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Sample records for early surgical results

  1. [Effect of early surgical interventions on results of burn treatment].

    PubMed

    Fistal', N M

    2009-01-01

    Results of treatment of 160 adults which were treated in the department of thermal defeats and plastic surgery of IURS named by V. K. Gusak AMS of Ukraine in 2005-2007 were analysed. 110 men in age 34.82 +/- 1.22 entered a basic group. All patients of this group were operated in early terms 1-2 days after a trauma. The group of comparison is made from 50 men in the same age with identical on an area and depth defeats. The patients of this group had prolongation of the specialized treatment, therefore primary surgical treatment began later. At the analysis of treatment results we found out that early surgical treatment of the burned adult brought to the decline burn disease, reduce the terms of treatment and amount of operative interferences, prevents formation of rough scars and deformations.

  2. Surgical treatment of bronchiectasis: early and long-term results.

    PubMed

    Giovannetti, Riccardo; Alifano, Marco; Stefani, Alessandro; Legras, Antoine; Grigoroiu, Madalina; Collet, Jean-Yves; Magdelenat, Pierre; Regnard, Jean-François

    2008-08-01

    Management of bronchiectasis remains controversial and information on long-term results of surgical treatment is poor. Clinical records of 45 patients, who underwent surgery for bronchiectasis in an 8-year period, were retrospectively reviewed. Bronchiectasis focus was isolated in 24 cases, associated with a limited homolateral or controlateral focus in 9 and 11, respectively; two patients had bilateral evident foci. Bronchiectasis was responsible for lobe destruction in 23 cases. All patients had symptoms: haemoptysis (n=7), recurrent pneumonia (n=7), persistent bronchorrea with recurrent infection (n=15), hemoptysis and recurrent infection (n=16). A total of 23 lobectomies, 11 lobectomies+segmentectomies, 2 bi-lobectomies, 9 segmentectomies and 1 pneumonectomy were carried out. There were no perioperative deaths; complications occurred in 5 patients (postoperative pneumonia in 2, prolonged air-leak, residual air-space and bronchial infection 1 each). Symptoms disappeared in 32 patients, 10 patients experienced a significant improvement. Exercise tolerance remained stable or improved in 33 and 2 cases, respectively, a slight impairment was observed in 9. Out of 32 evaluable patients 11 had an unchanged FEV(1), 15 had a limited FEV(1) lowering (<15%), and 9 had a more important functional loss. Surgical treatment of bronchiectasis obtains satisfactory long-term results, with acceptable morbidity rates.

  3. MIS unicondylar knee arthroplasty: surgical approach and early results.

    PubMed

    Gesell, Mark W; Tria, Alfred J

    2004-11-01

    Unicondylar arthroplasty of the knee has seen a resurgence of interest in the United States. The principles of unicondylar arthroplasty of the knee are different from those for total knee arthroplasty, allowing replacement of only the affected joint compartment with less bone loss. Minimally invasive surgery allows for less soft tissue dissection with the potential for less morbidity. The key question is: will the changes associated with the minimally invasive surgery procedure improve the clinical results of the standard unicondylar arthroplasty of the knee or will the changes make the procedure too difficult and lead to an increasing failure rate? This study reviews the surgical technique and presents the 2 to 4 year results of the minimally invasive unicondylar arthroplasty of the knee 47 knees in 41 patients. The average range of motion increased from 121 degrees -132 degrees . The Knee Society pain score improved from 45-80 and the function score improved from 47-78. Only one knee has been revised. With proper patient selection, minimally invasive unicondylar arthroplasty of the knee allows for results that are at least equal to those of the standard open procedure at 2 to 4 years after the surgery.

  4. Early results of a surgeon-led, perioperative surgical home.

    PubMed

    Powell, Anathea C; Thearle, Marie S; Cusick, Matthew; Sanderson, Dorothy Jensen; Van Lew, Holly; Lee, Candace; Kieran, Jennefer A

    2017-05-01

    The Perioperative Surgical Home is a novel care model designed to provide patient-centered, high-quality surgical care. In 2013, we implemented POSH, a pilot Peri-Operative Surgical Home at Phoenix Indian Medical Center (PIMC), an Indian Health Service hospital, as a quality improvement project. After 2 y, we sought to quantify the impact of POSH on the quality of surgical care at PIMC. We conducted a retrospective review of 33 surgical patients who underwent surgery at PIMC through the POSH process between 2013 and 2015 matched to 64 historical controls with similar operations. Study patients underwent surgery via the POSH treatment process. Primary outcomes were composite measures of (1) care standards and (2) care goals. Success was defined as meeting seven of nine care standards and six of eight care goals. The mean number of care standards met was 8.1 ± 1.0 versus 4.2 ± 1.4 (P < 0.001) and the mean number of care goals met was 6.7 ± 0.8 versus 6.1 ± 1.1 (P = 0.005) for POSH patients and historical controls, respectively. Patients participating in the POSH model were 8.6 (95% confidence interval: 3.5-22.3) and 1.5 (95% confidence interval: 1.2-1.9) times more likely to meet the minimum number of care standards and goals, respectively. Fourteen of the study patients (42%) would not have been offered surgery at PIMC before POSH due to elevated surgical risk. POSH may have improved quality of surgical care at PIMC while expanding services to more complex patients. POSH may present an opportunity for improved surgical quality in resource-constrained environments. Published by Elsevier Inc.

  5. Early results of surgical intervention for elbow deformity in cerebral palsy based on degree of contracture.

    PubMed

    Carlson, Michelle G; Hearns, Krystle A; Inkellis, Elizabeth; Leach, Michelle E

    2012-08-01

    Elbow flexion posture, caused by spasticity of the muscles on the anterior surface of the elbow, is the most common elbow deformity seen in patients with cerebral palsy. This study retrospectively evaluated early results of 2 surgical interventions for elbow flexion deformities based on degree of contracture. We hypothesized that by guiding surgical treatment to degree of preoperative contracture, elbow extension and flexion posture angle at ambulation could be improved while preserving maximum flexion. Eighty-six patients (90 elbows) were treated for elbow spasticity due to cerebral palsy. Seventy-one patients (74 elbows) were available for follow-up. Fifty-seven patients with fixed elbow contractures less than 45° were surgically treated with a partial elbow muscle lengthening, which included partial lengthening of the biceps and brachialis and proximal release of the brachioradialis. Fourteen patients (17 elbows) with fixed elbow contractures ≥ 45° had a more extensive full elbow release, with biceps z-lengthening, partial brachialis myotomy, and brachioradialis proximal release. Age at surgery averaged 10 years (range, 3-20 y) for partial lengthening and 14 years (range, 5-20 y) for full elbow release. Follow-up averaged 22 months (range, 7-144 mo) for partial lengthening and 18 months (range, 6-51 mo) for full elbow release. Both groups achieved meaningful improvement in flexion posture angle at ambulation, active and passive extension, and total range of motion. Elbow flexion posture angle at ambulation improved by 57° and active extension increased 17° in the partial lengthening group, with a 4° loss of active flexion. In the full elbow release group, elbow flexion posture angle at ambulation improved 51° and active extension improved 38°, with a loss of 19° of active flexion. Surgical treatment of spastic elbow flexion in cerebral palsy can improve deformity. We obtained excellent results by guiding the surgical intervention by the amount of

  6. [The early and middle-long term clinical results of surgical treatment for ventricular septal rupture].

    PubMed

    Gan, Hui-Li; Zhang, Jian-Qun; Chen, Bao-Tian; Zhou, Qi-Wen; Gu, Cheng-Xiong; Huang, Fang-Jiong; Wang, Sheng-Xun; Zheng, Si-Hong; Mu, Jun-Sheng

    2009-03-15

    To explore the way of promoting the efficacy of surgical treatment for ventricular septal rupture (VSR) after acute myocardium infarction in terms of perioperative and long term survival. The clinic data of 37 VSR cases underwent surgical treatment from October 1994 to October 2007 were analyzed retrospectively. There were 24 male and 13 female, and the age was (63.4 +/- 7.6) years old. The whole group was divided into the VSR repair plus revascularization group (group A, 26 cases) and simple VSR repair group (group B, 11 cases). There were 4 operative deaths in group A (15.4%), 7 deaths in group B (63.6%), P = 0.006. With the follow-up of (34.0 +/- 29.8) months ranged from 2 to 103 months of the 26 operational survivors, there were 5 late deaths, of which 2 deaths in group A and 3 deaths in group B. According to the Kaplan-Meier survival curve, the actuarial survival rate at 6 to 8 year was (64.3 +/- 21.0)% for group A and the actuarial survival rate at 4 year was (25.0 +/- 21.7)% for group B, P = 0.011. Of the 21 mid-long term survivors, 17 cases were in NYHA class I to II and 4 cases in NYHA class III to IV. There were 4 cases suffered from VSR recurrence. According to Logistic regression, the risk factors for the early death were not adoptive of revascularization, cardiogenic shock and emergency surgical procedure, while the risk factors for late death were not adoptive of revascularization and low cardiac output after the procedures. VSR repair plus revascularization could improve the perioperative and mid-long term survival for the surgical treatment of VSR. The appropriate timing and procedures of the surgical operation are very important to promote perioperative survival and to prevent VSR recurrence.

  7. Postoperative surveillance recommendations for early stage colon cancer based on results from the clinical outcomes of surgical therapy trial.

    PubMed

    Tsikitis, Vassiliki L; Malireddy, Kishore; Green, Erin A; Christensen, Brent; Whelan, Richard; Hyder, Jace; Marcello, Peter; Larach, Sergio; Lauter, David; Sargent, Daniel J; Nelson, Heidi

    2009-08-01

    Intensive postoperative surveillance is associated with improved survival and recommended for patients with late stage (stage IIB and III) colon cancer. We hypothesized that stage I and IIA colon cancer patients would experience similar benefits. Secondary analysis of data from the Clinical Outcomes of Surgical Therapy trial was performed by analyzing results according to TNM stage; early (stage I and IIA, 537 patients) and late (stage IIB and III, 254 patients) stage disease. Five-year recurrence rates were higher in patients with late (35.7%) versus early stage disease (9.5%). Early and late stage salvage rates, recurrence patterns and methods of first detection were compared by chi(2) test. Salvage rates for early- and late-stage disease patients with recurrence were the same (35.9% v 37%; P = .9, respectively). Median survival after second surgery after recurrence was 51.2 and 35.8 months for early- and late-stage patients, respectively. Single sites of first recurrence did not significantly differ between early and late stage, but multiple sites of recurrence occurred less often in early-stage patients (3.6% v 28.6%, for early v late, respectively; P < .001). METHODS of first detection of recurrence were not significantly different: carcinoembryonic antigen (29.1% v 37.4%), computed tomography scan (23.6% v 26.4%), chest x-ray (7.3% v 12.1%), and colonoscopy (12.7% v 8.8%), for early versus late stage disease, respectively. Patients with early-stage colon cancer have similar sites of recurrence, and receive similar benefit from postrecurrence therapy as late-stage patients; implementation of surveillance guidelines for early-stage patients is appropriate.

  8. Early promising results for the endoscopic surgical treatment of Cushing's disease.

    PubMed

    Berker, Mustafa; Işikay, Ilkay; Berker, Dilek; Bayraktar, Miyase; Gürlek, Alper

    2013-11-15

    High levels of endogenous cortisol due to Cushing's disease cause significant mortality and morbidity. Treatment of Cushing's disease is challenging. For many years, transsphenoidal microsurgical resection of the adenoma has been the treatment of choice. However, recently, neuroendoscope has taken its place in the neurosurgeon's armamentarium, and the endoscopic transsphenoidal resection of pituitary tumors has become a familiar approach. Our aim was to present the results of pure endoscopic surgery in the treatment of corticotropinomas for comparison with the results of previous endoscopic and microsurgical series. We present a retrospective analysis of 90 patients with diagnosis of Cushing's disease who were operated between 2006 and 2012. Among 90 patients, a total of 81 (90.0 %) had a remission (28 out of 29 macroadenomas (96.6 %) and 53 out of 61 microadenoma patients (86.9 %)). Of note is that 66 out of 69 (95.7 %) primary patients (i.e., those who were operated in our center) and 15 out of 21 (71.4 %) patients previously operated in other centers reached a hypo/eucortisolemic state. A remission rate comparable with previous endoscopic series was achieved. In nine patients, it was not possible to achieve remission at all. On the other hand, only four of our cases (5.6 %) had a recurrence, and with reoperation, all of these patients entered a re-remission. To our knowledge, our series is the largest series studying endoscopically operated adrenocorticotropic hormone-secreting adenomas. Our results suggest that the endoscopic approach has opened a new avenue in the treatment of Cushing's disease, previously a therapeutic challenge for both the clinician and the neurosurgeon. Endoscopic approach in the treatment of Cushing's disease is clearly better for patients because of its low morbidity rates and short duration of hospital stay. On the other hand, long-term follow-up of our patients will show whether these favorable observations will persist.

  9. Surgical treatment of severe necrotizing pancreatitis by the method of "open abdomen"--early and long-term results.

    PubMed

    Piotrowski, Z; Tołwiński, W

    2000-01-01

    The aim of our study was the evaluation of "open abdomen" method (OAM) in treatment of severe acute pancreatitis. Fifty patients were treated by this technique in our Department from 1983 to 1999 year. Patients were retrospectively classified into 3 groups: with sterile pancreatic necrosis (SPN), pancreatic abscess(PA) and infected pancreatic necrosis(IPN). Early results embraced: number of local and general complications and a lot of parameters, which let to recognise objectively efficiency of management(time of hospital and intensive care unit stay, time of total parenteral nutrition, number of reoperations and others). These results were compared with analogical groups, in which used other management. Long-term results embraced the pancreatic efficiency tests in 24 patients in period 2-16 years after surgical treatment of OAM. Based on these results three groups of patients were separated: 12 persons (50%) recognised healthy, 4 (17%) with exocrine insufficiency of pancreas and 8 (33%) with exocrine and endocrine insufficiency of pancreas. Our results prove that OAM is the efficient treatment of IPN, but it shouldn't be used in cases of PA or SPN. Patients after OAM need prospective monitoring of exocrine and endocrine pancreatic function due to serious risk of this organ dysfunction.

  10. Do Psychological Variables Affect Early Surgical Recovery?

    PubMed Central

    Mavros, Michael N.; Athanasiou, Stavros; Gkegkes, Ioannis D.; Polyzos, Konstantinos A.; Peppas, George; Falagas, Matthew E.

    2011-01-01

    Background Numerous studies have examined the effect of psychological variables on surgical recovery, but no definite conclusion has been reached yet. We sought to examine whether psychological factors influence early surgical recovery. Methods We performed a systematic search in PubMed, Scopus and PsycINFO databases to identify studies examining the association of preoperative psychological variables or interventions with objectively measured, early surgical outcomes. Results We identified 16 eligible studies, 15 of which reported a significant association between at least one psychological variable or intervention and an early postoperative outcome. However, most studies also reported psychological factors not influencing surgical recovery and there was significant heterogeneity across the studies. Overall, trait and state anxiety, state anger, active coping, subclinical depression, and intramarital hostility appeared to complicate recovery, while dispositional optimism, religiousness, anger control, low pain expectations, and external locus of control seemed to promote healing. Psychological interventions (guided relaxation, couple support visit, and psychiatric interview) also appeared to favor recovery. Psychological factors unrelated to surgical outcomes included loneliness, perceived social support, anger expression, and trait anger. Conclusion Although the heterogeneity of the available evidence precludes any safe conclusions, psychological variables appear to be associated with early surgical recovery; this association could bear important implications for clinical practice. Large clinical trials and further analyses are needed to precisely evaluate the contribution of psychology in surgical recovery. PMID:21633506

  11. Early results from an angiosome-directed open surgical technique for venous arterialization in patients with critical lower limb ischemia

    PubMed Central

    Houlind, Kim; Christensen, Johnny; Hallenberg, Christian; Jepsen, Jørn M.

    2013-01-01

    Background Patients with critical lower limb ischemia without patent pedal arteries cannot be treated by the conventional arterial reconstruction. Venous arterialization has been suggested to improve limb salvage in this subgroup of patients but has not gained wide acceptance. We report our early experience after implementing deep and superficial venous arterialization of the lower limb. Materials and methods Ten patients with critical ischemia and without crural or pedal arteries available for conventional bypass surgery or angioplasty were treated with distal venous arterialization. Inflow was from the most distal unobstructed segment. Run-off was the dorsal pedal venous arch (n=5), the dorsal pedal venous arch and a concomitant vein of the posterior tibial artery (n=3), or the dorsal pedal venous arch and a concomitant vein of the common plantar artery (n=2) depending on the location of the ischemic lesion. Venous valves were destroyed using antegrade valvulotomes, guide wires, knob needles, or retrograde valvulotomes via an extra incision. Results Seven of the operated limbs were amputated after 23 (1–256) days (median [range]). The main reasons for amputation were lack of healing of either the original wound, of incisional wounds on the foot, or persisting pain at rest. In three cases, the bypass was open at the time of amputation. Two patients experienced complete wound healing after 231 and 342 days, respectively. By the end of follow-up, the last patient was ambulating with slow wound healing but without pain 309 days after surgery. Conclusion Venous arterialization may be used as a treatment of otherwise unsalveable limbs. The success rate is, however, limited. Technical optimization of the technique is warranted. PMID:24358432

  12. Early results from an angiosome-directed open surgical technique for venous arterialization in patients with critical lower limb ischemia.

    PubMed

    Houlind, Kim; Christensen, Johnny; Hallenberg, Christian; Jepsen, Jørn M

    2013-01-01

    Patients with critical lower limb ischemia without patent pedal arteries cannot be treated by the conventional arterial reconstruction. Venous arterialization has been suggested to improve limb salvage in this subgroup of patients but has not gained wide acceptance. We report our early experience after implementing deep and superficial venous arterialization of the lower limb. Ten patients with critical ischemia and without crural or pedal arteries available for conventional bypass surgery or angioplasty were treated with distal venous arterialization. Inflow was from the most distal unobstructed segment. Run-off was the dorsal pedal venous arch (n=5), the dorsal pedal venous arch and a concomitant vein of the posterior tibial artery (n=3), or the dorsal pedal venous arch and a concomitant vein of the common plantar artery (n=2) depending on the location of the ischemic lesion. Venous valves were destroyed using antegrade valvulotomes, guide wires, knob needles, or retrograde valvulotomes via an extra incision. Seven of the operated limbs were amputated after 23 (1-256) days (median [range]). The main reasons for amputation were lack of healing of either the original wound, of incisional wounds on the foot, or persisting pain at rest. In three cases, the bypass was open at the time of amputation. Two patients experienced complete wound healing after 231 and 342 days, respectively. By the end of follow-up, the last patient was ambulating with slow wound healing but without pain 309 days after surgery. Venous arterialization may be used as a treatment of otherwise unsalveable limbs. The success rate is, however, limited. Technical optimization of the technique is warranted.

  13. Surgical Data and Early Postoperative Outcomes after Minimally Invasive Lumbar Interbody Fusion: Results of a Prospective, Multicenter, Observational Data-Monitored Study

    PubMed Central

    Pereira, Paulo; Buzek, David; Franke, Jörg; Senker, Wolfgang; Kosmala, Arkadiusz; Hubbe, Ulrich; Manson, Neil; Rosenberg, Wout; Assietti, Roberto; Martens, Frederic; Barbanti Brodano, Giovanni; Scheufler, Kai-Michael

    2015-01-01

    Minimally invasive lumbar interbody fusion (MILIF) offers potential for reduced operative morbidity and earlier recovery compared with open procedures for patients with degenerative lumbar disorders (DLD). Firm conclusions about advantages of MILIF over open procedures cannot be made because of limited number of large studies of MILIF in a real-world setting. Clinical effectiveness of MILIF in a large, unselected real-world patient population was assessed in this Prospective, monitored, international, multicenter, observational study. Objective: To observe and document short-term recovery after minimally invasive interbody fusion for DLD. Materials and Methods: In a predefined 4-week analysis from this study, experienced surgeons (≥30 MILIF surgeries pre-study) treated patients with DLD by one- or two-level MILIF. The primary study objective was to document patients’ short-term post-interventional recovery (primary objective) including back/leg pain (visual analog scale [VAS]), disability (Oswestry Disability Index [ODI]), health status (EQ-5D) and Patient satisfaction. Results: At 4 weeks, 249 of 252 patients were remaining in the study; the majority received one-level MILIF (83%) and TLIF was the preferred approach (94.8%). For one-level (and two-level) procedures, surgery duration was 128 (182) min, fluoroscopy time 115 (154) sec, and blood-loss 164 (233) mL. Time to first ambulation was 1.3 days and time to study-defined surgery recovery was 3.2 days. Patients reported significantly (P < 0.0001) reduced back pain (VAS: 2.9 vs 6.2), leg pain (VAS: 2.5 vs 5.9), and disability (ODI: 34.5% vs 45.5%), and a significantly (P < 0.0001) improved health status (EQ-5D index: 0.61 vs 0.34; EQ VAS: 65.4 vs 52.9) 4 weeks postoperatively. One adverse event was classified as related to the minimally invasive surgical approach. No deep site infections or deaths were reported. Conclusions: For experienced surgeons, MILIF for DLD demonstrated early benefits (short time to

  14. [Acute acalculous cholecystitis. Results of surgical treatment].

    PubMed

    de la Garza Villaseñor, L

    1993-01-01

    During an 11 year period, 47 patients with acute acalculous cholecystitis were operated on. Two to one male/female ratio was observed with a mean age of 55 age of 55 years. No one had a past history of biliary tract pathology but 70 per cent of the patients had risk factors, mainly diabetes mellitus, cardiovascular and collagenous diseases, some different of those reported in the world literature (sepsis, trauma, non biliary tract surgery, etc.). The ultrasound was the best diagnostic tool. Open cholecystectomy was performed in all patients and some sort of local complication was found in 85 per cent of patients (empyema, gangrene or perforation) in spite of the surgical procedure was done on emergency or early elective basis, a 31 per cent operative mortality rate was found and a 10.6% Operative mortality rates was observed. The bacterial cultures showed gram negative and anaerobic flora. This report shows that an early diagnosis and surgical treatment keeps a low morbidity and mortality rates but the gallbladder late complications have a high rates.

  15. [Results of the surgical treatment of thyrotoxicosis].

    PubMed

    Uchikov, A; Nonchev, B; Danev, V; Murdzhev, K; Vladeva, S; Terzieva, D

    2006-01-01

    The aim of this study was to evaluate the results of the surgical treatment of patients with thyrotoxicosis in three surgical clinics in Plovdiv. PATIENTS AND MEDHOTS: We studied 90 patients, who underwent surgical treatment for thyrotoxicosis between 2000-2004. Of those 19 men (21%) and 71 women (79%); men:women = 1:3.74; mean age 38 +/- 8.3 years. The nosological distribution was as follows: Graves' disease--72 subjects (80.00%), solitary toxic adenoma--4 subjects (4.40%), toxic nodular goiter--14 subjects (15.60%). 77 subtotal thyroidectomies (85%) and 9 total thyroidectomies were performed. Patients with solitary toxic adenoma underwent lobectomy. Massive bleeding witch required revision and haemostasis was encountered in 1 patient. Transient laryngeal nerve injury occurred in 3 patients (3.33%), and temporary hypoparathyroidism in 6 subjects (6.67%), necessitating calcium supplementation. One year postoperatively, 49.35% (n = 38) of the patients who have undergone subtotal thyroidectomy were euthyroid, 45.45% (n = 35) developed hypothyroidism, and 5.2% (n = 4) relapsed. Our results indicate that surgery is safe and effective for patients with thyrotoxicosis referred for radical treatment. Because of the high rate of postoperative thyroid disfunction, assessment of the non-operative factors, witch influence the functional results, is recommended.

  16. Early physics results.

    PubMed

    Jenni, Peter

    2012-02-28

    For the past year, experiments at the Large Hadron Collider (LHC) have started exploring physics at the high-energy frontier. Thanks to the superb turn-on of the LHC, a rich harvest of initial physics results have already been obtained by the two general-purpose experiments A Toroidal LHC Apparatus (ATLAS) and the Compact Muon Solenoid (CMS), which are the subject of this report. The initial data have allowed a test, at the highest collision energies ever reached in a laboratory, of the Standard Model (SM) of elementary particles, and to make early searches Beyond the Standard Model (BSM). Significant results have already been obtained in the search for the Higgs boson, which would establish the postulated electro-weak symmetry breaking mechanism in the SM, as well as for BSM physics such as Supersymmetry (SUSY), heavy new particles, quark compositeness and others. The important, and successful, SM physics measurements are giving confidence that the experiments are in good shape for their journey into the uncharted territory of new physics anticipated at the LHC.

  17. Effects of Early Surgical Exploration in Suspected Barotraumatic Perilymph Fistulas

    PubMed Central

    Park, Ga Young; Byun, HaYoung; Moon, Il Joon; Hong, Sung Hwa; Cho, Yang-Sun

    2012-01-01

    Objectives Treatment of traumatic perilymph fistula (PLF) remains controversial between surgical repair and conservative therapy. The aim of this study is to analyze the outcomes of early surgical exploration in suspected barotraumatic PLF. Methods Nine patients (10 cases) who developed sudden sensorineural hearing loss and dizziness following barotrauma and underwent surgical exploration with the clinical impression of PLF were enrolled. Types of antecedent trauma, operative findings, control of dizziness after surgery, postoperative hearing outcomes, and relations to the time interval between traumatic event and surgery were assessed retrospectively. Results All patients had sudden or progressive hearing loss and dizziness following trauma. Types of barotrauma were classified by the origin of the trauma: 4 external (car accident, slap injury) and 6 internal traumas (lifting, nasal blowing, straining). Surgical exploration was performed whenever PLF was suspected with the time interval of 2 to 47 days after the trauma. The possible evidence of PLF was found during surgery in 9 cases: a fibrous web around the oval window (n=3), fluid collection in the round window (RW; n=6) and bulging of the RW pseudomembrane (n=1). In every patient, vestibular symptoms disappeared immediately after surgery. The hearing was improved with a mean gain of 27.0±14.9 dB. When the surgical exploration was performed as early as less than 10 days after the trauma, serviceable hearing (≤40 dB) was obtained in 4 out of 7 cases (57.1%). Conclusion Sudden or progressive sensorineural hearing loss accompanied by dizziness following barotrauma should prompt consideration of PLF. Early surgical exploration is recommended to improve hearing and vestibular symptoms. PMID:22737287

  18. Lesson learned from early and long-term results of 327 cases of coexisting surgical abdominal diseases and aortic aneurysms treated in open and endovascular surgery.

    PubMed

    Bonardelli, Stefano; Cervi, Edoardo; Nodari, Franco; Guadrini, Cristina; Zanotti, Camilla; Giulini, Stefano Maria

    2012-06-01

    Patients with abdominal aortic aneurysm (AAA) frequently have other abdominal pathologies of surgical interest (other diseases, OD). Out of 1,375 elective open aortic replacements for AAA, 315 cases with OD were subdivided in Group 1 (82 patients with "clean wound" OD) and Group 2 (233 patients with "clean-contaminated wound" OD). The results of the sub-groups in which OD was treated at the same time as AAA were analysed (1a, 66 cases and 2a, 86 cases) and compared with OD not treated at the same time as AAA (1b, 16 cases and 2b, 147 cases). EVAR was done in 12 patients with a infrarenal AAA and concomitant abdominal disease. In this group post-operative complications occurred in two patients (endoleaks) and no sign of endograft infection was developed. Mean follow-up was 36 months. Mortality was 0% in Group 1a, 1b, 2b and 5.8% in Group 2a. In Group 1a there were one haemoperitoneum, one ischaemic colitis and one graft infection. In Group 1b there were 4 nefrectomies for renal carcinoma and three emergency hernia repairs within 18 months from AAA operation. In Group 2a the follow-up was uneventful. In Group 2b there was no acute complication of OD and 57.2% of patients were subsequently operated for OD. In the EVAR group the 30-day and late mortality rates were 0 and 25%, respectively and all deaths were cancer-related. Contemporary correction of OD in open surgery for AAA should be performed in clean wound cases, while clean-contaminated operations can be done only in selected cases. EVAR is a valid alternative technique to open vascular surgery for the concomitant treatment of aortic aneurysms and abdominal pathologies.

  19. Aortopulmonary window--impact of associated lesions on surgical results.

    PubMed

    Gangana, Cinthia Siqueira; Malheiros, Ana Flávia de Araújo; Alves, Elizabete Vilar; de Azevedo, Maurício Amir; Bernardes, Renata Moll; Simões, Luiz Carlos

    2007-04-01

    The aortopulmonary window (APW) is a communication between the pulmonary artery (PA) and the ascending aorta in the presence of two separate semilunar valves. This review describes the natural history of the APW and the impact of associated defects on surgical results in patients treated at our institution. Retrospective longitudinal study, based on the review of medical files of patients diagnosed between 1995 and 2005. Of nine patients diagnosed as having APW, six had associated lesions. Seven patients were submitted to surgical treatment with two deaths. One patient was not submitted to surgery due to pulmonary hypertension and another one died before the surgery due to a respiratory infection complication. The surgical results are satisfactory when the APW presents as an isolated defect and when surgery is performed early, preventing the development of irreversible arterial pulmonary hypertension (APH). The presence of associated complex congenital heart disease is a bad prognostic factor in our series.

  20. Surgical ablation for atrial fibrillation: techniques, indications, and results

    PubMed Central

    Lawrance, Christopher P.; Henn, Matthew C.; Damiano, Ralph J.

    2015-01-01

    Purpose of review The aim of this review is to focus specifically on the indications, evolution of technique, and results of surgical ablation for atrial fibrillation. Recent findings With the introduction of the Cox-Maze IV procedure utilizing bipolar radiofrequency ablation and cryoablation, long-term studies have demonstrated a significant decrease in aortic cross-clamp times and major complications with a comparable rate of restoration of sinus rhythm. New hybrid approaches utilizing both catheter-based ablation and minimally invasive surgical approaches have been developed, but have not been standardized. Early studies have demonstrated reasonable success rates of hybrid procedures, with advantages that include confirmation of conduction block, decreased surgical morbidity, and possibly reduced morbidity. However, hybrid approaches have the disadvantage of significantly increased operative times. Summary The Cox-Maze IV is currently the gold standard for surgical treatment of atrial fibrillation. New hybrid approaches have potential advantages with promising early results, but a standard lesion set, improvement in operative times, and long-term results still need to be evaluated. PMID:25389650

  1. Amygdalohippocampotomy: surgical technique and clinical results.

    PubMed

    Gonçalves-Ferreira, Antonio; Campos, Alexandre Rainha; Herculano-Carvalho, Manuel; Pimentel, Jose; Bentes, Carla; Peralta, Ana Rita; Morgado, Carlos

    2013-05-01

    The removal of mesial temporal structures, namely amygdalohippocampectomy, is the most efficient surgical procedure for the treatment of epilepsy. However, disconnection of the epileptogenic zones, as in temporal lobotomy or, for different purposes, hemispherotomy, have shown equivalent results with less morbidity. Thus, authors of the present study began performing selective amygdalohippocampotomy in cases of refractory mesial temporal lobe epilepsy (TLE) to treat mesial temporal lobe sclerosis (MTLS). The authors conducted a retrospective analysis of all cases of amygdalohippocampotomy collected in a database between November 2007 and March 2011. Since 2007, 21 patients (14 males and 7 females), ages 20-58 years (mean 41 years), all with TLE due to MTLS, were treated with selective ablation of the lateral amygdala plus perihippocampal disconnection (anterior one-half to two-thirds in dominant hemisphere), the left side in 11 cases and the right in 10. In 20 patients the follow-up was 2 or more years (range 24-44 months, average 32 months). Clinical outcome for epilepsy 2 years after surgery (20 patients) was good/very good in 19 patients (95%) with an Engel Class I (15 patients [75%]) or II outcome (4 patients [20%]) and bad in 1 patient (5%) with an Engel Class IV outcome (extratemporal focus and later reoperation). Surgical morbidity included hemiparesis (capsular hypertensive hemorrhage 24 hours after surgery, 1 patient), verbal memory worsening (2 patients), and quadrantanopia (permanent in 2 patients, transient in 1). Late psychiatric depression developed in 3 cases. Operative time was reduced by about 30 minutes (15%) on average with this technique. Amygdalohippocampotomy is as effective as amygdalohippocampectomy to treat MTLS and is a potentially safer, time-saving procedure.

  2. Early results from ISO

    NASA Astrophysics Data System (ADS)

    1996-01-01

    First findings by Europe's new space telescope ISO (Infrared Space Observatory) will be announced at a press conference to be held at ESA's satellite tracking station in Villafranca, Apartado 50727 - 28080-Madrid, on Wednesday 14 February 1996 Astronomers responsible for ISO's instruments will show results ranging from materials in the planet Saturn, through the birth and death of stars, to the behaviour of colliding galaxies. All instruments are working well and even their preliminary results confirm that ISO is a unique observatory making an unprecedented exploration of the universe by infrared rays. Parallel press conferences will be held at ESA Headquarters in Paris, ESTEC Noordwijk (the Netherlands) and ESOC Darmstadt (Germany) where a live television link will be established with Villafranca and from where the media can participate in the discussion.

  3. Early Results from the Flexibility in Surgical Training Research Consortium: Resident and Program Director Attitudes Toward Flexible Rotations in Senior Residency.

    PubMed

    Klingensmith, Mary E; Awad, Michael; Delman, Keith A; Deveney, Karen; Fahey, Thomas J; Lees, Jason S; Lipsett, Pamela; Mullen, John T; Smink, Douglas S; Wayne, Jeffrey

    2015-01-01

    To assess the attitudes of residents and program directors (PDs) involved in flexible training to gauge satisfaction with this training paradigm and elicit limitations. Anonymous surveys were sent to residents and PDs in participant programs. Respondents were asked to rate responses on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree). A total of 9 residency programs that are collaborating to prospectively study the effect of flexible tracks on resident performance and outcome. A total of 138 residents who were in clinical years 4 and 5 and 10 PDs. Of the 138 possible residents, 100 responded to the resident survey (72.5% response rate). Among resident respondents, 33% were participating in a flexible track option. The most frequently listed specialties of focus were cardiothoracic surgery (19%), vascular surgery (13%), acute care surgery (11%), colorectal surgery (8%), surgical oncology (7%), and pediatric surgery (7%). Participants in flexible tracks tended to strongly agree that their career would be enhanced by flexible rotations; interestingly, of those not in flexible tracks, most tended to also agree that flexible rotations would enhance their future careers. Flexible track participants report receiving greater autonomy on flexible rotations and believe they would be better prepared for fellowship and career. They express overall very high satisfaction with the flexible experience. Limitations expressed by residents (in flexible tracks or not) include uncertainty for how this paradigm serves those interested in comprehensive general surgery, concern about scheduling difficulties, and some displeasure in missing high-volume general surgery rotations in lieu of specialty-focused rotations. The PD survey was completed by 8 of 9 PDs for a response rate of 89%. All the respondents agreed or strongly agreed that careers of residents are enhanced by flexible rotations and that important operative and clinical experiences are gained. Overall, 87

  4. Surgical treatment of cervical spine trauma: Our experience and results

    PubMed Central

    Dobran, Mauro; Iacoangeli, Maurizio; Nocchi, Niccolò; Di Rienzo, Alessandro; di Somma, Lucia Giovanna Maria; Nasi, Davide; Colasanti, Roberto; Al-Fay, Mohuammad; Scerrati, Massimo

    2015-01-01

    Objective and Background: The objective of this study is to evaluate how the neurological outcome in patients operated for cervical spinal cord injury (SCI) is influenced by surgical timing, admission American Spinal Injury Association (ASIA) grading system, and age. Materials and Methods: From January 2004 to December 2011, we operated 110 patients with cervical SCI. Fifty-seven of them (44 males and 13 females) with preoperative neurological deficit, were included in this study with a complete follow-up. Age, sex, associated comorbidities (evaluated with Charlson comorbidity index [CCI]), mechanism of trauma, preoperative and follow-up ASIA score, time elapsed from injury to surgical treatment, preoperative cervical computed tomography scan or magnetic resonance imaging, type of fractures, and surgical procedure were evaluated for each patient. The patient population was divided into two groups related to the timing of surgery: Ultra-early surgery group (within 12 h from the trauma, 27 patients) and early surgery (within 12–72 h from the trauma, 30 patients). Statistical Analysis Used: The univariate analysis of data was carried out by the Chi-square test for discrete variables, the t-test for the continuous ones. Logistic regression was used for the multivariate analysis. Results: Neurological outcome was statistically better in ultra-early surgery group (<12 h) than in patient underwent surgery within 12–72 h (82.14% vs. 31%, multivariate analysis P = 0.005). The neurological improvement was also correlated with the age and the ASIA grade at admission in the univariate analysis (P = 0.006 and P = 0.017 respectively) and in the multivariate 1 (P = 0.037 and P = 0.006 respectively) while the CCI was correlated with the improvement only in the univariate analysis (P = 0.007). Conclusion: Nowadays, in patients with cervical SCI early surgery could be associated with improved outcome, most in case of young people with mild neurological impairment. PMID:26396608

  5. Surgical results of sacral perineural (Tarlov) cysts.

    PubMed

    Tanaka, Masato; Nakahara, Shinnosuke; Ito, Yasuo; Nakanishi, Kazuo; Sugimoto, Yoshihisa; Ikuma, Hisanori; Ozaki, Toshifumi

    2006-02-01

    The purpose of this study was to investigate the surgical outcomes and to determine indicators of the necessity of surgical intervention. Twelve consecutive patients harboring symptomatic sacral perineural cysts were treated between 1995 and 2003. All patients were assessed for neurological deficits and pain by neurological examination. Magnetic resonance of imaging, computerized tomography, and myelography were performed to detect signs of delayed filling of the cysts. We performed a release of the valve and imbrication of the sacral cysts with laminectomies in 8 cases or recapping laminectomies in 4 cases. After surgery, symptoms improved in 10 (83%) of 12 patients, with an average follow-up of 27 months. Ten patients had sacral perineural cysts with signs of positive filling defect. Two (17%) of 12 patients experienced no significant improvement. In one of these patients, the filling defect was negative. In conclusion, a positive filling defect may become an indicator of good treatment outcomes.

  6. The surgical management of early-stage cervical cancer.

    PubMed

    Salicrú, Sabina R; de la Torre, Javier F V; Gil-Moreno, Antonio

    2013-08-01

    The main objective is to update the literature data in the last year which may support a surgical approach to early cervical cancer [ECC; Stage International Federation of Gynecology and Obstetrics (FIGO) IA-IB1-IIA1]. Radical hysterectomy remains the gold standard by most international guidelines because surgical treatment has hardly changed in recent decades, except for stage IA1. Trends in clinical research in the past 12-18 months involve minimal invasive surgery (with laparoscopic surgery or robotic-assisted surgery), fertility preservation (in the initial stages and in the absence of bad prognostic factors), nerve-sparing and sentinel node techniques. Some institutions have published studies in specific groups such as older, obese or pregnant women. There is a growing trend to practice less aggressive surgery in order to preserve fertility in young women and avoid an excess of treatment in some selected patients. Therefore, nerve-sparing techniques can help to improve the quality of life. More studies are needed to demonstrate oncologic results of the sentinel node technique. Laparoscopic and robotic-assisted surgery can substitute open surgical treatment.

  7. Early and late surgical site infections in ear surgery.

    PubMed

    Bastier, P L; Leroyer, C; Lashéras, A; Rogues, A-M; Darrouzet, V; Franco-Vidal, V

    2016-04-01

    A retroauricular approach is routinely used for treating chronic otitis media. The incidence of surgical site infections after ear surgery is around 10% in contaminated or dirty procedures. This observational prospective study describes surgical site infections after chronic otitis media surgery with the retroauricular approach and investigated their potential predictive factors. This observational prospective study included patients suffering from chronic otitis media and eligible for therapeutic surgery with a retroauricular approach. During follow-up, surgical site infections were defined as "early" if occurring within 30 days after surgery or as "late" if occurring thereafter. The data of 102 patients were analysed. Concerning early surgical site infections, four cases were diagnosed (3.9%) and a significant association was found with preoperative antibiotic therapy, wet ear at pre-operative examination, class III (contaminated) in the surgical wound classification, NNIS (National Nosocomial Infection Surveillance) index > 1, and oral post-operative antibiotic use. Seven late surgical site infections were diagnosed (7.1%) between 90 and 160 days after surgery and were significantly correlated to otorrhoea during the 6 months before surgery, surgery duration ≤60 minutes, canal wall down technique and use of fibrin glue. Surgical site infections after chronic otitis media surgery seem to be associated with factors related to the inflammatory state of the middle ear at the time of surgery in early infections and with chronic inflammation in late infections.

  8. Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation.

    PubMed

    Song, Tengfei; Yan, Xu; Ye, Tianwen

    2016-06-01

    The aim of this study is to compare the clinical and radiographic results and the complication rate between early and delayed surgical treatment of acromioclavicular joint (ACJ) dislocation. Publications in the management of ACJ dislocation are identified from the PubMed database between January 1993 and December 2013 using "acromioclavicular joint" and "dislocation" as keywords. The eligibility criteria included are as follows: (1) ACJ dislocation; (2) intervention, early compared with delayed surgical treatment or the surgical treatment for acute compared with chronic ACJ dislocation; (3) human; and (4) English articles. Exclusion criteria consist of the following: (1) type I and type II ACJ dislocation, (2) no definition of the time of early and delayed surgery in studies, (3) no comparison between the clinical result of early and delayed surgery in studies, (4) laboratory studies, radiographic studies, biomechanical studies, (5) the cases including fractures or revisions in studies, and (6) systematic analyses. Eight studies comparing early and delayed surgical treatment of ACJ dislocation are included in this systematic review. According to Constant scores and shoulder subjective value, early surgery has better functional outcomes than delayed surgery in the treatment of ACJ dislocation (P < 0.05). Partial-dislocation/re-dislocation is found at 26.0 % in early and 38.1 % in delayed surgical treatment (P < 0.05). The rate of CC ossification in early surgical treatment is found as the same as the delayed. The complication rates are found at 12.5 % in early surgical treatment and 17.7 % in the delayed, which is not significantly different. Early surgical treatment may have superiority to the delayed procedure in the management of ACJ dislocation with better functional outcomes and more satisfied reduction. However, high-quality evidence studies are required to provide stronger support for this opinion in the future. IV.

  9. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial)

    PubMed Central

    Trinder, J; Brocklehurst, P; Porter, R; Read, M; Vyas, S; Smith, L

    2006-01-01

    Objective To ascertain whether a clinically important difference exists in the incidence of gynaecological infection between surgical management and expectant or medical management of miscarriage. Design Randomised controlled trial comparing medical and expectant management with surgical management of first trimester miscarriage. Setting Early pregnancy assessment units of seven hospitals in the United Kingdom. Participants Women of less than 13 weeks' gestation, with a diagnosis of early fetal demise or incomplete miscarriage. Interventions Expectant management (no specific intervention); medical management (vaginal dose of misoprostol preceded, for women with early fetal demise, by oral mifepristone 24-48 hours earlier); surgical management (surgical evacuation). Main outcome measures Confirmed gynaecological infection at 14 days and eight weeks; need for unplanned admission or surgical intervention. Results 1200 women were recruited: 399 to expectant management, 398 to medical management, and 403 to surgical management. No differences were found in the incidence of confirmed infection within 14 days between the expectant group (3%) and the surgical group (3%) (risk difference 0.2%, 95% confidence interval - 2.2% to 2.7%) or between the medical group (2%) and the surgical group (0.7%, - 1.6% to 3.1%). Compared with the surgical group, the number of unplanned hospital admissions was significantly higher in both the expectant group (risk difference - 41%, - 47% to - 36%) and the medical group (- 10%, - 15% to - 6%). Similarly, when compared with the surgical group, the number of women who had an unplanned surgical curettage was significantly higher in the expectant group (risk difference - 39%, - 44% to - 34%) and the medical group (- 30%, - 35% to - 25%). Conclusions The incidence of gynaecological infection after surgical, expectant, and medical management of first trimester miscarriage is low (2-3%), and no evidence exists of a difference by the method of

  10. Early surgical intervention in type I laryngeal cleft.

    PubMed

    Day, Kristine E; Smith, Nicholas J; Kulbersh, Brian D

    2016-11-01

    Diagnosis and treatment of type 1 laryngeal clefts remains a challenge. The purpose of this study is to determine if early surgical intervention in type I laryngeal clefts improves outcomes. A retrospective case series was conducted at an academic tertiary care children's hospital. 18 children undergoing early (≤3 months from diagnosis) surgical intervention for type I laryngeal cleft repair between August of 2012 and December 2014. Data was compiled through a manual chart review. 18 children who underwent early surgical intervention for type I laryngeal cleft repair were identified for review. 14 (78%) were male and 4 (22%) were female and the average age at time of repair was 1.6 years. Most frequent presenting symptoms included dysphagia (61%) and recurrent respiratory issues (22%). Successful swallowing outcomes, defined as subjective improvement (i.e. absence of previous symptoms) per parental report in follow-up visits, +/- normal post-operative MBS (modified barium swallow) findings, was seen in 11 patients (61%). 9 patients required hospitalization for respiratory issues prior to surgical repair. Post-operatively, 4 patients still incurred an admission for respiratory reasons. Our series shows a success rate of 61% with early surgical intervention (≤3 months from diagnosis). A decrease in post-operative hospitalizations is appreciated. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Surgical Therapy of Early Carcinoma of the Esophagus

    PubMed Central

    Pauthner, Michael; Haist, Thomas; Mann, Markus; Lorenz, Dietmar

    2015-01-01

    Summary Background The modern therapy of early esophageal carcinomas (pT1) requires an excellent cooperation between experienced gastroenterologists, pathologists, and esophageal surgeons. While endoscopic resection (ER) is accepted as the standard curative treatment for mucosal esophageal carcinomas, submucosal tumors are regarded as a strict indication for surgery. There is an ongoing discussion about the operative approach and the extent of lymph node dissection in these cases. Methods A literature review was performed to evaluate the operative treatment of early esophageal cancer. In view of oncological risk factors, treatment strategies, and operative procedures, current studies are summarized and compared to the results of our own center. Results and Conclusion In early esophageal cancer, lymph node involvement is the only independent risk factor for survival and recurrence rates. There is evidence that infiltrated lymph nodes (N+) are significantly correlated with tumor infiltration depth, lymphovascular (L1) and microvascular invasion (V1), and poor tumor differentiation (G3). Several studies suggest that early squamous cell carcinomas (eSCCs) and early adenocarcinomas (eACs) have a different tumor biology and therefore need a different treatment strategy. While eSCCs in stage m1 and m2 can be cured by ER, tumors infiltrating the submucosal layer (sm1-3) show a high rate of lymph node metastasis (LNM); thus, surgical resection (SR) is clearly indicated. In tumors with invasion into the deep mucosa (m3) the risk of LNM is up to 11%; however, reliable data are rare and the type of therapy should be discussed with the patients individually. In eACs, ER is the standard curative treatment for all mucosal tumors (m1-m4) and sm1 tumors with low-risk constellation (G1, L0, VO, R0). All high-risk sm1 tumors and those with deeper submucosal infiltration (sm2, sm3) show a high rate of LNM and require SR. The standard operative procedure for early esophageal carcinomas

  12. [Results of surgical therapy of cervical diverticulum].

    PubMed

    Maurer, K P; Junginger, T; Kaltenborn, H

    1991-09-01

    Eighteen patients with a pharyngoesophageal diverticulum were operated on at the University Department of Surgery, Mainz, between September 1985 and July 1990. Results are based on follow-up studies of 15 patients. Three patients were operated upon less than six months ago. All patients underwent excision of the diverticulum and a cricopharyngeal myotomy. The mean age was 69 (49-84) years and the average follow-up interval was 30 (6-52) months. Twelve of the fifteen patients are free of symptoms concerning the esophagus since the operation. Two patients who died 17 resp. 22 months after the operation were also free of symptoms concerning the esophagus. In all 11 patients who had a barium contrast, swallowing was normal and no recurrence was found. The results show excision of the diverticulum combined with a cricopharyngeal myotomy to be an effective method with low risk for the long-term removal of pharyngoesophageal diverticulum.

  13. Surgical staging of early invasive epithelial ovarian tumors.

    PubMed

    Leblanc, E; Querleu, D; Narducci, F; Chauvet, M P; Chevalier, A; Lesoin, A; Vennin, P; Taieb, S

    2000-01-01

    Early stage epithelial ovarian carcinoma is defined pathologically as a tumor strictly limited to one or both ovaries without any extra-ovarian disease (i.e., Stage IA or B of the International Federation of Gynecology and Obstetrics (FIGO) classification). This diagnosis can be obtained only after an exhaustive surgical staging procedure, performed as soon as the diagnosis of epithelial invasive ovarian carcinoma is established. This staging surgery currently encompasses a peritoneal cytology, the thorough inspection of all the visceral and parietal peritoneal surfaces with biopsy of any abnormality, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO), random peritoneal biopsies, omentectomy, appendectomy and bilateral pelvic and para-aortic lymphadenectomies, up to the left renal vein. The results of this staging procedure and its indications are discussed. In all of the cases, the radical removal of the pathologic adnexa is indicated, along with the complete peritoneal and retroperitoneal staging. While fertility-sparing surgery (avoiding hysterectomy and contralateral adnexectomy, if possible) seems to be safe for young women, a TAH + BSO is the rule for the others. Adjuvant chemotherapy can be omitted in well-differentiated tumors with a negative staging operation, but currently it remains indicated in all other cases. Indeed, the ultimate goal in early stage ovarian carcinoma is to not impair by inadequate management the high chance of a cure. Copyright 2000 Wiley-Liss, Inc.

  14. Tympanoplasty surgery and prophylactic antibiotics: surgical results.

    PubMed

    John, D G; Carlin, W V; Lesser, T H; Carrick, D G; Fielder, C

    1988-06-01

    This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. A total of 130 individuals were randomly allocated to either an antibiotic or a non-antibiotic group. Each individual was clinically and audiometrically assessed preoperatively, and 8 weeks postoperatively. It was found that systemic prophylactic antibiotics did not influence either the success rate of myringoplasty surgery or the audiometric result.

  15. The Planck Mission: Early Results

    SciTech Connect

    Marco Bersanelli

    2012-03-07

    The ESA Planck space mission, launched on May 14, 2009, is dedicated to high precision measurements of the cosmic microwave background (CMB), the first light of the universe, both in temperature and polarization. The satellite observes the full sky from a far-Earth orbit with two cryogenic instruments in the 30-850 GHz range at the focal plane of a 1.5-meter telescope. The primary objective of Planck is to measure with unprecedented precision the key cosmological parameters and to provide accurate tests of physics in the early universe. Planck has recently completed the fifth full-sky survey. The data analysis is underway. The first cosmology results are expected in early 2013 while a number of astrophysical results have been recently delivered to the community, including galactic and extragalactic astrophysics and a rich catalogue of radio and infrared sources. These results demonstrate the excellent in-orbit performance of the instruments and give excellent prospects for the forthcoming cosmological results.

  16. Early Surgical Therapy for Drug-Resistant Temporal Lobe Epilepsy

    PubMed Central

    Engel, Jerome; McDermott, Michael P.; Wiebe, Samuel; Langfitt, John T.; Stern, John M.; Dewar, Sandra; Sperling, Michael R.; Gardiner, Irenita; Erba, Giuseppe; Fried, Itzhak; Jacobs, Margaret; Vinters, Harry V.; Mintzer, Scott; Kieburtz, Karl

    2016-01-01

    Context Despite reported success, surgery for pharmacoresistant seizures is often seen as a last resort. Patients are typically referred for surgery after 20 years of seizures, often too late to avoid significant disability and premature death. Objective We sought to determine whether surgery soon after failure of 2 antiepileptic drug (AED) trials is superior to continued medical management in controlling seizures and improving quality of life (QOL). Design, Setting, and Participants The Early Randomized Surgical Epilepsy Trial (ERSET) is a multicenter, controlled, parallel-group clinical trial performed at 16 US epilepsy surgery centers. The 38 participants (18 men and 20 women; aged ≥ 12 years) had mesial temporal lobe epilepsy (MTLE) and disabling seizues for no more than 2 consecutive years following adequate trials of 2 brand-name AEDs. Eligibility for anteromesial temporal resection (AMTR) was based on a standardized presurgical evaluation protocol. Participants were randomized to continued AED treatment or AMTR 2003–2007, and observed for 2 years. Planned enrollment was 200, but the trial was halted prematurely due to slow accrual. Intervention Receipt of continued AED treatment (n=23) or a standardized AMTR plus AED treatment (n = 15). In the medical group, 7 participants underwent AMTR prior to the end of follow-up and 1 participant in the surgical group never received surgery. Main Outcome Measures The primary outcome variable was freedom from disabling seizures during year 2 of follow-up. Secondary outcome variables were health-related QOL (measured primarily by the 2-year change in the Quality of Life in Epilepsy 89 [QOLIE-89] overall T-score), cognitive function, and social adaptation. Results Zero of 23 participants in the medical group and 11 of 15 in the surgical group were seizure free during year 2 of follow-up (odds ratio=∞; 95% CI, 11.8 to ∞;P <.001). In an intention-to-treat analysis, the mean improvement in QOLIE-89 overall T-score was

  17. Early gastric cancer. A 25-year surgical experience.

    PubMed Central

    Moreaux, J; Bougaran, J

    1993-01-01

    OBJECTIVE: Special emphasis has been placed on pathologic features, survival after surgical treatment, and prognostic factors. SUMMARY BACKGROUND DATA: Incidence is much lower in Western countries than in Japan. All degrees of tumor differentiation met in invasive cancer may be found. Prognosis is remarkably good, compared with advanced gastric cancer. METHODS: After reexamination of the pathologic specimens of 115 patients, 101 patients were included in this study; 58 were male. Mean age was 60.7 years. Preoperative biopsies were positive in 88%. The lesion was located in the antrum in 78 patients. Subtotal gastrectomy was performed in 85 patients and total gastrectomy in 13 patients with a RI lymph node resection. RESULTS: Cancer was extended to submucosa in 68.3%, poorly differentiated in 48.5%, and multifocal in 12.9% of patients. Lymph node involvement was present in 18.8%. Secondary deaths (n = 25) were in relation with the cancer in 6 patients only. The 5-, 10-, 15-, and 20-year actuarial crude survival rates were 88, 65, 58, and 51%, respectively. The survival rate was significantly higher for mucosal lesions than for submucosal lesions (p < 0.01). Survival showed no significant correlation with lymph node involvement, tumor size, and differentiation. CONCLUSIONS: Subtotal gastrectomy is recommended, except for proximal lesions, with survey of the gastric stump. Prognosis is significantly better for cancers limited to mucosa. Early gastric cancer is not a specific entity. Transitions between early and advanced carcinomas, especially observed in the poorly differentiated carcinomas with signet ring cells, suggest that this type of cancer should be a precursor of the invasive gastric carcinomas. PMID:8385441

  18. The Surgical Safety Checklist: Results of Implementation in Otorhinolaryngology

    PubMed Central

    2017-01-01

    Objectives To assess the impact of implementing the surgical safety checklist (SSCL) on the outcome of patient safety in otorhinolaryngology (ENT) surgical procedures in two hospitals in Saudi Arabia: Aseer Central and Abha Private Hospitals. Methods This retrospective study conducted over seven years (1 July 2008 to 30 June 2015) followed a staff educational and training program for the implementation of the World Health Organization Surgical Safety Checklist (WHO SSCL). The program included the use of audiovisual aids and practical demonstrations. Incidents of non-compliance were treated as sentinel events and were audited by the process of root cause analysis. Results There were 5 144 elective ENT surgical cases in both hospitals in which the SSCL was utilized over the seven-year study period. The average compliance rate was 96.5%. Reasons for non-compliance included staff shortage, fast staff turnover, excessive workload, communication problems, and presence of existing processes. Conclusions The implementation of the SSCL was a substantial leap in efforts towards ensuring surgical patients’ safety. It is compulsory in the healthcare system in many countries. Such progress in healthcare improvement can be accomplished with the commitment of the operating suite staff by spending few moments checking facts and establishing an environment of teamwork for the benefit of the surgical patient. PMID:28042399

  19. Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?

    PubMed Central

    Assietti, Roberto; Corbino, Leonardo; Olindo, Giuseppe; Foti, Pietro V.; Russo, Vittorio; Albanese, Vincenzo

    2009-01-01

    We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion–nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3–15°) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors’ best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure. PMID:19415346

  20. Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?

    PubMed

    Barbagallo, Giuseppe M V; Assietti, Roberto; Corbino, Leonardo; Olindo, Giuseppe; Foti, Pietro V; Russo, Vittorio; Albanese, Vincenzo

    2009-06-01

    We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion-nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3-15 degrees ) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors' best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure.

  1. Patellar tendinopathy: late-stage results from surgical treatment☆

    PubMed Central

    Cenni, Marcos Henrique Frauendorf; Silva, Thiago Daniel Macedo; do Nascimento, Bruno Fajardo; de Andrade, Rodrigo Cristiano; Júnior, Lúcio Flávio Biondi Pinheiro; Nicolai, Oscar Pinheiro

    2015-01-01

    Objective To evaluate the late-stage results from surgical treatment of patellar tendinopathy (PT), using the Visa score (Victorian Institute of Sport Tendon Study Group) and the Verheyden method. Methods This was a retrospective study in which the postoperative results from 12 patients (14 knees) who were operated between July 2002 and February 2011 were evaluated. The patients included in the study presented patellar tendinopathy that was refractory to conservative treatment, without any other concomitant lesions. Patients who were not properly followed up during the postoperative period were excluded. Results Using the Verheyden method, nine patients were considered to have very good results, two had good results and one had poor results. In relation to Visa, the mean was 92.4 points and only two patients had scores less than 70 points (66 and 55 points). Conclusion When surgical treatment for patellar tendinopathy is correctly indicated, it has good long-term results. PMID:26535202

  2. Achilles tendon rupture: effect of early mobilization in rehabilitation after surgical repair.

    PubMed

    Sorrenti, Samiul J

    2006-06-01

    Surgical and nonsurgical treatments of Achilles tendon ruptures are available. Nonsurgical treatment using immobilization does not have the varying degrees of infection as seen with surgical procedures, but it frequently is linked to muscle atrophy, weakness, and higher rates of rerupture than surgical treatment. This study reports the results of 64 patients with Achilles tendon ruptures treated surgically and with early mobilization. Surgery of the ruptured tendon involved dividing the proximal stump into two separate strands and the distal stump into a single strand. The repair was advanced to a V-Y formation, and nonabsorbable sutures were used for repair. After wound closure, an early mobilization rehabilitation program was initiated, which consisted of wearing a moveable ankle brace for 4 to 6 weeks in 0 to 15 degrees of dorsiflexion and 10 weeks of regular exercises. All 64 patients resumed normal activities in an average of 3.3 months regardless of whether the rupture was acute or chronic. Tendons healed with no reruptures. There were 13 complications, all wound infections, which healed when treated with antibiotics. The infection rate dropped markedly when wounds were inspected and dressings changed 1 week postoperatively, instead of at 2 weeks. Surgery combined with early mobilization reduces range of motion loss, increases blood supply, and reduces the degree of muscle atrophy that typically occurs after Achilles tendon rupture, thereby decreasing the time to resumption of normal activities. Applying tension to the tendon also improved strength of the calf muscles and improved ankle movement. The main concern with early mobilization is rerupture, but this was lessened by patients carefully following the weightbearing and early mobilization protocols. The results of this study strengthen the argument to employ early mobilization rehabilitation after surgical repair.

  3. Pediatric Glaucoma: A Literature's Review and Analysis of Surgical Results

    PubMed Central

    Scuderi, Gianluca; Iacovello, Daniela; Pranno, Federica; Plateroti, Pasquale; Scuderi, Luca

    2015-01-01

    The purpose of this paper is to review the surgical options available for the management of pediatric glaucoma, to evaluate their advantages and disadvantages together with their long-term efficacy, all with the intent to give guidelines to physicians on which elements are to be considered when taking a surgical decision. Currently there is a range of surgical procedures that are being used for the management of pediatric glaucoma. Within these, some are completely new approaches, while others are improvements of the more traditional procedures. Throughout this vast range of surgical options, angle surgery remains the first choice in mild cases and both goniotomy and trabeculotomy have good success rates. Trabeculectomy with or without mitomycin C (MMC) is preferred in refractory cases, in aphakic eyes, and in older children. GDIs have a good success rate in aphakic eyes. Nonpenetrating deep sclerectomy is still rarely used; nevertheless the results of ongoing studies are encouraging. The different clinical situations should always be weighed against the risks associated with the procedures for the individual patients. Glaucomatous progression can occur many years after its stabilization and at any time during the follow-up period; for this reason life-long assessment is necessary. PMID:26451368

  4. Current surgical results with low-grade arteriovenous malformations

    PubMed Central

    Potts, Matthew B.; Lau, Darryl; Abla, Adib A.; Kim, Helen; Young, William L.; Lawton, Michael T.

    2015-01-01

    OBJECTIVE Surgical resection is an appealing therapy for brain arteriovenous malformations (AVM) because of its high cure rate, low complication rate, and immediacy, becoming the first-line therapy for many AVMs. To clarify safety, efficacy, and outcomes associated with AVM resection in the aftermath of ARUBA, we reviewed an experience with low-grade AVMs, the most favorable AVMs for surgery and the ones most likely to have been selected for treatment outside of ARUBA’s randomization process. METHODS A prospective AVM registry was searched to identify patients with Spetzler-Martin grade I and II AVMs treated with surgical resection during a 16-year period. RESULTS Of the 232 surgical patients included, 117 (50%) presented with hemorrhage, 33% had Spetzler-Martin grade I, and 67% had grade II AVMs. Overall, 99 patients (43%) underwent preoperative embolization, with unruptured AVMs embolized more often than ruptured AVMs. AVM resection was accomplished in all patients and confirmed angiographically in 218 patients (94%). There were no deaths among patients with unruptured AVMs. Good outcomes (mRS 0–1) were found in 78% of patients with 97% improved or unchanged from their pre-operative mRS scores. Unruptured AVM patients had better functional outcomes (91% good outcome compared to 65% in the ruptured group, p=0.0008), while relative outcomes were equivalent (98% improved/unchanged in ruptured AVM patients versus 96% in unruptured AVM patients). CONCLUSION Surgery should be regarded as the “gold standard” therapy for the majority of low-grade AVMs, utilizing conservative embolization as a preoperative adjunct. High surgical cure rates and excellent functional outcomes in both ruptured and unruptured patients support a dominant surgical posture, with radiosurgery reserved for risky AVMs in deep, inaccessible, and highly eloquent locations. Despite the technological advances in endovascular and radiosurgical therapy, surgery still offers the best cure rate

  5. Surgical versus medical treatment for children with epileptic encephalopathy in infancy and early childhood: Results of an international multicenter cohort study in Far-East Asia (the FACE study).

    PubMed

    Otsuki, Taisuke; Kim, Heung-Dong; Luan, Guoming; Inoue, Yushi; Baba, Hiroshi; Oguni, Hirokazu; Hong, Seung-Chyul; Kameyama, Shigeki; Kobayashi, Katsuhiro; Hirose, Shinichi; Yamamoto, Hitoshi; Hamano, Shin-ichiro; Sugai, Kenji

    2016-05-01

    To compare the seizure and developmental outcomes in infants and young children with epileptic encephalopathy who have undergone surgical and medical treatments. An international, multicenter, observational cohort study was undertaken. A total of 317 children aged <6 years, who had frequent disabling seizures despite intensive medical treatments, were registered. Among the enrolled children, 250 were treated medically (medical group), 31 underwent resective surgery (resective group), and 36 underwent palliative surgery [callosotomy (n=30) or vagal nerve stimulation (n=6); palliative group] on admission. Seizure and developmental outcomes were obtained for 230 children during the 3-year follow-up period. Cox proportional hazard model was used to adjust for clinical backgrounds among treatment groups when comparing the seizure-free survival rates. At the 3-year follow-up, seizure-free survival was 15.7%, 32.1%, and 52.4% in the medical, palliative, and resective groups, respectively. The adjusted hazard ratios for seizure recurrence in the resective and palliative groups versus the medical group were 0.43 (95% CI, 0.21-0.87, P=0.019) and 0.82 (95% CI, 0.46-1.46, P=0.50), respectively; the former was statistically significant. Regarding the developmental outcome, the mean DQs in the resective group increased significantly compared to those in the medical group during the follow-up (P<0.01). As for subgroup analysis, better seizure and development outcomes were demonstrated in the resective group compared to the medical group in children with nonsyndromic epilepsies (those to which no known epilepsy syndromes were applicable). These results suggest that surgical treatments, particularly resective surgeries, are associated with better seizure and developmental outcomes compared with successive medical treatment. The present observations may facilitate the identification of infants and young children with epileptic encephalopathy who could benefit from surgery. Copyright

  6. [Our results of surgical management of unstable pelvic ring injuries].

    PubMed

    Pavelka, T; Dzupa, V; Stulík, J; Grill, R; Báca, V; Skála-Rosenbaum, J

    2007-02-01

    -three patients (12 %) died during hospitalization. The difference in death rate between the patients with type C and those with type B fractures was significant (p = 0.021). Excellent and good clinical outcomes were achieved in 83 % and 70 % of the patients with type B and type C fractures, respectively. The difference was not significant (p = 0.236). Radiographs showed excellent reduction in 83 % of type B fractures and in 61 % of type C fractures; the difference was not significant (p = 0.271). Intra-operative complications were recorded in 22 %, early post-operative ones in 13 % and late complications in 11 % of the patients. The significant difference in primary neurological deficit between the patients with type C fractures and those with type B fractures was attributed to more severe injury and vertical dislocation of the posterior segment in type C fractures. On the other hand, the fact that urogenital involvement was not significantly higher in type C fractures can be explained by an equal presence of anterior segment injury in both type B and type C fractures. The significantly higher number of deaths in patients with type C fractures, as compared with those with type B fractures, was related more to severe injuries of other organ systems in polytraumatized patients than to injuries of the pelvis itself, although severe injury to the posterior segment in type C fractures can result in massive bleeding into the retroperitoneum. An active approach to the treatment of patients with unstable pelvic fractures, which is based on the correct diagnosis, comprehensive multi-disciplinary care, urgent primary stabilization and early definitive fixation by internal osteosynthesis, offers a prospect of survival and a good functional outcome for the patient. However, a high proportion of lasting sequelae due to altered biomechanics of the pelvic ring, and irreversible injuries to neural structures and the urogenital system may lessen good results achieved by a demanding surgical

  7. LISA Optics Model: Early Results

    NASA Technical Reports Server (NTRS)

    Waluschka, Eugene; Scherr, Larry

    2003-01-01

    The Laser Interferometer Space Antenna (LISA) optics model is used to generate a synthetic data stream in the absence of gravitational waves. The simulation has the spacecraft in moving in their respective Keplerian orbits. The pointing of the spacecraft and station keeping about the proof masses is accomplished using a control scheme, which minimizes the disturbance on the proof masses in the sensitive direction. The resulting data stream gives an indication of the magnitude of instrumental noise due to pointing jitter and motions of the spacecraft with respect to the proof masses. Computational details are presented and the results discussed.

  8. FlareLab: early results

    NASA Astrophysics Data System (ADS)

    Soltwisch, H.; Kempkes, P.; Mackel, F.; Stein, H.; Tenfelde, J.; Arnold, L.; Dreher, J.; Grauer, R.

    2010-12-01

    The FlareLab experiment at Bochum University has been constructed to generate and investigate plasma-filled magnetic flux tubes similar to arch-shaped solar prominences, which often result in coronal mass ejections (CMEs). In its first version, the device has been used to reproduce and extend previous studies of Bellan et al (1998 Phys. Plasmas 5 1991). Here the plasma source consists of two electrodes, which can be connected to a 1.0 kJ capacitor bank, and of a horseshoe magnet, which provides an arch-shaped guiding field. The discharge is ignited in a cloud of hydrogen gas that has been puffed into the space above the electrodes. In the first few microseconds the plasma current rises at a rate of several kA µs-1, causing the plasma column to pinch along the guiding B-field and to form an expanding loop structure. The observed dynamics of the magnetic flux tubes is analysed by means of three-dimensional MHD simulations in order to determine the influence of parameters like the initial magnetic field geometry on magnetic stability. At present, FlareLab is redesigned to mimic a model that was proposed by Titov and Démoulin (1999 Astron. Astrophys. 351 707) to investigate twisted magnetic configurations in solar flares.

  9. POSTEROSUPERIOR SURGICAL ACCESS ROUTE FOR TREATMENT OF ACROMIOCLAVICULAR DISLOCATIONS: RESULTS FROM 84 SURGICAL CASES

    PubMed Central

    Dal Molin, Danilo Canesin; Ribeiro, Fabiano Rebouças; Filho, Rômulo Brasil; Filardi, Cantídio Salvador; Tenor, Antonio Carlos; Stipp, Willian Nandi; Petros, Rodrigo Souto Borges

    2015-01-01

    Objective: To evaluate the results from surgical treatment of 84 cases of acute acromioclavicular dislocation, using a posterosuperior access route. Methods: Eighty-four cases of acute acromioclavicular dislocation (grade III in the Allman-Tossy classification) operated between November 2002 and May 2010 were evaluated. The patients’ mean age was 34 years. The diagnoses were made using clinical and radiographic evaluations. The patients were operated by the same surgical team, within three weeks of the date of the trauma, using a posterosuperior approach to the shoulder to access the top of the base of the coracoid process for placement of two anchors, which were used in reducing the dislocation. The minimum follow-up was 12 months. The postoperative clinical-radiographic evaluation was done using the modified Karlsson criteria and the University of California at Los Angeles (UCLA) score. Results: 92.8% of the 84 patients treated presented good or excellent results, and 7.2% presented fair or poor results, using the UCLA assessment score. According to the modified Karlsson criteria, 76.2% were assessed as grade A, 17.9% as grade B and 5.9% as grade C. Conclusion: The posterosuperior access route to the shoulder is a new option for accessing the coracoid process and treating acromioclavicular dislocation, with clinical and radiographic results equivalent to those in the literature. PMID:27047866

  10. POSTEROSUPERIOR SURGICAL ACCESS ROUTE FOR TREATMENT OF ACROMIOCLAVICULAR DISLOCATIONS: RESULTS FROM 84 SURGICAL CASES.

    PubMed

    Dal Molin, Danilo Canesin; Ribeiro, Fabiano Rebouças; Filho, Rômulo Brasil; Filardi, Cantídio Salvador; Tenor, Antonio Carlos; Stipp, Willian Nandi; Petros, Rodrigo Souto Borges

    2012-01-01

    To evaluate the results from surgical treatment of 84 cases of acute acromioclavicular dislocation, using a posterosuperior access route. Eighty-four cases of acute acromioclavicular dislocation (grade III in the Allman-Tossy classification) operated between November 2002 and May 2010 were evaluated. The patients' mean age was 34 years. The diagnoses were made using clinical and radiographic evaluations. The patients were operated by the same surgical team, within three weeks of the date of the trauma, using a posterosuperior approach to the shoulder to access the top of the base of the coracoid process for placement of two anchors, which were used in reducing the dislocation. The minimum follow-up was 12 months. The postoperative clinical-radiographic evaluation was done using the modified Karlsson criteria and the University of California at Los Angeles (UCLA) score. 92.8% of the 84 patients treated presented good or excellent results, and 7.2% presented fair or poor results, using the UCLA assessment score. According to the modified Karlsson criteria, 76.2% were assessed as grade A, 17.9% as grade B and 5.9% as grade C. The posterosuperior access route to the shoulder is a new option for accessing the coracoid process and treating acromioclavicular dislocation, with clinical and radiographic results equivalent to those in the literature.

  11. SURGICAL TREATMENT OF SEVERE OBESITY IN TEENS: LATE RESULTS

    PubMed Central

    FERRAZ, Álvaro Antônio Bandeira; de SIQUEIRA, Luciana Teixeira; NORONHA, Clarissa Guedes; de HOLANDA, Danilo Belem Rodrigues; de ARAÚJO-JÚNIOR, José Guido Corrêa; MUNIZ, Mariana Gomes

    2015-01-01

    Background : In children is estimated that the prevalence of overweight and obesity has increased up to five times in developed countries and up to four in developing countries. In Brazil, the proportion of children and adolescents who are overweight also increased from approximately 4.1% to 13.9%. Aim : To evaluate the surgical results of severe obesity in adolescents. Methods : Retrospective descriptive study of 2737 patients with severe obesity that underwent Roux-en-Y gastric bypass selecting from the total 44 patients with mean age of 18.1 years, 14 males and 30 females, most (37) operated by laparotomy. There was follow-up of 20 patients (45.45%). All were followed preoperatively by a multidisciplinary team and had indication confirmed for surgical unanimous approval of all team members. Results : Among the 20 adolescent, 14 were female. From five teenagers using anti-hypertension or hypoglycemic drugs before surgery, four (80%) had drug discontinuation and one (20%) reduced the dose in 50% postoperatively. The average weight loss was 45.4 kg after a mean follow up of 60 months. There were no deaths or severe postoperative complications. Among those who underwent postoperative follow-up with a multidisciplinary team, 18 were with BMI<30. Conclusions : Adolescents undergoing Roux-en-Y gastric bypass has good response in relation to weight loss and improvement of comorbidities. There was a low rate of complications and no deaths. All patients were satisfied with their personal results. PMID:26537264

  12. Early outcome and predictors of early outcome in patients treated surgically for central cord syndrome.

    PubMed

    Kepler, Christopher K; Kong, Christopher; Schroeder, Gregory D; Hjelm, Nikolaus; Sayadipour, Amir; Vaccaro, Alexander R; Anderson, D Greg

    2015-10-01

    The purpose of this study was to characterize changes in American Spinal Injury Association motor score (AMS) in the 1st week after traumatic central cord syndrome (CCS) to identify predictors of improved early outcome in patients treated with early versus delayed surgical intervention. All patients presenting to a regional spinal cord injury center between January 2004 and June 2009 were queried for those with a diagnosis of CCS. Patients treated conservatively were excluded. A prospectively maintained spinal cord injury database was used to track AMS throughout each patient's hospitalization. Hospital records provided information regarding demographics, presenting neurological examination, imaging findings, comorbidities, timing and nature of surgical procedures, and length of stay (LOS) in the hospital and intensive care unit (ICU). Patients were separated into those who underwent early surgery, within 1 day of presentation (early group), and those who underwent surgery on a delayed basis (delayed group). Differences between groups were analyzed using the Student t-test and chi-square test. Predictors of outcome were identified using correlation analysis and multiple linear regression. Of 426 patients in the database, 80 (18.8%) were diagnosed as having CCS, and 68 of them ultimately underwent surgical decompression. Nineteen (28%) of 68 patients underwent surgery within 1 day of presentation (early group) while the remaining 49 patients (72%) underwent surgery on a delayed basis (delayed group). The mean age in the early group was significantly younger than that of the delayed group (52 vs 59 years, p = 0.049). Other characteristics were similar between groups including sex, proportion of patients with cord edema on MRI (44% early vs 55% delayed, p = 0.47), and proportion of patients with cervical fracture (26% early vs 28% delayed, p = 0.98). Patients in the early group presented with an AMS of 62.5 versus 70.0 for the delayed group (p = 0.36). No difference

  13. Early surgical treatment benefits early staged pediatric moyamoya disease--single case report.

    PubMed

    Matsuoka, Go; Aihara, Yasuo; Yamaguchi, Koji; Ishikawa, Tatsuya; Kawashima, Akitsugu; Kawamata, Takakazu; Okada, Yoshikazu

    2015-07-01

    Surgical revascularization for pediatric moyamoya disease improves cerebral blood flow (CBF) and consequently may prevent further ischemic events. However, the timing of the treatment is controversial especially for patients with no ischemic symptom and normal CBF. The purpose of this case report is to inform and infer the surgical treatment timing for pediatric moyamoya disease patients. A 10-year-old female patient with unilateral moyamoya disease complaining of only headache as a symptom and whose Suzuki stage was II or in transition to III by angiography and CBF was almost normal was admitted to Tokyo Women's Medical University Hospital. We performed superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses for the patient because we estimated her headache was derived from low perfusion in the brain. STA-MCA bypass surgery was not only effective for relief of her severe headache but also valid for her cerebral perfusion. Her angiography showed much supply from external carotid artery to intracranial arteries via bypass grafts in 7 months. Our case showed early surgical treatment was beneficial for relief of severe headache even for early staged pediatric moyamoya disease patients by improving perfusion pressure and cerebral circulation.

  14. Surgical management of fungal endophthalmitis resulting from fungal keratitis

    PubMed Central

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

    2016-01-01

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

  15. [Early surgical treatment of deep thermal burns in children].

    PubMed

    Kazantseva, N D; Baindurashvili, A G; Girs, Iu M; Shpital'naia, T A; Men'shugin, I N

    1986-05-01

    Early one-step dissection of the crust in deep burns of about 40% of the body square surface within 3-7 days after trauma allowed to shorten the period of treatment at the hospital and to improve immediate results of plasty. Lethality was also reduced.

  16. Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results

    PubMed Central

    Araújo, José Augusto

    2017-01-01

    Sympathectomy and its variations have been performed in thoracic surgery for more than 100 years. However, its indications have undergone profound modifications in this period. Likewise, since then the surgical technique has also evolved dramatically up to the minimally invasive techniques worldwide accessible in present days. Currently, primary hyperhidrosis is, by far, the main indication for thoracic sympathectomy and this procedure is usually carried out thoracoscopically with excellent results. However, until today, hyperhidrosis is a part of thoracic surgery still surrounded by controversy, persisting as an open field over which some confusion still resides regarding its pathophysiology, terms definitions and operative approaches. The aim of this article is to provide a wide but easily comprehensible review of the theme, discussing and clarifying the major concepts with respect to its clinical presentation, all the presently available treatment options and strategies with their potential benefits and risks, the adequate patient selection for sympathectomy, as well as the postoperative clinical results. PMID:28446983

  17. Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results.

    PubMed

    Vannucci, Fernando; Araújo, José Augusto

    2017-04-01

    Sympathectomy and its variations have been performed in thoracic surgery for more than 100 years. However, its indications have undergone profound modifications in this period. Likewise, since then the surgical technique has also evolved dramatically up to the minimally invasive techniques worldwide accessible in present days. Currently, primary hyperhidrosis is, by far, the main indication for thoracic sympathectomy and this procedure is usually carried out thoracoscopically with excellent results. However, until today, hyperhidrosis is a part of thoracic surgery still surrounded by controversy, persisting as an open field over which some confusion still resides regarding its pathophysiology, terms definitions and operative approaches. The aim of this article is to provide a wide but easily comprehensible review of the theme, discussing and clarifying the major concepts with respect to its clinical presentation, all the presently available treatment options and strategies with their potential benefits and risks, the adequate patient selection for sympathectomy, as well as the postoperative clinical results.

  18. Novel surgical technique and early kinesiotherapy for acute Achilles tendon rupture.

    PubMed

    Jielile, Jiasharete; Sabirhazi, Gulnur; Chen, Jiangtao; Aldyarhan, Kayrat; Zheyiken, Jangannuer; Zhao, Qin; Bai, Jingping

    2012-12-01

    This prospective study was performed to investigate the contribution of early kinesiotherapy, the active exercise and movement of the ankle and knee joints, following a novel surgical technique for reconstruction of the acutely ruptured Achilles tendon and the underlying mechanisms involved. One hundred and seven patients with an acute Achilles tendon rupture received postoperative early kinesiotherapy treatment following the novel ``Pa-bone'' surgical technique. Clinical outcomes were evaluated using the Achilles tendon rupture score, a score for measuring outcomes related to symptoms and physical activity, and bilateral ultrasonographic examination of the Achilles tendon. Range-of-motion recovery equal to the intact side averaged 7~weeks. Double-legged heel rises and sustained single-leg heel rise exercises were possible at an average of 1~week and 60± 2 days, respectively. All patients could perform single-leg heel rise of the injured foot for 60± 23 seconds at an average of 12 weeks. No rerupture was observed. In addition, ultrasonographic examination revealed that the cross-sectional areas of the ruptured tendon were significantly larger than those of the healthy side. Overall reconstruction of the Achilles tendon was obtained for most of the patients. Postoperative early kinesiotherapy treatment following Pa-bone surgical technique resulted in excellent clinical outcomes and contributed to the overall reconstruction of the Achilles tendon.

  19. [Surgical treatment results of 52 cases of temporomandibular ankylosis].

    PubMed

    Kimura-Fujikami, Takao

    2003-01-01

    We courried out a retrospective study of 52 surgical cases of temporomandibular joint ankylosis, fibrous types I and II in 19 patients (36.4%) and osseous type III-IV in 33 patients (63.6%). Forty two children and teenagers at the Hospital de Pediatria (1983-1985/1989-1998) and Hospital General La Raza (1985-1989) were included also, 10 adults including those operated on at the Hospital de Especialidades, CMN Siglo XXI (IMSS) from 1998 to 2001 were included. We used Dunn modified method en 37 cases (67%) and 17 patients were with Risdon operated on technique (33%). Etiology of ankylosis were direct trauma to jaw, which affected temporomandibular joint mainly in children, while in adults causes were more varied and included as osteomyelitis, middle ear infection, sequels of hemifacial microsomy, and trauma results were considered as good upon obtaining mouth opening of 35 mm without neo-ankylosis during 1-year postoperative control.

  20. Brown recluse spider bites. A comparison of early surgical excision versus dapsone and delayed surgical excision.

    PubMed Central

    Rees, R S; Altenbern, D P; Lynch, J B; King, L E

    1985-01-01

    In a prospective study, 31 patients with brown recluse spider bites were treated by either immediate surgical excision or with the leukocyte inhibitor, dapsone, followed by delayed surgical excision. Patients were matched for age, gender, and lesion size and were excluded if the typical history and physical findings were not present. In patients treated with immediate surgical excision (N = 14), delayed wound healing (N = 5) and objectional scarring (N = 7) were common complications. However, pretreatment treatment with dapsone reduced the incidence of wound complications (N = 1) and objectional scarring (N = 1) (p less than 0.05), while reducing the need for surgical excision (N = 1). There were no severe drug reactions due to dapsone, although one patient had persistent G.I. upset. Pretreatment with dapsone not only reduced surgical complications but also improved the outcome of patients bitten by the brown recluse spider. PMID:4051613

  1. Extended endoscopic endonasal transsphenoidal approach for retrochiasmatic craniopharyngioma: Surgical technique and results

    PubMed Central

    Sankhla, Suresh K.; Jayashankar, Narayan; Khan, Ghulam M.

    2015-01-01

    Objective: Surgical treatment of retrochiasmatic craniopharyngioma still remains a challenge. While complete removal of the tumor with preservation of the vital neurovascular structures is often the goal of the treatment, there is no optimal surgical approach available to achieve this goal. Transcranial and transsphenoidal microsurgical approaches, commonly used in the past, have considerable technical limitations. The extended endonasal endoscopic surgical route, obtained by removal of tuberculum sellae and planum sphenoidale, offers direct midline access to the retrochiasmatic space and provides excellent visualization of the undersurface of the optic chiasm. In this report, we describe the technical details of the extended endoscopic approach, and review our results using this approach in the surgical management of retrochiasmatic craniopharyngiomas. Methods: Fifteen children, including 9 girls and 6 boys, aged 8 to 15 years underwent surgery using extended endoscopic transsphenoidal approach between 2008 and 2014. Nine patients had a surgical procedure done previously and presented with recurrence of symptoms and regrowth of their residual tumors. Results: A gross total or near total excision was achieved in 10 (66.7%) patients, subtotal resection in 4 (26.7%), and partial removal in 1 (6.7%) patient. Postoperatively, headache improved in 93.3%, vision recovered in 77.3%, and the hormonal levels stabilised in 66.6%. Three patients (20%) developed postoperative CSF leaks which were managed conservatively. Three (20%) patients with diabetes insipidus and 2 (13.3%) with panhypopituitarism required long-term hormonal replacement therapy. Conclusions: Our early experience suggests that the extended endonasal endoscopic approach is a reasonable option for removal of the retrochiasmal craniopharyngiomas. Compared to other surgical approaches, it provides better opportunities for greater tumor removal and visual improvement without any increase in risks. PMID:26962333

  2. Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey.

    PubMed Central

    Cubertafond, P; Gainant, A; Cucchiaro, G

    1994-01-01

    OBJECTIVE: The objective of this study was to evaluate the benefit of an aggressive approach to gallbladder carcinoma on long-term survival. SUMMARY BACKGROUND DATA: Recent studies have shown that an aggressive surgical treatment of bile duct carcinoma can be associated with a surprising long-term survival. However, recent data on gallbladder carcinoma are not available. METHODS: Data were obtained from a questionnaire sent to 73 institutions in France, Europe, and overseas, and they were analyzed retrospectively. The review included an analysis of patient sex and age, associated hepatobiliary diseases, symptoms and signs, diagnostic tests, operative management, pathology reports, and survival. RESULTS: Seventy-eight per cent of the patients were women, and 22% were men (p < 0.001). Gallstones were present in 86% of the cases. Four per cent of the patients had Tis stage lesions, 11% had T1 to T2 stage lesions, and 85% had T3 to T4 stage lesions (p < 0.001). Pain was the most frequent symptom (77%). Twenty-three per cent of the patients underwent curative operations, and 77% had a palliative treatment (25% of the patients underwent exploratory laparotomy). Exploratory laparotomy was followed by the highest mortality rate (66%), and older patients (> 70 years) had a higher operative risk (p < 0.04). The overall median survival was 3 months, and long-term survival correlated with the cancer stage (Tis, > 60 months; T1 to T2, > 22 months, and T3 to T4, 2 to 8 months). No differences were observed among the different surgical procedures adopted. CONCLUSIONS: No progress has been made in the last 10 years in the treatment of gallbladder malignancies. PMID:8147608

  3. The influence of surgical sites on early postoperative hypoxemia in adults undergoing elective surgery.

    PubMed

    Xue, F S; Li, B W; Zhang, G S; Liao, X; Zhang, Y M; Liu, J H; An, G; Luo, L K

    1999-01-01

    To determine the influence of the surgical sites on early postoperative hypoxemia, we studied postoperative hypoxemia in 994 patients, ASA physical status I or II, aged 18-68 yr, scheduled for various types of elective surgery. Patients were divided into three groups on the basis of the surgical sites: Group 1 = elective superficial plastic surgery (n = 288); Group 2 = upper abdominal surgery (n = 452); and Group 3 = thoracoabdominal surgery (n = 254). Anesthesia was maintained with 1%-2% enflurane and 67% nitrous oxide in oxygen; thiopental or fentanyl was given IV as required. SpO2 levels were recorded while patients breathed room air shortly after arrival in the recovery room (0 min) and 5, 10, 15, 20, 30, 40, 50, 60, 120, and 180 min thereafter. The results showed that during the early postoperative period, the degree of arterial desaturation and the incidences of hypoxemia (SpO2 86%-90%) and severe hypoxemia (SpO2 85%) were closely related to the operative sites and were greatest for thoracoabdominal operations, less for the upper abdominal operation, and least for the peripheral surgery. The incidence of hypoxemia and severe hypoxemia in the recovery room was 7% and 0.7%, respectively, in Group 1, 38% and 3% in Group 2, and 52% and 20% in Group 3. Mild airway obstruction and hypothermia in the postanesthesia recovery unit (PAR) were the predictive factors of early postoperative hypoxemia. We conclude that during the early postoperative period, there were significant differences in SpO2 levels and incidences of hypoxemia and severe hypoxemia among the three groups. We found that the severity of arterial desaturation and the incidence of hypoxemia during the early postoperative period are closely related to the surgical sites and are strongest for thoracoabdominal surgery, less for upper abdominal surgery, and least for peripheral surgery.

  4. Early nasoduodenal feeding for the post-biliary surgical patient.

    PubMed

    Hwang, T L; Huang, S L; Chen, M F

    1991-10-01

    The effects of early postoperative nasoduodenal feeding on nutrition and metabolic response were studied using 24 patients after biliary surgery. The patients were randomly divided into two groups with 12 in each group. Group I was fed via a nasoduodenal tube from the first postoperative day but control group II was not fed until the fourth postoperative day. The hospital blenderized tube feeding diet provided the enteric nutrition (17% protein, 33% fat and 50% carbohydrate). The nutritional status of the 2 groups was compared over a one week period. The changes in nitrogen balance were measured daily for 8 days. The group fed early had a significantly reduced negative nitrogen balance when compared to the group whose feeding was started later. (-1.91 +/- 1.05 g/day vs -5.84 +/- 0.48 g/day). There was no difference in serum albumin and transferrin levels, but serum prealbumin levels in the group fed early were more desirable than those of the control group (from 15.8 +/- 2.5 mg/dl to 28.9 +/- 3.8 mg/dl vs from 18.0 +/- 2.0 mg/dl to 25.9 +/- 3.9 mg/dl). Total lymphocyte count was also better in the group fed early than in the controls (from 1,325 +/- 204 cells/mm3 to 2,655 +/- 584 cells/mm3 vs from 1,277 +/- 188 cells/mm3 to 1,877 +/- 440 cells/mm3). All the patients in group I felt better than those in group II during the study course. These results indicated that those patients provided with early nasoduodenal feeding after a biliary operation displayed a better nitrogen balance, and a faster increase in short half life visceral protein and total lymphocyte count.

  5. Laparoscopic Pelvic Lymphadenectomy in the Surgical Treatment of Endometrial Cancer: Results of a Multicenter Study

    PubMed Central

    Jabor, Antonín; Bartos, Pavel; Eim, Josef; Kliment, Lev

    2002-01-01

    Objective: To analyze the results and determine the contribution of laparoscopic pelvic lymphadenectomy in the surgical treatment of women with endometrial cancer and compare with the open technique. Methods: A prospective multicenter study was carried out on 120 women who underwent laparoscopic surgery (96 women) and open procedures (24 women) for endometrial cancer between April 1996 and March 2000. Results: Four patients whose laparoscopic surgery was completed by laparotomy were excluded from the study. The other 92 laparoscopic procedures were successfully completed. Laparoscopically assisted surgical staging (LASS) was performed based on the grade of the tumor and the depth of myometrial invasion. Sixty-seven of the patients underwent hysterectomy, bilateral salpingooophorectomy (BSO), and pelvic lymphadenectomy, and 25 women also had para-aortic lymph node sampling dissection. Eleven of these patients had positive pelvic or para-aortic nodes. The mean operating time for the laparoscopic procedure was significantly longer (173.8 min, P < 0.0001) than the time for the open procedure (135.0 min). The rate of complications was similar in both groups. The recovery time was significantly reduced (P < 0.0001). Conclusion: The laparoscopic approach to hysterectomy and lymphadenectomy for early stage endometrial carcinoma is an attractive alternative to the abdominal surgical approach. The advantages of laparoscopically assisted surgical staging are patient related. Because the abdominal incision is avoided, the recovery time is reduced. Laparoscopic pelvic lymph node dissection is a procedure that is appropriate, when applicable. PMID:12113415

  6. Results of the surgical treatment of calcaneo-navicular coalito.

    PubMed

    Jerosch, J; Lindner, N; Finnen, D A

    1997-01-01

    We present the results after surgical treatment in 15 patients who suffered from calcaneo-navicular coalitio. A total of 20 operations were performed on 19 feet (3 T-arthrodesis, 5 simple resections, 9 resections with fat interposition, 3 resections with muscle interposition). At the time of follow-up, the patients were examined clinically and radiologically. In addition, different functional tests were performed (heel-tip test, balance test, single-leg high jump, single-leg jumping course). Ten of 17 patients who underwent radiographic study at the follow-up had a successful result. Patients who had a coalitio showed a tibial rotation (heel-tip test) of 11.5 degrees, and those patients without a coalitio had a tibia rotation of 20.3 degrees. Concerning the functional outcome, 12 of 17 patients had a successful result. The range of motion of the subtalar joint did not correlate with the functional capacity of the ankle. Seven of 20 patients subjectively judged the outcome as a failure. The worst results were found in patients with pre-existing degenerative changes at the time of resection.

  7. Surgical robotics: the early chronicles: a personal historical perspective.

    PubMed

    Satava, Richard M

    2002-02-01

    The use of robotics has been emerging for approximately 75 years, but only during the past 5 years has the potential of robotics been recognized by the surgical community as a whole. This personal perspective chronicles the development of robotics for the general surgical community, the role of the military medical research effort, and many of the major programs that contributed to the current success of robotics.

  8. LESS living donor nephrectomy: Surgical technique and results

    PubMed Central

    Alessimi, Abdullah; Adam, Emilie; Haber, Georges-Pascal; Badet, Lionel; Codas, Ricardo; Fehri, Hakim Fassi; Martin, Xavier; Crouzet, Sébastien

    2015-01-01

    Purpose: We present the findings of 50 patients undergoing pure trans-umbilical laparo-endoscopic single-site surgery (LESS) living donor nephrectomy (LDN), between February 2010 and May 2014. Materials and Methods: Laparo-endoscopic single-site surgery LDN was performed through an umbilical incision. Different trocars were used, namely Gelpoint (Applied Mιdical, Rancho Santa Margarita, CA) SILS port (Covidien, Hamilton, Bermuda), R-port (Olympus Surgical, Orangeburg, NY) and standard trocars, inserted through the same skin incision but using separate fascial punctures. The standard laparoscopic technique was employed. The kidney was pre-entrapped in a retrieval bag and extracted trans-umbilically. Data were collected prospectively including questionnaires containing patient reported oral pain medication duration and time to recovery. Results: LESS LDN was successful in all patients. Mean warm ischemia time was 6.2 min (3–15), mean procedure time was 233.2 min (172–300), and hospitalization stay was 3.94 days (3–7) with a visual analogue pain score at discharge of 1.32 (0–3). No intraoperative complications occurred. The mean time of oral pain medication was 8.72 days (1–20) and final scar length was 4.06 cm (3–5). Each allograft was functional. Conclusion: Although challenging, trans-umbilical LESS LDN seems to be feasible and safe. Hence, LESS has the potential to improve cosmetic results and decrease morbidity. PMID:26229326

  9. [Does pre-surgical cognitive impairment affect knee replacement results?].

    PubMed

    Jiménez, M; Zorrilla, P; López-Alonso, A; León, A; Salido, J A

    2014-01-01

    To determine the influence of the pre-operative cognitive impairment on results of the total knee arthroplasty according to a doctor and patient perspective. A prospective study was conducted on patient from the surgical waiting list who had undergone a primary total knee arthroplasty. The sample initially included 265 patients, but 50 were subsequently excluded. Cognitive impairment was assessed pre-operatively by the Mini Cognitive Examination (MEC-35). The Visual Analog Scale (VAS), the Knee Society Score (KSS), the Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Hospital Anxiety and Depression Scale (HADS), were used pre-operatively and one year later post-operatively. A total of 215 patients were assessed (57 men and 158 women). Cognitive impairment had no influence on the results of total knee arthroplasty. In fact, there was no statistical significance in any of the scales analyzed. Preoperatively, and one year later, the patients with cognitive impairment showed higher levels of anxiety and depression, with these differences being statistically significant. All of the patients experienced an improvement in the specific outcomes and quality of life after the total knee arthroplasty procedure, regardless of the presence of preoperative cognitive impairment. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  10. Distance learning improves attainment of professional milestones in the early years of surgical training.

    PubMed

    Smith, Paula J W; Wigmore, Stephen J; Paisley, Anna; Lamb, Peter; Richards, Jennifer M J; Robson, Andrew J; Revie, Erica; McKeown, Dermot; Dewhurst, David; Garden, O James

    2013-11-01

    To assess the impact of a surgical sciences e-learning programme in supporting the academic development of surgical trainees during their preparation for professional examination. In 2007, a 3-year online part-time Master of Surgical Sciences (MSc) degree programme was launched, utilizing an innovative platform with virtual case scenarios based on common surgical conditions addressed by the curriculum relating to the Membership Examination of the Royal Colleges of Surgeons (MRCS). Multiple-choice questions with feedback and discussion boards facilitated by expert clinical tutors provided formative assessment. Summative assessment comprised written examination at the end of each of the first 2 years (equivalent to MRCS level), culminating in submission of a research dissertation in year 3 toward an MSc. Students' age, gender, and level at entry to the programme were documented. Anonymized student feedback from 2008 to 2012 was examined using online questionnaires, and performance in the MSc programme was compared to MRCS examination outcomes for students who had consented to release of their results. A total of 517 surgical trainees from 40 countries were recruited over the 6-year period, and 116 MSc students have graduated to date. Of 368 students, 279 (76%) were foundation doctors (interns) and had not commenced formal surgical training on enrolling in the MSc programme. However, level at entry did not influence performance (P > 0.05 across all 3 years). Average pass rates since the programme launched, for those students completing all of the required assessments, were 84% ± 11% in year 1, 85% ± 10% in year 2, and 88% ± 7% in year 3 of the MSc programme. MSc students had significantly higher MRCS pass rates than nonenrolled trainees (67% vs 51%, P < 0.01, n = 352). There was a significant correlation between MRCS examination performance and overall performance in the MSc (R = 58%; P < 0.01, n = 37). Of 248 respondents, 202 (81%) considered that the MSc would

  11. Surgical results of the intraoral approach for plunging ranula.

    PubMed

    Yang, Yunsu; Hong, Kihwan

    2014-02-01

    The intraoral approach for removal of the plunging ranula is a safe and effective surgical approach as a primary treatment modality for plunging ranula. Although sclerotherapy is applied for plunging ranula, it can be primarily treated with surgery such as marsupialization, simple excision, and transcervical excision. This study was performed to assess the results of the intraoral approach for the treatment of plunging ranula. This prospective clinical study comprised a total of 23 patients with plunging ranula treated by the intraoral approach. All patients had complete removal of the sublingual gland with evacuation of cystic fluid. The cystic wall of the ranula could be dissected completely in only four patients, and in eight patients it was only possible to drain the cystic fluid. However, in 11 patients we could not dissect the cystic wall completely. Rupture of ranula developed in all patients during the intraoral dissection. Recurrence was not detected in any of the patients during the median follow-up period of 14 months after the intraoral excision. There were no complications or external scarring.

  12. Surgical menopause initiates molecular changes that do not result in mechanical changes in normal and healing ligaments

    PubMed Central

    Thornton, G. M.; Reno, C. R.; Achari, Y.; Morck, D. W.; Hart, D. A.

    2015-01-01

    Objectives Ligaments which heal spontaneously have a healing process that is similar to skin wound healing. Menopause impairs skin wound healing and may likewise impair ligament healing. Our purpose in this study was to investigate the effect of surgical menopause on ligament healing in a rabbit medial collateral ligament model. Methods Surgical menopause was induced with ovariohysterectomy surgery in adult female rabbits. Ligament injury was created by making a surgical gap in the midsubstance of the medial collateral ligament. Ligaments were allowed to heal for six or 14 weeks in the presence or absence of oestrogen before being compared with uninjured ligaments. Molecular assessment examined the messenger ribonucleic acid levels for collagens, proteoglycans, proteinases, hormone receptors, growth factors and inflammatory mediators. Mechanical assessments examined ligament laxity, total creep strain and failure stress. Results Surgical menopause in normal medial collateral ligaments initiated molecular changes in all the categories evaluated. In early healing medial collateral ligaments, surgical menopause resulted in downregulation of specific collagens, proteinases and inflammatory mediators at 6 weeks of healing, and proteoglycans, growth factors and hormone receptors at 14 weeks of healing. Surgical menopause did not produce mechanical changes in normal or early healing medial collateral ligaments. With or without surgical menopause, healing ligaments exhibited increased total creep strain and decreased failure stress compared with uninjured ligaments. Conclusions Surgical menopause did not affect the mechanical properties of normal or early healing medial collateral ligaments in a rabbit model. The results in this preclinical model suggest that menopause may result in no further impairment to the ligament healing process. Cite this article: Bone Joint Res 2015;4:38–44 PMID:25761872

  13. Surgical treatment results for flexible flatfoot in adolescents.

    PubMed

    Yontar, Necip Selcuk; Ogut, Tahir; Guven, Mehmet Fatih; Botanlioglu, Huseyin; Kaynak, Gokhan; Can, Ata

    2016-12-01

    Idiopathic flexible pes planus (IFPP) is a common foot problem in adolescents and young adults. Hypothesis for the present study was that combination of procedures for IFPP can achieve results in adolescents and young adults that are as good as those seen in adult-acquired pes planovalgus (AAPP) treatment in adults. A total of 21 feet of 18 patients (10 boys, 8 girls) with mean age of 15.6 years underwent surgical reconstruction for flatfoot deformity. Symptomatic patients who had been unresponsive to conservative treatment were included in study group. Mean follow-up time was 39.2 months. American Orthopedic Foot and Ankle Society (AOFAS) scores were calculated for all patients, and based on final results, all families were asked whether or not they would elect to have the surgery again in same circumstances. All procedures were performed by the same surgeon: lateral column calcaneal lengthening osteotomy on 21 feet; percutaneous lengthening or gastrocnemius recession for Achilles tendon on 21 feet; medializing calcaneal osteotomy on 15 feet; flexor digitorum longus tendon transfer on 15 feet; medial cuneiform opening wedge osteotomy on 5 feet, spring ligament plication on 3 feet, and accessory navicular bone excision on 2 feet. Preoperative mean AOFAS score increased significantly from 56.76 to 95.29. All parents stated that they were satisfied with surgery results and would choose to have the same surgery performed again. Soft tissue and bony procedures used for reconstruction of AAPP can be used safely for IFPP in adolescents and young adults. Level IV, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  14. Outcomes Associated with Early Postoperative Noninvasive Ventilation in Bariatric Surgical Patients with Sleep Apnea

    PubMed Central

    Stefan, Mihaela S.; Hill, Nicholas S.; Raghunathan, Karthik; Liu, Xiaoxia; Pekow, Penelope S.; Memtsoudis, Stavros G.; Ramachandran, Satya Krishna; Lindenauer, Peter K.

    2016-01-01

    Study Objectives: To examine the relationship of early initiation of noninvasive ventilation (NIV) with postoperative outcomes in patients with obstructive sleep apnea (OSA) undergoing bariatric surgery. Methods: We included 5,266 patients with OSA undergoing bariatric surgeries at 161 hospitals in the United States. We defined early postoperative NIV as NIV used on the day of or the day after surgery; this could include prophylactic NIV or NIV used for early signs of respiratory deterioration. We developed a hierarchical model to identify factors associated with early use of NIV. Then, in a propensity matched cohort, we assessed the association between NIV use and outcomes. Results: Overall, 996 patients (18.9%) were treated with early postoperative NIV. Predictors of NIV initiation were: male sex (odds ratio: 1.34, 95% confidence interval 1.14–1.59), older age, chronic obstructive pulmonary disease (COPD; odds ratio 1.39, confidence interval: 1.17–1.64), gastric bypass surgery, short-acting narcotics intravenous on the day of surgery and admission to a hospital with high rate of OSA diagnosis. In a propensity matched analysis, we found no significant association between early initiation of NIV and receipt of invasive mechanical ventilation (IMV) (early NIV 4.5% vs. no NIV 3.8% p = 0.46), cardiovascular complications or mortality. Results were consistent in several sensitivity analyses. Conclusions: In this large observational study of patients with OSA undergoing bariatric surgery, early postoperative NIV use was not associated with better outcomes including less intubation and mortality. Properly designed controlled trials will be necessary to provide more definitive answers to this important clinical question. Citation: Stefan MS, Hill NS, Raghunathan K, Liu X, Pekow PS, Memtsoudis SG, Ramachandran SK, Lindenauer PK. Outcomes associated with early postoperative noninvasive ventilation in bariatric surgical patients with sleep apnea. J Clin Sleep Med 2016

  15. Surgical interventions for the early management of Bell's palsy.

    PubMed

    McAllister, Kerrie; Walker, David; Donnan, Peter T; Swan, Iain

    2013-10-16

    Bell's palsy is an acute paralysis of one side of the face of unknown aetiology. Bell's palsy should only be used as a diagnosis in the absence of all other pathology. As the proposed pathophysiology is swelling and entrapment of the nerve, some surgeons suggest surgical decompression of the nerve as a possible management option. This is an update of a review first published in 2011. To assess the effects of surgery in the management of Bell's palsy. On 29 October 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL (2012, Issue 10), MEDLINE (January 1966 to October 2012) and EMBASE (January 1980 to October 2012). We also handsearched selected conference abstracts for the original version of the review. We included all randomised or quasi-randomised controlled trials involving any surgical intervention for Bell's palsy. We compared surgical interventions to no treatment, sham treatment, other surgical treatments or medical treatment. Two review authors independently assessed whether trials identified from the searches were eligible for inclusion. Two review authors independently assessed the risk of bias and extracted data. Two trials with a total of 69 participants met the inclusion criteria. The first study considered the treatment of 403 people but only included 44 participants in the surgical trial, who were randomised into surgical and non-surgical groups. However, the report did not provide information on the method of randomisation. The second study randomly allocated 25 participants into surgical or control groups using statistical charts. There was no attempt in either study to conceal allocation. Neither participants nor outcome assessors were blind to the interventions, in either study. The first study lost seven participants to follow-up and there were no losses to follow-up in the second study.Surgeons in both studies decompressed the nerves of all the surgical group participants using a retroauricular approach. The

  16. Good result after surgical treatment of Pellegrini-Stieda syndrome.

    PubMed

    Theivendran, Kanthan; Lever, Caroline J; Hart, William J

    2009-10-01

    Ossification of the femoral attachment of the medial collateral ligament (MCL) of the knee with associated pain and restricted movements is rare and is characteristic of the Pellegrini-Stieda (PS) syndrome. Although in mild cases conservative treatment is often successful, patients with more significant bone formation and persistent symptoms require surgical excision. We describe a case of PS syndrome with a description of the surgical technique consisting of excision of the bony lesion and reconstruction of the MCL by using the adductor magnus tendon.

  17. Early results of an objective olfactometer.

    PubMed

    Davies, C W; Donne, K E; Whittet, H B

    1998-01-01

    Although many people comment on their ability or inability to smell an odour, the accurate measurement of olfaction remains an elusive goal. Currently, there are no instruments available to objectively measure olfaction. This article outlines the design and early test results of a low cost, computer-based olfactometer which uses the frequency content of evoked potentials to quantify a subject's response to an olfactory stimulus. Clinical trials have been undertaken to establish the validity of the olfactometer and over a thousand tests have been carried out. Early results suggest that the methodology employed is appropriate and could be developed to enable a commercial olfactometer to be produced.

  18. Surgical management of bilateral bronchiectases: results in 29 patients.

    PubMed

    Aghajanzadeh, Manucher; Sarshad, Ali; Amani, Hosin; Alavy, Ali

    2006-06-01

    Bronchiectasis is a major cause of morbidity and mortality in developing countries. Staged bilateral segmental resection of the lungs is performed in selected patients. Our experience of surgical removal of 87 bilateral bronchiectases in 29 patients during an 11-year period was reviewed retrospectively. High-resolution computed tomography was performed preoperatively in all patients to locate the anatomic sites of bronchiectasis. The mortality and morbidity of the surgical procedure, clinical symptoms, age distribution, etiology, bacteriology, and operative procedures were analyzed. There were 22 males (76%) and 7 females (24%), aged 5 to 60 years, with a mean age of 30 years. Complications developed in 11 patients (38%); atelectasia was the most common (14%). There was one hospital death. Clinical symptoms disappeared in 19 (66%) patients, improved in 5 (17%), and were unchanged in 4 (14%). Staged bilateral resection for bronchiectases can be performed at any age with acceptable morbidity and mortality.

  19. Early- and Middle-Term Surgical Outcomes in Patients with Heterotaxy Syndrome.

    PubMed

    Chen, Weidan; Ma, Li; Cui, Hujun; Yang, Shengchun; Xia, Yuansheng; Zou, Minghui; Chen, Xinxin

    2016-01-01

    Heterotaxy syndrome is a recognized risk factor for surgical cardiac interventions. We evaluated the early- and middle-term results of a surgical intervention for patients with heterotaxy syndrome. A total of 42 patients with heterotaxy syndrome were enrolled (September 2008 to March 2015). Left and right atrial isomerism were identified in 26% (11 out of 42) and 74% of patients (31 out of 42), respectively. The median age of the patients at the time of surgery was 6.8 months (range: 5 days to 22.3 years). Biventricular repair was completed in 3 patients with left atrial isomerism. Seventeen out of 39 patients who were scheduled for single ventricular repair completed a modified Fontan procedure. The hospital mortality rate was 4.7% (2 out of 42). Another 5 deaths occurred in the remaining survivors following hospital discharge with a follow-up duration of 45.8 ± 23.6 months (range: 13-111 months). The 1-year and 5-year survival rates were 88.1% (37/42) and 83.3% (35/42), respectively. Univariate analysis and multivariate analysis identified pulmonary venous obstruction and atrioventricular valve replacement as additional risk factors for mortality. Right ventricular bypass surgery remains the preferred palliative procedure for patients with heterotaxy syndrome. Based on the current results, the early- and middle-term outcomes are satisfactory. © 2015 S. Karger AG, Basel.

  20. Surgical and obstetrical outcomes after laparoscopic radical trachelectomy and pelvic lymphadenectomy for early cervical cancer

    PubMed Central

    Yoo, So-Eun; So, Kyeong A; Kim, Seon-Ah; Kim, Mi Kyung; Lee, Yoo Kyung; Lee, In-Ho; Kim, Tae-Jin

    2016-01-01

    Objective The aim of this study was to evaluate the surgical and obstetrical outcomes of patients with early cervical cancer who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy. Methods We analyzed data from women who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy between July 2000 and October 2014. Results Of a total of 12 patients, 91.7% were FIGO (International Federation of Gynecology and Obstetrics) stages IA2 and IB1. Seven patients (58.3%) had squamous cell carcinoma. The median tumor size was 1.87 cm (range, focal to 4.6 cm) and two patients (16.7%) had a tumor lager than 2 cm. Lymphovascular space invasion in the tumor lesion was reported in six patients (50%). The following surgical complications were observed: neurogenic bladder (one patient), hemoperitoneum (one patient), and infection (one patient). A total of 33.3% had attempted to conceive, resulting in two pregnancies and two healthy babies. All pregnancies were achieved by in vitro fertilization and embryo transfer. Each woman underwent cesarean delivery because of premature pre-labor rupture of membranes at gestational weeks 27.3 and 33.3. After a median follow-up time of 4.4 years (range, 1 to 8 years), there were no recurrences or deaths. Conclusion Laparoscopic radical trachelectomy and pelvic lymphadenectomy should be offered as an alternative treatment for women with early stage cervical cancer who want to preserve their fertility. PMID:27668200

  1. Surgical treatment of early stage breast cancer in elderly: an international comparison.

    PubMed

    Kiderlen, M; Bastiaannet, E; Walsh, P M; Keating, N L; Schrodi, S; Engel, J; van de Water, W; Ess, S M; van Eycken, L; Miranda, A; de Munck, L; van de Velde, C J H; de Craen, A J M; Liefers, G J

    2012-04-01

    Over 40% of breast cancer patients are diagnosed above the age of 65. Treatment of these elderly patients will probably vary over countries. The aim of this study was to make an international comparison (several European countries and the US) of surgical and radiation treatment for elderly women with early stage breast cancer. Survival comparisons were also made. Data were obtained from national or regional population-based registries in the Netherlands, Switzerland, Ireland, Belgium, Germany, and Portugal. For the US patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Early stage breast cancer patients aged ≥ 65 diagnosed between 1995 and 2005 were included. An international comparison was made for breast and axillary surgery, radiotherapy after breast conserving surgery (BCS), and relative or cause-specific survival. Overall, 204.885 patients were included. The proportion of patients not receiving any surgery increased with age in many countries; however, differences between countries were large. In most countries more than half of all elderly patients received breast conserving surgery (BCS), with the highest percentage in Switzerland. The proportion of elderly patients that received radiotherapy after BCS decreased with age in all countries. Moreover, in all countries the proportion of patients who do not receive axillary surgery increased with age. No large differences in survival between countries were recorded. International comparisons of surgical treatment for elderly women with early stage breast cancer are scarce. This study showed large international differences in treatment of elderly early stage breast cancer patients, with the most striking result the large proportion of elderly who did not undergo surgery at all. Despite large treatment differences, survival does not seem to be affected in a major way.

  2. Comparison of minimally invasive surgery with standard open surgery for vertebral thoracic metastases causing acute myelopathy in patients with short- or mid-term life expectancy: surgical technique and early clinical results.

    PubMed

    Miscusi, Massimo; Polli, Filippo Maria; Forcato, Stefano; Ricciardi, Luca; Frati, Alessandro; Cimatti, Marco; De Martino, Luca; Ramieri, Alessandro; Raco, Antonino

    2015-05-01

    OBJECT Spinal metastasis is common in patients with cancer. About 70% of symptomatic lesions are found in the thoracic region of the spine, and cord compression presents as the initial symptom in 5%-10% of patients. Minimally invasive spine surgery (MISS) has recently been advocated as a useful approach for spinal metastases, with the aim of decreasing the morbidity associated with more traditional open spine surgery; furthermore, the recovery time is reduced after MISS, such that postoperative chemotherapy and radiotherapy can begin sooner. METHODS Two series of oncological patients, who presented with acute myelopathy due to vertebral thoracic metastases, were compared in this study. Patients with complete paraplegia for more than 24 hours and with a modified Bauer score greater than 2 were excluded from the study. The first group (n = 23) comprised patients who were prospectively enrolled from May 2010 to September 2013, and who were treated with minimally invasive laminotomy/laminectomy and percutaneous stabilization. The second group (n = 19) comprised patients from whom data were retrospectively collected before May 2010, and who had been treated with laminectomy and stabilization with traditional open surgery. Patient groups were similar regarding general characteristics and neurological impairment. Results were analyzed in terms of neurological recovery (American Spinal Injury Association grade), complications, pain relief (visual analog scale), and quality of life (European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 and EORTC QLQ-BM22 scales) at the 30-day follow-up. Operation time, postoperative duration of bed rest, duration of hospitalization, intraoperative blood loss, and the need and length of postoperative opioid administration were also evaluated. RESULTS There were no significant differences between the 2 groups in terms of neurological recovery and complications. Nevertheless, the MISS group showed a clear and significant

  3. Results of surgical management in 92 consecutive patients with Zollinger-Ellison syndrome.

    PubMed

    Bonfils, S; Landor, J H; Mignon, M; Hervoir, P

    1981-12-01

    Hospital records and follow-up information on 92 patients with surgically proven Zollinger-Ellison syndrome have been reviewed, and data relating to symptomatology, age and sex incidence, pathologic findings, and early and late results of surgical procedures have been summarized. The postoperative mortality rate was 15%, and was adversely affected by previous peptic ulcer surgery, by the necessity of urgent operation for complications of peptic ulcer, and by employment of a procedure that failed to control acid secretion. Thirteen patients were found to have primary gastrinomas of the duodenum and an additional 13 patients had islet cell hyperplasia without evidence of frank neoplasm; prognosis in these two groups appears to be particularly favorable. Despite the current availability of effective nonoperative measures for control of gastric hypersecretion, surgical exploration is warranted in all patients to determine location and extent of tumor and to attempt to control the ulcer diathesis by resection of tumor. Long-term therapy with H2 receptor antagonists is advised for patients whose hypersecretory state has not been alleviated by tumor resection or whose gastrinoma cannot be removed. Total gastrectomy is still indicated in patients whose tumors are not amenable to resection and who are resistant to, or cannot follow, a rigid medical regimen.

  4. Results of surgical management in 92 consecutive patients with Zollinger-Ellison syndrome.

    PubMed Central

    Bonfils, S; Landor, J H; Mignon, M; Hervoir, P

    1981-01-01

    Hospital records and follow-up information on 92 patients with surgically proven Zollinger-Ellison syndrome have been reviewed, and data relating to symptomatology, age and sex incidence, pathologic findings, and early and late results of surgical procedures have been summarized. The postoperative mortality rate was 15%, and was adversely affected by previous peptic ulcer surgery, by the necessity of urgent operation for complications of peptic ulcer, and by employment of a procedure that failed to control acid secretion. Thirteen patients were found to have primary gastrinomas of the duodenum and an additional 13 patients had islet cell hyperplasia without evidence of frank neoplasm; prognosis in these two groups appears to be particularly favorable. Despite the current availability of effective nonoperative measures for control of gastric hypersecretion, surgical exploration is warranted in all patients to determine location and extent of tumor and to attempt to control the ulcer diathesis by resection of tumor. Long-term therapy with H2 receptor antagonists is advised for patients whose hypersecretory state has not been alleviated by tumor resection or whose gastrinoma cannot be removed. Total gastrectomy is still indicated in patients whose tumors are not amenable to resection and who are resistant to, or cannot follow, a rigid medical regimen. PMID:7030236

  5. Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results

    PubMed Central

    2011-01-01

    Background In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. Methods Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. Results A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. Discussion Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. Conclusions Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures should be treated

  6. Parasellar meningiomas in pregnancy: surgical results and visual outcomes.

    PubMed

    Moscovici, Samuel; Fraifeld, Shifra; Cohen, José E; Dotan, Shlomo; Elchalal, Uriel; Shoshan, Yigal; Spektor, Sergey

    2014-01-01

    Rapid visual deterioration may occur as the result of the quick growth of parasellar meningiomas in the high-hormone/increased fluid retention milieu of pregnancy; however, surgery before delivery entails increased maternal-fetal risk. We present our experience in the management of parasellar meningiomas that compress the optic apparatus during pregnancy, with a focus on decisions regarding the timing of surgery. Serial visual examinations and other clinical data for 11 women presenting from 2002 to 2012 with visual deterioration during pregnancy or delivery as the result of parasellar meningiomas involving the optic apparatus were reviewed. Indications for surgery during pregnancy included severely compromised vision, rapid visual deterioration, and early-to-midstage pregnancy with the potential for significant tumor growth and visual decrease before delivery. All patients underwent surgery with the use of skull base techniques via pterional craniotomy. An advanced extradural-intradural (i.e., Dolenc) approach, with modifications, was used in seven. All women achieved a Glasgow Outcome Score of 5 at discharge with no new neurologic deficits; all children are developing normally at a mean 4.5 years of age (range, 1-9.5 years). Surgery during pregnancy was recommended for six women: four operated at gestational weeks 20-23 had excellent postoperative visual recovery; two who delayed surgery until after delivery have permanent unilateral blindness. Among five others operated after delivery, four had good visual recovery and one has pronounced but correctable deficits. Three of five women diagnosed at gestational weeks 32-35 experienced spontaneous visual improvement after delivery, before surgery. We recommend that surgery be offered to patients during pregnancy when a delay may result in severe permanent visual impairment. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Health Status after Transcatheter or Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis at Increased Surgical Risk. Results from the CoreValve US Pivotal Trial

    PubMed Central

    Arnold, Suzanne V.; Reynolds, Matthew R.; Wang, Kaijun; Magnuson, Elizabeth A.; Baron, Suzanne J.; Chinnakondepalli, Khaja M.; Reardon, Michael J.; Tadros, Peter N.; Zorn, George L.; Maini, Brij; Mumtaz, Mubashir A.; Brown, John M.; Kipperman, Robert M.; Adams, David H.; Popma, Jeffrey J.; Cohen, David J.

    2015-01-01

    Background In patients at increased surgical risk, TAVR with a self-expanding bioprosthesis is associated with improved 1-year survival compared with AVR. However, elderly patients may be just as concerned with quality of life improvement as with prolonged survival as a goal of treatment. Objectives To compare the health status outcomes for patients treated with either self-expanding transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (AVR). Methods Between 2011 and 2012, 795 patients with severe aortic stenosis at increased surgical risk were randomized to TAVR or AVR in the CoreValve US Pivotal Trial. Health status was assessed at baseline, 1 month, 6 months, and 1 year using the Kansas City Cardiomyopathy Questionnaire (KCCQ), SF-12, and EQ-5D; growth curve models were used to examine changes over time. Results Over the 1-year follow-up period, disease-specific and generic health status improved substantially for both treatment groups. At 1-month, there was a significant interaction between the benefit of TAVR over AVR and access site. Among surviving patients eligible for iliofemoral (IF) access, there was a clinically relevant early benefit with TAVR across all disease-specific and generic health status measures. Among the non-IF cohort; however, most health status measures were similar for TAVR and AVR, although there was a trend toward early benefit with TAVR on the SF-12 physical health scale. There were no consistent differences in health status between TAVR and AVR at the later time points. Conclusions Health status improved substantially in surviving patients with increased surgical risk who were treated with either self-expanding TAVR or AVR. TAVR via the IF route was associated with better early health status compared with AVR, but there was no early health status benefit with non-IF TAVR compared with AVR. PMID:26292584

  8. Surgical Factors in Pediatric Cochlear Implantation and Their Early Effects on Electrode Activation and Functional Outcomes

    PubMed Central

    Francis, Howard W.; Buchman, Craig A.; Visaya, Jiovani M.; Wang, Nae-Yuh; Zwolan, Teresa A.; Fink, Nancy E.; Niparko, John K.

    2009-01-01

    Objective To assess the impact of surgical factors on electrode status and early communication outcomes in young children in the first 2 years of cochlear implantation. Study Design Prospective multicenter cohort study. Setting Six tertiary referral centers. Patients Children 5 years or younger before implantation with normal nonverbal intelligence. Intervention Cochlear implant operations in 209 ears of 188 children. Main Outcome Measures Percent active channels, auditory behavior as measured by the Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale and Reynell receptive language scores. Results Stable insertion of the full electrode array was accomplished in 96.2% of ears. At least 75% of electrode channels were active in 88% of ears. Electrode deactivation had a significant negative effect on Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale scores at 24 months but no effect on receptive language scores. Significantly fewer active electrodes were associated with a history of meningitis. Surgical complications requiring additional hospitalization and/or revision surgery occurred in 6.7% of patients but had no measurable effect on the development of auditory behavior within the first 2 years. Negative, although insignificant, associations were observed between the need for perioperative revision of the device and 1) the percent of active electrodes and 2) the receptive language level at 2-year follow-up. Conclusion Activation of the entire electrode array is associated with better early auditory outcomes. Decrements in the number of active electrodes and lower gains of receptive language after manipulation of the newly implanted device were not statistically significant but may be clinically relevant, underscoring the importance of surgical technique and the effective placement of the electrode array. PMID:18401281

  9. Pre Surgical Nasoalveolar Molding: Changing Paradigms in Early Cleft Lip and Palate Rehabilitation

    PubMed Central

    Murthy, Prashanth Sadashiva; Deshmukh, Seema; Bhagyalakshmi, A; Srilatha, KT

    2013-01-01

    Background: Alveolar and nasal reconstruction for patients with cleft lip and palate is a challenge for the reconstructive surgeon. Various procedures have been attempted to reduce the cleft gap so as to obtain esthetic results post surgically. Yet there is need of continuous exploration of newer and better methods. Rehabilitation of cleft lip and palate generally requires a team approach with paedodontists playing a major role of performing nasoalveolar molding. Presurgical Nasoalveolar Molding (PNAM) was introduced to reshape the alveolar and nasal segments prior to surgical repair. Over the time there have been changes in the concepts of the same. To assess these changing concepts a pubmed search was performed with different related terminologies and articles over a period of 30 years were obtained. Among the articles retrieved, studies performed over different concepts in early management of cleft lip and palate was selected for the systematic review. Aims This paper describes the changing paradigms in the management of patients with cleft lip and palate, focuses on the current concept of Presurgical nasoalveolar molding(PNAM) and discusses the long term benefits of the same. Conclusion The concept of the management of cleft lip and palate has changed over the time with more emphasis on the nasal and alveolar molding prior to the primary lip repair. This molding reduces the number reconstructive surgeries performed later for the purpose of esthetics. How to cite this article: Murthy P S, Deshmukh S, Bhagyalakshmi A, Srilatha K T. Pre Surgical Nasoalveolar Molding: Changing Paradigms in Early Cleft Lip and Palate Rehabilitation. J Int Oral Health 2013; 5(2):76-86. PMID:24155594

  10. Results of surgical treatment for juvenile myasthenia gravis.

    PubMed

    Vázquez-Roque, F J; Hernández-Oliver, M O; Medrano Plana, Y; Castillo Vitlloch, A; Fuentes Herrera, L; Rivero-Valerón, D

    2017-04-01

    Radical or extended thymectomy is an effective treatment for myasthenia gravis in the adult population. There are few reports to demonstrate the effectiveness of this treatment in patients with juvenile myasthenia gravis. The main objective of this study was to show that extended transsternal thymectomy is a valid option for treating this disease in paediatric patients. Twenty-three patients with juvenile myasthenia gravis underwent this surgical treatment in the period between April 2003 and April 2014; mean age was 12.13 years and the sample was predominantly female. The main indication for surgery, in 22 patients, was the generalised form of the disease (Osserman stage II) together with no response to 6 months of medical treatment. The histological diagnosis was thymic hyperplasia in 22 patients and thymoma in one patient. There were no deaths and no major complications in the postoperative period. After a mean follow-up period of 58.87 months, 22 patients are taking no medication or need less medication to manage myasthenic symptoms. Extended (radical) transsternal thymectomy is a safe and effective surgical treatment for juvenile myasthenia gravis. Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Preliminary results of a computerized Placido disk surgical corneal topographer

    NASA Astrophysics Data System (ADS)

    Carvalho, Luis A.; Tonissi, S. A.; Castro, Jarbas C.

    1999-06-01

    We have developed a novel instrument for computerized corneal topography during surgery. The instrument measures a region of approximately 7 mm in diameter, providing the surgeon with precise values of power and astigmatism. The system is based on a Placido Disc projecting system, which is attached to the objective lens of the surgical microscope. The Placido Disc pattern is reflected by a 50% beam splitter attached to the body of the microscope. At the beam splitter we installed our home-made adaptor and a CCD monochromatic high resolution camera. A high quality frame grabber is installed on a PC and images are digitized at a 480x640 resolution. Algorithms based on image processing techniques were implemented for edge detection of pattern. Calibrating curves based on 4 spherical surfaces were generated and approximately 3600 points were calculated for each exam. Preliminary measurements on 10 healthy corneas were compared with the measurements made on an EyeSys Corneal Topographer. Mean deviation was 0.05 for radius of curvature, 0.24 D for power and 5 degrees for cylinder. This system, with some improvements, may be successfully used to diminish high post surgical astigmatisms in surgeries such as cataract and corneal transplant. This system could also be used to gather preoperative data in corneal topography assisted LASIK.

  12. [Primary cardiac hemangioendothelioma: early diagnosis and surgical resection].

    PubMed

    Gaytán-Cortés, Fernando Celso; Arteaga-Adame, Juan; Careaga-Reyna, Guillermo; Lezama-Urtecho, Carlos; Álvarez-Sánchez, Luis

    2016-01-01

    The term hemangioendothelioma encompasses all tumors that derive from the endothelium of blood vessels. It has an uncertain prognosis, and it is always considered as a low-grade malignancy. Male, 23, who was admitted to the emergency room with chest pain, intermittent paroxysmal nocturnal dyspnea and malaise. He denied having a history of degenerative diseases, and had a weight loss of 6 kg in two months. Chest X-rays suggested pericardial effusion. Patient presented a tendency to hypotension tamponade, which was solved with subxiphoid puncture, and drain 800 mL of liquid from ancient hematological parameters. He presented a tumor in the right atrium of 8x4 cm, attached to the anterior wall of the atrium without involucre of interatrial septum. When patient underwent surgery, it was identified a tumor lesion in the anterior wall of right appendage. It was done the resection of the tumor and of 70% of the right atrial appendage. The latter was replaced with bovine pericardium. Patient showed good outcome; it was discharged after 10 days of follow-up surgery for six months in the outpatient clinic. The hemangioendothelioma is a vascular tumor of unpredictable behavior, and whose origin rarely comes from the heart. A timely detection, and a radical surgical resection is, so far, the more acceptable management, given the worldwide little experience for handling this type of tumor. Our experience suggests an aggressive clinical approach and surgical removal within the first hours of the suspected diagnosis for the greatest chance of complete resection and reducing the risk of recurrence.

  13. ESOPHAGEAL MUCOSAL RESECTION VERSUS ESOPHAGECTOMY: A COMPARATIVE STUDY OF SURGICAL RESULTS IN PATIENTS WITH ADVANCED MEGAESOPHAGUS

    PubMed Central

    de OLIVEIRA, Gustavo Carvalho; da ROCHA, Rodrigo Lima Bastos; COELHO-NETO, João de Souza; TERCIOTTI-JUNIOR, Valdir; LOPES, Luiz Roberto; ANDREOLLO, Nelson Adami

    2015-01-01

    Background The surgical treatment of advanced megaesophagus has no consensus, being esophagectomy the more commonly used method. Since it has high morbimortality - inconvenient for benign disease -, in recent years an alternative has been introduced: the esophageal mucosal resection. Aim To compare early and late results of the two techniques evaluating the operative time, length of ICU stay; postoperative hospitalization; total hospitalization; intra- and postoperative complication rates; mortality; and long-term results. Methods Were evaluated retrospectively 40 charts, 23 esophagectomies and 17 mucosectomies. In assessing postoperative results, interviews were conducted by using a specific questionnaire. Results Comparing the means of esophagectomy and mucosal resection, respectively, the data were: 1) surgical time - 310.2 min and 279.7 min (p> 0.05); 2) length of stay in ICU - 5 days and 2.53 days (p <0.05); 3) total time of hospitalization - 24.25 days and 20.76 days (p> 0.05); 4) length of hospital stay after surgery - 19.05 days and 14.94 days (p> 0.05); 5) presence of intraoperative complications - 65% and 18% (p <0.05); 6) the presence of postoperative complications - 65% and 35% (p> 0.05). In the assessment of late postoperative score (range 0-10) esophagectomy (n = 5) obtained 8.8 points and 8.8 points also got mucosal resection (n = 5). Conclusions Esophageal mucosal resection proved to be good alternative for surgical treatment of megaesophagus. It was advantageous in the immediate postoperative period by presenting a lower average time in operation, the total hospitalization, ICU staying and complications rate. In the late postoperative period, the result was excellent and good in both operations. PMID:25861065

  14. Surgical results of lumbar interbody fusion using calcium phosphate cement.

    PubMed

    Hirasawa, Motohiro; Mure, Hideo; Toi, Hiroyuki; Nagahiro, Shinji

    2014-01-01

    Clinical and radiological outcomes of lumbar interbody fusion using artificial fusion cages filled with calcium phosphate cements (CPCs) were retrospectively reviewed. Between 2002 and 2011, 25 patients underwent lumbar interbody fusion at Tokushima University Hospital, and 22 patients were enrolled in this study. Of these, 5 patients received autologous local bone grafts and 17 received CPC. Japan Orthopedic Association (JOA) score was used for clinical outcome assessments. Lumbar radiography and computed tomography (CT) were performed at 12, 24 months and last follow-up period to assess bony fusion. The mean JOA score of all patients improved from 9.3 before surgery to 21.0 at 24 months after surgery. Fusion had occurred in 5 of 5 patients in the local bone graft group and in 16 of 17 patients in CPC group at 24 months postoperatively. No surgically related complication was occurred in both groups. CPC is a useful and safe graft material for lumbar interbody fusion.

  15. Iatrogenic Femoral Pseudoaneurysm and Secondary Ipsilateral Deep Vein Thrombosis: An Indication for Early Surgical Exploration.

    PubMed

    Papadakis, Marios; Zirngibl, Hubert; Floros, Nikolaos

    2016-07-01

    Pseudoaneurysm formation often complicates transfemoral interventional procedures. Nonsurgical treatment consists of femoral compression and thrombin injection under ultrasound guidance. We report a 74-year-old man who was diagnosed with a pseudoaneurysm, following coronary angiography. Duplex ultrasound revealed deep vein thrombosis of the ipsilateral common femoral vein. Ultrasound-guided thrombin injection was unsuccessfully performed, and the patient subsequently underwent surgical exploration for repair of the pseudoaneurysm and release of the venous compression. The increased local inflammation, because of the thrombosis, added in surgical difficulties. We conclude that early surgical intervention should be considered as a primary strategy in patients with femoral pseudoaneurysms and deep vein thrombosis secondary to femoral compression.

  16. A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    Background: The impact of early mobilization on perioperative comorbidities and length of stay (LOS) has shown benefits in other medical/surgical subspecialties. However, few spinal series have specifically focused on the “pros” of early mobilization for spinal surgery, other than in acute spinal cord injury. Here we reviewed how early mobilization and other adjunctive measures reduced morbidity and LOS in both medical and/or surgical series, and focused on how their treatment strategies could be applied to spinal patients. Methods: We reviewed studies citing protocols for early mobilization of hospitalized patients (day of surgery, first postoperative day/other) in various subspecialties, and correlated these with patients’ perioperative morbidity and LOS. As anticipated, multiple comorbid factors (e.g. hypertension, high cholesterol, diabetes, hypothyroidism, obesity/elevated body mass index hypothyroidism, osteoporosis, chronic obstructive pulmonary disease, coronary artery disease and other factors) contribute to the risks and complications of immobilization for any medical/surgical patient, including those undergoing spinal procedures. Some studies additionally offered useful suggestions specific for spinal patients, including prehabilitation (e.g. rehabilitation that starts prior to surgery), preoperative and postoperative high protein supplements/drinks, better preoperative pain control, and early tracheostomy, while others cited more generalized recommendations. Results: In many studies, early mobilization protocols reduced the rate of complications/morbidity (e.g. respiratory decompensation/pneumonias, deep venous thrombosis/pulmonary embolism, urinary tract infections, sepsis or infection), along with the average LOS. Conclusions: A review of multiple medical/surgical protocols promoting early mobilization of hospitalized patients including those undergoing spinal surgery reduced morbidity and LOS. PMID:24843814

  17. Multiple magnet ingestion: is there a role for early surgical intervention?

    PubMed

    Salimi, Amrollah; Kooraki, Soheil; Esfahani, Shadi Abdar; Mehdizadeh, Mehrzad

    2012-01-01

    Children often swallow foreign bodies. Multiple magnet ingestion is rare, but can result in serious complications. This study presents three unique cases of multiple magnet ingestion: one case an 8-year-old boy with multiple magnet ingestion resulting in gastric obstruction and the other two cases with intestinal perforations due to multiple magnet intake. History and physical examination are unreliable in children who swallow multiple magnets. Sometimes radiological findings are not conclusive, whether one magnet is swallowed or more. If magnets are not moved in sequential radiology images, we recommend early surgical intervention before gastrointestinal complications develop. Toy companies, parents, physicians, and radiologists should be warned about the potential complications of such toys.

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

    PubMed

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

    2014-07-26

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

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

    PubMed Central

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

    2014-01-01

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

  20. Kepler Mission Development Challenges and Early Results

    NASA Technical Reports Server (NTRS)

    Fanson, J.

    2011-01-01

    Kepler is NASA`s first mission capable of detecting Earth-size planets orbiting in the habitable zone of stars other than the sun. Kepler comprises a space telescope designed to continuously monitor the brightnesses of more than 100,000 target stars, and a ground segment to analyze the measured stellar light curves and detect the signatures of orbiting planets. In order to detect Earth-size planets orbiting Sun-like stars Kepler was designed to provide unprecedented photometric sensitivity and stability. This paper addresses some of the technical challenges encountered during the development of the Kepler mission and the measures taken to overcome them. Early scientific results are summarized.

  1. Kepler Mission Development Challenges and Early Results

    NASA Technical Reports Server (NTRS)

    Fanson, J.; Duren, R.; Frerking, M.

    2011-01-01

    Kepler is NASA s first mission capable of detecting Earth-size planets orbiting in the habitable zone of stars other than the Sun. Kepler comprises a space telescope designed to continuously monitor the brightnesses of more than 100,000 target stars, and a ground segment to analyze the measured stellar light curves and detect the signatures of orbiting planets. In order to detect Earth-size planets orbiting Sun-like stars Kepler was designed to provide unprecedented photometric sensitivity and stability. This paper addresses some of the technical challenges encountered during the development of the Kepler mission and the measures taken to overcome them. Early scientific results are summarized.

  2. Results of surgical lysis of lumbar adhesive arachnoiditis.

    PubMed

    Wilkinson, H A; Schuman, N

    1979-05-01

    From a series of 681 patients with lumbar disc disease treated between 1966 and 1978, 17 patients required surgical lysis of lumbar adhesive arachnoiditis, 8 having initially been operated upon by another surgeon. All patients had severe pain as a predominant feature, with pain being bilateral in 9 patients. Pain was the only major symptom in 3; the other 14 exhibited varying combinations of progressive neurological dysfunction. Three patients developed late symptoms after trauma, 8 to 21 years after back surgery. At operation, multisegmental arachnoiditis was found in 5 patients and anular or subtotal adhesions were found in 12. Complete lysis could not be obtained in 4 patients. Fourteen patients were treated with steroids at the time of operation. Follow-up after lysis was less than 1 year for 5 patients but averaged 4.8 years for the remaining 12. During the 1st year after operation, 76% experienced improvement in pain (35%, good to excellent), 71% experienced improvement in neurological status. Follow-up after at least 1 year revealed 50% still enjoying pain relief (25%, good to excellent) and 45% experiencing neurological improvement. Pain relief persisted in 4 of 5 patients followed 5 years or more. The etiological role of myelograpy and lumbar disc surgery in arachnoiditis has probably been over-rated. Arachnoiditis may be symptomatic or asymptomatic and may mask other, treatable lumbar lesions. More frequent intradural exploration for discrepancies between operative and myelographic findings might reveal, and benefit, more cases of spontaneous arachnoiditis mimicking lumbar disc disease.

  3. Early surgical treatment in a case of myoclonus dystonia syndrome.

    PubMed

    Kühn, Andrea A; Krause, Patricia; Lauritsch, Katharina; Zentner, Christian; Brücke, Christof; Schneider, Gerd-Helge

    2014-11-01

    Myoclonus dystonia syndrome is often misdiagnosed in young children and appropriate treatment is delayed, which has a negative impact on motor development, participation, and emotional well-being. In severely affected patients, deep brain stimulation of the globus pallidus internus has been used successfully to treat both dystonia and myoclonus. Here, the authors present a case of early successful treatment of myoclonus dystonia syndrome by pallidal deep brain stimulation in a patient at the age of 17 years leading to 83% reduction in dystonia score and 89% reduction in myoclonus. The patient gained significant improvement in motor function as well as increased participation and reduced stigma.

  4. Long-term surgical results of supplementary motor area epilepsy surgery.

    PubMed

    Alonso-Vanegas, Mario A; San-Juan, Daniel; Buentello García, Ricardo M; Castillo-Montoya, Carlos; Sentíes-Madrid, Horacio; Mascher, Erika Brust; Bialik, Paul Shkurovick; Trenado, Carlos

    2017-02-03

    OBJECTIVE Supplementary motor area (SMA) epilepsy is a well-known clinical condition; however, long-term surgical outcome reports are scarce and correspond to small series or isolated case reports. The aim of this study is to present the surgical results of SMA epilepsy patients treated at 2 reference centers in Mexico City. METHODS For this retrospective descriptive study (1999-2014), 52 patients underwent lesionectomy and/or corticectomy of the SMA that was guided by electrocorticography (ECoG). The clinical, neurophysiological, neuroimaging, and pathological findings are described. The Engel scale was used to classify surgical outcome. Descriptive statistics, Student t-test, and Friedman, Kruskal-Wallis, and chi-square tests were used. RESULTS Of these 52 patients, the mean age at epilepsy onset was 26.3 years, and the mean preoperative seizure frequency was 14 seizures per month. Etiologies included low-grade tumors in 28 (53.8%) patients, cortical dysplasia in 17 (32.7%) patients, and cavernomas in 7 (13.5%) patients. At a mean follow-up of 5.7 years (range 1-10 years), 32 patients (61%) were classified as Engel Class I, 16 patients (31%) were classified as Engel Class II, and 4 (8%) patients were classified as Engel Class III. Overall seizure reduction was significant (p = 0.001). The absence of early postsurgical seizures and lesional etiology were associated with the outcome of Engel Class I (p = 0.05). Twenty-six (50%) patients had complications in the immediate postoperative period, all of which resolved completely with no residual neurological deficits. CONCLUSIONS Surgery for SMA epilepsy guided by ECoG using a multidisciplinary and multimodality approach is a safe, feasible procedure that shows good seizure control, moderate morbidity, and no mortality.

  5. The early results of our initial experience with robotic adrenalectomy

    PubMed Central

    Akarsu, Cevher; Dural, Ahmet Cem; Kankaya, Burak; Çelik, Muhammet Ferhat; Köneş, Osman; Mert, Meral; Kalaycı, Mustafa Uygar; Alış, Halil

    2014-01-01

    Objective: Robotic adrenalectomy is one of the minimally invasive surgical methods gaining wide acceptance due to the three-dimensional imaging system and ergonomics of the equipment. We aimed to present the early data on patients who underwent robotic adrenalectomy due to adrenal masses in our hospital. Material and Methods: The records of eight cases, in which a unilateral robotic trans-peritoneal adrenalectomy was conducted due to an adrenal mass between 2011 and 2013, have been evaluated. Demographic characteristics of cases, body mass index (BMI), American Society of Anesthesiologists (ASA) score, preoperative diagnosis, diameter and localization of the adrenal mass, operative time, blood loss, conversion rate to open surgery, morbidity and mortality rates, length of hospital stay, total hospital charges and postoperative pathologic results were considered. Results: The female to male ratio was 6:2, the median age was 49.5 (26–71) and the median BMI was 29.7 (21.7–38.5). An adrenalectomy was performed in six cases for a right adrenal mass and in two cases for a left adrenal mass. The mean tumor diameter was 53.6 mm (20–90). The average surgical time (including docking) was 98 min. (55–175 min.) and the average blood loss was 50 mL. The only complication was a diaphragm injury which was repaired robotically. There were no conversions to traditional laparoscopic or open surgery and there have not been any mortality in the series. The median length of hospital stay was 4.1 days (range 2–11) and the average cost was 3617.12 TL ($1808.56). Conclusion: Robotic adrenalectomy is an effective and safe surgical alternative to laparoscopic adrenalectomy. However its high cost has emerged as its main disadvantage. PMID:25931887

  6. Differential effects of estradiol on carotid artery inflammation when administered early versus late after surgical menopause.

    PubMed

    Sophonsritsuk, Areepan; Appt, Susan E; Clarkson, Thomas B; Shively, Carol A; Espeland, Mark A; Register, Thomas C

    2013-05-01

    The aim of this study was to determine the effects of estrogen therapy (ET) on carotid artery inflammation when initiated early and late relative to surgical menopause. Female cynomolgus macaques consuming atherogenic diets were ovariectomized and randomized to control or oral estradiol (E2; human equivalent dose of 1 mg/d micronized E2) initiated at 1 month (early menopause, n = 24) or 54 months (late menopause, n = 40) after ovariectomy. The treatment period was 8 months. Carotid artery expression of the markers of monocyte/macrophages (CD68 and CD163), dendritic cells (CD83), natural killer cells (neural cell adhesion molecule-1), and interferon-γ was significantly lower in E2-treated animals in the early menopause group but not in the late menopause group (P < 0.05). In contrast, carotid artery transcripts for T-cell markers (CD3, CD4, CD8, and CD25), interleukin-10, type I collagen, monocyte chemoattractant protein-1, matrix metalloproteinase-9, and tumor necrosis factor-α were lower in E2-treated monkeys regardless of menopausal stage (P < 0.05). ET initiated soon after menopause inhibits macrophage accumulation in the carotid artery, an effect that is not observed when E2 is administered after several years of estrogen deficiency. No evidence for pro-inflammatory effects of late ET is observed. The results provide support for the timing hypothesis of postmenopausal ET with implications for the interpretation of outcomes in the Women's Health Initiative.

  7. A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss.

    PubMed

    Nadarajah, Ravichandran; Quek, Yek Song; Kuppannan, Kaliammah; Woon, Shu Yuan; Jeganathan, Ravichandran

    2014-07-01

    To show whether a clinically significant difference in success rates exists between expectant and surgical management of early pregnancy loss. Randomised controlled trial comparing expectant versus surgical management of early pregnancy loss over a 1-year period from 1st January to 31st December 2009 at Sultanah Aminah Hospital, Johor Bahru. Pregnant women with missed or incomplete miscarriages at gestations up to 14 weeks were recruited in this study. The success rate in the surgical group was measured as curettage performed without any complications during or after the procedure, while the success rate in the expectant group was defined as complete spontaneous expulsion of products of conception within 6 weeks without any complication. A total of 360 women were recruited and randomised to expectant or surgical management, with 180 women in each group. There was no statistically significant difference in the success rate between the groups and between the different types of miscarriage. With expectant management, 131 (74%) patients had a complete spontaneous expulsion of products of conception, of whom 106 (83%) women miscarried within 7 days. However, the rates of unplanned admissions (18.1%) and unplanned surgical evacuations (17.5%) in the expectant group were significantly higher than the rates (7.4% and 8% respectively) in the surgical group. The complications in both groups were similar. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. [ANALYSIS OF THE SURGICAL TREATMENT RESULTS IN THE THYROID GLAND DISEASES].

    PubMed

    Tarashchenko, Yu N; Bolgov, M Yu

    2015-08-01

    The results of surgical treatment of the thyroid gland diseases were analyzed, including the specific morbidity rate, cosmetic effect of the operation, stationary treatment of patients duration, the operation radicalism. Improvement of the operation methods and introduction of modern electric surgical instruments have permitted to reduce the operation duration, the surgical access length, the rate of postoperative hypocalcaemia occurrence, duration of the patients stationary treatment.

  9. Does an Antibiotic-Loaded Hydrogel Coating Reduce Early Post-Surgical Infection After Joint Arthroplasty?

    PubMed Central

    Romanò, Carlo Luca; Malizos, Kostantinos; Capuano, Nicola; Mezzoprete, Riccardo; D'Arienzo, Michele; Van Der Straeten, Catherine; Scarponi, Sara; Drago, Lorenzo

    2016-01-01

    Background: Infection remains among the main reasons for joint prosthesis failure. Preclinical reports have suggested that antibacterial coatings of implants may prevent bacterial adhesion and biofilm formation. This study presents the results of the first clinical trial on an antibiotic-loaded fast-resorbable hydrogel coating (Defensive Antibacterial Coating, DAC®) in patients undergoing hip or knee prosthesis. Methods: In this multicenter, randomized prospective study, a total of 380 patients, scheduled to undergo primary (n=270) or revision (n=110) total hip (N=298) or knee (N=82) joint replacement with a cementless or a hybrid implant, were randomly assigned, in six European orthopedic centers, to receive an implant either with the antibiotic-loaded DAC coating (treatment group) or without coating (control group). Pre- and postoperative assessment of clinical scores, wound healing, laboratory tests, and x-ray exams were performed at fixed time intervals. Results: Overall, 373 patients were available at a mean follow-up of 14.5 ± 5.5 months (range 6 to 24). On average, wound healing, laboratory and radiographic findings showed no significant difference between the two groups. Eleven early surgical site infections were observed in the control group and only one in the treatment group (6% vs. 0.6%; p=0.003). No local or systemic side effects related to the DAC hydrogel coating were observed, and no detectable interference with implant osteointegration was noted. Conclusions: The use of a fast-resorbable, antibiotic-loaded hydrogel implant coating can reduce the rate of early surgical site infections, without any detectable adverse events or side effects after hip or knee joint replacement with a cementless or hybrid implant. PMID:28529851

  10. A new semiquantitative culture method for early detection of surgical incisional wound infection.

    PubMed

    Yip, A W; Yuen, K Y; Seto, W H; Choi, T K

    1990-05-01

    A semiquantitative culture technique for early detection of surgical wound infection was done by rolling a segment of a plastic intravenous catheter across a blood agar plate after insertion into the most inflamed part of the wound on postoperative day 3. Patients were monitored daily for purulent discharge until healing. Of the 53 wounds studied, 44 (83%) had no growth or low-density superficial colonization on the blood agar (generally less than 15 colony-forming units and within the upper 1.5 cm of the catheter). None of these 44 wounds was subsequently infected; therefore, these colonies represented colonization. Of the 9 wounds (17%) that yielded greater than 15 colony-forming units and a diffuse subcutaneous pattern (colonies below the upper 1.5 cm of the catheter), all developed purulent discharge with a positive culture of the same organisms found by semiquantitative culture. This result differed significantly (P less than .01) from the 44 wounds without subsequent infection. This semiquantitative technique has the potential to distinguish infection from colonization and may be useful in diagnosing surgical wound infection.

  11. Ruptured cerebral aneurysms: early and late prognosis with surgical treatment. A personal series, 1958-1980.

    PubMed

    Shephard, R H

    1983-07-01

    An account is given of a personal prospective series of 815 patients with the syndrome of spontaneous subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm. It concerns all aneurysm patients at risk, both surgical and nonsurgical cases, referred to the author during two main periods: 606 patients were treated during the earlier period of 15 years, and 209 in the subsequent 7 years. The early mortality rate was determined at 3 months, and all survivors in the first period were followed for a mean of 9 years. Only operation survivors were observed during the second period, for 3 years on average. Patients alive at 3 months were studied in detail with respect to disabilities, work capacity, and later mortality. Of the 815 patients, 613, or 75%, were operated on. Comment is made on the influence of certain factors on early mortality. These include age, hypertension, condition of the patient at admission, and number of hemorrhages. From the results of this series, it is suggested that the preferable time to operate is between the 2nd and the 4th day after a single SAH. In this period, the early mortality rate is in the order of 10%. In this subgroup, a high proportion of the patients were in Botterell Grades 1 and 2, with only a few being in Grade 3. Also evident from the results was the protective value of operation against further aneurysm rupture in the 501 patients surviving at 3 months. However, the propensity of a second aneurysm to rupture in patients with multiple aneurysms has resulted recently in a change of operation policy. The early mortality in the whole series and later mortality in patients surviving 3 months is shown in tabular and histogram form. From these, it is clear the majority of later deaths are from causes unrelated to aneurysm rupture.

  12. Prevention of chronic post-surgical pain: the importance of early identification of risk factors.

    PubMed

    Tawfic, Qutaiba; Kumar, Kamal; Pirani, Zameer; Armstrong, Kevin

    2017-06-01

    Chronic post-surgical pain (CPSP) is currently an inevitable surgical complication. Despite the advances in surgical techniques and the development of new modalities for pain management, CPSP can affect 15-60% of all surgical patients. The development of chronic pain represents a burden to both the patient and to the community. In order to have a meaningful impact on this debilitating condition it is essential to identify those at risk. Early identification of patients at risk will help to reduce the percentage of patients who go on to develop CPSP. Unfortunately, evidence about any effective actions to reduce this condition is limited. This review will focus on providing context to the challenging problem of CPSP. The possible role of both the surgeon and anesthesiologist in reducing the incidence of this problem will be explored.

  13. [Immediate and long-term results of surgical treatment of patients for traumatic mandibular fracture].

    PubMed

    Kopchak, A V

    2014-01-01

    The analysis of immediate and long-term results of the surgical treatment of 286 patients, operated for traumatic mandibular fractures in the Department of Oral and Maxillofacial Surgery, National O. O. Bogomolets Medical University. In 67% of patients the anatomical shape of the bone was adequately restored. The presence of residual displacements in other cases was determined by the fracture type and localization, the technical complexity of the surgical intervention, lack of fixation rigidity under certain functional load conditions. In long terms of observation the infection and inflammatory complications were observed in 13.4% of patients, delayed unition and non-unition of bone fragments occurred--in 4.7%, arthosis with persistent dysfunction of the temporomandibular joint--in 6.7%, fibrous ankylosis--in 1.3%. Secondary displacement of fragments was observed in 23.5% of patients due to insufficient stiffness and reliaability of the bone-fixatorsystem. The non-precise reposition of fragments and secondary displacements in the early and late postoperative period were the main cause of occlusal disturbances of various severities, noted in 28% of operated patients, limitation of mouth opening (10%), TMJ disorders and changes in masticatory stereotype (33%), the sensation of pain and discomfort in tough food chewing (35%). A statistical analysis of the effectiveness of different osteosynthesis methods depending on the type and localization of the fracture was carried out and recommendations for usage of fixation devices in clinical practice were given.

  14. Comparison of the National Early Warning Score in non-elective medical and surgical patients.

    PubMed

    Kovacs, C; Jarvis, S W; Prytherch, D R; Meredith, P; Schmidt, P E; Briggs, J S; Smith, G B

    2016-09-01

    The National Early Warning Score (NEWS) is used to identify deteriorating patients in hospital. NEWS is a better discriminator of outcomes than other early warning scores in acute medical admissions, but it has not been evaluated in a surgical population. The study aims were to evaluate the ability of NEWS to discriminate cardiac arrest, death and unanticipated ICU admission in patients admitted to surgical specialties, and to compare the performance of NEWS in admissions to medical and surgical specialties. Hospitalwide data over 31 months, from adult inpatients who stayed at least one night or died on the day of admission, were analysed. The data were categorized as elective or non-elective surgical or medical admissions. The ability of NEWS to discriminate the outcomes above in these different groups was assessed using the area under the receiver operating characteristic curve (AUROC). There were too few outcomes to permit meaningful comparison of elective admissions, so the analysis was constrained to comparison of non-elective admissions. NEWS performed equally well, or better, for surgical as for medical patients. For death within 24 h the AUROC for surgical admissions was 0·914 (95 per cent c.i. 0·907 to 0·922), compared with 0·902 (0·898 to 0·905) for medical admissions. For the combined outcome of any of death, cardiac arrest or unanticipated ICU admission, the AUROC was 0·874 (0·868 to 0·880) for surgical admissions and 0·874 (0·871 to 0·877) for medical admissions. NEWS discriminated deterioration in non-elective surgical patients at least as well as in non-elective medical patients. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

  15. [Early gastric cancer surgically treated at Rebagliati Hospital: study of 76 cases during 5 years].

    PubMed

    Portanova, Michel; Mena, Victor; Yábar, Alejandro

    2010-01-01

    This report describes the characteristics of early gastric cancer surgically treated in the Gastric Cancer Unit at Rebagliati National Hospital between January 2004 and December 2008. Mean age was 68 years; males, distal location, submucosa infiltration and intestinal histological type predominate in these patients. Lymph node involvement was 13%.

  16. Influence of different surgical timing on outcome of patients with aneurysmal subarachnoid hemorrhage and the surgical techniques during early surgery for ruptured intracranial aneurysms.

    PubMed

    Zhou, Guo-Sheng; Song, Lai-Jun

    2014-01-01

    This study aims to investigate the influence of different surgical timing on outcome of patients with aneurysmal subarachnoid hemorrhage and to explore the surgical techniques for ruptured intracranial aneurysms. The clinical data were from 327 cases. 304 cases of the surgical group were further assigned to early surgery (89 cases), intermediate surgery(164 cases) and delayed surgery(51 cases) according to the surgical timing. The other 23 cases were the nonsurgical group. The ultimate outcome of all cases was graded according to the Glasgow Outcome Scale. After the cases of the no-surgical group were re-assigned to different surgical subgroups according to the rebleeding time, the ultimate outcome was graded once more. There was no significant difference among the 3 groups' pre-operative clinical data. After re-assigning the cases of no-surgical group to the different surgical subgroups, there was no significant difference among the 3 groups' preooperative clinical data, while the ultimate outcome grades of early surgery (3.6 ± 1.8) and intermediate surgery (3.5 ± 2.2) were superior to that of delayed surgery (2.9 ± 2.8). This retrospective study has demonstrated that early surgery can not only prevent re-rupture of aneurysm to decrease mortality rate but also improve the ultimate outcome.

  17. Attention to surgeons and surgical care is largely missing from early medicare accountable care organizations.

    PubMed

    Dupree, James M; Patel, Kavita; Singer, Sara J; West, Mallory; Wang, Rui; Zinner, Michael J; Weissman, Joel S

    2014-06-01

    The Affordable Care Act supports the growth of accountable care organizations (ACOs) as a potentially powerful model for health care delivery and payment. The model focuses on primary care. However, surgeons and other specialists have a large role to play in caring for ACOs' patients. No studies have yet investigated the role of surgical care in the ACO model. Using case studies and a survey, we examined the early experience of fifty-nine Medicare-approved ACOs in providing surgical care. We found that ACOs have so far devoted little attention to surgical care. Instead, they have emphasized coordinating care for patients with chronic conditions and reducing unnecessary hospital readmissions and ED visits. In the years to come, ACOs will likely focus more on surgical care. Some ACOs have the ability to affect surgical practice patterns through referral pressures, but local market conditions may limit ACOs' abilities to alter surgeons' behavior. Policy makers, ACO administrators, and surgeons need to be aware of these trends because they have the potential to affect the surgical care provided to ACO patients as well as the success of ACOs themselves. Project HOPE—The People-to-People Health Foundation, Inc.

  18. Surgical anatomy, transperitoneal approach, and early postoperative complications of a ventral lumbar spine surgical model in Lewis rats.

    PubMed

    Damle, Sheela R; Krzyzanowska, Agata; Frawley, Robert J; Cunningham, Matthew E

    2013-10-01

    Surgical models in animals are used extensively to study small molecules and devices for lumbar intervertebral disc repair, replacement, and fusion. Although the ventral lumbar animal models themselves are well described, critical assessment of morbidity and mortality avoidance when using the models have not been reported. Hypothesizing that technique modifications and the relative prevalence and severity of complications would be correlated, we collected and examined peri- and postoperative data stratified by surgical technique. We here report complications associated with the transperitoneal approach to the lumbar spine in 268 Lewis rats and offer data-driven suggestions regarding complication avoidance through technique modification. Compared with wider exposure, limiting the width of exposure to a maximum of 3 mm resulted in fewer neurologic complications in the lower limbs. In addition, avoiding extracorporeal reflection of the small intestine during the exposure was associated with lower incidence of postoperative gastrointestinal distress and fewer situations requiring euthanasia. These findings underscore the importance of detailed approaches in minimizing postoperative morbidity and attrition in surgical models.

  19. [Surgical procedures in 156 cases of pleural effusion. Immediate results].

    PubMed

    Cicero-Sabido, Raúl; Páramo-Arroyo, Rafael F; Navarro-Reynoso, Francisco Pascual; Pimentel-Ugarte, Lorenzo

    2006-01-01

    Pleural effusion is a common clinical entity. Proper diagnosis and management are important for successful treatment. We undertook this study to evaluate immediate results of the procedures used in a group of cases with pleural effusion. Of 2589 patients at first consultation, 787 were hospitalized and 156 had pleural effusion. Diagnostic and therapeutic procedures used were evaluated. With thoracentesis and evacuation of liquid, 23 nonneoplastic cases had resolution. Chest tube drainage with water seal was performed in 133 patients. This procedure suppressed the effusion in 109 patients, but in 24 patients another approach was necessary. In this group there were 35 neoplastic and 96 nonmalignant cases, the latter 36 were provoked by iatrogenic management. Twenty two cases of pneumothorax considered as gaseous effusion and 10 cases of chronic empyema sequelae of pleural effusions were also studied. Proportion comparison demonstrated significant differences between neoplastic and nonneoplastic effusions (p =0.001) and in cases managed with minimally invasive procedures and chest tube drainage (p =0.001). The performance of pleurodesis and thoracoscopy is discussed. In chronic cases, indications of open window thoracostomy and myoplasty are elucidated. In pleural effusion, opportune diagnosis and proper management are essential. Drainage tube can solve the majority of cases. Pneumothorax must be treated in the same way. In chronic empyema, open window thoracostomy and myoplasty are indicated. Careless patient management and poor treatment lead to iatrogenic complications.

  20. Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

    PubMed Central

    Bokhari, S; Walsh, U; Qurashi, K; Liasis, L; Watfah, J; Sen, M; Gould, S

    2016-01-01

    Introduction Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. Methods The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. Results The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to ‘surgeon preference/skill’, was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. Conclusions A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital. PMID:26673047

  1. The Kepler Mission and Early Results

    NASA Astrophysics Data System (ADS)

    Koch, David; Borucki, William; Jenkins, Jon; Basri, Gibor; Batalha, Natalie M.; Brown, Timothy M.; Caldwell, Douglas; Christensen-Dalsgaard, Jørgen; Cochran, William D.; Devore, Edna; Dunham, Edward W.; Gautier, Thomas N., III; Geary, John C.; Gilliland, Ronald L.; Gould, Alan; Jenkins, Jon; Latham, David W.; Lissauer, Jack J.; Marcy, Geoffrey; Monet, David; Sasselov, Dimitar; Boss, Alan; Caldwell, John; Dupree, Andrea K.; Howell, Steve B.; Kjeldsen, Hans; Meibom, Søren; Morrison, David; Tarter, Jill; Bryson, Stephen T.; Dotson, Jessie L.; Haas, Michael R.; Kolodziejczak, Jeffrey; Rowe, Jason F.; van Cleve, Jeffrey E.; Buzasi, Derek; Charbonneau, David; Doyle, Lau-Rance; Ford, Eric; Fortney, Jonathan; Holman, Matthew; Seager, Sara; Steffen, Jason; Welsh, William

    Kepler is a Discovery-class mission designed to determine the frequency of Earth-size planets in and near the habitable zone of solar-like stars. The instrument consists of a 0.95 m aperture photometer designed to obtain high-precision photometric measurement for more than 3.5 years of more than 100,000 stars to search for patterns of transits of exoplanets. The focal plane of the Schmidt telescope contains 42 CCDs with a total of 95 megapixels that cover 115 square degrees of sky. The single star field will be viewed for the entire duration of the mission. The photometer was launched into an Earth-trailing heliocentric orbit on March 6, 2009, finished its commissioning on May 12, and is now in the science operations mode. The bases for a number of the design choices are described. Although the data have not yet been fully corrected for the presence of systematic errors and artifacts, the data show the presence of thousands of eclipsing binaries and variable stars of amazing variety. The character of stellar variability allows us to distinguish dwarf stars from giants. Astrometric stability at the sub-millipixel level of the photocenters of stars allows us in many cases to distinguish transit candidates from background eclipsing binaries. Analysis of the early data shows transits, occultations and even visible light emission from the hot exoplanet HAT-P-7b. The latest results on exoplanet detections from Kepler will be presented. Funding for this mission is provided by NASA's Science Mission Directorate.

  2. Early intervention to promote medical student interest in surgery and the surgical subspecialties.

    PubMed

    Patel, Madhukar S; Mowlds, Donald S; Khalsa, Bhavraj; Foe-Parker, Jennifer E; Rama, Asheen; Jafari, Fariba; Whealon, Matthew D; Salibian, Ara; Hoyt, David B; Stamos, Michael J; Endres, Jill E; Smith, Brian R

    2013-01-01

    Concerns about projected workforce shortages are growing, and attrition rates among surgical residents remain high. Early exposure of medical students to the surgical profession may promote interest in surgery and allow students more time to make informed career decisions. The objective of this study was to evaluate the impact of a simple, easily reproducible intervention aimed at increasing first- and second-year medical student interest in surgery. Surgery Saturday (SS) is a student-organized half-day intervention of four faculty-led workshops that introduce suturing, knot tying, open instrument identification, operating room etiquette, and basic laparoscopic skills. Medical students who attended SS were administered pre-/post-surveys that gauged change in surgical interest levels and provided a self-assessment (1-5 Likert-type items) of knowledge and skills acquisition. First- and second-year medical students. Change in interest in the surgical field as well as perceived knowledge and skills acquisition. Thirty-three first- and second-year medical students attended SS and completed pre-/post-surveys. Before SS, 14 (42%) students planned to pursue a surgical residency, 4 (12%) did not plan to pursue a surgical residency, and 15 (46%) were undecided. At the conclusion, 29 (88%) students indicated an increased interested in surgery, including 87% (13/15) who were initially undecided. Additionally, attendees reported a significantly (p < 0.05) higher comfort level in the following: suturing, knot tying, open instrument identification, operating room etiquette, and laparoscopic instrument identification and manipulation. SS is a low resource, high impact half-day intervention that can significantly promote early medical student interest in surgery. As it is easily replicable, adoption by other medical schools is encouraged. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  3. Surgical treatment of lower limb ischemia in diabetic patients – long-term results

    PubMed Central

    Inan, Bekir; Ugurlucan, Murat; Aydin, Cemalettin; Teker, Melike Elif

    2013-01-01

    Introduction Lower limb ischemia may cause nonhealing ulcers, infection, amputation and even mortality in diabetic patients. In this study, we review our data of ischemic lower limb revascularization procedures in diabetic patients and present the early, mid- and long-term results. Material and methods From March 2004 to September 2008, 83 patients with lower limb ischemia in Fontaine class III and IV underwent distal arterial bypass procedures. Saphenous vein grafts were used for below-knee arterial bypasses in all patients. In 16 (19%) patients femoropopliteal bypasses were performed with PTFE grafts. Short-term and long-term surgical results were evaluated. Results Ulcer recovery was determined in 36% of patients. Graft patency was 95% and 1 death (1%) occurred in short-term follow-up. In long-term follow-up the total effectiveness rate was 74%. Graft patency was 79% and 6 deaths (7%) occurred during the follow-up. Conclusions Lower limb ischemia is a serious event in patients with diabetes mellitus. The consequences may include increased mortality and morbidity in this particular patient population. However, distal arterial revascularizations are considerably effective procedures to avoid amputation, to eliminate symptoms, to promote ulcer recovery and to help the patient participate in social life with acceptable short, mid- and long-term follow-up results. PMID:24482653

  4. ‘Minimum-incision’ endoscopically assisted transvesical prostatectomy: Surgical technique and early outcomes

    PubMed Central

    El-Karamany, Tarek M.; Al-Adl, Ahmed M.; Abdel-Baky, Shabieb A.; Abdel-Azeem, Abdallah F.; Zaazaa, Mohamed A.

    2014-01-01

    Objective To describe the surgical technique and report the early outcomes of a ‘minimum-incision’ endoscopically assisted transvesical prostatectomy (MEATP) for managing benign prostatic obstruction secondary to a large (>80 g) prostate. Patients and methods In a prospective feasibility trial, 60 men with large benign prostates underwent MEATP. The baseline and postoperative evaluation included the International Prostate Symptom Score (IPSS), a measurement of maximum urinary flow rate (Qmax), and the postvoid residual (PVR) urine volume. The adenoma was enucleated digitally through a 3-cm suprapubic skin incision, and haemostasis was completed with endoscopic coagulation of the prostatic fossa. Perioperative complications were recorded and stratified according to the modified Clavien–Dindo score. Results The mean (SD, range) prostate weight estimated by ultrasonography was 102.9 (15.4, 80–160) g, the operative duration was 52 (8, 40–65) min, the haemoglobin loss was 2.1 (1, 0.4–5) g/dL, the catheterisation time was 5.2 (1.3, 4–9) days, and the hospital stay was 6.2 (1.4, 5–10) days. There were 21 complications recorded in 16 (27%) patients, and most (86%) were of grades 1 and 2. The most frequent complications were bleeding requiring a blood transfusion (8%), and prolonged drainage (5%). There was a significant improvement at 3 months after surgery in the IPSS (8.6 vs. 21.6, P < 0.001), Qmax (19.5 vs. 7.7, P < 0.001), and PVR (15.8 vs. 83.9 mL, P < 0.001). Conclusion MEATP is feasible, safe and effective. Comparative studies and long-term data are required to determine its role in the surgical treatment of large-volume BPH. PMID:26019954

  5. Oncological results after surgical treatment of squamous cell cancer of the lateral wall of the oropharynx.

    PubMed

    Díaz-Molina, Juan P; Rodrigo, Juan P; Alvarez-Marcos, Cesar; Llorente, José L; Costales, María; Suárez, Carlos

    2011-07-01

    The gold standard of treatment of cancer of the lateral wall of the oropharynx continues to be unclear, especially in advanced stages. In this study, we report our experience with surgical treatment of these cancers and describe the functional and oncological results of the procedures. Retrospective review. A total of 155 previously untreated patients with squamous cell carcinoma of the lateral wall of the oropharynx who underwent a surgical resection of the lesion at our department from January 1990 to January 2008 were included. Sixty-seven percent of these patients received postoperative radiotherapy. The records of these patients were reviewed to obtain measures such as local and regional control, disease-specific survival, and speech and swallowing function. Six patients had a stage I disease, 15 had a stage II disease, 31 had a stage III disease, 86 had a stage IVA, and 17 had stage IVB disease. The overall recurrence rate was 60%, and the local recurrence rate was 40%. The 5-year overall survival and disease-specific survival rates were 33% and 43%, respectively. Five-year disease-specific survival rates by stage were as follows: 100%, 59%, 57%, 31%, and 33% for stages I to IVB, respectively. Multivariate analysis showed two parameters that were independent predictors of a reduced disease-specific survival: cervical lymph node metastases pN2-3 (P = .027) and primary tumor classified as pT3-4 (P = .029). In 122 patients, a tracheotomy was performed, and it couldn't be sealed in 23% of them. Oral alimentation was successfully recovered in 93% of the patients. Surgical treatment of cancer of the lateral wall of the oropharynx provides acceptable oncological and functional results, especially in early and moderately advanced stages (stages I-III). In advanced stages (stage IV), we obtained good functional preservation rates but poor oncological outcomes. Consequently, these groups of patients could be considered for another treatment modality, such as

  6. Prospective validation of an intraoperative algorithm to guide surgical staging in early endometrial cancer.

    PubMed

    Lefringhouse, Jason R; Elder, Jeffrey W; Baldwin, Lauren A; Miller, Rachel W; DeSimone, Chris P; van Nagell, John R; Samoyoa, Luis M; West, Dava S; Dressler, Emily V; Liu, Meng; Ueland, Frederick R

    2017-04-01

    Prospectively validate an intraoperative surgical staging algorithm to stratify patients with early endometrial cancer by risk of lymph node metastasis. Subjects with endometrial cancer clinically confined to the uterus were prospectively enrolled at an academic cancer center between Jan 2012 and Jun 2015. Study participants were stratified intraoperatively into two groups based on risk of nodal involvement using cell type, tumor grade, myometrial invasion, and tumor size in accordance with an established protocol from the Mayo Clinic. Low risk (LR) subjects received extrafascial hysterectomy with bilateral salpingo-oophorectomy; high risk (HR) patients received complete surgical staging including bilateral pelvic and para-aortic lymphadenectomy. Of the 200 subjects enrolled, 194 were eligible for analysis. The algorithm identified 132 (68%) HR and 62 (32%) LR cancers. Of the HR subjects, 126 had lymphadenectomy performed with 14 (11%) positive for nodal metastases. Five HR subjects experienced disease recurrence. Of the 62 LR cancers, two patients developed disease recurrence. Ten LR cancers were upgraded to HR on final pathology due to lesion size (6) and grade (4). None of these patients experienced disease recurrence. The algorithm demonstrated 90% sensitivity (18/20) and 36% specificity (62/174) as determined by positive lymph nodes and/or disease recurrence. Intraoperative assessment of early endometrial cancer can be used to determine the extent of surgical staging. The studied algorithm has low specificity and modifications are necessary to better match the surgical procedure to the risk of metastatic cancer. Published by Elsevier Inc.

  7. Influence of obesity on early surgical outcomes of laparoscopic-assisted gastrectomy in gastric cancer.

    PubMed

    Kim, Min Gyu; Yook, Jeong Hwan; Kim, Kap Choong; Kim, Tae Hwan; Kim, Hee Sung; Kim, Beom Su; Kim, Byung Sik

    2011-06-01

    The aim of this study is to estimate the impact of obesity on surgical outcomes of laparoscopic-assisted gastrectomy for gastric cancer. Between January 2005 and January 2010, 1100 consecutive patients who underwent laparoscopic-assisted distal gastrectomy for gastric cancer were reviewed to evaluate the impact of obesity. The patients were classified into 3 groups according to the World Health Organization classification, as normal weight [body mass index (BMI) 18.5 to 24.9 kg/m], overweight (BMI 25 to 29.9 kg/m), and obese patients (BMI ≥30 kg/m). The postoperative complication rates for normal weight, overweight, and obese patients were 5.7%, 10.0%, 15.4%, respectively. Overweight and obese patients had a significantly prolonged operation time, increased intraoperative blood loss, prolonged first flatus, day of commencement of soft diet, increased number of administration of analgesics, and prolonged hospital stay. Overweight and obesity were associated with poor early surgical outcomes of laparoscopic-assisted gastrectomy. This study suggested that greater cautions and improved surgical techniques were required to improve early surgical outcomes of laparoscopic-assisted gastrectomy for overweight and obese patients.

  8. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis.

    PubMed

    Anantha Narayanan, Mahesh; Mahfood Haddad, Toufik; Kalil, Andre C; Kanmanthareddy, Arun; Suri, Rakesh M; Mansour, George; Destache, Christopher J; Baskaran, Janani; Mooss, Aryan N; Wichman, Tammy; Morrow, Lee; Vivekanandan, Renuga

    2016-06-15

    Infective endocarditis is associated with high morbidity and mortality and optimal timing for surgical intervention is unclear. We performed a systematic review and meta-analysis to compare early surgical intervention with conservative therapy in patients with infective endocarditis. PubMed, Cochrane, EMBASE, CINAHL and Google-scholar databases were searched from January 1960 to April 2015. Randomised controlled trials, retrospective cohorts and prospective observational studies comparing outcomes between early surgery at 20 days or less and conservative management for infective endocarditis were analysed. A total of 21 studies were included. OR of all-cause mortality for early surgery was 0.61 (95% CI 0.50 to 0.74, p<0.001) in unmatched groups and 0.41 (95% CI 0.31 to 0.54, p<0.001) in the propensity-matched groups (matched for baseline variables). For patients who had surgical intervention at 7 days or less, OR of all-cause mortality was 0.61 (95% CI 0.39 to 0.96, p=0.034) and in those who had surgical intervention within 8-20 days, the OR of mortality was 0.64 (95% CI 0.48 to 0.86, p=0.003) compared with conservative management. In propensity-matched groups, the OR of mortality in patients with surgical intervention at 7 days or less was 0.30 (95% CI 0.16 to 0.54, p<0.001) and in the subgroup of patients who underwent surgery between 8 and 20 days was 0.51 (95% CI 0.35 to 0.72, p<0.001). There was no significant difference in in-hospital mortality, embolisation, heart failure and recurrence of endocarditis between the overall unmatched cohorts. The results of our meta-analysis suggest that early surgical intervention is associated with significantly lower risk of mortality in patients with infective endocarditis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. [Pathophysiological bases, clinical results and indications for surgical treatment in Parkinson disease].

    PubMed

    Obeso, J A; Linazasoro, G; Gorospe, A; Rodríguez, M C; Guridi, J; Ramos, E

    1999-05-01

    We review the present status of surgery for Parkinson's disease. Surgical options for Parkinson's disease are rapidly spanding. The main objectives of surgical techniques are to restore the dopaminergic deficit in the striatum (transplantation) and to normalize the neuronal activity of the subthalamic-pallidal circuit (pallidotomy and deep brain stimulation). Whereas cell transplantation is still considered an experimental procedure, ablative procedures and deep brain stimulation are widely used. Both types of surgical procedures are supported by strong scientific data. However, much work remains to be done in order to understand several aspects not clearly elucidated at present. The results and current indications for pallidotomy and deep brain stimulation are analyzed.

  10. Early versus late surgical decompression for traumatic thoracic/thoracolumbar (T1-L1) spinal cord injured patients

    PubMed Central

    Rahimi-Movaghar, Vafa; Niakan, Amin; Haghnegahdar, Ali; Shahlaee, Abtin; Saadat, Soheil; Barzideh, Ehsan

    2014-01-01

    Objective: To assess the efficacy of surgical decompression <24 (early) versus 24-72 hours (late) in thoracic/thoracolumbar traumatic spinal cord injury (TSCI). Methods: A randomized controlled trial (RCT) of 35 T1-L1 TSCI patients including early (n=16) and late (n=19) surgical decompression was conducted in the neurosurgery department of Shahid Rajaee Hospital from September 2010. Pre- and postoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor/sensory scores, length of hospitalization, complications, postoperative vertebral height restoration/rebuilding and angle reduction, and 12-month loss of height restoration/rebuilding and angle reduction were evaluated. Results: Sixteen patients (46%) had complete TSCI. No AIS change was seen in 17 (52%) patients. Complete TSCI patients had no motor improvement. The AIS change in this group was solely due to increased sensory scores. For incomplete TSCI, the mean motor score improved from 77 (±22) to 92 (±12) in early, and from 68 (±22) to 82 (±16) in late surgery. One deep vein thrombosis was observed in each group. There were 2 wound infections, one CSF leak, one case of meningitis, and one decubitus ulcer in the late surgery group. Six screw revisions were required. Conclusion: Our primary results show overall AIS and motor score improvement in both groups. Motor improvement was only observed in incomplete TSCI. Two-grade improvements in AIS were seen in 3 early, and one late surgery patient. PMID:24983279

  11. Early diagnosis of post-varicella necrotising fasciitis: A medical and surgical emergency

    PubMed Central

    Xavier, Rose; Abraham, Bobby; Cherian, Vinod Jacob; Joseph, Jobin I.

    2016-01-01

    Necrotising fasciitis (NF) is an extremely rare complication of a rather common paediatric viral exanthem varicella. Delayed diagnosis and treatment can lead to significant morbidity and mortality. Laboratory risk indicator of NF score aids in early clinical diagnosis in suspected cases of post-varicella NF thus enabling timely intervention. Surgery delayed for more than 24 hours, is an independent risk factor for death. Surgical debridement with good antibiotic coverage is the definitive treatment for NF. PMID:27251524

  12. Early Versus Delayed Surgical Decompression of Spinal Cord after Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis.

    PubMed

    Furlan, Julio C; Craven, B Catharine; Massicotte, Eric M; Fehlings, Michael G

    2016-04-01

    This cost-utility analysis was undertaken to compare early (≤24 hours since trauma) versus delayed surgical decompression of spinal cord to determine which approach is more cost effective in the management of patients with acute traumatic cervical spinal cord injury (SCI). This study includes the patients enrolled into the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) and admitted at Toronto Western Hospital. Cases were grouped into patients with motor complete SCI and individuals with motor incomplete SCI. A cost-utility analysis was performed for each group of patients by the use of data for the first 6 months after SCI. The perspective of a public health care insurer was adopted. Costs were estimated in 2014 U.S. dollars. Utilities were estimated from the STASCIS. The baseline analysis indicates early spinal decompression is more cost-effective approach compared with the delayed spinal decompression. When we considered the delayed spinal decompression as the baseline strategy, the incremental cost-effectiveness ratio analysis revealed a saving of US$ 58,368,024.12 per quality-adjusted life years gained for patients with complete SCI and a saving of US$ 536,217.33 per quality-adjusted life years gained in patients with incomplete SCI for the early spinal decompression. The probabilistic analysis confirmed the early-decompression strategy as more cost effective than the delayed-decompression approach, even though there is no clearly dominant strategy. The results of this economic analysis suggests that early decompression of spinal cord was more cost effective than delayed surgical decompression in the management of patients with motor complete and incomplete SCI, even though no strategy was clearly dominant. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women.

    PubMed

    Obeidat, Rana F

    2015-01-01

    To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers' support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system.

  14. Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women

    PubMed Central

    Obeidat, Rana F.

    2015-01-01

    To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers’ support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system. PMID:27981122

  15. Lateral Oncoplastic Breast Surgery (LOBS) - A new surgical technique and short term results.

    PubMed

    Singh, Gurpreet; Kohli, Pavneet Singh; Bagaria, Dinesh

    2017-09-21

    We present a new approach for BCS which we have named as the Lateral Oncoplastic Breast Surgery (LOBS) approach. Patients with biopsy proven breast cancer or phyllodes tumors in the outer quadrants of the breast were selected. The patients were operated in the lateral position using the principles of a Level 1 oncoplastic technique. 106 patients (93 breast cancer; 13 phyllodes tumor) were operated using this technique. For patients with breast cancer the mean tumor size was 2.7 cms. 3 patients had a positive margin. The mean tumor size for phyllodes tumors was 6.7 cms. Surgical site infections (15 patients), marginal skin necrosis (2 patients) and superficial NAC necrosis (1 patient) were observed. Although the mean follow up was only 355.8 days there were no early detected recurrences. LOBS is a new approach for BCS which offers distinct advantages. The short term results, both oncological and aesthetic, are encouraging. A new approach for performing oncoplastic breast conserving surgery (BCS) is described and the short term results of our first 106 cases are presented. Advantages of this approach over conventional techniques are reviewed. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. The influence of surgical technique on early posttransplant atrial fibrillation – comparison of biatrial, bicaval, and total orthotopic heart transplantation

    PubMed Central

    Rivinius, Rasmus; Helmschrott, Matthias; Ruhparwar, Arjang; Erbel, Christian; Gleissner, Christian A; Darche, Fabrice F; Thomas, Dierk; Bruckner, Tom; Katus, Hugo A; Doesch, Andreas O

    2017-01-01

    Purpose Early posttransplant atrial fibrillation (AF) has been associated with worse clinical outcomes after heart transplantation (HTX). The type of surgical technique may constitute a relevant risk factor for AF. Patients and methods This retrospective single-center study included 530 adult patients. Patients were stratified by surgical technique (biatrial, bicaval, or total orthotopic HTX) and early posttransplant heart rhythm (AF or sinus rhythm). Univariate and multivariate analyses were performed to evaluate risk factors for AF. Results A total of 161 patients received biatrial HTX (30.4%), 115 bicaval HTX (21.7%), and 254 total orthotopic HTX (47.9%). Sixty-one of 530 patients developed early posttransplant AF (11.5%). Patients with AF showed a statistically inferior 5-year survival compared to those with sinus rhythm (P<0.0001). Total orthotopic HTX had the lowest rate of AF (total orthotopic HTX [6.3%], bicaval HTX [14.8%], biatrial HTX [17.4%], P=0.0012). Multivariate analysis showed pretransplant valvular heart disease (P=0.0372), posttransplant enlarged left atrium (P=0.0066), posttransplant mitral regurgitation (P=0.0370), and non-total orthotopic HTX (P=0.0112) as risk factors for AF. Conclusion Early posttransplant AF was associated with increased mortality (P<0.0001). Total orthotopic HTX showed the lowest rate of AF compared to biatrial or bicaval HTX (P=0.0012). PMID:28331331

  17. Adjuvant intraperitoneal chromic phosphate therapy for women with apparent early ovarian carcinoma who have not undergone comprehensive surgical staging

    SciTech Connect

    Soper, J.T.; Berchuck, A.; Clarke-Pearson, D.L. )

    1991-08-15

    Forty-nine women with apparent Stage 1 and 2 ovarian carcinoma received intraperitoneal phosphate 32 as the only adjuvant therapy after primary surgery. In addition to bilateral salpingo-oophorectomy, 40 (82%) had analysis of peritoneal cytology, and 35 (71%) underwent omentectomy. Random peritoneal biopsies and retroperitoneal lymph node sampling were not done in any of these patients. The overall and disease-free survival rates were 86% and 75%, respectively, with no significant differences by stage, histologic grade, histologic type, or low-risk versus high-risk subsets recognized in patients who received comprehensive surgical staging. Seven (58%) of 12 patients had lymph node metastasis as the first site of recurrence, including two of three with late recurrences. Significant morbidity related to intraperitoneal chromic phosphate (32P) occurred in one (2%) woman. These results emphasize the need for comprehensive surgical staging of women with apparent early ovarian carcinoma to aid in the selection of appropriate initial adjuvant therapy.

  18. Early post-surgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons.

    PubMed

    Ruggiero, C; Bonamassa, L; Pelini, L; Prioletta, I; Cianferotti, L; Metozzi, A; Benvenuti, E; Brandi, G; Guazzini, A; Santoro, G C; Mecocci, P; Black, D; Brandi, M L

    2017-02-01

    This study investigates the relationship between cognitive dysfunction or delirium detected in the early post-surgical phase and the 1-year mortality among 514 hip fracture hospitalized older persons. Patients with early cognitive dysfunction or delirium experienced a 2-fold increased mortality risk. Early post-operative cognitive dysfunction and delirium are negative prognostic factors for mortality.

  19. [Remote results of surgical treatment of aging ptosis of face and neck tissues].

    PubMed

    Ezrokhin, V M; Pavlovich, V A

    2008-01-01

    Remote results of surgical treatment of patients with aging ptosis of face and neck tissues during 15 years are presented. Results were good there where suggested incisions marking was carried out and for those face and neck skin regions which should be corrected. Unsatisfactory results were received in the cases when wounds edges were sewn by uninterrupted blanket sutures without skin deeper layers fixing.

  20. Design rationale and biomechanics of Maverick Total Disc arthroplasty with early clinical results.

    PubMed

    Mathews, Hallett H; Lehuec, Jean-Charles; Friesem, Tai; Zdeblick, Thomas; Eisermann, Lukas

    2004-01-01

    This paper reviews the design criteria, biomechanical and biological (wear and safety) testing of this chrome cobalt metal-on-metal, ball and socket design prosthesis. The surgical technique and early clinical results of the initial implantations are also reviewed. Initial results of 7 Maverick implantations showed all 7 patients attaining a 15 point Oswestry improvement within 3 months after implantation. This early result in a small sample is significantly quicker in recovery and improvement when compared to the historical control of the LT cage with Infuse IDE study. Longer term results and more careful study are needed of this interesting and optimistic finding.

  1. Surgical Treatment of Severe Traumatic Brain Injury in Switzerland: Results from a Multicenter Study.

    PubMed

    Rossi-Mossuti, Frédéric; Fisch, Urs; Schoettker, Patrick; Gugliotta, Marinella; Morard, Marc; Schucht, Philippe; Schatlo, Bawarjan; Levivier, Marc; Walder, Bernhard; Fandino, Javier

    2016-01-01

    Since the introduction of modern surgical techniques and monitoring tools for the treatment of severe traumatic brain injury (TBI) in Switzerland, standardized nationwide operative procedures are still lacking. This study aimed to assess surgical management and monitoring strategies in patients admitted throughout Switzerland with severe TBI. Demographic, clinical, and radiologic data from a prospective national cohort study on severe brain-injured patients (Patient-relevant Endpoints after Brain Injury from Traumatic Accidents [PEBITA]) were collected during a 3-year period. This study evaluated patients admitted to 7 of the 11 trauma centers included in PEBITA. We retrospectively analyzed surgery-related computed tomography (CT) findings prior to and after treatment, intracranial pressure (ICP) monitoring, size and technical features of craniotomy, as well as surgical complications. ResULTS: This study included 353 of the 921 patients enrolled in PEBITA who underwent surgical treatment for severe TBI. At admission, acute subdural hematoma was the most frequent focal lesion diagnosed (n = 154 [44%]), followed by epidural hematoma (n = 96 [27%]) and intracerebral hematoma (n = 84 [24%]). A total of 198 patients (61%) presented with midline shift. Clinical deterioration in terms of Glasgow Coma Scale scores or intractable ICP values as an indication for surgical evacuation or decompression were documented in 20% and 6%, respectively. A total of 97 (27.5%) only received a catheter/probe for ICP monitoring. Surgical procedures to treat a focal lesion or decompress the cerebrum were performed in 256 patients (72.5%). Of the 290 surgical procedures (excluding ICP probe implantation), craniotomy (137 [47.2%]) or decompressive craniectomy (133 [45.9%]) were performed most frequently. The mean size of craniectomy in terms of maximal linear width on the CT axial slice was 8.4 ± 2.9 cm. Intraoperative ICP monitoring was reported in 61% of the interventions. Significant

  2. [Results of surgical treatment for acromioclavicular dislocation using a modified Mitchell method].

    PubMed

    Król, M; Jarco, K; Sleczkowski, M; Delimat, J; Szot, J

    2000-01-01

    The paper presents the results of surgical treatment in acromioclavicular dislocation (grade III according to Tossy) in 53 patients. Joint reconstruction was performed using Mitchell's modified method--acromioclavicular reconstruction was achieved by applying a with Dallos poliester fiber prosthesis. Clinically in 90.5% of the cases a good or excellent result was achieved.

  3. The results of early operation in talipes quino-varus. A preliminary report.

    PubMed

    Main, B J; Crider, R J; Polk, M; Lloyd-Roberts, G C; Swann, M; Kamdar, B A

    1977-08-01

    The results of operation performed within the first six months of life upon seventy-seven resistant club feet are presented. The indications for and the rationale of early operation are discussed. Particular attention has been paid to the relationship between the age at operation and the outcome more than four years later; the results were greatly superior when operation was undertaken early. Two surgical techniques are compared, the postero-medial release proving better than a simple posterior release. The relationship between clinical and radiological assessment is discussed, and also the influence of the results reported upon future practice.

  4. Preserving the pulmonary valve during early repair of tetralogy of Fallot: Anatomic substrates and surgical strategies.

    PubMed

    Vida, Vladimiro L; Angelini, Annalisa; Guariento, Alvise; Frescura, Carla; Fedrigo, Marni; Padalino, Massimo; Sanders, Stephen P; Thiene, Gaetano; Stellin, Giovanni

    2015-05-01

    To describe the anatomy of the PV in tetralogy of Fallot (TOF) and to define the influence of PV anatomy on the development of surgical techniques for PV preservation during early repair. The PV was evaluated in 79 anatomic specimens of patients with TOF who had not undergone surgery for repair, and in 82 patients who underwent early TOF repair at our institution. New surgical techniques for PV preservation during early repair are described. The PV in TOF was predominantly bicuspid (n = 118 of 160; 73.7%), less frequently tricuspid (n = 28 of 160; 17.5%), and seldom unicuspid (n = 14 of 160; 8.8%). In 82 cases (51.3%), the PV cusps were normal; in 78 cases (48.7%), they were thickened and dysplastic. Preservation of the PV was possible in 46 of 82 (56%) consecutive patients during TOF repair in our more recent experience, either using balloon dilation alone (18 of 46; 39%) or in association with other PV plasty procedures (28 of 46; 61%). Most bicuspid and tricuspid valves were salvageable, but unicuspid valves were not suitable. After a median follow-up time of 2.8 years (range, 0.5-6.8 years), the degree of PV regurgitation continued to be zero or mild in 40 patients (86%), and moderate in 6 (14%). The majority of patients with TOF (>90%) have a bicuspid or tricuspid PV, which is the most favorable surgical anatomy for preserving the PV, independent of the degree of leaflet dysplasia. The recent introduction of more-complex PV plasty techniques, such as delamination plasty, allowed us to further extend the applicability of PV-preservation techniques. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  5. Preservation of the Pulmonary Valve During Early Repair of Tetralogy of Fallot: Surgical Techniques.

    PubMed

    Vida, Vladimiro L; Guariento, Alvise; Zucchetta, Fabio; Padalino, Massimo; Castaldi, Biagio; Milanesi, Ornella; Stellin, Giovanni

    2016-01-01

    During the last decade interest in preserving pulmonary valve (PV) function has stimulated a few surgeons to apply valve-sparing techniques in repairing tetralogy of Fallot (TOF), with the aim of preserving long-term right ventricular function. Since June 2007, we embarked upon a program for preserving PV function in selected patients during TOF repair. More recently, the introduction of more complex PV plasty techniques allowed us to further extend the applicability of PV preservation techniques. We believe that preservation of PV function during early repair of TOF, by combining different intraoperative surgical maneuvers, can be extended to almost all patients with classic TOF.

  6. [Treating acute postoperative pain: evaluation of results on the surgical ward].

    PubMed

    Esteve, N; Ribera, H; Mora, C; Romero, O; Garrido, P; Verd, M

    2011-01-01

    To describe management of acute postoperative pain on the surgical ward. To study the relationship between pain and a variety of surgical procedures and approaches. To determine the level of information patients received, their expectations, and their satisfaction with treatment of postoperative pain. Cross-sectional observational study by survey and review of patient records. We studied 234 patients, including all who were hospitalized for more than 24 hours after scheduled or emergency operations. The main variables recorded were pain intensity at rest and during movement, including on the day after surgery, and the surgical procedure and approach. The prevalence of pain (>3 on a numerical scale) on the surgical ward was 33% at rest and 66% during movement. The prevalence of intense pain (>6 on the numerical scale) was 1.7% at rest and 7.3% during movement. Factors related to greater pain intensity were timing, that is, the first day after surgery, when 74.4% of patients experienced their most intense pain; type of surgery and approach (P<.004); and expecting to experience moderate or intense pain (P<.001). Recording the prevalence of postoperative pain on a surgical ward provides information about the real situation of acute postoperative pain control. Pain on movement is a principal indicator for detecting groups of patients for whom analgesic protocols could be improved. Type of surgery and approach is a fundamental factor to consider when comparing the results of analgesic protocols.

  7. Results of Surgical Treatment of Chronic Patellar Tendinosis (Jumper's Knee): A Systematic Review of the Literature.

    PubMed

    Brockmeyer, Matthias; Diehl, Nora; Schmitt, Cornelia; Kohn, Dieter M; Lorbach, Olaf

    2015-12-01

    To review the literature concerning surgical treatment options for chronic patellar tendinosis (jumper's knee), a common problem among athletes. When conservative treatment fails, surgical treatment is required. Systematic review of the literature concerning the results of current surgical treatment options for chronic patellar tendinosis. All articles of studies with an evidence level ≥IV from January 2000 until February 2015 presenting the surgical outcome after arthroscopic as well as open treatment of chronic patellar tendinosis were included. The literature research of the PubMed database was performed using the following key words: "patellar" and "tendinitis," "tendonitis," "tendinosis" or "tendinopathy"; "inferior patellar pole"; "jumper's knee"; "surgical treatment" and "open" or "arthroscopic patellar tenotomy." A systematic review of the literature was performed especially to point out the effectiveness of arthroscopic treatment of chronic patellar tendinosis. The results revealed good clinical results for arthroscopic as well as open treatment of chronic patellar tendinosis that is refractory to conservative treatment in athletes. An average success rate of 87% was found for the open treatment group and of 91% for the arthroscopic treatment group. However, after open surgery, the mean time of return to the preinjury level of activity is 8 to 12 months, with a certain number of patients/athletes who cannot return to the preinjury level of activity. Minimally invasive, arthroscopically assisted or all-arthroscopic procedures may lead to a significantly faster return to sporting activities and may, therefore, be the preferred method of surgical treatment. Level IV, systematic review of Level I-IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  8. Landsat-7 Mission and Early Results

    NASA Technical Reports Server (NTRS)

    Dolan, S. Kenneth; Sabelhaus, Phillip A.; Williams, Darrel L.; Irons, James R.; Barker, John L.; Markham, Brian L.; Bolek, Joseph T.; Scott, Steven S.; Thompson, R. J.; Rapp, Jeffrey J.

    1999-01-01

    The Landsat-7 mission has the goal of acquiring annual data sets of reflective band digital imagery of the landmass of the Earth at a spatial resolution of 30 meters for a period of five years using the Enhanced Thematic Mapper Plus (ETM+) imager on the Landsat-7 satellite. The satellite was launched on April 15, 1999. The mission builds on the 27-year continuous archive of thematic images of the Earth from previous Landsat satellites. This paper will describe the ETM+ instrument, the spacecraft, and the ground processing system in place to accomplish the mission. Results from the first few months in orbit will be given, with emphasis on performance parameters that affect image quality, quantity, and availability. There will also be a discussion of the Landsat Data Policy and the user interface designed to make contents of the archive readily available, expedite ordering, and distribute the data quickly. Landsat-7, established by a Presidential Directive and a Public Law, is a joint program of the National Aeronautics and Space Administration (NASA) Earth Science Enterprise and the United States Geological Survey (USGS) Earth Resources Observing System (EROS) Data Center.

  9. Early Results from the Qweak Experiment

    NASA Astrophysics Data System (ADS)

    Androic, D.; Armstrong, D. S.; Asaturyan, A.; Averett, T.; Balewski, J.; Beaufait, J.; Beminiwattha, R. S.; Benesch, J.; Benmokhtar, F.; Birchall, J.; Carlini, R. D.; Cates, G. D.; Cornejo, J. C.; Covrig, S.; Dalton, M. M.; Davis, C. A.; Deconinck, W.; Diefenbach, J.; Dowd, J. F.; Dunne, J. A.; Dutta, D.; Duvall, W. S.; Elaasar, M.; Falk, W. R.; Finn, J. M.; Forest, T.; Gaskell, D.; Gericke, M. T. W.; Grames, J.; Gray, V. M.; Grimm, K.; Guo, F.; Hoskins, J. R.; Johnston, K.; Jones, D.; Jones, M.; Jones, R.; Kargiantoulakis, M.; King, P. M.; Korkmaz, E.; Kowalski, S.; Leacock, J.; Leckey, J.; Lee, A. R.; Lee, J. H.; Lee, L.; MacEwan, S.; Mack, D.; Magee, J. A.; Mahurin, R.; Mammei, J.; Martin, J.; McHugh, M. J.; Meekins, D.; Mei, J.; Michaels, R.; Micherdzinska, A.; Mkrtchyan, A.; Mkrtchyan, H.; Morgan, N.; Myers, K. E.; Narayan, A.; Ndukum, L. Z.; Nelyubin, V.; Nuruzzaman; van Oers, W. T. H.; Opper, A. K.; Page, S. A.; Pan, J.; Paschke, K.; Phillips, S. K.; Pitt, M. L.; Poelker, M.; Rajotte, J. F.; Ramsay, W. D.; Roche, J.; Sawatzky, B.; Seva, T.; Shabestari, M. H.; Silwal, R.; Simicevic, N.; Smith, G. R.; Solvignon, P.; Spayde, D. T.; Subedi, A.; Subedi, R.; Suleiman, R.; Tadevosyan, V.; Tobias, W. A.; Tvaskis, V.; Waidyawansa, B.; Wang, P.; Wells, S. P.; Wood, S. A.; Yang, S.; Young, R. D.; Zhamkochyan, S.

    2014-03-01

    A subset of results from the recently completed Jefferson Lab Qweak experiment are reported. This experiment, sensitive to physics beyond the Standard Model, exploits the small parity-violating asymmetry in elastic e{{p}} scattering to provide the first determination of the proton's weak charge Q_w^p. The experiment employed a 180 μA longitudinally polarized 1.16 GeV electron beam on a 35 cm long liquid hydrogen target. Scattered electrons in the angular range 6° < θ < 12° corresponding to Q2 = 0.025 GeV2 were detected in eight Cerenkov detectors arrayed symmetrically around the beam axis. The goals of the experiment were to provide a measure of e{{p}} to 4.2% (combined statisstatistical and systematic error), which implies a measure of sin2(θw) at the level of 0.3%, and to help constrain the vector weak quark charges C1u and C1d. The experimental method is described, with particular focus on the challenges associated with the world's highest power LH2 target. The new constraints on C1u and C1d provided by the subset of the experiment's data analyzed to date will also be shown, together with the extracted weak charge of the neutron.

  10. Early Results from AIRS/AMSU/HSB

    NASA Technical Reports Server (NTRS)

    Susskind, Joel; Barnet, Christopher; Blaisdell, John; Iredell, Lena; Keita, Fricky; Kouvaris, Lou

    2003-01-01

    AIRS was launched on EOS Aqua on May 5, 2002, together with AMSU A and HSB, to form a next generation polar orbiting infiared and microwave atmospheric sounding system. The primary products of AIRS/AMSU/HSB are twice daily global fields of atmospheric temperature-humidity profiles, ozone profiles, sea/land surface skin temperature, and cloud related parameters including OLR. The sounding goals of AIRS are to produce 1 km tropospheric layer mean temperatures with an rms error of lK, and layer precipitable water with an rms error of 20%, in cases with up to 80% effective cloud cover. Pre-launch simulation studies indicated that these results should be achievable. Minor modifications have been made to the pre-launch retrieval algorithm as described in this paper. Sample fields of parameters retrieved from AIRS/AMSU/HSB data are presented and validated as a function of retrieved fractional cloud cover. As in simulation, the degradation of retrieval accuracy with increasing cloud cover is small. Select fields are also compared to those contained in the ECMWF analysis, done without the benefit of AIRS data, to demonstrate information that AIRS can add to that already contained in the ECMWF analysis.

  11. The magnetic survey mission CHAMP: Early results

    NASA Astrophysics Data System (ADS)

    Lühr, H.

    2001-05-01

    On July 15, 2000 the geoscientific satellite CHAMP was launched from the Russian launch site Plesetsk into a near-polar (87.3\\deg) orbit. The mission is devoted to global investigations of the gravity, magnetic and electric fields and to atmospheric profiling. Cruising at a low, circular orbit - 460 km at the beginning, decaying to 300 km after a 5 years mission period - CHAMP promises to return a unique data set. The orbital plane moves with respect to local time at rate of about 1h per 11days, thus covering all LTs within 4.5 months. In this talk I will focus on the magnetic field investigation. The satellite is equipped with a scalar Overhauser magnetometer at the tip of a 4m boom. Half way down the boom there are two (redundant) fluxgate magnetometers mounted together with a dual-head star camera on an optical bench. This magnetometry package provides the capability of maintaining absolutely calibrated vector field measurements throughout the mission. During an extended commissioning and calibration phase of 8 months the various instruments on board have been tuned to the environmental conditions and intrinsic factors and biases are determined. The evaluation of preliminary data sets confirms that all instruments meet their specification. Initial results will be presented which allow to show the performance of the measurements. When comparing repeat tracks it is encouraging to see how well features like crustal anomalies match each other. The precision of vector field data is particularly high on the night side. Here we can make use of the simultaneous readings of the two star trackers. By combining the individual measurements we obtain a precise attitude. The quality of the vector data will be demonstrated in comparison with main field models.

  12. Digital Imaging of Ice Cores: Early Results

    NASA Astrophysics Data System (ADS)

    Hargreaves, G.; McGwire, K.; Taylor, K.; Alley, R. B.; Dupont, T. K.; Reusch, D. B.

    2005-12-01

    Ice core science addresses fundamental questions of human interest related to global warming, abrupt climate change, biogeochemical cycling and more, and directly informs policymakers. The National Ice Core Laboratory (NICL) in Denver, Colorado, is currently developing a high-resolution optical scanning system for laboratory curation in order to expand the accessibility of ice core data sets through creation of a digital archive of ice core images. Additional goals of this project include development of internet-based search and retrieval capabilities from this digital archive; development of a digital image analysis system specifically for ice core studies; integration of digital optical data with other dating methods and testing of the image processing tools in scientific investigations. By providing permanent online digital archives of core quality, it will allow improved selection of samples, and documentation of possible core-quality artifacts for all U.S. ice core scientists. This project will allow any researcher to examine the core in similar detail to the few investigators who were fortunate enough to observe it before modifications from sampling and storage. This re-examination can be done decades later by anyone at any location, which is not possible now because only the interpretation of the original observer is recorded. Integration of this digital optical examination into ice core analysis will speed discovery, allow collaborative interpretation, and enhance consistency of analysis to improve ice core dating, identification of melt layers, location of flow disturbances, and more. Here we report on the current status of, and latest results from, these development efforts, including examples of images from the GISP2 (Greenland Ice Sheet Project Two) ice core. Preliminary work on this core shows that the imaging system successfully and accurately captures numerous features readily recognized by (trained) human observers, such as layering from changes in

  13. Current surgical results of acute type A aortic dissection in Japan

    PubMed Central

    2016-01-01

    Current surgical results of acute type A aortic dissection in Japan are presented. According to the annual survey by the Japanese Association of Thoracic Surgery, 4,444 patients with acute type A aortic dissection underwent surgical procedures and the overall hospital mortality was 9.1% in 2013. The prevalence of aortic root replacement with a valve sparing technique, total arch replacement (TAR), and frozen stent graft are presented and strategies for thrombosed dissection or organ malperfusion syndrome secondary to acute aortic dissection are discussed. PMID:27563550

  14. [Impairment of oxygenation of patients in surgical intensive care : Early symptom of severe sepsis].

    PubMed

    Hückstädt, M; Hofmann, G O; Mendel, T; Stuttmann, R; Hilbert-Carius, P

    2016-11-01

    PCT increased on values of >2 ng/ml. In 76 % of cases impairment of oxygenation occurred earlier than all other investigated parameters. Significant differences were found between surviving and deceased patients regarding to their age as well as the timeframe from the beginning of impaired oxygenation to the onset of the effect of the administered antibiotics. These two parameters (age, time to sufficient antibiotic therapy) were confirmed by regression analysis and showing similar effect coefficients, age 1.09 and time to sufficient antibiotic therapy 1.04 respectively. An urgent worsening of pulmonary function in patients in intensive care requires immediate differential diagnostics due to substantial therapeutic consequences. Our results confirm that impairment of pulmonary oxygenation is the first prognostic symptom of severe onset of sepsis. Consequently, we recommend that this parameter be considered in diagnostic staging. After exclusion of a few differential diagnoses impairment of oxygenation can be the very first symptom of severe sepsis. The patient's age and time to sufficient antibiotic therapy are two very important prognostic factors with respect to mortality. Early and sufficient antibiotic therapy, and in a few cases surgical intervention are of utmost importance.

  15. Early postoperative changes in cerebral oxygen metabolism following neonatal cardiac surgery: Effects of surgical duration

    PubMed Central

    Buckley, Erin M.; Lynch, Jennifer M.; Goff, Donna A.; Schwab, Peter J.; Baker, Wesley B.; Durduran, Turgut; Busch, David R.; Nicolson, Susan C.; Montenegro, Lisa M.; Naim, Maryam Y.; Xiao, Rui; Spray, Thomas L.; Yodh, A. G.; Gaynor, J. William; Licht, Daniel J.

    2013-01-01

    Objective The early postoperative period following neonatal cardiac surgery is a time of increased risk for brain injury, yet the mechanisms underlying this risk are unknown. To understand these risks more completely, we quantified changes in postoperative cerebral metabolic rate of oxygen (CMRO2), oxygen extraction fraction (OEF), and cerebral blood flow (CBF) compared with preoperative levels by using noninvasive optical modalities. Methods Diffuse optical spectroscopy and diffuse correlation spectroscopy were used concurrently to derive cerebral blood flow and oxygen utilization postoperatively for 12 hours. Relative changes in CMRO2, OEF, and CBF were quantified with reference to preoperative data. A mixed-effect model was used to investigate the influence of total support time and deep hypothermic circulatory arrest duration on relative changes in CMRO2, OEF, and CBF. Results Relative changes in CMRO2, OEF, and CBF were assessed in 36 patients, 21 with single-ventricle defects and 15 with 2-ventricle defects. Among patients with single-ventricle lesions, deep hypothermic circulatory arrest duration did not affect relative changes in CMRO2, CBF, or OEF (P > .05). Among 2-ventricle patients, total support time was not a significant predictor of relative changes in CMRO2 or CBF (P > .05), although longer total support time was associated significantly with greater increases in relative change of postoperative OEF (P = .008). Conclusions Noninvasive diffuse optical techniques were used to quantify postoperative relative changes in CMRO2, CBF, and OEF for the first time in this observational pilot study. Pilot data suggest that surgical duration does not account for observed variability in the relative change in CMRO2, and that more comprehensive clinical studies using the new technology are feasible and warranted to elucidate these issues further. PMID:23111021

  16. Harvey Cushing's early experience with the surgical treatment of head trauma.

    PubMed

    Kinsman, Michael; Pendleton, Courtney; Quinones-Hinojosa, Alfredo; Cohen-Gadol, Aaron A

    2013-01-01

    The evolution of techniques to manage patients with head injuries has served as the basis for the treatment of other neurosurgical disorders, including brain tumors, intracranial infections, and cerebrovascular disease. In the nineteenth century, advances in anesthesia, asepsis, and cerebral localization slowly took hold and created the groundwork for modern neurosurgery. To better understand the advances in the treatment of brain injuries in the late 1800s and early 1900s, we examine relevant historical literature and, through the courtesy of the Alan Mason Chesney Medical Archives, we review Dr. Harvey Cushing's patient records (1898-1909) in the Johns Hopkins Hospital surgical archives. The original case histories of 10 patients (6 in detail) who suffered head injuries and underwent treatment by Cushing illustrate some of Cushing's early attempts at intracranial surgery. We also examine the influences on Cushing as he developed into a leader in the new era of modern neurosurgery.

  17. [Results of surgical treatment of cholelithiasis by laparotomic and minimally invasive accesses].

    PubMed

    Aliev, Iu G; Chinikov, M A; Panteleeva, I S; Kurbanov, F S; Popovich, V K; Sushko, A N

    2014-01-01

    The article presents the results of surgical treatment of 1038 patients with cholelithiasis, acute and chronic calculous cholecystitis and complicated forms of the disease. Operations were performed with traditional laparotomic and minimally invasive approaches. Indications for choosing access, as well as the advantages and disadvantages of various options of surgery in patients with cholelithiasis are discussed.

  18. Early experience with the da Vinci® surgical system robot in gynecological surgery at King Abdulaziz University Hospital

    PubMed Central

    Sait, Khalid H

    2011-01-01

    Background: The purpose of this study was to review our experience and the challenges of using the da Vinci® surgical system robot during gynecological surgery at King Abdulaziz University Hospital. Methods: A retrospective study was conducted to review all cases of robot-assisted gynecologic surgery performed at our institution between January 2008 and December 2010. The patients were reviewed for indications, complications, length of hospital stay, and conversion rate, as well as console and docking times. Results: Over the three-year period, we operated on 35 patients with benign or malignant conditions using the robot for a total of 62 surgical procedures. The docking times averaged seven minutes. The mean console times for simple hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy were 125, 47, and 62 minutes, respectively. In four patients, laparoscopic procedures were converted to open procedures, giving a conversion rate of 6.5%. All of the conversions were among the first 15 procedures performed. The average hospital stay was 3 days. Complications occurred in five patients (14%), and none were directly related to the robotic system. Conclusion: Our early experience with the robot show that with proper training of the robotic team, technical difficulty with the robotic system is limited. There is definitely a learning curve that requires performance of gynecological surgical procedures using the robot. PMID:21845067

  19. Surgical alternatives in the treatment of intestinal intussusceptions resulting from polyps in adults.

    PubMed

    Arikanoglu, Zulfu; Onder, Akin; Taskesen, Fatih; Aliosmanoglu, Ibrahim; Gul, Mesut; Gumus, Hatice; Tas, Ilhan; Girgin, Sadullah

    2013-09-01

    Adult intussusception is an uncommon disease requiring surgical intervention. The aim of this study is to discuss the surgical alternatives and share our experience in the treatment of adult patients with intussusceptions formed as a result of polyps. The retrospective study included 16 adult patients who underwent surgery after the diagnosis of intestinal invaginations resulting from polyps between the years 2000 and 2011. Sixteen patients (seven males and nine females; mean age, 48.18 years; range, 18 to 76 years) presented with intestinal intussusceptions. Although a preoperative diagnosis was carried out in 11 (68.75%) patients, the diagnosis was made intraoperatively in five patients (31.25%). Among the patients, seven (43.8%) had undergone emergency surgeries and nine (52.8) had elective surgery. The invagination in 12 patients (75%) was located in the small intestine, in two patients (12.5%) in the colon, and in a further two patients (12.5%), it was ileocecally located. Ten patients (62.5%) had segmental resection + anastomosis; three patients underwent (18.8%) segmental resection + enterostomy, and three (18.8%) received hemicolectomies. In adults, surgical treatment is always the primary option in intussusceptions resulting from polyps. Although the surgical method of choice in colonically located ones is en bloc resection without reduction, because the polyps located in the small intestine are usually of a benign nature, segmental resection with reduction should be performed in elective surgery and segmental resection without reduction should be performed in emergency cases.

  20. Bile duct cyst type V (Caroli's disease): surgical strategy and results

    PubMed Central

    Schelotto, Pablo Barros; Rodríguez, Juan Alvarez; Duek, Fernando; Quarin, Carlos; Garay, Verónica; Amante, Marcelo; Cassini, Eduardo; Imventarza, Oscar

    2007-01-01

    Background. Caroli's disease (CD) is a benign congenital disorder characterized by segmental cystic dilatation of the intrahepatic biliary ducts. Therapeutic strategy includes medical treatment, percutaneous, endoscopic or surgical drainage of the affected bile ducts, liver resection or transplantation. The aim of this study was to analyse the results and long-term follow-up of a consecutive series of patients who underwent surgical treatment for CD. Patients and methods. Between 1995 and 2005, 10 patients were surgically treated for CD. Variables evaluated were: age, gender, clinical presentation, diagnostic procedures, percutaneous and surgical treatments, histopathological analysis and outcome. Results. The average age of the patients was 45.8 years. Recurrent cholangitis was the main clinical manifestation (70%). In unilateral CD a liver resection was performed in nine patients (left lateral sectionectomy in seven, left hepatectomy in one and right hepatectomy in one). In bilateral disease a cholecystectomy, duct exploration, hepaticojejunostomy and liver biopsy of both lobes were performed. Average follow-up was 60 months. All the patients are alive and free of symptoms without recurrence in the remnant liver. Discussion. Liver resection is the preferred therapeutic option for unilateral CD, demonstrating good results in long-term follow-up. In bilateral disease, hepaticojejunostomy could be considered as an alternative or a previous step to liver transplantation, which still remains the ultimate option. PMID:18345305

  1. Surgical factors in pediatric cochlear implantation and their early effects on electrode activation and functional outcomes.

    PubMed

    Francis, Howard W; Buchman, Craig A; Visaya, Jiovani M; Wang, Nae-Yuh; Zwolan, Teresa A; Fink, Nancy E; Niparko, John K

    2008-06-01

    To assess the impact of surgical factors on electrode status and early communication outcomes in young children in the first 2 years of cochlear implantation. Prospective multicenter cohort study. Six tertiary referral centers. Children 5 years or younger before implantation with normal nonverbal intelligence. Cochlear implant operations in 209 ears of 188 children. Percent active channels, auditory behavior as measured by the Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale and Reynell receptive language scores. Stable insertion of the full electrode array was accomplished in 96.2% of ears. At least 75% of electrode channels were active in 88% of ears. Electrode deactivation had a significant negative effect on Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale scores at 24 months but no effect on receptive language scores. Significantly fewer active electrodes were associated with a history of meningitis. Surgical complications requiring additional hospitalization and/or revision surgery occurred in 6.7% of patients but had no measurable effect on the development of auditory behavior within the first 2 years. Negative, although insignificant, associations were observed between the need for perioperative revision of the device and 1) the percent of active electrodes and 2) the receptive language level at 2-year follow-up. Activation of the entire electrode array is associated with better early auditory outcomes. Decrements in the number of active electrodes and lower gains of receptive language after manipulation of the newly implanted device were not statistically significant but may be clinically relevant, underscoring the importance of surgical technique and the effective placement of the electrode array.

  2. Results of surgical treatment of intrasylvian hematomas due to ruptured intracranial aneurysms.

    PubMed

    Başkaya, M K; Menendez, J A; Yüceer, N; Polin, R S; Nanda, A

    2001-04-01

    In this retrospective study, the surgical outcome of patients with intrasylvian hematomas due to rupture of intracranial aneurysms was analyzed. The authors studied ten patients who underwent aneurysm surgery and evacuation of the hematoma within 12 h of the onset of bleeding. All patients had an intrasylvian hematoma classified with computerized tomography and all patients underwent pre-operative angiography. In all patients, the origin of bleeding was a middle cerebral artery aneurysm, with the exception of one patient whose bleeding originated from a posterior communicating artery aneurysm. Three patients achieved good recovery without any significant neurological deficit and four achieved good recovery with moderate disabilities. One patient died due to pneumonia and two were in a vegetative state. Notably, three patients who were comatose (Hunt and Hess Grade V) at the time of presentation achieved good recovery following surgery. In this study, neurological status at presentation did not predict the outcome. The only significant prognostic factor in those patients who had intrasylvian hematoma was early surgery within 12 h of the bleeding. We suggest that early surgical treatment be performed in patients with intrasylvian hematoma, regardless of the neurological findings and grade on admission. Pre-operative angiography seems to be essential in identifying the source of bleeding.

  3. Risk of postoperative hemorrhage after intracranial surgery after early nadroparin administration: results of a prospective study.

    PubMed

    Gerlach, Rüdiger; Scheuer, Timm; Beck, Jürgen; Woszczyk, Alina; Seifert, Volker; Raabe, Andreas

    2003-11-01

    Early postoperative pharmacological prophylaxis of deep vein thrombosis after intracranial surgery is still a matter of debate because of concerns regarding the formation of postoperative hematoma. The objective of this study was to prospectively analyze the rate of postoperative hemorrhage during a 3-year period of early postoperative administration of the low molecular weight heparin nadroparin (Fraxiparin) plus compression stockings in a large cohort of patients undergoing intracranial surgery. A total of 2823 intracranial neurosurgical procedures, performed between June 1999 and 2002, were studied. Of these operations, 1319 (46.7%) were major intracranial surgical procedures (Group 1). Group 2 comprised 1504 operations (53.3%) considered to be minor surgical procedures (e.g., shunt procedures, biopsies). All patients except those with transnasal transsphenoidal removal of pituitary tumors underwent early postoperative imaging (computed tomography or magnetic resonance imaging) to determine postoperative hemorrhage. All significant postoperative hematomas (defined as those requiring surgical evacuation because of relevant space occupation and/or neurological deterioration) were treated surgically. Prophylaxis of venous thromboembolic events included early (<24 h) postoperative administration of 0.3 ml nadroparin subcutaneously plus intra- and postoperative compression stockings until discharge. Forty-three major postoperative hemorrhages (1.5%) were observed after 2823 intracranial procedures (95% confidence interval, 1.1-2.05). Forty-two (3.2%) of 1319 postoperative hematomas occurred in patients undergoing major intracranial procedures (Group 1). There was only 1 (0.07%) significant hemorrhage after 1504 minor intracranial procedures (Group 2). A subgroup analysis of patients who needed preoperative anticoagulation because of medical comorbidity did not reveal an increased frequency of postoperative hematoma when anticoagulation was stopped 24 hours before

  4. RESULTS FROM CLINICAL AND RADIOLOGICAL FOLLOW-UP, AFTER SURGICAL TREATMENT OF CHONDROBLASTOMA

    PubMed Central

    Penna, Valter; Toller, Eduardo Areas; Ferreira, Adriano Jander; Dias, Dante Palloni Costa

    2015-01-01

    Objectives: To evaluate the long-term clinical and radiological results from patients who underwent surgical treatment of chondroblastoma, between 2003 and 2009, by the same surgical team, using the same operative technique. Methods: A retrospective study was conducted on 12 patients with histological diagnoses of chondroblastoma, who were attended between 2003 and 2009 at the Pius XII Foundation (Barretos Cancer Hospital, Barretos, State of São Paulo). These patients underwent surgical treatment with intralesional resection of the tumor, adjuvant electrocauterization and replacement with methyl methacrylate (11 cases) or an autologous graft from the iliac crest (one case). The preoperative evaluation included physical examination, plain radiographs of the site, magnetic resonance imaging, computed axial tomography and bone scintigraphy. The patients were assessed clinically and radiologically according to a predefined protocol, with a series of plain radiographs, and a functional assessment in accordance with the Enneking functional score. Results: The average age at the time of diagnosis was 14 years and 4 months. The most frequent location affected was the distal femoral epiphysis (75%), followed by the proximal tibial epiphysis (16.6%) and the calcaneus (8.4%). There was higher prevalence among the female patients than among the male patients (3:1). In three cases, preoperative biopsy was necessary. During the follow-up, there was no evidence of local tumor recurrence, and all the patients presented an excellent functional result from the surgical technique used, with Enneking scores ranging from 20 to 30. Conclusion: Surgical treatment of chondroblastoma, using intralesional resection, adjuvant electrocauterization and replacement with methyl methacrylate or bone graft produced good results. PMID:27027054

  5. Role of concanavalin A lectin in recognition of pterygium remnant after surgical excision: Preliminary results of a prospective study

    PubMed Central

    Díaz-González, Juan A; Mayoral-Chávez, Miguel A; Bohórquez, Paulina Leyva; de la Torre, Ma. del Pilar Gabriel; Hernández-Cruz, Pedro; Martínez-Cruz, Ruth

    2007-01-01

    Background: Pterygium is one of the most common conjunctival diseases among ophthalmic pathologies. The frequency of recurrences is high, either after surgical treatment or after treatment combined with mitomycin C or beta-radiation therapy. Aims: The purpose of this study was to determine whether concanavalin A (ConA) lectin bound to the pterygial surface can be used to detect recurrence or remnants of pterygium after surgical excision. Materials and Methods: This was a prospective study on 20 patients with pterygium, divided in five stages, pre-surgery, early post-surgery (24h), late post-surgery (seven days), very late post-surgery (four weeks) and two months after the procedure. A drop of fluorescein-marked Con A (35 µg/mL) was instilled in the lower conjunctival eyelid sac and the eye was exposed to the light of a Wood′s lamp for an average of five seconds. Results: Out of the 20 patients, eight patients were found to have fluorescent stretch marks over the scar corresponding to residual pterygial tissue at four weeks; two months after the procedure of re-surgery we observed no fluorescent remnants. All residual pterygia were confirmed through histochemistry studies. Conclusion: It was possible to detect remnants of pterygium in postoperative patients and recurrences in early pre-clinical stages through the visualization of fluorescent ConA bound to the pterygial surface. PMID:17699943

  6. Short- and long-term racing performance of Standardbred pacers and trotters after early surgical intervention for tarsal osteochondrosis

    PubMed Central

    McCoy, A. M.; Ralston, S. L.; McCue, M. E.

    2014-01-01

    Summary Reasons for Performing Study Osteochondrosis (OC) is commonly diagnosed in young Standardbred racehorses, but its effect on performance when surgically treated at a young age is still incompletely understood. This is especially true for Standardbred pacers, which are underrepresented in the existing literature. Objective To characterise the short- (2-year-old) and long-term (through 5-year-old) racing performance in Standardbred pacers and trotters after early surgical intervention (<17 months of age) for tarsal OC. Study Design Retrospective clinical study. Methods The study population consisted of related, age-matched Standardbred racehorses (n = 278; 151 pacers, 127 trotters) with (n = 133) or without (n = 145) one or more tarsal OC lesions. All OC-affected horses were treated surgically prior to being sold as yearlings. Data obtained from publicly available race records for each horse included starts, wins, finishes in the top 3 (win, place, or show), earnings, and fastest time. Comparisons between OC-affected and unaffected horses were made for the entire population and within gaits. A smaller related population (n = 94) had these performance measures evaluated for their 2- through 5-year-old racing seasons. Results Osteochondrosis status was associated with few performance measures. Trotters were at higher risk for lesions of the medial malleolus, but lower risk for lesions of the distal intermediate ridge of the tibia compared to pacers. Horses with bilateral OC lesions and lateral trochlear ridge (LTR) lesions started fewer races at 2 years of age than those with unilateral lesions or without LTR lesions. Conclusions Osteochondrosis seemed to have minimal effect on racing performance in this cohort, although horses with bilateral and LTR lesions started fewer races at 2 years. There was evidence for different distribution of OC lesions among pacers and trotters, which should be explored further. Standardbreds undergoing early removal of tarsal OC

  7. Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF).

    PubMed

    Jerosch, Jörg; Schunck, Jochem; Liebsch, Dietrich; Filler, Tim

    2004-09-01

    The purpose of the present study is to present the surgical technique for, and review our indications and results after, endoscopic fascial release in patients with plantar fasciitis. In five thiel-embalmed human specimens, a biportal technique for endoscopic release of the plantar fascia was established. The aim was here to evaluate the relation between the plantar fascia and the heel spur and to perform a release that would not exceed 50-70% of the diameter of the calcaneoplantar fascia. The endoscopic technique was performed within the last 5 years in ten male and seven female patients. All patients with the clinical entity of plantar fasciitis underwent conservative treatment for at least 6 months. The average age at surgery was 35 years (24-56 years). In the first five patients, surgery was performed under c-arm control. In all patients the operation could be finished endoscopically. The endoscopic portals healed without complications. The time for surgery during the learning curve ranged between 21 and 74 min (average 41 min) and was still longer compared to the open technique. The clinical follow-up ranged between 4 and 48 months (average 18.5 months). Out of 17 patients, 13 improved clinically, and they would choose the treatment option again. In the Ogilvie-Harris score, seven patients showed good and six excellent results. In two patients, the initial results were not satisfactory, because of a bony stress reaction of the calcaneus. This complication was treated by 6 weeks of partial weight bearing, without any further problems. Two other patients developed secondary pain in the lateral column. In spite of the minimal invasive approach it seems to be important to be careful in increasing the weight bearing in early rehabilitation. The technique of the endoscopic plantar fascia release (E FRPF) can be performed in a standardised and reproducible procedure. The follow-up examination showed good midterm results, but a loss of stability of the plantar arch

  8. Surgical treatment of Crohn's disease: indications, results and predictive factors of recurrence and morbidity.

    PubMed

    Hefaiedh, Rania; Sabbeh, Mariem; Miloudi, Nizar; Ennaifer, Rym; Romdhane, Hayfa; Belhadj, Najet; Gharbi, Lassad; Khalfallah, Tahar

    2015-06-01

    Crohn's disease management represents a major problem in gastroenterology and general surgery because it affects young subjects and has a major impact on their quality of life. The aims of our study were to identify the indications for surgery in Crohn's disease, the results and the complications of surgery in our series, and to identify possible predictive factors of recurrence and postoperative morbidity. A retrospective descriptive study including 38 cases of patients with Crohn's disease who underwent surgical treatment in the department of surgery in Mongi Slim Hospital, during the period between January 1992 and December 2011 was performed. The occurrence of stenosis was the most common indication for surgical treatment in Crohn's disease in our series, and ileocecal resection was the most performed surgery. Twenty six patients (58%) received maintenance therapy after surgery. Twenty two patients relapsed and 13 had surgical management for recurrence. In univariate analysis, predictive factors of post operative morbidity in our study were leukocytosis, penetrating phenotype and intraabdominal sepsis. Ileocecal location was the only factor that significantly improved the incidence of recurrence. In multivariate analysis, only penetrating phenotype was a predictive factor or post operative morbidity. Despite the development of medical treatment, surgical treatment keeps large indications for the management of complications of Crohn's disease. The surgery should be an alternative to immunosuppressive therapy. Currently, prevention postoperative recurrence is well codified, reducing the risk of complications.

  9. [The results of the surgical treatment of otosclerosis in the elderly subjects].

    PubMed

    Kulakova, L A; Poliakova, E P; Bodrova, I V; Lopatin, A S

    2014-01-01

    The objective of the present study was to evaluate the effectiveness of the surgical treatment of otosclerosis in the subjects of advanced age. The medical histories of 19 patients aged above 65 years (20 ears) presenting with otosclerosis were available for the retrospective analysis. All of them had undergone surgical interventions (a total of 22 ones or 4.49% of the 489 operations performed between 2001 and 2012). The audiometric assessment was made at four wavelengths (0.5, 1, 2, and 4 kHz). Primary surgery (n=18) was preceded by the determination of the high air and bone conductivity thresholds (76.18 dB and 42.15 dB respectively), with the mean bone to air interval (BAI) being 33.99 dB. The surgical treatment resulted in the improvement of hearing; in 83.33% of the cases, BAI was reduced to 10 dB or below this value. It is concluded that the surgical intervention on the stirrup bone for the treatment of otosclerosis in the patients above 65 years of age is a safe and efficacious method despite marked hearing impairment in this group of patients.

  10. [Results of surgical treatment for the intervertebral disc protrusion within thoracic spine].

    PubMed

    Malawski, S; Lukawski, S

    1998-01-01

    Results of surgical treatment for intervertebral disc protrusion within thoracic spine in 4 cases are presented. Protrusion had caused spinal compression resulting in neurological impairment (plegia). There were 3 females and 1 male, all in their forties or fifties. Two cases are presented in details, with radiological investigations included. Lateral approach was used at surgery. Neurological deficits subsided completely in all cases. Follow-up ranged from 1-15 years, mean 8 years.

  11. [Results of the surgical treatment of acute thrombosis of the major arteries of the limbs].

    PubMed

    Ovchinnikov, V A; Vereshchagin, N A; Shavin, V V; Parakhoniak, N V

    1984-08-01

    An analysis of the surgical treatment of acute arterial trombosis of the extremities in 86 patients is presented. The causes of thrombosis were mainly obliterating atherosclerosis, artery trauma and postembolic occlusion. Best results of reconstructive operations were obtained in patients with postembolic occlusion of the arteries and their posttraumatic trombosis, worst results - in obliterating atherosclerosis. Thrombendarterectomy and autovenous shunts and prostheses were found to be the mos effective reconstructive operations.

  12. [Results of surgical treatment in patients with drug-resistant tuberculosis].

    PubMed

    Frolov, G A; Popkova, N L; Kalashnikov, A V

    2002-01-01

    Analysis of the results of surgical treatment in 105 patients with pulmonary tuberculosis revealed that 25 patients had postoperative complications. Complications, outcomes, dysfunctions, and life quality were analyzed in late postoperative periods after 4 types of operations: segmentectomy (n = 52), lobectomy (n = 26), pulmonectomy (n = 12), palliative operations (n = 15). The best immediate and long-term results were achieved after segmentectomy in patients with antibiotic-sensitive forms of MBT.

  13. Result from arthroscopic surgical treatment of renewed tearing of the rotator cuff of the shoulder☆

    PubMed Central

    Godinho, Glaydson Gomes; França, Flávio de Oliveira; Freitas, José Márcio Alves; Santos, Flávio Márcio Lago; Prandini, Alexandre; Godinho, André Couto; Costa, Rafael Patrocínio de Paula

    2015-01-01

    Objectives To evaluate function among patients with postoperative recurrence of rotator cuff injuries that was treated arthroscopically (case series) and compare this with function in patients without recurrence (control group); and to compare function among patients with recurrence of rotator cuff injuries that were greater than and smaller than 3 cm. Methods This was a retrospective evaluation of patients who underwent arthroscopic revision of rotator cuff injuries using the ASES, Constant & Murley and UCLA scores and a visual analog pain scale, in comparison with patients in a control group who underwent primary rotator cuff repair. Results The size of the rotator cuff injury recurrence had a statistically significant influence on the result from the arthroscopic surgical treatment. The functional scores showed worse results than those from the first procedure. Conclusion Arthroscopic surgical treatment of renewed tearing of rotator cuff injuries showed worse functional scores than those from primary repair of the injury. PMID:26229900

  14. Assessment of cosmetic and functional results of conservative versus surgical management of facial burns.

    PubMed

    Fraulin, F O; Illmayer, S J; Tredget, E E

    1996-01-01

    This study was undertaken to determine whether tangential excision and thick split-thickness skin grafting (STSG) of deep facial burns give a better cosmetic and functional result than conservative management. Forty patients (28 adults, 12 children) treated for facial burns between July 1989 and July 1991 were evaluated in follow-up (mean 18.3 +/- 8.3 months). The patients were categorized into the following groups according to depth and management of their facial burns: (A) healed without surgery in less than 21 days (n = 13), (B) healed without surgery in 21 days or more (n = 11), (C) early debridement and thick STSG in 18 days or less after the burn (n = 6), and (D) delayed debridement and thick STSG in more than 18 days after the burn (n = 10). Facial esthetics were evaluated by use of a modified scar assessment scale [range 0 (normal) to 16 (multiple abnormalities)], and functional problems of the face and neck were evaluated by use of physical examination. Group A patients had a significantly better overall rating on the scar assessment scale (2.1 +/- 2.9) than the patients in the other groups that required more than 21 days to heal, B (8.0 +/- 2.7), C (7.3 +/- 2.9), and D (5.7 +/- 2.5) (p < 0.01, analysis of variance). Also, skin-grafted areas in the surgically treated groups C and D had a significantly better scar rating than wounds that healed spontaneously in group B (5.7 +/- 4.0 vs 8.0 +/- 2.7, p < 0.05; and 5.1 +/- 2.6 vs 8.0 +/- 2.7, p < 0.05). There was no significant difference among groups B, C, and D when the total number of persistent functional problems after treatment were compared. The most common functional problems for these patients were microstomia (17/27) and eyelid ectropion (17/27). Patients with superficial facial burns that heal in less than 21 days appear to heal with generally very acceptable cosmetic and functional results. However, in those patients with deep facial burns that require prolonged periods for spontaneous wound healing

  15. Results of simple excision technique in the surgical treatment of symptomatic accessory navicular bones.

    PubMed

    Jasiewicz, Barbara; Potaczek, Tomasz; Kacki, Wojciech; Tesiorowski, Maciej; Lipik, Ewa

    2008-01-01

    Accessory navicular bones might cause not only cosmetic problems but also be a reason of discomfort and pain. In case of inefficient conservative treatment symptomatic accessory naviculars are treated surgically. Presentation of results of simple excision of symptomatic accessory navicular. Material consists of 22 patients (34 feet), 17 women and 5 men, treated surgically between 1992 and 2006. Mean age at surgery was 14.1 years (9-22 years). Accessory navicular type I was present in 5 feet (14.7%), type II in 17 (50%) and type III-in 12 (35.3%). Main symptom was localized pain on the medial arch of the foot, in the height of navicular bone. Surgery consisted of simple accessory navicular excision and if needed partial resection of navicular bone. The mean follow-up period was 5.6 years (1-13 years). We analyzed: intensity of pain (VAS score system), daily and sport activity. Subjective results were analyzed using a questionnaire. The questionnaire was returned from 21 patients: 9 patients had total pain relief, 11 considerable and one patient had persistent pain. Mean VAS results before surgery was 5.9 and 1.7 after surgery. Only one patient required analgesics occasionally. Complications were present in two patients (6.1%). All active patients returned to their sport activities. Surgical treatment of symptomatic accessory navicular by simple excision technique gives satisfying results, surgery is minimally traumatic and risk of complications low.

  16. Comparison of Laparoscopy and Laparotomy in Surgical Staging of Apparent Early Ovarian Cancer

    PubMed Central

    Lu, Qi; Qu, Hong; Liu, Chongdong; Wang, Shuzhen; Zhang, Zhiqiang; Zhang, Zhenyu

    2016-01-01

    Abstract The aim of this study was to compare the safety and morbidity of laparoscopic versus laparotomic comprehensive staging of apparent early stage ovarian cancer. In this retrospective study, the outcomes of patients with apparent stage I ovarian cancer who underwent laparoscopic or laparotomic comprehensive surgical staging from January 2002 to January 2014 were evaluated. The long-term survival of patients with early ovarian cancer was compared. Forty-two patients were treated by laparoscopy, and 50 were treated by laparotomy. The median operative time was 200 minutes in the laparoscopy group and 240 minutes in the laparotomy group (P >0.05). The median length of hospital stay was 3 days in the laparoscopy group and 7 days in the laparotomy group (P <0.05). Following laparoscopic and laparotomic staging, the cancer was upstaged for 9 (21.4%) and 10 (20.0%) women, respectively. The median follow-up time was 82 months in the laparoscopic and laparotomic groups, respectively. Excluding the upstaged patients, no recurrence was observed in the present study, and the overall survival and 5-year survival rates were 100% in both the laparoscopy and laparotomy groups. Laparoscopic and laparotomic comprehensive staging of early ovarian cancer were similar in terms of staging adequacy, accuracy and survival rate. Laparoscopic staging was associated with a significantly reduced hospital stay. Prospective randomized trials are required to evaluate the overall oncologic outcomes. PMID:27196468

  17. Early versus delayed surgical correction of malrotation in children with critical congenital heart disease.

    PubMed

    Sulkowski, Jason P; Cooper, Jennifer N; Duggan, Eileen M; Balci, Ozlem; Anandalwar, Seema; Blakely, Martin L; Heiss, Kurt; Rangel, Shawn J; Minneci, Peter C; Deans, Katherine J

    2015-01-01

    The purpose of this study was to compare outcomes between early and delayed surgical correction of malrotation in children with critical congenital heart disease (CHD). Patients with CHD who underwent cardiac surgery by 1 year of age and had malrotation diagnosed during their initial admission at 34 hospitals contributing to the Pediatric Health Information System in 2004-2009 were included. Ladd's procedures performed during the first admission were considered early correction, and those at a subsequent admission were considered delayed. Interhospital variability in the proportion of patients undergoing delayed correction was assessed, and outcomes were compared between the groups. Of the 324 patients identified, 85.2% underwent early correction. Significant variability existed in the proportion of patients undergoing delayed correction across hospitals (p<0.0001). Baseline characteristics, including severity of CHD, were similar between the groups. In the delayed group, 27% of patients underwent a Ladd's procedure during an urgent or emergent admission, but none had volvulus or underwent intestinal resection. Rates of mortality and readmission within 1 year of malrotation diagnosis were similar in both groups. Chart validation confirmed 100% accuracy of diagnosis and treatment group assignment. In patients with critical CHD, delayed operative intervention for malrotation without volvulus may be a reasonable alternative. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Midcarpal Hemiarthroplasty for Wrist Arthritis: Rationale and Early Results

    PubMed Central

    Vance, Michael C.; Packer, Greg; Tan, David; Crisco, J.J. Trey; Wolfe, Scott W.

    2012-01-01

    Midcarpal hemiarthroplasty is a novel motion-preserving treatment for radiocarpal arthritis and is an alternative to current procedures that provide pain relief at the expense of wrist biomechanics and natural motion. It is indicated primarily in active patients with a well-preserved distal row and debilitating arthritic symptoms. By resurfacing the proximal carpal row, midcarpal arthroplasty relieves pain while preserving the midcarpal articulation and the anatomic center of wrist rotation. This technique has theoretical advantages when compared with current treatment options (i.e., arthrodesis and total wrist arthroplasty) since it provides coupled wrist motion, preserves radial length, is technically simple, and avoids the inherent risks of nonunion and distal component failure. The KinematX midcarpal hemiarthroplasty has an anatomic design and does not disrupt the integrity of the wrist ligaments. We have implanted this prosthesis in nine patients with promising early results. The indications for surgery were as follows: scapholunate advanced collapse wrist (three), posttraumatic osteoarthritis (three), inflammatory arthritis (two), and Keinböck disease (one). Prospective data has been collected and the results are preliminary given the infancy of the procedure. The mean follow-up was 30.9 weeks (range: 16 to 56 weeks). The mean Mayo wrist score increased from 31.9 preoperatively to 58.8 (p < 0.05) and the mean DASH score improved significantly from 47.8 preoperatively to 28.7 (p < 0.05). There was a trend toward increased motion but statistical significance was not reached. Two patients required manipulation for wrist stiffness. There was no evidence of prosthetic loosening or capitolunate narrowing. The procedure is simple (average surgical time was 49 minutes) and maintains coupled wrist motion through preservation of the midcarpal articulation. The preliminary data show that it appears safe but considerably longer follow-up is required before

  19. [Early specialized surgical care for gunshot wounds of major vessels in Donbas].

    PubMed

    Rozin, Yu A; Ivanenko, A A

    2016-01-01

    The authors share their experience gained in rendering early specialized surgical care during combat operations in Donbas, having operated on a total of 139 wounded with lesions of large vessels, of these, 21 (15.1%) presenting with concomitant lesions of vessels. Reconstructive operations were carried out in 122 (87.8%) wounded, ligating operations - in 12 (8.6%), and primary amputations - in 5 (3.6%). Two (1.4%) patients died. Blood flow was restored in 117 (84.2%) patients, with six amputations performed after primary operations. The limb was saved in 116 (83.4%) wounded. Peculiarities of a vascular injury in Donbas comprise a large proportion of severe concomitant vascular wounds and lack of intermediate stages of evacuation. The prognosis of life and limb salvage largely depends on correctly chosen method of temporary arrest of bleeding at first stages of medical evacuation and shortening the terms of rendering first specialized surgical care. The variant of operation (reconstruction, ligation or primary amputation) in severe concomitant vascular wounds should be determined proceeding from the degree of ischaemia and severity of the condition of the wounded person, assessed by means of the Military Surgery - Mangled Extremity Severity Score.

  20. A case of spontaneous bilateral Achilles tendon rupture: surgical treatment with early mobilization.

    PubMed

    Yue, Dominic; Al-Hadithy, Nawfal; Domos, Peter

    2014-02-01

    Tendo-Achilles (TA) rupture is the most commonly ruptured tendon in the lower limb despite being one of the toughest tendons. Typically, it occurs unilaterally in middle-aged individuals who participate in strenuous activity. Spontaneous ruptures without any risk factors predisposing the patient is uncommon and for it to occur bilaterally is very rare. To raise awareness of the potential for TA ruptures to occur bilaterally and thus the importance of assessing the TA contralateral to a seemingly unilateral rupture. This is particularly the case in patients with risk factors, which are reviewed in this report. A summary of the main treatment options is also described. We report a case of spontaneous, bilateral TA rupture in a 40-year-old man with no identifiable risk factors. It occurred following a heavy impact during a sports activity and although painful, was able to mobilize slowly. After a clinical examination confirmed the diagnosis, the patient underwent early bilateral surgical repair and subsequently embarked on a comprehensive rehabilitation program with a good functional outcome at follow-up. His return to premorbid work and social life was uneventful. Bilateral TA ruptures are rare but increased awareness would help avoid a tear or rupture of the contralateral side being missed. All patients presenting clinically with any TA rupture should have risk factors reviewed. Surgical repair must be accompanied by a comprehensive rehabilitation program for adequate recovery and return of function.

  1. Serous Macular Detachment Secondary to Optic Pit: Surgical Treatment and Long Time Results

    PubMed Central

    Cevher, Selim; Sahinoglu-Keskek, Nedime; Unal, Fikret; Demirduzen, Selahaddin; Oksuz, Huseyin

    2016-01-01

    32-year-old Turkish male patient presented with an optic disk pit and serous macular detachment in the left eye. Spectral domain optical coherence tomography revealed serous macular detachment and retinoschisis. After vitrectomy the retina gradually flattened and vision was gradually improved. We aimed to report a case of serous macula detachment secondary to optic pit and long term result of surgical treatment. PMID:26881159

  2. [Early effect of non-surgical treatment using betamethasone valerate ointment for phimosis in childhood].

    PubMed

    Kitsukawa, Shin-ichi; Ito, Takaaki; Hosoda, Satoru; Samejima, Takeshi; Otsuru, Norihiko; Matsumoto, Taro; Yamamoto, Yutaka; Noda, Kenjiro; Matsumoto, Tetsuo; Aizawa, Taku

    2006-05-01

    We evaluated the early efficacy of non-surgical treatment using 0.07% betamethasone valerate ointment on, 34 boys with phimosis between January 2001 and June 2005. Patients were treated with 0.07% betamethasone valerate ointment applied to the distal aspect of the prepuce every other day for 2-6 weeks. During the treatment period, patients were instructed to retract the foreskin to penis root without overstraining. The overall success rate was 94.1% and therapeutic effects were observed in 58.8% of the patients in two weeks. There were no medical side effects. Treatment using betamethasone valerate ointment is very effective, easy and safe. We recommend this treatment for patients with phimosis and/or those with recurring balanoposthitis.

  3. Distal tears of the hamstring muscles: review of the literature and our results of surgical treatment

    PubMed Central

    Lempainen, Lasse; Sarimo, Janne; Mattila, Kimmo; Heikkilä, Jouni; Orava, Sakari

    2007-01-01

    Background Hamstring strains are among the most frequent injuries in sports, especially in events requiring sprinting and running. Distal tears of the hamstring muscles requiring surgical treatment are scarcely reported in the literature. Objective To evaluate the results of surgical treatment for distal hamstring tears. Design A case series of 18 operatively treated distal hamstring muscle tears combined with a review of previously published cases in the English literature. Retrospective study; level of evidence 4. Setting Mehiläinen Sports Trauma Research Center, Mehiläinen Hospital and Sports Clinic, Turku, Finland. Patients Between 1992 and 2005, a total of 18 athletes with a distal hamstring tear were operated at our centre. Main outcome measurements At follow‐up, the patients were asked about possible symptoms (pain, weakness, stiffness) and their return to the pre‐injury level of sport. Results The final results were rated excellent in 13 cases, good in 1 case, fair in 3 cases and poor in 1 case. 14 of the 18 patients were able to return to their former level of sport after an average of 4 months (range 2–6 months). Conclusions Surgical treatment seems to be beneficial in distal hamstring tears in selected cases. PMID:17138628

  4. Long term results (15-30 years) of surgical repair of aortic coarctation.

    PubMed Central

    Presbitero, P; Demarie, D; Villani, M; Perinetto, E A; Riva, G; Orzan, F; Bobbio, M; Morea, M; Brusca, A

    1987-01-01

    The late outcome in 226 patients who survived surgical repair of aortic coarctation was assessed 15-30 years after operation. Twenty six patients died during the follow up mainly from causes related to surgical repair or to associated cardiovascular anomalies. The survival rates of patients operated on between the ages of four and 20 years are 97%, 97%, 92% at 10, 20, and 30 years after operation. For patients operated on after the age of 20 the corresponding rates are 93%, 85%, and 68%. This difference is statistically significant from the fifteenth year of follow up onwards. The survival of patients operated on before the age of 20 is not significantly different from that of a comparable general Italian population. Recoarctation occurred in only 8% of patients who had end to end anastomosis, whereas it occurred in 35% of those who had other types of operation. Two thirds of the patients were hypertensive at the last visit. The actuarial curve shows that blood pressure was normal in most patients 5-10 years after operation, but 30 years after coarctation repair only 32% of patients are expected to be normotensive. Thus early repair of aortic coarctation appears to improve long term survival. Intervention in older patients and when blood pressure is high seem to be the most important predictors of late hypertension. PMID:3593616

  5. Surgical Training and the Early Specialization Program: Analysis of a National Program.

    PubMed

    Klingensmith, Mary E; Potts, John R; Merrill, Walter H; Eberlein, Timothy J; Rhodes, Robert S; Ashley, Stanley W; Valentine, R James; Hunter, John G; Stain, Steven C

    2016-04-01

    The Early Specialization Program (ESP) in surgery was designed by the American Board of Surgery, the American Board of Thoracic Surgery, and the Residency Review Committees for Surgery and Thoracic Surgery to allow surgical trainees dual certification in general surgery (GS) and either vascular surgery (VS) or cardiothoracic surgery (CTS) after 6 to 7 years of training. After more than 10 years' experience, this analysis was undertaken to evaluate efficacy. American Board of Surgery and American Board of Thoracic Surgery records of VS and CTS ESP trainees were queried to evaluate qualifying exam and certifying exam performance. Case logs were examined and compared with contemporaneous non-ESP trainees. Opinions of programs directors of GS, VS, and CTS and ESP participants were solicited via survey. Twenty-six CTS ESP residents have completed training at 10 programs and 16 VS ESP at 6 programs. First-time pass rates on American Board of Surgery qualifying and certifying exams were superior to time-matched peers; greater success in specialty specific examinations was also found. Trainees met required case minimums for GS despite shortened time in GS. By survey, 85% of programs directors endorsed satisfaction with ESP, and 90% endorsed graduate readiness for independent practice. Early Specialization Program participants report increased mentorship and independence, greater competence for practice, and overall satisfaction with ESP. Individuals in ESP programs in VS and CTS were successful in passing GS and specialty exams and achieving required operative cases, despite an accelerated training track. Programs directors and participants report satisfaction with the training and confidence that ESP graduates are prepared for independent practice. This documented success supports ESP training in any surgical subspecialty, including comprehensive GS. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Early Childhood Teacher Research: From Questions to Results

    ERIC Educational Resources Information Center

    Castle, Kathryn

    2011-01-01

    What is early childhood teacher research and why is it important? How does a teacher researcher formulate a research question and a plan for doing research? How do teachers apply research results to effect change? "Early Childhood Teacher Research" is an exciting new resource that will address the sorts of questions and concerns that pre- and…

  7. [Results of conservative and surgical treatment for placenta praevia (author's transl)].

    PubMed

    Sadauskas, W M; Maksimaitiene, D A; Butkewiczius, S S

    1982-01-01

    Modified cervix cerclage was applied to 75 women with placenta praevia, between the 16th and 36th weeks of pregnancy. Results obtained from conservative treatment of patients for placenta praevia are compared with those obtained from surgical treatment. Pregnancy was extended 38.4 days on average by cervix cerclage. Complaints were removed by surgery from 50.6 per cent of the patients who were dismissed from hospital. They showed neither bleeding nor any sings of imminent premature birth. Perinatal mortality went down to 6.45 per cent. Average extension of pregnancy by conservative treatment was 12.8 days. Only 7.3 per cent of the patients could be dismissed from hospital. Perinatal mortality went up to the order of 19.1 per cent. These data are interpreted as providing evidence to the advantage of surgical treatment of placenta praevia, as perinatal mortality is reduced.

  8. The role of radiographic measurements in the evaluation of congenital clubfoot surgical results.

    PubMed

    Fridman, Marcos William; de Almeida Fialho, Henrique Sodré

    2007-02-01

    A series of 50 patients with 71 clubfeet treated surgically was evaluated after exclusion of individuals with associated malformations, syndromes, neurological disorders, previous surgery and age over 30 months at the time of the surgical procedure. They underwent soft-tissue releases that addressed all the components of the deformity, including, when necessary, the calcaneocuboid joint. The age of the patients at the time of the surgery ranged from 6 to 26 months and the mean follow-up period was 77.03 months. The scores resulting from the application of the functional rating system designed by Laaveg and Ponseti were compared with several radiological parameters described in the medical literature to verify the degree of statistical association between these variables. The talo-first metatarsal angle, the calcaneal-second and fifth metatarsal angles were the only radiological measurements that correlated well with the functional score.

  9. Distal tears of the hamstring muscles: review of the literature and our results of surgical treatment.

    PubMed

    Lempainen, Lasse; Sarimo, Janne; Mattila, Kimmo; Heikkilä, Jouni; Orava, Sakari; Puddu, Giancarlo

    2007-02-01

    Hamstring strains are among the most frequent injuries in sports, especially in events requiring sprinting and running. Distal tears of the hamstring muscles requiring surgical treatment are scarcely reported in the literature. To evaluate the results of surgical treatment for distal hamstring tears. A case series of 18 operatively treated distal hamstring muscle tears combined with a review of previously published cases in the English literature. Retrospective study; level of evidence 4. Mehiläinen Sports Trauma Research Center, Mehiläinen Hospital and Sports Clinic, Turku, Finland. Between 1992 and 2005, a total of 18 athletes with a distal hamstring tear were operated at our centre. At follow-up, the patients were asked about possible symptoms (pain, weakness, stiffness) and their return to the pre-injury level of sport. The final results were rated excellent in 13 cases, good in 1 case, fair in 3 cases and poor in 1 case. 14 of the 18 patients were able to return to their former level of sport after an average of 4 months (range 2-6 months). Surgical treatment seems to be beneficial in distal hamstring tears in selected cases.

  10. Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression.

    PubMed Central

    Langmayr, J J; Ortler, M; Dessl, A; Twerdy, K; Aichner, F; Felber, S

    1995-01-01

    Spinal cord compression due to extradural and subdural haemorrhage is a neurosurgical emergency. Differences in clinical presentation in relation to localisation of the haematoma, value of MRI as a diagnostic tool, surgical treatment, and prognosis were investigated in a retrospective case series of eight patients with extradural (n = four) and subdural (n = four) haematomas. Results of MRI were compared with operative findings and proved to be of high sensitivity in defining the type of bleeding and delineating craniocaudal extension and ventrodorsal location. Surgical treatment by decompressive laminectomy, haematoma evacuation, and postoperative high dose corticosteroids resulted in resolution of symptoms in five patients and improvement in the clinical situation in two patients. One patient with a chronic subdural haematoma had a second operation because of arachnoidal adhesions. One patient presented with a complete cord transection syndrome due to an acute subdural haematoma and remained paraplegic. It is concluded that prompt, reliable, and non-invasive diagnosis by MRI leads to efficient surgical treatment and a favourable outcome in this rare condition. Images PMID:7561928

  11. Technical note: A new surgical technique for ovariohysterectomy during early pregnancy in beef heifers.

    PubMed

    McLean, K J; Dahlen, C R; Borowicz, P P; Reynolds, L P; Crosswhite, M R; Neville, B W; Walden, S D; Caton, J S

    2016-12-01

    We hypothesized that a standing flank ovariohysterectomy procedure could be developed in beef heifers that would provide high quality tissues for addressing critical questions during early pregnancy, while concomitantly keeping livestock stewardship a high priority. To test the hypothesis, we: 1) developed a standing flank ovariohysterectomy procedure for use in beef heifers, and 2) implemented this procedure in a cohort of heifers up to d 50 of pregnancy for tissue collections, documentation of post-surgical recovery, and assessment of feedlot finishing performance. Ovariectomy and cesarean section protocols are well established in research and veterinary medicine and were used as starting points for procedural development. Crossbred Angus heifers ( = 46; ∼ 15 mo of age; BW = 362.3 ± 34.7 kg) were used to develop this new surgical tissue collection technique. Heifers were subjected to the 5-d CO-Synch + CIDR estrous synchronization protocol so ovariohysterectomy occurred at d 16, 22, 28, 34, 40, and 50 of gestation. Key aspects of the standing flank ovariohysterectomy technique included 1) use of local anesthetic for a standing flank incision, 2) locate the uterine and ovarian arteries via blind palpation and ligate them through the broad ligament via an improved clinch knot, 3) cut the ovaries and uterus free from the broad ligament, 4) ligate the cervix and uterine branch of the vaginal artery, and 5) cut through the cervix and remove the reproductive tract. Surgical times, from skin incision to placement of the last suture, were influenced ( = 0.04) by stage of gestation. In pregnant heifers, time decreased from d 22 (120.0 ± 12.0 min) of gestation to d 40 (79.5 ± 12.0 min) of gestation; then increased at d 50 (90.5 ± 14.7 min) of gestation. Using this procedure, we obtained uterine, placental, and embryo/fetal tissues that had experienced limited hypoxia, little or no trauma, and thus were excellent quality for scientific study. All heifers recovered

  12. Endoluminal surgical triangulation 2.0: A new flexible surgical robot. Preliminary pre-clinical results with colonic submucosal dissection.

    PubMed

    Légner, András; Diana, Michele; Halvax, Péter; Liu, Yu-Yin; Zorn, Lucile; Zanne, Philippe; Nageotte, Florent; De Mathelin, Michel; Dallemagne, Bernard; Marescaux, Jacques

    2017-09-01

    Complex intraluminal surgical interventions of the gastrointestinal tract are challenging due to the limitation of existing instruments. Our group has developed a master-slave robotic flexible endoscopic platform that provides instrument triangulation in an endoluminal environment. Colonic endoscopic submucosal dissections (ESD) were carried out in eight pigs. The robot was introduced transanally. A combination of adapted tele-operated instruments was used. Specimens were inspected and measured. Out of 18 ESDs in total, 12 were successfully completed. Among the completed procedures, two perforations and one system failure occurred and were managed intraoperatively. There was no major bleeding. Mean size of the removed specimens was 18.2 ± 9.8 cm(2) and mean total procedure time was 73 ± 35.5 min. Experimental colorectal ESDs using the flexible surgical robot were feasible and reflected a short learning curve. After some technical improvements the system might allow for a wider adoption of complex endoluminal surgical procedures. Copyright © 2017 John Wiley & Sons, Ltd.

  13. When to Perform Surgical Resection or Radiofrequency Ablation for Early Hepatocellular Carcinoma?

    PubMed Central

    Liu, Po-Hong; Hsu, Chia-Yang; Lee, Yun-Hsuan; Hsia, Cheng-Yuan; Huang, Yi-Hsiang; Su, Chien-Wei; Chiou, Yi-You; Lin, Han-Chieh; Huo, Teh-Ia

    2015-01-01

    Abstract Radiofrequency ablation (RFA) is indicated for early-stage hepatocellular carcinoma (HCC), but the comparative efficacy between RFA and surgical resection (SR) is inconclusive. We aim to develop a prognostic nomogram for predicting recurrence-free survival (RFS) after RFA. We also evaluate the possibility of using nomogram in improving treatment algorithm. We retrospectively enrolled 836 patients with Barcelona Clínic Liver Cancer very-early/early-stage HCC receiving SR or RFA. A visually-orientated nomogram was constructed with Cox proportional hazards model, and number and size of tumor, platelet count, albumin level, and model for end-stage liver disease score were included. The concordance index of the nomogram was 0.69. Radiofrequency ablation patients were stratified into low and high-risk groups by the median of nomogram scores. The RFS and overall survival (OS) of 2 risk groups were compared with SR patients with propensity score matching analysis. SR provided better RFS and OS compared with high-risk (nomogram score ≥9.8) RFA patients in the propensity model. The 5-year RFS rates were 36% versus 11%, whereas the 5-year OS rates were 74% versus 60% for SR and high-risk RFA groups, respectively (both P < 0.05). However, SR was associated with better RFS (5-year RFS rates 41% vs 29%), but similar OS (5-year OS rates 80% vs 81%), compared with low-risk (nomogram score <9.8) RFA patients in the propensity model (P < 0.05 and P > 0.05, respectively). In conclusion, this user-friendly nomogram offers individualized recurrence risk estimation and stratification for early HCC patients receiving curative RFA. The nomogram can be integrated into current treatment algorithm. SR should be considered the first-line treatment for high-risk patients to achieve better long-term survival. PMID:26512576

  14. Early Surgical Management of Large Scalp Infantile Hemangioma Using the TopClosure® Tension-Relief System

    PubMed Central

    Zhu, Zhanyong; Yang, Xilin; Zhao, Yueqiang; Fan, Huajun; Yu, Mosheng; Topaz, Moris

    2015-01-01

    Abstract Infantile hemangiomas (IHs) are the most common benign vascular neoplasms of infancy and childhood. The majority do not need medical intervention. However, large ulcerated scalp IHs may lead to fatal bleeding as well as severe cosmetic disfigurement that indicate early surgical excision, inflicting substantial surgical risks, with short- and long-term morbidity. The TopClosure Tension-Relief System (TRS) is an innovative skin stretching and wound closure-secure system that facilitates primary closure of relatively large skin defects. This system has been shown as a substitute for skin grafts, flaps, or tissue expanders. We describe a case of a giant IH of the scalp usually requiring a complex surgical approach, which was immediately primarily closed applying the TRS. A 3-day-old female infant presented with a giant scalp hemangioma at birth that rapidly grew in the neonatal period with early signs of ulceration. The patient underwent surgical resection of the giant scalp hemangioma with immediate primary closure of the defect using the TRS. Surgical procedure and postoperative period were uneventful. Early surgical resections of IHs at infancy carry substantial surgical risks and morbidity. This is the first reported case of early resection of a scalp hemangioma in the neonatal period, with successful immediate primary closure by application of stress-relaxation technique through the TRS. The application of the TopClosure TRS in this age group has significant advantages. It reduces the complexity and length of surgery, reducing blood loss, eliminating donor site morbidity, improving wound aesthetics, and minimizing the need for future reconstructive procedures. PMID:26632734

  15. Early Surgical Management of Large Scalp Infantile Hemangioma Using the TopClosure® Tension-Relief System.

    PubMed

    Zhu, Zhanyong; Yang, Xilin; Zhao, Yueqiang; Fan, Huajun; Yu, Mosheng; Topaz, Moris

    2015-11-01

    Infantile hemangiomas (IHs) are the most common benign vascular neoplasms of infancy and childhood. The majority do not need medical intervention. However, large ulcerated scalp IHs may lead to fatal bleeding as well as severe cosmetic disfigurement that indicate early surgical excision, inflicting substantial surgical risks, with short- and long-term morbidity.The TopClosure Tension-Relief System (TRS) is an innovative skin stretching and wound closure-secure system that facilitates primary closure of relatively large skin defects. This system has been shown as a substitute for skin grafts, flaps, or tissue expanders.We describe a case of a giant IH of the scalp usually requiring a complex surgical approach, which was immediately primarily closed applying the TRS.A 3-day-old female infant presented with a giant scalp hemangioma at birth that rapidly grew in the neonatal period with early signs of ulceration. The patient underwent surgical resection of the giant scalp hemangioma with immediate primary closure of the defect using the TRS. Surgical procedure and postoperative period were uneventful.Early surgical resections of IHs at infancy carry substantial surgical risks and morbidity. This is the first reported case of early resection of a scalp hemangioma in the neonatal period, with successful immediate primary closure by application of stress-relaxation technique through the TRS. The application of the TopClosure TRS in this age group has significant advantages. It reduces the complexity and length of surgery, reducing blood loss, eliminating donor site morbidity, improving wound aesthetics, and minimizing the need for future reconstructive procedures.

  16. Surgical hip dislocation does not result in atrophy or fatty infiltration of periarticular hip muscles

    PubMed Central

    Glynn, Aaron A.; Barattiero, Fabio Y.; Albers, Christoph E.; Hanke, Markus S.; Steppacher, Simon D.; Tannast, Moritz

    2014-01-01

    Surgical hip dislocation is the gold standard for treatment of femoroacetabular impingement (FAI). It utilizes an intermuscular and internervous approach to the hip. Concerns have been expressed that this approach causes soft tissue trauma resulting in post-operative muscle weakness of patients undergoing this procedure. We therefore asked whether surgical hip dislocation leads to (i) atrophy (decreased muscle diameter or cross-sectional area [CSA]) and (ii) degeneration (fatty infiltration) of 18 evaluated periarticular hip muscles. We retrospectively evaluated 32 patients (34 hips) following surgical hip dislocation for the treatment of FAI using pre and post-operative magnetic resonance (MR) arthrography of the hip. We evaluated muscle diameter, CSA and degree of fatty infiltration according to Goutallier for 18 periarticular hip muscles on axial and sagittal views. The mean interval between pre and post-operative MR was 1.9 ± 1.5 years (range, 0.4–6.1 years). Pre and post-operative muscle diameter and CSA of all 18 evaluated hip muscles did not differ. There was no post-operative change in the Goutallier classification for any of the evaluated 18 muscles. No muscle had post-operative degeneration higher than Grade 1 according to Goutallier. No atrophy or degeneration of periarticular hip muscles could be found following surgical hip dislocation for treatment of FAI. Any raised concerns about the invasiveness and potential muscle trauma for this type of surgery are unfounded. Level III, retrospective comparative study. See guidelines for authors for a complete description of levels of evidence. PMID:27011807

  17. Athlete's hernia--a true, early direct inguinal hernia: diagnosis, pathophysiology, and surgical treatment.

    PubMed

    Chernyavsky, Victoriya S; Davidov, Tomer; Trooskin, Stanley Z; Boyarsky, Andrew

    2011-11-01

    Athlete's hernia (AH) is an activity limiting condition that presents as chronic inguinal pain in elite athletes. The diagnosis involves a thorough history and physical examination and can be aided by ultrasound interrogation of the groin. Operative treatment with a direct tissue repair of the inguinal floor successfully alleviates symptoms and allows for full return to activity. A retrospective analysis of patients with the diagnosis of AH from January 1998 to May 2010 who underwent operative repair was reviewed. Patients were evaluated based on age, gender, sport, time to presentation, subjective and objective physical findings, imaging findings, operative findings, length of follow-up, and return to activity. Ninety-six patients (6 females) with a median age of 22.6 years were evaluated. In the majority of these patients, operative exploration revealed a wide external ring with separation of the fibers of the external oblique aponeurosis and an unprotected and bulging transverses abdominis aponeurosis, very akin to an early direct inguinal hernia. The mean initial follow-up time was 6 weeks at which point all but two of the patients were able to resume their full level of activity without restrictions. The diagnosis of AH, although somewhat elusive, can be easily established with a high degree of suspicion after doing a thorough history and physical exam augmented with ultrasonography. AH is equivalent to an early direct inguinal hernia found in young athletes and can be surgically corrected allowing return to full activity.

  18. Early rehabilitation following less invasive surgical stabilisation plate fixation for distal femoral fractures.

    PubMed

    Smith, T O; Hedges, C; MacNair, R; Schankat, K

    2009-06-01

    The less invasive surgical stabilisation (LISS) plate fixation method is an orthopaedic procedure for the fixation of distal femoral fractures. Early physiotherapy treatments of motion and mobilisation have been advocated following this procedure. This article critically appraises the evidence base assessing the early rehabilitation of patients following LISS fixation for distal femoral fractures. A review of EMBASE, Medline, CINAHL and AMED, and a hand search were undertaken. Two independent reviewers identified all eligible articles. Two reviewers extracted the data, which were verified by a third reviewer. All included articles were critically appraised by two independent reviewers using the Critical Appraisal Skills Programme tool. Seventeen case series assessing 508 patients with 535 fractures were reviewed. No clinical trials comparing physiotherapy programmes were identified. The review identified that following LISS fixation for distal femoral fractures, patients begin range-of-motion exercises immediately and are initially required to restrict weight-bearing following surgery. It remains unclear whether casts, braces or immobilisation aids are applied during the initial postoperative period. The efficacy of different physiotherapy protocols following LISS fixation for distal femoral fractures remains unclear. Further well-designed randomised controlled trials are required to compare different postoperative physiotherapy rehabilitation programmes for patients following LISS fixation of distal femoral fractures in order to determine the optimal postoperative management for this complex patient group.

  19. The impact of an early Ibuprofen treatment protocol on the incidence of surgical ligation of the ductus arteriosus.

    PubMed

    Tefft, Robert G

    2010-01-01

    This study sought to determine whether early treatment of premature infants with ibuprofen would result in a reduced incidence of surgical ligation of patent ductus arteriosus. Secondary outcomes included duration of hospitalization, assisted ventilation and supplemental oxygen, mortality rate, persistent patent ductus arteriosus (PDA), hypotension, intraventricular hemorrhage, and intestinal perforation. Outcomes among 105 very low-birth-weight (VLBW) infants managed by clinical use of indomethacin were compared with outcomes of 80 infants treated under a standardized protocol for ibuprofen therapy on the first day of life among infants <25 weeks estimated gestational age (EGA) and among infants of 25 to 28 weeks EGA with respiratory distress syndrome or history of antenatal steroids. The incidence of PDA ligation was significantly lower among the early ibuprofen group than among the clinical indomethacin group (0/80 versus 9/105, P = 0.0056). No differences were found in secondary outcomes. The effect persisted (P = 0.0100 to 0.0153) when corrected for birth weight, EGA, gender, Apgar scores, initial pH and base deficit, transport from another hospital, surfactant treatment, and need for assisted ventilation. In our neonatal intensive care unit, the incidence of PDA ligation among VLBW infants decreased after adoption of an early ibuprofen treatment protocol. Thieme Medical Publishers.

  20. Long-Term Results after Surgical Treatment of Ebstein's Anomaly: a 30-year Experience

    PubMed Central

    Kim, Min-Seok; Lim, Hong-Gook; Kim, Woong Han; Lee, Jeong Ryul

    2016-01-01

    Background and Objectives The aim of the study is to evaluate the long-term results after a surgical repair of Ebstein's anomaly. Subjects and Methods Forty-eight patients with Ebstein's anomaly who underwent open heart surgery between 1982 and 2013 were included. Median age at operation was 5.6 years (1 day-42.1 years). Forty-five patients (93.7%) demonstrated tricuspid valve (TV) regurgitation of less than moderate degree. When the patients were divided according to Carpentier's classification, types A, B, C, and D were 11, 21, 12, and 4 patients, respectively. Regarding the type of surgical treatment, bi-ventricular repair (n=38), one-and-a half ventricular repair (n=5), and single ventricle palliation (n=5) were performed. Of 38 patients who underwent a bi-ventricular repair, TV repairs were performed by Danielson's technique (n=20), Carpentier's technique (n=11), Cone repair (n=4), and TV annuloplasty (n=1). Two patients underwent TV replacement. Surgical treatment strategies were different according to Carpentier's types (p<0.001) and patient's age (p=0.022). Results There were 2 in-hospital mortalities (4.2%; 1 neonate and 1 infant) and 2 late mortalities during follow-up. Freedom from recurrent TV regurgitation rates at 5, 10, and 15 years were 88.6%, 66.3%, 52.7%, respectively. TV regurgitation recurrence did not differ according to surgical method (p=0.800). Survival rates at 5, 10, and 20 years were 95.8%, 95.8%, and 85.6%, respectively, and freedom from reoperation rates at 5, 10, and 15 years were 85.9%, 68.0%, and 55.8%, respectively. Conclusion Surgical treatment strategies were decided according to Carpentier's type and patient's age. Overall survival and freedom from reoperation rates at 10 years were 95.8% and 68.0%, respectively. Approximately 25% of patients required a second operation for TV during the follow-up. PMID:27721863

  1. [Remote results of the surgical treatment of dystopia of the kidneys in children].

    PubMed

    Bairov, G A; Osipov, I Iu; Koval'chuk, V S; Kurbanov, T A

    1988-10-01

    An analysis of results of the surgical treatment of 61 patients aged from 1 to 14 years has been made. Follow-up examinations from 1 to 18 years after treatment was performed in 53 of the 61 patients. In sacral and iliac dystopia of the kidney good outcomes were obtained after combined reconstructive plastic operations consisting of nephropexy associated with ureterolysis, resection of accessory vessels, plasty of the pyeloureteral segment and resection of the kidney pole with abnormal blood supply. With pelvic and crossed dystopia nephrureterectomy is indicated. With the only dystopic kidney good remote results were obtained after a one-step radical correcting operation.

  2. Heparin-Induced Thrombocytopenia in Contemporary Cardiac Surgical Practice and Experience With a Protocol for Early Identification.

    PubMed

    Sun, Xiumei; Hill, Peter C; Taylor-PaneK, Sharon L; Corso, Paul J; Lindsay, Joseph

    2016-01-15

    This analysis was designed to (1) examine the impact of heparin-induced thrombocytopenia (HIT) on contemporary cardiac surgical practice and (2) describe the results of a protocol designed for early identification of the presence of the immune mechanisms involved. Consecutive patients who underwent cardiac surgery were screened postoperatively for thrombocytopenia. Patients with thrombocytopenia were tested for antiplatelet factor 4 (PF4)/heparin antibodies by ELISA and clinical evidence of thrombosis sought. Demographics, co-morbidities, operative details, and outcomes were abstracted from the departmental registry. Of 14,415 consecutive patients undergoing cardiac surgery, 1,849 patients (13%) had thrombocytopenia. Of them, 277 patients (15%) had PF4/heparin antibodies and 76 patients (4%) had both antibodies and clinical thrombosis. Antibodies were more frequent: (1) in women (p = 0.01), (2) in patients with an increased body mass index (p <0.01), and (3) in patients with clinical heart failure before surgery (p <0.01). Thirty-day mortality was greatest among the 76 patients with the triad of thrombocytopenia, antibodies, and clinical thrombosis (30%). Of the 1,849 patients with thrombocytopenia, the presence of PF4/heparin antibodies was an independent predictor of 30-day mortality (odds ratio 2.09, 95% CI 1.46 to 2.49; p <0.001). HIT remains an infrequent but very serious complication of heparin therapy in contemporary cardiac surgical practice. The possibility that the presence of HIT antibodies in patients with thrombocytopenia independently increases operative mortality deserves further study.

  3. The Value of Modified Early Warning Score (MEWS) in Surgical In-Patients: A Prospective Observational Study

    PubMed Central

    Gardner-Thorpe, J; Love, N; Wrightson, J; Walsh, S; Keeling, N

    2006-01-01

    INTRODUCTION The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients. PATIENTS AND METHODS A total of 334 consecutive ward patients were prospectively studied. MEWS were recorded on all patients and the primary end-point was transfer to ITU or HDU. RESULTS Fifty-seven (17%) ward patients triggered the call-out algorithm by scoring four or more on MEWS. Emergency patients were more likely to trigger the system than elective patients. Sixteen (5% of the total) patients were admitted to the ITU or HDU. MEWS with a threshold of four or more was 75% sensitive and 83% specific for patients who required transfer to ITU or HDU. CONCLUSIONS The MEWS in association with a call-out algorithm is a useful and appropriate risk-management tool that should be implemented for all surgical in-patients. PMID:17059720

  4. An Early Warning Score Predicts Risk of Death after In-hospital Cardiopulmonary Arrest in Surgical Patients.

    PubMed

    Stark, Alexander P; Maciel, Robert C; Sheppard, William; Sacks, Greg; Hines, O Joe

    2015-10-01

    In-hospital cardiopulmonary arrest can contribute significantly to publicly reported mortality rates. Systems to improve mortality are being implemented across all specialties. A review was conducted for all surgical patients >18 years of age who experienced a "Code Blue" event between January 1, 2013 and March 9, 2014 at a university hospital. A previously validated Modified Early Warning Score (MEWS) using routine vital signs and neurologic status was calculated at regular intervals preceding the event. In 62 patients, the most common causes of arrest included respiratory failure, arrhythmia, sepsis, hemorrhage, and airway obstruction, but remained unknown in 27 per cent of cases. A total of 56.5 per cent of patients died before hospital discharge. In-hospital death was associated with American Society of Anesthesiologists status (P = 0.039) and acute versus elective admission (P = 0.003). Increasing MEWS on admission, 24 hours before the event, the event-day, and a maximum MEWS score on the day of the event increased the odds of death. Max MEWS remained associated with death after multivariate analysis (odds ratio 1.39, P = 0.025). Simple and easy to implement warning scores such as MEWS can identify surgical patients at risk of death after arrest. Such recognition may provide an opportunity for clinical intervention resulting in improved patient outcomes and hospital mortality rates.

  5. Positive surgical margins in early stage oral cavity cancer: an analysis of 20,602 cases.

    PubMed

    Luryi, Alexander L; Chen, Michelle M; Mehra, Saral; Roman, Sanziana A; Sosa, Julie A; Judson, Benjamin L

    2014-12-01

    To report the incidence of positive surgical margins in early oral cavity cancer and identify patient, tumor, and system factors associated with their occurrence. Retrospective analysis of the National Cancer Database. Patients diagnosed with stage I or II oral cavity squamous cell cancer between 1998 and 2011 were identified. Univariate and multivariate analyses of factors associated with positive margins were conducted. In total, 20,602 patients with early oral cancer were identified. Margin status was reported in 94.8% of cases, and positive margins occurred in 7.5% of those cases. Incidence of positive margins by institution varied from 0% to 43.8%, with median incidence of 7.1%. Positive margins were associated with clinical factors including stage II disease (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.55-1.98), intermediate grade (OR, 1.20; 95% CI, 1.04-1.37), high grade (OR, 1.68; 95% CI, 1.39-2.03), and floor of mouth (OR, 1.78; 95% CI, 1.52-2.08), buccal mucosa (OR, 2.06; 95% CI, 1.59-2.68), and retromolar locations (OR, 2.40; 95% CI, 1.85-3.11). Positive margins were also associated with treatment at nonacademic cancer centers (OR, 1.23; 95% CI, 1.04-1.44) and institutions with a low oral cancer case volume (OR, 1.45; 95% CI, 1.23-1.69). Positive margins are associated with tumor factors, including stage, grade, and site, reflecting disease aggressiveness and difficulty of resection. Positive margins also are associated with factors such as treatment facility type, hospital case volume, and geographic region, suggesting potential variation in quality of care. Margin status may be a useful quality measure for early oral cavity cancer. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  6. Does surgical closure technique affect early mammographic detection of tumor recurrence after breast-conserving therapy?

    PubMed

    Newlin, Heather E; Indelicato, Daniel J; Abbitt, Patricia; Marshall, Julia; Wymer, David; Grobmyer, Stephen; Haigh, Linda; Copeland, Edward; Morris, Christopher G; Mendenhall, Nancy P

    2009-10-01

    Scarring in the tumor bed may mask or mimic local recurrence of tumor on surveillance mammography. Type of surgical closure technique used during lumpectomy may impact the pattern or density of scar tissue apparent in the tumor bed on mammography. This study sought to determine whether surgical closure type affects tumor-bed scar formation and impacts interpretation of surveillance mammography in women treated with breast-conserving therapy for early-stage breast cancer. One hundred women who received breast-conserving therapy were selected; 99 of them had 2-year post-treatment mammograms for the treated breast. Craniocaudal and mediolateral oblique views were reviewed by 3 subspecialty radiologists who routinely read mammograms. The mammograms were scored on 5-point scales for overall breast density and scarring within the tumor bed. The analyses did not demonstrate greater scarring or density in breast status post superficial closure compared with breast status post full-thickness closure, or vice versa (P > 0.05 for scarring and density). There were no detectable differences between the 2 closure techniques either within the data from individual reviewers, within the composite data for the entire group of reviewers, or in instances where 2 of 3 reviewers agreed (P > 0.05). There was significant interobserver variability in scoring among the mammographers for both scarring (P = 0.001) and density (P < 0.0001). Based on our study of the 2-year post-treatment mammograms, there was no evidence that closure technique impacts degree of scarring in the tumor bed. However, striking interobserver variability in scoring density and scarring was noted.

  7. Response to early repeat celiotomy in horses after a surgical treatment of jejunal strangulation.

    PubMed

    Bauck, Anje G; Easley, Jeremiah T; Cleary, Orlaith B; Graham, Sarah; Morton, Alison J; Rötting, Anna K; Schaeffer, David J; Smith, Andrew D; Freeman, David E

    2017-08-01

    To determine the outcome after early repeat celiotomy in horses operated for jejunal strangulation. Retrospective case series. Horses (n = 22) that underwent repeat celiotomy for postoperative reflux (POR) and/or postoperative colic (POC) that did not improve within 48 hours from onset after initial surgical treatment of strangulating jejunal lesions by jejunojejunostomy (n = 14) or no resection (n = 8). Medical records were reviewed for clinical signs, duration of signs before repeat surgery, surgical findings and treatment, and outcome. Survival was documented by phone call at long-term follow-up. The influence of POC and POR on timing of surgery were analyzed. Long-term survival was examined by Kaplan-Meier analyses. Repeat celiotomy was performed at a median of 57 hours after initial surgery and 16.5 hours from onset of signs, and earlier in horses with POC compared with POR (P < .05). A total of 3/22 horses were euthanatized under anesthesia. A total of 9 of 11 horses with initial jejunojejunostomy required resection of the original anastomosis due to anastomotic complications. In 8 horses without resection, second surgery included resection (4) or decompression (4). Repeat celiotomy was successful in 13/16 horses with POR. Repeat celiotomy eliminated POC in all horses (n = 9). A total of 19 horses were recovered from anesthesia and all survived to discharge. Incisional infections were diagnosed in 13/17 horses where both surgeries were performed through the same ventral median approach, and hernias developed in 4/13 infected incisions. Median survival time was 90 months. Repeat celiotomy can eliminate signs of POR and/or POC, and the additional surgery does not appear to aggravate POR. Criteria for repeat celiotomy in this study could provide guidelines for managing POC and POR after surgery for jejunal strangulation. © 2017 The American College of Veterinary Surgeons.

  8. Interest in international surgical volunteerism: results of a survey of members of the American Pediatric Surgical Association.

    PubMed

    Butler, Marilyn W; Krishnaswami, Sanjay; Rothstein, David H; Cusick, Robert A

    2011-12-01

    This study assesses interest in international volunteer work by members of the American Pediatric Surgical Association (APSA) and attempts to identify demographics, motivations, obstacles, and institutional issues of the respondents. An online survey service was used to send a 25-question survey to all APSA members with email addresses in November 2009. An answer to all questions was not required. Written comments were encouraged. The survey was sent to 807 members of whom 316 responded, for a response rate of 39%. International work had been done previously by 48% of respondents, whereas 95% stated that they were interested or perhaps interested in doing so. Most (83%) were interested in operating with local surgeons to teach them how to perform procedures. Altruism was the chief motivation in 75% of respondents. Primary obstacles to doing international work were family obligations and lack of time, although 37% stated that a lack of information about volunteer opportunities was an issue. A significant number of respondents (48%) stated that their institution had no established international collaborations. This study suggests that there is interest in international volunteerism among many members of APSA. Understanding the issues surrounding surgical volunteerism may facilitate humanitarian involvement among pediatric surgeons. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. [3D Virtual Reality Laparoscopic Simulation in Surgical Education - Results of a Pilot Study].

    PubMed

    Kneist, W; Huber, T; Paschold, M; Lang, H

    2016-06-01

    The use of three-dimensional imaging in laparoscopy is a growing issue and has led to 3D systems in laparoscopic simulation. Studies on box trainers have shown differing results concerning the benefit of 3D imaging. There are currently no studies analysing 3D imaging in virtual reality laparoscopy (VRL). Five surgical fellows, 10 surgical residents and 29 undergraduate medical students performed abstract and procedural tasks on a VRL simulator using conventional 2D and 3D imaging in a randomised order. No significant differences between the two imaging systems were shown for students or medical professionals. Participants who preferred three-dimensional imaging showed significantly better results in 2D as wells as in 3D imaging. First results on three-dimensional imaging on box trainers showed different results. Some studies resulted in an advantage of 3D imaging for laparoscopic novices. This study did not confirm the superiority of 3D imaging over conventional 2D imaging in a VRL simulator. In the present study on 3D imaging on a VRL simulator there was no significant advantage for 3D imaging compared to conventional 2D imaging. Georg Thieme Verlag KG Stuttgart · New York.

  10. [Mid-term results after complete surgical correction of transposition of the great arteries].

    PubMed

    Parezanović, Vojislav; Mrdjen, Mirko; Illić, Slobodan; Vulićević, Irena; Djukić, Milan; Jovanović, Ida; Stefanović, Igor; Illisić, Tamara; Kalanj, Jasna; Mimic, Branko; Milovanović, Vladimir

    2014-01-01

    Arterial switch operation (ASO) is a cardiosurgical method of choice for complete anatomical correction of transposition of great arteries. Improvement of this procedure has made considerably improved the outcome and long-term prognosis of children born with this complex congenital heart disease. The aim of this study was to estimate the success rate of ASO through retrospective analysis of mortality and late complications. This study included 57 children operated from 1st January 2005 until 31st December 2009. Parameters that could influence the outcome of surgery were investigated. The following late complications were investigated: neopulmonary artery stenosis, neoaortic stenosis and regurgitation, as well as clinical signs of heart failure. Early postoperative mortality was 15.8% (9/57 patients). During follow-up (8 to 72 months, average 36.5 months) there were no lethal outcomes. On the last echocardiography examination, 73.2% patients had neoaortic regurgitation and 67.4% patients had neopulmonary regurgitation, but all of them were mild in intensity. Neopulmonary stenosis had 32.6% of patients, but only two had moderate or severe stenosis. No one had ischemic ECG changes. Three reinterventions were performed due to serious residual problems: surgical correction of neoaortic stenosis, surgical correction of neopulmonary stenosis and transcatether balloon dilatation for aortic recoarctation. At the end of the follow-up period, only one of 46 consistently followed patients had signs of heart failure which required therapy (2.2%), while the majority of patients were without any symptoms and with good effort tolerance. Arterial switch operation has been successfully performed at our institution, with acceptable perioperative mortality and excellent late outcome.

  11. Surgical treatment of chronic idiopathic thrombocytopenic purpura: results in 107 cases

    SciTech Connect

    Cola, B.; Tonielli, E.; Sacco, S.; Brulatti, M.; Franchini, A.

    1986-07-01

    Between 1972 and 1985, 107 patients with chronic Idiopathic Thrombocytopenic Purpura underwent splenectomy. Platelet life span and sites of sequestration were studied with labelled platelets and external scanning. Medical treatment was always of scarce and transient effectiveness and had considerable side effects. Splenectomy had minimal complications and mortality and caused no hazard of overwhelming sepsis in adults. The results of splenectomy were very satisfying, especially when platelet sequestration was mainly splenic (remission in about 90% of patients). Surgical treatment is at present the most effective in patients with chronic ITP.

  12. Alternative surgical approach for the management of uterine prolapse in young women: preliminary results.

    PubMed

    Karatayli, Rengin; Balci, Osman; Gezginç, Kazim; Yildirim, Pinar; Karanfil, Fikriye; Acar, Ali

    2013-10-01

    To demonstrate an alternative surgical approach for the management of uterine prolapse in young women by a technique that was previously defined for post-hysterectomy vaginal vault suspension in published work and also to demonstrate successful operative results. The study population consisted of 12 women aged 28-41 years who had stage 4 uterine prolapse and who were surgically treated by abdominal hysteropexy using autogenous rectus fascia strips. Operative results and postoperative follow-up Pelvic Organ Prolapse Quantification and Prolapse Quality of Life results were recorded. Mean age of patients was 35.5 ± 4.1 years (range, 28-41). Mean parity in the study group was 2.6 ± 1.0 (range, 1-5). Mean operation time was 32.0 ± 5.2 min (range, 25-42). All patients were discharged on the postoperative 3rd day and no complications were observed postoperatively. Mean follow-up period was 20 ± 7.0 months (range, 12-36). All of the patients had complete remission for uterine prolapse and none of the patients had complaints related to the operation. Abdominal hysteropexy operation using rectus fascia strips provides a safe and alternative approach for the management of uterine prolapse in young women who desire to preserve their uterus. But further analysis is needed to confirm our results. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

  13. Functional results following surgical repair of simultaneous bilateral quadriceps tendon ruptures.

    PubMed

    Chang, Edward S; Dodson, Christopher C; Tjoumakaris, Fotios; Cohen, Steven B; Chang, Edward S; Dodson, Christopher C; Tjoumakaris, Fotios; Cohen, Steven B

    2014-05-01

    Unilateral quadriceps tendon ruptures are common conditions treated by orthopedic surgeons. There is a paucity of information concerning functional outcomes in bilateral tendon ruptures. The aim of this study is to assess a series of 5 cases with simultaneous quadriceps tendon ruptures that underwent acute surgical repair with the purpose of identifying the functional outcomes as compared with unilateral injuries. We hypothesize that patients with bilateral quadriceps tendon ruptures have worse functional outcomes than patients with unilateral ruptures. Five cases of bilateral quadriceps tendon ruptures were identified. All patients underwent acute surgical extensor tendon repair employing a 3-patellar hole and a locked, running, nonabsorbable suture technique followed by a 6-week period of immobilization and bracing for 10 to 12 weeks. Mechanism of injury, medical history, social history, operative report, and postoperative exam were recorded with a minimum 1-year follow-up. In addition, each patient completed a subjective International Knee Documentation Committee (IKDC) score at 18 months. Five patients with unilateral injuries and with similar medical history were included as age-matched controls. The mean age for the bilateral group was 54.8 years (range, 44-68 years). Mean postoperative knee flexion was 129 degrees and all patients had active, resisted knee extension. Only 1 patient had a medical comorbidity (diabetes mellitus). The mean IKDC score (mean follow-up, 25.4 months; range, 22-29 months) was 71.9 (range, 34.4 to 91.6), whereas the age-matched control group had a mean IKDC score of 88.3 (P = 0.23). There was no statistical significance between the 2 groups with regard to range of motion (P = 0.24), IKDC score, and return to activity (P = 0.29). Patients with early surgical repair of bilateral, simultaneous extensor mechanism ruptures exhibit adequate recovery and return to a high level of function. Our patients were younger than those reported in

  14. The Results of Surgical Treatment of Cushing Tumors in the Republic of Uzbekistan: Establishing Transsphenoidal Surgery in A Developing Nation.

    PubMed

    Powell, Michael P; Narimova, Gulshekra J; Halimova, Zamira J

    2017-01-01

    Transsphenoidal surgery (TSS) was introduced into the Republic of Uzbekistan in 2005 and has been developing since then. The principal center for the management of all pituitary disease is a single site for a nation with a population of approximately 30 million. Results in surgery for Cushing disease are a marker of surgical technical skill in TSS. All previously published series come from the developed world, where sophisticated investigations and management are available. Many of these investigations are not available in Uzbekistan. This mixed series of 154 patients from 2000 to 2013 presents the data from Uzbekistan. The management of Cushing disease before the introduction of TSS was with unilateral adrenalectomy, a procedure virtually unknown in the West. It reduces cortisol burden but is, in the long-term, only a temporary measure because it allows the tumor to continue to grow. The results of this procedure are presented and show that in the short-term, surprisingly reasonable remission is obtained. These results are contrasted with the experience with TSS, for which the impact of the input from an experienced team including an endocrinologist and neurosurgeon from the United Kingdom allowed a transformation in management and enabled outcomes to match what can be expected in the West. TSS for Cushing's Disease achieved an early remission of 68.7% (early morning cortisol of <50 nmol/L), although 4 patients relapsed. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Cerebellar Arteriovenous Malformations: Anatomical Subtypes, Surgical Results, and Increased Predictive Accuracy of the Supplementary Grading System

    PubMed Central

    Rodríguez-Hernández, Ana; Kim, Helen; Pourmohamad, Tony; Young, William L.; Lawton, Michael T.

    2013-01-01

    Background Anatomical diversity amongst cerebellar AVMs calls for a classification that is intuitive and surgically informative. Selection tools like the Spetzler-Martin grading system are designed to work best with cerebral AVMs, but have shortcomings with cerebellar AVMs. Objective To define subtypes of cerebellar AVMs that clarify anatomy and surgical management, determine results according to subtypes, and compare predictive accuracies of Spetzler-Martin and supplementary systems. Methods From a consecutive surgical series of 500 patients, 60 had cerebellar AVMs, 39 had brain stem AVMs and were excluded, and 401 had cerebral AVMs. Results Cerebellar AVM subtypes were: 18 vermian, 13 suboccipital, 12 tentorial, 12 petrosal, and 5 tonsillar. Patients with tonsillar and tentorial AVMs fared best. Cerebellar AVMs presented with hemorrhage more than cerebral AVMs (p<0.001). Cerebellar AVMs were more likely to drain deep (p=0.036) and less likely eloquent (p<0.001). The predictive accuracy of supplementary grade was better than that of Spetzler-Martin grade with cerebellar AVMs (areas under the ROC curve 0.74 and 0.59, respectively). The predictive accuracy of the supplementary system was consistent for cerebral and cerebellar AVMs, whereas that of the Spetzler-Martin system was greater with cerebral AVMs. Conclusion Patients with cerebellar AVMs present with hemorrhage more than patients with cerebral AVMs, justifying an aggressive treatment posture. The supplementary system is better than the Spetzler-Martin system at predicting outcomes after cerebellar AVM resection. Key components of the Spetzler-Martin system, like venous drainage and eloquence, are distorted by cerebellar anatomy in ways that components of the supplementary system are not. PMID:22986595

  16. Clinical Findings and Results of Surgical Resection in 19 Cases of Spinal Osteoid Osteoma

    PubMed Central

    Etemadifar, Mohammad Reza

    2015-01-01

    Study Design Descriptive cases series. Purpose To evaluate clinical findings and results of conventional surgery in patients with spinal osteoid osteoma (OO). Overview of Literature OO is a rare benign tumor with spinal involvement rate of about 10%-20%. Methods This descriptive study was conducted on 19 patients (11 males and 8 females with an average age of 19.8 years) with documented histopathological and imaging findings of OO referred to a university hospital. Neurologic symptoms and pain were scored before and after the open surgical excision. Data were analyzed by SPSS ver. 16 software using chi-square and significance level of 0.05. Results The most common complaint was back or neck pain (84.2%) and in 68.4% spinal deformity (mostly scoliosis) shown with an average cobb angle of 21° at presentation. The sites of involvement were 35% in the lumbar, 35% in the thoracic, 25% in the cervical, and 5% in the sacrum. Lamina was the most common site (50%) of involvement with predilection for the right side (p=0.001). All patients were treated by conventional surgical excision with a complete recovery of pain and deformity. No recurrence occurred after a mean follow up of 44.5 months, but 4 of 19 cases instrumented because of induced instability. In one case there were two levels of involvement (C7-T1) simultaneously. Interestingly, 10 out of 19 of our cases belonged to a specific race (Bakhtiari). Conclusions Surgical intra-lesional curettage is potentially an effective method without any recurrence, which can lead to spontaneous scoliosis recovery and pain relief. Race may be a potential risk factor for spinal (OO). PMID:26097653

  17. Endoscopic septoplasty in primary cases using electromechanical instruments: surgical technique, efficacy and results.

    PubMed

    De Sousa Fontes, Aderito; Sandrea Jiménez, Minaret; Chacaltana Ayerve, Rosa R

    2013-01-01

    The microdebrider is a surgical tool which has been used successfully in many endoscopic surgical procedures in otolaryngology. In this study, we analysed our experience using this powered instrument in the resection of obstructive nasal septum deviations. This was a longitudinal, prospective, descriptive study conducted between January and June 2007 on 141 patients who consulted for chronic nasal obstruction caused by a septal deviation or deformity and underwent powered endoscopic septoplasty (PES). The mean age was 39.9 years (15-63 years); 60.28% were male (n=85) The change in nasal symptom severity decreased after surgery from 6.12 (preoperative) to 2.01 (postoperative). Patients undergoing PES had a significant reduction of nasal symptoms in the pre- and postoperative period, which was statistically significant (P<.05). There were no statistically significant differences between the results at the 2 nd week, 6th week and 5th year after surgery. The 100% of patients were satisfied with the results of surgery and no patient answered "No" to the question added to compare patient satisfaction after surgery. Minor complications in the postoperative period were present in 4.96% of the cases. Powered endoscopic septoplasty allows accurate, conservative repair of obstructive nasal septum deviations, with fewer complications and better functional results. In our experience, this technique offered significant perioperative advantages with high postoperative patient satisfaction in terms of reducing the severity of nasal symptoms. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  18. Fracture-dislocation of the humeral condyles in adults: results of surgical treatment.

    PubMed

    Bentounsi, Abdelhakim

    2015-09-01

    Fracture-dislocation of the humeral condyle is exceptional in adults. The purpose was to analyze the results of surgical treatment by open reduction and internal fixation without ligamentous repair. There were six men with an average age of 31 years. According to the AO classification, five fractures were classified as AO type B1 and one as B2. Dislocation was reduced in emergency before osteosynthesis. Postoperatively, the joint was held immobile with a brace for 25.40 days. Five patients were reviewed after a mean follow-up of 52.96 months. The median arc of flexion/extension was 104.80° and 157.8° for pronation-supination. All elbows were stable and all fractures were consolidated. Two elbows were painful. The results were satisfactory in five patients. The elbow stability can be ensured only by the synthesis of bone structures. Surgical treatment should restore exact anatomy between the condyle and trochlea. This protocol may provide a joint stability and satisfactory results.

  19. [Current indications, surgical technique and results of anterior sphincter repair as a treatment of faecal incontinence].

    PubMed

    Dorcaratto, Dimitri; Martínez-Vilalta, Miquel; Parés, David

    2010-05-01

    Faecal incontinence is a high prevalence disease in the general population. This pathology is commonly under-estimated and causes a great impact on clinical status and on the quality of life of affected patients. The prevalence of faecal incontinence in several studies has been estimated between 2% and 15% of the general population. The prevalence increases if we study selected populations, such as elderly people. The main cause of faecal incontinence is obstetric anal sphincter damage. In the past years, the presence of incontinence due to sphincter lesions, especially the obstetric ones, was an absolute indication of anterior anal sphincter repair. Actually, after knowing the long term follow up results of this technique, as well as the evolving knowledge on faecal incontinence and the development of new diagnostic and therapeutic techniques, this technique might be selected for cases with large sphincter defects. However there is limited information in the current literature on indications, surgical technique and results of anterior sphincter repair. The aim of this review is to analyse scientific evidence on current indications, surgical technique features and results of anterior sphincter repair as a therapy for faecal incontinence, also giving our point of view on controversial issues. A bibliography search was undertaken using Medline database including articles published from January 1985 to January 2009. Copyright 2009 AEC. Published by Elsevier Espana. All rights reserved.

  20. The Oblique Metaphyseal Shortening Osteotomy of the Distal Ulna: Surgical Technique and Results of Ten Patients.

    PubMed

    Benis, Szabolcs; Goubau, Jean F; Mermuys, Koen; Van Hoonacker, Petrus; Berghs, Bart; Kerckhove, Diederick; Vanmierlo, Bert

    2017-02-01

    Background Ulnocarpal abutment is a common condition following distal radius fractures. There are different surgical methods of treatment for this pathology: open and arthroscopic wafer procedure or an ulnar shortening osteotomy. We describe an oblique metaphyseal shortening osteotomy of the distal ulna using two cannulated headless compression screws. We report the results of 10 patients treated with this method. Materials and Methods Out of 17 patients, 10 could be reviewed retrospectively for this study. Patient-rated outcomes were measured using the VAS (visual analogue scale) for pain, PRWHE (patient-rated wrist and hand evaluation) survey, and Quick-DASH (disability of arm, shoulder and hand) survey for functional outcomes. At the review we measured the range of motion (ROM) of the wrist (extension and flexion, ulnar and radial deviation, pronation and supination). Grip strength, pronation, and supination strength of the forearm was measured using a calibrated hydraulic dynamometer. ROM and strength of the affected wrist was compared with ROM and strength of the unaffected wrist. Surgical Procedure Oblique long metaphyseal osteotomy of the distal ulna (from proximal-ulnar to distal-radial), fixed with two cannulated headless compression screws. Results The average postoperative VAS score for pain was 23.71 (standard deviation [SD] of 30.41). The average postoperative PRWHE score was 32.55 (SD of 26.28). The average postoperative Quick-DASH score was 28.65 (SD of 27.21). The majority of patients had a comparable ROM and strength between the operated side and the non-operated side. Conclusion This surgical technique has the advantage of reducing the amount of hardware and to decrease the potential hinder caused by it on medium term. Moreover, the incision remains smaller, and the anatomic metaphyseal localization of the osteotomy potentially allows a better and rapid healing.

  1. Cerebellar arteriovenous malformations: anatomic subtypes, surgical results, and increased predictive accuracy of the supplementary grading system.

    PubMed

    Rodríguez-Hernández, Ana; Kim, Helen; Pourmohamad, Tony; Young, William L; Lawton, Michael T

    2012-12-01

    Anatomic diversity among cerebellar arteriovenous malformations (AVMs) calls for a classification that is intuitive and surgically informative. Selection tools like the Spetzler-Martin grading system are designed to work best with cerebral AVMs but have shortcomings with cerebellar AVMs. To define subtypes of cerebellar AVMs that clarify anatomy and surgical management, to determine results according to subtypes, and to compare predictive accuracies of the Spetzler-Martin and supplementary systems. From a consecutive surgical series of 500 patients, 60 had cerebellar AVMs, 39 had brainstem AVMs and were excluded, and 401 had cerebral AVMs. Cerebellar AVM subtypes were as follows: 18 vermian, 13 suboccipital, 12 tentorial, 12 petrosal, and 5 tonsillar. Patients with tonsillar and tentorial AVMs fared best. Cerebellar AVMs presented with hemorrhage more than cerebral AVMs (P < .001). Cerebellar AVMs were more likely to drain deep (P = .04) and less likely to be eloquent (P < .001). The predictive accuracy of the supplementary grade was better than that of the Spetzler-Martin grade with cerebellar AVMs (areas under the receiver-operating characteristic curve, 0.74 and 0.59, respectively). The predictive accuracy of the supplementary system was consistent for cerebral and cerebellar AVMs, whereas that of the Spetzler-Martin system was greater with cerebral AVMs. Patients with cerebellar AVMs present with hemorrhage more often than patients with cerebral AVMs, justifying an aggressive treatment posture. The supplementary system is better than the Spetzler-Martin system at predicting outcomes after cerebellar AVM resection. Key components of the Spetzler-Martin system such as venous drainage and eloquence are distorted by cerebellar anatomy in ways that components of the supplementary system are not.

  2. [Liver transplantation--indications, surgical technique, results--the analysis of a clinical series of 200 cases].

    PubMed

    Popescu, I; Ionescu, M; Braşoveanu, V; Hrehoreţ, D; Matei, E; Dorobantu, B; Zamfir, R; Alexandrescu, S; Grigorie, M; Tulbure, D; Popa, L; Ungureanu, M; Tomescu, D; Droc, G; Popescu, H; Cristea, A; Gheorghe, L; Iacob, S; Gheorghe, C; Boroş, M; Lupescu, I; Vlad, L; Herlea, V; Croitoru, M; Platon, P; Alloub, A

    2010-01-01

    Initially considered experimental, liver transplantation (LT) has become the treatment of choice for the patients with end-stage liver diseases. Between April 2000 and October 2009, 200 LTs (10 reLTs) were performed in 190 patients, this study being retrospective. There were transplanted 110 men and 80 women, 159 adults and 31 children with the age between 1 and 64 years old (mean age--39.9). The main indication in the adult group was represented by viral cirrhosis, while the pediatric series the etiology was mainly glycogenosis and biliary atresia. There were performed 143 whole graft LTs, 46 living donor LTs, 6 split LTs, 4 reduced LTs and one domino LT RESULTS: The postoperative survival was 90% (170 patients). The patient and graft one-year and five-year survivals were 76.9%, 73.6% and 71%, 68.2%, respectively. The early complications occurred in 127 patients (67%). The late complications were recorded in 71 patients (37.3%). The intraoperative and early postoperative mortality rate was 9.5% (18 patients). The Romanian liver transplantation program from Fundeni includes all types of current surgical techniques and the results are comparable with those from other international centers.

  3. Health Status After Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Increased Surgical Risk: Results From the CoreValve US Pivotal Trial.

    PubMed

    Arnold, Suzanne V; Reynolds, Matthew R; Wang, Kaijun; Magnuson, Elizabeth A; Baron, Suzanne J; Chinnakondepalli, Khaja M; Reardon, Michael J; Tadros, Peter N; Zorn, George L; Maini, Brij; Mumtaz, Mubashir A; Brown, John M; Kipperman, Robert M; Adams, David H; Popma, Jeffrey J; Cohen, David J

    2015-08-17

    This study sought to compare the health status outcomes for patients treated with either self-expanding transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (AVR). In patients at increased surgical risk, TAVR with a self-expanding bioprosthesis is associated with improved 1-year survival compared with AVR. However, elderly patients may be just as concerned with quality-of-life improvement as with prolonged survival as a goal of treatment. Between 2011 and 2012, 795 patients with severe aortic stenosis at increased surgical risk were randomized to TAVR or AVR in the CoreValve US Pivotal Trial. Health status was assessed at baseline, 1 month, 6 months, and 1 year using the Kansas City Cardiomyopathy Questionnaire, Medical Outcomes Study Short-Form 12 Questionnaire, and EuroQOL 5-dimension questionnaire; growth curve models were used to examine changes over time. Over the 1-year follow-up period, disease-specific and generic health status improved substantially for both treatment groups. At 1 month, there was a significant interaction between the benefit of TAVR over AVR and access site. Among surviving patients eligible for iliofemoral (IF) access, there was a clinically relevant early benefit with TAVR across all disease-specific and generic health status measures. Among the non-IF cohort, however, most health status measures were similar for TAVR and AVR, although there was a trend toward early benefit with TAVR on the Short-Form 12 Questionnaire's physical health scale. There were no consistent differences in health status between TAVR and AVR at the later time points. Health status improved substantially in surviving patients with increased surgical risk who were treated with either self-expanding TAVR or AVR. TAVR via the IF route was associated with better early health status compared with AVR, but there was no early health status benefit with non-IF TAVR compared with AVR. (Safety and Efficacy Study of the Medtronic Core

  4. One stage hip arthroscopy and periacetabular osteotomy: surgical technique and initial results

    PubMed Central

    Zanotti, Gerardo; Comba, Fernando; Genovesi, Eduardo; Buttaro, Martin; Piccaluga, Francisco

    2017-01-01

    Aim: We purposed to describe the surgical technique and preliminary outcomes of combined arthroscopic and periacetabular osteotomy (PAO) for the treatment of non-arthritic hip dysplasia. Methods: Between May and August 2015, 4 patients (3 female, 1 male) with an average age of 29 years old (range; 22-33) had undergone one-stage hip arthroscopy and periacetabular osteotomy. Primary symptom was pain associated with instability. Upon radiographic examination, mean lateral center-edge angle of Wiberg was 12° (range; 7°-18°). Intra-articular findings were computed and primary outomes were as follows: radiographic angular correction; time to healing after pelvis osteotomy and functional results according to Merle D’Aubigné Score. Results: Minimum follow-up was 6 months whereas maximum was 9 months. Mean surgical time was 98 minutes for hip arthroscopy and 132 minutes for the osteotomy. In all cases, a lesion of the antero-superior labrum and the chondro-labral junction was found and repaired. After correction, overall postoperative center-edge angle was 29° (range; 25°-35°). Bone healing was certified in all cases at 6 months postoperatively. Overall Merle D’Aubigné Score was 17/18 points. Conclusion: Combined treatment of non-arthritic hip dysplasia with hip arthroscopy and PAO obtained good clinical and radiological outcomes. Former arthroscopy enables the diagnosis of cartilage lesions and intra-articular pathology as well as it aids in proceeding or not to an open correction.

  5. Robotic technology results in faster and more robust surgical skill acquisition than traditional laparoscopy.

    PubMed

    Moore, Lee J; Wilson, Mark R; Waine, Elizabeth; Masters, Rich S W; McGrath, John S; Vine, Samuel J

    2015-03-01

    Technical surgical skills are said to be acquired quicker on a robotic rather than laparoscopic platform. However, research examining this proposition is scarce. Thus, this study aimed to compare the performance and learning curves of novices acquiring skills using a robotic or laparoscopic system, and to examine if any learning advantages were maintained over time and transferred to more difficult and stressful tasks. Forty novice participants were randomly assigned to either a robotic- or laparoscopic-trained group. Following one baseline trial on a ball pick-and-drop task, participants performed 50 learning trials. Participants then completed an immediate retention trial and a transfer trial on a two-instrument rope-threading task. One month later, participants performed a delayed retention trial and a stressful multi-tasking trial. The results revealed that the robotic-trained group completed the ball pick-and-drop task more quickly and accurately than the laparoscopic-trained group across baseline, immediate retention, and delayed retention trials. Furthermore, the robotic-trained group displayed a shorter learning curve for accuracy. The robotic-trained group also performed the more complex rope-threading and stressful multi-tasking transfer trials better. Finally, in the multi-tasking trial, the robotic-trained group made fewer tone counting errors. The results highlight the benefits of using robotic technology for the acquisition of technical surgical skills.

  6. Management of strangulated abdominal wall hernias with mesh; early results

    PubMed Central

    Ozbagriacik, Mustafa; Bas, Gurhan; Basak, Fatih; Sisik, Abdullah; Acar, Aylin; Kudas, Ilyas; Yucel, Metin; Ozpek, Adnan; Alimoglu, Orhan

    2015-01-01

    OBJECTIVE: Surgery for abdominal wall hernias is a common procedure in general surgery practice. The main causes of delay for the operation are comorbid problems and patient unwillingness, which eventually, means that some patients are admitted to emergency clinics with strangulated hernias. In this report, patients who admitted to the emergency department with strangulated adominal wall hernias are presented together with their clinical management. METHODS: Patients who admitted to our clinic between January 2009 and November 2011 and underwent emergency operation were included in the study retrospectively. Demographic characteristics, hernia type, length of hospital stay, surgical treatment and complications were assessed. RESULTS: A total 81 patients (37 female, 44 male) with a mean age of 52.1±17.64 years were included in the study. Inguinal, femoral, umbilical and incisional hernias were detected in 40, 26, 9 and 6 patients respectively. Polypropylene mesh was used in 75 patients for repair. Primary repair without mesh was used in six patients. Small bowel (n=10; 12.34%), omentum (n=19; 23.45%), appendix (n=1; 1.2%) and Meckel’s diverticulum (n=1; 1.2%) were resected. Median length of hospital stay was 2 (1–7) days. Surgical site infection was detected in five (6.2%) patients. No significant difference was detected for length of hospital stay and surgical site infection in patients who had mesh repair (p=0.232 and 0.326 respectively). CONCLUSION: The need for bowel resection is common in strangulated abdominal wall hernias which undergo emergency operation. In the present study, an increase of morbidity was seen in patients who underwent bowel resection. No morbidity was detected related to the usage of prosthetic materials in repair of hernias. Hence, we believe that prosthetic materials can be used safely in emergency cases. PMID:28058336

  7. Risk Factors for Lymph Node Metastasis in Western Early Gastric Cancer After Optimal Surgical Treatment.

    PubMed

    Pereira, Marina Alessandra; Ramos, Marcus Fernando Kodama Pertille; Dias, André Roncon; Faraj, Sheila Friedrich; Yagi, Osmar Kenji; Safatle-Ribeiro, Adriana Vaz; Maluf-Filho, Fauze; Zilberstein, Bruno; Cecconello, Ivan; de Mello, Evandro Sobroza; Ribeiro, Ulysses

    2017-07-28

    Lymph node metastasis (LNM) has a strong influence on the prognosis of patients with early gastric cancer (EGC). As minimally invasive treatments are considered appropriate for EGC, and lymphadenectomy may be restricted or even eliminated in some cases; it is imperative to identify the main risk factors for LNM to individualize the therapeutic approach. This study aims to evaluate the risk factors for LNM in EGC and to determine the adequacy of the endoscopic resection criteria in a western population. EGC patients who underwent gastrectomy with lymphadenectomy were retrospectively analyzed utilizing a prospective database. The clinicopathological variables were assessed to determine which factors were associated to LNM. Among 474 enrolled patients, 105 had EGC (22.1%). LNM occurred in 13.3% of all EGC (10% T1a; 15.4% T1b). Tumor size, venous, lymphatic, and perineural invasions were confirmed as independent predictors of LNM by multivariate analysis. Expanded criteria were safely adopted only in selected cases, and 13.6% of patients who matched expanded indication had LNM. Tumor size, venous, lymphatic, and perineural invasions were associated with LNM and should be considered as surrogate markers for surgical treatment of EGC. Expanded criteria for endoscopic resection can be safely adopted only in selected cases.

  8. Results of Surgical Management of Osteochondritis Dissecans of the Ankle in the Pediatric and Adolescent Population.

    PubMed

    Kramer, Dennis E; Glotzbecker, Michael P; Shore, Benjamin J; Zurakowski, David; Yen, Yi-Meng; Kocher, Mininder S; Micheli, Lyle J

    2015-01-01

    There is a paucity of published literature on operative management of osteochondritis dissecans (OCD) in the ankle in adolescents. This study seeks to elucidate patient and lesion characteristics associated with surgical success and failure as well as reporting functional outcomes. Retrospective chart review identified all patients aged 18 years old or younger surgically treated for OCD of the ankle at our institution from 2001 to 2010. This included 109 ankles in 100 patients (75 female, 25 male), mean age 14.3 ± 2.3 years (range, 7 to 18 y), with a median follow-up of 3.3 years (range, 1 to 10.8 y). Patient and lesion data, surgical procedure, clinical results, and complications were recorded. Postoperative radiographs were reviewed in 80 ankles. A return to sport survey and a Foot and Ankle Outcome Score (FAOS) was sent to all patients. Multivariate statistical analysis evaluated predictors of reoperation rate, Berndt and Harty clinical grade, and FAOS scores. Kaplan-Meier analysis was applied to determine freedom from reoperation. The OCD lesion was most commonly found on the medial talus (80, 73%). The most common procedures performed included transarticular drilling (59, 54%), fixation (22, 20%), and excision microfracture (27, 26%). The overall rate of reoperation was 27% (29/109). Berndt and Harty clinical grade was poor (33, 30%), fair (23, 21%), and good (53, 49%). Reoperation rates were significantly higher for OCD lesions in which postoperative radiographs had no change or looked worse (10/16, 63%) (P = 0.002). Thirty-six of 44 survey respondents (82%) were satisfied and 37 (84%) returned to sports at a median time of 6 months. Average FAOS score was 77 ± 18. Multiple linear regression confirmed that female sex and elevated body mass index were significant negative predictors for FAOS score. The reoperation rate following surgical intervention for OCD of the ankle is high. Females and those with a higher body mass index may have worse subjective

  9. Early and late surgical treatment of orbital dystopia in craniofacial malformation.

    PubMed

    De Ponte, F S; Fadda, T; Rinna, C; Brunelli, A; Iannetti, G

    1997-01-01

    Orbital dystopia is one of the most frequent clinical signs of craniofacial malformation. The term dystopia indicates the mono- and bilateral asymmetry of the orbits at least in one of the three-dimensional planes. The diagnosis is based on the clinical test of the patient with the support of diagnostic instruments such as teleradiography in both standard projections, axial computed tomographic (CT) scans at a rate of 1:1 through the neuro-orbital plan, and the three-dimensional CT. Good results of the surgical treatment depend on the patient's age and on adequate programming, which should consider the anomalies in the three spatial planes. The VTO is obtained through a protocol of analysis on cephalometric graphics of the teleradiographics on the CT at a rate of 1:1. The surgical treatment of orbital dystopia is different depending on the age of the patient and the cause of the orbital anomaly. In the case of growing patients, it is preferable to use the fronto-orbital bandeau technique so as not to damage the dental buds, whereas in grown patients Tessier's orbital quadrant technique is used. Even the fixation is quite different between patients who are growing and those who are already grown. In still-growing patients, rigid internal fixation is used only in some cases to avoid the interference with the growth mechanisms.

  10. Health Status Benefits of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Surgical Risk: Results From the PARTNER 2 Randomized Clinical Trial.

    PubMed

    Baron, Suzanne J; Arnold, Suzanne V; Wang, Kaijun; Magnuson, Elizabeth A; Chinnakondepali, Khaja; Makkar, Raj; Herrmann, Howard C; Kodali, Susheel; Thourani, Vinod H; Kapadia, Samir; Svensson, Lars; Brown, David L; Mack, Michael J; Smith, Craig R; Leon, Martin B; Cohen, David J

    2017-08-01

    In patients with severe aortic stenosis (AS) at intermediate surgical risk, treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) results in similar 2-year survival. The effect of TAVR vs SAVR on health status in patients at intermediate surgical risk is unknown. To compare health-related quality of life among intermediate-risk patients with severe AS treated with either TAVR or SAVR. Between December 2011 and November 2013, 2032 intermediate-risk patients with severe AS were randomized to TAVR with the Sapien XT valve or SAVR in the Placement of Aortic Transcatheter Valve 2 Trial and were followed up for 2 years. Data analysis was conducted between March 1, 2016, to April 30, 2017. Health status was assessed at baseline, 1 month, 1 year, and 2 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ) (23 items covering physical function, social function, symptoms, self-efficacy and knowledge, and quality of life on a 0- to 100-point scale; higher scores indicate better quality of life), Medical Outcomes Study Short Form-36 (36 items covering 8 dimensions of health status as well as physical and mental summary scores; higher scores represent better health status), and EuroQOL-5D (assesses 5 dimensions of general health on a 3-level scale, with utility scores ranging from 0 [death] to 1 [ideal health]). Analysis of covariance was used to examine changes in health status over time, adjusting for baseline status. Of the 2032 randomized patients, baseline health status was available for 1833 individuals (950 TAVR, 883 SAVR) who formed the primary analytic cohort. A total of 1006 (54.9%) of the population were men; mean (SD) age was 81.4 (6.8) years. Over 2 years, both TAVR and SAVR were associated with significant improvements in both disease specific (16-22 points on the KCCQ-OS scale) and generic health status (3.9-5.1 points on the SF-36 physical summary scale). At 1 month, TAVR was associated with better

  11. Early results of patellofemoral inlay resurfacing arthroplasty using the HemiCap Wave prosthesis.

    PubMed

    Patel, Akash; Haider, Zakir; Anand, Amarjit; Spicer, Dominic

    2017-01-01

    Common surgical treatment options for isolated patellofemoral osteoarthritis include arthroscopic procedures, total knee replacement and patellofemoral replacement. The HemiCap Wave patellofemoral resurfacing prosthesis is a novel inlay design introduced in 2009 with scarce published data on its functional outcomes. We aim to prospectively evaluate early functional outcomes and complications, for patients undergoing a novel inlay resurfacing arthroplasty for isolated patellofemoral arthrosis in an independent centre. From 2010 to 2013, 16 consecutive patients underwent patellofemoral resurfacing procedures using HemiCap Wave (Arthrosurface Inc., Franklin, Massachusetts, USA) for anterior knee pain with confirmed radiologically and/or arthroscopically isolated severe patellofemoral arthrosis. Standardized surgical technique, as recommended by the implant manufacturer, was followed. Outcome measures included range of movement, functional knee scores (Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form-36 (SF-36)), radiographic disease progression, revision rates and complications. Eight men and eight women underwent patellofemoral HemiCap Wave resurfacing, with an average age of 63 years (range: 46-83). Average follow-up was 24.1 months (6-34). Overall, post-operative scores were excellent. There was a statistically significant improvement in the post-operative OKS, KOOS and SF-36 scores ( p < 0.01). One patient had radiological disease progression. One patient underwent revision for deep infection. Two other minor complications were observed and treated conservatively. The HemiCap Wave patellofemoral resurfacing prosthesis has excellent early results in terms of functional outcomes, radiological outcomes and low complication rates. At the very least, early results show that the HemiCap Wave is comparable to more established onlay prostheses. The HemiCap Wave thus provides a safe and effective surgical option in the treatment

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

    PubMed

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

    2014-10-01

    There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  13. Laparoscopic vasectomy in African savannah elephant (Loxodonta africana); surgical technique and results.

    PubMed

    Marais, Hendrik J; Hendrickson, Dean A; Stetter, Mark; Zuba, Jeffery R; Penning, Mark; Siegal-Willott, Jess; Hardy, Christine

    2013-12-01

    Several small, enclosed reserves in southern Africa are experiencing significant elephant population growth, which has resulted in associated environmental damage and changes in biodiversity. Although several techniques exist to control elephant populations, e.g., culling, relocation, and immunocontraception, the technique of laparoscopic vasectomy of free-ranging bull elephants was investigated. Bilateral vasectomies were performed in 45 elephants. Of these elephants, one died within 24 hr of recovery and two had complications during surgery but recovered uneventfully. Histologic examination confirmed the resected tissue as ductus deferens in all the bulls. Most animals recovered uneventfully and showed no abnormal behavior after surgery. Complications recorded included incisional dehiscence, 1 full-thickness and 2 partial-thickness lacerations of the large intestine, and initial sling-associated complications, for example, deep radial nerve paresis. One bull was found dead 6 weeks after surgery without showing any prior abnormal signs. Vasectomy in free-ranging African bull elephants may be effectively performed in their normal environment. The surgical procedure can be used as a realistic population management tool in free-ranging elephants without major anesthetic, surgical, or postoperative complications.

  14. Long-term results of endosurgical and open surgical approach for Zenker diverticulum

    PubMed Central

    Bonavina, Luigi; Bona, Davide; Abraham, Medhanie; Saino, Greta; Abate, Emmanuele

    2007-01-01

    AIM: To assess the effectiveness of minimally invasive versus traditional open surgical approach in the treatment of Zenker diverticulum. METHODS: Between 1976 and 2006, 297 patients underwent transoral stapling (n = 181) or stapled diverticulectomy and cricopharyngeal myotomy (n = 116). Subjective and objective evaluations of the outcome of the two procedures were made at 1 and 6 mo after operation, and then every year. Long-term follow-up data were available for a subgroup of patients at a minimum of 5 and 10 years. RESULTS: The operative time and hospital stay were markedly reduced in patients undergoing the endosurgical approach. Overall, 92% of patients undergoing the endosurgical approach and 94% of those undergoing the open approach were symptom-free or were significantly improved after a median follow-up of 27 and 48 mo, respectively. At a minimum follow-up of 5 and 10 years, most patients were asymptomatic after both procedures, except for those individuals undergoing an endosurgical procedure for a small diverticulum (< 3 cm). CONCLUSION: Both operations relieve the outflow obstruction at the pharyngoesophageal junction, indicating that cricopharyngeal myotomy has an important therapeutic role in this disease independent of the resection of the pouch and of the surgical approach. Diverticula smaller than 3 cm represent a formal contraindication to the endosurgical approach because the common wall is too short to accommodate one cartridge of staples and to allow complete division of the sphincter. PMID:17552006

  15. The far lateral transpontomedullary sulcus approach to pontine cavernous malformations: technical report and surgical results.

    PubMed

    Abla, Adib A; Benet, Arnau; Lawton, Michael T

    2014-09-01

    Pontine cavernous malformations (CMs) located on a peripheral pontine surface or the fourth ventricular floor are resectable lesions, but those deep within the pons away from a pial surface are typically observed. However, the anterior bulge of the pons formed by the brachium pontis creates a unique entry point for access to deep pontine lesions from below, working upward through the pontomedullary sulcus. We developed a transpontomedullary sulcus (TPMS) approach to these lesions. The TPMS approach used the far lateral craniotomy and upper vagoaccessory triangle to define the surgical corridor. The entry point was above the olive, lateral to the pyramidal tracts and cranial nerve (CN) VI, above the preolivary sulcus and CN XII, and medial to CNs VII and VIII and CNs IX through XI. Four patients underwent this approach. All presented with hemorrhage and CN VI palsies. All pontine CMs were resected completely. Three patients were improved or unchanged, with good outcomes (modified Rankin Scale score ≤2) in all patients. The central pons remains difficult territory to access, and new surgical corridors are needed. The bulging underbelly of the pons allows access to pontine lesions deep to the pial surface from below. The far lateral TPMS approach is a novel and more direct alternative to the retrosigmoid transmiddle cerebellar peduncle approach. Unlike the retrosigmoid approach, the TPMS approach requires minimal parenchymal transgression and uses a brainstem entry point medial to most lower CNs. Favorable results demonstrate the feasibility of resecting pontine CMs that might have been previously deemed unresectable.

  16. Clinical Usefulness of Watch-PAT for Assessing the Surgical Results of Obstructive Sleep Apnea Syndrome

    PubMed Central

    Park, Chong Yoon; Hong, Joon Hyeong; Lee, Jae Heon; Lee, Kyu Eun; Cho, Hyun Sang; Lim, Su Jin; Kwak, Jin Wook; Kim, Kyung Soo; Kim, Hyun Jik

    2014-01-01

    Objective: This study aimed to assess the accuracy and clinical efficacy of a wrist-worn device that is based on peripheral arterial tonometry (watch-PAT) to evaluate the surgical results of obstructive sleep apnea (OSA) syndrome subjects. Study Design and Method: Thirty-five subjects who were diagnosed with OSA and underwent sleep surgeries such as septoplasty, tonsillectomy, or uvuloplasty to correct their airway collapse, participated in this study; the watch-PAT-derived respiratory disturbance index (RDI), apnea and hypopnea index (AHI), lowest oxygen saturation, and valid sleep time were measured after the sleep surgery. Results: The present study showed that RDI (32.8 ± 10.7 vs 14.8 ± 7.5), AHI (30.3 ± 8.6 vs 13.4 ± 8.2 events/h), lowest oxygen saturation (78.2% ± 8.4% vs 90.5% ± 7.1%), and valid sleep time (329.1 ± 47.2 min and a postoperative value of 389.1 ± 50.1 min) recovered to within a normal range after surgery in 28 subjects. In addition, good agreement was found between watch-PAT-derived factors and visual analogue scales for changes in subjective symptoms, such as snoring, apnea, and daytime somnolence. Seven of the 35 subjects showed no improvement for their subjective symptoms and complained of snoring and apnea after surgery. We found that the RDI and AHI of those 7 subjects were not reduced, and the changes between pre- and postoperative values which were measured with watch-PAT were minimal. Their postoperative lowest oxygen saturation and valid sleep time were not elevated per the watch-PAT. The results support a strong correlation between the findings from watch-PAT and improved symptoms after surgical correction of an airway collapse. Conclusions: Our study provides evidence that the factors measured by the watch-PAT might be reliable indicators of symptomatic changes in OSA subjects after sleep surgery and also shows that the watch-PAT is a highly sensitive portable device for estimating treatment results in OSA. Citation: Park CY

  17. A policy-based intervention for the reduction of communication breakdowns in inpatient surgical care: results from a Harvard surgical safety collaborative.

    PubMed

    Arriaga, Alexander F; Elbardissi, Andrew W; Regenbogen, Scott E; Greenberg, Caprice C; Berry, William R; Lipsitz, Stuart; Moorman, Donald; Kasser, James; Warshaw, Andrew L; Zinner, Michael J; Gawande, Atul A

    2011-05-01

    To develop and evaluate an intervention to reduce breakdowns in communication during inpatient surgical care. Communication breakdowns are the second most common cause of avoidable surgical adverse events after technical errors. In a pre- and postintervention study, a random selection of patients on the surgical services of 4 teaching hospitals were observed according to 3 measures: (1) resident-attending communication of critical patient events (eg, transfer into the intensive care unit, unplanned intubation, cardiac arrest); (2) resident-attending notification regarding routine weekend patient status; and (3) frequency of weekend patient visits by an attending. All departments then developed and adopted a set of policy and education initiatives designed to increase prompt and consistent resident-attending communication (especially in critical events) and to improve regular attending visits with surgical patients. Specific reinforcement of the policies included a pocket information card for residents, as well as periodic reminders. Repeat audits of the surgical services were then conducted. We reviewed information for 211 critical events and 1360 patients for the nature of resident and attending communication practices. After the intervention, the proportion of critical events not conveyed to an attending decreased from 33% (26/80) to 2% (1/47), and gaps in the frequency of attending notification of patient status on weekends were virtually eliminated (P < 0.0001); the proportion of weekend patients not visited by an attending for greater than 24 hours decreased by half (from 61% to 33%; P = 0.0002). Contact resulted in attending-led changes in patient management in one-third of cases. An intervention to improve surgical communication practices at 4 teaching hospitals led to significant reductions in potentially harmful communication breakdowns during inpatient care; significant alterations in patient management were noted in one-third of cases in which there was

  18. From Apprentice to Master: Social Disciplining and Surgical Education in Early Modern London, 1570-1640

    ERIC Educational Resources Information Center

    Chamberland, Celeste

    2013-01-01

    Due to its ascendancy as the administrative and commercial center of early modern England, London experienced sustained growth in the latter half of the sixteenth century, as waves of rural immigrants sought to enhance their material conditions by tapping into the city's bustling occupational and civic networks. The resultant crowded urban…

  19. From Apprentice to Master: Social Disciplining and Surgical Education in Early Modern London, 1570-1640

    ERIC Educational Resources Information Center

    Chamberland, Celeste

    2013-01-01

    Due to its ascendancy as the administrative and commercial center of early modern England, London experienced sustained growth in the latter half of the sixteenth century, as waves of rural immigrants sought to enhance their material conditions by tapping into the city's bustling occupational and civic networks. The resultant crowded urban…

  20. Prospective study comparing laparoscopic and open adenomectomy: Surgical and functional results.

    PubMed

    Garcia-Segui, A; Angulo, J C

    Open adenomectomy (OA) is the surgery of choice for large volume benign prostatic hyperplasia, and laparoscopic adenomectomy (LA) represents a minimally invasive alternative. We present a long-term, prospective study comparing both techniques. The study consecutively included 199 patients with benign prostatic hyperplasia and prostate volumes>80g who were followed for more than 12 months. The patients underwent OA (n=97) or LA (n=102). We recorded and compared demographic and perioperative data, functional results and complications using a descriptive statistical analysis. The mean age was 69.2±7.7 years (range 42-87), and the mean prostate volume (measured by TRUS) was 112.1±32.7mL (range 78-260). There were no baseline differences among the groups in terms of age, ASA scale, prostate volume, PSA levels, Qmax, IPSS, QoL or treatments prior to the surgery. The surgical time (P<.0001) and catheter time (P<.0002) were longer in the LA group. Operative bleeding (P<.0001), transfusion rate (P=.0015) and mean stay (P<.0001) were significantly lower in the LA group. The LA group had a lower rate of complications (P=.04), but there were no significant differences between the groups in terms of major complications (Clavien score≥3) (P=.13) or in the rate of late complications (at one year) (P=.66). There were also no differences between the groups in the functional postoperative results: IPSS (P=.17), QoL (P=.3) and Qmax (P=.17). LA is a reasonable, safe and effective alternative that results in less bleeding, fewer transfusions, shorter hospital stays and lower morbidity than OA. LA has similar functional results to OA, at the expense of longer surgical times and longer catheter times. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Early surgical managment of penetrating ocular injuries involving the posterior segment.

    PubMed

    Michels, R G

    1976-09-01

    Pars plana vitrectomy technic can be used in the early management of certain penetrating ocular injuries involving the posterior segment, including selected intraocular foreign bodies. This study reports the results of ten consecutive cases of intraocular foreign bodies in the posterior segment treated by a combination of vitrectomy (including lensectomy when necessary) and foreign-body extraction with forceps. The foreign body was successfully removed in nine of ten eyes, and nine of ten eyes were salvaged. This favorable experience using early vitreous surgery suggests that the vitrectomy technic can be used in other penetrating injuries involving the posterior segment that are not associated with intraocular foreign bodies. Possible indications for early vitrectomy are presented, including cases with a poor prognosis when managed by conventional methods.

  2. Early Scientific Results from the Rejuvenated Hubble Space Telescope

    NASA Technical Reports Server (NTRS)

    Niedner, Malcolm

    2010-01-01

    With the complete success of Servicing Mission 4 (SM4) to the Hubble Space Telescope in May, 2009, the Observatory's capabilities are extremely broad and beyond anything it has previously been equipped with. I will present results on the important early science corning out of the telescope and discuss prospects for the future."

  3. Early results from the ultra heavy cosmic ray experiment

    NASA Technical Reports Server (NTRS)

    Osullivan, D.; Thompson, A.; Bosch, J.; Keegan, R.; Wenzel, K.-P.; Jansen, F.; Domingo, C.

    1995-01-01

    Data extraction and analysis of the LDEF Ultra Heavy Cosmic Ray Experiment is continuing. Almost twice the pre LDEF world sample has been investigated and some details of the charge spectrum in the region from Z approximately 70 up to and including the actinides are presented. The early results indicate r process enhancement over solar system source abundances.

  4. Early Scientific Results from the Rejuvenated Hubble Space Telescope

    NASA Technical Reports Server (NTRS)

    Niedner, Malcolm

    2010-01-01

    With the complete success of Servicing Mission 4 (SM4) to the Hubble Space Telescope in May, 2009, the Observatory's capabilities are extremely broad and beyond anything it has previously been equipped with. I will present results on the important early science corning out of the telescope and discuss prospects for the future."

  5. Early results from the ultra heavy cosmic ray experiment

    SciTech Connect

    Osullivan, D.; Thompson, A.; Bosch, J.; Keegan, R.; Wenzel, K.P.; Jansen, F.; Domingo, C. |

    1995-02-01

    Data extraction and analysis of the LDEF Ultra Heavy Cosmic Ray Experiment is continuing. Almost twice the pre LDEF world sample has been investigated and some details of the charge spectrum in the region from Z approximately 70 up to and including the actinides are presented. The early results indicate r process enhancement over solar system source abundances.

  6. Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey.

    PubMed

    Butler, Elissa K; Tran, Tu M; Fuller, Anthony T; Brammell, Alexa; Vissoci, Joao Ricardo; de Andrade, Luciano; Makumbi, Fredrick; Luboga, Samuel; Muhumuza, Christine; Ssennono, Vincent F; Chipman, Jeffrey G; Galukande, Moses; Haglund, Michael M; Smith, Emily R

    2016-11-01

    Little is known about the prevalence of pediatric surgical conditions in low- and middle-income countries. Many children never seek medical care, thus the true prevalence of surgical conditions in children in Uganda is unknown. The objective of this study was to determine the prevalence of surgical conditions in children in Uganda. Using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey, we enumerated 4248 individuals in 2315 households in 105 randomly selected clusters throughout Uganda. Children aged 0-18 were included if randomly selected from the household; for those who could not answer for themselves, parents served as surrogates. Of 2176 children surveyed, 160 (7.4 %) reported a currently untreated surgical condition. Lifetime prevalence of surgical conditions was 14.0 % (305/2176). The predominant cause of surgical conditions was trauma (48.4 %), followed by wounds (19.7 %), acquired deformities (16.2 %), and burns (12.5 %). Of 90 pediatric household deaths, 31.1 % were associated with a surgically treatable proximate cause of death (28/90 deaths). Although some trauma-related surgical burden among children can be adequately addressed at district hospitals, the need for diagnostics, human resources, and curative services for more severe trauma cases, congenital deformities, and masses outweighs the current capacity of hospitals and trained pediatric surgeons in Uganda.

  7. Surgical Indications and Clinical Results of Patients with Exchanged Intraocular Lenses in a Tertiary Eye Hospital

    PubMed Central

    Kavuncu, Sevim; Omay, Aslıhan Esra; Tırhış, Mehmet Hakan; Yılmazbaş, Pelin

    2016-01-01

    Objectives: To evaluate the demographics, surgical indications and clinical results of patients with repositioned or explanted intraocular lens (IOL) in a tertiary referral eye hospital. Materials and Methods: Forty-eight eyes of 48 patients that underwent surgery to exchange or reposition the IOL at Ulucanlar Eye Training and Research Hospital between 2009 and 2013 were included in the study. Medical records of patients were evaluated for surgical indications, time elapsed since initial operation, preoperative and postoperative best corrected distance visual acuity and the presence of ocular disease. Results: The mean age of the 31 male and 17 female patients was 64.91±14.26 years. Median time between the initial and final operations was 36.0 months. Pseudoexfoliation syndrome (PEX) was present in 25% of the patients. There was history of previous vitreoretinal surgery in 18.8% of patients, ocular trauma in 6.3%, high myopia and refractive surgery in 4% of patients. In the first operation the IOL was implanted in the sulcus in 50%, in the bag in 27.1%, and in the anterior chamber in 20.8%; following the final surgery the IOL was in the sulcus in 27.1%, in the anterior chamber in 22.9%, and fixated to the sclera in 10.4% of the patients, while the remaining 29.1% remained aphakic. Indication for the secondary surgery was IOL dislocation in 58%, corneal decompensation in 20.8% and IOL degeneration in 6.3%. In the final surgery, IOL was exchanged in 54.2% of the cases, removed in 31.3% of cases, and repositioned in 14.6%. Visual acuity improved by 1-3 lines in 52.3% and remained stable in 13.6% of the patients postoperatively. Conclusion: IOL exchange may be necessary at any time following cataract surgery due to surgical complications, IOL dislocation, biometric measurement errors and corneal decompensation. Factors such as vitreoretinal surgery and the existence of PEX increase the risk of IOL exchange surgery. PMID:28058149

  8. A retrospective analysis of patients referred for implant placement to a specialty clinic: indications, surgical procedures, and early failures.

    PubMed

    Bornstein, Michael M; Halbritter, Sandro; Harnisch, Hendrik; Weber, Hans-Peter; Buser, Daniel

    2008-01-01

    This retrospective study analyzed the pool of patients referred for treatment with dental implants over a 3-year period in a referral specialty clinic. All patients receiving dental implants between 2002 and 2004 in the Department of Oral Surgery and Stomatology, University of Bern, were included in this retrospective study. Patients were analyzed according to age, gender, indications for implant therapy, location of implants, and type and length of implants placed. A cumulative logistic regression analysis was performed to identify and analyze potential risk factors for complications or failures. A total of 1,206 patients received 1,817 dental implants. The group comprised 573 men and 633 women with a mean age of 55.2 years. Almost 60% of patients were age 50 or older. The most frequent indication for implant therapy was single-tooth replacement in the maxilla (522 implants or 28.7%). A total of 726 implants (40%) were inserted in the esthetically demanding region of the anterior maxilla. For 939 implants (51.7%), additional bone-augmentation procedures were required. Of these, ridge augmentation with guided bone regeneration was performed more frequently than sinus grafting. Thirteen complications leading to early failures were recorded, resulting in an early failure rate of 0.7%. The regression analysis failed to identify statistically significant failure etiologies for the variables assessed. From this study it can be concluded that patients referred to a specialty clinic for implant placement were more likely to be partially edentulous and over 50 years old. Single-tooth replacement was the most frequent indication (> 50%). Similarly, additional bone augmentation was indicated in more than 50% of cases. Adhering to strict patient selection criteria and a standardized surgical protocol, an early failure rate of 0.7% was experienced in this study population.

  9. Misoprostol 1 to 3 h preprocedure vs. overnight osmotic dilators prior to early second-trimester surgical abortion.

    PubMed

    Ramesh, Shanthi; Roston, Alicia; Zimmerman, Lindsay; Patel, Ashlesha; Lichtenberg, E Steve; Chor, Julie

    2015-09-01

    We sought to compare the effectiveness of at least 1 h of 400 mcg of buccal misoprostol to overnight osmotic dilators for early second-trimester surgical abortion cervical preparation. We conducted a retrospective cohort study, reviewing 145 consecutive charts to compare procedure duration for women who received 400 mcg of buccal misoprostol at least 1 h preprocedure vs. overnight osmotic dilators before dilation and evacuation between 14 weeks, 0 days and 15 weeks, 6 days' gestation. Primary outcome was procedure duration and secondary outcomes included maximum mechanical dilator size, estimated blood loss and side effects. Sixty-four women (44.1%) received buccal misoprostol (mean 1.6 h), and 81 women (55.9%) received overnight osmotic dilators. Groups did not differ regarding mean gestational age or gynecologic history. All procedures in both groups were completed. Procedure duration was not significantly different between the misoprostol and osmotic dilator groups (median 11.0 min vs. 10.0 min, p=.22), even after multivariable linear regression (p=.17). The mean total cervical preparation duration was 1.6 h for women in the misoprostol group compared to 20.3 h in the osmotic dilator group (p<.001). Secondary outcomes did not differ between groups. We found that at least 1 h of preprocedure misoprostol decreased the duration of cervical preparation for early second-trimester procedures performed by an experienced surgeon. In this small, retrospective review, at least 1 h of preprocedure buccal misoprostol decreased the duration from cervical preparation initiation to procedure completion in early second-trimester procedures performed by an experienced surgeon. These results should be considered as a pilot evaluation, and further prospective study is needed to further clarify whether this short interval could be applied in general practice. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Reality of nerve sparing and surgical margins in surgeons' early experience with robot-assisted radical prostatectomy in Japan.

    PubMed

    Tatsugami, Katsunori; Yoshioka, Kunihiko; Shiroki, Ryoichi; Eto, Masatoshi; Yoshino, Yasushi; Tozawa, Keiichi; Fukasawa, Satoshi; Fujisawa, Masato; Takenaka, Atsushi; Nasu, Yasutomo; Kashiwagi, Akira; Gotoh, Momokazu; Terachi, Toshiro

    2017-03-01

    To analyze nerve sparing performance at an early stage of robot-assisted radical prostatectomy, and the correlation between the surgeons' experience and the risk of a positive surgical margin in patients treated with robot-assisted radical prostatectomy. Patients' records from January 2009 to March 2013 were retrospectively reviewed, and 3469 patients with localized prostate cancer were identified at 45 institutions. Individual surgeon's experience with nerve sparing was recorded as the number of nerve sparing cases among total robot-assisted radical prostatectomies beginning with the first case during which nerve sparing was carried out. Patients were selected by propensity score matching for nerve sparing, and predictive factors of positive surgical margins were analyzed in patients with and without positive surgical margins. A total of 152 surgeons were studied, and the median number of robot-assisted radical prostatectomy cases for all surgeons was 21 (range 1-511). In all, 54 surgeons (35.5%) undertook nerve sparing during their first robot-assisted radical prostatectomy case. For 2388 patients selected with (1194) and without (1194) nerve sparing, predictive factors for positive surgical margin were high initial prostate-specific antigen level (P < 0.0001), high biopsy Gleason score (P = 0.0379), presence of neoadjuvant hormone therapy (P = 0.0002) and surgeon's experience with >100 cases (P = 0.0058). Thus, nerve sparing was not associated with positive surgical margins. The surgeon's experience influences the occurrence of positive surgical margins, although a considerable number of surgeons carried out nerve sparing during their early robot-assisted radical prostatectomy cases. Surgeons should consider their own experience and prostate cancer characteristics before carrying out a nerve sparing robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  11. Surgical, antiseptic, and antibiotic practice in cataract surgery: Results from the European Observatory in 2013.

    PubMed

    Behndig, Anders; Cochener-Lamard, Beatrice; Güell, José; Kodjikian, Laurent; Mencucci, Rita; Nuijts, Rudy; Pleyer, Uwe; Rosen, Paul; Szaflik, Jacek; Tassignon, Marie-Jose

    2015-12-01

    To report the results from the first iteration of the European Observatory of Cataract Surgery, which was initiated to track changes in surgical, antiseptic, and antibiotic practices in cataract surgery over the coming years. Practicing European cataract surgeons (n = 479). Internet-based declarative questionnaire or telephone questionnaire. The questionnaire comprised 37 questions divided into 8 categories as follows: screening, surgeon profile, surgical procedure used, product use before arrival at the operating room, techniques for mydriasis and anesthesia, product use during the surgery, product use after the patient leaves the operating room, and surgeon's attitude to guidelines. Cataract surgeons (n = 2700) were initially contacted, of whom 479 (17.7%) were included in the survey. The current baseline survey revealed considerable variation between countries in their implementation of infectious postoperative endophthalmitis (IPOE) prophylaxis. In some countries, adoption of intracameral cefuroxime is almost universal, whereas in others, the use of such prophylaxis is below one half. When intracameral cefuroxime is used, it is generally cefuroxime powder designed for parenteral use. A preparation specifically registered for intracameral use is now available, and this formulation is more commonly used in countries in which intracameral cefuroxime was most widely adopted. The baseline results from this ongoing survey suggest a considerable level of heterogeneity between European countries in IPOE prophylaxis. Further iterations of this survey will monitor whether a consensus begins to emerge. This work was supported by Laboratoires Théa, under the supervision of the expert group. Members of the expert group were remunerated by Laboratoires Théa. J.F. Stolz, MD, PhD, provided editorial assistance in manuscript preparation, for which he was remunerated by Laboratoires Théa. Anders Behndig, Rita Mencucci, and Jacek P. Szaflik report no relevant conflicts of

  12. Correlation of clinical predictions and surgical results in maxillary superior repositioning.

    PubMed

    Tabrizi, Reza; Zamiri, Barbad; Kazemi, Hamidreza

    2014-05-01

    This is a prospective study to evaluate the accuracy of clinical predictions related to surgical results in subjects who underwent maxillary superior repositioning without anterior-posterior movement. Surgeons' predictions according to clinical (tooth show at rest and at the maximum smile) and cephalometric evaluation were documented for the amount of maxillary superior repositioning. Overcorrection or undercorrection was documented for every subject 1 year after the operations. Receiver operating characteristic curve test was used to find a cutoff point in prediction errors and to determine positive predictive value (PPV) and negative predictive value. Forty subjects (14 males and 26 females) were studied. Results showed a significant difference between changes in the tooth show at rest and at the maximum smile line before and after surgery. Analysis of the data demonstrated no correlation between the predictive data and the surgical results. The incidence of undercorrection (25%) was more common than overcorrection (7.5%). The cutoff point for errors in predictions was 5 mm for tooth show at rest and 15 mm at the maximum smile. When the amount of the presurgical tooth show at rest was more than 5 mm, 50.5% of clinical predictions did not match the clinical results (PPV), and 75% of clinical predictions showed the same results when the tooth show was less than 5 mm (negative predictive value). When the amount of presurgical tooth shown in the maximum smile line was more than 15 mm, 75% of clinical predictions did not match with clinical results (PPV), and 25% of the predictions had the same results because the tooth show at the maximum smile was lower than 15 mm. Clinical predictions according to the tooth show at rest and at the maximum smile have a poor correlation with clinical results in maxillary superior repositioning for vertical maxillary excess. The risk of errors in predictions increased when the amount of superior repositioning of the maxilla increased

  13. Provider-based research networks and diffusion of surgical technologies among patients with early-stage kidney cancer.

    PubMed

    Tan, Hung-Jui; Meyer, Anne-Marie; Kuo, Tzy-Mey; Smith, Angela B; Wheeler, Stephanie B; Carpenter, William R; Nielsen, Matthew E

    2015-03-15

    Provider-based research networks such as the National Cancer Institute's Community Clinical Oncology Program (CCOP) have been shown to facilitate the translation of evidence-based cancer care into clinical practice. This study compared the utilization of laparoscopy and partial nephrectomy among patients with early-stage kidney cancer according to their exposure to CCOP-affiliated providers. With linked Surveillance, Epidemiology, and End Results-Medicare data, patients with T1aN0M0 kidney cancer who had been treated with nephrectomy from 2000 to 2007 were identified. For each patient, the receipt of care from a CCOP physician or hospital and treatment with laparoscopy or partial nephrectomy were determined. Adjusted for patient characteristics (eg, age, sex, and marital status) and other organizational features (eg, community hospital and National Cancer Institute-designated cancer center), multivariate logistic regression was used to estimate the association between each surgical innovation and CCOP affiliation. During the study interval, 1578 patients (26.8%) were treated by a provider with a CCOP affiliation. Trends in the utilization of laparoscopy and partial nephrectomy remained similar between affiliated and nonaffiliated providers (P ≥ .05). With adjustments for patient characteristics, organizational features, and clustering, no association was noted between CCOP affiliation and the use of laparoscopy (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.81-1.53) or partial nephrectomy (OR, 1.04; 95% CI, 0.82-1.32) despite the more frequent receipt of these treatments in academic settings (P < .05). At a population level, patients treated by providers affiliated with CCOP were no more likely to receive at least 1 of 2 surgical innovations for treatment of their kidney cancer, indicating perhaps a more limited scope to provider-based research networks as they pertain to translational efforts in cancer care. © 2014 American Cancer Society.

  14. Laparoscopic Versus Laparotomic Surgical Staging for Early-Stage Ovarian Cancer: A Case-Control Study.

    PubMed

    Gallotta, Valerio; Petrillo, Marco; Conte, Carmine; Vizzielli, Giuseppe; Fagotti, Anna; Ferrandina, Gabriella; Fanfani, Francesco; Costantini, Barbara; Carbone, Vittoria; Scambia, Giovanni

    2016-01-01

    To evaluate the oncologic outcomes of patients with early-stage ovarian cancer (eOC) managed by laparoscopy or laparotomy in a single high-volume gynecologic cancer center. Retrospective case-control study (Canadian Task Force classification II-2). Catholic University of the Sacred Hearth, Rome, Italy. Data of consecutive women with eOC undergoing comprehensive laparoscopic staging between 2007 and 2013 were matched with a cohort of patients undergoing open surgery between 2000 and 2011. Four-year survival outcomes were analyzed using the Kaplan-Meier method. Sixty women undergoing staging via laparoscopy were compared with a cohort of 120 patients undergoing open surgery. Baseline characteristics were similar between groups. Seventy percent of patients underwent adjuvant platinum based chemotherapy without differences between the 2 groups. Operative time (p = .01), estimated blood loss (p = .032), and median hospital stay (p = .001) were higher in patients submitted to laparotomic versus laparoscopic staging. As of October 2015, median duration of follow-up was 38 months (range, 24 -48), recurrent disease was documented in 16 patients (13.3%) in the laparotomic group and in 5 patients (8.3%) in the laparoscopic group (p = .651), without differences in the pattern of recurrence presentation. Four-year progression-free survival (PFS) and overall survival (OS) rates were 89% and 92% in the laparoscopic group, respectively, and 81% and 91% in the laparotomic group, without any statistical significant difference between the groups (4-year PFS p = .651; 4-year OS p = .719). The findings of the present study suggests that in the surgical treatment of FIGO stage I ovarian cancer, laparoscopy is associated with equivalent oncologic outcome compared with a conventional abdominal approach. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  15. Preliminary results from digestive adaptation: a new surgical proposal for treating obesity, based on physiology and evolution.

    PubMed

    Santoro, Sérgio; Velhote, Manoel Carlos Prieto; Malzoni, Carlos Eduardo; Milleo, Fábio Quirino; Klajner, Sidney; Campos, Fábio Guilherme

    2006-07-06

    Most bariatric surgical techniques include essentially non-physiological features like narrowing anastomoses or bands, or digestive segment exclusion, especially the duodenum. This potentially causes symptoms or complications. The aim here was to report on the preliminary results from a new surgical technique for treating morbid obesity that takes a physiological and evolutionary approach. Case series description, in Hospital Israelita Albert Einstein and Hospital da Polícia Militar, São Paulo, and Hospital Vicentino, Ponta Grossa, Paraná. The technique included vertical (sleeve) gastrectomy, omentectomy and enterectomy that retained three meters of small bowel (initial jejunum and most of the ileum), i.e. the lower limit for normal adults. The operations on 100 patients are described. The mean follow-up was nine months (range: one to 29 months). The mean reductions in body mass index were 4.3, 6.1, 8.1, 10.1 and 10.7 kg/m2, respectively at 1, 2, 4, 6 and 12 months. All patients reported early satiety. There was major improvement in comorbidities, especially diabetes. Operative complications occurred in 7% of patients, all of them resolved without sequelae. There was no mortality. This procedure creates a proportionally reduced gastrointestinal tract, leaving its basic functions unharmed and producing adaptation of the gastric chamber size to hypercaloric diet. It removes the sources of ghrelin, plasminogen activator inhibitor-1 (PAI-1) and resistin production and leads more nutrients to the distal bowel, with desirable metabolic consequences. Patients do not need nutritional support or drug medication. The procedure is straightforward and safe.

  16. Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics.

    PubMed

    Losa, Marco; Donofrio, Carmine A; Barzaghi, Raffaella; Mortini, Pietro

    2013-12-01

    Few data are available on the surgical results in patients with incidentally discovered nonfunctioning pituitary adenoma (NFPA). We investigated the efficacy and safety of surgery in patients with incidentally discovered NFPA. Retrospective analysis of prospectively recorded outcomes. From 1990 to 2011, of 804 consecutive patients undergoing surgery for NFPA, 212 cases had an incidentally discovered tumor (26.4%). Among them, 117 patients were asymptomatic, while 95 had some visual and/or hormonal deficit. The main outcome of the study was to evaluate the frequency of radical resection as judged on the first postoperative neuroimaging study and detection of recurring disease during long-term follow-up. Postoperative residual tumor was detected in 8.9% of patients with asymptomatic incidentalomas as compared with 31.2% of patients with symptomatic incidentalomas (P<0.001) and 41.2% of patients in the control group (P<0.001). Multivariate analysis confirmed that having an asymptomatic incidentaloma was independently associated with a better outcome. The 5-year recurrence-free survival in patients with incidentaloma was 86.8% (95% CI 80.2-92.4%) as compared with 77.9% (95% CI 73.6-82.2%; P<0.01) in the control group. This difference was almost completely due to a lower frequency of relapse in asymptomatic patients. Multivariate analysis confirmed the independent lower risk of tumor recurrence in asymptomatic NFPA. Our study shows for the first time that surgically treated patients with asymptomatic NFPA have a better early and long-term outcome that is independent from all the other demographic, clinical, and morphologic characteristics of the patients.

  17. [Health-related quality of life after surgical haemorrhoid treatment - results, methods and problems].

    PubMed

    Bussen, D; Herold, A; Bussen, S

    2012-08-01

    In patients suffering from haemorrhoidal disease a hyperplasia of the corpus cavernosum recti is accompanied by various symptoms such as anal bleeding and minor continence disorders as well as itching, soiling and burning. According to the morphological findings, haemorrhoids are staged from grade I up to IV. Therapy strategies are adjusted to this staging. Early stages are treated by conservative measures, such as regulation of defaecation, sclerosis and rubber band ligations. Advanced stages require operative methods, such as segmental excision and stapled haemorrhoidopexy. Since patients demand a greater regard to the subjective experience of their disease and its treatment, quality of life evaluation has become an important issue in medical care. Therefore health-related quality of life is increasingly becoming a relevant primary or secondary end point of clinical studies. Since up to 4 % of the general adult population in industrial nations is annually diagnosed to suffer from haemorrhoidal disease, in Germany per annum 3.5 Mio patients seek medical advice due to this condition and 40 000-50 000 surgical procedures are performed. Nevertheless only very few studies have been carried out to investigate the influence of this widespread disease on the quality of life of those patients. Additionally cost-effectiveness analyses measuring quality-adjusted life years are becoming more and more decisive in health politics. The present article discusses the definitions of health-related as well as disease-related quality of life. Different psychometric tests applied to evaluate the quality of life are summarised, quality criteria are outlined and limitations discussed. Several studies were analysed in regard to the quality of life in patients with haemorrhoidal disease and the specific influence of different operative techniques was reviewed.

  18. Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry

    PubMed Central

    da Silva, Katia Regina; Albertini, Caio Marcos de Moraes; Crevelari, Elizabeth Sartori; de Carvalho, Eduardo Infante Januzzi; Fiorelli, Alfredo Inácio; Martinelli Filho, Martino; Costa, Roberto

    2016-01-01

    Background: Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. Objective: To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Methods: Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. Results: A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III­-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Conclusions: Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease. PMID:27579544

  19. Long Term Results of Innovative Procedure in Surgical Management of Chronic Lymphedema

    PubMed Central

    Mousavi, Seyed R.

    2016-01-01

    Background: Lymphedema is the result of impaired lymphatic drainage by the affected organ. This abnormality can be primary or secondary. Different operative approaches have been introduced to treat chronic lymphedema. Materials and Methods: This retrospective study included 816 patients who were diagnosed with chronic lower extremity lymphedema and did not respond to non-operative management for at least six months. Data was collected over 25 years, between March 1987 and March 2013. Doppler ultrasonography of the deep venous system was routinely undertaken in all patients to confirm patency. The patients underwent surgery and their progress was followed for at least one year postoperatively. Results: All patients were operated by the suggested technique and long term fallow-up which is a modified form of the Homan’s technique. The outcome was excellent, and 89.2% of patients were free of complication and 2% had poor results. The most common complication was wound seroma and wound infection. Conclusion: The long term results and considering the difficulties associated with the treatment of chronic lymphedema and the variety of surgical options, our method achieved excellent results, and may be proposed for the standard operative procedure for treating intractable forms of this disease. PMID:27990192

  20. [Midterm Results for Quality of Life After Surgical Treatment of Moore Type V Fractures of the Tibial Plateau].

    PubMed

    Wirbel, R; Weber, A; Heinzmann, J; Meyer, C; Pohlemann, T

    2016-10-01

    Background: Dislocation fractures of the tibial plateau often lead to functional restrictions and subjective complaints from the patients. Besides functional and radiological results, criteria to determine the quality of life are of increasing importance. Intermediate term restriction in quality of life was evaluated and correlated with objective radiological results in patients with Moore type V dislocation fracture of the tibial plateau. Patients and Methods: From 2003 to 2012, a multicentre retrospective cohort study in three hospitals was used to register 36 patients with 38 Moore type V dislocation fractures of the tibial plateau. The injury mechanism, the surgical treatment (one step or two step surgery, single or double plate fixation) the complication rate, the radiological result (Kellgren/Lawrence osteoarthritis score, loss of reduction, secondary deviation of the axis) after a mean follow-up of 37 months, and the quality of life (pain and function by NRS, IKDC form, EQ 5D score) after a mean follow-up of 68 months (range, 15-128 months), were analysed. Results: The mean age of the 27 men and the 9 women was 50.8 years. There were 30 cases of high impact injury. An external fixator was used for primary fracture stabilisation in 24 knees; definitive internal fixation was performed in a second step. Internal fixation using a single plate was used in 12 knees, and double plate fixation in 25 knees; one patient was treated definitively with an external fixator. Early complications (3 × infection, 2 × compartment syndrome, 4 × implant failure) were seen in 21.1 % of patients; all could be cured surgically. The function of the affected knee joint gave a mean NRS of 4.53; the IKDC score was 50.46, and the EQ 5D 7.47. Only two patients (5 %) were free of pain, 27 (75 %) reported mild to moderate pain, and 7 patients (20 %) reported severe pain. Four patients are retired or have applied for a pension. Altogether, the quality of life was calculated

  1. [C-reactive protein and blood picture parameters in the early diagnosis of infection in children with surgical diseases].

    PubMed

    Steinbrugger, B; Kurz, R

    1986-01-01

    Since its detection fifty years ago, CRP is known as prototype of the acute-phase-proteines. It is a more sensitive, then specific indicator for bacterial infections. We found that CRP in accordance with clinical symptoms and the neutrophil-cell-index (I. S-ratio) makes a good prediction for early diagnosis of infections. Caution has to be payed in immediate post-operative phase, because the surgical trauma by itself can increase CRP-values.

  2. Augmentation mastopexy after bariatric surgery: evaluation of patient satisfaction and surgical results.

    PubMed

    Junior, Wilson Cintra; Modolin, Miguel Luiz Antonio; Rocha, Rodrigo Itocazo; Gemperli, Rolf

    2016-01-01

    to evaluate patient satisfaction and surgical results obtained after mastopexy with breast implant inclusion. we conducted a prospective study of 20 consecutive female patients with a mean age of 39.9 years, submitted to augmentation mastopexy. We applied semi-directed psychological interviews pre and postoperatively. The answers to the evaluations were tabulated, categorized, and allowed patient satisfaction analysis. We evaluated surgical results through photographic analysis of three independent plastic surgeons, in the pre and postoperative periods, when scores were attributed to the following items: breasts shape, breasts volume, breasts symmetry, nipple-areolar complex position, and scar quality and extent. nineteen patients (95%) referred satisfaction with the surgical results attained (p<0,001). The mean sum of the scores attributed by the three surgeons to each patient varied between 4.7 and 10, with an overall mean of 7.28. The results were considered good or great for 65% of the sample and poor for 8.4%. there was a 95% satisfaction rate among patients with the results obtained through augmentation mastopexy. The photographic analysis of the results obtained a mean score of 7.28, considered as a good result, albeit the weak correlation among evaluators. avaliar a satisfação das pacientes e os resultados cirúrgicos obtidos após a mastopexia com inclusão de implantes mamários. estudo prospectivo com 20 pacientes consecutivas do sexo feminino, com média etária de 39,9 anos, que foram submetidas à mastopexia de aumento. Foram aplicadas entrevistas psicológicas semidirigidas nos períodos pré e pós-operatórios e cujas respostas foram tabuladas, divididas em categorias, e possibilitaram a avaliação da satisfação das pacientes. Foi realizada avaliação dos resultados cirúrgicos através da análise fotográfica por três cirurgiões plásticos independentes, nos períodos pré e pós-operatórios, que atribuíram notas aos seguintes itens

  3. Early Retinoic acid deprivation in developing zebrafish results in microphthalmia

    PubMed Central

    Le, Hong-Gam T.; Dowling, John E.; Cameron, D. Joshua

    2013-01-01

    Vitamin A deficiency causes impaired vision and blindness in millions of children around the world. Previous studies in zebrafish have demonstrated that retinoic acid (RA), the acid form of vitamin A, plays a vital role in early eye development. The objective of this study was to describe the effects of early RA deficiency by treating zebrafish with diethylaminobenzaldehyde (DEAB), a potent inhibitor of the enzyme retinaldehyde dehydrogenase (Raldh) that converts retinal to RA. Zebrafish embryos were treated for 2 hours beginning at 9 hours post-fertilization (hpf). Gross morphology and retinal development were examined at regular intervals for 5 days after treatment. The optokinetic reflex (OKR) test, visual background adaptation (VBA) test, and the electroretinogram (ERG) were performed to assess visual function and behavior. Early treatment of zebrafish embryos with 100 μM DEAB (9hr) resulted in reduced eye size and this microphthalmia persisted through larval development. Retinal histology revealed that DEAB eyes, had significant developmental abnormalities but had relatively normal retinal lamination by 5.5 days post-fertilization (dpf). However, the fish showed neither, an OKR or VBA response. Further, the retina did not respond to light as measured by the ERG. We conclude that early deficiency of RA during eye development causes microphthalmia as well as other visual defects, and that timing of the RA deficiency is critical to the developmental outcome. PMID:23013828

  4. Subjective results after surgical treatment for displaced intra-articular calcaneal fractures.

    PubMed

    Basile, Attilio

    2012-01-01

    We present a retrospective study investigating the results of the subjective assessment of displaced intra-articular calcaneal fractures in a selected cohort of 42 patients treated operatively, with a follow-up duration of at least 3 years. The adjusted American Orthopaedic Foot and Ankle Society questionnaire, Foot Function Index, and visual analog scale were used to quantify the subjective evaluations. Our hypothesis was that good subjective results could be predicted and obtained in patients with specific characteristics if anatomic reduction of the fracture was achieved. The results of the study confirmed our hypothesis. A number of specific subgroup analyses were undertaken. The study confirmed that Böhler angle restoration and the quality of reduction of the subtalar joint facet are important prognostic factors related to the outcome. In contrast, gender and Sanders type had less influence at the intermediate-term follow-up results. The main weaknesses of the present study included its retrospective nature, the lack of a control group managed nonoperatively for comparison, and the small sample size. Moreover, the operating surgeon performed the radiographic measurement and categorized the quality of the surgical reconstruction. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Early Results of ICRH Experiments in VX-10

    NASA Astrophysics Data System (ADS)

    Chang-Diaz, F. R.; Squire, J. P.; Ilin, A. V.; Petro, A. J.; Jacobson, V.; McCaskill, G.; Tarditi, A. G.; Winter, D. S.; Bengtson, R. D.; Breizman, B. N.; Baity, F. W.; Carter, M. D.; Colestock, P.; Light, M.; Bering, E. A.; Glover, T. W.; Davis, C.; Chavers, D. G.

    2003-10-01

    The Variable Specific Impulse Magnetoplasma Rocket (VASIMR) is an open-ended RF-heated propulsion concept currently under development by NASA. Current experiments (VX-10) focus on the demonstration of significant ion acceleration by ion cyclotron resonance. Theoretical and plasma simulation predictions are used to define the parameter space of interest in these experiments. Early results show significant ion energy absorption with concomitant plasma acceleration and agree well with predicted values. Plasma diagnostics include Mach, triple, RF and emissive probes, a momentum sensor, retarding potential analyzers, a spectrometer and a 70GHz microwave interferometer. An array of thermocouples monitor heat deposition to the walls of the discharge tube. A baratron sensor and a fast ion gauge provide time-tagged background pressure. Early results from these diagnostics will be presented and discussed.

  6. Impact cratering calculations. Part 1: Early time results

    NASA Technical Reports Server (NTRS)

    Thomsen, J. M.; Sauer, F. N.; Austin, M. G.; Ruhl, S. F.; Shultz, P. H.; Orphal, D. L.

    1979-01-01

    Early time two dimensional finite difference calculations of laboratory scale hypervelocity impact of 0.3 g spherical 2024 aluminum projectiles into homogeneous plasticene clay targets were performed. Analysis of resulting material motions showed that energy and momentum were coupled quickly from the aluminum projectile to the target material. In the process of coupling, some of the plasticene clay target was vaporized while the projectile become severely deformed. The velocity flow field developed within the target was shown to have features similar to those found in calculations of near surface explosion cratering. Specific application of Maxwell's analytic Z-Model showed that this model can be used to describe the early time flow fields resulting from the impact cratering calculations as well, provided the flow field centers are located beneath the target surface and most of the projectile momentum is dissipated before the model is applied.

  7. The role of attitudes, beliefs, and personal characteristics of Italian physicians in the surgical treatment of early breast cancer.

    PubMed Central

    Liberati, A; Apolone, G; Nicolucci, A; Confalonieri, C; Fossati, R; Grilli, R; Torri, V; Mosconi, P; Alexanian, A

    1991-01-01

    The influence of Italian physicians' attitudes, beliefs, and personal characteristics on medical decision making is examined in the case of surgical treatment of early breast cancer. Responses to a mail survey of 657 physicians from different specialties were analyzed comparing doctors recommending a radical procedure (9%) to those preferring a conservative procedure for younger patients only (25%), and those considering conservative surgery the treatment of choice regardless of patients' age (66%). The findings suggest that the likelihood of physicians' preferring a conservative procedure is influenced by their specialty and the extent to which they feel that a patient should have a role in the treatment decision more than by differences in the beliefs of treatment outcomes. Only preferences of the small group indicating radical surgery as the sole admissible treatment can be accounted for by ignorance or distrust of results of recent trials. These findings suggest that other than scientific factors guide many doctors in their decision making; they may help to explain why the diffusion of research results into clinical practice is often disappointingly slow. PMID:1983914

  8. Smart CO2 laser surgical system based on autodyne monitoring of laser-evaporated biotissues: first results in oncology

    NASA Astrophysics Data System (ADS)

    Dmitriev, A. K.; Varev, G. A.; Konovalov, A. N.; Kortunov, V. N.; Panchenko, V. Y.; Reshetov, I. V.; Matorin, O. V.; Maiboroda, V. F.; Ul'yanov, V. A.

    2005-08-01

    New method based on techniques of self-induced autodyne effect for diagnostics and control of laser-tissue evaporation by radiation of high-frequency pumped waveguide CO2 laser is developed. This method is used for creation of feed-back for smart CO2 laser surgical system of "Lancet" series. The results of medical testing of the smart laser surgical system are presented.

  9. Aortic Annulus Enlargement: Early and Long-Terms Results

    PubMed Central

    Dumani, Selman; Likaj, Ermal; Dibra, Laureta; Beca, Vera; Kuci, Saimir; Refatllari, Ali

    2017-01-01

    AIM: Patient-prosthesis mismatch (PPM) is a common occurrence in aortic valve surgery. Even the discussions about the impact of this phenomenon on the results of aortic valve surgery, the management of this problem remain one of the main topics in this kind of surgery. One of the ways of a solution is aortic annulus enlargement. The main topic of this study is to evaluate the early and longterm results of this technique in our country. METHODS: During the period January 2010 –January 2015, 641 patients performed aortic valve surgery. In ten patients we performed aortic annulus enlargement according to Manouguian technique to avoid severe patient-prothesis mismatch. Operative mortality and perioperative complications (low cardiac output, pulmonary complications, etc..) were considered the indicators of the early results. Survival, clinical presentation according to NYHA, quality of life were the indicators to evaluate long-term results. Preoperative and postoperative echocardiographic data were also used to evaluate our results. We collected the data from hospital registrations and periodical clinical visit and echographic examination after hospital discharge. RESULTS: In our group, 6 of 10 patients were diagnosed with stenotic aortic valve, two patients had aortic valve regurgitation and two mixed valve pathology. Four patients had concomitant cardiac surgery procedure, mitral or CABG. In all cases, aortic valve pathology was the primary diagnose. In the preoperative echocardiographic examination mean transvalvular gradient was 54.3 ± 6.42. We had no death during early or late postoperative period. Only one patient had pulmonary complications and long time of respiratory assistance because of his pulmonary pathology. The same patient had low cardiac output and wound infection. Early after surgery mean transprostethic gradient was 16.2 ± 3.44 and late postoperative was 15.9 ± 4.3. No patient had the severe patient-prothesis mismatch. Mean follow-up was 49 ± 20

  10. Natural history of retained surgical items supports the need for team training, early recognition, and prompt retrieval.

    PubMed

    Stawicki, S Peter; Cook, Charles H; Anderson, Harry L; Chowayou, Laurie; Cipolla, James; Ahmed, Hesham M; Coyle, Susette M; Gracias, Vicente H; Evans, David C; Marchigiani, Raffaele; Adams, Raeanna C; Seamon, Mark J; Martin, Niels D; Steinberg, Steven M; Moffatt-Bruce, Susan D

    2014-07-01

    Unintentionally retained items feature prominently among surgical "never events." Our knowledge of these rare occurrences, including natural history and intraoperative safety omission or variance (SOV) profile, is limited. We sought to bridge existing knowledge gaps by presenting a secondary analysis of a multicenter study focused on these important aspects of retained surgical items (RSIs). This is a post hoc analysis of results from a multicenter retrospective study of RSIs between January 2003 and December 2009. After excluding previously reported intravascular RSIs (n = 13), a total of 71 occurrences were analyzed for (1) item location and type; (2) time to presentation and/or discovery; (3) presenting signs and symptoms; (4) procedure and incision characteristics; (5) pathology reports; and (6) patterns of SOVs abstracted from medical and operative records. These SOV were then grouped into individual vs team errors and single- vs multifactorial occurrences. Among 71 cases, there were 48 women and 23 men. Mean patient age was 49.7 ± 17.5 years (range 19 to 83 years). Mortality was 4 of 71 (5.63%, only 1 attributable to RSI). Twelve cases (16.9%) occurred at nonparticipating referring hospitals. Most RSI procedures (62%) occurred on the day of hospital admission. The median time from index RSI case to retained item removal was 2 days (range <1 to >3,600 days, n = 63). Abdominal RSIs predominated, and plain radiography was the most common identification method. Most RSIs removed early (<24 hours, n = 23) were asymptomatic. The most common clinical/diagnostic findings in the remaining group were focal pain (n = 22), abscess/fluid collection (n = 18), and mass (n = 8). Most common pathology findings included exudative reaction (n = 22), fibrosis (n = 17), and purulence/abscess (n = 15). On detailed review of intraprocedural events, most RSI cases were found to involve team/system errors (50 of 71) and 2 or more SOVs (37 of 71). Isolated human error was seen in

  11. RESULTS OF SURGICAL TREATMENT OF DENERATIVE ARTHROPATHY OF THE ROTATOR CUFF USING HEMIARTHROPLASTY- CTA®

    PubMed Central

    Filho, Rômulo Brasil; Ribeiro, Fabiano Rebouças; Tenor, Antonio Carlos; Filho, Cantidio Salvador Filardi; da Costa, Guilherme Barbieri Leme; Storti, Thiago Medeiros; da Costa Garcia, André; Lutfi, Hilton Vargas

    2015-01-01

    Objective: To assess results of CTA® partial shoulder arthroplasty for treatment of degenerative arthropathy of the rotator cuff. Methods: Between December 2006 and June 2009, 23 shoulders of 23 patients were submitted to CTA® type partial shoulder arthroplasty for treatment of arthropathy secondary to rotator cuff injury. Post-operative follow up time ranged from 6 to 35 months. Mean age was 74.1 years. Patients were predominantly female, representing 78.3% of cases. The right limb was affected in 18 patients. All patients had undergone at least 6 months of physiotherapy without improvement of the algetic picture, and being submitted to surgery by the same surgical team. None of the patients had history of surgery on the affected shoulder. The method elected for assessing patients during post-operative follow up was based on UCLA scoring criteria. Results: Improvement in pain was observed in all patients after arthroplasty. Mean UCLA pain score was 9.22 (ranging from 10 to 8). Mean function was 6 (10 to 2). Active frontal flexion was 2.39 (highest score 4 and lowest 0). Mean frontal flexion force was 4.09, maximum was 5 and minimum 3. Mean score on the UCLA was 26.52. 95% were satisfied with the surgery. Conclusion: CTA® type partial shoulder arthroplasty produced satisfactory results in the treatment of degenerative arthropathy of the rotator cuff and had a low rate of complications. PMID:27028431

  12. Results of surgical management of symptomatic shoulders with partial thickness tears of the rotator cuff.

    PubMed

    Papalia, Rocco; Franceschi, Francesco; Del Buono, Angelo; Maffulli, Nicola; Denaro, Vincenzo

    2011-01-01

    The optimal management of partial thickness tears of the rotator cuff (PTRCT) is still controversial. A literature search, on PubMed, Cochrane and Google Scholar databases, identified 273 relevant abstracts of articles published in peer-reviewed journals. Twenty-three clinical studies reporting the outcomes of surgically treated patients affected by PTRCTs were selected. The different repair approaches results in variable functional outcomes. The Coleman Methodology Score (CMS) used to asses the quality of the studies showed great heterogeneity in study design, the sample, pre- and post-operative diagnostic assessments and the score used to evaluate outcomes. The mean CMS value was 67.95 (ranging from 30 to 82). The heterogeneity of the treatment options and of the outcome assessment methods makes it difficult to compare the results of the different studies. There is a need to use standardized pre- and post-operative assessment methods and functional outcome scores. To improve the diagnosis and to choose the best treatment, it may be useful to measure the thickness of the rotator cuff to ascertain whether the size correlates with outcome. There is a lack of scientifically based guidelines, probably a result of the relatively low levels of evidence of the studies. There is a need for adequately powered randomized clinical trials, using standard diagnostic assessment, common and validated scoring system comparing reported outcomes and duration of follow-up greater than 2 years.

  13. INPRES (intraoperative presentation of surgical planning and simulation results): augmented reality for craniofacial surgery

    NASA Astrophysics Data System (ADS)

    Salb, Tobias; Brief, Jakob; Welzel, Thomas; Giesler, Bjoern; Hassfeld, Steffan; Muehling, Joachim; Dillmann, Ruediger

    2003-05-01

    In this paper we present recent developments and pre-clinical validation results of our approach for augmented reality (AR, for short) in craniofacial surgery. A commercial Sony Glasstron display is used for optical see-through overlay of surgical planning and simulation results with a patient inside the operation room (OR). For the tracking of the glasses, of the patient and of various medical instruments an NDI Polaris system is used as standard solution. A complementary inside-out navigation approach has been realized with a panoramic camera. This device is mounted on the head of the surgeon for tracking of fiducials placed on the walls of the OR. Further tasks described include the calibration of the head-mounted display (HMD), the registration of virtual objects with the real world and the detection of occlusions in the object overlay with help of two miniature CCD cameras. The evaluation of our work took place in the laboratory environment and showed promising results. Future work will concentrate on the optimization of the technical features of the prototype and on the development of a system for everyday clinical use.

  14. Surgery and Surgical Consult Rates for Early Stage Lung Cancer in Ontario: A Population-Based Study.

    PubMed

    Bendzsak, Anna M; Waddell, Thomas K; Urbach, David R; Darling, Gail E

    2017-03-01

    Surgery offers the best chance for survival for early (stage I and II) non-small cell lung cancer (NSCLC), but worldwide resection rates range from 49% to 77%. We investigated factors that may play a role in resection rates. Using administrative data, new diagnoses of NSCLC from 2010 through 2012 were captured. The rate of surgical consultation and resection overall and by age group were determined, as well as rates of pulmonary function testing and radiation therapy. Of 4,309 persons diagnosed with stage I or II NSCLC between 2010 and 2012, 3,487 (80.9%) received surgical consultations, but only 58.9% (2,539) received surgery. Rates of consultation and surgery decreased with increasing patient age: only 60.3% of patients older than 80 received consultations and 29.9% had resections. Of the 1,770 patients who did not receive surgery, 948 (53.6%) received a surgical consultation, and in this group, 688 (72.5%) were treated with radiation. Of the 822 patients who did not see a surgeon, only 476 (57.9%) were treated with radiation. Pulmonary function testing was performed in 799 (84.3%) of patients who had surgical consults but in only 569 (69.2%) of those who did not see a surgeon. Resection rates for early lung cancer appear low, which may be partly due to low rates of surgical consultation. Interestingly, patients who are seen by surgeons but who do not receive surgery are more likely to receive radiation than patients who are not referred for surgery. Further research is required to identify factors influencing resection rates. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. The Effect of Adjuvant Intracameral Triamcinolone Acetonide on the Surgical Results of Trabeculectomy with Mitomycin C

    PubMed Central

    Alagöz, Neşe; Alagöz, Cengiz; Yıldırım, Yusuf; Yeşilkaya, Ceren; Altan, Çiğdem; Bozkurt, Ercüment; Şatana, Banu; Başarır, Berna; Taşkapılı, Muhittin

    2016-01-01

    Objectives: To evaluate the effect of adjuvant intracameral triamcinolone acetonide (TA) on the surgical results of trabeculectomy with mitomycin C. Materials and Methods: All consecutive trabeculectomy cases performed in the glaucoma clinic between July 2012 and December 2013 were retrospectively reviewed from the patient charts. Only those with follow-up of 12 months or longer were included. Patients with intraoperative intracameral TA (study group, n=19) were compared to those without TA (control group, n=21) in terms of surgical success, intraocular pressure (IOP) change, medication use and complications. Results: Forty eyes of 31 patients (21 male/10 female, mean age 64.2±13.8 years) were included in the study. The mean follow-up period was 20.9±5.1 months and 20.7±6.7 months in the study and control groups, respectively (p=0.830). Baseline IOP was 26.4±9.9 and 25.2±7.6 mmHg (p=0.979), and final IOP was 12.7±2.6 and 13.6±3 mmHg in both groups respectively (p=0.226). At the final follow-up, complete success was observed in 68.4% and 52.4% of the study and control groups (p=0.349) and anti-glaucoma medication was used by 31.6% (mean number of medications: 0.79±1.2) and 47.6% (mean number of medications: 1.33±1.7), respectively (p>0.05). Bleb encapsulation, leakage, suture-lysis and hypotony rates were similar in both groups (for all, p>0.05). Cataract progression was noted in six (35.3%) and in five (26.3%) of the phakic eyes in the study and control groups, respectively (p=0.720). Conclusion: When used intracamerally, TA did not increase the complication rate in trabeculectomy surgery. Although the group that received TA showed lower IOP levels, use of fewer medications and fewer eyes requiring medication, the differences did not reach significance. PMID:28058152

  16. Results of surgical correction of anorectal malformations. A 10-30 year follow-up.

    PubMed Central

    Iwai, N; Yanagihara, J; Tokiwa, K; Deguchi, E; Takahashi, T

    1988-01-01

    Of 119 patients with surgical correction of anorectal malformations, 47 who were 10-30 years of age were interviewed personally and had manometric studies to evaluate postoperative continence. This clinical study included not only long-term anorectal function but also sexual function. Patients with low type anomalies or with intermediate type anomalies were more likely to be continent, whereas patients with high type lesions had some problems with continence. However, only two of the 16 patients (12%) with high type anomalies were classified as having poor results. This rate is perhaps lower than might be expected. Thus, incontinent patients may become continent even if they were classified as having fecal incontinence before 6 years of age. Most patients who were 15-30 years of age had normal sexual function except for two females with irregular menstruation. These results indicate that achievement of fecal continence and sexual function in patients with high type anomalies treated by abdominoperineal rectoplasty depends on careful dissection as close as possible to the rectal wall and bringing the terminal bowel down exactly within the sling of the puborectal muscle. PMID:3341818

  17. Laparoscopic surgical treatment of ileocecal Crohn's disease: Impact of obesity on short term results.

    PubMed

    Parés, David; Shamali, Awad; Flashman, Karen; O'Leary, Daniel; Senapati, Asha; Conti, John; Parvaiz, Amjad; Khan, Jim

    2017-01-01

    The aim of our study was to analyse the short-term outcomes of laparoscopic surgery for a no medical responding ileocolic Cohn's disease in a single centre according to the presence of obesity. A cross-sectional study was performed including all consecutive patients who underwent laparoscopic resection for ileocecal Crohn's disease from November 2006 to November 2015. Patients were divided according to body mass index ≥ 30 kg/m(2) in order to study influence of obesity in the short-term outcomes. The following variables were studied: characteristics of patients, surgical technique and postoperative results (complications, reintervention, readmission and mortality) during first 30 postoperative days. A total of 100 patients were included (42 males) with a mean age of 39.7±15.2 years (range 18-83). The overall complication rate was 20% and only 3 patients had an anastomotic leak. Seven patients needed reoperation in the first 30 days postop (7%). The median postoperative length of hospitalization was 5.0 days. Operative time was significantly longer in patients with obesity (130 vs. 165minutes, P=.007) but there were no significant differences among the postoperative results in patients with and without obesity. This study confirmed that laparoscopic approach for ileocecal Cohn's disease is a safety and feasible technique in patients with obesity. In this last group of patients we only have to expect a longer operative time. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. [Surgical treatment of secondary hyperparathyroidism in chronic kidney failure. Results of total parathyroidectomy with parathyroid autotransplantation].

    PubMed

    Courant, O; Letessier, E; Moutel, M G; Hamy, A; Paineau, J; Visset, J

    1993-01-01

    Between 1978 and 1990, 68 patients, operated on for secondary hyperparathyroidism (HPT), received a forearm intramuscular free autologous parathyroid graft (37 women and 31 men--mean age: 43 +/- 16 years). The transplantation (Wells technique) was performed in the same time as the total parathyroidectomy and the remaining parathyroid material after surgical resection was cryopreserved. The results were evaluated in term of clinical and/or radiological and/or biological response respectively 3 or 5.5 years later, depending of the realisation of a renal transplantation (n = 27) or not. Four patients were lost to follow-up and 4 died post-operatively, including a wrong diagnosis (60 patients evaluated). Mortality rate was 12% (5 cases out of 7 related to chronic renal insufficiency). In 3 patients (5%) the transplanted gland had to be removed because of recurrent HPT (1 graft hyperplasia; 2 wrong diagnosis: 1 cervical gland left over and 1 aluminium intoxication). Second cervicotomy was performed in 3 cases (5%) for remaining cervical parathyroid gland (2 cases) and false-positive Tallium-Technetium scan (1 case). Overall results were good or very good in 51 cases (85%). A review of the literature indicate that subtotal parathyroidectomy in not superior to the Wells technique and the latter remain the landmark technique in the authors' hands in order to treat secondary HPT.

  19. Laparoscopic greater curvature plication: surgical techniques and early outcomes of a Chinese experience.

    PubMed

    Shen, Dijian; Ye, Huan; Wang, Yuedong; Ji, Yun; Zhan, Xiaoli; Zhu, Jinhui

    2014-01-01

    Laparoscopic greater curvature plication (LGCP) is a novel restrictive bariatric procedure that can reduce the gastric volume by infolding the gastric greater curvature without gastrectomy. The objective of this study was to describe the surgical technique of LGCP and validate the efficacy and safety of LGCP for the treatment of obesity in obese Chinese patients with a relatively low body mass index (BMI). Twenty-two obese patients (mean age 33.8±6.0 years; mean BMI 37.0±7.0 kg/m(2)) underwent LGCP between September 2011 and September 2012. After dissecting the greater omentum and short gastric vessels, the gastric greater curvature plication with 2 rows of nonabsorbable suture was performed under the guidance of a 32-F bougie. The data were collected during follow-up examinations performed at 1, 3, 6, and 12 months postoperatively. All procedures were performed laparoscopically. The mean operative time was 84.1 minutes (50-120 min), and the mean length of hospital stay was 3.8 days (2-10 d). There were no deaths or postoperative major complications that needed reoperation. The mean percentage of excess weight loss (%EWL) was 22.9%±6.9%, 38.6%±9.8%, 51.5%±13.5%, and 61.1%±15.9% at 1, 3, 6, and 12 months postoperatively. At 6 months, type 2 diabetes was in remission in 2 (50%) patients, hypertension in 1 (33.3%) patient, and dyslipidemia in 11 (78.6%) patients. Decreases in the index for homeostasis model assessment of insulin resistance (HOMA-IR) and in insulin and glucose concentrations were observed. The early outcomes of LGCP as a novel treatment for obese Chinese with a relatively low BMI are satisfactory with respect to the effectiveness and low incidence of major complications. Additional long-term follow-up and prospective, comparative trials are still needed. © 2013 American Society for Bariatric Surgery Published by American Society for Metabolic and Bariatric Surgery All rights reserved.

  20. EARLY SURGICAL COMPLICATIONS AFTER GASTRIC BY-PASS: A LITERATURE REVIEW

    PubMed Central

    ACQUAFRESCA, Pablo A.; PALERMO, Mariano; ROGULA, Tomasz; DUZA, Guillermo E.; SERRA, Edgardo

    2015-01-01

    Introduction Gastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones. Method Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. Results There were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction. Conclusions Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention. PMID:25861076

  1. Outcome of a one-stage tensile stress surgical technique and early postoperative rehabilitation in the treatment of neglected achilles tendon rupture.

    PubMed

    Badalihan, Ayinazi; Aihemaiti, Amina; Shawutali, Nuerai; Jielile, Jiasharete; Jialihasi, Ayidaer; Tangkejie, Wulanbai; Nuerdoula, Yeermike; Satewalede, Turde; Hunapiya, Beisen; Niyazebieke, Hadelebieke; Hezibieke, Hayilat; Zhao, Qin; Bahetijiang, Ahezhuoli; Kelamu, Mailamuguli; Qianman, Bayixiati

    2015-01-01

    The present study evaluated the effect of single-stage internal traction combined with early postoperative active rehabilitation and the yurt bone suture method, a new surgical technique, on the clinical outcomes after surgical repair of Achilles tendon. A total of 51 patients with neglected Achilles tendon rupture who underwent the yurt bone suture treatment also participated in an accelerated postoperative rehabilitation program. The clinical outcome was evaluated for 18 weeks using the Leppilahti scoring system, bilateral ultrasound examination, and computed tomography examination. The ultrasound and computed tomography examinations revealed that Achilles tendon elongation and adhesion occurred in none of the patients. All the patients could perform the single leg heel raise exercise for a mean of 30 ± 7.6 seconds at 12 weeks postoperatively. In addition, the patients could participate in sport exercises and heavy physical activities by around 13 weeks postoperatively. The mean Leppilahti score was 85.8 ± 3.7 at 8 weeks postoperatively, and it had increased to 96.1 ± 3.2 and 100.0 ± 0.0 at 12 and 18 weeks, respectively, after the operation. The 1-stage internal traction technique, combined with early postoperative active rehabilitation and the yurt bone surgical technique, resulted in good clinical outcomes for the treatment of neglected Achilles tendon rupture. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Early results after robot-assisted colorectal surgery.

    PubMed

    Eriksen, Jens Ravn; Helvind, Neel Maria; Jakobsen, Henrik Loft; Olsen, Jesper; Bundgaard, Mads; Harvald, Thomas; Gögenur, Ismail

    2013-12-01

    Implementation of robotic technology in surgery is challenging in many ways. The aim of this study was to present the implementation process and results of the first two years of consecutive robot-assisted laparoscopic (RAL) colorectal procedures. The study was a retrospective study of a consecutive, unselected patient population. All outcome parameters were predefined and all patients completed 30-day follow-up. All parameters were reported, including complication rate, reoperation rate and mortality. From April 2010 to April 2012, a total of 223 elective RAL colorectal procedures were performed. The procedures were grouped as follows: left colectomy/sigmoid resection (n = 65), low anterior resection (n = 50), abdominoperineal resection (n = 10), right colectomy (n = 56), rectopexia (n = 21), colectomy (n = 8), palliative procedure (n = 8) and stoma reversal (n = 8). The overall mortality rate was 0.4%; intra- and post-operative complication rates were 5.4% and 16%, respectively; and the reoperation rate was 9%. Conversion to open surgery was necessary in 9% of cases. A positive learning curve was found for low anterior resections with a significant decrease in duration of surgery over the course of the study period. RAL colorectal surgery can be performed as a standard procedure for most colorectal procedures. Appropriate staff education, surgical plan and quality assessment are necessary and we recommend a credentialing system for robotic surgery certification. Future randomized clinical trials should be performed to evaluate the short- and long-term results in these patients. not relevant. not relevant.

  3. [Surgical-pathologic correlation to assess the margin status in wide local excision for early-stages breast cancer].

    PubMed

    Mendoza-rojas, Juan José; Bautista-Hernández, María Yicel; Quintero-Beuló, Gregorio; Santoyo-Sánchez, Adrián; Ramos-Peñafiel, Christian Omar

    2015-02-01

    To know the surgical-pathologic correlation to assess the state of the edges in wide local excisions of breast cancer in clinical stages. retrospective and descriptive study, conducted in Breast Tumors Unit from Oncology Service of the General Hospital of Mexico, in the period from January 2009 to December 2011, with follow-up in December2012. Were included patients with breast cancer in early clinical stages, subject wide local excisions histopalogic report of a second surgery. From wide local excisions, 119 (28.5%) were due to breast cancer and included. Positive margins after initial surgery were diagnosed in 63 patients (52.9%). The residual tumor found in the second surgery was 39.7%. The variables associated with the presence of positive margins and statistically significant (p≤ 0.05) were: multicentricity, tumor size clinical and pathological, histological subtypes, and tumor grade. The age and clinical stage were not statistically significant. The variables associated with the presence of residual tumor and are statistical relevance (p≤ 0.05) were clinical stage, tumor size, clinical and pathological, histological variant and histological grade. Age and multicentricity were not associated with the presence of residual tumor. Although each case must be individualized, these results demonstrate the analyzed factors must be taken into account during the planning of breast conservative procedures, and despite an histopalogical report of margin after an initial surgery, even seconds procedures can be performed to conserve the organ.

  4. Early clinical experience with the da Vinci Xi Surgical System in general surgery.

    PubMed

    Hagen, Monika E; Jung, Minoa K; Ris, Frederic; Fakhro, Jassim; Buchs, Nicolas C; Buehler, Leo; Morel, Philippe

    2016-12-27

    The da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2014 to facilitate minimally invasive surgery. Novel features are targeted towards facilitating complex multi-quadrant procedures, but data is scarce so far. Perioperative data of patients who underwent robotic general surgery with the da Vinci Xi system within the first 6 month after installation were collected and analyzed. The gastric bypass procedures performed with the da Vinci Xi Surgical System were compared to an equal amount of the last procedures with the da Vinci Si Surgical System. Thirty-one foregut (28 Roux-en-Y gastric bypasses), 6 colorectal procedures and 1 revisional biliary procedure were performed. The mean operating room (OR) time was 221.8 (±69.0) minutes for gastric bypasses and 306.5 (±48.8) for colorectal procedures with mean docking time of 9.4 (±3.8) minutes. The gastric bypass procedure was transitioned from a hybrid to a fully robotic approach. In comparison to the last 28 gastric bypass procedures performed with the da Vinci Si Surgical System, the OR time was comparable (226.9 versus 230.6 min, p = 0.8094), but the docking time significantly longer with the da Vinci Xi Surgical System (8.5 versus 6.1 min, p = 0.0415). All colorectal procedures were performed with a single robotic docking. No intraoperative and two postoperative complications occurred. The da Vinci Xi might facilitate single-setups of totally robotic gastric bypass and colorectal surgeries. However, further comparable research is needed to clearly determine the significance of this latest version of the da Vinci Surgical System.

  5. Urethral obstruction after anti-incontinence surgery in women: evaluation, methodology, and surgical results.

    PubMed

    Austin, P; Spyropoulos, E; Lotenfoe, R; Helal, M; Hoffman, M; Lockhart, J L

    1996-06-01

    To evaluate a group of women with voiding dysfunction and a low maximum flow rate (MFR) (less than or equal to 12 mL/s) after surgery for stress urinary incontinence (SUI); to establish diagnostic parameters indicating obstruction in an attempt to determine treatment selection; and to evaluate preliminary surgical results. Eighteen women who underwent anti-incontinence surgery for SUI were diagnosed as having infravesical obstruction (IO). Thirteen women (group A [72%]) presented with clinically predominant symptoms of urgency, frequency, intermittency, and a variable vesical residual volume (RV), and five (group B [28%]) had as their most significant symptoms a high vesical RV and urinary tract infection that had been managed with intermittent catheterization (IC). The diagnosis of IO, suspected after clinical history, was established after physical examination and cystoscopic, cystographic and urodynamic investigations. Bladder instability was demonstrated in 6 group A patients (46%) and 1 group B patient (20%) (P = NS). Mean MFRs were 8.07 and 7.2 mL/s, respectively, in both groups (P = NS). Mean maximal voiding pressures (MVPs) were 20.23 and 5 cm H20, and mean RVs were 57.46 and 174 mL, respectively; both differences were statistically very significant (P <0.01 and P <0.001, respectively). High to normal MVPs occurred in 2 patients overall (11%). Bladder neck overcorrection, midurethral distortion, and postsurgical cystocele were demonstrated in both groups in 11 (85%), 0, and 2 (15%) patients in group A and 3 (60%), 2 (40%), and 3 (60%) patients in group B, respectively (P = NS). Patients in group A were treated surgically with cystourethrolysis and a repeated, less obstructive anti-incontinence operation. In group B 2 women (40%) had a similar surgical procedure; 1 (20%) underwent isolated urethrolysis; and 2 (40%) are currently maintained with IC. Among these 18 patients with voiding dysfunction after anti-incontinence surgery, a primary diagnosis of IO was

  6. Teaching and evaluation of surgical skills in dermatology: results of a survey.

    PubMed

    Reichel, Jennifer L; Peirson, Ryan P; Berg, Daniel

    2004-11-01

    To assess how the surgical skills of residents are taught and evaluated within dermatology residency programs in the United States; to assess which surgical techniques training directors and residents consider important for residents to perform or at least understand by the end of residency training. A 126-question survey was sent to all 106 of the US dermatology residency programs accredited by the Accreditation Council for Graduate Medical Education. Contact was initially made via e-mail. Surveys were addressed to the program director, surgical training director, and chief resident of each program. A follow-up survey was mailed to nonresponders. Ninety-five surveys were returned representing 71 (67%) of 106 programs. Eighty-nine percent of programs (n=63) reported having a formal curriculum in dermatologic surgery. Among programs represented, 97% (n=69) taught surgical skills in the procedure room, 84% (n=57) used pigs' feet, and fewer than 10% (n=6) used human cadavers. Ninety-four percent of programs (n=61) scheduled surgical lectures; two thirds (n=41) formally assigned surgical reading, and over half (n=36) used Web-based lectures to teach skills. To assess training, most programs (86%; n=50) used subjective global evaluation at the end of a surgery rotation. Fewer than 30% (n=15) discussed specific objectives prior to the rotation. Only about 25% of programs (n=17) reported the use of written or oral examinations to assess resident surgery skills. Traditional biopsy and simple surgical procedures were reported as most important to know and perform. Interest by both faculty members and residents in more advanced surgical techniques was more limited and variable. Cosmetic surgery techniques were most likely to be viewed as unimportant. Most dermatology programs teach surgical skills by traditional apprenticeship methods supplemented by work in pigs' feet laboratory classes and regularly scheduled lectures. Skill assessment is mainly done through subjective

  7. Effect of semiquantitative culture results from complex host surgical wounds on dehiscence rates.

    PubMed

    Elmarsafi, Tammer; Garwood, Caitlin S; Steinberg, John S; Evans, Karen K; Attinger, Christopher E; Kim, Paul J

    2017-01-16

    The primary aim of this study was to determine the effect of positive bacterial cultures at the time of closure on dehiscence rates. Pre- and post-débridement wound cultures from patients undergoing serial surgical débridement of infected wounds were compared with outcomes 30 days postoperatively. One-hundred patients were enrolled; 35 were excluded for incomplete culture data. Sixty-five patients were evaluated for species counts, including Coagulase negative Staphylococcus (CoNS), and semiquantitative culture data for each débridement. The post-débridement cultures on the date of closure had no growth in 42 patients (64.6%) of which 6 dehisced (14.3%), and 36 remained closed; with no statistically significant difference in dehiscence rates (p = 0.0664). Pre-débridement cultures from the 1st débridement of the 65 patients showed 8 patients had no growth, 29 grew 1 species, 19 grew 2 species, and 9 had 3-5 species. There was a reduction in the number of species and improvement of semiquantitative cultures with each subsequent débridement. The dehiscence rate for those who had 2 débridements (n = 42) was 21.4% at 30 day follow-up and 21.7% in those who had 3 débridements (n = 23). The number of débridements had no statistical significance on dehiscence rates. The presence of CoNS on the day of closure was a statistically significant risk for dehiscence within 30 days (p = 0.0091) postoperatively. This data demonstrates: (1) positive post-débridement cultures (scant/rare, growth in enrichment broth) at the time of closure did not affect overall dehiscence rates (p = 0.0664), (2) the number of species and semiquantitative culture results both improved with each subsequent débridement, (3) the number of surgical débridement did not influence postclosure dehiscence rates. (4) Positive cultures containing CoNS at the time of closure is a risk factor for dehiscence (p = 0.0091).

  8. Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint

    PubMed Central

    Kerkhoffs, G. M.M.J.; Rutten, S.; Marsman, A. J.W.; Marti, R. K.; Albers, G. H.R.

    2006-01-01

    Trapeziometacarpal osteoarthritis is a common entity, often bilateral and predominantly affecting postmenopausal women. In the case of failure of conservative treatment, surgery is a good option. The aim of this study was to compare three surgical procedures. 63 patients (74 thumbs) with osteoarthritis of the trapezio-metacarpal joint were surgically treated; 54 patients were seen for follow-up, 7 had died and 2 were lost to follow-up. The patients were stratified according to treatment; resection arthroplasty (the joint surface’s of the metacarpal and the trapezium are resected) (18 thumbs), trapeziectomy with tendon interposition (17 thumbs) or trapezio-metacarpal arthrodesis (28 thumbs). Baseline characteristics were comparable in the three groups for mean age at operation, Eaton classification, left right distribution and dominant hands operated. The average follow-up was 13 years for the resection group, 8 years for the trapeziectomy group and 9 years for the arthrodesis group. No statistically significant difference between the three groups was found for the visual analogue pain and satisfaction scale, pain frequency nor DASH score. Patients in the trapeziectomy group had significantly less pain compared to the arthrodesis group (p=0.025). Statistically, radial abduction was significantly better after trapeziectomy compared to resection arthroplasty (p<0.01) or arthrodesis (p=0.01). There was no difference among the three groups in grip and tip pinch strength nor in pain on palpation. None of the patients in the trapeziectomy group needed a re-operation, one patient in the resection arthroplasty group had a re-operation, and 22 patients in the arthrodesis group had one or more re-operations for hardware removal or because of a complication. This study shows that the resection arthroplasty has equally good long term results compared to trapeziectomy combined with tendon interposition or arthrodesis. Resection arthroplasty is performed through a single

  9. Impact of Cosmetic Result on Selection of Surgical Treatment in Patients With Localized Prostate Cancer

    PubMed Central

    Martinez-Salamanca, Juan Ignacio; Maestro, Mario Alvarez; Galarza, Ignacio Sola; Rodriguez, Joaquin Carballido

    2014-01-01

    Objectives: To analyze the effect of cosmetic outcome as an isolated variable in patients undergoing surgical treatment based on the incision used in the 3 variants of radical prostatectomy: open (infraumbilical incision and Pfannestiel incision) and laparoscopic, or robotic (6 ports) surgery. Patients and methods: 612 male patients 40 to 70 years of age with a negative history of prostate disease were invited to participate. Each patient was evaluated by questionnaire accompanied by a set of 6 photographs showing the cosmetic appearance of the 3 approaches, with and without undergarments. Participants ranked the approaches according to preference, on the basis of cosmesis. We also recorded demographic variables: age, body mass index, marital status, education level, and physical activity. Results: Of the 577 patients who completed the questionnaries, the 6-port minimally invasive approach represents the option preferred by 52% of the participants, followed by the Pfannestiel incision (46%), and the infraumbilical incision (11%), respectively. The univariate and multivariate analyses did not show statistically significant differences when comparing the approach preferred by the patients and the sub-analyses for demographic variables, except for patients who exercised who preferred the Pfannestiel incision (58%) instead of minimally invasive approach (42%) with statistically significant differences. Conclusion: The minimally invasive approach was the approach of choice for the majority of patients in the treatment of prostate cancer. The Pfannestiel incision represents an acceptable alternative. More research and investment may be necesary to improve cosmetic outcomes. PMID:25516703

  10. Surgically facilitated orthodontic therapy: a new tool for optimal interdisciplinary results.

    PubMed

    Roblee, Richard D; Bolding, Scotty L; Landers, Jason M

    2009-06-01

    Restorative-driven interdisciplinary therapy frequently requires orthodontic therapy to optimally address the underlying dentofacial problems. Limitations in traditional orthodontic techniques and the length of requisite treatment times often create barriers to providers and patients' willingness to accept orthodontics as part of the overall treatment plan. Two main types of surgically facilitated orthodontic therapy (SFOT), each with its own indications and protocols, are becoming popular. They can expand significantly the limitations of orthodontics and greatly shorten treatment times. The first uses corticotomies to cause bone demineralization through a regional acceleratory phenomenon (RAP) that "supercharges" dentoalveolar tooth movement. The second type of SFOT involves single- or multiple-tooth osteotomies combined with the principles of distraction osteogenesis to rapidly grow hard and soft tissues, thereby enabling changes in alveoloskeletal relationships. With these SFOT procedures, an interdisciplinary team can modify predictably the dentoalveolar complex so the teeth, alveolar bone, and skeletal components are addressed properly to maximize ideal functional and esthetic relationships, while greatly reducing treatment time and increasing stability of the result.

  11. Evaluation of the Nasal Surgical Questionnaire for Monitoring Results of Septoplasty

    PubMed Central

    Haye, Rolf; Tarangen, Magnus; Shiryaeva, Olga; Døsen, Liv Kari

    2015-01-01

    Monitoring the results of surgery is important. The otorhinolaryngology department of our hospital currently uses preoperative and postoperative versions of the Nasal Surgical Questionnaire (NSQ) for continuous evaluation of nasal septoplasty. In this study, 55 patients undergoing septoplasty answered the preoperative version twice to assess the NSQ's test-retest precision, and 75 patients answered the preoperative questionnaire before and the postoperative one 6 months after surgery to evaluate the NSQ's ability to detect change in symptoms following surgery. Both the pre- and postoperative versions of the NSQ use separate visual analogue scales (VAS) to assess nasal obstruction during the day, at night, and during exercise. Other nasal symptoms are graded as secondary outcomes using 4-point Likert scales. The mean VAS scores for the two preoperative obstruction ratings were not significantly different. The scores were significantly higher than in a normal population. There were also significant differences between preoperative and postoperative ratings. The mean pre- and postoperative scores at night for those who reported complete improvement were 66.1 and 8.4, substantial improvement 74.5 and 24.2, and no improvement 83.3 and 76.4. The NSQ reliably assesses nasal symptoms in patients and may be useful for both short and long term prospective studies of septoplasty. PMID:26612987

  12. [Paraganglioma of the middle ear. The retrospective analysis of the results of the surgical treatment].

    PubMed

    Rzayev, R M; Rzayev, Rt R

    2016-01-01

    The objective of the present study was to analyze the results of and to summarize the experience with diagnostics and surgical treatment of the patients presenting with paraganglioma of the middle ear (PME). A total of 5 patients were available for the examination (all of the women) including two in whom the extension of the tumour corresponded to class A paraganglioma (according to the classification of U. Fisch) and three with class B paraganglioma (two having the tumour that occupied mezo- and hypotympanum and one with the tumour extending into the infralabyrinthine space). All the patients of the former group and 2 of the three in the latter group were operated with the use of the retroauricular-endomeatal approach. The remaining patient with class B paraganglioma extending into the infralabyrinthine space and the suspected destruction of the outer wall of the internal carotid artery by the tumour or its penetration into the channel was treated with the use of the retroauricular-endomeata-transmastoidal approach. The long-term postoperative catamnesticobservation of the thus treated patients has demonstrated the absence of a recurrent tumour within at least 3 tears after surgery. All the patientseported he preserved hearing function.

  13. Surgical Results of Endoscopic Dacryocystorhinostomy and Lacrimal Trephination in Distal or Common Canalicular Obstruction

    PubMed Central

    Hwang, Gyu-Rin; Jung, Dong-Ho; Kim, I-Seok; Sin, Jae-Min; Lee, Heung-Man

    2012-01-01

    Objectives To evaluate the surgical outcomes of endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stenting in patients with distal or common canalicular obstructions. Methods The medical records of 29 patients (31 eyes) from January 2001 to December 2009 who underwent endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone tube insertion for the treatment of distal or common canalicular obstructions were retrospectively reviewed. The level of obstruction was confirmed by intraoperative probing. The outcome of the surgery was categorized as a complete success, partial success, or failure according to the functional and anatomic patency. Results The average age of the patients was 52 years. The duration of silicone intubation ranged from 4 to 11 months with an average of 5.7±1.6 months. The follow-up period after stent removal ranged from 4 to 15 months with an average of 8.2±3.3 months. Complete success was achieved in 25 out of 31 eyes (80.6%), partial success in 4 out of 31 eyes (12.9%), and failure in 2 out of 31 eyes (6.5%). Conclusion Endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stent intubation may be safe and considered as an initial treatment of patients with distal or common canalicular obstructions. PMID:22737291

  14. Requirements for a Stable Long-Term Result in Surgical Reduction of Vertebral Fragility Fractures.

    PubMed

    Crespo-Sanjuán, Jesús; Ardura, Francisco; Hernández-Ramajo, Rubén; Noriega, David C

    2017-09-01

    Osteoporotic vertebral fractures are one of the major health problems in the world. Minimally invasive surgical treatment has great advantages compared with conservative treatment in treating these fractures, because it eliminates pain and functional disability. The percutaneous intravertebral expandable titanium device SpineJack (Vexim SA, Balma, France) is beneficial compared with other kyphoplasty devices, showing results that are maintained over time and a reduction in complications. However, controversy exists about the minimum amount of cement that should be used to achieve long-term restoration and which is essential to minimize complications. We reviewed publications studying the maintenance of long-term restoration using this percutaneous expandable titanium device in cadavers. In this study, we show the first long-term work with patients treated with percutaneous expandable titanium device, describing precise indications concerning the minimum amount of cement that should be used. Results were evaluated from a clinical study including 178 patient outcomes with long-term follow-up results performed by our team. The mean total quantity of cement injected was 4.4 mL (25% vertebral body filling). The leakage rate was 12.9%, and all of these occurrences were asymptomatic. The mean follow-up time was 77 months (60-96 months). All clinical scales improved significantly after the procedure. A recollapse of the treated vertebra was observed in 3 cases (1.6%), and the adjacent fracture rate was 2.2%. From the results of our study and review of the literature, cement equivalent to 25% of the vertebral body filling volume, when combined with the titanium expandable device, seems to be sufficient to prevent recollapse in osteoporotic and type A.3 fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Weekend surgical handover enhances early management of acute clinical changes using a red flag system.

    PubMed

    White-Gibson, A; Manole, C; Kearney, D; Kavanagh, D

    2017-09-02

    Recent implementation of the European Working Time Directive in Ireland has resulted in a change from thetraditional model of patient care to a system characterised by shift work among clinicians. Effective handover ofpatient information is essential for transfer of responsibility between clinicians and maintaining continuity of care. The weekend has been identified as a particularly vulnerable transition of patient care. Our study aims to determine if implementing a formal face-to-face handover accompanied by an electronictemplate in our surgical department can improve the number of adverse events reported back to the primary teamafter a weekend on call. Data was collected over 12 weekends between February and May 2016. A list of adverseevents was established, and during an initial observation period of 6 weeks, we documented the number of adverseevents that were informally handed over. A 6-week intervention was then performed, involving a formal face-to-facehandover on Monday morning supported by an electronic patient census using a red-flag system to highlightpatients who experienced an adverse event over the weekend. Our results showed the mean number of adverse events recorded pre-intervention was 3.17 ± 0.6 over the 6-week period. Following the introduction of weekend face-to-face handover, there was 147% increase in the number of adverse events recorded with a mean of 7.83 ± 1.2. The introduction of a formal face-to-face weekend handover with a red-flag system resulted in increased reporting of patient adverse events, allowing earlier recognition and management.

  16. Early radiographic diagnosis of peri-implantitis enhances the outcome of peri-implantitis treatment: a 5-year retrospective study after non-surgical treatment

    PubMed Central

    Chang, Hee-Yung; Park, Shin-Young; Kim, Jin-Ah; Kim, Young-Kyun

    2015-01-01

    Purpose This retrospective study evaluated the relationship between the timing of peri-implantitis diagnosis and marginal bone level after a 5-year follow-up of non-surgical peri-implantitis treatment. Methods Thirty-three patients (69 implants) were given peri-implantitis diagnosis in 2008-2009 in Seoul National University Bundang Hospital. Among them, 31 implants from 16 patients were included in this study. They were treated non-surgically in this hospital, and came for regular maintenance visits for at least 5 years after peri-implantitis treatment. Radiographic marginal bone levels at each interval were measured and statistical analysis was performed. Results Timing of peri-implantitis was one of the significant factors affecting initial bone loss and total bone loss not additional bone after peri-implantitis diagnosis. Patients with cardiovascular disease and diabetic mellitus were positively influenced on both initial bone loss and total bone loss. Patients who needed periodontal treatment after implant placement showed a negative effect on bone loss compared to those who needed periodontal treatment before implant placement during entire periods. Implant location also significantly influenced on amounts of bone loss. Mandibular implants showed less bone loss than maxillary implants. Among surgical factors, combined use of autogenous and xenogenic bone graft materials showed a negative effect on bone loss compared to autogenous bone graft materials. Use of membrane negatively affected on initial bone loss but positively on additional bone loss and total bone loss. Thread exposure showed positive effects on initial bone loss and total bone loss. Conclusions Early peri-implantitis diagnosis led to early non-surgical intervention for peri-implantitis treatment, which resulted in the maintenance of the bone level as well as preservation of the implant. Graphical Abstract PMID:26131368

  17. [Immediate results of surgical reconstruction of the aortic arch in patients with proximal aortic dissection].

    PubMed

    Liashenko, M M; Cherniavskiĭ, A M; Al'sov, S A; Sirota, D A; Khvan, D S

    2014-01-01

    Despite obvious progress of surgical technologies in correction of proximal aortic pathology, improvement of methods of protection of the brain, one of the main problems of this direction remains the development of postoperative cerebral ischaemia of various degree of manifestation: strokes, transitory ischaemic attacks, or hypoxic encephalopathy. Of special interest is studying the group of patients presenting with aortic dissection, since this pathology may be accompanied by a wide variety of combinations of occlusive and stenotic lesions of the branches of the ascending portion of the aorta and aortic arch (coronary and brachiocephalic basins) by the detached intima. Over the period from 1999 to 2011, we operated on a total of 124 patients presenting with DeBakey type I aortic dissection. Of these, 194 were men (75.8%) and 30 (24.2%) women. The mean age amounted to 48.7±11.0 years. Etiologically prevailing were systemic atherosclerosis (91 patients, 73.4% of cases) and Marfan's syndrome in 14 (11.3%) cases. In all patients operative intervention included reconstruction of the aortic arch according to one of the following techniques: prosthetic repair according to the type of an aggressive oblique anastomosis ("hemiarch repair") - 78 (62.9%) patients, prosthetic repair of the aortic arch using the multiple-branch prosthesis Plexus Vascutek - 37 (29.8%) patients, and nine patients underwent prosthetic repair of the aortic arch with a vascular graft with reimplantation of the brachiocephalic arteries with a single islet. The average duration of artificial circulation amounted to 230.1±70.0 minutes, the mean time of aortic occlusion was 167.2±44.2 minutes and that of circulatory arrest equalled 51.9±16.2 minutes. The brain during hypothermic circulatory arrest was protected according to the following techniques: 16 (12.9%) patients - isolated hypothermia with no cerebral perfusion, 76 (61.3 %) patients retrograde cerebral perfusion (RCP) through the superior

  18. [Complex plasty of the atrioventricular valve in defects with a functional single ventricle--surgical technic and midterm results].

    PubMed

    Tláskal, T; Chaloupecký, V; Reich, O; Marek, J

    2002-05-01

    Congenital heart diseases with a functionally single ventricle can be surgically treated using total cavopulmonary connection. Regurgitation of atrioventricular valves represents one of risk factors for death and unfavourable long-term result after this operation. During 1996-2001 total cavopulmonary connection with a complex plastic repair of atrioventricular valves was performed in 8 patients at the age from 1.4 to 13.3 years (median 7.8 years). All patients had very complex congenital heart diseases with severe malformation of atrioventricular valves. All but one had pulmonary stenosis or atresia. Six patients had common atrioventricular orifice, 5 patients had bilateral superior caval veins and 4 patients had dextrocardia or mesocardia. In 6 (75%) patients one or two palliative operations had been performed earlier. Before surgery all patients were cyanotic with severe hypoxemia and polyglobulia. All patients had regurgitant atrioventricular valves. The surgery was performed from the midline sternotomy approach, in extracorporeal circulation and moderate hypothermia. The surgery consisted in excision of the atrial septum, construction of a direct connection of all superior and inferior caval veins with the pulmonary artery, transsection of the pulmonary trunk and complex plastic repair of atrioventricular valves. The inferior caval vein was derived to the pulmonary artery using an intraatrial lateral tunnel in 3 patients and using an external conduit from a Goretex vascular prosthesis in 5 patients. In 5 patients a fenestration in tunnel or conduit permitting decompression of the systemic venous return was done. Individualized plastic repair of atrioventricular valves consisted in the suture of the central portions of both common leaflets. Four patients required also commissuroplasty of one to four commissures and two patients required annuloplasty. All patients survived the early postoperative period. In the majority of them complications occurred: hypoxemia

  19. No-touch technique for radiocephalic arteriovenous fistula--surgical technique and preliminary results.

    PubMed

    Hörer, Tal M; Skoog, Per; Quell, Robin; Nilsson, Kristofer F; Larzon, Thomas; Souza, Domingos R

    2016-01-01

    The radiocephalic arteriovenous fistula (RC-AVF) has significant failure rates due to occlusions and failure to mature. The size and quality of the veins are considerable limiting factors for the procedure. The aim of this pilot study was to describe the No-Touch technique (NTT) to create RC-AVF and present the results up to 1 year of follow-up. Thirty-one consecutive patients who were referred for surgery for a RC-AVF were included (17 men, mean age 63 years, range 35-84) and operated by NTT where the vein and artery were dissected with a tissue cushion around it. Twenty-two patients had small veins or arteries (≤2 mm), 12 patients had a small cephalic vein (≤2 mm), and the mean distal cephalic vein diameter was 2.4 mm (range 1.0-4.1 mm). Technical surgical success and immediate patency were obtained in all patients. Clinical success was achieved in 23 of the 27 (85%) patients who required hemodialysis. The proportion of primary patency at 30 days and 6 months was 84% and 64%, respectively. Secondary patency at 30 days and 6 months was 97% and 83%, respectively. At 1-year follow-up, primary patency was 54% and secondary patency was 80%. There was no major difference in patency due to preoperative vein diameter. The results of this study indicate that NTT can be used for primary radio-cephalic fistula surgery with very good results. This method offers the potential to create a RC-AVF in patients who are not usually considered appropriate for a distal arm fistula due to a small cephalic vein.

  20. The Herschel Inner Galaxy Gas Survey (HIGGS): Early Results

    NASA Astrophysics Data System (ADS)

    Martin, Christopher; Walker, C.; Kulesa, C.; Stark, A.; Smith, H.; Tolls, V.; White, G.; Israel, F.; Guesten, R.; Requenna-Torres, M.; Shaw, T.; Chen, S.; Schlawin, E.

    The Herschel Inner Galaxy Gas Survey (HIGGS) is a Herschel Open Time Key Programme to use the HIFI and PACS instruments to observe [CII], [NII], [OI], [OIII], and high-J CO emission lines in focused regions near the Galactic Center. By separating and evaluating the distinctly different roles of the central nuclear engine, the Galactic Bar, and dynamical stellar and interstellar feedback mechanisms, HIGGS will provide a high-resolution template for the physical processes in galactic nuclei throughout the local universe, in particular those engaged in starburst activity. We intend to present our early results along with a description of the data reduction and analysis tools that we have developed.

  1. Simulation in coronary artery anastomosis early in cardiothoracic surgical residency training: The Boot Camp experience

    PubMed Central

    Fann, James I.; Calhoon, John H.; Carpenter, Andrea J.; Merrill, Walter H.; Brown, John W.; Poston, Robert S.; Kalani, Maziyar; Murray, Gordon F.; Hicks, George L.; Feins, Richard H.

    2014-01-01

    Objective We evaluated focused training in coronary artery anastomosis with a porcine heart model and portable task station. Methods At “Boot Camp,” 33 first-year cardiothoracic surgical residents participated in 4-hour coronary anastomosis sessions (6–7 attending surgeons per group of 8–9 residents). At beginning, midpoint, and session end, anastomosis components were assessed on a 3-point rating scale (1 good, 2 average, 3 below average). Performances were video recorded and reviewed by 3 surgeons in a blinded fashion. Participants completed questionnaires at session end, with follow-up surveys at 6 months. Results Ten to 18 end-to-side anastomoses with porcine model and task station were performed. Initial assessments ranged from 2.11 ± 0.58 (forceps use) to 2.44 ± 0.48 (needle angles). Midpoint scores ranged from 1.76 ± 0.63 (forceps use) to 1.91 ± 0.49 (needle angles). Session end scores ranged from 1.29 ± 0.45 (needle holder use) to 1.58 ± 0.50 (needle transfer and suture management and tension; P < .001). Video recordings confirmed improved performance (interrater reliability > 0.5). All respondents agreed that task station and porcine model were good methods of training. At 6 months, respondents noted that the anastomosis session provided a basis for training; however, only slightly more than half continued to practice outside the operating room. Conclusions Four-hour focused training with porcine model and task station resulted in improved ability to perform anastomoses. Boot Camp may be useful in preparing residents for coronary anastomosis in the clinical setting, but emphasis on simulation development and deliberate practice is necessary. PMID:19846125

  2. Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF).

    PubMed

    Phan, Kevin; Maharaj, Monish; Assem, Yusuf; Mobbs, Ralph J

    2016-09-01

    Lumbar interbody fusion represents an effective surgical intervention for patients with lumbar degenerative diseases, spondylolisthesis, disc herniation, pseudoarthrosis and spinal deformities. Traditionally, conventional open anterior lumbar interbody fusion and posterior/transforaminal lumbar interbody fusion techniques have been employed with excellent results, but each with their own advantages and caveats. Most recently, the antero-oblique trajectory has been introduced, providing yet another corridor to access the lumbar spine. Termed the oblique lumbar interbody fusion, this approach accesses the spine between the anterior vessels and psoas muscles, avoiding both sets of structures to allow efficient clearance of the disc space and application of a large interbody device to afford distraction for foraminal decompression and endplate preparation for rapid and thorough fusion. This review aims to summarize the early clinical results and complications of this new technique and discusses potential future directions of research.

  3. Early results of the modified Peterson bunion procedure for adolescent hallux valgus.

    PubMed

    Aronson, J; Nguyen, L L; Aronson, E A

    2001-01-01

    Adolescent hallux valgus has a high recurrence rate after conventional surgical corrections. Excellent results have been reported with a double osteotomy of the first metatarsal fixed with a 3/16" transarticular pin. The present study reports the early results of using a medial plate and screws with an osteoperiosteal distally based flap to correct metatarsophalangeal joint subluxation, decrease recurrence from laxity in the medial capsular repair, and avoid intra-articular damage. The study included 18 feet in 16 patients (8 males, 8 females). All osteotomies healed primarily without complications, though there was recurrence in 3 undercorrected feet (2 patients). The average preoperative hallux valgus angle of 34 degrees was reduced to 16 degrees at a minimum 1-year follow-up. The average intermetatarsal angle improved from 14 degrees (before operation) to 6 degrees. No patient has requested plate removal.

  4. A predictive model for early mortality after surgical treatment of heart valve or prosthesis infective endocarditis. The EndoSCORE.

    PubMed

    Di Mauro, Michele; Dato, Guglielmo Mario Actis; Barili, Fabio; Gelsomino, Sandro; Santè, Pasquale; Corte, Alessandro Della; Carrozza, Antonio; Ratta, Ester Della; Cugola, Diego; Galletti, Lorenzo; Devotini, Roger; Casabona, Riccardo; Santini, Francesco; Salsano, Antonio; Scrofani, Roberto; Antona, Carlo; Botta, Luca; Russo, Claudio; Mancuso, Samuel; Rinaldi, Mauro; De Vincentiis, Carlo; Biondi, Andrea; Beghi, Cesare; Cappabianca, Giangiuseppe; Tarzia, Vincenzo; Gerosa, Gino; De Bonis, Michele; Pozzoli, Alberto; Nicolini, Francesco; Benassi, Filippo; Rosato, Francesco; Grasso, Elena; Livi, Ugolino; Sandro, Sponga; Pacini, Davide; Di Bartolomeo, Roberto; De Martino, Andrea; Bortolotti, Uberto; Onorati, Francesco; Faggian, Giuseppe; Lorusso, Roberto; Vizzardi, Enrico; Di Giammarco, Gabriele; Marinelli, Daniele; Villa, Emmanuel; Troise, Giovanni; Picichè, Marco; Musumeci, Francesco; Paparella, Domenico; Margari, Vito; Tritto, Francesco; Damiani, Girolamo; Scrascia, Giuseppe; Zaccaria, Salvatore; Renzulli, Attilio; Serraino, Giuseppe; Mariscalco, Giovanni; Maselli, Daniele; Foschi, Massimiliano; Parolari, Alessandro; Nappi, Giannantonio

    2017-08-15

    The aim of this large retrospective study was to provide a logistic risk model along an additive score to predict early mortality after surgical treatment of patients with heart valve or prosthesis infective endocarditis (IE). From 2000 to 2015, 2715 patients with native valve endocarditis (NVE) or prosthesis valve endocarditis (PVE) were operated on in 26 Italian Cardiac Surgery Centers. The relationship between early mortality and covariates was evaluated with logistic mixed effect models. Fixed effects are parameters associated with the entire population or with certain repeatable levels of experimental factors, while random effects are associated with individual experimental units (centers). Early mortality was 11.0% (298/2715); At mixed effect logistic regression the following variables were found associated with early mortality: age class, female gender, LVEF, preoperative shock, COPD, creatinine value above 2mg/dl, presence of abscess, number of treated valve/prosthesis (with respect to one treated valve/prosthesis) and the isolation of Staphylococcus aureus, Fungus spp., Pseudomonas Aeruginosa and other micro-organisms, while Streptococcus spp., Enterococcus spp. and other Staphylococci did not affect early mortality, as well as no micro-organisms isolation. LVEF was found linearly associated with outcomes while non-linear association between mortality and age was tested and the best model was found with a categorization into four classes (AUC=0.851). The following study provides a logistic risk model to predict early mortality in patients with heart valve or prosthesis infective endocarditis undergoing surgical treatment, called "The EndoSCORE". Copyright © 2017. Published by Elsevier B.V.

  5. Initial Surgical Experience with Aortic Valve Repair: Clinical and Echocardiographic Results

    PubMed Central

    da Costa, Francisco Diniz Affonso; Colatusso, Daniele de Fátima Fornazari; da Costa, Ana Claudia Brenner Affonso; Balbi Filho, Eduardo Mendel; Cavicchioli, Vinicius Nesi; Lopes, Sergio Augusto Veiga; Ferreira, Andrea Dumsch de Aragon; Collatusso, Claudinei

    2016-01-01

    Introduction Due to late complications associated with the use of conventional prosthetic heart valves, several centers have advocated aortic valve repair and/or valve sparing aortic root replacement for patients with aortic valve insufficiency, in order to enhance late survival and minimize adverse postoperative events. Methods From March/2012 thru March 2015, 37 patients consecutively underwent conservative operations of the aortic valve and/or aortic root. Mean age was 48±16 years and 81% were males. The aortic valve was bicuspid in 54% and tricuspid in the remaining. All were operated with the aid of intraoperative transesophageal echocardiography. Surgical techniques consisted of replacing the aortic root with a Dacron graft whenever it was dilated or aneurysmatic, using either the remodeling or the reimplantation technique, besides correcting leaflet prolapse when present. Patients were sequentially evaluated with clinical and echocardiographic studies and mean follow-up time was 16±5 months. Results Thirty-day mortality was 2.7%. In addition there were two late deaths, with late survival being 85% (CI 95% - 68%-95%) at two years. Two patients were reoperated due to primary structural valve failure. Freedom from reoperation or from primary structural valve failure was 90% (CI 95% - 66%-97%) and 91% (CI 95% - 69%-97%) at 2 years, respectively. During clinical follow-up up to 3 years, there were no cases of thromboembolism, hemorrhage or endocarditis. Conclusions Although this represents an initial series, these data demonstrates that aortic valve repair and/or valve sparing aortic root surgery can be performed with satisfactory immediate and short-term results. PMID:27556321

  6. Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation.

    PubMed

    Benli, I Teoman; Ates, Bülent; Akalin, Serdar; Citak, Mehmet; Kaya, Alper; Alanay, Ahmet

    2007-03-01

    Last two decades witnessed great advances in the surgical treatment of idiopathic scoliosis. However, the number of studies evaluating the long-term results of these treatment methods is relatively low. During recent years, besides radiological and clinical studies, questionnaires like SRS-22 assessing subjective functional and mental status and life-quality of patients have gained importance for the evaluation of these results. In this study, surgical outcome and Turkish SRS-22 questionnaire results of 109 late-onset adolescent idiopathic scoliosis patients surgically treated with third-generation instrumentation [Texas Scottish Rite Hospital (TSRH) System] and followed for a minimum of 10 years were evaluated. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT), shift of head (SH), and shift of stable vertebra (SS). Mean age of the patients was 14.4+/-1.9 and mean follow-up period was 136.9+/-12.7 months. When all the patients were included, the preoperative mean Cobb angle of major curves in the frontal plane was 60.8 degrees +/-17.5 degrees . Major curves that were corrected by 38.7+/-22.1% in the bending radiograms, postoperatively achieved a correction of 64.0+/-15.8%. At the last follow-up visit, 10.3 degrees +/-10.8 degrees of correction loss was recorded in major curves in the frontal plane with 50.5+/-23.1% final correction rate. Also, the mean postoperative and final kyphosis angles and lumbar lordosis angles were 37.7 degrees +/-7.4 degrees , 37.0 degrees +/-8.4 degrees , 37.5 degrees +/-8.7 degrees , and 36.3 degrees +/-8.5 degrees , respectively. A statistically significant correction was obtained at the sagittal plane; mean postoperative changes compared to preoperative values were 7.9 degrees and 12.9 degrees for thoracic and lumbar regions, respectively. On the other hand, normal physiological thoracic and lumbar sagittal contours were achieved in 83.5% and 67.9% of the patients, respectively

  7. [Surgical therapy of acute and embolizing deep venous thrombosis--indication, technical principle, results].

    PubMed

    Kniemeyer, H W; Merckle, R; Stühmeier, K; Sandmann, W

    1990-12-17

    Between 1977 and 1986, 185 patients with deep venous thrombosis (117 with acute occlusive and 68 with embolizing deep venous thrombosis) underwent venous thrombectomy with arterio-venous fistula. The early patency rate was 96%, and the perioperative mortality rate, 3.8%. Of the 157 patients in whom extremities were involved, 147 were examined 12-118 months postoperatively (mean 43 +/- 23 months) clinically, by Doppler ultrasound and by light reflexion rheography (LRR). In 49% of the patients, various kinds of swelling or oedema of the involved extremities were present. There were no hemodynamical disturbances in 53% (LRR-examination); competent venous valves were found in 44%. According to the severity of symptoms and hemodynamical findings, postthrombotic syndrome was absent in 47%, mild in 20%, moderate in 28%, and severe in 5% (7 patients, 4 with venous ulcers). Six of the 7 patients with severe postthrombotic syndrome belonged to the group operated for embolizing thrombosis, where no selection of cases was performed. The best long-term results were achieved in patients operated for acute occlusive thrombosis of the iliac and iliofemoral veins. Venous thrombectomy with av fistula can achieve sufficient early and long-term results in the treatment of deep venous thrombosis, provided strict selection of patients and a meticulous technique are practised.

  8. Surgical apgar score predicts early complication in transfemoral amputees: Retrospective study of 170 major amputations

    PubMed Central

    Wied, Christian; Foss, Nicolai B; Kristensen, Morten T; Holm, Gitte; Kallemose, Thomas; Troelsen, Anders

    2016-01-01

    AIM To assess whether the surgical apgar score (SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery. METHODS This was a single-center, retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation (TTA) or transfemoral amputation (TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure (ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performed with sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint, performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate, blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups (SAS 0-4, SAS 5-6, SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk (SAS ≥ 7) and high-risk patients (SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery. RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00 (1.33-3.03), P = 0.001]. This effect was pronounced for TFA [OR = 2.61 (1.52-4.47), P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80 (1.40-5.61), P = 0

  9. Preface: The LAMOST Galactic surveys and early results

    NASA Astrophysics Data System (ADS)

    Liu, Xiao-Wei; Zhao, Gang; Hou, Jin-Liang

    2015-08-01

    By the time of this writing, the ongoing LAMOST Galactic surveys have collected approximately 4.5 million stellar spectra with signal-to-noise ratios better than 10 per pixel. This special issue is devoted to early results from the surveys, mostly based on the LAMOST Data Release 1 (DR1; Luo et al., this volume) that contains data secured by May 2013, the end of the first year of regular surveys, although a few studies have made use of data collected in the second year of regular surveys. LAMOST DR1 was released to the Chinese astronomical community and international partners in August 2013 and made public to the whole world in March 2015. Here we briefly review the scope and motivation, data reduction and release, as well as early results of the surveys. As the project advances, one can expect that these surveys will yield an exquisite description of the distribution, kinematics and chemistry of Galactic stellar populations, especially those within a few kpc of the Sun, a robust measurement of the local dark matter density, and, consequently, shed light on how our Galaxy, and other galaxies in general, form and evolve.

  10. Early Impact of the 2011 ACGME Duty Hour Regulations on Surgical Outcomes

    PubMed Central

    Scally, Christopher P.; Ryan, Andrew M.; Thumma, Jyothi R.; Gauger, Paul G.; Dimick, Justin B.

    2015-01-01

    Background In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented additional restrictions on resident work hours. While the impact of these restrictions on the education of surgical trainees has been examined, the effect on patient safety remains poorly understood. Methods We used national Medicare Claims data for patients undergoing general (n = 1,223,815) and vascular (n = 475,262) surgery procedures in the 3 years preceding the duty hour changes (January, 2009 – June, 2011) and the 18 months following (July, 2011 - December, 2012). Hospitals were stratified into quintiles by teaching intensity using a resident to bed ratio. We utilized a difference-in-differences analytic technique, using non-teaching hospitals as a control group, to compare risk adjusted 30-day mortality, serious morbidity, readmission, and failure to rescue (FTR) rates before and after the duty hour changes. Results Following duty hour reform, no significant changes were seen in the measured outcomes when comparing teaching to non-teaching hospitals. Even when stratifying by teaching intensity there were no differences. For example, at the highest intensity teaching hospitals (resident/bed ratio ≥ .6), mortality rates before and after the duty hour changes were 4.2% and 4.0%, compared to 4.7% and 4.4% for non-teaching hospitals (RR .98, 95% CI .89-1.07). Similarly, serious complication (RR 1.02, 95% CI .98-1.06), FTR (RR .95, 95% CI .87-1.04), and readmission (OR 1.00, 95% CI .96-1.03) rates were unchanged. Conclusions In Medicare beneficiaries undergoing surgery at teaching hospitals, outcomes have not improved since the 2011 ACGME duty hour regulations. PMID:26054323

  11. Simulation in coronary artery anastomosis early in cardiothoracic surgical residency training: the Boot Camp experience.

    PubMed

    Fann, James I; Calhoon, John H; Carpenter, Andrea J; Merrill, Walter H; Brown, John W; Poston, Robert S; Kalani, Maziyar; Murray, Gordon F; Hicks, George L; Feins, Richard H

    2010-05-01

    We evaluated focused training in coronary artery anastomosis with a porcine heart model and portable task station. At "Boot Camp," 33 first-year cardiothoracic surgical residents participated in 4-hour coronary anastomosis sessions (6-7 attending surgeons per group of 8-9 residents). At beginning, midpoint, and session end, anastomosis components were assessed on a 3-point rating scale (1 good, 2 average, 3 below average). Performances were video recorded and reviewed by 3 surgeons in a blinded fashion. Participants completed questionnaires at session end, with follow-up surveys at 6 months. Ten to 18 end-to-side anastomoses with porcine model and task station were performed. Initial assessments ranged from 2.11 +/- 0.58 (forceps use) to 2.44 +/- 0.48 (needle angles). Midpoint scores ranged from 1.76 +/- 0.63 (forceps use) to 1.91 +/- 0.49 (needle angles). Session end scores ranged from 1.29 +/- 0.45 (needle holder use) to 1.58 +/- 0.50 (needle transfer and suture management and tension; P < .001). Video recordings confirmed improved performance (interrater reliability >0.5). All respondents agreed that task station and porcine model were good methods of training. At 6 months, respondents noted that the anastomosis session provided a basis for training; however, only slightly more than half continued to practice outside the operating room. Four-hour focused training with porcine model and task station resulted in improved ability to perform anastomoses. Boot Camp may be useful in preparing residents for coronary anastomosis in the clinical setting, but emphasis on simulation development and deliberate practice is necessary. Published by Mosby, Inc.

  12. Breast reconstruction with submuscular prosthesis after modified radical or simple mastectomy. Surgical technique and early complications.

    PubMed

    Asplund, O

    1983-01-01

    A series of 100 women who underwent breast reconstruction is reviewed. They had previously been treated for breast cancer with modified radical or simple mastectomy. The technique and early results of reconstruction are presented. The same surgeon performed all these operations and the technique was not varied. Emotional need for reconstruction was the main factor in patient selection. The interval between mastectomy and reconstruction was as a rule at least one year after removal of stage I cancer and 2-5 years in stage II cases. Scar correction was required significantly more often after oblique than after horizontal mastectomy incision. A submuscular pocket was created to accommodate the prosthesis and a muscle and fascia flap was used to add tissue and contour. No major early complications occurred. The submuscular implantation of prosthesis facilitated clinical follow-up. In a background population of breast cancer patients, the overall frequency of breast reconstruction was 4%. The figure for premenopausal patients with stage I breast cancer treated with modified radical mastectomy was 18%.

  13. Early functional rehabilitation versus traditional immobilization for surgical Achilles tendon repair after acute rupture: a systematic review of overlapping meta-analyses

    PubMed Central

    Zhao, Jia-Guo; Meng, Xiao-Hui; Liu, Lin; Zeng, Xian-Tie; Kan, Shi-Lian

    2017-01-01

    Several meta-analyses comparing early functional rehabilitation and traditional immobilization following surgical Achilles tendon repair after acute rupture have been published. However, they have led to conflicting conclusions. The aims of this systematic review were to select high-quality meta-analyses from multiple discordant meta-analyses and to provide a postoperative rehabilitation strategy following surgical repair using currently available evidence. We performed a comprehensive search using the PubMed and Embase databases and the Cochrane Library. Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to assess the methodological quality. Three investigators independently applied the Jadad decision algorithm. Their results were then compared to ensure selection of a meta-analysis that provided the highest quality of evidence. Six meta-analyses met the eligibility criteria. AMSTAR scores ranged from 6 to 10. According to the Jadad decision algorithm, a high-quality meta-analysis with a greater number of RCTs was selected. This meta-analysis showed that early functional rehabilitation was superior to cast immobilization in terms of patient satisfaction and the time to return to pre-morbid sporting levels. There were no differences regarding major complications or the time before return to prior employment and sporting activity. Thus, we recommend early functional rehabilitation as the postoperative strategy for acute Achilles tendon ruptures. PMID:28054658

  14. Design and Early Experience With a Real-World Surgical Registry.

    PubMed

    Weber LeBrun, Emily E; Lynch, Lauren D; Peterson, Hanna V; Pena, Savannah Rose; Ruder, Kara; Vasilopoulos, Terrie

    2017-07-10

    We describe the rationale, design, and methods and 6-year experience with a real-world surgical registry for female pelvic reconstructive and incontinence procedures and postoperative outcomes. The primary goal of creating this registry was to establish the feasibility of prospective data capture for all urogynecologic procedures. Data captured included baseline demographics, surgical procedures, perioperative complications, and subjective and objective findings up to 36 months after surgery. The Pelvic Reconstruction and Incontinence Surgery ± Mesh Registry was developed over 3 years to include 194 unique variables for prospective data capture. The registry was implemented in December 2010, and data from 924 separate case events from a single surgeon were recorded, comprising 100% surgical case capture. Cases included a variety of procedures representing a comprehensive urogynecology practice on 804 unique patients. Patients who were asked to participate in long-term follow-up (n = 299) returned with attendance of 96% at 6 weeks, 64% at 6 months, 51% at 12 months, 39% at 24 months, and 22% at 36 months. The Pelvic Reconstruction and Incontinence Surgery ± Mesh Registry effectively captured all urogynecologic procedures for the purpose of quality improvement. This real-world tool demonstrates that 100% case capture is feasible and provides valuable information for the highly motivated surgeon, although adequate long-term follow-up is limited. Additional research is needed to better understand the role of surgical registries for quality improvement and development of patient-centered strategies to increase long-term follow-up.

  15. Severity of lung fibrosis affects early surgical outcomes of lung cancer among patients with combined pulmonary fibrosis and emphysema.

    PubMed

    Mimae, Takahiro; Suzuki, Kenji; Tsuboi, Masahiro; Ikeda, Norihiko; Takamochi, Kazuya; Aokage, Keiju; Shimada, Yoshihisa; Miyata, Yoshihiro; Okada, Morihito

    2016-07-01

    Combined pulmonary fibrosis and emphysema (CPFE) is defined as upper lobe emphysema and lower lobe fibrosis, which are representative lung disorders that increase the prevalence of lung cancer. This unique disorder may affect the morbidity and mortality during the early period after surgery. The present study aimed to identify which clinicopathological features significantly affect early surgical outcomes after lung resection in nonsmall cell lung cancer (NSCLC) patients and in those with CPFE.We retrospectively assessed 2295 patients with NSCLC and found that 151 (6.6%) had CPFE. All were surgically treated between January 2008 and December 2010 at 4 institutions.The postoperative complication rates for patients with and without CPFE were 39% and 17%, respectively. The 90-day mortality rates were higher among patients with than without CPFE (7.9% vs 1%). Acute exacerbation of interstitial pneumonia was the main cause of death among 12 patients with CPFE who died within 90 days after surgery. Multivariate logistic regression analysis selected CPFE, gender, age, and clinical stage as independent predictive factors for postoperative complications, and CPFE, clinical stage, and sex for 90-day mortality. The severity of lung fibrosis on preoperative CT images was an independent predictive factor for 90-day mortality among patients with CPFE.The key predictive factor for postoperative mortality and complications of lung resection for NSCLC was CPFE. The severity of lung fibrosis was the principal predictor of early outcomes after lung surgery among patients with CPFE and NSCLC.

  16. [The application of argon plasma coagulation in thoracic surgery: principles, surgical technique and clinical results].

    PubMed

    Radev, R; Nenkov, R; Kornovski, S; Dokov, V; Kuzmanov, Ia; Kuzmanov, S; Nenkova, S; Nanev, B

    2004-01-01

    In recent years, together with the well-known high-frequency electro-coagulation, the application of plasma coagulation has been also introduced in the clinical practice. The argon plasma coagulator (APC) is one of the representatives of this surgical technique. By its nature, the APC represents a non-contact electrothermal tissue coagulation, combining the principle of the augmented surface and enhanced autogenous haemostatic mechanisms. The main objective of this study was to evaluate whether APC is an effective and safe modality in the open pulmonary surgery. For the period from 01.01.2003 to 30.01.2004 year, in the Clinic of Thoracic Surgery, we have applied the technique of APC to 15 patients. The distribution by sex was: 10 males and 5 females. According to the nosological units, the distribution was as follows: pulmonary carcinoma in 3, pulmonary echinococcosis in 4, pleural empyema in 6, pulmonary abscessus in 1 and esophageal ahalasia in 1 patient. In our practice, we have used an argon plasma coagulator of BERCHTOLD GmbH. A power setting of 20W with exposition time 15 s and an argon gas flow setting of 1,5-2 1/h have been used in our series. Energy dose applied in our patients didn't exceed 300 J/cm2. The results we have obtained demonstrate the following fundamental advantages of APC: a possibility to work with long electrode--tissue distance; a possibility for large surface coagulation as well as coagulation under variable angle, limited and well controlled depth of penetration, substantial reduction of carbonization; regular distribution of the energy over the whole coagulating surface, a possibility to treat effectively larger bleeding surfaces. Although initial, our experience gives us the confidence to recommend the use of APC as an effective and safe procedure in the pulmonary surgery.

  17. Outcomes of Concurrent Operations: Results From the American College of Surgeons' National Surgical Quality Improvement Program.

    PubMed

    Liu, Jason B; Berian, Julia R; Ban, Kristen A; Liu, Yaoming; Cohen, Mark E; Angelos, Peter; Matthews, Jeffrey B; Hoyt, David B; Hall, Bruce L; Ko, Clifford Y

    2017-09-01

    To determine whether concurrently performed operations are associated with an increased risk for adverse events. Concurrent operations occur when a surgeon is simultaneously responsible for critical portions of 2 or more operations. How this practice affects patient outcomes is unknown. Using American College of Surgeons' National Surgical Quality Improvement Program data from 2014 to 2015, operations were considered concurrent if they overlapped by ≥60 minutes or in their entirety. Propensity-score-matched cohorts were constructed to compare death or serious morbidity (DSM), unplanned reoperation, and unplanned readmission in concurrent versus non-concurrent operations. Multilevel hierarchical regression was used to account for the clustered nature of the data while controlling for procedure and case mix. There were 1430 (32.3%) surgeons from 390 (77.7%) hospitals who performed 12,010 (2.3%) concurrent operations. Plastic surgery (n = 393 [13.7%]), otolaryngology (n = 470 [11.2%]), and neurosurgery (n = 2067 [8.4%]) were specialties with the highest proportion of concurrent operations. Spine procedures were the most frequent concurrent procedures overall (n = 2059/12,010 [17.1%]). Unadjusted rates of DSM (9.0% vs 7.1%; P < 0.001), reoperation (3.6% vs 2.7%; P < 0.001), and readmission (6.9% vs 5.1%; P < 0.001) were greater in the concurrent operation cohort versus the non-concurrent. After propensity score matching and risk-adjustment, there was no significant association of concurrence with DSM (odds ratio [OR] 1.08; 95% confidence interval [CI] 0.96-1.21), reoperation (OR 1.16; 95% CI 0.96-1.40), or readmission (OR 1.14; 95% CI 0.99-1.29). In these analyses, concurrent operations were not detected to increase the risk for adverse outcomes. These results do not lessen the need for further studies, continuous self-regulation and proactive disclosure to patients.

  18. Clinical characteristics of patients with asymptomatic intracranial meningiomas and results of their surgical management.

    PubMed

    Zeng, Lingcheng; Wang, Long; Ye, Fei; Chen, Jingcao; Lei, Ting; Chen, Jian

    2015-07-01

    Surgery performed during the asymptomatic phase of meningioma remains controversial. The effects of surgery and the factors associated with postsurgical complications and patient prognosis were studied to optimize surgical decisions for clinicians who treat asymptomatic patients. The medical records of 513 patients with meningiomas (112 patients were asymptomatic) treated at our hospital from May 2007 to April 2012 were retrospectively reviewed. The results were analyzed with univariate and multivariate analyses. Asymptomatic meningiomas were characterized by a more common cerebral hemispheric location, a smaller size, and a lack of peritumoral edema. A significantly higher Simpson I resection rate of 95.2 % was achieved in tumors located in the cerebral hemisphere; in contrast, a rate of 66.7 % was obtained in tumors located at the skull base (P = 0.003). The overall postsurgical complication rate was 13.6 %, which was lower than the rate of 21.7 % in the symptomatic patients. Hemiplegia was the most common complication, which occurred most often in the patients with tumors in parietal locations (P = 0.015). Ninety-two percent of the asymptomatic patients achieved a Glasgow Outcome Scale (GOS) score of 5 1 year after the operation, and significantly more patients younger than 60 years of age obtained a GOS score of 5 compared with patients older than 60 years of age (P = 0.006). To achieve maximal tumor resection and good patient recovery, tumor location and patient age should be carefully considered prior to choosing to perform surgery in asymptomatic patients.

  19. Results of surgical correction of abnormalities associated with brachycephalic airway obstruction syndrome in dogs in Australia.

    PubMed

    Torrez, C V; Hunt, G B

    2006-03-01

    To describe clinical features of brachycephalic airway obstructive disease in dogs, the incidence of laryngeal collapse in dogs presenting for surgery and the outcome after surgery in dogs with laryngeal collapse. Basic clinical details were reviewed retrospectively in 73 dogs. Presence of laryngeal collapse and short-term outcomes after surgery were determined for 64 dogs with complete medical records. Long-term outcomes were reviewed for 46 dogs by telephone survey between 19 and 77 months following surgery. Stenotic nares were present in 31 dogs (42.5 per cent), elongated soft palate in 63 (86.3 per cent) and everted laryngeal saccules in 43 (58.9 per cent). The most common breeds were the pug (19 dogs, 26 per cent), Cavalier King Charles spaniel (15 dogs, 20.5 per cent), British bulldog (14 dogs, 19.2 per cent) and Staffordshire bull terrier (4 dogs, 5.5 per cent). Laryngeal collapse was present in 34 of 64 (53 per cent) dogs. No dogs died perioperatively and only one dog was euthanased as a result of its respiratory disease three years after surgery. Telephone interviews indicated that 26 dogs (56.5 per cent) were much improved after surgery, 15 (32.6 per cent) had some improvement and 5 (10.9 per cent) showed no improvement. Signs that persisted after surgery were snoring during sleep (34 dogs, 73.9 per cent), stertor/stridor while conscious (23 dogs, 50 per cent), excessive panting (13 dogs, 28.3 per cent) and dyspnoea (10 dogs, 21.7 per cent). Long-term outcome was considered good, even in dogs with laryngeal collapse. Laryngeal collapse is relatively common in dogs presented for surgical correction of brachycephalic airway obstructive disease. Dogs with severe laryngeal collapse often respond well to surgery. Clinical signs rarely resolve completely following surgery.

  20. Earlier surgical intervention in congenital heart disease results in better outcome and resource utilization

    PubMed Central

    2011-01-01

    Background Congenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively; among patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan. Methods A prevalence based cost of illness study design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children ≤ 5 years of age from June 2006 to June 2009. A total of 120 patients were enrolled after obtaining an informed consent and the data was collected using a pre-tested questionnaire. Results The mean age at the time of surgery in group A (1-12 mo age) was 6.08 ± 2.80 months and in group B (1-5 yrs) was 37.10 ± 19.94 months. The cost of surgical admission was found to be significantly higher in the older group, p = 0.001. The total number and cost of post-operative outpatient visits was also higher in group B, p = 0.003. Pre and post operative hospital admissions were not found to be significantly different among the two groups, p = 0.166 and 0.627, respectively. The number of complications were found to be different between the two groups (p = 0.019). Majority of these were contributed by hemorrhage and post-operative seizures. Conclusion This study concluded that significant expenditure is incurred by people with CHD; with the implication that resources could be saved by earlier detection and awareness campaigns. PMID:22206493

  1. [Implementation and evaluation of error prevention measures in surgical clinics: Results of a current online survey].

    PubMed

    Rothmund, Matthias; Kohlmann, Thomas; Heidecke, Claus-Dieter; Siebert, Hartmut; Ansorg, Jörg

    2015-01-01

    In the autumn of 2014, more than 3,000 surgeons completed an online questionnaire asking for the prevalence and efficiency of instruments to prevent adverse events within surgical departments in Germany. About 90 % of the respondents stated that perioperative checklists, preoperative marking of the surgical site and the documentation of hospital infections had been implemented in their institution; and 75 % of the institutions had introduced critical incident reporting systems (CIRS), morbidity and mortality conferences and identification bracelets for patients. The surgeons were asked to rank the different instruments for the prevention of adverse events. According to the respondents, preoperative marking of the surgical site and the use of checklists were at the top of the efficacy ranking, followed by an introductory course for surgeons starting work in a hospital or when new devices became available. Only 50 % of the responding surgeons perceived CIRS as being efficient. Overall, the answers showed that instruments to increase patient safety were commonly available in surgical departments. On the other hand, there is still room for improvement in daily practice. Copyright © 2015. Published by Elsevier GmbH.

  2. Same day discharge, surgical training and early complications after open and laparoscopic repair of primary paraumbilical hernia.

    PubMed

    Shaikh, I; Willder, J M; Kumar, S

    2013-08-01

    The aims of this study were to compare same day discharges and early complications after open and laparoscopic primary paraumbilical hernia (PUH) repair, including the procedures performed by surgical trainees (STs). All patients who had open (suture or mesh) and laparoscopic repair of primary PUH in the Day Surgery Unit (DSU) between January 2007 and June 2009 were identified from the hospital database. The database was questioned regarding the grade of operating surgeon, type of surgical repair, day of admission and discharge from the DSU, and a patient's return to surgical services. Data were stored in Microsoft Excel(®) (TM 2007). Statistical significance was determined using Fisher's exact test. PUH was repaired in 337 patients: 252/337 (74.8 %) had open and 85/337 (25.2 %) had laparoscopic repair. Significantly, more patients were discharged home on the day of surgery after an open repair compared to the laparoscopic repair: open repair 187/252 (74.2 %), laparoscopic repair 35/85 (41.17 %), P = 0.0001. Overall early complications such as wound complications and hospital re-visits were similar in both groups: open repair 6.3 % (16/252), laparoscopic repair 11.7 % (10/85), P = 0.1554. STs performed 142/337 (42.1 %) of the PUH repairs with similar same day discharges from the DSU: STs 64.7 % (92/142), consultant surgeons 66.7 % (130/195), P = 0.7285. The difference in hernia recurrence between open repair 7/252 (2.78 %) and laparoscopic group 0/85 was not significant (P = 0.1985). Patients with PUH repair were more likely to go home on the day of surgery after open than after laparoscopic repair. This was not affected by the grade of the operating surgeon. Early complications were similar following open and laparoscopic repair of primary PUH.

  3. Early Results of the NASA Convection and Moisture Experiment (CAMEX)

    NASA Technical Reports Server (NTRS)

    Hood, Robbie; Kakar, Ramesh

    2004-01-01

    As reported at previous sessions of the Interdepartmental Hurricane Conference, the Office of Earth Science within the National Aeronautics and Space Administration (NASA) has been sponsoring the Convection And Moisture Experiment (CAMEX) since 1993. Although originally designed to support satellite calibration and validation activities and to demonstrate new remote sensing technology pertinent to the global water cycle, the CAMEX research objectives have evolved to include a strong emphasis on hurricane observational studies. A hallmark of CAMEX success has been fruitful research collaborations with the Hurricane Research Division (HRD) of the National Oceanic and Atmospheric Administration (NOAA) and the Hurricanes At Landfall Initiative of the United States Weather Research Program. Satellite, aircraft, and ground-based observations collected during the 1998 and 200 1 field phases of CAMEX represent a wealth of information describing the three dimensional structure of tropical cyclones. Early research results gleaned from these observations have been submitted to a special issue of the American Meteorological Society Journal of Atmospheric Sciences. An overview of these early findings and their expected significance to the operational community will be presented during this talk.

  4. Early removal of a Maverick disc prosthesis: surgical findings and morphological changes.

    PubMed

    François, Jens; Coessens, Ronald; Lauweryns, Philippe

    2007-02-01

    We report the case of a patient who underwent explantation of a Maverick total disc prosthesis at the L5S1 level because of severe persisting pain one year after initial implantation. Dynamic radiographic imaging studies showed good position and size of the prosthesis and no evidence of loosening. Intraoperatively residual mobility at the proximal bone-prosthesis interface was detected, as well as gross metallosis around the articulation of the total disc prosthesis. A safe and straightforward technique for the extraction of a Maverick prosthesis using a hooked instrument to hook-on the keel of the device is reported. After removal of the device, an anterior lumbar interbody fusion with subsequent posterior pedicle screw fixation and posterior bone grafting with autologous iliac bone was performed (360 degrees fusion). During this posterior procedure, severe L5S1 facet joint arthrosis was observed. Early clinical and radiographic results were good with excellent patient satisfaction.

  5. [Surgical treatment of blunt liver trauma, indications for surgery and results].

    PubMed

    Morales Uribe, Carlos H; López, Carolina Arenas; Cote, Juan Camilo Correa; Franco, Sebastián Tobón; Saldarriaga, Maria Fernanda; Mosquera, Jackson; Villegas Lanau, María I

    2014-01-01

    The liver is the most frequently injured organ in blunt abdominal trauma. Patients that are hemodynamically unstable must undergo inmmediate surgical treatment. There are 2 surgical approaches for these patients; Anatomical Liver resection or non-anatomic liver resection. Around 80-90% of patients are candidates for non-operative management. -Several risk factors have been studied to select the patients most suited for a non operative management. We performed a retrospective study based on a prospective database. We searched for risk factors related to immediate surgical management and failed non-operative management. We also described the surgical procedures that were undertaken in this cohort of patients and their outcomes and complications. During the study period 117 patients presented with blunt liver trauma. 19 patients (16.2%) required a laparotomy during the initial 24h after their admission. There were 11 deaths (58%) amongst these patients. Peri-hepatic packing and suturing were the most common procedures performed. A RTS Score<7.8 (RR: 7.3; IC 95%: 1.8-30.1), and ISS Score >20 (RR 2,5 IC 95%: 1.0-6.7), and associated intra-abdominal injuries (RR: 2.95; IC 95%: 1.25-6.92) were risk factors for immediate surgery. In 98 (83.7%) patients a non-operative management was performed. 7 patients had a failed non-operative management. The need for immediate surgical management is related to the presence of associated intra-abdominal injuries, and the ISS and RTS scores. In this series the most frequently performed procedure for blunt liver trauma was peri-hepatic packing. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  6. Reducing Length of Hospital Stay Does Not Increase Readmission Rates in Early-Stage Gastric, Colon, and Lung Cancer Surgical Cases in Japanese Acute Care Hospitals

    PubMed Central

    Kunisawa, Susumu; Fushimi, Kiyohide; Imanaka, Yuichi

    2016-01-01

    Background The Japanese government has worked to reduce the length of hospital stay by introducing a per-diem hospital payment system that financially incentivizes the timely discharge of patients. However, there are concerns that excessively reducing length of stay may reduce healthcare quality, such as increasing readmission rates. The objective of this study was to investigate the temporal changes in length of stay and readmission rates as quality indicators in Japanese acute care hospitals. Methods We used an administrative claims database under the Diagnosis Procedure Combination Per-Diem Payment System for Japanese hospitals. Using this database, we selected hospitals that provided data continuously from July 2010 to March 2014 to enable analyses of temporal changes in length of stay and readmission rates. We selected stage I (T1N0M0) gastric, colon, and lung cancer surgical patients who had been discharged alive from the index hospitalization. The outcome measures were length of stay during the index hospitalization and unplanned emergency readmissions within 30 days after discharge. Results From among 804 hospitals, we analyzed 42,585, 15,467, and 40,156 surgical patients for gastric, colon, and lung cancer, respectively. Length of stay was reduced by approximately 0.5 days per year. In contrast, readmission rates were generally stable at approximately 2% or had decreased slightly over the 4-year period. Conclusions In early-stage gastric, colon, and lung cancer surgical patients in Japan, reductions in length of stay did not result in increased readmission rates. PMID:27832182

  7. Predictors for Surgical Referral in Patients With Pancreatic Cystic Lesions Undergoing Endoscopic Ultrasound: Results From a Large Multicenter Cohort Study.

    PubMed

    Ge, Phillip S; Gaddam, Srinivas; Keach, Joseph W; Mullady, Daniel; Fukami, Norio; Edmundowicz, Steven A; Azar, Riad R; Shah, Raj J; Murad, Faris M; Kushnir, Vladimir M; Ghassemi, Kourosh F; Sedarat, Alireza; Watson, Rabindra R; Amateau, Stuart K; Brauer, Brian C; Yen, Roy D; Hosford, Lindsay; Hollander, Thomas; Donahue, Timothy R; Schulick, Richard D; Edil, Barish H; McCarter, Martin D; Gajdos, Csaba; Attwell, Augustin R; Muthusamy, V Raman; Early, Dayna S; Wani, Sachin

    2016-01-01

    Endoscopic ultrasound (EUS) plays an integral role in the evaluation of pancreatic cysts lesions (PCLs). The aim of the study was to determine predictors of surgical referral in patients with PCLs undergoing EUS. We performed a multicenter retrospective study of patients undergoing EUS for evaluation of PCLs. Demographics, EUS characteristics, and fine-needle aspiration results were recorded. Patients were categorized into surgery or surveillance groups on the basis of post-EUS recommendations. Univariate and multivariate analyses were performed to identify predictors of surgical referral. 1804 patients were included. 1301 patients were recommended to undergo surveillance and 503 patients were referred for surgical evaluation, of which 360 patients underwent surgery. Multivariate analysis revealed the following 5 independent predictors of surgical referral: symptoms of weight loss on presentation (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.44-5.03), EUS findings of associated solid mass (OR, 7.34; 95% CI, 3.81-14.16), main duct communication (OR, 4.13; 95% CI, 1.71-9.98), multilocular macrocystic morphology (OR, 2.79; 95% CI, 1.78-4.38), and fine-needle aspiration findings of mucin on cytology (OR, 3.06; 95% CI, 1.94-4.82). This study identifies factors associated with surgical referral in patients with PCLs undergoing EUS. Future studies should focus on creation of risk stratification models to determine the need for surgery or enrollment in surveillance programs.

  8. DEEP-South: Network Construction, Test Runs and Early Results

    NASA Astrophysics Data System (ADS)

    Moon, Hong-Kyu; Kim, Myung-Jin; Yim, Hong-Suh; Choi, Young-Jun; Bae, Young-Ho; Roh, Dong-Goo; Park, Jintae; Moon, Bora

    2016-01-01

    Korea Microlensing Telescope Network (KMTNet) which consists of three identical 1.6 m wide-field telescopes with 18k × 18k CCDs, is the first optical survey system of its kind. The combination of fast optics and the mosaic CCD delivers seeing limited images over a 4 square degrees field of view. The main science goal of KMTNet is the discovery and characterization of exoplanets, yet it also offers various other science applications including DEep Ecliptic Patrol of SOUTHern sky (DEEP-South). The aim of DEEP-South is to discover and characterize asteroids and comets, including Near Earth Objects (NEOs). We started test runs last February after commissioning, and will return to normal operations in October 2015. A summary of early results from the test runs will be presented.

  9. Early reoperation performed for the management of complications in patients undergoing general thoracic surgical procedures

    PubMed Central

    Foroulis, Christophoros N.; Kleontas, Athanasios; Karatzopoulos, Avgerinos; Nana, Chryssoula; Tagarakis, George; Tossios, Paschalis; Anastasiadis, Kyriakos

    2014-01-01

    Objective To detect the rate and predisposing factors for the development of postoperative complications requiring re-operation for their control in the immediate postoperative period. Methods During the time period 2009-2012, 719 patients (male: 71.62%, mean age: 54±19 years) who underwent a wide range of general thoracic surgery procedures, were retrospectively collected. Data of patients who underwent early re-operation for the management of postoperative complications were assessed for identification of the responsible causative factors. Results Overall, 33/719 patients (4.6%) underwent early re-operation to control postoperative complications. Early re-operation was obviated by the need to control bleeding or to drain clotted hemothoraces in nine cases (27.3%), to manage a prolonged air leak in six cases (18.2%), to drain a post-thoracotomy empyema in five cases (15.2%), to revise the thoracotomy incision or an ischemic musculocutaneous flap in five cases (15.2%), to manage a bronchopleural fistula in four cases (12.1%), to manage persistent atelectasis of the remaining lung in two cases (6.1%), to cease a chyle leak in one case (3%) and to plicate the right hemidiaphragm in another one case (3%). The factors responsible for the development of complications requiring reopening of the chest for their management were technical in 17 cases (51.5%), initial surgery for lung or pleural infections in 9 (27.3%), the recent antiplatelet drug administration in 4 (12.1%) and advanced lung emphysema in 3 (9.1%). Mortality of re-operations was 6.1% (2/33) and it was associated with the need to proceed with completion pneumonectomy in the two cases with persistent atelectasis of the remaining lung and permanent parenchymal damage. The majority of complications requiring reoperation were observed after lung parenchyma resection (17 out of the 228 procedures/7.4%) or pleurectomy (7 out of the 106 procedures/6.5%). Reoperations after video-assisted thoracic surgery (VATS

  10. Early results of HemiCAP(®) resurfacing implant.

    PubMed

    Aslan, Hakan; Citak, Mehmet; Bas, Emel Gonen; Duman, Evrim; Aydin, Erbil; Ates, Yalim

    2012-01-01

    Metallic implants in the first metatarsophalangeal (MTP) joint have been used for many years in the treatment of hallux rigidus (HR). The HemiCAP(®) prosthesis is the first implant used for resurfacing the metatarsal head in HR treatment. The aim of our study was to evaluate the early results of the HemiCAP(®) prosthesis for the treatment of HR. A total of 27 toes of 25 patients with MTP arthritis of the great toe were treated with an Arthrosurface(®)HemiCAP(®) resurfacing implant. The average follow-up time was 37.6 (range: 30 to 43) months. All patients were evaluated clinically and radiographically. Postoperative satisfaction and function were scored according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Pain was assessed with the use of a visual analogue scale (VAS) ranging from 0 to 10, with 0 indicating the absence of pain and 10 describing the worst pain imaginable. Mean preoperative AOFAS score improved from 40.94 (range: 25 to 63) to 85.1 (range: 54 to 98) at the final follow-up (p<0.0001). Preoperative average VAS pain scores improved from 8.30 preoperatively to 2.05 at the final follow-up (p<0.0001). The average MTP joint range of motion (ROM) the improved from 14.36 degrees preoperatively to 54.38 degrees at the final follow-up. No radiologic loosening or osteolysis was observed in patients with HemiCAP(®) implant. The early results of the HemiCAP(®) implant on the metatarsal head are promising. However, studies over a longer period involving more patients would be beneficial in terms of defining and reviewing the stability of the implant and any innovations in the treatment strategy for HR.

  11. Surgical Excision of a Symptomatic Thoracic Nerve Root Perineural Cyst Resulting in Complete Resolution of Symptoms: A Case Report.

    PubMed

    Aljuboori, Zaid; Yaseen, Alae; Simpson, Jessica; Boakye, Maxwell

    2017-06-12

    Tarlov (perineural) cysts of the nerve root are common and usually incidental findings during magnetic resonance imaging (MRI) of the lumbosacral spine. There are a few case reports where symptomatic thoracic perineural cysts have been described in the literature. We report a case of a high thoracic nerve root perineural cyst that failed conservative therapy, requiring surgical intervention. Our patient presented with radicular symptoms involving the left hand. Imaging workup revealed a cystic lesion of the left T1 nerve root at the level of the foramen. Surgical resection resulted in significant improvement in patient symptoms, and pathology revealed a perineural cyst. We conclude that a thoracic perineural (Tarlov) cyst can be symptomatic by causing nerve root compression and can be mistaken as a nerve root sheath tumor on imaging. Surgical treatment can be curative.

  12. Surgical Excision of a Symptomatic Thoracic Nerve Root Perineural Cyst Resulting in Complete Resolution of Symptoms: A Case Report

    PubMed Central

    Yaseen, Alae; Simpson, Jessica; Boakye, Maxwell

    2017-01-01

    Tarlov (perineural) cysts of the nerve root are common and usually incidental findings during magnetic resonance imaging (MRI) of the lumbosacral spine. There are a few case reports where symptomatic thoracic perineural cysts have been described in the literature. We report a case of a high thoracic nerve root perineural cyst that failed conservative therapy, requiring surgical intervention. Our patient presented with radicular symptoms involving the left hand. Imaging workup revealed a cystic lesion of the left T1 nerve root at the level of the foramen. Surgical resection resulted in significant improvement in patient symptoms, and pathology revealed a perineural cyst. We conclude that a thoracic perineural (Tarlov) cyst can be symptomatic by causing nerve root compression and can be mistaken as a nerve root sheath tumor on imaging. Surgical treatment can be curative. PMID:28706767

  13. [Gallstone ileus as a cause of acute abdomen. Importance of early diagnosis for surgical treatment].

    PubMed

    Martín-Pérez, Jesica; Delgado-Plasencia, Luciano; Bravo-Gutiérrez, Alberto; Burillo-Putze, Guillermo; Martínez-Riera, Antonio; Alarcó-Hernández, Antonio; Medina-Arana y, Vicente

    2013-10-01

    Gallstone ileus is an uncommon type of mechanical intestinal obstruction caused by an intraluminal gallstone, and preoperative diagnosis is difficult in the Emergency department. This study is a retrospective analysis of the clinical presentation of 5 patients with gallstone ileus treated between 2000-2010. Clinical features, diagnostic testing, and surgical treatment were analyzed. Five patients were included: 2 cases showed bowel obstruction; 2 patients presented a recurrent gallstone ileus with prior surgical intervention; and one patient presented acute peritonitis due to perforation of an ileal diverticula. In all cases CT confirmed the preoperative diagnosis. In our experience, gallstone ileus may present with clinical features other than intestinal obstruction. In suspicious cases CT may be useful to decrease diagnostic delay, which is associated with more complications.

  14. Early Results of a New Rotating Hinge Knee Implant

    PubMed Central

    Neuhaus, Hans-Joachim; Miehlke, Rolf; Schuh, Reinhard; Kubista, Bernd

    2014-01-01

    Background. Indication for rotating hinge (RH) total knee arthroplasty (TKA) includes primary and revision cases, with contradictory results. The aim of this study was to report prospective early results of a new modular rotating hinge TKA (EnduRo). For this implant several new design features and a new bearing material (carbon-fiber reinforced poly-ether-ether-ketone) have been developed. Furthermore, we tried to establish a new classification of failure modes for revision TKA. Methods. 152 EnduRo rotating-hinge prostheses were implanted in two centers. In 90 patients a primary implantation has been performed and 62 patients were revision cases. Knee Society Score (KSS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), and Range of motion (ROM) were assessed before surgery, 3 months postoperatively, 12 months postoperatively, and annually thereafter. We defined 3 types of complications: Type 1, infection; type 2, periprosthetic complications; type 3, implant failures. Results. KSS, WOMAC, OKS, and ROM revealed significant improvements between the preoperative and the follow-up investigations. There were 14 complications (9.2%) leading to revision surgery, predominantly type 2. Conclusion. Our study shows excellent clinical results of the EnduRo TKA. Furthermore, no premature material failure or unusual biological response to the new bearing material could be detected. PMID:25089279

  15. Surgical treatment of non-early gastric remnant carcinoma developing after distal gastrectomy for gastric cancer.

    PubMed

    Ohashi, Masaki; Morita, Shinji; Fukagawa, Takeo; Kushima, Ryoji; Katai, Hitoshi

    2015-02-01

    The optimal surgical procedure for gastric remnant carcinoma (GRC) remains debatable. The aim of this study was to retrospectively evaluate the surgical treatments for T2-4 GRC developing after distal gastrectomy for gastric cancer. Between 1970 and 2012, a total of 50 patients underwent R0 resection for T2-4 GRC. The clinicopathologic features, therapeutic methods, and follow-up data of these patients were reviewed. The tumor was located at a non-anastomotic site of the remnant stomach in 43 of the 50 patients. Total gastrectomy was performed in 48 patients and partial gastrectomy was in two patients. Lymph node metastasis was found in 19 patients. Major postoperative complications occurred in 16 patients. The overall 1-, 3-, and 5-year survival rates of the 50 patients were 90%, 66%, and 44%, respectively. Presence of small intestinal or esophageal infiltration and postoperative complications was independently associated with poorer survival. Dissection of the perigastric and splenic hilar/artery nodes was found to have potential therapeutic benefit. Surgical resection for T2-4 GRC developing after distal gastrectomy for gastric cancer can be invasive, but is feasible and effective. Total gastrectomy with splenectomy is one of the recommendable procedures for this disease. © 2014 Wiley Periodicals, Inc.

  16. Nurses' 'worry' as predictor of deteriorating surgical ward patients: A prospective cohort study of the Dutch-Early-Nurse-Worry-Indicator-Score.

    PubMed

    Douw, Gooske; Huisman-de Waal, Getty; van Zanten, Arthur R H; van der Hoeven, Johannes G; Schoonhoven, Lisette

    2016-07-01

    Nurses' 'worry' is used as a calling criterion in many Rapid Response Systems, however it is valued inconsistently. Furthermore, barriers to call the Rapid Response Team can cause delay in escalating care. The literature identifies nine indicators which trigger nurses to worry about a patient's condition. The objective of this study is to determine the significance of nurses' 'worry' and/or indicators underlying 'worry' to predict unplanned Intensive-Care/High-Dependency-Unit admission or unexpected mortality among surgical ward patients. A prospective cohort study. A 500-bed tertiary University affiliated teaching hospital. Adult, native speaking surgical patients, admitted to three surgical wards (traumatology, vascular- and abdominal/oncological surgery). We excluded patients with a non-ICU policy or with no curative treatment. Mentally incapacitated patients were also excluded. We developed a new clinical assessment tool, the Dutch-Early-Nurse-Worry-Indicator-Score (DENWIS) based on signs underlying 'worry'. Nurses systematically scored their 'worry' and the DENWIS once per shift or at any moment of 'worry'. DENWIS measurements were linked to routinely measured vital signs. The composite endpoint was unplanned Intensive-Care/High-Dependency-Unit admission or unexpected mortality. The DENWIS-indicators were included in a univariate and multivariate logistic regression analysis, subsequently inserting 'worry' and the Early Warning Score into the model. We calculated the area under the receiver-operating characteristics curve. In 3522 patients there were 102 (2.9%) patients with unplanned Intensive Care Unit/High Dependency Unit-admissions or unexpected mortality. 'Worry' (0.81) and the DENWIS-model (0.85) had a lower area under the receiver-operating characteristics curve than the Early Warning Score (0.86). Adding 'worry' and the Early Warning Score to the DENWIS-model resulted in higher areas under the receiver operating characteristics curves (0.87 and 0

  17. [Tubulo-villous rectal tumours. Results of surgical resection in relation to histotype (30 years' experience)].

    PubMed

    Carditello, Antonio; Milone, Antonino; Paparo, Domenica; Anastasi, Giuliana; Mollo, Francesco; Stilo, Francesco

    2004-01-01

    Adenomas of the rectum are frequently found during endoscopic examination. We report on our 30 years of experience with the treatment of tubulo-villous adenomas based on histotype. Between 1971 and 2001, 104 villous tumours of the rectum were treated surgically. The patients' average age was 65 years. These were sessile tumours in 69% of cases, pedunculated in 17.5% and flowing tumours in 13.5%. The mean tumour size was 3 cm. They were associated with colon cancer in 15% of cases and with polyadenoma in 10%. They were located in the rectum within 0 to 6 cm of the anal margin in half the cases. These tumours were treated by local excision in 74 cases and by wide excision in 30 cases. The malignant potential of the tumours was 30%, including 10% invasive malignancy. There were no surgical fatalities, but a 6% medical fatality rate was registered. There was a 20% complication rate related to the surgical technique. Twenty patients were lost to follow-up. Out of 84 villous tumours, monitored over a mean survival period of 6.5 years, there were 24 recurrences: 18 underwent endoscopic excision and in 6 cases a wide resection. The various tumour resection techniques and the operative indications of variable difficulty are presented. It would seem, at present, that total resection of the rectum with a colo-anal anastomosis is the best treatment for large flowing villous tumours occupying almost the entire rectum. Thorough preoperative examination and the mastering of various surgical procedures should allow the most suitable choice of treatment for each individual case.

  18. Malnutrition risk predicts surgical outcomes in patients undergoing gastrointestinal operations: Results of a prospective study.

    PubMed

    Ho, Judy W C; Wu, Arthur H W; Lee, Michelle W K; Lau, So-ying; Lam, Pui-shan; Lau, Wai-shan; Kwok, Sam S S; Kwan, Rosa Y H; Lam, Cheuk-fan; Tam, Chun-kit; Lee, Suk-on

    2015-08-01

    Patients undergoing gastrointestinal operations are at risk of malnutrition which may increase the chance of adverse surgical outcomes. This prospective study aimed at correlating nutritional status of patients having gastrointestinal operations with their short-term surgical outcomes captured by a territory-wide Surgical Outcomes Monitoring and Improvement Program. The preoperative malnutrition risk of Chinese adult patients undergoing elective/emergency ultra-major/major gastrointestinal operations in two surgical departments over a 12-month period were assessed by Chinese version of Malnutrition Universal Screening Tool. Their perioperative risk factors and clinical outcomes, including length of hospital stay, mortality and morbidity, were retrieved from the above mentioned program. Correlation of malnutrition risk with clinical outcomes was assessed by logistic regression analysis after controlling for known confounders. 943 patients (58% male; mean age 65.9 ± 14.8 years) underwent gastrointestinal operations (40.3% emergency operation; 52.7% ultra-major procedures; 66.9% bowel resections) had analyzable data. 15.8% and 17.1% of patients were at medium and high risk of malnutrition, respectively. Malnutrition risk score according to the screening tool was an independent predictor of length of hospital stay, 30-day mortality, 60-day mortality and minor medical complications. Similar correlations were found for various sub-scores of malnutrition risk. Weight loss sub-score was predictive of 30-day mortality, 60-day mortality and minor medical complications. Body mass index was predictive of mortality (30- and 60- day) whereas the acute disease sub-score was predictive of length of hospital stay. Preoperative malnutrition was an important predictor of poor clinical outcomes in patients undergoing gastrointestinal operations in Hong Kong. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  19. Surgical treatment of acetabular fractures in the elderly: a systematic review of the results

    PubMed Central

    Capone, Antomio; Peri, Marcella; Mastio, Michele

    2017-01-01

    We performed a systematic review of the literature involving a number of databases to identify studies that included outcomes of surgical treatment of acetabular fractures in patients aged > 55 years. An initial search identified 1564 studies. After exclusion by two independent reviewers, 15 studies met the inclusion criteria. All studies were case series and the mean Coleman Methodology score for methodological quality assessment was 43.7 (standard deviation 12.3). There were 354 patients with acetabular fractures. Pooled analysis revealed a mean age of 71.6 years (55 to 96) and a mean follow-up of 43 months (20 to 188). Complex fractures were reported in 70.1% of patients. Seven studies presented the results of open reduction and internal fixation (ORIF); in eight other studies a total hip arthroplasty (THA), alone or combined with different internal fixation techniques, was the chosen treatment. In the ORIF sub-group, conversion to THA was performed at a mean of 25.5 months with anatomical reduction in 11.6% and imperfect and poor reduction in 22.3%. In the THA sub-group, an acetabular ring or cage with a cemented acetabular component was used in four studies (52 patients) and a cementless acetabular component was implanted in five studies (78 patients). Six patients (4.9%) underwent revision at a mean of 39 months after the index procedure. The analysis of intra-operative and post-operative parameters showed a statistical difference between the two sub-groups with regards to the mean operating time (236 mins ORIF vs 178 mins THA), the mean blood loss (707 mL ORIF vs 974 mL THA) and the mean mortality rate at one year (22.6% ORIF vs 8.8% THA). Based on the current data available, acute THA (alone or in combination with internal fixation) may have a role in the treatment of older patients with complex acetabular fractures. Despite the wide heterogenecity of fracture types and patient co-morbidities, THA procedures were associated with lower rates of mortality and

  20. Does cognitive functioning predict chronic pain? Results from a prospective surgical cohort.

    PubMed

    Attal, Nadine; Masselin-Dubois, Anne; Martinez, Valéria; Jayr, Christian; Albi, Aline; Fermanian, Jacques; Bouhassira, Didier; Baudic, Sophie

    2014-03-01

    It is well established that chronic pain impairs cognition, particularly memory, attention and mental flexibility. Overlaps have been found between the brain regions involved in pain modulation and cognition, including in particular the prefrontal cortex and the anterior cingulate cortex, which are involved in executive function, attention and memory. However, whether cognitive function may predict chronic pain has not been investigated. We addressed this question in surgical patients, because such patients can be followed prospectively and may have no pain before surgery. In this prospective longitudinal study, we investigated the links between executive function, visual memory and attention, as assessed by clinical measurements and the development of chronic pain, its severity and neuropathic symptoms (based on the 'Douleur Neuropathique 4' questionnaire), 6 and 12 months after surgery (total knee arthroplasty for osteoarthritis or breast surgery for cancer). Neuropsychological tests included the Trail-Making Test A and B, and the Rey-Osterrieth Complex Figure copy and immediate recall, which assess cognitive flexibility, visuospatial processing and visual memory. Anxiety, depression and coping strategies were also evaluated. In total, we investigated 189 patients before surgery: 96% were re-evaluated at 6 months, and 88% at 12 months. Multivariate logistic regression (stepwise selection) for the total group of patients indicated that the presence of clinical meaningful pain at 6 and 12 months (pain intensity ≥ 3/10) was predicted by poorer cognitive performance in the Trail Making Test B (P = 0.0009 and 0.02 for pain at 6 and 12 months, respectively), Rey-Osterrieth Complex Figure copy (P = 0.015 and 0.006 for pain at 6 and 12 months, respectively) and recall (P = 0.016 for pain at 12 months), independently of affective variables. Linear regression analyses indicated that impaired scores on these tests predicted pain intensity (P < 0.01) and neuropathic

  1. Bronchoscopic phototherapy at comparable dose rates: Early results

    SciTech Connect

    Pass, H.I.; Delaney, T.; Smith, P.D.; Bonner, R.; Russo, A.

    1989-05-01

    Photodynamic therapy is a recently introduced treatment for surface malignancies. Since January 1987, 10 patients with endobronchial neoplasms have had bronchoscopic photodynamic therapy at similar dose rates (400 mW/cm) for total atelectasis (2), carinal narrowing with respiratory insufficiency (2), or partial obstruction without collapse (4). Two patients underwent photodynamic therapy as a preliminary to immunotherapy. Histologies included endobronchial metastases (colon, ovary, melanoma, and sarcoma, 1 each; and renal cell, 3) and primary lung cancer (3). The 2 patients with total atelectasis had complete reexpansion after photodynamic therapy, which permitted eventual sleeve lobectomy in 1. Carinal narrowing was ameliorated in the 2 patients seen with inspiratory stridor, thereby permitting hospital discharge. Endoscopically resected fragments after photodynamic therapy exhibited avascular necrosis. These data support further controlled studies of photodynamic therapy by thoracic surgical oncologists to define its limitations as well as to improve and expand its efficacy as a palliative or surgical adjuvant.

  2. Early Results from the MAVEN IUVS Echelle Channel

    NASA Astrophysics Data System (ADS)

    Clarke, J. T.; Mayyasi, M.; Schneider, N. M.; Deighan, J.; Stewart, I. F.; McClintock, B.; Jakosky, B. M.; Bhattacharyya, D.

    2015-12-01

    The IUVS instrument on MAVEN contains the first echelle spectrograph to be sent to another planet. The system has a novel optical design to enable long-aperture measurements of emission lines in the absence of continuum, intended primarily to measure the H and D Ly αlpha emission lines and thereby the D/H ratio from the martian upper atmosphere. The system also detects the OI 1304 triplet with the three component lines well resolved. The main scientific goal of the echelle channel is to measure the H and D Ly αlpha emissions, and to discover how the H and D densities, temperatures, and escape fluxes vary with location, season, topography, etc. The global D/H ratio of the martian atmosphere is roughly 5 times higher than in the terrestrial atmosphere due to the escape of a large volume of water into space, likely early in the history of Mars. Since H atoms escape faster than D atoms, the D/H ratio increases with time as more water is lost. Recent IR observations indicate large variations in the D/H ratio in the lower atmosphere from location to location, and possibly seasonal changes [Villanueva et al. 2015]. HST and MEX measurements of the H corona of Mars show large (order of magnitude) changes in the H exosphere and escape flux with changing seasons and/or heliospheric distance [Clarke et al. 2014; Chaffin et al. 2014]. Do the same variations apply to deuterium? Are there similar variations in the D/H ratio? Early results from the echelle channel will be presented.

  3. Late surgical results of reattachment to bone in repair of chronic lateral epicondylitis.

    PubMed

    Pruzansky, Mark E; Gantsoudes, George D; Watters, Nathan

    2009-06-01

    All cases of lateral epicondylitis surgically treated in Dr. Pruzansky's office practice between October 1986 and December 2005 yielded 24 elbows for this study. Patients were treated with surgical débridement and direct repair to bone through bone tunnels (18 elbows), repair with suture anchors (3 elbows), or augmentation with autologous tendon graft and reattachment to bone via suture anchors (3 elbows). This series represents the earliest reattachment cases to be reported, and with the longest follow-up. Mean follow-up (both telephone and office interviews) was 64.7 months. All patients reported satisfaction and graded their outcomes as good or excellent. Mean time to full painless preinjury level of use of the elbow was 4.3 months for patients who underwent simple repair and 2.75 months for patients repaired with a graft. Surgical reattachment of the débrided extensor tendon of origin of the elbow to bone, either directly or with autologous tendon graft, provided pain relief and return to preinjury level of function in a predictable manner. Both primary repair and tendon graft procedures can be used in primary and salvage surgeries in tennis elbow cases in which conservative treatment fails.

  4. Effect of different hormonal therapies on thyroid function in surgical menopause: short-term results.

    PubMed

    Erel, C Tamer; Gezer, Altay; Sentürk, Levent M; Somunkiran, Asli; Kaleli, Semih; Seyisoglu, Hakan

    2007-12-01

    To determine the effects of different hormone replacement therapy (HRT) regimens on thyroid function in surgical menopause. In a randomized, controlled study, 59 euthyroid women with surgical menopause were randomized to an estrogen-only (n=20), tibolone (n=20) or calcium-only (n=19) group. On the 5th postoperative day and 4th and 12th weeks, serum E2, TSH, free T3 and free T4 levels were determined. Although the initial and week 4 serum E2, TSH, free T3 and free T4 levels were comparable, the week 12 serum E2 and TSH levels were different between the subjects on estrogen therapy and those receiving tibolone or calcium only (p=0.008 and 0.000, respectively). Serum E2 levels were higher and TSH levels lower in subjects receiving estrogen. Moreover, serum TSH levels correlated negatively with serum E2 levels in the 12th week of estrogen use (r=-0.354, p=0.006). TSH increased in the tibolone group as compared to the estrogen group but was still lower than in the calcium-only group; however, the differences were not statistically significant. Irrespective of different regimens, HRT does not have an important short-term effect on thyroid function in women with surgical menopause.

  5. [Results and substantiation of surgical strategy in acute suppurative-destructive pyelonephritis in pregnant women].

    PubMed

    Doblatian, A A

    1995-01-01

    The effectiveness of treatment of acute purulent pyelonephritis in 2.256 pregnant women from 1986 to 1992 was analysed. 95-97% of them had diffuse purulent (nondestructive) pyelonephritis which was cured by drug treatment. Pyodestructive manifestations (apostematosis, carbuncle, abscess of the kidney) of uni- (84.8%) and bilateral (15.2%) pyelonephritis were found in 85 (3.8%) of the patients. Signs of pyoseptic intoxication predominated in the clinical picture. Antibacterial and detoxification therapy was applied in the pre- and postoperative periods. The choice of the surgical tactics and operative method was based on the peculiarities of the clinical course, the revealed complications, and the anatomical changes in the kidney. Nephrostomy and antibacterial therapy are sufficient for curing the apostematic form. Patients with a bilateral affection were treated by operative stage-by-stage kidney drainage (nephrostomy). When economical operations were ineffective clinically (9.4%), secondary nephrectomy was indicated. Primary nephrectomy is an adequate surgical intervention in cases of a total destructive process in the kidney, grave septic manifestations, and a toxic response of the liver. The high proportion of nephrectomies (37.6%) is explained by the clinicoanatomical severity of focal-purulent pyelonephritis and its complications (sepsis) which hazard the life in pregnancy. Pliant surgical tactics in the treatment of severe forms of pyodestructive pyelonephritis ensured clinical cure of 96.5% of patients and uneventful delivery in 91.8% of cases. Death occurred from sepsis and bacteriotoxic shock which developed due to purulent pyelonephritis of pregnancy.

  6. The role of surgical treatment in colon diverticulitis: indications and results.

    PubMed

    Netri, G; Verbo, A; Coco, C; Cogliandolo, S; Mattana, C; Salvadori, L; D'Andrilli, A; Picciocchi, A

    2000-01-01

    Colon diverticulitis is a common illness with affects 37-45% of western populations. Indications regarding therapy guidelines, operative timing and which surgical procedure to perform are still controversial. Between January 1977 and December 1997, 239 patients, diagnosed with diverticulitis, have been admitted, on emergency, to our Department of General Surgery; 135 males (56%) and 104 females (44%), (mean age of 63 years). Forty-two patients (18%), clearly diagnosed with diffuse or local peritonitis, underwent delayed emergency surgical procedure; 44 (22%) out of 197 patients, treated with medical therapy and subsequently underwent elective surgery procedures for complications (fistulas or stenosis). Among the 42 patients treated in emergency, 26 cases (62%) underwent to resection with immediate reconstruction. Among the elective surgery group 39 (89%) out of 44 underwent to resection with immediate reconstruction. Complications reached 40% in the group of emergency patients (mortality rate 12%) and 16% in the elective surgery group (mortality rate 2%). Several features possible influencing mortality rate have been analysed; age > 70 years, acute associated diseases, generalised peritonitis and surgical timing show a statistical significance. Therefore, a careful evaluation of the patients, an appropriate pre and post-operative medical treatment, with a wider use of the most recent techniques such as CT scan guided drain, intra-operative wash-out and peritoneal lavage are recommended in order to reduce morbidity and mortality.

  7. Development and Early Piloting of a CanMEDS Competency-Based Feedback Tool for Surgical Grand Rounds.

    PubMed

    Fahim, Christine; Bhandari, Mohit; Yang, Ilun; Sonnadara, Ranil

    2016-01-01

    Grand rounds offer an excellent opportunity for the evaluation of medical expertise, and other competencies, such as communication and professionalism. The purpose of this study was to develop a tool that would facilitate the provision of formative feedback for grand rounds to improve learning. The resulting CanMEDS-based evaluation tool was piloted in an academic surgical department. This study employed the use of a 3-phase, qualitatively-focused, embedded mixed methods approach. In Phase 1, an intrinsic case study was conducted to identify preliminary themes. These findings were crystallized using a quantitative survey. Following interpretation of these data, a grand rounds evaluation tool was developed in Phase 2. The tool was piloted in the Phase 3 focus group. This study was piloted at an academic surgical center among members of the Department of Surgery, McMaster University, Ontario, Canada. Purposive sampling was used for this study. A total of n = 7 individuals participated in the Phase 1 interviews, and n = 24 participants completed the Phase 1 survey. Participants included a representative sample of medical students, residents, fellows, and staff. The tool was piloted among n = 19 participants. The proposed evaluation tool contains 13 Likert-scale questions and 2 open-ended questions. The tool outlines specific questions to assess grand rounds presenters within the structure of the 7 CanMEDS competency domains. "Evaluation fatigue" was identified as a major barrier in the willingness to provide effective feedback. Further, a number of factors regarding the preferred content, structure, and format of surgical grand rounds were identified. This pilot study presents a CanMEDS-specific evaluation tool that can be applied to surgical grand rounds. With the increasing adoption of competency-based medical education, comprehensive evaluation of surgical activities is required. This form provides a template for the development of competency-based evaluation tools

  8. Lymphopenia at 4 Days Postoperatively Is the Most Significant Laboratory Marker for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

    PubMed Central

    Shigematsu, Hideki; Okuda, Akinori; Morimoto, Yasuhiko; Masuda, Keisuke; Nakajima, Hiroshi; Koizumi, Munehisa; Tanaka, Yasuhito

    2016-01-01

    Study Design Case control study. Purpose To identify the most significant laboratory marker for early detection of surgical site infection (SSI) using multiple logistic regression analysis. Overview of Literature SSI is a serious complication of spinal instrumentation surgery. Early diagnosis and treatment are crucial. Methods We retrospectively reviewed the laboratory data of patients who underwent posterior lumbar instrumentation surgery for degenerative spinal disease from January 2003 to December 2014. Six laboratory markers for early SSI detection were considered: renewed elevation of the white blood cell count, higher at 7 than 4 days postoperatively; renewed elevation of the C-reactive protein (CRP) level, higher at 7 than 4 days postoperatively; CRP level of >10 mg/dL at 4 days postoperatively; neutrophil percentage of >75% at 4 days postoperatively; lymphocyte percentage of <10% at 4 days postoperatively; and lymphocyte count of <1,000/µL at 4 days postoperatively. Results Ninety patients were enrolled; five developed deep SSI. Multivariate regression analysis showed that a lymphocyte count of <1,000/µL at 4 days postoperatively was the sole significant independent laboratory marker for early detection of SSI (p=0.037; odds ratio, 11.9; 95% confidence interval, 1.2–122.7). Conclusions A lymphocyte count of <1,000/µL at 4 days postoperatively is the most significant laboratory marker for early detection of SSI. PMID:27994779

  9. EARLY OR DELAYED SURGICAL TREATMENT IN COMPOUND LIMB FRACTURES DUE TO HIGH VELOCITY MISSILE INJURIES: A 5-YEAR RETROSPECTIVE STUDY FROM MEDICAL CITY IN BAGHDAD

    PubMed Central

    Al-Hilli, Ali Bakir; Salih, Dheyaa Saeed

    2010-01-01

    Background Compound limb fractures due to high-velocity missiles are complex and usually associated with multiple other injuries. These can occur in both military and civilian settings. Highvelocity missiles are presently used by terrorists worldwide. Early surgical debridement and skeletal fixation are the gold standards in managing these injuries, but data supporting these recommendations are lacking. Aim of the study Our aim was to determine the relationship between time (the time of injury to the time of surgical treatment) and the rate of deep infection in patients treated in Medical City, Baghdad, Iraq due to terrorist activity from 2004-2008. Design This is a retrospective review of a series of open limb fractures. Patients and method A total of 102 civilian patients with 114 limb fractures due to high-velocity missile injuries were selected for this study from Medical City records. Patients were followed in the outpatient department in Medical City Teaching Complex both clinically and radiologically. Results Surgical treatment was accomplished in less than six hours from time of injury in group A (55 fractures, 48.4%) and more than six hours in group B (59 fractures, 51.7%). The infection rate for group A was 30.9% and group B was 23.7%. Conclusion A very high infection rate was noted for these injuries, and there was no increase in the rate of deep infection in patients treated more than six hours after the injury. PMID:21045979

  10. Reducing Length of Hospital Stay Does Not Increase Readmission Rates in Early-Stage Gastric, Colon, and Lung Cancer Surgical Cases in Japanese Acute Care Hospitals.

    PubMed

    Kunisawa, Susumu; Fushimi, Kiyohide; Imanaka, Yuichi

    2016-01-01

    The Japanese government has worked to reduce the length of hospital stay by introducing a per-diem hospital payment system that financially incentivizes the timely discharge of patients. However, there are concerns that excessively reducing length of stay may reduce healthcare quality, such as increasing readmission rates. The objective of this study was to investigate the temporal changes in length of stay and readmission rates as quality indicators in Japanese acute care hospitals. We used an administrative claims database under the Diagnosis Procedure Combination Per-Diem Payment System for Japanese hospitals. Using this database, we selected hospitals that provided data continuously from July 2010 to March 2014 to enable analyses of temporal changes in length of stay and readmission rates. We selected stage I (T1N0M0) gastric, colon, and lung cancer surgical patients who had been discharged alive from the index hospitalization. The outcome measures were length of stay during the index hospitalization and unplanned emergency readmissions within 30 days after discharge. From among 804 hospitals, we analyzed 42,585, 15,467, and 40,156 surgical patients for gastric, colon, and lung cancer, respectively. Length of stay was reduced by approximately 0.5 days per year. In contrast, readmission rates were generally stable at approximately 2% or had decreased slightly over the 4-year period. In early-stage gastric, colon, and lung cancer surgical patients in Japan, reductions in length of stay did not result in increased readmission rates.

  11. Orbital soft tissue surgery for patients with Treacher-Collins or Nager syndrome. A new surgical approach with early correction of soft tissue: prospective study.

    PubMed

    Franchi, G; Kadlub, N; Diner, P A; Bandini, M; Vazquez, M-P; Picard, A

    2015-05-01

    Orbitopalpebral anomalies in mandibulofacial dysostosis (Treacher-Collins syndrome) can be difficult to correct surgically and most authors recommend correction of the malar bone after the age of 8 years. We propose a new, early surgical approach for periorbital defects that involves initial implantation of autologous fat and subperiosteal malar lift with a pedicled upper eyelid flap. We prospectively studied 5 children, 3 of whom had previously had orbital reconstruction. Initial fat graft into the periorbital area was followed by a subperiosteal malar lift with lateral canthopexy, and a pedicled upper eyelid flap if needed. Two surgeons independently assessed the patients' characteristics including scleral show before and after operation, antimongoloid palpebral fissures, canthal dystopia, number 6 cleft (Tessier classification), skin quality, and surgical and ophthalmic complications. Before operation 3 patients had had ophthalmic problems. Postoperative evaluation showed improvements in scleral show, canthal dystopia, and skin quality, and correction of antimongoloid palpebral fissures and subcutaneous number 6 clefts. There were no postoperative complications. The proposed protocol gave satisfactory aesthetic and functional results in children with Treacher-Collins syndrome. We recommend that it is considered for periorbital reconstruction in all patients with a mandibulofacial deformity.

  12. Modified semicircular constricting annuloplasty (Sagban's annuloplasty) in severe functional tricuspid regurgitation: alternative surgical technique and its mid-term results.

    PubMed

    Goksin, Ibrahim; Yilmaz, Arif; Baltalarli, Ahmet; Goktogan, Tayfun; Karahan, Nagihan; Turk, Ufuk Ali; Kara, Hakan; Sagban, Mansur

    2006-01-01

    De Vega annuloplasty is one of the most effective methods used in surgical correction of functional tricuspid regurgitation (FTR). Physiologic annular motions are protected by De Vega annuloplasty. However, recurrent tricuspid regurgitation secondary to Bowstring (Guitar string) phenomenon may be seen after De Vega annuloplasty as a result of gliding (jiggle) effect. The aim of this new annuloplasty was to prevent Bowstring phenomenon seen in De Vega annuloplasty. Twenty-five patients with severe FTR secondary to the left-sided valvular heart disease were included in this study. Modified semicircular constricting annuloplasty (Sagban's annuloplasty): The procedure is performed utilizing 0 and 2-0 polypropylene sutures. At first, 0 and 2-0 polypropylene sutures are fixed and knotted at anteroseptal and posteroseptal comissural regions (named as anchoring points). 2-0 Polypropylene sutures which come from anchoring points in clockwise and counterclockwise direction are used to encircle the free wall annulus as well as 0 polypropylene sutures in spiral fashion (spiral annulary suture technique). When both sutures get to the anteroposterior comissural region (tying point), they are passed through plastic snares. After the annuloplasty is completed, with the heart beating and the pulmonary artery clamped, competency of the valve is tested by injecting saline into the right ventricular chamber before the adjusting suture is tied. In this annuloplasty, 0 polypropylene sutures are used for reduction and constriction, 2-0 polypropylene sutures are used for the fixation of 0 polypropylene sutures in annular level. FTR improved totally in 16 patients (66.7%), 4 patients (16.7%) had first degree, 3 patients (12.5%) had second degree, and only 1 patient (4.2%) had third degree residual tricuspid regurgitation in an average follow-up period of 17.8 months. One patient died from low cardiac output in early postoperative period. There is no risk of recurrent regurgitation

  13. Long-term results of early contact lens use in pediatric unilateral aphakia.

    PubMed

    Chen, Ying-Chun Ellin; Hu, Annie C; Rosenbaum, Arthur; Spooner, Sharon; Weissman, Barry A

    2010-01-01

    To evaluate which factor(s) might predict excellent Snellen visual acuity results in unilateral nontraumatic pediatric aphakes. Retrospective review of all unilateral pediatric aphakic patients seen in a specialty contact lens clinic between 1982 and 2009. Inclusion criteria as follows: (1) cataract extraction before age 6 weeks, (2) no other health complications, (3) contact lens fitting within 3 weeks postsurgery, and (4) measurable subjective visual performance on a clinical Snellen acuity chart. Fifteen patients were identified: 10 patients with persistent fetal vasculature syndrome (PFV) and 5 patients with the diagnosis of idiopathic congenital cataract (ICC). Final Snellen acuity results showed seven patients (46.67%) developed excellent Snellen visual acuities (defined as 20/50 or better), four patients (26.67%) developed moderate Snellen visual acuities (20/125 to 20/60), and four total patients (26.67%) developed poor Snellen visual acuities (worse than 20/200). Analysis used descriptive statistics. Approximately 50% of our unilateral nontraumatic pediatric aphakic patients aged older than 5 years achieved excellent Snellen visual acuity in the aphakic eye. The amount of surgical or ocular complications seems to have an inverse relationship with Snellen visual acuity in PFV. Patching compliance, without implying cause-effect direction, also had a direct relationship with final Snellen visual acuity for patients. Early cataract extraction, good to moderate patching compliance, and aggressive early contact lens management can lead to moderate to excellent Snellen visual results in several unilateral pediatric aphakic patients.

  14. Bone Marrow Stem Cells Added to a Hydroxyapatite Scaffold Result in Better Outcomes after Surgical Treatment of Intertrochanteric Hip Fractures

    PubMed Central

    Gutierres, Manuel; Lopes, M. Ascenção; Santos, J. Domingos; Cabral, A. T.; Pinto, R.

    2014-01-01

    Introduction. Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC) to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures. Material and Methods. 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A) during the surgical procedure, or fracture fixation alone (Group B). Results. There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS), at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P < 0.05). Discussion. These results show a significant benefit of adding a bone marrow enriched scaffold to surgical fixation in intertrochanteric hip fractures, which can significantly reduce the associated morbidity and mortality rates. Conclusion. Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures. PMID:24955356

  15. Analysis of urinary metabolic signatures of early hepatocellular carcinoma recurrence after surgical removal using gas chromatography-mass spectrometry.

    PubMed

    Ye, Guozhu; Zhu, Bin; Yao, Zhenzhen; Yin, Peiyuan; Lu, Xin; Kong, Hongwei; Fan, Fei; Jiao, Binghua; Xu, Guowang

    2012-08-03

    The objective of present study was to offer insights into the metabolic responses of hepatocellular carcinoma (HCC) to surgical resection and the metabolic signatures latent in early HCC recurrence (one year after operation). Urinary metabolic profiling employing gas chromatography time-of-flight mass spectrometry (GC-TOF MS) was utilized to investigate the complex physiopathologic regulations in HCC after operational intervention. It was revealed that an intricate series of metabolic regulations including energy metabolism, amino acid metabolism, nucleoside metabolism, tricarboxylic acid (TCA) cycle, gut floral metabolism, etc., principally leading to the direction of biomass synthesis, could be observed after tumor surgical removal. Moreover, metabolic differences between recurrent and nonrecurrent patients had emerged 7 days after initial operation. The metabolic signatures of HCC recurrence principally comprised notable up-regulations of lactate excretion, succinate production, purine and pyrimidine nucleosides turnover, glycine, serine and threonine metabolism, aromatic amino acid turnover, cysteine and methionine metabolism, and glyoxylate metabolism, similar to metabolic behaviors of HCC burden. Sixteen metabolites were found to be significantly increased in the recurrent patients compared with those in nonrecurrent patients and healthy controls. Five metabolites (ethanolamine, lactic acid, acotinic acid, phenylalanine and ribose) were further defined; they were favorable to the prediction of early recurrence.

  16. Optimal MRI interval for detection of asymptomatic recurrence in surgically treated early cervical cancer by use of a mathematical model.

    PubMed

    Laios, A; Gubbala, K; Lampe, R; Tolis, A

    2016-01-01

    Applications of mathematical modeling may provide an insight into the timing of surveillance modalities. We aimed to determine the optimal magnetic resonance imaging (MRI) interval for the detection of surgically treated early cervical cancer asymptomatic recurrence by using a mathematical model for volumetric tumor growth time. We assumed that tumor volume increases by a factor equal to the basis of natural logarithms (e~2.718) at constant time intervals. Using a mathematical formula, the tumor volume (V) was converted to diameter (D), which could be expressed as a function of time (t), given an initial diameter Di (corresponding to initial volume Vi) and a constant DT, where DT is the time required for volumetric tumor growth by a factor (e). Three different DTs were used for demonstration of the model, i.e. 20, 100 and 400 days. Assuming complete surgical clearance, a worst-case scenario for a 20-day DT indicated that a 20 μm cervical tumor would need at least 12 months to reach 10 mm in diameter, which would be detected with an annual surveillance interval MRI. Over a 5-year (60 months) follow-up, nearly five surveillance MRIs would be required if the threshold of 10 mm was desired. For a 100-day DT over a 5-year (60 months) follow-up, a single only MRI would be required, if the threshold of 10 mm was desired. In the case of an indolent tumor (DT is 400 days), the model would not recommend a surveillance MRI to detect asymptomatic recurrence. A positive linear association between optimal MRI intervals and volumetric tumor DTs was demonstrated. In the absence of evidence, we postulate annual MRI scanning is probably the shortest interval, which can be clinically useful for optimization of routine surveillance follow-up protocols in surgically treated early cervical cancer. This mathematical model requires proper verification in prospective clinical studies. Hippokratia 2016, 20(1): 4-8.

  17. Early Commissioning Results of the NDCX-II Accelerator Facility

    NASA Astrophysics Data System (ADS)

    Lidia, Steve; Arbelaez, Diego; Greenway, Wayne; Jung, Jin-Young; Kwan, Joe; Roy, Prabir; Seidl, Peter; Takakuwa, Jeffrey; Waldron, William; Friedman, Alex; Grote, David; Sharp, William; Gilson, Erik; Ni, Pavel

    2012-10-01

    The Neutralized Drift Compression Experiment-II (NDCX-II) will generate ion beam pulses for studies of Warm Dense Matter science and heavy-ion-driven Inertial Fusion Energy. The machine accelerates 20-50 nC of Li+ to 1.2-3 MeV energy, starting from a 10.9-cm alumino-silicate ion source. At the end of the accelerator the ions are focused to a sub-mm spot size onto a thin foil (planar) target. The pulse duration is compressed from ˜500 ns at the source to sub-ns at the target following beam transport in a neutralizing plasma. We report on the results of early commissioning studies that characterize beam quality and beam transport, acceleration waveform shaping and beam current evolution. We present measurements of time-resolved beam phase space density and variation in transverse beam centroid position. We present simulation results to benchmark against the experimental measurements, and to predict performance in subsequent sections of the accelerator.

  18. Application of silver sulfadiazine cream with early surgical intervention in patients suffering from combined burn-blast injury facial tattoos.

    PubMed

    Ebrahimi, Ali; Kalantar Motamedi, Mohammad Hosein

    2012-01-01

    Severe combined burn-blast injury is a great challenge to surgical teams due to its high mortality. It also results in unsightly traumatic tattoos. The aims of these case reports were to clarify the clinical characteristic of the dynamite explosion burn-blast facial injuries and discuss appropriate management of these patients. We report two patients suffering from facial burn-blast injury following dynamite explosion in which after primary stabilization, silver sulfadiazine cream was applied to the wounds and 12 hours later the wounds were cleaned under general anesthesia with vigorous saline solution irrigation and brushing. The foreign particles were meticulously removed from wounds and simultaneous repairing of defects was done with nylon 6-0 sutures. We conclude application of silver sulfadiazine cream on facial burn-blast injury tattoos several hours before surgical removal of particles is highly efficacious in facilitating particle removal and attaining a good result following surgical intervention, and primary repair. Treatment of combined burn-blast tattoos is different from other types of tattoos not associated with burns. Debridement and removal of foreign particles under general anesthesia from skin immediately and primary reconstruction of wounds is essential. We recommend application of the topical agent silver sulfadiazine to wounds about 12 hours before surgical intervention.

  19. Application of Silver Sulfadiazine Cream With Early Surgical Intervention in Patients Suffering From Combined Burn-Blast Injury Facial Tattoos

    PubMed Central

    Ebrahimi, Ali; Kalantar Motamedi, Mohammad Hosein

    2012-01-01

    Severe combined burn-blast injury is a great challenge to surgical teams due to its high mortality. It also results in unsightly traumatic tattoos. The aims of these case reports were to clarify the clinical characteristic of the dynamite explosion burn-blast facial injuries and discuss appropriate management of these patients. We report two patients suffering from facial burn-blast injury following dynamite explosion in which after primary stabilization, silver sulfadiazine cream was applied to the wounds and 12 hours later the wounds were cleaned under general anesthesia with vigorous saline solution irrigation and brushing. The foreign particles were meticulously removed from wounds and simultaneous repairing of defects was done with nylon 6-0 sutures. We conclude application of silver sulfadiazine cream on facial burn-blast injury tattoos several hours before surgical removal of particles is highly efficacious in facilitating particle removal and attaining a good result following surgical intervention, and primary repair. Treatment of combined burn-blast tattoos is different from other types of tattoos not associated with burns. Debridement and removal of foreign particles under general anesthesia from skin immediately and primary reconstruction of wounds is essential. We recommend application of the topical agent silver sulfadiazine to wounds about 12 hours before surgical intervention. PMID:24829894

  20. Surgical treatment preferences in Chinese-American women with early-stage breast cancer.

    PubMed

    Killoran, Moira; Moyer, Anne

    2006-11-01

    Breast-conserving treatment (BCT) is considered preferable to radical or modified radical mastectomy (MRM) for most women diagnosed with early-stage breast cancer. Studies have found that Chinese-American women are more likely to be treated with MRM, regardless of age or stage of disease. The central question posed in this study is: what are the cultural factors that influence the selection of treatments by Chinese-American patients and the presentation of treatment options by providers? Focused group discussions, semi-structured interviews, and ethnographic observations were conducted with 69 Chinese-American women and 14 health professionals. Results indicated that (1) many Chinese-American women, regardless of age, migration status, education, and income level, expressed a preference for MRM because it was seen as safer; (2) this was primarily a communal belief that even women who had BCT felt pressure to conform to; (3) some women felt pressured into the BCT decision by their physician and/or were unhappy with their choice; (4) patient and physician bias and difficulties with translation issues and supplemental materials all led to cross-cultural miscommunication; and (5) this miscommunication was cited as a reason for (a) not completing treatment regimes or (b) drastic changes in the treatment selected.

  1. Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care.

    PubMed

    Harris, Lisa H; Dalton, Vanessa K; Johnson, Timothy R B

    2007-05-01

    Early pregnancy failure and induced abortion are often managed differently, even though safe uterine evacuation is the goal in both. Early pregnancy failure is commonly treated by curettage in operating room settings in anesthetized patients. Induced abortion is most commonly managed by office vacuum aspiration in awake or sedated patients. Medical evidence does not support routine operating room management of early pregnancy failure. This commentary reviews historical origins of these different care standards, explores political factors responsible for their perpetuation, and uses experience at University of Michigan to dramatize the ways in which history, politics, and biomedicine intersect to produce patient care. The University of Michigan initiated office uterine evacuations for early pregnancy failure treatment. Patients previously went to the operating room. These changes required faculty, staff, and resident education. Our efforts blurred the lines between spontaneous and induced abortion management, improved patient care and better utilized hospital resources.

  2. [Results of surgical treatment of oral cavity cancer T1-2N0M0].

    PubMed

    Karpenko, A V; Sibgatullin, R R; Belova, E N; Boĭko, A A; Zolotykh, V G; Roman, L D

    2014-01-01

    The article shows the results of treatment of 20 patients (aged from 46 to 85 years old) with early oral cavity squamous cell carcinoma at the period from April 2009 to January 2011. The surgery included the resection of primary tumor and neck dissection in all the patients. The primary tumor was removed by mouth access in 10 patients and combined method was used in 10 cases. The selective neck dissection was carried out in 22 cases. The oral cavity wounds were closed primarily by local flaps in 10 patients, some small residual defects were left open in 3 cases. The reconstructions with remote skin-muscular infrahyoid flap were performed in 7 patients. The free revascularized radial skin-fascia flap was used in 3 cases. A follow-up period was from 24 to 44 months. The primary local regional control consisted of 85% in given group of patients. The rate of recurrence of the second primary metachronous tumor was 15%. Tumors were located in the oral cavity. Overall 3-year survival was 90% (18 out of 20 patients).

  3. The Use of Cryotherapy for Papilloma and Early Laryngeal Cancers: Long-term Results.

    PubMed

    Benninger, Michael S; Derakhshan, Adeeb; Milstein, Claudio F

    2015-07-01

    Retrospective chart review. To determine the efficacy of adjuvant cryotherapy in the treatment of early glottic cancer and laryngeal papillomatosis. The use of cryotherapy in conjunction with traditional modalities has recently been proposed to improve voice outcomes in patients with early laryngeal cancer as compared to pretreatment conditions. This study investigates its utility in improving oncological outcomes and decreasing recurrences of laryngeal papillomatosis. Patients with either early glottic cancer or laryngeal papillomatosis that received cryotherapy as part of their surgical regimen were investigated. All patients were seen at a large tertiary care center within a 10-year window. Demographic data were collected and all postoperative notes were reviewed. Recurrences of the laryngeal cancer were noted, as was the duration of time between successive papillomatosis operations. The charts of 54 glottic cancer and 29 papillomatosis patients that received cryotherapy were reviewed. One patient from the papillomatosis cohort was excluded from statistical analysis due to lack of follow-up. Overall, 16 (30%) of the laryngeal cancer patient experienced a malignant recurrence. The overall 5-year survival of these patients was 98% and the 5-year disease-free survival was 74%. The use of adjuvant cryotherapy in the treatment of laryngeal papillomatosis extended the duration of time between surgeries by an average of 79 days (P=.23). The use of adjuvant cryotherapy in the treatment of early glottic cancer does not improve the rate of carcinoma recurrences. Additionally, cryotherapy does not result in a statistically significant increase in the duration of disease-free period for laryngeal papillomatosis patients, although the observed increase may be clinically important. © The Author(s) 2015.

  4. Early Results and Plans for the Time Domain Spectroscopic Survey

    NASA Astrophysics Data System (ADS)

    Green, Paul J.; Anderson, S. F.; Morganson, E.; Ruan, J. J.; PS1; SDSS-III; SDSS-IV

    2014-01-01

    With PanSTARRS-1 just finishing and LSST over the horizon, time-domain astronomy is a celestial tsunami just now hitting our shores. We outline the Time Domain Spectroscopic Survey (TDSS) - the first large-scale, all-sky spectroscopic survey of celestial variables. As part of SDSS-IV eBOSS program, the TDSS has begun obtaining BOSS-quality spectroscopy of variable objects selected primarily from the PS1 3pi survey. During the duration of SDSS-IV (2014-2020), TDSS should garner of order 1E+05 first-ever spectra of variables to i-band mag about 21. While AGN will dominate the sample, all kinds of variable stars will also be revealed, including RR Lyr, flare stars, eclipsing binaries, pulsating white dwarfs and more. We will outline target selection, and discuss early results. We also describe a TDSS subprogram testing for spectroscopic variability by obtaining 2d or 3d epoch spectra of several carefully chosen source classes.

  5. Early Results from the MODIS Atmosphere Cloud Algorithms

    NASA Technical Reports Server (NTRS)

    Platnick, S.; Ackerman, S. A.; King, M. D.; Menzel, W. P.; Gao, B.-C.; Einaudi, Franco (Technical Monitor)

    2000-01-01

    The Moderate Resolution Imaging Spectroradiometer (MODIS) is one of five instruments aboard the Terra Earth Observing System platform launched in December 1999. With 36 spectral bands from the visible through the infrared, and spatial resolution from 250m to 1km, the instrument provides an unprecedented opportunity for global cloud studies. A comprehensive set of remote sensing algorithms for cloud masking and retrieval of cloud physical and optical properties have been developed by members of the MODIS atmosphere team. The archived products from these algorithms have applications in climate change studies, climate modeling, numerical weather prediction, as well as fundamental atmospheric research. In addition to an extensive cloud mask, products include cloud top physical parameters (temperature, pressure, emissivity), cloud phase, cloud optical parameters (optical depth, effective particle radius, water path), visible cirrus reflectance, a contrail flag, and other derived parameters. All products are archived into two categories: pixel-level retrievals at a 1 km or 5 km spatial resolution at nadir (referred to as Level-2 products) and 1 degree global gridded statistics (Level-3 products). An overview of the MODIS atmosphere algorithms and products, their status, validation activities, and early level-2 and -3 results will be presented.

  6. [Early diagnosis importance for a correct surgical treatment of PAES (popliteal artery entrapment syndrome)].

    PubMed

    Catani, M; De Milito, R; Clementi, I; Romagnoli, F; Simonelli, L; Vardas, P N; Manili, G; Capitano, S

    2004-01-01

    Popliteal artery entrapment syndrome (PAES) is an uncommon pathological entity, caused by segmental popliteal artery compression by the surrounding myofascial structures. Clinical symptoms may appear acutely, with temporary ischaemic attacks, or chronically, with concerned calf claudicatio intermittens and for 30% are bilateral. Diagnosis, besides being based on clinical objectivity (acute and deep pain to the struck limb, mainly during active plantar hyperextension) and history-taking (subject-age and lack of atherosclerosis), is based on ultrasonographic (eco-color Doppler of the aortic-iliac-femural-popliteal trunks, tensiometric Doppler), angio-RM, angio-CT scan and dynamic angiographic exams. Treatment, essentially, is surgical by simple freeing of the popliteal artery from surrounding myofascial structures or by autologous vein (saphenous v.) interposition grafting and patching, or bypass without vessel resection. About clinical case reported by the authors, 44-years female with left calf acute pain symptoms, cold skin by the thermo-touch, hypo-paraesthesia with fifth toe cyanosis and walking inability, surgical treatment, because of precox diagnosis, consisted of simple cut of myofibrous shoot starting from medial head of the left gastrocnemious muscle and compressing popliteal artery, with clinical chart complete resolution.

  7. Results of two different surgical techniques in the treatment of advanced-stage Freiberg's disease

    PubMed Central

    Özkul, Emin; Gem, Mehmet; Alemdar, Celil; Arslan, Hüseyin; Boğatekin, Ferit; Kişin, Bülent

    2016-01-01

    Background: Freiberg's disease is an osteochondrosis most commonly seen in adolescent women and characterized by pain, swelling and motion restriction in the second metatarsal. The early stages of this disease can be managed with semirigid orthoses, metatarsal bars and short leg walking cast. Number of operative methods are suggested which can be used depending on the pathophysiology of the disease, including abnormal biomechanics, joint congruence and degenerative process. We evaluated the outcomes of the patients with Freiberg's disease who were treated with dorsal closing-wedge osteotomy and resection of the metatarsal head. Patients and Methods: 16 patients (11 female, 5 male) with a mean age of 24.5 (range 13–49 years) years who underwent dorsal closing wedge osteotomy or resection of the metatarsal head were included in this retrospective study. Second metatarsal was affected in 13 and third metatarsal in three patients. According to the Smillie's classification system, ten patients had type IV osteonecrosis and six patients had type V. The results of the patients were evaluated using the lesser metatarsophalangeal-interphalangeal (LMPI) scale. Results: According to the LMPI scale, the postoperative scores for the osteotomy and excision groups were 86 (range 64–100) and 72.6 (range 60–85), respectively. In the osteotomy group, mean passive flexion restriction was 18° (range 0°–35°) and mean passive extension restriction was 12° (range 0°–25°). Mean metatarsal shortening was 2.2 mm (range 2–4 mm) in the osteotomy group as opposed to 9.8 mm (range 7–14 mm) in the excision group. Significant pain relief was obtained in both groups following the surgery. Conclusions: The decision of performing osteotomy or resection arthroplasty in the patients with advanced-stage Freiberg's disease should be based on the joint injury and the patients should be informed about the cosmetic problems like shortening which may arise from resection. PMID:26955180

  8. Early Rehabilitation in the Medical and Surgical Intensive Care Units for Patients With and Without Mechanical Ventilation: An Interprofessional Performance Improvement Project.

    PubMed

    Corcoran, John R; Herbsman, Jodi M; Bushnik, Tamara; Van Lew, Steve; Stolfi, Angela; Parkin, Kate; McKenzie, Alison; Hall, Geoffrey W; Joseph, Waveney; Whiteson, Jonathan; Flanagan, Steven R

    2017-02-01

    Most early mobility studies focus on patients on mechanical ventilation and the role of physical and occupational therapy. This Performance Improvement Project (PIP) project examined early mobility and increased intensity of therapy services on patients in the intensive care unit (ICU) with and without mechanical ventilation. In addition, speech-language pathology rehabilitation was added to the early mobilization program. We sought to assess the efficacy of early mobilization of patients with and without mechanical ventilation in the ICU on length of stay (LOS) and patient outcomes and to determine the financial viability of the program. PIP. Prospective data collection in 2014 (PIP) compared with a historical patient population in 2012 (pre-PIP). Medical and surgical ICUs of a Level 2 trauma hospital. There were 160 patients in the PIP and 123 in the pre-PIP. Interprofessional training to improve collaboration and increase intensity of rehabilitation therapy services in the medical and surgical intensive care units for medically appropriate patients. Demographics; intensity of service; ICU and hospital LOS; medications; pain; discharge disposition; functional mobility; and average cost per day were examined. Rehabilitation therapy services increased from 2012 to 2014 by approximately 60 minutes per patient. The average ICU LOS decreased by almost 20% from 4.6 days (pre-PIP) to 3.7 days (PIP) (P = .05). A decrease of over 40% was observed in the floor bed average LOS from 6.0 days (pre-PIP) to 3.4 days (PIP) (P < .01). An increased percentage of PIP patients, 40.5%, were discharged home without services compared with 18.2% in the pre-PIP phase (P < .01). Average cost per day in the ICU and floor bed decreased in the PIP group, resulting in an annualized net cost savings of $1.5 million. The results of the PIP indicate that enhanced rehabilitation services in the ICU is clinically feasible, results in improved patient outcomes, and is fiscally sound. Most early

  9. Survival comparison between surgical resection and percutaneous radiofrequency ablation for patients in Barcelona Clinic Liver Cancer early stage hepatocellular carcinoma.

    PubMed

    Wong, Kiong-Ming; Yeh, Ming-Lun; Chuang, Shih-Chung; Wang, Liang-Yen; Lin, Zu-Yau; Chen, Shinn-Cherng; Tsai, Jung-Fa; Wang, Shen-Nien; Kuo, Kung-Kai; Dai, Chia-Yen; Yu, Ming-Lung; Lee, King-The; Chuang, Wan-Long

    2013-07-01

    To compare the survival outcome between surgical resection (SR) and radiofrequency ablation (RFA) for Barcelona Clinic Liver Cancer (BCLC) early stage hepatocellular carcinoma (HCC). The retrospective study enrolled eighty-two patients with newly diagnosed BCLC early HCC (single nodule, size ≦3 cm, and Child-Pugh class A) treated either surgically (n = 46) or with RFA (n = 36) from year 2004 to 2009. The patients' survival outcomes were compared. There were no significant differences in overall survival (OS) rates between SR and RFA (p = 0.204). The 3- and 5-year disease-free survival (DFS) rates were 65.8 % and 53.7 % respectively, in the SR group, which were significantly higher than those in the RFA group (34.8 % and 14.9 % respectively) (p = 0.009 and p = 0.001). In subgroup analysis, the DFS was similar between RFA and SR in patients with presentation of lower platelet count (≦100,000/mL) and smaller tumor size (tumor size ≦1 cm). Multivariate analysis showed SR as a procedure type was a significant predictive factor for DFS [HR = 2.26 (CI 1.462-5.227), p = 0.002]. SR yielded similar OS but better DFS when compared to RFA for patients with BCLC early HCC (single nodule, ≦3 cm and Child-Pugh class A). In subgroup patients with lower platelet count (≦100,000/mL) and smaller tumor size (tumor size ≦1 cm), DFS was similar between both treatments.

  10. [Effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection].

    PubMed

    Lin, Chen; Zhang, Zaizhong; Wang, Lie; Lin, Nan; Yang, Weijin; Wu, Weihang; Wang, Wen; Wang, Rong; Wang, Yu

    2017-08-25

    To explore the effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection. Thirty-five patients with early colon cancer accepted additional surgical procedures after endoscopic resection in Fuzhou General Hospital of PLA from May 2014 to November 2016. All the patients underwent nano carbon tattooing before the end of endoscopic resection: 0.1 ml carbon nanoparticles suspension was respectively injected into the normal intestinal submucosa from 1 cm outside the 4 sites (upper, lower, left and right) of the lesion border by colonoscopy, marking the original lesion location and guiding the subsequent additional surgery. Data of these 35 cases were summarized. All the 35 cases, including 22 males and 13 females, with a mean age of 46.5 years(range 35-70), completed the endoscopic disposable carbon nano marking, and the mean operative time was 7.5 minutes(range 5-10). No bleeding, no perforation and no adverse reaction occurred. Four to 21(10±3.5) days after endoscopic resection, the patients received the additional surgery as a result of pathological specimens of endoscopic resection in 10 cases of vascular invasion, 7 cases of severe submucosal infiltration, 7 cases of more than grade G2 in tumor budding, 6 cases of poorly differentiated adenocarcinoma and undifferentiated carcinoma, and 5 cases of positive margin. All the patients underwent laparoscopic surgery. The mean time of intraoperative detection and lesion location was 3.0 minutes(range 1-5). All tattooings were clearly visible under the naked eye. The colon wedge resection were performed in 5 cases, colon segment resection in 14 cases, and radical resection of colon cancer in 16 cases. The operative time was 45 to 180(120±30) min, and the blood loss was 50 ~ 200(50±15) ml. There was no intraoperative complications. The first gas passage time was 12 to 48(24±8) h. The postoperative hospital stay was 10 to 3(6.5±2.5) d

  11. Robotic Esophagectomy for Cancer: Early Results and Lessons Learned.

    PubMed

    Cerfolio, Robert J; Wei, Benjamin; Hawn, Mary T; Minnich, Douglas J

    2016-01-01

    Minimally invasive esophagectomy with intrathoracic dissection and anastomosis is increasingly performed. Our objectives are to report our operative technique, early results and lessons learned. This is a retrospective review of 85 consecutive patients who were scheduled for minimally invasive Ivor Lewis esophagectomy (laparoscopic or robotic abdominal and robotic chest) for esophageal cancer. Between 4/2011 and 3/2015, 85 (74 men, median age: 63) patients underwent robotic Ivor Lewis esophageal resection. In all, 64 patients (75%) had preoperative chemoradiotherapy, 99% had esophageal cancer, and 99% had an R0 resection. There were no abdominal or thoracic conversions for bleeding. There was 1 abdominal conversion for the inability to completely staple the gastric conduit. The mean operative time was 6 hours, median blood loss was 35ml (no intraoperative transfusions), median number of resected lymph nodes was 22, and median length of stay was 8 days. Conduit complications (anastomotic leak or conduit ischemia) occurred in 6 patients. The 30 and 90-day mortality were 3/85 (3.5%) and 9/85 (10.6%), respectively. Initial poor results led to protocol changes via root cause analysis: longer rehabilitation before surgery, liver biopsy in patients with history of suspected cirrhosis, and refinements to conduit preparation and anastomotic technique. Robotic Ivor Lewis esophagectomy for cancer provides an R0 resection with excellent lymph node resection. Our preferred port placement and operative techniques are described. Disappointingly high thoracic conduit problems and 30 and 90-day mortality led to lessons learned and implementation of change which are shared. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Early Results from the Gemini Multi-Object Spectrograph

    NASA Astrophysics Data System (ADS)

    Roth, K. C.; Jorgensen, I.; Hook, I. M.; Takamiya, M. Y.

    2001-12-01

    We present examples of early science results achieved with the newly commissioned Gemini Multi-Object Spectrograph (GMOS) on the Gemini North 8-m Telescope. GMOS provides long- and multi-slit spectroscopy and imaging over a 5.5 arcmin field of view, and these three modes were successfully commissioned during the second half of 2001. GMOS was built by a collaboration between the UK (Astronomical Technology Centre at ROE and University of Durham) and Canada (HIA). As part of System Verification (SV) we have executed several imaging, long-slit, and multi-object spectroscopic programs designed to test and demonstrate the scientific capabilities of GMOS. Two of these programs, for which we present the imaging and preliminary MOS results, target the fields around RXJ0142.0+2131 and UM224. The first program is aimed at investigating galaxy evolution through observations of a rich cluster at intermediate redshift (z=0.28) and measuring stellar populations and dynamics of the member galaxies. The goal of the second program is to measure redshifts of galaxies in the field of a high redshift QSO (z=2.08) with intervening metal-line absorption in order to identify which galaxies may be responsible for the absorption and investigate their group/clustering properties. All data obtained as part of SV will become public within a few months. We are currently in the final stages of SV observations including full commissioning of the IFU, and have begun obtaining data for the community as of November 2001. The Gemini Observatory is operated by AURA, Inc., under a cooperative agreement with the NSF on behalf of the Gemini partnership: NSF (United States), PPARC (United Kingdom), NRC (Canada), CONICYT (Chile), ARC (Australia), CNPq (Brazil) and CONICET (Argentina).

  13. Treatment of congenital anomalies in a missionary hospital in Bangladesh: results of 17 paediatric surgical missions.

    PubMed

    Del Rossi, Carmine; Fontechiari, Simona; Casolari, Emilio; Fainardi, Valentina; Caravaggi, Francesca; Lombardi, Laura

    2008-12-01

    We report 17 years of experience in a missionary hospital with decreased facilities in Bangladesh. Our interest was directed at children with congenital malformations since they live in a society where the exclusion of abnormal children is common. A better treatment for these children offers them a better future. Bangladesh is among the most densely populated countries in the world: its population ranges from 142 to 159 million, and it is one of the poorest nations in the world. From 1991 to 2008 our Italian pediatric surgical team performed 17 5 weeks missions in a missionary hospital in Khulna, Bangladesh, during the months of January and February. A total of 1556 patients underwent surgery, mostly for severe congenital anomalies. The infection rates were very low: 2-3%; the mortality rate was 0.4% for all the operations. Good pre-operative preparation and assistance, assurance of cyclical follow-up and a trained surgical team allowed the successful treatment of complex malformations in a missionary hospital with modest services.

  14. Results of a surgical resection of pulmonary metastasis from malignant head and neck tumor.

    PubMed

    Haro, Akira; Yano, Tokujiro; Yoshida, Tsukihisa; Ito, Kensaku; Morodomi, Yosuke; Shoji, Fumihiro; Nakashima, Torahiko; Maehara, Yoshihiko

    2010-05-01

    There have been only a few reports about a surgical resection of pulmonary metastasis from malignant head and neck tumor. Here we investigate the survival after a pulmonary metastasectomy, and discuss the prognostic factors. We retrospectively reviewed 25 patients who underwent a pulmonary metastasectomy from malignant head and neck tumor at Kyushu University Hospital from 1981 through 2008. We assessed the five year overall survival by the Kaplan-Meier method and the log-rank (Mantel-Cox) test using the Stat View software program. The three- or five-year overall survival after a metastasectomy was 53.3% and 50.0%, respectively. We investigated the clinico-pathological prognostic factors including gender, age, histology, disease free interval, number or size of pulmonary metastatic tumors, and the operative procedure. Both age (older than 60 years) (P=0.0189) and pulmonary metastases from squamous cell carcinomas in either oral cavity or pharyngeal region (P=0.0002) were identified to be adverse prognostic factors. To obtain a long survival, a positive surgical resection is considered to be an effective and standard treatment for pulmonary metastasis from malignant head and neck tumor. It is also necessary, however, to elucidate fully the primary site and histology of such pulmonary metastasis.

  15. [Results of surgical intervention depending on duration of preoperative treatment of pulmonary tuberculosis patients].

    PubMed

    Grigorian, V A; Golovchenko, R N; Ustinov, A I

    2001-01-01

    The case histories of 428 patients operated on for tuberculosis were analyzed. Three groups were identified. They were as follows: 1) 121 patients untreated with bactericidal drugs before surgery; 2) 247 patients treated less than 6 months before it; 3) 160 patients treated more than 6 months before surgery. Various complications due to resection of the lung were observed in 30 (7%) patients undergone surgery. They were 6.6, 6.8, and 7.5% in Groups 1, 2, and 3, respectively. A clinical effect was achieved in 99.8% of cases. The late outcomes of surgical intervention were studied within 1 to 10 years in 354 patients, including 102, 119, and 133 patients in Groups 1, 2, and 3, respectively. Progressive and recurrent tuberculosis was revealed in 7 (6.8%), 11 (9.2%), and 18 (13.5%), respectively. Thus, immediate and late outcomes of surgical treatment were not worse in patients with tuberculomas untreated with bactericidal drugs before surgery than in those who receive long-term therapy that substantially reduces the duration of therapy, which is a most important task of modern phthisiology. So patients should be operated on when they are found to have pulmonary tuberculomas without signs of a progressive tuberculous process.

  16. [ECHOCARDIOGRAPHIC PREDICTORS OF THE SEVERITY OF THE EARLY POSTOPERATIVE PERIOD IN PATIENTS AFTER SURGICAL MYOCARDIAL REVASCULARIZATION].

    PubMed

    Bockeria, L A; Sokolskaya, N O; Kopylova, N S; Alshibaya, M M

    2015-01-01

    Non-invasive and easily interpretable methods for assessing cardiac hemodynainic parameters including various echocardiographic technologies are highly valuable diagnostic methods in cardiac surgery patients admitting the intensive care unit in the postoperative period. The article presents echocardiographic features of the myocardial functional state in the early period after coronary artery bypass grafting performed in 201 CHD patients. The analysis includes standard echocardiographic parameters and data obtained from tissue Doppler imaging. Tissue Doppler imaging has shown to be informative for diagnosing heart failure. Low left ventricular volumes and restrictive type myocardial diastolic dysfunction have proven to be early echocardiographic predictors of poor prognosis in CAD patients after myocardial revascularization.

  17. Use of a surgical rehearsal platform and improvement in aneurysm clipping measures: results of a prospective, randomized trial.

    PubMed

    Chugh, A Jessey; Pace, Jonathan R; Singer, Justin; Tatsuoka, Curtis; Hoffer, Alan; Selman, Warren R; Bambakidis, Nicholas C

    2017-03-01

    OBJECTIVE The field of neurosurgery is constantly undergoing improvements and advances, both in technique and technology. Cerebrovascular neurosurgery is no exception, with endovascular treatments changing the treatment paradigm. Clipping of aneurysms is still necessary, however, and advances are still being made to improve patient outcomes within the microsurgical treatment of aneurysms. Surgical rehearsal platforms are surgical simulators that offer the opportunity to rehearse a procedure prior to entering the operative suite. This study is designed to determine whether use of a surgical rehearsal platform in aneurysm surgery is helpful in decreasing aneurysm dissection time and clip manipulation of the aneurysm. METHODS The authors conducted a blinded, prospective, randomized study comparing key effort and time variables in aneurysm clip ligation surgery with and without preoperative use of the SuRgical Planner (SRP) surgical rehearsal platform. Initially, 40 patients were randomly assigned to either of two groups: one in which surgery was performed after use of the SRP (SRP group) and one in which surgery was performed without use of the SRP (control group). All operations were videotaped. After exclusion of 6 patients from the SRP group and 9 from the control group, a total of 25 surgical cases were analyzed by a reviewer blinded to group assignment. The videos were analyzed for total microsurgical time, number of clips used, and number of clip placement attempts. Means and standard deviations (SDs) were calculated and compared between groups. RESULTS The mean (± SD) amount of operative time per clip used was 920 ± 770 seconds in the SRP group and 1294 ± 678 seconds in the control group (p = 0.05). In addition, the mean values for the number of clip attempts, total operative time, ratio of clip attempts to clips used, and time per clip attempt were all lower in the SRP group, although the between-group differences were not statistically significant

  18. [Pain management in surgical wards. Quality and solutions for improvement in the early postoperative period].

    PubMed

    Gross, T; Pretto, M; Aeschbach, A; Marsch, S

    2002-08-01

    Following guidelines pain levels should not exceed a score of 3 on the visual analog scale (VAS 1-10). We were interested in the actual surgical pain management of the postoperative period and the potential influences of a nurse-controlled intravenous morphine administration (NCA) on its quality. Interventional study: interview of patients and nursing staff and examination of records concerning pain treatment following surgery. The interviews were conducted with 110 patients before and 125 patients after the intervention program. Before the intervention, one-half of the patients noted that they were never asked about their pain intensity within the first 24 h after surgery. Only 42% of the records showed at least one VAS documentation. Every fourth individual experienced a pain intensity > 3 without having received a supplementary pain medication. Following the morphine intervention program, documentation of pain scores increased significantly (72%; p < 0.0001) and more patients were familiar with the VAS (64% vs 46%; p < 0.0004). Median maximum as well as actual pain at the time of the interview decreased by one point (VAS). The percentage of patients whose supplementary pain prescription was totally used showed a significant increase (p = 0.035). Following morphine administration, no single individual complained about an undue waiting time in comparison to 15% of patients previously. Even though the morphine intervention project caused more work for the nursing staff, 75% of the personnel were convinced that the procedure was worth this investment. This data revealed a relevant deficiency of surgical pain management. Already basic instructions on pain management can significantly improve this treatment. Assigning additional authority to the nursing staff, such as a nurse-based intravenous opioid administration, can significantly raise the motivation of the personnel as well as the satisfaction of the patients involved.

  19. Experiences of pretreatment laparoscopic surgical staging in patients with locally advanced cervical cancer: results of a prospective study

    PubMed Central

    Lim, Myong Cheol; Bae, Jaeman; Park, Jeong-Yoel; Lim, Soyi; Kang, Sokbom; Seo, Sang-Soo; Kim, Joo-Yong; Rho, Ju-Won

    2008-01-01

    Objective To prospectively evaluate the feasibility, safety, and survival of laparoscopic surgical staging in patients with locally advanced cervical cancer. Methods From Oct 2001 to Jul 2006, a total of 83 consecutive patients were eligible for inclusion and underwent laparoscopic surgical staging. Results Three patients with intraoperative great vessel injury and 1 patient in whom the colpotomizer was unable to be inserted were excluded. Laparoscopic surgical staging was feasible in 95.2% (79/83). Immediate postoperative complications were noted in 12 (15.2%) patients. Prolonged complications directly related to operative procedures numbered 2 (2.5%), and were trocar site metastases. The mean time from surgery to the start of radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) was 11 (5-35) days. All patients tolerated the treatment well and completed scheduled RT or CCRT without disruption of treatment and additional admission. The rate of modification of the radiation field after surgical staging was 8.9% (7/79). Five-year progression-free survival and overall survival (OS) rates were 79% and 89%, respectively. The OS of patients with microscopic lymph node metastases, which were fully resected, were comparable to those of patients without lymph node metastasis. However, the OS of patients with macroscopic lymph node metastases that were fully resected were poorer compared with those of patients without lymph node metastasis. Conclusion Pretreatment laparoscopic surgical staging is a feasible and safe treatment modality. However the survival benefit of debulking lymph nodes or full lymph node dissection is not clear. PMID:19471562

  20. Early joint degeneration and antagonism between growth factors and reactive oxygen species. Is non-surgical management possible?

    PubMed Central

    MANUNTA, ANDREA FABIO; ZEDDE, PIETRO; CUDONI, SEBASTIANO; CAGGIARI, GIANFILIPPO; PINTUS, GIANFRANCO

    2015-01-01

    Purpose in pathological conditions such as osteo-arthritis (OA), overproduction of reactive oxygen species (ROS) may overwhelm the antioxidant defenses of chondrocytes, thus promoting oxidative stress and cell death. It can be hypothesized that increasing the antioxidant machinery of chondrocytes may prevent the age-associated progression of this disease. Growth factors (GFs) play an important role in promoting both the resolution of inflammatory processes and tissue repair. In view of these considerations, we set out to investigate the protective effect, against H2O2-induced oxidative cell death, potentially exerted by fluid drained from the joint postoperatively. Methods the present study was conducted in 20 patients diagnosed with bilateral knee osteoarthritis and treated, between January 2013 and June 2014, with prosthetic knee implantation on the side more affected by the arthritic process, together with intraoperative placement of a closed-circuit drainage aspiration system. As a result, 20 different serum samples were collected from the drained articular fluid, prepared using two different methodologies. In addition, forty blood serum samples were obtained and prepared: 20 from the surgically treated patients and 20 from healthy controls. The present work was undertaken to investigate the potential protective effect of sera obtained from articular fluid drainage against hydrogen peroxide-induced oxidative stress in cultured human chondrocytes. Results exposure of chondrocytes to hydrogen peroxide elicited a dose-dependent increase in oxidative stress and chondrocyte cell death, phenomena that were significantly counteracted by the pre-treatment of cell cultures with sera from articular fluid drainage. Conclusions oxidatively stressed chondrocytes treated with sera obtained from articular fluid drainage lived longer than those treated with blood serum samples and longer than untreated ones. Clinical Relevance synovial fluids are usually discarded once the

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

    PubMed Central

    Lemaréchal, Angela; Zundel, Sabine; Szavay, Philipp

    2016-01-01

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

  2. Planned posterior assisted levitation in severe subluxated cataract: Surgical technique and clinical results

    PubMed Central

    Lifshitz, Tova; Levy, Jaime; Kratz, Assaf; Belfair, Nadav; Tsumi, Erez

    2012-01-01

    We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up. PMID:23202402

  3. Planned posterior assisted levitation in severe subluxated cataract: surgical technique and clinical results.

    PubMed

    Lifshitz, Tova; Levy, Jaime; Kratz, Assaf; Belfair, Nadav; Tsumi, Erez

    2012-01-01

    We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

  4. Medical versus surgical methods of early abortion: protocol for a systematic review and environmental scan of patient decision aids

    PubMed Central

    Donnelly, Kyla Z; Thompson, Rachel

    2015-01-01

    Introduction Currently, we lack understanding of the content, quality and impact of patient decision aids to support decision-making between medical and surgical methods of early abortion. We plan to undertake a systematic review of peer-reviewed literature to identify, appraise and describe the impact of early abortion method decision aids evaluated quantitatively (Part I), and an environmental scan to identify and appraise other early abortion method decision aids developed in the US (Part II). Methods and analysis For the systematic review, we will search PubMed, Cochrane Library, CINAHL, EMBASE and PsycINFO databases for articles describing experimental and observational studies evaluating the impact of an early abortion method decision aid on women's decision-making processes and outcomes. For the environmental scan, we will identify decision aids by supplementing the systematic review search with Internet-based searches and key informant consultation. The primary reviewer will assess all studies and decision aids for eligibility, and a second reviewer will also assess a subset of these. Both reviewers will independently assess risk of bias in the studies and abstract data using a piloted form. Finally, both reviewers will assess decision aid quality using the International Patient Decision Aid Standards criteria, ease of readability using Flesch/Flesch-Kincaid tests, and informational content using directed content analysis. Ethics and dissemination As this study does not involve human subjects, ethical approval will not be sought. We aim to disseminate the findings in a scientific journal, via academic and/or professional conferences and among the broader community to contribute knowledge about current early abortion method decision-making support. Trial registration number This protocol is registered in the International Prospective Register of Systematic Reviews (CRD42015016717). PMID:26173718

  5. Early and Midterm Results Following Interventional Coarctoplasty: Evaluation of Variables that Can Affect the Results

    PubMed Central

    Bassiri, Hossein Ali; Shafe, Omid; Sarpooshi, Javad

    2017-01-01

    Background and Objectives Stent coarctoplasty has been approved as the treatment of choice for adult patients with coarctation of the aorta. We have evaluated the early and midterm clinical and procedural results after interventional coarctoplasty. Also, variables that can affect these results were evaluated. Subjects and Methods Gathering clinical, angiographic and procedural data, we evaluated the pre-specified outcomes, including procedural success, complications, the incidence of hypertension after coarctoplasty etc., after the procedure. The effect of pre-specified variables including aortic arch shape, coarctation type and etc. on the procedural result was evaluated. Results Between February 2005 through March 2014, 133 stent coarctoplasty procedures were performed. Median age was 23.5 years old (interquartile range [IQR]:19-28), and 105 (71.9%) were male. Nearly all of the patients were undergone stent coarctoplasty, mostly with cheatham platinum (CP) stents. There was no association between aortic arch morphology and acute procedural complications. Balloon length more than 40 mm (p=0.028), aorta diameter at the site of Coarctation larger than 2.35 mm (p=0.008) was associated with higher rate of restenosis during follow-up. Comparison between the prevalence of hypertension (HTN) before and after coarctoplasty showed a significant reduction in the prevalence of HTN (117 [91.4%] vs. 95 [74.2%] p<0.001). Conclusion Stent coarctoplasty is a low-risk procedure with favorable early and delayed outcomes. Most mortality is related to the patient's comorbid conditions and not to the procedure. PMID:28154597

  6. Does human immunodeficiency virus status affect early wound healing in open surgically stabilised tibial fractures?: A prospective study.

    PubMed

    Howard, N E; Phaff, M; Aird, J; Wicks, L; Rollinson, P

    2013-12-01

    We compared early post-operative rates of wound infection in HIV-positive and -negative patients presenting with open tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV positive and 56 were HIV negative, were assessed for signs of infection using the ASEPIS wound score. There were 19 women and 65 men with a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive, 40 HIV-negative) treated with external fixation were also assessed using the Checkett score for pin-site infection. The remaining 28 fractures were treated with internal fixation. No significant difference in early post-operative wound infection between the two groups of patients was found (10.7% (n = 3) vs 19.6% (n = 11); relative risk (RR) 0.55 (95% confidence interval (CI) 0.17 to 1.8); p = 0.32). There was also no significant difference in pin-site infection rates (17.6% (n = 3) vs 12.5% (n = 5); RR 1.62 (95% CI 0.44 to 6.07); p = 0.47). The study does not support the hypothesis that HIV significantly increases the rate of early wound or pin-site infection in open tibial fractures. We would therefore suggest that a patient's HIV status should not alter the management of open tibial fractures in patients who have a CD4 count > 350 cells/μl.

  7. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: A propensity-matched comparison

    PubMed Central

    Goldstone, Andrew B.; Atluri, Pavan; Szeto, Wilson Y.; Trubelja, Alen; Howard, Jessica L.; MacArthur, John W.; Newcomb, Craig; Donnelly, Joseph P.; Kobrin, Dale M.; Sheridan, Mary A.; Powers, Christiana; Gorman, Robert C.; Gorman, Joseph H.; Pochettino, Alberto; Bavaria, Joseph E.; Acker, Michael A.; Hargrove, W. Clark; Woo, Y. Joseph

    2014-01-01

    Objective Minimally invasive approaches to mitral valve surgery are increasingly used, but the surgical approach must not compromise the clinical outcome for improved cosmesis. We examined the outcomes of mitral repair performed through right minithoracotomy or median sternotomy. Methods Between January 2002 and October 2011, 1011 isolated mitral valve repairs were performed in the University of Pennsylvania health system (455 sternotomies, 556 right minithoracotomies). To account for key differences in preoperative risk profiles, propensity scores identified 201 well-matched patient pairs with mitral regurgitation of any cause and 153 pairs with myxomatous disease. Results In-hospital mortality was similar between propensity-matched groups (0% vs 0% for the degenerative cohort; 0% vs 0.5%, P = .5 for the overall cohort; in minimally invasive and sternotomy groups, respectively). Incidence of stroke, infection, myocardial infarction, exploration for postoperative hemorrhage, renal failure, and atrial fibrillation also were comparable. Transfusion was less frequent in the minimally invasive groups (11.8% vs 20.3%, P = .04 for the degenerative cohort; 14.0% vs 22.9%, P .03 for the overall cohort), but time to extubation and discharge was similar. A 99% repair rate was achieved=in patients with myxomatous disease, and a minimally invasive approach did not significantly increase the likelihood of a failed repair resulting in mitral valve replacement. Patients undergoing minimally invasive mitral repair were more likely to have no residual post-repair mitral regurgitation (97.4% vs 92.1%, P = .04 for the degenerative cohort; 95.5% vs 89.6%, P = .02 for the overall cohort). In the overall matched cohort, early readmission rates were higher in patients undergoing sternotomies (12.6% vs 4.4%, P = .01). Over 9 years of follow-up, there was no significant difference in long-term survival between groups (P = .8). Conclusions In appropriate patients with isolated mitral valve

  8. [Early postoperative results of surgical treatment of patients with anterior clinoidal meningiomas].

    PubMed

    Chernov, S V; Rzaev, D A; Kalinovsky, A V; Dmitriev, A B; Kasymov, A R; Zotov, A V; Gormolysova, E V; Uzhakova, E K

    2017-01-01

    Resection of anterior clinoidal meningiomas is a challenging task due to their localization, frequent involvement of the major cerebral arteries and cranial nerves, a high risk of postoperative neurological deficits, and low radicalness of surgery.

  9. Compliance to surgical and radiation treatment guidelines in relation to patient outcome in early stage endometrial cancer.

    PubMed

    van Lankveld, Marieke A L; Koot, Nicole C M; Peeters, Petra H M; van Leeuwen, Jules Schagen; Jürgenliemk-Schulz, Ina M; van Eijkeren, Marion A

    2006-04-01

    We evaluated the adherence to treatment guidelines in early stage endometrial cancer and the influence of adherence to guidelines on overall survival. Patients were identified in the central region in the Netherlands from 1990 till 1995. Patient and tumour characteristics, surgical findings, radiation and follow-up data were abstracted from medical records. Endpoint was overall survival. Kaplan-Meier method was used to perform time-to-event analysis. Hazard ratios for overall survival were estimated with a Cox Proportional Hazards model. 359 patients were eligible for analysis. 335 patients presented with a clinical stage I cancer. 333 patients underwent a Total Abdominal Hysterectomy with Bilateral Salpingo Oophorectomy (TAH/BSO), of which 301 were staged as International Federation of Gynaecology and Obstetrics (FIGO) stage I, whereas 34 (10.2%) as FIGO stage II. Of the 24 patients with a clinical stage II cancer, 12 underwent a Radical Hysterectomy with Pelvic Lymph Node Dissection (RH/PLND), of which seven were diagnosed with FIGO stage II. In 72.1% of the patients adjuvant radiation was given or not in adherence to the guidelines. Whether treatment was given according to the guidelines or not did not affect 5 years overall survival. This suggests that extensive surgical procedures are redundant in the treatment of occult stage II endometrial cancer.

  10. The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study.

    PubMed

    Gardner-Thorpe, J; Love, N; Wrightson, J; Walsh, S; Keeling, N

    2006-10-01

    The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients. A total of 334 consecutive ward patients were prospectively studied. MEWS were recorded on all patients and the primary end-point was transfer to ITU or HDU. Fifty-seven (17%) ward patients triggered the call-out algorithm by scoring four or more on MEWS. Emergency patients were more likely to trigger the system than elective patients. Sixteen (5% of the total) patients were admitted to the ITU or HDU. MEWS with a threshold of four or more was 75% sensitive and 83% specific for patients who required transfer to ITU or HDU. The MEWS in association with a call-out algorithm is a useful and appropriate risk-management tool that should be implemented for all surgical in-patients.

  11. Western gulf culture-density study-early results

    Treesearch

    Mohd S. Rahman; Michael G. Messina; Richard F. Fisher; Alan B. Wilson; Nick Chappell; Conner Fristoe; Larry Anderson

    2006-01-01

    The Western Gulf Culture-Density Study is a collaborative research effort between Texas A&M University and five forest products companies to examine the effects of early silvicultural treatment intensity and a wide range of both densities and soil types on performance of loblolly pine. The study tests 2 silvicultural intensities, 5 planting densities (200 to 1,200...

  12. The Impact of Early Algebra: Results from a Longitudinal Intervention

    ERIC Educational Resources Information Center

    Brizuela, Bárbara M.; Martinez, Mara V.; Cayton-Hodges, Gabrielle A.

    2013-01-01

    In this paper, we provide evidence of the impact of early algebra (EA) over time. We document this impact in the following ways: (a) by showing the performance over time of an experimental group of 15 children on an algebra assessment, from 3rd to 5th grade; and (b) by showing how the performance on an algebra assessment of children from an…

  13. Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation

    PubMed Central

    Ates, Bülent; Akalin, Serdar; Citak, Mehmet; Kaya, Alper; Alanay, Ahmet

    2006-01-01

    Last two decades witnessed great advances in the surgical treatment of idiopathic scoliosis. However, the number of studies evaluating the long-term results of these treatment methods is relatively low. During recent years, besides radiological and clinical studies, questionnaires like SRS-22 assessing subjective functional and mental status and life-quality of patients have gained importance for the evaluation of these results. In this study, surgical outcome and Turkish SRS-22 questionnaire results of 109 late-onset adolescent idiopathic scoliosis patients surgically treated with third-generation instrumentation [Texas Scottish Rite Hospital (TSRH) System] and followed for a minimum of 10 years were evaluated. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT), shift of head (SH), and shift of stable vertebra (SS). Mean age of the patients was 14.4±1.9 and mean follow-up period was 136.9±12.7 months. When all the patients were included, the preoperative mean Cobb angle of major curves in the frontal plane was 60.8°±17.5°. Major curves that were corrected by 38.7±22.1% in the bending radiograms, postoperatively achieved a correction of 64.0±15.8%. At the last follow-up visit, 10.3°±10.8° of correction loss was recorded in major curves in the frontal plane with 50.5±23.1% final correction rate. Also, the mean postoperative and final kyphosis angles and lumbar lordosis angles were 37.7°±7.4°, 37.0°±8.4°, 37.5°±8.7°, and 36.3°±8.5°, respectively. A statistically significant correction was obtained at the sagittal plane; mean postoperative changes compared to preoperative values were 7.9° and 12.9° for thoracic and lumbar regions, respectively. On the other hand, normal physiological thoracic and lumbar sagittal contours were achieved in 83.5% and 67.9% of the patients, respectively. Postoperatively, a statistically significant correction was obtained in LT, SH, and SS values (P<0

  14. Effective treatment of haemorrhoids: early complication and late results after 150 consecutive stapled haemorrhoidectomies.

    PubMed

    Bove, Aldo; Bongarzoni, Giuseppe; Palone, Gino; Chiarini, Stella; Calisesi, Enrico Maria; Corbellini, Luciano

    2009-01-01

    Haemorrhoidectomy according to Longo potentially reduces post-operative pain and allows an early return to work. The aim of this study was to evaluate the efficacy of the technique, the early and especially late complications, and recurrences, in 150 patients. Between January 2005 and December 2006, we performed 150 consecutive haemorrhoidectomies with the Longo technique: 82 for third degree haemorrhoids and 68 for fourth degree haemorrhoids. The mean age of patients was 42 years. Every patient had a pre-operative proctoscopy and endoscopy KIT PPH01 (Ethicon Endo Surgery) was used. We evaluated the length of the operation, the post-operative pain, the early and late complications, and the recurrence of the disease. The mean follow up was 52 months (range 36-72). There was no mortality. The mean length of the operation was 25 minutes with a range of 15 to 45 minutes. Pain, evaluated using the V.A.S. scale, was very light in 114 patients (V.A.S. 2,1) and light in 36 (V.A.S. 3.2). Only 11 (7.5%) patients took painkillers, on demand, for a week after discharge from hospital and 2 patients (1,3%) for more than one month. Early complications (6.6%) were: 5 bleeding (2 after seven days), 4 acute urinary retentions, 1 external haemorrhoid thrombosis and 1 haematoma of the rectus wall. Mean Hospital stay was 2.1 days. Late complications (10%) were: 5 "faecal urgency" which disappeared after six months, 6 moderate asymptomatic strictures, and 4 persistent skin tags. There were 8 recurrences (5.1%), 2 for haemorrhoids of grade 3 e 6 for haemorrhoids of grade 4. All the recurrences appeared within the first 24 months. The stapled procedure according to Longo is an effective treatment for haemorrhoids. The results for postoperative pain and early return to work are very good. However, special care for haemostasis is essential in order to avoid bleeding. An effective surgical technique prevents late complications, but results after long term follow up show a not insignificant

  15. Early surgical complications after gastric by-pass: a literature review.

    PubMed

    Acquafresca, Pablo A; Palermo, Mariano; Rogula, Tomasz; Duza, Guillermo E; Serra, Edgardo

    2015-01-01

    Gastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones. Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. There were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction. Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.

  16. [Surgical treatment of rectal prolapse with transanal resection according to Altemeier. Experience and results].

    PubMed

    Carditello, Antonio; Milone, Antonino; Stilo, Francesco; Mollo, Francesco; Basile, Maurizio

    2003-01-01

    In recent years the number of patients with partial or total rectal prolapse has increased. Numerous techniques and surgical approaches have been described for its treatment. In this study we examine the main ones and stress the advantages of the transanal-perineal resection technique according to Altemeier and modified by Prasad, which we have used to treat the condition in the last 15 years. From 1988 to 2002, 269 patients with "haemorrhoidal prolapse" were referred to our department; 146 were females (54%), and the mean age was 58 years. Clinical examination and proctosigmoidoscopy revealed the presence of total rectal prolapse in 41 patients (15%, 32 F, 9 M), complicated in 4 cases by moderate incontinence and associated in 3 cases with post-haemorrhoidectomy stenosis. These 41 patients underwent transanal resection according to Altemeier. Thirty-four of them (83%) were operated on under local anaesthesia with sedation, 5 patients (12%) under peridural anaesthesia and 2 patients (5%) under narcosis. The mean hospital stay was 5 days and depended on the time of the first spontaneous evacuation. Check-ups were performed after 7 days, 1 months and every 3 months for 1 year. There was no postoperative mortality, and only 1 case of postoperative haemorrhage, which did not require reoperation, in a patient with a previous myocardial infarct who spontaneously continued to take salicylates up to 24 h before surgery. Thirty-three patients (80%) had their first postoperative evacuation within 48 h of surgery after taking sorbitol orally in the evening, 6 patients (15%) within 72 h, and 2 patients (5%) on postoperative day 4. No evacuative enemas were performed. We observed clinical healing in all patients 1 month after the operation, and regular, spontaneous evacuations without the use of oral laxatives. Stool or gas incontinence were never observed or reported. During the follow-up, only in 2% of cases did we observe partial recurrence of the prolapse. The choice

  17. Changing trends in the surgical treatment of Ménière's disease: results of a 10-year survey.

    PubMed

    Silverstein, Herbert; Lewis, William B; Jackson, Lance E; Rosenberg, Seth I; Thompson, Jack H; Hoffmann, Karen K

    2003-03-01

    In order to discern trends in surgical procedures used to treat Ménière's disease in the United States during the 1990s, we mailed a questionnaire to 700 members of the American Otological Society and the American Neurotology Society. These physicians were asked about the frequency, results, and complications of surgical procedures for Ménière's disease that they had performed between Jan. 1, 1990, and Dec. 31, 1999. Questionnaires were returned by 137 surgeons (19.6%). Their responses indicated that the number of vestibular neurectomies, labyrinthectomies, and endolymphatic sac surgeries all decreased during 1999. Meanwhile, the use of office-administered intratympanic gentamicin therapy increased rapidly throughout the entire 10-year period, and by 1999 it had become the most frequently used invasive treatment for Ménière's disease. Surgeons now seem to reserve inpatient procedures for cases where intratympanic gentamicin fails to control vertigo.

  18. [Surgical treatment of anal stenosis following hemorrhoid surgery. Results of 150 combined mucosal advancement and internal sphincterotomy].

    PubMed

    Carditello, Antonio; Milone, Antonino; Stilo, Francesco; Mollo, Francesco; Basile, Maurizio

    2002-01-01

    The aim of the study was to evaluate the efficacy of anoplasty by mucosal advancement combined with internal sphincterotomy for the treatment of iatrogenic anal stenosis. From January 1990 to December 2000, 149 patients with post-haemorrhoidectomy anal strictures underwent internal sphincterotomy and mucosal advancement flap anoplasty. Seventy-one percent of patients were operated on under local anaesthesia by perineal block according to Marti. In 90 percent of the patients, postoperative pain was mild. No significant complications were seen. The mean hospital stay was two days. Ninety-seven percent of patients were well satisfied with the surgical result one year after operation. Current surgical options for the treatment of post-haemorrhoidectomy anal stricture are reported and the advantages of mucosal advancement flap anoplasty outlined.

  19. [The immediate and late results of the surgical treatment of patients with complicated forms of pulmonary tuberculosis].

    PubMed

    Kerimov, R V; Badalov, R K; Medzhidov, F A; Mamedov, R I

    1996-01-01

    Immediate and long-term outcomes of repeated and multistage operations were analyzed in 190 patients with pulmonary tuberculosis. The aspects of work rehabilitation were studied in these patients. The efficiency of repeated and stage surgical interventions in patients both with disseminated and complicated types of tuberculosis and with pleural empyemas and in those with uncomplicated postoperative disease is 87.5 and 92.2%, respectively. The long-term results indicated that the complete clinical effect preserved in 79.2% of patients. Work rehabilitation was achieved in 64.8% of the examinees in the long-term postoperative period. The use of repeated and stage surgical interventions in patients with pulmonary tuberculosis may rehabilitate a rather large proportion of those operated on, assuming a great socioeconomic significance.

  20. Early rehabilitation treatment combined with equinovarus foot deformity surgical correction in stroke patients: safety and changes in gait parameters.

    PubMed

    Giannotti, Erika; Merlo, Andrea; Zerbinati, Paolo; Longhi, Maria; Prati, Paolo; Masiero, Stefano; Mazzoli, Davide

    2016-06-01

    Equinovarus foot deformity (EVFD) compromises several prerequisites of walking and increases the risk of falling. Guidelines on rehabilitation following EVFD surgery are missing in current literature. The aim of this study was to analyze safety and adherence to an early rehabilitation treatment characterized by immediate weight bearing with an ankle-foot orthosis (AFO) in hemiplegic patients after EVFD surgery and to describe gait changes after EVFD surgical correction combined with early rehabilitation treatment. Retrospective observational cohort study. Inpatient rehabilitation clinic. Forty-seven adult patients with hemiplegia consequent to ischemic or haemorrhagic stroke (L/R 20/27, age 56±15 years, time from lesion 6±5 years). A specific rehabilitation protocol with a non-articulated AFO, used to allow for immediate gait training, started one day after EVFD surgery. Gait analysis (GA) data before and one month after surgery were analyzed. The presence of differences in GA space-time parameters, in ankle dorsiflexion (DF) values and peaks at initial contact (DF at IC), during stance (DF at St) and swing (DF at Sw) were assessed by the Wilcoxon Test while the presence of correlations between pre- and post-operative values by Spearman's correlation coefficient. All patients completed the rehabilitation protocol and no clinical complications occurred in the sample. Ankle DF increased one month after surgery at all investigated gait phases (Wilcoxon Test, P<0.0001), becoming neutral at IC. Significant (P<0.05) variations were found for stride length, stride width, anterior step length of the affected side and for the duration of the double support phase of the contralateral side. The postsurgery ankle DF at St was found to be correlated (R=0.81, P<0.0001) with its pre-surgery value, thus being predictable. Weaker significant correlations were found for DF at Sw and DF at IC, where contribution from the dorsiflexor muscles is required in addition to calf muscle

  1. Randomized Controlled Trial of Forward-Planned Intensity Modulated Radiotherapy for Early Breast Cancer: Interim Results at 2 Years

    SciTech Connect

    Barnett, Gillian C.; Wilkinson, Jennifer S.; Moody, Anne M.; Wilson, Charles B.; Twyman, Nicola; Wishart, Gordon C.; Burnet, Neil G.; Coles, Charlotte E.

    2012-02-01

    Purpose: This single-center randomized trial was designed to investigate whether intensity-modulated radiotherapy (IMRT) reduces late toxicity in patients with early-stage breast cancer. Methods and Materials: The standard tangential plans of 1,145 nonselected patients were analyzed. The patients with inhomogeneous plans were randomized to a simple method of forward-planned IMRT or standard radiotherapy (RT). The primary endpoint was serial photographic assessment of breast shrinkage. Results: At 2 years, no significant difference was found in the development of any photographically assessed breast shrinkage between the patients randomized to the interventional or control group (odds ratio, 1.51; 95% confidence interval, 0.83-1.58; p = .41). The patients in the control group were more likely to develop telangiectasia than those in the IMRT group (odds ratio, 1.68; 95% confidence interval 1.13-2.40; p = .009). Poor baseline surgical cosmesis resulted in poor overall cosmesis at 2 years after RT. In patients who had good surgical cosmesis, those randomized to IMRT were less likely to deteriorate to a moderate or poor overall cosmesis than those in the control group (odds ratio, 0.63; 95% confidence interval, 0.39-1.03, p = .061). Conclusions: IMRT can lead to a significant reduction in telangiectasia at comparatively early follow-up of only 2 years after RT completion. An important component of breast induration and shrinkage will actually result from the surgery and not from the RT. Surgical cosmesis is an important determinant of overall cosmesis and could partially mask the longer term benefits of IMRT at this early stage.

  2. Results of a national multicenter audit assessment of gynecologic history in surgical patients.

    PubMed

    Wilson, Michael S J; Powell-Bowns, Matilda; Robertson, Andrew G; Luhmann, Andreas; Richards, Colin H

    2017-11-01

    To determine the adequacy of assessing gynecologic history for females of reproductive age (FRA) admitted to a general surgery department. The present prospective multicenter audit included FRA who were admitted for elective or emergency procedures to general surgery departments in Scotland between May 11 and May 25, 2015. Data were compared between patients who were admitted for elective and emergency treatment. There were 530 FRA included from 18 centers, including 169 (31.9%) and 361 (68.1%) elective and emergency admissions, respectively. The date of last menstrual period was document for 203 (38.3%) patients, use of contraception for 149 (28.1%), sexual activity for 83 (15.7%), pregnancy status for 274 (51.7%), and the possibility of pregnancy for 237 (44.7%). A higher incidence of documented date of last menstrual period (P=0.002) and pregnancy status (P<0.001) were identified among emergency admissions, and the possibility of pregnancy was documented more commonly among elective admissions (P<0.001). Key factors required for gynecologic assessment were often not documented for FRA admitted to general surgery both as elective and emergency admissions. Surgical teams and medical undergraduates require educating regarding the importance of obtaining gynecologic history for all FRA. © 2017 International Federation of Gynecology and Obstetrics.

  3. Impact of cosmetic result on selection of surgical treatment in patients with localized prostate cancer.

    PubMed

    Rojo, María Alejandra Egui; Martinez-Salamanca, Juan Ignacio; Maestro, Mario Alvarez; Galarza, Ignacio Sola; Rodriguez, Joaquin Carballido

    2014-01-01

    To analyze the effect of cosmetic outcome as an isolated variable in patients undergoing surgical treatment based on the incision used in the 3 variants of radical prostatectomy: open (infraumbilical incision and Pfannestiel incision) and laparoscopic, or robotic (6 ports) surgery. 612 male patients 40 to 70 years of age with a negative history of prostate disease were invited to participate. Each patient was evaluated by questionnaire accompanied by a set of 6 photographs showing the cosmetic appearance of the 3 approaches, with and without undergarments. Participants ranked the approaches according to preference, on the basis of cosmesis. We also recorded demographic variables: age, body mass index, marital status, education level, and physical activity. Of the 577 patients who completed the questionnaries, the 6-port minimally invasive approach represents the option preferred by 52% of the participants, followed by the Pfannestiel incision (46%), and the infraumbilical incision (11%), respectively. The univariate and multivariate analyses did not show statistically significant differences when comparing the approach preferred by the patients and the sub-analyses for demographic variables, except for patients who exercised who preferred the Pfannestiel incision (58%) instead of minimally invasive approach (42%) with statistically significant differences. The minimally invasive approach was the approach of choice for the majority of patients in the treatment of prostate cancer. The Pfannestiel incision represents an acceptable alternative. More research and investment may be necesary to improve cosmetic outcomes.

  4. [Antibiotic prophylaxis for surgical wound infection in cardiac surgery: results of a Spanish survey].

    PubMed

    Izquierdo-Blasco, J; Soler-Palacín, P; Campins-Martí, M; Vázquez Martínez, J L; Sanchez-de-Toledo, J

    2013-07-01

    No Spanish guidelines for the prevention of surgical wound infection in paediatric cardiac surgery are currently available. The aim of this study was to analyse the nationwide variability in antibiotic prophylaxis use. An online questionnaire was distributed to all members of the Cardiology Group of the Spanish Society of Paediatric Intensive Care. Fifteen centres participated in the study. In heart surgery with no delayed sternal closure, all 15 centres used a 1st or 2nd generation cephalosporin in paediatric patients, while 3 hospitals used a broader-spectrum antibiotic therapy in neonates. Prophylaxis was maintained for 12-72h in 11 centres and until drainage removal in four. Thirteen centres used delayed sternal closure, eight of which followed the same protocol for these patients as for standard procedures. Prophylaxis was maintained for 12-72h in 6 centres, and until sternal closure at the rest. Five out of 10 centres performing extracorporeal membrane oxygenation (ECMO) maintained the same antibiotic protocol as in standard surgery. A wide variability was observed in antibiotic prophylaxis use in high-risk patients. Thus, national protocols need to be standardised. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  5. Aneurysms of the extracranial internal carotid artery due to fibromuscular dysplasia: results of surgical management.

    PubMed

    Bour, P; Taghavi, I; Bracard, S; Frisch, N; Fiévé, G

    1992-05-01

    Between January 1977 and December 1990, eight patients underwent surgical correction of aneurysms of the extracranial internal carotid artery due to fibromuscular dysplasia. Mean age of patients was 50 years (range 31 to 70 years). Five patients presented with neurologic hemispheric symptoms. Most aneurysms were saccular and occurred preferentially at the level of C2 or C3. All of these patients underwent operation through conventional cervicotomy. Resection-anastomosis was performed in three cases whereas resection-graft was performed in five. Histopathological examination of the eight specimens was consistent with fibromuscular dysplasia of the media. There was no central nervous system-related mortality and morbidity. Seven patients were alive and free of new neurological manifestations at mean follow-up of 156 months (18 to 180 months). One patient died of myocardial infarction at 96 months. All patients had postoperative duplex scanning or arteriograms. These revealed that carotid restorations were patent in seven whereas one patient had asymptomatic occlusion at 18 months.

  6. [The surgical treatment of lumbar stenosis and its results. A series of 163 operated cases].

    PubMed

    Deburge, A; Lassale, B; Benoist, M; Cauchoix, J

    1983-01-01

    163 patients were operated for degenerative lumbar stenosis (only 10 did not have osteoarthrosis), following the failure of medical treatment. The surgical decompression varied according to the anatomical type of the stenosis: central, lateral or mixed. In 13 p. cent of cases, it was followed by an arthrodesis. There were no deaths. The most frequent complications were: haematoma (6 p. cent), infection (5 p. cent), aggravation of the neurological disturbance (3 cases), breeches in the dura, practically inevitable in very tight stenosis (13 p. cent) and epidural fibrosis (4 re-operations). When there is no sliding prior to the operation, the risk of aggravation or appearance of sliding in cases of spondylolisthesis is somewhat higher (6 cases out of 64). The different symptoms are unequally improved by the decompression: root pain is the best relieved (69 p. cent cure, 20 p. cent improvement) together with intermittent claudication (75 p. cent cure, 14 p. cent improvement) and, to a lesser degree, back pain (48 p. cent cure, 32 p. cent improvement). There is a possibility of recovery even in the severe forms of motor disturbance.

  7. [Pediatric case of congenital coronary artery fistula; surgical result and late changes in coronary artery aneurysm].

    PubMed

    Sugawara, Masaaki; Oguma, Fumiaki; Hirahara, Hiroyuki

    2014-07-01

    Congenital coronary artery fistula is an uncommon heart anomaly involving the coronary arteries. We report here a case of a 4-year-old boy who had a coronary fistula from the right coronary artery to the right ventricle, with a coronary aneurysm. He was asymptomatic, but the calculated ratio of pulmonary blood flow to systemic blood flow was shown to be high [pulmonary flow (Qp)/systemic flow(Qs)=1.78]. The coronary angiography showed that the right coronary artery was dilated beginning at the ostium and had an aneurysm at the acute marginal portion. A large spherical aneurysm approximately 20 mm in diameter was found to have been connected with coronary fistula opening into the right ventricle. Surgical repair by closure of the fistula under direct vision, partial resection and suture closure of the aneurysm was performed. Plication of the proximal portion of the right coronary artery was not performed, and the diffusely dilated artery was left untouched. After this operation, he recovered well under anticoagulant treatment with warfarin and aspirin. Postoperative angiography was performed 17 months after the surgery to evaluate morphological changes in the coronary artery. The angiography confirmed the closure of the fistula and the regression of coronary artery dilatation.

  8. Surgical results of endoscopic dacryocystorhinostomy and lacrimal trephination in distal or common canalicular obstruction.

    PubMed

    Baek, Byoung-Joon; Hwang, Gyu-Rin; Jung, Dong-Ho; Kim, I-Seok; Sin, Jae-Min; Lee, Heung-Man

    2012-06-01

    To evaluate the surgical outcomes of endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stenting in patients with distal or common canalicular obstructions. The medical records of 29 patients (31 eyes) from January 2001 to December 2009 who underwent endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone tube insertion for the treatment of distal or common canalicular obstructions were retrospectively reviewed. The level of obstruction was confirmed by intraoperative probing. The outcome of the surgery was categorized as a complete success, partial success, or failure according to the functional and anatomic patency. The average age of the patients was 52 years. The duration of silicone intubation ranged from 4 to 11 months with an average of 5.7±1.6 months. The follow-up period after stent removal ranged from 4 to 15 months with an average of 8.2±3.3 months. Complete success was achieved in 25 out of 31 eyes (80.6%), partial success in 4 out of 31 eyes (12.9%), and failure in 2 out of 31 eyes (6.5%). Endoscopic dacryocystorhinostomy followed by canalicular trephination and silicone stent intubation may be safe and considered as an initial treatment of patients with distal or common canalicular obstructions.

  9. Intraoperative radiation therapy in malignant glioma: early clinical results.

    PubMed

    Ortiz de Urbina, D; Santos, M; Garcia-Berrocal, I; Bustos, J C; Samblas, J; Gutierrez-Diaz, J A; Delgado, J M; Donckaster, G; Calvo, F A

    1995-08-01

    Intraoperative radiation therapy (IORT) with high energy electron beams is a treatment modality that has been included in multimodal programs in oncology to improve local tumor control. From August 1991 to December 1993, 17 patients with primary (8) or recurrent (9) high grade malignant gliomas, anaplastic astrocytoma (4), anaplastic oligodendroglioma (6) and glioblastoma multiforme (7), underwent surgical resection and a single dose of 10-20 Gy intraoperative radiation therapy was delivered in tumor bed. Fourteen patients received either pre-operative (8) or post-operative (6) external beam radiation therapy. Primary gliomas: 18-months actuarial survival rate has been 56% (range: 1-21+ months) and the median survival time has not yet been achieved. Four patients developed tumor progression (median time to tumor progression: 9 months). Recurrent gliomas: 18-months actuarial survival rate and median survival time has been 47% and 13 months (range: 6-32+ months) respectively. The median time to tumor progression was 11 months. No IORT related mortality has been observed. IORT is an attractive, tolerable and feasible treatment modality as antitumoral intensification procedure in high grade malignant gliomas.

  10. Evaluation of the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over☆

    PubMed Central

    Miyazaki, Alberto Naoki; da Silva, Luciana Andrade; Santos, Pedro Doenux; Checchia, Sergio Luiz; Cohen, Carina; Giora, Taís Stedile Busin

    2015-01-01

    Objectives To evaluate the results from arthroscopic surgical treatment of rotator cuff injuries in patients aged 65 years and over. Methods Between 1998 and 2009, 168 patients underwent operations. Five cases were excluded. The remaining 163 patients were stratified according to their age group: 65–69 years (49.1%), 70–74 (26.4%) and 75 years and over (24.5%). Their mean age was 71 years (range: 65–83). There were 63 male patients (38.7%). The mean length of time with pain, from the onset of symptoms to the surgery, was 23 months (range: 2 days to 240 months). Sixty-two patients (38%) reported histories of trauma and 26 (16%) reported that their pain worsened through exertion. Results From the UCLA criteria, 80.4% of the results were excellent, 16% good, 1.8% fair and 1.8% poor. Complications occurred in 11%. The final clinical result did not show any correlation with age progression, injury size or tendons affected. However, there was a significant association (p < 0.001) between the presence of trauma and larger injuries. The length of time between the onset of symptoms and the surgical procedure had a significant relationship (p < 0.027) with the postoperative results: the longer this time was, the worse the results were. Conclusion Arthroscopic treatment of rotator cuff injuries in patients aged 65 years and over presented excellent and good results in 96.4% of the cases, according to the UCLA assessment, with a low complication rate. Advanced age did not show any influence on the postoperative clinical evolution, but the earlier the surgical treatment was instituted, the better the results were. PMID:26229935

  11. Early results from NASA's SnowEx campaign

    NASA Astrophysics Data System (ADS)

    Kim, Edward; Gatebe, Charles; Hall, Dorothy; Misakonis, Amy; Elder, Kelly; Marshall, Hans Peter; Hiemstra, Chris; Brucker, Ludovic; Crawford, Chris; Kang, Do Hyuk; De Marco, Eugenia; Beckley, Matt; Entin, Jared

    2017-04-01

    SnowEx is a multi-year airborne snow campaign with the primary goal of addressing the question: How much water is stored in Earth's terrestrial snow-covered regions? Year 1 (2016-17) focuses on the distribution of snow-water equivalent (SWE) and the snow energy balance in a forested environment. The year 1 primary site is Grand Mesa and the secondary site is the Senator Beck Basin, both in western, Colorado, USA. Ten core sensors on four core aircraft will make observations using a broad suite of airborne sensors including active and passive microwave, and active and passive optical/infrared sensing techniques to determine the sensitivity and accuracy of these potential satellite remote sensing techniques, along with models, to measure snow under a range of forest conditions. SnowEx also includes an extensive range of ground truth measurements—in-situ samples, snow pits, ground based remote sensing measurements, and sophisticated new techniques. A detailed description of the data collected will be given and some early results will be presented. Seasonal snow cover is the largest single component of the cryosphere in areal extent (covering an average of 46M km2 of Earth's surface (31 % of land areas) each year). This seasonal snow has major societal impacts in the areas of water resources, natural hazards (floods and droughts), water security, and weather and climate. The only practical way to estimate the quantity of snow on a consistent global basis is through satellites. Yet, current space-based techniques underestimate storage of snow water equivalent (SWE) by as much as 50%, and model-based estimates can differ greatly vs. estimates based on remotely-sensed observations. At peak coverage, as much as half of snow-covered terrestrial areas involve forested areas, so quantifying the challenge represented by forests is important to plan any future snow mission. Single-sensor approaches may work for certain snow types and certain conditions, but not for others

  12. Surgical fusion of early onset severe scoliosis increases survival in Rett syndrome: a cohort study.

    PubMed

    Downs, Jenny; Torode, Ian; Wong, Kingsley; Ellaway, Carolyn; Elliott, Elizabeth J; Izatt, Maree T; Askin, Geoffrey N; Mcphee, Bruce I; Cundy, Peter; Leonard, Helen

    2016-06-01

    Scoliosis is a common comorbidity in Rett syndrome and spinal fusion may be recommended if severe. We investigated the impact of spinal fusion on survival and risk of severe lower respiratory tract infection in Rett syndrome. Data were ascertained from hospital medical records, the Australian Rett Syndrome Database, a longitudinal and population-based registry, and from the Australian Institute of Health and Welfare National Death Index database. Cox regression and generalized estimating equation models were used to estimate the effects of spinal surgery on survival and severe respiratory infection respectively in 140 females who developed severe scoliosis (Cobb angle ≥45°) before adulthood. After adjusting for mutation type and age of scoliosis onset, the rate of death was lower in the surgery group (hazard ratio [HR] 0.30, 95% confidence interval [CI] 0.12-0.74; p=0.009) compared to those without surgery. Rate of death was particularly reduced for those with early onset scoliosis (HR 0.17, 95% CI 0.06-0.52; p=0.002). There was some evidence to suggest that spinal fusion was associated with a reduction in risk of severe respiratory infection among those with early onset scoliosis (risk ratio 0.41, 95% CI 0.16-1.03; p=0.06). With appropriate cautions, spinal fusion confers an advantage to life expectancy in Rett syndrome. © 2015 Mac Keith Press.

  13. Surgical treatment for early hepatocellular carcinoma: comparison of resection and liver transplantation.

    PubMed

    Zhou, Jian; Wang, Zheng; Qiu, Shuang-Jian; Huang, Xiao-Wu; Sun, Jian; Gu, Wen; Fan, Jia

    2010-09-01

    The optimum strategy, hepatic resection (HR) or liver transplantation (LT), for treatment of early hepatocellular carcinoma (HCC) associated with liver diseases of Child-Pugh A is far from established. The aim of this study was to compare and determine which strategy is optimal for HCC fulfilling the Milan criteria. Consecutive data were collected in 1,018 HCC patients treated with HR and 89 HCC patients listed for LT (1 drop out for HCC progression) between January of 2003 and December of 2007. The independent prognostic factors identified by multivariate analysis were tumor size-plus-number, microscopic venous invasion, and operation type (LT or HR). When tumor size-plus-number was < or =4 or microscopic venous invasion was absent, there was no significant difference in overall survival (OS) between the LT and HR group. When tumor size-plus-number was >4 or microscopic venous invasion was present, OS was higher in the LT group. Since the pathological microscopic venous invasion was not easily available before operation which is limitation for widespread clinical use, thus in practice, we concluded that, for early HCC associated with Child-Pugh A cirrhosis, when tumor size-plus-number is >4, LT provides the best cure; when it is < or =4, HR remains the initial treatment of choice.

  14. Use of administrative data for surgical site infection surveillance after congenital cardiac surgery results in inaccurate reporting of surgical site infection rates.

    PubMed

    Atchley, Krista D; Pappas, Janine M; Kennedy, Andrea T; Coffin, Susan E; Gerber, Jeffrey S; Fuller, Stephanie M; Spray, Thomas L; McCardle, Kenneth; Gaynor, J William

    2014-02-01

    The National Healthcare Safety Network (NHSN) is a safety surveillance system managed by the Centers for Disease Control and Prevention that monitors procedure specific rates of surgical site infections (SSIs). At our institution, SSI data is collected and reported by three different methods: (1) the NHSN database with reporting to the Centers for Disease Control and Prevention; (2) the hospital billing database with reporting to payers; and (3) The Society of Thoracic Surgeons Congenital Heart Surgery Database. A quality improvement initiative was undertaken to better understand issues with SSI reporting and to evaluate the effect of different data sources on annual SSI rates. Annual cardiac surgery procedure volumes for all three data sources were compared. All episodes of SSI identified in any data source were reviewed and adjudicated using NHSN SSI criteria, and the effect on SSI rates was evaluated. From January 1, 2008, to December 31, 2011, 2,474 cardiac procedures were performed and reported to The Society of Thoracic Surgeons Congenital Heart Surgery Database. Billing data identified 1,865 cardiac surgery procedures using the 63 CARD International Classification of Diseases-Ninth Revision codes from the NHSN inclusion criteria. Only 1,425 procedures were targeted for NHSN surveillance using the NHSN's CARD operative procedure group in the same period. Procedures identified for NHSN surveillance annually underestimated the number of cardiac operations performed by 17% to 71%. As a result, annual SSI rates potentially differed by 12% to 270%. The NHSN CARD surveillance guidelines for SSI fail to identify all pediatric cardiac surgical procedures. Failure to target all at-risk procedures leads to inaccurate reporting of SSI rates largely based on identifying the denominator. Inaccurate recording of SSI data has implications for public reporting, benchmarking of outcomes, and denial of payment. Use of The Society of Thoracic Surgeons Congenital Heart Surgery

  15. Health economics and surgical treatment for Parkinson's disease in a world perspective: results from an international survey.

    PubMed

    Jourdain, Vincent A; Schechtmann, Gastón

    2014-01-01

    Most studies in the field of neurosurgical treatment for movement disorders have been published by a small number of leading centers in developed countries. This study aimed to investigate the clinical practice of stereotactic neurosurgery for Parkinson's disease (PD) worldwide. Neurosurgeons were contacted via e-mail to participate in a worldwide survey. The results obtained are presented in order of the countries' economic development according to the World Bank, as well as by the source of financial support. A total of 353 neurosurgeons from 51 countries who had operated on 13,200 patients in 2009 were surveyed. Surgical procedures performed in high-income countries were more commonly financed by a public health care system. In contrast, in lower-middle-income and upper-middle-income countries, patients frequently financed surgeries themselves, and ablative surgeries were most commonly performed. Unexpectedly, ablative surgery is still used by about 65% of neurosurgeons, regardless of their country's economic status. This study provides a previously unavailable picture of the surgical aspects of PD across the globe in relation to health economics and sociodemographic factors. Global educational and training programs are warranted to raise awareness of economically viable surgical options for PD that could be adopted by public health care systems in lower-income countries. © 2014 S. Karger AG, Basel.

  16. The contralateral transfalcine transprecuneus approach to the atrium of the lateral ventricle: operative technique and surgical results.

    PubMed

    Xie, Tao; Sun, Chongjing; Zhang, Xiaobiao; Zhu, Wei; Zhang, Jianping; Gu, Ye; Li, Wensheng

    2015-03-01

    Surgical approaches to the atrium of the lateral ventricle remain a challenging neurosurgical issue because of the eloquent nature of the surrounding anatomy. To report our operative techniques and preliminary surgical results with the contralateral transfalcine transprecuneus approach. A retrospective data review was performed of patients undergoing a contralateral transfalcine transprecuneus approach for the resection of lesions in the atrium of the lateral ventricle. Patients were positioned in the prone position with a 30° elevation, and a 15° rotation was used. After a contralateral parasagittal parieto-occipital craniotomy and falx incision, the corticotomy in the contralateral precuneus gyrus created a corridor to the tumor. An endoscope was used to assist with the surgery. Headache was the primary preoperative symptom, which improved in all patients after surgery. After treatment, symptoms were improved in all 3 patients with hemiparesis and in 3 of 6 patients with preexisting visual deficits; symptoms were unchanged in the other 3 patients with visual deficits during the 13- to 38-month follow-up. Nine lesions were totally removed, and 1 metastatic breast cancer lesion was subtotally removed; all patients had good neurological outcomes and no operative mortality. The contralateral transfalcine transprecuneus approach is appropriate for most lesions in the atrium of the lateral ventricle. It provides a wider surgical angle (especially for the lateral extension) and reduces the risk of disturbance of the optic radiation compared with the conventional approaches. The use of magnetic resonance venography-magnetic resonance imaging neuronavigation makes the procedure much easier and more accurate, and the neuroendoscope adds to the visualization of the microscope and can reduce surgical complications.

  17. No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study

    PubMed Central

    Farquhar, Jaclyn; Almahrabi, Yahya; Slobogean, Gerard; Slobogean, Bronwyn; Garraway, Naisan; Simons, Richard K.; Hameed, S. Morad

    2016-01-01

    Background Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols. Methods Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols. We compared short- and long-term outcomes between these cohorts. Results Our patient cohorts were well matched for age, sex, injury severity scores and abbreviated injury scores. The nonoperatively managed group had significantly better outcomes than the surgical group in terms of ventilator days (3.1 v. 6.1, p = 0.012), length of stay in the intensive care unit (3.7 v. 7.4 d, p = 0.009), total hospital length of stay (16.0 v. 21.9 d, p = 0.044) and rates of pneumonia (22% v. 63%, p = 0.004). There were no significant differences in long-term outcomes, such as chest pain or dyspnea. Conclusion Although considerable enthusiasm surrounds surgical fixation of flail chest injuries, our analysis does not immediately validate its universal implementation, but rather encourages the use of modern, multidisciplinary, nonoperative strategies. The role of rib fracture fixation in the modern era of chest wall trauma management should ultimately be defined by prospective, randomized trials. PMID:27438051

  18. [Arthrodesis of the elbow joint. Indications, surgical technique and clinical results].

    PubMed

    Moghaddam-Alvandi, A; Dremel, E; Güven, F; Heppert, V; Wagner, C; Studier-Fischer, S; Grützner, P A; Biglari, B

    2010-04-01

    Arthrodesis of the elbow joint (EA) is a rare salvage procedure which is disliked by both surgeons and patients. The aim of this study was to analyze the indications, the operation techniques and the outcome of EA in patients treated at our clinic. Between January 1997 and December 2005 a total of 20 patients with a mean age of 55 years (range 27-85 years) were treated with EA at our clinic. In 18 patients a compression plate was used as surgical technique. In 18 out of the 20 patients the operation was performed post-traumatically after infection, bone and tissue defects and painful loss of motion. Of these patients, 16 could be followed up for an average time of 66 months. The outcome was evaluated based on the degree of pain, range of motion, radiographic findings and grip strength measured with the Jamar dynamometer. All patients had a solid and fused EA, the average angle was 89 degrees (range 80-110 degrees) and the grip strength was reduced by 27% compared to the unaffected side. The patients achieved 56 points in the Morrey score, 38.29 points in the DASH (disabilities of the arm, shoulder and hand) score and 80 points in the Constant-Murley score. The indication of EA depends on several factors, therefore it is essential to take the patients' functional requirements into consideration and the best arthrodesis angle should be validated pre-operatively. In these cases the patients can regain good grip strength and a high level of stability within defined functional limitations.

  19. The Aristotle score: a complexity-adjusted method to evaluate surgical results.

    PubMed

    Lacour-Gayet, F; Clarke, D; Jacobs, J; Comas, J; Daebritz, S; Daenen, W; Gaynor, W; Hamilton, L; Jacobs, M; Maruszsewski, B; Pozzi, M; Spray, T; Stellin, G; Tchervenkov, C; Mavroudis And, C

    2004-06-01

    Quality control is difficult to achieve in Congenital Heart Surgery (CHS) because of the diversity of the procedures. It is particularly needed, considering the potential adverse outcomes associated with complex cases. The aim of this project was to develop a new method based on the complexity of the procedures. The Aristotle project, involving a panel of expert surgeons, started in 1999 and included 50 pediatric surgeons from 23 countries, representing the EACTS, STS, ECHSA and CHSS. The complexity was based on the procedures as defined by the STS/EACTS International Nomenclature and was undertaken in two steps: the first step was establishing the Basic Score, which adjusts only the complexity of the procedures. It is based on three factors: the potential for mortality, the potential for morbidity and the anticipated technical difficulty. A questionnaire was completed by the 50 centers. The second step was the development of the Comprehensive Aristotle Score, which further adjusts the complexity according to the specific patient characteristics. It includes two categories of complexity factors, the procedure dependent and independent factors. After considering the relationship between complexity and performance, the Aristotle Committee is proposing that: Performance = Complexity x Outcome. The Aristotle score, allows precise scoring of the complexity for 145 CHS procedures. One interesting notion coming out of this study is that complexity is a constant value for a given patient regardless of the center where he is operated. The Aristotle complexity score was further applied to 26 centers reporting to the EACTS congenital database. A new display of centers is presented based on the comparison of hospital survival to complexity and to our proposed definition of performance. A complexity-adjusted method named the Aristotle Score, based on the complexity of the surgical procedures has been developed by an international group of experts. The Aristotle score

  20. Randomized controlled trial of forward-planned intensity modulated radiotherapy for early breast cancer: interim results at 2 years.

    PubMed

    Barnett, Gillian C; Wilkinson, Jennifer S; Moody, Anne M; Wilson, Charles B; Twyman, Nicola; Wishart, Gordon C; Burnet, Neil G; Coles, Charlotte E

    2012-02-01

    This single-center randomized trial was designed to investigate whether intensity-modulated radiotherapy (IMRT) reduces late toxicity in patients with early-stage breast cancer. The standard tangential plans of 1,145 nonselected patients were analyzed. The patients with inhomogeneous plans were randomized to a simple method of forward-planned IMRT or standard radiotherapy (RT). The primary endpoint was serial photographic assessment of breast shrinkage. At 2 years, no significant difference was found in the development of any photographically assessed breast shrinkage between the patients randomized to the interventional or control group (odds ratio, 1.51; 95% confidence interval, 0.83-1.58; p = .41). The patients in the control group were more likely to develop telangiectasia than those in the IMRT group (odds ratio, 1.68; 95% confidence interval 1.13-2.40; p = .009). Poor baseline surgical cosmesis resulted in poor overall cosmesis at 2 years after RT. In patients who had good surgical cosmesis, those randomized to IMRT were less likely to deteriorate to a moderate or poor overall cosmesis than those in the control group (odds ratio, 0.63; 95% confidence interval, 0.39-1.03, p = .061). IMRT can lead to a significant reduction in telangiectasia at comparatively early follow-up of only 2 years after RT completion. An important component of breast induration and shrinkage will actually result from the surgery and not from the RT. Surgical cosmesis is an important determinant of overall cosmesis and could partially mask the longer term benefits of IMRT at this early stage. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Aquarius Radiometer Performance: Early On-Orbit Calibration and Results

    NASA Technical Reports Server (NTRS)

    Piepmeier, Jeffrey R.; LeVine, David M.; Yueh, Simon H.; Wentz, Frank; Ruf, Christopher

    2012-01-01

    The Aquarius/SAC-D observatory was launched into a 657-km altitude, 6-PM ascending node, sun-synchronous polar orbit from Vandenberg, California, USA on June 10, 2011. The Aquarius instrument was commissioned two months after launch and began operating in mission mode August 25. The Aquarius radiometer meets all engineering requirements, exhibited initial calibration biases within expected error bars, and continues to operate well. A review of the instrument design, discussion of early on-orbit performance and calibration assessment, and investigation of an on-going calibration drift are summarized in this abstract.

  2. Correlation Between Surgical Extent and Prognosis in Node-Negative, Early-Stage Papillary Thyroid Carcinoma Originating in the Isthmus.

    PubMed

    Lim, Seung Taek; Jeon, Ye Won; Suh, Young Jin

    2016-02-01

    The association between surgical extent and prognosis in papillary thyroid carcinoma originating in the isthmus is unclear. We included 233 patients with early-stage, node-negative papillary thyroid cancer originating in the isthmus; 126 were treated by lobectomy plus isthmusectomy with ipsilateral central neck dissection and 97 were treated by total thyroidectomy with bilateral central neck dissection. Subgroup analysis was performed according to tumor size (≤ 1 vs. >1 cm) to evaluate whether tumor size had a significant impact on determining the optimal extent of surgery in our cohort. Total thyroidectomy patients had longer recurrence-free survival (RFS) than those treated by lobectomy plus isthmusectomy. Subgroup analysis showed that this was true only for tumors >1 cm. In multivariate analysis, total thyroidectomy was an independent risk factor for RFS only for tumors >1 cm. Lobectomy plus isthmusectomy may be optimal for early-stage, node-negative papillary thyroid carcinoma originating in the isthmus for tumors ≤ 1 cm; total thyroidectomy might be better for tumors >1 cm.

  3. [Achilles tendon rupture--early functional and surgical options with special emphasis on rehabilitation issues].

    PubMed

    Knobloch, K; Thermann, H; Hüfner, T

    2007-03-01

    Achilles tendon ruptures are one end of a continuum starting with the healthy Achilles tendon via the thickened and painful tendinopathic Achilles tendon with neovascularisation to the complete tendon rupture. Often times chinolone antibiotics, cortisone therapy and valgus foot axis are associated risk factors. Incidence of Achilles tendon ruptures is estimated to be 10/100 000 per year with a mean age of 35-40 years. Physical activity is encountered in 75 % cases of Achilles tendon ruptures. Running is associated with Achilles tendinopathy as the predominant overuse injury in an analysis among 291 athletes with 10 million kilometers exposure. The Achilles tendinopathic rate was 0.016/1000 km differentiated in 0.008/1000 km mid-portion tendinopathy and 0.005/1000 km insertional tendinopathy. Achilles tendinopathy in running overuse injuries is followed by runner's knee (0.013/1000 km), shin splint (0.0104/1000 km) and plantar fasciitis (0.0054/1000 km). Dynamic ultrasound in 20 degrees plantar flexion is of utmost importance for therapeutic decision making. With an adaptation rate of 75 % or more of the ruptured tendon in 20 degrees plantar flexion and a high patient's compliance we perform an early functional conservative treatment regimen in Achilles tendon ruptures. In almost all other cases the percutaneous Achilles tendon repair is indicated, where nervus suralis lesions have to be appreciated. The vulnerable zone is 10-12 cm proximal to the calcaneus at the lateral border of the Achilles tendon with the sural nerve in close proximity with the tendon. Early functional rehabilitation is not associated with a higher risk of rerupture but with improved subjective assessments and should therefore be advocated.

  4. Minilaparotomy radical cystoprostatectomy (Minilap RCP) in the surgical management of urinary bladder carcinoma: early experience.

    PubMed

    Rawal, Sudhir; Raghunath, S K; Khanna, Samir; Jain, Deepak; Kaul, Rakesh; Kumar, Prem; Chhabra, Rakesh; Bhushan, Kirti

    2008-09-01

    To assess the feasibility of minilaparotomy for radical cystoprostatectomy (RCP) and urinary diversion in the management of urinary bladder carcinoma. A total of 45 consecutive patients with muscle invasive urinary bladder cancer underwent RCP and urinary diversion [32, 12 and 1 patients with pitchers pot orthotopic neobladder (NB), ileal conduit (IC) and sigma rectal pouch respectively], between May 2006 and June 2007, using 8-12 cm infraumbilical midline vertical incision from pubic symphysis, were prospectively analyzed for technical feasibility, operative time, blood loss, intraoperative and postoperative complications and return of bowel function. All the patients were males with average age of 59.65 years (44-79 years) and average body mass index of 23.97(17.7-29.5). The length of the incision was 8, 10 and 12 cm in 4, 39 and 2 patients, respectively. The average number of lymph nodes removed on the right and left side was 14 and 16, respectively. The average blood loss was 1046 ml (595-2100 ml). Return of bowel sounds was observed on an average by second postoperative day (1-5 days). Average postoperative stay was 14 days (range 10-24 days) for NB and 7 days (6-8 days) for IC patients. One (2.22%) patient died on the 18th postoperative day due to septicemia and acute renal failure. Minilaparotomy RCP is technically feasible without compromising the oncological principles. Complete removal of urachus and adequate clearance of pelvic lymph nodes is not difficult with the small incision. Early restoration of bowel function, early postoperative recovery and good cosmesis seem to be the main advantages.

  5. Utility of PET/CT Imaging Performed Early After Surgical Resection in the Adjuvant Treatment Planning for Head and Neck Cancer

    SciTech Connect

    Shintani, Stephanie A.; Foote, Robert L. Lowe, Val J.; Brown, Paul D.; Garces, Yolanda I.; Kasperbauer, Jan L.

    2008-02-01

    Purpose: To evaluate the utility of positron emission tomography (PET)/computed tomography (CT) early after surgical resection and before postoperative adjuvant radiation therapy. Methods and Materials: We studied a prospective cohort of 91 consecutive patients referred for postoperative adjuvant radiation therapy after complete surgical resection. Tumor histologies included 62 squamous cell and 29 non-squamous cell cancers. Median time between surgery and postoperative PET/CT was 28 days (range, 13-75 days). Findings suspicious for persistent/recurrent cancer or distant metastasis were biopsied. Correlation was made with changes in patient care. Results: Based on PET/CT findings, 24 patients (26.4%) underwent biopsy of suspicious sites. Three patients with suspicious findings did not undergo biopsy because the abnormalities were not easily accessible. Eleven (45.8%) biopsies were positive for cancer. Treatment was changed for 14 (15.4%) patients (11 positive biopsy and 3 nonbiopsied patients) as a result. Treatment changes included abandonment of radiation therapy and switching to palliative chemotherapy or hospice care (4), increasing the radiation therapy dose (6), extending the radiation therapy treatment volume and increasing the dose (1), additional surgery (2), and adding palliative chemotherapy to palliative radiation therapy (1). Treatment for recurrent cancer and primary skin cancer were significant predictors of having a biopsy-proven, treatment-changing positive PET/CT (p < 0.03). Conclusions: Even with an expectedly high rate of false positive PET/CT scans in this early postoperative period, PET/CT changed patient management in a relatively large proportion of patients. PET/CT can be recommended in the postoperative, preradiation therapy setting with the understanding that treatment-altering PET/CT findings should be biopsied for confirmation.

  6. Enlargement of the Pharynx Resulting From Surgically Assisted Rapid Maxillary Expansion.

    PubMed

    Vinha, Pedro Pileggi; Faria, Ana Célia; Xavier, Samuel Porfirio; Christino, Mariana; de Mello-Filho, Francisco Veríssimo

    2016-02-01

    Given that transverse maxillary deficiency is an etiologic factor of obstructive sleep apnea and is intimately connected to pharyngeal size, the objective of this study was to determine whether surgically assisted rapid maxillary expansion (SARME) would promote pharyngeal enlargement in adults. This prospective study was conducted in patients with uni- or bilateral posterior crossbite who underwent SARME. Participants were recruited from the Integrated Center for the Study of Face Defects, School of Medicine of Ribeirão Preto, University of São Paulo (São Paulo, Brazil). All patients underwent computed tomography of the pharynx before and after surgery (171.5 days on average), and the sagittal and transverse planes and the total area across 3 levels of the pharynx, including the upper (posterior nasal spine), middle (first cervical vertebra), and lower (second cervical vertebra) levels, were measured on the images. A paired-samples t test was used to evaluate changes in the pharynx before and after surgery. The studied sample consisted of 18 adult patients (10 women and 8 men) with an average age of 37.11 years (standard deviation, 11.73 yr); all patients resided in the region of Ribeirão Preto, São Paulo, Brazil. No statistical changes were observed in the upper level. An enlargement of 17.82% (P = .0107) was observed in the sagittal plane of the middle level. The cross-sectional and area values of this same portion were enlarged (16.96 and 37.38%, respectively), with a trend toward statistical significance (P = .067 and .051, respectively). The airway enlargements in the lower level were 26.41, 24.87, and 53.87% in the sagittal and transverse planes and total area, respectively; these differences were statistically significant (P = .0003, .0033, and .0016, respectively) for all 3 measurements. SARME promotes pharyngeal enlargement, especially in the lower levels of the pharynx. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons

  7. Perceptions on the surgical treatment of inflammatory bowel disease in Spain. Results of a national survey.

    PubMed

    Sánchez-Guillén, Luis; Blanco-Antona, Francisco; Millán-Scheiding, Mónica

    2016-12-01

    The incidence of inflammatory bowel disease (IBD) is increasing in Spain but there is little information on the availability of multidisciplinary care. This study aims to assess surgeon's opinions on the current situation of surgery for IBD in Spain. An electronic closed survey was sent to members of the Spanish Association of Surgeons (AEC) from January to March 2015. This was a 52-item anonymised questionnaire with questions about how the treatment of IBD patients is organized in each centre, the existence of specific units, the management strategy in IBD patients, and the opinion of colorectal, general and trainee surgeons about the surgical treatment of IBD in their centre and in Spain. One hundred and ninety-two surgeons responded. Most participants work in tertiary hospitals (45%), most of them from different hospitals, some from the same hospital. Only 50% of hospitals have multidisciplinary teams for IBD. The initial approach is laparoscopic in 56% of cases, and 80% of participants in centres with multidisciplinary teams consider the timing of surgery to be appropriate. The annual number of IBD surgeries in tertiary hospitals is higher than in secondary hospitals in ulcerative colitis (57 vs. 24% 10-15 patients/year, P<.001) and Crohn's disease (68 vs. 28% 3-5 patients/month, P<.001). Most centres operate less than 10 ulcerative colitis patients per year, even larger centres (67%) and they perform ≤3 J-pouches/month (ulcerative colitis and other indications) (P<.001). Ninety-five percent of surgeons consider that centralization of complex cases in specialized units and the creation of national registries should be developed. The majority of participants (70%) believe that there is a deficit in research and educational activities in IBD surgery in Spain. This survey suggests that most Spanish hospitals have a low volume of IBD surgery, even large tertiary hospitals, and many centres do not have a multidisciplinary team dedicated to IBD patients. Most

  8. Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry.

    PubMed

    Silva, Katia Regina da; Albertini, Caio Marcos de Moraes; Crevelari, Elizabeth Sartori; Carvalho, Eduardo Infante Januzzi de; Fiorelli, Alfredo Inácio; Martinelli, Martino; Costa, Roberto

    2016-09-01

    Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities. To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events. Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis. A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III--IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3). Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient's underlying heart disease. Complicações após procedimentos cirúrgicos em portadores de dispositivos cardíacos eletrônicos implantáveis (DCEI) são um

  9. The surgical solution: the writings of activist physicians in the early days of eugenical sterilization.

    PubMed

    Reilly, P

    1983-01-01

    A belief in the heritability of degeneracy and the extreme fecundity of degenerate persons emerged in the late 19th and early 20th centuries. Concern that an ever-greater proportion of the population would be burdened with defective germ plasm and an ever-rising portion of the nation's wealth would be diverted to covering the costs of the behavior and institutional care of these persons led to the formulation of 4 alternative solutions: marriage restriction laws, indefinite segregation in institutions, castration, and sterilization. This paper examines the role played by physicians in the development of a eugenical sterilization policy. In the 1907-13 period, 12 states (Indiana, Washington, California, Connecticut, Nevada, Iowa, New Jersey, New York, North Dakota, Michigan, Kansas, and Wisconsin) enacted sterilization laws. A review of the medical journals from this period suggests that a handful of activist physicians were outspoken lobbyists for involuntary sterilization. They educated their profession about the need for social control measures to stop the spread of defective germ plasm and frequently exaggerated the curative powers of vasectomy in this regard. Despite physicians' efforts, only 1422 sterilizations of institutionalized persons were performed pursuant to state law in 1907-17, and all eugenic sterilization laws were declared invalid in 1918.

  10. Pre-operative and early post-operative factors associated with surgical site infection after laparoscopic sleeve gastrectomy.

    PubMed

    Ruiz-Tovar, Jaime; Oller, Inmaculada; Llavero, Carolina; Arroyo, Antonio; Muñoz, Jose Luis; Calero, Alicia; Diez, María; Zubiaga, Lorea; Calpena, Rafael

    2013-08-01

    Surgical procedures on obese patients are expected to have a high incidence of surgical site infection (SSI). The identification of pre-operative or early post-operative risk factors for SSI may help the surgeon to identify subjects in risk and adequately optimize their status. We conducted a study of the association of comorbidities and pre- and post-operative analytical variables with SSI following laparoscopic sleeve gastrectomy for the treatment of morbid obesity. We performed a prospective study of all morbidly obese patients undergoing laparoscopic sleeve gastrectomy as a bariatric procedure between 2007 and 2011. An association of clinical and analytical variables with SSI was investigated. The study included 40 patients with a mean pre-operative body mass index (BMI) of 51.2±7.9 kg/m(2). Surgical site infections appeared in three patients (7.5%), of whom two had an intra-abdominal abscess located in the left hypochondrium and the third had a superficial incisional SSI. Pre-operatively, a BMI >45 kg/m(2) (OR 8.7; p=0.008), restrictive disorders identified by pulmonary function tests (OR 10.0; p=0.012), a serum total protein concentration <5.3 g/dL (OR 13; p=0.003), a plasma cortisol >30 mcg/dL (OR 13.0; p=0.003), and a mean corpuscular volume (MCV) <82 fL (OR 1.6; p=0.04) were associated with post-operative SSI. Post-operatively, a serum glucose >128 mg/dL (OR 4.7; p=0.012) and hemoglobin <11g/dL (OR 7.5; p=0.002) were associated with SSI. The study supports the role of restrictive lung disorders and the values specified above for preoperative BMI, serum total protein and cortisol concentrations, and MCV, and of post-operative anemia and hyperglycemia as risk factors for SSI. In these situations, the surgeon must be aware of and seek to control these risk factors.

  11. Early result of hemiarthroplasty in elderly patients with fracture neck of femur

    PubMed Central

    Daniel, Mue; Mohammed, Salihu; Francis, Awonusi; William, Yongu; Joseph, Kortor; Cornilius, Elachi

    2015-01-01

    Background: Fractured neck of femur is a frequent and severe injury in elderly patients with consequent high morbidity and mortality. Hemiarthroplasty is an established treatment modality for displaced intracapsular femoral neck fractures in elderly patients above 60 years. This study analysed the early functional outcome and complications of Austin Moore endoprosthesis in elderly patients above 60 years with fractured neck of femur. Materials and Methods: Retrospective data were obtained over a 5 year period from January 2007 to December 2012. Thirty-five elderly patients of 60 years and above with displaced intracapsular fracture neck of femur treated with hemiarthroplasty using Austin Moore endoprosthesis were included. Data were analysed using SPSS version 21. Results: A total of 35 patients were involved. The age-range was 60-90 years with mean age of 69.7 ± 7 years. The predominant mechanism of injury was trivial falls in 18 (66.7%) patients. The commonest complication was pressure sore in 2 (5.7%) patients, followed by surgical site infection in 1 (2.9%) patient and periprosthetic fracture in 1 (2.9%) patients. Early post-operative mortality was 2.9%. Post-operative hip functional status according to Postel and Merle d Aubigne revealed that majority (66.6%) of patients had satisfactory hip function. Conclusion: Functional outcome of Austin Moore in elderly patients above 60 years with fracture neck of femur wa