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Common Indication (common + indication)
Selected AbstractsHN08P AUDIT OF 115 CONSECUTIVE PARATHYROIDECTOMIES IN PATIENTS WITH RENAL HYPERPARATHYROIDISMANZ JOURNAL OF SURGERY, Issue 2007T. H. Low Objectives To review the characteristics and outcomes of patients undergoing parathyroidectomy for renal (secondary and tertiary) hyperparathyroidism. Methods Review of prospectively collected data from a dedicated head and neck database at RPAH between 1988 and 2004. A total of 115 patients underwent exploratory parathyroidectomy. Results Common indications for parathyroidectomy included hypercalcaemia, renal osteodystrophy, calciphylaxis and calcinosis, bone or joint pain, and pruritus. Sixty-nine patients had subtotal parathyroidectomy (STP), 47 had total parathyroidectomy (TP) of which 4 had total parathyroidectomy with autotransplant (TPA). Ten patients required re-exploration for recurrent hyperparathyroidism at a median time to reoperation of 55 months. Of those, 8 had STP, 1 had TP, and 1 had TPA. Predictors of recurrent hyperparathyroidism included higher post operative PTH level (median of 22.5 pmol/L vs 3.4 pmol/L) and higher total parathyroid weight (median of 7.75 gm vs 2.9 gm). 97% of patients reported resolution of symptoms on follow-up. The average length of hospital admission was 4.4 days. Morbidity of this series included wound infection (0.8%), temporary vocal cord paralysis (0.8%), seizure due to severe hypocalcaemia (0.8%) and neck haematomas requiring evacuation (0.8%). Conclusions Parathyroidectomy is effective in the management of renal hyperparathyroidism. Subtotal parathyroidectomy is associated with a higher re-exploration rate. Predictors for recurrent hyperparathyroidism include total parathyroid weight and post-operative PTH level. [source] Home Intravenous Antimicrobial Infusion Therapy: A Viable Option in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2007(See editorial comments by Dr. Kevin High on pp 79 OBJECTIVES: To determine whether older adults and younger adults are equally able to administer home intravenous antimicrobial infusion therapy (home IV antimicrobials) without intensive support from home care agencies. DESIGN: Retrospective cohort study. SETTING: Veterans Affairs Ann Arbor Healthcare System, a 100-bed tertiary care medical center. PARTICIPANTS: All patients who received home IV antimicrobials from July 1, 2000, through December 31, 2003. MEASUREMENTS: Demographic data, underlying medical conditions, indications for therapy, antimicrobial agents administered, concomitant medications, frequency of patient visits and phone calls, adverse events, and outcomes of infections. RESULTS: A total of 205 patients received 231 courses of home IV antimicrobials, with 107 courses in patients aged 60 and older and 124 courses in patients younger than 60. For both groups, the most common indication for therapy was osteoarticular infections, and the predominant pathogens were Staphylococcus aureus and coagulase-negative Staphylococcus. Older patients were significantly more likely than younger patients to require the assistance of family members to help with the infusion and were more likely to be seen in urgent care or to call the infectious diseases pharmacist or physicians with questions. Overall, clinical outcomes and numbers of adverse events were similar in both groups, with the exception of nephrotoxicity, which was greater in the older group (P=.02). CONCLUSION: With appropriate support from a hospital-based home IV antimicrobials therapy team, home IV antimicrobial appears to be a viable option for older adults. [source] Therapeutic plasma exchange as a nephrological procedure: A single-center experience ,,JOURNAL OF CLINICAL APHERESIS, Issue 4 2005Fred E. Yeo Abstract In the United States, therapeutic plasma exchange (TPE) is both performed and requested by a wide range of services, often on an empiric basis (before a diagnosis is established). Whether empiric therapy is beneficial has not been established. Patients were identified from an electronic procedure log that included those patients who received plasmapheresis at Walter Reed Army Medical Center from 1996 to 2003. The clinical indications, referring service, and outcomes (including deaths) that occurred were tabulated. Between March 1997 and August 2003, 568 TPE treatments were performed in 54 patients. The majority of the diagnoses were either neurologic (48%) or hematologic (37%). Thirty-three patients (61%) received TPE for a Category I indication. Twelve cases were performed empirically (without an established diagnosis) at the request of the referring service, most (7) performed for presumed thrombotic thrombocytopenic purpura (TTP). Almost 80% of patients required central venous catheters for treatment. Twelve patients (22%) experienced a major complication including death, and six patients (11%) died. Of the patients who died, 5 (83%) were treated empirically versus one death (17%) among patients not treated empirically, P < 0.001 by Chi Square. Only one of the seven patients treated empirically for TTP died, however. In logistic regression analysis, empiric treatment was the only factor independently associated with death, adjusted odds ratio, 34.2, 95% CI, 3.4, 334.8, P = 0.003. The most common indication for TPE was neurological disease, which also accounted for the highest proportion of complications. With the exception of presumed TTP, performing TPE in the absence of a confirmed diagnosis was not beneficial. J. Clin. Apheresis Published 2005 Wiley-Liss, Inc. [source] Assessing the dietetic needs of different patient groups receiving enteral tube feeding in primary careJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2002S. M. Madigan Abstract Aim To examine the nature of all contacts between adult tube-fed patients and the dietetic service and to refine the current dietetic protocols to reflect the findings of the study with a view to improving patient care. Methods All adult patients referred to the Community Nutrition and Dietetic Service within a 6-month period were included in the study. Using a proforma developed from a retrospective case-note analysis, data were collected on the complications that prompted more frequent contacts than the department protocol. Data were analysed using the Statistical Package for the Social Sciences. Results The most common indication for home enteral feeding in this group of adult patients was a swallowing disorder resulting from a cerebrovascular accident (59.5%) followed by cancer (21.5%). There was a trend for cancer patients to need more intervention compared with those patients with other medical conditions. A significant difference was observed in the total contacts and telephone calls given to those patients in there own homes (P=0.019) and there was a trend towards more domicilary visits with this group. Conclusions The department protocols have been revised to include a planned review within 2,6 weeks of initial dietetic assessment in the community for those patients who were identified to have the greatest need. More intensive dietetic monitoring has clear implications for dietetic services in the community. [source] Epidemic of Cesarean Section at the General, Private and University Hospitals in ThailandJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2000Dr. Boonsri Chanrachakul Abstract Objective: To undertake a survey of cesarean section in the general, private and university hospitals in Thailand. Methods: Postal questionnaires were sent to all the general, private and university hospitals with 200 beds or more. The questionnaires were prepared to find out the percentage, the indications and the trend of cesarean delivery, the measures taken to decrease cesarean section rate, and the practice of external cephalic version (ECV) and vaginal birth after cesarean section (VBAC) in the hospitals. Results: The overall response rate was 88%. Mean cesarean section rates were 24, 48, and 22% in the general, private and university hospitals, respectively. Cesarean section rates in most of the hospitals were increased in the past 5 years namely 78% in the general hospitals, 50% in the private hospitals, 66% in the university hospitals. However, only 38% of the hospitals had measures to regulate this operation. Repeated cesarean section was the most common indication in the private (63%) and the university hospitals (88%) while failure to progress was the most common indication in the general hospitals (55%). ECV and VBAC were performed in 26 and 12% of the hospitals. They were, however, not the standard practices. Conclusion: Rising of cesarean section rate without any measure to regulate it is the problem in the developing countries. Standardised labor management and reduction of unnecessary primary cesarean section will automatically reduce repeated operation and overall cesarean section. [source] Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal painALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009K. THAKKAR Summary Background, Abdominal pain is the most common indication for oesophagogastroduodenoscopy (OGD) in children. However, existing studies examining the diagnostic outcomes of OGD in children with abdominal pain are limited. Aim, To examine the diagnostic yield of OGD with biopsy in the evaluation of abdominal pain and to describe the endoscopic and histological findings in patients undergoing OGD for abdominal pain of unclear aetiology. Methods, We performed a retrospective cross-sectional cohort study in children under 18 years of age who had OGD for the primary indication of abdominal pain, at Texas Children's Hospital and Children's Hospital of The King's Daughters from 1 January 2002 to 30 June 2005. Results, Overall, OGD was diagnostic in 454 (38.1%) of the 1191 procedures, including reflux oesophagitis (23%, n = 271), Helicobacter pylori infections (5%, n = 55), peptic ulcers (3%, n = 32), eosinophilic oesophagitis (2%, n = 25), celiac disease (1%, n = 9) and Crohn's disease (0.5%, n = 7). Male gender, older age, elevated C-reactive protein and vomiting were associated with increased diagnostic yield. Conclusions, Our findings suggest that OGD is valuable for the evaluation of chronic abdominal pain in children, with a diagnostic yield of 38%. The majority of alarm symptoms and routine laboratory tests are not significantly associated with diagnostic yield. [source] Recurrence of hepatitis C infection: Where are we now?LIVER TRANSPLANTATION, Issue S2 2005Michael Charlton Key Points 1Hepatitis C-associated liver failure is the most common indication for liver transplantation, and approximately 10% of HCV-infected recipients will die or lose their allograft secondary to recurrent HCV infection. 2Risk factors associated with histological recurrence of HCV include donor (age, fat content, ischemic time, and living donor), recipient (age and non-Caucasian race), clinical (rejection and CMV), and viral (viral load and quasispecies). 3Treatment of recipients with histological recurrence is with pegylated IFN (± ribavirin). The role of hepatitis C immunoglobulin in the management of postransplant HCV is still evolving. (Liver Transpl 2005;11:S57,S62.) [source] Factors that identify survival after liver retransplantation for allograft failure caused by recurrent hepatitis C infectionLIVER TRANSPLANTATION, Issue 12 2004Guy W. Neff Hepatitis C virus (HCV) is becoming the most common indication for liver retransplantation (ReLTx). This study was a retrospective review of the medical records of liver transplant patients at our institution to determine factors that would identify the best candidates for ReLTx resulting from allograft failure because of HCV recurrence. The patients were divided into 2 groups on the basis of indication for initial liver transplant. Group 1 included ReLTx patients whose initial indication for LTx was HCV. Group 2 included patients who received ReLTx who did not have a history of HCV. We defined chronic allograft dysfunction (AD) as patients with persistent jaundice (> 30 days) beginning 6 months after primary liver transplant in the absence of other reasons. HCV was the primary indication for initial orthotopic liver transplantation (OLT) in 491/1114 patients (44%) from July 1996 to February 2004. The number of patients with AD undergoing ReLTx in Groups 1 and 2 was 22 and 12, respectively. The overall patient and allograft survival at 1 year was 50% and 75% in Groups 1 and 2, respectively (P = .04). The rates of primary nonfunction and technical problems after ReLTx were not different between the groups. However, the incidence of recurrent AD was higher in Group 1 at 32% versus 17% in Group 2 (P = .04). Important factors that predicted a successful ReLTx included physical condition at the time of ReLTx (P = .002) and Child-Turcotte-Pugh score (P = .008). In conclusion, HCV is associated with an increased incidence of chronic graft destruction with a negative effect on long-term results after ReLTx. The optimum candidate for ReLTx is a patient who can maintain normal physical activity. As the allograft shortage continues, the optimal use of cadaveric livers continues to be of primary importance. The use of deceased donor livers in patients with allograft failure caused by HCV remains a highly controversial issue. (Liver Transpl 2004;10:1497,1503.) [source] Liver transplantation for primary sclerosing cholangitis in the Nordic countries: Outcome after acceptance to the waiting listLIVER TRANSPLANTATION, Issue 9 2003Bjørn Brandsæter Primary sclerosing cholangitis (PSC) is a common indication for liver transplantation, but evaluation of patients and timing of liver transplantation remain as major problems. Data from PSC and control patients listed for liver transplantation from 1990 through 2000 in the Nordic countries were recorded prospectively. Outcomes from the waiting list and after transplantation have been recorded for both groups. For PSC patients, regression analyses have been performed to analyze predictors of outcome. A total of 255 PSC and 610 control patients were accepted on the liver transplantation waiting list from 1990 to 2000. In the PSC group, 223 patients (87%) received a first liver allograft, and 32 patients (13%) died without transplantation. The corresponding figures for the control group were 89% and 10%. For PSC patients, the 5- and 10-year survival from the time of acceptance was 68% and 58%, respectively. A higher Model for End-Stage Liver Disease score and a shorter duration of PSC predicted death on the waiting list for PSC patients. PSC is a frequent indication for liver transplantation. In our material, serum bilirubin or Model for End-Stage Liver Disease score and PSC duration are predictors of outcome including survival of the waiting list. [source] Fulminant hepatic failure: Outcome after listing for highly urgent liver transplantation,12 years experience in the nordic countriesLIVER TRANSPLANTATION, Issue 11 2002Bjørn Brandsæter Fulminant hepatic failure is a common indication for liver transplantation. Outcomes of patients listed for a highly urgent liver transplantation have been studied, with special emphasis on etiology of the liver disease, clinical condition, and ABO blood type. Data have been collected from the Nordic Liver Transplantation Registry. All Nordic patients listed for a highly urgent primary liver transplantation during a 12-year period have been included. Of the 315 patients listed for a highly urgent liver transplantation, 229 (73%) received a first liver allograft, 50 patients (16%) died without transplantation, and 36 patients (11%) were permanently withdrawn and survived. In 43% of the patients, no definite etiology of the liver failure could be established. Paracetamol intoxication was the most frequent specific indication for listing. Patients with blood type A had no significant shorter waiting time (3.8 v 6.6 days; P = .1) but a higher rate of transplantation (82% v 66%, P = .006) as compared with blood type O patients. In a multivariate analysis, paracetamol intoxication remained the single independent predictor of an outcome without transplantation. In conclusion, a high transplantation rate was observed among patients listed for a highly urgent liver transplantation because of fulminant hepatic failure. Blood type O patients had a lower chance of receiving a liver allograft. Patients with paracetamol intoxication had both a higher mortality without transplantation and a higher withdrawal rate attributable to improved condition. [source] Variability in Implantable Cardioverter Defibrillator Pulse Generator Longevity Between ManufacturersPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1p1 2003PATRICK T. ELLINOR ELLINOR, P.T., et al.: Variability in Implantable Cardioverter Defibrillator Pulse Generator Longevity Between Manufacturers.ICDs are used frequently to treat malignant ventricular arrhythmias. Despite the expanding role of these devices, little is known about the manufacturer variability in the performance of ICD generators. The purpose of this study is to explore the indications for ICD pulse generator replacement and to examine performance differences between the three major manufacturers of ICDs in the United States. The authors performed a retrospective review of ICD pulse generators that were implanted and replaced at Massachusetts General Hospital between February 1998 and March 2002. During the study period, 50 (7%) of the 707 devices in the study cohort were replaced. The most common indication for pulse generator replacement was related to battery performance followed by device recall, upgrade to a dual chamber device, and pulse generator malfunction. After exclusion of the recalled devices, a significantly higher number of pulse generators manufactured by St. Jude Medical (14/229) required replacement for battery depletion or prolonged charge times during the study period compared with devices from Guidant (2/220) or Medtronic (0/273),P = 0.003andP < 0.0001, respectively. This difference was attributable to reduced longevity in the Angstrom series of defibrillators. (PACE 2003; 26[Pt. I]:71,75) [source] Surgical Outcomes Following the Endoscopic Modified Lothrop Procedure,THE LARYNGOSCOPE, Issue 5 2007Mobeen A. Shirazi MD Abstract Objective: We performed a systematic review of 97 patients in whom an entirely endoscopic modified Lothrop procedure (EMLP) was performed. We studied the safety, efficacy, need for revision surgery, and rate of complication following an EMLP. Study Design: The study design was a retrospective chart analysis. Methods: We performed a retrospective chart review and patient survey of 97 patients who underwent an EMLP at our institution from January 1999 to March 2006. Main outcomes measured were the need for revision surgery including an osteoplastic flap (OPF), improvement in patients' symptoms, and rate of cerebrospinal fluid (CSF) leak. Results: The most common indication for the procedure was chronic frontal sinusitis and/or formation of mucocele. The frontal recess and floor of the frontal sinus were the most common areas of persistent disease. CSF leak rate was 1% (1/97) and was managed successfully at the time of surgery without any long-term sequelae. Twenty-two (23%) patients required revision surgery. Three (3%) patients required revision with an OPF. Some degree of symptomatic clinical improvement was reported by 98% (95/97) of patients. Conclusion: EMLP is a safe and effective surgical alternative to OPF for patients with recalcitrant frontal sinus disease. Major complications are rare. A large percentage of patients may require revision surgery. [source] A Practical Guide to the Management of HCV Infection Following Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009K. Watt Hepatitis C-associated liver failure is the most common indication for liver transplantation, with virological recurrence near ubiquitous. Approximately 30% of HCV-infected recipients will die or lose their allograft or develop cirrhosis secondary to hepatitis C recurrence by the fifth postoperative year, with the proportion increasing with duration of follow-up. Strategies for minimizing the frequency of severe HCV recurrence include avoidance of older donors, early diagnosis/treatment of CMV and minimization of immunosuppression, particularly T-cell depleting therapies and pulsed corticosteroid treatment of acute cellular rejection. Patients should be offered treatment with peginterferon and ribavirin before LT if MELD , 17 or as soon as histological evidence of recurrence of HCV is apparent post-LT. Because of the high frequency of hemotoxicity and renal insufficiency, ribavirin should be dosed according to renal function. [source] Use of inferior vena cava filters in a tertiary referral centre in AustraliaANZ JOURNAL OF SURGERY, Issue 5 2010Alok Tiwari Abstract Introduction:, To investigate the use of inferior vena cava (IVC) filters in a tertiary referral centre, looking at indication, types of filters and, with temporary/optional filters, removal rates. Methods:, Data was collected from a prospective database of all IVC filters inserted from January 2003 to January 2007. Patients' records and radiological imaging were all reviewed. Results:, 66 patients (40 males) had IVC filters inserted during the study period. The median age of the male patients was 57.5 (21,79) years, and females 56 (24,81). There were 49 (74.2%) temporary/optional filters and 17 (25.8%) permanent filters. The most common indication for filter was a contraindication to anticoagulation for both permanent (64.7%) and temporary/optional filters (77.6%). In the temporary/optional filter group, 38 of 49 (77.6%) patients had documented venous thromboembolism, while in the permanent filter group, this was 14 of 17 (82.4%). Of the optional filters, 22 of 49 (45.8%) have been removed. Conclusion:, More than half (54.2%) of temporary/optional filters were not removed and with potential for long-term complications. A protocol has now being instituted for vascular surgeons to authorize the insertion of filters and to then be responsible for ensuring their removal. [source] The iliac bifurcation device for endovascular iliac aneurysm repair: indications, deployment options and results at 1-year follow-up of 25 casesANZ JOURNAL OF SURGERY, Issue 11 2009Ravi L. Huilgol Abstract Background:, The iliac bifurcation device (William A Cook Australia, Brisbane, QLD, Australia) is a new endovascular device for iliac aneurysm repair. We review the indications for use, device characteristics, deployment options and the results of our case series. Methods:, The most common indication for deployment is endovascular aortic aneurysm repair (EVAR) with common iliac aneurysm repair. The standard deployment sequence can be adapted to increase the utility of the device. Data were collected prospectively. Follow-up was performed with plain X-ray, ultrasound and computed tomography (CT) scan. Results:, Between 2004 and 2007, 25 patients had their common iliac artery aneurysm repaired using the iliac bifurcation device. There were 23 male and 2 female patients. Median age was 75 years (range 60,85). The median follow-up was 12 months (range 1,38). Twenty-one procedures were combined with EVAR. The median abdominal aortic aneurysm diameter was 60 mm (range 31,97), and the median common iliac artery aneurysm diameter was 37 mm (range 24,71). Technical success was achieved in 100% of cases. There were no acute branch vessel occlusions. There was one early type I endoleak (4%). There was one death (4%) in the 30-day period post-procedure. There was one late type I endoleak (4%). Conclusions:, The iliac bifurcation device achieves endovascular common iliac artery aneurysm repair with preservation of internal iliac artery flow. There are multiple different applications of the device and complementary deployment techniques. High rates of technical success and low rates of branch vessel occlusion are possible. [source] Liver resection using heat coagulative necrosis: indications and limits of a new methodANZ JOURNAL OF SURGERY, Issue 9 2009Gregor A. Stavrou Abstract Background:, A new approach towards achieving bloodless liver resection is the use of heat coagulative necrosis. The latest stage of this technique is a four-probe device (Habib Sealer), which we used for a variety of resections to find the best indications for the method. Methods:, Between 2005 and 2006 we performed 28 liver resections in 20 consecutive patients. The most common indication was metastatic colorectal cancer (75%). We treated a heterogeneous patient collective in terms of tumour localization and extent of resection. Resection was performed after creating a necrotic zone. The device achieved an area of coagulation of 1-cm width in which even larger vessels and bile ducts were safely sealed. Results:, Operative spectrum covered atypical resections (8), one- or bisegmentectomies at different locations (15), hemihepatectomies (4) and one extended right hepatectomy. With one exception intra-operative blood loss was lower than 100 mL. Four patients (20%) developed operation-related complications comprising abscess formation at the resection site. Follow-up shows tumour-free survival for 13 of 18 patients 12 months after resection. Conclusion:, Liver resection using the sealer device seems safe. In proximity of hilar structures or large vessels the method is not favourable for the fear of thermal damage. Extended resections are possible but not parenchyma saving. Good indications are atypical (deep) resections , especially in Segment IVb. [source] LAPAROSCOPIC CHOLECYSTECTOMY: AN AUDIT OF OUR TRAINING PROGRAMMEANZ JOURNAL OF SURGERY, Issue 4 2005Swee Ho Lim Background: Laparoscopic cholecystectomy is a commonly performed procedure in general surgical practice but it also has an inherently steep learning curve. The training of surgeons in this procedure presents a challenge to teaching hospitals, which essentially have to strike a balance between effective training and safety of the patient. The present study aims first to assess the safety of the structured training programme for this procedure at the Department of Surgery, Changi General Hospital, Singapore. Secondly, it seeks to audit the conversion and bile duct injury rates among the laparoscopic cholecystectomies performed by the department, and the factors which influence these. Methods: Notes of all patients who underwent laparoscopic cholecystectomy in the department over an 18-month period were reviewed retrospectively and the relevant data prospectively collected. Demographics, as well as details of cases of conversion to open operation and of bile duct injury were identified and the reasons for each recorded. Results: A total of 443 patients underwent laparoscopic cholecystectomy in the 18-month period. The most common indication for surgery was biliary colic/dyspepsia (61.4%), followed by cholecystitis, cholangitis, pancreatitis and common bile duct stone. The overall conversion rate was 11.5%. Three hundred and fifty-five patients were operated on by consultant surgeons, while 88 were by registrars who had been through the structured training programme. There was no statistically significant difference found in the conversion rates between these two groups (P = 0.284). Twenty-two of the 268 female (8.2%) patients had conversion to open operation, while 29 of the 175 male patients (16.6%) underwent conversion (P = 0.007). Amongst cases of cholecystitis and cholangitis, the conversion rate for patients operated on within 7 days of onset of symptoms was 35%, while those operated on 8 or more days later had a conversion rate of 29.7% (P = 0.639). There was a solitary case of bile duct injury among the 443 cases, equating to a bile duct injury rate of 0.23%. Conclusion: A structured training programme involving stepwise progression of training, with close supervision by consultant surgeons and a built-in system of audit can effectively train junior surgeons in laparoscopic cholecystectomy without exposing patients to undue risks. [source] Original Article: Complications of laparoscopic myomectomy: A single surgeon's series of 1001 casesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010G. P. Paul Objective:, The objective of this retrospective study was to evaluate the safety, intra-operative and post-operative morbidity of laparoscopic approach for myomectomy. Methods:, The total 1001 subjects who underwent endoscopic surgery over a 16-year period were studied retrospectively. All the data were collected regarding clinical presentation, intra-operative findings, intra-operative and post-operative complications, and hospital stay, and statistically analysed. Results:, The average age of subjects was 32.62 years and the most common indication for surgery was infertility (48.5%). A total of 2167 myomas were removed; 43.98% of subjects required removal of multiple myomas. The average blood loss was 248 mL, and the average hospital stay was 1.5 days. The overall major and minor complication rate is very low except one subject who required laparotomy for post-operative bleeding, and there was one unexplained post-operative death. Conclusions:, Laparoscopic myomectomy is comparable to laparotomy myomectomy in terms of duration of surgery, blood loss and complication rates. This large single surgeon series on laparoscopic myomectomy also shows a low complication rate suggesting that laparoscopic myomectomy is a safe and reliable procedure, even in the presence of multiple or large myomas. [source] 4 Audit of androgen deprivation therapy (ADT) register in Auckland regionBJU INTERNATIONAL, Issue 2006H. ZARGAR Aim:, To determine the indications for therapy and disease state of men with prostate cancer on Luteinizing Hormone Releasing Hormone (LHRH) analogue treatment entered in the Auckland regional ADT register. Method:, Patients were identified from ADT register and further information was obtained using hospital electronic databases (Concerto and CRIS) and general practitioner records. Results:, Two hundred and eleven patients were registered from Jan 2000 to June 2005 on ADT register. The median age at diagnosis was 73 (45,91). 151 patients (71%) were alive at the time of audit. 118 of patients (56%)had a bone scan, 60 of which confirmed bony metastases (28% of all patients). Based on PSA score at diagnosis (>20), Gleason score (8,9,10) and stage of clinical disease (T3 or higher), high-risk patients were identified. The most common indication for LHRH analogue therapy as first line therapy was advanced local/metastatic disease (39%). 81 (38%) of patient developed hormone refractory disease while on treatment. The patients in high-risk group were more likely to develop hormone refractory disease (Chi Square test P = 0.009). PSA Doubling Time (PSADT) of less than 10 months was associated with significance risk of developing local/bony complications (Chi Square test P = 0.002) and mortality (Chi Square test P = 0.034). Presence of metastatic disease was associated with increased mortality (Chi Square test P = 0.012). Conclusion:, Patients in high-risk group are more likely to develop hormone refractory disease. PSADT can be used as an indicator for identifying patients with increased risk of developing complications. Presence of metastatic disease at the time of diagnosis is associated with increased mortality. [source] Single-fraction radiosurgery for the treatment of spinal breast metastasesCANCER, Issue 10 2005M.P.H., Peter C. Gerszten M.D. Abstract BACKGROUND The spine is the most common site of bony metastases in patients with osseous breast carcinoma metastases. Spine metastases are the source of significant pain and occasionally neurologic deficit in this patient population. Conventional external beam radiotherapy lacks the precision to allow delivery of large single-fraction doses of radiation and simultaneously limit the dose to radiosensitive structures such as the spinal cord. This study evaluated the clinical efficacy of the treatment of spinal breast carcinoma metastases with a single-fraction radiosurgical technique. METHODS In this prospective cohort evaluation, 68 breast carcinoma metastases to the spine in 50 patients were treated with a single-fraction radiosurgery technique with a follow-up period of 6,48 months, median 16 months. The most common indication for radiosurgery treatment was pain in 57 lesions, as a primary treatment modality in 8 patients, and for radiographic tumor progression, as a postsurgical boost, and for a progressive neurologic deficit in 1 patient each. RESULTS Tumor volume ranged from 0.8,197 cm3 (mean, 27.7 cm3). Maximum tumor dose was maintained at 15,22.5 Gy (mean, 19 Gy). No radiation-induced toxicity occurred during the follow-up period (6,48 mo). Long-term axial and radicular pain improvement occurred in 55 of 57 (96%) patients who were treated primarily for pain. Long-term radiographic tumor control was seen in all patients who underwent radiosurgery as their primary treatment modality, for radiographic tumor progression, or as a postsurgical treatment. CONCLUSIONS Spinal radiosurgery was found to be feasible, safe, and clinically effective for the treatment of spinal metastases from breast carcinoma. The results indicate the potential of radiosurgery in the treatment of patients with spinal breast metastases, especially those with solitary sites of spine involvement, to improve long-term palliation. Cancer 2005. © 2005 American Cancer Society. [source] National and regional incidence of surgery for adult hydrocephalus in SwedenACTA NEUROLOGICA SCANDINAVICA, Issue 2 2005M. Tisell In Sweden, the annual incidence of surgery for hydrocephalus was 3.4 per 100,000 adults between the years 1996 and 1998. The most common indication for surgery was normal pressure hydrocephalus (NPH; 47%), followed by high-pressure hydrocephalus (27%). Seventy-three percent of the patients had communicating hydrocephalus, of which 63% had NPH. Twenty percent of the patients had non-communicating hydrocephalus, of which half resulted from aqueduct stenosis. The annual incidence of operations varied between regional clinics from 2.3 to 6.3 per 100,000 inhabitants. [source] A study of the indications and changing trends of evisceration in north IndiaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2002Tanuj Dada MD Abstract Aim: To study the demographic pattern and indications for evisceration in north India and to evaluate the changing trends over the last decade. Methods: In a retrospective hospital-based study, case records of all patients who underwent evisceration at Rajendra Prasad Centre for Ophthalmic Sciences from January 1990 to December 1999 were reviewed. The parameters evaluated were the age and sex distribution, the place of residence (urban/rural) and the indications for evisceration. The aetiology responsible for evisceration was determined on the basis of history, clinical examination and investigations as determined from previous records. Results: One hundred and sixty-four patients had one eye eviscerated during the study period. The mean age of the patients was 51 ± 13.84 years (range 6 months to 90 years). Panophthalmitis was the most common indication for evisceration (78.6%, n = 129), followed by irreparable globe injury (21.3%, n = 35). There was a significant decrease in the eviscerations performed due to pano-phthalmitis from 104 cases during the period 1990,1994, to 25 cases in the period 1995,1999. Conclusion: Panophthalmitis and severe ocular injury are the major indications of evisceration in north India. There has been a significant decrease in the number of eviscerations related to panophthalmitis over the last decade. [source] Management of hepatitis C-infected liver transplant recipients at large North American centres: changes in recent yearsCLINICAL TRANSPLANTATION, Issue 1 2006Mandana Khalili Abstract:, Large (,45 transplants per year) North American liver transplant centres were surveyed regarding management of hepatitis C virus (HCV). A total of 25/41 (59%) and 28/48 (58%) of centres responded to the surveys in 1998 and 2003, respectively, with 17 centres participating in both surveys. HCV was the most common indication for transplantation. Use of protocol liver biopsies was higher in 2003 and 60% used them to monitor HCV disease. Fewer centres reported modifying primary immunosuppression (IMS) for HCV-positive (vs. non-HCV) patients in 2003 (26%) vs. 1998 (56%). IMS was most frequently tacrolimus-based, but mycophenolate mofetil use increased in 2003 (52% vs. 23% in 1998). In both years, approximately 40% treated allograft rejection differently in HCV-positive recipients, with less use of OKT3 in 2003. Combination anti-HCV therapy for 12 months or more was the treatment of choice and growth factor use was common (68%). HCV-positive recipients were considered candidates for retransplantation but HCV-specific criteria were used in decision-making. Practice of centres changed over time with an increase in HCV transplantation and use of protocol liver biopsies, and a trend towards lesser modification of IMS in HCV-positive recipients. We conclude that there is considerable variability in the management of HCV among transplant programs and over time. [source] Appropriate use of non-prescription ibuprofen: a survey of patients' perceptions and understandingINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2010Suong N. T. Ngo Abstract Objectives The aim was to investigate patients' perceptions and understanding on the appropriate use of non-prescription ibuprofen. Methods In this pilot study, a self-administered anonymous survey was completed by 183 patients presenting at one of the eight selected community pharmacy premises in South Australia and the Northern Territory during the study. The questionnaire comprised items on: demographics (age, gender), current medications, frequency of ibuprofen use, medical consultations, reading manufacturer's printed dosage/warning instructions, sources from which drug information was gathered and understanding of common indications for ibuprofen. Key findings Sixty per cent of patients (n= 110/183), predominantly females, were currently on other medications and 64.5% of patients (n= 118/183) did not seek medical advice before using non-prescription ibuprofen. Seventy-one per cent (n= 130) of these patients had used ibuprofen for more than a year. The majority of patients did not provide precise answers for the common indications of ibuprofen. Sixty-six per cent of patients (n= 110) reported rarely or never reading manufacturer's printed warning instructions on the potential drug interactions or adverse effects associated with the use of the product. Conclusions Many patients are unaware that non-presciption analgesics such as ibuprofen can cause potentially serious adverse effects when used in combination with other common medications. [source] Reconstruction of the chestwall and thorax,JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2006Roman J. Skoracki MD Abstract Chest wall reconstructions can be complex and challenging procedures and may require a multidisciplinary approach. The most common indications for chest wall reconstruction are the repair of defects due to tumor ablation, infection, radiation necrosis, congenital deformities, and trauma. Flap reconstruction by plastic surgery is often required when skin is removed as part of the chest wall resection or when radiation therapy is given pre- or post-operatively. Tissue flaps may be needed to provide vascularized tissue over alloplastic materials used to stabilize the chest wall, to cover vital structures of the chest cavity, to fill dead space, and to improve cosmesis. J. Surg. Oncol. 2006;94:455,465. © 2006 Wiley-Liss, Inc. [source] Outcomes following early red blood cell transfusion in acute upper gastrointestinal bleedingALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010S. A. Hearnshaw Aliment Pharmacol Ther 2010; 32: 215,224 Summary Background, Acute upper gastrointestinal bleeding (AUGIB) accounts for 14% of RBC units transfused in the UK. In exsanguinating AUGIB the value of RBC transfusion is self evident, but in less severe bleeding its value is less obvious. Aim, To examine the relationship between early RBC transfusion, re-bleeding and mortality following AUGIB, which is one of the most common indications for red blood cell (RBC) transfusion. Method, Data were collected on 4441 AUGIB patients presenting to UK hospitals. The relationship between early RBC transfusion, re-bleeding and death was examined using logistic regression. Results, 44% were transfused RBCs within 12 hours of admission. In patients transfused with an initial haemoglobin of <8 g/dl, re-bleeding occurred in 23% and mortality was 13% compared with a re-bleeding rate of 15%, and mortality of 13% in those not transfused. In patients transfused with haemoglobin >8 g/dl, re-bleeding occurred in 24% and mortality was 11% compared with a re-bleeding rate of 6.7%, and mortality of 4.3% in those not transfused. After adjusting for Rockall score and initial haemoglobin, early transfusion was associated with a two-fold increased risk of re-bleeding (Odds ratio 2.26, 95% CI 1.76,2.90) and a 28% increase in mortality (Odds ratio 1.28, 95% CI 0.94,1.74). Conclusions, Early RBC transfusion in AUGIB was associated with a two-fold increased risk of re-bleeding and an increase in mortality, although the latter was not statistically significant. Although these findings could be due to residual confounding, they indicate that a randomized comparison of restrictive and liberal transfusion policies in AUGIB is urgently required. [source] Practices and Outcome of Artificial Cardiac Pacing in 154 DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2001Mark A. Oyama Artificial pacing (AP) is a treatment for symptomatic bradyarrhythmias unresponsive to medical therapy. This retrospective study was designed to define the practices and outcome of AP in dogs at 7 referral institutions participating in the Companion Animal Pacemaker Registry and Repository (CANPACERS). The indications, implantation techniques, complications, long-term outcome, and owner satisfaction were examined. One hundred fifty-four dogs were identified as undergoing AP from January 1, 1991, to January 1, 1996. Third-degree atrioventricular (AV) block (n = 91; 59%) and sinus node dysfunction (n = 45; 29%) were the most common indications for AP. Transvenous endocardial AP systems were implanted in 136 dogs (88%), and epicardial systems were implanted in 18 (12%). Complications associated with AP were reported in 84 dogs (55%). Major complications occurred in 51 dogs (33%), including dislodgement of the pacing lead (n = 15; 10%), generator failure (n = 10; 6%), cardiac arrest during implantation (n = 9; 6%), and infection (n = 7; 5%). Minor complications occurred in 47 dogs (31%), including seroma formation (n = 18; 12%), muscle twitch (n = 17; 11%), and inconsequential arrhythmias (n = 15; 10%). Fourteen dogs (9%) experienced both major and minor complications. Survival analysis revealed 1-, 2-, and 3-year survival rates of 70, 57, and 45%, respectively. Age and presence of preexisting congestive heart failure (CHF) had a negative effect on survival (P= .001). Sixty percent of dogs with preexisting CHF died within 1 year of implantation, whereas 25% of dogs without heart failure died during the same period. Owners rated their satisfaction with the procedure as high in 80% of the dogs. [source] Late surgical complications following liver transplantationLIVER TRANSPLANTATION, Issue S2 2009Paige M. Porrett Key Points 1. Biliary strictures and incisional hernias are the most common surgical complications encountered late after liver transplantation. 2. Anastomotic biliary strictures are amenable to endoscopic intervention and rarely need surgical intervention. 3. The presence of a biliary stricture mandates an evaluation of the patency of the hepatic artery. 4. Ischemic-type intrahepatic strictures are common indications for retransplantation. 5. Recipients of living related liver transplantation and donation after cardiac death allografts are at the highest risk for biliary and vascular complications late after transplantation. Liver Transpl 15:S12,S18, 2009. © 2009 AASLD. [source] A practice survey on vasopressor and inotropic drug therapy in Scandinavian intensive care unitsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2003A. Oldner Background: This practice survey was performed to analyse the indications for use of vasopressor/inotropic drugs, preferred drugs and doses as well as concomitant monitoring and desired haemodynamic target values in Scandinavian ICUs. An internet-based reporting system was implemented. Methods: A total of 223 ICUs were identified in the Scandinavian countries and invited to participate in a one-day point-prevalence study. An internet-based database was constructed and a practice survey protocol designed to identify haemodynamic monitoring, indications for vasopressor/inotropic drug-therapy, fluids used for volume loading, pretreatment circulatory state, actual and targeted haemodynamic variables. Patients were eligible for the study if on vasopressor/inotropic drug-therapy for more than 4 h. Results: A total of 114 ICUs participated. A total of 114 adult patients matched the inclusion criteria. Sixty-seven per cent of the patients had received vasopressor/inotropic drug-treatment for >24 h and 32% received more than one drug. Arterial hypotension (92%) and oliguria (50%) were most common indications. Fluid loading prior to therapy was reported in 87% of patients. Dopamine (47%) and noradrenaline (44%) were the most commonly used drugs followed by dobutamine (24%). No other drug exceeded 6%. Non-catecholamine drugs were rarely used even in cardiac failure patients. Invasive arterial pressure was monitored in 95% of patients, pulmonary artery catheters were used in 19%. Other cardiac output monitoring techniques were used in 8.5% of the patients. Conclusion: Dopamine and noradrenaline seem to be the most commonly used inotropic/vasopressor drugs in Scandinavia. Traditional indications for inotropic/vasopressor support as hypotension and oliguria seem to be most common. Invasive monitoring was used in almost all patients, whereas a limited use of pulmonary artery catheters was noted. The internet-based reporting system proved to be an efficient tool for data collection. [source] Liver Transplantation for Alcoholic Liver Disease in Europe: A Study from the ELTR (European Liver Transplant Registry)AMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2010P. Burra Alcohol-related liver disease (ALD) is one of the most common indications for liver transplantation (LT). Long-term outcome after LT for ALD versus other etiologies is still under debate. The aim of this study was to compare outcome after LT of patients with ALD, viral (VIR), and cryptogenic cirrhosis. Donor, graft and recipient ELTR variables were analysed in transplants for alcoholic and nonalcoholic cirrhosis (1988,2005) and were correlated with patient survival. Causes of death and/or graft failure were compared between groups. Nine thousand eight hundred eighty ALD, 10 943 VIR, 1478 ALD + VIR and 2410 cryptogenic (CRYP) liver transplants were evaluated. One, 3, 5 and 10 years graft survival rates after LT in ALD patients were 84%, 78%, 73%, 58%, significantly higher than in VIR and CRYP (p = 0.04, p = 0.05). By multivariate analysis, ALD + VIR (RR 1.14) and viral alone (RR 1.06) were significant risk factors for mortality. De novo tumors, cardiovascular and social causes were causes of death/graft failure in higher percentage in ALD groups versus other etiologies. LT for ALD cirrhosis has a favorable outcome, however, hepatitis C virus co-infection seems to eliminate this advantage. Screening for de novo tumors and prevention of cardiovascular complications are essential to provide better long-term results. [source] | ||||||||||||||||||||||||||||