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Post Surgery (post + surgery)
Selected AbstractsThe Family Experience of "Sudden Health": The Case of Intractable EpilepsyFAMILY PROCESS, Issue 4 2003DAVID B. SEABURN Ph.D. This article reports the experience of "sudden health" among six families who participated in an exploratory qualitative study of families with a member who elects to have corrective surgery for intractable epilepsy. Families were interviewed pre- and post surgery (6,8months) and the interviews were analyzed using a constant comparative methodology. Findings indicated that (1) families were organized in two primary ways (nesting and crisis) to deal with epilepsy and the aftermath of surgery and (2) "sudden health" had differing effects on these families depending on their organizational style, emotional communication process, and developmental dynamics. [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] Diaphragmatic hernia in horses: 44 cases (1986,2006)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2009Samantha K. Hart BVMS (Hons) Abstract Objectives , To present a case series of horses diagnosed with diaphragmatic hernia, and to determine the significance of (1) historical information, examination findings, and laboratory data; and (2) exploratory laparotomy or necropsy findings on short- and long-term outcome. Setting , University Referral Hospital. Design , Retrospective study. Animals , Forty-four horses/foals admitted between 1986 and 2006 with a diagnosis of diaphragmatic hernia made either at exploratory laparotomy or necropsy. Interventions , None. Measurements and Main Results , Information from the medical records included history, clinical examination findings at presentation, and findings of exploratory laparotomy or necropsy. Logistic regression or the Fisher exact test was used to determine factors associated with survival. Outcome was defined as survival to discharge (short-term survival), and long-term survival was defined as horses alive at least 1-year post surgery. Of the 44 horses, 18 died or were euthanized before surgery. Twenty-six were taken to surgery, 17 were euthanized. Nine horses recovered from anesthesia, 7 of which survived to hospital discharge. Of these, 5 were alive at long-term follow-up. Survival was significantly associated with the age of the horse (,2 y old) at presentation, presence of normal peritoneal fluid at presentation, amount of compromised viscera at surgery (<50% small intestine), and the size (<10 cm) and location (ventral) of the diaphragmatic tear. Conclusion , This study confirms that size and location of the lesion do play a significant role in prognosis. And, although the prognosis for horses with diaphragmatic hernia is poor, if horses have operable lesions there is a fair prognosis for long-term survival. [source] Correlation of single photon emission computed tomography with pathology and seizure outcome in children undergoing epilepsy surgeryNEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 2 2002J. H. Cross Introduction:, Single photon emission computed tomography (SPECT) imaging regional cerebral blood flow (rCBF) can help localize the seizure focus in partial epilepsies during presurgical evaluation. Few studies have explored the possible relationship between preoperative SPECT and underlying pathology, or any relationship to postsurgical outcome. Study group:, Thirty-five children with medically intractable epilepsy undergoing resective surgery between the ages of 11 months and 18 years had presurgical ictal and interictal rCBF and post surgery follow up of 3,6 years. Results:, Pathological examination revealed 13 to have hippocampal sclerosis (HS): of these 11 had relatively low interictal rCBF perfusion on the side of seizure onset, and eight had hyperfusion ictally. Eight children had morphological evidence of cortical dysplasia: all had a localizing ictal rCBF concordant with the area resected whereas only six demonstrated localized reduction in perfusion on interictal rCBF. All three patients with Rasmussens encephalitis had informative rCBF scans, concordant with the seizure focus. However, infarct, tumours and nonspecific pathology demonstrated poor localization of the seizure focus. No SPECT parameter correlated independently with outcome, although overall the HS group had the best outcome, particularly those with localizing ictal SPECT. Comment:, Ictal SPECT appears predictive of underlying cortical dysplasia. Although in this small group of HS in children, ictal SPECT added little to interictal SPECT for seizure localization, it may be useful in the prediction of outcome. SPECT adds little to the evaluation of children being considered for hemispherectomy over and above the abnormalities detectable on MRI scan. [source] Antenatal urodynamic studies in the fetal lamb: experimental protocol and preliminary resultsPRENATAL DIAGNOSIS, Issue 3 2003Renaud de Tayrac Abstract Objectives To set up a fetal lamb model for intrauterine fetal urodynamic studies. Methods Fourteen fetal lambs underwent placement of a bladder catheter at a mean gestational age of 87 days. Three fetuses also had a partial urethral obstruction by the simultaneous placement of a peri-urethral constricting ring. Urodynamic and ultrasound studies were performed weekly by the filling cystometry method. Results Hundred and six voiding cycles were recorded during 25 urodynamic studies between 84- and 133-days gestation. All voiding profiles were biphasic with a mean duration of 4.2 min (range 1,10), a mean voiding pressure of 23 cm of water (range 7,33) and a mean periodicity of 19.2 min (range 11,50). The obstructed animals had bladder overactivity. This correlated with ultrasound and post-mortem findings of megacystis and bilateral hydroureteronephrosis. The fetal mortality rate was 85.7% and the mean duration of survival post surgery was 45 ± 5.7 days. Conclusion Serial urodynamic studies could be performed in a fetal lamb model. Following partial urethral obstruction, bladder overactivity was observed. Copyright © 2003 John Wiley & Sons, Ltd. [source] Longterm survival of transplanted human corneal epithelial cells and corneal stem cellsACTA OPHTHALMOLOGICA, Issue 4 2005Maria Egarth Abstract. Purpose:,To investigate the survival of donor-derived epithelial cells in conventional penetrating keratoplasty (PKP) and in homologous penetrating central limbal keratoplasty (HPCLK). Methods and Patients:,Epithelial cells from 26 eyes of 26 patients were analysed. All cases were sex-mismatched (i.e. the transplant and patient were of different genders). At suture removal more than 1 year post surgery, epithelial cells were obtained by gently wiping the removed sutures on glass slides. The cell samples were analysed using fluorescent in situ hybridization (FISH) of the sex chromosomes. This technique makes it possible to allocate the origin of each cell nucleus to either the donor or the recipient. Results:,All 19 conventional PKPs were clear and seven had donor-derived epithelial cells at suture removal. Five of the seven HPCLK grafts were clear at the time of investigation (365,1355 days post surgery), and donor-derived epithelial cells were found in two grafts. Conclusion:,Harvesting cells from removed sutures in combination with FISH enables the clinical study of cell survival in corneal transplants without jeopardizing functioning grafts. From the limited sample investigated, the following tentative conclusions can be made. Donor-derived epithelial cells can remain in conventional PKP for over 1 year. In combined stem cell and corneal grafts (HPCLK), donor-derived epithelial cells may also be retrieved at 1 year or beyond following surgery but the correlation between their presence and a remaining clear graft is uncertain. [source] | ||||||||||