (confined to the bladder lining such as transitional cell carcinoma [90%], squamous cell carcinoma [6-8%], and adenocarcinoma[2%]) in stages Ta, Tis, or T1. Segmental cystectomy is one surgical treatment for patients who have a low-grade invasive tumor. Transposition of small intestine is a viable surgical treatment option. Success of the transplantation is also dependent upon removal of the entire SI mucosal layer. A Clark Spitfire Ti:Sapphire laser operating at 775 nm and 1 kHz repetition rate, was used to investigate the damage induced to fresh cadaveric porcine small intestinal mucosal epithelium. The laser was held constant at a focal spot diameter of 100 μm using a 200 mm focal point lens, with a power output maximum of 257 mW. A high resolution motorized X-Y-Z stage translated the SI tissue through the beam at 500 μm/sec with a line spacing of 50 μm. This produced a 50% overlap in the laser etching for each pass over a 1 cm x 1.5 cm grid. To determine if the mucosal lining of the SI was adequately removed, the targeted area was covered with 1% fluorescein solution for 30 seconds and then rinsed with phosphate buffered saline. Fluorescein staining was examined under UV illumination, to determine the initial degree of mucosal removal. Tissues were fixed and processed for light and scanning electron microscopy by standard protocols. Brightfield light microscopy of hematoxylin and eosin stained 4 μm thick cross sections, scanning electron microscopy were examined to determine the degree of mucosal tissue removal. Clear delineation of the submucosal layer by fluorescein staining was also observed. The Ti:Sapphire laser demonstrated precise, efficient removal of the mucosal epithelium with minimal submucosal damage.

  8. Laparoscopic radical cystectomy with novel orthotopic neobladder with bilateral isoperistaltic afferent limbs: initial experience

    PubMed Central

    Xing, Nian-Zeng; Kang, Ning; Song, Li-Mming; Niu, Yi-Nong; Wang, Ming-Shuai; Zhang, Jun-Hui

    2017-01-01

    ABSTRACT Purpose To introduce a new method of constructing an orthotopic ileal neobladder with bilateral isoperistaltic afferent limbs, and to describe its clinical outcomes. Materials and Methods From January 2012 to December 2013, 16 patients underwent a new method of orthotopic ileal neobladder after laparoscopic radical cystectomy for bladder cancer. To construct the neobladder, an ileal segment 60cm long was isolated approximately 25cm proximally to the ileocecum. The proximal 20cm of the ileal segment was divided into two parts for bilateral isoperistaltic afferent limbs. The proximal 10cm of the ileal segment was moved to the distal end of the ileal segment for the right isoperistaltic afferent limb, and the remaining proximal 10cm ileal segment was reserved for the left isoperistaltic afferent limb. The remaining length of the 40cm ileal segment was detubularized along its antimesenteric border to form a reservoir. The neobladder was sutured to achieve a spherical configuration. Results All procedures were carried out successfully. The mean operative time was 330 min, mean blood loss was 328mL, and mean hospital stay was 12.5 days. The mean neobladder capacity 6 and 12 months after surgery was 300mL and 401mL, respectively. With a mean follow-up of 22.8 months, all patients achieved daytime continence and 15 achieved nighttime continence. The mean peak urinary flow rate was 11.9mL/s and 12.8mL/s at 6 and 12 months postoperatively, respectively. Conclusions This novel procedure is feasible, safe, simple to perform, and provides encouraging functional outcomes. However, comparative studies with long-term follow-up are required to prove its superiority. PMID:28124527

  9. Risk Factors for the Development of Parastomal Hernia after Radical Cystectomy

    PubMed Central

    Donahue, Timothy F.; Bochner, Bernard H.; Sfakianos, John P.; Kent, Matthew; Bernstein, Melanie; Hilton, William M.; Cha, Eugene K.; Yee, Alyssa M.; Dalbagni, Guido; Vargas, Hebert A.

    2014-01-01

    Purpose Parastomal hernia (PH) is a frequent complication from stoma formation after radical cystectomy (RC). We sought to determine the prevalence and risk factors for developing PH following RC. Material and Methods Retrospective study of 433 consecutive patients who underwent open RC and ileal conduit between 2006-2010. Postoperative cross-sectional imaging studies performed for routine oncologic follow-up (n=1736) were evaluated for PH, defined as radiographic evidence of protrusion of abdominal contents through the abdominal wall defect created by forming the stoma. Univariable and multivariable Cox regression analyses were used to determine clinical and surgical factors associated with PH. Results Complete data were available for 386 patients with radiographic PH occurring in 136. The risk of developing a PH was 27% (95% CI 22-33%) and 48% (95% CI 42-55%) at 1 and 2 years. Clinical diagnosis of PH was documented in 93 patients and 37 were symptomatic. Of 16 patients with clinical PH referred for repair, 8 had surgery. On multivariable analysis, female gender (HR=2.25, 95%CI 1.58-3.21; p<0.0001), higher BMI (HR=1.08 per unit increase 95%CI 1.05-1.12; p<0.0001), and lower preoperative albumin (HR=0.43 per g/dl, 95%CI 0.25-0.75; p=0.003) were significantly associated with PH. Conclusions The overall risk of radiographic evidence of PH approached 50% at 2 years. Female gender, higher BMI, and lower preoperative albumin were most associated with developing PH. Identifying those at greatest risk may allow for prospective surgical maneuvers at the time of initial surgery, such as placement of prophylactic mesh in selected patients, to prevent the occurrence of PH. PMID:24384155

  10. Perineal herniation of an ileal neobladder following radical cystectomy and consecutive rectal resection for recurrent bladder carcinoma

    PubMed Central

    Neumann, PA; Mehdorn, AS; Puehse, G; Senninger, N; Rijcken, E

    2016-01-01

    Secondary perineal herniation of intraperitoneal contents represents a rare complication following procedures such as abdominoperineal rectal resection or cystectomy. We present a case of a perineal hernia formation with prolapse of an ileum neobladder following radical cystectomy and rectal resection for recurrent bladder cancer. Following consecutive resections in the anterior and posterior compartment of the lesser pelvis, the patient developed problems emptying his neobladder. Clinical examination and computed tomography revealed perineal herniation of his neobladder through the pelvic floor. Through a perineal approach, the hernial sac could be repositioned, and via a combination of absorbable and non-absorbable synthetic mesh grafts, the pelvic floor was stabilised. Follow-up review at one year after hernia fixation showed no signs of recurrence and no symptoms. In cases of extensive surgery in the lesser pelvis with associated weakness of the pelvic compartments, meshes should be considered for closure of the pelvic floor. Development of biological meshes with reduced risk of infection might be an interesting treatment option in these cases. PMID:26985818

  11. Total cystectomy and subsequent urinary diversion to the prepuce or vagina in dogs with transitional cell carcinoma of the trigone area: A report of 10 cases (2005–2011)

    PubMed Central

    Saeki, Kohei; Fujita, Atsushi; Fujita, Naoki; Nakagawa, Takayuki; Nishimura, Ryohei

    2015-01-01

    The cases of 10 dogs with transitional cell carcinoma of the urinary bladder that underwent total cystectomy were retrospectively reviewed to evaluate the feasibility and outcome of total cystectomy and ureteral transplantation to the prepuce or vagina. Dehiscence of ureterostomy (n = 2), pyelonephritis (n = 3), oliguria (n = 2), azotemia (n = 1), and ureteral obstruction (n = 1) were observed complications. The estimated median survival time was 385 days. This study demonstrates the feasibility of total cystectomy and subsequent urinary diversion to the prepuce or vagina in dogs. Compared to previous ureterocolonic anastomosis, this technique is associated with fewer gastrointestinal and neurologic complications. PMID:25565719

  12. ACL Revision

    PubMed Central

    Costa-Paz, Matias; Dubois, Julieta Puig; Zicaro, Juan Pablo; Rasumoff, Alejandro; Yacuzzi, Carlos

    2017-01-01

    Objectives: The purpose of this study was to evaluate a series of patients one year after an ACL revision with clinical evaluation and MRI, to consider their condition before returning to sports activities. Methods: A descriptive, prospective and longitudinal study was performed. A series of patients who underwent an ACL revision between March 2014 and March 2015 were evaluated after one year post surgery. They were evaluated using the Lysholm score, IKDC, Tegner, artrometry and MRI (3.0 t). A signal pattern and osteointegration was determined in the MRI. Graft signal intensity of the ACL graft using the signal/noise quotient value (SNQ) was also determined to evaluate the ligamentatization process state. Results: A total of 18 male patients were evaluated with a mean age of 31 years old.Average scores were: Lysholm 88 points, IKDC 80 points, Pre-surgical Tegner 9 points and postoperative 4 points. Artrhometry (KT1000) at 20 newtons showed a side to side difference of less than 3 mm in 88%. Only 44% of patients returned to their previous sport activity one year after revision.The MRI showed a heterogeneous signal in neoligaments in 34% of patients. SNQ showed graft integration in only 28%. Synovial fluid was found in bone-graft interphase in 44% of tunnels, inferring partial osteointegration. The heterogeneous signal was present in 50% of patients who did not return to the previous sport level activity. (Fisher statistics: p = 0.043) There were no meaningful differences in patients with auto or allografts. Conclusion: Although the clinical evaluation was satisfactory, only 44% of patients returned to the previous level of sport activity one year after the ACL surgery. The ligamentatization process was found in 28% of knees evaluated with MRI one year later. Partial osteointegration is inferred in 44%. Results showed a meaningful relation between the signal of neoligaments in the MRI and the return to sport activity in said series of patients. MRI is a useful tool

  13. Open surgical revision provides a more durable repair than endovascular treatment for unfavorable vein graft lesions

    PubMed Central

    McCallum, John C.; Bensley, Rodney P.; Darling, Jeremy D.; Hamdan, Allen D.; Wyers, Mark C.; Hile, Chantel; Guzman, Raul J.; Schermerhorn, Marc L.

    2015-01-01

    Objective Lower extremity bypass grafts that develop stenoses are commonly treated with either open surgical or endovascular revision. Vein graft stenoses with unfavorable lesions (multiple lesions, lesions greater than 2cm in length, lesions in grafts less than 3 months old, lesions in grafts less than 3mm in diameter) fare worse than those with favorable lesions when treated with endovascular therapy. However, it is not known if unfavorable lesions fare better with surgical revision than with endovascular treatment or than favorable lesions treated with surgery. Methods We performed a retrospective review of 175 vein graft revisions performed at a single institution from 2000 to 2010. Characteristics of lesions treated with surgical and endovascular revision were identified. Cox proportional hazard models were used to identify predictors of revision failure (restenosis >75%, revision, or amputation). Results 91 (52%) failing vein grafts were treated with surgical revision and 84 (48%) with endovascular treatment, with a median follow up of 30 months. Favorable lesions fared better than unfavorable lesions after endovascular treatment, with 12-month freedom from failure of 59% vs 34% (P <.01), but not after surgical revision (66% vs 62%, P =.90). Unfavorable lesions had better freedom from failure after surgery than endovascular treatment (62%vs 34%, P <.01), while results in favorable lesions were similar (66% versus 59%, P =.57). Conclusion For the treatment of failing vein grafts, endovascular therapy appears adequate for favorable lesions while surgical revision is more durable for unfavorable lesions. PMID:26483000

  14. [Recurrence of bladder cancer in remnant urethra and inguinal lymph node metastasis nine years after total cystectomy: a case report].

    PubMed

    Obata, Jun; Kikuchi, Eiji; Kaneko, Gou; Miyajima, Akira; Kameyama, Kaori; Jinzaki, Masahiro; Oya, Mototsugu

    2011-01-01

    A 68-year-old man underwent total cystectomy, urethrectomy preserving fossa navicularis, and an Indiana pouch urinary diversion in 1997. The histopathology was UC, G3, pT4 (prostate). Nine years after the operation, he had multiple metastases to the inguinal and paraaortic lymph nodes (LNs), and he complained of erosion around the glans. Histological diagnosis of the glans revealed recurrent UC to the urethra of the glans. We considered the possibility that the inguinal LN metastasis was due to lymphatic spread from a remnant urethral recurrence. Thus, a partial penectomy and inguinal LN dissection were undertaken. Systemic chemotherapy was administered. Remnant urethral recurrence after urethrectomy preserving the fossa navicularis and inguinal LN metastasis are rare.

  15. Extent of lymphadenectomy in patients with bladder cancer undergoing radical cystectomy – a multi-institutional analysis

    PubMed Central

    Piotrowicz, Sebastian; Czarniecki, Stefan W.; Kowalski, Filip; Nowak, Grzegorz; Oszczudłowski, Maciej; Sochaj, Marta; Dobruch, Jakub; Radziszewski, Piotr

    2016-01-01

    Lymph node dissection (LND) performed at radical cystectomy (RC) has therapeutic and staging significance. However, the extent of LND remains controversial. The aim of this study was to analyze surgical patterns and results of LND in a contemporary series of patients with bladder cancer. This is a retrospective analysis of 113 consecutive patients subjected to RC in seven urological centres in the year 2013. The mean age of the cohort was 66.6 years. There were 49 cases of organ confined and 64 cases of locally advanced disease. Study endpoints were: status and extent of LND, number of LNs removed, and number of positive LNs. LND was performed in 102 patients (90.3%). Detailed data on the anatomical extent of LND was available in 82 patients (80.4%). Limited (lLND) and extended LND (eLND) was performed in 68.3% (n = 56) and 31.7% (n = 26) of patients, respectively. Obturator fossa LNs were removed in 84.1%, external iliac in 72.0%, internal iliac in 40.2%, common iliac in 31.7%, and presacral in 15.9% of cases. The median number of LNs removed in the whole study cohort, in patients who underwent lLND, and eLND, was 8.5, 5, and 16.5, respectively. In 28 patients (27.5%), LN metastases were diagnosed, including 6 cases (12.5%) in the organ-confined cohort and 22 cases (34.4%) in the locally advanced disease cohort. LND is an integral part of radical cystectomy in patients with bladder cancer. However, in the majority of patients, the extent of the procedure was suboptimal, potentially negatively affecting the survival and adequacy of pathological staging. PMID:28127445

  16. A 10-Year Retrospective Review of a Nonrandomized Cohort of 458 Patients Undergoing Radical Radiotherapy or Cystectomy in Yorkshire, UK

    SciTech Connect

    Munro, Nicholas P.; Sundaram, Subramnian K.; Weston, Philip; Fairley, Lesley; Harrison, Simon C.W.; Forman, David; Chahal, Rohit

    2010-05-01

    Purpose: We have previously reported on the mortality, morbidity, and 5-year survival of 458 patients who underwent radical radiotherapy or surgery for invasive bladder cancer in Yorkshire from 1993 to 1996. We aim to present the 10-year outcomes of these patients and to reassess factors predicting survival. Methods and Materials: The Northern and Yorkshire Cancer Registry identified 458 patients whose cases were subjected to Kaplan-Meier all-cause survival analyses, and a retrospective casenote analysis was undertaken on 398 (87%) for univariate and multivariate Cox proportional hazards modeling. Additional proportional hazards regression modeling was used to assess the statistical significance of variables on overall survival. Results: The ratio of radiotherapy to cystectomy was 3:1. There was no significant difference in overall 10-year survival between those who underwent radiotherapy (22%) and radical cystectomy (24%). Univariate analyses suggested that female sex, performance status, hydronephrosis and clinical T stage, were associated with an inferior outcome at 10 years. Patient age, tumor grade, treatment delay, and caseload factors were not significant. Multivariate analysis models were created for 0-2 and 2-10 years after treatment. There were no significant differences in treatment for 0-2 years; however, after 2 years follow-up there was some evidence of increased survival for patients receiving surgery compared with radiotherapy (hazard ratio 0.66, 95% confidence interval: 0.44-1.01, p = 0.06). Conclusions: a 10-year minimum follow-up has rarely been reported after radical treatment for invasive bladder cancer. At 10 years, there was no statistical difference in all-cause survival between surgery and radiotherapy treatment modalities.

  17. Robot-assisted partial cystectomy with intraoperative frozen section examination: Evolution and evaluation of a novel technique

    PubMed Central

    Klett, Dane E.; Abdollah, Firas; Sammon, Jesse D.; Pucheril, Dan; Menon, Mani; Jeong, Wooju; Peabody, James O.

    2016-01-01

    Purpose To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis. Materials and Methods A total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires. Results The mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction. Conclusions The 'modified' technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy. PMID:27195322

  18. Effect of Neoadjuvant Chemotherapy on Renal Function following Radical Cystectomy: Is there a Meaningful Impact?

    PubMed Central

    Chandrasekar, Thenappan; Pugashetti, Neil; Durbin-Johnson, Blythe; Dall’Era, Marc A.; Evans, Christopher P.; deVere White, Ralph W.; Yap, Stanley A.

    2016-01-01

    Objective: To evaluate the patterns of impact of neoadjuvant chemotherapy (NAC) on renal function across the initial year following treatment for muscle-invasive bladder cancer (MIBC) with radical cystectomy (RC). Methods: We reviewed the charts of 241 patients who underwent RC for urothelial carcinoma of the bladder between 2003-14 at our institution. Renal function was evaluated at multiple time points (pre-chemotherapy, pre-operatively, post-operatively, 6–12 months follow-up), and then classified by CKD staging. Univariable and multivariable logistic regression analyses were performed to determine relationship between NAC and change in CKD stage. Results: Of the 241 patients who underwent RC for urothelial carcinoma of the bladder, 66 (27%) received NAC and 175 (73%) did not. In multivariable analysis, NAC was significantly associated with a decrease of at least one CKD stage from baseline to post-op (p = 0.009), but not to the 6–12 months follow-up time point (p = 0.050). The loss of GFR in the NAC cohort occurs up-front with chemotherapy, but the peri-operative course is similar to those who underwent cystectomy alone. Of the 15 NAC patients (26.8%) who were Stage 3 CKD prior to chemotherapy, none progressed to a higher stage CKD. Conclusion: NAC is associated with an initial decline in GFR, which then remains stable through the first year following RC. Despite an initial insult, patients receiving NAC are not vulnerable to further deterioration. When appropriately selected, NAC does not appear to result in a clinically significant deterioration of renal function. PMID:28035325

  19. Scar revision

    PubMed Central

    Sharma, Mohit; Wakure, Abhijeet

    2013-01-01

    Most surgical patients end up with a scar and most of these would want at least some improvement in the appearance of the scar. Using sound techniques for wound closure surgeons can, to a certain extent, prevent suboptimal scars. This article reviews the principles of prevention and treatment of suboptimal scars. Surgical techniques of scar revision, i.e., Z plasty, W plasty, and geometrical broken line closure are described. Post-operative care and other adjuvant therapies of scars are described. A short description of dermabrasion and lasers for management of scars is given. It is hoped that this review helps the surgeon to formulate a comprehensive plan for management of scars of these patients. PMID:24516292

  20. Efficacy and Safety of Stroke Volume Variation-Guided Fluid Therapy for Reducing Blood Loss and Transfusion Requirements During Radical Cystectomy: A Randomized Clinical Trial.

    PubMed

    Kong, Yu-Gyeong; Kim, Ji Yoon; Yu, Jihion; Lim, Jinwook; Hwang, Jai-Hyun; Kim, Young-Kug

    2016-05-01

    Radical cystectomy, which is performed to treat muscle-invasive bladder tumors, is among the most difficult urological surgical procedures and puts patients at risk of intraoperative blood loss and transfusion. Fluid management via stroke volume variation (SVV) is associated with reduced intraoperative blood loss. Therefore, we evaluated the efficacy and safety of SVV-guided fluid therapy for reducing blood loss and transfusion requirements in patients undergoing radical cystectomy.This study included 48 patients who underwent radical cystectomy, and these patients were randomly allocated to the control group and maintained at <10% SVV (n = 24) or allocated to the trial group and maintained at 10% to 20% SVV (n = 24). The primary endpoints were comparisons of the amounts of intraoperative blood loss and transfused red blood cells (RBCs) between the control and trial groups during radical cystectomy. Intraoperative blood loss was evaluated through the estimated blood loss and estimated red cell mass loss. The secondary endpoints were comparisons of the postoperative outcomes between groups.A total of 46 patients were included in the final analysis: 23 patients in the control group and 23 patients in the trial group. The SVV values in the trial group were significantly higher than in the control group. Estimated blood loss, estimated red cell mass loss, and RBC transfusion requirements in the trial group were significantly lower than in the control group (734.3 ± 321.5 mL vs 1096.5 ± 623.9 mL, P = 0.019; 274.1 ± 207.8 mL vs 553.1 ± 298.7 mL, P <0.001; 0.5 ± 0.8 units vs 1.9 ± 2.2 units, P = 0.005). There were no significant differences in postoperative outcomes between the two groups.SVV-guided fluid therapy (SVV maintained at 10%-20%) can reduce blood loss and transfusion requirements in patients undergoing radical cystectomy without resulting in adverse outcomes. These findings provide useful information for

  1. A six-month evaluation of the VivaSight™ video double-lumen endotracheal tube after introduction into thoracic anaesthetic practice at a single institution.

    PubMed

    Rapchuk, I L; Kunju, Sam; Smith, I J; Faulke, D J

    2017-03-01

    For a six-month period, all airway options used for non-emergent patients undergoing thoracic surgery requiring one-lung ventilation at a single institution were assessed after introduction of the VivaSight™ double-lumen endotracheal tube (VivaSight-DL), a novel double-lumen tube with an integrated camera. This device displays a continuous view of the position of the tube relative to the carina. A total of 72 patients had lung separation with the VivaSight-DL. Lung separation was achieved on first attempt without additional manipulation in 85% of cases. In only three cases (4%) was a fibreoptic bronchoscope required, in each instance to reposition the tube after intraoperative dislodgement. The VivaSight-DL represents a novel method of one-lung ventilation allowing rapid identification of intraoperative airway problems and reducing the need for fibreoptic bronchoscopy.

  2. Rationale and early experience with prophylactic placement of mesh to prevent parastomal hernia formation after ileal conduit urinary diversion and cystectomy for bladder cancer

    PubMed Central

    Donahue, Timothy F.; Cha, Eugene K.; Bochner, Bernard H.

    2016-01-01

    Parastomal hernias represent a clinically significant problem for many patients after radical cystectomy and ileal conduit diversion. The prevalence may be as high as 60% and in some series, up to 30% of patients require surgical intervention due to the complications of pain, poor fit of an ostomy appliance, leakage, urinary obstruction, and bowel obstruction or strangulation. Due to the potential morbidity associated with PH repair, there have been efforts to prevent PH development at the time of the index surgery. Four randomized trials of prophylactic mesh placement at the time of colostomy and ileostomy stoma formation have demonstrated significant reductions in PH rates with acceptably low complication rates. In this review, we describe the clinical and radiographic definitions of PH, the clinical impact and risk factors behind its development, and the rationale behind prophylactic mesh placement for patients undergoing ileal conduit urinary diversion. Additionally, we report our experience with prophylactic mesh placed at radical cystectomy at our institution. PMID:26757903

  3. [Assessing the effect of subcuticular buried sutures with subcutaneous closed suction drain to prevent surgical site infection in patients undergoing total cystectomy with urinary diversion using intestine].

    PubMed

    Kanamaru, Sojun; Tsuchihashi, Kazunari; Makino, Yuki; Shimizu, Yosuke; Ito, Noriyuki

    2014-11-01

    We assessed the effect of subcuticular buried sutures with subcutaneous closed suction drain to prevent surgical site infection (SSI) in patients undergoing total cystectomy with urinary diversion using the intestine. We reviewed the clinical charts of 43 consecutive patients who underwent total cystectomy with urinary diversion using the intestine from February 2006 to March 2011 at Nishi-Kobe Medical Center. All patients received intravenous prophylactic antibiotics before and throughout surgery as well as for three days after surgery. Skin closure was performed with interrupted vertical mattress sutures with 2-0 nylon on the first 22 patients (mattress group), and with interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous closed suction drain on the remaining 21 patients (subcuticular buried suture with subcutaneous drain; SBD group). SSI occurred in 7 (31.8%) patients in the mattress group, but did not affect any patient in the SBD group. We compared risk factors for SSI between the groups, and found that the method of skin closure was significant risk factor for SSI (P = 0.005). We concluded that interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous suction drain is effective for prevention of SSI in total cystectomy with urinary diversion using the intestine.

  4. The Padua Inventory: Do Revisions Need Revision?

    ERIC Educational Resources Information Center

    Gonner, Sascha; Ecker, Willi; Leonhart, Rainer

    2010-01-01

    The purpose of the present study was to examine the psychometric properties, factorial structure, and validity of the Padua Inventory-Washington State University Revision and of the Padua Inventory-Revised in a large sample of patients with obsessive-compulsive disorder (n = 228) and with anxiety disorders and/or depression (n = 213). The…

  5. Validation of the Effectiveness and Safety of Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas: 10-year Experience of a Single Institution.

    PubMed

    Joo, Jin-Deok; Kim, Hansol; Kim, Young-Hoon; Han, Jung Ho; Kim, Chae-Yong

    2015-11-01

    This study was performed to validate the effectiveness and safety of concurrent chemoradiotherapy and adjuvant therapy with temozolomide for newly diagnosed glioblastoma multiforme as a standard treatment protocol. Between 2004 and 2011, patients newly diagnosed with glioblastoma who were treated with temozolomide during concurrent chemoradiotherapy and adjuvant chemotherapy were included from a single institution and analyzed retrospectively. The primary endpoint was overall survival, and the secondary endpoints were progression-free survival, response, and safety. A total of 71 patients were enrolled in this study. The response rate was 41% (29/71), and the tumor control rate was 80% (57/71). In the 67 patients who completed the concurrent chemoradiotherapy with temozolomide, the median overall survival was 19 months and the 1- and 2-yr overall survival rates were 78.3% and 41.7%, respectively. The median progression free survival was 9 months, and the 1- and 2-yr progression free survival rates were 33.8% and 14.3%, respectively. The mean duration of survival after progression of disease in salvage treatment group was 11.9 (1.3-53.2) months. Concurrent chemoradiotherapy with temozolomide resulted in grade 3 or 4 hematologic toxic effects in 2.8% of the patients. The current protocol of temozolomide during and after radiation therapy is both effective and safe and is still appropriate as the standard protocol for treatment of glioblastoma. An active salvage treatment might be required for a better prognosis.

  6. A single-institution, 20-year prospective experience with an affordable Fc-receptor blockade method to treat patients with chronic, refractory autoimmune thrombocytopenic purpura.

    PubMed

    Estrada-Gómez, Roberto; Vargas-Castro, Olga; Oropeza-Borges, Mabel; González-Carrillo, Martha L; Pérez-Romano, Beatriz; Ruiz-Argüelles, Guillermo J

    2007-01-01

    In a 20-year period in a single institution, 34 patients with chronic, refractory autoimmune thrombocytopenic purpura were prospectively treated with ex vivo anti-D opsonized autologous red blood cells. All patients had received previous treatment with steroids and/or immunosuppressive agents, and 11 had been splenectomized. Twenty one patients had an increase in the platelet count; in five cases, the increase was more than 50 x 10(9)/L platelets and in 16 the increase was more than 100 x 10(9)/L platelets. Early responses were observed in 20 patients and late responses in seven, whereas seven patients (20%) did not respond at all. Nine of the 20 individuals who achieved an ER had a subsequent drop in the platelet count; however, only three had a drop below 50 x 10(9)/L. When last censored, of the 34 patients, 24 (70%) had a platelet count above 50 x 10(9)/L. The 84-month thrombocytopenia-free (over 50 x 10(9)/L platelets) status of the whole group is 70%, whereas the 84-month complete remission (over 100 x 10(9)/L platelets) status of the whole group is 50%. It is concluded that the use of ex vivo anti-D opsonized red blood cells may represent another, substantially cheaper treatment of patients with chronic, refractory, autoimmune thrombocytopenic purpura.

  7. EGFR mutation testing on cytological and histological samples in non-small cell lung cancer: a Polish, single institution study and systematic review of European incidence.

    PubMed

    Szumera-Ciećkiewicz, Anna; Olszewski, Włodzimierz T; Tysarowski, Andrzej; Kowalski, Dariusz M; Głogowski, Maciej; Krzakowski, Maciej; Siedlecki, Janusz A; Wągrodzki, Michał; Prochorec-Sobieszek, Monika

    2013-01-01

    The targeted treatment of advanced non-small-cell lung cancer (NSCLC) depends on confirmation of activating somatic EGFR mutation. The aim of the study was to evaluate the incidence of EGFR mutations in NSCLC detected in cytological and histological material and present literature review on European EGFR mutation incidence. 273 patients with confirmed NSCLC were entered into the study: 189 histological, paraffin-embedded materials, 12 fresh and 72 fixed cytological specimens. DNA was extracted from both types of material and the EGFR mutation in exons 18-21 was analyzed by direct sequencing. In addition the EGFR gene copy number in cases with sufficient histological material (110 patients) was evaluated by fluorescent in situ hybridization (FISH) technique. The percentage of EGFR somatic mutations was 10.62%. FISH positive results (amplification or high polysomy of EGFR gene) were identified in 33 patients (30.0%). The strongest clinicopathological correlation with the EGFR mutation was found for histological type (adenocarcinoma; p < 0.01), gender (females; p < 0.01) and FISH positive result (p < 0.05). This is the first, single institution study that estimates the EGFR mutation incidence in the Polish population. Cytological material recovered from fixed preparations and stained with hematoxylin and eosin showed DNA quality comparable to fresh tumor cells and histological samples.

  8. Reduction of infection-related mortality after allogeneic PBSCT from HLA-identical siblings: longitudinal analysis from 1994 to 2008 at a single institution.

    PubMed

    Martino, R; Kerguelen, A; Valcárcel, D; Sureda, A; Fachini, L; Piñana, J L; Briones, J; Delgado, J; Brunet, S; Sierra, J

    2011-05-01

    Infection-related mortality (IRM) is responsible for a major proportion of all cases of non-relapse mortality (NRM) after allogeneic PBSCT (alloPBSCT). We analyzed 580 consecutive adults who received a first alloPBSCT from an HLA-identical sibling from 1994 to 2008 at a single institution to describe the severe infections and report the incidence, causes and risk factors for IRM and NRM. Both IRM and NRM decreased with time; within the period of 1994-2000, the 2-year incidence of IRM and NRM was 22 and 31%, respectively, vs 11 and 16% within the period of 2001-2008 (P<0.05 for both comparisons). In multivariate analysis, the variables that increased IRM were within the earlier period of 1994-2000 (P<0.01), poor performance status (P<0.01), grade II-IV acute GVHD (P<0.001) and invasive fungal infection (IFI) (P<0.001) or CMV disease (P<0.001) after transplant. With respect to NRM, earlier time period was also identified as a risk factor (P<0.001), as well as IFIs (P<0.001) and CMV disease (P<0.001). The intensity of the conditioning regimen had no effect on IRM and NRM. These results showed a significant reduction in IRM and NRM over a period of 15 years. The development of IFIs and CMV disease continue to have an impact on NRM.

  9. Radiofrequency Energy in Hepatic Bed during Partial Cystectomy for Hydatid Liver Disease: Standing Out from the Usual Conservative Surgical Management

    PubMed Central

    Dimitrokallis, Nikolaos; Sakarellos, Panagiotis; Griniatsos, John

    2016-01-01

    Background. Surgical treatment of hydatid liver disease (HLD) is divided into conservative and radical procedures. While conservative techniques are easier and faster to perform, there is an emerging need to reduce their morbidity and recurrence rates. Our aim was to present and evaluate the efficiency and safety of the application of radiofrequency energy (TissueLink® and Aquamantys® systems) in hepatic bed during partial cystectomy. Materials and Methods. Eighteen consecutive patients with hydatid liver cysts were referred to our department between April 2006 and June 2014. Data about demographics, mortality, morbidity, and recurrence rate were obtained and analyzed retrospectively. Results. The mean follow-up was 38 months (range: 4–84 months). The postoperative course of most patients was uneventful. One case of recurrence was found in our series in a patient with 4 cysts in the right lobe, 3 years after initial treatment. He was reoperated on with the same method. Conclusions. Saline-linked RF energy seems to be an effective means to be employed in conservative surgical procedures of HLD, with satisfactory postoperative morbidity. Recurrence rates appear to be low, but further follow-up is needed in order to draw safer conclusions. PMID:27525000

  10. Radiofrequency Energy in Hepatic Bed during Partial Cystectomy for Hydatid Liver Disease: Standing Out from the Usual Conservative Surgical Management.

    PubMed

    Mantonakis, Eleftherios; Papalampros, Alexandros; Moris, Demetrios; Dimitrokallis, Nikolaos; Sakarellos, Panagiotis; Griniatsos, John; Felekouras, Evangelos

    2016-01-01

    Background. Surgical treatment of hydatid liver disease (HLD) is divided into conservative and radical procedures. While conservative techniques are easier and faster to perform, there is an emerging need to reduce their morbidity and recurrence rates. Our aim was to present and evaluate the efficiency and safety of the application of radiofrequency energy (TissueLink® and Aquamantys® systems) in hepatic bed during partial cystectomy. Materials and Methods. Eighteen consecutive patients with hydatid liver cysts were referred to our department between April 2006 and June 2014. Data about demographics, mortality, morbidity, and recurrence rate were obtained and analyzed retrospectively. Results. The mean follow-up was 38 months (range: 4-84 months). The postoperative course of most patients was uneventful. One case of recurrence was found in our series in a patient with 4 cysts in the right lobe, 3 years after initial treatment. He was reoperated on with the same method. Conclusions. Saline-linked RF energy seems to be an effective means to be employed in conservative surgical procedures of HLD, with satisfactory postoperative morbidity. Recurrence rates appear to be low, but further follow-up is needed in order to draw safer conclusions.

  11. Use of liposuction for secondary revision of irradiated and nonirradiated free flaps.

    PubMed

    Bui, Duc T; Mehrara, Babak J; Disa, Joseph J; Cordeiro, Peter G

    2004-06-01

    A number of patients with free tissue transfer require secondary revision to improve contour and regional definition to maximize function or appearance. However, there is controversy with regard to whether irradiated free flaps can be revised safely using liposuction. The purpose of this study was to compare the outcomes of revisionary procedures requiring liposuction in irradiated versus nonirradiated flaps. From December 1992 to July 2001, office and hospital records were reviewed retrospectively to identify patients who had undergone free tissue transfer and subsequent flap revision at a single institution. The number of revisions, amount of fat aspirated, timing of revision and the postoperative complications including infection, hematoma, wound dehiscence, and flap loss were reviewed. A total of 41 flap revisions using liposuction alone or with direct excision were performed on 33 free flaps (31 head and neck, 1 chest wall, and 1 extremity). The rectus musculocutaneous flap was the most commonly revised (88%). The average length of time to secondary revision of patients who had received postoperative radiotherapy to their flaps was significantly higher that those whose flaps had not been irradiated (P < 0.05). There were no postoperative complications except for 1 partial (20%) flap loss in a patient whose flap was irradiated. The difference in complication rates between the irradiated and nonirradiated group was not statistically significant. Secondary free flap revision using liposuction and direct excision is a safe technique for recontouring free flaps. There was no significant difference in complication rates for irradiated and nonirradiated flaps. Postoperative radiation therapy is therefore not a contraindication to secondary revision. However, these procedures should be delayed for several months after the acute effects of radiation have resolved.

  12. Single-institution comparative study on the outcomes of salvage cryotherapy versus salvage robotic prostatectomy for radio-resistant prostate cancer

    PubMed Central

    Vora, Anup; Agarwal, Vidhi; Singh, Prabhjot; Patel, Rupen; Rivas, Rodolfo; Nething, Josh; Muruve, Nic

    2015-01-01

    Background Although primary treatment of localized prostate cancer provides excellent oncologic control, some men who chose radiotherapy experience a recurrence of disease. There is no consensus on the most appropriate management of these patients after radiotherapy failure. In this single-institution review, we compare our oncologic outcome and toxicity between salvage prostatectomy and cryotherapy treatments. Methods From January 2004 to June 2013, a total of 23 salvage procedures were performed. Six of those patients underwent salvage prostatectomy while 17 underwent salvage cryotherapy by two high-volume fellowship-trained urologists. Patients being considered for salvage therapy had localized disease at presentation, a prostate-specific antigen (PSA) < 10 ng/mL at recurrence, life expectancy > 10 years at recurrence, and a negative metastatic workup. Patients were followed to observe cancer progression and toxicity of treatment. Results Patients who underwent salvage cryotherapy were statistically older with a higher incidence of hypertension than our salvage prostatectomy cohort. With a mean follow up of 14.1 months and 7.2 months, the incidence of disease progression was 23.5% and 16.7% after salvage cryotherapy and prostatectomy, respectively. The overall complication rate was also 23.5% versus 16.7%, with the most frequent complication after salvage cryotherapy being urethral stricture and after salvage prostatectomy being severe urinary incontinence. There were no rectal injuries with salvage prostatectomy and one rectourethral fistula in the cohort after salvage cryotherapy. Conclusion While recurrences from primary radiotherapy for prostate cancer do occur, there is no consensus on its management. In our experience, salvage procedures were generally safe and effective. Both salvage cryotherapy and salvage prostatectomy allow for adequate cancer control with minimal toxicity. PMID:27014657

  13. Breast cancer in malaysia: are our women getting the right message? 10 year-experience in a single institution in Malaysia.

    PubMed

    Taib, Nur Aishah; Yip, Cheng Har; Ibrahim, Mohamed; Ng, C J; Farizah, H

    2007-01-01

    The message that health care providers caring for patients with breast cancer would like to put forth, is that, not only early detection is crucial but early treatment too is important in ensuring survival. This paper examines the pattern of presentation at a single institution over a 10-year period from 1995 to 2005. In Malaysia, education outreach programmes are ongoing, with contributions not only from the public sector, but also private enterprise. Articles on breast cancer in local newspapers and women magazines and television are quite commonplace. However are our women getting the right message? Now is an appropriate time to bring the stakeholders together to formulate a way to reach all women in Malaysia, not excluding the fact that we are from different races, different education levels and backgrounds requiring differing ways of delivering health promotion messages. To answer the question of why women present late, we prospectively studied 25 women who presented with locally advanced disease. A quantitative, quasi-qualitative study was embarked upon, as a prelude to a more detailed study. Reasons for presenting late were recorded. We also looked at the pattern of presentation of breast lumps in women to our breast clinic in UMMC and in the surgical clinic in Hospital Kota Bharu, in the smaller capital of the state of Kelantan, in 2003. There is hope for the future, the government being a socially responsible one is currently making efforts towards mammographic screening in Malaysia. However understanding of the disease, acceptance of medical treatment and providing resources is imperative to ensure that health behaviour exhibited by our women is not self-destructive but self-preserving. Women are an integral part of not only the nation's workforce but the lifeline of the family - hopefully in the next decade we will see great improvement in the survival of Malaysian women with breast cancer.

  14. Determination of prognosis of Philadelphia chromosome-negative myeloproliferative neoplasms with a simple clinical examination: Retrospective analysis of 71 patients in a single institution

    PubMed Central

    ITO, SHINICHI; TSUTSUMI, YUTAKA; OHIGASHI, HIROYUKI; SHIRATORI, SOUICHI; TESHIMA, TAKANORI

    2016-01-01

    Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocytosis (ET) and primary myelofibrosis (PMF), are clonal hematopoietic diseases. A single-institution retrospective analysis was performed, including 71 MPN patients diagnosed at the Hakodate Municipal Hospital between April, 2001 and April, 2014, and certain clinical characteristics were identified as effective prognostic factors. The patients were categorized by risk factor scoring based on age, number of abnormal blood cell lineages and splenomegaly at diagnosis, and the association between this categorization and prognosis was analyzed using a statistical procedure. The effect of Janus kinase 2 (JAK2) V617F mutation on prognosis was also investigated. The MPN patients were consolidated into three risk groups based on the margin of intergroup survival differences: i) Score 1–2 (n=23), ii) score 3 (n=24) and iii) score 4–5 (n=24). MPN patients with scores of 4 or 5 exhibited poorer overall survival (OS) compared with those with lower scores (P<0.001). In addition, there were significant differences in event-free survival (EFS) among scoring groups (P=0.0059). PV and ET had a better prognosis compared with PMF, although this analysis suggested that PV and ET patients with scores of 4 or 5 may have a poorer prognosis in terms of OS (P=0.0052) and EFS (P=0.022) and should be closely followed up. We observed no significant prognostic effect of the JAK2V167F mutation for OS (P=0.28) or EFS (P=0.17). Our results suggested that a simple scoring system based on age, blood cell counts and presence of splenomegaly at diagnosis may be used for the long-term prognosis of MPN patients. PMID:26870357

  15. 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.

  16. Is interval appendectomy indicated after non-operative management of acute appendicitis in patients with cancer? A retrospective review from a single institution.

    PubMed

    Samdani, Tushar; Fancher, Tiffany T; Pieracci, Frederic M; Eachempati, Soumitra; Rashidi, Laila; Nash, Garrett M

    2015-05-01

    Interval appendectomy (IA) is a controversial subject, with little consensus on its use in patients undergoing treatment for malignancy. We sought to determine the frequency of recurrent appendicitis in cancer patients managed nonoperatively (NOM) during index hospitalization (IHA) for acute appendicitis (AA). Clinical presentation, cancer treatment, and follow-up were collected from electronic medical records of patients with CT scan-confirmed AA treated at a single institution between August 1999 and August 2009. Seventy-two of 109 AA patients underwent appendectomy during IHA; 34 of these 109 were NOM during IHA. Median index length of NOM patients' stay was six days (0-55), median age was 59 (18-80) years. Indications for NOM were presence of abscess or phlegmon (14), mild symptoms (13), high surgical risk (3), end-stage cancer (3), and patient declining surgery (1). Eight NOM patients underwent percutaneous drainage of abdominal abscess (median total duration of intravenous + oral antibiotics = 12 days [0-55]). There were six deaths (1 IHA, 5 NOM): four sepsis and two cancer progression. At a median of 19-month follow-up (range 1-103), four NOM patients surviving IHA had recurrent AA (11.7%) at two (n = 2) and three months (n = 2) after the first episode. Overall, six had IA (17.6%) one to seven months post AA; 25 remained asymptomatic, without IA. In conclusion, among NOM patients at a cancer center at IHA for AA, recurrent AA was early (<4 months) but uncommon. IA should be offered to those with recurrent symptoms, but appears to have a very limited role after several months of asymptomatic follow-up.

  17. Two-fraction high-dose-rate brachytherapy within a single day combined with external beam radiotherapy for prostate cancer: single institution experience and outcomes

    PubMed Central

    Liu, Junyang; Kaidu, Motoki; Sasamoto, Ryuta; Ayukawa, Fumio; Yamana, Nobuko; Sato, Hiraku; Tanaka, Kensuke; Kawaguchi, Gen; Ohta, Atsushi; Maruyama, Katsuya; Abe, Eisuke; Kasahara, Takashi; Nishiyama, Tsutomu; Tomita, Yoshihiko; Aoyama, Hidefumi

    2016-01-01

    We investigated the outcomes of treatment for patients with localized prostate cancer (PCa) treated with 3D conformal radiation therapy (3D-CRT) followed by two-fraction high-dose-rate brachytherapy within a single day (2-fr.-HDR-BT/day) at a single institution. A total of 156 consecutive Asian males (median age, 67 years) were enrolled. To compare our findings with those of other studies, we analyzed our results using the D'Amico classification, assigning the patients to low- (n =5; 3.2%), intermediate- (n =36; 23.1%) and high-risk (n =115; 73.7%) groups (Stage T3 PCa patients were classified as high-risk). One patient in the D'Amico low-risk group (20%), 13 intermediate-risk patients (36.1%) and 99 high-risk patients (86.1%) underwent androgen deprivation therapy. We administered a prescription dose of 39 Gy in 13 fractions of 3D-CRT combined with 18 Gy of HDR-BT in two 9-Gy fractions delivered within a single day. We did not distinguish between risk groups in determining the prescription dose. The median follow-up period was 38 months. Of the 156 patients, one died from primary disease and five died from other diseases. The 3-year overall survival (OS) rates were 100%, 100% and 93.7%, and the 3-year ‘biochemical no evidence of disease (bNED)’ rates were 100%, 100% and 96.9% for the D'Amico low-, intermediate- and high-risk groups, respectively. No patient developed ≥ Grade 3 early toxicity. The Grade 3 late genitourinary toxicity rate was 2.6%, and no ≥ Grade 3 late gastrointestinal toxicity occurred. The efficacy and safety of this study were satisfactory, and longer-term follow-up is necessary. PMID:26983988

  18. Setting up a Prospective Thyroid Biobank for Translational Research: Practical Approach of a Single Institution (2004-2009, Pasteur Hospital, Nice, France).

    PubMed

    Lassalle, Sandra; Hofman, Véronique; Ilie, Marius; Butori, Catherine; Bonnetaud, Christelle; Gaziello, Marie Clotilde; Selva, Eric; Gavric-Tanga, Virginie; Guevara, Nicolas; Castillo, Laurent; Santini, José; Chabannon, Christian; Hofman, Paul

    2011-03-01

    In the last few years, conditions for setting up a human biobank in France have been upgraded by taking into account (1) the new laws and regulations that integrate the ethical and societal dimension of biobanking and delineate the risks for patients associated with the procurement of human cells and tissues, (2) the increasing request by scientists for human samples with proven biological quality and sophisticated sets of annotations, including information produced through the evergrowing use of molecular biology in pathology, and (3) establishment of procedures concerning the safety of the personnel working with biological products. For this purpose, health authorities and national research institutes in France have provided significant support for the set up of biobanks. The present work was conducted to describe how we set up a biobank targeting diseases of a specific organ (thyroid gland), with the aim of rapidly developing translational research projects. The prospective experience of a single institution (Pasteur Hospital, Nice, France) over a 6-year period (2004-2009) is presented from the practical point of view of a surgical pathology laboratory. We describe different procedures required to obtain high-quality thyroid biological resources and clinical annotations. The procedures were established for the management of biological products obtained from 1454 patients who underwent thyroid surgery. The preanalytical steps leading to the storage of frozen specimens were carried out in parallel with diagnostic procedures. As the number of international networks for research programs using biological products is steadily increasing, it is crucial to harmonize the procedures used by biobanks. In this regard, the described thyroid biobank has been set up using criteria established by the French National Cancer Institute (Institut National du Cancer) to guarantee the quality of different collections stored in biobanks.

  19. Current Trends in Regional Therapy for Melanoma: Lessons Learned from 225 Regional Chemotherapy Treatments between 1995 and 2010 at a Single Institution

    PubMed Central

    Raymond, Amanda K; Beasley, Georgia M; Broadwater, Gloria; Augustine, Christina K; Padussis, James C; Turley, Ryan; Peterson, Bercedis; Seigler, Hilliard; Pruitt, Scott K; Tyler, Douglas S

    2011-01-01

    Background Hyperthermic isolated limb perfusion (HILP) and isolated limb infusion (ILI) are utilized to manage advanced extremity melanoma but no consensus exists as to which treatment is preferable and how to monitor patients post-treatment. Study Design Using a prospectively-maintained database, we reviewed our experience with melphalan based HILP (that included 62 first time and 10 second time) and ILI (that included 126 first time and 18 second time) procedures performed in 188 patients. PET/CT was obtained 3 months post regional treatment for one year and then every 6 months thereafter. Results The overall response rate (complete response (CR) + partial response (PR)) of HILP was 81% (80% CI: 73-87%) while the overall response rate from ILI was 43% (80% CI: 37-49%) for first time procedures only. HILP had a CR rate of 55% with a median duration of 32 months, while ILI had a CR rate of 30% with median duration of 24 months. Patients who experienced a regional recurrence after initial regional treatment were more likely to achieve a CR following repeat HILP (50%, n = 10) compared to repeat ILI (28%, n = 18). Although the spectrum of toxicity was similar for ILI and HILP, the likelihood of rare catastrophic complication of limb loss was greater with HILP (2/62) than ILI (0/122). PET/CT was effective for surveillance after regional therapy to identify regional nodal and pulmonary disease that was not clinically evident, but often amenable to surgical resection (25/49, 51% of cases). In contrast, PET/CT was not effective at predicting complete response to treatment with an accuracy of only 50%. Conclusions In the largest single institution regional therapy series reported to date, we found that while ILI is effective, and well-tolerated, HILP is a more definitive way to control advanced disease. PMID:21493111

  20. Clinical characteristics and prognostic factors of patients with mature T-cell lymphoid malignancies: a single-institution study of 225 cases.

    PubMed

    Xue, Wen; Sheng, Yan; Weng, Xiangqin; Zhu, Yongmei; Zhao, Yan; Xu, Pengpeng; Fei, Xiaochun; Chen, Xiaoyan; Wang, Li; Zhao, Weili

    2015-12-01

    Mature T-cell lymphoid malignancies comprise a group of heterogeneous diseases that vary in clinicopathological features, biological behavior, treatment response, and prognosis. Bone marrow (BM) infiltration is more commonly present in mature T-cell lymphoid malignancies compared with their B-cell counterparts and hence important for differential diagnosis. In this study, clinical characteristics and prognostic factors were analyzed in 225 patients with mature T-cell lymphoid malignancies treated in a single institution. These included 29 cases of T-cell lymphoproliferative disorders (T-LPD, all with BM infiltration) and 196 cases of T-/natural-killer-cell lymphoma (T/NKCL, 56 with BM infiltration and 140 without BM infiltration). The estimated 5-year overall survival (OS) rates of T-LPD and T/NKCL were 96.6% and 37.3%, respectively. T-LPD patients were less likely to exhibit poor performance status, advanced disease stage, presence of B symptoms, or abnormal level of serum β-2 microglobulin. With similar pathological characteristics, T/NKCL patients with BM infiltration showed significantly lower response rates and shorter OS than those without BM infiltration (P = 0.0264 and P < 0.0001, respectively). Multivariate analysis indicated that poor performance status, advanced disease stage, elevated serum lactate dehydrogenase level, and BM involvement were independent unfavorable prognostic factors. The Glasgow Prognostic Score may be more efficient than the International Prognostic Index in predicting disease outcome in T/NKCL. In conclusion, clinical characteristics may be useful in more effectively stratifying patients with mature T-cell lymphoid malignancies.

  1. Do African American Patients Treated with Radical Cystectomy for Bladder Cancer have Worse Overall Survival? Accounting for Pathologic Staging and Patient Demographics Beyond Race Makes a Difference

    PubMed Central

    Kaye, Deborah R.; Canner, Joseph K.; Kates, Max; Schoenberg, Mark P.; Bivalacqua, Trinity J.

    2016-01-01

    Background: It is estimated that 74,000 men and women in the United States will be diagnosed with bladder cancer and 16,000 will die from the disease in 2015. The incidence of bladder cancer in Caucasian males is double that of African American males, but African American men and women have worse survival. Although factors contributing to this disparity have been analyzed, there is still great uncertainty as to why this disparity exists. Objective: To evaluate whether the disparities in bladder cancer survival after radical cystectomy for transitional cell carcinoma (TCC) of the bladder amongst African American (AA) and Caucasian patients is attributable to patient demographics, year of diagnosis, and/or tumor characteristics. Methods: Using Surveillance, Epidemiology, and End Results Program (SEER) data from 1973–2011, African American and Caucasian patients treated with a radical cystectomy for TCC of the bladder were identified. Primary outcomes were all-cause and cancer-specific mortality. Differences in survival between African Americans and Caucasian patients were assessed using chi-square tests for categorical variables and Student’s t-tests for continuous variables. Cox proportional hazards regression was used to measure the hazard ratio for African Americans compared to Caucasians for all-cause and cancer-specific mortality. In addition, coarsened matching techniques within narrow ranges, were used to match African American and Caucasian patients on the basis of age, sex, and cancer stage. Following matching, differences in all-cause and cancer-specific mortality were again assessed using a stratified Cox proportional hazards model, using the matching strata for the regression strata. Results: The study cohort consisted of 21,406 African American and Caucasian patients treated with radical cystectomy for bladder urothelial cancer, with 6.2% being African American and 73.9% male. African American patients had worse all-cause and cancer

  2. Evaluation of the improved tubeless cutaneous ureterostomy technique following radical cystectomy in cases of invasive bladder cancer complicated by peritoneal metastasis

    PubMed Central

    LIU, ZAN; TIAN, QIUYE; XIA, SHUNYAO; YIN, HUAIFU; YAO, DAYONG; XIU, YOUCHENG

    2016-01-01

    Radical cystectomy, as the most common surgical treatment for patients with invasive bladder cancer (IBC) complicated by peritoneal metastasis, is usually accompanied by a urinary diversion procedure. In this study, we evaluated the improved tubeless cutaneous ureterostomy technique by comparing the resulting clinical effects with either a traditional ureterostomy and an ileal conduit urinary diversion. Clinical data from 85 patients who underwent 1 of the 3 procedures between April 2012 and April 2015 were analyzed retrospectively. In total, 30 patients underwent improved tubeless cutaneous ureterostomy, 28 patients underwent a traditional cutaneous ureterostomy and 27 underwent an ileal conduit urinary diversion following radical cystectomy. The incidence of complications, including stoma infection, nipple atrophy, terminal necrosis, urine leakage, external orifice stenosis, uronephrosis and ureterectasia in the group of patients treated with the improved tubeless ureterostomy technique was significantly lower than that of the patients in the other 2 groups, and the difference was statistically significant (P<0.05). In addition, the duration of the surgery, intra-operative bleeding, the duration of the hospitalization period and the time to extubation in the patients treated with the improved tubeless ureterostomy technique were significantly decreased (P<0.05) compared with the patients in the other 2 groups. Finally, the health-related quality of life of the patients treated with the improved tubeless ureterostomy technique was significantly higher (P<0.05) than that of the patients in the other 2 groups. The findings of our study demonstrated that the use of the improved tubeless cutaneous ureterostomy technique following radical cystectomy in patients with IBC complicated by peritoneal metastasis resulted in improved clinical effects. Thus, improved tubeless cutaneous ureterostomy may be a promising alternative for enhancing the quality of life of patients

  3. A reported 20-gene expression signature to predict lymph node-positive disease at radical cystectomy for muscle-invasive bladder cancer is clinically not applicable

    PubMed Central

    van Kessel, Kim E. M.; van de Werken, Harmen J. G.; Lurkin, Irene; Ziel – van der Made, Angelique C. J.; Zwarthoff, Ellen C.; Boormans, Joost L.

    2017-01-01

    Background Neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) provides a small but significant survival benefit. Nevertheless, controversies on applying NAC remain because the limited benefit must be weight against chemotherapy-related toxicity and the delay of definitive local treatment. Therefore, there is a clear clinical need for tools to guide treatment decisions on NAC in MIBC. Here, we aimed to validate a previously reported 20-gene expression signature that predicted lymph node-positive disease at radical cystectomy in clinically node-negative MIBC patients, which would be a justification for upfront chemotherapy. Methods We studied diagnostic transurethral resection of bladder tumors (dTURBT) of 150 MIBC patients (urothelial carcinoma) who were subsequently treated by radical cystectomy and pelvic lymph node dissection. RNA was isolated and the expression level of the 20 genes was determined on a qRT-PCR platform. Normalized Ct values were used to calculate a risk score to predict the presence of node-positive disease. The Cancer Genome Atlas (TCGA) RNA expression data was analyzed to subsequently validate the results. Results In a univariate regression analysis, none of the 20 genes significantly correlated with node-positive disease. The area under the curve of the risk score calculated by the 20-gene expression signature was 0.54 (95% Confidence Interval: 0.44-0.65) versus 0.67 for the model published by Smith et al. Node-negative patients had a significantly lower tumor grade at TURBT (p = 0.03), a lower pT stage (p<0.01) and less frequent lymphovascular invasion (13% versus 38%, p<0.01) at radical cystectomy than node-positive patients. In addition, in the TCGA data, none of the 20 genes was differentially expressed in node-negative versus node-positive patients. Conclusions We conclude that a 20-gene expression signature developed for nodal staging of MIBC at radical cystectomy could not be validated on a qRT-PCR platform in a

  4. Clinical–Pathologic Stage Discrepancy in Bladder Cancer Patients Treated With Radical Cystectomy: Results From the National Cancer Data Base

    SciTech Connect

    Gray, Phillip J.; Lin, Chun Chieh; Jemal, Ahmedin; Shipley, William U.; Fedewa, Stacey A.; Kibel, Adam S.; Kamat, Ashish M.; Virgo, Katherine S.; Blute, Michael L.; Zietman, Anthony L.; Efstathiou, Jason A.

    2014-04-01

    Purpose: To examine the accuracy of clinical staging and its effects on outcome in bladder cancer (BC) patients treated with radical cystectomy (RC), using a large national database. Methods and Materials: A total of 16,953 patients with BC without distant metastases treated with RC from 1998 to 2009 were analyzed. Factors associated with clinical–pathologic stage discrepancy were assessed by multivariate generalized estimating equation models. Survival analysis was conducted for patients treated between 1998 and 2004 (n=7270) using the Kaplan-Meier method and Cox proportional hazards models. Results: At RC 41.9% of patients were upstaged, whereas 5.9% were downstaged. Upstaging was more common in females, the elderly, and in patients who underwent a more extensive lymphadenectomy. Downstaging was less common in patients treated at community centers, in the elderly, and in Hispanics. Receipt of preoperative chemotherapy was highly associated with downstaging. Five-year overall survival rates for patients with clinical stages 0, I, II, III, and IV were 67.2%, 62.9%, 50.4%, 36.9%, and 27.2%, respectively, whereas those for the same pathologic stages were 70.8%, 75.8%, 63.7%, 41.5%, and 24.7%, respectively. On multivariate analysis, upstaging was associated with increased 5-year mortality (hazard ratio [HR] 1.80, P<.001), but downstaging was not associated with survival (HR 0.88, P=.160). In contrast, more extensive lymphadenectomy was associated with decreased 5-year mortality (HR 0.76 for ≥10 lymph nodes examined, P<.001), as was treatment at an National Cancer Institute–designated cancer center (HR 0.90, P=.042). Conclusions: Clinical–pathologic stage discrepancy in BC patients is remarkably common across the United States. These findings should be considered when selecting patients for preoperative or nonoperative management strategies and when comparing the outcomes of bladder sparing approaches to RC.

  5. Readmission Rate and Causes at 90-Day after Radical Cystectomy in Patients on Early Recovery after Surgery Protocol

    PubMed Central

    Altobelli, Emanuela; Buscarini, Maurizio; Gill, Harcharan S.; Skinner, Eila C.

    2017-01-01

    Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014. We focused on early (30-day) and late (90-day) postoperative readmission rate and causes. Results were compared with a pre-ERAS consecutive series of 177 RC patients from January 2009 to December 2011. Results: In the post-ERAS time period a total of 56 patients were readmitted, 41 within the first 30 days after surgery (20%) and 15 within the following 60 days (7%). Fever, often associated with dehydration, was the most common reason for presentation to the hospital, accounting for 57% of all readmissions. At 90 days infection accounted for 53% of readmissions. Of all the patients readmitted during the first 90 days after surgery, 32 had positive urine cultures, mostly caused by Enterococcus faecalis isolated in 18 (56%). Readmission rates did not increase since the introduction of the ERAS protocol, with an incidence of 27% in the post-ERAS group versus 30% in the pre-ERAS group. Conclusions: Despite accurate adherence to most recent perioperative antibiotic guidelines, the incidence of readmissions after RC due to infection still remains significant. PMID:28149935

  6. Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

    PubMed Central

    Christopher Doiron, R.; Jaeger, Melanie; Booth, Christopher M.; Wei, Xuejiao; Robert Siemens, D.

    2016-01-01

    Introduction: Thoracic epidural analgesia (TEA) is commonly used to manage postoperative pain and facilitate early mobilization after major intra-abdominal surgery. Evidence also suggests that regional anesthesia/analgesia may be associated with improved survival after cancer surgery. Here, we describe factors associated with TEA at the time of radical cystectomy (RC) for bladder cancer and its association with both short- and long-term outcomes in routine clinical practice. Methods: All patients undergoing RC in the province of Ontario between 2004 and 2008 were identified using the Ontario Cancer Registry (OCR). Modified Poisson regression was used to describe factors associated with epidural use, while a Cox proportional hazards model describes associations between survival and TEA use. Results: Over the five-year study period, 1628 patients were identified as receiving RC, 54% (n=887) of whom received TEA. Greater anesthesiologist volume (lowest volume providers relative risk [RR] 0.85, 95% confidence interval [CI] 0.75–0.96) and male sex (female sex RR 0.89, 95% CI 0.79–0.99) were independently associated with greater use of TEA. TEA use was not associated with improved short-term outcomes. In multivariable analysis, TEA was not associated with cancer-specific survival (hazard ratio [HR] 1.02, 95% CI 0.87–1.19; p=0.804) or overall survival (HR 0.91, 95% CI 0.80–1.03; p=0.136). Conclusions: In routine clinical practice, 54% of RC patients received TEA and its use was associated with anesthesiologist provider volume. After controlling for patient, disease and provider variables, we were unable to demonstrate any effect on either short- or long-term outcomes at the time of RC. PMID:27800053

  7. Readmission Rate and Causes at 90-Day after Radical Cystectomy in Patients on Early Recovery after Surgery Protocol.

    PubMed

    Altobelli, Emanuela; Buscarini, Maurizio; Gill, Harcharan S; Skinner, Eila C

    2017-01-27

    Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014. We focused on early (30-day) and late (90-day) postoperative readmission rate and causes. Results were compared with a pre-ERAS consecutive series of 177 RC patients from January 2009 to December 2011. Results: In the post-ERAS time period a total of 56 patients were readmitted, 41 within the first 30 days after surgery (20%) and 15 within the following 60 days (7%). Fever, often associated with dehydration, was the most common reason for presentation to the hospital, accounting for 57% of all readmissions. At 90 days infection accounted for 53% of readmissions. Of all the patients readmitted during the first 90 days after surgery, 32 had positive urine cultures, mostly caused by Enterococcus faecalis isolated in 18 (56%). Readmission rates did not increase since the introduction of the ERAS protocol, with an incidence of 27% in the post-ERAS group versus 30% in the pre-ERAS group. Conclusions: Despite accurate adherence to most recent perioperative antibiotic guidelines, the incidence of readmissions after RC due to infection still remains significant.

  8. Outcome of pN0 Triple-Negative Breast Cancer with or without Lymph Node Irradiation: A Single Institution Experience.

    PubMed

    Khalifa, Jonathan; Duprez-Paumier, Raphaelle; Filleron, Thomas; Lacroix Triki, Magali; Jouve, Eva; Dalenc, Florence; Massabeau, Carole

    2016-09-01

    The optimal management of patients with pathologically node-negative triple-negative breast cancer (pN0 TNBC) remains unclear. We hypothesized that lymph node irradiation (LNI; internal mammary chain/periclavicular irradiation) had an impact on outcomes of pN0 TNBC. A cohort of 126 consecutive patients with pN0 TNBC treated between 2007 and 2010 at a single institute were included. All radiotherapy (breast/chest wall, ±LNI) was delivered adjuvantly, following completion of surgery ± chemotherapy. Tumors were reviewed and histologic features were described. Tissue microarrays were constructed and tumors were assessed by immunohistochemistry using antibodies against ER, PR, HER2, Ki-67, cytokeratins 5/6, 14, epidermal growth factor receptor and androgen receptor. Patients were divided into two groups for statistical analysis: LNI (LNI+) or no LNI (LNI-). We focused on disease-free survival (DFS), metastasis-free survival (MFS), and overall survival (OS). Fifty-seven and 69 patients received or not LNI, respectively. Median age was 52 (range [25-76]) and 55 (range [29-79]) in LNI+ and LNI- group (p = 0.23). LNI was associated with larger tumors (p = 0.033), central/internal tumors (33 versus 4, p < 0.01) and more chemotherapy (86% versus 59.4% p < 0.01). The median follow-up was 53.5 months. The rate of first regional relapse (associated or not with distant relapse) was low in both groups. There was no difference in 4-year DFS (82.2% versus 89.9%; p = 0.266), MFS (87.0% versus 91.1%; p = 0.286) and OS (85.8% versus 89.9%; p = 0.322) between LNI+ and LNI- group, respectively. In univariate analysis, only clinical size (T >10 mm versus ≤10 mm), histologic size (pT >10 mm versus ≤10 mm) and grade 3 (versus grade 2) were found to be significantly associated with shorter DFS. Omission of LNI in patients with pN0 TNBC does not seem to result in poorer outcome. Further studies are needed to specifically evaluate LNI in pN0 TNBC with histologic grade

  9. Similar Treatment Outcomes for Radical Cystectomy and Radical Radiotherapy in Invasive Bladder Cancer Treated at a United Kingdom Specialist Treatment Center

    SciTech Connect

    Kotwal, Sanjeev; Choudhury, Ananya; Johnston, Colin; Paul, Alan B.; Whelan, Peter; Kiltie, Anne E.

    2008-02-01

    Purpose: To conduct a retrospective analysis within a large university teaching hospital, comparing outcomes between patients receiving either radical surgery or radiotherapy as curative treatment for bladder cancer. Patients and Methods: Between March 1996 and December 2000, 169 patients were treated radically for muscle-invasive bladder cancer. Data were collected from patient notes. Statistical analyses were performed using Kaplan-Meier methods and Cox proportional hazards regression analysis to compare radiotherapy and surgical outcome data. Results: There was no difference in overall, cause-specific, and distant recurrence-free survival at 5 years between the two groups, despite the radiotherapy group being older (median age, 75.3 years vs. 68.2 years). There were 31 local bladder recurrences in the radiotherapy group (24 solitary), but there was no significant difference in distant recurrence-free survival. In a more recent (2002-2006) cohort, the median age of radiotherapy patients but not the cystectomy patients was higher than in the 1996-2000 cohort (78.4 years vs. 75.3 years for radiotherapy and 67.9 years vs. 68.2 years for surgery). Conclusions: Although the patients undergoing radical cystectomy were significantly younger than the radiotherapy patients, treatment modality did not influence survival. Bladder cancer patients are an increasingly elderly group. Radical radiotherapy is a viable treatment option for these patients, with the advantage of organ preservation.

  10. Effects of conservative laparoscopic endometrial cystectomy and use of kidney-reinforcing and blood activating traditional Chinese medicine on ovarian functions.

    PubMed

    Huang, Y H; Shen, L; Cai, A H; Liang, X F

    2015-01-30

    This study investigated functional changes in the ovaries of women who have had conservative laparoscopic endometrial cystectomy and the effects of traditional kidney-reinforcing and blood-activating Traditional Chinese Medicine (TCM) on ovarian function. Seventy female patients who underwent laparoscopic endometrial cystectomy were randomized into two groups: TCM group receiving kidney-reinforcing and blood-activating Chinese medicine (N = 35) and control group receiving only routine follow-up (N = 35). The serum levels of all study participants were measured for follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and inhibin B (INHB) prior to and after endometrial surgery. Postoperative menstruation conditions were also assessed. Compared to preoperative conditions, both LH and FSH levels during the postoperative 1st month increased in both groups, while E2 and INHB levels decreased (P < 0.05). In the TCM group, in contrast to the control group and the postoperative 1st month, we observed a decrease in LH and FSH levels during the postoperative 4th month, while E2 and INHB levels increased (P < 0.05). In this study, we found that certain TCM prescriptions lowered postoperative serum FSH and LH levels and increased the serum INHB and basal E2 levels, thereby improving the ovarian reserve.

  11. Writing as Revision.

    ERIC Educational Resources Information Center

    Della-Piana, Gabriel M.; Endo, George T.

    This proposal for a longitudinal experimental study with a treatment intervention focuses on the process of writing as revision. Revision refers to the process which occurs prior to and throughout the writing of a work, rather than the final editing. According to this process, the writer goes through five stages: preconceptions concerning style…

  12. A Novel Risk Stratification to Predict Local-Regional Failures in Urothelial Carcinoma of the Bladder After Radical Cystectomy

    SciTech Connect

    Baumann, Brian C.; Guzzo, Thomas J.; He Jiwei; Keefe, Stephen M.; Tucker, Kai; Bekelman, Justin E.; Hwang, Wei-Ting; Vaughn, David J.; Malkowicz, S. Bruce; Christodouleas, John P.

    2013-01-01

    Purpose: Local-regional failures (LF) following radical cystectomy (RC) plus pelvic lymph node dissection (PLND) with or without chemotherapy for invasive urothelial bladder carcinoma are more common than previously reported. Adjuvant radiation therapy (RT) could reduce LF but currently has no defined role because of previously reported morbidity. Modern techniques with improved normal tissue sparing have rekindled interest in RT. We assessed the risk of LF and determined those factors that predict recurrence to facilitate patient selection for future adjuvant RT trials. Methods and Materials: From 1990-2008, 442 patients with urothelial bladder carcinoma at University of Pennsylvania were prospectively followed after RC plus PLND with or without chemotherapy with routine pelvic computed tomography (CT) or magnetic resonance imaging (MRI). One hundred thirty (29%) patients received chemotherapy. LF was any pelvic failure detected before or within 3 months of distant failure. Competing risk analyses identified factors predicting increased LF risk. Results: On univariate analysis, pathologic stage {>=}pT3, <10 nodes removed, positive margins, positive nodes, hydronephrosis, lymphovascular invasion, and mixed histology significantly predicted LF; node density was marginally predictive, but use of chemotherapy, number of positive nodes, type of surgical diversion, age, gender, race, smoking history, and body mass index were not. On multivariate analysis, only stage {>=}pT3 and <10 nodes removed were significant independent LF predictors with hazard ratios of 3.17 and 2.37, respectively (P<.01). Analysis identified 3 patient subgroups with significantly different LF risks: low-risk ({<=}pT2), intermediate-risk ({>=}pT3 and {>=}10 nodes removed), and high-risk ({>=}pT3 and <10 nodes) with 5-year LF rates of 8%, 23%, and 42%, respectively (P<.01). Conclusions: This series using routine CT and MRI surveillance to detect LF confirms that such failures are relatively common

  13. Cementless acetabular revision arthroplasty

    PubMed Central

    Jain, Rina; Schemitsch, Emil H.; Waddell, James P.

    2000-01-01

    Objective To evaluate the effects of clinical factors on outcome after acetabular revision with a cementless beaded cup. Design Retrospective case series. Setting Tertiary care referral centre. Patients Forty-one patients who underwent acetabular revision with a cementless cup were followed up for a mean of 3.4 years. Interventions Acetabular revision with a beaded cementless cup in all patients. A morcellized allograft was used in 10 patients. Outcome measures A modified Harris hip score (range of motion measurement omitted), the SF-36 health survey, and the Western Ontario McMaster (WOMAC) osteoarthritis index. Multivariate analysis was used to evaluate the effects of age, gender, morcellized allografting, time to revision from the previous operation, acetabular screw fixation and concurrent femoral revision on outcome. Results Gender accounted for a significant portion of the variation seen in the SF-36 physical component scores (r = 0.36, p = 0.02), with women tending to have worse results. Increasing age was associated with lower WOMAC index function scores (r = 0.36, p = 0.03), whereas concurrent femoral revision tended to have a positive effect on WOMAC index function (r = 0.39, p = 0.01). None of the potential clinical predictors had any significant effect on the SF-36 mental component scores, or WOMAC index pain and stiffness scores. Conclusions In cementless acetabular revision arthroplasty, physical function, as measured by generic and limb-specific scales, may be affected by gender, age and the presence of a concurrent femoral revision. Time to revision from the previous operation, morcellized allografting and screw fixation of the acetabulum did not affect outcomes. This information may provide some prognostic value for patients’ expectations. PMID:10948687

  14. Revised Total Coliform Rule

    EPA Pesticide Factsheets

    The Revised Total Coliform Rule (RTCR) aims to increase public health protection through the reduction of potential pathways for fecal contamination in the distribution system of a public water system (PWS).

  15. The effect on erection and orgasm of cystectomy, prostatectomy and vesiculectomy for cancer of the bladder: a clinical and electromyographic study.

    PubMed

    Bergman, B; Nilsson, S; Petersén, I

    1979-04-01

    Forty-three men who had been subjected to cystectomy and concomitant prostatectomy, vesiculectomy and urethrectomy were interviewed about their pre-operative and post-operative sexual activities at a mean of 3 (range 1 to 8) years after operation. Twenty-eight of the 38 men (74%) who had been sexually active continued to have some form of sexual activity, 21 of them achieving orgasm. Only 3 men had penile erection; 2 of them had been subjected to prostatectomy and 1 to prostatic resection. One of these men treated by prostatectomy had also had urethrectomy. Electromyographic registration from the striated external urethral sphincter, the bulbocavernosus muscle and the levator ani muscle showed normal duration of muscular contractions and length of interval between contractions after operation. The pattern of impulses during organs did not differ from that of normal men.

  16. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Johnson, William R.; Makani, Amun; Wall, Andrew J.; Hosseini, Ali; Hampilos, Perry; Li, Guoan; Gill, Thomas J.

    2015-01-01

    Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction

  17. Survival up to 5–15 years in young women following genital sparing radical cystectomy and neobladder: oncological outcome and quality of life. Single–surgeon and single–institution experience

    PubMed Central

    Elganozoury, Hossam

    2015-01-01

    Introduction This is an observational retrospective study utilising long term patient follow–up for 15 years to determine the survival and quality of life in women (age range 20–54 years) after having been treated for carcinoma of the bladder by radical cystectomy with preservation of genital organs. Material and methods The study included 13 female patients with urothelial carcinoma of the bladder treated with genital sparing radical cystectomy during the period of 1995 until 2006. They had orthotopic ileal neobladder. Follow–up included recurrence–free survival, metastases–free survival, overall survival, continence, and sexual function. Results Genital sparing cystectomy was done in 13 women. Seven women were between the ages of 20–37, and 6 women were aged 38–54. Overall survival of 10–15 years was 61.53%, survival from 5 to 9 years was 38.46%. The procedure was done in 9 women with a muscle–invasive tumor of stage T2– T3a. Non–muscle invasive T1 tumor was present in four patients. Quality of life was assessed by continence, which was good in 10/13 patients. Three women needed CIC. Sexual function was tested by female sexual function index >20–30 and was scored at 84.61%. Conclusions The study provides evidence of safety and efficacy of radical cystectomy with sparing of genital organs in women aged 20 to 54 with urothelial carcinoma of the bladder. Oncological outcome for 5–15 years was good; continence and sexual function were good. This procedure should be considered when surgical approach appears to be feasible. The limitation of our findings is the small sample size of this case series. PMID:26251729

  18. Residential Wiring. Revised.

    ERIC Educational Resources Information Center

    Taylor, Mark

    This competency-based curriculum guide contains materials for conducting a course in residential wiring. A technically revised edition of the 1978 publication, the guide includes 28 units. Each instructional unit includes some or all of the following basic components: performance objectives, suggested activities for teachers and students,…

  19. Hospital Nurse Aide. Revised.

    ERIC Educational Resources Information Center

    Iowa Univ., Iowa City. Coll. of Education.

    This report presents results of a project to revise the current 120-hour advanced nurse aide course to include all recommended minimum competencies. A three-page description of project objectives, activities, and outcomes is followed by a list of the competencies for the 75-hour nurse aide course for long-term care and for the 120-hour advanced…

  20. School Safety Handbook. Revised.

    ERIC Educational Resources Information Center

    Association of School Business Officials International, Reston, VA.

    The revised edition of this handbook represents a concerted effort to bring school safety to the forefront of business managers' daily and long-range planning activities. Although statistics show few fatalities on school grounds, schools appear to have a high frequency and incident rate of nonfatal injuries. According to the introduction, school…

  1. Scar revision - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100098.htm Scar revision - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 ...

  2. Benefit of Adjuvant Chemotherapy and Pelvic Lymph Node Dissection in pT3 and Node Positive Bladder Cancer Patients Treated with Radical Cystectomy

    PubMed Central

    Boström, Peter J.; Mirtti, Tuomas; van Rhijn, Bas; Fleshner, Neil E.; Finelli, Antonio; Laato, Matti; Jewett, Michael A.; Moore, Malcom J.; Sridhar, Srikala; Nurmi, Martti; Tannock, Ian F.; Zlotta, Alexandre R.

    2016-01-01

    Background: Benefits of adjuvant chemotherapy (AC) and extent of pelvic lymph node dissection (PLND) in radical cystectomy (RC) are debated. Results from randomized trials are still expected. Objective: To analyze the effects of AC and PLND in two academic centers with opposite policies regarding their use. Methods: 581 bladder cancer patients who underwent RC without neoadjuvant chemotherapy, from Toronto (University Health Network), Canada, and Turku University Hospital, Finland were included. Disease specific survival (DSS) and failure patterns were assessed. Results: Centers differed in PLND rate (93% and 36% in Toronto and Turku respectively, p <  0.001), PLND extent (≥10 removed nodes, 58% vs. 8%, p <  0.001) and AC rate (21% vs. 2%, p <  0.001). Survival between centers among pT≤1 or pT4 patients was similar. pT3 patients in Toronto had an improved 10 year DSS (43% vs. 22%, p = 0.025). Distant failures were less common after AC (HR 0.56, 95%  CI 0.33–0.98, p <  0.042). In node positive (N+) patients, mortality was significantly higher in Turku (HR 2.19, 95%  CI 1.44–3.34, p <  0.001) and lower in patients receiving AC (HR 0.60, 95%  CI 0.37–0.99, p = 0.044). 41% DSS at 10 years was observed in N+ Toronto patients. Limitations included the non-randomized retrospective design and absence of propensity score analysis. Conclusion: Combining AC and PLND to RC is associated with improved survival in pT3 and N+ patients. PLND did not affect survival independently but helps in selecting patients for AC. Our data adds to the growing body of evidence supporting the usefulness of AC in addition to PLND in high risk patients operated by cystectomy. PMID:27376145

  3. A three-dimensional head-mounted display system (RoboSurgeon system) for gasless laparoendoscopic single-port partial cystectomy.

    PubMed

    Fujii, Yasuhisa; Kihara, Kazunori; Yoshida, Soichiro; Ishioka, Junichiro; Matsuoka, Yoh; Numao, Noboru; Saito, Kazutaka

    2014-12-01

    We developed a new three-dimensional (3D) head-mounted display (HMD) system (RoboSurgeon system) that combines a high-definition 3D organic electroluminescent HMD with a high-definition 3D endoscope and applies it to minimally invasive surgery. This system presents the surgeon with a higher quality of magnified 3D imagery in front of the eyes, regardless of head position. We report 5 cases of RoboSurgeon gasless laparoendoscopic single-port partial cystectomy, which is carried out as part of our selective bladder-sparing protocol, with a technique utilizing both an intravesical and extravesical approach. While carrying out the surgery, the system provides the surgeon with both excellent 3D imagery of the operative field and clear imagery of the cystoscopy. All procedures were safely completed and there were no complications except for a case of postoperative lymphorrhea. Our experience shows that the 3D HMD system might facilitate maneuverability and safety in various minimally invasive procedures.

  4. Comparison of pathological staging and grading of urothelial bladder carcinoma in post-transurethral resection and post-radical cystectomy specimens.

    PubMed

    Poletajew, S; Fus, Ł; Walędziak, M; Pomada, P; Ciechańska, J; Wasiutyński, A; Radziszewski, P; Górnicka, B

    2014-12-01

    Staging and grading of bladder cancer have a substantial impact on patients' prognosis. However, due to the relatively low quality and quantity of specimens from transurethral resection (TUR), initial histopathological examination may not be fully reliable. The aim of this study was to assess the repeatability of staging and grading in post-TUR and post-radical cystectomy (RC) specimens. Staging and grading in TUR and RC specimens were compared in a group of 181 consecutive patients. All microscopic examinations were performed by dedicated uropathologists. Median time from TUR to RC was 45 days. Additionally, an attempt to identify potential clinical variables influencing the risk of discrepancies was made. In post-RC specimens, the disease was down-staged in 13.8% and up-staged in 54.6% of patients (K = -0.03, p < 0.02). Muscle-invasive bladder cancer was diagnosed in 67.6% of patients initially staged as T1. Cancer was down-graded in 10.3% and up-graded in 17.9% of patients (K = 0.44, p < 0.02). Early onset of disease, female sex and time interval from transurethral resection of bladder tumor (TURBT) to RC had no effect on incidence of discrepancies. Pathological post-TUR examination is not predictive for the final stage of cancer. The incidence of under- or overgrading of bladder cancer is significant, and efforts should be made to reduce it.

  5. Grafting in revision rhinoplasty.

    PubMed

    Bussi, M; Palonta, F; Toma, S

    2013-06-01

    Rhinoplasty is one of the most difficult aesthetic surgery procedures with a high rate of revision. In revision rhinoplasty the surgeon should explore the patient's concerns and then verify the possibility to satisfy expectations after complete internal and external examination of the nose. For the vast majority of complex secondaries, an open approach is the only reasonable method. In fact, in secondary nasal surgery, because of the scarring process following the primary operation, dissection is tedious, and landmarks are lost. One of the main objectives for the surgeon who approaches secondary rhinoplasty is to restore the structural support of the nose and to replace the lost volume of soft tissues. To achieve this purpose, the surgeon must often rely on grafts. An ideal grafting material must be easy to sculpt, resistant to trauma, infection and extrusion, mechanically stable, inert and readily available. For all these reasons, autogenous cartilage grafts harvested from septum, auricular concha and rib represent the first choice in rhinoplasty. In order to obtain a camouflage graft that provides natural contouring to the nose, temporalis fascia can be used. All these carefully trimmed grafts are useful in tip revision surgery, in secondary surgery of the dorsum and to resolve or reduce functional problems.

  6. Revision and Validation of the Revised Teacher Beliefs Survey.

    ERIC Educational Resources Information Center

    Benjamin, Jane

    This study revised the Teacher Beliefs Survey (S. Wooley and A. Wooley, 1999; TBS), an instrument to assess teachers beliefs related to constructivist and behaviorist theories of learning, and then studied the validity of the revised TBS. Drawing on a literature review, researchers added items for the existing constructs of the TBS and added a new…

  7. Cholécystectomie laparoscopique pour cholécystite aiguë lithiasique: à propos de 22 cas colligés à l'hôpital de la renaissance de Ndjamena

    PubMed Central

    Kaimba, Bray Madoué; Mahamat, Youssouf; Akouya, Seid Dounia

    2015-01-01

    Déterminer la faisabilité de la cholécystectomie laparoscopique pour cholécystite aiguë lithiasique dans notre contexte d'exercice, et d'en évaluer les résultats. Nous rapportons une série de 22 patients ayant bénéficié d'une cholécystectomie laparoscopique pour cholécystite aiguë lithiasique sur une période de 16 mois (Décembre 2013- Mars 2015). Sur 22 patients été opérés, il y avait une nette prédominance féminine (20 femmes soit 91%). La durée moyenne de l'intervention était de 90 mn avec des extrêmes de 38 et 142 mn. L’âge moyen de nos patients était de 42 ans avec des extrêmes de 16 à 65 ans. La durée d'hospitalisation a été de 2 à 6 jours avec une moyenne de 3 jours. Le taux de conversion en laparotomie était de 4.5%. Les suites opératoires immédiates ont été simples dans 90.9% des cas. Les complications concernaient 2 patients (9.1%) dont 1 suppuration pariétale et 1 hémorragie de paroi. La cholécystectomie laparoscopique pour cholécystite aigue lithiasique est faisable dans notre contexte au delà des 72 heures d’évolution sans majoration de risques. PMID:26587159

  8. A greater number of dissected lymph nodes is associated with more favorable outcomes in bladder cancer treated by radical cystectomy: a meta-analysis

    PubMed Central

    Lin, Fengsheng; Chen, Pengliang; Pang, Shiyu

    2016-01-01

    The optimal extent of lymph node dissection (LND) is currently not established, and the debate regarding the association between the number of dissected nodes and the outcomes of bladder cancer treated by radical cystectomy (RC) is still ongoing. Therefore, the present meta-analysis was performed to clarify this potential relationship. Eligible studies were retrieved via an electronic search for studies published up to April 2016, and by manual review of the references. A total of 25 cohort studies involving 41,400 bladder cancer patients who underwent RC were included. The summary relative risk estimates (SRRE) based on the highest compared with the lowest categories of LND were estimated by variance-based meta-analysis. Heterogeneity among the study results was explored through stratified analyses. Overall, bladder cancer patients with the highest category of LND had 28%, 34% and 36% reduced risks, corresponding to overall survival (SRRE = 0.72; 95% CI, 0.64–0.80), cancer-specific survival (SRRE = 0.66; 95% CI, 0.54–0.80) and recurrence-free survival (SRRE = 0.64; 95% CI, 0.50–0.82), respectively, compared with patients with the lowest category of LND. In summary, the patients with a greater number of dissected lymph nodes had statistically significant survival advantages in terms of the outcomes of bladder cancer following RC. The number of dissected lymph nodes could be an independent prognostic factor for bladder cancer. These findings need to be validated in prospective and larger epidemiological studies with a longer follow-up period. PMID:27542252

  9. Concordance in Biomarker Status Between Bladder Tumors at Time of Transurethral Resection and Subsequent Radical Cystectomy: Results of a 5-year Prospective Study

    PubMed Central

    Passoni, Niccolò M.; Shariat, Shahrokh F.; Bagrodia, Aditya; Francis, Franto; Rachakonda, Varun; Xylinas, Evanguelos; Kapur, Payal; Sagalowsky, Arthur I.; Lotan, Yair

    2016-01-01

    Purpose: To assess the concordance rate in alterations of molecular markers at the time of transurethral resection (TUR) and subsequent radical cystectomy (RC) among patients with high-grade urothelial carcinoma of the bladder (UCB). Methods: We prospectively performed immunohistochemical staining p53, p21, p27, Ki-67 and cyclin E1 on TUR and on RC specimens from 102 patients treated with RC and bilateral lymphadenectomy for high-grade UCB. We analyzed the concordance rate of individual markers and of the number of altered markers. Concordant and discordant findings were reported in the overall population and according to clinical stage. Results: Median patient age was 74 years (IQR 67–79) and mostly male (86%). Median time from TUR to RC was 1.5 months (IQR 1.0–2.4). Clinical stage at time of RC was cTa/Tis/T1 in 50% , cT2 in 47% , and cT4 in 1% of patients Nine (9%) patients received neoadjuvant chemotherapy. The concordance of biomarkers between TUR and RC specimens was 92.2% , 77.5% , 80.4% , 77.5% , and 83.3% for cyclin E1, p21, p27, p53 and Ki-67, respectively. The concordance between number of altered biomarkers was 51.0%. Conclusions: The rate of individual marker alterations at time of TUR closely approximates that found at RC specimens. However, the correlation of number of altered markers is lower. Molecular marker status at TUR could help predict the marker status at RC and may help guide multimodal therapeutic planning. PMID:27376130

  10. Shed urinary ALCAM is an independent prognostic biomarker of three-year overall survival after cystectomy in patients with bladder cancer

    PubMed Central

    Egloff, Shanna A. Arnold; Du, Liping; Loomans, Holli A.; Starchenko, Alina; Su, Pei-Fang; Ketova, Tatiana; Knoll, Paul B.; Wang, Jifeng; Haddad, Ahmed Q.; Fadare, Oluwole; Cates, Justin M.; Lotan, Yair; Shyr, Yu; Clark, Peter E.; Zijlstra, Andries

    2017-01-01

    Proteins involved in tumor cell migration can potentially serve as markers of invasive disease. Activated Leukocyte Cell Adhesion Molecule (ALCAM) promotes adhesion, while shedding of its extracellular domain is associated with migration. We hypothesized that shed ALCAM in biofluids could be predictive of progressive disease. ALCAM expression in tumor (n = 198) and shedding in biofluids (n = 120) were measured in two separate VUMC bladder cancer cystectomy cohorts by immunofluorescence and enzyme-linked immunosorbent assay, respectively. The primary outcome measure was accuracy of predicting 3-year overall survival (OS) with shed ALCAM compared to standard clinical indicators alone, assessed by multivariable Cox regression and concordance-indices. Validation was performed by internal bootstrap, a cohort from a second institution (n = 64), and treatment of missing data with multiple-imputation. While ALCAM mRNA expression was unchanged, histological detection of ALCAM decreased with increasing stage (P = 0.004). Importantly, urine ALCAM was elevated 17.0-fold (P < 0.0001) above non-cancer controls, correlated positively with tumor stage (P = 0.018), was an independent predictor of OS after adjusting for age, tumor stage, lymph-node status, and hematuria (HR, 1.46; 95% CI, 1.03–2.06; P = 0.002), and improved prediction of OS by 3.3% (concordance-index, 78.5% vs. 75.2%). Urine ALCAM remained an independent predictor of OS after accounting for treatment with Bacillus Calmette-Guerin, carcinoma in situ, lymph-node dissection, lymphovascular invasion, urine creatinine, and adjuvant chemotherapy (HR, 1.10; 95% CI, 1.02–1.19; P = 0.011). In conclusion, shed ALCAM may be a novel prognostic biomarker in bladder cancer, although prospective validation studies are warranted. These findings demonstrate that markers reporting on cell motility can act as prognostic indicators. PMID:27894096

  11. Change in Psoas Muscle Volume as a Predictor of Outcomes in Patients Treated with Chemotherapy and Radical Cystectomy for Muscle-Invasive Bladder Cancer

    PubMed Central

    Zargar, Homayoun; Almassi, Nima; Kovac, Evan; Ercole, Cesar; Remer, Erick; Rini, Brian; Stephenson, Andrew; Garcia, Jorge A.; Grivas, Petros

    2017-01-01

    Objective: Sarcopenia, or the age-related loss of skeletal muscle mass and function, has been investigated as a potential marker of adverse outcomes among surgical patients. Our aim was to assess for changes in psoas muscle volume (PMV) following administration of neoadjuvant chemotherapy (NAC) in patients with bladder cancer and to examine whether changes in PMV following NAC are predictive of perioperative complications, pathologic response or survival. Methods: During the period of 2009–2013, patients undergoing NAC and radical cystectomy (RC) at our institution with pre and post NAC cross sectional images available were included. Bilateral total psoas muscle volume (PMV) was obtained from pre- and post- NAC images and the proportion of PMV change was calculated by dividing the change PMV by pre-NAC PMV. Analyses for the assessment of factors predicting PMV loss, partial/complete pathologic response (pPR/pCR), complications, readmission, cancer specific (CSS), recurrence-free (RFS) and overall survival (OS) were performed. Results: Total of 60 patients had complete radiological data available. Post-NAC PMV and BMI declines were statistically significant, 4.9% and 0.05%, respectively. NAC dose reduction/delay was a significant predictor of PMV loss (coefficient B 4.6; 95% CI 0.05–9.2; p = 0.047). The proportion of PMV decline during NAC was not a predictor of pPR, pCR, complications, readmission, CSS, RFS, or OS. Conclusions: We observed an interval decline in PMV during the period of NAC administration and this decline was more than it could be appreciated with changes in BMI during the same period. PMV decline was associated with the need for dose reduction/dose delay during NAC. In our series, PMV changes occurring during NAC administration were not predictive of pathologic response to chemotherapy, postoperative complications or survival. PMID:28149936

  12. Trends in the Use of Chemotherapy before and after Radical Cystectomy in Patients with Muscle-invasive Bladder Cancer in Korea.

    PubMed

    Kim, Sung Han; Seo, Ho Kyung; Shin, Hee Chul; Chang, Sung Ja; Yun, Sooin; Joo, Jungnam; Ku, Ja Hyeon; Kim, Hyung Suk; Jeon, Hwang Gyun; Jeong, Byong Chang; Jeong, In Gab; Kang, Seok Ho; Hong, Bumsik

    2015-08-01

    We investigated trends in perioperative chemotherapy use, and determined factors associated with neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) use in Korean patients with muscle-invasive bladder cancer (MIBC). We recruited 1,324 patients who had MIBC without nodal invasion or metastases and had undergone radical cystectomies (RC) between 2003 and 2013. The study's cut-off time for AC was three months after surgery, and the study's timespan was divided into three periods based on NAC use, namely, 2003-2005, 2006-2009, and 2010-2013. Complete remission was defined as histologically confirmed T0N0M0 after RC. NAC and AC were administered to 7.3% and 18.1% of the patients, respectively. The median time interval between completing NAC and undergoing RC was 32 days and the mean number of cycles was 3.2. The median time interval between RC and AC was 43 days and the mean number of cycles was 4.1. Gemcitabine and cisplatin were most frequently used in combination for NAC (49.0%) and AC (74.9%). NAC use increased significantly from 4.6% between 2003 and 2005 to 8.4% between 2010 and 2013 (P < 0.05), but AC use did not increase. Only 1.9% of patients received NAC and AC. Complete remission after NAC was achieved in 12 patients (12.5%). Multivariable modeling revealed that an advanced age, the earliest time period analyzed, and clinical tumor stage ≤ cT2 bladder cancer were negatively associated with NAC use (P < 0.05). While NAC use has slowly increased over time, it remains an underutilized therapeutic approach in Korean clinical practice.

  13. Does skip metastasis or other lymph node parameters have additional effects on survival of patients undergoing radical cystectomy for bladder cancer?

    PubMed Central

    Baltaci, Sumer; Aslan, Guven; Can, Cavit; Cal, Cag; Elhan, Atilla; Turkeri, Levent; Mungan, Aydin

    2015-01-01

    Purpose To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND). Materials and Methods RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis. Results The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS. Conclusions No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients. PMID:25964836

  14. Multimodal Revision Techniques in Webtexts

    ERIC Educational Resources Information Center

    Ball, Cheryl E.

    2014-01-01

    This article examines how an online scholarly journal, "Kairos: Rhetoric, Technology, Pedagogy," mentors authors to revise their webtexts (interactive, digital media scholarship) for publication. Using an editorial pedagogy in which multimodal and rhetorical genre theories are merged with revision techniques found in process-based…

  15. TRICARE reimbursement revisions. Final rule.

    PubMed

    2012-06-27

    This final rule provides several necessary revisions to the regulation in order for TRICARE to be consistent with Medicare. These revisions affect: Hospice periods of care; reimbursement of physician assistants and assistant-at-surgery claims; and diagnosis-related group values, removing references to specific numeric diagnosis-related group values and replacing them with their narrative description.

  16. Surgical Scar Revision: An Overview

    PubMed Central

    Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh

    2014-01-01

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

  17. Annotation and Classification of Argumentative Writing Revisions

    ERIC Educational Resources Information Center

    Zhang, Fan; Litman, Diane

    2015-01-01

    This paper explores the annotation and classification of students' revision behaviors in argumentative writing. A sentence-level revision schema is proposed to capture why and how students make revisions. Based on the proposed schema, a small corpus of student essays and revisions was annotated. Studies show that manual annotation is reliable with…

  18. 78 FR 48667 - Revised Company Registration System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-09

    ... Energy Regulatory Commission Revised Company Registration System AGENCY: Federal Energy Regulatory Commission. ACTION: Notice. SUMMARY: This document revises the effective date of the Revised Company... in Docket No. RM07-16-000, et al. (February 7, 2013 Order) directing revisions to the...

  19. Incidence, histopathology, and surgical outcome of tumors of spinal cord, nerve roots, meninges, and vertebral column - Data based on single institutional (Sher-i-Kashmir Institute of Medical Sciences) experience

    PubMed Central

    Bhat, Abdul Rashid; Kirmani, Altaf Rehman; Wani, Muhammed Afzal; Bhat, Mohammed Haneef

    2016-01-01

    Context: In the absence of a community-based study on the spinal tumors in the Valley, medical records of the only Regional Neurosurgical Center are available. Aim: The aim of this study is to establish a hospital-based regional epidemiology of spinal tumors in the Valley since the data are derived from a single institution. Materials and Methods: A retrospective analysis of 531 malignant and nonmalignant tumors of spinal cord, its coverings and vertebrae, which were managed in a Regional Neurosurgical Center under a standard and uniform medical-protocol over 30-year period from 1983 to 2014. Results: The hospital-based incidence for all spinal tumors was 0.24/100,000 persons per year. The malignant spinal cord and vertebral tumors comprised 32.58% (173/531) of all tumors, and benign spinal cord and vertebral tumors comprised 67.42% (358/531). The extradural–intradural tumors such as metastatic lesions and primary malignant vertebral tumors were on rise with 16.38% (87/531) cases. The children below 18 years were 5.46% (29/531), of which 55.17% (16/29) were below 9 years. The most common primary bone malignancy was multiple myeloma (54.54% =12/22). Histopathologically, the most common metastatic deposit in the spinal canal was non-Hodgkin's lymphoma (24.61% =16/65). A mortality of 3.20% (17/531) was noted. Recurrences were noted in 4.90% (26/531), and adjuvant therapies were given to 16.38% (87/531) patients. Conclusion: The malignant spinal cord and vertebral tumors, especially metastatic deposits, are on rise in elderly population. The surgical outcome, in terms of recovery and spinal stability, of benign tumors, is comparatively better than malignant ones. The study reveals a low regional incidence (hospital-based) of spinal tumors. PMID:27365955

  20. Are Increased Tumor Aneuploidy and Heightened Cell Proliferation Along With Heterogeneity Associated With Patient Outcome for Carcinomas of the Uterine Cervix? A Combined Analysis of Subjects Treated in RTOG 9001 and a Single-Institution Trial

    SciTech Connect

    Wolfson, Aaron H. Winter, Kathryn; Crook, William

    2008-01-01

    Purpose: To look for possible associations between measurements of DNA index (DI), S-phase fraction (SPF), and tumor heterogeneity (TH) using flow cytometry and overall survival for patients with invasive cervical carcinoma treated with definitive irradiation. Methods and Materials: A total of 57 patients with International Federation of Obstetrics and Gynecology Stages IB{sub 2} through IVB cervical carcinomas treated with definitive radiotherapy with or without concurrent chemotherapy were enrolled into this registry study that involved flow cytometric analysis of fresh tissue from each cervical cancer obtained by pretreatment biopsy. These specimens were evaluated for DNA aneuploidy (DI {<=}1.5 vs. >1.5), SPF ({<=}15% vs. >15%), and TH (uniploid vs. multiploid). Results: In these analyses 27 of the patients were treated in Radiation Therapy Oncology Group protocol 9001, and an additional 30 were offered chemoradiation at a single institution. Forty-one patients had DI {<=}1.5 and 16 DI >1.5. Twenty-nine patients had SPF {<=}15%, 26 >15%, and 2 had no determinable SPF. Forty-three patients had uniploid and 14 multiploid tumors. The 4-year estimated overall survival rate for the entire study cohort was 62% (95% confidence interval 48%-74%). With a median follow-up of 3.7 years, there were no observable associations by univariate analysis for DI, SPF, or TH concerning patient survival. Conclusions: There were no statistically significant associations among DI, SPF, or TH and patient outcome. Additional studies are indicated to identify tumor biomarkers that could predict patients at risk for disseminated disease.

  1. Knowledge-Directed Theory Revision

    NASA Astrophysics Data System (ADS)

    Ali, Kamal; Leung, Kevin; Konik, Tolga; Choi, Dongkyu; Shapiro, Dan

    Using domain knowledge to speed up learning is widely accepted but theory revision of such knowledge continues to use general syntactic operators. Using such operators for theory revision of teleoreactive logic programs is especially expensive in which proof of a top-level goal involves playing a game. In such contexts, one should have the option to complement general theory revision with domain-specific knowledge. Using American football as an example, we use Icarus' multi-agent teleoreactive logic programming ability to encode a coach agent whose concepts correspond to faults recognized in execution of the play and whose skills correspond to making repairs in the goals of the player agents. Our results show effective learning using as few as twenty examples. We also show that structural changes made by such revision can produce performance gains that cannot be matched by doing only numeric optimization.

  2. Arthroscopic revision of Bankart repair.

    PubMed

    Neri, Brian R; Tuckman, David V; Bravman, Jonathan T; Yim, Duke; Sahajpal, Deenesh T; Rokito, Andrew S

    2007-01-01

    The success of revision surgery for failed Bankart repair is not well known. This purpose of this study was to report the success rates achieved using arthroscopic techniques to revise failed Bankart repairs. Twelve arthroscopic revision Bankart repairs were performed on patients with recurrent unidirectional shoulder instability after open or arthroscopic Bankart repair. Follow-up was available on 11 of the 12 patients at a mean of 34.4 months (range, 25-56 months). The surgical findings, possible modes of failure, shoulder scores (Rowe score, University of California Los Angeles [UCLA], Simple Shoulder Test), and clinical outcome were evaluated. Various modes of failure were recognized during revision arthroscopic Bankart repairs. Good-to-excellent results were obtained in 8 patients (73%) undergoing revision stabilization according to Rowe and UCLA scoring. A subluxation or dislocation event occurred in 3 (27%) of the 11 patients at a mean of 8.7 months (range, 6-12 months) postoperatively. Arthroscopic revision Bankart repairs are technically challenging procedures but can be used to achieve stable, pain-free, functional shoulders with return to prior sport. Owing to limited follow-up and the small number of patients in this study, we were unable to conclude any pattern of failure or selection criteria for this procedure.

  3. Revised Extended Grid Library

    SciTech Connect

    Martz, Roger L.

    2016-07-15

    The Revised Eolus Grid Library (REGL) is a mesh-tracking library that was developed for use with the MCNP6TM computer code so that (radiation) particles can track on an unstructured mesh. The unstructured mesh is a finite element representation of any geometric solid model created with a state-of-the-art CAE/CAD tool. The mesh-tracking library is written using modern Fortran and programming standards; the library is Fortran 2003 compliant. The library was created with a defined application programmer interface (API) so that it could easily integrate with other particle tracking/transport codes. The library does not handle parallel processing via the message passing interface (mpi), but has been used successfully where the host code handles the mpi calls. The library is thread-safe and supports the OpenMP paradigm. As a library, all features are available through the API and overall a tight coupling between it and the host code is required. Features of the library are summarized with the following list: • can accommodate first and second order 4, 5, and 6-sided polyhedra • any combination of element types may appear in a single geometry model • parts may not contain tetrahedra mixed with other element types • pentahedra and hexahedra can be together in the same part • robust handling of overlaps and gaps • tracks element-to-element to produce path length results at the element level • finds element numbers for a given mesh location • finds intersection points on element faces for the particle tracks • produce a data file for post processing results analysis • reads Abaqus .inp input (ASCII) files to obtain information for the global mesh-model • supports parallel input processing via mpi • support parallel particle transport by both mpi and OpenMP

  4. Perioperative use of crystalloids in patients undergoing open radical cystectomy: balanced Ringer’s maleate versus a glucose 5%/potassium-based balanced solution: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background The optimal crystalloid solution to use perioperatively in patients undergoing open radical cystectomy remains unclear. Many of the fluids used for intravenous hydration contain supraphysiologic concentrations of chloride, which can induce hyperchloremia and metabolic acidosis, resulting in renal vasoconstriction and decreased renal function. In addition, patients receiving less fluid and less sodium show faster recovery of gastrointestinal (GI) function after colonic surgery. Methods and design This is an investigator-initiated, single-center, randomized, controlled, parallel group trial with assessor-blinded outcome assessment, in the Department of Urology, University Hospital Bern, Switzerland. The study will involve 44 patients with bladder cancer scheduled for radical cystectomy and urinary diversion. The primary outcome is the duration between the end of surgery and the return of the GI function (first defecation). Secondary outcomes are fluid balance (body weight difference postoperatively versus preoperatively) and the incidence of kidney function disorders according to the Risk – Injury – Failure – Loss - End Stage Renal Disease (RIFLE classification). An equal number of patients are allocated to receive Ringerfundin® solution or a glucose/potassium-based balanced crystalloid solution as baseline infusion during the entire time that intravenous administration of fluid is necessary during the perioperative period. The randomized crystalloid solution is infused at a rate of 1 ml/kg/h until the bladder has been removed, followed by 3 ml/kg/h until the end of surgery. Postoperative hydration is identical in both groups and consists of 1,500 ml of the randomized crystalloid solution per 24 hours. Postoperative patient care is identical in both groups; patients are allowed to drink clear fluids immediately after surgery, and liquid diet is started on postoperative day 1, as well as active mobilization and the use of chewing gum. Body weight

  5. Revision of Primary Series Maps

    USGS Publications Warehouse

    ,

    2000-01-01

    In 1992, the U.S. Geological Survey (USGS) completed a 50-year effort to provide primary series map coverage of the United States. Many of these maps now need to be updated to reflect the construction of new roads and highways and other changes that have taken place over time. The USGS has formulated a graphic revision plan to help keep the primary series maps current. Primary series maps include 1:20,000-scale quadrangles of Puerto Rico, 1:24,000- or 1:25,000-scale quadrangles of the conterminous United States, Hawaii, and U.S. Territories, and 1:63,360-scale quadrangles of Alaska. The revision of primary series maps from new collection sources is accomplished using a variety of processes. The raster revision process combines the scanned content of paper maps with raster updating technologies. The vector revision process involves the automated plotting of updated vector files. Traditional processes use analog stereoplotters and manual scribing instruments on specially coated map separates. The ability to select from or combine these processes increases the efficiency of the National Mapping Division map revision program.

  6. The revised classification of eukaryotes

    PubMed Central

    Adl, Sina M.; Simpson, Alastair. G.; Lane, Christopher E.; Lukeš, Julius; Bass, David; Bowser, Samuel S.; Brown, Matt; Burki, Fabien; Dunthorn, Micah; Hampl, Vladimir; Heiss, Aaron; Hoppenrath, Mona; Lara, Enrique; leGall, Line; Lynn, Denis H.; McManus, Hilary; Mitchell, Edward A. D.; Mozley-Stanridge, Sharon E.; Parfrey, Laura Wegener; Pawlowski, Jan; Rueckert, Sonja; Shadwick, Lora; Schoch, Conrad; Smirnov, Alexey; Spiegel, Frederick W.

    2012-01-01

    This revision of the classification of eukaryotes, which updates that of Adl et al. (2005), retains an emphasis on the protists and incorporates changes since 2005 that have resolved nodes and branches in phylogenetic trees. Whereas the previous revision was successful in re-introducing name stability to the classification, this revision provides a classification for lineages that were then still unresolved. The supergroups have withstood phylogenetic hypothesis testing with some modifications, but despite some progress, problematic nodes at the base of the eukaryotic tree still remain to be statistically resolved. Looking forward, subsequent transformations to our understanding of the diversity of life will be from the discovery of novel lineages in previously under-sampled areas and from environmental genomic information. PMID:23020233

  7. The revised classification of eukaryotes.

    PubMed

    Adl, Sina M; Simpson, Alastair G B; Lane, Christopher E; Lukeš, Julius; Bass, David; Bowser, Samuel S; Brown, Matthew W; Burki, Fabien; Dunthorn, Micah; Hampl, Vladimir; Heiss, Aaron; Hoppenrath, Mona; Lara, Enrique; Le Gall, Line; Lynn, Denis H; McManus, Hilary; Mitchell, Edward A D; Mozley-Stanridge, Sharon E; Parfrey, Laura W; Pawlowski, Jan; Rueckert, Sonja; Shadwick, Laura; Shadwick, Lora; Schoch, Conrad L; Smirnov, Alexey; Spiegel, Frederick W

    2012-09-01

    This revision of the classification of eukaryotes, which updates that of Adl et al. [J. Eukaryot. Microbiol. 52 (2005) 399], retains an emphasis on the protists and incorporates changes since 2005 that have resolved nodes and branches in phylogenetic trees. Whereas the previous revision was successful in re-introducing name stability to the classification, this revision provides a classification for lineages that were then still unresolved. The supergroups have withstood phylogenetic hypothesis testing with some modifications, but despite some progress, problematic nodes at the base of the eukaryotic tree still remain to be statistically resolved. Looking forward, subsequent transformations to our understanding of the diversity of life will be from the discovery of novel lineages in previously under-sampled areas and from environmental genomic information.

  8. Segmentary ureteral resection followed by ureteroneocystostomy associated with radical hysterectomy and partial cystectomy in a patient with bulky residual disease after chemoirradiation for invasive cervical cancer - A case report -

    PubMed Central

    Bacalbaşa, N; Bălescu, I

    2014-01-01

    Cervical cancer represents the second most frequent malignancy in women worldwide, a significant number of cases still being diagnosed in an advanced stage of the disease. In some of these cases, local invasion is already present at the moment of diagnosis and even if neo-adjuvant chemoirradiation is performed in some patients, it persists at the moment of surgery. In these cases, more aggressive surgical procedures are needed in order to obtain a good control of the disease. The case of a 50-year-old patient diagnosed with locally advanced cervical cancer invading the right ureter is presented, in whom this aspect was present even after neo-adjuvant chemoirradiation and in whom a total radical hysterectomy with bilateral en bloc adnexectomy with partial cystectomy and the invaded zone of the right ureter was performed. The ureter was then mobilized and reimplanted in the urinary bladder through a neocystostomy. The postoperative course was uneventful. PMID:25713622

  9. HEDR modeling approach: Revision 1

    SciTech Connect

    Shipler, D.B.; Napier, B.A.

    1994-05-01

    This report is a revision of the previous Hanford Environmental Dose Reconstruction (HEDR) Project modeling approach report. This revised report describes the methods used in performing scoping studies and estimating final radiation doses to real and representative individuals who lived in the vicinity of the Hanford Site. The scoping studies and dose estimates pertain to various environmental pathways during various periods of time. The original report discussed the concepts under consideration in 1991. The methods for estimating dose have been refined as understanding of existing data, the scope of pathways, and the magnitudes of dose estimates were evaluated through scoping studies.

  10. Revision Process and Practice: A Kindergarten Experience

    ERIC Educational Resources Information Center

    Chase, Maggie

    2012-01-01

    Many educators teach students that are reluctant about the revisions process in writing. However, this longitudinal study follows a group of students from kindergarten through 8th grade who embraced the importance of the revision process. (Contains 8 figures.)

  11. Diet History Questionnaire: Database Revision History

    Cancer.gov

    The following details all additions and revisions made to the DHQ nutrient and food database. This revision history is provided as a reference for investigators who may have performed analyses with a previous release of the database.

  12. Revised Human Health Risk Assessment on Chlorpyrifos

    EPA Pesticide Factsheets

    We have revised our human health risk assessment and drinking water exposure assessment for chlorpyrifos that supported our October 2015 proposal to revoke all food residue tolerances for chlorpyrifos. Learn about the revised analysis.

  13. Soft tissue trauma and scar revision.

    PubMed

    Mobley, Steven R; Sjogren, Phayvanh P

    2014-11-01

    Numerous techniques and treatments have been described for scar revision, with most studies focusing on the adult population. A comprehensive review of the literature reveals a paucity of references related specifically to scar revision in children. This review describes the available modalities in pediatric facial scar revision. The authors have integrated current practices in soft tissue trauma and scar revision, including closure techniques and materials, topical therapy, steroid injection, cutaneous laser therapy, and tissue expanders.

  14. Automated revision of CLIPS rule-bases

    NASA Technical Reports Server (NTRS)

    Murphy, Patrick M.; Pazzani, Michael J.

    1994-01-01

    This paper describes CLIPS-R, a theory revision system for the revision of CLIPS rule-bases. CLIPS-R may be used for a variety of knowledge-base revision tasks, such as refining a prototype system, adapting an existing system to slightly different operating conditions, or improving an operational system that makes occasional errors. We present a description of how CLIPS-R revises rule-bases, and an evaluation of the system on three rule-bases.

  15. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form...

  16. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form...

  17. 7 CFR 3015.115 - Budget revisions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2)...

  18. 7 CFR 3015.115 - Budget revisions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2)...

  19. 7 CFR 3015.115 - Budget revisions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2)...

  20. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form...

  1. 7 CFR 3015.115 - Budget revisions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2)...

  2. Competencies Revisited: Revising the Overseas ESL Curriculum.

    ERIC Educational Resources Information Center

    Kharde, Linda Smith; Corey, Kathleen

    1986-01-01

    This paper reports on the review and revision of the Overseas Refugee Training Program's curriculum in English as a second language. The discussion focuses on the rationale and guidelines for the revision, the resources used to guide the process, and the criteria used in the selection of competencies. Specific intentions in revising the list of…

  3. 24 CFR 968.225 - Budget revisions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget revisions. 968.225 Section... Fewer Than 250 Units) § 968.225 Budget revisions. (a) A PHA shall not incur any modernization cost in excess of the total HUD-approved CIAP budget. A PHA shall submit a budget revision, in a form...

  4. 7 CFR 3015.115 - Budget revisions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Budget revisions. 3015.115 Section 3015.115..., DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Programmatic Changes and Budget Revisions § 3015.115 Budget revisions. (a) Nonconstruction projects. (1) Except as provided in paragraph (a)(2)...

  5. Humeral windows in revision total elbow arthroplasty.

    PubMed

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.

  6. Revising: New Essays for Teachers of Writing.

    ERIC Educational Resources Information Center

    Sudol, Ronald A., Ed.

    Intended to help writing teachers better understand how to help students effectively revise their written work, this book contains essays that, as a group, focus on the problem of the definition of revision. The first half of the book discusses the background of revision, while the second half discusses contexts and techniques for application. The…

  7. The evolution of a manual revision.

    PubMed

    Luzinski, Craig

    2012-10-01

    This month, the director of the Magnet Recognition Program® provides an in-depth overview of the Magnet Recognition Program's Application Manual revision process. The history of the 2005 Manual revision, an evidence-based review of the literature, and revisions to the 2008 Manual are key elements of this article.

  8. Air Pollution Primer. Revised Education.

    ERIC Educational Resources Information Center

    Corman, Rena

    This revised and updated book is written to inform the citizens on the nature, causes, and effects of air pollution. It is written in terms familiar to the layman with the purpose of providing knowledge and motivation to spur community action on clean air policies. Numerous charts and drawings are provided to support discussion of air pollution…

  9. Nuffield Chemistry: Revised and Revisited.

    ERIC Educational Resources Information Center

    Dawson, B. E.

    1980-01-01

    Presents data from a survey of schools, colleges, and other institutions and entering candidates for the special GCE examination using Nuffield O-level materials. Examines the effects of curriculum design on subject choice in these institutions. Reviews teacher comments on the publications associated with revision of course materials. (Author/CS)

  10. Modern Indian Psychology. Revised Edition.

    ERIC Educational Resources Information Center

    Bryde, John F.

    Written on the basis of senior Indian verbal relatings collected over a 23-year span, this revised edition on modern Indian psychology incorporates suggestions from Indian students and their teachers, Indian and non-Indian social studies experts, and other Indian people. The book contains 6 major divisions: (1) "Culture and Indian…

  11. How Adults Learn. Revised Edition.

    ERIC Educational Resources Information Center

    Kidd, J. R.

    The book's emphasis is on learning during the years of adulthood and examines present-day practice of adult education for practitioners. This revised edition brings up to date advances in such areas of learning as controversial theory; the effects of environment; sensory processes; intellectual capacities; motivation and attitude; transactional…

  12. Ethical considerations in revision rhinoplasty.

    PubMed

    Wayne, Ivan

    2012-08-01

    The problems that arise when reviewing another surgeon's work, the financial aspects of revision surgery, and the controversies that present in marketing and advertising will be explored. The technological advances of computer imaging and the Internet have introduced new problems that require our additional consideration.

  13. Error Correction, Revision, and Learning

    ERIC Educational Resources Information Center

    Truscott, John; Hsu, Angela Yi-ping

    2008-01-01

    Previous research has shown that corrective feedback on an assignment helps learners reduce their errors on that assignment during the revision process. Does this finding constitute evidence that learning resulted from the feedback? Differing answers play an important role in the ongoing debate over the effectiveness of error correction,…

  14. Standards for Reading Professionals. Revised.

    ERIC Educational Resources Information Center

    International Reading Association, Newark, DE.

    A revision of a 1992 publication, this booklet presents standards intended to assist in the establishment and evaluation of programs of teacher preparation, to guide the assessment of the qualifications of literacy professionals, and to inform private and state agencies, policymakers, and the general public as they shape literacy instruction now…

  15. Revised Accounting for Business Combinations

    ERIC Educational Resources Information Center

    Wilson, Arlette C.; Key, Kimberly

    2008-01-01

    The Financial Accounting Standards Board (FASB) has recently issued Statement of Financial Accounting Standards No. 141 (Revised 2007) Business Combinations. The object of this Statement is to improve the relevance, representational faithfulness, and comparability of reported information about a business combination and its effects. This Statement…

  16. DDN New User Guide. Revision.

    DTIC Science & Technology

    1992-10-01

    it to the sender . Many mail programs allow you to use a local text editor to revise or correct the text of the message you are ptepermg. The mail ...23 5.1 Electronic M ail .................................................. 23 5.1.1 UNIX Mail Examples...25 Sending Mail Via UNIX ........................................ 25 Reading UNIX Mail

  17. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  18. Clean Air Act. Revision 5

    SciTech Connect

    Not Available

    1994-02-15

    This Reference Book contains a current copy of the Clean Air Act, as amended, and those regulations that implement the statute and appear to be most relevant to DOE activities. The document is provided to DOE and contractor staff for informational purposes only and should not be interpreted as legal guidance. This Reference Book has been completely revised and is current through February 15, 1994.

  19. Revision IPAA: strategies for success.

    PubMed

    Larson, David W

    2014-07-01

    The history of ileal pouch-anal anastomosis (IPAA) is one of success with durable surgical and functional results. However, pouch failure, due to infection, mechanical, or functional disability, represents a challenge to both surgeon and patient. Practicing surgeons who deal with the revision pouch face a variety of challenges. Success requires a strategy, which includes critical planning, preparation, and surgical techniques in order that surgeons continue to provide solutions and hope to patients.

  20. Revision rhinoplasty for the Asian nose.

    PubMed

    Lam, Samuel M

    2008-08-01

    Revision rhinoplasty of the Asian nose requires a combination of cultural sensitivity and unique surgical strategies to achieve a successful outcome. Cultural sensitivity means understanding some of the folkloric motivations to undergo rhinoplasty and divergent ethnic standards of beauty. Basic techniques for Asian rhinoplasty are reviewed as a prerequisite knowledge for revision rhinoplasty of the Asian nose, specifically a combination technique of expanded polytetrafluoroethylene for bridge augmentation and autogenous cartilage tip grafting. Revision Asian nose surgery oftentimes involves removal of a previously placed solid silicone implant, which remains the most popular option for augmentation rhinoplasty in Asia. Strategies for revision rhinoplasty in the Asian nose are then reviewed.

  1. The revised Flat Galaxy Catalogue.

    NASA Astrophysics Data System (ADS)

    Karachentsev, I. D.; Karachentseva, V. E.; Kudrya, Yu. N.; Sharina, M. E.; Parnovskij, S. L.

    The authors present a new improved and completed version of the Flat Galaxy Catalogue (FGC) named the Revised Flat Galaxy Catalogue (RFGC) containing 4236 thin edge-on spiral galaxies and covering the whole sky. The Catalogue is intended to study large-scale cosmic streamings as well as other problems of observational cosmology. The dipole moment of distribution of the RFGC galaxies (l = 273°, b = +19°) lies within statistical errors (±10°) in the direction of the Local Group motion towards the Microwave Background Radiation.

  2. Revision and product generation software

    USGS Publications Warehouse

    ,

    1997-01-01

    The U.S. Geological Survey (USGS) developed revision and product generation (RevPG) software for updating digital line graph (DLG) data and producing maps from such data. This software is based on ARC/INFO, a geographic information system from Environmental Systems Resource Institute (ESRI). RevPG consists of ARC/INFO Arc Macro Language (AML) programs, C routines, and interface menus that permit operators to collect vector data using aerial images, to symbolize the data on-screen, and to produce plots and color-separated files for use in printing maps.

  3. Revision and Product Generation Software

    USGS Publications Warehouse

    ,

    1999-01-01

    The U.S. Geological Survey (USGS) developed revision and product generation (RevPG) software for updating digital line graph (DLG) data and producing maps from such data. This software is based on ARC/INFO, a geographic information system from Environmental Systems Resource Institute (ESRI). RevPG consists of ARC/INFO Arc Macro Language (AML) programs, C routines, and interface menus that permit operators to collect vector data using aerial images, to symbolize the data onscreen, and to produce plots and color-separated files for use in printing maps.

  4. [Spinal column: implants and revisions].

    PubMed

    Krieg, S M; Meyer, H S; Meyer, B

    2016-03-01

    Non-fusion spinal implants are designed to reduce the commonly occurring risks and complications of spinal fusion surgery, e.g. long duration of surgery, high blood loss, screw loosening and adjacent segment disease, by dynamic or movement preserving approaches. This principle could be shown for interspinous spacers, cervical and lumbar total disc replacement and dynamic stabilization; however, due to the continuing high rate of revision surgery, the indications for surgery require as much attention and evidence as comparative data on the surgical technique itself.

  5. Food safety: revising the statute.

    PubMed

    Kessler, D A

    1984-03-09

    There is increasing recognition that federal food safety laws and policies need to be revised. Congressional debate on proposed amendments to the Food, Drug, and Cosmetic Act has generated several different perspectives on how the food safety laws should be changed. Before a consensus can be reached, scientists, regulators, the food industry, and consumers will have to review such complex and controversial issues as the level of acceptable risk, the value of risk-benefit analysis, the proper role of independent scientific review, and the reliability of quantitative risk assessment.

  6. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision...

  7. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision...

  8. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision...

  9. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision...

  10. 42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision...

  11. 78 FR 44559 - Effective Date of Revised Company Registration Requirements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-24

    ... Energy Regulatory Commission Effective Date of Revised Company Registration Requirements AGENCY: Federal... of the Revised Company Registration Requirements. The Commission issued a Notice in the Federal..., anthony.barracchini@ferc.gov . SUPPLEMENTARY INFORMATION: Notice of Effective Date of Revised...

  12. Revision of IAU Style Manual

    NASA Astrophysics Data System (ADS)

    Wilkins, G. A.

    The 1989 edition of the "IAU Style Manual" is in need of revision to reflect the changes in practice that have taken place since its preparation. These changes include the use of desk-top systems for the production of high-quality copy, the electronic transmission of text with embedded typesetting codes and the electronic publication of papers and reports, which may contain numerical data and images. The Manual should give advice and recommendations about the new procedures and typographical formats, but it is more important than ever that it should give clear and appropriate recommendations on matters that affect the quality of the content of all astronomical publications. The Manual should provide especially for the needs of astronomers who do not have English as their first language and it should include advice to them on the oral presentation of their papers. The editor. G. A. Wilkins, would be pleased to have the assistance of astronomers and others who are concerned with the quality of astronomical publications and who would be willing to participate in any aspect of the revision.

  13. 76 FR 4258 - Occupational Radiation Protection; Revision

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-25

    ... Part 835 RIN 1901-AA-95 Occupational Radiation Protection; Revision AGENCY: Department of Energy...) proposes to revise the values in an appendix to its Occupational Radiation Protection requirements. The... requirements in title 10, Code of Federal Regulations, part 835 (10 CFR part 835), Occupational...

  14. Sequenced Peer Revision: Creating Competence and Community

    ERIC Educational Resources Information Center

    Bowman, Ingrid K.; Robertson, John

    2013-01-01

    Mastering techniques of self- and peer revision is a valuable tool for all writers, especially US-educated Generation 1.5 students, whose near fluency enables them to dialogue successfully about their writing. Using action research, 2 academic writing instructors systematically trained students to more responsibly and effectively revise their…

  15. 25 CFR 276.14 - Budget revision.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Budget revision. 276.14 Section 276.14 Indians BUREAU OF... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS § 276.14 Budget revision. Criteria and procedures to be followed by grantees in reporting deviations from grant budgets and requesting approval for...

  16. 25 CFR 276.14 - Budget revision.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false Budget revision. 276.14 Section 276.14 Indians BUREAU OF... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS § 276.14 Budget revision. Criteria and procedures to be followed by grantees in reporting deviations from grant budgets and requesting approval for...

  17. 25 CFR 276.14 - Budget revision.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true Budget revision. 276.14 Section 276.14 Indians BUREAU OF... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS § 276.14 Budget revision. Criteria and procedures to be followed by grantees in reporting deviations from grant budgets and requesting approval for...

  18. 25 CFR 276.14 - Budget revision.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Budget revision. 276.14 Section 276.14 Indians BUREAU OF... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS § 276.14 Budget revision. Criteria and procedures to be followed by grantees in reporting deviations from grant budgets and requesting approval for...

  19. The Teacher Observation Form: Revisions and Updates

    ERIC Educational Resources Information Center

    Peters, Scott J.; Gates, Jillian C.

    2010-01-01

    This article discusses the original development and subsequent updates and revisions made to the Teacher Observation Form (TOF). The TOF is a 12-item form to be used by evaluators in the observation of teachers of gifted and talented students. After nearly 25 years of use, the original TOF was revised based on input from content experts and…

  20. 25 CFR 276.14 - Budget revision.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Budget revision. 276.14 Section 276.14 Indians BUREAU OF... UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS § 276.14 Budget revision. Criteria and procedures to be followed by grantees in reporting deviations from grant budgets and requesting approval for...

  1. 48 CFR 315.307 - Proposal revisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Proposal revisions. 315.307 Section 315.307 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Source Selection 315.307 Proposal revisions....

  2. How Mind Works To Revise Compositions.

    ERIC Educational Resources Information Center

    Lin, Deh-nan

    This study investigated cognitive processes involved in English-as-a-Second-Language (ESL) students' correcting and revising drafts after receiving oral feedback from their teachers, noting factors that led to better written products and factors that did not improve student writing. The study examined what kinds of revision strategies students…

  3. Evaluating Writing: Effects of Feedback on Revision.

    ERIC Educational Resources Information Center

    Chaudron, Craig

    The effect of evaluation method on English as second language (ESL) learners' revisions of their compositions was investigated. Teacher comments, peer evaluations, and English-speaking peer reformulations were compared. Judges rated the revised compositions of 9 advanced and 14 intermediate college ESL students using the ESL Composition Profile.…

  4. Revised State Budget Sells Kids Short

    ERIC Educational Resources Information Center

    Children Now, 2012

    2012-01-01

    The Administration's May Revision of the 2012-2013 state budget addresses a $15.7 billion shortfall through funding shifts, cuts, and new revenue sources that place children squarely in harms way. California's kids are already grossly underserved relative to the rest of the nation's children. If the May Revise budget is passed by the Legislature,…

  5. 77 FR 73454 - Revision of Information Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-10

    ... requirements; revise the Grant Application Narrative questions to clarify new concepts; Simplify language and... alignment between narrative sections and the performance measures work plans. The proposed revisions do...

  6. Laparoscopic revision surgery for gastroesophageal reflux disease

    PubMed Central

    Celasin, Haydar; Genc, Volkan; Celik, Suleyman Utku; Turkcapar, Ahmet Gökhan

    2017-01-01

    Abstract Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of gastroesophageal reflux in surgical clinics. Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients. The objective of this study is to evaluate the mechanism of recurrences after antireflux surgery and to share our results after revision surgery in recurrent cases. From 2001 to 2014, revision surgery was performed on 43 patients (31 men, 12 women) between the ages of 24 and 70 years. The technical details of the first operation, recurrence symptoms, endoscopy, and manometry findings were evaluated. The findings of revision surgery, surgical techniques, morbidity rates, length of hospitalization, and follow-up period were also recorded and evaluated. The first operation was Nissen fundoplication in 34 patients and Toupet fundoplication in 9 patients. Mesh hiatoplasty was performed for enforcement in 18 (41.9%) of these patients. The period between the first operation and the revision surgery ranged from 4 days to 60 months. The most common finding was slipped fundoplication and presence of hiatal hernia during revision surgery. Revision fundoplication and hernia repair with mesh reinforcement were used in 33 patients. The other techniques were Collis gastroplasty, revision fundoplication, and hernia repair without mesh. The range of follow-up period was from 2 to 134 months. Recurrence occurred in 3 patients after revision surgery (6.9%). Although revision surgery is difficult and it has higher morbidity, it can be performed effectively and safely in experienced centers. PMID:28072725

  7. Radiological control manual. Revision 1

    SciTech Connect

    Kloepping, R.

    1996-05-01

    This Lawrence Berkeley National Laboratory Radiological Control Manual (LBNL RCM) has been prepared to provide guidance for site-specific additions, supplements and interpretation of the DOE Radiological Control Manual. The guidance provided in this manual is one methodology to implement the requirements given in Title 10 Code of Federal Regulations Part 835 (10 CFR 835) and the DOE Radiological Control Manual. Information given in this manual is also intended to provide demonstration of compliance to specific requirements in 10 CFR 835. The LBNL RCM (Publication 3113) and LBNL Health and Safety Manual Publication-3000 form the technical basis for the LBNL RPP and will be revised as necessary to ensure that current requirements from Rules and Orders are represented. The LBNL RCM will form the standard for excellence in the implementation of the LBNL RPP.

  8. The Salto Talaris XT Revision Ankle Prosthesis.

    PubMed

    Roukis, Thomas S

    2015-10-01

    The Salto Talaris XT Revision Ankle Prosthesis is an anatomically designed fixed-bearing prosthesis available in the United States based on the design of previous Salto systems. The Salto Talaris XT Revision Ankle Prosthesis design optimizes surface area, cortical contact, and ultrahigh-molecular-weight polyethylene conformity. Two tibial component designs, both with the same base plate dimensions, are available, the standard conical fixation plug affixed to a short keel and a long-stemmed version. The author presents an overview of the Salto Talaris XT Revision Ankle Prosthesis surgical technique and pearls for successful application.

  9. Real Revision: Authors' Strategies to Share with Student Writers

    ERIC Educational Resources Information Center

    Messner, Kate

    2011-01-01

    How do you show students that revision is more than a classroom exercise to please the teacher? Take them into the real world of writing for publication. In Real Revision, award-winning author and teacher Kate Messner demystifies the revision process for teachers and students alike and provides tried-and-true revision strategies, field tested by…

  10. A Comparative Study of Three Revision Methods in EFL Writing

    ERIC Educational Resources Information Center

    Srichanyachon, Napaporn

    2011-01-01

    In an attempt to explore effective instruction in the English as a Foreign Language (EFL) setting, this study investigated language errors identified by students and teachers in three different revision stages: self-revision, peer revision, and teacher revision. It gave the focus to the effects of the three different methods on learners' writing…

  11. Nevada Test Site Radiological Control Manual. Revision 1

    SciTech Connect

    None, None

    2010-02-09

    This document supersedes DOE/NV/25946--801, “Nevada Test Site Radiological Control Manual,” Revision 0 issued in October 2009. Brief Description of Revision: A minor revision to correct oversights made during revision to incorporate the 10 CFR 835 Update; and for use as a reference document for Tenant Organization Radiological Protection Programs.

  12. Quantum Field Theory, Revised Edition

    NASA Astrophysics Data System (ADS)

    Mandl, F.; Shaw, G.

    1994-01-01

    Quantum Field Theory Revised Edition F. Mandl and G. Shaw, Department of Theoretical Physics, The Schuster Laboratory, The University, Manchester, UK When this book first appeared in 1984, only a handful of W± and Z° bosons had been observed and the experimental investigation of high energy electro-weak interactions was in its infancy. Nowadays, W± bosons and especially Z° bosons can be produced by the thousand and the study of their properties is a precise science. We have revised the text of the later chapters to incorporate these developments and discuss their implications. We have also taken this opportunity to update the references throughout and to make some improvements in the treatment of dimen-sional regularization. Finally, we have corrected some minor errors and are grateful to various people for pointing these out. This book is designed as a short and simple introduction to quantum field theory for students beginning research in theoretical and experimental physics. The three main objectives are to explain the basic physics and formalism of quantum field theory, to make the reader fully proficient in theory calculations using Feynman diagrams, and to introduce the reader to gauge theories, which play such a central role in elementary particle physics. The theory is applied to quantum electrodynamics (QED), where quantum field theory had its early triumphs, and to weak interactions where the standard electro-weak theory has had many impressive successes. The treatment is based on the canonical quantization method, because readers will be familiar with this, because it brings out lucidly the connection between invariance and conservation laws, and because it leads directly to the Feynman diagram techniques which are so important in many branches of physics. In order to help inexperienced research students grasp the meaning of the theory and learn to handle it confidently, the mathematical formalism is developed from first principles, its physical

  13. Revision total knee arthroplasty using a custom tantalum implant in a patient following multiple failed revisions.

    PubMed

    McNamara, Colin A; Gösthe, Raúl G; Patel, Preetesh D; Sanders, Kristopher C; Huaman, Gustavo; Suarez, Juan C

    2017-03-01

    The number of revision total knee arthroplasty procedures performed annually is increasing and, subsequently, so is the number of patients presenting following a failed revision. Rerevising a total knee arthroplasty after one or more failed revision procedures presents many challenges, including diminished bone stock for prosthetic fixation. "Off the shelf" implants may not offer the best alternative for reconstruction. We present the case of a 55-year-old patient who required a rerevision total knee arthroplasty following multiple failed revisions with severe femoral and tibia bone loss. We describe a novel technique we employed to improve component fixation within the compromised bone stock.

  14. Lead and Copper Rule Revisions White Paper

    EPA Pesticide Factsheets

    The Lead and Copper Rule (LCR) Revisions White Paper provides examples of regulatory options to improve the existing rule. The paper highlights key challenges, opportunities, and analytical issues presented by these options.

  15. Revised Nuffield Chemistry: October 1979 School Survey.

    ERIC Educational Resources Information Center

    Dawson, B. E.

    1980-01-01

    Presents some of the preliminary results of a survey study about the use of both the revised publications and GCE O-Level examinations for Nuffield Chemistry in 495 British schools and colleges in 1979. (HM)

  16. Revised Certification Standards for Pesticide Applicators

    EPA Pesticide Factsheets

    EPA has finalized stronger standards for people who apply restricted use pesticides (RUPs). These revisions to the Certification of Pesticide Applicators rule will reduce the likelihood of harm from the misapplication of toxic pesticides.

  17. New and revised standards for coke production

    SciTech Connect

    G.A. Kotsyuba; M.I. Alpatov; Y.G. Shapoval

    2009-07-15

    The need for new and revised standards for coke production in Ukraine and Russia is outlined. Such standards should address improvements in plant operation, working conditions, environmental protection, energy conservation, fire and explosion safety, and economic indices.

  18. Revision in the Providence Public Schools

    ERIC Educational Resources Information Center

    Shinn, Ridgway F.

    1971-01-01

    Curriculum revision of the school systems K-12 social studies program involves a model built around a geo-historical unit developed through the joint efforts of many specialists. Social science concepts were introduced through an interdisciplinary approach. (CB)

  19. Facial Scar Revision: Understanding Facial Scar Treatment

    MedlinePlus

    ... Contact Us Trust your face to a facial plastic surgeon Facial Scar Revision Understanding Facial Scar Treatment When ... face like the eyes or lips. A facial plastic surgeon has many options for treating and improving facial ...

  20. Facial Scar Revision: Understanding Facial Scar Treatment

    MedlinePlus

    ... Contact Us Trust your face to a facial plastic surgeon Facial Scar Revision Understanding Facial Scar Treatment ... face like the eyes or lips. A facial plastic surgeon has many options for treating and improving ...

  1. Revised Total Coliform Webinar for Primacy Agencies

    EPA Pesticide Factsheets

    This webinar was created to assist Primacy Agencies in the implementation of the Revised Total Coliform Rule. It provides an overview of the requirements in the rule and implementation guidance for Primacy Agencies.

  2. 78 FR 59982 - Revisions to Radiation Protection

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-30

    ... From the Federal Register Online via the Government Publishing Office ] NUCLEAR REGULATORY COMMISSION Revisions to Radiation Protection AGENCY: Nuclear Regulatory Commission. ACTION: Standard review... Reports for Nuclear Power Plants: LWR Edition'': Section 12.1, ``Assuring that Occupational...

  3. Bladder tear during revision total hip arthroplasty.

    PubMed

    Grauer, Jonathan N; Halim, Andrea; Keggi, Kristaps J

    2014-08-01

    Total hip arthroplasty (THA) and revision total hip arthroplasty are among the most commonly performed orthopedic procedures. There are many reported complications of THA, but intrapelvic complications are a rare subset. Bladder injuries have infrequently been described in association with this common procedure. We present an unusual case of a bladder tear occurring intraoperatively during a revision THA. It is suspected that the patient's history of multiple prior hip procedures caused adhesions of the bladder to the pelvic floor and predisposed the bladder to injury during acetabular revision. Previous reports of bladder injury relating to THA have described thermal necrosis, component migration, and occasional direct perforation. There are no prior case reports describing bladder tears related to adhesions occurring intraoperatively during revision THA. This case report highlights the importance of surgeon awareness of an unusual complication. In this case, intraoperative and postoperative recognition of a hematuria diagnosis led to the appropriate treatment, and this patient had an acceptable outcome.

  4. Revision of failed humeral head resurfacing arthroplasty

    PubMed Central

    Streubel, Philipp N.; Simone, Juan P.; Cofield, Robert H.; Sperling, John W.

    2016-01-01

    Purpose: The purpose of this study is to assess the outcomes of a consecutive series of patients who underwent revision surgery after humeral head resurfacing (HHR). Our joint registry was queried for all patients who underwent revision arthroplasty for failed HHR at our institution from 2005 to 2010. Eleven consecutive patients (average age 54 years; range 38-69 years) that underwent revision of 11 resurfacing arthroplasties were identified. The primary indication for resurfacing had been osteoarthritis in six, glenoid dysplasia in two, a chondral lesion in two, and postinstability arthropathy in one patient. The indication for revision was pain in 10 and infection in one patient. Seven patients had undergone an average of 1.9 surgeries prior to resurfacing (range 1-3). Materials and Methods: All patients were revised to stemmed arthroplasties, including one hemiarthroplasty, two reverse, and eight anatomic total shoulder arthroplasties at a mean 33 months after primary resurfacing (range 10-131 months). A deltopectoral approach was used in seven patients; four patients required an anteromedial approach due to severe scarring. Subscapularis attenuation was found in four cases, two of which required reverse total shoulder arthroplasty. Bone grafting was required in one glenoid and three humeri. Results: At a mean follow-up of 3.5 years (range 1.6-6.9 years), modified Neer score was rated as satisfactory in five patients and unsatisfactory in six. Abduction and external rotation improved from 73° to 88° (P = 0.32) and from 23° to 32° (P = 0.28) respectively. Reoperation was required in two patients, including one hematoma and one revision for instability. Conclusion: Outcomes of revision of HHR arthroplasty in this cohort did not improve upon those reported for revision of stemmed humeral implants. A comparative study would be required to allow for definitive conclusions to be made. PMID:26980986

  5. Revised FIGO staging system for endometrial cancer.

    PubMed

    Lewin, Sharyn N

    2011-06-01

    In 1988 the International Federation of Gynecologists and Obstetricians (FIGO) developed a surgical staging system for endometrial cancer. The FIGO staging system was recently revised in 2009 to reflect our growing understanding of the natural history of endometrial cancer. In this review, we describe the revised 2009 FIGO staging system for tumors of the uterine corpus and examine the effect of the new changes in the staging criteria.

  6. HLW system plan - revision 2

    SciTech Connect

    Not Available

    1994-01-14

    The projected ability of the Tank Farm to support DWPF startup and continued operation has diminished somewhat since revision 1 of this Plan. The 13 month delay in DWPF startup, which actually helps the Tank Farm condition in the near term, was more than offset by the 9 month delay in ITP startup, the delay in the Evaporator startups and the reduction to Waste Removal funding. This Plan does, however, describe a viable operating strategy for the success of the HLW System and Mission, albeit with less contingency and operating flexibility than in the past. HLWM has focused resources from within the division on five near term programs: The three evaporator restarts, DWPF melter heatup and completion of the ITP outage. The 1H Evaporator was restarted 12/28/93 after a 9 month shutdown for an extensive Conduct of Operations upgrade. The 2F and 2H Evaporators are scheduled to restart 3/94 and 4/94, respectively. The RHLWE startup remains 11/17/97.

  7. Revised positions for CIG galaxies

    NASA Astrophysics Data System (ADS)

    Leon, S.; Verdes-Montenegro, L.

    2003-12-01

    We present revised positions for the 1051 galaxies belonging to the Karachentseva Catalog of Isolated Galaxies (CIG). New positions were calculated by applying SExtractor to the Digitized Sky Survey CIG fields with a spatial resolution of 1 arcsper 2. We visually checked the results and for 118 galaxies had to recompute the assigned positions due to complex morphologies (e.g. distorted isophotes, undefined nuclei, knotty galaxies) or the presence of bright stars. We found differences between older and newer positions of up to 38 arcsec with a mean value of 2 arcsper 96 relative to SIMBAD and up to 38 arcsec and 2 arcsper 42 respectively relative to UZC. Based on star positions from the APM catalog we determined that the DSS astrometry of five CIG fields has a mean offset in (alpha , delta ) of (-0 arcsper 90, 0 arcsper 93) with a dispersion of 0 arcsper 4. These results have been confirmed using the 2MASS All-Sky Catalog of Point Sources. The intrinsic errors of our method combined with the astrometric ones are of the order of 0 arcsper 5. Full Table 1 is only available in electronic form at the CDS via anonymous ftp to cdsarc.u-strasbg.fr (130.79.128.5) or via http://cdsweb.u-strasbg.fr/cgi-bin/qcat?J/A+A/411/391

  8. Revision of the DELFIC Particle Activity Module

    SciTech Connect

    Hooper, David A; Jodoin, Vincent J

    2010-09-01

    The Defense Land Fallout Interpretive Code (DELFIC) was originally released in 1968 as a tool for modeling fallout patterns and for predicting exposure rates. Despite the continual advancement of knowledge of fission yields, decay behavior of fission products, and biological dosimetry, the decay data and logic of DELFIC have remained mostly unchanged since inception. Additionally, previous code revisions caused a loss of conservation of radioactive nuclides. In this report, a new revision of the decay database and the Particle Activity Module is introduced and explained. The database upgrades discussed are replacement of the fission yields with ENDF/B-VII data as formatted in the Oak Ridge Isotope Generation (ORIGEN) code, revised decay constants, revised exposure rate multipliers, revised decay modes and branching ratios, and revised boiling point data. Included decay logic upgrades represent a correction of a flaw in the treatment of the fission yields, extension of the logic to include more complex decay modes, conservation of nuclides (including stable nuclides) at all times, and conversion of key variables to double precision for nuclide conservation. Finally, recommended future work is discussed with an emphasis on completion of the overall radiation physics upgrade, particularly for dosimetry, induced activity, decay of the actinides, and fractionation.

  9. Validation of the revised International Prognostic Scoring System in treated patients with myelodysplastic syndromes

    PubMed Central

    Mishra, Asmita; Corrales-Yepez, Maria; Ali, Najla Al; Kharfan-Dabaja, Mohamed; Padron, Eric; Zhang, Ling; Epling-Burnette, Pearlie K.; Pinilla-Ibarz, Javier; Lancet, Jeffrey E.; List, Alan F.; Komrokji, Rami S.

    2015-01-01

    The International Prognostic Scoring System (IPSS) was recently revised (IPSS-R) under the auspices of the MDS Foundation as a collaborative international effort to refine its prognostic power. Our purpose was to externally validate this new risk model using a large single-institution cohort, determine its prognostic power in patients receiving active treatment, and explore its utility in guiding therapeutic decisions. Data were collected retrospectively from our myelodysplastic syndrome (MDS) database and verified by chart review. Of the data available for 1,088 patients, 152 (14%), 353 (32%), 237 (22%), 190 (18%), and 156 (14%) patients were classified as very low, low, intermediate, high, and very high risk, respectively, with median overall survival (OS) of 90 (95%CI 71–109), 54 (95%CI 50–59), 34 (95%CI 26–43), 21 (95%CI 17–25), and 13 months (95%CI 11– 15), respectively (P < 0.005). We found that the IPSS-R further refined prognostic discrimination in all IPSS risk categories, particularly in the intermediate 1 and 2 groups. Among high and very high IPSS-R patients receiving azacitidine, OS was significantly improved versus patients not receiving azacitidine, with corresponding median OS of 25 versus 18 months (P = 0.028) and 15 versus 9 months (P = 0.005), respectively. Similarly, patients with IPSS-R high- and very high-risk disease who underwent allogeneic hematopoietic stem cell transplantation had significantly improved OS versus nontransplant approaches (P < 0.005). High and very high IPSS-R patients derived a survival advantage from disease-modifying therapies. Our data validate the prognostic value of the proposed IPSS-R and show that its refined IPSS prognostic discrimination can be applied to actively treated patients. PMID:23605934

  10. Results of Wagner SL revision stem with impaction bone grafting in revision total hip arthroplasty

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: As the number of total hip arthroplasties (THAs) performed increases, so do the number of required revisions. Impaction bone grafting with Wagner SL Revision stem is a good option for managing bone deficiencies arising from aseptic osteolysis. We studied the results of cementless diaphyseal fixation in femoral revision after total hip arthroplasty and whether there was spontaneous regeneration of bone stock in the proximal femur after the use of Wagner SL Revision stem (Zimmer, Warsaw, IN, USA) with impaction bone grafting. Materials and Methods: We performed 53 hip revisions using impaction bone grafting and Wagner SL Revision stems in 48 patients; (5 cases were bilateral) for variety of indications ranging from aseptic osteolysis to preiprosthetic fractures. The average age was 59 years (range 44-68 years). There were 42 male and 6 female patients. Four patients died after surgery for reasons unrelated to surgery. 44 patients were available for complete analysis. Results: The mean Harris Hip Score was 42 before surgery and improved to 86 by the final followup evaluation at a mean point of 5.5 years. Of the 44 patients, 87% (n=39) had excellent results and 10% (n=5) had good results. The stem survival rate was 98% (n=43). Conclusion: Short term results for revision THA with impaction bone grafting and Wagner SL revision stems are encouraging. However, it is necessary to obtain long term results through periodic followup evaluation, as rate of complications may increase in future. PMID:23960279

  11. Analyzing the Benefits of Revision Memos during the Writing and Revision Process

    ERIC Educational Resources Information Center

    Bardine, Bryan Anthony; Fulton, Anthony

    2008-01-01

    In this article, the authors examine the role revision memos played in composition classrooms. Both authors used the memos to help students reflect on their writing and continue revising. The memos also served as guides for the instructors as they responded to their students' writing. The memos were a reminder that the instructors needed to focus…

  12. The Effects of a Systematic Revision Model on Revisers in Terms of Student Outcomes.

    ERIC Educational Resources Information Center

    Dupont, Daniel; Stolovitch, Harold D.

    1983-01-01

    Describes the process by which Learner Verification and Revision (LVR) transforms information gathered during learner verification into revision prescriptions for the development of instructional materials. Robinson's and Gropper's procedural models for formative evaluation are also discussed and a study comparing the effectiveness of materials…

  13. Unforced Revision in Processing Relative Clause Association Ambiguity in Japanese: Evidence Against Revision as Last Resort.

    PubMed

    Yamada, Toshiyuki; Arai, Manabu; Hirose, Yuki

    2016-11-19

    The current study tackles a long standing question of whether comprehenders perform structural revision when it is not forced by grammar or not. Using an eye-tracking reading paradigm, we addressed this issue by making use of global structural ambiguity in Japanese. Our results show that comprehenders initially associate a relative clause with the first potential head noun and that they revise this analysis when the second noun is lexico-semantically possible as the relative clause head, but do not when it is impossible. The results are incompatible with the Revision as Last Resort hypothesis. Instead, they support the parsing with unforced revision that is immediately sensitive to lexical properties. We argue that our results cannot be accounted for by serial modular processing models but that they can be explained by ranked-parallel interactive processing models. Furthermore, we propose that head-finality is a key factor involved in the availability of unforced revision.

  14. One hundred pancreas transplants at a single institution.

    PubMed Central

    Sutherland, D E; Goetz, F C; Najarian, J S

    1984-01-01

    Clinical pancreas transplantation at the University of Minnesota began in 1966. An initial series of 14 whole pancreas grafts was reported in part to the American Surgical Association in 1970. Only one patient survived for more than 1 year with a functioning graft. Twenty attempts at islet allotransplantation in the mid-1970s were unsuccessful. In 1978 we resumed performing pancreas transplants by the segmental technique, allowing the use of related donors. The current series (July 25, 1978 to December 20, 1983) includes 86 pancreas transplants (51 cadaver, 35 related) in 75 patients (41 with and 34 without previous kidney grafts). Variations in management of the pancreatic duct include three ligated, 15 duct-open, 39 duct-injected, and 29 pancreaticojejunostomies. The latter technique is currently preferred. Currently (April 1984) 61 patients are alive (81%), 24 have functioning grafts (32%), and 21 are insulin-independent (28%), three with open-duct grafts for 4.4 to 5.7 years, seven with silicone-injected grafts from 10 to 39 months, and 14 with pancreaticojejunostomies for 3 to 31 months; 15 of the grafts have functioned for greater than 1 year. Twenty-two of the grafts (25%) failed for technical reasons (thrombosis, infection, or ascites); 35 grafts functioned for 1 to 13 months before totally failing from either rejection, fibrosis, or recurrent disease; five patients died with functioning grafts. The graft survival rate has been higher for pancreases from related (15/35, 43% functioning) than from cadaver (9/51, 18% functioning) donors. The success rate has increased, e.g., 11/22 recipients of pancreas transplants in 1983 currently have functioning grafts (50%). Metabolic studies show most patients with functioning grafts to be euglycemic; however, three of 24 have chronic hyperglycemia unless supplemented with insulin, but they are no longer ketosis-prone. Glucose tolerance test results are normal or nearly normal in 12 and abnormal in 12 of the recipients with currently functioning grafts. Regression of diabetic nephropathy has been documented in two long-term recipients. Pancreas transplantation is currently applicable as treatment for selected diabetics who have demonstrated their propensity to develop serious secondary complications. PMID:6385874

  15. Symptomatic versus asymptomatic pyeloplasties: A single institution review

    PubMed Central

    Metcalfe, Peter D.; Assmus, Mark; Kiddoo, Darcie

    2014-01-01

    Introduction: Historically, pyeloplasties have been performed after symptoms and radiographic confirmation of an ureteropelvic junction obstruction (UPJO). However, with prenatal ultrasonography, the approach to patients has fundamentally changed. Increasingly, patients are diagnosed and treated before the advent of morbidity, based on imaging findings alone. However, optimum screening strategies and thresholds for intervention vary significantly, are controversial, and are not founded on outcome-based evidence. We examined all pyeloplasties performed at our institution and reviewed their indication for surgery. We hypothesized that, despite ubiquitous screening for UPJO, most pyeloplasties had been performed secondary to symptoms and did not benefit from antenatal screening. Methods: A retrospective chart review was performed of all pyeloplasties performed at the Stollery Children’s Hospital, Edmonton, Alberta, over the past 8 years. Patients were categorized according to indication for surgery: symptomatic or asymptomatic. Results: Most (60%) of our pyeloplasties were performed for symptomatic indications. Furthermore, 12% of these patients had antenatally detected hydronephrosis that was thought to have resolved spontaneously during follow-up. Of our symptomatic patients, 37% were undergoing surveillance with the expectation for spontaneous resolution. Of the 29 patients who underwent pyeloplasty, 8 suffered a preoperative loss of function on renal scans; however, only 50% returned to within 90% of their original function. Conclusion: Despite active surveillance of antenatally detected hydronephrosis, most pyeloplasties at our institution were performed for de-novo symptoms. We believe that this simple observation reinforces that our current surveillance strategies are unable to predict and eliminate all morbidity from UPJO. PMID:25553157

  16. Cavernous sinus hemangioma: a fourteen year single institution experience.

    PubMed

    Bansal, Sumit; Suri, Ashish; Singh, Manmohan; Kale, Shashank Sharad; Agarwal, Deepak; Sharma, Manish Singh; Mahapatra, Ashok Kumar; Sharma, Bhawani Shankar

    2014-06-01

    Cavernous sinus hemangioma (CSH) is a rare extra-axial vascular neoplasm that accounts for 2% to 3% of all cavernous sinus tumors. Their location, propensity for profuse bleeding during surgery, and relationship to complex neurovascular structures are factors which present difficulty in excising these lesions. The authors describe their experience of 22 patients with CSH over 14 years at a tertiary care center. Patients were managed with microsurgical resection using a purely extradural transcavernous approach (13 patients) and with Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) (nine patients). Retrospective data analysis found headache and visual impairment were the most common presenting complaints, followed by facial hypesthesia and diplopia. All but one patient had complete tumor excision in the surgical series. Transient ophthalmoparesis (complete resolution in 6-8 weeks) was the most common surgical complication. In the GKRS group, marked tumor shrinkage (>50% tumor volume reduction) was achieved in two patients, slight shrinkage in five and no change in two patients, with symptom improvement in the majority of patients. To our knowledge, we describe one of the largest series of CSH managed at a single center. Although microsurgical resection using an extradural transcavernous approach is considered the treatment of choice in CSH and allows complete excision with minimal mortality and long-term morbidity, GKRS is an additional tool for treating residual symptomatic lesions or in patients with associated comorbidities making surgical resection unsuitable.

  17. Myelopathy following intrathecal chemotherapy in adults: a single institution experience.

    PubMed

    Cachia, David; Kamiya-Matsuoka, Carlos; Pinnix, Chelsea C; Chi, Linda; Kantarjian, Hagop M; Cortes, Jorge E; Daver, Naval; Woodman, Karin

    2015-04-01

    Methotrexate and cytarabine arabinoside are frequently administered intrathecally in the prophylaxis and treatment of patients with hematological malignancies. Myelopathy as a complication of intrathecal (IT) chemotherapy is rare in adults, with most of the cases described in the literature occurring in the pediatric population. Between January 2010 and March 2014, 587 newly diagnosed B cell acute lymphoblastic leukemia and 24 chronic myeloid leukemia lymphoid blast phase patients were seen at The University of Texas MD Anderson Cancer Center. This case series discusses seven adult cases deemed to have IT chemotherapy-induced myelopathy between 2010 and 2014 at MD Anderson Cancer Center. Five out of the seven patients had T2 abnormalities involving the dorsal columns of the spinal cord. An elevated myelin basic protein level was noted in the two patients in whom it was checked. The wide range of dosage and timing with respect to IT chemotherapy administration suggests an idiosyncratic reaction or individual threshold to the development of myelopathy. By describing the largest case series of myelopathy in adults, we aim to raise awareness about this rare albeit devastating complication. Based on the seven cases described we would recommend-MRI of the spine with T2-weighted imaging in the sagittal and axial planes in leukemia patients with unexplained myelopathy and consideration to delay IT chemotherapy until after an extensive work-up to rule out CNS leukemia. Though more data are needed on the use of folate metabolites, preliminary results have shown some promise in the treatment of methotrexate-induced myelopathy and may be a potential consideration for future patients suspected to have chemotherapy induced myelopathy.

  18. Photodynamic therapy in thoracic oncology: a single institution experience

    NASA Astrophysics Data System (ADS)

    Luketich, James D.; Fernando, Hiran C.; Christie, Neil A.; Litle, Virginia R.; Ferson, Peter F.; Buenaventura, Percival O.

    2001-04-01

    We have performed 800 photodynamic therapy (PDT) treatments in over 300 patients at the University of Pittsburgh since 1996. Over 150 patients have undergone PDT for palliation of dysphagia for esophageal cancer. Of the first 77 dysphagia improved in 90.8% with a mean dysphagia-free interval of 80 days. An expandable metal stent was required for extrinsic compression in 19 patients. We have treated 14 high-risk patients with early esophageal cancer or Barrett's high-grade dysplasia for curative intent. At a median follow-up of 12.8 months eight remain free of cancer. Over 100 patients have undergone PDT for lung cancer. Sixty-two patients received 77 courses for palliation. Thirty-five patients were treated for non-massive hemoptysis with resolution in 90%. Forty-four patients were treated for dyspnea with improvement in 59%. A subset of seven high-risk patients with early lung cancer were treated with curative intent. A complete response was seen in 7/10 lesions at a mean follow-up of 30 months. PDT offers good palliation for both advanced esophageal and lung cancer. The role of PDT for curative intent needs further investigation in protocol settings. In our preliminary experience we have treated a small number of non-surgical, high-risk patients with a reasonable success rate.

  19. [ABVD chemotherapy for Hodgkin lymphoma at a single institute].

    PubMed

    Ohshima, Rika; Motomura, Shigeki; Hashimoto, Chizuko; Miyazaki, Takuya; Ito, Satomi; Takasaki, Hirotaka; Hyo, Rie; Koharazawa, Hideyuki; Takemura, Sachiya; Yamazaki, Etsuko; Fujimaki, Katsumichi; Tomita, Naoto; Fujita, Hiroyuki; Fujisawa, Shin; Harano, Hiroshi; Kanamori, Heiwa; Ishigatsubo, Yoshiaki

    2010-12-01

    Fifty-eight newly diagnosed patients with Hodgkin lymphoma were treated with ABVD chemotherapy at Yokohama City University Hematology group from October 1996 to June 2005. The median age of patients age was 41 years old and ranged from 15 to 75. Thirty-eight patients were in the early stage and 20 patients were in the advanced stage. Patients in the early stage received 3 cycles of ABVD chemotherapy and involved-field radiation therapy, while those in the advanced stage received 6 cycles of ABVD chemotherapy. The overall response rate in patients was 100% (CR 87%, PR 13%) in the early stage and 95% in the advanced stage. With a median follow-up of 44 months, the 3-year progression-free survival and overall survival were 89% and 95% in the early stage, and 70% and 81% in the advanced stage, respectively. The results of this study were similar to those previously reported in Western countries.

  20. Glioblastoma in Children: A Single-Institution Experience

    SciTech Connect

    Perkins, Stephanie M.; Rubin, Joshua B.; Leonard, Jeffrey R.; Smyth, Matthew D.; El Naqa, Issam; Michalski, Jeff M.; Simpson, Joseph R.; Limbrick, David L.; Park, Tae S.; Mansur, David B.

    2011-07-15

    Purpose: Current treatment recommendations for pediatric glioblastoma include surgery, chemotherapy, and radiation therapy. However, even with this multispecialty approach, overall survival remains poor. To assess outcome and evaluate treatment-related prognostic factors, we retrospectively reviewed the experience at our institution. Methods and Materials: Twenty-four glioblastoma patients under the age of 21 were treated with radiation therapy with curative intent at Washington University, St. Louis, from 1970 to 2008. Patients underwent gross total resection, subtotal resection or biopsy alone. Fourteen (58%) of the patients received chemotherapy. All patients received radiation therapy. Radiation consisted of whole-brain radiation therapy in 7 (29%) patients with a median dose of 50.4 Gy. Seventeen (71%) patients received three-dimensional conformal radiation therapy with a median dose of 54 Gy. Results: Median follow-up was 12.5 months from diagnosis. One and 2-year overall survival rates were 57% and 32%, respectively. Median overall survival was 13.5 months. There were no differences in overall survival based on patients' age, race, gender, tumor location, radiation volume, radiation dose, or the use of chemotherapy. There was a significant improvement in overall survival for patients in whom gross total resection was achieved (p = 0.023). Three patients were alive 5 years after gross total resection, and 2 patients were alive at 10 and 24 years after diagnosis. Conclusions: Survival for children with glioblastoma remains poor. Data from this and other studies demonstrate the importance of achieving a gross total resection. Continued investigation into new treatment options is needed in an attempt to improve outcome for these patients.

  1. Robotic hepatectomy: initial experience of a single institution in Singapore

    PubMed Central

    Kam, Juinn Huar; Goh, Brian KP; Chan, Chung-Yip; Wong, Jen-San; Lee, Ser-Yee; Cheow, Peng-Chung; Chung, Alexander YF; Ooi, London LPJ

    2016-01-01

    INTRODUCTION In this study, we report our initial experience with robotic hepatectomy. METHODS Consecutive patients who underwent robotic hepatectomy at Singapore General Hospital, Singapore, from February 2013 to February 2015 were enrolled in this study. The difficulty level of operations was graded using a novel scoring system for laparoscopic hepatectomies. RESULTS During the two-year period, five consecutive robotic hepatectomies were performed (one left lateral sectionectomy, one non-anatomical segment II/III resection, one anatomical segment V resection with cholecystectomy, one extended right posterior sectionectomy and one non-anatomical segment V/VI resection). Two hepatectomies were performed for suspected hepatocellular carcinoma, two for solitary liver metastases and one for a large symptomatic haemangioma. The median age of the patients was 53 (range 38–66) years and the median tumour size was 2.5 (range 2.1–7.3) cm. The median total operation time was 340 (range 155–825) minutes and the median volume of blood loss was 300 (range 50–1,200) mL. There were no open conversions and no mortalities or major morbidities (> Clavien-Dindo Grade II). The difficulty level of the operations was graded as low in one case (Score 2), intermediate in three cases (Score 5, 6 and 6) and high in one case (Score 10). There was one minor morbidity, where the patient experienced Grade A bile leakage, which resolved spontaneously. The median length of postoperative hospital stay was 5 (range 4–7) days. CONCLUSION Our initial experience confirmed the feasibility and safety of robotic hepatectomy. PMID:26843059

  2. The developing management of esthesioneuroblastoma: a single institution experience.

    PubMed

    Bäck, Leif; Oinas, Minna; Pietarinen-Runtti, Petra; Saarilahti, Kauko; Vuola, Jyrki; Saat, Riste; Öhman, Juha; Haglund, Caj; Niemelä, Mika; Leivo, Ilmo; Hagström, Jaana; Mäkitie, Antti A

    2012-01-01

    Esthesioneuroblastoma remains a challenging disease because of its rarity, the complexity of surrounding structures, missing opinions of optimal treatment protocol, and complications associated with necessary surgery. Our objective was to analyse the management and outcome of a cohort of patients with esthesioneuroblastoma from 1990 to 2009 in a tertiary medical centre. There were 17 eligible patients (8 males and 9 females) with the median age of 53 years (range 20-75 years). An obvious inconsistency was noted in the management of the various tumours of the present series during the two decades due to a lack of a uniform treatment protocol. The median follow-up time was 57.5 months (range 3-158 months). Nine patients (seven with curative treatment intent) died of the disease with the median time from diagnosis to death of 60 months (range 3-161 months). Eight patients had no evidence of the disease at last follow-up visit (median 76 months, range 24-119 months). Recurrences were documented in seven of the patients. The median time from end of primary treatment to a recurrence was 57 months (range 6-110 months). The 5-year overall survival and disease-free survival was 68 and 62%, respectively. The management of ENB should be planned by an experienced head and neck surgeon as part of a multidisciplinary team in a tertiary referral setting. Multimodality therapy with long-term follow-up is preferable and should be set based on the available disease-specific classifications for clinical staging and histopathological grading.

  3. Neuroendocrine Tumors of the Kidney: A Single Institution Experience

    PubMed Central

    Teegavarapu, Purnima Sravanti; Rao, Priya; Matrana, Marc; Cauley, Diana H.; Wood, Christopher G; Tannir, Nizar M.

    2014-01-01

    Background Renal neuroendocrine tumors (NET), comprising carcinoid tumors and small cell carcinomas, are a rare group of neoplasms. The rarity of these tumors poses a diagnostic and therapeutic challenge. Our purpose was to characterize the cases treated at a tertiary cancer center and to evaluate patients' outcomes with the available treatment modalities. Methods This is a retrospective study of patients with renal NET seen at The University of Texas MD Anderson Cancer Center between January 1, 2001, and January 1, 2011. Patient and tumor data were analyzed by descriptive statistical methods. Results Three cases of carcinoid tumors and six cases of small cell carcinoma were identified. The median age at diagnosis was 53 years for patients with carcinoid and 65 years for patients with small cell carcinoma. The most common presenting symptoms were back pain, flank pain, and hematuria. The morphological appearance of the tumor cells and their immunohistochemical reactivity for neuroendocrine markers and cytokeratin helped establish the diagnosis. Nephrectomy was the mainstay of treatment for carcinoid tumors, yielding good long-term results, even in the presence of metastases. Surgery and chemotherapy were utilized for small cell carcinoma of the kidney. The median overall survival for patients with small cell carcinoma of the kidney was 17.3 months. Conclusion Renal carcinoid tumors are indolent and are associated with prolonged survival, while small cell carcinomas of the kidney are aggressive tumors with relatively short overall survival. Although palliative in nature, cytotoxic chemotherapy is the mainstay of therapy and is best given before surgery. PMID:25088468

  4. Clinicopathologic analysis of pituitary adenoma: a single institute experience.

    PubMed

    Cho, Hwa Jin; Kim, Hanna; Kwak, Yoon Jin; Seo, Jeong Wook; Paek, Sun Ha; Sohn, Chul-Ho; Yun, Jung Min; Kim, Da Seu Ran; Kang, Peter; Park, Peom; Park, Sung-Hye

    2014-03-01

    Pituitary adenoma (PA) is a common benign neuroendocrine tumor; however, the incidence and proportion of hormone-producing PAs in Korean patients remain unknown. Authors analyzed 506 surgically resected and pathologically proven pituitary lesions of the Seoul National University Hospital from 2006 to 2011. The lesions were categorized as: PAs (n = 422, 83.4%), Rathke's cleft cysts (RCCs) (n = 54, 10.6%), inflammatory lesions (n = 8, 1.6%), meningiomas (n = 4), craniopharyngiomas (n = 4), granular cell tumors (n = 1), metastatic renal cell carcinomas (n = 2), germinomas (n = 1), ependymomas (n = 1), and unsatisfactory specimens (n = 9, 1.8%). PAs were slightly more prevalent in women (M: F = 1:1.17) with a mean age of 48.8 yr (9-80 yr). Immunohistochemical analysis revealed that prolactin-producing PAs (16.6%) and growth hormone-producing adenomas (9.2%) were the most common functional PAs. Plurihormonal PAs and nonfunctioning (null cell) adenomas were found in 14.9% and 42.4% of patients with PAs, respectively. The recurrence rate of PAs was 11.1%, but nearly 0% for the remaining benign lesions such as RCCs. 25.4% of patients with PAs were treated by gamma-knife after surgery due to residual tumors or regrowth of residual tumor. In conclusion, the pituitary lesions and the proportions of hormone-producing PAs in Korean patients are similar to those of previous reports except nonfunctioning (null cell) PAs, which are unusually frequent.

  5. Intraoperative Radiotherapy for Parotid Cancer: A Single-Institution Experience

    SciTech Connect

    Zeidan, Youssef H.; Shiue, Kevin; Weed, Daniel; Johnstone, Peter A.; Terry, Colin; Freeman, Stephen; Krowiak, Edward; Borrowdale, Robert; Huntley, Tod; Yeh, Alex

    2012-04-01

    Purpose: Our practice policy has been to provide intraoperative radiotherapy (IORT) at resection to patients with head-and-neck malignancies considered to be at high risk of recurrence. The purpose of the present study was to review our experience with the use of IORT for primary or recurrent cancer of the parotid gland. Methods and Materials: Between 1982 and 2007, 96 patients were treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. The median age was 62.9 years (range, 14.3-88.1). Of the 96 patients, 33 had previously undergone external beam radiotherapy as a component of definitive therapy. Also, 34 patients had positive margins after surgery, and 40 had perineural invasion. IORT was administered as a single fraction of 15 or 20 Gy with 4-6-MeV electrons. The median follow-up period was 5.6 years. Results: Only 1 patient experienced local recurrence, 19 developed regional recurrence, and 12 distant recurrence. The recurrence-free survival rate at 1, 3, and 5 years was 82.0%, 68.5%, and 65.2%, respectively. The 1-, 3-, and 5-year overall survival rate after surgery and IORT was 88.4%, 66.1%, and 56.2%, respectively. No perioperative fatalities occurred. Complications developed in 26 patients and included vascular complications in 7, trismus in 6, fistulas in 4, radiation osteonecrosis in 4, flap necrosis in 2, wound dehiscence in 2, and neuropathy in 1. Of these 26 patients, 12 had recurrent disease, and 8 had undergone external beam radiotherapy before IORT. Conclusions: IORT results in effective local disease control at acceptable levels of toxicity and should be considered for patients with primary or recurrent cancer of the parotid gland.

  6. Systemic Therapy In Acquired Haemophilia – A Single Institute Experience

    PubMed Central

    Prantik, Das; Gary, Benson

    2016-01-01

    A cornerstone of the management of Acquired Haemophilia A (AHA) involves inhibitor eradication. First line immunosuppressive agents are usually steroids, either alone or in combination with cyclophosphamide. We present the use of Rituximab, cyclophosphamide, vincristine and prednisolone (RCVP) combination as immunosuppressant in AHA in a small cohort of patients in order to control their symptoms and eradicate inhibitors. This was a retrospective analysis of all AHA patients treated at the Northern Ireland Haemophilia centre over a six year period. During this time, a total of six patients were newly diagnosed with AHA. Four of these patients failed to respond conventional therapy of steroids and cyclophosphamide, they were however successfully treated with RCVP/ RCV. All patients achieved complete remission with this regimen after 1 to 2 cycles of treatment. Remission has been maintained for an extended time period (range 33-69 months). As AHA is related to immune modulation and, in some cases, underlying malignancy we decided to use this regime as it is effective in either condition. From our experience, we demonstrate that RCVP combination is a promising treatment in patients with AHA who fail to respond to steroids alone or who have been on pre-existing immunosuppression. PMID:27698522

  7. Revision Lapidus Arthrodesis by Bone Endoscopy.

    PubMed

    Lui, Tun Hing

    2016-08-01

    Revision arthrodesis is indicated in symptomatic nonunion of the first tarsometatarsal joint. Revision by first tarsometatarsal arthroscopy cannot deal with the dilated screw tract and associated bone cysts. Revision by bone endoscopy is indicated in symptomatic nonunion of the first tarsometatarsal joint, which is previously fixed by transarticular screw along with loosening of the screw and bone cyst formation. The screw tract makes up the portal tract, with the proximal and distal ends of the tract corresponding to the proximal and distal portals, respectively. In this technical note, we describe zonal debridement and bone grafting of the bone cysts, nonunion site, and the screw tract via the bone endoscopy. This can resolve all the co-pathologies of nonunion of the first tarsometatarsal fusion.

  8. 49 CFR Appendix C to Part 227 - Audiometric Baseline Revision

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... potential revision, the final decision for revision rests with a human being. Because the goal of the guidelines is to foster consistency among different professional reviewers, human override of the...

  9. 49 CFR Appendix C to Part 227 - Audiometric Baseline Revision

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... potential revision, the final decision for revision rests with a human being. Because the goal of the guidelines is to foster consistency among different professional reviewers, human override of the...

  10. 49 CFR Appendix C to Part 227 - Audiometric Baseline Revision

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... potential revision, the final decision for revision rests with a human being. Because the goal of the guidelines is to foster consistency among different professional reviewers, human override of the...

  11. 76 FR 75782 - Revising Standards Referenced in the Acetylene Standard

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-05

    ... the Acetylene Standard AGENCY: Occupational Safety and Health Administration (OSHA), Department of... is revising its Acetylene Standard for general industry by updating a reference to a standard... and Explanation of Revisions to the Acetylene Standard IV. Procedural Determinations A....

  12. Joint Line Reconstruction in Navigated Total Knee Arthroplasty Revision

    ClinicalTrials.gov

    2012-05-16

    Revision Total Knee Arthroplasty Because of; Loosening; Instability; Impingement; or Other Reasons Accepted as Indications for TKA Exchange.; The Focus is to Determine the Precision of Joint Line Restoration in Navigated vs. Conventional Revision Total Knee Arthroplasty

  13. Revised Total Coliform Rule Assessments and Corrective Actions

    EPA Pesticide Factsheets

    EPA has developed the Revised Total Coliform Rule Assessment and Corrective Actions Guidance Manual for public water systems (e.g., owners and operators) to assist in complying with the requirements of the Revised Total Coliform Rule.

  14. 40 CFR 142.12 - Revision of State programs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS IMPLEMENTATION Primary Enforcement Responsibility... enforcement responsibility, States must adopt all new and revised national primary drinking water regulations... each State request for approval of a program revision based on the requirements of the Safe...

  15. 40 CFR 142.12 - Revision of State programs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS IMPLEMENTATION Primary Enforcement Responsibility... enforcement responsibility, States must adopt all new and revised national primary drinking water regulations... each State request for approval of a program revision based on the requirements of the Safe...

  16. 40 CFR 142.12 - Revision of State programs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS IMPLEMENTATION Primary Enforcement Responsibility... enforcement responsibility, States must adopt all new and revised national primary drinking water regulations... each State request for approval of a program revision based on the requirements of the Safe...

  17. 40 CFR 142.12 - Revision of State programs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS IMPLEMENTATION Primary Enforcement Responsibility... enforcement responsibility, States must adopt all new and revised national primary drinking water regulations... each State request for approval of a program revision based on the requirements of the Safe...

  18. 40 CFR 142.12 - Revision of State programs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS IMPLEMENTATION Primary Enforcement Responsibility... enforcement responsibility, States must adopt all new and revised national primary drinking water regulations... each State request for approval of a program revision based on the requirements of the Safe...

  19. Zero-Base Curriculum Revision: A Concept Worth Trying.

    ERIC Educational Resources Information Center

    Miller, William C.

    1981-01-01

    Argues for a "zero-base" revision of school curricula in order to weed out poorly functioning components. Outlines procedures for carrying out such a revision at both the district and building levels. (WD)

  20. Code of Fair Testing Practices in Education (Revised)

    ERIC Educational Resources Information Center

    Educational Measurement: Issues and Practice, 2005

    2005-01-01

    A note from the Working Group of the Joint Committee on Testing Practices: The "Code of Fair Testing Practices in Education (Code)" prepared by the Joint Committee on Testing Practices (JCTP) has just been revised for the first time since its initial introduction in 1988. The revision of the Code was inspired primarily by the revision of…

  1. Promoting Self-Directed Revision in EFL Writing Classes

    ERIC Educational Resources Information Center

    Coomber, Matthew

    2016-01-01

    Second language writers need to develop the ability to revise their writing independently of third party advice; thus, it is important that teachers devise methods by which to promote habits of self-directed revision. This quasi-experimental study investigates three classroom activities designed to encourage students to independently revise essays…

  2. 7 CFR 277.3 - Budgets and budget revision procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 4 2013-01-01 2013-01-01 false Budgets and budget revision procedures. 277.3 Section... OF STATE AGENCIES § 277.3 Budgets and budget revision procedures. The preparation, content, submittal, and revision requirements for the State Food Stamp Program Budget shall be as specified in §...

  3. 40 CFR 60.4124 - Hg budget permit revisions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 6 2011-07-01 2011-07-01 false Hg budget permit revisions. 60.4124... Coal-Fired Electric Steam Generating Units Permits § 60.4124 Hg budget permit revisions. Except as provided in § 60.4123(b), the permitting authority will revise the Hg Budget permit, as necessary,...

  4. 40 CFR 60.4124 - Hg budget permit revisions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 6 2010-07-01 2010-07-01 false Hg budget permit revisions. 60.4124... Coal-Fired Electric Steam Generating Units Permits § 60.4124 Hg budget permit revisions. Except as provided in § 60.4123(b), the permitting authority will revise the Hg Budget permit, as necessary,...

  5. 46 CFR 8.550 - Plan review and revisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... revisions. The CAP and VAP(s) must be reviewed and revised as follows: (1) Every 2 years after the plan... the VAP. (3) If a reportable casualty occurs, the cognizant OCMI will review the portions of the VAP... revisions to the VAP are appropriate. (4) When statutes or regulations change, the appropriate sections...

  6. Social network integration of the ICD11 revision platform.

    PubMed

    Della Mea, Vincenzo; Vuattolo, Omar; Celik, Can; Ustun, Bedirhan

    2013-01-01

    Classification revision and update can be defined as a social experience, with the participating community of experts behaving like a social network. ICD11 is being revised using an innovative web based process, for which we envisioned also tools for social platforms integration. The present poster preliminarily describes the Facebook tools developed for soliciting expert and participation in the ICD11 revision process.

  7. Cognitive Processes in Revision. CDC Technical Report No. 12.

    ERIC Educational Resources Information Center

    Hayes, John R.; And Others

    A new model of the revision process in written composition, based on the results of thinking aloud protocol studies, is presented in this report. The report begins by discussing earlier observations and theories of revision that establish four points: (1) there are large differences among writers in the amount of revising they do, (2) expert…

  8. Integrating Relational Reasoning and Knowledge Revision during Reading

    ERIC Educational Resources Information Center

    Kendeou, Panayiota; Butterfuss, Reese; Van Boekel, Martin; O'Brien, Edward J.

    2017-01-01

    Our goal in this theoretical contribution is to connect research on knowledge revision and relational reasoning. To achieve this goal, first, we review the "knowledge revision components framework" (KReC) that provides an account of knowledge revision processes, specifically as they unfold during reading of texts. Second, we review a…

  9. A National Survey of Revising Practices in the Primary Classroom

    ERIC Educational Resources Information Center

    Saddler, Bruce; Saddler, Kristie; Befoorhooz, Bita; Cuccio-Slichko, Julie

    2014-01-01

    A random national sampling of primary grade teachers in the United States were surveyed to determine how they teach revising to writers in the elementary grades. Our findings suggest that in our sample of teachers, little time is dedicated in the school day to writing and especially revising. The teachers believed that more time spent revising did…

  10. 12 CFR 332.8 - Revised privacy notices.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Revised privacy notices. 332.8 Section 332.8... PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 332.8 Revised privacy notices. (a... described in your prior notice. (c) Delivery. When you are required to deliver a revised privacy notice...

  11. 12 CFR 332.8 - Revised privacy notices.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Revised privacy notices. 332.8 Section 332.8... PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 332.8 Revised privacy notices. (a... described in your prior notice. (c) Delivery. When you are required to deliver a revised privacy notice...

  12. 12 CFR 332.8 - Revised privacy notices.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Revised privacy notices. 332.8 Section 332.8... PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 332.8 Revised privacy notices. (a... described in your prior notice. (c) Delivery. When you are required to deliver a revised privacy notice...

  13. 12 CFR 332.8 - Revised privacy notices.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Revised privacy notices. 332.8 Section 332.8... PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 332.8 Revised privacy notices. (a... described in your prior notice. (c) Delivery. When you are required to deliver a revised privacy notice...

  14. 12 CFR 332.8 - Revised privacy notices.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 5 2013-01-01 2013-01-01 false Revised privacy notices. 332.8 Section 332.8... PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 332.8 Revised privacy notices. (a... described in your prior notice. (c) Delivery. When you are required to deliver a revised privacy notice...

  15. 50 CFR 660.717 - Framework for revising regulations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 13 2012-10-01 2012-10-01 false Framework for revising regulations. 660... Migratory Fisheries § 660.717 Framework for revising regulations. (a) General. NMFS will establish and..., removed, or revised. Any such action will be made according to the framework measures in section 8.3.4...

  16. 50 CFR 660.717 - Framework for revising regulations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Framework for revising regulations. 660... Migratory Fisheries § 660.717 Framework for revising regulations. (a) General. NMFS will establish and..., removed, or revised. Any such action will be made according to the framework measures in section 8.3.4...

  17. 50 CFR 660.717 - Framework for revising regulations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 13 2014-10-01 2014-10-01 false Framework for revising regulations. 660... Migratory Fisheries § 660.717 Framework for revising regulations. (a) General. NMFS will establish and..., removed, or revised. Any such action will be made according to the framework measures in section 8.3.4...

  18. 50 CFR 660.717 - Framework for revising regulations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 11 2011-10-01 2011-10-01 false Framework for revising regulations. 660... Migratory Fisheries § 660.717 Framework for revising regulations. (a) General. NMFS will establish and..., removed, or revised. Any such action will be made according to the framework measures in section 8.3.4...

  19. 50 CFR 660.717 - Framework for revising regulations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 13 2013-10-01 2013-10-01 false Framework for revising regulations. 660... Migratory Fisheries § 660.717 Framework for revising regulations. (a) General. NMFS will establish and..., removed, or revised. Any such action will be made according to the framework measures in section 8.3.4...

  20. 78 FR 44596 - Minor Boundary Revision at Yosemite National Park

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-24

    ... National Park Service Minor Boundary Revision at Yosemite National Park AGENCY: National Park Service, Interior. ACTION: Notification of Boundary Revision. SUMMARY: The boundary of Yosemite National Park is... boundary of Yosemite National Park. DATES: The effective date of this boundary revision is July 24,...

  1. 75 FR 33165 - Revision of Class E Airspace; Galena, AK

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-11

    ... revising Class E airspace at Edward G. Pitka Sr. Airport, AK, to accommodate three amended SIAPs and one... TRANSPORTATION Federal Aviation Administration 14 CFR Part 71 Revision of Class E Airspace; Galena, AK AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Final Rule. SUMMARY: This action revises Class...

  2. Distributive Education: Secondary, Course Outline. Revised 1972.

    ERIC Educational Resources Information Center

    Washington State Coordinating Council for Occupational Education, Olympia.

    The document is a revision of earlier units, updated to include behavioral or performance objectives. Divided into 22 units of instruction, the course outline for distributive education presents suggested length of time for each part of a unit, prerequisites, a description of the part, objectives, sources, outline for the section, activities,…

  3. Revision of the Delta Nursing Scales.

    ERIC Educational Resources Information Center

    Wilson, Barry J.; Packwood, Gene

    An item analysis was performed on two rating scales, the Delta Survey of Nurses and the Delta Nursing Survey, developed for evaluating the preparation and job performance of nursing graduates. Resulting data supported the basic design of the instruments. The revised instruments consist of seven fewer items; two subtests were deleted, and a number…

  4. Personalisation: The Emerging "Revised" Code of Education?

    ERIC Educational Resources Information Center

    Hartley, David

    2007-01-01

    In England, a "revised" educational code appears to be emerging. It centres upon the concept of "personalisation". Its basis is less in educational theory, more in contemporary marketing theory. Personalisation can be regarded in two ways. First, it provides the rationale for a new mode of public-service delivery, one which…

  5. Revised Reynolds Stress and Triple Product Models

    NASA Technical Reports Server (NTRS)

    Olsen, Michael E.; Lillard, Randolph P.

    2017-01-01

    Revised versions of Lag methodology Reynolds-stress and triple product models are applied to accepted test cases to assess the improvement, or lack thereof, in the prediction capability of the models. The Bachalo-Johnson bump flow is shown as an example for this abstract submission.

  6. Compendium of Copyright Office Practices. 1973 Revisions.

    ERIC Educational Resources Information Center

    Library of Congress, Washington, DC. Copyright Office.

    Proposed revisions and additions to the Compendium of Copyright Office practices for 1973 are presented. The bulk of the changes occur in Chapter 2, "Copyrightable Matter." The sub-areas, "Periodicals (Class B),""Works Prepared for Oral Delivery (Class C),""Music (Class E)," and "Motion Pictures…

  7. 75 FR 60485 - NRC Enforcement Policy Revision

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-30

    ... Base Civil Penalties: a. Geologic Repository for Spent Fuel and/or High-Level Waste Repository The... of High-Level Radioactive Wastes in Geologic Repositories,'' and 10 CFR Part 63, ``Disposal of High... the revised Policy under the generic heading ``High-Level Waste Repository'' to address...

  8. Schools without Drugs. What Works. Revised Edition.

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    This revised edition focuses on the prevention of drug use among school students, with increased attention to alcohol, tobacco, and steroids. The handbook, which begins with an introduction by Secretary of Education, Lauro F. Cavazos, provides new information about the effects of alcohol on young people; statistics on the harm it causes; and…

  9. 43 CFR 1610.5-6 - Revision.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Revision. 1610.5-6 Section 1610.5-6 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) PLANNING, PROGRAMMING, BUDGETING Resource...

  10. EMC (Electromagnetic Compatibility) Standards Handbook. Revision 4,

    DTIC Science & Technology

    1982-11-01

    Regulations arc prepared EMC November 1982 3-2 STANDARDS HANDBOOK REVISION DATE SECTION-PAGE by VDE Standards Committees (VDE Normen Ausschuss). Individual...regulation has a well- % publicized review that is coordinated with the German Standards Institute (Deutches Institute fuer Normen , DIN) and the German

  11. Mass Media and Communication. Second, Revised Edition.

    ERIC Educational Resources Information Center

    Steinberg, Charles S., Ed.

    This revised and enlarged second edition contains sections focusing on a number of mass media: newspapers, the American magazine, motion pictures, broadcasting media, and book publishing. Other section topics include the structure and development of mass communication, public opinion, international communication, the motivation of assent, the…

  12. Psychometric Characteristics of the Revised Procrastination Inventory.

    ERIC Educational Resources Information Center

    Johnson, Erica M.; Green, Kathy E.; Kluever, Raymond C.

    2000-01-01

    The Procrastination Inventory developed for use with doctoral students in clinical psychology was modified for use with all-but-dissertation students and doctoral graduates in a college of education. Factor and Rasch analyses of the revised measure identified three subscales: (1) procrastination, (2) perfectionism, and (3) graduate school comfort.…

  13. Revised charge equilibration potential for liquid alkanes.

    PubMed

    Davis, Joseph E; Warren, G Lee; Patel, Sandeep

    2008-07-17

    We present a revised liquid alkane force field based on the charge equilibration formalism for incorporating electrostatic nonadditive effects arising from local polarization. The model is a revision of earlier work by Patel and Brooks, specifically addressing deficiencies in the dihedral potential, electrostatic, and Lennard-Jones (van der Waals) parameters of the force field. We discuss refinement of the alkane backbone torsion potential to match high-level ab initio relative conformational energetics for pentane, hexane, and heptane. We further discuss refinement of the electrostatic and Lennard-Jones (van der Waals) parameters to reproduce the experimental polarizability, liquid density, and vaporization enthalpy of hexane. Finally, we calculate bulk liquid properties including densities, vaporization enthalpies, self-diffusion constants, isothermal compressibilities, constant pressure heat capacities, and NMR T 1 relaxation times for a series of linear alkanes ranging from hexane to pentadecane based on the current revised model. We also compute free energies of hydration for pentane, hexane, and heptane. The revised force field offers a significantly improved overall description of these properties relative to the original parametrization. The current alkane force field represents a platform for ongoing development of a CHARMM (Chemistry at Harvard Molecular Mechanics) polarizable force field for lipids and integral membrane proteins.

  14. More Than A Native Speaker, Revised Edition

    ERIC Educational Resources Information Center

    Snow, Don, Ed.

    2006-01-01

    This revised edition includes an expanded discussion of student-directed language learning, workbook activities for volunteer teachers enrolled in courses or studying the book individually, and a full array of culture-based discussion topics for use as supplementary activities or core material for an English course. The book includes 16 chapters.…

  15. 76 FR 57012 - Progress Reports Rules Revision

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-15

    ... of Prisons 28 CFR Part 524 RIN 1120-AB60 Progress Reports Rules Revision AGENCY: Bureau of Prisons, Justice. ACTION: Proposed rule. SUMMARY: In this document, the Bureau of Prisons (Bureau) proposes to..., Office of General Counsel, Bureau of Prisons, 320 First Street, NW., Washington, DC 20534. You may...

  16. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the...

  17. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the...

  18. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the...

  19. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the...

  20. 50 CFR 37.25 - Revision.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) THE NATIONAL WILDLIFE REFUGE SYSTEM GEOLOGICAL AND GEOPHYSICAL EXPLORATION OF THE COASTAL PLAIN, ARCTIC NATIONAL WILDLIFE REFUGE, ALASKA Exploration Plans § 37.25 Revision. (a) A permittee may request the...

  1. Guide to Vocational Program Planning. Revised.

    ERIC Educational Resources Information Center

    Virginia State Dept. of Education, Richmond. Div. of Adolescent Education.

    This revised edition of a guide to vocational program planning in Virginia is intended to be used as a principal resource for vocational program design and application and to serve as a supplement to program information provided to localities by the individual service areas. The guide is organized in eight sections, one for each program area:…

  2. Revision Planned for the Cambridge Latin Course.

    ERIC Educational Resources Information Center

    Sebesta, Judith Lynn

    1980-01-01

    Summarizes a discussion on the revision of the Cambridge Latin Course (CLC) held during the 1980 ACL Institute at the University of New Hampshire by CLC users and Cambridge University Press representatives. Emphasizes suggestions by users on grammar instruction strategies better suited to American students' needs. (MES)

  3. Needs Assessment for Continuous Curriculum Revision.

    ERIC Educational Resources Information Center

    Weddington, Doris

    Continuous curriculum revision in community/junior colleges can be provided by treating the curriculum as a self-correcting set of systems with feedback loops and marginal sensors which supply information needed for constant system evaluation. This curriculum-related set of sub-systems is comprised of the institution, the curriculum, programs, and…

  4. AAHPER Youth Fitness Test Manual. Revised Edition.

    ERIC Educational Resources Information Center

    American Alliance for Health, Physical Education, and Recreation, Washington, DC.

    The Revised AAHPER Youth Fitness Test is a battery of six test items designed to give a measure of physical fitness for boys and girls in grades 5-12. The tests were selected to evaluate specific aspects of physical status which, taken together, give an overall picture of fitness. Tests can be given in the gymnasium or outdoors. They are as…

  5. Accreditation Standards Revision: Democratic, Unilateral, or Dictatorial?

    ERIC Educational Resources Information Center

    Kandor, Joseph R.; Bobby, Carol L.

    1991-01-01

    Responds to the questions and concerns raised in the previous article by Engels that relate to the accreditation procedures and standards revision process of the Council for Accreditation of Counseling and Related Educational Programs (CACREP). Notes articles such as Engels' must consider CACREP Board's activities, decision, and interpretations.…

  6. 44 CFR 65.7 - Floodway revisions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... by communities participating in the NFIP). (4) Engineering analysis for the revised floodway, as described below: (i) The floodway analysis must be performed using the hydraulic computer model used to... output data from the original and modified computer models must be submitted. (5) Delineation of...

  7. 44 CFR 65.7 - Floodway revisions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... by communities participating in the NFIP). (4) Engineering analysis for the revised floodway, as described below: (i) The floodway analysis must be performed using the hydraulic computer model used to... output data from the original and modified computer models must be submitted. (5) Delineation of...

  8. 44 CFR 65.7 - Floodway revisions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... by communities participating in the NFIP). (4) Engineering analysis for the revised floodway, as described below: (i) The floodway analysis must be performed using the hydraulic computer model used to... output data from the original and modified computer models must be submitted. (5) Delineation of...

  9. Revision of the Oberthuerellinae (Cynipoidea: Liopteridae)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Afrotropical endemic Oberthuerellinae is revised, and new dichotomous and multi-entry keys to the species of Oberthuerella, Tessmannella, and Xenocynips are provided. All previously described species in these genera are redescribed; descriptions are augmented by color images of each species' ho...

  10. Mid-Prairie. First Grade Revision.

    ERIC Educational Resources Information Center

    Joint County System of Cedar, Johnson, Linn, and Washington Counties, Cedar Rapids, IA.

    Written by teachers in the Mid-Prairie Community School District, this revised 1st grade social studies curriculum guide will be tested in the 1970-71 school year and evaluated in the Spring. The units emphasize general communication skills and the building of a background for specific social studies skills: reading social studies material;…

  11. Anomalies of Nuclear Criticality, Revision 6

    SciTech Connect

    Clayton, E. D.; Prichard, Andrew W.; Durst, Bonita E.; Erickson, David; Puigh, Raymond J.

    2010-02-19

    This report is revision 6 of the Anomalies of Nuclear Criticality. This report is required reading for the training of criticality professionals in many organizations both nationally and internationally. This report describes many different classes of nuclear criticality anomalies that are different than expected.

  12. IRIS Toxicological Review of Ammonia (Revised External ...

    EPA Pesticide Factsheets

    In August 2013, EPA submitted a revised draft IRIS assessment of ammonia to the agency's Science Advisory Board (SAB) and posted this draft on the IRIS website. EPA had previously released a draft of the assessment for public comment, held a public meeting about the draft, and then revised it based on the comments received. The SAB CAAC-Ammonia panel will review this draft assessment. Details about the meeting dates, times, and location are available via the Federal Register Notice posted on March 25, 2014. The SAB provided information on how the public can participate in the external peer review meetings, as well as instructions about how to provide comments to the SAB in the notice. Additional information on the SAB review of ammonia is on the SAB website. Report Information: The Toxicological Review of Ammonia was originally released for a 60-day public comment period on June 8, 2012. [Federal Register Notice Jun 8, 2012] EPA revised the toxicological review in response to the public comments received. EPA has released the revised external review draft ammonia assessment and the SAB CAAC is conducting a peer review of the scientific basis supporting the assessment that will appear in the Integrated Risk Information System (IRIS) database. Information regarding the peer review can be found at the SAB review of ammonia website. EPA is undertaking an Integrated Risk Information System (IRIS) health assessment for ammonia. IRIS is an EPA database cont

  13. New Ways of Classroom Assessment. Revised

    ERIC Educational Resources Information Center

    Brown, J. D., Ed.

    2013-01-01

    In this revised edition in the popular New Ways Series, teachers have once again been given an opportunity to show how they do assessment in their classrooms on an everyday basis. Often feeling helpless when confronted with large-scale standardized testing practices, teachers here offer classroom testing created with the direct aim of helping…

  14. Revision of Benedictus Scherer (Coleoptera: Chrysomelidae: Galerucinae)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The alpine flea beetle genus Benedictus Scherer (Coleoptera: Chrysomelidae: Galerucinae) is revised. Twenty new species, namely B. chilalla, B. dochula, B. ha, B. nobding, B. thumsila and B. yatongla from Bhutan, B. belousovi, B. cangshanicus, B. kabaki, B. kurbatovi, B. nigrinus, B. sichuanensis a...

  15. CO2 laser in revision stapes surgery

    NASA Astrophysics Data System (ADS)

    Jovanovic, Sergije; Schoenfeld, Uwe; Scherer, Hans H.

    1997-05-01

    Successful restoration of audition in revision stapedotomies involves precise identification and correction of the pathological condition without traumatizing the inner ear. Conventional surgical procedures often lead to unsatisfactory audition results and inner ear damages. In revision stapedotomy, the carbon-dioxide laser provides the ear surgeon with three important advantages over the conventional technique: (1) improved diagnostic and therapeutic precision, (2) better stabilization of the new prosthesis in the oval niche, and (3) reduction of inner ear trauma through non- contact atraumatic management. The surgical procedure of revision stapedotomies with the carbon dioxide laser is discussed, and case examples are used to illustrate the diversity of pathological conditions that can be treated by carbon-dioxide laser surgery. Our experience with revision carbon-dioxide laser stapedotomy suggests an improvement of postoperative audition compared to the conventional technique and demonstrates a significant elimination of sensorineural deafness. The carbon-dioxide laser enables the ear surgeon to precisely and reliably correct conduction deafness recurring after stapedotomy.

  16. 30 CFR 585.617 - What activities require a revision to my SAP, and when will BOEM approve the revision?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What activities require a revision to my SAP... FACILITIES ON THE OUTER CONTINENTAL SHELF Plans and Information Requirements Activities Under An Approved Sap § 585.617 What activities require a revision to my SAP, and when will BOEM approve the revision? (a)...

  17. 30 CFR 585.617 - What activities require a revision to my SAP, and when will BOEM approve the revision?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What activities require a revision to my SAP... FACILITIES ON THE OUTER CONTINENTAL SHELF Plans and Information Requirements Activities Under An Approved Sap § 585.617 What activities require a revision to my SAP, and when will BOEM approve the revision? (a)...

  18. 30 CFR 585.617 - What activities require a revision to my SAP, and when will BOEM approve the revision?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false What activities require a revision to my SAP... FACILITIES ON THE OUTER CONTINENTAL SHELF Plans and Information Requirements Activities Under An Approved Sap § 585.617 What activities require a revision to my SAP, and when will BOEM approve the revision? (a)...

  19. 30 CFR 285.617 - What activities require a revision to my SAP, and when will MMS approve the revision?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What activities require a revision to my SAP... OUTER CONTINENTAL SHELF Plans and Information Requirements Activities Under An Approved Sap § 285.617 What activities require a revision to my SAP, and when will MMS approve the revision? (a) You...

  20. Intraventricular hemorrhage after ventriculoperitoneal shunt revision: a retrospective review.

    PubMed

    Calayag, Mark; Paul, Alexandra R; Adamo, Matthew A

    2015-07-01

    OBJECT The authors review their ventriculoperitoneal (VP) shunt revisions over a 3-year period to determine the rate of intraventricular hemorrhage (IVH) and subsequent need for re-revision. METHODS Review of medical records identified 35 pediatric patients who underwent 52 VP shunt revisions between 2009 and 2012. The presence and amount of IVH as determined by CT and the time to re-revision were documented. The reason for shunting, catheter position, and time between initial VP shunt placement and subsequent revisions were also recorded. RESULTS After 13 (25%) of the 52 revisions, IVH was evident on postoperative CT scans. The majority of patients had a trace amount of IVH, with only 2% having IVH greater than 5 ml. After 2 (15%) of the 13 revisions associated with IVH, re-revision was required within 1 month. In contrast, the re-revision rate in patients without IVH was 18%. All of the patients who developed IVH had occipital catheters. CONCLUSIONS Some degree of IVH can be expected after approximately one-quarter of all VP shunt revision procedures in pediatric patients, but the rate of significant IVH is low. Furthermore, the presence of IVH does not necessitate an early shunt revision.

  1. [Revision arthroplasty of the ankle joint].

    PubMed

    Hintermann, B; Barg, A; Knupp, M

    2011-11-01

    In the last 20 years total ankle replacement has become a viable alternative to arthrodesis for end-stage osteoarthritis of the ankle. Numerous ankle prosthesis designs have appeared on the market in the past and attracted by the encouraging intermediate results reported in the literature, many surgeons have started to perform this procedure. With increased availability on the market the indications for total ankle replacement have also increased in recent years. In particular, total ankle replacement may now be considered even in younger patients. Therefore, despite progress in total ankle arthroplasty the number of failures may increase. Up to now, arthrodesis was considered to be the gold standard for salvage of failed ankle prostheses. Because of extensive bone loss on the talar side, in most instances tibiocalcaneal fusion is the only reliable solution. An alternative to such extended hindfoot fusions would be revision arthroplasty. To date, however, there are no reported results of revision arthroplasty for salvage of a failed ankle replacement.Based on our experience prosthetic components with a flat undersurface are most likely to be able to find solid support on remaining bone stock. The first 83 cases (79 patients, 46 males, 33 females, average age 58.9 years, range 30.6-80.7 years) with a average follow-up of 5.4 years (range 2-11 years) showed excellent to good results in 69 cases (83%), a satisfactory result in 12 cases (15%) and a fair result in 2 cases (2%) and 47 patients (56%) were pain free. Primary loosening was noted in three cases and of these two cases were successfully revised by another total ankle replacement and in one case with arthrodesis. Another case with hematogenous infection was also revised by arthrodesis. At the last follow-up control two components were considered to be loose and the overall loosening rate was thus 6%.This series has proven that revision arthroplasty can be a promising option for patients with failed total

  2. Guidance document for revision of DOE Order 5820.2A, Radioactive Waste Technical Support Program. Revision 1

    SciTech Connect

    Kudera, D.E.; McMurtrey, C.D.; Meagher, B.G.

    1993-04-01

    This document provides guidance for the revision of DOE Order 5820.2A, ``Radioactive Waste Management.`` Technical Working Groups have been established and are responsible for writing the revised order. The Technical Working Groups will use this document as a reference for polices and procedures that have been established for the revision process. The overall intent of this guidance is to outline how the order will be revised and how the revision process will be managed. In addition, this document outlines technical issues considered for inclusion by a Department of Energy Steering Committee.

  3. Revision of Articular Surface Replacement (ASR) Total Hip Arthroplasty: Correlation of Perioperative Data and Early Post-Revision Outcome Results.

    PubMed

    Cip, Johannes; Bach, Christian; Widemschek, Mark; Luegmair, Matthias; Martin, Arno

    2015-09-01

    The articular surface replacement (ASR) total hip arthroplasty (THA) showed accelerated failure rates due to adverse-reaction to metal debris (ARMD). Literature correlating preoperative with intraoperative revision findings respectively post-revision outcome results are rare. 30 of 99 available ASR THA were revised due to ARMD. Mean post-revision follow-up term was 2.3 years. In part, preoperative data did not correlate with intraoperative revision findings. ARMD was even found in asymptomatic patients with non-elevated ion levels. Postoperative pain and metal ions decreased significantly (P ≤ 0.016). Cobalt decreased faster than chrome. Patients with intraoperative pseudotumors, osteolysis or bilateral THA did not have higher pre- or postoperative ion values (P ≥ 0.053). Females showed higher postoperative chrome levels (P=0.031). One major post-revision complication (femoral nerve palsy) and one re-revision (late onset infection) occurred.

  4. Revision of the IAU Style Manual

    NASA Astrophysics Data System (ADS)

    Wilkins, George A.

    The current IAU Style Manual (1989) is in need of revision to take into account the changes in publishing practices since it was prepared. In particular, it needs to give guidance for the electronic publication of papers, reports and data. It is clear that the revised version should be made available on the World Wide Web, but consideration must also be given to those astronomers who do not have ready access to the Web. The value of the Manual should be increased by giving links to other sources of information that would be useful to authors and readers. Further efforts should be made to encourage editors of astronomical publications to adopt the IAU recommendations so as to simplify the work of authors and to improve the quality of the quality of the publications.

  5. Standards for vision science libraries: 2014 revision

    PubMed Central

    Motte, Kristin; Caldwell, C. Brooke; Lamson, Karen S.; Ferimer, Suzanne; Nims, J. Chris

    2014-01-01

    Objective: This Association of Vision Science Librarians revision of the “Standards for Vision Science Libraries” aspires to provide benchmarks to address the needs for the services and resources of modern vision science libraries (academic, medical or hospital, pharmaceutical, and so on), which share a core mission, are varied by type, and are located throughout the world. Methods: Through multiple meeting discussions, member surveys, and a collaborative revision process, the standards have been updated for the first time in over a decade. Results: While the range of types of libraries supporting vision science services, education, and research is wide, all libraries, regardless of type, share core attributes, which the standards address. Conclusions: The current standards can and should be used to help develop new vision science libraries or to expand the growth of existing libraries, as well as to support vision science librarians in their work to better provide services and resources to their respective users. PMID:25349547

  6. Laparoscopic revision of a ventriculoperitoneal shunt.

    PubMed

    Turner, Raymond; Chahlavi, Ali; Rasmussen, Peter; Brody, Fred

    2004-10-01

    Ventriculoperitoneal (VP) shunts are the most common treatment modality for hydrocephalus. Distal catheter malfunction represents a surgical emergency and a significant cause of procedural morbidity. We report the case of a patient with acute abdominal pain following VP shunt insertion. On examination she had a tender, irreducible bulge at the abdominal laparotomy site. Exploratory laparoscopy of the abdomen yielded no abdominal wall abnormalities. At the same time, the distal catheter was noted to be absent. The abdominal bulge was incised along the laparotomy scar and clear cerebrospinal fluid was encountered. The incision was explored and the distal catheter was coiled and knotted within the preperitoneal space. The catheter was laparoscopically returned to the peritoneal cavity. This case exemplifies the utility of laparoscopy for VP shunt revision and we present a review of laparoscopic shunt revision.

  7. Clean Air Act: Senate mulls revision bill

    SciTech Connect

    Fairley, P.

    1995-12-13

    Senator Lauch Faircloth (R., NC) has circulated a draft summary of possible revisions of the Clean Air Act (CAA). Chemical industry sources say the proposal would provide some regulatory relief but fear that supporting Faircloth could jeopardize their relationship with EPA. Faircloth`s proposal addresses various controversial aspect of CAA`s Title V permit program including the monitoring and permit modification provisions. The proposal would also define a facility`s {open_quotes}potential to emit,{close_quotes} upon which Title V permits are based. In the past year EPA has substantially revised its Title V program to address complaints from industry, the states, and Congress that the monitoring and modification provisions were too burdensome.

  8. Tantalum Cones in Revision Total Knee Arthroplasty.

    PubMed

    Kim, Eric G; Patel, Nirav K; Chughtai, Morad; Elmallah, Randa D K; Delanois, Ronald E; Harwin, Steven F; Mont, Michael A

    2016-11-01

    The best strategy to address large bony defects in revision total knee arthroplasty has yet to be determined. The relatively recent development of porous tantalum cones and their use to address massive bone loss in knee arthroplasty has shown promising short- and intermediate-term results. The purpose of this review is to present the current literature on: (1) basic science of porous tantalum, (2) classification and treatment for bone loss, (3) clinical results, and (4) evolution of newer generation cones.

  9. Revised Unfilling Procedure for Solid Lithium Lenses

    SciTech Connect

    Leveling, A.; /Fermilab

    2003-06-03

    A procedure for unfilling used lithium lenses to has been described in Pbar Note 664. To date, the procedure has been used to disassemble lenses 20, 21, 17, 18, and 16. As a result of this work, some parts of the original procedure were found to be time consuming and ineffective. Modifications to the original procedure have been made to streamline the process and are discussed in this note. The revised procedure is included in this note.

  10. Coal within a revised energy perspective

    SciTech Connect

    Darmstadter, J.

    2006-07-15

    The author considers the use of coal within a revised energy perspective, focusing on the factors that will drive which fuels are used to generate electricity going forward. He looks at the world markets for fossil fuels and the difficulties of predicting oil and natural gas supply and prices, as demonstrated by the variability in projections from one year to another in the EIA's Annual Energy Outlook. 4 refs., 1 tab.

  11. Revision of ISO 15859 Aerospace Fluid Standards

    NASA Technical Reports Server (NTRS)

    Greene, Benjamin; McClure, Mark B.

    2012-01-01

    A detailed review of ISO 15859 "Space Systems - Fluid Characteristics, Sampling and Test Methods" was performed An approach to revising Parts 1-9 and 11-13 was developed and concurred by the NASA Technical Standards Program Office. The approach was to align them with the highest level source documents, and not to program-specific requirements. The updated documents were prepared and presented.

  12. The Modular Universal Tumour And Revision System (MUTARS®) in endoprosthetic revision surgery

    PubMed Central

    Gebert, Carsten; Götze, Christian; Gosheger, Georg; Hardes, Jendrik

    2010-01-01

    The aim of this study was to present the clinical and functional results of revision surgery after failed hip endoprostheses using the Modular Universal Tumour And Revision System (MUTARS®). Functional results of the hip endoprostheses were recorded by applying the Harris hip score. The extent of the presurgical radiological bone defect was measured according to the classification system of the German orthopaedic association (DGOOC). Indications for revision surgery on 45 patients (21 female, 24 male) were aseptic loosening (19 patients), infection (16 patients), or periprosthetic fracture (Vancouver classification B2, B3 and C, in nine patients). Revision surgery was performed after 8.6 years on average (min. 0.6; max. 14.25 years). Large defects of the proximal femur (80% medial or lateral diaphysis; 20% meta-diaphysis according to DGOOC classification) were adequately reconstructed. The average follow-up was 38.6 months. Complications occurred in eight patients: one luxation, two aseptic loosenings, and five reinfections were diagnosed. The Harris hip score (presurgical 30; postsurgical 78) showed significant improvement after revision surgery. Regarding the extent of the patients’ bone defects, good functional results were achieved. The comparatively low number of luxations and loosenings is due to the high modularity of the prosthesis with arbitrary antetorsion in the hip joint. However, high reinfection rates in mega-implants still constitute a problem and should be the subject of further studies. PMID:20379815

  13. The Modular Universal Tumour And Revision System (MUTARS®) in endoprosthetic revision surgery.

    PubMed

    Gebert, Carsten; Wessling, Martin; Götze, Christian; Gosheger, Georg; Hardes, Jendrik

    2010-12-01

    The aim of this study was to present the clinical and functional results of revision surgery after failed hip endoprostheses using the Modular Universal Tumour And Revision System (MUTARS®). Functional results of the hip endoprostheses were recorded by applying the Harris hip score. The extent of the presurgical radiological bone defect was measured according to the classification system of the German orthopaedic association (DGOOC). Indications for revision surgery on 45 patients (21 female, 24 male) were aseptic loosening (19 patients), infection (16 patients), or periprosthetic fracture (Vancouver classification B2, B3 and C, in nine patients). Revision surgery was performed after 8.6 years on average (min. 0.6; max. 14.25 years). Large defects of the proximal femur (80% medial or lateral diaphysis; 20% meta-diaphysis according to DGOOC classification) were adequately reconstructed. The average follow-up was 38.6 months. Complications occurred in eight patients: one luxation, two aseptic loosenings, and five reinfections were diagnosed. The Harris hip score (presurgical 30; postsurgical 78) showed significant improvement after revision surgery. Regarding the extent of the patients' bone defects, good functional results were achieved. The comparatively low number of luxations and loosenings is due to the high modularity of the prosthesis with arbitrary antetorsion in the hip joint. However, high reinfection rates in mega-implants still constitute a problem and should be the subject of further studies.

  14. Revised Hazard Ranking System (HRS): Final rule

    SciTech Connect

    Not Available

    1990-11-09

    The U.S. Environmental Protection Agency (EPA) has revised the Hazard Ranking System (HRS) in response to the Superfund Amendments and Reauthorization Act of 1986 (SARA). The HRS is the scoring system EPA uses to assess the relative threat associated with the release or potential release of hazardous substances from a waste site. The HRS score is the primary criterion EPA uses to determine whether a site should be placed on the National Priorities List (NPL). The NPL identifies sites that warrant further investigation to determine if they pose risks to public health or the environment. Sites on the NPL are eligible for long-term remedial action financed under the Comprehensive Environmental Response, Compensation and Liability Act of 1980 (CERCLA), as amended by SARA. The revised HRS retains the same cutoff score and basic approach as the original HRS, while incorporating SARA requirements as well as improvements identified as necessary by EPA and the public. The revised HRS retains the ground water, surface water, and air pathways drops the direct contact and fire/explosion pathways, and adds a forth pathway, soil exposure.

  15. Clinical Outcomes Following Revision Anterior Shoulder Stabilization

    PubMed Central

    Frank, Rachel M.; Mellano, Chris; Shin, Jason J.; Feldheim, Terrence F.; Mascarenhas, Randhir; Yanke, Adam Blair; Cole, Brian J.; Nicholson, Gregory P.; Romeo, Anthony A.; Verma, Nikhil N.

    2015-01-01

    Objectives: The purpose of this study was to determine the clinical outcomes following revision anterior shoulder stabilization performed either via all-arthroscopic soft tissue repair or via Latarjet coracoid transfer. Methods: A retrospective review of prospectively collected data on 91 shoulders undergoing revision anterior shoulder stabilization was performed. All patients underwent prior soft tissue stabilization; those with prior open bone grafting procedures were excluded. For patients with 25% glenoid bone loss, Latarjet was performed (n=28). Patients were queried regarding recurrent instability (subluxation or dislocation). Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Western Ontario Shoulder Instability Index (WOSI). Results: A total of 63 shoulders in 62 patients (46 males, 16 females) with an average age of 23.2 ± 6.9 years were included in the revision arthroscopy group. At an average follow-up of 46.9 ± 16.8 months (range, 15 to 78), the mean WOSI score was 80.1 (range, 15.0 to 100), and there were significant improvements (p<0.001) in ASES (63.7 to 85.1), SST (6.2 to 9.1), and VAS pain scores (2.89 to 0.81). Recurrent instability occurred in 12 of 63 shoulders (19%); the number of prior surgeries and baseline hyperlaxity were significant risk factors for failure (p<0.001 and p=0.04, respectively). No patients developed clinical or radiographic evidence of arthritis. A total of 28 shoulders in 28 patients (21 male, 7 female) with an average age of 27.5 years (range 14 to 45) were included in the Latarjet group. Thirteen (46%) had more than one previous stabilization attempt. ), the average WOSI score was 71.9, and there were significant improvements (p<0.001) in ASES (65.7 to 87.0), SST (7.2 to 10.3), and VAS (3.1 to 1.1). Recurrent instability occurred in 2 of 28 shoulders

  16. Surgical technique for revision surgery of cervical artificial disc replacements.

    PubMed

    Onken, Julia; Meyer, Bernhard; Vajkoczy, Peter

    2017-01-01

    OBJECTIVE Cervical artificial disc replacement (C-ADR) is a widely used procedure with low risk at implantation. Few cases have been reported about the surgical techniques of C-ADR revision. The authors describe their surgical experience with the explantation of a Galileo C-ADR. METHODS Revision surgery was performed in a 58-year-old patient. Patient positioning and surgical opening techniques were performed as appropriate for anterior cervical decompression. RESULTS Revision surgery via the initial anterior approach was successful following an atraumatic removal of the implant. Fusion of the C5-6 segment was performed without complications. CONCLUSIONS In general, the authors observed recurrent nerve palsy and malpositioning of the revised implant in C-ADR revision surgery. Problems with implant removal did not occur because the fusion rate was low due to the short time between initial surgery and C-ADR revision surgery. The video can be found here: https://youtu.be/32CUEDquinc .

  17. Revised Push-Up Test Norms for College Students

    ERIC Educational Resources Information Center

    Baumgartner, Ted A.; Hales, Derek; Chung, Hyuk; Oh, Suhak; Wood, Heather M.

    2004-01-01

    A revised push-up test for college students was presented in 2002. The purpose of this study was to develop percentile norms for the revised push-up test when it is used with college students. Revised push-up scores collected on 177 male and 274 female college students were used to develop percentile norms. The norms for the men have a different…

  18. Computer Strategies for Teaching Revision: It May Be Convenient, but It's Not Easy.

    ERIC Educational Resources Information Center

    Strickland, James

    Word processing does not, in itself, teach revision. Students with incomplete revision strategies will not begin revising at a higher level simply by using a word processor. New computer strategies for teaching revision are needed--revision strategies that use the computer to reorganize, elaborate, and strengthen what has already been written. For…

  19. Creative revision - From rough draft to published paper

    NASA Technical Reports Server (NTRS)

    Buehler, M. F.

    1976-01-01

    The process of revising a technical or scientific paper can be performed more efficiently by the people involved (author, co-author, supervisor, editor) when the revision is controlled by breaking it into a series of steps. The revision process recommended here is based on the levels-of-edit concept that resulted from a study of the technical editorial function at the Jet Propulsion Laboratory of the California Institute of Technology. Types of revision discussed are Substantive, Policy, Language, Mechanical Style, Format, Integrity, and Copy Clarification.

  20. 76 FR 71707 - Revising Underground Storage Tank Regulations-Revisions to Existing Requirements and New...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ...EPA is proposing to make certain revisions to the 1988 underground storage tank (UST) technical, financial responsibility, and state program approval regulations. These changes establish federal requirements that are similar to key portions of the Energy Policy Act of 2005; they also update certain 1988 UST regulations. Proposed changes include: Adding secondary containment requirements for......

  1. Actitud Hacia las Matematicas: Revision Bibliografica (Attitudes Toward Mathematics: Revised Bibliography). Publication No. 39.

    ERIC Educational Resources Information Center

    Rodriguez Feijoo, Nelida

    Investigations about attitudes toward mathematics carried out in the past decade were revised. The instruments used to measure attitudes toward mathematics were analysed as well as the attitudes toward different aspects of mathematics, their relation with other school subjects and their stability through time. Opinions about the influence of…

  2. Actitudes Haci la Enfermedad Mental: Revision Bibliografica (Attitudes toward Mental Illness: Revised Bibliography). Publication No. 40.

    ERIC Educational Resources Information Center

    Stefani, Dorina

    In this work, some of the most important instruments used to measure attitudes toward mental illness were analysed. A revision of different experimental investigations which studied attitudes toward mental illness among general public, mental health professionals and patients and their relatives was made. Some of the strategies applied to change…

  3. Microgravity science and applications bibliography, 1991 revision

    NASA Technical Reports Server (NTRS)

    1992-01-01

    This edition of the Microgravity Science and Applications (MSA) Bibliography is a compilation of government reports, contractor reports, conference proceedings, and journal articles dealing with flight experiments using a low gravity environment to elucidate and control various processes, or with ground based activities that provide supporting research. It encompasses literature published but not cited in the 1990 Revision and that literature which has been published in the past year. Subdivisions of the bibliography include: Electronic materials; Metals, alloys, and composites; Fluids, interfaces and transport; Glasses and ceramics; Biotechnology; Combustion science; and Experimental technology, instrumentation, and facilities. Also included are a limited number of publications from the European, Soviet, and Japanese programs.

  4. Microgravity science and applications bibliography, 1990 revision

    NASA Technical Reports Server (NTRS)

    1991-01-01

    This edition of the Microgravity Science and Applications (MSA) Bibliography is a compilation of government reports, contractor reports, conference proceedings, and journal articles dealing with flight experiments utilizing a low gravity environment to elucidate and control various processes, or with ground based activities that provide supporting research. It encompasses literature published but not cited in the 1989 Revision and that literature which has been published in the past year. Subdivisions of the bibliography include: electronic materials; metals, alloys, and composites; fluids, interfaces, and transport; glasses and ceramics; biotechnology; combustion science; and experimental technology, facilities, and instrumentation. Also included are publications from the European, Soviet, and Japanese programs.

  5. Revised numerical wrapper for PIES code

    NASA Astrophysics Data System (ADS)

    Raburn, Daniel; Reiman, Allan; Monticello, Donald

    2015-11-01

    A revised external numerical wrapper has been developed for the Princeton Iterative Equilibrium Solver (PIES code), which is capable of calculating 3D MHD equilibria with islands. The numerical wrapper has been demonstrated to greatly improve the rate of convergence in numerous cases corresponding to equilibria in the TFTR device where magnetic islands are present. The numerical wrapper makes use of a Jacobian-free Newton-Krylov solver along with adaptive preconditioning and a sophisticated subspace-restricted Levenberg-Marquardt backtracking algorithm. The details of the numerical wrapper and several sample results are presented.

  6. Basic petroleum geology, 2nd ed. , revised

    SciTech Connect

    Link.

    1990-01-01

    This book contains revised and updated material, including approximately 200 additional illustrations and an extensive glossary of terms. A valuable reference for geology students and petroleum professionals, the text presents fundamental concepts of geology in terms of sedimentary deposition, petroleum occurrence, exploration, and recovery. This book contains information on geologic time, historical geology and stratigraphy; Minerals and rocks; Weathering erosion, and deposition; Marine erosion and deposition; Depositional basins; Lacustrine, desert and glacial environments; Subsurface water and diagenesis; Structural geology; petroleum traps; Petroleum and reservoirs; Geological considerations and engineering practices; Rocks, reservoirs, and recovery techniques; Exploration techniques for petroleum; Bibliography Glossary; Index.

  7. Microgravity science and applications bibliography, 1989 revision

    NASA Technical Reports Server (NTRS)

    1990-01-01

    This edition of the Microgravity Science and Applications (MSA) Bibliography is a compilation of government reports, contractor reports, conference proceedings, and journal articles dealing with flight experiments utilizing a low gravity environment to elucidate and control various processes, or with ground based activities that provide supported research. It encompasses literature published but not cited in the 1988 Revision and that literature which has been published in the past year. Subdivisions of the Bibliography include: electronic materials, metals, alloys, and composites; fluids, interfaces, and transport; glasses and ceramics; biotechnology; combustion science; experimental technology, facilities, and instrumentation. Also included are publications from the European, Soviet, and Japanese programs.

  8. Revision of the family Nothybidae (Diptera: Schizophora).

    PubMed

    Lonsdale, O; Marshall, S A

    2016-04-05

    The family Nothybidae (Diptera: Schizophora) is revised. The family consists of 11 species in the single genus Nothybus Rondani, which occurs in Papua New Guinea, Nepal and much of the Oriental Region. Three species are described as new: N. absens spec. nov. (China), N. cataractus spec. nov. (Laos, Thailand) and N. procerus spec. nov. (India). Nothybus longithorax Rondani, 1875 is treated as a junior synonym of N. longicollis (Walker, 1856). Nothybus decorus Meijere, 1924 syn. nov. is included as a junior synonym of N. lineifer Enderlein, 1922.

  9. Taxonomic revision of Neotropical Murdannia Royle (Commelinaceae)

    PubMed Central

    Pellegrini, Marco Octávio de Oliveira; Faden, Robert B.; de Almeida, Rafael Felipe

    2016-01-01

    Abstract This study provides a taxonomic revision for the Neotropical species of the genus Murdannia. Six species are recognized as native, including a new species and a new combination, while two Asian species are recognized as invasive. We present an identification key, a table summarizing the morphologic differences among the species, a new synonym, six lectotypifications, a distribution map, and descriptions, comments and photographic plates for each species. We also provide comments on the morphology of the Neotropical species of Murdannia, comparing them with the Paleotropical species, and a discussion of inflorescence architecture in the genus as a whole. PMID:28127236

  10. FFTF reactor immersion heaters. Revision 1

    SciTech Connect

    Romrell, D.M.

    1994-08-26

    This specification establishes requirements for design, testing, and quality assurance for electric heaters that will be used to maintain primary Sodium temperature in the Fast Test Facility (FFTF) reactor vessel. The Test Specification (WHC-SD-FF-SDS-003) has been revised to Rev. 1. This change modifies the fabrication of approximately 25 feet of the subject heater using ceramic insulators over the heater lead wire rather than compressed magnesium oxide. Also, 304 or 316 stainless steel can be used for the heater sheath. This change should simplify fabrication and improve the heater operational reliability.

  11. 77 FR 63355 - Proposed Revision to Emergency Action Level Development Guidance Document

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-16

    ... revision to the Nuclear Energy Institute (NEI) 99-01, proposed Revision 6, ``Development of Emergency... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Proposed Revision to Emergency Action Level Development Guidance Document AGENCY:...

  12. 77 FR 22792 - Non-Competitive Program Expansion Supplement To Revise, Update, and Disseminate Educational...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-17

    ... To Revise, Update, and Disseminate Educational Curricula Regarding Alzheimer's Disease and Related... Program Expansion Supplement To Revise, Update, and Disseminate Educational Curricula Regarding Alzheimer...) Program grantees to revise, update, and disseminate educational curricula regarding Alzheimer's...

  13. 76 FR 61293 - Extension of Public Comment Period: Mandatory Reporting of Greenhouse Gases: Technical Revisions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-04

    ... Gases: Technical Revisions to the Electronics Manufacturing and the Petroleum and Natural Gas Systems..., Mandatory Reporting of Greenhouse Gases: Technical Revisions to the Electronics Manufacturing and the... Gases: Technical Revisions to the Electronics Manufacturing and the Petroleum and Natural Gas...

  14. Curriculum revision: product innovation for quality outcomes.

    PubMed

    Thomas, Georgianna; Carroll, V Susan

    2006-01-01

    The education of any professional discipline rests on a curricular foundation that reflects the discipline's theory and knowledge bases, practice patterns, and unique skills. In addition, professional health care education must respond to and reflect changes in technology, societal definitions of health and wellness, and broad social issues such as access to care, health care funding, and changing patient demographics. These issues are interwoven with efforts to also provide high-quality education with positive learning outcomes. In this article, the authors describe a school of nursing's efforts to revise its curriculum to reflect a professional shift in focus to community-based nursing practice and the goals of the federal health goals outlined in Healthy People 2010. The revision also served as the starting point for a change in the process through which the college will seek accreditation in the future; this process-Academic Quality Improvement Program-requires institutions of higher learning to use a continuous quality model as its base.

  15. Three Principles to REVISE People's Unethical Behavior.

    PubMed

    Ayal, Shahar; Gino, Francesca; Barkan, Rachel; Ariely, Dan

    2015-11-01

    Dishonesty and unethical behavior are widespread in the public and private sectors and cause immense annual losses. For instance, estimates of U.S. annual losses indicate $1 trillion paid in bribes, $270 billion lost due to unreported income, and $42 billion lost in retail due to shoplifting and employee theft. In this article, we draw on insights from the growing fields of moral psychology and behavioral ethics to present a three-principle framework we call REVISE. This framework classifies forces that affect dishonesty into three main categories and then redirects those forces to encourage moral behavior. The first principle, reminding, emphasizes the effectiveness of subtle cues that increase the salience of morality and decrease people's ability to justify dishonesty. The second principle, visibility, aims to restrict anonymity, prompt peer monitoring, and elicit responsible norms. The third principle, self-engagement, increases people's motivation to maintain a positive self-perception as a moral person and helps bridge the gap between moral values and actual behavior. The REVISE framework can guide the design of policy interventions to defeat dishonesty.

  16. Taxonomic revision of Rochefortia Sw. (Ehretiaceae, Boraginales)

    PubMed Central

    Irimia, Ramona-Elena

    2016-01-01

    Abstract Background Rochefortia is a small taxon of woody plants in the Ehretiaceae (Boraginales) exhibiting coriaceous leaves with cystoliths, small whitish flowers and drupaceous fruits containing four pyrenes. It shares the dioecious sex distribution with its sister group Lepidocordia and can be delimited from the latter (and all other Ehretiaceae) by the presence of thorns. Neotropical Rochefortia is distributed over most Caribbean islands, Central America and northern South America. Twenty-eight validly published names (corresponding to twenty-one typified taxa at the species level and below) are available in Rochefortia, but the precise number of species to be accepted has been elusive before this revision. New information In the course of the present revision, 353 herbarium collections, comprising approximately 540 Rochefortia specimens, were entried into a BRAHMS data base providing information about protologues and types and retrospective georeferences if possible. Based on the combination of molecular and morphological data we propose to recognise nine species of Rochefortia, namely R. acanthophora, R. bahamensis, R. barloventensis, R. cubensis, R. cuneata, R. lundellii, R. oblongata, R. spinosa and R. stellata (the remaining nineteen validly published names are synonymised under such names). Morphological description of each species and an identification key are provided. PMID:27346952

  17. [Revision of the drinking water regulations].

    PubMed

    Hauswirth, S

    2011-11-01

    The revision the Drinking Water Regulations will come into effect on 01.11.2011. Surveillance authorities and owners of drinking water supply systems had hoped for simplifications and reductions because of the new arrangements. According to the official statement for the revision the legislature intended to create more clarity, consider new scientific findings, to change regulations that have not been proved to close regulatory gaps, to deregulate and to increase the high quality standards. A detailed examination of the regulation text, however, raises doubts. The new classification of water supply systems requires different modalities of registration, water analyses and official observation, which will complicate the work of the authorities. In particular, the implementation of requirements of registration and examination for the owners of commercial and publicly-operated large hot-water systems in accordance with DVGW Worksheet W 551 requires more effort. According to the estimated 30 000 cases of legionellosis in Germany the need for a check of such systems for Legionella, however, is not called into question. Furthermore, the development of sampling plans and the monitoring of mobile water supply systems requires more work for the health authorities.

  18. Patellar options in revision total knee arthroplasty.

    PubMed

    Rorabeck, Cecil H; Mehin, Ramin; Barrack, Robert L

    2003-11-01

    There are numerous options that need to be considered by the surgeon at the time of revision total knee arthroplasty (TKA). One needs to consider the reason for the revision, the type of patella in place, and the length of time the patella has been in place. The surgeon also needs to consider the status of the patellar bone stock, the stability of the patellar component (well-fixed or loose), and the component type (cemented or metal-backed). Assuming that the existing prosthesis is not metal-backed and has minimal PE wear, then it is preferable to retain a well-fixed all-PE cemented patellar button. However, if the button is metal-backed, then it probably is best to remove the button and replace it with an all-PE domed patellar component. Assuming more than 8 mm of patellar bone stock is remaining, it usually is best to cement an all-PE dome-shaped patella. However, if less than 8 mm is remaining, then that patient can be left with a patelloplasty, recognizing that this individual is going to continue with a high likelihood of anterior knee pain, subluxation, and poor functional results. In that situation, it may be preferable to consider a bone stock augmentation.

  19. Setting Writing Revision Goals after Assessment for Learning

    ERIC Educational Resources Information Center

    Huang, Shu-Chen

    2015-01-01

    This study examined the effects of goal setting for revision in an EFL writing classroom where principles of assessment "for" learning (AfL) were followed. Following draft writing, instruction, and assessment, college freshmen were put into control, goal, and goal+ groups. Before students started to revise their drafts, individuals in…

  20. Subject Heading Revision: A System for Small Libraries.

    ERIC Educational Resources Information Center

    Leibtag, Susan

    1982-01-01

    Outlines the processes involved in improving the subject catalog at a medical library. Policy decisions concerning heading sources and revision methodology and plans for analyzing, weeding, and increasing the relevance of subject terms is discussed. The making of catalog changes and the results of catalog revision are also described. (JL)

  1. The Effects of Online Feedback Training on Students' Text Revision

    ERIC Educational Resources Information Center

    Yang, Yu-Fen; Meng, Wen-Ting

    2013-01-01

    Oftentimes, college students who learn English as a Foreign Language (EFL) provide their peers with incorrect and misleading feedback during text revision. To improve the effectiveness of peer feedback, this study examined the degree to which online feedback training impacted EFL college students' text revisions. A sample of 50 college students…

  2. 30 CFR 57.5042 - Revised exposure levels.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Revised exposure levels. 57.5042 Section 57..., Radiation, Physical Agents, and Diesel Particulate Matter Radiation-Underground Only § 57.5042 Revised exposure levels. If levels of permissible exposures to concentrations of radon daughters different...

  3. 30 CFR 57.5042 - Revised exposure levels.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Revised exposure levels. 57.5042 Section 57..., Radiation, Physical Agents, and Diesel Particulate Matter Radiation-Underground Only § 57.5042 Revised exposure levels. If levels of permissible exposures to concentrations of radon daughters different...

  4. 30 CFR 57.5042 - Revised exposure levels.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Revised exposure levels. 57.5042 Section 57..., Radiation, Physical Agents, and Diesel Particulate Matter Radiation-Underground Only § 57.5042 Revised exposure levels. If levels of permissible exposures to concentrations of radon daughters different...

  5. 30 CFR 57.5042 - Revised exposure levels.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Revised exposure levels. 57.5042 Section 57..., Radiation, Physical Agents, and Diesel Particulate Matter Radiation-Underground Only § 57.5042 Revised exposure levels. If levels of permissible exposures to concentrations of radon daughters different...

  6. 30 CFR 57.5042 - Revised exposure levels.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Revised exposure levels. 57.5042 Section 57..., Radiation, Physical Agents, and Diesel Particulate Matter Radiation-Underground Only § 57.5042 Revised exposure levels. If levels of permissible exposures to concentrations of radon daughters different...

  7. 40 CFR 97.24 - NOX Budget permit revisions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 21 2011-07-01 2011-07-01 false NOX Budget permit revisions. 97.24... (CONTINUED) FEDERAL NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS Permits § 97.24 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating permit, except as...

  8. 14 CFR 152.323 - Budget revision: Airport development.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Budget revision: Airport development. 152... TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Accounting and Reporting Requirements § 152.323 Budget... change in the budget estimates, the sponsor shall submit a request for budget revision on a...

  9. 40 CFR 96.25 - NOX Budget permit revisions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 22 2013-07-01 2013-07-01 false NOX Budget permit revisions. 96.25... (CONTINUED) NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO 2 TRADING PROGRAMS FOR STATE IMPLEMENTATION PLANS Permits § 96.25 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating...

  10. 40 CFR 97.24 - NOX Budget permit revisions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 22 2013-07-01 2013-07-01 false NOX Budget permit revisions. 97.24... (CONTINUED) FEDERAL NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS Permits § 97.24 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating permit, except as...

  11. 14 CFR 152.323 - Budget revision: Airport development.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Budget revision: Airport development. 152... TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Accounting and Reporting Requirements § 152.323 Budget... change in the budget estimates, the sponsor shall submit a request for budget revision on a...

  12. 40 CFR 96.25 - NOX Budget permit revisions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 22 2012-07-01 2012-07-01 false NOX Budget permit revisions. 96.25... (CONTINUED) NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS FOR STATE IMPLEMENTATION PLANS Permits § 96.25 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating...

  13. 45 CFR 63.19 - Budget revisions and minor deviations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 1 2014-10-01 2014-10-01 false Budget revisions and minor deviations. 63.19 Section 63.19 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION GRANT PROGRAMS... Budget revisions and minor deviations. Pursuant to § 74.102(d) of this title, paragraphs (b)(3) and...

  14. 40 CFR 97.24 - NOX Budget permit revisions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 21 2014-07-01 2014-07-01 false NOX Budget permit revisions. 97.24... (CONTINUED) FEDERAL NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS Permits § 97.24 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating permit, except as...

  15. 45 CFR 63.19 - Budget revisions and minor deviations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Budget revisions and minor deviations. 63.19 Section 63.19 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GRANT PROGRAMS... Budget revisions and minor deviations. Pursuant to § 74.102(d) of this title, paragraphs (b)(3) and...

  16. 40 CFR 97.24 - NOX Budget permit revisions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 22 2012-07-01 2012-07-01 false NOX Budget permit revisions. 97.24... (CONTINUED) FEDERAL NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS Permits § 97.24 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating permit, except as...

  17. 40 CFR 96.25 - NOX Budget permit revisions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 21 2014-07-01 2014-07-01 false NOX Budget permit revisions. 96.25... (CONTINUED) NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS FOR STATE IMPLEMENTATION PLANS Permits § 96.25 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating...

  18. 45 CFR 63.19 - Budget revisions and minor deviations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Budget revisions and minor deviations. 63.19 Section 63.19 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GRANT PROGRAMS... Budget revisions and minor deviations. Pursuant to § 74.102(d) of this title, paragraphs (b)(3) and...

  19. 14 CFR 152.323 - Budget revision: Airport development.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Budget revision: Airport development. 152... TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Accounting and Reporting Requirements § 152.323 Budget... change in the budget estimates, the sponsor shall submit a request for budget revision on a...

  20. Initiating Curriculum Revision: Exploring the Practices of Educational Developers

    ERIC Educational Resources Information Center

    O'Neill, Geraldine

    2010-01-01

    Curriculum revision is an important part of academic work. Despite theoretical literature on curriculum development and design, there is a scarcity of literature available for either academic staff or novice educational developers on the initiation of this curriculum revision process. This study, therefore, set out to explore the practices of…

  1. 40 CFR 97.24 - NOX Budget permit revisions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false NOX Budget permit revisions. 97.24... (CONTINUED) FEDERAL NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS Permits § 97.24 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating permit, except as...

  2. Is Peer Review Training Effective in Iranian EFL Students' Revision?

    ERIC Educational Resources Information Center

    Esmaeeli, Hadiseh; Abasi, Maasumeh; Soori, Afshin

    2014-01-01

    This study aims to investigate the effect of peer review training on the Iranian EFL students' subsequent revision in an advanced writing class in Larestan Islamic Azad University. After 12 weeks class demonstration, teacher-reviewer conferences with 20 male and female students, the students' first drafts, revisions, and reviewers' comments were…

  3. 14 CFR 77.35 - Extensions, terminations, revisions and corrections.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Extensions, terminations, revisions and corrections. 77.35 Section 77.35 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Studies and Determinations § 77.35 Extensions, terminations, revisions and corrections. (a) You...

  4. 14 CFR 77.35 - Extensions, terminations, revisions and corrections.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false Extensions, terminations, revisions and corrections. 77.35 Section 77.35 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Studies and Determinations § 77.35 Extensions, terminations, revisions and corrections. (a) You...

  5. 14 CFR 77.35 - Extensions, terminations, revisions and corrections.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Extensions, terminations, revisions and corrections. 77.35 Section 77.35 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Studies and Determinations § 77.35 Extensions, terminations, revisions and corrections. (a) You...

  6. 76 FR 33366 - New Jail Planning Initiative; Review and Revision

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-08

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF JUSTICE National Institute of Corrections New Jail Planning Initiative; Review and Revision The following funding... Agreement--New Jail Planning Initiative: Review and Revision. Funding Opportunity Number 11JA03, found...

  7. Improving Revision in Wiki-Based Writing: Coordination Pays Off

    ERIC Educational Resources Information Center

    Wichmann, Astrid; Rummel, Nikol

    2013-01-01

    Wiki-based writing possesses a great deal of educational potential, yet students face difficulties while writing a shared document. Revising a shared document, in particular, seems to be a demanding activity for students. This study investigated whether collaboration scripts can help to improve students' revision activities and overall text…

  8. 49 CFR Appendix C to Part 227 - Audiometric Baseline Revision

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... baseline audiograms. B. Although these procedures can be programmed by a computer to identify records for potential revision, the final decision for revision rests with a human being. Because the goal of the guidelines is to foster consistency among different professional reviewers, human override of the...

  9. Evaluation and Revision of an Introduction to Experiential Rotations Course

    ERIC Educational Resources Information Center

    Dy, Eliza A.; Nisly, Sarah A.

    2014-01-01

    The objectives of this study were to evaluate the perceived student value of topics taught in Butler University's Introduction to Experiential Rotations (RX500) course, implement course revisions to address any perceived weaknesses, and to reassess the course following implementation of those course revisions. Advanced Pharmacy Practice Experience…

  10. 40 CFR 96.25 - NOX Budget permit revisions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS FOR STATE IMPLEMENTATION PLANS Permits § 96.25 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating permit... 40 Protection of Environment 21 2011-07-01 2011-07-01 false NOX Budget permit revisions....

  11. 40 CFR 96.25 - NOX Budget permit revisions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (CONTINUED) NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS FOR STATE IMPLEMENTATION PLANS Permits § 96.25 NOX Budget permit revisions. (a) For a NOX Budget source with a title V operating permit... 40 Protection of Environment 20 2010-07-01 2010-07-01 false NOX Budget permit revisions....

  12. Nurturing Thoughtful Revision Using the Focused Question Card Strategy

    ERIC Educational Resources Information Center

    Sandmann, Alexa

    2006-01-01

    Because revising can feel overwhelming even for competent writers, the author designed the Focused Question Card (FQC) strategy to ease students through a critically important aspect of the writing process--revision. The strategy is ideal for writing intended as thoughtful reflection of thinking over time and can be used with students from fourth…

  13. Using Time-Life Editorial Procedures to Revise Texts.

    ERIC Educational Resources Information Center

    Redd-Boyd, Teresa M.

    To determine whether revisions incorporating features of a Time-Life style would improve students' recall of text, a writer and an editor revised two expository passages from a high school history textbook. They added action verbs, created a sense of drama, made explicit transitions, provided background information, and inserted "nuggets"--vivid…

  14. 14 CFR 152.323 - Budget revision: Airport development.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Budget revision: Airport development. 152... TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Accounting and Reporting Requirements § 152.323 Budget revision: Airport development. (a) If any performance review conducted by the sponsor discloses a need...

  15. 14 CFR 152.323 - Budget revision: Airport development.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Budget revision: Airport development. 152... TRANSPORTATION (CONTINUED) AIRPORTS AIRPORT AID PROGRAM Accounting and Reporting Requirements § 152.323 Budget revision: Airport development. (a) If any performance review conducted by the sponsor discloses a need...

  16. Stalls and Revisions: A Developmental Perspective on Sentence Production

    ERIC Educational Resources Information Center

    Rispoli, Matthew; Hadley, Pamela; Holt, Janet

    2008-01-01

    Purpose: The purpose of this research was to test the empirical validity of the stall-revision distinction and to provide a characterization of the development of sentence production using this distinction. Method: The stall-revision dichotomy for sentence disruptions was studied in 20 typically developing children. The children's production of…

  17. 78 FR 3083 - Revised Pricing for Five 2013 Products

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-15

    ... United States Mint Revised Pricing for Five 2013 Products AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing revised pricing for five 2013 products. Please see the table below. 2013 retail Product price United States Mint Happy Birthday Coin...

  18. 18 CFR 401.6 - Proposed revisions and changes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Proposed revisions and changes. 401.6 Section 401.6 Conservation of Power and Water Resources DELAWARE RIVER BASIN COMMISSION ADMINISTRATIVE MANUAL RULES OF PRACTICE AND PROCEDURE Comprehensive Plan § 401.6 Proposed revisions and...

  19. 42 CFR 416.130 - Publication of revised payment methodologies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Publication of revised payment methodologies. 416.130 Section 416.130 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Facility Services Furnished Before January 1, 2008 § 416.130 Publication of revised payment...

  20. Structural revision of two flavanonol glycosides from Smilax glabra.

    PubMed

    Zhou, Xiang; Xu, Qiang; Li, Jian-Xin; Chen, Ting

    2009-05-01

    The structures of two flavanonol glycosides isolated from Smilax glabra, named smitilbin and neosmitilbin, have been revised to isoastilbin and neoastilbin, respectively. The revised structures were determined based on intensive studies of chemical interconversion, NMR spectroscopy, and X-ray crystallographic analysis. The latest NMR data were also summarized.

  1. 77 FR 72295 - Revision of the Commission's Program Access Rules

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-05

    ... From the Federal Register Online via the Government Publishing Office FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 76 Revision of the Commission's Program Access Rules AGENCY: Federal Communications... Further Notice of Proposed Rulemaking (``FNPRM'') on revisions to the program access rules. The FNPRM...

  2. 36 CFR 212.54 - Revision of designations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... TRAVEL MANAGEMENT Designation of Roads, Trails, and Areas for Motor Vehicle Use § 212.54 Revision of designations. Designations of National Forest System roads, National Forest System trails, and areas on National Forest System lands pursuant to § 212.51 may be revised as needed to meet changing...

  3. 20 CFR 410.676 - Notice of revision.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Notice of revision. 410.676 Section 410.676 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV..., Finality of Decisions, and Representation of Parties § 410.676 Notice of revision. (a) When...

  4. 77 FR 13969 - Revising Standards Referenced in the Acetylene Standard

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-08

    ... the Acetylene Standard AGENCY: Occupational Safety and Health Administration (OSHA), Department of... date of its direct final rule that revises the Acetylene Standard for general industry by updating the... that revised the Acetylene Standard for general industry by updating a reference to the Compressed...

  5. 76 FR 75840 - Revising Standards Referenced in the Acetylene Standard

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-05

    ... the Acetylene Standard AGENCY: Occupational Safety and Health Administration (OSHA), Department of... rulemaking, the Agency is proposing to revise its Acetylene Standard for general industry by updating a... Companion Proposed Rule C. Request for Comment III. Summary and Explanation of Revisions to the...

  6. Fundamentals of Marketing. Missouri Marketing Education Curriculum. Competency Listing. Revised.

    ERIC Educational Resources Information Center

    Smith, Clifton L.

    This guide lists the core curriculum competencies expected to be developed by students in secondary Fundamentals of Marketing courses in Missouri. It was developed through revision of the prior core curriculum by a project team with input from all the marketing instructors in the state. Competencies listed in the revised fundamentals of marketing…

  7. 76 FR 1440 - Notice of Revised Child Outcomes Framework

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-10

    ..., renamed The Head Start Child Development and Learning Framework: Promoting Positive Outcomes in Early... HUMAN SERVICES Administration for Children and Families Notice of Revised Child Outcomes Framework AGENCY: Office of Head Start (OHS), HHS. ACTION: Notice of Revised Child Outcomes Framework....

  8. 78 FR 53794 - Notice of Revision of Standard Form 15

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-30

    ... MANAGEMENT Notice of Revision of Standard Form 15 AGENCY: U.S. Office of Personnel Management. ACTION: Notice... Management and Budget (OMB) a request for clearance of a revised information collection, Standard Form (SF) 15, Application for 10-Point Veteran Preference. The SF-15 is used by agencies, OPM examining...

  9. ISO 9000:2000 revisions and their implications.

    PubMed

    Sim, P

    2000-05-01

    The planned revision of the ISO 9000 series of standards means that all medical device companies will have to revise their quality systems to align them with the new ISO 9000:2000 standards. This overview outlines the changes and the factors companies need to consider, and highlights future standards activity.

  10. A revision of the fern genus Oleandra (Oleandraceae) in Asia

    PubMed Central

    Hovenkamp, Peter H.; Ho, Boon-Chuan

    2012-01-01

    Abstract The Asiatic species of Oleandra (Oleandraceae) are revised. We reduce a large number of species to Oleandra neriiformis and Oleandra sibbaldii, we provide a revised circumscription of Oleandra cumingii and Oleandra undulata and we establish the identity of Oleandra vulpina. In total, we recognize 9 species, with full synonymy, descriptions and distribution maps. A list of identifications is appended. PMID:22577332

  11. 77 FR 42002 - Revision of Approved Information Collection

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-17

    ... Bureau of Land Management Revision of Approved Information Collection AGENCY: Bureau of Land Management, Interior. ACTION: 30-day notice and request for comments. SUMMARY: The Bureau of Land Management (BLM) has submitted an information collection request to the Office of Management and Budget (OMB) to revise...

  12. 12 CFR 573.8 - Revised privacy notices.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 6 2013-01-01 2012-01-01 true Revised privacy notices. 573.8 Section 573.8 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 573.8 Revised privacy notices. (a) General rule. Except as...

  13. 12 CFR 40.8 - Revised privacy notices.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Revised privacy notices. 40.8 Section 40.8 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 40.8 Revised privacy notices. (a) General rule. Except as...

  14. 12 CFR 40.8 - Revised privacy notices.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Revised privacy notices. 40.8 Section 40.8 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 40.8 Revised privacy notices. (a) General rule. Except as...

  15. 12 CFR 1016.8 - Revised privacy notices.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Revised privacy notices. 1016.8 Section 1016.8 Banks and Banking BUREAU OF CONSUMER FINANCIAL PROTECTION PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 1016.8 Revised privacy notices. (a) General rule. Except...

  16. 12 CFR 1016.8 - Revised privacy notices.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 8 2014-01-01 2014-01-01 false Revised privacy notices. 1016.8 Section 1016.8 Banks and Banking BUREAU OF CONSUMER FINANCIAL PROTECTION PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 1016.8 Revised privacy notices. (a) General rule. Except...

  17. 12 CFR 573.8 - Revised privacy notices.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Revised privacy notices. 573.8 Section 573.8 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 573.8 Revised privacy notices. (a) General rule. Except as...

  18. 16 CFR 313.8 - Revised privacy notices.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Revised privacy notices. 313.8 Section 313.8 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 313.8 Revised privacy notices. (a) General rule....

  19. 12 CFR 1016.8 - Revised privacy notices.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Revised privacy notices. 1016.8 Section 1016.8 Banks and Banking BUREAU OF CONSUMER FINANCIAL PROTECTION PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 1016.8 Revised privacy notices. (a) General rule. Except...

  20. 16 CFR 313.8 - Revised privacy notices.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Revised privacy notices. 313.8 Section 313.8 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 313.8 Revised privacy notices. (a) General rule....

  1. 12 CFR 716.8 - Revised privacy notices.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Revised privacy notices. 716.8 Section 716.8 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 716.8 Revised privacy notices. (a)...

  2. 12 CFR 573.8 - Revised privacy notices.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 6 2012-01-01 2012-01-01 false Revised privacy notices. 573.8 Section 573.8 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 573.8 Revised privacy notices. (a) General rule. Except as...

  3. 12 CFR 716.8 - Revised privacy notices.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Revised privacy notices. 716.8 Section 716.8 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 716.8 Revised privacy notices. (a)...

  4. 12 CFR 216.8 - Revised privacy notices.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 2 2012-01-01 2012-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy...

  5. 16 CFR 313.8 - Revised privacy notices.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Revised privacy notices. 313.8 Section 313.8 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 313.8 Revised privacy notices. (a) General rule....

  6. 12 CFR 40.8 - Revised privacy notices.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Revised privacy notices. 40.8 Section 40.8 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 40.8 Revised privacy notices. (a) General rule. Except as...

  7. 12 CFR 573.8 - Revised privacy notices.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 6 2014-01-01 2012-01-01 true Revised privacy notices. 573.8 Section 573.8 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 573.8 Revised privacy notices. (a) General rule. Except as...

  8. 12 CFR 216.8 - Revised privacy notices.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 2 2011-01-01 2011-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy...

  9. 16 CFR 313.8 - Revised privacy notices.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Revised privacy notices. 313.8 Section 313.8 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 313.8 Revised privacy notices. (a) General rule....

  10. 12 CFR 716.8 - Revised privacy notices.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Revised privacy notices. 716.8 Section 716.8 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 716.8 Revised privacy notices. (a)...

  11. 12 CFR 216.8 - Revised privacy notices.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 2 2014-01-01 2014-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy...

  12. 16 CFR 313.8 - Revised privacy notices.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Revised privacy notices. 313.8 Section 313.8 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 313.8 Revised privacy notices. (a) General rule....

  13. 12 CFR 40.8 - Revised privacy notices.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Revised privacy notices. 40.8 Section 40.8 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 40.8 Revised privacy notices. (a) General rule. Except as...

  14. 12 CFR 216.8 - Revised privacy notices.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 2 2013-01-01 2013-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy...

  15. 17 CFR 160.8 - Revised privacy notices.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 17 Commodity and Securities Exchanges 1 2011-04-01 2011-04-01 false Revised privacy notices. 160.8 Section 160.8 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 160.8 Revised privacy notices. (a) General rule....

  16. 12 CFR 40.8 - Revised privacy notices.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Revised privacy notices. 40.8 Section 40.8 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 40.8 Revised privacy notices. (a) General rule. Except as...

  17. 17 CFR 160.8 - Revised privacy notices.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Revised privacy notices. 160.8 Section 160.8 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 160.8 Revised privacy notices. (a) General rule....

  18. 12 CFR 573.8 - Revised privacy notices.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Revised privacy notices. 573.8 Section 573.8 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 573.8 Revised privacy notices. (a) General rule. Except as...

  19. 12 CFR 216.8 - Revised privacy notices.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 2 2010-01-01 2010-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy...

  20. 12 CFR 716.8 - Revised privacy notices.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Revised privacy notices. 716.8 Section 716.8 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS PRIVACY OF CONSUMER FINANCIAL INFORMATION Privacy and Opt Out Notices § 716.8 Revised privacy notices. (a)...

  1. 50 CFR 660.517 - Framework for revising regulations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 13 2013-10-01 2013-10-01 false Framework for revising regulations. 660... Pelagics Fisheries § 660.517 Framework for revising regulations. (a) General. NMFS will establish and... to the framework measures in section 2 of Amendment 8 to the FMP and will be published in the...

  2. 50 CFR 660.517 - Framework for revising regulations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 11 2011-10-01 2011-10-01 false Framework for revising regulations. 660... Pelagics Fisheries § 660.517 Framework for revising regulations. (a) General. NMFS will establish and... to the framework measures in section 2 of Amendment 8 to the FMP and will be published in the...

  3. 50 CFR 660.517 - Framework for revising regulations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 13 2012-10-01 2012-10-01 false Framework for revising regulations. 660... Pelagics Fisheries § 660.517 Framework for revising regulations. (a) General. NMFS will establish and... to the framework measures in section 2 of Amendment 8 to the FMP and will be published in the...

  4. 50 CFR 660.517 - Framework for revising regulations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Framework for revising regulations. 660... Pelagics Fisheries § 660.517 Framework for revising regulations. (a) General. NMFS will establish and... to the framework measures in section 2 of Amendment 8 to the FMP and will be published in the...

  5. 42 CFR 426.463 - Future new or revised LCDs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Future new or revised LCDs. 426.463 Section 426.463 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Review of an LCD § 426.463 Future new or revised LCDs. The contractor may not reinstate an LCD...

  6. 42 CFR 426.463 - Future new or revised LCDs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Future new or revised LCDs. 426.463 Section 426.463 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Review of an LCD § 426.463 Future new or revised LCDs. The contractor may not reinstate an LCD...

  7. Using a Local Area Network to Teach Computer Revision Skills.

    ERIC Educational Resources Information Center

    Thompson, Diane P.

    1989-01-01

    Describes the use of a local area network and video switching equipment in teaching revision skills on computer. Explains that reading stories from texts, rewriting them from differing character viewpoints, and editing them as a group exposed students to a variety of writing problems and stimulated various revision strategies. (SG)

  8. 40 CFR 93.151 - State implementation plan (SIP) revision.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 21 2012-07-01 2012-07-01 false State implementation plan (SIP... implementation plan (SIP) revision. The provisions and requirements of this subpart to demonstrate conformity... nonattainment and maintenance areas where EPA has not approved the General Conformity SIP revision allowed...

  9. 40 CFR 93.151 - State implementation plan (SIP) revision.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 21 2013-07-01 2013-07-01 false State implementation plan (SIP... implementation plan (SIP) revision. The provisions and requirements of this subpart to demonstrate conformity... nonattainment and maintenance areas where EPA has not approved the General Conformity SIP revision allowed...

  10. 40 CFR 93.151 - State implementation plan (SIP) revision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 20 2010-07-01 2010-07-01 false State implementation plan (SIP... implementation plan (SIP) revision. The Federal conformity rules under this subpart, in addition to any existing... requirements until such time as the required conformity SIP revision is approved by EPA. A State's...

  11. 40 CFR 51.851 - State Implementation Plan (SIP) revision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false State Implementation Plan (SIP... Plan (SIP) revision. Link to an amendment published at 75 FR 17272, April 5, 2010. (a) Each State must... to meet the Act requirements until such time as the required conformity SIP revision is approved...

  12. 40 CFR 93.151 - State implementation plan (SIP) revision.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 20 2011-07-01 2011-07-01 false State implementation plan (SIP... implementation plan (SIP) revision. The provisions and requirements of this subpart to demonstrate conformity... nonattainment and maintenance areas where EPA has not approved the General Conformity SIP revision allowed...

  13. 40 CFR 93.151 - State implementation plan (SIP) revision.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 20 2014-07-01 2013-07-01 true State implementation plan (SIP... implementation plan (SIP) revision. The provisions and requirements of this subpart to demonstrate conformity... nonattainment and maintenance areas where EPA has not approved the General Conformity SIP revision allowed...

  14. 76 FR 9079 - Revision of Distilled Spirits Plant Regulations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-16

    ...In this document, the Alcohol and Tobacco Tax and Trade Bureau adopts as a final rule, with some changes, a proposed revision of its distilled spirits plant regulations. The revision modernizes the requirements for operating distilled spirits plants and includes a number of organizational changes to improve the layout of the regulatory texts. These changes make the regulations easier to apply,......

  15. Merlin C. Wittrock and the Revision of Bloom's Taxonomy

    ERIC Educational Resources Information Center

    Krathwohl, David R.; Anderson, Lorin W.

    2010-01-01

    Merl Wittrock, a cognitive psychologist who had proposed a generative model of learning, was an essential member of the group that over a period of 5 years revised the "Taxonomy of Educational Objectives," originally published in 1956. This article describes the development of that 2001 revision (Anderson and Krathwohl, Editors) and Merl's…

  16. 75 FR 3680 - Revisions to the California State Implementation Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-22

    ... AGENCY 40 CFR Part 52 Revisions to the California State Implementation Plan AGENCY: Environmental... Implementation Plan (SIP). These revisions concern oxides of nitrogen (NO X ) from residential water heaters. We... 1990 (CAA or the Act). We are taking comments on this proposal and plan to follow with a final...

  17. 77 FR 24160 - Revisions to the Hawaii State Implementation Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-23

    ... AGENCY 40 CFR Part 52 Revisions to the Hawaii State Implementation Plan AGENCY: Environmental Protection... Implementation Plan (SIP). These revisions would update and replace the minor new source review rules that EPA... not plan to open a second comment period, so anyone interested in commenting should do so at this...

  18. 77 FR 25111 - Revisions to the Hawaii State Implementation Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

    ... AGENCY 40 CFR Part 52 Revisions to the Hawaii State Implementation Plan AGENCY: Environmental Protection... Implementation Plan (SIP). These revisions concern volatile organic compound (VOC), oxides of nitrogen (NO X... not plan to open a second comment period, so anyone interested in commenting should do so at this...

  19. Science. Iowa Developed Energy Activity Sampler, 6-12. Revised.

    ERIC Educational Resources Information Center

    Iowa State Dept. of Education, Des Moines. Div. of Instructional Services.

    The revised Iowa Developed Energy Activity Sampler (IDEAS) was compiled using the original IDEAS program and the Energy Conservation Activity Packets (ECAPS). This document is one of a series of revised IDEAS booklets, and provides activities for teaching science. The activities are intended to present energy principles in an interesting manner…

  20. Mathematics. Iowa Developed Energy Activity Sampler, 6-12. Revised.

    ERIC Educational Resources Information Center

    Iowa State Dept. of Education, Des Moines.

    The revised Iowa Developed Energy Activity Sampler (IDEAS) was compiled using the original IDEAS program and the Energy Conservation Activity Packets (ECAPS). This document is one of the series of revised IDEAS booklets, and provides activities for teaching mathematics. The activities are intended to present energy principles in an interesting…