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Postoperative Assessment (postoperative + assessment)
Selected AbstractsValue of power Doppler sonography with 3D reconstruction in preoperative diagnostics of extraprostatic tumor extension in clinically localized prostate cancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2008Miroslav Zalesky Aim: The aim of the study is to investigate the value of preoperative power Doppler sonography with 3D reconstruction (3D-PDS) for diagnostics of extraprostatic extension of prostate cancer. Patients and Methods: In the prospective study we examined 146 patients with clinically localized prostate cancer who underwent radical prostatectomy. Prior to surgery, each patient underwent 3D-PDS, transrectal ultrasound (TRUS), and digital rectal examination (DRE). Furthermore, we determined the prostate volume, prostate specific antigen (PSA) level, PSA density (PSAD), and Gleason score. The risk of locally advanced cancer was assessed using Partin tables. We determined the sensitivity, specificity, and predictive values of these diagnostic procedures. We plotted the receiver operating characteristic (ROC) curves and calculated the areas under the curves (AUC). Multivariate logistic regression was used to identify the significant predictors of extraprostatic tumor extension. Based on this we developed diagnostic nomograms maximizing the probability of accurate diagnosis. Results: The significant differences between patients with organ confined and locally advanced tumor (based on the postoperative assessment) were observed in the PSA levels (P < 0.014), PSAD (P < 0.004), DRE (P < 0.037), TRUS (P < 0.003), and 3D-PDS (P < 0.000). The highest AUC value of 0.776 (P < 0.000) was found for 3D-PDS. The observed AUC value for TRUS was 0.670 (P < 0.000) and for PSAD 0.639 (P < 0.004). In multivariate regression analysis, the PSAD, preoperative Gleason score, and 3D-PDS finding were identified as significant preoperative predictors of extraprostatic tumor extension. Conclusion: Our data suggest that the 3D-PDS is a valuable preoperative diagnostic examination to identify locally advanced prostate cancer. Therefore, it can be used to maximize the probability of the accurate diagnosis of extraprostatic tumor extension. [source] Neurocognitive Functions after Beating Heart Mitral Valve Replacement without Cross-Clamping the AortaJOURNAL OF CARDIAC SURGERY, Issue 2 2008Ferit Cicekcioglu M.D. The aim of this study was to compare preoperative and postoperative neurocognitive functions in patients who underwent beating heart mitral valve replacement on cardiopulmonary bypass without cross-clamping the aorta. Methods: The prospective study included 25 consecutive patients who underwent mitral valve replacement. The operations were carried out on a beating heart method using normothermic cardiopulmonary bypass without cross-clamping the aorta. All patients were evaluated preoperatively (E1) and postoperatively (at sixth day [E2] and second month [E3]) for neurocognitive functions. Results: Neurologic deficit was not observed in the postoperative period. Comparison of the neurocognitive test results, between the preoperative and postoperative assessment for both hemispheric cognitive functions, demonstrated that no deterioration occurred. In the three subsets of left hemispheric cognitive function test evaluation, total verbal learning, delayed recall, and recognition, significant improvements were detected at the postoperative second month (E3) compared to the preoperative results (p = 0.005, 0.01, and 0.047, respectively). Immediate recall and retention were significantly improved within the first postoperative week (E2) when compared to the preoperative results (p = 0.05 and 0.05, respectively). Conclusions: The technique of mitral valve replacement with normothermic cardiopulmonary bypass without cross-clamping of the aorta may be safely used for majority of patients requiring mitral valve replacement without causing deterioration in neurocognitive functions. [source] Gender differences in patients with Parkinson's disease treated with subthalamic deep brain stimulationMOVEMENT DISORDERS, Issue 8 2007Ettore Accolla MD Abstract We investigated gender-differences in clinical phenomenology and response to deep brain stimulation (DBS) of the subthalamic nucleus (STN) in a group of patients with advanced Parkinson's disease (PD). Thirty-eight consecutive patients with PD (22 men and 16 women), bilaterally implanted for DBS of the STN, were evaluated 1 month before and 11 to 14 months after surgery. Gender differences in severity of the disease (HY and UPDRS), ability in the activities of daily living (ADL, UPDRS II), tremor and rigidity (UPDRS III), bradykinesia (UPDRS III and hand tapping test), levodopa-induced dyskinesias (LIDs, UPDRS IV), and levodopa equivalent daily dosage (LEDD) were analyzed before and after intervention. We found a predominantly male population, with no gender-related differences in age at onset, disease progression rate, or severity of disease. Nevertheless, women had more severe LIDs than men, only before the intervention. Bradykinesia was significantly less responsive to any kind of treatment (pharmacologic and neurosurgical) in women than in men. Finally, although STN-DBS induced similar total benefits in both genders, postoperative assessment suggested that the ADL improved more in women than in men. Women and men with advanced PD appear to differ in some clinical features and in response to dopaminergic and STN-DBS treatment. © 2007 Movement Disorder Society [source] Postoperative pain assessment in preverbal children and children with cognitive impairmentPEDIATRIC ANESTHESIA, Issue 6 2008BABITA GHAI MD DNB Summary Postoperative pain assessment and management in preverbal children and children with cognitive impairment poses major challenges to pediatric anesthesiologists. An accurate diagnosis of extent of pain is the keystone for the successful management of pain. This article reviews the neurobiology of pain at birth, long-term consequences of early pain and different pediatric pain assessment tools used for postoperative assessment in infants, young children, and children with cognitive disabilities. [source] Efficacy of dye disappearance test and tear meniscus height in diagnosis and postoperative assessment of nasolacrimal duct obstructionACTA OPHTHALMOLOGICA, Issue 3 2010Joon Ho Roh Abstract. Objective:, To evaluate the efficacy of the fluorescein dye disappearance test (FDDT) and measurement of tear meniscus height (TMH) in the diagnosis and postoperative assessment of nasolacrimal duct obstruction (NLDO). Methods:, The study group included 42 eyes of 42 patients who had a diagnosis of primary acquired nasolacrimal duct obstruction (PANDO) or functional nasolacrimal duct obstruction (FNDO) and underwent endoscopic transnasal dacryocystorhinostomy. The control group included 38 eyes of 38 people without tearing. The values of the FDDT, TMH and tearing symptom score (TSS), which was evaluated in five levels based on patients' history taking, were measured before surgery, and 1 day, 2 weeks, 1, 3 and 6 months after surgery. The values of the FDDT, TMH and TSS in the study group were compared with those of the control group. Results:, The preoperative values of the FDDT, TMH and TSS were 0.7 ± 0.4, 0.22 ± 0.08 mm and 1.6, respectively, in the control group and 3.0 ± 0.8, 0.53 ± 0.15 mm and 4.4, respectively, in the study group. These differences were statistically significant. Also, at each follow-up, the postoperative values of the FDDT and TMH decreased significantly compared to their preoperative values in the study group. The postoperative TSS decreased significantly compared to the preoperative values at each follow-up except at postoperative 1-day follow-up. There were no significant differences in the preoperative values of the FDDT, TMH and TSS between the types of NLDO. The TSS had positive correlations with the FDDT and TMH before and after surgery. Conclusion:, These results suggest that the FDDT and TMH measurement might be effective in the diagnosis and postoperative assessment of NLDO. 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