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Surgical Cases (surgical + case)
Selected AbstractsMultivariate Neuropsychological Prediction of Seizure Lateralization in Temporal Epilepsy Surgical CasesEPILEPSIA, Issue 8 2007Therese A. Keary Summary:,Purpose: Neuropsychological assessment can be of assistance in determining seizure lateralization in cases where EEG and MRI findings do not provide clear lateralizing data. While several studies have examined the lateralizing value of individual neuropsychological measures, clinicians are still in need of a statistically sound method that permits the incorporation of multiple neuropsychological variables to predict seizure lateralization in the individual patient. Method: The present study investigated the lateralizing value of several commonly used neuropsychological measures in a large sample of patients (n = 217) who eventually underwent surgical resection to treat their epilepsy. Side of surgery was used to operationally define seizure lateralization. A comparison of the relative utility of a multivariate versus univariate approach to predict seizure lateralization was conducted in temporal epilepsy cases. Results: The results provide evidence for the incremental validity of neuropsychological measures, other than memory and IQ tests, in the prediction of seizure lateralization in patients with medically intractable epilepsy. These data indicate that a multivariate approach increases the accuracy of prediction of seizure lateralization for temporal lobe epilepsy cases. Conclusion: This study supports the use of a multivariate approach using neuropsychological measures to predict seizure lateralization in temporal epilepsy surgical candidates. Regression formulas are provided to enhance the clinical utility of these findings. [source] Clinical findings and outcomes of ulcerative keratomycosis in 30 horses in the mid-Atlantic United States (2006,2007)EQUINE VETERINARY EDUCATION, Issue 1 2010M. E. Utter Summary The purpose of this study was to determine the clinical course and outcome associated with keratomycosis in horses in the mid-Atlantic USA. Records of horses diagnosed with keratomycosis at New Bolton Center from November 2006 to November 2007 with positive fungal culture were retrospectively studied. Neither horses with ulcerative keratitis and a negative fungal culture nor those with stromal abscesses were included. Subject details, history, clinical findings, therapy and outcome were recorded. Thirty horses fitted both inclusion criteria (diagnosis of keratomycosis and positive corneal fungal culture). Fourteen of 30 cases occurred during summer. Aspergillus was the most commonly cultured fungal genus (17/30, or 57%) followed by Alternaria (4/30). Seventeen horses had positive bacterial and fungal cultures. Fifteen of 30 horses were treated surgically by a keratectomy and amnion (8) or conjunctival (7) graft. Itraconazole was the most common topical anti-fungal therapy and was utilised in 25/30 horses. Globe survival was 97% (29/30). All surviving globes had a positive menace response and were visual at the last examination. It was concluded that in the mid-Atlantic USA, fungal keratitis is common, has the highest incidence in summer, and is usually associated with a positive outcome. Aspergillus may be a relatively more common corneal pathogen in this region than elsewhere in the USA. Surgical cases were more likely to have fungal hyphae identified on cytology and tended to be hospitalised longer than medical cases. There was no apparent association between surgical disease and all other patient, organism and treatment variables. [source] Clinical features and outcomes of severe ulcerative keratitis with medical and surgical management in 41 horses (2000,2006)EQUINE VETERINARY EDUCATION, Issue 6 2009M. E. Utter Summary The clinical features and outcomes of equine ulcerative keratitis with and without conjunctival graft surgery were assessed using a retrospective study. Medical records of horses hospitalised from July 2000-January 2006 for ulcerative keratitis were included if a diagnosis of melting ulcer, descemetocele or iris prolapse was made, or if surgery was recommended due to severity of corneal disease, and aggressive medical therapy using a subpalpebral catheter was instituted. Treatment and outcome variables were evaluated with and without conjunctival graft surgery. Forty-one horses, 21 that had surgery and 20 for whom surgery was recommended but not performed, were included. Horses were hospitalised for an average of 24 days, with 37/41 melting ulcers, 17/41 descemetoceles and 3/41 iris prolapses, with no statistical difference in frequencies between groups. Bacterial or fungal organisms were cultured from 22/39 cases, with 10 Aspergillus spp. and 8 Pseudomonas spp. Infectious organisms were seen on corneal cytology in 23/30 cases. Surgical cases were hospitalised for an average of 4.9 days prior to surgery. Abdominal discomfort was observed in 8/41 hospitalised horses, with 5/8 operated horses developing caecal impactions. Thirty-five horses retained an intact globe, including 18/20 treated medically and 17/21 that had surgery. Hospitalisation cost was 24% more for cases that had surgery than for medical cases. It was concluded that there was no statistical difference in length or cost of hospitalisation between surgical and nonsurgical groups. Outcomes from both groups were similar, with a high frequency of globe retention. [source] A Risk Scale for Predicting Extensive Subclinical Spread of Nonmelanoma Skin CancerDERMATOLOGIC SURGERY, Issue 2 2002R. Sonia Batra MD background. The clinical appearance of nonmelanoma skin cancer may represent only a portion of microscopic tumor invasion. objective. To develop a scale based on high-risk characteristics for predicting the probability of extensive subclinical spread of nonmelanoma skin cancer. methods. Retrospective analysis of 1095 Mohs micrographic surgical cases (MMS) yielded high-risk factors for extensive tumor spread, defined as requirement of ,3 MMS layers. Predictive characteristics included: any BCC on the nose, morpheaform BCC on the cheek, neck tumors and recurrent BCC in men, location on the eyelid, temple, or ear helix, and size>10 mm. Multivariate logistic regression was applied to develop a risk index. results. Tumor characteristics were assigned point values calculated from the respective odds of extension and categorized into six risk classes with probabilities of extensive subclinical spread ranging from 10% to 56%. conclusion. A risk scale simplifies and enhances prediction of extensive tumors. The associated probabilities can help to guide patient preparation and appropriate therapy. [source] SURGICAL INDICATIONS AND PROCEDURES FOR BLEEDING PEPTIC ULCERDIGESTIVE ENDOSCOPY, Issue 2010Nobutsugu Abe Recent important insights into the surgical treatment of bleeding peptic ulcer are reviewed in this article. Although the widespread use of endoscopic treatment and interventional radiology has reduced the number of surgical cases, surgery still plays a pivotal role in managing bleeding peptic ulcer. Failure to stop the bleeding by endoscopy and/or interventional radiology is the most important indication for emergency surgery. An early elective/planned surgery after the initial endoscopic control to prevent life-threatening rebleeding seems justified in patients who have risk factors for rebleeding, although its true efficacy still remains controversial. The surgical procedures in emergency situations should be limited to safe hemostasis. The addition of acid-reduction surgery may be unnecessary as a result of the increasing utilization of proton pump inhibitors. Angiographic embolization may be a less invasive alternative to surgery, and may further enhance endoscopic hemostasis. [source] Considerations in the revision of previous surgical proceduresENDODONTIC TOPICS, Issue 1 2005WILLIAM P. SAUNDERS The microbial etiology of periradicular periodontitis requires that efforts must be made to eliminate infection from the root canal system and the periradicular tissues. Periradicular surgery is an option of endodontic re-treatment when non-surgical root canal treatment and re-treatment fails. Unfortunately, surgery is not always successful for a number of reasons including, extraradicular infection, associated marginal periodontal disease, inability to seal the root canal system from the periradicular tissues, anatomical anomalies and poor surgical technique. This paper reviews the use of re-surgery in the treatment of failed surgical cases, discussing some of the problems that may be encountered and how they may be managed. [source] Clinicopathological characteristics of primary gastric T-cell lymphomaHISTOPATHOLOGY, Issue 6 2009Kenichiro Kawamoto Aims:, To investigate the clinicopathological characteristics of 20 primary gastric T-cell lymphoma (GTCL) cases without human T-lymphotropic virus type I infection in Japan, a non-endemic area for coeliac disease. Methods and results:, Fifteen cases had no history of persistent diarrhoea or severe hypoproteinaemia. Histologically, 13 cases (65%) consisted of large cell lymphoma and seven (35%) were of medium-sized cells. Intraepithelial lymphoma cell invasion was found in three cases (15%). Two of 10 surgical cases (20%) showed intramucosal tumour cell spreading with enteropathy-like features. Helicobacter pylori CagA gene was detected in three of 10 cases (30%). The lymphoma cells of all 20 cases were positive for CD3 and/or TCR,F1 and negative for CD56. CD4, and CD8, lymphoma was found in 11 cases (55%), CD4+ lymphoma in seven (35%) and CD8+ lymphoma in two (10%). CD30+, CD5+ and CD25+ lymphomas were detected in nine (45%), 10 (50%) and 11 (55%) cases, respectively. Five-year survival of the 16 available cases was 54%. Early clinical stage and medium-sized cell lymphoma were significantly (P < 0.05) better prognostic factors. Conclusions:, Patients with GTCL exhibit distinct clinicopathological findings and prognoses from those with enteropathy-associated T-cell lymphomas. GTCL may be mainly derived from lamina propria and parafollicular T cells. [source] Non-hematopoietic cutaneous metastases in children and adolescents: thirty years experience at St. Jude Children's Research HospitalJOURNAL OF CUTANEOUS PATHOLOGY, Issue 10 2000W. A. Wesche Background: The spectrum of cutaneous metastasis of non-hematopoietic neoplasms in the pediatric population is not well documented. We report the histologic diversity of this unusual process over a 30-year period at a tertiary care center for pediatric malignancy (St. Jude Children's Research Hospital, Memphis, TN, USA). Methods: Of 1,971 pathology accessions which included histologic material on skin (1,604 surgical cases and 367 autopsy cases) we found 40 cases (2% of total skin accessions) coded for metastatic non-hematopoietic malignancy. Results: The patients (n=34) ranged in age from 1 month to 20 years (mean=9.8 years) and had a male:female ratio of 1:1. The histologic diagnoses were as follows: rhabdomyosarcoma NOS (6 cases), embryonal rhabdomyosarcoma (4 cases), alveolar rhabdomyosarcoma (4 cases), neuroblastoma (8 cases), osteosarcoma (2 cases), choriocarcinoma (2 cases), peripheral neuroepithelioma or Ewing's sarcoma (2 cases), malignant rhabdoid tumor (1 case), paraganglioma (1 case), nasopharyngeal carcinoma (1 case), sarcoma NOS (1 case), colon adenocarcinoma (1 case), and malignant melanoma (1 case). Conclusions: Cutaneous or subcutaneous metastasis of non-hematopoietic malignancies in children and adolescents is a rare occurrence but in a high percentage of cases may be the first manifestation of disease. The tumors most likely to metastasize to the skin in children are rhabdomyosarcoma and neuroblastoma and they are more likely than adult malignancies to disseminate to multiple distant sites. [source] An analysis of the evidence-practice continuum: is surgery for obstructive sleep apnoea contraindicated?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Adam G. Elshaug BA BSc(Hons) MPH Abstract Rationale, aims and objectives, Currently there are multiple surgical interventions utilized in the treatment of adult obstructive sleep apnoea (OSA). The role of these operations remains controversial, with perspectives on treatment efficacy varying considerably. Despite this, their use is proliferating. Objectives, In this paper, we present the degree of variability that occurs in the application of these procedures, and examine the effectiveness of surgical intervention as a treatment for OSA. Method, A multi-centre retrospective clinical audit of consecutive, unselected surgical cases presenting at the sleep disorder clinics of two teaching hospitals in a major Australian city. Patients acted as their own historical controls, undergoing polysomnography pre and post surgery to gauge effectiveness. Results, On variability demonstrate 94 individuals in this cohort received 220 individual upper airway surgical procedures, 184 occurred in their first operation (mean 2.5 per person; range 1,7) and 36 occurred in a second operation (n = 18; cumulative mean of 4 per person; range 3,7). These 94 individuals received 41 varying combinations of surgery. Results on effectiveness demonstrate an overall physiological success rate of 13% (87% fail). One operation reduced OSA severity by 20% (patients still had severe OSA), and two operations by 35% (still moderate OSA). In contrast, conventional Continuous Positive Airway Pressure therapy controlled OSA (n = 64). Conclusions, This case study demonstrates substantial procedural variability and limited effectiveness. This raises questions as to the quality of care, the treatment-derived health outcomes of this population and of efficient resource allocation. This issue requires greater policy attention. [source] Preparation Techniques for the Injection of Human Autologous Cartilage: An Ex Vivo Feasibility Study,THE LARYNGOSCOPE, Issue 1 2008J Pieter Noordzij MD Abstract Objectives: To determine the optimum donor site and preparation technique for injecting human autologous cartilage as a potentially permanent implant material for vocal fold medialization. Study Design: Prospective ex vivo experimental model. Methods: Human nasal septal and auricular cartilage was obtained from eight surgical cases after institutional review board approval. The auricle and nasal septum were chosen as potential donor sites because of ease of accessibility, volume of cartilage potentially available, and minimal subsequent cosmetic deformity after the tissue harvesting procedure. Various preparation techniques readily available in most operating rooms were tested for their efficacy in generating an injectable cartilage slurry. The various cartilage slurries were injected through sequentially smaller needles and examined cytologically. Results: The best injection properties for both nasal septal and auricular cartilage were obtained by drilling the cartilage down with a 5 mm otologic cutting bur, which allowed free passage through an 18 gauge needle. Cytologic examination of drilled septal cartilage showed good uniformity of cartilage pieces with a mean largest dimension of 0.44 ± 0.33 mm, and 33% of lacunae contained viable-appearing chondrocytes. Cytologic examination of drilled auricular cartilage was similar, exceptonly 10% of lacunae were occupied by chondrocytes. Other techniques tested (knife, morselizer, and cartilage crusher) did not yield injectable cartilage slurries. Conclusions: Both nasal septal and auricular cartilage can be prepared for injection via an 18 gauge needle using a cutting otologic bur. Further testing of in vivo viability and long-term volume retention is needed. [source] Expression of Angiogenic Growth Factors in Paragangliomas,THE LARYNGOSCOPE, Issue 1 2000Robert W. Jyung MD Abstract Objective/Hypothesis: To determine if angiogenic growth factors including vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) are expressed in human paragangliomas. Study Design: A histopathologic and molecular examination of paraganglioma specimens obtained from surgical cases or retrieved from the Pathology Department of the Massachusetts Eye and Ear Infirmary. Methods: Fresh tumor or archival, paraffin-embedded paraganglioma specimens were analyzed by immunohistochemistry, Western blotting, and ELISA. Results: Positive immunohistochemical staining for VEGF was observed in five of nine surgical specimens and in six of eight archival specimens (11/17, or 65%). PD-ECGF immunoreactivity was detected in four of five surgical specimens and six of eight archival specimens (10/13, or 77%). The presence of PD-ECGF was confirmed by Western blot assay and ELISA confirmed the presence of VEGF in tumor extract. Conclusions: Both VEGF and PD-ECGF are expressed in paragangliomas and may contribute to the extreme vascularity of these tumors. [source] AL02 ADVERSE EVENTS: OUR RESPONSIBILITY FOR REPORTING, REVIEWING AND RESPONDINGANZ JOURNAL OF SURGERY, Issue 2009D. A. Watters An adverse event is defined as unintentional harm (to a patient) arising from an episode of healthcare and not due to the disease process itself. Surgical adverse events include death, unplanned reoperation, unplanned readmission, unplanned ICU readmission, medication errors and side-effects, falls, pressure ulcers, hospital acquired infection, and inadvertent injury during surgery. Adverse events occur in around 10% of general surgical cases. The rates also vary between specialties. Reporting: , Adverse events need to be reported through both a hospital incident reporting system (eg Riskman) and through surgical audit. Each adverse event should be graded using a Severity Assessment Code (1,4) on the basis of its effect on the patient or hospital service, and the likelihood of it recurring. Some of the more severe events will trigger an entry on the risk register, making service managers responsible for action. Reviewing: , The opportunity must be seized to improve system issues. An investigation (eg root cause analysis) should be conducted in an atmosphere of ,no-blame' with engagement of and consultation with the major stakeholders who are responsible for delivering solutions. Training in system-wide approaches and teamwork can be invaluable. Responding: , The response needs to recognise the needs of the patient who has been harmed. There should be an honest and frank discussion with the patient and/or their family, acknowledging their suffering with empathy and an apology should be offered without necessarily admitting any liability. Open disclosure has the potential to reduce risk of litigation. Surgeons need to engage in reporting, reviewing and responding if the rate of adverse events is to be reduced. [source] Possible Role of Artificial Oxygen Carriers in Transfusion Medicine: A Retrospective Analysis on the Current Transfusion PracticeARTIFICIAL ORGANS, Issue 2 2009Fumiaki Yoshiba Abstract Artificial oxygen carriers (AOC) are under development as a substitute for red blood cells (RBC) in homologous transfusion (Tx). The lack of surface antigen in AOC makes ABO-typing and antibody-screening (T/S) unnecessary. Pathogen elimination renders it much safer, and long-term stability allows ubiquitous storage for emergency use. To delineate the utility of AOC, we retrospectively examined current Tx practices in Tokai University and the Japanese Red Cross Society. The emergency department of Tokai University Hospital has been using O(+)Rh(+) RBC in patients with hemorrhagic shock before Tx becomes available. Those who received the RBCs within 60 min of injury had a significantly higher survival rate than those who received it later (,60 min). The Red Cross Blood Center provided 411 units of RBC for 138 urgent requests for rare blood types. Our analysis suggests that if an AOC were available for the initial six units, 96% of such requests could have been covered to avoid urgent donor allocation, preparation, and Tx. Among 2079 surgical cases who ordered T/S, only 29% actually required Tx, rendering >70% of the T/S unnecessary. Because only 7.4% required nine units or more, more than 92% of T/S and Tx could have been avoided in retrospect if an AOC were available for the initial eight units. The results suggest that an AOC might be useful in various situations to alleviate problems, concerns, and technical burden in the current Tx practices. Because the expected utility is based mainly on physical characteristics, AOC may remain advantageous even when biogenetically derived RBC becomes available. [source] Reproducibility of Diagnosis and Its Influence on the Distribution of Lung Cancer by Histologic Type in Osaka, JapanCANCER SCIENCE, Issue 1 2000Seiichiro Yamamoto The histologic types of lung cancer cases diagnosed in 1979,1980 (n=799) and 1987 (n=587) were independently reviewed by two pathologists in order to investigate the reproducibility of the diagnosis of the histologic type when the WHO classification (1981) was used. The specimens from 354 surgical cases and biopsy or cytology specimens from 1032 non-surgical cases were reviewed. The inter-observer agreement was 87.9% (k=0.79) for surgical cases and 81.4% (k=0.72) for non-surgical cases. When compared to the original diagnosis, the agreement was 86.8% (k=0.78) for surgical and 86.4% (k=0.79) for non-surgical cases in 1979,1980 and the agreement was 92.8% (k=0.87) for surgical and 89.1% (k=0.83) for non-surgical cases in 1987. By histologic type, no difference in the agreement was observed except for large cell carcinoma. The distribution of histologic types after the review differed only slightly (less than 6%) from the original distribution. This suggests that in Osaka, Japan, the diagnosis based on the WHO classification (1981) had only a limited influence on the distribution of histologic types, and is not a major reason for the changing trends in lung cancer incidence by histologic type. [source] | ||||||||||