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Sample records for preoperative transurethral excision

  1. Prediction of clinical manifestations of transurethral resection syndrome by preoperative ultrasonographic estimation of prostate weight

    PubMed Central

    2014-01-01

    Background This study aimed to investigate the relationship between preoperative estimated prostate weight on ultrasonography and clinical manifestations of transurethral resection (TUR) syndrome. Methods The records of patients who underwent TUR of the prostate under regional anesthesia over a 6-year period were retrospectively reviewed. TUR syndrome is usually defined as a serum sodium level of < 125 mmol/l combined with clinical cardiovascular or neurological manifestations. This study focused on the clinical manifestations only, and recorded specific central nervous system and cardiovascular abnormalities according to the checklist proposed by Hahn. Patients with and without clinical manifestations of TUR syndrome were compared to determine the factors associated with TUR syndrome. Receiver operating characteristic curve analysis was used to determine the optimal cutoff value of estimated prostate weight for the prediction of clinical manifestations of TUR syndrome. Results This study included 167 patients, of which 42 developed clinical manifestations of TUR syndrome. There were significant differences in preoperative estimated prostate weight, operation time, resected prostate weight, intravenous fluid infusion volume, blood transfusion volume, and drainage of the suprapubic irrigation fluid between patients with and without clinical manifestations of TUR syndrome. The preoperative estimated prostate weight was correlated with the resected prostate weight (Spearman’s correlation coefficient, 0.749). Receiver operator characteristic curve analysis showed that the optimal cutoff value of estimated prostate weight for the prediction of clinical manifestations of TUR syndrome was 75 g (sensitivity, 0.70; specificity, 0.69; area under the curve, 0.73). Conclusions Preoperative estimation of prostate weight by ultrasonography can predict the development of clinical manifestations of TUR syndrome. Particular care should be taken when the estimated prostate

  2. Surgical excision of intracranial arteriovenous malformations after preoperative embolisation with N-butylcyanoacrylate.

    PubMed

    Wong, S H; Tan, J; Yeo, T T; Ong, P L; Hui, F

    1997-07-01

    The aim of this study was to determine the usefulness of preoperative embolisation of intracranial arteriovenous malformations (AVMs) with N-Butylcyanoacrylate (NBCA) since the introduction of this interventional neuroradiology technique in March 1994 at Tan Tock Seng Hospital, Singapore. Twenty-one patients who underwent complete surgical excision of their AVMs (proven on postoperative angiograms) were studied. Eight patients had preoperative embolisation with NBCA prior to surgical excision of their AVMs. Thirteen patients had excision of their AVMs without preoperative embolisation and these were used as the control group. The parameters studied were the patient's AVM characteristics, the amount of blood loss and the length of operative time. Statistically significant reduction in blood loss occurred in Spetzler and Martin Grade 3 and 4 AVMs but not in Grade 1 and 2 AVMs undergoing preoperative embolisation with NBCA. Operative time was reduced in Grade 3 and 4 AVMs but not in Grade 1 and 2 AVMs, although this was not statistically significant. Preoperative embolisation of AVMs is hence a useful and important adjunct in the management of patients with Grade 3 and 4 AVMs of the brain undergoing conventional open microneurosurgery.

  3. Preoperative chemoradiotherapy followed by local excision in clinical T2N0 rectal cancer

    PubMed Central

    Shin, Young Seob; Yoon, Yong sik; Lim, Seok-Byung; Yu, Chang Sik; Kim, Tae Won; Chang, Heung Moon; Park, Jin-hong; Ahn, Seung Do; Lee, Sang-Wook; Choi, Eun Kyung; Kim, Jin Cheon; Kim, Jong Hoon

    2016-01-01

    Purpose To investigate whether preoperative chemoradiotherapy (PCRT) followed by local excision (LE) is feasible approach in clinical T2N0 rectal cancer patients. Materials and Methods Patients who received PCRT and LE because of clinical T2 rectal cancer within 7 cm from anal verge between January 2006 and June 2014 were retrospectively analyzed. LE was performed in case of a good clinical response after PCRT. Patients’ characteristics, treatment record, tumor recurrence, and treatment-related complications were reviewed at a median follow-up of 49 months. Results All patients received transanal excision or transanal minimally invasive surgery. Of 34 patients, 19 patients (55.9%) presented pathologic complete response (pCR). The 3-year local recurrence-free survival and disease free-survival were 100.0% and 97.1%, respectively. There was no recurrence among the patients with pCR. Except for 1 case of grade 4 enterovesical fistula, all other late complications were mild and self-limiting. Conclusion PCRT followed by an LE might be feasible as an alternative to total mesorectal excision in good responders with clinical T2N0 distal rectal cancer. PMID:27730804

  4. Predictors of Pathologic Complete Response in Rectal Cancer Patients Undergoing Total Mesorectal Excision After Preoperative Chemoradiation.

    PubMed

    Han, Yoon Dae; Kim, Woo Ram; Park, Seung Wan; Cho, Min Soo; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young; Kim, Nam Kyu

    2015-11-01

    Preoperative chemoradiotherapy (CRT) is the standard of care for patients with stage II and III rectal cancer. This strategy leads to pathologic complete response (pCR) in a significant number of patients. Factors predictive of pCR are currently being extensively investigated. The aim of this study was to analyze clinical factors that might be predictive of pCR.This study was a retrospective analysis of rectal cancer patients from January 2004 through December 2012. A total of 332 stage II and III patients with middle and low rectal cancer (≤10 cm) who received CRT and underwent curative total mesorectal excision were eligible. The median radiation dose was 50.4 Gy, and 72.6% of patients received infusional 5-fluorouracil with leucovorin, whereas 19.6% of patients received TS-1 with irinotecan, and 7.8% of patients received xeloda only. Pathologic complete response was confirmed by using pathologic specimens and analyzed based on predictive clinical factors.Among the 332 patients, 27.4% (n = 91) achieved pCR. Age, sex, body mass index, clinical T and N stages, tumor differentiation, the chemotherapy agent for CRT, and the time interval between CRT and surgery did not differ between the pCR and non-pCR groups. Carcinoembryogenic antigen (CEA) levels before CRT were 4.61 ± 7.38 ng/mL in the pCR group and 10.49 ± 23.83 ng/mL in the non-pCR group (P = 0.035). Post-CRT CEA levels were 1.4 ± 1.07 ng/mL in the pCR group and 2.16 ± 2.8 ng/mL in the non-pCR group (P = 0.014), and the proportion of middle rectal cancer patients was higher in pCR group (54.9%, P = 0.028). The results from multivariate logistic regression analysis indicated that higher tumor location (odds ratio 2.151; P = 0.003) and low post-CRT CEA level (odds ratio 0.789; P = 0.04) were independent predictive factors for pCR.Tumor location and post-CRT CEA level were predictive factors in pCR for rectal cancer patients. Therefore, these factors may

  5. Long-term Oncologic Outcome Following Preoperative Combined Modality Therapy and Total Mesorectal Excision of Locally Advanced Rectal Cancer

    PubMed Central

    Guillem, Jose G.; Chessin, David B.; Cohen, Alfred M.; Shia, Jinru; Mazumdar, Madhu; Enker, Warren; Paty, Philip B.; Weiser, Martin R.; Klimstra, David; Saltz, Leonard; Minsky, Bruce D.; Wong, W Douglas

    2005-01-01

    Objective: Our aims were to (1) determine the long-term oncologic outcome for patients with rectal cancer treated with preoperative combined modality therapy (CMT) followed by total mesorectal excision (TME), (2) identify factors predictive of oncologic outcome, and (3) determine the oncologic significance of the extent of pathologic tumor response. Summary Background Data: Locally advanced (T3–4 and/or N1) rectal adenocarcinoma is commonly treated with preoperative CMT and TME. However, the long-term oncologic results of this approach and factors predictive of a durable outcome remain largely unknown. Methods: Two hundred ninety-seven consecutive patients with locally advanced rectal adenocarcinoma at a median distance of 6cm from the anal verge (range 0–15 cm) were treated with preoperative CMT (radiation: 5040 centi-Gray (cGy) and 5-fluorouracil (5-FU)-based chemotherapy) followed by TME from 1988 to 2002. A prospectively collected database was queried for long-term oncologic outcome and predictive clinicopathologic factors. Results: With a median follow-up of 44 months, the estimated 10-year overall survival (OS) was 58% and 10 year recurrence-free survival (RFS) was 62%. On multivariate analysis, pathologic response >95%, lymphovascular invasion and/or perineural invasion (PNI), and positive lymph nodes were significantly associated with OS and RFS. Patients with a >95% pathologic response had a significantly improved OS (P = 0.003) and RFS (P = 0.002). Conclusions: Treatment of locally advanced rectal cancer with preoperative CMT followed by TME can provide for a durable 10-year OS of 58% and RFS of 62%. Patients who achieve a >95% response to preoperative CMT have an improved long-term oncologic outcome, a novel finding that deserves further study. PMID:15849519

  6. Preoperative Radiation Therapy Followed by Reexcision May Improve Local Control and Progression-Free Survival in Unplanned Excisions of Soft Tissue Sarcomas of the Extremity and Chest-Wall

    PubMed Central

    Saeed, Hina; Johnstone, Candice A.; Charlson, John A.; Hackbarth, Donald A.; Neilson, John C.

    2016-01-01

    Background. The management for unplanned excision (UE) of soft tissue sarcomas (STS) has not been established. In this study, we compare outcomes of UE versus planned excision (PE) and determine an optimal treatment for UE in STS. Methods. From 2000 to 2014 a review was performed on all patients treated with localized STS. Clinical outcomes including local recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) were evaluated using the Kaplan-Meier estimate. Univariate (UVA) and multivariate (MVA) analyses were performed to determine prognostic variables. For MVA, Cox proportional hazards model was used. Results. 245 patients were included in the analysis. 14% underwent UE. Median follow-up was 2.8 years. The LR rate was 8.6%. The LR rate in UE was 35% versus 4.2% in PE patients (p < 0.0001). 2-year PFS in UE versus PE patients was 4.2 years and 9.3 years, respectively (p = 0.08). Preoperative radiation (RT) (p = 0.01) and use of any RT for UE (p = 0.003) led to improved PFS. On MVA, preoperative RT (p = 0.04) and performance status (p = 0.01) led to improved PFS. Conclusions. UEs led to decreased LC and PFS versus PE in patients with STS. The use of preoperative RT followed by reexcision improved LC and PFS in patients who had UE of their STS. PMID:27803813

  7. Bladder outlet obstruction treated with transurethral ultrasonic aspiration

    NASA Astrophysics Data System (ADS)

    Malloy, Terrence R.

    1991-07-01

    Fifty-nine males with bladder outlet obstruction were treated with transurethral ultrasonic aspiration of the prostate. Utilizing a 26.5 French urethral sheath, surgery was accomplished with a 10 French, 0-700 micron vibration level ultrasonic tip with an excursion rate of 39 kHz. Complete removal of the adenoma was accomplished, followed by transurethral electrocautery biopsies of both lateral lobes to compare pathologic specimens. One-year follow-up revealed satisfactory voiding patterns in 57 of 59 men (96%). Two men developed bladder neck contractures. Pathologic comparisons showed 100% correlation between aspirated and TUR specimens (56 BPH, 3 adeno-carcinoma). Forty-sevel men were active sexually preoperatively (6 with inflatable penile prostheses). Post ultrasonic aspiration, 46 men had erectile function similar to preoperative levels with one patient suffering erectile dysfunction. Forty men (85%) had antegrade ejaculation while 7 (15%) experienced retrograde or retarded ejaculation. No patients were incontinent.

  8. Transurethral resection of the prostate

    MedlinePlus

    TURP; Prostate resection - transurethral ... used to remove the inside part of your prostate gland using electricity. ... if you have benign prostatic hyperplasia ( BPH ). The prostate gland often grows larger as men get older. ...

  9. Transurethral incision of prostate compared with transurethral resection of prostate in 132 matching cases.

    PubMed

    Orandi, A

    1987-10-01

    In a prospective project during a 2-year period 132 patients with bladder outlet obstruction who were candidates for transurethral incision of the prostate were managed alternately by transurethral incision and transurethral resection of the prostate. Both operations were compared in matched patients. The results and complications favored transurethral incision, although there was no statistical significance except for the high incidence of bladder neck contracture after transurethral resection (p equals 0.028). PMID:2443728

  10. Excision without excision

    SciTech Connect

    Brown, David; Sarbach, Olivier; Schnetter, Erik; Diener, Peter; Tiglio, Manuel; Hawke, Ian; Pollney, Denis

    2007-10-15

    to turducken (turduckens, turduckening, turduckened, turduckened) [math.]: To stuff a black hole. We analyze and apply an alternative to black hole excision based on smoothing the interior of black holes with arbitrary initial data, and solving the vacuum Einstein evolution equations everywhere. By deriving the constraint propagation system for our hyperbolic formulation of the BSSN evolution system we rigorously prove that the constraints propagate causally and so any constraint violations introduced inside the black holes cannot affect the exterior spacetime. We present evolutions of Cook-Pfeiffer binary black hole initial configurations showing that these techniques appear to work robustly for generic data. We also present evidence from spherically symmetric evolutions that for the gauge conditions used the same stationary end-state is approached irrespective of the choice of initial data and smoothing procedure.

  11. Approaching the optimal transurethral resection of a bladder tumor.

    PubMed

    Jurewicz, Michael; Soloway, Mark S

    2014-06-01

    A complete transurethral resection of a bladder tumor (TURBT) is essential for adequately diagnosing, staging, and treating bladder cancer. A TURBT is deceptively difficult and is a highly underappreciated procedure. An incomplete resection is the major reason for the high incidence of recurrence following initial transurethral resection and thus to the suboptimal care of our patients. Our objective was to review the preoperative, intraoperative, and postoperative considerations for performing an optimal TURBT. The European Association of Urology, Society of International Urology, and The American Urological Association guidelines emphasize a complete resection of all visible tumor during a TURBT. This review will emphasize the various techniques and treatments, including photodynamic cystoscopy, intravesical chemotherapy, and a perioperative checklist, that can be used to help to enable a complete resection and reduce the recurrence rate. A Medline/PubMed search was completed for original and review articles related to transurethral resection and the treatment of non-muscle-invasive bladder cancer. The major findings were analyzed and are presented from large prospective, retrospective, and review studies.

  12. Approaching the optimal transurethral resection of a bladder tumor

    PubMed Central

    Jurewicz, Michael; Soloway, Mark S.

    2014-01-01

    A complete transurethral resection of a bladder tumor (TURBT) is essential for adequately diagnosing, staging, and treating bladder cancer. A TURBT is deceptively difficult and is a highly underappreciated procedure. An incomplete resection is the major reason for the high incidence of recurrence following initial transurethral resection and thus to the suboptimal care of our patients. Our objective was to review the preoperative, intraoperative, and postoperative considerations for performing an optimal TURBT. The European Association of Urology, Society of International Urology, and The American Urological Association guidelines emphasize a complete resection of all visible tumor during a TURBT. This review will emphasize the various techniques and treatments, including photodynamic cystoscopy, intravesical chemotherapy, and a perioperative checklist, that can be used to help to enable a complete resection and reduce the recurrence rate. A Medline/PubMed search was completed for original and review articles related to transurethral resection and the treatment of non-muscle-invasive bladder cancer. The major findings were analyzed and are presented from large prospective, retrospective, and review studies. PMID:26328154

  13. Laparoscopic Total Mesorectum Excision

    PubMed Central

    Quilici, F.A.; Cordeiro, F.; Reis, J.A.; Kagohara, O.; Simões Neto, J.

    2002-01-01

    The main controversy of colon-rectal laparoscopic surgery comes from its use as a cancer treatment. Two points deserve special attention: the incidence of portsite tumor implantation and the possibility of performing radical cancer surgery, such as total mesorectum excision. Once these points are addressed, the laparoscopic approach will be used routinely to treat rectal cancer. To clarify these points, 32 patients with cancer of the lower rectum participated in a special protocol that included preoperative radiotherapy and laparoscopic total mesorectum excision. All data were recorded. At the same time, all data recorded from the experience of a multicenter laparoscopic group (Brazilian Colorectal Laparoscopic Surgeons – 130 patients with tumor of the lower rectum) were analyzed and compared with the data provided by our patients. Analysis of the results suggests that a laparoscopic approach allows the same effective resection as that of conventional surgery and that preoperative irradiation does not influence the incidence of intraoperative complications. The extent of lymph nodal excision is similar to that obtained with open surgery, with an average of 12.3 lymph nodes dissected per specimen. The rate of local recurrence was 3.12%. No port site implantation of tumor was noted in this series of patients with cancer of the lower rectum. PMID:12113422

  14. Photoacoustic imaging of prostate brachytherapy seeds with transurethral light delivery

    NASA Astrophysics Data System (ADS)

    Lediju Bell, Muyinatu A.; Guo, Xiaoyu; Song, Danny Y.; Boctor, Emad M.

    2014-03-01

    We present a novel approach to photoacoustic imaging of prostate brachytherapy seeds utilizing an existing urinary catheter for transurethral light delivery. Two canine prostates were surgically implanted with brachyther- apy seeds under transrectal ultrasound guidance. One prostate was excised shortly after euthanasia and fixed in gelatin. The second prostate was imaged in the native tissue environment shortly after euthanasia. A urinary catheter was inserted in the urethra of each prostate. A 1-mm core diameter optical fiber coupled to a 1064 nm Nd:YAG laser was inserted into the urinary catheter. Light from the fiber was either directed mostly parallel to the fiber axis (i.e. end-fire fire) or mostly 90° to the fiber axis (i.e. side-fire fiber). An Ultrasonix SonixTouch scanner, transrectal ultrasound probe with curvilinear (BPC8-4) and linear (BPL9-5) arrays, and DAQ unit were utilized for synchronized laser light emission and photoacoustic signal acquisition. The implanted brachytherapy seeds were visualized at radial distances of 6-16 mm from the catheter. Multiple brachytherapy seeds were si- multaneously visualized with each array of the transrectal probe using both delay-and-sum (DAS) and short-lag spatial coherence (SLSC) beamforming. This work is the first to demonstrate the feasibility of photoacoustic imaging of prostate brachytherapy seeds using a transurethral light delivery method.

  15. [Obturator nerve block in transurethral surgery].

    PubMed

    Rubial Alvarez, M; Molins Gauna, N; Rubio Pascual, P; Martín Bermejo, P; Pamplona Casamayor, M

    1989-01-01

    The obturator nerve passes in close proximity to the bladder as it courses through the pelvis. During transurethral operations, resection may result in stimulation of the obturator nerve, causing violent adductor contraction. Bladder perforation and incomplete tumor resection are the most important complications. All techniques proposed since transurethral surgery began, until nowadays are reviewed: neuromuscular blockade, electric circuit modifications, transparietal endoscopic blockade, periprostatic and subvesical infiltration, obturator nerve blockade and the "3 in 1 block" described by Winnie. Practical advices are proposed finally.

  16. Xanthogranulomatous Cystitis Treated by Transurethral Resection.

    PubMed

    Yamamoto, Sachi; Yoshida, Kanae; Tsumura, Koji; Nomiya, Akira; Yoda, Kenji; Iida, Katsuyuki; Homma, Yukio; Enomoto, Yutaka

    2015-09-01

    Xanthogranulomatous cystitis (XC) is a rare benign chronic inflammatory disease of unknown etiology. Curative treatment of XC requires surgical resection, and most of reported cases were treated by partial cystectomy. Here we describe a case with XC that was treated using transurethral resection.

  17. Transurethral holmium-YAG laser lithotripsy for large symptomatic prostatic calculi: initial experience.

    PubMed

    Goyal, Neeraj Kumar; Goel, Apul; Sankhwar, Satyanarayan

    2013-08-01

    Symptomatic prostatic calculi are a rare clinical entity with wide range of management options, however, there is no agreement about the preferred method for treating these symptomatic calculi. In this study we describe our experience of transurethral management of symptomatic prostatic calculi using holmium-YAG laser lithotripsy. Patients with large, symptomatic prostatic stones managed by transurethral lithotripsy using holmium-YAG laser over 3-year duration were included in this retrospective study. Patients were evaluated for any underlying pathological condition and calculus load was determined by preoperative X-ray KUB film/CT scan. Urethrocystoscopy was performed using 30° cystoscope in lithotomy position under spinal anesthesia, followed by transurethral lithotripsy of prostatic calculi using a 550 μm laser fiber. Stone fragments were disintegrated using 100 W laser generators (VersaPulse PowerSuite 100 W, LUMENIS Surgical, CA). Larger stone fragments were retreived using Ellik's evacuator while smaller fragments got flushed under continuous irrigation. Five patients (median age 42 years) with large symptomatic prostatic calculi were operated using the described technique. Three patients had idiopathic stones while rest two had bulbar urethral stricture and neurogenic bladder, respectively. Median operative time was 62 min. All the patients were stone free at the end of procedure. Median duration of catheterization was 2 days. Significant improvement was observed in symptoms score and peak urinary flow and none of the patient had any complication. Transurethral management using holmium-YAG laser lithotripsy is a safe and highly effective, minimally invasive technique for managing symptomatic prostatic calculi of all sizes with no associated morbidity.

  18. Transurethral resection syndrome in elderly patients: a retrospective observational study

    PubMed Central

    2014-01-01

    Background Transurethral resection of the prostate (TURP) involves the risk of transurethral resection (TUR) syndrome owing to hyponatremia. Irrigation fluid type, duration of operation, and weight of resected mass have been evaluated as risk factors for TUR syndrome. The purpose of the present study was to identify risk factors related to TUR syndrome in the elderly. Methods After obtaining approval from the Institutional Review Board, data on all elderly males (aged 70 years and older) who underwent TURP under regional anesthesia over a 6-year period at our institution were retrospectively reviewed. TUR syndrome was defined as evidence of a central nervous system disturbance such as nausea, vomiting, restlessness, confusion, or even coma with a circulatory abnormality both intra- and post-operatively. Patients were divided into two groups, positive and negative, for the occurrence of the syndrome. Data such as previous medical history, preoperative and postoperative serum data, weight of resected mass, duration of operation, irrigation fluid drainage technique, anesthetic technique, operative infusion and transfusion volume, and neurological symptoms were collected. Only observational variables with p < 0.05 on univariate analyses were included in the multivariate logistic regression model to ascertain their independent effects on TUR syndrome. Results Of the 98 patients studied, 23 had TUR syndrome (23.5%, 95% confidence interval [CI] 14.9–32.0%). Multivariate regression analysis revealed that volume of plasma substitute ≥ 500 ml (odds ratio [OR] 14.7, 95% CI 2.9–74.5), continuous irrigation through a suprapubic cystostomy (OR 4.7, 95% CI 1.3–16.7), and weight of resected mass > 45 g (OR 4.1, 95% CI 1.2–14.7) were associated with significantly increased risks for TUR syndrome (Hosmer-Lemeshow test, p = 0.94, accuracy 84.7%). Conclusions These results suggest that the use of a plasma substitute and continuous irrigation through a

  19. Bladder irrigation with chlorhexidine for the prevention of urinary infection after transurethral operations: a prospective controlled study.

    PubMed

    Ball, A J; Carr, T W; Gillespie, W A; Kelly, M; Simpson, R A; Smith, P J

    1987-09-01

    The value of postoperative bladder irrigation with the antiseptic agent chlorhexidine was assessed in a randomized prospective controlled study of men after transurethral operations. In patients with sterile preoperative urine the incidence of postoperative bacteriuria was 12.8 per cent, compared to 36.7 per cent in control patients. The difference is significant (chi-square 5.54, p less than 0.02). On the other hand, chlorhexidine irrigation did not eliminate pre-existing infection. Small amounts of chlorhexidine were demonstrated in the blood of some patients. There was no evidence of damage to the bladder and no toxic side effects.

  20. Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture

    NASA Astrophysics Data System (ADS)

    Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin

    2005-07-01

    Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.

  1. Transurethral prostatectomy--studies with different intravesical pressures.

    PubMed

    Rabe, H B; de Kock, M L

    1982-05-22

    In an attempt to study the safety of transurethral prostatectomy in our unit, the use of a low-pressure continuous-flow water irrigation system was compared with out routine method of intermittent bladder emptying during transurethral prostatectomy in 14 patients. The products of haemolysis and parameters of haemodilution were studied, and no significant differences were noted. However, a simple suprapubic shunt provided significant surgical advantages. PMID:7079889

  2. Hemangioma excision (image)

    MedlinePlus

    A hemangioma is a non-cancerous (benign) growth of blood vessels. They are the most common benign blood vessel ( ... time and occasionally with medication. Large or disfiguring hemangiomas may require surgical excision.

  3. Transurethral light delivery for prostate photoacoustic imaging

    NASA Astrophysics Data System (ADS)

    Lediju Bell, Muyinatu A.; Guo, Xiaoyu; Song, Danny Y.; Boctor, Emad M.

    2015-03-01

    Photoacoustic imaging has broad clinical potential to enhance prostate cancer detection and treatment, yet it is challenged by the lack of minimally invasive, deeply penetrating light delivery methods that provide sufficient visualization of targets (e.g., tumors, contrast agents, brachytherapy seeds). We constructed a side-firing fiber prototype for transurethral photoacoustic imaging of prostates with a dual-array (linear and curvilinear) transrectal ultrasound probe. A method to calculate the surface area and, thereby, estimate the laser fluence at this fiber tip was derived, validated, applied to various design parameters, and used as an input to three-dimensional Monte Carlo simulations. Brachytherapy seeds implanted in phantom, ex vivo, and in vivo canine prostates at radial distances of 5 to 30 mm from the urethra were imaged with the fiber prototype transmitting 1064 nm wavelength light with 2 to 8 mJ pulse energy. Prebeamformed images were displayed in real time at a rate of 3 to 5 frames per second to guide fiber placement and beamformed offline. A conventional delay-and-sum beamformer provided decreasing seed contrast (23 to 9 dB) with increasing urethra-to-target distance, while the short-lag spatial coherence beamformer provided improved and relatively constant seed contrast (28 to 32 dB) regardless of distance, thus improving multitarget visualization in single and combined curvilinear images acquired with the fiber rotating and the probe fixed. The proposed light delivery and beamforming methods promise to improve key prostate cancer detection and treatment strategies.

  4. Transurethral induction of mouse urinary tract infection.

    PubMed

    Thai, Kim H; Thathireddy, Anuradha; Hsieh, Michael H

    2010-08-05

    Uropathogenic bacterial strains of interest are grown on agar. Generally, uropathogenic E. coli (UPEC) and other strains can be grown overnight on Luria-Bertani (LB) agar at 37 degrees C in ambient air. UPEC strains grow as yellowish-white translucent colonies on LB agar. Following confirmation of appropriate colony morphology, single colonies are then picked to be cultured in broth. LB broth can be used for most uropathogenic bacterial strains. Two serial, overnight LB broth cultures can be employed to enhance expression of type I pili, a well-defined virulence factor for uropathogenic bacteria. Broth cultures are diluted to the desired concentration in phosphate buffered saline (PBS). Eight to 12 week old female mice are placed under isoflurane anesthesia and transurethrally inoculated with bacteria using polyethylene tubing-covered 30 gauge syringes. Typical inocula, which must be empirically determined for each bacterial/mouse strain combination, are 10(6) to 10(8) cfu per mouse in 10 to 50 microliters of PBS. After the desired infection period (one day to several weeks), urine samples and the bladder and both kidneys are harvested. Each organ is minced, placed in PBS, and homogenized in a Blue Bullet homogenizer. Urine and tissue homogenates are serially diluted in PBS and cultured on appropriate agar. The following day, colony forming units are counted.

  5. Transurethral radio frequency ablation of the prostate

    NASA Astrophysics Data System (ADS)

    Kabalin, John N.

    1996-05-01

    Since 1993, radiofrequency ablation of the prostate has been studied as a potential treatment for symptomatic bladder outlet obstruction due to benign prostatic hyperplasia. Two transurethral radiofrequency delivery systems have been developed to the point of undergoing initial human clinical trials. The TUNATM system involves focal interstitial radiofrequency energy application, while the TURAPYTM system involves a circumferential application of radiofrequency energy to the prostatic urethra via a simple delivery catheter. Experimental studies in animal models and human prostate tissue have demonstrated the nature of radiofrequency induced tissue heating and thermal injury. Observed thermal effects are relatively focused, with steep temperature gradients occurring over a few millimeters from the radiofrequency emission source. This allows precise and focused tissue treatment with little or no danger of injury to surrounding structures. Early human clinical experience in the treatment of benign prostatic hyperplasia has demonstrated efficacy in the relief of voiding symptoms and safety and minimal morbidity associated with this technology. The existing operative approaches are relatively simple. Ongoing development of more versatile delivery systems for radiofrequency ablation of the prostate is expected. Results from larger clinical trials with longer term followup will eventually allow adequate assessment of the role of radiofrequency ablation in the surgical management of benign prostatic hyperplasia.

  6. [Experimental studies on hemolysis in transurethral interventions].

    PubMed

    Bichler, K H; Ideler, V; Zöfel, P; Harzmann, R

    1985-07-01

    The question whether distilled water can be used as irrigating fluid for the transurethral electroresection has repeatedly given occasion for discussion. Price and better visibility when resecting speak in favour of its application. Haemolytic alterations, however, might occur and seem to make its application dangerous. Our own experiments in animals show that especially blood haemolised through distilled water in the bladder (a mixture of aqua dest. and haemolised erythrocytes) has a strong haemolytic effect. Intravenous instillation of distilled water leads to haemolytic processes as well, which, however, are weaker than those occurring after instillation of erythrocytes haemolised through distilled water. Solutions of Sorbitol and Manitol (e.g. Purisole) had no measurable haemolytic effect. On the basis of our examinations we can retain the fact that with massive absorption of already haemolised erythrocytes, dangerous alterations, occur. Such alterations depend on duration of resection, technique of resection and pressure conditions (use of low pressure irrigation resectoscopes or trocar irrigation). For the experienced urologic surgeon these factors might be less relevant, for the beginner, however, who might not take into consideration the facts mentioned, results could be disastrous. The use of Sorbitol- and Manitol-fluids during TUR, prevents haemolytic incidents with certainty. PMID:2412327

  7. Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia

    PubMed Central

    Wang, Jinguo; Li, Hongqin; Ma, Haichun; Wang, Na

    2016-01-01

    Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP). Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT) intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C) was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS), and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects. PMID:26977315

  8. Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia.

    PubMed

    Wang, Jinguo; Li, Hongqin; Ma, Haichun; Wang, Na

    2016-01-01

    Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP). Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT) intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C) was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS), and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects.

  9. Are Histological Findings of Thulium Laser Vapo-Enucleation Versus Transurethral Resection of the Prostate Comparable?

    PubMed

    Carmignani, Luca; Macchi, Alberto; Ratti, Dario; Finkelberg, Elisabetta; Casellato, Stefano; Bozzini, Giorgio; Maruccia, Serena; Marenghi, Carlo; Picozzi, Stefano

    2015-09-01

    We investigated if an adequate histological diagnosis can be made from tissue after Thulium laser vapo-enucleation of the prostate (ThuVEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with symptomatic benign prostatic hyperplasia. We analyzed 350 ThuLEP and 100 matched TURP tissue specimens from patients who underwent one of the two procedures between January 2009 and June 2014. Thulium Laser Enucleation of Prostate (ThuVEP) was combined with mechanical morcellation of the resected lobe. Each histological specimen was reviewed by two pathologists. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups (2.5 % in the ThuVEP group versus 3 % in the TURP group). Tissue thermal artifacts induced by the Thulium laser are mostly due to coagulation as that of the conventional monopolar diathermy in TURP. Tissue quality was maintained in the ThuVEP histological specimens. Tissue maintain histological characteristics and proprieties without modification for successive immunoistochemical analysis. The pathologist ability to detect incidental prostate cancer and PIN was maintained even if there is a quoted of vaporized tissue.

  10. Is an adjustment by transurethral surgery simultaneously needed during the suprapubic open prostatectomy?

    PubMed Central

    Shin, Yu Seob; Zhang, Li Tao; Zhao, Chen; You, Jae Hyung; Park, Jong Kwan

    2015-01-01

    Purpose To compare suprapubic open prostatectomy (SOP) and a novel SOP with transurethral adjustment of residual adenoma and bleeding (TURARAB) for large sized prostates. Methods Between March 2010 and March 2014, 49 patients with symptomatic BPH (>100 g) were scheduled for SOP or SOP with TURARAB. The patients were subdivided into two groups. In Group I, each patient underwent SOP. In Group II, each patient underwent SOP with TURARAB. Additional transurethral resection of residual adenoma and bleeding control were done through the urethra after enucleation of the prostate adenoma by SOP. Prior to intervention, all patients were analyzed by preoperative complete blood count, blood chemistry, prostate specific antigen, International Prostate Symptom Scores, and transrectal ultrasound of the prostate and uroflowmetry. SOP was performed by a suprapubic transvesical approach via a midline incision. The bladder neck mucosa was circularly incised to expose the prostate adenoma, and the plane between the adenoma and surgical capsule was developed by finger dissection. In addition, in Group II TURARAB was performed using Urosol. Postoperative outcome data were compared in the 1st month and 3rd month. Results There were no statistically significant differences in baseline characteristics between the two groups. Group I required a longer operative time than Group II. Blood transfusion during the operation was unnecessary due to the short amount of time available to control arterial bleeding in the prostatic fossa leading to a marked decrease in perioperative bleeding in Group II. Postoperative voiding function improved significantly in both groups. Conclusions Even for large prostate glands, our novel procedure appears to be an effective and safe operation to reduce operation time, bleeding, and complications. PMID:26157764

  11. Transurethral light delivery for prostate photoacoustic imaging

    PubMed Central

    Lediju Bell, Muyinatu A.; Guo, Xiaoyu; Song, Danny Y.; Boctor, Emad M.

    2015-01-01

    Abstract. Photoacoustic imaging has broad clinical potential to enhance prostate cancer detection and treatment, yet it is challenged by the lack of minimally invasive, deeply penetrating light delivery methods that provide sufficient visualization of targets (e.g., tumors, contrast agents, brachytherapy seeds). We constructed a side-firing fiber prototype for transurethral photoacoustic imaging of prostates with a dual-array (linear and curvilinear) transrectal ultrasound probe. A method to calculate the surface area and, thereby, estimate the laser fluence at this fiber tip was derived, validated, applied to various design parameters, and used as an input to three-dimensional Monte Carlo simulations. Brachytherapy seeds implanted in phantom, ex vivo, and in vivo canine prostates at radial distances of 5 to 30 mm from the urethra were imaged with the fiber prototype transmitting 1064 nm wavelength light with 2 to 8 mJ pulse energy. Prebeamformed images were displayed in real time at a rate of 3 to 5 frames per second to guide fiber placement and beamformed offline. A conventional delay-and-sum beamformer provided decreasing seed contrast (23 to 9 dB) with increasing urethra-to-target distance, while the short-lag spatial coherence beamformer provided improved and relatively constant seed contrast (28 to 32 dB) regardless of distance, thus improving multitarget visualization in single and combined curvilinear images acquired with the fiber rotating and the probe fixed. The proposed light delivery and beamforming methods promise to improve key prostate cancer detection and treatment strategies. PMID:25734406

  12. Subungual glomus tumors of the hand: Treated by transungual excision

    PubMed Central

    Jawalkar, Harshad; Maryada, Venkateshwar Reddy; Brahmajoshyula, Venkatramana; Kotha, Guruvardhan Kumar V

    2015-01-01

    Background: Glomus tumors are benign hamartomas arising from the glomus body, mostly occurring in the subungual region of the digits. A triad of excruciating pain, localized tenderness and cold sensitivity is the key to diagnosing these tumors. Two surgical approaches are described in the literature for excision of subungual glomus tumors-transungual and periungual. We reviewed retrospectively the results of subungual glomus tumors of the hand treated by transungual excision. Materials and Methods: Twelve patients (9 females and 3 males) with histopathologically confirmed subungual glomus tumors of the hand were treated by transungual excision at our institute. The mean age of the patients was 40.5 years (range 28–63 years). All patients presented with pain in the nail bed and cold sensitivity. A bluish-brown discoloration was present in 6 patients. Love's pin test was positive in all and Hildreth's test was positive in 8 patients. The mean duration of followup was 38 months (range 8–72 months). Results: All patients had complete pain relief. There was no new nail deformity and no recurrence till last followup. One patient had deformity of the nail preoperatively due to previous surgery, which persisted after excision of the tumor. All of them returned to their preoperative occupation and regained full function of the hand. Conclusions: The transungual approach provides good access to the entire lesion and facilitates complete excision. Contrary to reported literature, we did not find the development of any new nail deformity with this approach. PMID:26229160

  13. Transurethral biopsy of the prostatic urethra is associated with final apical margin status at radical cystoprostatectomy

    PubMed Central

    von Rundstedt, Friedrich-Carl; Mata, Douglas A; Shen, Steven; Li, Yi; Godoy, Guilherme; Lerner, Seth P

    2015-01-01

    Purpose Biopsy of the prostatic urethra is an integral part of clinical staging in patients prior to radical cystoprostatectomy (RC) and urinary diversion. We examined whether preoperative transurethral resection (TUR) biopsy was associated with final apical urethral margin status and hypothesized that a negative biopsy could replace intraoperative frozen section for decision making regarding the feasibility of orthotopic neobladder reconstruction. Methods TUR biopsy, frozen section, urethrectomy, and final apical urethral margin pathologic data were extracted from the charts of men who had undergone RC at the Houston Methodist Hospital between 1987 and 2013. TUR biopsies were performed at five and seven o’clock adjacent to the verumontanum. A positive biopsy was defined as the presence of in situ or invasive urothelial carcinoma. Clinical and perioperative variables were analyzed using descriptive and inferential statistics. Results We reviewed the medical records of 272 men. Preoperative TUR biopsies of the prostatic urethra were negative in 74% (200/272) and positive in 26% (72/272) of men. The overall incidence of apical urethral margin positivity on final pathology was 2.2% (six of 272). Four men underwent primary or secondary urethrectomy. TUR biopsy negative and positive predictive values for apical urethral margin positivity were 99.5% (95% confidence interval (CI): 97.2 to 99.9) and 6.9% (95% CI: 2.3 to 15.5), respectively. Conclusions The incidence of a positive apical urethral margin was low in patients undergoing RC. A negative preoperative TUR biopsy of the prostatic urethra was reliably associated with a negative final margin, obviating the need for intraoperative frozen section. Furthermore, a positive biopsy was not reliably associated with final margin status. These data will aid in the counseling of patients regarding the feasibility of neobladder reconstruction.

  14. Frequency of Electrolyte Derangement after Transurethral Resection of Prostate: Need for Postoperative Electrolyte Monitoring

    PubMed Central

    Aziz, Wajahat; Ather, M. Hammad

    2015-01-01

    Objective. To determine the electrolyte derangement following transurethral resection of prostate (TURP). Methods. All patients undergoing TURP from June 2012 to April 2013 were included. Preoperative electrolytes were performed within a week of procedures. Monopolar TURP using 1.5% glycine was performed. Serum Na+ and K+ were assessed within 1 hour postoperatively and subsequently if clinically indicated. Results. The study included 280 patients. Sixty-six patients (23.6%) had electrolyte derangement after TURP. Patients with deranged electrolytes were older (mean age of 73.41 ± 4.08 yrs. versus 68.93 yrs. ± 10.34) and had a longer mean resection time (42.5 ± 20.04 min versus 28.34 ± 14.64 min). Mean weight of tissue resected (41.49 ± 34.46 g versus 15.33 ± 9.74 g) and volume of irrigant used (23.55 ± 15.20 L versus 12.81 ± 7.57 L) were also significantly higher in patients with deranged electrolytes (all p = 0.00). On multivariate logistic regression analysis preoperative sodium level was found to be a significant predictor of postoperative electrolyte derangement (odds ratio 0.267, S.E. = 0.376, and p value = 0.00). Conclusion. Electrolyte derangement occurs in older patients, with larger amount of tissue and longer time of resection and higher volume of irrigant, and in those with lower serum preoperative sodium levels. PMID:26089874

  15. Transurethral ultrasound-guided laser-induced prostatectomy

    NASA Astrophysics Data System (ADS)

    Babayan, Richard K.; Roth, Robert A.

    1991-07-01

    A transurethral ultrasound-guided Nd:YAG laser delivery system has been developed for use as an alternative approach to the treatment of benign prostatic hyperplasia. The TULIP system has been extensively tested in canine models and is currently undergoing FDA trials in humans.

  16. Submandibular gland excision.

    PubMed

    Crabtree, G M; Yarington, C T

    1988-10-01

    A review of 107 submandibular gland excisions was made to determine the relative frequency of neoplastic versus non-neoplastic disease. The results show a preponderance of non-neoplastic pathology. Benign tumors were found in 6% of glands, primary glandular and metastatic carcinoma in 3%. Timely treatment of a submandibular gland mass is indicated due to the relatively aggressive behavior of malignancies originating in this location.

  17. Base Excision Repair and Cancer

    PubMed Central

    Wallace, Susan S.; Murphy, Drew L.; Sweasy, Joann B.

    2012-01-01

    Base excision repair is the system used from bacteria to man to remove the tens of thousands of endogenous DNA damages produced daily in each human cell. Base excision repair is required for normal mammalian development and defects have been associated with neurological disorders and cancer. In this paper we provide an overview of short patch base excision repair in humans and summarize current knowledge of defects in base excision repair in mouse models and functional studies on short patch base excision repair germ line polymorphisms and their relationship to cancer. The biallelic germ line mutations that result in MUTYH-associated colon cancer are also discussed. PMID:22252118

  18. Incidence and risk factors of postoperative delirium in elderly patients undergoing transurethral resection of prostate: a prospective cohort study

    PubMed Central

    Xue, Peng; Wu, Ziyu; Wang, Kunpeng; Tu, Chuanquan; Wang, Xiangbo

    2016-01-01

    Aim The aim of the present study was to investigate the occurrence of postoperative delirium (POD) in elderly patients undergoing transurethral resection of prostate (TURP) and to identify those factors associated with delirium. Methods From July 2010 to February 2015, 358 patients, aged ≥65 years and undergoing TURP were prospectively enrolled. Personal, medical and cognitive data, laboratory assessments, pain intensity, preoperative medications, and details of hemodynamic control were collected as predictors of delirium. POD was assessed using the Confusion Assessment Method. Results In the present study, POD occurred in 28 out of 358 cases (7.8%) after TURP, with duration of 1–4 days. The multivariate analysis showed that old age and visual analog scale pain scores were associated with POD. Marital status, body mass index, education, alcohol consumption, smoking history, preoperative psychotropic medication usage, activities of daily living scores, preoperative Mini-Mental Status Examination score, anesthesia type, American Society of Anesthesiologists classification, or hypotensive episodes during surgery did not significantly correlate with the occurrence of POD. Conclusion Old age and pain intensity after surgery were found as the risk factors for the development of delirium in elderly patients undergoing TURP. These findings might help develop preventive strategies to decrease POD through targeted evaluation. PMID:26834475

  19. Transurethral ultrasound-guided laser prostatectomy: initial Luebeck experince

    NASA Astrophysics Data System (ADS)

    Thomas, Stephen; Spitzenpfeil, Elisabeth; Knipper, Ansgar; Jocham, Dieter

    1994-02-01

    Transurethral ultrasound guided laser prostatectomy is one of the most promising alternative invasive treatment modalities for benign prostatic hyperplasia. The principle feature is an on- line 3-D controlling of Nd:YAG laser denaturation of the periurethral tissue. Necrotic tissue is not removed, but sloughs away with the urinary stream within weeks. The bleeding hazard during and after the operation is minimal. By leaving the bladder neck untouched, sexual function is not endangered. Thirty-one patients with symptomatic BPH were treated with the TULIP system and followed up for at least 12 weeks. Suprapubic bladder drainage had to be maintained for a mean time of 37 days. Conventional TURP was performed in four patients due to chronic infection, recurrent bleeding, and poor results. Our initial experience with the TULIP system shows it to be very efficient and safe. A longer follow up of a larger patient population is necessary to compare the therapeutic efficiency to conventional transurethral resection.

  20. Fluoroscopy Guided Transurethral Placement of Ureteral Metallic Stents

    PubMed Central

    Myung Gyu, Song; Seo, Tae Seok; Park, Cheol Min; Choi, Jae Woong; Lee, Jong Mee; Park, Yang Shin

    2015-01-01

    Ureteral stent exchange is usually performed under both fluoroscopic and cystoscopic guidance. We experienced two cases with retrograde placement of metallic ureteral stent via urethra under fluoroscopic guidance. When patients with double-J ureteral stent (DJUS)have symptom and want to change DJUS to metallic stent, fluoroscopic guided transurethral placement of ureteral metallic stent is a good option as alternative of cystoscopic procedure or percutaneous procedure through percutaneous nephrostomy tract. PMID:26557281

  1. Complete transurethral bladder eversion 3 months after hemipelvectomy.

    PubMed

    Lowe, Gregory; Mandalapu, Subbarao; Gilleran, Jason

    2010-02-01

    A 46-year-old white female underwent a left hemipelvectomy for chondrosarcoma. She presented with total incontinence and a bulging vaginal mass. Exam confirmed complete transurethral bladder eversion that was addressed with transvaginal multilayer bladder neck closure and suprapubic tube placement. Eventually she underwent abdominal hysterectomy, mesh sacral colpopexy, and catheterizable stoma creation. Patient is continent of urine 3 months postoperatively. We present the first reported case of bladder eversion after hemipelvectomy and propose possible pathophysiologic mechanisms. PMID:19629370

  2. Current status of transurethral thermotherapy at the Mayo Clinic.

    PubMed

    Blute, M L; Larson, T R; Hanson, K A; King, B F

    1998-06-01

    With the ever-expanding elderly population in the United States, benign prostatic hyperplasia (BPH) has become a widespread condition. Although surgical intervention (open prostatectomy and transurethral resection of the prostate) was the typical management approach for BPH in the past, other options currently include drug therapy and transurethral thermotherapy, a minimally invasive procedure that involves the targeting of heat deep within the prostate transition zone while cooling the surrounding anatomic structures with circulating water. Two thermo-therapy-devices--the Prostatron and the T3 transurethral thermoablation therapy catheter--have been studied in randomized controlled clinical trials at the Mayo Clinic. Both devices were shown to be effective in a substantial subset of patients with BPH: symptom scores decreased, peak urinary flow rates increased, and total serum prostate-specific antigen levels increased, an indication of destruction of adenomatous tissue. All patients were able to complete the treatment without the need for general or regional anesthesia, and thermotherapy was associated with few postprocedural events. Although this therapeutic strategy is currently used selectively in patients with lateral lobe prostatic adenoma, improvements in technology and understanding of the thermoregulatory properties of the prostate should broaden the application of thermotherapy devices in the management of BPH.

  3. Changes in serum sodium concentration after transurethral procedures.

    PubMed

    Georgiadou, Th; Vasilakakis, I; Meitanidou, M; Georgiou, M; Filippopoulos, K; Kanakoudis, F; Radopoulos, D

    2007-01-01

    The aim of this study is to evaluate the changes in serum sodium concentration and the degree of correlation with factors such as the amount of intravenous fluid intake, the kind and the amount of irrigating fluids and the duration of the procedure. In this framework, 98 male patients who underwent transurethral procedure were studied and the correlation between the magnitude of hyponatraemia and the above-mentioned parameters was evaluated. All procedures were performed under spinal anesthesia and a solution of either manitol-sorbitol or sterilized water was used as irrigation fluid. Serum sodium concentration was measured before and after the procedure, while the kind and amount of the irrigating fluids, the amount of fluid intake and the duration of the procedure were also recorded. The patients were divided into three groups according to the duration of the procedure (i) <30 min, (ii) 30-60 min, and (iii) >60 min. Significant reduction in serum sodium concentration was found postoperatively (P < 0.001) and this was more profound in procedures longer than 1 h. This reduction was strongly correlated only with the duration of the transurethral procedure (P < 0.01). In conclusion, in transurethral procedures the reduction in serum sodium is postoperatively related to the duration of the procedure, while the intravenous and irrigating fluids to play no role on it. PMID:17390229

  4. Treatment Outcomes of Transurethral Macroplastique Injection for Postprostatectomy Incontinence

    PubMed Central

    Lee, Sin Woo; Kang, Jung Hun; Sung, Hyun Hwan; Jeong, U-Seok; Lee, Young-Suk; Baek, Minki

    2014-01-01

    Purpose We investigated the efficacy of transurethral injection of Macroplastique bulking agent (Uroplasty) for male stress urinary incontinence (SUI) after prostate surgery. Materials and Methods This retrospective review included men with SUI treated by transurethral injection for symptoms resulting from prostate surgery. Patients were evaluated at 1 month and 6 months after injection by determining the number of pads used per day and changes in incontinence symptoms. Treatment success was defined as use of 1 pad or fewer per day combined with subjective symptom improvement. Results The study population comprised 30 men with a mean age of 66.1±5.3 years. Of the 30 patients, 24 (80.0%) underwent prostate cancer surgery and the remaining 6 (20.0%) underwent surgery for benign prostatic hyperplasia. The preinjection pad number was 2.9±1.9 pads per day. After injection treatment, the mean follow-up period was 9.3±12.7 months and the success rate was 43% (13/30) at 1 month and 32% (6/19) at 6 months. Injection was more likely to result in a successful outcome in patients with no preinjection radiation treatment history and higher abdominal leak point pressure (ALPP) than in those with a previous history of radiation treatment and lower ALPP, although this result was not statistically significant. Acute urinary retention occurred in 5 patients (17%). Conclusions Transurethral Macroplastique injection treatment is a relatively non-invasive treatment method for male SUI with a success rate of 43% at 1 month and 32% at 6 months. Patients with a higher ALPP and no previous history of radiation therapy may experience better treatment outcomes. PMID:24648873

  5. Excision of nasopharyngeal angiofibroma facilitated by intra-operative 3D-image guidance.

    PubMed

    Murray, A; Falconer, M; McGarry, G W

    2000-04-01

    The latest 3D-image guidance systems to assist surgeons have greatly improved over earlier models. We describe the use of an optical infra-red system to assist in the removal of a juvenile nasopharyngeal angiofibroma. The specific advantages of this system in pre-operative assessment, intra-operative evaluation and excision of the angiofibroma are discussed.

  6. Comparison of outpatient versus inpatient transurethral prostate resection for benign prostatic hyperplasia: Comparative, prospective bi-centre study

    PubMed Central

    Kim, Jae Heon; Park, Jae Young; Shim, Ji Sung; Lee, Jeong Gu; Moon, Du Geon; Yoo, Jeong woo; Choi, Hoon; Bae, Jae Hyun

    2014-01-01

    Introduction: We compare the symptomatic relief with urodynamic parameter change and operative safety of the outpatient transurethral resection in saline (TURIS-V) technique with inpatient transurethral resection of the prostate (TURP) for the management of benign prostatic hyperplasia (BPH). Methods: This prospective cohort comparison study enrolled patients who needed BPH surgery. Between January 2010 and June 2011, outpatient TURIS-V was performed at 1 centre and the results of the treatment were compared with inpatient TURP performed at a separate hospital. Preoperative characteristics, including prostate volume, were similar in both groups. Perioperative data and any treatment complications were recorded. The analysis compared postoperative outcomes, including a 6-month postoperative International Prostate Symptom Score (IPSS), a quality of life (QoL) evaluation and a record of any changes in uroflowmetry findings, between the 2 groups. Results: In the TURIS-V patient group, 75 patients agreed to be in the study. Of these, 69 ultimately complete the study. In the TURP group, 76 patients agreed and 71 of these completed the study. Both study groups were well-matched for age, IPSS, QoL and uroflowmetry findings. The TURIS-V group experienced both shorter operation times (54.6 vs. 74.8 minutes) and shorter catheterization times (2.2 vs. 4.2 days) when compared to the TURP group. There were comparable improvements in the 6-month postoperative IPSS, QoL, and uroflowmetry findings between the 2 groups. There were also equally low incidence rates of procedural complications. Conclusions: Both TURIS-V and TURP relieve lower urinary tract symptoms in a similar way, with great efficacy and safety. Overall, TURIS-V had shorter operative and catheterization times compared to TURP. Notwithstanding the paper’s limitations (non- randomized cohort comparison with possible selection or surgeon bias and small heterogeneous sample size), TURIS-V can be performed safely even in

  7. [Preoperative analysis in rhinoplasty].

    PubMed

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

    2014-12-01

    Preoperative analysis in rhinoplasty consists in analyzing individual anatomical and functional characteristics without losing sight of the initial requirements of the patient to which priority should be given. The examination is primarily clinical but it also uses preoperative photographs taken at specific accurate angles. Detecting functional disorders or associated general pathologies, which will reduce the risk of complications. All of these factors taken into account, the surgeon can work out a rhinoplasty plan which he or she will subsequently explain to the patient and obtain his or her approbation.

  8. Avoiding Unnecessary Preoperative Testing.

    PubMed

    Rusk, Matthew H

    2016-09-01

    Given the low-risk nature of cataract surgery, no preoperative testing is indicated unless the patient needs it for another reason. Although electrocardiograms may have a role in preoperative testing in patients at high risk of cardiovascular disease, or if the procedure carries with it significant operative risks, they are often unnecessary. Urinalysis and coagulation studies not should be routine because they have not shown any value in predicting complications. Although these tests are not individually expensive, the aggregate cost is substantial. As good stewards of the medical system, physicians need to use these tests more judiciously. PMID:27542420

  9. [The preoperative anaesthetic visit].

    PubMed

    Harms, Christoph; Kindler, Christoph H

    2009-07-01

    Anaesthetists often visit their patients in exceptional situations characterised by preoperative anxiety or distress. Therefore, even brief contact with the patient can be considered intense and meaningful. The initial preoperative anaesthetic visit is the beginning of the relationship between patient and anaesthetist, and should help to explain the planned anaesthetic technique. Preoperative anaesthetic visits are intense and last for 20 minutes on average. They should assert a professional approach to the patient's emotions, particularly to preoperative anxiety, and a structured and clear collection of information including the past history of the patient. These visits should also provide information about the anaesthesia itself and instructions for the patient with respect to the perioperative period. Communication about the side effects and risks of anaesthetic techniques, and the discussion of potential alternatives are mandatory. Worldwide, courts of law increasingly require a documented discussion between the anaesthetist and patient based on risk-benefit evidence. Today, there is in general a shift away from decisions made solely by physicians, reflecting an increased respect for the autonomy of the patient towards a model of shared decision-making and informed choice. Ideally, the preoperative visit follows the four key habits of highly effective clinicians, i.e., to rapidly establish a rapport with the patient and provide an agenda for the visit, to explore the patient's perspectives and expectations, to demonstrate empathy, and to focus on the end of the visit with providing information and including the patient in the decision-making process. Visits are then concluded upon obtaining informed consent from the patient. PMID:19565444

  10. Influence of various irrigation fluids on serum enzyme patterns following transurethral resection of the prostate.

    PubMed

    Norlén, H; Allgén, L G; Bendz, R; Wiklund, A

    1986-01-01

    Serum levels of a variety of enzymes were determined preoperatively and repeatedly postoperatively in a comprehensive biochemical study of 60 patients undergoing transurethral resection of the prostate (TURP). These patients were divided into four groups depending on the type of fluid used for irrigation during TURP. Prostatic acid phosphatase (PAP, analysed by radio-immunoassay) in serum showed a marked postoperative increase but wide inter-individual variation in all groups. It returned to normal within 24 to 48 hours. When water was used for irrigation, similar but less pronounced increases were observed for serum lactate dehydrogenase (LD, LD-1) and aminotransferases (ASAT, ALAT). This is interpreted as being due to an influx of irrigating fluid into the general circulation from the bladder through opened veins, by absorption from a perivesical accumulation or, in the case of PAP, also from the prostatic wound. The enzyme increases (other than PAP) may be due to their release from haemolysed red cells in the bladder or in a perivesical fluid accumulation, which conjecture is supported by the marked increase also seen in plasma haemoglobin. When iso-osmolar fluids were used for irrigation signs of haemodilution, such as a postoperative decrease in serum sodium, were observed. Several of the variables studied may be used as markers to indicate the quantity of irrigating fluid absorbed during resection. Plasma haemoglobin, serum LD (or LD-1) in connection with water irrigation, serum sodium in connection with iso-osmolar fluid irrigation and serum PAP, regardless of the type of irrigating fluid used, are some practical suggestions for such markers. PMID:3092348

  11. Comparison between thulium laser resection of prostate and transurethral plasmakinetic resection of prostate or transurethral resection of prostate.

    PubMed

    DeCao, Hong; Wang, Jia; Huang, Yu; LiangLiu, Ren; JunLei, Hao; Gao, Liang; Tang, Zhuang; YingHu, Chun; Li, Xiang; JiuYuan, Hong; Dong, Qiang; Wei, Qiang

    2015-01-01

    Benign prostatic hyperplasia (BPH) is one of the most common diseases in middle-aged and elderly men. In the present study, we aimed to compare the efficacy and safety of thulium laser resection of the prostate (TMLRP) with either transurethral plasmakinetic resection of the prostate (TUPKP) or transurethral resection of the prostate (TURP). A literature search was performed, eventually, 14 studies involving 1587 patients were included. Forest plots were produced by using Revman 5.2.0 software. Our meta-analysis showed that operation time, decrease in hemoglobin level, length of hospital stay, catheterization time, and development of urethral stricture significantly differed, whereas the transitory urge incontinence rate, urinary tract infection rate, and recatheterization rate did not significantly differ between TMLRP and either TURP or TUPKP. The blood transfusion rate was significantly different between TMLRP and TURP, but not between TMLRP and TUPKP. In addition, the retrograde ejaculation rate between TMLRP and TURP did not significantly differ. At 1, 3, 6, and 12 months of postoperative follow-up, the maximum flow rate, post-void residual, quality of life, and International Prostate Symptom Score did not significantly differ among the procedures. Thus, the findings of this study indicate that TMLRP may be a safe and feasible alternative. PMID:26444930

  12. Comparison between thulium laser resection of prostate and transurethral plasmakinetic resection of prostate or transurethral resection of prostate.

    PubMed

    DeCao, Hong; Wang, Jia; Huang, Yu; LiangLiu, Ren; JunLei, Hao; Gao, Liang; Tang, Zhuang; YingHu, Chun; Li, Xiang; JiuYuan, Hong; Dong, Qiang; Wei, Qiang

    2015-01-01

    Benign prostatic hyperplasia (BPH) is one of the most common diseases in middle-aged and elderly men. In the present study, we aimed to compare the efficacy and safety of thulium laser resection of the prostate (TMLRP) with either transurethral plasmakinetic resection of the prostate (TUPKP) or transurethral resection of the prostate (TURP). A literature search was performed, eventually, 14 studies involving 1587 patients were included. Forest plots were produced by using Revman 5.2.0 software. Our meta-analysis showed that operation time, decrease in hemoglobin level, length of hospital stay, catheterization time, and development of urethral stricture significantly differed, whereas the transitory urge incontinence rate, urinary tract infection rate, and recatheterization rate did not significantly differ between TMLRP and either TURP or TUPKP. The blood transfusion rate was significantly different between TMLRP and TURP, but not between TMLRP and TUPKP. In addition, the retrograde ejaculation rate between TMLRP and TURP did not significantly differ. At 1, 3, 6, and 12 months of postoperative follow-up, the maximum flow rate, post-void residual, quality of life, and International Prostate Symptom Score did not significantly differ among the procedures. Thus, the findings of this study indicate that TMLRP may be a safe and feasible alternative.

  13. Comparison between thulium laser resection of prostate and transurethral plasmakinetic resection of prostate or transurethral resection of prostate

    PubMed Central

    DeCao, Hong; Wang, Jia; Huang, Yu; LiangLiu, Ren; JunLei, Hao; Gao, Liang; Tang, Zhuang; YingHu, Chun; Li, Xiang; JiuYuan, Hong; Dong, Qiang; Wei, Qiang

    2015-01-01

    Benign prostatic hyperplasia (BPH) is one of the most common diseases in middle-aged and elderly men. In the present study, we aimed to compare the efficacy and safety of thulium laser resection of the prostate (TMLRP) with either transurethral plasmakinetic resection of the prostate (TUPKP) or transurethral resection of the prostate (TURP). A literature search was performed, eventually, 14 studies involving 1587 patients were included. Forest plots were produced by using Revman 5.2.0 software. Our meta-analysis showed that operation time, decrease in hemoglobin level, length of hospital stay, catheterization time, and development of urethral stricture significantly differed, whereas the transitory urge incontinence rate, urinary tract infection rate, and recatheterization rate did not significantly differ between TMLRP and either TURP or TUPKP. The blood transfusion rate was significantly different between TMLRP and TURP, but not between TMLRP and TUPKP. In addition, the retrograde ejaculation rate between TMLRP and TURP did not significantly differ. At 1, 3, 6, and 12 months of postoperative follow-up, the maximum flow rate, post-void residual, quality of life, and International Prostate Symptom Score did not significantly differ among the procedures. Thus, the findings of this study indicate that TMLRP may be a safe and feasible alternative. PMID:26444930

  14. Transurethral prostatectomy: practice aspects of the dominant operation in American urology.

    PubMed

    Holtgrewe, H L; Mebust, W K; Dowd, J B; Cockett, A T; Peters, P C; Proctor, C

    1989-02-01

    In a national survey of all American urologists transurethral prostatectomy accounted for 38 per cent of the major surgical procedures performed by the respondents. They regarded the operation as complex and they believe achievement of proficiency requires that more be performed during residency training than any other urological operation. Furthermore, they assigned transurethral prostatectomy a significantly higher relative value than have medical economists doing research in the field of physician reimbursement. The effect of recent legislated congressional reductions in the allowable Medicare fees for transurethral prostatectomy is discussed along with the impact of these reductions on urological patient care and the American urologist. Practice patterns and geographic variations in the costs of transurethral prostatectomy also are considered.

  15. Bladder Explosion during Transurethral Resection of the Prostate with Nitrous Oxide Inhalation

    PubMed Central

    Hirai, Eiko; Tokumine, Joho; Lefor, Alan Kawarai; Ogura, Shinobu; Kawamata, Miwako

    2015-01-01

    Bladder explosions are a rare complication of transurethral resection of the prostate. We report a patient who suffered a bladder rupture following transurethral resection of the prostate. Although explosive gases accumulate during the procedure, a high concentration of oxygen is needed to support an explosion. This rare phenomenon can be prevented by preventing the flow of room air into the bladder during the procedure to maintain a low concentration of oxygen inside the bladder. PMID:26294981

  16. Magnetic-resonance-guided directional transurethral ultrasound thermal therapy

    NASA Astrophysics Data System (ADS)

    Ross, Anthony; Diederich, Chris J.; Nau, William H.; Tyreus, Per Daniel; Gill, Harchi; Bouley, Donna; Butts, R. K.; Rieke, Viola; Daniel, Bruce; Sommer, Graham

    2003-06-01

    Two catheter-based transurethral ultrasound applicators designed for selective thermal coagulation of prostate tissue were evaluated. The first applicator utilized two 3.5 mm piezoelectric sectored tubes with the active transducer surface forming 90°. The second applicator's transducer assembly consisted of a linear array of 3.5 x 10 mm planar transducer elements. Both applicators operated at 8 MHz and were positioned on a 4 mm diameter catheter within an integrated expandable balloon (10 mm). Manual rotation of the transducer assembly within the balloon allowed for angular control and/or sweeping of the treatment volume. Ambient temperature degassed cooling water (~120 ml/min) was circulated inside the balloon to preserve the urethral mucosa. Acoustic efficiencies of 20-54% and acoustic beam distributions were measured. The thermal treatment characteristics of the applicator were investigated in vivo (canine prostate) under MRI guidance in an interventional open magnet (0.5 T). Magnetic resonance thermal imaging (MRTI) monitored the treatments (GRE phase mapping, multiple planes, 15 sec update intervals). Post-treatment imaging (T1 w/contrast) and TTC staining of the prostate were used to verify zones of thermal damage. Single sonications lasting 8-15 min produced coagulated zones of tissue extending to the outer boundary of the prostate while preserving 2-3 mm of urethral mucosa. Multiple sonications in sequence produced larger contiguous sectors of coagulated tissue (~ 3/4 of the gland). In summary, highly directional transurethral applicators under MRI guidance were able to produce selective and controllable thermal coagulation.

  17. Pre-operative anaemia.

    PubMed

    Clevenger, B; Richards, T

    2015-01-01

    Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

  18. Extended transurethral resection and Nd:YAG laser ablation of the prostate (TURLAP) for carcinoma: a pilot study

    NASA Astrophysics Data System (ADS)

    Childs, Stacy J.

    1993-05-01

    Transurethral resection of the prostate (TURP) has been combined with Nd:YAG application for the treatment of prostatic carcinoma for a decade. The inability to deliver the energy at right angles has made the procedure technically difficult, but results have been encouraging. A pilot study was begun in 1991 on ten patients who refused or were not candidates for radical prostatectomy. The protocol consisted of transrectal ultrasound imaging (TRUS) during extended TURP (EXTURP) followed immediately by Nd:YAG energy applied to the prostate bed and capsule. A second laser application under real time TRUS followed in eight weeks and a third (or fourth in one patient) was undertaken eight weeks later. Energy of 30,000- 85,000 Joules was applied during each procedure with the right angle urolase fiber (Bard) at 60 watts. Lesions were created for 30-60 seconds in each area of remaining tissue documented on TRUS. A thermocoupler was used to monitor rectal temperature. Complications include urinary retention, gross hematuria, bladder neck contracture, early incontinence, late incontinence, and probable permanent incontinence. Of the only four potent patients preoperatively, all (100%) are impotent now. TURLAP appears to be a safe and effective method of killing prostate malignant tissue and should be further studied perhaps in combination with interstitial laser irradiation to increase efficacy and lessen complications.

  19. Hypertensive crisis during wide excision of gastrointestinal stromal cell tumor (GIST): Undiagnosed paraganglioma -A case report-.

    PubMed

    Shinn, Helen Ki; Jung, Jong Kwon; Park, Jay Kim; Kim, Jong Hoon; Jung, In Young; Lee, Hong Sik

    2012-03-01

    Although paraganglioma (PGL), an extra-adrenal retroperitoneal pheochromocytoma (PHEO), is a rare catecholamine-secreting neuroendocrine tumor, it can cause severe hypertensive crisis during anesthesia or surgery if undiagnosed preoperatively. Extraluminal perigastric masses may be presumed to be gastrointestinal stromal tumors (GISTs) or soft tissue sarcomas even when histologic confirmation is not possible. Therefore, without a histologic diagnosis or symptoms of excessive catecholamine secretion, PGL may be mistaken for GIST. We report a case of preoperatively undiagnosed PGL which caused hypertensive crisis during anesthesia for retroperitoneal mass excision.

  20. Nucleotide excision repair in humans.

    PubMed

    Spivak, Graciela

    2015-12-01

    The demonstration of DNA damage excision and repair replication by Setlow, Howard-Flanders, Hanawalt and their colleagues in the early 1960s, constituted the discovery of the ubiquitous pathway of nucleotide excision repair (NER). The serial steps in NER are similar in organisms from unicellular bacteria to complex mammals and plants, and involve recognition of lesions, adducts or structures that disrupt the DNA double helix, removal of a short oligonucleotide containing the offending lesion, synthesis of a repair patch copying the opposite undamaged strand, and ligation, to restore the DNA to its original form. The transcription-coupled repair (TCR) subpathway of NER, discovered nearly two decades later, is dedicated to the removal of lesions from the template DNA strands of actively transcribed genes. In this review I will outline the essential factors and complexes involved in NER in humans, and will comment on additional factors and metabolic processes that affect the efficiency of this important process. PMID:26388429

  1. Wide excision of accessory parotid gland with anterior approach.

    PubMed

    Choi, Hwan Jun; Lee, Young Man; Kim, Jun Hyuk; Tark, Min Seong; Lee, Jang Hyun

    2012-01-01

    Accessory parotid gland tissue has been described as salivary tissue adjacent to the Stensen duct that is distinctly separate from the main body of the parotid gland. Of all parotid gland tumors, 1% to 8% arise from the accessory parotid gland. Little is known about the accessory parotid gland, and it is seldom mentioned in the literature. Between 1999 and 2010, we have treated and followed 8 patients with tumors of the accessory parotid gland. There were 5 males and 3 females with a mean age of 35 years. They all presented with an asymptomatic cheek mass, and 4 of them underwent fine-needle aspiration. Ultrasound or computed tomographic scan was used in all patients. All the patients underwent surgical intervention with standard parotidectomy incision and anterior extension. The mean follow-up time was 44 months (range, 6-120 months). Seven patients had benign disease. Four cases were pleomorphic adenoma, and the remaining 3 benign cases were parotid cyst, basal cell adenoma, and hemangioma. Only 1 patient had a malignant tumor that was a lymphoepithelioma-like carcinoma. In 7 cases, wide excision (excision of mass and accessory lobe of the parotid gland) was done because of the intra-accessory parotid gland lesion. One patient had concomitant superficial parotidectomy because the tumor was located very close to and has involved the parotid gland proper. There was no serious postoperative complication and recurrence. Prudent preoperative diagnostic evaluation and meticulous surgical approach are the keys to successful management of midcheek lesions. A wide excision of the accessory lobe of the parotid gland can be a definitive surgery in case of solitary tumor with an intact parotid fascia, and wide excision with anterior approach through a standard parotidectomy incision is preferred to a direct incision over the mass.

  2. Transurethral canine prostatectomy with a cylindrically diffusing fiber

    NASA Astrophysics Data System (ADS)

    Cromeens, Douglas M.; Johnson, Douglas E.; Price, Roger E.

    1994-09-01

    In this study, visual laser ablation of the prostate (VLAP) was performed on eight mongrel dogs utilizing a cylindrically diffusing fiber attached to a 1.06 neodymium:YAG (Nd:YAG) laser. All dogs received one continuous dose totaling 15,000 J (25 W for 10 min) applied from the vesical neck to the colliculus seminalis. There was no visible hemorrhage from the lasing intraoperatively in any dog. Postoperative recovery was uneventful with no dog experiencing urinary incontinence and only one incident of dysuria with urinary retention during their observation period. Gross and histopathologic examinations of serial sections of the prostate were performed from 2 hours to 7 weeks postoperatively and demonstrated a consistent spherical zone of destruction 2.9 cm (average) in diameter. We believe the simplified fiber placement and complete lack of postoperative complications in this small group of dogs suggest that the cylindrically diffusing fiber offers significant advantage over laterally deflecting fibers for transurethral prostatectomies in the dog.

  3. Clinical and technical aspects of bipolar transurethral prostate resection.

    PubMed

    Faul, Peter; Schlenker, Boris; Gratzke, Christian; Stief, Christian G; Reich, Oliver; Hahn, Robert Gustaw

    2008-01-01

    This review aims to provide an overview and critical assessment of the developments in transurethral electroresection in non-conductive and conductive irrigants. In the 1970s, measurements of the electric pathway in saline were performed for different locations of the neutral electrode. It was then concluded that the current pathway and the possible hazards of burn injuries to the patient should be investigated separately for each arrangement of the neutral electrode. The position and shape of the neutral electrode have decisive effects on the current flow in the patient. Thus, different electrode arrangements of the various bipolar resection systems need to be analysed separately. Furthermore, not only electrical power, but also conductivity and quality of the lubricant gel have to be considered as critical factors with regard to electrothermal injuries of the urethra. The supposedly better cutting quality seems to be based more on subjective observations than on scientific valid data. When performing "bipolar" TUR it is necessary to consider all electrotechnical and clinical aspects, particularly with regard to the potential risk of thermoelectrical urethral damage. PMID:18622807

  4. Transurethral Photoacoustic Endoscopy for Prostate Cancer: A Simulation Study.

    PubMed

    Tang, Shanshan; Chen, Jian; Samant, Pratik; Stratton, Kelly; Xiang, Liangzhong

    2016-07-01

    The purpose of this study was to optimize the configuration of a photoacoustic endoscope (PAE) for prostate cancer detection and therapy monitoring. The placement of optical fiber bundles and ultrasound detectors was chosen to maximize the photoacoustic imaging penetration depth. We performed both theoretical calculations and simulations of this optimized PAE configuration on a prostate-sized phantom containing tumor and various photosensitizer concentrations. The optimized configuration of PAE with transurethral light delivery simultaneously increases the imaging penetration depth and improves image quality. Thermal safety, investigated via COMSOL Multiphysics, shows that there is only a 4 mK temperature rise in the urethra during photoacoustic imaging, which will cause no thermal damage. One application of this PAE has been demonstrated for quasi-quantifying photosensitizer concentrations during photodynamic therapy. The sensitivity of the photoacoustic detection for TOOKAD was 0.18 ng/mg at a 763 nm laser wavelength. Results of this study will greatly enhance the potential of prostate PAE for in vivo monitoring of drug delivery and guidance of the laser-induced therapy for future clinical use. PMID:26886974

  5. Canine transurethral laser prostatectomy using a rotational technique

    NASA Astrophysics Data System (ADS)

    Cromeens, Douglas M.; Johnson, Douglas E.

    1995-05-01

    Conventional radical prostatectomy in the dog has historically been attended by unacceptably high incidence of urinary incontinence (80 - 100%). Ablation of the prostate can be accomplished in the dog by transurethral irradiation of the prostate with the Nd:YAG laser and a laterally deflecting fiber. Exposure has ranged between 40 and 60 watts for 60 seconds at 4 fixed locations. Although prostatectomies performed with the above described technique offers significant advantage over conventional prostatectomies, the high power density at each location can result in small submucosal explosions (`popcorn effect') that increase the potential for bleeding and rupture of the prostatic capsule. We describe a new technique in which the energy is applied continuously by a laser fiber rotating around a central point. Delivering 40 watts of Nd:YAG energy for 4 minutes using a new angle-delivery device (UrotekTM), we produced results comparable to those of other previously reported techniques in the canine model with two added advantages: (1) a more even application of heat resulting in no `popcorn' effect and (2) a more reliably predictable area of coagulative necrosis within a given axial plane. This technique should provide additional safety for the veterinary surgeon performing visual laser ablation of the prostate in the dog.

  6. [Hydro-electrolyte changes induced by transurethral prostatic resection].

    PubMed

    Ponce, P; Correia, R; Guimarães, P; Freitas, M; Barata, J D; Santos, J R

    1989-01-01

    Transurethral resection prostatectomy (TURP) has been associated with severe hyponatremia due to massive absorption of bladder irrigation fluid (IF). TURP was performed in 41 patients using Sorbitol-Mannitol IF (Group A) and in 6 patients using distilled water (Group B). Six other patients were operated upon using surgical procedures identical in time and type of anesthesia to TURP (Group C). The three groups were studied with the same protocol that included blood collected before (time I), immediately after (time II) the procedure and 1 hour later (time III). Serum sodium decreased significantly in the 3 groups from time I to time II, an average of 3.4 mEq/l with Mannitol-Sorbitol, 2.3 mEq/l with distilled water, and 4.4 mEq/l in group C. Osmolality did not change significantly between the 3 times of collection and Osmolar Gap only increased from time I to II in the Sorbitol-Mannitol group. In conclusion, mild decrements in serum sodium with no clinical relevance are a common post-TURP finding, but should not be greater than in other similar general surgery without bladder irrigation. Hyposmolality did not constitute a problem. PMID:2624153

  7. New laser side fiber linked with resectoscope for transurethral surgery

    NASA Astrophysics Data System (ADS)

    Tasca, Andrea; Guazzieri, Stefano; Cecchetti, Walter; Zattoni, Filiberto; Pagano, Francesco

    1994-12-01

    Optical fiber systems with lateral emission of laser radiation are currently used for laser treatment of benign prostatic hyperplasia (BPH). They can be classified in reflective or refractive systems in which a mirror or a prism, respectively, is connected to the fiber tip. Both systems are disposable making the cost of treatment too high. An alternative solution for refractive systems is the prismatic cut of the fiber tip. A side fiber of this type was conceived at the Department of Chemical Physics of the University of Venice and then patented. An Olympus 27ch transurethral resectoscope was also modified for use with our side fiber as well as with the resecting blade. Our modified resectoscope with a Nd-YAG laser has been clinically used for the laser treatment of BPH (6 cases), as well as in high risk patients with bulky bleeding bladder tumors (4 cases), and in transitional tumors of the prostate infiltrating the parenchyma (2 cases). Laser treatment with our resectoscope resembles traditional endoscopic treatment, guarantees the precision of fiber tip translation, and permits combined treatments with laser and traditional blade.

  8. Glomus Tumors: A Review of Preoperative Magnetic Resonance Imaging to Detect Satellite Lesions.

    PubMed

    Giugale, Juan M; Fowler, John R

    2015-10-01

    Glomus tumors are malformations of the neuromyoarterial system that commonly develop in the digits and cause exquisite tenderness, especially with cold temperatures. Treatment typically involves surgical excision, although there is a tendency to avoid aggressive resections, which may lead to aesthetically displeasing nail plate deformities. In a minority of patients, symptoms may persist and the tumor may recur. The etiology of the persistent of symptoms is debatable. One theory for the persistence of symptoms is an incomplete initial excision of the glomus tumor. Another theory suggests that clinically unapparent satellite lesions exist at the time of diagnosis that are not excised, and they later mature into symptomatic recurrent tumors. Although not clinically visible, if present, these satellite lesions should be seen on preoperative magnetic resonance imaging. The authors reviewed all cases of pathology-confirmed glomus tumors in the past 7 years at a single institution in which preoperative magnetic resonance imaging using a high-powered 3.0 Tesla (General Electric, Buckinghamshire, United Kingdom) magnet was performed. Six cases met inclusion criteria and only 1 case developed a recurrent glomus tumor. None of the cases were found to have satellite lesions associated with the primary glomus tumor on magnetic resonance imaging. Preventing recurrence seems to be dependent on the completeness of the initial excision. Preoperative magnetic resonance imaging is a valuable tool used to delineate the extent of the tumor for surgical planning. PMID:26488783

  9. Costs of minimally invasive laser surgery compared with transurethral electrocautery resection of the prostate.

    PubMed Central

    Kabalin, J N; Butler, E D

    1995-01-01

    We reviewed hospital charges for patients undergoing uncomplicated endoscopic surgical resection for symptomatic bladder outlet obstruction due to benign prostatic hyperplasia over a 1-year period at a single institution. Of 115 patients, 67 underwent transurethral electrocautery resection of the prostate, and 48 underwent endoscopic neodymium:yttrium-aluminum-garnet laser ablation of the prostate under direct vision. Analysis showed a cost differential between these 2 surgical treatments in excess of $2,000, favoring laser prostatectomy (P < .0001) over transurethral electrocautery resection. The single greatest difference between the treatments was the ability to manage all patients receiving laser treatment as outpatients, whereas the mean and median hospital stay after transurethral electrocautery resection was 3.0 days. Taking additional cost variables into account and decreasing the cost of laser delivery systems would further increase this cost differential in favor of laser therapy. The diminished postoperative morbidity associated with laser treatment also promises lower total costs over the long term. PMID:7785256

  10. Transurethral optical-laser knife and probe director for lateral firing laser probes

    NASA Astrophysics Data System (ADS)

    Malek, Reza S.

    1994-02-01

    Laser energy has been used by many for transurethral incision of small, obstructive prostates, vesical neck contractures, and urethral strictures. The customary techniques of moving the tip of the laser fiber through a cystoscope with a conventional laser guide, almost tangentially to the tissue to be incised, or drilling radially arranged holes in the scar, or both, have been cumbersome and imprecise. To provide exact control of the laser fiber and precise delivery of laser energy, a new guide was devised. It conducts the quartz fiber through the sheath and along the lens of an optical urethrotome. The tip of the quartz fiber contacts the tissue at an angle of 20 degree(s). KTP/532 laser energy is used to perform internal urethrotomy for urethral stricture, transurethral incision of postoperative contracture of the vesical neck, and transurethral incision of the small prostate under constant visual control.

  11. The role of internal urethrotomy in the prevention of urethral stricture following transurethral resection of prostate.

    PubMed

    Bailey, M J; Shearer, R J

    1979-02-01

    Urethral stricture is the commonest late complication of transurethral prostatectomy. Although internal urethrotomy is widely practised to prevent structures, there are no reports of any controlled trials of the procedure. A prospective trial of internal urethrotomy, using the Otis urethrotome, in 210 consecutive transurethral prostatectomies is presented. Patients were divided into 2 groups, those undergoing urethrotomy before TUR ("Trial group") and those undergoing TUR without urethrotomy ("Control group"), and they were followed for a minimum of 6 months. The incidence of stricture in the control group was significantly greater than in the trial group (P less than 0.01). Analysis of all other variables revealed no difference between the 2 groups and it is concluded that internal urethrotomy does prevent stricture formation and that it should be undertaken routinely before transurethral resection.

  12. Technological advances in transurethral resection of the prostate: bipolar versus monopolar TURP.

    PubMed

    Issa, Muta M

    2008-08-01

    One of the most significant recent advancements in transurethral resection of the prostate (TURP) is the incorporation of bipolar technology. Bipolar circuitry allows TURP to be performed in a normal saline environment, which addresses a fundamental concern of conventional monopolar TURP (i.e., the use of hypo-osmolar irrigation). As a result, the risks of dilutional hyponatremia and transurethral resection (TUR) syndrome are eliminated, allowing for longer and safer resection. This review discusses the principles and applications of electrosurgery in conventional monopolar as well as new bipolar saline-based TURP systems. This review also addresses the positive impact on patient safety and resident training.

  13. Application of two micron laser vaporesection combined with transurethral resection of the prostate in treatment of benign prostatic hyperplasia: analysis of 340 cases

    PubMed Central

    Yao, Zhiyong; Sun, Bin; Zhou, Gaobiao; Yang, Yonghong; Zhang, Lei; Liu, Lanlan; Sheng, Haibo; Guo, Heqing

    2015-01-01

    Purpose: To evaluate clinical efficacy and safety of two micron laser vaporesection combined with transurethral resection of the prostate (TURP) in treating benign prostatic hyperplasia (BPH). Methods: In total, 340 BPH patients aged 62-86 years, were treated with two micron laser vaporesection plus TURP. Mean prostatic volume was measured as 38-182 ml. Operative time, intraoperative hemorrhage volume, time of postoperative bladder irrigation, time of indwelling urinary catheter and surgical complications were examined. International Prostate Symptom Score (IPSS), quality of life score (QOL), maximal urinary flow rate (Qmax) and post void residual urine volume (PVR) were analyzed. Results: All cases underwent the surgery successfully. No transurethral resection syndrome was noted. Mean operative time was (72±15) min. Mean intra operative hemorrhage volume was (48.4±13.0) ml. Four patients were transfused with 2 U of suspended red blood cells. Time of postoperative bladder irrigation ranged from 0.5-2.5 d. Time of indwelling urinary catheter was 3-6 d. After removing urinary catheter, mild urinary irritation symptoms were noted in 19 cases. Ten patients developing urinary infection were recovered following anti-infection therapy. One with secondary urethral stenosis was healed after urethral dilatation for three times. Postoperative IPSS, QOL, Qmax and PVR were (6.0±2.0), (2.0±0.2), (18.5±1.6) ml/s and (11.0±4.0) ml, significantly improved compared with preoperative levels (all P<0.05). Fifty eight cases with normal sexual function retained sexual function postoperatively and had no retrograde ejaculation. Conclusions: Two micron laser vaporesection plus TURP is efficacious and safe in treating BPH with mild lower urinary tract symptoms and perioperative complications. PMID:26770585

  14. Preferential heating using transurethral thermoablation (T3) improves clinical results

    NASA Astrophysics Data System (ADS)

    Ramsey, Ernest W.; Miller, Paul D.; Parsons, Keith

    1997-05-01

    Transurethral microwave thermotherapy (TUMT) has been widely reported for the treatment of benign prostatic hyperplasia (BPH) but with variable results. This is likely due to the inability to develop and maintain high intraprostatic temperatures. The T3 device has a preferential heating pattern which prevents shutdowns as a result of rectal heating thus allowing continuous energy delivery throughout the therapy. High temperatures greater than 70 degrees Celsius are maintained resulting in extensive coagulative necrosis in the transitional zone. Treatment was performed in an outpatient clinic using topical anaesthesia with occasional low dose I.V. analgesia. One hundred and fifty-four patients have been treated in 3 centers using a similar protocol. Inclusion criteria required an AUA symptom score greater than or equal to 9 and a peak uroflow rate less than or equal to 12 ml/sec. Mean prostate size was 40.6 cc. One hundred and eighteen patients have been followed for at least 12 months, and 58 for 24 months. AUA symptom score decreased from a mean of 19.8 to 8.9 (12 M), and 7.6 (24 M). Improvement was seen in all 7 symptoms evaluated. Peak flow rates increased from a mean of 9.3 to 13.4 (12 M), and 13.1 (24 M). Improvement in symptom score and peak flow was observed across all prostate sizes. By 2 years, 15 patients had dropped out of the study, 8 for alternative treatment (6 TURP, 1 bladder neck incision, 1 urethrotomy) and 7 for administrative or other reasons. Treatment with the T3 device provides excellent improvement in symptoms, flow rates and patients satisfaction. T3 fulfills the criteria for an effective, minimally invasive, outpatient treatment for symptomatic BPH.

  15. Transurethral electrolaser complex therapy to treat chronic prostatitis

    NASA Astrophysics Data System (ADS)

    Zharov, Vladimir P.

    2000-05-01

    According to the world statistics, from 30 to 60 percent of elderly male population suffer from chronic prostatitis in different countries. This disease has a number of consequences such as urino-genital inflammation, dysuria, perineal pain, reduction in the physiological activity of smooth muscles, blockage of the anus passages with micro-organism vital activity products, appearance of stagnant zones and low blood circulation complicated by disorders of the sexual function. Most of these features make it difficult to use standard drug therapies with antibiotics or immunocorrectors. For that reason, the objective of this study is to develop and to investigate a novel combined electrolaser therapy which improves drug delivery in the prostate gland and simultaneously provides an independent physiotherapeutic effect. The main feature of this therapy is the utilization of two diode lasers emitting in the red (0.67 micrometer, 10 mW) and in the infrared (0.85 micrometer, 1 W) spectrum ranges in combination with transurethral electrostimulation. An electrolaser catheter containing both hollow cylindrical electrodes and an axial optical fiber to deliver laser radiation was brought along the urethra to the seminal vesicles. The red laser in combination with a photosensitizer ('Photosens,' Russia) was used to realize the antibacterial treatment of the urethra. The infrared laser was employed to heat the prostate gland and to stimulate the blood perfusion without thermal damage of tissues. The laser heating of the prostate at a local tissue temperature of 41 degrees Celsius in combination with the electrostimulation provided approximately a 4.5-fold increase in the blood flow. The realization of an additional mode of photovacuum therapy inside the urethra together with the electrostimulation made it possible to 'clean' the anus passages and to improve the DNA diagnosis reliability in respect of the urogenital infectious remainder. The clinical data obtained in 980 patients

  16. Bipolar Transurethral Resection Versus Monopolar Transurethral Resection for Benign Prostatic Hypertrophy: A Systematic Review and Meta-Analysis

    PubMed Central

    Tang, Yin; Li, Jinhong; Pu, Chuanxiao; Bai, YunJin; Yuan, HaiChao; Wei, Qiang

    2014-01-01

    Abstract Purpose: To evaluate the efficacy and safety of monopolar (M-TURP) and bipolar (B-TURP) transurethral resection of the prostate in benign prostatic hypertrophy (BPH) patients. Materials and Methods: Eligible randomized controlled trials (RCTs) were identified from electronic databases without language restrictions. Database search, quality assessment, and data extraction were independently performed. The primary postoperative outcomes of topical M-TURP and B-TURP were maximum flow rate (Qmax) and/or International Prostate Symptom Score (IPSS). Safety was estimated by TUR syndrome; need for transfusion; clot retention; bladder neck contracture (BNC); urethral stricture (US); and catheter removal time. Efficacy and safety were investigated using the Review Manager. Results: Thirty-one trials met the inclusion criteria. Pooled analysis revealed significant difference in efficacy between the M-TURP and B-TURP groups. Safety analysis revealed significant improvement in the TUR syndrome with B-TURP than with M-TURP. Pooled analysis revealed that clot retention was significantly higher in M-TURP than in B-TURP. Moreover, pooled analysis revealed no significant difference between both groups in the blood transfusion frequency or late complications (urethral strictures) and bladder neck constriction. Conclusions: This systematic review indicates that B-TURP was significantly better in the result of Qmax and for decreasing the incidence of TUR syndrome and clot retention. No significant differences were observed in the nature of adverse events such as transfusions, retention after catheter removal, and urethral complications between both groups. Thus, B-TURP is the next generation “gold standard” for benign prostatic obstruction (BPO) because it is associated with a lower rate of clinically relevant complications such as TUR syndrome and clot retention. PMID:24754254

  17. Voiding Dysfunction after Total Mesorectal Excision in Rectal Cancer

    PubMed Central

    Kim, Jae Heon; Noh, Tae Il; Oh, Mi Mi; Park, Jae Young; Lee, Jeong Gu; Um, Jun Won; Min, Byung Wook

    2011-01-01

    Purpose The aim of this study was to assess the voiding dysfunction after rectal cancer surgery with total mesorectal excision (TME). Methods This was part of a prospective study done in the rectal cancer patients who underwent surgery with TME between November 2006 and June 2008. Consecutive uroflowmetry, post-voided residual volume, and a voiding questionnaire were performed at preoperatively and postoperatively. Results A total of 50 patients were recruited in this study, including 28 male and 22 female. In the comparison of the preoperative data with the postoperative 3-month data, a significant decrease in mean maximal flow rate, voided volume, and post-voided residual volume were found. In the comparison with the postoperative 6-month data, however only the maximal flow rate was decreased with statistical significance (P=0.02). In the comparison between surgical methods, abdominoperineal resection patients showed delayed recovery of maximal flow rate, voided volume, and post-voided residual volume. There was no significant difference in uroflowmetry parameters with advances in rectal cancer stage. Conclusions Voiding dysfunction is common after rectal cancer surgery but can be recovered in 6 months after surgery or earlier. Abdominoperineal resection was shown to be an unfavorable factor for postoperative voiding. Larger prospective study is needed to determine the long-term effect of rectal cancer surgery in relation to male and female baseline voiding condition. PMID:22087426

  18. Goserelin acetate before transurethral resection of moderately enlarged benign prostatic hyperplasia: Prospective randomised-controlled clinical trial

    PubMed Central

    Abo El-Enen, Mohamed; Tawfik, Ahmed; El-Abd, Ahmed S.; Ragab, Maged; El-Abd, Sherin; Elrashidy, Mohamed; Elmashad, Nehal; Rasheed, Mohamed; El-Abd, Shawky

    2015-01-01

    Objective To evaluate the impact of a luteinising hormone-releasing hormone (LHRH) agonist, goserelin acetate (GA), on surgical blood loss during transurethral resection of the prostate (TURP), as well as its histopathological effect on prostatic microvessel density (MVD). Patients and methods Patients who underwent TURP due to benign prostatic enlargement (60–100 mL) were randomly subdivided into two equal groups according to whether they received preoperative GA administration (3.6 mg; group A) or not (group B). Evaluation parameters were operative time, weight of resected prostatic tissue, perioperative haematocrit (HCT) changes, estimation of intraoperative blood loss, and suburethral and stromal prostatic MVD. Effects of GA on prostate weight and any possible side-effects were also monitored. Results In all, 35 and 33 patients were included in groups A and B, respectively. Operative time and HCT values’ changes were significantly less in group A (P < 0.05). Also, operative blood loss (both total and adjusted per weight of resected tissue) was lower in group A, at a mean (SD) of 178.13 (77.71) mL and 3.74 (1.52) mL/g vs 371.75 (91.09) mL and 8.59 (2.42) mL/g (P < 0.001). The median MVD in both suburethral [8 vs 11 vessels/high-power field (HPF)] and stromal tissues (9 vs 17 vessels/HPF) were significantly lower in group A (P < 0.001). Side-effects were minimal. Conclusion A single dose of GA, a LHRH agonist, before TURP is safe and effective in reducing surgical blood loss. It significantly reduced MVD in both suburethral and stromal nodular prostatic tissues without regional discrepancy. PMID:26966595

  19. Experience with hypotonic 2.5% sorbitol solution as an irrigating fluid in transurethral resection of the prostate.

    PubMed

    Dimberg, M; Allgén, L G; Norlén, H; Kolmer, T

    1987-01-01

    19 patients were studied in connection with transurethral resection of the prostate using the intermittent technique and hypotonic 2.5% sorbitol solution as an irrigating fluid. No diuretics were given postoperatively. In 2 patients there was a slight elevation of the serum creatinine level preoperatively but in 17 patients serum creatinine was within the reference limits. The plasma sorbitol concentration was determined at 20-min intervals for two hours. The mean plasma concentration of sorbitol immediately postoperatively was 379 mg/l (2.1 mmol/l) and the highest level observed was 1,900 mg/l (10.6 mmol/l). The half-life for sorbitol in plasma was 21 min (mean calculated in 11 cases). The range was 11-33 min. With increasing immediate postoperative plasma sorbitol levels there was also an increase in the half-life, corresponding to saturation of the sorbitol metabolizing enzyme system. The absorbed fluid volumes were calculated from the immediate postoperative plasma concentration of sorbitol, which gave a mean of 0.23 1 and a maximum of 1.01. Haemodilution effects with decrease in the serum sodium and serum albumin concentrations were noted, but they were much less marked than when 5% sorbitol solution was used as an irrigating fluid. There were only insignificant increases in the plasma haemoglobin concentrations postoperatively, which were probably due to heat decomposition of red blood cells in the bladder during the operation. About 7% of the absorbed amount of sorbitol was eliminated in the urine (mean). The highest value observed was 18% in the case showing the highest plasma sorbitol concentration immediately postoperatively (1,900 mg/l). Sorbitol was eliminated in the urine over a period of 6 hours postoperatively. PMID:2448869

  20. Transurethral optical laser knife and probe director for lateral firing laser probes

    NASA Astrophysics Data System (ADS)

    Malek, Reza S.

    1993-05-01

    Laser energy has been used by many for transurethral incision of small, obstructive prostates, vesical neck contractures, and urethral strictures. The customary techniques of moving the tip of the laser fiber through a cystoscope with a conventional laser guide, almost tangentially to the tissue to be incised, or drilling radially arranged holes in the scar, or both, have been cumbersome and imprecise. To provide exact control of the laser fiber and precise delivery of laser energy, a new guide was devised. It conducts the quartz fiber through the sheath and along the lens of an optical urethrotome. The tip of the quartz fiber contacts the tissue at an angle of 20 degree(s). KTP/532 laser energy is used to perform internal urethrotomy for urethral stricture, transurethral incision of postoperative contracture of the vesical neck, and transurethral incision of the small prostate under constant visual control. Recently, a straight version of this guide, called probe director, was devised to conduct the newly marketed lateral firing laser probes. This probe director allows precise control of such a probe within the prostatic urethral lumen and excellent maneuverability of the probe during transurethral laser prostatectomy.

  1. Hybrid method of transurethral resection of ejaculatory ducts using holmium:yttriumaluminium garnet laser on complete ejaculatory duct obstruction.

    PubMed

    Lee, Joo Yong; Diaz, Richilda Red; Choi, Young Deuk; Cho, Kang Su

    2013-07-01

    A 32-year old single man presented with azoospermia and low semen volume which was noted one and half a year ago. Transrectal ultrasonography and seminal vesiculography were performed to evaluate ejaculatory duct obstruction, and transurethral resection of the ejaculatory duct was performed using a hybrid technique of holmium:yttriumaluminium garnet laser with monopolar transurethral resection to overcome the narrow prostatic urethra. To our knowledge, this is the first report on the successful outcome of a hybrid technique applied for transurethral resection of the ejaculatory duct.

  2. Sequential transurethral surgery, multiple drug chemotherapy and radiation therapy for invasive bladder carcinoma: Initial report

    SciTech Connect

    Cervek, J.; Cufer, T.; Kragelj, B.; Zakotnik, B. ); Stanonik, M. )

    1993-04-02

    Forty-seven patients with muscle-invasive bladder cancer (T2--T4, Nx, MO) were treated by transurethral resection, followed by 3--4 cycles of combination chemotherapy (methothrexate 30 mg/m2 on days 1, 14; cis-platinum 100 mg/m2 on day 2; vinblastine 3 mg/m2 on days 1, 14; repeated every 21 days), and external beam irradiation (64--66 Gy to the bladder and 40 Gy to the pelvic lymphatics). Complete remission after transurethral resection and chemotherapy was achieved in 24 out of 45 patients (53%). Cystectomy was performed in patients without complete response to transurethral resection and chemotherapy. The therapy was completed as planned in 45/47 patients. After transurethral resection, chemotherapy, and radiation therapy, biopsy proven complete response was achieved in 62% (28/45); Stage T2T3 in 67% (23/24), Stage T4 in 45% (5/11) of patients. Among 19 patients with positive biopsy findings after transurethral resection and chemotherapy, 14 underwent cystectomy. After follow-up of 4--55 months (median 23 months) 75% (34/45) are alive, 68% (31/45) have had their bladders preserved, and 53% (24/45) are free of the primary tumor. The actuarial survival of all 45 patients is 73%. Moderate nausea and vomiting during treatment were common; severe leukopenia and mucositis were observed in five patients. Late side effects such as miction disorders and diarrhea were predominantly mild. Although the observation period has been too short to allow a definitive evaluation of treatment results, the authors feel both from the point of bladder preservation and disease-free survival that the presented treatment approach is successful in a majority of T2T3 patients, whereas a large tumor size (T4) renders this treatment less effective. 17 refs., 4 figs., 4 tabs.

  3. Preoperative staging of rectal cancer: the MERCURY research project.

    PubMed

    Brown, G; Daniels, I R

    2005-01-01

    The development of a surgical technique that removes the tumour and all local draining nodes in an intact package, namely total mesorectal excision (TME) surgery, has provided the impetus for a more selective approach to the administration of preoperative therapy. One of the most important factors that governs the success of TME surgery is the relationship of tumour to the circumferential resection margin (CRM). Tumour involves the CRM in up to 20% of patients undergoing TME surgery, and results in both poor survival and local recurrence. It is therefore clear that the importance of the decision regarding the use of pre-operative therapy lies with the relationship of the tumour to the mesorectal fascia. In addition, a high-spatial-resolution MRI technique will identify tumours exhibiting other poor prognostic features, namely, extramural spread >5 mm, extramural venous invasion by tumour, nodal involvement, and peritoneal infiltration. The potential benefits of a selective approach using MRI-based selection criteria are evident. That is, over 50% of patients can be treated successfully with primary surgery alone without significant risk of local recurrence or systemic failure. Of the remainder, potentially dramatic improvements may be achieved through the use of intensive and targeted preoperative therapy aimed not only at reducing the size of the primary tumour and rendering potentially irresectable tumour resectable with tumour-free circumferential margins, but also at enabling patients at high risk of systemic failure to benefit from intensive combined modality therapy aimed at eliminating micrometastatic disease. PMID:15865021

  4. State cigarette excise taxes - United States, 2009.

    PubMed

    2010-04-01

    Increasing the price of cigarettes can reduce smoking substantially by discouraging initiation among youths and young adults, prompting quit attempts, and reducing average cigarette consumption among those who continue to smoke. Increasing cigarette excise taxes is one of the most effective tobacco control policies because it directly increases cigarette prices, thereby reducing cigarette use and smoking-related death and disease. All states and the District of Columbia (DC) impose an excise tax on cigarettes. Because many states increased their cigarette excise taxes in 2009, CDC conducted a survey of these tax increases. For this report, CDC reviewed data contained in a legislative database to identify cigarette excise tax legislation that was enacted during 2009 by the 50 states and DC. During that period, 15 states (including DC), increased their state excise tax on cigarettes, increasing the national mean from $1.18 per pack in 2008 to $1.34 per pack in 2009. However, none of the 15 states dedicated any of the new excise tax revenue by statute to tobacco control. Additionally, for the first time, two states (Connecticut and Rhode Island) had excise tax rates of at least $3.00 per pack. Additional increases in cigarette excise taxes, and dedication of all resulting revenues to tobacco control and prevention programs at levels recommended by CDC, could result in further reductions in smoking and associated morbidity and mortality.

  5. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...

  6. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2012-04-01 2011-04-01 true Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...

  7. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2014-04-01 2014-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...

  8. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...

  9. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2013-04-01 2013-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...

  10. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...

  11. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...

  12. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...

  13. 27 CFR 70.412 - Excise taxes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Excise taxes. 70.412 Section 70.412 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Beer § 70.412 Excise taxes. (a) Collection. Taxes on distilled spirits, wines, and beer are paid...

  14. 27 CFR 26.30 - Excise taxes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Excise taxes. 26.30 Section 26.30 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT... Into the United States From Areas Other Than Puerto Rico and the Virgin Islands § 26.30 Excise...

  15. Stellate excision of malignancies on the auricles.

    PubMed

    Bumsted, R M; Ceilley, R I

    1980-01-01

    Primary excision of malignancies on the auricles with the standard "wedge technique" may produce lateral protrusion of the helix. A stellate-type excision eliminates the possibility of this undesirable effect and allows the surgeon to close large defects in the helix. The technique is described in detail.

  16. Effect of transurethral split of the prostate using a double-columnar balloon catheter for benign prostatic hyperplasia

    PubMed Central

    Huang, Weiguo; Huang, Zheng; Xiao, Guofeng; Qin, Xiang

    2016-01-01

    Abstract We aimed to evaluate the long-term therapeutic effect of transurethral split of the prostate (TUSP) with a newly improved double-columnar balloon catheter on patients with benign prostatic hyperplasia (BPH). Total 565 BPH patients (mean age 73.6 years, range 46–94 years) who underwent TUSP surgery between January 2006 and January 2015 were included. Patient's baseline characteristics, prostate size, PSA, preoperative and postoperative maximum urinary flow rate (Qmax), postvoid residual (PVR), international prostate symptoms score (IPSS) and quality of life (QOL) score, perioperative data and postoperative complications were recorded. The mean preoperative prostates size was 48.6 ± 8.2 mL (range 33–230 mL), and the PSA level was 0.8 to 18.6 ng/mL. The mean duration of TUSP procedure from the catheter localization to the split of capsula prostatica was ∼10 minutes. After surgery, the mean Qmax increased from 5.2 ± 1.4 to 12.8 ± 2.2 mL/s (P < 0.001). Patients had improved mean PVR, QOL score, and IPSS after TUSP (76 ± 8 vs 20 ± 8.5 mL, 4.6 ± 0.2 vs 1.4 ± 0.3, and 20.2 ± 4.4 vs 6.6 ± 1.1, respectively, all P < 0.001). Until September 2014, 328 patients were successfully followed up for a long-term period of 38 to 99 months. There was no other case of recurrence with dysuria despite 2 recurrent cases. The TUSP with a double-columnar balloons catheter was a safe and long-term efficient treatment for BPH, with minimal invasion, short operative time, few postoperative complications, and low recurrence rate. PMID:27749528

  17. Pre-operative electrocardiograph examination.

    PubMed Central

    Nash, G. F.; Cunnick, G. H.; Allen, S.; Cook, C.; Turner, L. F.

    2001-01-01

    The leading cause of death following surgery is a cardiac event, and an electrocardiogram is the most common pre-operative test to investigate coronary artery disease. Fifty adults, who required an electrocardiogram, undergoing general surgical procedures, were recruited into this pilot study, which investigated the examination rate of electrocardiographs by doctors pre-operatively. Each tracing was folded in one corner and a paperclip prevented full pre-operative viewing without its removal. Results suggest that 30% of ECGs were not opened and the records of 58% patients overall had no mention of the ECG having been performed. Further analysis showed no correlation with the examination rate of the electrocardiograph with patient age or fitness. If this reflects normal clinical practice, it is sub-optimal use of resources and warrants further audit. PMID:11777129

  18. Pre-operative electrocardiograph examination.

    PubMed

    Nash, G F; Cunnick, G H; Allen, S; Cook, C; Turner, L F

    2001-11-01

    The leading cause of death following surgery is a cardiac event, and an electrocardiogram is the most common pre-operative test to investigate coronary artery disease. Fifty adults, who required an electrocardiogram, undergoing general surgical procedures, were recruited into this pilot study, which investigated the examination rate of electrocardiographs by doctors pre-operatively. Each tracing was folded in one corner and a paperclip prevented full pre-operative viewing without its removal. Results suggest that 30% of ECGs were not opened and the records of 58% patients overall had no mention of the ECG having been performed. Further analysis showed no correlation with the examination rate of the electrocardiograph with patient age or fitness. If this reflects normal clinical practice, it is sub-optimal use of resources and warrants further audit.

  19. [Preoperative fasting guidelines: an update].

    PubMed

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

    2015-03-01

    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery.

  20. Preoperative Psychological Preparation of Children

    PubMed Central

    Güleç, Ersel; Özcengiz, Dilek

    2015-01-01

    Surgery and anaesthesia are significant sources of anxiety for children. In the preoperative period, reducing anxiety helps in preventing the negative consequences that may occur after surgery. The predetermined high-risk children in terms of the development of anxiety play an important role in reducing the negative consequences. Recently featured approaches are modelling and coping techniques, although many techniques are used in the preoperative psychological preparation. The use of computer programs in this area may facilitate important achievements, and it needs to support new studies to be performed. PMID:27366525

  1. Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series

    PubMed Central

    Quintanilla-Dieck, Lourdes; Virgin, Frank; Wootten, Chistopher; Goudy, Steven; Penn, Edward

    2016-01-01

    Objectives. First branchial cleft anomalies (BCAs) constitute a rare entity with variable clinical presentations and anatomic findings. Given the high rate of recurrence with incomplete excision, identification of the entire tract during surgical treatment is of paramount importance. The objectives of this paper were to present five anatomic variations of first BCAs and describe the presentation, evaluation, and surgical approach to each one. Methods. A retrospective case review and literature review were performed. We describe patient characteristics, presentation, evaluation, and surgical approach of five patients with first BCAs. Results. Age at definitive surgical treatment ranged from 8 months to 7 years. Various clinical presentations were encountered, some of which were atypical for first BCAs. All had preoperative imaging demonstrating the tract. Four surgical approaches required a superficial parotidectomy with identification of the facial nerve, one of which revealed an aberrant facial nerve. In one case the tract was found to travel into the angle of the mandible, terminating as a mandibular cyst. This required en bloc excision that included the lateral cortex of the mandible. Conclusions. First BCAs have variable presentations. Complete surgical excision can be challenging. Therefore, careful preoperative planning and the recognition of atypical variants during surgery are essential. PMID:27034873

  2. Histological assessment of tangentially excised burn eschars

    PubMed Central

    Gurfinkel, Reuven; Rosenberg, Lior; Cohen, Sarit; Cohen, Arnon; Barezovsky, Alex; Cagnano, Emanuela; Singer, Adam J

    2010-01-01

    BACKGROUND: The burn eschar serves as a medium for bacterial growth and a source of local and systemic infection. To prevent or minimize these complications, it is important to debride the eschar as early as possible. OBJECTIVE: To identify the presence of viable skin within the excisions by examining tangentially excised burn eschars. METHODS: A total of 146 samples of burned human tissue were removed during 54 routine sharp tangential excision procedures (using dermatomes). The samples were histologically examined to identify the relative thickness of the dead, intermediate and viable layers. RESULTS: The mean (± SD) thickness of the excised samples was 1.7±1.1 mm. The sacrificed viable tissue (mean thickness 0.7±0.8 mm) occupied 41.2% of the entire thickness of the excision. In 32 biopsies (21.8%; 95% CI 16.0 to 29.3), the excision did not reach viable skin. Only eight biopsies (5.4%; 95% CI 2.8 to 10.1) contained all of the necrotic tissue without removing viable tissue. CONCLUSIONS: The thickness of a single tangentially excised layer of eschar is not much greater than the actual thickness of the entire skin and often contains viable tissue. Because surgical debridement is insufficiently selective, more selective means of debriding burn eschars should be explored. PMID:21886431

  3. Clinicopathological correlation of an excised choroidal neovascular membrane in pseudotumour cerebri

    PubMed Central

    Castellarin, A.; Sugino, I.; Nasir, M.; Zarbin, M.

    1997-01-01

    AIMS/BACKGROUND—To correlate the histopathology of an excised choroidal neovascular membrane (CNV) with the clinical and angiographic findings in a 32-year-old woman with pseudotumour cerebri and a peripapillary CNV with subfoveal extension.
METHODS—The patient's visual acuity was assessed by individuals experienced in low vision refraction and who were not members of the surgical team. The CNV was excised via a conventional three port vitrectomy with subretinal dissection. The excised tissue was studied with light and electron microscopy. Preoperative and serial postoperative fluorescein angiograms (FAs) and fundus photographs were obtained to study the dissection bed.
RESULTS—One week after surgery, the FA showed mottled subfoveal choriocapillaris perfusion. Three weeks after surgery, this area showed retinal pigment epithelium (RPE) atrophy clinically, and the FA showed choriocapillaris non-perfusion. Six months after surgery, the area of RPE atrophy and the corresponding area of choriocapillaris non-perfusion had expanded. Histologically, the excised CNV disclosed hyperplastic RPE, fibrovascular tissue, and no choriocapillaris. Fragments of RPE basement were present along the external edge of the specimen. The patient's visual acuity did not improve significantly after surgery.
CONCLUSIONS—Choriocapillaris non-perfusion can develop even in young patients following CNV excision. In this particular case, it is believed that choriocapillaris atrophy was caused by incomplete ingrowth of RPE into the dissection bed following RPE removal with CNV excision. As far as is known, this is the first report describing the results of surgery for CNV secondary to papilloedema associated with pseudotumour cerebri.

 PMID:9505826

  4. Nonsurgical transurethral radiofrequency collagen denaturation: results at three years after treatment.

    PubMed

    Elser, Denise M; Mitchell, Gretchen K; Miklos, John R; Nickell, Kevin G; Cline, Kevin; Winkler, Harvey; Wells, W Glen

    2011-01-01

    Objective. To assess treatment efficacy and quality of life in women with stress urinary incontinence 3 years after treatment with nonsurgical transurethral radiofrequency collagen denaturation. Methods. This prospective study included 139 women with stress urinary incontinence due to bladder outlet hypermobility. Radiofrequency collagen denaturation was performed using local anesthesia in an office setting. Assessments included incontinence quality of life (I-QOL) and urogenital distress inventory (UDI-6) instruments. Results. In total, 139 women were enrolled and 136 women were treated (mean age, 47 years). At 36 months, intent-to-treat analysis (n = 139) revealed significant improvements in quality of life. Mean I-QOL score improved 17 points from baseline (P = .0004), while mean UDI-6 score improved (decreased) 19 points (P = .0005). Conclusions. Transurethral collagen denaturation is a low-risk, office-based procedure that results in durable quality-of-life improvements in a significant proportion of women for as long as 3 years.

  5. Nonsurgical Transurethral Radiofrequency Collagen Denaturation: Results at Three Years after Treatment

    PubMed Central

    Elser, Denise M.; Mitchell, Gretchen K.; Miklos, John R.; Nickell, Kevin G.; Cline, Kevin; Winkler, Harvey; Wells, W. Glen

    2011-01-01

    Objective. To assess treatment efficacy and quality of life in women with stress urinary incontinence 3 years after treatment with nonsurgical transurethral radiofrequency collagen denaturation. Methods. This prospective study included 139 women with stress urinary incontinence due to bladder outlet hypermobility. Radiofrequency collagen denaturation was performed using local anesthesia in an office setting. Assessments included incontinence quality of life (I-QOL) and urogenital distress inventory (UDI-6) instruments. Results. In total, 139 women were enrolled and 136 women were treated (mean age, 47 years). At 36 months, intent-to-treat analysis (n = 139) revealed significant improvements in quality of life. Mean I-QOL score improved 17 points from baseline (P = .0004), while mean UDI-6 score improved (decreased) 19 points (P = .0005). Conclusions. Transurethral collagen denaturation is a low-risk, office-based procedure that results in durable quality-of-life improvements in a significant proportion of women for as long as 3 years. PMID:22190917

  6. Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula

    PubMed Central

    2013-01-01

    Background Arteriovesical fistulas are extremely rare. Only eleven cases were previously reported in the literature. They can occur iatrogenically, traumatically or spontaneously. Case presentation We report an unusual case of a 62-year-old woman with arteriovesical fistula that developed fatal hematuria after transurethral electrocoagulation. Computed tomography (CT) and selective angiography revealed a pseudoaneurysm of the right superior vesical artery with arteriovesical fistula formation, which was managed by transarterial embolization. Conclusions Contrast enhanced CT or CT angiography should be performed when a pulsatile hemorrhage is revealed during cystoscopy. Therapeutic vesical arterial embolization should be considered as a safe and effective procedure for arteriovesical fistulas. Transurethral electrocoagulation may cause severe hematuria for pulsatile bladder bleeding in patients with pelvic vascular malformation. PMID:24289138

  7. Amino acid concentrations in plasma and skeletal muscle after transurethral resection syndrome.

    PubMed

    Hahn, R; Essén, P; Wernerman, J

    1992-01-01

    The concentrations of amino acids in plasma and skeletal muscle were measured 1 and 4 hours after transurethral prostatic resection in three patients who developed symptoms of the transurethral resection syndrome. The irrigating solution contained 1.5% of glycine and 1% of ethanol. The concentrations of glycine in plasma and muscle were equal within an hour of the operation, and at four hours the abnormally high glycine concentration persisted in muscle, though it had decreased rapidly in plasma. Our data suggest that skeletal muscle is a quantitatively important reservoir for glycine when this amino acid is supplied in potentially toxic amounts, but that the plasma glycine concentration returns to normal as the patient's clinical condition improves. PMID:1279783

  8. Pleomorphic adenoma of the breast should be excised with a cuff of normal tissue.

    PubMed

    John, Biku J; Griffiths, Carl; Ebbs, Steven R

    2007-01-01

    Pleomorphic adenoma is a benign tumor found rarely in the breast but commonly in the salivary gland. Unlike the salivary gland variant management guidelines are poorly defined in the breast. We describe the first case of pleomorphic adenoma of the breast that has recurred for the second time following previous surgical excisions, and review the available literature. Due to the risk of recurrence and malignant transformation, we recommend complete excision of the lesion with a cuff of normal tissue, as is the practice in the salivary gland. Clinicians should be aware of the condition, as preoperative diagnosis will facilitate adequate surgery. Patients should be informed about the risk of recurrence. We recommend follow-up for at least a period of 5 years with yearly clinical examinations.

  9. Transurethral Unroofing of a Symptomatic Imperforate Cowper's Syringocele in an Adult Male

    PubMed Central

    Harris, Catherine R.; Gaither, Thomas W.; Osterberg, E. Charles

    2016-01-01

    Cystic dilatation of bulbourethral gland ducts (Cowper's gland syringocele) is a rare abnormality. The condition has been described among pediatric populations, but it is uncommon in adults. It can be asymptomatic or present with obstructive and irritative urinary symptoms. We report a case of a symptomatic imperforate Cowper's syringocele in a young patient that was successfully managed with transurethral unroofing of the cyst. PMID:27119039

  10. Physiopathology and surgical treatment of extravasated peritoneal fluid after transurethral resection.

    PubMed

    Montesinos Baillo, A; Banús Gassol, J M; Palou Redorta, J; Nogueron Castro, M; Macias Giménez, N

    1984-01-01

    We present 9 cases (0.57%) of vesicoprostatic perforation during transurethral resection of 1,562 consecutive operations done during the last 3 years in our urology department. We review the symptomatology, medical and surgical treatment from the point of view of the physiopathology of the intra-abdominal extravasated fluid. A new technique for the evacuation of the extravasate is presented ( multiperforated intraperitoneal catheter) because of its speed and ease of performance. PMID:6723737

  11. [Optimization of hydrodynamic conditions in transurethral resection of benign prostatic hyperplasia].

    PubMed

    Kamalov, A A; Tolstova, S S; Martov, A G; Osmolovskiĭ, E O

    1998-01-01

    Water intoxication remains a serious complication of transurethral resection (TUR) occurring more frequently in patients with large-size benign prostatic hyperplasia (BPH) and in those who was operated for more than 1 hour. An advanced irrigation system employing mechanical valve "Floval" and active aspiration provides controlled irrigation of the bladder preventing spontaneous rise of intravesical pressure in conducting TUR in BPH patients. PMID:9532945

  12. Giant rhinophyma: Excision with coblation assisted surgery.

    PubMed

    Sahin, Caner; Turker, Mesut; Celasun, Bulent

    2014-01-01

    An 83-year-old man presented with an unusually severe case of rhinophyma. Giant rhinopyhma is very rare in literature. The giant lesion was widely excised using sharp surgical incision and coblation assisted surgery. Using direct coblation to the nasal dorsum may cause edema in the surrounding tissue. There was minimal edema in surrounding tissue using this technique. A full thickness-skin graft was applied after excision. Cosmetic and functional postoperative results were satisfactory.

  13. Giant rhinophyma: Excision with coblation assisted surgery

    PubMed Central

    Sahin, Caner; Turker, Mesut; Celasun, Bulent

    2014-01-01

    An 83-year-old man presented with an unusually severe case of rhinophyma. Giant rhinopyhma is very rare in literature. The giant lesion was widely excised using sharp surgical incision and coblation assisted surgery. Using direct coblation to the nasal dorsum may cause edema in the surrounding tissue. There was minimal edema in surrounding tissue using this technique. A full thickness-skin graft was applied after excision. Cosmetic and functional postoperative results were satisfactory. PMID:25593440

  14. Pelvic Support Osteotomy in the Treatment of Patients With Excision Arthroplasty

    PubMed Central

    2008-01-01

    Resistant hip infection in adults can be a complicated problem that does not respond to surgical and medical treatment. In such cases, the only remaining option is excision arthroplasty. This line of treatment can eradicate the infection but also is associated with poor function. In some cases, conversion of excision arthroplasty to artificial joint replacement is associated with too great a risk because of local hip surgical risks or low immunity with risk of recurrent infection. Pelvic support osteotomy with the Ilizarov modification can present an alternative solution for such patients. This study included 11 patients with resistant hip infection who were treated using excision arthroplasty. Pelvic support osteotomy then was used to improve hip stability and abductor muscle function. The Ilizarov modification was applied to correct mechanical alignment of the limb and the limb length discrepancy. Harris hip scores improved in all patients: the average score preoperatively was 43.5 (range, 31–50), whereas at final followup, the average score was 70.9 (range, 65–80). Pelvic support osteotomy, along with the Ilizarov modification, can provide an alternative treatment to improve function in patients previously managed with excision hip arthroplasty and Girdlestone surgery. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18264860

  15. Preoperative Oral Carbohydrate Loading in Pancreaticoduodenectomy

    PubMed Central

    Son, Kum-Hee; Kim, So-Young; Cho, Yeong-Ah; Han, Sung-Sik; Park, Sang-Jae

    2016-01-01

    Overnight fasting before elective surgery has been the routine to reduce the risk of pulmonary aspiration. Recently, several international guidelines for preoperative fasting recommend to intake carbohydrate-containing fluids up to 2 to 3 hours before the induction of anesthesia to improve postoperative recovery. Based on the recommendations, we developed a "preoperative carbohydrate diet" provided for the preoperative patients. The purpose of this case report is to share our experience of applying preoperative carbohydrate loading prior to surgery. PMID:27482525

  16. Biothermal modeling of transurethral ultrasound applicators for MR-guided prostate thermal therapy (Invited Paper)

    NASA Astrophysics Data System (ADS)

    Ross, Anthony B.; Diederich, Chris J.; Nau, William H.; Tyreus, Per D.; Gill, Harcharan; Bouley, Donna; Butts, R. K.; Rieke, Viola; Daniel, Bruce; Sommer, Graham

    2005-04-01

    Thermal ablation is a minimally-invasive treatment option for benign prostatic hyperplasia (BPH) and localized prostate cancer. Accurate spatial control of thermal dose delivery is paramount to improving thermal therapy efficacy and avoiding post-treatment complications. We have recently developed three types of transurethral ultrasound applicators, each with different degrees of heating selectivity. These applicators have been evaluated in vivo in coordination with magnetic resonance temperature imaging, and demonstrated to accurately ablate specific regions of the canine prostate. A finite difference biothermal model of the three types of transurethral ultrasound applicators (sectored tubular, planar, and curvilinear transducer sections) was developed and used to further study the performance and heating capabilities of each these devices. The biothermal model is based on the Pennes bioheat equation. The acoustic power deposition pattern corresponding to each applicator type was calculated using the rectangular radiator approximation to the Raleigh Sommerfield diffraction integral. In this study, temperature and thermal dose profiles were calculated for different treatment schemes and target volumes, including single shot and angular scanning procedures. This study also demonstrated the ability of the applicators to conform the cytotoxic thermal dose distribution to a predefined target area. Simulated thermal profiles corresponded well with MR temperature images from previous in vivo experiments. Biothermal simulations presented in this study reinforce the potential of improved efficacy of transurethral ultrasound thermal therapy of prostatic disease.

  17. Accuracy of lesion boundary tracking in navigated breast tumor excision

    NASA Astrophysics Data System (ADS)

    Heffernan, Emily; Ungi, Tamas; Vaughan, Thomas; Pezeshki, Padina; Lasso, Andras; Gauvin, Gabrielle; Rudan, John; Engel, C. Jay; Morin, Evelyn; Fichtinger, Gabor

    2016-03-01

    PURPOSE: An electromagnetic navigation system for tumor excision in breast conserving surgery has recently been developed. Preoperatively, a hooked needle is positioned in the tumor and the tumor boundaries are defined in the needle coordinate system. The needle is tracked electromagnetically throughout the procedure to localize the tumor. However, the needle may move and the tissue may deform, leading to errors in maintaining a correct excision boundary. It is imperative to quantify these errors so the surgeon can choose an appropriate resection margin. METHODS: A commercial breast biopsy phantom with several inclusions was used. Location and shape of a lesion before and after mechanical deformation were determined using 3D ultrasound volumes. Tumor location and shape were estimated from initial contours and tracking data. The difference in estimated and actual location and shape of the lesion after deformation was quantified using the Hausdorff distance. Data collection and analysis were done using our 3D Slicer software application and PLUS toolkit. RESULTS: The deformation of the breast resulted in 3.72 mm (STD 0.67 mm) average boundary displacement for an isoelastic lesion and 3.88 mm (STD 0.43 mm) for a hyperelastic lesion. The difference between the actual and estimated tracked tumor boundary was 0.88 mm (STD 0.20 mm) for the isoelastic and 1.78 mm (STD 0.18 mm) for the hyperelastic lesion. CONCLUSION: The average lesion boundary tracking error was below 2mm, which is clinically acceptable. We suspect that stiffness of the phantom tissue affected the error measurements. Results will be validated in patient studies.

  18. Intra-operative haemodynamic volatility in a patient undergoing retroperitoneal cyst excision.

    PubMed

    Tantry, Thrivikrama Padur; Shenoy, Sunil P; Shetty, Pramal; Adappa, Karunakara K

    2012-03-01

    Excision of a suspected retroperitoneal, duodenal duplication cyst was performed in a pre-operatively normotensive patient under combined epidural and general anaesthesia. Intraoperatively, the cystic tumour was discovered to be a retroperitoneal mass, free from duodenal or adrenal origin. Development of severe arrhythmias, ST segment changes and hypertensive spikes during cyst handling and dissection suggested the possibility of a catecholamine-secreting tumour. These were managed effectively with pharmacological agents. Subsequently, histopathology of the specimen revealed a paraganglioma. Vasoactive tumour has to be suspected in every patient undergoing anaesthesia for retroperitoneal cystic lesion.

  19. Intra-operative haemodynamic volatility in a patient undergoing retroperitoneal cyst excision

    PubMed Central

    Tantry, Thrivikrama Padur; Shenoy, Sunil P; Shetty, Pramal; Adappa, Karunakara K

    2012-01-01

    Excision of a suspected retroperitoneal, duodenal duplication cyst was performed in a pre-operatively normotensive patient under combined epidural and general anaesthesia. Intraoperatively, the cystic tumour was discovered to be a retroperitoneal mass, free from duodenal or adrenal origin. Development of severe arrhythmias, ST segment changes and hypertensive spikes during cyst handling and dissection suggested the possibility of a catecholamine-secreting tumour. These were managed effectively with pharmacological agents. Subsequently, histopathology of the specimen revealed a paraganglioma. Vasoactive tumour has to be suspected in every patient undergoing anaesthesia for retroperitoneal cystic lesion. PMID:22701212

  20. [Algorithm for treating preoperative anemia].

    PubMed

    Bisbe Vives, E; Basora Macaya, M

    2015-06-01

    Hemoglobin optimization and treatment of preoperative anemia in surgery with a moderate to high risk of surgical bleeding reduces the rate of transfusions and improves hemoglobin levels at discharge and can also improve postoperative outcomes. To this end, we need to schedule preoperative visits sufficiently in advance to treat the anemia. The treatment algorithm we propose comes with a simple checklist to determine whether we should refer the patient to a specialist or if we can treat the patient during the same visit. With the blood count test and additional tests for iron metabolism, inflammation parameter and glomerular filtration rate, we can decide whether to start the treatment with intravenous iron alone or erythropoietin with or without iron. With significant anemia, a visit after 15 days might be necessary to observe the response and supplement the treatment if required. The hemoglobin objective will depend on the type of surgery and the patient's characteristics.

  1. AB174. Clinical analysis of transurethral end-fire greenlight PVRP-ST for the treatment of elderly and high-risk patients with

    PubMed Central

    Yang, Guosheng; Qiu, Xiaofo

    2016-01-01

    Objective Analyzing the features of transurethral end-fire greenlight photoselective vaporesection of prostate-shovel technique (PVRP-ST) and evaluating the safety and efficacy of transurethral end-fire greenlight PVRP-ST for high-risk and elderly patients with benign prostatic hyperplasia (BPH) by comparing with TURP. Methods We analyzed a total of 93 high-risk and elderly patients with BPH underwent PVRP-ST (50 cases) and TURP (43 cases) from September 2013 to March 2015 in Guangdong NO. 2 Provincial People’s Hospital prospectively. We collected their generally information (including age, duration of oral drug finasteride time, prostate volume, past medical history, PSA situation and complications etc.), and recorded operative time, blood loss, the number of intraoperative flushing fluid bag, postoperative bladder irrigation time, postoperative catheter indwelling time, the postoperative hospitalization days, intraoperative complications and postoperative complications. The variables such as sodium (Na+) concentration, potassiumions (K+) concentration, hemoglobin (Hb) concentration, and hematocrit (HCT) were compared before and after operation. Detecting the maximum urinary flow rate (Qmax), residual urine volume (RUV), fill in the International Prostate Symptom (IPSS) score sheet, quality of life (QoL) score sheet before the surgery. Following up the IPSS, QoL, Qmax and RUV after 3 months of operation. The IPSS, QoL, Qmax and RUV were compared between preoperation and 3 months after operation. Using relevant statistical methods to compare the data between preoperation and postoperation with SPSS 17.0 software. Results All patients were successfully performed surgery with no serious complications, no deaths, no case turn to open surgery and no capsular perforation. (I) There were not significant differences in values of preoperative general information between two the groups of patients (P>0.05); (II) the average operative time of group PVRP-ST was (68.2±23

  2. 29 CFR 794.121 - Exclusion of excise taxes.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Exclusion of excise taxes. 794.121 Section 794.121 Labor... Exclusion of excise taxes. The computation of the annual gross volume of sales of the enterprise for purposes of section 7(b)(3) is made “exclusive of excise taxes.” It will be noted that the excise...

  3. Transnasal endoscopic resection of juvenile nasopharyngeal angiofibroma without preoperative embolization.

    PubMed

    Borghei, Peyman; Baradaranfar, Mohammad Hossein; Borghei, Seyed Hebatodin; Sokhandon, Farnoosh

    2006-11-01

    Juvenile nasopharyngeal angiofibroma (JNA) is a benign, highly vascular, and locally invasive tumor. Because the location of these tumors makes conventional surgery difficult, interest in endoscopic resection is increasing, particularly for the treatment of lesions that do not extend laterally into the infratemporal fossa. We report the results of our series of 23 patients with JNA (stage IIB or lower) who underwent transnasal endoscopic resection under hypotensive general anesthesia without preoperative embolization of the tumor All tumors were successfully excised. The amount of intraoperative blood loss was acceptable. We observed only 1 recurrence, which was diagnosed 19 months postoperatively in a patient with a stage IIB primary tumor. We observed only 3 complications during follow-up-all synechia. We conclude that endoscopic resection of JNAs is safe and effective. The low incidence of recurrence and complications in this series indicates that preoperative embolization may not be necessary for lesions that have not undergone extensive spread; instead, intraoperative bleeding can be adequately controlled with good hypotensive general anesthesia.

  4. The Effect of Two Weeks of Treatment with Dutasteride on Bleeding after Transurethral Resection of the Prostate

    PubMed Central

    Kim, Kyu Shik; Jeong, Won Sik; Park, Sung Yul; Kim, Yong Tae

    2015-01-01

    Purpose Dutasteride affects the prostate by reducing intraprostatic dihydrotestosterone and prostate tissue vascularity. We evaluated the effect of pretreatment with dutasteride for two weeks on perioperative and postoperative bleeding during transurethral resection of the prostate (TURP). Materials and Methods Eighty-three patients who had benign prostatic hyperplasia together with the criteria for eligibility for TURP were included. The dutasteride group consisted of 40 patients who were treated with dutasteride (0.5 mg/d) for two weeks before surgery, and the control group consisted of 43 patients who did not receive dutasteride. Blood loss was evaluated in terms of reduction in serum hemoglobin (Hb) and hematocrit (Hct) levels, which were measured before, immediately after, and 24 hours after surgery. We also measured the durations of indwelling urethral catheter use, continuous saline bladder irrigation, and hospitalization. Results Lower mean blood loss was observed in the dutasteride group than the control group immediately after and 24 hours after surgery (ΔHb=0.65±1.27 g/dL vs. 1.16±0.73 g/dL, 1.30±1.00 g/dL vs. 1.86±1.05 g/dL respectively, p=0.019, p=0.011; ΔHct=1.89%±3.83% vs. 3.47%±2.09%, 3.69%±2.95% vs. 5.39%±3.23% respectively, p=0.016, p=0.011). In addition, there were fewer days of indwelling urethral catheter use (2.95±1.02 d vs. 3.92±1.14 d, p=0.000), continuous saline bladder irrigation (1.81±1.08 d vs. 2.36±1.06 d, p=0.016), and hospitalization after TURP (3.95±1.09 d vs. 4.76±1.19 d, p=0.001) in the dutasteride group. Conclusions Preoperative treatment with dutasteride for two weeks before TURP reduces surgical bleeding and length of hospitalization after TURP. This pretreatment can be used to decrease surgical bleeding associated with TURP. PMID:25927058

  5. Bacteraemia during Transurethral Resection of the Prostate: What Are the Risk Factors and Is It More Common than We Think?

    PubMed

    Mohee, Amar Raj; Gascoyne-Binzi, Deborah; West, Robert; Bhattarai, Selina; Eardley, Ian; Sandoe, Jonathan A T

    2016-01-01

    The aim of this work was to investigate the microbial causes, incidence, duration, risk factors and clinical implications of bacteraemia occurring during transurethral resection of the prostate (TURP) surgery to better inform prophylaxis strategies. An ethically approved, prospective, cohort study of patients undergoing TURP was conducted. Clinical information and follow-up details were collected using standardized data collection sheets. Blood was obtained for culture at 6 different time points peri-procedure. Standard of care antibiotic prophylaxis was given prior to surgery. Bacteriuria was assessed in a pre-procedure urine sample. Histopathology from all prostate chips was assessed for inflammation and malignancy. 73 patients were consented and 276 blood samples obtained. No patients developed symptomatic bacteraemia during the procedure, 17 patients developed asymptomatic bacteraemia (23.2%). Enterococcus faecalis and Pseudomonas aeruginosa were the most common organisms cultured. 10 minutes after the start of the TURP, the odds ratio (OR) of developing bacteraemia was 5.38 (CI 0.97-29.87 p = 0.05), and 20 minutes after the start of the procedure, the OR was 6.46 (CI 1.12-37.24, p = 0.03), compared to before the procedure. We also found an association between the development of intra-operative bacteraemia and recent antibiotic use (OR 4.34, CI 1.14-16.62, p = 0.032), the presence of a urinary catheter (OR 4.92, CI 1.13-21.51, p = 0.034) and a malignant histology (OR 4.90, CI 1.30-18.46, p = 0.019). There was no statistical relationship between pre-operative urine culture results and blood culture results. This study shows that asymptomatic bacteraemia is commonly caused by TURP and occurs in spite of antibiotic prophylaxis. Our findings challenge the commonly held view that urine is the primary source of bacteraemia in TURP-associated sepsis and raise the possibility of occult prostatic infection as a cause of bacteraemia. More work will be needed to determine

  6. Bacteraemia during Transurethral Resection of the Prostate: What Are the Risk Factors and Is It More Common than We Think?

    PubMed Central

    West, Robert; Bhattarai, Selina; Eardley, Ian; Sandoe, Jonathan A. T.

    2016-01-01

    The aim of this work was to investigate the microbial causes, incidence, duration, risk factors and clinical implications of bacteraemia occurring during transurethral resection of the prostate (TURP) surgery to better inform prophylaxis strategies. An ethically approved, prospective, cohort study of patients undergoing TURP was conducted. Clinical information and follow-up details were collected using standardized data collection sheets. Blood was obtained for culture at 6 different time points peri-procedure. Standard of care antibiotic prophylaxis was given prior to surgery. Bacteriuria was assessed in a pre-procedure urine sample. Histopathology from all prostate chips was assessed for inflammation and malignancy. 73 patients were consented and 276 blood samples obtained. No patients developed symptomatic bacteraemia during the procedure, 17 patients developed asymptomatic bacteraemia (23.2%). Enterococcus faecalis and Pseudomonas aeruginosa were the most common organisms cultured. 10 minutes after the start of the TURP, the odds ratio (OR) of developing bacteraemia was 5.38 (CI 0.97–29.87 p = 0.05), and 20 minutes after the start of the procedure, the OR was 6.46 (CI 1.12–37.24, p = 0.03), compared to before the procedure. We also found an association between the development of intra-operative bacteraemia and recent antibiotic use (OR 4.34, CI 1.14–16.62, p = 0.032), the presence of a urinary catheter (OR 4.92, CI 1.13–21.51, p = 0.034) and a malignant histology (OR 4.90, CI 1.30–18.46, p = 0.019). There was no statistical relationship between pre-operative urine culture results and blood culture results. This study shows that asymptomatic bacteraemia is commonly caused by TURP and occurs in spite of antibiotic prophylaxis. Our findings challenge the commonly held view that urine is the primary source of bacteraemia in TURP-associated sepsis and raise the possibility of occult prostatic infection as a cause of bacteraemia. More work will be needed to

  7. AB174. Clinical analysis of transurethral end-fire greenlight PVRP-ST for the treatment of elderly and high-risk patients with

    PubMed Central

    Yang, Guosheng; Qiu, Xiaofo

    2016-01-01

    Objective Analyzing the features of transurethral end-fire greenlight photoselective vaporesection of prostate-shovel technique (PVRP-ST) and evaluating the safety and efficacy of transurethral end-fire greenlight PVRP-ST for high-risk and elderly patients with benign prostatic hyperplasia (BPH) by comparing with TURP. Methods We analyzed a total of 93 high-risk and elderly patients with BPH underwent PVRP-ST (50 cases) and TURP (43 cases) from September 2013 to March 2015 in Guangdong NO. 2 Provincial People’s Hospital prospectively. We collected their generally information (including age, duration of oral drug finasteride time, prostate volume, past medical history, PSA situation and complications etc.), and recorded operative time, blood loss, the number of intraoperative flushing fluid bag, postoperative bladder irrigation time, postoperative catheter indwelling time, the postoperative hospitalization days, intraoperative complications and postoperative complications. The variables such as sodium (Na+) concentration, potassiumions (K+) concentration, hemoglobin (Hb) concentration, and hematocrit (HCT) were compared before and after operation. Detecting the maximum urinary flow rate (Qmax), residual urine volume (RUV), fill in the International Prostate Symptom (IPSS) score sheet, quality of life (QoL) score sheet before the surgery. Following up the IPSS, QoL, Qmax and RUV after 3 months of operation. The IPSS, QoL, Qmax and RUV were compared between preoperation and 3 months after operation. Using relevant statistical methods to compare the data between preoperation and postoperation with SPSS 17.0 software. Results All patients were successfully performed surgery with no serious complications, no deaths, no case turn to open surgery and no capsular perforation. (I) There were not significant differences in values of preoperative general information between two the groups of patients (P>0.05); (II) the average operative time of group PVRP-ST was (68.2±23

  8. Complications of Mohs' chemosurgical excision of eyelid and canthal tumors.

    PubMed

    Baylis, H I; Cies, W A

    1975-07-01

    Seven patients with basal cell epithelioma of the eyelids, canthi, or periorbital skin who were initially treated by Mohs' chemosurgery or by fresh-staged excisions developed complications directly referable to the initial method of excision. Five patients achieved excellent results. Methods of one-staged complete excision and plastic reconstruction were used when tumor excision was incomplete. When excision was complete, secondary reconstructive surgery was sometimes necessary to assuage the effects of healing by granulation.

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

    SciTech Connect

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

    2010-07-15

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

  10. Base Excision Repair of Oxidative DNA Damage

    PubMed Central

    David, Sheila S.; O’Shea, Valerie L.; Kundu, Sucharita

    2010-01-01

    Base excision repair plays an important role in preventing mutations associated with the common product of oxidative damage, 8-oxoguanine. Recent structural studies have shown that 8-oxoguanine glycosylases use an intricate series of steps to efficiently search and locate 8-oxoguanine lesions within the multitude of undamaged bases. The importance of prevention of mutations associated with 8-oxoguanine has also been illustrated by direct connections between defects in the BER glycosylase MUTYH and colorectal cancer. In addition, the properties of other guanine oxidation products and the BER glycosylases that remove them are being uncovered. This work is providing surprising and intriguing new insights into the process of base excision repair. PMID:17581577

  11. Retroperitoneoscopic excision of a mesenteric cyst.

    PubMed

    Horiuchi, T; Shimomatsuya, T; Uchinami, M; Yoshida, M; Amaya, H; Aotake, T; Chiba, Y; Imamura, Y

    2000-02-01

    Mesenteric cysts are rare intra-abdominal lesions. We present a case of a mesenteric cyst that was discovered by abdominal computed tomography (CT) and excised by retroperitoneoscopic surgery. There have been 10 reports of excision of mesenteric cysts by laparoscopy in the literature, but retroperitoneoscopic resection of such cysts has not been reported. This case suggests that when a mesenteric cyst arises from the ascending or descending colon, the retroperitoneal approach has a lower risk of traumatizing the bowel than does the laparoscopic intra-abdominal approach, and it does not have to compress other intra-abdominal organs.

  12. Thermal analysis of the surrounding anatomy during 3-D MRI-guided transurethral ultrasound prostate therapy

    NASA Astrophysics Data System (ADS)

    Burtnyk, Mathieu; Chopra, Rajiv; Bronskill, Michael

    2010-03-01

    Previous numerical simulations have shown that MRI-guided transurethral ultrasound therapy can generate highly accurate volumes of thermal coagulation conforming to 3-D human prostate geometries. The goal of this work is to simulate, quantify and evaluate the thermal impact of these treatments on the rectum, pelvic bone, neurovascular bundles (NVB) and urinary sphincters. This study used twenty 3-D anatomical models of prostate cancer patients and detailed bio-acoustic simulations incorporating an active feedback algorithm which controlled a rotating, planar ultrasound transducer (17-4×3 mm elements, 4.7/9.7 MHz, 10 Wac/cm2). Heating of the adjacent surrounding anatomy was evaluated using thermal tolerances reported in the literature. Heating of the rectum poses the most important safety concern and is influenced largely by the water temperature flowing through an endorectal cooling device; temperatures of 7-37° C are required to limit potential damage to less than 10 mm3 on the outer 1 mm layer of rectum. Significant heating of the pelvic bone was predicted in 30% of the patient models with an ultrasound frequency of 4.7 MHz; setting the frequency to 9.7 MHz when the bone is less than 10 mm away from the prostate reduced heating in all cases below the threshold for irreversible damage. Heating of the NVB was significant in 75% of the patient models in the absence of treatment planning; this proportion was reduced to 5% by using treatment margins of up to 4 mm. To avoid damaging the urinary sphincters, margins from the transducer of 2-4 mm should be used, depending on the transurethral cooling temperature. Simulations show that MRI-guided transurethral therapy can treat the entire prostate accurately. Strategies have been developed which, along with careful treatment planning, can be used to avoid causing thermal injury to the rectum, pelvic bone, NVB and urinary sphincters.

  13. MRI-compatible transurethral ultrasound system for the treatment of localized prostate cancer using rotational control.

    PubMed

    Chopra, Rajiv; Baker, Nicole; Choy, Vanessa; Boyes, Aaron; Tang, Kee; Bradwell, David; Bronskill, Michael J

    2008-04-01

    Magnetic resonance imaging (MRI)-guided transurethral ultrasound therapy is a potential minimally invasive treatment for localized prostate cancer offering precise targeting of tissue within the gland, short treatment times, and the capability to quantify the spatial heating pattern delivered during therapy. A significant challenge in MRI-guided ultrasound therapy is the design and construction of MRI-compatible equipment capable of operation in a closed-bore MR imager. We describe a prototype system developed for MRI-guided transurethral ultrasound therapy and characterize the performance of the different components including the heating applicator design, rotational motor, and radio frequency electronics. The ultrasound heating applicator described in this study incorporates a planar transducer and is capable of producing high intensity ultrasound energy in a localized region of tissue. Results demonstrated that the heating applicator exhibits excellent MRI-compatibility, enabling precise MR temperature measurements to be acquired as close as 6 mm from the device. Simultaneous imaging and rotational motion was also possible during treatment using a motor based on piezoelectric actuators. Heating experiments performed in both phantoms and in a canine model with the prototype system verified the capability to perform simultaneous MR imaging and therapy delivery with this system. Real-time control over therapy using MR temperature measurements acquired during heating can be implemented to achieve precise patterns of thermal damage within the prostate gland. The technical feasibility of using the system developed in this study for MRI-guided transurethral ultrasound therapy in a closed-bore MR imager has been demonstrated. PMID:18491529

  14. Preoperative information management system using wireless PDAs.

    PubMed

    Sawa, Tomohiro; Okahara, Masaharu; Santo, Masayuki; Schmidt, Ulrich; Nakata, Yoshinori; Morita, Shigeho; Ohno-Machado, Lucila

    2003-01-01

    Personal Digital Assistant (PDA) and wireless communication are currently available in clinical settings. We developed wireless PDA software that assists anesthesiologists in pre-operative patient assessment. The device communicates with the hospital information system through a wireless LAN and is equipped with pre-programmed data entry templates for pre-operative assessment. As a preliminary test of the device, we randomly assigned residents in preoperative assessment to an intervention and a control arm and compared the results.

  15. Spatiotemporal filtering of MR-temperature artifacts arising from bowel motion during transurethral MR-HIFU

    SciTech Connect

    Schmitt, Alain; Mougenot, Charles; Chopra, Rajiv

    2014-11-01

    Purpose: Transurethral MR-HIFU is a minimally invasive image-guided treatment for localized prostate cancer that enables precise targeting of tissue within the gland. The treatment is performed within a clinical MRI to obtain real-time MR thermometry used as an active feedback to control the spatial heating pattern in the prostate and to monitor for potential damage to surrounding tissues. This requires that the MR thermometry measurements are an accurate representation of the true tissue temperature. The proton resonance frequency shift thermometry method used is sensitive to tissue motion and changes in the local magnetic susceptibility that can be caused by the motion of air bubbles in the rectum, which can impact the performance of transurethral MR-HIFU in these regions of the gland. Methods: A method is proposed for filtering of temperature artifacts based on the temporal variance of the temperature, using empirical and dynamic positional knowledge of the ultrasonic heating beam, and an estimation of the measurement noise. A two-step correction strategy is introduced which eliminates artifact-detected temperature variations while keeping the noise level low through spatial averaging. Results: The filter has been evaluated by postprocessing data from five human transurethral ultrasound treatments. The two-step correction process led to reduced final temperature standard deviation in the prostate and rectum areas where the artifact was located, without negatively affecting areas distal to the artifact. The performance of the filter was also found to be consistent across all six of the data sets evaluated. The evaluation of the detection criterion parameter M determined that a value of M = 3 achieves a conservative filter with minimal loss of spatial resolution during the process. Conclusions: The filter was able to remove most artifacts due to the presence of moving air bubbles in the rectum during transurethral MR-HIFU. A quantitative estimation of the filter

  16. Coagulation of human prostate volumes with MRI-controlled transurethral ultrasound therapy: Results in gel phantoms

    PubMed Central

    N’Djin, William Apoutou; Burtnyk, Mathieu; Kobelevskiy, Ilya; Hadjis, Stefan; Bronskill, Michael; Chopra, Rajiv

    2012-01-01

    Purpose: The feasibility and safety of magnetic resonance imaging (MRI)-controlled transurethral ultrasound therapy were demonstrated recently in a preliminary human study in which a small subvolume of prostate tissue was treated prior to radical prostatectomy. Translation of this technology to full clinical use, however, requires the capability to generate thermal coagulation in a volume up to that of the prostate gland itself. The aim of this study was to investigate the parameters required to treat a full 3D human prostate accurately with a multi-element transurethral applicator and multiplanar MR temperature control. Methods: The approach was a combination of simulations (to select appropriate parameters) followed by experimental confirmation in tissue-mimicking phantoms. A ten-channel, MRI-compatible transurethral ultrasound therapy system was evaluated using six human prostate models (average volume: 36 cm3) obtained from the preliminary human feasibility study. Real-time multiplanar MR thermometry at 3 T was used to control the spatial heating pattern in up to nine planes simultaneously. Treatment strategies incorporated both single (4.6 or 8.1 MHz) and dual (4.6 and 14.4 MHz) frequencies, as well as maximum acoustic surface powers of 10 or 20 W cm−2. Results: Treatments at 4.6 MHz were capable of coagulating a volume equivalent to 97% of the prostate. Increasing power from 10 to 20 W cm−2 reduced treatment times by approximately 50% with full treatments taking 26 ± 3 min at a coagulation rate of 1.8 ± 0.4 cm3 min−1. A dual-frequency 4.6/14.4 MHz treatment strategy was shown to be the most effective configuration for achieving full human prostate treatment while maintaining good treatment accuracy for small treatment radii. The dual-frequency approach reduced overtreatment close to the prostate base and apex, confirming the simulations. Conclusions: This study reinforces the capability of MRI-controlled transurethral ultrasound therapy to treat

  17. Transurethral needle biopsy: a novel technique for pathologic diagnosis of bladder tumors in children.

    PubMed

    Lightfoot, Michelle; Li, Roger; Alsyouf, Muhannad; Nicolay, Lesli; Chamberlin, David

    2014-12-01

    Although rare, both benign and malignant bladder tumors are occasionally encountered in the pediatric population. In the present article, the technique of transurethral needle biopsy, which utilizes an 18-gauge core biopsy instrument inserted through a 9.5 French offset pediatric cystoscope to obtain diagnostic biopsies, is described. This technique has been used successfully in two patients, both of whom had an inflammatory myofibroblastic tumor on biopsy and on final pathology from partial cystectomy. This provides an alternative technique, which may be used when a pediatric resectoscope is not available or in patients with a small caliber urethra.

  18. [Transurethral prostate resection prior to kidney transplantation leading to urethral cicatricial tissue].

    PubMed

    Schou-Jensen, Katrine; Mohammad, Wael

    2015-01-26

    In Denmark, kidney transplantations in patients above 50 years have increased during the last decade. Consequently, the number of patients with lower urinary tract symptoms due to prostate hypertrophy increases accordingly. We describe two patients, who both had a resection of the prostate while having anuria and waiting for a kidney transplantation from a deceased donor. In both cases it was impossible to place a urethral catheter during the following transplantation due to total urethral occlusion, so a suprapubic catheter was inserted until the scar tissue was dilated or resected by a later transurethral intervention. PMID:25612989

  19. Primary prostate sarcoma: how to manage following diagnosis at transurethral resection

    PubMed Central

    Hicks, Natalie; Gurung, Pratik M.S.; Deshmukh, Nayneeta; Apakama, Ikechukwu; Patel, Prashant

    2016-01-01

    Primary prostate sarcomas are rare, reportedly comprising just 0.7% of all prostate malignancies. Here, we present the case of a 66-year-old man who was diagnosed with prostate stromal sarcoma after undergoing a routine transurethral resection of prostate for bladder outflow obstruction. Primary prostate sarcoma can be aggressive even when low-grade, with a high risk of local recurrence and, high malignant potential when high-grade. They require aggressive multimodality treatment with surgery, chemotherapy and radiotherapy for durable survival outcomes. They also require close surveillance with long-term follow-up. PMID:27147716

  20. Primary prostate sarcoma: how to manage following diagnosis at transurethral resection.

    PubMed

    Hicks, Natalie; Gurung, Pratik M S; Deshmukh, Nayneeta; Apakama, Ikechukwu; Patel, Prashant

    2016-05-03

    Primary prostate sarcomas are rare, reportedly comprising just 0.7% of all prostate malignancies. Here, we present the case of a 66-year-old man who was diagnosed with prostate stromal sarcoma after undergoing a routine transurethral resection of prostate for bladder outflow obstruction. Primary prostate sarcoma can be aggressive even when low-grade, with a high risk of local recurrence and, high malignant potential when high-grade. They require aggressive multimodality treatment with surgery, chemotherapy and radiotherapy for durable survival outcomes. They also require close surveillance with long-term follow-up.

  1. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  2. Visual outcome and efficacy of conjunctival autograft, harvested from the body of pterygium in pterygium excision

    PubMed Central

    Bhandari, Vipul; Rao, Chandan Latha; Ganesh, Sri; Brar, Sheetal

    2015-01-01

    Purpose To evaluate the efficacy of conjunctival autograft after the pterygium excision with fibrin adhesive using conjunctiva over the pterygium. Patients and methods This prospective study included 25 eyes of 25 patients with a mean age of 40±10 years, who underwent the pterygium excision with conjunctival autograft derived from the body of the pterygium and attached using fibrin glue. The mean follow-up period was 6 months. On all postoperative visits, changes in uncorrected visual acuity, corrected distance visual acuity, astigmatism, complications, and the evidence of recurrence were recorded. Results At the end of mean follow-up, uncorrected visual acuity and corrected distance visual acuity improved by one or two lines in all eyes treated. Mean astigmatism reduced significantly from a preoperative value from 2.308D to 1.248D postoperatively (P<0.026). Minor postoperative complications such as congestion, chemosis, and subconjunctival hemorrhage were seen, which resolved with time. No major sight-threatening or graft-related complications were detected. There was no evidence of recurrence during a follow-up period of 6 months. Conclusion Self-conjunctival autograft following the pterygium excision appears to be a feasible, safe, and effective alternative method for management of pterygium. It also preserves the superior conjunctiva for future surgeries. However, longer follow-up is required to study the long-term outcomes, especially the incidence of recurrence. PMID:26664044

  3. Local excision as a treatment for tumors of ampulla of Vater

    PubMed Central

    Demetriades, Haralampos; Zacharakis, Emmanouil; Kirou, Ioanna; Pramateftakis, Manousos-Georgios; Sapidis, Nikolaos; Kanellos, Ioannis; Betsis, Dimitrios

    2006-01-01

    Background Although local excision (ampullectomy) was first described by Halsted in 1899, its adequacy as an alternative surgical treatment for the ampullary tumors is still a matter of debate. The aim of this study was to evaluate the results of ampullectomy as a curative treatment for benign and malignant tumors arising from the ampulla, in a 14-year single-institution experience. Methods From 1990 to 2004, a total of 20 patients of adenocarcinoma (12) or adenoma (8) of the ampulla of Vater underwent local excision. Clinical data were collected and morbidity, mortality, as well as long-term survival were evaluated. The usefulness of several pre or intraoperative diagnostic methods was also recorded. Median follow-up was 85 (range 6–180) months. Results The combination of endoscopic preoperative biopsies and intraoperative frozen section examination adequately diagnosed ampullary tumors in all cases. The postoperative morbidity and mortality were 0%, whereas the 3 and 5-year survival rates for the patients with adenocarcinoma was 75 % and 33.3 % respectively. All the patients with adenoma are still alive without any sign of recurrence. Conclusion In our series, local excision was a safe option, associated with satisfactory long-term survival rates in patients with benign lesions and in those with small(<2 cm), pT1, well differentiated ampullary tumours without nodal involvement. PMID:16524478

  4. Use of intracranial and ocular thermography before and after arteriovenous malformation excision

    NASA Astrophysics Data System (ADS)

    Hwang, Peter Y. K.; Lewis, Philip M.; Maller, Jerome J.

    2014-11-01

    Excision of arteriovenous malformations (AVMs) is known to carry a risk of postoperative hemorrhage, postulated to be the result of normal perfusion pressure breakthrough. It is also possible that AVMs may cause a steal effect, reducing perfusion in nearby vessels. There is currently no simple method of visualizing the presence or absence of steal effect intraoperatively. We hypothesized that the infrared thermographic (heat sensitive) imaging of perilesional brain may be useful for detecting reduced perfusion due to steal. Moreover, we hypothesized that if steal effect was present, it could impact on ocular perfusion and thereby temperature. Our objective was, therefore, to investigate whether perilesional cortical and ocular temperature (OT) may be a marker of steal effect. We intraoperatively acquired conventional and thermal images of the surgical field and eyes bilaterally, pre- and post-excisions of a large left hemisphere AVM. We found OT asymmetry preoperatively, which was absent after the AVM was excised. Intraoperative thermal images showed an increase of perilesional temperature, although this could be confounded by generalized changes in cortical perfusion due to anesthetics or surgery.

  5. Preoperative Embolization of a Posterior Mediastinal Lipid-Poor Angiolipoma Mimicking a Paravertebral Nerve Sheath Tumor.

    PubMed

    Gorospe, Luis; García-Poza, Javier; González-Gordaliza, María Cristina; Cabañero-Sánchez, Alberto; Muñoz-Molina, Gemma María; Saldaña-Garrido, David

    2015-08-01

    Mediastinal angiolipomas are extremely rare tumors within the thorax, and only 6 cases have been previously reported in the literature. We describe the case of a lipid-poor angiolipoma within the posterior mediastinum of a 63-year-old man who complained of chest pain. Interestingly, initial imaging of the posterior mediastinal mass of our patient suggested a nerve sheath tumor. A specimen from a percutaneous transthoracic core needle biopsy confirmed an angiolipoma. We decided to preoperatively embolize the posterior mediastinal mass to reduce intraoperative bleeding and to facilitate the excision of the tumor.

  6. Ergonomic assessment of the posture of surgeons performing endoscopic transurethral resections in urology

    PubMed Central

    Luttmann, Alwin; Jäger, Matthias; Sökeland, Jürgen

    2009-01-01

    Background During transurethral endoscopic prostate and bladder operations the influence of an ergonomic redesign of the arrangement of the operation equipment - including the introduction of a video-assisted resection method ('monitor endoscopy') instead of directly viewing onto the operation area via the endoscope ('direct endoscopy') - was studied with respect to the postures of the surgeons. Methods Postures were analysed on the basis of video recordings of the surgeons performed in the operation theatre during live operations and subsequent visual posture estimation executed by an observer. In particular, head, trunk and arm positions were assigned to posture categories according to a newly developed posture classification schema. 10 urological operations with direct endoscopy and 9 with monitor endoscopy were included. Results Application of direct endoscopy coincides with distinct lateral and sagittal trunk and head inclinations, trunk torsion and strong forearm and upper arm elevations of the surgeons whereas operations with monitor endoscopy were performed with an almost upright head and trunk and hanging arms. The disadvantageous postures observed during direct endoscopy are mainly caused by the necessity to hold the endoscope continuously in close contact with the eye. Conclusion From an ergonomic point of view, application of the video-assisted resection method should be preferred in transurethral endoscopic operations in order to prevent awkward postures of the surgeons and to limit muscular strain and fatigue. Furthermore, the application of the monitor method enables the use of a chair equipped with back support and armrests and benefits the reduction of postural stress. PMID:19840390

  7. The Feasibility of Conformal Thermal Therapy with Transurethral Ultrasound Heating Applicators and MR Temperature Feedback

    NASA Astrophysics Data System (ADS)

    Choy, Vanessa; Tang, Kee; Wachsmuth, Jeff; Chopra, Rajiv; Bronskill, Michael

    2006-05-01

    Transurethral thermal therapy offers a minimally invasive alternative for the treatment of prostate diseases including benign prostate hyperplasia (BPH) and prostate cancer. Accurate heating of a targeted region of the gland can be achieved through the use of a rotating directional heating source incorporating planar ultrasound transducers, and the implementation of active temperature feedback along the beam direction during heating provided by magnetic resonance (MR) thermometry. The performance of this control method with practical spatial, temporal, and temperature resolution (such as angular alignment, spatial resolution, update rate for temperature feedback (imaging time), and the presence of noise) for thermal feedback using a clinical 1.5 T MR scanner was investigated in simulations. As expected, the control algorithm was most sensitive to the presence of noise, with noticeable degradation in its performance above ±2°C of temperature uncertainty. With respect to temporal resolution, acceptable performance was achieved at update rates of 5s or faster. The control algorithm was relatively insensitive to reduced spatial resolution due to the broad nature of the heating pattern produced by the heating applicator, this provides an opportunity to improve signal-to-noise ratio (SNR). The overall simulation results confirm that existing clinical 1.5T MR imagers are capable of providing adequate temperature feedback for transurethral thermal therapy without special pulse sequences or enhanced imaging hardware.

  8. Transurethral photodynamic therapy in benign prostatic hyperplasia : a canine pilot study using benzoporphyrin derivative

    NASA Astrophysics Data System (ADS)

    Shetty, Sugandh D.; Peabody, James O.; Beck, Elsa R.; Cerny, Joseph C.; Amin, Mahul B.; Richter, Anna M.

    1999-06-01

    Photodynamic therapy (PDT) principles were evaluated in management of benign prostatic hyperplasia (BPH) in a canine model. Five dogs were injected with benzoporphyrin derivative (BPD) and samples of prostate, bladder, urethra and rectum were taken at 1, 2, 3 and 4 hours and analyzed for BPD. Next, 16 dogs were treated with 100 Joules at 690 nm light form argon dye laser 1 hour after administration of BPD at 0.5 mg/kg using cylindrical diffuser tip fiber passed transurethrally. The prostates were harvested weekly up to 4 weeks and the size of the lesion was measured and the prostates were examined. Prostate had the highest BPD levels. Hemorrhagic lesion of 2.5 cm in diameter was noted at 1 week after PDT. At 3 and 4 weeks there were changes of glandular atrophy in the periurethral region. Minimally invasive technique of transurethral PDT causes glandular and stromal changes in the periurethral zone and has potential in the treatment of BPH.

  9. Bipolar Transurethral Incision of Bladder Neck Stenoses with Mitomycin C Injection

    PubMed Central

    Lyon, Timothy D.; Ayyash, Omar M.; Ferroni, Matthew C.; Rycyna, Kevin J.; Chen, Mang L.

    2015-01-01

    Introduction. To determine the efficacy of bipolar transurethral incision with mitomycin C (MMC) injection for the treatment of refractory bladder neck stenosis (BNS). Materials and Methods. Patients who underwent bipolar transurethral incision of BNS (TUIBNS) with MMC injection at our institution from 2013 to 2014 were retrospectively reviewed. A total of 2 mg of 40% mitomycin C solution was injected in four quadrants of the treated BNS. Treatment failure was defined as the need for subsequent intervention. Results. Thirteen patients underwent 17 bipolar TUIBNS with MMC injection. Twelve (92%) patients had failed a mean of 2.2 ± 1.1 prior endoscopic procedures. Median follow-up was 16.5 months (IQR: 14–18.4 months). Initial success was 62%; five (38%) patients had a recurrence with a median time to recurrence of 7.3 months. Four patients underwent a repeat procedure, 2 (50%) of which failed. Overall success was achieved in 77% (10/13) of patients after a mean of 1.3 ± 0.5 procedures. BNS recurrence was not significantly associated with history of pelvic radiation (33% versus 43%, p = 0.9). There were no serious adverse events. Conclusions. Bipolar TUIBNS with MMC injection was comparable in efficacy to previously reported techniques and did not result in any serious adverse events. PMID:26635876

  10. Method for MRI-guided conformal thermal therapy of prostate with planar transurethral ultrasound heating applicators

    NASA Astrophysics Data System (ADS)

    Chopra, Rajiv; Burtnyk, Mathieu; Haider, Masoom A.; Bronskill, Michael J.

    2005-11-01

    A method for conformal prostate thermal therapy using transurethral ultrasound heating applicators incorporating planar transducers is described. The capability to shape heating patterns to the geometry of the prostate gland from a single element in a multi-element heating applicator was evaluated using Bioheat transfer modelling. Eleven prostate geometries were obtained from patients who underwent MR imaging of the prostate gland prior to radical prostatectomy. Results indicate that ultrasound heating applicators incorporating multi-frequency planar transducers (4 × 20 mm, f = 4.7 MHz, 9.7 MHz) are capable of shaping thermal damage patterns to the geometry of individual prostates. A temperature feedback control algorithm has been developed to control the frequency, rotation rate and applied power level from transurethral heating applicators based on measurements of the boundary temperature during heating. The discrepancy between the thermal damage boundary and the target boundary was less than 5 mm, and the transition distance between coagulation and normal tissue was less than 1 cm. Treatment times for large prostate volumes were less than 50 min, and perfusion did not have significant impact on the control algorithm. Rectal cooling will play an important role in reducing undesired heating near the rectal wall. Experimental validation of the simulations in a tissue-mimicking gel phantom demonstrated good agreement between the predicted and generated patterns of thermal damage.

  11. Preliminary study of transurethral photodynamic therapy mediated with Tookad in a canine prostate model

    NASA Astrophysics Data System (ADS)

    Huang, Zheng; Hetzel, Fred W.; Chen, Qun; Dole, Kenneth C.

    2008-02-01

    Background: photodynamic therapy (PDT) mediated with vascular acting photosensitizer Tookad (pd-bacteriopheophorbide) was investigated as an alternative modality for treating prostate cancer. Our previous studies show that Tookad PDT can induce marked prostatic tissue lesion but minimal urethral lesion. In this study a transurethral procedure was used to evaluate the response of the prostatic urethra to direct urethral irradiation. Materials and Methods: Tookad solution (2.5 mg/ml) was administered (1 mg/kg) through IV catheter by an infusion pump over 10 min. A diffuser fiber (1 cm active length) was inserted into the prostatic urethra. The light irradiation (50 or 100 J/cm) started at 4 min after the onset of drug infusion. Urinalysis was performed for 24 - 48 h post PDT. One week after PDT, prostates (n = 4) were removed at necropsy and subjected to histopathological examination. Results: The cross section of prostates showed severe hemorrhagic and necrotic lesions on the right lobe. The diameter of the lesion, measured from urethra to capsule, was >13 mm for 50 J/cm treatment and >18 mm for 100 J/cm, respectively. Although underlying periurethral lesion was visible, the urethral surface was intact and prostatic urethra was open. Conclusions: The joint point of the diffuser tip and the guide fiber might be bent while passing through the sharp turn at the Ischial Arch, which could affect the light distribution and cause the asymmetric lesion. Nonetheless, the transurethral direct irradiation can induce marked prostatic tissue lesion but minimal urethral lesion.

  12. Evaluation of transurethral and transperineal tin ethyl etiopurpurin-photodynamic therapy on the canine prostate one week after drug injection

    NASA Astrophysics Data System (ADS)

    Selman, Steven H.; Keck, Rick W.; Kondo, Sandy; Albrecht, Detlef

    1999-06-01

    We have been investigating the potential applicability of photodynamic therapy for the treatment of benign and malignant disease of the prostate. Both transurethral and transperineal approaches to the delivery of light to the tin ethyl etiopurpurin sensitized canine prostate have been studied. Pharmacologic studies were performed and suggested that delaying light treatment for 7 days after drug administration would maximize the desired effect on the targeted prostatic tissue while minimizing the damage to surrounding bladder and rectum. A total of 12 dogs were treated with transurethral light alone (n=6) or the combination of transurethral light and transperineal light one week after tin ethyl etiopurpurin administration. (Previous studies have shown that light alone has no effect on prostate size or histology.) Animals were euthanized 48 hours and 3 weeks after completion of treatment (drug, 1mg/kg day 0, light [400mw/750sec]day 7). Tissue response was determined by gross and microscopic examination. Additionally, pre- and post- treatment transrectal ultrasounds were compared to assess changes in prostate volume and tissue echogenicity. The combination of transurethral and transperineal light results in extensive destruction of glandular epithelium with minimal damage to surrounding structures. Prostate volumes decreased by an average of 52%. Untreated areas were found to lie greater than 0.5 cm from the light diffuser. These studies have encouraged us to continue to investigate this modality as a technique for total ablation of prostatic glandular epithelium.

  13. 27 CFR 24.323 - Excise Tax Return form.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Excise Tax Return form. 24..., DEPARTMENT OF THE TREASURY LIQUORS WINE Records and Reports § 24.323 Excise Tax Return form. A proprietor who removes wine subject to tax shall prepare an TTB F 5000.24, Excise Tax Return, unless exempted under...

  14. 26 CFR 25.2512-7 - Effect of excise tax.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Effect of excise tax. 25.2512-7 Section 25.2512... TAXES GIFT TAX; GIFTS MADE AFTER DECEMBER 31, 1954 Transfers § 25.2512-7 Effect of excise tax. If jewelry, furs or other property, the purchase of which is subject to an excise tax, is purchased at...

  15. 29 CFR 779.264 - Excise taxes separately stated.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Excise taxes separately stated. 779.264 Section 779.264... Coverage Excise Taxes § 779.264 Excise taxes separately stated. A tax is separately stated where it clearly... was no invoice or sales slip. In the absence of a sales slip or invoice, the amount of the tax...

  16. Techniques in Total Mesorectal Excision Surgery

    PubMed Central

    Lichliter, Warren E.

    2015-01-01

    Advances in the surgical management of rectal cancer have placed the quality of total mesorectal excision (TME) as the major predictor in overall survival. A standardized TME technique along with quality increases the percentage of patients undergoing a complete TME. Quality measurements of TME will place increasing demands on surgeons maintaining competence with present and future techniques. These efforts will improve the outcome of the rectal cancer patients. PMID:25733970

  17. Oncologic Safety of Local Excision Compared With Total Mesorectal Excision for ypT0-T1 Rectal Cancer

    PubMed Central

    Jung, Sung Min; Yu, Chang Sik; Park, In Ja; Kim, Tae Won; Kim, Jong Hoon; Yoon, Yong Sik; Lim, Seok-Byung; Kim, Jin Cheon

    2016-01-01

    Abstract Good oncologic outcomes, demonstrated by a complete pathologic response after preoperative chemoradiotherapy (PCRT), have led to local excision (LE) in selected patients with rectal cancer. We evaluated the oncologic safety of LE compared with total mesorectal excision (TME) in patients with ypT0-T1 rectal cancer. A retrospective review of 304 patients who underwent PCRT, followed by LE or TME, for ypT0-T1 rectal cancer was performed. Propensity scores were computed and used to match groups (LE:TME = 1:1), and analysis of disease-free survival (DFS) and overall survival (OS) was made by comparing patients who underwent LE or TME. Prognostic factors of relapse were analyzed for all patients. Tumor categories were ypT0 in 25 (61.9%) cases, ypTis in 6 (14.3%) cases, and ypT1 in 11 (26.2%) cases for the LE group, and ypT0 in 28 (66.7%) cases, ypTis in 4 (9.5%) cases, and ypT1 in 10 (23.8%) cases for the matched TME patients. There was no significant difference between the matched LE and TME groups in relapse (4.8% and 7.14%, respectively; P = 0.646), 5-year DFS (95.2% vs 91.6%; P = 0.33) and 5-year OS (96.6% vs 88.0%; P = 0.238). In the multivariate Cox regression analysis, tumor distance from the anal verge (hazard ratio [HR] = 0.78; 95% confidence interval (CI) = 0.616–0.992) and the tumor grade (HR = 4.29; 95% CI = 1.430–12.886) were significantly associated with the recurrence risk. LE results in oncologic outcomes that are comparable to those achieved by TME in selected patients with ypT0-T1 rectal cancer after PCRT. PMID:27196490

  18. Rotatory subluxation of the scaphoid after excision of dorsal carpal ganglion and wrist manipulation--a case report.

    PubMed

    Crawford, G P; Taleisnik, J

    1983-11-01

    Surgical excision of a ganglion on the dorsum of the wrist is usually a benign procedure. The most frequent complications are transient postoperative stiffness and recurrence of the ganglion. This paper reports the development of a rotatory subluxation of the scaphoid after the manipulation of the wrist of a patient who had developed postoperative stiffness after the surgical excision of a dorsal wrist ganglion. This unusual complication was successfully treated by closed pinning under radiographic control followed by immobilization in palmar flexion. Manipulation of the wrist for the management of postoperative stiffness is rarely, if ever, indicated. Limitation of motion of a wrist without underlying structural changes is best managed by gentle, gradual splinting, both static and dynamic. It is suggested that preoperative x-rays should be obtained as part of the routine workup for a dorsal wrist ganglion.

  19. MRI-guided transurethral ultrasound therapy of the prostate gland: simulations under clinical conditions

    NASA Astrophysics Data System (ADS)

    N'Djin, W. A.; Burtnyk, M.; Kobelevskiy, I.; Bronskill, M.; Chopra, R.

    2011-09-01

    The feasibility of performing MRI-guided transurethral ultrasound therapy in humans has been shown by our group for the treatment of small subvolumes prior to radical prostatectomy. One challenge is to use this technology to treat a volume of tissue equivalent to the entire prostate gland. This simulation study evaluates the feasibility of treating the whole prostate gland and characterizes the nature of the treatment with respect to treatment time, accuracy, and safety. A numerical model was used to simulate a multi-element heating applicator rotating inside the urethra in five human prostates. 3D prostate profiles were segmented from clinical MR images obtained from subjects after insertion of a transurethral heating applicator into the prostate gland. Clinical treatment planning conditions were simulated including device orientation, prostate & rectum geometry, temperature uncertainty, imaging time, and spatial resolution. During ultrasound exposures, acoustic power, frequency and rotation rate were varied based on the prostate radius and on temperature feedback every 5 seconds using MR thermometry. Two treatment approaches (10 or 20 W.cm-2 acoustic power) were tested as well as single and dual-frequency strategies (4.05/13.10 MHz). A 20 W.cm-2 dual-frequency treatment was shown to be the most efficient configuration in achieving full human prostate treatments. Increasing the power from 10 to 20 W.cm-2 led, on average, to treatment times shorter by 50%. Full prostate coagulations were performed in 20.6±1.6 min at a rate of 1.6±0.2 cm3.min-1, and resulted in <8% of undertreated tissue. This configuration succeeded in preserving high-priority critical regions such as the adjacent rectal wall tissues. The principles of prostate thermal therapy using an MR thermometry-guided transurethral ultrasound technique were shown in simulations to be suitable for full gland treatment in prostate geometries derived from human subjects undergoing partial coagulations. Dual

  20. Preoperative assessment and premedication in paediatrics.

    PubMed

    Lerman, Jerrold

    2013-11-01

    Preoperative assessment and premedication represent important preparatory steps to ensuring a smooth and effective induction of anaesthesia. A thorough review of the child's medical history, previous anaesthetics, medications, allergies and family history is essential to design the optimal anaesthetic for the child and his/her surgery. Risks must be addressed with the parents as appropriate based on the local standards. Preoperative anxiolysis may assume several strategies, with premedication with a pharmacologic agent very common and most successful. This review focuses on the preoperative assessment and premedication for children undergoing elective surgery.

  1. Preoperative Evaluation of the Surgical Patient.

    PubMed

    O'Donnell, Frederick T

    2016-01-01

    Primary care physicians and specialists are frequently involved in the care of surgical patients. Changes in reimbursement have prompted re-examination of preoperative testing and health care expenditures. Physicians have additional incentives to improve health care delivery and reduce costs. The perioperative surgical home concept involves coordinating all aspects of patient care, including behavioral modifications, during the perioperative period. Evidence-based guidelines on preoperative evaluation are available to assist practitioners in managing cardiovascular disease, and communicating surgical risks. Shared decision making in the preoperative period can improve surgical outcomes and patient satisfaction. PMID:27443045

  2. Tautomerization-dependent recognition and excision of oxidation damage in base-excision DNA repair.

    PubMed

    Zhu, Chenxu; Lu, Lining; Zhang, Jun; Yue, Zongwei; Song, Jinghui; Zong, Shuai; Liu, Menghao; Stovicek, Olivia; Gao, Yi Qin; Yi, Chengqi

    2016-07-12

    NEIL1 (Nei-like 1) is a DNA repair glycosylase guarding the mammalian genome against oxidized DNA bases. As the first enzymes in the base-excision repair pathway, glycosylases must recognize the cognate substrates and catalyze their excision. Here we present crystal structures of human NEIL1 bound to a range of duplex DNA. Together with computational and biochemical analyses, our results suggest that NEIL1 promotes tautomerization of thymine glycol (Tg)-a preferred substrate-for optimal binding in its active site. Moreover, this tautomerization event also facilitates NEIL1-catalyzed Tg excision. To our knowledge, the present example represents the first documented case of enzyme-promoted tautomerization for efficient substrate recognition and catalysis in an enzyme-catalyzed reaction. PMID:27354518

  3. Tautomerization-dependent recognition and excision of oxidation damage in base-excision DNA repair.

    PubMed

    Zhu, Chenxu; Lu, Lining; Zhang, Jun; Yue, Zongwei; Song, Jinghui; Zong, Shuai; Liu, Menghao; Stovicek, Olivia; Gao, Yi Qin; Yi, Chengqi

    2016-07-12

    NEIL1 (Nei-like 1) is a DNA repair glycosylase guarding the mammalian genome against oxidized DNA bases. As the first enzymes in the base-excision repair pathway, glycosylases must recognize the cognate substrates and catalyze their excision. Here we present crystal structures of human NEIL1 bound to a range of duplex DNA. Together with computational and biochemical analyses, our results suggest that NEIL1 promotes tautomerization of thymine glycol (Tg)-a preferred substrate-for optimal binding in its active site. Moreover, this tautomerization event also facilitates NEIL1-catalyzed Tg excision. To our knowledge, the present example represents the first documented case of enzyme-promoted tautomerization for efficient substrate recognition and catalysis in an enzyme-catalyzed reaction.

  4. [Acute non-inflammatory renal failure after transurethral electroresection of the prostate combined with irrigation of the bladder with distilled water].

    PubMed

    Orłowska-Kowalik, G; Janicka, L; Ksiazek, A

    1989-05-01

    A case is presented of acute non-inflammatory renal failure developing after transurethral prostatectomy connected with bladder irrigation with distilled water. This irrigation caused haemolysis which was the direct cause of renal failure. PMID:2483472

  5. Transurethral resection of tension-free vaginal tape under tactile traction.

    PubMed

    Quiroz, Lieschen H; Cundiff, Geoffrey W

    2009-07-01

    Urethral erosion is a rare complication after the tension-free vaginal tape (TVT) procedure. Surgical management of this complication is challenging due to the potential for significant patient morbidity. A 50-year-old patient presented with lower urinary tract symptoms (LUTS) and incomplete voiding, 6 years after a TVT procedure performed for stress incontinence. An attempt at cystoscopy revealed an almost complete occlusion of the urethral lumen by a urethral erosion of the polypropylene mesh. A transurethral resection was performed under tactile traction. This procedure is a minimally invasive approach that avoids the need for a transvaginal procedure. Careful cystourethroscopy should be performed in patients presenting with new lower LUTS after TVT in order to avoid a delay in diagnosing a mesh erosion.

  6. Trans-urethral ultrasound (TUUS) imaging for visualization and analysis of the prostate and associated tissues

    NASA Astrophysics Data System (ADS)

    Holmes, David R., III; Robb, Richard A.

    2000-04-01

    Accurate assessment of pathological conditions in the prostate is difficult. Screening methods include palpation if the prostate gland, blood chemical testing, and diagnostic imaging. Trans-rectal Ultrasound (TRUS) is commonly used for the assessment of pathological conditions, however, TRUS is severely constrained by the relative distal location of the imaging probe. Trans-urethral Ultrasound (TUUS) may overcome some limitations of TRUS. A TUUS catheter was used to image the prostate, rectum, bladder, ureter, neuro-vascular bundles, arteries, and surrounding tissue. In addition, 360 degrees rotational scans were recorded for reconstruction into 3D volumes. Segmentation was challenging, however, new techniques such as active contour methods show potential. 3D visualizations, including both volume and surface rendering, were provided to clinicians off-line. On-line 3D visualization techniques are currently being developed. Potential applications of TUUS include: prostate cancer diagnosis and staging as well as image guided biopsy and therapy.

  7. Is transurethral resection of the prostate safe and effective in the over 80-year-old?

    PubMed Central

    Brierly, R. D.; Mostafid, A. H.; Kontothanassis, D.; Thomas, P. J.; Fletcher, M. S.; Harrison, N. W.

    2001-01-01

    OBJECTIVE: To assess the safety and effectiveness of transurethral resection of the prostate (TURP) in patients over 80 years old. PATIENTS AND METHODS: The records of all patients over 80 years old undergoing TURP at one institution over a 3.5-year period were studied retrospectively. RESULTS: 31% of patients underwent TURP for symptoms and 68% for urinary retention. The early complication rate was 41%. The late complication rate was 22%. There were no deaths within 30 days of surgery. Of all patients, 80% were satisfied with the outcome of their operation. Of all patients with retention, 80% were able to void with small residual volumes by 6 weeks after operation. CONCLUSIONS: Although TURP in the over 80-year-old male is associated with significant morbidity, it is an effective treatment for urinary symptoms or retention. The majority of patients are able to void afterwards and are satisfied with the outcome of their surgery. PMID:11212452

  8. Hand-held transendoscopic robotic manipulators: A transurethral laser prostate surgery case study

    PubMed Central

    Hendrick, Richard J.; Mitchell, Christopher R.; Herrell, S. Duke; Webster, Robert J.

    2016-01-01

    Natural orifice endoscopic surgery can enable incisionless approaches, but a major challenge is the lack of small and dexterous instrumentation. Surgical robots have the potential to meet this need yet often disrupt the clinical workflow. Hand-held robots that combine thin manipulators and endoscopes have the potential to address this by integrating seamlessly into the clinical workflow and enhancing dexterity. As a case study illustrating the potential of this approach, we describe a hand-held robotic system that passes two concentric tube manipulators through a 5 mm port in a rigid endoscope for transurethral laser prostate surgery. This system is intended to catalyze the use of a clinically superior, yet rarely attempted, procedure for benign prostatic hyperplasia. This paper describes system design and experiments to evaluate the surgeon’s functional workspace and accuracy using the robot. Phantom and cadaver experiments demonstrate successful completion of the target procedure via prostate lobe resection. PMID:27570361

  9. Comparison of ethanol absorption during continuous and intermittent flow irrigation in transurethral resection.

    PubMed

    Hahn, R G; Algotsson, L A; Törnebrandt, K

    1990-01-01

    Transurethral resection of the prostate was performed using intermittent-flow bladder irrigation (n = 50), or by continuous-flow irrigation, using a suprapubic trocar (n = 50). The irrigant solution contained 1.5% glycine +1% ethanol and fluid absorption was measured from the ethanol content of the expired breath. Fluid absorption was significantly lower in patients receiving continuous-flow irrigation (p less than 0.007) although major absorption occurred in one of these patients. The immediate detection of absorption with the ethanol method allowed us to stop one of the operations performed with intermittent bladder irrigation, at which 2 l of fluid had been absorbed in 20 min. With correction for the amount of removed prostatic tissue, there were no differences in operation time or blood loss between the two types of irrigation. PMID:1690917

  10. Transurethral Nd:YALO3 laser prostatectomy for prostatic hyperplasia--18 cases

    NASA Astrophysics Data System (ADS)

    Chen, Wen B.; Chen, Zi-Fu; Huang, Chao; Gao, Xiang-Xun; Lin, Sheng-Sheng; Zhan, Tian-qi; Shen, Hong Y.; Zeng, Rui R.; Zhou, Ye P.; Yu, Gui F.; Huang, Cheng H.; Zeng, Zhang D.

    1994-05-01

    18 cases of BHP were treated since 1990 by Nd:YALO3 (Nd:YAP) laser transurethral prostatectomy. The ages of these patients from 54 to 88 years with a mean age of 69.6 years. In all cases, there were dysuria, 10 cases acute retention of urine, 5 cases residual urine more than 50 ml, 12 cases abnormal ECG. 4 cases chronic bronchitis and pulmonary emphysema, 4 cases hypertension and 3 cases diabetic. The working conditions of the laser machine are as follows: wavelength of laser: 1079.5 nm; output power of fiber: variation range from 0 to 100 w. The merits of the procedure were less bleeding during operation, shorter operation time and more quick convascence. Cure has been achieved in 11 cases and improvement in 2 cases. The indication, merits and complication of TULP were discussed.

  11. AB138. Experience on thulium laser treatment in transurethral resection of bladder tumor

    PubMed Central

    Gan, Xiuguo; An, Ruihua

    2016-01-01

    Objective To study the safety and efficacy of thulium laser treatment of bladder cancer. Methods Thulium laser surgery system was used for the treatment of 45 cases of bladder cancer patients, including 33 cases of single tumor, 12 cases of multiple tumors. Tumor diameter were 5–25 mm. Tumor pathology were bladder transitional cell carcinoma, clinical stage at T1–T2. Results All the surgery was successfully completion. Operation time was 10–35 minutes. Blood loss was 0–5 mL. None of bladder has perforation, water intoxication, urinary leakage or postoperative bleeding. All of the patients had received immediate intravesical chemotherapy within 0.5 hours, and to maintain bladder chemotherapy. All had catheter indwelled 5 to 7 days. Patients were followed up 1 year, no recurrence of the surgical area. Conclusions Thulium laser surgery system for the transurethral treatment of bladder cancer within stage T2 is safe and effective.

  12. Histological Evaluation of 3D MRI-Guided Transurethral Ultrasound Therapy in the Prostate

    NASA Astrophysics Data System (ADS)

    Vedula, Siddharth; Boyes, Aaron; Chopra, Rajiv; Bronskill, Michael

    2010-03-01

    Previous work from our group has shown that transurethral ultrasound therapy, with a single ultrasound transducer guided by temperature feedback from a single MRI plane (slice), can be used to treat a targeted region accurately in the prostate gland. We have extended this approach to a larger, 3D, targeted volume within the prostate, using a multi-element transducer controlled concurrently by temperature feedback from multiple imaging planes. Animals were placed supine in a 1.5 T clinical MRI, and the transurethral heating device was positioned with image guidance. A four-element transducer (each element was 5 mm long, operating at ˜8 MHz) was rotated to treat a targeted volume around the device. Temperature maps transverse to each element were acquired during heating and used to control the acoustic power of each element and the rate of rotation of the device. T2-weighted and contrast-enhanced (CE) MR images were obtained pre- and post-heating. Following the treatment, prostates were removed and fixed, axially sliced, stained with H&E, and digitally imaged at high-resolution to outline boundaries of cell death. Slice alignment and image registration techniques were developed to enable quantitative comparison of the axial MRI images and matching histological sections. Prostate sections showed clear regions of coagulative necrosis, extending ˜20 mm along the urethra, which correlated well with CE MRI data and transducer length. After registration, the outer border of coagulative necrosis on H&E conformed well to the target isotherm, similar to results from our previous (single element) acute studies. These results confirm that our previous analysis techniques for a single transducer can be extended to multiple elements, and that a large volumetric ablation of the prostate gland is feasible with a high degree of accuracy.

  13. Highly directional transurethral ultrasound applicators with rotational control for MRI-guided prostatic thermal therapy

    NASA Astrophysics Data System (ADS)

    Ross, Anthony B.; Diederich, Chris J.; Nau, William H.; Gill, Harcharan; Bouley, Donna M.; Daniel, Bruce; Rieke, Viola; Butts, R. Kim; Sommer, Graham

    2004-01-01

    Transurethral ultrasound applicators with highly directional energy deposition and rotational control were investigated for precise treatment of benign prostatic hyperplasia (BPH) and adenocarcinoma of the prostate (CaP). Two types of catheter-based applicators were fabricated, using either 90° sectored tubular (3.5 mm OD × 10 mm) or planar transducers (3.5 mm × 10 mm). They were constructed to be MRI compatible, minimally invasive and allow for manual rotation of the transducer array within a 10 mm cooling balloon. In vivo evaluations of the applicators were performed in canine prostates (n = 3) using MRI guidance (0.5 T interventional magnet). MR temperature imaging (MRTI) utilizing the proton resonance frequency shift method was used to acquire multiple-slice temperature overlays in real time for monitoring and guiding the thermal treatments. Post-treatment T1-weighted contrast-enhanced imaging and triphenyl tetrazolium chloride stained tissue sections were used to define regions of tissue coagulation. Single sonications with the 90° tubular applicator (9-15 W, 12 min, 8 MHz) produced coagulated zones covering an 80° wedge of the prostate extending from 1-2 mm outside the urethra to the outer boundary of the gland (16 mm radial coagulation). Single sonications with the planar applicator (15-20 W, 10 min, ~8 MHz) generated thermal lesions of ~30° extending to the prostate boundary. Multiple sequential sonications (sweeping) of a planar applicator (12 W with eight rotations of 30° each) demonstrated controllable coagulation of a 270° contiguous section of the prostate extending to the capsule boundary. The feasibility of using highly directional transurethral ultrasound applicators with rotational capabilities to selectively coagulate regions of the prostate while monitoring and controlling the treatments with MRTI was demonstrated in this study.

  14. Investigation of parameters affecting treatment time in MRI-guided transurethral ultrasound therapy

    NASA Astrophysics Data System (ADS)

    N'Djin, W. A.; Burtnyk, M.; Chopra, R.; Bronskill, M. J.

    2010-03-01

    MRI-guided transurethral ultrasound therapy shows promise for minimally invasive treatment of localized prostate cancer. Real-time MR temperature feedback enables the 3D control of thermal therapy to define an accurate region within the prostate. Previous in-vivo canine studies showed the feasibility of this method using transurethral planar transducers. The aim of this simulation study was to reduce the procedure time, while maintaining treatment accuracy by investigating new combinations of treatment parameters. A numerical model was used to simulate a multi-element heating applicator rotating inside the urethra in 10 human prostates. Acoustic power and rotation rate were varied based on the feedback of the temperature in the prostate. Several parameters were investigated for improving the treatment time. Maximum acoustic power and rotation rate were optimized interdependently as a function of prostate radius and transducer operating frequency, while avoiding temperatures >90° C in the prostate. Other trials were performed on each parameter separately, with the other parameter fixed. The concept of using dual-frequency transducers was studied, using the fundamental frequency or the 3rd harmonic component depending on the prostate radius. The maximum acoustic power which could be used decreased as a function of the prostate radius and the frequency. Decreasing the frequency (9.7-3.0 MHz) or increasing the power (10-20 W.cm-2) led to treatment times shorter by up to 50% under appropriate conditions. Dual-frequency configurations, while helpful, tended to have less impact on treatment times. Treatment accuracy was maintained and critical adjacent tissues like the rectal wall remained protected. The interdependence between power and frequency may require integrating multi-parametric functions inside the controller for future optimizations. As a first approach, however, even slight modifications of key parameters can be sufficient to reduce treatment time.

  15. [Radical transurethral resection of the prostate. An alternative therapy for the treatment of prostate cancer].

    PubMed

    Reuter, M A; Dietz, K

    2009-07-01

    The value of radical transurethral resection of prostate cancer (TURPC) as an alternative therapy was investigated in this prospective study. From January 1995 to July 2008, 533 patients with a median age of 67 years (range 40-89 years) and with clinically localized prostate cancer were resected by the corresponding author with curative intention. The tumor stages were as follows: pT1 8%; pT2 61%; pT3 31%; G1 2%; G2 80%; G3 18%. TURPC requires continuous low-pressure irrigation with the irrigator liquid level at 10 cm water above the pubic region. It also requires a suprapubic trocar, a resectoscope with a 28F sheath, an autoregulated electrosurgical unit, and video monitoring. The prostate is resected completely with peripheral capsule and seminal vesicles. The specimen is retrieved in fractions for correct histopathological staging. If indicated, laparoscopic staging lymphadenectomy is performed. A secondary session for control of positive margins follows after 8 weeks. The transfusion rate was 1.5%, revision for hemorrhage 2.4%, lung embolism 0.2%, bladder neck incision 14%, grade 2 incontinence 0.6% out of 314, and impotence 30% out of 136. The prostate-specific antigen (PSA) nadir was < or =0.2 ng/ml in 95% of 444 cases. PSA recurrence at 5 years was 6% for pT1, 18% for pT2, and 31% for pT3. Postoperative survival at 10 years was 96% for pT1, 91% for pT2, and 85% for pT3 patients. Prostate cancer can be resected transurethrally with reasonable oncological results. The outcome with respect to survival and PSA recurrence is comparable with the results of other published procedures. Low-pressure irrigation with a suprapubic trocar is mandatory for safe performance. PMID:19484215

  16. Laparoscopic excision of intra-abdominal paragonimiasis.

    PubMed

    Kim, Jun-Young; Kang, Chang-Moo; Choi, Gi-Hong; Yang, Woo-Ick; Sim, Seo-Bo; Kwon, Ji-Eun; Kim, Kyung-Sik; Choi, Jin-Sub; Lee, Woo-Jung; Kim, Byong-Ro

    2007-12-01

    Lung fluke, Paragonimus westermani of Paragonimus species usually are accompanied by a persistent cough, hemoptysis, and chest pain. Extrapulmonary paragonimiasis caused by ectopic parasites in aberrant locations such as the abdominal wall, abdominal organs, and brain has been reported and the most commonly involved extrapulmonary organ is the brain. We present a case of 56-year-old male patient with intra-abdominal paragonimiasis who underwent laparoscopic excision of abdominal granuloma caused by parasite infection. An intra-abdominal mass associated with eosinophilia might be related to parasite infection. A laparoscopic approach is the most appropriate treatment modality in such benign abdominal pathology.

  17. Pathologic Processing of the Total Mesorectal Excision

    PubMed Central

    Campa-Thompson, Molly; Weir, Robert; Calcetera, Natalie; Quirke, Philip; Carmack, Susanne

    2015-01-01

    Total mesorectal excision (TME) is the current optimal surgical treatment for patients with rectal carcinoma. A complete TME is related to lower local recurrence rates and increased patient survival. Many confounding factors in the patient's anatomy and prior therapy can make it difficult to obtain a perfect plane, and thus a complete TME. The resection specimen can be thoroughly evaluated, grossly and microscopically, to identify substandard surgical outcomes and increased risk of local recurrence. Complete and accurate data reporting is critical for patient care and helps surgeons improve their technique. PMID:25733973

  18. Transanal total mesorectal excision: Myths and reality

    PubMed Central

    Buchs, Nicolas C; Penna, Marta; Bloemendaal, Alexander L; Hompes, Roel

    2016-01-01

    Transanal total mesorectal excision (TaTME) is a new and promising approach for the treatment of rectal cancer. Whilst the experience is still limited, there are growing evidences that this approach might overcome the limits of standard low anterior resection. TaTME might help to decrease the conversion rate especially in difficult patients, and to improve the pathological results, while preserving the urogenital function. Evaluation of data from large registries and randomized studies should help to draw firmer conclusions. Beyond these technical considerations, the next challenge seems to be clearly the safe introduction of this approach, motivating the development of dedicated courses. PMID:27777876

  19. Laparoscopic excision of a mesenteric cyst.

    PubMed

    Mackenzie, D J; Shapiro, S J; Gordon, L A; Ress, R

    1993-06-01

    Benign abdominal cystic tumors are rare. They include retroperitoneal, mesenteric, and omental cysts. Most of these lesions present with vague abdominal pain and nausea. Less commonly they will present with bowel obstruction due to external compression. The diagnosis of these tumors is by abdominal ultrasound or computed tomography. Surgical enucleation is the treatment of choice. Laparoscopic surgical techniques are replacing or complimenting open abdominal surgical procedures. As the indications for these techniques increase, newer applications will arise. Presented here is a case of laparoscopic excision of a mesenteric cyst.

  20. [Laparoscopic approach excision of mesenteric cysts].

    PubMed

    Bosco, L; Clerico, G; Galetto, P V; Jon, G

    1997-11-01

    The authors reports a case of a young woman suffering from mesenteric cyst. The incidence of these lesions is 1 to 100,000 admissions in adult patients and 1 to 20,000 admissions in pediatric age. These cysts, with retroperitoneal and omental cysts, have a similar etiopathogenesis as lymphatic ectopic tissue. In the majority of cases these cysts are asymptomatic and often the diagnosis is intraoperative. In this case the cyst was removed successfully with laparoscopic approach. This mini-invasive method allows a complete and radical excision of the cyst and reduces postoperative hospital stay and morbidity.

  1. Transurethral prostatectomy.

    PubMed

    Holtgrewe, H L

    1995-05-01

    In properly selected patients, TURP has the highest probability of symptom relief of any strategy of BPH management except open prostatectomy, the outcomes of which are but marginally better. However, open prostatectomy suffers from lack of patient acceptance, increased postoperative discomfort, and prolonged hospitalization, factors which over the past six decades relegated it to a minor role in the surgical management of BPH. Given the advanced age and compromised health status of most men undergoing TURP, the procedure's current mortality, morbidity, and long-term complication rates are remarkable. The ultimate role of the emerging alternative strategies of BPH management--hormonal, pharmacologic, thermal, and device discussed elsewhere in this issue, will be dependent upon their durability and their long-term outcomes, which remain to be fully defined. In the meantime, TURP remains the standard against which all new therapies must be measured. The resectoscope is being challenged but is not yet ready for the history books.

  2. Surgical resection of low-grade gliomas in eloquent areas with the guidance of the preoperative functional magnetic resonance imaging and craniometric points

    PubMed Central

    Abdullah, Ahmed; El Shitany, Hisham; Abbass, Waleed; Safwat, Amr; Elsamman, Amr K; El Refaee, Ehab

    2016-01-01

    Objectives: Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations. Materials and Methods: The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI), pre- and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases) were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors. Results: Total-near total excision in 14 (66.67%) subtotal in 6 (28.57%), and biopsy in 1 case (4.57%). In long-term follow–up, only one case experienced persistent dysphasia. Conclusion: In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision. PMID:27695239

  3. Surgical resection of low-grade gliomas in eloquent areas with the guidance of the preoperative functional magnetic resonance imaging and craniometric points

    PubMed Central

    Abdullah, Ahmed; El Shitany, Hisham; Abbass, Waleed; Safwat, Amr; Elsamman, Amr K; El Refaee, Ehab

    2016-01-01

    Objectives: Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations. Materials and Methods: The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI), pre- and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases) were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors. Results: Total-near total excision in 14 (66.67%) subtotal in 6 (28.57%), and biopsy in 1 case (4.57%). In long-term follow–up, only one case experienced persistent dysphasia. Conclusion: In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision.

  4. Base Excision Repair in the Mitochondria

    PubMed Central

    Prakash, Aishwarya; Doublié, Sylvie

    2015-01-01

    The 16.5 kb human mitochondrial genome encodes for 13 polypeptides, 22 tRNAs and 2 rRNAs involved in oxidative phosphorylation. Mitochondrial DNA (mtDNA), unlike its nuclear counterpart, is not packaged into nucleosomes and is more prone to the adverse effects of reactive oxygen species (ROS) generated during oxidative phosphorylation. The past few decades have witnessed an increase in the number of proteins observed to translocate to the mitochondria for the purposes of mitochondrial genome maintenance. The mtDNA damage produced by ROS, if not properly repaired, leads to instability and can ultimately manifest in mitochondrial dysfunction and disease. The base excision repair (BER) pathway is employed for the removal and consequently the repair of deaminated, oxidized, and alkylated DNA bases. Specialized enzymes called DNA glycosylases, which locate and cleave the damaged base, catalyze the first step of this highly coordinated repair pathway. This review focuses on members of the four human BER DNA glycosylase superfamilies and their subcellular localization in the mitochondria and/or the nucleus, as well as summarizes their structural features, biochemical properties, and functional role in the excision of damaged bases. PMID:25754732

  5. [Transurethral drainage of the prostate in chronic prostatitis by means of the Intraton-4 electrostimulator-aspirator].

    PubMed

    Gus'kov, A R; Vasil'ev, A I; Bogacheva, I D; Kulinich, A Iu; Abrazheev, V G

    1997-01-01

    486 patients with clinical symptoms of chronic prostatitis were examined. In 98 of them transurethral ultrasound has revealed undrained prostatic lobules undergoing different stages of chronic inflammation (pseudomicroabscesses). The combined treatment included transurethral vacuum drainage and direct electrostimulation of the prostate on Intraton-4 unit. Morphological examination has discovered in the aspirate plugs of two types (epithelial and pussy) occluding excretory ducts of the prostatic lobules. These plugs were responsible for poor drainage of the lobules that supported chronic inflammation. Intraton-4 proved to be an efficient modality in combined treatment of chronic prostatitis providing a complete drainage of the affected lobules with aspiration of the plugs and clinical recovery. No complications were registered. PMID:9123665

  6. A simple technique for evacuating air bubbles with scum from the bladder dome during transurethral resection of bladder tumor.

    PubMed

    Takeshita, Hideki; Moriyama, Shingo; Chiba, Koji; Noro, Akira

    2014-12-01

    Air bubbles floating in the bladder dome during transurethral resection of a bladder tumor can interfere with the resection, causing intravesical explosion and increasing the potential risk of tumor cell reimplantation. We describe a simple and effective technique for evacuating air bubbles from the bladder dome using routine resectoscopes. First, the beak of the resectoscope is positioned near the air bubble in the bladder dome. Second, the drainage channel of the resectoscope is closed. Third, the irrigation tube is detached from the irrigation channel, and then the channel is opened. Subsequently, the air bubble with entangled scum will be retrogradely aspirated from the beak of the resectoscope to the irrigation channel. Reversing the direction of the water stream enables evacuation of the air bubble with the scum under direct vision. This simple and effective technique may assist surgeons and ensure the safety of patients during a transurethral procedure. PMID:25562002

  7. [Transurethral drainage of the prostate in chronic prostatitis by means of the Intraton-4 electrostimulator-aspirator].

    PubMed

    Gus'kov, A R; Vasil'ev, A I; Bogacheva, I D; Kulinich, A Iu; Abrazheev, V G

    1997-01-01

    486 patients with clinical symptoms of chronic prostatitis were examined. In 98 of them transurethral ultrasound has revealed undrained prostatic lobules undergoing different stages of chronic inflammation (pseudomicroabscesses). The combined treatment included transurethral vacuum drainage and direct electrostimulation of the prostate on Intraton-4 unit. Morphological examination has discovered in the aspirate plugs of two types (epithelial and pussy) occluding excretory ducts of the prostatic lobules. These plugs were responsible for poor drainage of the lobules that supported chronic inflammation. Intraton-4 proved to be an efficient modality in combined treatment of chronic prostatitis providing a complete drainage of the affected lobules with aspiration of the plugs and clinical recovery. No complications were registered.

  8. Transurethral microwave thermotherapy for management of benign prostatic hyperplasia: results of the United States Prostatron Cooperative Study.

    PubMed

    Blute, M L; Tomera, K M; Hellerstein, D K; McKiel, C F; Lynch, J H; Regan, J B; Sankey, N E

    1993-11-01

    The primary objective of the study was to determine the safety and efficacy of transurethral microwave thermotherapy for the treatment of symptomatic benign prostatic hyperplasia. From March to August 1991, 150 patients were entered into a multi-site study and treated with transurethral microwave thermotherapy under a Food and Drug Administration approved protocol. Only patients with symmetrical trilobar or bilobar prostatic hypertrophy, peak flow rate of less than 15 cc per second (on 2 voided volumes of 150 cc or greater) and a total Madsen symptom score of more than 8 were treated. Transurethral microwave thermotherapy was performed with a 20F catheter and 1,296 MHz. microwave antenna for 60 minutes. The mean power achieved for this single session was 32.1 watts, with a mean power at maximum urethral temperature of 41.1 watts. Mean urethral temperature was 44.3C and the mean rectal temperature was 42.2C. The rectal and urethral temperatures were continuously monitored. Mean peak urinary flow rates, Madsen symptom score, post-void residual volume and improvement in motivating symptom to seek treatment were measured at 6 weeks, and 3, 6 and 12 months. Mean peak urinary flow rates improved 33% at 12 months (p < 0.0001). Overall, the mean Madsen symptom score improved 61% (p < 0.0001). The obstructive score and the irritative score improved 67% and 43%, respectively. Of 17 patients 12 (71%) reported improvement in weak stream when that was the motivating symptom to seek treatment. Of 28 men 18 (64%) reported improvement in nocturia, while 11 of 30 (37%) reported improvement in daytime frequency and 12 of 17 (71%) reported improvement in urgency. There was no statistically significant difference in post-void residual volume at 12 months from baseline. The treatment was well tolerated by all patients, and side effects were considered mild and transitory. Our study demonstrates the safety, effectiveness, patient tolerability and durability of transurethral microwave

  9. Preoperative therapy in locally advanced esophageal cancer

    PubMed Central

    Garg, Pankaj Kumar; Sharma, Jyoti; Jakhetiya, Ashish; Goel, Aakanksha; Gaur, Manish Kumar

    2016-01-01

    Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer (T2 or greater or node positive); however, a high rate of disease recurrence (systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment (preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy (radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.

  10. Base excision repair capacity in informing healthspan

    PubMed Central

    Brenerman, Boris M.; Illuzzi, Jennifer L.; Wilson, David M.

    2014-01-01

    Base excision repair (BER) is a frontline defense mechanism for dealing with many common forms of endogenous DNA damage, several of which can drive mutagenic or cell death outcomes. The pathway engages proteins such as glycosylases, abasic endonucleases, polymerases and ligases to remove substrate modifications from DNA and restore the genome back to its original state. Inherited mutations in genes related to BER can give rise to disorders involving cancer, immunodeficiency and neurodegeneration. Studies employing genetically defined heterozygous (haploinsufficient) mouse models indicate that partial reduction in BER capacity can increase vulnerability to both spontaneous and exposure-dependent pathologies. In humans, measurement of BER variation has been imperfect to this point, yet tools to assess BER in epidemiological surveys are steadily evolving. We provide herein an overview of the BER pathway and discuss the current efforts toward defining the relationship of BER defects with disease susceptibility. PMID:25355293

  11. Local excision by transanal endoscopic surgery

    PubMed Central

    García-Flórez, Luis J; Otero-Díez, Jorge L

    2015-01-01

    Transanal endoscopic surgery (TES) consists of a series of anorectal surgical procedures using different devices that are introduced into the anal canal. TES has been developed significantly since it was first used in the 1980s. The key point for the success of these techniques is how accurately patients are selected. The main indication was the resection of endoscopically unresectable adenomas. In recent years, these techniques have become more widespread which has allowed them to be applied in conservative rectal procedures for both benign diseases and selected cases of rectal cancer. For more advanced rectal cancers it should be considered palliative or, in some controlled trials, experimental. The role of newer endoscopic techniques available has not yet been defined. TES may allow for new strategies in the treatment of rectal pathology, like transanal natural orifice transluminal endoscopic surgery or total mesorectal excision. PMID:26309355

  12. Variation in Base Excision Repair Capacity

    PubMed Central

    Wilson, David M.; Kim, Daemyung; Berquist, Brian R.; Sigurdson, Alice J.

    2010-01-01

    The major DNA repair pathway for coping with spontaneous forms of DNA damage, such as natural hydrolytic products or oxidative lesions, is base excision repair (BER). In particular, BER processes mutagenic and cytotoxic DNA lesions such as non-bulky base modifications, abasic sites, and a range of chemically distinct single-strand breaks. Defects in BER have been linked to cancer predisposition, neurodegenerative disorders, and immunodeficiency. Recent data indicate a large degree of sequence variability in DNA repair genes and several studies have associated BER gene polymorphisms with disease risk, including cancer of several sites. The intent of this review is to describe the range of BER capacity among individuals and the functional consequences of BER genetic variants. We also discuss studies that associate BER deficiency with disease risk and the current state of BER capacity measurement assays. PMID:21167187

  13. Elasticity of excised dog lung parenchyma

    NASA Technical Reports Server (NTRS)

    Vawter, D. L.; Fung, Y. C.; West, J. B.

    1978-01-01

    An optical-electromechanical system is used to measure the force-deformation behavior of biaxially loaded rectangular slabs of excised dog lung parenchyma. In the course of the study, the effects of time, the consistency of reference lengths and areas, the presence of hysteresis, the necessity of preconditioning, the repeatability of results, the effects of lateral load, the effect of strain rate, the effect of pH, the influence of temperature, and the variations among specimens are considered. A new finding is that there is a change in elastic behavior when the tissue undergoes a compressive strain. When the tissue is in tension, increasing the lateral load decreases the compliance, whereas the opposite is true when compressive strain is present.

  14. Mammalian Transcription-Coupled Excision Repair

    PubMed Central

    Vermeulen, Wim; Fousteri, Maria

    2013-01-01

    Transcriptional arrest caused by DNA damage is detrimental for cells and organisms as it impinges on gene expression and thereby on cell growth and survival. To alleviate transcriptional arrest, cells trigger a transcription-dependent genome surveillance pathway, termed transcription-coupled nucleotide excision repair (TC-NER) that ensures rapid removal of such transcription-impeding DNA lesions and prevents persistent stalling of transcription. Defective TC-NER is causatively linked to Cockayne syndrome, a rare severe genetic disorder with multisystem abnormalities that results in patients’ death in early adulthood. Here we review recent data on how damage-arrested transcription is actively coupled to TC-NER in mammals and discuss new emerging models concerning the role of TC-NER-specific factors in this process. PMID:23906714

  15. Oxidative DNA Damage and Nucleotide Excision Repair

    PubMed Central

    Melis, Joost P.M.; Luijten, Mirjam

    2013-01-01

    Abstract Significance: Oxidative DNA damage is repaired by multiple, overlapping DNA repair pathways. Accumulating evidence supports the hypothesis that nucleotide excision repair (NER), besides base excision repair (BER), is also involved in neutralizing oxidative DNA damage. Recent Advances: NER includes two distinct sub-pathways: transcription-coupled NER (TC-NER) and global genome repair (GG-NER). The CSA and CSB proteins initiate the onset of TC-NER. Recent findings show that not only CSB, but also CSA is involved in the repair of oxidative DNA lesions, in the nucleus as well as in mitochondria. The XPG protein is also of importance for the removal of oxidative DNA lesions, as it may enhance the initial step of BER. Substantial evidence exists that support a role for XPC in NER and BER. XPC deficiency not only results in decreased repair of oxidative lesions, but has also been linked to disturbed redox homeostasis. Critical Issues: The role of NER proteins in the regulation of the cellular response to oxidative (mitochondrial and nuclear) DNA damage may be the underlying mechanism of the pathology of accelerated aging in Cockayne syndrome patients, a driving force for internal cancer development in XP-A and XP-C patients, and a contributor to the mixed exhibited phenotypes of XP-G patients. Future Directions: Accumulating evidence indicates that DNA repair factors can be involved in multiple DNA repair pathways. However, the distinct detailed mechanism and consequences of these additional functions remain to be elucidated and can possibly shine a light on clinically related issues. Antioxid. Redox Signal. 18, 2409–2419. PMID:23216312

  16. Preoperative progressive pneumoperitoneum for giant inguinal hernias.

    PubMed

    Piskin, Turgut; Aydin, Cemalettin; Barut, Bora; Dirican, Abuzer; Kayaalp, Cuneyt

    2010-01-01

    Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient's tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients.

  17. [Transurethral pyelocalycolithotripsy and lithoextraction--a new method of nephrolithiasis treatment].

    PubMed

    Martov, A G; Ergakov, D V; Moskalenko, S A; Lisenok, A A; Stepanov, V S; Fatikhov, R R

    2009-01-01

    Transurethral pyelocalycolithotripsy (TUPCL) was made in 87 patients (36 males and 51 females, age 7-82 years) with solitary uroliths from April 2007 to April 2008. Of 51 pelvic and ureteropelvic nephroliths, 24 (47%) had the size of 0.5-1 cm, 22 (43%)--1.1-2 cm, 5 (10%)--over 2 cm. Nineteen stones of the upper segment calyx were of less than 1 cm in size, 6 (32%)--1.1-2 cm, 4 (21%)--more than 2 cm. Nine stones of the middle segment calyx were less than 1 cm in size (44%), 4--1 to 2 cm (44%). One patient had the stone of more than 2 cm in size. Transurethral contact pyelolithotripsy was performed in all 87 patients. The rigid ureteropyeloscope was employed in 64 (74%) cases, fibropyelocalycolithotripsy was made in 23 (26%) cases. Indications for TUPCL were failure or aftereffects of extracorporeal pyelolithotro[sy (50 cases, 65%), suspected stricture under the stone (10 cases, 12%), ligature stones (7 cases, 6%). Pelvic stones were detected at diapevtic ureteropyeloscopy in 11 (17%) patients suspected of calycopelvic papillary tumor. In 8(9%) patients nephroliths were destructed with the electromechanic probe (Medline, Russia), pneumatic contact lithotripsy was made in 22 (25%) cases (Lithoclast Master, EMS, Switzerland), Ho laser lithotripsy was made in 41 patients (WaveLight Laser Technologie AG, Germany) with a 365 mcm waveguide in 14 (17%) cases and a 600 mcm waveguide in 27 (31%) cases. Pyelocalycolithoextraction was conducted in 16 (18%) patients. Elimination of the nephroliths was achieved in 71 (81.6%) patients. This shows that TUPCL is effective and comparable by efficacy with such methods as extracorporeal lithotripsy, percutaneous nephrolitholapaxy. Rigid ureteropyeloscopy eliminated nephroliths in 53 (83%) patients, fibropyeloscopy--in 18 (77%) patients. The experience of the authors and literature data allowed them to formulate indications for TUPCL: cacycopelvic nephroliths up to 2 cm in size in their location in the pelvis and upper segment calyx and

  18. Transurethral prostate ablation with saline electrode allows controlled production of larger lesions than conventional methods.

    PubMed

    Hoey, M F; Mulier, P M; Leveillee, R J; Hulbert, J C

    1997-08-01

    A novel technique for prostate ablation using radiofrequency (RF) energy coupled to tissue with interstitial perfusion of saline solutions from a screw-tip catheter has been developed. The electrolyte spreads the current density away from the metal electrode and increases the effective electrode surface area, allowing more RF power input. This prevents tissue desiccation and impedance rise, resulting in controlled production of large lesions. In this study, we attempted to produce similar results using a straight needle and the saline electrode with a transurethral approach and compared the results with those of the same technique without electrolyte perfusion (conventional RF method). For this study, we designed an insulated 22-gauge needle with thermocouples embedded along its length and a 1-cm exposed tip with a retractable intraluminal thermocouple. This needle was inserted into the urethra of 10 dogs through a small perineal incision. Under transrectal ultrasound guidance, the exposed tip of the needle was placed in the center of each lobe. The intraluminal thermocouple was moved from the exposed tip up to the prostate capsule to monitor temperature. The highest power that could be applied in conventional RF methods without immediate desiccation was determined from preliminary experiments as 10 W. Subsequently, 10 W of RF power (475 kHZ) was delivered in one lobe until either the capsule temperature reached 48 degrees C or high impedance (> 400 omega) occurred. In the other lobe, 50 W of RF energy (475 kHz) and electrolyte perfusion (14.6% NaCl, 1 mL/min) were delivered until the capsule temperature reached 48 degrees C or high impedance occurred. Prostate lobe sizes ranged from 3.93 cm3 to 44.47 cm3 (mean 15.07 cm3). At 10 W without saline perfusion, high impedance from tissue desiccation occurred at 45 +/- 27 seconds, with lesions ranging from 0.06 cm3 to 0.93 cm3 (mean 0.34 cm3). At 50 W with saline perfusion, there was no tissue desiccation or impedance

  19. Transurethral resection of the bladder tumour (TURBT) for non-muscle invasive bladder cancer: basic skills.

    PubMed

    Furuse, Hiroshi; Ozono, Seiichiro

    2010-08-01

    Transurethral resection of the bladder tumour (TURBT) is the standard surgical procedure for non-muscle invasive bladder cancer. We believe that all urologists should be trained in this procedure. This DVD provides an overview of TURBT with particular focus on basic skills, including basic surgical techniques such as the obturator nerve block. Important basic surgical skills required for complete TURBT in non-muscle invasive bladder cancer are: (i) resection of all visible tumors; (ii) resection of apparently normal mucosa on the border of the tumor; (iii) resection of the muscle layer at the base of the tumor until normal muscle fibers are visible; (iv) in applicable cases, random biopsy of apparently normal urothelium of the bladder wall and transurethral resection (TUR) biopsy of both sides of the prostatic urethra; and (v) when possible, after these procedures are completed, a different operating surgeon should inspect the bladder lumen to confirm that there are no remaining tumors. In particular, sampling resection should be implemented in apparently normal mucosa for approximately 1 cm around the tumor, and at the base of the tumor down to the superficial muscle layer. Resected specimens should be examined histopathologically in order to confirm the absence of malignant findings. Fundamental procedures for TURBT include both one-stage and two-stage resection. One-stage resection is used for relatively small tumors and involves a single procedure with simultaneous resection of both the tumor and the tissue at the tumor base down to the superficial muscle layer. In the two-stage resection, the first resection exposes the lower level of the mucosa and the second resection removes that lower mucosal layer in order to sample the superficial muscle layer for cancer staging. At the start of the resection, the loop is electrified before it makes contact with the mucosa. Delicate movements of the sheath should be used, along with delicate movement of the loop itself

  20. 3D conformal MRI-guided transurethral ultrasound therapy: results of gel phantom experiments

    NASA Astrophysics Data System (ADS)

    N'Djin, W. A.; Burtnyk, M.; McCormick, S.; Bronskill, M.; Chopra, R.

    2011-09-01

    MRI-guided transurethral ultrasound therapy shows promise for minimally invasive treatment of localized prostate cancer. Previous in-vivo studies demonstrated the feasibility of performing conservative treatments using real-time temperature feedback to control accurately the establishment of coagulative lesions within circumscribed prostate regions. This in-vitro study tested device configuration and control options for achieving full prostate treatments. A multi-channel MRI compatible ultrasound therapy system was evaluated in gel phantoms using 3 canine prostate models. Prostate profiles were 5 mm-step-segmented from T2-weighted MR images performed during previous in-vivo experiments. During ultrasound exposures, each ultrasound element was controlled independently by the 3D controller. Decisions on acoustic power, frequency, and device rotation rate were made in real time based on MR thermometry feedback and prostate radii. Low and high power treatment approaches using maximum acoustic powers of 10 or 20 W.cm-2 were tested as well as single and dual-frequency strategies (4.05/13.10 MHz). The dual-frequency strategy used either the fundamental frequency or the 3rd harmonic component, depending on the prostate radius. The 20 W.cm-2 dual frequency approach was the most efficient configuration in achieving full prostate treatments. Treatment times were about half the duration of those performed with 10 W.cm-2 configurations. Full prostate coagulations were performed in 16.3±6.1 min at a rate of 1.8±0.2 cm3.min-1, and resulted in very little undertreated tissue (<3%). Surrounding organs positioned beyond a safety distance of 1.4±1.0 mm from prostate boundaries were not damaged, particularly rectal wall tissues. In this study, a 3D, MR-thermometry-guided transurethral ultrasound therapy was validated in vitro in a tissue-mimicking phantom for performing full prostate treatment. A dual-frequency configuration with 20 W.cm-2 ultrasound intensity exposure showed good

  1. Excision technique in constrained formulations of Einstein equations: collapse scenario

    NASA Astrophysics Data System (ADS)

    Cordero-Carrión, I.; Vasset, N.; Novak, J.; Jaramillo, J. L.

    2015-04-01

    We present a new excision technique used in constrained formulations of Einstein equations to deal with black hole in numerical simulations. We show the applicability of this scheme in several scenarios. In particular, we present the dynamical evolution of the collapse of a neutron star to a black hole, using the CoCoNuT code and this excision technique.

  2. 48 CFR 970.2902 - Federal excise taxes.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Federal excise taxes. 970.2902 Section 970.2902 Federal Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Taxes 970.2902 Federal excise taxes....

  3. 48 CFR 970.2902 - Federal excise taxes.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Federal excise taxes. 970.2902 Section 970.2902 Federal Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Taxes 970.2902 Federal excise taxes....

  4. 48 CFR 970.2902 - Federal excise taxes.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Federal excise taxes. 970.2902 Section 970.2902 Federal Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Taxes 970.2902 Federal excise taxes....

  5. 27 CFR 24.323 - Excise Tax Return form.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Excise Tax Return form. 24.323 Section 24.323 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Records and Reports § 24.323 Excise Tax Return form. A proprietor...

  6. P element excision in drosophila melanogaster and related drosophilids

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The frequency of P element excision and the structure of the resulting excision products were determined in three drosophilid species, Drosophila melanogaster, D. virilis, and Chymomyza procnemis. A transient P element mobility assay was conducted in the cells of developing insect embryos, but unlik...

  7. Dimer excision in Escherichia coli in the presence of caffeine

    SciTech Connect

    Rothman, R.H.

    1980-07-01

    The observation that polA1 and recL152 mutations result in both slow pyrimidine dimer excision and large repair patch size leads to the hypothesis that patch size is directly related to the rate of excision. In this study caffeine, a known inhibitor of excision repair, was used to examine the extent of correlation between excision rate and patch size by measuring patch size in the presence of several concentrations of caffeine. Both the rate of excision and the resistance to ultraviolet radiation were reduced with increasing concentrations of caffeine after irradiation. Caffeine also inhibited the rate at which incisions were made and prolonged the time required to rejoin the discontinuities. Patch size, however, was unaffected by caffeine treatment.

  8. State cigarette excise taxes - United States, 2010-2011.

    PubMed

    2012-03-30

    Increasing the price of cigarettes reduces the demand for cigarettes, thereby reducing youth smoking initiation and cigarette consumption and decreasing the prevalence of cigarette use in the United States overall, particularly among youths and young adults. The most common way governments have increased the price of cigarettes is by increasing cigarette excise taxes, which currently are imposed by all states and the District of Columbia. To update data on state cigarette excise taxes in 2009, CDC conducted a survey of changes in state cigarette excise taxes during 2010-2011. During that period, eight states increased their cigarette excise taxes, and one state decreased its tax; as a result, the mean state tax increased from $1.34 in 2009 to $1.46 in 2011. Previous evidence indicates that further increases in cigarette excise taxes would be expected to result in further reductions in demand for cigarettes, decreasing smoking and associated morbidity and mortality.

  9. State cigarette excise taxes - United States, 2010-2011.

    PubMed

    2012-03-30

    Increasing the price of cigarettes reduces the demand for cigarettes, thereby reducing youth smoking initiation and cigarette consumption and decreasing the prevalence of cigarette use in the United States overall, particularly among youths and young adults. The most common way governments have increased the price of cigarettes is by increasing cigarette excise taxes, which currently are imposed by all states and the District of Columbia. To update data on state cigarette excise taxes in 2009, CDC conducted a survey of changes in state cigarette excise taxes during 2010-2011. During that period, eight states increased their cigarette excise taxes, and one state decreased its tax; as a result, the mean state tax increased from $1.34 in 2009 to $1.46 in 2011. Previous evidence indicates that further increases in cigarette excise taxes would be expected to result in further reductions in demand for cigarettes, decreasing smoking and associated morbidity and mortality. PMID:22456118

  10. Preoperational test report, vent building ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Vent Building Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides Heating, Ventilation, and Air Conditioning (HVAC) for the W-030 Ventilation Building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  11. Urinary incontinence following transurethral, transvesical and radical prostatectomy. Retrospective study of 489 patients.

    PubMed

    Van Kampen, M; De Weerdt, W; Van Poppel, H; Baert, L

    1997-12-01

    Urinary incontinence following prostate surgery was evaluated in 489 consecutive patients: 216 patients underwent a transurethral resection, 98 patients a transvesical prostatectomy for benign prostatic hyperplasia and 175 patients a radical prostatectomy for localized prostate cancer. In the first group incontinence was present in 19% of the patients immediately after catheter withdrawal, 16% after 1 month, 8% after 3 months, 3% and 2% after 6 and 9 months, 1.5% after 1 year and 0.5% after 15 months. In the second group incontinence was present in 15% immediately after catheter withdrawal, 12% after 1 month, 5% after 3 months, 2% after 6 months and 1% after 9, 12 and 15 months. In the last group the incontinence rate was higher, 66% were incontinent immediately after catheter withdrawal, 53% after 1 month, 33% after 3 months, 12% after 6 months, 8% after 9 months. After 12 and 15 months still 2% had problems with persistent incontinence. These results compare favourably with the results from the literature. The fact that a rehabilitation program was introduced for the patients with post-operative incontinence, may have been a contributing factor.

  12. Long-Term Followup after Electrocautery Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

    PubMed Central

    Kallenberg, F.; Hossack, T. A.; Woo, H. H.

    2011-01-01

    Introduction. For decades, transurethral resection of the prostate (TURP) has been the “gold standard” operation for benign prostatic hyperplasia (BPH) but is based mainly on historic data. The historic data lacks use of validated measures and current TURP differs significantly from that performed 30 years ago. Methods. Men who had undergone TURP between 2001 and 2005 were reviewed. International prostate symptom score (IPSS), quality of life (QOL) and peak urinary flow rate (Qmax⁡), and postvoid residual (PVR) were recorded. Operative details and postoperative complications were documented. Patients were then invited to attend for repeat assessment. Results. 91 patients participated. Mean follow-up time was 70 months. Mean follow-up results were IPSS—7; QoL—1.5; Qmax⁡—23 mL/s; PVR—45 mL. These were an improvement from baseline of 67%, 63%, 187%, and 80%, respectively. Early complication rates were low, with no blood transfusions, TUR syndrome, or deaths occurring. Urethral stricture rate was higher than anticipated at 14%. Conclusion. This study shows modern TURP still produces durable improvement in voiding symptoms which remains comparable with historic studies. This study, however, found a marked drop in early complications but, conversely, a higher than expected incidence of urethral strictures. PMID:22162679

  13. The Efficacy of a Transurethral Incision for Diurnal and Nocturnal Enuresis in Young Males

    PubMed Central

    Tobu, Shohei; Noguchi, Mitsuru; Takahara, Kohei; Ichibagase, Yuka; Ikoma, Saya; Udo, Kazuma; Nanri, Maki; Uozumi, Jiro

    2016-01-01

    Introduction In this study, we investigated the effects of treatment with a transurethral incision (TUI) for congenital urethral stenosis, which was accompanied by diurnal and nocturnal enuresis. Methods We recruited 21 young males who presented to our department for the treatment of diurnal and nocturnal enuresis from January 2010 to March 2014. All patients underwent TUI due to urethral stricture found by a close investigation. We surveyed each case to evaluate the improvement of diurnal and/or nocturnal enuresis after TUI. Results One and a half years after TUI, an improvement in diurnal enuresis was observed in 17 of 21 cases (80.9%), whereas that of nocturnal enuresis was observe in only 7 of 21 cases (33.3%), showing the significant contribution of TUI to the improvement of diurnal enuresis (p = 0.001). In the case of diurnal enuresis, continual improvement was observed more than a year after surgery, whereas no improvement was observed in nocturnal enuresis at more than 6 months after surgery. Conclusion TUI is more effective for diurnal enuresis than nocturnal enuresis. At postoperative 6 months, clinicians should thus consider other etiologies for unresponsive cases and start other treatment options. PMID:27390580

  14. Length of postoperative hospital stay after transurethral resection of the prostate.

    PubMed Central

    Kirollos, M. M.

    1997-01-01

    The aim of the study is to explore the value of audit in investigating and reducing the length of stay (LOS) of patients after transurethral resection of the prostate (TURP). All TURPs in a district general hospital (DGH) were audited over 30 weeks. Particular attention was paid to patients whose LOS was longer than the average for the group (mean: 6.4 nights; median: 5 nights). Older age of the patient, larger resections and late removal of suprapubic catheters were statistically significant in prolonging LOS (P < 0.001). General anaesthesia was associated with longer stay than regional anaesthesia, but the difference was not statistically significant. Among patients whose LOS exceeded the average of 6 nights, social circumstances and detrusor underactivity were the most important causes of late discharge, accounting for 44% (28/63) of these cases. Where factors were avoidable, changes were implemented. Increased use of regional anaesthesia was encouraged. Catheters were removed earlier, and discharges, whenever possible, were pre-planned. A re-audit was carried out 1 year after the original audit and a significant decrease in LOS was found (mean: 5.2 nights; median: 4 nights; P < 0.01). Audit can increase awareness of prolonged hospital stay and highlight areas for change. Re-audit can confirm the effectiveness of these changes. PMID:9244074

  15. The changing practice of transurethral prostatectomy: a comparison of cases performed in 1990 and 2000.

    PubMed Central

    Wilson, J. R.; Urwin, G. H.; Stower, M. J.

    2004-01-01

    OBJECTIVES: Transurethral resection of the prostate (TURP) is considered by many to be the 'gold standard' treatment for benign prostatic enlargement. However, with the relatively recent introduction of pharmacological and other surgical treatment modalities, the performance of TURP appears to be in decline. METHODS: A retrospective casenote analysis of 200 patients who underwent TURP in 1990 and the year 2000 with the aim of identifying changes in the incidence and practice of TURP. RESULTS: There was a decline in the number of TURPs performed of 31.6% over the 10-year period, with more being carried out because of urinary retention. In 2000, the patient was older and the operative procedure took statistically longer than 10-years earlier, but the weight of prostate tissue resected, patient satisfaction and complication rates were similar. CONCLUSIONS: At present, TURP is in decline, with urinary retention being the commonest indication. The population at present is older but this does not carry additional co-morbidity. The weight of resection has not altered, although surgery currently takes longer to perform. PMID:15527580

  16. The Transurethral Suprapubic endo-Cystostomy (T-SPeC): A Novel Suprapubic Catheter Insertion Device

    PubMed Central

    Egerdie, R. Blair; Albala, David M.; Flynn, Brian J.

    2013-01-01

    Abstract Background and Purpose Current methods of suprapubic cystostomy (SPC) catheter insertion may be difficult for patients in poor health and can result in significant morbidity and mortality. These include a highly invasive open procedure, as well as the use of the percutaneous trocar punch methods, commonly associated with short-term SPC. We present the first human experience with the Transurethral Suprapubic endo-Cystostomy (T-SPeC®) device, a novel disposable device used for introducing a suprapubic catheter via a retrourethral (inside-to-out) approach similar to the Lowsley technique. Patients and Methods Four men at St. Mary's General Hospital in Kitchener Ontario, Canada, received the T-SPeC device (model T7) under general anesthesia. Results Patients had no complications from catheterization using the T-SPeC T7 Surgical System. The mean surgical time of the four procedures was 9.7 minutes, with a range of 7.9 to 13.5 minutes, including instrument preparation and cystoscopy. All four procedures were highly accurate and rapid. There were no complications and minimal blood loss from the procedure. Conclusions We found that the T-SPeC device allows for efficient and safe insertion of a suprapubic catheter in an outpatient setting and may be a useful addition to the urologic armamentarium. The T-SPeC Surgical System facilitates rapid and precise suprapubic catheter placement. PMID:23488708

  17. Sham versus transurethral microwave thermotherapy in patients with symptoms of benign prostatic bladder outflow obstruction

    SciTech Connect

    Ogden, C.W.; Reddy, P.; Johnson, H.; Ramsay, J.W.; Carter, S.C. . Dept. of Urology)

    1993-01-02

    Transurethral microwave thermotherapy (TUMT) is a single-session, minimally invasive outpatient treatment for patients with symptoms of benign prostatic bladder outflow obstruction. The authors designed a prospective randomized trial to identify any placebo response. Patients with a Madsen symptom score over 8 for at least 6 months were eligible for study. Patients with renal dysfunction, upper urinary tract disease, co-existing bladder disease and malignant prostatic change were excluded. 43 patients were studied: 21 were randomized to receive a sham treatment and 22 to thermotherapy. The thermotherapy group showed a 70% decrease in the mean Madsen score, a 53% increase in flow-rate, and 92% decrease in residual urine volume. No Significant change was seen in these mean indices in the sham group. There was no difference in the main complication of transient hematuria between the two groups. However, there was a 22% frequency of acute retention in the TUMT group. The results show a little significant placebo component to the subjective and objective improvement that occurs in patients who have received TUMT.

  18. Efficacy of ultrasound-guided obturator nerve block in transurethral surgery

    PubMed Central

    Thallaj, Ahmed; Rabah, Dany

    2011-01-01

    Background: During transurethral resection surgery (TUR), accidental stimulation of the obturator nerve can cause violent adductor contraction, leading to serious intraoperative complications. General anesthesia with muscle relaxation is currently the preferred technique for TUR surgery. Spinal anesthesia combined with obturator nerve block has also been used for TUR surgery in geriatric population. Blind, anatomical methods for identifying the obturator nerve are often unsatisfactory. Therefore, we conducted this prospective study to validate the efficacy of ultrasound-guided obturator nerve block (USONB) during TUR procedures. Methods: Eighteen male patients undergoing TURP surgery under spinal anesthesia were included in the study. Bilateral USONB with maximum 20 ml of 1% lidocaine per patient was performed. An independent observer was present to monitor any adduction movements during the operation and to record patient and surgeon satisfactions. Results: In all patients, obturator nerve was visualized from the first attempt, requiring an average of 4.3 min for blocking of each side. USONB was successful (97.2%) in preventing an adductor spasm in all except one patient. Patient’s and surgeon’s satisfaction were appropriate. In all patients, adductor muscle strength recovered fully within 2 h following the surgical procedure. Conclusions: USONB is safe and effective during TUR surgery. It provides optimal intra-and postoperative conditions. PMID:21655015

  19. Urethral ultrasonography: A novel diagnostic tool for dysuria following bipolar transurethral plasma kinetic prostatectomy.

    PubMed

    Wang, Guang-Chun; Bian, Cui-Dong; Zhou, Ting-Ting; Liu, Min; Huang, Jian-Hua; Peng, Bo

    2016-04-29

    Urethral ultrasonography is non-invasive and able to indicate the urethral lumen clearly, as well as the surrounding tissues of the posterior urethra, without contrast agent or X-ray irradiation. In this paper, we evaluate the reliability of urethral ultrasonography in the diagnosis of dysuria following bipolar transurethral plasma kinetic prostatectomy (TUPKP). A total of 120 benign prostate hyperplasia (BPH) patients with dysuria undergoing TUPKP were enrolled in this study, with a mean age of 72.8 years. All the patients received urethral ultrasonography, urethroscopy and bladder neck urethra stenosis oulectomy. Among the 120 cases, there were 22 cases of bladder neck closure, 20 bladder orifice stricture, 60 urethral stricture, 10 prostate remnants, 2 calculi in prostatic urethra, 4 dysfunction of bladder detrusor muscle and 2 flap of internal urethral orifice. χ2-test was used for the comparison of ultrasonography and urethral cystoscopy in the diagnosis of dysuria following TRPKP, and no significant difference was found between two diagnostic tools (χ 2 = 0.94, P > 0.05). Urethral ultrasonography is a reliable and minimally invasive diagnostic tool for dysuria following TUPKP and is conducive to early treatment of dysuria following prostatectomy. PMID:27163308

  20. Treatment Control and Device Optimization of Transurethral Curvilinear Applicators for Prostate Thermal Therapy

    NASA Astrophysics Data System (ADS)

    Sridhar, Mallika; Wootton, Jeffery H.; Juang, Titania; Diederich, Chris J.

    2009-04-01

    Transurethral ultrasound catheter devices in curvilinear configurations are being optimized for improved treatment control and accuracy, reduced treatment times and minimizing surrounding heating of thermally sensitive structures beyond the prostate. A transient acoustic and biothermal model was used to estimate prostate temperature distributions, treatment times and rectal heating for various device configurations and control strategies while accommodating sweeping of curvilinear applicators, power modulation, outer target boundary pilot-point temperature control (sequential rotation) and changes in attenuation with lethal thermal dose. Large prostates can be treated in clinically reasonable times (20-40 min) with low rectal heating if the curvilinear device radius of curvature are increased to 25 mm, device frequency is kept low between 5-6.5 MHz and large device dimensions are chosen (5 X 20 mm) with high maximum allowable temperatures along device length. Pilot-point temperature feedback treatment control can be enhanced with decreased rectal thermal dose by using variable boundary temperatures at the posterior prostate near rectum.

  1. In-vitro and clinical evaluation of transurethral laser-induced prostatectomy (TULIP)

    NASA Astrophysics Data System (ADS)

    van Swol, Christiaan F. P.; Verdaasdonck, Rudolf M.; Mooibroek, Jaap; Boon, Tom A.

    1993-05-01

    Transurethral ultrasound-guided laser induced prostatectomy (TULIP) is a recent development in the treatment of benign prostatic hyperplasia. The system is based upon Nd:YAG laser irradiation delivered by a right angled fiber. The dosimetry used in a clinical situation is mostly based upon animal studies. In this study, the light and temperature distribution in the prostate during Nd:YAG laser irradiation were modeled using Monte Carlo and finite differences theory. The results of this model were compared with in vitro experiments. The influence of the different parameters involved, e.g., the scanning speed and the power of the laser beam, were evaluated. Initial results show the temperature distribution and thus the therapeutic effect of the TULIP procedure. Until now 36 patients have been treated successfully. The mean in-hospital time was somewhat shorter than for a TURP treatment while the results were comparable. These treatments, however, show the need for a better understanding of the mechanisms involved. Modeling and subsequent in vitro and in vivo measurements might improve the understanding and safe and successful application of prostate treatment using laser based systems.

  2. [TRANSURETHRAL URETEROLITHOTRIPSY FOR UPPER URINARY TRACT STONE IN SMALL CHILDREN WEIGHNING AROUND 10KG].

    PubMed

    Nishimura, Yoko; Moriya, Kimihiko; Mitsui, Takahiko; Kitta, Takeya; Kanno, Yukiko; Kon, Masafumi; Shinohara, Nobuo

    2015-10-01

    Management strategy for upper urinary tract calculi in small children is still a matter controversial. We report successful management of ureteral stone with transurethral ureterolithotripsy (TUL) in 2 boys weighing around 10 kg. Case 1: A 2-year-old boy (78 cm in height, 9.6 kg in weight), who received hydrocortisone and fludrocortisone for the treatment of 21-hydroxylase deficiency, was referred to our hospital with a right 9-mm lower ureteral stone. For TUL, a 7.5 Fr rigid cystoscope was introduced into the ureter directly after dilation of the ureteral orifice. By using Holmium:YAG laser for lithotripsy, complete stone evacuation was achieved. Stone analysis showed the composition of calcium phosphate and calcium oxalate. Case 2: A 1-year-old boy (80 cm in height, 10.5 kg in weight) with neurofibromatosis type 1 was referred to our hospital with a left 7.5-mm ureteral stone at the ureteropelvic junction. TUL was performed using a 4.5 F rigid ureteroscope and Holmium:YAG laser. No residual stone was identified. Stone analysis showed the composition of calcium oxalate. TUL is a safe and feasible option for small children, even in boys weighing approximately 10 kg. PMID:26717789

  3. Lingual Thyroid Excision with Transoral Robotic Surgery

    PubMed Central

    Ersoy Callıoglu, Elif; Bozdemir, Kazım; Ulusoy, Bulent; Oguzhan, Tolga; Korkmaz, M. Hakan

    2015-01-01

    Ectopic thyroid gland may be detected at any place between foramen caecaum and normal thyroid localization due to inadequacy of the embryological migration of the thyroid gland. It has a prevalence varying between 1/10.000 and 1/100000 in the community. Usually follow-up without treatment is preferred except for obstructive symptoms, bleeding, and suspicion of malignity. Main symptoms are dysphagia, dysphonia, bleeding, dyspnea, and obstructive sleep apnea. In symptomatic cases, the first described method in surgical treatment is open approach since it is a region difficult to have access to. However, this approach has an increased risk of morbidity and postoperative complications. Transoral robotic surgery, which is a minimally invasive surgical procedure, has advantages such as larger three-dimensional point of view and ease of manipulation due to robotic instruments. In this report, a case at the age of 49 who presented to our clinic with obstructive symptoms increasing within the last year and was found to have lingual thyroid and underwent excision of ectopic thyroid tissue by da Vinci surgical system is presented. PMID:26064746

  4. Nucleotide Excision Repair in Caenorhabditis elegans

    PubMed Central

    Lans, Hannes; Vermeulen, Wim

    2011-01-01

    Nucleotide excision repair (NER) plays an essential role in many organisms across life domains to preserve and faithfully transmit DNA to the next generation. In humans, NER is essential to prevent DNA damage-induced mutation accumulation and cell death leading to cancer and aging. NER is a versatile DNA repair pathway that repairs many types of DNA damage which distort the DNA helix, such as those induced by solar UV light. A detailed molecular model of the NER pathway has emerged from in vitro and live cell experiments, particularly using model systems such as bacteria, yeast, and mammalian cell cultures. In recent years, the versatility of the nematode C. elegans to study DNA damage response (DDR) mechanisms including NER has become increasingly clear. In particular, C. elegans seems to be a convenient tool to study NER during the UV response in vivo, to analyze this process in the context of a developing and multicellular organism, and to perform genetic screening. Here, we will discuss current knowledge gained from the use of C. elegans to study NER and the response to UV-induced DNA damage. PMID:22091407

  5. Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery

    PubMed Central

    Geng, Wujun; Hong, Wandong; Wang, Junlu; Dai, Qinxue; Mo, Yunchang; Shi, Kejian; Sun, Jiehao; Qin, Jinling; Li, Mei; Tang, Hongli

    2015-01-01

    Objective. Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Methods. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA) pump, (2) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3) 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Results. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL-) 6 levels at 24 and 48 h after the operation. Conclusion. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery. PMID:26273138

  6. Laparoscopic excision of infarcted accessory spleen.

    PubMed

    Yousef, Yasmin; Cameron, Brian H; Maizlin, Zeev V; Boutross-Tadross, Odette

    2010-04-01

    An accessory spleen is present in about 10-30% of the population and, usually, does not cause symptoms. We present a case report of an unusual presentation of accessory spleen infarction, with a literature review. A 12-year old male presented with acute left-upper quadrant pain that slowly resolved. An ultrasound and computed tomography scan showed a 3.5 x 2.5 x 2 cm solid mass abutting and displacing the splenic flexure of the colon, with surrounding inflammatory changes. This was interpreted as a colonic duplication cyst, and the boy was treated with antibiotics and underwent elective laparoscopic exploration. It was removed laparoscopically without complication and, on pathologic examination, proved to be consistent with an infarcted accessory spleen. Less than two dozen similar cases of accessory spleen infarction have been reported in the literature, most presenting with acute abdominal pain. Preoperative diagnoses included appendicitis, ovarian torsion, neoplasm, and, in our case, colonic duplication. The natural course of infarcted accessory spleen would be to atrophy, but, even with advanced imaging techniques, it may be impossible to diagnose infarcted accessory spleen with enough confidence to avoid surgery.

  7. 77 FR 37806 - Disregarded Entities and the Indoor Tanning Services Excise Tax

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-25

    ... Services Excise Tax AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final and temporary... (including qualified subchapter S subsidiaries) and the indoor tanning services excise tax. These regulations affect disregarded entities responsible for collecting the indoor tanning services excise tax and...

  8. Wrist flexion strength after excision of the pisiform bone.

    PubMed

    Arner, M; Hagberg, L

    1984-01-01

    Diseases of the pisiform triquetral (P-T) joint and the pisiform itself are often treated with excision of the pisiform bone. The flexor carpi ulnaris (FCU) tendon inserts on the volar aspect of the pisiform, suggesting a loss of strength in wrist flexion following excision of the bone. Isometric and dynamic, isokinetical measurements were made using a strain-gauge dynamometer (Cybex II). Slight postoperative reduction of wrist flexion strength, compared with the contralateral wrist, was noted but not of clinical significance. It is concluded that one should not refrain from excision of the pisiform bone for fear of considerable strength loss in wrist joint flexion.

  9. Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy.

    PubMed

    Kayaalp, Cüneyt; Soyer, Vural; Ersan, Veysel; Aydın, Cemalettin; Karagül, Servet

    2016-01-01

    Congenital choledochal cysts are rare in adults. Due to the risk of developing cholangiocarcinoma, the current standard of care is complete excision of the cyst and reconstruction with hepaticojejunostomy. So far, more than 200 laparoscopic resections have been reported in adults, the majority being from Far Eastern countries over the last five years. Herein, the technique of laparoscopic type I choledochal cyst excision and hepaticojejunostomy is presented in a 37-year-old male with an accompanying video. The advantages of laparoscopic surgery are applicable for choledochal cyst excision as well. We believe that teamwork, expertise on intracorporeal suturing and hepatobiliary surgery are central issues for this operation.

  10. Laparoscopic excision of a retroperitoneal lymphatic malformation in a newborn.

    PubMed

    Solari, Valeria; Mullassery, Dhanya; Lansdale, Nick; Jesudason, Edwin C

    2011-02-01

    Abdominal lymphatic malformations may be challenging to eradicate. Retroperitoneal lesions may more difficult to resect than mesenteric ones; however, the latter may predispose to intestinal volvulus, leading to calls for their prompt excision. Such lesions identified perinatally may pose particular challenges: in one case, respiratory failure caused by abdominal distension required emergency drainage followed by later laparoscopic excision; laparoscopy has also been used promptly to diagnose and resect neonatal mesenteric lymphatic malformations with their inherent volvulus risk. We illustrate that even if neonatal laparoscopy identifies a retroperitoneal rather than mesenteric lymphatic malformation, curative endosurgical excision remains feasible.

  11. [Face necrotizing fasciitis following spinocellular epithelioma excision].

    PubMed

    Gindre, S; Dellamonica, J; Couadau, E; Carles, M; Vandenbos, F; Delgiudice, P; Grimaud, D; Ichai, C

    2005-06-01

    Necrotizing fasciitis is a bacterial dermo-hypodermitis with superficial aponevrosis necrosis due to Streptococcus pyogenes. Head and neck region are some rare localization of this infection especially after surgery. We report herein a case of a face necrotizing fasciitis following minor face surgery. A 86 year-old Caucasian male without any antecedents, nor treatment, has been operated for a fronthead spinocellular epithelioma under local anesthesia. Twelve hours later, a severe pain localized to the face occurred, with sleeplessness, followed up with a face orbitary oedema and fever. Twenty-four hours later, an intravenous antibiotherapy was therefore started and surgical treatment was performed as soon as the diagnosis of necrotizing fasciitis was considered. An important inflammatory oedema was noticed, associated to a large necrotic softening of the face, the eyelid and the neck sub-cutaneous tissues. Then, the patient has been transferred in intensive care unit because multi-organ failure clinical and biological signs occurred. Pre-operatory bacteriological samples culture identified Streptococcus pyogenes. Repeated surgical explorations and debridement (excision, cleaning, draining and bandages recovery) were performed daily as needed until all the necrotic tissue was all eradicated. The antibiotherapy was prescribed to totalised 15 days. Our report underlines the importance of an early recognition of the diagnosis of soft tissue infection, because early surgical treatment has a better prognosis and antibiotic treatment alone is inefficient for the recovery. Alert is delivered by the local signs quickly followed up by skin changes. Anti-inflammatory therapy must be avoid in case of any soft tissue infection sign: they may increase the lesions, hide alarm signs and delay surgical treatment.

  12. [Face necrotizing fasciitis following spinocellular epithelioma excision].

    PubMed

    Gindre, S; Dellamonica, J; Couadau, E; Carles, M; Vandenbos, F; Delgiudice, P; Grimaud, D; Ichai, C

    2005-06-01

    Necrotizing fasciitis is a bacterial dermo-hypodermitis with superficial aponevrosis necrosis due to Streptococcus pyogenes. Head and neck region are some rare localization of this infection especially after surgery. We report herein a case of a face necrotizing fasciitis following minor face surgery. A 86 year-old Caucasian male without any antecedents, nor treatment, has been operated for a fronthead spinocellular epithelioma under local anesthesia. Twelve hours later, a severe pain localized to the face occurred, with sleeplessness, followed up with a face orbitary oedema and fever. Twenty-four hours later, an intravenous antibiotherapy was therefore started and surgical treatment was performed as soon as the diagnosis of necrotizing fasciitis was considered. An important inflammatory oedema was noticed, associated to a large necrotic softening of the face, the eyelid and the neck sub-cutaneous tissues. Then, the patient has been transferred in intensive care unit because multi-organ failure clinical and biological signs occurred. Pre-operatory bacteriological samples culture identified Streptococcus pyogenes. Repeated surgical explorations and debridement (excision, cleaning, draining and bandages recovery) were performed daily as needed until all the necrotic tissue was all eradicated. The antibiotherapy was prescribed to totalised 15 days. Our report underlines the importance of an early recognition of the diagnosis of soft tissue infection, because early surgical treatment has a better prognosis and antibiotic treatment alone is inefficient for the recovery. Alert is delivered by the local signs quickly followed up by skin changes. Anti-inflammatory therapy must be avoid in case of any soft tissue infection sign: they may increase the lesions, hide alarm signs and delay surgical treatment. PMID:15963844

  13. Preoperative blood transfusions for sickle cell disease

    PubMed Central

    Estcourt, Lise J; Fortin, Patricia M; Trivella, Marialena; Hopewell, Sally

    2016-01-01

    Background Sickle cell disease is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. Sickle cell disease can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Surgical interventions are more common in people with sickle cell disease, and occur at much younger ages than in the general population. Blood transfusions are frequently used prior to surgery and several regimens are used but there is no consensus over the best method or the necessity of transfusion in specific surgical cases. This is an update of a Cochrane review first published in 2001. Objectives To determine whether there is evidence that preoperative blood transfusion in people with sickle cell disease undergoing elective or emergency surgery reduces mortality and perioperative or sickle cell-related serious adverse events. To compare the effectiveness of different transfusion regimens (aggressive or conservative) if preoperative transfusions are indicated in people with sickle cell disease. Search methods We searched for relevant trials in The Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to 23 March 2016. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register: 18 January 2016. Selection criteria All randomised controlled trials and quasi-randomised controlled trials comparing preoperative blood transfusion regimens to different regimens or no transfusion in people with sickle cell disease undergoing elective or emergency surgery. There was no restriction by outcomes examined, language or publication status. Data collection and analysis Two authors independently assessed trial eligibility and the risk of bias and extracted data. Main results Three trials with 990 participants were eligible for inclusion in the review. There were no

  14. Theoretical Analysis of the Accuracy and Safety of MRI-Guided Transurethral 3-D Conformal Ultrasound Prostate Therapy

    NASA Astrophysics Data System (ADS)

    Burtnyk, Mathieu; Chopra, Rajiv; Bronskill, Michael

    2009-04-01

    MRI-guided transurethral ultrasound therapy is a promising new approach for the treatment of localized prostate cancer. Several studies have demonstrated the feasibility of producing large regions of thermal coagulation adequate for prostate therapy; however, the quantitative assessment of shaping these regions to complex 3-D human prostate geometries has not been fully explored. This study used numerical simulations and twenty manually-segmented pelvic anatomical models derived from high-quality MR images of prostate cancer patients to evaluate the treatment accuracy and safety of 3-D conformal MRI-guided transurethral ultrasound therapy. The simulations incorporated a rotating multi-element planar dual-frequency ultrasound transducer (seventeen 4×3 mm elements) operating at 4.7/9.7 MHz and 10 W/cm2 maximum acoustic power. Results using a novel feedback control algorithm which modulated the ultrasound frequency, power and device rate of rotation showed that regions of thermal coagulation could be shaped to predefined prostate volumes within 1.0 mm across the vast majority of these glands. Treatment times were typically 30 min and remained below 60 min for large 60 cc prostates. With a rectal cooling temperature of 15° C, the rectal wall did not exceed 30EM43 in half of the twenty patient models with only a few 1 mm3 voxels above this threshold in the other cases. At 4.7 MHz, heating of the pelvic bone can become significant when it is located less than 10 mm from the prostate. Numerical simulations show that MRI-guided transurethral ultrasound therapy can thermally coagulate whole prostate glands accurately and safely in 3-D.

  15. Preoperatively diagnosed mucocele of the appendix.

    PubMed

    Rojnoveanu, Gh; Ghidirim, Gh; Mishin, I; Vozian, M; Mishina, A

    2014-01-01

    Mucocele of the appendix is an infrequent entity, characterized by distension of the lumen due to accumulation of mucoid substance and is rarely diagnosed preoperatively. If untreated, mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and the histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadeno carcinoma. In this paper, we report a case of an asymptomatic 37-year-old woman in whom mucocele was found on a routine ultrasound examination and preoperative computed tomography scan. Surgery revealed a big appendix measuring 84 mm in length and 40 mm in diameter. The final pathologic diagnosis was simple mucocele.

  16. Dual-frequency ultrasound focal therapy for MRI-guided transurethral treatment of the prostate: Study in gel phantom

    NASA Astrophysics Data System (ADS)

    N'Djin, W. Apoutou; Mougenot, Charles; Kobelevskiy, Ilya; Ramsay, Elizabeth; Bronskill, Michael; Chopra, Rajiv

    2012-11-01

    Ultrasound thermal therapy of localized prostate cancer offers a minimally-invasive non-ionizing alternative [1-3] to surgery and radiotherapy. MRI-controlled transurethral ultrasound prostate therapy [4-6] has previously been investigated in a pilot human feasibility study [7], by treating a small sub-volume of prostate tissue. In this study, the feasibility of transurethral dual-frequency ultrasound focal therapy has been investigated in gel phantom. A database of pelvic anatomical models of human prostate cancer patients have been created using MR clinical images. The largest prostate boundary (47 cm3) was used to fabricate an anatomical gel phantom which included various MR characteristics to mimic prostate tissues, 4 localized tumors and surrounding prostate tissues. A 9-element transurethral ultrasound applicator working in dual-frequency mode (f = 4.6/14.5 MHz) was evaluated to heat: (i) the entire prostate volume (Full prostate treatment strategy), (ii) a prostate region restricted to tumors (Focal therapy). Acoustic power of each element and rotation rate of the device were adjusted in realtime based on MR-thermometry feedback control (nine thermal slices updated every 6.2s). Experiments have been performed using dual-frequency ultrasound exposures (surface Pmax: 20W.cm-2). (i) For full prostate heating, 7 elements of the device were used to cover the entire prostate length. The heating process was completed within 35 min. Ultrasound exposures at the fundamental frequency allowed full heating of the largest prostate radii (>18 mm), while exposures at the 3rd harmonic ensured homogeneous treatment of the smallest radii. Undertreated and overtreated regions represented respectively 2% and 17% of the prostate volume. (ii) For focal therapy, the target region was optimized to maintain safe regions in the prostate and to cover all tumor-mimics. Only 5 ultrasound elements were used to treat successfully all tumor-mimics within 26 min. Undertreated and

  17. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients.

    PubMed

    Mebust, W K; Holtgrewe, H L; Cockett, A T; Peters, P C

    1989-02-01

    The mortality rate for transurethral prostatectomy was 0.2 per cent in 3,885 patients reviewed retrospectively. The immediate postoperative morbidity rate was 18 per cent. Increased morbidity was found in patients with a resection time of more than 90 minutes, gland size of more than 45 gm., acute urinary retention and patient age greater than 80 years, and in the black population. Of the patients 77 per cent had significant pre-existing medical problems. Operative mortality, significant morbidity and hospital stay were reduced in comparison to studies done 15 and 30 years ago.

  18. Intravesical irrigation with distilled water during and immediately after transurethral resection and later for superficial bladder cancer.

    PubMed

    Moskovitz, B; Levin, D R

    1987-01-01

    In a retrospective study, the influence of distilled water, used as the irrigation fluid during and immediately after the complete removal of superficial bladder cancer, on the recurrences of bladder cancer was evaluated. Thirty-two percent recurrence developed in the first year (25 patients) and 50% in the second year (39 patients). The 3-month and 1-year recurrence-free rates were 87.2 and 68% respectively. The results support the concept that recurrences may arise from tumor cell implantation at the time of transurethral management of bladder tumors and may be reduced effectively by using distilled water. PMID:3582456

  19. Does previous transurethral prostate surgery affect oncologic and continence outcomes after RARP?

    PubMed

    Su, Yu-Kai; Katz, Benjamin F; Sehgal, Shailen S; Yu, Sue-Jean S; Su, Yu-Chen; Lightfoot, Andrew; Lee, Ziho; Llukani, Elton; Monahan, Kelly; Lee, David I

    2015-12-01

    We examined the effect of previous transurethral resection of the prostate (TURP) on multiple oncologic and continence outcomes after robotic-assisted radical prostatectomy (RARP). We performed a retrospective cohort study of a total of 2693 patients from 2007 to 2014 who underwent RARP. Patients were stratified into 49 patients who had previous TURP prior to RARP (group 1) and 2644 patients who had no TURP prior to RARP (group 2). We collected operative variables including estimated blood loss, operative time, and positive surgical margin (PSM) rates. Urinary continence, defined as 0 pads per day (PPD), and social continence, defined as 1-PPD, were also assessed. American Urological Association Symptoms Score (AUASS), overall ability to function sexually, and Expanded Prostate Cancer Index Composite (EPIC) questionnaire were evaluated at 3 and 12 months after RARP. Weakness of urinary stream (EPIC #4d) at 12 months imposed a greater problem for group 1 patients with prior TURP compared to group 2 patients without prior TURP (p = 0.012). PSM was not statistically significant between the two groups (p = 0.110). Group 1 patients had a greater PSM rate (30.61 %) as compared to group 2 (20.95 %). PSM locations in group 1 patients showed the most common locations at the posterior and apex. The difference between the two groups for AUASS, overall sexual function, estimated blood loss, operative time, urinary continence, and social continence was not statistically significant. We examined the effect of previous TURP on postoperative RARP continence and oncologic outcomes. This data can be used to counsel those with prior TURP before RARP. PMID:26530840

  20. [Perioperative complications of transurethral resection of bladder tumor in patients receiving antithrombotic therapy].

    PubMed

    Wada, Naoki; Okazaki, Satoshi; Kobayashi, Shin; Hashizume, Kazumi; Hori, Junichi; Azumi, Makoto; Kita, Masafumi; Iwata, Tatsuya; Matsumoto, Seiji; Kakizaki, Hidehiro

    2014-11-01

    We examined perioperative complications of transurethral resection of bladder tumor (TURBT) in patients receiving antithrombotic therapy. We retrospectively studied 276 patients who underwent TURBT in our institute from January 2007 to March 2013. The study group consisted of 105 patients (38%) who were receiving antithrombotic agents, and the other 171 patients (62%) without antithrombotic agents were assigned to the control group. The period of discontinuation of antithrombotic agents complied with our institutional rule. The most frequently used agent was aspirin (69 patients : 66%), followed by warfarin (25 patients : 24%). Fourteen patients receiving warfarin (56%) needed heparin bridging therapy. There was no significant difference in average operative time (51 minutes versus 54 minutes), or average days to removal of urethral catheter (3.7 days versus 3.3 days) between the study and control groups. Hemorrhagic and ischemic complications were noted in 11 (10.5%) and 2 (1.9%) patients in the study group and 11 (6.4%) and none (0%) of the patients in the control group, respectively, with no significant difference between the 2 groups. However, prevalence of hemorrhagic complications in patients receiving heparin bridging therapy (21.4%) was significantly higher than that in the control group. Ischemic complications in the study group included chest pain suggestive of angina in one patient and acute myocardial infarction leading to death in another patient. We should pay attention to hemorrhagic complications in patients receiving heparin bridging therapy and keep in mind the possibility of lethal ischemic complications after discontinuation of antithrombotic agents. PMID:25511938

  1. Intrathecal clonidine added to small-dose bupivacaine prolongs postoperative analgesia in patients undergoing transurethral surgery

    PubMed Central

    Gecaj-Gashi, Agreta; Terziqi, Hasime; Pervorfi, Tune; Kryeziu, Arben

    2012-01-01

    Introduction: The aim of this prospective, double-blinded study was to investigate the effects of clonidine in co-administration with bupivacaine during spinal anesthesia, regarding the onset and regression of motor and sensory block, postoperative analgesia and possible side effects. Methods: We randomly selected 66 male patients (age 35 to 70), from the American Society of Anesthesiologists (ASA) class I–II; these patients were scheduled for transurethral surgical procedures. These patients were randomly allocated into two groups of 33 patients each: group B (bupivacaine) only received 0.5% isobaric bupivacaine 7.5 mg intrathecally and group BC (bupivacaine + clonidine) received bupivacaine 7.5 mg and clonidine 25 μg intrathecally. We performed the spinal anesthesia at a level of L3–L4 with a 25-gauge needle. We assessed the sensory block with a pin-prick, the motor block using the Bromage scale, analgesia with the visual analog scale and sedation with the modified Wilson scale. We also recorded the hemodynamic and respiratory parameters. Results: The groups were demographically similar. The mean time of achievement of motor block (Bromage 3) and sensory block at level T9 was significantly shorter in the BC group compared with B group (p = 0.002, p = 0.000, respeectively). The motor block regression time was not significantly different between the two groups (p = 0.237). The postoperative analgesia requirement was significantly longer in group BC compared with group B (p = 0.000). No neurological deficit, sedation or other significant adverse effects were recorded. Conclusion: The intrathecal application of clonidine in combination with bupivacaine improves the duration and quality of spinal anesthesia; it also provides longer duration of postoperative analgesia, without significant side effects. PMID:22396363

  2. [Transurethral uretero-lithotripsy of ureteral stones in Osaka City University].

    PubMed

    Kishimoto, T; Sugimura, K; Nakatani, T; Yamamoto, K; Yasumoto, R; Wada, S; Sakamoto, W; Asakawa, M; Nishikawa, K; Ohyama, A

    1989-12-01

    During the 39 months since the introduction of transurethral lithotripsy (TUL) for the treatment of ureteral stones at our hospital in August 1985, TUL was performed a total of 200 times in 178 patients with ureteral stones. Among them, 111 patients had left ureteral stones and 65 had right ureteral stones, while 2 patients had ureteral stones in both sides. The stones were divided into upper ureteral stone (84 patients) and lower ureteral stone (94 patients) at above and below the iliac brim. 89% of the stones were less than 2 cm in diameter. Most of the patients were given lumbar anesthesia, and a guide wire was inserted into the ureter. The ureter was dilated with a ureteral bougie, and a 13F or 14F Storz ureteroscope was inserted. The stones were disintegrated by an ultrasound lithotripto and removed using forceps and a basket catheter. After the TUL procedure, a double J catheter was indwelled and removed within 5 days. The results were evaluated by DIP which was done 2 to 3 months after TUL. The success rate included residual stones less than 4 mm in diameter, as they could be spontaneously discharged. As a result, the success rate for upper ureteral stones was 53%, and it was higher for smaller stones. On the other hand, the success rate for lower ureteral stones was 85% and significantly higher. The main reasons for failure were the upper migration of the stones (60%) and inability to insert the ureteroscope up to the stone due to ureterostenosis and ureteral perforation (39%).(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Grading of complications of transurethral resection of bladder tumor using Clavien–Dindo classification system

    PubMed Central

    Bansal, Ankur; Sankhwar, Satyanarayan; Goel, Apul; Kumar, Manoj; Purkait, Bimalesh; Aeron, Ruchir

    2016-01-01

    Introduction: Clavien–Dindo classification system is used for grading complications of various oncological, renal, and endourological procedures. We applied this system for grading the severity of perioperative complications in patients undergoing transurethral resection of bladder tumor (TURBT) and identify parameters predicting these complications. Materials and Methods: Data of 984 patients who underwent TURBT from 2006 to 2014 were included in this study. All data was retrospectively collected and analyzed for complications occurring within the first postoperative month. All complications were classified according to the five grades of modified CCS (.Clavien classification system). Results: A total of 172 complications were observed in 138 patients. Majority were low grade complications (Grade 1 [77.3%] and Grade 2 [12.7%]). Higher grade complications were rare (Grade 3 [6.4%] and Grade 4 [3.0%]). There was one death (Grade 5 0.6%), with an overall mortality rate of 0.1%. The incidence of complications was significantly greater for age >60 years, baseline serum creatinine >1.4 mg/dl, size of tumor >4 cm, tumor located at dome, resection time >60 min, incomplete resection and if surgery performed by a resident urologist. Conclusions: Clavien–Dindo classification system can be easily applied to grade the complications of TURBT, and it is easily reproducible. We observed that TURBT was a safe procedure. Majority of complications were Grade 1–2 (90%) and Grade 3–5 were rare (10%). Postoperative bleeding is the most common complication. A greater rate of complications of TURBT was associated with patient age, size of tumor, location of tumor, surgeon experience, resection time, and completion of tumor resection. PMID:27555684

  4. Simulation of MRI-Guided Transurethral Conformal 3-D Ultrasound Therapy of the Prostate

    NASA Astrophysics Data System (ADS)

    Burtnyk, Mathieu; Chopra, Rajiv; Bronskill, Michael

    2007-05-01

    The capability of MRI to measure spatial heating patterns during therapy delivery with ultrasound makes adaptive thermal therapy possible. Active feedback provided by MR thermometry enables on-line adjustment of the treatment to compensate for tissue/perfusion changes during heating. The feasibility of performing 3-D conformal thermal therapy of the entire prostate gland with a multi-element transurethral ultrasound heating applicator was considered in this study. The major challenge was using MR temperature feedback to adjust simultaneously the device's rate of rotation and the power and frequency of multiple independent ultrasound transducers, to shape the region of thermal damage to the prostate gland in all spatial dimensions while sparing surrounding tissues from damage. The 3-D Bioheat Transfer Equation was used to model the ultrasound therapy using manually segmented MRI prostate geometries from 20 prostate cancer patients. Average prostate dimensions (±SD) were: length: 37.8±7.2 mm, width: 47.1±5.5 mm, height: 28.9±5.7 mm. Typical treatments of the entire prostate volume take less than 30 min. Results from various treatment strategies were compared by calculating the percentage volume of under- and over-treated tissue and the potential thermal damage incurred by important adjacent anatomical structures using "dose-effect" curves. Visualization tools were developed to investigate patient-specific prostate and periprostatic anatomy, as well as the simulated coagulated volumes in 3-D, enabling evaluation of individual patient outcomes. These simulations also enabled the investigation of the number and size of transducer segments required for accurate treatment delivery. In general, the under-treated fraction can be maintained below 1% of the prostate volume, but the over-treated fraction can range up to 15%, emphasizing the importance of accurate location of sensitive adjacent structures.

  5. Implications of preoperative hypoalbuminemia in colorectal surgery

    PubMed Central

    Truong, Adam; Hanna, Mark H; Moghadamyeghaneh, Zhobin; Stamos, Michael J

    2016-01-01

    Serum albumin has traditionally been used as a quantitative measure of a patient’s nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient’s chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery. PMID:27231513

  6. Implications of preoperative hypoalbuminemia in colorectal surgery.

    PubMed

    Truong, Adam; Hanna, Mark H; Moghadamyeghaneh, Zhobin; Stamos, Michael J

    2016-05-27

    Serum albumin has traditionally been used as a quantitative measure of a patient's nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient's chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery. PMID:27231513

  7. Preoperative Planning in Primary Total Knee Arthroplasty.

    PubMed

    Tanzer, Michael; Makhdom, Asim M

    2016-04-01

    Preoperative planning is of paramount importance in primary total knee arthroplasty. A thorough preoperative analysis helps the surgeon envision the operation, anticipate any potential issues, and minimize the risk of premature implant failure. Obtaining a thorough history is critical for appropriate patient selection. The physical examination should evaluate the integrity of the soft tissues, the neurovascular status, range of motion, limb deformity, and the status of the collateral ligaments to help determine the soft-tissue balancing and constraint strategy required. Standard radiographs, with a known magnification, should be obtained for preoperative total knee arthroplasty templating. Routine standing AP, lateral, and skyline radiographs of the knee can help the surgeon plan the bone cuts and tibial slope as well as the implant size and position at the time of surgery. In certain circumstances, such as severe coronal deformities, bone deficiencies, and/or extra-articular deformities, additional measures are frequently necessary to successfully reconstruct the knee. Constrained implants, metal augments, and bone graft must be part of the surgeon's armamentarium. PMID:26990712

  8. Nucleotide excision repair of DNA: The very early history.

    PubMed

    Friedberg, Errol C

    2011-07-15

    This article, taken largely from the book Correcting the Blueprint of Life: An Historical Account of the Discovery of DNA Repair Mechanisms, summarizes the very early history of the discovery of nucleotide excision repair.

  9. A Prospective Pathologic Analysis Using Whole-Mount Sections of Rectal Cancer Following Preoperative Combined Modality Therapy

    PubMed Central

    Guillem, Jose G.; Chessin, David B.; Shia, Jinru; Suriawinata, Arief; Riedel, Elyn; Moore, Harvey G.; Minsky, Bruce D.; Wong, W Douglas

    2007-01-01

    Objective: The aims of this study were to use a comprehensive whole-mount pathologic analysis to characterize microscopic patterns of residual disease, as well as circumferential and distal resection margins, in rectal cancer treated with preoperative CMT; and to identify clinicopathologic factors associated with residual disease. Summary Background Data: Recent studies have shown that preoperative combined modality therapy (CMT) for rectal cancer enhances rates of sphincter preservation. However, the efficacy of preoperative CMT in conjunction with a total mesorectal excision (TME)-based resection, in terms of resection margins using whole-mount sections, has not been reported. Furthermore, since patterns of residual disease and extent of distal spread following preoperative CMT are largely unknown, intraoperative determination of distal rectal transection remains a surgical challenge. Methods: We prospectively accrued 109 patients with endorectal ultrasound (ERUS)-staged, locally advanced rectal cancer (T2–T4 and/or N1), located a median distance of 7 cm from the anal verge, requiring preoperative CMT, and undergoing a TME-based resection. Comprehensive whole-mount pathologic analysis was performed, with particular emphasis on extent of residual disease, margin status, and intramural tumor extension. Clinicopathologic factors associated with residual disease were identified. Results: A sphincter-preserving resection was feasible in 87 patients (80%), and in all 109 patients, distal margins were negative (median, 2.1 cm; range, 0.4–10 cm). Intramural extension beyond the gross mucosal edge of residual tumor was observed in only 2 patients (1.8%), both ≤0.95 cm. There were no positive circumferential margins (median, 10 mm; range, 1–28 mm), although 6 were less than or equal to 1 mm. On multivariate analysis, residual disease was observed more frequently in distally located tumors (distance from anal verge <5 cm) (P = 0.03). Conclusion: Our comprehensive

  10. Base excision repair: a critical player in many games.

    PubMed

    Wallace, Susan S

    2014-07-01

    This perspective reviews the many dimensions of base excision repair from a 10,000 foot vantage point and provides one person's view on where the field is headed. Enzyme function is considered under the lens of X-ray diffraction and single molecule studies. Base excision repair in chromatin and telomeres, regulation of expression and the role of posttranslational modifications are also discussed in the context of enzyme activities, cellular localization and interacting partners. The specialized roles that base excision repair play in transcriptional activation by active demethylation and targeted oxidation as well as how base excision repair functions in the immune processes of somatic hypermutation and class switch recombination and its possible involvement in retroviral infection are also discussed. Finally the complexities of oxidative damage and its repair and its link to neurodegenerative disorders, as well as the role of base excision repair as a tumor suppressor are examined in the context of damage, repair and aging. By outlining the many base excision repair-related mysteries that have yet to be unraveled, hopefully this perspective will stimulate further interest in the field.

  11. Base excision repair: A critical player in many games

    PubMed Central

    Wallace, Susan S.

    2014-01-01

    This perspective reviews the many dimensions of base excision repair from a 10,000 foot vantage point and provides one person’s view on where the field is headed. Enzyme function is considered under the lens of X-ray diffraction and single molecule studies. Base excision repair in chromatin and telomeres, regulation of expression and the role of posttranslational modifications are also discussed in the context of enzyme activities, cellular localization and interacting partners. The specialized roles that base excision repair play in transcriptional activation by active demethylation and targeted oxidation as well as how base excision repair functions in the immune processes of somatic hypermutation and class switch recombination and its possible involvement in retroviral infection are also discussed. Finally the complexities of oxidative damage and its repair and its link to neurodegenerative disorders, as well as the role of base excision repair as a tumor suppressor are examined in the context of damage, repair and aging. By outlining the many base excision repair-related mysteries that have yet to be unraveled, hopefully this perspective will stimulate further interest in the field. PMID:24780558

  12. Preoperative chemoradiotherapy with capecitabine versus protracted infusion 5-fluorouracil for rectal cancer: A matched-pair analysis

    SciTech Connect

    Das, Prajnan . E-mail: PrajDas@mdanderson.org; Lin, Edward H.; Bhatia, Sumita; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Feig, Barry W.; Chang, George J.; Hoff, Paulo M.; Eng, Cathy; Wolff, Robert A.; Delclos, Marc E.; Krishnan, Sunil; Janjan, Nora A.; Crane, Christopher H.

    2006-12-01

    Purpose: To retrospectively compare the acute toxicity, pathologic response, relapse rates, and survival in rectal cancer patients treated with preoperative radiotherapy (RT) and either concurrent capecitabine or concurrent protracted infusion 5-fluorouracil (5-FU). Methods: Between June 2001 and February 2004, 89 patients with nonmetastatic rectal adenocarcinoma were treated with preoperative RT and concurrent capecitabine, followed by mesorectal excision. These patients were individually matched by clinical T and N stage (as determined by endoscopic ultrasound and CT scans) with 89 control patients treated with preoperative RT and concurrent protracted infusion 5-FU between September 1997 and August 2002. Results: In each group, 5 patients (6%) had Grade 3-4 toxicity during chemoradiotherapy. The pathologic complete response rate was 21% with capecitabine and 12% with protracted infusion 5-FU (p = 0.19). Of the 89 patients in the capecitabine group and 89 in the 5-FU group, 46 (52%) and 55 (62%), respectively, had downstaging of the T stage after chemoradiotherapy (p = 0.20). The estimated 3-year local control (p = 0.15), distant control (p = 0.86), and overall survival (p = 0.12) rate was 94.4%, 86.3%, and 89.8% for patients treated with capecitabine and 98.6%, 86.6%, and 96.4% for patients treated with protracted infusion 5-FU, respectively. Conclusion: Preoperative concurrent capecitabine and concurrent protracted infusion 5-FU were both well tolerated, with similar, low rates of Grade 3-4 acute toxicity. No significant differences were seen in the pathologic response, local and distant recurrence, or overall survival among patients treated with preoperative RT and concurrent capecitabine compared with those treated with RT and concurrent protracted infusion 5-FU.

  13. Characteristics of phenol. Instillation in intralesional tumor excision of chondroblastoma, osteoclastoma and enchondroma.

    PubMed

    Quint, U; Müller, R T; Müller, G

    1998-01-01

    Because of the typical metaphyseal-epiphyseal growth of giant cell tumors and chondroblastomas, the optimal result of an en bloc resection can usually only be achieved by a loss of joint function. For this reason, intralesional excision has prevailed, though it leads to a high rate of relapses. Adjuvant therapy involving irrigation of the remaining bone cavity with phenol can distinctly decrease the rate of relapse. Little is known about the amount of phenol applied that is absorbed. This study investigated the urinary excretion of phenol following the instillation of 102 ml of a 5% phenol solution. The method consisted of urine collection from 11 patients treated by phenol instillation preoperatively, and at 1, 3, 6, 12 and 24 h postoperatively. The urine specimens were analysed for phenol by mass spectrometry. Preoperatively, the value was 5.1 mg/l on average. The maximum concentration of 62 mg/l was found 1 h after instillation, with an average value of 41.5 mg/l, and after 3 h of 18.9 mg/l. A further rapid decrease in the excretion rate was recorded, with normal values being reached after 12 h. This means a maximum of 9% and an average of 2% of the instilled amount of phenol were excreted in the urine within 24 h postoperatively. By comparing these urinary concentrations to published standards, we conclude that the instillation of a 5% phenol solution into bony lesions is associated with a relatively low risk of systemic toxicity. PMID:9457335

  14. AB071. Do we need a new technique to insert a foley catheter just after transurethral surgery of the BPH?

    PubMed Central

    Shin, Yu Seob; You, Jae Hyung; Park, Jong Kwan

    2016-01-01

    Objective Transurethral resection of the prostate (TURP) is a gold standard surgical procedure to treat the bothersome BPH induced LUTS within the range less than 100 mL. Just after a complete resection of the prostate, especially the posterior portion, however, the insertion of a Foley catheter could be very difficult or impossible, even while using a stylet. We demonstrates two techniques to more easily insert a Foley catheter just after performing the TURP. Methods Among 152 men who underwent TURP by bipolar surgical unit, we found that 27 men experienced the Foley catheter getting stuck while being inserted in the usual way. This was because of the excessive resection of the posterior portion of the prostate just underneath the bladder neck. In the 27 men, we then inserted a 20 Fr sized Foley catheter through an anterior- and upward-movement of posterior prostatic capsule by pressing the rectal wall using a finger and a flexible urethral catheter instead of a stylet. We filmed the inside view of the patient who underwent suprapubic open prostatectomy and transurethral adjustment continuously. Results For the case of the 27 men concerned, by adopting this novel technique, the Foley catheter was completely and safely inserted just after the TURP without any complication. Conclusions The two techniques to insert a Foley catheter just after the TURP can be performed safely within the set time limit without having to use any other medical device such as the stylet.

  15. Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Long-term results

    PubMed Central

    Prada, Pedro J.; Anchuelo, Javier; Blanco, Ana García; Payá, Gema; Cardenal, Juan; Acuña, Enrique; Ferri, María; Vázquez, Andrés; Pacheco, Maite; Sanchez, Jesica

    2016-01-01

    ABSTRACT Objectives We analyzed the long-term oncologic outcome for patients with prostate cancer and transurethral resection who were treated using low-dose-rate (LDR) prostate brachytherapy. Methods and Materials From January 2001 to December 2005, 57 consecutive patients were treated with clinically localized prostate cancer. No patients received external beam radiation. All of them underwent LDR prostate brachytherapy. Biochemical failure was defined according to the “Phoenix consensus”. Patients were stratified as low and intermediate risk based on The Memorial Sloan Kettering group definition. Results The median follow-up time for these 57 patients was 104 months. The overall survival according to Kaplan-Meier estimates was 88% (±6%) at 5 years and 77% (±6%) at 12 years. The 5 and 10 years for failure in tumour-free survival (TFS) was 96% and respectively (±2%), whereas for biochemical control was 94% and respectively (±3%) at 5 and 10 years, 98% (±1%) of patients being free of local recurrence. A patient reported incontinence after treatment (1.7%). The chronic genitourinary complains grade I were 7% and grade II, 10%. At six months 94% of patients reported no change in bowel function. Conclusions The excellent long-term results and low morbidity presented, as well as the many advantages of prostate brachytherapy over other treatments, demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and clinical organ-confined prostate cancer. PMID:27136466

  16. [A large amount of distilled water ineffective for prevention of bladder cancer cell implantation at the time of transurethral resection].

    PubMed

    Sakai, Yasuyuki; Fujii, Yasuhisa; Hyochi, Nobuhiko; Masuda, Hitoshi; Kawakami, Satoru; Kobayashi, Tsuyoshi; Kageyama, Yukio; Kihara, Kazunori

    2006-03-01

    A previous study indicated that distilled water could prevent bladder tumor cell implantation in an in vitro assay. We investigated whether a large amount of distilled water irrigation prevented recurrence of superficial bladder cancer in the clinical setting and then we estimated whether cancer cell implantation at the time of transurethral resection is a major mechanism of recurrence. Between May 2000 and January 2002, 22 patients with primary, superficial bladder carcinoma who underwent transurethral resection of bladder tumors (TURBT) were enrolled in this study. The patients underwent bladder washout with 1,000 ml distilled water immediately after TURBT, and then intravesical irrigation with 3,000 ml water for three hours. Control patients were randomly chosen from those who previously underwent TURBT in our hospital and had similar prognostic factors. The 1- and 2-year recurrence-free rates in the patients undergoing distilled water irrigation were both 45% and those in the control patients were 65% and 45%, respectively. There were no significant differences between the two groups. This result indicates that distilled water was ineffective in preventing recurrence of superficial bladder tumor. PMID:16617868

  17. Sacral Insufficiency Fractures After Preoperative Chemoradiation for Rectal Cancer: Incidence, Risk Factors, and Clinical Course

    SciTech Connect

    Herman, Michael P.; Kopetz, Scott; Bhosale, Priya R.; Eng, Cathy; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Feig, Barry W.; Chang, George J.; Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H.; Das, Prajnan

    2009-07-01

    Purpose: Sacral insufficiency (SI) fractures can occur as a late side effect of pelvic radiation therapy. Our goal was to determine the incidence, risk factors, and clinical course of SI fractures in patients treated with preoperative chemoradiation for rectal cancer. Materials and Methods: Between 1989 and 2004, 562 patients with non-metastatic rectal adenocarcinoma were treated with preoperative chemoradiation followed by mesorectal excision. The median radiotherapy dose was 45 Gy. The hospital records and radiology reports of these patients were reviewed to identify those with pelvic fractures. Radiology images of patients with pelvic fractures were then reviewed to identify those with SI fractures. Results: Among the 562 patients, 15 had SI fractures. The 3-year actuarial rate of SI fractures was 3.1%. The median time to SI fractures was 17 months (range, 2-34 months). The risk of SI fractures was significantly higher in women compared to men (5.8% vs. 1.6%, p = 0.014), and in whites compared with non-whites (4% vs. 0%, p = 0.037). On multivariate analysis, gender independently predicted for the risk of SI fractures (hazard ratio, 3.25; p = 0.031). Documentation about the presence or absence of pain was available for 13 patients; of these 7 (54%) had symptoms requiring pain medications. The median duration of pain was 22 months. No patient required hospitalization or invasive intervention for pain control. Conclusions: SI fractures were uncommon in patients treated with preoperative chemoradiation for rectal cancer. The risk of SI fractures was significantly higher in women. Most cases of SI fractures can be managed conservatively with pain medications.

  18. Excision of plastid marker genes using directly repeated DNA sequences.

    PubMed

    Mudd, Elisabeth A; Madesis, Panagiotis; Avila, Elena Martin; Day, Anil

    2014-01-01

    Excision of marker genes using DNA direct repeats makes use of the predominant homologous recombination pathways present in the plastids of algae and plants. The method is simple, efficient, and widely applicable to plants and microalgae. Marker excision frequency is dependent on the length and number of directly repeated sequences. When two repeats are used a repeat size of greater than 600 bp promotes efficient excision of the marker gene. A wide variety of sequences can be used to make the direct repeats. Only a single round of transformation is required, and there is no requirement to introduce site-specific recombinases by retransformation or sexual crosses. Selection is used to maintain the marker and ensure homoplasmy of transgenic plastid genomes. Release of selection allows the accumulation of marker-free plastid genomes generated by marker excision, which is spontaneous, random, and a unidirectional process. Positive selection is provided by linking marker excision to restoration of the coding region of an herbicide resistance gene from two overlapping but incomplete coding regions. Cytoplasmic sorting allows the segregation of cells with marker-free transgenic plastids. The marker-free shoots resulting from direct repeat-mediated excision of marker genes have been isolated by vegetative propagation of shoots in the T0 generation. Alternatively, accumulation of marker-free plastid genomes during growth, development and flowering of T0 plants allows the collection of seeds that give rise to a high proportion of marker-free T1 seedlings. The simplicity and convenience of direct repeat excision facilitates its widespread use to isolate marker-free crops. PMID:24599849

  19. 29 CFR 779.262 - Excise taxes at the retail level.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Excise taxes at the retail level. 779.262 Section 779.262... Coverage Excise Taxes § 779.262 Excise taxes at the retail level. (a) Federal excise taxes are imposed at the retail level on highway vehicle fuels other than gasoline under the provisions of 26 U.S.C....

  20. Preoperational test report, primary ventilation condensate system

    SciTech Connect

    Clifton, F.T.

    1997-01-29

    Preoperational test report for Primary Ventilation Condensate System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides a collection point for condensate generated by the W-030 primary vent offgas cooling system serving tanks AYIOI, AY102, AZIOI, AZI02. The system is located inside a shielded ventilation equipment cell and consists of a condensate seal pot, sampling features, a drain line to existing Catch Tank 241-AZ-151, and a cell sump jet pump. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  1. Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy

    PubMed Central

    Povoski, Stephen P.; Karpeh, Martin S.; Conlon, Kevin C.; Blumgart, Leslie H.; Brennan, Murray F.

    1999-01-01

    Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased

  2. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia

    PubMed Central

    Bouza, Carmen; López, Teresa; Magro, Angeles; Navalpotro, Lourdes; Amate, José María

    2006-01-01

    Background Benign prostatic hyperplasia (BPH) constitutes a major clinical problem. Minimally invasive therapies for the treatment of symptomatic BPH include Transurethral Needle Ablation (TUNA), but it is unclear what impact this technique has on the disease and its role among other currently available therapeutic options. The objective of this study is to ascertain the efficacy and safety of TUNA in the treatment of BPH. Methods Systematic review of the literature until January 2005 and meta-analysis of clinical studies assessing TUNA in symptomatic BPH. Studies were critically appraised. Estimates of effect were calculated according to the random-effects model. Results 35 studies (9 comparative, 26 non-comparative) were included. Although evidence was limited by methodological issues, the analysis of relevant outcomes indicates that while TUNA significantly improves BPH parameters with respect to baseline, it does not reach the same level of efficacy as TURP in respect to all subjective and objective variables. Further, its efficacy declines in the long-term with a rate of secondary-treatment significantly higher than of TURP [OR: 7.44 (2.47, 22.43)]. Conversely, TUNA seems to be a relatively safe technique and shows a lower rate of complications than TURP [OR:0.14 (0.05, 0.14)] with differences being particularly noteworthy in terms of postoperative bleeding and sexual disorders. Likewise, TUNA has fewer anesthetic requirements and generates a shorter hospital stay than TURP [WMD: -1.9 days (-2.75, -1.05)]. Scarce data and lack of replication of comparisons hinder the assessment of TUNA vs. other local therapies. No comparisons with medical treatment were found. Conclusion The body of evidence on which TUNA has been introduced into clinical practice is of only moderate-low quality. Available evidence suggest that TUNA is a relatively effective and safe technique that may eventually prove to have a role in selected patients with symptomatic BPH. TUNA

  3. Developmentally programmed excision of internal DNA sequences in Paramecium aurelia.

    PubMed

    Gratias, A; Bétermier, M

    2001-01-01

    The development of a new somatic nucleus (macronucleus) during sexual reproduction of the ciliate Paramecium aurelia involves reproducible chromosomal rearrangements that affect the entire germline genome. Macronuclear development can be induced experimentally, which makes P. aurelia an attractive model for the study of the mechanism and the regulation of DNA rearrangements. Two major types of rearrangements have been identified: the fragmentation of the germline chromosomes, followed by the formation of the new macronuclear chromosome ends in association with imprecise DNA elimination, and the precise excision of internal eliminated sequences (IESs). All IESs identified so far are short, A/T rich and non-coding elements. They are flanked by a direct repeat of a 5'-TA-3' dinucleotide, a single copy of which remains at the macronuclear junction after excision. The number of these single-copy sequences has been estimated to be around 60,000 per haploid genome. This review focuses on the current knowledge about the genetic and epigenetic determinants of IES elimination in P. aurelia, the analysis of excision products, and the tightly regulated timing of excision throughout macronuclear development. Several models for the molecular mechanism of IES excision will be discussed in relation to those proposed for DNA elimination in other ciliates. PMID:11879729

  4. [Excision: basis for family stability or cruel ritual?].

    PubMed

    1975-04-01

    Female circumcision, or excision of the clitoris, is still practiced in many African countries. It does not have any religious significance, but it is a rite of passage from childhood to womanhood, and its function is to distinguish the sexes by the excision of the clitoris, which is the female counterpart of the male penis. The ritual is done in groups of girls aged 12-15 by an old woman and outside of the village; a big celebration follows the rite. Many tribes still consider the excision of the penis as a means to limit the sexual appetities of females, thereby guaranteeing fidelity to an often polygamous husband. Convalescence from the operation lasts 4-6 weeks, during which a girl is instructed about her future role as mother and wife. Consequences of female excision are infection, mainly tetanus, and hemorrhage; they both can lead to death. Other consequences are ugly deformations, mostly by occlusion of the vagina, dyspareunia and frigidity. Opposition to female excision is growing especially in urban areas, but it is still practiced by more than half of the population. Acceleration of female education together with health and sex education would certainly help speed up the eradication of such a barbarous practice. PMID:12311057

  5. DNA excision repair: where do all the dimers go?

    PubMed

    Kemp, Michael G; Sancar, Aziz

    2012-08-15

    Exposure of cells to UV light from the sun causes the formation of pyrimidine dimers in DNA that have the potential to lead to mutation and cancer. In humans, pyrimidine dimers are removed from the genome in the form of ~30 nt-long oligomers by concerted dual incisions. Though nearly 50 y of excision repair research has uncovered many details of UV photoproduct damage recognition and removal, the fate of the excised oligonucleotides and, in particular, the ultimate fate of the chemically very stable pyrimidine dimers remain unknown. Physiologically relevant UV doses introduce hundreds of thousands of pyrimidine dimers in diploid human cells, which are excised from the genome within ~24 h. Once removed from the genome, "where do all the dimers go?" In a recent study we addressed this question. Although our study did not determine the fate of the dimer itself, it revealed that the excised ~30-mer is released from the duplex in a tight complex with the transcription/repair factor TFIIH. This finding combined with recent reports that base and oligonucleotide products of the base and double-strand break repair pathways also make stable complexes with the cognate repair enzymes, and that these complexes activate the MAP kinase and checkpoint signaling pathways, respectively, raises the possibility that TFIIH-30-mer excision complexes may play a role in signaling reactions in response to UV damage.

  6. Dynamic control of strand excision during human DNA mismatch repair.

    PubMed

    Jeon, Yongmoon; Kim, Daehyung; Martín-López, Juana V; Lee, Ryanggeun; Oh, Jungsic; Hanne, Jeungphill; Fishel, Richard; Lee, Jong-Bong

    2016-03-22

    Mismatch repair (MMR) is activated by evolutionarily conserved MutS homologs (MSH) and MutL homologs (MLH/PMS). MSH recognizes mismatched nucleotides and form extremely stable sliding clamps that may be bound by MLH/PMS to ultimately authorize strand-specific excision starting at a distant 3'- or 5'-DNA scission. The mechanical processes associated with a complete MMR reaction remain enigmatic. The purified human (Homo sapien or Hs) 5'-MMR excision reaction requires the HsMSH2-HsMSH6 heterodimer, the 5' → 3' exonuclease HsEXOI, and the single-stranded binding heterotrimer HsRPA. The HsMLH1-HsPMS2 heterodimer substantially influences 5'-MMR excision in cell extracts but is not required in the purified system. Using real-time single-molecule imaging, we show that HsRPA or Escherichia coli EcSSB restricts HsEXOI excision activity on nicked or gapped DNA. HsMSH2-HsMSH6 activates HsEXOI by overcoming HsRPA/EcSSB inhibition and exploits multiple dynamic sliding clamps to increase tract length. Conversely, HsMLH1-HsPMS2 regulates tract length by controlling the number of excision complexes, providing a link to 5' MMR.

  7. Purification of PCNA as a nucleotide excision repair protein

    PubMed Central

    Nichols, Anne F.; Sancar, Aziz

    1992-01-01

    Human cell free extracts carry out nucleotide excision repair in vitro. The extract is readily separated into two fractions by chromatography on a DEAE column. Neither the low salt (0.1 M KCl) nor the high salt (0.8 M KCl) fractions are capable of repair synthesis but the combination of the two restore the repair synthesis activity. Using the repair synthesis assay we purified a protein of 37 kDa from the high salt fraction which upon addition to the low salt fraction restores repair synthesis activity. Amino acid sequence analysis, amino acid composition and immunobloting with PCNA antibodies revealed that the 37 kDa protein is the proliferating cell nuclear antigen (PCNA) known to stimulate DNA Polymerases δ and ε. By using an assay which specifically measures the excision of thymine dimers we found that PCNA is not required for the actual excision reaction per se but increases the extent of excision by enabling the excision repair enzyme to turn over catalytically. Images PMID:1352873

  8. Preoperative Preparation and Anesthesia for Trabeculectomy

    PubMed Central

    2016-01-01

    ABSTRACT Preoperative preparation should improve the likelihood of successful trabeculectomy surgery. The team can reconsider the appropriateness of the proposed surgery, and steps can be taken to maximize the chance of a good outcome. For example, adjustments to anti-hypertensive or anti-coagulant medications may be made, and topical ocular medications adjusted. Choice of anesthesia technique is of particular relevance to the trabeculectomy patient. Some anesthesia techniques are more likely to have serious complications, and glaucoma patients may be at higher risk of some sight-threatening complications, because the optic nerve is already damaged and vulnerable. Posterior placement of local anesthesia (retrobulbar, peribulbar, posterior sub-Tenon’s techniques) could potentially damage the optic nerve, and thereby cause “wipe-out” of vision. Anesthesia technique may influence the likelihood of vitreous bulge and surgical difficulty. Regarding long-term control of intraocular pressure, there is no good evidence to indicate that any particular anesthesia technique is better than another. There is little high-quality evidence on this topic. The author’s preferred technique for trabeculectomy is subconjunctival-intracameral anesthesia without sedation. How to cite this article: Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10(1):21-35. PMID:27231416

  9. Preoperative embolization of hypervascular skull base tumors.

    PubMed

    Gruber, A; Bavinzski, G; Killer, M; Richling, B

    2000-06-01

    The purpose of the present study is to review the results and complications of preoperative embolization of hypervascular skull base tumors at a neurosurgical center with a team of neurosurgeons cross-experienced in the application of both microsurgery and endovascular techniques. One hundred and twenty-eight endovascular approaches were performed in 66 patients treated for skull base meningiomas (n = 41), paragangliomas of the temporal bone (n = 18), and juvenile nasopharyngeal angiofibromas (n = 7). One death and 2 permanent disabilities were attributable to endovascular therapy. These complications occurred early in our experience (1982-1989) and were related to thromboembolic events rather than complications of transcatheter embolization itself. Our current standard is to perform transfemoral superselective embolizations with either finely corpuscular embolizing substances (PVA particles) or cyanoacrylates (NBCA) under local anesthesia. Using this protocol no embolization-related complications have occurred over the last 9 years. We thus conclude that preoperative embolization of hypervascular skull base tumors can be accomplished safely with the endovascular techniques now available.

  10. [CT in preoperative assessment of renal tumors?].

    PubMed

    Lanng, C; Bowall, P; Egeblad, M; Meyhoff, H H

    1992-04-13

    The value of CT-scanning as part of the preoperative morphological investigation of patients with renal tumours was calculated in a material of 28 patients. In eight patients, operative treatment was not found to be indicated. In the 20 patients in whom operation was undertaken, the operative and histological findings were compared with the findings on CT-scanning. In cases of disagreement, the CT-scanning findings were reassessed. It was found that interpretation of the CT-scan was accurate in 40% of the cases while minor disagreements were present in 25% but these did not have any significance for the indications for operation. In the remaining 35% considerable disagreement was found between the CT-scan and the operative or histological findings such as invasion of neighbouring organs, cysts interpreted as solid tumours with necrosis and as regards interpretation of the retroperitoneal glands. The present authors consider that CT-scanning provides an important supplement to the conventional morphological investigation of renal tumours with intravenous urography and radiography of the thorax. CT-scanning appears to be preferable to ultrasonic scanning in cases which are difficult to review and where expert interpretation of ultrasonic findings is not available. In addition, routine preoperative biopsy of the tumour guided by ultrasound is recommended together with peroperative biopsy for freeze microscopic examination prior to nephrectomy.

  11. A preoperative stress inquiry and a vulnerable US military population.

    PubMed

    Bopp, Eric J; Spence, Dennis L; Burkard, Joseph F

    2013-04-01

    The preoperative setting is fraught with many stressors, often increasing in magnitude as patients progress through the perioperative environment. Individuals exposed to traumatic or threatening environments, such as US military personnel involved in combat operations, may be at increased risk of developing altered mental and physical health conditions. Collectively, this may result in a hyperarousal state significantly amplifying psychological symptoms and magnifying physiological alterations. The purposes of this article are to (1) describe stress-related concepts and preoperative stress, (2) discuss potential risk factors for preoperative stress in the adult surgical population, (3) present various psychological and physiological measures of preoperative stress, (4) explore preoperative stress interventions, and (5) discuss potential implications for future preoperative stress research in high-stressed populations.

  12. Bevacizumab with preoperative chemotherapy versus preoperative chemotherapy alone for colorectal cancer liver metastases

    PubMed Central

    Lu, Zhen-Hai; Peng, Jian-Hong; Wang, Fu-Long; Yuan, Yun-Fei; Jiang, Wu; Li, Yu-Hong; Wu, Xiao-Jun; Chen, Gong; Ding, Pei-Rong; Li, Li-Ren; Kong, Ling-Heng; Lin, Jun-Zhong; Zhang, Rong-Xin; Wan, De-Sen; Pan, Zhi-Zhong

    2016-01-01

    Abstract This study aimed to assess the efficacy and safety of bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer in Chinese patients compared with those of preoperative chemotherapy alone. Patients with histologically confirmed liver-only metastatic colorectal cancer were sequentially reviewed, and received either preoperative chemotherapy plus bevacizumab (bevacizumab group, n = 32) or preoperative chemotherapy alone (chemotherapy group, n = 57). Progression-free survival, response rate, liver resection rate, conversion rate, and safety were analyzed. With median follow-up of 28.7 months, progression-free survival was 10.9 months (95% confidence interval: 8.7–13.1 months) in bevacizumab group and 9.9 months (95% confidence interval: 6.8–13.1 months) in chemotherapy group (P = 0.472). Response rates were 59.4% in bevacizumab group and 38.6% in chemotherapy group (P = 0.059). Overall liver resection (R0, R1, and R2) rate was 68.8% in bevacizumab group and 54.4% in chemotherapy group (P = 0.185). Conversion rate was 51.9% in bevacizumab group and 40.4% in chemotherapy group (P = 0.341). No postoperative complication was observed in all patients. Bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer tends to achieve better clinical benefit with controllable safety in Chinese patients. PMID:27583930

  13. Unique use of botulinum toxin to decrease adductor tone and allow surgical excision of vulvar carcinoma.

    PubMed

    Guo, Y; Shin, K

    2004-01-01

    Here, we present the case of an 86-year-old woman with vulvar carcinoma requiring surgical resection and with Parkinson's disease with severe spasticity and contractures of the lower extremities. Because of the patient's severe contractures and spasticity (her knees could only be separated by 2 cm with sustained abducting force), surgical positioning and access to the vulva were impossible. The patient was admitted, intending to undergo surgery after injection with botulinum toxin (BTX) to hip adductors and intensive physical therapy. After confirmed healed hip arthroplasty, the patient underwent BTX injection (400 U) to her bilateral adductor brevis, adductor longus, adductor magnus, and semimembranosus and semitendinosus muscles on day 2 of her hospital stay. On day 3, a physical therapist began a twice-a-day stretching program. An adjustable abduction brace was custom-made to provide sustained stretching. On day 9, the patient underwent wide local excision of vulvar carcinoma with the abductor brace in place. The patient tolerated the surgery well and was discharged home on day 11 with continuous physical therapy. Upon discharge, the distance between the patient's knees was 14 cm. This unique case demonstrated a new indication for BTX treatment in the preoperative setting to allow surgical positioning and access.

  14. Neodymium:yttrium-aluminium-garnet laser for excision of pulmonary nodules: an institutional review.

    PubMed

    Moghissi, Keyvan; Dixon, Kate

    2009-03-01

    Eighty patients amongst 850 undergoing pulmonary surgery with the use of neodymium:yttrium-aluminium-garnet (Nd:YAG) laser had a solitary pulmonary nodule (< or = 50 mm) on chest radiography, which was confirmed or suspected pre-operatively to be primary lung cancer. All patients had a mini-thoracotomy to expose the lesion. They then had Nd:YAG laser to excise the nodule locally. There was no hospital mortality. Six patients had non-fatal post-operative complications. Pathologically, 46 patients had primary lung cancer and ten had secondary lung cancer. Twenty-four others had benign lesions. Mean hospital stay was 5.5 days. Post-operative reduction of forced vital capacity (FVC) and forced expiratory volume in one second (FEV(1)) was 14% and 13% (mean), respectively. Thirty-seven patients with primary lung cancer were followed up for between 12 months and 60 months. Mean survival time of these patients was 39 months (s.d. 13 months). It was concluded that Nd:YAG laser for pulmonary nodular lesions should be considered for a selected group of patients unsuitable for standard resection. PMID:18214573

  15. Laparoscopic excision of retroperitoneal tumors: technique and review of the laparoscopic experience.

    PubMed

    Cadeddu, M O; Mamazza, J; Schlachta, C M; Seshadri, P A; Poulin, E C

    2001-04-01

    A technique for laparoscopic excision of benign retroperitoneal tumors, including a teratoma and two cystic lesions, is described. Laparoscopic resection of a 12-cm retroperitoneal teratoma was accomplished with the patient in the left lateral decubitus position. Medial mobilization of the ascending colon and the duodenum was required for access to the lesion. Resections of two cystic lesions (measuring 20 cm and 12 cm) were performed with the patients in the lithotomy position. The colon required medial mobilization in both cases to gain access to the cysts. Once the cysts were dissected from surrounding structures, they were punctured, and the aspirated fluid was sent for cytologic analysis. There were no complications or conversions. Mean operating time was 122 minutes (range, 80-190). Patients were discharged 1 day after surgery, requiring only nonsteroidal anti-inflammatory medications for analgesia. Retroperitoneal tumors can be resected laparoscopically with careful preoperative investigation and meticulous laparoscopic technique. A major advantage of laparoscopic resections is that the patient recovers rapidly with minimal morbidity.

  16. Transurethral ultrasound applicators with dynamic multi-sector control for prostate thermal therapy: In vivo evaluation under MR guidance

    SciTech Connect

    Kinsey, Adam M.; Diederich, Chris J.; Rieke, Viola; Nau, William H.; Pauly, Kim Butts; Bouley, Donna; Sommer, Graham

    2008-05-15

    The purpose of this study was to explore the feasibility and performance of a multi-sectored tubular array transurethral ultrasound applicator for prostate thermal therapy, with potential to provide dynamic angular and length control of heating under MR guidance without mechanical movement of the applicator. Test configurations were fabricated, incorporating a linear array of two multi-sectored tubular transducers (7.8-8.4 MHz, 3 mm OD, 6 mm length), with three 120 deg. independent active sectors per tube. A flexible delivery catheter facilitated water cooling (100 ml min{sup -1}) within an expandable urethral balloon (35 mm longx10 mm diameter). An integrated positioning hub allows for rotating and translating the transducer assembly within the urethral balloon for final targeting prior to therapy delivery. Rotational beam plots indicate {approx}90 deg. - 100 deg. acoustic output patterns from each 120 deg. transducer sector, negligible coupling between sectors, and acoustic efficiencies between 41% and 53%. Experiments were performed within in vivo canine prostate (n=3), with real-time MR temperature monitoring in either the axial or coronal planes to facilitate control of the heating profiles and provide thermal dosimetry for performance assessment. Gross inspection of serial sections of treated prostate, exposed to TTC (triphenyl tetrazolium chloride) tissue viability stain, allowed for direct assessment of the extent of thermal coagulation. These devices created large contiguous thermal lesions (defined by 52 deg. C maximum temperature, t{sub 43}=240 min thermal dose contours, and TTC tissue sections) that extended radially from the applicator toward the border of the prostate ({approx}15 mm) during a short power application ({approx}8-16 W per active sector, 8-15 min), with {approx}200 deg. or 360 deg. sector coagulation demonstrated depending upon the activation scheme. Analysis of transient temperature profiles indicated progression of lethal temperature

  17. Hysteroscopic myomectomy: techniques and preoperative assessment.

    PubMed

    Casadio, Paolo; Guasina, Francesca; Morra, Ciro; Talamo, Maria T; Leggieri, Concetta; Frisoni, Jessica; Seracchioli, Renato

    2016-04-01

    Even if usually asymptomatic, uterine myomas have been associated with a number of clinical issues such as abnormal uterine bleeding (AUB), heavy menstrual bleeding (HMB), infertility, recurrent pregnancy loss, especially when these masses are submucous. Golden standard treatment for symptomatic submucous fibroids has long been considered their laparotomic removal or a total hysterectomy. The development of endoscopy has made these fibroids accessible and removable from the inner surface of uterus. Hysteroscopy arose as a diagnostic technique, but then it also became an alternative surgical technique for many diseases, offering therapeutic and irreplaceable possibilities of treatment, avoiding major surgery on the one hand, and allowing the correction of pathologies specifically related to female fertility, on the other hand. Excision by slicing has been described as traditional resectoscopic submucosal myomectomy, but today there are new procedures among which the operator can choose, that allow overcoming the initial limitations of the traditional resectoscopic myomectomy in clinical practice. PMID:26928414

  18. Dermatofibrosarcoma Protuberans: Wide Local Excision Versus Mohs Micrographic Surgery.

    PubMed

    Mullen, John T

    2016-10-01

    Dermatofibrosarcoma protuberans (DFSP) is a rare dermal soft tissue sarcoma characterized by a typically indolent clinical course. The greatest clinical challenge in management of DFSP is achieving local control. There is vigorous debate in the literature as to the optimal surgical approach to these tumors. The choice between wide local excision and Mohs micrographic surgery for DFSP should be governed by the attainment of three goals: (1) to completely excise the tumor with negative margins, tantamount to cure; (2) to preserve function, optimize cosmesis, and minimize morbidity of resection; and (3) to minimize cost and inconvenience to the patient and the health care system at large. PMID:27591501

  19. Microsurgical technique in excision of intramedullary craniocervical ependymomas. Video report.

    PubMed

    El Refaee, Ehab; Matthes, Marc; Schroeder, Henry W S

    2014-09-01

    We present the microsurgical technique in excision of intramedullary craniocervical ependymomas. A 27-year-old female came presenting with neck pain and parasthesia in her both arms and hands, where MRI was performed showing intramedullary lesion that extend in the medulla just beyond the foramen magnum to the level of C5-6 disc. Tumor was totally excised using irrigation-dissection microscopic technique with favorable outcome. The video can be found here: http://youtu.be/Yj1yvZOaz58. PMID:25175578

  20. Laparoscopic excision of an infected "egg-shelled" retroperitoneal pseudocyst.

    PubMed

    Palanivelu, Chinnusamy; Rangarajan, Muthukumaran; Senthilkumar, Rangaswamy; Madhankumar, Madhupalayam Velusamy; Annapoorni, Shankar

    2008-12-01

    Primary retroperitoneal pseudocysts are rare entities. Though laparoscopic approach has been described in their treatment, open surgical excision is still the mainstay of treatment for these lesions. We present a case of infected retroperitoneal pseudocyst and its successful laparoscopic excision. The patient was an 80-year old female. Contrast enhanced CT scan of the abdomen and ultrasonography confirmed a large retroperitoneal cyst. Laparoscopic resection was accomplished after puncturing and decompressing the cyst. There were no complications or conversion. The operating time was 176 minutes. The patient was discharged 3 days after surgery. Histopathology revealed a pseudocyst. Retroperitoneal pseudocysts can be resected laparoscopically with careful and meticulous laparoscopic dissection, utilizing the advantages of laparoscopy.

  1. Expression of the excision repair gene, ERCC3 (excision repair cross-complementing), during mouse development.

    PubMed

    Hubank, M; Mayne, L

    1994-08-12

    Expression of the human ERCC3 (excision repair cross-complementing) gene in cells from patients with xeroderma pigmentosum (XP) group B (XP-B) corrects the defect in repair of UV light-induced DNA damage. XP-B is one of three groups of XP which exhibit the clinical symptoms of both XP and Cockayne's Syndrome (CS). CS and XP-B/CS patients develop severe neurological dysfunction during development. In order to explore the link between the defective gene and the neurological deficits in XP/CS, we have studied the expression of ERCC3 mRNA in developing mice by in situ hybridisation. ERCC3 was found to be ubiquitously expressed in cells from all regions and all developmental stages, from 9 day post-coitum embryo, to 15 day post-natal brain. In post-natal brain, regional differences in expression correlated with cell density and there was no evidence of cell specific or developmental alterations in levels of expression. These results indicate that the constitutively expressed gene does not perform a discrete developmental function. The neurological defects apparent in XP-B are likely to arise pleiotypically from the participation of ERCC3 in interactions with other elements involved in particular aspects of neurodevelopmental control. These results emphasise the developmental importance of genes whose primary functions are apparently unconnected with development. PMID:7805288

  2. Studies on the three-dimensional temperature transients in the canine prostate during transurethral microwave thermal therapy.

    PubMed

    Liu, J; Zhu, L; Xu, L X

    2000-08-01

    Thermal therapy of benign prostatic hyperplasia requires accurate prediction of the temperature distribution induced by the heating within the prostatic tissue. In this study, the Pennes bioheat transfer equation was used to model the transient heat transfer inside the canine prostate during transurethral microwave thermal therapy. Incorporating the specific absorption rate of microwave energy in tissue, a closed-form analytical solution was obtained. Good agreement was found between the theoretical predictions and in-vivo experimental results. Effects of blood perfusion and the cooling at the urethral wall on the temperature rise were investigated within the prostate during heating. The peak intraprostatic temperatures attained by application of 5, 10, or 15 W microwave power were predicted to be 38 degrees C, 41 degrees C, and 44 degrees C. Results from this study will help optimize the thermal dose that can be applied to target tissue during the therapy.

  3. "The lobbying strategy is to keep excise as low as possible" - tobacco industry excise taxation policy in Ukraine

    PubMed Central

    2010-01-01

    Background Tobacco taxes are one of the most effective ways to reduce tobacco use. Transnational tobacco companies (TTCs) claim they wish to develop and secure excise systems that benefit both governments and the profitability of the companies themselves. The objective of the paper is to use the case of Ukraine, with its inconsistent history of excise tax changes in 1992-2008, to explore tobacco industry taxation strategies and tactics, and their implications for governmental revenues. Methods Details of tobacco industry policy on tobacco taxation in Ukraine were obtained by searching tobacco industry internal documents and various published reports. Results Even before entering the market in Ukraine, TTCs had made efforts to change the excise system in the country. In 1993-1994, TTCs lobbied the Ukrainian Government, and succeeded in achieving a lowering in tobacco tax. This, however, did not produce revenue increase they promised the Government. In 1996-1998, Ukrainian authorities increased excise several times, ignoring the wishes of TTCs, caused significant growth in revenue. Due to TTCs lobbying activities in 1999-2007 the tax increases were very moderate and it resulted in increased tobacco consumption in Ukraine. In 2008, despite the TTCs position, excise rates were increased twice and it was very beneficial for revenues. Conclusions The Framework Convention on Tobacco Control includes provisions both on tobacco taxation policy and on protection of public health policy from vested interests of tobacco industry. This paper provides arguments why tobacco taxation policy should also be protected from vested interests of tobacco industry. TTCs taxation strategy appears to be consistent: keep excise as low as possible. Apparent conflicts between TTCs concerning tax structures often hide their real aim to change tax structures for competing interests without increasing total tax incidence. Governments, that aim to reduce levels of tobacco use, should not allow

  4. Preoperational test report, recirculation condenser cooling systems

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  5. Pancoast tumors: characteristics and preoperative assessment

    PubMed Central

    Panagopoulos, Nikolaos; Leivaditis, Vasilios; Koletsis, Efstratios; Prokakis, Christos; Alexopoulos, Panagiotis; Baltayiannis, Nikolaos; Hatzimichalis, Antonios; Tsakiridis, Kosmas; Zarogoulidis, Konstantinos; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Kesisis, Georgios; Siminelakis, Stavros; Madesis, Athanasios; Dougenis, Dimitrios

    2014-01-01

    Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner’s syndrome (ptosis, miosis, and anhidrosis) and atrophy of the intrinsic hand muscles comprises a clinical entity named as “Pancoast-Tobias syndrome”. Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment. PMID:24672686

  6. Preoperative nuclear scans in patients with melanoma

    SciTech Connect

    Au, F.C.; Maier, W.P.; Malmud, L.S.; Goldman, L.I.; Clark, W.H. Jr.

    1984-05-15

    One hundred forty-one liver scans, 137 brain scans, and 112 bone scans were performed in 192 patients with clinical Stage 1 melanoma. One liver scan was interpreted as abnormal; liver biopsy of that patient showed no metastasis. There were 11 suggestive liver scans; three of the patients with suggestive liver scans had negative liver biopsies. The remaining eight patients were followed from 4 to 6 years and none of those patients developed clinical evidence of hepatic metastases. All of the brain scans were normal. Five patients had suggestive bone scans and none of those patients had manifested symptoms of osseous metastases with a follow-up of 2 to 4.5 years. This study demonstrates that the use of preoperative liver, brain and bone scan in the evaluation of patients with clinical Stage 1 melanoma is virtually unproductive.

  7. Pre-operative antiseptic skin preparation.

    PubMed

    Murkin, Claire Elizabeth

    Theatre nurses use antiseptic skin preparation products every day, but little thought seems to be given as to why a surgeon has a particular preference for one antiseptic skin preparation over another - whether it is for its efficacy, safety or application properties. Woodhead et al (2004) states that nurses still work in a ritualistic environment. Rituals are 'any action performed according to custom, without understanding the reasons why it is being practised'. Nursing practice should be evidence-based; nurses should understand the rationale behind the choice of a particular antiseptic, and be knowledgable about the clinical effectiveness of antiseptic's use pre-operatively, to achieve optimum results. This article focuses on the main types of antiseptic skin preparation while highlighting each product's activity and the relevant considerations for choosing the appropriate product for each patient. Theatre staff need to emphasize the importance of skin preparation and the correct application techniques, while educating the scrub team and surgeons with respect to skin preparation.

  8. Pre-operative optimisation of lung function

    PubMed Central

    Azhar, Naheed

    2015-01-01

    The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4–6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function. PMID:26556913

  9. Pre-operative nutrition and carbohydrate loading.

    PubMed

    Kratzing, Caroline

    2011-08-01

    An optimal nutritional state is an important consideration in providing successful operative outcomes. Unfortunately, many aspects of surgery are not constructive to providing this. In addition, the metabolic and immune response to injury induces a catabolic state and insulin resistance, a known risk factor of post-operative complications. Aggressive insulin therapy post-operatively has been shown to reduce morbidity and mortality but similar results can be achieved when insulin resistance is lessened by the use of pre-operative carbohydrate loading. Consuming carbohydrate-containing drinks up to 2 h before surgery has been found to be an effective way to attenuate insulin resistance, minimise protein losses, reduce hospital stays and improve patient comfort without adversely affecting gastric emptying. Enhanced recovery programmes have employed carbohydrate loading as one of several strategies aimed at reducing post-operative stress and improving the recovery process. Studies examining the benefits of these programmes have demonstrated significantly shorter post-operative hospital stays, faster return to normal functions and lower occurrences of surgical complications. As a consequence of the favourable evidence they are now being implemented in many surgical units. Further benefit to post-operative recovery may be found with the use of immune-enhancing diets, i.e. supplementation with n-3 fatty acids, arginine, glutamine and/or nucleotides. These have the potential to boost the immune system, improve wound healing and reduce inflammatory markers. Research exploring the benefits of immunonutrition and solidifying the use of carbohydrate loading is ongoing; however, there is strong evidence to link good pre-operative nutrition and improved surgical outcomes.

  10. Transurethral Procedures for Lower Urinary Tract Symptoms Resulting From Benign Prostatic Enlargement: A Quality and Meta-Analysis

    PubMed Central

    Lee, Seung Wook; Choi, Jong Bo; Lee, Kyu-Sung; Kim, Tae-Hyoung; Son, Hwancheol; Jung, Tae Young; Oh, Seung-June; Jeong, Hee Jong; Bae, Jae Hyun; Lee, Young-Suk

    2013-01-01

    Purpose Thanks to advancements in surgical techniques and instruments, many surgical modalities have been developed to replace transurethral resection of the prostate (TURP). However, TURP remains the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). We conducted a meta-analysis on the efficacy and safety of minimally invasive surgical therapies for BPH compared with TURP. Methods This meta-analysis used a Medline search assessing the period from 1997 to 2011. A total of 784 randomized controlled trials were identified in an electronic search. Among the 784 articles, 36 randomized controlled trials that provided the highest level of evidence (level 1b) were included in the meta-analysis. We also conducted a quality analysis of selected articles. Results Only 2 articles (5.56%) were assessed as having a low risk of bias by use of the Cochrane collaboration risk of bias tool. On the other hand, by use of the Jadad scale, there were 26 high-quality articles (72.22%). Furthermore, 28 articles (77.78%) were assessed as high-quality articles by use of the van Tulder scale. Holmium laser enucleation of the prostate (HoLEP) showed the highest reduction of the International Prostate Symptom Score compared with TURP (P<0.0001). Bipolar TURP, bipolar transurethral vaporization of the prostate, HoLEP, and open prostatectomy showed superior outcome in postvoid residual urine volume and maximum flow rate. The intraoperative complications of the minimally invasive surgeries had no statistically significant inferior outcomes compared with TURP. Also, there were no statistically significant differences in any of the modalities compared with TURP. Conclusions The selection of an appropriate surgical modality for BPH should be assessed by fully understanding each patient's clinical conditions. PMID:23869269

  11. [Elimination of the obturator reflex with prilocaine in transurethral resection of bladder tumors in combination with spinal and general anesthesia].

    PubMed

    Schwilick, R; Steinhoff, H

    1987-04-01

    During transurethral resection of bladder tumors under either spinal or general anesthesia without muscular relaxation, direct stimulation of the obturator nerve by the electroresectoscope is possible. The resulting obturator reflex may lead to severe complications, at the worst to a perforation of the bladder. Therefore, if resection in lateral bladder regions is necessary, blockade of the obturator nerve is often required to provide optimal conditions for transurethral resection of bladder tumors. To interrupt the obturator reflex are, we blocked the inguinal lumbar plexus using the "3-in-1-block" as described by Winnie because of its advantages compared to isolated blockade of the obturator nerve. Prilocaine 1% was the chosen local anesthetic because of its low tendency towards cardiac and cerebral side effects. Spinal anesthesia was induced with 3-4 ml hyperbaric bupivacaine 0.5%. After the onset of analgesia, making use of a nerve stimulator, a "3-in-1-block" was completed with 30-35 ml prilocaine 1%. The study included over 90 patients. Firstly we observed the efficiency of the obturator motor block by the "3-in-1-block"; secondly clinical side effects of prilocaine were evaluated; and finally in 20 cases methemoglobin levels were measured before and 90 min after injection of prilocaine. A "3-in-1-block" with prilocaine 1% provided a good motor block of the obturator nerve. Neither clinical side effects nor relevant methemoglobinemia occurred. In 3 cases methemoglobin levels were elevated by 1%, whereas in the remaining 17 cases methemoglobin values were normal.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Fast Conformal Thermal Ablation in the Prostate with Transurethral Multi-Sectored Ultrasound Devices and MR Guidance

    NASA Astrophysics Data System (ADS)

    Kinsey, Adam M.; Diederich, Chris J.; Nau, William H.; Ross, Anthony B.; Pauly, Kim Butts; Rieke, Viola; Sommer, Graham

    2007-05-01

    Transurethral ultrasound applicators incorporating an array of multisectored tubular transducers were evaluated in theoretical simulations and in vivo canine prostates under MR guidance as a method for fast, conformal thermal therapy of the prostate. Comprehensive simulations with a biothermal model investigated the effect on lesion creation of sector size, perfusion, treatment time, rectal cooling, prostate target dimensions, and feedback controller parameters (maximum temperature, pilot points at boundary, update times). In vivo canine prostates (n = 4) were treated with trisectored ultrasound transducers (3 mm OD) under MR temperature monitoring to contour the ablation zone (>52 C for 1-2 min) to the boundary of the prostate. Contiguous thermal lesions extended 2 cm in radius from the urethra in less than 15 min and independent sector control simultaneously allowed for conformal treatment in the angular dimension. Experiments investigated sequential translation of the transducer assembly within the catheter for tailoring heat treatments to different partitions in the prostate (base, apex) without changing the initial setup. This treatment method offered greater lesion shape control in three dimensions and slightly lengthened the overall treatment time. The MR temperature images correlated with post-treatment histology and accurately controlled the heating to the target boundary. MR-based control of transurethral ultrasound devices appeared more practical with multisectored transducers compared to rotating curvilinear and planar applicators due to less stringent requirements on spatial and temporal MR parameters. This study demonstrated the applicability of these devices in the prostate for anterior-lateral BPH treatment, and whole gland or quadrant target volumes for cancer treatment.

  13. Excise Taxes and the Price Elasticity of Demand.

    ERIC Educational Resources Information Center

    Gamble, Ralph C., Jr.

    1989-01-01

    Points out that, although the analysis of the imposition of an excise tax is widely used in economics courses, the consequences of a change in the tax rate are different and ignored. This article presents an effective way to teach about such a change. (GG)

  14. Nucleotide excision repair by dual incisions in plants

    PubMed Central

    Canturk, Fazile; Karaman, Muhammet; Selby, Christopher P.; Kemp, Michael G.; Kulaksiz-Erkmen, Gulnihal; Hu, Jinchuan; Li, Wentao; Lindsey-Boltz, Laura A.; Sancar, Aziz

    2016-01-01

    Plants use light for photosynthesis and for various signaling purposes. The UV wavelengths in sunlight also introduce DNA damage in the form of cyclobutane pyrimidine dimers (CPDs) and pyrimidine (6-4) pyrimidone photoproducts [(6-4)PPs] that must be repaired for the survival of the plant. Genome sequencing has revealed the presence of genes for both CPD and (6-4)PP photolyases, as well as genes for nucleotide excision repair in plants, such as Arabidopsis and rice. Plant photolyases have been purified, characterized, and have been shown to play an important role in plant survival. In contrast, even though nucleotide excision repair gene homologs have been found in plants, the mechanism of nucleotide excision repair has not been investigated. Here we used the in vivo excision repair assay developed in our laboratory to demonstrate that Arabidopsis removes CPDs and (6-4)PPs by a dual-incision mechanism that is essentially identical to the mechanism of dual incisions in humans and other eukaryotes, in which oligonucleotides with a mean length of 26–27 nucleotides are removed by incising ∼20 phosphodiester bonds 5′ and 5 phosphodiester bonds 3′ to the photoproduct. PMID:27071131

  15. Structural basis of HIV-1 resistance to AZT by excision.

    PubMed

    Tu, Xiongying; Das, Kalyan; Han, Qianwei; Bauman, Joseph D; Clark, Arthur D; Hou, Xiaorong; Frenkel, Yulia V; Gaffney, Barbara L; Jones, Roger A; Boyer, Paul L; Hughes, Stephen H; Sarafianos, Stefan G; Arnold, Eddy

    2010-10-01

    Human immunodeficiency virus (HIV-1) develops resistance to 3'-azido-2',3'-deoxythymidine (AZT, zidovudine) by acquiring mutations in reverse transcriptase that enhance the ATP-mediated excision of AZT monophosphate from the 3' end of the primer. The excision reaction occurs at the dNTP-binding site, uses ATP as a pyrophosphate donor, unblocks the primer terminus and allows reverse transcriptase to continue viral DNA synthesis. The excision product is AZT adenosine dinucleoside tetraphosphate (AZTppppA). We determined five crystal structures: wild-type reverse transcriptase-double-stranded DNA (RT-dsDNA)-AZTppppA; AZT-resistant (AZTr; M41L D67N K70R T215Y K219Q) RT-dsDNA-AZTppppA; AZTr RT-dsDNA terminated with AZT at dNTP- and primer-binding sites; and AZTr apo reverse transcriptase. The AMP part of AZTppppA bound differently to wild-type and AZTr reverse transcriptases, whereas the AZT triphosphate part bound the two enzymes similarly. Thus, the resistance mutations create a high-affinity ATP-binding site. The structure of the site provides an opportunity to design inhibitors of AZT-monophosphate excision.

  16. Nucleotide excision repair by dual incisions in plants.

    PubMed

    Canturk, Fazile; Karaman, Muhammet; Selby, Christopher P; Kemp, Michael G; Kulaksiz-Erkmen, Gulnihal; Hu, Jinchuan; Li, Wentao; Lindsey-Boltz, Laura A; Sancar, Aziz

    2016-04-26

    Plants use light for photosynthesis and for various signaling purposes. The UV wavelengths in sunlight also introduce DNA damage in the form of cyclobutane pyrimidine dimers (CPDs) and pyrimidine (6-4) pyrimidone photoproducts [(6-4)PPs] that must be repaired for the survival of the plant. Genome sequencing has revealed the presence of genes for both CPD and (6-4)PP photolyases, as well as genes for nucleotide excision repair in plants, such as Arabidopsis and rice. Plant photolyases have been purified, characterized, and have been shown to play an important role in plant survival. In contrast, even though nucleotide excision repair gene homologs have been found in plants, the mechanism of nucleotide excision repair has not been investigated. Here we used the in vivo excision repair assay developed in our laboratory to demonstrate that Arabidopsis removes CPDs and (6-4)PPs by a dual-incision mechanism that is essentially identical to the mechanism of dual incisions in humans and other eukaryotes, in which oligonucleotides with a mean length of 26-27 nucleotides are removed by incising ∼20 phosphodiester bonds 5' and 5 phosphodiester bonds 3' to the photoproduct. PMID:27071131

  17. The surgical treatment of familial cylindromatosis through subgaleal scalp excision

    PubMed Central

    Karalija, Amar; Andersson, Magnus N.

    2015-01-01

    We treated a 65-year-old woman with familial cylindromatosis, with cylindromas covering the entire scalp. Subgaleal tumor excision and split skin grafting was performed. The graft take was deemed to be excellent, with almost 100% coverage 2.5 weeks after operation, no complications and a satisfying esthetic result. PMID:27252972

  18. A Rat Excised Larynx Model of Vocal Fold Scar

    ERIC Educational Resources Information Center

    Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.

    2009-01-01

    Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…

  19. Total mesorectal excision for cancer following ventral mesh rectopexy

    PubMed Central

    Al-Whouhayb, M; Middleton, S

    2013-01-01

    Since the introduction of ventral mesh rectopexy for rectal prolapse, concern exists as to how this may interfere with subsequent rectal cancer surgery. To our knowledge, this is the first report of total mesorectal excision for cancer after such a rectopexy. We discuss surgical technique, pitfalls encountered and oncological outcome. PMID:24025277

  20. [CIRCUMCISION AND EXCISION: TOWARDS A NON-LAW OF BIOETHICS?].

    PubMed

    Delage, Pierre-Jérôme

    2015-07-01

    This article defines the practices of circumcision and excision, and studies their foundations. Then, it considers some of the conflicts (of rights, laws and cultures) inherent to these practices. Finally, it suggests that the solution to these conflicts may not lie in the law, but in a non-law of bioethics. PMID:27356346

  1. 75 FR 9359 - Drawback of Internal Revenue Excise Tax

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-02

    ... Federal Register (74 FR 52928) proposing changes to parts 113 and 191 within title 19 of the Code of... the Federal Register (74 FR 52928) on October 15, 2009, so that relevant issues involved in the... Parts 113 and 191 RIN 1505-AC18 Drawback of Internal Revenue Excise Tax AGENCY: Customs and...

  2. An Economic Analysis of a Change in an Excise Tax

    ERIC Educational Resources Information Center

    Barron, John M.; Blanchard, Kelly Hunt; Umbeck, John R.

    2004-01-01

    The authors present an example of the effect a change in the excise tax can have on retail gasoline prices. The findings provide support for standard economic theory, as well as provide a vehicle for illustrating some of the subtleties of the analysis, including the implicit assumptions regarding the implications for the buying and selling prices…

  3. Structural basis of HIV-1 resistance to AZT by excision

    SciTech Connect

    Tu, Xiongying; Das, Kalyan; Han, Qianwei; Bauman, Joseph D.; Clark, Jr., Arthur D.; Hou, Xiaorong; Frenkel, Yulia V.; Gaffney, Barbara L.; Jones, Roger A.; Boyer, Paul L.; Hughes, Stephen H.; Sarafianos, Stefan G.; Arnold, Eddy

    2011-11-23

    Human immunodeficiency virus (HIV-1) develops resistance to 3'-azido-2',3'-deoxythymidine (AZT, zidovudine) by acquiring mutations in reverse transcriptase that enhance the ATP-mediated excision of AZT monophosphate from the 3' end of the primer. The excision reaction occurs at the dNTP-binding site, uses ATP as a pyrophosphate donor, unblocks the primer terminus and allows reverse transcriptase to continue viral DNA synthesis. The excision product is AZT adenosine dinucleoside tetraphosphate (AZTppppA). We determined five crystal structures: wild-type reverse transcriptase-double-stranded DNA (RT-dsDNA)-AZTppppA; AZT-resistant (AZTr; M41L D67N K70R T215Y K219Q) RT-dsDNA-AZTppppA; AZTr RT-dsDNA terminated with AZT at dNTP- and primer-binding sites; and AZTr apo reverse transcriptase. The AMP part of AZTppppA bound differently to wild-type and AZTr reverse transcriptases, whereas the AZT triphosphate part bound the two enzymes similarly. Thus, the resistance mutations create a high-affinity ATP-binding site. The structure of the site provides an opportunity to design inhibitors of AZT-monophosphate excision.

  4. Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children

    ERIC Educational Resources Information Center

    Wright, Kristi D.; Stewart, Sherry H.; Finley, G. Allen; Buffett-Jerrott, Susan E.

    2007-01-01

    Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination, and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been…

  5. Preoperative embolisation in the management of juvenile nasopharyngeal angiofibroma.

    PubMed

    Palmer, F J

    1989-11-01

    Thirteen cases of juvenile angiofibroma were treated surgically with preoperative embolisation. One case occurred in a female. Embolisation significantly reduced blood loss and allowed complete surgical removal of the tumour in all cases. No significant complications occurred. Preoperative embolisation should be employed routinely in the surgical management of these patients.

  6. Gamma probe-assisted excision of an ectopic parathyroid adenoma located within the thymus: case report and review of the literature

    PubMed Central

    2014-01-01

    Primary hyperparathyroidism due to parathyroid adenomas may be associated with ectopic parathyroid gland localization in 20-25% of the patients. We report herein the excision of an ectopic parathyroid adenoma which was detected in the thymus gland by gamma probe intraoperatively. A 38-year-old patient presented to our clinic with a history of bilateral nephrolithiasis, chronic hypercalcaemia, and PTH elevation. A combination of Technetium-99 m sestamibi scintigraphy and Computed Tomography scan of the chest and neck revealed an ectopic parathyroid adenoma of 8.5 mm in its greatest dimension. The patient underwent sternotomy and the adenoma was found within the right lobe of the thymus gland with the intraoperative use of gamma probe. PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively. We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery. The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration. PMID:24685256

  7. Curvilinear transformation of z-shaped upper lip scar by diamond-shaped excision in secondary cleft lip deformities: a photogrammetric evaluation.

    PubMed

    Han, Kihwan; Jeong, Hoijoon; Choi, Tae Hyun; Kim, Jun Hyung; Son, Daegu

    2015-03-01

    Purpose : The visible Z-shaped upper lip scar that occurs after the Tennison and Randall triangular flap technique remains a cleft stigma. Herein, we present our curvilinear transformation technique for the Z-shaped upper lip scar by diamond-shaped excision and evaluate the results using photogrammetric analyses. Patients and Methods : From 1997 to 2006, 23 patients with secondary cleft lip deformity with the visible Z-shaped upper lip scar underwent correction with the technique. The scar was excised in the diamond shape above the muscle. After curvilinear closure, the elongated length of the upper lip was excised just below the nostril sill, as the measured Cupid's bow height discrepancy. The result was assessed by the authors' standardized photogrammetry technique. Results : There was a statistically significant decrease between the preoperative central limb of the Z-shaped scar and the width of the postoperative curvilinear upper lip scar. The pre- and postoperative Cupid's bow height differences were not statistically significant. Conclusions : The curvilinear transformation of the Z-shaped scar is an efficient procedure that provides (1) a significant decrease in the width of an upper lip scar to make it less conspicuous, (2) incorporation of the scar into the philtral column, (3) a biconcave natural philtral column shape in frontal view, and (4) formation of the natural concave philtral contour in profile view. PMID:25714266

  8. Craniotomy for cerebellar hemangioblastoma excision in a patient with von Hippel–Lindau disease complicated by uncontrolled hypertension due to pheochromocytoma

    PubMed Central

    Mizobuchi, Yoshifumi; Kageji, Teruyoshi; Tadashi, Yamaguchi; Nagahiro, Shinji

    2015-01-01

    Introduction This report describes a patient with Von Hippel–Lindau (VHL) syndrome and uncontrolled hypertension due to pheochromocytoma who underwent craniotomy for the excision of a cerebellar hemangioblastoma combined with a laparoscopic adrenalectomy. Case report A 31-year-old man presented with severe headache. MRI showed areas of abnormal enhancement in the left cerebellum that were determined to be hemangioblastoma with mass effect and obstructive hydrocephalus. His blood pressure rose abruptly and could not be controlled. CT of the abdomen revealed bilateral suprarenal tumors, and the patient was diagnosed as having VHL syndrome.On the third day, he presented with increasing headache, a decreased level of consciousness, and hemiparesis. We were not able to perform an craniotomy because abdominal compression in the prone or sitting position resulted in severe hypertension. We performed ventricular drainage to control his ICP. On the fifth day, we first performed a bilateral laparoscopic adrenalectomy to control ICP and then moved the patient to the prone position before performing a craniotomy to remove the left cerebellar hemangioblastoma. Discu ssion & conclusion In patients with pheochromocytoma, the effects of catecholamine oversecretion can cause significant perioperative morbidity and mortality, but these can be prevented by appropriate preoperative medical management. When carrying out an excision of cerebellar hemangioblastomas in patients with intracranial hypertension complicated by abnormal hypertension due to pheochromocytoma whose blood pressure is not sufficiently controlled, tumor resection of the pheochromocytoma prior to cerebellar hemangioblastoma excision in the same surgery may prevent increased ICP and reduce perioperative risk. PMID:26595895

  9. Curvilinear transformation of z-shaped upper lip scar by diamond-shaped excision in secondary cleft lip deformities: a photogrammetric evaluation.

    PubMed

    Han, Kihwan; Jeong, Hoijoon; Choi, Tae Hyun; Kim, Jun Hyung; Son, Daegu

    2015-03-01

    Purpose : The visible Z-shaped upper lip scar that occurs after the Tennison and Randall triangular flap technique remains a cleft stigma. Herein, we present our curvilinear transformation technique for the Z-shaped upper lip scar by diamond-shaped excision and evaluate the results using photogrammetric analyses. Patients and Methods : From 1997 to 2006, 23 patients with secondary cleft lip deformity with the visible Z-shaped upper lip scar underwent correction with the technique. The scar was excised in the diamond shape above the muscle. After curvilinear closure, the elongated length of the upper lip was excised just below the nostril sill, as the measured Cupid's bow height discrepancy. The result was assessed by the authors' standardized photogrammetry technique. Results : There was a statistically significant decrease between the preoperative central limb of the Z-shaped scar and the width of the postoperative curvilinear upper lip scar. The pre- and postoperative Cupid's bow height differences were not statistically significant. Conclusions : The curvilinear transformation of the Z-shaped scar is an efficient procedure that provides (1) a significant decrease in the width of an upper lip scar to make it less conspicuous, (2) incorporation of the scar into the philtral column, (3) a biconcave natural philtral column shape in frontal view, and (4) formation of the natural concave philtral contour in profile view.

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

    SciTech Connect

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

    2012-02-01

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

  11. Comparison of Three Surgical Methods in Treatment of Patients with Pilonidal Sinus: Modified Excision and Repair/Wide Excision/Wide Excision and Flap in RASOUL, OMID and SADR Hospitals( 2004-2007).

    PubMed

    Hosseini, Mostafa; Heidari, Afshin; Jafarnejad, Babak

    2013-10-01

    This study is a comparison between three methods that are frequently used for the surgical treatment of pilonidal disease all over the world: modified excision and repair, wide excision and secondary repair, and wide excision and flap. The first technique is done by our group for the first time, and has not been described previously in the literature. This is an interventional study performed at Omid, Sadr, and Rasoul Akram hospitals on patients who had undergone operation because of pilonidal sinus disease and met the inclusion criteria between 2004 and 2007. Exclusion criteria were (1) acute pilonidal sinus diseases, (2) history of pilonidal sinus surgery, (3) history of systemic diseases (DM, malignancy, etc.), and (4) pilonidal abscess. Essential information was extracted from complete medical archives. Any data not available in files or during follow-up visits (all patients supposed to be followed at least for 1 year) were gathered by a telephone interview. A total of 194 patients met the criteria and had complete archived files. Longer duration of hospital stay was found in the "wide excision and closing with flap" method comparing with two other methods (P < 0.05). Length of incapacity for work was not different between the "wide excision and modified repair" and "wide excision" (P > 0.5) methods, but longer for "wide excision and flap" in comparison with two others (P < 0.05). Healing time was significantly longer in the "wide excision" method in comparison with two other methods (P < 0.05). However, "wide excision and modified repair" method had the least healing time between all above techniques, except for length of leaving the office. All the three recurrences (1.5 %) occurred in the wide excision and flap method (P < 0.05). The frequency of postoperative complications was 2 (3.3 %) in wide excision and modified repair, 15 (18.5 %) in wide excision, and 17 (32.7 %) in wide excision and flap closure; these differences in

  12. Changes in the serum concentrations of sodium, potassium, and free haemoglobin during transurethral resection of the prostate--parts of the TUR-syndrome?

    PubMed

    Mommsen, S; Genster, H G; Moller, J

    1977-01-01

    In 133 patients undergoing transurethral resection of the prostate under standardized conditions the concentration of serum sodium decreased, and the concentration of free plasma haemoglobin increased significantly after the operation. Such changes were not found in a control group of 31 patients undergoing cystoscopy or bladder biopsy. The changes in the operated group are believed to be caused by the absorption of water used as irrigating fluid during the resection. PMID:595248

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

    PubMed Central

    2013-01-01

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

  14. Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

    PubMed Central

    CAO, YINGXIAO; WANG, FENGJU; LIU, ZHENBO; JIAO, BAOHUA

    2016-01-01

    Pituitary adenomas are benign intracranial endocrine tumors, accounting for ~10% of intracranial tumors. The aim of the present study was to analyze the effects of preoperative treatment with bromocriptine on the surgical treatment and postoperative complications of prolactin-secreting pituitary adenomas (prolactinomas). Data from 102 patients whose prolactinomas were surgically treated between March 2006 and March 2010 were retrospectively reviewed in the present study. The study group included 54 patients who had been treated preoperatively with bromocriptine. The patients were examined by magnetic resonance imaging (MRI) of the head and coronal computed tomography (CT) scanning, after which the pathological diagnosis of prolactinoma was confirmed. A total of 64 patients underwent total resection surgery through the nose and sphenoid sinus, and 25 patients underwent subtotal resection surgery or excision of a large portion of the tumor, leaving only a small quantity of residual tumor or tumor capsule. Patients were followed up for 1–9 months using MRI and measurements of serum prolactin levels. Seven patients were lost to follow-up. The results of the present study demonstrated that patients who were treated with large doses of bromocriptine or used bromocriptine chronically suffered from an increased rate of surgical difficulties and postoperative complications, as compared with the patents who had not been pre-treated with bromocriptine. In conclusion, oral administration of bromocriptine is important in the treatment of prolactinoma tumors. However, large doses or long-term use of bromocriptine may increase difficulties in surgery or postoperative complications, and reduce its ability to treat prolactinonas, as it can lead to hardening of the tumor tissue and capsules, and aggravate pituitary stalk adhesions. PMID:27168837

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

    SciTech Connect

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

    2007-03-15

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

  16. The Preoperative Patient With a Systolic Murmur

    PubMed Central

    Cowie, Brian

    2015-01-01

    Context: Patients with undifferentiated systolic murmurs present commonly during the perioperative period. Traditional bedside assessment and auscultation has not changed significantly in almost 200 years and relies on interpreting indirect acoustic events as a means of evaluating underlying cardiac pathology. This is notoriously inaccurate, even in expert cardiology hands, since many different valvular and cardiac diseases present with a similar auditory signal. Evidence Acquisition: The data on systolic murmurs, physical examination, perioperative valvular disease in the setting of non-cardiac surgery is reviewed. Results: Significant valvular heart disease increases perioperative risk in major non-cardiac surgery and increases long term patient morbidity and mortality. We propose a more modern approach to physical examination that incorporates the use of focused echocardiography to allow direct visualization of cardiac structure and function. This improves the diagnostic accuracy of clinical assessment, allows rational planning of surgery and anaesthesia technique, risk stratification, postoperative monitoring and appropriate referral to physicians and cardiologists. Conclusions: With a thorough preoperative assessment incorporating focused echocardiography, anaesthetists are in the unique position to enhance their role as perioperative physicians and influence short and long term outcomes of their patients. PMID:26705529

  17. New strategies for preoperative skin antisepsis.

    PubMed

    Ulmer, Miriam; Lademann, Juergen; Patzelt, Alexa; Knorr, Fanny; Kramer, Axel; Koburger, Torsten; Assadian, Ojan; Daeschlein, Georg; Lange-Asschenfeldt, Bernhard

    2014-01-01

    During the past decades, encouraging progress has been made in the prevention of surgical site infections (SSI). However, as SSI still occur today, strategic prevention measures such as standardized skin antisepsis must be implemented and rigorously promoted. Recent discoveries in skin physiology necessitate the development of novel antiseptic agents and procedures in order to ameliorate their efficacy. In particular, alternate target structures in the skin need to be taken into consideration for the development of the next generation of antiseptics. Recent investigations have shown that a high number of microorganisms are located within and in the close vicinity of the hair follicles. This suggests that these structures are an important reservoir of bacterial growth and activity in human skin. To date, it has not been fully elucidated to what extent conventional liquid antiseptics sufficiently target the hair follicle-related microbial population. Modern technologies such as tissue-tolerable plasma (TTP) have been tested for their potential antiseptic efficiency by reducing the bacterial load in the skin and in the hair follicles. First experiments using liposomes to deliver antiseptics into the hair follicles have been evaluated for their potential clinical application. The present review evaluates these two innovative methods for their efficacy and applicability in preoperative skin antiseptics.

  18. Does resectoscope size play a role in formation of urethral stricture following transurethral prostate resection?

    PubMed Central

    Günes, Mustafa; Keles, Muzaffer Oguz; Kaya, Cevdet; Koca, Orhan; Sertkaya, Zülfü; Akyüz, Mehmet; Altok, Muammer; Umul, Mehmet; Karaman, Muhammet Ihsan

    2015-01-01

    ABSTRACT Background and aims: To investigate the possible effect of resectoscope size on urethral stricture rate after monopolar TURP. Materials and Methods: A retrospective study of 71 men undergoing TURP was conducted at two centers’ from November 2009 to May 2013. The patients were divided into one of two groups according to the resectoscope diameter used for TURP. Resectoscope diameter was 24 F in group 1 (n=35) or 26 F in group 2 (n=36). Urethral catheter type, catheter removal time and energy type were kept constant for all patients. Urethral stricture formation in different localizations after TURP was compared between groups. Results: There was no significant difference between the two groups in terms of age, pre-operative prostate gland volume (PV), prostate-specific antigen (PSA), maximal urinary flow rates (Qmax), International Prostate Symptom Score (IPSS) and post-voiding residual urine volume (PVR). The resection time and weight of resected prostate tissue were similar for both groups (p>0.05). A statistically significant higher incidence of bulbar stricture was detected in group 2 compared to group1 (p=0.018). Conclusions: The use of small-diameter resectoscope shafts may cause a reduction in the incidence of uretral strictures in relation to urethral friction and mucosal damage. PMID:26401868

  19. Biomolecular Simulation of Base Excision Repair and Protein Signaling

    SciTech Connect

    Straatsma, TP; McCammon, J A; Miller, John H; Smith, Paul E; Vorpagel, Erich R; Wong, Chung F; Zacharias, Martin W

    2006-03-03

    The goal of the Biomolecular Simulation of Base Excision Repair and Protein Signaling project is to enhance our understanding of the mechanism of human polymerase-β, one of the key enzymes in base excision repair (BER) and the cell-signaling enzymes cyclic-AMP-dependent protein kinase. This work used molecular modeling and simulation studies to specifically focus on the • dynamics of DNA and damaged DNA • dynamics and energetics of base flipping in DNA • mechanism and fidelity of nucleotide insertion by BER enzyme human polymerase-β • mechanism and inhibitor design for cyclic-AMP-dependent protein kinase. Molecular dynamics simulations and electronic structure calculations have been performed using the computer resources at the Molecular Science Computing Facility at the Environmental Molecular Sciences Laboratory.

  20. Excise Tax Avoidance: The Case of State Cigarette Taxes

    PubMed Central

    DeCicca, Philip; Kenkel, Donald; Liu, Feng

    2013-01-01

    We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower-tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20 percent smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes. PMID:24140760

  1. Hip Arthroscopy for Excision of Osteoid Osteoma of Femoral Neck

    PubMed Central

    Said, Hatem Galal; Abdulla Babaqi, AbdulRahman; AbdelSalam El-Assal, Maher

    2014-01-01

    Osteoid osteoma (OO) is the most commonly seen benign bone-forming lesion. It can occur anywhere, including the metaphyseal regions of small and large bones. We present 2 cases that underwent an arthroscopic technique for removal of OO of the femoral neck. The diagnosis was confirmed by computed tomography in addition to magnetic resonance imaging. The lesions were accessed arthroscopically and excised by unroofing and curettage. The clinical and radiographic findings are presented, along with the surgical management. The patients improved dramatically postoperatively. OO of the femoral neck should be included in the differential diagnosis of hip pain in young patients. Arthroscopic excision and curettage provide a good choice for management, with low morbidity and rapid recovery. PMID:24749036

  2. Excision of Thoracic Chondrosarcoma: Case Report and Review of Literature

    PubMed Central

    Wadhwa, Rishi; Theodore, Pierre; Mummaneni, Praveen

    2016-01-01

    Chondrosarcomas are cartilage-matrix-forming tumors that make up 20-27% of primary malignant bone tumors and are the third most common primary bone malignancy after multiple myelomas and osteosarcomas. Radiographic assessment of this condition includes plain radiography, computed tomography, and magnetic resonance imaging for tumor characterization and delineation of intraosseous and extraosseous involvement. Most chondrosarcomas are refractory to chemotherapy and radiation therapy; therefore, wide en bloc surgical excision offers the best chance for cure. Chondrosarcomas frequently affect the pelvis and upper and lower extremities. In rare instances, the chest wall can be involved, with chondrosarcomas occurring in the ribs, sternum, anterior costosternal junction, and posterior costotransverse junction. In this article, we present a patient with thoracic chondrosarcoma centered at the left T7 costotransverse joint with effacement of the left T7-T8 neuroforamen. We also detail our operative technique of wide en bloc chondrosarcoma excision and review current literature on this topic. PMID:27588229

  3. Excision of Thoracic Chondrosarcoma: Case Report and Review of Literature.

    PubMed

    Le, Hai V; Wadhwa, Rishi; Theodore, Pierre; Mummaneni, Praveen

    2016-01-01

    Chondrosarcomas are cartilage-matrix-forming tumors that make up 20-27% of primary malignant bone tumors and are the third most common primary bone malignancy after multiple myelomas and osteosarcomas. Radiographic assessment of this condition includes plain radiography, computed tomography, and magnetic resonance imaging for tumor characterization and delineation of intraosseous and extraosseous involvement. Most chondrosarcomas are refractory to chemotherapy and radiation therapy; therefore, wide en bloc surgical excision offers the best chance for cure. Chondrosarcomas frequently affect the pelvis and upper and lower extremities. In rare instances, the chest wall can be involved, with chondrosarcomas occurring in the ribs, sternum, anterior costosternal junction, and posterior costotransverse junction. In this article, we present a patient with thoracic chondrosarcoma centered at the left T7 costotransverse joint with effacement of the left T7-T8 neuroforamen. We also detail our operative technique of wide en bloc chondrosarcoma excision and review current literature on this topic. PMID:27588229

  4. Endoscopic excision of intraventricular neurocysticercosis blocking foramen of Monro bilaterally

    PubMed Central

    Shah, Harshil Chimanlal; Jain, Kapil; Shah, Jaimin Kiran

    2016-01-01

    Neurocysticercosis (NCC) is a parasitic infestation of the central nervous system. NCC parasitic infestation can be misdiagnosed as hydatid cyst or intraventricular epidermoid cyst that can cause a diagnostic dilemma. A 23-year-old male patient presented with headache and vomiting for 3–4 days and giddiness for 4–5 days. Magnetic resonance imaging with contrast was suggestive of a rim-enhancing lesion at the level of the foramen of Monro. Endoscopic excision of the lesion was done, and the patient had relief of a headache and vomiting immediately after the procedure. He is being followed up regularly. Intraventricular NCC occluding both foramen of Monro is a rare entity. Complete endoscopic surgical excision followed by appropriate drug therapy should be given to achieve a cure. PMID:27057236

  5. Excise tax avoidance: the case of state cigarette taxes.

    PubMed

    DeCicca, Philip; Kenkel, Donald; Liu, Feng

    2013-12-01

    We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20% smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes.

  6. 29 CFR 779.263 - Excise taxes not at the retail level.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Excise taxes not at the retail level. 779.263 Section 779... Coverage Excise Taxes § 779.263 Excise taxes not at the retail level. There are also a wide variety of taxes levied at the manufacturer's or distributor's level and not at the retail level. It should...

  7. 27 CFR 25.298 - Excise tax return, Form 5000.24.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Excise tax return, Form... BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Records and Reports § 25.298 Excise tax return, Form 5000.24. All entries on the excise tax return, Form 5000.24, will be fully supported by accurate...

  8. 77 FR 37838 - Disregarded Entities and the Indoor Tanning Services Excise Tax

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-25

    ... Services Excise Tax AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed rulemaking... (including qualified subchapter S subsidiaries) and the indoor tanning services excise tax. These regulations affect disregarded entities responsible for collecting the indoor tanning services excise tax and...

  9. Increased Ac excision (iae): Arabidopsis thaliana mutations affecting Ac transposition.

    PubMed

    Jarvis, P; Belzile, F; Page, T; Dean, C

    1997-05-01

    The maize transposable element Ac is highly active in the heterologous hosts tobacco and tomato, but shows very much reduced levels of activity in Arabidopsis. A mutagenesis experiment was undertaken with the aim of identifying Arabidopsis host factors responsible for the observed low levels of Ac activity. Seed from a line carrying a single copy of the Ac element inserted into the streptomycin phosphotransferase (SPT) reporter fusion, and which displayed typically low levels of Ac activity, were mutagenized using gamma rays. Nineteen mutants displaying high levels of somatic Ac activity, as judged by their highly variegated phenotypes, were isolated after screening the M2 generation on streptomycin-containing medium. The mutations fall into two complementation groups, iae1 and iae2, are unlinked to the SPT::Ac locus and segregate in a Mendelian fashion. The iae1 mutation is recessive and the iae2 mutation is semi-dominant. The iae1 and iae2 mutants show 550- and 70-fold increases, respectively, in the average number of Ac excision sectors per cotyledon. The IAE1 locus maps to chromosome 2, whereas the SPT::Ac reporter maps to chromosome 3. A molecular study of Ac activity in the iae1 mutant confirmed the very high levels of Ac excision predicted using the phenotypic assay, but revealed only low levels of Ac re-insertion. Analyses of germinal transposition in the iae1 mutant demonstrated an average germinal excision frequency of 3% and a frequency of independent Ac re-insertions following germinal excision of 22%. The iae mutants represents a possible means of improving the efficiency of Ac/Ds transposon tagging systems in Arabidopsis, and will enable the dissection of host involvement in Ac transposition and the mechanisms employed for controlling transposable element activity.

  10. Excising das All: Evolving Maxwell waves beyond Scri

    NASA Technical Reports Server (NTRS)

    vanMeter, James R.; Fiske, David R.; Misner, Charles W.

    2006-01-01

    We study the numerical propagation of waves through future null infinity in a conformally compactified spacetime. We introduce an artificial cosmological constant, which allows us some control over the causal structure near null infinity. We exploit this freedom to ensure that all light cones are tilted outward in a region near null infinity, which allows us to impose excision-style boundary conditions in our finite difference code. In this preliminary study we consider electromagnetic waves propagating in a static, conformally compactified spacetime.

  11. Base excision repair and the role of MUTYH

    PubMed Central

    Kairupan, Carla; Scott, Rodney J

    2007-01-01

    The correction of exogenous and endogenous environmental insult to DNA involves a series of DNA repair mechanisms that reduce the likelihood of mutation accumulation and hence an increased probability of tumour development. The mechanisms underlying the process of base excision repair are relatively well understood and are placed in context with how deterioration of this process is associated with an increased risk of malignancy. PMID:19725997

  12. Laparoscopic excision of subdiaphragmatic epidermoid cyst: a case report.

    PubMed

    Hagr, A; Laberge, J M; Nguyen, L T; Emil, S; Bernard, C; Patenaude, Y

    2001-06-01

    Retroperitoneal epidermoid cysts are rare. The authors report a case of an 11-year-old boy with an asymptomatic subdiaphragmatic cyst, which was found incidentally during an investigation for hypertension. At laparoscopy, the cyst was densely adherent to the diaphragm, resulting in a pneumothorax during dissection. Nevertheless, the excision and the diaphragmatic repair could be completed laparoscopically without complication. Microscopic examination showed an epidermoid cyst. No similar case has been reported in the literature.

  13. Staged Excision for Lentigo Maligna and Lentigo Maligna Melanoma

    PubMed Central

    Wilson, Joshua B.; Walling, Hobart W.; Scupham, Richard K.; Bean, Andrew K.; Ceilley, Roger I.

    2016-01-01

    Introduction: Lentigo maligna is a form of in situ melanoma that occurs commonly on sun-exposed skin of middle-aged to elderly adults. Margin-control surgery offers the highest cure rate for lentigo maligna/lentigo maligna melanoma. Materials and methods: Charts from the authors’ private office from the 20-year period from January 1986 to December 2005 were reviewed to identify patients with histologically confirmed lentigo maligna or lentigo maligna melanoma treated by staged excision. Results: Sixty-eight patients (39 men, 29 women; mean age at diagnosis 67.4±10.2 years, range 48-87 years) with 68 tumors were treated in the authors’ office for lentigo maligna (58) or lentigo maligna melanoma (10) between January 1986 and December 2005. After excision, patients were followed clinically for a minimum of three years. The mean follow-up duration was 138 months (median 139 months; range 37-330 months). The overall margin for tumor clearance was 7.0±0.55mm with a recurrence rate of 5.9 percent. Limitations: The limitations of this study include the retrospective nature of the authors’ review, and data collected from a single, private practice setting. Conclusion: The authors’ findings support staged excision as an effective method of treating lentigo maligna and lentigo maligna melanoma, offering a high cure rate while maximally preserving normal tissue. PMID:27386048

  14. [Retarded excision of pyrimidine dimers in human unstimulated lymphocytes].

    PubMed

    Snopov, S A; Roza, L; de Gruijl, F R

    2006-01-01

    Using immuno-labelling of cyclobutane pyrimidine dimers (CPDs) in nuclei of peripheral lymphocytes after their UVC-irradiation and cultivation, we have found that within the first four hours of cultivation the CPD-specific fluorescent signal from cell nuclei increased. Earlier, a similar increase in binding of antibody specific for pyrimidine (6-4) pyrimidone photoproducts to undenatured DNA isolated from UV-irradiated Chinese hamster ovary cells was reported (Mitchell et al., 1986). Our experiments showed that nucleotide excision repair enzyme might induce such of DNA modification in lymphocyte nuclei that increased specific antibody binding to DNA fragments with lesions. We suggest that enzymatic formation of open structures in DNA predominated qualitatively over dual-incision and excision of these fragments, and resulted in the enhanced exposure of the pyrimidine dimers in nuclei to specific antibodies. The results evidence that nucleotid excision repair in unstimualted human lymphocytes being deficient in dual incision and removal of UV-induced DNA lesions appear to be capable of performing chromatin relaxation and pre-incision uncoiling of DNA fragments with lesions.

  15. A molecular beacon assay for measuring base excision repair activities.

    PubMed

    Maksimenko, Andrei; Ishchenko, Alexander A; Sanz, Guenhaël; Laval, Jacques; Elder, Rhoderick H; Saparbaev, Murat K

    2004-06-18

    The base excision repair (BER) pathway plays a key role in protecting the genome from endogenous DNA damage. Current methods to measure BER activities are indirect and cumbersome. Here, we introduce a direct method to assay DNA excision repair that is suitable for automation and industrial use, based on the fluorescence quenching mechanism of molecular beacons. We designed a single-stranded DNA oligonucleotide labelled with a 5'-fluorescein (F) and a 3'-Dabcyl (D) in which the fluorophore, F, is held in close proximity to the quencher, D, by the stem-loop structure design of the oligonucleotide. Following removal of the modified base or incision of the oligonucleotide, the fluorophore is separated from the quencher and fluorescence can be detected as a function of time. Several modified beacons have been used to validate the assay on both cell-free extracts and purified proteins. We have further developed the method to analyze BER in cultured cells. As described, the molecular beacon-based assay can be applied to all DNA modifications processed by DNA excision/incision repair pathways. Possible applications of the assay are discussed, including high-throughput real-time DNA repair measurements both in vitro and in living cells.

  16. Modified excised teat model for laboratory screening of teat dips.

    PubMed

    Hall, P A; Yordy, C J

    1981-09-01

    Because of numerous indigenous microorganisms on excised teats that interfere with enumeration of challenge cultures on nonselective media, a series of experiments used various physical and chemical treatments to reduce overall numbers. Physical treatments of teats included autoclaving at 121 degrees C for 15 min, boiling in distilled water for 10 min, and heating by microwaves for 2 min. Chemical treatments included exposing teats to various concentrations of sodium hypochlorite, hydrogen peroxide, iodophor disinfectant, and combinations of the three. All treatments were unsuitable. Selective and differential media were screened for their ability to restrict bacterial contamination from excised teats while maintaining good recovery of Streptococcus agalactiae. Edwards and NPC agars were superior for recovery of S. agalactiae. Four methods for recovery of S. agalactiae from excised teats were evaluated. Hand agitation of teats in neutralizer and stomaching teats in neutralizer were equally superior to swabbing teats and rinsing teats with neutralizer expelled from a syringe. Studies of elapsed time demonstrated that 1 min or less between challenge exposure and teat dip exposure was just as suitable and more expedient than 5 min.

  17. 3D conformal MRI-controlled transurethral ultrasound prostate therapy: validation of numerical simulations and demonstration in tissue-mimicking gel phantoms.

    PubMed

    Burtnyk, Mathieu; N'Djin, William Apoutou; Kobelevskiy, Ilya; Bronskill, Michael; Chopra, Rajiv

    2010-11-21

    MRI-controlled transurethral ultrasound therapy uses a linear array of transducer elements and active temperature feedback to create volumes of thermal coagulation shaped to predefined prostate geometries in 3D. The specific aims of this work were to demonstrate the accuracy and repeatability of producing large volumes of thermal coagulation (>10 cc) that conform to 3D human prostate shapes in a tissue-mimicking gel phantom, and to evaluate quantitatively the accuracy with which numerical simulations predict these 3D heating volumes under carefully controlled conditions. Eleven conformal 3D experiments were performed in a tissue-mimicking phantom within a 1.5T MR imager to obtain non-invasive temperature measurements during heating. Temperature feedback was used to control the rotation rate and ultrasound power of transurethral devices with up to five 3.5 × 5 mm active transducer elements. Heating patterns shaped to human prostate geometries were generated using devices operating at 4.7 or 8.0 MHz with surface acoustic intensities of up to 10 W cm(-2). Simulations were informed by transducer surface velocity measurements acquired with a scanning laser vibrometer enabling improved calculations of the acoustic pressure distribution in a gel phantom. Temperature dynamics were determined according to a FDTD solution to Pennes' BHTE. The 3D heating patterns produced in vitro were shaped very accurately to the prostate target volumes, within the spatial resolution of the MRI thermometry images. The volume of the treatment difference falling outside ± 1 mm of the target boundary was, on average, 0.21 cc or 1.5% of the prostate volume. The numerical simulations predicted the extent and shape of the coagulation boundary produced in gel to within (mean ± stdev [min, max]): 0.5 ± 0.4 [-1.0, 2.1] and -0.05 ± 0.4 [-1.2, 1.4] mm for the treatments at 4.7 and 8.0 MHz, respectively. The temperatures across all MRI thermometry images were predicted within -0.3 ± 1.6 °C and 0

  18. Feasibility of transanal endoscopic total mesorectal excision for rectal cancer: results of a pilot study

    PubMed Central

    Oh, Jae Hwan; Park, Sung Chan; Kim, Min Jung; Park, Byung Kwan; Hyun, Jong Hee; Chang, Hee Jin; Han, Kyung Su

    2016-01-01

    Purpose To evaluate the feasibility of transanal total mesorectal excision (TME) in patients with rectal cancer. Methods This study enrolled 12 patients with clinically node negative rectal cancer located 4–12 cm from the anal verge who underwent transanal endoscopic TME with the assistance of single port laparoscopic surgery between September 2013 and August 2014. The primary endpoint was TME quality; secondary endpoints included number of harvested lymph nodes and postoperative complications within 30 days (NCT01938027). Results The 12 patients included 7 males and 5 females, of median age 59 years and median body mass index 24.2 kg/m2. Tumors were located on average 6.7 cm from the anal verge. Four patients (33.3%) received preoperative chemoradiotherapy. Median operating time was 195 minutes and median blood loss was 50 mL. There were no intraoperative complications and no conversions to open surgery. TME was complete or nearly complete in 11 patients (91.7%). Median distal resection and circumferential resection margins were 18.5 mm and 10 mm, respectively. Median number of harvested lymph nodes was 15. Median length of hospital stay was 9 days. There were no postoperative deaths. Six patients experienced minor postoperative complications, including urinary dysfunction in 2, transient ileus in 3, and wound abscess in 1. Conclusion This pilot study showed that high-quality TME was possible in most patients without serious complications. Transanal TME for patients with rectal cancer may be feasible and safe, but further investigations are necessary to evaluate its long-term functional and oncologic outcomes and to clarify its indications. PMID:27757396

  19. [Conservative surgical treatment of renal carcinoma. Personal experience with 29 surgical excisions of tumors].

    PubMed

    Villani, U; Pastorello, M

    1991-03-01

    From 1980 to 1988, elective conservative surgery (tumorectomy by enucleo-resection) was performed for renal cell carcinoma at stage I in 29 patients. An accurate preoperative renal investigation was carried out to identify the exact extension of the tumor and to study all the parenchimal situation, through IVP, ultrasound, CT scanning and, particularly, conventional selective angiography. The operative technique employed was: lymphadenectomy, peri-pararenal fat extirpation, in situ tumor enucleation by circular incision of the renal capsule and blunt dissection of the renal parenchyma with 2 cm safety margin to the tumor; multiple biopsies in the "bed" of resection for histopathologic peroperative evaluation; careful examination of the pseudocapsule and surrounding renal tissue; hemostasis. Follow-up was 10-113 months (mean 40,34 months). 2 of 29 patients died for progression of disease (at 52nd and 16yh month from surgery, 2/29 died for non-neoplastic reasons; 25/29 pts are living without local recurrences or distant metastases. In the same period (1980-1988), radical nephrectomy was performed for renal tumors at stage I in 34 patients. In an average observation period of 49,67 months, 2/34 patients died for progression of disease; 3/34 pts died for non-neoplastic reasons. 1/34 patient is living with pulmonar metastases and 28/34 are living without evidence of cancer. From this study we have got the conclusion that elective renal-sparing excision of the tumor (with macro-micro examination of the abscission surfaces) should be considered as a curative treatment in the case of low stage single tumors smaller than 7 cm, peripherally located in renal cortex, with unbroken pseudocapsule. PMID:1830417

  20. [Conservative surgical treatment of renal carcinoma. Personal experience with 29 surgical excisions of tumors].

    PubMed

    Villani, U; Pastorello, M

    1991-03-01

    From 1980 to 1988, elective conservative surgery (tumorectomy by enucleo-resection) was performed for renal cell carcinoma at stage I in 29 patients. An accurate preoperative renal investigation was carried out to identify the exact extension of the tumor and to study all the parenchimal situation, through IVP, ultrasound, CT scanning and, particularly, conventional selective angiography. The operative technique employed was: lymphadenectomy, peri-pararenal fat extirpation, in situ tumor enucleation by circular incision of the renal capsule and blunt dissection of the renal parenchyma with 2 cm safety margin to the tumor; multiple biopsies in the "bed" of resection for histopathologic peroperative evaluation; careful examination of the pseudocapsule and surrounding renal tissue; hemostasis. Follow-up was 10-113 months (mean 40,34 months). 2 of 29 patients died for progression of disease (at 52nd and 16yh month from surgery, 2/29 died for non-neoplastic reasons; 25/29 pts are living without local recurrences or distant metastases. In the same period (1980-1988), radical nephrectomy was performed for renal tumors at stage I in 34 patients. In an average observation period of 49,67 months, 2/34 patients died for progression of disease; 3/34 pts died for non-neoplastic reasons. 1/34 patient is living with pulmonar metastases and 28/34 are living without evidence of cancer. From this study we have got the conclusion that elective renal-sparing excision of the tumor (with macro-micro examination of the abscission surfaces) should be considered as a curative treatment in the case of low stage single tumors smaller than 7 cm, peripherally located in renal cortex, with unbroken pseudocapsule.

  1. Total mesorectal excision for mid and low rectal cancer: Laparoscopic vs robotic surgery

    PubMed Central

    Feroci, Francesco; Vannucchi, Andrea; Bianchi, Paolo Pietro; Cantafio, Stefano; Garzi, Alessia; Formisano, Giampaolo; Scatizzi, Marco

    2016-01-01

    AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer. METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared. RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P < 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P < 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P < 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P < 0.001). The three-year overall survival and disease-free survival rates were similar between groups. CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies. PMID:27053852

  2. Treatment of Giant Fibroadenoma in Young Women: Results after Tumor Excision without Reconstructive Surgery

    PubMed Central

    Hille-Betz, U.; Klapdor, R.; Henseler, H.; Soergel, P.; Länger, F.

    2015-01-01

    Introduction: Giant fibroadenoma (GFA) of the breast is defined as fibroadenoma larger than 5 cm, usually presenting unilaterally and manifesting as breast asymmetry or deformity of the breast. Material and Methods: A retrospective database search was done of all patients with giant fibroadenoma who underwent surgery for GFA in the breast center of Hanover Medical School between 2007 and 2014; all patients with GFA were followed up. Data were analyzed with regard to tumor and patient characteristics and esthetic outcome. Results: A total of 13 patients with symptomatic GFA underwent surgery between 2007 and 2014. Mean patient age was 21.2 years (range 14–31 years). In 8 of 13 patients the tumor had resulted in breast deformity and/or breast asymmetry. Average size of the mass was 10.2 cm (range 8.5–12 cm) and average weight was 203.6 g (range 151.2–323.5 g). Initial clinical suspicion of GFA was confirmed by ultrasound examination. Preoperative core biopsy revealed fibroadenoma in 8/13 cases, cellular fibroepithelial lesions with a differential diagnosis of benign phyllodes tumor in 3 cases and unspecific histological findings in the remaining 2 cases. Conclusion: Excision was done using an inframammary or periareolar approach without reconstructive plasty. The cosmetic results were good, as were the outcomes on follow-up. We therefore favor this surgical technique to treat giant fibroadenoma of similar size to those described above. PMID:26500369

  3. Transurethral 160-W straight beam green laser vaporesection of the prostate: initial experience after 180 procedures.

    PubMed

    Li, Lianjun; Hu, Bo; Wang, Muwen; Sun, Peng; Jin, Xunbo

    2016-01-01

    Although the photoselective vaporization of the prostate has been considered one of the most promising alternatives for treatment of benign prostatic hyperplasia (BPH), published clinical data with the surgical technology of straight beam lithium triborate laser (LBO) is still lacking. To evaluate the technical improvement and initial experience of the 160-W straight beam LBO laser photoselective vaporesection of the prostate (PVRP) for the surgical treatment of BPH. From September 2012 to September 2014, including a 12-month follow-up, a prospective randomized study was performed. 180 patients undergoing PVRP were included in the study. All patients were preoperatively assessed by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual urine (PVR), prostate-specific antigen level, and prostate volume measurement. Perioperative parameters and complications were recorded. Patients were reassessed at 1, 3, 6 and 12 months postoperatively. PVRP resulted in a significant improvement of IPSS, Qmax, and PVR. Mean operative time was 48.3 ± 14.4 min. A significant improvement for PVRP was achieved regarding the catheter indwelling and hospital stay time. No severe perioperative complications were recorded. No requiring blood transfusion in all patients. Capsule perforation was observed in four patients in the group. There were four patients experienced bladder neck contracture and another four patients were diagnosed urethral stricture, all of whom were treated well by dilatation finally without reoperation. 160-W straight beam LBO laser PVRP appears to be a feasible and safe alternative for symptomatic BPH with decreased length of catheter indwelling and hospital stay time postoperatively. PMID:27429868

  4. Alpha blockade in preoperative preparation of patients with pheochromocytomas.

    PubMed

    Kocak, Savas; Aydintug, Semih; Canakci, Necati

    2002-01-01

    Preoperative preparation in pheochromocytoma is usually performed by alpha-adrenergic blockers. We retrospectively reviewed the efficiency of phenoxybenzamine, prazosin, and doxazosin in preoperative preparation. Phenoxybenzamine was used for preoperative preparation of 21 pheochromocytoma patients, prazosin was used in 11 patients, and doxazosin was used in 17 patients. Intraoperative and early postoperative blood pressure records and postoperative volume replacement records were reviewed. Intraoperative hypertension occurred in 17 patients in the phenoxybenzamine group (81%), eight patients in the prazosin group (73%), and 14 patients in the doxazosin group (82%). There was no statistical difference among the groups (P > 0.05). There was also no significant difference between postoperative blood pressure measurements and the operative and postoperative volume replacements. We have found that there were no significant difference in the operative and postoperative blood pressure and plasma volume control among the three groups. We conclude that pheochromocytoma surgery is safe with any of these preoperative medications.

  5. Appraisal of guidelines for pre-operative body wash.

    PubMed

    Edström, Elisabet; Westerberg, Lisa; Henricson, Maria

    The pre-operative body wash is a strategy for reducing post-operative infection. However, there is a lack of knowledge about its importance. The purpose of the present study was to evaluate the quality of guidelines for the pre-operative body wash using the AGREE instrument--35 guidelines containing instructions for the pre-operative body wash or preparation were included. The AGREE instrument was employed to establish a quality assessment framework that facilitated a comparison of the guidelines. The results were based on the six domains of the AGREE instrument, all of which were found to have low adherence. Descriptive statistics were used to present the assessment score. The AGREE instrument is useful for evaluating the quality of clinical guidelines. The development of evidence-based guidelines must include clinical activities. Further research is required to clarify the pre-operative body wash process and how it should be performed to reduce post-operative infection. PMID:25426523

  6. [Retroperitoneal cystic lymphangioma. Preoperative diagnosis. Apropos of a case].

    PubMed

    Guérin, E; Babin, C; Moulle, P; Barret, F

    1987-11-01

    Retroperitoneal cystic lymphangioma is an uncommon tumor. One case is reported, with surgical confirmation. Authors point out the diagnostic value of ultrasonography and computed tomography in the pre-operative diagnosis.

  7. State-Specific Liquor Excise Taxes and Retail Prices in Eight U.S. States, 2012

    PubMed Central

    Siegel, Michael; Grundman, Jody; DeJong, William; Naimi, Timothy S.; King, Charles; Albers, Alison B.; Williams, Rebecca S.; Jernigan, David H.

    2013-01-01

    We investigated the relationship between state excise taxes and liquor prices in eight states, using 2012 data for 45 brands. We made 6,042 price observations among 177 liquor stores with online prices. Using a hierarchical model, we examined the relationship between excise taxes and product prices. State excise taxes were significantly related to liquor prices, with an estimated pass-through rate of 0.93. The proportion of price accounted for by excise taxes averaged 7.0%. We find that excise taxes do increase the price of alcohol, but states are not taking advantage of this opportunity to reduce alcohol-related morbidity and mortality. PMID:24159914

  8. State-specific liquor excise taxes and retail prices in 8 US states, 2012.

    PubMed

    Siegel, Michael; Grundman, Jody; DeJong, William; Naimi, Timothy S; King, Charles; Albers, Alison B; Williams, Rebecca S; Jernigan, David H

    2013-01-01

    The authors investigated the relationship between state excise taxes and liquor prices in 8 states, using 2012 data for 45 brands. The authors made 6042 price observations among 177 liquor stores with online prices. Using a hierarchical model, the authors examined the relationship between excise taxes and product prices. State excise taxes were significantly related to liquor prices, with an estimated pass-through rate of 0.93. The proportion of price accounted for by excise taxes averaged 7.0%. The authors find that excise taxes do increase the price of alcohol, but states are not taking advantage of this opportunity to reduce alcohol-related morbidity and mortality.

  9. New insights about excisable pathogenicity islands in Salmonella and their contribution to virulence.

    PubMed

    Nieto, Pamela A; Pardo-Roa, Catalina; Salazar-Echegarai, Francisco J; Tobar, Hugo E; Coronado-Arrázola, Irenice; Riedel, Claudia A; Kalergis, Alexis M; Bueno, Susan M

    2016-05-01

    Pathogenicity islands (PAIs) are regions of the chromosome of pathogenic bacteria that harbor virulence genes, which were probably acquired by lateral gene transfer. Several PAIs can excise from the bacterial chromosome by site-specific recombination and in this review have been denominated "excisable PAIs". Here, the characteristic of some of the excisable PAIs from Salmonella enterica and the possible role and impact of the excision process on bacterial virulence is discussed. Understanding the role of PAI excision could provide important insights relative to the emergence, evolution and virulence of pathogenic enterobacteria.

  10. The Therapeutic Effects of Intracavernosal Plaque Excision in Peyronie’s Disease: A None Grafting or Tunical Excising Procedure

    PubMed Central

    Ahmadnia, Hassan; Kamalati, Ali; Younesi Rostami, Mehdi; Imani, Mohammad Mehdi; Asadpour, Amir Abbas; Hariri, Mohammad Kazem

    2016-01-01

    BACKGROUND Current surgical treatments in Peyronie’s disease are accompanied by complications such as penile shortening, loss of sensation, erectile dysfunction and recurrence of disease. The aim of this study was the evaluation of clinical results of intracavernosal plaque excision in Peyronie’s disease. METHODS The operation was performed on 35 men. It was consisted of incising the tunica albuginea parallel to the plaque and through this incision, and the plaque was removed from the inside surface without excision or replacing the underlying tunica albuginea by grafts. All patients were evaluated before and periodically within 12 months after the surgery with measurement of penile length, curvature angle in the rigidity phase, and sexual satisfaction. RESULTS The mean age of patients was 51.4±5.3 years (range 42-59 years). The angle of penile curvature was 25-45° (mean=35°). Thirty patients (86%) obtained a nearly complete straightening of penis. All patients restored their previous penile length without any disorder of sensation within the glans penis and expressed improvement of sexual activity. CONCLUSION Intracavernosal plaque excision is a simple, easy and minimal invasive method that does not result in penile shortening, loss of sensation or erectile dysfunction. In properly selected patients, this technique can lead to acceptable elimination of penile curvature and sexual satisfaction. PMID:27308243

  11. Procedures and experiences with preoperative skin preparation in Sweden.

    PubMed

    Tunevall, T G

    1988-04-01

    The current situation with preoperative skin preparation in Sweden is described. Patients are given two preoperative washes with chlorhexidine scrub, and are sent to theatre on a clean bed, so no extra linen is required. Wound infection rates are acceptably low, and use of chlorhexidine has also assisted in reduction of infection associated with central venous catheters. Use of chlorhexidine scrub is recommended to help healing of infected wounds.

  12. Preoperative evaluation of patients with obesity and obstructive sleep apnea.

    PubMed

    Cartagena, Rafael

    2005-09-01

    Obesity and obstructive sleep apnea are conditions frequently encountered by the anesthesiologist and may have a significant impact on perioperative outcomes. This article discusses the preoperative evaluation of patients with one or both of these conditions. The goals of the preoperative assessment are to identify issues that can adversely affect the patient. This information is critical to forming an effective plan for the perioperative care of the patient.

  13. Effect of supplemental vitamin A on colon anastomotic healing in rats given preoperative irradiation

    SciTech Connect

    Winsey, K.; Simon, R.J.; Levenson, S.M.; Seifter, E.; Demetriou, A.A.

    1987-02-01

    We studied the effect of dietary supplementation with vitamin A on the healing of colon anastomoses in irradiated bowel. Rats were divided into two groups. Those in the first group were fed a standard chow diet and those in the second group were fed the same diet supplemented with 150 IU vitamin A/g of chow. The rats were maintained on their respective diets throughout the experiment. After 7 days, half the rats in each group underwent abdominal irradiation (200 rads). Seven days later, all of the rats underwent distal colon division and anastomosis under pentobarbital anesthesia. All rats were killed 7 days postoperatively, the colons excised, and bursting strength and hydroxyproline determinations performed on both the anastomotic segment and a normal proximal segment of adjacent colon. There was a significant decrease in the bursting strength at the colon anastomosis (p less than 0.02) and in the collagen content (p less than 0.02) after preoperative irradiation. This effect was mitigated by dietary vitamin A supplementation.

  14. Ruptured Rudimentary Horn Pregnancy Diagnosed by Preoperative Magnetic Resonance Imaging Resulting in Fetal Salvage.

    PubMed

    Pillai, Silja A; Mathew, Mariam; Ishrat, Noreen; Kakaria, Anupam; Qureshi, Asim; Vaidyanathan, Gowri

    2015-08-01

    Pregnancy in a rudimentary horn is very rare. The rupture of the horn during pregnancy is an obstetric emergency which can be life-threatening for both the mother and fetus. Preoperative diagnosis of such pregnancies can be challenging and they are usually diagnosed intraoperatively. We report a unique case of a 31-year-old multiparous woman who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in January 2013 at 32 gestational weeks with abdominal pain. Ultrasonography was inconclusive. A rudimentary horn pregnancy was subsequently diagnosed via magnetic resonance imaging (MRI). An emergency laparotomy revealed haemoperitoneum and a ruptured rudimentary horn pregnancy. A live baby with an Apgar score of 2 at one minute and 7 at five minutes was delivered. The rudimentary horn with the placenta in situ was excised and a left salpingo-oophorectomy was performed. The postoperative period was uneventful. The authors recommend MRI as an excellent diagnostic modality to confirm rudimentary horn pregnancies and to expedite appropriate management. PMID:26357563

  15. Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems.

    PubMed

    Steinberg, Ely L; Segev, Eitan; Drexler, Michael; Ben-Tov, Tomer; Nimrod, Snir

    2016-06-01

    The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders.

  16. Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems.

    PubMed

    Steinberg, Ely L; Segev, Eitan; Drexler, Michael; Ben-Tov, Tomer; Nimrod, Snir

    2016-06-01

    The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders. PMID:27468530

  17. Preoperative Planning in Orthopaedic Surgery. Current Practice and Evolving Applications.

    PubMed

    Atesok, Kivanc; Galos, David; Jazrawi, Laith M; Egol, Kenneth A

    2015-12-01

    Preoperative planning is an essential prerequisite for the success of orthopaedic procedures. Traditionally, the exercise has involved the written down, step by step "blueprint" of the surgical procedure. Preoperative planning of the technical aspects of the orthopaedic procedure has been performed on hardcopy radiographs using various methods such as copying the radiographic image on tracing papers to practice the planned interventions. This method has become less practical due to variability in radiographic magnification and increasing implementation of digital imaging systems. Advances in technology along with recognition of the importance of surgical safety protocols resulted in widespread changes in orthopaedic preoperative planning approaches. Nowadays, perioperative "briefings" have gained particular importance and novel planning methods have started to integrate into orthopaedic practice. These methods include using software that enables surgeons to perform preoperative planning on digital radiographs and to construct 3D digital models or prototypes of various orthopaedic pathologies from a patient's CT scans to practice preoperatively. Evidence-to-date suggests that preoperative planning and briefings are effective means of favorably influencing the outcomes of orthopaedic procedures.

  18. Transurethral En Bloc Resection of Bladder Tumor Using an Endoscopic Submucosal Dissection Technique: Preliminary Results in an Animal Model

    PubMed Central

    Morizane, Shuichi; Sejima, Takehiro; Iwamoto, Hideto; Masago, Toshihiko; Honda, Masashi; Ikebuchi, Yuichiro; Matsumoto, Kazuya; Ueki, Masaru; Takenaka, Atsushi

    2016-01-01

    Background Transurethral resection of bladder tumor (TURBT) technique has been considered the routine method for removing most bladder tumors for decades. In contrast, endoscopic submucosal dissection (ESD) is the gold-standard treatment for gastrointestinal superficial tumors. We investigated the effectiveness and applicability of a new technique for en bloc bladder tumor resection using ESD procedure. Methods Four Landrace Large White Duroc female pigs were anesthetized with isoflurane prior endoscopic resection using a large-caliber prototype fiber bronchoscope. After local infiltration of the submucosa with sodium hyaluronate using an injector needle, a section of the target area (1.0–2.0 cm diameter circular area) was cut with the Dual Knife. Results In total, seven target sections were resected from the pigs. The median size of the resected sections was 1.8 cm (range 1.0–2.5 cm) and the median time taken to perform the resection of one section was 20 min (range 4–35 min). These target sections were completely resected en bloc. Although the small bladder perforations occurred on two occasions, no other short-term complications such as uncontrollable bleeding were observed. Conclusion This procedure is a slightly difficult in the pigs with thin bladder walls. However, this procedure with the slim flexible cystoscope may allow us to be able to remove bladder tumors using only light sedation, especially for cases when small tumor recurrence is observed during routine cystoscopy for the patients with non-muscle invasive bladder cancer. PMID:27493485

  19. Transurethral laser urethrotomy with argon laser: experience with 900 urethrotomies in 450 patients from 1978 to 1993.

    PubMed

    Becker, H C; Miller, J; Nöske, H D; Klask, J P; Weidner, W

    1995-01-01

    From April 1978 to September 1993, the Department of Urology of Giessen Medical School used laser urethrotomy as standard endoscopic treatment in benign urethral strictures. In this period, 900 urethrotomies were performed in 450 patients. The majority of strictures treated were iatrogenic (65%), located in the posterior urethra (62.8%) and classified as short (< or = 1 cm) (71%). Argon laser urethrotomy was carried out in the 12 degrees position according to the technique of internal optical urethrotomy. An indwelling transurethral catheter was left for 48 h after urethrotomy. Uroflowmetry after argon laser urethrotomy revealed the efficacy of the method. A retrospective analysis of the operations was performed. Analysis showed that recurrence appeared on average after 15.2 months (range 1-39) in up to 70.1%. Nearly 50% of recurrence was evident within 1 year following surgery. Recurrence was independent of location, length and etiology of the stricture. We conclude according to our data that argon laser urethrotomy is technically feasible. Due to the high recurrence rate the method offers no advantage over conventional internal optical urethrotomy.

  20. Development of a 3D patient-specific planning platform for interstitial and transurethral ultrasound thermal therapy

    NASA Astrophysics Data System (ADS)

    Prakash, Punit; Diederich, Chris J.

    2010-03-01

    Interstitial and transurethral catheter-based ultrasound devices are under development for treatment of prostate cancer and BPH, uterine fibroids, liver tumors and other soft tissue disease. Accurate 3D thermal modeling is essential for designing site-specific applicators, exploring treatment delivery strategies, and integration of patient-specific treatment planning of thermal ablations. We are developing a comprehensive 3D modeling and treatment planning platform for ultrasound ablation of tissue using catheter-based applicators. We explored the applicability of assessing thermal effects in tissue using critical temperature, thermal dose and Arrhenius thermal damage thresholds and performed a comparative analysis of dynamic tissue properties critical to accurate modeling. We used the model to assess the feasibility of automatic feedback control with MR thermometry, and demonstrated the utility of the modeling platform for 3D patient-specific treatment planning. We have identified critical temperature, thermal dose and thermal damage thresholds for assessing treatment endpoint. Dynamic changes in tissue attenuation/absorption and perfusion must be included for accurate prediction of temperature profiles and extents of the ablation zone. Lastly, we demonstrated use of the modeling platform for patient-specific treatment planning.

  1. Preoperative segmental embolization of the proper hepatic artery prior to pylorus-preserving pancreaticoduodenectomy: A case report

    PubMed Central

    Taguchi, Masanobu; Sata, Naohiro; Kaneda, Yuji; Koizumi, Masaru; Hyodo, Masanobu; Lefor, Alan Kawarai; Kawata, Hirotoshi; Yasuda, Yoshikazu

    2015-01-01

    Introduction Radical resection of bile duct carcinoma may require resection of hepatic arteries. Preoperative segmental embolization of the hepatic artery for resection of hilar cholangiocarcinoma has been reported. We report a patient with bile duct carcinoma infiltrating the proper hepatic artery. Presentation of case A 66-year old male with jaundice was diagnosed with mid-distal bile duct carcinoma. A replaced left hepatic artery originated from the left gastric artery. Pylorus-preserving pancreaticoduodenectomy (PPPD) with combined resection of hepatic artery was planned. To promote the development of collateral blood flow after excision of the hepatic artery, preoperative segmental embolization of the proper hepatic artery was performed. The patient underwent PPPD with concurrent resection of the common hepatic, right hepatic, and middle hepatic arteries without arterial reconstruction. He received adjuvant chemotherapy with gemcitabine for six months and is alive three years after surgery without tumor recurrence. Discussion The growth of collateral vessels after selective embolization of the proper hepatic artery has been used for hilar lesions and bile duct lesions. Resection of the hepatic artery without the need for complex arterial reconstruction, allowing a radical resection, may have contributed to this patient's relatively unremarkable recovery and long-term survival. Retroperitoneal mobilization of the pancreatic head and duodenum must be limited as important collaterals may originate in that area. Conclusion Preoperative segmental embolization of the hepatic artery before PPPD for a patient with a replaced left hepatic artery encouraged the growth of collateral blood supply, allowing radical resection including the vessels and obviated the need for arterial reconstruction. PMID:25625493

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

    SciTech Connect

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

    2011-11-01

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

  3. Long-Term Results of Local Excision for Rectal Cancer

    PubMed Central

    Paty, Philip B.; Nash, Garrett M.; Baron, Paul; Zakowski, Maureen; Minsky, Bruce D.; Blumberg, David; Nathanson, Daniel R.; Guillem, Jose G.; Enker, Warren E.; Cohen, Alfred M.; Wong, W. Douglas

    2002-01-01

    Objective To review the authors’ experience with local excision of early rectal cancers to assess the effectiveness of initial treatment and of salvage surgery. Summary Background Data Local excision for rectal cancer is appealing for its low morbidity and excellent functional results. However, its use is limited by inability to assess regional lymph nodes and uncertainty of oncologic outcome. Methods Patients with T1 and T2 adenocarcinomas of the rectum treated by local excision as definitive surgery between 1969 to 1996 at the authors’ institution were reviewed. Pathology slides were reviewed. Among 125 assessable patients, 74 were T1 and 51 were T2. Thirty-one patients (25%) were selected to receive adjuvant radiation therapy. Fifteen of these 31 patients received adjuvant radiation in combination with 5-fluorouracil chemotherapy. Median follow-up was 6.7 years. One hundred fifteen patients (92%) were followed until death or for greater than 5 years, and 69 patients (55%) were followed until death or for greater than 10 years. Recurrence was recorded as local, distant, and overall. Survival was disease-specific. Results Ten-year local recurrence and survival rates were 17% and 74% for T1 rectal cancers and 26% and 72% for T2 cancers. Median time to relapse was 1.4 years (range 0.4–7.0) for local recurrence and 2.5 years (0.8–7.5) for distant recurrence. In patients receiving radiotherapy, local recurrence was delayed (median 2.1 years vs. 1.1 years), but overall rates of local and overall recurrence and survival rates were similar to patients not receiving radiotherapy. Among 26 cancer deaths, 8 (28%) occurred more than 5 years after local excision. On multivariate analysis, no clinical or pathologic features were predictive of local recurrence. Intratumoral vascular invasion was the only significant predictor of survival. Among 34 patients who developed tumor recurrence, the pattern of first clinical recurrence was predominantly local: 50% local only

  4. Flexor Tendon Sheath Ganglions: Results of Surgical Excision

    PubMed Central

    Spencer, Edwin E.

    2007-01-01

    The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient’s medical and operative records were reviewed. Each patient was invited to return for an evaluation, which consisted of a clinical interview, completion of a questionnaire, and physical examination. Those patients that were unable to return underwent a detailed telephone interview. Sixteen patients returned for a clinical evaluation, while eight patients underwent a telephone interview. There were 15 women and nine men, with an average age of 43 years (range, 21–68 years). The dominant hand was involved in 15 patients. The long finger was most commonly involved (11 cases). The ganglion arose from the A1 pulley in 13 cases, between the A1 and A2 pulleys in three cases, and from the A2 pulley in nine cases. At an average follow-up of 18.5 months (range, 5–38 months), all of the patients were satisfied with their final result. No patient developed a recurrence and all returned to their previous functional level. There were two minor complications that resolved uneventfully; one patient experienced mild incisional tenderness, while an additional patient experienced transient digital nerve paresthesias. We conclude that surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath. PMID:18780066

  5. Evolving excised black holes with TVD numerical methods

    NASA Astrophysics Data System (ADS)

    Neilsen, David

    2003-04-01

    Total Variation Diminishing (TVD) numerical methods have improved stability properties for nonlinear differential equations, and are widely used in computational fluid dynamics. While Einstein's equations are not genuinely nonlinear, these methods may be advantageous for solving the Einstein equations in specific instances, such as evolving fluid spacetimes and black holes with excision. Using a Frittelli-Reula formulation of the Einstein equations, I will present results of 1-D and 3-D black hole evolutions, and compare the performance of TVD methods with other numerical approaches.

  6. Tensile testing of rodlike trabeculae excised from bovine femoral bone.

    PubMed

    Ryan, S D; Williams, J L

    1989-01-01

    Individual trabeculae, rodlike in form, were excised from bovine femora and tested in tension to obtain stress-strain plots. Tensile grips were constructed to permit such small specimens to be tested and to avoid slippage during the test. Data were collected for 38 specimens. The results of these tests show that rodlike trabeculae obtained from the femora of young bovine animals have an average Young's modulus in tension of approximately 1 GPa. This value is an order of magnitude lower than the corresponding value for cortical bone in the diaphysis of the femur.

  7. [Alternative therapeutic excision of intraepithelial conjunctival carcinoma with corneal extension].

    PubMed

    Zemba, M; Stamate, Alina-Cristina; Avram, Corina Ioana; Sîrbu, Laura Nicoleta Urucu; Camburu, Raluca Lăcrămioara; Ochinciuc, Uliana; Burcea, M

    2013-01-01

    Surgical treatment for conjunctival neoplasms, with wide local excision, with or without supplemental cryotherapy to the surgical margins represents the treatment of choice for this pathology. In some cases, these neoplasms can be diffuse or multifocal, with borders that are difficult to detect clinically, such that topical therapies offer a more efficient method for treating the entire ocular surface, delivering high drug concentrations at this level, with negligible systemic side effects. Beginning from the clinical case of a patient diagnosed with conjunctival intraepithelial neoplasia, we try to present other therapeutical alternatives, although in this case the therapeutical approach was the classic one.

  8. [The transphincteric approach excision of rectal villous adenomas].

    PubMed

    Qiu, H; Tang, W; Zhu, Y

    1995-03-01

    Twenty-four patients with rectal villous adenomas were operated on which posterior transphincteric approach. They had benign villous adenona in (13 patients), villous adenomas showing atypia (2), and villous adenomas developed malignancy (9). All the patients gained excellent results, except one with wounded infection after operation. No patient died at operation. No patient developed rectal fistula and incontinence of feces. The different methods of operation with excised villous adenoma of the rectum were discussed and compared. We conclude that the posterior transsphincteric approach is better than others. PMID:7555388

  9. Laparoscopic Excision of a Mesenteric Cyst During Pregnancy

    PubMed Central

    2003-01-01

    Background: Laparoscopic management of mesenteric cysts during pregnancy has not been reported before. Case Report: A young woman with a mesenteric cyst associated with a crossed ectopic kidney, underwent laparoscopic excision of the cyst in the second trimester of pregnancy. The procedure was completed without complications, and the patient was discharged on the third postoperative day. Thereafter, the pregnancy progressed uneventfully, and she delivered a healthy baby at term. Conclusions: Laparoscopic management of mesenteric cysts during pregnancy is feasible, safe, and less invasive than laparotomy when performed in select patients by experienced surgeons. PMID:12723004

  10. Fate of Kaluza-Klein black holes: Evaporation or excision?

    SciTech Connect

    Murata, Keiju; Soda, Jiro; Kanno, Sugumi

    2007-05-15

    We study the evaporation process of black strings which are typical examples of Kaluza-Klein black holes. Taking into account the backreaction of the Hawking radiation, we deduce the evolution equation for the radion field. By solving the evolution equation, we find that the shape of the internal space is necked by the Hawking radiation and the amount of the deformation becomes large as the evaporation proceeds. Based on this analysis, we speculate that the Kaluza-Klein black holes would be excised from the Kaluza-Klein spacetime before the onset of the Gregory-Laflamme instability and therefore before the evaporation.

  11. Arthroscopic excision of a painful bipartite patella fragment.

    PubMed

    Carney, Joseph; Thompson, Darcy; O'Daniel, Joseph; Cassidy, Jeffrey

    2010-01-01

    Bipartite patella is an uncommon finding, with the majority of cases discovered incidentally on radiographs. Occasionally, bipartite patella can become painful through sports activities, overuse, or following an injury, and the large majority of these cases resolve with nonoperative treatment. However, for patients who do not respond to a prolonged course of nonoperative treatment, surgical options may be considered. We report a successful case of arthroscopic excision of a painful bipartite patella fragment in a 19-year-old male collegiate basketball player. A review of the literature is included.

  12. 26 CFR 55.4981-2 - Imposition of excise tax with respect to certain undistributed income of real estate investment...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... certain undistributed income of real estate investment trusts; calendar years beginning after December 31... (CONTINUED) MISCELLANEOUS EXCISE TAXES (CONTINUED) EXCISE TAX ON REAL ESTATE INVESTMENT TRUSTS AND REGULATED INVESTMENT COMPANIES Excise Tax on Real Estate Investment Trusts § 55.4981-2 Imposition of excise tax...

  13. Validation of a virtual preoperative evaluation clinic: a pilot study.

    PubMed

    Zetterman, Corey V; Sweitzer, Bobbie J; Webb, Brad; Barak-Bernhagen, Mary A; Boedeker, Ben H

    2011-01-01

    Patients scheduled for surgery at the Omaha VA Medical Center were evaluated preoperatively via telemedicine. Following the examination, patients filled out a 15 item, 5 point Likert scale questionnaire regarding their opinion of preoperative evaluation in a VTC format. Evaluations were performed under the direction of nationally recognized guidelines and recommendations of experts in the field of perioperative medicine and were overseen by a staff anesthesiologist from the Omaha VA Medical Center. No significant difficulties were encountered by the patient or the evaluator regarding the quality of the audio/visual capabilities of the VTC link and its ability to facilitate preoperative evaluation. 87.5% of patients felt that virtual evaluation would save them travel time; 87.5% felt virtual evaluation could save them money; 7.3% felt uncomfortable using the VTC link; 12.2% felt the virtual evaluation took longer than expected; 70.7% preferred to be evaluated via VTC link; 21.9% were undecided; 9.7% felt they would rather be evaluated face-to-face with 26.8% undecided; 85.0% felt that teleconsultation was as good as being seen at the Omaha surgical evaluation unit; 7.5% were undecided. Our study has shown that effective preoperative evaluation can be performed using a virtual preoperative evaluation clinic; patients are receptive to the VTC format and, in the majority of cases, prefer it to face-to-face evaluation.

  14. Effect of Preoperative Pain on Inferior Alveolar Nerve Block.

    PubMed

    Aggarwal, Vivek; Singla, Mamta; Subbiya, Arunajatesan; Vivekanandhan, Paramasivam; Sharma, Vikram; Sharma, Ritu; Prakash, Venkatachalam; Geethapriya, Nagarajan

    2015-01-01

    The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis. PMID:26650491

  15. Preoperative myocardial ischaemia: its relation to perioperative infarction.

    PubMed Central

    Yousif, H; Davies, G; Westaby, S; Prendiville, O F; Sapsford, R N; Oakley, C M

    1987-01-01

    One hundred consecutive patients undergoing coronary artery bypass surgery were randomly allocated to a preoperative (24 h) intravenous infusion of isosorbide dinitrate (1.5-15 mg/hr) (50 patients) or to placebo (50 patients). The characteristics of the two groups were similar. Evidence of acute myocardial ischaemia was sought by continuous electrocardiographic Holter recordings and acute myocardial infarction by the appearance of new Q waves and increased activity of the creatine kinase MB isoenzyme. Episodes of acute myocardial ischaemia were found in 18% of patients in the control group and in none of those who received isosorbide dinitrate. None the less, the frequency of perioperative myocardial infarction was similar (22% and 18% respectively) in the two groups. Perioperative infarction was significantly more common in women, in patients with unstable angina or poor left ventricular function, in those who had coronary endarterectomy, and in those in whom the aortic clamping time was greater than 50 minutes. These factors may have obscured any effect that prevention of preoperative ischaemia had on perioperative infarction. Preoperative infusion of isosorbide dinitrate eliminated preoperative ischaemia but did not influence the occurrence of perioperative infarction. The probable benefits of prevention of preoperative ischaemia on postoperative left ventricular function, which is a determinant of long term survival, remain to be established. PMID:3304371

  16. Premature aging and cancer in nucleotide excision repair-disorders

    PubMed Central

    Diderich, K.; Alanazi, M.; Hoeijmakers, J.H.J.

    2014-01-01

    During past decades the major impact of DNA damage on cancer as ‘disease of the genes’ has become abundantly apparent. In addition to cancer recent years have also uncovered a very strong association of DNA damage with many features of (premature) aging. The notion that DNA repair systems not only protect against cancer but equally against too fast aging has become evident from a systematic, integral analysis of a variety of mouse mutants carrying defects in e.g. transcription-coupled repair with or without an additional impairment of global genome nucleotide excision repair and the corresponding segmental premature aging syndromes in man. A striking correlation between the degree of the DNA repair deficiency and the acceleration of specific progeroid symptoms has been discovered for those repair systems that primarily protect from the cytotoxic and cytostatic effects of DNA damage. These observations are explained from the perspective of nucleotide excision repair mouse mutant and human syndromes. However, similar principles likely apply to other DNA repair pathways including interstrand crosslink repair and double strand break repair and genome maintenance systems in general, supporting the notion that DNA damage constitutes an important intermediate in the process of aging. PMID:21680258

  17. A review of wide surgical excision of hidradenitis suppurativa

    PubMed Central

    2012-01-01

    Background Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disorder that involves the infundibular terminal follicles in areas rich of apocrine glands. It can be associated with fistulating sinus, scarring and abscesses formation. Hidradenitis suppurativa is a challenging aspect and requires a proper treatment plan which may involve different specialties. We present herein the option of surgical treatment involving wide surgical excision and methods of reconstruction as well as the rate of recurrence. Furthermore, review of the literature regarding surgical treatment of hidradenitis suppurativa is provided. Methods A retrospective analysis reviewed 50 operative procedures for 32 patients in 5 anatomical sites. These anatomical sites have been divided to 23 sites involving the axilla, 17 sites involving the inguinal region and 8 sites involving the perianal/perineal area, 1 site involving the gluteal region and 1 site involving the trunk region. Results Twenty six patients (81, 25 %) showed no recurrence after surgery and the average time of hospital stay period was 5 days. Recurrence was observed only in 6 patients (18, 75 %). Conclusion Elimination of the acute inflammatory process should occur in advance, including the use of antibiotics and minor surgeries such as abscess drainage with proper irrigations. After stabilizing the acute phase, wide surgical excision is recommended. Herein, planning of surgical reconstruction should be initiated to achieve the best outcome and consequently decreasing the risk of recurrence and complications after surgery. PMID:22734714

  18. Pterygium excision with conjunctival autografting: an effective and safe technique.

    PubMed Central

    Allan, B D; Short, P; Crawford, G J; Barrett, G D; Constable, I J

    1993-01-01

    The optimum mode of treatment for symptomatic pterygia would combine efficacy (a low recurrence rate) with safety (freedom from sight threatening complications), and would not affect visual acuity adversely. The efficacy of pterygium excision with conjunctival autografting in a sun exposed population in which pterygia are prevalent has previously been questioned. A cross sectional review of 93 eyes of 85 patients was carried out by slit-lamp examination a minimum of 6 months (range 6-76 months) after pterygium excision and free conjunctival autografting. Case notes were reviewed to obtain details of complications and visual acuity changes related to surgery. Of six recurrences (6.5%) four of these were asymptomatic with minor recurrences. Two patterns of recurrence were identified: cross graft recurrence (three cases) and outflanking (three cases). Complications (wound dehiscence, three cases; Tenon's granuloma one case; conjunctival cyst, one case) were all corrected by minor surgical revision without sequelae. Unaided acuities were unchanged or improved 3 months after surgery in 86 cases, with a minor diminution (1 Snellen line) in seven cases. This study demonstrates a low recurrence rate for a safe technique in an area in which ongoing ultraviolet light exposure levels are high and pterygia are prevalent. Images PMID:8280682

  19. Validating Excised Rodent Lungs for Functional Hyperpolarized Xenon-129 MRI

    PubMed Central

    Lilburn, David M. L.; Hughes-Riley, Theodore; Six, Joseph S.; Stupic, Karl F.; Shaw, Dominick E.; Pavlovskaya, Galina E.; Meersmann, Thomas

    2013-01-01

    Ex vivo rodent lung models are explored for physiological measurements of respiratory function with hyperpolarized (hp) 129Xe MRI. It is shown that excised lung models allow for simplification of the technical challenges involved and provide valuable physiological insights that are not feasible using in vivo MRI protocols. A custom designed breathing apparatus enables MR images of gas distribution on increasing ventilation volumes of actively inhaled hp 129Xe. Straightforward hp 129Xe MRI protocols provide residual lung volume (RV) data and permit for spatially resolved tracking of small hp 129Xe probe volumes during the inhalation cycle. Hp 129Xe MRI of lung function in the excised organ demonstrates the persistence of post mortem airway responsiveness to intravenous methacholine challenges. The presented methodology enables physiology of lung function in health and disease without additional regulatory approval requirements and reduces the technical and logistical challenges with hp gas MRI experiments. The post mortem lung functional data can augment histological measurements and should be of interest for drug development studies. PMID:24023683

  20. Photobiomodulatory effects of He-Ne laser on excision wounds

    NASA Astrophysics Data System (ADS)

    Prabhu, Vijendra; Rao, Satish B. S.; Kumar, Pramod; Rao, Lakshmi; Mahato, Krishna K.

    2011-03-01

    Presently, great importance has been given to Low Level Laser Therapy (LLLT) with the intent of promoting wound healing process. The present study was aimed to investigate the promotive effect of LLLT on full thickness excision wounds in Swiss albino mice using optical fiber probe based light device. Circular wounds of diameter 15 mm were illuminated with single exposure of various laser doses 1, 2, 3, 4, 6, 8 and 10 J/cm2 along with appropriate controls. Further, an optimal dose of 2 J/cm2 was applied to excision wounds at different post-wounding treatment schedules (0, 24 h and 48 h) to explicate the relations between treatment schedule and its tissue regeneration potential. Wound area, mean wound healing time along with hydroxyproline and glucosamine levels from wound ground tissue was assessed to evaluate the resultant photobiostimulatory outcome. Histological analysis was performed on day 10 of post-wounding. A significant increase in hydroxyproline (P< 0.001) and glucosamine levels (P< 0.01) were observed in 2 J/cm2 irradiation group, which was also substantiated by histological findings. In conclusion, the present study demonstrated that the immediate irradiation of 2 J/cm2 dose following wounding hasten the healing process compared to the unilluminated control.

  1. [Case of multiple encrusted stones on the ureteral stent left for 7 years: the efficacy of extracting the ureteral stent on transurethral lithotripsy].

    PubMed

    Okuda, Hidenobu; Yamanaka, Masaki; Kimura, Toshio; Takeyama, Masami

    2009-09-01

    A 48 years-old man had undergone transurethral lithotripsy (TUL) and Extracorporeal Shockwave Lithotripsy (ESWL) for bilateral ureteral stones and bilateral ureteral stents had been placed in 2001. He was lost to the follow-up for about 7 years after the removal of left ureteral stent. He had complained of right back pain and fever for two months. KUB showed right ureteral stones and encrustation along the ureteral stent. We performed TUL extracting the ureteral stent by silk, referring to silk loop technique. All stones and the encrusted ureteral stent were removed. This was very effective for patients with encrusted ureteral stent.

  2. Anesthesia management during aortic surgery: Preoperative patient assessment.

    PubMed

    Mahlmann, Adrian; Weiss, Norbert

    2016-09-01

    Patients with aortic diseases have a high rate of cardiac, cerebrovascular, or pulmonary comorbidities. Open surgery or endovascular interventions of the aorta are associated with high perioperative cardiac risk. Simple scoring systems for preoperative risk stratification can be used to identify high-risk patients. In these patients, further diagnostic and therapeutic interventions are required to reduce perioperative morbidity and mortality. In contrast, low-risk patients can be identified, who may proceed to intervention without additional cardiopulmonary diagnostic testing. According to evidence-based recommendations in patients at risk, statin therapy should be initiated and beta blockers should be uptitrated preoperatively. Smoking cessation preoperatively reduces perioperative complications and should be encouraged in all patients. PMID:27650337

  3. Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic

    PubMed Central

    Tariq, Hassan; Ahmed, Rafeeq; Kulkarni, Salil; Hanif, Sana; Toolsie, Omesh; Abbas, Hafsa; Chilimuri, Sridhar

    2016-01-01

    Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care. Although there are several constraints in the development of PAT clinics, with increasing awareness about the usefulness of pre-operative risk assessments, growing bodies of literature, and evidence-based guidelines, these clinics are becoming a medical necessity for the improvement of perioperative care. PMID:27812286

  4. Preoperative embolization of juvenile angiofibromas of the nasopharynx.

    PubMed

    Pletcher, J D; Newton, T H; Dedo, H H; Norman, D

    1975-01-01

    The juvenile nasopharyngeal angiofibroma is a vascular tumor. Careful and complete removal is challenging because of the brisk bleeding during surgery. The means applied to reduce this blood loss have included preoperative estrogens, ligation of feeding vessels, silicone embolization of feeding vessels, and cryosurgery. We have used preoperative Gelfoam embolization of the internal maxillary artery in seven patients. Our clinical impression of significant reduction in loss of blood was confirmed by comparison with 16 previous patients. The average amount of blood lost in the embolized group was half that of the control group. A study of this type comprises many variables; however, the results do suggest that preoperative embolization of the internal maxillary artery is of advantage in the surgical treatment of juvenile angiofibromas.

  5. [Transrectal magnetotherapy of the prostate from Intramag device in prophylaxis of postoperative complications of transurethral resection of prostatic adenoma].

    PubMed

    Neĭmark, A I; Snegirev, I V; Neĭmark, B A

    2006-01-01

    The authors analyse preoperative preparation of 91 patients with benign prostatic hyperplasia (BPH). Two groups of patients received conventional preparation (group 1) and magnetotherapy (group 2) before TUR of the prostate. The examination covered immune system, bacteriological indices of urine and prostatic tissue. Infection of the urinary tract is a main risk factor of complications after TUR. Conventional preoperative preparation fails to correct immunity, to change bacterial urine flora, to improve hemodynamics in the prostate. Transrectal magnetotherapy with running magnetic field eliminates deficiency of T- and B-cell immunity, raises functional activity of B-lymphocytes and phagocytic ability of neutrophils, reduces endogenic intoxication, tissue edema, bacterial contamination, number of thrombohemorrhagic complications. This leads to a decrease in the number of postoperative complications. PMID:16708596

  6. Transurethral ultrasound of the prostrate for applications in prostrate brachytherapy: analysis of phantom and in-vivo data

    NASA Astrophysics Data System (ADS)

    Holmes, David R., III; Davis, Brian J.; Bruce, Charles; Wilson, Torrence; Robb, Richard A.

    2001-05-01

    3D Trans-Urethral Ultrasound (TUUS) imaging is a new imaging technique for the diagnosis and treatment of prostate disease. Our current research focuses on the potential of TUUS in therapy guidance during tansperineal interstitial permanent prostate brachytherapy (TIPPB). TUUS may complement of potentially replace x-ray fluoroscopy and TRUS in providing data for determining the prostate boundary and radiation source locations. Prostate boundary detection and source localization using TUUS were tested on an ultrasound- equivalent prostate phantom and ina patient during TIPPB. Data collection was conducted with a 10 French, 10 MHz ultrasound catheter controlled by an Acuson SequoiaTM workstation. 2D and 3D TUUS scans were acquired after radioactive seeds were placed in the phantom and in the patient. Data was reconstructed, processed, and analyzed using Analyze software. Segmentation of the prostate boundary was performed semi-automatically, and seed segmentation was performed manually. Image artifacts in TUUS data resulted in incorrect reconstruction of the seeds. Intelligent processing of the seed data improved reconstruction. Comparison to the CT data suggests that TUUS dat provides: 1) greater spatial resolution, 2) greater temporal resolution and 3) better contrast for soft tissue differentiation. The reconstructed source sizes and locations were measured and found accurate. Placement of the TUUS catheter into the urethra provides excellent 2D sections which can be used to acquire volumetric data for 3D analysis of the prostate and radioactive sources. Preliminary results suggest that TUUS will be useful for guidance of seed placement, post-implant seed localization, and intra-operative dosimetry.

  7. Micropapillary morphology is an indicator of poor prognosis in patients with urothelial carcinoma treated with transurethral resection and radiochemotherapy.

    PubMed

    Bertz, Simone; Wach, S; Taubert, H; Merten, R; Krause, F S; Schick, S; Ott, O J; Weigert, E; Dworak, O; Rödel, C; Fietkau, R; Wullich, B; Keck, B; Hartmann, A

    2016-09-01

    Purpose of this study was to evaluate prognostic impact of rare variants of urothelial bladder cancer (BC) after treatment with combined radiochemotherapy (RCT). To this end tumour tissue of 238 patients with urothelial carcinoma (UC) treated with transurethral resection of the bladder (TUR-B) and RCT with curative intent was collected. Histomorphological analysis included re-evaluation and semi-quantitative assessment of rare UC subtypes. Additionally, human epidermal growth factor receptor 2 (HER2) chromogenic in situ hybridisation (CISH) was performed in tumours with a micropapillary component exceeding 30 %. Long-term follow-up was available for 200 patients (range 3-282 months). Variant UC histology was found in 45 of 238 tumours, most frequently micropapillary UC (N = 17) including cases with a small fraction of tumour with micropapillary morphology. The mere presence of micropapillary morphology did not affect prognosis. In tumours with extensive (≥30 %) micropapillary morphology (N = 8) Kaplan-Meier analysis revealed significantly worse cancer specific survival (CSS) (P = 0.002) compared to conventional UC (mean survival times 97 months and 229 months, respectively). Univariate Cox regression analysis of cases with ≥30 % micropapillary morphology revealed a hazard ratio of 4.726 (95 % CI 1.629-13.714) for CSS (P = 0.004). CISH revealed HER2 gene amplification in 3/10 tumours with ≥30 % micropapillary component. In conclusion, for BC treated with TUR-B and RCT, the presence of micropapillary morphology in more than 30 % of the tumour is an adverse prognostic factor. Further studies are needed to evaluate a potential benefit of different, especially multimodal treatment strategies for micropapillary UC and also other subtypes of UC. Her2 represents a promising therapeutic target in a subset of micropapillary UC. PMID:27392930

  8. Micropapillary morphology is an indicator of poor prognosis in patients with urothelial carcinoma treated with transurethral resection and radiochemotherapy.

    PubMed

    Bertz, Simone; Wach, S; Taubert, H; Merten, R; Krause, F S; Schick, S; Ott, O J; Weigert, E; Dworak, O; Rödel, C; Fietkau, R; Wullich, B; Keck, B; Hartmann, A

    2016-09-01

    Purpose of this study was to evaluate prognostic impact of rare variants of urothelial bladder cancer (BC) after treatment with combined radiochemotherapy (RCT). To this end tumour tissue of 238 patients with urothelial carcinoma (UC) treated with transurethral resection of the bladder (TUR-B) and RCT with curative intent was collected. Histomorphological analysis included re-evaluation and semi-quantitative assessment of rare UC subtypes. Additionally, human epidermal growth factor receptor 2 (HER2) chromogenic in situ hybridisation (CISH) was performed in tumours with a micropapillary component exceeding 30 %. Long-term follow-up was available for 200 patients (range 3-282 months). Variant UC histology was found in 45 of 238 tumours, most frequently micropapillary UC (N = 17) including cases with a small fraction of tumour with micropapillary morphology. The mere presence of micropapillary morphology did not affect prognosis. In tumours with extensive (≥30 %) micropapillary morphology (N = 8) Kaplan-Meier analysis revealed significantly worse cancer specific survival (CSS) (P = 0.002) compared to conventional UC (mean survival times 97 months and 229 months, respectively). Univariate Cox regression analysis of cases with ≥30 % micropapillary morphology revealed a hazard ratio of 4.726 (95 % CI 1.629-13.714) for CSS (P = 0.004). CISH revealed HER2 gene amplification in 3/10 tumours with ≥30 % micropapillary component. In conclusion, for BC treated with TUR-B and RCT, the presence of micropapillary morphology in more than 30 % of the tumour is an adverse prognostic factor. Further studies are needed to evaluate a potential benefit of different, especially multimodal treatment strategies for micropapillary UC and also other subtypes of UC. Her2 represents a promising therapeutic target in a subset of micropapillary UC.

  9. Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate

    PubMed Central

    Tao, Huang; Jiang, Yu Yong; Jun, Qi; Ding, Xu; Jian, Duan Liu; Jie, Ding; Ping, Zhu Yu

    2016-01-01

    ABSTRACT Purpose: To determine risk factors of postoperative urethral stricture (US) and vesical neck contracture (BNC) after transurethral resection of prostate (TURP) from perioperative parameters. Materials and Methods: 373 patients underwent TURP in a Chinese center for lower urinary tract symptoms suggestive of benign prostatic obstruction (LUTS/BPO), with their perioperative and follow-up clinical data being collected. Univariate analyses were used to determine variables which had correlation with the incidence of US and BNC before logistic regression being applied to find out independent risk factors. Results: The median follow-up was 29.3 months with the incidence of US and BNC being 7.8% and 5.4% respectively. Resection speed, reduction in hemoglobin (ΔHb) and hematocrit (ΔHCT) levels, incidence of urethral mucosa rupture, re-catheterization and continuous infection had significant correlation with US, while PSA level, storage score, total prostate volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), resection time and resected gland weight had significant correlation with BNC. Lower resection speed (OR=0.48), urethral mucosa rupture (OR=2.44) and continuous infection (OR=1.49) as well as higher storage score (OR=2.51) and lower TPV (OR=0.15) were found to be the independent risk factors of US and BNC respectively. Conclusions: Lower resection speed, intraoperative urethral mucosa rupture and postoperative continuous infection were associated with a higher risk of US while severer storage phase symptom and smaller prostate size were associated with a higher risk of BNC after TURP. PMID:27256185

  10. The effect of immediate surgical bipolar plasmakinetic transurethral resection of the prostate on prostatic hyperplasia with acute urinary retention

    PubMed Central

    He, Le-Ye; Zhang, Yi-Chuan; He, Jing-Liang; Li, Liu-Xun; Wang, Yong; Tang, Jin; Tan, Jing; Zhong, Kuangbaio; Tang, Yu-Xin; Long, Zhi

    2016-01-01

    In the present study, we evaluated the safety and efficacy of immediate surgical bipolar plasmakinetic transurethral resection of the prostate (PK-TURP) for patients with benign prostatic hyperplasia (BPH) with acute urinary retention (AUR). We conducted a retrospective analysis of clinical data of BPH patients who received PK-TURP. A total of 1126 BPH patients were divided into AUR (n = 348) and non-AUR groups (n = 778). After the urethral catheters were removed, the urine white blood cell (WBC) count in the AUR group significantly increased compared with the non-AUR group (P < 0.01). However, there was no significant difference in international prostate symptom score, painful urination, and maximal urinary flow rate. The duration of hospitalization of the AUR group was longer than that of the non-AUR group (P < 0.001). A total of 87.1% (303/348) patients in the AUR group and 84.1% (654/778) patients in the non-AUR group completed all of the postoperative follow-up visits. The incidence of urinary tract infection in the AUR group within 3 months after surgery was significantly higher than that in the non-AUR group (P < 0.01). The incidence of temporary urinary incontinence in the AUR group did not exhibit significant difference. During 3–12 months after surgery, there were no significant differences in major complications between the two groups. Multivariate regression analyses showed that age, postvoid residual, maximal urinary flow rate, diabetes, and hypertension, but not the presence of AUR, were independent predictors of IPSS post-PK-TURP. In conclusion, immediate PK-TURP surgery on patients accompanied by AUR was safe and effective. PMID:26178398

  11. The effect of complete transurethral resection of the prostate on symptoms, quality of life, and voiding function improvement

    PubMed Central

    Verikaite, Jone; Jievaltas, Mindaugas

    2015-01-01

    Introduction Transurethral resection of the prostate (TURP) still remains the most popular surgical treatment for patients with lower urinary tract symptoms. However, in some patients, the improvement of symptoms after TURP is insufficient. The aim of our study was to evaluate the impact of the resected prostate tissue weight (RPTW) on the improvement of symptoms (IPSS), quality of life (QoL), and voiding function after TURP. Material and methods The study included 89 men who had undergone TURP in our institution. IPSS, QoL, post–voiding residual urine volume (PVR) and Qmax were recorded before the operation and six months after TURP. The total prostate volume (TPV) and transition zone volume (TZV) were measured before the operation by transrectal ultrasound. The impact of RPTW, RPTW/TZV ratio, and RPTW/TPV ratio were analyzed according to the efficacy of TURP. Results The mean Qmax after TURP increased by 10.15 mL/s, IPSS decreased by 16.7 points, QoL increased by 3.57 points, and PVR decreased by 95.3 mL. According to Qmax, the treatment was effective in 74.2%, according to IPSS, in 91%, and according to QoL, in 74.2% of patients. The ROC analysis demonstrated that RPTW/TZV and RPTW/TPV ratios were the most significant predictors of obtaining favorable results. Survival analysis (life table) shows that in order to achieve 50% improvement on Qmax, QoL, and IPSS, more than 30–35% of TPV and more than 60% of the TZV should be removed. Conclusions The efficacy of the TURP at short term follow-up depends on the completeness of the resection. PMID:26251736

  12. Photoselective vaporization of prostate vs. transurethral resection of prostate: A prospective, randomized study with one year follow-up

    PubMed Central

    Mohanty, Nayan K.; Vasudeva, Pawan; Kumar, Anup; Prakash, Sanjay; Jain, Manoj; Arora, Rajender P.

    2012-01-01

    Objectives: To evaluate in a prospective, randomized study, the efficacy and safety profile of photoselective vaporization of prostate (PVP) using a 80W potassium titanyl phosphate (KTP) laser when compared to standard transurethral resection of prostate (TURP) in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). Materials and Methods: Between February 2009 and August 2009, 117 patients satisfying the eligibility criteria underwent surgery [60 PVP{Group A}; 57 TURP{Group B}]. The groups were compared for functional outcome (both subjective and objective parameters), perioperative parameters and complications, with a follow up of one year. P value<0.05 was considered statistically significant. Results: The baseline characteristics of the two groups were comparable. Mean age was 66.68 years and 65.74 years, mean IPSS score was 19.98 and 20.88, mean prostate volume was 44.77 cc and 49.02 cc in Group A and B, respectively. Improvements in IPSS, QOL, prostate volume, Q max and PVRU at 12 months were similar in both groups. PVP patients had longer operating time, lesser perioperative blood loss, shorter catheterization time and a higher dysuria rate when compared to TURP patients. The overall complication rate was similar in the two groups. Conclusions: In patients with LUTS due to BPE, KTP-PVP is an equally efficacious alternative to TURP with durable results at one year follow up with additional benefits of lesser perioperative blood loss, lesser transfusion requirements and a shorter catheterization time. Long term comparative data is awaited to clearly define the role of KTP-PVP in such patients. PMID:23204660

  13. Phyllodes tumor diagnosed after ultrasound-guided vacuum-assisted excision: should it be followed by surgical excision?

    PubMed

    Youk, Ji Hyun; Kim, Hana; Kim, Eun-Kyung; Son, Eun Ju; Kim, Min Jung; Kim, Jeong-Ah

    2015-03-01

    Our aim was to retrospectively evaluate the results of ultrasound (US)-guided vacuum-assisted excision (US-VAE) of phyllodes tumors (PTs). A total of 41 PTs diagnosed at US-VAE followed by surgery (n = 27) or at least 2 y of US monitoring (n = 14) were included. By comparison of US-VAE pathology with surgical histology or follow-up US results, cases were divided into upgraded (malignant) and non-upgraded (benign) groups. These two groups were compared with respect to clinical, procedural and US features. Among 27 surgical cases, 2 (8.7%) of 23 benign PTs were upgraded to malignant PTs. The Breast Imaging Reporting and Data System category was retrospectively assigned as 4a (50%) or 4b (50%) in the upgraded group (n = 2) and 3 (64%) or 4a (36%) in the non-upgraded group (n = 39) (p = 0.018). Residual tumor was observed at the site of US-VAE in 15 of 27 surgical cases and 0 of 14 US follow-up cases (36.6%, 15/41). Given the rates of upgrade to malignancy (8.7%) and residual tumor (36.6%), PTs diagnosed after US-VAE should be surgically excised. PMID:25619780

  14. [Research hotspot and progress of preoperative chemoradiotherapy for rectal cancer].

    PubMed

    Peng, Jianhong; Pan, Zhizhong

    2016-06-01

    Preoperative chemoradiotherapy (CRT) has become an important component of comprehensive treatment for rectal cancer. Although local recurrent risk has been remarkably reduced by CRT, distant metastasis remains the main cause of therapeutic failure. Therefore, more and more studies focused on controlling distant metastasis in order to prolong long-term survival. Recently, CRT has achieved certain progression in rectal cancer: (1)Patients with stage T3 should be classified into specific subgroups to formulate individualized treatment regimen. For stage T3a, it is feasible to perform surgery alone or administrate low intensity preoperative CRT; for stage T3b and T3c, conventional preoperative CRT should be performed in order to reduce the risk of recurrence postoperatively. (2)With regard to combined regimen for chemotherapy, oral capecitabine superiors to intravenous bolus 5-fluorouracil (5-FU) and is comparable to continuous intravenous infusion 5-FU with a better safety. Therefore, capecitabine is recommended for older patients and those with poor tolerance to chemotherapy. Compared to single 5-FU concurrent CRT, addition of oxaliplatin into preoperative CRT may result in a higher survival benefit in Chinese patients. As to the application of irinotecan, bevacizumab or cetuximab, unless there are more evidence to confirm their efficacy and safety from randomized controlled trial, they should not be recommended for adding to preoperative CRT routinely. (3)On the optimization in CRT pattern, the application values of induction chemotherapy before concurrent CRT, consolidation chemotherapy after concurrent CRT, neoadjuvant sandwich CRT, neoadjuvant chemotherapy alone and short-course preoperative radiotherapy remain further exploration. (4)On the treatment strategy for clinical complete response (cCR) after CRT, whether "wait and see" strategy is able to be adopted, it is still a hot topic with controversy. PMID:27353093

  15. Two cases of synovial haemangioma of the knee joint: Gd-enhanced image features on MRI and arthroscopic excision.

    PubMed

    Sasho, Takahisa; Nakagawa, Koichi; Matsuki, Kei; Hoshi, Hiroko; Saito, Masahiko; Ikegawa, Naoshi; Akagi, Ryuichiro; Yamaguchi, Satoshi; Takahashi, Kazuhisa

    2011-12-01

    Synovial haemangioma of the knee joint is a relatively rare benign condition with around 200 reported cases. We have recently encountered two cases of synovial haemangioma of the knee joint which preoperative MRI had assessed as highly suspect and which arthroscopic resection and subsequent histological examinations confirmed as synovial hemangiomas. Published studies have identified the following as characteristic MRI features of synovial haemangioma: homogenous low intensity to iso-intensity on T1 sequence; and heterogeneous high intensity with low-intensity septa or spots within the lesion on T2 sequence. However, several other intra-knee disorders mimic these characteristics. In our two cases, we found that gadolinium (Gd)-enhanced images, which have been relatively rarely discussed in the literature, were useful for making the diagnosis and for determining the extent of this condition. These images also were very helpful during arthroscopic excision of the lesion. Nonetheless, even after Gd enhancement, differentiating between malignant conditions such as synovial sarcoma and haemangioma solely from MRI findings is still difficult.

  16. Minimizing preoperative anxiety with alternative caring-healing therapies.

    PubMed

    Norred, C L

    2000-11-01

    This article reviews holistic caring-healing therapies that may decrease preoperative anxiety for the surgical patient, based on the philosophy and science of caring developed by Jean Watson, RN, PhD, FAAN. Dr Watson reveals a new paradigm emerging in health care that blends the compassion and caring of nursing in harmony with the curative therapies of medicine. Hypnosis, aromatherapy, music, guided imagery, and massage are integrative caring-healing therapies that may minimize preoperative anxiety. Alternative therapies offer a high-touch balance when integrated with high-tech conventional surgical treatments.

  17. Effect of preoperative irradiation on healing of low colorectal anastomoses

    SciTech Connect

    Morgenstern, L.; Sanders, G.; Wahlstrom, E.; Yadegar, J.; Amodeo, P.

    1984-02-01

    The effect of preoperative irradiation on the healing of low colorectal anastomoses was studied experimentally. In 12 dogs in whom preoperative irradiation of 4,000 rads was given before low colorectal stapled anastomosis was performed, anastomotic leakage occurred in 66 percent. More than half of the anastomotic leaks were associated with either severe sepsis or death. In a matched group of control animals that underwent stapled anastomoses without irradiation, no anastomotic complications occurred. The clinical implications of this study are that stapled anastomoses in irradiated colon are at serious risk of anastomotic dehiscence and, therefore, should be protected with a proximal colostomy.

  18. [Importance of preoperative and intraoperative imaging for operative strategies].

    PubMed

    Nitschke, P; Bork, U; Plodeck, V; Podlesek, D; Sobottka, S B; Schackert, G; Weitz, J; Kirsch, M

    2016-03-01

    Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy. PMID:26939896

  19. A Rat Excised Larynx Model of Vocal Fold Scar

    PubMed Central

    Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Hee Choi, Seong; Bless, Diane M.

    2008-01-01

    Purpose To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic and vocal fold vibratory changes resulting from vocal fold scar. Method Twenty four 4-month-old male Sprague Dawley rats were assigned to one of four experimental groups: Chronic vocal fold scar, chronic vocal fold scar treated with 100 ng basic fibroblast growth factor (bFGF), chronic vocal fold scar treated with saline (sham treatment), and unscarred untreated control. Following tissue harvest, histological and immunohistochemical data were collected to confirm extracellular matrix alteration in the chronic scar group, and acoustic, aerodynamic and high speed digital imaging data were collected using an excised larynx setup in all groups. Phonation threshold pressure (Pth), glottal resistance (Rg), glottal efficiency (Eg), vibratory amplitude and vibratory area were employed as dependent variables. Results Chronically scarred vocal folds were characterized by elevated collagen I and III and reduced hyaluronic acid abundance. Phonation was achieved and data were collected from all control and bFGF treated larynges, however phonation was not achieved with 3 of 6 chronically scarred and 1 of 6 saline treated larynges. Compared to control, the chronic scar group was characterized by elevated Pth, reduced Eg, and intra-larynx vibratory amplitude and area asymmetry. The bFGF group was characterized by Pth below control group levels, Eg comparable to control, and vocal fold vibratory amplitude and area symmetry comparable to control. The sham group was characterized by Pth comparable to control, Eg superior to control, and vocal fold vibratory amplitude and area symmetry comparable to control. Conclusions The excised larynx model reported here demonstrated robust deterioration across phonatory indices under the scar condition and sensitivity to treatment induced change under the bFGF condition. The improvement observed under the sham condition may reflect

  20. Excision of Sleeping Beauty transposons: parameters and applications to gene therapy

    PubMed Central

    Liu, Geyi; Aronovich, Elena L.; Cui, Zongbin; Whitley, Chester B.; Hackett, Perry B.

    2007-01-01

    A major problem in gene therapy is the determination of the rates at which gene transfer has occurred. Our work has focused on applications of the Sleeping Beauty (SB) transposon system as a non-viral vector for gene therapy. Excision of a transposon from a donor molecule and its integration into a cellular chromosome are catalyzed by SB transposase. In this study, we used a plasmid-based excision assay to study the excision step of transposition. We used the excision assay to evaluate the importance of various sequences that border the sites of excision inside and outside the transposon in order to determine the most active sequences for transposition from a donor plasmid. These findings together with our previous results in transposase binding to the terminal repeats suggest that the sequences in the transposon-junction of SB are involved in steps subsequent to DNA binding but before excision, and that they may have a role in transposase–transposon interaction. We found that SB transposons leave characteristically different footprints at excision sites in different cell types, suggesting that alternative repair machineries operate in concert with transposition. Most importantly, we found that the rates of excision correlate with the rates of transposition. We used this finding to assess transposition in livers of mice that were injected with the SB transposon and transposase. The excision assay appears to be a relatively quick and easy method to optimize protocols for delivery of genes in SB transposons to mammalian chromosomes in living animals. PMID:15133768

  1. Transanal total mesorectal excision: A valid option for rectal cancer?

    PubMed Central

    Buchs, Nicolas C; Nicholson, Gary A; Ris, Frederic; Mortensen, Neil J; Hompes, Roel

    2015-01-01

    Low anterior resection can be a challenging operation, especially in obese male patients and in particular after radiotherapy. Transanal total mesorectal excision (TaTME) might offer technical advantages over laparoscopic or open approaches particularly for tumors in the distal third of the rectum. The aim of this article is to review the current experience with TaTME. The limits and future developments are also explored. Although the experience with TaTME is still limited, it might be a promising alternative to laparoscopic TME, especially for difficult cases where laparoscopy is too demanding. The preliminary data on complications and short-term oncological outcomes are good, but also emphasize the importance of careful patient selection. Finally, there is a need for large-scale trials focusing on long-term outcomes and oncological safety before widespread adoption can be recommended. PMID:26556997

  2. Nucleosome positioning, nucleotide excision repair and photoreactivation in Saccharomyces cerevisiae.

    PubMed

    Guintini, Laetitia; Charton, Romain; Peyresaubes, François; Thoma, Fritz; Conconi, Antonio

    2015-12-01

    The position of nucleosomes on DNA participates in gene regulation and DNA replication. Nucleosomes can be repressors by limiting access of factors to regulatory sequences, or activators by facilitating binding of factors to exposed DNA sequences on the surface of the core histones. The formation of UV induced DNA lesions, like cyclobutane pyrimidine dimers (CPDs), is modulated by DNA bending around the core histones. Since CPDs are removed by nucleotide excision repair (NER) and photolyase repair, it is of paramount importance to understand how DNA damage and repair are tempered by the position of nucleosomes. In vitro, nucleosomes inhibit NER and photolyase repair. In vivo, nucleosomes slow down NER and considerably obstruct photoreactivation of CPDs. However, over-expression of photolyase allows repair of nucleosomal DNA in a second time scale. It is proposed that the intrinsic abilities of nucleosomes to move and transiently unwrap could facilitate damage recognition and repair in nucleosomal DNA.

  3. Nucleotide excision repair: new tricks with old bricks.

    PubMed

    Kamileri, Irene; Karakasilioti, Ismene; Garinis, George A

    2012-11-01

    Nucleotide excision repair (NER) is a major DNA repair pathway that ensures that the genome remains functionally intact and is faithfully transmitted to progeny. However, defects in NER lead, in addition to cancer and aging, to developmental abnormalities whose clinical heterogeneity and varying severity cannot be fully explained by the DNA repair deficiencies. Recent work has revealed that proteins in NER play distinct roles, including some that go well beyond DNA repair. NER factors are components of protein complexes known to be involved in nucleosome remodeling, histone ubiquitination, and transcriptional activation of genes involved in nuclear receptor signaling, stem cell reprogramming, and postnatal mammalian growth. Together, these findings add new pieces to the puzzle for understanding NER and the relevance of NER defects in development and disease.

  4. Study of freshly excised brain tissues using terahertz imaging

    PubMed Central

    Oh, Seung Jae; Kim, Sang-Hoon; Ji, Young Bin; Jeong, Kiyoung; Park, Yeonji; Yang, Jaemoon; Park, Dong Woo; Noh, Sam Kyu; Kang, Seok-Gu; Huh, Yong-Min; Son, Joo-Hiuk; Suh, Jin-Suck

    2014-01-01

    We demonstrated that tumors in freshly excised whole brain tissue could be differentiated clearly from normal brain tissue using a reflection-type terahertz (THz) imaging system. THz binary images of brain tissues with tumors indicated that the tumor boundaries in the THz images corresponded well to those in visible images. Grey and white-matter regions were distinguishable owing to the different distribution of myelin in the brain tissue. THz images corresponded closely with magnetic resonance imaging (MRI) results. The MRI and hematoxylin and eosin-stained microscopic images were investigated to account for the intensity differences in the THz images for fresh and paraffin-embedded brain tissue. Our results indicated that the THz signals corresponded to the cell density when water was removed. Thus, THz imaging could be used as a tool for label-free and real-time imaging of brain tumors, which would be helpful for physicians to determine tumor margins during brain surgery. PMID:25136506

  5. Simulation of Tangential Excision: A Test for Construct Validity.

    PubMed

    Gallagher, James J; Goldin, Ian M; O'Sullivan, Geoffrey M; Silverman, Elliott L; Mitchell, Katrina B; Yurt, Roger W

    2015-01-01

    A foundational skill in burn surgery is tangential excision (TE). The purpose of this study was to develop a simulation model for TE, hypothesizing that simulation could be used in surgical training. TE simulation was created using the TE knife, foam, mineral oil, and base. Subjects, surgeons, or surgeons in training, were given a pre- and post-task questionnaire about experience with TE. Subjects were divided into three TE experience groups: novice--none, intermediate--some, and expert--TE in current or past practice. The task was to excise pre-marked rectangles, generating four excisional products (EPs). Evaluators blindly assessed performance by EP analysis using a novel scoring tool and reviewed videos using a modified objective structured assessment of technical skill (OSATS) rubric. Inter-rater reliabilities and P values were obtained, comparing Novice and Intermediate with Expert scores. Forty subjects completed the study: 16 were identified as TE novices, 17 as intermediates, and seven as experts. All EPs and videos were reviewed blindly by two evaluators using the EP scoring tool and OSATS methodology, respectively. Intraclass correlation coefficients were calculated to measure inter-rater reliabilities, which were acceptable (ICC => 0.42) for OSATS, time, and EP analysis: border and texture. Statistical differences between Novice and Expert scores were found (P < .0100, P < .0200, P < .0025, and P < .0005, respectively). Statistical differences between Intermediate and Expert scores were also found (P < .0100, P < .0200, P < .0100, and P < .0025, respectively). Post-simulation survey results showed experts 86% of the time agreeing or strongly agreeing that the simulation was similar to the clinical skin and 100% felt it would be a useful for training before clinical performance. Simulation for TE was successfully created to blindly discern level of TE experience. Participants agreed that simulation could play an essential role in burn surgical training.

  6. Microbiological sampling of carcasses by excision or swabbing.

    PubMed

    Gill, C O; Jones, T

    2000-02-01

    Groups of 25 carcasses were obtained by random selection of carcasses at the end of each of eight commercial processes for the dressing or cooling of carcasses. Samples were collected from six groups of pig or beef carcasses by excision or swabbing with sponge, gauze, or cotton wool, with one sample obtained by each of the four methods from a separate, randomly selected site on each carcass. Total aerobic counts, coliforms, and Escherichia coli from each sample were enumerated. Values for the mean log10, log10 mean, and log10 total numbers recovered were calculated for each set of total aerobic counts. Those statistics indicated that the numbers of bacteria recovered by excision or swabbing with sponge or gauze were similar, while the numbers recovered by swabbing with cotton wool were at the lower end of or below the range of the numbers recovered by the other methods. The numbers of coliforms or E. coli recovered from carcasses by sampling areas up to 100 cm2 were too few for the estimation of log mean numbers. Sampling of two groups of carcasses by swabbing with gauze indicated that each 10-fold increase in the area sampled, from 10 to 1,000 cm2, approximately doubled the number of samples from which coliforms or E. coli were recovered. Sampling of six groups of carcasses from one process indicated that the sizes of swabs and volumes of diluent used for processing swabs did not have to be increased proportionally to the area of carcass surface sampled to recover numbers of E. coli proportional to the sampled area. It therefore appears that carcass sampling techniques can be varied widely without compromising the recovery of bacteria, and that the relative efficiencies with which bacteria are recovered by different techniques can be assessed by sampling each carcass in a group of 25 by each of the methods to be compared. PMID:10678419

  7. Long-term results of intraoperative presacral electron boost radiotherapy (IOERT) in combination with total mesorectal excision (TME) and chemoradiation in patients with locally advanced rectal cancer

    SciTech Connect

    Krempien, Robert . E-mail: robert_krempien@med.uni-heidelberg.de; Roeder, Falk; Oertel, Susanne; Roebel, Marianne; Weitz, Juergen; Hensley, Frank W.; Timke, Carmen; Funk, Angela; Bischof, Marc; Zabel-Du Bois, Angelika; Niethammer, Andreas G.; Eble, Michael J.; Buchler, Markus W.; Treiber, Martina; Debus, Juergen

    2006-11-15

    Background: We analyzed the long-term results of patients with locally advanced rectal cancer using a multimodal approach consisting of total mesorectal excision (TME), intraoperative electron-beam radiation therapy (IOERT), and pre- or postoperative chemoradiation (CRT). Patients and Methods: Between 1991 and 2003, 210 patients with locally advanced rectal cancer (65 International Union Against Cancer [UICC] Stage II, 116 UICC Stage III, and 29 UICC Stage IV cancers) were treated with TME, IOERT, and preoperative or postoperative CHT. A total of 122 patients were treated postoperatively; 88 patients preoperatively. Preoperative or postoperative fluoropyrimidine-based CRT was applied in 93% of these patients. Results: Median age was 61 years (range, 26-81). Median follow-up was 61 months. The 5-year actuarial overall survival (OS), disease-free survival (DFS), local control rate (LC), and distant relapse free survival (DRS) of all patients was 69%, 66%, 93%, and 67%, respectively. Multivariate analysis revealed that UICC stage and resection status were the most important independent prognostic factors for OS, DFS, and DRS. The resection status was the only significant factor for local control. T-stage, tumor localization, type of resection, and type of chemotherapy had no significant impact on OS, DFS, DRS, and LC. Acute and late complications {>=}Grade 3 were seen in 17% and 13% of patients, respectively. Conclusion: Multimodality treatment with TME and IOERT boost in combination with moderate dose pre- or postoperative CRT is feasible and results in excellent long-term local control rates in patients with intermediate to high-risk locally advanced rectal cancer.

  8. Patterns of Response After Preoperative Treatment in Gastric Cancer

    SciTech Connect

    Diaz-Gonzalez, Juan A.; Rodriguez, Javier; Hernandez-Lizoain, Jose L.; Ciervide, Raquel; Gaztanaga, Miren; San Miguel, Inigo; Arbea, Leire; Aristu, J. Javier; Chopitea, Ana; Martinez-Regueira, Fernando; Valenti, Victor; Garcia-Foncillas, Jesus; Martinez-Monge, Rafael; Sola, Jesus J.

    2011-07-01

    Purpose: To analyze the rate of pathologic response in patients with locally advanced gastric cancer treated with preoperative chemotherapy with and without chemoradiation at our institution. Methods and Materials: From 2000 to 2007 patients were retrospectively identified who received preoperative treatment for gastric cancer (cT3-4/ N+) with induction chemotherapy (Ch) or with Ch followed by concurrent chemoradiotherapy (45 Gy in 5 weeks) (ChRT). Surgery was planned 4-6 weeks after the completion of neoadjuvant treatment. Pathologic assessment was used to investigate the patterns of pathologic response after neoadjuvant treatment. Results: Sixty-one patients were analyzed. Of 61 patients, 58 (95%) underwent surgery. The R0 resection rate was 87%. Pathologic complete response was achieved in 12% of the patients. A major pathologic response (<10% of residual tumor) was observed in 53% of patients, and T downstaging was observed in 75%. Median follow-up was 38.7 months. Median disease-free survival (DFS) was 36.5 months. The only patient-, tumor-, and treatment-related factor associated with pathologic response was the use of preoperative ChRT. Patients achieving major pathologic response had a 3-year actuarial DFS rate of 63%. Conclusions: The patterns of pathologic response after preoperative ChRT suggest encouraging intervals of DFS. Such a strategy may be of interest to be explored in gastric cancer.

  9. Preoperative digital mammography imaging in conservative mastectomy and immediate reconstruction

    PubMed Central

    Angrigiani, Claudio; Hammond, Dennis; Nava, Maurizio; Gonzalez, Eduardo; Rostagno, Roman; Gercovich, Gustavo

    2016-01-01

    Background Digital mammography clearly distinguishes gland tissue density from the overlying non-glandular breast tissue coverage, which corresponds to the existing tissue between the skin and the Cooper’s ligaments surrounding the gland (i.e., dermis and subcutaneous fat). Preoperative digital imaging can determine the thickness of this breast tissue coverage, thus facilitating planning of the most adequate surgical techniques and reconstructive procedures for each case. Methods This study aimed to describe the results of a retrospective study of 352 digital mammograms in 176 patients with different breast volumes who underwent preoperative conservative mastectomies. The breast tissue coverage thickness and its relationship with the breast volume were evaluated. Results The breast tissue coverage thickness ranged from 0.233 to 4.423 cm, with a mean value of 1.952 cm. A comparison of tissue coverage and breast volume revealed a non-direct relationship between these factors. Conclusions Preoperative planning should not depend only on breast volume. Flap evaluations based on preoperative imaging measurements might be helpful when planning a conservative mastectomy. Accordingly, we propose a breast tissue coverage classification (BTCC). PMID:26855903

  10. The Role of Preoperative TIPSS to Facilitate Curative Gastric Surgery

    SciTech Connect

    Norton, S.A.; Vickers, J.; Callaway, M.P. Alderson, D.

    2003-08-15

    The use of TIPSS to facilitate radical curative upper gastrointestinal surgery has not been reported. We describe a case in which curative gastric resection was performed for carcinoma of the stomach after a preoperative TIPSS and embolization of a large gastric varix in a patient with portal hypertension.

  11. Comparison of preoperative anxiety in reconstructive and cosmetic surgery patients.

    PubMed

    Sönmez, Ahmet; Bişkin, Nurdan; Bayramiçli, Mehmet; Numanoğlu, Ayhan

    2005-02-01

    Surgery is a serious stressor and a cause of anxiety for the patients. Reconstructive surgery patients are mostly operated on because of certain functional impairment or disability; on the contrary, cosmetic surgery patients do not have any physical impairment and they are operated on because of mostly psychologic reasons. The aim of this study was to compare the anxiety levels in the reconstructive surgery patients and cosmetic surgery patients preoperatively. Thirty-two patients in the reconstructive surgery group and 30 patients in the cosmetic surgery group were included in the study. State Trait Anxiety Inventory was used to measure the anxiety levels in these 2 groups preoperatively. The 2 groups were similar in characteristics such as age, gender distribution, number of previous operations, and trait anxiety scores. Mean state anxiety scores obtained for the reconstructive surgery group was 38.0 +/- 8.7, while it was 44.2 +/- 10.79 for the cosmetic surgery group (t test, degrees of freedom = 60, P = 0.015). This study reveals that preoperative anxiety levels in the cosmetic surgery patients are higher than those of the reconstructive surgery patients. Therefore, adequate preoperative preparation for cosmetic surgery should include attempts to cope with anxiety. Anxiolytics may be used more liberally and professional psychologic assistance may be required.

  12. The Concept of Death in Preoperational Retarded Children.

    ERIC Educational Resources Information Center

    Sternlicht, Manny

    1980-01-01

    Fourteen preoperational retarded boys and girls were interviewed for their concepts of death. Subjects did not have realistic concepts of when they would die, or of the permanence of death, but did have knowledge of how things die. Types of replies subjects made were significantly related to subjects' cognitive level. (Author/RH)

  13. Preoperative evaluation of a patient for abdominal aortic aneurysm repair.

    PubMed Central

    Chonchubhair, A. N.; Cunningham, A. J.

    1998-01-01

    Coexistent cardiovascular disease is common in patients presenting for repair of aortic aneurysms. However, preoperative cardiac evaluation prior to abdominal aortic aneurysm (AAA) surgery remains contentious with significant variations in practice between countries, institutions and individual anesthetists. The following case report raises some everyday issues confronting clinical anesthetists. PMID:10604782

  14. Preoperative diagnosis of colonic angiolipoma: a case report.

    PubMed

    Chen, Yang-Yuan; Soon, Maw-Soan

    2005-08-28

    Angiolipoma, a common benign tumor mostly seen in the subcutaneous tissue, is a rare pathological condition in the gastrointestinal tract that is usually diagnosed postoperatively. In this case report, an angiolipoma was diagnosed preoperatively by imaging (including CT scans, abdominal echo, barium enema, and colonoscopy). This pathology was confirmed postoperatively. Computed tomography scan, abdominal echo, and barium enema images were presented.

  15. Pre-operative preparation for otologic surgery: temporal bone simulation

    PubMed Central

    Sethia, Rishabh; Wiet, Gregory J.

    2015-01-01

    Purpose of review The field of temporal bone simulation (TBS) has largely focused on the development and validation of simulators as training and assessment tools. However, as technology has progressed over the years, researchers have envisioned new clinical applications for simulators extending to pre-operative surgical planning and case rehearsal. The purpose of this article is to review the current state of the art in TBS and to highlight recent advancements in the field. Due to space limitations, we will limit our discussion to computer-based virtual reality (VR) simulators. Recent findings A review of the recent literature on TBS revealed very limited application of VR simulators for pre-operative preparation. Current evidence suggests limitations in fidelity preclude successful patient-specific case rehearsal using VR simulation. Further investigation and clinical evaluation are required to validate its use outside of training and skill assessment. Summary This article provides an overview of the current use of VR simulators with emphasis on pre-operative planning. We evaluate the limitations of the technology, and discuss potential areas of improvement for the future. More studies are necessary to assess the value of VR simulation for pre-operative preparation. PMID:26339966

  16. [Nasopharyngeal fibroma. Excision under hemodilution and delayed autotransfusion].

    PubMed

    Brinquin, L; Bonsignour, J P; Dorne, R; Legulluche, Y; Le Bever, H; Trannoy, P; Rigaud, A; Welfringer, P; Pharaboz, C

    1986-01-01

    The surgical treatment of juvenile naso-pharyngeal angiofibroma involved a potential haemorrhagic risk: the average intra-operative blood loss was estimated at between 1,300 and 2,800 ml in many reports. Two cases are reported in which haemodilution and autologous blood transfusion were used. The method consisted in pre-operative repeated phlebotomies ("leap-frog") and normovolaemic acute haemodilution; thus, 1,700 ml of autologous blood was collected in the first case, and 2,300 ml in the second one. Autotransfusion was carried out and no homologous blood transfusion was used in the peri-operative period. The use of this method, although compelling, had many advantages (financial saving, suppression of adverse reactions with homologous transfusion, transfusion of fresh blood, reduction of postoperative oedema).

  17. Colorectal Stenting: An Effective Therapy for Preoperative and Palliative Treatment

    SciTech Connect

    Jost, Rahel S. Jost, Res; Schoch, Erich; Brunner, Brigit; Decurtins, Marco; Zollikofer, Christoph L.

    2007-06-15

    Purpose. To demonstrate the effectiveness of preoperative and palliative colorectal stent placement in acute colonic obstruction. Methods. Sixty-seven consecutive patients (mean age 67.3 years, range 25-93 years) with clinical and radiological signs of colonic obstruction were treated: 45 (67%) preoperatively and 22 (33%) with a palliative intent. In 59 patients (88%) the obstruction was malignant, while in 8 (12%) it was benign. A total of 73 enteric Wallstents were implanted under combined fluoroscopic/endoscopic guidance. Results. Forty-five patients were treated preoperatively with a technical success rate of 84%, a clinical success rate of 83%, and a complication rate of 16%. Of the 38 patients who were successfully stented preoperatively, 36 (95%) underwent surgery 2-22 days (mean 7.2 days) after stent insertion. The improved general condition and adequate bowel cleansing allowed single-stage tumor resection and primary end-to-end anastomosis without complications in 31 cases (86% of all operations), while only 5 patients had colostomies. Stent placement was used as the final palliative treatment in 22 patients. The technical success rate was 95%, the clinical success rate 72%, and the complication rate relatively high at 67%, caused by reocclusion in most cases. After noninvasive secondary interventions (e.g., tube placement, second stenting, balloon dilatation) the secondary patency of stents was 71% and mean reported survival time after stent insertion was 92 days (range 10-285 days). Conclusion. Preoperative stent placement in acute colonic obstruction is minimally invasive and allows an elective one-stage surgery in most cases. Stent placement also proved a valuable alternative to avoid colostomy in palliation.

  18. [The randomized study of efficiency of preoperative photodynamic].

    PubMed

    Akopov, A L; Rusanov, A A; Molodtsova, V P; Gerasin, A V; Kazakov, N V; Urtenova, M A; Chistiakov, I V

    2013-01-01

    The authors made a prospective randomized comparison of results of preoperative photodynamic therapy (PhT) with chemotherapy, preoperative chemotherapy in initial unresectable central non-small cell lung cancer in stage III. The efficiency and safety of preoperative therapy were estimated as well as the possibility of subsequent surgical treatment. The research included patients in stage IIIA and IIIB of central non-small cell lung cancer with lesions of primary bronchi and lower section of the trachea, which initially were unresectable, but potentially the patients could be operated on after preoperative treatment. The photodynamic therapy was performed using chlorine E6 and the light of wave length 662 nm. Since January 2008 till December 2011,42 patients were included in the research, 21 patients were randomized in the group for photodynamic therapy and 21--in group without PhT. These groups were compared according to their sex, age, stage of the disease and histological findings. After nonadjuvant treatment the remissions were reached in 19 (90%) patients of the group with PhT and in 16 (76%) patients without PhT and all the patients were operated on. The explorative operations were made on 3 patients out of 16 operated on in the group without PhT (19%). In the group PhT 14 pneumonectomies and 5 lobectomies were perfomed opposite 10 pneumonectomies and 3 lobectomies in group without PhT. The degree of radicalism of resection appears to be reliably higher in the group PhT (RO-89%, R1-11% as against RO-54%, R1-46% in group without PhT), p = 0.038. The preoperative endobronchial PhT conducted with chemotherapy was characterized by efficiency and safety, allowed the surgical treatment and elevated the degree of radicalism of this treatment in selected patients, initially assessed as unresectable. PMID:23808222

  19. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

    PubMed

    Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

    2014-12-01

    Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p < 0.02) and used less narcotic use (average 1.7 tablets, p < 0.02) for the first 36 hours compared with group 1. No statistically significant differences were identified between the two groups with regard to demographics, hours of postoperative cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction.

  20. Mechanisms of DNA Repair by Photolyase and Excision Nuclease (Nobel Lecture).

    PubMed

    Sancar, Aziz

    2016-07-18

    Ultraviolet light damages DNA by converting two adjacent thymines into a thymine dimer which is potentially mutagenic, carcinogenic, or lethal to the organism. This damage is repaired by photolyase and the nucleotide excision repair system in E. coli by nucleotide excision repair in humans. The work leading to these results is presented by Aziz Sancar in his Nobel Lecture. PMID:27337655

  1. Excision repair of bulky lesions in the DNA of mammalian cells

    SciTech Connect

    Setlow, R B; Grist, E

    1980-01-01

    The report examines the process of excision repair of pyrimidine dimers from uv-irradiated and chemically challenged human cells. It is shown by means of a sensitive endonuclease assay that the amount of excision observed depends upon the isotope used to label cells, and that XP heterozygotes are between normals and XPs. (ACR)

  2. Posterior Endoscopic Excision of Os Trigonum in Professional National Ballet Dancers.

    PubMed

    Ballal, Moez S; Roche, Andy; Brodrick, Anna; Williams, R Lloyd; Calder, James D F

    2016-01-01

    Previous studies have compared the outcomes after open and endoscopic excision of an os trigonum in patients of mixed professions. No studies have compared the differences in outcomes between the 2 procedures in elite ballet dancers. From October 2005 to February 2010, 35 professional ballet dancers underwent excision of a symptomatic os trigonum of the ankle after a failed period of nonoperative treatment. Of the 35 patients, 13 (37.1%) underwent endoscopic excision and 22 (62.9%) open excision. We compared the outcomes, complications, and time to return to dancing. The open excision group experienced a significantly greater incidence of flexor hallucis longus tendon decompression compared with the endoscopic group. The endoscopic release group returned to full dance earlier at a mean of 9.8 (range 6.5 to 16.1) weeks and those undergoing open excision returned to full dance at a mean of 14.9 (range 9 to 20) weeks (p = .001). No major complications developed in either group, such as deep infection or nerve or vessel injury. We have concluded that both techniques are safe and effective in the treatment of symptomatic os trigonum in professional ballet dancers. Endoscopic excision of the os trigonum offers a more rapid return to full dance compared with open excision. PMID:27289219

  3. 75 FR 46844 - Excise Taxes on Prohibited Tax Shelter Transactions and Related Disclosure Requirements...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-04

    ... Time for filing returns. * * * * * (g) * * * (3) Transition rule. A Form 4720, for a section 4965 tax... return, statement or list. * * * * * (c) * * * (2) Transition rule. A Form 5330, ``Return of Excise Taxes... Internal Revenue Service 26 CFR Parts 53 and 54 RIN 1545-BG18 Excise Taxes on Prohibited Tax...

  4. A history of the DNA repair and mutagenesis field: The discovery of base excision repair.

    PubMed

    Friedberg, Errol C

    2016-01-01

    This article reviews the early history of the discovery of an DNA repair pathway designated as base excision repair (BER), since in contrast to the enzyme-catalyzed removal of damaged bases from DNA as nucleotides [called nucleotide excision repair (NER)], BER involves the removal of damaged or inappropriate bases, such as the presence of uracil instead of thymine, from DNA as free bases.

  5. 26 CFR 53.4940-1 - Excise tax on net investment income.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...) MISCELLANEOUS EXCISE TAXES (CONTINUED) FOUNDATION AND SIMILAR EXCISE TAXES Taxes on Investment Income § 53.4940... section 4940(c) and paragraph (c) of this section) of a tax-exempt private foundation (as defined in... the foundation is required to file under section 6033 for the taxable year and will be paid...

  6. Chromosomal excision of a new pathogenicity island modulates Salmonella virulence in vivo.

    PubMed

    Tobar, Hugo E; Salazar-Echegarai, Franciso J; Nieto, Pamela A; Palavecino, Christian E; Sebastian, Vatenlina P; Riedel, Claudia A; Kalergis, Alexis M; Bueno, Susan M

    2013-08-01

    Although the excision of unstable pathogenicity islands is a phenomenon that has been described for several virulent bacteria, whether this process directly affects the capacity of these microorganisms to cause disease in their hosts remains unknown. Salmonella enterica serovar Enteritidis (S. Enteritidis) is an enterobacterium that harbors several unstable pathogenicity islands that can excise from the main bacterial chromosome. Here we have evaluated whether excision of one of these pathogenicity islands, denominated as Region of Difference 21 (ROD21), is required for S. Enteritidis to cause disease in the host. By means of genetic targeting of the integrase encoded by the ROD21 we have generated S. Enteritidis strains unable to excise ROD21. The failure to excise ROD21 significantly reduced the capacity to cause a lethal disease and to colonize the spleen and liver of mice, as compared to wild type S. Enteritidis. On the contrary, S. Enteritidis strains overexpressing an excisionase protein increased the frequency of ROD21 excision and showed an improved capacity to cause lethal disease in mice. Accordingly, strains unable to excise ROD21 showed an altered expression of genes located in this pathogenicity island. Our results suggest that the genetic excision of the pathogenicity island ROD21 in S. Enteritidis modulates the capacity of this bacterium to cause disease in mice due to a change in the expression of virulence genes.

  7. 77 FR 43157 - Disregarded Entities and the Indoor Tanning Services Excise Tax; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-24

    ... the Federal Register on June 25, 2012 (77 FR 37806) relating to disregarded entities (including qualified subchapter S subsidiaries) and the indoor tanning services excise tax. DATES: This correction is... Excise Tax; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Correcting...

  8. 76 FR 77053 - Proposed Collection; Income, Excise, and Estate and Gift Taxes Effective Dates, etc.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-09

    ... Internal Revenue Service Proposed Collection; Income, Excise, and Estate and Gift Taxes Effective Dates... information collection requirements related to income, excise, and estate and gift taxes; effective dates and other issues arising under the employee benefit provisions of the tax reform act of 1984. DATES:...

  9. Posterior Endoscopic Excision of Os Trigonum in Professional National Ballet Dancers.

    PubMed

    Ballal, Moez S; Roche, Andy; Brodrick, Anna; Williams, R Lloyd; Calder, James D F

    2016-01-01

    Previous studies have compared the outcomes after open and endoscopic excision of an os trigonum in patients of mixed professions. No studies have compared the differences in outcomes between the 2 procedures in elite ballet dancers. From October 2005 to February 2010, 35 professional ballet dancers underwent excision of a symptomatic os trigonum of the ankle after a failed period of nonoperative treatment. Of the 35 patients, 13 (37.1%) underwent endoscopic excision and 22 (62.9%) open excision. We compared the outcomes, complications, and time to return to dancing. The open excision group experienced a significantly greater incidence of flexor hallucis longus tendon decompression compared with the endoscopic group. The endoscopic release group returned to full dance earlier at a mean of 9.8 (range 6.5 to 16.1) weeks and those undergoing open excision returned to full dance at a mean of 14.9 (range 9 to 20) weeks (p = .001). No major complications developed in either group, such as deep infection or nerve or vessel injury. We have concluded that both techniques are safe and effective in the treatment of symptomatic os trigonum in professional ballet dancers. Endoscopic excision of the os trigonum offers a more rapid return to full dance compared with open excision.

  10. Mechanisms of DNA Repair by Photolyase and Excision Nuclease (Nobel Lecture).

    PubMed

    Sancar, Aziz

    2016-07-18

    Ultraviolet light damages DNA by converting two adjacent thymines into a thymine dimer which is potentially mutagenic, carcinogenic, or lethal to the organism. This damage is repaired by photolyase and the nucleotide excision repair system in E. coli by nucleotide excision repair in humans. The work leading to these results is presented by Aziz Sancar in his Nobel Lecture.

  11. Aerodynamic and Nonlinear Dynamic Acoustic Analysis of Tension Asymmetry in Excised Canine Larynges

    ERIC Educational Resources Information Center

    Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.

    2012-01-01

    Purpose: To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Method: SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension…

  12. 29 CFR 779.262 - Excise taxes at the retail level.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Federal excise taxes on gasoline, tires, and inner tubes reflect that, although they are listed under the....” Federal excise taxes on gasoline, tires, and inner tubes, when “separately stated,” may therefore be... under section 3(s)(1) of the Act and section 13(a)(2) for purposes of applying the $250,000 test...

  13. 29 CFR 779.262 - Excise taxes at the retail level.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Federal excise taxes on gasoline, tires, and inner tubes reflect that, although they are listed under the....” Federal excise taxes on gasoline, tires, and inner tubes, when “separately stated,” may therefore be... under section 3(s)(1) of the Act and section 13(a)(2) for purposes of applying the $250,000 test...

  14. Solitary fibrous tumor on needle biopsy and transurethral resection of the prostate: a clinicopathologic study of 13 cases.

    PubMed

    Herawi, Mehsati; Epstein, Jonathan I

    2007-06-01

    One of the least commonly encountered spindle cell tumors seen on prostatic needle biopsy or transurethral resection (TUR) of the prostate is solitary fibrous tumor (SFT). We studied 13 cases of SFTs identified on either prostate needle biopsy (n=9) or TUR of the prostate (n=4). Mean patient age at diagnosis was 63 years (range: 46 to 75 y; median: 65 y). Twelve men presented with urinary tract symptoms and 1 patient was biopsied during work-up of bone metastases. Ten cases were SFTs originating in the prostate, 2 cases arose between the prostate and rectum extending into the prostate (n=2), and 1 case was a pelvic mass without infiltration of the prostate. In 9 cases, a complete tumor resection was attempted by cystoprostatectomy (n=2), radical prostatectomy (n=4), pelvic exenteration (n=2), or pelvic tumor resection (n=1). Enucleation (n=1) and TUR (n=1) were performed in 2 other cases. Tumor sizes ranged from 8.5 to 15 cm in 7 radically resected cases. Mitotic rates were 3 to 5 per 10 high power fields in 5 cases, with the remaining cases having either rare (n=4) or no mitoses (n=4). Seven cases demonstrated areas of necrosis. Based on a combination of increased cellularity, mitotic activity, necrosis, nuclear pleomorphism, and infiltrativeness, 4 prostatic SFTs were malignant, 4 were benign, and 2 were borderline. Of the 3 non-prostatic SFTs, 1 was malignant and 2 were borderline. All tumors but 1 were immunoreactive for CD34 (n=12). Material for additional immunohistochemistry was available for the majority of cases with positive stains for Bcl-2 (11/11), CD99 (7/10), beta-catenin (5/10), and c-kit (0/11). Three SFTs demonstrated >or=10% p53 immunoreactivity including 1 tumor with 50% positivity; and 3 cases had Ki-67 rates of >or=20%. Although all SFTs were initially clinically considered to be of prostatic origin, some of the cases arose in the pelvis with secondary involvement of the prostate. Approximately 50% of prostatic SFTs were malignant. Even in the

  15. Simultaneous transurethral resection of bladder cancer and prostate may reduce recurrence rates: A systematic review and meta-analysis

    PubMed Central

    LI, SHENG; ZENG, XIAN-TAO; RUAN, XIAO-LAN; WANG, XING-HUAN; GUO, YI; YANG, ZHONG-HUA

    2012-01-01

    The aim of this study was to evaluate the recurrence rate of simultaneous transurethral resection of bladder cancer and prostate (TURBT+TURP) in the treatment of non-muscle invasive bladder cancer (NMIBC) with benign prostatic hyperplasia (BPH). We searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and the ISI Web of Knowledge databases from their establishment until March 2012, to collect all the original studies on TURBT+TURP vs. TURBT alone in the treatment of NMIBC with BPH. After screening the literature, methodological quality assessment and data extraction was conducted independently by two reviewers and meta-analysis was performed using the RevMan 5.1 software. The quality of data was assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Eight studies, including seven non-randomized concurrent controlled trials (NRCCTs) and one randomized controlled trial (RCT), involving a total of 1,372 patients met the criteria. Meta-analyses of NRCCTs showed that in the TURBT+TURP group, overall recurrence rates were lower [odds ratio (OR), 0.76; 95% confidence interval (CI), 0.60–0.96; P=0.02] and the difference was statistically significant. The postoperative recurrence rate in the prostatic fossa/bladder neck (OR, 0.96; 95% CI, 0.64–1.45; P=0.86) and bladder tumor progression rates (OR, 0.96; 95% CI, 0.49–1.87; P=0.91) were similar between the TURBT+TURP and TURBT groups, but the difference was not significant. According to the GRADE approach, the level of evidence was moderate or low. Only one RCT demonstrated that overall postoperative tumor recurrence rates, recurrence rates at prostate fossa/bladder neck and bladder tumor progression rates between simultaneous groups and control groups were almost equal. There was no significant difference (P>0.05), and the level of evidence was moderate. For patients with NMIBC and BPH, simultaneous resection did not increase the overall

  16. Cell death caused by excision of centromeric DNA from a chromosome in Saccharomyces cerevisiae.

    PubMed

    Miyamoto, Akihiro; Yanamoto, Toshiaki; Matsumoto, Takehiro; Hatano, Takushi; Matsuzaki, Hiroaki

    2013-01-01

    If genetically modified organisms (GMOs) are spread through the natural environment, it might affect the natural environment. To help prevent the spread of GMOs, we examined whether it is possible to introduce conditional lethality by excising centromeric DNA from a chromosome by site-specific recombination in Saccharomyces cerevisiae as model organism. First, we constructed haploid cells in which excision of the centromeric DNA from chromosome IV can occur due to recombinase induced by galactose. By this excision, cell death can occur. In diploid cells, cell death can also occur by excision from both homologous chromosomes IV. Furthermore, cell death can occur in the case of chromosome V. A small number of surviving cells appeared with excision of centromeric DNA, and the diploid showed greater viability than the haploid in both chromosomes IV and V. The surviving cells appeared mainly due to deletion of a recombination target site (RS) from the chromosome. PMID:24018677

  17. Resolution and recurrence of vitiligo following excision of congenital melanocytic nevus.

    PubMed

    Workman, Meredith; Sawan, Kamal; El Amm, Christian

    2013-01-01

    Vitiligo associated with halo congenital melanocytic nevus (CMN) is rare. There are limited reports in the literature, especially with regard to CMN excision. We present the case of a 5-year-old girl who presented with vitiligo of the periorbital and axillary regions and halo formation around CMN of the buttock. The lesion was excised, and all areas of vitiligo improved, but 18 months postoperatively, a halo of depigmentation appeared around the excision scar and later in the periorbital and axillary regions. In review of literature, there is only one report of excision of halo CMN and resultant improvement of vitiligo. Although initial resolution of vitiligo in this case was promising, the recurrence indicates that this complex process is not reliably controlled with excision of the inciting lesion.

  18. Total mesorectal excision for the treatment of rectal cancer

    PubMed Central

    Zedan, Ali; Salah, Tareq

    2015-01-01

    Introduction In the surgical treatment of rectal cancer, a clear circumferential resection margin and distal resection margin should be obtained. The aim of this study was to determine the morbidity, mortality, survival outcome, and local failure after total mesorectal excision (TME) in the surgical treatment of rectal cancer. Methods This retrospective study was conducted on 101 patients treated for rectal cancer using low anterior resection (LAR), abdominoperinial resection (APR), or Hartmaan’s technique. In all operative procedures, total mesorectal excisions (TMEs) were done. The patients were treated from November 2000 to April 2011 in the South Egypt Cancer Institute (SECI) of Assuit University (Egypt). Neo-adjuvant therapy was given to those patients with serosalin filtration, lymph node involvement, and sexual and urinary function impairment. Data were analyzed using IBM-SPSS version 21, and survival rates were estimated using the Kaplan-Meier method. Results One hundred one patients were evaluable (61 males, 40 females). Regarding the operative procedure used, it was: (APR), LAR, Hartmaan’s technique in 15.8%, 71.3%, and 12.9% of patients, respectively. Operation-related mortality during the 30 days after surgery was 3%. The operations resulted in morbidity in 25% of the patients, anastomotic site leak in 5.9% of the patients, urinary dysfynction in 9.9% of the patients, and erectile dysfunction in 15.8% of the male patients. Regarding safety margin, the median distances were distal/radial margin, 23/12 mm, distal limit 7 cm. Median lymph nodes harvest 19 nodes. Primary tumor locations were anteriorly 23.8%, laterally 13.9%, posteriorly 38.6%, and circumferential 23.8%. Protective stoma 16.8%. Primary Tumor TNM classification (T1, T2, T3, and T4; 3, 28.7, 55.4, and 12.9%, respectively). Nodes Metastases (N0, N1, and N2; 57.4, 31.7, and 10.9%, respectively). TNM staging (I, II, III, and IV; 15.8, 29.7, 46.5, and 7.9%, respectively). Chemotherapy was

  19. 77 FR 70484 - Preoperational Testing of Onsite Electric Power Systems To Verify Proper Load Group Assignments...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-26

    ... encompass preoperational testing of electrical power systems used to meet current Station Blackout... COMMISSION Preoperational Testing of Onsite Electric Power Systems To Verify Proper Load Group Assignments, Electrical Separation, and Redundancy AGENCY: Nuclear Regulatory Commission. ACTION: Draft regulatory...

  20. Bevacizumab with preoperative chemotherapy versus preoperative chemotherapy alone for colorectal cancer liver metastases: a retrospective cohort study.

    PubMed

    Lu, Zhen-Hai; Peng, Jian-Hong; Wang, Fu-Long; Yuan, Yun-Fei; Jiang, Wu; Li, Yu-Hong; Wu, Xiao-Jun; Chen, Gong; Ding, Pei-Rong; Li, Li-Ren; Kong, Ling-Heng; Lin, Jun-Zhong; Zhang, Rong-Xin; Wan, De-Sen; Pan, Zhi-Zhong

    2016-08-01

    This study aimed to assess the efficacy and safety of bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer in Chinese patients compared with those of preoperative chemotherapy alone.Patients with histologically confirmed liver-only metastatic colorectal cancer were sequentially reviewed, and received either preoperative chemotherapy plus bevacizumab (bevacizumab group, n = 32) or preoperative chemotherapy alone (chemotherapy group, n = 57). Progression-free survival, response rate, liver resection rate, conversion rate, and safety were analyzed.With median follow-up of 28.7 months, progression-free survival was 10.9 months (95% confidence interval: 8.7-13.1 months) in bevacizumab group and 9.9 months (95% confidence interval: 6.8-13.1 months) in chemotherapy group (P = 0.472). Response rates were 59.4% in bevacizumab group and 38.6% in chemotherapy group (P = 0.059). Overall liver resection (R0, R1, and R2) rate was 68.8% in bevacizumab group and 54.4% in chemotherapy group (P = 0.185). Conversion rate was 51.9% in bevacizumab group and 40.4% in chemotherapy group (P = 0.341). No postoperative complication was observed in all patients.Bevacizumab plus preoperative chemotherapy as first-line treatment for liver-only metastatic colorectal cancer tends to achieve better clinical benefit with controllable safety in Chinese patients. PMID:27583930

  1. Three-Dimensional Analysis of Recurrence Patterns in Rectal Cancer: The Cranial Border in Hypofractionated Preoperative Radiotherapy Can Be Lowered

    SciTech Connect

    Nijkamp, Jasper; Kusters, Miranda; Beets-Tan, Regina G.H.; Martijn, Hendrik; Beets, Geerard L.; Velde, Cornelis J.H. van de; Marijnen, Corrie A.M.

    2011-05-01

    Purpose: The aim of this study was to determine whether and where the radiotherapy (RT) clinical target volume (CTV) could be reduced in short-course preoperative treatment of rectal cancer patients. Methods and Materials: Patients treated in the Dutch total mesorectal excision trial, with a local recurrence were analyzed. For 94 (25 who underwent radiation therapy 69 who did not) of 114 patients with a local recurrence, the location of the recurrence was placed in a three-dimensionalthree (3D) model. The data in the 3D model were correlated to the clinical trial data to distinguish a group of patients eligible for CTV reduction. Effects of CTV reduction on dose to the small bowel was tested retrospectively in a dataset of 8 patients with three-field conformal plans and intensity-modulated RT (IMRT). Results: The use of preoperative RT mainly reduces anastomotic, lateral, and perineal recurrences. In patients without primary nodal involvement, no recurrences were found cranially of the S2-S3 interspace, irrespective of the delivery of RT. In patients without primary nodal involvement and a negative circumferential resection margin (CRM), only one recurrence was found cranial to the S2-S3 interspace. With a cranially reduced CTV to the S2-S3 interspace, over 60% reduction in absolute small bowel exposure at dose levels from 15 to 35 Gy could be achieved with three-field conventional RT, increasing to 80% when IMRT is also added. Conclusions: The cranial border of the CTV can safely be lowered for patients without expected nodal or CRM involvement, yielding a significant reduction of dose to the small bowel. Therefore, a significant reduction of acute and late toxicity can be expected.

  2. Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes

    PubMed Central

    Allal, A S; Bieri, S; Pelloni, A; Spataro, V; Anchisi, S; Ambrosetti, P; Sprangers, M A G; Kurtz, J M; Gertsch, P

    2000-01-01

    The present study assesses the choice of surgical procedure, oncologic results and quality of life (QOL) outcomes in a retrospective cohort of 53 patients with low-lying rectal cancers (within 6 cm of the anal verge) treated surgically following preoperative radiotherapy (RT, median dose 45 Gy) with or without concomitant 5-fluorouracil. QOL was assessed in 23 patients by using two questionnaires developed by the QOL Study Group of the European Organization for Research and Treatment of Cancer: EORTC QLQ-C30 and EORTC QLQ-CR38. After a median interval of 29 days from completion of RT, abdominoperineal resection (APR) was performed in 29 patients (55%), low anterior resection in 23 patients (20 with coloanal anastomosis) and transrectal excision in one patient. The 3-year actuarial overall survival and locoregional control rates were 71.4% and 77.5% respectively, with no differences observed between patients operated by APR or restorative procedures. For all scales of EORTC QLQ-C30 and EORTC QLQ-CR38, no significant differences in median scores were observed between the two surgical groups. Although patients having had APR tended to report a lower body image score (P = 0.12) and more sexual dysfunction in male patients, all APR patients tended to report better physical function, future perspective and global QOL. In conclusion, sphincter-sparing surgery after preoperative RT seems to be feasible, in routine practice, in a significant proportion of low rectal cancers without compromising the oncologic results. However, prospective studies are mandatory to confirm this finding and to clarify the putative QOL advantages of sphincter-conserving approaches. © 2000 Cancer Research Campaign PMID:10735495

  3. Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning

    SciTech Connect

    Tho, Lye Mun . E-mail: l.tho@beatson.gla.ac.uk; Glegg, Martin; Paterson, Jennifer; Yap, Christina; MacLeod, Alice; McCabe, Marie; McDonald, Alexander C.

    2006-10-01

    Purpose: The relationship between volume of irradiated small bowel (VSB) and acute toxicity in rectal cancer radiotherapy is poorly quantified, particularly in patients receiving concurrent preoperative chemoradiotherapy. Using treatment planning data, we studied a series of such patients. Methods and Materials: Details of 41 patients with locally advanced rectal cancer were reviewed. All received 45 Gy in 25 fractions over 5 weeks, 3-4 fields three-dimensional conformal radiotherapy with daily 5-fluorouracil and folinic acid during Weeks 1 and 5. Toxicity was assessed prospectively in a weekly clinic. Using computed tomography planning software, the VSB was determined at 5 Gy dose intervals (V{sub 5}, V{sub 1}, etc.). Eight patients with maximal VSB had dosimetry and radiobiological modeling outcomes compared between inverse and conformal three-dimensional planning. Results: VSB correlated strongly with diarrheal severity at every dose level (p < 0.03), with strongest correlation at lowest doses. Median VSB differed significantly between patients experiencing Grade 0-1 and Grade 2-4 diarrhea (p {<=} 0.05). No correlation was found with anorexia, nausea, vomiting, abdominal cramps, age, body mass index, sex, tumor position, or number of fields. Analysis of 8 patients showed that inverse planning reduced median dose to small bowel by 5.1 Gy (p = 0.008) and calculated late normal tissue complication probability (NTCP) by 67% (p = 0.016). We constructed a model using mathematical analysis to predict for acute diarrhea occurring at V{sub 5} and V{sub 15}. Conclusions: A strong dose-volume relationship exists between VSB and acute diarrhea at all dose levels during preoperative chemoradiotherapy. Our constructed model may be useful in predicting toxicity, and this has been derived without the confounding influence of surgical excision on bowel function. Inverse planning can reduce calculated dose to small bowel and late NTCP, and its clinical role warrants further

  4. The Prognostic Importance of Patient Pre-Operative Expectations of Surgery for Lumbar Spinal Stenosis.

    ERIC Educational Resources Information Center

    Iversen, Maura D.; Daltroy, Lawren H.; Fossel, Anne H.; Katz, Jeffrey N.

    1998-01-01

    Examines patients (N=257) with lumbar spinal stenosis preoperatively and at six months to relate patient expectation to baseline function and pain and to determine how patient expectations and preoperative function interact to predict postoperative outcomes. Results show that patients with many preoperative expectations, particularly those with…

  5. Excision of 5-hydroxymethylcytosine by DEMETER family DNA glycosylases

    PubMed Central

    Jang, Hosung; Shin, Hosub; Eichman, Brandt F.; Huh, Jin Hoe

    2016-01-01

    In plants and animals, 5-methylcytosine (5mC) serves as an epigenetic mark to repress gene expression, playing critical roles for cellular differentiation and transposon silencing. Mammals also have 5-hydroxymethylcytosine (5hmC), resulting from hydroxylation of 5mC by TET family-enzymes. 5hmC is abundant in mouse Purkinje neurons and embryonic stem cells, and regarded as an important intermediate for active DNA demethylation in mammals. However, the presence of 5hmC in plants has not been clearly demonstrated. In Arabidopsis, the DEMETER (DME) family DNA glycosylases efficiently remove 5mC, which results in DNA demethylation and transcriptional activation of target genes. Here we show that DME and ROS1 have a significant 5hmC excision activity in vitro, although we detected no 5hmC in Arabidopsis, suggesting that it is very unlikely for plants to utilize 5hmC as a DNA demethylation intermediate. Our results indicate that both plants and animals have 5mC in common but DNA demethylation systems have independently evolved with distinct mechanisms. PMID:24661881

  6. Nucleosomes determine their own patch size in base excision repair.

    PubMed

    Meas, Rithy; Smerdon, Michael J

    2016-01-01

    Base excision repair (BER) processes non-helix distorting lesions (e.g., uracils and gaps) and is composed of two subpathways that differ in the number of nucleotides (nts) incorporated during the DNA synthesis step: short patch (SP) repair incorporates 1 nt and long patch (LP) repair incorporates 2-12 nts. This choice for either LP or SP repair has not been analyzed in the context of nucleosomes. Initial studies with uracil located in nucleosome core DNA showed a distinct DNA polymerase extension profile in cell-free extracts that specifically limits extension to 1 nt, suggesting a preference for SP BER. Therefore, we developed an assay to differentiate long and short repair patches in 'designed' nucleosomes containing a single-nucleotide gap at specific locations relative to the dyad center. Using cell-free extracts or purified enzymes, we found that DNA lesions in the nucleosome core are preferentially repaired by DNA polymerase β and there is a significant reduction in BER polymerase extension beyond 1 nt, creating a striking bias for incorporation of short patches into nucleosomal DNA. These results show that nucleosomes control the patch size used by BER. PMID:27265863

  7. Evidence implying DNA polymerase beta function in excision repair.

    PubMed

    Siedlecki, J A; Szyszko, J; Pietrzykowska, I; Zmudzka, B

    1980-01-25

    Comparison was made of the ability of calf thymus DNA polymerases alpha and beta to replicate the following templates: native E. coli CR-34 DNA (T-DNA), calf thymus DNA activated by DNase I (act.DNA), BU-DNA (from E. coli CR-34 cells cultured on BUdR-containing medium) with damages resulting from incomplete excision repair, as well as thermally denatured act.DNA and BU-DNA (s.s.act.DNA and s.s.BU-DNA). 3H-TTP incorporation during extensive replication of act.DNA was similar for both enzymes, being, as expected, 40 times higher than for T-DNA. Likewise, the differences in the yield of the s.s.act.DNA or s.s.BU-DNA replication between both enzymes were negligible. In contrast, damaged native DNA was 6 - 30 times more extensively replicated by DNA polymerase beta than alpha. We propose that this is due to the greater ability of DNA polymerase beta compared with alpha to replicate single-stranded gaps, the presence of which is more likely in damaged BU-DNA than in T-DNA and act.DNA.

  8. Response of base excision repair enzymes to complex DNA lesions.

    PubMed

    Weinfeld, M; Rasouli-Nia, A; Chaudhry, M A; Britten, R A

    2001-11-01

    There is now increasing evidence that ionizing radiation generates complex DNA damage, i.e. two or more lesions--single-strand breaks or modified nucleosides--located within one to two helical turns on the same strand or on opposite strands. Double-strand breaks are the most readily recognizable clustered lesions, but they may constitute a relatively minor fraction of the total. It is anticipated that clustered lesions may play a significant role in cellular response to ionizing radiation since they may present a major challenge to the DNA repair machinery. The degree of lesion complexity increases with increasing LET. This has potential implications for space travel because of exposure to high-LET cosmic radiation. It is therefore critical that we begin to understand the consequences of such damaged sites, including their influence on DNA repair enzymes. This paper presents a short review of our current knowledge of the action of purified DNA repair enzymes belonging to the base excision repair pathway, including DNA glycosylases and apurinic/apyrimidinic endonucleases, on model complex lesions.

  9. HMGB1 is a cofactor in mammalian base excision repair.

    PubMed

    Prasad, Rajendra; Liu, Yuan; Deterding, Leesa J; Poltoratsky, Vladimir P; Kedar, Padmini S; Horton, Julie K; Kanno, Shin-Ichiro; Asagoshi, Kenjiro; Hou, Esther W; Khodyreva, Svetlana N; Lavrik, Olga I; Tomer, Kenneth B; Yasui, Akira; Wilson, Samuel H

    2007-09-01

    Deoxyribose phosphate (dRP) removal by DNA polymerase beta (Pol beta) is a pivotal step in base excision repair (BER). To identify BER cofactors, especially those with dRP lyase activity, we used a Pol beta null cell extract and BER intermediate as bait for sodium borohydride crosslinking. Mass spectrometry identified the high-mobility group box 1 protein (HMGB1) as specifically interacting with the BER intermediate. Purified HMGB1 was found to have weak dRP lyase activity and to stimulate AP endonuclease and FEN1 activities on BER substrates. Coimmunoprecipitation experiments revealed interactions of HMGB1 with known BER enzymes, and GFP-tagged HMGB1 was found to accumulate at sites of oxidative DNA damage in living cells. HMGB1(-/-) mouse cells were slightly more resistant to MMS than wild-type cells, probably due to the production of fewer strand-break BER intermediates. The results suggest HMGB1 is a BER cofactor capable of modulating BER capacity in cells. PMID:17803946

  10. Total Humeral Endoprosthetic Replacement following Excision of Malignant Bone Tumors

    PubMed Central

    Kotwal, Suhel; Moon, Bryan; Lin, Patrick; Satcher, Robert; Lewis, Valerae

    2016-01-01

    Humerus is a common site for malignant tumors. Advances in adjuvant therapies and reconstructive methods provide salvage of the upper limb with improved outcomes. Reports of limb salvage with total humeral replacement in extensive humeral tumors are sparse. We undertook a retrospective study of 20 patients who underwent total humeral endoprosthetic replacement as limb salvage following excision of extensile malignant tumor from 1990 to 2011. With an average followup of 42.9, functional and oncological outcomes were analyzed. Ten patients were still alive at the time of review. Mean estimated blood loss was 1131 mL and duration of surgery was 314 minutes. Deep infection was encountered in one patient requiring debridement while mechanical loosening of ulnar component was identified in one patient. Subluxation of prosthetic humeral head was noted in 3 patients. Mean active shoulder abduction was 12.5° and active flexion was 15°. Incompetence of abduction mechanism was the major determinant of poor active functional outcome. Mean elbow flexion was 103.5° with 30.5° flexion contracture in 10 patients with good and useful hand function. Average MSTS score was 71.5%. Total humeral replacement is a reliable treatment option in restoring mechanical stability and reasonable functional results without compromising patient survival, with low complication rate. PMID:27042158

  11. Single channel currents from excised patches of muscle membrane.

    PubMed Central

    Horn, R; Patlak, J

    1980-01-01

    The currents through single acetylcholine-activated channels were measured on membrane fragments that had been torn from rat muscle myotubes with patch pipettes. The membrane fragments were sealed into the pipette by using the "gigohm-seal" technique of Neher, which also permitted voltage clamp of the membrane via the patch electrode. Membrane patches were excited by sudden withdrawal of the electrode from the cell. Substitution of fluoride for chloride ions in the bathing solution could prevent or reverse the tendency for the membrane at the electrode tip to seal over into a closed vesicle. The single membrane layer at the electrode tip could remain functional for up to 30 min. The apparent single channel conductance was minimally affected by excision. The current-voltage relationships for the single channel currents show that the inside (i.e., cytoplasmic surface) of the membrane fragment was exposed to the bathing solution. In symmetric Na solutions the current-voltage curve was nearly linear and reversed at approximately 0 mV. In other bathing solutions from 40 to 500 mM NaF, the observed zero current potential was close to that predicted by the Nernst equation. We present evidence that internal Na interacts with the channel, causing both saturation of outward current and block of inward current. At + 100 mV the apparent dissociation constant for internal Na was 138 mM. PMID:6256772

  12. Regulation of WRN helicase activity in human base excision repair.

    PubMed

    Ahn, Byungchan; Harrigan, Jeanine A; Indig, Fred E; Wilson, David M; Bohr, Vilhelm A

    2004-12-17

    Werner syndrome patients are deficient in the Werner protein (WRN), which is a multifunctional nuclear protein possessing 3'-5' exonuclease and ATP-dependent helicase activities. Studies of Werner syndrome cells and biochemical studies of WRN suggest that WRN plays a role in several DNA metabolic pathways. WRN interacts with DNA polymerase beta (pol beta) and stimulates pol beta strand displacement synthesis on a base excision repair (BER) intermediate in a helicase-dependent manner. In this report, we examined the effect of the major human apurinic/apyrimidinic endonuclease (APE1) and of pol beta on WRN helicase activity. The results show that WRN alone is able to unwind several single strand break BER intermediates. However, APE1 inhibits WRN helicase activity on these intermediates. This inhibition is likely due to the binding of APE1 to nicked apurinic/apyrimidinic sites, suggesting that APE1 prevents the promiscuous unwinding of BER intermediates. This inhibitory effect was relieved by the presence of pol beta. A model involving the pol beta-mediated hand-off of WRN protein is proposed based on these results.

  13. Germline excision of transgenes in Aedes aegypti by homing endonucleases.

    PubMed

    Aryan, Azadeh; Anderson, Michelle A E; Myles, Kevin M; Adelman, Zach N

    2013-01-01

    Aedes (Ae.) aegypti is the primary vector for dengue viruses (serotypes1-4) and chikungunya virus. Homing endonucleases (HEs) are ancient selfish elements that catalyze double-stranded DNA breaks (DSB) in a highly specific manner. In this report, we show that the HEs Y2-I-AniI, I-CreI and I-SceI are all capable of catalyzing the excision of genomic segments from the Ae. aegypti genome in a heritable manner. Y2-I-AniI demonstrated the highest efficiency at two independent genomic targets, with 20-40% of Y2-I-AniI-treated individuals producing offspring that had lost the target transgene. HE-induced DSBs were found to be repaired via the single-strand annealing (SSA) and non-homologous end-joining (NHEJ) pathways in a manner dependent on the availability of direct repeat sequences in the transgene. These results support the development of HE-based gene editing and gene drive strategies in Ae. aegypti, and confirm the utility of HEs in the manipulation and modification of transgenes in this important vector.

  14. Deep foot burns: effects of early excision and grafting.

    PubMed

    Shakirov, Babur M

    2011-12-01

    Few on the problem of foot burns can be found in the available scientific literature. It is necessary to mention that often deep foot burns occur in Central Asia since many natives still use the ancient means of heating called 'Sandal' during the winter months. Eighty-four patients with severe foot burns were treated in the Burn department of RCSUMA and the Inter-regional Burn Center, Uzbekistan. The patients were subdivided into two groups, depending upon the terms of performing operative intervention. There was no special allocation of patients to groups. Criteria for selection were isolated deep burns of the foot. As for the character of the injury, area of deep burn and the severity of injury, patients of the control and basic groups were not different. The first group included 34 patients on whom early excision was done using skin graft 4-5 days after resuscitation, and the second group consisted of 50 patients who were treated in the traditional way. Methods used on the first group, described in this article, helped to improve the general condition of patients, contributed to the restoration of their foot function, lessened joint deformities and post-burn contracture deformities, shortened their stay in hospital and also reduced expenses.

  15. Central to peripheral sound propagation in excised lung.

    PubMed

    Rice, D A; Rice, J C

    1987-10-01

    The time it takes audible sound to travel from the trachea to the pleura in five intact, excised horse lungs and one dog lung inflated with several gases was measured. Regression estimates of sound speed at total lung capacity (TLC) using straight line distance from the carina to the pleura are: helium, 775 +/- 60.5 m/s (means +/- 95% confidence limits); air, 282 +/- 23.5; carbon dioxide, 219 +/- 25.5; sulfur hexafluoride, 142 +/- 43.5. With the exception of sulfur hexafluoride, these speeds are 15%-20% less than the free-field speed of sound in each gas. Total airway length did not predict time delay any better or worse than straight line distance, but the high correlation between these two predictors (r = 0.94) prevents showing either to be the more predictive. In one lung, airway length was partitioned according to airway diameter. A regression using partitioned airway lengths significantly improved time delay prediction (p less than 0.001) over an unpartitioned model. Sound speed in the trachea equals free-field sound speed. Sound speed in air-filled airways 1 to 25 mm in diameter equals 268 +/- 44 m/s. We conclude that the first sound to reach the surface travels in the airways for at least 90% of the distance, spending at least 87% of the total travel time there. PMID:3680773

  16. Nucleosomes determine their own patch size in base excision repair

    PubMed Central

    Meas, Rithy; Smerdon, Michael J.

    2016-01-01

    Base excision repair (BER) processes non-helix distorting lesions (e.g., uracils and gaps) and is composed of two subpathways that differ in the number of nucleotides (nts) incorporated during the DNA synthesis step: short patch (SP) repair incorporates 1 nt and long patch (LP) repair incorporates 2–12 nts. This choice for either LP or SP repair has not been analyzed in the context of nucleosomes. Initial studies with uracil located in nucleosome core DNA showed a distinct DNA polymerase extension profile in cell-free extracts that specifically limits extension to 1 nt, suggesting a preference for SP BER. Therefore, we developed an assay to differentiate long and short repair patches in ‘designed’ nucleosomes containing a single-nucleotide gap at specific locations relative to the dyad center. Using cell-free extracts or purified enzymes, we found that DNA lesions in the nucleosome core are preferentially repaired by DNA polymerase β and there is a significant reduction in BER polymerase extension beyond 1 nt, creating a striking bias for incorporation of short patches into nucleosomal DNA. These results show that nucleosomes control the patch size used by BER. PMID:27265863

  17. Effect of pulley excision on flexor tendon biomechanics.

    PubMed

    Peterson, W W; Manske, P R; Bollinger, B A; Lesker, P A; McCarthy, J A

    1986-01-01

    Flexor tendon function following excision of various portions of the fibro-osseous pulley system was measured biomechanically using a tensile testing machine. The biomechanical parameters measured were tendon excursion (the excursion of the tendon required to fully flex the digit) and work of flexion (the area under the force-excursion curve, representing all the forces that resist tendon flexion). In this experiment, work of flexion included the forces necessary to accomplish full digital flexion against a 15-g counter-weight, as well as the frictional forces that resist tendon gliding. The results indicate that the work of flexion was affected to a greater degree by pulley loss than was tendon excursion, suggesting that it is a more sensitive measurement of tendon function. A2 was found to be the single most important pulley for flexor tendon function, followed by A4. However, both A2 and A4 had to be present if near-normal hand function was to be achieved; sacrificing the A1 pulley was not associated with a significant loss of flexion. The "pulley effect" of the skin and soft tissue as a supplement to the fibro-osseous pulleys in reducing tendon bow-stringing was also noted. Although the parameters of tendon excursion and work of flexion were used in this study to determine the effect of pulley loss on tendon function, they can also be used to evaluate other flexor tendon studies, such as pulley reconstruction.

  18. Asian Rhinoplasty: Preoperative Simulation and Planning Using Adobe Photoshop.

    PubMed

    Kiranantawat, Kidakorn; Nguyen, Anh H

    2015-11-01

    A rhinoplasty in Asians differs from a rhinoplasty performed in patients of other ethnicities. Surgeons should understand the concept of Asian beauty, the nasal anatomy of Asians, and common problems encountered while operating on the Asian nose. With this understanding, surgeons can set appropriate goals, choose proper operative procedures, and provide an outcome that satisfies patients. In this article the authors define the concept of an Asian rhinoplasty-a paradigm shift from the traditional on-top augmentation rhinoplasty to a structurally integrated augmentation rhinoplasty-and provide a step-by-step procedure for the use of Adobe Photoshop as a preoperative program to simulate the expected surgical outcome for patients and to develop a preoperative plan for surgeons.

  19. Preoperative Proton Beam Therapy for Thymoma: A Case Report

    PubMed Central

    Isaka, Mitsuhiro; Nagata, Masashi; Onoe, Tsuyoshi; Murayama, Shigeyuki; Ohde, Yasuhisa

    2015-01-01

    We performed preoperative proton beam therapy for locally advanced thymoma and subsequently achieved complete resection. The patient was 31-year old woman, in whom chest computed tomography revealed a huge mass at the left anterior mediastinum. We diagnosed locally advanced type B3 thymoma. Because of the potential for complications to the lung and heart, definitive photon radiation therapy would have been difficult to administer. Therefore, we performed proton beam therapy, which could be administered within dose limitations. After proton beam therapy, the huge tumor had remarkably decreased in size. We were thereby able to achieve complete resection. As of 24 months after surgery, the patient has not developed any severe adverse events associated with proton beam therapy. Our experience suggests that preoperative proton beam therapy may be an effective modality for reducing tumor size, facilitating complete resection, and preventing toxicity of radiation therapy. PMID:26356685

  20. [Preoperative evaluation, management and outcome in the elderly patient].

    PubMed

    Ueki, Masaaki; Maekawa, Nobuhiro

    2010-09-01

    Two principles should be kept in mind when performing preoperative evaluation of the elderly patient. First, we should suspect the disease processes commonly associated with aging. Second, we should assess the degree of functional reserve of specific, pertinent organ systems. Preoperative risk assessment is focused on detailed review from anamnesis and physical examination together with the assessment of functional status. Especially, it is important to examine the cardiovascular and respiratory functions in the elderly patient. Further, this also includes assessment of consumed drugs, physiological function, cognitive function, competency, availability of social support, and sign of depression. Surgical risk and outcome in the elderly patient depend primarily on four factors: age, the patient's physiological status and coexisting disease, whether the surgery is elective or urgent, and the type of procedures.

  1. Combined modality preoperative therapy for unresectable rectal cancer.

    PubMed

    Percarpio, B; Bitterman, J; Sabbath, K; Alfano, F; Ruszkowski, R; Bowen, J

    1992-01-01

    Locally advanced rectal cancer has been a surgical challenge because of fixation of the primary tumor to the boney pelvis or to other pelvic soft tissues. During a 12-month period seven patients with locally advanced adenocarcinoma of the rectum were treated preoperatively with simultaneous pelvic irradiation (4500-5040 cGy) and infusion chemotherapy (5-fluorouracil 1000 mg per m2 per day over 96 hours and mitomycin 10 mg per m2. Tolerance was reasonable and all patients underwent successful resection of the primary lesion. Two patients had a complete response to preoperative combined modality therapy with no cancer found in the surgical specimen. With a short follow-up period, all patients have experienced satisfactory healing and none have suffered local or distant recurrence. The results of this limited series are encouraging for future clinical trials.

  2. Preoperative risk factors in recurrent endometrioma after primary conservative surgery

    PubMed Central

    Chon, Seung Joo; Lee, Seung Hyeong; Choi, Joo Hyun

    2016-01-01

    Objective Endometriosis is a common gynecological disorder caused by ectopic implantation of endometrial glandular and stromal cells outside the uterine cavity. Among several types of endometriosis, endometrioma is the only subtype that could be determined preoperatively using pelvic ultrasonography, and guidelines recommend pathologic confirmation of endometrioma greater than 3 cm in diameter. However, although surgery is performed in cases of endometrioma, endometrioma has a high cumulative rate of recurrence. Therefore, because determining the possibility of recurrence before performance of initial surgery is important, we examined preoperative factors associated with recurrent endometrioma. Methods This was a retrospective, comparative study including 236 patients who visited the outpatient clinic between January 2009 and December 2011. Patients who were pathologically diagnosed with endometrioma were included in this study. They were followed up postoperatively and were divided into two groups according to presence of recurrent endometrioma. Results We examined associations between baseline factors and recurrent endometrioma. In multivariate analysis, dysmenorrhea and cyst septation were statistically significant after adjusting with age, parity, surgical staging and postoperative management. We examined cumulative recurrence free survival within cases of recurrent endometriosis, based on the presence of inner cyst septation. The cumulative recurrence free survival was lower in cases with septation. Conclusion Our study found that recurrent endometrioma is more likely in patients with inner cyst septation and the recurrence occurred within a shorter duration of time than in patients without inner cyst septation on preoperative ultrasonography. Therefore intensive caution and postoperative long term medical therapy would be appropriate in patients with inner cyst septation on preoperative ultrasonography before undergoing primary surgery for endometrioma. PMID

  3. Preoperative embolization of primary bone tumors: A case control study

    PubMed Central

    Jha, Roushan; Sharma, Raju; Rastogi, Shishir; Khan, Shah Alam; Jayaswal, Arvind; Gamanagatti, Shivanand

    2016-01-01

    AIM: To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time. METHODS: Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison. RESULTS: The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications. CONCLUSION: Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume. PMID:27158424

  4. Diagnostic accuracy of preoperative clinical examination in upper limb injuries

    PubMed Central

    Dehghani, Mohammad; Shemshaki, Hamidreza; Eshaghi, Mohammad Amin; Teimouri, Mehdi

    2011-01-01

    Background: Injuries in hands and forearms may cause significant discomfort and disability. Aim: To evaluate the accuracy of preoperative clinical examination in depicting lesions caused by penetrating wounds of hands or forearms. Setting and Design: This prospective study was conducted from August 2006 to September 2009 at Kashani University Hospital, Isfahan University of Medical Sciences, Iran. Materials and Methods: Two hundred and fifty patients with clean penetrating injury to the hand/forearm were enrolled in this study. After patient's data registration, a careful clinical examination and routine exploration without expansion of wound were done by an orthopedic resident. Each tendon was tested at each joint level. Nerves were evaluated with a two-point discrimination test, and arteries were tested with palpable pulses. Surgical exploration was done by a single hand surgeon in operation room. Accuracy of clinical examination was compared to surgical examination. Results: During the study period, 180 (72%) males and 70 (28%) females with mean age of 28±4 years participated. The preoperative examination showed a predominance of the volar zone IV injuries followed by volar zone II, III, thumb zone II, volar zone V and thumb zone III. Despite the enough accuracy of preoperative examinations in dorsal side injuries of hands and forearms (error rate = 8.3%), the preoperative examinations significantly underestimated the amount of damage to soft tissues on the volar side of hands and forearms (error rate = 14%). Conclusions: The precise surgical evaluations should be considered in patients with penetrating injury to the hand or forearm, especially in those with volar side injuries. PMID:22090738

  5. Psychrometric Field Measurement of Water Potential Changes following Leaf Excision 1

    PubMed Central

    Savage, Michael J.; Cass, Alfred

    1984-01-01

    In situ measurement of sudden leaf water potential changes has not been performed under field conditions. A laboratory investigation involving the measurement of leaf water potential prior to and 2 to 200 minutes after excision of citrus leaves (Citrus jambhiri) showed good linear correlation (r = 0.99) between in situ leaf psychrometer and Scholander pressure chamber measurements. Following this, a field investigation was conducted which involved psychrometric measurement prior to petiole excision and 1 minute after excision. Simultaneous pressure chamber measurements were performed on neighboring leaves prior to the time of excision and then on the psychrometer leaf about 2 minutes after excision. These data indicate that within the first 2 minutes after excision, psychrometer and pressure chamber measurements were linearly correlated (r = 0.97). Under high evaporative demand conditions, the rate of water potential decrease was between 250 and 700 kilopascals in the first minute after excision. These results show that the thermocouple psychrometer can be used as a dynamic and nondestructive field technique for monitoring leaf water potential. PMID:16663394

  6. [Preoperative Management of Patients with Bronchial Asthma or Chronic Bronchitis].

    PubMed

    Hagihira, Satoshi

    2015-09-01

    Bronchial asthma is characterized by chronic airway inflammation. The primary goal of treatment of asthma is to maintain the state of control. According to the Japanese guidelines (JGL2012), long-term management consists of 4 therapeutic steps, and use of inhaled corticosteroids (ICS) is recommended at all 4 steps. Besides ICS, inhalation of long-acting β2-agonist (LABA) is also effective. Recently, omalizumab (a humanized antihuman IgE antibody) can be available for patients with severe allergic asthma. Although there is no specific strategy for preoperative treatment of patients with asthma, preoperative systemic steroid administration seemed to be effective to prevent asthma attack during anesthesia. The most common cause of chronic bronchitis is smoking. Even the respiratory function is within normal limits, perioperative management of patients with chronic bronchitis is often troublesome. The most common problem is their sputum. To minimize perioperative pulmonary complication in these patients, smoking cessation and pulmonary rehabilitation are essential. It is known that more than 1 month of smoking cessation is required to reduce perioperative respiratory complication. However, even one or two weeks of smoking cessation can decrease sputum secretion. In summary, preoperative optimization is most important to prevent respiratory complication in patients with bronchial asthma or chronic bronchitis. PMID:26466493

  7. The preoperative interview. Its effect on perioperative nurses' empathy.

    PubMed

    Alverson, E

    1987-05-01

    Further studies need to be done to determine the impact preoperative visits have on the perioperative nurse's empathy level. The results of this study could be confirmed, or refuted, if a study with more subjects was conducted over a longer period of time. Also, subjects in both the control and experimental groups should be chosen randomly and should be from the same institution. To measure the long-term effect of preoperative visits on empathy levels, a study could be conducted that measures the levels at various times (eg, six months to a year following the first study). Other evaluations of empathy levels, such as observer rating and patient rating, could be used to supplement nurses self-rating scores to avoid using one standard instrument and rating scale. Few conclusions can be drawn from this limited study, but it does help nurses realize that preoperative interviews can help the nurse become more aware of the surgical patient as a human being. This increased awareness may help the nurse function more effectively and efficiently in helping the patient during intraoperative care.

  8. [Possibility of rice porridge for preoperative feeding in children].

    PubMed

    Kushikata, T; Matsuki, A; Murakawa, T; Sato, K

    1996-08-01

    To determine the effect of rice porridge feeding before elective surgery on preoperative gastric fluid pH, volume and starvation, a prospective study was undertaken in pediatric patients. Twenty healthy children ranged in age from 5 to 12 years were allocated randomly to either a fasted or rice porridge group. The children of fasted group (control group) were allowed to take solid food until midnight before the operation. The rice porridge group (study group) patients received a small amount of rice porridge 5 hours 30 minutes before the induction of anesthesia. The patients of both groups were permitted to take clear fluid until 5 hours before the induction of anesthesia. After the induction of anesthesia, gastric fluid was aspirated through an orogastric tube. The mean gastric fluid volume was 0.43 +/- 0.32 ml.kg-1 in the control group and 0.5 +/- 0.6 ml.kg-1 in the study group. The mean gastric fluid pH was 1.43 +/- 0.27 ml.kg-1 in the control group and 1.89 +/- 0.75 ml.kg-1 in the study group. There were no significant differences between the two groups concerning the gastric fluid volume and pH. The patient of the study group complained of less hunger. Preoperative rice porridge feeding is a possible preoperative feeding for pediatric patients.

  9. Recurrence Rates of Benign Phyllodes Tumors After Surgical Excision and Ultrasonography-Guided Vacuum-Assisted Excision.

    PubMed

    Kim, Ga Ram; Kim, Eun-Kyung; Yoon, Jung Hyun; Kim, Min Jung; Moon, Hee Jung

    2016-06-01

    The recurrence rates of benign phyllodes tumors diagnosed through surgery and ultrasound-guided vacuum-assisted excision (US-VAE) were evaluated. A total of 146 benign phyllodes tumors diagnosed by surgery (n = 126) or US-VAE (n = 20) in 144 patients who had further follow-up after surgery or US-VAE were included (median follow-up period, 32.3 months; range, 6.7-142.5 months). Comparisons of recurrence rate, interval to recurrence, patient age, initial tumor size, Breast Imaging Reporting and Data System category, or follow-up interval were performed between the surgery and VAE groups and between groups with and without recurrence. Three cases (2.1%, 3/146) had recurrence and all were in the surgery group (2.4%, 3/126). The surgery group demonstrated larger size than the VAE group (median, 25 vs 16 mm; P < 0.001). The median age of women in the surgery group was older than those in the VAE group (39 vs 33 years, P = 0.509). The median age of women with recurrence (n = 3) was older than those without recurrence (n = 143, 49 vs 38 years, P = 0.023). In conclusion, when benign phyllodes tumor is unexpectedly diagnosed at US-VAE, if there is no residual lesion at US, clinical follow-up rather than further surgery might be recommended. PMID:27233071

  10. Polymorphism of the DNA Base Excision Repair Genes in Keratoconus

    PubMed Central

    Wojcik, Katarzyna A.; Synowiec, Ewelina; Sobierajczyk, Katarzyna; Izdebska, Justyna; Blasiak, Janusz; Szaflik, Jerzy; Szaflik, Jacek P.

    2014-01-01

    Keratoconus (KC) is a degenerative corneal disorder for which the exact pathogenesis is not yet known. Oxidative stress is reported to be associated with this disease. The stress may damage corneal biomolecules, including DNA, and such damage is primarily removed by base excision repair (BER). Variation in genes encoding BER components may influence the effectiveness of corneal cells to cope with oxidative stress. In the present work we genotyped 5 polymorphisms of 4 BER genes in 284 patients and 353 controls. The A/A genotype of the c.–1370T>A polymorphism of the DNA polymerase γ (POLG) gene was associated with increased occurrence of KC, while the A/T genotype was associated with decreased occurrence of KC. The A/G genotype and the A allele of the c.1196A>G polymorphism of the X-ray repair cross-complementing group 1 (XRCC1) were associated with increased, and the G/G genotype and the G allele, with decreased KC occurrence. Also, the C/T and T as well as C/C genotypes and alleles of the c.580C>T polymorphism of the same gene displayed relationship with KC occurrence. Neither the g.46438521G>C polymorphism of the Nei endonuclease VIII-like 1 (NEIL1) nor the c.2285T>C polymorphism of the poly(ADP-ribose) polymerase-1 (PARP-1) was associated with KC. In conclusion, the variability of the XRCC1 and POLG genes may play a role in KC pathogenesis and determine the risk of this disease. PMID:25356504

  11. Modeling expiratory flow from excised tracheal tube laws.

    PubMed

    Aljuri, N; Freitag, L; Venegas, J G

    1999-11-01

    Flow limitation during forced exhalation and gas trapping during high-frequency ventilation are affected by upstream viscous losses and by the relationship between transmural pressure (Ptm) and cross-sectional area (A(tr)) of the airways, i.e., tube law (TL). Our objective was to test the validity of a simple lumped-parameter model of expiratory flow limitation, including the measured TL, static pressure recovery, and upstream viscous losses. To accomplish this objective, we assessed the TLs of various excised animal tracheae in controlled conditions of quasi-static (no flow) and steady forced expiratory flow. A(tr) was measured from digitized images of inner tracheal walls delineated by transillumination at an axial location defining the minimal area during forced expiratory flow. Tracheal TLs followed closely the exponential form proposed by Shapiro (A. H. Shapiro. J. Biomech. Eng. 99: 126-147, 1977) for elastic tubes: Ptm = K(p) [(A(tr)/A(tr0))(-n) - 1], where A(tr0) is A(tr) at Ptm = 0 and K(p) is a parametric factor related to the stiffness of the tube wall. Using these TLs, we found that the simple model of expiratory flow limitation described well the experimental data. Independent of upstream resistance, all tracheae with an exponent n < 2 experienced flow limitation, whereas a trachea with n > 2 did not. Upstream viscous losses, as expected, reduced maximal expiratory flow. The TL measured under steady-flow conditions was stiffer than that measured under expiratory no-flow conditions, only if a significant static pressure recovery from the choke point to atmosphere was assumed in the measurement.

  12. DNA glycosylases in the base excision repair of DNA.

    PubMed Central

    Krokan, H E; Standal, R; Slupphaug, G

    1997-01-01

    A wide range of cytotoxic and mutagenic DNA bases are removed by different DNA glycosylases, which initiate the base excision repair pathway. DNA glycosylases cleave the N-glycosylic bond between the target base and deoxyribose, thus releasing a free base and leaving an apurinic/apyrimidinic (AP) site. In addition, several DNA glycosylases are bifunctional, since they also display a lyase activity that cleaves the phosphodiester backbone 3' to the AP site generated by the glycosylase activity. Structural data and sequence comparisons have identified common features among many of the DNA glycosylases. Their active sites have a structure that can only bind extrahelical target bases, as observed in the crystal structure of human uracil-DNA glycosylase in a complex with double-stranded DNA. Nucleotide flipping is apparently actively facilitated by the enzyme. With bacteriophage T4 endonuclease V, a pyrimidine-dimer glycosylase, the enzyme gains access to the target base by flipping out an adenine opposite to the dimer. A conserved helix-hairpin-helix motif and an invariant Asp residue are found in the active sites of more than 20 monofunctional and bifunctional DNA glycosylases. In bifunctional DNA glycosylases, the conserved Asp is thought to deprotonate a conserved Lys, forming an amine nucleophile. The nucleophile forms a covalent intermediate (Schiff base) with the deoxyribose anomeric carbon and expels the base. Deoxyribose subsequently undergoes several transformations, resulting in strand cleavage and regeneration of the free enzyme. The catalytic mechanism of monofunctional glycosylases does not involve covalent intermediates. Instead the conserved Asp residue may activate a water molecule which acts as the attacking nucleophile. PMID:9224623

  13. Robotic complete mesocolic excision for right-sided colon cancer.

    PubMed

    Ozben, Volkan; Baca, Bilgi; Atasoy, Deniz; Bayraktar, Onur; Aghayeva, Afag; Cengiz, Turgut Bora; Erguner, Ilknur; Karahasanoglu, Tayfun; Hamzaoglu, Ismail

    2016-10-01

    Complete mesocolic excision (CME) with central vascular ligation for right-sided colon cancer has been proven to provide superior oncologic outcomes and survival advantage when compared to standard lymphadenectomy [1]. A number of studies comparing conventional laparoscopic versus open CME have shown feasibility and safety of the laparoscopic approach with acceptable oncological profile and postoperative outcomes [2, 3]. The introduction of robotic systems with its technical advantages, including improved vision, better ergonomics and precise dissection, has further revolutionized minimally invasive approach in colorectal surgery. However, there seems to be a relatively slow adoption of robotic approach in the CME technique for right-sided colon cancer. This video demonstrates our detailed operative technique and feasibility for performing right-sided CME robotically. The surgical procedure is performed with a medial-to-lateral approach through four 8-mm robotic and one assistant ports. First, the ileocolic vessels are isolated, clipped and transected near their origins. Cephalad dissection continues along the ventral aspect of the superior mesenteric vein. Staying in the embryological planes between the mesocolon and retroperitoneal structures, mesenteric dissection is extended up to the root of the right colic vessels, if present, and the middle colic vessels, which are clipped and divided individually near their origins. After the terminal ileum is transected using an endolinear staple, the colon is mobilized fully from gastrocolic tissue and then from its lateral attachments. The transverse colon is transected under the guidance of near-infrared fluorescence imaging. Creation of an intracorporeal side-to-side ileotransversostomy anastomosis and extraction of the specimen complete the operation. We consider robotic CME to be feasible, safe and oncologically adequate for the treatment of right-sided colon cancer. Its technical advantages may lead to further

  14. Excision Arthroplasty for First CMC Joint Tuberculous Osteomyelitis

    PubMed Central

    Vora, Harshil J.; Patil, Sanjay; latkar, Chintamani; Sawant, Sarvesh

    2015-01-01

    Introduction: Tuberculous involvement of metacarpals and phalanges is a rare presentation of extrapulmonary tuberculosis in adult. Tuberculous infection of the metacarpals, metatarsal and phalanges of hands and feet is known as tubercular dactylitis. Case Report: A 65 years old female with history of pain and swelling at 1st metacarpal of left hand, since 3 months which gradual in onset and progressive in nature associated with multiple cervical swellings. While radiographs showed a pathological fracture of the 1st carpo-metacarpal joint (CMCJ) with soft tissue swelling, MRI revealed a large heterogenous lesion at the carpo-metacarpal joint of the thumb with bony erosions of the trapezium and 1st metacarpal base on T2W-STIR images. The lesion was extending upto the palmar aspect of the hand and displacing flexor pollicis longus tendon medially. During surgery, there was caseous material seen which was debrided and the fractured fragment was excised and sent for biopsy. The CMCJ was found to be unstable and a kirschner wire was used to stabilize the 1st CMCJ and immobilized in a POP splint. The biopsy of the fragment revealed tuberculous osteomyeltis. On follow-up the K-wire had backed out partially at the end of 5 weeks which was then removed and range of motion was started. At end of 1 year follow up the patient had little restriction of movement as compared to the opposite hand with no pain and hindrance in daily activity. Conclusion: The swelling subsided once Anti-Tubercular Treatment was started. The cervical lymphadenopathy also resolved over a period of 1 month. PMID:27299036

  15. Monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: Operative outcomes and surgeon preferences, a real-world scenario

    PubMed Central

    Madduri, Vijay Kumar Sarma; Bera, Malay Kumar; Pal, Dilip Kumar

    2016-01-01

    Context: Monopolar transurethral resection of prostate (M-TURP) is considered the gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia. Its newly introduced modification, bipolar TURP (B-TURP), promises to overcome its most prominent shortcomings, namely bleeding and dilutional hyponatremia. Literature is conflicting regarding merits of B-TURP over M-TURP. Aims: To find a difference, if any, in perioperative outcomes between M-TURP and B-TURP in a real-wold setting. Settings and Design: Prospective nonrandomized study. Subjects and Methods: Operative outcomes of patients undergoing M-TURP and B-TURP from February 2014 to October 2015 were compared. Statistical Analysis Used: Categorical data were compared by Fischer exact test and numerical data were compared by independent samples Mann–Whitney U-test. P <0.05 was considered statistically significant. Results: The mean size of prostate operated by bipolar technology was significantly greater than those operated by monopolar technology (38.12 ± 9.59 cc vs. 66.49 ± 22.95 cc; P < 0.001). The mean fall in postoperative serum sodium concentration was 0.99 ± 0.76 mEq/L for the B-TURP group as compared to 3.60 ± 2.89 mEq/L for the M-TURP group (P < 0.001). The mean drop in postoperative hemoglobin concentration (P = 0.28) was statistically insignificant, even though larger glands were operated by B-TURP. There were three instances of the transurethral resection (TUR) syndrome in the M-TURP group whereas no TUR syndrome occurred in the B-TURP group. Conclusions: In spite of various contrary viewpoints in literature, surgeons prefer to operate on larger prostates using bipolar technology. B-TURP definitely reduces the incidence of bleeding and dilutional hyponatremia, making it a contender to replace M-TURP as the new gold standard. PMID:27453650

  16. An observational study of extending FOLFOX chemotherapy, lengthening the interval between radiotherapy and surgery, and enhancing pathological complete response rates in rectal cancer patients following preoperative chemoradiotherapy

    PubMed Central

    Huang, Chun-Ming; Huang, Ming-Yii; Tsai, Hsiang-Lin; Huang, Ching-Wen; Ma, Cheng-Jen; Yeh, Yung-Sung; Juo, Suh-Hang; Huang, Chih-Jen; Wang, Jaw-Yuan

    2016-01-01

    Introduction: Patients with rectal cancer who exhibit a pathologic complete response to preoperative concurrent chemoradiotherapy have excellent oncologic outcomes. In this study, we evaluated the potential advantages of adding oxaliplatin to preoperative fluoropyrimidine-based chemoradiotherapy administered in rectal cancer patients. Methods: A total of 78 patients with rectal cancer were enrolled. Patients were administered chemoradiotherapy, which comprised radiotherapy and chemotherapy involving a 5-fluorouracil, leucovorin, and oxaliplatin regimen every 2 weeks. Surgery was performed 10–12 weeks after radiotherapy completion. Tumor regression, adverse events, surgical complications, and short-term clinical outcomes were recorded. Results: Two patients were excluded because of incomplete radiotherapy treatment or refusal of surgery. Eventually, 76 patients underwent total mesorectal excision and no perioperative mortality was observed. Of these, 20 patients (25.6%) developed grade 3 or 4 toxicity during concurrent chemoradiotherapy. Among the 76 patients who underwent surgery, 24 (31.6%) patients achieved a pathologic complete response. The sphincter preservation rate was 96.1% (73/76) in all patients and 92.2% (39/42) in patients with tumors located less than 5 cm from the anal verge. The 2-year overall and disease-free survivals were 94% and 87.4%, respectively. Conclusion: The intensified multimodality therapy was well tolerated in our cohort and resulted in a considerably high pathologic complete response rate. Regardless of favorable short-term clinical outcomes, long-term oncologic outcomes will be closely monitored among the patients with a pathologic complete response. PMID:27582883

  17. Use of pre-operative Tc99m-Sestamibi scintigraphy and intraoperative parathyroid hormone monitoring to eliminate neck exploration in mediastinal parathyroid adenocarcinoma.

    PubMed

    Damadi, Amir; Harkema, James; Kareti, Rao; Saxe, Andrew

    2007-01-01

    A 66-year-old white woman was found to have an elevated serum calcium and parathyroid hormone (PTH) on routine health evaluation. Physical examination was unremarkable as was ultrasonography of the neck. A sestamibi parathyroid scan revealed abnormal uptake in the anterior mediastinum. Computed tomography of the chest demonstrated an anterior mediastinal mass compatible with a parathyroid adenoma but no neck masses. The patient underwent mediastinoscopy that was converted to a median sternotomy to fully access the mass. The mass was completely resected with surrounding thymus gland. Frozen section confirmed that excised tissue was parathyroid gland in origin. An intraoperative PTH obtained 20 minutes after specimen removal showed a decrease of more than 50% from preoperative levels. The strategy for initial surgery for hyperparathyroidism when a sestamibi scan is "positive" in the mediastinum (only) is a point of some controversy. Traditional recommendations have been to "clear the neck" of abnormal parathyroid tissue before undertaking a more morbid sternotomy. Mediastinoscopy was attempted to remove the mediastinal lesion and to avoid a sternotomy. Preoperative Tc99m sestamibi scintigraphy, frozen section histology, and intraoperative PTH monitoring permitted the authors to conclude that neck exploration was unnecessary.

  18. Preoperative chemoradiotherapy with 5-fluorouracil and oxaliplatin for locally advanced rectal cancer: long-term results of a phase II trial.

    PubMed

    Liu, Luying; Cao, Caineng; Zhu, Yuan; Li, Dechuan; Feng, Haiyang; Luo, Jialin; Tang, Zhongzhu; Liu, Peng; Lu, Ke; Ju, Haixing; Zhang, Na

    2015-03-01

    The aim of this study was to report long-term results of patients with locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy with fluorouracil, leucovorin, and oxaliplatin. From February 2002 to November 2006, a total of 58 patients with locally advanced rectal cancer were recruited. Secondary endpoints included the cumulative incidence of local and distant recurrences, disease-free survival, and overall survival. The median follow-up time was 138 months (109-151 months). The cumulative incidence of local recurrence at 10 years was 12.1%. The cumulative incidence of distant recurrence at 10 years was 53.4%. The overall survival in the intention-to-treat population was 39.5% at 10 years. Disease-free survival in the intention-to-treat population was 41.8% at 10 years. Univariate analysis revealed that pathologic complete response was associated with local recurrence, distant recurrence, disease-free survival, and overall survival (p < .05). Distant recurrence remains the predominant pattern of failure for patients with locally advanced rectal cancer after preoperative chemoradiotherapy and total mesorectal excision. Pathologic complete response is an independent prognostic factor for locally advanced rectal cancer after preoperative chemoradiotherapy.

  19. Radioguided localisation of impalpable breast lesions using 99m-Technetium macroaggregated albumin: Lessons learnt during introduction of a new technique to guide preoperative localisation

    SciTech Connect

    Landman, Joanne; Kulawansa, Sagarika; McCarthy, Michael; Troedson, Russell; Phillips, Michael; Tinning, Jill; Taylor, Donna

    2015-03-15

    Preoperative wire-guided localisation (WGL) of impalpable breast lesions is widely used but can be technically difficult. Risks include wire migration, inaccurate placement, and inadequate surgical margins. Research shows that radioguided occult lesion localisation (ROLL) is quicker, easier, and can improve surgical and cosmetic outcomes. An audited introduction of ROLL was conducted to validate the technique as a feasible alternative to WGL. Fifty patients with single impalpable lesions and biopsy proven malignancy or indeterminate histology underwent WGL followed by intralesional radiopharmaceutical injection of 99m-Technetium macroaggregated albumin. Postprocedural mammography was performed to demonstrate wire position, and scintigraphy to evaluate radiopharmaceutical migration. Lymphoscintigraphy and intraoperative sentinel node biopsy were performed if indicated, followed by lesion localisation and excision using a gamma probe. Specimen imaging was performed, with immediate reexcision for visibly inadequate margins. Accurate localisation was achieved in 86% of patients with ROLL compared to 72% with WGL. All lesions were successfully removed, with clear margins in 71.8% of malignant lesions. Reexcision and intraoperative sentinel node localisation rates were equivalent to preaudit figures for WGL. ROLL was easy to perform and problems were infrequent. Inaccurate radiopharmaceutical placement necessitating WGL occurred in four patients. Minor radiopharmaceutical migration was common, but precluded using ROLL in only two cases. ROLL is effective, simple, inexpensive, and easily learnt; however, preoperative confirmation of correct radiopharmaceutical placement using mammography and the gamma probe is important to help ensure successful lesion removal. Insertion of a backup hookwire is recommended during the initial introduction of ROLL.

  20. A New Laparoscopic Surgical Procedure to Achieve Sufficient Mesorectal Excision in Upper Rectal Cancer

    PubMed Central

    Ohigashi, Seiji; Taketa, Takashi; Sudo, Kazuki; Shiozaki, Hironori; Onodera, Hisashi

    2011-01-01

    Objective. Mesorectal excision corresponding to the location of a tumor, termed tumor-specific mesorectal excision (TSME), is commonly performed for resection of upper rectal cancer. We devised a new laparoscopic procedure for sufficient TSME with rectal transection followed by mesorectal excision. Operative Technique. After mobilization of the sigmoid colon and ligation of inferior mesenteric vessels, we dissected the mesorectum along the layer of the planned total mesorectal excision. The rectal wall was carefully separated from the mesorectum at the appropriate anal side from the tumor. After the rectum was isolated and transected using an endoscopic linear stapler, the rectal stump drew immediately toward the anal side, enabling the mesorectum to be identified clearly. In this way, sufficient TSME can be performed easily and accurately. This technique has been successfully conducted on 19 patients. Conclusion. This laparoscopic technique is a feasible and reliable procedure for achieving sufficient TSME. PMID:22312519

  1. Frequent Imprecise Excision among Reversions of a P Element-Caused Lethal Mutation in Drosophila

    PubMed Central

    Voelker, Robert A.; Greenleaf, Arno L.; Gyurkovics, Henrik; Wisely, G. Bruce; Huang, Shu-Mei; Searles, Lillie L.

    1984-01-01

    RpII215D50 (= D50) is a lethal mutation caused by the insertion of a 1.3-kb P element 5' to sequences encoding the largest (215 kilodaltons) subunit of Drosophila RNA polymerase II. In dysgenic males D50 reverted to nonlethality at frequencies ranging from 2.6 to 6.5%. These reversions resulted from loss of P element sequences. Genetic tests of function and restriction enzyme analysis of revertant DNAs revealed that 35% or more of the reversion events were imprecise excisions. Two meiotic mutations that perturb excision repair and postreplication repair (mei-9a and mei-41D5, respectively) had no influence on reversion frequency but may have increased the proportion of imprecise excisions. We suggest that these excisions are by-products of, rather than intermediates in, the transposition process. PMID:17246216

  2. On the Incidence of Excise Taxes on a Monopolist's Price: A Pedagogical Note.

    ERIC Educational Resources Information Center

    Mixon, J. Wilson, Jr.

    1986-01-01

    Maintains that intermediate level undergraduate microeconomic theory texts mislead by their treatment of the effect of an excise tax on a monopolist's price and output. Offers a simple demonstration of the correct approach. (Author/JDH)

  3. Ambulatory narrow excision for thin melanoma (< or = 2 mm): results of a prospective study.

    PubMed

    Bono, A; Bartoli, C; Clemente, C; Del Prato, I; Boracchi, P; Rossi, N; Cascinelli, N

    1997-07-01

    Although narrow surgical excision may be sufficient for thin melanoma, questions remain concerning how narrow the excision should be and how it should be related to tumour thickness. To address these issues, a group of 168 consecutive patients with primary invasive melanoma up to 2 mm thick underwent ambulatory surgery with excision margins of 1 cm. 40 (24%) of these patients had lesions thicker than 1 mm. In a median follow-up of 5 years, 11 patients relapsed and 3 developed second malignancies. The crude cumulative incidence of regional and distant metastases were, respectively, 5.6% and 1.5%. No local isolated recurrence was observed, indicating that ambulatory narrow excision is justified for melanoma up to 2 mm thick.

  4. Providing Preoperative Information for Children Undergoing Surgery: A Randomized Study Testing Different Types of Educational Material to Reduce Children's Preoperative Worries

    ERIC Educational Resources Information Center

    Fernandes, S. C.; Arriaga, P.; Esteves, F.

    2014-01-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery.…

  5. Preoperative Chemotherapy in Patients With Intermediate-Risk Rectal Adenocarcinoma Selected by High-Resolution Magnetic Resonance Imaging: The GEMCAD 0801 Phase II Multicenter Trial

    PubMed Central

    Brown, Gina; Estevan, Rafael; Salud, Antonieta; Montagut, Clara; Maurel, Joan; Safont, Maria Jose; Aparicio, Jorge; Feliu, Jaime; Vera, Ruth; Alonso, Vicente; Gallego, Javier; Martin, Marta; Pera, Miguel; Sierra, Enrique; Serra, Javier; Delgado, Salvadora; Roig, Jose V.; Santos, Jesus; Pericay, Carles

    2014-01-01

    Background. The need for preoperative chemoradiation or short-course radiation in all T3 rectal tumors is a controversial issue. A multicenter phase II trial was undertaken to evaluate the efficacy and safety of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab in patients with intermediate-risk rectal adenocarcinoma. Methods. We recruited 46 patients with T3 rectal adenocarcinoma selected by magnetic resonance imaging (MRI) who were candidates for (R0) resection located in the middle third with clear mesorectal fascia and who were selected by pelvic MRI. Patients received four cycles of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab (final cycle without bevacizumab) before total mesorectal excision (TME). In case of progression, preoperative chemoradiation was planned. The primary endpoint was overall response rate (ORR). Results. On an intent-to-treat analysis, the ORR was 78% (n = 36; 95% confidence interval [CI]: 63%–89%) and no progression was detected. Pathologic complete response was observed in nine patients (20%; 95% CI: 9–33), and T downstaging was observed in 48%. Forty-four patients proceeded to TME, and all had R0 resection. During preoperative therapy, two deaths occurred as a result of pulmonary embolism and diarrhea, respectively, and one patient died after surgery as a result of peritonitis secondary to an anastomotic leak (AL). A 13% rate of AL was higher than expected. The 24-month disease-free survival rate was 75% (95% CI: 60%–85%), and the 2-year local relapse rate was 2% (95% CI: 0%–11%). Conclusion. In this selected population, initial chemotherapy results in promising activity, but the observed toxicity does not support further investigation of this specific regimen. Nevertheless, these early results warrant further testing of this strategy in an enriched population and in randomized trials. PMID:25209376

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

    SciTech Connect

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

    2013-05-01

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

  7. Preoperative Chemoradiotherapy (CRT) Followed by Laparoscopic Surgery for Rectal Cancer: Predictors of the Tumor Response and the Long-Term Oncologic Outcomes

    SciTech Connect

    Lee, Jong Hoon; Kim, Sung Hwan; Kim, Jun-Gi; Cho, Hyun Min; Shim, Byoung Yong

    2011-10-01

    Purpose: We have evaluated the predictors of a tumor response to chemoradiotherapy (CRT) and the long-term oncologic outcomes of preoperative CRT and laparoscopic surgery for patients who suffer from rectal cancer. Methods and Materials: The study involved 274 patients with locally advanced rectal cancer and who had been treated with preoperative CRT and curative laparoscopic total mesorectal excision between January 2003 and January 2009. We assessed the long-term oncologic outcomes, in terms of recurrence and survival, of the treated patients. Results: Forty-two (15.3%) of the 274 patients had complete pathologic responses (pCR). The pre-CRT carcinoembryonic antigen level was the only significant predictor of a pCR on the multivariate analysis (p = 0.01). The overall survival at 5 years was 73.1%, with a mean survival period of 59.7 months (95% CI, 57.1-62.3). The disease-free survival at 5 years was 67.3% with a mean survival period of 54.7 months (95% CI, 51.7-57.8). The pCR group had a higher rate of overall survival at 5 years than did the non-pCR group, and the difference was significant (86.0% vs. 71.2%; hazard ratio = 0.87; 95% CI, 0.78-0.96; p = 0.03). The cumulative incidences of local and distant recurrences at 5 years were 5.8% and 28.3%, respectively. A total of 84.5% (234 of 274) of the patients had their anal sphincters preserved. Grade 3 or 4 acute and long-term toxic effects occurred in 22.2% and 8.4% of the patients, respectively. Conclusion: Preoperative CRT and laparoscopic surgery seems safe and feasible with favorable long-term outcomes and a high rate of sphincter preservation for the patients with low-lying tumors of the rectum.

  8. Thoracoscopic excision of two bronchogenic cysts located in highest upper mediastinum: Report of two cases

    PubMed Central

    Lin, Fengwu; Zhang, Chuan; Cheng, Kunpeng; Dang, Dan; Zhao, Yan

    2015-01-01

    Bronchogenic cysts are rare congenital malformation that need surgical removal. To date, bronchogenic cysts located in highest upper mediastinum excised by thoracoscopy have not been reported, though complete thoracoscopic extirpation of a bronchogenic cyst has been reported before. We excised two highest upper bronchogenic cysts by thoracoscopy successfully without any postoperative complication, demonstrating thoracoscopy could be a first-line therapeutic option even for highest upper mediastinum brochogenic cysts. PMID:26150875

  9. Light effects on the nucleic acids of excised cotton cotyledons.

    PubMed

    Basler, E

    1966-03-01

    The effects of light and glucose in the nutrient medium on the nucleic acid metabolism of excised 8-day cotton (Gossypium hirsutum var. Acala 44) cotyledons were determined. The rates of synthesis as affected by light and glucose were determined by brief exposures to C(14)-labeled orotic acid. The nucleic acids were fractionated by homogenizing in Tris-HCl buffer and centrifuging to obtain soluble and microsomal RNA (20,000 x g supernatant) and a particulate nucleic acid fraction (20,000 x g precipitate) or by extracting in phenol followed by 10% NaCl extraction at 100 degrees . The phenol extract was analyzed by density gradient centrifugation. Light and glucose caused parallel changes in nucleic acid levels of the various fractions, in orotic acid-6-C(14) absorption and in rates of synthesis of nucleic acids. Light and glucose appear to enhance binding of the ribosome nucleic acid so that it becomes less extractable in Tris-HCl buffer or phenol. The bound nucleic acids were labeled at a slightly higher rate than the total nucleic acids extracted by Tris-HCl or phenol. However, light treatment for 48 hours promoted a very high labeling rate in the soluble, low molecular weight nucleic acid as shown by density gradient centrifugation of the phenol extractable fraction.It was concluded that a part of the nucleic acid changes were brought about by light acting through the photosynthetic production of carbohydrate. This conclusion was strengthened by the observation that herbicide inhibitors of photosynthesis and limited atmospheric CO(2) concentrations partially inhibited the nucleic acid changes. However, glucose did not cause changes in nucleic acid levels as large as those caused by light and changes were observed to occur in light even though the endogenous sugar levels were maintained at a low level by the inhibition of photosynthesis with herbicides. The data indicated that light may produce changes in nucleic acid levels by other mechanisms additional to those

  10. Epigenetic self-regulation of developmental excision of an internal eliminated sequence on Paramecium tetraurelia.

    PubMed

    Duharcourt, S; Butler, A; Meyer, E

    1995-08-15

    Differentiation of the somatic macronucleus of ciliates after sexual events involves the programmed excision of thousands of single-copy internal eliminated sequences (IESs) from the germ-line genome. We have studied two cell lines of Paramecium tetraurelia that have identical germ-line genomes but differ in their macronuclear genomes. In the IES- cell line, a 222-bp IES interrupting a coding sequence is reproducibly excised during macronuclear differentiation, whereas it is not in the IES+ cell line. In a cross between the two lines, the developmental alternative in maternally inherited, suggesting that it is epigenetically controlled by the old (prezygotic) macronucleus in each cell. Transformation of the macronucleus of both lines with plasmids carrying fragments of either version of the gene shows that the presence of the IES sequence in the old macronucleus results in retention of the IES in the new macronuclear genome of sexual progeny. This could be attributable to (1) inhibition of excision, or (2) repair of a double-strand gap left in the genomic sequence after constitutive excision of the IES, by a polymerization mechanism using a homologous IES+ template from the old macronucleus. The latter possibility is ruled out by experiments showing that modified IESs can inhibit excision without being copied in the new macronuclear genome. Possible mechanisms are discussed in the light of a quantitative analysis of excision inhibition by the maternal IES sequence. PMID:7649484

  11. Laparoscopic excision of subdiaphragmatic bronchogenic cyst occurring in the retroperitoneum: report of a case.

    PubMed

    Inaba, Kazuki; Sakurai, Yoichi; Umeki, Yusuke; Kanaya, Seiichiro; Komori, Yoshiyuki; Uyama, Ichiro

    2010-12-01

    Although bronchogenic cysts (BCs) are benign congenital malformations usually occur in thoracic cavity, retroperitoneal location is extremely uncommon. We reported a case of BC occurred in the retroperitoneum, which was excised laparoscopically. A 64-year-old Japanese woman was admitted to the hospital because of submucosal tumor in the upper part of the stomach. An upper gastrointestinal endoscopy revealed a submucosal tumor located just distal to the esophagogastric junction. The abdominal computed tomography scan revealed a cystic mass located in contact with lesser curvature of the stomach and the dorsal surface of the liver. As the cystic mass was well-circumscribed and showed no positive findings suggestive of malignancy, the laparoscopic excision of the cystic mass was performed. The cystic tumor was completely excised with a laparoscopic procedure. The histologic findings indicated that the cyst was surfaced by the ciliated pseudostratified epithelium without the presence of the cartilage, which was compatible with the BC of the retroperitoneum. This case highlights the safety and the feasibility of complete laparoscopic excision of retroperitoneal BC. Laparoscopic excision of retroperitoneal BC definitely provides all advantages of minimally invasive procedure, which improves postoperative patient discomfort and pain and shortens hospital stay. Laparoscopic procedure may definitely be a standard approach for the excision of retroperitoneal BC.

  12. Preoperative color Doppler assessment in planning of gluteal perforator flaps.

    PubMed

    Isken, Tonguc; Alagoz, M Sahin; Onyedi, Murat; Izmirli, Hakki; Isil, Eda; Yurtseven, Nagehan

    2009-02-01

    Gluteal artery perforator flaps have gained popularity due to reliability, preservation of the muscle, versatility in flap design without restricting other flap options, and low donor-site morbidity in ambulatory patients and possibility of enabling future reconstruction in paraplegic patients. But the inconstant anatomy of the vascular plexus around the gluteal muscle makes it hard to predict how many perforators are present, what their volume of blood flow and size are, where they exit the overlying fascia, and what their course through the muscle will be. Without any prior investigations, the reconstructive surgeon could be surprised intraoperatively by previous surgical damage, scar formation, or anatomic variants.For these reasons, to confirm the presence and the location of gluteal perforators preoperatively we have used color Doppler ultrasonography. With the help of the color Doppler ultrasonography 26 patients, 21 men and 5 women, were operated between the years 2002 and 2007. The mean age of patients was 47.7 (age range: 7-77 years). All perforator vessels were marked preoperatively around the defect locations. The perforator based flap that will allow primary closure of the donor site and the defect without tension was planned choosing the perforator that showed the largest flow in color Doppler ultrasonography proximally. Perforators were found in the sites identified with color Doppler ultrasonography in all other flaps. In our study, 94.4% flap viability was ensured in 36 perforator-based gluteal area flaps. Mean flap elevation time was 31.9 minutes. We found that locating the perforators preoperatively helps to shorten the operation time without compromising a reliable viability of the perforator flaps, thus enabling the surgeon easier treatment of pressure sores.

  13. Preoperative defining system for pancreatic head cancer considering surgical resection

    PubMed Central

    Yang, Seok Jeong; Hwang, Ho Kyoung; Kang, Chang Moo; Lee, Woo Jung

    2016-01-01

    AIM: To provide appropriate treatment, it is crucial to share the clinical status of pancreas head cancer among multidisciplinary treatment members. METHODS: A retrospective analysis of the medical records of 113 patients who underwent surgery for pancreas head cancer from January 2008 to December 2012 was performed. We developed preoperative defining system of pancreatic head cancer by describing “resectability - tumor location - vascular relationship - adjacent organ involvement - preoperative CA19-9 (initial bilirubin level) - vascular anomaly”. The oncologic correlations with this reporting system were evaluated. RESULTS: Among 113 patients, there were 75 patients (66.4%) with resectable, 34 patients (30.1%) with borderline resectable, and 4 patients (3.5%) with locally advanced pancreatic cancer. Mean disease-free survival was 24.8 mo (95%CI: 19.6-30.1) with a 5-year disease-free survival rate of 13.5%. Pretreatment tumor size ≥ 2.4 cm [Exp(B) = 3.608, 95%CI: 1.512-8.609, P = 0.044] and radiologic vascular invasion [Exp(B) = 5.553, 95%CI: 2.269-14.589, P = 0.002] were independent predictive factors for neoadjuvant treatment. Borderline resectability [Exp(B) = 0.222, P = 0.008], pancreatic head cancer involving the pancreatic neck [Exp(B) = 9.461, P = 0.001] and arterial invasion [Exp(B) = 6.208, P = 0.010], and adjusted CA19-9 ≥ 50 [Exp(B) = 1.972 P = 0.019] were identified as prognostic clinical factors to predict tumor recurrence. CONCLUSION: The suggested preoperative defining system can help with designing treatment plans and also predict oncologic outcomes. PMID:27468199

  14. Preoperative fasting: current practice and areas for improvement.

    PubMed

    Falconer, R; Skouras, C; Carter, T; Greenway, L; Paisley, A M

    2014-03-01

    Preoperative fasting aims to increase patient safety by reducing the risk of adverse events during general anaesthesia. However, prolonged fasting may be associated with dehydration, hypoglycaemia and electrolyte imbalance as well as patient discomfort. We aimed to examine compliance with the current best practice guidelines in a large surgical unit and to identify areas for improvement. Adult patients undergoing elective and emergency general, orthopaedic, gynaecology and vascular surgery procedures in the Royal Infirmary of Edinburgh were surveyed over a 3-month period commencing November 2011. A standardised questionnaire was used to collect information on the duration of preoperative fasting and the advice administered by medical and nursing staff. 292 patients were included. Median fast from solids was 13.5 h for elective patients (IQR 11.5-16) and 17.38 h for emergency patients (IQR 13.68-28.5 h). Similarly, the median fast from fluids was 9.36 h for elective patients (IQR 5.38-12.75 h) and 12.97 h for emergency patients (IQR 8.5-16.22 h). The instructions that elective patients received contributed to prolonged fasting times. The median fast for elective patients fully compliant with fasting advice would be 10 h for solids (IQR 8.75-12 h) and 6.25 h (IQR 3.83-9.25 h) for clear fluids. Elective patients fasted for longer than recommended confirming that clinical practice is slow to change. The use of universal fasting instructions and patient choice are factors that unnecessarily prolong preoperative fasting, which however appears to be multifactorial. Service improvement by abbreviation of the observed fasting periods will rely on targeted staff education and effective clinical communication by provision of written information for both elective and emergency surgical patients. The routine use of preoperative nutritional supplements may need to be re-examined when further evidence is available.

  15. Preparing for surgery: this practical workup pinpoints preoperative dangers.

    PubMed

    Kozak, E A

    1993-09-01

    Older patients undergo 20 to 40% of surgical procedures and account for 50% of surgical emergencies. Your presurgical workup can pinpoint potential cardiac, pulmonary, or metabolic problems that could endanger your patient in the operating room. Not everyone needs an extensive cardiac workup. To determine who does, you can use the Goldman criteria to predict the risk for postoperative cardiac complications. Preoperative test selection is based on these predicted risks and on information from the patient history and physical exam. Medication adjustments and discharge planning are important considerations as well.

  16. The value of preoperative functional cortical mapping using navigated TMS.

    PubMed

    Lefaucheur, Jean-Pascal; Picht, Thomas

    2016-04-01

    The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery. PMID:27229765

  17. The value of preoperative functional cortical mapping using navigated TMS.

    PubMed

    Lefaucheur, Jean-Pascal; Picht, Thomas

    2016-04-01

    The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery.

  18. Colonoscopic preoperative localization using submucosal injection of radiolabelled colloid

    PubMed Central

    Cho, Carolyn; Jain, Sanjiv; Pilbeam, Mark; Tait, Noel; Thomson, Andrew

    2008-01-01

    Malignant colonic polyps can be removed endoscopically but surgical resection is sometimes required. However, the polypectomy site can be difficult to locate. Current methods use various tattooing agents, with varying degrees of success. A new technique using pre-operative injection of technetium-99m-labelled antimony colloid, with intraoperative localization using a handheld gamma probe, is described. Although unsuccessful in terms of localizing a previously partially resected polyp, the technique itself proved safe and simple, and has some advantages over other endoscopic approaches. PMID:18629395

  19. Preoperative evaluation of the cardiac patient for noncardiac surgery.

    PubMed Central

    Fleisher, L. A.; Barash, P. G.

    1993-01-01

    Perioperative cardiac events continue to represent a significant cause of morbidity in patients undergoing noncardiac surgery. The evaluation of the high risk patient should begin with an assessment of the probability of coronary artery disease and exercise tolerance. Decisions to undergo further evaluation, including noninvasive testing, should be based upon the perioperative morbidity and mortality rate for the planned surgical procedure. In patients with significant coronary artery stenoses and a high probability of perioperative cardiac morbidity, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, and preoperative optimization of hemodynamics in an intensive care unit have all been advocated as means of reducing risk. PMID:7825340

  20. Preoperative anxiety management, emergence delirium, and postoperative behavior.

    PubMed

    Banchs, Richard J; Lerman, Jerrold

    2014-03-01

    Preoperative anxiolysis is important for children scheduled for surgery. The nature of the anxiety depends on several factors, including age, temperament, past hospitalizations, and socioeconomic and ethnic backgrounds. A panoply of interventions effect anxiolysis, including parental presence, distraction, and premedication, although no single strategy is effective for all ages. Emergence delirium (ED) occurs after the use of sevoflurane and desflurane in preschool-aged children in the recovery room. Symptoms usually last approximately 15 minutes and resolve spontaneously. The Pediatric Anesthesia Emergence Delirium scale is used to diagnose ED and evaluate therapeutic interventions for ED such as propofol and opioids. PMID:24491647