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One Procedure (one + procedure)
Selected AbstractsEuropean Carotid PROCAR Trial: Prospective Multicenter Trial to Evaluate the Safety and Performance of the ev3 ProtégéÔ Stent in the Treatment of Carotid Artery Stenosis,1- and 6-Month Follow-UpJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2006JENNIFER SUGITA Background: The purpose of the European PROCAR Trial was to evaluate the safety and performance of the Protégé stent in the treatment of common and/or internal carotid artery stenoses with adjunctive use of a filter embolic protection device. Method: The Protégé® GPS stent is a self-expanding Nitinol stent system mounted on a 6 Fr 0.018, (6,9 mm stent) or 7 Fr 0.035, (10 mm stent) over-the-wire delivery system. Study patient assessments were conducted at baseline, periprocedure, discharge, and 1 and 6 months postprocedure. A total of 77 patients have been enrolled in the trial. Results: In the 77 lesions treated (31 symptomatic, 46 asymptomatic), the procedure was technically successful in 76 (99%), with an average residual stenosis of less than 30%. One procedure failed because the embolic protection device could not be retrieved and the patient was sent to surgery. Within 30 days, there were four (5.2%) major adverse neurological events (MANEs). Three of the MANEs were major strokes (3.9%), one a minor stroke. The fifth MANE occurred prior to the 6-month follow-up visit; this patient had a major stroke 75 days after the procedure and died 36 days later. One additional death occurred because of urosepsis. Conclusions: The PROCAR trial shows that the Protégé stent with adjuvant use of a filter embolic protection device satisfies safety and performance criteria for the treatment of carotid artery stenosis. The incidence of MANEs for the Protégé stent is comparable to the incidence of these events in other recent carotid stent studies and standard carotid endarterectomy (CEA). [source] Ten-year experience of totally laparoscopic liver resection in a single institutionBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2009A. Sasaki Background: Recent developments in liver surgery include the introduction of laparoscopic liver resection. The aim of the present study was to review a single institution's 10-year experience of totally laparoscopic liver resection (TLLR). Methods: Between May 1997 and April 2008, 82 patients underwent TLLR for hepatocellular carcinoma (HCC) (37 patients), liver metastases (39) and benign liver lesions (six). Operations included 69 laparoscopic wedge resections, 11 laparoscopic left lateral sectionectomies and two thoracoscopic wedge resections. Nine patients underwent simultaneous laparoscopic resection of colorectal primary cancer and synchronous liver metastases. Results: Median operating time was 177 (range 70,430) min and blood loss 64 (range 1,917) ml. Median tumour size and surgical margin were 25 (range 15,85) and 6 (range 0,40) mm respectively. One procedure was converted to a laparoscopically assisted hepatectomy. Three patients developed complications. Median postoperative stay was 9 (range 3,37) days. The overall 5-year survival rate after surgery for HCC and colorectal metastases was 53 and 64 per cent respectively. Conclusion: TLLR can be performed safely for a variety of primary and secondary liver tumours, and seems to offer at least short-term benefits in selected patients. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Emergency Medicine Resident Patient Care Documentation Using a Hand-held Computerized DeviceACADEMIC EMERGENCY MEDICINE, Issue 12 2001Steven B. Bird MD Abstract Objective: To determine whether emergency medicine (EM) resident documentation of procedures, patient encounters, and patient follow-ups improved after implementation of a personal digital assistant (PDA) hand-held recording system. Methods: All first-year EM residents were provided a PalmV (Palm, Inc., Santa Clara, CA) PDA. A customized patient procedure and encounter program was constructed using Pendragon Forms (Pendragon Software Corporation, Libertyville, IL) and loaded into each PDA. Residents were instructed to enter information on patients who had any of 21 procedures performed or were considered to be clinically unstable. These data were downloaded to the residency coordinator's desktop computer. The mean number of procedures, encounters, and follow-ups performed per resident were then compared with those of a group of 36 historical controls from the three previous first-year resident classes who recorded the same information using a handwritten card system. Data from the historical controls were combined and the means of each group were compared by Student's t-test. Results: Mean documentation of three procedures was significantly increased in the PDA group versus the index card system: conscious sedation 5.8 vs. 0.03 (p < 0.000005), thoracentesis 2.2 vs. 0.0 (p = 0.002), ultrasound 6.3 vs. 0.0 (p = 0.002). The mean numbers of pericardiocenteses and unstable pediatric surgical patient evaluations were significantly decreased in the hand-held group [from 1.2 to 0.4 (p = 0.03) and from 9.1 to 2.2 (p = 0.02), respectively]. Patient follow-up documentations were not statistically different between the two groups. Conclusions: Use of a hand-held PDA was associated with an increase in first-year EM resident documentation in three of 20 procedures and a decrease in one procedure and the number of unstable surgical pediatric patient resuscitations. The overall time savings in constructing a resident procedure database, as well as the other uses of the PDAs, may make transition to a hand-held computer-based procedure log an attractive option for EM residencies. [source] Candidates' Ability to Identify Criteria in Nontransparent Selection Procedures: Evidence from an assessment center and a structured interviewINTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT, Issue 3 2007Cornelius J. König In selection procedures like assessment centers (ACs) and structured interviews, candidates are often not informed about the targeted criteria. Previous studies have shown that candidates' ability to identify these criteria (ATIC) is related to their performance in the respective selection procedure. However, past research has studied ATIC in only one selection procedure at a time, even though it has been assumed that ATIC is consistent across situations, which is a prerequisite for ATIC to contribute to selection procedures' criterion-related validity. In this study, 95 candidates participated in an AC and a structured interview. ATIC scores showed cross-situational consistency across the two procedures and accounted for part of the relationship between performance in the selection procedures. Furthermore, ATIC scores in one procedure predicted performance in the other procedure even after controlling for cognitive ability. Implications and directions for future research are discussed. [source] Solid-phase synthesis of C -terminally modified peptidesJOURNAL OF PEPTIDE SCIENCE, Issue 11 2006Hefziba T. Ten Brink Abstract In this paper, a straightforward and generic protocol is presented to label the C -terminus of a peptide with any desired moiety that is functionalized with a primary amine. Amine-functional molecules included are polymers (useful for hybrid polymers), long alkyl chains (used in peptide amphiphiles and stabilization of peptides), propargyl amine and azido propyl-amine (desirable for ,click' chemistry), dansyl amine (fluorescent labeling of peptides) and crown ethers (peptide switches/hybrids). In the first part of the procedure, the primary amine is attached to an aldehyde-functional resin via reductive amination. To the secondary amine that is produced, an amino acid sequence is coupled via a standard solid-phase peptide synthesis protocol. Since one procedure can be applied for any given amine-functional moiety, a robust method for C -terminal peptide labeling is obtained. Copyright © 2006 European Peptide Society and John Wiley & Sons, Ltd. [source] Decision analysis: an aid to the diagnosis of Whipple's diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2006M. OLMOS Summary Background Diagnosis of Whipple's disease, a rare systemic infection affecting predominantly the small bowel, is based on the identification of the bacterium Tropheryma whipplei. Aims To make explicit diagnostic uncertainties in Whipple's disease through a decision analysis, considering two different clinical scenarios at presentation. Methods Using appropriate software, a decision tree estimated the consequences after testing different strategies for diagnosis of Whipple's disease. Probabilities and outcomes to determine the optimum expected value were based on MEDLINE search. Results In patients with clinically-predominant intestinal involvement, diagnostic strategies considering intestinal biopsy for histology (including appropriate staining) and the polymerase chain reaction testing for bacterial DNA were similarly effective. In case of failure of one procedure, the best sequential choice was a polymerase chain reaction analysis after a negative histology. Of the five strategies tested for cases with predominant focal neurological involvement, the stereotaxis cerebral biopsy evidenced the highest expected value. However, using quality-adjusted life-years considering the morbidity of methods, intestinal biopsy for PCR determination was the best choice. Conclusions In patients with Whipple's disease having predominant digestive involvement, intestinal biopsies for histology should be indicated first and, if negative, a bacterial polymerase chain reaction determination should be the next option. Although the molecular polymerase chain reaction assessment of cerebral biopsies has the highest diagnostic yield in neurological Whipple's disease, its associated morbidity means that analyses of intestinal samples are more appropriate. [source] Pre-audit survey of documentation of invasive procedures in paediatric anaesthesiaPEDIATRIC ANESTHESIA, Issue 9 2002A. Patil Introduction Consent of patients for any medical procedure is an essential part of good practice (1). Verbal consent is increasingly sought for invasive anaesthetic procedures and documentation of this is an important feature of risk management. Paediatric consent is a complex issue and although it is common practice to explain things to the child, written consent is generally still sought from the parent (2). Recent guidelines from the Royal College (3) are quite specific about having a ,child centred approach'. They clearly state that ,where special techniques (e.g. epidurals, other regional blocks including caudal, and invasive monitoring or blood transfusion) are used there should generally be written evidence that these have been discussed with the child (when appropriate) and the parents'. Our aim was to discover the current amount of documentation on invasive procedures in our paediatric anaesthetic notes and to subsequently agree on a local standard. Method We looked retrospectively at anaesthetic records of children aged 10, 11 and 12 years undergoing general anaesthesia for elective surgery over a 2-month period. We specifically looked for documentation of who was present at the pre-operative discussion and where an invasive anaesthetic technique was planned. written evidence that it had been discussed. Results 73 anaesthetic records were examined. The case mix was as follows: 37% ENT, 28% Plastic Surgery, 24% General Surgery, 11 % Orthopaedic and Oral Surgery. A Consultant was present for 98% of the anaesthetics and was accompanied by a trainee in half of those cases. In 82% (60 patients) there was no documentation of who was present at the pre-operative discussion. In 2 cases (3%) the child was seen alone, in 8 cases (11 %) both a parent and child were documented to have been involved in the discussion and in 3 cases (4%) only the parents appeared to have been involved. Of the 73 anaesthetic records, 11 did not have invasive procedures planned or performed and the following data is from the remaining 62 anaesthetic records ,,83.5% of invasive procedures were documented pre-operatively ,,12 patients (19%) had more than one procedure. ,,Only 7 notes (11 %) had a record of the procedure being specifically discussed with the child. ,,2 out of the 4 caudal (50%) were done without documentatior, of discussion about the procedure ,,7 out of 48 suppositories (14%) were given without record of verbal consent ,,5 out of 16 (31 %) of the local anaesthetic techniques were performed without documentation of discussion. Discussion This pre-audit survey demonstrates that in 82% of cases there was no record of exactly who was present at the preoperative discussion and that some invasive procedures were carried out without any record of a discussion having taken place. We feel that this level of documentation is insufficient. We looked at the age range 10,12 years as this might be regarded as approximately the age at which agreement should be sought for relatively simple procedures such as those chosen in this survey. This is not to imply that children below this age should not be involved in a plan of management or that all children of this age will be fully competent to participate in decisions. We deliberately chose to look at elective surgery, as there should be better documentation in these cases. One reason for such poor results may be that most anaesthetists do not realise the importance of documentation. Our current chart provides no means of prompting the anaesthetist to record who was present at pre-operative discussions. There is also a lack of a clear standard as to an age when invasive procedures should generally be discussed. We feel that this is probably a common problem and hope this surveys increases awareness on this important topic. Conclusions The results of this survey are to be brought to the attention of the local department. Having identified the problem we hope to agree on a local standard and audit against these standards. [source] Flexible fiberoptic bronchoscopy in children with heart diseases: A twelve years experiencePEDIATRIC PULMONOLOGY, Issue 4 2007Jaime Cerda MD Abstract In children, cardiac diseases and respiratory disorders are tightly linked entities whose evaluation should be performed integrally. Flexible fiberoptic bronchoscopy (FB) presents a diagnostic and therapeutic role by assessing the airway anatomically, dynamically, and through the performance of several procedures. The present study describes our experience on FB assessment in children with congenital and acquired cardiac diseases, providing a characterization of the principal demographic and clinical features. Records of 72 patients under 14 years (mean age 21 months) with heart diseases, corresponding to 104 FB performed between January 1993 and October 2004 were reviewed. The principal cardiac diseases were left-to-right shunt (51.9%), followed by right-to-left shunt (17.3%) and miscellaneous cardiopathies (8.7%). The main indications for FB assessment were study of atelectasis (35%), stridor (14%), and pneumonia (14%). Airway malacias, as a group, were the commonest finding, represented mainly by left main bronchus malacia (24%). The second most common finding was stenosis by extrinsic compression, and among these, 75% corresponded to left main bronchus compression. Sixteen different types of clinically meaningful utilities were obtained. No mortality was reported and in only one procedure was there a major complication, which was easily managed. We concluded that FB is an important and safe diagnostic,therapeutic tool in the health care of neonates, infants, and children with a variety of cardiac diseases. Pediatr Pulmonol. 2007; 42:319,324. © 2007 Wiley-Liss, Inc. [source] Cell Subpopulation-related Volumetric Parameters: a Complementary Tool of the Modified Hypo-osmotic Swelling Test on Model of Boar SpermatozoaREPRODUCTION IN DOMESTIC ANIMALS, Issue 5 2000A. Petrounkina Content It is a general property of the intact animal cell to swell rapidly in response to hypo-osmotic conditions. The modified hypo-osmotic swelling test (HOS-test) is an indicative test to evaluate the integrity of the plasma membrane by means of an electronic cell counter, based on the relative increase of the cell volume in response to hypo-osmotic conditions. In this study the relationships between the osmotically induced changes of the cell volume of boar spermatozoa as determined by cell counter and the integrity of the membrane as determined by propidium iodide staining (PI) were studied. Boar sperm cell volume distributions were measured under iso-osmotic (300 mosmolar) conditions and after a hypo-osmotic stress (150 mosmolar). The relative volume shift of mean and modal volume were calculated as a proportion coefficient of modal and mean values of the cell volume distributions by transition from iso-osmotic to hypo-osmotic conditions. The volumetric parameters related to the different cell subpopulations were derived from the different peaks of cell volume distributions. PI-staining techniques were used for comparison. The values of the volume shift and of derived percentages of the osmotically inactive cells were correlated negatively and positively, respectively (p < 0.05) with the percentage of the PI-stained cells. This correlation indicates that a relationship exists between membrane functions of the different cell compartments (sperm head and tail) due to the circumstance that the increase of the cell volume in the HOS-test is associated with the morphological changes in the tail and the PI-staining is associated with the membrane integrity and permeability of the head region. The advantage of computer-assisted volume measurement is that a large number of cells (5000,50 000 spermatozoa) can be measured and evaluated during one procedure and in a very short time. The relative volume shift is a quantitative continuous parameter characterizing the osmotic reactivity and membrane functional competence of a cell population and of subpopulations within one ejaculate. This parameter could be useful to evaluate membrane functional competence rapidly and sensitively. Inhalt Es ist eine generelle Eigenschaft membranintakter tierischer Zellen, mit einer Volumenzunahme auf eine hypoosmotische Belastung zu reagieren. Der auf der relativen Vergrößierungdes Zellvolumens basierende modifizierte hypoosmotischeSchwelltest ist ein indikativer Test zur Beurteilung der Membranintegrität mittels eines elektronischen Partikelzählers. In dieser Studie wurden die Zusammenhänge zwischen der mittels der Propidiumjodid-Färbung bestimmten Zellmembranintegrität und den osmotisch induzierten Veränderungen des Zellvolumens von Eberspermien untersucht. Volumenverteilungen von Eberspermien wurden unter isoosmotischen (300 mosmolar) und hypoosmotischen (150 mosmolar) Bedingungen gemessen. Die relative Volumenverschiebung der modalen und mittleren Werte der Volumenverteilung wurde als Quotient aus Modalwerten der Zellvolumenverteilungen und des mittleren Zellvolumens beim Übergang von isotonen zu hypotonen Bedingungen berechnet. Die auf verschiedene Subpopulationen bezogenen volumetrischen Parameter werden aus den originalen Volumenverteilungen berechnet. Der Betrag der Zellvolumenzunahme und die aus den Volumenverteilungen bestimmten Anteile an Zellen mit beschädigter Geißielmembran korrelierten signifikant negativ bzw. positiv (p < 0,05) mit dem Anteil an den Zellen mit beschädigter Kopfmembran, der sich aus der Propidiumjodid-Färbung ergab. Es wird geschlossen, daßi im Verhalten zwischen den Membranen der verschiedenen Zellkompartimente (Spermienkopf und-Geißiel) ein Zusammenhang besteht. Die beschriebene Methode ermöglicht die Analyse großier Zellpopulationen (5.000,50.000 Zellen). Die relative Volumenverschiebung stellt einen quantitativen kontinuierlichen Parameter dar, der den Membranzustand der Eberspermien einer Spermatozoenpopulation und Subpopulationen innerhalb eines Ejakulates charakterisiert. Diese Parameter können zur schnellen und sensitiven Beurteilung der Membranzustandes eingesetzt werden. [source] Patterns of Surgical Treatment for Women with Breast Cancer in Relation to AgeTHE BREAST JOURNAL, Issue 1 2010Jim Wang PhD Abstract:, Although treatment recommendations have been advocated for all women with early breast cancer regardless of age, it is generally accepted that different treatments are preferred based on the age of the patient. The aim of this study was to assess the pattern of breast cancer surgery after adjusting for other major prognostic factors in relation to patient age. Data on cancer characteristics and surgical procedures in 31,298 patients with early breast cancer reported to the National Breast Cancer Audit between 1999 and 2006 were used for the study. There was a close association between age and surgical treatment pattern after adjusting for other prognostic factors, including tumor size, histologic grade, number of tumors, lymph node positivity, lymphovascular invasion (LVI), and extensive intraduct component. Breast Conserving Surgery (BCS) was highest among women aged ,40 years (OR = 1.140; 95% CI: 1.004,1.293) compared to women aged 51,70 years (reference group). BCS was lowest in women aged >70 years (OR = 0.498, 95% CI: 0.455,0.545). Significantly more women aged ,50 years underwent more than one operation for breast conservation (20.4,24.8%) compared with women aged >50 years (11.4,17.0%). Women aged >70 years were more likely to receive no surgical treatment, 3.5% versus 1.0,1.3% in all other age groups (,40, 41,50 51,70 years). There is an association between patient age and the type of breast cancer surgery for women in Australia and New Zealand. Women age ,40 years are more likely to undergo BCS despite having adverse histologic features and have more than one procedure to achieve breast conservation. Older women (>70 years) more commonly undergo mastectomy and are more likely to receive no surgical treatment. [source] Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphologyACTA OPHTHALMOLOGICA, Issue thesis2 2009Ulrik Correll Christensen MD Abstract. Idiopathic macular hole is characterized by a full thickness anatomic defect in the foveal retina leading to loss of central vision, metamorphopsia and a central scotoma. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex separation and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. With increasing use of ILM peeling and indocyanine green (ICG) staining, which is used for specific visualization of the ILM, concerns about the safety of the procedure have arisen. At present, it is not known whether ICG-assisted ILM peeling potentially reduces the functional outcome after macular hole surgery. The purpose of the present PhD thesis was to examine whether ICG-assisted ILM peeling offers surgical and functional benefit in macular hole surgery. We conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (iii) vitrectomy plus 0.15% trypan blue (TB)-assisted ILM peeling. Morphologic and functional outcomes were assessed 3, 6 and 12 months after surgery. The results show that surgery with ILM peeling, for both stages 2 and 3 macular holes, is associated with a significantly higher closure rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (,20/40). Macular hole surgery can be considered a safe procedure with a low incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better mean visual acuity in the non-peeling group (78.2 letters) compared to the ICG-peeling group (70.9 letters), p = 0.06. Performing repeated macular hole surgery was associated with a significant reduction in functional outcome indicating that primary focus should be on closing the macular hole in one procedure. Morphological studies of closed macular holes with contrast-enhanced optical coherence tomography (OCT) found thinning and discontinuity of the central photoreceptor layer matrix that were highly specific for predicting the likelihood of an eye having regained reading vision 12 months after macular hole surgery. Additionally, healing after macular hole surgery appeared to begin with the contraction of the inner aspect of the retina, forming a roof over a subfoveal fluid-filled cavity, and to end with a gradual restoration of the anatomy in the outer layers of the retina at the junction of the photoreceptor inner and outer segments. We found the more intact this structure was on contrast-enhanced OCT 3 months after macular hole surgery, the better the visual acuity after 12 months, whereas late rather than early resolution of subfoveal fluid had no impact on final visual outcome. The use ILM peeling and intraoperative dyes did not have any functionally important effects on postoperative macular structure. Based on the above findings, we conclude that ILM peeling should be performed in all cases of full thickness macular hole surgery. The use of 0.05% intraoperative isotonic ICG with short exposure time appears to be a safe alternative in stage 3 macular hole surgery, whereas a slight reduction in functional potential not can be excluded when performing 0.05% isotonic ICG-assisted ILM peeling in stage 2 macular hole surgery. [source] | ||||||||||