Operated Patients (operated + patient)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Parkinson's disease patients with bilateral subthalamic deep brain stimulation gain weight

MOVEMENT DISORDERS, Issue 2 2004
Frédéric Macia MD
Abstract Weight, body mass index (BMI) and energy expenditure/energy intake (EE/EI) was studied in 19 Parkinson's disease (PD) patients after subthalamic deep brain stimulation (STN-DBS) versus 14 nonoperated ones. Operated patients had a significant weight gain (WG, + 9.7 ± 7 kg) and BMI increase (+ 4.7 kg/m2). The fat mass was higher after STN-DBS. Resting EE (REE; offdrug/ON stimulation) was significantly decreased in STN-DBS patients, while their daily energy expenditure (DEI) was not significantly different. A significant correlation was found among WG, BMI increase, and pre-operative levodopa-equivalent daily dose, their reduction after STN-DBS, and the differential REE related to stimulation and the REE in the offdrug/OFF stimulation condition. In conclusion, STN-DBS in PD induces a significant WG associated with a reduction in REE without DEI adjustment. © 2003 Movement Disorder Society [source]


4233: Outcomes of the Boston Keratoprosthesis Type II

ACTA OPHTHALMOLOGICA, Issue 2010
J CHODOSH
Purpose To report the long term outcomes of Boston keratoprosthesis type II implantation in the management of severe ocular surface disease and corneal blindness. Methods A retrospective review of medical records of patients after Boston keratoprosthesis type II implantation at the Massachusetts Eye and Ear Infirmary from January, 1, 2000 through December 31, 2009. Main outcome measures included visual acuity, device retention, and postoperative complications. Results A total of 29 eyes of 26 patients received a Boston keratoprosthesis type II during the study period. Operated patients had corneal blindness due to mucous membrane pemphigoid (51.7%), Stevens Johnson syndrome/toxic epidermal necrolysis (41.4%), or other ocular surface disease (6.9%). Visual acuity after surgery improved to at least 20/200 in 23 eyes (79.3%), and to 20/30 or better in 10 eyes (34.5%). In patients with at least 1 year of follow-up (n=21), visual acuity of 20/200 or better was maintained in 14 eyes (66.7%). Of these 14 eyes, 6 eyes (42.9%) retained visual acuity of 20/200 or better for more than 5 years. Overall, visual acuity of 20/200 or better was maintained for at least 5 years in 6 of 23 eyes (26.0%). Eyes that failed to improve to 20/200 or lost vision during follow-up were found to have end stage glaucoma, previous retinal detachment, or age related macular degeneration. Of the total of 29 eyes, 17 devices (58.6%) were retained without extrusion or replacement during a total follow-up time of 107.9 person-years. Conclusion The Boston keratoprosthesis type II is a viable option for corneal blindness from severe autoimmune ocular surface diseases. Complications require prompt recognition and management to promote retention of the device and preservation of vision. [source]


Characterization of reflux events after fundoplication using combined impedance,pH recording,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2007
S. Roman
Background: Laparoscopic fundoplication effectively controls symptoms of gastro-oesophageal reflux disease (GORD) and decreases acid reflux, but its impact on non-acid reflux is not known. The aim of the study was to characterize reflux events after fundoplication using oesophageal combined multichannel intraluminal impedance (MII),pH monitoring, to demonstrate its efficacy on acid as well as non-acid reflux events. Methods: Thirty-six patients in whom ambulatory MII,pH recording was performed after laparoscopic fundoplication were reviewed retrospectively. There were 23 symptomatic and 13 asymptomatic patients, whose results were compared with those of 72 healthy volunteers. Results: Oesophageal acid exposure was low in all but one operated patient, and there was no difference between those with and without symptoms. The median number of reflux events over 24 h was lower after fundoplication (11 in operated patients compared with 44 in healthy volunteers; P < 0·001). Almost all reflux events were non-acid after surgery whereas acid reflux episodes were predominant in healthy volunteers. Proximal reflux events were less common in operated patients. Non-acid reflux events were significantly associated with symptoms after surgery in some patients. Conclusion: Fundoplication restores a competent barrier for all types of reflux. Reflux events are mostly non-acid after surgery, and such events may be positively correlated with symptoms. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]


Persistent dysphagia after laparoscopic fundoplication for gastro-esophageal reflux disease

DISEASES OF THE ESOPHAGUS, Issue 3 2008
U. Fumagalli
SUMMARY., Persistent postoperative dysphagia is a potentially severe complication of fundoplication for gastroesophageal reflux disease (GERD). The aim of this retrospective study was to analyze our experience of laparoscopic fundoplication for GERD in 276 consecutive patients, to determine the frequency of postoperative dysphagia and assess treatments and outcomes. There was no relation between preoperative dysphagia, present in 24 patients (8.7%), and postoperative DeMeester grade 2 or 3 dysphagia, present in 25 patients (9.1%). Ten (3.6%) patients had clinically significant postoperative dysphagia, eight (2.9%) underwent esophageal dilation, with symptom improvement in five. Four (1.4%) of our patients (two with failed dilation) and 11 patients receiving antireflux surgery elsewhere, underwent re-operation for persistent dysphagia 12 months (median) after the first operation. DeMeester grade 0 or 1 dysphagia was obtained in 10/13 evaluable patients. Our experience is fully consistent with that of the recent literature. Redo surgery is necessary in only a small fraction of operated patients with GERD with good probability of resolving the dysphagia. Best outcomes are obtained when an anatomical cause of the dysphagia is documented preoperatively. [source]


Electrical source imaging for presurgical focus localization in epilepsy patients with normal MRI

EPILEPSIA, Issue 4 2010
Verena Brodbeck
Summary Purpose:, Patients with magnetic resonance (MR),negative focal epilepsy (MRN-E) have less favorable surgical outcomes (between 40% and 70%) compared to those in whom an MRI lesion guides the site of surgical intervention (60,90%). Patients with extratemporal MRN-E have the worst outcome (around 50% chance of seizure freedom). We studied whether electroencephalography (EEG) source imaging (ESI) of interictal epileptic activity can contribute to the identification of the epileptic focus in patients with normal MRI. Methods:, We carried out ESI in 10 operated patients with nonlesional MRI and a postsurgical follow-up of at least 1 year. Five of the 10 patients had extratemporal lobe epilepsy. Evaluation comprised surface and intracranial EEG monitoring of ictal and interictal events, structural MRI, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET), ictal and interictal perfusion single photon emission computed tomography (SPECT) scans. Eight of the 10 patients also underwent intracranial monitoring. Results:, ESI correctly localized the epileptic focus within the resection margins in 8 of 10 patients, 9 of whom experienced favorable postsurgical outcomes. Discussion:, The results highlight the diagnostic value of ESI and encourage broadening its application to patients with MRN-E. If the surface EEG contains fairly localized spikes, ESI contributes to the presurgical decision process. [source]


The emerging role of adipocytokines as inflammatory mediators in inflammatory bowel disease

INFLAMMATORY BOWEL DISEASES, Issue 9 2005
Konstantinos Karmiris MD
Abstract Anorexia, malnutrition, altered body composition and development of mesenteric obesity are well known features of inflammatory bowel disease (IBD). Recent data suggest that dysregulation of protein secretion by white adipose tissue is involved in these manifestations of patients with IBD. Adipocytes are recently recognized as endocrine cells that secrete a variety of bioactive substances known as adipocytokines. There is evidence that adipocytokines are involved in inflammatory and metabolic pathways in human beings. Overexpression of adipocytokines such as leptin, adiponectin and resistin in mesenteric adipose tissue of operated patients with Crohn's disease has recently been reported, suggesting that mesenteric adipocytes in IBD may act as immunoregulating cells. Therefore, it could be suggested that adipocytokines play an important role in the disease pathogenesis. Moreover, modulators of mesenteric adipose function have been suggested as potential therapeutic drugs in IBD. In this review, the importance of white adipose tissue function and adipocytokines, is discussed with respect to IBD. [source]


Influence of therapy on the antioxidant status in patients with melanoma

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2008
V. Gadjeva DSc
Summary Background and objective:, Some anticancer drugs can result in increased production of reactive oxygen species (ROS). Alkylating agents are the most frequently used drugs in chemotherapeutic regimens for the treatment of malignant melanoma. It is known that triazenes exhibit in vivo activity by alkylation of nucleic acids and proteins, but there is no data about ROS formation during oxidative metabolism. Single agents of most interest for treatment of malignant melanomas include 5-(3,3-dimethyltriazene-1-yl)-imidazole-4-carboxamide (DTIC) and nitrosoureas such as 1-(2-chloroethyl) -3-cyclohexyl-1-nitrosourea (CCNU), but complete response to these drugs is rare. The present study aimed to determine whether an oxidative stress occurs during the clinical course of melanoma and the influence of therapy on the antioxidant status of patients with melanoma. For this purpose, we investigated plasma concentrations of MDA as indices of the levels of lipid peroxidation products. In addition, we studied the activities of the antioxidant enzymes superoxide dismutases (SOD) and catalase (CAT) in patients with melanoma before any treatment, after surgical removal of melanoma, and after chemotherapy with DTIC or in combination with CCNU of the operated patients. Methods:, Twenty one patients with melanoma were studied. Patients were operated prior to chemotherapy. After recovery for 10,20 days postoperatively, they were studied again for MDA, SOD and CAT activity. The patients were divided into two groups according to the chemotherapy (3,7 treatment cycles): with DTIC , given orally daily for 5 days, every 3 weeks as a single 2200 mg/kg dose and with the combination , DTIC (the same dose) + CCNU , administered orally at a dosage of 120 mg/m2 once every 40 days in accordance with protocols, approved by the Bulgarian Ministry of Health. The total amount of lipid peroxidation products in plasma was assayed. Results and discussion:, Plasma levels of MDA and CAT activity were significantly higher, and erythrocyte SOD activity significantly lower, in patients with melanoma, than in control healthy volunteers (P < 0·0001). Ten to twenty days after surgery, oxidative stress decreased but levels of MDA increased as a result of therapy. Important sources of increased ROS production may be the monocytes, phagocytosis of tumour cells and the cancer tissues. Plasma MDA in patients treated with DTIC + CCNU were significantly higher (P < 0·001), but erythrocyte SOD statistically lower (P < 0·00001), compared with patients treated with DTIC only. However, a combination of DTIC + CCNU did not attenuate oxidative stress, or reduced antioxidant status. Patients treated with this combination are at bigger risk of oxidative injury. Therefore, this disturbance might be due to augmented generation of toxic ROS, possibly from the metabolism of CCNU. Conclusion:, Increased oxidative stress follows an imbalance in antioxidant defence in non-treated patients with melanoma. The impaired antioxidant system favours accumulation of ROS, which may promote the cancer process. After complete removal of melanoma tissues, oxidative stress decreased. The antioxidant status of melanoma patients operated on was influenced by the different chemotherapeutic regimens used and may play an important role in the response. Patients on DTIC + CCNU are at higher risk of oxidative injury. This drug combination probably exerts its toxic activity by ROS, which could be products of the metabolism of CCNU. [source]


Death by midgut infarction: clinical lessons from 88 post-mortems in Auckland, New Zealand

ANZ JOURNAL OF SURGERY, Issue 1-2 2009
O'Grady Gregory
Abstract Background:, Mortality rates from acute arterial mesenteric ischaemia remain high. Early diagnosis is of prognostic importance; however, early features are often non-specific, necessitating a high index of suspicion and knowledge of the at-risk patient. This study reviewed three decades of fatal cases in Auckland, New Zealand, to identify risk factors and associated pathologies that might help guide early diagnosis. Diagnostic delay was also evaluated. Methods:, Cases were identified through a pathology database maintained from 1977 to 2006. Autopsy reports were assessed together with available clinical detail. Results:, Eighty-eight cases were recovered. Mean age was 75.4 years, with women predominating (57%). Thromboembolic occlusion was the leading cause, followed by thrombotic occlusion. Embolic sources included atrial disease, aortic disease and myocardial infarction. Patients routinely showed extensive comorbidities, especially cardiovascular. Pain was the most constant presenting symptom, but features were often subtle and clinicians frequently misdiagnosed more minor ailments. Of operated patients, 36% received operations within 6 h of admission, 33% within 24 h, 17% at between 1 and 2 days, and the remainder between 2 and 12 days. Conclusion:, Knowledge of risk factors defined here is important to guide early diagnosis of mesenteric ischaemia. Diagnostic delay is again shown to be significant and case experience gathered in this series may improve doctors' discernment when meeting this condition. [source]


Influence of surgical and postoperative treatment on survival in differentiated thyroid cancer

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2007
C. I. Lundgren
Background: The extent of thyroidectomy in patients with differentiated thyroid cancer (DTC) remains controversial. The aim of this study was to identify how surgical technique and postoperative treatments influence survival and locoregional recurrence in DTC. Methods: A nested case-control study was conducted in a cohort of 5123 patients diagnosed with DTC in Sweden between 1958 and 1987. One matched control subject was selected randomly for each patient who died from DTC. Details regarding surgery and postoperative treatments were obtained from medical records. The effect of treatment on survival was estimated by conditional logistic regression. Results: Patients not treated surgically had a poorer prognosis, but the risk of death from DTC was not affected by the choice of surgical technique. The extent of surgery influenced survival only in patients with TNM stage III disease. Locoregional recurrence resulted in a fivefold increased risk of death. Postoperative treatment was not associated with improved survival. Conclusion: In operated patients, the most important prognostic factor was complete removal of the tumour. The extent of removal of remaining thyroid tissue was of prognostic importance in stage III disease only. Adjuvant postoperative treatment did not influence the prognosis favourably. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]


Characterization of reflux events after fundoplication using combined impedance,pH recording,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2007
S. Roman
Background: Laparoscopic fundoplication effectively controls symptoms of gastro-oesophageal reflux disease (GORD) and decreases acid reflux, but its impact on non-acid reflux is not known. The aim of the study was to characterize reflux events after fundoplication using oesophageal combined multichannel intraluminal impedance (MII),pH monitoring, to demonstrate its efficacy on acid as well as non-acid reflux events. Methods: Thirty-six patients in whom ambulatory MII,pH recording was performed after laparoscopic fundoplication were reviewed retrospectively. There were 23 symptomatic and 13 asymptomatic patients, whose results were compared with those of 72 healthy volunteers. Results: Oesophageal acid exposure was low in all but one operated patient, and there was no difference between those with and without symptoms. The median number of reflux events over 24 h was lower after fundoplication (11 in operated patients compared with 44 in healthy volunteers; P < 0·001). Almost all reflux events were non-acid after surgery whereas acid reflux episodes were predominant in healthy volunteers. Proximal reflux events were less common in operated patients. Non-acid reflux events were significantly associated with symptoms after surgery in some patients. Conclusion: Fundoplication restores a competent barrier for all types of reflux. Reflux events are mostly non-acid after surgery, and such events may be positively correlated with symptoms. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]


Long-term outcome after surgery for Chiari I malformation

ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2009
M. Tisell
Objective,,, To examine the long-term effects of suboccipito-cervical decompression on an intention-to-treat basis in patients with Chiari I malformation (CMI). Patients and methods,,, Twenty-four consecutive patients, 14 females and 10 males with a median age of 26 years, underwent decompressive surgery for CMI during 1998,2006. All patients were contacted by an independent examiner and asked to complete a questionnaire regarding headache, other neurological symptoms and negative impact of the disease on the daily life before and after surgery. The median follow-up time after surgery was 3.2 years (range 1.7,9.2 years). Twenty-three patients (96%) completed the questionnaire. Results,,, On an intention-to-treat basis there was an improvement in headache in 75%, decreased associated neurological symptoms in 88% and less negative impact on daily life in 75% of the 24-operated patients. Conclusions,,, More than three-quarters of the patients still considered their situation improved at long-term follow-up after surgery. These results support surgical intervention in symptomatic Chiari I patients. [source]