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Operative Treatment (operative + treatment)
Selected AbstractsBleeding peptic ulcer , time trends in incidence, treatment and mortality in SwedenALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009J. SADIC Summary Background, The incidence of peptic ulcer disease was expected to decrease following the introduction of acid inhibitors and Helicobacter pylori eradication. Aim, To analyse possible changes in the incidence of bleeding peptic ulcer, treatment and mortality over time. Methods, Residents of Malmö hospitalized for bleeding gastric or duodenal ulcer disease during 1987,2004 were identified in hospital databases (n = 1610). The material was divided into 6-year periods to identify changes over time. All patients who had been submitted to emergency surgery (n = 137) were reviewed. Results, The incidence rate for bleeding gastric or duodenal ulcers decreased by one half in males and by one-third in females and emergency operations decreased significantly (9.2%, 7.5% and 5.7% during the three time periods, respectively (P < 0.05). The post-operative mortality tended to decrease (9.7, 2.4 and 3.7%, respectively) and the 30-day mortality rates in the whole material were 1.2%, 3.6% and 3.4% during the different time periods. Conclusion, The incidence of bleeding gastric and duodenal ulcer disease has decreased markedly. Operative treatment has been replaced by endoscopic treatment. The bleeding ulcer-related mortality was less than 4% and has not changed over time. [source] Neurological recovery in obstetric brachial plexus injuries: an historical cohort studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2004Agnes F Hoeksma MD An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good. [source] Intraoperative cytology,Role in bone lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2010Khaliqur Rahman M.D. Abstract In spite of becoming an integral part of surgical pathology, very few reports are available regarding the utility of intraoperative cytology (IOC) exclusively for bone lesions. This study was undertaken in a view to fill this lacuna. Sixty bone lesions were evaluated intraoperatively with the help of cytology smears prepared by touch, scrape, or crush technique. The diagnosis made on cytological preparation was compared with histopathological diagnosis taking the latter as gold standard. Different parameters like reasons for Intraoperative consultation, best technique for preparation of smear, average time taken to render a diagnosis, and finally the accuracy of IOC was evaluated. Common reasons for the intraoperative consultation were to make or confirm a diagnosis for proper surgical intervention and to evaluate the surgical resection margin. Scrape was found to be the best method for cytological smear preparation. Average time taken to render a diagnosis was 20 minutes. Sensitivity, specificity, and overall diagnostic accuracy was 96.7, 96.6, and 96.6%, respectively. Cytology can play a valuable role in the intraoperative diagnosis of bone lesions. The method is simple, cheap, quick, and has no complication. It should be undertaken routinely, as a rapid intraoperative diagnosis will expedite timely and proper management of the patients, along with early post operative treatment and thus avoid the aggravating delays. Diagn. Cytopathol. 2010;38:639,644. © 2009 Wiley-Liss, Inc. [source] Class II restorations in primary teeth: 7-year study on three resin-modified glass ionomer cements and a compomerEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 2 2004V. Qvist The aim of this randomized study was to compare the longevity and cariostatic effects of 1565 class II restorations in primary teeth placed by 15 clinicians in the Danish Public Dental Health Service in 971 children, aged 3.6,14.9 yr. The restorations were performed using three resin-modified glass ionomer cements and one compomer (polyacid-modified composite resin) with and without their respective cavity conditioners. The restorations were in contact with 1023 unrestored proximal surfaces in 853 primary and 170 permanent teeth. The study was terminated after 7 yr with 1% of the restorations in function, 7% patient dropouts, 18% failed restorations, and operative treatment on 24% of the adjacent surfaces. Multivariate survival analyses showed that the restorative material and cavity conditioning influenced the survival of restorations but not the progression of caries on adjacent surfaces. The 50% survival times were estimated to exceed 5 yr for the restorations and 4.5 yr for the adjacent unfilled surfaces in all treatment groups. It was concluded that resin-modified glass ionomer cement and compomer are both appropriate materials for class II restorations in primary teeth. The differences in longevity and cariostatic effects among the four materials used with and without conditioner were less than the intra-individual differences between clinicians. [source] Attitudes and use of rubber dam by Irish general dental practitionersINTERNATIONAL ENDODONTIC JOURNAL, Issue 6 2007C. D. Lynch Abstract Aim, To investigate the attitudes towards and use of rubber dam by Irish general dental practitioners. Methodology, A pre-piloted questionnaire was distributed amongst a group of 600 dentists randomly selected from the Irish Register of Dentists. Replies from dentists working in specialist practice or the hospital dental service were excluded. Dentists were surveyed in relation to their use of rubber dam during a variety of operative and root canal treatments, as well as their attitudes to the use of rubber dam in dental practice. Results, A total of 300 replies were considered from a total of 324 that were received. Seventy-seven per cent of respondents (n = 231) worked in general dental practice and 23% (n = 69) worked in the Irish Health Board/Community Dental Service. Rubber dam was ,never' used by 77% of respondents (n = 228) when placing amalgam restorations in posterior teeth, 52% (n = 147) when placing composite restorations in posterior teeth, and 59% (n = 177) when placing composite restorations in anterior teeth. Rubber dam was ,never' used by 39% of respondents (n = 114) when performing root canal treatment on anterior teeth; 32% (n = 84) when performing root canal treatment on premolar teeth; and 26% (n = 51) when performing root canal treatment on molar teeth. Fifty-seven per cent (n = 171) considered rubber dam ,cumbersome and difficult to apply', and 41% (n = 123) considered throat pack ,as good a prevention against inhalation of endodontic instruments as rubber dam'. Conclusions, Whilst rubber dam is used more frequently for root canal treatment than operative treatment, its use is limited. This presents quality issues, as well as medico-legal and safety concerns for both the profession and patients. [source] Astrocyte metabolism is disturbed in the early development of experimental hydrocephalusJOURNAL OF NEUROCHEMISTRY, Issue 1 2003Daniel Kondziella Abstract The proper diagnosis of the arrested or the progressive form of hydrocephalus has a critical impact on treatment, but remains difficult. The assessment of early changes in cerebral metabolism might help in the development of adequate non-invasive diagnostic tools. This study examined the alterations in label incorporation in neurotransmitter amino acids and other compounds in kaolin-induced progressive hydrocephalus in rats by means of magnetic resonance spectroscopy (MRS) combined with the administration of [1- 13C]glucose and [1,2- 13C]acetate. Some 2, 4 and 6 weeks after kaolin injection into the cisterna magna, cerebrum, brainstem and cerebellum were dissected. Interestingly, labelling of most amino acids derived from [1- 13C]glucose showed no alterations, whereas labelling from [1,2- 13C]acetate was affected. Two weeks after induction of hydrocephalus the taurine concentration was decreased, whereas the concentration of [1,2- 13C]lactate was increased in the cerebrum and that of [1,2- 13C]GABA in the brainstem. Furthermore, labelling from [1,2- 13C]acetate was significantly decreased in [4,5- 13C]glutamate, [1,2- 13C]glutamate and [1,2- 13C]GABA in cerebrum from 4 weeks after hydrocephalus induction. The concentration of N -acetylaspartate, a neuronal marker, was unchanged. However, labelling of the acetyl group from [1- 13C]glucose was decreased in cerebellum and brainstem at 6 weeks after the induction of hydrocephalus. As glucose is metabolized predominately by neurones, whereas acetate is exclusively taken up by astrocytes, these results indicate that mostly astrocytic, and only later neuronal, metabolism is disturbed in the kaolin model of hydrocephalus. If verified in patients using in vivo MRS, impaired astrocyte metabolism might serve as an early indication for operative treatment. [source] Lower genital tract lesions requiring surgical intervention in girls: Perspective from a developing countryJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2009Sebastian O Ekenze Aim: To determine the spectrum, outcome of treatment and the challenges of managing surgical lesions of lower genital tract in girls in a low-resource setting. Method: Retrospective study of 87 girls aged 13-years and younger, with lower genital tract lesions managed between February 2002 and January 2007 at the University of Nigeria Teaching Hospital, Enugu, southeastern Nigeria. Clinical charts were reviewed to determine the types, management, outcome of treatment and management difficulties. Results: The median age at presentation was 1 year (range 2 days,13 years). Congenital lesions comprised 67.8% and acquired lesions 32.2%. The lesions included: masculinised external genitalia (24), vestibular fistula from anorectal malformation (23), post-circumcision labial fusion (12), post-circumcision vulval cyst (6), low vaginal malformations (6), labial adhesion (5), cloacal malformation (3), bifid clitoris (3) urethral prolapse (3), and acquired rectovaginal fistula (2). Seventy-eight (89.7%) had operative treatment. Procedure related complications occurred in 19 cases (24.4%) and consisted of surgical wound infection (13 cases), labial adhesion (4 cases) and urinary retention (2 cases). There was no mortality. Overall, 14 (16.1%) abandoned treatment at one stage or another. Challenges encountered in management were inadequate diagnostic facilities, poor multidisciplinary collaboration and poor patient follow up. Conclusion: There is a wide spectrum of lower genital lesion among girls in our setting. Treatment of these lesions may be challenging, but the outcome in most cases is good. High incidence of post-circumcision complications and poor treatment compliance may require more efforts at public enlightenment. [source] Technologic innovations in surgery: A philosophic reflection on their impact on operations for cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2009Walter Lawrence Jr. MD Abstract Technologic advances this past half-century have clearly had a positive effect on our ability to both diagnose and treat human cancer as well as on the operative treatment of other diseases. However, the impact of these innovations on the surgical treatment of cancer is not as clear as it is for many other problems that are managed surgically. This review is an "opinion piece" that attempts to assess the successes and failures of technologic innovations that have been introduced for the purpose of improving the operative treatment of cancer. J. Surg. Oncol. 2009;100:163,168. © 2009 Wiley-Liss, Inc. [source] Surgical treatment of "terrible triad of the elbow": technique and outcomeORTHOPAEDIC SURGERY, Issue 2 2010Yu-xing Wang MD Objective:, To describe the authors' surgical technique and to evaluate the final functional outcome of surgical treatment of the "terrible triad of the elbow". Methods:, Eight patients identified with "terrible triad" injury patterns, including posterior elbow dislocation, radial head fracture and coronoid fracture, were available for a minimum of 11 months follow-up. Evaluation of functional outcome was based on Mayo elbow performance, Broberg-Morrey scores, and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Complications were also recorded. Results:, Five elbows redislocated while in a splint after manipulative reduction. Three had residual subluxation after operative treatment. The final mean extent of forearm movement was as follows: 21° of extension deficit (range, 5° to 45°), 126° of flexion (range, 110° to 140°), 75° of supination (range, 45° to 90°), and 71° of pronation (range, 30° to 90°). The mean Mayo, Broberg-Morrey, and DASH scores were 78.0 ± 13.4, 76.0 ± 14.0, and 28.0 ± 24.7, respectively. Conclusions:, When an elbow joint is affected by the terrible triad, it is very unstable and prone to numerous complications. With operative treatment, the surgeon should attempt to perform internal fixation of the coronoid fracture, to regain normal radiocapitellar contact (either by preserving the radial head with open reduction and internal fixation (ORIF) or by replacing it with a prosthesis), and to repair the lateral collateral ligament (LCL). Thus early functional recovery and a successful final functional outcome can be achieved. [source] Results after surgical treatment of transtectal transverse acetabular fracturesORTHOPAEDIC SURGERY, Issue 1 2010Xi-gong Li MD Objective:, To retrospectively evaluate the results of operative treatment of transtectal transverse fractures of the acetabulum. Methods:, From May 1990 to July 2006, 40 patients with displaced transtectal transverse fracture of the acetabulum were treated surgically. A mean postoperative follow-up of 88.6 months' (range, 16,121 months) was achieved in 37 patients. Final clinical results were evaluated by a modified Merle d'Aubigné and Postel grading system. Postoperative radiographic results were evaluated by the Matta criteria. Fracture and radiographic variables were analyzed to identify possible associations with clinical outcome. Results:, Fracture reduction was graded as anatomic in 31 patients, imperfect in 4 and unsatisfactory in 2. Two hips were diagnosed to have subtle instability by postoperative radiography. The clinical outcome was graded as excellent in 16 patients, good in 14, fair in 4 and poor in 3. The radiographic result was graded as excellent in 14 patients, good in 15, fair in 4 and poor in 4. There was a strong association between the final clinical and radiographic outcomes. Variables identified as risk factors for unsatisfactory results included residual displacement greater than 2 mm, comminuted fracture of the weight bearing dome, postoperative subtle hip instability and damage to the cartilage of the femoral head. Conclusion:, The uncomplicated radiographic appearance of transtectal transverse fracture belies its complexity. Comminuted fracture of the weight bearing dome, unsatisfactory fracture reduction, subtle hip instability and damage to the cartilage of the femoral head are risk factors for the clinical outcome of transtectal transverse fracture of the acetabulum. [source] Surgical treatment of thoracolumbar fracture through an approach via the paravertebral muscleORTHOPAEDIC SURGERY, Issue 3 2009Wei Pang MD Objective:, To investigate the methods for, and clinical outcome of, the operative treatment of thoracolumbar fractures through an approach via the paravertebral muscle (PVM). Methods:, From June 2005 to August 2006, 62 patients, comprising 48 men and 14 women with an average age of 45.2 years (range, 21,58) with thoracolumbar fractures without neurological involvement underwent surgical treatment. Twenty-one fractures were located at T12, 24 at L1 and 17 at L2. The study comprised 15 compression and 47 burst fractures with an intact posterior column. Thirty-four cases were selected randomly to undergo surgery through the above approach, while the other 28 cases underwent the traditional procedure. After making a posterior midline incision, which not only facilitates insertion of pedicle screws and fusion of the graft bone at facet joints, but spares the attachment of PVM, the interval between the longissimus and multifidus muscles was undermined. Drainage was not routinely needed and the patients became ambulant with a brace earlier post-operatively. Results:, The new approach had statistically significant advantages (P < 0.005) over the traditional one in regard to blood loss, drainage, duration of recumbency and visual analogue scale (VAS), although the time required was almost the same for the two procedures. Till August 2007, 56 patients were successfully followed up for 12 to 26 months (mean, 18.6) and bone fusion was identified in all cases. Neither reduction loss nor loosening or breakage of the fixation occurred. Conclusion:, The technique of operating through an approach between the PVM is recommended for thoracolumbar fractures because it is much less invasive, can reduce blood loss and accelerates rehabilitation. [source] The Effect of treatment on survival in patients with advanced laryngeal carcinoma,THE LARYNGOSCOPE, Issue 7 2009Christine G. Gourin MD Abstract Objectives/Hypothesis: Over the last 2 decades, survival from laryngeal cancer has decreased. We sought to identify factors associated with decreased survival in laryngeal cancer. Methods: Patients diagnosed with laryngeal squamous cell carcinoma from 1985 to 2002 were retrospectively reviewed. Results: A total of 451 patients met study criteria. Five-year survival rates were 85% for stage I, 77% for stage II, 51% for stage III, and 35% for stage IV disease. Survival for patients with stage I,III disease was similar for patients treated operatively or nonoperatively (P = .4). However, patients with stage III disease treated nonoperatively had worse survival with radiation alone (XRT) compared to chemoradiation (CR) (P = .006). Patients with stage IV disease had significantly better survival with surgery (49%) than CR (21%) or XRT alone (14%) (P < .0001). Analysis by primary tumor stage demonstrated that survival for T1,T3 disease was independent of treatment modality (P = .2); however, for T4 patients, operative treatment was associated with significantly better survival (55%) than CR (25%) or XRT (0%) (P < .0001). Proportional hazards models confirmed significantly worse survival for stage IV, T4, N2 or N3 disease, and nonoperative treatment. For T4 disease, after controlling for nodal status, nonoperative treatment was the only significant predictor of worse survival. Conclusions: Primary surgical treatment is associated with improved survival for patients with stage IV disease and specifically T4 primary tumors. These data suggest that the observed national decrease in survival from laryngeal cancer may be due to a shift toward nonoperative treatment in that subset of patients with advanced primary disease. Laryngoscope, 2009 [source] Emergency laparoscopic splenectomy for haemoperitoneum because of ruptured primary splenic pregnancy: a case report and review of literatureANZ JOURNAL OF SURGERY, Issue 1-2 2010Federico Biolchini Abstract Background:, Primary abdominal pregnancies are potentially life-threatening, particularly without an accurate preoperative diagnosis. Case:, A 41-year-old woman presented to the emergency room with 2 days-lasting left upper quadrant abdominal pain, irradiated to the left shoulder. An urine ,-human chorionic gonadotropin test was positive. Transvaginal sonography raised a suspicion of ectopic pregnancy. The patient was then submitted to abdominal laparoscopy that revealed no sign of active bleeding or ectopic pregnancy. Because of worsening of abdominal pain and progressive anaemia, the patient underwent abdominal ultrasound and multislice computerized tomography scan (TC) that showed the presence of a mass at the superior splenic pole with haemoperitoneum. The patient was taken to the operating room and submitted to a laparoscopic total splenectomy. The post-operative course was uneventful, and the patient was discharged 8 days after intervention. Conclusion:, Abdominal pregnancy should be considered in the differential diagnosis of acute abdomen in women of reproductive age. Abdominal ultrasound and computerized tomography studies must be performed before operative treatment if an ectopic pregnancy is suspected and no intrauterine gestational sac could be showed on transvaginal sonography. [source] The relationship of physical trauma and surgical stress to menstrual dysfunctionAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2000William W K. To SUMMARY To evaluate the incidence and pattern of menstrual dysfunction in reproductive age group women suffering acute musculoskeletal trauma, 198 women between 15 and 50 years of age admitted consecutively into an acute orthopaedic unit were recruited over a 6-month period. The patients were then followed up for 6 months with menstrual diaries to compare their menstrual pattern with their preadmission status. Excluding those with significant menstrual problems before admission, the menstrual pattern remained normal in 135 (68%) (EM), while 12 (6%) developed polymenorrhoea (PM), and 51 (25%) had oligomenorrhoea or amenorrhoea (OAM) within the 6-month observation. The three groups did not differ in their mean age, body mass index, parity or age of menarche, but previous cycle lengths were shortest in the PM group (25.4 days, SD 7.64) (p<0.05) and history of amenorrhoea in the previous one year was most common in the OAM group (p<0.025). Univariate analysis showed the incidence of moderate to major trauma, operative treatment, longer operative time, general anaesthesia, blood transfusion and immobilisation were significantly higher in the PM and OAM groups compared to the unchanged group (p<0.05). A logistic regression model showed that general anaesthesia and longer surgical operations remained significantly related to the development of menstrual dysfunction. We conclude that the pattern of menstrual dysfunction after acute orthopaedic trauma appeared to be dictated by the woman's pre-existing menstrual characteristics and the stress of surgical treatment. [source] | ||||||||||