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Other Procedures (other + procedure)
Selected AbstractsCandidates' Ability to Identify Criteria in Nontransparent Selection Procedures: Evidence from an assessment center and a structured interviewINTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT, Issue 3 2007Cornelius J. König In selection procedures like assessment centers (ACs) and structured interviews, candidates are often not informed about the targeted criteria. Previous studies have shown that candidates' ability to identify these criteria (ATIC) is related to their performance in the respective selection procedure. However, past research has studied ATIC in only one selection procedure at a time, even though it has been assumed that ATIC is consistent across situations, which is a prerequisite for ATIC to contribute to selection procedures' criterion-related validity. In this study, 95 candidates participated in an AC and a structured interview. ATIC scores showed cross-situational consistency across the two procedures and accounted for part of the relationship between performance in the selection procedures. Furthermore, ATIC scores in one procedure predicted performance in the other procedure even after controlling for cognitive ability. Implications and directions for future research are discussed. [source] Synthesis of poly(phenylsilsesquioxane) having organostannyl groupsJOURNAL OF POLYMER SCIENCE (IN TWO SECTIONS), Issue 13 2001Yasutaka Matsubara Abstract Poly(phenylsilsesquioxane) (PSQ) having tributylstannyl groups (TBPSQ) was prepared from phenyltrimethoxysilane and bis(tributyltin) oxide [(Bu3Sn)2O] under basic conditions. The procedure, using a catalytic amount of basic reagent such as triethylamine, sodium hydroxide, or aqueous ammonia, afforded yields of TBPSQ based on Si in the range of 12,45% at a number-average molecular weight precipitated from ethanol of about 3500. In the other procedure, starting from PSQ with (Bu3Sn)2O, the incorporation of tributylstannyl groups into PSQ proceeded effectively in the presence of an acid catalyst such as methanesulfonic acid or sulfuric acid, giving TBPSQ in moderate yields of greater than 52%. Dibutyltin oxide, a bifunctional organotin compound, was also used, affording dibutylstannylated poly(phenylsilsesquioxane) (DBPSQ) without crosslinking. The highest ratio of Si and Sn contained in TBPSQ or DBPSQ, prepared under acidic conditions, was Si/Sn = 7/1. © 2001 John Wiley & Sons, Inc. J Polym Sci Part A: Polym Chem 39: 2125,2133, 2001 [source] Nontransplant Surgical Options for Congestive Heart FailureCONGESTIVE HEART FAILURE, Issue 1 2003Aftab R. Kherani MD A wide array of surgical options are currently available for the treatment of congestive heart failure ranging from traditional coronary artery bypass grafting to total artificial heart implantation. The indications for each procedure depend on the severity of disease and the individual patient's desires. Some surgical options are indicated for patients with moderate disease and prevent worsening heart failure, whereas other procedures are limited to patients who will only survive with high-risk surgery. Ongoing technologic advances are increasing the number of patients that benefit from the reparative surgical treatment of congestive heart failure. [source] Do family members interfere in the delivery of care when present during invasive paediatric procedures in the emergency department?EMERGENCY MEDICINE AUSTRALASIA, Issue 3 2007Glenn Ryan Abstract Objective:, To determine whether family members interfere with patient care when present during invasive procedures performed on their children in the ED. Methods:, A prospective observational study of consecutive cases of procedural sedation of children aged between 12 months and 16 years was conducted between March 2002 and March 2006 in the ED of a secondary-level regional hospital in south-east Queensland. Procedures performed included laceration repair, fracture reduction, foreign body removal and abscess incision and drainage. Parents/primary caregivers were encouraged to stay with their child. A stepwise explanation of the procedure and sedation to be used was undertaken, informed consent obtained and telephone follow up attempted 5,14 days post procedure. Results:, Six hundred and fifty-two patient encounters with parents or primary caregivers present for the procedure were included for a total of 656 procedures: 234 laceration repairs, 250 fracture reductions, 85 foreign body removals, 33 abscess incision and drainages, 14 dislocation reductions and 40 other procedures. Telephone follow up was successful in 65% (424) of cases. The mean age was 6.5 years. Family member interference occurred in one case (0.15%, 95% confidence interval 0,0.73%). In 17 cases (2.68%, 95% confidence interval 2.1,5.9%) family members present expressed concerns about the procedure during the telephone follow up but had not interfered at the time of the procedure. There were no significant differences between the concerned parents at follow up and the study group across key patient variables such as child's age (P = 0.369), weight (P = 0.379), respiratory rate (P = 0.477), sex (P = 0.308), procedure indication (P = 0.308) and airway manoeuvres (P = 0.153). Conclusion:, When family members are encouraged to stay for invasive procedures performed on their child, and careful explanation of the procedure, sedation, possible complications, choice of medication for sedation and possible side-effects is undertaken, family member interference is extremely rare. [source] Analysis of single-locus tests to detect gene/disease associations,GENETIC EPIDEMIOLOGY, Issue 3 2005Kathryn Roeder Abstract A goal of association analysis is to determine whether variation in a particular candidate region or gene is associated with liability to complex disease. To evaluate such candidates, ubiquitous Single Nucleotide Polymorphisms (SNPs) are useful. It is critical, however, to select a set of SNPs that are in substantial linkage disequilibrium (LD) with all other polymorphisms in the region. Whether there is an ideal statistical framework to test such a set of ,tag SNPs' for association is unknown. Compared to tests for association based on frequencies of haplotypes, recent evidence suggests tests for association based on linear combinations of the tag SNPs (Hotelling T2 test) are more powerful. Following this logical progression, we wondered if single-locus tests would prove generally more powerful than the regression-based tests? We answer this question by investigating four inferential procedures: the maximum of a series of test statistics corrected for multiple testing by the Bonferroni procedure, TB, or by permutation of case-control status, TP; a procedure that tests the maximum of a smoothed curve fitted to the series of of test statistics, TS; and the Hotelling T2 procedure, which we call TR. These procedures are evaluated by simulating data like that from human populations, including realistic levels of LD and realistic effects of alleles conferring liability to disease. We find that power depends on the correlation structure of SNPs within a gene, the density of tag SNPs, and the placement of the liability allele. The clearest pattern emerges between power and the number of SNPs selected. When a large fraction of the SNPs within a gene are tested, and multiple SNPs are highly correlated with the liability allele, TS has better power. Using a SNP selection scheme that optimizes power but also requires a substantial number of SNPs to be genotyped (roughly 10,20 SNPs per gene), power of TP is generally superior to that for the other procedures, including TR. Finally, when a SNP selection procedure that targets a minimal number of SNPs per gene is applied, the average performances of TP and TR are indistinguishable. Genet. Epidemiol. © 2005 Wiley-Liss, Inc. [source] An optimized method to separate reticulocytes from peripheral blood for molecular analysisINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 3 2009R. PETRUZZELLI Summary A method based on immunomagnetic sorting of reticulocytes from peripheral blood was set up and combined to a commercial extraction kit for the isolation of total RNA from whole blood. This procedure resulted in high-quality RNA samples suitable for molecular analysis. We used this procedure to analyse erythroid-specific transcripts, starting from peripheral blood samples, to search for differently expressed mRNAs in patients with hereditary persistence of foetal haemoglobin. After erythrocyte lysis, CD15+and CD45+ peripheral cells were negatively sorted to remove leucocyte populations that could have affected the subsequent screening procedure. The cell sorting and RNA extraction procedure was completed within 1,2 h of erythrocyte lysis, which represents a consistent saving of time compared with other procedures. Moreover, it produced 1 ,g of total RNA per ml of blood samples, which is sufficient for molecular analysis. Therefore, our method is a reliable and efficient tool to isolate RNA from specific cell subpopulations poorly represented in peripheral blood, particularly when accurate detection and characterization of highly unstable and poorly expressed molecules is required. [source] Change in subgingival microbial profiles in adult periodontitis subjects receiving either systemically-administered amoxicillin or metronidazoleJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2001M. Feres Abstract Aim: The current investigation evaluated changes in levels and proportions of 40 bacterial species in subgingival plaque samples during, immediately after and up to 1 year after metronidazole or amoxicillin therapy combined with SRP. Method: After baseline clinical and microbiological monitoring, 17 adult periodontitis subjects received full mouth SRP and 14 days systemic administration of either metronidazole (250 mg, TID, n=8) or amoxicillin (500 mg, TID, n=9). Clinical measurements including % of sites with plaque, gingival redness, bleeding on probing and suppuration, pocket depth (PD) and attachment level (AL) were made at baseline, 90, 180 and 360 days. Subgingival plaque samples were taken from the mesial surface of all teeth in each subject at baseline, 90, 180 and 360 days and from 2 randomly selected posterior teeth at 3, 7, and 14 days during and after antibiotic administration. Counts of 40 subgingival species were determined using checkerboard DNA-DNA hybridization. Significance of differences over time was determined using the Quade test and between groups using ANCOVA. Results: Mean PD was reduced from 3.22±0.12 at baseline to 2.81±0.16 (p<0.01) at 360 days and from 3.38±0.23 mm to 2.80±0.14 mm (p<0.01) in the amoxicillin and metronidazole treated subjects respectively. Corresponding values for mean AL were 3.21±0.30 to 2.76±0.32 (p<0.05) and 3.23±0.28 mm to 2.94±0.23 mm (p<0.01). Levels and proportions of Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola were markedly reduced during antibiotic administration and were lower than baseline levels at 360 days. Counts (×105, ±SEM) of B. forsythus fell from baseline levels of 0.66±0.16 to 0.04±0.02, 0.13±0.04, 0.10±0.03 and 0.42±0.19 in the amoxicillin group at 14, 90, 180 and 360 days respectively (p<0.001). Corresponding values for metronidazole treated subjects were: 1.69±0.28 to 0.02±0.01, 0.20±0.08, 0.22±0.06 and 0.22±0.08 (p<0.001). Counts of Campylobacter species, Eubacterium nodatum, Fusobacterium nucleatum subspecies, F. periodonticum and Prevotella nigrescens were also detected at lower mean levels during and immediately after therapy, but gradually increased after withdrawal of the antibiotics. Members of the genera Actinomyces, Streptococcus and Capnocytophaga were minimally affected by metronidazole. However, amoxicillin decreased the counts and proportions of Actinomyces species during and after therapy. Conclusions: The data suggest that metronidazole and amoxicillin are useful in rapidly lowering counts of putative periodontal pathogens, but must be accompanied by other procedures to bring about periodontal stability. Zusammenfassung Ziel: Die gegenwärtige Untersuchung evaluiert die Veränderungen in den Niveaus und Proportionen von 40 bakteriellen Spezies in subgingivalen Plaqueproben während, sofort nach und bis zu 1 Jahr nach Metronidazol- oder Amoxicillintherapie in Kombination mit SRP. Methoden: Nach der klinischen und mikrobiologischen Basisuntersuchung erhielten 17 erwachsene Personen mit Parodontitis eine vollständige SRP und 14 Tage eine systemische Gabe von entweder Metronidazol (250 mg, TID, n=8) oder Amoxicillin (500 mg, TID, n=9). Die klinischen Messungen schlossen die Prozentwerte der Flächen mit Plaque, der gingivalen Rötung, der Provokationsblutung und Suppuration, der Sondierungstiefe (PD) und des Stützgewebeniveaus (AL) ein. Die Messungen wurden zur Basis, am 90., am 180. und 360. Tag gemacht. Die subgingivalen Plaqueproben wurden von der mesialen Oberfläche aller Zähne zur Basis, zum 90., zum 180. und 360. Tag von jedem Probanden genommen sowie von 2 zufällig ausgesuchten posterioren Zähnen am Tag 3, 7 und 14 während und nach der Antibiotikaverordnung. Die Mengen von 40 subgingivalen Spezies wurden unter Nutzung einer checkerboard DNA-DNA Hybridisation bestimmt. Die Signifikanzen der Differenzen über die Zeit wurden mit dem Quade-Test und zwischen den Gruppen mit der ANCOVA überprüft. Ergebnisse: Die mittleren PD reduzierten sich von 3.22±0.12 mm zur Basis zu 2.81±0.16 mm (p<0.01) zum 360. Tag und von 3.38±0.23 mm zu 2.80±0.14 mm (p<0.01) bei den mit Amoxicillin bzw. mit Metronidazol behandelten Patienten. Korrespondierende Werte für die mittleren AL waren 3.21±0.30 zu 2.76±0.32 (p<0.05) und 3.23±0.28 mm zu 2.94±0.23 mm (p<0.01). Die Niveaus und die Verteilung von Bacteroides forsythus, Porphyromonas gingivalis und Treponema denticola wurden während der Antibiotikabehandlung deutlich reduziert und waren am 360. Tag niedriger als zur Basis. Die Mengen (×105, ±SEM) von B. forsythus fielen von der Basis von 0.66±0.16 auf 0.04±0.02, 0.13±0.04, 0.10±0.03 und 0.42±0.19 in der Amoxicillin Gruppe an den Tagen 14, 90, 180 und 360 (p<0.001). Korrespondierende Werte für die mit Metronidazol behandelten Personen waren: 1.69±0.28 zu 0.02±0.01, 0.20±0.08, 0.22±0.06 und 0.22±0.08 (p<0.001). Die Mengen von Campylobacter sp., Eubacterium nodatum, Fusobacterium nucleatum subspecies, F. peridonticum und Prevotella nigrescens waren in den mittleren Niveaus während und sofort nach der Therapie auch niedriger, aber graduell erhöht nach Absetzen der Antibiotika. Mitglieder der Klassen Actinomyces, Streptococcus und Capnocytophaga wurden durch Metronidazol minimal beeinflußt. Jedoch verringerte Amoxicillin die Mengen und Verhältnisse von Actinomyces sp. während und nach der Therapie. Zusammenfassung: Die Daten suggerieren, daß Metronidazol und Amoxicillin in der schnellen Verringerung der Mengen von putativen parodontalen Pathogenen nützlich sind, daß dies aber durch andere Prozeduren begleitet wurden muß, um parodontale Stabilität zu erbringen. Résumé But: La présente recherche a évalué les modifications de niveaux et de proportions de 40 espèces bactériennes dans des prélèvements de plaque sous gingivale pendant, immédiatement après, et jusqu'à un an après un traitement par métronidazole ou amoxicilline associè avec le détartrage/surfaçage radiculaire. Méthode: Après avoir relevé les paramètres cliniques et microbiologiques initiaux, 17 sujets atteints de parodontite de l'adulte ont subi un détartrage/surfaçage radiculaire de toute la bouche et l'administration systémique pendant 14 jours de métronidazole (250 mg, 3× fois par jour, n=8) ou d'amoxicilline (500 mg, 3× par jour, n=9). Les mesures cliniques relevées initialement, à 90 jours, à 180 jours, et à 360 jours, étaient: le % de sites avec de la plaque, la rougeur gingivale, le saignement au sondage et la suppuration, la profondeur de poche (PD) et le niveau d'attache (AL). Des échantillons de plaque sous gingivale étaient prélevés sur la surface mésiale de toutes les dents, chez chaque sujet, initialement, à 90 jours, à 180 jours, et á 360 jours, et sur 2 dents postérieures choisies au hasard à 3, 7, et 14 jours pendant et après l'administration d'antibiotique. Le comptage de 40 expèces sous gingivales fut déterminé par la technique de l'hybridisation en damier DNA-DNA. La signification des différences au cours du temps fut déterminée par le test de Quade et entre les groupes par ANCOVA. Résultats: La profondeur moyenne des poches a étê réduite de 3.22±0.12 mm initialement à 2.81±0.16 mm (p<0.01) à 360 jours et de 3.38±0.28 mm à 2.80±0.14 mm (p<0.01) dans les groupes amoxicilline et metronidazole, respectivement. Les valeurs correspondantes pour AL étaient 3.21±0.30 à 2.76±0.32 (p<0.05) et 3.23±0.28 à 2.94±0.23 (p<0.01). Les niveau de B. forsythus, P. gingivalis et T. denticola, étaient fortement réduits pendant l'administration d'antibiotique et restaient plus bas à 360 jours qu'initialement. Les comptages (×105, ±SEM) de B. forsythus tombaient de niveaux initiaux de 0.66±0.16 à 0.04±0.02, 0.13±0.04, 0.10±0.03 et 0.42±0.19 dans le groupe amoxicilline à 14 jours, 90 jours, 180 jours, et 360 jours, respectivement (p<0.001). Les valeurs correspondantes pour les sujets traits par métronidazole étaient de: 1.69±0.28 à 0.02±0.01, 0.20±0.08, 0.22±0.06 et 0.22±0.08 (p<0.001). Les comptages des espèces Camopylobacter, Eubacterium nodatum, des espèces Fusobacterium nodatum, F. periodonticum et Prevotella nigrescensétaient également détectés à des niveaux moyens plus bas pendant, et immédiatement après traitement, mais augmentaient graduellement après cessation des antibiotiques. Les membres des genres Actinomyces, Streptococcus et Capnocytophagaétaient très peu affectés par le métronidazole. Par contre, l'amoxicilline diminuait les comptage et les proportions des Actinomyces pendant et après le traitement. Conclusions: Ces données suggèrent que le métronidazole et l'amoxicilline sont utiles pour diminuer rapidement les comptages des pathogènes parodontaux putatifs, mais qu'ils doivent être accompagnés d'autres procédés pour apporter une stabilité parodontale. [source] Aging well , the role of minimally invasive aesthetic dermatological procedures in women over 65JOURNAL OF COSMETIC DERMATOLOGY, Issue 1 2010Uwe Wollina MD Summary Background, The western world is getting older. Aging well has become the new target of preventative medicine. Aesthetic dermatology can contribute to this quest. Females over 65 represent an important and growing group of consumers of cosmetic procedures. In this group, there is a paucity of scientific evaluation of aesthetic procedures. Objective, To review the use of minimally invasive procedures for facial rejuvenation in women over 65. Methods, Drawing from both the literature and personal experience, the opportunities, modifications, and limitations of minimally invasive techniques for facial rejuvenation in older women are considered. Results, In this older age group, dermal fillers, chemical and laser peels, and nonablative photorejuvenation remain useful and can each be used as stand-alone treatments. In this age group, botulinum toxin (BTX) injections are more often used in combination with other procedures. Conclusions, With respect to aesthetic procedures, women over 65 are different from younger women. More scientific investigation is necessary to better meet needs of this growing part of the population. Available data suggest that aesthetic dermatology can make a major contribution to the complex matter of aging well. [source] Dynesthetic and Dentogenic Concept RevisitedJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 3 2002WILLIAM S. JAMESON BS ABSTRACT: The dynesthetic and dentogenic concept, when applied, provides a more natural, harmonious prosthesis, which not only is desired by patients, but also is a quality of care they deserve. Outstanding esthetics can be achieved by simple guidelines, using tooth molds specifically sculpted for males and females, arranging prosthetic teeth to correspond with personality and age and sculpting the matrix (visible denture base) with more natural contours. There is no reason for edentulous individuals to be provided with care of any less quality than that available with other procedures, such as crowns, bridges, veneers, or implant restorations. Providing this upscale product can be rewarding and satisfying to patient and operator alike. This concept produces superior results no matter what posterior occlusal scheme is employed but, in the opinion of the author, works best when used in conjunction with a noninterceptive linear occlusion approach (not to be confused with lingualized occlusion), which precludes anterior contact. CLINICAL SIGNIFICANCE: Dentogenics provides an approach to esthetics in prosthodontics that enables the dentist to create a restoration in harmony with the patient's objective personality. This concept considers gender, I age, and personality to restore the patient's dignity and unique individuality that has been missing in far too many prostheses. [source] Determination of Sudan IV in hot chilli powder with luminol/dissolved oxygen chemiluminescence systemJOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 2 2010Lichuan Niu Abstract BACKGROUND: A green, simple and sensitive flow injection chemiluminescence (CL) procedure is proposed for the determination of Sudan dyes. The method is based on the finding that Sudan I, II, III and IV markedly enhance the CL intensity of the luminol/dissolved oxygen reaction. RESULTS: The increment in CL intensity was proportional to the concentration of Sudan I, II, III and IV, giving calibration graphs linear over the ranges 0.007,1, 0.5,30, 1,10 and 0.7,300 ng mL,1 respectively (R2 , 0.9981), with limits of detection of 0.002, 0.2, 0.3 and 0.2 ng mL,1 respectively. At a flow rate of 2 mL min,1, complete determination of Sudan dyes, including sampling and washing, could be accomplished in 40 s, with relative standard deviations of less than 5% (n = 7). CONCLUSION: The proposed method was successfully applied to the determination of Sudan IV in contaminated hot chilli powder, with recoveries ranging from 89.3 to 108.4%. The possible mechanism of enhancement of the lumininol/dissolved oxygen CL reaction by Sudan IV can be attributed to the acceleration of electron transfer. Compared with other procedures, the proposed CL method offers the highest sensitivity and the least reagent consumption for the determination of Sudan IV. Copyright © 2009 Society of Chemical Industry [source] Seasonal Unit Root Tests Under Structural Breaks,JOURNAL OF TIME SERIES ANALYSIS, Issue 1 2004Uwe Hassler C12; C22 Abstract., In this paper, several seasonal unit root tests are analysed in the context of structural breaks at known time and a new break corrected test is suggested. We show that the widely used HEGY test, as well as an LM variant thereof, are asymptotically robust to seasonal mean shifts of finite magnitude. In finite samples, however, experiments reveal that such tests suffer from severe size distortions and power reductions when breaks are present. Hence, a new break corrected LM test is proposed to overcome this problem. Importantly, the correction for seasonal mean shifts bears no consequence on the limiting distributions, thereby maintaining the legitimacy of canonical critical values. Moreover, although this test assumes a breakpoint a priori, it is robust in terms of misspecification of the time of the break. This asymptotic property is well reproduced in finite samples. Based on a Monte-Carlo study, our new test is compared with other procedures suggested in the literature and shown to hold superior finite sample properties. [source] EOG correction: A comparison of four methodsPSYCHOPHYSIOLOGY, Issue 1 2005Rodney J. Croft Abstract EOG correction is a class of techniques that account for ocular artifact in the electroencephalogram (EEG) by subtracting electrooculographic data from the EEG. The purpose of this study was to evaluate four of these correction techniques (Verleger, Gasser, & Möcks, 1982 [VGM]; Gratton, Coles, & Donchin, 1983 [GCD]; Semlitsch, Presslich, Schuster, & Anderer, 1986 [SPSA]; Croft & Barry, 2000 [CB]). Blinks, vertical eye movements (VEM), and horizontal eye movements (HEM) from 26 subjects were corrected using these techniques, and eye movement event-related potentials computed to aid validation. HEMs were corrected better by CB, VGM/GCD then SPSA, VEMs by CB, VGM/GCD then SPSA, and blinks by CB, SPSA, GCD and then VGM, with the advantage of CB substantial for blinks (,2>.72), VEMs (,2>.60), and HEMs (,2>.27). It is argued that the CB procedure adequately accounts for ocular artifact in the EEG. Reasons for the limitations of the other procedures are discussed. [source] Assessing the magnitude of the concentration parameter in a simultaneous equations modelTHE ECONOMETRICS JOURNAL, Issue 1 2009D. S. Poskitt Summary, This paper provides the practitioner with a method of ascertaining when the concentration parameter in a simultaneous equations model is small. We provide some exact distribution theory for a proposed statistic and show that the statistic possesses the minimal desirable characteristics of a test statistic when used to test that the concentration parameter is zero. The discussion is then extended to consider how to test for weak instruments using this statistic as a basis for inference. We also discuss the statistic's relationship to various other procedures that have appeared in the literature. [source] Use of a single silastic chest drain following thoracotomy: initial evaluationANZ JOURNAL OF SURGERY, Issue 8 2005Nand K. Kejriwal Background: It is standard practice to use multiple large bore semi-rigid chest tubes to drain the pleural cavity following thoracic procedures. These can cause pain and discomfort at the insertion site. Methods: We describe our experience with the use of a single small silastic drain following thoracotomy. From November 2001 to November 2003, size19-F silastic chest tubes (Blake drains) were used for drainage of the pleural cavity in 37 patients at our institution. The patients ranged in age from 18 to 81 years (mean 65). The operations included 22 lobectomies, two bilobectomies, 10 wedge resections, and three other procedures. Results: Total drainage in each patient ranged from 420 to 5440 mL (mean 1387 mL). Tubes were left in place for an average of 4.3 days (range 1,12). The average postoperative length of stay was 7.6 days (range 3,44, median 5). Three patients required insertion of an additional tube for dislodgement, persistent air leak, and bronchopleural fistula, respectively. These complications occurred among the first 15 patients in the present series. None of the patients had persistent pleural effusion. Subjectively, these tubes were more comfortable for the patients and were easier to remove. Summary: The use of a single, small silastic chest drains following thoracotomy may be safe and effective in draining both fluid and air, though an additional tube may be necessary for persistent leaks. [source] SEVERE TRAUMA CAUSED BY STABBING AND FIREARMS IN METROPOLITAN SYDNEY, NEW SOUTH WALES, AUSTRALIAANZ JOURNAL OF SURGERY, Issue 4 2005Kenneth Wong Background: Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre. Methods: Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed. Results: Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15,82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty-two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy-four operations were performed , laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty-eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1,107 days). The total mortality rate for the severely injured patients was 21%, with gun-related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination. Conclusions: Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma. [source] PILONIDAL DISEASE IN SINGAPORE: CLINICAL FEATURES AND MANAGEMENTANZ JOURNAL OF SURGERY, Issue 3 2000H. C. Lee Background: Pilonidal disease has not been well documented in Asian people. The aims of the present study were to investigate any variations in the clinical features and effectiveness of various surgical treatments in such a population. Methods: A prospectively collected computerized database of 61 consecutive patients admitted to a specialist colorectal unit over a 9-year period was studied. The five methods of surgical treatment used during this period (incision and drainage; laying open; marsupialization; primary closure; and the flap procedure) were compared. Results: There were 38 men and 23 women with a mean age of 27 ± 1.02 years. Pilonidal disease was significantly more common among the Indian people (52.5% of patients) than the other ethnic races in the Singaporean community (P < 0.001). Chronic discharging sinuses were the most common presentation (93.4%). There were no differences between the various surgical techniques employed with regard to the time required for wound healing (mean: 48 ± 21 days) and recurrence rates (4/61, 6.6%). Wound dehiscence after primary wound closure (10%) and flap procedures (42%) meant that the overall healing rate was not faster than when the wound was just laid open. Furthermore, flap procedures required a longer hospitalization than other procedures (P = 0.005). Conclusion: Pilonidal disease was more common among Indian people, the more hirsute among the Singaporean population. Primary closure and flap procedure did not improve overall wound healing because of dehiscence. [source] Intensive Imaging Assessment for Successful Minimally Invasive Cardiac SurgeryARTIFICIAL ORGANS, Issue 5 2002Masaya Kitamura Abstract: To clarify special imaging assessment that is useful for minimally invasive cardiac surgery (MICS), we examined 141 cases of MICS operations with ministernotomy or minithoracotomy. In the 141 patients, 62 valve, 42 coronary, 37 congenital heart, and 2 other procedures were successfully completed without conversion to full sternotomy. Preoperative chest x-ray, computed tomography, and/or magnetic resonance imaging were necessary for determining the level of ministernotomy, especially in aortic valve operations. Transthoracic echocardiography was useful for selecting procedures of mitral valve or intracardiac repair through the MICS approach. Intraoperative transesophageal echocardiography was essential for continuous monitoring of cardiac function, intracardiac flow, air bubbles, and so forth. The above results suggest that intensive imaging assessment might be very important for successful MICS operations with ministernotomy or minithoracotomy and that extensive indications for this technique exist for various cardiovascular diseases. [source] Survey of surgical skills of RANZCOG traineesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009Andreas OBERMAIR Background: In Australia, the Integrated Training Program (ITP) of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) offers training in obstetrics and gynaecology. There is anecdotal concern among trainees and Fellows that the surgical component of training is inadequate, with new specialists lacking the confidence and competence to perform many ,standard' surgical procedures. These concerns have not previously been quantified in Australia and New Zealand. Aim: To determine trainees' subjective competence and confidence with surgical procedures and trainees' satisfaction with their surgical training. Methods: All 430 active RANZCOG trainees and 108 Fellows elevated within the previous two years were invited to complete a self-administered questionnaire (65% response rate), which assessed details of procedures performed and confidence to perform them; satisfaction with the surgical training; and perceived teaching ability of the supervising consultants. Results: Those in ITP year 6 rated their confidence high (, 4 of 5) for procedures performed very frequently, but lower for other procedures. No procedure regarding the management of complications reached a confidence score of , 4. Teaching abilities were rated best for obstetric procedures, with 54% rating their consultants' teaching ability as ,excellent'; but for laparoscopic procedures and procedures dealing with complications, 21.2% and 23.4% of respondents rated their consultants' teaching ability as ,poor', respectively. Conclusions: Advanced trainees lacked confidence in a range of surgical procedures; and possible weaker areas were identified in the teaching experience of trainers. These limitations must be addressed by medical educators and training program coordinators. [source] Experience with non-cycled artificial urinary sphinctersBJU INTERNATIONAL, Issue 7 2004C.D.A. Herndon Papers in this section review experience with artificial urinary sphincters, hypospadias, and the exstrophy/epispadias complex. Also, in keeping with a significant theme of urological trauma in this issue of the journal, authors from Mansoura evaluate the late renal functional and morphological evaluation of high-grade renal injuries in children after conservative treatment. OBJECTIVE To report our experience in children and adolescents with a non-cycled artificial urinary sphincter. While some children with the AUS can void, others require clean intermittent catheterization (CIC) through the sphincter or an alternative site for catheterization; in some of the latter we have either not cycled (pumped) an activated AUS or the AUS has failed, and there is concern about ischaemia in some adults with a non-cycled AUS. PATIENTS AND METHODS In all, 143 patients who had an AUS placed between 1980 and 2002 were reviewed retrospectively; 15 (10 boys and five girls) no longer cycled (pumped) their AUS. The mean age at AUS insertion was 11 years and the mean (range) follow-up after insertion was 10.4 (1.64,22.2) years. The diagnoses included myelomeningocele in 11, sacral agenesis in three and cloaca in one. Nine patients have an activated functioning AUS and in six the AUS does not function; in the first nine the sphincter has not routinely been cycled (pumped) for a mean (range) of 1.6 (0.6,2.9) years. In the other six with a nonfunctioning AUS the mean (range) observation period is 6.4 (1.5,10) years since the system has not functioned. RESULTS All patients were completely continent, including the six with a nonfunctioning AUS. After inserting the AUS, two patients voided in combination with CIC (one each urethral and abdominal stoma) and 13 emptied by CIC (nine abdominal stoma, four urethral). There was a mechanical complication in eight patients; three had the AUS repaired and are dry, and five are dry with no repair. In one patient the AUS was never activated. To date there has been no erosion of the cuff in any of the 15 patients with a non-cycled AUS. CONCLUSION The AUS remains an extremely reliable procedure to achieve continence in children and young adults. It is versatile and can be combined with other procedures that provide an alternative means for catheterization. While some have noted the need to routinely cycle the AUS to prevent erosion, this has not been our experience in these 15 patients. [source] Sodium hyaluronate gels as a drug-release system for corticosteroids: release kinetics and antiproliferative potential for glaucoma surgeryACTA OPHTHALMOLOGICA, Issue 8 2008Martin S. Spitzer Abstract. Purpose:, To evaluate the release kinetics, biocompatibility and antiproliferative potential of a concentrated hydrophilic steroid formulation from commercially available sodium hyaluronate gels as a potential adjunct in glaucoma surgery. Methods:, Dexamethasone and sodium hyaluronate 1% (Healon) and sodium hyaluronate 2.3% (Healon 5) were mixed to yield sodium hyaluronate formulations containing dexamethasone in concentrations of 4,20 mg/ml (7.7,38 mm). Non-cumulative and cumulative release into balanced salt solution (BSS) or phosphate buffered saline (PBS) was measured spectrophotometrically over 2,6 days. For cytotoxicity assays, human tenon fibroblasts (HTFB) and human retinal pigment epithelium cells (ARPE19) were cultured in a serum-deficient medium to ensure a static milieu; 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazoliumbromide (MTT) assay and Live/DeadÔ cell-mediated cytotoxicity assay were used to exclude cytotoxicity. Cellular proliferative activity was monitored by 5,-bromo-2,-deoxyuridine (BrdU)-incorporation into cellular DNA. Results:, The release kinetics from sodium hyaluronate 1% and 2.3% were almost identical. Steady state was achieved after approximately 44 hrs in non-cumulative measurements. The release plotted as a function of the square root of time was consistent with a largely diffusion-controlled release system. No cytotoxicity could be observed. Dexamethasone-loaded sodium hyaluronate showed a significant antiproliferative effect on HTFB and ARPE19 cells. Conclusion:, Dexamethasone-loaded sodium hyaluronate shows extended release of steroid over almost 2 days in concentrations high enough to inhibit the proliferation of HTFB and RPE cells without evoking cytotoxic effects. Thus, this formulation may be an easy-to-prepare adjunct in glaucoma surgery or other procedures in which cellular growth inhibition is desired. [source] An unusual innervation of pectoralis minor and major muscles from a branch of the intercostobrachial nerveCLINICAL ANATOMY, Issue 4 2006Marios Loukas Abstract Variations of the branching pattern of the intercostobrachial nerve have been known to complicate dissection during mastectomy and other procedures involving the axilla. We present a unilateral case of a 73-year-old Caucasian female, in which the intercostobrachial nerve gives rise to an additional medial pectoral branch, which partially innervates the pectoralis minor muscle, as well as the abdominal head of pectoralis major muscle. Clinical consequences of such a variation may include motor losses, in addition to the commonly reported sensory losses, resulting from accidental or intentional dissection of the intercostobranchial nerve. Clin. Anat. 19:347,349, 2006. © 2006 Wiley-Liss, Inc. [source] Anatomical variations of the sural nerveCLINICAL ANATOMY, Issue 4 2002Pasuk Mahakkanukrauh Abstract An anatomical study of the formation of the sural nerve (SN) was carried out on 76 Thai cadavers. The results revealed that 67.1% of the SNs were formed by the union of the medial sural cutaneous nerve (MSCN) and the lateral sural cutaneous nerve (LSCN); the MSCN and LSCN are branches of the tibial and the common fibular (peroneal) nerves, respectively. The site of union was variable: 5.9% in the popliteal fossa, 1.9% in the middle third of the leg, 66.7% in the lower third of the leg, and 25.5% at or just below the ankle. One SN (0.7%) was formed by the union of the MSCN and a different branch of the common fibular nerve, running parallel and medial to but not connecting with the LSCN, which joined the MSCN in the lower third of the leg. The remaining 32.2% of the SNs were a direct continuation of the MSCN. The SNs ranged from 6,30 cm (mean = 14.41 cm) in length with a range in diameter of 3.5,3.8 mm (mean = 3.61 mm), and were easily located 1,1.5 cm posterior to the posterior border of the lateral malleolus. The LSCNs were 15,32 cm long (mean = 22.48 cm) with a diameter between 2.7,3.4 mm (mean = 3.22 mm); the MSCNs were 17,31 cm long (mean = 20.42 cm) with a diameter between 2.3,2.5 mm (mean = 2.41 mm). Clinically, the SN is widely used for both diagnostic (biopsy and nerve conduction velocity studies) and therapeutic purposes (nerve grafting) and the LSCN is used for a sensate free flap; thus, a detailed knowledge of the anatomy of the SN and its contributing nerves are important in carrying out these and other procedures. Clin. Anat. 15:263,266, 2002. © 2002 Wiley-Liss, Inc. [source] | |||||||||||||||||||