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Multiple Operations (multiple + operations)
Selected AbstractsOutcome of craniopharyngioma in children: long-term complications and quality of lifeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2004Andrea Poretti MB BS Childhood craniopharyngiomas are histologically benign tumours arising from remnants of Rathke's pouch in the hypothalamic,pituitary region. The two common treatment approaches are primary total resection or limited resection followed by radiotherapy. To study the outcome after a primary surgical approach, we followed 25 consecutive patients (10 females, 15 males) under 16 years of age who were treated in a single institution with a management policy of radical tumour excision (mean age at diagnosis 9 years 2 months, SD 4 years 3 months; range 2 years 9 months to 15 years 11 months). Mean follow-up after primary surgery was 11 years 3 months (SD 7 years 7 months). Tumour control, and neurological, endocrine, and hypothalamic complications and their impact on health-related quality of life were assessed (medical follow-up, semi-structured interview, and questionnaires). Results of tumour control were generally good, however, local failure was observed in 6 of 25 patients, and severe late-treatment complications decreased quality of life for many long-time survivors. Endocrine deficiency occurred in 24/25, visual complications in 16/24, neurological complications in 8/24, obesity in 14/23, increased daytime sleepiness in 6/21, and significant school problems in 10/20. Patients with craniopharyngioma rated their health-related quality of life as considerably lower than healthy controls; the domains of social and emotional functioning were particularly affected. Parents'ratings were considerably lower than those of the patients. Poor functional outcome was associated with large tumours infiltrating or displacing the hypothalamus, the occurrence of hydrocephalus, and young age at diagnosis, but also with multiple operations due to tumour recurrence. Alternative treatment strategies should be considered, especially in very young patients with large tumours. [source] Modulation of temporally coherent brain networks estimated using ICA at rest and during cognitive tasksHUMAN BRAIN MAPPING, Issue 7 2008Vince D. Calhoun Abstract Brain regions which exhibit temporally coherent fluctuations, have been increasingly studied using functional magnetic resonance imaging (fMRI). Such networks are often identified in the context of an fMRI scan collected during rest (and thus are called "resting state networks"); however, they are also present during (and modulated by) the performance of a cognitive task. In this article, we will refer to such networks as temporally coherent networks (TCNs). Although there is still some debate over the physiological source of these fluctuations, TCNs are being studied in a variety of ways. Recent studies have examined ways TCNs can be used to identify patterns associated with various brain disorders (e.g. schizophrenia, autism or Alzheimer's disease). Independent component analysis (ICA) is one method being used to identify TCNs. ICA is a data driven approach which is especially useful for decomposing activation during complex cognitive tasks where multiple operations occur simultaneously. In this article we review recent TCN studies with emphasis on those that use ICA. We also present new results showing that TCNs are robust, and can be consistently identified at rest and during performance of a cognitive task in healthy individuals and in patients with schizophrenia. In addition, multiple TCNs show temporal and spatial modulation during the cognitive task versus rest. In summary, TCNs show considerable promise as potential imaging biological markers of brain diseases, though each network needs to be studied in more detail. Hum Brain Mapp, 2008. © 2008 Wiley-Liss, Inc. [source] Growth after intestinal resection for Crohn's disease in children, adolescents, and young adultsINFLAMMATORY BOWEL DISEASES, Issue 4 2000Timothy A. Sentongo Abstract Objective: Growth before and after intestinal resection for Crohn's disease (CD) was examined in a group of children, adolescents, and young adults. Methods: Retrospective chart review of patients who had intestinal resections as clinical management of complications of CD between 1985 and 1996. Pre- and postoperative measurements of weight and height were reviewed. Z-scores were computed for weight-forage (WAZ), height-for-age (HAZ), and weight-for-height (WHZ). Two tailed t tests were used to compare postoperative growth patterns. Significance was defined as p < 0.05. Results: Twenty-five subjects (8 females, mean age 16.2 ± 2.8 years with one operation, and 3 males, mean age 15.7 years with multiple operations) were identified. There were significant improvements in the postoperative growth patterns of subjects who had one operation: HAZ (-1.28 ± 1.45 versus ,0.98 ± 1.37, p = 0.041), WAZ (-1.35 ± 1.02 versus ,0.74 ± 0.93, p = 0.0006) and WHZ (-0.64 ± 0.95 versus ,0.23 ± 0.81, p = 0.036). Furthermore, the magnitude of postoperative weight gain directly correlated with the age at CD diagnosis, R2 = 0.16, p = 0.046. Trends towards improved postoperative WAZ (-0.83 versus ,0.49) and HAZ (-0.47 versus ,0.27) were also observed in the three subjects who had multiple operations. Conclusion: The pattern of weight and height growth was improved after intestinal resection for CD. Nonetheless, close monitoring of postoperative growth is necessary especially in children diagnosed with CD at a young age. [source] Percutaneous Closure of Paravalvular LeaksJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2006RALPH HEIN M.D. Paravalvular leak occurs in about 2,3% of patients after surgical valve replacement. The leak may cause heart failure, arrhythmias, or hemolysis. Patients who have had multiple operations or who have significant comorbidity constituting a contraindication to surgery might be considered candidates for transcatheter closure. In the past, occluding paravalvular leaks has been attempted using coils or double umbrella devices; defect specific devices are under development. Interventional experiences with various Amplatzer occluders are described. [source] Use of a retrograde femoral nail in a patient with McCune,Albright syndromeANZ JOURNAL OF SURGERY, Issue 12 2003John D. Garvan McCune,Albright Syndrome is a rare condition characterized by endocrine abnormalities, precocious puberty, pigmented skin lesions and polyostotic fibrous dysplasia with consequent fractures and limb deformity. Patients with this syndrome might have had multiple operations on a limb and might also have extensive internal fixation in-situ. We review the case of a 41-year-old woman with McCune,Albright syndrome, who presented with a pathological fracture of her left femur below a long plate and screws. Our management of this challenging problem included the use of a retrograde femoral nail, which, because of the need to retain pre-existing internal fixation, had to be locked proximally through a hole in a femoral plate. This technique, combined with reaming, and thus bone grafting of the fracture, and also perioperative infusions of pamidronate, allowed an early recovery and return to premorbid function for the patient. In the present study we detail our technique and discuss its advantages over other possible methods of treatment. [source] | ||||||||||